A genome-wide association study identifies two novel susceptibility loci and trans population polygenicity associated with bipolar disorder.

Genome-wide association studies (GWASs) have identified several susceptibility loci for bipolar disorder (BD) and shown that the genetic architecture of BD can be explained by polygenicity, with numerous variants contributing to BD. In the present GWAS (Phase I/II), which included 2964 BD and 61 887 control subjects from the Japanese population, we detected a novel susceptibility locus at 11q12.2 (rs28456, P=6.4 × 10-9), a region known to contain regulatory genes for plasma lipid levels (FADS1/2/3). A subsequent meta-analysis of Phase I/II and the Psychiatric GWAS Consortium for BD (PGC-BD) identified another novel BD gene, NFIX (Pbest=5.8 × 10-10), and supported three regions previously implicated in BD susceptibility: MAD1L1 (Pbest=1.9 × 10-9), TRANK1 (Pbest=2.1 × 10-9) and ODZ4 (Pbest=3.3 × 10-9). Polygenicity of BD within Japanese and trans-European-Japanese populations was assessed with risk profile score analysis. We detected higher scores in BD cases both within (Phase I/II) and across populations (Phase I/II and PGC-BD). These were defined by (1) Phase II as discovery and Phase I as target, or vice versa (for 'within Japanese comparisons', Pbest~10-29, R2~2%), and (2) European PGC-BD as discovery and Japanese BD (Phase I/II) as target (for 'trans-European-Japanese comparison,' Pbest~10-13, R2~0.27%). This 'trans population' effect was supported by estimation of the genetic correlation using the effect size based on each population (liability estimates~0.7). These results indicate that (1) two novel and three previously implicated loci are significantly associated with BD and that (2) BD 'risk' effect are shared between Japanese and European populations.

Effects of changes in afterload impedance on left ventricular ejection in isolated canine hearts: dissociation of end ejection from end systole.

To examine how end systole differs from end ejection and also whether the slope of the end systolic pressure-volume relation can be approximated to that of the end ejection pressure-volume relation, nine isolated, perfused, paced canine hearts ejecting into a hydraulic loading system that simulated the aortic input impedance of a dog's arterial tree were studied. To measure left ventricular volume changes the heart was placed in a plethysmograph. Peripheral resistance (Rp) and arterial compliance (C) were independently varied from 1.9 (Rp = 1.9) to 3.3, 6.4, and 9.6 X 10(8) Pa.m-3.s (Rp run) with a constant value of compliance 1.3 X 10(-9) Pa-1.m3 (C = 1.3), and from C = 0.4 to C = 0.8, C = 1.3 and C = 2.3 (C run) with a constant value of resistance (Rp = 6.4). Five pressure-volume loops were obtained by changing the end diastolic volume at each value of compliance and peripheral resistance. It was clearly shown that ventricular ejection continued after end systole and the time duration between end systole and end ejection became longer with increasing arterial compliance (24(4) at C = 0.4 vs 49(4) ms at C = 2.3, p less than 0.001), while the time duration between end diastole and end systole was constant regardless of afterload impedance change. Regarding the left ventricular pressure-volume relation the end systolic relation was almost linear (r greater than or equal to 0.98) and the slope was not significantly affected by change in any afterload impedance tested. End ejection pressure-volume relation was also linear (r greater than or equal to 0.97) and the slopes in the peripheral resistance and compliance runs were lower than those of the end systolic pressure-volume relation in each corresponding run. The former slopes decreased at smaller values of Rp or larger values of C--namely, 4.4(0.6) at Rp = 9.6 vs 3.6(0.6) at Rp = 1.9, p less than 0.05; 4.8(0.6) at C = 0.4 vs 3.1(0.5) mmHg.ml-1 at C = 2.3, p less than 0.001. Thus it is concluded that end ejection is usually different from end systole and the time difference between them is affected by changes in arterial compliance. In addition, the slope of end ejection pressure-volume relation was dependent on the changes in afterload impedance and cannot be approximated to that of the end systolic pressure-volume relation.

Effects of alpha and beta adrenergic blockade on coronary arterial microvessels in the beating canine heart.

OBJECTIVE: The aim was to clarify the effects of alpha and beta adrenergic blockade on coronary arterial microvessels and to assess the role of alpha and beta adrenergic tone in normally beating hearts. METHODS: 47 anaesthetised open chest dogs were studied. The diameters of epicardial arterial microvessels were measured in beating hearts using an incident light fluorescence microscope equipped with a floating objective. Drugs were infused into the left anterior descending coronary artery keeping the heart rate and aortic pressure at control levels. To examine the effect of alpha adrenergic blockade, phentolamine (100 micrograms.kg-1) was given in the absence or presence of beta adrenergic blockade (propranolol 50 micrograms.kg-1). To examine the effect of beta adrenergic blockade, propranolol (50 micrograms.kg-1) or three doses of ICI 118,551 (a selective beta 2 antagonist, 0.1, 0.5, and 1.0 microgram.kg-1.min-1) was given. RESULTS: Coronary arterial microvessels were divided into three groups according to the control diameters (D) of small (D less than 100 microns), medium (100 less than or equal to D less than 200 microns) and large (D greater than or equal to 200 microns) groups. In the absence of beta adrenergic blockade, phentolamine significantly dilated all vessel groups: small +19.6 (SEM 5.6)%, medium +5.8(2.3)%, large +5.3(0.9)%. In the presence of beta adrenergic blockade, the vasodilator effect of phentolamine was completely abolished. Propranolol constricted all vessel groups: small -3.6(1.1)%, medium -4.8(1.0)%, large -3.5(1.0)%. ICI 118,551 significantly constricted the large vessel group [-2.5(0.6)%] at the mid dose, and the medium and large vessel groups [medium -3.1(0.8)%, large -3.5(1.3)%] at the highest dose. CONCLUSIONS: These data indicate that (1) the vasodilator effect of phentolamine is induced by beta adrenergic stimulation; (2) resting alpha adrenergic tone of coronary arterial microvessels is minimal in normally beating hearts, and (3) resting beta adrenergic tone may play a physiological role in coronary arterial microvessels, and beta 2 adrenergic tone predominates in arterial microvessels greater than 100 microns in diameter.

A genome-wide association study of periodontitis in a Japanese population.

Periodontitis is a multifactorial disease in which bacterial, lifestyle, and genetic factors are involved. Although previous genetic association studies identified several susceptibility genes for periodontitis in European populations, there is little information for Asian populations. Here, we conducted a genome-wide association study and a replication study consisting of 2,760 Japanese periodontitis patients and 15,158 Japanese controls. Although single-nucleotide polymorphisms that surpassed a stringent genome-wide significance threshold (P < 5 × 10(-8)) were not identified, we found 2 suggestive loci for periodontitis: KCNQ5 on chromosome 6q13 (rs9446777, P = 4.83 × 10(-6), odds ratio = 0.82) and GPR141-NME8 at chromosome 7p14.1 (rs2392510, P = 4.17 × 10(-6), odds ratio = 0.87). A stratified analysis indicated that the GPR141-NME8 locus had a strong genetic effect on the susceptibility to generalized periodontitis in Japanese individuals with a history of smoking. In conclusion, this study identified 2 suggestive loci for periodontitis in a Japanese population. This study should contribute to a further understanding of genetic factors for enhanced susceptibility to periodontitis.

Effect of diltiazem, a calcium antagonist, on myocardial ischemia.

In line with studies on the metabolism of the ischemic myocardium, the effectiveness of diltiazem hydrochloride, a potent calcium antagonist, in reducing the effects of ischemia was evaluated. Nonischemic and ischemic tissue samples were examined in two groups of dogs--Group I, dogs receiving no drug and killed after 60 minutes of regional ischemia, and Group II, dogs given diltiazem after 10 minutes of ischemia and killed 50 minutes later. Administration of diltiazem proved beneficial in several ways: The decrease in adenosine-5'-triphosphate in the ischemic region was halved, inhibition of anaerobic glycolysis was reduced, tissue levels of lactic acid and free fatty acids were lowered and the contractility of glycerinated heart muscle fibers was improved. However, administration of the drug did not influence mitochondrial function. Mitochondrial oxygen consumption and respiratory control were reduced by equal amounts in both groups, as was mitochondrial calcium ion binding. These observations demonstrate that diltiazem is capable of minimizing the consequences of acute ischemic, although the beneficial effects do not extend to all aspects of myocardial metabolism.

Effects of afterload elevation on the ischemic myocardium in isolated, paced canine heart with partial coronary stenosis.

The effect of afterload elevation on the ischemic myocardium was examined in an isolated, paced canine heart with a partial coronary stenosis. The coronary blood flow of the left circumflex coronary artery was reduced to approximately one-third of the values before stenosis. The left circumflex coronary stenosis produced a decrease in global ventricular function, a decrease in systolic shortening and deviation of the ST-segment of the epicardial electrocardiogram and an increase in myocardial carbon dioxide (CO2) tension of the ischemic region. Then, afterload elevation with constant preload decreased the myocardial CO2 tension and improved the ST-segment deviation of the ischemic myocardium. Mechanical function, estimated by the relation between mean aortic pressure and systolic shortening, also improved with elevation of mean aortic pressure. In contrast, afterload elevation combined with preload elevation did not improve ischemic injury, as estimated by myocardial CO2 tension, and did not improve ST-segment deviation or mechanical function despite an increase in left circumflex coronary flow. These results suggest that the elevation of afterload pressure under constant preload improves ischemia produced by a partial coronary stenosis due to increased coronary blood supply; however, the preload elevation counterbalances the beneficial effects of afterload elevation.

Comparative effects of chronic ethanol and acetaldehyde exposure on myocardial function in rats.

This study was conducted to compare separately the chronic effects of high blood levels of ethanol and acetaldehyde on the metabolism of the heart. Levels of ethanol and acetaldehyde were altered by administration of either 4-methylpyrazole (4-MP), a potent alcohol dehydrogenase inhibitor, or pargyline (PAR), a monoamine oxidase inhibitor that markedly increases acetaldehyde levels in the blood following ethanol administration. Measurements were made in rats consuming ethanol for three to four weeks. Mitochondrial respiration, in vitro contractility of glycerinated heart muscle fibers, and myocardial protein synthesis were determined. As compared to animals receiving only ethanol, administration of either-4-methyl-pyrazole or pargyline plus ethanol resulted in more severe damage to mitochondrial respiration and myocardial protein synthesis. The data illustrate that both acetaldehyde and ethanol in high concentrations can cause severe damage to myocardial metabolism.

[Distribution of cefotiam dihydrochloride to the intraabdominal exudate (author's transl)].

The concentration of serum and intraperitoneal exudate after dripping intravenous administration of CTM were measured. Four male cases of the emergent laparotomy, a Cushing's ulcer, a hemorrhagic gastric ulcer, an adhesive ileus and acute terminal ileitis were investigated on this study. Two grams of CTM dissolving into 100 ml of physiological saline solution were prepared and administered in a period of 1 hour by intravenous drip (i.v.d.) for all cases after operation. The measurement of CTM-concentration in serum and intraperitoneal exudate were made at 30 minutes, 60 minutes following administration by serum and intraperitoneal exudate were made at 30 minutes, 60 minutes following administration by i.v.d. and at 30 minutes, hourly intervals over a 6-hour period after total administration. The intraperitoneal exudate for this study were collected through a drain which provided at the operation. These samples were measured by Agar-well method at Takeda Central Research Laboratory. Takeda Co., Ltd. The mean value of serum CTM at 30 minutes after the beginning of i.v.d. administration was 65.7 micrograms/ml and the maximum value, 79 micrograms/ml was obtained at 60 minutes. The following mean values at 30 minutes, 1 hour, 2 hours, 3 hours, 4 hours, 5 hours and 6 hours after total administration were 39.1, 26.4, 14.6, 8.9, 4.7 and 0.6 microgram/ml. On the other hand, the mean values of CTM intraperitineal exudate at the same time intervals were 4.9, 20.7, 32.0, 34.3, 22.4, 13.9, 11.2, 8.7 and 3.3 micrograms/ml. These results showed that there were much transfer of CTM between serum and intraperitoneal exudate corresponding to the amount of administration.

[t-PA activity, antigen and PAI-1 antigen levels in blood obtained from the patients with cerebral infarction].

Tissue plasminogen activator (t-PA) produced by endothelial cells exerts a powerful effect on the course of thrombosis, embolism, or arteriosclerosis. However, the fluctuations of fibrinolytic system in the patients with cerebral infarction (CI), have yet to be demonstrated. This study was designed to investigate t-PA activity, t-PA antigen and plasminogen activator inhibitor-1 (PAI-1) antigen levels in the CI patients. The mean t-PA activity, t-PA antigen and PAI-1 levels in patients were 0.53 +/- 0.64 IU/ml, 10.9 +/- 5.2 ng/ml and 23.0 +/- 14.9 ng/ml, and the normal ranges were 0.02-0.28 IU/ml, 1.0-7.0 ng/ml and 5.3-45.0 ng/ml, respectively. Almost all the patients were plotted out to the abnormal range by scattergrams relating t-PA activity to t-PA antigen, and no daytime fluctuations of the above three parameters in the patients differed from those in normal controls. When CI patients were followed up to the 8th hospital day, abnormal fluctuations were also observed. Consequently we suggest that this information may help to attain the more progressive treatment or the preventive therapy of CI.

Interaction in culture between mouse ascites hepatoma (MH-134) cells and lymphoid cells of isologous mice.

Thymocytes or lymphocytes of mesenteric lymph nodes were obtained from mice bearing subcutaneously mouse ascites hepatoma MH-134 for 5 to 40 days. These lymphoid cells were added into the cultures of MH-134 cells. Morphological changes of cells in the mixed cultures were observed by time-lapse cinemicrography for the period of 4 weeks. Lymphoid cells were phagocytosed by MH-134 cells, and, in most cases, the tumor cells did not undergo any damage due to the phagocytosis. The exceptional cases were as follows: When MH-134 cells were mixed with thymocytes from mice bearing MH-134 tumor for 5 days, MH-134 cells phagocytosed thymocytes but some of them died later. In the mixed cultures of MH-134 cells and thymocytes or mesenteric lymph node lymphocytes from mice bearing MH-134 for 14 or 15 days, MH-134 cells phagocytosed lymphoid cells but died later by the burst of cytoplasm. By the burst many lymphoid cells phagocytosed appeared from the broken cytoplasm of MH-134 cells and, in some cases, the lymphoid cells looked to be alive. These findings suggest the possibility that lymphoid cells attack tumor cells not only from the cell surface but also from the inside being phagocytosed by tumor cells.

Interaction in culture between mouse ascites mammary carcinoma (MM2) cells and lymphoid cells of isologous mice.

MM2 cells, ascitic tumor originated from spontaneous mammary carcinoma of C3H/He mouse, were mix-cultured with lymphoid cells of thymus or mesenteric lymph nodes from isologous animals of the same sex. The interaction in culture between these cells was examined by time-lapse cinemicrography. In single culture, thymocytes, mesenteric lymph node lymphocytes and MM2 cells were kept for 7 days with little change in cell population. Lymphocytes of both sources showed a marked decrease in cell number when cultured together with MM2 cells, being evidently phagocytosed by MM2 cells. Lymphocytes from MM2-bearing mice or mice sensitized with deoxycholate-extracted MM2 antigen were also all phagocytosed. MM2 cells exhibited no sign of damage or degeneration due to the phagocytosis. Thymocytes were not phagocytosed by histiocytes obtained from ascitic fluid 3 days after i.p. injection of 5% starch suspension. Phagocytosis of erythrocytes or lymphoid cells from spleen by MM2 cells was not detected.

Phasic blood flow velocity pattern in epimyocardial microvessels in the beating canine left ventricle.

We quantitated phasic epimyocardial microcirculatory coronary blood flow velocity patterns in the beating left ventricle. Using a newly developed floating objective and high-speed cinematography, red cell velocities in small arterioles, capillaries, and small venules and microvascular diameters in the superficial layer of the epimyocardium of beating left ventricle were determined throughout the entire cardiac cycle in open-chest anesthetized dogs. Heart rate was maintained at 140 beats/min by means of left atrial pacing. Peak red cell velocity was observed in midsystole in small arterioles and capillaries, and in late systole in small venules. Abrupt decline in red cell velocity and, in many cases, a momentary cessation or reverse of flow, was observed in these microvessels during the pre-ejection period. The internal diameter of small venule was increased in late systole, while that of small arteriole remained almost constant during the cardiac cycle. Furthermore, in these epimyocardial microvessels, a higher percentage of the total area under the velocity curve occurred during the ejection phase; 51% in small arterioles, 43% in capillaries, and 40% in small venules. These findings indicate that the phasic blood flow pattern is markedly different in the subepimyocardial microvessels from that in the large epicardial artery and the septal artery. During vasodilation following dilazep (50 micrograms/kg, i.v.), an adenosine potentiator, red cell velocity increased throughout the entire cardiac cycle in epimyocardial microvessels with significant increases in the total area under the velocity curves accompanied by significant dilation of the arterioles. The present data will provide information useful in predicting or simulating transmural differences in the phasic blood flow pattern.

A new microscopic system for the continuous observation of the coronary microcirculation in the beating canine left ventricle.

A microscope system was designed using a new type of objective lens which makes possible the direct and continuous observation of the coronary microcirculation throughout the entire cardiac cycle in the beating canine heart. The microscope system consists of a standard microscope and a floating objective system which is composed of a pair of convex lenses and transmits a real image of the coronary microcirculatory bed to a standard microscope without any change in magnification. The convex lens facing the heart is supported by a weight-adjusting coil spring and low-resistance ball bearings which allow the lens to move perpendicularly in unison with cardiac motion. To reduce excessive cardiac movement, two 24-gauge needles connected to the animal table by a needle holder are horizontally inserted through the midmyocardium of the left ventricle beneath the area of interest. The epimyocardium of the left ventricle is transilluminated by means of a light pipe and a xenon-arc lamp. The distance between the floating lens and the cardiac surface is kept constant using a spacing device connected to the light pipe holder to prevent the compression of the tissue in the microscopic field of view. This improvement in the microscope system combined with high-speed cinematography greatly facilitates the continuous analysis of the coronary microcirculation in the beating left ventricle throughout the entire cardiac cycle, and may provide a useful approach to the understanding of the regulation mechanism of the coronary circulation.

The relationship of regional coronary blood flow to mitochondrial function during reperfusion of the ischemic myocardium.

The relationship of changes in regional coronary flow to the nature and degree of biochemical disturbances during occlusion of branches of the left anterior descending coronary artery and following reestablishment of flow was investigated in two groups of dogs: group I, moderate ischemia before reflow, and group II, severe ischemia prior to reflow. Regional coronary blood flow was determined before ligation, after 60 min of ischemia and after 15 min of reflow using labelled microspheres. Hearts made ischemic for 60 min but not reperfused served as controls. Groups I and II were distinguished by the following features. Group II showed a marked exacerbation of biochemical damage on reperfusion of the ischemic region (reduced levels of ATP, impairment of mitochondrial oxygen consumption and mitochondrial calcium binding). This was accompanied by significant subendocaridial hyperemia. Reperfusion in group I, on the otherhand, partially reversed these changes (increased level of ATP in the ischemic-reperfused region, improved mitochondrial oxygen consumption and calcium binding). Mitochondrial calcium uptake and oxidative phosphorylation (ADP/O ratio) were not affected in any group. These data illustrate that the degree of biochemical damage following reperfusion of the ischemic myocardium is determined by the degree of ischemia, and suggest that interference with ATP production by the mitochondria is not responsible for the damage.

Bile duct carcinoma associated with an anomaly in the bile duct.

This paper reports a case of bile duct carcinoma associated with an extra-hepatic bile duct anomaly. In the present case, the anomaly induced an uncorrect preoperative diagnosis and obliged to change the surgical procedures during operation. A correct preoperative diagnosis was difficult to make in the present case, when the anomaly in the biliary system was not kept in mind.