Building areas of hospitals in Japan and distribution of areas by department--1980's

(1) Areas of entire hospitals which have been continuously increasing in the past 30 years are finally showing signs for slowing down. The areas of the hospitals completed in the 1980's were generally 50 to 80 m2 per bed. (2) The distribution of the nursing department to the entire hospitals in area ratio ranges from 30 to slightly more than 40%, or higher than 35% in most cases. The actual areas of the nursing department has surpassed 20 m2 per bed in a considerably large number of hospitals. (3) The area ratio of the outpatient department tends to concentrate to about 12%. Of this percentage, in almost all hospitals, the proportion of the emergency division was less than 2%. (4) As in the 1970's, the diagnostic and treatment facilities were within the range of 18 to 22% in the majority of the hospitals. The distribution shifted to ratios higher than the previous survey. The distributions for the various sections are as follows: 1) Specimen test rooms 3 to 5% 2) Physiological examination rooms slightly below 1% to slightly above 2% 3) X-ray diagnosis rooms about 4% 4) Radiation therapy rooms about 1% 5) Nuclear medicine rooms about 1% 6) Operating department 3 to 5%, 2 to 3 m2/bed 7) Delivery suite less than 1% 8) Rehabilitation department 1 to 4% 9) Hemodialysis suite about 1% (5) The area ratios of the supply department dispersed substantially between 12 and 25%. About 70% of the hospitals remained in the range of 15 to 20%. The ratios of the various sections in the department are as follows: 1) Pharmacy: slightly less than 2% to slightly less than 3% 2) Central sterile and supply department: about 2% 3) Blood bank: installed in hospitals with more than 500 beds 4) Kitchen: slightly more than 2% to slightly more than 3%, 1.5 to 2.5 m2/bed 5) Laundry: less than 1% 6) Central storage and material hundling unit: about 1% 7) Mechanical plant: 5 to 13% (6) The administration department allocates 7 to 14% of its area to the management division and 2 to 6% to the welfare division.

[A case of pseudoxanthoma elasticum associated with asymptomatic multiple cerebral infarction, hypothyroidism, glucose tolerance abnormality and multiple congenital anomalies]

We report a case of pseudoxanthoma elasticum (PXE) associated with asymptomatic multiple cerebral infarction on magnetic resonance imaging (MRI), endocrinological abnormalities and multiple congenital physical anomalies. A 40-year-old woman suddenly developed paresthesia in the right half of the body. Physical examination demonstrated loosening of the skin and yellowish papules in the neck and axilla, retinal angioid streaks, cardiac mitral regurgitation, congenital aplasia of the uterus and vagina, and congenital abduction palsy of the right eye. The biopsy of the papules in the neck showed typical features of PXE. Laboratory tests revealed positive antibodies to thyroglobulin and microsome, high TSH level with normal free T3 and T4, and impaired glucose tolerance. The laboratory data and the findings of ultrasonic examination on the thyroid suggested presence of Hashimoto's disease. MRI of the brain demonstrated multiple cerebral infarcts through they were asymptomatic. MRI failed to clarify the lesion responsible for the hemiparesthesia. Carotid arteriography showed slight stenosis with ulceration near the origin of the right internal carotid artery, and severe stenosis of the horizontal portion of the right middle cerebral artery. MRI study of the brain is recommended in PXE patients since the complication of brain pathology worsens the prognosis of the disease.

A case of Sjögren's syndrome complicating immune-mediated aplastic anaemia

A 78-year-old Japanese woman with Sjögren's syndrome complicating immune-mediated aplastic anaemia is described. A diagnosis of aplastic anaemia was made from severe pancytopenia with hypoplastic marrow. Laboratory studies suggested an association of bone marrow suppressive T-lymphocytes with the pathogenesis of aplastic anaemia. Following the administration of mepithiostan and prednisolone, pancytopenia improved gradually. Two years after the onset of aplastic anaemia, Raynaud's phenomenon developed and examinations revealed the existence of keratoconjunctivitis sicca and anti-SSA/Ro and anti-SSB/La antibodies.

[An evaluation of a therapy with antibacterial and antifungal agents infections with hematological disorders]

The primary objective of this study is to confirm the efficacy and safety of combination therapy with antibacterial and antifungal drugs for patients with hematological disorders complicated with infections of unknown causative organisms. The subjects consisted of 55 patients with hematological disorders, 28 males and 27 females, ranging from 1 to 78 years of age, with an average age of 34 years. The breakdown of the patients by disease was: 41 leukemias, 10 malignant lymphomas, 3 myelodysplastic syndromes and an aplastic anemia. All patients were treated with sulbactam/cefoperazone (SBT/CPZ) and aminoglycoside (AG) plus fluconazole (FLCZ) as an empiric therapy. Overall efficacy rate was 54.5% for all the patients: 57.7% for patients with suspected sepsis and 0% for those with pneumonia from which unknown organisms were detected. The efficacy rate was 59.4% for patient who had been previously treated with other antibiotics and 47.8% for those who had not previously been treated. The above results suggested that this combination therapy might be effective for severe infections of unknown causative organisms associated with hematological disorders.

Chronic destructive monoarthritis of the wrist in patients with anti-SSA/Ro antibodies: report of two cases

Among 340 patients with rheumatic diseases, two cases of chronic destructive monoarthritis of the wrist with anti-SSA/Ro antibodies and rheumatoid factor, were observed for over three years. It is not clear whether these cases represent a specific subset of rheumatoid arthritis (RA) or whether they may progress to diffuse symmetrical destructive polyarthritis typical of RA. Long-term follow-up studies including analysis of autoantibodies will be needed to clarify the characteristics and course of chronic monoarthritis.

Effects of prolonged application of isoprenaline on intracellular free magnesium concentration in isolated heart of rat

1. The effect of prolonged application of isoprenaline on intracellular free-Mg2+ concentration ([Mg2+]i) was examined by use of 31P-nuclear magnetic resonance (31P-n.m.r.) in rat isolated hearts. Left ventricular pressure (LVP) was simultaneously measured. 2. [Mg2+]i was estimated from the separation of the alpha- and beta-ATP peaks, using the dissociation constant of MgATP 38 microM (established previously). In normal (phosphate-free, Krebs-Henseleit) solution, [Mg2+]i was approximately 0.4 mM. 3. When isoprenaline was applied for 100 min, a transient increase in [Mg2+]i was observed during the initial 25 min, whilst concentrations of ATP ([ATP]) and phosphocreatine ([PCr]) decreased and [Pi] correspondingly increased. During the subsequent 75 min of isoprenaline application, [Mg2+]i decreased below its resting levels. Washout of isoprenaline restored [Mg2+]i and [PCr], but [ATP] remained low. These changes elicited by isoprenaline were not observed in the presence of propranolol, a typical alpha-adrenoceptor blocker. 4. Isoprenaline increased both LVP and heart rate. The increased LVP and heart rate slowly returned to lower values during prolonged application of isoprenaline, but remained higher than those before application. 5. The transient rise in [Mg2+]i elicited by isoprenaline could be attributed to the decrease in [ATP] resulting in a release of Mg2+. The subsequent decrease in [Mg2+]i during the prolonged applications suggests that beta-adrenoceptor stimulation itself facilitates Mg(2+)-extruding mechanism(s).

[Effects of disinfectants on erythrocytes and isolated hepatocytes from rats and surface tension]

The effects of formaldehyde (F), m-cresol (C), guaiacol (G), ethanol (E) and their mixture (FC, FCE, FG, FGE) on erythrocytes and isolated hepatocytes from rats and surface tension in water were examined. Hypotonic hemolysis of erythrocytes was inhibited by m-cresol, while guaiacol, formaldehyde and ethanol accelerated the hemolysis. Lower concentrations of the mixture inhibited hypotonic hemolysis, but higher concentrations accelerated hemolysis. Formaldehyde caused a decrease of transaminase (GOT, GPT) in the medium and hepatocytes. GOT and GPT in the medium were increased by m-cresol, but those in the hepatocyte were decreased by this agent. FC and FCE at 10 mM increased GOT in the medium, but FG and FGE decreased GOT. All mixtures decreased GOT and GPT in hepatocytes and GPT in the medium. All mixtures and formaldehyde inhibited GOT and GPT activity. Formaldehyde and m-cresol decreased hepatocyte viability. In the all mixtures-added hepatocytes, the viability was markedly lowered. Formaldehyde, m-cresol, guaiacol and ethanol caused a depression of surface tension, but the depressive effects of FG and FGE were weaker than that of guaiacol. These results suggest that the observed effects of the drug mixtures on erythrocytes and hepatocytes were the additive effects of the component drugs.

Evolution of EF-hand calcium-modulated proteins. III. Exon sequences confirm most dendrograms based on protein sequences: calmodulin dendrograms show significant lack of parallelism

In the first report in this series we presented dendrograms based on 152 individual proteins of the EF-hand family. In the second we used sequences from 228 proteins, containing 835 domains, and showed that eight of the 29 subfamilies are congruent and that the EF-hand domains of the remaining 21 subfamilies have diverse evolutionary histories. In this study we have computed dendrograms within and among the EF-hand subfamilies using the encoding DNA sequences. In most instances the dendrograms based on protein and on DNA sequences are very similar. Significant differences between protein and DNA trees for calmodulin remain unexplained. In our fourth report we evaluate the sequences and the distribution of introns within the EF-hand family and conclude that exon shuffling did not play a significant role in its evolution.

Evolution of EF-hand calcium-modulated proteins. IV. Exon shuffling did not determine the domain compositions of EF-hand proteins

In the previous three reports in this series we demonstrated that the EF-hand family of proteins evolved by a complex pattern of gene duplication, transposition, and splicing. The dendrograms based on exon sequences are nearly identical to those based on protein sequences for troponin C, the essential light chain myosin, the regulatory light chain, and calpain. This validates both the computational methods and the dendrograms for these subfamilies. The proposal of congruence for calmodulin, troponin C, essential light chain, and regulatory light chain was confirmed. There are, however, significant differences in the calmodulin dendrograms computed from DNA and from protein sequences. In this study we find that introns are distributed throughout the EF-hand domain and the interdomain regions. Further, dendrograms based on intron type and distribution bear little resemblance to those based on protein or on DNA sequences. We conclude that introns are inserted, and probably deleted, with relatively high frequency. Further, in the EF-hand family exons do not correspond to structural domains and exon shuffling played little if any role in the evolution of this widely distributed homolog family. Calmodulin has had a turbulent evolution. Its dendrograms based on protein sequence, exon sequence, 3'-tail sequence, intron sequences, and intron positions all show significant differences.

[Introduction of intra-aortic balloon pumping catheter through left subclavian artery guided by trans-esophageal echocardiography]

It is very difficult to insert an intra-aortic balloon pumping catheter into the descending aorta through the subclavian artery by the blind technique. But the technique with the guidance by trans-esophageal echocardiography to introduce the balloon into the descending aorta was simple and useful.

[Effects of Sino-Japanese herbs in the family Labiatae on the hepatic drug metabolizing enzymes and lipid peroxidation in rats]

The effects of hot water extracts (HWEs) and distanninized fractions (DTFs) from 9 kinds of Labiatae herbs on rat hepatic lipid peroxidation (LPO) and the activities of aminopyrine N-demethylase (APD) and aniline hydroxylase (ANH) were examined in vitro. The APD activity was inhibited by the HWEs from 6 herbs, of which the effect of HWE from Ogon was remarkable. The APD activity was increased by HWE from Shisoshi. The inhibitory effect of the HWE from Ogon was not different compared that of the DTF from Ogon, whereas the APD activity was decreased in the DTF from Shisoshi in comparison with that of the HWE. The ANH activity was inhibited by the HWEs from 7 herbs. Except in the case of Kakko and Shisoyo, the inhibitory effects of the HWEs were enhanced by these of the DTFs from the 7 herbs, of which the effect of DTF from Ogon was remarkable. LPO was inhibited by the HWEs from 8 herbs. Especially, HWE from Ogon strikingly inhibited LPO, and this effect was retained by the DTF from Ogon. The present results suggested that Ogon, which showed remarkable effects on LPO, and the activities of APD and ANH might also exert their effects in vivo.

Mechanisms of the hypolipidemic effect of NIP-200 in rats

We studied the mechanisms of hypolipidemic effects of NIP-200 (3,5-dimethyl-4,6-diphenyltetrahydro-2H-1,3,5-thiadiazine- 2-thione), a potent hypolipidemic compound, in cholesterol biosynthesis in the liver, cholesterol absorption in small intestine, and cholesterol catabolism and excretion in rats. NIP-200 did not reduce cholesterol biosynthesis and had no effects on cholesterol absorption in the small intestine. In the cholesterol catabolism and excretion, NIP-200 induced increases in cholesterol and bile acids levels in the bile and acidic steroids in the feces, and it enhanced cholesterol 7 alpha-hydroxylase activity in the liver. These results suggest that NIP-200 increases the synthesis of bile acids as a result of the activation of cholesterol 7 alpha-hydroxylase, the rate-limiting enzyme in the conversion of cholesterol to bile acids. Therefore, it is considered that one of the probable mechanisms of the serum total cholesterol lowering action of NIP-200 involves the enhancement of catabolism and excretion of cholesterol in the liver.

[Impairment of learning and memory and the accessory symptom in aged rats as senile dementia model (1)--Emotional behavior]

It is well known that there is an increase of emotional behavior in senile dementia. There are few studies investigating age-related emotional behavior. We attempted to investigate emotional behavior of aged rats using various tests. Locomotor activity for 24 h decreased in aged rats compared with that in young rats. There was no difference in locomotor activity between light and dark periods in aged rats. There was no visual abnormality on light/dark discrimination test in aged rats. It suggests that locomotor activity during dark period may be impaired by aging. Head-dips and social interaction time in hole board and social interaction tests, respectively decreased, while start latency, defecation and urination in open field test increased in aged rats. Furthermore, ambulation and rearing in hole board, social interaction and open field tests decreased, and entries into open or closed arms in elevated plus-maze test reduced in aged rats compared with those in young rats. These findings suggest that anxiety may increase, but spontaneous activity decrease in aged rats. These results indicate that aged rats may be useful as an accessory symptom model of senile dementia.

[Impairment of learning and memory and the accessory symptom in aged rats as senile dementia model (2)--Learning and memory]

We attempted to investigate the ability of learning and memory of aged rats. Swimming speed of aged rats in Morris's water maze was slower compared with that of young rats. Therefore, we used goal distance to indicate ability of learning and memory. In training session, distance for both groups decreased with training, but in aged rats it was significantly longer than that in young rats. In retention test 24 d after the training, distance in aged rats was longer than that in young rats, although there was no difference in distance for both groups between acquisition and retention tests. The distance in the working memory tended to increase with aging. There was no difference in time spent within platform phase in probe trial, in percent movement of first trial in habituation test, and in step-through latency in passive avoidance, between young and aged rats. Drinking latency for aged rats in water finding task was significantly longer compared with that in young rats. These findings suggest that learning and memory were impaired by aging in spatial and latent learning tasks. Aged rats could acquire and maintain memory of simple tasks, but in spatial tasks they tended to show decreased ability of retention and working memory.

Expression of human minor histocompatibility antigen on cultured kidney cells

Incompatibility of human minor histocompatibility (hmH) antigens can induce rejection of grafts in organ transplantation and graft-versus-host reactions in bone marrow transplantation. In spite of their importance in clinical transplantation, hmH antigens are not well studied. Previous studies have demonstrated the expression of hmH antigens on T and B cells, hematopoietic progenitor cells and keratinocytes. We have for the first time demonstrated the expression of hmH antigens on cultured kidney cells using HLA-B35-restricted, hmH antigen-specific cytotoxic T lymphocyte (CTL) clones, which were previously established from a patient who rejected two kidneys from HLA-identical sisters. The CTL clones could not kill cultured kidney cells. Since cultured kidney cells expressed very low levels of HLA class I antigens it was thought that their failure to be killed by the CTL clones was due to lack of expression of HLA-B35 antigens. After induction of class I antigens on cultured kidney cells by interferon-gamma (IFN-gamma), the IFN-gamma-treated cultured kidney cells were killed by the CTL clones. Furthermore, we isolated hmH antigens as peptides from cultured kidney cells after treatment with IFN-gamma. These results indicate that cultured kidney cells express hmH antigens when HLA class I antigen is induced by IFN-gamma and hmH antigens on cultured kidney cells are recognized by T cells as peptides presented by HLA-B35 molecules.

Alport syndrome diagnosed by immunofluorescence using a new monoclonal antibody

A 14-year-old female with microscopic hematuria was admitted for a renal biopsy. She had a family history of renal disease without deafness. The findings of light microscopy and conventional immunofluorescence were normal. Electron microscopy showed a diffuse thinning of the glomerular basement membrane (GBM) with its mild splitting. Irregular thickening of GBM and glomerular small dense particles was not observed. Thin basement membrane syndrome was suspected from these findings. However, it was difficult to differentiate from Alport syndrome. Immunofluorescence analysis using the monoclonal antibody to the 28-kilodalton monomers of the noncollagenous domain of type IV collagen verified the diagnosis of heterozygous Alport syndrome.

A case of long-standing classical rheumatoid arthritis complicated by serological and clinical characteristics of SLE

A patient with RA who developed anti-Sm antibodies, a false positive serological test for syphilis (FPSTS), pericardial effusion, and leukopenia, 19-year after the onset of classical RA, is described. This case indicates a possible clinical association between the development of specific autoantibodies and clinical symptoms of SLE.

Localized, aggregative, and diffuse adherence to HeLa cells, plastic, and human small intestines by Escherichia coli isolated from patients with diarrhea

Adherence of diarrhea-associated Escherichia coli was studied by scanning electron microscopy. Enteropathogenic E. coli (EPEC) adherence factor-positive (EAF+) E. coli of EPEC serotypes (class I EPEC) adhered to plastic and human jejunal and ileal mucosa, similar to case and HeLa cells. Localized adherence, elongation of cell microvilli, and "locking" of the bacterial aggregates by the elongated microvilli were evident after incubation for 20 min. EAF+ E. coli adhered strikingly to mucus but rarely to M cells in Peyer's patch-associated epithelium. Most enteroaggregative E. coli (EAggEC) strains adhered to plastic, similar to HeLa cells. Some diffuse-adhering E. coli (DAEC) strains displayed no adherence to plastic but formed "dimples" on HeLa cells. Both EAggEC and DAEC adhered at lower levels to human small intestines (except M cells) than did EAF+ E. coli. In all cases of EAF+ E. coli, EAggEC, and DAEC, strains were found with atypical characteristics. The data demonstrate the unique adherence characteristics of EAF+ E. coli, EAggEC, and DAEC.

Re-evaluation of death by asphyxia based on cerebral blood flow (VII)--on the information on electric potentials obtained from deep electroencephalographic electrodes

The author presents electroencephalographic patterns (a physiological parameter of the brain function observed at rapid and fatal drowning of rabbits), cerebral blood flow (CBF) which support the physiological activities of the brain, and the relationship between systemic respiration and circulation with special reference to changes in the electrical potentials detected by deep electroencephalographic electrodes. The possibility of diagnosis of fatal drowning is examined, based on the results.

Ascending contraction mediated by 5-hydroxytryptamine3 receptors in canine small intestine

We investigated the mechanism of ascending contraction induced by activation of 5-hydroxytryptamine3 (5-HT3) receptors in anesthetized dogs. Pressure-measuring balloons were inserted into a loop of extrinsically denervated jejunum. Drugs were administered via the arterial tree to the oral or the anal segment and the ensuing mechanical responses were monitored. Administration of 2-methyl-5-HT (440 pmol-44 nmol) to the anal segment caused contractions in the oral segment in a dose-dependent manner. This response was inhibited by treating the anal segment with ICS 205-930, cocaine, hexamethonium, or tetrodotoxin and by treating the oral segment with atropine or hexamethonium. The response persisted even after abolition of contraction in the anal segment by nifedipine. These results imply that activation of 5-HT3 receptors can induce an ascending contraction through an enteric excitatory pathway formed by a series of cholinergic interneurons and final cholinergic motor neurons, apart from the anal contraction.