[Effectiveness of a programme to improve housing conditions for elderly requiring supportive care in Edogawa-ku, Tokyo]

The programme in Edogawa-ku, Tokyo, for improvement of housing conditions for the elderly requiring supportive care, is unique in Japan in that it offers unlimited amount of benefits regardless of income status of beneficiaries. Between October, 1990, when the programme started, to March, 1992, total of 447 people utilized the programme. These 18 months were divided into three periods for comparative analysis of characteristics of users, details of improvement in housing conditions and cost (amount of benefits). The proportion of bed-ridden cases decreased during the later periods, with a corresponding increase in those who had improvements made to entrances and approaches to their residence. However, average cost of changes in housing features decreased in the later periods because there was less demand for expensive changes such as bathtub remodeling or installation of lifts on stairs. A survey by mail was conducted to find out the effect from the users' viewpoint. Valid responses were collected from 290 cases. Three aspects of improvement in housing conditions were assessed: improvement in daily activities, reduction in the care taker's burden, and reduction in the need for long-term institutional care. More than one-third of the users reported improvement in each of three aspects, and two-thirds had improvements in at least one out of the three items. There were intercorrelation among the three items, especially between improvement in daily activities and reduction of the care taker's burden. Analysis showed that improvements were reported in a greater proportion of those living alone or in a two-person household, those who utilized the programme following discharge from inpatient care, those who had their bathroom or bathtub remodeled, and those who had the more expensive changes made. Changes in entrances and approaches to the residence was correlated to an improvement in daily activities. Reduction in care-taker's burden was seen where stroke was the cause of being dependent and where a specially equipped bed was provided. Reduction in the need for long-term institutional care is related to family structure and number of rooms in the home, which are barriers to continuing home care.

AS-186 compounds, new inhibitors of acyl-CoA: cholesterol acyltransferase from Penicillium asperosporum KY1635

AS-186a, b, c, d, and g were isolated from the cultured broth of Penicillium asperosporum KY1635 as inhibitors of acyl-CoA: cholesterol acyltransferase (ACAT). IC50 values for the effect of AS-186a, b, c, d, and g against ACAT activity of the microsomes from cholesterol-fed rabbit liver were calculated to be 22.9, 8.2, 11.5, 12.4, and 13.9 microM, respectively. Although AS-186a, and b were identical to penicillide and purpactin A, respectively, AS-186c, d, and g were found to be new compounds.

Characterization of the electron acceptors of old yellow enzyme: mechanistic approach to the mode of one electron transfer from the enzyme to menadione or dyestuffs

Molecular oxygen or cytochrome c has been described as the electron acceptor of the reaction of old yellow enzyme with NADPH. In this study, menadione was found to be a sensitive electron acceptor of the reaction under aerobic as well as anaerobic conditions. The Km value of menadione for old yellow enzyme is as low as 2-3 x 10(-7) M in the presence or absence of superoxide dismutase. The rate enhancement of the cytochrome c reduction of old yellow enzyme with NADPH was about eight times in the presence of menadione. The rate increment was slightly higher under aerobic than anaerobic conditions. The rate enhancement by menadione enabled sensitive determination of the enzyme activity in the assay system, which contained NADPH, cytochrome c, menadione, and old yellow enzyme. In the reaction course, the semiquinone species of menadione was trapped by the reaction with t-butyl-alpha-phenylnitrone. The radical adduct was detected on EPR. The dyestuff, 2,6-dichlorophenolindophenol, was found to be reduced ineffectively even in the presence of menadione; moreover, it was inhibitory in the NADPH consumption reaction. Methylene blue or Lauth's violet, known to be capable of semiquinone formation, also behaved, like menadione, as a mediator of electron transport to cytochrome c. On the basis of the experimental results, the occurrence of the one electron transfer of the old yellow enzyme reaction was emphasized.

Effects of zopiclone on slow wave sleep and spontaneous K-complexes for normal healthy young adults

Benzodiazepine (BZD) hypnotics have been known to decrease, to some degree, human slow wave sleep (SWS) although they elevate the arousal threshold during sleep. Zopiclone (ZPC), a cyclopyrrolone hypnotic, has attracted the interest of sleep researchers because an increase in human SWS has been reported. Since the increase has not been fully confirmed by all of the studies, the authors investigated the effects of ZPC 10 mg on SWS and the K-complexes for 7 healthy young adults because there is evidence indicating that delta waves consisting of SWS and the spontaneous K-complexes are identical. SWS and st. 4 sleep did not decrease on any of the ZPC nights but st. 3 sleep showed a tendency to reduce on the 1st ZPC night. The frequency of the K-complexes decreased significantly on the 2nd ZPC night and tended to reduce on the 1st ZPC night. Moreover, a significant positive correlation was noted between the decrease rates of SWS and the K-complexes on both the ZPC nights. The authors, therefore, could not obtain any findings suggesting an increase in SWS with ZPC.

AS-183, a novel inhibitor of acyl-CoA: cholesterol acyltransferase produced by Scedosporium sp. SPC-15549

A novel compound, AS-183, which inhibits acyl-CoA: cholesterol acyltransferase (ACAT), was isolated from the culture broth of a fungus, Scedosporium sp. SPC-15549. AS-183 inhibited ACAT activity in an enzyme assay system using rabbit liver microsomes with an IC50 value of 0.94 microM. AS-183 also inhibited cholesterol ester formation in HepG2, CaCo2, and THP-1 cells with IC50 values of 18.1, 25.5, and 34.5 microM, respectively.

Mortality of frail elderly people living at home in relation to housing conditions

STUDY OBJECTIVE

The study was undertaken to identify any relationship between the mortality of frail elderly people living at home and their housing conditions.

DESIGN AND SETTING

A cohort of frail elderly people living in Yao City, Osaka Prefecture, Japan was followed for six years. Data on demographic variables, activities of daily living, the disease that was the main cause of the disability, medical treatment, the feasibility of continuing family care, and some housing conditions were collected in December 1983 by interview during home visits. Deaths were checked for each year for five years.

SUBJECTS

Altogether 423 people aged 65 years or more living at home in Yao City who were disabled and housebound for at least three months were studied.

MEASUREMENTS AND MAIN RESULTS

Life table analysis and multivariate logistic regression analysis were done. The cumulative survival rates of old people with good housing conditions were higher than those with poor housing conditions in each group stratified by age, sex, or the activities of daily living level. The odds ratio for poor housing conditions compared with good housing conditions for five year mortality remained highly significant after adjustment for potential confounding factors including age, sex, and the activities of daily living level by logistic regression analysis.

CONCLUSIONS

The mortality of frail elderly people living at home is affected by housing conditions. Programmes to improve housing conditions of the disabled are important for home care of the elderly.

[Prediction of outcome in putaminal hemorrhage]

We obtained information on patients with putaminal hemorrhage (3,638 medically treated cases and 3,372 surgically treated cases). With these data, we have developed easily applicable and clinically useful prediction models for both mortality and activities of daily living (ADL) at three months after admission. We derived these models by Hayashi's discriminant technique for categorical data. Before their derivation, variables generally available on the initial day of hospitalization and possibly related to outcome were examined individually with tests of homogeneity. Neurological grading (NG), age, deformity of cisterns around midbrain, midline shift, hematoma volume, and motor paralysis were identified as candidate predictors of both mortality and ADL. CT classification was also added to the predictors of ADL. Initially, all these factors were included in tentative models, and then those which were found not to contribute substantially to the prediction were deleted. Ultimately, we proposed two models, one for mortality and the other for ADL. The mortality model used NG, hematoma volume, and deformity of cisterns around midbrain as predictors, and the ADL model used age, NG, CT classification, hematoma volume, and motor paralysis. Average correct classification rates were 87% (medical) and 69% (surgical) for mortality, and 64% (medical) and 60% (surgical) for ADL. With these models, we evaluated indications of both kinds of treatment by comparing each predicted ADL of the medically treated cases with that of the surgically treated cases.

Main trends in hospital use in different cities in Japan

In this study, trends in hospital use were identified in Japanese cities. Data for all inpatient care in May 1985 (9,555 patients) and in May 1988 (11,205 patients) paid for by National Health Insurance in 12 cities in Osaka Prefecture were analyzed. The main factor affecting differences in inpatient days per insured person of all ages (hospital use) among the cities were differences in hospital use by long-stay patients aged 70 years or older, which depended not on inpatient days per patient but on the rate of hospital admission. The main factor affecting change in mean hospital use from May 1985 to May 1988 seemed to be an increase in hospital use by long-stay patients 70 years of age or older, which did not depend on increases in the rate of hospital admission, but did depend on the number of insured persons 70 years of age or older. Calculation showed that an increase of 13 long-stay patients 70 years of age or older for 10,000 insured persons 70 years of age or older per year was to have accounted for about 40% of the increase in hospital use by all patients. If the trend for increasing hospital use in Japan is to be altered, the first step might be the careful planning for this comparatively small increase in long-stay elderly patients by promotion of a non-hospital-based care system.

Preparation of glycyrrhetic acid beta-glycosides having beta (1-->2)-linked disaccharides by the use of 2-O-trichloroacetyl-beta-D-pyranosyl chlorides and their cytoprotective effects on hepatic injury in vivo

Stepwise glycosidation was adopted for the construction of glycyrrhetic acid beta-glycosides (27-30) having beta (1-->2)-linked disaccharides such as 2-O-beta-D-glucuronopyranosyl-beta-D-glucopyranose, 2-O-beta-D-glucuronopyranosyl-beta-D-galactopyranose, 2-O-beta-D-glucopyranosyl-beta-D-glucuronopyranose and 2-O-beta-D-galactopyranosyl-beta-D-glucuronopyranose. In the first glycosidation, 2-O-trichloroacetyl-beta-D-payranosyl chlorides (9-11) were utilized as starting sugar derivatives to react with methyl glycyrrhetinate (5): Glycosidation of 5 with 9 and 10 gave beta- and alpha-monoglycosides (12) and (13), and (15) and (16), respectively. Treatment of the beta-glycosides 12 and 15 with ammonia-saturated ether gave products (14) and (17), respectively. The glycosidation of 5 with 11 followed by treatment with ammonia-saturated ether gave compounds (18) and (19), respectively. The second step glycosidations of 14 and 17 with methyl 2,3,4-tri-O-acetyl-alpha-D-glucuronatopyranosyl bromide (20) gave diglycoside derivatives (23) and (24), respectively, and that of 18 with 2,3,4,6-tetra-O-acetyl-alpha-D-glucopyranosyl bromide (21) and -alpha-D-galactopyranosyl bromide (22) gave diglycoside derivatives (25) and (26), respectively. The removal of the protecting groups of 23-26 gave diglycosides 27-30, respectively, having a beta-D-glucuronopyranose (beta-D-glcUA) as one of two sugar components in the molecules. The cytoprotective effects of the synthesized glycosides 27-30 on carbon tetrachloride (CCl4)-induced hepatotoxicity in vivo were compared with diglycosides 31-33 having only neutral sugar components and naturally occurring glycyrrhizin (34) having two acidic sugar components (beta-D-glcUA).(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of the specific labile sites in the 180 kDa catalytic polypeptide of the Drosophila melanogaster DNA polymerase alpha-primase complex

The immunoaffinity-purified DNA polymerase alpha-primase complex from Drosophila melanogaster Kc cells contains three high molecular weight polypeptides besides the 180 kDa catalytic polypeptide. These polypeptides are immunologically cross-reactive with the 180 kDa polypeptide. When the immunoaffinity-purified complex was kept at 4 degrees C for about four weeks, the amounts of the three polypeptides increased, while the 180 kDa polypeptide completely disappeared. Sodium bisulfite inhibited the decrease in the 180 kDa polypeptide. The N-terminal amino acid sequences of all the polypeptides were all assigned to ones present in a portion close to the N-terminus of the 180 kDa polypeptide. The N-terminal residue of all the three polypeptides was Ser. The cleavage sites were Phe130-Ser131, Thr180-Ser181, and Phe237-Ser238. These results show that the three polypeptides are cleavage products of the 180 kDa catalytic polypeptide, the cleavage occurring at specific labile sites including a Ser residue. The amino acid residues at the sites are quite different from those (Lys-Lys) in the human 180 kDa catalytic polypeptide.

Primary liposarcoma of the omentum

This report is of a 54 year old female with omental liposarcoma. Diagnosis was made by ultrasonography, computed tomography, angiography and operation. The patient was treated by surgical excision. The histological examination revealed that the tumour was round cell liposarcoma. This is the first report to our knowledge of round cell liposarcoma of the omentum.

Characterization of the internalization of bacillus Calmette-Guerin by human bladder tumor cells

Adjuvant intravesical Mycobacterium bovis BCG is the treatment of choice for recurrent superficial bladder cancer. Fibronectin (FN) was previously demonstrated to be necessary for the retention of BCG within the bladder and for the expression of antitumor activity. Recent studies have demonstrated that BCG attach and are ingested by bladder epithelial cells, suggesting the existence of a second bacterial attachment mechanism. We report the characterization of the molecules involved in BCG attachment and internalization by the human bladder transitional cell carcinoma cell line T-24. Pretreatment of T-24 cells with monoclonal antibodies to either alpha 5 or beta 1 integrin subunits significantly inhibited both BCG attachment and ingestion. Exogenous FN was observed to enhance both attachment and ingestion of BCG, and anti-FN was observed to inhibit both phenomena. Latex beads precoated with either FN or laminin (LN) but not BSA were ingested by T-24 cells, but only FN-coated beads inhibited BCG attachment and ingestion. Pretreatment of BCG with FN augmented both attachment and ingestion. The role of bacterial FN binding proteins was evaluated. A monoclonal antibody to a 55-kD FN-binding protein was observed to abrogate attachment and ingestion. These results demonstrate that attachment and ingestion of BCG are mediated in part by the alpha 5 beta 1 integrin receptor and are dependent on FN. These studies demonstrate a mechanism of entrance of mycobacteria into epithelial cells and suggest a second role for FN in the adjuvant antitumor effect of BCG.

13C- and 15N-NMR studies on medium-chain acyl-CoA dehydrogenase reconstituted with 13C- and 15N-enriched flavin adenine dinucleotide

The 13C- and 15N-NMR spectra of porcine kidney medium-chain acyl-CoA dehydrogenase (MCAD) reconstituted with 13C- and 15N-enriched FADs were measured. The positions of selective enrichment were C(2), C(4), C(4 alpha), C(10 alpha), N(1), N(3), and N(5) of the isoalloxazine nucleus of FAD. The NMR signals of the labeled atoms were observed as broad but distinct peaks in each NMR spectrum. The chemical shift values of the 2-, 4-, 4 alpha-, and 10 alpha-13C for the oxidized form of MCAD were 159.5, 166.8, 141.1, and 155.5 ppm, respectively, relative to the methyl resonance of 3-(trimethylsilyl)propionic acid-d4, while those of 1-, 3-, and 5-15N for the oxidized form were 183.6, 161.1, and 334.7 ppm, relative to liquid ammonia, respectively. The upfield shift of 2-13C of MCAD relative to that of FMN in the aqueous medium and its downfield shift relative to that of tetraacetylriboflavin in an apolar medium imply that a weaker hydrogen bond exists between C(2) = O and apoMCAD or a water molecule than that of free FMN with a water molecule. That the 4-13C resonance was observed downfield-shifted relative to that of free FMN in aqueous solution suggests a strong hydrogen bond between C(4) = O and apoMCAD. The chemical shift for 4 alpha-13C in oxidized MCAD is considerably downfield-shifted from that of FMN or any other flavoprotein observed thus far, indicating a unique environment around this position in MCAD. The 1-15N resonance of MCAD was most upfield-shifted among the flavoproteins observed.(ABSTRACT TRUNCATED AT 250 WORDS)