Selective Ion Exchange in Supramolecular Channels in the Crystalline State

Artificial ion channels are of increasing interest because of potential applications in biomimetics, for example, for realizing selective ion permeability through the transport and/or exchange of selected ions. However, selective ion transport and/or exchange in the crystalline state is rare, and to the best of our knowledge, such a process has not been successfully combined with changes in the physical properties of a material. Herein, by soaking single crystals of Li₂ ([18]crown-6)₃ [Ni(dmit)₂ ]₂ (H₂ O)₄ (1) in an aqueous solution containing K⁺ , we succeeded in complete ion exchange of the Li⁺ ions in 1 with K⁺ ions in the solution, while maintaining the crystalline state of the material. This ion exchange with K⁺ was selectively conducted even in mixed solutions containing K⁺ as well as Na⁺ /Li⁺ . Furthermore, remarkable changes in the physical properties of 1 resulted from the ion exchange. Our finding enables not only the realization of selective ion permeability but also the development of highly sensitive biosensors and futuristic ion exchange agents, for example.

Structural, Optical, Magnetic, and Dielectric Properties in Hybrid Solid Solutions of ZnαNi1-α(en)3Ag2I4 (0 < α < 1) by Varying the Relative Zn/Ni Content

The hybrids of M(en)₃Ag₂I₄ (M = Zn or Ni) are isostructural to each other and crystallize in space group P6₃22 with quite similar lattice parameters. The hybrid solid solutions Zn_αNi_1-α(en)₃Ag₂I₄ (0 < α < 1) have been prepared via self-assembly in the mixed N,N-dimethylformamide solution of AgNO₃, KI, and ethylenediamine, meanwhile, with certain relative amount of [Zn(en)₃]²⁺ and [Ni(en)₃]²⁺ ions at ambient condition. All hybrid solid solutions are isostructural to the parent hybrids M(en)₃Ag₂I₄ (M = Zn or Ni). The UV-vis-near IR diffuse reflection spectra in solid state, thermogravimetric analysis, variable-temperature magnetic susceptibility, and dielectrics have been investigated for Zn_αNi_1-α(en)₃Ag₂I₄ (0 < α < 1). The intensity of bands centered at 540 and 860 nm in UV-vis-near IR spectra, arising from the d-d electron transition in Ni²⁺ ion, as well as the Curie constant decreases linearly with the molar fraction of Zn (α)/Ni (1 - α), whereas the c-axis length, the C-N and C-C bond lengths in the ethylenediamine, the frequency-independent dielectric permittivity and the onset temperature of dielectric relaxation, and so forth show nonmonotonical alternation with the fraction of Zn (α)/Ni (1 - α) in the solid solution, and the origin for these differences is further discussed.

Preparation of Preyssler-type Phosphotungstate with One Central Potassium Cation and Potassium Cation Migration into the Preyssler Molecule to form Di-Potassium-Encapsulated Derivative

A mono-potassium cation-encapsulated Preyssler-type phosphotungstate, [P₅W₃₀O₁₁₀K]^14- (1), was prepared as a potassium salt, K₁₄[P₅W₃₀O₁₁₀K] (1a), by heating mono-bismuth- or mono-calcium-encapsulated Preyssler-type phosphotungstates (K₁₂[P₅W₃₀O₁₁₀Bi(H₂O)] or K₁₃[P₅W₃₀O₁₁₀Ca(H₂O)]) in acetate buffer. Characterization of the potassium salt 1a by single-crystal X-ray structure analysis, ³¹P and ¹⁸³W nuclear magnetic resonance (NMR) spectroscopy, Fourier transform infrared spectroscopy, high-resolution electrospray ionization mass spectroscopy, and elemental analysis revealed that one potassium cation is encapsulated in the central cavity of the Preyssler-type phosphotungstate molecule with a formal D _5h symmetry. Density functional theory calculations have confirmed that the potassium cation prefers the central position of the cavity over a side position, in which no water molecules are coordinated to the encapsulated potassium cation. ³¹P NMR and cyclic voltammetry analyses revealed the rapid protonation-deprotonation of the oxygens in the cavity compared to that of other Preyssler-type compounds. Heating of 1a in the solid state afforded a di-K⁺-encapsulated compound, K₁₃[P₅W₃₀O₁₁₀K₂] (2a), indicating that a potassium counter-cation is introduced in one of the side cavities, concomitantly displacing the internal potassium ion from the center to a second side cavity, thus providing a new method to encapsulate an additional cation in Preyssler compounds.

Size-dependent immune-modulating effect of amorphous nanosilica particles

The immune-modulating effect following intradermal injection of various-sized amorphous silica particles was analyzed in terms of induction of ovalbumin-specific CD8+ T cells in vivo. IFN-gamma ELISPOT assays revealed that only nanosilica particles with a diameter of less than 100 nm significantly enhanced CD8+ T cell responses against ovalbumin. These results indicate that the size of nanomaterials is a critical determinant in terms of their safe use.

Ventricular tachycardia in a neonate with prenatally diagnosed cardiac tumors: a case with tuberous sclerosis

We report a patient with prenatally diagnosed tuberous sclerosis. Fetal ultrasonography demonstrated multiple cardiac tumors and arrhythmia. After birth, because of frequent supraventricular extrasystoles, the infant was admitted to the neonatal intensive care unit. Findings on 24-hour ambulatory electrocardiogram (ECG) showed frequent supraventricular tachycardia and ventricular tachycardia with four beats as the longest run. At the age of 12 days, he developed cardiopulmonary arrest after crying out. A monitored ECG showed ventricular tachycardia. Twenty minutes after onset, a 12-lead ECG showed ventricular fibrillation, which returned to normal sinus rhythm with repeated DC cardioversion. Oral antiarrhythmic therapy with carteolol hydrochloride was effective. The patient showed no further symptoms after oral medication was initiated and the tumors regressed spontaneously.

Flow pattern of the superior caval vein in children after closure of atrial septal defect: a comparison of catheter therapy with open-heart surgery

To compare the flow pattern of the superior caval vein (superior vena cava; SVC) after catheter therapy with that after open-heart surgery, we examined the flow velocity curves of the SVC in 10 pediatric patients who underwent catheter closure of atrial septal defect (ASD) and in 20 pediatric patients who underwent open-heart surgery. We used pulsed Doppler examinations to record the velocity curves. On the velocity curve of the SVC in children after open-heart surgery, the velocity in systole was lower than that in diastole, which is contrary to the normal pattern. The velocity in systole increased more than that in diastole during inspiration, which also differs from the normal pattern. In contrast, the velocity curve of the SVC in patients after catheter therapy showed a normal pattern. The change of flow velocity during respiration became smaller after treatment in the surgery group, although it did not change after treatment in the catheter group. These results might indicate less reserve ability in the right atrium in patients who undergo open-heart surgery. ASD closure by catheter is useful not only for its economy and noninvasiveness but also for its potential to contribute conservation of right atrial function.

Endogenous formation of protein adducts with carcinogenic aldehydes: implications for oxidative stress

In the present study, we characterize the covalent modification of a protein by crotonaldehyde, a representative carcinogenic aldehyde, and describe the endogenous production of this aldehyde in vivo. The crotonaldehyde preferentially reacted with the lysine and histidine residues of bovine serum albumin and generated a protein-linked carbonyl derivative. Upon incubation with the histidine and lysine derivatives, crotonaldehyde predominantly generated beta-substituted butanal adducts of histidine and lysine and N(epsilon)-(2,5-dimethyl-3-formyl-3,4-dehydropiperidino)lysine (dimethyl-FDP-lysine) as the putative carbonyl derivatives generated in the crotonaldehyde-modified protein. To verify the endogenous formation of crotonaldehyde in vivo, we raised the monoclonal antibody (mAb82D3) against the crotonaldehyde-modified protein and found that it cross-reacted with the protein-bound 2-alkenals, such as crotonaldehyde, 2-pentenal, and 2-hexenal. The anti-2-alkenal antibody recognized multiple crotonaldehyde-lysine adducts, including dimethyl-FDP-lysine and an unknown product, which showed the greatest immunoreactivity with the antibody. On the basis of the chemical and spectroscopic evidence, the major antigenic product was determined to be a novel Schiff base-derived crotonaldehyde-lysine adduct, N(epsilon)-(5-ethyl-2-methylpyridinium)lysine (EMP-lysine). It was found that the lysine residues that had disappeared in the protein treated with crotonaldehyde were partially recovered by EMP-lysine. The presence of immunoreactive materials with mAb82D3 in vivo was demonstrated in the kidney of rats exposed to the renal carcinogen, ferric nitrilotriacetate. In addition, the observations that the metal-catalyzed oxidation of polyunsaturated fatty acids in the presence of proteins resulted in an increase in the antigenicity of the protein indicated that lipid peroxidation represents a potential pathway for the formation of crotonaldehyde/2-alkenals in vivo. These data suggest that the formation of carcinogenic aldehydes during lipid peroxidation may be causally involved in the pathophysiological effects associated with oxidative stress.

Prenatal MRI in a fetus with a giant neck hemangioma: a case report

We report a fetus with a giant neck hemangioma which was examined by MRI in utero. The initial diagnosis was made by ultrasonography. The sonolucent aspect of the mass, together with the presence of pulsating Doppler flow signals, was highly suggestive of a fetal hemangioma. In late pregnancy, fetal MRI revealed the location, size and characteristics of the neck tumor. Following prenatal corticosteroid treatment and premature delivery of the pregnancy due to fetal cardiac failure, the newborn received angiography and coil embolization of the tumor vessels. Despite vigorous treatments, the newborn died 12 h after birth. Evaluation of a fetal neck hemangioma by MRI is recommended late in pregnancy for precise information on the tumor and adjacent organs since the image is valuable for planning optimal perinatal treatment.

Abnormal pattern of flow in the superior caval vein in children after open heart surgery

To investigate the pattern of flow in the superior caval vein in children after open heart surgery, we examined the flow velocity curves in 37 patients who had undergone surgical correction of either ventricular or atrial septal defects. The control group consisted of 64 age-matched children. We used pulsed Doppler examinations to record the velocity curves. We measured the highest and lowest peak flow velocities during systole and diastole, and calculated ratios for the various measurements. We found that the velocity of the wave in systole is lower than that of the wave in diastole in the postoperative patients, which is contrary to the normal pattern. The velocity in systole increases more than that in diastole during inspiration, which is also different from the normal pattern. The change in pattern of flow velocity curve during respiration was smaller in patients after surgery than in normal subjects, which might indicate that there is less reserve ability in the right atrium in postoperative patients.

High-speed counter-current chromatography of apple procyanidins

Apple procyanidins were separated by high-speed counter-current chromatography using a type-J multilayer coil planet centrifuge. Several two-phase solvent systems with a wide range of hydrophobicities from a non-polar hexane system to polar n-butanol systems were evaluated their performance in terms of the partition coefficient and the retention of the phase. The best separation of procyanidins B and C was achieved with a two-phase solvent system composed of n-butanol-methyl tert.-butyl ether-acetonitrile-0.1% trifluoroacetic acid (2:4:3:8) using the lower phase as a mobile at a flow-rate of 1.0 ml/min.

Inhalation of nebulized nitroglycerin in dogs with experimental pulmonary hypertension induced by U46619

BACKGROUND

Pulmonary hypertension (PH) causes mortality in some congenital and acquired heart and lung diseases. However, inhalation of NO gas requires complicated and expensive instruments and elaborate preparations to avoid toxic gas administration. We tested the effectiveness and safety of inhaled nebulized nitroglycerin (Neb-NTG) in dogs with experimental PH.

METHODS

Experimental PH was induced by continuous infusion of a thromboxane analog (U46619). The U46619 infusion rate was adjusted to maintain a systolic pulmonary artery pressure (PAP) at 40 mmHg in 10 anesthetized and mechanically ventilated dogs. Then, 20 micrograms/kg of NTG liquid nebulized by compressed air was inhaled.

RESULTS

After infusion of U46619, the systolic, diastolic and mean PAP increased by 119%, 228% and 169%, respectively, and the systolic, diastolic and mean systemic arterial pressures (SAP) increased by 19%, 29% and 23%, respectively. The systolic pulmonary to systemic pressure ratio (Pp/Ps) and mean Pp/Ps increased by 83% and 113%, respectively, and the pulmonary vascular resistance (PVR), systemic vascular resistance (SVR) and pulmonary to systemic resistance ratio (Rp/Rs) increased by 341%, 100% and 145%, respectively. After inhalation of Neb-NTG in dogs with experimental PH, systolic, diastolic and mean PAP and PVR decreased by 25 +/- 4, 26 +/- 11, 25 +/- 9 and 31 +/- 21%, respectively. There were no significant changes in systolic, diastolic and mean SAP, SVR, cardiac output and plasma methemoglobin concentrations. The systolic and mean Pp/Ps decreased by 18 +/- 7 and 20 +/- 7%, respectively. The Rp/Rs decreased by 25 +/- 13%.

CONCLUSIONS

The results of this study demonstrate that Neb-NTG is an effective and selective pulmonary vasodilator and may offer a new therapeutic option for PH.

Effects of aging on aortic diameters and distensibility in Marfan's syndrome: comparison with healthy subjects

The relationships between age, aortic diameter, and aortic distensibility were examined in patients with Marfan's syndrome. Aortic diameters were measured at the sinus of Valsalva, the ascending aorta, the aortic arch, and the abdominal aorta in 20 patients (aged 5-63 years) with Marfan's syndrome and 30 age-matched normal control subjects. The aortic distensibility was calculated as follows: aortic distensibility = 2 (change in aortic diameter)/(diastolic aortic diameter) (systolic pressure-diastolic pressure). Aortic diameter increased with age in both groups. The diameters of the sinus of Valsalva and the ascending aorta were greater in the Marfan group than in the control group, and increased even after adolescence in patients with Marfan's syndrome. Aortic distensibility was the highest at the abdominal aorta and the lowest at the sinus of Valsalva in both groups. Aortic distensibility decreased with age in both groups, but aortas were less distensible in the Marfan group than in the control group at all ages. The sinus of Valsalva and the ascending aorta dilate abnormally after adolescence in patients with Marfan's syndrome. However, aortic elastic properties in patients with Marfan's syndrome were abnormal even in childhood.

Changes in ventricular and muscle volumes of neonates

BACKGROUND

To examine the changes in cardiac ventricular and muscle volumes in neonates, echocardiography was performed in 25 normal neonates at 3-5 and 30-35 days after birth.

METHODS

A standard apical four chamber view and a parasternal short axis view were used for the analysis of the left ventricle. For the analysis of the right ventricle, only an apical four-chamber view was used. A formula based on the area length method was used to calculate the left ventricular and muscle volumes and the single plane Simpson's rule was used for the right ventricular and muscle volumes.

RESULTS

The left ventricular and muscle volumes per body surface did not change during the month following birth. The ratio of the muscle to ventricular volume of the left ventricle was also unchanged. However, the ratios of the right muscle volume to body surface and to the ventricular volume decreased after one month.

CONCLUSIONS

The authors suggest that the decreases in pulmonary hypertension and right ventricular stroke volume play a role in the changes of right muscle volume.

Change in cardiac diastolic function in neonates

In this study we used Doppler echocardiography to examine changes in ventricular diastolic function in neonates. Echocardiograms were performed in 25 healthy neonates at 1-6 days (2.7+/-1.6 days) and at 25-35 days (29.4+/-3.3 days) after birth. Ventricular inflow velocity curves were recorded using the pulsed-Doppler method. Peak velocities (peak E, A). mean velocities (mean E, A), times (time E, A), and diastolic velocity-time integrals (area E, A) were measured during both early ventricular filling and atrial systole. The acceleration time of the wave during early ventricular filling was also measured. Peak E and A and mean E and A in both ventricles increased at 1 month after birth. Acceleration times in both ventricles were shortened. The ratio of area E to A in both ventricles and of peak E to A in the left ventricle did not change at 1 month after birth. Only the ratio of peak E to A in the right ventricle increased. The ratio of peak E to (area E + area A), which is thought to be a load-independent index, increased in both ventricles. The authors concluded that ventricular relaxation appears to increase in both ventricles, 1 month after birth, and that changes in diastolic function occur even in neonates.

[Examination on aspirin-induced asthma and hypersensitivity to steroids--a questionnaire to 850 asthma on hypersensitivity to non-steroidal anti-inflammatory drugs and hypersensitivity to steroids]

We surveyed 850 patients with bronchial asthma and investigated such clinical features as the frequency of aspirin-induced asthma and hypersensitivity to steroids in the 457 available answers. We divided them into two groups, one was ASN: the asthmatics who had history of hypersensitivity to non-steroidal anti-inflammatory drugs, another was non-ASN: the asthmatics who had no history of hypersensitivity to non-steroidal anti-inflammatory drugs, and compared the two groups. The survey showed that the frequency of ASN was 12.0%. Its frequency rose with the severity of asthma to a level of 29.0% in severe cases. In ASN it was more frequent rates of female, infectious type, severe cases, and ASN had more frequent histories of oral use of steroids, use of ambulance, treatment in emergency rooms, and hospitalization than non-ASN. The serum IgE level was lower in ASN. The patients were 6 in ASN, none in non-ASN who had histories of hypersensitivity to steroids. They were 1.3% in all patients. 5 of 6 had past asthma attack progressived severely by rapid injection of succinate ester steroids and 2 of 6 had past by rapid injection of phosphoric acid ester steroids. In conclusion it was considered that we had to avoid rapid injection of steroids to aspirin-induced asthma and severe cases who were doubtful of aspirin-induced asthma in case of treatment of asthma attack.

Cerebellar ataxia in patients with Leber's hereditary optic neuropathy

We report the cases of a mother and son with Leber's hereditary optic neuropathy (LHON), where a point mutation of mitochondria DNA from guanine to adenine on nucleotide position 11778 was verified. Both also had cerebellar ataxia and dysarthria and in both cases cerebellar atrophies were detected by computed tomography or magnetic resonance imaging. It was not possible to elucidate the relationship between LHON and the cerebellar atrophy, but it should be kept in mind that various neurological complications may occur in LHON.

[Stress analysis on the acetabular side of bipolar hemiarthroplasty by the two-dimensional finite element method incorporating the boundary friction layer]

We compared the biomechanical characteristics of bipolar and unipolar hemiarthroplasty on the proximal migration of the outer head by determining the von Mises stress distribution and acetabular (outer head) displacement with clinical assessment of hemiarthroplasty in 75 patients. This analysis used the two-dimensional finite element method, which incorporated boundary friction layers on both the inner and outer bearings of the prosthesis. Acetabular reaming increased stress within the pelvic bone and migration of the outer head. A combination of the acetabular reaming and bone transplantation increased the stress within the pelvic bone and grafted bone, and caused outer head migration. These findings were supported by clinical results. Although the bipolar endoprosthesis was biomechanically superior to the unipolar endoprosthesis, migration of the outer head still occurred. The bipolar endoprosthesis appeared to be indicated in cases of a femoral neck fracture or of avascular necrosis in the femoral head, but its use in cases of osteoarthritis in the hip required caution.

Central diabetes insipidus caused by nonspecific chronic inflammation of the hypothalamus: case report

A case of central diabetes insipidus (DI) caused by non-specific chronic inflammation of the hypothalamus was reported. As the central DI was associated with acute posterior multifocal placoid pigment epitheliopathy with an immunogenic predisposition, and human leukocyte antigen class I antigen A2 and class II antigen DR4 were found, it might be a case of autoimmune reaction.

New topographic mapping of temporal lobe seizures

A unique topographic map has been developed based on EEG data of ictal events originating from the basal/mesiotemporal lobe regions. This technique involves a new mapping method of temporal lobe seizures as opposed to the interictal activity maps of most commercially available software. The map integrates data from sphenoidal electrodes as well as the standard 10-20 surface electrodes recorded with bipolar montages. A basal view is ideal for visualization of onset of temporal lobe ictal discharges recorded with chronic sphenoidal electrodes. We used the last 150 ictal events from 40 patients with basal/mediotemporal lobe epilepsy to develop this technique. Results indicate that a topographic view incorporating sphenoidal and scalp electrodes may provide a useful adjunct for interpretation of EEG recordings and a basis for comparison between and among patient groups for both ictal and interictal epileptic discharges.

The use of intravenous immunoglobulin in Miller Fisher syndrome

We report a patient with Miller Fisher syndrome who was treated with an intravenous high-dose of immunoglobulin. This syndrome is considered to be a benign variety of acute inflammatory demyelinating polyneuropathy (Guillain-Barré syndrome). However, there have been several reports of the need for ventilatory support and a few cases have had a fatal outcome. We observed a case of progressive Miller Fisher syndrome in a 3-year-old boy. Following 2 episodes of apnea lasting about 50 s each, he was treated with intravenous immunoglobulin (400 mg/kg/day) for 5 consecutive days. His respiratory state, general muscle strength, truncal ataxia and emotional state improved remarkably after this therapy.

Paroxysmal kinesigenic choreoathetosis with abnormal electroencephalogram during attacks

An 18-year-old man with paroxysmal kinesigenic choreoathetosis (PKC) showed rhythmic electroencephalographic (EEG) discharges of 5-Hz spikes over the entire scalp during episodes. The EEG findings in this case suggest that PKC may have an epileptogenic basis.

Hepatic cell necrosis with congenital heart disease in the newborn

Hepatic cell necrosis is a recognized complication of circulatory failure. Histological examination of the adult liver in such cases reveals centrilobular necrosis and hepatic congestion. Two cases of hepatic cell necrosis in infancy are reported: a four-day-old girl with the hypoplastic left heart syndrome, and a nine-day-old girl with interruption of the aortic arch. In the former, midzonal hepatic necrosis (and not centrilobular necrosis) was demonstrated at autopsy. Both patients exhibited severe hepatic insufficiency, but hepatic function improved rapidly with treatment of the coexistent heart failure. It is suggested that there is milder form of hepatic cell necrosis than that previously reported in autopsies.

Cerebral and abdominal arterial hemodynamics in preterm infants with patent ductus arteriosus

Using Doppler echocardiography we evaluated the effect of ductal shunt flow on the cerebral and abdominal arterial blood flow in 25 preterm infants. Eligible for inclusion in this study were healthy preterm newborn infants. They were divided into two groups based on their gestational age: group A, 33-36 weeks (15 infants) and group B, 28-32 weeks (10 infants). Two-dimensional Doppler echocardiograms were obtained in each infant during the first 8 hours of life and repeated every 6-12 hours until no ductal shunt flow could be detected. Flow in the ductus arteriosus, the basilar artery and the coeliac artery were examined. Closure of the ductus arteriosus occurred significantly later (p less than 0.05) in group B than in group A. Pulsatility indices of flow in the basilar and coeliac arteries were high when the ductus was patent, decreasing to a fixed level with closure. This study suggests that a shunt of the patent ductus arteriosus (PDA) adversely influences the cerebral and abdominal blood flow in preterm infants.

Expression of cellular retinoic acid binding protein in the developing nervous system of mouse embryo

The expression of cellular retinoic acid binding protein, CRABP, in developing mouse embryos was immunohistochemically analyzed. Differentiating young neurons and neuronal fibers in the myelencephalon, metencephalon, mesencephalon and spinal cord in 10.5- and 12.5-day embryos showed intense expression of CRABP, but undifferentiated cells in the neural tube did not. Neural tissue in 16.5-day embryos expressed less amount of binding protein than the tissues of the younger stages. These expressions of CRABP suggest that retinoic acid participates in neurogenesis at early developmental stages via expression of cellular retinoic acid binding protein.

Solitary interruption of the aortic arch with stenotic origin of the left subclavian artery in 45, XO/46, XY/47, XYY mosaicism

A four-year-old boy whose karyotype was 45, XO/46, XY/47, XYY mosaicism was diagnosed as having interruption of the aortic arch without ventricular septal defect or patent ductus arteriosus, complicated by stenotic origin of the left subclavian artery, which resembled coarctation of the aorta hemodynamically. Solitary interruption of the aortic arch is a very rare anomaly.

Serial imaging of Menkes disease

The patient developed myoclonic seizures at 3 months of age and his hair demonstrated the pili torti pattern. The low serum copper content and ceruloplasmin confirmed the diagnosis of Menkes disease. The characteristic signs on the images were: high echo level regions in the cerebrum as detected by brain ultrasonography, low density areas of white matter detected by CT scan, and low signal intensities of white matter by both T1 and balanced MR images.

[Bidirectional ductal shunts in the early neonatal period: evaluation by Doppler color flow imaging]

Serial Doppler echocardiographic examinations were performed in 10 normal neonates (0.3-4.0 hrs after birth). The flow patterns through the ductus arteriosus were evaluated using Doppler color flow imaging, pulsed Doppler echocardiography and continuous-wave Doppler echocardiography. At the initial examination, flow through the ductus arteriosus was clearly visualized in all the neonates using Doppler color flow imaging. The ductal flow patterns were categorized as follows: 1. Systolic blue color (right-to-left shunt flow) and diastolic red color (left-to-right shunt flow) in four neonates (group 1). 2. Systolic blue color and diastolic mosaic colors in four neonates (group 2). 3. Continuous mosaic colors in two neonates (group 3). Using pulsed Doppler echocardiography, the systolic right-to-left ductal shunt flow in the groups 1 and 2 was triangular in shape beginning in early systole. The diastolic left-to-right shunt flow was box-like in shape beginning late in systole and lasting long in diastole in the group 1. In the group 2, the diastolic flow showed a wide spectrum (turbulent flow). In the group 3, the flow through the ductus arteriosus had a continuous wide spectrum (turbulent flow). Mosaic or turbulent ductal flow of a left-to-right ductal shunt had high velocities by continuous-wave Doppler echocardiography. Serial examinations revealed that the ductal flow pattern observed in the group 1 changed to the flow pattern observed in the group 2, and then to that of the group 3 with increasing diastolic ductal flow velocities. The estimated aorto-pulmonary pressure gradient according to the simplified Bernoulli equation (delta p = 4V2) using a maximum diastolic left-to-right ductal shunt velocity increased within 12 hrs after birth. It was concluded that bidirectional ductal shunts may be observed in most normal neonates (8/10). With increasing diastolic velocities the bidirectional ductal flows changed to the pattern of a continuous left-to-right shunt. The bidirectional ductal shunt is considered due to physiologic pulmonary hypertension of the newborn and due to less conduction time from the pulmonary valve to the pulmonary end of the ductus than from the aortic valve to the aortic end of the ductus. Analysis of the flow through the ductus provides informations about the neonatal circulatory adaptation, especially in the early neonatal period.

[Aortic flow patterns in normal neonates with patent ductus arteriosus: evaluation by Doppler color flow imaging]

Serial Doppler echocardiography was performed in 12 normal neonates (0.5-4.0 hrs after birth) to evaluate flow patterns through the ductus arteriosus, and in the aorta and brachiocephalic artery. At the initial examination, flow through the ductus arteriosus was bidirectional in eight of the 12 neonates and continuously left-to-right in the remaining four. The bidirectional ductal shunts became continuous left-to-right flows within 11-21 hrs after birth in seven of the eight neonates and resolved by 29-47 hrs after birth. In the remaining four neonates, the continuous left-to-right shunts disappeared 14-36 hrs after birth. Systolic ejection flow patterns in the aorta and brachiocephalic artery had a triangular shape with the peak velocity in early systole, followed by a minimal flow reversal in all sites examined. Diastolic flow patterns in each arterial site were as follows: 1. In the ascending aorta, there was slow and sustained diastolic forward flow, which did not change with increasing age. 2. In the brachiocephalic artery, there was a pan-diastolic flow reversal in the neonates with bidirectional ductal flow (7/8). This pattern changed to slow pan-diastolic forward flow when the ductal changed to continuous left-to-right flow or when the ductal closure was confirmed. Most (3/4) of the remaining four neonates with continuous left-to-right ductal flow exhibited pan-diastolic forward flow. Another showed a pan-diastolic flow reversal 2 hrs after birth, which changed to pan-diastolic forward flow in the second examination 6 hrs after birth. 3. In the distal aortic arch, there was a pan-diastolic forward flow in all the neonates, and the velocity decreased when a closure of the ductus was confirmed. 4. In the descending aorta, there was a pan-diastolic flow reversal in neonates with bidirectional ductal flow (7/8). This reversal changed to pan-diastolic forward flow, when the ductal flow changed to continuous left-to-right flow or when the ductal closure was confirmed. In the remaining four neonates with continuous left-to-right ductal flow, two showed a pan-diastolic flow reversal at the initial examinations 2 to 3 hrs after birth. This became a pan-diastolic forward flow at the second examinations 6 and 12 hrs after birth. In the other two, there was a pan-diastolic forward flow which did not change. This pan-diastolic flow reversal observed in the brachiocephalic artery and descending aorta was closely related to the bidirectional ductal flow.(ABSTRACT TRUNCATED AT 400 WORDS)

[Left and right ventricular cardiac outputs in early neonatal periods examined using Doppler echocardiography]

To evaluate early neonatal circulatory adaptation, left and right ventricular cardiac outputs were examined in 10 normal neonates using Doppler echocardiography. Serial examinations were performed until ductal closure was confirmed. Two-dimensional echocardiography and Doppler echocardiography were used to evaluate structures of the heart and great vessels and flow within them. Then, the diameters of the ascending aorta (dAo) and pulmonary artery (dPA) were measured using M-mode echocardiography. The flow velocity patterns of the ascending aorta and pulmonary artery were recorded, measuring mean aortic (VAo) and pulmonary artery velocities (VPA). Left (LVCO) and right ventricular cardiac outputs (RVCO) were calculated as follows: LVCO = (dAo)2/4 x pi x VAo x 60, RVCO = (dPA)2/4 x pi x VPA x 60. 1. Patency of the ductus arteriosus was confirmed by the shunt through it in all neonates initially examined. The initial velocity pattern of the ductal shunts was bidirectional (9/10) or continuous left-to-right (1/10). The flow velocity pattern changed to continuous left-to-right in most neonates, and spontaneous closure of the ductus was confirmed at the age of 13 to 64.5 (mean 31.4) hrs. 2. Left-to-right shunt through the stretched foramen ovale was noted in six neonates temporarily. 3. As for the arterial diameter, dAo did not change, but dPA decreased at the time of spontaneous closure of the ductus. 4. Concerning mean aortic velocity, VAo increased when a continuous ductal left-to-right shunt was initially suspected, while VPA increased when spontaneous closure of the ductus was confirmed. 5. For cardiac output, LVCO (ml/min) changed from 618.4----718.3----562.7, while RVCO showed no change (576.1----546.5----557.8) according to a ductal flow change from bidirectional to continuous left-to-right and finally to no shunt. The LVCO/RVCO ratio increased with increasing age and (in 7/9) the maximal rate was noted when the continuous left-to-right ductal shunt was confirmed. The increased LVCO contributed to the increased LVCO/RVCO ratio. Using this method, serial evaluations of two ventricular cardiac outputs could be made.

[Left-to-right shunt via the foramen ovale in the early neonatal period: evaluation by Doppler color flow mapping]

Serial two-dimensional Doppler echocardiography was performed in 22 normal neonates (2-9 hours after birth). A left-to-right shunt through the foramen ovale and a shunt through the ductus arteriosus were evaluated. Interatrial shunts were observed as transseptal jets in 16 of 22 neonates on initial examination and resolved nine to 26 hours after birth in 13 neonates. In the remaining three neonates the shunts were observed more than six days and resolved by two months of age. Shunts through the ductus arteriosus were observed in all neonates examined as diastolic or continuous flows toward the transducer in the main pulmonary artery at the initial examination. The ductal flow resolved simultaneously with (3/13) or after (10/13) the disappearance of interatrial flow. With two-dimensional echocardiography, the enlarged left atrium and rightward deviation of the interatrial septum were observed in the neonates with interatrial shunts. This was confirmed by the immobile septum primum and the increased ratio of the left atrial to aortic diameters (LA/Ao ratio) on the M-mode echo. The interatrial septum became mobile and the LA/Ao ratio decreased after disappearance of the interatrial shunts. It was speculated that in neonates with large ductal shunts, large pulmonary venous flow enters into the less compliant left ventricle and raises the left ventricular end-diastolic pressure. Then, increased left atrial pressure distends the interatrial septum and causes left-to-right interatrial shunts via the stretched foramen ovale. This shunt is considered one of the physiological phenomena occurring in the early neonatal period.