Post-immunobiotics increase resistance to primary respiratory syncytial virus infection and secondary pneumococcal pneumonia.

Previously, we demonstrated that post-immunobiotics derived from Lactobacillus gasseri TMT36, TMT39, and TMT40 strains (HK36, HK39 and HK40, respectively) differentially regulated Toll-like receptor 3 (TLR3)-mediated antiviral respiratory immunity in infant mice. In this work, we investigated whether the HK36, HK39 and HK40 nasal treatments were able to improve the resistance against primary respiratory syncytial virus (RSV) infection and secondary pneumococcal pneumonia. Our results demonstrated that the three treatments increased the resistance to primary viral infection by reducing variations in body weight, RSV titers and lung damage of infected infant mice. Post-immunobiotics significantly enhanced the expressions of interferon (IFN)-λ, IFN-ß, IFN-γ, interleukin(IL) - 1ß, IL-6, IL-27, Mx1, RNAseL and 2'-5'-oligoadenylate synthetase 1 (OAS1) genes and decreased tumour necrosis factor (TNF)-α in alveolar macrophages of RSV-challenged mice. In addition, the studies in the model of RSV-Streptococcus pneumoniae superinfection showed that the HK39 and HK40 treatments were capable of reducing lung damage, lung bacterial cell counts, and the dissemination of S. pneumoniae into the blood of infant mice. The protective effect was associated with increases in IFN-ß, IFN-γ, IL-10, and IL-27 in the respiratory tract. This study demonstrates that the nasal application of the post-immunobiotics HK39 and HK40 stimulates innate respiratory immunity and enhances the defences against primary RSV infection and secondary pneumococcal pneumonia offering an alternative to combat respiratory superinfections in children, which can be fatal.

Soymilk-fermented with Lactobacillus delbrueckii subsp. delbrueckii TUA4408L improves immune-health in pigs.

Lactobacillus delbrueckii subsp. delbrueckii TUA4408L has the ability to grow and ferment soymilk and is able to modulate the innate immune response of intestinal epithelial cells in vitro. These two properties prompt us to evaluate whether the soymilk fermented with the TUA4408L strain can induce beneficial immunomodulatory effects in vivo. For this purpose, pigs were selected as a preclinical model. The studies performed here demonstrated that the L. delbrueckii subsp. delbrueckii TUA4408L-fermented soymilk (TUA4408L FSM) reduced blood markers of inflammation and differentially regulated the expression of inflammatory and regulatory cytokines in the intestinal mucosa. These immunological changes induced by the TUA4408L FSM were associated to an enhanced resistance to pathogenic Escherichia coli and an improved grow performance and meat quality of pigs. The experiments and analysis in our study indicate that the immunobiotic TUA4408L FSM could be an interesting non-dairy functional food to beneficially modulate the intestinal immune system, improve protection against pathogens and reduce inflammatory damage. The preclinical study carried out here in pigs could have a better correlation in humans, compared to a rodent model. However, the clinical relevance of these findings still needs to be confirmed by further research, for example, in controlled human challenge studies.

Effects of heat-treated Lactobacillus crispatus KT-11 strain consumption on improvement of oral cavity environment: a randomised double-blind clinical trial.

Heat-treated lactic acid bacteria is added to some foods because it is easier to store and transport, and have less interference with other food ingredient compared with living lactic acid bacteria. We have reported that oral administration of heat-treated Lactobacillus crispatus KT-11 strain (KT-11) suppressed the symptoms of periodontal disease in mice orally infected with Porphyromonas gingivalis. However, the preventive effect of KT-11 on periodontal disease in human is unclear. The aim of this randomised double-blind clinical trial was to examine the effects of KT-11 consumption on the oral environment in healthy volunteers. Sixteen healthy volunteers were randomly assigned to two groups (KT-11 or placebo), and they consumed a KT-11 food tablet (1.2×1010 KT-11 cells) or a placebo food tablet (without KT-11) every day for 4 weeks. Clinical parameters including numbers of major periodontopathic bacteria in saliva, plaque score, gum conditions, and oral mucosal fluid level were evaluated at weeks 0 and 4. Amount of change in P. gingivalis numbers decreased in the KT-11 group compared to that in the placebo group at week 4. Female participants in the KT-11 group had decreased plaque scores, reddish tinge, and gingival swelling scores compared to those in the placebo group at week 4. Furthermore, male participants in the KT-11 group demonstrated increased oral mucosa fluid scores. These clinical findings suggest that daily KT-11 intake can prevent periodontal disease through the improvement of oral conditions.

Mechanisms of perianeurysmal edema following endovascular embolization of aneurysms.

SUMMARY: After coil embolization for an aneurysm, edema surrounding the aneurysm revealed by magnetic resonance imaging (MRI) is rarely seen and is usually associated with neurological symptoms. Perianeurysmal edema was found by postoperative MRI in three out of 182 patients with cerebral aneurysm, which was treated with Guglielmi Detachable Coil (GDC), and neurological symptoms developed simultaneously. In cases where neurological symptoms improved with conservative medical treatment, a temporary increase in the volume of an aneurysm, due to coil and thrombus formation, may result in edema. In cases where symptoms were not alleviated with conservative medical treatment, persistent water-hammer effect against the residual lumen of the aneurysm as well as an increase in the volume of aneurysm by hemorrhage in the aneurysmal wall may contribute to the development of perianeurysmal edema. Consideration of the mechanism of edema development by neurological symptoms, MRI findings, and angiographic findings is needed in order to select appropriate treatment.

Direct carotid puncture for the endovascular treatment of anterior circulation aneurysms.

We report the usefulness of Guglielmi detachable coil (GDC) embolization by direct carotid puncture for anterior circulation aneurysms. For all 27 patients, GDC embolization by direct carotid puncture was safely performed by using a 5F sheath introducer 5 cm long and a Tracker-38 catheter. Neurologic deficits and hemorrhage were not found in any patient during the follow-up period. If the transfemoral approach cannot be applied, GDC embolization should be considered as an alternative method.

The significance of incomplete stent apposition in patients undergoing stenting of internal carotid artery stenosis.

BACKGROUND AND PURPOSE: Incomplete stent apposition after carotid angioplasty and stent placement (CAS) is often seen but little is known about how the incomplete attachment goes after stent placement. For example, some may change into restenosis around the stent edge and some may remain unchanged. The purpose of this study is to clarify the morphologic prognosis of an incomplete stent apposition at the stent edge. METHODS: CAS was attempted on 135 consecutive stenotic lesions (124 patients). Angiograms were then evaluated immediately after the procedure. An incomplete stent apposition at stent edge was found in 15 patients, and all of them were followed up by angiography and MR imaging with antiplatelet therapy. RESULTS: No ischemic event caused by the lesions occurred during the mean follow-up period of 11 months (from 4 to 32 months). The angiography findings of 15 lesions at a mean of 8.8 months (from 2 to 28 months) after CAS showed that all remained unchanged. No patients required any additional intervention. No new ischemic lesions were detected in any of the 15 patients who underwent follow-up MR imaging at a mean of 10 months (from 2 to 32 months) after CAS. CONCLUSION: In this study, the existence of a segment of incomplete stent apposition had no adverse morphologic or clinical effect.

[Intracranial occlusion of the internal carotid artery after minor closed head injury].

Thrombosis of the extracranial portion of the internal carotid artery as a result of nonpenetrating head and neck injury is not uncommon. However, intracranial occlusion of the internal carotid artery after minor head and neck injury without skull fracture is rare. We report a case of 14-year-old male who suffered a minor head injury during an athletic meeting of his school and developed a right hemiparesis and a lethargy state resulting from thrombosis of the supraclinoid portion of the left internal carotid artery. On admission, skull films and a CT scan revealed no abnormality. One hour later, he fully recovered. One day later, no definite lesions were detected on T1-weighted and T2-weighted image of MRI, but an abnormal high signal lesion in the left frontal lobe was detected on diffusion-weighted image of MRI. On additional MR angiography, intracranial occlusion of the internal carotid artery due to dissection was demonstrated.

Endarterectomy for narrowing of the external carotid artery in a patient who underwent extracranial-intracranial bypass for occlusion of the internal carotid artery--case report.

A 56-year-old man had undergone extracranial-intracranial (EC-IC) bypass surgery for occlusion of the right internal carotid artery. Six years later, he complained of transient episodes of numbness in the left arm, occurring periodically over the previous 3 months. Neuroimaging showed the right external carotid artery was severely narrowed and cerebral blood flow (CBF) was diffusely low. Endarterectomy of the right external carotid artery was performed. Postoperative CBF was markedly improved, suggesting that EC-IC bypass became effective again by endarterectomy of a parent artery.

[Craniopharyngioma with rapid regrowth--role of MIB-1 labeling index].

The treatment of craniopharyngioma becomes quite difficult when it extends into the third ventricle. In a 4-year-old boy, we encountered a large cystic craniopharyngioma which grew into the third ventricle. Initially, the tumor was successfully removed via a right transcallosal transchoroidal approach. A residual part seemed to have remained in the right perioptic region. Even though the patient had an episode of SIADH, his postoperative course was uneventful. He developed visual disturbance 4 months after the initial operation. CT and MRI revealed a large suprasellar mass. The tumor was totally resected via a right pterional approach. Careful follow-up disclosed again a small recurrent lesion in the anterior commisure. Gamma knife therapy was used to successfully reduce the volume of the tumor. The MIB-1 labeling index (LI) of the specimen taken at the time of the first operation was at 9.2% and that of the second operation at 21.2%. Recently, the importance of MIB-1 LI for assessing proliferative activity of this tumor was reported. In patients whose MIB-1 LI is higher, they have more significant rate of recurrence. Our results also indicate that in cases where MIB-1 LI indicates a high value, careful follow-up is necessary. Through fact of the necessity of two operations and additional gamma knife therapy, we would like to stress the importance of MIB-1 LI in indicating the proliferative activity of this tumor. These surgical procedures are presented here, and the role of MIB-1 LI in determining the proliferative activity of craniopharyngioma is also discussed.

[A case of aneurysm of the peripheral middle cerebral artery undetectable on preoperative angiogram].

The authors describe a rare case of an aneurysm of the peripheral middle cerebral artery. A 63-year-old female with a past history of hypertension suddenly fell into a comatose state, and was brought to our hospital. On admission, CT scan showed intracerebral hematoma located in the right putamen with diffuse subarachnoid hemorrhage. To exclude vascular lesions, an angiography was performed just after admission. The right carotid angiogram showed an aneurysm at the cavernous portion of the internal carotid artery (ICA), but failed to show any aneurysms in the rest of the intracranial circulation. Just after the angiography, emergent operation was performed for the main purpose of evacuation of the hematoma, and with only the secondary purpose of searching for undetectable aneurysms. The patient underwent a right frontotemporal craniotomy. After partial evacuation of the hematoma through the corticotomy of the right frontal operculum, the Sylvian fissure was opened widely. No aneurysm was observed either in the main trunk of the right ICA or the middle cerebral artery (MCA). During the final stage of evacuation of the hematoma through the corticotomy, arterial bleeding occurred. While evacuating the blood, we detected a saccular aneurysm arising from MCA branch (M2-M3 junction) and we clipped the aneurysm. We discuss peripheral MCA aneurysms with a review of the literature.

[Aneurysms of the distal posterior inferior cerebellar artery--analysis of 14 aneurysms in 13 cases].

Thirteen cases of distal posterior inferior cerebellar artery (PICA) aneurysms are reported here. All the aneurysms were found after a subarachnoid hemorrhage. Dissecting aneurysm, incidentally found unruptured aneurysms, and aneurysms associated with arteriovenous malformation have been eliminated from this study. Characteristics for this type of lesion are a high rate of recurrent hemorrhage and rapid death due to direct compression of the brain stem, which clearly indicates the necessity of early surgery. Attention should be paid to the fact that angiography cannot always reveal aneurysms, especially when they are located in the peripheral PICA. One should also pay attention to multiple lesions and rapid growing acute subdural hematoma as initial findings for ruptured distal PICA aneurysm. Prognostic factors for these lesions are, vasospasm, especially when the aneurysm is located proximally in the PICA, and direct compression of the brain stem due to intraventricular hemorrhage when the aneurysm is located distally. It has been suggested that the pathogenesis of this lesion could be hemodynamic stress or embryogenesis. The shape and anomalous arterial structures of the 14 aneurysms presented here tend to agree with this suggestion. Our results suggest that the pathogenesis is hemodynamic stress that had developed due to embryological and/or arteriosclerotic factors.

[Effects of long-term administration of cilostazol on chronic cerebral circulatory insufficiency--with special reference to cerebral blood flow and clinical symptoms].

This report deals with a study of the effectiveness, safety, and usefulness of long-term administration of Cilostazol for the improvement of cerebral blood flow and clinical symptoms in 24 patients with Chronic Cerebral Circulatory Insufficiency. Cerebral blood flow was investigated quantitatively using the Patlak plot method. Cilostazol was orally administered for 209 days on average. In the global improvement rating assessed on the basis of all subjective symptoms, the final improvement rate, comprising all cases showing moderate or better improvement, was 52.2%. Regarding individual symptoms, dizziness, orthostatic syncope, dull headache, and headache showed improvement rates of 30% or more. Regional cerebral blood flow (rCBF) was increased in both cerebral and cerebellar hemispheres. The global improvement rating for subjective symptoms and the delta % rCBF for every region except the cerebral hemispheres were positively correlated. However, there was no positive correlation between the global improvement rating for psychiatric symptoms and the delta % rCBF for any region. Regarding individual subjective symptoms, dizziness showed an especially high positive correlation of above 0.7 between the improvement rating and the delta % rCBF in the left temporal lobe, basal ganglia, and cerebellum. Headache was observed as an adverse drug reaction in 8 of 24 patients, but it disappeared with reduction of the dose or discontinuation of administration. No other severe adverse drug reactions were noticed. In summary, it was concluded that Cilostazol was useful for treating chronic cerebral circulatory insufficiency.

[Choroidal artery aneurysms of the posterior inferior cerebellar artery presented with fourth ventricular hemorrhage: report of 2 cases].

Two cases involving a ruptured aneurysm in a choroidal branch of the posterior inferior cerebellar artery are reported here. Case 1: A 61-year-old woman was admitted after an episode of severe headache with persistent vomiting. A CT revealed an intraventricular hemorrhage within the fourth ventricle. An angiography showed an aneurysmal shadow in the choroidal artery branching from the telovelotonsillar segment of the distal posterior inferior cerebellar artery (PICA). The operation disclosed a fusiform aneurysm in the choroidal artery which was successfully trapped using Yasargil's mini-clips. The postoperative course was uneventful and the patient was discharged without any neurological deficit. Case 2: A 64-year-old woman became unresponsive after complaining of a severe headache. On admission, she was semicomatose with positive bilateral Babinski's sign. A CT scan showed that the fourth and third ventricles were packed and dilated by a massive hematoma. An angiography demonstrated an aneurysmal shadow in a branch from the PICA with an occlusion of the right vertebral artery. Furthermore, the left vertebral artery was also occluded and the basilar artery was fed by collateral circulation. The patient underwent an operation immediately. The fusiform aneurysm was resected after ligation. Her postoperative course was satisfactory. She was able to go home without neurological deficit. There has been only one article about "pure" choroidal artery aneurysm, reported by Uranishi, et. al in 1994. They suggested that the pathogenesis of this lesion could be due to hemodynamic stress. Our two cases also present the same characteristics, in the shape of the aneurysms as well as in the anomalous structures in the posterior circulation. Our results offer further evidence concerning the pathogenesis of that type of lesion.