Cerebrospinal fluid orexin-A levels in systemic lupus erythematosus patients presenting with excessive daytime sleepiness.

Objective Involvement of the hypothalamus is rare in patients with systemic lupus erythematosus (SLE). In this study, we measured cerebrospinal fluid (CSF) orexin-A levels in SLE patients with hypothalamic lesions to investigate whether the orexin system plays a role in SLE patients with hypothalamic lesions who present with excessive daytime sleepiness (EDS). Methods Orexin-A levels were measured in CSF from four patients with SLE who presented with hypothalamic lesions detected by MRI. Three patients underwent repeated CSF testing. All patients met the updated American College of Rheumatology revised criteria for SLE. Results Tests for serum anti-aquaporin-4 antibodies, CSF myelin basic protein and CSF oligoclonal bands were negative in all patients. All patients presented with EDS. Low to intermediate CSF orexin-A levels (92-180 pg/ml) were observed in three patients in the acute stage, two of whom (patients 1 and 2) underwent repeated testing and showed increased CSF orexin-A levels, reduced abnormal hypothalamic lesion intensities detected by MRI and EDS dissipation at follow-up. In contrast, CSF orexin-A levels were normal in one patient (patient 4) while in the acute stage and at follow-up, despite improvements in EDS and MRI findings. Patient 4 showed markedly increased CSF interleukin-6 levels (1130 pg/ml) and a slightly involved hypothalamus than the other patients. Conclusions Our findings suggest that the orexinergic system has a role in EDS in SLE patients with hypothalamic lesions. Furthermore, cytokine-mediated tissue damage might cause EDS without orexinergic involvement.

Mode of photocatalytic bactericidal action of powdered semiconductor TiO2 on mutans streptococci.

Powdered semiconductor TiO2 has a photocatalytic bactericidal capacity on some kinds of bacteria, but its mechanism still remains unclear. The mode of its photocatalytic bactericidal action on the mutans group of streptococci was investigated. Powdered TiO2 had a bactericidal capacity on all serotypes of mutans streptococci. Streptococcus sobrinus AHT was mainly used for these experiments. The most effective concentration of TiO2 was about 1 mg ml-1 and, at this concentration, 10(5) colony-forming units of S. sobrinus AHT per millilitre were completely killed within 1 min. In order to search for the mechanism of this effect, a high bacterial cell density (10(9) colony-forming units ml-1) was used in the following studies. "Rapid" leakage of potassium ions from the bacteria occurred parallel to the decrease in cell viability. Protein and RNA were "slowly" released from bacterial cells for a reaction time up to 120 min. The pH of the reaction mixture decreased continuously to 4.5 after 120 min. Co-aggregation of S. sobrinus AHT and powdered TiO2 occurred at high bacterial densities (above 10(8) colony-forming units ml-1). Aggregates gradually decomposed with light irradiation. Transmission electron microscopy of S. sobrinus AHT after photocatalytic action for 60-120 min indicated complete destruction of bacterial cells. From these results, bacterial death appears to be caused by a significant disorder in cell membranes and finally the cell walls were decomposed.