Traditional Chinese medicine Jia Wei Gui Pi Tang improves behavioural and psychological symptoms of dementia and favourable positive emotions in patients.

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) are challenging to manage, leading to caregiver burden and often to subsequent transfer of patients to a nursing home or psychiatric hospital for treatment. Eliciting favourable positive emotions should be an important goal in the treatment of negative emotions associated with BPSD. To date, no data have indicated that antipsychotic medications can improve positive emotions. BPSD are known to be associated with anxiety in patients with dementia. The traditional Chinese medicine Jia Wei Gui Pi Tang is officially indicated and approved for anxiety treatment in Japan. METHODS: Here, we performed a multicentre, randomised, observer-blind control study of the effect of Jia Wei Gui Pi Tang on BPSD in Alzheimer's disease (AD) patients. Patients with AD or AD with cerebral vascular disease were randomly divided into the Jia Wei Gui Pi Tang treatment group and the control group that received no traditional Chinese medicine. BPSD were scored using the Neuropsychiatric Inventory Nursing Home Version (NPI-NH) and by favourable positive emotions using the Delightful Emotional Index (DEI). RESULTS: A total of 63 participants (18 male and 45 female; mean age: 83.3 ± 6.0 years) were included in the study. Changes in NPI-NH scores differed significantly between the two groups (one-way analysis of variance, P < 0.001). Within the treatment group, there was a significant improvement in the NPI-NH score from 29.8 ± 17.3 at baseline to 13.2 ± 9.4 at the endpoint (paired t-test, P < 0.001), whereas there was no statistically significant change in the control group. Changes in DEI scores differed significantly between the two groups. Within the treatment group, there was a significant improvement in the DEI score from 24.3 ± 23.0 at baseline to 32.5 ± 21.2 at the endpoint (paired t-test, P = 0.001), whereas there was no statistically significant change in the control group. CONCLUSION: The traditional Chinese medicine Jia Wei Gui Pi Tang significantly improved both BPSD and positive emotions.

Precolumn derivatization LC/MS method for observation of efficient hydrogen sulfide supply to the kidney via d-cysteine degradation pathway.

d-Cysteine (d-Cys) is metabolized to hydrogen sulfide (H2S) by d-amino acid oxidase (DAO)/3-mercaptopyruvate sulfurtransferase pathway. The pathway is required for H2S supplementation that ameliorates acute kidney injury after the oral administration of d-Cys in mice. However, whether the rate-limiting activity of DAO regulates the tissue-selectivity or the extent of d-Cys degradation and H2S supplementation remains unclear. Here, to analyze the levels of d-Cys and H2S, we use two derivatization methods, a new method with no detectable isomerization of Cys and an established method for H2S. The derivatives were determined by LC/MS using a C18 column. With the methods, we show that inhibition of DAO significantly suppresses the H2S supplementation and d-Cys degradation in the mouse kidney. Additionally, we found that d-Cys is more efficiently metabolized into H2S than l-Cys in the kidney. Our results reveal the utility of the method and support the advantage of d-Cys administration in improving the supply of H2S to the kidneys.

Acute portal vein thrombosis due to chronic relapsing pancreatitis: a fistula between a pancreatic pseudocyst and the splenic vein.

Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but several other causes might play an important role in PVT pathogenesis. We present a case of alcoholic chronic pancreatitis complicated by acute extensive PVT. The patient was managed conservatively with danaparoid sodium at first, but the thrombosis gradually extended. We then tried radiological intervention using the direct transhepatic and transjugular intrahepatic postsystemic shunt approaches. Although we were able to successfully catheterize the percutaneous transhepatic portal vein (PTP), we could not achieve recanalization of the portal vein. Therefore, PTP catheterization and systemic intravenous infusion of urokinase and heparin was performed to prevent further progression of the thrombosis and cavernous transformation was finally achieved. Computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a pancreatic stone which had possibly induced dilatation of the tail duct and formation of a pancreatic pseudocyst and caused intractable pancreatitis. We performed endoscopic retrograde cholangiopancreatography and placed a stent in the pancreatic duct, which completely cured the pancreatitis. Retrospectively, the previous CT with curved multi-planar reconstruction was reviewed and a fistula was detected between the pancreatic pseudocyst and splenic vein. We concluded that the etiology of the PVT was not only inflammatory extension from pancreatitis but also a fistula between the pancreatic duct and the splenic vein.

[Gamma knife radiosurgery for temporal bone chondroblastoma: case report].

A case with chondroblastoma arising from the right temporal bone was reported. A 52-year-old woman demonstrated residual tumor growth after surgical excision. The patient presented continuous right temporalgia and right facial twitch while opening her mouth. The tumor was an expansile mass (tumor volume: 12.8 cm3) and showed homogeneous hypo-intensity on T1 and T2-weighted images, but little contrast enhancement. The patient underwent gamma knife radiosurgery (GKR: marginal dose: 12 Gy, maximum dose: 24 Gy). One month later, her symptoms improved completely. The size of the tumor was reduced to 6.4 cm3 twenty months after GKR. The patient has been free of recurrence and side effects for four years since GKR. GKR may be useful to control residual chondroblastoma of the skull after surgery.

Effects of bone morphogenetic protein 4 on differentiation of embryonic stem cells into myosin VIIa-positive cells.

CONCLUSION: Our results indicate that myosin VIIa-positive cells are generated from embryonic stem cells (ESCs) co-cultured with PA6 cells; however, bone morphogenetic protein 4 (BMP4) may not be a key molecule for induction of myosin VIIa-positive cells from the ESCs. BACKGROUND: ESCs have been considered as a basis for cell therapy in a range of organs, because of their potential for self-renewal and pluripotency. Co-culture with PA6 stromal cells can induce differentiation of ESCs into various types of ectodermal cells including sensory progenitors. BMP4 plays an essential role in the development of sensory hair cells in the inner ear. MATERIALS AND METHODS: We examined effects of BMP4 on differentiation of ESCs into the hair cell immunophenotype. BMP4 was supplemented at different time points to ESCs co-cultured on PA6 stromal cells. The ESCs were then collected and examined for the expression of myosin VIIa, a hair cell marker, and betaIII-tubulin, a neural marker. The expression of myosin VIIa and betaIII-tubulin was identified. RESULTS: Quantitative assessments revealed that exogenous BMP4 has significant effects on the expression of betaIII-tubulin, but not of myosin VIIa.

[A case of brain metastasis from gastric cancer involving bilateral middle cerebellar peduncles].

A case with brain metastasis involving bilateral middle cerebellar peduncles (bMCP) was reported. A 71-year-old male with gastric cancer was treated for multiple brain metastasis by gamma knife radiosurgery (GKR) in September, 2004. Two months after the initial GKR, MRI showed asymmetrical enhanced lesions involving bMCP. A few months later, MRI revealed an expansional infiltration of bMCP lesions. The patient had presented with headache loss of appetite, cerebellar ataxia, diplopia and slight dysmetria. PET showed 2-deoxy-2- [18F] fluoro-D-glucose (FDG) uptake of the bMCP lesions. The lesions were diagnosed as brain metastasis of gastric cancer. The patient underwent his second GKR (marginal dose : 19Gy, maximum dose 38Gy) MRI revealed the disappearance of the tumors 3 months after the second GKR. One year later, the patient showed no evidence of recurrence. For the last time, our case was diagnosed as brain metastasis from gastric cancer without meningeal carcinomatosis. It was suggested that FDG-PET can provide additional information about the lesion of bMCP. GKR may be useful to treat the tumor in bMCP.

Surgical treatment of a lenticulostriate artery aneurysm. Case report.

A previously healthy 61-year-old man presented with basal ganglia hemorrhage caused by rupture of a small aneurysm arising from the distal lenticulostriate artery associated with moyamoya-like disease and manifesting as left hemiparesis and dysarthria. The patient underwent frontotemporal craniotomy. Neck clipping of the aneurysm was performed through the hematoma cavity. He was transferred for rehabilitation with left hemiparesis. Three-dimensional computed tomography angiography was very useful for preoperative planning and evaluation of the anatomical correlation between the aneurysm and the hemorrhage.

Neural connections between embryonic stem cell-derived neurons and vestibular hair cells in vitro.

This study aimed to examine the potential of embryonic stem cell (ESC)-derived neural progenitors for restoration of the neural network in the peripheral vestibular system. Mouse ESC-derived neural progenitors were co-cultured with explants of vestibular sensory epithelia from neonatal mice. Histological analyses demonstrated that ESC-derived neurons substantially elongated their neurites towards vestibular hair cells, and attached to hair cells at the regions corresponding to the location of nerve endings in normal vestibular epithelia. Immunoreactivity for synaptophysin, a marker for synaptic vesicles, was present only in the cytoplasm of hair cells in sensory epithelia cultured alone, while the nerve endings of ESC-derived neurons attached to hair cells exhibited intense immunoreactivity for synaptophysin and some hair cells were moderately reactive in co-cultured specimens. The pattern of synaptophysin expression in co-cultured specimens was very similar to that observed in developing sensory epithelia, in which synaptic connections between hair cells and nerve endings are actively formed. These findings indicate that ESC-derived neurons have the potential to restore neural connections in the peripheral vestibular system.

Innervation of stem cell-derived neurons into auditory epithelia of mice.

This study examined the potential of embryonic stem cell-derived neurons as transplants for cell therapy for the primary loss of spiral ganglion neurons. To assess the ability of embryonic stem cell-derived neurons for innervation into auditory epithelia, they were cocultured with auditory epithelium explants of mice for 7 days. Histological analysis demonstrated massive elongation of neurites from embryonic stem cell-derived neurons toward auditory hair cells. Embryonic stem cell-derived neurites were adjacent to or surrounding hair cells, and exhibited expression of synaptophysin, a marker for synaptic vesicles. These findings demonstrate the ability of embryonic stem cell-derived neurons for reinnervation into auditory epithelia, indicating a high potential of embryonic stem cell-derived neurons as transplants for replacing spiral ganglion neurons.

Persistent primitive trigeminal artery-cavernous sinus fistula with intracerebral hemorrhage: endovascular treatment using detachable coils in a transarterial double-catheter technique. Case report and review of the literature.

Intracerebral hemorrhage occurred in this 61-year-old woman with preexisting diplopia and proptosis. Results of angiography demonstrated a persistent primitive trigeminal artery (PPTA)-cavernous sinus fistula with cortical venous reflux. Two microcatheters were introduced transarterially through the PPTA into the two draining pathways in the cavernous sinus. Coils were delivered in both pathways simultaneously to prevent further venous overload on either path. The fistula was successfully occluded without complication while the PPTA was preserved. The authors describe this double-catheter technique for coil embolization of a fistula and review the literature concerning PPTA-cavernous sinus fistulas.

Ruptured vertebral artery dissecting aneurysm associated with parent artery occlusion.

A 63-year-old hypertensive man presented with vertebral artery (VA) dissection manifesting as subarachnoid hemorrhage located mainly in the posterior fossa. Left vertebral angiography on the day of hemorrhage showed complete occlusion of the left VA. Right vertebral angiography showed retrograde filling of the distal portion of the left VA and the left posterior inferior cerebellar artery, and a "double lumen"-like finding in the left VA. He was managed conservatively. Follow-up angiography on Day 29 showed spontaneous recanalization of the occlusive lesion and an almost normal arterial configuration. T2-weighted magnetic resonance (MR) imaging on Day 45 revealed multiple infarctions in the brainstem. T1-weighted MR imaging showed a high intensity area, suggestive of intramural hematoma, in the left VA. He was transferred to another hospital in a persistent vegetative state.