Remimazolam anaphylaxis confirmed by serum tryptase elevation and skin test.

Anaphylactic reactions during the induction of general anaesthesia are rare. Anaesthetists should determine the pathogenesis of anaphylaxis in order to establish appropriate treatment and prevent recurrence. Very little clinical information has been published to date about anaphylaxis induced by the recently launched drug remimazolam. A 78-year-old man, scheduled for elective surgery for colon cancer, became profoundly hypotensive and hypoxic shortly following the induction of general anaesthesia with remimazolam, remifentanil and rocuronium. His physiological derangement was successfully managed with adrenaline, vasopressors and intravenous fluid resuscitation. His serum tryptase level was significantly elevated and an intradermal test with diluted remimazolam revealed a positive reaction, confirming the diagnosis of anaphylaxis. We believe this is the first case report of remimazolam-induced anaphylactic shock diagnosed with a serum tryptase elevation and positive skin test.

Online CHDF system: excellent cost-effectiveness for continuous renal replacement therapy with high efficacy and individualization.

We developed an online continuous hemodiafiltration (CHDF) system with a central reverse osmosis (RO) fluid delivery system in 1996. This was improved to a system composed of a single-patient dialysis machine and RO module in 2003. This comprises a water treatment system, an RO module, a dialysis machine with 3 endotoxin retentive filters, 2 additional roller pump units, and a disposable special circuit. Dialysate is produced online by a dialysis machine using RO water and dialysate concentrate, which passes through endotoxin retentive filters and is supplied via the machine in the usual manner. A disposable special circuit and additional two roller pumps independently regulate dialysate flow and substitute flow from 0 to 12 in steps of 0.1 l/h. Seventy-seven patients with acute kidney injury (AKI) were treated with online CHDF from December 1996 to June 2004. Patient outcome was compared with the other modality of continuous renal replacement therapy from July 1992 to June 2004. The survival rates of each modality were 68.3, 65.0, 56.6 and 74.0% for conventional CHDF, high-flow continuous hemodialysis, high-flow CHDF and high-flow/high-volume CHDF (online CHDF), respectively. The survival rate of the high-volume modality (online CHDF) group was significantly higher (p = 0.046) than that of the low volume modality group (61.1%). Increases in efficacy and efficiency are a challenge facing blood purification therapy, and, moreover, individualized prescriptions are crucial in AKI patients in ICU. However, the cost of the dialysate and substitution fluid is a limitation of the therapy. The greatest advantage of the system is that a very high dose of delivered dialysate and substitute does not lead to a proportional rise in the cost. The online CHDF system is currently one of the most feasible solutions.

Inorganic polyphosphate induces osteoblastic differentiation.

Inorganic polyphosphate [Poly(P)] is especially prevalent in osteoblasts. We tested the hypothesis that Poly(P) stimulates osteoblastic differentiation and polyphosphate metabolism for bone formation. The osteoblast-like cell line, MC 3T3-E1, was cultured with Poly(P), and gene expression was evaluated by real-time reverse-transcription polymerase chain-reaction. Phosphatase activity and extracellular matrix mineralization were also determined. The role of Poly(P) was assessed in a beagle dog alveolar bone regeneration model. Poly(P) increased osteocalcin, osterix, bone sialoprotein, and tissue non-specific alkaline phosphatase gene expression, with a high level of end-polyphosphatase activity, resulting in low-chain-length Poly(P), inorganic pyrophosphate, and inorganic phosphate production. MC3T3-E1 cells differentiated into mature osteoblasts and showed expression of ectonucleotide pyrophosphatase phosphodiesterase 1, while mouse progressive ankylosis gene expression remained unchanged. Promotion of alveolar bone regeneration was observed in Poly(P)-treated beagle dogs. These findings suggest that Poly(P) induces osteoblastic differentiation and bone mineralization, and acts as a resource for mineralization.

Measuring tooth mobility with a no-contact vibration device.

BACKGROUND AND OBJECTIVE: Mechanical parameters obtained from the frequency response at tooth vibration informs of various periodontal tissue conditions. An electromagnetic vibration device was investigated for measuring tooth mobility using mechanical parameters obtained from the frequency response characteristics of an experimental tooth model. This electromagnetic vibration device was able to assess the overall condition of periodontal tissue associated with the alteration of each parameter. In this study, reliability and effects of bottom thicknesses of simulated periodontal ligament relative to mechanical parameters were analysed. MATERIAL AND METHODS: Measurement of tooth vibration was performed by an electromagnetic vibration device on experimental tooth models with different bottom thicknesses of simulated periodontal ligament. Using an electromagnetic vibration device, the mechanical parameters resonant frequency, elastic modulus and coefficient of viscosity were calculated from the frequency response characteristics derived from tooth vibration by an electromagnetic force. Variation of those parameters was investigated under four different experimental conditions and the implications of the results were discussed. RESULTS: An electromagnetic vibration device clearly detected three mechanical parameters in all experimental conditions. The resonant frequency and the elastic modulus decreased with increasing bottom thickness. However, no significant difference in the coefficient of viscosity was observed among the experimental conditions. CONCLUSION: Assessment of tooth mobility using mechanical parameters of an electromagnetic vibration device reproduced fine details of various simulated periodontal ligament conditions. Variation in the parameters resonant frequency, elastic modulus and coefficient of viscosity might be useful in evaluating changes of components in periodontal tissues.

Inorganic polyphosphate: a possible stimulant of bone formation.

Inorganic polyphosphates [Poly(P)] are often distributed in osteoblasts. We undertook the present study to verify the hypothesis that Poly(P) stimulates osteoblasts and facilitates bone formation. The osteoblast-like cell line MC 3T3-E1 was cultured with Poly(P), and gene expression and potential mineralization were evaluated by reverse-transcription polymerase chain-reaction. Alkaline phosphatase activity, von Kossa staining, and resorption pit formation analyses were also determined. The potential role of Poly(P) in bone formation was assessed in a rat alveolar bone regeneration model. Poly(P) induced osteopontin, osteocalcin, collagen 1alpha, and osteoprotegerin expression and increased alkaline phosphatase activity in MC 3T3-E1 cells. Dentin slice pit formation decreased with mouse osteoblast and bone marrow macrophage co-cultivation in the presence of Poly(P). Promotion of alveolar bone regeneration was observed locally in Poly(P)-treated rats. These findings suggest that Poly(P) plays a role in osteoblastic differentiation, activation, and bone mineralization. Thus, local poly(P) delivery may have a therapeutic benefit in periodontal disease.

Genetic analysis of HLA, NA and HPA typing in type 2 diabetes and ASO.

We examined the genetic status of human leucocyte antigens (HLA), human platelet alloantigens (HPA) and neutrophil-specific antigens (NA) in patients with type 2 diabetes mellitus and diabetic arteriosclerosis obliterans (ASO). To our knowledge, the present study is the first report showing the relationship among three genetic factors in type 2 diabetes mellitus and ASO patients. HLA typing was performed by the polymerase chain reaction (PCR)-restriction fragment length polymorphism method. HPA-typing and NA-typing were by a PCR-sequence-specific primer method. The incidence of HLA-DRB1*1501 was found to be significant in type 2 diabetes and non-diabetic, particularly ASO-positive patients, compared to control subjects. There were no differences in NA1/NA2 between the control and diabetic or non-diabetic ASO groups. However, the frequency of NA2/NA2 in ASO-positive diabetes and non-diabetic ASO patients was significantly higher than controls. The a/b genotype of HPA-5a/5b was significantly lower in type 2 diabetes and non-diabetic ASO-positive patients than in controls. These findings suggest that genetic studies of HLA, NA and HPA could be useful to understand the pathogenesis of type 2 diabetes and ASO.

Overeruption without root exposure of third molars and periodontal health in the mandible.

Bone formation is seen around the third molar even when the tooth is exposed to the oral environment due to overeruption. To determine if overeruption of the third molar with or without root exposure is related to the status of the exposure of other teeth in the mandible, using orthopantomographs, 424 third molars were studied in 371 patients who were over 41 years of age. The rate of overeruption and root exposure in third molars was measured, and its relationship to the number of teeth lost and the rate of root exposure in other teeth in the mandible was analyzed. Tooth loss in the group of third molars with overeruption without root exposure was greater than in that without overeruption or root exposure in men, whereas the relationship was not seen in women. We found that root exposures of other teeth in the group of third molars with overeruption without root exposure were significantly smaller than in those with root exposure in both genders. Third molars with overeruption without root exposure, in which bone formation was easy to observe for radiographic diagnosis, were correlated with periodontal health in the mandible, suggesting a component of precision determination for predicting resistance to periodontitis.

Induction of calcification in MC3T3-E1 cells by inorganic polyphosphate.

Relatively large amounts of inorganic polyphosphate [poly(P)] (400 microM) have been found in normal osteoblasts. The effect of poly(P) with an average chain length of 65 phosphate residues on cell calcification was therefore investigated with the use of MC3T3-E1 cells. Expression of both osteopontin and osteocalcin was induced by poly(P) (0.1 approximately 1 mM), and cells treated with poly(P) were strongly stained by alizarin red. In addition, the level of alkaline phosphatase activity induced in poly(P)-treated cells was two-fold higher than that in either orthophosphate-treated or control cells but not higher than that in cells treated with beta-glycerophosphate and ascorbic acid. In contrast, however, polyphosphatase activities were activated by poly(P) treatment to levels up to six-fold greater than that in controls. MC3T3-E1 cells may utilize poly(P) as a phosphate source for calcification rather than phosphate sources that are mainly produced by ALPase. Poly(P)-dependent induction of polyphosphatase activities may therefore promote calcification in MC3T3-E1 cells.

Rapid estimation of lipids in oleaginous fungi and yeasts using Nile red fluorescence.

A rapid estimation method of the intracellular lipid content in microorganisms using a fluorescent probe, Nile red, was established by optimization of the Nile red staining and data processing. The protocol was designed to be applicable to a wide range of microorganisms and culture conditions. In the optimized procedure, cells diluted with buffer were stained with 0.24-0.47 microg/ml of Nile red for 5 min, and the fluorescent emission spectra in the wavelength region of 400 to 700 nm excited at 488 nm were acquired before and after the Nile red addition. The fluorescence intensity corresponding to the intracellular lipid amount was determined at the peak of the corrected spectrum. The value showed a linear relation with the lipid content of various oleaginous fungi and yeasts measured by the conventional method. The relative intensities against the unit lipid amounts were almost similar except for one yeast. For the application to mycelia forming various types of pellets, a simple and easy pretreatment of shaking with glass beads for 5-10 min was added to the protocol. The established method was applicable to estimate the lipid content of a wide range of microorganism cultures containing 2-5000 microg-lipid/ml-broth.

Relationship of the hyoid bone and posterior surface of the tongue in prognathism and micrognathia.

In order to study relationship of the hyoid bone and posterior surface of the tongue in prognathism and micrognathia, we focused on the effect of the tongue on the upper airway lumen in 16 patients with Angle's Class II and 51 patients with Angle's Class III, and assessed the position of the hyoid, the depth from the posterior surface of the tongue, from the bottom of the vallecula and from hyoid bone to the posterior pharyngeal wall using lateral cephalograms. We were able to assess significant correlations between the posterior surface of the tongue and hyoid position in Angle's Class III. However, we found no association between them in Angle's Class II. This could be an adaptive feature of the genioglossus in response to hyoid localization to serve a compensatory role to prevent respiratory impairment in micrognathia at risk of apnoea.

Production of long-chain polyunsaturated fatty acids by monoxenic growth of labyrinthulids on oil-dispersed agar medium.

A novel method is proposed for the production of long-chain polyunsaturated fatty acids (LCPUFA) by labyrinthulids. The method comprises a monoxenic culture with Psychlobacter phenylpyruvicus, using agar medium in which oil was dispersed. Soybean oil (SBO) was selected as the optimum material for an oil-dispersed agar medium. The labyrinthulids showed three-dimensional growth and an anastomosing ectoplasmic network in the SBO-dispersed agar medium. The oil plate changed from an opaque culture to a more transparent culture, due to growth of the labyrinthulids. The optimum culture conditions were 25-30 degrees C, an initial pH of 6-10 and artificial seawater with a salt concentration of 50-100%. These conditions are close to those where these strains were isolated. The maximum LCPUFA production (0.59 g/l) and dry cell weight (4.93 g/l) was obtained using strain S3-2 (isolated from Ishigaki Island) with 1.5% SBO at 14 days. This value was about 30 times more than that using glucose instead of SBO. The method proposed is promising in terms of the production of LCPUFA from reproducible oils.

Hypertension and impairment of endothelium-dependent relaxation of arteries from spontaneously hypertensive and L-NAME-treated Wistar rats.

Effects of chronic treatment of normotensive Wistar rats with N(omega)-nitro-L-arginine methyl ester (L-NAME) on blood pressure and on endothelium-dependent relaxation of the aorta, carotid and iliac arteries were studied. The endothelium-dependent relaxation was compared in arteries from normotensive Wistar Kyoto rats (WKY) and genetically hypertensive rats (stroke-prone spontaneously hypertensive rats, SHRSP). Chronic treatment of normotensive Wistar rats with L-NAME caused an elevation of blood pressure. The elevated blood pressure at 15 weeks of age was significantly higher in these animals than that of untreated Wistar rats, but lower than that of SHRSP. Endothelium-dependent relaxation of the arteries induced by acetylcholine (ACh) was almost abolished by chronic treatment with L-NAME. The remaining small relaxation in arteries from L-NAME-treated rats was completely inhibited by application of L-NAME (10(-4) M). In such preparations, higher concentrations of ACh induced a contraction, which was abolished by removal of the endothelium or by an application of indomethacin (10(-5) M). Endothelium-independent relaxation induced by sodium nitroprusside was similar between preparations from untreated and L-NAME-treated Wistar rats. Endothelium-dependent relaxation was significantly impaired in preparations from SHRSP, when compared with that in those from WKY. However, the impairment was less prominent in preparations from SHRSP than in those from L-NAME-treated rats. These results suggest that the impairment of endothelium-dependent relaxation in the arteries from L-NAME-treated rats is not due to the elevated blood pressure resulting from the chronic treatment, and that impairment of NO synthesis by the endothelium does not play a major role in the initiation of hypertension in SHRSP.

Three-dimensional STEM for observing nanostructures.

A new scanning transmission electron microscope has been developed for three-dimensional (3D) observations of nanostructures. Using double spherical fulcra, accurate eucentric rotation was achieved. Cylindrical specimens for 3D-observation were prepared by a microsampling technique using a focused ion beam. Copper via-holes of a semiconductor memory device and ZnO particles were observed by the 3D-STEM from different directions, and 3D-data of the ZnO particles were successfully reconstructed in a topography mode.

Mice with only rat mtDNA are required as models of mitochondrial diseases.

We examined the possibility of generation of mice expressing mitochondrial dysfunction by introduction of exogenous mtDNA from different species using mouse mtDNA-less (rho(0)) cells as mtDNA recipients. For determination of how genetically distant species of mtDNA could replicate in cells with only the mouse nuclear genome, we introduced mtDNA of the Syrian hamster (Mesocricetus auratus) into mouse rho(0) cells, and found that its replication was not sufficient to propagate to following generations, probably due to significant incompatibility between mouse-nuclear and Syrian hamster-mitochondrial genomes. On the other hand, rat mtDNA, which propagated stably and expressed mitochondrial dysfunction in mouse cells, also disappeared rapidly by exogenous introduction of mouse mtDNA, suggesting that mouse mtDNA in mouse cells must be excluded completely before introduction of rat mtDNA for generation of mice with rat mtDNA as mitochondrial disease models.

Alteration of the angle of the coronoid process in prognathism.

Muscles and bones may dynamically affect the functions of each other, resulting in changes in the activity of the muscle and/or morphological change in the bones. However, alterations of the morphology of the coronoid process have not been documented in relation to the temporal muscle between the mandible and the cranium. Angles of the coronoid process to the line through the right and the left frontotemporale were measured on posteroanterior (PA) cephalograms in patients with normal occlusions and Class II, division 1 malocclusions, and those with true skeletal Class III malocclusions. Standard deviation of the angle of the coronoid process in patients with Class III malocclusions was greater than those subjects with normal occlusion or Class II, division 1 malocclusions. Differences of angles between the right and the left coronoid process in each patient of either sex were significantly large in true skeletal Class III malocclusions (both P < 0.001). Large variation of angle of the coronoid process was related to prognathism, and this effect may represent adaptation of temporal muscle function to a variety of alterations in mandibular morphology.

P-glycoprotein expression in human major and minor salivary glands.

Sodium pump and carbonic anhydrase activity have been described in the salivary glands. However, it remains to be elucidated whether these energy sources are used for secretion, excretion or both. In addition, the differences in the function of excretion and the role of the excretory duct cells are currently unknown in salivary glands. Expression of P-glycoprotein (P-gp), which is an ATPase-binding efflux pump, was tested in normal major and minor salivary glands from humans. P-gp was distributed on the basolateral membrane of serous acinar cells in the major salivary glands and the minor salivary glands. In particular, it was found to be present on the basolateral membrane and cytoplasm of acinar demilunar cells in the anterior lingual gland. Intense expression was identified in the basolateral membrane of the striated duct cells of the major salivary glands. P-gp was distinctly positive in the basolateral and/or luminal membranes of the initial part and in the luminal membrane of the terminal part of the excretory duct cells of the major salivary glands, whereas it was positive in the luminal membranes of both the initial part and the terminal part of the excretory duct cells of the minor salivary glands. These disparate distributions between the major and the minor salivary glands suggest different physiological excretions in the striated duct. P-gp may be physiologically involved in an important part of the transporter system, not only in the acinar serous cells and the striated duct cells, but also in the excretory duct cells in the salivary glands.

Multidrug resistance gene 1 expression in salivary gland adenocarcinomas and oral squamous-cell carcinomas.

In combined chemotherapy for head-and-neck cancer (HNC), salivary gland-cell adenocarcinoma (SGA) shows insufficient clinical outcome, and it has been suggested that the sensitivity and/or the mechanism of resistance to anti-cancer drugs are different between SGA and oral squamous-cell carcinoma (SCC). The aim of our study was to clarify whether P-glycoprotein (P-gp) expression is associated with multidrug resistance (MDR) in HNC and the difference in the process of its development between SGA and SCC. In immunohistochemical analysis, P-gp expression was found in the ductal cells of salivary glands but not in oral mucosal epithelium. In cancer tissues, a few SCC cells in 12 of 37 and most cells in all SGAs expressed P-gp. The intensive P-gp expression was significantly found in SGA compared with SCC. In an in vivo chemotherapeutic model using tumor-bearing nude mice, P-gp expression in counterparts was observed in only a few cells of the HSY line, while no P-gp expression was observed in Hepd cells. However, P-gp expression was developed in both HSY and Hepd cell lines after vincristine (VCR) treatment. RT-PCR showed that the mean ratios of mdr1 mRNA expression levels in HSY clones were 3.7-fold higher than those in Hepd clones after VCR treatment, while each cell line exhibited both induction and activated production of P-gp. These results suggest that P-gp-related MDR in SGA is an inherent phenotype caused by both high levels of P-gp induction and activated P-gp production during VCR treatment, while that in SCC is an acquired phenotype chiefly caused by induction of P-gp.

Relationship of third molar development and root angulation.

Angled roots are seen in mandibular third molars, which have a high frequency of incomplete impaction. We examined the relationship between incomplete impaction and angled roots. We enrolled orthopantomographs to determine the prevalence of angled roots in 239 men and 222 women aged 21--35 years with bilateral mandibular third molars. Angled roots were more frequent in subjects in whom the third molars had a different status on each side than in those with the same status on both sides (men: P<0.05; women: P<0.01). The incidence of women with angled roots in those with bilateral incomplete impactions was higher than that in those with bilateral eruption (P<0.01). Angled roots among mandibular third molars are related to environmental factors. Angled roots occur more frequently in women with incomplete impaction than in those with full eruption.

T-cell responses to mitogens in atomic bomb survivors: a decreased capacity to produce interleukin 2 characterizes the T cells of heavily irradiated individuals.

Significant decreases in the fraction of lymphocytes that are CD4(+) and increases in serum levels of some classes of immunoglobulin have been reported to occur in atomic bomb (A-bomb) survivors and in victims of the Chernobyl nuclear plant accident. To investigate the long-term effects of nuclear radiation on cellular immunity in more detail, we used limiting dilution assays with peripheral blood mononuclear cell preparations to analyze the T-cell responses of 251 A-bomb survivors exposed to less than 0.005 Gy and 159 survivors exposed to more than 1.5 Gy. The percentages of CD2-positive cells that were capable of proliferating in response to phytohemagglutinin (PHA) in the presence of exogenous interleukin 2 (IL2) did not differ substantially between distally exposed and more heavily exposed survivors. The heavily exposed survivors appeared to possess fewer T cells that were capable of proliferating in response to concanavalin A (Con A) or of producing interleukin 2. Assuming that CD4 T cells were the ones primarily responsible for producing IL2 in response to Con A, we were able to estimate how many cells in any given CD4 T-cell population were actually producing IL2. The results indicated that peripheral blood samples from heavily exposed survivors contained significantly fewer IL2-producing CD4 T cells than did similar samples from distally exposed survivors, indicating that significant exposure to A-bomb radiation may have a long-lasting negative effect on the capacity of CD4 T-cell populations to produce IL2.