Microbial fucoidan degradation by Luteolibacter algae H18 with deacetylation.

A bacterial strain that assimilates fucoidan from Cladosiphon okamuranus as sole carbon source was isolated as Luteolibacter algae H-18. It was found that it degraded fucoidan by intracellular enzymes, and that the degradation reactions were catalyzed by multiple enzymes. One enzyme, designated fraction B, was established to exhibit the deacetylation reaction of fucoidan. Other enzyme(s), designated fraction A, catalyzed the reaction(s) lowering the molecular weight of fucoidan.

Effect of fucoidan extracted from mozuku on experimental cartilaginous tissue injury.

We investigated the effect of fucoidan, a sulfated polysaccharide, on acceleration of healing of experimental cartilage injury in a rabbit model. An injured cartilage model was surgically created by introduction of three holes, one in the articular cartilage of the medial trochlea and two in the trochlear sulcus of the distal femur. Rabbits in three experimental groups (F groups) were orally administered fucoidan of seven different molecular weights (8, 50, 146, 239, 330, 400, or 1000 kD) for 3 weeks by screening. Control (C group) rabbits were provided water ad libitum. After the experimental period, macroscopic examination showed that the degree of filling in the fucoidan group was higher than that in the C group. Histologically, the holes were filled by collagen fiber and fibroblasts in the C group, and by chondroblasts and fibroblasts in the F groups. Image analysis of Alcian blue- and safranin O-stained F-group specimens showed increased production of glycosaminoglycans (GAGs) and proteoglycans (PGs), respectively. Some injured holes were well repaired both macroscopically and microscopically and were filled with cartilage tissues; cartilage matrices such as PGs and GAGs were produced in groups F 50, F 146, and F 239. Thus, fucoidan administration enhanced morphologically healing of cartilage injury.

Effects of oral administration of fucoidan extracted from Cladosiphon okamuranus on tumor growth and survival time in a tumor-bearing mouse model.

We evaluated the anti-tumor activities of the oral administration of fucoidan extracted from Cladosiphon okamuranus using a tumor (colon 26)-bearing mouse model. The materials used included low-molecular-weight fucoidan (LMWF: 6.5-40 kDa), intermediate-molecular-weight fucoidan (IMWF: 110-138 kDa) and high-molecular-weight fucoidan (HMWF: 300-330 kDa). The IMWF group showed significantly suppressed tumor growth. The LMWF and HMWF groups showed significantly increased survival times compared with that observed in the control group (mice fed a fucoidan-free diet). The median survival times in the control, LMWF, IMWF and HMWF groups were 23, 46, 40 and 43 days, respectively. It was also found that oral administration of fucoidan increased the population of natural killer cells in the spleen. Furthermore, from the results of the experiment using Myd-88 knockout mice, it was found that these effects are related to gut immunity. These results suggest that fucoidan is a candidate anti-tumor functional food.

Morphological Analysis of the Sylvian Fissure Stem to Guide a Safe Trans-sylvian Fissure Approach.

The sylvian fissure stem and its deep cisternal part (SDCP) consist mainly of the orbital gyrus (OG) and anterior medial portion of the temporal lobe. SDCP's adhesion has been found to make a trans-sylvian approach difficult due to the various patterns of adhesion. Thus, in this study, we aim to clarify the morphological features of the SDCP, and to guide a safe trans-sylvian approach. We retrospectively classified the morphology of the SDCP in 81 patients into 3 types (tight, moderate, loose type) according to the degree of adhesion of the arachnoid membrane and analyzed the morphological features of the OG and the temporal lobe using intraoperative video images. In addition, we have retrospectively measured each width of the SDCP's subarachnoid space at the three points (Point A, lateral superior portion; Point B, downward portion; Point C, medial inferior portion of SDCP) and analyzed their relationship to the degree of adhesion using the preoperative coronal three-dimensional computed tomography angiography (3D-CTA) images of 44 patients. As per the results, SDCP's adhesions were determined to be significantly tighter in cases with large OG and young cases. The temporal lobe had four surfaces (posterior, middle, anterior, and medial) that adhered to the OG in various patterns. The tighter the adhesion between the OG and each of the three distal surfaces of the temporal lobe, the narrower the width of the subarachnoid space at each point (A, B, C). Understanding of the morphological features of the SDCP, and estimating its adhesion preoperatively are useful in developing a surgical strategy and obtaining correct intraoperative orientation in the trans-sylvian approach.

Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein.

The superficial middle cerebral vein (SMCV) is one of the main factors that can impede a wide opening of the sylvian fissure. To reveal the most efficient SMCV dissection for a wide operative field while preserving the veins in the trans-sylvian approach, we retrospectively investigated the SMCVs through intraoperative video images. We characterized the SMCV as composed of the frontosylvian trunk (FST; receiving frontosylvian veins [FSVs] or parietosylvian veins [PSVs]), the temporosylvian trunk (TST; receiving temporosylvian veins [TSVs]), and the superficial middle cerebral common trunk (SMCCT; receiving both FSV/PSV and TSV), and classified the SMCVs of the 116 patients into 5 types based on the morphological classification of the SMCV. Type A SMCV (60.4%) with the SMCCT anastomosed to the frontal side had few bridging veins (BVs) between the SMCCT and the temporal side during dissection. Type B (7.8%) had the SMCCT with no anastomoses to the frontal side. In Type C (17.2%) consisting of the FST and TST and Type D (12.9%) with a merging of the vein of Trolard and Labbé posteriorly and the SMCVs dividing into the FST and the TST again proximally, there were few BVs between the FST and the TST during dissection. Finally, in Type E (1.7%) showing an undeveloped SMCV, there were no BVs between the frontal and the temporal lobes. Postoperative venous infarction occurred in 2.6%. Morphological classification of the SMCV can inform appropriate dissection line to create a wide operative field while preserving the veins in the trans-sylvian approach.

Isolation and characterization of a novel fucoidan-degrading microorganism.

A bacterium utilizing fucoidan from the brown alga Cladosiphon okamuranus as sole carbon source was isolated and identified as Flavobacterium sp. F-31. The strain produced intracellular enzymes involved in fucoidan degradation and desulfation, but desulfation activity was not detected until the molecular weight of fucoidan fell to less than several tens of thousands due to enzymatic degradation. Only fucoidan proved to be an inducible substance for the production of the degrading enzymes.

[Evaluation of the diaphragm in patients with COPD (emphysema dominant type) by abdominal ultrasonography].

UNLABELLED: The aim of this study was to clarify whether the diaphragm in patients with COPD (emphysema dominant type) can be evaluated by abdominal ultrasonography. We therefore established a method for diaphragm scanning: The dome of the right hemidiaphragm was detected by epigastric right oblique scan passing through the right edge of the inferior vena cava and the zone of apposition. Diaphragmatic flattening, correlation between the flattening and %FEV1.0, diaphragmatic motion, and the inspiratory time cycle were also measured. We studied 14 patients with COPD (emphysema dominant type) and 12 healthy control subjects. RESULTS: (i) Diaphragmatic flattening was recognized in patients with COPD and the radius of the right hemidiaphragmatic curvature (index of diaphragmatic flattening) correlated with %FEV1.0. (ii) Motion of the anterior diaphragm was poor in patients with COPD. (iii) Expiration time was prolonged in patients with COPD. CONCLUSION: Flattening and motion of the diaphragm, as well as the prolonged expiratory time were possible to evaluate by abdominal ultrasonography. Diaphragmatic flattening reflects %FEV1.0. Based on these observations we believe that abdominal ultrasonography may be useful to avoid underdiagnosis of COPD.

Cloning and sequencing analysis of alginate lyase genes from the marine bacterium Vibrio sp. O2.

We isolated a new marine bacteria, which displayed alginate-depolymerizing activity in plate assays, from seawater in Mihonoseki Harbor, Japan. Analysis of the 16S ribosomal RNA gene sequence of one of the isolates proved that this alginate-depolymerizing bacterium belonged to the genus Vibrio and it was named Vibrio sp. O2. The alginate lyase genes of Vibrio sp. O2 were cloned and expressed in Escherichia coli. Two alginate lyase-producing clones, pVOA-A4 and pVOA-B5, were obtained. The alginate lyase gene alyVOA from pVOA-A4 was composed of an 858-bp open reading frame (ORF) encoding 285 amino acid residues, while alyVOB from pVOA-B5 was composed of an 828-bp ORF encoding 275 amino acid residues. The degree of identity between the deduced amino acid sequences of AlyVOA or AlyVOB and Photobacterium sp. ATCC43367 alginate poly(ManA)lyase AlxM was 92.3% or 32.6%, respectively. Alginate lyase consensus regions corresponding to the sequences YFKAGXYXQ and RXELR were observed in all three of these sequences. AlyVOA and AlyVOB both degraded polymannuronate in plate assays and were therefore confirmed to be poly(beta-D-mannuronate)lyases.

[New monitoring test for sleep apnea syndrome].

We introduce change in pulse transit time (change in PTT: noninvasive intrathoracic pressure monitoring) as a new monitoring test of sleep apnea syndrome, which is being developed for clinical application. In addition, we report the kinetics of cardiogenic oscillation (CGO: noninvasive upper airway obstruction monitoring), which was published in this journal in 2003, and the response of the upper airway in clinical practice (under an endoscope). We also review diaphragmatic movement by abdominal echography (respiration generator monitoring).

Large carboxy-terminal parathyroid hormone (PTH) fragment with a relatively longer half-life than 1-84 PTH is secreted directly from the parathyroid gland in humans.

OBJECTIVE: It was discovered that an immunoreactive large carboxy-terminal parathyroid hormone (PTH) fragment (large C-PTH), likely 7-84 PTH, is present in the circulation. However, very little is known about the production and metabolism of this large C-PTH. Combining a whole molecule PTH (whole PTH) immunoradiometric assay (IRMA) specifically for 1-84 PTH and an intact PTH (iPTH) IRMA for the sum of 1-84 PTH and large C-PTH, we were able to assess the circulating level of this large C-PTH as well as the glandular secretion and metabolism of this large C-PTH in primary hyperparathyroidism (pHPT). METHODS: This study consisted of two patient groups consisting of 77 pHPT patients with a single adenoma. Of these, 43 comprised the venous sampling study group and 70 comprised the intra-operative PTH study group. (Seven patients belonged only to the former group, 34 patients to only the latter group, and 36 patients to both groups.) Preoperatively, blood samples were drawn from the bilateral internal jugular vein by ultrasonographic guidance and from the peripheral vein (n=43). During surgery, blood samples were drawn after anesthesia (basal level), before excision (pre-excision level) of one enlarged parathyroid gland, and at 5, 10, and 15 min post-excision (n=70). RESULTS: There were 26 patients whose iPTH assay levels differed by more than 10% between the right and left internal jugular. In 24 of the 26 patients, the large C-PTH levels obtained from the adenoma side were significantly higher than those from the contralateral side (117+/-135 vs 43+/-33 pg/ml, P<0.001). The plasma whole PTH values decreased more rapidly than the iPTH values after parathyroidectomy (P<0.001). CONCLUSIONS: Our study has demonstrated that the large C-PTH, likely 7-84 PTH, is directly released from the parathyroid gland in humans. Since the half-life of 1-84 PTH is much shorter than large C-PTH, likely 7-84 PTH, it would be advantageous to use an assay that specifically measures 1-84 PTH for intra-operative monitoring of parathyroidectomy.

Comparison of parathyroid hormone levels from the intact and whole parathyroid hormone assays after parathyroidectomy for primary and secondary hyperparathyroidism.

BACKGROUND: Most commercial intact parathyroid hormone (intact PTH) assays cross-react with non-(1-84) PTH (likely 7-84 PTH). Using a whole-molecule PTH (whole PTH) assay that specifically measured only 1-84 PTH, we compared the kinetics of whole PTH and intact PTH after parathyroidectomy in patients with primary hyperparathyroidism (HPT) and secondary HPT. METHODS: This study comprised 74 patients with primary HPT caused by a single adenoma and 18 patients with secondary HPT who underwent parathyroidectomy. Blood samples were drawn after anesthesia, just before excision of a single adenoma in primary HPT, and just before excision of the last parathyroid gland in secondary HPT, and at 5, 10, and 15 minutes after excision. The 7-84 PTH level was calculated by subtracting the whole PTH value from the intact PTH value. RESULTS: There was a difference between the percentage of 7-84 PTH/intact PTH in plasma samples from patients with primary HPT and secondary HPT (28%+/-12% vs 35%+/-9%; P<.05). Plasma whole PTH decreased more rapidly than intact PTH after parathyroidectomy in patients in both the primary HPT (P<.0001) and secondary HPT groups (P<.0001). Decline of intact PTH was slower in patients with secondary HPT than in patients with primary HPT; however, there was no significant difference in the decline of whole PTH between the 2 groups. CONCLUSIONS: The quick intact PTH assay is not used frequently during surgery in patients with secondary HPT; however, our results suggest that a quick whole PTH assay may be a more useful adjunct to parathyroidectomy in both secondary HPT and primary HPT.

Acute surgery for ruptured dissecting aneurysm of the M3 portion of the middle cerebral artery.

A 65-year-old woman presented with a ruptured dissecting aneurysm of the M3 portion of the middle cerebral artery (MCA) manifesting as disturbance of consciousness and motor aphasia. Computed tomography revealed subarachnoid hemorrhage. Emergent angiography demonstrated segmental aneurysmal dilatation of the M3 portion of the left MCA. Infectious aneurysm was excluded. Surgery was performed to prevent repeated hemorrhage from the aneurysm. The lesion was excised and flow to the distal MCA was preserved with an anastomosis of the superficial temporal artery to the MCA. Histological examination confirmed that the aneurysmal dilatation was due to arterial dissection caused by disruption of the internal elastic lamina. Distal dissecting aneurysm may occur in the absence of infectious disease. Such ruptured distal dissecting aneurysm should preferably be treated surgically in the acute stage, immediately after detection of the aneurysm. The parent artery of the proximal and distal sides of the aneurysm should be trapped because of the probable weakness of the arterial wall, and bypass surgery performed to preserve the distal circulation.

Anterior cerebral artery dissections manifesting as cerebral hemorrhage and infarction, and presenting as dynamic angiographical changes--case report.

A 65-year-old woman presented with multiple dissecting aneurysms of the anterior cerebral artery (ACA) manifesting as hemiparesis on the right with dominance in the lower extremity. Computed tomography revealed hematoma in the left frontal lobe, corresponding to the area perfused by the callosomarginal artery. Initial angiography showed string sign and occlusion in the distal portion of the left callosomarginal artery and abnormal feeding suggesting double lumen of the A2 portion of the left ACA. The patient was treated conservatively under a diagnosis of multiple spontaneous dissecting aneurysms of the left ACA. Repeat angiography on Day 8 showed improvement of the string sign and occlusion in the left callosomarginal artery, and change of the double lumen of the A2 portion into string sign. Further angiography on Day 36 showed normalization of the left callosomarginal artery and improvement of the string sign in the A2 portion. Multiple spontaneous dissecting aneurysms of the ACA are extremely rare. Serial angiography beginning in the early stage will be important for correct diagnosis.

Subsequent rupture after clip on wrap method for ruptured dissecting aneurysm of the distal middle cerebral artery: a case report and review of the literature.

Dissecting aneurysms rarely occur in the middle cerebral artery (MCA). Furthermore, recurrent subarachnoid hemorrhage from ruptured dissecting aneurysms is rare with no published report of subsequent rupture after treatment by the clip on wrap method. The case reported is a 41-year-old man with subarachnoid hemorrhage. Angiography demonstrated aneurysm at the right M2 portion. We performed surgery to prevent rebleeding during the acute stage. Surgery revealed a discolored protrusion of the arterial wall of the lesion. The lesion was clipped on wrapping with Bemsheet. At one month postoperatively, angiography showed neither aneurysmal formation nor stenosis at the right M2, but after 5 months a subsequent rupture occurred. Angiography demonstrated pseudoaneurysm formation at the same portion of the right M2. The lesion was trapped with anastomosis of the superficial temporal artery (STA) to the MCA. He was discharged following a good recovery. The rate of subsequent rupture in ruptured dissecting aneurysm in the MCA is 14.3% in published papers. Acute surgery must be performed to prevent the risk of re-rupture. In our single case report, trapping was effective treatment.

[Intracavernous iatrogenic aneurysm causing subarachnoid hemorrhage after removal of intracranial tumor, treated by coil embolizatioin].

We describe a rare case of subarachnoid hemorrhage due to a ruputured iatrogenic traumatic aneurysm in the cavernous carotid artery, caused by injury during surgery for skull base meningioma that was performed 2 years ago. A 64-year-old woman underwent craniotomy for resection of meningioma of the right sphenoid ridge. During surgery, venous bleeding from the cavernous sinus was easily controlled by packing. Tumor infiltration into the artery had not occurred, and total resection was successfully performed. Two years later, the patient was admitted to our hospital for subarachnoid hemorrhage, without clinical signs of carotid cavernous fistula. Angiography displayed an aneurysm in the cavernous portion of the right carotid artery, which had not been detected on a previous angiogram. The aneurysm was successfully embolized with a GDC via an endovascular approach. Three months later, the residual aneurysm became enlarged and aneurysmal embolization was performed for a second time. Follow-up angiography was performed 7 months after initial embolization, and revealed complete packing.

[Usefulness of diffusion-weighted magnetic resonance imaging in diagnosis and therapeutic strategy of deep cerebral venous thrombosis: a case report].

We present the usefulness of Diffusion-weighted magnetic resonance images (DWI) in diagnosis and therapeutic strategy of deep cerebral venous thrombosis (VT). We report a 37-year-old man who suffered general convulsion and deep coma. Magnetic resonance imaging (MRI) showed high intensity in the right caudate nuclei and bilateral thalamus on T2-weighted images. DWI showed slightly high intensity in the same area and apparent diffusion coefficient (ADC) is normal or slightly high (0.748-1.100 x 10(-3) mm2/s). Cerebral angiography showed occlusion of straight sinus from basal veins and internal cerebral veins bilaterally. We treated by anticoagulation, ventricle drainage, barubiturate and normothermia therapy with intracranial pressure (ICP) monitoring. We considered endovascular thrombolysis to be dangerous in this case because of hemorrhage and didn't it. ICP was more than 40 mmHg and consciousness was comatose in acute stage, however, ICP gradually got to be normal, consciousness became almost clear and he recovered. Follow-up Cerebral angiography showed recanalization of deep venous thrombosis. Follow-up MRI showed disappearance of high intensity in the right caudate nuclei and bilateral thalamus on T2-weighted images and DWI. In this case, we could predict reversible vasogenic edema by DWI and ADC in VT.

[A case with surgical repair for delayed occult cerebrospinal fluid rhinorrhea presented as meningitis fourteen years after blunt head trauma].

We describe a case of a 34-year-old woman in whom delayed occult cerebrospinal fluid rhinorrhea presented as meningitis. Removal of an implanted shunt system and surgical repair of the fistula were required. The cerebrospinal fluid fistula was located in the left frontoethmoidal region. Fourteen years previously, the patient had been treated successfully for injury to the left internal carotid artery in a motor vehicle collision, by clipping and by implantation of ventriculoperitoneal and subduralperitoneal shunts to reverse the associated hydrocephalus. To prevent the spread of intracranial infection, we immediately removed the implanted shunt system and followed this by placement of lumbar drainage. After complete resolution of meningitis in response to antimicrobial agents, we performed surgical repair of the fistula. Shunt reconstruction was not required. The patient was discharged with good performance status. This case illustrates the point that effective treatment of meningitis is greatly facilitated by timely removal of associated foreign material.

[A case of Rathke's cleft cyst in association with a ruptured aneurysm of the anterior cerebral artery mimicking pituitary apoplexy].

We present a rare case of a Rathke's cleft cyst in association with a ruptured aneurysm of the anterior cerebral artery (ACA). A 44-year-old man suffered from sudden onset of headache. Initial computed tomographic (CT) scan revealed a high-density mass lesion in the suprasellar region and a diffuse high-density area in the basal cistern. Using emergent magnetic resonance imaging (MRI), we found a cyst showed homogeneously high and iso-intensity on T1 and T2-weighted image, respectively. The cyst showed no enhancement of the cyst wall, but on Gd-DTPA, it was shown to compress the normal pituitary gland. Angiography showed an aneurysm at the A1 portion of the left ACA. Based on/these findings, we were able to diagnose Rathke's cleft cyst and a ruptured aneurysm. An operation was performed through the interhemispheric approach. The suprasellar cystic mass compressed the optic nerves and chiasm upward. Neck clipping of the aneurysm and opening of the cyst were performed. We confirmed the cause of the subarachnoid hemorrhage as being a ruptured aneurysm at the A1 portion of the left ACA. Histological diagnosis was Rathke's cleft cyst. Postoperative course was uneventful. There has been only one reported case of Rathke's cleft cyst in association with a ruptured aneurysm. When we encounter a case presenting subarachnoid hemorrhage with suprasellar mass and intracerebral aneurysm, we must discriminate between ruptured aneurysm and pituitary apoplexy in the acute stage as the cause of the subarachnoid hemorrhage. If the mass is Rathke's cleft cyst, we speculate that the cause of the subarachnoid hemorrhage is a ruptured aneurysm, because there are no reports of Rathke's cleft cyst with subarachnoid hemorrhage.

[Effort-independent pulmonary function tests].

Many pulmonary function tests require forced expiration, and the precision of the tests depends on the effort of the subjects. In elderly people, the reproducibility of test results may be inadequate because of insufficiency of the subjects' effort, and the diagnosis of COPD, which is frequently observed in elderly people, is often difficult. To improve the accuracy of the diagnosis, pulmonary function tests that do not require effort are needed. In this study, effortless pulmonary function tests (examinations of the cardiogenic oscillation, negative expiratory pressure, exhaled temperature, and exhaled breath condensate), the application of which to various respiratory disorders (i.e., sleep apnea syndrome, COPD, bronchial asthma) is attempted, are presented.

[Pulmonary function tests].

The spirometry has been most valuable pulmonary function test and it defines pulmonary physiology. But the spirometry has not been widely used by general physicians in Japan. The spirometry is effort-dependent test, so, they seem to keep it at a distance. It's desirable that pulmonary function tests are effort-independent. We introduce some effort-independent pulmonary function tests and refer to analysis of exhaled breath condensate.