Two new 2-arylbenzofuran derivatives from hypoglycemic activity-bearing fractions of Morus insignis

Ethyl acetate- and n-butanol-soluble fractions of the leaves of Morus insignis showed a significant hypoglycemic activity on streptozotocin (STZ)-induced hyperglycemic rats. From these hypoglycemic activity-showing fractions, two new compounds, mulberrofuran U (2) and moracin M-3-O-beta-D-glucopyranoside (3) were isolated, along with six known compounds [beta-sitosterol, beta-sitosterol-3-O-beta-glucopyranoside, ursolic acid, moracin M (1), kaempferol-3-O-beta-glucopyranoside and quercetin-3-O-beta-glucopyranoside] and the structures of the new compounds were determined by spectroscopic and chemical methods.

Hypersensitivity to heparin; a case report

Hypersensitivity reactions to heparin are very rare. A generalized hypersensitivity reaction including as fever and skin rash to a porcine- and bovine-derived heparin preparation was observed in a hemodialysis patient due to the nephrotic syndrome. The patient revealed peripheral eosinophilia and normal serum IgE. The results of a drug lymphocyte stimulating test on heparin were positive. Following prednisolone administration and infusion of nafamostat mesilate as anticoagulant therapy during hemodialysis, the high fever and generalized urticaria disappeared. Caution is required when conducting heparin therapy on hemodialysis patients.

Case report: left ventricular apical hypertrophy in progressive limb-girdle muscular dystrophy

Cardiac involvement is uncommon in patients with limb-girdle muscular dystrophy. This report describes a patient in whom concentric hypertrophy localized to the apical left ventricle was revealed during a long clinical course of skeletal muscular dystrophy, with evolving electrocardiographic changes also compatible with apical hypertrophic cardiomyopathy. Endomyocardial biopsy revealed similar histologic changes in the skeletal muscle biopsy specimen, characterized by muscle fiber atrophy and hypertrophy with a mild degree of interstitial fibrosis. The pathogenesis of cardiac hypertrophy in this case is unclear. However, the pathologic findings suggest that the myocardium may be involved in the same dystrophic process as the skeletal muscles.

Palbinone, a novel terpenoid from Paeonia albiflora; potent inhibitory activity on 3 alpha-hydroxysteroid dehydrogenase

Palbinone, a novel terpenoid isolated from the roots of Paeonia albiflora, showed a strong inhibitory activity on the reduced form of nicotinamide adenine dinucleotide phosphate (NADPH)-linked 3 alpha-hydroxysteroid dehydrogenase (3 alpha-HSD) of rat liver cytosol. The structures of palbinone and a known compound, paeonilactone-B isolated from the active fraction of this plant were determined by the use of 2D NMR techniques (1H-1H COSY, 1H-13C COSY, 1H-13C long-range COSY, and HMBC).

Physiological properties and morphological characteristics of cutaneous and mucosal mechanical nociceptive neurons with A-delta peripheral axons in the trigeminal ganglia of crotaline snakes

Primary A-delta nociceptive neurons in the trigeminal ganglia of immobilized crotaline snakes were examined by intrasomal recording and injection of horseradish peroxidase in vivo. Thirty-four neurons supplying the oral mucosa or facial skin were identified as A-delta nociceptive neurons which responded exclusively to noxious mechanical stimuli and had a peripheral conduction velocity ranging from 2.6 to 15.4 m/s. These neurons were subdivided into a fast-conducting type (FC-type) and a slowly conducting type (SC-type). Neurons of both types had a receptive field limited to a single spot which responded to pin prick stimulus with a threshold of more than 5 g. The FC-type neurons had a narrow spike followed by a shorter after-hyperpolarization. In contrast, SC-type neurons exhibited a broad spike with a hump on the falling phase and a longer after-hyperpolarization. The diameters of the stem, central and peripheral axons of the FC-type neurons were significantly thicker than those of the SC-type neurons, but there was no statistical difference in the soma size of the two types. Central axons of both types of neurons were thinner than their stem and peripheral axons. Dichotomizing fibers of peripheral axons were observed within the ganglion on 3 neurons. Central axons of the FC-type neurons terminated ipsilaterally in the nucleus principalis, the subnucleus oralis, interpolaris and caudalis and the interstitial nucleus, whereas those of the SC-type neurons generally projected only to the caudal half of the subnucleus interpolaris, subnucleus caudalis and interstitial nucleus ipsilaterally. The present data showed for the first time the physiological and morphological heterogeneity of the primary trigeminal A-delta nociceptive neurons and revealed that the trigeminal nucleus principalis and all the subdivisions of the trigeminal descending nucleus are involved in nociception as relay nuclei, but the subnucleus caudalis and the caudal half subnucleus interpolaris are the essential relay sites of the primary nociceptive afferents supplying the oral mucosa and facial skin. The interstitial nucleus also appears to play an important role in orofacial nociception.

[A successfully treated case of acute renal failure due to acute immune hemolytic anemia and nontraumatic rhabdomyolysis induced by streptomycin reinjection]

A case of acute immune hemolytic anemia associated with non-traumatic rhabdomyolysis (NTR) induced by streptomycin (SM) reinjection, which developed acute renal failure, has been reported. A 70-year-old female was admitted to our hospital because of sudden macroscopic hematuria after reinjection of 1g. SM. Laboratory findings on admission were as follows; hemoglobin and myoglobin were positive in urine. RBC 129 x 10(4)/microliters, Hb 4.9g/dl, Ht 11.1%, reticulocytes 52/1000, serum indirect billirubin 3.8g/dl, LDH 9, 230 WU, BUN 149mg/dl, Cr 7.9mg/dl, myoglobin 1, 400ng/ml and haptoglobin 10.6mg/dl. The drug lymphocyte stimulating test of SM was positive (215%). A direct antiglobulin test was also positive. An indirect antiglobulin test was negative, but became positive after incubation with SM. These observations made the diagnosis of SM-induced hemolytic anemia associated with NTR. On the second hospital day she developed anuria, and was put on hemodialysis treatment. Two months after the acute hemolytic episode and acute renal failure she recovered and is presently in good health without recurrence.

Malignant hyperthermia caused by intravenous lidocaine for ventricular arrhythmia

We encountered a case of malignant hyperthermia caused by intravenous lidocaine which had been administered as treatment for a ventricular arrhythmia. The patient, a 72-year-old male, was admitted with chronic renal failure and aortic valvular stenosis. His chronic renal failure progressed, and congestive heart failure developed, and ventricular arrhythmias occurred frequently. For the treatment of these arrhythmias, lidocaine was injected and continuous infusion was started. Despite initial improvement in symptoms and laboratory data following hemofiltration, refractory ventricular tachycardia occurred. The patient was treated with large doses of lidocaine. His body temperature rose to a maximum of 41.7 degrees C, and generalized muscular twitching was observed before he lost consciousness. Serum and urinary myoglobin levels became elevated. This abnormally high fever was relieved only by dantrolene sodium. After we made a diagnosis of malignant hyperthermia and stopped the lidocaine infusion, the high fever resolved quickly. It is important to note that malignant hyperthermia can be caused by lidocaine and amide-linked local anesthetics.

The effect of percutaneous transluminal coronary angioplasty on anaerobic threshold in patients with angina pectoris

The anaerobic threshold (AT) is regarded an objective parameter for evaluating exercise tolerance, but its relationship to the improvement of myocardial ischemia remains uncertain. To investigate this relationship, submaximal treadmill exercise tests were performed for 15 consecutive patients with angina pectoris who had undergone successful percutaneous transluminal coronary angioplasty (PTCA). Before and after PTCA, the AT was determined using cardiorespiratory monitoring, while the patients were receiving their usual vasodilator medications. 1) Before PTCA, the minute oxygen uptake (VO2) at the AT correlated well with the peak VO2 (r = 0.92, p < 0.002). The VO2 at the AT, however, showed less correlation (r = 0.71, p < 0.002) with the VO2 at ST segment depression, while the latter parameter correlated closely with the peak VO2 (r = 0.91, p < 0.002). 2) After PTCA, exercise time, peak VO2, and the double product at peak exercise increased significantly (from 640.1 +/- 212.2 to 772.9 +/- 230.0 sec, p < 0.001, from 19.1 +/- 5.2 to 22.4 +/- 4.9 ml/min/kg, p < 0.05, and from 19.7 +/- 5.0 x 10(3) to 23.7 +/- 4.5 x 10(3), p < 0.001, respectively). However, the VO2 at the AT did not increase significantly (from 15.8 +/- 4.1 to 16.6 +/- 3.5 ml/min/kg, p = NS). The heart rate, systolic blood pressure, and double product at the AT did not change significantly. In conclusion, in patients with angina pectoris, the AT is apparently related to the onset of myocardial ischemia. However, the AT does not necessarily reflect acute improvement of myocardial ischemia immediately after PTCA.

Studies on aldose reductase inhibitors from natural products. IV. Constituents and aldose reductase inhibitory effect of Chrysanthemum morifolium, Bixa orellana and Ipomoea batatas

The hot water extracts of Chrysanthemum morifolium, Bixa orellana and Ipomoea batatas, were found to have potent inhibitory activity towards lens aldose reductase (AR). Ellagic acid (4) was isolated from C. morifolium and I. batatas, isoscutellarein (7) from B. orellana and 3,5-dicaffeoylquinic acid (10) from I. batatas, respectively, as potent inhibitors.

Temperature neurons in the crotaline trigeminal ganglia

1. Intrasomal recordings were made with microelectrodes from 153 warm (infrared) neurons in the trigeminal ganglia of 36 crotaline snakes, Trimeresurus flavoviridis. Background discharges were observed at room temperature. The 153 warm neurons were classified into two groups: 81 were sensitive to less than or equal to 10 mg of von Frey hair mechanical stimulation (warm T + M neuron), and 72 were insensitive to up to 100 mg or more of mechanical stimulation (warm T neuron). For T + M and T neurons the receptive fields were all located in the pit organ. The mechanically sensitive field of warm T + M neurons located within the infrared receptive field on the pit membrane was less than 1 mm in diameter, and there was only one field per neuron. 2. Electrophysiological parameters were measured. These measurements included membrane potential, action potential amplitude, time of peaking, time duration at the resting membrane potential level, afterhyperpotential (AHP) height and AHP time to half-decay, and maximum rates of depolarization and repolarization. No difference in action potential parameters between the means of these two submodality groups was observed. 3. Intracellular horseradish peroxidase (HRP) labeling was used for defining the warm neuron profile. The somata of warm T and warm T + M neurons and T- or Y-shaped bifurcations of the axon were observed in the ganglion. At the bifurcation point, nodes of Ranvier were observed, but without broad triangular expansion. Diameters of the central axons were thinner than those of the peripheral or stem axons. There were no differences between the mean diameters of the two submodalities. 4. The central axons of warm T and T + M neurons projected to the lateral descending nucleus of the trigeminal nerve (LTTD). Their synaptic boutons were found in the LTTD. No branching of the axons to the principal sensory nucleus or the descending nucleus of the trigeminal nerve was found. These results were the same for six warm T and eight warm T + M neurons. 5. Conduction velocities of the peripheral fibers were measured by stimulating superficial branches of the maxillary nerve electrically. Three groups of conduction velocity were identified in the compound potentials. The conduction velocity of the peak action potential of the warm T fibers was 6.9 +/- 1.2 (SD) m/s (n = 18), that of the T + M fibers 6.7 +/- 0.9 m/s (n = 23). These fell into the second group of the compound potentials.(ABSTRACT TRUNCATED AT 400 WORDS)

[Evaluation of coronary arterial stenosis before and after PTCA: visual estimation versus computer-assisted analysis]

Coronary arteriogram of 34 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) were evaluated visually and by computer-assisted analysis, that employed an edge detection method and cine-videodensitometry. The results of visual estimation were in general agreement with those of computer-assisted analysis for determination of percent area of stenosis in severe stenosis, and percent diameter of stenosis in slightly stenotic lesions. Before PTCA, the findings obtained by densitometry agreed with those using the edge detection method. However, after PTCA, the results were significantly different. This discrepancy may have been due to asymmetric morphologic changes in the luminal cross sectional area immediately after PTCA, which could not be assessed by the edge detection method in a single-plane view. Through these studies it was concluded that the densitometry is most useful for evaluating the effects of PTCA.

[A prominent retrograde flow in coronary artery in patients with hypertrophic cardiomyopathy]

Pathophysiology and clinical significance of a systolic backward flow in the epicardial coronary artery have not been elucidated. Using a 20 MHz Doppler catheter, we assessed coronary flow velocity waveforms in the left anterior descending coronary artery in 19 patients with hypertrophic cardiomyopathy (HCM) and 11 patients without apparent cardiac abnormalities as control subjects. Systolic flow fraction was smaller in HCM than in controls. Only 4 patients with HCM showed a prominent retrograde flow persisting during almost the entire systole. All the 4 had marked cavity obliteration and two of them had systolic intraventricular pressure gradients of 80 and 110 mmHg respectively. Exercise thallium-201 ECT revealed that myocardial hypoperfusion was more frequent in those 4 patients. Through these observations, it is concluded that a high intramyocardial systolic pressure combined with a relatively low coronary perfusing pressure may result in a large systolic retrograde flow in the left epicardial coronary artery, and that it may be related to myocardial ischemia in patients with HCM.

Active transport pumps of HVA and DOPAC in dopaminergic nerve terminals

The effect of the membrane potential on the efflux of HVA and DOPAC from DA neurons was studied in anesthetized (1% halothane in gas mixture of 70% N2O and 30% O2) cats. Extracellular DA, HVA and DOPAC were measured continuously from the putamen, the hypothalamus, the thalamus, the raphe nuclei and the cortex using brain microdialysis technique combined with HPLC-ED monoamine measurements. HVA and DOPAC concentrations were highest in the putamen and lowest in the cerebral cortex. Extracellular HVA levels exceed those of the DOPAC. Increases in the extracellular potassium from 4 to 120 mM invariably produced decreases of the extracellular HVA and DOPAC in all the tested brain regions. These decreases were inversely proportional to the extracellular potassium concentration. Thus, it is concluded that the HVA and the DOPAC are extruded from inside the cell to the extracellular space by active mechanisms of transport similar to that reported for 5-HIAA in serotonergic neurons.

[Assessment of transient dilation of the left ventricular cavity in patients with hypertrophic cardiomyopathy by exercise thallium-201 scintigraphy]

Exercise Tl scintigraphy (EX-Tl) provides a noninvasive means of identifying myocardial perfusion abnormalities in patients (pts) with hypertrophic cardiomyopathy (HCM). We have noted that some pts with HCM have a pattern of transient dilation of the left ventricle (LV) on the immediate post exercise images as compared with 3 hour redistribution images. We presumed that left ventricular dilation was caused by subendocardial hypoperfusion. So we studied transient dilation of the LV in 50 pts with HCM and 20 controls (C). Initial and delayed conventional short tomographic images were obtained after reconstruction of 30 projections acquired over 180 degrees. Thirty six radii every 10 degrees were generated from the center of the middle myocardial images of the short axis. An area surrounded by the thirty six points of maximal count on each radius was calculated in initial and delayed images. Transient Dilation Index (TDI) as an index of dilation was determined by dividing an area in initial image by an area in delayed image. TDI in pts with HCM was larger than that in C. Pts with HCM were classified into the two groups, Group A: TDI greater than 1.11 (mean + 2 SD in C), 24 pts, Group B: TDI greater than 1.11, 26 pts. Frequency of pts with history of chest pain in Group A was higher than that in Group B, and frequency of pts with positive exercise ECG in Group A was higher than that in Group B. End diastolic volume in Group B did not change 10 minutes after exercise by radionuclide ventriculography. In conclusion, transient dilation of the LV in pts with HCM by EX-Tl is in appearance, and may reflect subendocardial ischemia.

Studies on aldose reductase inhibitors from medicinal plant of "sinfito," Potentilla candicans, and further synthesis of their related compounds

For several years we have screened natural products having aldose reductase (AR) inhibitory activity. 3,3',4-Tri-O-methylellagic acid 4'-sulfate potassium salt (2) was isolated from a Mexican herb "Sinfito" (Potentilla candicans) as a potent AR inhibitory active constituent. 2 was more potent (IC50 = 8.0 x 10(-8)M) than ellagic acid, which is one of the natural inhibitors of AR. So we examined the synthesis of ellagic acid derivatives and found that the sulfate group is one of the important function.

[Regional myocardial coronary blood flow reserve in hypertrophic cardiomyopathy assessed by digital subtraction coronary angiography]

Previous observations suggest the presence of ischemia in the disproportionately thickened interventricular septum (IVS) of patients with hypertrophic cardiomyopathy (HCM), although the details remain obscure. Utilizing digital subtraction coronary angiography (DSA) with LAO projection before and after intracoronary papaverine (P) injection, we evaluated regional myocardial coronary blood flow reserve (rMFR) consecutively 18 patients with HCM, and compared it with that of 8 patients without apparent cardiac abnormality (C). Time-density curves were obtained from digital angiograms of the myocardial region of interest. We measured peak contrast density (Cm) and time to peak contrast (Tm). An index of rMFR was calculated as the quotient of Cm/Tm before and after P. In HCM, rMFR in IVS and apex was significantly lower than that of C (Mid-IVS: 1.9 +/- 0.5 vs 3.9 +/- 0.5, p less than 0.001; Low-IVS: 2.0 +/- 0.5 vs 4.4 +/- 0.9, p less than 0.001; Apex: 2.0 +/- 0.7 vs 4.5 +/- 1.6, p less than 0.01). There was correlation between the impairment of rMFR and the extent of hypertrophy in HCM. In conclusion, we could state that, in HCM, the region of impaired myocardial coronary blood flow reserve is localized. In HCM, DSA is useful in evaluating myocardial coronary blood flow reserve.

Efflux of 5-HIAA from 5-HT neurons: a membrane potential-dependent process

The effect of the membrane potential on the efflux of 5-HIAA from 5-HT neurons was studied in anesthetized (halothane: 1% in gas mixture of N2O: 70% and O2: 30%) cats. The endogenous 5-HT and its metabolite 5-HIAA were measured continuously from the cortex, the thalamus, the hypothalamus and the raphe nuclei using brain microdialysis technique combined with HPLC-ED monoamine measurements. Membrane potential variations were induced by changing the extracellular concentration of potassium through the microdialysis membrane. The levels of the extracellular 5-HIAA varied according to the different regions of the brain, being highest in the hypothalamus and lowest in the cerebral cortex. Increases in the extracellular potassium from 4 to 120 mM invariably produced a decrease of the extracellular 5-HIAA in all the tested brain regions. This decrease was inversely proportional to the logarithm of extracellular potassium concentration. Thus, it is postulated that the 5-HIAA is moved from inside the cell to extracellular space by an active mechanism of transport electrically coupled to the membrane potential.

Studies on aldose reductase inhibitors from natural products. II. Active components of a Paraguayan crude drug "Para-parai mí," Phyllanthus niruri

Aldose reductase (AR) inhibitory activity-directed fractionation of the 70% ethanolic extract of Para-parai mí, Phyllanthus niruri, has led to the isolation of three active components, ellagic acid (1), brevifolin carboxylic acid (4) and ethyl brevifolin carboxylate (5). Among them, 1 showed the highest inhibitory activity, being about 6 times more potent than quercitrin, which is a known natural inhibitor of AR.

[The effect of protease inhibitors in shock]

Protease inhibitors, such as ulinastatin and gabexate mesilate, are widely used for the patients in shock state. The purpose of this study was to evaluate the effects of these protease inhibitors on renal protection and coagulofibrinolytic disorders. The obtained results were as follows: 1. Ulinastatin studies. 1) Beta 2-microglobulin (BMG) excretion and N-acetyl-beta-D-glucosaminidase (NAG) activity in urine were increased in cases of emergency operation (10 patients) compared with elective operation (38 patients). 2) In canine experimental model of renal ischemia, ulinastatin significantly improved urine volume and urine NAG levels. 3) Administration of ulinastatin suppressed urine NAG level in 12 patients, but BMG level did not significantly change. 2. Gabexate mesilate (FOY) studies. 1) All patients in shock state showed coagulofibrinolytic disorders. Especially remarkable hypercoagulability was observed in 21 patients. 2) FOY suppressed platelet aggregation and the release of beta-thromboglobulin and platelet factor 4. 3) In 24 patients, administration of FOY markedly increased the antithrombin III levels in early postoperative period. 4) Fibrinolytic system was not affected any significant changes with administration of FOY.

CONCLUSION

Our results suggested that protease inhibitors are useful for management of the patients in shock state.

A case of left ventricular aneurysm of uncertain etiology presenting as ventricular tachycardia

A case of a 59-year-old Asian male with several episodes of syncope and palpitation is reported. Electrophysiologic study disclosed that sustained ventricular tachycardia was induced by programmed electrical stimulation at the right ventricular apex. The electrogram in the left ventricular aneurysm showed delayed activities and the fastest depolarization. Entrainment was observed by faster pacing. Left ventriculography showed a large aneurysm and normal coronary arteries. Congenital left ventricular aneurysm is the most likely clinical diagnosis given the lack of past history of chest pain, myocarditis, cardiomyopathy, etc. Congenital aneurysm which presents as ventricular tachycardia is very rare, and has never been reported in an Asian. Medical management has thus far been successful.

Elastic properties and beta-sheet structure of connectin threads

Connectin is a very long and flexible protein of striated muscle, linking myosin filaments to z discs in a sarcomere. Isolated native connectin in solution frequently forms elastic threads upon concentration of the solution, by side-by-side association of molecules. An X-ray diffraction study was performed to examine the presence of beta-sheet structure in artificially prepared threads. The elastic properties of such threads were measured at various temperatures. Negative temperature dependence of the elastic coefficient suggests that the elasticity of connectin threads is due to deformation of the three-dimensional structure and not to rubber-like behavior.