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Biomedical subjects

K Hayashida

Publications and source records attributed to K Hayashida.

At least 55 records · Page 3Linked to original sources

Nucleotide variations amongst V(H)Genes of AMA-producing B cell clones in primary biliary cirrhosis.

Primary biliary cirrhosis, a chronic liver disease characterized by progressive inflammatory destruction of intrahepatic bile ducts, is also characterized by the presence of antimitochondrial antibodies (AMA). The predominant autoantibody is directed at the E2 component of pyruvate dehydrogenase (PDC-E2). Recent studies of this autoantibody response have analysed immunoglobulin-variable regions of human monoclonal antibodies and provided evidence for antigen-driven clonal selection. However, the number of clones analysed has been very limited and the presence of somatic mutations not formally proven. In this study, we took advantage of three stable B cell lines producing human IgG anti-PDC-E2 mAbs from a patient with PBC. We analysed the V(H)and V(L)gene structure of these reagents and, in addition, analysed 10 V(H)-D and D-J(H)sequences over a period of nearly 3 years. The expressed Ig V regions of the heavy chain (V(H)) and the light chain (V(L)) genes of mAb18, mAb37, and mAb82 utilized the V(H)III-VlambdaI, V(H)IV-VlambdaIII, and V(H)IV-V(k)IV gene families, respectively. The utilized gene elements were Ig gene elements that were found frequently in other antibodies with different specificity and affinity. Presence of somatic point-mutations was confirmed in mAb82 by comparison of the expressed V(H)gene sequence with that of corresponding germline V(H)gene obtained from the granulocyte genomic DNA of the same patient. Interestingly, clonally related B cells were consistently found throughout the observation period and nucleotide variations among the V(H)genes were very few, ranging from 0.19 to 0.72% per base. These findings suggest that long-lived B cell clones can exist and may contribute, at least in part, to maintenance of autoantibodies in humans.

Amino Acid Sequence↗

Hemodynamic and metabolic state of hyperfixation with 99mTc-HMPAO brain SPECT in subacute stroke.

By means of positron emission tomography (PET), we investigated the hemodynamic and metabolic state of the hyperfixation identified as the increased accumulation with 99mTc-d,l-hexamethylpropyleneamine oxime (HMPAO) by single photon emission computed tomography (SPECT) in patients with subacute stroke. We studied four patients with subacute stroke having hyperfixed areas evaluated with CBF, CMRO2, OEF and CBV by PET. The hyperfixation rate with 99mTc-HMPAO was obtained by comparing the surplus rate with standardized CBF. The OEF and CMRO2 values in the hyperfixed areas of 4 patients were significantly lower than those in normal 5 controls (p < 0.01), but CBF and CBV were almost the same in patients and normal controls, but the hyperfixation rate of 0.30 +/- 0.15 in 4 patients correlated well with CBV (r = 0.97, y = 11.75x + 0.42; p < 0.05). Hyperfixation with 99mTc-HMPAO in the infarct area revealing a mismatch between CMRO2 and CBF meant relative luxury perfusion. The hyperfixation rate determined by 99mTc-HMPAO brain SPECT correlated with CBV in the PET study. We can conclude that one of the main factors which caused hyperfixation was vasodilatation as well as the blood brain barrier disruption and the neovascularization.

Adult↗

Low cell binding ability of HCV is closely related to interferon treatment especially in patients with HCV genotype 2a/2b. A large series prospective study on Japanese patients with chronic hepatitis C.

BACKGROUND/AIMS: We have previously shown that the quantity of antibody-free virion in the pre-treatment sera of the patients with chronic hepatitis C is a good predictive factor for the efficacy of interferon treatment. However, the biological significance of the free virion should be verified by a prospective study. METHODS: We prospectively evaluated 152 consecutive patients with chronic hepatitis C who received a standardized interferon treatment, and analyzed the free virion and the binding titers, the ability of hepatitis C virus (HCV) to bind to the human lymphocytic cell line. RESULTS: Sixty-five patients achieved a long-term sustained remission, 76 patients did not respond to the interferon therapy, and 11 patients dropped out. The sera from the patients with genotype 2a/2b had significantly lower free virion and cell binding titers than those with genotype 1b. A multivariate analysis showed three independent variables associated with the interferon response; cell binding titer <10(0.5)/ml, viral load <10(4.5) copies/50 microl, and genotype 2a/2b with odds ratios of 14.6, 11.8, and 9.8, respectively. CONCLUSIONS: The low level of in vitro cell binding ability of HCV helped to clarify the good responsiveness to interferon observed in patients especially with a high viral load of genotype 2a/2b.

Adult↗

Changes in subjective sleepiness, subjective fatigue and nocturnal sleep after anaesthesia with propofol.

The purpose of this study was to clarify the changes in psycho-physiological functions after anaesthesia with propofol (PF). The subjects were seven healthy male volunteers and the duration of the anaesthesia was 1 h (14:00-15:00 h). The plasma concentration of PF immediately decreased after the anaesthesia. The subjective sleepiness and VAS (visual liner analogue scale) scores (i.e. effort to do something) increased significantly at 20 min after the anaesthesia. However, these changes were improved at 80 min after the anaesthesia. The sleep latency at the nocturnal sleep 8 h after the anaesthesia was prolonged significantly, but the other parameters including the distributions of stage 3 + 4 and the rapid eye movement 'REM' stage were not changed.

Adult↗

Foot deformities in rheumatoid arthritis and relevance of disease severity.

OBJECTIVE: To investigate foot deformities in rheumatoid arthritis (RA) in relation to the disease severity. METHODS: Radiographs of 100 weight bearing feet of 50 patients who had had RA for >10 years (mean 13.5 years) were studied. The patients were classified into 2 study groups according to the severity of disease. We measured hallux valgus angle (HVA), intermetatarsal angle between first and 2nd (M1/2), and intermetatarsal angle between first and 5th (M1/5) on anteroposterior (AP) radiographs, as well as calcaneal pitch (CP) and first metatarsal pitch (MP) on lateral radiographs. The differences in these angles between the 2 groups (Inter-group study) and the correlations among angles within each group (Intra-group study) were examined. RESULTS: Inter-group study showed significant differences between the 2 groups for all variables. Intra-group study, on the other hand, showed no correlation between variables of the 2 deformities, i.e., splaying of forefoot (M1/2 and M1/5) and flattening of longitudinal arch (CP and MP). Only HVA correlated with the splaying (M1/2 and M1/5) in both study groups. CONCLUSION: Disease severity is related to the progression of foot deformities in RA, but the flattening and the splaying are not correlated with each other. We believe that foot deformities should be treated properly and early, especially for patients who are expected to have severe disease.

Adult↗

Brain fluorine-18 fluorodeoxyglucose imaging with dual-head coincidence gamma camera: comparison with dedicated ring-detector positron emission tomography.

BACKGROUND AND PURPOSE: Dual-head coincidence gamma camera (DHC) imaging has been proposed as an alternative to dedicated ring-detector positron emission tomography (dr-PET) for clinical fluorodeoxyglucose (FDG) studies. The purpose of this investigation was to assess the quality of DHC images in FDG studies of the human brain. METHODS: Seven healthy volunteers and 12 patients with various cerebral disorders underwent consecutive brain dr-PET and DHC with FDG. All sets of images were compared semiquantitatively using regions of interest. RESULTS: Cortical count ratios to the cerebellum on DHC and dr-PET images did not differ significantly among the volunteers, except in the superior frontal cortex and thalamus. In all studies including those of cerebral disorders, the mean cortical-to-cerebellar ratios of DHC and dr-PET images correlated closely. CONCLUSION: FDG imaging with DHC delineated the metabolic distribution of glucose in the brain as well as dr-PET did, except in the superior frontal cortex and thalamus. Therefore, DHC may be a dedicated cost-effective means of detecting metabolic abnormalities in the brain.

Adult↗

Antibody-free virion titer greatly differs between hepatitis C virus genotypes.

Hepatitis C virus (HCV) virions have been shown to be bound to antibodies in patients with chronic HCV infection. The sera from patients infected with genotype 1b HCV contained more antibody-free virions than those from patients with genotype 2a/2b HCV. When compared at the same levels of serum HCV RNA, free virion titers of genotype 2a/2b-infected patients were much lower than those of genotype 1b-infected patients, indicating that a larger fraction of HCV virions are bound to antibodies in the former than in the latter. The gene segments encoding the hypervariable region (HVR) 1, a principal neutralization epitope, of HCV were amplified from the patients' sera by reverse transcription-polymerase chain reaction. The majority of genotype 2a/2b-infected patients had very similar HVR 1 sequences to one another, whereas patients infected with genotype 1b HCV had highly heterogeneous sequences. Differences in the amount of antibody-free virion and HVR1 sequence variability between genotypes may have an implication in HCV pathogenesis.

Adult↗

Attenuation correction for cardiac dual-head gamma camera coincidence imaging using segmented myocardial perfusion SPECT.

UNLABELLED: The diagnostic accuracy of cardiac FDG imaging obtained with the dual-head coincidence gamma camera (DHC) is impaired by artifacts induced by nonuniform attenuation. This study proposed a new method (registration and segmentation method for attenuation correction [AC-RS]) to correct these attenuations in the chest region without the need for additional hardware or expensive transmission scanning equipment. METHODS: Before DHC imaging, 99mTc-tetrofosmin SPECT was performed using dual-energy acquisition from both the photopeak and Compton scatter windows. The scatter window images of the 99mTc-tetrofosmin were then registered 3-dimensionally with the cardiac DHC images and segmented into anatomic regions to obtain body and lung contours by applying the optimal threshold method on localized histograms. Theoretic attenuation coefficient values were assigned to the corresponding anatomic regions, and the DHC emission images were reconstructed using these attenuation correction factors. The results were quantitatively evaluated by imaging a cardiac phantom filled with a uniform solution and placed in a chest phantom. Eight nondiabetic subjects were also examined using this technique, and the results were compared with those of measured attenuation-corrected PET images. RESULTS: Use of this technique in phantom and clinical studies decreased the degree of artifacts seen in the inferior wall activity and corrected the emission images. When the results were compared with those of PET scans, the regional relative counts of the uncorrected DHC scan did not correlate with the results of the PET scan. However, the regional relative counts of the AC-RS-corrected DHC scan exhibited a linear correlation with the results of the PET scan (r = 0.73; P < 0.001). CONCLUSION: Reasonably accurate attenuation-corrected cardiac DHC images can be obtained using AC-RS without the need for transmission scanning.

Aged↗

[Midazolam-atropine lollipop for pediatric premedication].

Strawberry flavored sweet lollipop containing midazolam (5 mg) and atropine (0.25 mg) was evaluated for the premedication of pediatric patients as judged by sedative and anti-anxious effects and gastric fluid volume and acidity. The subjects of this prospective, double blind, random and controlled study were 175 children aged between 6 months and 10 years. They were divided into three groups: group A patients receiving the lollipop containing only 5 mg midazolam (n = 78), group B patients receiving the lollipop containing only 0.25 mg atropine (n = 21), and group C patients receiving the lollipop containing 5 mg midazolam and 0.25 mg atropine (n = 76). The plasma midazolam concentration was measured in ten children in group A. The sedative and anti-anxious effects were scaled with four levels. The children receiving the lollipop containing midazolam (group A and C) showed a better level of the sedative and anti-anxious state. The volume of gastric fluid of group A was more than those of group B and C. The pH of group A gastric fluid was also higher than those of other groups. The correlation equation of the plasma midazolam concentration (y ng.ml-1) against time (t min) was y = 149 x e(-t/64), (r = 0.775). These results suggest that midazolam-atropine lollipop is one of the favorable choices as the premedication for pediatric patients.

Adjuvants, Anesthesia↗

Estimation of myocardial perfusion and viability using simultaneous 99mTc-tetrofosmin--FDG collimated SPECT.

UNLABELLED: This study was designed to elucidate the usefulness of crosstalk correction for dual-isotope simultaneous acquisition (DISA) with 99mTc-tetrofosmin and FDG in estimating myocardial perfusion and viability. METHODS: Eighteen patients with coronary artery disease were studied. First, SPECT was performed with a low-energy high-resolution collimator after a single injection of 99mTc-tetrofosmin (single 99mTc-tetrofosmin). Second, PET and DISA with an ultra-high-energy collimator were performed after glucose loading and an injection of FDG. DISA was designed to operate with simultaneous 3-channel acquisition, and weighted scatter correction of crosstalk from the 18F photopeak to the 99mTc photopeak was performed by modification of an existing dual-window technique. The FDG SPECT images were compared with the images obtained by PET. Both crosstalk-corrected and uncorrected 99mTc-tetrofosmin images were generated and compared with the single 99mTc-tetrofosmin images. RESULTS: Regional percentage uptake of FDG agreed well between DISA and PET. However, regional percentage uptake of 99mTc-tetrofosmin was generally higher on the uncorrected 99mTc-tetrofosmin images than on the single 99mTc-tetrofosmin images, especially in areas of low flow (percentage count of 99mTc-tetrofosmin > or = 50%). The crosstalk correction contributed to improving the agreement between regional percentage uptakes and significantly improved the detectability of myocardial perfusion-metabolism mismatching. CONCLUSION: With 3-channel acquisition and weighted-scatter correction of crosstalk from the 18F photopeak to the 99mTc photopeak, DISA with 99mTc-tetrofosmin and FDG is feasible for assessing regional myocardial perfusion and viability.

Aged↗

Protective effect of S-nitrosylated alpha(1)-protease inhibitor on hepatic ischemia-reperfusion injury.

S-Nitrosylated compounds (nitrosothiols; RS-NOs) function as nitric oxide (NO) reservoirs and preserve the antioxidant activities of NO. We found remarkable cytoprotection by an S-nitrosylated protease inhibitor from human plasma, S-nitroso-alpha(1)-protease inhibitor (S-NO-alpha(1)-PI) that possesses a completely nitrosylated SH group, in hepatic ischemia-reperfusion injuries in rats. Liver ischemia was induced in rats by occluding both the portal vein and hepatic artery for 30 min and was followed by reperfusion. S-NO-alpha(1)-PI and control compounds such as native alpha(1)-PI, an NO synthase (NOS) inhibitor, and standard RS-NOs were given via the portal vein just after reperfusion was initiated. Liver injury was evaluated by measuring the extracellular release of liver enzymes (aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase). Infiltration of neutrophils and induction of apoptosis and heme oxygenase-1 (HO-1) in the liver were also examined. Maximal liver injury occurred at 3 h after reperfusion and then decreased gradually. Not only did S-NO-alpha(1)-PI treatment (0.1 micromol; 5.3 mg/rat) greatly reduce elevation of liver enzymes in plasma, as well as neutrophil accumulation and apoptotic change in liver, it also improved the impaired hepatic blood flow as assessed by laser Doppler flowmetry and potentiated the induction of HO-1 in the liver. Although native alpha(1)-PI moderately reduced liver injury, low molecular weight RS-NOs such as S-nitrosoglutathione and S-nitroso-N-acetyl penicillamine produced no obvious protective effect. An NOS inhibitor exacerbated the hepatic ischemia-reperfusion injuries. These results suggest that S-NO-alpha(1)-PI exerts a potent cytoprotective effect on ischemia-reperfusion liver injury by maintaining tissue blood flow, inducing HO-1, and suppressing neutrophil-induced liver damage and apoptosis.

Animals↗

Efficacy of direct revascularization in adult Moyamoya disease: haemodynamic evaluation by positron emission tomography.

To evaluate the efficacy of direct cerebrovascular reconstruction to prevent intracranial bleeding from the point of view of haemodynamic status, we performed positron emission tomography (PET) studies in 5 adult patients with Moyamoya disease before and after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. Regional cerebral blood flow (rCBF), regional cerebral metabolic rate of oxygen (rCMRO2) and regional oxygen extraction fraction (rOEF) in the MCA territories and regional cerebral blood volume (rCBV) in the striatum were measured before and after STA-MCA anastomosis. Correlation between the change of these PET parameters and post-operative decreased opacification of Moyamoya vessels were analyzed. Pre-operatively, significant elevation of rCBV were observed in the basal ganglia as well as significant reduction of rCBF and elevation of rOEF with reduction of rCMRO2 in the MCA territories, indicating "misery" perfusion in the cerebral hemisphere and blood pooling in the Moyamoya vessels under increased haemodynamic stress. Post-operative PET study showed improvement of misery perfusion and reduction of rCBV in the basal ganglia. Reduction of rCBV in the basal ganglia generally compatible with decreasing Moyamoya vessels on angiographic findings. Our results suggests that direct bypass surgery could have a potential both for decreasing haemodynamic stress on Moyamoya vessels and to improve misery perfusion in the hemisphere.

Adult↗

Modified Caspari technique for traumatic anterior shoulder instability: comparison of absorbable sutures versus absorbable plus nonabsorbable sutures.

The efficacy of the Caspari technique using a combination of absorbable and nonabsorbable sutures was compared with that of using only absorbable sutures. Forty-four patients (45 shoulders) underwent our modified Caspari technique for traumatic anterior shoulder instability and were followed-up for 2 to 3 years postoperatively. The average age at operation was 22 years. Among 27 patients treated using all absorbable PDS sutures, 7 patients had recurrent instability (success rate, 74%). Among 18 patients treated using both PDS and nonabsorbable polypropylene sutures, only one showed apprehension after a direct blow to the shoulder sustained by falling from a height (success rate, 94%). The mean stability score according to Rowe's criteria was significantly higher in the combination of absorbable and nonabsorbable group (P = .0412). External rotation increased more slowly in the combination of absorbable and nonabsorbable group than in the absorbable group. The mean limitation of external rotation was 8.4 degrees and 2.7 degrees, respectively (P = .0129). The modified Caspari technique using both absorbable and nonabsorbable sutures achieved excellent stability according to Rowe's criteria and external rotation showed more gradual improvement compared to repair with absorbable sutures alone.

Absorbable Implants↗

Viable tissue in an area of severely reduced perfusion demonstrated with I-123 iomazenil brain SPECT imaging of benzodiazepine receptors.

A 70-year-old woman who experienced transient left hemiparesis had 90% stenosis of the right internal carotid artery. CT revealed small low-density areas in the subcortical frontal area. Baseline cerebral blood flow was reduced, and vasoreactivity was poor in the right frontoparietal area according to I-123 IMP brain SPECT with acetazolamide. The distribution of I-123 iomazenil was normal on the delayed SPECT image but reduced in the early SPECT image, mimicking baseline cerebral blood flow. The distribution of I-123 iomazenil SPECT on the delayed image reflected the normal binding potential of the benzodiazepine receptor and thus identified viable tissue in an area of severely reduced perfusion. These findings were confirmed by positron emission tomography.

Acetazolamide↗

Visualization of functional improvement by 123I-IMP lung SPET after thromboendarterectomy for chronic pulmonary embolism.

We report on six patients with chronic pulmonary embolism who underwent 123I-IMP and 99Tcm-MAA lung SPET before and after thromboendarterectomy. 123I-IMP lung SPET can assess the viability of lung parenchyma, because it is a non-particulate agent that accumulates in the endothelial membranes of pulmonary capillaries. Chronic pulmonary thromboembolism accompanied by pulmonary hypertension has a poor prognosis that may be improved only by thromboendarterectomy. We compared 123I-IMP and 99Tcm-MAA lung SPET in terms of functional improvement after such surgery. After thromboendarterectomy, all six patients were functionally improved, according to the criteria of the New York Heart Association. The pre- and post-surgery percentage of vascular obstruction did not differ significantly with 99Tcm-MAA lung SPET (44.8 +/- 11.2% and 32.5 +/- 15.6% pre- and post-surgery, respectively). In contrast, 123I-IMP lung SPET revealed a significant pre- versus post-surgery difference (15.5 +/- 9.5% and 3.3 +/- 5.9% pre- and post-surgery, respectively). 123I-IMP lung SPET could be useful for evaluating thromboendarterectomy because pulmonary parenchymal viability owing to arterial microvasculature can be estimated.

Adult↗

Dermatomyositis associated with invasive thymoma.

We report a case of dermatomyositis (DM) associated with invasive thymoma in a 22-year-old woman who was admitted to our hospital complaining of dyspnea which required ventilation support. The reddened elevated scaly eruptions were prominent over the extensor surfaces. Chest X-ray and computed tomography showed mediastinal masses, which were diagnosed as mixed type thymoma. Muscle and skin biopsy specimens were compatible with DM. She was treated with methylprednisolone pulse therapy followed by extended removal of the anterior mediastinal tumor and subsequent radiotherapy. She has had a good clinical course without recurrence of thymoma or DM for more than 3 years. The role of thymoma in the development of DM is discussed.

Adult↗