The acute effects of glycemic control on axonal excitability in human diabetic nerves

OBJECTIVE: To investigate whether glycemic control is associated with reversible changes in axonal excitability in human diabetic nerves. It is known that voluntary contraction or compression ischemia alters nerve Na+/K+ pump activity, and axonal excitability changes due to the pump activity can be estimated by threshold tracking. METHODS: Threshold, the current required to produce a compound muscle action potential 50% of maximum, was determined from the stimulus-response curve, and threshold changes produced by maximal voluntary contraction or ischemia were measured before and after insulin treatment in 10 diabetic patients. RESULTS: Within 3 weeks of the start of treatment, the threshold changes became greater following voluntary contractions (+13+/-4% versus +23+/-5%; mean+/-SEM; p=0.04) and during ischemia (-5+/-2% versus -11+/-2%; p=0.04). CONCLUSIONS: The extent of threshold fluctuation depends on multiple metabolic factors associated with diabetes such as decreased Na+/K+ ATPase activity, increased anaerobic glycolysis, and tissue acidosis, and nerve excitability can respond quickly to glycemic control in diabetic patients.     

Digital ulcers/gangrene and immunoglobulin classes/complement fixation of anti-dsDNA in systemic lupus erythematosus patients

The immunoglobulin classes/complement fixation of anti-dsDNA were studied in sera obtained from 17 systemic lupus erythematosus (SLE) patients with digital ulcers and/or gangrene (Group A); 13 SLE patients with leg ulcer, peripheral neuropathy or livedo (Group B); 24 SLE patients with Raynaud's phenomenon (Group C); and 18 SLE patients with active lupus nephritis (Group D). Antibodies to dsDNA of IgG and IgA classes were commonly present (often in high titers) in Groups A and D. However, complement fixation of anti-dsDNA was more common in Group D than in any of the other 3 groups.     

Relative risks of death due to liver disease among Japanese male adults having various statuses for hepatitis B s and e antigen/antibody in serum: a prospective study

Taking advantage of the compulsory annual medical check-up at the Central Institute of Health, Japan National Railways, hepatitis B seromarkers were tested in male employees at work and their "dead and alive" status was followed for more than 6 years for their prognostic significance. Two prospective studies were carried out. In the first study, two groups (cohorts) of males age 40 to 55 years were tested in 1973 and 1978, respectively, for HBsAg and anti-HBs. The relative risk of dying from primary liver cancer in HBsAg-positive carriers (n = 126) as compared to the controls who were negative for both HBsAg and anti-HBs (n = 5,322) was 30.03 and significantly high, whereas those positive for anti-HBs (n = 1,470) had no increased risk of dying from primary liver cancer or from other liver diseases. The follow-up period ranged from 6.5 to 11.5 years, averaging 8.5 years. In the second study, three male cohorts of the same ages were tested for HBsAg and HBeAg/anti-HBe (micro-Ouchterlony method) in 1977, 1978 and 1979, respectively. There were 513 HBsAg-positive carriers among 25,547 examinees, who were followed for an average of 7.3 (6 to 8) years. Among these HBsAg carriers, those who were positive for HBeAg on entry had the highest risk of dying from primary liver cancer (relative risk, 50.25) and from other liver diseases (78.06), followed by those negative for both (28.95 and 21.78, respectively) and those positive for anti-HBe (9.47 and 6.43) when compared with 25,034 noncarriers.(ABSTRACT TRUNCATED AT 250 WORDS)     

Radial dependence of lineal energy distribution of 290-MeV/u carbon and 500-MeV/u iron ion beams using a wall-less tissue-equivalent proportional counter

Using a wall-less tissue-equivalent proportional counter for a 0.72-μm site in tissue, we measured the radial dependence of the lineal energy distribution, yf(y), of 290-MeV/u carbon ions and 500-MeV/u iron ion beams. The measured yf(y) distributions and the dose-mean of y, y¯D, were compared with calculations performed with the track structure simulation code TRACION and the microdosimetric function of the Particle and Heavy Ion Transport code System (PHITS). The values of the measured y¯D were consistent with calculated results within an error of 2%, but differences in the shape of yf(y) were observed for iron ion irradiation. This result indicates that further improvement of the calculation model for yf(y) distribution in PHITS is needed for the analytical function that describes energy deposition by delta rays, particularly for primary ions having linear energy transfer in excess of a few hundred keV μm⁻¹.     

Usefulness of C-arm CT during superselective infusion chemotherapy for advanced head and neck carcinoma

Purpose of the study: To evaluate the usefulness of C‐arm computed tomography (CT) during superselective intra‐arterial infusion chemotherapy for advanced head and neck carcinoma. Methods: C‐arm CT was performed during superselective intra‐arterial infusion chemotherapy for 11 patients with advanced head and neck carcinoma located in the hypopharynx (n = 3), maxillary sinus (n = 3), oropharynx (n = 1), larynx (n = 1), extra‐auditory canal (n = 1), tonsil (n = 1) and tongue (n = 1). The usefulness of C‐arm CT during superselective catheterisation was evaluated. Results: On arteriography, nine tumours showed tumour stains and two in the oropharynx or tonsil showed no obvious tumour stains. C‐arm CT was performed one to four times (mean ± standard deviation, 2.5 ± 0.8) in each patient during a single procedure. C‐arm CT clearly showed not only the vascular territory of the selected branch but also the tumour itself in all patients. Intra‐arterial infusion chemotherapy was performed through one to three branches (mean, 1.7 ± 0.9) according to C‐arm CT findings without any complications. Conclusion: C‐arm CT during superselective intra‐arterial infusion chemotherapy was useful to determine the arterial supply of head and neck carcinoma. C‐arm CT may replace conventional CT during superselective arteriography in this procedure.     

Living donor pancreas transplantation in Japan

Background/purpose

Living-donor pancreas transplants (LDPs) were introduced at Chiba-East National Hospital in 2004, and 12 LDPs have been performed at this institution to date. Based on the outcome of these 12 LDPs, the efficacy and safety of LDPs are herein discussed.

Methods

Twelve diabetic patients underwent LDPs; ten had simultaneous pancreas and kidney transplants from living donors, one had pancreas transplant after a kidney transplant from a living donor, and one had a pancreas transplant alone from a living donor. The donors were parents or brothers and the ABO blood types were incompatible in three LDPs. The procedures for the donor and recipient operations were performed according to the technique established by the University of Minnesota. Bladder drainage was used in 11 recipients and enteric drainage was used in one patient. Tacrolimus, basiliximab, mycophenolate mofetil, and prednisone were used for induction and immunosuppressive treatment. A splenectomy, double-filtered plasmapheresis, and plasma exchange were added in the ABO-incompatible LDPs.

Results

No complications were observed in the donors during hospitalization. The 1-year survivals of the patients, kidney grafts, and pancreas grafts were 100, 100, and 100%, respectively. The 3-year survivals were 91.7, 90, and 91.7%, respectively. Three patients developed leakage of pancreatic juice and one patient required a surgical procedure. Cytomegalovirus antigenemia was detected in five patients (42%).

Conclusions

Based on the excellent outcome of the LDPs at this institution, LDPs is therefore expected to become a promising option for the treatment of patients with severe diabetes.     

Chest tightness is relieved with the use of asthma drugs except bronchodilators

Objective: Many patients with a chief complaint of chest tightness are examined in medical facilities, and a lack of diagnosis is not uncommon. We have reported that these patients often include those with chest tightness relieved with bronchodilator use (CTRB) and those with chest tightness relieved with the use of asthma drugs except bronchodilators (CTRAEB). The purpose of this study was to demonstrate the clinical characteristics of the patients with CTRAEB and compare them with data from patients with CTRB. Methods: Patients with CTRB (n?=?13) and CTRAEB (n?=?7) underwent a bronchodilator test, assessments of airway responsiveness to methacholine, bronchial biopsy, and bronchial lavage under fiberoptic bronchoscopy before receiving treatment. In all, 10 healthy subjects, 11 bronchial biopsy control patients, and 10 asthmatic patients were recruited for comparison. Results: Inhalation of a short-acting ß₂-agonist (SABA) increased the forced expiratory volume in one second (FEV₁) by 5.1%?±?4.0% in patients with CTRB and by 1.3%?±?3.5% in patients with CTRAEB, and the difference was statistically significant (p?=?0.0449). The bronchial biopsy specimens from the patients with CTRB and CTRAEB exhibited significant increases in T cells (p?<?.05) compared with those of the control subjects. The bronchial responsiveness to methacholine was increased in only a minor portion of patients with CTRB and CTRAEB. Conclusions: We hypothesized that the clinical condition of patients with CTRAEB involves chest tightness arising from inflammation alone, and this chest tightness is mostly associated with airway T cells, without constriction of the airways. There is little to distinguish CTRAEB from CTRB aside from the response to bronchodilator treatment.

This clinical trial is registered at www.umin.ac.jp (UMIN13994, 13998, and 16741).     

Senescent case of cholesterol ester storage disease that progressed to liver cirrhosis with a novel mutation (N250H) of lysosomal acid lipase gene

The patient, a 69‐year‐old man, had a chief complaint of hepatomegaly. The liver was palpated four fingerbreadths below the costal margin, and the spleen was three fingerbreadths below the costal margin. There were no other abnormal findings. Laparoscopy showed that the liver resembled an orange‐yellow crayon in appearance and was nodular. The pathological findings of the liver biopsy tissue were consistent with liver cirrhosis. Inside the fibrous septum was an apparent aggregation of enlarged macrophages that phagocytosed lipid components, as well as enlarged Kupffer cells that phagocytosed lipid droplets. Electron microscopy showed the lipid droplets to have a moth‐eaten appearance. Using monocytes extracted from the peripheral blood, acid lipase activity was measured by fluorescence spectrometry using 4‐methylumbelliferone palmitate as a substrate. This patient's human lysosomal acid lipase activity was 0.020 nM/min per 10⁶ cells, corresponding to 5.9% of that in healthy subjects (0.332 ± 0.066 nM/min per 10⁶ cells). Cholesterol ester storage disease was therefore diagnosed. The acid lipase A base sequence obtained from leukocytes by direct sequencing was compared with a library. This patient had a point mutation of N250H/N250H in exon 7, a novel gene abnormality that has not previously been reported.