Background and aims: The pathogenesis of Crohn’ s disease (CD), a chronic inflammatory bowel disease characterised by a Th1 immune response, remains unclear. Osteopontin (OPN) is a phosphoprotein known as an adhesive...Background and aims: The pathogenesis of Crohn’ s disease (CD), a chronic inflammatory bowel disease characterised by a Th1 immune response, remains unclear. Osteopontin (OPN) is a phosphoprotein known as an adhesive bone matrix protein. Recent studies have shown that OPN playsan important role in lymphocyte migration, granuloma formation, and interleukin 12 (IL- 12) production. The present study investigated expression and the pathophysiological role of OPN in CD. Methods: Plasma OPN concentration was measured by enzyme linked immunosorbent assay. Expression of OPN in human intestinal mucosa was determined using reverse transcription- polymerase chain reaction and western blot, and localisation of OPN was examined by immunohistochemistry. Expression of integrin β 3, an OPN receptor, on lamina propria mononuclear cells (LPMC)was assessed by flow cytometry. Functional activation of OPN in LPMC was investigated by measuring the production of cytokines. Results: Plasma OPN concentration was significantly higher in patients with CD compared with normal controls or patients with ulcerative colitis (UC). OPN was upregulated in intestinal mucosa from UC and CD patients. OPN producing cells were epithelial or IgG producing plasma cells, or partial macrophages. OPN was detected in areas surrounding granuloma from mucosa in CD. Integrin β 3 expressing macrophages infiltrated inflamed mucosa in UC and CD; in contrast, there was no expression of integrin β 3 on intestinal macrophages in normal mucosa. OPN induced production of IL- 12 from LPMC in CD but not in normal controls or UC. Conclusions: Increased OPN expression facilitates cytokine production and is closely involved in the Th1 immune response associated with CD.展开更多
Background: Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. We previously reported on the usefulness of ECDUS (convex-type scanning instruments with forwa...Background: Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. We previously reported on the usefulness of ECDUS (convex-type scanning instruments with forward -Oblique viewing) for evaluating the hemodynamics of esophageal varices. In the present study, we report the usefulness of new electronic radial ECDUS in cases of esophageal varices by comparison with convex-type ECDUS. Methods: Twenty-six patients with esophageal varices were identified and studied. The underlying pathologies of portal hypertension included liver cirrhosis (15 patients) and cirrhosis associated with hepatocellular carcinoma (11 patients). Endoscopic findings of esopha-geal varices were as follows: Cb, F3, and Ls varices in four patients; Cb, F2, and Lm varices in 21 patients; and Cb, Lm, and F1 varices in one patient. RC1 was observed in the esophagus in 14 of the 26 patients. RC2 was noted in 11 cases, and RC0 was seen in one patient. ECDUS was performed using a Pentax EG- 3630UR (forward view) with a distal tip diameter of 12mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0MHz). A Hitachi EUB 6500,8500 was used for the display, providing 270° images. We monitored the color flow images of esophageal varices, paraesophageal veins, palisade veins, perforating veins, and pulsatile waves using this technique. As a control, 110 patients were examined by convex-type ECDUS. Results: (1) Color flow images of esophageal varices and paraesophageal veins were obtained in 26 of the 26 patients, whereas color flow images of perforating veins were obtained in 18 of the 26 patients (69.2% ). Color flow images of palisade veins were obtained in 12 of the 26 patients (46.2% ). (2) Color flow images of pulsatile waves were obtained in 10 of the 26 patients (38.5% ). Color flow images of pulsatile waves were detected in zero (0% ) of the 4 F3 varices, in nine (42.9% ) of the 21 F2 varices, and in the 1 (100% ) case of F1 varices. Also, color flow images of pulsatile waves were detected in seven (50.0% of the 14 RC1 varices, in two (18.2% ) of the 11 RC2 varices, and in the 1 (100% ) case of RC0 varices. (3) As a control, 110 patients were examined by convex-type ECDUS. Color flow images of esophageal varices and paraesophageal veins were obtained in 110 of the 110 patients, whereas color flow images of perforating veins were obtained in 74 of 110 (67.3% ) with convex-type ECDUS. The detection rate of palisade veins with electronic radial ECDUS (12 of the 26 patients, 46.2% )was significantly higher than with convex-type ECDUS (28 of the 110 patients,25.5% ) (P < 0.05) . The detection rate of pulsatile waves with electronic radial ECDUS (10 of the 26 cases, 38.5% ) was significantly higher than with convex-type ECDUS (3 of the 110 cases, 2.7% ) (P < 0.0001). Conclusions: Electronic radial ECDUS provides clear color flow images of blood vessels in esophageal varices with the additional advantages of forward-view optics and extended 270° views. Electronic radial ECDUS was superior to convextype ECDUS in detecting palisade veins and pulsatile waves.展开更多
Background: No method for the clinical diagnosis of MM2-type sporadic Creutzfeldt-Jakob disease (sCJD) has been established exce pt for pathologic examination. Objective: To identify a reliable marker for the clinical...Background: No method for the clinical diagnosis of MM2-type sporadic Creutzfeldt-Jakob disease (sCJD) has been established exce pt for pathologic examination. Objective: To identify a reliable marker for the clinical diagnosis of MM2-type sCJD.Methods: CSF, EEG, and neuro imaging studie s were performed in eight patients with MM2-type sCJD confirmed by neuropatholo gic,genetic, and western blot analyses. Results: The eight cases were pathologic ally classified into the cortical (n= 2), thalamic (n = 5), and combined (cortic othalamic) (n =1) forms. The cortical form was characterized by late-onset,slow ly progressive dementia, cortical hyperintensity signals on diffusion-weighted imaging (DWI) of brain, and elevated levels of CSF 14-3-3 protein. The thalami c form showed various neurologic manifestations including dementia, ataxia, and pyramidal and extrapyramidal signs with onset at various ages and relatively lon g disease duration. Characteristic EEG and MRI abnormalities were almost absent. However, all four patients examined with cerebral blood flow (CBF) study using SPECT showed reduction of the CBF in the thalamus as well as the cerebral cortex . The combined form had features of both the cortical and the thalamic forms, sh owing cortical hyperintensity signals on DWI and hypometabolism of the thalamus on [18F]2-fluoro-2-deoxy-D-glucose PET. Conclusion: For the clinical diagno sis of MM2-type sporadic Creutzfeldt-Jakob disease,cortical hyperintensity sig nals on diffusion-weighted MRI are useful for the cortical form and thalamic hy poperfusion or hypometabolism on cerebral blood flow SPECT or [18F]2-fluoro-2 -deoxy-D-glucose PET for the thalamic form.展开更多
In a woman aged 73 years who recovered from hypoglycemic coma without neurologic deficit after glucose infusion, admission diffusion weighted MRI showed the presence of hyperintensive lesions. The lesions regressed af...In a woman aged 73 years who recovered from hypoglycemic coma without neurologic deficit after glucose infusion, admission diffusion weighted MRI showed the presence of hyperintensive lesions. The lesions regressed after glucose infusion.展开更多
文摘Background and aims: The pathogenesis of Crohn’ s disease (CD), a chronic inflammatory bowel disease characterised by a Th1 immune response, remains unclear. Osteopontin (OPN) is a phosphoprotein known as an adhesive bone matrix protein. Recent studies have shown that OPN playsan important role in lymphocyte migration, granuloma formation, and interleukin 12 (IL- 12) production. The present study investigated expression and the pathophysiological role of OPN in CD. Methods: Plasma OPN concentration was measured by enzyme linked immunosorbent assay. Expression of OPN in human intestinal mucosa was determined using reverse transcription- polymerase chain reaction and western blot, and localisation of OPN was examined by immunohistochemistry. Expression of integrin β 3, an OPN receptor, on lamina propria mononuclear cells (LPMC)was assessed by flow cytometry. Functional activation of OPN in LPMC was investigated by measuring the production of cytokines. Results: Plasma OPN concentration was significantly higher in patients with CD compared with normal controls or patients with ulcerative colitis (UC). OPN was upregulated in intestinal mucosa from UC and CD patients. OPN producing cells were epithelial or IgG producing plasma cells, or partial macrophages. OPN was detected in areas surrounding granuloma from mucosa in CD. Integrin β 3 expressing macrophages infiltrated inflamed mucosa in UC and CD; in contrast, there was no expression of integrin β 3 on intestinal macrophages in normal mucosa. OPN induced production of IL- 12 from LPMC in CD but not in normal controls or UC. Conclusions: Increased OPN expression facilitates cytokine production and is closely involved in the Th1 immune response associated with CD.
文摘Background: Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. We previously reported on the usefulness of ECDUS (convex-type scanning instruments with forward -Oblique viewing) for evaluating the hemodynamics of esophageal varices. In the present study, we report the usefulness of new electronic radial ECDUS in cases of esophageal varices by comparison with convex-type ECDUS. Methods: Twenty-six patients with esophageal varices were identified and studied. The underlying pathologies of portal hypertension included liver cirrhosis (15 patients) and cirrhosis associated with hepatocellular carcinoma (11 patients). Endoscopic findings of esopha-geal varices were as follows: Cb, F3, and Ls varices in four patients; Cb, F2, and Lm varices in 21 patients; and Cb, Lm, and F1 varices in one patient. RC1 was observed in the esophagus in 14 of the 26 patients. RC2 was noted in 11 cases, and RC0 was seen in one patient. ECDUS was performed using a Pentax EG- 3630UR (forward view) with a distal tip diameter of 12mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0MHz). A Hitachi EUB 6500,8500 was used for the display, providing 270° images. We monitored the color flow images of esophageal varices, paraesophageal veins, palisade veins, perforating veins, and pulsatile waves using this technique. As a control, 110 patients were examined by convex-type ECDUS. Results: (1) Color flow images of esophageal varices and paraesophageal veins were obtained in 26 of the 26 patients, whereas color flow images of perforating veins were obtained in 18 of the 26 patients (69.2% ). Color flow images of palisade veins were obtained in 12 of the 26 patients (46.2% ). (2) Color flow images of pulsatile waves were obtained in 10 of the 26 patients (38.5% ). Color flow images of pulsatile waves were detected in zero (0% ) of the 4 F3 varices, in nine (42.9% ) of the 21 F2 varices, and in the 1 (100% ) case of F1 varices. Also, color flow images of pulsatile waves were detected in seven (50.0% of the 14 RC1 varices, in two (18.2% ) of the 11 RC2 varices, and in the 1 (100% ) case of RC0 varices. (3) As a control, 110 patients were examined by convex-type ECDUS. Color flow images of esophageal varices and paraesophageal veins were obtained in 110 of the 110 patients, whereas color flow images of perforating veins were obtained in 74 of 110 (67.3% ) with convex-type ECDUS. The detection rate of palisade veins with electronic radial ECDUS (12 of the 26 patients, 46.2% )was significantly higher than with convex-type ECDUS (28 of the 110 patients,25.5% ) (P < 0.05) . The detection rate of pulsatile waves with electronic radial ECDUS (10 of the 26 cases, 38.5% ) was significantly higher than with convex-type ECDUS (3 of the 110 cases, 2.7% ) (P < 0.0001). Conclusions: Electronic radial ECDUS provides clear color flow images of blood vessels in esophageal varices with the additional advantages of forward-view optics and extended 270° views. Electronic radial ECDUS was superior to convextype ECDUS in detecting palisade veins and pulsatile waves.
文摘Background: No method for the clinical diagnosis of MM2-type sporadic Creutzfeldt-Jakob disease (sCJD) has been established exce pt for pathologic examination. Objective: To identify a reliable marker for the clinical diagnosis of MM2-type sCJD.Methods: CSF, EEG, and neuro imaging studie s were performed in eight patients with MM2-type sCJD confirmed by neuropatholo gic,genetic, and western blot analyses. Results: The eight cases were pathologic ally classified into the cortical (n= 2), thalamic (n = 5), and combined (cortic othalamic) (n =1) forms. The cortical form was characterized by late-onset,slow ly progressive dementia, cortical hyperintensity signals on diffusion-weighted imaging (DWI) of brain, and elevated levels of CSF 14-3-3 protein. The thalami c form showed various neurologic manifestations including dementia, ataxia, and pyramidal and extrapyramidal signs with onset at various ages and relatively lon g disease duration. Characteristic EEG and MRI abnormalities were almost absent. However, all four patients examined with cerebral blood flow (CBF) study using SPECT showed reduction of the CBF in the thalamus as well as the cerebral cortex . The combined form had features of both the cortical and the thalamic forms, sh owing cortical hyperintensity signals on DWI and hypometabolism of the thalamus on [18F]2-fluoro-2-deoxy-D-glucose PET. Conclusion: For the clinical diagno sis of MM2-type sporadic Creutzfeldt-Jakob disease,cortical hyperintensity sig nals on diffusion-weighted MRI are useful for the cortical form and thalamic hy poperfusion or hypometabolism on cerebral blood flow SPECT or [18F]2-fluoro-2 -deoxy-D-glucose PET for the thalamic form.
文摘In a woman aged 73 years who recovered from hypoglycemic coma without neurologic deficit after glucose infusion, admission diffusion weighted MRI showed the presence of hyperintensive lesions. The lesions regressed after glucose infusion.
