Emphasis on the need for timing of autogenic training

The need for an individualized assessment of the blood pressure response to autogenic training based on longitudinal monitoring is commented upon with separate emphasis on the need for testing the effect of timing administration of autogenic training by stage of circadian rhythms and other pertinent components of a broader chronome (time structure).

Hippocratic thermography

The thermal measurement method of Hippocrates, which has been referred to as the first for measuring body temperature, was reproduced and the image obtained was compared with an infra-red radiation thermogram. Hippocrates' method involves covering the patient's thorax with an earth-soaked cloth. As the warmer areas dry faster, the pattern of enlargement of the dry area shows the temperature distribution. Therefore, it appears that Hippocrates was the first to obtain thermograms.

Meta-analyzed heart rate variability, exposure to geomagnetic storms, and the risk of ischemic heart disease

The aim was to examine how heart rate variability (HRV) relates to the risk of ischemic heart disease (IHD) and may provide a means to assess effects of exposure to geomagnetic storms. In Stockholm, the 24-hour SD of hourly estimates of heart rate (HR) were obtained by Holter monitoring from 50 men who had had an acute myocardial infarction or had angina pectoris and compared to that of 50 clinically healthy men of similar age. In Tokyo, the HR 121 normotensives and 176 treated hypertensives was monitored. The incidence of IHD was recorded prospectively for 6 years. These results are aligned with those of a retrospective analysis of archived data on all crews of the Soyuz spacecraft for 1990-1994 focused on ECG from cosmonauts (47 male and 2 female) at times corresponding to geomagnetic storms. The results clearly indicate a decrease in HRV in association with IHD (20.5%, p=0.002 in Stockholm, 20.0%, p=0.04 in Tokyo). By comparison, the about 30% decrease (p=0.041) in rms SD of HR in cosmonauts studied during a geomagnetic storm as compared to cosmonauts monitored on quiet days adds supportive evidence to the proposition that exposure to geomagnetic disturbances increases cardiovascular disease risk.

Evaluation of bone marrow iron by magnetic resonance imaging

Bone marrow iron was estimated by magnetic resonance imaging (MRI) using spin-echo sequences with multiple echoes in 22 patients with varying degrees of tissue storage iron. Levels of bone marrow iron concentration (BMIC) were determined chemically in biopsied specimens concurrently. Concentrations of serum iron, serum ferritin, and transferrin saturation were also measured to evaluate body iron status. Significant correlation was observed between BMIC and T2 relaxation rate (1/T2) (r = 0.77; p < 0.001) in all patients with BMIC levels below 400 micrograms/ml, while BMIC was not correlated with T2 in patients with extremely high BMIC levels. MRI was considered to be inappropriate for quantitation of 1/T2 in patients with extremely high BMIC due to an extreme shortening of T2 relaxation time. These observations suggest that MRI may be a useful and noninvasive method for systemic quantitative determination of bone marrow iron.

Individual assessment of antihypertensive response by self-starting cumulative sums

A self-interpreted control chart, on an individualized basis, assesses the effect of a switch from beta-blockers to an angiotensin-converting enzyme (ACE)-inhibitor in a patient with occasional blood pressure (BP) excess. In dense and long data series, the BP and heart rate (HR) of this patient respond to the change in treatment by the test criterion of a self-starting Cumulative Sum (cusum), which reaches values outside a decision interval with a lowering of BP and an increase in HR and vice versa, at least for BP, after treatment cessation. Thereafter, minimal sampling requirements are sought in the same data by applying the same control chart approach to decimated data. Skeleton sampling schemes in a system of chronobiologic self-analysis and interpretation of manually recorded data obtained at strategically placed times (established on the basis of data decimations) could complement control charts that are used on a home computer or preferably would be built into the output of ambulatory monitors used at the outset as a minimum and routinely as an optimum.

Parametric resonance in a modulated microchip multimode laser

A nonlinear response of a laser-diode-pumped microchip LiNdP(4)O(12) (LNP) multimode laser that is subjected to multiple-frequency modulations is investigated. Clustering and breathing motions featuring intermode parametric resonances are demonstrated when the LNP laser was modulated by rational frequencies chosen to be nearly resonant to multiple relaxation-oscillation frequencies inherent in multimode lasers. A simple correspondence between the modulation signal patterns and the total-output power-spectrum patterns is demonstrated.

Nemaline bodies of skeletal muscle fibers of the neck in a case of pharyngeal cancer

Nemaline bodies were found in the regenerating muscle fibers of the neck of a 74-year-old Japanese male with pharyngeal cancer. Histologically, the nemaline bodies were needle-shaped structures and hematoxophilic with phosphotungstic acid-hematoxylin stain. Electron microscopic examination suggested that they arise as extensions of the Z bands. Although nemaline bodies occur in a variety of pathological conditions other than nemaline myopathy, their occurrence in regenerating skeletal muscle fibers invaded by cancer has not been reported previously. The pathogenesis of the nemaline body formation in the present case is discussed.

Effect of dental cyst epithelium-conditioned medium on collagenase production by periodontal ligament fibroblasts

Seven dental cyst epithelia were cultured in vitro and the conditioned media were analyzed for periodontal ligament fibroblast collagenase production. All the cyst epithelium-conditioned media stimulated fibroblast collagenase production, indicating that dental cyst epithelium, which is considered to be identical to the cell rests of Malassez, might play a role in periodontal pocket formation.

Experimental suppression of chaos in a modulated multimode laser

Suppressing chaotic behavior by addition of a weak second periodic perturbation signal, which is nearly resonant to a subharmonic of the fundamental system frequency, is observed in a modulated microchip LiNdP(4)O(12) multimode laser by a highly sensitive self-mixing modulation technique. The stabilization of the unstable period-2 orbit embedded in a chaotic attractor is demonstrated in a wide parameter region. The chaos-suppressing experiments are well reproduced by simulations of globally coupled modulated Tang-Statz-deMars [J. Appl. Phys. 34 8289 (1963)] multimode laser equations, including a spatial hole-burning effect.

Nocturnal blood pressure fall on ambulatory monitoring in a large international database. The "Ad Hoc' Working Group

A wide range of definitions is used to distinguish subjects in whom blood pressure (BP) falls at night (dippers) from their counterparts (nondippers). In an attempt to standardize the definition of nondipping, we determined the nocturnal BP fall and night-day BP ratio by 24-hour ambulatory monitoring in 4765 normotensive and 2555 hypertensive subjects from 10 to 99 years old. In all subjects combined, the systolic/diastolic nocturnal fall and corresponding ratio averaged (+/- SD) -16.7 +/- 11.0/ -13.6 +/- 8.1 mm Hg and 87.2 +/- 8.0%/83.1 +/- 9.6%, respectively. In normotensive subjects, the 95th percentiles were -0.3/-1.1 mm Hg for the nocturnal fall and 99.7%/98.3% for the night-day ratio. Both the fall and ratio showed a curvilinear correlation with age. The smallest fall and largest ratio were observed in older (> or = 70 years) subjects. A higher BP on conventional sphygmomanometry was associated with a larger systolic (partial r = .11) and diastolic (r = .12) nocturnal BP fall. The diastolic (r = .08) but not the systolic night-day ratio increased with higher conventional BP. The nocturnal BP fall was larger and the corresponding night-day ratio smaller in oscillometric (n = 5884) than in auscultatory (n = 1436) recordings, in males (n = 3730) than in females (n = 3590), and in Europe (n = 4556) than in the other continents (n = 2764). The distributions of the nocturnal BP fall and night-day ratio showed considerable overlap among normotensive and hypertensive subjects, but the overlap tended to be larger for the ratio than for the fall. Of all subjects, 3.2% had systolic and diastolic ratios of 100% or more. With adjustments applied for confounders, the probability of being a nondipper increased 2.8 times (95% confidence interval, 2.0-4.0) from 30 to 60 years and 5.7 times (4.4-7.4) from 60 to 80 years. The odds ratios were 1.0 (0.8-1.4) for males versus females. 1.6 (1.2-2.1) for subjects with definite hypertension versus normotensive subjects, 2.4 (1.2-4.7) for Asians (n = 2213, 96% Japanese) versus inhabitants of the other continents, and 2.4 (1.5-3.8) for subjects examined with auscultatory versus oscillometric devices. In conclusion, the mathematical definition of nondipping, ie, having a night-day ratio of 100% or more for systolic and diastolic BPs, closely approximated the 95th percentiles of the night-day ratio in normotensive subjects. The ratio depends less on BP level than the nocturnal BP fall and is therefore to be preferred in the definition of dipping status. Notwithstanding the present findings, the reproducibility of nondipping and its prognostic significance need further clarification.

Excessive circadian amplitude of blood pressure increases risk of ischaemic stroke and nephropathy

After 48-h ambulatory blood pressure monitoring, the incidence of ischaemic stroke, nephropathy, coronary heart disease and retinopathy was prospectively assessed for 6 years in 297 subjects, including 176 treated patients with an elevated blood pressure mean (MESOR-hypertensives). The relative risk associated with an excessive circadian blood pressure amplitude is 8.2 (95% confidence interval 3.1 to 21.7; p < 0.001) for ischaemic stroke and 6.9 (2.9 to 16.3; p < 0.001) for nephropathy. In MESOR-hypertensives, the relative risk for ischaemic stroke and nephropathy is 6.3 (p < 0.005) and 4.0 (p < 0.05), respectively. In MESOR-normotensives as well, an excessive circadian blood pressure amplitude is associated with a large increase in risk for ischaemic stroke and nephropathy (p < 0.05). An excessive circadian blood pressure amplitude is an entity in its own right that increases the risk of adverse vascular events irrespective of the blood pressure MESOR, age and the presence of other known risk factors. The diagnosis of this condition requires around-the-clock monitoring of blood pressure. The treatment of patients with this condition should aim not only at lowering the blood pressure mean but also at reducing blood pressure variability within 24 h.

Modified Kasai's procedure for a choledochal cyst with a very narrow hilar duct

Excision has been widely recognized as the treatment of choice for choledochal cysts. For biliary reconstruction after cyst excision, we have strongly recommended hepaticoenterostomy at the hepatic hilum with a wide anastomotic stoma to prevent postoperative cholangitis. However, we recently treated two infants in whom a wide anastomotic stoma could not be made due to a narrow hilar duct. Therefore, a hepatic portojejunostomy with Roux-en-Y anastomosis (Kasai's procedure) was performed after cyst excision in both case to permit free drainage of bile. The mucosa of the hilar duct was everted and fixed to the liver parenchyma to prevent stricture formation. Both babies have done well since the surgery.

Chronobiometric assessment of autogenic training effects upon blood pressure and heart rate

Autogenic training, a method of self-hypnosis, lowers the extent of within-day variation of systolic blood pressure assessed by the circadian double amplitude. The blood pressure and heart rate of ten patients, conventionally diagnosed as having hypertension or white-coat hypertension, were automatically monitored at 30-min intervals for 7 days before autogenic training and again for 7 days, at 1 or 2 months after the start of autogenic training (practiced three times daily). The circadian double amplitude of systolic blood pressure of the patients investigated was 3 to 17 mm Hg lower on autogenic training. In 5 patients, reductions by 7 to 17 mm Hg were statistically significant. These results are regarded as provisional statistics, the utility of which depends on replication. By contrast, the over-all group reduction of the circadian double amplitude of systolic blood pressure by 8 mm Hg on the average can be taken at face value. Autogenic training also lowered the circadian double amplitude of diastolic blood pressure, but the effect was small as was the effect of autogenic training upon the MESOR (a rhythm adjusted mean) and acrophase (a measure of the timing of over-all high values recurring each day). The effect of autogenic training upon the circadian double amplitude of systolic blood pressure suggests its trial as first-line treatment of patients with an excessive circadian blood pressure amplitude, a condition which, even in the absence of an elevated 24-hr, average of blood pressure, is associated with a large increase in the risk of developing ischemic stroke or nephropathy.

Clinical relevance of about-yearly changes in blood pressure and the environment

Changes identified by inferential statistics from summer to winter of high to low arterial blood pressures (BP) have been quantified as a large predictable about-yearly BP swing. This condition of a large annual BP amplitude (LABPA) raises concern about hypotension as well as hypertension and raises new questions regarding appropriate guidelines for diagnosis and treatment. Recommendations made in the fall on the basis of data collected in the summer may be totally inadequate in dealing with the patient's condition in the winter. In order to avoid such mistakes, it is imperative to implement a systematic surveillance of BP in the light of current chronobiological limits. Patients with a large circannual BP amplitude are particularly suited for a study of the underlying hormonal mechanisms. The longitudinal monitoring of their BP is also amenable to the study of environmental influences from near and far.

Activation by estrogen of the number and function of forbidden T-cell clones in intermediate T-cell receptor cells

When estrogen (1 mg/mouse) was subcutaneously administered once into mice, the number of liver MNC increased but the number of thymocytes decreased profoundly from Day 3 to Day 20. Phenotypic characterization revealed that the proportion of intermediate (int) TCR cells with IL-2 receptor beta-chain (IL-2R beta) was elevated in both the liver and the thymus. Attention was then focused on how forbidden clones were distributed among various T-cell subsets, including IL-2R beta+ int TCR cells and IL-2R beta-high TCR cells. IL-2R beta+ int TCR cells are generated through the extrathymic pathway in the liver and an alternative intrathymic pathway, whereas IL-2R beta- high TCR cells are generated through the mainstream of T-cell differentiation in the thymus. It was demonstrated that forbidden clones, V beta 3+ and V beta 11+ cells, in BALB/C mice (Mls-1b2a) were confined to IL-2R beta+ int TCR cells, irrespective of the administration of estrogen. Interestingly, the proportion of forbidden clones among int TCR cells increased in the liver but decreased in the thymus after the administration of estrogen. Liver MNC that contained a high level of forbidden clones showed unexpected high levels of spontaneous proliferation and of the proliferative response to immobilized anti-V beta mAb (even in the combination of forbidden clone stimulations). The present results reveal that the levels of both int TCR cells and forbidden clones that induce hepatocyte damage preferentially increase in the liver, one of the prime target organs in autoimmune diseases, when estrogen is administered.

[Expression of decay-accelerating factor on CD8-positive lymphocytes as an index of aging and of host defense function]

Decay-accelerating factor (DAF) is a membrane glycoprotein that prevents complement activation on blood cells. Among CD8+ T cells, DAF-negative cells can be distinguished from DAF-positive cells. We computed the proportion of DAF-negative CD8+ T cells in the peripheral blood of 59 normal healthy subjects, 27 to 93 years old, and analyzed the differences between subjects of different ages. The proportion of CD8+ T cells that were DAF-negative correlated significantly and positively with age. We also studied these lymphocytes in patients with cerebrovascular dementia, Alzheimer's dementia, cancer, rheumatoid arthritis and systemic lupus erythematosus. The proportion of CD8+ T cells that were DAF-negative did not correlate significantly with age in patients with cerebrovascular dementia, Alzheimer's dementia or cancer, but it correlated significantly and positively with age in patients with rheumatoid arthritis and in those with systemic lupus erythematosus. Therefore, healthy subjects and patients with various diseases can be classified according to age and to the proportion of CD8+ T cells that are DAF-negative. This proportion can then be used as an index of aging and of host defense function.

[Surgical treatment of infective endocarditis : an analysis of the risk factor for operative mortality]

From January 1980, through December 1995, 60 patients underwent surgical treatment of infective endocarditis (IE) at Sakakibara Hospital. Of 60 patients, 40 showed active endocarditis and 20 healed endocarditis at the time of operation. The over-all hospital mortality was 10% (6/60). The complication of cerebral accident (embolism and bleeding) was related to a higher incidence of operative mortality. The reconstructions of destruction and disruption of ventricular-aortic or mitral-aortic continity in the presence of acute infection of the annular tissue were in need of radical and complex surgical techniques. It is recommended to follow up these patients thoughtfully and to perform reoperation or re-reoperation before a patient develops severe heart failure or multiple organ failure.

Sodium balance and hypertension in obese and fatty rats

To investigate the role of sodium in obesity induced hypertension, Wistar fatty rats (WFR) were employed. This rat has the following characteristics: (1) hyperglycemia, (2) hyperinsulinemia, and (3) hypertriglycemia. Four percent sodium chloride with constant amount of food intake was administered to these rats from 8 to 16 weeks. During this period, body wt, food intake, water consumption, urine volume, systolic blood pressure, urinary excretion of sodium and potassium, urinary albumin excretion, plasma sodium and potassium, and plasma glucose and immunoreactive insulin (IRI) were measured before, and twice more during eight weeks. No remarkable changes were observed in plasma glucose level during these periods between the two groups. On the other hand, in group 1 IRI significantly increased compared with group 2. Mean blood pressure was increased from 110 +/- 5 to 130 +/- 8 mm Hg (P < 0.01). To ascertain whether this salt sensitivity relates to the abnormalities in pressure-natriuresis responses, the pressure-natriuresis (P-N) was characterized. The P-N curve in WFR was shifted to the right and its slope was flattened compared to its control Wistar lean rats. In conclusion, an excess of dietary sodium intake may contribute to an elevation of blood pressure in Wistar fatty rat with hyperglycemia and hyperinsulinemia. This salt sensitivity may change the abnormal pressure-natriuresis responses.

Blood pressure "dipping" and "non-dipping" in obstructive sleep apnea syndrome patients

Obstructive sleep apnea syndrome (OSAS) has been associated with a higher than normal cardiovascular morbidity and mortality. Some OSAS patients lack the sleep-related, nocturnal decrease, or "dip," in blood pressure which is seen in normal individuals. These subjects, called "non-dippers," may be at greater risk for cardiovascular problems. We studied 40 OSAS patients (including 3 women) and 6 control subjects, all identified by polysomnography, for nocturnal blood pressure "dipping." We performed a second nocturnal polysomnogram to determine their apnea and hypopnea indices, (A + H)I, and oxygen saturation levels at the beginning of the study and then initiated 48 hours of ambulatory blood pressure monitoring, with data points collected every 30 minutes. Controls, which included one hypertensive subject, were all dippers. Nineteen OSAS subjects (48% of OSAS individuals) were systolic non-dippers and only 9 of them (22.5%) were diastolic non-dippers. We considered the following clinical variables as potential predictors of non-dipping: age, body mass index, respiratory disturbance index, years of reported loud snoring by bed partners, lowest oxygen saturation during nocturnal sleep, and percentage of sleep time spent with oxygen saturation below 90%. Multiple regression analyses indicated respiratory disturbance index as the only significant variable for systolic (p = 0.04) and diastolic (p = 0.03) blood pressure non-dipping. When we forced the following two nonsignificant variables into the model, they showed a very meager impact: number of years with reported loud snoring (p = 0.4 and p = 0.5, respectively for systolic and diastolic blood pressure non-dipping) and age (p = 0.5 and p = 0.6). The calculated model explained only a low percentage of the variance with an r2 of 0.25 and 0.26 for systolic and diastolic blood pressure non-dipping, respectively. Analysis of hypertension/normotension and dipping/non-dipping failed to show a significant relationship in the studied population. Fifty percent of the normotensive OSAS subjects were non-dippers and 43% of the hypertensive OSAS subjects were also non-dippers. We found a relationship between increasing respiratory disturbance index and increasing average 24-hour systolic blood pressure only when OSAS subjects were non-dippers and hypertensive.

Adsorption of saliva-coated and plain streptococcal cells to the surfaces of hydroxyapatite beads

This study was conducted to observe the differences between the adsorption of Streptococcus sanguis by saliva-coated and non-saliva-coated cells (plain cells) to the surfaces of saliva-coated, bovine serum albumin-coated or buffer-washed hydroxyapatite beads. Saliva treatment of bacterial cells altered the manner of saturation due to changes of affinity and/or the maximal number of adsorption sites on the hydroxyapatite beads. This result indicates that saliva treatment of bacterial cells might be a necessary step in testing bacterial adsorption to saliva-coated hydroxyapatite beads or saliva-coated teeth.

Nature and distribution of chondroitin sulphate and dermatan sulphate proteoglycans in rabbit alveolar bone

The type and distribution of mineral binding and collagenous matrix-associated chondroitin sulphate and dermatan sulphate proteoglycans in rabbit alveolar bone were studied biochemically and immunocytochemically, using three monoclonal antibodies (mAb 2B6, 3B3, and 1B5). The antibodies specifically recognize oligosaccharide stubs that remain attached to the core protein after enzymatic digestion of proteoglycans and identify epitopes in chondroitin 4-sulphate and dermatan sulphate; chondroitin 6-sulphate and unsulphated chondroitin; and unsulphated chondroitin, respectively. In addition, mAb 2B6 detects chondroitin 4-sulphate with chondroitinase ACII pre-treatment, and dermatan sulphate with chondroitinase B pre-treatment. Bone proteins were extracted from fresh specimens with a three-step extraction procedure: 4 M guanidine HCl (G-1 extract), 0.4 M EDTA (E-extract), followed by guanidine HCl (G-2 extract), to characterize mineral binding and collagenous matrix associated proteoglycans in E- and G2-extracts, respectively. Biochemical results using Western blot analysis of SDS-polyacrylamide gel electrophoresis of E- and G2-extracts demonstrated that mineral binding proteoglycans contain chondroitin 4-sulphate, chondroitin 6-sulphate, and dermatan sulphate, whereas collagenous matrix associated proteoglycans showed a predominance of dermatan sulphate with a trace of chondroitin 4-sulphate and no detectable chondroitin 6-sulphate or unsulphated chondroitin. Immunocytochemistry showed that staining associated with the mineral phase was limited to the walls of osteocytic lacunae and bone canaliculi, whereas staining associated with the matrix phase was seen on and between collagen fibrils in the remainder of the bone matrix. These results indicate that mineral binding proteoglycans having chondroitin 4-sulphate, dermatan sulphate, and chondroitin 6-sulphate were localized preferentially in the walls of the lacunocanalicular system, whereas collagenous associated dermatan sulphate proteoglycans were distributed over the remainder of the bone matrix.