Longitudinal change in the physical performance of older adults in the community

The primary purposes of this study were 1) to confirm age-related deterioration of physical performance in older adults longitudinally, and 2) to predict future functional status and mortality by initial level of physical performances. The subjects were 517 older adults examined both in 1992 and 1996 in the Tokyo Metropolitan Institute of Gerontology, Longitudinal Interdisciplinary Study on Aging. The same battery consisting of muscle strength, balance, walking, and manual speed was administered to the subjects in the baseline and follow-up examinations. A significant longitudinal decline was observed in all physical performances except for grip strength. The age-related decline accelerated with aging for preferred walking velocity. Inter-subject variability in walking velocity significantly increased for 4 years period. Maximum walking velocity was a common predictor for functional status and mortality. The results suggest that physical performance measures, especially maximum walking velocity, is a valid means for physical therapy to evaluate physical functioning of community-living older persons.

Elevated CO2 and nitrogen availability have interactive effects on canopy carbon gain in rice

•  Here we analysed the effects of CO₂ (C_a ) elevation and nitrogen availability on canopy structure, leaf area index (LAI) and canopy photosynthesis of rice (Oryza sativa). •  Rice was grown at ambient and elevated C_a (c. 200 µmol mol^-1 above ambient, using the free-air CO₂ enrichment, FACE) and at two N availabilities. We measured leaf area, area-based leaf N contents and leaf photosynthesis, and calculated net daily canopy photosynthesis. •  FACE plants had higher light-saturated rates of photosynthesis (P_max ) and apparent quantum yields than ambient plants, when measured at their own growth CO₂ . C_a elevation reduced the total leaf N in the canopy (N_leaf ) but had no effect on LAI, and the average leaf N content (N_leaf /LAI) was therefore reduced by 8%. This reduction corresponded well with our model predictions. Leaf area index increased strongly with N availability, which was also consistent with our model. •  Calculated canopy photosynthesis increased more strongly with N_leaf under elevated than under ambient C_a . This indicates that there is an N × C_a interactive effect on canopy carbon gain. This interaction was caused by the increase in LAI with N availability, which enhanced the positive effect of the higher quantum yield under C_a elevation.

Sharing Pacific-Rim experiences in disasters: summary and action plan

INTRODUCTION

The discussions in this theme provided an opportunity to address the unique hazards facing the Pacific Rim.

METHODS

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 3 and Theme 7 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates.

RESULTS

The main points developed during the presentations and discussion included: (1) communication, (2) coordination, (3) advance planning and risk assessment, and (4) resources and knowledge.

DISCUSSION

Action plans were summarized in the following ideas: (1) plan disaster responses including the different types, identification of hazards, focusing training based on experiences, and provision of public education; (2) improve coordination and control; (3) maintain communications, assuming infrastructure breakdown; (4) maximize mitigation through standardized evaluations, the creation of a legal framework, and recognition of advocacy and public participation; and (5) provide resources and knowledge through access to existing therapies, the media, and increasing and decentralizing hospital inventories.

CONCLUSIONS

The problems in the Asia-Pacific rim are little different from those encountered elsewhere in the world. They should be addressed in common with the rest of the world.

Interleukin-2 receptor beta subunit-dependent and -independent regulation of intestinal epithelial tight junctions

Interleukin (IL)-15 is able to regulate tight junction formation in intestinal epithelial cells. However, the mechanisms that regulate the intestinal barrier function in response to IL-15 and the involved subunits of the IL-15 ligand-receptor system are unknown. We determined the IL-2Rbeta subunit and IL-15-dependent regulation of tight junction-associated proteins in the human intestinal epithelial cell line T-84. The IL-2Rbeta subunit was expressed and induced signal transduction in caveolin enriched rafts in intestinal epithelial cells. IL-15-mediated tightening of intestinal epithelial monolayers correlated with the enhanced recruitment of tight junction proteins into Triton X-100-insoluble protein fractions. IL-15-mediated up-regulation of ZO-1 and ZO-2 expression was independent of the IL-2Rbeta subunit, whereas the phosphorylation of occludin and enhanced membrane association of claudin-1 and claudin-2 by IL-15 required the presence of the IL-2Rbeta subunit. Recruitment of claudins and hyperphosphorylated occludin into tight junctions resulted in a more marked induction of tight junction formation in intestinal epithelial cells than the up-regulation of ZO-1 and ZO-2 by itself. The regulation of the intestinal epithelial barrier function by IL-15 involves IL-2Rbeta-dependent and -independent signaling pathways leading to the recruitment of claudins, hyperphosphorylated occludin, ZO-1, and ZO-2 into the tight junctional protein complex.

Initial symptoms of acute radiation syndrome in the JCO criticality accident in Tokai-mura

A criticality accident occurred on September 30, 1999, at the uranium conversion plant in Tokai-mura (Tokai-village), Ibaraki Prefecture, Japan. When the criticality occurred, three workers saw a "blue-white glow," and a radiation monitor alarm was sounded. They were severely exposed to neutron and gamma-ray irradiation, and subsequently developed acute radiation syndrome (ARS). One worker reported vomiting within minutes and loss of consciousness for 10-20 seconds. This worker also had diarrhea an hour after the exposure. The other worker started to vomit almost an hour after the exposure. The three workers, including their supervisor, who had no symptoms at the time, were brought to the National Mito Hospital by ambulance. Because of the detection of gamma-rays from their body surface by preliminary surveys and decreased numbers of lymphocytes in peripheral blood, they were transferred to the National Institute of Radiological Sciences (NIRS), which has been designated as a hospital responsible for radiation emergencies. Dose estimations for the three workers were performed by prodromal symptoms, serial changes of lymphocyte numbers, chromosomal analysis, and 24Na activity. The results obtained from these methods were fairly consistent. Most of the data, such as the dose rate of radiation, its distribution, and the quality needed to evaluate the average dose, were not available when the decision for hematopoitic stem cell transplantation had to be made. Therefore, prodromal symptoms may be important in making decisions for therapeutic strategies, such as stem-cell transplantation in heavily exposed victims.

Claudins regulate the intestinal barrier in response to immune mediators

BACKGROUND & AIMS

To determine the functional role of immune mediators in the formation of the intestinal barrier, we have examined the regulation of claudin expression by interleukin (IL)-17 in human intestinal epithelial cells.

METHODS

Expression of claudins, extracellular signal-related (ERK) mitogen-activated protein kinases (MAPKs), and activated ERK MAPKs was determined by immunoblotting. Claudin membrane association was assessed by immunohistochemistry and claudin messenger RNA expression by Northern blot analysis. Intestinal epithelial barrier function was characterized through transepithelial electrical resistance and mannitol tracer flux.

RESULTS

IL-17 induced the development of a paracellular barrier of T84 cell monolayers. Inhibition of ERK activation with the MEK inhibitor PD98059 blocked IL-17 as well as basal development of tight junctions in T84 cells. IL-17 induced formation of tight junctions correlated with up-regulation of claudin-1 and claudin-2 gene transcription. Inhibition of MEK reduced the activated and basal expression of claudin-2 messenger RNA and protein expression. Functional MEK was required for the expression and membrane association of claudin-2 but not claudin-1 in T84 cells.

CONCLUSIONS

MEK activity is required for claudin-mediated formation of tight junctions. IL-17 is able to regulate the intestinal barrier through the ERK MAPK pathway.

Determination of optimal time for mating by artificial insemination with chilled semen using luteinizing hormone surge as an indicator in beagles

Artificial insemination (AI) was conducted using the second fraction of semen, which was collected from 15 male dogs, diluted to a total sperm count of 100x10(6) for each insemination with egg-yolk Tris (eyT) citrate acid buffer and incubated at 4 degrees C for 48 hours. Luteinizing hormone (LH) surge was detected to determine the optimal time for mating using canine LH assay kits. Artificial insemination using 100x10(6) sperm was performed on the fourth and sixth days or the fifth and seventh days after the LH surge. The conception rates were 33% (4/12) and 89% (8/9), respectively; the whelping rates also showed similar results. Serum LH and follicle stimulating hormone (FSH) concentrations were measured in nine dogs, and the mean LH concentration (+/- standard deviation) at LH surge was 15.77+/-7.66 ng/ml. The time of the LH surge detected by the canine LH assay kit was very similar to that measured by radioimmunoassay (RIA).

[A case of gastric cancer with multiple bone metastasis treated by nocturnal 5-fluorouracil infusion combined with pamidronate]

Nocturnal infusion of 5-fluorouracil (5-FU) combined with pamidronate was performed in a 62-year-old male gastric cancer patient with multiple bone metastasis. The patient was administered 500 mg of 5-FU five days a week continuously for 10 hours per day from 21 o'clock to 7 o'clock for 5 months. In addition to 5-FU, 45 mg of pamidronate was administered intravenously every two weeks. Remarkable sclerotic changes were shown during the treatment in the bone metastatic foci, and the range of motion was enlarged. Serum levels of CEA and CA19-9 were decreased to the normal levels. There were no serious side effects such as myelosuppression, diarrhea or palmo-plantar dermatitis. This combination therapy of nocturnal infusion of 5-FU with pamidronate was considered effective for gastric cancer in patients with multiple bone metastasis without serious side effects.

Exogenous thrombospondin stimulates the proliferation of non-thrombospondin-producing cells

The effects of thrombospondin (TSP) on the proliferation of two different human carcinoma cell lines (KIM-1 and CW-2) were investigated. The characterization of these two carcinoma cells by immunohistochemistry using anti-TSP antibody and anti-TSP-receptor antibody showed that the KIM-1 had TSP-receptors and TSP, while the CW-2 had only TSP-receptors. The addition of exogenous TSP (10 or 20 microg/ml) to culture medium stimulated the cell proliferation of CW-2 but not that of KIM-1. The cell count for CW-2 was increased dosage-dependently from 10.3 0.6x104/ml at zero TSP concentration to 12.9 0.6x104/ml at 10 microg/ml TSP concentration and to 14.7 0. 4x104/ml at 20 microg/ml TSP (each p<0.0001). In conclusion, though TSP promoted the proliferation of non-TSP-producing cells, it did not promote proliferation of TSP-producing cells. Therefore, it is predicted that TSP was already at saturated activity concentration in the TSP-producing cell line (KIM-1).

Reliability and validity of the Motor Fitness Scale for older adults in the community

Responses to 14 items of a questionnaire on motor fitness were collected from 990 subjects, all 65 years of age or older, living in a community. The Motor Fitness Scale was created by totalling the score for each item on the questionnaire. A second-order covariance structure analysis revealed that the Scale has a unidimensional structure with three subscales, Mobility, Strength, and Balance. The Scale appeared highly reliable with alpha = 0.92 and test-retest = 0.92. The Scale correlated with the summary physical performance score (r = 0.59). High discriminant validity, using the age and sex of the subjects, and construct validity, using their health status and level of sports participation, were confirmed for both the Scale and the summary physical performance score. The Scale can also discriminate among older persons who are at the high end of the functional spectrum that determines their level of competence in daily life. The results suggest that the Motor Fitness Scale is a feasible substitute for the application of physical performance measures in assessing the physical function of older adults in the community.

Expression of four CEA family antigens (CEA, NCA, BGP and CGM2) in normal and cancerous gastric epithelial cells: up-regulation of BGP and CGM2 in carcinomas

Four human carcinoembryonic antigen (CEA) family members, CEA (CD66e), non-specific cross-reacting antigen (NCA, CD66c), biliary glycoprotein (BGP, CD66a) and CEA gene-family member 2 (CGM2), are expressed in normal mucosal epithelia of the colon. Expression of BGP and CGM2 has recently been demonstrated to be down-regulated in colorectal adenocarcinomas. We have now investigated the expression of the 4 CEA family antigens in gastric adenocarcinoma and carcinoma cell lines in comparison with adjacent normal gastric mucosa. The transcripts of the CEA, NCA and BGP genes evaluated by reverse transcription-polymerase chain reaction were detectable at various levels in all the gastric adenocarcinoma cell lines tested, while CGM2 mRNA was detectable in the cell lines of poorly differentiated but not of well-differentiated carcinomas. The levels of CEA mRNA in normal gastric mucosa were variable but mostly increased in adenocarcinomas. The sparse expression of NCA observed in the normal tissues was markedly up-regulated in the carcinomas. In contrast to previous findings on normal and cancerous colonic tissues, the transcripts of CGM2 were totally undetectable and those of BGP were recognized only marginally, if at all, in normal gastric mucosa, while both messages were detected at significant levels in most of the gastric adenocarcinomas. This was confirmed by in situ hybridization. Our findings indicate that expression of the CEA family antigens, particularly that of BGP and CGM2, is differently regulated in epithelial cells of the colon and the stomach.

Expression of four CEA family antigens (CEA, NCA, BGP and CGM2) in normal and cancerous gastric epithelial cells: up-regulation of BGP and CGM2 in carcinomas

Four human carcinoembryonic antigen (CEA) family members, CEA (CD66e), non-specific cross-reacting antigen (NCA, CD66c), biliary glycoprotein (BGP, CD66a) and CEA gene-family member 2 (CGM2), are expressed in normal mucosal epithelia of the colon. Expression of BGP and CGM2 has recently been demonstrated to be down-regulated in colorectal adenocarcinomas. We have now investigated the expression of the 4 CEA family antigens in gastric adenocarcinoma and carcinoma cell lines in comparison with adjacent normal gastric mucosa. The transcripts of the CEA, NCA and BGP genes evaluated by reverse transcription-polymerase chain reaction were detectable at various levels in all the gastric adenocarcinoma cell lines tested, while CGM2 mRNA was detectable in the cell lines of poorly differentiated but not of well-differentiated carcinomas. The levels of CEA mRNA in normal gastric mucosa were variable but mostly increased in adenocarcinomas. The sparse expression of NCA observed in the normal tissues was markedly up-regulated in the carcinomas. In contrast to previous findings on normal and cancerous colonic tissues, the transcripts of CGM2 were totally undetectable and those of BGP were recognized only marginally, if at all, in normal gastric mucosa, while both messages were detected at significant levels in most of the gastric adenocarcinomas. This was confirmed by in situ hybridization. Our findings indicate that expression of the CEA family antigens, particularly that of BGP and CGM2, is differently regulated in epithelial cells of the colon and the stomach.

Preparation and characterization of two human carcinoembryonic antigen family proteins of neutrophils, CD66b and c, in silkworm larvae

As a step to investigate the cell adhesion mechanism and physiological roles of two CD66 antigens in human neutrophils, carcinoembryonic antigen gene family member 6 (CGM6, CD66b) and nonspecific cross-reacting antigen (NCA, CD66c), we prepared their soluble recombinant forms in silkworm larvae. Each cDNA fragment for CGM6 and NCA was ligated into the transfer vector pBK283 after modification to encode the protein lacking the membrane anchor. The resultant vectors were introduced to the Bombyx mori nuclear polyhedrosis virus, with which silkworm larvae were infected. Recombinant proteins secreted into the hemolymph of larvae at concentrations up to 1.3 mg/ml were purified by cation exchange followed by gel filtration or antibody affinity chromatography. The smaller apparent masses of the antigens compared with those of the native antigens appeared to be primarily due to incomplete glycosylation. Both recombinant antigens are quite similar to the corresponding native antigens in terms of the antigenic reactivity against a panel of CD66 monoclonal antibodies. In addition, the recombinant CGM6 and NCA exhibited cell binding activity against CHO cells expressing NCA and CGM6, respectively. Thus the two biologically active recombinant CD66 antigens prepared in large quantities in silkworm larvae should be useful for their functional studies, and our present system will be available for the production and purification of other carcinoembryonic antigen family members, whose biological functions are also unknown.

Walking patterns and finger rhythm of older adults

Walking patterns and rhythmic movement of the fingers were examined in a total of 1,134 male and female community residents 65 years of age and over. Walking patterns were characterized according to the ratio of step length divided by step rate (cadence), called the Walk Ratio, during level walking at preferred and maximum speeds. The walking pattern tended to change according to age; older subjects walked with shorter steps (smaller Walk Ratio). Rhythmic movement was examined using the finger-tapping test in time to the sound of a 4-Hz metronome. Hastened tapping or finger festination, in which the subject tapped faster than requested (constant error of 3 msec. and over in the intertap interval), was characteristic of aging; 16.8% of the subjects exhibited finger festination and the occurrence increased with age, especially among those in their eighties (29.3%). Finger festination was accompanied by walking patterns with an increased step rate, or a smaller Walk Ratio. These characteristics of aging were discussed as similar to extrapyramidal symptoms of walking and rhythm production in patients with Parkinson's disease.

[Iatrogenic injury of tracheobronchial membranous wall]

Tracheobronchial injuries remain uncommon, but they are of great significance, because they can result in death or substantinal functional compromise. Such injuries are mostly from blunt trauma and motor vehicle accidents, but there also is an incidence of penetrating thoracic trauma inclunding iatrogenic accidents. Three cases of iatrogenic injury of tracheobronchial membranous wall were reported. Two cases were tear at the membraneous portion of the left main bronchus and trachea by forceful endotracheal intubation. Another case was tracheal membranous wall injury during operation at blunt dissection for esophageal carcinoma. We reported the emergent managements for iatrogenic injury of tracheobroncheal membranous wall in differents 3 ways. We should select the best treatment according to the condition of the patients and situation of the injury.

Non-proteolytic release of carcinoembryonic antigen from normal human colonic epithelial cells cultured in collagen gel

Recent studies have shown that, even with a minimal content of carcinoembryonic antigen (CEA), normal human colonic epithelial cells express substantial amounts of CEA mRNA and colonic mucosal fragments cultured in vitro produce CEA quite actively, indicating that CEA should no longer be considered to be of an oncofetal nature. To understand the basis of the usefulness of CEA as a tumor marker, we analyzed the release of CEA, a glycosyl-phosphatidylinositol (GPI)-anchored protein, from colonic epithelial cells, by culturing isolated colonic crypts in collagen gel. The crypts appeared to preserve their morphological and biochemical integrity in the gel for at least 16 hr, and released CEA spontaneously. Three forms of CEA--spontaneously released CEA, CEA liberated with phosphatidylinositol-specific phospholipase C (PI-PLC) and CEA in cell lysates--were indistinguishable on SDS-PAGE. This is in contrast to recombinant CEA spontaneously released from CHO transfectants, which showed a smaller molecular mass than that of PI-PLC-cleaved recombinant CEA. By phase separation using Triton X-114, CEA in the cell lysates of crypts was separated mostly into the detergent phase, while the spontaneously released and the PI-PLC-cleaved CEA were separated into the aqueous phase. When the cells were metabolically labeled with the precursors of the GPI-anchor, 3H-ethanolamine but not 3H-palmitic acid was found in the spontaneously released CEA. These findings suggest that, in contrast to the proteolysis-like release of the recombinant CEA from CHO cells, CEA in normal colonic epithelial cells is released by a non-proteolytic cleavage, which probably occurs through the action of some endogenous phospholipase.

[Age-related difficulty in rhythmic movement]

In order to identify a characteristic difficulty in rhythmic movements with aging, a total of 380 healthy participants aged from 18 to 85 years (group 1), and 1,134 elderly community residents aged from 65 to 89 years (group 2), were examined using a finger-tapping test. The test requested the participant to tap in time to a periodic sound train with frequencies of 2, 3, 4, and 5 Hz (cycles/sec) for group 1, and with 4 Hz for group 2. Tapping deviated towards a faster rate from the stimulus frequency by more than 3 msec at 4 Hz and/or 5 Hz, "hastened tap" (HT), was found to be characteristic of aging. In group 1, the participants who exhibited HT increased with age and reached more than 35% in their 60s and 70s. In group 2, the percentages of participants with HT at 4 Hz were 14.6 (60s), 15.9 (70s) and 29.3 (80s), which were very close to the 16.9% of participants with HT at 4 Hz over 65 years in group 1. This figure suggested that more than 50% of participants over 80 years exhibited HT in tapping test at 2 through 5 Hz. HT in the elderly appears to be similar to hastened tapping observed typically in patients with Parkinson's disease, suggesting a parallel of extrapyramidal motor dysfunction between normal aging and parkinsonism.

[Effect of aging on the aerobic capacity measured by a step-test]

The purpose of this study was to develop a step-test in order to evaluate age-related change in aerobic capacity. A total of 149 healthy men of age through 18 to 83 yrs ascended and descended a single step of 0.2 m height in time to a metronome. The step rate increased step-wise through three stages, each of 3 min duration; 15, 20 and 25 (step/min) for subjects aged 59 or less, and 10, 15, and 20 (step/min) for those age 60 and over. Using the linear relationship between load and heart rate, physical work capacity (PWC, watt/kg) was estimated as the work load with maximum heart rate predicted by age (220-age). In the elderly group (n = 34), heart rate at the end of the last stage was within 60-80% of the maximum heart rate for 25 subjects, and more than 80% for the other 9 subjects. No risky arrhythmia or significant ST change on ECG appeared in any subject. A retest of the step-test for 16 elderly subjects showed its repeatability and a linear relationship between heart rate and oxygen consumption. The results suggested that the step-test was applicable to the elderly in regard to appropriate work load and safety. The PWC significantly declined with aging (r = 0.52, p < 0.001). Relative aerobic capacity, taking that at age 20 as 100%, was 60% and 53% for subjects aged 60 and 70, respectively, which was in good agreement with available reports which measured oxygen consumption directly.

Augmented expression and release of nonspecific cross-reacting antigens (NCAs), members of the CEA family, by human neutrophils during cell activation

Nonspecific cross-reacting antigens (NCAs) are a group of human glycoproteins immunologically cross-reactive with carcinoembryonic antigen (CEA). Our previous studies have shown that at least seven NCA glycoproteins different in molecular weight and antigenic reactivity, including a species corresponding to CD67, can be detected in neutrophil granulocytes. In the present paper, it is demonstrated that neutrophil activation induced with soluble stimulators, the calcium ionophore A23187, N-formylmethionyl-leucyl-phenylalanine, and phorbol myristate acetate, results in augmented release and cell surface expression of NCAs. The NCA release was correlated with the discharge of azurophil granules but not with that of specific granules and was attributable to the release of NCA species of 53 and 30 kd. The increased NCA expression on the cell surface was due to increments of the NCAs of 160, 100 (CD67), 95, 90, 30, and 26 kd. These results, together with the previous findings that the CEA family members can mediate intercellular adhesion and bind Escherichia coli in vitro, imply that the neutrophil NCAs participate in the functions of neutrophils such as phagocytosis, chemotaxis, and adherence.

Three different NCA species, CGM6/CD67, NCA-95, and NCA-90, are comprised in the major 90 to 100-kDa band of granulocyte NCA detectable upon SDS-polyacrylamide gel electrophoresis

Human granulocytes express several species of nonspecific cross-reacting antigens (NCA), glycoproteins belonging to the carcinoembryonic antigen (CEA) family. Our previous studies have shown that at least two different NCA of 95 and 90 kDa are contained in the major NCA band of 90 to 100 kDa detectable upon gel electrophoresis of immunoprecipitates obtained from the cell surfaces of granulocytes with polyclonal anti-NCA. In the present study, the 90 to 100-kDa NCA band was found to include one more species of 100 kDa. This component was reactive with an anti-CD67 antibody as well as polyclonal anti-NCA and released from the cell surface with phosphatidylinositol-specific phospholipase C, indicating that the 100-kDa NCA species is CD67. Both antibodies revealed high binding activities with a recombinant protein of CGM6, which has been identified in a leukocyte cDNA library as an NCA gene and found to encode a glycosyl-phosphatidylinositol-anchored heterotypic cell adhesion molecule. Furthermore, the apparent molecular mass of the deglycosylated CD67 (38 kDa) corresponded with that of the CGM6 protein. These results suggest that CD67 is equivalent to the NCA species CGM6.

Inhibitory effect of dietary iron deficiency on the induction of putative preneoplastic foci in rat liver initiated with diethylnitrosamine and promoted by phenobarbital

The effects of dietary iron deficiency on induction of putative preneoplastic, gamma-glutamyltransferase (GGT)-positive hepatocyte focal lesions in the liver of rats treated with diethylnitrosamine (DEN) followed by phenobarbital (PB) were investigated. Male Fischer 344 rats of 4 weeks old were placed on an iron deficient (ID) diet containing less than 5 p.p.m. of iron or an iron supplemented (IS) diet containing 180 p.p.m. of iron throughout experimental period of 12 weeks. Both groups of rats were administered 200 mg kg-1 body weight of DEN by a single intraperitoneal injection at Week 4 followed by PB mixed into each diet at a concentration of 0.05% from Week 6 to the final sacrifice at Week 12 when induction of GGT-positive foci was quantitatively analysed. On the ID and IS diets, respective numbers of GGT-positive foci were 6.3 and 14.2 cm-2. The sizes of foci were not altered by the iron content of the diet. The present results indicate that iron plays a role in the development of preneoplastic foci in the livers of rats initiated with DEN and promoted by PB especially in the initiation phase.

Post-contraction variations in motor pool excitability

Previous evidence has shown a marked increase in motoneuronal excitability during muscle contraction and decreased post-contraction excitability. This post-contraction inhibition has been shown to persist up to 800 msec following the end of contraction (Gottlieb and Agarwal, 1973) and apparently continues with gradual recovery up to one minute (Enoka, Hutton and Eldred, 1980). These effects have been attributed in part to influences of muscle receptors on the homonymous motor pool. The purpose of the present study was to observe the time course of short term post-contraction effects, following a maximum isometric contraction, on excitability of the homonymous motoneuronal pool as measured by the Hoffmann reflex. Each of five subjects lay supine on a table with shoulder blocks to prevent movement during resisted plantar flexion. The subject's preferred foot was placed in a stirrup attached to a force gauge which measured tension. Recording electrodes were applied over the soleus muscle, and M- and H-responses were evoked by percutaneous electrical stimulation of the tibial nerve at the popliteal fossa. The stimulus strength was set to elicit a control H-reflex at rest of half the magnitude of the maximum H-reflex value. For each trial the subject performed a 6 s maximum contraction of the triceps surae muscle group, beginning on one visual signal and ending on a second visual signal. The H-reflex was elicited at semi-random intervals prior to and after the visual signal to relax. Increased H-reflex excitability was observed during muscle contraction followed by a marked decrease in evoked amplitudes with gradual recovery following the end of contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of timing of administration of liposome-encapsulated superoxide dismutase on its prevention of acetaminophen-induced liver cell necrosis in rats

The possible participation of acute oxidative stress in the in vivo mechanism by which acetaminophen (APAP) induces hepatocellular injury was examined. Male Sprague-Dawley rats were administered 3-methylcholanthrene, fasted for 18 h, then given APAP and sacrificed after a further 6 h of fasting. Extensive centrilobular liver cell necrosis along with markedly elevated serum activity of aminotransferases was observed. Liposome-encapsulated human recombinant Cu-Zn superoxide dismutase (LSOD) administered 1 or 0.5 h prior to APAP or simultaneously with the toxin completely prevented APAP-induced hepatocellular injury. In contrast, LSOD administered 5 or 2.5 h before or 1, 2.5 or 5 h after the toxin treatment did not prevent APAP toxicity. Incomplete protection against APAP-induced injury was obtained when LSOD was administered 0.5 h after the toxin. These results support the proposal of an oxidative mechanism for APAP hepatotoxicity.

Endocytosis-independent uptake of liposome-encapsulated superoxide dismutase prevents the killing of cultured hepatocytes by tert-butyl hydroperoxide

Liposome-encapsulated (LSOD) or free (FSOD), human recombinant Cu-Zn superoxide dismutase prevented the killing of cultured rat hepatocytes by tert-butyl hydroperoxide (TBHP). A dose of 32 U/ml of LSOD reduced the cell killing by 50%. By contrast, it required 288 U/ml of FSOD to similarly reduce the toxicity of TBHP by 50%. Both LSOD and FSOD increased the cell-associated superoxide dismutase activity of the cultured hepatocytes. Whereas 64 U/ml of LSOD increased cell-associated superoxide dismutase activity fourfold, it required 500 U/ml of FSOD to achieve a similar increase. Furthermore, methylamine, benzyl alcohol, cytochalasin B, oligomycin, and monensin, all inhibitors of endocytosis, prevented the increase in cell-associated superoxide dismutase produced by 500 U/ml of FSOD. These same inhibitors had no effect on the increase in cell-associated superoxide dismutase activity produced by a much lower concentration of LSOD. Thus, liposome-encapsulated superoxide dismutase prevented the cell killing by TBHP more efficiently than free superoxide dismutase because it more efficiently entered the hepatocytes by a mechanism that was independent of the endocytosis responsible for the uptake of FSOD. These data further define the conditions of the toxicity of TBHP. The target hepatocyte must contribute superoxide anions, in addition to the previously shown ferric iron. It is hypothesized that superoxide anions reduce ferric to ferrous iron; the latter then reacts with the hydroperoxide to form tert-butyl alkoxyl radicals. Such radicals are potent oxidizing agents that can initiate the peroxidation of cellular lipids previously shown to lethally injure the hepatocytes.

Liposome-encapsulated superoxide dismutase prevents liver necrosis induced by acetaminophen

Liposome-encapsulated human recombinant superoxide dismutase (LSOD) protected male rats that were pretreated with 3-methylcholanthrene from the liver necrosis produced by acetaminophen. By contrast, SOD-free liposomes, free SOD, or heat-denatured LSOD had no protective effect. Liposome-encapsulated SOD did not simply delay the onset of liver necrosis. A second dose of LSOD at 12 hours prevented the necrosis of the liver as assessed 24 hours after treatment with 500 mg/kg body weight of acetaminophen. Liposome-encapsulated human recombinant superoxide dismutase did not alter the metabolism of acetaminophen as assessed by either the rate or extent of the depletion of hepatic stores of glutathione or by the extent of the covalent binding of the metabolites of [3H]acetaminophen to total liver cell proteins. Evidence of the peroxidation of lipids in the accumulation of malondialdehyde in the livers was detected within 3 hours of the administration of acetaminophen and before the appearance of liver necrosis. Liposome-encapsulated human recombinant superoxide dismutase prevented the accumulation of malondialdehyde in parallel with the prevention of liver necrosis. Finally, LSOD also prevented the potentiation by 1,3-bis(2-chloroethyl)-1-nitrosourea of the hepatotoxicity of acetaminophen. These data document the participation of superoxide anions in the hepatotoxicity of acetaminophen in intact rats.

[A case report of advanced gastric cancer remarkably responding to mitomycin C, aclacinomycin A, SF-SP and lentinan combination therapy]

A 63-year-old female diagnosed as inoperable gastric cancer was treated with combination immunochemotherapy of Mitomycin C, Aclacinomycin A, SF-SP and Lentinan. In this case, the tumor directly invaded the pancreas and the peritoneal dissemination, metastasis to the para-aortic lymph nodes and Virchow's metastasis were identified. As the result of this therapy, the primary tumor was remarkably reduced in size. The subjective symptoms and the metastasis of the para-aortic lymph nodes and Virchow's metastasis disappeared. The side effect was only mild thrombocytopenia.

Possible involvement of arachidonic acid metabolism in phenobarbital promotion of hepatocarcinogenesis

The effects of inhibitors of arachidonic acid metabolism and antioxidants on the rat liver tumor promotion activity of phenobarbital (PB) were assessed using the enzyme-altered focus as the end-point lesion. Fischer 344 male rats were initiated with N-nitrosodiethylamine (200 mg/kg) and then divided into five groups placed on basal diet, diet containing 0.05% PB, diet containing 0.05% PB plus 0.75%, 1% or 1.5% levels of various inhibitors of arachidonic acid metabolism or antioxidants, or diet containing 1% or 1.5% inhibitors or antioxidants alone for 10 weeks, and then killed. p-Bromophenacyl bromide, an inhibitor of phospholipase A2, significantly inhibited the promotion activity of PB at dose levels of 0.75% and 1.5%, reaching plateau at 0.75%. Both quercetin, an inhibitor of lipoxygenase, and morin, a dual inhibitor of lipoxygenase-cyclooxygenase, significantly reduced the promotion activity of PB at the 1.5% but not 0.75% dose levels. Moreover, acetylsalicylic acid, an inhibitor of cyclooxygenase dose-dependently inhibited the promotion activity of PB. Among the antioxidants investigated, vitamin E did not affect, but n-propyl gallate and ethoxyquin exerted a dose-dependent inhibition of PB promotion. These results are strongly suggestive of an involvement of phospholipase A2, lipoxygenase and cyclooxygenase arachidonic acid metabolic pathways in the mechanisms underlying PB enhancement of hepatocarcinogenesis.

Sequence of preparatory set for response movement

Electromyographic reaction times (EMG-RTs) of the right biceps brachii muscle were examined for two movement patterns, elbow flexion and forearm supination, in 8 healthy male subjects under simple and complex RT conditions with varied preparatory intervals (PIs): 0, 200, 400, 600, and 800 msec. In the simple RT condition, the subject was informed of the movement patterns to be performed prior to beginning the trials. In the complex RT condition the subject had to choose one of the two movement patterns at the time of the presentation of a warning signal. The results indicated that: (1) compared with the simple RT condition a delay of about 100 msec. in over-all mean EMG-RT was observed at PI = 0 msec. in the complex RT condition; (2) the difference of over-all mean EMG-RT between the two RT conditions disappeared when PI = 400 msec.; and (3) the difference in EMG-RTs between flexion and supination in the complex RT condition became the same as that in the simple RT condition when PI = 700 msec. It is assumed that the preparatory set for response movements is organized in an order, resulting in the differentiation of RT.

Persistent effect of a low dose of preadministered diethylnitrosamine on the induction of enzyme-altered foci in rat liver

The effect of a low dose of preadministered diethylnitrosamine (DEN) on the induction of enzyme-altered foci in the livers of male full-grown Fischer 344 rats was studied. As a pretreatment, DEN at a dose of 10 mg/kg body wt was injected i.p. At various times after DEN pretreatment a complete initiation, consisting of administration of the same dose of DEN by the same route in rats subjected to partial hepatectomy (PH), was performed, followed by application of selection pressure. Enzyme-altered foci stained with gamma-glutamyltranspeptidase (gamma-GTP) and glutathione S-transferase placental form (GST-P) were then assayed. Decreases in the numbers and areas of foci in the rats which received saline + PH 14 or 28 days after DEN pretreatment were observed in comparison with rats which received saline + PH immediately after DEN. On the other hand, the numbers and areas of foci were not decreased in rats which received the complete initiation, consisting of DEN + PH, at various times after DEN pretreatment when compared with rats which received these at the same time as the DEN pretreatment. This persistent effect of DEN pretreatment on the complete initiation lasted up to 182 days after the time of DEN pretreatment. In this experiment, GST-P was found to be a more sensitive marker for the detection of putative preneoplastic liver-cell foci than gamma-GTP.

Combined effects of cholecystectomy and lithocholic acid on pancreatic carcinogenesis of N-nitrosobis(2-hydroxypropyl)amine in Syrian golden hamsters

The effects of cholecystectomy and/or lithocholic acid (LCA) on the composition of biliary bile acid and on pancreatic carcinogenesis by N-nitrosobis(2-hydroxypropyl)amine (BHP) were examined in male Syrian golden hamsters. Cholecystectomy was performed 1 wk before BHP initiation. BHP (250 mg/kg of body weight) was injected s.c. once a wk for 5 wk. A diet containing 0.5% LCA was begun 1 wk after the final BHP injection. All hamsters were sacrificed 36 wk after cholecystectomy, and the pancreas was examined histologically. Only the LCA treatment but no other treatment influenced the bile acid composition, i.e., the increase in LCA and decrease in cholic acid. The incidence of pancreatic carcinoma was 23 of 30 (76.7%) in hamsters receiving cholecystectomy plus BHP followed by LCA diet. The tumor incidence was five of 18 (27.8%) with BHP followed by basal diet, ten of 18 (55.6%) with cholecystectomy plus BHP followed by basal diet, and six of 18 (33.3%) with BHP followed by LCA diet, respectively. The total number of pancreatic carcinomas in hamsters receiving cholecystectomy and BHP followed by LCA diet also increased significantly. These results indicate that combined treatments of cholecystectomy and dietary LCA enhanced BHP-inducing pancreatic carcinogenesis in hamsters.

Effects of phenobarbital and secondary bile acids on liver, gallbladder, and pancreas carcinogenesis initiated by N-nitrosobis (2-hydroxypropyl)amine in hamsters

The effects of dietary administration of phenobarbital [(PB) CAS: 50-06-6] or the secondary bile acids, deoxycholic acid [(DCA) CAS: 83-44-3] and lithocholic acid [(LCA) CAS: 434-13-9], on tumorigenesis in the liver, gallbladder, and pancreas were investigated in male Syrian golden hamsters after carcinogenic initiation by N-nitrosobis(2-hydroxypropyl)amine [(BHP) CAS: 53609-64-6]. BHP [500 mg/kg (body wt)] was injected sc once weekly for 5 weeks. The animals were then maintained on a basal diet or a diet containing either 0.05% PB, 0.1% DCA, 0.5% DCA, or 0.5% LCA for 30 weeks. DCA enhanced the development of cholangiocarcinomas without influencing that of hepatocellular lesions. PB promoted the induction of hepatocellular carcinomas but not that of cholangiocarcinomas. LCA was without effect on the induction of either hepatocellular carcinomas or cholangiocarcinomas. DCA at a dose of 0.5% enhanced the induction of polyps in the gallbladder. Both DCA, at a dose of 0.1%, and LCA significantly enhanced the induction of pancreas carcinomas. PB had no effect on the induction of polyps in the gallbladder or of pancreas carcinomas. These data document that different tumors may be differentially promoted following initiation with a common carcinogen.

Comparative histochemical investigation of the glutathione S-transferase placental form and gamma-glutamyltranspeptidase during N-nitrosobis(2-hydroxypropyl)amine-induced pancreatic carcinogenesis in hamsters

Immunohistochemical staining using anti-rat glutathione S-transferase placental form (GST-P) rabbit antibody and enzyme histochemical staining for gamma-glutamyltranspeptidase (gamma-GT) were investigated in putative preneoplastic lesions and adenocarcinomas in the pancreas of Syrian golden hamsters treated with N-nitrosobis(2-hydroxypropyl)amine (BHP). Areas with ductular proliferation, ductal hyperplasia, and intraductal carcinoma were strongly positive for GST-P binding and negative for gamma-GT. Cystic adenoma, microcarcinoma, and carcinomas were constantly positively stained by GST-P and partially positive for gamma-GT. GST-P appears to be useful as a positive marker for putative preneoplastic lesions in pancreatic carcinogenesis. Since normal acinar cells are strongly positive for gamma-GT, the findings might suggest that acinar cells contribute to the development of cystic adenoma, microcarcinoma, and carcinomas.

Changes in activity of motor units preceding a rapid voluntary movement

Motor unit activity was studied during slightly sustained contraction of the erector spinal muscle before a rapid trunk extension from a moderately bent position, with special reference to a change of the surface EMG to a rhythmic slower wave with a periodicity of 20-30 msec preceding the movement. Synchronous discharge of a few motor units appeared at regular intervals of 20-30 msec during the slower wave. EMG peaks in the slower wave corresponded to synchronous discharges at the regular intervals.

The double-eyelid operation in Japan: its evolution as related to cultural changes

Of the many aspects of aesthetic surgery, the double-eyelid operation generates the most interest for Japanese surgeons, as there has been an enormous demand for it by patients who are fashion-conscious. It has been possible to locate 32 operative procedures that have been published in the Japanese literature over the past ninety years. Some of these procedures have been reviewed here in relation to the cultural and social changes which are important factors determining the extent of the demand for the operation and which correlate with various changes in surgical technique. This study chronologically describes each of the principal methods related to these social changes and also considers the influence of cultural fads and fashions.

Effect of bile duct ligation on bile acid metabolism in rats

The effect of bile duct ligation on the quantitative and qualitative changes of bile acids in serum, liver, urine, and feces, and the concentration of cholesterol and phospholipids in serum and liver were examined in male rats. The concentration of bile acids in serum increased over 100-fold on day 5 but was lower than the 5-day level on days 10 and 15. The concentration in the liver also increased about 10-fold. beta-Muricholic acid predominantly increased but the secondary bile acids, deoxycholic acid and hyodeoxycholic acid, decreased. The urinary excretion of bile acids increased to about 40 mg/day per rat on the first day of bile duct ligation but this increase was reduced on day 2 to about half and remained at that level until day 24. These values exceeded that of fecal bile acids, 12 mg/day per rat, before bile duct ligation. The amount of bile acid sulfates in the urine was as low as 1% of the total. The urinary non-sulfated bile acids consisted mainly of beta-muricholic acid (60%) and cholic acid (20%), while the sulfates contained a considerable amount of unidentified acidic substances (40%) in addition to cholic acid and beta-muricholic acid. The concentration of cholesterol and phospholipids in serum markedly increased on day 5 but declined gradually thereafter. The liver cholesterol concentration did not change but the phospholipid concentration decreased. Fecal sterols did not change in both the total amount and composition. These data indicated that daily synthesis of bile acids, especially beta-muricholic acid, was accelerated in bile duct-ligated rats.

Endocrine and androgen-receptor studies in a patient with XY gonadal agenesis

A 19-year-old phenotypic female with gonadal agenesis and XY karyotype underwent an endocrinologic study. She lacked secondary sexual characteristics and there was posterior labial fusion, absence of vagina, and no gonadal or gonadal duct tissues present at laparotomy. Elevated levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) responded well to intravenous injection of LH-releasing hormone (LH-RH) but did not respond to clomiphene citrate. Both OH and FSH levels were suppressed by administration of testosterone or estrogen. Low serum concentration of testosterone did not respond to human chorionic gonadotropin (hCG) injection. Dihydrotestosterone binding by cultured skin fibroblast revealed the existence of a binding component with low capacity and high affinity. This is the first report of a patient with XY gonadal agenesis in whom androgen receptors in the target cells are demonstrated.

Suppression of serum levels of luteinizing hormone by short- and long-loop negative feedback in ovariectomized women

The suppressive effects of short- and long-loop negative feedback on serum levels of LH were assessed after administration of human chorionic gonadotrophin (HCG) and conjugated oestrogens. Fourteen ovariectomized women were injected intravenously with 5 mg conjugated oestrogens, eight of these patients were also given an intramuscular injection of 10,000 i.u. HCG 8 h later, while the other six patients were given a control injection of 0.9% saline. The serum levels of LH decreased by similar amounts in both groups of women. Thirteen other ovariectomized women were initially injected with 10,000 i.u. HCG, i.m., seven of these patients were also given an i.v. ijection of 5 mg conjugated oestrogens 8 h later, while the remaining six patients received a control injection of 0.9% saline. The results showed that conjugated estrogens could further supress the serum level of LH which had been reduced by prior HCG treatment. In six ovariectomized women who received i.m. saline injections at the start of the experiment and 8 h later, the serum levels of LH did not change significantly. It is concluded that the suppression of the serum concentrations of LH by long-loop negative feedback after administration of 5 mg conjugated oestrogens is greater than that by short-loop negative feedback after treatment with 10,000 i.u. HCG.

Clinical and endocrinological analyses of patients with galactorrhea and menstrual disorders due to sulpiride or metoclopramide

The clinical courses of galactorrhea and menstrual disorders were studied in 18 women with galactorrhea induced by sulpiride (SLP) or metoclopramide (MCP) given for the treatment of gastrointestinal diseases. The response of PRL and TSH to 500 micrograms iv TRH and the response of LH and FSH to 100 micrograms LRH were assessed by retrospective analysis during treatment in nine patients (six, SLP; three, MCP) and shortly after the end of treatment in nine patients (seven, SLP; two, MCP). The average time from the initiation of treatment to the onset of galactorrhea was 27.2 +/- 4.7 (mean +/- SE) days in the 13 SLP-treated patients and 23.2 +/- 5.8 days in the 5 MCP-treated patients. Five of the SLP-treated patients experienced amenorrhea, four had oligomenorrhea, and one had dysfunctional bleeding. In the MCP-treated patients, oligomenorrhea and dysfunctional bleeding occurred in one each. The average length of time from the end of treatment to disappearance of galactorrhea was 50.0 +/- 7.3 days in the SLP-treated patients and 56.6 +/- 12.1 days in the MCP-treated patients. Cyclic uterine bleeding returned within 2 months after treatment was stopped. Elevated PRL levels with good response to TRH were observed in four of six patients during SLP treatment, and in two of three patients during MCP treatment. Basal PRL levels and response to TRH were normal in almost all patients after the drugs were withdrawn. Normal HL and FSH levels with exaggerated responses of LH to LRH were observed in most patients during treatment, whereas the response of LH to LRH was normal in about half of the patients after treatment. Our findings suggest that hyperprolactinemia in patients treated with SLP or MCP may be in part the cause of both galactorrhea and menstrual abnormalities, and that these symptoms can be reversed by stopping treatment, provided the patients have not taken the drugs for longer than a year.

The time course change after castration in short-loop negative feedback control of LH by HCG in women

The time course of change in the suppressive effect of human chorionic gonadotrophin (HCG) on luteinizing hormone (LH) and/or LH-beta following castration was studied by a specific LH-beta radioimmunoassay. At 14-50 days after castration 8 women were given 10 000 IU of HCG in a single intramuscular injection (group 1), 5 women were given 2000 IU of HCG in the same way (group 2), and 5 were injected with saline as controls (group 5). In addition, 5 women 6-15 months (group 3) and 7 women 3-8 years (group 4) after castration were given 10 000 IU of HCG. The serum concentrations of HCG in groups 1, 2, 3 and 4 reached peak levels of 209.4, 44.1, 210.6 and 238.6 uU/ml, respectively, 4 h after the HCG injection. The serum LH concentration in group 1 was reduced significantly (P less than 0.01) by HCG administration, but the reductions in the LH levels in groups 2, 3 and 4 after HCG injection were not significantly different from that of the controls. These findings suggest that the threshold of the short-loop negative feedback control of LH in women changes with time after castration.

Absence of positive feedback effect of oestrogen on LH release in patients with testicular feminization syndrome

The response of serum LH to exogenous oestrogen administration was studied in 5 patients with testicular feminization syndrome (TFS). The serum LH levels were elevated in all the patients, while serum testosterone levels were within the normal male range. Serum FSH levels were elevated in 4 patients and normal in one patient. Intravenous administration of 100 microgram of LH-RH provoked a further increase in both LH and FSH. Following intravenous injection of 20 mg of conjugated oestrogen (Premarin), the LH levels were serially determined until 120 h in TFS patients, 5 normal males, and 10 normal females during the mid-follocular phase (D7-9). Both TFS patients and normal males showed no LH release following oestrogen injection in contrast to normal females who displayed a significant increase in LH with a peak at 48 to 56 h after the injection. These results seem to suggest that the insensitivity of the hypothalamus to androgen in TFS patients do not affect the sex differentiation of the hypothalamus. The possible role of oestradiol conversion from testosterone in the hypothalamus is discussed.

Afferent fiber connections from lower brain stem to hypothalamus studied by the horseradish peroxidase method with special reference to noradrenaline innervation

Attempts were made to determine the afferent projections to the anterior hypothalamus including the preoptic area from the lower brain stem by means of the horseradish peroxidase method combined with monoamine oxidase staining to identify noradrenaline (NA) neurons. In addition to this technique, a histofluorescence analysis was performed. NA fibers in the medial part of the anterior hypothalamus were mainly supplied by A1 and A2 NA neuron groups, while the lateral part and periventricular zone received NA terminals from both pontine and medulla oblongata NA neuron groups. Furthermore, the present study indicated that there were direct projections to the anterior hypothalamus from non-noradrenergic neurons in the lower brain stem: nuclei raphe dorsalis, centralis superior, cells in the mesencephalic and pontine central gray matter, nuclei parabrachialis lateralis and medialis, cells around fasciculus longitudinalis medialis.

Responses of serum gonadotrophins to LH-releasing hormone and oestrogens in Japanese women with polycystic ovaries

In order to define the abnormality in gonadotrophin secretion in Japanese women with polycystic ovaries (PCO) who rarely show virilization and markedly enlarged ovaries, basal levels of LH and FSH, and responses of serum gonadotrophins to LH-releasing hormone (LH-RH) or oestrogens were determined by radioimmunoassay. Eleven patients with PCO diagnosed by laparotomy or laparoscopy and 30 normal women in the follicular phase were studied. The mean (+/- SD) basal level of LH was significantly higher in patients with PCO than in normal controls (PCO 28.6 +/- 2.4 vs. normal 10.9 +/- 3.0 mIU/ml), while the mean FSH level in PCO patients was not significantly different from that in the normal controls (9.7 +/- 0.7 vs. 11.4 +/- 2.6 mIU/ml). The mean LH/FSH ratio in PCO patients was significantly higher than that in normal controls (3.2 +/- 0.9 vs. 1.0 +/- 0.3). Exaggerated response of LH to LH-RH was observed in PCO patients, while the FSH response was comparable with the normal controls. Ten out of 11 patients with PCO showed LH release exceeding the basal level after bolus iv injection of 20 mg conjugated oestrogens (Premarin), and virtually the same mean net increase in LH from the basal level was obtained in both PCO patients and normal controls. Since the abnormalities in gonadotrophin secretion in Japanese women with PCO are not different from those reported in patients with PCO in Europe and USA, it seems likely that lower incidence of markedly enlarged ovaries and virilization in Japanese patients may be caused by the difference in ovarian response to gonadotrophin.