Development of a potassium-specific adsorbent for direct hemoperfusion

Direct hemoperfusion (DHP) over an exchange resin for sodium is capable of rapidly lowering an elevated serum potassium level but has not been used clinically because of subsequent electrolyte abnormalities. After the completion of detailed in vitro studies, we developed a sodium/calcium/magnesium exchange resin mixture specifically to remove potassium from the blood. The mixture, which consisted of exchange resins for sodium (48%), calcium (48%), and magnesium (4%), gave the most satisfactory results in vitro. DHP through these resin-mixture columns for 2 h reduced elevated plasma potassium levels (6.7 +/- 1.1 to 3.5 +/- 0.6 mEq/L, p < 0.001) in anephric dogs without including any significant change in the levels of sodium, calcium, magnesium, albumin, total protein, or cholesterol. The platelet losses and changes in the plasma free hemoglobin levels observed were similar to those found with activated charcoal hemoperfusion. These results suggest that this resin hemoperfusion may be useful in patients with acute hyperkalemia.

Specific neutrophil elastase inhibitor does not attenuate acute lung injury induced by air embolism in awake sheep

To investigate the role played by neutrophil-derived elastase in acute lung injury, this study examined the effects of treatment of ONO-5046, a competitive, reversible, and specific neutrophil elastase inhibitor, on lung dysfunction induced by air emboli in awake sheep. Sheep were prepared with chronic lung lymph fistula. In experiment 1, air (1.23 mL/min) was infused over a 2-h period into the pulmonary artery and hemodynamic monitoring was performed over a 5-h period. In experiment 2, air was infused in the same manner as in experiment 1, 1 h after the continuous infusion of ONO-5046 (10 mg/kg h-1) had begun. In experiment 1, pulmonary artery pressure (Ppa) increased from the baseline value of 17.0 +/- 0.7 cm H2O to 28.3 +/- 1.8 1 h after the beginning of the air infusion. Ppa returned to the baseline values within 1 h after the air infusion was stopped. Lung lymph flow (Qlym) increased from the baseline value of 3.7 +/- 0.7 mL/0.5 h to 8.5 +/- 1.9 after 1 h of air infusion. After the air infusion was stopped, Qlym continued to increase. When sheep were treated with ONO-5046, Ppa and Qlym increased in a fashion similar to that in the experiment 1. These findings suggest that ONO-5046 does not attenuate air embolism-induced lung injury and that neutrophil-derived elastase may not play an important role in air embolism-induced lung injury in awake sheep.

Effects of muscle relaxation therapy using specially designed plates in patients with pulmonary emphysema

It has been suggested that respiratory muscle dysfunction plays a major role in the development of acute ventilatory failure in patients with chronic obstructive pulmonary disease (COPD). In this study, we devised a respiratory muscle relaxation maneuver using wedge-shaped wooden plates, with which pressure was exerted on the intercostal and accessory respiratory muscles by hand, or by tapping with a wooden hammer, for 15-20 minutes twice a day. The muscle relaxation maneuver was performed in 5 moderate to severe pulmonary emphysema patients for 4 weeks and in 7 emphysema patients for 6 weeks, and the effects on pulmonary function were examined. After the therapy, inspiratory capacity (IC) and vital capacity (VC) in both the 4 weeks-and 6 weeks-treated groups, and the forced expiratory volume in 1 second (FEV 1.0) in the 6 weeks-treated group were significantly increased, and CO2 retention had also improved. Daily peak expiratory flow (PEF) showed significant increases from 2 weeks after the initiation of the therapy. These results suggest that the respiratory muscle relaxation maneuver is effective for improving the pulmonary function of pulmonary emphysema patients.

Photoelectron holography of the si(001) surface

Three-dimensional images of the near-surface atom arrangement were calculated from two-dimensional photoelectron diffraction data by several imaging algorithms: (i) a basic method with a Fourier transformation at one kinetic energy over k space, considering the phase factor due to the path-length difference; (ii) energy summation of the above results; (iii) Fourier transformation within small k-space windows; and (iv) their combinations. Atomic images produced by these methods from the experimental Si 2p photoelectron diffraction patterns of an Si(001) surface are compared with the crystal geometry. The results show that the energy-summed small-window method, called SWEEP, gives the best images.

Modulation of human soleus H reflex in association with voluntary clenching of the teeth

1. To determine the effects of motor activity in the jaw on more general motor behavior, we examined the modulation of the soleus H reflex in association with voluntary clenching of the teeth in healthy adult volunteers. 2. The amplitude of the H reflex increased remarkably during teeth clenching. The increase during maximal teeth clenching was greater than that induced either by maximal voluntary isometric contraction of the wrist extensors or by maximal voluntary clenching of the fists. 3. The increase in amplitude of the soleus H reflex showed a positive correlation with the strength of teeth clenching, as monitored by recording electromyographic (EMG) activity from the masseter muscle. 4. The increase in amplitude of the H reflex associated with teeth clenching started before the onset of the EMG activity of the masseter muscle, reached a peak shortly after the onset, and then declined to a plateau that continued in parallel with the masseter EMG until the end of teeth clenching. 5. The increase in amplitude of the H reflex in association with teeth clenching was partially decreased during the inhibitory masseteric reflex evoked by innocuous electrical stimulation of the lip. 6. It is concluded that the soleus H reflex is facilitated in association with voluntary teeth clenching, and that descending influences from the cerebral cortex, as well as peripheral afferent impulses from the oral-facial region, are involved in this facilitation. It is proposed that oral motor activity can exert strong influences on the motor activity of the other parts of the body.

Case report: mucin-producing cystic neoplasm of the pancreas with onset in childhood

Mucin-producing tumours of the pancreas have been recently reported with increasing frequency and most cases have occurred in middle-aged and elderly people. In the present report, a case of a 21-year-old man with mucinous cystadenoma of the pancreas is reported. He had a long history of recurrent pancreatitis from the age of 8. When he was aged 10, the first branch of the main pancreatic duct was shown to be enlarged on endoscopic retrograde pancreaticography (ERP). A series of ERP studies and computed tomography scans performed over a period of 11 years demonstrated continuing growth of this enlargement of the pancreatic duct. Pancreaticoduodenectomy was performed and the patient has been well without further episodes of acute pancreatitis and has been free of recurrent tumour for 1 year.

Participation of nitric oxide in the sympathetic response to anaphylactic hypotension in anesthetized dogs

The role of nitric oxide (NO) was determined using a NO synthase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME; 20 mg/kg bolus and 0.05 mg/kg per min) in the renal sympathetic and hypotensive response to systemic anaphylaxis induced by Ascaris suum antigen (10 mg, i.v.) in naturally sensitized anesthetized dogs. Renal nerve activity (RNA) in animals pretreated with D-NAME, the biologically inactive enantiomer (n = 7), showed an initial increase (192 +/- 32%, (mean +/- SE) followed by a decrease (61 +/- 14%) after antigen. Pretreatment with L-NAME (n = 7) did not affect the initial sympathoexcitation but abolished the secondary sympathoinhibition (110 +/- 13%). However, the depressor response to antigen was not different between the L-NAME and D-NAME groups (-87 +/- 13 mmHg and -84 +/- 12 mmHg). In conclusion, NO is involved in the anaphylaxis-induced renal sympathoinhibitory response but not hypotension in anesthetized dogs.

Acute hypoxic pulmonary vascular response does not accompany plasma endothelin-1 elevation in subjects susceptible to high altitude pulmonary edema

We have previously shown that high altitude pulmonary edema-susceptible subjects (HAPE-S) have an accentuated pulmonary vascular response to hypoxia. In this study, we investigated the relationship between plasma endothelin-1 (ET-1) levels and the acute hypoxic pulmonary vascular response in HAPE-S and control subjects. In six HAPE-S and seven healthy subjects, we evaluated acceleration time/right ventricular ejection time (AcT/RVET) using Doppler echocardiography, and measured plasma ET-1 levels by radioimmunoassay (RIA) before and after 5 minutes of breathing 10% oxygen. The HAPE-S showed a significantly increased pulmonary vascular response to hypoxia compared with healthy subjects. However, no statistically significant changes of plasma ET-1 levels were observed before and after hypoxia in both groups. We conclude that the increased pulmonary vascular response to acute hypoxia in HAPE-S may not be related to ET-1 release.

[Acute lung injury and chemical mediators]

The essential abnormality in acute lung injury is an increase in pulmonary permeability. The mechanisms involved are complex, and may include direct effects on endothelial cells; the actions of neutrophils, macrophages, and lymphocytes; and chemical mediators generated by these cells. Neutrophils are known to be important in acute lung injury, and the mediators they produce, especially protease and oxidants, may be responsible for endothelial cell injury. We studied the roles of neutrophil elastase and oxygen radicals in acute lung injury by Escherichia coli endotoxin in sheep with lung lymph fistulae. The results of these and other studies indicate that these substances are related to the increase in pulmonary permeability during the late phase of injury.

New chronic pancreatitis model with diabetes induced by cerulein plus stress in rats

To establish a new experimental model of chronic pancreatitis (CP) with diabetes, we investigated pancreatic endocrine function, blood flow, and histopathology in CP induced by repetition of cerulein injection plus water immersion stress in rats. CP rats were treated with water immersion stress for 5 hr and two intraperitoneal injections of 20 micrograms/kg body weight of cerulein once a week for 16 weeks. In the CP group, pancreatic contents of protein, amylase, elastase, and lipase significantly decreased to 64, 38, 23, and 68% of the control group, respectively. In oral glucose tolerance test (glucose 2 g/kg body wt), blood glucose level in the CP group was 212.1 +/- 97.8 mg/dl (mean +/- SD) at 30 min and was significantly higher than the control group (126.3 +/- 15.4 mg/dl)(P < 0.05). Two of seven rats in the CP group showed an obvious diabetic insulin in the CP group was 640.1 +/- 148.7 pM, significantly lower than in the control group (1133.4 +/- 242.0 pM)(P < 0.001). However, insulin content in the pancreas was 12.37 nmol/pancreas). In CP rats, winding and dilatation of surface blood vessels and gland atrophy were evident. Marked fibrosis, fatty changes, and destruction of lobular architecture were also demonstrated microscopically, although the structure of each pancreatic islet was preserved and each islet was fully stained with anti-insulin antibody. In the CP group, pancreatic blood flow by the hydrogen gas-clearance method was 197.6 +/- 33.0 ml/min/100 g, which was significantly less than the control group (276.2 +/- 19.1 ml/min/100 g) (P < 0.001). Thus, we conclude that the CP model induced by cerulein plus stress is a new CP model with diabetes in rats, in which the glucose tolerance was impaired without loss of insulin reserve.

High nitric oxide synthase activity in endothelial cells in ulcerative colitis

Endothelial nitric oxide (NO) synthase, a unique NO synthase (NOS) isoform that is expressed constitutively by the vascular endothelium both in vivo and in vitro, is believed to be essential to systemic and/or local vascular integrity. NOS expression by endothelial cells may indicate vascular activation. We successfully established a simple method for the culture of microvascular endothelial cells from a small amount of tissue and investigated ulcerative colitis (UC), in which condition vascular factors have not been studied extensively. We cultured endothelial cells from the mesenteries of surgical patients with UC and assayed NOS activity by reduced nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase histochemistry. Strong NOS activity was demonstrated in the cells from all UC patients (5/5), whereas no activity was detected in the cells from human umbilical veins and the mesenteries of colon cancer patients (0/10 and 0/5, respectively). This strong NOS activity was not diminished by incubation with a high concentration of glucocorticoid, suggesting that it was constitutive. These results indicate a close relationship of vascular activation (high NOS activity) with the pathogenesis of UC.

Stimulative effects of lead on bone resorption in organ culture

To clarify whether hypercalcemia after injection of Pb to rats is due to biological bone resorption or physicochemical mineral dissolution, the effect of lead (Pb) on release of previously incorporated 45Ca in organ culture was investigated. Pb at 50 microM and above stimulated the release of 45Ca and hydroxyproline (Hyp). Pb did not stimulate 45Ca release from the bones inactivated by freezing and thawing. Eel calcitonin (ECT), bafilomycin A1 and scopadulcic acid B (SDB) inhibited Pb-stimulated 45Ca release. These results indicate that Pb-induced 45Ca release is due to osteoclastic bone resorption. Pb-stimulated bone resorption was inhibited by indomethacin and flurbiprofen. Pb stimulated the release of prostaglandin E2 (PGE2) from the bones into the media. There was significantly high correlation between 45Ca and PGE2 release. Pb-induced bone resorption was inferred to be mediated by PGE2. From these results, it was suggested that hypercalcemia after Pb injection might be caused by biological bone resorption.

Improvement in exercise-induced left ventricular dysfunction by infusion of alpha-human atrial natriuretic peptide in coronary artery disease

The effects of recombinant alpha-human atrial natriuretic peptide (alpha-hANP) infusion an acute left ventricular dysfunction provoked by exercise were examined in 14 men with coronary artery disease. Patients performed symptom-limited, graded exercise on a supine bicycle ergometer. Plasma alpha-hANP and guanosine 3',5'-monophosphate (cyclic GMP) concentrations as well as hemodynamic variables were measured at rest, during and after exercise. In 14 patients whose pulmonary artery wedge pressure was > 20 mm Hg at peak exercise, the same exercise protocol was repeated at 30 minutes after starting intravenous alpha-hANP infusion (0.05 microgram.kg-1.min-1). In 8 of these patients, a Webster thermodilution catheter was advanced into the coronary sinus for measurement of coronary sinus blood flow. From the control exercise test, plasma alpha-hANP concentration increased from 86 +/- 20 pg/ml at rest to 188 +/- 32 pg/ml at peak exercise (p < 0.001), and plasma cyclic GMP concentration increased from 4.8 +/- 1.9 pmol/ml at rest to 7.2 +/- 2.9 pmol/ml at peak exercise (p < 0.001). Both plasma alpha-hANP and cyclic GMP concentrations showed a significant positive correlation with pulmonary artery wedge pressure during control exercise. With alpha-hANP infusion, systolic and diastolic pulmonary artery pressures and pulmonary artery wedge pressure were significantly decreased at all time points during exercise testing. Heart rate was increased and systolic blood pressure was significantly decreased at rest and at 3 minutes of exercise. Diastolic blood pressure, systemic vascular resistance, and pulmonary vascular resistance were significantly decreased at rest.(ABSTRACT TRUNCATED AT 250 WORDS)

Elongation of the side chain of analogs of 1 alpha,25-dihydroxyvitamin D3 prevents osteopenia in a rat model

Five analogs of 1 alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3] [1], 26,27-dimethyl-1 alpha,25-dihydroxyvitamin D3 [1,25(OH)2(Me)2D3] [2], 26,27-dimethyl-1 alpha,25-dihydroxyvitamin D3 [1,25(OH)2(Et)2D3] [3], 26,27-dipropyl-1 alpha,25-dihydroxyvitamin D3 [1,25(OH)2(Pr)2D3] [4], 26,27-dimethyl-24,24-difluoro-1 alpha,25-dihydroxyvitamin D3 [24F2-1,25(OH)2(Me)2D3], and [5] 24a-homo-24,24-difluoro-1 alpha,25- dihydroxyvitamin D3 [24aF2-homo-1,25(OH)2D3] were investigated to clarify the possibility that prevents osteopenia induced in rats by ovariectomy and sciatic neurotomy. The objective of our studies was to determine whether these analogs may be effective for treatment of subjects with osteoporosis. 1,25(OH)2(Me)2D3, 24F2-1,25(OH)2(Me)2D3, and 24aF2-homo-1,25(OH)2D3 prevented decreases in bone mineral density (BMD) of the femur, as measured by dual energy X-ray absorptiometry (DXA). The potency of 1,25(OH)2(Me)2D3 in this test was higher than that of 1,25(OH)2D3. The potencies of 24F2-1,25(OH)2(Me)2D3 and 24aF2-homo-1,25(OH)2D3 were similar to that of 1,25(OH)2D3. On the other hand, though 1,25(OH)2(Et)2D3 and 1,25(OH)2(Pr)2D3 had a preventive effect on the decrease in BMD, the potency of two analogs was lower than that of 1,25(OH)2D3. Decreases in cortical and trabecular bone areas of the femur were prevented by three analogs of 1,25(OH)2D3, 1,25(OH)2(Me)2D3, 24F2-1,25(OH)2(Me)2D3, and 24aF2-homo-1,25(OH)2D3. Serum calcium (Ca) concentration was elevated at the last administration of three analogs of 1,25(OH)2D3, 1,25(OH)2(Me)2D3, 24F2-1,25(OH)2-(Me)2D3 and 24aF2-homo-1,25(OH)2D3.(ABSTRACT TRUNCATED AT 250 WORDS)

Left ventricular performance during exercise testing in patients with silent and symptomatic myocardial ischemia

We compared cardiohemodynamic response to dynamic exercise in 32 patients with exercise-induced silent or symptomatic myocardial ischemia. All patients had coronary artery disease without prior myocardial infarction and left ventricular hypertrophy. Patients underwent supine leg-exercise testing and received right heart catheterization. All patients exhibited ischemic ST-segment depression on electrocardiogram during exercise testing. They were classified retrospectively into two groups according to the absence (n = 10, group 1) or presence (n = 22, group 2) of chest pain induced by exercise. There was no significant difference between groups in the magnitude of peak ST-segment depression. Pulmonary artery wedge pressure at peak exercise was significantly lower (p < 0.01), and the cardiac index was significantly higher (p < 0.01), in group 1 versus group 2. Our results indicate that exercise-induced left ventricular dysfunction is less severe in patients with silent myocardial ischemia than in those with symptomatic ischemia.