Detailed Arterial Anatomy and Its Anastomoses of the Sphenoid Ridge and Olfactory Groove Meningiomas with Special Reference to the Recurrent Branches from the Ophthalmic Artery.

BACKGROUND AND PURPOSE: Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of the arterial anatomy and the relationships of feeders in these lesions. MATERIALS AND METHODS: This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder. RESULTS: We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder. CONCLUSIONS: Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.

Visualization of Aneurysmal Neck and Dome after Coiling with 3D Multifusion Imaging of Silent MRA and FSE-MR Cisternography.

BACKGROUND AND PURPOSE: Our aim was to visualize the precise configuration of the aneurysmal neck and dome with/without remnants combined with a coiled dome after coiling treatment for cerebral aneurysms. We developed 3D multifusion imaging of silent MRA and FSE-MR cisternography. MATERIALS AND METHODS: We examined 12 patients with 3D multifusion imaging by composing 3D images reconstructed from TOF-MRA, silent MRA, and FSE-MR cisternography. The influence of magnetic susceptibility artifacts caused by metal materials affecting the configuration of the aneurysmal complex with coiling was assessed in a single 3D image. RESULTS: In all cases, TOF-MRA failed to depict the aneurysmal neck complex precisely due to metal artifacts, whereas silent MRA delineated the neck and parent arteries at the coiled regions without serious metal artifacts. FSE-MR cisternography depicted the shape of the coiled aneurysmal dome and parent artery complex together with the brain parenchyma. With the 3D multifusion images of silent MRA and FSE-MR cisternography, the morphologic status of the coiled neck and parent arteries was clearly visualized with the shape of the dome in a single 3D image. CONCLUSIONS: Silent MRA is a non-contrast-enhanced form of MRA. It depicts the coiled neck complex without serious metal artifacts. FSE-MR cisternography can delineate the shape of the coiled dome. In this small feasibility study, 3D multifusion imaging of silent MRA and FSE-MR cisternography allowed good visualization of key features of coiled aneurysms. This technique may be useful in the follow-up of coiled aneurysms.

Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity.

Large avulsed skin flaps of the lower extremity caused by degloving injuries eventually develop skin necrosis in most cases. The current treatment option involves excision of the degloved skin and reapplication as a full- or split-thickness skin graft. We considered that reattachment of avulsed skin flaps without excision would be theoretically beneficial, since some circulation may remain around the connected pedicle and thus facilitate graft take. Furthermore, securing the skin to the original anatomic position is much easier using retained landmarks. We treated a total of 12 patients (13 cases) with degloving injuries of the lower extremity. In all cases, the avulsed skin flap was defatted and sewn back to the original position, then negative-pressure wound therapy was applied over those grafts as a bolster for approximately 7 days. Most of the avulsed skin flap took excellently, particularly close to the connected pedicle. Nine cases did not need any additional surgical procedures. Four cases required secondary skin graft for a small area of open wound due to partial necrosis of the defatted skin, as well as the raw surface left by the primary skin defect in the initial operation. Primary reattachment of the avulsed skin flaps without excision is convenient and efficient to cover the open wound over the exposed fascia and periosteum in degloving injuries. This would potentially offer a better alternative to definitive wound closure.

The effect of horizontal X-ray beam angulation on the detection of furcation defects of mandibular first molars in intraoral radiography.

OBJECTIVES: The aim was to investigate the effect of changes in horizontal X-ray beam angulation in intraoral radiography on the detection accuracy of furcation defects in the mandibular first molar, and to examine the anatomical relationship between the roots and furcation area as a possible cause of changes in detectability. METHODS: Simulated furcation defects with various depths were created in five mandibular first molars. Intraoral radiographs were taken at various horizontal angulations of the projection beams. The diagnostic accuracies were determined based on receiver operating characteristic analysis. The geometric relationship that might influence the accuracy was investigated through use of a compact cone beam CT in 59 first molar areas. RESULTS: Although the horizontal angulations showing the highest accuracies were shifted mesially, no differences were found between the angles of -10 degrees and 20 degrees . The relationship between the roots and the furcation area was relevant to the range of angulations showing high detectabilities. CONCLUSIONS: The angulations traditionally used for detecting proximal caries are also suitable for detecting furcation defects.

Identification of the distal dural ring with use of fusion images with 3D-MR cisternography and MR angiography: application to paraclinoid aneurysms.

BACKGROUND AND PURPOSE: The distal dural ring (DDR) represents the anatomic border between the extradural and intradural internal carotid arteries (ICAs). The purpose of this study was to examine whether 3D-MR cisternography and MR angiography (MRA) fusion images can identify the boundary between the CSF and the cavernous sinus, which might represent the DDR. MATERIALS AND METHODS: Thirty-six consecutive patients with 39 ICA aneurysms were examined with use of MR fusion images with 3D-cisternography and MRA on a 1.5T unit. Two neuroradiologists evaluated the configuration of the carotid cave and the location of the aneurysms on fusion images and classified them as intradural, transdural, and extradural aneurysms. RESULTS: The borderline between the CSF and the cavernous sinus was visualized on fusion images in all patients. The carotid cave configuration in 72 ICAs was classified as having no dent (n = 31), a shallow dent (n = 27), and a deep dent (n = 14). The MR fusion images led to the classification of 39 ICA aneurysms as 21 intradural, 6 transdural, and 12 extradural. The interobserver agreement of MR fusion images was excellent (kappa = 0.80). CONCLUSIONS: Fusion images with 3D-cisternography and MRA yielded clear visualization of the boundary between the suprasellar cistern and cavernous sinus indicating the DDR. This imaging technique may provide additional information in consideration of a treatment option for paraclinoid aneurysms.

The Stenting to Internal Carotid Artery Stenosis (ICS) in Petrous Portion. The Evaluation of Plaque Figures in Magnetic Resonance Image.

SUMMARY: In the safety stenting, it is important to get to know the characteristics of a plaque. In petrous carotid artery stenosis, it is difficult to know the characteristics of the plaque.We paid our attention to the MPRAGE (Magnetization Prepared Rapid Acquisition with Gradient Echo) method on high resolving power MRI. By the MPRAGE method, low intensity was observed in these lesions of all cases. This result suggested that the plaque in petrous portion was a fibrous plaque. This method is useful to get to know the characteristics of a plaque in petrous portion before endovascular treatment.

DNA methylation in systemic lupus erythematosus.

Recent studies on epigenetics, including DNA methylation and its regulatory enzymes, seem likely to contribute to elucidation of the pathogenesis of autoimmune diseases such as systemic lupus erythematosus (SLE), although the relationship between DNA methylation and SLE has long been the subject of investigation. To obtain a deeper understanding of the role of DNA methylation in the induction of SLE, we reviewed the relationship between DNA methylation and SLE based on findings reported in the literature and our own data. Various studies, including ours, have indicated the possible importance of DNA methylation, especially hypomethylation, in the etiology of SLE. These epigenetic studies may give us clues towards elucidation of the pathogenesis of SLE and development of new therapeutic strategies for this disease.

Possible role of DNA hypomethylation in the induction of SLE: relationship to the transcription of human endogenous retroviruses.

OBJECTIVE: We investigated the contribution of DNA methyltransferase activity to the transcription of human endogenous retroviruses (HERV), which have been reported to be a plausible causative agent for systemic lupus erythematosus (SLE). METHODS: The reverse transcriptase-polymerase chain reaction (RT-PCR) and real-time quantitative-PCR (RQ-PCR) were used. RESULTS: Our results indicated that treatment with 5-aza-deoxycytidine (5-aza C), a demethylating agent, increased the transcription of messenger RNA (mRNA) for HERV clone 4-1 and decreased mRNA for DNA methyltransferase-1 (DNMT-1; methylation-regulating enzyme) in peripheral blood mononuclear cells (PBMC) from normal individuals. Also, transcription of DNMT-1 mRNA in PBMC from patients with SLE was lower than in cells from normal controls. CONCLUSION: DNA hypomethylation seems to play a significant role in the transcription of HERV clone 4-1 and may be related to the pathogenesis of SLE.

Lessons from similarities between SLE and HIV infection.

OBJECTIVE: We attempted to obtain deeper understanding of systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection through comparative studies between both diseases. METHOD: For this purpose, we reviewed and discussed lessons from similarities in both diseases based on our own and reported findings in literatures. RESULT: Such comparative studies may contribute to the progress in understanding the clinical or pathogenetic features of these diseases. CONCLUSION: Further studies into the relationship between SLE and HIV infection may bring to light important clues to assist in the development of better treatments for each disease.

Retroviruses and autoimmunity.

The investigation of human retroviruses has shown dramatic progress since the discovery of human immunodeficiency virus (HIV). These studies have also contributed to the exploration of the role of retroviruses, including endogenous retroviruses, in the induction of autoimmune diseases such as systemic lupus erythematosus (SLE). This review describes the potential role of retroviruses in autoimmunity, based on recent findings including our own results.

Quantitative analyses of messenger RNA of human endogenous retrovirus in patients with systemic lupus erythematosus.

OBJECTIVE: Human endogenous retrovirus (HERV) has emerged as a possible causative agent of systemic lupus erythematosus (SLE). To investigate the role of HERV in the etiology of SLE, we performed quantitative analyses of messenger RNA (mRNA) of the HERV clone 4-1 in patients with SLE. METHODS: Reverse transcriptase (RT)-polymerase chain reaction (PCR) and real-time quantitative PCR (RQ-PCR; TaqMan methodology) were used in this experiment. RESULTS: The quantities of mRNA of the HERV clone 4-1 gag region in patients with SLE were significantly higher than in healthy controls, and the amounts of such mRNA in the patients were decreased by steroid treatment. CONCLUSION: These phenomena may be related to the production of viral components derived from HERV clone 4-1 and contribute to the pathogenesis of SLE; studies using a larger number of patients are required to confirm these points.

Gene expression of osteoclast differentiation factor is induced by lipopolysaccharide in mouse osteoblasts via Toll-like receptors.

Osteoclast differentiation factor (ODF), a recently identified cytokine of the TNF family, is expressed as a membrane-associated protein in osteoblasts and stromal cells. ODF stimulates the differentiation of osteoclast precursors into osteoclasts in the presence of M-CSF. Here we investigated the effects of LPS on the gene expression of ODF in mouse osteoblasts and an osteoblast cell line and found that LPS increased the ODF mRNA level. A specific inhibitor of extracellular signal-regulated kinase or protein kinase C inhibited this up-regulation, indicating that extracellular signal-regulated kinase and protein kinase C activation was involved. A protein synthesis inhibitor, cycloheximide, rather enhanced the LPS-mediated increase of ODF mRNA, and both a neutralizing Ab of TNF-alpha and a specific inhibitor of PGE synthesis failed to block the ODF mRNA increase by native LPS. Thus, LPS directly induced ODF mRNA. Mouse osteoblasts and an osteoblast cell line constitutively expressed Toll-like receptor (TLR) 2 and 4, which are known as putative LPS receptors. ODF mRNA increases in response to synthetic lipid A were defective in primary osteoblasts from C3H/HeJ mice that contain a nonfunctional mutation in the TLR4 gene, suggesting that TLR4 plays an essential role in the process. Altogether, our results indicate that ODF gene expression is directly increased in osteoblasts by LPS treatment via TLR, and this pathway may play an important role in the pathogenesis of LPS-mediated bone disorders, such as periodontitis.

Sequence analysis of human endogenous retrovirus clone 4-1 in systemic lupus erythematosus.

Human endogenous retroviruses (HERV) have emerged as a possible cause of systemic lupus erythematosus (SLE). We previously detected serum antibodies to the gag region of HERV clone 4-1 in patients with SLE, but not in normal volunteers. In the present study, we detected clone 4-1 messenger RNA (mRNA) in peripheral blood mononuclear cells (PBMC) from SLE patients and performed sequence analysis of the cDNA or genomic DNA from clone 4-1 in these patients. Clone 4-1 mRNA was detected in all of the SLE patients tested, although it was not found in normal controls. Sequence analysis of clone 4-1 in these SLE patients revealed inactivation of the stop codons in part of the gag region. In addition, a computer search of current sequence libraries revealed that the clone 4-1 gag genomic DNA from SLE patients was more highly homologous with the clone 4-1 sequence in chromosome 11 from normal individuals when compared with the sequence of clone 4-1 integrated in the other chromosomes. It is possible that transcription of clone 4-1 from chromosome 11 occurs in SLE, and that the stop codon inactivation contributes to the translation of clone 4-1 gag proteins in patients with this disease.

[Pharmacokinetic analysis of cefozopran in neonatal infections--population pharmacokinetics using nonmem].

This report describes the results on pharmacokinetics, efficacy and safety of cefozopran (CZOP) in neonatal patients. Enrolled patients were 136 in total whose informed consents to enter this study had been given by their parents. Among them, blood samples were collected from 42 neonates to analyze concentrations of CZOP by population pharmacokinetics (PPK) methods. Based on this analysis, the average pharmacokinetic parameters of CZOP and the variabilities of them in different morbid pharmacological backgrounds and in different subjects were evaluated. This PPK analysis showed that clearance (CL) and distribution volume (Vd) of CZOP could be estimated by the following equations; CL = 0.0452 x WT1.75 (in the case of the postnatal age of over than 1 day) CL = 0.623 x 0.0452 WT1.75 (in the case of the postnatal age of 1 day or less) Vd = 0.455 x WT where WT indicates body weight in kg. The coefficients of variation among individual subjects on CL and Vd were found to be 20.7% and 20.0%, respectively. From this PPK analysis it was indicated that the elimination of CZOP is dependent on the postnatal age and is approximately 38% lower in the younger group than in the older group. Therefore, it could be concluded that, though the cases of evaluation were small in number, adjustment of dosing of CZOP is necessary, particularly in prolongation of intervals of administration, in cases of postnatal age of 1 day or less.

Circulating levels of beta-chemokines in systemic lupus erythematosus.

OBJECTIVE: Recent evidence suggests the role of beta-chemokines and their receptors in human immunodeficiency virus infection. We examined the serum levels of beta-chemokines in patients with systemic lupus erythematosus (SLE). METHODS: The serum levels of beta-chemokines, macrophage inflammatory protein-1alpha (MIP-1alpha), MIP-1beta, RANTES, and monocyte chemoattractant protein-1 (MCP-1) in patients with SLE were determined by ELISA. RESULTS: There were significant differences between the patients with SLE and healthy controls in the serum concentrations of RANTES (p < 0.001) and MCP-1 (p < 0.01), but not MIP-1alpha (p = 0.07) and MIP-1beta (p = 0.68). A decrease of RANTES and an increase of MCP-1 was observed with the progression of disease activity in the patients with SLE. CONCLUSION: Changes in the serum levels of RANTES and MCP-1 may indicate an interaction between SLE disease activity and the production of beta-chemokines.