A comparison of ultrastructural changes on endomyocardial biopsy specimens obtained from patients with diabetes mellitus with and without hypertension

The pathogenesis of diabetic cardiomyopathy is unknown. The synergistic, or enhanced, effect of hypertension on pathological changes in the heart of diabetic patients has been highly suspected. The purpose of this study was to evaluate the myocardial changes related to diabetes mellitus with and without hypertension, using biopsy specimens. We examined the ultrastructural changes in biopsy specimens of the endomyocardium obtained from 25 patients. They were divided into four groups: controls without hypertension or diabetes mellitus (n = 6), and patient with hypertension (n = 3), diabetes mellitus (n = 8), and diabetes with hypertension (n = 8). The diabetic patients showed nearly normal or mildly depressed systolic left ventricular function. Ultrastructural pictures were analyzed for thickening of the capillary basement membrane, presence of toluidine blue-positive materials (i.e., materials showing metachromasia) in the myocytes, size of myocytes, and interstitial fibrosis. The thickening of the capillary basement membrane, the accumulation of toluidine blue-positive materials, and interstitial fibrosis were all significantly greater in the patients with diabetes mellitus compared to the control subjects. The myocytes tended to be small (cell atrophy) in the diabetes group. Although these pathological changes in the heart were characteristic of diabetic patients, irrespective of the presence or absence of hypertension, the presence of hypertension increased the pathological changes of myocardial cells as well as abnormality in the capillary vessels in patients with diabetes mellitus. Alterations in the myocardial cells and capillaries, caused by diabetes mellitus, may lead to myocardial cell injury and interstitial fibrosis and, ultimately, to ventricular systolic and diastolic dysfunction, especially when the diabetes is accompanied by hypertension.

Glutathione-doxorubicin conjugate expresses potent cytotoxicity by suppression of glutathione S-transferase activity: comparison between doxorubicin-sensitive and -resistant rat hepatoma cells

The cytotoxic mechanism of a conjugate of doxorubicin (DXR) and glutathione (GSH) via glutaraldehyde (GSH-DXR) was investigated using DXR-sensitive (AH66P) and -resistant (AH66DR) rat hepatoma cells. GSH-DXR accumulated in AH66DR cells as well as in AH66P cells without efflux by P-gp and exhibited the potent cytocidal activity against both cells compared with DXR. To examine whether thiol from GSH-DXR affected the expression of cytotoxicity, two conjugates of DXR, with modified peptides containing alanine or serine substituted for cysteine in GSH were prepared and their cytotoxicities determined. Substitution of these amino acids for cysteine resulted in an approximately two- to fourfold reduction in cytotoxic activity against both cell lines compared with the effect of GSH-DXR. Depletion of intracellular GSH by treatment of both cells with buthionine sulphoximine did not change the cytotoxic activity of DXR, BSA-DXR or GSH-DXR. By co-treating the cells with tributyltin acetate, an inhibitor of glutathione S-transferase (GST), and either DXR, BSA-DXR or GSH-DXR, the cytotoxicity was markedly increased. Interestingly, GSH-DXR showed non-competitive inhibition of GST activity and its IC50 value was 1.3 microM. These results suggested that the inhibition of GST activity by GSH-DXR must be an important contribution to the expression of potent cytotoxicity of the drug.

[A case of CEA and CA19-9 producing recurrent transitional cell carcinoma in an Indiana pouch after total cystectomy]

A 73-year-old female with transitional cell carcinoma (TCC) of the bladder underwent total cystectomy and Indiana pouch replacement in April, 1992. Histological examination revealed grade 3 TCC. In February 1995, she complained of gross hematuria. Intravenous pyelography (IVP) revealed a right non-functional kidney and filling defect in the Indiana pouch. We suspected colon cancer in the Indiana pouch because the levels of serum carcino-embryonic antigen (CEA) and CA19-9 were elevated. Endoscopic biopsy of intrapouch tumor was done. Pathological examination revealed grade 2 TCC. In July 1995, right nephroureterectomy with resection of Indiana pouch was performed and the surgical specimen revealed renal pelvic and ureteral cancer, grade 2 TCC. The levels of serum CEA and CA19-9 returned to the normal range 21 days after the operation. CEA and CA19-9 histochemical stain of renal pelvic and ureteral cancer were positive. Also CEA-, CA19-9-positive cells were detected in the specimens of the bladder tumor from the total cystectomy performed in 1992. This rare case is discussed and the literature is reviewed.

Speech-induced changes in corticospinal excitability

The aim of the experiments was to investigate the effects of speech on the excitability of corticospinal pathways to human hand muscles. Single transcranial magnetic stimuli were given randomly over the hand area of either the left or right motor cortex of 10 right-handed and 3 left-handed normal volunteers. Electromyographic responses were recorded in the relaxed first dorsal interosseous muscle while the subjects (a) read aloud a piece of text, (b) read silently, (c) spoke spontaneously, or (d) made sounds without speaking. The only consistent effect across subjects occurred during task a, which significantly increased the size of responses evoked in the dominant hand of all subjects, but had either no effect (8 subjects) or a smaller effect in the nondominant hand. Tasks b and d had no reliable effect, whereas task c tended to increase response size in both hands. Control measurements suggest that the effects in task a were caused by changes in cortical rather than spinal excitability. This is the first demonstration of lateralized speech effects on the excitability of cortical arm areas. The results provide a useful adjunct to other tests of cerebral dominance, using only single- rather than repetitive-pulse cortical stimulation.

Emotional and behavioral correlates of mediodorsal thalamic neurons during associative learning in rats

Neuronal activity was recorded from the mediodorsal thalamic nucleus (MD) of behaving rats that were trained to lick a protruding spout just after a conditioned stimulus to obtain reward or to avoid shock. Conditioned stimuli included both elemental (auditory or visual stimuli) and configural (simultaneous presentation of auditory and visual stimuli predicting reward outcome opposite that predicted by each stimulus presented alone) stimuli. Of 122 MD neurons responding during the task, the activity of 13 increased just before licking only during the task, but not before spontaneous licking during the intertrial interval (conditioned behavior related). These conditioned behavior-related neurons were located mainly in the lateral MD, which has intimate anatomical connections with motor-related areas such as anterior cingulate and striatum. The activity of the other 109 neurons was related to conditioned stimulation (conditioned stimulus related). Most of these neurons responded differentially to both elemental and configural stimuli in terms of reward contingency, and also changed their responses during extinction and relearning trials. Conditioned stimulus-related neurons with latencies < 300 msec were located mainly in the rostromedial MD, which receives afferents from the basolateral nucleus of the amygdala in which sensory information from various sources converge. Furthermore, most differential neurons that were tested responded during the delay period in a reward task in which a delay was imposed between the conditioned stimulus and reward delivery. The present results, along with previous anatomical studies, suggest the existence of two limbic circuits: anterior cingulate-striatum-lateral MD (motor) and amygdala-medial MD-orbital prefrontal cortex (short-term memory/emotion).

[The prognostic factors in astrocytic tumors: analysis by the Kaplan-Meier method and the Weibull log-linear model]

As the prognosis of astrocytic tumors depends on various factors, identifying prognostic factors should be useful for developing strategies to cope with them. Between 1975 and 1994, more than 200 patients with astrocytic tumors were treated in Kagoshima University. Of these patients, 149 (grade I: 17, grade II: 42, grade III: 41, grade IV: 42, unproven: 7) have been followed up. Records of these patients were retrospectively reviewed for age at the time of initial symptoms, gender, histological grade (WHO), extent of tumor resection, radiation therapy, and administration of anticancer agents. We used the Kaplan-Meier method and the Weibull log-linear model to analyze the relation between survival time and these prognostic factors. Survival time was counted from onset of symptoms, and age of initial treatment was used as a covariant. The mean age of males at the initial diagnosis was 40.8 years (n = 77), and that of females was 39 years (n = 72). Using the Kaplan-Meier method, the mean survival time of the 149 patients was 101 months (males; 72.7 months, females; 134.5 months). Mean survival time of grade II was 144.3 months, that of grade III was 95.2 months, and grade IV (glioblastoma) was 15.9 months. Histological grades and mean ages of the groups showed a positive correlation. Among grades II, III and IV, the Kaplan-Meier survival curves were significantly different (p < 0.0001) according to the log-rank test. By the extent of surgical resection (subtotal or greater resection, partial resection, and less than partial resection), the mean survival time showed a significant difference (p < 0.05) on the log-rank test. However, we could not detect a significant difference in survival time between the group that received chemotherapy and the group which did not. The Weibull log-linear analysis indicated that gender, age, histological grade (WHO), extent of surgery, and dose of radiation therapy were prognostic factors. Covariants of grades II, III, and IV made survival time 0.314, 0.179, and 0.069 times as long as that of grade I. The survival time after "partial resection" became 1.415 times as long as the survival time after "less than partial resection". The covariant of "greater than subtotal resection" showed a prolonged survival time of 2.916 compared with that of "less than partial resection". As for age at treatment, the older the patient was, the shorter the survival time. The rate was 0.986 for each year of age. Irradiation of one Gy increased survival time by 1.015 times. Chemoimmunotherapy (dose of ACNU and interferon beta) could not be confirmed as an effective covariant.

Pharmacokinetic analysis of protein-conjugated doxorubicin (DXR) and its degraded adducts in DXR-sensitive and -resistant rat hepatoma cells

After treatment of AH66DR cells with the multidrug resistance (MDR) phenotype with bovine serum albumin (BSA)-conjugated [14C]doxorubicin (DXR), accumulation of the drug in the secondary lysosomal fraction increased as a function of time up to 24 h without any significant increase of the drug in other organellae. By contrast, AH66P cells showed a marked increase in accumulation of the drug in the mitochondrial fraction, and a moderate increase in the lysosomal and nuclear fractions. The intracellular degradation of the internalized conjugate was assessed by HPLC gel filtration as molecular change of the drug. The initial molecular mass (M(r)) of BSA-conjugated [14C]DXR was estimated to be 70 kDa; however, the secondary lysosomal fraction contained mainly three peaks of [14C]compounds ranging from 3 to 70 kDa. The [14C]compound extracted from the nuclear and mitochondrial fractions showed only one peak, which was estimated to be smaller than 2 kDa. By contrast, the cytosolic fraction contained mainly two peaks of [14C]compounds, which were smaller than 2 kDa and larger than 500 kDa. These results indicated that the intracellular distribution of the administered drug, based probably on the drug-traffic mechanism in the cells, was quite different between the two cell lines, but some of the biochemical characteristics of the degraded compounds from each subcellular fraction were similar because the degradation processes in each fraction might be almost identical. The possibility of lysosomal degradation of the protein-conjugated DXR leading to expression of cytotoxicity was also confirmed by the fact that only lysosomal digestable poly-L-lysine-conjugated DXR exhibited dose-dependent cytotoxicity against both cell lines in marked contrast to the cells treated with poly-D-lysine-conjugated DXR. It was concluded that lysosomal breakdown of protein-conjugated DXR, which had been taken up by endocytosis, and the liberation of the degraded active adducts of the conjugate without efflux by the MDR pump mechanism must be an essential stage in the development of the cytotoxicity against tumor cells with or without the MDR phenotype.

[A case report of active aortic prosthetic valve endocarditis due to methicillin-resistant Staphylococcus epidermidis]

A 71-year-old woman with active aortic prosthetic endocarditis due to Methicillin-resistant Staphylococcus epidermidis (MRSE) and subannular mycotic aneurysm and paravalvular leakage and acute mitral regurgitation underwent emergent surgical treatment. The mycotic aneurysm was closed using a prosthetic patch after surgical debridement. Re-aortic valve replacement with a 21-mm Hancock II prosthesis was performed at the paraannular position by utilizing the patch. Mitral valve was also replaced with a 27-mm Hancock II prosthesis. Antibiotic therapy was provided by vancomycin combined with rifampicin and gentamicin. The following regimen was given, vancomycin 1 g i.v. q12h for 6 weeks plus gentamicin 80 mg/day i.v. for 4 weeks plus rifampicin 450 mg/day orally for 6 weeks. Vancomycin and gentamicin doses were modified appropriately according to the monitored serum levels in the patient with renal failure. Postoperative course was uneventful. The patient is doing well 11 months after surgery and no recurrence of infection has been seen. We conclude that prompt surgical removal of the infected sources and appropriate antibiotic therapy based on the bacteriology may be the only curative treatment for uncontrolled infection at the active phase of MRSE prosthetic endocarditis.

Design and synthesis of C-linked fucosides as inhibitors of E-selectin

Two series of C-linked fucosides as mimetics for the tetrasaccharide sialyl Lewis X have been synthesized and tested as inhibitors of E-Selectin. The fucopeptides have been prepared from three key intermediates, including alpha-C-allyl fucose, natural and unnatural amino acids bearing hydroxyl groups and an alpha, omega-diacid moiety for the imitation of the essential three parts of SLex, i.e., the Fuc, Gal, and NeuAc. The nature and distance of the linkage of the fucose moiety to the amino acids as well as the distance between the amino acids and the terminal carboxylic acid group turned out to be crucial for the biological activity. In addition the necessity of both OH groups (4- and 6-OH) in the Gal part could be confirmed. Conformational NMR study of the most active mimetic supports the structure-activity relationship. A second series of mimetics was prepared, where Fuc and Gal moieties were purely C-linked. In the synthesis of beta-C-allyl galactose an intramolecular 1,2-hydride shift led to an interesting side product. However, the substituted glycosidic oxygens led to a substantial loss of conformational constrain, which could not be compensated and resulted in low activity.

The effects of pH on N-methacryloyl glycine primer on bond strength to acid-etched dentin

To develop a more effective adhesive primer, it is imperative to understand the adhesion mechanisms of the resin to the demineralized dentin through a dentin primer. When the bonding agent was directly applied to the dentin etched by 40 wt % phosphoric acid without a primer pretreatment, the bond strength of the resin to the dentin was 5 MPa. Conversely, when the demineralized dentin was pretreated with the N-methacryloyl glycine (NM alpha A) primer solution with a pH value of 1.5, the bond strength increased considerably to 15 MPa. However, the bond strength dropped dramatically from 15 to 3 MPa when the sodium salt of NM alpha A was added, thereby increasing the pH value of the NM alpha A primer solution from 3.2 to 5.0. When the pH value was increased above 3.5 (pKa value), the number of ionized NM alpha A species increased in the solution. As a result, the bond strength of the resin fell to approximately 3 MPa. This result was obtained despite the 5-micron-thick hybrid layer that was created in the subsurface of the intertubular dentin. The number of unionized NM alpha A species increased by lowering the pH value below 3.5. As a result, the NM alpha A primer provided a higher bond strength of the resin to the demineralized dentin. In contrast, when 10 wt % citric acid containing 3 wt % ferric chloride was applied to the dentin, maximum bond strength was obtained when the pH value of the NM alpha A primer solution was 3.5. The pH dependency of the bond strength obtained following 10 wt % citric acid containing 3 wt % ferric chloride etching is different from the results obtained from 40 wt % phosphoric acid etching. This can be attributed to the difference in the characteristics of the demineralized collageous layer.

Prognostic significance of Ki-67 labeling index in urothelial tumors of the renal pelvis and ureter

PURPOSE

We evaluated the prognostic significance of the Ki-67 labeling index in 70 patients with primary urothelial tumors of the renal pelvis and ureter.

MATERIALS AND METHODS

Immunohistochemical staining for Ki-67 in archival tumor materials was done by the streptavidin-biotin method.

RESULTS

Univariate survival analysis showed that the prognosis of patients with a high Ki-67 labeling index of 21.7 or more was significantly worse than that of patients with an intermediate labeling index of 13.3 to less than 21.7 (p < 0.01) or a low labeling index of less than 13.3 (p < 0.001). Multivariate survival analysis showed that staining for Ki-67 labeling index was significantly correlated with prognosis (p < 0.01).

CONCLUSIONS

Analysis of Ki-67 labeling index provides useful prognostic information about patients with primary urothelial tumors of the renal pelvis and ureter.

[Third mitral valve replacement--review of clinical aspects and surgical management in 10 cases]

Third mitral valve replacement (3rd MVR) have become more frequent as use of replacement procedures has become more widespread. However, little information exists to clearly document the determinants of 3rd MVR. To evaluate backgrounds and risks and complications of 3rd MVR, we reviewed data on 10 patients (6 male and 4 female, age averaged 58 +/- 8 years) who underwent 3rd MVR because of prosthetic valve malfunction during December 1986-May 1995. This represented 7.1% of total number of reoperations for valve surgery (10/140) during that period. The incremental effect of the 3rd MVR on hospital mortality and mobidity was studied by comparing first mitral valve replacement (1st MVR) and second mitral valve replacement (2nd MVR) and 3rd MVR. After an interval of 134 +/- 23 months, 3rd MVR was undertaken for congestive heart failure due to primary tissue failure in 65%, paravalvular leakage in 20%, prosthetic valve endocarditis in 15%. One patient died at 11 days postoperatively, for a mortality rate of 10%. Cause of death was related to multiple organ failure due to low cardiac output syndrome. The surgical risk of 2nd MVR and 3rd MVR is higher than that of 1st MVR, but there is no conclusive evidence that the difference between 2nd MVR and 3rd MVR is statistically significant. With improvement intraoperative strategies, the operative risk in patients undergoing 3rd MVR has been markedly reduced.

[Transesophageal echocardiography as a early postoperative monitoring patients after cardiovascular surgery: analysis of 500 consecutive studies]

In cardiac surgery significant residual lesions increase postoperative morbidity and mortality. To evaluate the usefulness of transesophageal echocardiography (TEE) as a early postoperative monitor in patients immediately after cardiovascular surgery, 500 consecutive patients were studied from April 1990 to December 1994. TEE was performed at the bedside in the intensive-care unit in all of these patients. TEE detected findings unsuspected by other perioperative tests or clinical examination in 103 (20.6%) of 500 patients. Imaging revealed unsatisfactory operative results that necessitated further surgery in 18 (3.6%) of the 500 patients. These data indicate that early postoperative TEE is useful in assessing immediate operative results and identifying patients with unsatisfactory results who are at increased risk for postoperative complications.

Enhanced backscattering of partially coherent light

The backscattering enhancement of light from random media is analyzed for situations in which the scatterers are illuminated with spatially partially coherent light. The effect of coherence is incorporated into the existing theories by use of the angular correlation description for the illuminating light field. When the area of illumination is infinite, an analogy to the van Cittert-Zernike theorem leads to the expression for the intensity distribution that is given by the sum of backscattered intensities, each of which would arise from each incident plane-wave component of the angular spectrum. It is shown that the backscattering cone is partially suppressed and deformed owing to breaking of the time-reversal symmetry of mutiple-scattering paths.

[Treatment of scrotal hydrocele using fibrin adhesive]

For the purpose of adhesion of the tunica vaginalis in scrotal hydrocele, we used fibrin adhesive, Bolheal. Between September 1993 and December 1994, 13 patients with scrotal hydrocele received occlusion therapies using Bolhead. The therapy was effective in 1 of the 6 patients (17%) administered 2.4 mg of fibrinogen and 750 units of thrombin into the vaginal cavity after aspiration of fluids, and in 5 of the 7 patients (71%) administered 240 mg of fibrinogen and 7.5 units of thrombin. Therefore, fibrin adhesive may be useful in the treatment of scrotal hydrocele.

Proximal branching patterns of middle cerebral artery (MCA) in rats and their influence on the infarct size produced by MCA occlusion

The branching patterns of the proximal middle cerebral artery (MCA) and their influence on the infarct size following MCA occlusion in rats were studied. In the proximal part from the level of the olfactory tract, the MCA most often presented one surface branch extending anteriorly, with a variable number of surface branches extending posteriorly. We classified the branching patterns of the posteriorly extending surface branches as follows: Type 1 (57.5%), one prominent proximal surface branch; Type 2 (30.2%), no prominent branch but two or more small surface branches; and Type 3 (12.3%), no surface branches with a visible junction with the MCA but surface branches probably arising from the internal carotid artery at the origin of the MCA. When the proximal surface branches (especially that in Type 1) remained uncoagulated, the infarct size in both the cortex and striatum was significantly reduced compared with that when coagulation was proximal to the most proximal surface branch. The reduction of cortical and striatal infarct sizes was particularly prominent in the posterior portion. To increase the infarct size and reduce variability, it is suggested that the MCA trunk should be coagulated from the origin to the rhinal fissure including the surface branches.

Percentage of reversibly and irreversibly sickled cells are altered by the method of blood drawing and storage conditions

We previously reported that the percentage of reversibly and irreversibly sickled cells (RSC and ISC, respectively) in the blood of patients with sickle cell disease is strongly influenced by the method of blood drawing (PNAS 91:12589, 1994). We now document the effect of blood storage conditions on the percentage of RSC and ISC. The percentage of RSC was lowest when blood was stored at 0 degree C, while the percentage of RSC was highest in specimens kept at 37 degrees C. At room temperature, the percentage of RSC increased slightly over 8 hours. The percentage of ISC was also temperature dependent and was reduced significantly upon cooling. Our results showed that many ISC reverted to a discoidal shape after 3 hrs of cooling after treatment of blood with oxygen or carbon monoxide. Since no Hb S polymers were detected in ISC treated with oxygen or carbon monoxide, the time required for shape restoration may be attributed to the membrane. We measured ISC levels of 10 patients with consideration of storage temperature and compared the values with those determined by the conventional method and also with those published previously.

Regulation of pyridoxal-5'-phosphate level by biogenic amines in mouse brain

We investigated the relationship between the concentration of pyridoxal-5'-phosphate (PLP) and biogenic amine in mouse brain. The production of PLP from pyridoxal (PL) by pyridoxal kinase (PLK) was inhibited by the addition of dopamine (DA), norepinephrine (NE) and 5-hydroxytryptamine (5-HT), but not by that of epinephrine and N-acetyl-serotonin. DA and NE were combined with PLP by a non-enzymatic reaction, whereas 5-HT was bound only slightly with PLP. The conjugated product of PLP with DA was also detected by HPLC analysis when PLK activity was assayed using PL as a substrate in the presence of DA. In an in vivo investigation, the depletion of DA and 5-HT in mouse brain after an intraperitoneal injection of 5 mg/kg reserpine, led to slight elevation of the PLP level to 120% of the control level. By contrast, the increase in DA in the brain caused by intraperitoneal administration of 150 mg/kg L-DOPA caused the PLP concentration to decrease to 70% of the control level. However, no change in PLK activity in the brain was observed when the mice were treated with either reserpine or L-DOPA. These results suggested that the level of PLP in mouse brain was partly regulated by the concentration of biogenic amines, such as DA, NE and 5-HT, without apparent induction of PLK.

The relationship between amide proton chemical shifts and secondary structure in proteins

The parameters for HN chemical shift calculations of proteins have been determined using data from high-resolution crystal structures of 15 proteins. Employing these chemical shift calculations for HN protons, the observed secondary structure chemical shift trends of HN protons, i.e., upfield shifts on helix formation and downfield shifts on β-sheet formation, are discussed. Our calculations suggest that the main reason for the difference in NH chemical shifts in helices and sheets is not an effect from the directly hydrogen-bonded carbonyl, which gives rise to downfield shifts in both cases, but arises from an additional upfield shift predicted in helices and originating in residues i-2 and i-3. The calculations also explain the well-known relationship between amide proton shifts and hydrogen-bond lengths. In addition, the HN chemical shifts of the distorted amphipathic helices of the GCN4 leucine zipper are calculated and used to characterise the solution structure of the helices. By comparing the calculated and experimental shifts, it is shown that in general the agreement is good between residues 15 and 28. The most interesting observation is that in the N-terminal half of the zipper, although both calculated and experimental shifts show clear periodicity, they are no longer in phase. This suggests that for the N-terminal half, in the true average solution structure the period of the helix coil is longer by roughly one residue compared to the NMR structures.

Evidence for the occurrence of multiple aspartic proteinases in rice seeds

Using reverse transcription polymerase chain reaction (RT-PCR), we identified two cDNA fragments encoding aspartic proteinases (APs). The encoded proteins, pL4 and pL5, are similar in sequence to other plant APs including barley AP and cardoon flower AP (cyprosin). The identity was 58-76% with one another. Genomic Southern blot analysis suggested that the rice AP gene constitutes a multigene family.

Rice aspartic proteinase, oryzasin, expressed during seed ripening and germination, has a gene organization distinct from those of animal and microbial aspartic proteinases

The gene organization and nucleotide sequence of an aspartic proteinase (AP) of plant origin were first disclosed by cDNA and genomic DNA cloning of a rice AP (oryzasin). The deduced amino acid sequence of oryzasin 1 was significantly similar to those of other APs (34-85%), with highest similarity (85%) to barley AP (HvAP). Oryzasin 1, as well as HvAP, is distinct from animal and microbial APs in that the plant APs contain a unique 104-amino-acid insertion in the C-terminal region. The oryzasin 1 gene spans approximately 6.6 kbp and is composed of 14 exons and 13 introns. The exon-intron organization of the oryzasin 1 gene is totally different from those of genes for animal and microbial APs such as human cathepsin D, rat renin, bovine chymosin, aspergillopepsin A of Aspergillus awamori, proteinase A of Saccharomyces cerevisiae and rhizopuspepsin of Rhizopus niveus, despite the fact that oryzasin 1 shows overall sequence similarity to these APs.

Aneurysm of the distal anterior inferior cerebellar artery--case report

A 38-year-old female presented with vertigo, right hearing disturbance, and slight headache which were treated medically. However, she suddenly developed severe headache with vomiting and vertigo. Computed tomography revealed subarachnoid hemorrhage, and right vertebral angiography disclosed a rare aneurysm at the distal portion of the anterior inferior cerebellar artery. She underwent a right suboccipital craniectomy in the lateral position. The aneurysm could not be clipped because the aneurysm was tightly adhered to the brainstem, so it was trapped. Postoperatively, she showed slight VIIIth to Xth cranial nerve disturbances. Three months postoperatively, the IXth and Xth cranial nerve disturbances had disappeared, but the tinnitus and right hearing disturbance were still present. The initial symptoms were probably caused by minor bleeding from the aneurysm.

Left atrial function after Cox's maze operation concomitant with mitral valve operation

BACKGROUND

This study examined whether the atrial fibrillation that commonly occurs in patients with a mitral valve operation could be eliminated by a concomitant maze operation.

METHODS

Left atrial function after Cox's maze operation performed concomitantly with a mitral valve operation was evaluated in 10 patients ranging in age from 38 to 67 years (mean age, 54 years). Seven patients who had had coronary artery bypass grafting served as the control group. Using transthoracic echocardiography, the ratio between the peak speed of the early filling wave and that of the atrial contraction wave (A/E ratio) and the atrial filling fraction (AFF) were determined from transmitral flow measurements. These two indices have been considered to represent the contribution of left atrial active contraction to ventricular filling.

RESULTS

The A/E ratio and the AFF were significantly lower in the maze group (0.35 +/- 0.17 versus 0.97 +/- 0.28 [p < 0.01] and 17.6% +/- 8.8% versus 36.8% +/- 6.4% [p < 0.01], respectively). The A/E ratio and the AFF correlated inversely with age (r = -0.72, p < 0.05 and r = 0.76, p < 0.05, respectively) in the maze group. In an angiographic study, the mean left atrial maximal volume index in the maze group was approximately three times larger than that in the control group (117.5 +/- 24.3 mL/m2 versus 35.3 +/- 6.6 mL/m2 [p < 0.01]). The left atrial active emptying volume index was significantly smaller in patients in the maze group (7.2 +/- 2.5 mL/m2 versus 13.1 +/- 4.6 mL/m2 [p < 0.01]).

CONCLUSIONS

After the maze procedure performed concomitantly with a mitral valve operation in patients with a dilated left atrium, left atrial contraction is detectable but incomplete in the elderly.

[Local chemotherapy for malignant brain tumors using methotrexate-containing fibrin glue]

Fibrin glue (FG) is an agent developed for achieving hemostasis and the adhesion of living tissue during surgical operations. Incorporation of a drug into FG may be expected to have a sustained local release. In the present study, methotrexate (MTX) included in FG (FG-MTX) was used. The release of MTX into human plasma and cerebrospinal fluid was studied by in vitro study to confirm the sustained release effect of this preparation, by in vivo study, in which the antitumor effect of FG-MTX was assessed in rats bearing 9L-gliosarcoma subcutaneously; and clinically, FG-MTX therapy was attempted in patients with malignant brain tumors. The in vitro study showed that MTX levels rapidly decreased over 1 to 3 days, but was still detected on days 7 and 14. The results showed the sustained release effect of MTX. The in vivo study showed that in the FG-MTX group, all tumors began to decrease soon after administration and disappeared in four out of five animals (80%) on about day 10. In the clinical study, sustained release for more than one week was found, and tumor decrease occurred in the case of a malignant brain tumor. Thus, FG-MTX appears to provide an effective local chemotherapy.

Functional magnetic resonance imaging of the human motor cortex

Functional magnetic resonance (MR) imaging of the brain was performed during motor task activation in five normal subjects and a patient with meningioma using conventional fast low-angle shot sequences and a 2.0 T system. A high intensity area in the motor cortex was observed in all normal subjects. Single-slice studies showed the right-sided finger task produced an increase of 1.9-23.5% (6.67 +/- 4.36%) in the signal intensity of the left motor cortex, while the left-sided finger task increased the signal by 1.5-18.2% (6.09 +/- 3.34%) in the right motor cortex. There was no significant difference between the sides. Multiple-slice studies also showed the activated motor cortex as a high intensity area. The maximum signal intensity increase in the activated motor area was 11.0% for the left motor cortex and 8.8% for the right motor cortex. There was no significant difference between the sides. Preoperative mapping of the patient with meningioma showed that the motor cortex was displaced posteriorly by the tumor. Functional MR imaging is possible with a standard MR imaging system and conventional gradient echo sequences. Useful clinical information can be obtained by preoperative mapping of the motor cortex.

Application of 1H NMR chemical shifts to measure the quality of protein structures

We have developed a program that can calculate proton NMR chemical shifts for proteins, using a set of co-ordinates provided for example from an X-ray or NMR structure. When applied to NMR structures, agreement between calculated and observed shifts is generally of the same quality as that for crystal structures of resolution between 2.0 and 3.0 A. There is a rather weak correlation between standard deviation (SD) and the number of NMR constraints per residue, but none with the root-mean-square deviation of one NMR structure from another. Where minimised averaged structures are present, they have about the same SD as the population from which they were taken. Refinement methods such as energy minimisation and the use of relaxation matrices and back calculation produce little or no improvement in SD. The calculation has several applications, particularly as an independent means of measuring the quality of a structure (either in the crystal or in solution), and in identifying possible assignment errors.

[Ventilatory insufficiency due to upper cervical injury treated by diaphragm pacing: a case report]

A 33-year-old man suffered chronic ventilatory insufficiency with tetraplegia after an operation for atlantoaxial dislocation. He was alert and his tetraplegia gradually improved. However, continuous mechanical ventilation was necessary for him. Thirteen months after the operation, a diaphragm pacer (Avery Laboratory Inc.) was implanted on the right phrenic nerve in the cervical region. Nineteen days after the implantation of the right side pacer, a left side diaphragm pacer was also implanted. Diaphragm pacing was started two weeks after the second implantation. The pacing period was gradually prolonged and continuous pacing for 9 hours by the right side pacer and three hours by the left side pacer was able to be obtained. One year after implantation, twelve continuous hours of diaphragm pacing became possible. During diaphragm pacing, blood gas analysis was satisfactory and the patient could move sitting on a wheel chair, watch television and write letters using a word processor. We were unable to achieve total ventilatory support for him using these diaphragm pacers. We thought that the main cause of our partial failure originated from the procedure used in implanting the electrode onto the phrenic nerve. Left side pacing needs higher amplitude than that used on the right side to obtain sufficient tidal volume. The patient refused our continuing the left side pacing because of pain around the anterior chest and shoulder. Another problem to be watched is diaphragm fatigue. However, diaphragm pacing has been continued for six years and it has been useful in improving his quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Histopathological study on the effect of octreotide

The present investigation was performed to clarify the mechanism of action of octreotide. On a quantitative study by electron microscopy showed that lysosomes were markedly increased in the patients receiving octreotide. Growth hormone (GH) was shown to be in the secretory granules by the postembedding immunogold technique, but no GH immunostaining was noted of the lysosomes. The present investigation suggests that retention of secretory granules and subsequent lysosomal increase are the mechanism of GH-lowering effect of octreotide.

Effects of a structural change in collagen upon binding to conditioned dentin studied by 13C NMR

To develop a better adhesive functional monomer, it is imperative to understand the adhesion mechanisms of the resin to the dentin surface. Bond strength to the decalcified dentin surface pretreated with dentin primer, an aqueous ethanol solution of N-methacryloyl glycine, increases by increasing the water content in the primer. The aqueous primer could increase the thickness of the hybrid layer. The structural change of dentinal collagen with NM alpha A was studied by using a model compound for collagen,--(1Pro-2Pro-3Gly)10--, by 13C nuclear magnetic resonance (NMR). The model compound was aggregated in ethanol but dissociated in water. It was found that NM alpha A effectively dissociated the aggregated model compound in water. The dissociation of decalcified dentin was essential to create a thick hybrid layer that could afford a higher bond strength to dentin.

Changes of contractile properties of extensor digitorum longus in response to creatine-analogue administration and/or hindlimb suspension in rats

Changes of contractile properties of extensor digitorum longus in response to hindlimb suspension and/or altered high-energy phosphate contents were studied in rats. A reduction of high-energy phosphates, especially phosphocreatine, was seen in rats fed creatine analogue beta-guanidinopropionic acid (beta-GPA), but they were elevated after 10-d supplementation of creatine. The one-half relaxation time was increased by feeding beta-GPA, but was normalized by creatine supply. The fatigue resistance of creatine-depleted muscle was significantly improved, but tended to decrease by suspension and creatine supply, although it was still better than that in the control diet group. It is indicated that the contractile properties of muscle are influenced by the high-energy phosphate content. It is also suggested that the endurance capacity may be influenced by the mitochondrial respiratory capacity, but not necessarily by the levels of high-energy phosphates.

Effects of chronic iron deficiency anemia on brain metabolism

The effects of chronic iron deficiency anemia on brain (cortex) metabolism were estimated by 31P-nuclear magnetic resonance spectroscopy and biochemical analyses in male Wistar rats. Iron deficiency anemia was induced by supplying diet containing either approximately 2 or approximately 6 ppm Fe. Control diet was supplemented with 100 ppm Fe as ferric citrate. After 8-9 weeks, blood hemoglobin levels were approximately 13, 5, and 3 g/100 ml in the 100 ppm, 6 ppm, and 2 ppm Fe group, respectively. The blood lactate levels at rest in these groups were approximately 3, 5, and 6 mM. The blood glucose concentration also tended to be elevated in iron-deficient rats. The high-energy phosphate contents in brain were not affected by iron deficiency. The activities of succinate dehydrogenase and cytochrome oxidase per unit protein in the 2 ppm Fe group were significantly less than in the 100 ppm Fe group, but those activities were not significantly affected by feeding diet with 6 ppm Fe. The activities of lactate dehydrogenase in iron-deficient group tended to be elevated but not significantly. The activities of non-iron containing mitochondrial enzymes, citrate synthase and beta-hydroxyacyl CoA dehydrogenase, were unchanged. It is suggested that the brain has a higher tolerance to iron deficiency than skeletal muscle in terms of the metabolic characteristics, although this may be associated with a lower level of neural activity.

Partially oxygenated sickled cells: sickle-shaped red cells found in circulating blood of patients with sickle cell disease

A previously uncharacterized type of sickled cell was found in venous blood of patients with sickle cell disease when blood was collected without exposure to air and fixed immediately with 1% glutaraldehyde solution equilibrated with 5% oxygen. These cells were either elongated, resembling irreversibly sickled cells (ISCs), or nonelongated, with a raisin-like shape. Both types assumed a normal discoidal shape upon full oxygenation. Since these cells exist only under partially oxygenated conditions, they are described as partially oxygenated sickled cells (POSCs). POSCs are morphologically distinct from partially deoxygenated sickled cells formed during deoxygenation by having rounded edges, while the latter have sharp edges. Transmission electron microscopy of POSCs revealed various amounts of misaligned Hb S polymers. Investigations in vitro demonstrated the formation of POSC-like cells by partial oxygenation of deoxygenated cells. Since POSCs contain intracellular fibers and sickle readily upon deoxygenation, they may have clinical and pathological significance.

[Outcome evaluation in putaminal hemorrhage by multiple regression analysis]

The aim of this study was to determine the factors that influence the prognosis of hypertensive putaminal hemorrhage. We investigated the outcome of the activity of daily living (ADL 1: full recovery at social life, 2: self cared, 3: required partial care at home, 4: remained bedridden, 5: vegetative state, 6: dead) one year after the onset of putaminal hemorrhage in comparison with initial data obtained on the day when it occurred. The following parameters were assessed: sex, age, side of hematoma, classification of computed tomography (CT) findings, neurological grade, degree of muscle power, hematoma volume, treatment, past history of cerebrovascular disease, and laboratory data. In 67 patients with putaminal hemorrhage, the relationships among these parameters were examined using Spearman's rank correlation analysis. Additionally, in 55 patients (24 male and 31 female) with complete data from the day of onset, multiple regression analysis was performed. The data of muscle power were handled by the quantification method. The result of Spearman's rank correlation coefficient indicated that the outcome had a positive correlation with age (correlation coefficient = 0.375), CT classification (0.595), neurological grade (0.714), hematoma volume (0.689), a past history of cerebrovascular disease (0.475), the white blood cell count (0.541), and the lactate dehydrogenase level (0.347). The outcome had a negative correlation with muscle power (-0.579) and the cholinesterase (-0.340).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical experience and early results of aortic valve replacements with Medtronic Hall 20 A]

We experienced aortic valve replacement for 18 patients (4 male and 14 female, ranging from 40 to 81 years old, mean 64 years old) with small aortic annulus with new small prosthesis. Medtronic Hall 20 A (MH 20 A). The average body surface area was 1.47 m2 (range 1.28 to 1.81 m2). One patient was died of lung cancer at 3 months postoperatively. One nonstructural dysfunction and one low cardiac output syndrome was noted during operation. Sixteen survivors with MH 20 A, showed satisfactory clinical results, except for minor thromboembolism, in 2 patients. The MH 20 A had the same function as that of MH 21 A, already reported. We concluded that aortic valve replacement by Medtronic Hall 20 A prosthesis was usefull for the patient with small aortic annulus.

Recombinant human hemoglobins designed for gene therapy of sickle cell disease

Two human hemoglobins designed to inhibit the polymerization of sickle hemoglobin (Hb S; alpha 2 beta S2) have been produced. Mutations that disrupt the ability of Hb S to form polymers were introduced into the normal human beta-globin gene by site-specific mutagenesis. These mutations affect the axial and lateral contacts in the sickle fiber. The recombinant hemoglobin designated anti-sickling hemoglobin 1 (Hb AS1) contains the mutations beta 22 glutamic acid to alanine and beta 80 asparagine to lysine. Hb AS2 has the same beta 22 glutamic acid to alanine mutation combined with beta 87 threonine to glutamine. Human alpha- and beta AS-globin genes were separately fused downstream of beta-globin locus control region sequences and these constructs were coinjected into fertilized mouse eggs. Transgenic mouse lines that synthesize high levels of each anti-sickling hemoglobin were established and anti-sickling hemoglobins were purified from hemolysates and characterized. Both AS hemoglobins bind oxygen cooperatively and the oxygen affinities of these molecules are in the normal range. Delay time experiments demonstrate that Hb AS2 is a potent inhibitor of Hb S polymerization; therefore, locus control region beta AS2-globin gene constructs may be suitable for future gene therapy of sickle cell disease.

[Early repair of postinfarction ventricular septal perforation: a case report of an improved surgical technique]

Accurate repair of postinfarction ventricular septal perforation (VSP) has mainly depended on the technique for friable septal reinforcement. Modified closure of VSP with Xenomedica patch was performed in 63-year-old male. Friable border of the septum was successfully sandwiched between horse-shoe shape prejett (right side) and main patch (left side). The advantages of this modified surgical procedure are as follows: (1) septum can be seen through horse-shoe shape patch (even when tying the mattress sutures; (2) Xenomedica patch is flexible enough for avoiding the cutting for friable septum, and is strong enough for sandwiching the septum.

Pyridoxal kinase immunoreactivity in rabbit brain

Murine polyclonal antibody against purified bovine brain pyridoxal kinase (EC 2.7.1.35) was generated and showed cross-reactivity with rabbit brain pyridoxal kinase. This antibody was used to immunohistochemically examine the distribution of pyridoxal kinase in the rabbit brain. The cytoplasm of neuronal cells and neuroglial cells in the cerebral cortex, hippocampal region, brain nuclei and cerebellar cortex showed positive staining with various degrees of intensity. The neuronal cells and surrounding fibers in some brain nuclei, such as the area tegmentalis ventralis or the substantia nigra, showed intense staining. The neuronal cells of the hippocampal region showed somewhat weak reactivity, but some with intense reactivity were found sparsely distributed and positive staining fiber networks of a very low density were also observed.

Autofocusing based on power-spectra analysis

An autofocusing mechanism based on the concept of autocorrelation is described. The method may be performed optically with ring detectors in the Fourier domain or electronically with a special computing chip or software.

Rotation-invariant joint transform correlator

We propose a new method for a rotation-invariant joint transform correlator that uses a rotating reference image that can potentially be applied to machine vision.

[Thrombolytic therapy of thrombosed Björk-Shiley aortic valve prosthesis--report of four cases]

Prosthetic valve thrombosis is associated with high mortality. Thrombolytic therapy is a promising alternative to valve replacement in the management of prosthetic valve thrombosis. To determine the efficacy and safety of thrombolytic therapy for thrombosed Björk-Shiley aortic valve prosthesis, 4 patients who received urokinase intravenously for this disorder were analyzed. In 3 patients, the successful outcome was sustained in that they remained asymptomatic and did not require operative intervention during follow-up, which ranged from 17 to 101 months. In one patient clinical signs of mild congestive heart failure occurred. This patient was surgically treated by thrombectomy and debridement of the prosthetic valve. Failure of urokinase treatment to resolve the thrombus after 1 week indicates that tissue overgrowth or fibrous, organized thrombus is the cause of prosthetic malfunction. Surgical intervention for this problem should be considered only after thrombolytic therapy has been tried and has failed. Our experience with urokinase treatment of thrombosis of aortic Björk-shiley prostheses indicates that this form of treatment should always be applied before surgical intervention. We also attempted to define the optimum protocol of fibrinolytic therapy by clinical evaluation. A protocol for the safe treatment of thrombosed valve is urokinase in initially administered in the doses as 960,000 units for 24 hours, then followed by a maintenance infusion at the half dose every 24 or 48 hours later. Thrombolytic therapy should be continued for 1 week at least to prevent rethrombosis even normalization of valve function was documented clinically. Simultaneous heparin infusion of 10,000 units for 24 hours is then started to replaced by warfarin treatment adjusted to obtain optimal prothrombin times.(ABSTRACT TRUNCATED AT 250 WORDS)

Structural analysis of highly oriented poly(p-phenylene-terephthalamide) by 15N solid-state nuclear magnetic resonance

The structure of an aromatic polyamide, poly(p-phenylene-terephthalamide) (PPTA), was studied in the solid state using 15N nuclear magnetic resonance (NMR) spectroscopy. Spectra of uniaxially aligned molecules placed with the axis of alignment both parallel with and perpendicular to the applied magnetic field were analyzed to yield the orientations of specific molecular bonds with respect to the fiber axis. The 15N chemical shift tensor was characterized by simulating powder pattern spectra of both PPTA and a model compound, benzanilide. Chemical shift and dipolar coupled chemical shift line shapes were calculated through Euler angle transformations from the principal axis system (PAS) reference frame to the fiber axis system (FAS) frame. The orientations of NH and NC' bonds in PPTA are determined as well as the orientational distribution of the PPTA fiber axis. The structural parameters determined for PPTA are compared with those obtained by X-ray diffraction.

Metabolic adaptation of skeletal muscles to gravitational unloading

Responses of high-energy phosphates and metabolic properties to hindlimb suspension were studied in adult rats. The relative content of phosphocreatine (PCr) in the calf muscles was significantly higher in rats suspended for 10 days than in age-matched cage controls. The Pi/PCr ratio, where Pi is inorganic phosphate, in suspended muscles was less than controls. The absolute weights of soleus and medial gastrocnemius (MG) were approximately 40% less than controls. Although the % fiber distribution in MG was unchanged, the % slow fibers decreased and the % fibers which were classified as both slow and fast was increased in soleus. The activities (per unit weight or protein) of succinate dehydrogenase and lactate dehydrogenase in soleus were unchanged but those of cytochrome oxidase, beta-hydroxyacyl CoA dehydrogenase, and citrate synthase were decreased following unloading. None of these enzyme activities in MG changed. However, the total levels of all enzymes in whole muscles decreased by suspension. It is suggested that shift of slow muscle toward fast type by unloading is associated with a decrease in mitochondrial biogenesis. Further, gravitational unloading affected the levels of muscle proteins differently even in the same mitochondrial enzymes.

[Changes in cerebral extracellular pH, cerebral blood flow and intracranial pressure induced by hypercarbic ventilation--assessment as a potential in vivo model of cerebral acidosis]

The effects of acidosis on ischemic brain damage are unclear and probably diverse. To establish an in vivo model of acidosis, the authors assess changes in extracellular brain pH (pHe), CBF and ICP induced by hypercarbic ventilation, and discuss the reliability and short comings of this experimental model. Acidosis was induced by increasing the inspired CO2 concentration in mechanically ventilated rats. pHe was measured with a pH-sensitive electrode implanted into the cortical mantle. The rats were divided into five groups according to the CO2 concentrations inspired: G-1, 0% control; G-2, -5-% CO2; G-3, -10-% CO2; G-4, -20-% CO2; G-5, -25-% CO2. Cortical blood flow was measured using a laser Doppler flowmeter, and ICP was also determined in each of the experimental groups. pHe decreased rapidly after the CO2 supply was turned on and remained almost constant at fixed concentrations of inspired CO2. pHe values diminished as the concentration of inspired CO2 decreased, as follows: G-2, -0.10 +/- 0.03; G-3, -0.31 +/- 0.08; G-4, -0.49 +/- 0.09; G-5, -0.64 +/- 0.10. The changes in pHe almost perfectly paralleled the changes in blood pH. The percentage increase in CBF was more than 200% in the G-2 groups and minimal increases in CBF, probably due to changes in blood pressure, were observed in from G-2 to G-5. Changes in CBF paralleled changes in systemic blood pressure, especially after the CO2 supply was turned off. ICP also rose after increasing the CO2 supply, and the pattern of changes was similar to that of CBF.(ABSTRACT TRUNCATED AT 250 WORDS)