[Epidemiological investigation of tinea pedis in groups of healthy students, research workers and females wearing boots]

The infection rate, causative dermatophytes, and dermatophyte dissemination of tinea pedis in young healthy Japanese were studied by direct microscopic examination, slant cultures, and foot-press culture method. Questionnaires on subjective symptoms and treatments were also distributed. Among fifty-eight medical students with a mean age of 23.9 years, thirteen (22.4%) showed positive by direct microscopic examination and T. mentagrophytes was more dominant than T. rubrum by slant cultures. In one hundred and sixteen student feet, twelve were infected and disseminating dermatophytes, four were infected but not disseminating, three were not infected but adhering dermatophytes. The infection rate of tinea pedis was thus 24.1%. Among thirty-seven research workers (mean age: 34.8), twenty-one (56.8%) showed positive by direct microscopic examination. All the dermatophytes isolated by slant cultures were T. mentagrophytes. In seventy-four feet, twenty-nine were infected and disseminating, ten were infected but not disseminating, and three were adhering dermatophytes. The infection rate was 64.9%. Among thirty-one females wearing boots (mean age: 21.0), seven (22.6%) were infected and T. mentagrophytes was more dominant. In sixty-two feet, eight were infected and disseminating, one was infected but not disseminating, and five were adhering dermatophytes. The infection rate of tinea pedis was quite high and T.r/T.m rate was low in the three groups. Most of the patients had had no treatment and were disseminating dermatophytes.

Delayed enhancement of hepatocellular carcinoma on dynamic CT: sign of extrahepatic collaterals after transcatheter arterial chemoembolization or transcatheter arterial chemoinfusion

BACKGROUND

We examined the factors of delayed enhancement of hepatocellular carcinoma (HCC) on dynamic computed tomography (CT).

METHODS

Dynamic CT and angiography were compared in 113 patients who had undergone transcatheter arterial chemoembolization or transcatheter arterial chemoinfusion and were suspected of developing new HCCs.

RESULTS

Eight of 113 patients had HCC nodules that enhanced gradually from the arterial phase to the portal venous phase on dynamic CT and were fed by extrahepatic arteries on angiography. The feeding artery was an omental branch of the splenic artery in one lesion, an omental branch of the gastroduodenal artery in five, and the intercostal artery in two.

CONCLUSION

We believe that the recurrence of HCCs delayed enhancement on dynamic CT because the hepatic artery was hidden and long narrow extrahepatic collaterals fed the tumor.

Endomorphin-1 improves scopolamine-induced impairment of short-term memory via mu1-opioid receptor in mice

The effects of intracerebroventricular injection of endomorphin-1 and 2, endogenous mu-opioid receptor agonists, on the scopolamine-induced impairment of spontaneous alternation performance associated with short-term memory were investigated in mice. Endomorphin-1 (0.03 microg) inhibited scopolamine (1 mg/kg)-induced impairment of spontaneous alternation performance without affecting total arm entries, while endomorphin-2 (0.01-10 microg) failed to significantly influence the scopolamine (1 mg/kg)-induced impairment. Endomorphin-1 (0.03 microg) itself had no marked effects on spontaneous alternation performance in intact mice. Although beta-funaltrexamine (5 microg), a mu-opioid receptor antagonist, did not significantly affect the inhibitory effects of endomorphin-1 (0.03 microg) on the scopolamine (1 mg/kg)-induced impairment, naloxonazine (35 mg/kg), a mu1-opioid receptor antagonist, significantly reversed the inhibitory effects of endomorphin-1 (0.03 microg) on the impairment. Naloxonazine (35 mg/kg) unlike beta-funaltrexamine (5 microg) did not significantly influence the scopolamine (1 mg/kg)-induced impairment of spontaneous alternation performance. These results suggest that endomorphin-1 improves the disturbance of short-term memory resulting from cholinergic dysfunction through the mediation of mu1-opioid receptors.

[Effects of smoking on pulmonary function: a cross-sectional and longitudinal study]

Cross-sectional and longitudinal studies were done to investigate the influence that a change in smoking habit can have on the pulmonary function. Seventeen hundred and thirty nine people (698 men, 1,041 women), 39 years of age or older, from the population of a farming village located in the central part of Miyazaki Prefecture were examined. A population-based cohort study with a 4-time observation was done over an interval of 12 years. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1.0) were used as the index of respiratory function, and adjusted annual change of FVC and adjusted annual change of FEV1.0 were used as a pulmonary function inspection index. There was a statistical significance in both %FVC and %FEV1.0 to the predicted values between smokers and non-smokers at the beginning of observation. The adjusted annual change of FVC both of male- and female-smokers and the adjusted annual change of FEV1.0 of male-smokers was higher than those of non-smokers in the longitudinal study. Percent FVC, %FEV1.0 and the adjusted FEV1.0 change of former male-smokers were lower than those of continuing smokers. In addition to %FVC and %FEV1.0, annual change of FVC and annual change of FEV1.0 were important predictors of pulmonary function related to cigarette smoking.

Ligand-induced changes in the Streptomyces lividans TipAL protein imply an alternative mechanism of transcriptional activation for MerR-like proteins

TipAL is a Streptomyces transcriptional activator assigned to the MerR/SoxR family based both on homology within its putative DNA recognition domain and the fact that its operator binding sites lie within a region of its promoter normally occupied by RNA polymerase. The tipA gene is also independently translated as the C-terminal ligand-binding domain of TipAL (TipAS; residues 111-254). Both TipAS and TipAL share broad recognition specificity for cyclic thiopeptide antibiotics. The molecular mechanism by which TipAL catalyzes prokaryotic transcriptional activation at the tipA promoter (ptipA) in response to thiostrepton was studied using a combination of analytical ultracentrifugation (AU), circular dichroism (CD), optical waveguide lightmode spectroscopy (OWLS; a sensitive in situ binding assay), and mutational analyses. AU showed that TipAL, but not TipAS, was a dimer in solution in the presence or absence of thiostrepton. This indicated that activation of TipAL by thiostrepton was not mediated by changes in multimerization and mapped the dimerization domain to its N-terminal 110 amino acids, presumably within amino acids predicted to form a coil-coil domain (residues 77-109). CD spectra showed that TipAL had more alpha-helical content than TipAS, probably because of the presence of the additional N-terminal region. The helicity of TipAL and TipAS both increased slightly after binding thiostrepton demonstrating conformation changes upon thiostrepton binding. OWLS experiments determined the overall binding constants via measurements of association and dissociation rates for both TipA proteins and RNA polymerase with ptipA. Thiostrepton slightly enhanced the rate of specific association of TipAL with ptipA, but drastically lowered the rate of dissociation from the binding site. TipAL-thiostrepton increased the affinity of RNA polymerase for ptipA more than 10-fold. In conjunction with genetic experiments, we propose that, while there are some similarities, the mechanism by which TipAL activates transcription is distinctly different from the established MerR/SoxR paradigm.

Clinical and pathological significance of vitamin D receptor gene polymorphism for prostate cancer which is associated with a higher mortality in Japanese

The purpose of this study was to investigate the TaqI vitamin D receptor (VDR) polymorphism in both Japanese prostate cancer patients and Japanese noncancer controls in order to determine if an association exists between VDR genotype with clinical and pathological risk of prostate cancer patients. This study involved 115 patients with prostate cancer and 133 male age-matched noncancer controls genotyped for a previously described TaqI restriction fragment length polymorphism (RFLP) at codon 352 in exon 9 of the VDR gene. Products were digested into T allele or t allele according to the absence or presence of TaqI restriction site with individuals being classified as TT, Tt, or tt. The genotype tt was higher among the control group (6.0%) compared to the patients with prostate cancer (1.8%), but not so (OR=0.28; 95%o CI, 0.06-1.33; p=0.081). In addition, the genotype TT was statistically higher among patients with locally advanced or metastatic disease (T3/T4/NI/M1) compared to controls (OR=2.52; 95%o CI, 1.21-5.27; p=0.009). Lastly, the genotype TT was statistically higher among patients with poorly differentiated adenocarcinoma compared to controls (OR=5.38; 95%o CI, 1.57-18.50; p=0.002). These data demonstrate that VDR genotype plays an important role in determining the risk of more clinically advanced and pathologically aggressive prostate cancer which is associated with a higher mortality rate in Japanese men.

Development of the fluorometric ELISA method for determination of alpha1-microglobulinuria in a cadmium-polluted area in Japan

OBJECTIVES

To evaluate the usefulness of a newly developed fluorometric enzyme-linked immunosorbent assay (fluorometric ELISA) method for quantification of alpha1 -microglobulin (alpha1-m, protein HC) in an epidemiological study.

METHODS

Urinary alpha1-m in 37 female inhabitants in a cadmium-polluted area, including seven cases with Itai-itai disease, and ten inhabitants in a non-polluted area in Japan were examined. The alpha1-m was measured by both the fluorometric ELISA and a commercially available enzyme immunoassay (EIA) method to evaluate correlation of the two measurements. Concentration of beta2-microglobulin (beta2-m) was also determined in the same samples.

RESULTS

The detection limit of this method was 3 ng/ml or less of alpha1-m. A significant, high positive correlation was obtained between the alpha1-m concentrations measured with the fluorometric ELISA and that of EIA (r = 0.95, P < 0.0001). A significant association was also shown between the alpha1-m and beta2-m concentrations in the urine samples. The concentrations of urinary alphal-m of the inhabitants in the cadmium-polluted area (mean: 6.21 mg/l, 95% confidence interval (95% CI): 4.06-9.50 mg/l) were significantly higher than those of the reference area (mean: 2.19 mg/l, 95% CI: 1.90-2.67 mg/l). The urinary alpha1-m level of the Itai-itai patients was shown to be highest at 39.63 mg/l (95% CI: 28.27 55.55 mg/l). When the cut-off value of 10 mg/l was employed, alpha1-m had a sensitivity of 100% and specificity of 100% for Itai-itai disease.

CONCLUSION

These results suggest that this fluorometric ELISA is a useful tool to determine urinary alpha1-m in the epidemiological survey of renal tubular dysfunction, especially in the cadmium-polluted area of Japan.

Studies toward the total synthesis of popolohuanone E: enantioselective synthesis of 8-O-methylpopolohuanone E

[structure: see text]. 8-O-methylpopolohuanone E (2) was synthesized in a highly convergent manner starting from the cis-fused decalin derivative accessible from the (-)-Wieland-Miescher ketone analogue. The synthetic method features a biogenetic-type annulation of the phenolic and quinone segments to regioselectively construct the central tricyclic ring system as the key step.

Molecular phylogeny of butterflies Parnassius glacialis and P. stubbendorfii at various localities in East Asia

The phylogeny of butterflies, Parnassius stubbendorfii and P. glacialis, collected at various localities in the Japan archipelago and the eastern part of the Asian continent was analyzed using mitochondrial DNA sequences coding for NADH dehydrogenase subunit 5 (805 bp). The molecular phylogenetic trees revealed that P. glacialis and P. stubbendorfii diverged from a common ancestor, and then the populations inhabiting the Japan archipelago and the Asian continent diverged in each species. The reliability of these divergences was supported by high bootstrap values. The divergences within the Japan archipelago and within the Asian continent in each species were unclear because of low bootstrap values. The genetic distance and a rough time-estimation in the UPGMA tree suggest that the both populations of P. glacialis and P. stubbendorfii may have been isolated in the Japan archipelago at the early time (about 1.7-2.0 Mya) of the glacial period in the Pleistocene. The genetic distance between the Japanese and the continental subspecies may be large enough that they can be classified as different species, in comparison with the genetic distances among some other parnassian species.

Auditory evoked potential index predicts the depth of sedation and movement in response to skin incision during sevoflurane anesthesia

BACKGROUND

The auditory evoked potential (AEP) index, which is a single numerical parameter derived from the AEP in real time and which describes the underlying morphology of the AEP, has been studied as a monitor of anesthetic depth. The current study was designed to evaluate the accuracy of AEPindex for predicting depth of sedation and anesthesia during sevoflurane anesthesia.

METHODS

In the first phase of the study, a single end-tidal sevoflurane concentration ranging from 0.5 to 0.9% was assigned randomly and administered to each of 50 patients. The AEPindex and the Bispectral Index (BIS) were obtained simultaneously. Sedation was assessed using the responsiveness portion of the observer's assessment of alertness-sedation scale. In the second phase of the study, 10 additional patients were included, and the 60 patients who were scheduled to have skin incisions were observed for movement in response to skin incision at the end-tidal sevoflurane concentrations between 1.6 and 2.6%. The relation among AEPindex, BIS, sevoflurane concentration, sedation score, and movement or absence of movement after skin incision was determined. Prediction probability values for AEPindex, BIS, and sevoflurane concentration to predict depth of sedation and anesthesia were also calculated.

RESULTS

The AEPindex, BIS, and sevoflurane concentration correlated closely with the sedation score. The prediction probability values for AEPindex, BIS, and sevoflurane concentration for sedation score were 0.820, 0.805, and 0.870, respectively, indicating a high predictive performance for depth of sedation. AEPindex and sevoflurane concentration successfully predicted movement after skin (prediction probability = 0.910 and 0.857, respectively), whereas BIS could not (prediction probability = 0.537).

CONCLUSIONS

Auditory evoked potential index can be a guide to the depth of sedation and movement in response to skin incision during sevoflurane anesthesia.

Ventricular parasystolic couplets originating in the pathway between the ventricle and the parasystolic pacemaker: mechanism of "irregular" parasystole

This article explains the mechanism of "irregular" parasystole. Two theories have been suggested: "electrotonic modulation" and "type I second degree entrance block." This study attempts to clarify the mechanism of irregular parasystole in cases of true ventricular parasystole associated with ventricular parasystolic couplets. Cases associated with ventricular parasystolic couplets were selected from 37 clinical cases of true ventricular parasystole in which one or more pure parasystolic cycles with no intervening nonectopic QRS complexes were found. Of the 37 cases of true ventricular parasystole, ventricular parasystolic couplets were found in 4 cases. In none of the other 33 cases, ventricular parasystolic couplets were found. In all the cases coexisting with ventricular parasystolic couplets, the latter ectopic QRS complex of the couplet failed to reset the parasystolic rhythm. The above findings suggest that the latter ectopic QRS complex of the parasystolic couplet originated not in the parasystolic pacemaker but in the pathway between the ventricle and the parasystolic pacemaker. It seems that when a sinus impulse fell late in the parasystolic cycle, it passed through the site of second degree entrance block and that the parasystolic couplets originated from the reentrant pathway between the ventricle and the pacemaker. This strengthens our previous suggestion that the mechanism of irregular parasystole is governed by "type I second degree entrance block" and not by "electrotonic modulation."

Renal tubular dysfunction in male inhabitants of a cadmium-polluted area in Toyama, Japan--an eleven-year follow-up study

An eleven-year follow-up study was carried out to elucidate the changes in the level of environmental exposure to cadmium (Cd) from rice after soil replacement of polluted paddy fields and these effects on urinary excretion of Cd in male inhabitants of a Cd-polluted area in Toyama, Japan. In addition, the prevalence of renal tubular dysfunction (RTD) was examined to clarify the progress of Cd-induced RTD. One hundred and twenty-seven male inhabitants born between 1914 and 1929 in 11 districts of the Cd-polluted Jinzu River basin and 31 reference subjects in 2 adjacent districts were examined twice in 1985-86 and 1996-97. The geometric means of Cd concentrations in polished rice (Cd-R) in the Cd-polluted areas were 0.18 ppm in 1985 and 0.21 ppm in 1986; these values were significantly higher than those of the reference areas (0.13 ppm in 1985 and 0.12 ppm in 1986). After 11 years, the Cd-R levels were significantly decreased to approximately half (0.08 ppm in 1996, 0.12 ppm in 1997) due to soil replacement of polluted paddy fields, which has been carried out since 1980. The mean Cd levels in urine (Cd-U) were significantly reduced from 7.9 and 9.5 microg/g creatinine in the initial study to 6.9 and 6.8 microg/g creatinine in the follow-up study. However, the prevalence of RTD, which was determined by urinary beta2-microglobulin exceeding 1 mg/g creatinine and urinary glucose exceeding 150 mg/g creatinine, increased from 18 and 23% in the 1985-86 study to 25 and 32% in the 1996-97 study, and a total of 12 new cases (12%) of RTD were found. Whereas, only one subject (4%) in the reference control areas was identified as RTD. Cd-induced RTD was prevalent, progressive and irreversible for male inhabitants of the Cd-polluted Jinzu River basin, although the environmental exposure to Cd through rice was significantly reduced by soil replacement of polluted paddy fields.

Plasma natriuretic peptide levels and daily physical activity in patients with pacemaker implantation

To determine whether plasma ANP and/or BNP levels can be used to detect limitations in daily physical activity after pacemaker implantation, we measured plasma ANP and BNP levels at a pacemaker follow-up clinic in 56 patients (62+/-15 yrs, 2AAI, 9VVI, 34DDD, 7VDD and 4 rate-responsive modes), daily physical activity evaluated by a specific activity scale questionnaire (METs) and VO2 max obtained by expired gas analysis during ergometer exercise. A very close correlation (n=6, r=0.89, p<0.05) was obseved between. ANP in patients with daily physical activity class III (2-4 METs, n=21) was significantly higher than class II (5-6 METs, n=23, p<0.01) and class I (>7 METs, n=8, p<0.01), while BNP in class III patients was significantly higher than in class II (p<0.0001) and class I (p<0.0001) patients. Significant correlations between daily physical activity and BNP (r=-0.64, p<0.0001) and ANP (r=-0.43, p<0.001) were observed. Physiological pacing mode did not necessarily offer a better profile for BNP levels compared with non-physiological pacing modes. Patients with ventricular pacing (wide QRS: VDD, RR-VVI and VVI) showed significantly high ANP (p<0.01) and BNP (p<0.01) levels compared with those in patients with atrial pacing (narrow QRS: AAI and RR-AAI). During exercise, plasma catecholamines and ANP levels were significantly elevated, however, BNP levels, which were already elevated at rest, did not change significantly, and reflected a limitation of daily physical activity. The present study revealed that 37.5% of the patients displayed an elevation in BNP and this was judged to be a limitation of physical activity class III being equivalent to NYHA II or more. Elevated resting BNP levels reflected a limitation in daily physical activity in these patients. These findings suggested a third condition for physiological pacing--synchronization of ventricular contraction (narrow QRS pacing)--in addition to the two conventional conditions of atrioventricular synchrony and rate-responsiveness.

Impact of genetic polymorphisms of 17-hydroxylase cytochrome P-450 (CYP17) and steroid 5alpha-reductase type II (SRD5A2) genes on prostate-cancer risk among the Japanese population

Steroid hormones, especially testosterone, play important roles in the carcinogenesis of prostate cancer, and several studies have reported changes in risk with polymorphisms of genes involved in steroid metabolism. One example is the CYP17 gene, which has a polymorphic T-to-C substitution in the 5'-untranslated region giving rise to A1 (T) and A2 (C) alleles. Steroid 5alpha-reductase type II (SRD5A2), which converts testosterone to the metabolically more active dihydrotestosterone, exhibits 2 polymorphisms: V89L, which substitutes leucine for valine at codon 89, and A49T, which substitutes threonine for alanine at codon 49. We therefore designed a case-control study of 105 prostate-cancer patients and 210 controls with benign prostatic hyperplasia for the purpose of investigating the association between prostate-cancer risk and polymorphisms in the SRD5A2 and CYP17 genes among the Japanese. The frequency of the CYP17 A2/A2 genotype in cases (18.8%) was higher than in controls (14.5%). Compared with the A1/A1 genotype, the odds ratio for the A2/A2 genotype was 2.39 (95% confidence interval 1.04-5.46, p = 0.04). The frequency of the SRD5A2 LL genotype in cases (29.3%) was also slightly higher than in controls (24.6%), but this was not significant. Regarding the A49T polymorphism of SRD5A2, we could not detect the T allele in any of the examined samples. These data suggest a significant association between the CYP17 polymorphism and prostate-cancer risk among the Japanese.

Individual differences in urinary cotinine levels in Japanese smokers: relation to genetic polymorphism of drug-metabolizing enzymes

Urinary cotinine, one of the main metabolites of nicotine, has been widely used as a biomarker for assessment of direct or passive exposure to cigarette smoke. However, there is wide variation of the cotinine level among smokers who smoke the same number of cigarettes. To use urinary cotinine as a proper exposure-biomarker for cigarette smoke, interindividual variations of cotinine formation must be considered. Therefore, we studied the effects of genetic polymorphisms in drug metabolic enzymes on urinary cotinine levels among 190 male Japanese smokers (ages 19-66 years; mean, 40.6 years). Genetic polymorphisms in cytochrome P-450s (CYP1A1, CYP2A6, CYP2E1), and aldehyde dehydrogenase 2 (ALDH2) were determined by analyzing DNA isolated from peripheral blood. Cotinine in morning spot urine was analyzed by high-performance liquid chromatography. Lifestyle, i.e., smoking, alcohol consumption, and intake of coffee or tea, was examined using a questionnaire. The number of cigarettes smoked and CYP2A6 polymorphism were significantly associated with the urinary cotinine level. Especially, the urinary cotinine levels was drastically lower in CYP2A6-deleted homozygous (CYP2A6*4/*4) subjects than in CYP2A6*1 allele-positive subjects. The polymorphism in the CYP2E1 5'-flanking region was related to the urinary cotinine level in intermediate smokers (who smoke 11-20 cigarettes/day; P < 0.01). Polymorphisms in CYP1A1 or ALDH2, and consumption of alcohol, coffee, or tea were not associated with the urinary cotinine level.

Studies toward the total synthesis of scyphostatin: first entry to the highly functionalized cyclohexenone segment

The cyclohexenone segment 2 of scyphostatin (1), a potent inhibitor of neutral sphingomyelinase, was synthesized in an enantioselective manner starting from the bromo ether 5 and D-serinal derivative 3. The synthetic method features a coupling reaction of 5 with 3 to construct the asymmetric quaternary carbon center and a stereospecific epoxide ring formation as the key steps.

Ventricular tachycardia induced by supraventricular extrasystoles

Electrocardiography was performed in a newborn boy without organic heart disease, in whom supraventricular extrasystoles with varying coupling were seen. The supraventricular extrasystoles were occasionally followed by ventricular extrasystoles. The coupling intervals of ventricular extrasystoles to the preceding supraventricular extrasystoles were also considerably variable. Ventricular tachycardia occurred following comparatively late coupled ventricular extrasystoles. This is the first known report on ventricular tachycardia following comparatively late coupled ventricular extrasystoles in a newborn infant. This strengthens our previous suggestion that such ventricular tachycardia can be caused by longitudinal dissociation in the reentrant pathway of extrasystoles.

Genetic polymorphisms in cytochrome P450 (CYP) 1A1, CYP1A2, CYP2E1, glutathione S-transferase (GST) M1 and GSTT1 and susceptibility to prostate cancer in the Japanese population

Associations between genetic polymorphisms of CYP1A1, CYP1A2, CYP2E1, GSTM1 and GSTT1 and prostate cancer (PCa) were analyzed in a case-control study of 315 individuals. The frequency of valine (Val)/valine (Val) genotypes for CYP1A1 was 11.3% in cases compared with 5.5% in controls, this polymorphism thus being associated with a significantly increased risk of PCa (odds ratio=2.4, 95% confidence interval (CI)=1.01-5.57). No links were detected between PCa and polymorphisms in other enzymes. However, the combination of CYP1A1 (Ile/Val and/or Val/Val) polymorphisms with the GSTM1 null type resulted in an OR of 2.2 (CI=1.10-4.57, 1.12-4.20, respectively). This study suggests that the CYP1A1 polymorphism and its combination with GSTM1 may be associated with PCa susceptibility in the Japanese population.

Multicenter prospective nonrandomized study of long-term antiarrhythmic drug therapy in patients with tachyarrhythmias: Japanese Antiarrhythmics Long-Term Study-2 (JALT-2 Study)

Based on the results of the Cardiac Arrhythmia Suppression Trial (CAST), strategies for the treatment of tachyarrhythmias have changed rapidly. The Japanese Antiarrhythmics Long-Term (JALT) study was planned to investigate the present methods for choosing antiarrhythmic drugs, and the effects on long-term prognosis in patients with tachyarrhythmias in Japan. Following a 6-month preliminary study (JALT-1), there was a multicenter nonrandomized prospective study (JALT-2), with a 2-year follow-up, of patients with paroxysmal atrial fibrillation (PAF), sustained ventricular tachycardia (SVT) and nonsustained VT (NSVT). Four hundred fifty-five patients were registered, and 361 of them (79%) were analyzed. Cerebral infarction occurred in 10 of 193 patients (5.2%) with PAF. Transition to chronic AF was observed in 21 patients (10.9%), but in none of the patients receiving Ca antagonist therapy. Twenty-five patients died: 5 deaths were arrhythmic, 10 were because of pump failure, and 9 were noncardiac. The most significant difference in drug selection between JALT-1 and JALT-2 was the increase in the use of slow kinetic Na channel blockers for PAF and the decrease in the use of the same agents for VT in the JALT-2 study. A marked change of therapeutic strategy occurred in JALT-2 compared with JALT-1. Most patients with a poor prognosis had underlying heart diseases and heart failure, but the per annum rate of death by arrhythmia and pump failure in JALT-2 was less than that in JALT-1.

Repetitive supernormal conduction in the right bundle branch in high degree bilateral bundle branch block

Electrocardiograms were taken from a 67-year-old woman with high-degree atrioventricular block in which ventricular escape beats of right bundle branch block pattern occurred, accompanying occasional ventricular capture beats. Only when a sinus P wave occurred 0.60 s after the preceding escape beat, it was followed by a capture beat of left bundle branch block pattern with the RP interval of 0.60 s and the PR interval of 0.19 s. Similar left bundle branch block with left axis deviation pattern had been shown in the electrocardiogram taken 2 years before. Such RP and PR intervals in capture beats were invariable. These suggest that capture beats occurred as a result of supernormal conduction in the right bundle branch, which denies the possibility of ventricular extrasystoles. Such capture beats with the above RP and PR intervals were observed repeatedly.

Radiotherapy after hyperbaric oxygenation improves radioresponse in experimental tumor models

We examined the effect of radiotherapy after hyperbaric oxygen (HBO) breathing in experimental tumors using a tumor growth delay assay. Tumor models used were SCCVII (radiobiological hypoxic fraction: approximately 10%) and 9L tumors (containing less hypoxic cells) subcutaneously transplanted into C3H/He mice and Fisher 344 rats, respectively. Irradiation using X-rays was locally administered to the tumors immediately after decompression. HBO breathing enhanced the radiation response in SCCVII tumors but not in 9L ones. In the next experiment using SCCVII tumors, irradiation was administered 5, 15, 30, and 90 min after decompression. A significant growth delay was seen in the treated animals within 30 min after HBO breathing, and the tumor growth delay time was prolonged 1.61 times as long as that in radiotherapy alone. We concluded that: (1) radiotherapy after HBO breathing is effective for tumors with hypoxic cells; and (2) the time lapse from decompression to irradiation is an important factor in improving radiosensitivity. Radiotherapy after HBO breathing can be used to enhance the efficacy of clinical treatments.