Spatial Distribution of PCR-Identified Species of Anopheles gambiae senu lato (Diptera: Culicidae) Across Three Eco-Vegetational Zones in Cross River State, Nigeria

Anopheles gambiae sensu lato complex (An. gambiae s.l.) describes a group of nine morphologically indistinguishable members that vary in their distribution, ability to transmit malaria, and susceptibility to pyrethroids. Here, we recorded the spatial patterns of PCR-identified An. gambiae s.l. complex species collected from four sites in Cross River State, Nigeria that represented three different ecological zones. Trapping was conducted between October 2015 and June 2016. Anopheles gambiae s.l. complex species identification was performed using species-specific primers followed by An. gambiae and An. coluzzii differentiation using the restriction fragment length polymorphism (RFLP) method. Bivariate and multivariate logistic regression models were used to identify ecological and seasonal variables closely associated with An. coluzzii and An. gambiae distribution. Out of 1,388 An. gambiae s.l. successfully amplified, 1,074 (77.4%) were An. coluzzii, 278 (20%) were An. gambiae, and 25 (1.8%) were hybrids (An. coluzzii/An. gambiae). A very small number of An. arabiensis (0.8%, n = 11) were also collected. Statistical analysis indicated that An. coluzzii is predominant in Guinea-savannah and tropical rainforest, and is highly associated with rainy seasons, while, An. gambiae is prevalent in mangrove swamp forest during dry seasons. Only 13 An. gambiae s.l. females were infected with Plasmodium falciparum (P. falciparum). The sporozoite infection rate was higher in mangrove swamp forest (53.8%, n = 7) than in rain forest (38.5%, n = 5) followed by Guinea-savannah (7.7%, n = 1) ecological zones. These results provide important insights for strategic planning of malaria control programs in Nigeria.

Ecological niche modeling for predicting the potential geographical distribution of Aedes species (Diptera: Culicidae): A case study of Enugu State, Nigeria

Arbovirus transmission by Aedes mosquitoes has long been a significant problem in Africa. In West Africa, Aedes vector management faces significant challenges; lack of recent Aedes distributional data and potential distributional modeling hinder effective vector control and pose serious public health issues. In this study, larval and adult mosquitoes were collected from four study sites in Enugu State, Nigeria every other month between November 2017 and September 2018. A total number of 2997 Aedes mosquitoes were collected and identified, and 59 positive field occurrence points for both Aedes adult and larvae were recorded. A total of 18 positive occurrence points were used for modeling. Ecological Niche Models (ENMs) were used to estimate the current geographic distribution of Aedes species (spp.) in Enugu State, south-east Nigeria, and mosquito presence was used as a proxy for predicting risk of disease transmission. Maximum Entropy distribution modeling or “MaxEnt” was used for predicting the potential suitable habitats, using a portion of the occurrence records. A total of 23 environmental variables (19 bioclimatic and four topographic) were used to model the potential geographical distribution area under current climatic conditions. The most suitable habitat for Aedes spp. was predicted in the northern, central, and southeastern parts of Enugu State with some extensions in Anambra, Delta, and Edo States in the west, and Ebonyi State in the east. Seasonal temperature, precipitation of the wettest month, mean monthly temperature range, elevation, and precipitation of the driest months were the highest estimated main variable contributions associated with the distribution of Aedes spp. We found that Aedes spp. prefer to be situated in environmental conditions where precipitation of wettest month ranged from 265 to 330 mm, precipitation of driest quarter ranged from 25 to 75 mm while precipitation of wettest quarter ranged from 650 to 950 mm. Aedes mosquitoes, such as Ae. aegypti and Ae. albopictus, pose a significant threat to human health, hence, the results of this study will help decision makers to monitor the distribution of these species and establish a management plan for future national mosquito surveillance and control programs in Nigeria.

Analysis of absorption and spreading of moisturizer on the microscopic region of the skin surface with near-infrared imaging

BACKGROUND/PURPOSE

Near-infrared (NIR) light with high water absorption enables us to visualize the water content distribution appeared in the superficial skin layer. The light penetration depth with the wavelength of 1920 nm is almost 100 μm from the skin surface. Thus, the water distribution in the stratum corneum can be effectively imaged by detecting the wavelength band around 1920 nm. The aim of this article was to measure the time-lapse behavior of the tiny droplet of the moisturizer spreading on the skin surface by imaging in 1920 nm wavelength band for investigating the correlation with the traditional index of the skin condition such as the water content and transepidermal water loss (TEWL).

METHODS

Experiment is performed with three moisturizer products and seven volunteer subjects. The NIR image is acquired by an originally designed imaging scope equipped with the white light of the strong brightness [super continuum (SC) light], the bandpass filter with the center wavelength of 1920 nm, and the NIR image sensor. A tiny droplet of the moisturizer is put on the surface of the skin and the time-lapse images are saved. Each acquired image is analyzed from a view point of the droplet area and elapsed time for absorption into the skin. The water content and TEWL of all subjects are measured by the conventional electrical method for investigating the relationship with the measured droplet dynamics parameters.

RESULTS

Elapsed time for moisturizer droplet to be absorbed into the skin, the droplet area just before absorption for three moisturizer products, skin water contents, and TEWL for seven subjects were measured and correlation coefficients for each parameters were calculated. It was found that the skin with higher water contents or lower TEWL absorbed the moisturizer faster and spreads moisturizer wider. Also absorption and spreading speed depend on moisturizer property (moisturizing or fresh) which is originated from the moisturizer constituents.

CONCLUSION

The correlation values between the moisturizer dynamics on the skin surface and the traditional index of the skin property were clarified. It was found that the skin with the high water content or low TEWL absorbs the moisturizer droplet fast. The spreading area depends not only on the skin property but on the constituents of the moisturizers.

Spectral study of metabolism-based autofluorescence and white-light reflectance for endoscopic tumor imaging

Metabolism-based autofluorescence redox imaging is one of the promising options for non-invasive screening of digestive tumors. In this paper, autofluorescence from fluorescent coenzymes such as NADH and FAD related to cellular metabolism as well as total hemoglobin and oxygen saturation are analyzed based on a point spectrum. As a redox index based on the metabolism, the ratio of the 450nm-490nm fluorescence intensities for 365nm and 405nm excitation wavelengths (F365/F405) is used. Although F365/F405 is a good index in many samples, inversion and weakened contrast are observed. A Simplified models with and without collagen based on Lambert-Beer law are built to explain how F365/F405 depicts the tumor region.

Early and late outcomes after reoperation for prosthetic valve endocarditis

OBJECTIVE

Prosthetic valve endocarditis remains a challenging complication after heart valve replacement. To identify predictive risk factors, we have reviewed 30 patients who underwent surgery for prosthetic valve endocarditis between March 1986 and May 1999.

METHODS

There were 15 men and 15 women (mean age 51 years). Prosthetic valve endocarditis was classified as early (< or = 1 year after operation) in 10 cases, and as late in the other 20 cases. The most common indication for surgery was moderate to severe congestive heart failure due to prosthetic valve dysfunction in 21 (70%) patients. The average follow-up period was 6.5 years, with a range of 0.3 to 14.1 years.

RESULTS

The most common microorganism was Staphylococcus epidermidis in both patients with early (50%) and late prosthetic valve endocarditis (25%). The in-hospital mortality was 13.3% (4/30). There were six late deaths. The actuarial survival at 5 years was 78% and 66% at 10 years. An early onset of prosthetic valve endocarditis was the only significant determinant of both in-hospital mortality (p = 0.005) and overall mortality (p = 0.021). Emergency surgery had a statistically significant relationship with in-hospital mortality (p = 0.045). No significant influence on mortality after reoperation for prosthetic valve endocarditis was found in age, sex, valve position, antecedent native valve endocarditis, or in the type of pathological findings (ring abscess, valve dehiscence, and vegetation).

CONCLUSION

Early onset of prosthetic valve endocarditis and emergency surgery were important risk factors for mortality due to prosthetic valve endocarditis.

Chemically-Enhanced GaAs Maskless Etching Using a Novel Focused Ion Beam Etching System with a Chlorine Molecular and Radical Beam

Chlorine-enhanced GaAs maskless etching using a novel focused-ion-beametching (FIBE) system has been examined for establishing high-rate and smooth FIBE. The system is composed of an air-locked ultrahigh-vacuum chamber, a 30 KeV Ga+ FIB column and two kinds of chlorine-irradiation nozzles. A fine nozzle enabled us to irradiate a high-density Cl2 flux on a desired, small area of the sample while retaining a sufficiently low surrounding-gas pressure for stable Ga+ FIB emission. Highly chemically-enhanced sputtering yields (up to 50 GaAs molecules per incident ion) were obtained. At the maximum yield, line-scanned deep-groove (6.5 um) etching with a smooth surface, capable of fabricating a laser-cavity optical mirror, was demonstrated. The chemical-enhancement effect showed high FIB-scanning-time dependence. This effect was also observed by irradiating with a plasma-dissociated Cl radicals using a novel radical beam gun. An analytical model, based on the Ga+-ion bombardment on the chlorine-adsorbed substrate surface, suggested that the maximum chemical enhancement is obtained when the Ga+-FIB scanning time is adjusted to the chlorine-coverage time, given by the Cl2-molecule or Cl-radical flux density.

Exacerbation of thyroid associated ophthalmopathy after arterial embolization therapy in a patient with Graves' disease

A novel treatment approach to Graves' disease (GD), embolization of the thyroid gland arteries, is evaluated with respect to its indications and adverse effects. We describe an exacerbation of thyroid associated ophthalmopathy (TAO) following thyroid artery embolization in a woman with GD and mild stable TAO (NOSPECS classification, class I grade a). A 45-year-old woman with GD and inactive TAO, in whom thyroid function was stable following blockade of hormone release combined with replacement therapy, underwent embolization of three thyroid arteries. Initially, there were neither adverse effects nor complications; however, the patient developed severe TAO (NOSPECS classification, class IV grade b) 3 months after the arterial embolization. Steroid pulse treatments followed by total thyroidectomy resulted in improvement of the eye signs and symptoms. The clinical course and the serial changes of the thyroglobulin and thyroglobulin-antibody titers suggested that the destruction of thyroid follicles, induced by the arterial embolization, triggered the exacerbation of her TAO. Our experience argues for the use of caution when arterial embolization is considered for GD patients with even the mildest TAO (NOSPECS classification, class I).

Scheme for creating a subcutaneous tunnel to place an indwelling implantable central venous access system in the forearm

We report a method that we have devised in which a secure subcutaneous tunnel is prepared during the placement of an indwelling central venous reservoir in the forearm. Subjects included 69 cases in which a procedure for implanting an indwelling reservoir in the forearm was performed between June 2006 and May 2007. For the subcutaneous tunnel, a 22-G Cathelin needle was advanced from the puncture site, turning toward the subcutaneous pocket side to the deep subcutaneous area. A 14-G Surflo IV catheter was then advanced along the 22-G Cathelin needle from the subcutaneous pocket. With the tip of the 14-G Surflo IV catheter emerging above the skin at the puncture site, the inner needle of the 14-G Surflo IV catheter and the 22-G Cathelin needle were removed. The catheter was passed through the outer 14-G Surflo IV catheter to emerge on the subcutaneous pocket site, then the outer needle of the Surflo catheter was also removed, and a connection to the port was made to create the subcutaneous tunnel. In all 69 cases, the subcutaneous tunnel in the forearm of the nondominant arm was successfully created within a short period of time (100% success rate). No problems were observed due to slack in the catheter until removal of the sutures 1 week later and for 3 months after treatment. With this method, we believe that a subcutaneous tunnel can be prepared in which the contained catheter has minimal freedom of movement, and which minimizes any damage induced by slack in the catheter within the subcutaneous tunnel.

[New proximal anastomotic system in coronary artery bypass grafting]

The Heartstring proximal anastomotic system is a device designed to facilitate the creation of a clampless hand-sewn proximal anastomosis. Thirty-four patients who underwent coronary artery revascularization had 40 proximal anastomoses using the Heartstring device. There were 26 men and 8 women, with the mean age of 70 +/- 8.9 years. Thirty-one patients underwent coronary artery bypass grafting through off-pump procedures and 3 patients on-pump beating procedures. In all patients, saphenous vein grafts were anastomosed to the aorta using the Heartstring device, the median number of distal anastomoses being 2.4 +/- 0.7. Either emergent or urgent surgery was required in 14 patients (41%). Diseased aorta was found in 11 patients (32%). One patient (2.9%) died postoperatively due to ischemic necrosis of the small intestine and the colon. There was no occurrence of postoperative stroke. Of 40 saphenous vein grafts anastomosed with the Heartstring system, 39 (97.5%) were patent. The occluded saphenous vein was not considered to be device related. Our clinical experience demonstrated that the Heartstring system allow us to create clampless and reproductive hand-sewn proximal anastomosis and to decrease the incidence of neurological complication.

[Aortic root replacement in Marfan syndrome with hemophilia A]

A 34-year-old man with Marfan syndrome was admitted to our hospital for surgical treatment of aortic regurgitation due to annuloaortic ectasia. He had no history of bleeding complications. Preoperative investigation revealed a slight prolongation of an activated partial thromboplastin time, which went unnoticed. He underwent aortic root replacement with a composite valve graft. During the operation, he had excessive bleeding due to coagulopathy after the termination of cardiopulmonary bypass, and needed a large amount of blood transfusion to obtain hemostasis. Before his discharge from our hospital, he was diagnosed as mild hemophilia A because of the decline in his factor VII level. To our knowledge, there has been no published case of cardiac operations in Marfan syndrome with hemophilia A.

Assessment of Two 3D MDCT Colonography Protocols for Observation of Colorectal Polyps

OBJECTIVE

The objective of our study was to assess the value of two-way interpretation (i.e., from rectum to cecum and vice versa) compared with one-way interpretation (i.e., from rectum to cecum only) in terms of polyp detection and interpretation time on MDCT colonography.

MATERIALS AND METHODS

Fifty consecutive patients underwent both CT colonography and conventional colonoscopy. Three radiologists independently analyzed the CT colonographic examinations of each patient using a primary 3D method. All examinations were analyzed using two techniques: navigation from rectum to cecum only (one-way) and navigation from rectum to cecum and vice versa (two-way). Sensitivity and positive predictive value were calculated on both a per-polyp basis and a per-patient basis. Alternative free-response receiver operating characteristic (ROC) curve analysis was estimated, and image interpretation time was documented.

RESULTS

One hundred fifty-five polyps were depicted in 45 patients by colonoscopy. The mean sensitivity of CT colonography for polyp detection with two-way (88.4%) was significantly superior to that with one-way (78.1%) (p < 0.01). The mean positive predictive value of each observer with one-way was 66.7%, whereas that with two-way was 65.8%. The mean area under the alternative free-response ROC curve (A(z) value) with two-way (0.827) was higher than that with one-way (0.816), but there was not a statistically significant difference. The average interpretation time of each observer with two-way (39 min) was statistically significantly longer than that with one-way (25 min) (p < 0.01).

CONCLUSION

When using a primary 3D interpretation technique at CT colonography, complete 3D navigation from rectum to cecum and from cecum to rectum is mandatory to maximize polyp detection. The image interpretation time for two-way interpretation is statistically significantly longer than that with one-way interpretation.

[Coronary endarterectomy and on-lay patch anastomosis in a case with unstable angina due to diffusely diseased coronary artery]

A 76-year-old woman with unstable angina due to diffusely diseased coronary artery successfully underwent coronary artery bypass grafting (CABG) using endarterectomy and on-lay patch anastomosis. She had triple vessel disease in the coronary artery and all of them were diffusely stenotic. It was impossible to undertake simple CABG. We were able to perform 3 coronary artery bypass grafting using endarterectomy and on-lay patch anastomosis. The postoperative course was uneventful and postoperative angiogram revealed well patent 3 grafts. Coronary endarterectomy and on-lay patch anastomosis were effective procedure in a patient with diffusely diseased coronary artery.

Secondary mitral valve replacement in antiphospholipid syndrome and chronic renal failure

A 48-year-old woman admitted with progressive dyspnea had previously been diagnosed with systemic lupus erythematosus, antiphospholipid syndrome, and chronic renal failure, and had undergone mitral valve replacement with a Carpentier-Edwards pericardial bioprosthesis for mitral insufficiency 9 years before. She suffered a cerebral infarction 5 years earlier, despite appropriate anticoagulant therapy. On admission, echocardiography showed severe bioprosthetic stenosis. Repeat mitral valve replacement was conducted using a Mosaic bioprosthesis. On postoperative day 2, when heparinization was commenced, she suddenly had an epileptic fit. She also developed ischemic necrosis of the fingers and toes, considered secondary to microthrombosis. Aspirin was administered and heparin replaced by warfarin sodium. Necrosis gradually disappeared, and she was discharged 3 months after surgery. The original bioprosthesis showed degenerative changes with significant thrombus formation on cusps, thought to be mainly due to her hypercoagulable state. Considering the thrombophilic tendency in patients with antiphospholipid syndrome, strict management of anticoagulant therapy is required.

Liver injury suppressing compounds from avocado (Persea americana)

To evaluate the protective activity of fruits against liver injury, 22 different fruits were fed to rats with liver damage caused by D-galactosamine, a powerful liver toxin. As measured by changes in the levels of plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST), avocado showed extraordinarily potent liver injury suppressing activity. Five active compounds were isolated and their structures determined. These were all fatty acid derivatives, of which three, namely, (2E,5E,12Z,15Z)-1-hydroxyheneicosa-2,5,12,15-tetraen-4-one, (2E,12Z,15Z)-1-hydroxyheneicosa-2,12,15-trien-4-one, and (5E,12Z)-2-hydroxy-4-oxoheneicosa-5,12-dien-1-yl acetate, were novel.

Integral three-dimensional imaging with digital reconstruction

A computed three-dimensional (3-D) display system based on integral imaging is presented. The 3-D image is reconstructed by numerical processing of an optically observed image array formed by a microlens array. The algorithm for reconstructing 3-D images is robust, and it enables us to obtain the images viewed from arbitrary directions. This computer-based image retrieval makes it possible to improve qualities of the image such as contrast, brightness, and resolution by numerical techniques. Also, this method eliminates the need for special purpose optical equipment such as high-quality liquid-crystal display and micro-optics components to display the 3-D images. We present experimental results of 3-D image reconstruction to test and verify the performance of the algorithms and the imaging system.

Primary malignant lymphoma of the cavernous sinus--case report

A 59-year-old female presented with a very rare case of primary malignant lymphoma of the cavernous sinus manifesting as diplopia and right facial hypesthesia. Magnetic resonance (MR) imaging showed the tumor located in the right cavernous sinus as low intensity with marked enhancement by gadolinium. The tumor was partially removed by the transzygomatic extradural approach. The histological diagnosis was malignant lymphoma. Chest and abdominal computed tomography and gallium-67 scintigraphy revealed no other lesions in the body. The patient received conventional radiotherapy and her diplopia and right facial hypesthesia gradually improved. At 1 month after radiotherapy, MR imaging showed no evidence of residual tumor. Primary cavernous sinus malignant lymphoma is extremely rare, but should be considered in the differential diagnosis of cavernous sinus lesions. Histological confirmation of tumors in this region is essential for choosing the most appropriate treatment to achieve a better outcome.

Taxol and discodermolide represent a synergistic drug combination in human carcinoma cell lines

Recently, three natural products have been identified, the epothilones, eleutherobin, and discodermolide, whose mechanism of action is similar to that of Taxol in that they stabilize microtubules and block cells in the mitotic phase of the cell cycle. In this report, we have compared and contrasted the effects of these new agents in Taxol-sensitive and -resistant cell lines. We also have taken advantage of a human lung carcinoma cell line, A549-T12, that was isolated as a Taxol-resistant cell line and found to require low concentrations of Taxol (2-6 nM) for normal cell division. This study then examined the ability of these new compounds to substitute for Taxol in sustaining the growth of A549-T12 cells. Immunofluorescence and flow cytometry have both indicated that the epothilones and eleutherobin, but not discodermolide, can substitute for Taxol in this Taxol-dependent cell line. In A549-T12 cells, the presence of Taxol significantly amplified the cytotoxicity of discodermolide, and this phenomenon was not observed in combinations of Taxol with either the epothilones or eleutherobin. Median effect analysis using the combination index method revealed a schedule-independent synergistic interaction between Taxol and discodermolide in four human carcinoma cell lines, an effect that was not observed between Taxol and epothilone B. Flow cytometry revealed that concurrent exposure of A549 cells to Taxol and discodermolide at doses that do not induce mitotic arrest caused an increase in the hypodiploid population, thereby indicating that a possible mechanism for the observed synergy is the potentiation of apoptosis. Our results suggest that Taxol and discodermolide may constitute a promising chemotherapeutic combination.

Analysis of experimental autoimmune encephalomyelitis induced in F344 rats by pertussis toxin administration

To elucidate the factor(s) accelerating the autoimmune disease processes, we induced two types of experimental autoimmune encephalomyelitis (EAE), severe and very mild, in F344 rats by immunization with myelin basic protein (MBP) plus pertussis toxin (PT) (PT+) or with MBP alone (PT-) and compared the differences between the two. Immunohistochemical examinations showed that although the nature of inflammation was essentially the same between the two groups, the proportion of Vbeta8.2(+) T cells in the CNS lesion of PT (+) rats was larger than that of PT (-) rats. Cytokine analysis by competitive PCR revealed that IL-10 mRNA in the lymphoid organ was significantly suppressed in the PT(+) group, whereas levels of IFN-gamma,TNF-alpha and TGF-beta mRNA were insignificantly different after PT administration. In addition, T cells taken from PT (+) rats proliferated well in response to MBP, while those from PT (-) rats showed a marginal response to the same antigen. However, this finding does not indicate the switching of non-encephalitogenic to encephalitogenic T cells upon PT administration because PT (-) rats contained encephalitogenic T cells and/or their precursor cells as revealed by adoptive transfer experiments. Taken together, these findings suggest that suppression of IL-10 by PT administration is the major factor contributing to the exacerbation of EAE in PT(+) rats.

Gram-scale synthesis of (+)-discodermolide

[formula: see text] A triply convergent, highly efficient second-generation synthesis of the potent antimitotic agent (+)-discodermolide (1) has been achieved on a 1-g scale.

Analysis of neurotrophic effects of hepatocyte growth factor in the adult hypoglossal nerve axotomy model

Recent studies have shown that hepatocyte growth factor (HGF) promotes the survival of embryonic motor neurons. However, it remains unclear whether HGF has trophic effects on mature motor neurons. In the present study, we examined the effects of HGF on adult motoneurons using the hypoglossal nerve transection model. In adult rats, neurons in the hypoglossal nucleus show a dramatic loss of choline acetyltransferase (ChAT) protein and mRNA after the axotomy. This reduction of ChAT was markedly prevented when HGF was administered continuously at the cut end of the nerve using an osmotic pump. The HGF receptor, c-met, protein and mRNA, which were faintly expressed in hypoglossal neurons under normal conditions, gradually increased and reached maximal levels 2 weeks after the axotomy. Administration of HGF reduced this c-met upregulation almost to normal levels. We also quantified HGF mRNA in the tongue and hypoglossal nucleus. The tongue contained abundant HGF mRNA, whereas the nucleus contained only low levels. Interestingly, the HGF mRNA level in the nucleus did not increase after the axotomy. These findings suggest that HGF is principally produced in the tongue and contributes to maintain ChAT expression in the nucleus. HGF produced in the hypoglossal nucleus alone after disconnection from the tongue may not be sufficient for the maintenance of the motor neuron function. Thus, exogenously applied HGF was effective to prevent the downregulation of ChAT activities. These findings provide a strong rationale for the potential clinical use of HGF for the treatment of motor neuron degenerative disease.

Determination of the angular separation and the spectra of two-point sources from spectral coherence measurements

We present a novel method not only for determining the angular separation of unknown two-point spectral sources but also for obtaining each of their spectral profiles from measurements of both their complex degree of spectral coherence and their spectra across an observation area in the space-frequency domain. The theoretical predictions are fully proved by an experimental demonstration with a pair of uncorrelated two-point spectral sources.

Measurements of the complex degree of spectral coherence by use of a wave-front-folded interferometer

A wave-front-folded interferometer composed of a Kösters prism and an image-forming lens provides a good way of measuring the complex degree of spectral coherence. Demonstrative experiments are implemented by incorporation of uncorrelated two-point spectral sources in the primary-source plane; these sources establish a spatially partially coherent wave field over the secondary source plane just in front of the interferometer. The complex degree of spectral coherence of the secondary source is successfully measured after an a priori calibration is made for the interferometer that was constructed.

A comparison of young and aged populations for the diphtheria and tetanus antitoxin titers in Japan

The antitoxin levels for diphtheria and tetanus were measured with samples of a young group immunized with diphtheria-tetanus-acellular pertussis combined vaccine and those of an aged group, members of which had not received vaccination in their youth. In the young group members of which had already received basic immunization with diphtheria-tetanus-acellular pertussis combined vaccine, the levels of both antitoxins rose well after injection at 11 to 12 years old with diphtheria-tetanus combined toxoids and remained high until 20 years of age. In the aged group, more than 80% showed antitoxin levels above 0.01 u/ml for diphtheria, while all had levels below that for tetanus, except three persons with confirmed tetanus immunization history. Maintenance of the protective antitoxin levels in the population by vaccination is necessary to prevent outbreaks of infection among unvaccinated or only partially immunized persons.

Selective determination of haloperidol in human serum: surface ionization mass spectrometry and gas chromatography with surface ionization detection

Surface ionization organic mass spectrometry (SIOMS) has been performed on the clinically important drug haloperidol using quadrupole mass spectrometry in which the thermal ion source has a rhenium oxide emitter. The surface ionization (SI) mass spectrum is presented, interpreted in a purely empirical way by means of evidence from previous investigations, and then compared to results from conventional electron impact (EI) ionization. An approach to detection of this drug in serum by gas chromatography (GC) with a surface ionization detector (SID) and GC-SIOMS is described. This approach demonstrates that (a) haloperidol is efficiently surface-ionized, giving a unique SI mass spectrum, (b) experimental results rationalize the combined sensitivity and selectivity of the GC-SID for the examined drug, (c) the detection limit for haloperidol in serum is 1.1 ng/ml (S/N = 3) by GC-SID (the coefficients of variation of the assay are generally low, i.e., below 8.5%) and (d) the GC-SIOMS coupling can be used for sensitive and selective detection of haloperidol in serum.

[Rapidly progressive outer retinal necrosis in a patient with acquired immunodeficiency syndrome]

We report a case of rapidly progressive varicella zoster virus retinitis, which is distinct from acute retinal necrosis syndrome. The patient was a 52-year-old male and suffered acquired immunodeficiency syndrome. Two months after the varicella zoster dermatitis in the distribution of the first division of the left trigeminal nerve, pseudodendritic keratitis and iridocyclitis were observed in the left eye. After 5 weeks, multifocal and patchy white exudates were observed in the peripheral deeper layer of the retina in the left eye, but retinal vasculitis in the exudative lesions was slight. Despite systemic administration of acyclovir, white exudates progressed confluently from the periphery to the post pole of the retina and reached the macula in 10 weeks. Eight weeks after the observation of lesions in the left eye, we found the same lesions in the right eye. After the white exudative lesions disappeared, the retina became atrophic and the retinal vessels were narrowed, but no retinal detachment was observed. Recently, Foster and associates described the rapidly progressive outer retinal necrosis as a new entity of varicella zoster virus retinitis in AIDS patients. We think our case was very similar to the rapidly progressive outer retinal necrosis. This case shows that we must carefully follow up the rapidly progressive outer retinal necrosis in the AIDS patients with a varicella zoster dermatitis.

Surface ionization organic mass spectrometry of imipramine, desipramine, clomipramine, and lidocaine

Surface ionization organic mass spectrometry (SIOMS) has been performed on some clinically important drugs (imipramine, desipramine, clomipramine, lidocaine) by using quadrupole mass spectroscopy in which the thermal ion source has a rhenium oxide emitter. The mass spectra were presented, interpreted in a purely empirical way, by means of evidence from previous investigations, and then compared to conventional EI techniques. Sensitivity and selectivity have also been studied, demonstrating that (a) these drug compounds are efficiently surface-ionized, (b) experimental results rationalize the high sensitivity of the surface ionization detector (SID) of gas chromatography (GC) for the examined drugs, and (c) the GC/SIOMS coupling can be used for sensitive and selective detection of the drugs in the serum. An approach to detection of these drugs in serum by GC/SIOMS and GC with SID is described. The characteristics of both methods provide a reliable, sensitive, and selective method, which is needed for low concentration level measurements in complex mixtures.

Cancer mortality survey in a spa area (Misasa, Japan) with a high radon background

The 1952-88 cancer mortality records for inhabitants of the Misasa spa area, Japan, which has a high radon background, and a neighboring control area without any radon spa were analyzed (average outdoor Rn concentration: 26 mBq.liter-1 in Misasa vs. 11 mBq.liter-1 in the control area). Standardized mortality ratios (SMRs) for cancers of all sites were significantly lower among the inhabitants of both Misasa (male 0.538; female 0.463) and the control area (male 0.850; female 0.770), than in the whole Japanese population. Poisson regression analysis showed that the relative risks among the inhabitants of Misasa were significantly lower than in the control area for deaths from cancers of all sites (0.67) and stomach cancer (0.59). The relative risk of lung cancer death was also lower (0.55 times) in Misasa than in the control area, although the difference was not statistically significant. These results suggest that the linear no-threshold hypothesis for radiation risk may not be valid for exposure to low doses of radon.

Determination of sultopride and tiapride in serum by gas chromatography using a surface ionisation detector

A sensitive and selective method has been developed for the determination of sultopride and tiapride in serum using gas chromatography with a surface ionisation detector. No interfering peaks from endogenous substances were observed. The method showed good reproducibility and accuracy, and the standard curve was linear up to 2 micrograms/ml with a correlation coefficient of 0.999. This method is applicable to pharmacokinetic studies and therapeutic drug monitoring of sultopride and tiapride.

Multiple primary cancers in patients with initial laryngeal cancer

The risk of a person developing a second primary cancer was evaluated in 1,215 patients with laryngeal cancer at the National Cancer Center Hospital. Overall, 92 (8.2%) of the male patients and 5 (5.7%) of the female patients developed a second cancer, compared with 83.0 and 3.7, respectively, expected on the basis of general population rates, resulting observed: expected values (O/E) to be 1.1 and 1.3. The numbers of second cancers of the lung (O/E = 1.9), oropharynx (O/E = 8.8) and esophagus (O/E = 2.8) were significantly in excess of those expected, while the number of second stomach cancers (O/E = 0.5) was far below expectation. Synchronous second cancers were significantly higher than expected (O/E = 4.6). Smoking, especially heavy smoking, was related to second lung cancers, but alcohol drinking featured less. Histories of benign respiratory tract and digestive organ diseases were related to second oropharyngeal cancers. Alcohol drinking was related to second stomach cancers. Radiation therapy for the initial laryngeal cancer was related to second oropharyngeal cancers, while hazardous occupations related to noxious agents for respiratory systems featured more prevalently in cases of second lung cancer. Further analytical studies should clarify the roles of smoking, drinking, occupation and various forms of therapy on the risk of developing a different second cancer following laryngeal cancer.

Second malignant lymphomas and leukemias in the National Cancer Center from 1962 to 1987

Occurrence of second hematopoietic malignancies (SHM) among 49,163 patients with cancer, who had been admitted to the National Cancer Center Hospital from 1962 to 1987, was investigated. Forty-two cases of malignant lymphomas (38 non-Hodgkin lymphomas, 3 Hodgkin's diseases and 1 multiple myeloma) and 17 cases of leukemias (11 acute leukemias, 4 chronic leukemias and 2 myelodysplastic syndromes) developed as SHM. Second malignant lymphomas were 1.37 times more frequent than expected (P less than 0.05), whereas no excess incidence was seen in second leukemias. The incidence of malignant lymphomas was 2.2 times higher than expected in patients with initial stomach cancer (P less than 0.01). Two-thirds of second non-Hodgkin lymphomas occurred in extranodal regions. Nodal lymphomas were more prevalent in cases treated with chemotherapy and/or radiotherapy. Second leukemias were all of myeloid origin except one case of acute lymphoblastic leukemia. Etiological heterogeneity of SHM is discussed in relation to treatment and other risk factors.

Carcinoma of the uterine cervix treated by irradiation alone. Results of treatment at the National Cancer Center, Tokyo

Six hundred and twelve patients with previously untreated invasive carcinoma of the uterine cervix were treated by irradiation alone at the National Cancer Hospital from 1972 to 1983. The number of patients was 7, 39, 43, 127, 15, 319, 28 and 34 in stages IA, IB, IIA, IIB, IIIA, IIIB, IVA and IVB respectively. Low-dose-rate intracavitary irradiation with or without external irradiation was used in 383 patients, high-dose-rate intracavitary irradiation with or without external irradiation in 130, external irradiation alone in 98, and external irradiation combined with radon-222 seed implantation in one patient. Five-year-survival rates were 85, 65, 57, 41, 14 11% for stages IB, IIA, IIB, IIIB, IVA, and IVB respectively. The rate of complications was rather high in the present series, and so we have been investigating whether it is possible to reduce the dose. Low-dose-rate intracavitary irradiation has been replaced by high-dose-rate irradiation by using a remotely controlled afterloading system.

[Studies on the method of sterilization with ethylene oxide gas. 1. Sterilization procedure and sterilizing effect]

Undertaken to ensure perfection of sterilization with ethylene oxide gas (EO gas) in routine clinical laboratory practice, an investigation was made of the relationship between sterilization procedure and sterilizing effect using the film bag delivery system and chamber system. Using a biological indicator as a monitor of sterilizing effect, the efficiency of sterilization was studied under various likely conditions and compared. The results led to the following conclusions: 1. Sterilization with EO gas by the film bag delivery system, because of this procedure being unable to be performed at a constant temperature, was shown to prove inadequate due to insufficient exposure to gas especially in winter season (when room temperature fell below 10 degrees C). 2. With the EO gas sterilization method using the film bag delivery system, which is believed to be effective within the ordinary range of humidity of the atmosphere, sterilizing effect was recognized to be affected by excess wetting of an object of sterilization that was caused by inadvertent manipulation or due to a predisposing attribute of the object, such as shape or outline. 3. All materials are sterilized upon being packaged. It is necessary therefore to make best choice of package material with respect of texture and size. Reuse influence to sterilizing effect. 4. The method of sterilization with EO gas using the chamber system has the advantage in that operating conditions are all automatically controlled. For this reason, there was not a single instance of failure to sterilize due to inappropriateness of temperature and humidity. From these results it is concluded that sterilising effect was affected by sterilization procedure and condition.(ABSTRACT TRUNCATED AT 250 WORDS)

[Studies on the method of sterilization with ethylene oxide gas. 2. Residual EO gas on sterilized objects]

Ethylene oxide gas (EO gas) adsorbed onto sterilized objects was quantitated in an effort to take a safety measure against residual EO gas following its use in sterilization. We measured residual amounts of EO gas adsorbed onto laboratory wares, small medical tools and appliances just after post-sterilization airation to examine whether they were rendered entirely free from EO gas by the process. The results led us to arrive at the following conclusions: 1. EO gas was recognized to remain on sterilized objects even after allowing them to stand for about 16 hours following airation. 2. The amount of residual EO gas was smaller on metallic products and larger on rubber products (notably rubber gloves). An exceedingly high concentration of EO gas was noted to remain on a tooth-brush, among other plastic materials. These facts seem to indicate that the amount of residual EO gas is closely related to the texture and shape of materials to be sterilized. 3. As regards the potential toxicity of residual EO gas. However, their sensitivity was proved to be questionable, judgment on a result being subject to considerable individual variations. 4. Nevertheless, it is incontestable that these devices can at least provide a rough estimate of unavailing since monitoring by direct measurement of residual EO gas is virtually infeasible from a practical point of view.

Rapid and sensitive determination of aprindine in serum by gas chromatography using a surface ionization detector

A rapid and highly sensitive method for the determination in serum of aprindine, an antiarrhythmic drug, was developed employing gas chromatography with a surface ionization detector. No interfering peak from endogenous substances appeared when an organic phase was directly injected into the system after single extraction from a serum sample. A standard curve obtained was linear up to the serum level of 6 micrograms/ml, and the limit of sensitivity was 16 pg. The method described is applicable to routine therapeutic monitoring of serum concentrations of aprindine.

High-dose-rate intracavitary irradiation in the treatment of carcinoma of the uterine cervix: early experience with 84 patients

Eighty-four patients with previously untreated invasive carcinoma of the uterine cervix were treated by high-dose-rate intracavitary irradiation using a remotely controlled afterloading system (Ralstron) with or without external irradiation at the National Cancer Center Hospital, Tokyo, between 1977 and 1981. Survival rates and local control rates were comparable to those for 372 patients treated by low-dose-rate intracavitary irradiation with or without external irradiation from 1972 to 1981 at the hospital. The incidence of major complications was 5.1 and 2.4% for the patients treated by low-dose-rate intracavitary irradiation and by high-dose-rate irradiation, respectively. The results are comparable to those reported by other institutions. We have abandoned the conventional low-dose-rate intracavitary irradiation with the impression that the high-dose-rate remotely controlled afterloading system is a good alternative to the conventional one.

Smoking, occupation and family history in lung cancer patients under fifty years of age

A hospital based case-control study was conducted to investigate the factors affecting the development of lung cancer among young adults. A total of 185 inpatients (males: 128, females: 57) aged from 30 to 49 have been histologically classified in the National Cancer Center Hospital during the last 10 years. Most frequent was adenocarcinoma in both males (57.0%) and females (73.7%). Basic factors were obtained from clinical charts including smoking history, occupation and family history of cancers. Elevated risks were found for squamous cell carcinoma in patients with a history of smoking (all had smoked v. 15/20 for controls) and an occupation possibly related to respiratory irritations (15/20 v. 3/20 for controls). Heavy smokers were distributed more in the cancer patients. Moreover, the average Smoking Index among those without "at risk" occupation was 1,002 with the least being 700, while that with such an occupation was 723. Heavy smoking alone and a smoking/occupation combination could contribute to an early onset of squamous cell carcinoma. On the other hand, there were no significant risk factors for adenocarcinoma, the relative risk from a history of smoking being less than 1.00 and from a family history of cancer, approximately 1.00.

Trend of lung cancers in the National Cancer Center of Japan and comparison with that of Japanese pathological autopsy records

Trends in the histologic types of lung cancers during 1966-1985 by 5-year intervals were analyzed by using 4,419 cases in the National Cancer Center Hospital, Japan. Histologically confirmed cases increased to 76.6% in the last 5-year interval. The proportions of histological types in males have remained relatively unchanged; about 40% squamous cell carcinoma, one-third adenocarcinoma, and about 10% each of large cell carcinoma, small cell carcinoma and other types. In females, an increase of adenocarcinoma from 52% to 69.1% and a decrease of squamous cell carcinoma from 21% to 11.4% were noteworthy, and the other three types amounted to less than 10% each. These trends were compared with those obtained from the Annals of Pathological Autopsy Records in Japan during 1974-1983, which contained 26,844 lung cancer cases; the results were similar except for an increase of small cell carcinoma. The recent increase of small cell carcinoma was considered to be due to a change in diagnostic categorization, associated with a decreased rate of undifferentiated carcinoma. However, the increase of small cell carcinoma as well as adenocarcinoma in younger patients requires further study from both demographic and etiological viewpoints.