Left ventricular preload reserve in preterm infants with patent ductus arteriosus

The left ventricular Frank-Starling response was studied in 15 preterm infants, less than 1500 g birth weight, and in 16 fullterm infants with patent ductus arteriosus. Left ventricular end diastolic volume (LVEDV), stroke volume, and cardiac output were calculated from biplane echocardiographic images with a modified Simpson's rule, and the left ventricular function curve was obtained by standardising with birth weight and body length. In the relationship between LVEDV and stroke volume, the slope of the regression line was significantly milder in preterm than in fullterm infants; however, there was no significant difference in the relationship between LVEDV and cardiac output. The heart rate was significantly higher in preterm than in fullterm infants. Our data indicated that the premature infants had less left ventricular reserve capacity to respond to the increased preload through the left-to-right ductal shunting than the mature ones, and that the high pulse rate made it possible to generate adequate cardiac output in premature infants.

[Assessment of osteoporosis in the local population by means of a portable dual energy X-ray absorptiometry unit]

We assessed bone mineral density (BMD) in the local population by means of a portable dual energy X-ray absorptiometry (DXA) unit. BMD was measured by DXA in 197 women (62 premenopausal and 135 postmenopausal) in Shiunji town. Age, height, weight, body mass index (BMI), menstrual history, obstetric history, habits, symptoms and hormonal cytology (eosinophilic index (EI), karyopyknotic index (KPI) and maturation value (MV)) were investigated. A negative correlation (r = -0.645, p < 0.01) was found between BMD and age. Low BMD (BMD < 0.8g/cm2) was found at a rate of 3.2% in premenopausal women and 51.1% in postmenopausal women. The low BMD group of postmenopausal women had significantly lower BMI and higher age at first delivery than the normal BMD group (BMD > or = 0.8g/cm2). There were no differences between the 2 groups in other factors. We found a positive correlation between BMD and hormonal cytology (KPI and MV). These findings suggest that the rate of osteopenia in postmenopausal women is high than expectation and it is difficult to predict bone loss by symptoms, history and habits. The portable DXA unit is useful for screening osteopenia in local populations.

Effect of the synthetic lipid A-related compound, DT-5461, on resistance to Sendai virus infection in mice

DT-5461 enhanced host resistance to Sendai virus infection in mice. Intranasal (i.n.) administration of 200 micrograms of DT-5461 per mouse 3 days before infection was the most effective administration route, dose and timing. DT-5461 enhanced the cytotoxicity of murine natural killer (NK) cells. In addition, DT-5461 activated murine peritoneal macrophages, resulted in augmented of cytotoxicity and the induction of tumor necrosis factor-alpha (TNF-alpha). Therefore, these immunomodulating activities presented by DT-5461 caused protection against Sendai virus infection.

Effects of flavonoid compounds on the activity of NADPH diaphorase prepared from the mouse brain

The effects of flavonoids on NADPH diaphorase activity were studied in vitro, and we found that the enzyme activity was markedly inhibited by quercetin. This inhibitory action was shown to be accompanied by an increase in the apparent Km value of the enzyme for the cofactor NADPH, with a decrease in the Vmax, and an increase in the apparent Km for the substrate nitro blue tetrazolium, without any significant change in the Vmax. These results indicate that quercetin may directly inhibit NADPH diaphorase, thus suggesting the possibility that this compound may be able to inhibit the production of nitric oxide in the brain.

Modulation of the in vivo immune response by selective depletion of neutrophils using a monoclonal antibody, RP-3. III. Enhancement by RP-3 treatment of the anti-sheep red blood cell plaque-forming cell response in rats

Because recent work has shown that neutrophils produce various cytokines and are activated by these agents, this study was undertaken to examine neutrophil participation in immune networks. In our previous work, we demonstrated that delayed type hypersensitivity to SRBC and accompanying mononuclear leukocyte recruitment are inhibited in vivo by selective depletion of neutrophils using a mAb designated RP-3. To elucidate the function of these cells in Ab production, we assessed the splenic plaque-forming cell response to SRBC in a rat model through selective depletion of circulating neutrophils by RP-3. This depletion which occurred at the time of immunization resulted in an increase in the number of anti-SRBC Ab producing cells, as determined by the direct and indirect plaque-forming cell response. This phenomenon was observed only when the Ag was administered i.p. and not with i.v. immunization. These results suggest that neutrophils suppress Ab production in certain situations.

Identification of a DNA sequence involved in osteoblast-specific gene expression via interaction with helix-loop-helix (HLH)-type transcription factors

To elucidate regulatory mechanism(s) underlying differentiation of osteoblasts, we examined involvement of helix-loop-helix (HLH)-type transcription factors in osteoblast-specific expression of a phenotypic marker gene which encodes osteocalcin, a major noncollagenous bone matrix protein, exclusively expressed in osteoblasts. Overexpression of a dominant negative HLH protein, Id-1, decreased the activity of the 1.1-kb osteocalcin gene promoter cotransfected into rat osteoblastic osteosarcoma ROS17/2.8 cells. Analysis of deletion mutants revealed that a 264-bp fragment of osteocalcin promoter (-198 to +66) was sufficient for the Id-1-dependent suppression. Furthermore, the activity of the same promoter fragment (-198 to +66) was enhanced when antisense Id-1 expression vector was cotransfected. This osteocalcin gene promoter region contains two sites of an E-box motif, a consensus binding site for HLH proteins, which we refer to as OCE1 (CACATG, at -102) and OCE2 (CAGCTG, at -149), respectively. Mutagenesis in OCE1 but not OCE2 led to greater than 50% reduction in transcriptional activity of the osteocalcin gene promoter. Electrophoresis mobility shift assay indicated that factors in nuclear extracts prepared from ROS17/2.8 cells bound to the 30-bp oligonucleotide probe containing the E-box motif of OCE1. This binding was competed out by OCE1 oligonucleotide but neither by OCmE1 oligonucleotide in which E-box motif was mutated nor by OCE2. The OCE1-binding activity in the nuclear extracts of ROS17/2.8 cells was reduced by 70% when bacterially expressed Id-1 protein was added to the reaction mixture, suggesting the involvement of HLH proteins in the DNA/protein complex formation. In contrast to the osteoblast-like cells, OCE1-binding activity in the nuclear extracts of C3H10T1/2 fibroblasts was very low. However, when these fibroblasts were treated with recombinant human bone morphogenetic protein-2 which induced expression of osteocalcin as well as other phenotypic markers of osteoblasts, OCE1-binding activity was increased approximately 40-fold, indicating that OCE1 would be involved in the tissue-specific expression of the osteocalcin gene. These findings indicated for the first time that osteoblast-specific gene transcription is regulated via the interaction between certain E-box binding transcription factor(s) in osteoblasts and the OCE1 sequence in the promoter region of the osteocalcin gene.

Dynamic features of hemodynamic and metabolic changes in the human brain during all-night sleep as revealed by near-infrared spectroscopy

By the use of near-infrared spectroscopy, hemodynamic and metabolic changes were monitored continuously in the human brain during all-night sleep in a similar time dimension as closely monitored by electroencephalography. Measurements were started in the awake state, the values of which were taken as the control. Contrary to what many have predicted, the cerebral oxygen metabolic rate (CMRO2) increased during the transition from wakefulness to sleep. Cerebral blood flow (CBF) decreased during non-rapid eye movement (non-REM) sleep, in which a dissociation between changes in CBF and those in CMRO2 was observed. The CBF returned to the control level even in response to the only 20-s appearance of alpha activity on the electroencephalogram. During REM sleep both CBF and CMRO2 were practically the same as the control level, whereas during the transition from REM sleep to arousal a disproportionate increase in CBF compared with CMRO2 was observed. Thus, it is suggested that the flow-metabolic coupling mechanism is reset to a new level during sleep.

[Seasonal variation in intraocular pressure]

Generally speaking, physicians have the impression that intraocular pressure (IOP) in winter is higher than in summer, but it is very difficult to evaluate the difference between summer and winter IOP statistically, because the treatments of glaucoma patients are changed according to their conditions. We compared the winter and summer IOP of normal subjects and of several glaucoma patients who had no therapy or no change in therapy. The subjects were divided into four groups, i.e., 20 eyes of the normal group, 17 eyes of the ocular hypertensive group, 24 eyes of the primary open angle glaucoma group, and 52 eyes of the low tension glaucoma group. The difference in mean IOP between summer and winter were evaluated for each subject. In all groups, the mean difference in mean winter IOP was significantly higher. The ups and downs of IOP were greater in the ocular hypertensive group and the primary open angle glaucoma group than in the normal group and the low tension glaucoma group. These results suggest that the seasonal variation of IOP should be taken in consideration when treating glaucoma patients.

Stimulation of fracture repair by recombinant human basic fibroblast growth factor in normal and streptozotocin-diabetic rats

The effect of local application of recombinant human basic fibroblast growth factor (rhbFGF) on fracture repair was examined using normal rats and streptozotocin-diabetic rats with impaired repairing ability. Immediately after fracturing the fibula, rhbFGF was applied by a single injection to the fracture site. Application of rhbFGF increased the volume and mineral content of callus in a dose-dependent manner in both normal and diabetic rats, and callus formation of diabetic rats was stimulated to levels similar to those in nontreated normal rats. The marked effect of rhbFGF on fracture repair was associated with an improvement in the mechanical properties of the healing fibula in both normal and diabetic rats. Immunohistochemical staining showed that endogenous bFGF was widely distributed in normal rats 1 and 3 weeks after fracture, especially in the soft callus and periosteum, whereas much less bFGF was detected in diabetic rats. Insulin treatment of diabetic rats restored the immunostaining for bFGF. These results demonstrate that bFGF is expressed during the early stage of fracture repair, and that the impaired fracture-repairing ability in diabetic rats is associated with reduced expression of bFGF at the fracture site. A single application of bFGF immediately after fracture not only facilitates the repair process in normal rats, but also recovers the impaired repairing ability in diabetic rats. These results suggest that local application of bFGF may facilitate bone union in patients with impaired as well as normal repairing ability.

Modulation of the in vivo immune response by selective depletion of neutrophils using a monoclonal antibody, RP-3. III. Enhancement by RP-3 treatment of the anti-sheep red blood cell plaque-forming cell response in rats

Because recent work has shown that neutrophils produce various cytokines and are activated by these agents, this study was undertaken to examine neutrophil participation in immune networks. In our previous work, we demonstrated that delayed type hypersensitivity to SRBC and accompanying mononuclear leukocyte recruitment are inhibited in vivo by selective depletion of neutrophils using a mAb designated RP-3. To elucidate the function of these cells in Ab production, we assessed the splenic plaque-forming cell response to SRBC in a rat model through selective depletion of circulating neutrophils by RP-3. This depletion which occurred at the time of immunization resulted in an increase in the number of anti-SRBC Ab producing cells, as determined by the direct and indirect plaque-forming cell response. This phenomenon was observed only when the Ag was administered i.p. and not with i.v. immunization. These results suggest that neutrophils suppress Ab production in certain situations.

Non-invasive monitoring of brain oxygen sufficiency on cardiopulmonary bypass patients by near-infra-red laser spectrophotometry

A new portable high-performance apparatus for near-infra-red (NIR) laser spectrophotometry was developed to monitor the oxygenation state in the human brain. Three different wavelengths of 780, 805 and 830 nm of the NIR light illuminated the head using a fibre-optic bundle, and the transmitted or reflected light was detected by a photodiode placed on the forehead. The oxygenated Hb (oxy Hb), deoxygenated Hb (deoxy Hb) content and the Hb (blood) volume changes in the brain were continuously monitored in cardiopulmonary bypass (CPB) patients in the reflectance mode. In hypothermic CPB with selective brain perfusion, the brain bypass flow rates of 0.5 L min-1 at 24-25 degrees C and 0.3 L min-1 at 21-22 degrees C were confirmed as the safe lower limits by our NIR monitoring. During deep hypothermic circulatory arrest, the brain oxy Hb and blood volume decreased significantly. The result indicates that brain Hb oxygenation decreases significantly during circulatory arrest. In the adult patients group, during moderate hypothermic CPB, the brain blood oxygenation level was maintained roughly constant at mean arterial perfusion pressure of over 60 mm Hg, whereas below 50-55 mmHg a progressive decline in the brain Hb oxygenation was observed. These findings led us to conclude that non-invasive monitoring of brain oxygenation using NIR light can provide valuable data at the bed-side regarding tissue metabolism, and it can allow for the proper management of critical patients.

Biochemical and histochemical studies of the effects of cerebral metabolism-improving drugs on NADPH diaphorase activity in mouse brain

The effects of cerebral metabolism-improving drugs on NADPH diaphorase activity in the mouse brain were studied, and we found that diaphorase activity in the post-mitochondrial fraction of brain homogenate was enhanced by idebenone in a concentration-dependent manner. Histochemical studies also indicated that diaphorase staining was intensified by idebenone at the same concentration. These results suggest that idebenone may stimulate the production of nitric oxide, probably through its direct action on nitric oxide synthase, thus producing its protective action on neurological disorders due to cerebral hypoxia or ischemia as a consequence of dilating the cerebral blood vessels.

Liveborn twin with intrauterine death of one twin: report of two cases

Twin pregnancies carry a greater mortality and morbidity rate than singleton pregnancies. In case of an intrauterine fetal death (IUFD), the risk of mortality and morbidity of the surviving twin is increased. The pathogenesis is usually due to twin to twin transfusion. The donor twin is hypovolemic, anemic and often shows a growth retardation or even severe enough to cause an IUFD. The recipient twin is hypervolemic, polycythemic and weighs more than its co-twin. In this paper we reported two cases of liveborn twin complicated by an IUFD of its co-twin. Both cases were monochorionic twins. The first case was born at 29 weeks and 6 days of gestation, a male infant weighed 1054 g. His co-twin was stillborn and weighed 722 g. At birth the surviving infant showed respiratory distress syndrome (RDS), anemia and bilateral periventricular echogenicity (PVE). The second case was a female infant with a gestational age of 26 weeks and 2 days and weighed 850 g. Her stillborn co-twin weighed 804 g. Both twins showed signs of hydrops, and the liveborn infant had RDS, marked anemia (Hb 6 g/dl) and hypoalbuminemia. We will discuss the possible pathogenesis in our cases and also review some literature.

Nasal continuous positive airway pressure following surfactant replacement for the treatment of neonatal respiratory distress syndrome

To evaluate whether nasal continuous positive airway pressure (N-CPAP) could be an alternative to ventilator treatment in infants with severe respiratory distress syndrome (RDS) after surfactant treatment, we performed the trial on 15 newborn babies with birth weight > or = 1500 g. All babies were put on N-CPAP as soon as the diagnosis of RDS was established. The N-CPAP system that we used in this study consisted of no ventilator. When FiO2 > or = 0.7 was required for maintaining PaO2 > 50 mmHg, surfactant treatment was decided. After the tracheal instillation of surfactant (120 mg/kg body weight), the babies were randomly assigned into 2 groups. In the ventilator group (n = 7), the babies were connected to mechanical ventilation following surfactant instillation. In the N-CPAP group (n = 8), the babies were extubated immediately after instillation of surfactant and were connected to N-CPAP. There was a marked improvement in the ratio of arterial PO2 to alveolar PO2 (a/A PO2) immediately following surfactant treatment and the effect was sustained during the study period of 72 hours in both groups. No significant differences in a/A PO2 were noted in 2 groups. There was a significantly higher PaCO2 in the N-CPAP group than in the ventilator group. PaCO2 declined significantly in the ventilator group 8 hours after surfactant treatment. A delayed decline in PaCO2 until 48 hours after surfactant instillation in the N-CPAP group was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

[Three cases of hypersensitivity pneumonitis caused by inhalation of spores of Pholiota nameko and the background of the disease]

Here we report a new type of hypersensitivity pneumonitis caused by inhalation of spores of Pholiota nameko. P. nameko is a kind of mushroom which is of Japanese delicacy. Among people who are working in nameko cultivation, we found three patients suffering from hypersensitivity pneumonitis, and identified that it was caused by inhalation of spores of P. nameko. Every patient was engaged in indoor nameko cultivation inside a building equipped with a air and moisture conditioning system for two to ten years. In the indoor environment, it was thought that they were exposed to and inhaled a high density of nameko spores. Among 15 healthy indoor nameko growers, we found 6 who had precipitating antibody against extracts from nameko spores; however, there were no antibody positive people in 17 outdoor nameko growers. As seen in dairy farmers, it was clarified that there is a percentage of precipitin positive nameko growers who are asymptomatic. This is concrete evidence that changes of mushroom cultivation style can induce a new type of hypersensitivity pneumonitis. These findings were considered to be an important experience from the view points of environmental pulmonary diseases and industrial medicine.

Eosinophilic leukaemia with a t(2;5) (p23;q35) translocation

Although the diagnosis of rare eosinophilic leukaemia is possible based on cytogenetic abnormalities, the chromosomal aberrations reported are diverse. We found a t(2;5) (p23;q35) translocation on bone marrow cells of a patient with chronic eosinophilia who suffered from multiple pustular folliculitis but lacked the clinical symptoms commonly observed in hypereosinophilic syndrome. No morphological abnormalities in an eosinophilic series were apparent and other haemopoietic cells were well preserved. A therapeutic trial with interferon-alpha failed after a 2-month period, and the patient is currently undergoing a combination therapy with interferon and intermittent administrations of hydroxyurea.

[Multiple cooperative study of UFT-adjuvant chemotherapy for malignant tumor in the jaw and oral cavities. The Oral Surgery Malignant Tumor Research Association in Kanto Kohshinetsu District]

We studied the usefulness and safety of long-term administration of uracil and tegafur (UFT) after primary therapy of the malignant tumor in jaw and oral cavity regions randomized controlled trial. 112 cases were totallized 6 institutes belonging to the Oral Surgery Malignant Tumor Research Association in Kanto Kohshinetsu District during 2 years and 10 months, beginning in September 1986. After completing the primary therapy, treatment was not performed in group A and 400 mg/day of UFT was orally administered in group B for 1 year. A variation was observed in the stages of background factors such as sex and age (more than 30 years old and less than 80 years old), while no such discrepancy was observed in other stages. No significant difference of 1-year-survival ratio and non-recurrence ratio was noted in either group, while the non-recurrence ratio was more favorable in group B than group A, and the usefulness of UFT for adjuvant chemotherapy was suggested. The incidence of side effects in group B was 42.6%, and no serious side effect was observed.

Congenital diaphragmatic hernia treated by perinatal stabilization

The delay of surgery in conjunction with high-frequency oscillation ventilation combined with preoperative stabilization is a standard treatment for congenital diaphragmatic hernia neonates in the high-risk group. A new protocol of perinatal stabilization with this preoperative stabilization has been developed at the University of Tokyo Hospital. The most important components of this method of perinatal stabilization are cesarean section and the injection of morphine and pancuronium through the umbilical vein prior to ligation of the umbilical cord. In order to benefit from this treatment, congenital diaphragmatic hernia patients should be diagnosed antenatally by ultrasonography and be delivered by cesarean section. This protocol of perinatal stabilization appears effective in congenital diaphragmatic hernia patients.

Subtype cross-reactive, infection-enhancing antibody responses to influenza A viruses

Antibody-dependent enhancement of the uptake of influenza A virus by Fc receptor-bearing cells was analyzed by using virus strains of the three human influenza A virus subtypes, A/PR/8/34 (H1N1), A/Japan/305/57 (H2N2), and A/Port Chalmers/1/73 (H3N2). Immune sera obtained from mice following primary infection with an H1N1, H2N2, or H3N2 subtype virus neutralized only virus of the same subtype; however, immune sera augmented the uptake of virus across subtypes. Immune sera from H1N1-infected mice augmented uptake of the homologous (H1N1) and H2N2 viruses. Antisera to the H2N2 virus augmented the uptake of virus of all subtypes (H1N1, H2N2, or H3N2). Antisera to the H3N2 virus augmented the uptake of the homologous (H3N2) and H2N2 viruses. These results show that subtype cross-reactive, nonneutralizing antibodies augment the uptake of influenza A virus strains of different subtypes. Antibodies to neuraminidase may contribute to the enhanced uptake of viruses of a different subtype, because N2-specific monoclonal antibodies augmented the uptake of both A/Japan/305/57 (H2N2) and A/Port Chalmers/1/73 (H3N2) viruses.

Non-synchronous behavior of neuronal activity, oxidative metabolism and blood supply during mental tasks in man

In near-infrared spectroscopic studies during mental tasks such as problem solving and mental arithmetic, we found that 9 of 33 healthy volunteers showed decreases in both the regional cerebral blood flow (r-CBF) and oxygen consumption rate (CMRO2) in the frontal region of the dominant hemisphere. To confirm these unexpected observations, we performed simultaneous measurements by positron emission tomography (PET) and near-infrared spectroscopy (NIRS) in two such subjects. PET images also showed that CBF decreased within the presumptive area illuminated by near-infrared light during mental task. However, CBF decreased in almost all regions while the subject gave a correct answer. Thus, the questions arose: Are mental tasks always associated with increases in r-CBF and/or CMRO2?

Extra-axial ependymoma--case report

A 13-year-old boy presented with a very unusual ependymoma extending extra-axially. Computed tomography demonstrated a tumor with a cyst and calcification adjacent to the dura and extending over the right occipital and parietal lobes. The cyst wall and solid tumor were enhanced postcontrast. Magnetic resonance imaging revealed that the solid tumor was isointense on T1-weighted images and a mixed iso- and high-intensity on T2-weighted images. The solid tumor and tissue surrounding the cyst were enhanced markedly by gadolinium-diethylenetriaminepentaacetic acid. Sagittal and coronal images demonstrated a multilocular tumor shadow. Cerebral angiography demonstrated a tumor fed by a posterior branch of the right middle meningeal artery but no feeders from the internal carotid and vertebral arteries. The tumor was removed en bloc. The histological diagnosis was clear cell-type ependymoma.