Association of mast cell-derived VEGF and proteases in dengue shock syndrome

Background: Recent in-vitro studies have suggested that mast cells are involved in Dengue virus infection. To clarify the role of mast cells in the development of clinical Dengue fever, we compared the plasma levels of several mast cell-derived mediators (vascular endothelial cell growth factor [VEGF], soluble VEGF receptors [sVEGFRs], tryptase, and chymase) and -related cytokines (IL-4, -9, and -17) between patients with differing severity of Dengue fever and healthy controls. Methodology/Principal Findings: The study was performed at Children\u27s Hospital No. 2, Ho Chi Minh City, and Vinh Long Province Hospital, Vietnam from 2002 to 2005. Study patients included 103 with Dengue fever (DF), Dengue hemorrhagic fever (DHF), and Dengue shock syndrome (DSS), as diagnosed by the World Health Organization criteria. There were 189 healthy subjects, and 19 febrile illness patients of the same Kinh ethnicity. The levels of mast cell-derived mediators and -related cytokines in plasma were measured by ELISA. VEGF and sVEGFR-1 levels were significantly increased in DHF and DSS compared with those of DF and controls, whereas sVEGFR-2 levels were significantly decreased in DHF and DSS. Significant increases in tryptase and chymase levels, which were accompanied by high IL-9 and -17 concentrations, were detected in DHF and DSS patients. By day 4 of admission, VEGF, sVEGFRs, and proteases levels had returned to similar levels as DF and controls. In-vitro VEGF production by mast cells was examined in KU812 and HMC-1 cells, and was found to be highest when the cells were inoculated with Dengue virus and human Dengue virus-immune serum in the presence of IL-9. Conclusions: As mast cells are an important source of VEGF, tryptase, and chymase, our findings suggest that mast cell activation and mast cell-derived mediators participate in the development of DHF. The two proteases, particularly chymase, might serve as good predictive markers of Dengue disease severity

Different biomass-allocation patterns among four tree species in heavily disturbed sites on a volcanic mountain in Hokkaido, northern Japan

We have compared biomass-allocation patterns and frequency of sprouting among saplings of four tree species (Larix kaempferi, Betula platyphylla var. japonica, Populus maximowiczii, and Populus sieboldii) growing on a volcanic mountain in Hokkaido, northern Japan. Growing conditions were very harsh on the mountainside. Leaf mass and fine root mass relative to root mass were larger in L. kaempferi, and L. kaempferi root mass was less than for the other species. Sprouting ratios were high for the broadleaved species. Different allometries and sprouting ratios among species suggest that survival strategies for L. kaempferi were different from those for the broadleaved species. L. kaempferi has greater ability to increase leaf mass under harsh growing conditions; this probably results in large photosynthetic production by L. kaempferi on the volcano. In contrast, the two Populus species and Betula platyphylla seem to maintain populations through their ability to produce sprouts from large root systems

American-model Welfare State and Fiscal Discipline (<Featured Theme>American model of Welfare State 2)

本稿では, アメリカ･モデルの福祉国家における財政規律の問題を, 連邦レベルの均衡予算憲法修正と, 連邦補助金による州･地方レベルの財政構造への誘導効果の関係という分野で考えてみたい. 均衡予算憲法修正の連邦議会公聴会で保守派の証言者は, 「ケインズ的な赤字財政は, 財政規律の麻痺をもたらし, アメリカ全体の道徳の低下につながる」と述べる. さらに, 州･地方財政にまで視野を広げると, 「ケインズ的な赤字財政」で賄われる連邦補助金は, 福祉拡充バイアスがあり, アメリカ･モデルの福祉国家の原型(均衡財政原理に規定される州･地方財政の下の「小さな政府」的な福祉国家)に歪みを与えることになる. このような論理は, 前企画特集「アメリカ･モデルの福祉国家」で分析された1990年代の福祉改革における保守ベクトルの背景をなしている.We examine the fiscal discipline of the American-model welfare state. In the congressional hearing on the balanced budget amendment, a conservative witness told that Keynesian\u27s deficits destroy not only the fiscal discipline but also American moral. From the conservative viewpoint, the federal-aids, financed with Keynesian\u27s deficits, have the pro-welfare bias and distort the basic pattern of the American-model welfare state, which is managed under state and local governments as the balanced finance-style "small government"

重症例からみた気管支喘息治療の現状と危機管理に関する検討

1998年よりステロイド剤規則的吸入療法を主体としたガイドライン療法が導入され喘息死は徐々に減少してきたが,2000年度の本邦における喘息死は4,473名を数える.標準的治療が確立されたにもかかわらずなぜ死亡例が多いのかを,救命救急センターに3次救急搬送された重症気管支喘息患者54例を対象に検討した.救急搬送前の投薬内容をみると,ガイドラインにそった治療は行われず,喘息発作時だけβ受容体刺激剤(スプレー)を使用していた症例が平均92.9%でCPA(cardio pulmonary arrest)症例では100%であった.それに対してステロイド剤規則的吸入療法は2例3.7%にしか行われていなかった.気管支喘息を専門とする呼吸器専門医やアレルギー専門医はガイドラインにそった治療を行っているが,一般臨床医には未だ浸透していない可能性が示唆された.気管支喘息死を減少させるには,一般臨床医による患者教育の徹底,ステロイド剤規則的吸入療法をベースにした適切な定期的通院・治療の厳守,発作急変時に備えた病歴カードの常時携帯,救急医療機関側は救急隊のオーバートリアージを容認するなど危機管理の徹底を図ることが重要と考えられた.Asthmatic deaths have been gradually reduced since 1998 when regular steroid inhalation therapy was proved effective and widely introduced as guideline therapy. There were, however, still as many as 4,473 Japanese people who died of asthma in 2000. We examined the reasons for this large number of deaths, despite establishment of the guideline therapy, by investigating emergency patients who were carried to our emergency care center by ambulance as tertiary emergency cases for treatment of serious asthma. The investigation of medications used before emergency arrival showed that patients were not treated according to the guideline therapy: 92.9% of all patients and 100% of CPA (cardio pulmonary arrest) patients were treated with β-receptor stimulators (spray) only when they had asthmatic fits, and regular steroid inhalation therapy was performed on only 2 patients (3.7%). Although respiratory and allergy experts specializing in bronchial asthma follow the guideline therapy, it may not be widespread among general clinicians. To reduce the deaths from bronchial asthma, it is important to fully manage the possible risks of bronchial asthma by making general practitioners give patients full information on the disease; making patients strictly follow the appropriate hospital visit and treatment schedule based on regular steroid inhalation therapy; instructing patients to always carry their medical history cards for sudden attacks of bronchial asthma; and persuading emergency care centers to permit over-triaging by ambulance teams

重症例からみた気管支喘息治療の現状と危機管理に関する検討

1998年よりステロイド剤規則的吸入療法を主体としたガイドライン療法が導入され喘息死は徐々に減少してきたが,2000年度の本邦における喘息死は4,473名を数える.標準的治療が確立されたにもかかわらずなぜ死亡例が多いのかを,救命救急センターに3次救急搬送された重症気管支喘息患者54例を対象に検討した.救急搬送前の投薬内容をみると,ガイドラインにそった治療は行われず,喘息発作時だけβ受容体刺激剤(スプレー)を使用していた症例が平均92.9%でCPA(cardio pulmonary arrest)症例では100%であった.それに対してステロイド剤規則的吸入療法は2例3.7%にしか行われていなかった.気管支喘息を専門とする呼吸器専門医やアレルギー専門医はガイドラインにそった治療を行っているが,一般臨床医には未だ浸透していない可能性が示唆された.気管支喘息死を減少させるには,一般臨床医による患者教育の徹底,ステロイド剤規則的吸入療法をベースにした適切な定期的通院・治療の厳守,発作急変時に備えた病歴カードの常時携帯,救急医療機関側は救急隊のオーバートリアージを容認するなど危機管理の徹底を図ることが重要と考えられた.Asthmatic deaths have been gradually reduced since 1998 when regular steroid inhalation therapy was proved effective and widely introduced as guideline therapy. There were, however, still as many as 4,473 Japanese people who died of asthma in 2000. We examined the reasons for this large number of deaths, despite establishment of the guideline therapy, by investigating emergency patients who were carried to our emergency care center by ambulance as tertiary emergency cases for treatment of serious asthma. The investigation of medications used before emergency arrival showed that patients were not treated according to the guideline therapy: 92.9% of all patients and 100% of CPA (cardio pulmonary arrest) patients were treated with β-receptor stimulators (spray) only when they had asthmatic fits, and regular steroid inhalation therapy was performed on only 2 patients (3.7%). Although respiratory and allergy experts specializing in bronchial asthma follow the guideline therapy, it may not be widespread among general clinicians. To reduce the deaths from bronchial asthma, it is important to fully manage the possible risks of bronchial asthma by making general practitioners give patients full information on the disease; making patients strictly follow the appropriate hospital visit and treatment schedule based on regular steroid inhalation therapy; instructing patients to always carry their medical history cards for sudden attacks of bronchial asthma; and persuading emergency care centers to permit over-triaging by ambulance teams