Approach to obstructive sleep apnea syndrome at Tokyo Dental College, Ichikawa General Hospital.

In this communication, we report the current status of OSAS (Obstructive Sleep Apnea Syndrome) in the southern region of Higashikatsushika around Ichikawa City, our effort to improve patient QOL as well as to establish diagnostic and therapeutic methods, and the results of a comparison of therapeutic options with the focus on improvement of compliance by using nCPAP (nasal continuous positive airway pressure). We examined 112 patients who visited the Otolaryngology Department at Tokyo Dental College, Ichikawa General Hospital, with the chief complaint of nocturnal snoring or sleep apnea from January 2001 to April 2003 and underwent all-night PSG (polysomnography). Based upon the results of these all-night PSGs, 89 and 23 patients were diagnosed as having OSAS and simple snoring, respectively. Using the AHI classification of severity, 58 and 31 patients were assessed as having severe OSAS and mild OSAS, respectively. (1) nCPAP was tried in 61 patients, and 39 patients (63%) were able to continue it. After the introduction of nCPAP, surgery was performed in 18 patients (30%). As a result, weaning from nCPAP was successfully achieved in 10 cases, compliance with nCPAP was improved in six cases, alleviation of symptoms (decreased pressure) was seen in one case, and aggravation was noted in one case. In addition, four patients (7%) unilaterally discontinued nCPAP. (2) Surgery was performed in 34 patients, and 18 of them had surgery after nCPAP was tried. (3) We asked the dental department to make OAs (oral appliances) for 31 patients but seven of them did not attend the department, so a total of 24 patients used OAs. Fourteen patients (58%) were able to tolerate an OA for 3 months or more. Based on these results, we are hoping to achieve a better control of OSAS by combining nCPAP and other modalities.

Functional and Vbeta repertoire characterization of human CD8+ T-cell subsets with natural killer cell markers, CD56+ CD57- T cells, CD56+ CD57+ T cells and CD56- CD57+ T cells.

We investigated the individual CD8+ populations with natural killer (NK) cell markers (NK-type T cell); CD56 single positive (CD56)-T cells, CD56/CD57 double positive (DP)-T cells and CD57 single positive (CD57)-T cells in the peripheral blood. All NK-type T-cell populations expressed CD122 and intermediate levels of T-cell receptor (TCR; regular CD8+ T cells are CD122- and express high levels of TCR). The number of both DP-T cells and CD57-T cells, but not CD56-T cells, gradually increased with age. All NK-type T-cell populations produced larger amounts of interferon-gamma than did regular CD8+ T cells after stimulation with interleukin (IL)-2, IL-12 and IL-15. However, CD56-T cells and CD57-T cells but not DP-T cells showed a potent antitumour cytotoxity to NK-sensitive K562 cells, whereas only CD56-T cells showed a potent cytotoxity to NK-resistant Raji cells. Furthermore, although NK-type T cells produced large amounts of soluble Fas-ligands, their cytotoxic activities appeared to be mediated by the perforin/granzyme pathway. The oligoclonal or pauciclonal expansions of certain VbetaT cells were found in each NK-type T-cell population. The non-variant CDR3 region(s) for the TCRbeta chain(s) showed CD57-T cells and CD56-T cells to be derived from distinct origins, while the DP-T cell population consisted of a mixture of the clones seen in both CD56-T cells and CD57-T cells. Our results suggest that CD57-T cells and CD56-T cells are functionally and ontogenically different populations while DP-T cells appear to originate from both CD56-T cells and CD57-T cells.

Miller Fisher syndrome with transient coma: comparison with Bickerstaff brainstem encephalitis.

We herein report a 4-year-old boy with Miller Fisher syndrome (MFS) who presented with transient coma in addition to the typical triad of internal and external ophthalmoplegia, cerebellar ataxia and areflexia after an influenza type B infection. The electroencephalogram findings revealed intermittently generalized slow wave bursts. The cerebrospinal fluid revealed high protein and a lack of any cellular response. The serum anti-GQ1b IgG antibody was elevated in the acute phase and disappeared in the convalescent phase. The transient coma with the triad of MFS in this patient indicated an extended brainstem lesion including a reticular formation, which is also the responsible lesion of Bickerstaff brainstem encephalitis (BBE), but the magnetic resonance imaging repeatedly showed no abnormal finding. Our patient suggested the involvement of central nervous system in addition to the peripheral nerve injury in MFS. He also suggested that MFS and BBE may belong to the same group of disorders as syndrome of ophthalmoplegia, ataxia and areflexia (SOAA).

Effect of weight loss on T-cell receptor-mediated T-cell function in elite athletes.

PURPOSE: Long-term intensive exercise by athletes may sometimes lead to a susceptibility to infections. In the present study, we examined the differences in immune function between amateur wrestlers experiencing weight loss (WL) and those without WL who underwent similar intensive exercise training. METHODS: Eighteen elite amateur wrestlers who attended the Japanese national championship were classified into two groups. One group consisted of those with either slight or no WL (without WL) (<4%; mean, 1%) (N = 9), and the other group consisted of those who needed a significant WL (with WL) (> or = 4%; mean, 7%) (N = 9) during a 1-month period of intensive training. The leukocyte counts as well as the leukocyte subsets in the peripheral blood were examined. The proliferation and cytokine production in T lymphocytes in response to bacterial superantigens (staphylococcal enterotoxin B, streptococcal pyrogenic exotoxin A) and anti-CD3 antibody (Ab) were also examined. RESULTS: The total leukocyte counts and leukocyte subsets did not differ substantially between the groups and were also not different from the findings before starting the intensive exercise training. Natural killer cells and T cells among the lymphocytes significantly increased in both groups, whereas the increase in each group was not different. Although the T-cell responses to bacterial superantigens were not different, the anti-CD3 Ab-stimulated proliferation and interferon-gamma production of lymphocytes from the wrestlers with WL were significantly lower than those of the wrestlers without WL. This hyporesponsiveness to CD3 stimulation recovered 2 months after the tournament when the wrestlers reverted to their normal weight. CONCLUSION: Intensive exercise in athletes accompanied by a rapid WL was found to compromise the CD3/T-cell receptor-mediated T-cell function in athletes.