High-performance liquid chromatography-fluorescence determination of dinitropyrenes in soil after column chromatographic clean-up and on-line reduction

In order to quantify 1,3-dinitropyrene (DNP), 1,6-DNP and 1,8-DNP in soil, we developed an efficient clean-up procedure and a sensitive determination method using fluorescence detection. DNP isomers were efficiently cleaned by three stages of fractionation, i.e., a silica gel open column chromatography using stepwise elution and two further purification steps by high-performance liquid chromatography (PPLC) using a monomeric-type octadecylsilyl (ODS) column and a polymeric-type ODS column. The recoveries of DNPs during the whole clean-up process were 94% or more. The fraction corresponding to DNPs was injected into an analytical polymeric-type ODS column for HPLC to separate DNP isomers. The effluent from the analytical ODS column was directly introduced to a catalyst column, which was packed with 5 microns alumina coated with platinum and rhodium (Pt-Rh), in order to reduce DNPs to diamino compounds, and then the fluorescence of diaminopyrenes was detected. The immediate detection of diaminopyrene isomers after on-line reduction afforded a sensitive detection of DNP isomers. The detection limits for DNPs were in the range of 0.7 to 4 pg. These developed methods were applied to four soil samples collected at parks in residential areas.

[A case of atypical Miller Fisher syndrome associated with antiphospholipid antibodies]

We report a 56-year-old man with external ophthalmoplegia and ataxic gait following a diarrhea, being diagnosed atypical Miller Fisher syndrome (FS). On admission, he had severe diplopia and bilateral external ophthalmoplegia were observed. The deep tendon reflexes were decreased on the right upper extremity. He could not walk straight and his tandem gait was impaired. Serum IgG anticardiolipin antibody (aCL) and APTT-lupus anticoagulant (LA) were found to be increased. The serum of the patient had low titer of anti-GQ 1 b and anti-GM 1 antibodies. After the first immunoadsorption therapy, his ophthalmoplegia was improved moderately, but peripheral facial palsy appeared. He was treated with immunoadsorption again, then all neurologic symptoms improved and a follow-up study revealed normalized aCL and LA titers. There have been no previous reports of FS associated with antiphospholipid antibody. The low titer of serum anti-GQ1b and anti-GM 1 antibodies in this patient suggests that the antiphospholipid antibodies, such as aCL and LA, may be linked to the pathogenesis of FS.

Severe juvenile retinoschisis associated with a 33-bps deletion in XLRS1 gene

X-linked juvenile retinoschisis is a form of vitreoretinal dystrophy that is characterized by foveal and peripheral splitting of the retinal nerve fiber layer. Pathognomonic of this disorder is a microcystic radiate appearance in the fovea. We encountered a 10 year-old, mildly retarded, Japanese boy, who exhibited a widely extended macular retinoschisis bilaterally. A break in the inner layer of the left eye mimicked a lamellar macular hole, which is a rare manifestation of the disease. Peripheral retinoschisis was absent. Only a few reports have described marked bilateral macular retinoschisis that involved entire posterior pole, while various other macular findings have been reported. This patient with a severe form of retinoschisis was found to harbor the deletion of 33 base pairs, including the boundary region of exon 3 and intron 3 in the XLRS1 gene.

Clinical usefulness of conjugated bilirubin levels in patients with acute liver diseases

We used a specific method to measure conjugated bilirubin levels in patients with acute liver diseases to examine its clinical usefulness. Conjugated and total bilirubin levels were measured in 102 samples obtained from six patients with acute liver diseases (three with fulminant hepatic failure, one with acute severe hepatitis and two with acute hepatitis; see text for criteria). Total and conjugated bilirubin levels were measured with Iatro T (total)-Bil and D (direct)-Bil kits (Iatron Laboratories Tokyo, Japan) and with conventional Nescauto T(total)-Bil and D(direct)-Bil VE kits (Nippor Shoji, Osaka, Japan). The Iatro D-Bil kit measures conjugated bilirubin correctly, while the Nescauto D-Bil VE kit measures some nonconjugated bilirubin and delta bilirubin as well as conjugated bilirubin. Total bilirubin levels determined by the two methods showed good correlation. The conjugated bilirubin level measured with the Iatro D-Bil kit was strongly correlated with the direct bilirubin level measured with the Nescauto D-Bil VE kit, but there was no correlation between the conjugated-to-total bilirubin ratio and the direct-to-total bilirubin ratio. When we examined the changes in bilirubin levels in our patients with respect to outcome, we found that the two patients in whom the ratio of conjugated-to-total bilirubin exceeded 0.3 died, while all four patients in whom the ratio remained below 0.3 survived. The ratio of direct-to-total bilirubin was unrelated to outcome. The conjugated bilirubin level measured with the Iatro kits was therefore considered useful for the diagnosis and follow-up of acute liver diseases.

Identification of 1,6- and 1,8-dinitropyrene isomers as major mutagens in organic extracts of soil from Osaka, Japan

The organic extracts of soil collected at parks in residential areas in Osaka and neighboring cities in the Kansai area, Japan, showed mutagenicity in Salmonella typhimurium strain TA98 in the presence or absence of a mammalian metabolic activation system (S9 mix). The soil extracts from Ibaraki and two different sites in Osaka, i.e., Sumiyoshi-ku and Minato-ku, were mutagenic in strain TA100 as well as in strain TA98. Direct-acting mutagenicity of soil extracts from Sumiyoshi-ku and Minato-ku toward strain TA98 were 66 or more times higher than that of the other cities. Both extracts exerted stronger mutagenicity in strains YG1021 and YG1024 than TA98 and TA100, and the potency was especially high in strain YG1024: Sumiyoshi-ku, 153 000 revertants/g of soil; and Minato-ku, 246 000 revertants/g of soil. Two mutagenic compounds (I and II) were isolated from the Soxhlet extract of soil from the park in Sumiyoshi-ku by repetitive separation using normal-phase and reversed-phase column chromatography. By comparing the mass and UV spectra and retention times for HPLC on two individual ODS columns of compounds I and II with those of authentic chemicals, we identified these two compounds as 1,6- and 1,8-dinitropyrene (DNPy) isomers. Amounts of DNPy isomers in soil from Sumiyoshi-ku and Minato-ku were 1.7-2.2 ng/g. Forty-three percent and 40% of the mutagenicity of soil from Sumiyoshi-ku and Minato-ku could be attributed to these DNPy isomers, respectively.

Photosensitive seizures provoked while viewing "pocket monsters," a made-for-television animation program in Japan

PURPOSE

To describe the recent epidemic of photosensitive seizure that occurred in relation to an episode of the television animation program "Pocket Monsters," we report four patients who experienced seizures while watching the episode in question. We also report some technical aspects of the program episode.

METHODS

We investigated the clinical symptoms of the four patients and performed routine EEGs with intermittent photic stimulation (IPS). If IPS provoked no photoparoxysmal response (PPR) during the routine EEG examination, a second EEG was performed with the photic stimulator placed 10 cm from the patient's eyes. In addition, we reviewed the "Pocket Monsters" episode, focusing our attention on the visual techniques used with reference to the Independent Television Commission (ITC) guidelines.

RESULTS

One patient who had myoclonic jerks before the convulsion in question was diagnosed as having juvenile myoclonic epilepsy, and the diagnosis of another patient was pure photosensitive epilepsy. The remaining two patients had their first seizures, which could be occasional seizures, and we therefore could not reach a diagnosis of epilepsy. In our four patients, only one showed PPR on the routine EEG. Two patients revealed PPR on the second EEG, and the remaining patient showed no PPR. Rapid changes in color are believed to be responsible for the photosensitive seizures because all four patients had seizures at around 18:50, when seconds of deep red and bright blue flashes, alternating at a frequency of 12 Hz, were shown.

CONCLUSIONS

Regulations for technical aspects of children's programming, including the use of colors, are urgently needed in Japan to prevent a repeated incident. In addition, the IPS procedure needs to be standardized, especially for patients who are suspected to have photosensitivity.

Stevens-Johnson syndrome caused by a health drink (Eberu) containing ophiopogonis tuber

Stevens-Johnson syndrome is considered to be a severe type of erythema exsudativum multiforme. It is characterized by erythema with bullous and eroded lesions of skin and mucous membranes. We report a case of Steven-Johnson syndrome following consumption of a health drink containing ophiopogonis tuber. A 66-year-old female took an O.T.C. health drink for fever. The next morning, she noted erythema and swelling of her face, neck, and chest. She started to develop bullous and eroded lesions on the skin of her entire body and the mucous membranes of her oral cavity, conjunctiva, and cornea, and she became feverish. She had high degrees of corneal erosion and liver dysfunction. Skin biopsy showed diffuse necrosis of the epidermis. After admission to the hospital, steroid pulse therapy (1000 mg/day of methylprednisolone sodium succinate) was continued for 5 days. The health drink induced a positive drug lymphocyte stimulation test (DLST) and patch test. A challenge test was done with a one hundredth dose, and it was positive. We did patch tests with all components of the drink and found that Mai-Meu-Dong-Tang (ophiopogonis) alone was positive at 72 hours. There is no previous report of Stevens-Johnson syndrome caused by a health drink or Mai-Meu-Dong-Tang. Even though it is a health drink, we should be aware of the possibility of a severe reaction.

Genetic analysis enables definite and rapid diagnosis of cerebrotendinous xanthomatosis

Mutations in the sterol 27-hydroxylase gene (CYP27) cause cerebrotendinous xanthomatosis (CTX). Early diagnosis of CTX is crucial because treatment with chenodeoxycholic acid can prevent or reverse some of the neurologic disability associated with the disease. We report the identification of three types of mutations (Arg441Trp, Arg372Gln, and Arg441Gln) in the CYP27 gene in five patients with suspected CTX from four unrelated families by restriction endonuclease analysis.

Enhancement of nitroxide-reducing activity in rats after chronic administration of vitamin E, vitamin C, and idebenone examined by an in vivo electron spin resonance technique

Rats were given vitamin E (Vit-E), idebenone (ID), or vitamin C (Vit-C) in their food for 2 or 4 weeks. After feeding, the ability of rats to reduce 4-hydroxy-2,2,6,6-tetramethylpiperidine-1-oxyl (Tempol) in terms of the half-life of Tempol was examined as a specific marker. Tempol was repeatedly injected intravenously, and its half-life was serially evaluated by an in vivo electron spin resonance (ESR) technique. The radical-reducing ability in rats was enhanced differently by Vit-E, ID, and Vit-C, i.e., slow onset of the ability after Vit-E and ID (lipid-soluble antioxidants) and fast onset after Vit-C (a water-soluble antioxidant).

A pilot study of dehydroepiandrosterone sulfate in myotonic dystrophy

We studied the effect of i.v. administration of a dehydroepiandrosterone sulfate (DHEAS) preparation (200 mg/day for 8 weeks) in 11 patients with myotonic dystrophy (MyD). After DHEAS, activities of daily living improved, muscle strength increased, and myotonia decreased. Conduction block and premature beats also improved in the four patients with cardiac involvement. This pilot study may provide a rationale for a controlled study of DHEAS in MyD.

Isolation and characterization of a cytokinin up-regulated gene from tobacco mesophyll protoplasts

We have isolated a cytokinin up-regulated cDNA clone, H13, from an early stage of cultured tobacco mesophyll protoplasts by a differential display method. The expression of this gene was specifically induced by natural and synthetic cytokinins including N-(2-chloro-4-pyridyl)-N'-phenylurea (4PU30), a diphenylurea-type cytokinin, although the simultaneous presence of auxin was also required. It seems that the preceding treatment of the tobacco mesophyll protoplasts by auxin is necessary for the gene to respond to cytokinin. The addition of a cytokinin antagonist, compound 182, which suppressed the induction of cell division in tobacco mesophyll protoplasts, completely abolished the expression of this gene. Though the predicted gene product of H13 did not suggest us any sequences of defined functions, two domains of the predicted sequence had significant homology to several reported sequences in the data base. The gene product of H13 is proposed to have a role in regenerating cell wall in cultured protoplasts, since a cDNA clone E6, from cotton fiber cells, which has the most closely related structure to H13, has been isolated from cells which showed active cellulose synthesis. This supposition is supported by the evidence that in the absence of cytokinin, cell wall regeneration was significantly suppressed, resulting in failure of the induction of cell division. Thus, the gene product of H13 is supposed to have a role in regenerating cell walls and facilitating the progression of the cell cycle, resulting in the sustained cell division of tobacco mesophyll protoplasts.

E2F3 activity is regulated during the cell cycle and is required for the induction of S phase

Previous work has demonstrated the important role of E2F transcription activity in the induction of S phase during the transition from quiescence to proliferation. In addition to the E2F-dependent activation of a number of genes encoding DNA replication activities such as DNA Pol alpha, we now show that the majority of genes encoding initiation proteins, including Cdc6 and the Mcm proteins, are activated following the stimulation of cell growth and are regulated by E2F. The transcription of a subset of these genes, which includes Cdc6, cyclin E, and cdk2, is also regulated during the cell cycle. Moreover, whereas overall E2F DNA-binding activity accumulates during the initial G1 following a growth stimulus, only E2F3-binding activity reaccumulates at subsequent G1/S transitions, coincident with the expression of the cell-cycle-regulated subset of E2F-target genes. Finally, we show that immunodepletion of E2F3 activity inhibits the induction of S phase in proliferating cells. We propose that E2F3 activity plays an important role during the cell cycle of proliferating cells, controlling the expression of genes whose products are rate limiting for initiation of DNA replication, thereby imparting a more dramatic control of entry into S phase than would otherwise be achieved by post-transcriptional control alone.

Paradoxically shortened QT interval after a prolonged pause

We analyzed Holter ECG recordings in 15 patients with episodes of prolonged RR intervals > 2.5 seconds. In 13 patients, the QT interval showed a linear prolongation when RR interval was < 1.5 seconds and became relatively flat at longer RR intervals. In the remaining two patients, the QT and RR intervals were correlated within physiological range of RR intervals. However, at longer RR intervals, the QT interval was unexpectedly shortened and constant. The paradoxically shortened QT interval observed in the present 2 cases may indicate an abnormal adaptation of repolarization time to an abrupt increase in the preceding RR intervals.

A case of hemolytic uremic syndrome associated with emphysematous cholecystitis and a liver abscess

Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Most cases of HUS are characterized by a prodromal phase of diarrhea and melena, and affect mainly children. Here we report a unique case of adult-onset HUS that was associated with emphysematous cholecystitis and a liver abscess. The patient did not suffer from diarrhea or melena on admission, but abdominal CT scans revealed emphysematous cholecystitis and a liver abscess. Cholecystectomy was performed and the liver abscess was drained. Cultures of the bile and liver abscess contents were negative, but the serum samples had antibodies against Escherichia coli (E. coli) O157. The patient was anuric for 14 days, and underwent hemodialysis that was repeated 15 times and plasma exchanges 6 times. She recovered from acute renal failure but with inadequate urinary concentrating ability as a sequela. Histopathological examination of renal biopsy specimens on the 83rd hospital day revealed almost normal glomeruli and patchy atrophy of tubules with an increase of interstitium. This is a very rare case of HUS associated with emphysematous cholecystitis and a liver abscess successfully treated with aggressive supportive care. It is possible that an infection with verotoxin-producing E. coli O157 caused the disease.

Postrest shortening of the action potential duration in rabbits: in vitro and in vivo correlation

Previous evidence has shown that the action potential duration of rabbit ventricular muscle cells shortens after a rest period (postrest shortening). However, there has not been much research on postrest shortening in the intact heart. We recorded transmembrane action potentials (TAPs) of isolated papillary muscle from rabbit ventricle with glass microelectrodes and monophasic action potentials (MAPs) of the rabbit left ventricular endocardium with contact electrodes. In the in vitro experiments, repetitive regular stimuli (S1) at a cycle length of 1 sec were followed by a single extrastimulus (S2) at coupling intervals (S1S2) ranging between 0.5 sec and 8 sec. The increase in the S1S2 interval resulted in a progressive shortening of the duration of TAP elicited by the S2, which was abolished by the simultaneous application of 1 mmol/L 4-aminopyridine and 2 micromol/L ryanodine. In the in vivo experiments, regular right ventricular pacing (S1) at a cycle length of 0.35 sec was followed by a single extrastimulus (S2) with coupling intervals (S1S2) ranging between 0.25 sec and 3 sec. The increase in the S1S2 interval also resulted in a progressive shortening of the duration of MAP elicited by the S2. This is the first report to demonstrate postrest shortening in the intact heart, which probably occurs because of a mechanism analogous to that observed in the isolated ventricular muscle.

Case report: Alanine aminotransferase deficiency detected in a patient with chronic hepatitis C

We report a case of alanine aminotransferase (ALT) deficiency in a 68-year-old Japanese female with chronic hepatitis C. The serum was positive for antibody to hepatitis C virus (HCV) and HCV-RNA. Liver biopsy showed histological evidence of chronic active hepatitis. The level of serum aspartate aminotransferase (sAST) was elevated, but sALT was extremely low. The patient was followed up for her serum aminotransferase levels for 1.5 years under the treatment with ursodeoxycholic acid. The low sALT level persisted during all the follow-up period. The ALT activity in liver tissue was also decreased. Based on these findings, ALT deficiency was suspected. sALT activity was also found to be low in her two sons. This latter finding suggests the hereditary character of this abnormality.

Circadian rhythm of the signal averaged electrocardiogram and its relation to heart rate variability in healthy subjects

OBJECTIVE

To examine the circadian variation in the signal averaged electrocardiogram (saECG) and heart rate variability and investigate their relations in healthy subjects.

METHODS

24 hour ECGs were obtained with a three channel recorder using bipolar X, Y, and Z leads in 20 healthy subjects. The following variables were determined hourly: heart rate, filtered QRS (f-QRS) duration, low and high frequency components of heart rate variability (LF and HF), and the LF/HF ratio.

RESULTS

Heart rate, f-QRS duration, HF, and the LF/HF ratio showed significant circadian rhythms, as determined by the single cosinor method. Heart rate and the LF/HF ratio increased during daytime, and f-QRS duration and HF increased at night. f-QRS duration was negatively correlated with heart rate (r = 0.95, p < 0.001) and the LF/HF ratio (r = 0.94, p < 0.001) and positively with HF (r = 0.93, p < 0.001).

CONCLUSIONS

f-QRS duration has a significant circadian rhythm in healthy subjects and is closely related to the circadian rhythm of autonomic tone.

[Aqueous levels of eosinophil cationic protein and major basic protein in patients with retinal detachment associated with atopic dermatitis]

We measured the aqueous levels of eosinophil cationic protein (ECP) and major basic protein (MBP) to investigate a possible relationship between cytotoxic eosinophil granule proteins and retinal detachment (RD) in patients with atopic dermatitis. While aqueous ECP was detected in only 1 of 15 cases of RD associated with atopic dermatitis, aqueous MBP was detected in 6 of 14 cases (42.9%). 11 cases of RD without atopic dermatitis were also studied, but neither ECP nor MBP was detected. Although the role of aqueous ECP and MBP was not elucidated, the results indicate that cytotoxic eosinophil granule proteins, especially MBP, are present in aqueous humor in certain cases of RD associated with atopic dermatitis.

Signal-averaged electrocardiogram shows a heart rate dependent diurnal variation in healthy subjects

It has not been determined if signal-averaged electrocardiograms (SAECGs) have a diurnal variation. We recorded 3-channel 24-hour ECGs in 30 healthy volunteers and calculated the following parameters for the first 500 sec of every hour over the 24-hour period: the mean heart rate, the filtered QRS duration (f-QRS), the root-mean-square voltage of the signals in the last 40 msec of the QRS (RMS40), and the duration of low-amplitude signals (< 40 microV) in the terminal portion of the QRS (LAS40). Heart rate and RMS40 increased in the daytime compared with the nighttime; f-QRS and LAS40 increased during the nighttime hours. The f-QRS and LAS40 were negatively correlated with heart rate in all and 22 (73%) of 30 subjects, respectively, and RMS40 was positively correlated with heart rate in 21 subjects (70%). In conclusion, SAECGs exhibit a clear diurnal variation in healthy subjects, which is closely related to changes in heart rate.

Dynamics of QT interval in a patient with long QT syndrome and a normal QT interval

A case report of a 15-year-old girl who experienced syncope and torsades de pointes is presented. The girl had a normal QT interval (QTc=0.37 sec) on the resting electrocardiogram (ECG). Infusion of isoproterenol induced QT prolongation (QTc=0.62 sec) and frequent occurrence of multiform ventricular premature beats. Her Holter ECG showed a prolongation of the QTc interval with a shortening of the RR interval. Low-frequency power (LF) and high-frequency power (HF) of heart rate variability were evaluated from the Holter ECG. The patient showed a statistically significant negative QTc/HF and a significant positive QTc/(LF/HF) relationship, whereas none of the age- and sex-matched healthy subjects showed these relationships. The slope of the QT/RR relationship for the patient was below the lower limit of the normal range. This report describes the unusual relationship of QT interval to RR interval and heart rate variability in a long QT syndrome patient with a normal QT interval on resting ECG.

[Acute renal failure in non-fulminant acute hepatitis without hepatitis A, B or C virus infection]

Here, we report a 35-year-old man with non-fulminant acute non A, non B, non C hepatitis which developed into acute renal failure. The patient was admitted to hospital with the chief complaints of general fatigue, nausea and a high-grade fever of 40 degrees C. Laboratory examination revealed severe liver dysfunction and renal insufficiency on admission: his serum glutamic oxaloacetic transaminase was 3.203 IU/ml, serum glutamic pyruvic transaminase was 3.825 IU/ml, lactic dehydrogenase was 2.840 IU/ml, blood urea nitrogen was 65 mg/dl, and creatinine was 7.6 mg/dl. Hemodialysis was conducted during the initial 19-day period after admission because anuria was manifested on admission. On the 36th day after onset, renal functions returned to normal and the patient was negative for IgM-HA antibody. HBs antigen, IgM-HBC antibody, HCV antibody, cytomegalovirus antibody, and Epstein-Barr virus antibody. However, liver biopsy for histological examination on the 44th day after onset revealed no specific findings except the healing stage of acute hepatitis. Renal biopsy on the 49th day showed the healing stage of acute tubular necrosis without any glomerular change. It has been infrequently reported that acute renal failure develops following a non-fulminant acute state without hepatitis A, B or C virus infection. It is necessary to take acute renal failure into account in the clinical course of non-fulminant non A, non B, non C hepatitis.