Anomalous electronic structure and pseudogap effects in Nd1.85Ce0.15CuO4

We report a high-resolution angle-resolved photoemission spectroscopic study of the electron-doped ( n-type) cuprate superconductor Nd1.85Ce0.15CuO4. We observe regions along the Fermi surface where the near- E(F) intensity is suppressed and the spectral features are broad in a manner reminiscent of the high-energy "pseudogap" in the underdoped p-type (hole doped) cuprates. However, instead of occurring near the (pi,0) region, as in the p-type materials, this pseudogap falls near the intersection of the underlying Fermi surface with the antiferromagnetic Brillouin zone boundary.

Diffuse intrasinusoidal liver metastasis of small cell lung cancer causing fulminant hepatic failure: CT findings-a case report

A 65-year-old man with small cell lung cancer treated with two courses of chemotherapy manifested appetite loss and abdominal distention 10 days before admission. Helical CT scanning of the abdomen and pelvis disclosed marked hepatomegaly without any visible nodular lesion in the hepatic parenchyma. He died of severe liver dysfunction with multiorgan failure on the 20th hospital day. Autopsy revealed diffuse invasion of tumor cells into the sinusoid throughout the liver.

Nature of e(g) electron order in La(1-x)Sr(1+x)MnO(4)

X-ray scattering measurements of the low-temperature structure of La(1-x)Sr(1+x)MnO(4) ( 0.33< or =x< or =0.67) indicate the existence of three distinct regions: a disordered phase (x<0.4), a charge-ordered phase (x> or =0.5), and a mixed phase (0.4< or =x<0.5). For x>0.5, the modulation vector associated with the charge order is incommensurate with the lattice and depends linearly on the concentration of e(g) electrons. The primary superlattice reflections are strongly suppressed along the modulation direction and the higher harmonics are weak, implying the existence of a largely transverse and nearly sinusoidal structural distortion, consistent with a charge-density wave of the e(g) electrons.

Hyperthermia: is it an ominous sign after cardiac arrest?

OBJECTIVE

To clarify the clinical characteristics of hyperthermia at an early stage after resuscitation from cardiac arrest (CA).

MATERIALS AND METHODS

We reviewed the medical records of 43 adult patients with non-traumatic out-of-hospital CA, who survived for longer than 24 h after admission to our intensive care unit (ICU) between January, 1995, and December, 1998. The patients were divided into two groups: a clinical brain death (CBD) group (n=23) and a non-CBD group (n=20), and various factors relating to hyperthermia were compared between the two groups.

RESULTS

The mean value of peak axillary temperatures within 72 h of admission was 39.8+/-0.9 degrees C for the CBD group, which was significantly greater than 38.3+/-0.6 degrees C for the non-CBD group (P<0.0001). The time of occurrence of the peak axillary temperature was at 19+/-16 h of admission in the CBD group and 20+/-18 h in the non-CBD group (not significantly different). There were no significant differences in risk factors relating to the occurrence of hyperthermia between the two groups, except for the number of patients who received epinephrine at ICU. In 23 patients with a peak axillary temperature of > or =39 degrees C during the first 72 h of hospitalization, brain death was diagnosed in 20 patients, whereas only 3 of 20 patients having a peak axillary temperature of <39 degrees C developed brain death (odds ratio, 37.8; 95% confidence interval, 6.72-212.2).

CONCLUSION

Hyperthermia at an early stage after resuscitation from CA may be associated with the outcome of brain death.

Reversal of cisplatin resistance by the 1,4-benzothiazepine derivative, JTV-519

The 1,4-benzothiazepine derivative JTV-519 is a new type of calcium ion channel modulator. We examined the modulatory effect of JTV-519 on the antitumor activity of several platinum compounds (cisplatin, carboplatin, and nedaplatin) in a human cancer cell line resistant to cisplatin (PC-14 / CDDP) in vitro. PC-14 / CDDP cells showed 8-fold resistance to cisplatin compared with the parental PC-14 cells as determined by dye formation [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, MTT] assay. In PC-14 / CDDP, but not PC-14 cells, augmentation of cytotoxicity was observed when a nontoxic concentration (10 mM) of JTV-519 was combined with the platinum compounds. Increased intracellular cisplatin accumulation was observed in PC-14 / CDDP cells in the presence of JTV-519 as measured by atomic absorption assay. Therefore, increased cisplatin accumulation was considered to be a possible mechanism underlying the reversing effect of JTV-519 on cisplatin resistance. These results suggest that JTV-519 is a potent agent reversing cisplatin resistance.

Effects of addition of hydrophobic sucrose fatty acid oligoesters on crystallization rates of n-hexadecane in oil-in-water emulsions

Ultrasonic velocity measurements were made on crystallization rates of n-hexadecane dispersed in an oil-in-water (O/W) emulsion (20 wt.% oil and 80 wt.% water) in which Tween 20 was employed for emulsification. Highly hydrophobic emulsifiers, sucrose fatty acid oligoesters involving stearic acid (S-170), lauric acid (L-195) and oleic acid (O-170) moieties, were added to n-hexadecane in an attempt to modify the crystallization rate of n-hexadecane. The crystallization process of n-hexadecane was monitored by variations in the ultrasonic velocity values, which increase with increasing amount of crystal fractions in the oil phase of the emulsion. In comparison with the results of the O/W emulsion systems with the additive P-170 (a sucrose palmitate) (N.Kaneko et al., J. Crystal Growth 197 (1999) 263), the following results were obtained: (a) the addition of S-170 accelerated the nucleation in the emulsion system in the same manner as P-170, no acceleration was revealed with the additive O-170, and L-195 showed moderate effects; (b) the rate of crystal growth was retarded by S-170 and L-195, but not by O-170; (c) the effects of acceleration of nucleation occurred singly in the emulsion system, but not in the bulk system; and (d) the acceleration of nucleation was exhibited through two stages with increasing concentrations of the additives. These results showed the remarkable influence of the fatty acid chain structures of sucrose oligoesters on the acceleration of heterogeneous nucleation of n-hexadecane in the O/W emulsions. The heterogeneous nucleation effected by the addition of S-170 and P-170 was discussed taking into account the adsorption at the oil-water interface and the formation of reversed micelles of the sucrose oligoesters added in the oil phase.

Localization of annexin V in rat normal kidney and experimental glomerulonephritis

The localization of annexin V, a calcium binding protein, was immunochemically and immunohistologically studied in experimental rat glomerulonephritis using annexin V polyclonal antibody. Plasma and urinary annexin V levels were measured by a sandwich enzyme-linked immunosorbent assay (ELISA). Urinary annexin V level, which was correlated with urinary L-lactate dehydrogenase activity, N-acetyl-beta-D-glucosaminidase activity and protein level, increased time-dependently after the injection of nephritogenic antigen (bovine glomerular basement membrane), progressively increasing to attain a peak level at 4 weeks of 51.5 +/- 11.3 ng/h. However, plasma annexin V level showed no increase during the study period. Normal kidneys showed strong staining for annexin V in distal tubules, being particularly strong in tubules of the inner stripe of the outer medulla, but could not be detected in proximal tubules. Annexin V was seen in visceral epithelial cells. Bowman's capsule of the glomerulus, the vascular endothelium of arterioles and interlobular arteries, and vascular smooth muscle. In nephritis, the lumen of distal tubules and the luminal cell membrane were deeply stained, with leakage of annexin V being observed from tubular cells. In the present study, renal annexin V was markedly excreted into urine, and its urinary level reflected the severity of damage of renal tissue and the progression of nephritis. These changes of annexin V in the distal tubule and visceral epithelial cells may be of significance in cell injury of the kidney.

Comparison of hemodynamic effects of enhanced external counterpulsation and intra-aortic balloon pumping in patients with acute myocardial infarction

This study compared the hemodynamic effects of enhanced external counterpulsation and intra-aortic counterpulsation in patients with acute myocardial infarction. Results demonstrated similarity between these 2 methods, except enhanced external counterpulsation had a transient effect of increasing right atrial pressure, pulmonary capillary wedge pressure, and cardiac index.

Suppressive effect of sarpogrelate hydrochloride on respiratory failure and right ventricular failure with pulmonary hypertension in patients with systemic sclerosis

We evaluated the effect of 12 months of 300-mg oral sarpogrelate hydrochloride (SH) once daily on the symptoms of Raynaud's phenomenon, respiratory failure and cardiac function in seven patients with systemic sclerosis. Arterial blood gases, pulmonary function, mean pulmonary arterial pressure, left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), white blood cell count, C-reactive protein and the plasma concentrations of fibrinopeptide A, beta-thromboglobulin, platelet factor 4 and thrombomodulin were evaluated before and 2 and 12 months after SH administration. After 2 and 12 months of SH administration, a significant decrease was found in the frequency and duration of Raynaud's phenomenon, as well as the coldness, numbness and pain of Raynaud's phenomenon. Respiratory failure, as estimated by Hugh-Jones classification, was significantly decreased, whereas the percentage carbon monoxide diffusion capacity was significantly increased. The mean pulmonary arterial pressure decreased significantly, as did plasma fibrinopeptide A, beta-thromboglobulin and platelet factor 4. There was no significant change in LVEF after 2 or 12 months, but after 12 months of SH administration, RVEF increased significantly. In conclusion, use of SH may prevent Raynaud's phenomenon, respiratory failure and right ventricular failure in patients with systemic sclerosis.

Is emergency open chest cardiopulmonary resuscitation accepted by patients' families?

Emergency open chest cardiopulmonary resuscitation (OCCPR) is sometimes performed on patients with cardiopulmonary arrest (CPA), especially those resulting from trauma. Since OCCPR is frequently carried out without the permission of patients' families, we surveyed the opinions of the families. A total of 1058 CPA patients were transferred to our department during the last 15 years. We sent questionnaires individually to the families of these patients to ask their opinions about OCCPR. The questionnaire provided the six questions allowing multiple answers; (1) Do you unconditionally agree with OCCPR? (2) Do you agree with OCCPR in children? (3) Do you agree with OCCPR in elderly patients? (4) Do you agree with OCCPR without permission from patient's families? (5) Do you entrust OCCPR to the doctors in charge? and (6) others. The questionnaire reached 846 families, of which 277 (32.7%) responded. The percentage response to each question was (1) 70.2, (2) 5.8, (3) 21.8, (4) 7.1, (5) 4.2 and (6) 5.0%. The younger the age of the responders the more they agreed with OCCPR. All the responders less than 30 years old agreed with the procedure. Of the 277 families, 95 had CPA patients treated with OCCPR. This group of families responded to six questions at the following rates: (1) 79.5, (2) 6.0, (3) 13.3, (4) 2. 4, (5) 4.8 and (6) 4.8%, suggesting that families with OCCPR patients are more cooperative to our treatment than those with non-OCCPR patients. The results of this study suggest that OCCPR in CPA patients is generally accepted by the patients' families, especially by young generations, although post-OCCPR careful explanation to patients' families is still indispensable.

Dermoid cyst in the adrenal gland

The first case of a dermoid cyst arising from the unilateral adrenal gland is reported with special reference to its embryonal development and imaging analysis.

Measurement of urinary annexin V by ELISA and its significance as a new urinary-marker of kidney disease

To confirm the significance of excretion of annexin V into the urine and the change of urinary annexin V concentration in kidney disease, a sandwich enzyme-linked immunosorbent assay (ELISA) was developed using two monoclonal antibodies. Urinary annexin V concentration was measured in healthy individuals and patients with kidney and other diseases. Urinary annexin V did not change over a range of pH between 5.0 and 8.0, and was stable during the course of the study for 24 h at room temperature and for 8 days at 4 degrees C. The mean urinary annexin V concentration in 105 normal healthy individuals was 1.5+/-1.5 ng/ml, while that in patients with nephrotic syndrome and systemic lupus erythematosis (SLE) nephritis was 9.3+/-9.1 and 6.6+/-6.7 ng/ml, respectively, and that in IgA nephropathy and chronic renal failure was 2.6+/-2.1 and 1.3+/-0.7 ng/ml, respectively. Annexin level correlated with urinary protein concentration (r=0. 717), but not the serum creatinine concentration, blood urea nitrogen (BUN) and 24-h creatinine clearance. Mean urinary annexin V concentration in patients with ischemic heart disease, hypertension, and diabetes mellitus was 1.4+/-1.0, 1.4+/-1.1, and 1.7+/-1.3 ng/ml, respectively. In one case of relapsing nephrotic syndrome, the urinary annexin V concentration was markedly increased in the early phase after admission and then decreased. This patient later required hemodialysis. These results suggest that a high urinary annexin V concentration may be an indicator of acute renal injury related to the urinary protein level.

Effects of static magnetic field on dissolved oxygen levels in aqueous solutions containing copper(II), iron(II), and heme iron(III) complexes

Trace metal ions like copper and iron play important roles such as binding, transport, and storage of molecular dioxygen in a wide variety of living systems. The effects of static magnetic fields on the dissolved oxygen (DO) levels in aqueous solutions containing copper(II), iron(II), and their bioligand complexes were investigated. The DO levels in aqueous solutions containing the stable copper(II) complexes such as Cu(II)-Arg, His, GGH and BSA systems increased when the applied magnetic field increased. However, the magnetic field-dependent changes of DO levels were not observed by the unstable Cu(II) complexes such as Cu(II)-Lys, Gly, Gly-His and Hb systems. Especially, DO levels in aqueous solutions containing Cu(II)-His or BSA complexes increased 1.1-fold to those of the control levels at 200 mT of the applied magnetic field. In contrast, DO levels in aqueous solutions containing iron(II) decreased significantly when the magnetic field increased, which in turn promoted the Fe(II)-induced lipidperoxidation in liposomes. DO levels in aqueous solutions containing Fe(II)-His complex decreased 0.9-fold to those of the control levels at 200 mT of the magnetic field for 30 min. While, the magnetic field-dependent changes of DO levels increased significantly in aqueous solutions containing heme iron(III)-complexes, suggesting that heme iron(III) is reduced to heme iron(II) under exposure of the magnetic field and thus the incorporation of molecular dioxygen in aqueous solutions is enhanced. These results indicate that the effect of the magnetic fields on DO levels in aqueous solutions must be discussed in terms of a concept: formation of intermediate complexes consisting of molecular dioxygen-copper or iron and bioligands under physiological conditions and the following enhancement of incorporation of molecular dioxygen by the complexes, that in turn activate the molecular dioxygen.

[Rapidly progressed secondary amyloidosis in a patient with Still's disease with gamma-allele in his SAA 1 gene]

A fifteen-year-old boy was admitted to our hospital because of lower abdominal pain, watery diarrhea and mucobloody stool. Two years before admission, he was diagnosed to have Still's disease presenting with polyarthritis, sore throat, remittent fever and typical skin rash. He had been treated with non-steroidal anti-inflammatory agents, oral prednisolone and low-dose methotrexate. Although he was almost free of symptoms during the next two years, serum C-reactive protein (CRP) levels continued to be elevated moderately. He began to complain of lower abdominal pain and loose stool in May 1997 and came down with mucous-bloody diarrhea in June. Laboratory data on admission showed an elevated level of serum CRP (13.9 mg/dl). The biopsy of the stomach, ileum, sigmoid colon and rectum revealed the deposition of amyloid protein of AA type, which confirmed the diagnosis of secondary amyloidosis. The dose of prednisolone was increased and dimethyl sulfoxide per os or rectum was instituted, which improved his gastro-intestinal symptoms to some extent. However, fever, arthritis and diarrhea recurred along with tapered prednisolone dosage. In addition to gastro-intestinal symptoms, arrhythmia and proteinuria appeared. These symptoms were considered to reflect general deposition of amyloid in his body. He is now on immunosuppressive agent and high-dose prednisolone. Several studies report the higher frequency of gamma-allele of SAA 1 gene in the cases of rheumatoid arthritis with AA-amyloidosis than in those without. In the patient presented here, molecular biological analysis revealed that his SAA 1 gene was composed of beta- and gamma-allele. The presence of gamma-allele in his SAA 1 gene might be one of the factors that predisposed him for generalized deposition of amyloid protein in such a short period of time.

[Study of how to continue peak flow monitoring for patients with bronchial asthma: questionnaire to continuation and interruption patients]

Since 1993, our hospital has actively pursuing introduction of peak flow monitoring for patients with bronchial asthma. However, a number of patients are found to discontinue PEF monitoring. In order to determine the causes, a comparative analysis of recognition between patients who continued PEF monitoring (continuation group, hereafter) and those who discontinued PEF monitoring (interruption group, hereafter) was conducted through a questionnaire survey. The number of patients with bronchial asthma who responded to the questionnaire was 120; among them, the number of cases who continued and interrupted PEF monitoring were 68 and 52, respectively. The percentage of patients whose symptoms improved after the introduction of PEF monitoring was higher in the continuation group than in the interruption group. Approximately half of the patients in the interruption group commented that PEF monitoring was valid. The percentage of patients who believed that PEF monitoring is valid was higher in the group of patients who experienced reduction in the severity of symptom after introduction of PEF monitoring compared with those who did not. From these results, to keep high compliance of PEF monitoring, we propose that introduction of PEF monitoring and education of self-management should be positively stated for patients in unstable state. Furthermore, we found that some of the patients in the interruption group expressed interest in restarting PEF monitoring, indicating that each patient should be dealt with on a case by case basis. Appeals from doctors, patients education and advice of relatively few measurements, were found to be especially important in motivating patients to use PEF monitoring.

[Three patients with systemic lupus erythematosus complicated by cytomegalovirus colitis]

We report three female patients with systemic lupus erythematosus complicated by massive intestinal hemorrhage during the recovery from lupus nephritis (case 1, 2) or central nervous system lupus (case 3) on high dose corticosteroid therapy. Large number of cytomegalovirus (CMV) antigen-positive leukocytes and cessation of bleeding with concurrent disappearance of the viral antigens after ganciclovir therapy indicated CMV colitis in all of the three patients. No recurrence of the symptom and a favorable response to ganciclovir without reduction in steroid regimen was common to these patients.

Suppressive effect of saprogrelate hydrochloride on Raynaud's phenomenon and respiratory failure in patients with systemic sclerosis

OBJECTIVE

In seven patients with systemic sclerosis (SS), we evaluated the clinical effectiveness of oral administration of saprogrelate hydrochloride (SH: 300 mg/day) for 2 months on Raynaud's phenomenon (RP) and respiratory failure estimated by Hugh-Jones classification.

METHODOLOGY

We evaluated laboratory data (arterial blood gas (pH, PaO2 and PaCO2), pulmonary function tests (%VC, FEV1/FVC and %DL(CO)), mean pulmonary arterial pressure (mPAP), white blood cell count, C-reactive protein and the plasma levels of fibrinopeptide A (FPA), beta-thrombogloblin (beta-TG), platelet factor 4 (PF4) and thrombomodulin (TM)) before and after SH administration.

RESULTS

The frequency and duration of RP, as well as the coldness, numbness and pain of RP were significantly decreased after SH administration (P < 0.05, P < 0.01 and P < 0.001). Respiratory failure estimated by Hugh-Jones classification was also significantly decreased after SH administration (P < 0.05), and the %DL(CO) was significantly increased (P < 0.01). The mPAP decreased significantly after SH administration (P < 0.05). Plasma FPA, beta-TG and PF4 significantly decreased after administration (P < 0.05 and P < 0.01).

CONCLUSIONS

SH therapy could prevent RP and respiratory failure in patients with SS.

Intravascular ultrasound imaging of the pulmonary arteries in primary pulmonary hypertension

OBJECTIVE

Intravascular ultrasound has the unique ability to provide cross-sectional images of the arterial wall. This study examined intravascular ultrasound (IVUS) images of the proximal pulmonary arteries in primary pulmonary hypertension (PPH).

METHODOLOGY

Study 1: Specimens from four patients who had died of PPH (in vitro PPH group) were compared with those of three patients who had died of subarachnoid haemorrhage but had no evidence of cardiopulmonary disease (in vitro control group). Three-centimetre segments of the following levels were examined by IVUS: pulmonary trunk, eight secondary branch arteries of the upper, middle, and lower lobes of both lungs, and the thoracic descending aorta. Study 2: Four patients with PPH (in vivo PPH group) and five patients without pulmonary hypertension and no evidence of cardiopulmonary disease (in vivo control group) were examined. The IVUS images of the apical segmental artery of the right upper lobe and the descending branch of the right pulmonary artery were studied.

RESULTS

Echographic examination of formalin-fixed preparations of secondary branch sections of the pulmonary artery failed to show a clear three-layer structure in the in vitro control group (24 preparations), but a distinct three-layer structure and increased vessel wall thickness were observed in the in vitro PPH group (32 preparations). Similar findings were obtained in the in vivo study. The mean echo density of the proximal pulmonary arterial wall correlated well with the mean pulmonary arterial pressure (mPA) in the in vitro PPH, and also correlated with the mPA in the in vivo study (r = 0.960, P < 0.0001). The echo intensity of secondary branch sections of the pulmonary artery was higher in the in vitro PPH group than in the in vitro control group (180.5 +/- 27.0 vs 132.5 +/- 26.7 counts, P < 0.001); similar results were obtained in the in vivo study (144.7 +/- 23.4 vs 85.0 +/- 14.3 counts, P < 0.01).

CONCLUSIONS

These results suggest that the histological changes detected in the pulmonary artery walls in the PPH group were responsible for the increased echo intensity.

[Three patients with systemic sclerosis complicated by microangiopathic hemolytic anemia and thrombocytopenia]

Clinical profiles and the treatment process of three female patients with systemic sclerosis (cases 1, 2, and 3) complicated by thrombotic microangiopathic hemolytic anemia (TMHA) were described. Thrombocytopenia preceded renal damage and hypertension in cases 1 and 2, although the chronological relationship between these parameters were unknown in case 3. Plasma exchange therapy using fresh frozen plasma was beneficial in cases 1 and 2. Cases land 3 presented with delirium and fluctuating psychosis, respectively. Early detection of thrombocytopenia and insidious hemolysis might be essential for starting effective plasmapheresis treatment in a part of patients with scleroderma kidney who present with thrombotic thrombocytopenic purpura (TTP) like disorder.

Merits of soft nitriding scalers

BACKGROUND

It has been demonstrated that nitriding modifies the physical characteristics of metals. The purpose of this study was to evaluate the changes induced by 3 levels of inexpensive soft nitriding treatments on commercial sickle scalers.

METHODS

Taglite scalers (NT) were soft nitrided for 30 (SN30), 60 (SN60), or 90 (SN90) minutes. The cumulated scaled material was weighed every 10 strokes x 10 and thereafter every 1,000 to 8,000 strokes by an automatic scaling apparatus against epoxy resin. Weight differences were used to indicate abrasion resistance; the relative efficiency (RE) was calculated as the ratio of scaled amount at a given number of strokes (SN/NT). The hardness and the tensile strengths were determined for each soft nitriding treatment level. The nitrided layer thickness of representative SN scalers was observed by electron probe x-ray microanalysis.

RESULTS

The SN60 was not significantly different from SN30 or SN90, but the SN90 was more efficient than SN30 for the first 100 strokes (P<0.01). The RE of all SN scalers was significantly greater (2.3 to 2.7 times) than the NT scalers from the beginning of the study and throughout all time periods (SN90 > SN60 > SN30); it increased further during the first 100 strokes (9.7 to 15.5 times), indicating the NT scalers wore out faster than SN scalers. The untreated scalers' performance decreased to 10% of baseline after 100 strokes; but even after 1,000 strokes, the SN60 and SN90 performed better than new untreated scalers. Thereafter, all scalers' performance, including SN scalers, decreased. While the NT blades ceased to cut measurable amounts after 7,000 to 8,000 strokes, all SN scalers continued to cut. Although SN90 scalers had the thickest soft layer and were the hardest (P<0.01), the SN60 had the highest tensile strength (P <0.01), suggesting that it might be the safest in practice.

CONCLUSIONS

Sixty minutes of soft nitriding treatment of commercially available taglite scalers seem to be the optimal treatment duration to increase their durability, on the order of 100 to 1,000 times, without jeopardizing safety for clinical use.