The Biomarker Salivary SP-D May Indicate Small Airway Inflammation and Asthma Exacerbation.

BACKGROUND: Noninvasive and child-friendly biomarkers are important tools for understanding the various phenotypes of childhood asthma. Objective: The aim of this study was to examine the usefulness of salivary surfactant protein (SP) D in assessing the pathophysiology of childhood asthma. METHODS: We measured salivary concentrations of SP-D and forced oscillation technique (FOT) indexes in 19 healthy controls and 21 asthmatic children. Regression equations for the predictive values of FOT indexes were generated from healthy controls. We analyzed the correlations between salivary SP-D concentration and percentages of the predictive values of FOT indexes, as well as the severity of exacerbation. RESULTS: We found that salivary SP-D levels were higher in asthmatic children than in healthy controls. In the asthmatic children, salivary SP-D levels correlated with the percentages of predicted differences in resistance between 5 Hz and 20 Hz (%R5-R20), which represented the resistance of peripheral airways, and with the severity of asthma exacerbation. CONCLUSIONS: Salivary SP-D may reflect asthmatic inflammation in peripheral small airways and may be a useful marker for monitoring the degree of exacerbation in childhood asthma.

Influência da adubação com nitrogênio e fósforo na produção de Jambu, Acmella oleracea (L) R. K. Jansen / Influence of the fertilization with nitrogen and phosphorus in the production of jambu (Acmella oleracea (L) R. K. Jansen)

Com o objetivo de avaliar a influência de doses de nitrogênio e fósforo na cultura do Jambu, foi instalado experimento na fazenda experimental da APTA Polo Vale do Ribeira utilizando-se sementes da cultivar Nazaré. Os tratamentos foram conduzidos em blocos casualizados em esquema fatorial 4 x 4, e quatro repetições dos seguintes tratamentos: quatro doses de nitrogênio, (0; 37,5; 75 e 112,5 kg ha-1 N), quatro doses de fósforo (0; 75; 150 e 300 Kg ha-1 de P2O5). O solo foi inicialmente preparado recebendo calagem e adubação de plantio conforme recomendação em função da analise de solo. Após essas operações foi feito o transplante das mudas no espaçamento de 0,50 x 0,50 m e aplicado os tratamentos. A área útil da parcela foi de 1,0 m x 1,0 m. Foram analisadas as massas frescas e secas de folhas e flores, e o número de flores. A produção de matéria fresca e seca das folhas e flores foi influenciada pela adubação. Houve efeito das doses de nitrogênio, que proporcionaram aumento linear em todas as variáveis analisadas e, para a adubação fosfatada, a dose com 75 Kg ha-1 de P2O5 proporcionou a maior produção do número de flores e na massa fresca e seca das flores.

The objective of this work was to evaluate the influence of the use of nitrogen and phosphorus in the culture of jambu. The experiment was initiated at the experimental farm of the agency APTA Polo Vale do Ribeira, using the Nazaré cultivar. The experimental design was complete randomized with fourlevelsof nitrogen (0, 37.5, 75 and 112.5 kg ha-1 N) and phosphorus (0, 75, 150 and 300 Kg ha-1P2O5),and four reapplications. After soil preparation, liming and fertilization, seedlings of jambu were transplanted at a spacing of 0.50 x 0.5 m. The experimental plot was 1.0 x 1.0 m. Fresh and dry mass of leaves and flowers and number of flowers were analyzed. The production of fresh and dry leaves and flowers were influenced by fertilization. Thelevelsof nitrogen affected the outcome, as theyprovided a linear increase in all variables, and the phosphorus level of 75 kgha-1 P2O5 caused the highest average production in the number of flowers and in the fresh and dried mass of flowers.

Association study of genetic variants on chromosome 7q31 with susceptibility to normal tension glaucoma in a Japanese population.

The caveolin 1 to caveolin 2 (CAV1-CAV2) gene region on chromosome 7q31 has been reported to be associated with susceptibility to primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) in previous studies. We investigated whether genetic variants in the CAV1-CAV2 region are associated with NTG in Japanese patients. Two hundred and ninety-two Japanese patients with NTG and 352 Japanese healthy controls were recruited. We genotyped three single-nucleotide polymorphisms; that is, rs1052990, rs4236601, and rs7795356, in the CAV1-CAV2 gene region and assessed the allelic diversity among cases and controls. The frequency of the minor allele (G) of rs1052990 was significantly decreased in NTG cases compared with controls (P=0.014, OR=0.71), whereas NTG or POAG cases had a significantly higher frequency of the allele than controls in previous studies. Conversely, rs7795356 did not show any significant association with NTG cases, and rs4236601 was monomorphic in the Japanese study population. Our findings did not correspond with previous positive results, suggesting that CAV1-CAV2 variants studied in the present study are not important risk factors for NTG susceptibility in all populations. Further studies are needed to elucidate the possible contribution of the CAV1-CAV2 region to the development of glaucoma.

A survey of the entomofauna associated with the inflorescences of pejibaye (Arecaceae: Bactris gasipaes Kunth) in the Ribeira Valley, SP, Brazil / Levantamento da entomofauna associada às inflorescências de pupunheira (Arecaceae: Bactris gasipaes Kunth) no Vale do Ribeira, SP

The cultivation of pejibaye (Bactris gasipaes Kunth) has been expanding in Brazil, especially in the Vale do Ribeira, SP, where the edaphoclimatic condition is compatible with its production. With the purpose of learning about insects that visit the inflorescence of pejibaye, a survey was conducted at Polo Regional do Vale do Ribeira, located in the municipality of Pariquera-açu, SP, Brazil, and on a private property located in the municipality of Registro, SP, areas where selected pejibaye palm trees from Yurimaguas, Peru, are grown. During the month of January of 2006 and 2007, yellow sticky insect traps were placed at the inflorescences of different pejibaye matrices, soon after the bracts opened. The traps were kept throughout female and male anthesis, and removed at the end of the cycle, which lasted for about 72 hours. The 9,743 insects collected were then separated, counted, and identified according to their orders. It was observed that the most frequent insects on the inflorescence of pejibaye palms in the Vale do Ribeira, SP are Diptera, Coleoptera, and Hymenoptera.

Levantamento da entomofauna associada às inflorescências de pupenheira (Arecaceae: bactris gasipaes kunth) no vale do Ribeira, SP. A cultura da pupunheira (Bactris gasipaes Kunth) vem se expandindo no Brasil, especialmente no Vale do Ribeira, SP, onde encontra condição edafoclimática compatível à sua produção. Com o objetivo de conhecer os insetos visitantes da inflorescência da pupunheira, foi realizado levantamento em duas áreas de coleção de pupunheiras selecionadas originárias de Yurimaguas, Peru, no - Polo Regional do Vale do Ribeira – APTA/SAA-SP, localizado no Município de Pariquera-açu, SP, e em uma propriedade particular no Município de Registro, SP. Durante o mês de janeiro de 2006 e 2007, foram instaladas armadilhas adesivas entomológicas amarelas em inflorescências de diferentes matrizes de pupunheira logo após a abertura de suas brácteas, as quais foram mantidas durante a antese feminina e masculina e retiradas no término do ciclo, cerca de 72 horas. Efetuou-se a separação, contagem e identificação ao nível de ordem dos 9.743 insetos totais coletados. Verificou-se que os insetos mais frequentes na inflorescência da pupunheira no Vale do Ribeira, SP, pertencem às ordens Diptera, Coleoptera e Hymenoptera.

The Endoscopic Surgical Skill Qualification System for gastric surgery in Japan.

INTRODUCTION: Laparoscopic surgery has been increasing in popularity in recent years. In 2004, the Japan Society for Endoscopic Surgery developed its Endoscopic Surgical Skill Qualification System (ESSQS) to assess surgeons. METHODS: To earn the ESSQS accreditation, applicants must submit an unedited operative video in which they perform either a distal gastrectomy or pylorus-preserving gastrectomy with lymph node dissection for gastric cancer. The videos are assessed by two separate judges based on detailed criteria for common and procedure-specific technical-grade slips. Common criteria from all fields of gastrointestinal and general surgery are used to evaluate the basic laparoscopic surgical skills and autonomy of the operator. The target organ determines the procedure-specific criteria are set to assess whether or not adequate oncological clearance has been achieved. RESULTS: Between 2004 and 2009, 154 (44.6%) out of 345 applicant surgeons assessed under the ESSQS for gastric surgery have been accredited. Interrater agreement was acceptable and ranged between 0.21 and 0.59. CONCLUSION: The ESSQS system may facilitate improvement in surgical technique and the standardization of laparoscopic surgery in Japan.

Positional relationship between recurrent intracerebral hemorrhage/lacunar infarction and previously detected microbleeds.

BACKGROUND AND PURPOSE: Although MBs, ICH, and LI are secondary to cerebral microangiopathy, it remains unclear whether the location of subsequent ICH/LI corresponds to the previous location of MBs. We performed this study to clarify the positional relationship between recurrent ICH/LI and previously detected MBs. MATERIALS AND METHODS: We evaluated patients with recurrent ICH/LI who had MBs, as shown on prior T2*-weighted MR imaging. We assessed retrospectively whether the location of recurrent ICH/LI corresponded to that of the prior MB. Patients with ICH were divided into the deep ICH group and the lobar ICH group, and the positional relationship between hematoma and previously detected MBs was evaluated. RESULTS: A total of 55 patients, including 34 with recurrent ICH and 21 with recurrent LI were evaluated. Although the location of the LI corresponded to prior MBs in only 1 patient (4.8%), the location of ICH corresponded to prior locations of MBs in 21 patients (61.8%) (OR, 32.3; 95% CI, 3.86-270.3; P < .001). Among the patients with ICH, the correspondence ratio was higher in the deep ICH group (19 of 24 patients, 79.2%) than in the lobar ICH group (2 of 10 patients, 20%) (OR, 15.2; 95% CI, 2.42-95.3; P < .002). CONCLUSIONS: The close positional association between recurrent ICH and prior MBs suggests that MBs represent hemorrhage-prone microangiopathy. In addition, different correspondence ratios between the deep ICH group and the lobar ICH group may be attributable to their different pathogenesis.

HLA-B is the best candidate of susceptibility genes in HLA for Japanese ulcerative colitis.

Recently, a genome-wide association study for ulcerative colitis (UC) in the UK population was reported, and several susceptibility loci including the human leukocyte antigen (HLA) region were identified. The strongest association in the HLA region was found at a 400 kb haplotype block containing HLA-DRB1. In Japanese population, previous study suggested the association between UC and HLA-B*52; however, HLA typing was determined using serotyping with the small sample size. The purpose of this study was to perform an association study in HLA-B by genotyping. A total of 320 patients with UC and 322 healthy controls were recruited in this case-control study. All subjects were Japanese. Genotyping of HLA-B was performed by polymerase chain reaction using a sequence-specific primer. When the allele frequencies were compared, significant associations were found with B*52 [odds ratio (OR) = 3.65, P = 1.6 x 10(-17), P(c) = 3.7 x 10(-16)] and B*4002 (OR = 0.52, P = 0.00030, P(c) = 0.0068). The allele frequency of B*52 was significantly higher in patients diagnosed before 40 years of age than in those diagnosed after 40 years (OR = 1.79, P = 0.010, P(c) = 0.020). A combination association map of Japanese UC using our current and previous studies showed two equal peaks of association on HLA-DRB1 and HLA-B, indicating the possible existence of two casual variants in the HLA region inside and outside the 400 kb block found in UK. We conclude that HLA-B contributes to the susceptibility to Japanese UC, especially cases with younger age of onset. The strength of association for HLA-B was equal to that for HLA-DRB1 in Japanese UC, in contrast to the UK population.

Ancillary N.O.T.E.S. procedures for early stage gastric cancer.

The potential for performing truly scarless, safe surgery that at the same time may be less morbid is tempting both patients and physicians alike to seriously consider Natural Orifice Transluminal Endoscopy Surgery (NOTES) for a range of clinical applications. Given the move towards gastric-preservation by minimally invasive techniques for definitive management of early gastric cancer, this radical approach may find a niche within future clinical care paradigms for early stage malignant lesions of the stomach. Indeed already selected T1,N0 adenocarcinoma is being treated and even cured by advanced endoscopic techniques such as Endoscopic Submucosal Dissection. NOTES may initially therefore find a role in furthering the application of such endeavour by ensuring oncological providence in the treatment of those T1 lesions with higher risk of lymphatic metastases that currently are advised to lie outwith the scope of pure endoscopic resection (for reasons of oncological propriety rather than technical capacity). One such means NOTES could supplement ESD is by providing for direct sampling of sentinel nodes from the perigastric lymph basins. Subsequently perhaps a NOTES technique may develop capable of performing localized, full-thickness gastric wedge or sleeve resection for T2,N0 adenocarcinoma (and indeed perhaps other pathologies such as small gastrointestinal stromal tumors). This review examines how advancing technology along with progressive surgical thinking and innovation could lead to NOTES becoming absorbed into clinical care pathways for early gastric malignancy.

Association between cerebral microbleeds on T2*-weighted MR images and recurrent hemorrhagic stroke in patients treated with warfarin following ischemic stroke.

BACKGROUND AND PURPOSE: Although accumulating evidence suggests the presence of microbleeds as a risk factor for intracerebral hemorrhage (ICH), little is known about its significance in anticoagulated patients. The aim of this study was to determine whether the presence of microbleeds is associated with recurrent hemorrhagic stroke in patients who had received warfarin following atrial fibrillation-associated cardioembolic infarction. MATERIALS AND METHODS: A total of 87 consecutive patients with acute recurrent stroke, including 15 patients with ICH and 72 patients with cerebral infarction, were enrolled in this study. International normalized ratios (INRs), vascular risk factors, and imaging characteristics, including microbleeds on T2*-weighted MR images and white matter hyperintensity (WMH) on T2-weighted MR images, were compared in the 2 groups. RESULTS: Microbleeds were noted more frequently in patients with ICH than in patients with cerebral infarction (86.7% versus 38.9%, P = .0007). The number of microbleeds was larger in patients with ICH than in patients with cerebral infarction (mean, 8.4 versus 2.1; P = .0001). INR was higher in patients with ICH than in patients with cerebral infarction (mean, 2.2 versus 1.4; P < .0001). The frequency of hypertension was higher in patients with ICH than in patients with cerebral infarction (86.7% versus 45.8%, P = .0039). Multivariate analysis revealed that the presence of cerebral microbleeds (odds ratio, 7.383; 95% confidence interval, 1.052-51.830) was associated with ICH independent of increased INR and hypertension. CONCLUSION: The presence of cerebral microbleeds may be an independent risk factor for warfarin-related ICH, but more study is needed because of strong confounding associations with elevated INR and hypertension.

HLA-DRB1 alleles influence clinical phenotypes in Japanese patients with ulcerative colitis.

The human leukocyte antigen (HLA) region has been implicated in the disease susceptibility of inflammatory bowel disease by several linkage and association studies. In Caucasians, HLA-DRB1 has been reported to determine the clinical phenotypes of ulcerative colitis (UC). Others and we previously reported that HLA-DRB1*1502 was strongly associated with UC in the Japanese population. However, the contribution of HLA-DRB1 to the clinical phenotypes in Japanese UC has not been elucidated yet. The aim of this study was to determine whether HLA-DRB1 alleles were associated with the clinical phenotypes in Japanese patients with UC. A total of 353 patients with UC were recruited. Patients were classified into subgroups by sex, age at diagnosis, disease extent, need for steroid therapy or need for surgical treatment. The allele frequency of HLA-DRB1*08 was significantly higher in patients whose disease extended beyond the rectum (left-sided and extensive UC) than in those with proctitis [odds ratio (OR)=2.20, Pc=0.043). The allele frequency of HLA-DRB1*09 was significantly higher in patients with UC diagnosed at the age of 40 years or older than in those with UC diagnosed before the age of 40 years (OR=2.31, Pc=0.022). Besides these positive associations, no significant differences were found in the allele frequencies between the other subgroups. We conclude that HLA-DRB1*09 is associated with the age at diagnosis and HLA-DRB1*08 is associated with the disease extent of UC in Japanese. These results indicate that HLA-DRB1 is not only associated with the overall UC susceptibility but also associated with the clinical phenotypes in Japanese.

A review of medial temporal lobe and caudate contributions to visual category learning.

Here we review recent functional neuroimaging, neuropsychological and behavioral studies examining the role of the medial temporal lobe (MTL) and the caudate in learning visual categories either by verbalizeable rules or without awareness. The MTL and caudate are found to play dissociable roles in different types of category learning with successful rule-based (RB) categorization depending selectively on the MTL and non-verbalizeable information-integration (II) category learning depending on the posterior caudate. These studies utilize a combination of experimental cognitive psychology, mathematical modeling (Decision Bound Theory (DBT)) and cognitive computational modeling (the COVIS model of Ashby et al. [1998. A neuropsychological theory of multiple systems in category learning. Psychological Review 105, 442-481]) to enhance the understanding of data obtained via functional magnetic resonance imaging (fMRI). The combination of approaches is used to both test hypotheses of the cognitive model and also to incorporate hypotheses about the strategies used by participants to direct analysis of fMRI data. Examination of the roles of the MTL and caudate in visual category learning holds the promise of bridging between abstract cognitive models of behavior, systems neuroscience, neuropsychology, and the underlying neurophysiology of these brain regions.

A schwannoma of the S1 dural sleeve was resected while the intact nerve fibers were preserved using a microscope. Report of a case with early MRI findings.

In this report, we describe a small schwannoma of the dural sleeve and mention that it is often difficult to differentiate this tumor from lumbar disc herniation, especially a sequestered hernia, or a discal cyst. Gadolinium-enhanced MR images were a useful preoperative examination modality for differentiating this lesion from other diseases. Microscopically, the intradural tumor was successfully removed. The dura mater of the S1 nerve root was opened microsurgically, allowing the nerve fibers involved in the tumor to be identified. The involved fibers were cut around the tumor, and the lesion was resected while the intact nerve fibers were preserved. Based on histological examination of the resected specimen, the tumor was diagnosed as a schwannoma with multilocular cystic degeneration. Microsurgery allowed the tumor to be removed with minimal impairment from cutting of nerve fibers in the nerve root.

Butyrophilin-like 2 gene is associated with ulcerative colitis in the Japanese under strong linkage disequilibrium with HLA-DRB1*1502.

The human leukocyte antigen (HLA) region has been implicated in the pathogenesis of inflammatory bowel disease (IBD), which is classified into Crohn's disease (CD) and ulcerative colitis (UC). Recently, an association between sarcoidosis and the butyrophilin-like 2 (BTNL2) gene was reported. BTNL2 is located in the HLA region and its messenger RNA is expressed most abundantly in the intestine. In this study, we performed a case-control association study of BTNL2 in the Japanese patients with IBD and performed linkage disequilibrium (LD) analysis between BTNL2 and HLA-DRB1. We analyzed eight polymorphisms selected after direct sequencing and found that none of the polymorphisms were associated with the Japanese CD cohort. In contrast, five polymorphisms were significantly associated with UC, especially three single nucleotide polymorphisms (BTNL2_19, BTNL2_22 and BTNL2_23) were associated as a haplotype. The most frequent haplotype (GGC haplotype) was a low-risk haplotype (P= 0.000052), whereas the other TCT haplotype was a high-risk haplotype (P= 0.0000085). Among the eight polymorphisms, the strongest association with UC was found in BTNL2_19 (OR = 1.92, P= 0.0000035). As expected, the BTNL2_19-T allele showed strong LD with DRB1*1502 (D'= 0.92). When BTNL2_19 was tested as conditional on the DRB1*1502 carrier status, the significant association disappeared, suggesting that the association was because of its strong LD with DRB1*1502. We conclude that BTNL2 does not contribute to the susceptibility to Japanese CD but is associated with Japanese UC because of the strong LD with HLA-DRB1*1502. The strong LD between BTNL2 and HLA-DRB1 raises another issue about the potential role of BTNL2 in other diseases associated with HLA-DRB1.

Neural correlates of rule-based and information-integration visual category learning.

An emerging theory of the neurobiology of category learning postulates that there are separate neural systems supporting the learning of categories based on verbalizeable rules (RB) or through implicit information integration (II). The medial temporal lobe (MTL) is thought to play a crucial role in successful RB categorization, whereas the posterior regions of the caudate are hypothesized to support II categorization. Functional neuroimaging was used to assess activity in these systems during category-learning tasks with category structures designed to afford either RB or II learning. Successful RB categorization was associated with relatively increased activity in the anterior MTL. Successful II categorization was associated with increased activity in the caudate body. The dissociation observed with neuroimaging is consistent with the roles of these systems in memory and dissociations reported in patient populations. Convergent evidence from these approaches consistently reinforces the idea of multiple neural systems supporting category learning.

Plasma total homocysteine levels are associated with advanced leukoaraiosis but not with asymptomatic microbleeds on T2*-weighted MRI in patients with stroke.

Both leukoaraiosis and asymptomatic microbleeds are associated with small-artery diseases. Although an association between hyperhomocysteinemia and leukoaraiosis has been reported, no studies have evaluated the association between total homocysteine (tHcy) level and presence of microbleeds in stroke patients. We evaluated the association between tHcy level and leukoaraiosis or microbleeds in stroke patients. In 102 patients with stroke (69.5 +/- 10.3 years old, 54 men and 48 women), microbleeds on T2*-weighted MR images were counted, leukoaraiosis on T2-weighted images was graded and fasting plasma tHcy concentrations were measured. Plasma tHcy level was significantly higher in patients with advanced leukoaraiosis than in those without advanced leukoaraiosis (13.9 +/- 4.6 micromol/l vs. 10.2 +/- 3.4 micromol/l, P < 0.0001). Plasma tHcy level was not significantly different in patients with microbleeds and those without microbleeds (11.3 +/- 4.1 micromol/l vs. 11.4 +/- 4.3 micromol/l, P = 0.9441). Elevated tHcy level is significantly and independently associated with advanced leukoaraiosis [odds ratio (OR), 1.330; 95% CI, 1.130-1.565] but not with the presence of microbleeds. Elevated tHcy level appears to be associated with ischemic small-artery disease rather than with bleeding-prone small-artery disease.