High-dose cutaneous exposure to mite allergen induces IgG-mediated protection against anaphylaxis.

BACKGROUND: The relationship among natural allergen exposure, induction of blocking antibody and the occurrence of atopic allergy-particularly in the presence of IgE production-is debatable. OBJECTIVE: To clarify the relationship between the dose of cutaneous exposure to dust mite allergen and susceptibility to the IgE-mediated allergic response in relation to IgG production. METHODS: NC/Nga mice were epicutaneously exposed to various doses of Dermatophagoides pteronyssinus allergen to induce atopic dermatitis-like skin lesions. We then evaluated the skin lesions, induction of mite-specific immune responses, and susceptibility to anaphylaxis. RESULTS: Dose-dependent exacerbation of atopic dermatitis-like skin lesions and increases in mite-specific IgG and IgE production were observed. However, mice exposed to relatively low doses of mite allergen showed hypersusceptibility to mite allergen-specific anaphylaxis. We also showed that adoptive transfer of total IgG from Dp-sensitized mice rescued mice from the hypersusceptibility seen in those exposed to low doses of mite allergen. CONCLUSIONS AND CLINICAL RELEVANCE: High-dose cutaneous exposure to dust mites induced effective blocking IgG production, even if accompanied by IgE production. Our data might support the concept that an increase in IgG titre, not a decrease in IgE titre, is a marker of clinical improvement in allergen-specific immunotherapy.

Distinct outcome of stage I lung adenocarcinoma with ACTN4 cell motility gene amplification.

BACKGROUND: Even if detected at an early stage, a substantial number of lung cancers relapse after curative surgery. However, no method for distinguishing such tumors has yet been established. PATIENTS AND METHODS: The copy number of the actinin-4 (ACTN4) gene was determined by fluorescence in situ hybridization on tissue microarrays comprising 543 surgically resected adenocarcinomas of the lung. RESULTS: Amplification (an increase in the copy number by ≥ 2.0 fold) of the ACTN4 gene was detected in two of seven lung adenocarcinoma cell lines and 79 (15%) of 543 cases of pathological stage I-IV lung adenocarcinoma. Multivariate analysis revealed that ACTN4 gene amplification was the most significant independent factor associated with an extremely high risk of death (hazard ratio, 6.78; P = 9.48 × 10(-5), Cox regression analysis) among 290 patients with stage I lung adenocarcinoma. The prognostic significance of ACTN gene amplification was further validated in three independent cohorts totaling 1033 patients. CONCLUSIONS: Amplification of the ACTN4 gene defines a small but substantial subset of patients with stage I lung adenocarcinoma showing a distinct outcome. Such patients require intensive medical attention and might benefit from postoperative adjuvant chemotherapy.

Algae-removal performance of a fluidized-bed biofilm reactor system for lake water treatment.

The algae removal efficiency of a pilot plant--based on a fluidized-bed biofilm reactor system for treating--was investigated. This system does not require back-washing because the fluidized-bed suffers no clogging. Moreover, the system uses dissolved oxygen in the influent water for aerobic biological treatment without the need for additional aeration equipment. This, it is an easy-maintenance, low-energy system for purifying eutrophic lake water. The system was operated continuously at a flow rate of 1500 m3/d for nine months at Tsuchiura Port in Lake Kasumigaura. And concentrations of chlorophyll-a and dissolved oxygen in both the influent and effluent water were continuously monitored. In summer (August to September) when water bloom occurred, the average efficiency of chlorophyll-a removal was 64% at an average influent chlorophyll-a concentration of 137.8 micrograms/L. Over the entire experimental period of nine months, the average daily amount of removed chlorophyll-a was 40.3 g/d at an average influent chlorophyll-a concentration of 89.5 micrograms/L. By analyzing the relationship between the amount of removed chlorophyll-a and the consumption of dissolved oxygen, it was estimated that almost all of the algae trapped in the reactor was biologically degraded.

Difference in tracks between habitual open and close mandibular movements at the condyle in children.

Although previous studies have paid much attention to the condylar movement in adults with permanent dentition, little attention has been paid to such movement in children. In this study, we therefore clarified the difference in habitual open and close movements at the condyle in children. Three groups of subjects were used; primary (10 children), early mixed (10 children), and permanent dentition (10 adults). The habitual open and close mandibular movement of each subject was measured using a TRIMET, which can three-dimensionally analyse the simultaneous movements of multiple points on the mandible of a subject. The measurements were then compared among the three groups. The three-dimensional analysis detected significant difference in all directions between children with primary dentition and adults with permanent dentition: primary dentition had the smallest anterior-posterior and superior-inferior directions, and the largest left-right direction. Coincidence of the open and close tracks occurred in the adults (adult group) but not in the children (primary and early-mixed dentition groups). The early-mixed dentition group showed tracks that were between those for the primary dentition group and the adult group. These results suggest that the regularity of the condylar track might be well established with dental development.

Occlusal contacts during lateral excursions in children with primary dentition.

The presence of non-working occlusal contacts in adults is considered abnormal and may initiate parafunctional activity. Few studies have looked for non-working occlusal contacts in children with primary dentition. The purposes of this study were (1) to prove the existence of non-working-side occlusal contacts, and (2) to quantify their area during lateral excursion in children with primary dentition. To achieve this purpose, we developed a measurement system that combined a tracking system for mandibular movements with a three-dimensional digitizer for tooth shape. Ten children were selected for this study. Estimated occlusal contact area of the primary second molar on the non-working side was 0.8 mm2, in contrast to 2.0 mm2 on the working side, at 3.0 mm of movement of the lower incisor. All children examined had some occlusal contacts on the non-working side during the first part of lateral excursion.

Choledochoduodenostomy: simple side-to-side anastomosis.

Choledochoduodenostomy, using a simple side-to-side anastomosis technique, was performed in a 74-year-old woman with common bile duct stones. She had chronic heart failure and chronic obstructive lung disease. The choledochoduodenostomy was performed with a cholecystectomy. A 2-cm-longitudinal incision was made in the common bile duct, and an adjacent longitudinal incision was made in the first portion of the duodenum. The first sutures to be placed were the two corner sutures of the posterior anastomotic wall. Then the two sides were sutured, one from the hepatic side corner of the common duct to the anal side corner of the duodenum, and the other from the duodenal side corner of the common duct to the oral side corner of the duodenum. This anastomosis was performed with one layer of interrupted 4-0 adsorbable sutures. The anterior wall of the anastomosis was constructed in a similar manner. The patient recovered uneventfully, and had no complaints of abdominal pain or fever. This procedure, our original method, is technically simple and safe, and results in minimal tension of the anastomosis.

[A patient with hepatic metastasis of breast cancer successfully treated with combined chemoendocrine therapy using epirubicin, tegafur and tamoxifen].

A solitary 1 cm sized metastatic lesion was found in the S5 region of the liver on a postoperative ultrasound screening of a 52-year-old breast cancer patient. It was confirmed by CT, MRI and hepatic angiography. At first, she was successfully treated with trans-arterial pirarubicin and lipiodol infusion but a metastatic lesion of similar size was found 6 months later in the same region. We then administered a triple 20 mg dose of epirubicin intravenously, and 450 mg of UFT and 30 mg of tamoxifen daily. Six months later the lesion had disappeared on US and CT scans and a complete remission has persisted for 18 months.

A calculation method for the range of occluding phase at the lower incisal point during chewing movements using the curved mesh diagram of mandibular excursion (CMDME).

The purpose of this study was to develop a method for calculating the range of the occluding phase in chewing movements. In this study, we defined 'range' as the distance of the movement at the lower incisal point while the mandible moves with tooth contact. First, mandibular excursions were measured using an opto-electronic movement analysis system, which can measure mandibular movement with six degrees-of-freedom at a sampling frequency of 100 Hz. With use of this measurement data, the curved mesh diagram of mandibular excursion (CMDME) previously reported was made. Then, chewing movements were measured using the same analysis system. The movements were separated into their component chewing cycles. Finally, we calculated the distance between each cycle and the CMDME. The occluding range of our subject was 0.4 mm at the closing phase and 3.4 mm at the opening phase. These results suggest that tooth contact occurs during chewing movement and demonstrate that the range of the occluding phase for the opening and closing phases of a subject can be calculated without morphological data from a dental cast.

Nerve regeneration over a 20-mm gap through a nerve conduit containing blood vessels in rats: the influence of interstump distance on nerve regeneration.

BACKGROUND: The present study was conducted in rats to investigate whether a tube with additional intrachamber vascularization could permit axons to extend over a distance greater than 10 mm, which appears to be the maximum axon regeneration distance for rat sciatic nerve axons through a normal empty tube. METHODS: A sural vessel-containing tube (VCT) was designed and interposed between transected sciatic nerve stumps in the thigh, leaving a 20-mm interneural gap. RESULTS: Twelve weeks after tubulation, six out of nine rats showed successful nerve regeneration and re-innervation of the soleus muscle using the VCT. At 24 weeks, intrachamber nerve regeneration and re-innervation of the soleus and pedal adductor muscles were electrophysiologically and histologically confirmed in all rats. However, no neural tissue was observed within any ligated sural vessel-containing tube (LVCT) or empty unmodified tube (ET) with a 20-mm interneural gap. When nerves regenerated in the VCT with a 20-mm gap were compared with those regenerated in a VCT with a 10-mm gap 12 and 24 weeks after surgery, the results produced by the VCT with a 20-mm gap were inferior to those after use of the VCT with a 10-mm gap, except for motor nerve conduction velocity at 24 weeks. CONCLUSIONS: The value recovered to almost identical levels (about 50-60% normal) in both groups.

CMDME (curved mesh diagram of mandibular excursion) method for visualization and diagnosis of mandibular movement.

The CMDME (curved mesh diagram of mandibular excursion) method was developed for easy visualization and diagnosis of mandibular movement. This method uses measured mandibular movement to produce a diagram of the range, shape, and inclination of mandibular excursion in three dimensions using any arbitrary landmark of the mandible. First, the mandibular movement of a subject was measured by an opto-electronic movement analysis system capable of measuring mandibular movement with six degrees-of-freedom at a sampling frequency of 100 Hz. For the measurement, the subject was initially instructed to perform four repetitions of mandibular excursion at will, with tooth contact, each lasting 30 s. A total of 12 000 positions of the mandible were thus obtained. Secondly, an attempt was made to match these positions to intersection points (0.1 mm apart) of a CMDME (i.e. mesh) for arbitrary mandibular landmarks with intercuspal position at the origin. The CMDME method can visualize mandibular excursion, and can be used to compare several landmarks, different subjects, or different times. This makes this method an effective diagnostic tool for mandibular movement.

Characteristics of protrusive and lateral excursions of the mandible in children with the primary dentition.

This study characterizes the mandibular protrusive and lateral excursions of children with primary dentition. With use of a Selspot system, the protrusive and lateral excursions of nine children with the primary dentition and nine adults with the permanent dentition were measured and compared. This system was able to analyse the simultaneous movements of multiple points on the mandible of a subject in three dimensions. Furthermore, the system proved appropriate for use in young children because of the small burden imposed on them during the measurements. Using this subject-friendly system, the directions of the mandibular excursion for five reference points on the mandibular dental arch at each measurement distance (i.e. at 0.5 mm intervals) for three projected angles (frontal, sagittal and horizontal) were calculated. From the results it was found that the excursions of the primary dentition can move more horizontally and more forward with small descent compared with the permanent dentition. The underlying reason for these findings may be physiological growth, maturation, and adaptation of the occlusal function.

Enchondroma of the distal phalanx of the hand.

We saw five patients who had enchondroma of the distal phalanx, a relatively uncommon site for that lesion. Three patients had pain secondary to a pathological fracture and were managed with curettage and bone-grafting through a palmar longitudinal incision. The other two patients had severe deformities of the fingertip and nail. One was managed with disarticulation of the distal interphalangeal joint and the other, with curettage and grafting through a dorsal approach followed by reconstruction of the nail matrix. We believe that the palmar incision in the pulp of the finger has few, if any, complications.

Nerve regeneration over a 25 mm gap in rat sciatic nerves using tubes containing blood vessels: the possibility of clinical application.

This study was undertaken to investigate the effect of including vessels in a tube used to promote nerve regeneration across a gap. A tube containing sural vessels was designed in a rat model and interposed between the proximal and distal stumps of a divided sciatic nerve, leaving a 25 mm gap. At 12 weeks, a few myelinated axons were seen at the most distal parts of regenerated nerves in 6 out of 10 rats, none of which evoked action potentials in the tibialis anterior muscle, but by 24 weeks all the rats had developed neural tissue in the tubes, which evoked action potentials in the muscle. The vessels within the tube enhanced nerve regeneration and its distance up 25 mm. This type of vessel-containing tube would be useful for the repair of divided human peripheral nerves with long gaps, almost equivalent to or slightly longer than the maximum length over which nerve fibres can regenerate through a unvascularised unmodified tube.

Uptake of pentavalent technetium-99m dimercaptosuccinic acid in idiopathic synovial chondromatosis.

We reported two Tc-99m(V) DMSA scintigrams in patients with idiopathic synovial chondromatosis which affected the metacarpo-phalangeal joint and shoulder joint. Tc-99m(V) DMSA accumulated markedly and diffusely in the tumor. Tc-99m(V) DMSA scintigraphy would be valuable for deciding the optimal site for biopsy.

Relationship between axonal regeneration and vascularity in tubulation--an experimental study in rats.

This study investigated the effect of vascularity in a nerve conduit on peripheral nerve regeneration. The effect of three different types of tube (empty, blood vessel-containing and ligated vessel-containing) was compared using a rat sciatic nerve preparation with a 10-mm gap. Nerve regeneration through the vessel-containing tube was more efficient than in the other tubes 6 and 12 weeks after tubulation surgery, but there were no statistically significant differences among the three types of tube after 24 weeks. Electrophysiological, histological and microangiographic studies showed that vessels which were preinserted in the nerve conduit accelerated axonal regeneration through rapid capillary formation in the tube.

Two-stage reconstruction for the hypoplastic thumb.

A 2-year-old boy with grade 3 hypoplastic thumb (Blauth's classification) underwent reconstruction in two stages. Stage 1 was an abductor digiti quinti musculocutaneous flap, first web space widening, and insertion of a silicone rod to prepare for a flexor pollicis longus transfer. Stage 2 (6 months later) was a vascularized second toe proximal interphalangeal joint transfer for carpometacarpal joint replacement, plus tendon transfers for thumb flexion, extension, and adduction. Three years following the procedures, the thumb had an open physis by x-ray film and was functioning well. Pollicization is the traditional procedure for this degree of thumb hypoplasia, but the two-stage reconstruction is an alternative for patients in cultures where the presence of five fingers is important.

Toe-to-finger transfer combined with wrap-around flap: a new technique for four-finger amputation.

A surgical technique for reconstruction of four-finger amputation, toe-to-finger transfer combined with wrap-around flap procedure, is described. Opposable ulnar fingers, reconstructed using the second and third toe, provide sufficient grip function. The long finger, reconstructed with the wrap-around flap using the lateral aspect of the great toe, provides pinch function. Improving the hand function is worthwhile despite morbidity from losing two toes.

Wrap-around neurorrhaphy: an improved method of repair for disparate nerve stumps.

We report a new method of nerve Reconstruction, wrap-around neurorrhaphy, in which the funicular suture site is wrapped with the epineurium of the larger stump. The specific applications of this procedure in brachial plexus reconstruction are described and the clinical results presented. The method was applied in intercostal nerve transfer to the musculocutaneous nerve in 21 patients and in 12 patients with axillary nerve injury who underwent reconstruction with autografts using wrap-around neurorrhaphy. Rigid fixation of the neurorrhaphy site could be obtained using this method, and the clinical results were satisfactory.