The advanced lung cancer inflammation index predicts outcomes in patients with Crohn's disease after surgical resection.

AIM: Precise biomarkers for predicting prognosis could help to identify high-risk Crohn's disease (CD) patients to facilitate better follow-up during the postoperative course. In this study, the primary aim is the identification of the most reliable nutrition marker that predicts surgical relapse in CD patients. METHOD: We first evaluated the predictive value of various nutrition markers for postoperative surgical relapse in CD patients and identified the advanced lung cancer inflammation index (ALI) as a promising biomarker. Then, we assessed the clinical significance of preoperative ALI in CD patients using two cohorts. RESULTS: Preoperative ALI showed the highest correlation with reoperation rate compared with other nutritional parameters in CD patients receiving surgical resection (sensitivity 53%, specificity 86%, area under the curve 0.71). Lower levels of preoperative ALI were significantly correlated with the presence of perianal disease. A lower level of preoperative ALI was an independent prognostic factor for reoperation rate after an intestinal resection (hazard ratio 3.37, 95% CI 1.38-10.12, P = 0.006), and the prognostic impact of preoperative ALI was successfully validated in an independent cohort using the same cut-off value. CONCLUSION: Preoperative ALI might be useful for postoperative management of CD patients.

Construction of self-cloning bottom-fermenting yeast with low vicinal diketone production by the homo-integration of ILV5.

The vicinal diketones (VDK), such as diacetyl and 2,3-pentandione, impart an unpleasant butter-like flavour to beer. Typically, these are required to be reduced below the flavour thresholds during the maturation (lagering) stages of the brewing process. To shorten beer maturation time, we constructed a self-cloning, bottom-fermenting yeast with low VDK production by integrating ILV5, a gene encoding a protein that metabolizes α-acetolactate and α-aceto-α-hydroxybutyrate (precursors of VDK). A DNA fragment containing Saccharomyces cerevisiae-type ILV5 was inserted upstream of S. cerevisiae-type ILV2 in bottom-fermenting yeast to construct self-cloning strains with an increased copy number of ILV5. Via transformation, ILV2 was replaced with the sulfometuron methyl (SM) resistance gene SMR1B, which differs by a single nucleotide, to create SM-resistant transformants. The wort fermentation test, using the SC-ILV5-homo inserted transformant, confirmed a consecutive reduction in VDK and a shortening period during which VDK was reduced to within the threshold. The concentrations of ethyl acetate, isoamyl acetate, isoamyl alcohol, 1-propanol, isobutyl alcohol and active isoamyl alcohol (flavour components) were not changed when compared with the parent strain. We successfully constructed self-cloning brewer's yeast in which SC-ILV5 was homo-inserted. Using the transformed yeast, the concentration of VDK in fermenting wort was reduced, whereas the concentrations of flavour components were not affected. This genetically stable, low VDK-producing, self-cloning bottom-fermenting yeast would contribute to the shortening of beer maturation time without affecting important flavour components produced by brewer's yeast.

Relation between the TIMI frame count and the degree of microvascular injury after primary coronary angioplasty in patients with acute anterior myocardial infarction.

OBJECTIVE: To investigate the relation between thrombolysis in myocardial infarction (TIMI) frame count (TFC) and coronary blood flow velocity (CBFV) parameters reflecting the degree of microvascular injury in patients with acute myocardial infarction. RESULTS: TFC and CBFV were measured after primary coronary angioplasty in 103 consecutive patients with their first anterior wall acute myocardial infarction. TFC correlated inversely with the averaged peak velocity (r = -0.43, p < 0.0001). However, TFC did not correlate significantly with diastolic deceleration time and with the averaged systolic peak velocity (r = -0.16, p = 0.22, and r = -0.23, p = 0.16, respectively). The patients were divided into two groups according to presence (35 patients) or absence (68 patients) of systolic flow reversal. There was no significant difference in TFC between the two groups (29 (16) v 25 (13), p = 0.20). CONCLUSIONS: These findings suggest that the TFC reflects epicardial CBFV. However, it is not accurate enough to assess the degree of microvascular injury after primary coronary angioplasty.

Factor validity of the temperament and character inventory in patients with major depression.

Cloninger has proposed a seven-factor psychobiological model of personality and has developed the Temperament and Character Inventory (TCI) to measure four temperament dimensions and three character dimensions. This theory of personality may be of great importance in developing an integrated understanding of psychosocial and biological processes underlying the etiology and course of depression, and a large number of studies are being carried out using the TCI to determine the pathology of depression. The present study investigated the factor validity of the TCI in 156 mildly to moderately depressed patients with major depression. The results indicate that the TCI is an internally consistent and factor-analytically valid instrument in patients. Although there was some evidence that a state of depression strengthened correlation between harm avoidance and cooperativeness, the proposed factor structure of the TCI appeared, in general, robust against the state effect of depression, when the state was mild to moderate. These results suggested that the TCI has considerable promise as an instrument for characterizing the underlying personality structure of mildly to moderately depressed patients with major depression.

[Usefulness of time-resolved projection MRA on evaluation of hemodynamics in cerebral occlusive diseases].

The usefulness for evaluation of cerebral hemodynamics using time-resolved projection MRA was studied in normal volunteers and patients of cerebrovascular diseases. Six normal volunteers and ten patients with cerebrovascular occlusive diseases including 6 of IC occlusion and 4 of post EC/IC bypass surgery underwent time-resolved projection MRA on a 1.5 T clinical MRI system. Projection angiograms are acquired with 2 D-fast SPGR sequence with a time resolution of approximately one image per second, 40 images being acquired consecutively before and after bolus injection Gd-DTPA. And all images were calculated by complex subtraction from the background mask in a work station. In normal volunteers, the quality of images of time-resolved projection MRA was satisfactory. The arteries from internal carotid artery through M 2 segment of middle cerebral artery and all major venous systems were well portrayed. In 4 cases of IC occlusion who were assessed the collateral flow through the anterior communicating artery and posterior communicating artery, there were delayed to demonstrate the ipsilateral MCA. However, in 2 cases of IC occlusion that were assessed the collateral flow through leptomeningeal anastomosis, ipsilateral MCA and collateral circulation were not demonstrated. In all patients of post EC/IC bypass surgery, the patency of EC/IC bypass could be evaluated as properly with time-resolved projection MRA as 3 D-TOF MRA. Although the temporal and spatial resolutions are insufficient, time-resolved projection MRA was powerful non-invasive method to evaluate the cerebral hemodynamics via the basal communicating arteries in IC occlusion and identify the patency of EC/IC bypass.

Is interpersonal sensitivity specific to non-melancholic depressions?

BACKGROUND: We investigated whether melancholic and non-melancholic Japanese depressive patients differed in regard to a personality feature, interpersonal sensitivity, as measured by the Interpersonal Sensitivity Measure (IPSM). METHODS: In addition to 154 normal controls, 66 remitted melancholic patients and 55 remitted non-melancholic patients filled out the IPSM and two widely-used comprehensive personality inventories, the Temperament and Character Inventory (TCI) and the Munich Personality Test (MPT). The subdivision of patients was made according to three major symptom-based criteria for melancholia (those of RDC, DSM-III, DSM-IV). RESULTS: Multivariate and post-hoc univariate analyses of variance revealed significant differences among the three groups in several personality dimensions after Bonferroni's adjustments of P values. While reported scores of both melancholic and non-melancholic patients deviated from normative scores on several personality dimensions, non-melancholic patients reported significantly higher scores on the total IPSM and the 'fragile inner-self' (a subscore of the IPSM) than did normal controls or melancholic depressives. The principal component analysis isolated two factors related to depressive disorders: one factor corresponding to the five IPSM scores; and the other corresponding to harm avoidance, neuroticism and frustration tolerance. The scores on the former factor differentiated non-melancholic depressives from melancholic depressives and normal controls. The scores on the latter factor differentiated both melancholic and non-melancholic depressives from normal controls. LIMITATIONS: Prospective studies in which depressive subjects are subdivided into melancholic and non-melancholic subjects will be required to see whether the personality deviations here related to depressive disorders strongly reflect the premorbid personality function. CONCLUSIONS: These results indicate that the IPSM scales (particularly, the fragile inner-self scale and the total IPSM scale) are relatively independent of all dimensions included in the two comprehensive personality inventories, and have a capability to describe personality differences between non-melancholic depression and melancholia.

Evaluation of dietary intake using carbon and nitrogen isotope analysis of human hair of Chinese living in southern part of China.

We examined dietary intakes among 69 people of three ethnic groups (Yao Chinese, Zhung Chinese and Han Chinese) in the autonomous country of Bama in China where many elderly people have a long life span in 1998. Dietary intake was evaluated using carbon and nitrogen isotope ratios of human hair (delta 13C, delta 15N) standardized by standard gas. The distributions of delta 13C in Yao Chinese and Han Chinese were scattered from -21 to -17/1000, which were close to that of C4 plants such as corn and millet. The distribution of delta 13C in Zhung Chinese was located from -25 to -22/1000, which was near that of C3 plants such as rice, wheat and potato. These values showed a much wider range when compared with delta 13C in Chinese living in urban areas. On the other hand, delta 15N in each group was distributed in the area ranged from 8 to 11/1000. The result of delta 13C was consistent with data obtained from a nutritional survey, but that of delta 15N was a little higher than expected. The carbon and nitrogen isotope ratios of human hair among three ethnic groups showed characteristic distributions, although the relation between these isotope ratios and longevity is uncertain.

Low novelty-seeking differentiates obsessive-compulsive disorder from major depression.

OBJECTIVE: To make a direct comparison of patients with obsessive-compulsive disorder (OCD) and major depression (MD) and a normal control group in terms of the Temperament and Character Inventory (TCI) personality dimensions. METHOD: Additionally to 43 patients with primary OCD, 43 MD patients and 43 normal subjects who were matched against the OCD patients for sex and age filled out the TCI. RESULTS: Compared to the controls, the OCD and MD patients scored significantly higher on harm avoidance and significantly lower on self-directedness and co-operativeness. The OCD patients scored significantly lower on novelty-seeking than the MD patients and the controls. CONCLUSION: Whereas OCD and MD share similar personality deviations on harm avoidance, self-directedness and co-operativeness, OCD is distinguishable from MD in terms of low novelty-seeking. Low novelty-seeking may have a profound relationship to the specific aetiology of OCD.

[A case of adult moyamoya disease progressed after vascular reconstructive surgery].

We report an adult onset patient with moyamoya disease showing acute progress after contralateral vascular reconstructive surgery. A 47-year-old female developed cerebral infarction in the left corona radiata. A magnetic resonance (MR) angiography and a cerebral angiogram revealed severe stenosis extending from the terminal portion of left internal carotid artery (ICA) to the M1 portion. The right ICA showed slight stenosis. We performed direct bypass surgery (STA-MCA anastomosis) on the affected left side. MR angiography 1 month after surgery revealed the progressive stenosis of the C1 portion of the right ICA. While measurement of cerebral blood flow (CBF) showed a slight impairment of vascular reactivity to acetazolamide loading in the region of the right MCA, we continued without vascular reconstructive surgery for the right side because there was no ischemic attack. The patient had a transient sensory disturbance of the left upper extremity 16 months after surgery. MR angiography and a cerebral angiogram revealed more progressive stenosis extending from the right ICA to the M1 portion. CBF study showed a low CBF at rest and a negative response to acetazolamide loading in the region of the right MCA. Direct bypass surgery was performed on the right hemisphere. Follow-up study revealed an increment of rest CBF and improvement of vascular reactivity. We underlined the necessity for careful postoperation observation of progressive contralateral arterial stenosis using MR angiography and CBF study in adult onset patients with moyamoya disease.

[Evaluation of hemodynamics in cerebral infarction using MRI with FAIR sequence].

In comparison with 99mTc-ECD SPECT, the usefulness for evaluation of cerebral blood flow by the perfusion images using MRI with FAIR sequence was studied in ischemic stroke patients. Among 27 cases, 15 patients showed lacunar infarctions and 12 patients showed cortical infarctions determined by T2 weighted MR images. FAIR images were obtained as single images at the slice position running through the basal ganglia or corona radiata. The inversion times(TI) were varied, ranging from 800 to 1,400 msec. In 15 patients without definite low perfusions in the SPECT study, FAIR images showed sequentially proxymal arterial branches in early phase and distal arterial branches or capillary beds in the cortical tissues in a late phase as the TI was elongated. Nine of the 12 patients with low cerebral perfusions in the SPECT study showed perfusion defects in FAIR imaging. Five of the 12 patients with a small low cerebral perfusion area in the SPECT study showed a delay of the depiction of cortical arteries along with TI elongation. In 3 patients, ischemic lesions demonstrated by the SPECT study was not shown in the MRI study because of motion artifacts. In conclusion, FAIR imagings are considered to be useful in the evaluation of cerebral flow dynamics in the ischemic stroke patients.

Changes in visibility of intracranial arteries on MRA with normal ageing.

We investigated age-related changes in the visibility of intracranial arteries on magnetic resonance angiography (MRA) and the influence of risk factors for stroke. We studied 230 adult patients without specific neurological deficits. MRA was performed using the three-dimensional time-of-flight technique with a spoiled gradient-recalled acquisition sequence. We classified internal carotid artery (IC) and the horizontal (M1) and distal (beyond M2) middle cerebral segments into 4 grades. Linear regression revealed a significant negative relation between age and the quality of demonstration on MRA. For IC and M1, the score was significantly lower in subjects with risk factors than in those without. The distal MCA was poorly seen in patients without a history of hypertension or lacunar infarcts. A marked correlation was observed between visibility and age patients with no history of hypertension, diabetes mellitus and hyperlipidaemia. We suggest that atherosclerotic change and decline in flow velocity with normal ageing are factors leading to decreased visibility on MRA.

Diagnostic use of isotropic diffusion-weighted MRI in patients with ischaemic stroke: detection of the lesion responsible for the clinical deficit.

We examined the diagnostic use of isotropic diffusion-weighted (DW) MRI in 140 consecutive patients suspected of or diagnosed as having an ischaemic stroke. Isotropic DW imaging could demonstrate the lesion responsible for the clinical deficit in patients with multiple cerebral infarcts at an early stage, even small lesions without a perifocal oedema or mass effect. Accurate diagnosis by DW images may, however, be difficult about 2 weeks after the onset of stroke.

Enantioselective recognition mechanism of secondary alcohol by surfactant-coated lipases in nonaqueous media.

The enantioselective recognition mechanism of secondary alcohol by lipases originated from Candida rugosa and Pseudomonas cepacia was elucidated on the basis of the kinetic study of the esterification of alcohol with lauric acid in isooctane. To obtain inherent kinetic parameters, we utilized a surfactant-coated lipase whose conformation is considered to be an "open" form in a homogeneous organic solvent. Based on the experimental results, the enantioselectivity of lipases was found to be derived from the difference in the V(max) values between the two enantiomers. The same result was observed when lipases of different origin and substrates with different molecular structures were applied. © 1999 John Wiley & Sons, Inc.

[Changes in visualization of cerebral MR angiography with normal aging].

MR angiograms from 200 neurologically normal subjects aged 30 to 79 years were analyzed to assess the influence of aging and hypertension on the degree of the--visualization of the cerebral arteries. The degree of MR visualization of the cerebral arteries, including the IC, M 1, and distal MCA, was evaluated on a 4-degree scale. IC and M 1 differ in appearance. The MR gradings of each cerebral arteries showed a significant (p < 0.001) negative correlation with age. Hypertension, which is a risk factors for arteriosclerosis, significantly reduced MR grade. The degree of visualization of M 1 and the distal MCA decreased significantly with age in the normotensive group. Therefore, the decrease visualization of the cerebral arteries appears to involve not only cerebral arteriosclerosis but other factors associated with aging.

Confirmatory factor analysis of the Parental Bonding Instrument in a Japanese population.

BACKGROUND: There is controversy surrounding the factor structure of the Parental Bonding Instrument (PBI), a widely used instrument for assessing perceived parental rearing behaviours. Recent studies have proposed five different factor structures, including Parker et al.'s original two-factor model. METHODS: Four hundred and eighteen employed Japanese adults filled out the PBI. Maximum likelihood confirmatory factor analyses were performed to compare the five different factor structures in terms of model-fit. RESULTS: Parker's original two-factor structure fitted the data poorly. In general, three-factor structures showed better fit. Among the three-factor structures, Murphy's model and Kendler's model were superior (the adjusted goodness-of-fit index > 0.8), with the latter providing the best fit to the data (the goodness-of-fit index > 0.9). When considering invariance of factor structure across gender subgroups and across age subgroups, only Kendler's model was acceptable. CONCLUSIONS: Parker's two-factor structure of the PBI may not be appropriate for assessing perceived parental rearing behaviours in a Japanese population. Three-factor structures, in particular Murphy's model and Kendler's model, are preferable. Kendler's model provided the best fit to the data and was relatively invariant across the subgroups in this study. Thus, Kendler's model might prove to be very important for obtaining a factor structure invariant across different cultures.

Temperament and character inventory dimensions as a predictor of response to antidepressant treatment in major depression.

BACKGROUND: Cloninger's theory of personality, including 4 temperament dimensions and 3 character dimensions, is one of the most noteworthy theories in recent years. Several studies have explored temperament dimensions as a predictor of response to antidepressant treatments in major depression, but these have provided inconsistent results. The present study explored temperament as well as character dimensions, as measured by the Temperament and Character Inventory (TCI), as possible predictors of response to maprotiline, the most-widely prescribed antidepressant in Japan. METHODS: 86 consecutive patients with major depression underwent a 16-week open trial of maprotiline. They filled out the TCI at baseline, and were followed up at weeks 8 and 16 by using the Hamilton Rating Scale for Depression. RESULTS: Hierarchial logistic regression analyses demonstrated that response to maprotiline was significantly predicted by the cooperativeness score at the 8-week outcome assessment, and by the self-directedness score at the 16-week outcome assessment, after controlling the possible effects of clinical variables on the response. There was no evidence that either temperament dimensions or their 2-way interactions significantly predicted the response. LIMITATIONS: Large replication studies with other antidepressants are needed for generalizing the results in this study. CONCLUSIONS: The results in this study regarding temperament dimensions seem consistent with findings in previous studies, which are, as a whole, inconsistent with each other. It is suggested that character dimensions (particularly cooperativeness and self-directedness), rather than temperament dimensions, may be important predictors of response to antidepressants. Antidepressants may differ in the personality configurations that predict optimal responses.

Dried green leaf powders of Jew's mellow (Corchorus), persimmon (Diosphyros kaki) and sweet potato (Ipomoea batatas poir) lower hepatic cholesterol concentration and increase fecal bile acid excretion in rats fed a cholesterol-free diet.

A cholesterol-free diet containing dried powder of Jew's mellow leaves, persimmon leaves or sweet potato leaves respectively at 5% level as dietary fiber was fed to male Sprague-Dawley rats for about one month. The experiment was conducted twice except for sweet potato leaves. In the groups fed the diet mixed with powders of any of the three different dried green leaves, the hepatic cholesterol concentration significantly decreased. Such lowering was not observed in serum cholesterol concentration compared with the control (cellulose) group. A significant increase in fecal weight was observed in all the groups fed the green leaf samples. All the dried green leaves increased fecal excretion of bile acids per gram or per day compared with the control group in both experiments, but only the dried Jew's mellow leaves showed an increased excretion of neutral sterols. These results suggest that lowering of hepatic cholesterol by powdered green leaves is not necessarily due to the same factor, but to the increased fecal excretion of bile acids due to inhibited enterohepatic circulation in animals given these samples.

Magnetic resonance angiography in patients with acute stroke treated by local thrombolysis.

Although magnetic resonance angiography (MRA) is accepted for showing chronic intracranial stenotic or occlusive lesions, the method has not been practically examined in patients with acute cerebral ischaemia. We carried out three-dimensional time-of-flight MRA in six patients with acute ischaemia treated by local thrombolysis, and compared the findings with those of digital subtraction angiography (DSA). In all patients, MRA before thrombolysis clearly demonstrated the occluded arteries, which corresponded precisely to those shown by DSA. In four patients with complete recanalisation of the occluded vessels after thrombolysis, the recanalisation could be demonstrated by postoperative MRA. In one patient with reocclusion of the recanalised artery, repeat MRA also demonstrated the reocclusion, confirmed by DSA. These results suggest that MRA may be helpful for noninvasive investigation before and after thrombolysis.

[Surgical management for preserving motor function in patients with gliomas near the primary motor cortex: usefulness of preoperative identification of motor cortex and intraoperative monitoring of motor evoked potentials].

Preoperative identification of precentral gyrus and intraoperative monitoring of motor evoked potentials (MEPs) were performed to preserve postoperative motor function in seven patients with gliomas near the primary motor cortex. Tumors were astrocytomas in 3 patients, glioblastomas in 2 patients, anaplastic astrocytoma and mixed glioma in one patient each. Preoperative identification of the primary motor cortex was performed by three-dimensional (3D) display of magnetic resonance (MR) images and by functional images using MR imaging and single-photon emission tomography. The primary motor cortex identified by 3D display of MR images coincided well with that identified by functional images. 3D display of MR images was also useful for detecting the relationship between the tumor and the primary motor cortex. Intraoperatively, the central sulcus was confirmed by the finding of phase reversal of cortical somatosensory evoked potential, and this corresponded with the preoperative identifications by 3D display and by functional mapping. The primary motor cortex was stimulated electrically, and MEP (corticospinal evoked potential) was continuously monitored during surgery using electrodes inserted in the cervical epidural space. The amplitude of direct waves of MEPs during surgery was maintained above half of that recorded at the beginning of tumor removal, and all patients showed preservation of preoperative motor function. These results suggest that preoperative identification of precentral gyrus and intraoperative MEP monitoring provide useful information for preserving motor function in patients with gliomas near the primary motor cortex.

Histochemical observation and cellular distribution of ascorbic acid in persimmon leaves.

This study was carried out to resolve the discrepancy of data for the proportion of ascorbic acid and dehydroascorbic acid in persimmon leaves at the final stage of the season and to clarify their cellular distributions using histochemical and biochemical techniques. Fresh persimmon leaves were collected and used on July 31, September 5 and October 7, 1996. Ascorbic acid and dehydroascorbic acid in subcellular fractions were determined by the HPLC method that was found to be the most reliable for separation. The percent of dehydroascorbic acid in the total leaves was found to be almost constant (between 32 and 37%) in all preparations tested. In all preparations, more than 90% of the ascorbic acid and dehydroascorbic acid was found in the soluble fraction. The histochemical detection of ascorbic acid and an electron micrograph of persimmon leaf cells showed that the reactive color, after the reduction of silver nitrate under acidic conditions, in the leaves of all three preparations was mainly found on the face side of columned-type palisade parenchyma cells where chloroplasts were not rich and large vacuoles were seen. On the inner side of the palisade parenchyma cells where chloroplasts were the richest, only weak color development was observed. This study demonstrates that the percent of dehydroascorbic acid in persimmon leaves did not exceed 40% at least until October 7. It also shows that in persimmon leaf cells, ascorbic acid is mainly localized in the cytosol of palisade parenchyma tissue cells where large vacuoles are seen.