Foetal exposure to phthalate esters and anogenital distance in male newborns

Phthalate esters, commonly used as plasticizers, show anti-androgenic activity and cause male reproductive malformation in experimental animals. However, the effects of prenatal exposure to phthalate esters in humans have not been extensively studied. The purpose of this study was to examine the relationship between prenatal exposure to phthalate esters and the anogenital distance (AGD) as a reproductive endpoint in human male newborns. Spot urine samples were collected from 111 Japanese pregnant women after obtaining their informed consent. Seven urinary phthalate ester metabolites were determined by high performance liquid chromatography-tandem mass spectrometry. Urinary isoflavones concentrations were measured as possible covariates because their oestrogenicities and high exposure levels among Japanese have the potential to affect male genital development. Birth outcomes and AGD, the distance from the centre of the anus to external genitalia, were measured for their male newborns. In a multiple regression model, the log-transformed mono-2-ethylhexyl phthalate concentration (specific gravity-corrected) was negatively significant, and maternal smoking status was positively significant, in explaining anogenital index (AGI) when potential covariates were controlled for. Urinary isoflavones did not significantly contribute to AGI in any models. Our results suggest that prenatal exposure to di(2-ethylhexyl) phthalate affects reproductive development in human males.

Dietary intake of toxic and essential trace elements by the children and parents living in Tokyo Metropolitan Area, Japan

This study estimated the dietary intakes of 25 pairs of Japanese children and their parents to 12 toxic and essential trace elements using 7-day duplicate diet composites. The estimated intakes of lead (children = 5.34 microg day-1, adults = 6.74 microg day-1) and tin (162 and 152 microg day-1) were below tolerable limits, but large difference in aluminium intakes (7.32 and 12.1 mg day-1) among the subjects warranted further investigations. Intakes of cadmium in both children and adults (13.2 and 15.9 microg day-1) were high, but a low uranium (U) intake was observed (0.593 and 0.587 microg day-1). Intakes of copper (567 and 784 microg day-1), manganese (1.56 and 2.72 mg day-1), zinc (4.93 and 6.75 mg day-1), and molybdenum (103 and 131 microg day-1) were close to the recommended values. Concentrations of chromium, nickel and selenium were lower than the detection limits in most cases.

Analysis of organic esters of plasticizer in indoor air by GC-MS and GC-FPD

The aim of this study was to assess the performance of a method of analyzing organic esters of plasticizer in indoor air by sampling air in a charcoal tube and extracting the esters in toluene using a gas chromatography-mass spectrometer (GC-MS) and flame photometric detector (FPD). An internal standardization method was used for the GC-MS measurement of phthalate esters, whereas an external calibration method was employed to determine the levels of phosphate esters by FPD. The instrumental detection limit, the instrumental lower limit of determination, and the blank and method detection limits were also determined. Mean recoveries of phthalate esters from the charcoal tube were 97.9-115%. Mean recoveries of phosphate esters were lower but reproducible. Recoveries of the esters from indoor air were generally greater than 80%. For all the compounds, no significant breakthrough was detected up to 100 microg. Thus, indoor organic esters could be accurately determined in the range of 0.6 x 10(-3)-23 microg/m3 by the procedure presented here. Preliminary analysis of the organic esters indicated that exposure to phthalate esters via indoor air inhalation could constitute a significant contribution to total daily intake.

Amelioration of frozen gait by tandospirone, a serotonin 1A agonist, in a patient with pure akinesia developing resistance to L-threo-3,4-dihydroxyphenylserine

A 71-year-old woman presented with severe akinesia, frozen gait, and compromised postural reflexes, without rigidity, tremor, or vertical gaze disturbance. With a working diagnosis of pure akinesia, we administered amantadine (150 mg/d) and L-threo-3,4-dihydroxyphenylserine (DOPS) (600 mg/d), which alleviated her symptoms. When frozen gait recurred 2 months later, we increased the dose of L-threo-DOPS to 900 mg/d and added levodopa (300 mg/d) combined with carbidopa, but this failed to improve the patient's symptoms. We then combined administration of tandospirone, a serotonin (5-HT) 1A agonist with L-threo-DOPS (600 mg/d), resulting in marked clinical improvement. Tandospirone is reported to activate noradrenergic neurons via the 5-HT 1A receptor, which could account for such striking improvement in a patient previously responsive to the noradrenergic precursor L-threo-DOPS given alone.

Human urine certified reference material for arsenic speciation

BACKGROUND

Chemical speciation analysis is essential for the biological monitoring of inorganic arsenic exposure using urine as indicator medium. There is increasing demand for a certified reference material (CRM) of urine matrix for arsenic speciation.

METHODS

Urine (10 L) was collected from non-occupationally exposed Japanese males. We prepared 954 bottles of urine, each containing approximately 10 mL, after filtering and blending the urine stock. The urine in each bottle was freeze-dried. Between-bottle homogeneity was confirmed by measuring the concentrations of selected minor and trace elements in the material and subsequent statistical analysis. Certification was based on a collaborative analysis involving 15 laboratories.

RESULTS

Certified values were determined for arsenobetaine (0.069+/-0.012 mg As/L), dimethylarsinic acid (0.036+/-0.009 mg As/L), and total arsenic (0.134+/-0.011 mg/L) as well as for total selenium (0.059+/-0.005 mg/L) and zinc (0.62+/-0.05 mg/L), based on the analytical values from the collaborating laboratories. Reference values are given for copper (0.010 mg/L) and lead (0.0011 mg/L), based on definitive analysis at the National Institute for Environmental Studies (NIES).

CONCLUSIONS

The present CRM, NIES CRM No. 18 Human Urine, is the first human urine CRM for arsenic speciation and will be of value for analytical quality assurance of the biological monitoring of arsenic exposure.

Determination of arsenic compounds by high-performance liquid chromatography-ultrasonic nebulizer-high power nitrogen-microwave-induced plasma mass spectrometry: an accepted coupling

To establish a sensitive, accurate, and precise determination of arsenic compounds, a high power nitrogen microwave-induced plasma (1.3 kW) mass spectrometer (N2-MIP-MS) has been successfully coupled with an ultrasonic nebulizer (HPLC-USN) that is attached to a high-performance liquid chromatograph. It is examined as an element-specific detector for its applicability to the optimization and determination of seven arsenic compounds [arsenic acid, methylarsonic acid (MA), dimethylarsinic acid (DMA), arsenobetaine (AB), arsenocholine (AC), trimethylarsine oxide (TMAO), and tetramethylarsonium ion (CMI)]. This HPLC-USN-MIP-MS coupling is an encouraging combination as an alternative method for mass spectroscopy for elemental speciation analysis. Interchanging of the MIP-MS fabricated nebulizer (concentric) with an ultrasonic nebulizer, increases 3-6 times the ion signals for the anionic and 6-12 times those for the cationic arsenic compounds as compared to traditional methods. The HPLC-USN-MIP-MS combination used is excellent, amplifying the ion signals about 1.5-2 times for cationic and 1.3-2.8 times for the anionic arsenic compounds as compared to the HPLC-ICPMS coupling. The detection limits for As(V), MA, DMA, AB, TMAO, AC, and TMI (in Milli-Q-water) obtained with the optimized HPLC-USN-N2-MIP-MS system are 0.46, 0.36, 0.73, 0.21, 3.64, 0.39, and 0.32 microg L(-1), respectively, about 13-50 times lower than the HPLC-MIP-MS and about 3-11 times lower than the HPLC-ICPMS. The detection limits of As(V), MA, DMA, AB, TMAO, AC, and TMI, which spike in the urine, are deteriorated by 1.7-4.2 times compared with the detection limits of the seven different As compounds, which are prepared in the Milli-Q-water. The repeatability (RSD for three successive analyses) and reproducibility (RSD for three successive analyses performed on three different days), considering peak area and peak height, achieved for seven different arsenic compounds are 0.5-7 and 0.7-8%, comparable with the HPLC-ICPMS (0.3-8.5%; 4-12%) and HPLC-MIP-MS (0.4-9%; 5-12%) systems. The combined HPLC-USN-N2-MIP-MS has been adequately applied to the determination of AB in NIES Candidate Human Urine CRM. The results agree with the HPLC-ICPMS values. Chloride interference as 40Ar35Cl+ is not found in the urine and with the high chloride matrix (10000 mg L(-1)).

[Multivariate analysis of the problems of long-term levodopa therapy in Parkinson's disease]

We investigated clinical features of adverse reactions to long-term levodopa therapy by the multivariate analysis. Dyskinesia, wearing off effect, on-off effect, mental symptoms, and frozen gait were noted in 29 (11.2%), 78 (30.0%), 17 (6.5%), 45 (17.7%), and 52 (20.0%), respectively, of 260 patients with Parkinson's disease to whom levodopa had been administered for over one year. In the statistical investigation by the multivariate analysis (quantification method type II), the age of initial levodopa therapy, the duration from the onset to the initiation of levodopa therapy, and the duration of levodopa therapy were not closely related to the development of any adverse reaction, while Hoehn & Yahr's stage and the dosage of levodopa had the most significant influence on the development of adverse reactions. Furthermore, concomitant use of amantadine hydrochloride produced an inhibitory effect on the development of dyskinesia. We conclude that early institution of levodopa therapy in Parkinson's disease may not be an important risk factor of adverse reactions.

Specimen banking at National Institute for Environmental Studies, Japan

The National Institute for Environmental Studies (NIES) in Japan has had more than fifteen years practical experience in specimen banking. Stored specimens are used for the assessment of long-term trends of pollutants. The use of new analytical techniques facilitates the finding of the pollutants of the past.

[A case of atypical progressive supranuclear palsy with degeneration of the fronto-pontine tracts, and without grumose degeneration of the dentate nucleus]

An autopsy case of progressive supranuclear palsy (PSP) with degeneration of the fronto-pontine tracts of the midbrain and pons, and without grumose degeneration of the dentate nucleus is reported. A 72-year-old woman was suffering from dysarthria and gait disturbance. Moderate dementia was noted and gradually worsened. Pyramidal and extrapyramidal signs and cerebellar ataxia were not observed. Eye movements were fully preserved. Brain CT showed cerebellar atrophy. Three years later, she was unable to stand or move, and became mutistic. At the age of 75, she died suddenly. The duration of her illness was approximately 4 years. Clinical diagnosis was LCCA (late cortical cerebellar atrophy). Neuropathological examination revealed gliosis of the deep layers of the cerebral cortex around the precentral gyrus, fronto-pontine tracts degeneration (posterior part of the anterior crus, genu and anterior part of the posterior crus of the internal capsule, cerebral peduncles of the midbrain, pontine base and pyramis of the medulla oblongata). Also, atrophy of the pons and marked degeneration of the superior colliculi and substantia nigra were observed. Neurofibrillary tangles (NFTs) and glial fibrillary tangles (GFTs) were found in the subcortical nuclei. These findings were almost consistent with PSP. However, the following differed from those of previously reported typical PSP cases: firstly, mild gliosis in the reticular formation of the midbrain; secondly, few NFTs in the pontine nuclei and superior colliculi and; thirdly, no grumose degeneration in the dentate nucleus. In addition, clinical symptoms of the present case are not consistent with PSP. Therefore, we concluded this case to be an atypical PSP both clinically and neuropathologically.

Possible distinct pathogenesis in low responder myasthenia gravis: association of soluble interleukin-2 receptor with acetylcholine receptor antibody titre or abnormal thymus

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Stable carbon and nitrogen isotopic composition of diet and hair of Gidra-speaking Papuans

The carbon and nitrogen stable isotopic composition of the scalp hair and diet of Gidra-speaking people in four villages in Papua New Guinea is presented. The isotopic composition of hair was measured, while that of the diet was estimated from food consumption survey data and the measured isotopic composition and protein and carbohydrate contents of food items. The average isotopic ratios of the hair samples and of the diet varied among the four study villages, which were selected because of their diverse ecological settings. Comparison was made between hair and calculated dietary isotopic compositions. Two of the four diet-hair enrichment values obtained for 13C (+1.8 and 2.2%) were similar to those previously reported (1.4-2.0%), but the other two values (3.7 and 4.8%) were greater than in earlier reports. 15N enrichment was systematically greater (by 1.0%) than reported values (4.3%) except for one village, where a much greater enrichment (6.9%) was found. The factors potentially relevant to these deviations are discussed. Possible errors in estimating the dietary isotopic composition and minor modifications of dietary habits revealed by food consumption surveys could explain most of the discrepancies. However, the great enrichment of 15N found in one of the villages remains unexplained.

Isotope ratio analysis of lead in biological materials by inductively coupled plasma mass spectrometry

Inductively coupled plasma mass spectrometry (ICP-MS) allowed 0.2-0.3% imprecision (1 sigma) in 204Pb/206Pb, 207Pb/206Pb, and 208Pb/206Pb measurements at the 20-100 ppb level, which was precise enough to detect some of the isotopic variations observed in nature. Mass discrimination could be corrected within +/- 0.5% of the true value by periodical analysis of standard reference material of known lead isotopic composition. As a separation method for lead in human bone, which contains enormous amounts of calcium and phosphorus, anion exchange of the Pb-Br complex was found to be effective. Lead isotope ratios in bone, measured by ICP-MS after separation, were consistent with those measured by thermal ionization mass spectrometry. Hair matrix did not have any influence on the accuracy and precision of the analysis; a digested sample could be directly analyzed and this offered rapid sample throughput. Preliminary data on lead isotope ratios in bone and hair from prehistoric and contemporary Japanese are presented.

An application of nitrogen microwave-induced plasma mass spectrometry to isotope dilution analysis of selenium in marine organisms

Nitrogen microwave-induced plasma mass spectrometry was studied for its applicability to the isotope dilution analysis of selenium in biological samples. Spectroscopic interference by calcium, which is present in high concentrations in biological samples, was investigated. No detectable background spectrum was observed for the major selenium isotopes of 78Se and 80Se. No detectable interferences by sodium, potassium, calcium and phosphorus on the isotope ratio 80Se/78Se were observed up to concentration of 200 mg/ml. The method was applied to the analysis of selenium in biological reference materials of marine organisms. The results showed good agreement between the certified and found values.

[Inductively coupled plasma atomic emission spectrometry and ICP mass spectrometry]

General analytical procedures for determination of trace elements in clinical samples (serum, urine, milk, organs and bone) by inductively coupled plasma atomic emission spectrometry (ICP-AES) and ICP mass spectrometry (ICP-MS) are described. Minerals and major trace elements can be simultaneously determined only after 10-20 fold dilution, which is preceded by acid digestion in the case of solid sample, by ICP-AES. Elements of lower concentration range can be determined by ICP-MS but there are some analytical limitations. Reference values in these samples from Japanese, determined by ICP-AES, are also presented. Use of ICP-AES and ICP-MS for chemical speciation analysis is referred.

Long-term change of anti-acetylcholine receptor antibody in patients with myasthenia gravis after thymectomy

Anti-acetylcholine receptor antibody (AChR Ab) plays an important role in the pathogenesis of myasthenia gravis (MG). We investigated the change of anti-AChR Ab titer after thymectomy of 10 MG patients including five patients whose age at onset was younger than 16 years. Anti-AChR Ab titer was increased in four of six patients with remission and three of four patients without remission. Change of anti-AChR Ab titer in individual patients showed an increase occurred 1-4 years after thymectomy. It is likely that thymectomy influences immune response and induces autoreactive lymphocytes and autoantibodies.

Trace elements in ribs of elderly people and elemental variation in the presence of chronic diseases

Element concentrations in ribs obtained from elderly Japanese people (17 males and 28 females; mean age, 81.5 years) were determined by atomic absorption spectrometry (AAS), inductively coupled plasma atomic emission spectrometry (ICP-AES), and ICP mass spectrometry (ICP-MS). Nine elements--Na, Mg, P, K, Ca, Fe, Zn, Sr, and Pb--were determinable in most of the subjects by a combination of AAS and ICP-AES. The levels of these elements were generally comparable with those obtained in our previous study on ribs from younger Japanese. By the use of ICP-MS, Sn (median, 0.79 micrograms/g dry bone) and Ba (1.3 micrograms/g) were determinable in all of the subjects analysed (n = 35) and 18 other elements at lower concentration levels were also detected in some of the subjects. An exploratory statistical analysis was carried out to find element(s) of which level(s) in rib vary in the presence of degenerative chronic diseases, using information obtained from pathological autopsy reports and medical histories of the present subjects. It indicated that (i) Pb and Zn, (ii) Ba, and (iii) Sr levels in the ribs varied in the presence of cancer, cerebrovascular damage, and bone problems, respectively. The present results were discussed in relation to the results of the previous epidemiologic and experimental studies.

Comparison of antibody titer to human and rat acetylcholine receptor in myasthenia gravis

Antibody titer to acetylcholine receptor (AChR Ab) was measured in 34 patients with myasthenia gravis (MG) using an immunoprecipitation method with human and rat AChR as antigens, to study the reliability of these assay systems and the cross-reactivity between human and rat AChR. There was a good correlation in the titer of Ab to AChR between human and rat (P < 0.01) when Ab titers were expressed logarithmically. The titer of Ab to human AChR was higher in a group of patients with a high concentration of AChR Ab and lower in a group with a low concentration of AChR Ab than that to rat AChR. This indicates that there may be distinctive characteristics in AChR Ab between groups of patients with high and low concentrations of AChR Ab.

Analysis of serum elements and the contaminations from devices used for serum preparation by inductively coupled plasma mass spectrometry

Two different samples of serum were prepared from a blood specimen by using two types of serum-separation tubes. Each serum sample was diluted by 100 times with deionized and sub-boiling distilled water. Thirty-six elements in the serum and exudate, from devices used for the serum preparation, were determined by inductively coupled plasma mass spectrometry (ICP-MS). From the comparison of elemental concentrations in two groups of 11 serum samples, it was found that the exudate from serum-separation tubes, as well as from disposable stainless steel needles, had serious effects on the elemental concentrations in the serum. Means for the concentrations of Li, Co, Ga, Cd, Sn, Sb, Ba, La, and Ce in the two serum groups were statistically different from each other. The concentrations of Cr, Mn, Fe, and Mo in both groups were apparently higher than those reported in the literature, suggesting contamination from the disposable stainless steel needle and spectral interferences due to molecular species produced in the argon plasma.

Trace elements determined along single strands of hair by inductively coupled plasma mass spectrometry

Flow injection-inductively coupled plasma mass spectrometry has been evaluated for determining the distribution profile of trace elements along a single strand of hair. Hair was cut into several mm long sections from follicle to the distal end. Each section was solubilized in a capped 1.5-mL polypropylene tube with small volume of nitric acid (typically 50 microL) at room temperature. After dilution an aliquot (50 microL) was introduced into the mass spectrometer by flow injection. The limit of determination was typically 5-50 pg with 5-10% precision (CV), depending on the element examined; this corresponds to sub-microgram/g concentrations of these elements in hair segments. Recent exposure and intake history of individuals to thallium or mercury could be reconstructed by this system.

Trace elements determined along single strands of hair by inductively coupled plasma mass spectrometry

Flow injection-inductively coupled plasma mass spectrometry has been evaluated for determining the distribution profile of trace elements along a single strand of hair. Hair was cut into several mm long sections from follicle to the distal end. Each section was solubilized in a capped 1.5-mL polypropylene tube with small volume of nitric acid (typically 50 microL) at room temperature. After dilution an aliquot (50 microL) was introduced into the mass spectrometer by flow injection. The limit of determination was typically 5-50 pg with 5-10% precision (CV), depending on the element examined; this corresponds to sub-microgram/g concentrations of these elements in hair segments. Recent exposure and intake history of individuals to thallium or mercury could be reconstructed by this system.

The hair-organ relationship in mercury concentration in contemporary Japanese

The hair-organ relationship of mercury concentration was investigated in 46 autopsy samples in Tokyo, Japan. Hair mercury levels were highly significantly correlated with organ Hg levels in the cerebrum, cerebellum, heart, spleen, liver, kidney cortex, and kidney medulla, when the total mercury or methyl mercury value in the organ was compared with the hair total mercury or organic mercury, respectively. When the inorganic mercury value was tested, significant correlations remained, with weaker coefficients in all the organs but the spleen. Stepwise multiple regression analysis evidenced that the hair organic mercury value was the major explanatory variable for the organ total mercury or organ methyl mercury value in all the organs. To explain the organ inorganic mercury value, the hair organic mercury value was the major variable for the cerebrum and kidney (both cortex and medulla), the hair inorganic mercury value was the major variable for the cerebellum and heart, and the hair phosphorous and hair organic mercury were the major variables for the liver; no explanatory variable existed for the spleen. Auxiliary explanatory variables accounted for the organ total mercury and inorganic mercury levels, among which the hair selenium value was conspicuous with negative regression coefficients.

Nutritional assessment of a group of Japanese elementary school children in Tokyo: with special emphasis on growth, anemia, and obesity

Anthropometric data, nutrient intake data, and blood biochemical parameters were analyzed for 66 elementary school children living in Tokyo, Japan, and their nutritional status was evaluated focusing on three problems: (1) zinc nutriture and growth, (2) anemia with iron deficiency, and (3) lipid nutriture and obesity. The subjects' mean energy and protein intakes met the recommended levels for Japanese children. However, their zinc intake levels were inadequate at 7.2, 8.3, and 8.5 mg in grades 2 (mean age: 8 yr), 4 (10 yr), and 6 (12 yr), respectively. Mean serum zinc concentration was 0.82 +/- 0.15 microgram/ml; the percentages of subjects who showed serum zinc concentration lower than 0.68 microgram/ml, the lower limit of the normal serum zinc concentration, were 28.6, 15.4, and 5.0% in grades 2, 4, and 6, respectively. These serum zinc concentrations indicated the existence of marginal zinc deficiency in some children, particularly in grade 2, though it was not severe enough to retard growth. Their iron intake levels (8.2, 10.2, and 10.2 mg for grades 2, 4, and 6, respectively) in combination with the proportion of iron intake from animal foods (37%) were judged to be adequate because no children showed serum ferritin, serum iron, or transferrin saturation levels lower than the criteria levels recommended for iron deficiency. Moreover, no definitely anemic children were found. Daily lipid intakes were 65.7, 74.5, and 78.3 g in grades 2, 4, and 6, respectively, and the mean percentage of energy intake from lipid to total energy intake, 32%, exceeded the level recommended. Mean serum total cholesterol concentrations and the percentage of subjects with elevated cholesterol levels (greater than or equal to 200 mg/dl) were high compared with the reported values. Means of the body mass index (BMI) and Rohrer Index (RI) for the subjects were slightly higher than Japanese standards. With these parameters for obesity, triglycerides and atherogenic index were positively correlated and HDL cholesterol and HDL cholesterol percentage to total cholesterol were negatively correlated.

[An autopsy case of ataxic form of Creutzfeldt-Jakob disease]

An autopsy case of ataxic form of Creutzfeldt-Jakob disease (Brownell and Oppenheimer, 1965) was reported. The patient, a 71-year-old male, noticed ataxic gait at the beginning of June in 1988, and was admitted to the Hiroshima City Hospital for the neurological examination at the end of June. He showed ataxia of the left arm and legs and diplopia. Gradually he became delirious at night. On July 16, tremor-like involuntary movement of the left hand was noticed. On July 20, he became somnolent and doubly incontinent. Myoclonus and paratonic rigidity were also observed. The EEG showed periodic synchronous discharge on July 25. The brain CT and MRI were normal. He became apallic gradually and died on October 28. The duration of illness was 5 months. At autopsy, brain weighed 1000gr. Cerebral atrophy and slight enlargement of the ventricles were observed. The cerebellum was also slightly atrophic. Histologically, the destruction of the cerebral cortical layer, slight sieve-like spongy state of the neuropil, slight neuronal loss of the thalamus and sieve-like spongy state of the striatum were observed. The cerebellar lesion was the most severe, where granular cell loss and gliosis of the cortex were observed.

Lysinuric protein intolerance presenting deficiency of argininosuccinate synthetase

A 35-yr-old woman, who suffered from relapsing coma with hyperammonemia for 17 yr, was diagnosed to have lysinuric protein intolerance (LPI). Increased urinary dibasic amino acids (lysine, arginine and ornithine) and impaired absorption of orally administered lysine and arginine proved the defects of renal tubular and intestinal transport of dibasic amino acids. These defects are the primary cause of impaired urea cycle metabolism in LPI. Further, the level of argininosuccinate synthetase (ASS), a urea cycle enzyme, was analyzed and it was found to be below the normal level. This is the second reported case of LPI presenting ASS deficiency.

Trace elements in human transitory milk. Variation caused by biological attributes of mother and infant

Multielement analysis was performed on human milk collected on 5-9-d postpartum from 51 Japanese females using inductively coupled plasma (ICP) mass spectrometry (MS), ICP atomic emission spectrometry (ICP-AES) and fluorometry. Thirty-one elements were detected by these analytical methods in milk. Twelve elements (Na, Mg, P, S, K, Ca, Cu, Zn, Se, Sr, Rb, and Mo) were detected in all of the samples. Al, Cs, and Ba were the elements detected by ICP-MS in more than half of the samples. Multiple regression analysis extracted biological attributes of mother and infant, such as maternal stature, maternal wt, or infant's birth wt, as statistically significant factors contributing to the variation in elemental concentration in milk. However, the rates of contribution were small in all cases. It was concluded that the biological attributes of mother and infant examined in this study were not the major factors that contribute to elemental variation in human milk.

Mineral and trace element content of human transitory milk indentified with inductively coupled plasma atomic emission spectrometry

Mineral and trace element content of the human transitory milk collected on days 6 to 9 postpartum in Tokyo was measured by inductively coupled plasma atomic emission spectrometry (ICP-AES). Ten elements (Na, Mg, P, S, K, Ca, Fe, Cu, Zn, and Sr) were detected in ten-fold diluted milk sample with this method. With the stepwise multiple regression analysis, maternal and infants' biological attributes, such as weight, stature, sex, or age, were noted as factors contributing to the interindividual variation in Na, Mg, P, S, and Sr. Biological mechanism responsible for this selection cannot be found. Days postpartum for the milk collection was selected as a highly significant (p less than 0.001) variable with negative coefficient to explain milk S variation.

Granuloma-forming activity and antitumor activity of newly isolated mycoloyl glycolipid from Rhodococcus terrae 70012 (Rt. GM-2)

A newly isolated mycoloyl glycolipid (Rt. GM-2) from Rhodococcus terrae 70012 was identified and the granulomagenic and antitumor activities were studied as compared with trehalose-6,6'-dimycolate (cord factor) also from R. terrae (Rt. TDM). The alkaline hydrolysis products of Rt. GM-2 contained trehalose, methyl-alpha-mycolate and a less-polar ester than the usual methyl-alpha-mycolate, possibly beta-keto mycolate (1:1:1, by mol. ratios). On the other hand, analysis of alditol acetate obtained after the mild permethylation, NaBH4 reduction, and acetylation showed the occurrence of 2,3,4-tri-O-methyl-6-O-acetylglucitol. Therefore, the original glycolipid (Rt. GM-2) was identified tentatively as 6-O-alpha-mycoloyl 6'-O-beta-ketomycoloyl trehalose. Intravenous injection of Rt. GM-2 in the form of water-in-oil-in-water emulsion caused prominent granulomas in lungs and spleen of ICR and BALB/c mice. The granulomagenic effects were as strong as those caused by Rt. TDM. The lung and spleen weights reached peaks one week after an injection of Rt. GM-2 in mice and then gradually decreased. Multiple intravenous injections of Rt. GM-2 and Rt. TDM showed antitumor activity against subcutaneously implanted Sarcoma-180, and caused prominent granulomatous changes and growth suppression of mice.

[A manifesting carrier of Duchenne muscular dystrophy presenting mosaic distribution of dystrophin negative and positive muscle fibers]

A 25-year-old female patient with an approximate 10-year-history of slowly progressive muscle weakness was diagnosed as a manifesting carrier of Duchenne muscular dystrophy (DMD) because her muscle biopsy showed scattered fibers with no dystrophin on immunohistochemical staining. She had no family history of neuromuscular disorders. She was in good health until about 14 years of age, when she developed muscle weakness and atrophy of the extremities with slow aggravation. On admission at the age of 25 years, she had asymmetrical muscle atrophy in the lower extremities; the left femur, right femur, left crus, and right crus measured 36.0, 40.5, 31.5, and 35.5 cm in circumference, respectively. However, the muscle weakness of the extremities was symmetrical with no laterality, and the proximal muscles in the lower extremities were predominantly affected to 3+/5 MMT test. She walked with a mild wadding manner and stood up with Gower' maneuver. Deep tendon reflexes of the extremities were almost normoactive with no pathologic reflexes. As to laboratory findings, serum enzymes of muscular origin were elevated; GOT was 44 IU/l, GPT 60 IU/l, LDH 829 IU/l, CK 4238 IU/l, and aldolase 31 SL units. The electromyogram showed myopathic changes mixed with some neurogenic components. Peripheral nerve conduction velocity was normal. A computed tomography of the skeletal muscles showed more marked atrophy and lower density in the left lower extremity than in the right. The biopsied left gastrocnemius muscle demonstrated a marked variation in fiber size with some necrotic and regenerating fibers. On immunohistochemical stain with anti-dystrophin antibody, the dystrophin negative fibers were scattered among positive fibers in a mosaic distribution.

[Acetylcholinesterase activity in CSF in senile dementia of Alzheimer type, vascular dementia, and Parkinson's disease]

Acetylcholinesterase (AChE) activity was measured in cerebrospinal fluid (CSF) from 25 patients with senile dementia of Alzheimer type (SDAT), 11 patients with vascular dementia (VD), 26 patients with Parkinson's disease (PD), and 30 normal controls. AChE activity also was measured in 46 normal subjects whose ages ranged from 15 to 85 to evaluate the effect of age on AChE activity. CSF AChE activity for the SDAT, VD and PD groups showed no significant difference compared with the value for the control group. However, there were significant decreases in CSF AChE activity in the VD and PD groups with the development of ventricular enlargement. There was no significant correlation between CSF AChE activity decrease and ventricular enlargement in the SDAT group. AChE activity increased significantly over the age range of 15 to 85. These results suggest that, although CSF AChE activity is not a useful parameter in the diagnosis of dementia, it may be a marker indicating abnormalities of the intracerebral cholinergic system during the process of cerebral atrophy.

Minerals and vitamin-A status in relation to gustatory functions for salt in healthy female college students

Twenty-five healthy female college students were studied for the gustatory function tests for salt (NaCl) and some selected biochemical parameters including plasma retinol and plasma retinol-binding protein (PRBP). Plasma zinc (PZn) and retinol levels were comparable with those of good responders in tests of discrimination between two levels of NaCl in the previous report, but PRBP was lower in the present subjects. From the results of correlation analysis and stepwise multiple regression analysis, the individual student's discriminability of NaCl concentrations was related to the parameters regarding metabolic status of calcium (Ca), magnesium (Mg), sodium (Na), and selenium (Se). The detection threshold of NaCl concentration ranged from 1 to 60 mmol/liter and was related to PRBP. Plasma Zn was significantly positively correlated with both plasma retinol and PRBP, but significantly negatively correlated only for the detection threshold of NaCl concentration. On the basis of these results, the importance of vitamin-A nutrition and the relation of minerals such as Na, Ca, Mg, and Zn to the gustatory functions of NaCl was confirmed and a possible participation of Se to the functions was suggested.

Minerals in plasma and urine and gustatory function tests for salt in a group of healthy young men

Detection threshold for salt (NaCl) and discrimination between two levels of NaCl concentration (0.6 and 0.7%) in foods, and their relation to some selected biochemical parameters in plasma and urine (Zn, Na, K, Mg, Ca, Se for plasma and urine, Cu and retinol binding protein for plasma) were investigated in 15 healthy male college students. No subject failed to discriminate the NaCl concentrations in more than 50% of the tests. The rate of correct discrimination (RCD) was not associated with plasma Zn (P-Zn), plasma retinol binding protein (P-RBP), urinary potassium (U-K) or urinary sodium (U-Na), which significantly correlated with RCD in our previous study, while the detection threshold was significantly correlated with urinary Ca-Mg ratio (U-Ca/Mg), urinary Ca (U-Ca), U-Na, and urinary Mg. In the stepwise multiple regression analysis, U-Ca/Mg, plasma Ca, plasma Na, and RCD were selected as significant independent variables. These indicate that the status of minerals such as Na, Ca, and Mg is related to the gustatory function. One possible explanation for the discrepancy between the present and previous results is the elevated P-Zn and P-RBP levels in the present subjects.

Heterogeneity in myasthenia gravis: HLA phenotypes and autoantibody responses in ocular and generalized types

HLA phenotypes and autoantibody responses were studied in 71 Japanese patients with myasthenia gravis. HLA-A2, Bw61, and DRw9 were associated with ocular myasthenia gravis (corrected p [CP] less than 0.05 relative risk [RR] = 2.88; CP less than 0.02, RR = 3.60; and CP less than 0.001, RR = 4.63, respectively) and HLA-DRw8 was associated with generalized myasthenia gravis (CP less than 0.001, RR = 5.40). Neither HLA-B8 nor DR3 was found in Japanese patients. The titer of antiacetylcholine receptor antibody (AChR Ab) and the incidence of autoantibodies other than AChR Ab were higher in patients with generalized myasthenia gravis than in those with the ocular type (2.77 +/- 0.62 versus 0.17 +/- 0.03 pmol/ml, p less than 0.001; and 60.6 versus 29.0%, p less than 0.02, respectively). Patients with a high titer of AChR Ab or with autoantibodies had an increased frequency of HLA-DRw8 (CP less than 0.02, RR = 4.61, and CP less than 0.005, RR = 4.53, respectively); whereas patients with a low titer of AChR Ab or without autoantibodies had an increased frequency of HLA-DRw9 (CP less than 0.001, RR = 8.26, and CP less than 0.005, RR = 4.08, respectively). These findings suggest that ocular and generalized myasthenia gravis might have different immunogenetic backgrounds.

A case of progressive supranuclear palsy with fibrillary gliosis of the midbrain and pontine reticular formation

An autopsy case of progressive supranuclear palsy with onset at age 53 and a clinical course of 7 years is reported. The clinico-pathological characteristics of the case were as follows: Fibrillary gliosis of the midbrain and pontine reticular formation corresponded clinically to personality changes: The patient had formerly been irascible and became extremely mild-mannered. He showed lack of spontaneity and initiative and slowing of thought processes, taking him longer than normal to find words and ideas. Gliosis of the nucleus ventralis lateralis of the thalamus was secondary to the degeneration of the cerebellar dentate nucleus and the globus pallidus from which they receive fibers. Neurofibrillary tangles were found in the cerebral cortex.

[A study on mental symptoms developing during the treatment of Parkinson's disease (author's transl)]

We studied on mental symptoms which developed during the treatment of Parkinson's disease. Hallucination, delusion, and/or delirious state were observed in 23 (22.8%) of 101 cases. The cases with mental symptoms were studied for the incidence, detail of the symptoms, and the factors involved in their development.

RESULT

1) Mental symptoms were observed in 23 patients and the incidence tended to be highest in the patients in their sixties. 2) In classification of the cases with mental symptoms, 12 cases showed the change of visual experience as main symptom and 3 cases had delusion. In these two cases, disturbance of consciousness was minimum, if any. Eight cases showed delirious state. 3) As for mental symptoms, visual hallucination was most frequently observed. 4) Complication of hypertension and history of depressive state were more frequently observed in the cases with mental symptoms than in those without. 5) Mean daily dose of L-dopa upon the onset of mental symptoms was less than mean daily maximum dose in the cases without mental symptoms. 6) The cases with cerebral atrophy in CT had a tendency to develop mental symptoms. 7) The cases with abnormal EEG were liable to develop mental symptoms. 8) The cases with mental symptoms were more often complicated by dyskinesia than those without.

CONCLUSION

The incidence of mental symptoms during the treatment of Parkinson's disease tended to be high in the aged patients who had all or some of these findings as previous history of psychiatric illness, hypertension, cerebral atrophy and abnormal EEG.

[Left atrial myxoma with repeated multiple cerebral emboli]

A case of left atrial myxoma with repeated multiple cerebral emboli is reported. A-44-year-old man first developed a sudden right hemiparesis in October 1969. After intensive physical theraphy, strength improved and he was able to return to his work. In March 1970, he suddenly lost consciousness and remained comatose for a day. Upon waking, he had a profound right hemiparesis, motor aphasia and Gerstmann's syndrome. He was admitted to Hiroshima City Hospital on August 1, 1970. The cardiac examination, including an electrocardiogram, was entirely normal. Laboratory studies revealed a normal blood count and urinalysis; erythrocyte sedimentation rate was elevated (32mm/hour). On a left cerebral angiographic study, performed on September 6, 1971, multiple aneurysmal dilatations of the branches of the left middle cerebral artery were demonstrated. No specific diagnosis was made. In January 1973, he developed dysarthria, dysphagia and quadriplegia because of the recurrent cerebral attacks. He had a high temperature continuously for three days and died on May 30, 1974. At autopsy a myxoma with the peduncle was attached to the septal wall of left atrium, and there were old infarcts in the brain, the myocardium and the kidneys.