FB21 was reactive with the glomerular endothelial cells and distal tubules of the human kidney and was bound to a sialic-acid-dependent cell surface antigen. We evaluated the FB21 staining in fetal kidneys, and the kidneys of children and adults with normal kidneys and glomerulonephritis and investigated whether FB21 can be used as a marker for endothelial cell injury. FB21 was reactive with the endothelial cells of normal kidneys and was detected on the surface of endothelial cells by immunoelectron microscopy. FB21 was reactive with endothelial cells in the kidneys of over 32-week fetuses. The endothelial cell FB21 staining scores in the first renal biopsy specimens of patients with hemolytic uremic syndrome (HUS) were lower than in the kidneys of children with normal kidneys and was negatively correlated with their serum E-selectin concentrations. The FB21 staining of glomerular endothelial cells was similar to the staining for the other endothelial markers, CD34 and von Willebrand factor (vWF). However, FB21 staining of interstitial blood vessels was very weak and was distinct from that of other endothelial markers. These results suggest that FB21 can be used as a specific marker for glomerular endothelial cell injury in various types of glomerulonephritis.

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Electrical field stimulation (EFS) produced a biphasic contractile response ; viz. initial rapid phasic contraction and second slow tonic contraction, in isolated guinea pig vas deferens. Pretreatment with the substrate of nitric oxide (NO) synthase (NOS); 1 mM L-arginine (L-ARG), augmented both the initial rapid and the second slow contractile responses to EFS (5 Hz, 0.5 msec, 30 V, for 30 sec). The increase of stimulation frequency from 5 Hz to 10 Hz or 20 Hz tended to attenuate the augmented responses. On the contrary, pretreatment with an inhibitor of NOS, 0.1 mM N^G-nitro-L-arginine (L-NNA) suppressed both the initial rapid and the second slow contractile responses to EFS. The suppressive effect on the initial rapid contraction was also attenuated by the increase of stimulation frequency from 5 Hz or 10 Hz to 20 Hz. Contractile response to exogenously administered 1 mM adenosine triphosphate (A TP) tended to be slightly increased and decreased by the treatment with 1 mM L-ARG and 0.1 mM L-NNA, respectively. Contractile response to exogenously administered 10 μM noradrenaline (NA) was almost unaffected by the treatment with 1 mM L-ARG, while the treatment with 0.1 mM L-NNA slightly depressed the response. Potentiated contractile response to 1 mM ATP in the presence of 10 μM NA was further potentiated by the treatment with 1 mM L-ARG, while the response was almost unaffected by the treatment with 0.1 mM L-NNA. These findings may indicate that NO acts mainly on presynaptic site and increases the release of chemical transmitter, ATP or prevents the inactivation of A TP. Also, NO may act, at least in part, on postsynaptic site and potentiates the contractile response to ATP in the presence of NA.

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The present author has kept observation for concentrations of atmospheric radon, radon progeny and thoron progeny for several years at the campus of Fukushima Medical University. Accidentally, in the midst of an observation term, i.e., February 2005, the faci lity management group of the university changed a strategy for the manner of ventilation, probably because of a recession : (I) tidy everyday ventilation of 7 : 30-24 : 00 into (II) shortened weekday ventilation of 8 : 00-21 : 00 with weekend halts. This change of ventilation manner brought a clear alteration for the concentrations of radon-related natural radioactivity in indoor air. The present paper concerns an investigation of the effect of the ventilation strategy on the indoor-atmospheric radon-related radioactivity.

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We evaluated the expression of human glucocorticoid receptor beta (hGRβ) in patients with severe autoimmune hepatitis (AIH). The subjects were 27 patients with AIH, including 6 with severe type (prothrombin time [PT] <40%) and 21 with non-severe type (PT ≥ 40%). Total RNA extracted from peripheral blood mononuclear cells (PBMCs) was reversed using reverse transcriptase. The resultant complementary DNA was amplified by reverse transcription polymerase chain reaction (RT-PCR) using specific primers for hGR α and β. The six patients with severe AIH were female ; three presented fulminant hepatic failure with hepatic encephalopathy. In all patients with AIH, hGR α was detected. The incidence of hGR β expression in patients with non-severe type was 42.9% (9/21) ; it was 100% (6/6) in those with severe type. The positive ratio was significantly higher in severe-type patients. These results suggest that hGR β expression in PBMCs is a novel predictor of AIH severity.

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To clarify the clinicolaboratory characteristics of patients with primary biliary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap, we analyzed their clinicolaboratory findings and compared them with those of patients with AIH or PBC retrospectively. We analyzed the laboratory findings of 177 patients that diagnosed 103 PBC and 74 AIH patients at our department during the period from January 1990 to April 2005. Of 103 PBC patients with a diagnosis of PBC, we identified 10 cases (9.7%) of PBC-AIH overlap (2 male, 8 female; mean age 56.5 years). PBC preceded AIH in 2 patients, and both diseases occurred simultaneously in the other 8 patients. There is no patients AIH preceded PBC. Positive frequency of anti-smooth muscle antibody (ASMA), IgG and IgM levels were significantly higher in patients with overlap than in those with AIH or PBC. Ursodeoxychoric acid (UDCA) was administered to all 10 patients initially, and later an immunosuppressant, prednisolone or azathioprine, was added in 6 patients. Two of the 10 patients died of liver failure 5 and 12 years after diagnosis, respectively. Both patients had been treated by either prednisolone or UDCA alone. We conclude that in patients with PBC-AIH overlap, the clinical characteristics of both PBC and AIH exist in an enhanced manner.

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Cytotoxic T lymphocyte antigen-4 (CTLA-4) is an important inhibitor of T-lymphocyte response. Polymorphisms in the CTLA-4 gene have been reported to be associated with numerous autoimmune diseases. The aim of this study was to determine whether polymorphisms of CTLA-4 exon 1 (+49) genes are associated with susceptibility and clinicolaboratory findings of primary biliary cirrhosis (PBC) in the J apanease population. Blood samples were obtained from 45 patients (6 men and 39 women, aged 23-56 years) with PBC and 73 healthy controls (48 men and 25 women, aged 22-72 years). CTLA-4 exon 1 (+49) polymorphism was defined using a polymerase chain reaction-restriction fragment length polymorphism with Bst71I restriction enzyme. The genotype frequencies of A/A, A/G, and G/G in 45 patients with PBC were 11% (5 patients), 44% (20 patients), and 44% (20 patients), respectively. There was no significant difference between frequencies in PBC patients and healthy controls. PBC patients with G/G genotype had significantly higher serum levels of AL T, GGT, and IgM than those in patients with A/A or A/G genotype. In conclusion, CTLA-4 gene polymorphisms are not associated with susceptibility of PBC in Japan; however, G/G genotype may be associated with liver damage.

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Ventricular fibrillation (VF) is most frequent in the very early phase in acute coronary occlusion, and is triggered by the re-entrant mechanism in this phase. An inhomogeneous conduction in the ischemic myocardium would be substrates for re-entry. The aim of this study was to examine the relationship between the severity of irregularities of the QRS complex and VF. Eleven pigs were analyzed, and the heart was fixed in the pericardia! cradle. Ag-AgCI bipolar electrodes were fixed on the epicardium in ischemic and non-ischemic regions. The proximal portion of the left anterior descending coronary artery was occluded for one hour. Electrocardiograms (ECGs) were continuously recorded on a magnetic tape, and wavelet analysis was performed on signal-averaged ECG (25 beats) every 60 sec after the experiment. The number of local maxima (N) and the duration between the first and the last local maximum (D) were automatically measured. N and D significantly increased in the ischemic area, but not in the non-ischemic area. N and D increased approximately twofold just before the occurrence of VF in 8 fibrillated pigs (p<0.01, each). There were significant positive linear relationships between the rate of increase inN and D to VF and basal heart rate before coronary occlusion (r=0.90, p<0.01 in N, r=0.84, p<0.01 in D at 160 Hz). These results suggest that there would be a threshold inhomogeneous conduction for the occurrence of VF and an increase in heart rate would accelerate the inhomogeneous conduction in acute myocardial ischemia.

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To evaluate the usefulness of Bb, a split product of complement factor B, as a clinical marker for disease activity of lupus nephritis, we measured the Bb concentration of sera from 42 patients with lupus nephritis. Serum Bb levels were significantly higher in patients with active nephritis (active nephritis group, n=30) than in patients with nephritis in remission (remission group, n=12) (14.3±8.3 versus 7.4±5.9 μg/ml; p=0.012). In contrast, there was no significant difference in serum C3 levels between active nephritis group and remission group (42.5±20.9 versus 44.7±15.9 mg/dl; p=0.77). In the comparison of Bb levels between active nephritis group and remission group, the sensitivity was 66.6%, specificity was 83.3%, and the positive and negative likelihood ratios were 3.95% and 0.41%, respectively. The present results suggest that serum Bb level is a useful clinical marker for disease activity in lupus nephritis.

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We investigated the effects of isosorbide dinitrate (IDN) on gastric blood flow (GBF), portal venous pressure (PVP) and blood gas of rats with liver cirrhosis (LC) accompanied by portal hypertension. Thirty male Wistar rats (LC in 17 and normal in 13) were used. Before and after IDN administration, GBF, PVP and blood gas in the femoral artery and portal vein were measured. Portal blood oxygen concentration was estimated by calculating the ratio of PO₂ in portal blood and that in arterial blood (PpvO₂/PaO₂) of each rat. The GBF in the LC rats was significantly lower than that in the normal rats. In the LC group, IDN administration significantly increased the GBF. The PpvO₂/PaO₂ value in the group with LC was significantly lower after IDN administration than that before IDN administration. In the investigation whether changes in PVP or Ppv/PaO₂ contributed more to the change in GBF after IDN administration, a significant correlation was found between rates of change in GBF and PpvO₂/PaO₂ were significantly correlated (r=−0.733, p<0.05). The effect of IDN on changes in the stomach accompanying portal hypertension is mainly attributable to a decrease in preload, which suppresses inflow to the stomach, as reflected by a decrease in PpvO₂/PaO₂, rather than to a decrease in afterload on GBF, as reflected by a decrease in PVP.

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The effects of acupuncture stimulation to the sacral segment on the electroencephalogram (EEG) and activity of the cholinergic neurons in the laterodorsal tegmental nucleus (LDT) were examined in urethane-anesthetized rats. When EEG was small amplitude and higher frequency , the stimulation to the sacral segment induced large amplitude and slow EEG with latencies ranged from 45 sec to 12 min, and durations from 48 sec to 56 min. The stimulus induced EEG is composed of significant increase in delta power and significant decrease in theta and beta powers. Firing rate of the cholinergic LDT neurons significantly decreased from 2.9±1.5 Hz to 1.1±0.8 Hz after the stimulus (n=l2, p<0.05). The decrease of neuronal activity always preceded to the start of large and slow EEG, while the increase of the activity always preceded to the change of EEG from large slow wave to small faster wave. These results suggest that the acupuncture stimulation to the sacral segment changes the state of the animals from light anesthesia to deep anesthesia, and that the change is mediated by the suppression of the cholinergic neurons in the LDT.

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A 70-year-old man with acute pancreatitis (acute exacerbation of chronic pancreatitis) was admitted to our department. Despite temporary improvement, the pancreatitis worsened on the 21st hospital day, forming a pancreatic pseudocyst, with infection in the cyst. After treatment with various antibiotics, a blood test on the 71st hospital day indicated improved inflammatory response despite continuing abdominal cramps. From the 75th hospital day, the patient developed purpura and arthralgia of the lower limbs, with melena and hematuria. Henoch-Schönlein purpura was diagnosed definitively by skin biopsy. Such a complication of acute pancreatitis with Henoch-Schönlein purpura is rare. This case also suggests that microvasculitis around the pancreas resulting from Henoch-Schönlein purpura might have prolonged the pancreatitis.

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OBJECTIVE : To report 3 cases of severe behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD) with fluvoxamine treatment and to discuss the treatment implications for use of the drug.
CASE SUMMARY: An 83-year-old woman was diagnosed with AD. Before treatment, she showed sudden irritation and excitement. Her BEHAVE-AD score was 40. She was started on fluvoxamine and quetiapine. Eight weeks later, she was friendly and thankful towards the staff. Her BEHAVE-AD score was 10. The second case was a 79-year-old woman diagnosed with AD. Before treatment, she attempted to leave our hospital and wandered and shouted throughout the day. Her BEHAVE-AD score was 42. She was started on fluvoxamine, and the dosage was gradually increased. Eight weeks later, the shouting and excitement disappeared almost completely. Her BEHAVE-AD score was 13. The third case was a 79-year-old man diagnosed with AD. Before treatment, we put him in a private, locked room because he was extremely agitated and violent because of delusions. His BEHAVE-AD score was 42. He was started on fluvoxamine and sodium valproate. Eight weeks later, the delusion became mild and did not affect his mood or behavior. His BEHAVE-AD score at this point was 4.
DISCUSSION : Fluvoxamine was effective in controlling BPSD with AD. This finding shows that the pathophysiology of BPSD due to AD may occur because of a hyposerotonergic state in the brain.
CONCLUSION : These cases show that fluvoxamine appears to be effective in the control of BPSD with AD.

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We report a case of 14-year-old male patient who underwent bile-duct-to-jejunum anastomosis because of congenital biliary atresia at the age of 2 months. A 15 mm hypervascular nodule was detected for the first time in the S1 region of the liver at the age of 9 years. Two years later, 6 hypervascular nodules were found in the liver. A tumor biopsy was performed. It was diagnosed as a focal nodular hyperplasia (FNH). However, the number of nodules increased from 6 to 12 and those diameters were enlarged two to seven times one year later; the tumor biopsy was performed again. Histologically, the findings were consistent with those obtained previously, which indicated FNH. We consider that this is a very rare case of FNH in which both the number of nodules and the size were increased in a short period of time. We present it here as a valuable case report.

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