Larger Posterior Revascularization Associated with Reduction of Choroidal Anastomosis in Moyamoya Disease: A Quantitative Angiographic Analysis.

BACKGROUND AND PURPOSE: Choroidal anastomosis, a hemorrhage-prone periventricular collateral manifestation in Moyamoya disease, outflows to the cortex posterior to the central sulcus. The objective of the present study was to test whether the angiographic extent of revascularization posterior to the central sulcus contributes to the postoperative reduction of choroidal anastomosis. MATERIALS AND METHODS: This retrospective cohort study included choroidal anastomosis-positive hemispheres before direct bypass surgery. The postoperative reduction of choroidal anastomosis was determined by a consensus of 2 raters according to the previous research. An imaging software automatically traced the angiographic revascularization area, which was subsequently divided into anterior and posterior parts by an anatomic line corresponding to the central sulcus. Each area was quantitatively measured as a percentage relative to the whole supratentorial area. RESULTS: Postoperative reduction of choroidal anastomosis was achieved in 68 (85.0%) of the 80 included hemispheres. The revascularization area posterior to the central sulcus was significantly larger in the hemispheres with reduction than in those with no reduction (mean, 15.2% [SD, 7.1%] versus 4.2% [SD, 3.4%], P < .001), whereas no significant difference was observed in the revascularization area anterior to the central sulcus. Multivariate analysis revealed that the revascularization area posterior to the central sulcus was the only significant factor associated with reduction (OR, 1.57; 95% CI, 1.21-2.03, for every 1% increase). CONCLUSIONS: The results suggest that a larger revascularization posterior to the central sulcus is associated with postoperative reduction of choroidal anastomosis regardless of the extent of anterior revascularization. It might facilitate optimal selection of the revascularization site for preventing hemorrhage.

Orbital-independent superconducting gaps in iron pnictides.

The origin of superconductivity in the iron pnictides has been attributed to antiferromagnetic spin ordering that occurs in close combination with a structural transition, but there are also proposals that link superconductivity to orbital ordering. We used bulk-sensitive laser angle-resolved photoemission spectroscopy on BaFe(2)(As(0.65)P(0.35))(2) and Ba(0.6)K(0.4)Fe(2)As(2) to elucidate the role of orbital degrees of freedom on the electron-pairing mechanism. In strong contrast to previous studies, an orbital-independent superconducting gap magnitude was found for the hole Fermi surfaces. Our result is not expected from the superconductivity associated with spin fluctuations and nesting, but it could be better explained invoking magnetism-induced interorbital pairing, orbital fluctuations, or a combination of orbital and spin fluctuations. Regardless of the interpretation, our results impose severe constraints on theories of iron pnictides.

DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging activity of flavonoids obtained from some medicinal plants.

A reactive oxygen species has been implicated in a range of human pathological diseases such as atherosclerosis and certain cancers. Flavonoids are reported to exhibit various biological activities, including antioxidative and free radical scavenging activities. Several flavonoids obtained from barley leaves, soybean and some medicinal plants, Silybum marianum, Sophorae Flos, Cinnamon, Ephedrae Herba and Scutellariae Radix, were tested for their DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging activity. The structure-activity relationships suggested that not only the numbers of hydroxy group but also the position of hydroxy group might be important for mediating potent activity.

Interaction of phytoestrogens with estrogen receptors alpha and beta.

The human estrogen receptor (hER) exists as two subtypes, hER alpha and hER beta, that differ in the C-terminal ligand-binding domain and in the N-terminal transactivation domain. In this study, we investigated the estrogenic activities of soy isoflavones after digestion with enteric bacteria in competition binding assays with hER alpha or hER beta protein, and in a gene expression assay using a yeast system. The estrogenic activities of these isoflavones were also investigated by the growth of MCF-7 breast cancer cells. Isoflavone glycoside binds weakly to both receptors and estrogen receptor-dependent transcriptional expression is poor. The aglycones bind more strongly to hER beta than to hER alpha. The binding affinities of genistein, dihydrogenistein and equol are comparable to the binding affinity of 17 beta-estradiol. Equol induces transcription most strongly with hER alpha and hER beta. The concentration required for maximal gene expression is much higher than expected from the binding affinities of the compounds, and the maximal activity induced by these compounds is about half the activity of 17 beta-estradiol. Although genistin binds more weakly to the receptors and induces transcription less than does genistein, it stimulates the growth of MCF-7 cells more strongly than does genistein.

[Two pediatric cases of malignant hyperthermia caused by sevoflurane].

We experienced two cases of malignant hyperthermia (MH) triggered by sevoflurane. Case 1 was a six-year-old girl, 15.8 kg, undergoing strabismus repair. She had flat back, elevated diaphragm and high arched palate. Anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Her trachea was intubated without the use of muscle relaxant. Thirty minutes after the induction of anesthesia, ETco2 was over 60 mmHg despite hyperventilation. Muscle rigidity of legs and the rise in temperature were noted. MH was diagnosed and dantrolene i.v. was administered. Her maximum esophageal temperature was 40.2 degrees C. ETco2 and temperature returned to baseline values after dantrolene administration. Creatine phosphokinase (CK) level was 252 U.l-1 preoperatively, and 1690 U.l-1 next day. Case 2 was a year-and-9-month-old boy undergoing accessory ear resection. Anesthesia was induced with sevoflurane and nitrous oxide in oxygen. His trachea was intubated with an aid of vecuronium. Forty minutes after administration of sevoflurane his temperature rose to 38.6 degrees C with heart rate 191 bpm and Spo2 93%, and muscle rigidity of legs. MH was diagnosed and dantrolene was administered. His highest temperature was 39.3 degrees C and was reduced promptly after dantrolene. Postoperatively he was noted to have downslanting palpebral fissures, micrognathia, low set ears, and a single crease of the fifth finger and diagnosed as King syndrome which is reported to have association with MH. Both patients had no history of anesthesia nor abnormal family history. Both of them were rescued with dantrolene and recovered without sequelae.

Diurnal fluctuation of sleep propensity and hormonal secretion across the menstrual cycle.

BACKGROUND: The fact that most women experience sleep changes across the menstrual cycle is thought to be associated with changes in circadian rhythms; however, few studies have investigated this relationship. METHODS: We applied an ultrashort sleep-wake schedule to eight healthy women and studied diurnal fluctuations in sleep propensity, sleepiness, rectal temperature, and serum concentrations of melatonin, thyroid-stimulating hormone, and cortisol in the follicular and luteal phases. RESULTS: In the luteal phase, amplitude of core body temperature, total melatonin secretions, and amplitudes of TSH and cortisol rhythms were significantly decreased, whereas sleepiness and occurrence of slow-wave sleep during the daytime were significantly increased. Differences in the amount of daytime slow-wave sleep across the menstrual cycle were positively correlated with differences in the daily mean rectal temperature. CONCLUSIONS: The findings suggest that the amplitude of circadian oscillation may be dampened in the luteal phase. Increased daytime sleepiness in the luteal phase may be associated with increased daytime slow-wave sleep, due possibly to changes in thermoregulation in the luteal phase.

Demography of sleep disturbances associated with circadian rhythm disorders in Japan.

To clarify the demography of delayed sleep phase syndrome (DSPS), non-24-h sleep-wake syndrome, and irregular sleep-wake pattern in Japan, a cross-sectional nationwide epidemiological survey was conducted. 1525 adults (age: 15-59 years) were randomly sampled from telephone directories, and they received screening questions over the phone. Persons who were suspected of having the disorders were requested to fill out the second questionnaire, and asked to keep a sleep log for 4 weeks. Diagnoses were made according to the International Classification of Sleep Disorders criteria. As a result, the prevalence of DSPS was estimated to be 0.13%.

Lifestyles and sleep disorders among the Japanese adult population.

To clarify the effects of daily stress, habitual exercise, drinking and smoking on the prevalence of sleep disorders, we selected 4000 residents (> or =20 years) in Japan by stratified random sampling and carried out structured interviews (response rate 75.8%). Frequencies of sleep disorders (difficulty initiating sleep: DIS; difficulty maintaining sleep: DMS; early morning awakening and hypnotic medication use) were treated as dependent variables. Significant effects of stress were prevalent in all sleep disorders. Habitual exercise had significant negative association with DIS and DMS. Drinking and smoking did not affect sleep disorders.

Study of structure--hepatoprotective relationships of oleanene-type triterpenoidal glucuronides obtained from several fabaceous plants on rat primary hepatocyte cultures.

The protective effects of nine oleanene-type triterpenoidal glucuronides obtained from several fabaceous plants (Lupinus polyphyllus x arboreus Hybrid, Astragalus complanatus, Wistaria brachybotrys) on in vitro immunological liver injury in primary cultured rat hepatocytes were studied. Although all tested saponins showed hepatoprotective action, the levels of activity of the individual saponins differed. Structure-activity relationships for the sapogenol moiety suggested that the presence of the carbonyl group at C-22 would show a similar hepatoprotective effect to that of the hydroxyl group at C-22 while the presence of the hydroxyl group at C-30 would reduce the hepatoprotective action. This structure-activity relationship substantiated other recently obtained data. Furthermore, the beta-orientation of the hydroxyl group at C-21 is more effective than the alpha-configuration in regard to the hepatoprotection. Furthermore, structure-activity relationships for the sugar moiety substantiated previously obtained data that the hydroxyl group at C-5" enhances the hepatoprotective action.

[Radiotherapy for locally advanced esophageal cancer].

The conventional treatment for patients with locally advanced esophageal cancer has been surgery or radiotherapy. The indication of the treatment depends on the location of the primary tumor, tumor stage, resectability of the lesion and operability of the patient. Radiotherapy is used in a case refusing surgery, medical contraindications to surgery, extensive locoregional disease or poor general condition. The survival rate by surgery alone or radiotherapy alone is poor. Thus, single modality therapy is not a standard treatment, but combined multimodal therapy including chemotherapy is a standard approach for locally advanced esophageal cancer. Further studies of optimization of multimodal therapies which are surgery and/or radiotherapy combined with chemotherapy are needed to improve the results in the treatment of esophageal cancer.

[Radiotherapy for elderly patients].

Radiotherapy is of particular benefit to elderly patients as alternative surgery, and it is widely used with curative and palliative intent. Patients aged 75 and older accounted for 5-10% of all cases, and half of them had some complications. Radical radiotherapy was performed in 63-73% of the elderly patients and 88-100% were able to complete the planned course. Several authors reported that the elderly patients adequately staged, can tolerate radical radiotherapy and have survival comparable to that of younger patients. But careful management is needed.

[Clinical evaluation of chemoradiotherapy for advanced cervical cancer].

Locally advanced cervical cancer has a poor prognosis, poor survival rate, and high local failure rate. A number of questions regarding the optimal agents and schedule of concurrent chemoradiation remain unanswered. To improve the cure rate for advanced or recurrent cervix cancer, we studied intra-arterial infusion chemotherapy (IAIC) with or without radiotherapy. We analyzed 52 cases of advanced or recurrent cervical cancer treated by IAIC with or without radiotherapy. IAIC regimen was separated into two groups: group I consisted of 5-FU + MMC+/-ADM (30 cases) and group II of CDDP + MMC+/-5-FU (22 cases). The tip of the catheter was placed in the bifurcation of abdominal aorta or the bilateral internal iliac arteries (7 cases). The overall response rate (CR + PR) was 71%, 87% in patients receiving radiotherapy, 50% in those without radiotherapy, and 100% in primary cases. The five-year survival rate was 20% in primary cases, 14% in recurrent cases, 3% in group I and 38% in group II by chemotherapy regimen. Severe (more than grade III) hematological acute side effects were found in 48% of all cases, but recovered by interruption of drugs. In 7 cases in which the tip of the catheter was placed in internal iliac arteries, there were severe skin ulcers in 2 cases and severe pain of leg or gluteal region which need narcotics in 2 cases. These data suggest that IAIC mainly with cisplatin with or without radiotherapy is one of the effective treatments for advanced or recurrent cervical cancer. But we should check blood flow distribution periodically, and control the concentration of drugs. To improve the survival rate for advanced or recurrent cervical cancer, we should discuss neoadjuvant chemotherapy followed by chemoradiotherapy and maintenance systemic chemotherapy.

[Clinical evaluation of intra-arterial infusion chemotherapy for advanced or recurrent cervical cancer with or without radiotherapy].

We analyzed 52 cases of advanced or recurrent cancer of the cervix treated by intra-arterial infusion chemotherapy (IAIC) with or without radiotherapy. IAIC regimen was separated into two groups: Group I consisted of 5-FU + MMC +/- ADR (30 cases) and group II of CDDP + MMC +/- 5-FU (22 cases). The tip of the catheter was placed in the bifurcation of abdominal aorta or the bilateral internal iliac arteries (7 cases). The overall response rate (CR + PR) was 71%, 87% in patients given radiotherapy, 50% in those without radiotherapy, and 100% in primary cases. The five-year survival rate was 20% in primary cases, 14% in recurrent cases, 3% in Group I and 38% in Group II (p = 0.00182) by chemotherapy regimen. Severe (more than grade III) hematological acute side effect was 48% for all cases, but recovered by interruption of drugs. In 7 cases in which the tip of the catheter was placed in internal iliac arteries, there were severe skin ulcers in 2 cases and severe pain of leg or gluteal region requiring narcotics in 2 cases. These data suggest that IAIC mainly with cisplatin with or without radiotherapy is one of the effective treatments for advanced or recurrent cervix cancer. But we should check the blood flow distribution periodically, and control the concentration of drugs.

[Antinuclear antibody screening by an enzyme-linked immunosorbent assay using multiple nuclear antigens].

We assessed the clinical value of an enzyme-linked immunosorbent assay (ELISA) kit (MESACUP ANA, MANA) which uses multiple nuclear antigens for screening antinuclear antibody (ANA). Since the screening procedure for ANA by the indirect fluorescence method (FANA) requires trained personnel and gives rather subjective results, development of a suitable screening test for ANA by ELISA which uses specific nuclear antigens has been long awaited. Serum samples from 350 patients with connective tissue diseases (CTD), and from 300 normal subjects were assayed for ANA by ELISA and the results were compared with those of FANA and of single-antigen ELISAs for RNP, Sm, SS-A, SS-B, Scl-70, Jo-1, dsDNA, and ssDNA. For discrimination between patients with systemic lupus erythematosus and normal subjects, the sensitivity, specificity and accuracy for MANA were 85.7%, 97.5%, and 91.6%, and those for FANA were 95.8%, 77.0%, and 86.4%, respectively. Analysis of CTD sera showing discordant results between FANA and MANA using single-antigen ELISAs revealed that FANA - MANA + sera (n = 8) contained antibodies against SS-A (n = 1) or dsDNA (n = 3) or ssDNA (n = 3), and that some FANA + MANA - sera (n = 82), which were frequently found in RA patients (43/98, 43.9%), also contained antibodies against RNP (n = 3) or ssDNA (n = 13). MANA + normal sera (n = 9) were found to contain antibodies against SS-A (n = 1) or dsDNA (n = 1) or ssDNA (n = 2). In conclusion, MANA was found to be objective, much less labor intensive and suitable for screening large numbers of CTD sera for disease-specific ANAs.

Decreased N-myc expression in human medulloblastoma cell lines during differentiation.

Medulloblastoma is the most common primitive neuroectodermal tumor of the central nervous system, and shares some biochemical and immunological features with neuroblastoma. It could be suggested that N-myc expression in medulloblastoma is correlated with primitiveness or cell differentiation, as in neuroblastoma. N-myc expression in two human medulloblastoma cell lines (ONS-76 and -81) was investigated during drug-induced differentiation by immunocytochemistry and Western blotting. The growth rates of the two medulloblastoma cell lines showed a marked decrease and morphological differentiation occurred after treatment with 1 mM dibutyryl cyclic-adenosine 3',5'-monophosphate (dbt-cAMP). The decrease in N-myc expression with differentiation of cells was confirmed by immunocytochemistry and Western blotting. We believe that decreased N-myc expression is correlated with cell differentiation, and a decrease in the primitiveness of medulloblastoma cells.

[Clinical evaluation of intra-arterial infusion chemotherapy for advanced or recurrent pelvic tumors with or without radiotherapy].

We analyzed 97 cases of various advanced or recurrent pelvic tumors which were cervix, rectal, ovarian and other tumors treated by intra-arterial infusion chemotherapy (IAIC) with or without radiotherapy. The IAIC regimen was separated into two groups: group I consisting of 5-FU + MMC +/- ADR (54 cases) and group II consisting of CDDP + MMC +/- 5-FU (43 cases) from 1985. The catheter was placed in the bifurcation of abdominal aorta, and from 1990, the catheters were placed in bilateral internal iliac arteries (8 cases). The overall response rate (CR + PR) was 65%, 74% in patients receiving radiotherapy, and 47% in those without radiotherapy. There were no significant differences between each primary site and presence of radiotherapy combination in survival rate. Two-year survival rate and 5-year survival rate was 32% and 15% for all cases, and 65% and 33% for CR cases, respectively. A significantly better survival rate was obtained in patients with CR. Five-year survival rate was 4% in group I, and 35% in group II (p = 0.00216) by chemotherapy regimen. Severe (more than grade III) hematological acute side effects were 45% for all cases. In 8 cases in which the catheters were placed in internal iliac arteries, there were severe skin ulcers in 2 cases, and severe pain of leg or gluteal region requiring narcotics in 3 cases. These data suggest that IAIC mainly with cisplatin with or without radiotherapy is one of the effective treatment for advanced or recurrent pelvic tumors. Also, we should check blood flow distribution periodically, and control the concentration of drugs.

[The role and future of radiotherapy in cancer treatment].

The basic principle of radiotherapy for cancer patients is that it has the possibility of a good result (curability), is tolerable and promises a comfortable life thereafter. Radiotherapy is the important tool for early stage cancer by conserving the organ and function and for an advanced or recurrent stage of cancer by helping improve the quality of life. Radiotherapy must be planned on the basis of considering the therapeutic ratio with a 3-dimensional technique. It should be performed with optimum radiation methods in the multimodal treatment of cancer and will undoubtedly prove effective in the future.

Superficial esophageal cancer: multicenter analysis of results of definitive radiation therapy in Japan.

PURPOSE: To assess the effectiveness of definitive radiation therapy in patients with superficial esophageal cancer. MATERIALS AND METHODS: Method of irradiation, local control rate, survival rate, and complications were assessed in 105 patients (89 men, 16 women; age range, 50-88 years) with superficial esophageal cancer treated with definitive radiation therapy at 15 hospitals in 1981-1990. RESULTS: All lesions were confirmed to be squamous cell carcinoma. The overall 5-year survival rate was 38.7%; the 5-year disease-specific survival rate was 71.0%. The 2-year local control rate was 83.0%. Late complications occurred in 16 patients. The prevalence of complications was relatively high in the group treated with intraluminal radiation therapy. CONCLUSION: Local control and survival rates in patients treated with radiation therapy were excellent, especially in the group treated with external and intraluminal radiation therapy; however, the optimal dose and optimal combination of external and intraluminal radiation therapy should be further assessed.

[Multiple colonic ulcers in a patient with Sjögren's syndrome].

A 25-year-old female with Sjögren's syndrome was admitted to our hospital because of fever and abdominal pain. Multiple colonic ulcers were demonstrated by gastrographin enema and colonoscopy. Histological examination revealed the presence of necrotizing vasculitis in the submucosal region. Large dose of prednisolone (60 mg/day) brought a prompt relief of her symptoms and an improvement of positive inflammatory signs. Pseudoaneurysm in the arteria colica media, which had been demonstrated by abdominal selective angiography at the time of diagnosis, became extinct after the steroid treatment. Healing of ulcers were also noted by colonoscopy. A variety of extraglandular symptoms has been reported in Sjögren's syndrome. Multiple colonic ulcers due to vasculitis are rarely complicated but may have a great impact on the prognosis of the disease.