Periodic mobile application (eMOM) with self-tracking of glucose and lifestyle improves treatment of diet-controlled gestational diabetes without human guidance: a randomized controlled trial

BACKGROUND

Digitalization with minimal human resources could support self-management among women with gestational diabetes and improve maternal and neonatal outcomes.

OBJECTIVE

This study aimed to investigate if a periodic mobile application (eMOM) with wearable sensors improves maternal and neonatal outcomes among women with diet-controlled gestational diabetes without additional guidance from healthcare personnel.

STUDY DESIGN

Women with gestational diabetes were randomly assigned in a 1:1 ratio at 24 to 28 weeks' gestation to the intervention or the control arm. The intervention arm received standard care in combination with use of the periodic eMOM, whereas the control arm received only standard care. The intervention arm used eMOM with a continuous glucose monitor, an activity tracker, and a food diary 1 week/month until delivery. The primary outcome was the change in fasting plasma glucose from baseline to 35 to 37 weeks' gestation. Secondary outcomes included capillary glucose, weight gain, nutrition, physical activity, pregnancy complications, and neonatal outcomes, such as macrosomia.

RESULTS

In total, 148 women (76 in the intervention arm, 72 in the control arm; average age, 34.1±4.0 years; body mass index, 27.1±5.0 kg/m2) were randomized. The intervention arm showed a lower mean change in fasting plasma glucose than the control arm (difference, -0.15 mmol/L vs -2.7 mg/mL; P=.022) and lower capillary fasting glucose levels (difference, -0.04 mmol/L vs -0.7 mg/mL; P=.002). The intervention arm also increased their intake of vegetables (difference, 11.8 g/MJ; P=.043), decreased their sedentary behavior (difference, -27.3 min/d; P=.043), and increased light physical activity (difference, 22.8 min/d; P=.009) when compared with the control arm. In addition, gestational weight gain was lower (difference, -1.3 kg; P=.015), and there were less newborns with macrosomia in the intervention arm (difference, -13.1 %; P=.036). Adherence to eMOM was high (daily use >90%), and the usage correlated with lower maternal fasting (P=.0006) and postprandial glucose levels (P=.017), weight gain (P=.028), intake of energy (P=.021) and carbohydrates (P=.003), and longer duration of the daily physical activity (P=.0006). There were no significant between-arm differences in terms of pregnancy complications.

CONCLUSION

Self-tracking of lifestyle factors and glucose levels without additional guidance improves self-management and the treatment of gestational diabetes, which also benefits newborns. The results of this study support the use of digital self-management and education tools in maternity care.

Gyroscope sensor data of shank motion during normal and barefoot walking

In recent years, shank angular velocity (SAV) has emerged as a valuable tool for accurate temporal gait analysis and motion pattern assessment. To explore SAV among healthy subjects and its capability to distinguish differences between walking conditions, three-dimensional SAV data was measured with a gyroscope sensor during normal and barefoot walking. The resulting dataset contains measurement data from 58 healthy adult subjects aged 19 to 75 years. A single gyroscope was positioned on the lateral side of both shanks just above the lateral malleolus. The data collection involved the subjects walking a 10 m distance three times, both wearing shoes and barefoot. The subjects were instructed to walk with their own natural walking velocity, and each walk began from a stationary position. The dataset has the potential to provide information on how height and weight affect gait kinematics and how barefoot walking differ from walking with shoes. The data also supports designing the collection protocol for more extensive datasets of IMU-based shank motion during gait.

Unsupervised gait detection using biomechanical restrictions

Quantification of human gait with sensors has enormous potential in health and rehabilitation applications. Objective measurement of gait features in the home and community can reveal the true nature of impact of disease on activities of daily living or response to interventions. Previously reported gait event detection methods have achieved good success, yet can produce errors in some irregular gait patterns. In this paper, we propose a novel unsupervised detection of gait events and gait duration by combining two exclusive processes: (i) exploration of gait event candidates based on iterative running of existing methods with changing parameters and, (ii) selection of the candidate which satisfies gait-specific biomechanical restrictions (e.g., when one leg is in swing, another leg is likely to be in stance). We evaluated this approach using data from a single-axis gyroscope on the left and right ankles in three experimental conditions. The proposed method decreased the timing error for detection of gait events (toe off and heel strike) in irregular gait patterns compared with the conventional method. It also improved the accuracy of measurement of gait duration in a longitudinal free-living dataset and distinguishing gait from non-gait actions.

The Characteristics of Amorphous Silicon TFT and its Application in Liquid Crystal Display

An amorphous silicon TFT particularly suited for the full color liquid crystal display driver has been developed and reported here. Various fundamental factors involved in the a-Si TFT, such as the effects of structure, materials, and the method of fabrications were reviewed and investigated in terms of the field effect mobility, the threshold voltage and the reliabilities. An inverted-staggered TFT structure was employed for the purpose wherein the interface states between two layers was successfully lowered by employing the successive deposition procedures of SiNx gate insulator on the a-Si layer. Proper ohmic contacts and the blocking of hole injections were accomplished by forming a n+ layer between the a-Si layer and the source/drain metal electrodes which consists of a double layer of Al/MoSi2 in order to prevent the aluminum diffusion into the a-Si layer during the 300°C heat treatment at the succeeding fabrication processes. The degradation of display images due to the high intensity backlights was minimized by employing a light shielding layer and by making the thickness of a-Si layer 200 Å against the direct sunlight of up to 100,000 luxes. Stable actual performances of TFT for more than 4000 hours at 80 °C were confirmed. The development of a color LCD TV driven by this TFT is also reported.

Light-Emitting Diodes Using Semiconducting Oligothiophenes

The light-emitting diodes (LEDs) using semiconducting oligothiophenes, dimethylquater-thiophene (DMQtT, tetramer), dimethylquinquethiophene (DMQqT, pentamer) and dimethyl-sexithiophene (DMSxT, hexamer), have been investigated. These oligomers were deposited on ITO-coated glass in ultra high vacuum and an aluminum electrode was subsequently vacuum-deposited on top of the oligomers. These structures have the diode configuration with Schottky barrier between the oligomers and aluminum.

The LED using DMSxT shows good rectifying feature with the rectifying ratio of 1500 at ±10V.Red-orange emission is clearly observed above 4V bias. In this LED, DMSxT acts not only as an emitting layer but also as a hole transport layer. We have also fabricated and studied alternate layered structures of DMSxT/DMQtT and DMSxT/DMQqT as the emitting layer. In these configurations, the carrier recombination can be modulated because both DMQtT and DMQqT have energy gaps wider than that of DMSxT.The quantum efficiencies (photons emitted per carriers injected) of the LEDs using DMSxT/DMQtT and DMSxT/DMQqT are about one hundred times and one thousand times larger than that of the LED solely based on DMSxT, respectively. These results indicate that the layered structures are advantageous in increasing quantum efficiency of the emission.

Inhibition factor of ammonification in stored urine with fecal contamination

Inhibition factors of urea hydrolysis caused by fecal contamination as source of urease were investigated. The urea hydrolysis was described by initial ammonification rate (IAR). Three factors for the inhibition (pH, free ammonia nitrogen (FAN) and salinity) were investigated in this study. It was found that the optimum pH value for the urea hydrolysis was obtained at pH 7 (30 degrees C). Similar results were obtained from pH 5 to pH 8 whereas pH 9 provided a little amount of negative effect on the hydrolysis. Significant effect of the FAN as inhibition factor on the urea hydrolysis was obtained in the urea solution: the hydrolysis was observed within 120 mg-N/l of the FAN level in artificial urea solution with fecal contamination. However in storage process of real urine the urea hydrolysis was observed until the FAN level increased up to 2,000 mg-N/l. Salinity obviously provided negative effect on the urea hydrolysis in stored urine with fecal contamination at 30 degrees C. It was assumed that high concentration of the NaCl (150 g/l) was required to achieve 50% reduction of the IAR.

Experimental study on nitrogen components during composting process of feces

We measured nitrogen components during composting process of feces in a batch test in which sawdust was used as a matrix. Further decomposition rates of fecal nitrogen and carbon were obtained in the batch tests of different feces loading. In composting material that was a mixture of sawdust and fresh feces, fecal organic matter decomposed to CO2 and fecal nitrogen mineralized to ammonia during the composting process. The biological response of organic matter and nitrogen in the composting material was evaluated by oxygen consumption (OUR) and ammonia production that was a sum of volatilized ammonia gas and ammonia remaining in the composting material. Since composting material contains two different sources of organic matter from feces and sawdust, the OUR by using the sawdust matrix only was evaluated in preliminary tests. The fecal contribution to the OUR in the composting material was therefore calculated by subtraction of the result in the preliminary tests from the one in the composting material. The ammonia production from the fecal nitrogen was obtained by the same procedure. The decomposition rates of input organic matter in feces were approximately 83 and 70% respectively, whereas ammonia production rates were approximately 73 and 58% of input fecal nitrogen. There was an interesting time lag of the peak time between volatilisation rates of ammonia and CO2 during the composting process while fecal carbon and nitrogen simultaneously decomposed to ammonia and CO2 in the composting material.

Aberrant vertebral artery course in a case of Chiari malformation and occipitoatlantal assimilation. Case report

tThe authors report an unusual case of a patient with combined vertebral artery and Chiari malformation anomalies. Unless such anomalies are properly recognized prior to decompression and fusion, this condition can have grave surgical consequences. The diagnostic and surgery-related implications of such anomalous codiseases are discussed.

Pituitary apoplexy as a consequence of lymphocytic adenohypophysitis in a pregnant woman: a case report

OBJECTIVE AND IMPORTANCE

A patient with pituitary apoplexy resulting from lymphocytic adenohypophysitis, which caused visual disturbance during pregnancy, is described. This is the first report of such case.

CLINICAL PRESENTATION

A 23-year-old primigravida in her 25th week of gestation experienced headache and bitemporal hemianopsia of sudden onset. Magnetic resonance imaging (MRI) revealed a large pituitary mass with intratumoral hemorrhage. Although conservative treatment with intravenous glycerol improved the symptoms partially, the visual symptoms worsened again 6 weeks later. After delivering a girl by scheduled caesarean section her visual symptoms improved. Despite the symptomatic improvement, MRI showed the chiasmatic compression by the enlarged pituitary gland had not changed. Therefore, trans-sphenoidal surgery to decompress the chiasm was performed. Necrotic tissue was seen exuding behind the enlarged pituitary gland and adenohypophysitis with bleeding (apoplexy) was diagnosed histologically. After follow-up for 40 months, she was doing well without any visual or neurological deficits.

CONCLUSION

Although relatively rare, pituitary apoplexy as a consequence of lymphocytic adenohypophysitis should be borne in mind when a pregnant woman presents with headache and visual disturbance of sudden onset.

Time-intensity trade of bilaterally bone-conducted sounds in normal hearing subjects

OBJECTIVE AND METHODS

In an effort to examine the rules by which information of bilaterally applied bone-conducted signals arising from interaural time differences (ITD) and interaural intensity differences (IID) is combined, data were measured for continuous 500 Hz narrow-band noise at 60 dBHL in 30 normal-hearing subjects using a centering method. Time-intensity trading functions were obtained by means of a sound image shifted towards one side by presenting an ITD, and shifted back to a centered sound image by varying the IID in the same ear. ITD values were varied from -600 to +600 microseconds at 200 microseconds steps, where negative values indicate delays to the right ear.

RESULTS

Time-intensity trading functions in response to bone-conducted signals showed significantly lower discrimination thresholds across IIDs, when compared to a control group with applied air-conducted signals. These findings can be interpreted as a constructive interference effect related to the intimate mechanism of bilateral bone conduction, where interaural time differences play a major role.

CONCLUSION

Time-intensity trade of bilaterally bone-conducted sounds in normal-hearing subjects is the highly sensitive. The high speed of sound through the skull may be the main reason for the high sensitivity of time-intensity trading.

Tilting operating table with self-control foot switch: a new neurosurgical tool

BACKGROUND

Observation of the surgical field from all directions is essential in microneurosurgery. A tilting operating table operated by the surgeon can satisfy this need.

METHODS

A tilting operating table operated by the surgeon using a foot switch was developed by modifying the Sugita table incorporating the X-Y shifter.

RESULTS AND CONCLUSIONS

The modified operating table allows the surgeon to move the patient in the head up or down directions, as well as the left side down or right side down directions, so the surgical field can be inspected from all aspects without changing the vertical axis of the operating microscope.

Snare technique of vascular transposition for microvascular decompression--technical note

Recurrence of trigeminal neuralgia (TN) or hemifacial spasm (HFS) after microvascular decompression (MVD) is not rare. The prosthesis material eventually adheres to the neurovascular structures and again transmits arterial pulsation to the nerve. A snare ligature technique using a Gore-Tex tape can be used for the transposition of the offending artery. No prosthesis is necessary once the transposition is complete. This technique requires introduction of either Gore-Tex tape or thread around the artery and suture over the petrous dura, so an adequate working space as if operating in a shallow basin is essential. Therefore, the osteoplastic craniotomy is a little larger than usual with the scalp flap entirely reflected using a semicircular skin incision. The Gore-Tex tape can be directly snared around the artery and sutured over the petrous dura. If this procedure is difficult, a thread can be attached to both ends of the Gore-Tex tape to pass the tape around the vessel. Seven patients with TN and 13 patients with HFS have undergone this surgery. Although the follow-up period is not yet long enough, there has been no case of recurrence. The present technique for MVD can provide complete and permanent transposition of the offending artery.

[Surgery of AVM of the inferior medullary velum by the uvulotonsillar approach--advantage of moving of the cerebellar tonsil: technical case report]

An incidentally found arteriovenous malformation (AVM) of the inferior medullary velum behind the medulla was removed by the lateral approach to the fourth ventricle originally described by Seeger in 1980. A wide posterior fossa craniotomy was performed to move the cerebellar tonsil laterally with C-1 laminectomy. The tela chroidea and inferior medullary velum, the two main sheets of tissue that form the lower half of the roof of the fourth ventricle can be exposed by gently displacing the tonsils laterally without splitting the vermis. Both the cerebellomedullary and uvulotonsillar spaces were exposed. Because the lateral cerebellomedullary cistern was also exposed, the moving of the cerebellar tonsil in a lateral direction was easy to do without injuring the cerebellar tissues. The nidus was located mainly in the extrapial plane that received feeding arteries from the posterior inferior cerebellar artery. The nidus was removed in a dry field without bleeding. This report is the first report of surgical removal of unruptured AVM of the inferior medullary velum through the so-called telovelar or transcerebellomedullary fissure approach. We propose to call this approach the uvulotonsillar approach to emphasize the dissecting plane between the uvula and the tonsil.

The effects of tone exposure on the inner ear functions in the guinea pig: impact tone vs. steady state tone

The damage-risk criterion (DRC) for hearing supposes that sound exposure with equal energy implies equal risk for noise-induced hearing loss (NIHL). We measured cochlear microphonics (CM), compound action potential (CAP), endocochlear potential (EP) and K+ ion concentration in the scala media, to see if the same level of Leq24h (impact tone and steady state tone) induced the same physiological changes in the inner ear function or not. Regarding the equal energy principle (EEP), we also examined if the EEP is appropriate or not at exposure of moderate level tone. We also checked how the time interval between impact tones affects or not the inner ear functions at the same Leq24h tone exposure. Therefore we used exposure at 1 pulse/second or 1 pulse/3 seconds and steady state tone exposure at Leq24h=90, 85 and 80 dB. The results are the following. Both steady state and impact tone exposure causes change of the electrophysiological data. First, CM maximum output voltage after exposure to impact tone of 115 dB (Leq24h=90 dB) was lower than after exposure to a 8 kHz steady state tone of 90 dB. CAP threshold (below 10 microV) obtained after the 115 and 110 dB exposure of impact tone were 5-10 dB higher than that of steady state tone of 90 dB. The negative EP induced by impact tone exposures showed the same tendency as the CM experiments. Having more frequent pulses (1 pulse/second vs. to 1 pulse/3 seconds) showed more inhibition. The K+ concentration time course remained similar to the control when the Leq24h was low (80 dB). Impact tone exposure induced stronger effects to the inner ear at exposure of moderate level tone than that of steady state tone of Leq24h.

Light dose and time dependency of photodynamic cell membrane damage

We have investigated the light dose and time dependency of photodynamic cell membrane damage using electrophysiological methods. This study controls the level of cell membrane damage by precisely administration of the light dose. The photosensitizer used was 5',5"-bis(aminomethyl)-2,2':5',2"-terthiophene dihydrochloride (BAT). A confocal laser scanning microscope was used to provide rapid light activation (< 1 s) and the subsequent membrane damage was monitored using standard patch clamp techniques. In the presence of 49 microM BAT, light levels less than 0.94 J/cm2 led to a reversible depolarization (approximately 20 mV) and reduction of resistance (approximately 10%) within 3 s of illumination. Higher intensities of illumination (> 1.57 J/cm2) caused a complete and irreversible loss of membrane potential and cell membrane resistance within 8 s illumination. The threshold dose of light required to induce cell death by illumination in the presence of BAT was increased in the presence of the antioxidant Trolox-C.

[An autopsy case of intravascular malignant lymphomatosis with hemophagocytic syndrome, mental confusion and liver dysfunction]

A 66-year-old Japanese man was admitted to Hitachi General Hospital because of fatigue, fever, edema, and icterus. A blood examination showed anemia, leukocytosis, and hyperbilirubinemia. Antibiotics did not alleviate the inflammatory symptoms. On the 13th hospital day, the patient demonstrated mental confusion, with progressive anemia and thrombocytopenia. Bone marrow aspiration revealed an increase of macrophages showing erythrophagocytosis. A diagnosis of hemophagocytic syndrome was made, but no viral infection or hematological malignancy could be detected. The patient was treated with gamma-globulin and methylprednisolone for hemophagocytic syndrome, but died of respiratory insufficiency with progressive hyperbilirubinemia and trombocytopenia on the 29th hospital day, A postmortem examination showed proliferation of lymphoma cells within the small blood vessels of the brain, lungs, liver, and many other organs, but the bone marrow was not involved. An immunohistochemical examination resulted in a diagnosis of intravascular malignant lymphomatosis (IML) of B cell origin. No viral infection was detected with in situ hybridization methods. Although IML occasionally accompanies thrombocytopenia, infiltration of lymphoma cells in the bone marrow is rare. Lymphoma associated hemophagocytic syndrome may cause cytopenia in some patients with IML, as indicated in this case.

Experimental study on the effects of gentamicin injection on the guinea-pig: electrophysiological studies

The inner ear distortion induced by gentamicin (GM), a type of aminoglycoside antibiotic, was examined in guinea-pigs. Previous studies which investigated the function of the eighth cranial nerve and organ of Corti using cochlear microphonics (CM) and compound action potential (CAP) reported ototoxicity following experimental exposure to GM. In this report, the effects of GM on the cochlea and the eighth cranial nerve were investigated systematically by measuring CM, CAP, summating potentials induced by 90 dB (SPL) tone burst, endocochlear potential (EP) and K+ ion concentration of the endolymph. Guinea-pigs were treated with a daily intramuscular injection of GM (60 mg in 1.5 cc) at a dose of 60 mg/kg during different treatment periods. The maximum output voltage of AP was decreased by injection of GM (60 mg/kg x 24). A decrease in the CM maximum output voltage and the elevation of CM pseudothreshold were typically seen after GM injection at a test frequency of 8 kHz and a decrease in CAP was also observed. Changes in EP during 3 min anoxia were observed, in particular a decrease in the absolute value of the negative potential. The endolymph K+ ion concentration remained unchanged. These findings indicate that the diffusion potentials decreased at the same time as reduction of maximum output voltage in CM induced by GM injection.

An electrophysiological study of the effects of acute methylmercury chloride exposure on the function of the guinea pig cochlea

The inner ear function of methylmercury chloride (MMC)-exposed guinea-pigs was examined in this study. Previous studies which investigated the function of the eighth cranial nerve and Corti-organ using cochlear microphonics (CM), compound action potential (CAP) and measurement of endocochlear potential (EP) reported ototoxicity following experimental exposure to MMC. In this report, the effect of MMC on the cochlea and the eighth cranial nerve were investigated systematically by measuring CM, action potential (AP), EP and K+ ion concentration of the endolymph. Guinea-pigs were injected with 5 mg/kg MMC (using 0.2% solution) twice a week for 1-3 weeks. The maximum output voltage of AP was decreased by injection of MMC (5 mg/kg x 6). A decrease in the CM maximum output voltage and the elevation of CM pseudothreshold was seen after MMC injection. Changes in EP during 3 min anoxia were observed, especially a decrease in the absolute value of the negative potential. The endolymph K+ ion concentration remained unchanged. These findings indicate that the diffusion potentials decreased and at the same time was reduced the maximum output voltage in CM induced by MMC injection (5 mg/kg x 6) in this experiment.

Dengue hemorrhagic fever in Jakarta, Indonesia in 1988: isolation of dengue virus from patient whole blood using cell cultures

During an outbreak of dengue hemorrhagic fever (DHF) in Jakarta, Indonesia in 1988, we attempted to isolate dengue virus using mosquito cells and a medium containing heparin. Whole blood, immediately after being drawn from patients, was inoculated into Aedes albopictus cell cultures temporarily maintained in the heparin-containing medium. The overall virus isolation rate was 25% (17 of 69) samples collected within three days after admission of the patients to hospital. No virus was obtained thereafter. The successful virus isolation was apparently not related to titers of anti-dengue virus hemagglutination-inhibiting antibodies present in patients' sera. The viruses were recovered from cases of each of the four World Health Organization grades of DHF without significant differences. The technique is simple and easily performed at bedside.

Combined effects of acute lead acetate exposure and tone exposure of the guinea pig cochlea

Lead acetate exposure to humans can induce various disorders of the cranial nerves. Although vertigo and sensorineural deafness have been reported in lead workers, the dose effects of lead acetate on the cochlea and eighth cranial nerve are not well documented. We investigated the effects of lead acetate on the male albino Hartley guinea pig cochlea by measuring cochlear microphonics (CM), whole nerve action potential (AP), endocochlear potential (EP) and K+ ion concentration of the endolymph. Animals were given lead acetate by intraperitoneal injection as 20 mg/week for 4 consecutive weeks. A total dose < 80 mg did not induce electrophysiological changes in the cochlea. However, the AP output voltage (N1) decreased if the 80 mg lead acetate treatment was followed by an 80 dB tone exposure at 6 kHz during 24 h. A change was observed in CM and EP but not K+ ion concentration in the scala media.

A comparative study on the effect of pure-tone exposure of the guinea pig cochlea

Electrophysiological methods were applied to 160 healthy adult male guinea pigs in order to investigate the effects of pure-tone exposure for 24 h on the inner ear. A reduction in cochlear microphonics (CM), action potential (AP) and endocochlear potential was observed following exposure to 110 dB at 100 Hz, 100 dB at 200 and 600 Hz and 95 dB at 2 kHz. The observed K+ endolymphatic concentration during 40 min anoxia remained unchanged. In contrast K+ decreased in control animals and following exposure to pure tones varying from 110 dB at 60 Hz to 85 dB at 2 kHz. These findings indicate that high frequency tones have a greater effect on inner ear functions than those of lower frequency, decreasing the maximum output voltage of CM and AP but not changing K+ endolymphatic concentration.

Immediate changes in subcellular structures of transplanted tumors following photodynamic and laser hyperthermic therapy

BACKGROUND AND OBJECTIVE

To further understand the precise process of the tumor cell degeneration after photodynamic therapy (PDT), laser hyperthermic therapy (LH), and combined treatments using an Nd:YAG laser. It is important to examine initial morphological alteration of tumor cells after these treatments.

STUDY DESIGN/MATERIALS AND METHODS

In this study, nude mice bearing HeLa cell tumors were treated with PDT, LH, and combined treatments of the two. Tumor tissues obtained immediately after these treatments were analyzed using electron microscopy and morphometry.

RESULTS

In the combined treatments, which produced more severe effects on tumor cells, morphological features of apoptosis such as cytoplasmic condensation, blebs, and apoptotic bodies appeared in the cells, although the typical alteration in the nuclear chromatin was not seen.

CONCLUSION

Cytoplasmic alterations may proceed more rapidly than nuclear alterations in the cellular degeneration induced by the single or combined treatments of PDT and LH.

Molecular comparison of dengue type 1 Mochizuki strain virus and other selected viruses concerning nucleotide and amino acid sequences of genomic RNA: a consideration of viral epidemiology and variation

Dengue-1 (D1) Mochizuki strain was examined for its nucleotide and amino acid sequences of genomic RNA and the data obtained were compared with those of other selected virus strains reported previously. Genomic regions corresponding to C, preM and M proteins were the major subjects of study. Parts of E protein were additionally examined. Among the D1 viruses investigated, the Mochizuki virus which was isolated in 1943 in Japan was shown to be close to Philippine 836-1 strain isolated in 1984 and Nauru Island strain isolated in 1974 at the respective places, in contrast with Thai AHF 82-80 strain isolated in 1980 and Caribbean CV1636/77 strain isolated in 1977. At the same time, a difference was noted between the Mochizuki and Philippine/Nauru strains at the cleavage site of preM/M junction: Mochizuki possessed RRGKR/S sequence whereas the Philippine/Nauru had RRDKR/S. The glycosylation site in preM and hydrophobic regions at the carboxyl termini of M and E were well conserved. Significances of the data are discussed in connection with viral epidemiology and variation.

Proton beam therapy for patients with esophageal carcinoma

Fifteen patients with esophageal carcinoma (superficial, six cases; advanced, nine cases) were treated with 250 MeV proton beam irradiation with or without external x-ray irradiation (12 MV linear accelerator) from October, 1985, to May, 1991. Eleven patients were initially treated with x-ray at doses of 16.2-50.4 (mean 42.5) Gy, followed by proton beam at doses of 30.0-52.9 (mean 37.6) Gy. The other four patients were treated with proton beams alone at total doses of 75.0-88.5 (mean 81.4) Gy. The mean total dose for the 15 patients was 80.4 Gy. As a result, the primary tumor lesions of all 15 patients disappeared and complete responses were obtained. Approximately four to five months later, nine of the 15 patients developed esophageal ulcer formations at the circumferences of their primary lesions. The ulcerations were healed, however, by conservative management. There was no evidence of local recurrence throughout the observations on six cases of superficial carcinoma. Among nine advanced carcinoma patients, three relapsed into esophageal carcinoma. Recurrences were observed eight, 16 and 44 months, respectively, after the treatment. Ten of the 15 patients died, but eight died of other diseases. Three of four cases at autopsy did not show any cancer cells in irradiated primary lesions. Four of the 15 patients lived for over five years. The results suggest that a high dose of irradiation delivered by a well-defined proton field could result in improved local control and long-term survival in esophageal carcinoma without undue risk of injury to primary and adjacent organs.

The effect of 6 kHz tone exposure on inner ear function of the guinea pig: relation to changes in cochlear microphonics, action potential, endocochlear potential and chemical potentials of K(+)-ions and Na(+)-ions, using a double-barrel glass electrode

Using 97 male albino guinea pigs and applying electrophysiological methods, the effects of a 6 kHz tone were investigated at a moderate sound pressure level to the inner ear during a 24-h exposure time. Following exposure to the 6 kHz tone at 90 dB, cochleas showed decreased maximum output voltage of cochlear microphonics (CM) and action potential (AP). In the endolymph, K+ ion and Na+ ion concentrations remained unchanged during 40 min anoxia and 90 dB tone exposure. At 80 dB sound exposure decreases in maximum output voltage of CM and AP and decreases in the absolute value of EP could not be detected. Endolymph K(+)-ion Na(+)-ion concentrations were also unchanged. These findings indicate that diffusion potentials are induced at the same time as decreases of maximum output voltage in CM induced by exposure to sound at 90 dB.