Association of the G-protein ß3 subunit gene polymorphism with the incidence of cardiovascular disease independent of hypertension: the Funagata study.

Association of the C825T G-protein ß3 subunit (GNB3) gene polymorphism with cardiovascular disease (CVD) incidence was examined in a population-based longitudinal study of the Japanese individuals. The incidence of CVD (stroke and coronary heart disease (CHD)) was assessed in a cohort population (n=1524) consisting of participants of the 2001-2005 Funagata study through March 2008. Cumulative incidences according to genotype were compared with the Kaplan-Meier product-limit method. During the follow-up, 78 subjects experienced a CVD event (stroke: n=54; CHD: n=30; both consecutively: n=6). At the end of the follow-up (longest and median follow-up periods: 81 and 68 months, respectively), the cumulative incidence of CVD for the TT genotype was significantly higher than that of the C-carriers (0.077 vs 0.042, P=0.004). Blood pressures and the prevalence of hypertension were not different between the genotypes. Cox's proportional hazard analysis showed that the TT genotype is a significant risk factor for CVD (hazard ratio (HR)=1.82 (95% confidence interval (CI) 1.14-2.89); P=0.012) and stroke (HR=1.76 (95% CI: 1.01-3.07); P=0.048) incidences after adjustment for age, sex, hypertension, hyperlipidemia, diabetes, alcohol drinking and smoking at baseline. The TT genotype of the C825T GNB3 gene polymorphism was found to be a significant risk factor for the incidence of CVD and stroke independent of hypertension and other established CVD risk factors in a Japanese population.

Angiotensin-converting enzyme gene and retinal arteriolar narrowing: the Funagata Study.

The purpose of this study is to determine whether the angiotensin-converting enzyme (ACE) gene polymorphism is associated with retinal arteriolar narrowing, a subclinical marker of chronic hypertension. The Funagata Study examined a population-based sample of Japanese aged 35+ years; 368 participants had both retinal vessel diameter measurements and ACE insertion/deletion (ACE I/D) polymorphism analyses performed. Assessment of retinal vessel diameter and retinal vessel wall signs followed the protocols used in the Blue Mountains Eye Study. ACE gene polymorphisms D/D, I/D and I/I were present in 34 (9.2%), 170 (46.2%) and 164 (44.5%) participants, respectively, distributed in Hardy-Weinberg equilibrium. After multivariable adjustment, retinal arteriolar diameter was significantly narrower in subjects with the D/D genotype compared to subjects with I/D and I/I genotypes (mean difference -6.49 microm, 95% confidence interval (CI): -12.86 microm, -0.11 microm). Our study suggests that the ACE I/D polymorphism may be associated with subclinical structural arteriolar changes related to chronic hypertension.

The metabolic syndrome and retinal microvascular signs in a Japanese population: the Funagata study.

AIMS: To determine the relationship of metabolic syndrome and its components with retinopathy and other retinal microvascular signs in a Japanese population. METHODS: The Funagata study recruited 1961 (53.3% of eligible) Japanese aged 35 or older. The metabolic syndrome was diagnosed primarily using definitions of the International Diabetes Federation. Retinopathy and retinal microvascular signs were assessed from fundus photographs. Retinal arteriolar and venular diameters were measured using a computer-assisted programme. RESULTS: Data were available for analysis in 1638 persons for retinopathy and retinal microvascular signs and 921 persons for retinal vessel diameters. Various components of the metabolic syndrome were associated with retinal microvascular signs: a larger waist circumference was associated with wider venular diameter and retinopathy lesions; a higher blood pressure level was associated with focal arteriolar narrowing, arteriovenous nicking, enhanced arteriolar wall reflex and narrower arteriolar diameter; and a higher triglyceride level was associated with enhanced arteriolar wall reflex. Overall, persons with the metabolic syndrome were more likely to have retinopathy (odds ratio 1.64, 95% CI: 1.02 to 2.64) and wider venular diameter 4.69 microm (95% CI: 1.20 to 8.19 microm) than persons without the metabolic syndrome. CONCLUSION: We report associations of metabolic syndrome components with retinopathy and wider venular diameter in Japanese adults. These data suggest that metabolic abnormalities, indicated by metabolic syndrome components, are associated with microvascular changes in the retina. There was no synergistic effect of the metabolic syndrome on retinal microvascular changes beyond its individual components.

Genotype Arg/Arg, but not Trp/Arg, of the Trp64Arg polymorphism of the beta(3)-adrenergic receptor is associated with type 2 diabetes and obesity in a large Japanese sample.

OBJECTIVE: Despite a large number of studies, no association of the Trp64Arg polymorphism of the beta(3)-adrenergic receptor gene with obesity and type 2 diabetes has yet to be clearly elucidated. We examined the associations in a large population-based sample. RESEARCH DESIGN AND METHODS: A total of 1,685 subjects (935 women and 750 men, aged 58.7 +/- 12.4 years) from a cohort population (n = 3,706) of the Funagata Diabetes Study were divided into three groups according to genotypes: Trp/Trp (n = 1,155), Trp/Arg (n = 486), and Arg/Arg (n = 44). Glucose tolerance was diagnosed according to the 1985 World Health Organization criteria. Subjects who had a BMI > or =30 kg/m(2) were considered obese. Associations with the traits related to obesity, diabetes, hypertension, and dyslipidemia were also examined. The chi(2) test and analysis of variance were used for the association studies and to assess the differences in the traits' values, respectively. RESULTS: More subjects with genotype Arg/Arg were obese and had diabetes (13.6% for each) than those with genotype Trp/Trp (3.29%, P < 0.001; and 4.16%, P = 0.007, respectively) or genotype Trp/Arg (2.06%, P < 0.001; and 5.97%, P = 0.051, respectively). No significant differences in the frequencies of occurrence of these conditions were observed between genotypes Trp/Arg and Trp/Trp. Traits related to obesity, such as percent body fat (28.82 +/- 7.95 vs. 25.93 +/- 7.21, P = 0.038) and BMI (25.07 +/- 3.84 vs. 23.63 +/- 3.18, P = 0.018), were higher in the genotype Arg/Arg than in the genotype Trp/Trp groups. CONCLUSIONS: Genotype Arg/Arg, but not Trp/Arg, of the beta(3)-adrenergic receptor was associated with both obesity and type 2 diabetes in a large Japanese sample.

Removal of anterior clinoid process for basilar tip aneurysm: clinical and cadaveric analysis.

The difficulty in the operation for basilar tip aneurysm is the restriction in surgical working space. To resolve this problem, aggressive skull base surgery has been reported, but these techniques are not prevalent. Pterional and subtemporal approaches are commonly used for basilar tip aneurysms. In an attempt to increase the surgical working space during the pterional approach, the anterior clinoid process and the roof of the optic nerve were removed extradurally to increase the mobilization of the intracranial internal carotid artery and optic nerve. The effects of removing the anterior clinoid process and microanatomy in the perioptic area were analyzed by cadaveric procedures in 10 cases (20 sides). With this procedure, the internal carotid artery can be retracted medially with a spatula 6.1 +/- 0.8 mm (mean +/- SD). The length and the area of dural fold in the bone defect region in the optic canal roof are 2.1 mm and 13.6 mm. In 10 clinical cases, this procedure allowed enough space to approach the basilar tip aneurysm without disturbing the internal carotid artery blood flow. The clinical outcome was satisfactory.

Method to improve cosmetic outcome following craniotomy.

This technical note describes a simple method for reducing the dead space created by craniotome due to the loss of bone dust and improving the cosmetic outcome following a craniotomy. After drilling the burr holes for the craniotomy, the bone between the holes is drilled away in a standard fashion except that multiple regions of about 1 cm in length are left intact. These intact regions are broken using a periosteal elevator and fixed like a bridge when the bone is replaced. The resulting bone flap is readily returned to its original position without making the dead space created by regular craniotomy. The amount of the dead space caused by losing the bone dust is reduced and a good cosmetic recovery is obtained. This technique is useful for both craniotomy and facial bone surgery, which requires cosmetic results.

Enlarged entry space for the transpetrosal approach.

This report describes the removal of the roof of the external auditory meatus in approaching the tentorial edge, the cerebropontine angle, hippocampal brainstem lesions, and upper clival lesions. This procedure not only provides more space in approaching the tentorial edge or upper brainstem, it also provides a wider entry space for approaching posterior fossa lesions. This approach is also for lesions located lower than the tentorium or in the upper clivus. There is still some confusion about the method for removing the roof of the external auditory canal. We describe the clinical experience and comprehensive surgical procedures used on cadavers. Our extended temporal craniotomy technique using the removal of the roof of the external auditory meatus is a simple, safe, and useful method for obtaining a wider entry space to approach deep perimesencephalic lesions and the posterior fossa.

Expression of water channel mRNA following cerebral ischemia.

Water channel is a protein which regulates transcellular water permeability. Among mRNA expression of six principal mammalian water channels, AQ4 mRNA expression was highest in the brain. Water channels are supposed to regulate cerebral edema but the detailed physiological and pathological function is unknown. Brain edema has been analyzed as an aspect of ion channel injury or membrane injury. However the transportation of water molecule itself following cerebral ischemia is unknown. As water channels transport only water molecules, the functional changes of water channels following cerebral ischemia are of great interest. To evaluate the role of water channels in cerebral edema following cerebral ischemia, the changes of water channel mRNA expression were evaluated. Cerebral edema was induced by suture method. The extraction of water channel mRNA was performed according to Chomczynsli and Sacchi. RT-PCR was applied to extracted mRNA. Water channel mRNA electrophoresis was performed. For semi-quantified evaluation of water channel, mRNA intensities of the infarct hemisphere and normal hemisphere were compared. The expression of water channel mRNA was decreased following cerebral ischemia. This damage leads to loose physiological control of water permeability of the cell membrane in the neuron, glia and endothelial cells which leads to brain edema.

Zygomatic arch cracking for cosmetic improvement: technical note.

We describe a simple cracking method for removing the zygomatic arch. The drilling line of the zygomatic arch is partially drilled from the back, and the surface is left undrilled. The zygomatic arch is cracked during its removal in order to secure its position for later fixation. Dead bone spaces can be avoided by this method and the zygomatic arch can be replaced in its original position. By adding this procedure to the standard technique, this cracking method is a simple, safe and useful way to achieve better cosmetic results.

[The use of computers and networking in the neurosurgical field].

Due to the improvements in computer and network technology, we are able to use medical information easily and safely on the network in medical institutions. In our department, we constructed and used an original Intranet with light fibers. The network links the outpatient room, ward, operation room, staff room and the examination room. Moreover, many computers and medical instruments are connected to the Intranet. Since our original Intranet has no connection with the outside network, we are able to access the patient's medical information safely. Using access management of identity and a password on the server, the client can present the medical information with sound and movie upon request of the patients and their families, medical students, nurses and doctors. Doctors can also search and input the patient's most recent medical information on a network database of every client. By linking the examination machine and operation aided instrument to the Intranet, we were able to forward the patient's medical information to the operation aided instrument easily and quickly. Furthermore, we will be able to perform tele-medicine and tele-operation in the near future: that is, the medical staff can guide the neurosurgical operation outside of the operation room with a microscope and computer view using picture mutual communication devices. By strict access to the management of our Intranet, we are able to use the medical information effectively for patient's treatment, operation, education and study on the network with no connection to the outside network.

[Skull base metastasis from renal cell carcinoma presenting as abducens nerve paresis: report of two cases].

We report two cases of skull base metastasis from renal cell carcinoma. Case 1: A 55-year-old female presented with a skull base tumor located on the clivus. Partial removal of the tumor was performed via the transsphenoidal approach. Case 2: A 44-year-old male presented with a skull base tumor occupying the orbital, nasal, and paranasal cavities. The first operation, partial removal of the tumor, was performed via the transsphenoidal approach. Thereafter, the tumor regrowth and the patient's symptoms were progressive, so a second operation was performed via Le-Forte I craniotomy to prevent cranial nerve dysfunction and air way obstruction. The initial symptom of these two cases was abducens nerve paresis, which is caused by the tumor extending from the clivus to the cavernous sinus. The neuroradiological features were the destruction of skull base bone and angiographic tumor stain. Histopathological examination of the surgically resected specimens revealed clear cell carcinoma, and thereafter they were diagnosed as skull base metastasis from renal cell carcinoma. We emphasize the necessity of a thorough medical workup to enable speedy diagnosis of renal cell carcinoma in such cases.

Sub-kilohertz flash X-ray generator utilising a glass-enclosed cold-cathode triode.

The construction and fundamental studies are described for a sub-kilohertz X-ray generator for producing low-dose rate flash X-rays. The X-ray tube was a glass-enclosed cold-cathode triode, composed of a tungsten plate target, a rod-shaped graphite cathode, a mesh-type trigger electrode made of tungsten wires, and a glass tube body. The coaxial condenser was charged up to 60 kV by a power supply, and the electric charges in the condenser were discharged to the X-ray tube repetitively when a negative high-voltage pulse was applied to the trigger electrode. The maximum tube voltage before the discharging was equivalent to the initial charged voltage of the condenser, and the maximum tube current was about 0.3 kA with a charged voltage of 60 kV. The X-ray durations were about 1 microsecond, and the X-ray intensity was about 0.47 microC kg-1 at 0.5 m per pulse with a charged voltage of 60 kV. The maximum repetition rate of the X-rays was about 0.4 kHz, and high-speed radiography was performed.

10 kHz microsecond pulsed X-ray generator utilising a hot-cathode triode with variable durations for biomedical radiography.

A 10 kHz pulsed X-ray generator utilising a hot-cathode triode in conjunction with a new type of grid control device for controlling X-ray duration is described. The energy-storage condenser was charged up to 70 kV by a power supply, and the electric charges in the condenser were discharged to the X-ray tube repetitively by the grid control device. The maximum values of the grid voltage (negative value), the tube voltage, and the tube current were -1.5 kV, 70 kV, and 0.4 A, respectively. The duration of the flash X-ray pulse was primarily determined by the time constant of the grid control device and the cut-off voltage of thermoelectrons. The X-ray duration was controlled within a region of less than 1 ms; the X-ray intensity with a pulse width of 0.27 ms, a charged voltage of 70 kV, and a peak tube current of 0.4 A was 0.92 microC kg-1 at 0.5 m per pulse. The maximum repetition rate was about 10 kHz, and the size of the focal spot was about 3.5 x 3.5 mm.

Disk-cathode flash X-ray tube driven by a repetitive two-stage Marx pulser.

Fundamental studies of a repetitive flash X-ray generator using a disk-cathode radiation tube are described. The high-voltage pulser employed a modified two-stage surge-Marx circuit. The two condensers in the pulser were charged from 40 to 60 kV, and the electric charges were discharged to the X-ray tube repetitively to generate flash X-rays. The total capacity during the main discharge was 425 pF, and the maximum output voltage from the pulser was about 1.9 times the charged voltage. The flash X-ray tube was of the demountable-diode type and was composed of a rod-shaped anode tip made of tungsten, a disk cathode made of graphite and a tube body made of polymethylmethacrylate. The peak tube voltage was primarily determined by the anode-cathode (A-C) space, and the peak tube current was less than 0.5 kA. Thus the maximum photon energy could be easily controlled by varying the A-C space, and the tube current roughly increased according to increases in the charged voltage. The pulse width ranged from 40 to 100 ns, and the X-ray intensity was less than 1.1 microC kg-1 at 0.5 m per pulse. The repetition rate was less than 50 Hz, and the effective focal spot size was equivalent to the anode diameter.