Intravenous midazolam as a sedative for colonoscopy: a randomized, double-blind clinical trial

METHODS

Forty patients, aged between 36 and 60 years, scheduled to undergo colonoscopic removal of colorectal polyps were randomly assigned to receive 0.9% saline solution (n = 20) or 0.05 mg/kg body weight of midazolam (n = 20) intravenously.

RESULTS

Midazolam significantly (P < 0.001) increased the tolerance of patients to colonoscopy. It had no significant effect on pulse or systolic blood pressure during endoscopy. Arterial oxygen saturation decreased significantly (P < 0.01) during endoscopy in patients pre-treated with midazolam, but it did not decrease by more than 5%.

CONCLUSIONS

Intravenous midazolam is useful as a sedative for colonoscopy, but we recommend continuous oxygen saturation monitoring during endoscopy.

Precursor-product relationship between oval cells and hepatocytes: comparison between tritiated thymidine and bromodeoxyuridine as tracers

The expansion and differentiation of oval cells in the acetylaminofluorene (AAF)/partial hepatectomy (PH) model was studied utilizing pulse-chase labeling with both tritiated thymidine ([3H]TdR) and bromodeoxyuridine (BUdR). Animals in which a significant decrease in serum albumin and increase in alanine aminotransferase and bilirubin were observed demonstrated the most prominent differentiation of oval cells into hepatocytes. Administration of [3H]TdR or BUdR, either individually or together, to the animals on day 6 after partial hepatectomy resulted in labeling of the majority of the oval cells by days 7 and 9 after PH. A striking difference in the distribution of [3H]TdR- and BUdR-labeled cells in the double labeling experiments was observed on day 11, at which time the number of [3H]TdR-labeled cells increased 6-fold and that of double labeled cells decreased 2-fold. Furthermore, on day 11 the basophilic foci were weakly positive for BUdR and negative at later time points in animals receiving BUdR alone or together with [3H]TdR. In contrast, the cells in basophilic foci as well as transitional cells were positive for [3H]TdR. Cells heavily labeled with both [3H]TdR and BUdR were present at all time points, indicating an inhibition of the proliferative activity. Pulse labeling of rat liver epithelial cells with BUdR in vitro demonstrated that immunodetection of BUdR was lost after three or more cell divisions. We conclude that the BUdR tagging method is particularly sensitive to label dilution during cell cycling and may not be suitable for establishment of a precursor-product relationship between cell lineages when the progenitor population proliferates more than three times.

An Ancient Chemosensory Mechanism Brings New Life to Coral Reefs

The first scleractinians, progenitors of modern corals, began to appear 240 million years ago; by the late Jurassic (150 Ma) most families of modern corals had evolved and begun forming reefs (1, 2). Mechanisms controlling the recruitment of new corals to sustain these structures are, however, poorly understood (3). Corals, like many marine invertebrates, begin life as soft-bodied larvae that are dispersed in the plankton (3, 4). As the first step in developing a calcified coral colony, the larva must settle out of the plankton onto a suitable substratum and metamorphose to the single calcified polyp stage cemented to the reef (3, 5). Our analyses of the metamorphic requirements of larvae in divergent coral families surprised us by revealing the existence of a common chemosensory mechanism that is required to bring larvae out of the plankton and onto the reef. This mechanism appears to be quite old, predating both the phylogenetic divergence of these coral families and the development of different modes of coral reproduction.

Expression of leukemia inhibitory factor and its receptor during liver regeneration in the adult rat

Leukemia inhibitory factor (LIF) is a polyfunctional cytokine that was discovered in the conditioned medium from Buffalo rat liver cells. In the liver, LIF is known to induce acute phase proteins in the hepatocytes. No comprehensive study has yet been performed on the physiological role of this cytokine during liver regeneration. Thus, we studied the level of expression and cellular distribution of transcripts for LIF, its receptor (LIFR), and signal transducing subunit gp13O during rat liver regeneration after both simple partial hepatectomy (PH) and the oval cell activation induced by the combination of 2-acetylaminofluorene and PH. In addition, the expression of an acute phase protein alpha1-acidglycoprotein was examined. The level of transcripts for LIF and its receptor subunits increased and remained elevated during oval cell expansion. In contrast, after PH, the transcripts were induced only transiently, showing a peak 24 hours after the operation. LIF and receptor subunits were expressed in both parenchymal and nonparenchymal fractions in the 2-acetylaminofluorene/PH model, but the level of expression was most pronounced in the nonparenchymal fraction. In situ hybridization clearly revealed a strong expression of LIF, LIFR, and gp13O in the oval cells and demonstrated only a weak expression in the parenchyma. Interestingly, transcripts of alpha1-acidglycoprotein were exclusively detected in the parenchyma. These results suggest a phenotypic difference between oval cells and hepatocytes in their signaling through gp130. We hypothesize that the LIF/LIFR gp130 system may be involved in the expansion and differentiation of the liver stem cell compartment.

Expression of transforming growth factor alpha/epidermal growth factor receptor, hepatocyte growth factor/c-met and acidic fibroblast growth factor/fibroblast growth factor receptors during hepatocarcinogenesis

It is widely believed that abnormal production of polypeptide growth factors, together with other molecular alterations, play an important role in neoplastic development. Transforming growth factor alpha (TGFalpha), hepatocyte growth factor (HGF) and acidic fibroblast growth factor (aFGF) are the three major growth factors that contribute to liver regeneration occurring via both hepatocyte replication and oval cell proliferation. It is not clear, however, whether and to what extent these growth factors are also involved in hepatocarcinogenesis. In the present study, the gene expression of TGFalpha, HGF and aFGF and their corresponding receptors was examined by Northern blotting and in situ hybridization during hepatocarcinogenesis induced by the Solt-Farber protocol. All three growth factor/receptor systems, TGFalpha/epidermal growth factor receptor (EGFR), HGF/c-met and aFGF/FGF receptors (flg and bek) were significantly elevated at early time points when oval cells were proliferating. Their respective expression decreased after 1 month and remained at a low level until the development of liver tumors. In all hepatocellular carcinomas (HCC) examined, the transcripts of TGFalpha and aFGF were highly expressed, while those of HGF were low. With regard to the receptor expression in the tumors, EGFR was present at varying levels, c-met was expressed at higher levels and flg increased significantly, whereas bek remained at low levels. These data suggest that TGFalpha and aFGF are the major growth factors involved in the progression of HCC, and that the signal of aFGF is mainly transduced by the receptor flg in HCC. Furthermore, HCC cells were phenotypically very similar to oval cells with regard to the gene expression of growth factor/receptor systems. These results, along with the finding that all the HCC cells are positive for the oval cell antigen OV6, and that cytokeratin 19 is heavily expressed in both tumor and oval cells, strongly suggest that at least some of the HCC induced by the Solt-Farber protocol may be derived from oval cells.

Quantitative EEG in never-treated schizophrenic patients

To clarify whether patients with schizophrenia still show EEG slowing in the absence of psychopharmacological treatment, EEG was analyzed in 20 acute never-treated schizophrenics and 20 age-matched healthy controls using the computerized wave-form recognition method. Compared to controls, schizophrenics had more fast theta (6-8 Hz) and slow alpha (8-9 Hz) activity, and less fast alpha activity (9-13 Hz). The average EEG frequency at O1 correlated negatively with total and positive symptom scores on the BPRS in the schizophrenic group. These findings confirm that the frequency of alpha rhythm is slowed in schizophrenia and that this slowing is possibly related to the expression of psychopathology in this disorder.

Effect of vitamin A deficiency on the integrity of hepatocytes after partial hepatectomy

The effect of vitamin A deficiency on hepatic regeneration in male and female rats was studied after partial hepatectomy. A fourfold increase in the number of positive dUTP end-labeled nuclei was observed in the deficient animals as early as 30 minutes after partial hepatectomy and their number reached a peak by 8 hours after the operation. The bile duct cells were both morphologically and biochemically intact at all time points. Administration of retinyl palmitate 1 hour before partial hepatectomy significantly reduced the number of positive nuclei, and treatment with retinyl palmitate 24 or 48 hours before the operation reduced the number of positive cells to the level observed in control vitamin A-supplemented rats. The level of transcripts for c-jun, c-fos, c-myc, and transforming growth factor-beta 1 were increased for an extended period of time in livers of deficient animals, whereas the expression of both p53 and max were unchanged. Immunocytochemistry demonstrated the presence of latent transforming growth factor-beta 1 in cells showing evident apoptotic or necrotic changes in their nuclei. This study demonstrates the importance of vitamin A for the survival of hepatocytes both in intact vitamin A-deficient liver and after partial hepatectomy, whereas the ductal cells appear to be less sensitive to vitamin A deficiency.

Isolation and characterization of a mini-collagen gene encoding a nematocyst capsule protein from a reef-building coral, Acropora donei

Genomic and cDNA clones of a mcol gene encoding mini-collagen (MCOL), a nematocyst capsule protein, have been isolated from a reef-building coral, Acropora donei (Anthozoa). The gene and its flanking regions, comprising 5382 bp and covering three exons and two introns, were sequenced. Exons 2 and 3 together have an open reading frame which can encode a MCOL of 176 amino acids (aa). The coral MCOL has all the characteristic regions present in the four hydra MCOL specified by the four mcol cDNA clones previously isolated from Hydra magnipapillata (Hydrozoa) by Kurz et al. [J. Cell Biol. 115 (1991) 1159-1169], including a central Gly-Xaa-Yaa region and flanking Pro-rich and Cys-repeat regions. This observation suggests that a mcol family is highly conserved in Anthozoa and Hydrozoa, and also that the characteristic regions present in MCOL are essential for the structure and function of these peptides.

Serial proton magnetic resonance spectroscopy in a patient with the interval form of carbon monoxide poisoning

Serial proton magnetic resonance spectroscopy (1H-MRS) studies were performed from immediately after the appearance of sequelae in a patient with the interval form of carbon monoxide (CO) poisoning. The volume of interest was set over the frontal lobe white matter. In the early period a persistent increase in choline was found, which was thought to reflect the course of progressive demyelination. The appearance of lactate and decrease in N-acetylaspartate reflected the point at which neuron injury became irreversible. These were followed later by the finding of irreversible changes on MRI and single photon emission computed tomography. The findings suggest that 1H-MRS may be a useful modality to determine neuron viability and prognosis early in the course of the interval form of CO poisoning.

[Bathing a patient with cancer pain treated with continuous epidural blockade--subcutaneous catheter track and Lapack method]

Continuous epidural blockade is considered to be the most useful device for the management of cancer pain. However, it has the disadvantage to compel the patients to restrict their daily activities. We report a unique "Subcutaneous catheter track & Lapack-method" that enabled a patient with epidural catheter to safely bath at home. A 56-year-old male with a local recurrence of rectal cancer was suffering from perineal pain, which was well controlled by oral and epidural morphine. Since his wishing was to bath, we made a long subcutaneous catheter track with Tuohy-needle to prevent infection, and let him bath with transparent film dressings (Bioclusive) and Lapack to tightly cover and seal up the catheter. Although subcutaneous pustule occurred 7 days after the beginning of bathing, it was easily cured by local disinfection. He was able to enjoy bathing without any infection with this method at home for about 2 months after discharge, until he returned to the hospital. "Subcutaneous catheter track & Lapack-method" offers a safe and comfortable bathing to patients with epidural catheter, and contributes to the improvement of their quality of life.

Molecular cloning and nucleotide sequence of the beta-galactosidase gene from Enterobacter cloacae GAO

The gene encoding a beta-galactosidase from Enterobacter cloacae GAO was cloned and expressed in Escherichia coli. The nucleotide sequence of the insert of a positive clone had an open reading frame of 3084 bp that encoded a polypeptide of 1028 amino acid residues with a calculated molecular mass of 116,677 daltons. The amino acid sequence of beta-galactosidase deduced from the nucleotide sequence, especially the sequence around the putative active site and of the fourteen regions, showed significant homology to beta-galactosidases of other microorganisms, E. coli, Klebsiella pneumoniae, Lactobacillus bulgaricus, and Clostridium acetobutylicum.

Inhibitory effects of (-)-epigallocatechin gallate on spontaneous hepatoma in C3H/HeNCrj mice and human hepatoma-derived PLC/PRF/5 cells

The inhibitory effect of (-)-epigallocatechin gallate (EGCG), a main constituent of Japanese green tea, on spontaneous hepatoma in C3H/HeNCrj mice was investigated. A total of 72 mice were divided into three groups; the control group without EGCG, and two experimental groups receiving 0.05% (w/w) or 0.1% EGCG in drinking water. EGCG reduced the incidence of hepatoma-bearing mice from 83.3% (control) to 56.0% (0.05% EGCG) and 52.2% (0.1% EGCG), and also reduced the average number of hepatomas per mouse from 1.83 (control) to 0.72 (0.05% EGCG) and 0.91 (0.1% EGCG) at week 65. Ridit analysis of the distribution of the number of hepatomas in each group revealed that EGCG significantly increased the rate of mice without hepatoma in the two EGCG groups as compared to the control. EGCG did not affect body weight gain, food consumption or any serum biochemical parameter. EGCG inhibited the growth and secretion of alpha-fetoprotein by human hepatoma-derived PLC/PRF/5 cells without decreasing their viability. These results indicate that EGCG may be a practical, nontoxic preventive agent against human hepatoma.

In vivo proton magnetic resonance spectroscopy study on premature aging in adult Down's syndrome

Proton magnetic resonance spectroscopy (1H-MRS) was performed in a group of 18 adult patients with Down's syndrome (DS) aged 20-46 years, and the peak area ratios (NAA/Cr, Cho/Cr, NAA/Cho) of N-acetylaspartate (NAA), total creatine (Cr), and choline-containing compounds (Cho) calculated separately in the patients in their 20's, 30's, and 40's. In age-matched healthy control groups, there were no significant age-related changes in any of the peak area ratios. In contrast, in the DS group, although the relative amount of NAA (NAA/Cr) showed no significant change with increasing age, the relative amount of Cho (Cho/Cr and NAA/Cho) was significantly increased in the 40's group. At least as judged by MRI, few age-related general morphological changes such as brain atrophy were apparent in the third, fourth, and fifth decade groups. However, the MRI findings considered together with the age-related changes in the peak area ratios suggest that in DS patients in the fifth decade metabolic abnormalities such as degradation and/or rapid synthesis of brain cell membrane may occur prior to neuronal loss and degeneration.

The influence of light drowsiness on the latency and amplitude of P300

Light drowsiness affected the P300 obtained with a standard auditory oddball paradigm. A simple two-tone discrimination paradigm was used. The frequent nontarget stimuli were 1000 Hz pure tones and the infrequent target stimuli were 2000 Hz pure tones. The subjects were required to press a button whenever infrequent target tones were presented. With light drowsiness, P300 increased in latency and decreased in amplitude, but the counts of infrequent tones remained correct nevertheless. It was concluded that electrophysiological brain function differs in the light drowsy and awake states. In studies on P300, it is essential to rule out light drowsiness to obtain valid P300 amplitudes and latencies.

Quantitative EEG of elderly schizophrenic patients

To investigate the brain function of elderly schizophrenic patients, quantitative EEGs of such patients were compared with those of healthy elderly controls. In schizophrenics, increases in delta and slow theta (4.0-6.0 Hz) waves were thought to be due to the influence of antipsychotics. Characteristic EEG features of these patients included the following: 1) more fast theta (6.0-8.0 Hz) wave was observed, with less alpha wave faster than 9.0 Hz, 2) the reduction in alpha 3 (10.0-11.0 Hz) wave was limited to the frontal regions. The present EEG findings are thought to characterize the traits of the subtype of chronic severe schizophrenia. The reduction in alpha 3 wave in the frontal regions may be one expression of the hypofrontality of schizophrenia.

Frontal intermittent delta activity in schizophrenic patients receiving antipsychotic drugs

FIRDA was found in 14 EEGs recorded from 338 schizophrenic patients receiving antipsychotic drugs, although they showed no FIRDA in the baseline EEG. The daily dose of antipsychotic drugs when FIRDA was found was larger than when FIRDA disappeared. FIRDA was assumed to be induced by relatively high doses of antipsychotic drugs. Thus, the effect of antipsychotic drugs should be added to the list of differential diagnoses associated with FIRDA. FIRDA did not correlate with the baseline psychopathology of schizophrenic patients. Patients without FIRDA tended to respond poorly to antipsychotic drugs in terms of negative symptoms. Improvement of positive symptoms in FIRDA patients was not as remarkable as in patients without FIRDA.

Two-way cleavage of beta-amyloid protein precursor by multicatalytic proteinase

The beta-amyloid protein (beta-AP) derived from a beta-amyloid protein precursor (APP) is a hallmark of Alzheimer's disease. The abundant generation of beta-AP suggests the abnormal processing of APP, but the molecular mechanism remains unclear. The main APP-processing enzyme was purified from the rat brain and identified to be a macropain-like multicatalytic proteinase. The purified enzyme cleaved the Gln15-Lys16 bond of beta-AP, but altered to cleave at the N-terminus of beta-AP to release the extracellular domain of beta-AP in the presence of Ca2+. These findings suggest that the functional change in this multicatalytic proteinase may result in abnormal processing of APP.

Inhibitory effect of sarcophytol A on development of spontaneous hepatomas in mice

The inhibitory effect of sarcophytol A, a cembrane-type diterpene isolated from a marine soft coral, Sarcophyton glaucum, on development of spontaneous hepatomas was investigated in C3H/HeNCrj mice. A total of 80 mice were divided equally into two groups. The experimental and control groups were given basal diets with and without 0.01% sarcophytol A, respectively. At week 65 of the experiment, mice were examined for hepatomas. The percentages of hepatoma-bearing mice of the subgroup with three or more tumors and the tumor diameters of the group treated with sarcophytol A were smaller than those of the control group. Ridit analysis revealed that these differences were statistically significant. The body weight gain, and the food intake were not significantly different between these two groups. Analysis of blood serum revealed that feeding the diet containing 0.01% sarcophytol A for 65 weeks did not show any adverse effects. These results suggest that sarcophytol A inhibits the development of spontaneous hepatomas without toxicity, and should be considered as a possible cancer chemopreventive agent for hepatomas in humans.

Inhibitory effects of acyclic retinoid (polyprenoic acid) and its hydroxy derivative on cell growth and on secretion of alpha-fetoprotein in human hepatoma-derived cell line (PLC/PRF/5)

Acyclic retinoid (polyprenoic acid) has a slightly different structure from retinoic acid. However, acyclic retinoid acts similarly to retinoic acid, because both bind to cellular retinoic acid-binding protein and cellular retinoid-binding protein. F-type, with the same strong binding affinity. We studied the effects of acyclic retinoid, the 7-hydroxy derivative of acyclic retinoid (7OH-acyclic retinoid) and retinoic acid on a human hepatoma-derived cell line PLC/PRF/5 (Alexander cells). Acyclic retinoid inhibited cell growth with an ID50 value of 14 microM, and reduced cell viability with an LD50 value of 86 microM. The ratios of LD50 value to ID50 value were 6.1 for acyclic retinoid, 2.4 for 7OH-acyclic retinoid and 1.4 for all-trans-retinoic acid. Taking this ratio as a parameter of relative cytotoxicity, we concluded that acyclic retinoid is the least toxic compound. Growth inhibition of cells by acyclic retinoid was associated with the incorporation of 3H-thymidine in the logarithmic phase. Acyclic retinoid reduced secretion of alpha-fetoprotein (AFP) and reciprocally increased secretion of albumin in the culture media, suggesting that acyclic retinoid influences gene expression of these proteins. Thus, acyclic retinoid, one of the less toxic retinoids, inhibits cell growth of human cancer cell line PLC/PRF/5 and appears to alter gene expression of AFP and albumin toward a "normal" direction.