Sitting maneuver to uncover latent left ventricular outflow tract obstruction in patients without hypertrophic cardiomyopathy

BACKGROUND

Left ventricular outflow tract obstruction [LVOTO; pressure gradient (PG) ≥30 mmHg] is observed in some patients without hypertrophic cardiomyopathy (HCM), and it may develop especially in older patients without HCM (non-HCM). The aim of this study is to investigate if the Valsalva or an upright sitting maneuver can unveil latent LVOTO in patients with non-HCM.

METHODS

A total of 33 non-HCM patients with a late peaking or dagger-shaped pulsed Doppler waveform of the LVOT and PG <30 mmHg were included. The Doppler flow velocity of the LVOT was measured at rest, after the Valsalva and a sitting maneuver. Peak PG of ≥30 mmHg after either maneuver was defined as latent LVOTO. The angle between the left ventricular septum and the aorta in the parasternal long-axis view and the apical three-chamber view was measured.

RESULTS

Twenty (61 %) of the 33 patients (mean age 74 ± 9 years) were diagnosed with latent LVOTO. Of these, five (25 %) patients were diagnosed after both the Valsalva and sitting maneuver, and 15 (75 %) were diagnosed only after the sitting maneuver. The latent LVOTO group had a significantly smaller angle than the no-LVOTO group between the ventricular septum and the aorta in the parasternal long axis views (107 ± 8° vs. 117 ± 8°, p < 0.01).

CONCLUSION

The sitting maneuver is better than the Valsalva maneuver in unveiling latent LVOTO in older, non-HCM patients.

Francium ion source with novel methods of target heating and beam characterization

We have developed a novel ion source and beam diagnostic system for the production and detection of radioactive francium (Fr) isotopes. The Fr ions are produced using a fusion-evaporation reaction at the RIKEN Nishina Center, Japan. The installation of an infrared heater has enabled a precise and rapid control of the target temperature, and the newly developed diagnostic system allows for a quantitative characterization of the extracted ion beam. With the new system, an analysis of the Fr208-211 isotopes has been performed. Additionally, the flux of Fr210 ions has been estimated as 6.7 × 10⁶ s^-1 corresponding to an extraction efficiency of 24.5% and a beam purity of 1.6 × 10^-5.

Parental readiness for the transition to adulthood of children with a chronic disease

PURPOSE

To investigate parental readiness for their child's transition to adulthood among pediatric patients with chronic disease in Japan.

DESIGN AND METHODS

In this cross-sectional study, parents of children with chronic diseases attending a pediatric outpatient hospital completed an anonymous self-administered questionnaire to investigate demographics and parental readiness for children's transition to adulthood. Logistic regression analysis was conducted to determine whether parents' readiness differed according to their children's disease types.

RESULTS

A total of 179 parents responded to the survey. Of these, 60% confirmed awareness and knowledge of their children's disease and treatment with their children. They also thought and accepted that there would be a time when their children would move from pediatrics to an adult department. More than half of parents had discussions with their children about the children's interests and would discuss with each other if their children's choice differed from the parents' opinion. <20% of parents had gathered information about the transition and made sure their children saw the outpatient clinic alone or encouraged them to write a record of their visits. The readiness of parents of children with diabetes and of children with cardiovascular disease was higher than those of children with cancer and blood diseases on several items.

CONCLUSIONS

Parental readiness to support their children's transitions did not progress well, suggesting the need for relevant interventions.

PRACTICE IMPLICATIONS

Children and parents should be supported in acquiring information about the transition to adulthood and in implementing child-oriented outpatient visits.

Development of adolescent childhood cancer survivors' psychosocial issues scale

BACKGROUND

Follow-up care for adolescent childhood cancer survivors (ACCS) after they return to school requires an understanding of their psychosocial issues. Therefore, this study developed the adolescent childhood cancer survivors' psychosocial issues scale (ACCSPIS) and evaluated its reliability and validity.

METHODS

In the development phase, pediatric oncology clinical professionals created the 24 item questionnaire of ACCS's psychosocial issues. In the feasibility phase, a survey was administered to 165 ACCS aged 12-18 years after discharge from hospital in Japan, and 57 completed questionnaires were analyzed. The survey items were psychosocial issues, attributes, K6 scale, and impact of event scale-revised (IES-R) scale. Factor analysis was conducted for psychosocial issues. Regarding reliability, Cronbach's α coefficients and item-total correlation coefficients were calculated. Regarding validity, Spearman's rank correlation coefficients between ACCSPIS and K6 and IES-R were calculated, and confirmatory factor analysis was conducted.

RESULTS

Four factors comprising 15 items were extracted: "appearance changes due to treatment effects," "anxiety about marriage and the future," "change in appearance due to treatment", and "psychological distress due to interpersonal relationships and information about the disease." The model fit was good, with a total ACCSPIS α coefficient of 0.901 and α coefficients for the subscales ranging from 0.651 to 0.914. The K6 and IES-R were significantly associated with the total ACCSPIS, and item-total correlations were satisfactory.

CONCLUSIONS

The reliability and validity of ACCSPIS were generally confirmed. This scale could be useful to measure psychosocial issues in ACCS aged 12-18 years after their return to school.

P–763 Neonatal outcomes of the first 65 infants delivered after IVF treatment with progestin-primed ovarian stimulation using dienogest in patients with endometriosis

Study question

What is the perinatal outcome of pregnancies resulting from a controlled ovarian hyperstimulation (COH) regimen of progestin-primed ovarian stimulation (PPOS) protocol using dienogest (DNG) in patients with endometriosis?

Summary answer

No difference in mean birth weight, however preterm and low birth weight babies are significantly more in the group treated with PPOS using DNG.

What is known already

Dienogest is an oral progestin effective for the treatment of endometriosis, such as reduction of endometrial lesion and control of pain intensity with safety profile and good tolerability. We reported for the first time in the world that DNG was better than dydrogesterone (DYG) for PPOS in terms of the mature oocytes rate and the fertilization rate in patients with endometriosis. Although there have been several reports of infants born with PPOS using DYG, it is essential to report on the perinatal outcome of embryos transferred after treatment with PPOS using DNG from now on. Study design, size, duration: We prospectively investigated the perinatal outcomes of 65 newborns which were the result of using a new COH regimen; PPOS with DNG. The results were compared with perinatal outcome data of babies born between 2018 and 2020 to 815 patients who underwent assisted reproductive technology (ART) treatment at our fertility center. As for the congenital malformation rate, the data was also compared with the 2017 Japanese data bank of babies born after ART treatment.

Participants/materials, setting, methods

We studied the perinatal data of all babies born after transfer of frozen embryos acquired by COH using PPOS protocol with DNG. The rate of maternal complications during pregnancy, pregnancy duration, birth weight, congenital malformations and method of delivery were investigated. We compared the perinatal outcomes of infants born after in vitro fertilization (IVF) and frozen embryo transfer at our center during the same period.

Main results and the role of chance

Perinatal data of 65 babies (study group) were compared with the perinatal data of 840 babies born after IVF at our center, and 47807 babies born after ART in Japan, 2017. We found 3 twin and 59 singleton pregnancies in the study group, compared to 23 twins, 1 triplet and 791 singleton pregnancies during the same period at our center. Considering singletons, there was no difference in mean birthweight (study group; 2893.2±652g vs. total at our center; 3001.2±425g, respectively, p = 0.102). Preterm births (&lt;37 weeks) were significantly more frequent in the PPOS using DNG treatment group than in total at our center (19.2% vs. 9.7%, p = 0.016). The percentage of infants with a birth weight &lt; 2.5 kg was also significantly higher in the PPOS treatment group compared to the total at our center (22.6% vs.11.9%, p = 0.015). The Caesarean section rate was 53.2% in the study group vs. 47.1% control group of our center respectively (p = 0.353). One babies in the study group had malformations in the ocular region. There was no significant difference in congenital malformations between the study group and ART data bank in Japan, 2017 (OR 0.67, 95% CI 0.093: 4.836).

Limitations, reasons for caution

The number of babies is still low, further prospective studies including larger populations are needed to confirm the efficacy of PPOS protocol with DNG.

Wider implications of the findings: This is the first report on the perinatal outcome of babies born by a new COH method using PPOS with DNG, which is a combination of endometriosis treatment and COH for IVF. The association of endometriosis with preterm birth and low birth weight needs to be further investigated.

Trial registration number

UMIN000031111

Mothers' Experiences about Decisions to Use Children's Proton Beam Therapy

Recently, proton beam therapy has been recommended in radiation therapy for child-hood cancer. However, facilities for children are limited, and parents who choose this treatment for their children face a variety of challenges. This study reveals mothers’ experiences about the decision to use the aforementioned therapy. A semi-structured interview was conducted with 16 mothers of children who received proton beam therapy in Japan, and a grounded theory approach was adopted. The results revealed that mothers were very worried about late complications concerning their children due to radiation. While the mothers strongly expected proton beam therapy to reduce the risk of late complications, they felt uncertainty and anxiety throughout the entire decision-making process. Despite having to deal with their feelings, they had to transfer to another hospital and prepare support for their children to begin treatment, and this put a lot of strain on them. From decision-making to start of treatment, these emotional fluctuations and the need for psychological support became apparent.

Does surgery improve live birth rates in patients with recurrent miscarriage caused by uterine anomalies?

We found that congenital uterine anomalies have a negative impact on reproductive outcome in recurrent-miscarriage couples, being associated with further miscarriage with a normal embryonic karyotype. There has been no study comparing live birth rates between patients with and without surgery. We conducted a prospective study to prove that surgery for a bicornuate or septate uterus might improve the live birth rate. A total of 170 patients with congenital uterine anomalies suffering two or more miscarriages were examined. The live birth rate after ascertainment of anomalies, cumulative live birth rate and infertility rate, were compared between patients with and without surgery. In patients with a septate uterus, the live birth rate (81.3%) at the first pregnancy after ascertainment of anomalies with surgery tended to be higher than that (61.5%) in those without surgery. The infertility rates were similar in both groups, while the cumulative live birth rate (76.1%) tended to be higher than without surgery (60.0%). Surgery showed no benefit in patients with a bicornuate uterus for having a baby, but tended to decrease the preterm birth rate and the low birth weight. The possibility that surgery has benefits for having a baby in patients with a septate uterus suffering recurrent miscarriage could not be excluded.

Intraoperative MRI for Brain Tumor Resection

Computer aided neurosurgery is now a highly advanced and essential technique, especially for the gliomas in the vicinity to the eloquent areas or deep inside of the brain. The intraoperative MRI (iMRI) is an important tool for the computer navigation system, considering brain shift under craniotomy. Real time navigation by the iMRI with brain mapping by subcortical stimulation and verbal confirmation by awake craniotomy can lead to the safe and precise tumor resection. The usefulness of an intraoperative low-field open MRI is defined for neuronavigation, especially for demonstration of the pyramidal tract in relation to the precise tumor location, considering brain shift during the operative procedure, to avoid tract injury.

[Minimally invasive cardiac surgery for transposition of the great arteries in neonates]

We evaluated our results of arterial switch operation (Jatene) for complete transposition of the great arteries between May 2003 and October 2005 particularly concerning various operation-related durations. Twenty neonates were studied. The mean age and body weight were 11.6 +/- 2.7 (range 5 to approximately 15) days and 3.0 +/- 0.4 kg, respectively. Duration of anesthesia, operation, extracorporeal circulation (ECC), and aortic cross-clamp were 199.4 +/- 30.1, 162.7 +/- 29.9, 91.6 +/- 8.8 and 59.8 +/- 8.1 minutes, respectively. Time differences between anesthesia and operation, operation and ECC, ECC and aortic cross-clamp were calculated, and their correlations with the duration of anesthesia were investigated. The items, whose coefficient of correlation with anesthetic time was greater than 0.6 were operation time, ECC time, aortic cross-clamp time, operation time minus ECC time, and operation time after ECC come-off. Furthermore, the operation time after ECC come-off was strongly correlated with plasma lactate concentrations and intraoperative bleeding. In conclusion, the time required for hemostasis and closure of the chest should be as short as possible. Therefore secure anastomoses with least hemorrhage possible is important.

Tentorial schwannoma: a case report

A rare case of tentorial schwannoma in a 29-year-old male is described. The schwannoma was located within the leaves of the tentorium. MRI showed a wedge-shaped enhancing tumour. Exact nerve of origin of the tumour could not be identified. We speculate that the tumour arose from the tentorial branch of the trigeminal nerve. The literature concerning intracranial schwannoma unrelated to a major cranial nerve is reviewed.

A phylogenetic-tree analysis elucidating nosocomial transmission of hepatitis C virus in a haemodialysis unit

Nosocomial transmission of hepatitis C virus (HCV) subtype 1b involving 11 haemodialysis patients occurred in a haemodialysis unit in Japan in March 2000. Sequencing of the HCV-E1 region (411-bp) and phylogenetic-tree analysis showed near identity between HCV isolates derived from these patients and a haemodialysis patient who was known to be HCV-positive. The mode of transmission could not be conclusively established, but retrospective analysis suggested that the sharing of contaminated multidose vials of heparin-saline solutions, which were prepared in the Haemodialysis Center using accidentally contaminated instruments such as needles, may have been responsible for the outbreak. To prevent transmission of HCV in a haemodialysis unit, it may be important to observe strictly standard precautions and to prepare all medications in the Pharmacy. After these measures were taken, no new seroconversions and no new nosocomial transmissions of HCV have been observed in our haemodialysis unit.

Pharmacokinetics, toxicokinetics, distribution, metabolism and excretion of linezolid in mouse, rat and dog

1. Linezolid (ZYVOX), the first of a new class of antibiotics, the oxazolidinones, is approved for treatment of Gram-positive bacterial infections. 2. The aim was to determine the absorption, distribution, metabolism and excretion (ADME) of linezolid in mouse, rat and dog in support of preclinical safety studies and clinical development. 3. Conventional replicate study designs were employed in animal experiments, and biofluids were assayed by HPLC or HPLC-MS. 4. Linezolid was rapidly absorbed after p.o. dosing with an p.o. bioavailability of > 95% in rat and dog, and > 70% in mouse. Twenty-eight-day i.v./p.o. toxicokinetic studies in rat (20-200mg kg(-1) day(-1)) and dog (10-80 mg kg(-1) day(-1)) revealed neither a meaningful increase in clearance nor accumulation upon multiple dosing. 5. Linezolid had limited protein binding (<35%) and was very well distributed to most extravascular sites, with a volume of distribution at steady-state (V(ss)) approximately equal to total body water. 6. Linezolid circulated mainly as parent drug and was excreted mainly as parent drug and two inactive carboxylic acids, PNU-142586 and PNU-142300. Minor secondary metabolites were also characterized. In all species, the clearance rate was determined by metabolism. 7. Radioactivity recovery was essentially complete within 24-48 h. Renal excretion of parent drug and metabolites was a major elimination route. Parent drug underwent renal tubular reabsorption, significantly slowing parent drug excretion and allowing a slow metabolic process to become rate-limiting in overall clearance. 8. It is concluded that ADME data were relatively consistent across species and supported the rat and dog as the principal non-clinical safety species.

EXAFS study of crystal structures of (Ba1-xLax)2In2O5+x and their oxide ion conductivity

Crystal structures of(Ba1-xLax)2In2O5+x (x=0.00, 0.20, 0.30, 0.40, 0.50) were analyzed by EXAFS and the powder X-ray Rietveld method. A Fourier transform of In K-edge EXAFS data from (Ba1-xLax)2In2O5+x showed a peak between 1.2 and 2.0 A attributed to the nearest oxide ions around In3+ cation. The peak as back-Fourier transformed, and the structural parameters were refined by the least square fitting. The coordination number of In3+ cation increases with increasing La3+ cation) content. This means oxygen is introduced at interstitial site by keeping an electroneutrality. As a result of the oxygen distribution, the oxide ion vacancies distribute randomly. The electrical conductivities of (Ba1-xLax)2In2O5 rapidly increased above 1203 K due to the order-disorder transition of oxygen vacancy. On the other hand, the electrical conductivities of (Ba1-xLax)2In2O5+x (x=0.20, 0.30, 0.35. 0.40, 0.45, 0.50) did not show the sharp discontinuity in the conductivity because the disorder phase of defective perovskite type structure was stabilized by doping La3+ cations at A-site even at low temperature.

Lack of interaction between bropirimine and 5-fluorouracil on human dihydropyrimidine dehydrogenase

1. Bropirimine (2-amino-5-bromo-6-phenyl-4-pyrimidinone) is a member of a class of antineoplastic agents that are administered concomitantly or sequentially with anticancer 5-fluorouracil (5-FU) prodrugs in clinical patients. Interactions between bropirimine and 5-fluorouracil (5-FU) were investigated on dihydropyrimidine dehydrogenase (DPD) activity, the rate-limiting enzyme of 5-FU metabolism, in human liver cytosol. Apparent DPD activity was determined by measuring the recovery of [14C]5-FU by HPLC. 2. The apparent activity of 5-FU metabolism (2.1-100 microM) showed a linear relationship in the Eadie-Hofstee plot in the pooled cytosol, suggesting that a single enzyme is responsible for apparent 5-FU metabolism. Km and Vmax were estimated to be 23 microM and 0.32 nmol min(-1) mg(-1) protein, respectively. Apparent DPD activity for 5-FU (25 microM) in the cytosol from 12 individual donors ranged from 0.017 to 0.39 (0.16 +/- 0.12) nmol min(-1) mg(-1) protein, indicating a large intersubject variance. 3. The suicidal inactivators of the DPD enzyme, (E)-5-(2-bromovinyl)uracil and 5-bromouracil (6.3-50 microM), illustrated concentration-dependent inhibition on DPD activity. Isocytosine (6.3-100 microM), used as a negative control, did not affect DPD activity. Bropirimine (6.3-100 microM) also did not show any inhibition of DPD activity. Therefore, bropirimine is unlikely to cause increases in 5-FU levels in clinical patients after co-administration of bropirimine with 5-FU prodrugs.

Anti-paternal antibodies by flow cytometry in the management of alloimmunization on recurrent miscarriages

PROBLEM

There is no reliable laboratory test available to diagnose immunologically mediated miscarriages. We investigated the clinical significance of maternal anti-paternal leukocyte antibodies by flow cytometry after alloimmunization.

METHOD OF STUDY

The flow cytometry crossmatch (FCXM) was performed in 158 patients with a history of three or more unexplained first-trimester miscarriages without live birth. After negative FCXM patients were immunized, subsequent pregnancy outcomes and FCXM results were followed.

RESULTS

Of 112 subsequent pregnancies, 83 of 100 (83.0%) FCXM-positive patients after immunotherapy had successful pregnancy outcomes, whereas seven of 10 (70.0%) FCXM-negative patients had miscarriages (P = 0.0001). The percent live birth ratio was 2.77 (CI, 1.07-7.16; P=0.0001) for FCXM-positive patients compared to FCXM-negative patients. The calculated predictive value showed that 75.6% of FCXM-negative patients would have subsequent miscarriages.

CONCLUSIONS

Positive FCXM is closely associated with successful pregnancy outcome following immunotherapy. We propose that FCXM might be included in the routine laboratory tests for the management of recurrent miscarriages.

[A surgical case of papillary muscle reconstruction and double-CABGs for mitral regurgitation due to ruptured papillary muscle after myocardial infarction]

A 76-year-old female patient underwent papillary muscle reconstruction, and d-CABGs a month after the onset of myocardial infarction. Posterior papillary muscle (PPM) was recognized to be ruptured partially, its stump was sewn to original PPM. An ePTFE suture (CV 5) was placed from anterior mitral leaflet to anterior papillary muscle in attempt to reinforce PPM-repair. Carpentier-Edwards ring was inserted and d-CABGs (LITA to LAD and GEA to RCA) were performed, simultaneously. Postoperative examination revealed no regurgitation and no stenosis of bypass grafts during follow-up period of 5 months after the procedure. Papillary muscle reconstruction was effective procedure for MR due to the ruptured papillary muscle.

Cholesterol 7-hydroperoxides in rat skin as a marker for lipid peroxidation

Concentrations of cholesterol 7alpha- and 7beta-hydroperoxides (Ch 7-OOHs) in the skin of rats were determined by HPLC with a chemiluminescence detector. We demonstrated that (a) the concentrations of Ch 7-OOHs in rat skin were highly correlated with rat age (r = 0.929; N = 51, 1 to 55 weeks old), (b) the concentrations of Ch 7-OOHs in the skin of rats in an ambient light room were not significantly different from those found in rats kept in a dark room for 12 weeks, and (c) lipid peroxidation in vitro induced by ADP-Fe2+ caused an increase in the concentrations of Ch 7-OOHs in homogenates of rat skin. These results indicated that levels of Ch 7-OOHs in skin might be a good marker for aging of rats and might be independent of housing illumination, thus a good marker for endogenous lipid peroxidation. Furthermore, we observed that ultraviolet light B (UVB) irradiation markedly enhanced the concentrations of Ch 7-OOHs in the skin of rats in vivo depending on the duration of the irradiation, and the increases in Ch 7-OOHs were inhibited by radical scavengers, i.e. tocopherols. Therefore, it was suggested that the levels of Ch 7-OOHs in the skin could also be a good marker for UVB-dependent lipid peroxidation.

Photogeneration of 3beta-hydroxy-5alpha-cholest-6-ene-5-hydroperoxide in rat skin: evidence for occurrence of singlet oxygen in vivo

We identified singlet oxygen adduct of cholesterol, 3beta-hydroxy-5alpha-cholest-6-ene-5-hydroperoxide (5alpha-OOH), in skin of rats pretreated with oral doses of pheophorbide a and subsequent visible irradiation, that have been known to induce photosensitive diseases in animals and humans. In a living animal body, this is the first demonstration of presence of 5alpha-OOH, that is known to be formed exclusively by reaction in vitro between singlet oxygen and cholesterol. By the quantitative determination with high performance liquid chromatography equipped with a chemiluminescence detector, we observed time-dependent increase in concentrations of 5alpha-OOH in skin of rats pretreated with oral doses of pheophorbide a and subsequent visible irradiation, suggesting the occurrence of a labile activated oxygen species, singlet oxygen, in this system.

Quantitative determination of cholesterol 5alpha-, 7alpha-, and 7beta-hydroperoxides in rat skin

An assay method for determination of cholesterol 5alpha-, 7alpha-, and 7beta-hydroperoxides (ChOOHs) in rat skin using high-performance liquid chromatography (HPLC) with a chemiluminescence detector has been developed. In the assay method, free form and free plus ester forms of ChOOHs could be separately determined by HPLC in combination with the treatment of a tissue extract by cholesterol esterase. Lower limits of quantitation for cholesterol 5alpha-, 7alpha-, and 7beta-hydroperoxides were 0.2, 0.1, and 0.5 nmol/g skin, respectively. This assay method showed that (i) good absolute recoveries of ChOOHs from rat skin (80-90% of radiolabeled ChOOHs added to rat skin); (ii) negligible autoxidation of cholesterol caused by the assay procedure (<9.4x10(-5)% of radiolabeled cholesterol added to rat skin); and (iii) good correlation between ChOOHs added to rat skin and ChOOHs determined, indicating this assay method is applicable to quantify ChOOHs in rat skin. By using this assay method, we observed that (i) cholesterol 5alpha-hydroperoxide was detected in skin of rats pretreated with oral doses of pheophorbide a and subsequent visible irradiation; (ii) concentrations of cholesterol 7-hydroperoxides in skin of rats in an ambient light room were not significantly different from those in a dark room for 12 weeks; and (iii) ultraviolet light B irradiation markedly enhanced the concentrations of cholesterol 7-hydroperoxides in the skin of rats.

Determination of linezolid in plasma by reversed-phase high-performance liquid chromatography

An HPLC-UV method was developed for assay of linezolid in dog, rat, mouse, and rabbit plasma. Linezolid and the internal standard were extracted on a solid phase cartridge (SPE) and separated on a reversed-phase column (C8, 4.6x150 mm, 5 microm) with 20% acetonitrile in water as mobile phase. The SPE quantitatively recovered linezolid and the internal standard from plasma samples. The chromatographic peak height ratio or peak area ratio based on UV absorbency at 251 nm was used for quantitative analysis. The assay procedures were simple and the assay was specific and had adequate precision and accuracy. Calibration standards with concentrations over the range of 0.01 20 microg/ml were validated for routine sample analysis to support the pharmacokinetic and toxicology studies with linezolid in dog, rat, mouse, and rabbit. Analysis of quality control samples showed the coefficients of variation were usually <10% and the measured and theoretical concentrations differed by <10% in most assays. Linezolid in the plasma samples was stable when stored at below -20 degrees C for at least 63 days, at room temperature (22-23 degrees C) for up to 24 h, and after three freeze-thaw cycles. This HPLC method has been successfully used in multiple laboratories to assay plasma samples from pharmacokinetic and toxicology studies with linezolid in the animal species.

Increases in cholesterol 7-hydroperoxides in lipids of human skin by sunlight exposure

Free and ester forms of cholesterol 7alpha- and 7beta-hydroperoxides (Ch 7-OOHs) in skin lipids of humans were separated and determined by high performance liquid chromatography with a chemiluminescence detector. We first demonstrated the presence of Ch 7-OOHs in lipids of human skin. The levels of Ch 7-OOHs found in skin lipids of healthy Japanese volunteers (n = 5) ranged from 2.78 to 25.2 pmol/cm2 skin, indicating large inter-individual differences. However, the intra-individual differences of Ch 7-OOHs levels in skin lipids between right and left arms were less than 25% (-16.4% to 24.0%). Inter-day differences of Ch 7-OOHs in 5 subjects at 1 week interval were also small (-36.7% to 47.7%). Additionally, we investigated effects of sunlight exposure on the levels of Ch 7-OOHs in skin lipids of healthy Japanese volunteers (n = 24). The levels of Ch 7-OOHs in skin lipids significantly increased from 10.0+/-6.7 to 38.9+/-38.0 pmol/cm2 skin by sunlight exposure (10-40 mJ/cm2/min) for 3 h. Therefore, natural sunlight exposure causes lipid peroxidation in skin lipids of humans. These results suggest that the level of Ch 7-OOHs is a good marker for lipid peroxidation in human skin.

Comparative studies on the catalytic roles of cytochrome P450 2C9 and its Cys- and Leu-variants in the oxidation of warfarin, flurbiprofen, and diclofenac by human liver microsomes

S-Warfarin 7-hydroxylation, S-flurbiprofen 4'-hydroxylation, and diclofenac 4'-hydroxylation activities were determined in liver microsomes of 30 humans of which 19 were wild-type (Arg144.Ile359), 8 were heterozygous Cys (Cys144.Ile359), and 3 were heterozygous Leu (Arg144.Leu359) allelic variants of the cytochrome P450 2C9 (CYP2C9) gene. All of the human samples examined contained P450 protein(s) immunoreactive with anti-CYP2C9 antibodies in liver microsomes. Individuals with the Cys144 allele of CYP2C9 had similar, but slightly lower, activities for the oxidations of these substrates than those of wild-type CYP2C9. One of the three human samples heterozygous for the Leu359 allele had very low Vmax and high Km values for the oxidation of three substrates examined, while the other two individuals gave kinetic parameters comparable to those seen in the wild-type and Cys144 CYP2C9. Reverse transcriptase-polymerase chain reaction analysis, however, showed that all of the three human samples with the heterozygous Leu359 variant were found to express both Ile359 and Leu359 variants at relatively similar extents in liver RNA of three humans. These results suggest that the Cys144 variant of CYP2C9 catalyzes the CYP2C9 substrates at rates comparative to, but slightly lower than, those of wild-type CYP2C9, while the Leu359-allelic variant has slower rates for the oxidation of these drug substrates. Activities for the oxidation of these CYP2C9 substrates in humans with heterozygous Leu359 allele is likely to be dependent on the levels of expression of each of the wild- and Leu-variants in the livers. However, one of the humans with a heterozygous Leu allele was found to have very low activities towards the oxidation of CYP2C9 substrates. The basis of this defect in catalytic functions towards CYP2C9 substrates is unknown.

Phasic increase of monoamine-related electrochemical signal in the rat caudate nucleus following conditioned auditory stimulation during the reaction-time task

Monoamine-related electrochemical signal was measured by in vivo chronoamperometry at a sampling rate of 5 Hz with a Nafion-coated carbon fiber placed in the caudate nucleus of the rat (n=5) performing an auditory reaction-time task. During the task, the rat pressed a lever in response to a tone stimulus to get food reward. An averaging technique was employed to extract event-related changes in monoamine concentration with respect to the tone stimulus, lever pressing or feeding. It was found that the oxidation current increased phasically for several seconds following the tone presentation with the mean onset latency being 0.4+/-0.2 s. Lever pressing was preceded by the onset of increase in two rats. Prominent increase was not observed following the tone presentation during the resting state, passive feeding, and lever pressing unrelated to the task. The results indicate that phasic increase in monoamine concentration occurs at the caudate nucleus in response to conditioned auditory stimulation in the reaction-time task. This response is not simply the consequence of sensory stimulation, motor reaction, or feeding, but is possibly influenced by integrative processes. The present electrochemical findings are consistent with the previous electrophysiological data on dopamine neuronal activity. However, pharmacological researches will be necessary in order to determine the substance involved in the phasic response.

Subunit Ya-specific glutathione peroxidase activity toward cholesterol 7-hydroperoxides of glutathione S-transferases in cytosols from rat liver and skin

Dermal 7alpha- and 7beta-hydroperoxycholest-5-en-3beta-ols (cholesterol 7alpha- and 7beta-hydroperoxides), regarded as good aging markers in the rat (Ozawa, N., Yamazaki, S., Chiba, K., Aoyama, H., Tomisawa, H., Tateishi, M., and Watabe, T. (1991) Biochem. Biophys. Res. Commun. 178, 242-247), were reduced in the presence of glutathione (GSH) with concomitant formation of GSSG by cytosol from rat liver in which no detectable level of the hydroperoxides had been demonstrated to occur. The GSH peroxidase (GSH Px) activity toward the toxic steroid hydroperoxides was exerted to almost the same extent by both Alpha-class GSH S-transferases (GSTs), Ya-Ya and Ya-Yc, and by selenium-containing GSH Px (Se-GSH Px) in rat liver cytosol. None of three Mu-class GSTs, Yb1-Yb1, Yb1-Yb2, and Yb2-Yb2, and a Theta-class GST, Yrs-Yrs, from rat liver and a Pi-class GST, Yp-Yp, from rat kidney showed any appreciable GSH Px activity toward the hydroperoxides. The subunit Ya-bearing GSTs and Se-GSH Px purified from rat liver cytosol showed marked differences in apparent specific activity toward the cholesterol hydroperoxides (GSTs Ya-Ya > Ya-Yc >> Se-GSH Px). However, a kinetic study indicated that Se-GSH Px had a higher affinity for steroid hydroperoxides than did the GSTs, so that Se-GSH Px could catalyze the reduction of lower concentrations of cholesterol 7-hydroperoxides with approximately equal Vmax/Km values to those by the GSTs. Rat skin had no GST bearing the subunit Ya but contained only a very low concentration of Se-GSH Px, possibly resulting in the accumulation of cholesterol 7-hydroperoxides in the skin but not in the liver. From rat skin cytosol, GSTs Yc-Yc, Yb1-Yb1, Yb1-Yb2, Yb2-Yb2, and Yp-Yp were isolated, purified to homogeneity, and identified with the corresponding GSTs from liver and kidney. The GSTs accounted for 0.23% of total skin cytosolic protein, and the most abundant isoform of skin GSTs was Yb2-Yb2, followed by Yc-Yc, Yp-Yp, Yb1-Yb1, and Yb1-Yb2 in decreasing order.

Strategic proposals for avoiding toxic interactions with drugs for clinical use during development and after marketing of a new drug--proposals for designing non-clinical and clinical studies--is the non-clinical study useful?

Since sorivudine incident has happened in Japan in 1993, an adverse drug-drug interaction has been of special meanings at each step of new drug development including the discovery step, NDA process, and on market. While it is known that several mechanisms are involved in the drug-drug interactions, the mechanisms related to drug metabolism are 1) inhibition of drug metabolizing enzymes, 2) induction of the enzymes, 3) drug absorption, 4) renal excretion, 5) hepatic transport, and 6) protein binding (displacement) interaction. In this report, proposals to avoid serious/lethal drug-drug interactions are presented with the examples. The proposals are: 1) To estimate the drug-drug interactions in consideration of the mechanisms reported so far, 2) To be especially careful for drugs with a small therapeutic index and severe/lethal toxicity, 3) To estimate the drug-drug interactions in consideration of physiological factors of patients, who receive drugs in combination, 4) Not to leave the mechanism unclear, when some data, which do not deny the critical drug-drug interactions, were obtained, and 5) To conduct the drug-drug interaction studies in humans in careful consideration of the safety.

Event-related potentials in the dorsal hippocampus of rats during an auditory discrimination paradigm

The relation of the hippocampal neuronal activity to the rat event-related potential (ERP) generation was examined during an auditory discrimination oddball paradigm. ERPs were recorded using a linearly-arranged series of electrodes chronically implanted at the skull, in the frontoparietal cortex, in the CA1 and CA3 regions of the dorsal hippocampus and in the thalamus. The target tone elicited N40, P100, N200, and P450 at the skull electrode. The non-target tone, on the other hand, prominently evoked only the P100 component. At the intracranial electrodes, the ERP amplitude at the latency of the skull P450 was significantly greater in the CA3 region than that at other recording sites, although a phase reversal was not observed. The results indicate that the P450 of the rat may correspond to the human P3, and that the neuronal activity in the hippocampus is involved in its generation.

Five Hundred Twenty-two Resectoscopic Myomectomies

Between January 1985 and March 1996, 522 women with submucous myomas underwent resectoscopic myomectomy. Fifty-two were treated with subsequent endometrial ablation. To ensure easy and complete resection of sessile or large submucous myomata, the two-resectoscope method was used. To increase safety, the procedure was monitored by simultaneous ultrasound, and in 1995 Lin's myoma forceps was produced to facilitate the procedure. The average specimen weight was 23.9 g (505 patients). The largest intrauterine myoma was 148 g and the largest myoma delivery was 210 g. The average operating time was 34.2 minutes (517 patients). No uterine perforation occurred. No laparotomy was necessary during or after the operation. Almost all of the women experienced improvement of their symptoms.

Effects of gonadotropin-releasing hormone agonist (GnRHa) and ovariectomy on leukocyte subpopulations in rats with autotransplanted endometrium

PROBLEM

To determine the effect of estrogen deficiency on populations of immune cells in rats with autotransplanted endometrium.

METHOD OF STUDY

Autologous endometrial segments were implanted in the peritoneum of rats. Leukocyte subsets in the peripheral blood (PB) and peritoneal fluid (PF) of autotransplanted rats treated with gonadotropin-releasing hormone agonist (GnRHa) or ovariectomy were analyzed by flow cytometry.

RESULTS

Endometrial growth was suppressed in association with increases in natural killer (NK) cells and macrophages in rats treated surgically or medically after endometrial implantation compared with autotransplanted-only rats. Normal rats treated with GnRHa showed no significant alterations in PB and PF leukocyte subsets, even in NK cells and macrophages, compared with untreated normal rats.

CONCLUSIONS

Data suggest that GnRHa itself did not have an immunomodulating effect when rats were treated for 3 weeks, but that a hypoestrogenic state reduced the size of the ectopic endometrium in association with increases in NK cells and macrophages. Our findings support the hypothesis that ectopic endometrial cells may release immunosuppressive factors.

Evaluation of human skin irritation by carboxylic acids, alcohols, esters and aldehydes, with nitrocellulose-replica method and closed patch testing

Closed patch testing and the nitrocellulose-replica method are performed as useful clinical methods for the evaluation of human skin irritation by cosmetics and topical medicaments. Comparison of the sensitivity between microscopic scoring by nitrocellulose-replica method and visual scoring by closed patch test in the detection of skin irritation, however, has not been well studied with statistical analysis. Here, we evaluated human skin irritation by carboxylic acids, alcohols, esters and aldehydes, with different chain length (C8-C18), using both methods. The results of closed patch testing showed that, although the score of skin irritation for carboxylic acids (C8, C12), alcohols (C8) and aldehydes (C8), tested at a concentration of 0.5 m-2.0 m, significantly increased with increasing concentration of the test compounds, ester compounds scarcely caused any irritation on the surface of the skin occluded. In addition, an increase of carbon chain length in the test compounds made it impossible to detect skin irritation. In contrast, the nitrocellulose-replica method could evaluate skin reactions against very weak irritants that gave no macroscopic alterations on the skin surface in the closed patch test. However, the scoring system is somewhat subjective and should be improved to make the analysis more objective.

Effects of metamfetamine on auditory P3 component of event-related potentials in rats

Three rats were trained with an oddball paradigm, in which 5 kHz frequent and 10 kHz target rare tones were presented with a probability of 0.8 and 0.2. Pressing the lever within 2 s following the onset of the target tones was rewarded with a drop of food paste. Long latency event-related potentials (ERPs) corresponding to those in humans could be recorded in rats. After the administration of metamfetamine (0.2 mg/kg), the amplitude of surface and intracortical N1 increased, indicating an augmentation of the primary cortical response. Surface P3 showed a decrease of amplitude, accompanied by an increase of intracortical negativity. These alterations of ERPs may be caused by the dysregulation of central noradrenergic system.

Daily walking combined with diet therapy is a useful means for obese NIDDM patients not only to reduce body weight but also to improve insulin sensitivity

OBJECTIVE

To evaluate the effects of walking combined with diet therapy (1,000-1,600 kcal/day) on insulin sensitivity in obese non-insulin-dependent diabetes mellitus (NIDDM) patients.

RESEARCH DESIGN AND METHODS

Subjects were divided into two groups: 10 patients were managed by diet alone (group D), and 14 patients were placed in the diet and exercise group (group DE). Group DE was instructed to walk at least 10,000 steps/day on a flat field as monitored by pedometer (19,200 +/- 2,100 steps/day), and group D was told to maintain a normal daily routine (4,500 +/- 290 steps/day). A glucose clamp procedure at an insulin infusion rate of 40 microU.min-2.min-1 was performed before and after the 6- to 8-week training program. Mean serum insulin concentrations ranged from 720 to 790 pmol/l.

RESULTS

While body weight (BW) in groups D and DE decreased significantly (P < 0.01) during the study, the amount of BW reduction in group DE was greater than that in group D (7.8 +/- 0.8 vs. 4.2 +/- 0.5 kg, P < 0.01). After training, glucose infusion rate (GIR) and metabolic clearance rate (MCR) in group D did not significantly increase; however, GIR and MCR increased significantly in group DE, from 17.21 +/- 1.11 to 26.09 +/- 1.11 mumol.kg-1.min-1 (P < 0.001) and from 3.0 +/- 0.3 to 5.3 +/- 0.4 ml.kg-1.min-1 (P < 0.001), respectively. The analysis of variance showed significant effects of exercise (time x exercise, P = 0.0005) for the improvement of MCR. Significant correlations were also observed between delta MCR and average steps per day (r = 0.7257, P < 0.005) in group DE.

CONCLUSIONS

Walking, which can be safely performed and easily incorporated into daily life, can be recommended as an adjunct therapy to diet treatment in obese NIDDM patients, not only for BW reduction, but also for improvement of insulin sensitivity.

Leukocyte subpopulation changes in rats with autotransplanted endometrium and the effect of danazol

PROBLEM

This study examines immune cell populations in rats with autotransplanted endometrium and determines the effect of danazol on leukocyte subsets.

METHODS

As an experimental model of endometriosis, an autologous endometrial segment was implanted in the rat peritoneum. We used flow cytometry to analyze lymphocyte subsets in the peripheral blood (PB) and peritoneal fluid (PF) of the following groups of rats: no treatment, sham operation, endometrial implantation, endometrial implantation treated with danazol, and normal rats treated with danazol.

RESULTS

The natural killer (NK) cell population was decreased in both the PB and PF of rats with autotransplanted endometrium. Moreover, NK cells increased in a dose-dependent manner following danazol administration. Surgery itself increased the number of peritoneal macrophages as compared with the untreated group. This elevation was suppressed partially by endometrium-implantation and was attenuated by subsequent administration of danazol in a dose-dependent fashion.

CONCLUSIONS

These data suggest that ectopic endometrial cells may release immunosuppressive factors. This is the first documentation that rats with autotransplanted endometrium show the same immunologic changes as humans with endometriosis, and establishes the utility of this model for the study of endometriosis.

Accessibility to tissue-specific genes from methylation profiles of mouse brain genomic DNA

The DNA methylation status of a large number of genomic loci is visualized simultaneously and quantitatively as two-dimensional gel spots in the newly developed restriction landmark genomic scanning with a methylation-sensitive restriction enzyme (RLGS-M). Here, we demonstrate that RLGS-M using NorI as a methylation-sensitive enzyme could also scan gene loci of mammalian genomes, since almost all of the NotI loci corresponding to randomly chosen RLGS-M spots were located near or in transcriptional units (6 out of 7 NotI-linking clones) when mouse brain genomic DNA was used. This supports the previous prediction that most NotI sites are located in CpG islands (Lindsay and Bird, Nature 1987, 327, 336-338). Furthermore, beginning with RLGS-M spots we examined how to approach their corresponding RNA messages, whose expression may be associated with methylation. We compared RLGS-M patterns among various developmental stages of the mouse brain from embryonic day 9.5 to postnatal 8 weeks or among in vitro cell lines, and detected alterations of RLGS-M spots which were due to methylation of NotI sites. Two experiments using NotI-linking clones or polymerase chain reaction (PCR) were carried out to approach to their corresponding RNA messages. Consequently, we isolated two PCR-amplified clones (# 15 and # 91) which corresponded to methylatable loci and gave positive signals to mRNA from the adult brain. Furthermore, we identified two NotI-linking clones (C211 and C198) whose corresponding NotI loci localized near or at transcriptional units and were methylated in cell lines.(ABSTRACT TRUNCATED AT 250 WORDS)