The question of whether or not to perform therapeutic hypothermia: A case of neonatal spinal cord injury.

Neonatal spinal cord injury is an extremely rare perinatal complication that often occurs concurrently with hypoxic ischemic encephalopathy (HIE), further complicating diagnosis of spinal cord injury. Although therapeutic hypothermia for moderate to severe HIE is widely recommended in Japan, it is difficult to determine whether it satisfies the neurological findings-related entry criteria in some patients.We describe a female infant with neonatal spinal cord injury after forceps delivery, who underwent therapeutic hypothermia upon diagnosis of HIE. The Apgar scores were 5 at 1 min, 6 at 5 min, and not recorded at 10 min. Blood gas analysis of her umbilical artery was not performed. Since respiratory failure, hypotonia and the absence of primitive reflexes were found at 2 hours after birth, she was initially diagnosed with moderate HIE and underwent a therapeutic hypothermia. Magnetic resonance imaging after therapeutic hypothermia revealed the spinal cord was narrowed from the lower medulla oblongata to the upper cervical cord. Thus she was diagnosed with an upper spinal cord injury at that time.Some patients with neonatal spinal cord injuries satisfy the criteria for therapeutic hypothermia. When neonates with asphyxia present with prolonged respiratory failure and hypotonia, spinal cord injury should be considered in the differential diagnosis. Thus, an early MRI is vital for the diagnosis of spinal cord injury.

Slater Insulator in Iridate Perovskites with Strong Spin-Orbit Coupling.

The perovskite SrIrO_{3} is an exotic narrow-band metal owing to a confluence of the strengths of the spin-orbit coupling (SOC) and the electron-electron correlations. It has been proposed that topological and magnetic insulating phases can be achieved by tuning the SOC, Hubbard interactions, and/or lattice symmetry. Here, we report that the substitution of nonmagnetic, isovalent Sn^{4+} for Ir^{4+} in the SrIr_{1-x}Sn_{x}O_{3} perovskites synthesized under high pressure leads to a metal-insulator transition to an antiferromagnetic (AF) phase at T_{N}≥225 K. The continuous change of the cell volume as detected by x-ray diffraction and the λ-shape transition of the specific heat on cooling through T_{N} demonstrate that the metal-insulator transition is of second order. Neutron powder diffraction results indicate that the Sn substitution enlarges an octahedral-site distortion that reduces the SOC relative to the spin-spin exchange interaction and results in the type-G AF spin ordering below T_{N}. Measurement of high-temperature magnetic susceptibility shows the evolution of magnetic coupling in the paramagnetic phase typical of weak itinerant-electron magnetism in the Sn-substituted samples. A reduced structural symmetry in the magnetically ordered phase leads to an electron gap opening at the Brillouin zone boundary below T_{N} in the same way as proposed by Slater.

Lipopolysaccharide of Aggregatibacter actinomycetemcomitans up-regulates inflammatory cytokines, prostaglandin E2 synthesis and osteoclast formation in interleukin-1 receptor antagonist-deficient mice.

BACKGROUND AND OBJECTIVE: The interleukin (IL)-1 receptor antagonist (Ra) binds to IL-1 receptors and inhibits IL-1 activity. However, it is unclear whether the IL-1Ra plays a protective role in periodontal disease. The purpose of this study was to compare IL-1Ra knockout (KO) and wild-type (WT) mice in regard to proinflammatory cytokine production, osteoclast formation and bone resorption in response to periodontal bacterial lipopolysaccharide (LPS). MATERIAL AND METHODS: Peritoneal macrophages (Mφs) were obtained from 13-wk-old IL-1Ra KO and WT mice. Peritoneal Mφs were cultured with or without 10 µg/mL of Aggregatibacter actinomycetemcomitans LPS for 24 h. The levels of IL-1alpha (IL-1α), IL-1beta (IL-1ß), tumor necrosis factor-α (TNF-α) and IL-6 were measured in periotoneal Mφs supernatant fluid (PM-SF) using an ELISA. Bone marrow cells were obtained from the mice and stimulated with PM-SF for 9 d, then stained with TRAP. The frequency of TRAP-positive multinucleated giant cell formation was calculated based on a fusion index. PM-SF-stimulated calvarial bone resorption was analyzed using micro-computed tomography, and calvarial histological analysis was performed using hematoxylin and eosin and TRAP staining. The expression of cyclooxygenase-2 (Cox2), prostanoid receptor EP4 (Ep4) and Rank mRNAs in bone marrow cells were measured using real-time quantitative PCR, while prostaglandin E2 (PGE2 ) production was determined by ELISA. RESULTS: The levels of IL-1α, IL-1ß, TNF-α and IL-6 in IL-1Ra KO mice PM-SF stimulated with A. actinomycetemcomitans LPS were significantly increased by approximately 4- (p < 0.05), 5- (p < 0.05), 1.3- (p < 0.05) and 6- (p < 0.05) fold, respectively, compared with the levels in WT mice. Moreover, osteoclast formation, expression of Rank, Ep4 and Cox2 mRNAs and production of PGE2 were significantly increased by approximately 2- (p < 0.05), 1.6- (p < 0.05), 2.5- (p < 0.05), 1.6- (p < 0.05) and 1.9- (p < 0.05) fold, respectively, in IL-1Ra KO mice stimulated with A. actinomycetemcomitans LPS compared with WT mice. CONCLUSION: IL-1Ra regulates IL-1 activity and appears to reduce the levels of other inflammatory cytokines, including TNF-α and IL-6, while it also reduces expression of the EP4 receptor related to prostanoid sensitivity and osteoclast formation. These results suggest that IL-1Ra is an important molecule for inhibition of inflammatory periodontal bone resorption.

Spontaneous formation of a superconducting and antiferromagnetic hybrid state in SrFe2As2 under high pressure.

We report a novel superconducting (SC) and antiferromagnetic (AF) hybrid state in SrFe(2)As(2) revealed by (75)As nuclear magnetic resonance (NMR) experiments on a single crystal under highly hydrostatic pressure up to 7 GPa. The NMR spectra at 5.4 GPa indicate simultaneous development of the SC and AF orders below 30 K. The nuclear spin-lattice relaxation rate in the SC domains shows a substantial residual density of states, suggesting proximity effects due to the spontaneous formation of a nanoscale SC-AF hybrid structure. This entangled behavior is a remarkable example of a self-organized heterogeneous structure in a clean system.

CaCrO3: an anomalous antiferromagnetic metallic oxide.

Combining infrared reflectivity, transport, susceptibility, and several diffraction techniques, we find compelling evidence that CaCrO3 is a rare case of a metallic and antiferromagnetic transition-metal oxide with a three-dimensional electronic structure. Local spin density approximation calculations correctly describe the metallic behavior as well as the anisotropic magnetic ordering pattern of C type: The high Cr valence state induces via sizable pd hybridization remarkably strong next-nearest-neighbor interactions stabilizing this ordering. The subtle balance of magnetic interactions gives rise to magnetoelastic coupling, explaining pronounced structural anomalies observed at the magnetic ordering transition.

Smooth muscle dysfunction in patients older than 54 years of age with objective evidence of arteriosclerosis.

OBJECTIVE: This investigation was designed to assess the relationship between flow-mediated vasodilatation (FMD) and nitroglycerin (NTG)-mediated vasodilatation (NMD) with atherosclerotic risk factors. METHODS: FMD and NMD were measured in 75 subjects including 57 patients with atherosclerotic disease (AAA/PAOD=30/27, age 72+/-7 years) and 18 controls. Brachial response to hyperemia and NTG were measured every minute after cuff deflation and NTG administration. RESULTS: In the 75 subjects, responses to NTG showed a sigmoid curve. Only 2 cases reached maximal diameter within 4 minutes after NTG, and 90% of the cases reached maximal diameter at 6 minutes or later (7.5+/-2.0 minutes). In patients with atherosclerotic disease, a multiple regression analysis showed higher FMD was associated with higher NMD, and higher NMD was associated with smaller vessel size, lower systolic blood pressure, higher FMD, lower carotid maximal IMT, lower serum levels of insulin, and lower HOMA-IR. CONCLUSIONS: In subjects older than 54, NMD measured at 3 or 4 minutes after NTG administration would underestimate the NTG-dependent vasodilatation. NMD measured with the maximal responded diameter was associated with atherosclerotic risk factors, and it is therefore considered to be an important parameter in patients with atherosclerotic disease.

Stereoselective glucuronidation and hydroxylation of etodolac by UGT1A9 and CYP2C9 in man.

1. In vitro metabolic studies with etodolac were performed. S- and R-etodolac were converted to the acylglucuronide and hydroxylated metabolites by UDP-glucuronosyltransferase (UGT) and cytochrome P450 in microsomes. However, the stereoselectivities of UGT and P450 for the isomers were opposite. S-etodolac was glucuronidated preferentially than R-etodolac by UGT. In contrast, R-etodolac was hydroxylated preferentially than S-etodolac by P450. 2. Of several human P450 enzymes, CYP2C9 had the greatest activity for hydroxylation of R-etodolac. Sulfaphenazole, an inhibitor of CYP2C9, and anti-CYP2C9 antibody inhibited the hydroxylation of R-etodolac in human liver microsomes. CYP2C9 therefore contributes to the stereoselective hydroxylation of R-etodolac. 3. Of several human UGT enzymes, UGT1A9 had the greatest activity for glucuronidation of S-etodolac. Propofol and thyroxine, inhibitors of UGT1A9, inhibited the glucuronidation of S-etodolac in human liver microsomes. Therefore, UGT1A9 is mainly responsible for the stereoselective glucuronidation of S-etodolac. 4. Because S-etodolac was metabolized more rapidly than R-etodolac in human cryopreserved hepatocytes, the stereoselectivities of UGT1A9 for etodolac substantially influenced the overall metabolism of S- and R-etodolac in man.

The usefulness of 3D MR angiography in surgery for ruptured cerebral aneurysms.

BACKGROUND: We have used magnetic resonance angiography (MRA) in screening for unruptured cerebral aneurysms since 1993. The development of high-resolution magnetic resonance (MR) imaging has led to a remarkable improvement in image quality. Three-dimensional (3D) MRA can be used for surgical simulation. Here, we report on the usefulness of and problems associated with 3D MRA for the surgery of ruptured cerebral aneurysms. METHODS: Between June 1998 and June 2000, 106 patients with SAH diagnosed by 3D MRA underwent surgery. We compared 3D MRA images with operative findings and investigated the usefulness of this assessment tool. RESULTS: In 48 of 106 cases (45.3%), we were able to perform surgery based on 3D MRA alone. By using the 3D images, we could easily detect the relative location of the aneurysm, its neck and the surrounding arteries. The remaining cases required further examinations because of uncertainty of diagnosis or insufficient information. CONCLUSION: 3D MRA is a safe and useful procedure for the diagnosis and surgery of ruptured cerebral aneurysms. However, in approximately half of all cases, 3D computed tomographic angiography (CTA) or digital subtraction angiography (DSA) is required in addition for the planning of surgery. It is important to use 3D MRA for surgery only after taking sufficient consideration of certain limitations peculiar to MRA.

[Fungal infection in patients with serious disease. Risk analysis of fungal infection].

BACKGROUND: Candidemia is still a major source of high morbidity and mortality in severely disease patients. However, the etiology and risk factor is still unknown. PURPOSE: To evaluate the risk factor of fungal infection in intensive care patients. SUBJECTS AND METHOD: 505 patients who stayed in the intensive care unit of the Critical Care Center, Kyorin University more than 10 days between May 1, 1997 to June 31, 1998 were studied. They were divided into 7 groups: 1) trauma (injury severity score<10), 2) burn (burn index<10), 3) cerebro-vascular disease (unconsciousness15), were in a coma, and had severe injury of lung parenchyme with chest AIS 3 or higher. In these serious patients, it is necessary to make a rapid diagnosis and treatment based on the surveillance culture and serological examination of sputum and urine for occult fungal infection.

[Cerebral diplopia and triplopia--a proposal for responsible lesion and mechanism].

We reported 2 cases of multiple images of cerebral origin. Case 1 was a 26-year-old right-handed woman, who showed a defect in the peripheral part of right visual field, with photopsia in the defective field, and cerebral diplopia within the perimetry-determined preserved part of the right hemifield. This was associated with a small infarction in the deep and anterior part of the area 17. The phenomenon was well-illustrated by her own detailed drawing. Case 2 was a 67-year-old right-handed man, who, following a hypoxic accident, developed monocular triplopia. MRI revealed laminar necrosis in the areas 18 and 19 bilaterally. Triplopia was reproducible when he fixed his attention upon the circumscribed afterimage given by a strobo-flash. This would serve as counterevidence against the Bender's hypothesis that this phenomenon was caused by the pseudofovea. In both cases, multiple images occurred only to objects upon which they fixed their gaze, only in the specific sector of the visual field. Both experienced diplopia and triplopia only after a few seconds of fixation. When they turned away the gaze, the extraimages disappeared. We proposed a new hypothesis for this phenomenon, i.e., it is caused by the impaired lateral inhibition, selective to the magnocellular system in the area 17 or other early visual cortices.

[Studies on Hepatocystis sp. in rhesus monkeys from Yunnan, China].

A survey for the prevalence of Hepatocystis sp. was done on 10 rhesus monkeys (M. mulatta) from Yunnan, China. Examinations were performed on blood smears to detect erythrocytic gametocytes of the parasite, and on livers to detect merocysts. In 6 out of 10 monkeys, Hepatocystis sp. infection was confirmed. The gametocytes took about 6 days to reach maturity. The fully grown macrogametocytes were about 8 microns in diameter. The cytoplasm was stained pale lilac and the nucleus consisted of dense chromatin dots lying in an unstained zone. The microgametocytes had cytoplasm dyed a biscuit color and large nuclei dyed pink. In the pathological section of livers, the merocyst measured about 3 mm in diameter and had a smooth outline without any projecting limb. The characteristics of this protozoan species were very similar to those of H. taiwanensis. However, more work should be done to clarify the relationship between this species and H. taiwanensis.

[An analysis of the cellular DNA contents in lung-metastasized stomach cancers].

A study has been conducted of the cellular DNA contents in the primary and metastatic lesions of 30 cases of lung-metastasized stomach cancers, in which each DNA Index (DI) was calculated and analysed comparatively. As a consequence, the rate of the diploid type in the nodular lung metastases was found to be higher than the rate of the others. Further, the DI's of 22 out of 30 (73%) metastatic lymph nodes corresponded with those of the primary lesions. Four lung metastatic lesions out of five differed from their primary lesions, but all five lesions simulated their metastatic lymph nodes. Thus understanding of the properties of the metastatic lymph nodes, rather than their primary lesions, would seen to be helpful in planning the therapy to combat recurrent cancers.

Increased activity on radiocolloid scintigraphy in splenic hamartoma.

A higher uptake of radiocolloid in a splenic tumor than in the rest of the spleen was observed in a 17-year-old boy. The pathologic diagnosis of the surgically resected tumor was hamartoma composed of anomalous mixtures of splenic elements, and radiocolloid was considered to be distributed to reticuloendothelial cells in the tumor. Radiocolloid scintigraphy, which can demonstrate the function of the reticuloendothelial system, is helpful in the diagnosis of splenic hamartoma.

[Application of synthetic hydroxyapatite to periodontal therapy].

The purpose of the present study was to evaluate the effectiveness of granular hydroxyapatite as an alloplastic bone implant material in infrabony periodontal defects. Thirty-five infrabony defects in 28 subjects with marginal periodontitis were used. The patients were instructed in oral hygiene and received several sessions of scaling and root planing. Granular hydroxyapatite was implanted into test sites with infrabony defects following application of internally beveled full thickness flaps, root planing, and defect debridement. Pocket depth and attachment level were recorded before and 3 and 6 months after surgery. Gingival recession, mobility of the tooth, plaque index, and gingival index were also recorded before and 1 and 2 weeks, and 1, 3 and 6 months after surgery. Redness and swelling of the gingiva and increase in tooth mobility appeared transiently after surgery, however, they disappeared in a short time. A significant reduction of mean pocket depth of 3.4 mm and a significant increase in the mean attachment level of 2.5 mm were observed at 6 months after surgery. The mean gingival recession during the experimental period was only 0.9 mm. The amount of hydroxyapatite remaining implanted in the infrabony defect was 73% 6 months after surgery. The data and clinical impression suggest that hydroxyapatite has a potential as an alloplastic implant with clinically apparent acceptance by soft and hard tissue.