Isolation of Rhodococcus equi from the gastrointestinal contents of earthworms (family Megascolecidae)

Rhodococcus equi was isolated from the gastrointestinal contents of earthworms (family Megascolecidae) and their surrounding soil collected from pastures of two horse-breeding farms in Aomori Prefecture, outdoor pig pens, forest in Towada campus, orange groves and forest where wild boars (Sus scrofa) are established in Tanabe, Wakayama Prefecture. The number of R. equi in the lower gastrointestinal contents of 23 earthworms collected from our campus was significantly larger than that of the upper gastrointestinal content. The mean numbers of R. equi from the gastrointestinal contents of earthworms collected from the various places were 2·3-fold to 39·7-fold more than those of the surrounding soil samples. In all, 1771 isolates from the earthworms and 489 isolates from the soil samples were tested for the presence of vapA and vapB genes using polymerase chain reaction. At the horse-breeding farm N, 9 of the 109 isolates (8·3%) from the earthworms and 7 of the 106 isolates (6·6%) from the soil samples were positive for the vapA gene. At the University's forest, one of the 250 isolates (0·4%) from the gastrointestinal contents of the earthworm was positive for the vapB gene. These results revealed that R. equi can be found in significant quantities in the gastrointestinal contents of earthworms, suggesting that they act as an accumulator of R. equi in the soil environment and as a source or reservoir of animal infection.

Effects of dried natto diet on the transcript levels of the peroxisome proliferator-activated receptor-γ, coactivator-1α and -1β, and nuclear receptor corepressor 1 genes in laying hens

The effects of natto, a fermented soybean food, on transcript levels of hen peroxisome proliferator-activated receptor-γ (PPARG), PPARG coactivator-1α and -1β (PPARGC1A and PPARGC1B), and nuclear receptor corepressor 1 (NCOR1) were investigated using real-time polymerase chain reaction in white leghorn (Julia strain) hens. Twenty-one- and 34-week-old hens were fed a basic or 3% dried natto-supplemented diet for 8 weeks. In the 21- and 34-week-old hens fed the natto-supplemented diet, hepatic PPARGC1B and NCOR1 transcript levels and adipose and hepatic PPARG transcript levels were significantly lower, respectively, than those in the control group. Furthermore, 34- and 42-week-old hens were fed a basic diet supplemented with 3% of the protein/fiber-enriched fraction (PFB) or 0.6% of the fat-enriched fraction (FAT) of natto, respectively, for 8 weeks. Adipose PPARG transcript levels were higher in the FAT diet group and significantly lower in the PFB diet group than in the control group. However, both FAT and PFB diet groups showed significantly lower hepatic PPARG transcript levels than did the control group. These results suggest that dried natto influences the transcript levels of PPARG, PPARGC1B, and NCOR1, and the FAT and PFB of natto influence the adipose and hepatic PPARG transcript levels in hens.

Clinical significance of controlling nutritional status score for predicting short-term clinical events in takotsubo syndrome: a multicenter study

Background

The Controlling Nutritional Status (CONUT) score is well known as a marker of nutritional status. Previous studies have reported that CONUT score could predict a prognosis of acute or chronic heart failure, and infective endocarditis. Takotsubo syndrome (TTS) is said to have a relatively good prognosis, but some patients have a bad turning point in hospital stay. Lower systolic blood pressure on admission, history of diabetes mellitus, and β-blocker use before admission have been reported as predictors of in-hospital cardiac complications. However, the prognostic utility of CONUT score in TTS is unclear. The aim of study was to evaluate duration of hospital stay and short-term clinical events with CONUT score in TTS.

Methods

Seventy-nine TTS patients who were admitted to 3 medical centers in Japan between January 2011 and October 2019 were enrolled. The average age was 71.8±11.5 years old, and the prevalence of female sex was 81%. The CONUT score was calculated based on the serum albumin, total lymphocyte and total cholesterol on admission. We retrospectively investigated the association between the short-term clinical events and CONUT score. The duration of hospital stay was defined as the primely outcome, and all cause death and congestive heart failure in hospital stay as the secondary outcome.

Results

The average CONUT score was 3.7±3.0. A positive correlation was found between the CONUT score and the duration of hospital stay (r=0.56, p<0.01). Twenty (25.3%) patients suffered from clinical events (all cause death and congestive heart failure in hospital). Those patients with clinical events had significantly higher the CONUT score than those without (all cause death, 7.2±2.6 vs. 3.5±2.9, p<0.01, congestive heart failure, 5.3±3.4 vs. 3.3±2.8, p=0.02, composite clinical events, 5.8±3.2 vs. 3.0±2.6, p<0.01). ROC curve analysis revealed that the optimal cut-off value of the CONUT score for the prediction of composite clinical events was 4.0 (AUC: 0.75, sensitivity: 80%, Specificity: 64%). The patients with CONUT score of 4 or more (high COUNT score) were more prevalent in patients who experienced composite clinical events than in those who didn't (80% vs. 35.6%, p<0.01). The patients with a high CONUT score had a longer hospital stay and higher occurrence of composite clinical events than those with CONUT score less than 4 (respectively, 27.2±19.1 days vs. 13.8±8.3 days, p<0.01, 25.3% vs. 9.5%, p<0.01).

Conclusions

The CONUT score in TTS patients was strongly associated with the duration of hospital stay and clinical events in hospital. The CONUT score is a simple indicator that can be calculated with only three factors. Therefore, the CONUT score on admission may be useful for a predictor of short-term clinical events in TTS patients.

Funding Acknowledgement

Type of funding source: None

THU0155 SERUM MYOSTATIN IN PATIENTS WITH RHEUMATOID ARTHRITIS AND ITS CORRELATION WITH BODY COMPOSITIONS

Background:

Altered body composition is one of common findings in rheumatoid arthritis (RA), and it is estimated that up to two-thirds of patients may be affected loss of muscle mass and strength and concomitant increase in fat mass, so-called “rheumatoid cachexia”. Despite great advances in the treatment of RA such as biologics and small molecule compounds, it appears that rheumatoid cachexia persists even after joint inflammation improves. Myostatin, a member of the transforming growth factor-beta superfamily, is a potent negative regulator of skeletal muscle growth and its inactivation can induce skeletal muscle hypertrophy, while its overexpression or systemic administration causes muscle atrophy. It enhances proteolysis and inhibits protein synthesis in skeletal muscle, and has generated increasing interest as a potential regulator of cachexic status such as patients with cancers, cardiac failure, and HIV infections.

Objectives:

In this study, we investigated the possible role of myostatin for altered body compositions in patients with RA.

Methods:

This was a cross-sectional study. Ninety-six RA patients who visited Niigata University Hospital between April to June 2017, were recruited in this study. Body composition was measured by bioelectrical impedance analysis with a tetrapolar impedance meter (InBody S-10, InBody Japan Inc, Tokyo, Japan) in each subject. The right femoral neck bone density was measured using the dual energy X-ray absorption method (DEXA). Serum myostatin level was measured by enzyme-linked immunosorbent assay with a commercially available kit (Quantikine ELISA GDF-8/ Myostatin Immunoassay, R&D systems, MN, USA). Patients’ laboratory findings and disease activities were also measured, and the correlations between the titer of serum myostatin and these factors were analyzed by Spearman’s correlation coefficient and stepwise multiple regression analysis. A p-value of <0.05 was taken to denote statistical significance.

Results:

In Spearman’s correlation coefficient analysis, serum myostatin level was positively correlated with skeletal muscle mass index and FFMI, and negatively correlated with percent body fat (%BF), fat mass index (FMI), right femoral neck bone density, swollen joint counts, ESR, and DAS28(4)-ESR. In stepwise multiple regression analysis, FFMI was selected as a positive independent variable (rho=0.3620, p=0.00019) and DAS28(4)-ESR as a negative independent variable (rho=-0.2298, p=0.0154) against serum myostatin levels, respectively. In 70 female patients in this study, %BF and FMI/FFMI ratio was significantly higher in patients with low FFMI group, compared to those with normal FFMI group.

Conclusion:

Serum myostatin level was significantly correlated with body composition and disease activity in patients with RA. Patients with lower level of myostatin showed a trend of decreased skeletal muscle and increased body fat, suggesting serum myostatin as a possible biomarker for rheumatoid cachexia.

References:

[1]Elkan A-C, et al. Arthritis Res Therapy 2009; 11: R37.

[2]Lemmey AB, et al. Rheumatology 2016; 55: 1736-45.

[3]Rodriguez J, et al. Cell Mol Life Sci 2014; 71: 4361-71.

Disclosure of Interests:

None declared

AB0539 URINARY INFLAMMATORY CELL ANALYSIS REFLECTS THE RENAL HISTOPATHOLOGY IN ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS

Background:

The anti-neutrophil cytoplasmic autoantibody (ANCA)- associated vasculitides (AAVs) include microscopic polyangiitis (MPA), granulomatosis with polyangitis (GPA), and eosinophilic granulomatosis with polyangitis (EGPA). These small-vessel vasculitides are characterized by necrotizing inflammation of the vessel wall, particularly affecting small arteries, arterioles, and capillaries in systemic organs, and the kidney is one of the most frequently involved organs. Although kidney biopsy is necessary for deciding the therapeutic protocol, it is invasive and is sometimes hard to perform biopsy because of patient’s severe general condition. We have already reported that T cells and macrophages appear in the urine of patients with glomerulonephritis, accompanied by active cellular infiltration such as cellular crescent formation and diffuse interstitial cell infiltration, but not in the urine of patients with glomerulonephritis without the active inflammatory lesions.

Objectives:

In this study, we examined the utility of urinary inflammatory cell analysis for accessing kidney histopathological findings in AAVs.

Methods:

This was a cross-sectional, retrospective chart study. Thirty-six AAV patients who had been referred to Niigata University Hospital between 2002 and 2018, and performed percutaneous kidney biopsy and urinary inflammatory cell analysis, were participated in this study. Thirty-two patients had MPA, and 4 had GPA. The kidney biopsy findings were classified into Berden’s classification (a method to categorize glomerular lesions into four classes) and Neumann’s classification (a method to evaluate glomerular, tubulo-interstitial, and vascular lesions by using activity indexes and chronicity indexes). Flow-cytometric analysis of urinary inflammatory cells was performed for each subject. Numbers of urinary T cells or macrophages were determined by multiplying the number of viable cells in the gated mononuclear cell region in each sample by the percentage of urinary CD3-positive or CD14-positive cells in the population, respectively. The correlations between the results of both methods and the numbers of urinary inflammatory cells were examined using Kruskal-Wallis test and Spearmann’s rank correlation coefficient. A p-value of <0.05 was taken to denote statistical significance.

Results:

The numbers of urinary inflammatory cells showed a trend of increase in crescentic category without statistical significance in Berden’s classification. Meanwhile, activity indexes had significant positive correlations with the number of urinary CD3-positive cells (r = 0.541, p = <0.001), CD14-positive cells (r = 0.354, p = 0.034), and total inflammatory cells (r = 0.449, p = 0.006) in Neumann’s classification.

Conclusion:

The numbers of urinary inflammatory cells reflect the active lesions of kidney histopathological findings, and these results indicate the usefulness of urinary inflammatory cell analysis for assessment of kidney biopsy findings in patients with AAVs.

References:

[1]Berden AE, et al. J Am Soc Nephrol. 2010 Oct;21(10):1628-36. 2) Neumann I, et al. Nephrol Dial Transplant. 2005 Jan;20(1):96-104.

Disclosure of Interests:

None declared

P1828Aortic calcification detected by computed tomography and aortic vulnerable plaques: aortic angioscopy study

Background

Aortic calcification is associated with atherosclerotic risk factors and an increased risk of death and cardiovascular disease. However, the relationships aortic calcification and aortic plaque instability are not yet elucidated. Recently, some reports showed non-obstructive aortic angioscopy seemed to visualize atherosclerotic changes of aortic wall more clearly compared with computed tomography (CT). The purpose of this study was to evaluate whether aortic calcification is associated with aortic vulnerable plaques in patients with cardiovascular disease.

Methods

We investigated 60 consecutive patients with confirmed or suspected coronary artery disease who underwent both aortic angioscopy and CT. The AC volume (ACV) was measured using the volume-rendering method by extracting the area >130 HU within the whole aorta. ACV index (ACVI) was defined as ACV divided by the body surface area. We evaluated the number of ruptured plaque (RP), ulceration and fissure by aortic angioscopy in the whole aorta. We excluded 4 hemodialysis patients. All patients were divided into the median value of ACVI.

Results

The mean age of patients was 68±10. The median of ACVI was 10.7 ml/m2 [3.9–22.7]. High ACVI patients had significantly greater number of RP, ulceration and atheromatous plaques detected by aortic angioscopy compared with those of low ACVI (2.2±2.7 vs 0.8±1.1, p=0.033, 1.6±1.2 vs 0.9±1.0, p=0.041, 4.0±3.1 vs 1.9±1.8, p=0.009, respectively). Furthermore, the patients without aortic calcification did not have RP at all. In a multivariate model, the number of the atheromatous plaques was independently associated with high ACVI (odds ratio 1.57, 95% confidence interval 1.07–2.69, p=0.018)

Conclusions

Aortic calcification detected by CT was related to aortic vulnerable plaques in patients with cardiovascular disease.

6125High wall shear stress predicts plaque rupture of the aortic arch: computational fluid dynamics model and non-obstructive general angioscopy study

Background

Wall shear stress (WSS) has been considered as a major determinant of aortic atherosclerosis. Recently, non-obstructive general angioscopy (NOGA) was developed to be able to visualize a variety of its atherosclerotic pathology, including in vivo ruptured plaque (RP) in the aorta. We, therefore, investigated the relationship between NOGA derived RP in the aortic arch and the stereographic distribution of WSS by using computational fluid dynamics modeling (CFD) on three-dimensional CT angiography (3D-CT).

Methods

We investigated 30 consecutive patients who underwent 3D-CT before and NOGA during coronary angiography. WSS in the aortic arch was measured with an application of CFD based on finite element method by using uniform inlet and outlet flow conditions. Aortic RP was detected by NOGA.

Results

The maximum and mean values of WSS were 67.2±29.2 Pa and 2.4±0.6 Pa. A total of 18 RPs was detected by NOGA. The patients with a distinct RP showed a significantly higher maximum WSS in the whole aortic arch, and the greater and lesser curvature of the aortic arch than those without it (73.3±29.0 Pa vs 50.4±15.2 Pa, p=0.035, 95.0±27.5 Pa vs 42.8±25.2 Pa, p=0.003, 70.8±29.3 Pa vs 46.1±11.9 Pa, p=0.013, respectively), whereas there was no significant difference in the mean WSS between those with and without it. In a multivariate analysis, the maximum value of WSS was an independent predictor of RP in the aortic arch (odds ratio 1.05, 95% confidence interval 1.01–1.13, p=0.019).

Representative picture of WSS and NOGA

Conclusions

Aortic RP detected by NOGA was strongly associated with the higher maximum WSS in the aortic arch derived by CFD using 3D-CT. Maximum WSS may explain the underlying mechanism of not only aortic atherosclerosis, but also aortic RP.

Joint Effect of Solar UVB and Heat Stress on the Seasonal Change of Egg Hatching Success in the Herbivorous False Spider Mite (Acari: Tenuipalpidae)

Seasonal population dynamics of an herbivorous mite has been documented in terms of the relationship between thermoresponses and temporal biological factors such as resource availability or predation risk. Although recent studies emphasize the deleterious effects of solar ultraviolet-B (UVB; 280-320 nm wavelengths) radiation on plant-dwelling mites, how UVB affects mite population remains largely unknown. On a wild shrub Viburnum erosum var. punctatum in Kyoto, an herbivorous false spider mite, Brevipalpus obovatus Donnadieu, occurs only in autumn. Females of this species lay one-third of their eggs on upper leaf surfaces. Oviposition on upper surfaces is beneficial for avoiding predation by phytoseiids, but exposes eggs to solar UVB and heat stress. To test the hypothesis that the seasonal occurrence of this mite is determined by interactions between solar UVB radiation and temperature, we examined variation in egg hatching success under near-ambient and UV-attenuated sunlight conditions from spring to autumn. The UV-attenuation significantly improved hatching success. However, most eggs died under heat stress regardless of UV treatments in July and August. We established a deterministic heat stress-cumulative UVB dose-egg hatching success response model, which we applied to meteorological data. The model analyses illustrated lower and higher survivability peaks in late May and October, respectively, which partly corresponded to data for annual field occurrence, indicating the importance of solar UVB radiation and heat stress as determinants of the seasonal occurrence of this mite.

KPT-330 has antitumour activity against non-small cell lung cancer

BACKGROUND

We investigated the biologic and pharmacologic activities of a chromosome region maintenance 1 (CRM1) inhibitor against human non-small cell lung cancer (NSCLC) cells both in vitro and in vivo.

METHODS

The in vitro and in vivo effects of a novel CRM1 inhibitor (KPT-330) for a large number of anticancer parameters were evaluated using a large panel of 11 NSCLC cell lines containing different key driver mutations. Mice bearing human NSCLC xenografts were treated with KPT-330, and tumour growth was assessed.

RESULTS

KPT-330 inhibited proliferation and induced cell cycle arrest and apoptosis-related proteins in 11 NSCLC cells lines. Moreover, the combination of KPT-330 with cisplatin synergistically enhanced the cell kill of the NSCLC cells in vitro. Human NSCLC tumours growing in immunodeficient mice were markedly inhibited by KPT-330. Also, KPT-330 was effective even against NSCLC cells with a transforming mutation of either exon 20 of EGFR, TP53, phosphatase and tensin homologue, RAS or PIK3CA, suggesting the drug might be effective against a variety of lung cancers irrespective of their driver mutation.

CONCLUSIONS

Our results support clinical testing of KPT-330 as a novel therapeutic strategy for NSCLC.

[Carcinomatous pericarditis successfully treated with thoracoscopic pericardial fenestration; report of a case]

We report a case of malignant pericardial effusion after lung cancer surgery treated with thoracoscopic pericardial fenestration. The patient was admitted to our hospital because of dyspnea. Computed tomography (CT) and ultrasound cardiography (UCG) revealed cardiac tamponade which was diagnosed as carcinomatous pericarditis by cytology. We attempted to inject 25 mg of cisplatin (CDDP) into the pericardial space twice. The response of the treatment was unexpectedly poor for the patient. The thoracoscopic pericardial fenestration was performed and the patient was discharged without a drainage tube on the 17th postoperative day. Malignant pericardial effusion is a common complication of advanced cancers and is often associated with significant morbidity. Thoracoscopic pericardial fenestration appears to be a safe, effective and minimally invasive treatment for patients with malignant pericardial effusion. This surgery might also have a favorable effect on the improvement of the quality of life for patients with malignant pericardial effusion resistant to chemotherapy.

Long-term fluctuation and regional variation of nutrient loads from the atmosphere to lakes

The atmospheric depositions were collected by ordinary bulk-samplers mounted with a glass or polyethylene funnel of 30 cm orifice. A long-term observation was carried out at a site (35 degrees 01'30"N, 135 degrees 58'07"E) in the urbanized area for 21 years since 1974. The annual volume-weighted average concentrations of total nitrogen (TN) and phosphorus (TP) were 1.02 +/- 0.30 and 0.031 +/- 0.015 mg(-1), respectively, and the loading rates were 14.5 +/- 2.8 and 0.43 +/- 0.16 kg ha(-1) yr(-1). The rates neither had a relationship with the precipitation (1,492 +/- 343 mm yr(-1)) nor showed any diachronic tendencies. In order to obtain the loading rate of TN and TP within 10% uncertainty under the significant level of 0.01, there is no way but to continue the observation for seven and eleven years or more, respectively. In order to clarify the regional variation of the loading amounts of the depositions, the samplers were set at 12 sites distributing throughout the Kinki District for two years. The distance from northernmost (2322 mm yr(-1)) to southernmost (1242 mm yr(-1)) is about 150 km. The average loading rates of the 12 sites were 16.2 +/- 2.5 kg ha(-1) yr(-1) of TN and 0.730 +/- 0.247 kg ha(-1) yr(-1) of TP. The depositions of NO3-N, NH4-N, and TN as well as TP showed tendencies with distances neither from a big city nor from Japan Sea.

Decrease in herbicide concentrations and affected factors in lagoons located around Lake Biwa

The contamination levels and changes in the concentrations in four lagoons around Lake Biwa of paddy-use herbicide were studied. Four lagoons, Sone-numa (52 days of HRT (hydraulic residence time) estimated from the lagoon volume and the average discharge at the outlet, 21 ha area), Yanagihira-ko (40 days, 5.0 ha), Noda-numa (11 days, 6.0 ha), and Iba-naiko (2 days, 55.5 ha), were selected as monitoring sites. Intensive water sampling was carried out once a week from May to June at the outlet of each lagoon. Although twelve of the monitored herbicides were detected, the maximum concentrations did not exceed the guidelines for water-supply law in Japan. The relation between half-lives in herbicide concentrations and characteristics of a lagoon such as HRT and chlorophyll-a concentrations were examined. The shorter half-lives of herbicide concentrations in lagoons with shorter HRT means that replacement by influent water effectively decreased the pesticide concentrations. Shorter half-lives in lagoons with high chlorophyll-a concentrations between the lagoons with similar HRT suggest that biological degradation during the residence time worked more efficiently in the lagoon with high chlorophyll-a concentrations.

[Thoracoscopic lung biopsy in the diagnosis of diffuse lung disease]

The diagnosis of diffuse lung disease can only be made accurately by performing a thoracoscopic lung biopsy. We evaluated the safety and efficacy of thoracoscopic lung biopsy in diffuse lung disease. Between May 1999 and April 2003, 34 patients were referred to us for thoracoscopic lung biopsy. We compared the clinical characteristics, number of biopsies, operation times, postoperative course, complications, and mortality in 19 patients with dyspnea and 15 patients who were asymptomatic. Although the number of biopsies, operation times, duration of chest drainage, and postoperative stay did not differ significantly between the 2 groups, postoperative oxygen support was needed for significantly longer in the dyspnea group (p =0.038). A pathological diagnosis was established in all patients. Postoperative complications developed in 4 patients. A prolonged air leak in 1 patient and a wound infection in another resolved conservatively, but 2 patients died of acute exacerbation. Thus, we conclude that the indications for surgery must be carefully considered in dyspneic patients with diffuse lung to prevent acute exacerbation.

Unusual hypersensitivity to warfarin in a critically ill patient

A patient was admitted to the intensive care unit because of respiratory failure, and warfarin therapy was started at 2 mg/day for the treatment of pulmonary embolism, together with other medications. Despite the low dosage of warfarin, international normalized ratio (INR) was markedly elevated from 1.15 to 11.28 for only 4 days, and bleeding symptoms concurrently developed. Vitamin K2 was infused along with discontinuation of warfarin. One day later, the INR was found to have decreased, and bleeding was also improved. An objective causality assessment indicated a probable relationship between clotting abnormality and warfarin administration, although the degree of elevation of the INR was unusual in the light of the daily warfarin dose and duration of its exposure. Based on the clinical status of the patient, it was suspected that several conditions contributed to the abnormal hypersensitivity to warfarin. Contributory factors probably included pharmacokinetic interactions with co-administrated drugs, vitamin K deficiency caused by decreased dietary intake, reduced gut bacterial production, impaired intestinal absorption and hepatic synthetic capacity, and increased consumption of clotting factors. In view of our experience in the present case, it should be stressed that close monitoring of coagulation capacity is necessary in critically ill patients in order to avoid fatal haemorrhage after initiating warfarin therapy regardless of the dosage.

Night-time restricted feeding normalises clock genes and Pai-1 gene expression in the db/db mouse liver

AIMS/HYPOTHESIS

An increase in PAI-1 activity is thought to be a key factor underlying myocardial infarction. Mouse Pai-1 (mPai-1) activity shows a daily rhythm in vivo, and its transcription seems to be controlled not only by clock genes but also by humoral factors such as insulin and triglycerides. Thus, we investigated daily clock genes and mPai-1 mRNA expression in the liver of db/db mice exhibiting high levels of glucose, insulin and triglycerides.

METHODS

Locomotor activity was measured using an infrared detection system. RT-PCR or in situ hybridisation methods were applied to measure gene expression. Humoral factors were measured using measurement kits.

RESULTS

The db/ db mice showed attenuated locomotor activity rhythms. The rhythmic expression of mPer2 mRNA was severely diminished and the phase of mBmal1 oscillation was advanced in the db/db mouse liver, whereas mPai-1 mRNA was highly and constitutively expressed. Night-time restricted feeding led to a recovery not only from the diminished locomotor activity, but also from the diminished Per2 and advanced mBmal1 mRNA rhythms. Expression of mPai-1 mRNA in db/db mice was reduced to levels far below normal. Pioglitazone treatment slightly normalised glucose and insulin levels, with a slight reduction in mPai-1 gene expression.

CONCLUSIONS/INTERPRETATION

We demonstrated that Type 2 diabetes impairs the oscillation of the peripheral oscillator. Night-time restricted feeding rather than pioglitazone injection led to a recovery from the diminished locomotor activity, and altered oscillation of the peripheral clock and mPai-1 mRNA rhythm. Thus, we conclude that scheduled restricted food intake may be a useful form of treatment for diabetes.

[Negative pleural cytology after intrapleural perfusion hyperthermo-chemotherapy for malignant pleural effusion]

We gave intrapleural perfusion hyperthermo-chemotherapy to a 72-year-old woman in whom malignant pleural effusion developed after surgery for primary cancer. This procedure involved irrigating the pleural space for 2 hours with a water solution at 42-43 degrees containing 240 mg cisplatin using specially devised extracorporeal circuits. Thoracoscopy was used to examine the intrapleural cavity and to place the catheters for perfusion. The patient had an uneventful postoperative course and was discharged for hospital on the second postoperative day. Thereafter, she experienced good quality of life with negative pleural cytology. Unfortunately, the patient died 3 months after the therapy, but the cause of death was unknown and there was no cancer recurrence. This technique may be safe and feasible for controlling malignant effusion to preserve quality of life, although the survival benefit has not yet been clarified.

Constant light housing attenuates circadian rhythms of mPer2 mRNA AND mPER2 protein expression in the suprachiasmatic nucleus of mice

Constant light (LL) or constant dark (DD) environmental lighting conditions cause a free-running period and activity reduction in the rodent behavioral circadian rhythm. In order to understand the molecular process underlying behavioral rhythms in LL or DD housing conditions, we examined the circadian profile of mPer2 mRNA and mPER2 in the suprachiasmatic nucleus (SCN), a main oscillator, of free-running mice. The circadian expression rhythm of mPer2 in the SCN was dampened under 7-day LL conditions, whereas that of mPER2 protein was moderately attenuated and its expression peak delayed. The circadian expression of mPer2 and its product was slightly attenuated and advanced by 7-day DD conditions. With arrhythmic behavioral activity caused by long-term LL housing, mPER2 protein lost its rhythmicity in the SCN. On the other hand, LL or DD housing did not affect the mPer2 gene and its product in the cerebral cortex. The present results suggest that mPER2 circadian expression in the SCN corresponds well with behavioral circadian oscillation under LL or DD conditions. Thus, the behavioral circadian rhythm seems to correlate with molecular clock works in the SCN.

[Subjective criteria of chest CT findings for predicting pathological features and postoperative outcomes of small peripheral lung cancer (< or = 2 cm)]

One hundred fifty five patients with completely resected peripheral non-small cell lung cancer, clinically diagnosed 2 cm or less in diameter, are retrospectively reviewed on their preoperative chest CT films, clinico-pathological features, and postoperative outcomes. Pathologic type was classified according to Noguchi's classification. 7% and 8% of all the patients had pathologic N 1 and N 2 diseases, respectively. 19% of all the patients undergone limited resection (segmentectomy or partial resection). Maximum area of the tumor/soft tissue density area of the tumor (M/S ratio) was manually measured by chest CT film. According to the logistic regression analysis, M/S ratio was the only predicting factor of regional lymph node metastasis among factors including pleural indentation, spiculation, and maximum area of the tumor. Univariate analysis showed that maximum area of the tumor, pleural indentation, and M/S ratio were the significant factor for postoperative disease free survival. According to multivariate analysis of postoperative disease free survival with adjustment for operative modality, the result was same as that of univariate analysis. In conclusion, our determined criteria of the chest CT accurately predicted pathological status and postoperative outcome of patients with small peripheral lung cancer. These factors would be useful for stratification factor of prospective clinical study.

Surgically treated primary lung cancer associated with Brugada syndrome: report of a case

A 71-year-old man with primary lung cancer associated with Brugada syndrome was safely operated on following the placement of an implantable cardioverter defibrillator (ICD). During examinations for Brugada syndrome, a tumor in the apicoposterior segment of the left lung was incidentally detected by chest computed tomography. Following the implantation of an ICD, surgical treatment of the left lung tumor was scheduled. A lung biopsy was thoracoscopically performed and adenocarcinoma was diagnosed based on a frozen section analysis. A left upper lobectomy with lymph node dissection was performed through a standard posterolateral thoracotomy. Ventricular fibrillation, which occurred during the night of the first day following surgery, was successfully managed by the ICD.

Propofol activates vanilloid receptor channels expressed in human embryonic kidney 293 cells

Propofol (2,6-diisopropylphenol) is an intravenous anesthetic agent structurally unrelated to any other intravenous anesthetics. We examined the effect of propofol on a rat vanilloid receptor that was expressed in the human embryonic kidney (HEK) 293 cells by using calcium imaging method. Propofol caused a concentration-dependent increase in [Ca(2+)](i) in the HEK293 cells with the receptor. These responses were inhibited by removing extracellular calcium ions. The propofol-evoked increase in [Ca(2+)](i) in the HEK293 cells with the receptor was partially inhibited by capsazepine, a competitive antagonist of capsaicin. We conclude that propofol acts as an agonist for the receptor.

(1)H nuclear magnetic resonance spectroscopic analysis for determination of glucuronic and iduronic acids in dermatan sulfate, heparin, and heparan sulfate

(1)H NMR spectroscopy has been established for the determination of uronate residues in glycosaminoglycans (GAGs) such as dermatan sulfate (DS), heparin (HP), and heparan sulfate (HS). Because of variation in the sulfonation positions in DS, HP, or HS, interpretation of spectra is difficult. Solvolysis was applied to remove O-sulfo groups from these GAG chains in dimethyl sulfoxide containing 10% methanol at 80 degrees C for 5 h. In the cases of HP and HS, N-sulfo groups on glucosamine residues were also removed under the same conditions. The resulting unsubstituted amino groups in HP and HS chains were re-N-acetylated using acetic anhydride to obtain homogeneous core structure with the exception of the variation of uronate residues. The contents of glucuronate and iduronate residues in the chemically modified DS, HP, and HS samples were analyzed by 600-MHz (1)H NMR spectroscopy. These methods were applied to compositional analysis of uronate residues in GAGs isolated from various sources.

Variable effects of nitrous oxide at multiple levels of the central nervous system in goats

The direct and indirect effects of nitrous oxide (N2O) on the nociceptive responses of lumbar dorsal horn neurons, and the indirect effects on midbrain reticular formation (MRF) neurons and thalamic neurons were determined in goats anaesthetized with isoflurane. The technique used enabled the differential delivery of N2O to either the torso or the cerebral circulation, thus allowing assessment of the direct spinal and indirect brain effects of N2O. Systemic delivery of N2O appeared to have divergent effects, facilitating (4/11) or depressing (7/11) the responses of dorsal horn neurons. Such divergent effects were also observed when N2O was differentially delivered to the circulation in the torso (i.e. the spinal cord). Likewise, MRF and thalamic responses to noxious stimulation were variably affected by administration of N2O to the torso, with some cells facilitated (7/13 MRF neurons, 3/8 thalamic neurons) and others depressed (6/13 MRF neurons, 5/8 thalamic neurons). It appears that N2O has variable effects on the caprine CNS. The facilitatory action of N2O might partially explain why it is a relatively weak anaesthetic.

Involvement of thioredoxin in the regulation of growth hormone secretion in rat pituitary cell cultures

We report here an examination of the effect of thioredoxin (TRX) on the secretion of growth hormone (GH) from rat anterior pituitary cells in vitro. Treatment of rat pituitary cells with growth hormone-releasing factor (GRF), but not GH, led to a significant increase in intracellular TRX protein levels. GRF, recombinant human TRX (rhTRX), and a combination thereof were all shown to induce immediate GH secretion from pituitary cells, as evidenced by perifusion experiments. RhTRX, but not other reducing agents such as beta-mercaptoethanol and N-acetyl-L-cysteine, augmented GRF-stimulated and -unstimulated GH secretion from rat pituitary cells in a dose-dependent manner. RhTRX did not significantly affect the GH mRNA expression of pituitary cells stimulated in the presence or absence of GRF. In addition, rhTRX-augmented GH secretion was not significantly affected by the presence of cycloheximide. Collectively, these findings suggest that TRX is induced by stimulation with GRF and plays a regulatory role in GH secretion from rat anterior pituitary cells by enhancing the secretion of stored GH, rather than by the synthesis of GH.

Thiopental directly depresses lumbar dorsal horn neuronal responses to noxious mechanical stimulation in goats

BACKGROUND

Thiopental has hypnotic actions in the brain, but it also depresses nociceptive transmission. In this study we examined whether thiopental had direct (spinal) and/or indirect (supraspinal) effects on the responses of single lumbar dorsal horn neurons to noxious mechanical stimulation, using a method to deliver thiopental differentially to either the torso or cranial circulation in goats.

METHODS

Goats (n=10) were anesthetized with isoflurane and neck dissections performed to permit cranial bypass. A lumbar laminectomy was made to permit single-unit recording of lumbar dorsal horn neuronal activity (1-2 neurons/animal). Isoflurane was maintained at 0.8+/-0.1% to both head and torso throughout the study. During cranial bypass, thiopental was separately administered to the torso (low dose, 1.5+/-0.5 mg/kg; high dose, 3.7+/-0.5 mg/kg) or cranial (low dose, 0.12+/-0.03 mg/kg; high dose, 0.2 mg/kg) circulation.

RESULTS

Thiopental administered to the torso significantly depressed dorsal horn neuronal responses to noxious stimulation at the high dose: 757+/-471 to 392+/-305 impulses/min at 1 min post-injection, P<0.006 (n=14); evoked responses recovered at 5 min post-injection. At the low dose, there was a similar numerical decrease, but this did not reach significance: 876+/-780 to 407+/-499 impulses/min at 1 min post-injection, P>0.05 (n=6). No significant change was observed when thiopental was administered to the cranial circulation: low dose, 1061+/-1167 to 965+/-874 impulses/min at 1 min post-injection, P>0.05 (n=10); high dose, 864+/-331 to 917+/-525 impulses/min at 1 min post-injection, P>0.05 (n=8).

CONCLUSION

Thiopental has a direct (spinal) depressant effect on dorsal neuronal responses to noxious stimulus, but no significant supraspinal effect.

Glia-synapse interaction through Ca2+-permeable AMPA receptors in Bergmann glia

Glial cells express a variety of neurotransmitter receptors. Notably, Bergmann glial cells in the cerebellum have Ca2+-permeable alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-type glutamate receptors (AMPARs) assembled without the GluR2 subunit. To elucidate the role of these Ca2+-permeable AMPARs, we converted them into Ca2+-impermeable receptors by adenoviral-mediated delivery of the GluR2 gene. This conversion retracted the glial processes ensheathing synapses on Purkinje cell dendritic spines and retarded the removal of synaptically released glutamate. Furthermore, it caused multiple innervation of Purkinje cells by the climbing fibers. Thus, the glial Ca2+-permeable AMPARs are indispensable for proper structural and functional relations between Bergmann glia and glutamatergic synapses.

[Successful management of a patient who developed intra-operative pulmonary tumor embolism]

A 68-year-old female with retroperitoneal tumor extending into the inferior vena cava (IVC) developed massive pulmonary tumor embolism during removal of the tumor. Because of her unstable hemodynamics, emergency pulmonary embolectomy under cardiopulmonary bypass was performed. Successful management of her intra- and post-operative persistent right heart failure led to a satisfactory postoperative course without serious neurological complications. In peri-operative management of a patient with an extended tumor into IVC, prevention of the embolism, detection of the pulmonary embolism and treatment of intra- and post-operative right heart failure are important.

[Assessment of stage IIB lung cancer from the pathological factors]

In our experience, the prognosis of patients with pathological T3N0M0 lung cancer is generally poor, the 5-year survival rate being almost the same as that of patients with stage IIIA disease. Thus, we assessed patients with stage IIB disease by examining the pathological factors, lymphatic invasion, vessel invasion, histological type, differentiation, tumor size, and node dissection. Lymphatic invasion was found to be positive in 20 of 21 cases, patients with T3N0M0 lung cancer, and all of those with positive vessel invasion had a significantly poor prognosis. This indicates that positive lymphatic and vessel invasion could be a prognostic factor predicting a poor outcome. Patients with T3N0M0 lung cancer that are found to have this poor prognostic factor may not be diagnosed as having stage IIB disease.

Neurotoxicity induced by a single oral dose of aniline in rats

The neurotoxicity of aniline and its age-dependent responses were investigated in male rats. Groups of 6 rats, 4-week-old, were treated once with aniline (500, 750 or 1,000 mg/kg) or olive oil by gavage. Additional groups of 6 rats, 7- or 10-week-old, were treated once with 800 mg/kg of aniline or olive oil. Paralytic gait or hindlimb paralysis was observed between post-treatment days 8 and 15 in two out of six rats receiving 1,000 mg/kg of aniline at 4 weeks of age. On post-treatment day 15, spongy change in the white matter of the spinal cord was observed in all rats receiving 750 or 1,000 mg/kg of aniline at 4 weeks of age. The lateral and ventral columns of the thoracic spinal cord were the most severely affected. Spongy change in the facial nerve and spinal trigeminal tracts of pons and medulla oblongata, and mild degeneration of the peripheral nerves was found in 3 out of 6 rats receiving 1,000 mg/kg of aniline. At the ultrastructural level, the spongy change was due to distention of the myelin sheath and splitting of the intraperiod line. Axons were well preserved in the affected nerve fibers. No abnormalities were seen in the neuronal cell bodies. Although transient cyanosis was observed in all rats receiving 800 mg/kg of aniline at 7- or 10-week-old, as well as in rats receiving 750 or 1,000 mg/kg of aniline at 4-week-old, no treatment-related neurobehavioral or morphologic abnormalities were found in the former. These findings demonstrate the neurotoxicity of orally administered aniline for rats, depending upon the age of the animal at the time of administration.

Differential daily expression of Per1 and Per2 mRNA in the suprachiasmatic nucleus of fetal and early postnatal mice

It is well known that there are circadian rhythms of 2-deoxyglucose uptake and neuronal firing in the rat suprachiasmatic nucleus (SCN) during fetal and early postnatal periods. A core clock mechanism in the mouse SCN appears to involve a transcriptional feedback loop in which CLOCK and BMAL1 function as positive regulators and three mPeriod (mPer) genes play a role in negative feedback. Per genes expression occurs not only in the adult SCN but also in the fetal SCN. However, the developmental change in these genes remains unclear. In this experiment, we examined the day--night pattern of expression of Per1 and Per2 mRNA in the mouse SCN and cerebral cortex on embryonic day 17, postnatal day 3, and in young adult mice under a light-dark cycle. Daily rhythms of mRNA content were observed in mPer1 but not mPer2 in the fetal SCN. Interestingly, the expression of mPer2 in the SCN was high throughout the entire day, and a significant daily rhythm of this gene was observed on postnatal day 6. The expression pattern of SCN mPer1 in constant darkness was similar to that seen in the light-dark cycle. The present results suggest that the daily oscillation of mPer1 but not of mPer2 in the SCN in fetal and early postnatal mice may be associated with the daily rhythms of 2-deoxyglucose uptake and neuronal firing.

Comparison of nutrient budgets between three forested mountain watersheds on granite bedrock

The budgets of nutrients and major ions between the input flux from atmospheric deposition and the output flux to streams were measured on three forested small mountain watersheds, Aburahi-N (23.8 ha), Aburahi-S (3.8 ha, 2 km south from Aburahi-N) and Myokoji (1.77 ha, 28 km northwest from Aburahi-N), located at 34-35 N and 136 E around the central part of Japan. The bedrock of the watersheds is granite. The main vegetation of Aburahi-N and Aburahi-S was planted with Japanese cypress (Chamaecyparis obtusa Sieb. et Zucc), and Myokoji was a secondary forest growing deciduous broadleaf trees and Japanese red pine. The chemical analysis of the stream waters was carried out once a week at Aburahi-N from 1987 to 1991, at Aburahi-S from 1995 to 1998, and at Myokoji from 1991 to 1993. Wet and dry depositions were collected every month at Aburahi-N. The annual mean concentrations of total nitrogen (TN) of the stream water of Aburahi-N, Aburahi-S and Myokoji were 0.408, 0.614 and 0.349 mg/l, respectively, total phosphorus (TP) contents were 0.0074, 0.0046 and 0.0096 mg/l, and the potassium ion (K+) contents were 0.83, 0.49 and 0.77 mg/l. The average annual output fluxes of TN from the watersheds of Aburahi-N, Aburahi-S and Myokoji were calculated to be 5.85, 4.10 and 12.7 kg/ha/y, TP 0.131, 0.045 and 0.280 kg/ha/y, K+ 9.63, 3.23 and 9.70 kg/ha/y, and discharge 1062, 508 and 1265 mm/y, respectively. The annual outputs tended to increase as the annual precipitation increased. The average annual input fluxes of TN, TP and K+ for six years from 1990-1998 were 12.5, 1.31 and 7.64 kg/ha/y, respectively, and the precipitation averaged 1449 (1019-1947) mm/y.

The comparative effects of propofol versus thiopental on middle cerebral artery blood flow velocity during electroconvulsive therapy

Electroconvulsive therapy provokes abrupt changes in both systemic and cerebral hemodynamics. An anesthetic that has a minor effect on cerebral hemodynamics might be more suitable for patients with intracranial complications, such as cerebral aneurysm. The purpose of our present study was to compare the effects of thiopental and propofol on cerebral blood flow velocity. We continuously compared cerebral blood flow velocity at the middle cerebral artery (MCA) during electroconvulsive therapy, using propofol (1 mg/kg, n = 20) versus thiopental (2 mg/kg, n = 20) anesthesia. Systemic hemodynamic variables and flow velocity at the MCA were measured until 10 min after the electrical shock. Heart rate and arterial blood pressure increased in the thiopental group until 5 min after the electrical shock. In the propofol group, an increase in mean blood pressure was observed to 1 min after the electrical shock. Mean flow velocity at the MCA decreased after anesthesia in both groups, and increased at 0.5-3 min after the electrical shock in the thiopental group and at 0.5 and 1 min after the shock in the propofol group. The flow velocities at 0.5-5 min after the electrical shock were significantly more rapid in the thiopental group compared with the propofol group. ¿abs¿

IMPLICATIONS

Cerebral blood flow velocity change, measured by transcranial Doppler sonography during electroconvulsive therapy, was minor using propofol anesthesia compared with barbiturate anesthesia. Propofol anesthesia may be suitable for patients who cannot tolerate abrupt cerebral hemodynamic change.

Neonatal mature teratoma of the sphenoidal sinus: a case report

Teratoma in the head and neck region is very rare. We treated a child with a mature congenital teratoma that arose from the right sphenoidal sinus. He is doing well after early surgical treatment with endoscopic endonasal resection of the tumor.

Isoflurane depresses electroencephalographic and medial thalamic responses to noxious stimulation via an indirect spinal action

Anesthetics such as isoflurane act in the spinal cord to suppress movement in response to noxious stimulation. Spinal anesthesia decreases hypnotic/sedative requirements, possibly by decreasing afferent transmission of stimuli. We hypothesized that isoflurane action in the spinal cord would similarly depress the ascending transmission of noxious input to the thalamus and cerebral cortex. In six isoflurane-anesthetized goats, we measured electroencephalographic (EEG) and thalamic single-unit responses to a clamp applied to the forelimb. Cranial bypass permitted differential isoflurane delivery to the torso and cranial circulations. When the cranial-torso isoflurane combination was 1.3% +/- 0.2%-1.0% +/- 0.4% the noxious stimulus did not evoke significant changes in the EEG or thalamic activity: 389 (153-544) to 581 (172-726) impulses/min, (median, 25th-75th percentile range, P: > 0.05). When the cranial-torso isoflurane combination was 1.3% +/- 0.2%-0.3% +/- 0.2%, noxious stimulation increased thalamic activity: 804 (366-1162) to 1124 (766-1865) impulses/min (P: < 0.05), and the EEG "desynchronized": total EEG power decreased from 25 +/- 20 microV(2) to 12 +/- 8 microV(2) (P: < 0.05). When the cranial-torso isoflurane was 1.7% +/- 0.1%-0.3% +/- 0.2%, the noxious stimulus did not significantly affect thalamic: 576 (187-738) to 1031 (340-1442) impulses/min (P: > 0.05), or EEG activity. The indirect torso effect of isoflurane on evoked EEG total power (12.6 +/- 2.7 microV(2)/vol%, mean +/- SE) was quantitatively similar to the direct cranial effect (17.7 +/- 3.0 microV(2)/vol%; P: > 0.05). These data suggest that isoflurane acts in the spinal cord to blunt the transmission of noxious inputs to the thalamus and cerebral cortex, and thus might indirectly contribute to anesthetic endpoints such as amnesia and unconsciousness.

IMPLICATIONS

Isoflurane action in the spinal cord diminished the transmission of noxious input to the brain. Because memory and consciousness are likely dependent on the "arousal" state of the brain, this indirect action of isoflurane could contribute to anesthetic-induced amnesia and unconsciousness.

Sensitization, desensitization and stimulus-induced recovery of trigeminal neuronal responses to oral capsaicin and nicotine

Repeated application of capsaicin at a 1-min interstimulus interval (ISI) to the tongue induces a progressively increasing irritant sensation (sensitization), followed after a rest period by reduced sensitivity to further capsaicin (desensitization). Sequential reapplication of capsaicin induces irritation that eventually increases to initial levels: stimulus-induced recovery (SIR). In contrast, repeated application of nicotine elicits a declining irritant sensation across trials. To investigate possible neural correlates of these phenomena, we recorded from single units in superficial laminae of the dorsomedial trigeminal subnucleus caudalis (Vc) that responded to noxious thermal (54 degrees C) and chemical (1 M pentanoic acid) stimulation of the tongue of anesthetized rats. We then recorded responses to either capsaicin (330 microM) or nicotine (0.6 M), delivered either once, repeatedly at 1-min ISI, or continually by constant flow. After the initial capsaicin application and a rest period, the capsaicin was reapplied in the identical manner to test for SIR. The mean response of 14 Vc units to sequential application of pentanoic acid did not vary significantly across trials, indicating lack of tachyphylaxis or sensitization. The averaged response of 11 Vc units to repeated capsaicin increased significantly across the first eight trials and then plateaued. Following the rest period, spontaneous firing had returned to the precapsaicin level. With capsaicin reapplication, the averaged response increased again after a significant delay (due to desensitization), but did not reattain the peak firing rate achieved in the initial series (partial SIR). Constant-flow application of capsaicin induced an identical sensitization followed by nearly complete SIR. A single application of capsaicin induced a significant rise in firing in eight other units, but the rate of rise and maximal firing rate were both much lower compared with repetitive or constant-flow capsaicin. When capsaicin was reapplied once after the rest period, there was no change in firing rate indicating absence of SIR. These results indicate that maintenance of the capsaicin concentration induces a progressive increase in neuronal response that parallels sensitization. With recurrent capsaicin application, desensitization can be overcome to result in a delayed recovery of Vc responses similar to SIR. In contrast, the averaged response of 17 Vc units to repeated or constant-flow application of nicotine increased only over the first 3 min, and then decreased to spontaneous levels even as nicotine was still being applied. These results are consistent with the decrease in the perceived irritation elicited by sequential application of nicotine in humans.

Organic change of effusion in the mastoid in otitis media with effusion and its relation to attic retraction

To try to solve the pathogenesis of severe attic retraction viewed from mastoid condition, we examined the residual soft tissue density (RSTD) in the mastoid by computed tomography (CT) in 85 patients (107 ears) with otitis media with effusion (OME) 3 months after tympanostomy tube insertion or later. The incidence of RSTD in the mastoid was significantly higher in OME of adults (52.6%) than in children (24.1%). Ears with severe attic retraction had RSTD significantly more frequently (80%) than those with no or mild attic retraction, and many of the mastoids with severe attic retraction were occupied totally by RSTD. The area of the mastoid (mastoid pneumatization) was significantly smaller, and CT density of the mastoid (sclerotic tendency) was significantly higher in ears with RSTD than in those without. RSTD after tympanostomy tube insertion in the mastoid indicating organic change of effusion was considered one of the important factors relating to the pathogenesis of severe attic retraction.

[Asthma death among adults in Japan 1995-1997. Analysis of 295 cases reported questionnaires sent to hospitals with more than 100 beds. Asthma Death Investigation Committee]

To clarify recent trends in adult asthma mortality, the Asthma Death Investigation Committee of Japan studied the clinical characteristics of 295 patients who died of asthma between 1995 and 1997. Males were slightly more than females among the death cases. Approximately half of the patients ranged in age from 60 to 79 years. Tendency to increase of death among young male adults continued. One third of the patient deaths involved the asphyxic type, while status asthmaticus was the cause death in 21.9%. Half of the asthmatics died in hospitals or emergency rooms, and places where the fatal attacks occurred were mainly patients' houses. The main cause fatal asthma attacks was respiratory infection, followed by fatigue, stress, and discontinuation of medication. Most of the patients were classified moderate or severe type of asthma 1 month before death. Histories of life-threatening attacks and hospitalization due to severe attacks, irregular visits to the hospital, low compliance, and insufficiency of corticosteroid treatment were suggested as the main risk factors in adult asthma deaths.

Intraoperative QRS-interval changes caused by hyperkalaemia in an infant with Arima syndrome

A one-year-and-ten-months-old male infant with Arima syndrome, a very rare genetic disorder, underwent urgent insertion of a catheter for continuous ambulatory peritoneal dialysis (CAPD) under general anaesthesia. During the procedure he showed QRS-interval changes caused by hyperkalaemia which was successfully treated with calcium gluconate. The management and intraoperative complications of this syndrome are reported and available literature reviewed.

Postnatal development of the tympanic cavity: a computer-aided reconstruction and measurement study

A computer-aided 3-D reconstruction and measurement method was used to assess postnatal volume and height changes in the tympanic cavity. Materials used were 14 normal human temporal bones obtained from 6 infants (under 1 year of age) and 8 adults (over 18 years of age). After defining the boundaries of the tympanic cavity, its total volume and height and the volume and height of the epitympanum, mesotympanum and hypotympanum were measured. The relationship between the volume of the tympanic cavity and age, and the correlation between the volume of the tympanic cavity and the grade of pneumatization of the air cells were also studied. The average volume of the tympanic cavity in adults (640.1+/-69.1 mm3, n = 8) was about 1.5 times larger than the volume of the infant cavity (451.7+/-68.2 mm3, n = 6). The hypotympanum increased most postnatally and the mesotympanum least. The volume of the tympanic cavity increased in proportion to increasing pneumatization in bone surrounding the cavity. The postnatal increase in the height of the tympanic cavity appears to be the major contributor to the increase in volume of the cavity. Postnatal changes in the tympanic cavity have clinical implications.

A study on liquid-liquid distribution based on single picoliter droplets and in situ electrochemical measurements

A microelectrode technique combined with the microcapillary injection/manipulation of a single organic droplet in water was developed. The technique was applied to the study of the distribution of a ferrocene derivative across a single-picoliter-nitrobenzene-droplet/water interface and to the simultaneous in situ electrochemical determination of the distributed solute in the picomole-femtomole range. The liquid-liquid distribution processes were discussed in terms of droplet size and solute concentration (in water) dependencies of the interfacial mass transfer rate.