The changes in muscle strength and relaxation time after a comprehensive rehabilitation program for patients with myotonic dystrophy

Myotonic dystrophy is a muscular disorder characterized by muscle weakness and myotonia. Myotonia manifests with abnormally slow relaxation after strong voluntary contraction of the muscles. In our previous study we reported that quinine sulfate provided therapeutic benefit to myotonia and a home exercise program based on muscle strengthening exercises improved muscle strength. The purpose of this study was to determine the effect of a multi-therapeutic program in patients with myotonic dystrophy. For six months, seven patients with myotonic dystrophy received heat therapy, were given psychologic intervention using relaxation techniques, were trained at home, and were given quinine sulfate. The changes in muscle strength and relaxation time between the post-six-months home exercise program combined with quinine sulfate therapy, and the post-six months multi-therapeutic program, were assessed from the first dorsal interossei, the elbow flexors, and the knee extensors. The results were as follows: 1) The mean muscle strength of the each of the three muscles after the six months multi-therapeutic program was improved but was not significant compared with the post-six-months home exercise program combined with quinine sulfate therapy. 2) The mean relaxation time of each of the three muscles after the six months multi-therapeutic program was significantly reduced compared with the home exercise program combined with quinine sulfate therapy. In conclusion, the multi-therapeutic program undertaken in this study was the better program for the patients with myotonic dystrophy.

Removal of hydrogen peroxide by thiol-specific antioxidant enzyme (TSA) is involved with its antioxidant properties. TSA possesses thiol peroxidase activity

The thiol-specific antioxidant protein (TSA) protects glutamine synthetase from inactivation by a metal-catalyzed oxidation (MCO) system comprised of dithiothreitol (DTT)/Fe3+/O2 but not by the ascorbate/Fe3+/O2 MCO system. The removal of sulfur-centered radicals or H2O2 has been proposed as the protective mechanism of TSA. Like catalase, TSA prevents the initiation of the rapid O2 uptake phase during MCO of DTT but causes only partial inhibition when added after the reaction is well into the propagation phase. Stoichiometric studies showed that the antioxidant property of TSA is, at least in part, due to its ability to catalyze the destruction of H2O2 by the overall reaction 2 RSH + H2O2 --> RSSR + H2O. Results of kinetic studies demonstrate that the removal of H2O2 by TSA correlates with its ability to protect glutamine synthetase from inactivation. In the presence of thioredoxin, TSA is more active, whereas C170S (an active mutant of TSA in which cysteine 170 was replaced by a serine) and open reading frame 6 (a human antioxidant protein homologous to TSA with only one conserved cysteine residue) are only slightly affected. The thiol specificity of the protective activity of TSA derives from the fact that the oxidized form of TSA can be converted back to its sulfhydryl form by treatment with thiols but not by ascorbate.

Factors affecting low values of serum albumin in CAPD patients

To investigate the factors affecting low values of serum albumin (SA) in continuous ambulatory peritoneal dialysis (CAPD) patients, we undertook a cross-sectional study of 106 CAPD patients, with a mean age of 49.0 years and dialysis duration of 43.4 months, with respect to demographic, clinical, and biochemical parameters. In group I (n = 28, SA < or = 3.5 g/dL), diabetics were more common, patients were significantly older, and more patients were malnourished, according to the subjective global assessment (SGA), compared to group II (n = 78, SA > 3.5 g/dL). Serum C-reactive protein (CRP), lipoprotein (a), and 24-hour dialysate-to-plasma creatinine concentration ratio (D/P) were significantly higher, and 24-hour dialysate albumin was greater in group I. Compared to group II, group I had significantly lower serum creatinine and urea nitrogen appearance (UNA). Blood urea nitrogen (BUN), lean body mass (LBM), % of body weight (%BW), and normalized protein equivalent of nitrogen appearance (nPNA) tended to be lower in the low SA group, without statistical significance. There were no differences in the duration of CAPD, peritonitis rate, serum insulin-like growth factor-I (IGF-I), anthropometric data, dietary assessment, dialysis adequacy, and residual renal function (RRF) between the two groups. SA was positively correlated with serum creatinine, IGF-I, LBM, UNA, BUN, nPNA, and CAPD duration, and was negatively correlated with 24-hour D/P, 24-hour dialysate albumin, age, CRP, and bicarbonate (HCO3-). By stepwise multiple logistic regression analysis, 24-hour D/P, age, CRP, and SGA were independent risk factors for low SA level. In conclusion, SA seems to be influenced not only by nutritional factors but also by nonnutritional factors such as peritoneal membrane transport characteristics, age, and presence of acute phase protein response manifested by CRP elevation.

Induction of vitreolysis and vitreous detachment with hyaluronidase and perfluoropropane gas

To simulate the posterior vitreous detachment (PVD) in the rabbit, 1 IU hyaluronidase and/or 0.2 ml of perfluoropropane gas was intravitreally injected. Ophthalmoscopic, light microscopic examination prepared by cryotechnique, electron microscopic examination, and electroretinogram were done on the 3rd and 28th postoperative days. As a result, the eyes undergone simultaneous intravitreal injection of 1 IU hyaluronidase and 0.2 ml perfluoropropane gas showed membranous structure split from the internal limiting membrane of the superior retina in 3 days after injection. The eyes also demonstrated membranous structure separated from the superior retina after 28 days, simulating vitreous detachment. On the contrary, neither agent alone induced vitreous detachment. No toxic retinal changes associated with simultaneous intravitreal injection of 1 IU hyaluronidase and 0.2 ml perfluoropropane gas were observed. Therefore, with a future support by histologic examination other than cryotechnique and by immunohistochemical analysis, the simultaneous intravitreal injection of perfluoropropane gas and hyaluronidase would be a promising method to induce vitreous detachment in non-vitrectomized eye.

The effect of lovastatin on proliferation of cultured rat mesangial and aortic smooth muscle cells

In order to investigate the anti-proliferative effect of 3-hydroxy-3-methylglutaryl coenzyme. A reductase inhibitor, we evaluated the effects of lovastatin on DNA replication and the proliferation of rat mesangial and aortic smooth muscle cells, both of which were mesenchymal origin cells. Proliferations were determined by measuring [3H]thymidine uptake, and counting the number of cells. Growth-arrested mesangial and aortic smooth muscle cells were exposed to platelet-derived growth factor (PDGF), endothelin (ET) and angiotensin II (Ang II) to stimulate mitogenesis. All agents exhibited dose-dependent stimulation of [3H] thymidine uptake. PDGF was more potent than the others. Ang II increased [3H] thymidine uptake without demonstrable mitogenic activity. Lovastatin inhibited PDGF (10 ng/ml in mesangial cell, 25 ng/ml in smooth muscle cell)-, ET (10(-7)M)- and Ang II (10(-7)M)-induced [3H] thymidine uptake significantly in a dose-dependent manner in both cells. The increase of cell number in response to PDGF and ET treatment were also inhibited at 10 microM of lovastatin. The inhibitory effect of lovastatin was largely overcome in the presence of exogenous mevalonate at 200 microM, with 75.5% restoration from lovastatin-induced inhibition on PDGF-induced [3H] thymidine uptake in mesangial cells (77.8% in aortic smooth muscle cells). However, the addition of cholesterol did not prevent inhibition by lovastatin. In conclusion, lovastatin had an inhibitory effect on mesangial and aortic smooth muscle cell proliferation, and mevalonate was essential for DNA replication in both types of cells. Lovastatin may reduce glomerular and atherosclerotic injury through an anti-proliferative effect on mesangial and vascular smooth muscle cells, in addition to lowering circulating lipids.

Production of cellulase and xylanase in a bubble column using immobilized Aspergillus niger KKS

Aspergillus niger KKS, isolated from a farmland near Suwon, was immobilized on Celite and polyurethane foams. Enzyme activities produced by the immobilized cell system in a bubble column were higher than that of shake-flask culture. The enzyme productivities were twice as high. beta-Glucosidase, beta-xylosidase, and xylanase activities obtained in a bubble column were significant when the ground rice straw was used as a substrate.

Prognostic factors and renal survival rates in IgA nephropathy

A retrospective study of 223 patients with IgA nephropathy (IgAN) was performed to clarify the prognostic factors and the renal survival rates of the disease. One hundred twenty-two patients were followed-up for more than 6 months after their renal biopsy (mean follow-up duration: 43.0 months), and 20 of them (16.4%) had progressed to end-stage renal disease (ESRD). Using univariate analysis, 8 risk factors (2 clinical and 6 histopathological findings) for developing ESRD were identified: renal insufficiency at initial presentation (serum creatinine > or = 1.5 mg/dl); heavy proteinuria (> or = 3.5 gm/day); moderate to severe histopathologic findings such as class IV/V lesions by W.H.O. classification, mesangial hypercellularity, glomerular sclerosis, interstitial infiltration, interstitial fibrosis, and tubular atrophy. In multivariate regression analysis, class IV/V lesions and renal insufficiency at initial presentation were the independent prognostic factors of IgAN. The renal survival rates were 100% at 1 year, 97.0% at 3 years, and 78.9% at 5 years. In conclusion, it seems that about 20% of IgAN patients have a risk to progress to ESRD within 5 years, and a careful follow-up is recommended especially in patients who have either renal insufficiency at the time of presentation or severe renal pathology (class IV/V lesions).

Correlation of spinal mobility with the severity of chronic lower back pain

The purpose of this study is to show the correlation between the range of spinal motion and the severity of chronic lower back pain. The subjects of this study were 40 female patients with chronic lower back pain over a 6 months' duration. The range of spinal and hip joint motion was measured with a electrogoniometer, and the severity of back pain was evaluated with the Rolland's score and Pollard's pain disability index. Results were as follows. There was a correlation between the severity of pain and the range of lumbar lateral flexion, rotation, and extension (p < 0.05). Age, height, weight and body mass index had no correlation with the range of spinal motion. These results suggest that the range of lumbar spinal motion can be used as an objective measure for the evaluation of classifying chronic lower back pain patients and for planning and following their treatment.

Exercise effect of modified contralateral stabilization bar during one-legged isokinetic exercise

We compared the electrical activities recorded from the muscles of the unexercised leg with changing the position of the contralateral stabilization bar to determine whether the degree of muscle contraction was influenced by the position of the bar during one-legged isokinetic exercise using an isokinetic dynamometer. The root mean square (RMS) values recorded from the medial hamstring sites of the unexercised legs showed a significantly higher value when the bar was located behind and on both in front of and behind the unexercised leg during one-legged extension exercise. Results from the isokinetic knee flexion exercise test indicated that a significantly greater RMS value was recorded from the vastus lateralis sites when the bar was located in front of and on both sides of the unexercised leg. During one-legged isokinetic extension-flexion exercise, the mean values of RMS voltage were greater when the bar was positioned in front of and on both sides of the unexercised leg in the vastus lateralis site. At the medial hamstring site, a greater value was noticed when the bar was located behind or on both sides.

Wrist instability series: increased yield with clinical-radiologic screening criteria

PURPOSE

To develop screening criteria for patients with wrist pain who have carpal instability.

MATERIALS AND METHODS

Data were accumulated retrospectively from the cases of 535 patients with painful wrists (321 male and 214 female patients, aged 11-71 years), who underwent wrist arthrography and wrist instability series between 1979 and 1990. Four screening criteria were evaluated: abnormal carpal alignment on routine radiographs, scapholunate joint or ligament pain, reproducible painful clicking or popping, and positive capitolunate instability pattern. Patients with one or more criteria were assigned to group 1. Patients without any of the criteria were assigned to group 2.

RESULTS

Group 1 comprised 142 patients (27%) and group 2 comprised 393 patients (73%). In group 1, 69 (49%) patients had abnormal wrist instability findings, and in group 2, nine (2%) had such findings. All abnormalities in group 2 were depicted on routine arthrograms.

CONCLUSION

With use of these screening criteria, the majority of patients with wrist pain do not need to undergo wrist instability series and those that do can undergo a specially tailored series.

Thallium-201 uptake in keloid tissue masquerading as a pulmonary neoplasm

Tl-201 imaging is useful in the diagnostic work-up of tumors. However, Tl-201 uptake is not specific for tumor and is also noted in other conditions. A case is described in which Tl-201 was taken up by a keloid.

Novel malonamidases in Bradyrhizobium japonicum. Purification, characterization, and immunological comparison

Three novel malonamidases (E1a, E1b, and E2) occurring constitutively in Bradyrhizobium japonicum were purified to electrophoretic homogeneity. They were found to catalyze one or more of the following three types of reactions: malonyl transfer to hydroxylamine (reaction 1), hydroxaminolysis of malonamate (reaction 2), and hydrolysis of malonamate (reaction 3). The molecular sizes of E1a, E1b, and E2 were 126, 107, and 103 kDa, respectively, and they were each composed of two identical subunits. The pIs of E1a and E1b, 5.5 and 5.0 respectively, were similar, but that of E2 was 7.2. Optimum pH values varied with the type of reactions catalyzed, but among the enzymes they were found to be similar. The affinity of E2 for malonamate was about 30- and 70-fold higher than that of E1a and E1b, respectively. Acetate and propionate inhibited E1a activity competitively, whereas malonate inhibited E2 activity noncompetitively. The amino acid composition and N-terminal amino acid sequence of the three enzymes were found to be different. These enzymes were also immunologically different. E1a was found to form a malonyl-enzyme intermediate during the catalysis through the isolation of [14C]malonyl-enzyme with gel filtration and through isotope exchange experiments with [18O]malonate. These malonamidases may play a role for the self-protection against malonate toxicity in nodule bacteroids and may also be involved in the transport of fixed nitrogen to the plant cell.

[Isolation of Cryptosporidium parvum oocysts from fecal samples--the combination of ether extraction and discontinuous sucrose gradients]

A calf and 50 mice were infected with Cryptosporidium parvum, and their fecal materials were collected and treated with ether extraction (EE), followed by discontinuous sucrose gradients (DSG) method. EE method was to remove some of fat or lipid from feces. Sediments were washed by centrifugation (1,500 x g for 10 min., 3 times) in phosphate-buffered saline and then these washed sediments were sieved sequentially through stainless steel screens with a final mesh of 250 (61 microns porosity) to remove other debris. After sieving, the materials were suspended in 2.5% potassium dichromate solution. Oocysts were counted by using a hemocytometer and the recovery rate of pure oocysts was calculated on the basis of the count. Following centrifugation (1,500 x g for 30 min.) by DSG method, most oocysts were recovered at the interface between a gravity of 1.103 and 1.064. The recovery rates of pure oocysts from the fecal suspension of the calf (3.8 x 10(7)/ml) and the mouse (3.2 x 10(6)/ml) treated with EE method were 81.6% and 51.6%, respectively. It is suggested that the recovery rate was dependent on the number of oocysts in each suspension treated with EE method. To get the 50% recovery rate, there must be more than 2 x 10(6) oocysts per ml of the fecal suspension treated with EE method. By the combination of the two methods it was possible to isolate C. parvum oocysts from normal feces of the calf and mouse as well as from diarrheic feces.

Steady-state kinetics of malonyl-CoA synthetase from Bradyrhizobium japonicum and evidence for malonyl-AMP formation in the reaction

Malonyl-CoA synthetase catalyses the formation of malonyl-CoA directly from malonate and CoA with hydrolysis of ATP into AMP and PP1. The catalytic mechanism of malonyl-CoA synthetase from Bradyrhizobium japonicum was investigated by steady-state kinetics. Initial-velocity studies and the product-inhibition studies with AMP and PPi strongly suggested ordered Bi Uni Uni Bi Ping Pong Ter Ter system as the most probable steady-state kinetic mechanism of malonyl-CoA synthetase. Michaelis constants were 61 microM, 260 microM and 42 microM for ATP, malonate and CoA respectively, and the value for Vmax, was 11.2 microM/min. The t.l.c. analysis of the 32P-labelled products in a reaction mixture containing [gamma-32P]ATP in the absence of CoA showed that PPi was produced after the sequential addition of ATP and malonate. Formation of malonyl-AMP, suggested as an intermediate in the kinetically deduced mechanism, was confirmed by the analysis of 31P-n.m.r. spectra of an AMP product isolated from the 18O-transfer experiment using [18O]malonate. The 31P-n.m.r. signal of the AMP product appeared at 0.024 p.p.m. apart from that of [16O4]AMP, indicating that one atom of 18O transferred from [18O]malonate to AMP through the formation of malonyl-AMP. Formation of malonyl-AMP was also confirmed through the t.l.c. analysis of reaction mixture containing [alpha-32P]ATP. These results strongly support the ordered Bi Uni Uni Bi Pin Pong Ter Ter mechanism deduced from initial-velocity and product-inhibition studies.

Comparative study of hepatitis C virus antibody between hemodialysis and continuous ambulatory peritoneal dialysis patients

We have done cross sectional and prospective studies to determine the prevalence and the clinical significance of antibodies to the hepatitis C virus (Anti-HCV) in 54 hemodialysis (HD) patients and 227 continuous ambulatory peritoneal dialysis (CAPD) patients. Fifteen patients (27.8%) were anti-HCV (+) among the HD group, and twelve patients (5.3%) were anti-HCV (+) among the CAPD group. In the HD group, the positivity of anti-HCV correlated with the duration of HD, but there was no significant correlation with the history of transfusion, the amount of transfusion and abnormal alanine aminotransferase (ALT). At the follow-up study in 164 cases (HD 50 cases, CAPD 114 cases) after 6 months, one of 14 anti-HCV (+) CAPD patients was converted to anti-HCV (-) and two of 35 anti-HCV (-) HD patients were converted to anti-HCV (+). In conclusion, the prevalence of anti-HCV was significantly higher in HD patients compared to CAPD patients, and the positivity for anti-HCV in HD patients correlated with the duration of HD. A regular follow-up of anti-HCV and isolation of anti-HCV (+) HD patients with a separate machine may be needed to prevent the transmission of the hepatitis C virus during hemodialysis.

Evaluation of a nasal/oral discriminate sampling system for capnographic respiratory monitoring

Although continuous end-tidal carbon dioxide (PETCO2 mmHg) measurements permit the earliest detection of alveolar hypoventilation, apnea and/or obstruction, technical difficulties have thus far precluded its reliable implementation in the spontaneously breathing patient with a natural (e.g., nonartificially secured) airway. Among the technical difficulties is the fact that conventional sampling devices do not take into account the possibility that breathing may take place primarily through either the nose or the mouth. As a result, the efficacy of a new nasal/oral discriminate sampling system (NODSS) was examined for capnographic observation of respiratory adequacy. NODSS is unique because it provides the opportunity to select simultaneous or discriminate collection of carbon dioxide exhaled through the nose and/or mouth. Twenty-four American Society of Anesthesiologists physical status I to IV patients (ages 30-88 years) were capnographically monitored in the postanesthesia care unit following general anesthesia for various surgical procedures. All patients were extubated and breathing spontaneously. Simultaneously, direct arterial carbon dioxide (PaCO2 mmHg) determinations were made using an indwelling radial artery catheter to determine their correlation with PETCO2 obtained by NODSS. A comparison between PaCO2 values and noninvasive nasal and/or oral PETCO2 obtained by NODSS showed a positive correlation (r value) of 0.602 to 0.849 when statistically analyzed by Pearson's product-moment correlation coefficient. There was no significant difference between the mean (PaCO2-PETCO2) gradient derived through nasal sampling, as compared to the mean gradient derived by oral sampling with this device (P > 0.05). Noninvasive capnographic monitoring by NODSS is a convenient, reliable, effective, and accurate alternative to direct arterial blood gas determination that may be used for the early detection of respiratory inadequacy in the spontaneously breathing patient who has a natural airway.

Sensitivity analysis of a thin-film optical waveguide biochemical sensor using evanescent field absorption

A multichannel thin-film optical waveguide sensor for determining aqueous biochemical concentration with a high dynamic range of measurement is proposed. The sensitivity dependence of the proposed sensor on interaction length and waveguide thickness is investigated for dye solutions and three different hemoglobin concentration levels of carboxyhemoglobins. The sensitivity is inversely proportional to the waveguide thickness while proportional to the interaction length. As a consequence the variability of the interaction length makes the proposed sensor a flexible tool for concentration measurements. Moreover, an efficient method for determining the absorption coefficient is discussed.

Changes in spectral indices of heart rate variability during exercise in acute myocardial infarction

Physical exertions are related to sudden cardiac death following acute myocardial infarction (AMI). Abnormalities in the autonomic modulation during exercise were noted in animals with AMI that were susceptible to potentially lethal arrhythmias. This study was done to evaluate the changes in the autonomic activity during exercise and recovery in AMI patients with good exercise capacity, using spectral analysis of R-R intervals of electrocardiogram (ECG). Symptom-limited treadmill exercise test was done on 17 patients of AMI with mild heart failure (in 7-10 days after the attack) and 21 healthy controls. The exercise was divided into 7 stages; rest, early exercise, mid-exercise, peak exercise, early recovery, mid-recovery, and late recovery. Power spectral analysis of R-R intervals of ECG was performed for each stage. Low frequency (0.04-0.15 Hz) and high frequency (0.15-0.40 Hz) powers, and their ratio were obtained. These parameters were observed throughout the stages in both groups. The trend of their changes during exercise and recovery was essentially the same for both groups; high and low frequency powers progressively decreased during exercise and abruptly increased during early recovery, but did not return to the values at those of rest until 9 minutes into the recovery. When the parameters were compared between the groups, there was a significantly greater decrease of high frequency power during the early exercise (p < 0.05), and a higher ratio of low to high frequency power during the early recovery (p < 0.05) in the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Pudendal somatosensory evoked potential and bulbocavernosus reflex testing in erectile dysfunction

Pudenal somatosensory evoked potential (PSEP) and bulbocavernosus reflex (BCR) testing have been reported to be useful in the evaluation of erectile dysfunction and neurogenic bladder. 461 patients with sexual dysfunction were studied to determine the usefulness of the above tests. Abnormality of PSEP was found significantly in upper motor neuron (UMN) type spinal cord patients and average prolonged P1 latency was 47.4 +/- 9.8 msec. Lower motor neuron (LMN) type spinal cord patients revealed great abnormality in BCR latency with an average value of 44.9 +/- 14.5 msec on the right and 44.2 +/- 15.6 msec on the left. Additionally significant differences were obtained in patients with diabetes mellitus, pelvic trauma and spinal cord lesion of the UMN type in the study of PSEP. There was also a significant difference in the patients with diabetes mellitus, pelvic trauma and spinal cord lesion of the LMN type in the BCR study. The findings of our study suggest that PSEP together with BCR study is useful in assessing the integrity of the sacral reflex arc and the central afferent pathway, in differentiating the lesion site and in providing basic data for the management plan in sexual rehabilitation. Furthermore, because erection is under the influence of both the somatic and autonomic nervous system, BCR study and PSEP combined with currently studied electrical activity of the corpus cavernosum would provide a more accurate evaluation of the neurogenic erectile dysfunction patients.

Normal palmar tilt: is dorsal tilting really normal?

Palmar tilt measured on true lateral radiographs of 100 normal wrists revealed that dorsal palmar tilt is not found in the normal adult, and women generally have a larger palmar tilt (average 12.4°) than men (average 9.3°).