Association of resting energy expenditure with phase angle in hospitalized older patients: a cross-sectional analysis

BACKGROUND/OBJECTIVES

Resting energy expenditure (REE) constitutes the largest component of total energy expenditure and undergoes an age-related decline that is unexplained by decreased fat-free mass. Phase angle (PhA) is a cellular health indicator that is possibly associated with REE. We investigated the association of REE and PhA in hospitalized older adults.

SUBJECTS/METHODS

This single-center, cross-sectional analysis utilized the baseline data from a prospective longitudinal study and included 131 eligible patients aged ≥70 years. The REE was measured using indirect calorimetry, and PhA and body composition were assessed using bioelectrical impedance. The association between REE, PhA, and body composition was examined, and REE was compared using previously reported PhA cutoff values.

RESULTS

In this cohort with a mean (±standard deviation) age of 87.4 (±7.0) years, 34.4% of the participants were men. REE and PhA correlated strongly (r: 0.562, p < 0.001) and significantly after adjusting for age and sex (r: 0.433, p < 0.001). Multivariate analysis showed a significant independent association between REE and PhA and skeletal muscle mass (standardized β [95% CI]; 28.072 [2.188-53.956], p = 0.035) without any significant interaction between PhA and age on REE. The low PhA group had a significantly lower REE (kcal/day; 890 [856-925] vs. 1077 [1033-1122], p < 0.001), and this remained significant after adjusting for age, sex, and skeletal muscle mass index.

CONCLUSIONS

PhA is associated with REE in older adults. Adjusting REE calculation algorithms based on PhA values and correcting predicted REE according to PhA may aid in determining more accurate energy requirements.

New prediction equations for resting energy expenditure in older hospitalized patients: Development and validation

OBJECTIVES

Accurate resting energy expenditure (REE) prediction is needed to prevent over- or underfeeding in older hospitalized patients. However, few validated REE prediction Equations are known for such patients. Therefore, this study aimed to develop new REE prediction Equations and evaluate their validity.

METHODS

This single-center, cross-sectional study enrolled 134 patients ages ≥70 y. For holdout validation, patients were randomized in a 3:1 ratio; for the development data set, a new Equation was developed according to the measured REE using indirect calorimetry. The new and existing Equations were compared using the validation data set.

RESULTS

Mean patient age was 87.4 ± 6.9 y, and 34.3% were male. Two Equations were developed in multivariable regression models: Equation 1: REE (kcal/day) = 313.582 + Height (cm) × 3.973 + Body weight (kg) × 5.332 - Age (y) × 5.474 - (0 if male; 1 if female) × 20.012 + Calf circumference (cm) × 12.174; and Equation 2: REE (kcal/day) = 594.819 + Height (cm) × 3.760 + Body weight (kg) × 8.888 - Age (y) × 6.298 - (0 if male; 1 if female) × 16.396. The mean relative bias (95% CI) with measured REE as a reference had a small bias for Equations 1 and 2 (-0.1 [-4.1 to 3.9]% and -0.2 [-4.4 to 4.1]%, respectively); however, the Harris-Benedict, Food and Agriculture Organization of the United Nations/World Health Organization/United Nations University, Ganpule, and body weight × 20 Equations had larger biases (-6.2 [-10.3 to -2.0]%; 5.3 [1.3 to 9.3]%; -13.9 [-18.6 to -9.3]%; and -11.6 [-16.1 to -7.1]%, respectively).

CONCLUSIONS

New prediction Equations using height, body weight, age, sex, and calf circumference improve REE prediction accuracy in older hospitalized patients.

Resting Energy Expenditure in Older Inpatients: A Comparison of Prediction Equations and Measurements

Determining energy requirements are an important component of nutritional support for patients with malnutrition; however, the validity of prediction equations for resting energy expenditure (REE) is disputed in older hospitalized patients. We aimed to assess the validity of these equations in older hospitalized patients in Japan. This was a single-center, cross-sectional study of 100 patients aged ≥70 years, hospitalized between January 2020 and December 2021. REE was measured using an indirect calorimeter and was compared to the predicted values calculated from five REE prediction equations. The mean (95% confidence interval) measured REE was 968.1 (931.0, 1005.3) kcal/day, and the mean predicted REE was higher for the FAO/WHO/UNU (1014.3 [987.1, 1041.6] kcal/day, p = 0.164) and Schofield (1066.0 [1045.8, 1086.2] kcal/day, p < 0.001) equations and lower for the Harris-Benedict (898.6 [873.1, 924.1] kcal/day, p = 0.011), Ganpule (830.1 [790.3, 869.9] kcal/day, p < 0.001), and body weight (kg) × 20 (857.7 [821.9, 893.5] kcal/day, p < 0.001) equations. In the age group analysis, none of the predicted values were within a 10% error for more than 80% of patients aged 70−89 years and ≥90 years. The five REE prediction equations did not provide accurate estimates. Validated REE prediction equations need to be developed for older hospitalized patients.

Effects of cocaine and ethanol on mouse fetuses

In the presence of ethanol, cocaine is metabolized to its ethyl homolog, cocaethylene. To investigate the embryotoxic effects of cocaethylene, pregnant ICR mice receiving ethanol orally during pregnancy were treated with 50 mg/kg/day cocaine i.p. on days 7, 8 and 9 of gestation. Treatment with either cocaine or ethanol alone did not affect the fetal mortality rate or the mean fetal body weight. Concurrent cocaine and ethanol treatment increased the fetal mortality rate, and decreased the mean fetal body weight, although teratogenicity was not noted. These results suggest that concurrent use of cocaine and ethanol during pregnancy is more harmful to fetal body weight gain and their lives than the use of either drug alone, at least in the present experimental settings.

[Determination of bisphenol A in foods using GC/MS]

An analytical method using GC/MS was developed for bisphenol A (BPA) in foods and BPA was determined in canned foods and fresh foods such as vegetables, fruit and meat. BPA was extracted with acetone from the samples and the extract was concentrated at under 40 degrees C in vacuo to afford an aqueous solution, which was washed with hexane after alkalization and extracted with 50% diethyl ether-hexane after acidification. Extracts were cleaned up on a PSA and/or a C18 cartridge column, and BPA was derivatized with heptafluorobutyric anhydride and determined by GC/MS (SIM). This method was applicable to the detection and determination of BPA residues in food samples at the level of 1 ng/g. Among canned foods, BPA was found in 6 corned beef, 1 chicken, 9 sweet corn and 3 bean samples at the levels of 17-602 ng/g, 212 ng/g, 2.3-75 ng/g and 3.5-26 ng/g, respectively. BPA was also detected in 1 retort soup and 1 retort pack product at the levels of 11 ng/g and 86 ng/g, respectively. As for dairy products, BPA was not detected in butter and milk. Among fresh foods, BPA was detected in 2 fish and 3 liver samples at the levels of trace (tr)-6.2 ng/g and tr-2.2 ng/g, respectively. In vegetables, fruits and chocolates, a trace level of BPA was detected in only 1 chocolate. Traces of BPA were also detected in 3 samples of 6 boxed lunches.

Effects of umbilical arterial resistance on its arterial blood flow velocity waveforms

BACKGROUND

We propose to clarify the effect of umbilical arterial resistance on umbilical arterial blood flow patterns in normal pregnant women.

SUBJECTS

Pulsed Doppler examination was administered to 145 pregnant women of between 28 and 31 weeks of normal gestation without any prenatal complications.

METHODS

The arterial flow velocity waveforms from two different arteries, one in the intra-abdominal portion and the other at the placental insertion, were sampled with the color flow mapping method, and the peak systolic velocity and the resistance index were calculated.

RESULTS

The peak systolic velocity and resistance index on the placental side were significantly lower than those of the fetal side.

CONCLUSION

A major difference exists between the umbilical arterial flow velocity waveforms on the fetal and placental sides, which might be caused by difference in the umbilical arterial resistance.

Eosinophilic apoptosis in sinus mucosa: relationship to tissue eosinophilia and its resolution in allergic sinusitis

BACKGROUND

Apoptosis, which is regulated by both cell survival and death signals, is important for the swift clearance of unwanted cells.

OBJECTIVE

We sought to elucidate whether eosinophilic apoptosis is associated with tissue eosinophilia and to determine its resolution in allergic sinusitis (AS).

METHODS

Numbers of eosinophils, numbers of IL-5(+) cells, and the apoptosis index of eosinophils were calculated in the submucosa (both superficial and deep layers) of patients with AS by using histochemical methods before and after prednisolone treatment. Patients without AS were used for control groups. Anti-EG2 antibody was used to identify eosinophils. IL-5, Fas, or Bax expression of eosinophils was evaluated to elucidate the role of the factors affecting eosinophilic apoptosis.

RESULTS

EG2 and IL-5(+) cells were abundant in the submucosa of patients with AS, especially in the superficial layer. About 50% to 60% of the IL-5-producing cells were eosinophils. Apoptotic eosinophils were less numerous in the superficial layer than the deep layer in these diseases. After prednisolone treatment, an induction of eosinophilic apoptosis was accompanied by a significant decrease in the number of EG2(+) and IL-5(+) cells. No remarkable difference was observed in the Fas or Bax expression of eosinophils after prednisolone treatment.

CONCLUSION

Autocrine secretion of IL-5 from eosinophils may be one reason why eosinophilic disease is difficult to manage. Induction of eosinophilic apoptosis is critical for reversing tissue eosinophilia in patients with AS.

[Empyema thoracis accompanied by hyperammonemic encephalopathy]

A 50-year-old man was admitted to our hospital due to consciousness disturbance. On admission, he was comatose (200 on the Japan Coma Scale) but brain computed tomographic (CT) scans were normal. Chest radiographs and CT scans on admission revealed massive pleural effusion in the right hemithorax. A culture of purulent pleural fluid yielded three species of anaerobes, including Bacteroides fragilis. Laboratory examinations revealed markedly elevated WBC count, CRP, and serum ammonia (586 micrograms/dl). However, liver function was almost normal and no other metabolic disorders were demonstrated. After the initiation of antibiotic therapy and pleural drainage, the patient's cousciousness level gradually improved in parallel with decreasing serum levels of ammonia and CRP. Because no other potential causes of hyperammonemia were observed, we concluded that the consciousness disturbance was due to hyperammonemia presumably caused by a urease-producing anaerobe infecting the right pleural space.

Fetal peripheral bronchial fluid flow during breathing movement in normal pregnancies: a preliminary study

OBJECTIVE

To determine the fluid flow velocity waveforms in the fetal peripheral bronchus during fetal breathing movement by means of pulsed Doppler ultrasonography.

DESIGN

A preliminary cross-sectional study.

SUBJECTS

Twenty-eight normal pregnant women between 32 and 38 weeks of gestation.

METHODS

Velocity waveforms from fetal peripheral respiratory fluid flow were acquired from the segmental bronchus (B6 or B8) which runs along the segmental artery (A6 or A8). The maximum velocity of the intrabronchial fluid flow and duration of inspiratory and expiratory phases were quantified.

RESULTS

The flow velocity signal from the fluid in the fetal segmental bronchus of 17 of the 28 fetuses was detected. We observed two types of fetal breathing movement.

CONCLUSION

During fetal breathing movement, the fluid in the fetal respiratory tract moves in the fetal segmental bronchus. This movement can be detected by pulsed Doppler velocimetry aided by power Doppler ultrasonography.

Stimulation of fetal granulopoiesis by intrauterine injection of recombinant human granulocyte colony- stimulating factor into rat fetuses

The small neutrophil reserve and exaggerated release of stored neutrophils are factors which predispose neonates to neutrophil reserve exhaustion during bacterial sepsis. Our objective is to try to improve in utero the myelopoietic function of the fetus before delivery. In the first series, recombinant human (rh) granulocyte colony-stimulating factor (G-CSF) (rhG-CSF; 100 microg/kg) was injected subcutaneously into rat fetuses at the indicated times to assess drug absorption and fetal response. In the second series, rhG-CSF (100 microg/kg) or saline (control) was injected into the fetuses once every other day to investigate the effect of repeated injections of rhG-CSF on enhancing fetal myelopoiesis preceding birth. Delivery was performed by cesarean section on embryonic day 21. The plasma concentration of G-CSF was determined by ELISA. The effect of rhG-CSF injection on granulopoiesis was assessed by measurement of the neutrophil count in the fetal peripheral blood and by histological examination of the fetal bone marrow, spleen, and liver. Fetally administered rhG-CSF enhanced fetal myelopoiesis preceding birth.

Staining of interleukin-10 predicts clinical outcome in patients with nasopharyngeal carcinoma

BACKGROUND

Interleukin-10 (IL-10) has been implicated as an important modulator of lymphoid cells, and its sequence is homologous to an open reading frame in the Epstein-Barr virus (EBV) genome. Nasopharyngeal carcinoma (NPC) is a representative tumor related to EBV infection.

METHODS

The authors investigated the expression of IL-10 in 21 primary NPCs by using an immunohistochemical approach to examine its prognostic significance.

RESULTS

IL-10 staining was positive in 12 of 21 primary NPCs (57%). There was no association between IL-10 expression and gender, tumor size, the occurrence of lymph node metastases, clinical stage, or recurrence. However, there was a significant difference in overall survival between the negative expression and positive expression of IL-10 (P = 0.0348). Although 87.5% of the IL-10 negative group survived for 5 years, only 15.6% of IL-10 positive patients survived for that length of time by the Kaplan-Meier method. IL-10 expression was significant as an independent prognostic indicator of overall survival by multivariate analysis using the Cox proportional hazards model (odds ratio, 26.64; P = 0.0019).

CONCLUSIONS

The results imply that expression of IL-10 is a prognostic factor in patients with NPC and may prove valuable in selecting patients with NPC who are candidates for aggressive therapy.

Characteristics of blood flow in intrauterine growth-restricted fetuses with hypercoiled cord

OBJECTIVE

To clarify the characteristics of fetoplacental blood flow of growth-restricted fetuses with hypercoiled umbilical cord.

SUBJECTS

Eight growth-restricted fetuses with hypercoiled cord.

METHODS

Flow velocity waveforms of the umbilical cord artery and vein, fetal abdominal aorta and fetal inferior vena cava were analyzed.

RESULTS

The resistance index in the umbilical artery in the hypercoiled cases was lower than that in normal fetuses. Early-diastolic reversed flow was observed in the abdominal aorta in some cases. In all cases, umbilical venous pulsation was observed in the entire cord until delivery. In one case, fetal heart failure occurred, resulting in pre-mature delivery. An atrophic type of single umbilical artery was observed in four cases.

CONCLUSION

Fetal blood flow disturbance caused by a hypercoiled umbilical cord may be a cause of growth restriction.

Effects of maternal prone position on the umbilical arterial flow

OBJECTIVE

The objective of our study was to clarify the effect of the maternal prone position on the feto-placental flow. In this position, the uterine compression of the large maternal vessels was expected to be completely eliminated.

METHODS

Twenty-three normal pregnant women were cross-sectionally examined in the supine, the left lateral, the right lateral and the prone position. The systolic/diastolic ratios for the umbilical artery were calculated for each position.

RESULTS

The umbilical arterial systolic/diastolic ratio in the prone position significantly decreased compared with that in the supine position. The left and right lateral position showed no significant change in the systolic/diastolic ratio.

CONCLUSION

The maternal prone position can provide complete relief of uterine compression of the large maternal vessels.

[Hemophagocytic syndrome associated with tuberculosis and mycoplasma infection in two patients]

Patient 1: A 48-year-old man was admitted to Osaka Red Cross Hospital because of fever and dyspnea. Laboratory examination revealed pancytopenia, liver dysfunction and hematostatic abnormality. Chest radiographs obtained on admission revealed ground-glass opacity in both lung fields, and an analysis of arterial blood showed severe hypoxemia (PaO2:46.8 Torr). Pulse therapy with methylprednisolone was started. Although the hypoxemia subsided and radiographic findings rapidly improved, pancytopenia persisted. Examination of bone marrow aspirate revealed mature histiocytes with marked hemophagocytosis. Amplified Mycobacterium tuberculosis direct tests of bronchoalveolar lavage fluid, sputum, urine, and bone marrow were all positive, and Mycobacterium tuberculosis was cultured from sputum and urine. Although the patient was taking antituberculous agents, his pancytopenia persosted. Treatment with etoposide induced remssion. Patient 2: A 19-year-old woman was admitted to Osaka Red Cross Hospital because of prolonged cough and fever. Laboratory examination revealed leukocytosis, liver dysfunction, and hematostatic abnormality. Serologic tests provided conclusive evidence of Mycoplasma infection and a CRP test was strongly positive. Chest radiographs obtained on admission revealed infiltration shadows in the middle and lower lung fields on both sides, with left pleural effusion. An analysis of arterial blood showed hypoxemia (PaO2: 54.2 Torr). Examination of bone marrow and pleural effusion samples revealed mature histiocytes with marked hemophagocytosis. Although treatment with antibiotics and pulse therapy with methylprednisolone was started, the patients respiratory functions deteriorated. Endotracheal intubation was performed. Therapy with etoposide induced remission. Hemophagocytic syndrome associated with Mycoplasma infection and tuberculosis appears to be exceedingly rare. In these 2 cases, it was difficult to achieve remission with therapy for the underlying infections, but etoposide treatment was effective.

Characterization of ribonucleases from culture medium of Lentinus edodes

Lentinus edodes (shiitake) cultivated in potato dextrose medium produced five RNases in the culture filtrate. The two major RNases (RNase Le37 and RNase Le45) were highly purified and their molecular masses, base specificities, N-terminal amino acid sequences, and amino acid compositions were analyzed and compared to RNase Le2 isolated from the fruit bodies of the same mushroom. RNase Le37 and RNase Le45 are base non-specific and adenylic acid preferential RNases like RNase Le2 and their N-terminal sequences are very similar to RNase Le2, but they are glycoproteins and their amino acid compositions are significantly different from that of RNase Le2. In addition to these enzymes, a guanylic acid-specific RNase with a molecular mass 13 kDa was partially purified. Since RNase Le2, which has very similar N-terminal sequence to RNase Le37 and RNase Le45, was not excreted from the mycelia, the analysis of the structures of these two excreted RNase may shade a light on the mechanism of excretion of RNases in this organism.

[The questionnaire concerned with the start and end point of the treatment for nasal allergy]

The precise primary end point of the treatment for nasal allergy has never been indicated. In this study, we conducted a questionnaire of specialists who actually treat with nasal allergy. The questionnaire is about start and end point of the treatment for nasal allergy. Answers were obtained from 49 doctors. The results were as follows. 1. About the goal at the start of the treatment. Perennial nasal allergy was put stress on control of the symptom, keeping of remission and improvement of quality of life. Pollinosis was put stress on control of the symptom, prevention of acute exacerbation and improvement of quality of life. No significant difference was observed between adult and child. 2. About the condition at the end point of the treatment. Perennial nasal allergy was put stress on the condition that symptoms were indisposition, no obstacle to daily life and no or a little medication was necessary. Pollinosis was put stress on the condition that symptoms were indisposition, no obstacle to daily life, and a little medication was necessary or that symptoms were continually stable and acute exacerbation was very rare. No significant difference was observed between adult and child.

Umbilical arterial flow change during hemodialysis

A pregnant woman was performed hemodialysis 3 times a week from early gestation. At 30 weeks of gestation, fetal growth and amniotic fluid volume were normal. We performed 3-hour hemodialysis 6 times a week. Cesarean section was performed at 38 weeks of gestation, she delivered a healthy neonate weighing 2575 g. During hemodialysis, we performed Doppler flow velocimetry on the umbilical artery. The resistance index revealed a remarkable decrease after 1.5 hour hemodialysis. But it recovered 3 hours of administration as well as after completion of treatment. We speculated this change in the resistance index of the umbilical artery was caused by transient maternal hypovolemia.

Evidence for structural differences between the two highly homologous actin-regulatory proteins, destrin and cofilin

The amino acid sequences of destrin and cofilin are very similar (84% homology) throughout the entire range of proteins, but they have different functions. In this study, we constructed a new cofilin expression plasmid, which had high expression frequency, and the structures of destrin and cofilin were analyzed by limited proteolysis and circular dichroism (CD). When destrin was digested by trypsin, two fragments of 17.0 kDa and 9.2 kDa were obtained, whereas only one 8.4 kDa fragment was obtained from cofilin. In spite of the overall sequence homology, an N-terminal amino acid sequence analyses of the fragments revealed the cleavage sites on destrin and cofilin to be different. These results suggest that destrin and cofilin differ in their overall tertiary folds. Cofilin showed activity similar to destrin at high pH values, although no pH-dependent structural change in cofilin was confirmed by using limited proteolysis and CD.

Cytofluorometric DNA analysis by stathmokinetic method of experimental thyroid neoplasms in rats

Thyroid neoplasms were induced in rats by the intraperitoneal injection of N-bis(2-hydroxy-propyl)nitrosamine as a carcinogenic substance and by the oral administration of KCIO4 as a promoter. The nuclear DNA content was measured in tissue sections of the tumors by the stathmokinetic method with the use of vincristine, and was correlated with the histopathological findings in the process of tumorigenesis and progression. Histological examination showed various types of lesions were produced in 47 surviving rats. A diploid pattern was seen in 82 (92%) of 89 tumors and an aneuploid pattern in 7 (8%) of 89 tumors. Papillary carcinomas and mixed carcinomas only had a diploid pattern, while two of 17 follicular carcinomas and five of 13 anaplastic carcinomas had an aneuploid pattern. On the other hand, benign proliferative nodules only had a diploid pattern. DNA heterogeneity was noted in seven malignant tumors. In four of them it was associated with the histopathological evidence of change, but in three there was no histological difference between the aneuploid and diploid areas other than a difference in the mitotic index. Mitotic indices were significantly higher in the aneuploid than in the diploid areas. These findings suggest that changes in the DNA ploidy cause histological abnormalities and/or affect the mitotic index. It is hypothesized that a change occurs in some diploid cells in a region of a tumor, and that aneuploid cells develop from the diploid cells which then acquire high proliferative activity.

Uterine blood flow velocity waveforms during early postpartum course following caesarean section

OBJECTIVE

To assess the change of uterine blood flow after Caesarean section.

STUDY DESIGN

Doppler flow velocity waveforms were acquired from the uterine arteries and small arteries near the myometrial wound detected by transvaginal power Doppler ultrasonography in 23 patients on the 3rd, 6th and 9th postoperative days.

RESULTS

The resistance index for the uterine artery did not show any change during the study period, while that for the small arteries slightly decreased.

CONCLUSION

Uterine blood flow resistance after Caesarean section did not show any change during the early postpartum period.

Favorable response to heparin in a pregnant woman with possible glomerular thrombosis as a complication of systemic lupus erythematosus and anti-phospholipid antibody syndrome

A rare case of possible glomerular thrombosis during pregnancy is reported in a patient with active systemic lupus erythematosus and the presence of anti-phospholipid antibodies. Acute renal impairment was restored by administering infusions of heparin. Cesarean section was performed due to fetal distress, and resulted the live birth of a healthy infant.

Umbilical venous pulsation and regional circulatory disturbance

The umbilical cord conditions at the point where regional umbilical venous pulsation occurred were examined in 15 patients between the 28th and 40th gestational week. The patients delivered appropriate-for-date infants without anomalies. Regional venous pulsation was observed in cases of large-angle cord winding (especially more than 60 degrees). It was also observed where the umbilical cord was compressed by the fetus, uterine wall or placenta, even if the umbilical cord was straight. From these findings, we concluded that regional umbilical venous pulsation is the result of regional circulatory disturbance of the umbilical cord.

Umbilical venous pulsation associated with hypercoiled cord in growth-retarded fetuses

Venous pulsatile flows were detected by pulsed Doppler flow velocimetry throughout the entire umbilical cord in 2 cases of intrauterine growth retardation. Although the hearts of these fetuses had no anomalies and their inferior vena cava flows had normal flow velocity patterns, their cords were severely coiled. In these cases, the pulsatile flow in the umbilical cord vein was caused not by an increase in the preload of the fetal heart, but only by hypercoiling of the umbilical cord. This phenomenon also suggests that the coiled umbilical cord exerts a pump-like effect known as a 'pulsometer'.

Intake ratio of water-insoluble dietary fiber to the water-soluble one in Japanese: an estimation on dietary records and the secular consideration on the national nutrition survey

Thirty-four foods were analyzed in order to determine the content of water-soluble dietary fiber (SDF) and insoluble dietary fiber (IDF). Using the results with the standard table for 227 foods, the intake ratio of IDF/SDF of an average Japanese was calculated for the period 1946-1990. The ratio was 3.22 in 1990 as calculated on the food intakes shown in the national nutrition survey, and the secular change was not detected since 1946 when the ratio was 3.30. The ratio was also shown to be well preserved between types of households including the age of the head. Using dietary records of 60 healthy city workers (average 42.8 years) for 4 weeks, however, the weekly average ratio for an individual was found to vary in the range of 2.25-5.13 although the total average for 60 individuals was 3.33. Thus, the well preserved IDF/SDF intake ratio for an average Japanese showed, on the contrary, a wide variation of food selection between each person.

Prenatal diagnosis of succinyl-coenzyme A:3-ketoacid coenzyme A transferase deficiency

Succinyl-CoA:3-ketoacid CoA transferase (SCOT) deficiency is a rare disorder of ketone body catabolism. In the present study, we prenatally diagnosed SCOT deficiency in a fetus in a family of which the proband was the first patient with SCOT deficiency identified in Japan, by analysis of enzyme activity levels in samples of chorionic villi and cultured amniocytes. In the fetus of the family, SCOT activity was not detected in either chorionic villi or cultured amniocytes. Since the levels of SCOT activity in control chorionic villi were close to our minimal detectable level and were much lower than those in control cultured amniocytes, enzyme assay in cultured amniocytes was more feasible than that in chorionic villi for prenatal diagnosis of SCOT deficiency. No elevated accumulation of 3-hydroxybutyrate or acetoacetate was detected in the amniotic fluid of the fetus. To our knowledge, this report is the first of prenatal diagnosis of SCOT deficiency.

Diagnostic and prognostic value of nucleolar organizer regions in squamous-cell carcinomas of the maxillary sinus

The clinicopathological implications of nucleolar organizer regions (NORs) were assessed in 25 squamous-cell carcinomas arising in the maxillary sinuses. NORs in the carcinoma tissue were stained with silver colloid and counted. As the histological differentiation of the tumors decreased, the mean AgNOR number rose significantly. The mean AgNOR number in T4 cancers was higher than that in T2 and T3 cancers, and the difference between T3 and T4 categories was significant. On the other hand, there were no significant differences in the AgNOR number between tumors of patients with and without recurrence after therapy, between those with different clinical stages or between those with good or poor response to treatment. Moreover, there was no significant difference in survival rates between patients with low and high AgNOR counts. These studies indicate that, in the collective examined, the AgNOR staining method was of no prognostic value for patients with squamous-cell carcinomas of the maxillary sinus.

Identification of phylloquinone (vitamin K1) as an unknown peak in electron capture detection gas chromatograms of pyrethroid insecticide residues

An unknown peak was observed in spinach extract during routine analysis of 7 pyrethroid insecticides by gas chromatography with electron capture detection (GC-ECD) using a DB-1 column (20 m x 0.25 mm id, 0.1 micron film thickness). It eluted later than the 7 pyrethroids, and it was also found in other agricultural crops. The intensity of the unknown peak was related to the green color of the sample: It was absent in white vegetables such as radish root or onion. Data from GC/direct deposition/Fourier-transform infrared spectroscopy (FTIR) suggested it might be phylloquinone (vitamin K1). The identity was confirmed also by using electron impact capillary GC/mass spectrometry (MS). Although phylloquinone has no halogens, it showed very high sensitivity by ECD (63Ni), responding to 10 pg.

Massive fetomaternal hemorrhage

We evaluated the potential prognostic factors for fetomaternal hemorrhage (FMH). Sinusoidal heart rate pattern and decrease in fetal movement are considered important signs of FMH. However these findings were detected in only two of six cases of FMH and were thought to be late signs of FMH. Fetal hemoglobin levels in the maternal circulation for infants born alive following FMH were less than 5%. Our findings suggest that this amount of blood loss could cause fetal death.

Tracheo-esophageal shunt speech: report of an unusual case

A rare case of laryngectomee who acquired TE shunt speech is reported. Our patient was a 64-year-old woman with laryngeal cancer (glottic type T3N0M0). She underwent laryngectomy in 1990, and a Komorn tracheo-esophageal shunt operation was performed simultaneously. A voice prosthesis (BIVONA) was inserted into the shunt, but the voice valve was not used. She acquired shunt speech soon after the operation, and there was no need to close the tracheostoma during phonation. Fiberoptic, X-ray and aerodynamic findings of the shunt and esophagus were as follows: (i) The one-way valve of the voice prosthesis was open during inspiration and closed during phonation. (ii) Swallowing of air, as seen in esophageal speech, was not observed. (iii) The neoglottis was in the upper part of the esophagus. It was concluded that the air for the vibration of the neoglottis entered the esophagus through the T-E shunt during inspiration.

Umbilical cord venous pulsation in normal fetuses and its incidence after 13 weeks of gestation

A total of 1175 umbilical venous Doppler flow velocity waveforms were acquired from 449 normal pregnant women whose fetuses were delivered at term without neonatal asphyxia or anomalies. Arterial and venous flow velocity waveforms were acquired from a free loop of the umbilical cord. The incidence of umbilical venous pulsation decreased from 30.4% at 13-14 weeks of gestation to 14.8% at 21-22 weeks of gestation. After 23 weeks, this incidence was settled within 5.0-7.8%. There was no difference between the umbilical arterial resistance index of the fetuses with venous pulsation and without pulsation before 22 weeks. But the resistance index was lower in the pulsatile fetuses than in the nonpulsatile fetuses after 23 weeks of gestation. The origin of venous pulsations before early second trimester was suspected to be different from that after late second trimester.

Measurement of fetal urine production in mild infantile polycystic kidney disease--a case report

It is generally recognized that the sonographic findings of infantile polycystic kidney disease (IPKD) are bilaterally enlarged kidneys, oligohydramnios, an absent fetal bladder, and the typical kidney texture. Since there is a broad spectrum of renal compromise with IPKD, in utero diagnosis is thought to be limited to the severe forms. This paper reports a mild case of IPKD, where the in utero diagnosis was established by measuring fetal urine production and amniotic fluid volume serially during pregnancy, and by ultrasonographic examination of fetal kidneys.

[Cytofluorometric DNA analysis in different histological patterns of thyroid papillary carcinoma]

Some papillary carcinomas of thyroid glands contain not only typical papillary structures but also various histological features in the same tumor. To investigate how areas with variable histological features differ in proliferative activity and how these differences influence the biological behavior of the whole tumor, we measured DNA contents by cytofluorometry in six papillary carcinomas with different histological features in the same tumor. DNA ploidy patterns were determined and the percentage of S plus G2M phase cells (S + G2M fraction) was calculated only in diploid tumors to assess the proliferative activity. The following conclusions were drawn. 1) It was demonstrated that there were differences in proliferative activity among areas with variable histological features in 4 of six tumors. 2) In the tumors which invaded adjacent tissues, the proliferative activity of the invasive area tended to be higher than that of the original area of the tumor. Therefore, the possibility exists that more precise evaluation of the biological behavior of the tumor can be obtained by measuring DNA contents of the tumor cells in invasive areas. 3) There was the gap in S + G2M fractions among some tumors with the same histological differentiation. Accordingly, DNA analysis of tumors would be of value in estimating proliferative activity.

[Combined treatment of head and neck cancers by radiation therapy and chemotherapy with a small dose of CDDP]

Two-route infusion chemotherapy with a smaller dose of CDDP was applied for combined modality treatment with radiation therapy for head and neck cancer from 1985 to 1992. To determine the appropriate dose of CDDP in this treatment, we investigated parameters concerned with its toxicity by comparing two groups given 5 and 10 mg of CDDP as a daily dose. Complete response was attained in 18 of 24 cases in the 5 mg group and 8 of 11 cases in the 10 mg group. The toxicity due to CDDP in this protocol was found generally to be slight in both groups. Among the parameters of toxicity, creatinine clearance was most affected. A decrease in 24 hr. creatinine clearance was noted in 15 of 29 cases in the 5 mg group and 10 of 12 cases in the 10 mg group. We had to discontinue this treatment after the first course because of lowered creatinine clearance in a patient in the 5 mg group. Stomatitis due to radiation therapy appeared to become worse in combination with this chemotherapy. The 10 mg dose of CDDP can be applied as a safe combination treatment with radiation therapy for head and neck cancer. To improve the outcome of this treatment modality for carcinomas of the tongue and oral floor, the 10 mg dose of CDDP was thought to be more beneficial. However, in the case of cumulative doses of CDDP over 100 mg, precaution should be taken to avoid the risk from the toxicity of more CDDP administration.

Significance of fetography in prenatal diagnosis of limb-body wall complex (LBWC)

The diagnosis of limb body wall complex (LBWC) by ultrasonography does not usually present a problem. The major difficulty we found was severe oligohydramnios or a very complex relationship between the herniated viscera and the deformities. We performed fetography in a pregnant woman with fetal anterior abdominal wall defect at the 28th gestational week to show a peculiar structure of intrauterine membranes of LBWC, and we could obtain a successful prenatal diagnosis of LBWC.

Pulsatile umbilical venous flow and its clinical significance

OBJECTIVE

To determine the prevalence and significance of pulsatile waveforms from the umbilical vein.

SETTING

A tertiary referral clinic for high risk pregnancies.

SUBJECTS

209 fetuses from 24-41 weeks gestation.

MAIN OUTCOME MEASURES

The presence of pulsatile waveforms in the umbilical vein and the pregnancy outcome.

RESULTS

9/209 fetuses demonstrated pulsatile waveforms and seven had severe growth retardation or congenital anomalies of the heart. Pulsatile flow and abnormalities of the inferior vena cava waveforms were observed in these seven but not in the two infants who were born at term. Double pulsations are described for the first time.

CONCLUSION

Examination of the umbilical venous waveform for pulsatile flow is a useful test as it indicates the presence of asphyxial cardiomyopathy or congenital heart lesions.

New technologies for the management of preterm premature rupture of membranes

The catheterization described is still incomplete, posing many problems yet to be solved. However, this method has shed light on new issues, including the intraamniotic administration of antibiotics against amniotic fluid infection and fetal infection, amnioinfusion of saline for oligohydramnios, and development of artificial amniotic fluid. These issues are much easier than the nursing of extremely small premature babies and should be solved by the collective wisdom of obstetricians.

Significance of exercise and bed rest in pregnancy--study on the lying postures of gravidas during sleep (2)

For the purpose of determining the most reasonable lying posture for pregnant women, we investigated the lying positions of both 247 non-pregnant women and 302 pregnant women during sleep. As for the rate of each position during the entire period of observation, 33.2% of the non-pregnant women were in the supine position, 41.2% in the lateral position, 18.4% in Sims' position and 7.1% in the prone position. In the pregnant group, the rate of supine position, simple lateral position and Sims' position was 34.2%, 52.2% and 12.7%, respectively, but the rate of the prone position was limited to 0.8%. All of the gravidas assuming the prone position were at less than 16 weeks of gestation. Non-pregnant women could sleep in a variety of positions, but pregnant women could assume the prone position during sleep only in the stage when the abdomen is not yet prominent or distended. Pregnant women were restricted significantly, either consciously or unconsciously, with progress in gestation.

Effects of far-infrared radiation on lactation

Massage and warm compresses to the breast have been commonly used for stimulating and/or increasing blood flow to the breasts, and for enhancing lactation consequently. However, more effective and easier remedies seem to be necessary. The vasodilating and warming effects of ceramics far-infrared radiation were studied. Based on the results obtained, the effect of a ceramic disc on lactation, attached to the breast skin, was evaluated in 27 puerperal women who had had poor lactation previously and in 36 with currently poor lactation monthly until weaning. Approximately 3/4 of these puerperal women enhanced lactation significantly one month after attachment and 1/2 of the women were able to breast-feed until weaning. Thus, we found that ceramics far-infrared radiation may be an effective remedy for enhancing lactation.

Saline solution amnioinfusion for oligohydramnios after premature rupture of the membranes. A preliminary report

In the conservative management of premature rupture of the membranes, most patients have oligohydramnios caused by continuous leakage of amniotic fluid. To avoid unfavorable effects of oligohydramnios on fetal development and well-being, we infused physiologic saline solution continuously into the amniotic cavity at a flow rate of 10 to 20 ml/hr with a new cervical indwelling catheter (PROM-fence). As a result the average pocket size of amniotic cavity was 2.7 cm before amnioinfusion, 5.9 cm 1 day after, 5.8 cm 5 days after, and 5.0 cm 10 days after amnioinfusion. The saline solution amnioinfusion made it possible to keep the amniotic cavity fluid level adequate. Variable deceleration disappeared in one case. No side effects such as uterine contractions were observed. We recommend the method of saline solution amnioinfusion for its favorable effects on fetal environment during management of premature rupture of membranes.

Effect of amniotic fluid volume on umbilical cord length

To study effect of amniotic fluid volume on umbilical cord length, 939 pregnant women at 24-41 weeks of gestation, including 10 twin cases, 51 preterm premature rupture of the membranes (PROM) and 70 premature delivery cases, were examined for their amniotic fluid volume within a week of delivery by the ultrasound procedure and these 949 newborns were also examined for umbilical cord length and incidence of fetal distress. In the polyhydramnios group (pocket size of more than 8 cm), 8 of 20 infants (40%) had longer cords and 6 infants (30%) had shorter cords, while only one of 49 infants (2%) with oligohydramnios (pocket size of less than 2 cm) had a longer cord and 36 infants (73.5%) had shorter cords than the mean cord length (+/- SD) of the normal group. The 20 twins had significantly shorter cords than those of the normal group (P less than 0.05) and the polyhydramnios group (P less than 0.01). The PROM group showed significantly higher incidence of oligohydramnios (P less than 0.05) and fetal distress (P less than 0.01), which suggests that intrauterine space availability is important for assuring fetal well-being.

Clinical effectiveness of a new cervical indwelling catheter in the management of premature rupture of the membranes: a Japanese collaborative study

The aim of this multiinstitutional study was to evaluate a new cervical indwelling catheter in 84 patients with premature rupture of the membranes at less than 33 weeks' gestation. The average time of insertion of the catheter was 29.1 weeks' gestation, at an average of 2.0 days after rupture, and was left in place for an average of 6.5 days. The mean birth weight was 1417 gm. The mortality rate and the incidence of respiratory distress syndrome were 5.7% and 11.9%, respectively. Amniotic fluid culture was positive in 39.1% of patients before catheter insertion and only 4.3% at the time of delivery. Infection was noted in only four of 84 infants. The incidence of infection was very low in those treated for 3 days or more after catheter insertion.

Transcervical amnioinfusion of antibiotics: a basic study for managing premature rupture of membranes

To determine the best method of preventing ascending infection in the management of premature rupture of membranes, antibiotics such as latamoxef sodium, cefoperazone sodium, and cefotaxime sodium were infused directly into the amniotic cavity in 64 patients undergoing induction of labor at term. A single infusion of 100 or 500 mg of each drug resulted in a concentration of 200 to 1000 micrograms/ml immediately after infusion, and the concentration remained above 10 micrograms/ml for about 24 hours without significant increase in fetal or maternal blood levels. Consequently, a daily single dose of 100 mg or more is probably effective prophylaxis in cases of premature rupture of membranes. When intrauterine infection is suspected, the dose can be increased to 500 mg or more, and transplacental administration may be added to achieve a higher concentration in fetal blood. The present study simulates well premature rupture of membranes, and an amnioinfusion of antibiotics will be reliable and effective in managing premature rupture of membranes.