Accuracy of self-report of HIV viral load among people with HIV on antiretroviral treatment

OBJECTIVES

The aim of the study was to assess, among people living with HIV, knowledge of their latest HIV viral load (VL) and CD4 count.

METHODS

Agreement between self-report and clinic record was assessed among 2771 HIV-diagnosed individuals on antiretroviral treatment (ART) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes Study (2011-2012). A confidential self-completed questionnaire collected information on demographic, socioeconomic, HIV-related and health-related factors. Participants were asked to self-report their latest VL [undetectable (≤ 50 copies/mL), detectable (> 50 copies/mL) or "don't know"] and CD4 count (< 200, 200-350, 351-500 or > 500 cells/μL, or "don't know"). Latest clinic-recorded VL and CD4 count were documented.

RESULTS

Of 2678 participants on ART, 434 (16.2%) did not accurately report whether their VL was undetectable. Of 2334 participants with clinic-recorded VL ≤ 50 copies/mL, 2061 (88.3%) correctly reported undetectable VL; 49 (2.1%) reported detectable VL; 224 (9.6%) did not know their VL. Of 344 participants with clinic-recorded VL > 50 copies/mL, 183 (53.2%) correctly reported detectable VL; 76 (22.1%) reported undetectable VL; 85 (24.7%) did not know their VL. Of 2137 participants who reported undetectable VL, clinic-recorded VL was ≤ 50 copies/mL for 2061 (96.4%) and <1000 copies/mL for 2122 (99.3%). In analyses adjusted for gender/sexual orientation, ethnicity, age and time since starting ART, factors strongly associated with inaccurate self-report of VL (including "don't know") included socioeconomic disadvantage [prevalence ratio (95% CI) for "not" vs. "always" having enough money for basic needs: 2.4 (1.9, 3.1)], poor English fluency [3.5 (2.4, 5.1) vs. UK born], nondisclosure of HIV status [1.7 (1.3, 2.1)], ART nonadherence [2.1 (1.7, 2.7) for three or more missed doses vs. none in the past 2 weeks] and depressive symptoms (PHQ-9 score ≥ 10) [1.9 (1.6, 2.2)]. Overall, 612 (22.9%) of 2667 participants on ART did not accurately self-report whether or not their CD4 count was ≤ 350 cells/μL.

CONCLUSIONS

There is a high level of accuracy of a self-report of undetectable VL in people on ART in the UK. Overall, accurate knowledge of personal VL level varied according to demographic, socioeconomic, HIV-related and health-related factors. Active identification of people who may benefit from increased levels of support and engagement in care is important.

Antiretroviral therapy for prevention of HIV transmission: implications for Europe

The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm3. The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm3. The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.

P1-15-01: Oral Fluoropyrimidine (UFT and S-1) May Augment the Efficacy of Aromatase Inhibitor Via the Down-Regulation of Estrogen Receptor in Estrogen-Responsive Breast Cancer Xenografts

Breast cancer patients has tended to be more personalized by biomarkers, such as estrogen receptor (ER), HER-2 and other risk factors. Adjuvant endocrine therapy is recommended for all ER-positive breast cancer patients, and the addition of adjuvant chemotherapy to endocrine therapy has been shown to further improve the prognosis of ER-positive breast cancer patients. Addition of an oral fluoropyrimidine, UFT was shown to improve the outcome of patients with luminal A cancer. Based on these studies, the present preclinical study was designed to evaluate a new combination therapy comprised of the aromatase inhibitor anastrozole (ANA) and the oral fluoropyrimidines, UFT and S-1 against luminal A human breast cancer cell line MCF-7/Arom 14, which was stably transfected with the cDNA of human aromatase. MCF-7/Arom 14 cells showed a high aromatase activity (111.6±69.6 fmole/mg protrin/hr) in vivo. Testosterone failed to induce cell growth of parent MCF-7. But, MCF-7/Arom 14 cells were potentiated by both testosterone and E2 in vitro, and ANA and 5-fluorouracil (5-FU) inhibited cell growth at concentrations of 0.005 to 10 and 0.2 to 5 μM, respectively. The combination of 5-FU and ANA additively inhibited cell growth. MCF-7/Arom 14 was implantable in vivo, but it failed to grow in he absence of E2 or testosterone releasing pellet (Tes-P). The growth of MCF-7/Arom 14 was significantly inhibited by ANA and S-1 or UFT alone vs Control (Tes-P alone) in vivo. The combination of ANA with S-1 or UFT administered using a 21-day consecutive, metronomic-like regimen. On day 22, relative tumor volume (RTV) treated by ANA and UFT or ANA and S-1 was significantly lower than either mono-therapy by Welch's t-test. Based on RTV change the period required for the RTV to reach 3 was estimated, and its differences between control was designated as growth delay period (GDP). GDP of combination-therapy was 2 to 4 times longer than either mono-therapy.

Simultaneous determination of delta(15)N and delta(18)O of N2O and delta(13)C of CH4 in nanomolar quantities from a single water sample

We have developed a rapid, sensitive, and automated analytical system to simultaneously determine the concentrations and stable isotopic compositions (delta(15)N, delta(18)O, and delta(13)C) of nanomolar quantities of nitrous oxide (N(2)O) and methane (CH(4)) in water, by combining continuous-flow isotope-ratio mass spectrometry and a helium-sparging system to extract and purify the dissolved gases. Our system, which is composed of cold traps and a capillary gas chromatograph that use ultra-pure helium as the carrier gas, achieves complete extraction of N(2)O and CH(4) in a water sample and separation among N(2)O, CH(4), and the other component gases. The flow path following exit from the gas chromatograph was periodically changed to pass the gases through the combustion furnace to convert CH(4) and the other hydrocarbons into CO(2), or to bypass the combustion furnace for the direct introduction of eluted N(2)O into the mass spectrometer, for determining the stable isotopic compositions through monitoring the ions of m/z 44, 45, and 46 of CO(2) (+) and N(2)O(+). The analytical system can be operated automatically with sequential software programmed on a personal computer. Analytical precisions better than 0.2 per thousand and 0.3 per thousand and better than 1.4 per thousand and 2.6 per thousand were obtained for the delta(15)N and delta(18)O of N(2)O, respectively, when more than 6.7 nmol and 0.2 nmol of N(2)O, respectively, were injected. Simultaneously, analytical precisions better than 0.07 per thousand and 2.1 per thousand were obtained for the delta(13)C of CH(4) when more than 5.5 nmol and 0.02 nmol of CH(4), respectively, were injected. In this manner, we can simultaneously determine stable isotopic compositions of a 120 mL water sample with concentrations as low as 1.7 nmol/kg for N(2)O and 0.2 nmol/kg for CH(4).

Thermochemical stabilities and structures of the cluster ions OCS+, S2+, H+(OCS), and C2H5+ with OCS molecules in the gas phase

The gas-phase clustering reactions of OCS+, S2+, H+(OCS), and C2H5+ ions with carbonyl sulfide (OCS) molecules were studied using a pulsed electron-beam high-pressure mass spectrometer and applying density functional theory (DFT) calculations. In the cluster ions OCS+(OCS)(n) and H+(OCS)(OCS)(n), a moderately strong, here referred to as "semi-covalent", bond was formed with n = 1. However, the nature of bonding changed from semi-covalent to electrostatic with n = 1 --> 2. The bond energy of S2(+)(OCS) was determined experimentally to be 12.9 +/- 1 kcal/mol, which is significantly smaller than that of the isovalent S2(+)(CS2) complex (30.9 +/- 1.5 kcal/mol). DFT based calculations predicted the presence of several isomeric structures for H+(OCS)(OCS)(n) complexes. The bond energies in the C2H5+(OCS)(n) clusters showed an irregular decrease for n = 1 --> 2 and 7 --> 8. The nonclassical bridge structure for the free C2H5+ isomerized to form a semi-covalent bond with one OCS ligand, [H3CCH2...SCO]+, i.e., reverted to classical structure. However, the nonclassical bridge structure of C2H5+ was preserved in the cluster ions C2H5+(OCS)(n) below 140 K attributable to the lack of thermal energy for the isomerization. DFT calculations revealed that stability orders of the geometric isomers of H+(OCS)(OCS)(n) and C2H5+(OCS)(n) changed with increasing n values.

Low anterior interhemispheric approach--a narrow corridor to aneurysms of the anterior communicating artery

BACKGROUND

Many approaches for clipping anterior communicating artery (ACoA) aneurysms are reported in the literature. We describe here a new approach called "low anterior interhemispheric approach" for clipping of ACoA aneurysms.

MATERIALS AND METHODS

A low anterior interhemispheric approach utilizing a unilateral frontal craniotomy flap with minimal unilateral frontal lobe retraction was used in treating four patients harboring an unruptured ACoA aneurysm. The approach axis is directed to the ACoA area itself with minimal exposure to the anterior cerebral vessels.

FINDINGS

In all patients, complete neck clipping was possible with minimal brain retraction, without vascular damage and preserved olfaction.

INTERPRETATION

This approach is preferred on anatomical grounds for cases of unruptured small and medium sized ACoA aneurysms projecting anteriorly or posteriorly because the anterior communicating artery complex area can be fully visualized with minimal manipulation of the frontal lobes and anterior cerebral arteries.

Thymidylate synthase (TS) and ribonucleotide reductase (RNR) may be involved in acquired resistance to 5-fluorouracil (5-FU) in human cancer xenografts in vivo

A human tumour sub-line resistant to 5-fluorouracil (5-FU) was established by once a day and every 5, with at least 50 administrations of 5-FU to KM12C human colorectal xenografts in nude mice. KM12C tumours treated with 5-FU showed less sensitivity to 5-FU with an inhibition rate (IR) of 7.9%, while non-treated tumours were highly sensitive to 5-FU with an IR of 81.8%. To clarify the mechanism of 5-FU-resistance, the activities of various enzymes and gene expressions involved in the metabolism of 5-FU in both parental and 5-FU-treated KM12C tumours were measured. A 2- to 3-fold increase in thymidylate synthase (TS) activity and 4- to 5-fold decrease in ribonucleotide reductase (RNR) activity were observed in 5-FU-resistant KM12C tumours, while the activities of orotate phosphoribosyltransferase (OPRT) thymidine and uridine phosphorylases (TP,UP) and thymidine kinase (TK) were not markedly changed as a consequence of repeated treatment of KM12C tumours with 5-FU. The expression of TS mRNA was also amplified in accordance with the increased TS activity in a 5-FU-treated tumour sub-line (KM12C/5-FU) compared with that in parental tumours, but changed expressions of both RNR-R1 and RNA-R2 mRNA could not be detected in the 5-FU-resistant tumour sub-line compared with the parental tumours, suggesting possible post-transcriptional regulation of RNR. Moreover, RNR, in addition to TS and OPRT, seemed to be related to the inherent insensitivity to 5-FU in human cancer xenografts. From these results, it may be concluded that RNR activity is one of the acquired or inherent resistant factors, including TS, to 5-FU in human cancer xenografts in vivo.

Stable carbon and oxygen isotopic analysis of carbon monoxide in natural waters

Techniques have been developed to allow on-line simultaneous analysis of concentration and stable isotopic compositions ((13)C and (18)O) of dissolved carbon monoxide (CO) in natural water, using continuous-flow isotope ratio mass spectrometry (CF-IRMS). The analytical system consisted sequentially of a He-sparging bottle of water, a gas dryer, CO(2)-trapping stage using both Ascarite trap and silica-gel packed gas chromatography (GC), on-line oxidation to CO(2) using the Schütze reagent, cryofocusing, GC purification using a capillary column and measurement by CF-IRMS. Each sample analysis takes about 40 minutes. The detection limit with delta(13)C standard deviation of 0.5 per thousand is 300 pmol and that with delta(18)O deviation of 1.0 per thousand is 750 pmol. Analytical blanks associated with these methods are 21+/-9 pmol. The procedures are evaluated through analyses of temporally varying concentration and isotopic compositions of CO in an artificial lake on the university campus. The delta(13)C and delta(18)O values of CO showed wide variation in accordance with diurnal variation of CO concentration, probably due to significant isotopic effects during photochemical production and microbial oxidation of CO in the aquatic environment. The delta(13)C and delta(18)O values of CO should be a useful tool in studies of the mechanism and pathways of CO production and consumption in natural waters.

Endovascular treatment of basilar trunk aneurysm associated with fenestration of the basilar artery

Basilar trunk saccular aneurysms associated with fenestration are infrequent, especially in the middle or distal portion of the basilar artery. Surgical treatment of the basilar trunk aneurysm is difficult, due to its anatomical environment and the complicated surgical exposure. A 46-year-old woman presenting with Hunt and Kosnik grade II subarachnoid hemorrhage was found to have a ruptured aneurysm arising at the proximal corner of the associated fenestration in the middle portion of the basilar artery. Because of surgical difficulties anticipated in approaching the aneurysm, it was decided to treat it with endovascular embolization utilizing the Guglielmi detachable coil; and complete occlusion of the aneurysm was obtained. The efficacy of endovascular treatment for the basilar trunk aneurysm with associated fenestration is discussed from anatomical and embryological points of view, and relevant literature is reviewed.

De-epithelialised anterior (anterolateral and anteromedial) thigh flaps for dead space filling and contour correction in head and neck reconstruction

Anterior (anterolateral and anteromedial) thigh flaps based on the descending branch of the lateral circumflex femoral vessels provide a long vascular pedicle and a large flap without sacrificing main vessels and muscles. Twenty-eight de-epithelialized anterior thigh flaps were transferred for reconstruction of head and neck defects following tumour ablation. Two flaps were lost in patients that had previously undergone high-dose radiotherapy following free tissue transfer. Vascularised fibula, vascularised iliac bone and other tissues were combined with anterior thigh flaps in 13 cases utilising the distal end or derivative branches of the vascular pedicle. Salivary fistula was seen in only one case, although there were many minor and major complications. In five cases, double skin flaps were harvested from the ipsilateral thigh. One of these flaps was used for coverage of intraoral defects, while the other was placed in the submandibular area to fill dead space. Compared with other methods, this multi-flap method is considered to be most suitable for dead space filling and contour correction.

Morphologic changes in the upper airway structure following surgical correction of mandibular prognathism

The purpose of this study was to investigate morphologic changes in oropharyngeal structures in mandibular prognathic patients after orthognathic surgery. The study consisted of 25 patients (12 males and 13 females) with mandibular prognathism who underwent surgical and orthodontic treatment. A set of 4 standardized lateral cephalograms were obtained from each subject preoperatively and at 3 months, 6 months, and 1 year postoperatively. Morphologic changes in upper airway structures were evaluated longitudinally by gender. Parameters of the anteroposterior width of the pharynx significantly decreased at 3 and 6 months in both genders, and these parameters tended to rebound to the preoperative values 1 year postoperatively in females, but not in males. The hyoid bone significantly descended inferiorly 1 year postoperatively in males, while there were no significant changes in females. The distance between the hyoid bone and the third vertebra gradually decreased in males postoperatively; however, there were no significant changes in females. The cross-sectional area of the hypopharynx significantly decreased 1 year postoperatively in males, but not in females. These results indicate that the upper airway morphology changed differently in males and females following surgery. To compensate for skeletal changes following surgery, it appears that males and females responded in different ways to preserve a functional upper airway.

Clinical analysis of internal carotid artery aneurysms with reference to classification and clipping techniques

An intraoperative classification of intradural internal carotid artery (ICA) aneurysms not related to the arterial division but based on their operative presentation and clipping techniques is introduced. On the basis of the surgeon's view of the operative field via the pterional approach in 156 operated intradural ICA aneurysms in 143 patients, these aneurysms were classified according to their location in relation to the long axis of the ICA as either proximal, middle or distal in type and also according to their relation to the cross section of the ICA as either lateral, medial, ventral or dorsal in type. Numerically the largest in frequency is the middle type of aneurysm by axial location and the lateral type of aneurysms by cross sectional location. Eighty five percent of the lateral type aneurysms were at the arterial division. The majority of the large to giant aneurysms were of the ventral type and no dorsal type aneurysms were seen. About one third of the ICA aneurysms in this series were located free of the arterial division. All dorsal type aneurysms and most of the medial type aneurysms were not related to the arterial division. Clipping techniques were classified into perpendicular and parallel clipping, as to the direction of the clip-blades in relation to the carotid axis. The parallel clipping was further classified into forward clipping, in which a clip was applied from the distal side of the ICA, and reversed clipping, in which a clip was applied from the proximal side of the ICA. Most of the aneurysms located at the arterial division required the perpendicular clipping and those free of the arterial division required the parallel clipping. Furthermore, the forward clipping was useful for proximal type aneurysms and the reversed clipping for distal type aneurysms. For the middle type aneurysms clipping was performed bidirectionally. This classification includes all types of the ICA aneurysms located at any points along its long axis and on its cross section, and is useful for planning safe and exact clipping of the ICA aneurysms.

[A clinical comparison of orthodox myringoplasty and a simple method with fibrin glue]

Orthodox myringoplasty was clinically compared with a simple method with fibrin glue which rapidly came into wide use after the report of Yuasa in 1989. In Okayama Saiseikai General Hospital, orthodox myringoplasty was performed in 109 ears from September 1988 to November 1995, and the simple method with fibrin glue was performed in 84 ears from May 1991 to November 1995. The results showed that 90.8% of all eardrum perforations treated by orthodox myringoplasty and 79.8% of all eardrum perforations treated by the simple fibrin glue method were successfully closed. The rate of closure with each method was low in patients with large perforations. Generally speaking the hearing prognosis with each method, hearing improvement was observed right after the operation, and the improved hearing became stable about six months later. The difference in hearing prognosis was investigated in patients with small or large perforations. In patients with large perforations, the improved hearing slightly worsened a year after treatment by orthodox myringoplasty. These results show that the simple method with fibrin glue had the advantage of good hearing prognosis over orthodox myringoplasty, while it was inferior in the rate of closure of large eardrum perforations. It was considered that a simple fibrin glue method should be devised to prevent reperforation and should be used for patients with large perforations.

Combined anterior thigh flaps and vascularised fibular graft for reconstruction of massive composite oromandibular defects

Six massive, composite oromandibular defects were reconstructed using combined anterior (anterolateral and anteromedial) thigh flaps and vascularised fibular graft in bridge or chimeric fashion. Except for minor dehiscence in one case and infection in another, all flaps survived without complication. Anterior thigh flaps provide large-calibre, long vascular pedicles while derivative branches from the lateral circumflex femoral system facilitate simultaneous transplantation of multiple components. Because the pedicle of the vascularised fibular graft is of insufficient length, the lateral circumflex femoral vessels provide a remote vascular source as a flow-through vascular conduit. A combined flap using the lateral circumflex femoral system is considered to be most suitable for reconstruction of through-and-through defects of the head and neck. The authors describe the advantages of this method and the detailed anatomy of the cutaneous perforators of the anterior thigh flaps.

A case of pulmonary arteriovenous malformation in a patient with brain abscess successfully treated with video-assisted thoracoscopic resection

A 45-year-old women was admitted to the hospital with a brain abscess due to asymptomatic pulmonary arteriovenous malformation (PAVM). The brain abscess was removed by craniotomy and excision following antibiotic therapy. The stapled wedge excision of the lung with the PAVM was successful under video-assisted thoracoscopic surgery.

Noninvasive cerebral optical spectroscopy: depth-resolved measurements of cerebral haemodynamics using indocyanine green

To investigate the feasibility of a newly developed, near-infrared optical spectroscopy device, we analysed measurements of the infrared tracer indocyanine green (ICG) using sensors with a single near infrared light source and multiple light detectors. Two ml of ICG dye, 1.0 mg ml-1 in concentration, were injected into the internal carotid artery during cerebral angiography in 14 adult patients. The resultant washout curves were measured bilaterally using sensors with 4 detectors spaced at 10, 20, 30 and 40 mm from the infrared light source on the right side, and 15, 25, 35 and 45 mm from the source for the left side, respectively. Washout curves were analysed to determine the relative amplitude of the ICG absorption signal and deduce each detector's penetration distance. When ICG was injected into the internal carotid artery, relative absorption increased with detector distance from the light source. No substantial difference in attenuation was observed in any of the detectors during external carotid injection of ICG. The resultant information related depth of penetration of the light with source-detector separation distances. The feasibility of the system for measuring cerebral oxygen saturation and haemodynamics noninvasively or monitoring at bedside is discussed.

Major basic protein, eosinophil cationic protein, and arylsulfatase in nasal secretions of patients with Japanese cedar pollinosis

In 15 patients with Japanese cedar pollinosis and 10 healthy control subjects, levels of major basic protein (MBP), eosinophil cationic protein (ECP), and arylsulfatase B (As) in the nasal secretions were examined before and after challenge with Japanese cedar pollen extract. The MBP and ECP levels in the patients were significantly higher 30 min after challenge than those before challenge (P < 0.005). MBP and ECP levels after challenge were significantly higher in the nasal secretions of patients than in the controls (MBP: P < 0.01, ECP: P < 0.05). The level of As after challenge was significantly higher in the nasal secretions of patients than in the controls. These results suggest that eosinophils activate or modify the immediate, nasal allergic reaction and have a role in regulating immunological responses.

Allergens of the house dust mite, Dermatophagoides pteronyssinus, in patients with mite allergic rhinitis: a clinical investigation by intracutaneous skin tests and nasal provocation tests

To determine the allergens of mite allergic rhinitis, we studied 31 patients with mite allergic rhinitis by skin tests and nasal provocation tests (15 for skin and 16 for nasal tests) using 6 fractions of Dermatophagoides pteronyssinus (Dp) extract differing in molecular weights (15, 25, 32, 53, 95 and 190 kDMW). In skin testing, patients showed intense positive reactions to the fractions of 15, 25, 32, 95 and 190 kDMW, among which the most patients showed positive reactions to the fractions of 15 and 25 kDMW. Significant differences were found in patients' positive reactivity among each fraction and between low (15 and 25 kD) and high (95 and 190 kD) molecular weight fractions as well. In nasal provocation tests, patients showed intense positive reactions to the fractions of 15, 32, 53 and 95 kDMW, especially to the fractions of 15 and 95 kDMW. Furthermore, the insidence of positive reactions to the 15 kDMW fraction was significantly higher than that to any other fraction in the skin tests (P < 0.05). From these results, the low molecular weight fraction, 15 kDMW, is considered to be the main allergen of this mite and the high molecular weight fractions, 95 and 190 kDMW, may also be considered to be allergens of this mite.

Suprachiasmal carotid-ophthalmic artery aneurysm--report of two cases

Two rare suprachiasmal carotid-ophthalmic artery aneurysms, one large and one giant, were discovered incidentally. The patients had no visual disturbances. Angiography showed superomedial projection of the sac. The aneurysms were clipped via an ipsilateral pterional approach. A suprachiasmal carotid-ophthalmic artery aneurysm is indicated when preoperative angiography reveals a superomedial carotid-ophthalmic artery aneurysm without visual disturbances. Direct surgery to clipp a suprachiasmal aneurysm should be carried out to prevent rupture of these frequently large aneurysms.

Dorsal internal carotid artery aneurysms with special reference to angiographic presentation and surgical management

Aneurysms arising from the dorsal wall of the internal carotid artery are rare. The authors surgically treated twenty dorsal internal carotid artery aneurysms. Pre-operative angiographic findings were reviewed and classified into three types. Eleven aneurysms projecting superiorly on the lateral angiogram were found to be adherent to the base of the frontal lobe by the pterional approach. Five aneurysms which had been superimposed with the internal carotid artery on the lateral angiogram were found adhered to the medial surface of the temporal lobe. Four aneurysms not seen on the angiogram had no adhesion. Two aneurysms, which had not been seen on the initial angiograms, were visualized on the angiograms taken during the period of vasospasm. This type of aneurysms can be the source of a subarachnoid haemorrhage of unknown origin and requires repeated examinations. Premature rupture occurred intra-operatively in five cases and postoperative bleeding was encountered in two. Clipping technique is discussed from the viewpoint of preventing intra- and postoperative rupture.

[Present situation of sampling by nurses]

Sampling specimens is one of the important routines for the nurse. Nurses in 19 divisions (floors) of Fukushima College Hospital were asked on their time-table of sampling, number of in- and out-patients and specimens collected and so on. Daily sampling was done on 26% of the inpatients and 12% of outpatients. Blood sampling was started as early as at 4:30 AM in the Division of Internal Medicines, at 5:00 AM in 8 and at 5:30 AM in 5 divisions. In NICU and Pediatrics, bleeding was done by pediatricians, starting at 7:00 and 7:50 AM respectively. The mean time from sampling to transportation was speculated to be 3-4 hours. More informations on preanalytical as well as analytical quality control will improve our recognition to better quality control.

Kinetic analysis of enantiomers of threo-methylphenidate and its metabolite in two healthy subjects after oral administration as determined by a gas chromatographic-mass spectrometric method

A gas chromatographic-mass spectrometric method was developed for the stereoselective quantification of threo-methylphenidate (MPD) and its metabolite, ritalinic acid (RA), in plasma or urine. The plasma concentrations of (+)-MPD after oral administration of two 10-mg conventional tablets containing racemic MPD.HCl or of 20-mg of racemic MPD.HCl crystals to two healthy subjects were much higher than those of the (-)-isomer. The plasma concentrations of the metabolite, (-)-RA, were higher than that of the (+)-isomer during the first 4 h after administration of racemic MPD.HCl in both tablet and crystal forms. Although in urine both (+)- and (-)-RA were largely excreted in 48 h (37 and 40% of the dose, respectively), the percentage excretion of (-)-RA during the first 3-4 h was approximately twice that of the (+)-isomer. These results suggest that one reason for the difference in the plasma levels between (+)- and (-)-MPD may be due to differences in their rates of metabolism. Pharmacokinetic parameters of (+)-MPD after administration of 10 mg of (+)-MPD.HCl crystals were almost the same as those after administration of racemic MPD.HCl crystals. The AUC infinity 0 of (-)-MPD after administration of 10 mg of (-)-MPD.HCl crystals was smaller than that after administration of racemic MPD.HCl crystals.

Sex difference of the metabolic disposition of clioquinol in rats

The order of plasma levels of clioquinol and its conjugates in male rats after intraduodenal administration of 32.7 mumol/kg dose of clioquinol was clioquinol sulfate (C-Sul) greater than glucuronide (C-Glu) much greater than clioquinol, whereas that in female rats was C-Glu greater than C-Sul much greater than clioquinol. Total (urine + bile) recovery was almost the same among male and female rats. The percentage of excretion amounts of C-Sul (urine + bile) to the total excretion amounts for 24 h in male rats after intravenous administration of clioquinol was about twice that in female rats, while the percentage of excretion amounts of C-Glu to the total excretion amounts in male rats was smaller than that in female rats. In intravenous administration of 16.4 mumol/kg dose of C-Glu, C-Sul and clioquinol other than C-Glu were found in bile and urine of male and female rats. The percentage of excretion amounts of C-Sul and C-Glu (urine + bile) to the total excretion amounts was similar among male and female rats, respectively. In intravenous administration of 16.4 mumol/kg dose of C-Sul, C-Glu and clioquinol other than C-Sul were found in bile and urine of male and female rats, and the percentage of excretion amounts of C-Sul (urine + bile) to the total excretion amounts in male rats was 1.3 fold that in female rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of ambenonium in biological samples by reversed-phase ion-pair liquid chromatography

A sensitive and selective analytical method for the determination of ambenonium ion in biological samples is described. The procedure involves ion-pair extraction of the drug, followed by reversed-phase ion-pair chromatographic analysis with ultraviolet detection at 217 nm. The detection limits at a signal-to-noise ratio of 5 were 100 pmol/ml using 0.2 ml of plasma and bile, 250 pmol/ml using 0.2 ml of urine and 200 pmol/g using 1 ml of tissue homogenates containing 0.1 g/ml of each tissue. This assay procedure was used to study the pharmacokinetics of ambenonium ion after intravenous administration in rats.

Determination of pemoline in plasma, urine and tissues by reversed-phase high-performance liquid chromatography

A simple and selective high-performance liquid chromatographic method with ultraviolet detection at 215 nm for the determination for pemoline in rat plasma, urine and tissues is described. Pemoline in the samples was extracted with methylene chloride at pH 10 and the organic phase was evaporated after adding 5-methyl-5-phenylhydantoin used as an internal standard. Pemoline and the internal standard were separated on a Kaseisorb LC C8-60-5 reversed-phase column. The limits of determination of pemoline in 0.1-0.2 ml of plasma, urine and tissue homogenates were 2, 100 and 20 ng, respectively. The method should be useful for studies of the pharmacokinetics and distribution of pemoline in small animals.

Changes in lipid peroxide concentrations in plasma and tissues by repeated administration of clioquinol to neonatal rats

The changes in lipid peroxide concentrations in plasma and tissues after subcutaneous administration of clioquinol to clioquinol-sensitive (S-rats) and -resistant neonatal rats (R-rats) were investigated. When a fixed dose of 150 mg/kg/d of clioquinol was given to R-rats for 14 d after birth, no significant difference in lipid peroxide concentrations in plasma, liver, kidney, brain and spinal cord at 5, 10 and 15 d was observed between clioquinol-treated and untreated rats. However, with increasing doses of clioquinol to R-rats every 5 d (150----300----600 mg/kg/d), the lipid peroxide concentrations at 15 d were higher in plasma, brain and spinal cord of clioquinol-treated rats than in those of untreated rats. These results suggested that repeated administrations of large doses of clioquinol to rats increased the lipid peroxides in nerve tissues. With S-rats at 5 d after birth, the lipid peroxide concentrations in liver were approximately twice those in R-rats regardless of the clioquinol administration.

Postnatal appearance of glycoconjugate with terminal N-acetylgalactosamine on the surface of selected neurons in mouse brain

Selected neurons in the cortex and other regions of the brain of adult mice stain with Vicia villosa agglutinin (VVA) conjugated to horseradish peroxidase (HRP). This staining demonstrates glycoconjugate with terminal N-acetylgalactosamine (GalNAc) in periodic foci on the neuronal surface. However, brains from mice at 1 week of age lacked neurons with surface reactivity for VVA-HRP but showed neurons with faint cytoplasmic staining. Two weeks postnatally, infrequent cortical neurons located mostly in layer IV disclosed light surface affinity for VVA-HRP. The deep cerebellar nucleus at 2 weeks revealed VVA-positive neurons that were less abundant than in adults but exceeded in number the stained neurons in the cortex of 2-week-old mice. By 3 weeks of age the prevalence of positive neurons in cortical layers II-VI and the deep cerebellar nucleus and the intensity of the surface staining approximated that observed in adult mice. No staining of fiber tracts was observed 1 week postnatally. However, certain tracts exemplified by decussating fibers in the basal pontine region showed strong VVA-HRP reactivity in brains of 2-week-old mice as in adults. Acquisition of VVA surface affinity 3 weeks postnatally coincided with the appearance of cytosolic immunostaining for glutamic acid decarboxylase in a population of GABAergic neurons in the cortex. These findings demonstrate the postnatal development of GalNAc-containing glycoconjugate associated with selected neurons and the variable acquisition of the glycoconjugate among these neurons possibly related to onset of function.

Absorption, distribution and metabolism of clioquinol in clioquinol-sensitive and -resistant neonatal rats

Three types of rats with respect to sensitivity to clioquinol have been identified, the highly sensitive (S-rat), the intermediately sensitive, and the resistant (R-rat). In a toxicity test that lasted for 20 d after birth, the difference in sensitivity to clioquinol between S- and R-rats was confirmed by repeated subcutaneous administration of a clioquinol suspension prepared with polysorbate 80 (clioquinol dose of 150 or 300 mg/kg/d). Plasma and tissue concentrations of clioquinol and the rate of metabolism of the drug in neonatal S- and R-rats were measured. Plasma concentration of clioquinol in 1-d-old S-rats after a single subcutaneous administration was higher than that in the same age R-rats and the area under the mean plasma concentration-time curve for the S-rats was approximately twice that for the R-rats. In addition, clioquinol concentrations in liver, kidney and brain of S-rats at 9 h after the administration were more than twice those of the R-rats. From the experiments on the formation of clioquinol glucuronide and sulfate with 9000 g supernatant fraction of liver, it was suggested that the difference in the plasma concentration after the administration may be responsible for the difference in the metabolizing rate of clioquinol.

Lectin cytochemical evaluation of somatosensory neurons and their peripheral and central processes in rat and man

Paraffin sections of the trigeminal nerve root of the rat, and human spinal nerve root and trigeminal ganglion were stained with a battery of lectin-horseradish peroxidase conjugates to localize and characterize glycoconjugate (GC) in situ. In the rat the myelin sheath of the peripheral segment contained GC with sialic acid most probably linked to the penultinate disaccharide galactose-(beta 1----4)-N-acetylglucosamine (Gal(beta 1----)-GlcNAc), and complex type N-glycosidic side chains. The myelin sheath in the central segment differed in containing little if any of the GC named above and in containing GC with terminal beta-Gal linked to N-acetylgalactosamine (GalNAc), terminal GalNAc and fucose. Schwann cells stained for GC with GlcNAc or mannose whereas oligodendroglia stained for GC with the terminal disaccharide Gal-(beta 1----3)-GalNAc and N-glycosidic side chains, especially in presumed Golgi zones, but also in processes continued as the outer myelin sheath. The human myelin sheath in the central segment differed from that of the rat in not staining with lectins specific for fucose and terminal GalNAc. Sialic acid and terminal beta-Gal were seen in the human central segment but these sugars appeared to bind to astroglial structures rather than to the myelin sheath as in the rat. Astrocytes in both rat and man were stained by two fucose-binding lectins. Several lectins revealed affinity for GC in the neurilemmal sheath, and staining of this structure was stronger in the human specimens. Neurons in the human trigeminal ganglion ranged from unstained to strongly positive for fucoconjugate in cytoplasmic bodies and plasmalemma. Positive ganglion cells gave rise to unmyelinated fibers which also stained for fucoconjugate. Remak fibers and their extensions into the substantia gelatinosa of the human spinal cord stained strongly for content of fucose. The stronger lectin affinity for N-glycosidic core sugars in the peripheral as compared with the central segment suggests that lectins localize Po protein in peripheral myelin. The reactivity for several sugars in the central segment can possibly be attributed to myelin-associated glycoprotein (MAG) of central myelin, but lectin staining for GalNAc shows in addition a biochemically unrecognized GC with O-glycosidic linked oligosaccharides in myelin. The lectin cytochemistry indicates that the 170 K Dalton glycoprotein with PNA affinity obtained from rat sciatic nerves occurs in nodes of Ranvier.

Aneurysms protruding from the dorsal wall of the internal carotid artery

Saccular aneurysms arising at locations other than at arterial divisions are extremely rare. The authors describe eight such aneurysms that protruded from the dorsal wall of the internal carotid artery (ICA) and were unrelated to any arterial junction. Radical surgery was performed in all eight cases. The aneurysms were saccular with a fragile wide or semifusiform neck. Intraoperative rupture occurred in three cases. From this experience, it is emphasized that these unusual protruding aneurysms of the dorsal ICA should be clipped with the clip blade parallel to the parent artery. In addition to clipping, complete wrapping with fascia or Bemsheet (cellulose fabric) is often advisable to prevent slippage of clips or postoperative rupture of residual aneurysm.

GABAergic neurons of rodent brain correspond partially with those staining for glycoconjugate with terminal N-acetylgalactosamine

Sections of fixed, paraffin-embedded brain from mice and rats were stained with agglutinin from Vicia villosa conjugated to horseradish peroxidase (VVA-HRP) to localize glycoconjugate containing terminal N-acetylgalactosamine (GalNAc). VVA-HRP binding sites were localized in periodic foci at the surface of a selective population of non-pyramidal interneurons in layers II through IV of the rodent cerebral cortex. These multipolar interneurons were shown to utilize gamma-aminobutyric acid (GABA) as a transmitter and thus to be GABAergic by their immunostaining for glutamic acid decarboxylase (GAD) throughout the cytoplasm in serial sections. Pyramidal and other non-pyramidal cortical neurons received GABAergic input as evidenced by punctate immunostaining for GAD on their soma and proximal dendritic arborizations, but these cells failed to show VVA affinity or cytosolic GAD reactivity. Most neurons in the thalamic reticular nucleus stained for the presence of glycoconjugate with terminal GalNAc on their surface and for GAD in the cytosol. In contrast, cerebellar Purkinje cells showed strong cytosolic reactivity with anti-GAD but lacked surface staining with VVA-HRP. These observations show that some but not other populations of GABAergic neurons possess binding capacity for VVA on their surface. The surface of neurons in the deep cerebellar nucleus stained heavily with VVA but failed to show clear cytosolic reactivity for GAD. Some neurons with surface glycoconjugate containing terminal GalNAc are therefore not GABAergic.

The immunocytochemical demonstration of copper-zinc superoxide dismutase in the brain

Copper-zinc superoxide dismutase (CuZn-SOD) has been localized in formalin-fixed, paraffin-embedded sections of both canine and rat brains. Staining with an immunoenzyme bridge sequence revealed CuZn-SOD in all regions of the brains examined. Specific sites of localization included cerebral cortical pyramidal cells, cerebellar Purkinje cells, neurons in 'subcortical nuclei', and oligodendrocytes throughout the brain. Similar sites of CuZn-SOD localization were identified in both species. These results are compared with reports by various investigators of SOD bioactivity in the brain.

Selective cytochemical demonstration of glycoconjugate-containing terminal N-acetylgalactosamine on some brain neurons

Paraffin embedded sections of rat, mouse, dog, and human brain were stained with a battery of lectin-horseradish perioxidase conjugates to localize and characterize glycoconjugates. In the rat and mouse cerebral cortex, a subpopulation of nonpyramidal neurons stained selectively with three lectins with specific affinity for terminal N-acetylgalactosamine (GalNAc). These and only these lectins stained the surface of the cell body, dendritic shafts, and proximal parts of the dendritic arborization. Most reactive, nonpyramidal neurons revealed a multipolar dendritic pattern, but some possibly belonged to the bitufted and bipolar types of neuron. The GalNAc-containing neurons appeared widely distributed in layers II-VI with relatively greater abundance in layers IV and V. In the cortex of rats and mice the stained neurons occurred in moderate numbers in the frontal, frontoparietal, striate, retrosplenial, and entorhinal regions, but were less numerous in the hippocampal gyrus, dentate gyrus, and olfactory area. Other neurons in the basal ganglia and brain stem stained weakly for GalNAc. Examination of the frontal cortex of human and canine brains showed a similar distribution of nonpyramidal neurons with affinity for GalNAc-binding lectins. At high magnification, the surface staining of neurons in the cerebral cortex, deep cerebellar nucleus, and other sites appeared periodic rather than continuous. The periodic character of the neuronal surface staining suggested a location for the reactive glycoconjugate in or between the synapses. The GalNAc-containing glycoconjugate occurred in a selected cell type, failed to bind the other lectin conjugates, and differed from biochemically detected glycoconjugates. It is, therefore, considered a newly recognized entity of possible physiologic significance for a population of cortical neurons.

Lectin cytochemistry of cell types in human and canine pituitary

Labeled lectins specific for different sugars were employed to identify different cell types in pituitaries from six human autopsies and seven dogs. To determine the lectins bound by each cell type, fixed-paraffin embedded sections serial to those stained with lectins were immunostained for specific hormones and the serial pairs were examined in a comparison microscope. In human pituitaries corticotrophs stained selectively with lectins having affinity for alpha-L-fucose and the core region of complex type N-glycosyl-proteins. Some corticotrophs also stained for the presence of terminal beta-galactose. Thyrotrophs stained selectively with a periodate oxidation-borohydride reduction-concanavalin A sequence. Some mammotrophs evidenced content of glycoconjugate with terminal beta-galactose. Dendritic cells stained selectively for abundant glycogen with the periodate-reduction-concanavalin A sequence and a lectin from Griffonia simplicifolia. Adenohypophyseal cells of dog pituitary differed in showing absence of terminal beta-galactose in corticotrophs, presence of terminal beta-galactose in thyrotrophs, presence of glycoconjugate with N-glycosidically bound oligosaccharide in thyrotrophs and gonadotrophs and presence of terminal beta-galactose with a different lectin affinity in mammotrophs. The main contributions of lectin histochemistry applied to the pituitary include providing an additional histologic method for identification of some cell types, and localizing glycosylated prohormone or other biochemically unrecognized non-hormone glycoconjugates whose function in pituitary cells remains to be explained.

Biological properties of griseolic acid, a cyclic AMP phosphodiesterase inhibitor with an adenine group

Griseolic acid inhibited cAMP phosphodiesterase (PDE) at low concentrations, the I50 being of the order of 0.01-0.1 microM. Administration of griseolic acid to rats increased the cAMP level in liver and plasma several-fold. It increased glycogen degradation in mouse liver and stimulated lipolysis in isolated rat fat cells. Griseolic acid did not block the adenosine-elicited accumulation of cAMP in guinea pig brain slices. It had no effect on cAMP-dependent protein kinase from rat liver nor on the adenyl cyclase from rat brain.

Glycoconjugate localization with lectin and PA-TCH-SP cytochemistry in rat hypophysis

Glycoconjugates were localized by light microscopy with lectin-peroxidase conjugates and by electron microscopy with the periodic acid-thiocarbohydrazide-silver proteinate (PA-TCH-SP) sequence in immunocytochemically or morphologically identified cell types in rat pituitary. Lectin histochemistry demonstrated sialic acid and glycoconjugates with N-glycosidically linked oligosaccharides in gonadotrophs, thyrotrophs, and corticotrophs. Galactose penultimate to sialic acid was observed mostly in gonadotrophs. The terminal galactose-N-acetylgalactosamine disaccharide was detected in a few gonadotrophs and in a moderate number of mammotrophs. Fucose was localized in only corticotrophs with two fucose-binding lectins and in thyrotrophs with another. Several different monosaccharides were seen in glycoconjugates in melanotrophs and in Herring bodies. Melanotrophs displayed heterogeneous staining with fucose-binding lectins. A small number of nonsecretory cells were also visualized in the pars distalis by virtue of their glycogen content. PA-TCH-SP staining revealed complex carbohydrates in secretory granules and some Golgi cisternae in all types of hormone-producing cells in the pars distalis except for the somatotrophs. Melanotrophs of pars intermedia exhibited stained secretory granules and irregular dense bodies containing a stained meshwork. Corticotrophs of the pars distalis lacked the latter bodies, although they form the same glycoprotein precursor hormone as melanotrophs. Lectin conjugates and the PA-TCH-SP sequence stained some groups of secretion granules in Herring bodies, possibly representing vasopressin-containing granules as well as other cell types in the pars nervosa.