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Seizures are uncommon with posterior circulation strokes. They are more often associated with anterior circulation strokes, with only a limited number of cases of status epilepticus reported to be related to brain stem ischemia. The literature includes case reports of generalized tonic-clonic seizures and associated status epilepticus as an initial presentation of acute basilar artery thrombosis. However, there are only rare cases reporting focal motor seizure as status epilepticus in the setting of acute basilar artery thrombosis, an important clinical presentation that should prompt evaluation for acute brain stem ischemia.

Background The diagnosis of epilepsy is at times elusive for both neurologists and nonneurologists, resulting in delays in diagnosis and therapy. The development of screening methods has been identified as a priority in response to this diagnostic and therapeutic gap. EpiFinder is a novel clinical decision support tool designed to enhance the process of information gathering and integration of patient/proxy respondent data. It is designed specifically to take key terms from a patient's history and incorporate them into a heuristic algorithm that dynamically produces differential diagnoses of epilepsy syndromes. Objective The objective of this study was to test the usability and diagnostic accuracy of the clinical decision support application EpiFinder in an adult population. Methods Fifty-seven patients were prospectively identified upon admission to the Epilepsy Monitoring Unit (EMU) for episode classification from January through June of 2017. Based on semiologic input, the application generates a list of epilepsy syndromes. The EpiFinder-generated diagnosis for each subject was compared to the final diagnosis obtained via continuous video electroencephalogram (cVEEG) monitoring. Results Fifty-three patients had habitual events recorded during their EMU stay. A diagnosis of epilepsy was confirmed (with cVEEG monitoring) in 26 patients while 27 patients were found to have a diagnosis other than epilepsy. The algorithm appropriately predicted differentiation between the presence of an epilepsy syndrome and an alternative diagnosis with 86.8% (46/53 participants) accuracy. EpiFinder correctly identified the presence of epilepsy with a sensitivity of 86.4% (95% confidence interval [CI]: 65.0–97.1) and specificity of 85.1% (95% CI: 70.2–96.4). Conclusion The initial testing of the EpiFinder algorithm suggests possible utility in differentiating between an epilepsy syndrome and an alternative diagnosis in adult patients.

Purpose Renal dysfunction is a well-known long-term complication which could increase mortality after non-renal solid organ transplantation. Recently, the UNCX variant (rs10277115), which encodes a paired-type homeobox transcription factor and has essential roles in skeleton formation and kidney development, has been shown to be associated with increased risk for chronic kidney disease in east Asian populations. However, the association between the UNCX variant and renal dysfunction after lung transplantation (LT) has not yet been elucidated. In the present study, we evaluated the association between the UNCX variant and the postoperative change of renal function after LT. Methods A total of 99 recipients of LT more than 18 years were genotyped for the functional polymorphism of the UNCX gene (rs10277115) and divided into two groups: the wild-type allele (AA) group and the heterozygous and homozygous mutant allele (AT/TT) group. The results of renal function tests were compared between the two groups. Delta creatinine (ΔCr) and delta eGFR (ΔeGFR) were defined as the difference between the postoperative level and the preoperative baseline level. Results The clinical characteristics of the patients were similar between the two groups. There were no significant differences in the previously described risk factors for renal function, including age, diabetes mellitus, hypertension and dyslipidemia. The postoperative change of ΔCr was significantly higher in the AA group than the AT/TT group after LT (Figure 1(a)). Moreover, the postoperative change of ΔeGFR was significantly lower in the AA group than the AT/TT group after LT (Figure 1(b)). The multivariate analysis revealed that the UNCX variant was independently associated with the levels of ΔCr and ΔeGFR. Conclusion The UNCX variant was associated with significant differences in Cr and eGFR in the long term and the development of renal dysfunction after LT.

Purpose Chronic lung allograft dysfunction (CLAD) is known as one of the major fatal disorders in the long-term phase after lung transplantation. Because CLAD is a heterogeneous disease, proper classification of phenotypes is important to understand each pathogenesis. In this study, we retrospectively evaluated the impact of new 2019 ISHLT classification system on living-donor lobar lung transplantation (LDLLT). Methods Between 1998 and 2019, a total of 96 patients underwent LDLLT at our hospital, and 73 patients who underwent bilateral LDLLT were included in this study. CLAD after bilateral LDLLT were diagnosed and classified according to the ISHLT consensus report in 2019. Results The median follow-up time was 10.3 years. A total of 27 (37.0%) patients were diagnosed as CLAD, including bronchiolitis obliterans syndrome (BOS) (n = 8, 29.6%), restrictive allograft syndrome (RAS) (n = 11, 40.7%), mixed (n = 1, 3.7%), undefined (n = 2, 7.4%), and unclassified (n = 5, 18.5%). CLAD developed in the unilateral lung in 26 patients. Five-year survival of the patients developing CLAD after LDLLT was 84.1%, whereas 5-year survival of the patients after CLAD onset was 58.4%. Survival after CLAD onset was worse in the patients with RAS (p=0.008) and undefined (p=0.003) than those with BOS. Though survival after CLAD onset did not differ between the patients with or without CT opacities (p=0.40), the patients with restriction on pulmonary function test had significantly worse survival than those without restriction (Figure, p=0.001). Conclusion While the patients with BOS had better prognosis, the presence of restriction on pulmonary function test could predict worse prognosis of the CLAD patients after bilateral LDLLT.

Purpose Histidine-rich glycoprotein (HRG) is a 75 kDa plasma glycoprotein produced in and secreted from the liver. Recently, supplementary HRG treatment has been shown to inhibit acute respiratory distress syndrome (ARDS) and prevent septic lethality. The pathogenesis of primary graft dysfunction (PGD) after lung transplantation (LT) could be similar to that of ARDS. However, the relationship between plasma levels of HRG and PGD after LT remains unknown. Methods Blood samples were collected from a total of 68 patients who underwent LT, including the patients with PGD grade 0-1 (the non-PGD group, n = 43), those with PGD grade 2 (the moderate PGD group, n = 18) and those with PGD grade 3 (the severe PGD group, n = 7) at 72 hours after LT. Plasma levels of HRG were quantified using ELISA and compared among the three groups. Appropriate cut-off values of HRG levels were set for overall survival (OS) after LT. Results The median follow-up period was 1208 (286-2982) days. Plasma levels of HRG at 72 hours after LT in the severe PGD group were significantly lower than those of the other groups (the non-PGD group vs. the severe PGD group, P = 0.042; the moderate PGD group vs. the severe PGD group, P = 0.040) (Fig. 1). An ROC analysis of the performance of plasma levels of HRG as a marker of overall survival yielded an AUC of 0.61 at a threshold level of 34.4 µg/mL. Patients with plasma levels of HRG ≥ 34.4 µg/mL showed significantly better OS and chronic lung allograft dysfunction (CLAD) free survival than those with plasma levels of HRG Conclusion Plasma level of HRG at 72 hours after LT was associated with the development of PGD, suggesting its usefulness as a predictor of the development of CLAD and survival after LT.

Purpose Recently, various disciplines have recognized the importance of preoperative nutritional and inflammatory status in influencing postoperative clinical outcomes. However, the usefulness of existing prognostic scoring methods has not yet been validated in lung transplantation (LT), except for the prognostic nutrition index. In the present study, we evaluated the usefulness of 9 prognostic scoring methods related to nutrition and inflammation in LT, which have been shown to be useful for predicting surgical prognosis in other fields. We also analyzed most accurate combination of the scoring methods in predicting prognosis after LT. Methods We conducted a single-center retrospective cohort study of 150 recipients of LT. We used 9 prognostic scoring methods (Figure 1A) for survival analysis by the log-rank test. Next, we performed a receiver operating characteristic analysis for overall mortality on all 36 combinations of two scoring methods out of the 9 scoring methods to detect the best combination to improve prognostic accuracy in LT. Survival analysis was performed on the best combination of scoring methods by the log-rank test. Results All of the 9 scoring methods significantly predicted prognosis after LT (Figure 1A). Among the 36 combinations, the combination of neutrophil to lymphocyte ratio (NLR) and Glasgow prognostic score (GPS) demonstrated the highest concordance index (c-index, 0.706), enabling the prognostic stratification in LT (NLR low and GPS 0: 0 point, NLR low and GPS 1-2 or NLR high and GPS 0: 1 point, NLR high and GPS 1-2: 2 point) (Figure 1B). Conclusion All of the 9 scoring methods significantly predicted prognosis even after LT. The combination of NLR and GPS predicted prognosis most accurately of 36 combination of two scoring methods, which could be a more accurate prognostic predictor than a single scoring method.

Purpose Lung ischemia reperfusion (IR) injury increases the mortality and morbidity in patients undergoing lung transplantation. Inflammatory mediators called Damage Associated Molecular Patterns (DAMPs) concern with inflammatory response to develop the organ damages during IR injury and High Mobility Group Box 1 (HMGB1) is one of the most important DAMPs. We had previously developed anti-HMGB1 monoclonal antibody (mAb) and assessed the therapeutic effect of the antibody in lung IR injury. Methods A mice hilar clamp model of IR was used, and animals were divided into sham groups and IR groups with or without administration of anti-HMGB 1 mAb. We analyzed the effect of anti-HMGB 1 mAb against IR injury by assessing lung oxygenation, injury, neutrophil infiltrations, expression of proinflammatory cytokines and chemokines, MAPK signaling and apoptosis. Results The severity of IR injury represented by oxygenation capacity, lung injury score and neutrophil infiltrations was significantly improved by anti-HMGB1 mAb treatment. The expressions of proinflammatory factors including IL-1b, IL-6, IL-12, TNFα, CXCL1 and CXCL2 and phosphorylation of p38 MAPK were significantly reduced by the anti-HMGB1 mAb treatment. Furthermore, the antibody decreased TUNEL positive cells to detect apoptosis. Conclusion Anti-HMGB1 mAb obviously ameliorated lung IR injury by reduction of inflammatory responses and apoptosis. Our findings indicate that anti-HMGB1 mAb have a potential as therapeutic drug to improve IR injury in lung transplantation.

Purpose Post-transplant lymphoproliferative disorder (PTLD) affects 3-9% of lung transplant (LTx) recipients, with a mortality range of 20-50%. Despite this high morbidity and mortality, few large studies on Asian population are reported, therefore, we lack fixed consensus regarding specific predictive risk factors in LTx recipients. This study was aimed at uncovering the risk factors of PTLD and evaluating the treatment strategy and outcome of Japanese PTLD cases. Methods We retrospectively reviewed 195 patients (re-transplantation cases were excluded) who underwent LTx at our hospital between October 1998 and February 2020. Results Seven PTLD patients (3.6%) were identified. The indication for LTx in PTLD group was 2 (28.6%), 3 (42.8%), 2 (28.6%) patients for idiopathic pulmonary fibrosis, other interstitial pneumonia including connective tissue disease, lung disease after hematopoietic stem cell transplantation, respectively. The proportion of indication was significantly different from those in non-PTLD patients (p=0.046). All PTLD patients had taken corticosteroid at the time of LTx (p Conclusion Long-term preoperative corticosteroid therapy can be a risk factor of PTLD after LTx. Regardless of the state of PTLD, opportunistic infection was a lethal complication and should be desperately prevented. CLAD may occur at a higher rate after treatment of PTLD, therefore, close monitoring and adjustment of immunosuppressants are needed.

Purpose Since 1998 our center has performed not only cadaveric lung transplantation (CLTx) but living-donor lobar lung LTx (LDLLTx), especially recently, including non-standard procedures of middle lobe LTx and segmental LTx in order to save younger children. The aim of this study was to show outcomes of pediatric LTx of a lung transplant center in Japan. Methods We retrospectively reviewed 203 consecutive LTx recipients between 1998 and 2020 including 43 pediatric ( Results The 1-, 5-, and 10-year overall survival (OS) in pediatric vs adult recipients were 93% vs 91%, 84% vs 74% and, 79% vs 61%, respectively (p = 0.11). The 1-, 5-, and 10-year lung-graft survival (GS) in pediatric vs adult recipients were 85% vs 83%,62% vs 62% and 36% vs 48%, respectively (p = 0.26). There was no significant difference in survival rates between pediatric and adult recipients. In pediatric recipients, the 1- and 5-year OS in 0-6 years old vs 7-17 years old were 70% vs 100% and 56% vs 92%, respectively (p = 0.004). The 1- and 5-year GS in 0-6 years old vs 7-17 years old were 60% vs 93% and 24% vs 72%, respectively (p = 0.02). Although the number is small, younger children under 7 years old have poorer OS and GS when compared with older children of 7-17 years old. From patient characteristics, lower height (p Conclusion Outcome of pediatric LTx is comparable with that of adult LTx. However, younger children under 7 years old have poorer OS and GS compared with older children of 7-17 years old.

Purpose Irisin is a skeletal muscle cell-derived myokine associated with physical activity. Recently, decreased serum irisin levels have been shown to cause alveolar epithelial apoptosis resulting in lung emphysema in patients with chronic obstructive pulmonary disease. Similar to the patients with emphysema, the patients with chronic lung allograft dysfunction (CLAD) after living-donor lobar lung transplantation (LDLLT) could show emphysematous changes, because in LDLLT, small lobar grafts expand to fit into the recipient's chest cavity due to the size mismatch. However, the relationship between serum irisin levels and CLAD after LDLLT remains unknown. Methods Blood samples were collected from a total of 33 patients who underwent bilateral LDLLT, including patients with CLAD (the CLAD group, n=11) and those without CLAD (the non-CLAD group, n=22). Serum samples were assayed for irisin using ELISA kit and compared between the two groups. Appropriate cut-off values of irisin level were set for the diagnosis of CLAD. Results The median follow-up period was 4366 (1055-7180) days. Serum irisin levels of the CLAD group were significantly lower than those of the non-CLAD group (9.5 ± 3.4 vs. 13.2 ± 4.2 ng/mL, P = 0.018) (Fig. 1). An ROC analysis of the performance of the serum irisin level as a marker of CLAD yielded an AUC of 0.76 (sensitivity=0.91 and specificity=0.64 at a threshold level of 12.6 ng/mL). Moreover, patients with irisin level ≥12.6 ng/mL (n=16) showed significantly better CLAD-free survival than those with irisin level Conclusion Decreased serum irisin levels are associated with the development of CLAD after bilateral LDLLT. Irisin might be a novel biomarker for the diagnosis of CLAD after LDLLT.

Purpose In the diagnosis of chronic lung allograft dysfunction (CLAD) after living-donor lobar lung transplantation (LDLLT), lung ventilation scintigraphy using 133 Xe has been shown to be useful. However, the supply of 133 Xe has been discontinued worldwide in 2016 and a new diagnostic tool is required for CLAD after LDLLT. Generally, because CLAD has been shown to develop predominantly on one side after bilateral LDLLT, lung perfusion scintigraphy (LPS) could show a perfusion shift to the unilateral healthy lung ( Figure 1A ). Nevertheless, the usefulness of LPS in the diagnosis of CLAD after LDLLT is unknown. Methods We conducted a single-center retrospective cohort study of 58 recipients who underwent bilateral LDLLT at Okayama University Hospital between October 1998 and June 2016. The unilateral shift values in LPS were calculated, and compared between the CLAD group (N=27) and the non-CLAD group (N=31) from 5 years before the CLAD onset to 5 years after the CLAD onset. Results The median time to the CLAD onset was 2176 days (326-4763 days). The unilateral shift values in LPS of the CLAD group were significantly higher than those of the non-CLAD group during 5 years before the CLAD onset (P Figure 1B ). An ROC analysis of the performance of the unilateral shift value in LPS as a marker of CLAD yielded an AUC of 0.79 (sensitivity=0.54 and specificity=1.00 at a unilateral shift threshold level of 8.6%). The unilateral shift values in LPS were significantly correlated with the results of the forced expiratory volume in 1 second (P = 0.036, r = - 0.322) ( Figure 1C ). Conclusion In the patients with unilateral CLAD after bilateral LDLLT, LPS showed the unilateral perfusion shift to the healthy lung even during 5 years before the CLAD onset. LPS might have a potential to diagnose unilateral CLAD early after bilateral LDLLT.

Purpose When extended criteria donor was transplanted to reduce on waitlist time and mortality for severe donor shortage, it had a potential risk to cause worse outcome. Furthermore, using marginal donor for single lung transplant (LT) was more difficult than double LT. In case of adult male recipients, living donor lobar lung transplant (LDLLT) might not be established due to the lung volume and function after LT. We reported good outcome due to new technique which was combined merits of LDLLT with cadaveric LT as called “hybrid LT”. Methods The relatively high-quality cadaveric single lung was choose and transplanted to unilateral chest, living donor lower lobe was transplanted to the other when extended criteria donor lung was allocated for severe illness recipient. Results Both of recipients were diagnosed idiopathic pulmonary fibrosis . They were registered on waiting list. However, they were considered no survive on the list for their severe illness, because long waiting time, approximately 3 years, was needed in Japan for severe donor shortage. On the other hand, donors were rejected by all other transplant centers because of the lungs on the basis of the initial conventional assessments. PaO2/FiO2 ratio of case 1 was at less than 250 and case 2 was at less than 188. Left cadaveric and right living donor lower robe was transplanted on case 1. The recipient experienced grade 2 primary graft dysfunction (PGD) but rapidly recovered. The other was transplanted right cadaveric and left living donor lower robe on case 2 and had no severe PGD. Both of them returned to their normal daily life and is doing well for 2 years after lung transplantation. Conclusion Hybrid LT using unilateral cadaveric lung and living donor lower lobe is feasible and reasonable option for a high-risk recipient when using marginal lung grafts. Hybrid LT reduce perioperative risk due to overcome lung volume, function and quality at the same time and have merit of bilateral LT at the long term outcome.

Amyloid beta-related angiitis (ABRA) is a subtype of cerebral amyloid angiopathy-related inflammation, with distinctive pathology and prognosis compared with cerebral amyloid angiopathy (CAA). On a spectrum of increasing severity, ABRA is considered to be in-between the less aggressive inflammatory-CAA and the more severe primary central nervous system (CNS) angiitis. Whereas retinal pathological changes were described in subjects with primary or secondary CNS angiitis, and non-inflammatory CAA, bilateral posterior pole superficial and peripapillary retinal hemorrhages have not been reported as initial signs in patients with pathology-confirmed ABRA, accompanying neurological spells and characteristic neuroimaging findings.

Introduction Lung transplantation (LTx) is still limited by a shortage of suitable donor lungs. Evolving flexible surgical procedures help increase the chances of LTx by unfolding recipient-to-donor matching options based on the pre-existing organ allocation concept. In particular, right single LTx using an inverted left donor lung may be considered under the following conditions: 1) Despite a right-side-predominant lung dysfunction in a recipient candidate, the option is limited to the use of a left single donor lung due to evidence of lung injury in the right donor lung or necessity to share the organ with another candidate prioritized on the waitlist; 2) Left side LTx in the recipient is impossible due to a past history in the recipient of thoracic surgery. One of the key challenges in performing inverted LTx is to adjust the positional relationship between the recipient's and graft's hilar structures. Herein, we report a case of successful left-to-right inverted LTx using interposition of a pericardial conduit for pulmonary venous anastomosis. Case Report A left lung graft was offered to a 59-year-old male who had predominant damage of the right lung by idiopathic pulmonary fibrosis (Fig.1A). We decided to transplant the left donor lung into the right thorax of the recipient, considering his serious disease condition. Due to the anterior-posterior position gap, adjustment of the cuff length of the pulmonary artery and vein was required. Pulmonary artery anastomosis could be performed by leaving both the donor and recipient cuff long, but an extension of the pulmonary vein by interposition of a pericardial conduit was required for anastomosis (Fig.1B). The patient developed no anastomotic complications after the LTx. Summary left-to-right inverted LTx is technically feasible by using an autologous pericardial conduit in selected cases. The technique has the potential benefit of encouraging exploration and expansion of unprecedented donor-recipient matching patterns in LTx.

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.5 months. Recovery of deltoid function was assessed by the power of both abduction and retropulsion, the deltoid bulk and extension lag. The deltoid bulk was almost symmetrical in nine of 34 cases, good in 22 and wasted in three. Grade M4 or M5* was achieved in 30 of 35 for abduction and in 32 of 35 for retropulsion. There was an extension lag in four patients. Deltoid bulk continued to improve with a longer follow-up following surgery. Nerve grafting to the axillary nerve is a reliable method of regaining deltoid function when the lesion is distal to its origin from the posterior cord.

Objective The aim of this study was to evaluate right and left ventricular functions in patients with pulmonary arterial hypertension after living-donor lobar lung transplantation compared with those without hypertension. Methods Thirty-three recipients of living-donor lobar lung transplantation were divided into two groups: those with pulmonary arterial hypertension (PAH group; n=12) and those without (non-PAH group; n=21). Their systolic pulmonary artery pressure was 93.1 ± 6.7 mm Hg versus 31.4 ± 2.9 mm Hg, respectively. Right and left ventricular ejection fractions, systolic pulmonary artery pressure, and cardiac index were serially measured by radionuclide ventriculography and right heart catheterization, respectively. Results Pretransplant right and left ventricular ejection fractions were lower in the PAH group (29.8% ± 7.0%, 49.9% ± 6.6%) than in the non-PAH group (49.7% ± 3.3%, 65.2% ± 1.9%) ( P = .010, .068). Two months after living-donor lobar lung transplantation, right ventricular ejection fraction and systolic pulmonary artery pressure in the PAH group (57.3% ± 5.1%, 25.7 ± 1.8 mm Hg) improved dramatically, equal to those in the non-PAH group. In contrast, left ventricular ejection fraction and cardiac index in the PAH group (50.9% ± 3.7%, 2.66 ± 0.12 L · min −1 · m −2 ) were still significantly lower than in the non-PAH group (65.4% ± 2.8%, 3.13 ± 0.15 L · min −1 · m −2 ) ( P = .0038, .037). At 6 to 12 months, the PAH group demonstrated a significant rise in left ventricular ejection fraction and cardiac index that reached similar values in the non-PAH group measured at 2 months. These values were stable for up to 3 years. Conclusions Right ventricular function recovered early after living-donor lobar lung transplantation in the PAH group. In contrast, recovery of left ventricular function required 6 to 12 months. Improved cardiac function was sustained for up to 3 years, suggesting long-term durability of cardiac function recovery after living-donor lobar lung transplantation.

For the purpose of a nationwide surveillance of the antimicrobial susceptibility of bacterial respiratory pathogens in patients in Japan, the Japanese Society of Chemotherapy conducted their second year survey, during the period from January to August, 2007. A total of 1178 strains were collected from clinical specimens obtained from adult patients with well-diagnosed respiratory tract infections. Susceptibility testing was evaluable for 1108 strains (226 Staphylococcus aureus, 257 Streptococcus pneumoniae, 6 Streptococcus pyogenes, 206 Haemophilus influenzae, 120 Moraxella catarrhalis, 122 Klebsiella pneumoniae, and 171 Pseudomonas aeruginosa). A total of 44 antibacterial agents, including 26 beta-lactams (four penicillins, three penicillins in combination with beta-lactamase inhibitors, four oral cephems, eight parenteral cephems, one monobactam, five carbapenems, and one penem), three aminoglycosides, four macrolides (including ketolide), one lincosamide, one tetracycline, two glycopeptides, six fluoroquinolones, and one oxazolidinone were used for the study. Analysis was conducted at the central reference laboratory according to the method recommended by the Clinical and Laboratory Standards Institute (CLSI). The incidence of methicillinresistant Staphylococcus aureus (MRSA) was high, at 59.7%, and the incidences of penicillin-intermediateresistant and -resistant Streptococcus pneumoniae (PISP and PRSP) were 30.4% and 5.1%, respectively. Among Haemophilus influenzae strains, 19.9% of them were found to be beta-lactamase-non-producing ampicillin (ABPC)-intermediately-resistant (BLNAI), 29.1% to be beta-lactamasenon-producing ABPC-resistant (BLNAR), and 6.7% to be beta-lactamase-producing ABPC-resistant (BLPAR) strains. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae was not isolated. Two isolates (1.2%) of Pseudomonas aeruginosa were found to be metallo-beta-lactamase-producing strains, including one (0.6%) suspected multidrug-resistant strain showing resistance to imipenem, amikacin, and ciprofloxacin. These data will be a useful reference for future periodic surveillance studies and for investigations to control resistant infections as well. Continued surveillance is required to prevent the further spread of these antimicrobial resistances.

Background The indication of lung transplantation for patients with pulmonary complications of hematopoietic stem cell transplantation (HSCT) remains controversial, and only few such cases have been reported. We reviewed our experiences regarding living-donor lobar lung transplantation (LDLLT) in patients with pulmonary complications of HSCT. Methods We reviewed and assessed seven patients (age, 6-45 yr) who underwent LDLLT at Okayama University Hospital for pulmonary complications of HSCT (HSCT group). Their characteristics and postoperative results were compared with those of 41 LDLLT without HSCT patients (non-HSCT group). In the HSCT group, indications for LDLLT included bronchiolitis obliterans (n=6) and pulmonary fibrosis (n=1) that had developed after treatments involving HSCT. Preexisting hematologic diseases included acute lymphocyte leukemia (n=4), acute promyelocystic leukemia (n=1), myelodysplastic syndrome (n=1), and aplastic anemia (n=1). Results In the HSCT group, two patients died due to infectious complications, whereas five are currently alive (an overall survival of 71.4%) without any recurrence of the hematologic diseases (mean follow-up period, 35.7 months). The mean of acute rejection episodes was 1.1 per patient in the HSCT group and 1.8 in the non-HSCT group. One of the seven HSCT (14.4%) and 10 non-HSCT (24.4%) patients have currently developed bronchiolitis obliterans syndrome. Conclusion Our results showed that LDLLT for patients with respiratory failure because of pulmonary complications of HSCT could be an effective approach with less rejection episodes; however, it has a possibly higher risk of the development of infectious complications.

Living-donor lobar lung transplantation (LDLLT) is performed in critically ill patients, although the outcome is generally expected to be poor for those who are ventilator dependent. The aim of this study was to compare the outcomes of LDLLT in ventilator-dependent patients compared with those in ventilator-independent patients.We reviewed 31 consecutive patients who received LDLLT between October 1998 and May 2004.Five patients were ventilator dependent and 26 were ventilator independent. All five ventilator-dependent patients were female, with a mean age of 29.6 years. The duration of preoperative ventilation was 23.4 +/- 5.7 days. The underlying diagnoses in the ventilator-dependent patients included only obstructive (n = 3) and infectious lung diseases (n = 2), whereas those in the ventilator-independent patients included hypertensive and restrictive diseases (P = 0.004). There were no significant differences between the groups in early postoperative clinical values. The incidences of acute rejection and bronchiolitis obliterans syndrome (BOS) were comparable. The 5-year survival rates were 100% for the ventilator-dependent patients and 92.3% for the ventilator-independent patients (P = 0.45).Our findings suggest that LDLLT can have a favorable outcome in selected ventilator-dependent patients.

The living-donor lobar lung transplantation procedure has been developed clinically as an alternative approach for patients considered too ill to await cadaveric transplantation. With this procedure, 2 lobes are implanted in the recipient in place of whole right and left lungs, respectively. However, the shortage of graft volume can be a problem when compared with full-sized cadaveric grafts. In an attempt to solve this problem, we have developed a native lobe-preserving lobar transplant technique using a large animal model. We report a first successful case of a patient undergoing native lobe-preserving lobar lung transplantation for severe pulmonary emphysema.

In this study we report the case of a 28-year-old female patient with recurrent lymphangioleiomyomatosis (LAM) in the allografts after bilateral living-donor lobar lung transplantation. Although her post-operative course under immunosuppression with tacrolimus and prednisolone had been uneventful without rejection episodes, she had developed shortness of breath and a progressive chylous effusion with diffuse cystic changes in both lungs 5 years after transplantation. In spite of a diagnosis of having a recurrence of LAM based on radiologic findings and deteriorating pulmonary function, her clinical symptoms, which included dyspnea and chylothorax, were significantly improved after treatment with sirolimus. Although a beneficial effect of sirolimus in the treatment of LAM has not been definitively determined, this report may provide useful information for management of recurrent LAM after lung transplantation.

Behçet’s disease is a chronic, relapsing, inflammatory disorder. This case report describes how use of an improvised topical negative pressure (TNP) device in a patient with a non-healing para-ileostomal ulcer with Behçet’s disease

The Japanese Society of Chemotherapy (JSC) conducted the first nationwide surveillance of bacterial respiratory pathogens during the period from January to August 2006. With the cooperation of 32 medical institutions throughout Japan, a total of 924 strains belonging to seven clinically relevant bacterial species were collected from adult patients with well-diagnosed respiratory tract infections (RTIs). Antimicrobial susceptibility testing of the 887 evaluable strains (205 Staphylococcus aureus, 200 Streptococcus pneumoniae, 9 Streptococcus pyogenes, 165 Haemophilus influenzae, 91 Moraxella catarrhalis, 74 Klebsiella pneumoniae, and 143 Pseudomonas aeruginosa) to 42 antibacterial agents was conducted at the Central Laboratory of the Research Center for Anti-infective Drugs of the Kitasato Institute, according to recommendations issued by the Clinical and Laboratory Standards Institute (CLSI). The antibacterial agents employed were 25 beta-lactams, three aminoglycosides, four macrolides (including one azalide and one ketolide), one lincosamide, one tetracycline, two glycopeptides, five fluoroquinolones, and one oxazolidinone. The incidence of methicillin-resistant S. aureus (MRSA) was 63.4%, and the incidences of penicillin-intermediately resistant S. pneumoniae (PISP) and penicillin-resistant S. pneumoniae (PRSP) were 35.0% and 4.0%, respectively. Among H. influenzae, 21.2% of the strains were found to be beta-lactamase-nonproducing ampicillin (ABPC)-intermediately resistant (BLNAI), 29.1% to be beta-lactamase-nonproducing ABPC-resistant (BLNAR), and 4.8% to be beta-lactamaseproducing ABPC-resistant (BLPAR) strains. The incidence of extended-spectrum beta-lactamase-producing K. pneumoniae was 2.7% (2 of 74 strains). Three (2.1%) of the 143 P. aeruginosa strains were found to be metallo-beta-lactamaseproducing, including 1 (0.7%) multidrug-resistant strain. Through the nationwide surveillance, we obtained fundamental antimicrobial susceptibility data of clinically relevant bacterial pathogens in adult RTI to various antibacterial agents. These data will be a useful reference for future periodic surveillance studies, as well as for investigations to control antimicrobial-resistant pathogens.

ObjectivesThe aim of this study was to evaluate the long-term effects of living-donor lobar lung transplantation (LDLLT) for critically ill patients with pulmonary arterial hypertension (PAH) who failed in epoprostenol treatment.BackgroundAlthough continuous epoprostenol infusion has markedly improved survival in patients with PAH, some patients do not benefit from this therapy.MethodsFrom July 1998 to December 2003, 28 consecutive PAH patients who were treated with epoprostenol and accepted as candidates for lung transplantation were enrolled. All data were prospectively collected. As of July 2006, LDLLT was performed in 11 of those patients whose condition was deteriorating. Cadaveric lung transplantation (CLT) was performed in 2 patients. Medical treatment was continued in 15 patients.ResultsThere was no mortality in patients receiving LDLLT during a follow-up period of 11 to 66 months (average 48 months), and all patients returned to World Health Organization functional class I. Mean pulmonary artery pressure decreased from 62 ± 4 mm Hg to 15 ± 2 mm Hg (p < 0.001) at discharge and remained normal at 3 years. One CLT patient died of primary graft failure. Among medically treated patients, 6 patients died of disease progression. The survival rate was 100% at 5 years for patients receiving LDLLT, and 80% at 1 year, 67% at 3 years, and 53% at 5 years for patients medically treated (p = 0.028). All living donors have returned to their previous lifestyles.ConclusionsThese follow-up data support the option of LDLLT in patients with PAH who would die soon otherwise.

As an alternative to cadaveric transplantation, living donor lobar lung transplantation (LDLLT) has been applied in critical patients with end-stage pulmonary disease because of the mismatch between the supply and demand of lungs for transplantation. However, it is unclear whether two pulmonary lobes can provide adequate long-term pulmonary function and satisfactory clinical outcome in recipients.Between October 1998 and September 2004, 28 females and 3 males, including 5 children, underwent LDLLT at Okayama University Hospital. Their mean age was 31.8 years, and the mean observation period was 53.8 months. One patient who underwent single-lung transplantation and another who died peri-operatively were excluded from further analyses.The most common indication for transplantation was pulmonary arterial hypertension (32.3%). The overall survival rate was 93.6%. Seven recipients (22.6%) developed bronchiolitis obliterans syndrome after LDLLT. The mean percent predicted forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) improved between 12 and 24 months after transplantation (71.8 +/- 12.9% and 65.8 +/- 17.2% at 12 months vs 77.4 +/- 16.6% and 72.8 +/- 14.6% at 24 months; p0.005 and p0.05, respectively). The actual recipient FVC ultimately reached 123.0% of the estimated graft FVC of two donor lobes (calculated based on the donor FVC and number of segments implanted) at 36 months after LDLLT.Although LDLLT may be associated with the limitation of size mismatch, it holds promise for providing well-functioning pulmonary lobar grafts to critically ill patients with poor life expectancy.

Carbonate apatite (CO3Ap) was synthesized at 60+1°C and pH 7.4+0.2, to develop a new biodegradable scaffold biomaterial. The synthetic CO3Ap was mixed with a neutralized collagen gel and the CO3Ap-collagen mixtures with different kinds of CO3Ap contents and porosity were frozen and dried in lyophilized into the sponges. CO3Ap-collagen mixtures were also lyophilized into sponges in a HAp frame ring with 0.5 mm pores. To examine the degree of cell invasion, mouse MC3T3-E1 cells were grown in αMEM with 10% heat-inactivated FBS in 96-well plates containing the CO3Ap-collagen sponges at 37°C in a 5% humidified atmosphere. Under pentobarbital anesthesia, samples of UV-irradiated CO3Ap-collagen sponges with frames were surgically implanted beneath the periosteum cranii of rats. SEM observation of CO3Ap-collagen sponges showed favorable pores for cell invasion. Approximately 50~300 µm size pores seemed to continue into the deep bottom. X-ray high-resolution microtomography revealed a clear image of 3D structure of the sponges. 70 wt% CO3Ap-collagen sponge seemed to be most favorable biomaterial from the viewpoint of the natural bone properties. Then, to avoid the shrinkage of the sponges, we successfully made a hybridized CO3Ap-collagen sponge with a frame. When these sponge-frame complexes were implanted beneath the periosteum cranii of rats, newly created bone was observed toward the inner core of the complex from the surface of the periosteum cranii.

We experienced three cases of nocardiosis by Nocardia farcinica in the same ward within a six-month period. The result of gene analysis by randomly amplified polymorphic DNA gave the same pattern. Thus, these three cases were considered to be caused by the same strain of N. farcinica, implying the presence of nosocomial infection.

Of 175 patients with 181 aneurysms initially treated with Guglielmi Detachable Coils (GDC), 25 were retreated. All retreatments except one were performed on previously ruptured aneurysms. Thirteen aneurysms were retreated because of recurrence, and 12 aneurysms were retreated to complete initial insufficient embolization. Sixteen patients underwent re-embolization and 9 patients were operated upon surgically. No complications related to the retreatment were experienced. We consider that repeat embolization should be attempted before considering surgical treatment in case that additional therapy is required. However, it is difficult to retreat aneurysms having wide necks. In regard to surgical clipping, aneurysms without a coil in the neck are easier to treat with primary clipping, whereas aneurysms with a coil mass in the neck are difficult to surgical clip. We have never used temporary clipping and coil extraction if the distance between the coil and the parent artery was wider than 2 mm. Emerging new embolic agents or devices and technical improvement might decrease the need for retreatment and increase long-term efficacy after endovascular treatment.

Periodontal ligament tissue is remodeled on both the tension and compression sides of moving teeth during orthodontic tooth movement. The present study was designed to clarify the hypothesis that the expression of MMP-8 and MMP-13 mRNA is promoted during the remodeling of periodontal ligament tissue in orthodontic tooth movement. We used the in situ hybridization method and semi-quantitative reverse-transcription/polymerase chain-reaction analysis to elucidate the gene expression of MMP-8 and MMP-13 mRNA. Expression of MMP-8 and MMP-13 mRNA transiently increased on both the compression and tension sides during active tooth movement in vivo. The gene expression of MMP-8 and MMP-13 was induced by tension, while compression indirectly promoted the gene expression of MMP-8 and MMP-13 through soluble factors in vitro. Thus, we concluded that the expression of MMP-8 and MMP-13 is differentially regulated by tension and compression, and plays an important role in the remodeling of the periodontal ligament.

An in vitro experimental technique was performed to measure the viscoelastic properties of the bovine disc. Thirteen TMJ discs from young cattle (3-year-old) were used. Each disc was divided into five specimens of anterior, central, posterior, lateral and medial regions, and they were used for compression tests. A series of stress-relaxation tests was conducted for each specimen from 5% strain up to 20% strain with 5% intervals. The stress-relaxation was monitored over a period of 5 min. Each region exhibited a different biomechanical behavior, which is presumably related to the organization and distribution of proteoglycans that indirectly modulate the stiffness of the collagen network. It is suggested that an improved understanding of the viscoelastic properties of the disc under function may guide consideration for design and selection of biomaterials for TMJ reconstruction.

Granule cells with recurrent basal dendrites (RBDs) were previously reported in both control and epileptic rats. RBDs are dendrites that arise from the basal half of granule cell bodies and curve toward and extend into the molecular layer. They are increased in frequency in the pilocarpine model of epilepsy. The present study was undertaken to analyze the distribution and morphology of granule cells with RBDs and the synaptic connections of RBDs. Granule cells were labeled by retrograde transport of biocytin. Those with an RBD were found throughout the granule cell layer, but were most numerous at the hilar border. The morphology of these cells varied in the different depths of the granule cell layer; the angle of their cell body's long axis was mainly vertical at the hilar margin, and changed to virtually horizontal close to the molecular layer border. Quantitative data on the distribution of granule cells with RBDs and the angle of the cell body's long axis confirmed these descriptions. At the electron microscopic level, RBDs showed the typical features of dendrites and formed numerous axodendritic and axospinous synapses with labeled and unlabeled axon terminals. These results showed that RBDs of granule cells from epileptic rats are postsynaptic to axon terminals, including mossy fibers, and thus are involved in a similar synaptic circuitry as apical dendrites of granule cells from these animals.

In many persons with temporal lobe epilepsy, dentate granule cells form an interconnected synaptic network. This recurrent mossy fiber circuit mediates reverberating excitation that may facilitate seizure propagation by synchronizing granule cell discharge. The involvement of specific glutamate receptors in granule cell epileptiform activity evoked by stimulating the mossy fibers was investigated with use of rat hippocampal slices superfused with bicuculline, with or without increasing [K+](o) to 6 mM. The occurrence of short-latency mossy fiber-evoked granule cell epileptiform activity in slices from pilocarpine-treated rats correlated with the presence and extent of recurrent mossy fiber growth. Blockade of AMPA receptors nearly abolished the orthodromic component of the response; subsequent antagonism of kainate receptors as well appeared to have no further action. Antagonism of NMDA receptors reduced the duration of epileptiform discharge, but increased the amplitude of population spikes within the evoked burst. Thus AMPA and NMDA, but perhaps not kainate, receptors play an important role in this type of epileptiform activity. Activation of type II metabotropic glutamate receptors, which inhibits the release of glutamate from mossy fiber boutons, reduced the magnitude of epileptiform discharge. This action was reversed by a partial agonist of these receptors. However, neither an agonist nor an antagonist of type III metabotropic glutamate receptors significantly altered the response. Considering the importance of synchronous granule cell discharge for seizure propagation from the entorhinal cortex to the hippocampus, agonists of type II metabotropic glutamate receptors may be useful in suppressing such discharge both experimentally and clinically.

Mossy fiber sprouting into the inner molecular layer of the dentate gyrus is an important neuroplastic change found in animal models of temporal lobe epilepsy and in humans with this type of epilepsy. Recently, we reported in the perforant path stimulation model another neuroplastic change for dentate granule cells following seizures: hilar basal dendrites (HBDs). The present study determined whether status epilepticus-induced HBDs on dentate granule cells occur in the pilocarpine model of temporal lobe epilepsy and whether these dendrites are targeted by mossy fibers. Retrograde transport of biocytin following its ejection into stratum lucidum of CA3 was used to label granule cells for both light and electron microscopy. Granule cells with a heterogeneous morphology, including recurrent basal dendrites, and locations outside the granule cell layer were observed in control preparations. Preparations from both pilocarpine and kainate models of temporal lobe epilepsy also showed granule cells with HBDs. These dendrites branched and extended into the hilus of the dentate gyrus and were shown to be present on 5% of the granule cells in pilocarpine-treated rats with status epilepticus, whereas control rats had virtually none. Electron microscopy was used to determine whether HBDs were postsynaptic to axon terminals in the hilus, a site where mossy fiber collaterals are prevalent. Labeled granule cell axon terminals were found to form asymmetric synapses with labeled HBDs. Also, unlabeled, large mossy fiber boutons were presynaptic to HBDs of granule cells. These results indicate that HBDs are present in the pilocarpine model of temporal lobe epilepsy, confirm the presence of HBDs in the kainate model, and show that HBDs are postsynaptic to mossy fibers. These new mossy fiber synapses with HBDs may contribute to additional recurrent excitatory circuitry for granule cells.

A 38-year-old woman with Eisenmenger's syndrome underwent bilateral living-donor lobar lung transplantation and simultaneous closure of atrial septal defect. The grafts were a right lower lobe from her husband and a left lower lobe from her brother. Although only 2 lobes were implanted, the dramatic improvement in pulmonary hemodynamics has been well maintained for more than 5 years. Living-donor lobar lung transplantation and simultaneous cardiac repair may be one of the therapeutic options for patients with adult Eisenmenger's syndrome with simple congenital heart disease.

GABAB-receptor–mediated inhibition was investigated in anatomically identified inhibitory interneurons located at the border between the dentate gyrus granule cell layer and hilus. Biocytin staining was used to visualize the morphology of recorded cells. A molecular layer stimulus evoked a pharmacologically isolated slow inhibitory postsynaptic current (IPSC), recorded with whole cell patch-clamp techniques, in 55 of 63 interneurons. Application of the GABAB receptor antagonists, CGP 35348 (400 μM) or CGP 55845 (1 μM) to a subset of 25 interneurons suppressed the slow IPSC by an amount ranging from 10 to 100%. In 56% of these cells, the slow IPSC was entirely GABAB-receptor–mediated. However, in the remaining interneurons, a component of the slow IPSC was resistant to GABAB antagonists. Subtraction of this antagonist resistant current from the slow IPSC isolated the GABAB component (IPSCB). This IPSCB had a similar onset and peak latency to that recorded from granule cells but a significantly shorter duration. The GABAB agonist, baclofen (10 μM), produced a CGP 55845-sensitive outward current in 19 of 27 interneurons. In the eight cells that lacked a baclofen current, strong or repetitive ML stimulation also failed to evoke an IPSCB, indicating that these cells lacked functional GABABreceptor-activated potassium currents. In cells that expressed a baclofen current, the amplitude of this current was ∼50% smaller in interneurons with axons that projected into the granule cell dendritic layer (22.2 ± 5.3 pA; mean ± SE) than in interneurons with axons that projected into or near the granule cell body layer (46.1 ± 10.0 pA). Similarly, the IPSCBamplitude was smaller in interneurons projecting to dendritic (9.4 ± 2.7 pA) than perisomatic regions (34.3 ± 5.1 pA). These findings suggest that GABAB inhibition more strongly regulates interneurons with axons that project into perisomatic than dendritic regions. To determine the functional role of GABAB inhibition, we examined the effect of IPSPB on action potential firing and synaptic excitation of these interneurons. IPSPB and IPSPA both suppressed depolarization-induced neuronal firing. However, unlike IPSPA, suppression of firing by IPSPB could be easily overcome with strong depolarization. IPSPB markedly suppressed N-methyl-d-aspartate but not AMPA EPSPs, suggesting that GABAB inhibition may play a role in regulating slow synaptic excitation of these interneurons. Heterogeneous expression of GABAB currents in hilar border interneurons therefore may provide a mechanism for the differential regulation of excitation of these cells and thereby exert an important role in shaping neuronal activity in the dentate gyrus.

Recurrent mossy fiber pathway in rat dentate gyrus: synaptic currents evoked in presence and absence of seizure-induced growth. A common feature of temporal lobe epilepsy and of animal models of epilepsy is the growth of hippocampal mossy fibers into the dentate molecular layer, where at least some of them innervate granule cells. Because the mossy fibers are axons of granule cells, the recurrent mossy fiber pathway provides monosynaptic excitatory feedback to these neurons that could facilitate seizure discharge. We used the pilocarpine model of temporal lobe epilepsy to study the synaptic responses evoked by activating this pathway. Whole cell patch-clamp recording demonstrated that antidromic stimulation of the mossy fibers evoked an excitatory postsynaptic current (EPSC) in ∼74% of granule cells from rats that had survived >10 wk after pilocarpine-induced status epilepticus. Recurrent mossy fiber growth was demonstrated with the Timm stain in all instances. In contrast, antidromic stimulation of the mossy fibers evoked an EPSC in only 5% of granule cells studied 4–6 days after status epilepticus, before recurrent mossy fiber growth became detectable. Notably, antidromic mossy fiber stimulation also evoked an EPSC in many granule cells from control rats. Clusters of mossy fiber-like Timm staining normally were present in the inner third of the dentate molecular layer at the level of the hippocampal formation from which slices were prepared, and several considerations suggested that the recorded EPSCs depended mainly on activation of recurrent mossy fibers rather than associational fibers. In both status epilepticus and control groups, the antidromically evoked EPSC was glutamatergic and involved the activation of both AMPA/kainate and N-methyl-d-aspartate (NMDA) receptors. EPSCs recorded in granule cells from rats with recurrent mossy fiber growth differed in three respects from those recorded in control granule cells: they were much more frequently evoked, a number of them were unusually large, and the NMDA component of the response was generally much more prominent. In contrast to the antidromically evoked EPSC, the EPSC evoked by stimulation of the perforant path appeared to be unaffected by a prior episode of status epilepticus. These results support the hypothesis that recurrent mossy fiber growth and synapse formation increases the excitatory drive to dentate granule cells and thus facilitates repetitive synchronous discharge. Activation of NMDA receptors in the recurrent pathway may contribute to seizure propagation under depolarizing conditions. Mossy fiber-granule cell synapses also are present in normal rats, where they may contribute to repetitive granule cell discharge in regions of the dentate gyrus where their numbers are significant.

Standard reference ranges for all laboratory test values are mandatory. This study was designed to establish a reference range for blood vitamin B1 levels, since the normal range has not been determined in the Japanese population. We founded the Japan Committee for Vitamin Laboratory Standards, which was incorporated with the Vitamin Society of Japan and the Japanese Society of Nutrition and Food Science. We standardized whole blood vitamin B1 levels using three HPLC techniques (post-column reverse-phase HPLC, pre-column reverse-phase HPLC, and precolumn GP-HPLC). The reference range was obtained in 54 volunteers administered a 1,800 kcal diet with 2 mg of vitamin B1 (1.74 mg measured) daily to avoid marginal vitamin B1 deficiency in the population. The range for each assay was 26-47, 28-51, and 28-56 ng/ml, respectively. Our data suggest that 26-28 ng/ml is the lower limit of normal for whole blood vitamin B1, but further studies in a larger population are needed in order to obtain more definitive results.

Three patients with angiographically invisible aneurysms found after attempted fibrinolytic therapy are presented. One aneurysm bled during the procedure with a tragic result. All of aneurysms were located distal to the occluded arteries. Aneurysms were preexisting and invisible distal to the occluded artery, or they developed rapidly after the fibrinolysis. These aneurysms were at a risk for rupture during and after fibrinolytic therapy.

Interneurons located near the border of the dentate granule cell layer and the hilus were studied in hippocampal slices using whole-cell current clamp and biocytin staining. Because these interneurons exhibit both morphological and electrophysiological diversity, we asked whether passive electrotonic parameters or repetitive firing behavior correlated with axonal distribution. Each interneuron was distinguished by a preferred axonal distribution in the molecular layer or granule cell layer, and four groups could be discerned, the axons of which arborized in (1) the granule cell layer, (2) the inner molecular layer, (3) the outer molecular layer, and (4) diffusely in the molecular layer. In our sample, interneurons with axons arborizing diffusely in the molecular layer were most frequent, and those with axons restricted to the granule cell layer were least frequent. Resting potential, input resistance, time constant, electrotonic length, and spike frequency adaptation (SFA) were not significantly different among the four groups, and the variability in SFA between cells with similar axonal distributions was striking. Clear differences in action potential morphology and afterhyperpolarizations, however, emerged when nonadapting interneurons were compared with those exhibiting SFA. Interneurons exhibiting SFA had characteristically broader spikes, progressive slowing of action potential repolarization during repetitive firing, and slow afterhyperpolarizations that distinguished them from nonadapting interneurons. We propose that the variability in repetitive firing behavior and morphology exhibited by each of these interneurons makes each interneuron unique and may provide a high level of fine tuning of inhibitory control critical to information processing in the dentate.

An activated carbon was oxidized by HNO3 at boiling temperature. The influence of acidic surface oxides of the activated carbon was experimentally studied on the adsorption characteristics of eleven different gases or vapors. In the adsorption of cyclohexane, benzene, 2-propanol and 2-butanol, the adsorption capacity decreased greatly with oxidizing the carbon by 13.2 N HNO3. This was because the surface area and micropore volume had decreased by the strong oxidation as suggested by the t-plot analysis of oxidized carbons. When methanol, ethanol, acetone, acetonitrile and sulfur dioxide were adsorbed on the carbons, it was found that the isotherms on the carbon oxidized by 13.2 N HNO3 were much lower than those on the original carbon except in the low partial pressure range. On the other hand, the adsorption capacity of ammonia or water increased greatly with increasing surface oxides on the carbon. Especially, ammonia was strongly adsorbed on the surface oxides, and irreversible adsorption appeared. The experimental results suggest that the adsorption sites increase greatly with the surface oxides for the polar molecules whose polarizability is very small.

The technique of endoscopic excision of large capsulated lipomas is presented and the versatility of this method is discussed based on our clinical experience. We have applied this new technique in 6 cases. In all cases the lipoma was completely removed in one piece through a single incision, up to 1.5 cm in length. The endoscope made it possible to view the lipoma through a narrow space with a wide range of vision on a TV monitor. We stress that this method is not only appropriate as treatment for benign lipomas but also effective from a cosmetic point of view. The applications of the endoscope should widen in plastic surgery when the advantages of it are recognized and new operative approaches for using it are developed.

While growth of blood vessels is important in hypertension, relatively little is known about the contribution of catecholamines. Using isolated rat aorta and cultured smooth muscle cells, we examined adrenergic stimulation of gene expression. Phenylephrine, a selective alpha 1 adrenergic receptor agonist, caused a rapid and transient increase in c-fos mRNA accumulation which was inhibited by prazosin, an alpha 1 receptor antagonist. Similarly, phenylephrine stimulated c-jun and c-myc mRNA accumulation. Chloroethyl-clonidine, a compound which irreversibly blocks alpha 1B receptors, completely blocked the phenylephrine-induced increase in c-fos mRNA. RNase protection experiments demonstrated that rat aorta prominently expressed mRNA for alpha 1B and alpha 1A/D receptors. Phenylephrine-induced c-fos mRNA was partially inhibited by H-7, a protein kinase C inhibitor, and by nifedipine, a Ca2+ channel blocker; these two compounds together had additive effects. In situ hybridization showed that expression of c-fos mRNA induced by phenylephrine was localized to aorta's medial layer. These results suggest that alpha 1 receptor-induced increase in c-fos mRNA in aorta is mediated by a chloroethyl-clonidine-sensitive receptor subtype signaling via increasing intracellular Ca2+ concentrations and activating protein kinase C.