Significance of high levels of serum IgA and IgA-class circulating immune complexes (IgA-CIC) in patients with non-insulin-dependent diabetes mellitus

Significance of serum IgA and IgA-class circulating immune complexes (IgA-CIC) elevation in patients with non-insulin-dependent diabetes mellitus (NIDDM) was described. Seventeen patients with NIDDM and 17 patients with diffuse mesangial proliferative glomerulonephritis without deposition of IgA (DPGN) as controls were examined. The levels of serum IgA in patients with NIDDM were significantly higher than those in patients with DPGN (p < or = 0.01). The levels of IgA-CIC in patients with NIDDM were also significantly higher than those in patients with DPGN (p < or = 0.01). Production of IgA derived from B cells and the proportion of IgA bearing B cells in patients with NIDDM were not significantly higher than those in patients with DPGN. Furthermore, the levels of IgA in pharyngeal washings from diabetic patients were not significantly higher than those for DPGN patients. Duration of diabetes, the level of HbA1c, and the presence of hypertension, microalbuminuria, or retinopathy showed no significant correlations with the levels of serum IgA or IgA-CIC in patients with NIDDM. It was postulated that the elevations of serum IgA and IgA-CIC were based on subclinical infection of the mucosa and/or deterioration of IgA clearance in patients with NIDDM.

A sensitive postcolumn derivatization/UV detection system for HPLC determination of antitumor divalent and quadrivalent platinum complexes

A sensitive postcolumn derivatization/UV detection system has been developed for HPLC analysis of antitumor divalent and quadrivalent platinum complexes. It is based on the derivatization of platinum complexes by reaction with sodium bisulfite to corresponding product(s) which has enhanced absorptivity at 280-300 nm. Platinum complexes examined in this study were cisplatin, carboplatin and oxaliplatin (divalent platinum complexes) and oxoplatin and tetraplatin (quadrivalent ones). The proposed detection system was sensitive to all these complexes. Under the detection conditions optimized for individual complexes, the HPLC gave linear relationships between the complex concentration and the peak height. Detection limits at 290 nm with 100 microliters injection were 20 nM for cisplatin, 40 nM for oxoplatin, 60 nM for carboplatin and tetraplatin and 100 nM for oxaliplatin (S/N = 3 at 0.005 AUFS). The proposed system was successfully applied for the determination of cisplatin and oxoplatin in plasma and urine. Pharmacokinetic behavior of oxoplatin and its reduced product cisplatin following a single intravenous injection of oxoplatin in rabbits has been discussed.

Infantile spasms with predominantly unilateral cerebral abnormalities

To investigate the pathogenesis of infantile spasms, 12 children underwent a combination of neurophysiologic and neuroimaging studies including brainstem evoked potentials and single photon emission computed tomography with 99mTcHMPAO. Three of the children had localized cerebral abnormalities on neuroimaging, i.e. right frontotemporal cortical microdysgenesis, left frontotemporal polymicrogyria, and right parietooccipitotemporal porencephalic cyst. Neurophysiologic studies also indicated that a single cerebral hemisphere was predominantly involved, while the other hemisphere and the brainstem were relatively spared, a result compatible with the clinical findings of hemiparesis and hemiconvulsion. In these three patients, administration of carbamazepine was followed by marked improvement of the clinical and electroencephalographic findings. Our results suggest that a combination of noninvasive examinations can distinguish a particular subtype of infantile spasms associated with a localized cerebral abnormality and responsive to carbamazepine.

Identification as beta-adducin of a protein interacting with rabphilin-3A in the presence of Ca2+ and phosphatidylserine

Rabphilin-3A is a putative target protein for Rab3A small GTP-binding protein implicated in neurotransmitter release. We have previously identified a Rabphilin-3A-interacting protein with a Mr of about 115 kDa in bovine brain. We have attempted here to purify this protein and to determine its primary structure. Amino acid sequence analysis has revealed that this protein is a bovine counterpart of human beta-adducin which is known to be a good substrate for protein kinase C. The Rabphilin-3A-interacting protein also binds to protein kinase C in the presence of Ca2+ and phosphatidylserine. These results indicate that Rabphilin-3A binds to beta-adducin in the presence of Ca2+ and phosphatidylserine.

Up-regulation of hepatic LDL receptor gene expression by monatepil, a novel calcium antagonist, in high cholesterol diet-fed Japanese monkeys

The action of the novel antihypertensive calcium antagonist monatepil on the hepatic LDL receptor was investigated at the gene expression level to clarify the mechanism of its hypolipidemic effect. In cholesterol-fed control monkeys, the LDL receptor mRNA level decreased to approximately 30% of that in the normal diet-fed monkeys. However, the administration of monatepil increased LDL receptor mRNA to normal levels (three- to fourfold stimulation). It is suggested that monatepil raises the number of LDL receptors in liver tissue and that this increase may accelerate the removal of plasma LDL. Treatment with prazosin, an alpha 1-adrenoceptor antagonist, also increased the LDL receptor mRNA level, but this restorative effect was much weaker than that of monatepil, suggesting that mechanisms additional to its alpha 1-adrenoceptor blocking activity are involved in the hypolipidemic effect of monatepil.

Elongation factor 1 alpha is a component of the subcortical actin bundles of characean algae

Antibodies to elongation factor 1 alpha (EF1 alpha), a known 50 kDa actin-bundling protein in Dictyostelium, identified a protein in a whole cell extract of the characean alga Nitella pseudoflabellata that had an apparent molecular weight of 51 kDa. Indirect immunofluorescence microscopy revealed labelling by the EF1 alpha antibodies of the subcortical actin bundles, even after the motile organelles of the endoplasm were removed by perfusion with ATP-containing solutions.

Serum hyaluronate in the assessment of liver endothelial cell function after orthotopic liver transplantation in the rat

This study was designed to evaluate the use of serum hyaluronate as a marker of liver endothelial cell function after liver transplantation. We performed orthotopic liver transplantation in both isogeneic and allogeneic rejector models. After transplantation, hepatocyte function was assessed on the basis of serum ALT and total bilirubin levels, and liver endothelial cell function was judged on the basis of serum hyaluronate levels. Significant increase of hyaluronate in the rejector model, compared with the isogeneic model, was seen before any significant results could be obtained from conventional liver function tests. The impaired metabolism of hyaluronate in the rejector model was observed after intravenous injection of trace amounts of radioactive material. Serial studies demonstrate that the endothelial cell is a more susceptible target for the immune response than the hepatocyte. Serum hyaluronate concentration may be a better indicator in the early assessment of graft function. We also examined serum hyaluronate levels to evaluate cold ischemia-reperfusion injury to the liver endothelial cells in the isogeneic model. At 2 hr after reperfusion, hyaluronate levels in the 6-hr cold ischemia (nonviable allograft) group were significantly higher than in the 1-hr and 3-hr cold ischemia (viable allograft) groups. However, there was little difference between the viable allograft groups. After an intravenous injection of 1 mg/kg hyaluronate, the hyaluronate elimination rate in the 3-hr group was distinctly slower than that in the 1-hr group. These data indicate that the hyaluronate elimination rate may be a more sensitive marker of liver endothelial cell function in viable liver after a short period of ischemia.

The effect of the partial pressure of oxygen on blood glucose concentration examined using glucose oxidase with ferricyan ion

Glucose oxidase with ferricyan ion (GOD-F) is widely applied in clinical settings as a glucose sensor. However, blood oxygen concentration affects this blood glucose value because oxygen, at increased concentrations, consumes blood glucose, which cannot then be measured by this sensor. We investigated the effect of PO2 on blood glucose concentration in 48 patients who were breathing high concentrations of oxygen. Arterial and pulmonary arterial blood glucose values were analyzed using the GOD-F method and, as a control, the hexokinase method. The respective PO2 values were also measured. The blood glucose concentrations measured by the GOD-F method show a significant linear relation with that measured by the hexokinase method in both arterial (y = -24.4 + 1.01x, r = 0.99) and pulmonary arterial blood (y = -3.4 + 1.01x, r = 0.96). The difference of intercepts is statistically significant, but because of the relatively large limits of agreement indicating any hidden extraneous variabilities, the error of the GOD-F method could not be assessed just by the difference. The equation defining the effect of PO2 on the percent change between blood glucose measured by the GOD-F method and that measured by the hexokinase method is -19.8/(1 + 203900/PO2(2.68) (r = 0.62). This formula generally follows our measured materials and introduces the relationship among blood glucose value, PO2, and the error of the GOD-F method. We hesitate to suggest that the arterial blood glucose concentration when measured by the GOD-F method could be underestimated by as much as 20% in patients with high arterial oxygen pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Development of the brainstem and cerebellum in autistic children]

Studies of magnetic resonance images have revealed morphological disorders of the brainstem and cerebellum in autistic children and adults. When we studied development of the brainstem and cerebellum in autistic patients, these structures were significantly smaller in autistic patients than in controls. Although the brainstem and cerebellum significantly increased in size with age in both groups, the development of the pons, cerebellar vermis I-V and cerebellar vermis VI-VII was significantly more rapid in autistic patients than in controls. However, the development of the other brain structures in the posterior fossa did not differ between autistic patients and controls. The regression intercepts of the brainstem and cerebellum as well as those of their components were significantly smaller in autistic patients than in controls. These results suggested that significant anatomical changes took place in the posterior fossa brain structures in the prenatal period in autistic children, but were not progressive.

Antihypertensive, antiatherosclerotic, and plasma lipid-lowering effects of monatepil, a novel calcium antagonist with alpha 1-adrenoceptor-blocking activity in experimental animals

Traditional antihypertensive therapy has been shown to reduce the incidence of hypertension-related vascular injuries; however, it is not fully effective against cardiovascular abnormalities. In some animal models, calcium antagonists have been demonstrated to possess antiatherogenic properties but to have no effects on plasma lipid levels, whereas alpha 1-adrenoceptor blockers have been shown to reduce plasma lipid levels. Monatepil is a new type of calcium antagonist that also has alpha 1-adrenoceptor-blocking activity. Therefore, it is thought that monatepil may have both antiatherosclerotic and plasma lipid-lowering effects in addition to its slow-onset and long-lasting antihypertensive effect. To determine the antiatherosclerotic effects of monatepil, we examined its effect on experimental atherosclerosis induced by feeding a high-cholesterol diet to monkeys, whose lipid metabolism resembles that of humans. Monatepil, at a daily dose of 30 mg/kg, at which plasma levels are equivalent to those in clinical antihypertensive therapy, was administered orally for 6 months. Monatepil suppressed elevation of cholesterol in the aorta and reduced the atherogenic (sudanophilic) area. Histologic examination revealed that monatepil-treated monkeys exhibited little aggregation of foam cells in either the aorta or coronary arteries compared with vehicle-treated atherogenic monkeys. In addition, monatepil showed preventive effects against increases in total cholesterol and low density lipoprotein (LDL), and against decreases in high density lipoprotein in plasma caused by cholesterol loading. The plasma lipid-lowering effect may be mediated through up-regulation of the number of hepatic LDL receptors by the alpha 1-adrenoceptor-blocking activity, and the antiatherosclerotic effect may be produced by the combined calcium antagonist, alpha 1-adrenoceptor-blocking, and antilipid peroxidation activities. In summary, monatepil is an antihypertensive agent belonging to a new class with antiatherogenic properties and the ability to reduce plasma lipid levels.

Spectral analysis of electromyogram in lumbar muscles: fatigue induced endurance contraction

In the last few years, epidemiological studies have shown correlations between the low endurance capacity of the erector spinae muscle and low back pain (LBP). In this study, the function of the erector spinae muscle and localized muscle fatigue in LBP were investigated in both LBP patients and control subjects without LBP, using surface multi-channel electromyograms (EMG). Four positions (L1, L2, L4, L5) were chosen as representative locations for the different functions of the erector spinae muscle. Median frequency (fm) parameters of an EMG power density spectrum were monitored to quantify localized muscle fatigue. This research indicated a statistically significant difference (P < 0.05) in fm parameters between the LBP patients and the control subjects. The integrated electromyogram (iEMG) signals of LBP patients were considerably higher than for the control subjects during endurance isometric contraction. Our research suggested that human fatiguing erector spinae muscle, in submaximal voluntary contractions tests, induced a different firing order of motor unit spikes between two groups.

[Omental pedicle flap for chronic empyema]

We have used the omental pedicle flap (OPF) method to treat 10 patients with chronic empyema secondary to pulmonary tuberculosis. Since 1987 they included 9 men and one woman ranging from 48 to 70 years in age. Two patients were required re-operation because of residual bronchopleural fistulas, and the additional procedures (muscle plombage and thoracoplasty) performed in order to close residual dead space produced more severe thoracic deformity and pulmonary dysfunction. In our first successful case, complete thoracoplasty combined with the OPF method also produced pulmonary dysfunction. On the other hand, thoracic deformity was avoided in 3 other patients and 4 patients without thoracoplasty showed better pulmonary function postoperatively. A comparison of the re-operated patients with the successful cases highlighted two important points regarding the OPF method. One is the need for firm fixation of the OPF to a fistula. We usually place a muscular pedicle flap over the OPF, and add limited thoracoplasty as necessary. The other important point is the control of infection. Open window thoracostomy before the OPF method is effective in patients with active infection. The OPF method is an effective radical operation for severe empyema even when residual dead space is present, and it can also be applied to patients with poor pulmonary function.

Characteristics of auditory P300 in children: application of single trial analysis

As, especially in children, cognitive function might vary from one stimulus to the other, even when the same target stimuli are presented in the oddball paradigm, we applied the single trial analysis adopting discrete Fourier transformation followed by inverse discrete Fourier transformation to the auditory P300 for the first time in children. In 9 children, age 9-13 years, a positive peak was clearly identified in approximately a quarter of the processed single sweep responses to target stimuli (single sweep P300), whereas it was observed less frequently for non-target stimuli. In 2 children of age 6 years, it was difficult to discriminate single sweep P300 from background EEG activities even in the processed data. As for the former group, the detection ratio of P300 in single sweep target responses ranged from 10.0 to 40.0%, and its mean latency and amplitude ranged from 311 to 348 ms and from 31.7 to 41.5 microV, respectively. There was a significant correlation between average data and single sweep data in terms of the P300 latency. However, the amplitude of P300 in the average data bore no relation to the detection ratio, mean amplitude or variability of latency among single sweep P300s. As compared with adult data previously reported, the detection ratio of single sweep P300 was lower and the P300 amplitude was higher in childhood. P300 in children, at least past puberty, can be analyzed by using the single trial method, which is expected to provide more information about the development of human higher brain functions, especially cognitive function.

Electrogastrography in neonates

We recorded the electrical signals from bipolar electrodes placed on the abdomen of 7 adults and 10 newborn infants. Data were analyzed by visual inspection and by a wave analysis computer program with a fast Fourier transform. Waves of 3 cycles/min were recorded in adults, and similar 3 cycles/min waves were recorded in infants as well. The percentage of time of 3 cycles/min waves was lower in neonates (13.8% +/- 10.8%) than in adults (57.9% +/- 27.8%) (p < 0.01). Only an electrocardiogram superimposing the flat baseline was recorded in the remaining recording time. Spectral analysis confirmed the validity of the visual analysis, showing clear peaks at 0.05 Hz only when 3 cycles/min waves were visually present and motion artifact was absent. The electrode positions where percentage of time of 3 cycles/min waves was greatest were different for newborns and adults. There was no significant difference in the mean amplitude of the waves between groups. These facts indicate that the electrogastrogram of neonates is different from that of adults in terms of best electrode positions and percentage of time of 3 cycles/min waves.

Infantile spasms: localized cerebral lesions on SPECT

Ten infantile spasms (IS) patients had single photon emission computed tomography (SPECT) with [99mTc]HMPAO, EEG, and magnetic resonance imaging (MRI) studies. SPECT showed localized cerebral hypoperfusion in 7 infants (4 unifocal; 3 multifocal) always involving the temporal regions either unilaterally or bilaterally. EEGs obtained in near time of the SPECT studies showed focal abnormalities in all 7 infants with hypoperfusion on SPECT, with complete correspondence of the abnormalities in 5. MRI showed localized cerebral lesions in only 3 of the 10 infants, all of whom had corresponding areas of hypoperfusion on SPECT. Our study indicates that localized cerebral abnormalities (especially of the temporal lobes) may often be associated with IS and that such patients may have localized cerebral hypoperfusion on SPECT even when the MRI is normal.

Serial EEG and sleep polygraphic studies on lissencephaly (agyria-pachygyria)

We carried out serial EEG studies on 12 cases of lissencephaly (6 of agyria and 6 of pachygyria), polysomnograms being recorded in 8 of the 12 cases. Fourteen Hz sleep spindles appeared from early infancy in all cases. They were poorly observed after the age of 1 year, and 5-11 Hz high-amplitude rhythmic activity (HARA) of more than 300 microV appeared predominantly in place of the 14 Hz spindles. Both the 14 Hz spindles and HARA showed asymmetry, but the dominant cerebral area for both types of waves was much the same. Four of the 6 agyria cases showed hypsarrhythmia within the first 6 months after birth, 3 of the 4 cases showing asymmetric hypsarrhythmia at first. Their hypsarrhythmia consisted of very high-voltage 5-7 Hz slow sharp waves and delta waves. The EEG abnormalities transformed from hypsarrhythmia to focal spikes in the 6 pachygyria cases. The polygraphic study on 8 cases revealed that the proportion of REM sleep decreased in 3 cases and the REMs/min values decreased in 7. Infantile spasms occurred in 4 of the 8 cases. The REM/min values decreased in all of these 4 cases, and, furthermore, the proportion of REM sleep decreased in 3 of the 4 cases. These findings suggest that lissencephaly involves a disorder of the brainstem, and that the combination of brainstem lesions and severe cerebral dysplasia is important for the manifestation of infantile spasms in lissencephaly.

Activation of hydrogen peroxide by copper (II) complexes with some histidine-containing peptides and their SOD-like activities

The reactivities of copper(II) complexes with histidine-containing oligopeptides towards active oxygen species such as hydrogen peroxide (H2O2) and superoxide ion (O2-) were investigated by electron spin resonance (ESR)-spin trapping and thiobarbituric acid (TBA) methods. At physiological pH values, Cu(II) complexes with oligopeptides containing histidyl residue at the N-terminal could more easily activate H2O2 to yield hydroxyl radical (.OH) than other Cu(II)-oligopeptide complexes containing histidyl residue in the second or third position. Further, it was suggested that since all Cu(II)-oligopeptide complexes examined could scavenge O2-, these complexes have SOD-like activities.

[Neurophysiologic studies on patients with migration disorder]

Neurophysiologic studies on six patients (five lissencephaly and one schizencephaly) with migration disorder were performed in order to evaluate the CNS function by multimodality evoked potentials. All cases revealed abnormalities in SSEP, four cases lost components below P 3 or had low voltage of P 3 indicating brainstem dysfunction in the somatosensory pathway. Two cases lost component below N 1 indicating sensory cortical dysfunction. Three cases revealed ABR abnormalities including a low amplitude of wave V, and one case revealed a prolonged peak latency of wave I and a low amplitude of all components. Two cases revealed abnormalities of poor cortical components in SEP, two cases in VEP, and three cases in MLR. Five cases had normal findings in P-SEP and three cases in VEP. The result of this study demonstrates that patients with migration disorder are frequently associated with cortical, brainstem and peripheral dysfunctions and has heterogeneity in pathophysiology.

Epidemiological characteristics on human immunodeficiency virus infection and acquired immunodeficiency syndrome in Japan

The first case of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) in Japan was diagnosed in a homosexual male in 1985. The Ministry of Health and Welfare formed the AIDS Surveillance Committee, which published HIV seropositive and AIDS data at 2-month intervals. Excluding persons infected through blood products there were 971 HIV seropositives by April 1993, and 204 reported cases of AIDS. One of the epidemiological characteristics of HIV infection and AIDS in Japan is the rapid increase of cases of transmission through heterosexual contact since 1991. Before this, homosexual transmission was the commonest reported mode of transmission. Sporadic cases of mother-to-child transmission and some cases due to injecting drug use were also reported. It is predicted that heterosexual contact will be the primary mode of transmission of HIV in the future. Virtually all the diagnosed AIDS cases so far have been reported to this surveillance network, and it will be an important task of the network to monitor the HIV seropositive cases.

A novel saturation transfer contrast method for 3D time-of-flight magnetic resonance angiography: a slice-selective off-resonance sinc pulse (SORS) technique

Saturation transfer contrast (STC) techniques have been employed to decrease the signal intensity of observed water by saturating a broad proton component. The STC pulse, generally spatially nonselective, reduces the signal of brain background tissues as well as inflowing blood in 3D time-of-flight (TOF) angiography. We present a novel technique, a slice-selective off-resonance sinc pulse (SORS), which is employed to enhance inflowing blood and to suppress the signal of stationary background tissues. The STC effects of the SORS and other spatially nonselective methods influencing inflowing blood is discussed in detail. Angiograms using the SORS method are also presented to demonstrate improved vessel conspicuity. In addition, the SORS method is applicable to imagers with a whole-body RF transmitter system.

Partial splenic embolization for the treatment of chronic idiopathic thrombocytopenic purpura

OBJECTIVE

The purpose of this study was to assess the effectiveness of partial splenic embolization in the treatment of chronic idiopathic thrombocytopenic purpura.

SUBJECTS AND METHODS

Twenty-six patients with chronic idiopathic thrombocytopenic purpura underwent partial splenic embolization and were followed up for 6-61 months. The condition was refractory to steroids in 20 of 26 patients. The other six patients, in whom a response to steroids was shown, could not be withdrawn from steroid therapy because their platelet counts decreased with any decrease in steroid dose. Five of 26 patients underwent splenectomy after partial splenic embolization, and the other patients were followed up without medical treatment until platelet counts decreased below 3 x 10(10)/l. The therapeutic effect of partial splenic embolization was defined on the basis of the platelet count at the last follow-up after partial splenic embolization: complete response, greater than 10 x 10(10)/l; partial response, 5 x 10(10)/l to 10 x 10(10)/l; and no response, less than 5 x 10(10)/l without medication.

RESULTS

Partial splenic embolization brought a complete response in seven (33%) of 21 patients, a partial response in eight (38%), and no response in six (29%). In four of five patients, who later underwent splenectomy, response to partial splenic embolization was coincident with the response to splenectomy. No serious complications occurred, but minor complications such as abdominal pain, fever, and nausea were observed in most patients.

CONCLUSION

This study suggests that partial splenic embolization might be useful as an alternative to splenectomy in the treatment of chronic idiopathic thrombocytopenic purpura.