Spontaneous regression of lymphovascular invasion and metastasis of malignant melanoma: ultrasound findings

This report presents a case of malignant melanoma in a 40-year-old male who underwent resection of the tumor in his right ankle. Eleven months after the resection, a subcutaneous mass was observed on his right femur. Ultrasound examination revealed a hypoechoic tubular structure in the right thigh, with a small amount of blood flow in the lesion. Using ultrasound and fine-needle aspiration, the patient was diagnosed with metastasis and lymphovascular invasion of malignant melanoma. Treatment with an immune checkpoint inhibitor was originally scheduled, but the lesion disappeared spontaneously after the fine-needle aspiration.

Self-learning followed by telepresence instruction of focused cardiac ultrasound with a handheld device for medical students: a preliminary study

Purpose

This study aimed to assess the feasibility and efficiency of self-learning with or without self-training (subjects performed scans on themselves) and telepresence instruction in focused cardiac ultrasound (FOCUS) education for medical students.

Methods

This study included 24 medical students. The participants initially completed a written pre-test and were randomized into a video lecture (participants watched a video lecture) or self-training (participants watched a video lecture and self-performed FOCUS) group. After finishing self-learning, they completed a written post-test. Then they undertook a skill pre-test and a first perception survey. Telepresence instruction was then provided. Finally, they undertook a skill post-test and a second perception survey.

Results

The written post-test total scores were significantly higher than the pre-test total scores (P < 0.001). In the skill pre-test, the scores for the video lecture and self-training groups were not significantly different (P = 0.542). The skill post-test total scores were significantly higher than the skill pre-test total scores (P = 0.008). Forty-two percent of the video lecture group participants agreed that the video lecture was effective preparation for the skill pre-test, while all participants in the same group agreed that the combination of the video lecture and telepresence instruction was effective preparation for the skill post-test.

Conclusion

This study demonstrated the feasibility and efficiency of self-learning followed by telepresence instruction on FOCUS for medical students.

Inhibitory effects of ultrasound irradiation on Staphylococcus epidermidis biofilm

PURPOSE

We aimed to investigate whether low-intensity continuous and pulsed wave ultrasound (US) irradiation can inhibit the formation of Staphylococcus epidermidis biofilms, for potential application in the treatment of catheter-related bloodstream infections (CRBSI).

METHODS

S. epidermidis biofilms that formed on the bottom surfaces of 6-well plates were irradiated on the bottom surface using the sound cell incubator system for different intervals of time.

RESULTS

US irradiation with continuous waves for 24 h notably inhibited biofilm formation (p < 0.01), but the same US irradiation for 12 h had no remarkable effect. Further, double US irradiation with pulsed waves for 20 min inhibited biofilm formation by 33.6%, nearly two-fold more than single US irradiation, which reduced it by 17.9%.

CONCLUSION

US irradiation of a lower intensity (I_SATA = 6-29 mW/cm²) than used in a previous study and lower than recommended by the Food and Drug Administration shows potential for preventing CRBSI caused by bacterial biofilms.

[The Accurate Quantification of Monoclonal Immunoglobulin by A Capillary Electrophoresis System]

The amount of monoclonal immunoglobulin (M protein) distinguishes multiple myeloma (M) from mono- clonal gammopathy of undetermined significance (MGUS) and indicates the effectiveness of treatment for MM. It should be calculated by serum total protein (g/dL) and M peak ratio (%) on the densitometry of se- rum electrophoresis. However, the ordinary method possibly overestimates the amount of M protein, be- cause this method utilizes the area from the baseline of the M peak (baseline method). For the more accu- rate measurement of M protein, in this study, we evaluated a capillary electrophoresis system that enables to extract the proper area of M peak by manual operation (peak method). Three serum samples with positive M protein were mixed with M protein negative serum at various ratio, and the measured values of M protein were compared with the theoretical values for both baseline and peak methods. All the results showed that the peak method gave the values close to the theoretical values compared with the baseline method. Espe- cially, the less M protein positive serum was mixed, the further the values by the baseline method parted from the theoretical one. In conclusion, the peak method using a capillary electrophoresis system should be introduced for the accurate quantification of M protein. [Original].

Incidence of human papillomavirus contamination of transvaginal probes in Japan and possible contamination prevention strategy

PURPOSE

To clarify the present status of human papillomavirus (HPV) contamination of transvaginal probes in Japan and propose a preventive method.

METHODS

This study was performed at three institutes: a tertiary center, secondary hospital, and primary facility. To identify contamination rates, probes were disinfected and covered with probe covers and condoms; the cover was changed for each patient. The probes were tested for HPV, and those with HPV detected were analyzed to identify the type of HPV. Next, nurses put on new gloves before covering the probe for each patient, and the probes were similarly tested for HPV.

RESULTS

A total of 120 probes were tested, and HPV was detected from a total of five probes, a contamination rate of 4.2 % (5/120). HPV was detected in all three institutes. Importantly, high-risk HPV, i.e., HPV-52, 56, and 59, was detected. After the "glove change strategy" was implemented, HPV was not detected on any of 150 probes tested at any of the three institutions.

CONCLUSIONS

In Japan, the HPV contamination rate of vaginal probes in routine practice was 4.2 %. There was no HPV contamination of probes after changing the gloves for cover exchange for each patient. This strategy may prevent HPV probe contamination.

Endothelial dysfunction by flow-mediated dilation assessed ultrasonically in patients with Kawasaki Disease

Kawasaki Disease (KD) is a febrile disorder seen in infants and young children. One of the most serious complications of the disease is coronary aneurysm. Endothelial dysfunction is considered to underlie the etiopathology of coronary aneurysm. Flow-mediated dilation (FMD), as assessed ultrasonically, is used to observe the endothelial function. The current paper summarizes, by providing a systematic review, the clinical studies that have examined endothelial dysfunction by determining the FMD ultrasonically in patients with KD. A PubMed-based search found eight articles published until 2013. Six studies reported the FMD level to be significantly lower in the patients with KD compared to controls, while two studies reported no significant difference in the FMD level between those with and without KD. Although patients with KD appeared to have endothelial dysfunction in the current summary, most reports have been associated with limitations, such as a small size and no prospective design for vascular outcomes. Further studies are therefore needed to draw definite conclusions regarding whether patients with KD suffer from endothelial dysfunction as determined by the FMD and/or whether this determination can be useful for understanding and managing vascular complications in these patients.

Coexistence of papillary thyroid cancer and Hashimoto thyroiditis in children: report of 3 cases

This report documents 3 pediatric papillary thyroid carcinoma cases with associated Hashimoto thyroiditis. In all 3 cases, hypoechoic nodules accompanied by multiple echogenic spots were noted on sonography of the thyroid. Hashimoto thyroiditis was suspected on the basis of positive thyroid autoantibody test results and pathologic examinations of thyroidectomy specimens, which revealed chronic thyroiditis with lymphocytic infiltration as the background of papillary thyroid carcinoma development. The potential for papillary carcinoma development warrants close follow-up, and meticulous sonographic examinations must be performed in children with Hashimoto thyroiditis.

Ultrasound probes as a possible vector of bacterial transmission

Ultrasound probes are usually in a direct contact with the skin when used for detecting pathologic abnormalities. The probe could be a vector of bacterial transmission, but there have been few studies on this topic.We have made such studies, briefly reviewing 1)the conditions governing a possible bacterial transmission by probe, 2) the deterioration of an ultrasound probe by alcohol disinfection, 3) a suitable method for evaluating bacterial contamination of an ultrasound probe, and 4) the best procedure for decontaminating such probes. This paper ,may lead to a formal consideration of the relationship between ultrasound probes and their roles in bacterial transmission in clinical practice.

Sonographic findings of Sister Mary Joseph's nodule from ovarian cancer

Sister Mary Joseph's nodule (SMJN), which is known as a malignant tumor metastasized to the umbilicus, is a rare condition. We report ultrasonic findings of SMJN secondary to ovarian cancer in a 66-year-old woman. The umbilical tumor was observed as a hypoechoic mass with punctate hyperechoic foci. A pathological specimen obtained by needle biopsy confirmed adenocarcinoma with psammoma bodies. A comparison of the ultrasonographic findings with the pathological findings of the resected specimen suggested that the hyperechoic foci corresponded to psammoma bodies. When hyperechoic foci are observed inside SMJN by ultrasonography, adenocarcinoma from ovarian cancer should be included in the differential diagnosis.

The relationship between serum C-reactive protein and daily physical activity in Japanese hypertensive patients

Hypertension (HT) and C-reactive protein (CRP) are risk factors of cardiovascular diseases (CVD). The current study's purpose was to investigate the relationship between serum CRP levels and daily lifestyles, including physical activity, in Japanese HT patients. Lifestyle factors, blood pressure (BP), blood cholesterol, glucose, and CRP were measured in a total of 312 HT patients (153 men/159 women, mean age: 62.6 y). Women with physical activity of ≥ 1 time/week showed significantly lower CRP levels than those without it (p < 0.05). The data suggest that regular physical activity could reduce the CRP levels in HT patients, thereby maybe preventing CVD.

Degradation of ultrasound probes caused by disinfection with alcohol

The aim of this study was to clarify the degree of degradation of ultrasonic probes that results from their disinfection with alcohol. No defect in the ultrasound beams was found in any of the probes, but a significant decrease of the brightness was found after a certain period of use of the linear-type probe. Disinfection with alcohol may degrade ultrasound probes despite its high degree of effectiveness in preventing iatrogenic bacterial transmission.

The correlation between CVR-R and carotid atherosclerosis in type 2 diabetes mellitus patients with diabetic neuropathy

We examined the relationship between the coefficient of variation in the R-R intervals (CVR-R) using electrocardiograms and the ultrasonic intima-media thickness (IMT) of the carotid artery, an atherosclerotic parameter, in type 2 diabetes mellitus (DM) patients with diabetic neuropathy (n=47, males/females: 29/18; mean age: 62 years). In this study, the CVR-R-related indexes, including CVR-R at rest (CVR-R(rest)), CVR-R with deep breaths (CVR-R(breath)) and their difference (CVR-R(breath) minus CVR-R(rest): CVR-R(dif)), were defined. Data such as body mass index, smoking habits, hemoglobin A1c, blood pressure, and serum low-density lipoprotein were collected. A significant inverse correlation was observed between max-IMT and CVR-R(dif) (beta=-0.34, p=0.042), but not CVR-R(rest) or CVR-R(breath), in multivariate analyses adjusted for all the data. Therefore, the CVR-R(dif) may serve as a clinical index for the diabetic autonomic neuropathy-atherosclerosis relation in type 2 DM patients.

Relationship between reactive oxygen metabolites and carotid intima-media thickness in subjects with hypercholesterolemia

OBJECTIVE

It was the aim of this study to investigate whether there is any relationship between oxidative stress, as assessed by the diacron reactive oxygen metabolite (d-ROM) test, and carotid atherosclerosis among hypercholesterolemic patients.

SUBJECTS AND METHODS

A well-defined group of patients with type II hypercholesterolemia (n = 81, mean age 59 years) was studied to observe the correlation between the levels of serum d-ROMs and carotid artery intima-media thickness (IMT) using B-mode ultrasound, in relation to the traditional atherosclerotic risk factors (age, sex, smoking, body mass index, blood pressure, glucose and lipid panels).

RESULTS

The mean level in low-density lipoprotein cholesterol (LDL-C) in this population was 4.45 mmol/l, d-ROMs were 323.2 Carr U, and IMT was 0.91 mm. A multiple regression analysis revealed a positive and significant correlation between IMT and d-ROMs (β = 0.27, p < 0.05), along with age and LDL-C.

CONCLUSION

These results indicate that the increased oxidative stress levels using the d-ROM test, independent of aging and increased LDL-C levels, may be associated with carotid atherosclerosis even in hypercholesterolemic patients.

Phase structure of a surface model with many fine holes

We study the phase structure of a surface model by using the canonical Monte Carlo simulation technique on triangulated, fixed connectivity, and spherical surfaces with many fine holes. The size of a hole is assumed to be of the order of lattice spacing (or bond length) and hence can be negligible compared to the surface size in the thermodynamic limit. We observe in the numerical data that the model undergoes a first-order collapsing transition between the smooth phase and the collapsed phase. Moreover the Hasudorff dimension H remains in the physical bound, i.e., H < 3 not only in the smooth phase but also in the collapsed phase at the transition point. The second observation is that the collapsing transition is accompanied by a continuous transition of surface fluctuations. This second result distinguishes the model in this paper and the previous one with many holes, whose size is of the order of the surface size, because the previous surface model with large-sized holes has only the collapsing transition and no transition of surface fluctuations.

An unusual case of a glomus tumor developing in a subcutaneous vein of the wrist

Glomus tumors are benign tumors that originate in a neuromyoarterial glomus body and most commonly occur in the subungual regions. We present an unusual case of a glomus tumor in a subcutaneous vein of the dorsum of the wrist in a 65-year-old man and describe its gray-scale and power Doppler sonographic appearance, with a brief discussion of the clinical and histologic findings.

Compressibility of gastrointestinal tract tumors during transabdominal sonographic examination: a clue to the diagnosis of gastrointestinal lymphoma

PURPOSE

To evaluate the use of sonography in the assessment of compressibility of the affected bowel in the differential diagnosis of gastrointestinal (GI) lymphoma.

METHODS

Thirty-two cases of advanced gastric cancer, 28 cases of advanced colon cancer, 7 cases of gastric lymphoma, and 6 cases of colon lymphoma were included in the study. To assess the compressibility of the affected bowel, a transducer was used to exert external compression. Deformation of the tumor and its lumen by compression was considered to indicate positive compressibility.

RESULTS

Compressibility was absent in advanced gastric and colon cancer but was present in 11/13 (85%) cases of GI lymphoma. In the diagnosis of GI lymphoma, compressibility showed 85% (11/13) sensitivity, 97% (58/60) specificity, and 95% (69/73) overall accuracy.

CONCLUSION

Compressibility of the affected bowel is a useful clue in the diagnosis of GI lymphoma.

Primary peripheral T-cell lymphoma in subcutaneous tissue: sonographic findings

We describe the sonographic findings in a case of Lennert's lymphoma, a rare type of peripheral T-cell lymphoma, involving the subcutaneous tissues of the arm. The sonographic appearance was thought to be more helpful than MRI to establish the diagnosis.

Simultaneous voiding cystourethrography and voiding urosonography reveals utility of sonographic diagnosis of vesicoureteral reflux in children

AIM

To evaluate the diagnostic potential of voiding urosonography (VUS) compared with fluoroscopic voiding cystourethrography (VCUG) under identical conditions and to evaluate potential reasons for false-negative VUS results, particularly regarding bladder concentrations of the US contrast agent, Levovist.

METHODS

Fifty-six paediatric patients (M/F 34/22, mean age 2.3 y, age range 1 mo-14 y) underwent simultaneous VUS and VCUG under identical conditions. The bladder was filled by simultaneous administration of Levovist and the X-ray contrast medium, DIP Conray. Levovist concentrations in bladders were calculated using amounts of Levovist injected and total DIP Conray infused when reflux was first observed in either procedure.

RESULTS

Sensitivities of VUS and VCUG for detection of vesicoureteral reflux (VUR) were both 86%, assuming that VUR detected by either method represented a true-positive, and no reflux by either method represented a true-negative. Patients under 24-mo of age displayed a better VUS sensitivity, of 94%. Levovist concentrations in bladders ranged from 1.8% to 23%, with older children tending to demonstrate increased bladder capacity and lower concentration. All VUS false-negative units displayed Levovist bladder concentrations of less than 5%.

CONCLUSION

The present simultaneous study suggests that: 1) the two techniques demonstrate similar sensitivity for detection of reflux; 2) sustained Levovist bladder concentrations of below 5% may not allow detection of reflux on VUS; and 3) VUS represents a suitable technique, particularly for small children whose bladder capacity is not so large.

[Laboratory examinations performed in rural practice]

Graduates from Jichi Medical School are obligated to work at rural clinics or hospitals, where most of them are the only medical doctor in the house. To understand how these graduates actually use laboratory examinations, what examinations they found most important in their practice, and when they were confident of their laboratory techniques, we designed a questionnaire to address these questions. Many respondents reported that their institutions had electrocardiographs, abdominal and/or cardiac ultrasonographs, urinalysis test paper, and portable blood glucose meters, and more than half of them reported having used these instruments without assistance in emergency situations. Moreover, a majority of the respondents said that they considered it important that a physician is able to use these instruments without the help of other staff members. Proficiency in many laboratory techniques was obtained and physicians were confident during their first postgraduate clinical practice. These responses clearly show the importance and usefulness of covering examination techniques and the principles of laboratory medicine in medical education and the first postgraduate clinical practice.

[Selection of appropriate antimicrobial agents to test and report by clinical microbiology laboratories]

Clinical microbiology laboratories in Japan have not yet established standards for selecting the most appropriate antimicrobial agents for testing and reporting antimicrobial susceptibility that are comparable to the performance standards of the National Committee for Clinical Laboratory Standards(NCCLS) in the United States of America. Selection of the most appropriate antimicrobial agents for testing and reporting was discussed by a working group(WG) consisting of medical physicians, surgeons, pharmacists, medical technologists and medical microbiologists. The WG agreed on the following basic criteria for the selection of antimicrobial agents: 1) the agent should be useful when screening various resistant bacteria, 2) the agent should serve as a useful guide for physicians and residents when selecting antimicrobial agents, and 3) the agent should be useful for controlling nosocomial infections and resistant bacteria. Clinically isolated microorganisms were classified into 7 groups based on susceptibility to antimicrobial agents. These groups were Staphylococcus spp. or Enterococcus spp., Streptococcus spp. or Haemophilus spp., enterobacteriae, glucose non-fermenting gram positive rods(NFRs), anaerobic bacteria, fungi and mycobacterium. After considering clinical and bacteriological evidence, the WG decided on several antimicrobial agents for testing in clinical microbiology laboratories in Jichi Medical School Hospital. For the NFR group, these were Piperacillin(PIPC), ceftazidime(CAZ), cefepime, imipenem, amikacin and levofloxacin(LVFX). For the enterobacteriae group, these were Amplicillin(ABPC), PIPC, aztreonam, CAZ and LVFX. For the Staphylococcus spp. or Enterococcus spp. group, these were oxacillin, ABPC, vancomycin and gentamicin. We concluded that the most appropriate antimicrobial agent for testing and reporting must be economical and agreed upon at the hospital level, although the ultimate selection must be based on the available clinical and bacteriological evidence.

Bonding to dentin with a self-etching primer: the effect of smear layers

OBJECTIVE

The purpose of this study was to investigate the effect of smear layers on the tensile bond strength to human dentin. Bond strength was determined on dumbbell-shaped specimens to determine the feasibility for clinical use of a self-etching primer.

METHODS

The dentin of extracted human teeth was exposed by grinding with either #180 or #600 abrasive paper. A self-etching primer was then applied to the prepared dentinal surfaces and left undisturbed for 30s. It was then air-dried and a photocured bonding agent applied and irradiated for 20s. A composite resin was then added to the primed dentin and light-cured for 60s to complete the bonded assemblies. Mini-dumbbell specimens (3.0 x 2.0 mm2) were prepared from the bonded samples. These specimens were stored in 37 degrees C water for 24h before tensile loading to failure at a crosshead speed of 1.0 mm/min. Surfaces of fractured specimens, both resin and dentin, were examined under a scanning electron microscope (SEM).

RESULTS

Significantly different tensile bond strengths (TBS) of 10.0+/-7.2 and 28.5+/-5.2MPa were found for #180- and #600-prepared dentin, respectively (p<0.01). The former specimens fractured within the hybridized, relatively coarse smear layer, while the latter demonstrated adhesive failure between the composite resin and an attached PMMA rod, not between the dentin and applied adhesive agent.

SIGNIFICANCE

The presence and quality of a smear layer yields significantly different bond strengths to prepared human dentin, in vitro. However, a TBS of 10+/-7MPa is evidently adequate, since self-etching primers have been well accepted in dental clinics.

Effects of topical nipradilol, a beta blocking agent with alpha blocking and nitroglycerin-like activities, on intraocular pressure and aqueous dynamics in humans

AIMS

To study the effects of topical nipradilol, a non-selective beta blocker with alpha blocking and nitroglycerin-like activities, on intraocular pressure (IOP) and aqueous humour dynamics in normal humans and in patients with ocular hypertension.

METHODS

Nipradilol (0.06%, 0.125%, 0.25%, 0.5%) was applied to normal volunteers (n = 12) to test for IOP lowering effects. In a second group of normal volunteers (n = 11), nipradilol (0.125% and 0.25%) and timolol (0. 5%) were compared for IOP lowering effects. After a single administration of 0.25% nipradilol, IOP, flare intensity in the anterior chamber, aqueous flow, uveoscleral outflow, tonographic outflow facility, and episcleral venous pressure were either directly measured or mathematically calculated. Topical nipradilol (0.25%) was administered to 24 patients with ocular hypertension twice daily for 8 weeks.

RESULTS

Administration of 0.25% nipradilol decreased IOP with a maximum reduction of 4.2 mm Hg lasting 12 hours. A single instillation of both 0.25% nipradilol and 0.5% timolol reduced the IOP in normotensive human subjects to the same degree. A single instillation of 0.25% nipradilol decreased the aqueous flow rate in the treated eye by 20%. Nipradilol produced no significant effect in tonographic outflow facility or episcleral venous pressure, but uveoscleral outflow was increased. In patients with ocular hypertension, twice daily instillation of 0.25% nipradilol decreased IOP without tachyphylaxis for the 8 week test period.

CONCLUSION

Topical nipradilol (0.25%) reduced IOP by decreasing the aqueous flow rate and probably also by increasing uveoscleral outflow. Nipradilol should be further investigated as a new antiglaucoma drug.

[Sulfonylureas and daily blood glucose profiles in elderly diabetics]

The aim of this study is to clarify the relationship between the efficacy of sulfonylureas and duration of diabetes in elderly diabetics. Daily blood glucose profiles were measured in 87 Type 2 elderly diabetic patients on sulfonylureas (tolbutamide, gliclazide or glibenclamide). Plasma glucose concentrations were determined at 08.00 (before breakfast), 10.00, 12.00 (before lunch), 14.00, 18.00 (before dinner), 20.00, 24.00, 03.00, 06.00, 08.00 hours. The subjects were divided into 4 sub-groups, according to their duration of the diabetes (< 10, 10-14, 15-19, 20 or more years). Mean plasma glucose values at 08.00, 10.00, 20.00, 03.00 and 06.00 hours were not significantly different among the four groups. However, mean plasma glucose values at 12.00, 14.00, 18.00, 00.00 hours and mean total blood glucose area under the daily profile (total BG) were significantly different among the four groups and the values in patients with a history of diabetes of 15 years or more increased. Duration of diabetes positively correlated with blood glucose values at 12.00, 14.00, 18.00, 00.00, 03.00 hours and total BG, and the dose of sulfonylureas positively correlated with blood glucose values at 12.00, 14.00, 18.00, 00.00 hours and total BG in multiple regression analysis. These results suggest that duration of diabetes and dose of sulfonylureas are important determinants of blood glucose control with sulfonylureas in elderly diabetic patients.

[An elderly case of giant infected liver cyst that decreased dramatically without percutaneous aspiration]

A 70-year-old woman was referred to our hospital for treatment of cholelithiasis. A giant liver cyst (6 cm in diameter) had been diagnosed three years earlier. On admission, she had low grade fever and hepatomegaly. High values were observed for WBC (9900/microliter), CRP (8.9 mg/dl), GPT (45 IU/l), ALP (1399 IU/l), gamma-GTP (333 IU/l) and LAP (249 IU/l). The diagnosis of infected liver cyst (8 cm in diameter) was made based on contrast-enhanced CT scan. Endoscopic retrograde cholangiopancreaticography showed no communication between the cyst and the intrahepatic bile duct. She was successfully managed with antibiotics and discharged without percutaneous aspiration the cyst. On abdominal CT scan 4 months after the discharge, the liver cyst had decreased dramatically in size (1 cm in diameter). The patient remains healthy without symptoms.

[Morning blood glucose determination in the monitoring of metabolic control in type 2 elderly diabetic cases treated by oral hypoglycemic agents]

Daily blood glucose profiles were measured in 163 Type 2 elderly diabetic cases to evaluate whether a fasting (before breakfast) or a post-prandial (after breakfast) blood glucose concentration is able to predict blood glucose values throughout the day. In the diet-treated alone group (n = 61), the percentage of daily blood glucose profiles having plasma glucose values less than the 08:00 hours (before breakfast) value were as follows: 59.0%, 32.8%, 59.0%, and 55.7% at 18.00 (before supper), 24.00, 03.00, 06.00 hours, respectively. In group treated by oral hypoglycemic agents (OHA) (n = 102), these were as follows: 45.1%, 26.5%, 52.9%, and 67.6%, respectively. In the OHA group, the mean plasma glucose value at 08:00 hours was significantly higher in patients with the lowest plasma glucose levels between 60-79 mg/dl than in patients with these levels between 80-99 mg/dl (103.7 +/- 19.6 vs 118.7 +/- 16.9 mg/dl, p < 0.01), but that at 10:00 hours was similar in the two groups (218.8 +/- 43.9 vs 214.5 +/- 40.1 mg/dl). In patients with lowest plasma glucose levels of between 60-99 mg/dl, the 08:00 hours value correlated positively with that of 24:00 (r = 0.40), 03.00 (r = 0.53), and the 06.00 hours value (r = 0.69), but no correlation was observed with the 18.00 hours value. On the other hand, the 10:00 hours value was not associated with these time-points values. Our results reveal that before breakfast plasma glucose values are more predictive of low blood glucose values in the night during sleep than after-breakfast blood glucose values, but do not predict low blood glucose values before supper in patients on OHA.

[Effect of nipradilol on aqueous flow in glaucoma patients treated with timolol]

The effect of nipradilol solution (KT-210) on aqueous flow was evaluated using fluorophotometry in 10 patients (6 primary open-angle glaucoma and 4 ocular hypertension) treated with timolol for more than one month. A single dose of 0.5% timolol was instilled into both eyes at 8 AM, and 0.25% KT-210 or placebo was instilled into both right and left eye at 11 AM; the treated eye was chosen randomly. Aqueous flow was measured every hour from 9 AM to 3 PM. There was no significant difference in pretreatment aqueous flow between the two eyes; 1.98 +/- 0.53 microliters/min in the KT-210 treated eyes, and 1.98 +/- 0.76 microliters/min in the placebo treated eyes. The flow measured 1 to 4 hours after KT-210 instillation was 1.66 +/- 0.69 microliters/min, 2.23 +/- 1.02 microliters/min, 2.20 +/- 0.67 microliters/min, and 1.68 +/- 0.64 microliters/min, respectively. This flow did not differ significantly from the flow in the placebo treated eyes (1.83 +/- 0.86 microliters/min, 1.79 +/- 0.69 microliters/min, 2.26 +/- 0.58 microliters/min, and 1.84 +/- 0.32 microliters/min).

[Anterior chamber dimensions in patients with angle-closure glaucoma measured by an anterior eye segment analysis system]

The corneal curvatures, iridocorneal angles, anterior chamber depths, and anterior chamber volumes in 26 (5 male and 21 female) patients with primary angle-closure glaucoma were measured using an anterior eye segment analysis system (EAS-1000, Nidek). The radius of corneal curvature was 7.65 +/- 0.25 mm (mean +/- standard deviation), significantly smaller than age-matched controls, and the iridocorneal angles ranged between 19 and 21 degrees. The anterior chamber depth and volume of angle-closure glaucoma eyes did not correlate with age; the depth averaged 1.90 +/- 0.41 mm, and the volume averaged 83.3 +/- 28.4 microliters.

Purification and characterization of the Pseudomonas aeruginosa NfxB protein, the negative regulator of the nfxB gene

The protein NfxB, involved in conferring resistance to quinolones in Pseudomonas aeruginosa, has a helix-turn-helix motif which is similar to that of other DNA-binding proteins. It appears to affect the membrane-associated energy-driven efflux of some antibiotics (H. Nikaido, Science 264:382-388, 1994). We constructed a plasmid that overproduced NfxB in Escherichia coli and purified the protein. Two species of NfxB (23 and 21 kDa), which are probably translated from different initiation codons, were isolated. Both proteins are also expressed in vivo in P. aeruginosa, with the 23-kDa NfxB being the major species. NfxB specifically binds upstream of the nfxB coding region as demonstrated by gel retardation and DNase I footprinting. Expression of the phi (nfxB'-lacZ+) (Hyb) gene was repressed in the presence of the nfxB gene product provided by a second compatible plasmid in E. coli. In the P. aeruginosa wild-type strain (PAO2142), NfxB was undetectable by immunoblotting; however, it was detected in the nfxB missense mutant (PK1013E). These results suggested that NfxB negatively autoregulates the expression of nfxB itself. Since the 54-kDa outer membrane protein (OprJ) (N. Masuda, E. Sakagawa, and S. Ohya, Antimicrob. Agents Chemother. 39:645-649, 1995) was overproduced in nfxB mutants, NfxB may also regulate the expression of membrane proteins that are involved in the drug efflux machinery of P. aeruginosa.

[Anterior chamber dimensions in normal subjects on Kume Island, Okinawa]

The anterior chamber dimension and axial length were studied by photogrammetry and ultrasonography in 365 normal subjects over 21 years of age on Kume island, Okinawa. There was no difference between right and left eyes in the anterior chamber dimensions, corneal curvature, or axial length. Male subjects had a larger anterior chamber and longer axial length than female subjects. The volume, depth, and diameter of the anterior chamber diminished with age and degree of hyperopia. The axial length was related to the anterior chamber dimensions, corneal curvature, and degree of ametropia. The anterior chamber dimensions and axial length in subjects over 60 years of age on Kume island were significantly smaller than in normal subjects over 60 years in Tokyo.

[Newly devised subcutaneous needle electrodes for EMG recording]

Subcutaneous needle electrodes made of stainless steel were newly devised for ease of handling and perfect insulation. This needle (phi 0.20 mm) is used for acupuncture. The electrodes had the capability to record the EMG activity easily from a certain muscle. Then, the EMG activities of the masseter muscle were recorded with both these needle electrodes and surface electrodes and the results were compared. 1. Insertion of the electrodes into the subcutaneous tissue was easily performed because of the application of the acupuncture needle and their lightness of 0.2g was effective in fixing the electrodes on the skin without causing any tension. 2. After the insertion of the needle electrodes, the impedance showed below 5 kohm immediately, and the EMG recordings during biting could be simply achieved with great stability. 3. The action potential from the needle electrodes was less than that from the surface ones. The former reacted more sensitively to the change in the distance between the electrodes, compared with the latter.

[Effects of positions of experimental premature contacts on jaw function]

The effects of different positions of experimental premature contacts on the jaw function were investigated on 6 subjects. The metal castings of 100-microns thickness were fabricated to make experimental premature contacts on each of 4 mandibular posterior teeth (from the first premolar to the second molar on the preferable masticatory side). The EMG activity of the masseter, anterior and posterior temporal muscles during maximum clenching and gum chewing as well as the mandibular movement during gum chewing were evaluated. The experimental premature contacts reduced the muscle activity, especially on the contralateral side during maximum clenching. As the premature contact was moved more posteriorly, the following results were observed. 1. The activity of the posterior temporal muscle was decreased on the ipsilateral side while it increased on the contralateral side during maximum clenching in many subjects. 2. The duration of the occlusion phase during the ipsilateral chewing was shortened in many subjects. 3. During ipsilateral chewing, a larger muscle activity was produced during the closing phase and the muscle activity produced during the occlusion phase was the least on the first molar. 4. In any chewing side, the closing and opening paths tended to go toward the chewing side.