HPLC Analysis of Homocysteine and Related Compounds

Homocysteine (Hcy), a sulfur-containing amino acid, is a representative intermediate metabolite of methionine (Met) to cysteine (Cys) via several intermediates. An elevated level of Hcy in plasma plays an important role in diseases such as neural tube defects and Down syndrome. Homocystinuria is the most common inborn error of sulfur metabolism and is caused by mutations in the metabolic enzymes of Hcy. These errors can be caused by abnormal levels of Met metabolites and classified on the basis of plasma Met levels. Additionally, Hcy and related compounds such as glutathione play an important role in maintaining homeostasis. Therefore, the simultaneous determination of Hcy and/or related compounds is required for appropriate clinical management of several diseases. The sulfur-containing amino acids and their derivatives in biological samples are quantified sensitively using high-performance liquid chromatography methods coupled with various detection methods such as UV/Vis, fluorescence, chemiluminescence, electrochemical, mass spectrometry, and tandem mass spectrometry. In this chapter, we review recent advances in these analytical methods and their applications

Bilateral Multiple Pulmonary Sclerosing Hemangioma in a Young Male Patient

The patient was a 24-year-old male who visited our University Hospital complaining of chest pain, and chest computed tomography revealed multiple bilateral nodules. The chest pain disappeared almost immediately, but the tumor underwent no changes during the 3 years of follow-up observations. We used a thoracoscope to perform a partial lung resection of a nodule that reached a maximum diameter of 9 mm for the purpose of obtaining a definite diagnosis. From the pathological findings, the patient was diagnosed to have pulmonary sclerosing hemangioma in which circular tumor cells lacking nuclear atypia rose to papillary hyperplasia. The mindbomb homolog-1 positive rate (MIB-1 index) of the tumor cells was less than 1%, and it is believed to have a poor proliferation activity. Pulmonary sclerosing hemangioma is predominantly found in cases of middle-aged female patients and occurs unilaterally. Cases of bilateral multiple forms in young males are extremely rare. Some cases of enlargement, metastasis and relapse have also been reported, so in the future, careful follow-up is required

The Utility of the Combined Use of 123I-FP-CIT and 123I-MIBG Myocardial Scintigraphy in Differentiating Parkinson’s Disease from Other Parkinsonian Syndromes

【Background】123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and 123I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguish Parkinson’s disease (PD) from parkinsonian syndromes other than PD (non-PD), including atypical parkinsonian disorder (APD) and non-PD other than APD (nPD-nAPD). The purpose of this study was to determine whether combining DAT-SPECT and MIBG myocardial scintigraphy using multiparametric scoring system (MSS) could improve diagnostic test accuracy in discriminating PD from APD or discriminating PD from nPD-nAPD. 【Methods】A total of 52 patients, including 36 PD, eight APD and eight nPD-nAPD, underwent both MIBG myocardial scintigraphy and DAT-SPECT, were evaluated. The heart-to-mediastinum (H/M) ratios (early and delayed), washout-rate (WR), the average (Ave) and asymmetry index (AI) of specific binding ratio (SBR) were calculated. Cutoff values were determined, using ROC analysis, for discriminating PD from APD and for discriminating PD from nPD-nAPD, on five parameters. All cases were scored as either 1 (PD) or 0 (nPD-nAPD or APD) for each parameter according to its threshold in each discrimination. These individual scores were summed for each case, yielding a combined score to obtain a cutoff value for the MSS in each discrimination. 【Results】For discriminating PD from nPD-nAPD, the highest accuracy was 80% at a cutoff value of 19% for the WR and a cut off value of 2 improved diagnostic accuracy to 84% for MSS. For discriminating PD from APD, the highest accuracy was 86% at a cutoff value of 2.8 for the H/M ratio (late) and a cut off value of 2 showed diagnostic accuracy of 86% for MSS. 【Conclusion】A MSS has comparable or better accuracy compared to each parameter of MIBG myocardial scintigraphy and DAT-SPECT in distinguishing PD from nPD-nAPD or distinguishing PD from APD

Clinical Study Status of Systemic Oxidative Stress during Therapeutic Hypothermia in Patients with Post-Cardiac Arrest Syndrome

Therapeutic hypothermia (TH) is thought to be due to the downregulation of free radical production, although the details of this process remain unclear. Here, we investigate changes in oxidative stress and endogenous biological antioxidant potential during TH in patients with post-cardiac arrest syndrome (PCAS). Nineteen PCAS patients were enrolled in the study. Brain temperature was decreased to the target temperature of 33 ∘ C, and it was maintained for 24 h. Patients were rewarmed slowly (0.1 ∘ C/h, <1 ∘ C/day). The generation of reactive oxygen metabolites (ROMs) was evaluated in plasma samples by d-ROM test. Plasma antioxidant capacity was measured by the biological antioxidant potential (BAP) test. Levels of d-ROMs and BAP levels during the hypothermic stage (33 ∘ C) were suppressed significantly compared with pre-TH induction levels ( < 0.05), while both d-ROM and BAP levels increased with rewarming (33-36 ∘ C) and were correlated with brain temperature. Clinical monitoring of oxidative stress and antioxidant potential is useful for evaluating the redox state of patients undergoing TH after PCAS. Additional therapy to support the antioxidant potential in the rewarming stage following TH may reduce some of the observed side effects associated with the use of TH

An Autopsy Case of Acute Pulmonary Embolism after Lung Cancer Surgery

The patient was a 77-year-old female who had difficulty breathing at 48 h after undergoing a right upper lobectomy for lung cancer and experienced sudden cardiopulmonary arrest. Emergency resuscitation was performed, and she was therefore put under artificial respiration, but she died 15 h after resuscitation. A pathological autopsy was performed upon obtaining informed consent from the family. An examination of the lungs in which the right upper lobectomy was performed detected multiple embolisms blocking the bilateral main pulmonary arteries to the periphery, and the cause of death was established as acute pulmonary embolism. The rate of occurrence of fatal pulmonary embolism after surgery is assumed to be 0.08%, but the rate of occurrence after thoracic surgery shows a high rate of 0.34%. It is important to implement early detection and the early treatment of pulmonary embolism that occurred by misfortune while also reviewing all risk assessments and preventive measures established under the medical guidelines in order to prevent such cases from becoming fatal

Status of Systemic Oxidative Stress during Therapeutic Hypothermia in Patients with Post-Cardiac Arrest Syndrome

Therapeutic hypothermia (TH) is thought to be due to the downregulation of free radical production, although the details of this process remain unclear. Here, we investigate changes in oxidative stress and endogenous biological antioxidant potential during TH in patients with post-cardiac arrest syndrome (PCAS). Nineteen PCAS patients were enrolled in the study. Brain temperature was decreased to the target temperature of 33°C, and it was maintained for 24 h. Patients were rewarmed slowly (0.1°C/h, <1°C/day). The generation of reactive oxygen metabolites (ROMs) was evaluated in plasma samples by d-ROM test. Plasma antioxidant capacity was measured by the biological antioxidant potential (BAP) test. Levels of d-ROMs and BAP levels during the hypothermic stage (33°C) were suppressed significantly compared with pre-TH induction levels (P<0.05), while both d-ROM and BAP levels increased with rewarming (33–36°C) and were correlated with brain temperature. Clinical monitoring of oxidative stress and antioxidant potential is useful for evaluating the redox state of patients undergoing TH after PCAS. Additional therapy to support the antioxidant potential in the rewarming stage following TH may reduce some of the observed side effects associated with the use of TH