Transformation of Antirrhinum majus L. by a rol-type multi-auto-transformation (MAT) vector system

A total of 11 independent beta-glucuronidase (GUS) positive hairy roots were induced following co-cultivation of leaf explants of Antirrhinum majus L. with Agrobacterium tumefaciens strain GV2260 containing rol-type multi-auto-transformation (MAT) vector pNPI702. A total of 326 adventitious shoots were regenerated from the hairy root lines on 1/2 MS medium without plant growth regulators at 25 degrees C under a 16 h/day photoperiod condition 4 months after infection of the A. tumefaciens GV2260. The absence of the rol genes in five plants was verified by polymerase chain reaction (PCR) and Southern blot analysis. Acclimatized transformants exhibited normal phenotypes in height and in the morphology of leaves and flowers. Furthermore, the GUS gene was strongly expressed in the leaves, inflorescence of the transformed plant, and the progeny. This result demonstrates that the rol-type MAT vector can be used to study gene functions controlling the morphogenesis of Antirrhinum majus plants.

Reflex sympathetic dystrophy following transbrachial cardiac catheterization

We experienced a rare case of complication by reflex sympathetic dystrophy (RSD) following transbrachial cardiac catheterization which may have been caused by poorly executed hemostasis using a hemostatic device. The symptoms of RSD markedly limited the patientOs daily work activities. Although the transbrachial approach is a useful procedure for cardiac catheterization, interventionalists should be aware that RSD may cause serious complications.

Investigation of ACTBP2 mutations in the Japanese population

In the investigation of ACTBP2 (human beta-actin related pseudogene H-beat-Ac-psi-2) mutation in the Japanese population, 230 meioses were analyzed, and two cases of paternal mutations were observed. Paternity confirmation analyses were carried out using seventeen genetic marker systems including erythrocyte antigens, HLA types, D1S80, and nine STR loci contained in the AmpFlSTR Profiler Kit. Excluding ACTBP2, the paternity probabilities for the two cases were each calculated to be over 99.99%. Genotyping of the ACTBP2 locus was performed using the fluorescence detection method under denaturing conditions on an ABI PRISM 310 Genetic Analyzer. After sequencing analysis using the BigDye terminator method, the paternally originated alleles of the two children were found in one case to show one repeat insertion and in the other case one repeat deletion as compared with each father. Although the number of meioses observed in this study is limited, it appears that ACTBP2 mutations are not rare events in the Japanese population.

Comparison of the Ca2+ entry channels responsible for mechanical responses of guinea-pig aorta to noradrenaline and thapsigargin using SK&F 96365 and LOE 908

Noradrenaline (NA) produces sustained contractions in conduit arteries such as aorta isolated from various animal species. In guinea-pig aorta, NA-produced sustained contraction is largely dependent upon the influx of extracellular Ca2+, but is refractory to the treatment with organic Ca2+ entry blockers. In the present study, we attempted to characterize pharmacologically the Ca2+ entry channel responsible for NA-produced sustained contraction of guinea-pig aorta using SK&F 96365 (1-[beta-[3-(4-methoxyphenyl)propoxy]-4-methoxyphenylethyl]-1H-imi dazole) and LOE 908 ((R,S)-(3,4-dihydro-6,7-dimethoxy-isoquinoline-1-yl)-2-phenyl-N,N-di-[2- (2,3,4-trimethoxyphenyl)ethyl]-acetamide), both of which block voltage-independent Ca2+ channels. The effects of SK&F 96365 and LOE 908 on NA-produced contraction were compared with those on extracellular Ca2+-dependent contractile and endothelium-dependent relaxant responses to thapsigargin (TSG), an inhibitor of Ca2+-pump Ca2+-ATPase. NA (3x10(-6) M)-produced sustained contraction of guinea-pig aorta without endothelium exhibited a strong dependency on the extracellular Ca2+. Nicardipine (10(-7) M), diltiazem (10(-5) M) and verapamil (10(-5) M) did not show any appreciable inhibitory effects on NA-produced sustained contraction. SK&F 96365 concentration-dependently (10(-6)-10(-4) M) attenuated the NA-produced sustained contraction whereas LOE 908 did not affect it at concentrations up to 10(-4) M. Similarly, extracellular Ca2+-dependent contraction of guinea-pig aorta without endothelium in response to TSG was also diminished by SK&F 96365 but was unaffected by LOE 908. In fura-PE3-loaded vascular preparations, SK&F 96365 decreased both cytoplasmic Ca2+ level ([Ca2+]i) and muscle tension elevated by NA and TSG. Both SK&F 96365 and LOE 908 did not affect an endothelium-dependent relaxation of guinea-pig aorta in response to TSG. These findings suggest that in guinea-pig aortic smooth muscle cells, NA activates Ca2+ influx across the plasma-membrane through the Ca2+-permeable channel which is identical with or has similar properties to the store-operated Ca2+ channel (SOCC) stimulated by TSG, but is distinct from endothelial cell SOCC.

Synthesis and characterization of helical multi-shell gold nanowires

Suspended gold nanowires were made in an ultra-high vacuum. The finest of them was 0.6 nanometer in diameter and 6 nanometers in length. By high-resolution electron microscopy, they were shown to have a multi-shell structure composed of coaxial tubes. Each tube consists of helical atom rows coiled round the wire axis. The difference between the numbers of atom rows in outer and inner shells is seven, resulting in magic shell-closing numbers.

Insulin resistance affects endothelium-dependent acetylcholine-induced coronary artery response

AIMS

This study was designed to investigate the relationship between insulin resistance and the acetylcholine-induced endothelium-dependent coronary artery response in patients without angiographically significant atherosclerotic coronary artery disease and to elucidate the pathophysiological significance of insulin resistance in the early stages of coronary atherosclerosis.

METHODS AND RESULTS

Insulin resistance was calculated from fasting plasma glucose and insulin concentration using homeostasis model assessment in 40 patients suspected of having ischaemic heart disease, but without angiographic evidence of atherosclerotic coronary artery disease defined as a discrete stenosis or intimal irregularity. They were selected for an acetylcholine provocation test in both left and right coronary arteries. The homeostasis model assessment level was higher in 16 acetylcholine-positive patients than in 24 acetylcholine-negative patients (1.84+/-1.24 vs 0.72+/-0.62, P<0.01). Comparisons of the percentage change in vessel lumen diameter after the acetylcholine test in each of proximal, mid and distal segments of three coronary arteries among the three groups of low (less than 0.7; n=13), intermediate (0.7 to 1.4; n=13), and high homeostasis model assessment level (more than 1.4; n=14) revealed that a higher level resulted in a worse acetylcholine-induced constrictive response in coronary arteries.

CONCLUSION

These results suggest that there is an association between high insulin resistance and coronary vascular endothelial cell dysfunction, and that insulin resistance may be an indicator of early stage coronary artery atherosclerosis not detectable by angiography.

Idiopathic adrenal hemorrhage

A case of idiopathic adrenal hemorrhage is reported. A 76-year-old woman exhibited a left adrenal tumor, 3 cm in diameter, on abdominal computed tomography. The patient was receiving aspirin medication for atrial fibrillation. There was no evidence of increased adrenal hormones. The mass enlarged to 6 cm in diameter within 18 months, and malignancy was suspected. The mass was diagnosed as adrenal hematoma by operative findings.

[Does disclosure of medical records to patients influence medical care?]

Disclosure of medical records to patients has been assessed, but the influence of disclosure on medical care has not been well researched. To address this situation, this study was conducted to test three hypotheses: 1) doctors think that the disclosure can influence medical care, 2) whether doctors think disclosure can influence medical care depends on how they rank medical records (for example, as evidence for diagnosis and treatment, a process to reach a diagnosis, a tool to communicate with other medical staff, etc), and on whether they think medical record disclosure could change the content of the record. Questionnaires were sent to 881 doctors who work at two hospitals affiliated with N Medical School and K Medical University.

RESULTS

Four hundred eighty-eight doctors responded. The findings related to the hypotheses were as follows: 1) Those who answered that the disclosure could have an influence on medical care were 49.1% of the total. 2) There was no relation between how doctors ranked medical records and whether they thought disclosure could influence medical care. 3) Doctors who answered that there were things that they would not be able to write if medical records were disclosed accounted for 73.5% of the total. These doctors answered "yes" significantly higher to the question that the disclosure could influence medical care than others (Odds 3.6, P < 0.01). Doctors who thought they would not be able to enter the diagnosis, the name of the disease for insurance, self-evaluation, information that could be judged and subjective information answered that disclosure could influence on medical care (P < 0.05). It was assumed that disclosure of medical records to patients could change the content of the medical records and that could influence medical care. How to deal with information will become an important issue if records are disclosed.

Air embolism in the right coronary artery occurring during the left coronary angioplasty using the guiding catheter with a side hole

Coronary air embolism is one of the inadvertent complications of coronary angioplasty. We report two rare cases of complicating air embolism in the right coronary artery occurring during control left coronary angiography using a guiding catheter with a side hole, just prior to a coronary intervention procedure for a left coronary artery lesion. The air seemed to be injected into the right coronary artery through the side hole. When we use an angiographic or guiding catheter with a side hole, we should be aware that an air embolism can occur in the contralateral coronary artery and should carefully and repeatedly perform aspiration of the catheter.

Changes of the sacrum in severe spondylolisthesis: a possible key pathology of the disorder

Deficient development of the posterior lumbosacral portion has been thought to be a possible etiology of severe spondylolisthesis. However, the precise causes of the deformity have yet to be revealed. To our knowledge, progression of the disorder has not been discussed in the light of sacral changes on magnetic resonance imaging (MRI). The objectives of the present study were to document changes of the sacrum on MRI scans in patients with severe spondylolisthesis and to discuss the relation of these changes to the progression of deformities. Roentgenograms and MRI scans of 13 patients (10 women and 3 men) with severe spondylolisthesis were retrospectively reviewed. Average age at first MRI examination was 20 years (range, 12 to 50 years). The MRI scans commonly showed a defect at the antero-superior portion of the sacrum. This lesion seems to appear during the period of progression of slipping associated with lumbosacral kyphosis. The defect of the sacrum was considered a unique feature to discriminate this type of olisthesis from others. Taking into consideration the present results, the deformity can be called kyphospondylolisthesis.

Direct discrimination and full-day disclosure of ventricular parasystole on new heart rate tachograms

INTRODUCTION

To discriminate ventricular parasystole from fixed coupling interval ventricular premature complexes (VPCs), we developed a new diagnostic method using a dot distribution pattern corresponding to VPCs recorded on a heart rate tachogram using ambulatory ECG monitoring data. We tested our hypothesis that widely scattered VPC dots on instantaneous heart rate tachograms indicate a constant VPC-VPC interval compatible with parasystole.

METHODS AND RESULTS

Patients with frequent VPCs > 5,000/day) were divided into two groups depending on the tachogram dot distribution patterns: group S (n = 10, aged 61 +/- 16 years) showed widely scattered VPC dot distribution, whereas group F (n = 10, 60 +/- 17 years) showed fixed VPC dot distribution limited to a narrow zone. Using digitized R-R interval data, full-day heart rate tachograms and VPC-VPC intervals were depicted simultaneously. Group S demonstrated constant basic VPC-VPC intervals (1,285 to 2,052 msec, mean 1,738 +/- 219), with a coefficient of variation (CV) of 0.061 +/- 0.018. Their VPC coupling intervals were markedly variable (651 +/- 113 msec; CV = 0.193 +/- 0.034). Each patient's basic VPC-VPC intervals showed small diurnal alterations (minimum -13% +/- 3% to maximum +15% +/- 6%). VPC-VPC intervals in group F were not constant and showed marked variation. Group F VPC coupling intervals were shorter and constant (480 +/- 30 msec, P = 0.0002; with CV = 0.076 +/- 0.013, P < 0.0001).

CONCLUSION

Ventricular parasystole with constant VPC-VPC intervals consistently became evident based on VPC dot patterns recorded on heart rate tachograms.

A preliminary study on the knowledge and attitudes of physicians at two university hospitals towards the medical insurance system of Japan

In this preliminary study, we surveyed the physicians at two academic hospitals on their knowledge of and attitudes toward the medical insurance system in Japan. Most of the physicians had not read the "Ministerial Ordinance on Insurance Medical Institutions' and Insurance Medical Doctors' Medical Treatment under Health Insurance." Of the 433 physicians who filled out the questionnaire completely, 34% had either not read or rarely read the "Medical Fee Point List." Most (89.1%) of the physicians knew that there is a stepwise reduction in the hospitalization fee as the length of a patient's hospital stay increases. However, approximately 30% did not know the stipulation of obtaining an informed consent from the patient prior to blood transfusion. As for the right of patients to see their medical care remuneration statements, which was decided by the government in 1997, 26.8% of the physicians did not know this rule. Physicians who had read the "Ministerial Ordinance on Medical Treatment," were more likely to read the "Medical Fee Point List" frequently; were more likely to know the stipulation about diminishing hospitalization fee; were more likely to know that an informed consent must be obtained prior to blood transfusion; and were more likely to know that patients had a right to see their medical care remuneration statements. The longer the clinical experience of the physician, the more likely that the physician had read the "Ministerial Ordinance on Medical Treatment" and know the other stipulations well. In these two academic hospitals, it is important to establish educational seminars for physicians on the guidelines of the medical insurance system so that physicians will become familiar with the medical insurance system quickly.

The effect of low calcium diet on bone in ovariectomized mice

This study investigates the effects of Ca on bone in the ovariectomized mice. Twenty-six female ICR mice aged 5 weeks were used. They were ovariectomized (OVX) or sham-operated (SHAM) and fed standard mouse diet (SF) or special low calcium diet (L.Ca), respectively. All animals were sacrificed at day 100 after operation. Mechanical strength of the left femur and tibia was measured by the three-point bending strength test. The bones were dried, weighed and burned to ash. Correlation between mechanical strength and ash content was found. A specimen of the right tibia was prepared. Mechanical strength, ash content and ratio of dry bone weight to body weight of the femur and tibia in OVX and L.Ca mice were significantly less than in SHAM and SF mice. SHAM/SF mice and OVX/L.Ca group showed highest and lowest values in all cases. The values for the femur and tibia in OVX/SF mice were lower than in SHAM/SF group and in OVX/L.Ca group were less than in OVX/SF mice. Correlation coefficients for mechanical strength and ash content were 0.704 and 0.776 for the femur and tibia. Ca is thus related to inhibition of bone loss and maintenance of bone mass and effective prevention of osteoporosis.

Application of short tandem repeat of genomic DNA and mitochondrial DNA for identification of mixed-up tissue specimens

Deoxyribonucleic acid (DNA) typing methods, short tandem repeat of genomic DNA and mitochondrial DNA with the use of polymerase chain reaction amplification, were applied to formalin-fixed, paraffin-embedded tissues submitted for diagnosis, to identify and sort out mixed-up tissue specimens. These techniques were found to be reliable, reproducible and specific for personal identification, and thus to eliminate the need for further examinations and to prevent unnecessary surgery.

Simultaneous STM and UHV electron microscope observation of silicon nanowires extracted from Si(111) surface

A miniaturized scanning tunnelling microscope (STM) was fitted in a side-entry holder of an ultra-high vacuum electron microscope. The clean Si(111)7 x 7 surface was observed by both STM and reflection electron microscopy (REM) at atomic resolution. The tungsten tips were often rounded off upon tip-approach with a constant current, through a gentle touch with the sample surface. The apices of such rounded tips had radii of several tens of granometre with widths of about 3 x 3 nm. Atomically resolved STM of the Si(111)7 x 7 surface was obtainable when an atom or an atomic cluster sits on the tip surface. The rounded tips were used for fabrication of Si nanowires by the touch-and-away operation of the tip. The nanowires grew longer at higher substrate temperature and they reached as long as several tens of nanometre at 700 degrees C. The nanowire had many twins and the (111) twin lamellae were stacked in the direction of the wire axis. In another case, the twin planes were oblique to the wire axis so that the (112) direction was nearly parallel to the wire axis.

Modification of postural response caused by footwear conditions

The purpose of this study was to clarify the effect of changing footwear conditions on postural response against postural perturbation. Twenty-three healthy subjects participated in this study. Postural response was induced by moving a platform forward, hereafter referred to as forward-perturbation of a platform. The center of pressure (COP) from the force plate and the electromyograms (EMG) of the tibialis anterior (TA) and quadriceps femoris (QUAD), which are both agonists of the response, were measured. The effect of plantar material and shape of footwear on postural response was examined as footwear condition. Changing plantar materials had an effect on integrated EMG of the agonists (IEMG) but not on the response pattern. On the other hand, the shape of footwear had an effect on the response pattern but not on IEMG. It was supposed from this result that changes in somatosensory input, caused by coupling of plantar material and shape of footwear, modifies postural response variously.

D1S80 subtyping by PCR-RFLP: new nomenclature and further characterization

In a previous study, we screened out sequence variations within alleles at the D1S80 locus of a Japanese population using PCR-RFLP with EcoRII as a restriction enzyme. In the present study, through analyzing the alleles in a Chinese population, we were able to demonstrate four new electrophoretic band patterns that were complementary to the Japanese data. After summarizing the band patterns and sequencing results of these two populations, we established a new nomenclature for the PCR-RFLP band patterns, closely relating them to their corresponding sequences so that the new types could be designated easily and accurately. After PCR-RFLP subtyping, nineteen alleles in the Chinese population were revealed to have a total of thirty-seven subtypes. The discrimination power of this locus in the Chinese population was elevated from 0.974 to 0.988, and the Hardy-Weinberg equilibrium in this population showed no deviation when checked. Two samples typed as homozygotes 24/24 and 30/30 were identified to be actually heterozygous according to their band patterns. The result was supported by the sequencing analysis of the two samples in which overlapping of eight and eleven repeat units, respectively, were revealed. The heterozygosity was thus elevated from 0.85 to 0.87. The present study proved that PCR-RFLP was an effective method for subtyping D1S80 alleles in the Chinese.

Serum levels of circulating adhesion molecules after coronary angioplasty

The activation of platelets, leukocytes, and vascular endothelial cells mediated by cell adhesion molecules may play a role in the mechanism of restenosis, which is still a significant complication after coronary angioplasty. We observed serial changes in the circulating soluble forms of adhesion molecules in 25 patients with coronary artery disease who underwent coronary angioplasty for a single lesion of the left anterior descending artery. Serum levels of sICAM-1 (p < 0.05) and sP-selectin (p < 0.05) were significantly increased immediately after angioplasty in the coronary sinus blood samples. These increases continued during the 48-hour observation period, and the maximum increase was seen 48 h after angioplasty for sICAM-1 (p < 0.01) and 24 h after angioplasty for sP-selectin (p < 0. 01). The level of sL-selectin increased 24 h (p < 0.01) and 48 h (p < 0.001) after angioplasty. These changes were not observed in the peripheral blood samples. The sE-selectin level did not change after angioplasty. A multiple regression analysis showed that the late loss index obtained from quantitative angiographic (QCA) analysis was correlated with the changes in sICAM-1 (r = 0.31, p < 0.05), sL-selectin (r = 0.28, p < 0.05), and sP-selectin (r = 0.26, p < 0. 05) 48 h after angioplasty in the coronary sinus blood samples, but was not correlated with procedural variables, other QCA variables, or the change in the sL-selectin level. The measurements of these adhesion molecule levels may help to evaluate traumatic vessel wall injury and inflammation at the intervention site after coronary angioplasty.

The judgment of a gunshot wound with severe post-mortem changes

This is a report on an autopsy case that revealed a gunshot wound to the back of the head. On examination of the external surface, an entrance and exit wound could not be found in the head region because of the severe post-mortem changes and the atypical entrance wound position and direction of the bullet tract; X-rays taken before the internal examination were effective in this case. In this case, the direction of the bullet tract was supposed to be similar to that of the suboccipital puncture.

[Research on the influences that affect the physician's perception of discharge summaries. A survey of outpatient department physicians]

The object of this study was to improve the completion of discharge summaries. The purpose of this article is: 1. to describe the perceptions of outpatient department physicians as to whether incomplete discharge summaries affect outpatient medical care or not, and 2. to elucidate the factors contributing to their perceptions. The physicians were randomly selected from among "the National Certified Training Hospitals" and "Japan Society for Quality in Health Care", and the size of the hospitals, the medical record management system and the format of the discharge summary were chosen for analysis of the factors that affect physicians' perceptions. Of the 2,304 questionnaires sent, 935 (40.6%) were returned. The results showed that 832 (89.0%) of the physicians thought that outpatient medical care would be affected if discharge summaries were not completed. Based on the analysis of the factors affecting the perceptions of the physicians, there was a trend showing that the influence was lower in small hospitals (p < 0.05), that the centralized management system for medical records had a higher influence (p < 0.05), and that the format of the discharge summary also affects physician's perceptions (p < 0.05).

The Japanese health care system: citizen complaints, citizen possibilities

The Japanese health care system is sometimes considered one of the best in the world because it appears to have achieved universal coverage, high quality, and a comparatively low level of expenditure. But under compulsory national health insurance and the uniform fee schedule which has worked well so far, various problems have been produced in Japan. A growing number of persons believe some reform or readjustment may be required. Following a brief review of the Japanese health care system which includes health insurance mechanisms, the relationship among physicians, hospitals and clinics, and the impact of these structures on access to care are explored. The resulting cost of care and the quality of care are then addressed. The lack of consumer information and the nature of the physician-patient relationship related to cultural factors are important components of this health care system. These latter factors are in the process of change and the likely direction of their influence upon the Japanese health care system is explored.

Colony stimulating factor-inducing activity of hesperidin

To evaluate immunomodulating activities of bioflavones, colony-stimulating factor (CSF)-inducing activity of two dihydroflavones, three flavones and three flavonols were tested. These samples were suspended in saline and injected intraperitoneally (i.p.) into mice at a dose of 1 mg 6 h before bleeding. All compounds carrying the glucosyl-rhamnose moiety showed potent activity. Among them, hesperidin exhibited the strongest activity. Serum CSF production in mice injected with 1 mg hesperidin reached a peak at 9 h later. The activity of hesperidin was dose-dependent at a range of 0.3 to 20 mg/mouse.

The cost of burn care and implications for efficient care

OBJECTIVE

To clarify the social issues and problems associated with burn care in Japan, based on a cost analysis of acute burn care.

METHODS

A retrospective review was undertaken of 71 patients admitted with burns at Nippon Medical School between January 1 and December 31, 1997. A cost analysis was performed for three major burn patients with a burn surface area (BSA) of 70% to 80% and three minor burn patients with a BSA of 20% to 30%. A questionnaire was administered to both burn patients and medical providers in all 127 emergency centers to help improve long-term quality of life (QOL).

RESULTS

80% of burn patients were under age 70. In the major burn cases, the amount of reimbursement according to the government-regulated fee schedule was much less than the cost of treatment. The ratio of the cost of both medication and materials to total cost of treatment was higher for patients with major burns. Patients responding to the survey acknowledged being generally happy despite suffering from psychological and financial problems. A total of 413 medical providers from 63 institutions responded to the survey regarding improving long-term QOL.

CONCLUSIONS

Acute burn care is a costly service. The goal of burn care should shift from saving lives to allowing for a productive return to society. Quality improvement, outcome measurement, and technology assessment combined with health economics research for burn care should be carried out in Japan.

The psychological and physiological effects of an intensive-care unit environment on healthy individuals

OBJECTIVE

The ideal inpatient environment would be one in which patient stress and anxiety are alleviated, but current inpatient hospital settings often do not seem to take this fact into consideration. To date, the effects of the actual hospital environment itself on patients is poorly understood. The purpose of the present study was to investigate the types of psychological and physiological changes that people undergo in response to being placed in an inpatient setting.

DESIGN AND SETTING

Ten healthy volunteers were admitted to an intensive-care unit (ICU) for 4 days and 3 nights. The psychological and physiological changes before and after admission were examined. A qualitative assessment was also performed.

RESULTS

Most healthy individuals at times develop feelings of depression, which can be measured by the Profile of Mood States and the Zung Self-Rating Depression Scale (P < .05). In this study, participants' fatigue and confusion increased (P < .05) and vigor decreased (P < .01) as measured by the Profile of Mood States. There was also an increase in the General Health Questionnaire scores (P < .01). However, no significant physiological effects were apparent, as measured by peripheral lymphocyte counts, natural killer cells activity, and urinary 17-kerosteroid and 17-hydroxycorticosteroid levels. Subjects often engaged in introspection during hospitalization and often had a negative attitude towards the hospital environment.

CONCLUSIONS

The findings of increased feelings of depression attributable solely to being in an ICU setting are inconsistent with the type of environment generally considered necessary to alleviate patient anxiety and tension in a critical-care-ward environment. The negative perception of this environment strongly suggests room for improvement. Efforts in this regard should focus on improving the five senses, particularly sight, sound, and taste within the ICU.

Cyclic bursts of ventricular premature contractions of more than one minute intervals

Ventricular premature contractions (VPCs) occasionally appear successively in the form of bigeminy, trigeminy or quadrigeminy associated with quiescent periods. However, details of these rhythmic VPC bursts have not been well documented. We analyzed the incidence, periodicity and interval of VPC bursts exhibiting bigeminy or trigeminy using ambulatory ECG monitoring and computer analysis. We defined VPC bursts as more than 5 successive groups of VPCs each containing more than 20 VPCs in the form of bigeminy or trigeminy that were interrupted by normal sinus rhythm lasting for more than 60 seconds. Bursts thus defined were observed transiently or continuously in 78 out of 500 consecutive patients showing > 3000 VPCs a day. Their age ranged from 14 to 76 years (mean 48). Forty patients were men and 38 were women. We could discriminate between two types of bursts on the instantaneous heart rate tachograms. Dome type bursts (n = 48) showed gradual shortening of the VPC coupling intervals whereas horizontal type bursts (n = 30) demonstrated fixed coupling intervals during the bursts. Cycle length of the dome type burst was 185 +/- 40 seconds and regular, whereas it was 210 +/- 63 seconds and irregular in the horizontal type (NS). Duration of the VPC bursts was 101 +/- 31 seconds in the dome type and 98 +/- 41 seconds in the horizontal type. Both burst types were associated with transient increases in sinus rate and abbreviated VPC-VPC intervals. We suspect ventricular parasystole to be the mechanism of these bursts especially in the dome type. Recognition of these two burst types from heart rate tachograms may be of value in the suppression of VPCs.

[Evaluation of restenosis after percutaneous transluminal coronary angioplasty using a Doppler index, the Tei index]

Cardiac function and restenosis were evaluated after percutaneous transluminal coronary angioplasty (PTCA) using a Doppler index (the Tei index). Thirty-eight patients, 31 men and 7 women (mean age 57 years) with ischemic heart disease were studied. The underlying heart diseases were angina pectoris without left ventricular asynergy in 16 patients and old myocardial infarction (OMI) with left ventricular asynergy in 22 . Ejection fraction was measured by M-mode echocardiography and deceleration time, and the interval between cessation and onset of the mitral inflow velocity (a), ejection time at aortic valve (b), and the Tei index [(a-b)/b] were measured by M-mode echocardiography performed before and 6 months after PTCA. The ejection fraction, deceleration time and Tei index showed no changes after PTCA in patients with angina pectoris with or without restenosis. In patients with OMI with restenosis, the Tei index increased slightly after PTCA, from 0.56 +/- 0.15 to 0.61 +/- 0.13. The deceleration time changed from 0.23 +/- 0.03 to 0.24 +/- 0.02 msec, and the ejection fraction from 0.46 +/- 0.11 to 0.51 +/- 0.17, neither significantly. However, in patients with OMI without restenosis (15 out of 22 patients), the Tei index significantly improved after PTCA, from 0.55 +/- 0.13 to 0.48 +/- 0.12 (p < 0.05). In patients with left ventricular asynergy due to old myocardial infarction, without restenosis, the Tei index significantly improved after PTCA. The Tei index is useful for evaluating restenosis after PTCA in patients with OMI.

Postoperative changes over time in size of anterior capsulorrhexis in phacoemulsification/aspiration

In the present study, we attempted to determine the extent to which an anterior capsulorrhexis carried out during cataract surgery contracts postoperatively. The size of the continuous curvilinear capsulorrhexis (CCC) was measured at the end of surgery and at the final follow-up examination in 52 eyes of 40 patients who underwent phacoemulsification/aspiration and implantation of an intraocular lens (IOL) with 6-mm optics. Images obtained by video during surgery and by slit-lamp microscopy were used to determine the CCC size with reference to the optics of the IOL. The average CCC size was 5.0 mm at the end of surgery; it contracted to 4.4 mm by the final postoperative examination. The contraction of the anterior capsule progressed rapidly in the first 50 days following surgery and then gradually thereafter. The extent of contraction was greater in older patients. The smaller the CCC size immediately after surgery, the more rapidly it contracted. The size of the capsulorrhexis contracted an average of 22% following cataract surgery. The contraction rate tended to be higher in older patients. The results suggest that the capsulorrhexis carried out in cataract surgery for elderly patients should be sufficiently large, but not larger than the optics size of the IOL.

Preventable trauma deaths: evaluation by peer review and a guide for quality improvement. Emergency Medical Study Group for Quality

BACKGROUND

The trauma-injury severity-score (TRISS) methodology was developed in the United States to calculate the probability of survival for trauma patients presenting for emergency care.

OBJECTIVE

We assessed the utility of using the TRISS methodology to identify preventable trauma deaths and compared the results to peer review using explicit standards.

METHODS

Explicit peer review standards were developed by a focus group. The validity of these standards was evaluated by comparing the results of peer review performed by two independent expert panels. All trauma cases admitted to 10 centers in Japan between April 1, 1994, and March 31, 1996, were evaluated using the TRISS methodology. Cases with an expected probability of survival of more than 0.5 were considered preventable. These cases were subjected to peer review. Patients who were dead on arrival were excluded from analysis.

RESULTS

Of 3,125 patients who were not dead on arrival, the TRISS methodology identified 2,525 as having a probability of survival greater than 0.5. In this group, 189 patients died; thus, 25.3% of all deaths were considered preventable by the TRISS method. Peer review found that only 11.2% of the deaths were preventable; thus, only 46.6% of preventable deaths identified by TRISS were confirmed by peer review. Agreement between the two expert peer review panels was very good (kappa = 0.62).

CONCLUSION

TRISS can be used as a screening tool to identify potentially preventable trauma deaths. Peer review is appropriate to confirm preventability and to identify potential medical errors.

Primary prostatic lymphoma of mucosa-associated lymphoid tissue

We present a case of primary prostatic lymphoma referring to a 57-year-old man, who was admitted with the symptom of bladder outlet obstruction, and had a history of urination difficulty for two years. The symptoms and signs were compatible with a diagnosis of benign prostatic hypertrophy (BPH). The pathology of the specimen obtained from transurethral prostatectomy showed B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. The patient has been asymptomatic and under complete remission after completion of chemotherapy consisting of doxorubicin, cyclophosphamide, vincristine and prednisone for 6 cycles.

Carbamazepine-induced sinus node dysfunction and atrioventricular block in elderly women

We report on four elderly women in whom carbamazepine was suspected of inducing sinus node dysfunction (3 patients) and atrioventricular block (1 patient). Patients were treated with carbamazepine, 200 to 600 mg a day, for trigeminal neuralgia (n = 3) or epilepsy (n = 1). After 1 to 16 months of carbamazepine therapy, these patients were admitted to our emergency room because of bradyarrhythmia. Their conduction disturbances on electrocardiographic monitoring disappeared immediately after the cessation of carbamazepine intake. Provocation tests were performed on three patients. Because of renal insufficiency, one patient could not undergo the provocation test. Her carbamazepine clearance was markedly decreased. Carbamazepine induced sinus arrest in two patients within 48 hours after intake, but did not induce atrioventricular block in the remaining patient. In two patients, computer simulation of carbamazepine pharmacokinetics was performed and disclosed a clear-cut relationship between the plasma concentration of carbamazepine and the frequency of sinus arrest. During the test, the maximum plasma carbamazepine concentration in these two patients did not exceed the therapeutic range. However, it did exceed the range in the one with a negative test. Our results suggest that careful monitoring of ECG and plasma drug concentration is required with carbamazepine therapy, especially in elderly women.

Possibility of independence in ADL (Activities of Daily Living) for patients with cervical spinal cord injuries--an evaluation based on the Zancolli Classification of Residual Arm Functions

For patients with cervical spinal cord injuries to become independent in their ADL (Activities of Daily Living), residual arm function is very important. Also, age, sex, physical strengths, obesity, spasticity, pain, contracture and motivation are related. We investigated the possibility of independence in ADL for patients with cervical spinal cord injuries, carrying out our evaluation based on the Zancolli Classification of Residual Arm Functions. Zancolli classification C6BII is taken as the boundary level for ADL independence. Rehabilitation is not only controlled by the patients with cervical spinal cord injuries themselves but also by the ability of the rehabilitation staff. This implies that taking responsibility in rehabilitation important.

cDNA cloning, expression, and characterization of the human bifunctional ATP sulfurylase/adenosine 5'-phosphosulfate kinase enzyme

A cDNA encoding the human bifunctional ATP sulfurylase/adenosine 5'-phosphosulfate (APS) kinase was cloned and sequenced. The enzyme contains an APS kinase domain in its N-terminal portion and an ATP sulfurylase domain in its C-terminal portion. Recombinant full-length enzyme and its constituent APS kinase and ATP sulfurylase domains were individually expressed, purified, and shown to have their respective enzymatic activities.

Clinical significance of neutrophil adhesion molecules expression after coronary angioplasty on the development of restenosis

To investigate the neutrophil activation process following percutaneous transluminal coronary angioplasty (PTCA), we examined the expressions of Mac-1 (CD11b/CD18), L-selectin (CD62L), and sialyl-LewisX (SLX) on the surface of neutrophils after the PTCA procedure, by flow cytometric analysis. Twenty-nine patients with single vessel coronary artery disease of the left anterior descending artery who underwent elective PTCA were enrolled. In the 17 patients without restenosis at the follow-up angiography, the mean channel fluorescence intensity (MFI) for CD18, CD62L and SLX did not change after PTCA. Only the CD11b level was increased at 48 h after the PTCA. In the remaining 12 patients who developed restenosis, the MFI values for CD18 and CD11b were increased at 24 h and 48 h after the PTCA. The MFI value for CD62L was decreased and that for SLX was increased at 48 h after the PTCA. These changes were more prominent in the coronary sinus blood samples than in those of the peripheral blood samples. Our data indicate the down-regulation of L-selectin, probably by shedding, as well as the up-regulations of Mac-1 and sialyl-LewisX, especially in patients with restenosis. It is suggested that neutrophil activation by an interaction between the selectin family and carbohydrate ligands after PTCA may play a role in the development of restenosis, as does the integrin family.

Arrhythmia curve interpretation using a dynamic system model of the myocardial pacemaker

A problem of identifying the phase response curve of the myocardial pacemaker was investigated using a simple dynamic system model of cardiac arrhythmia. A hybrid optimization method of a genetic algorithm and a local optimization technique was employed to obtain a solution of the model fitting. The method was applied to two categories of arrhythmias, ventricular parasystole and high-degree AV block. The present study offered a new insight into the mechanism of cardiac arrhythmias.

Effect of enalapril maleate on cerebral blood flow in patients with chronic heart failure

The effect of enalapril on cerebral blood flow (CBF) was studied in 11 patients with chronic heart failure (NYHA II or III, dilated cardiomyopathy in 6 and old myocardial infarction in 5). CBF was evaluated by analyzing the Patlak-Plot curve obtained from radionuclide angiography with technetium-99m hexamethylpropylene amine oxime (99mTC-HM-PAO). Cardiac index (CI) and stroke volume (SV) were simultaneously measured by impedance cardiography. These measurements were performed before and at four weeks after daily administration of 5 mg enalapril. The stroke volume, cardiac index, and heart rate were not significantly changed after four weeks of enalapril administration. However, CBF was increased by 6.5% from 36.72 +/- 4.66 to 39.13 +/- 5.65 mL/100g/min (P < 0.05). These results suggest that enalapril increased cerebral blood flow, which was not related to increased cardiac output in congestive heart failure. Patlak-Plot analysis of radionuclide angiography using 99mTC-HM-PAO may be available for quantitative assessment of brain perfusion.

Difference in HMG1-induced DNA bending among microsatellites

Sequence-dependency of high-mobility group protein (HMG) 1-induced DNA bending is examined for microsatellites using a circularization assay which can measure the extent of bending. Fragments of 133 bp containing (GGA/TCC)11 in the middle showed greater bending than those harboring (GAA/TTC)11 and (GT/AC)17 repeats, and fragments possessing (GA/TC)17 exhibited only slight bending. Differences were not detected for fragments having the repeats near the end. Filter binding assays showed no difference in their binding affinity, suggesting that GGA/TCC repeats are more flexible than the other three repeats as concerns HMG1-induced bending. These results suggest that the mammalian genomes comprise flexible and inflexible regions of microsatellites which might play roles in chromatin architectures and in dynamic packaging of genomic DNA during the cell division cycle.

The 26S-proteasome: regulation and substrate recognition

There is extensive reprogramming of the ATPase regulators of the 26S proteasome before the programmed elimination of the abdominal intersegmental muscles (ISM) after eclosion in Manduca sexta [1]. This extensive ATPase reprogramming only occurs in ISM which are destined to die and not in flight muscle (FM). The MS73 ATPase also increases in the proleg retractor muscles which die at a developmentally different stage to ISM. The non-ATPase regulator S5a shows a similar increase to the ATPase regulators. We have cloned the Manduca SUG2 ATPase and shown that this ATPase is a component of the 26S proteasome. This ATPase shows a similar increase in concentration to the other ATPases in 26S proteasomes before muscle death. The SUG2 ATPase is also associated with other smaller complexes besides the 26S proteasome which act as activators of the 26S proteasome. Finally, in a yeast two-hybrid genetic screen we have identified a protein in human brain which interacts with the MS73 ATPase (and human S6). The interacting protein contains 6 ankyrin repeats and is co-immunoprecipitated with anti-MS73 antiserum after in vitro transcription/translation. The ankyrin repeat protein may interact with the MS73 ATPase as part of the substrate recognition process by the 26S proteasome. Many proteins degraded by the 26S proteasome contain ankyrin repeats, e.g. IkB and some cyclins: binding through ankyrin repeats to an ATPase regulator may complement protein ubiquitination and S5a binding as recognition signals by the 26S proteasome.

Organotin compounds and polychlorinated biphenyls of livers in squid collected from coastal waters and open oceans

The current status of global marine pollution by TBT (tributyltin), TPT (triphenyltin) and polychlorinated biphenyls (PCBs) was examined by determining their concentrations in squid livers. TBT and TPT concentrations in squid livers were higher in coastal waters than in open oceans. The highest values of TBT and TPT of 279 and 519 ng g(-1), respectively, were detected off Japan. TBT concentrations were higher in the northern hemisphere than those of the southern hemisphere organisms. TPT was not detected in squid livers collected in the southern hemisphere. The variation in TBT and TPT concentrations between the northern and the southern hemisphere was greater than those recognized for PCBs distribution in the world oceans. This global distribution pattern of TBT, TPT and PCB seemed to reflect their usage (amount, period and manner of utilization). Approximate TBT concentrations in seawater estimated from bioaccumulation factor in the squid liver were 0.1-5.8 ng litre(-1) in waters around Japan, tr-0.8 ng litre(-1) in oceanic waters in the northern hemisphere, and tr-0.4 ng litre(-1) in the southern hemisphere oceans.

A novel activity of HMG domains: promotion of the triple-stranded complex formation between DNA containing (GGA/TCC)11 and d(GGA)11 oligonucleotides

The high mobility group protein (HMG)-box is a DNA-binding domain found in many proteins that bind preferentially to DNA of irregular structures in a sequence-independent manner and can bend the DNA. We show here that GST-fusion proteins of HMG domains from HMG1 and HMG2 promote a triple-stranded complex formation between DNA containing the (GGA/TCC)11 repeat and oligonucleotides of d(GGA)11 probably due to G:G base pairing. The activity is to reduce association time and requirements of Mg2+ and oligonucleotide concentrations. The HMG box of SRY, the protein determining male-sex differentiation, also has the activity, suggesting that it is not restricted to the HMG-box domains derived from HMG1/2 but is common to those from other members of the HMG-box family of proteins. Interestingly, the box-AB and box-B of HMG1 bend DNA containing the repeat, but SRY fails to bend in a circularization assay. The difference suggests that the two activities of association-promotion and DNA bending are distinct. These results suggest that the HMG-box domain has a novel activity of promoting the association between GGA repeats which might be involved in higher-order architecture of chromatin.

Specific developmental changes in the regulatory subunits of the 26 S proteasome in intersegmental muscles preceding eclosion in Manduca sexta

Previously, we have shown extensive reprogramming of the ATPase regulator of the 26S proteasome preceding the programmed destruction of intersegmental muscles (ISM) in the tabacco horn moth Manduca sexta (Dawson et al., J. Biol. Chem, 270, 1850-1858, 1995). We now show that the extensive reprogramming of the regulatory components of the 26S proteasome occurs only in ISM and not in flight muscles (FM), which undergo terminal differentiation at ecdysis. Unlike in ISM, the ATPase regulators, MS73, MSS1, TBP1 and mts2, remain at low levels in 26S proteasomes in FM from developmental Stage-0 to Stage-7. The non-ATPase regulator subunit 5a, which binds to multiubiquitin chains, increased in ISM similarly to the ATPases but not in FM. The ecdysteroid agonist RH-5849 prevented these subunit increases in ISM. These findings show that reprogramming of 26 S proteasomes is involved in the specific elimination of ISM during eclosion and does not occur in FM which are needed for adult moth flight.

Expression of polymorphonuclear leukocyte adhesion molecules and its clinical significance in patients treated with percutaneous transluminal coronary angioplasty

OBJECTIVES

This study evaluated the role of neutrophil adhesion molecules LFA-1 (CD11a/CD18), Mac-1 (CD11b/CD18) and p150,95 (CD11c/CD18) in patients undergoing percutaneous transluminal coronary angioplasty (PTCA).

BACKGROUND

Several recent studies have suggested that cell adhesion molecules on both neutrophils and vascular endothelial cells play an important role in the process of tissue inflammation.

METHODS

Thirty-eight patients (30 men, 8 women; mean [+/-SE] age 56 +/- 5 years, range 38 to 76) with single-vessel coronary artery disease of the left anterior descending artery underwent coronary angioplasty. Peripheral blood was sampled at baseline before, immediately after and 12, 24, 48 and 144 h after PTCA. The expression of CD18, CD11a, CD11b and CD11c on the surface of polymorphonuclear leukocytes was examined by flow cytometry with monoclonal antibodies.

RESULTS

In patients without subsequent restenosis, there was no change in mean channel fluorescence intensity (MFI) of CD18 at each sampling time. However, in the patients with restenosis, the MFI of CD18 significantly increased at 48 h after PTCA (from 57 +/- 6 to 73 +/- 8, p = 0.0008). The MFI of CD11b increased slightly at 48 h after PTCA in patients without restenosis (from 584 +/- 121 to 735 +/- 114, p = 0.037). In patients with restenosis, the MFI of CD11b was slightly increased at 24 h after PTCA (from 586 +/- 122 to 768 +/- 214, p = 0.018) and significantly increased at 48 h after PTCA (to 1,534 +/- 268, p = 0.0006). The expression of CD11a and CD11c did not change at any sampling points after PTCA in either of the two patient groups. Percent change in the expression of CD18 at 48 h after PTCA (from baseline) and that of CD11b were correlated (r = 0.73, p = 0.0008) in patients with restenosis.

CONCLUSIONS

Inflammatory stimuli within the coronary vessels associated with coronary angioplasty may upregulate Mac-1 expression on the surface of polymorphonuclear leukocytes. This process may be more marked in patients who experience later restenosis. Thus, activation of neutrophil adhesion molecule Mac-1 at 48 h after PTCA may have value as a predictor of subsequent restenosis.

A mechanism of ischemic preconditioning during percutaneous transluminal coronary angioplasty

Manifestation of ischemic preconditioning and its mechanisms during percutaneous transluminal coronary angioplasty (PTCA) was evaluated. Twenty-two patients with angina pectoris, who had one-vessel coronary artery disease of the proximal left anterior descending artery but without visual collateral circulation, underwent elective PTCA performed by balloon inflations of 90 s, repeated three times or more. Changes in standard 12-lead electrocardiogram, hemodynamics and oxygen saturation of the great cardiac vein by a fiber-optic catheter were analyzed. Anginal chest pain occurred in 21 patients (95%) during the first balloon inflation, and in only 9 patients (41%) during the third inflation. In comparison with the first inflation, the third produced less shifts in ST junction (p < 0.01) and peak T (p < 0.01), which were measured and averaged by 4 chest leads from V2 to V5. The heart rate-blood pressure product during the third inflation was equivalent to that during the first. The great cardiac vein oxygen saturation decreased equally during the first and third inflations. However, the ratio of the saturation at reactive hyperemia after balloon deflation to baseline was higher (p < 0.01) in the third than in the first inflation. The adenosine content of the great cardiac vein measured in 11 patients just prior to balloon deflation was also higher (p < 0.05) in the third inflation than the value in the first. Repeated coronary artery occlusion during PTCA could cause ischemic preconditioning, which may be derived from mechanisms common to accelerated reactive hyperemia, for example an increase in intrinsic adenosine levels.

Spinal cord injures in children observed over many years

The known salient features of spinal cord injuries in children are that 1) plane X-rays may not show dislocations or fractures, 2) many of these injuries are complete transections, 3) many injuries are located at the level of upper thoracic spine, and 4) the duration of spinal shock is short. Complications such as pressure sores occur just as easily in children as in adults and the injuries tend to be just as intractable. Complications characteristic in children with spinal cord injuries are spinal deformity and hip dislocation. In this paper, we describe a case involving a C7 spinal cord injury caused by a fall when the patient was 3 years old. We have observed the physical complications for 15 years following that injury. We also report on other observed cases of spinal cord injury.

Relationship of thallium-201 clearance on exercise stress myocardial scintigraphy to coronary flow reserve in patients with coronary artery disease

OBJECTIVE

We evaluated thallium-201 (201Th) clearance measurement during exercise myocardial scintigraphy in patients with coronary artery disease, for the assessment of coronary circulatory function and diagnosis.

DESIGN

The clearance rate of 201Th was compared with the coronary flow reserve measured by Doppler coronary flow velocimetry.

METHODS

We selected 20 patients who had chronic stable angina with single-vessel coronary artery disease of the left anterior descending artery (LAD) and underwent percutaneous transluminal coronary angioplasty (PTCA). Ten control patients had atypical chest pain but no detectable heart disease. Regional net clearance of 201Th was measured from the early and delayed bull's-eye images of 201Th exercise stress single photon emission tomography (SPECT). Using a Doppler catheter, we also measured coronary flow reserve of the LAD, which was obtained by the intracoronary administration of papaverine.

RESULTS

The net 201Th clearance in the anterior wall myocardium in the patients with coronary artery disease before PTCA was significantly less than that in the controls. At follow-up angiography after successful PTCA, it increased. The coronary flow reserve before PTCA was also lower than that in the controls. It was increased immediately after PTCA, and was more markedly increased at the follow-up angiography. Before PTCA, regional net clearance in the anterior myocardium was correlated with the coronary flow reserve of the LAD. The ratio for the net clearance of the anterior myocardium at follow-up angiography to that before PTCA was also correlated with the ratio for coronary flow reserve.

CONCLUSIONS

In patients with coronary artery disease, the regional 201Th clearance in the ischaemic area measured by exercise 201Th SPECT is correlated with the coronary flow reserve of the affected artery. Moreover, the increase in the clearance rate after PTCA is also correlated with that in the coronary flow reserve. Thus the measurement of regional 201Th clearance might be a useful non-invasive method of estimating of the coronary flow reserve.

Population pharmacokinetics of phenytoin in Japanese patients with epilepsy: analysis with a dose-dependent clearance model

The population pharmacokinetic parameters of phenytoin were estimated using routine therapeutic drug monitoring data from 116 epileptic patients. The 531 serum concentration values at steady-state after repetitive oral administration were analyzed using a nonlinear mixed effects model (NONMEM) program designed for estimation of population pharmacokinetic parameters. A one-compartment model with dose-dependent clearance was used for the pharmacokinetic analysis of phenytoin. The volume of distribution (V) was estimated to be 1.231/kg in a typical 42-kg patient, assuming that the bioavailability of orally administered phenytoin is 100%. The maximal elimination rate (V(max)) and the Michaelis-Menten constant (K(m)) were 9.80 mg/d/kg and 9.19 micrograms/ml, respectively. The parameter of power function of weight to adjust V and V(max) was estimated to be 0.463. In addition, K(m) for phenytoin appeared to be 16% increased in patients receiving zonisamide concurrently. The population pharmacokinetic parameters of phenytoin will be useful for designing dosage regimens in epileptic patients.