Frontal brain activation in young children during picture book reading with their mothers.

AIM: This study was to measure changes in frontal brain activation in young children during picture book reading with their mothers. METHODS: The cross-sectional sample consisted of 15 young Japanese children (eight girls and seven boys, mean age 23.1 +/- 3.4). Two experimental tasks were presented as follows: Task 1 (picture book reading with their mothers); Task 2 (viewing of book-on-video). Duration of task stimulus was 180-sec and the 60-sec interval was filled. Brain activation was measured using an optical topography system. RESULTS: Significant increases in oxy-Hb were observed in both right and left frontal areas in response to Task 1 compared with Task 2. There were significant correlations between child's brain activity and mothers' and children's verbal-nonverbal behaviours. CONCLUSION: There was greater frontal lobe activation in children when they were engaged in a picture book reading task with their mothers, as opposed to passive viewing of a videotape in which the story was read to them. Social and verbal engagement of the mother in reading picture books with her young child may mediate frontal brain activity in the child.

Inhibition of ets, an essential transcription factor for angiogenesis, to prevent the development of abdominal aortic aneurysm in a rat model.

The pathophysiology of abdominal aortic aneurysms (AAA) is considered to be complicated. As matrix degradation contributes to the progression of AAA, the destruction and degradation of elastin fibers caused by an increase in matrix metalloproteinases (MMPs) plays a pivotal role in the development of AAA. Although ets, an essential transcription factor for angiogenesis, regulates MMPs, the role of ets in the development of AAA has not yet been clarified. Thus, we evaluated the role of ets in a rat AAA model using a decoy strategy. Transfection of ODN into AAA was performed by transient aortic perfusion of elastase and by wrapping the AAA in a delivery sheet containing decoy ODN. The inhibitory effect of ets decoy ODN on ets binding activity was confirmed by gel mobility shift assay. MMPs expression was decreased in the aorta transfected with ets decoy ODN as compared to scrambled decoy ODN. Also, ultrasound study demonstrated that elastase-induced aneurismal dilation was significantly suppressed by transfection of ets decoy ODN at 4 weeks after treatment as compared to scrambled decoy ODN. Moreover, the destruction of elastin fibers was inhibited in the aorta transfected with ets decoy ODN, accompanied by a reduction of MMPs expression. An inhibitory effect of decoy ODN on MMP expression was confirmed by ex vivo experiments showing that transfection of decoy ODN into an organ culture of human aorta resulted in significant inhibition of the secretion of both MMP-1 and MMP-9. Here, we demonstrated that ets may play a pivotal role in the progression of AAA through the activation of MMPs in a rat model. Ets might be a potential target to develop pharmacotherapy/gene therapy to treat AAA through the inhibition of MMPs.

Effect of an early intervention programme on low birthweight infants with cerebral injuries.

OBJECTIVE: To determine the effect of an early intervention programme (EIP) on low birthweight infants with cerebral injuries. METHODS: Subjects were 23 high-risk low birthweight infants (periventricular leukomalacia 15, intraventricular haemorrhage 5, both 3) receiving care in the neonatal intensive care unit (NICU) at Nagasaki University Hospital. Subjects were randomly assigned to the EIP group (n = 12) or the control group (n = 11). Participants in the EIP group received a Neonatal Behavioral Assessment scale (NBAS)-based intervention combined with developmental support designed to enhance the infants' development and the quality of the parent-infant relationship. The control group received routine medical nursing care without the EIP. The EIP began prior to discharge from the NICU and lasted until 6 months of corrected age. All children were examined on the NBAS preintervention and again at 44 weeks postconceptional age. Maternal anxiety status (STAI) and maternal feelings of confidence in dealing with her baby (LCC) were measured pre and postintervention. Mental and motor development was assessed postintervention using the Bayley Scale of Infant Development. RESULTS: Orientation and State Regulation of infant behavioural profiles, the STAI and LCC scores significantly improved in the EIP group (mean difference (95% CI): Orientation 0.7 (0.4, 1.1), State Regulation 0.9 (0.3, 1.5), STAI -5.5 (- 9.1, -1.9, LCC 5.3 (4.2, 6.5)), but not in the control group. Bayley mental developmental index (MDI) score in the EIP group was higher than in the control group, but there was no significant difference between the two groups (mean difference (95% CI): MDI 8.5 (- 0.8, 17.8), PDI 6.7 (- 1.9, 15.4)). CONCLUSION: The EIP has beneficial effects on neonatal neurobehavioural development and maternal mental health of low birthweight infants with cerebral injuries. This evidence suggests that short-term changes in maternal mental health and infant neurobehaviour promoted by an EIP may serve to initiate a positive interaction between parents and infants.

Common hepatic artery aneurysm branching from the superior mesenteric artery. Report of a case.

A 58-year-old man was notified as having a mass in the head of the pancreas at medical checkup on September 26, 2000. He was admitted to our department after being diagnosed as having an aneurysm in the common hepatic artery, branching from the superior mesenteric artery (SMA), based on selective SMA angiography. From an abdominal midline incision, we were able to reach his common hepatic artery aneurysm (CHAA) by mobilizing the pancreas through the route lateral to the greater curvature of the stomach. This aneurysm arose in the common hepatic artery immediately after branching from the SMA. After proximal and distal control of the SMA and common hepatic artery, the aneurysm was incised and the distal hepatic artery was anastomosed end to side to the SMA. The patient had an uneventful postoperative course.

Randomised controlled trial of swaddling versus massage in the management of excessive crying in infants with cerebral injuries.

BACKGROUND: Infants with neonatal cerebral insults are susceptible to excessive crying as a result of difficulties with self-regulation. AIMS: To compare the effectiveness of swaddling versus massage therapy in the management of excessive crying of infants with cerebral insults. METHODS: Randomised three-week parallel comparison of the efficacy of two intervention methods. Infants with symptoms of troublesome crying and their parents were randomly assigned to a swaddling intervention group (n = 13) or a massage intervention group (n = 12). RESULTS: The amount of total daily crying decreased significantly in the swaddling group, but did not decrease significantly in the massage group. Infant behavioural profiles and maternal anxiety levels improved significantly in the swaddling group post-intervention. Parents in the swaddling group were more satisfied with the effectiveness of the intervention in reducing crying than parents in the massage group. CONCLUSION: Results indicate that swaddling may be more effective than massage intervention in reducing crying in infants with cerebral injuries.

Quantitative air-plethysmographic venous function and ambulatory venous pressure in patients with primary varicose vein.

AIM: The purpose of this study was to investigate the relationship between air-plethysmographic volume parameters under standard exercise loading and foot venous pressure parameters under ideal exercise loading in patients with primary varicose veins. METHODS: Seventy-one lower limbs in 39 patients with primary varicose veins and 8 lower limbs in 4 healthy controls were examined. The patients included 12 males and 27 females, ranging in age from 36 to 79 years. Eighteen limbs were asymptomatic (class 0) limbs, 28 limbs had symptoms of swelling or heaviness (class 1), and 25 had skin lesions (class 2+3). The patients and controls were examined with duplex scanning, air-plethysmography, and ambulatory foot venous pressure measurement. RESULTS: The mean ambulatory venous pressure (AVP) was significantly higher in the class 2+3 limbs than in the other classes, but it was not significantly higher in class 1 than in class 0. There were no significant differences between the class 2+3 limbs and class 1 limbs in any of the air-plethysmographic parameters. However, the VFI in the class 0 limbs was significantly different from that in the other 2 groups. Among all parameters examined, the venous filling index (VFI) was the most closely correlated with the AVP. All air-plethysmographic parameters were negatively correlated with the VRT. CONCLUSIONS: Among non-invasive air-plethysmographic volume parameters, VFI is the most reliable indicator for quantitative evaluation of calf pump function.

Relationships between matrix metalloproteinases and tissue inhibitor of metalloproteinases in the wall of abdominal aortic aneurysms.

AIM: The pathologic feature of aortic aneurysm is considered to be the remodeling of the aortic wall, involving fragmentation and decrease of elastic fibers in the tunica media. Matrix metalloproteinases (MMPs), particularly MMP-2 and MMP-9, have been implicated in collagen and elastin degeneration within the aortic wall. The precise relationship among MMPs and tissue inhibitor of metalloproteinases (TIMPs) is still unclear. We have studied the expression of MMP-2, MMP-9 tissue inhibitor of metalloprotein-1 (TIMP-1), TIMP-2 and membrane type 1-MMP (MT-1-MMP) in the wall of small AAAs (30-45 mm), large AAAs (>45 mm) and controls (<25 mm). We investigated the relationship among expressions of MMP-2, TIMP-2 and MT1-MMP in the walls. METHODS: The aortic walls in the patients with AAA were harvested from the maximum diameter, while the aortic walls in autopsy cases were harvested as controls. We analyzed tissue distribution of cell types by immunochemistry, protein expression by Western blotting and mRNA expression by competitive polymerase chain reaction. RESULTS: They consisted of 11 in controls, 8 in small AAAs and 26 in large AAAs. Among the MMPs-positive-cells, mainly macrophage, MMP-2-positive cells were in the intima, but MMP-9-positive cells in the intima and adventitia. In the small size, MMP-2 and MMP-9 mRNA were higher than those of control. In the large size, MT1-MMP and MMP-9 mRNA were higher than those of the controls. In the mRNA level of the whole AAA, significant correlations were present between MMP-2 and MMP-9, between MMP-2 and TIMP-1, and between MMP-9 and TIMP-1. These expressions were confirmed by Western blotting. CONCLUSION: We concluded as follows: 1) MMP-2 and MMP-9 may play an important role in the developmental process of AAA. 2) TIMP-1 plays an important role of interacting MMP-2 and/or MMP-9. 3) MMP-2 and MT1-MMP may play an important role in the early stages of AAAs.

Heterotaxy syndrome with pancreatic malrotation: CT features.

We report the case of an asymptomatic elderly man with heterotaxy syndrome who presented with incomplete pancreatic rotation and an aplastic pancreatic uncinate process, polysplenia, nonrotation of the intestine, a midline liver, a midline gallbladder, a right-sided stomach, and interruption of the inferior vena cava with azygos continuation. To our knowledge, pancreatic malrotation with resultant oblique placement has not been described in patients with heterotaxy syndrome, and we speculate that the pancreatic rotation was interfered with by the left lobe of the midline liver in the embryo.

[Clinicopathological character and long-term results of thymic epithelial tumor categorized by WHO classification].

We analyzed clinicopathological character and long term results of 50 thymic epithelial tumors with reference to WHO histologic classification. There were 1 type A tumor, 8 type AB tumors, 13 type B1 tumors, 16 type B2 tumors, 10 type B3 tumors, and 2 type C tumors. Clinical stages were progressive in order of classification type A, AB, B1, B2, B3, and C. Type B1 and B2 were highly associated with myasthenia gravis (MG). There were four multiple thimic tumor in patients of advance clinical stage with polygonal epithelial cell tumor. Long term results were poor in order of the classification of type A, AB, B1, B2, B3, and C. In our study, WHO classification finely reflected the clinical character and prognosis of thymic epithelial tumors.

Left renal artery aneurysm with left accessory renal arteries. A case report.

A 57-year-old man was suspected of having a left renal artery aneurysm on enhanced computed tomography (CT) findings. Aortic angiography showed 3 left renal arteries with an aneurysm of the distal main renal artery. A 3 mm upper pole renal artery which crossed near the aneurysm was preserved. Dissection of the aneurysm was followed by arterial reconstruction with end-to-end anastomosis.

[A case of permanent pacemaker implantation in small infant using steroid-eluting epicardial pacing lead: changes of the pacing threshold in acute phase].

A 1-year-old infant with complete atrioventricular block was successfully treated with the pacemaker implantation using steroid-eluting epicardial pacing lead by the subxyphoid approach. Pacing threshold after implantation were measured frequently to use the function named "Capture management" of the generator (Medtronic: Kappa, Model 701). The postoperative pacing threshold were kept lower and stabilized after 5 weeks.

Atrial blood cyst in an adult with regurgitation of mitral and tricuspid valves.

Blood cysts of the heart are extremely rare in adults and usually involve valves or the left ventricle. Although two cases of blood cysts in the right atrium in adults have been reported, a cyst combined with a disorder of the valves has never been reported. We report a 52-year-old woman with a blood cyst that generated from the right atrial septum. Furthermore, the patient had regurgitation of both the mitral and tricuspid valves and then underwent surgical excision of the blood cyst, mitral valve plasty and tricuspid valve annuloplasty. We believe that it is possible to diagnose blood cysts with echocardiography, CT and magnetic resonance imaging. Echocardiography showed the cyst as a circle without a complete inner free-echo. CT and magnetic resonance imaging showed a mass with a non-enhanced inner structure. Furthermore, the latter showed a cyst that was enhanced by T1- but not T2-weighted images, indicating that the content of the cyst was a persistent substance such as blood. Concerning the generation of blood cysts, we hypothesize that heteroplastic growth arising from primitive pericardial mesothelium causes disorders of valves and blood cysts.

Mitochondrial DNA deletion associated with the reduction of adenine nucleotides in human atrium and atrial fibrillation.

BACKGROUND: Structural changes in the number, size, and shape of mitochondria (mt) have been observed in the atrial muscles of patients with atrial fibrillation (AF) and of animals with rapid atrial pacing, however, it is not known whether the mitochondrial function is impaired in human atrium with AF. MATERIALS AND METHODS: We determined adenine nucleotides concentrations and mtDNA deletions in 26 human right atria obtained at the time of cardiac surgery, using HPLC and PCR amplification, and studied the relationship between mtDNA deletions and clinical manifestations, the haemodynamic parameters of the patients and adenine nucleotide concentrations in their atrium. RESULTS: The age and the prevalence of AF were significantly higher in the patients with a mtDNA deletion of 7.4 kb than in those without a deletion; there were no significant differences regarding haemodynamic parameters between the two groups. The concentrations of ATP, ADP, AMP and total adenine nucleotides in the right atrium were significantly lower in the patients with mtDNA deletions than the patients without a deletion. In a gender- and diseased-matched population, the mtDNA deletion was still significantly associated with age and a decreased concentration of adenine nucleotides in the atrium. Using quantitative PCR analysis, the proportion of mtDNA deletion to normal mtDNA of the atrium, was estimated to be 0.3-2% in four cases. CONCLUSION: These results suggest that the deletion of mtDNA associated with ageing or AF can lead to a bioenergetic deficiency due to an impaired ATP synthesis in the human atrium; however, no conclusion can be made whether mtDNA deletion were the result or the cause of an impaired ATP synthesis, ageing, hemodynamic deterioration, or AF.

Ultrasonic pleural debridement of empyema.

Thoracic decortication is a common procedure for empyema. However, effective dissection without injuring the lung parenchyma is sometimes difficult. We introduce a new technique using an ultrasonic surgical unit (USUTM) to search the dissection plane and simultaneously perform pleural debridement and irrigation with minimal injury of the lung parenchyma. USUTM was used on 5 patients with acute empyema with fibrino-purulent phase and good clinical course was achieved. This procedure facilitates effective pleural debridement under either thoracoscopy or conventional thoracotomy.

Dissociation between T helper type 1 and type 2 differentiation and cytokine production in tumor-infiltrating lymphocytes in patients with lung cancer.

We recently reported the balance of T helper type 1 (Th1) cells and type 2 (Th2) cells in patients with lung carcinomas. This study was conducted to investigate their activity and role in tumors, which remain unclear. We determined the population of lymphocytes with intracellular interferon (IFN)-gamma or interleukin (IL)-4 by flow cytometry, and investigated cytokine production using enzyme-linked immunosorbent assay (ELISA) in 22 patients with non-small cell lung cancer. The IFN-gamma-positive subset showed a significant increase in the number of tumor-infiltrating lymphocytes (TIL) compared with the peripheral blood lymphocytes (PBL) (PBL, 13.8% +/- 1.5%; TIL, 34.3% +/- 3.4%; P < 0.001), and the IL-4 positive subset showed reverse results (PBL, 3.7% +/- 0.6%; TIL, 2.1% +/- 0.3%; P = 0.037). However, TIL did not produce more IFN-gamma than PBL. The results of intracellular IFN-gamma analysis and the production of IFN-gamma in PBL and TIL were significantly correlated (PBL: n = 22, r = 0.50, P = 0.025; TIL: n = 22, r = 0.44, P = 0.022). The dissociation between Th1 differentiation and IFN-gamma production in TIL was one of the host factors influencing the immune anergy against tumors.

Surgical removal of left atrial myxoma through mini sternotomy and the superior transseptal approach.

A 32-year-old man admitted for treatment of a left atrial myxoma showed a 76 x 25 mm tumor in the left atrium originating in the interatrial septum upon echocardiography. The myxoma was surgically removed using a mini sternotomy and the superior transseptal approach. The hospital course was unremarkable. In the 2 years since operation, the patient has remained asymptomatic and tumor-free. The superior transseptal approach is thus useful in surgical removal of left atrial myxoma because it can be excised with minimum manipulation despite the mini sternotomy and small skin incision.

Protein expression of matrix metalloproteinases 2 and 9 and tissue inhibitors of metalloproteinase 1 and 2 in papillary thyroid carcinomas.

Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) play an important role in tumor invasion and metastasis. There have been only a few studies on the protein expression of MMPs and TIMPs in thyroid carcinomas. Therefore, we investigated the protein expression of MMP-2, MMP-9, TIMP-1 and TIMP-2 in 86 papillary thyroid carcinomas using immunohistochemistry, semiquantitative scoring morphometry of immunohistochemistry, gelatin zymography, and western blotting. We also examined the correlations between the immunohistochemical scores and several clinicopathological parameters. The immunoreactivities of MMP-2, MMP-9, TIMP-1, and TIMP-2 were largely located in the tumor cells or non-tumor follicular cells and to a much lesser extent in the fibroblasts and endothelial cells in the tumor and non-tumor regions. Compared with non-tumor regions, these four proteins tended to be overexpressed in the tumor cells; the overexpression was found in 64 of 86 (74%), 80 of 86 (93%), 79 of 86 (92%), and 64 of 86 (74%) cases for MMP-2, MMP-9, TIMP-1, and TIMP-2, respectively. Gelatin zymography showed distinct bands of MMP-2 and MMP-9 in tumor extracts but vague bands in non-tumor extracts. Western blotting revealed the specific bands of MMP-2 and MMP-9 in both tumor and non-tumor extracts. Morphometric scoring revealed that high expression of these proteins significantly correlated with large tumor size, presence of lymph node metastasis, high clinical stage, high intrathyroidal invasion, and high vascular invasion. These data suggest that MMP-2, MMP-9, TIMP-1, and TIMP-2 proteins and activities are increased in tumors cells of papillary thyroid carcinomas and that they play an important role in the invasion and metastasis of papillary thyroid carcinomas.

The correlation between spontaneous and radiation-induced apoptosis in T3B bladder cancer (histological grade G3), and the precedence between the two kinds of apoptosis for predicting clinical prognosis.

PURPOSE: The correlation between the frequency of spontaneous and radiation-induced apoptosis, and the precedence between those for predicting prognosis were studied at clinical level. METHODS AND MATERIALS: Twenty-one patients (mean age, 65.8 years; 16 men and 5 women) with bladder cancer (transitional cell carcinoma Grade 3, T3bN0M0, Stage IIIb) underwent intraoperative radiotherapy: single 30-Gy 12-MV electron beam irradiation to bladder, followed by total cystectomy 6 h after irradiation. The specimens of pretreatment and irradiated bladder cancer were assayed for apoptosis, using TUNEL staining with counter staining of hematoxylin. The apoptotic index (AI) was calculated by dividing the number of apoptotic cells by the total number of cells and multiplying by 100. The Pearson's linear fitting was used to test the correlation between spontaneous and radiation-induced apoptosis. The Kaplan-Meier product-limit estimation was used for overall survival (OS) and freedom from recurrence (FFR). The precedence between spontaneous and radiation-induced apoptosis for predicting the clinical prognosis was estimated using the proportional hazard regression. RESULTS: The mean AI of spontaneous and radiation-induced apoptosis was 1.18 +/- 0.16 and 2.63 +/- 0.45, respectively, which was significantly different. There was strong correlation between spontaneous and radiation-induced apoptosis (r(2) = 0.864, adjusted r(2) = 0.857). Radiation-induced apoptosis was estimated by equation: y (radiation-induced apoptosis) = 2.67 x (spontaneous apoptosis) -0.52. However, the proportional hazard regression test indicated that only spontaneous apoptosis was significant for predicting OS and FFR (&z.sfnc;t&z.sfnc; > 0.2), but radiation-induced apoptosis was not. CONCLUSION: Estimating AI in radiation-induced apoptosis from AI in spontaneous apoptosis is possible. However, spontaneous apoptosis is more accurate in predicting clinical prognosis.

Percutaneous balloon fenestration in a case of traumatic abdominal aortic dissection with lower extremity ischemia.

A 38-year-old man was involved in a traffic accident and experienced a heavy blow to the abdomen. He had traumatic abdominal aortic dissection with right lower extremity ischemia. He underwent percutaneous balloon fenestration, which is safe and minimally invasive, for relief of right lower extremity ischemia. He has been working for 2 years without any signs of vascular compromise. Percutaneous balloon fenestration is one of the few treatments for traumatic abdominal aortic dissection.

Chemosensitivity testing of irinotecan (CPT-11) in ovarian and endometrial carcinomas: a comparison with cisplatin.

BACKGROUND: The tetrazolium dye (MTT) assay is useful in predicting chemosensitivity. MATERIALS AND METHODS: Using an MTT assay, we designed an in vitro chemosensitivity test for irinotecan (CPT-11) and compared it with sensitivity to cisplatin in gynecologic carcinomas removed from 49 patients. RESULTS: The mean tumor inhibition rate (I.R.: %) for irinotecan was relatively inferior to the I.R. for cisplatin in both ovarian and endometrial carcinomas [40.2 vs 53.2 and 43.5 vs 58.0] (p < 0.05, respectively). In ovarian carcinomas, 13 (48.1%) of 27 cases were irinotecan-sensitive (I.R. > or = 50%) and 77% of the tumors were judged to be irinotecan and/or cisplatin-sensitive. There was no significant difference in the I.R. for irinotecan among the various histologic subtypes. Comparing in vitro sensitivity to irinotecan with clinical responses in 8 patients who received irinotecan, the overall accuracy of the MTT assay for evaluating clinical effectiveness was 75% (6 out of 8). In endometrial carcinomas, we found 9 (40.9%) out of 22 cases to be irinotecan-sensitive. The I.R. for irinotecan in G1 carcinomas [33.5] was significantly lower than in G2 carcinomas [59.3] (p < 0.05). CONCLUSION: Our data suggest that irinotecan appears to have moderate antitumor activity in vitro against both ovarian and endometrial carcinomas and that differences in irinotecan sensitivity among the histologic subtypes were evident in the latter but not in the former.