Lower-lobe shrinkage relative to total lung volume in collagen vascular diseases.

PURPOSE: It has been reported that the prognosis differs between patients who have collagen vascular diseaseassociated interstitial pneumonia (CVD-IP) and those with idiopathic IP (IIP). In this study, chest computed tomography (CT) findings were compared between patients with CVD-IP and IIP. MATERIALS AND METHODS: A retrospective analysis was performed of 47 consecutive patients (23 with CVD-IP and 24 with IIP). The lower-lobe volume (LLV), total lung volume (TLV), and their ratio (LLV/TLV) were determined by volumetry using three-dimensional computed tomography (CT). RESULTS: There was no significant difference of the LLV/TLV ratio between the CVD-IP and IIP groups. However, the LLV/TLV ratio was <0.33 in 9/23 patients with CVD-IP versus 2/24 patients with IIP, and there was a significant difference in the percentage of patients with a ratio<0.33 between the CVD-IP and IIP groups (p = 0.01). The LLV/TLV ratio was not influenced by the severity of lung disease. CONCLUSIONS: Measuring the LLV/TLV ratio by threedimensional CT can help distinguish between CVD-IP and IIP at initial diagnosis, especially in patients with CVD-IP who have pulmonary involvement before other organ diseases and symptoms caused by CVD.

Clock gene dysfunction in patients with obstructive sleep apnoea syndrome.

Clock genes regulate mammalian circadian rhythms, and dysfunction of clock genes can contribute to various disorders. To investigate whether obstructive sleep apnoea syndrome (OSAS) influences clock gene function, the present authors examined Period1 (Per1) mRNA expression in vitro and in vivo. In eight healthy subjects and eight OSAS patients, plasma noradrenaline, serum interleukin (IL)-6, high-sensitivity C-reactive protein (hsCRP) and Per1 mRNA expression in peripheral whole blood were measured. Expression of Per1 mRNA in cultured cells was examined under IL-6 or noradrenaline stimulation in vitro. After noradrenaline was administered to mice in vivo, Per1 mRNA expression in the brain was examined. The concentrations of serum IL-6, hsCRP and plasma noradrenaline were elevated in OSAS patients, but improved by continuous positive airway pressure (CPAP) therapy. Per1 mRNA expression in the peripheral blood significantly decreased at 02:00 h by CPAP in OSAS patients. Stimulation with IL-6 did not directly induce Per1 mRNA in vitro. Administration of noradrenaline induced Per1 mRNA in the cerebral cortex of mice in vivo. The current study revealed that obstructive sleep apnoea syndrome caused clock gene dysfunction, and continuous positive airway pressure helped to improve it. Sympathetic activation and elevation of the plasma noradrenaline concentration in obstructive sleep apnoea syndrome may be one of the factors involved in disorders of Period1 mRNA expression.

Near 10-year and longer periods modulate circadians: intersecting anti-aging and chronoastrobiological research.

Biological cycles with relatively long and some unusual periods in the range of the half-week, the half-year, years, or decades are being discovered. Their prior neglect constituted a confounder in aging and much other research, which then"flew blind" concerning the uncertainties associated with these cycles when they are not assessed. The resolution of more about 10-year and other cycles, some reported herein, replaces the admission of complete unpredictability, implied by using the label "secularity." Heretofore unaccounted-for variability becomes predictable insofar as it proves to be rhythmic and is mapped systematically to serve as a battery of useful reference values. About 10-year cycles in urinary 17-ketosteroid excretion and in heart rate and its variability, among others, are aligned with cycles of similar length in mortality from myocardial infarction. Associations accumulate between cycles of natural physical time structures, chronomes such as the 10.5-year (circadecennian) Schwabe and the 21-year (circavigintunennian) Hale cycles of solar activity, and chronomes in biota. There are about 50-year (circasemicentennian) cycles in mortality from stroke in Minnesota and in the Czech Republic and also in human morphology at birth, the latter result reducing the likelihood that these cycles are purely human made. Associations among large populations warrant long-term systematic coordinated sampling of natural physical and biological variables of interest for the design of countermeasures against already documented elevated risks of stroke, myocardial infarction, and other catastrophic diseases, notably in elderly adults. New findings will be introduced against the background of the documented value of mapping rhythms in medicine and gerontology. In both these fields, rhythms promise the seeming paradox of better care for less.

Relationship between correlation dimension and indices of linear analysis in both respiratory movement and electroencephalogram.

OBJECTIVE: We investigate the relationships between signals from the electroencephalogram (EEG) and those from respiratory movement using the correlation dimension (D(2)). METHODS: Respiratory movement and EEG were recorded for 7.5h from 7 clinically healthy men. D(2) was calculated by applying an algorithm slightly modified from that proposed by Grassberger and Procaccia (Phys Rev Lett 50 (1983) 346). Non-linearity in respiratory movement and EEG was tested by comparing D(2) for the original data with that for surrogate data. RESULTS: A statistically significant positive correlation between D(2) of the EEG and D(2) of the respiratory movement was observed for the original data, but not for the surrogate data. CONCLUSIONS: A reduced D(2) of the EEG may be associated with an increased regularity of breathing in deep sleep (stage IV). Likewise, the increased D(2) of respiratory movement during rapid eye movement may be associated with increased complexity of the signals. Whether there is a direct coordination between brain and lungs or whether brainstem systems, including that of the cholinergic system, affect both respiration and cortex requires further investigation.

Mucoepidermoid carcinoma of the trachea with airway hyperresponsiveness.

We report a case of mucoepidermoid carcinoma of the trachea in a 23-year-old pregnant female in her 39th week. The patient had cough and wheezing in the early morning for 9 months before admission. No abnormalities were detected on a chest roentgenogram. At Caesarean section, fiberscopy revealed a polypoid lesion narrowing the trachea. The pathologic diagnosis made from the biopsy specimen obtained was low-grade mucoepidermoid carcinoma and the lesion was resected. Airway hyperresponsiveness was shown before resection with airflow limitation, however, airway reactivity and airflow limitation improved 1 year after resection.

Human pulmonary dirofilariasis presenting as a small nodule with a cavity.

A 73-year-old woman had a 4-year history of lung fibrosis from collagen vascular disease. She presented with a complaint of dry cough. A chest radiograph showed a 2-cm solitary pulmonary nodule with a small cavity in the right lower lobe. Preoperatively, we performed computed tomography of the chest and measured tumor markers. Video-assisted thoracotomy was performed because we could not rule out lung cancer. Pathologic analysis confirmed the presence of a granuloma with Dirofilaria immitis. In Japan, the incidence of human dirofilariasis has steadily increased and must be considered in the workup of cavitary pulmonary nodules.

Clinical and in vitro evaluation of membrane humidifier that does not require addition of water.

It is well known that conventional bubbling humidifiers are capable of producing micro-aerosols contaminated with bacteria. We developed a unique humidifier, named a membrane humidifier, that does not require an external water supply. This new system obtains moisture from room air. We investigated the clinical and in vitro evaluation of the membrane humidifier. Ten patients with chronic pulmonary disease participated in the study. We evaluated the partial pressure of oxygen in arterial blood (PaO2) of 10 patients who used the new device. We conducted an in vitro study to determine whether the device could prevent the bacterial contamination of humidified-oxygen. We passed compressed air contaminated with Pseudomonas aeruginosa outside the hollow fibres of the membrane humidifier, and the humidified-oxygen passed inside the hollow fibres was sampled into nutrient broth periodically for 10 days. We also compared the relative humidity of oxygen humidified by a membrane humidifier with that of oxygen humidified by a bubbling humidifier. There was no significant difference between measured PaO2 while breathing oxygen humidified using a membrane humidifier and that while breathing oxygen humidified using a bubbling humidifier. Cultures of the humidified-oxygen passed through the hollow fibres were negative for bacteria. The membrane humidifier could produce good humidification. The new device appeared to prevent bacterial contamination, and may help to reduce the risk of infection in patients at hospital and home.

Theophylline chronotherapy of nocturnal asthma using bathyphase of circadian rhythm in peak expiratory flow rate.

We studied the efficacy of theophylline chronotherapy for nocturnal asthma using the changes of the circadian rhythms in peak expiratory flow rate (PEF). Eight patients with nocturnal asthma were evaluated for the periods with nocturnal symptoms and with an evening dose of theophylline administered daily. Patients recorded their PEF every 4 hours on one of the days (from 7:00 to 23:00 h) in each period. Circadian rhythms in PEF were examined using the single and group-mean cosinor method. Significant circadian rhythms in PEF were observed in the period with nocturnal symptoms. When nocturnal symptoms were present, the bathyphase of PEF was present between midnight and morning. A significant circadian rhythm disappeared or PEF amplitude decreased during theophylline chronotherapy. The circadian rhythm in PEF was altered according to the severity of the asthma. In patients with symptoms present between midnight and early morning, an evening dose of theophylline chronotherapy can be prophylactically used for nocturnal asthma attacks. Consideration of the circadian rhythm and bathyphase of PEF is useful in selecting appropriate chronotherapy for nocturnal asthma.

The week, inherited in neonatal human twins, found also in geomagnetic pulsations in isolated Antarctica.

About 7-day (circaseptan) components, found at different levels of organization, notably in relation to growth, regeneration, repair and development, are often viewed as reflecting no more than the 7-day societal schedule, ample evidence for a built-in feature notwithstanding. Herein, we resolve circaseptans in geomagnetic pulsations recorded by a stand-alone magnetometer residing in Antarctica, far away from societal influences. Human physiological data, collected in the neonatal intensive care unit, show by intra-class correlation analysis that the nonlinearly assessed circaseptan period of heart rate, diastolic blood pressure and body weight is more similar between same-gender twins than among twin pairs, lending additional support for the endogenicity of circaseptans. Like circadians, about-weekly features in environmental variables such as geomagnetic pulsations were genetically acquired in the course of evolution.

Circadian rhythm in peak expiratory flow: alteration with nocturnal asthma and theophylline chronotherapy.

We investigated changes in the circadian rhythm of peak expiratory flow (PEF) in seven persons with nocturnal asthma for a 24h span when (1) they were symptom free and their disease was stable, (2) their asthma deteriorated and nocturnal symptoms were frequent, and (3) they were treated with theophylline chronotherapy. Subjects recorded their PEF every 4h between 07:00 and 23:00 one day each period. Circadian rhythms in PEF were assessed using the group-mean cosinor method. The circadian rhythm in PEF varied according to asthma severity. Significant circadian rhythms in PEF were detected during the period when asthma was stable and when it was unstable and nocturnal symptoms were frequent. When nocturnal symptoms were present, the bathyphase (trough time) of the PEF rhythm narrowed to around 04:00; during this time of unstable asthma, the amplitude of the PEF pattern increased 3.9-fold compared to the symptom-free peiiod. No significant group circadian rhythm was detected during theophylline chronotherapy. Evening theophylline chronotherapy proved to be prophylactic for persons whose symptoms before treatment had occurred between midnight and early morning. Changes in the characteristics of the circadian rhythm of PEF, particularly amplitude and time of bathyphase, proved useful in determining when to institute theophylline chronotherapy to avert nocturnal asthma symptoms.

Nonlinear behavior of human respiratory movement during different sleep stages.

To investigate the nonlinear properties of respiratory movement during different sleep stages, we applied an algorithm proposed by Grassberger and Procaccia to calculate the correlation dimension in rapid eye movement and non-rapid eye movement sleep. We also tested for nonlinearity in respiratory movement by comparing the correlation dimension for the original data with that for surrogate data. The study population included eight healthy volunteers. We recorded respiratory movement and the sleep electroencephalogram for 8 h. The correlation dimension for respiratory movement was 3.28+/-0.19 (mean +/- SD) during rapid eye movement sleep, 2.31+/-0.21 during light sleep (stage I) and 1.64+/-0.25 during deep slow-wave sleep (stage IV). Thus, the correlation dimension differed significantly by sleep stage (p < 0.001): it was least during stage IV sleep and greatest during REM. The correlation dimension for the original data also differed from that for surrogate data, confirming nonlinearity in original data. The results suggest that the nonlinear dynamics of respiratory movement in sleep changes with sleep stage, presumably due to the information processing by the cerebral cortex. The increased correlation dimension for respiratory movement in REM sleep may be related to increased cortical information processing associated with dreaming.

The brain decade in debate: IV. Chronobiology.

The present article is the adapted version of an electronic symposium organized by the Brazilian Society of Neuroscience and Behavior (SBNeC) which took place on June 14, 2000. The text is divided into three sections: I. The main issues, II. Chronodrugs, and III. Methods. The first section is dedicated to the perspectives of chronobiology for the next decade, with opinions about the trends of future research being emitted and discussed. The second section deals mostly with drugs acting or potentially acting on the organism's timing systems. In the third section there are considerations about relevant methodological issues concerning data analysis.

Efficacy of newly developed pressure swing adsorption type oxygen concentrator with membrane humidifier: comparison with conventional oxygen concentrator with bubble water humidifier.

To examine the clinical efficacy of a newly developed pressure swing adsorption (PSA) type oxygen concentrator with a membrane humidifier without added water for humidification, the new machine was compared with the conventional PSA type oxygen concentrator with bubble water humidifier in 10 patients with chronic pulmonary disease. Relative humidity, partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) in arterial blood were measured when the patient breathed air and oxygen from the oxygen concentrators. No significant difference between PaO2 while breathing oxygen flow from the new machine and that while breathing oxygen from the conventional oxygen concentrator was observed. All patients answered that there was no difference on subjective impression between breathing oxygen from the new machine and from the conventional oxygen concentrator. Sufficient relative humidity (above 50%) of oxygen flow was obtained by using membrane humidifier. Since this machine saves the troublesome procedures of cleaning the container and changing the water, it will be beneficial to the patients who use a PSA-type oxygen concentrator in their home.

[A case of stage IV advanced lung adenocarcinoma treated effectively using paclitaxel with the fibrosing radiographically on the chest CT].

A 48-year-old man presented with dyspnea. He was diagnosed as having advanced lung adenocarcinoma of stage IV (T4N2M1). After 3 courses of paclitaxel therapy every 3 weeks intravenously, subjective symptoms, arterial blood gas and radiographical findings improved very much. In the process of the tumor reduction, chest CT showed unique radiographical findings of so-called lung fibrosis over the entire lung and reduction of lung volume. An additional 3 courses of weekly paclitaxel therapy have been given on an outpatient basis. After the change of therapy, the reduction in the tumor has continued and the tumor progression is under control without a decline in the patient's QOL from the start of the chemotherapy over 6 months to the present.

[Respiratory function in students who had asthma in childhood].

Students who had asthma in childhood can be divided into three groups: "asthma-remission" group "asthma-relapsing" group and "non-asthma-remission" group. When we made inquiries about three different groups, the incidence of each group was 58%, 27% and 15%, respectively. In order to determine if childhood asthma affects respiratory function in adulthood, we measured respiratory functions by spirometry in 26 students who had asthma in childhood, and in seven control students. There was no significant difference between students with childhood asthma and control students in terms of FEV1.0% of predicted value. However, students who had asthma in childhood had lower levels of V25/HT% of predicted value in comparison with control students. The effects of deep inhalation in the three groups were evaluated by determining the values of maximal expiratory flow at 40% (MEF40) of vital capacity from partial (P) and maximal (M) flow-volume curves. There was no difference between the remission group and the control group in the MEF40 M/P ratio. This suggests that childhood asthma may deteriorate respiratory functions in adulthood by remodeling of peripheral airways.

[Recent advance in evaluation of lung function of obstructive lung disease].

Chaos of the abdominal movement was examined in obstructive lung disease. Body inductive plethysmograph was used and the analog record was digitized at sampling interval of 100 ms. Correlation dimension was calculated according to the method of Grassberger-Procaccia. In chronic obstructive lung disease and chronic pulmonary emphysema (CPE), correlation dimension was positively correlated with respiratory frequency. The degrees of freedom were between 3-6. The subjects with CPE with periodic breathing showed a lower correlation dimension, which was comparable with Cheyne-Stokes respiration. One subject with dyspnea due to asthmatic attack showed a higher dimension than at the time of remission. Assessment of respiratory chaos may provide a new way of approach to elucidate breathing impairment in obstructive lung disease.

[Chronopharmacology and chronotherapy for asthma by using PEF].

Several attempts have recently been made to develop chronotherapy for nocturnal asthma, using theophylline, inhaled corticosteroid, inhaled anticolinergic agent and beta 2-agonist. Pharmacological chronotherapy is the administration of medication according to biological rhythm to maximize pharmacological effects and minimize side effects. The circadian rhythm of biological rhythms is particularly important in understanding the declined changes in lung function of asthmatics at night. Since diurnal variations of PEF obtained from asthmatics, include circadian rhythms at a high rate, it is thought that PEF may be suitable for evaluating the effect of chronotherapy. Chronotherapy of a once-daily evening dose of a new controlled-release theophylline preparation, that achieves to peak blood concentrations at 10-12 hours after dosage, effectively improved the values of PEF and symptoms of nocturnal asthmatics. Hereafter, it is speculated that more effective therapy will be developed by using chronopharmacological designed drugs.

[A case of left intrathoracic kidney with renal anomalies].

A rare case of intrathoracic kidney was reported. A 71-year-old female with no complaint presented for evaluation of an abnormal shadow in the left lung field. A routine chest roentgenograms showed a sharply outlined mass in the postero-medial portion of the left lung field. Computed tomography demonstrated left intrathoracic kidney with anomalies of rotation. Intravenous pyelography demonstrated a left high ectopic kidney with complete duplication of the renal pelvis and incomplete duplication of a ureter. The patient was diagnosed as left intrathoracic kidney with renal anomalies. The 79 cases of intrathoracic kidney reported in Japan were analyzed concerning their etiology.