サーモグラフィーによる体表面温度の測定 3.体表面温度の回復率と末消血流量との相関

The body surface peripheral circulation in 12 cases,　including 9 patients with　diabetes mellitus who were suffering coldness, numbness or pain in their feet, and 3 healthy volunteers was examined using Laser-Doppler blood flowmetry. At the same time, the body surface temperature was estimated by thermography. Thermographic results were analyzed quantitatively by calculating a recovery ratio as : Recovery ratio = [Total counts of thermography(Pixels) over temperature (T) after cold loading] ÷ [Initial counts over T before cold loading] x 100(%). The recovery ratio and the blood flow were correlated, r=0.68, p<O.01. The peripheral circulation of 16 patients with diabetes mellitus was observed at three different conditions including, l)placed at room temperature at 20℃for 15 min, 2) submerged and warmed for 5 min in a hot bath at 36℃(i.e. hot loading), and 3) submerged and cooled for 5 min in a water bath at 20℃ (i.e. cold loading). Three different baseline temperatures, 26℃, 27℃ and 28 ℃, were used in processing the　thermographic results into pictures. The highest correlation (r=0.59, p=0.0002) was obtained under the condition of cold loading using a baseline temperature limitation of27℃.The difference ratio (%) of blood flow was calculated as the blood flow at cold loading divided by the blood flow at hot loading in these 16 patients. The difference　ratio of the blood flow and the recovery ratio of thermography were correlated, r=0.46, p<O.OOO1. We found a strong correlation between the results of Laser-Doppler blood flowmetry and one of thermographic methods used to monitor peripheral circulation in patients with diabetes mellitus. Cold loading using a baseline temperature limitation of 27℃ were recommended for further examinations. Patients with low blood flow as well as　with large differences in their peripheral circulation between cold loading and hot　loading had severe coldness in their body surface temperature. We showed the usefulness of the results of thermography, when quantified by picture processing using computer software, in relation with the results of Laser-Doppler blood flowmetry.末梢神経障害を有する糖尿病患者の末梢循環障害の程度を数量的に検討する目的で､下肢に冷感ならびにしびれ感または疼痛を訴える糖尿病患者9症例と健常ボランティア3例の計12例(平均年齢59歳)についてサーモグラフィーを用いて体表面温度を測定した｡更に,サーモグラフィーで得られた結果と末梢皮膚血流量をレーザードプラー血流計を用いて測定して得られた結果と比較した｡サーモグラフィーによる測定で得られた結果は回復率として数量化して表示された｡回復率の算出方法は回復率= [冷水負荷後の特定温度27℃以 上の体表面温度のサーモグラフィーのPixelの総数]÷ [冷水負荷前の特定温度27℃以上の体表面温度のサーモグラフィーのPixelの総数]×100%で求めた｡レーザードプラ-血流計を用いて測定して得られた末梢血流量は左右それぞれ5カ所,計10カ所の測定値の平均で表示した｡その結果,末梢皮膚温度の回復率と末梢皮膚の血流量との問には正の相関関係(r=0.68,p<0.01)が認められた｡次に,末梢皮膚血流量について,室温20℃安静15分後,温水36℃浸水負荷10分後,冷水20℃浸水負荷30分後の異なる3条件について､またサーモグラフィーで得られた結果を,画像処理の過程で用いられた,26℃,27℃,28℃の3つの異なる特定温度との関連について検討を行なった｡対象は,下肢に冷感ならびにしびれ感または疼痛を訴える糖尿病患者16症例(平均年齢69歳,平均HbAIC9.6%)について測定した｡その結果,末梢皮膚 血流量は冷水20℃浸水負荷30分後に測定して得られた結果と,回復率は特定温度27℃で画像処理して得られた結果とが最も相関が高い(r=0.59,p=0.0002)ことが示された｡`次に,相関が高い条件は,室温20℃安静15分後に血流量を測定した場合(r=0.483,p=0.0002)であった｡そして温 水36℃浸水負荷10分後に測定して得られた結果とが最も相関関係が低い結果となった｡更に,冷水20℃浸水負荷30分後に測定して得られた結果を温水36℃浸水負荷10分後に測定して得られた結果で割った比を%で表示したところ回復率とこの比との間には正の相関関係(r=0.46,p<0.0001)が認められた｡このことから,温水36℃負荷時と,冷水20℃負荷時との差が大きい患者 において末梢皮膚温度の低下が著しいことが示された｡これまで悲観血的に測定されてきたサーモグラフィーによる末梢循環の数量的評価の試みは,レーザー血流計による結果と組み合わせることで,両者の間に正の相関関係が示されたことにより,今後,数量化された客観的評価を可能にした

サーモグラフィーによる体表面温度の測定 2.温水負荷の効果

The body surface temperature of 41 patients suffering coldness, numbness or pain in their feet was examined using thermography. Thermographic results were analyzed quantitatively by calculating a recovery ratio as: Recovery ratio =[Total counts of thermography (Pixels) over temperature (T) after cold loading] ÷ [Initial counts over T before cold loading] x 100(%). Three different baseline temperatures, 26℃. 27℃ and 28℃, were used in processing the thermographic results into pictures. The recovery ratio was susceptible to temperature, and we recommend a baseline temperature limitation of 27℃ for clinical study. A bi-modal distribution of recovery ratio was observed in 18 patients with diabetes mellitus. One group (6 subjects) had high recovery ratio between 80%-100%, and another group (10 subjects) had a low recovery ratio between 0%-19%. The results of thermography were also influenced by weather. To reduce the effect of outside temperature, we used pre-loading with hot water at 36℃ for 5 min (hot loading).　A large difference in　recovery ratio between presence and absence of hot loading was observed in 6 of the 30 subjects. The difference was over-estimated in more than 20% of recovery ratio without hot loading as compared with hot loading in these 6 subjects. The effect of drugs on peripheral circulation, such as beraprost sodium and sarpogrelate hydrochloride, was clear and quantified using thermography under these conditions of hot loading.下肢に冷感ならびにしびれ感または疼痛を訴える患者41症例についてサーモグラフィーを用いて体表面温度を測定した｡測定で得られた結果は回復率として数量化して表示された｡回復率の算出方法は回復率=[冷水負荷後の特定温度T℃以上の体表面温度のサーモグラフィーのPixelの総数]÷[温水負荷前の特定温度T℃以上の体表面温度のサーモグラフィーのPixelの総数]× 100%で求めた｡サーモグラフィーで得られた結果と画像処理の過程で用いられた,26℃,27℃,28℃の3つの異なる特定温度T℃ との関連について検討を行なった｡その結果,回復率は特定温度T℃に影響を受けやすいことが明らかとなった｡下肢の体表面温度の低い臨床症例においては27℃の条件が適当と考えられた｡前述の41症例中の18症例の糖尿病患者について検討を行なった｡そのサーモグラフィーの結果は,比較的回復率の高い(80%～100%)群の6症例と比較的回復率の低い(0%～19%)群の10症例の2群に別れた｡わずかに残り2症例が20%から79%の間であった｡下肢の症状が気温の低い時期に出親しやすいためにサーモグラフィーの検査を冬期に行なう必要性が高まった｡しかし,天候の影響を受けやすいために冷水負荷前の測定領域の下肢が冷えすぎているために20℃の室温に15分間の安静時間では体表面温度が十分に暖まることが出来ず,27℃以上の領域として測定範囲全体を観察できない 問題に直面した｡この間温点を解決する手段として36℃の温水に5分間下肢を入れて暖める温水負荷を加えることにした｡そこで, 温水負荷を行なった症例30症例について,温水負荷を行なう前(室温)の回復率と温水負荷を行なった後の回復率について比較検討を行なったところ,20%にあたる6症例において温水負荷を行なわなかった場合に20%以上の回復率の過剰評価が認めら れた｡温水負荷を行なうことにより年間を通じて天候の影響を最小限にすることが可能となり,この結果,長期間の内服薬の末梢循環に及ぼす影響の測 定を行なった場合に,季節の影響を最小限にしてサーモグラフィーにより回復率を用いて数値化された測定結果を検討することが可能となった｡具体的に末梢循環の改善に薬効が有ると言われている薬剤であるベラプロストおよびサルポグレラートを3ヵ月間内服した場合の前後のサーモグラフィーで得られた回復率について検討を行なった｡その結果はベラプロストにおいては,6.9%から41.9%に上昇または回復率の6.1倍の上昇を認めた。サルポグレラートにおいては,1.9%から17.3%に上昇または回復率の9.1倍の上昇を認めた。以上より,温水負荷を加えたサーモグラフィーの測定結果の数値化は下肢に症状の有る患者の末梢循環の評価ならびに薬効の評価の比較に有用であることが表わされた

気管支喘息患者における白血球ロイコトリエン産生能に対する不飽和脂肪酸食の効果に影響する因子

Dietary supplementation with perilla seed oil, a vegetable oil rich in α -lin- olenic acid, inhibits the generation of leukotrienes(LTs) by leucocytes in patients with bronchial asthma. We examined the factors that affect the suppression of LT generation by leucocytes with perilla seed oil-rich supplementation in patients with asthma, by comparing the clinical features of patients with asthma, whose generation of leukotriene (LT) C4 was suppressed by dietary supplementation with perilla seed oil (n-3 fatty acids) (group A), with those of patients who showed no suppression of LTC4 generation (group B). Group A showed a significant increase in the generation of LTB4 and L TC4 by leucocytes after corn oil-rich supplementation (n-6 fatty acids), and a significant decrease in the generation of LTB4 and LTC4 after perilla seed oil-rich supplementation (n-3 fatty acid). However, this was not observed in group B. The level of serum IgE and peak expiratory flow (PEF) in group A were significantly higher than in group B. Furthermore, the serum levels of LDL-cholesterol, β-lipoprotein and　phospholipid were significantly lower in group A than in group B. These results suggest that the clinical features differ between these two asthmatic populations with respect to suppression of LTB4 and LTC4 generation by n-3 fatty acids in perilla seed oil-rich supplementation.a-リノレン酸の豊富なエゴマ油の食事は気管支喘息患者の白血球ロイコトリエン(LT)産生能を抑制する｡気管支喘息患者の内,エゴマ油食によりLTC4の産生が抑制された群(A群)と抑制されない群(B群)の臨床データを比較することにより,気管支喘息患者の白血球ロイコトリエン産生能に影響する因子を検討した｡A群はコーン油(n-6系脂肪酸)の豊富な食事後,白血LTB4,LTC4の産生能が増加し,エゴマ油(n-3系脂肪酸)の豊富な食事後LTB4,LTC4の産生能が減少した｡これらの変化はB群では認められなかった｡A群のIgE値,ピークフロー(PEF)値はB群に比し,有意に高値であった｡またLDL-コレステロール,β-リポ蛋白,リン脂質はA群ではB群に比し,有意に低値であった｡これらの結果はエゴマ油の豊富な食事のn-3系脂肪酸によるLTB4,LTC4の産生能の抑制に関して2群の気管支喘息患者群間に臨床データの相違があることを示唆している

Post mortem activation of human blood fibrinolytic enzyme in sudden and natural deaths

With the purpose to elucidate the cause and difference of blood fluidity in sudden death and natural one, we have observed the fibrinolysis of the blood in medico-legal and pathological autopsies by means of Fibrin Plate Method, a routine method devised in our laboratory. As the result it has been found that in the blood serum of sudden death and in some of natural deaths from tumors, leukemias, etc., the decrease in fibrinolytic activity is equivalent to the amount of proactivator that combined with the SK-like substance liberated into blood. On the other hand, in the blood of most of natural deaths, and in that bled from vessels and stored in body cavities, no natural fibrinolysis is observable and the same fibrinolytic activity with SK as normal one is demonstrated. Thus it is concluded that the cause of blood fluidity in sudden death is due to the fibrinolysis.</p

Functional interaction of hepatitis C virus NS5B with nucleolin GAR domain

金沢大学がん研究所Hepatitis C Virus (HCV) non-structural proteins are major components of replication complex that is modulated by several host factors. We previously reported that nucleolin, a representative nucleolar marker, interacts with the NS5B through two separated sequences, amino acids (aa) 208-214 and 500-506, and that W208 in the former stretch is essential for both nucleolin-binding and HCV replication. Here we evaluated the role of the latter stretch aa 500-506 of WRHRARS in nucleolin-binding and HCV replication scanned by alanine-substituted clustered mutant (cm) or point mutant (pm). One tryptophan and three arginine residues in the sequence were found to be essential both for nucleolin-binding in vivo and HCV replication detected with a HCV subgenomic replicon transfected into Huh7 cells. NS5B-binding of nucleolin was further delineated by truncation and clustered mutants of nucleolin. Arginine-glycine-glycine (RGG) repeat in the Glycine arginine rich (GAR) domain were defined to be indispensable for NS5B-binding immunologically detected in in vivo and in vitro although short internal-truncations of RGG repeat are tolerable for NS5B-binding. These results indicate that nucleolin is a critical host factor for HCV replication through the direct interaction between W208 and several residues at the sequence, aa 500-505, of NS5B, and the long-turn motif including RGG repeat at nucleolin C-terminal. © 2007 The Japanese Biochemical Society

腰椎MRI画像と腰痛の関係

The purpose of this study was to examine the potential role of magnetic resonance imaging (MRI) in the evaluation of low back pain (LBP). The study group, 19 patients with low back pain (2 subjects aged 32-39 years and 17 aged 59-78), underwent MRI of the lumbar spine. Disc degeneration at L4/5 was the most common finding (68.4%). Overall in present study, all patients with LBP had abnormalities around the lumbar spine (evidence of disc degeneration, deformity of lumbar spine, disc bulging or protrusion, facet hypertrophy, nerve root compression and so on).この研究の目的は腰痛評価におけるMRIの役割を検討することであった｡対象は腰痛を訴え腰椎MRIを受けた19名(32歳から39歳2名,59歳から78歳17名)であった｡椎間板変成はL4/5levelで最も多く認められた(68.4%)｡本研究において腰痛を有する全患者に腰椎の異常(椎間板変性,disc bulging, protrusion, facet hypertrophy,神経根圧迫,腰椎変形など)を認めた

気管支喘息症例における気道過敏性と鼻腔･副鼻腔疾患の関係に関する検討

Pathological changes of nasosinus occur often in subjects with bronchial asthma. Coexisting nasosinus lesion may affect pathophysiology of lower respiratory tract in asthmatics. The extent of nasal and sinus lesion was quantified in 17 patients with bronchial asthma, and their relationships to atopic status, asthma severity and bronchial hyperresponsiveness were evaluated in this study. Opacification degree of maxillary sinuses and nasal mucosa thickening were quantified using CT scans. The opacification degree was evaluated as (total opacification area)/(total maxillary sinus area). Although the opacification degree of maxillary sinuses in atopic patients showed no significant difference compared with that in non-atopic patients, maximum nasal mucosa thickening in atopic patients had a significant difference compared with that in non-atopic patients (p=0.028). In severe asthmatics, the opacification degree of maxillary sinuses was significantly more prominent compared with those in moderate and mild asthmatics (p=0.0005, p=0.036, respectively). Significantly marked nasal mucosa thickening was recognized in mild asthmatics compared with that in moderate asthmatics (p=0.0462). Regarding bronchial hyperresponsiveness, a significant correlation between Dmin and the opacification degree of maxillary sinuses was observed (rs= -0.551, p=0.0276). Nasal mucosa thickening had no correlation with bronchial hyperresponsiveness. The results suggest that sinusitis may affect bronchial hyperresponsiveness and asthma severity. Treatment of sinusitis may lead to improvement of asthma symptoms.鼻腔･副鼻腔疾患はしばしば気管支喘息症例に合併が認められ,喘息症例の下気道病態に影響を及ぼしている可能性が考えられる｡今回,気管支喘息17例において,CTを用いて上顎洞の不透明化率･鼻腔粘膜肥厚を計測し,アトピー性の有無,喘息の重症度,気道過敏性との関係を検討した｡上顎洞不透明化率は全上顎洞面積の総計に対する不透明化領域面積総計として計算を行った｡上顎洞不透明化率はアトピー性の有無で差は認められなかったが,鼻腔粘膜はアトピー性喘息症例で有意に肥厚していた｡重症気管支喘息における上顎 洞不透明化率は,中等症および軽症喘息症例に比べ有意に高値であった｡鼻腔粘膜肥厚は中等症喘息症例に比べ,軽症症例で有意に肥厚していた｡気道過敏性(Dmin)は上顎洞不透明化率とのあいだに弱い負の相関が認められた(rs=-0.551,p=0.0276).鼻粘膜肥厚と気道過敏性は相関が認められなかった｡今回の結果から副鼻腔病変が気道過敏性･喘息重症度に影響を及ぼしている可能性が考えられ.副鼻腔疾患の治療により喘息症状の改善に繋がる可能性が考えられた

ステロイド依存性重症難治性気管支喘息症例における胃粘膜病変の検討

Recently, we experienced two asthmatic patients with advanced gastric cancer. The two patients had steroid-dependent intractable asthma (SDIA) who had been on administration of corticosteroids for more than 2 years. To determine the influence of pathophysiology of SDIA on stomach mucous lesion, gastroscopic examinations and immunological examinations were performed in eight patients with SDIA, compared with 25 patient with non-SDIA. In patients with SDIA, gastric cancer, its precursor condition and immunosuppressive state were observed. These results suggest that the immunosuppressive state in SDIA induced by the long-term administration of corticosteroids may lead to the risk of gastric cancer development.最近,進行胃癌を合併した気管支喘息症例を2例経験した｡2症例ともにステロイド依存性重症難治性喘息(SDIA)症例であり,SDIAが胃悪性腫瘍に関与している可能性が考えられた｡今回,SDIA症例における胃粘膜病変の臨床像および背景因子を検討する目的で,8例のSDIA症例における胃内視鏡検査,末梢血液分画,免疫グロブリン定量を行い,非SDIA症例と比較検討を行った｡SDIA症例においては胃癌･前癌状態が認められたが,非SDIA例では認められなかった｡SDIA群において,末梢血白血球は有意に増加し,リンパ球分画･IgGは有意に減少していた｡これらの結果より,ステロイド依存性重症難治性気管 支喘息症例においては免疫状態が抑制され,胃悪性腫瘍が発生する危険性があるものと考えられた

鼻腔･副鼻腔疾患を合併する気管支喘息症例に対するクラリスロマイシン投与の効果

We experienced a case of 59-year-old woman with intractable asthma, who had aspirin intolerance. Despite various treatments including systemic corticosteroid administration, she was often admitted due to severe asthma attacks. Furthermore, she had allergic rhinitis and sinusitis. Computed tomography (CT) scans of sinonasal cavity revealed marked thickness of nasal mucosa and air-fluid level in maxillary sinuses. Although her asthma symptoms such as wheezing and dyspnea were improved by administration of bronchodilator, systemic corticosteroids and beclomethasone diisoccyanate (BDI) accompanied with spa therapy, her peak expiratory flow (PEF) showed no improvement. After readmission due to asthma attacks, clarithromycin (CAM) administration for sinonasal disorders was started. The PEF value showed marked improvement after starting CAM administration, and pulmonary functions and bronchial hyperresponsiveness were also improved. It is suggested from her clinical course that CAM may have beneficial effects in asthmatic patients with sinonasal disorders.気管支喘息にアレルギー性鼻炎や副鼻腔炎を合併する症例は頻回に経験される｡副鼻腔炎症状の増悪が喘息症状の増悪を引き起こす症例も存在し,鼻腔･副鼻腔における炎症が気管支喘息の病態と何らかの関係を持っていることが考えられる｡今回,59才の難治性アスピリン喘息症例を呈示する｡副腎皮質ホルモンの全身投与を含めた様々な治療にも関わらず頻回に重篤な喘息発作を呈し,入退院を繰り返している症例である｡アレルギー性鼻炎も合併し,CTでは著明な鼻粘膜肥厚と上顎洞の鏡面形成が認められた｡入院後の投薬や温泉療法によって呼吸困難は改善したが,ピークフロー値は上昇が認められないまま退院となった｡再入院後,副鼻腔炎に対しクラリスリマイシン投与を開始したところ､ピークフロー値は著明に改善を示し,肺機能･気道過敏性も改善した｡この症例のように,鼻腔･副鼻腔疾患を合併する気管支喘息症例に対しては,クラリスロマイシン投与が有効である可能性が考えられた