Prognostic difference between walk-in and ambulance-transported patients with ST elevation myocardial infarction from Mie ACS Registry

Background

The prognostic impact of walk-in patients with ST elevated myocardial infarction (STEMI) is unknown. The aim of this study was to compare the prognosis of walk-in STEMI patients and ambulance-transported STEMI patients.

Methods

We evaluated 260 walk-in STEMI patients and 1,641 ambulance-transported STEMI patients enrolled from Mie ACS registry, which was a prospective and multicenter registry between 2013 and 2019. Propensity score matched analysis was performed to validate the results. Coronary risk factor, sex, Killip class, and door-to-balloon time was used for compute the propensity score.

Results

Propensity score matching yielded 226 cases per group. All-cause mortality was tended to be higher in walk-in group than ambulance-transported group without reaching significant difference, although ambulance-transported group had slightly higher mortality before propensity score matching (See Figure 1). Symptom-onset-to-reperfusion time was significantly longer in walk-in group (241 vs 184 minutes, p<0.01).

Conclusion

The short and mid-term prognosis of walk-in STEMI patients was similar with ambulance-transported patients. However, prehospital delay should be shortened by using ambulance for better prognosis in walk-in STEMI patients.

Funding Acknowledgement

Type of funding sources: None.

Estimation of Polychlorinated Biphenyls Intake through Fish Oil-Derived Dietary Supplements and Prescription Drugs in the Japanese Population

Background: Oily fish and their extracted oils may be a source of polychlorinated biphenyls (PCBs) which can induce toxic effects on the consumers. The main aim of this survey was estimation of PCBs intake through fish oil-derived dietary supplements and prescription drugs in the Japanese population. Methods: PCBs levels were determined in 20 fish oil-derived dietary supplements and 6 oil-derived prescription drugs from the Japanese market using Gas Chromatography-Mass Spectrometry. Then, the daily exposure to PCBs was estimated. Data were statistically analyzed using JMP software suite. Results: Totally, 17 of the 26 fish oil-derived products were contaminated with PCBs. The median PCB concentrations in the total set of fish oil-derived products was 2.2 ng/g oil wt. with a range of <MDL-720 ng/g oil wt. The average total daily intake of PCBs was estimated to be ranged from 770 to 2800 ng/day in the Japanese population. Conclusion: PCBs intakes through fish oil-derived dietary supplements and prescription drugs in the Japanese adults were much lower than tolerable daily intake

P5007Acute natriuretic activity of sodium-glucose cotransporter 2 inhibitor in heart failure patients with type 2 diabetes mellitus

Background

Sodium-glucose cotransporter 2 (SGLT2) inhibitor promotes diuresis and reduces the risk of hospitalization for heart failure (HF). However, the mechanisms of diuretic effects of SGLT2 inhibitor in HF patients with type 2 diabetes mellitus (T2DM) remain under investigation.

Purpose

The purpose of this study was to investigate the mechanisms of acute diuretic effects of SGLT2 inhibitor and to identify its predictor in HF patients with T2DM.

Methods

We prospectively enrolled 40 hospitalized HF patients with T2DM (68±13 years, 63% male, and hemoglobin A1c 7.1±0.9%) between July 2014 and June 2018. All patients received ipragliflozin at a dose of 50 mg once daily after breakfast. They underwent 24-hour urine test and first-morning blood and urine tests before and after ipragliflozin therapy.

Results

Urine volume significantly increased from 1,365±511 ml/day on day 0 to 1,698±595 ml/day on day 3 (p<0.001). Multivariate linear regression analyses showed that the increase of 24-hour urine sodium but not urine sugarwas significantlyand independently associated with the increase of 24-hour urine volume (β-Coefficient=0.80; P<0.001). Univariate and multivariate logistic regression analyses showed that higher dosage of furosemide-equivalent loop diuretics and lower level of first-morning urine sodium concentration (per 1 mEq/L) at baseline were significantly associated with the diuretic effect of ipragliflozin therapy, and the latter independently predicted increase of 24-hour urine volume (Table).

Predictors for increase of urine volume Univariate Multivariate Odds ratio (95% CI) P value Odds ratio (95% CI) P value Dosage of furosemide, mg 1.09 (1.01–1.18) 0.04 – – HbA1c, % 1.45 (0.56–3.78) 0.44 Fasting blood glucose, mg/dL 1.02 (0.99–1.04) 0.24 eGFR, mL/min/1.73m2 1.01 (0.97–1.05) 0.65 Plasma BNP, pg/mL 1.00 (0.99–1.01) 0.12 Left ventricular ejection fraction, % 0.98 (0.94–1.02) 0.24 First-morning urine sugar, mg/dL 1.20 (0.96–1.50) 0.12 First-morning urine sodium, mEq/L 0.96 (0.93–0.99) 0.02 0.96 (0.93–0.99) 0.02 24-hour urine sugar, g/day 3.49 (0.13–93.40) 0.46 24-hour urine sodium, mEq/day 0.98 (0.96–1.01) 0.20 eGFR, estimated glomerular filtration rate; BNP, brain natriuretic peptide.

Conclusion

SGLT2 inhibitor has acute natriuretic activity and may restore loop-diuretic resistance in HF patients with T2DM.

Acknowledgement/Funding

None

Rapid susceptibility testing for slowly growing nontuberculous mycobacteria using a colorimetric microbial viability assay based on the reduction of water-soluble tetrazolium WST-1

Rapid susceptibility testing for slowly growing nontuberculous mycobacteria (NTM) using a colorimetric microbial viability assay based on the reduction of the water-soluble tetrazolium salt {2-(4-iodophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H-tetrazolium, monosodium salt (WST-1)} using 2,3,5,6-tetramethyl-1,4-benzoquinone as an electron mediator was developed. Using the Clinical and Laboratory Standards Institute (CLSI) method, a long-term incubation time (7-14 days) was required to determine the minimum inhibitory concentrations (MICs) of the slowly growing NTM. The MICs for a variety of different antibiotics against the slowly growing NTM were determined by the WST-1 colorimetric method and compared with those obtained using the broth microdilution methods approved by the CLSI. Good agreement was found between the MICs determined after 3-4 days using the WST-1 colorimetric method and those obtained after 10-14 days using the broth microdilution method. The results suggest that the WST-1 colorimetric assay is a useful method for the rapid determination of the MICs for the slowly growing NTM.

Self-monitoring has potential for home exercise programmes in patients with haemophilia

Haemophiliacs who have had to keep a physically inactive lifestyle due to bleeding during childhood are likely to have little motivation for exercise. The purpose of this study is to clarify the effectiveness of the self-monitoring of home exercise for haemophiliacs. A randomized controlled trial was conducted with intervention over 8 weeks at four hospitals in Japan. Subjects included 32 male outpatients aged 26-64 years without an inhibitor who were randomly allocated to a self-monitoring group and a control group. Individual exercise guidance with physical activity for improvement of their knee functions was given to both groups. The self-monitoring materials included an activity monitor and a feedback system so that the self-monitoring group could send feedback via the Internet and cellular phone. The self-monitoring was performed by checking exercise adherence and physical activity levels, bleeding history and injection of a coagulation factor. Both groups showed significant improvements in exercise adherence (P < 0.001) and physical function such as the strength of knee extension (P < 0.001), range of knee extension (P < 0.001), range of ankle dorsiflexion (P < 0.01), a modified Functional Reach (P < 0.05) and 10 metre gait time (P < 0.01). In particular, improvements in exercise adherence (P < 0.05), self-efficacy (P < 0.05), and strength of knee extension (P < 0.05) were significant in the self-monitoring group compared with those in the control group. No increase in bleeding frequency and pain scale was noted. The self-monitoring of home exercise for haemophilic patients is useful for the improvement of exercise adherence, self-efficacy and knee extension strength.

Displays of paternal mouse pup retrieval following communicative interaction with maternal mates

Compared with the knowledge of maternal care, much less is known about the factors required for paternal parental care. Here we report that new sires of laboratory mice, though not spontaneously parental, can be induced to show maternal-like parental care (pup retrieval) using signals from dams separated from their pups. During this interaction, the maternal mates emit 38-kHz ultrasonic vocalizations to their male partners, which are equivalent to vocalizations that occur following pheromone stimulation. Without these signals or in the absence of maternal mates, the sires do not retrieve their pups within 5 min. These results show that, in mice, the maternal parent communicates to the paternal parent to encourage pup care. This new paradigm may be useful in the analysis of the parental brain during paternal care induced by interactive communication.

Parental responsibilities in mice are usually carried out by the mother of the pups. In this study, the authors show that when mothers are separated from their mouse pups, they emit ultrasonic vocalizations to their male partners, who respond by administering paternal care to the pups.

Production of monoclonal antibodies and development of an ELISA for solamargine

The ratio of hapten and bovine serum albumin in an antigen conjugate was determined by matrix-assisted laser desorption/ionization mass spectrometry. A hybridoma secreting monoclonal antibodies against solamargine was produced by fusing splenocytes immunized with a solamargine-bovine serum albumin conjugate with HAT-sensitive mouse myeloma cell line, P3-X63-Ag8-653. Extensive cross-reaction of anti-solamargine antibodies against solasonine appeared. Aglycone of solamargine, solasodine cross-reacted with anti-solamargine antibodies resulting in a 43.8% cross-reaction. Insignificant cross-reaction appeared with tomatine (2.06%). The full measuring range of the assay extends from 57.5 pmol ml(-1) to 11.5 nmol ml(-1) of solamargine.

Changes of human menisci in osteoarthritic knee joints

OBJECTIVE

To investigate the changes of knee menisci in osteoarthritis (OA) in human.

METHODS

OA and control menisci were obtained from 42 end-stage OA knees with medial involvement and 28 non-arthritic knees of age-matched donors, respectively. The change of menisci in OA was evaluated by histology, and gene expression of major matrix components and anabolic factors was analyzed in the anterior horn segments by quantitative PCR (qPCR). In those regions of menisci, the rate of collagen neo-synthesis was evaluated by [(3)H]proline incorporation, and the change of matrix was investigated by ultrastructural observation and biomechanical measurement.

RESULTS

In OA menisci, the change in histology was rather moderate in the anterior horn segments. However, despite the modest change in histology, the expression of type I, II, III procollagens was dramatically increased in those regions. The expression of insulin-like growth factor 1 (IGF-1) was markedly enhanced in OA menisci, which was considered to be responsible, at least partly, for the increase in procollagen gene expression. Interestingly, in spite of marked increase in procollagen gene expression, incorporation of [(3)H]proline increased only modestly in OA menisci, and impaired collagen synthesis was suggested. This finding was consistent with the results of ultrastructural observation and biomechanical measurement, which indicated that the change of meniscal matrix was modest in the macroscopically preserved areas of OA menisci.

CONCLUSION

Although the expression of major matrix components was markedly enhanced, matrix synthesis was enhanced only modestly, and the changes of matrix in human OA menisci were rather modest in the non-degenerated areas.

Pedicle involvement on MR imaging is common in osteoporotic compression fractures

BACKGROUND AND PURPOSE

Pedicle involvement on MR imaging has been considered specific for malignancy. However, we also noted the findings in many patients with osteoporosis and hypothesized that it is not specific for malignant lesions. The aim of this study was to evaluate the prevalence of pedicle involvement in painful osteoporotic compression fractures and to determine whether the sign is specific for malignancy.

MATERIALS AND METHODS

We retrospectively reviewed MR images and CT scans of 152 patients who underwent PV for painful compression fractures. There were 140 patients (225 vertebrae) with osteoporotic fractures and 12 patients (19 vertebrae) with malignant fractures. Three radiologists evaluated the degree and extent of signal-intensity changes of the pedicle on MR imaging by consensus. The CT findings were also evaluated. The chi(2) test was used for statistical analyses.

RESULTS

Of the 225 vertebrae of osteoporotic fractures and 19 vertebrae of malignant fractures, pedicle involvement on MR imaging was seen in 144 (64%) and 16 (84.2%) vertebrae, respectively, and there was no statistically significant difference (P = .065). Positive pedicle involvement in osteoporotic fractures was seen in 84 (77%) of 109 vertebrae with early-phase fractures (< or =3 months) and 60 (51.7%) of 116 vertebrae with chronic-phase fractures (>3 months), and this was statistically significant (P < .001). Among 144 osteoporotic vertebrae that showed positive pedicle involvement on MR imaging, 45 (31%) showed pedicle fractures and 55 (38.2%) showed sclerotic change on CT.

CONCLUSIONS

Pedicle involvement was seen frequently in patients with osteoporotic compression fractures and was not specific for malignancy in our study group.

[Ross procedure with aortic replacement for aortic stenosis with ascending aortic aneurysm: report of a case]

Bicuspid aortic valve (BAV) is a common congenital heart disease, and it is well known to be a risk factor for ascending aortic dilatation and dissection. We here report a case of 34-year-old woman who underwent Ross procedure with ascending aortic replacement under the diagnosis of subaortic stenosis and ascending aortic aneurysm. She was pointed out to have heart murmur soon after the birth diagnosed as patent ductus arteriosus. The ductus was ligated when she was 3-years-old, however, heart murmur remained. Further examinations revealed that she also had aortic stenosis with BAV. During her 20-year-follow-up, subaortic stenosis and ascending aorta ectasia were also progressed. Pathological examinations of resected ascending aortic wall showed mucoid degeneration and laceration of collagen fibers, suggesting the fragility of dilated aortic wall with BAV.

Validation of amelogenesis imperfecta inferred from amelogenin evolution

We used the evolutionary analysis of amelogenin (AMEL) in 80 amniotes (52 mammalian and 28 reptilian sequences) to aid in the genetic diagnosis of X-linked amelogenesis imperfecta (AIH1). Out of 191 residues, 77 were found to be unchanged in mammals, and only 34 in amniotes. The latter are considered crucial residues for enamel formation, while the 43 residues conserved only in mammals could indicate that they play new, important roles for enamel formation in this lineage. The 5 substitutions leading to AIH1 were validated when the mammalian dataset was used, and 4 of them with the amniote dataset. These 2 sequence datasets will facilitate the validation of any human AMEL mutation suspected of involvement in AIH1. This evolutionary analysis also revealed numerous residues that appeared to be important for correct AMEL function, but their role remains to be elucidated.

Brachial-ankle pulse wave velocity measured automatically by oscillometric method is elevated in diabetic patients with incipient nephropathy

AIMS

To examine whether brachial-ankle pulse wave velocity (baPWV), a possible early marker of atherosclerotic vascular damage, is associated with albuminuria in patients with Type 2 diabetes.

METHODS

BaPWV was measured by automatic oscillometric method in 346 Type 2 diabetic patients with normoalbuminuria (a mean level of three times measurements of albumin-to-creatinine (ACR)<30 microg/mg creatinine; n=200), incipient nephropathy (a mean level of ACR> or =30 and <300 microg/mg creatinine; n=119), and clinical nephropathy (a mean level of ACR> or =300 microg/mg creatinine; n=27), and without peripheral vascular disease.

RESULTS

BaPWV (cm/s) was significantly higher in patients with incipient nephropathy (1722 +/- 382) and clinical nephropathy (1763 +/- 322) than in patients with normoalbuminuria (1559 +/- 343, P<0.0001, respectively). By univariate analysis it correlated significantly with age (r=0.44, P<0.0001), systolic blood pressure (r=0.55, P<0.0001), diastolic blood pressure (r=0.42, P<0.0001), albuminuria (r=0.24, P<0.0001) and HbA1C (r=0.11, P<0.05). Albuminuria revealed an independent significant association with baPWV (P<0.01) after adjustment for age, sex, smoking, BMI, HbA1C, hyperlipidemia, and hypertension. Multiple regression analysis showed age, diastolic blood pressure and albuminuria were independently associated with baPWV (adjusted R2=0.42, P<0.0001).

CONCLUSIONS

The results might indicate a possible link between the pathogenesis of atherosclerosis and diabetic nephropathy. Future studies are needed to clarify the usefulness and its predictable value.

[A case report of ross operation and ventricular septal defect closure following correction of type A interruption by modified Blalock-Park, pulmonary artery banding and patent ductus arteriosus division]

A 2-year-old boy who had undergone a correction of a type A interruption using a modified Blalock-Park operation, pulmonary artery banding and the division of a patent ductus arteriosus, underwent a Ross operation and closure of ventricular septal defect (VSD). Although a pre-operative echo cardiogram revealed a bicuspid aortic valve, and a Doppler echocardiogram showed only 10 mmHg of pressure gradient across the aortic valve, Ross procedure was performed as a procedure accompanying the closure of a total conus VSD. The total conus VSD was closed with a Dacron patch using pledget mattress sutures. In addition, a running suture was applied over the denuded aortic root and the cranial margin to achieve water tight closure. An aortic root replacement procedure was our first choice for the Ross operation. After both coronary buttons were re-implanted into pulmonary sinuses, a pulmonary artery autograft was wrapped around by the remaining aortic wall for reinforcement to prevent future dilatation. The main pulmonary artery was reconstructed using a bicuspid pericardial valve conduit with a diameter of 24 mm. A post-operative echocardiogram showed no neoaortic valve regurgitation, good coaptation of tri-leaflets, mild regurgitation of pericardial valve and good cardiac performance.

[A modified Fontan operation in the presence of a supracardiac total anomalous pulmonary venous connection]

We report a case of 2-year-old girl with asplenia syndrome who successfully underwent modified Fontan procedure and concomitant repair of supracardiac total anomalous pulmonary venous connection (TAPVC). The preoperative diagnosis included a common atrioventricular canal (type C), a double outlet right ventricle, a common atrium, common atrioventricular valve regurgitation, pulmonary stenosis, and a bilateral superior vena cava (SVC). Cardiac catheterization revealed a Qp/Qs of 1.3, mean PA pressure of 16 mmHg and an Rp of 1.3. The TAPVC drained to left SVC (LSVC) at a position proximal to the hemiazygos vein with an ostium of 5 mm in diameter. The LSVC was divided distal to its connection to the common pulmonary vein (CPV). The TAPVC ostium was cut back into the CPV, then it was anastmosed with posterior aspect of the atrial wall in an effort to provide a wide anastomosis. The postoperative course was uneventful and the patient was discharged from hospital on the 35th postoperative day.

Conservative treatment of hemolytic complication following coil embolization in two adult cases of patent ductus arteriosus

Two adult cases of relatively large patent ductus arteriosus (PDA) were treated by coil embolization, but were complicated by hemolysis that was successfully managed by medical treatment. Case 1 was a 67-year-old woman and Case 2 was a 71-year-old woman with a PDA of minimal diameter of 5.3 mm and 5.5 mm, respectively. The approach was via the pulmonary artery and 2 coils were delivered simultaneously into the ductus, known as the 'kissing coil technique'. Although immediately after the procedure only a small residual shunt was revealed by aortogram, hemolysis occurred for several hours after the procedure in both cases. A hemolytic complication usually needs additional coil embolization or surgical treatment, but in these 2 cases it was successfully treated by haptoglobin infusion to prevent nephropathy and by antiplasmin infusion to promote thrombus formation. Hemolytic complications of coil embolization of PDA can managed by medication when the residual shunt is minimal and the degree of hemolysis is mild.

Abortive secretion of an enamel matrix in the inner enamel epithelial cells during an enameloid formation in the gar-pike, Lepisosteus oculatus (Holostei, Actinopterygii)

The tooth in the gar-pike, Lepisosteus oculatus, an actinopterygian fish, is characterized by the occurrence of both enamel and enameloid, the former covering the tooth shaft and the latter, the tooth cap. Our previous research demonstrated that the enamel in this species was, as in the lungfish, immunoreactive for amelogenin, indicating its homologous nature with the mammalian tooth enamel, whereas the enameloid was completely immunonegative. The present study demonstrates that, during the early maturation stage of the enameloid formation, the inner enamel epithelial cells (IEECs) synthesize through a well-developed Golgi apparatus a fine-granular substance which is intensely immunoreactive for amelogenin. This substance was accumulated in a large saccule extended in a suprabasal zone of the cell; we were unable to find any morphological sign indicating a connection of the substance with the enameloid matrix. The abortive secretion of the enamel matrix-like substance in the IEEC during an enameloid formation was considered to be an instance of rudimental enamel formation. In the gar-pike, the synthesis of amelogenin in the IEEC has been demonstrated to occur independently from that of the enameloid matrix. The present findings demonstrate a prominent difference between the tooth enamel and enameloid.

The vascular supply of the villiform processes in the pharynx of the soft-shelled turtle, Trionyx sinensis japonicus. A scanning electron microscopic study of corrosion casts

Following our observations of the fine structure of the pharyngeal villiform processes of the hibernating soft-shelled turtle, Trionyx sinensis japonicus (Yokosuka et al., 2000), this paper deals with a scanning electron microscope study of the resin casts of blood vessels supplying those processes. Each villiform process contained arterioles and venules which ran in the axial portion of the process; capillaries formed a network at the periphery of the connective tissue core of the villus. In the distal portions of the villus, the capillaries increased markedly in their caliber to form sinusoidal capillaries. Such a vascular architecture supports the view that the villiform processes serve in the aquatic respiration of the soft-shelled turtle. The casts indicated an occurrence of sphincters in the vascular bed of the villi.

Villiform processes in the pharynx of the soft-shelled turtle, Trionyx sinensis japonicus, functioning as a respiratory and presumably salt uptaking organ in the water

Some species of soft-shelled turtle have been known to use a conspicuous mass of villiform processes of the pharyngeal mucosa as an aquatic respiratory organ when staying underwater for prolonged periods, such as hibernation. Using hibernating turtles, Trionyx sinensis japonicus, the present study employed scanning electron microscopy to demonstrate for the first time the detailed morphology and distribution of these villiform processes. Two types of processes, complex and simple, could be identified. Light microscope observation of the transverse sections of the villi demonstrated a rich vascularization in the connective tissue of the villi, comprising arterioles and venules running in the core and capillaries in the periphery. Most of the capillaries were invaginated into the multilayered cuboidal epithelium. Near the tip of the villi they became swollen, forming sinusoidal capillaries. Transmission electron microscopy clarified the fine structure of the blood-water barrier, which consisted of a non-fenestrated endothelium and an attenuated epithelium that sandwiched a connective tissue with a discontinuous subendothelial and a continuous subepithelial basement lamina. The epithelium consisted of secretory cells, mitochondria-rich cells, and basal cells. The mitochondria-rich cells contained a cytoplasmic area filled with tubulovesicular elements. Based on their ultrastructural resemblance with the chloride cells in the fish and tadpole, these cells are suggested to be involved in the uptake of Na+ and Cl from fresh water for keeping ionic balance in the blood.

An immunocytochemical study of amelogenin proteins in the developing tooth enamel of the gar-pike, Lepisosteus oculatus (Holostei, Actinopterygii)

Previous studies have demonstrated the morphological similarity of the enamel-like layer found in the teeth of the coelacanth, lungfish and gar-pike to the enamel of tetrapods. In order to clarify the phylogenetic continuity between both structures, tooth germs of the gar-pike were immunocytochemically studied using an anti-bovine amelogenin polyclonal antibody. Intense immunoreaction was shown over the enamel-like matrix layer. Certain cell organelles associated with the secretory pathway of the ameloblasts were recognized as immunoreactive. These results indicate that the enamel-like layer of the gar-pike is a tissue homologous with the mammalian enamel because both possess a common, amelogenin-like substance.

Physical and mental correlates of hearing impairment in the elderly in Japan

Seven hundred and forty seven elderly people aged from 65 to 98 (209 male and 538 female) admitted to the Geriatric Health Service Facility were evaluated with pure-tone audiometry, Office of Population Censuses and Surveys (OPCS) personal care severity score, OPCS hearing severity score, Mini-mental State Examination (MMSE) and Self-rating Depression Scale (SDS). A single correlation study indicated that the hearing level significantly correlated with age, OPCS hearing severity score, MMSE total score and SDS total score. A multiple regression analysis showed that age, OPCS hearing severity score, and MMSE total score were significantly associated with the hearing level. We demonstrated here that the objective auditory function strongly correlated with the cognitive function measured by MMSE total score, suggesting that a regular audiological check-up and the early detection of the hearing impairment could contribute to the maintenance of the quality of life in the elderly.

Amelogenin protein in tooth germs of the snake Elaphe quadrivirgata, immunohistochemistry, cloning and cDNA sequence

In the snake, Elaphe quadrivirgata, the occurrence of amelogenin was immunohistochemically demonstrated in the enamel of developing tooth germs. Teeth of the snake are covered with a thin true enamel layer about 1-2 microns in thickness. Light and electron microscopic immunohistochemistry indicated an intense amelogenin immunoreactivity occurring in the enamel layer during the secretory stage of tooth development. Cloning and cDNA sequence of snake amelogenin was performed by RT-PCR. The amino acid sequence of the snake amelogenin cDNA--in its portion corresponding to the area from exon 5 to exon 7 of human X189 amelogenin gene--showed 45% homology with humans. Regions of both the N-terminus and C-terminus were well conserved. Furthermore, the positions of prolin in the amino acid alignment of the snake amelogenin corresponded well with those of human amelogenin. It is suggested that prolin is an essential constituent of amelogenin and therefore its positions in the molecule have been conserved after the evolutionary divergence of reptiles and mammals. This study using reptiles is the first detection of specific amelogenin immunoreactivity by high resolutional immunoelectron microscopy and the first cloning of amelogenin cDNA in a non-mammalian animal.

Delayed diagnosis of anomalous origin of the left coronary artery 16 years after mitral valve replacement

Mitral insufficiency caused by ischemia is frequently found in anomalous origin of the left coronary artery from the pulmonary artery. We report a case of a 25-year-old woman who was diagnosed to have anomalous origin of the left coronary artery from the pulmonary artery and had successful left internal mammary artery bypass grafting 16 years after mitral valve replacement for mitral insufficiency of an unknown cause in her childhood.

Infant cold exposure changes Fos expression to acute cold stimulation in adult hypothalamic brain regions

It is known that cold exposure as an infant results in a permanent cold tolerance which is accompanied by a reduced rate of colonic temperature decline and increased metabolic heat production to cold stimulation. The present study was aimed to elucidate the central mechanism of cold tolerance of adult rats with cold exposure as infants. Newborn infants were exposed to cold ambient (4 degrees C) daily for 2 weeks, and when they were 15-weeks old, Fos expression to acute cold stimulation (10 degrees C) in whole brain regions was investigated using quantitative immunohistochemistry. Acute cold stimulation induced a significant increase of Fos-positive neurons in many nuclei of whole brain areas in adult rats both with and without cold exposure as infants. However, the number of Fos-positive neurons was significantly less in the rats with cold exposure than without cold exposure as infants, particularly in the hypothalamic nuclei such as the lateral septal nucleus (LS), preoptic area (POA), parvocellular paraventricular nucleus (pPVN0, ventromedial hypothalamic nucleus (VMH) and supramammillary nucleus (SuM). However, there was no significant difference in the number of Fos-positive neurons in the extra-hypothalamic regions between the rats with and without cold exposure as infants. These results suggest that the central mechanism of cold tolerance with cold exposure as infants is due to metabolic changes of the hypothalamic brain regions.

[Surgical relief of airway obstruction from a double aortic arch associated with corrected transposition of the great arteries, pulmonary atresia and bilateral patent ductus arteriosus in a neonate]

A rare 20-day-old male with double aortic arch, corrected transposition of the great arteries (cTGA), pulmonary atresia and bilateral patent ductus arteriosus (PDA) was transported to our institute because of severe respiratory dysfunction and cyanosis. The patient had been already intubated and ventilated on respirator. A echocardiography and cine-angiography demonstrated that the both sides aortic arch had almost identical sizes, originating common carotid arteries and subclavian arteries and PDAs respectively, and the descending aorta located on the left side of the mid-line. At the first surgery, the distal of the right aortic arch was divided just proximal to the descending aorta after complete tissue dissection around the arch. The divided right sided aortic arch was mobilized from posterior to anterior aspect of the bronchus. Then the right subclavian artery was divided and an original Blalock-Taussig shunt was employed. The right sided PDA was ligated. After the first surgery, respiratory dysfunction lasted for weeks mainly because of the PGE1 dependent left sided PDA. At the second surgery, left sided modified Blalock-Taussig shunt was constructed and the left sided PDA was divided. These procedures resulted in stable respiratory status and oxygen saturation. The patient was extubated three days later and now in satisfactory clinical condition.

A combined assay of cell viability and in vitro cytotoxicity with a highly water-soluble tetrazolium salt, neutral red and crystal violet

Cell viability and in vitro cytotoxicity assay methods were developed using a combination of dyes, 4-[3-(4-iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate (WST-1), neutral red (NR) and crystal violet (CV), with HeLa cells as a bioindicatior. As WST-1 produces a highly water soluble and non-cytotoxic formazan dye, ti allows each assay to be carried out in one culture dish. The combined cell viability assay using WST-1, NR and CV gave an absorbance that correlated linearly with the number of cells over the range 1000 to 50,000 cells/well. The combined assay was applied to the evaluation of IC50 values for sodium dodecyl sulfate as a model toxicant, which yielded similar values to those obtained with each assay independently.

Stability of a metabolizable ester bond in radioimmunoconjugates

Ester bonds have been used as metabolizable linkages to reduce radioactivity levels in non-target tissues following the administration of antibodies labeled with metallic radionuclides. In this radiochemical design of antibodies, while the ester bonds should be cleaved rapidly in non-target tissues, high stability of the ester bonds in plasma is also required to preserve target radioactivity levels. To assess the structural requirements to stabilize the ester bond, a new benzyl-EDTA-derived bifunctional chelating agent with an ester bond, (1-[4-[4-(2- maleimidoethoxy)succinamido]benzyl]ethylenediamine-N,N,N',N' -tetraacetic acid; MESS-Bz-EDTA), was developed. MESS-Bz-EDTA was coupled with a thiolated monoclonal antibody (OST7, IgG1) prepared by reducing its disulfide bonds to introduce the ester bond close and proximal to the antibody molecule. For comparison, 1-[4-(5- maleimidopentyl)aminobenzyl]ethylenediamine-N,N,N',N'-tetraacetic acid (EMCS-Bz-EDTA) and meleimidoethyl 3-[131I]iodohippurate (MIH) was coupled to OST7 under the same conjunction chemistry. When incubated in 50% murine plasma or a buffered-solution of neutral pH, OST7-MESS-Bz-EDTA-111In rapidly released the radioactivity, and more than 95% of the initial radioactivity was liberated after a 24 h incubation in both solutions, due to a cleavage of the ester bond. On the other hand, only about 20% of the radioactivity was released from OST7-MIH-131I in both solutions during the same incubation period. In mice biodistribution studies, while a slightly faster radioactivity clearance from the blood with less radioactivity levels in the liver and kidneys was observed with OST7-MIH-131I than with OST7-EMCS-Bz-EDTA-111In, OST7-MESS-Bz-EDTA-111In indicated radioactivity clearance from the blood much faster than and almost comparable to that of OST7-MIH-131I and succinamidobenzyl-EDTA-111In, respectively. These findings as well as previous findings on radiolabeled antibodies with ester bonds suggested that while an introduction of an ester bond close to an antibody molecule stabilized the ester bond against esterase access, chemical structures of the linkages and radiolabels attached to the ester bonds play a significant role in the chemical stability of the ester bond. This may explain the different stability of the ester bonds in radioimmunoconjugates so far reported.

[Effects of 5-fluorouracil in shrinking residual gastric cancer: a case report]

The patient was a 79-year-old man who underwent extensive gastrectomy and Billroth-II reconstruction for gastric ulcer in 1974. He complained of heartburn in November, 1992, and endoscopy for the residual stomach revealed IIb + IIa-like lesion mainly in the posterior wall of the anastomosed site, which was diagnosed as well differentiated adenocarcinoma. As the patient refused to be operated, 150 mg/day of 5-FU was administered. For 4 months before he decided to undergo operation, 12.9 g of 5-FU was administered in total. After rehospitalization, endoscopy of the residual stomach showed shrinkage of the lesion, and biopsy revealed no malignant findings. The pathological examination after total resection of the residual stomach showed atypism, but no evidence to support malignancy. He has continued to be well without sign of recurrence for 1 year since the operation. The administration of 5-FU is widely used as preoperative adjuvant chemotherapy. This case it is rare for 5-FU to cause the disappearance or falling off of malignant cells.

Central mechanism of neural activation with cold acclimation of rats using Fos immunohistochemistry

The expression of Fos protein in the rat diencephalon, brain stem, cerebellum, and spinal cord was investigated using immunohistochemistry during chronic cold exposure, in order to clarify the neural regions involved in the thermoregulatory responses and the central mechanism of neural activation with cold acclimation. Numerous Fos-positive cells were observed in many brain regions after cold exposure and changes in the number of Fos-positive cells were analyzed quantitatively. Fos-positive regions were classified into three groups on the basis of the expression period of Fos protein. The first group was where a significant number of Fos-positive cells were seen 3 h and 24 h after cold exposure, but not observed 14 days after exposure; the regions included the lateral septal nucleus (LS), parvocellular paraventricular hypothalamic nucleus (pPVN), posterior hypothalamic area (PH), supramammillary nucleus (SuM), locus coeruleus (LC), dorsal tegmental nucleus (DTg), vestibular nucleus (Ves), and nucleus of solitary tract (Sol). The second group was where a significant number of Fos-positive cells were found 3 h, 24 h and 14 days after cold exposure; the regions included the preoptic hypothalamic area (POA), paraventricular thalamic nucleus (PV), lateral preoptic area (LPO), zona incerta (ZI), subparafascicular thalamic nucleus (SPF), lateral dorsal central grey (CGLD), lateral ventral central grey (CGLV), microcellular tegmental nucleus (MiTg), lateral lemniscus nucleus (LL), dorsal parabrachial nucleus (DPB), and the cerebellum. The third group was where Fos-positive cells were more numerous 14 days after cold exposure than they were after 3 h and 24 h of exposure; these regions included the ventromedial hypothalamic nucleus (VMH) and the spinal cord. These results demonstrate that the numbers and regions of Fos-positive cells in the rat brains changed during chronic cold exposure, and such changes may reveal the cellular adaptation of the thermogenic responsive neurons in the rat brain to cold acclimation.

Temporal changes of c-fos expression in oxytocinergic magnocellular neuroendocrine cells of the rat hypothalamus with restraint stress

The present experiments were undertaken to examine c-fos expression in magnocellular neuroendocrine cells (MNCs) of the rat hypothalamus with restraint stress using dual immunohistochemistry for c-fos and oxytocin. Restraint stress induced c-fos expression in oxytocinergic MNCs in the supraoptic nucleus (SON) and paraventricular nucleus (PVN). Quantitative immunohistochemical analysis revealed that percentages of c-fos-positive cells to oxytocin-immunoreactive MNCs in the SON and PVN maximally increased at 2 h after restraint stress had started, and began to decline in spite of the fact that the restraint of animals were continued. Similar results were obtained from time course of c-fos expression in parvocellular neurons of the PVN. When animals were released to move freely in their home cages following the 3-h restraint, the plasma levels of oxytocin declined to reach basal levels within 30 min and c-fos immunoreactivity in the hypothalamic MNCs and parvocellular neurons disappeared faster than those of the continually restrained. These results demonstrate that restraint stress induces c-fos expression in oxytocinergic MNCs in the SON and PVN, and that time course of c-fos expression is transient even in the continuation of restraint stress.

[A case report: reopacified thrombosed dissection of Stanford type A]

A 60-year-old male, who had been hospitalized with a Stanford type B acute aortic dissection 3 years ago, was admitted with severe disquiet caused by discomfort of the chest and the neck. Enhanced CT scans demonstrated the ascending aorta compressed by non-opacified false lumen, so-called "thrombosed dissection" or "closing aortic dissection", and normal descending aorta. Aortography showed no intimal tear in the ascending aorta and aortic arch. "Hibernation therapy" with pentobarbital was performed to be sedated over during 13 days. 29 days later follow-up CT scans showed reopacified false lumen and enlargement of the ascending aorta, although he had no complaints during the medical therapy. Large intimal tear just under the brachiocephalic artery and giant false lumen without reentry occupying the ascending aorta was found by the repeat aortography. Graft replacement of the ascending aorta was successfully performed. This case suggested that thrombosed dissection might have the risk of recanalization of clotted false lumen asymptomatically, and it would be important to take care of radiographic changes during the medical therapy even if the patient had no symptoms.

A case of extraadrenal pheochromocytoma with papillary thyroid carcinoma

A 63-year-old housewife with a history of partial thyroidectomy was referred to our hospital because of a neck mass and abdominal tumor. Aspiration biopsy of the neck tumor revealed the recurrence of papillary thyroid carcinoma. Magnetic resonance imaging (MRI) of the abdomen and urinary and plasma catecholamine levels indicated that the tumor beside the abdominal aorta was an extraadrenal pheochromocytoma. Two tumors were excised and histologic studies confirmed the diagnosis. So far two cases of extraadrenal pheochromocytoma with papillary thyroid carcinoma have been reported. The present case indicates that the presence of papillary thyroid carcinoma should be considered in patients with extraadrenal pheochromocytoma.

Urinary N-acetyl-beta-D-glucosaminidase (NAG) activity in patients with Graves' disease, subacute thyroiditis, and silent thyroiditis: a longitudinal study

Urinary N-acetyl-beta-D-glucosaminidase (NAG) activity was measured longitudinally in 12 patients with Graves' disease, 5 patients with subacute thyroiditis, and 1 patient with silent thyroiditis, and compared with that of 36 normal controls. The patients with Graves' disease and subacute thyroiditis were treated with anti-thyroid drug (methimazole or propylthiouracil) and prednisolone, respectively. On the other hand, no treatment was given to the patient with silent thyroiditis. Since two patients with Graves' disease clearly showed transient deterioration of the thyroid function during the treatment period, data from these two patients were separately investigated. Urinary levels of NAG in the remaining ten patients with Graves' disease before, 1, 3, 6 and 12 months after the treatment were 15.59 +/- 7.93 (SD), 8.96 +/- 6.82, 4.39 +/- 2.33, 3.46 +/- 2.24, and 3.63 +/- 2.38 U/g.creatinine (g.Cr.), respectively. Those obtained before, 1 and 3 months after the treatment were significantly higher than those of the controls (2.85 +/- 1.12 U/g.Cr.). Free thyroid hormone levels became normal or low 3 months after the treatment. The two Graves' patients mentioned above showed a transient increase in urinary NAG with concomitant changes in free thyroid hormone levels. Urinary NAG levels in the patients with subacute thyroiditis before, 2, 4, and 6 weeks after the treatment were 16.56 +/- 10.97, 6.76 +/- 2.79, 3.14 +/- 0.48 and 3.70 +/- 1.44 U/g.Cr., respectively. Those obtained before and 2 weeks after the treatment were significantly higher than those of the controls. Free thyroid hormones were normal 2 weeks after therapy. Urinary NAG in the patient with silent thyroiditis was 9.60 U/g.Cr. on the first visit and gradually decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Studies on the distribution of mineral elements in the tooth of zinc-deficient rats

Elemental analysis of plaque-like black deposits noted on the surface of teeth in zinc-deficient rats at necropsy was performed. Rats deficient in zinc show signs of abnormality in iron metabolism and increase or accumulation of iron in plasma and tissues. This study was designed, therefore, to examine the plasma and salivary levels of iron and other elements and to determine the distribution of mineral elements in the dental substances of zinc-deficient rats by contact microradiography, electron probe microanalysis (EPMA) and X-ray fluorescent element mapping spectrometry (XEMS) on ground sections of teeth. Rat tooth specimens were analyzed also for zinc, iron, copper and manganese using colorimetry and Inductively Coupled Plasma, ICP. EPMA and XEMS analyses revealed the presence of iron on the enamel surface of maxillary molars teeth of zinc-deficient rats. However, no such deposition was seen on those of controls. The zinc-deficient rats showed higher iron concentration in mixed saliva and in plasma, compared with the controls. Thus, the sign of abnormality in iron metabolism noted in the oral cavity of zinc-deficient rats was investigated by EPMA and XEMS analyses, with discussion on the origin of supradental iron deposits.

The fine structure and formation of hypermineralized petrodentine in the tooth plate of extant lungfish (Lepidosiren paradoxa and protopterus sp.)

Histological features of the tooth plate of lungfish were investigated by light and electron microscopy and contact microradiography with primary reference to the fine structure and formation of petrodentine, one of the principal constituents of the tooth plates. Petrodentine is a highly mineralized tissue noticeably analogous to that of enameloid, and is deposited intermittently in a proximal direction by the sole participation of mesenchymal petroblasts. The petroblasts appear very likely to have prominent biphasic functions of secreting the petrodentine matrix and of eliminating the matrix by resorption. The petrodentine thus may be capable of attaining hypermineralization with the participation mesenchymal cells alone. Mineral crystals constituting the petrodentine are large, hexagonal or similar but irregularly shaped columns. Initially these crystals appeared extremely thin, with curled ones frequently noted. The petrodentine of lungfish tooth plates is considered to be structurally distinct from the pleromin (Kosmin) of holocephalian tooth plates because of the difference between their constituent crystals.

Microstructural features of dipnoan tooth enamel

Tooth plates of extant lungfishes were examined by contact microradiography, light microscopy and TEM, to elucidate the nature and origin of the hypermineralized surface layer. TEM indicated that the matrix of this layer consisted of organic filamentous material, and no collagen fibres were seen in the matrix. The matrix appeared to be secreted by oral epithelial cells of the inner fold surrounding the surface of the tooth plate, and deposited in the area between the cell membrane and basal lamina-like structure of these epithelial cells. Therefore, it is suggested that the hypermineralized surface layer of lungfish plates is enamel of ectodermal origin.

The structure and development of the collar enameloid in two teleost fishes, Halichoeres poecilopterus and Pagrus major

Histologically the outer layer of the collar enameloid obviously differs from the inner layer, and it has a degree of mineralization nearly as high as the cap enameloid which has the highest. In the stage of matrix formation, the organic matrix of the collar enameloid contains a number of collagen fibers, and odontoblasts display features suggesting that these cells actively synthesized and secreted collagen. A number of cell processes, matrix vesicles and some cell debris which were probably derived from the odontoblasts were observed in the organic matrix of the collar enameloid. We consider that the majority of the organic matrix in collar enameloid originates from the odontoblasts. In the stage of maturation, collagen fibers were not observed in the outer layer of the collar enameloid in demineralized specimens. In the IDE cells during this stage, the complex infoldings of cell membranes developed in the distal portion, and several lysosomal granules and irregular-shaped granules containing many tubular structures, were observed in the distal cytoplasm. In the ODE cells, abundant labyrinthine canals appeared in the cytoplasm, and capillary vessels were found close to the outer surface of the ODE cells. We assume that the higher mineralized outer layer of the collar enameloid is made possible by the absorptive and transport functions of the epithelial cells during the stage of maturation. It is considered that the collar enameloid in this study was initially produced by the odontoblasts and then reconstructed by the epithelial cells, so that the collar enameloid differs from true enamel.

Enamel structure in odontocete whales

With regard to the enamel structure of mammals, a large number of studies have been reported in the past. Of them, however, the enamel structure of odontocetes has not yet been sufficiently elucidated. The author therefore observed the enamel structure of 11 species in 7 families of living odontocetes. A clear prism structure in the enamel is noted in delphinids and Pontoporia blainvillei. Neophocaena phocaenoides has a very simple-structured prism, but even this structure is obvious only in the deep layer of the enamel, disappearing gradually from the mid layer to surface layer. The prism pattern of delphinids differs significantly depending on the site of the enamel; that of Pontoporia shows as a whole pattern 1. On the other hand, the enamel of Physeter catodon, Berardius bairdi, Phocoena phocoena, Phocoenoides dalli and Delphinapterus leucus is prismless. The enamel of Physeter and Phocoena shows pseudoprisms; that of Phocoenoides contains enamel tubuli. The enamel of Berardius and Delphinapterus is 3 to 8 micron thick, which is extremely thin for mammalian enamel. No enamel was noted in Monodon monoceros teeth. The enamel structure of living odontocetes is thus very variable. Several characteristic structures having been present during the evolutionary course of this tissue are still present in some of them. As the results of comparative histologic study, it is considered that the variable enamel structure of living odontocetes is a secondary phenomenon produced during the degenerative history of the enamel.