IgG4-related skin disease.

IgG4-related disease (IgG4-RD) is a recently established clinical entity characterized by high levels of circulating IgG4, and tissue infiltration of IgG4(+) plasma cells. IgG4-RD exhibits a distinctive fibroinflammatory change involving multiple organs, such as the pancreas and salivary and lacrimal glands. The skin lesions of IgG4-RD have been poorly characterized and may stem not only from direct infiltration of plasma cells but also from IgG4-mediated inflammation. Based on the documented cases together with ours, we categorized the skin lesions into seven subtypes: (1) cutaneous plasmacytosis (multiple papulonodules or indurations on the trunk and proximal part of the limbs), (2) pseudolymphoma and angiolymphoid hyperplasia with eosinophilia (plaques and papulonodules mainly on the periauricular, cheek and mandible regions), (3) Mikulicz disease (palpebral swelling, sicca syndrome and exophthalmos), (4) psoriasis-like eruption (strikingly mimicking psoriasis vulgaris), (5) unspecified maculopapular or erythematous eruptions, (6) hypergammaglobulinaemic purpura (bilateral asymmetrical palpable purpuric lesions on the lower extremities) and urticarial vasculitis (prolonged urticarial lesions occasionally with purpura) and (7) ischaemic digit (Raynaud phenomenon and digital gangrene). It is considered that subtypes 1-3 are induced by direct infiltration of IgG4(+) plasma cells, while the other types (4-7) are caused by secondary mechanisms. IgG4-related skin disease is defined as IgG4(+) plasma-cell-infiltrating skin lesions that form plaques, nodules or tumours (types 1-3), but may manifest secondary lesions caused by IgG4(+) plasma cells and/or IgG4 (types 4-7).

Fabrication and characterization of fully flattened carbon nanotubes: a new graphene nanoribbon analogue.

Graphene nanoribbons (GNR) are one of the most promising candidates for the fabrication of graphene-based nanoelectronic devices such as high mobility field effect transistors (FET). Here, we report a high-yield fabrication of a high quality another type of GNR analogue, fully flattened carbon nanotubes (flattened CNTs), using solution-phase extraction of inner tubes from large-diameter multi-wall CNTs (MWCNTs). Transmission electron microscopy (TEM) observations show that flattened CNTs have width of typically 20 nm and a barbell-like cross section. Measurements of the low-bias conductance of isolated flattened CNTs as a function of gate voltage shows that the flattened CNTs display ambipolar conduction which is different from those of MWCNTs. The estimated gap based on temperature dependence of conductivity measurements of isolated flattened CNTs is 13.7 meV, which is probably caused by the modified electronic structure due to the flattening.

Localization and function of histamine H3 receptor in the nasal mucosa.

BACKGROUND: Histamine is an important chemical mediator of allergic rhinitis (AR). Histamine H(3) receptors (H(3)R) are located on cholinergic and NANC neurons of the myenteric plexus, and activation of H(3)R regulates gastric acid secretion. However, little is known about the localization and function of H(3)R in the upper airway. OBJECTIVE: The objective of this study was to examine the localization and possible function of H(3)R in the nasal mucosa. METHODS: We extracted total RNA from the inferior turbinate mucosa of patients with AR. H(3)R mRNA and beta-actin mRNA were amplified by RT-PCR. We used immunohistochemistry to examine localization of H(3)R protein in the inferior turbinate mucosa excised during clinically indicated surgery. We used alcian blue/periodic acid-shiff staining to examine the effects of the H(3)R agonist (R)-alpha-methylhistamine and the H(3)R antagonist thioperamide on secretion from rat submucosal glands. RESULTS: H(3)R protein was expressed around submucosal gland cells. Thioperamide induced degranulation in the submucosal gland in the nasal septum. CONCLUSION: The present results suggest that H(3)R is localized mainly around submucosal glands, and that H(3)R plays an important role in the secretion of submucosal glands in the nose.

Long-term outcome of benign paroxysmal positional vertigo.

To clarify long-term outcome of benign paroxysmal positional vertigo (BPPV), 50 patients were followed up for a mean of 52 months. Overall recurrence rate by Kaplan-Meier estimation was 37% at 60 months. The patients with horizontal canal BPPV (n = 19) had a significantly higher recurrence rate (50%) at 60 months than those with posterior canal BPPV (n = 28; 26%). There was no significant association between recurrence rates and sex or age.

Differential properties of mucous glycoproteins in rat nasal epithelium. A comparison between allergic inflammation and lipopolysaccharide stimulation.

To examine the differential properties of mucous glycoproteins, we produced hypertrophic and metaplastic changes in goblet cells of rat nasal epithelium by intranasal instillation of ovalbumin (OVA) in OVA-sensitized rats, and by intranasal lipopolysaccharide (LPS) instillation. The epithelial mucosubstance was quantitatively examined by alcian blue-periodic acid-Schiff (AB-PAS) and lectin histochemistry. The newly produced mucin after OVA challenge or LPS instillation contained a high amount of sulfomucin and a low amount of neutral glycoprotein: LPS-induced mucin contained more sulfomucin (70.1% of total) and less neutral glycoprotein (8.6%) than OVA-induced mucin (sulfomucin, 33.6%; neutral glycoprotein, 41.8%; p < 0.01). Four of the lectins stained some of the mucosubstance, indicating the presence of galactose-N-acetylgalactosamine, alpha2,3- and alpha2,6-linked sialic acid-galactose, and fucose residues. After LPS instillation, the reactivity was higher for galactose-N-acetylgalactosamine (64.8% of total) and alpha2,3-linked sialic acid-galactose (75.8%) than after saline instillation (3.5 and 19.1%, respectively) or OVA challenge (5.8 and 32.3%; p < 0.05). OVA challenge did not induce the alteration of terminal sugar residues. A 2-fold increase in mucin mRNA (rat Muc5ac) expression was induced after LPS instillation or OVA challenge, compared with animals treated with saline instillation (p < 0.05). These results indicate that mucin mRNA expression (for peptide backbone) increases similarly after LPS instillation or OVA challenge; however, carbohydrate compositions of newly produced mucin are different between the two groups.

Current trends in cataract and refractive surgery in Japan: 1999 survey.

PURPOSE: The eighth annual survey was carried out by mail in February 2000 to investigate the current trends in cataract and refractive surgery in Japan. RESPONDENTS: Questionnaires were sent to 930 ophthalmologist members of the Japanese Society of Cataract and Refractive Surgery. Data received from 457 (49.1%) of the recipients were cross-analyzed and compared with those from the previous surveys. RESULTS: In cataract surgery, 17% of respondents were doing 51 or more cases per month, 94% preferred phacoemulsification, 58% employed the self-sealing wound closure technique, and 26% used topical anesthesia for phacoemulsification. In refractive surgery, excimer laser surgery and astigmatic keratotomy attracted notably high interest, while less attention was directed toward radial keratotomy and intrastromal corneal ring. Laser in situ keratomileusis, photorefractive keratectomy, phakic intraocular lens, intrastromal corneal ring, and radial keratotomy were judged to be useful refractive surgical procedures by 69.0%, 40.0%, 24.6%, 14.2%, and 8.0% of the respondents, respectively. CONCLUSION: There are trends toward more surgical procedures performed by a surgeon, shorter period of hospitalization, and increasing preference for small incision cataract surgery. Refractive surgery is not yet widely performed, but laser in situ keratomileusis is viewed as the most promising procedure.

Shape of lens epithelial cells after intraocular lens implantation.

PURPOSE: To evaluate the morphological behavior of lens epithelial cells (LECs) after human cataract surgery with implantation of a poly(methyl methacrylate) (PMMA) or silicone intraocular lens (IOL). SETTING: Department of Ophthalmology, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan. METHODS: Morphological observations of LECs in the patients with IOLs were made by light and transmission electron microscopy. The LECs were from 4 areas: (1) the region below the anterior capsule, touching the IOL; (2) the area between region 1 and the equatorial region; (3) the equatorial region; and (4) the central equatorial region and of the posterior capsule not touching the IOL. Case 1 had implantation of a single-piece IOL with a PMMA optic and haptics. Case 2 had a 3-piece IOL with a PMMA optic and polypropylene haptics. Case 3 had a 3-piece IOL with a silicone optic and polypropylene haptics. Areas 1 and 4 could not be observed in Case 2. RESULTS: The major difference between the patient with a PMMA IOL (Case 1) and the patient with a silicone IOL (Case 3) was that among the 4 areas observed, collagen fibers were present only in area 1 in Case 1 but in areas 2 or 3 as well in Case 3. CONCLUSIONS: Fibrous collagen fibers appeared in regions in which LECs adhered and there was capsule contact with the IOL optic. In addition fibrous collagen fibers appeared in more areas in the eye with the silicone IOL than in that with the PMMA IOL, perhaps because IOLs with silicone optics move slightly while in the capsular bag.

Quantitative analysis of mucin and lectin in maxillary sinus fluids in patients with acute and chronic sinusitis.

OBJECTIVES: Sinusitis is characterized by quantitative and qualitative changes in mucus biosynthesis that contribute to sinus disease. In general, patients with acute sinusitis complain of purulent rhinorrhea, whereas those with chronic sinusitis complain of mucoid or mucopurulent rhinorrhea Locally produced mucin largely contributes to the high viscoelasticity of mucus in sinusitis. In this study, the authors attempt to quantify the concentrations of mucin and lectin in the maxillary sinus fluids from these patients. STUDY DESIGN: To assess the concentrations of mucin and lectin in aspirates of 11 acutely and 11 chronically inflamed maxillary sinuses, the concentration of mucin was measured by enzyme-linked immunosorbent assay (ELISA) and that of lectin by sandwiched enzyme-linked lectin assay (ELLA). RESULTS: The concentrations of mucin and lectin that were measured using monoclonal antibodies (HCS 4, HCS 14, and HCS 18) and Ulex europaeus agglutinin-1 (UEA-1) in chronic sinusitis were higher than those in acute sinusitis. The concentration of total protein in chronic sinusitis was lower than that in acute sinusitis. Each mucin and lectin versus total protein ratio in chronic sinusitis was higher than that in acute sinusitis. CONCLUSIONS: These data suggest that hypersecretion in chronic sinusitis may result from locally increased mucin production. Comprehension of this mechanism may be a strategy to prevent the viscous cycle of paranasal sinus fluids in chronic sinusitis.

Histamine alters gene expression in cultured human nasal epithelial cells.

BACKGROUND: Airway epithelial cells produce cytokines and participate in the regulation of mucosal immunity. Although nasal epithelial cells express histamine receptors, it is not exactly known how nasal epithelial cells respond to histamine. OBJECTIVE: The objective of this study was to examine whether histamine can alter the expression of the 4 genes encoding H1 receptor, IL-8, TNF-alpha, and ZO-1 tight-junction protein in cultured nasal epithelial cells. METHODS: We added histamine or vehicle to cultured human nasal epithelial cells and extracted RNA from them 4 hours later. After DNase treatment, mRNAs of beta-actin, H1 receptor, IL-8, TNF-alpha, and ZO-1 tight-junction protein were amplified by using RT-PCR. RESULTS: Histamine significantly upregulated IL-8 mRNA expression and significantly downregulated ZO-1 mRNA expression. The latter effect was blocked by pretreatment with mepyramine, an H1 receptor antagonist. CONCLUSION: The reduction of ZO-1 mRNA by histamine may cause increased permeability of the mucosa during allergic reactions in the nose.

Hearing impairment and quality of life for the elderly in nursing homes.

OBJECTIVE: The purpose of this study is to find out the effects of hearing impairment on the QOL of nursing home residents. METHODS: We constructed the self-assessment questionnaire designed for evaluating the QOL for the elderly in nursing homes. The questionnaire is constructed of physical, social, communicational and psychological states. It was administered to 60 subjects >65 years of age (mean age: 79 years) living in nursing homes, with hearing threshold levels in the better ear ranging from normal to severe and their response were analyzed. RESULTS: Chronbach's alpha-values of the questionnaire obtained ranged from 0.66 to 0.91 and was 0.84 overall. The reliability and validity of the questionnaire as well as its brevity, simplicity, ease of administration and interpretation, all satisfied its use in assessing the QOL of the elderly in nursing homes. It tended to decrease the points of communication scale, sociability scale and psychological scale (PGC Morale Scale) accordingly to elevate the threshold. As for subscales of communication, hearing disability was correlated statistically to the sociability and psychological. CONCLUSION: Our questionnaire is regarded as a useful tool for evaluating the QOL of the elderly. Hearing loss affects the communication, sociability and psychological aspect of the QOL for the elderly in the nursing homes.

Role of neutrophil elastase in endotoxin-induced mucus hypersecretion in rat nasal epithelium.

In the present study, hypertrophic and metaplastic changes of goblet cells were induced in rat nasal epithelium by intranasal instillation of endotoxin or elastase. A significant increase in the amount of intraepithelial mucosubstance was observed after 24 hours during 3 days of instillation. The elastase-induced mucus production was not inhibited in neutrophil-depleted rats, but the endotoxin-induced change was significantly inhibited. Intranasal instillation of the neutrophil elastase inhibitor ONO-5046 partially inhibited the endotoxin-induced mucus production. Epithelial mucus secretion was evaluated by the temporary decrease in the amount of intraepithelial mucosubstance. The endotoxin-induced mucus secretion peaked 3 to 6 hours after intranasal instillation, coinciding with the peak of the intraepithelial neutrophil infiltration. The elastase-induced mucus secretion peaked 1 to 3 hours after intranasal instillation; intraepithelial neutrophil infiltration was not induced by elastase. These results indicate that neutrophil elastase is an important mediator of the intraepithelial mucus synthesis and secretion induced by endotoxin.

[Study on endoscopic sinus surgery management of chronic sinusitis with nasal polyps].

Endoscopic sinus surgery is commonly used to treat chronic sinusitis. Subjects were 79 chronic sinusitis patients--50 men and 29 women aged 17 to 79 years (average: 50.6 years) undergoing endoscopic sinus surgery in our department from January 1993 to December 1997. Mean follow-up was 17.5 months. We evaluated preoperative staging of chronic sinusitis based on Kennedy staging. Most were stage 3. This type of staging was not effective in predicting nasal polyp relapse. We found that cases with diffuse polyposis and associated disease such as bronchial asthma or aspirin-induced asthma tended to experience a polyp relapse. Our results suggest that postoperative treatment is important in maintaining patency of the ostiomeatal complex, nasal polyp or edematous mucosa relapse must be treated early in on in occurrence.

Bright loop appearance; a characteristic ultrasonography sign of early hepatocellular carcinoma.

Ultrasonography (US) and computed tomography (CT) are the most effective screening methodologies for hepatocellular carcinoma (HCC). In our US screening, 20% of small HCC nodules less than 20 mm in diameter were detected as hyperechoic tumors. Among these hyperechoic HCC nodules, we have often observed (BL) which is defined as hypoechoic nodules in the hyperechoic tumor. In this study, we report that the BL is a sign of dedifferentiation of early stage of HCC with fatty change by US. From 1994 to 1998, we performed tumor targeting needle biopsy in 938 hepatic nodular lesions. Among them, 284 nodules <20 mm in diameter, histologically diagnosed as HCC, were studied. BL is defined as a hyperechoic tumor containing a hypoechoic nodule >4 mm in diameter by US. Among 284 nodules, well, moderately and poorly differentiated HCC were 183 (64.4%), 100 (35.2%) and 1 (0.4%), respectively. On US, hypoechoic, isoechoic, and hyperechoic nodules were 188 (66.2%), 32 (11.3%) and 64 (22.5%), respectively. Forty-seven nodules of 64 hyperechoic HCC nodules <20 mm in diameter, 47 nodules (73.4%) showed fatty changes. Of 64 hyperechoic HCC nodules, we recognized 22 nodules (34.4%) as BL. The proportion of BL type hyperechoic nodules increased with the tumor size. Two hyperechoic nodules followed by US changed to BL with tumor enlargement. Histologic examination of a resected HCC with BL showed that hyperechoic HCC nodule represented well-differentiated HCC with fatty change and inner hypoechoic lesion represented moderately differentiated HCC without fatty change. In US screening for HCC, BL was often observed in HCC nodules from 11 to 20 mm in diameter. Histologic examination revealed that BL of HCC on US was associated with tumor progression and indicated dedifferentiation showing moderately differentiated HCC in well-differentiated HCC with fatty change.

Tumor necrosis factor gene polymorphism in chronic sinusitis.

OBJECTIVES: It is likely that genetic factors play a role in the etiology of chronic sinusitis, and airway inflammation is an important pathological feature in chronic sinusitis. We hypothesized that individuals with greater inflammatory responses may be more likely to acquire the disease. Polymorphisms of the tumor necrosis factor (TNF) genes have been described, and certain inflammatory diseases are reportedly associated with certain alleles of TNF genes. The purpose of this study is to examine whether there is an association between some alleles of TNF genes and chronic sinusitis. STUDY DESIGN: Thirty-eight Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells on plain radiographic films. METHODS: Both tumor necrosis factor-alpha (TNF-alpha) and tumor necrosis factor-beta (TNF-beta) gene polymorphisms were analyzed by polymerase chain reaction (PCR) with restriction fragment length polymorphisms in these patients and 35 healthy control subjects. RESULTS: A significantly higher frequency (P < .05) of TNFB*2 allele of TNF-beta gene polymorphism was observed in patients with chronic sinusitis (74%) compared with control subjects (56%). There was no association between alleles of TNF-alpha and chronic sinusitis. CONCLUSION: We concluded that TNF-beta gene polymorphism may form a component of the genetic predisposition to chronic sinusitis in Japanese patients.

[Clinical efficacy of immunotherapy with house dust in the patients with perennial nasal allergy].

We tried to elucidate the relation of age and severity with the efficacy of immunotherapy. The subjects included 51 patients with perennial allergic rhinitis who had immunotherapy for more than a year. Symptom scores, serum total IgE levels, Dermatophagoides pteronyssinus specific IgE, and peripheral blood eosinophils counts were evaluated before, half a year, one year and two years after the onset of immunotherapy. 64% of the children's group and 69% of the adults' group of patients showed significant improvement in their nasal symptoms, showing that age is not a factor influencing the efficacy of immunotherapy. The severity of the disease influenced the clinical efficacy; the more severe the disease, the poorer the efficacy of the immunotherapy. Periphipheral blood eosinophils counts gradually decreased after the onset of immunotherapy. High eosinophil counts before immunotherapy predicted poor efficacy of the immunotherapy.

The Vdelta1 T cell receptor repertoire in human nasal mucosa.

The gamma/delta T cells play important roles as the first line of defence in mucosal immunity. Vdelta1 bearing T cells comprise the major population of gamma/delta T cells in the human nasal mucosa. Recently, it was reported that certain receptors are predominant at given anatomical locations. The purpose of this study was to elucidate the gamma/delta T-cell receptor repertoire in human nasal mucosa. Nasal epithelia were scraped and peripheral blood were obtained from three healthy volunteers. We performed reverse-transcription polymerase chain reaction (RT-PCR) analysis and characterized the junctional sequences of Vdelta1 T-cell receptor (TCR) transcripts. Vgamma and Vdelta gene usage in intraepithelial lymphocytes (IELs) in right and left nasal mucosa were almost the same, but they were different from those in peripheral blood lymphocytes (PBLs). The VDJ sequence of nasal Vdelta1 T-cell receptor transcripts showed diversity and were different for each individual. Vdelta1 in the IELs were rearranged to Jdelta1 and Vdelta1 in the PBLs were rearranged not only to Jdelta1 but also to Jdelta3. Vdelta1 sequences in the IELs in the nasal mucosa showed no overlap with those in the PBLs. These results indicate that gamma/delta T cells in the nose are organ specific lymphocytes.