Plasmodium coatneyi-infected rhesus monkeys: a primate model for human cerebral malaria

Although several animal models for human cerebral malaria have been proposed in the past, none have shown pathological findings that are similar to those seen in humans. In order to develop an animal model for human cerebral malaria, we studied the pathology of brains of Plasmodium coatneyi (primate malaria parasite)-infected rhesus monkeys. Our study demonstrated parasitized erythrocyte (PRBC) sequestration and cytoadherence of knobs on PRBC to endothelial cells in cerebral microvessels of these monkeys. This is similar to the findings seen in human cerebral malaria. Cerebral microvessels with sequestered PRBC were shown by immunohistochemistry to possess CD36, TSP and ICAM-1. These proteins were not evident in cerebral microvessels of uninfected control monkeys. Our study indicates, for the first time, that rhesus monkeys infected with P. coatneyi can be used as a primate model to study human cerebral malaria.

Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution

BACKGROUND

In view of the popular acceptance of the adenoma-carcinoma sequence, endoscopic polypectomy is indicated for the removal of colorectal adenomas. Larger or sessile lesions should be removed by an experienced endoscopist, but complications such as hemorrhage and perforation still may occur.

METHODS

To render the removal of sessile lesions feasible by endoscopic polypectomy and to reduce the risk of complications, we attempted local submucosal injection of hypertonic saline-epinephrine solution [(HSE) a mixture of 4.7% sodium chloride and 0.005% epinephrine] before electrosurgical snare excision; 0.5-2 ml HSE were injected into the base and immediate vicinity of polyps to produce mucosal bulging.

RESULTS

Between August 1990 and April 1992, 645 polyps in 403 patients were removed by this method; sessile lesions could be more readily removed. Of these, 17 (2.6%) revealed invasive carcinoma and 19 (3.0%) carcinoma in situ. The largest sessile polyp removed was 40 mm in diameter and 7 mm in height and contained a carcinoma in situ. Even a 6-mm depressed adenoma and two rectal carcinoid tumors could be excised completely. No serious complications were encountered with this method.

CONCLUSION

We conclude that local injection of HSE makes the endoscopic removal of colorectal polyps much easier and safer.

Formulation of inactivated influenza vaccines for providing effective cross-protection by intranasal vaccination in mice

Attempts were made to formulate an inactivated influenza vaccine to provide effective cross-protection by intranasal vaccination in mice. Mice were immunized with a nasal site-restricted volume of various HA vaccines (split-product virus vaccines), prepared from some of the H1N1 subtype viruses which circulated in humans from 1934 to 1986, together with cholera toxin B subunit (CTB) as an adjuvant. Four weeks later, they were challenged intranasally with a lethal dose of the earliest H1N1 virus strain, A/PR/8/34 (PR8) or the latest virus strain, A/Yamagata/120/86 (Yamagata/86). The adjuvant-combined vaccines, prepared from drift H1N1 viruses, A/Kumamoto/37/79 and A/Bangkok/10/83, provided a higher degree of cross-protection against a challenge with Yamagata/86 than with PR8. A booster with another drift virus vaccine given 4 weeks after the primary vaccination increased the protection against Yamagata/86; the effect was higher when mice were vaccinated with a later strain as the second antigen than when boosted with PR8. These results suggest that vaccination with a later virus strain followed by another later strain in a two-dose nasal vaccination regimen gives effective cross-protection against the current epidemic virus strains.

Lipoprotein analysis in transgenic mice expressing human apolipoprotein (apo) A-I and apo C III: use of micromethods in analysis of lipoprotein system in mice

Transgenic animal technology has added a new dimension to the study of lipoprotein physiology. The unique advantage of the technology is that the exact physiological role (s) of a gene and the corresponding protein whose function (s) has been undefined may be revealed in vivo by the expression or inactivation of the expression of the gene. Although mice are most frequently used transgenic animals, the lipoprotein system has not been studies extensively. This report primarily focuses on practical applications of the existing laboratory methods to transgenic mice expressing human apoproteins. Described below is the summary of the results obtained from transgenic mice expressing human apo A-I and apo C III. In one line of transgenic mice expressing human apo A-I, the total plasma apo A-I level (mouse plus human) was higher than that in control (mean +/- SEM, 381 +/- 18 vs. 153 +/- 7 mg/dl, n = 6, respectively, p = 0.0001) with 64% increase in the HDL cholesterol (HDL-C) level (90 +/- 3 vs. 55 +/- 5 mg/dl, p = 0.0001). High fat feeding further increased the apo A-I and HDL-C levels. One line of apo C III transgenic mice with approximately 100 copies of human apo C III gene were severely hypertriglyceridemic compared to negative littermates (mean +/- SEM; 959 +/- 217 vs. 49 +/- 6 mg/dl). In a second line, animals with one to two copies of the human apo C III gene manifested mild hypertriglyceridemia. These experiments revealed for the first time in vivo that overexpression of apo A-I and C III could lead respectively to hyperalphalipoproteinemia and hypertriglyceridemia and may suggest possible etiology for these disorders in human.

Characterization of diazepam-insensitive [3H]Ro 15-4513 binding in rodent brain and cultured cerebellar neuronal cells

Experiments were performed to characterize diazepam-insensitive [3H]Ro 15-4513 binding sites in discrete regions of rodent brain and cultured rat cerebellar granule cells. Scatchard analysis of [3H]Ro 15-4513 binding in the presence of 10 microM diazepam revealed that diazepam-insensitive binding sites in the rat brain were most abundant in the cerebellum, followed by the hippocampus, cerebral cortex and olfactory bulb. Diazepam-insensitive sites represented approximately 80% of the total [3H]Ro 15-4513 binding sites in the membranes of cultured rat cerebellar granule cells. The Bmax values for total [3H]Ro 15-4513 and [35S]TBPS are almost identical, and 5-6 times larger than that for [3H]diazepam in this preparation. Although some annelated [1,5-a]benzodiazepine analogues such as Ro 15-4513, ro 16-6028, flumazenil and Ro 15-3505, and an imidazothieno-diazepine, Ro 19-4603, showed high affinity for cortical and cerebellar diazepam-insensitive sites, all the annelated benzodiazepine compounds tested showed higher affinity for cerebellar diazepam-insensitive sites than cortical ones. In contrast, a pyrazoloquinoline compound, CGS 8216, and beta-carboline analogues such as beta-carboline-3-carboxylate ethyl ester (beta-CCE) and beta-carboline-3-carboxylate methyl ester (beta-CCM) exhibited higher affinity for cortical than cerebellar sites. These results suggest that diazepam-insensitive sites are heterogeneous in brain areas with respect to ligand specificity.

Effects of epithelial cell supernatant on membrane potential and contraction of dog airway smooth muscles

We investigated the effects of cultured epithelial cells and supernatants on resting membrane potential and excitatory neuroeffector transmission in smooth muscle cells of dog trachea and bronchioles. The mean resting membrane potential of the mucosa-free tracheal smooth muscle cells was -59.5 +/- 1.5 mV (+/- SD). Application of cultured epithelial cells (> 2.5 x 10(5) cells/ml) hyperpolarized the membrane, resulting in a potential of -64.5 +/- 1.7 mV. The supernatant of the cultured epithelial cells also increased the resting membrane potential of the mucosa-free tracheal smooth muscle cells by 4 to 9 mV. These hyperpolarizing actions were not modified by indomethacin (10(-5) M), l-NG-nitroarginine (10(-5) M), or oxyhemoglobin (10(-5) M), but were inhibited by glibenclamide (10(-6) M). The supernatants of the cultured epithelial cells completely or partially suppressed the contractile response of epithelium-denuded bronchioles to electrical field stimulations and suppressed the amplitude of excitatory junction potentials of the trachealis evoked by electrical field stimulations. Indomethacin prevented the inhibitory effect of supernatants on the amplitude of twitch contractions and excitatory junction potentials and markedly suppressed supernatant-associated inhibition of the excitatory neuroeffector transmission. Furthermore, indomethacin with AA861, a lipoxygenase inhibitor, completely suppressed this effect. Our findings suggest that cultured airway epithelial cells spontaneously release at least two factors. One factor selectively modulates the resting membrane potential, and the other inhibits the excitatory neuroeffector transmission.

HN proteins of human parainfluenza type 4A virus expressed in cell lines transfected with a cloned cDNA have an ability to induce interferon in mouse spleen cells

Primary monkey kidney cells infected with human parainfluenza type 4A virus (HPIV-4A) were treated with various concentrations of formaldehyde. Formaldehyde (0.275%) treatment completely blocked virus production. However, when mouse spleen cells were cocultured with the fixed virus-infected cells, interferon was produced in the culture fluid. On the other hand, when mouse spleen cells were incubated with the fixed virus-infected cells in the presence of anti-HPIV-4A antiserum or a mixture of anti-HN protein monoclonal antibodies, interferon activity could scarcely be detected in the culture fluid. These findings indicated that the fixed virus-infected cells had an ability to induce interferon in mouse spleen cells and that the HN protein was related to interferon induction. Subsequently, a recombinant plasmid was constructed by inserting the cDNA of the HN gene of HPIV-4A into a pcDL-SR alpha expression vector. Mouse spleen cells produced interferon when cocultured with COS7 cells transfected with the recombinant plasmid, but did not when cocultured with COS7 cells transfected with the vector alone. Furthermore, we established HeLa cells constitutively expressing HPIV-4A HN (HeLa-4aHN cells) or F protein (HeLa-4aF cells). Type I (alpha/beta) interferon was detected in culture fluids of mouse spleen cells with HeLa-4aHN cells, but was not detected in those with HeLa-4aF cells. Therefore, it was concluded that the HN glycoproteins on the cell surface were sufficient for interferon induction to occur.

[Infection in genitourinary cancer patients during cancer chemotherapy]

To examine the frequency and the type of infection during cancer chemotherapy in the urological field, we studied the causes of fever in 67 patients with genitourinary cancer. Twenty-six patients had developed a fever of higher than 38 degrees C. Although fever without proven infection was seen in 11 patients (42.3%), fever caused by pyelonephritis was the most common infection. There was a relationship between fever and the presence of hydronephrosis. Fever was observed more often in patients with a leucocyte count of less than 2,000 white blood cell/mm3. In conclusion, we recommend the interruption of cancer chemotherapy or the use of granulocyte colony-stimulating factor for the prevention of infection, when the leukocyte count is less than 2,000 cell/mm3, especially in patients with hydronephrosis.

Significance of hepatocellular proliferation in the development of hepatocellular carcinoma from anti-hepatitis C virus-positive cirrhotic patients

BACKGROUND

There is a hypothesis explaining the pathogenesis of carcinoma that increased proliferation of tissue cells correlates with the development of carcinoma, presumably by increased rate of random mutations and by promotion. In this study, the significance of hepatocellular proliferation in the development of human hepatocellular carcinoma (HCC) from anti-hepatitis C virus (HCV)-positive cirrhotic patients was studied.

METHODS

Twenty-eight Child A cirrhotic patients who were anti-HCV (C-100 antibody) positive were studied. At the beginning of the study, the in vitro uptake of bromodeoxyuridine (BrdU, a thymidine analogue) by hepatocytes in biopsied liver specimens was investigated as labeling indices (LIs), and they were divided into high-DNA synthetic (BrdU LI > or = 1.5%) and low-DNA synthetic (BrdU LI < 1.5%) groups. The patients were then surveyed prospectively with frequent ultrasonography (every 3 months) for the development of HCC for 3 years.

RESULTS

The mean BrdU LI plus or minus standard deviation for 14 cirrhotic patients with high-DNA synthesis activity (BrdU LI > or = 1.5%) was 2.7 +/- 0.8%, and this was significantly (P < 0.001) higher than that for 14 cirrhotic patients with low-DNA synthesis activity (BrdU LI < 1.5%, 0.5 +/- 0.3%). Nine of 14 (64.3%) of the cirrhotic patients with high-DNA synthesis activity developed HCC in the 3-year period, in contrast to only 2 of 14 (14.3%) of the cirrhotic patients with low-DNA synthesis activity P < 0.05).

Functional innervation of bovine ophthalmic artery

To investigate the functional innervation pattern in smooth muscle of bovine ophthalmic artery, we studied the effect of electrical stimulation and various drugs on the mechanical responses of this muscle using isometric tension recording methods. Electrical stimulation evoked phasic contractions which were abolished by guanethidine and tetrodotoxin (TTX), suggesting that the responses were neurogenic in origin. Phentolamine (10(-5) M) and 10(-5) M timolol did not affect this contractions, but 10(-5) M phentolamine and 10(-6) M prazosin markedly reduced the amplitude of contraction evoked by exogenously applied phenylephrine (10(-5) M). Electrical stimulation applied during sustained contraction evoked by 5-hydroxytryptamine in the presence of guanethidine and atropine evoked relaxation which was markedly suppressed by TTX. These results indicate that bovine ophthalmic artery is innervated by adrenergic nerve fibers, and an unidentified neurotransmitter, other than noradrenaline, may play an important role in the excitatory neuroeffector transmission, and that the tissue is also innervated by non-adrenergic non-cholinergic inhibitory nerve fibers.

Fetal heart rate recorder for long-duration use in active full-term pregnant women

We sought to assess the signal consistency and accuracy of a long-duration fetal heart rate (FHR) recorder (a 1-MHz ultrasonic Doppler transducer composed of six miniprobes and an autocorrelation technique) in active, full-term pregnant women. The FHR data of 15 normal full-term fetuses were obtained every 250 milliseconds in various maternal positions using the new Doppler system or a direct scalp electrocardiographic (ECG) transducer. Differences between simultaneous Doppler and ECG measures were small and within acceptable limits except for short-term variability. Signal loss, assessed in 15 subjects in various positions, was less than 10% except during sitting or walking. The mean (+/- standard deviation) percentages of FHR signals lost over 2 hours in bed, 1 hour out of bed, and 24 hours in and out of bed were 1.2 +/- 2.1, 12.9 +/- 16.2, and 3.8 +/- 4.4, respectively. This system for recording FHR is suitable for clinical research and routine FHR monitoring, and provides data comparable to Holter ECG monitoring in patients with heart disease.

[Common carotid artery thrombosis--clinical and radiological evaluation]

Common carotid artery thrombosis (CCAT) is not common. We studied 4 patients with CCAT to clarify the clinical and radiological features of this disorder. Case 1 had only episodes of TIA. Case 2 was diagnosed by chance as having CCAT at the time of admission due to cerebellar infarction. On the contrary, Cases 3 and 4 were admitted because of disturbance of consciousness and hemiparesis. Case 4 died soon after his stroke because of complications. We evaluated cases 1, 2 and 3 using head CT, head MRI, neck MRI, MR angiography, SPECT and cerebral angiography. Case 4, who was evaluated with head CT and cerebral angiography, was autopsied to confirm the occlusion of the common carotid artery. The clinical severity of CCAT varies from asymptomatic to severe, because each differs in the time taken for complete occlusion of the common carotid artery; the development of collateral circulation; and hemodynamics of the brain. As for the collaterals their contribution is variable; for example, the thyrocervical and other arteries function as the bypass. We can diagnose CCAT easily and noninvasively using MR angiography and neck MRI based on disappearance of the flow void in the common carotid artery or internal carotid artery. On physical examination, it is important to detect faded pulsation of the superficial temporal artery that is ipsilateral to the occluded common carotid artery.

The character of endogenous retrovirus in pancreatic beta-cells of NOD mice

The character of retrovirus type C in NOD mouse pancreatic-beta-cells was investigated. First, the in vitro response of retrovirus type C to glucose stimulation was examined. When the pancreatic islets of control NON mice were observed with an electron microscopy retrovirus types C could not be detected in the beta-cells with or without glucose stimulation. Retrovirus type C particles and intracisternal type A particles (IAPs) in NOD mouse pancreatic beta-cells increased by glucose stimulation, but the increase in retrovirus type C differed from that of IAPs. The clusters of retrovirus type C were found in some beta-cells, whereas IAPs were scattered in beta-cells. Next, we investigated the expression of retrovirus type C transcript in NOD mouse pancreatic islets. From polymerase chain reaction analysis using two primers of retrovirus type C designed from a conserved U3 region, a major product was found to be endogenous polytropic retrovirus (Pmv). The subcloned PCR probe and oligonucleotide probes specific for Pmv and modified polytropic retrovirus were used for Northern blot analysis. Pancreatic islets from NOD and NON mice (control mice) contained 8.4-kb and 3.0-kb Pmv transcripts. The quantity of transcripts of Pmv in NOD mouse pancreatic beta-cells were the same as that in NON mice. The transcript level of islets was much higher than those of thymus and liver. The appearance of retrovirus type C particles in beta-cells of NOD mice may involve the mechanisms by which diabetes is generated in NOD mice.

[A case of generalized disseminated atypical mycobacteriosis caused by M. avium complex with a giant gravitation abscess]

A case of generalized disseminated atypical mycobacteriosis caused by M. avium complex (MAC) was reported. The case was a female of 52 years of age. She was admitted to our hospital due to high fever and polyarthralgia. Her chest X-ray and CT scan revealed infiltrative shadows in the right S2b and S4 segments, and multiple accumulation shadows were seen on osteoscintigraphy. Pus aspirated from a lesion of the right fifth rib were acid-fast bacilli positive by smear (Gaffky v). The administration of four drugs, INH, RFP, EB and SM, was introduced, then corticosteroid was added, and the case became afebrile. Later, acid-fast bacilli were also isolated from bronchial washing and aspirated specimen from bone marrow, and all of them were identified as MAC. Based on these findings, the case was diagnosed as generalized disseminated mycobacteriosis. After several months remission, tenderness over the fifth lumbar vertebra deteriorated, and MRI scan on lumbar vertebrae showed high-intensity area both on T1-weighted and T2-weighted images. MAC was isolated from the pus of the fifth lumbar vertebra. Lumbar lesions deteriorated gradually, and a giant gravitation abscess which involved right ilium was revealed by CT scan of the pelvis. In spite of vigorous treatment including chemotherapy, aspiration of pus and drainage, general condition of the case deteriorated, and the case finally died of renal insufficiency.

Site-directed mutagenesis, fluorescence, and two-dimensional NMR studies on microenvironments of effector region aromatic residues of human c-Ha-Ras protein

The Tyr residues in positions 32 and 40 of human c-Ha-Ras protein were replaced by site-directed mutagenesis (Y32F, Y32W, Y40K, and Y40W) to examine their roles in the signal-transducing activity and the sensitivity to the GTPase activating protein (GAP). The signal-transducing activity of the oncogenic Ras protein in PC12 cells was lost upon mutations Y32F and Y40K, but retained upon mutations Y32W and Y40W. These results suggest that residues 32 and 40 are both required to have aromatic groups and residue 32 is further required to have a hydrogen donor. On the other hand, three mutations (Y32F, Y32W, and Y40W) caused no appreciable reduction in either GAP-binding affinity or GAP sensitivity. By the Y40K mutation, GAP-binding affinity was slightly lowered, while GAP sensitivity was drastically impaired. Therefore, for residues 32 and 40 of Ras, interactions with GAP appear to be different from those with the target of signal transduction in the PC12 cell. As for the Y32W-Ras protein bound with an unhydrolyzable GTP analogue (GMPPNP), the Trp32 fluorescence is appreciably red-shifted, weaker, and more susceptible to KI quenching as compared to that of the GDP-bound form. Two-dimensional NMR spectroscopy with selectively deuterated Ras proteins revealed fewer and weaker nuclear Overhauser effects on the aromatic protons of Trp32 in the GMPPNP-bound form than in the GDP-bound form. This indicates that the side chain of Trp32 is more exposed to the solvent in the GMPPNP-bound form than in the GDP-bound form.(ABSTRACT TRUNCATED AT 250 WORDS)

[Studies on zwitter-ionization of drugs. III. Synthesis and pharmacological activities of N-alkylcarboxylic acid derivatives of 1,2,3,4,10,14b-Hexahydrodibenzo[c,f]-pyrazino[1,2-a]azepine and 2,3,4,9-tetrahydro-1H-dibenzo[3,4: 6,7]cyclohepta[1,2-c]pyridine]

The N-alkylcarboxylic acids of 1,2,3,4,10,14b-hexahydrodibenzo[c,f]pyrazino[1,2-alpha]az epi ne (6a) and 2,3,4,9-tetrahydro-1H-dibenzo[3,4: 6,7]cyclohepta[1,2- c]pyridine (6b) were synthesized and examined for pharmacological activities in vitro: an inhibitory effect on the monoamine [noradrenaline (NA) and 5-hydroxytryptamine (5-HT)] uptake into the rat crude synaptosome, an inhibitory effect on the 5-HT- and NA-induced contraction in the isolated rabbit aorta and on the histamine- and acetylcholine-induced contraction in the isolated guinea-pig ileum, and binding affinity for alpha 2-adrenoceptor and D2-receptor. The in vitro tests indicated that zwitter-ionization was capable of maintaining antihistaminic activity while greatly reducing other pharmacological activities such as effects on central nervous system. 3-[2,3,4,9-Tetrahydro-1H-dibenzo[3,4: 6,7]cyclohepta[1,2- c]pyridin-2-yl]propionic acid (6b-2), selected as a candidate antiallergic agent having equally potent activities in rats and guinea-pigs, exhibited strong inhibitory effects on 48 h homologous passive cutaneous anaphylaxis (PCA) in rats (ED50 = 0.012 mg/kg, p.o.) and on histamine-induced bronchoconstriction in anesthetized guinea-pigs (ED50 = 0.0088 mg/kg, p.o.).

[Official inspection estimated production of coal-tar dyes (including dye aluminum lakes) in 1993-1994]

The number of official inspections of coal-tar dyes and their aluminum lakes from April 1993 till March 1994 were 734 in total, with the quantity which passed inspection amounting to 213 tons in Japan. Data for production by color for each month are summarised in Table 1, and by each producing company in Table 2. The food coal-tar dye produced in the largest quantity was Food Yellow No. 4, occupying a 42.9% proportion of the total during this period.

Synthesis and nonthrombogenicity of fluoroalkyl polyetherurethanes

New polyetherurethanes carrying fluoroalkyl substituents in the side chains were synthesized from N,N-di(hydroxyethyl)heptadecafluorooctyl-sulfonamide (a chain extender), 4,4'-disocyanatodiphenylmethane, and poly(tetramethylene glycol). Various kinds of polyetherurethanes having different tensile properties were prepared by changing the content of fluoroalkyl chain extender or the molecular weight of poly(tetramethylene glycol). The surface of a film made from the fluoroalkyl polyetherurethane was strongly water-repulsive. The in vitro thrombus formation on the fluoroalkyl polyetherurethanes was reduced by increasing the content of chain extender for the same molecular weight of poly(tetramethylene glycol). Protein adsorption, platelet adhesion, and platelet activation on the fluoroalkyl polyetherurethanes were also investigated.

Doxazosin withdrawal and ambulatory blood pressure monitoring in normotensive subjects

The effect of doxazosin withdrawal on normotensive subjects was examined by ambulatory blood pressure monitoring (ABPM) during twenty-four hours. Eight normotensive volunteers were treated with doxazosin for four weeks. ABPM was done the day before withdrawal and on the second and seventh days after withdrawal. The average systolic and diastolic BP were not altered by doxazosin withdrawal either on day 2 or day 7, but pulse rate (PR) decreased on day 2 and day 7. Daytime PR decreased on day 2, but both daytime and nighttime PR decreased on day 7. On withdrawal of doxazosin, the plasma norepinephrine concentration decreased and the plasma renin activity tended to decrease. Neither overshooting hypertension nor cardiovascular event was related to doxazosin withdrawal was observed. It is concluded that, in normotensive subjects, discontinuation of doxazosin may result in bradycardia without hypotension or signs of withdrawal syndrome.

Uptake of remnant like particles (RLP) in diabetic patients from mouse peritoneal macrophages

To investigate whether the remnant like particles (RLP), separated from serum by an immunoaffinity gel mixture of anti-apo B-100 and apo A-I monoclonal antibodies, are relevant to the initiation or progression of atherosclerosis, the incorporation of RLP into mouse macrophages was studied using histochemical and biochemical techniques. Remnant lipoproteins such as RLP are reported to contain a large quantity of chyloniron and very low density lipoprotein (VLDL) remnants, especially in diabetic patients. The RLP separated from the sera of 32 diabetic patients were found to be predominantly taken up into macrophages harvested from mouse abdominal cavities by the staining method applying oil red O. Furthermore, using 14C-oleate to prove the uptake of lipoproteins by macrophages, the uptake of RLP-VLDL, a VLDL fraction of RLP by ultracentrifugation, was the next highest to that of the oxidized LDL, which suggests that RLP-VLDL is also aggressively taken up by macrophages. The degree of uptake of RLP-VLDL by macrophages was positively correlated with HbA1c of these diabetic patients (r = 0.556, p < 0.01), irrespective of the ways of the treatment of diabetes. In conclusion, RLP can contribute to the foaming of macrophages, which in turn may explain the acceleration of atherosclerosis in diabetic patients.

Design and synthesis of a protein device that releases insulin in response to glucose concentration

To synthesize a glucose-sensitive insulin-releasing protein device, insulin was esterified with methanol and connected to glucose oxidase with intervention of a disulfide compound, 5,5'-dithiobis(2-nitrobenzoic acid). On adding glucose to an aqueous solution containing the hybrid enzyme, the modified insulin was released. The amount of insulin released increased with increasing concentration of added glucose. The insulin release from the hybrid enzyme was specific to glucose. The activity of released insulin was about 80% of the unmodified insulin.

Idiopathic deafness or hearing loss of unknown etiology following discharge from the NICU

The clinical course, treatment and respiratory management of 6 infants who developed profound hearing loss (n = 5) or high tone hearing loss (n = 1) some months after discharge from the NICU are presented. All 6 infants had congenital and/or perinatal diseases causing hypoxia, and all were treated with gentamycin. All were nearly normal at discharge but later rose to 80-90 dB, or 60 dB in the case with high tone hearing loss. The hearing impairment was thought to be due to hypoxia, in combination with medications and invasive procedures. Follow-up audiologic testing is recommended after NICU discharge.