Carnitine palmitoyl transferase I and the control of myocardial beta-oxidation flux

Carnitine palmitoyltransferase I is assumed to be rate limiting for beta-oxidation in all tissues. However, the concentration of malonyl-CoA in heart and muscle is high and is enough to completely inhibit beta-oxidation if this assumption is correct. In this review, we consider whether: (i) there is a malonyl-CoA-insensitive carnitine palmitoyltransferase I activity; (ii) the measured malonyl-CoA concentration in the heart is physiologically meaningful; and (iii) carnitine palmitoyltransferase I is rate-limiting for beta-oxidation in the heart.

Distribution analysis of epoxy groups in polymers by derivatization-electron probe X-ray microanalysis

An analytical method, referred to as "derivatization-electron probe X-ray micro-analysis (XMA)", has been developed to determine the distribution of a small amount of the functional groups in a polymer. The suitable conditions for the derivatization reaction with epoxy groups, which contribute to the hardening reactions of polymers, were investigated. It was found that epoxy groups in polymers were derivatized selectively using gas-phase esterification with hydrochloric acid (HCI). The most suitable amount of HCl in a 50 ml vial was 300 microl. After setting a sample in the vessel without directly contacting the reagent, by reacting the reagent and the sample at 25 degrees C for 1 h, the highest reaction yield and selectivity were obtained. By derivatization-XMA using this reaction condition, the measurement of the distribution of epoxy groups in the polymer became feasible. Actual applications to a depth analysis of epoxy groups in the hardened acrylic coating and epoxy resin proved that this method is useful for the characterization of polymers and for the study of the hardening reaction of polymers.

Modification of polysulfone with phospholipid polymer for improvement of the blood compatibility. Part 2. Protein adsorption and platelet adhesion

Protein adsorption and platelet adhesion from human plasma on polysulfone (PSf) membranes modified with 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer were studied. The modification was carried out by blending of the MPC polymer in the PSf. The amount of protein adsorbed on the PSf/MPC polymer blend membrane was significantly decreased with an increase in the composition of the blended MPC polymer. The distribution of the specific proteins adsorbed on the membrane surface was also determined by a gold-colloid immunoassay. Albumin, gamma-globulin and fibrinogen were observed on every membrane surface after contact with plasma. However, in the case of the blended membrane, the density of the adsorbed proteins decreased compared with that of original PSf membrane. That is, the MPC polymer blended in the membrane could function as a protein-adsorption-resistant additive. The number of platelets adhered on the PSf membrane was reduced, and change in the morphology of adherent platelets was also suppressed by the modification with the MPC polymer. Therefore, the PSf/MPC polymer blend membrane had improved blood compatibility compared with the PSf membrane.

Modification of polysulfone with phospholipid polymer for improvement of the blood compatibility. Part 1. Surface characterization

To improve the surface blood compatibility of polysulfone (PSf) membranes, we prepared novel polymeric additives which have suitable blood compatibility. They were polymers with a phosphorylcholine group, a 2-methacryloyloxyethyl phosphorylcholine (MPC) unit. The MPC polymer could be blended with polysulfone by a solvent evaporation method during membrane processing, and a transparent membrane could be obtained. The mechanical properties of the blend membrane were similar to that of the original PSf membrane. Surface analysis of the blend membrane by X-ray photoelectron spectroscopy and dynamic contact angle measurement revealed that the MPC unit in the polymeric additive was concentrated on the surface of the membrane. The blend membrane significantly reduced plasma protein adsorption compared with that of the PSf membrane.

The fourth-compartment syndrome: its anatomical basis and clinical cases

We propose a new term, the "fourth-compartment syndrome" to describe chronic dorsal wrist pain of the fourth compartment. Five main causes responsible for this syndrome are thought to be as follows: 1. Ganglion involvement, including an occult ganglion; 2. Extensor digitorum brevis manus muscle; 3. Abnormal extensor indicis muscle; 4. Tenosynovialitis; 5. Anomaly or deformity of carpal bones. Should the above mentioned conditions occur in the fourth compartment, pressure within the fourth compartment increases, ultimately compressing the posterior interosseous nerve directly or indirectly. Anatomical studies of the fourth compartment of the wrist and the posterior interosseous nerve are presented and the fourth-compartment syndrome is summarized with twelve clinical cases (six cases of occult ganglions, two cases of extensor digitorum brevis manus, two cases of tenosynovialitis, one case of abnormal extensor indicis muscle, and one case of carpal bossing).

Significant decrease of serum vitamin A level in Japanese Black beef steers after introduction to a farm

Significant decrease of serum vitamin A (V.A) level in 4 out of 5 Japanese Black beef steers on day 7 after introduction was described in the present study. The feeder steers were fed the diets containing much more V.A than they required. In the farm where they were introduced, the productivity was high and the frequency was low in bovine cases of death and disease. The herd management; i.e. feeding method and environment of the farm were properly arranged. Results obtained from blood serum analyses revealed that health and nutritional status of the feeder steers were good on the day of introduction. The feeder steers, clinically healthy on the day of introduction, manifested mild bronchitis and diarrhea on days 2 and 10 after introduction, respectively, and slightly decreased dietary intake on both days. Serum V.A levels of the feeder steers were within the normal range. However, significantly decreased serum V.A level was detected in 4 feeder steers out of 5 on day 7 after introduction. This may be attributed to stress-increased V.A consumption rather than the decreased V.A intake.

[Developments of highly stereoselective domino reactions and application to medicinal chemistry]

Simple and highly effective methods for the synthesis of polycyclic ring systems via two types of intramolecular domino reactions are developed and presented. The first example is an intramolecular double Michael reaction, whose scope-limitation, mechanism and application to natural product synthesis are discussed. The intramolecular Michael-aldol reaction is the second case, which provides a nice method for the preparation of polycyclic compounds having a four-membered ring system. In addition, some related reactions of these methods are described.

[Usefulness of the prick test for anaphylactoid reaction in intravenous fluorescein administration]

We examined whether a prick test was a valuable method in comparison with an intradermal skin test for predicting an anaphylactoid reaction to intravenous injection of fluorescein solution. Fifteen hundred cases were tested. The number (rate) of positive reactions to the prick test with 10% and 1.0% fluorescein solution was 2 (0.1%) and 0 (0.0%), respectively. In contrast, positive reaction to the intradermal skin tests with 10% and 0.1% fluorescein solution was observed in 686 cases (45.7%) and 13 cases (0.9%), respectively. Fluorescein angiography (FAG) was performed in 1,499 of the 1,500 cases. Adverse reactions such as nausea, cough, cold sweat, urticaria, and shock were noted in 85 cases (5.7%). Typical anaphylactoid shock occurred in one case (0.07%), which was one of the two cases positive to the prick test with 10% fluorescein. In the other positive prick test case, FAG was cancelled because of the high probability of anaphylactoid shock. The results suggest that a prick test with 10% fluorescein solution can markedly cut down the false positive reactions and can be a useful test for the prospective diagnosis of anaphylactoid reactions to intravenous fluorescein administration.

[Adenosine deaminase isoenzymes in patients with Graves' disease]

CD26, the T cell activation antigen, is identical to the ADA binding protein and is considered to interact with ADA to activate the T cells on the surface. Therefore, we examined the activity of serum ADA isoenzymes in patients with Graves' disease in whom CD26 presented T cells were increased. The activities of total ADA and ADA2 were significantly higher in Graves' disease than normals. We also observed that the levels of soluble interleukin-2 receptor (sIL-2R) and neopterin, markers of T cell activation, were significantly higher in Graves' disease. The correlation coefficients among ADA2, neopterin, and sIL-2R were significantly high (p < 0.001). Among these parameters, only sIL-2R was correlated with the thyroid hormones. ADA2 activity was considered to reflect the activated state of T cells and to be, independent of the thyroid hormone levels.

Subungual exostosis of the finger

Subungual exostosis is a benign tumor or cartilaginous bone beneath or adjacent to the nail. It is usually a solitary lesion that develops most often in the substance of the great toe and less frequently in other toes. It rarely occurs in the fingers. We present a case of subungual exostosis of the finger. At 4-year follow-up, the result was excellent, with no sign of recurrence.

Ethanol injection sclerotherapy for Baker's cyst, thyroglossal duct cyst, and branchial cleft cyst

Six patients with Baker's cysts, 3 with branchial cleft cysts, and 2 with thyroglossal duct cysts were treated with percutaneous aspiration and absolute ethanol sclerotherapy using a 7-French pigtail catheter. Cystography was performed before ethanol injection to confirm that there was no extravasation and that it was a monocystic lesion. One recurrence of a Baker's cyst was revealed in follow-up examinations, which ranged from 11 months to 36 months (mean, 25 months). The major complication of hypoesthesia of the popliteal region was observed in 1 patient treated for Baker's cyst. The results of this series suggest that ethanol sclerotherapy is the treatment of choice for Baker's cyst, branchial cleft cyst, and thyroglossal duct cyst.

Improvement of hemocompatibility on a cellulose dialysis membrane with a novel biomedical polymer having a phospholipid polar group

To improve surface hemocompatibility on cellulose hollow fibers for hemodialysis, newly designed hemocompatible polymers with a phospholipid polar group, 2-methacryloyloxyethyl phosphorylcholine (MPC) polymers, were introduced on the surface through two different methods: direct grafting of MPC on the surface, or coating of a water-soluble cellulose grafted with MPC. The MPC was polymerized using cerium ion as an initiator in the cellulose hollow fibers, and the poly(MPC) chains were grafted directly on the surface. Another modification of the cellulose hollow fibers was attempted by coating them with a water-soluble graft copolymer composed of a poly(MPC) side chain and a cellulose backbone. The coating process from an aqueous solution of the graft copolymer was very convenient, and the graft copolymer on the surface was not detached even after water circulated into the hollow fibers. These cellulose hollow fibers modified with MPC polymers displayed excellent hemocompatibility such as prevention of blood cell adhesion and aggregation after contact with blood without an anticoagulant. The permeability of the hollow fibers did not decrease as a result of these modifications. From these results, it is clearly suggested that introduction of the MPC units was effective for improving the hemocompatibility of the hollow fibers for hemodialysis.

[Personnel requirements for health examination of infants under 5 months in municipalities in Japan]

Municipalities offer health education, health counseling, health examinations, and home visitation service for infants and their mothers. In order to determine what the personnel staffing requirements were for health examination of infants under 5 months for municipalities in Japan in 1989, a questionnaire survey was conducted in 1990. Questionnaires were sent to all municipalities and 3,198 responses were received for a response rate of 97.9%. Responses from 912 municipalities were considered invalid, leaving a total of 2,286 responses that were analysed. Results showed that 79.2% of the 2,286 municipalities were able to perform health examinations for infants under 5 months independently, while in 6.5% of the municipalities these examinations were performed by the clinical hospitals. Analysis by size of municipalities showed that 85.7% of the cities with populations of 500,000 or more were able to perform health examinations independently. In the large cities designated by the Government, the health personnel system adequately supported these health examinations. However in rural towns and villages with small populations, it was necessary for public health nurses to be assisted by other staff, most of whom were public health nurses from prefectural health centers. For example, in areas with populations of less than 3,000, about 60% of the total volume of the work required to be performed by public health nurses during the health examinations had to be covered by assistance from prefectural public health nurses.

[Mechanism and prevention of postoperative hemolysis in the corrective surgery of subarterial ventricular septal defects]

Intravascular hemolysis following the repair of subarterial ventricular septal defects (VSD) was studied in 34 patients. The VSD was closed through a main pulmonary arteriotomy with a Dacron double-velour patch (Meadox, Oakland, NJ) in 17 cases (Group B) and with a Dacron single-velour patch covered by autologous pericardium facing toward the right ventricular outflow tract (RVOT) in 17 cases (Group A). No significant intergroup difference in age, weight, Qp/Qs, Pp/Ps, and Rp/Rs was found. There were no significant differences in the preoperative values of serum LDH, total bilirubin, and flow velocity at the RVOT (Group A: 1.7 +/- 0.4 m/sec vs Group B 1.8 +/- 1.0 m/sec). The severity of hemolysis was evaluated by serum LDH levels, total bilirubin levels, and hemoglobinuria on the morning of the first operative day. Postoperative LDH levels were significantly lower in the Group A (812 +/- 205 IU/L) than in the Group B (1098 +/- 427 IU/L) (p < 0.05). Hemoglobinuria developed in 2 patients in Group B (12%) and none in Group A. These data suggest that the pericardium apparently protects against postoperative hemolysis. The intensity of the turbulence at the RVOT was graded as follows using color-doppler echocardiography (0: none; Grade 1: turbulence was detected near the patch only; Grade 2: turbulence was detected halfway to the RVOT; Grade 3: turbulence extended to the anterior wall of the RVOT). The relationship between the presence of hemolysis and the degree of turbulence was examined. Turbulence at the RVOT appeared in 73% of those in Group A and in 82% of those in Group B.(ABSTRACT TRUNCATED AT 250 WORDS)

[Peritoneal dialysis following open heart surgery in children]

From 1982 to 1991, 13 (3.9%) of 336 children who underwent open heart surgery required peritoneal dialysis postoperatively, including 5 with transposition of the great arteries, 4 with tetralogy of Fallot, 2 with ventricular septal defect, 1 each with atrioventricular canal defects and total anomalous pulmonary venous connection. Patients ages ranged from 12 days to 4 years (mean, 1 year and 4 months). The infusion catheter was directed toward diaphragm from the right lower quadrant, and the drainage catheter was placed in the pelvis from the left upper quadrant. Dialysis solution was instilled and drained simultaneously. Seven children (54%) recovered renal function, with six (46%) longterm survivors. Differences between patients who did and did not recovered renal function (Group A and Group B respectively) were examined. No significant intergroup difference existed in age or weight. PD was initiated significantly sooner in Group B (1.2 +/- 0.8 days) than in Group A (3.2 +/- 1.9 days) (p < 0.05). The negative fluid balance was 88.0 +/- 31 mL/kg/day in Group A and 78.4 +/- 25.0 mL/kd/day (NS). BUN and serum creatinine concentrations were slightly elevated in both group, but were not significant different. Patients in Group A were dialyzed from 3 days to 21 days (mean 9.9 +/- 6.4 days), and patients in Group B were dialyzed from 1 day to 14 days (mean 5.3 +/- 5.2 days) (NS). The central venous pressure (CVP) in Group A decreased while blood pressure (BP) and renal perfusion pressure (RPP) increased following initiation of PD. CVP increased in Group B, while BP and RPP decreased. All patients died of low cardiac output syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

[A survey of goals and the utilization of numerical goals in the health planning of 47 prefectures]

Health plans of 47 prefectural governments based on the Medical Law of 1985, were evaluated regarding four health planning factors: final goal, implementation plan, development of resources, and evaluation planning. Results of the evaluation showed that 8.5% of the 47 prefectures had defined future level of health based on numerical goals. On the other hand, all of the prefectures had developed numerical goals specifying the number of hospital beds in each medical district. A major component of health planning is improvement in the accomplishment of the implementation plan. There were 14 prefectures which had numerical goals for the upgrading of facilities and for manpower development to meet future health care activities. The following factors are required in the health planning to meet the needs for improving the health status of the population. 1) Including in the future health goals, in addition to the number of medical bed in regional areas, objective levels of health that should be attained. 2) Development of practical plans for evaluation of effectiveness of health planning.

[Health personnel staffing requirements for health examination for three year old children in municipalities in Japan]

Based on the Maternal and Child Health Law, municipalities offer health education, health counseling, health examination, and home visitation service for three year old children and for their mothers. In order to determine personnel staffing requirements for the health examination of three year old children for municipalities in Japan for 1989, data from a questionnaire survey in 1990 conducted by the Ministry of Health, was analyzed. Questionnaires were sent to all municipalities and there were 3,198 responses for a response rate of 97.9%. Results showed that in 1989, only 7% of the 3,198 municipalities were able to perform health examinations for three year old children independently. However 83% of the cities which had populations 500,000 or more were able to perform the health examinations independently. In both the large cities designated by the Government and those cities which have Health Centers, the health personnel system adequately supported these health examinations. Due to the lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, most often public health nurses from prefectural Health Centers. For example, in those areas with populations less than 3,000, 43% of the total volume of the work required to be performed by public health nurses during the health examinations had to be covered by assistance for prefectural public health nurses.

Factors influencing surgical results in proliferative diabetic retinopathy

Although the anatomical results of diabetic vitrectomy have been reported to be rather good when silicone oil is used as a tamponade substitute, the functional results remain unsatisfactory. To investigate the factors influencing the functional results in these cases of severe diabetic retinopathy, the correlation between the surgical results and the overall condition of these patients, including the tamponade substitute, was examined. The vitrectomy results obtained in cases of diabetic retinopathy treated using silicone-oil tamponade were studied retrospectively in comparison with those obtained using SF6 gas tamponade or without any tamponade substitute. The visual acuity of more than 80% of eyes belonging to the groups treated with SF6 gas or without any tamponade improved postoperatively, whereas the rate of improvement in the silicone-oil group was limited to low and the postoperative vision ranged widely, since the silicone was usually used in much more severe cases. Iris rubeosis that occurred after pars plana vitrectomy subsided following secondary silicone-oil injection into the vitreous cavity. Only one disadvantage in using silicone oil was that an additional operation was required to remove it, and the visual acuity of nearly 30% of the eyes deteriorated after its removal. As far as the general condition of these patients is concerned, the visual outcome of subjects who had hypoalbuminemia and anemia due to renal dysfunction was poor as compared with that of patients who did not have these disorders. Blood transfusion did not lead to better function.(ABSTRACT TRUNCATED AT 250 WORDS)

An anatomic study of the innervation of the wrist joint and Wilhelm's technique for denervation

Innervation of the wrist joint has been clarified in this study by loupe dissection and histologic examination. The posterior interosseous nerve, the lateral antebrachial cutaneous nerve, the superficial branch of the radial nerve, and the dorsal branch and the perforating branches of the ulnar nerve innervate the wrist joint from the dorsal side. The anterior interosseous nerve, the palmar cutaneous branch of the median nerve, and the deep branch and the main trunk of the ulnar nerve innervate it from the palmar side. The findings indicate that surgical denervation of most of the articular nerves of the wrist joint is possible with the use of Wilhelm's procedure, but denervation of the palmar side of the intercarpal and carpometacarpal joints, which are innervated by the deep branch of the ulnar nerve, is not included in Wilhelm's technique.