Regulatory T and B cells in peripheral blood of subcutaneous immunotherapy-treated Japanese cedar pollinosis patients.

AIM: The aim of this study was to clarify whether there are more regulatory T (Treg) and regulatory B (Breg) cells, and higher levels of IL-10-related transcription factors in subcutaneous immunotherapy (SCIT)-treated pollinosis patients than in non-SCIT-treated patients. METHODS: Japanese cedar pollinosis patients undergoing SCIT had received treatment for at least 2.8 years. Peripheral blood mononuclear cells were used for flow cytometer analyses and mRNA measurement. RESULTS: The numbers of type 1 regulatory T (Tr1)-like cells and Breg cells, and expression of E4BP4 mRNA by peripheral blood mononuclear cells in SCIT-treated patients were higher than those in non-SCIT-treated patients. CONCLUSION: Tr1-like cells, Breg cells and E4BP4 may be involved in the effectiveness of SCIT.

Antigen-specific airway IL-33 production depends on FcγR-mediated incorporation of the antigen by alveolar macrophages in sensitized mice.

Although interleukin (IL)-33 is a candidate for the aggravation of asthma, the mechanisms underlying antigen-specific IL-33 production in the lung are unclear. Therefore, we analysed the mechanisms in mice. Intra-tracheal administration of ovalbumin (OVA) evoked increases in IL-33 and IL-33 mRNA in the lungs of both non-sensitized and OVA-sensitized mice, and the increases in the sensitized mice were significantly higher than in the non-sensitized mice. However, intra-tracheal administration of bovine serum albumin did not increase the IL-33 level in the OVA-sensitized mice. Depletion of neither mast cells/basophils nor CD4+ cells abolished the OVA-induced IL-33 production in sensitized mice, suggesting that the antigen recognition leading to the IL-33 production was not related with either antigen-specific IgE-bearing mast cells/basophils or memory CD4+ Th2 cells. When a fluorogenic substrate-labelled OVA (DQ-OVA) was intra-tracheally administered, the lung cells of sensitized mice incorporated more DQ-OVA than those of non-sensitized mice. The lung cells incorporating DQ-OVA included B-cells and alveolar macrophages. The allergic IL-33 production was significantly reduced by treatment with anti-FcγRII/III mAb. Depletion of alveolar macrophages by clodronate liposomes significantly suppressed the allergic IL-33 production, whereas depletion of B-cells by anti-CD20 mAb did not. These results suggest that the administered OVA in the lung bound antigen-specific IgG Ab, and then alveolar macrophages incorporated the immune complex through FcγRII/III on the cell surface, resulting in IL-33 production in sensitized mice. The mechanisms underlying the antigen-specific IL-33 production may aid in development of new pharmacotherapies.

[Neuromuscular blockade after a chain of two laparotomies in a few hours].

A 59-year-old man with chronic renal failure underwent the ascending colectomy. After administration of neostigmine 2 mg, his postoperative neuromuscular recovery was good. The second laparotomy was undertaken one hour after extubation because gauze was left in his abdomen. Fifty minutes after intubation using rocuronium 40 mg (0.6 mg x kg(-1)), neostigmine 4 mg (0.06 mg x kg(-1)) was administrated. But we failed to reverse neuromuscular blockade and the patient fell into respiratory depression. After a chain of two operations, the administration of neostigmine in second operation requires circumspection when the effect of neostigmine administrated in the first operation is continuing, because the proper evaluation of residual neuromuscular blockade is difficult.

A novel selective stimulus presentation for P300 speller.

The P300 speller is one of the brain-computer interfaces, allowing users to spell letters just by thoughts. Due to the low signal-to-noise ratio of the P300, however, stimuli are repeatedly presented so that EEG signals can be averaged, which improves the accuracy but degrades the speed. The authors have proposed to discontinue the stimulus presentation adaptively to the P300 response and have shown its superiority in the performance over the standard way that presents a prefixed number of stimuli. In addition to this adaptive stimulus termination, this paper proposes to select stimuli to be presented to avoid presenting redundant stimuli. Both off-line and on-line experiments show that the proposed method is more effective than our conventional method.

[Ventricular tachycardia on arrival at the operating room in a patient with bilateral recurrent nerve paralysis].

A 66-year-old man developed dyspnea at rest due to bilateral recurrent nerve paralysis. He was rushed into the operating room for emergency tracheostomy. He developed ventricular tachycardia (VT) due to hypoxemia before induction of general anesthesia. After tracheal intubation, VT returned to regular sinus rhythm. Although the similar case is rare, reliable airway controls such as tracheostomy and intubation are necessary for patients with dyspnea at rest due to bilateral recurrent nerve paralysis.

Application of support vector machines to reliability-based automatic repeat request for Brain-Computer Interfaces.

A Brain-Computer Interface (BCI) is a system that could enable patients like those with Amyotrophic Lateral Sclerosis to control some equipment and to communicate with other people, and has been anticipated to be achieved. One of the problems in BCI research is a trade-off between speed and accuracy, and it is practically important to adjust those two performance measures effectively. So far the authors have considered BCIs as communications between users and computers, and have proposed an error control method, Reliability-Based Automatic Repeat reQuest (RB-ARQ). It has been shown that, with Linear Discriminant Analysis (LDA) as a classifier, RB-ARQ is more effective than other error control methods. In this paper, Support Vector Machines (SVMs), one of the most popular classifiers, are applied to RB-ARQ. A quantitative comparison showed that there was no significant difference between LDA and SVM. Also, it was demonstrated that RB-ARQ improved the accuracy from the one acquired by the top ranked methods in the BCI competition to 100 percents, with less loss of the speed.

[Aggravation of congestive heart failure after cesarean section in a patient with undiscovered hyperthyroidism].

A 27-year-old woman with toxicity of pregnancy and congestive heart failure underwent an emergency cesarean section. In spite of antihypertensive drugs, blood pressure and heart rate were high preoperatively. She coughed many times and SpO2 was 88%. Circulatory state became stable without antihypertensive drugs under combined spinal-epidural anesthesia and continuous intravenous infusion of propofol intraoperatively. After surgery, blood pressure and heart rate became elevated again and congestive heart failure became worse. She was diagnosed as hyperthyroidism by postoperative laboratory examination. If we had discovered her hyperthyroidism, her symptoms of congestive heart failure would not have become worse. We should be more careful about hyperthyroidism in pregnancy because it is not rare.

[Blood lactate concentrations as predictors of outcome in serious hemorrhagic shock patients].

BACKGROUND: There is no useful predictor of treatment preventing progress from hemorrhagic shock to systemic inflammatory response syndrome or disseminated intravascular coagulation. Recent reports have shown that blood lactate levels could be related to outcome of critically ill patients including those with septic shock. METHODS: We retrospectively investigated the relation between blood lactate concentrations and outcomes of 19 patients with Hb < or = 5 g x dl(-1) caused by preoperative or intraoperative bleeding. RESULTS: There were 15 survivors and 4 nonsurvivors from hemorrhagic shock. No significant difference was found in the highest intraoperative blood lactate concentrations between survivors and nonsurvivors. However, survivors had significantly lower blood lactate concentrations immediately after operation and after recovery from shock. CONCLUSIONS: Blood lactate concentrations and especially their time courses have a strong relation with survival from hemorrhagic shock and can be reliable clinical predictors of therapy.

[An elderly patient without evidence of major organ damage following severe hemodilution caused by massive intraoperative hemorrhage].

An 82-year-old woman with hematemesis was admitted to our hospital. Diagnosis of bleeding from gastric ulcer was made and an emergency operation was performed. Although she fell into sudden hypotension, ventricular tachycardia and severe hemodilution lasting for 45 minutes (minimum hemoglobin concentration of 1.8 g x dl(-1)) caused by intraoperative massive hemorrhage, she recovered without any apparent postoperative damage in major organs. The major reasons for evading organ damage may be attributable to maintenance of blood pressure and circulatory volume, and to early medication for prevention of systemic inflammatory response syndrome or disseminated intravascular coagulation.

Evaluation of 18F-FDG PET in patients with advanced, metastatic, or recurrent gastric cancer.

UNLABELLED: PET with 18F-FDG has been widely used in oncology, but its application for stomach neoplasms has been limited. The aim of this study was to evaluate the visual diagnostic accuracy of (18)F-FDG PET for advanced, metastatic, or recurrent gastric cancer and to generate semiquantitative values for lesions. METHODS: 18F-FDG PET scans were obtained on 42 patients (29 men, 13 women; age, 27-78 y; median age, 63 y): 20 patients with a PT931/04 scanner and 22 patients with a SET2400W scanner. The PT931/04 has a spatial resolution of 6.0 mm at full width at half maximum (FWHM) and covers 15 cm above and below the targeted lesion, and the SET2400W has a spatial resolution of 3.9 mm at FWHM and images the entire body. All PET images were interpreted visually, and tracer uptakes were quantitated as standardized uptake values (SUVs) on SET2400W images. RESULTS: The sensitivity, specificity, and accuracy as a whole were as follows: 71%, 74%, and 73%, respectively, with the SET2400W scanner and 47%, 79%, and 62%, respectively, with the PT931/04 scanner. Values were high for primary lesions, liver, lymph node, and lung metastases, but were low for bone metastases, ascites, peritonitis, and pleuritis carcinomatoses. SUVs were 8.9 +/- 4.2 (primary lesions, 19 patients/19 lesions), 6.5 +/- 2.2 (liver, 9/55), 6.1 +/- 2.5 (lymph nodes, 14/38), 6.5 +/- 1.8 (abdominal wall, 4/7), 3.9 +/- 2.0 (bone, 3/27), and 4.7 +/- 2.6 (lung, 2/3). Comparing SUVs and histologic findings for 17 untreated patients, values for well-differentiated and moderately differentiated adenocarcinomas versus poorly differentiated adenocarcinomas and signet ring cell carcinomas were 13.2 +/- 6.3 (4/4) versus 7.7 +/- 2.6 (13/13) (P < 0.05) for the primary lesions, 7.0 +/- 2.4 (5/39) versus 5.6 +/- 2.8 (2/2) for the liver, and 5.5 +/- 1.9 (9/28) versus 8.8 +/- 3.3 (3/8) (P < 0.05) for the lymph nodes. CONCLUSION: Our results indicate that 18F-FDG PET is a useful diagnostic modality for advanced, metastatic, or recurrent gastric cancer but not for detecting bone metastases, peritonitis, or pleuritis carcinomatoses. 18F-FDG uptake by gastric cancers is relatively high but does not parallel histopathologic features of malignancy.