The use of zona-free aged unfertilized human oocytes as a predictor for successful subzonal insemination

OBJECTIVE

To examine the reliability of the zona-free aged (1 day old) human unfertilized oocyte sperm penetration assay for assessing sperm fertilizing ability and to determine the predictive value of this assay for subsequent subzonal insemination (SUZI) outcomes.

DESIGN

A total of 253 unfertilized oocytes from total fertilization failure patients and from good fertilization rate (> 70%) patients in standard IVF were inseminated with donors' spermatozoa, and penetration rates were compared in each group. Two hundred seventy-two unfertilized oocytes from total fertilization failure, poor fertilization (< 30%), and normal fertilization (> 30%) were inseminated with husbands' spermatozoa, and penetration rates were compared between the three groups. In 29 patients, the results of the zona-free assay performed in previous IVF were compared with the fertilization rates of subsequent SUZI.

RESULTS

In the zona-free assay using donors' spermatozoa, there was no difference in penetration rates between the two groups (109/122, 89.3% versus 114/131, 87.0%). Penetration rates using partners' spermatozoa were positively correlated with fertilization rates in standard IVF (total fertilization failure 34/75, 45.3%; poor fertilization 56/77, 72.7%; normal fertilization 108/120, 90.0%). There was a significant difference in fertilization rates after SUZI between the patients with negative and positive penetration in zona-free assay (4/53, 7.5%, versus 54/174, 31.0%).

CONCLUSION

The zona-free human oocyte assay may primarily reflect sperm fertilizing ability. This asssay also could be a reliable predictor for subsequent SUZI outcome.

Three-dimensional movements of a maxillary complete denture: the development of a measuring system and preliminary measurement

To measure the movements of a maxillary denture in vivo it is necessary to analyze the three-dimensional displacements induced. A measuring system consisting of four main units (a magnetic sensor, three optical fiber sensors, a sensor-setting jig, and a recorder) was developed. Using this system, the movements of a maxillary denture were continuously measured during tapping and during the mastication of a peanut.

Learning and recall algorithm for optical associative memory using a bistable spatial light modulator

A learning and recall algorithm for optical associative memory based on the conventional correlationlearning method with three effective improvements (sparse-encoding method, constant-total-activity method, and binary memory) is proposed from a viewpoint of practical implementation. It is shown that the algorithm is suitable for implementation with a bistable spatial light modulator such as a ferroelectric liquid-crystal spatial light modulator, which has high resolution and a fast response time. The results of theoretical analysis and simulations indicate that the algorithm permits an associative-memory system with a large memory capacity to be realized. An example of an optical system for executing this algorithm is proposed. To determine the performance specifications that are required for the various optical components within the system, we simulate and evaluate the effect of noise (which is caused by nonideal components) on system performance. These results show that the system is robust in the presence of predicted noise levels.

[A case of arteriovenous malformation successfully treated with functional mapping of the language area by PET activation study]

The authors report a case of temporal AVM safely treated by mapping the language area with PET activation study. The patient was a 50-year-old woman with temporal epilepsy as her chief complaint. MRI and angiography revealed a right temporal AVM. Before surgical treatment, we assessed the dominant hemisphere with PET activation study. We performed PET scanning while the patient was playing "capping" (called "Shiritori" in Japanese), from which we subtracted PET images performed when she was in a resting state, and then we superimposed those images upon MRIs. The blood flow increased in the left frontal operculum (Broca's area), the left caudal head, the left putamen and the right cerebellar hemisphere. We were thus able to determine that her left hemisphere was dominant, and that it was safe to undertake embolization and operation for the AVM. Postoperative course was uneventful and higher cortical functions were preserved perfectly. In cases of cerebral AVMs, unusual dominancy of cerebral hemispheres is often encountered, and so, preoperative evaluation of the relation of AVM to the eloquent cortex is essential. In our study, blood flow increased in some areas other than the language area, but they were considered to be areas related to phonation, and we think that we were able to map the language area. Though this method is still in its preliminary stage, we think it gives us useful information for surgical treatment of cerebral AVMs.

Immunological study of anti-M2 in antimitochondrial antibody-negative primary biliary cirrhosis

We investigated the specificity of various autoantibodies in antimitochondrial antibody (AMA)-negative patients with primary biliary cirrhosis (PBC). We examined sera from 144 patients with PBC, 17 of whom were AMA negative by indirect immunofluorescence. The AMA-negative group showed a significantly higher positivity for smooth muscle antibody, but not for antinuclear antibody, as compared with the AMA-positive group. IgG class anti-PDH by enzyme-linked immunosorbent assay (ELISA) were detected in 13% of the AMA-negative group. However, all PBC patients showed positive IgG, IgA, and/or IgM class anti-M2 to the four M2 proteins by immunoblotting. These results suggest that the detection of IgG and IgM class anti-PDH and that of antibodies to the four M2 proteins increases the positivity of this ELISA method, and that detection of IgG, IgA, and IgM class anti-M2 to the four M2 proteins by immunoblotting is useful in diagnosing AMA-negative patients with PBC.

Pregnancy, labor and delivery in a woman with a damaged spinal cord

We report here a case involving the pregnancy, labor and delivery of a woman with a damaged spinal cord. In our case, even though the cord was damaged below the Th11, continuous epidural anesthesia was needed to prevent autonomic hyperreflexia. The patient's and infant's subsequent courses were normal.

Formation of brome mosaic virus RNA-dependent RNA polymerase in yeast requires coexpression of viral proteins and viral RNA

In this report we show that yeast expressing brome mosaic virus (BMV) replication proteins 1a and 2a and replicating a BMV RNA3 derivative can be extracted to yield a template-dependent BMV RNA-dependent RNA polymerase (RdRp) able to synthesize (-)-strand RNA from BMV (+)-strand RNA templates added in vitro. This virus-specific yeast-derived RdRp mirrored the template selectivity and other characteristics of RdRp from BMV-infected plants. Equivalent extracts from yeast expressing 1a and 2a but lacking RNA3 contained normal amounts of 1a and 2a but had no RdRp activity on BMV RNAs added in vitro. To determine which RNA3 sequences were required in vivo to yield RdRp activity, we tested deletions throughout RNA3, including the 5',3', and intercistronic noncoding regions, which contain the cis-acting elements required for RNA3 replication in vivo. RdRp activity was obtained only from cells expressing 1a, 2a, and RNA3 derivatives retaining both 3' and intercistronic noncoding sequences. Strong correlation between extracted RdRp activity and BMV (-)-strand RNA accumulation in vivo was found for all RNA3 derivatives tested. Thus, extractable in vitro RdRp activity paralleled formation of a complex capable of viral RNA synthesis in vivo. The results suggest that assembly of active RdRp requires not only viral proteins but also viral RNA, either to directly contribute some nontemplate function or to recruit essential host factors into the RdRp complex and that sequences at both the 3'-terminal initiation site and distant internal sites of RNA3 templates may participate in RdRp assembly and initiation of (-)-strand synthesis.

A carrier of Duchenne muscular dystrophy with dilated cardiomyopathy but no skeletal muscle symptom

A 29-year-old female developed dilated cardiomyopathy at 20 years of age but with no muscle symptoms. Her 2-year-old son with Duchenne muscular dystrophy (DMD)_had no demonstrable deletion in the dystrophin gene, but all fibers except for 5% 'revertant' fibers in a muscle biopsy specimen had no dystrophin. Both skeletal and cardiac muscle biopsy specimens from the mother showed a mosaic distribution of dystrophin-positive and -negative fibers, and so she was diagnosed as being a manifesting carrier of DMD. We conclude that, when one encounters a female patient with idiopathic cardiomyopathy with a high serum creatine kinase level, the suspicion of her being a manifesting DMD carrier should be ruled out.

From motilin to motilides: a new direction in gastrointestinal endocrinology

Investigation into gastrointestinal irritation from the use of erythromycin lead to the discovery of the gastrointestinal motor effect of this antibiotic. Erythromycin and gastrointestinal peptide motilin share many similar gastrokinetic activities, and studies indicate that erythromycin mimics the effect of motilin through motilin receptor agonism. Since erythromycin is readily available for clinical use, it may offer an alternative therapeutic approach to gastroparesis and related conditions. Several analogs of erythromycin without antimicrobial activity are also shown to possess similar motor effects, thus termed "motilides". A growing number of motilides may expand our knowledge on gastrointestinal peptides.

Meningeal rhabdomyosarcoma. Report of a case with cytologic, immunohistologic and ultrastructural studies

Primary rhabdomyosarcoma of the meninges, a very rare brain tumor, is reported. Cytologic findings by squash preparation were useful as an adjunct to frozen section diagnosis during surgery. The cytologic features of rhabdomyosarcoma without cross-striation have some similarities to those of gemistocytic astrocytomas and anaplastic meningiomas, but the cytoplasmic filaments of rhabdomyosarcoma are different from those of gemistocytic astrocytoma and anaplastic meningioma. Histologically the tumor was embryonal rhabdomyosarcoma with a partially botryoid pattern. The tumor cells have no cross-striations but react positively to antimyoglobin serum on immunoperoxidase staining. In this case, intracytoplasmic filaments resembling poorly formed myofibrils were found on electron microscopic study. The histologic and immunohistologic findings suggest that this rare mesenchymal malignancy might arise from primitive totipotential cells.

Age-related decrease in the effect of parathyroid hormone-related protein on cytosolic free calcium level and tension in rat aortic smooth muscle

Age-related changes in the effect of parathyroid hormone-related protein (PTHrP) on the cytosolic free calcium level ([Ca2+]i) and on the tension in rat aortic smooth muscle were investigated. The possible involvement of cAMP, a second messenger of PTHrP, in such changes was also investigated. Spiral aortic strip preparations without endothelium from 8-weeks, 6-months, and 24-months old rats were treated with fura 2/AM, and the fluorescence ratio R340/380, an index of [Ca2+]i was measured. Simultaneously, the tension of the preparations was measured. PTHrP-(1-34) and dibutyryl cAMP produced concentration-dependent decreases in the tension and in R340/380 in aortas precontracted with phenylephrine (10(-7) M). These effects were significantly lower in the aortas of 24-months old rats than in the vessels of 8-weeks and 6-months old rats. The effects were similar in the aortas of 8-weeks and 6-months old rats. PTHrP-(1-34) concentration-dependently increased cAMP production in vascular smooth muscle cells (VSMCs) from 8-weeks old rats. However, the increase in cAMP production was significantly lower in cultured VSMCs from 6-months and 24-months old rats than in cells from 8-weeks old rats. These results suggest that the reduced cAMP production stimulated by PTHrP and the reduced effects of cAMP with aging might contribute to the age-related changes in the decreases in tension and [Ca2+]i in response to PTHrP in the rat aorta.

Changes in surgical strategies for peptic ulcers before and after the introduction of H2-receptor antagonists and endoscopic hemostasis

A total of 902 surgical patients with peptic ulcer disease were evaluated to clarify the effects of H2-receptor antagonists and endoscopic hemostasis on surgical treatment. Following the introduction of these treatments to our institute in 1982, the number of operations performed annually decreased by 40%, or 36 cases per year. However, a remarkable increase in the frequency of surgical emergency intervention since 1982 was concurrently observed, with the ratio of emergency procedures to the total number of operated cases increasing to 72.5% in the last 5 years of the study. Moreover, intractability as an indication for surgery decreased to 34.1%, compared with an increase in the number of patients with bleeding and perforated ulcers requiring operation. There were 13 postoperative deaths recorded (1.4%). All of the deaths were in patients who had undergone emergency surgery in poor health. Of these 13 patients, 10 had bleeding ulcers. A study of bleeding ulcers for which endoscopic hemostasis had been unsuccessful revealed that shock on admission and a concomitant medical condition had been evident in all the patients who died, and in 52.2% and 30.4% of the survivors, respectively. The current study suggests that the frequency of high-risk patients requiring surgery is increasing since the introduction of H2-receptor antagonists and endoscopic hemostasis, and thus, prompt surgical treatment and intensive management for such patients is essential.

Differential effects of OPC-18790, amrinone and dobutamine on cardiac function and energy metabolism in the guinea-pig isolated ischaemic heart

1. The effects of OPC-18790, a novel positive inotropic agent, on cardiac function and myocardial energy metabolism in the guinea-pig isolated heart with ischaemia were studied by 31P-magnetic resonance spectroscopy (MRS) and compared with those of amrinone and dobutamine. 2. Cardiac ischaemia was induced by intracoronary infusion of 15 microns microspheres to reduce coronary perfusion flow (CPF) by 50%. Microsphere embolisation caused a 40% decrease in left ventricular systolic pressure (LVSP), cardiac contractility measured by peak of ventricular pressure development (LVdP/dt) and slightly reduced heart rate. There was also a decrease in ATP and creatine phosphate (PCr) by 20%, an increase in inorganic phosphate (Pi) by 25% and an acidic shift of intracellular pH in the ischaemic heart. 3. In the ischaemic heart, OPC-18790, amrinone and dobutamine were applied at concentrations which increased LVdP/dt by about 60%. These compounds increased LVP by 15% to 30% and increased CPF by about 10%. Amrinone and dobutamine but not OPC-18790 increased heart rate. When these drugs produced the haemodynamic changes described above, amrinone and dobutamine reduced ATP and PCr, increased Pi and produced further intracellular acidosis, whereas, OPC-18790 did not change these parameters. 4. Cardiac pacing at 285 beats min-1 produced decreases in LVP, LVdP/dt and CPF by about 30%, 20%, 5%, respectively and an increase in Pi, decreases in PCr and ATP, and intracellular acidosis. 5. These results suggest that degradation of high energy phosphate compounds closely relates to increase in heart rate in the ischaemic heart. Positive inotropic agents without chronotropic action seem to be beneficial in support of the ischaemic heart.

[Assisted reproductive technology; IVF-ET]

To summarize the procedures and outcomes of assisted reproductive technology (ART). Novel and updated ART for the practical management of infertile couples are presented and compared with conventional modalities. The outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, still birth and delivery. Of ART treatments, 19,319 cycles initiated was IVF with 12.7% clinical pregnancy per retrieval in the world in 1991. In Japan, pregnancy rate of 9,667 cycles with IVF was 12.7% in 1991. 300 cycles initiated was IVF with 20% pregnancy rate at the Department of Obstetrics and Gynecology, Asahikawa Medical College in 1994. In 1995, there will be more program offering more treatments cycles of ART. Improvements in stimulation, the culture system for fertilization and embryo growth, cryopreservation and microinsemination are expected to enhance the rates of clinical pregnancy.

[A case of Kasabach-Merrit syndrome complicated with DIC treated effectively by long term oral administration of warfarin]

A 20 year-old female patient with Kasabach-Merrit syndrome, suffered from chronic consumption coagulopathy due to localized intravascular coagulation in the tumors. She had been diagnosed as Kasabach-Merrit syndrome immediately after birth and below knee amputation of her right lower leg was performed at the age of 2 years because of her giant hemangioma on the right foot and lower leg. After the operation, she had often complained of severe pain and enlargement of the residual tumors due to continuous thrombus formation within the tumors. She was admitted to the third Department of Tohoku University Hospital in order to initiate oral anticoagulant therapy with Warfarin at the age of 12 years. After the administration of 2.5 mg/day Warfarin, she has maintained good clinical condition until now, despite the occasional occurrence of coagulation abnormalities. We believe that the results of this case indicate the efficacy of oral anticoagulant therapy in the treatment of chronic consumption coagulopathies complicated with other diseases.

Impaired cholinergic peripheral vasodilation and its relationship to hyperemic calf blood flow response and exercise intolerance in patients with chronic heart failure

This study examined the peripheral endothelium-dependent vasodilatory response to acetylcholine and the endothelium-independent vasodilatory response to nitroprusside in 19 patients with chronic heart failure and eight controls. These peripheral blood flow responses were compared with hyperemic calf blood flow changes after maximum leg exercise and 5-min femoral occlusion. The peripheral blood flow response to forearm intra-arterial infusion of acetylcholine and sodium nitroprusside, and reactive hyperemic calf blood flow changes were measured by plethysmography. All peripheral blood flow responses were significantly reduced in patients with chronic heart failure (P < 0.05). Reduction of acetylcholine-mediated changes in peripheral blood flow was correlated with exercise-induced calf blood flow response (r = 0.51, P < 0.05), but not with occlusion-induced calf blood flow response (r = 0.02, NS). Sodium nitroprusside-mediated changes were not correlated with any reactive hyperemic blood flow responses (exercise: r = 0.27, NS; occlusion: r = 0.11, NS). When the patients were divided into two subgroups based on the median exercise-induced calf blood flow change, the subgroup with the lower calf blood flow response showed a reduction in exercise capacity (anaerobic threshold: 11.8 +/- 0.6 vs. 14.6 +/- 1.0 ml/kg/min; P < 0.05). These findings suggest that endothelial dysfunction is related to a decrease in exercise-induced skeletal muscle blood flow and exercise capacity in patients with chronic heart failure.

Comprehensive study on iterative algorithms of multiple sequence alignment

Multiple sequence alignment is an important problem in the biosciences. To date, most multiple alignment systems have employed a tree-based algorithm, which combines the results of two-way dynamic programming in a tree-like order of sequence similarity. The alignment quality is not, however, high enough when the sequence similarity is low. Once an error occurs in the alignment process, that error can never be corrected. Recently, an effective new class of algorithms has been developed. These algorithms iteratively apply dynamic programming to partially aligned sequences to improve their alignment quality. The iteration corrects any errors that may have occurred in the alignment process. Such an iterative strategy requires heuristic search methods to solve practical alignment problems. Incorporating such methods yields various iterative algorithms. This paper reports our comprehensive comparison of iterative algorithms. We proved that performance improves remarkably when using a tree-based iterative method, which iteratively refines an alignment whenever two subalignments are merged in a tree-based way. We propose a tree-dependent, restricted partitioning technique to efficiently reduce the execution time of iterative algorithms.

[Complete resection of superior mediastinal seminoma, following reconstruction of superior vena cava--a case report]

The patient was a 37-year-old man with superior mediastinal seminoma, which invaded the bilateral brachiocephalic vein, superior vena cava, pericardium and left lung. These invaded organs were resected with the tumor and a vascular reconstruction was performed with EPTFE graft and pericardial patch. EPTFE graft was interposed between the left brachiocephalic vein and right atrium. Superior vena cava was reconstructed by means of pericardial patch. Histologically, the tumor was diagnosed as pure seminoma. He received the prophylactic irradiation (45 Gy). Although venography two years after operation demonstrated the obstruction of the EPTFE graft and marked stenosis of the pericardial patch, the patient remains free from the symptom and is doing well without recurrence 45 months after operation.

Screening of patients with ischemic heart disease by transesophageal atrial pacing and the selection of surgical therapy: in patients with arteriosclerosis obliterans and aortic aneurysm

This study evaluated (1) a screening method for ischemic heart disease (IHD) using transesophageal atrial pacing (TEP), and (2) the appropriate surgical therapy for patients with concomitant IHD which was evaluated on the basis of the coronary score (CS) by Leaman. Thirty-nine patients with arteriosclerosis obliterans of the lower extremities (ASO) and 35 with aortic aneurysm underwent TEP and coronary angiography (CAG). Coexistent IHD was diagnosed in 25 patients (64%) with ASO and in 14 (40%) with aortic aneurysm. Screening for IHD by TEP was 96% sensitive, 71% specific, and 87% accurate in patients with ASO, and 79% sensitive, 90% specific, and 86% accurate in patients with aortic aneurysm. Coronary artery bypass grafting (CABG) and peripheral arterial revascularization (PAR) were performed by one stage surgery in 3 patients with a CS of 16 or more. In 18 patients with a CS of 5.5 or less, only PAR was performed. One stage surgery was performed in 6 patients with aortic aneurysm. Four patients had a CS of 9.5 or more, and 2 patients with coexistent stenosis of the left anterior descending branch (LAD) had CS of 3.5 and 8, respectively. Repair of the aneurysm was undertaken in 5 patients with a CS of 8 or less without LAD disease. In patients with ASO showing a CS of 5.5 or less and in those with aortic aneurysm showing a CS of 8 or less (and without LAD disease), the only surgical procedure performed was either PAR or repair of the aneurysm. There were no complications attributable to IHD observed in these patients during the perioperative period.