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Human parechovirus has rarely been shown to cause clinical disease in adults. During June-August 2008, a total of 22 adults sought treatment at Yonezawa City Hospital in Yamagata, Japan, for muscle pain and weakness of all limbs; most also had fever and sore throat. All patients received a clinical diagnosis of epidemic myalgia; clinical laboratory findings suggested an acute inflammatory process. Laboratory confirmation of infection with human parechovirus type 3 (HPeV3) was made for 14 patients; we isolated HPeV3 from 7 patients, detected HPeV3 genome in 11, and observed serologic confirmation of infection in 11. Although HPeV3 is typically associated with disease in young children, our results suggest that this outbreak of myalgia among adults was associated with HPeV3 infection. Clinical consideration should be given to HPeV3 not only in young children but also in adults when an outbreak occurs in the community. [ABSTRACT FROM AUTHOR]

A 51-year-old man developed acute disturbances in consciousness and psychiatric symptoms one month prior to admission. He was referred and admitted to the Department of Psychiatry of our hospital and transferred to the neurology department because diffuse white matter lesions were found on his brain during MRI. 123 I-IMP-SPECT showed extensive cerebral hypoperfusion mainly in the frontal lobes. Anti-Tg, anti-TPO, and anti-NAE antibodies were positive. These findings led to a diagnosis of Hashimoto's encephalopathy. The patient responded to steroid pulse therapy, high-dose steroid therapy, and intravenous immunoglobulin therapy, showing improvement in symptoms and imaging findings. Hashimoto's encephalopathy often presents with MRI findings similar to those of limbic encephalitis, when the patient presents with acute consciousness disturbance and psychiatric symptoms. However, this case showed diffuse white matter lesions, which may be clinically important for the differential diagnosis.

Primary familial brain calcification (PFBC) is a rare neuropsychiatric disorder with characteristic symmetrical brain calcifications. Patients with PFBC may have a variety of symptoms, although they also may be clinically asymptomatic. Parkinsonism is one of the most common movement disorders; however, the underlying mechanism remains unclear. This condition is typically transmitted in an autosomal dominant fashion. To date, mutations in SLC20A2, PDGFRB, PDGFB, and XPR1 have been reported to cause PFBC. The aim of the study was to identify the genetic cause of brain calcification in probands from three PFBC families and in 8 sporadic patients and to perform clinical and radiological assessments focusing on parkinsonism in mutation carriers. Three familial PFBC probands and their relatives and eight sporadic patients affected with brain calcifications were enrolled in this study. Whole-exome sequencing identified three novel mutations: c.269G > T, p.(Gly90Val) and c.516+1G > A in SLC20A2 in familial cases, and c.602-1G > T in PDGFB in a sporadic patient. The c.516+1G > A mutation resulted in exon 4 skipping in SLC20A2 (p.Val144Glyfs*85). Dopamine transporter single photon emission computed tomography using 123 I-ioflupane and 123 I-metaiodobenzylguanidine cardiac scintigraphy revealed pre-synaptic dopaminergic deficit and cardiac sympathetic nerve dysfunction in two SLC20A2-related PFBC patients with parkinsonism.

N-Phenethyl-substituted ortho-a and para-a oxide-bridged phenylmorphans have been obtained through an improved synthesis and their binding affinity examined at the various opioid receptors. Although the N-phenethyl substituent showed much greater affinity for μ- and κ-opioid receptors than their N-methyl relatives (e.g., K(i)=167 nM and 171 nM at μ- and κ-receptors vs >2800 and 7500 nM for the N-methyl ortho-a oxide-bridged phenylmorphan), the a-isomers were not examined further because of their relatively low affinity. The N-phenethyl substituted ortho-b and para-b oxide-bridged phenylmorphans were also synthesized and their enantiomers were obtained using supercritical fluid chromatography. Of the four enantiomers, only the (+)-ortho-b isomer had moderate affinity for μ- and κ-receptors (K(i)=49 and 42 nM, respectively, and it was found to also have moderate μ- and κ-opioid antagonist activity in the [(35)S]GTP-γ-S assay (K(e)=31 and 26 nM)., (Copyright © 2011. Published by Elsevier Ltd.)

The clinical benefits of repetitive transcranial magnetic stimulation (rTMS) for Parkinson's disease (PD) remain controversial. We performed a comprehensive study to examine whether rTMS is a safe and effective treatment for PD. Twelve PD patients received rTMS once a week. The crossover study design consisted of 4-week sham rTMS followed by 4-week real rTMS. The Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoehn and Yahr Stage, Schwab and England ADL Scale, Actigraph, Mini-Mental State Examination, Hamilton Depression Scale, Wechsler Adult Intelligence Scale-revised, and cerebral blood flow (CBF) and cerebrospinal fluid (CSF) examinations were used to evaluate the rTMS effects. Under both drug-on and drug-off conditions, the real rTMS improved the UPDRS scores significantly, while the sham rTMS did not. There were no significant changes in the results of the neuropsychological tests, CBF and CSF. rTMS seems to be a safe and effective therapeutic option for PD patients, especially in a wearing-off state.

Human T-cell leukemia virus type-1 (HTLV-1)-specific T-cell immunity, a potential antitumor surveillance system in vivo, is impaired in adult T-cell leukemia (ATL). In this study, we aimed to clarify whether the T-cell insufficiency in ATL is present before the disease onset or occurs as a consequence of the disease. We investigated T-cell responses against Tax protein in peripheral blood mononuclear cells (PBMCs) from individuals at earlier stages of HTLV-1-infection, including 21 asymptomatic HTLV-1 carriers (ACs) and four patients with smoldering-type ATL (sATL), whose peripheral lymphocyte count was in normal range. About 30% of samples tested showed clear Tax-specific interferon (IFN)-gamma producing responses. Proviral loads in this group were significantly lower than those in the other less-specific response group. The latter group was further divided to two subgroups with or without emergence of Tax-specific responses following depletion of CC chemokine receptor 4 (CCR4)(+) cells that contained HTLV-1-infected cells. In the PBMCs with Tax-specific responses, CD8(+) cells efficiently suppressed HTLV-1 p19 production in culture. The remaining group without the emergence of Tax-specific response after CCR4(+) cell-depletion included at least two sATL and one AC samples, which spontaneously produced HTLV-1 p19 in culture, where tetramer-binding, Tax-specific cytotoxic T-lymphocytes were either undetectable or unresponsive. Our results indicated that HTLV-1-specific T-cell responsiveness widely differed among HTLV-1 carriers, and that impairment of HTLV-1-specific T-cell responses was observed not only in advanced ATL patients but also in a subpopulation at earlier stages, which was associated with insufficient control of HTLV-1.

Background: The aim of this study was to evaluate the distribution of pentraxin 3 (PTX3) values in healthy subjects and to characterize its relationship with gender, age, body mass index (BMI), lipid profile, and blood sugar levels., Methods: A Japanese population of 1749 healthy subjects (818 men and 931 women) with a mean (SD) age of 59.6 (11.4) years (range 37-87 years) were examined., Results: Plasma PTX3 levels (PTX3 data are expressed as the geometric mean and confidence intervals) were i) significantly lower in men than in women (1.87 [1.81, 1.94] ng/mL vs. 2.12 [2.05, 2.19] ng/mL, p<0.0001), ii) significantly higher in the high age group (men, lowest quartile 1.62 [1.50, 1.74] ng/mL vs. highest quartile 2.14 [2.02, 2.27] ng/mL, p<0.001; women, lowest quartile 2.05 [1.92, 2.18] ng/mL vs. highest quartile 2.23 [2.02, 2.46] ng/mL, p<0.05), iii) inversely correlated with triglycerides (r=-0.19 in men and r=-0.18 in women, p<0.00001), and BMI (r=-0.16 in men and r=-0.24 in women, p<0.00001), and iv) lower in subjects with metabolic syndrome (MetS) than in the absence of MetS (1.82 [1.70, 1.95] ng/mL vs. 2.11 [2.06, 2.16] ng/mL, p=0.021)., Conclusions: We defined the normal range of plasma PTX3 in healthy Japanese subjects, and also showed the relationship between plasma PTX3 levels and established coronary risk factors, including MetS. PTX3 could be an ideal biomarker because it is a marker relatively independent from established coronary risk factors.

In the isomeric series of 12 racemic topologically rigid N-methyl analogues of oxide-bridged phenylmorphans, all but two of the racemates, the ortho- and para-b-oxide-bridged phenylmorphans 20 and 12, have remained to be synthesized. The b-isomers were very difficult to synthesize because of the highly strained 5,6-trans-fused ring junction that had to be formed. Our successful strategy required functionalization of the position para (or ortho) to a fluorine atom on the aromatic ring using an electron-withdrawing nitro group to activate that fluorine. The racemic N-phenethyl analogues 24 and 16 were moderately potent kappa-receptor antagonists in the [(35)S]GTPgammaS assay. We synthesized the N-phenethyl-substituted oxide-bridged phenylmorphans in the ortho- and para-d-oxide-bridged phenylmorphan series (51 and 52) which had not been previously evaluated using contemporary receptor binding assays to see whether they also have higher affinity for opioid receptors than their N-methyl relatives 46 and 47.

Sporadic Parkinson's disease (sPD) is a common neurodegenerative disorder, characterized by selective degeneration of dopaminergic neurons in the substantia nigra. Although the pathogenesis of the disease remains undetermined, phosphorylation of alpha-synuclein and its oligomer formation seem to play a key role. However, the protein kinase(s) involved in the phosphorylation in the pathogenesis of sPD has not been identified. Here, we found that G-protein-coupled receptor kinase 5 (GRK5) accumulated in Lewy bodies and colocalized with alpha-synuclein in the pathological structures of the brains of sPD patients. In cotransfected cells, GRK5 phosphorylated Ser-129 of alpha-synuclein at the plasma membrane and induced translocation of phosphorylated alpha-synuclein to the perikaryal area. GRK5-catalyzed phosphorylation also promoted the formation of soluble oligomers and aggregates of alpha-synuclein. Genetic association study revealed haplotypic association of the GRK5 gene with susceptibility to sPD. The haplotype contained two functional single-nucleotide polymorphisms, m22.1 and m24, in introns of the GRK5 gene, which bound to YY1 (Yin Yang-1) and CREB-1 (cAMP response element-binding protein 1), respectively, and increased transcriptional activity of the reporter gene. The results suggest that phosphorylation of alpha-synuclein by GRK5 plays a crucial role in the pathogenesis of sPD.

We report a 16-year-old woman with Vogt-Koyanagi-Harada's (VKH) disease, presenting polymorphonuclear pleocytosis in the cerebrospinal fluid (CSF) and neurological manifestation similar to meningoencephalitis. VKH disease, which has severe neurological manifestations including numerous CSF polymorphonuclear pleocytosis, should be considered as a differential diagnosis from infectious meningoencephalitis.

Anteromedial rotatory instability (AMRI) of the knee joint was investigated with an instrument newly designed to simulate the manual AMRI test and to quantify its magnitude. Thirty healthy subjects, 20 patients with anterior cruciate ligament (ACL) injury, and 10 with both ACL and medial collateral ligament (MCL) injuries were examined. Using the instrument, 100 N of anterior force was applied to the proximal part of the tibia with the foot in neutral rotation, 30 degrees of internal rotation, and 30 degrees of external rotation, and the magnitude of anterior displacement was recorded. The measurement was carried out at 20 degrees and 90 degrees of flexion. A significant increase in anterior laxity was observed in all three rotation positions in the injured patients. However, the magnitude of laxity in external rotation was less than that in neutral rotation in the ACL injured patients, whereas it was the greatest in external rotation in ACL + MCL injured patients. Thus, we conclude that an injury involving both the ACL and MCL causes AMRI.

Purpose: The purpose of this study was to evaluate the frequency and precise pathology of articular cartilage injuries after acute patellar dislocation., Type of Study: Case series., Methods: In 39 consecutive knees with initial lateral patellar dislocation, the articular cartilage injuries were examined using arthroscopy or macroscopic observation., Results: Thirty-seven knees (95%) had articular cartilage injuries of the patellofemoral joint and 2 knees (5%) had no cartilage injury. In all 37 knees (95%), articular cartilage injuries were observed in the patella. The appearances were categorized into 3 groups: cracks alone (9 knees), cartilage defect caused by osteochondral or chondral fracture (7 knees), and cartilage defects caused by osteochondral or chondral fracture associated with cracks (21 knees). The main site of osteochondral fracture was the medial facet, and the main site of cracks was the central dome. Twelve knees (31%) had cartilage injury of the lateral femoral condyle., Conclusions: From this study, articular cartilage injuries, especially of the patella, seem to be common occurrences after acute patellar dislocation. Chondral and osteochondral injuries of the patella were classified into 3 groups.

To determine whether posteroventral pallidotomy (PVP) induces topographical changes of the ipsilateral midbrain and degeneration of the substantia nigra in Parkinson's disease patients, we obtained magnetic resonance (MR) images of 18 patients who had undergone PVP and measured the width of the cerebral peduncle at the mid-point of the inner margin. Then, we assessed MR signal changes in the substantia nigra on T2-weighted images in all patients and on multishot diffusion-weighted images in seven patients. In MR images taken within 1 year of PVP, a comparison between the ratio of the ipsilateral side/contralateral side of the cerebral peduncle of patients after PVP and that of the unaffected side/affected side in the preoperative images revealed no significant difference ( P>0.05). In MR images 1 to 2 years after PVP, there was a significant difference in the ratio of the cerebral peduncle ( P<0.01). A significant difference was still evident in MR images more than 2 years after PVP ( P<0.001). On T2-weighted images obtained within 1 year of PVP, an area of patchy high signal appeared in the posterolateral region of the ipsilateral substantia nigra in six of 13 patients. However, there was no signal change in the substantia nigra in any T2-weighted images more than 1 year after PVP. Multishot diffusion-weighted images obtained from all six patients more than 1 year after PVP revealed an abnormal area of high signal in the posterolateral region of the ipsilateral substantia nigra, however, within 1 year of PVP such a signal change was not seen. PVP would induce degeneration of the ipsilateral substantia nigra and atrophy of the ipsilateral midbrain.

The discovery of a series of nonpeptide arginine vasopressin V(2) receptor agonists is described. After identifying the aniline derivative 8 as our lead compound from the metabolites of compound 7 that showed antidiuretic activity by po administration to Brattleboro rats, improvements in the in vitro potency involving evaluations of the structural requirements for agonist action and optimizing the structure of the benzoyl moiety have been intensively undertaken. These studies led to compounds 16g, 19a, and 23b,h,i that show potent agonist activity for the V(2) receptor.

DNA-based mutation analysis on the connexin 32 gene was performed in 49 families with Charcot-Marie-Tooth disease (CMT) type 1 but without duplication involving the chromosomal region, 17p12-p11.2. Mutations were identified in five of the 49 families, and four of the five mutations were hitherto undescribed: Va137Met, Glu57His, Arg142Glu, Val177Ala. X-linked CMT sometimes lacks evidence for X-linked transmission and cannot be differentiated from CMT type 2, especially in females with mildly decreased nerve conduction velocity. Therefore, molecular analysis is useful for molecular pathology of their disease.

The prognostic value of ubiquitin levels in cerebrospinal fluid (CSF) was studied in human global brain ischemia (anoxic-ischemic encephalopathy). Twenty four samples were collected from 13 patients who were resuscitated from cardio-pulmonary arrest and survived for at least 1 day. The outcome was classified according to the Glasgow Outcome Scale (GOS1-5). The ubiquitin levels (normal: 14.3 +/- 1.1 ng/ml, mean +/- S.E.M.) in neurologically symptomatic patients (GOS1-4) were 151 +/- 32.5 ng/ml on day 1-2 and elevated to 1,960 +/- 849 ng/ml on day 3-4. The Spearman's rank correlation of ubiquitin levels on day 3-4 and the GOS was -0.855, showing a better correlation than CSF neuron-specific enolase levels (r = -0.846). Ubiquitin is a heat shock protein associated with the degradation of abnormal cellular proteins. Thus, the elevation of CSF ubiquitin levels represents both its overproduction by a cytoprotective response to brain ischemia and its leakage from the damaged tissue. The present study suggests that the measurement of CSF ubiquitin level is useful for the early prognostic assessment of global brain ischemia.

Mitogenicity and the production of tumor necrosis factor (TNF) by a chemically synthesized lipotetrapeptide analog (KAB-8), S-[2,3-bis(palmitoyloxy)-2R-propyl]-N-[(2,2,2)-trichloro- ethoxycarbonyl: Troc group]-(R)-cysteinyl-(S)-seryl-(S)-seryl-(S)-asparagine, the amino acid sequence of which corresponds to that of the lipopeptide part of lipoprotein in Escherichia coli, and several derivatives (KAB-30-41), which possessed the altered glycerocysteine moiety, were examined. A 1-cysteinyl glycerol skeleton-type compound (KAB-8), a propane-type compound (KAB-31), a homoglycerol-type (KAB-39 and 40) and a 2-cysteinyl glycerol-type (KAB-41) exhibited mitogenic activity on splenocytes from C3H/He mice at various concentrations ranging from 0.4 to 100 micrograms/ml. However, propane-type compounds, except KAB-31, and ethane-type compounds showed lower mitogenic activity than other types of compounds. Compounds KAB-8, 31, 40 and 41 induced the production of TNF in peritoneal exudated macrophages from C3H/He mice at concentrations of 25 and 50 micrograms/ml. The results indicate that the structural differences of the glycerol moiety in the synthetic lipopeptides affect the potency of its biological activities.

Optically active lipopeptide derivatives have been synthesized by the use of chiral glycerol derivatives. Lipopeptide WS1279 derivatives with (R)-glycerol moieties showed a higher mitogenic activity than those with the (S)-configuration. Various N-protected lipopeptide and N-deprotected derivatives showed increased mitogenic activity.

Clinical characteristics of late deterioration in adult cerebral palsy were reported with detailed neurological evaluations and analyses. 10 adult cases, 9 male and 1 female, with cerebral palsy (CP) were included aged from 24 to 58 years on admission. Without marked mental retardation all had been ambulant and completely independent of ADL with residual spasticity and/or dyskinesia of minimal degree until the second or third decade. Late deterioration of functional abilities starting with numbness or pain in upper extremities at age 24-45 (mean: 36.2 y), associated with profound atrophy of the shoulder girdle and hand muscles. Dyskinesia and spasticity markedly aggravated with urinary and respiratory dysfunctions, resulting in tetraplegia in a couple of years. Mentality is generally unaffected, however, severe dementia occurred in one case. Intensive clinical examinations revealed no particular abnormalities except for mild segmental neurogenic changes by needle EMG. Neuroradiological surveys revealed a marked narrowing of upper to middle cervical spinal canal with deformity and shrinkage of the corresponding cord in most cases. Cranial CT scans and MRI were unremarkable except for diffuse cortical atrophy and ventricular dilation. These studies showed that in adult CP an unexpectedly severe deterioration of sensory, motor and/or mental functions may appear even in previously well achieved cases. These dramatic changes of the clinical features of CP after middle age might be suggestive of the degenerating process and precocious aging of the CNS.

Mitogenicity, lethal toxicity, and antitumor activity against Meth A fibrosarcoma of chemically synthesized lipopeptide analogs, S-[2,3-bis(palmitoyloxy)-2R-propyl]-N-[(2,2,2)-tri- chloroethoxycarbonyl: Troc group]-cysteinyl-seryl-seryl-asparaginyl-alanine (compound KAB-2), which contain the amino acid sequence of lipopeptide in Escherichia coli, S-[2,3-bis(palmitoyloxy)- 2R-propyl]-N-(Troc- or amino-group)-cysteinyl-asparaginyl-seryl-glycyl-glycine (compound KAB-14 or -20), which is found in the amino acid sequence of lipopeptide in Streptomyces, and the compounds binding one to six amino acids, were examined. The analogs showed the mitogenic activity toward splenocytes of C3H/He mice. Low concentrations (0.4 and 2.0 micrograms/ml) of compounds KAB-20 and -21, which have five and six amino acids, respectively, increased the incorporation of [3H]thymidine better than a high concentration (50 micrograms/ml), suggesting that KAB compounds carrying amino groups exert better mitogenicity than KAB compounds carrying Troc group. The decrease of amino acid number in lipopeptide analogs appears to result in a lowering of mitogenicity at low concentrations. KAB-14 and KAB-2 did not exhibit the lethality at a high dose of 50 micrograms/mouse in galactosamine-loaded C57BL/6 mice. By twice intravenous injections of 50 micrograms against Meth A fibrosarcoma in BALB/c mice, KAB-2 showed a higher inhibitory effect than KAB-14. Based on these results, we concluded that the difference of amino acid sequence in the synthetic lipopeptides affects the potency of biologic activities.

The synthesis of optically active lipopeptide derivatives has been accomplished by the use of chiral glycerol derivatives. Lipopeptide derivatives with (R)-glycerol moieties showed higher mitogenic activities than those with the (S)-configuration. N-2,2,2-Trichloroethoxycarbonyl lipopeptide derivatives increased mitogenic activity.

Mitogenicity, lethal toxicity, induction of tumor necrotizing factor (TNF), and antitumor activity against Meth A fibrosarcoma of four chemically synthesized lipopentapeptide analogs, S-[2,3-bis(palmitoyloxy)-2R (designated as KAB-1), -2S(KAB-3)-propyl]-N-palmitoyl-(R)-cysteinyl-(S)-seryl- (S)-seryl-(S)-asparaginyl-(S)-alanine, S-[2,3-bis(palmitoyloxy)-2R(KAB-2), and -2S(KAB-4)-propyl]-N-[(2,2,2)-trichloroethoxycarbonyl]-(R)- cysteinyl-(S)-seryl-(S)-seryl-(S)-asparaginyl-(S)-alanine, of bacterial lipoprotein were investigated. These four analogs, as well as bacterial lipopolysaccharide (LPS) or synthetic Escherichia coli-type lipid A (506), were capable of increasing of [3H]thymidine into splenocytes of C3H/He mice. Although LPS and 506 did not exhibit the mitogenic activity in C3H/HeJ mice, KAB compounds showed remarkable mitogenicity. These analogs did not show the lethal toxicity at a high dose of 50 micrograms/mouse in galactosamine-loaded C57BL/6 mice. Peritoneal macrophages, stimulated with four analogs, caused the production of TNF which induces the L929 cell lysis in vitro. Twice, intravenous injections of 50 micrograms/mouse of these analogs showed weak growth inhibition of Meth A fibrosarcoma in BALB/c mice. The inhibitory effect of KAB-2 compound, which caused the strong TNF-induction among the four analogs, was the most potent. These results indicate that the biological activity of KAB-2 (R-configuration of the C-2 position in glycerol moiety with dipalmitoyl) is stronger than that of the other three analogs.