The host galaxy of a fast radio burst

In recent years, millisecond-duration radio signals originating in distant galaxies appear to have been discovered in the so-called fast radio bursts. These signals are dispersed according to a precise physical law and this dispersion is a key observable quantity, which, in tandem with a redshift measurement, can be used for fundamental physical investigations. Every fast radio burst has a dispersion measurement, but none before now have had a redshift measurement, because of the difficulty in pinpointing their celestial coordinates. Here we report the discovery of a fast radio burst and the identification of a fading radio transient lasting ~6 days after the event, which we use to identify the host galaxy; we measure the galaxy's redshift to be z = 0.492 ± 0.008. The dispersion measure and redshift, in combination, provide a direct measurement of the cosmic density of ionized baryons in the intergalactic medium of ΩIGM = 4.9 ± 1.3 per cent, in agreement with the expectation from the Wilkinson Microwave Anisotropy Probe, and including all of the so-called 'missing baryons'. The ~6-day radio transient is largely consistent with the radio afterglow of a short γ-ray burst, and its existence and timescale do not support progenitor models such as giant pulses from pulsars, and supernovae. This contrasts with the interpretation of another recently discovered fast radio burst, suggesting that there are at least two classes of bursts.

P-ρ-T measurements of H2O up to 260 GPa under laser-driven shock loading

Pressure, density, and temperature data for H2O were obtained up to 260 GPa by using laser-driven shock compression technique. The shock compression technique combined with the diamond anvil cell was used to assess the equation of state models for the P-ρ-T conditions for both the principal Hugoniot and the off-Hugoniot states. The contrast between the models allowed for a clear assessment of the equation of state models. Our P-ρ-T data totally agree with those of the model based on quantum molecular dynamics calculations. These facts indicate that this model is adopted as the standard for modeling interior structures of Neptune, Uranus, and exoplanets in the liquid phase in the multi-Mbar range.

Spondylolysis originates in the ventral aspect of the pars interarticularis: a clinical and biomechanical study

Lumbar spondylolysis is a stress fracture of the pars interarticularis. We have evaluated the site of origin of the fracture clinically and biomechanically. Ten adolescents with incomplete stress fractures of the pars (four bilateral) were included in our study. There were seven boys and three girls aged between 11 and 17 years. The site of the fracture was confirmed by axial and sagittal reconstructed CT. The maximum principal tensile stresses and their locations in the L5 pars during lumbar movement were calculated using a three-dimensional finite-element model of the L3-S1 segment. In all ten patients the fracture line was seen only at the caudal-ventral aspect of the pars and did not spread completely to the craniodorsal aspect. According to the finite-element analysis, the higher stresses were found at the caudal-ventral aspect in all loading modes. In extension, the stress was twofold higher in the ventral than in the dorsal aspect. Our radiological and biomechanical results were in agreement with our clinical observations.

Adult onset tethered cord syndrome associated with intradural dermoid cyst. A case report

STUDY DESIGN

A case report and a review of literature.

OBJECTIVES

To describe a rare case of adult onset tethered cord syndrome associated with intradural dermoid cyst.

SETTING

General Orthopedics, Japan.

METHODS

A 50-year-old woman was referred to us because of right leg pain and pollakiuria. Neurological examinations and radiological assessments including myelography, computerized tomography scan and Magnetic resonance image were carried out. We diagnosed it as the adult onset tethered cord syndrome associated with an intradural cystic lesion.

RESULTS

The cystic lesion was totally removed following laminectomy from L5 through S4. Histologically, the tumor was diagnosed as a dermoid cyst.

CONCLUSIONS

Intradural dermoid could produce adult onset tethered cord syndrome, but it was not reported in the English literatures to our knowledge.

Allelic loss analysis of early-stage flat-type colorectal tumors

BACKGROUND

Flat-type colorectal tumors are rare, but are known for their unusual flat morphology and aggressive clinical behavior despite their small size. To identify distinct genetic alterations, loss of heterozygosity (LOH) analysis was performed on microdissected tissues.

MATERIALS AND METHODS

DNA was extracted from multiple microdissected foci in 43 cases of early-stage flat-type colorectal tumors and LOH analysis was performed on 2q, 4q, 5q, 12q, 14q, 15q, 17p, 18q, 18p and 22q.

RESULTS

LOH patterns were detected in one of two forms: (i) homogeneous LOH throughout the microdissected foci, which indicated the early acquisition of LOH; and (ii) heterogeneous LOH, which were detected in a part of analyzed foci. Homogeneous and heterogeneous LOH were most frequently detected on 17p (92%) followed by 18q (81%), 18p (81%), 5q (61%), 22q (51%), 14q (44%), 15q (41%), 2q (39%), 12q (36%) and 4q (32%). Homogeneous LOH was detected most frequently on 17p (68%) followed by 18p (53%), 18q (53%), 22q (34%) and 12q (27%). The average fractional allelic loss (FAL) for heterogeneous and homogeneous LOH was 0.57 and the average FAL for homogeneous LOH was 0.37.

CONCLUSIONS

Early flat-type colorectal tumors frequently shows the early occurrence of multiple LOH including 17p, 18p, 18q and 22q, which is coupled with additional LOH of other loci either simultaneously or in the early clonal progression phase. The extent and sequences of LOH may be the mechanisms responsible for the aggressive clinical behaviors of these tumors.

Biomechanical comparison of lumbar spine with or without spina bifida occulta. A finite element analysis

STUDY DESIGN

Biomechanical study using finite element model (FEM) of lumbar spine.

OBJECTIVES

Very high coincidence of spina bifida occulta (SBO) has been reported more than in 60% of lumbar spondylolysis. The altered biomechanics due to SBO is one considerable factor for this coincidence. Thus, in this study, the biomechanical changes in the lumbar spine due to the presence of SBO were evaluated.

SETTING

United States of America (USA).

METHODS

An experimentally validated three-dimensional nonlinear FEM of the intact ligamentous L3-S1 segment was used and modified to simulate two kinds of SBO at L5. One model had SBO with no change in the length of the spinous process and the other had a small dysplastic spinous process. Von Mises stresses at pars interarticularis were analyzed in the six degrees of lumbar motion with 400 N axial compression, which simulates the standing position. The range of motion at L4/5 and L5/S1 were also calculated.

RESULTS

It was observed that the stresses in all the models were similar, and there was no change in the highest stress value when compared to the intact model. The range of motion was also similar in all the models. The lumbar kinematics of SBO was thus shown to be similar to the intact model.

CONCLUSION

SBO does not alter lumbar biomechanics with respect to stress and range of motion. The high coincidence of spondylolysis in spines with SBO may not be due to the mechanical factors.

Ethyl esterification of docosahexaenoic acid in an organic solvent-free system with immobilized Candida antarctica lipase

Ethyl docosahexaenoate (EtDHA) is regarded as a potentially useful pharmaceutical substance on account of its beneficial physiological activities. We attempted the ethyl esterification of docosahexaenoic acid (DHA) in an organic solvent-free system using Candida antarctica lipase, which acts strongly on DHA and ethanol. Esterification of 88% was attained by shaking a mixture of DHA/ethanol (1:1, mol/mol) and 2 wt% immobilized C. antarctica lipase at 30 degrees C for 24 h. However, even in the presence of an excess amount of ethanol, the extent of esterification could not be raised above 90%. To attain a higher level of esterification, a two-step reaction was found to be effective. The first step was performed in a mixture of DHA/ethanol (1:1, mol/mol), and the reaction mixture was then dehydrated. In the second step, the resulting mixture was shaken at 30 degrees C for 24 h with 5 molar equivalents of ethanol against the remaining DHA using 2 wt% immobilized lipase. By means of this two-step procedure, 96% esterification was attained. Repetition of the first and second reactions showed that the immobilized lipase was reusable for at least 50 cycles. In addition, DHA remaining in the second-step reaction mixture was removed by a conventional alkali refining process, giving purified EtDHA with a high yield.

Mucosa-associated bacteria in ulcerative colitis before and after antibiotic combination therapy

BACKGROUND

We proposed that Fusobacterium varium is one of the causative agents in ulcerative colitis.

AIM

To examine the efficacy of antibiotic combination therapy against F. varium and to investigate the mucosa-associated bacteria before and after the therapy using a new molecular approach.

METHODS

Twenty patients with ulcerative colitis were randomly assigned into the antibiotic treatment group (amoxicillin, tetracycline and metronidazole for 2 weeks) and no-antibiotics group. Clinical assessment, colonoscopic and histological evaluations were performed at 0 and 3-5 months after the treatment. DNA from mucosal bacteria was isolated from biopsy specimens. We investigated the mucosa-associated bacterial components by terminal restriction fragment length polymorphism with the restriction enzyme HhaI and MspI, and quantified the change in the number of bacteria by real-time polymerase chain reaction. Immunohistochemical detection of F. varium in biopsy specimens was also performed.

RESULTS

After the treatment, the clinical assessment, colonoscopic and histological scores improved in the antibiotic group compared with the control group. Three peaks of terminal restriction fragment length polymorphism decreased after treatment only in the antibiotic group. Eubacterium rectale, Dorea formicigenerans, Clostridium clostridioforme and F. varium were included in these peaks. Based on the real-time polymerase chain reaction study, only F. varium was significantly reduced after treatment. In the immunostaining, post-treatment scores in treatment group were significantly lower than that in control group.

CONCLUSIONS

Antibiotics combination therapy was effective for ulcerative colitis. The number of mucosa-associated F. varium significantly decreased after the treatment.

Biomechanical Rationale of Endoscopic Decompression for Lumbar Spondylolysis as an Effective Minimally Invasive Procedure - A Study Based on the Finite Element Analysis

We evaluated the biomechanical behavior of the endoscopic decompression for lumbar spondylolysis using the finite element technique. An experimentally validated, 3-dimensional, non-linear finite element model of the intact L3 - 5 segment was modified to create the L4 bilateral spondylolysis and left-sided endoscopic decompression. The model of Gill's laminectomy (conventional decompression surgery of the spondylolysis) was also created. The stress distributions in the disc and endplate regions were analyzed in response to 400 N compression and 10.6 Nm moment in clinically relevant modes. The results were compared among three models. During the flexion motion, the pressure in the L4/5 nucleus pulposus was 0.09, 0.09 and 0.16 (MPa) for spondylolysis, endoscopic decompression and Gill's procedure, respectively. The corresponding stresses in the annulus fibrosus were 0.65, 0.65 and 1.25 (MPa), respectively. The stress at the adjoining endplates showed an about 2-fold increase in the Gill's procedure compared to the other two models. The stress values for the endoscopic and spondylolysis models were of similar magnitudes. In the other motions, i. e., extension, lateral bending, or axial rotation, the results were similar among all of the models. These results indicate that the Gill's procedure may lead to an increase in intradiscal pressure (IDP) and other biomechanical parameters after the surgery during flexion, whereas the endoscopic decompression did not change the segment mechanics after the surgery, as compared to the spondylolysis alone case. In conclusion, endoscopic decompression of the spondylolysis, as a minimally invasive surgery, does not alert mechanical stability by itself.

Mass spectrometric investigation of gaseous YbH, YbO and YbOH molecules

The high-temperature gaseous molecules YbH, YbO and YbOH have been identified and their thermochemistry investigated by the Knudsen effusion mass spectrometry technique coupled with a controlled pressure gas inlet system. Solid ytterbium monosilicide and disilicide samples were made to react in the Knudsen cell with H2(g) and H2(g)/O2(g); in these conditions, several gaseous species (Yb, YbO, YbH, YbOH, SiO, SiO2, H2O) were formed under equilibrium conditions. The temperature dependences of the partial pressures of the observed gaseous molecules were analyzed to derive the Yb--X bond energies (X = H, O, OH). Selected values are D0o(Yb--H) = 179.4 +/- 2.0 kJ mol(-1), D0o(Yb--O) = 384 +/- 10 mol(-1) and D0o(Yb--OH) = 322 +/- 12 kJ mol(-1), and Delta(at)H0o(YbOH) = 746 +/- 12 kJ mol(-1). Density functional theory (DFT) calculations were also performed. Experimental and computational results are discussed and compared to previous data when available. The SiO/SiO2 high-temperature gaseous equilibrium was also observed.

Improvement in serum pepsinogens and gastrin in long-term monitoring after eradication of Helicobacter pylori: comparison with H. pylori-negative patients

BACKGROUND

A decrease in pepsinogen and gastrin levels 1-3 months after Helicobacter pylori eradication is well known. However, few data are available on the long-term progression of these decreases beyond 1 year after eradication, and there has been no investigation into whether pepsinogen and gastrin levels return to normal levels as defined by data from H. pylori-negative patients with dyspepsia.

AIM

We studied the effect of H. pylori eradication on pepsinogen and gastrin levels for more than 1 year, and compared levels to those in H. pylori-negative patients with dyspepsia. We also investigated the effect of H. pylori eradication on the course of atrophic corpus gastritis as reflected by histology, and on PGI levels and PG I/II ratio.

METHODS

We enrolled 172 H. pylori-positive patients with dyspepsia who had undergone successful eradication therapy of more than 1 year's duration and 101 non-treated H. pylori-negative patients with dyspepsia. H. pylori status was assessed at entry and at each endoscopy after eradication by culture, histological results, the rapid urease test and the urea breath test. In both groups, patients were evaluated for fasting serum pepsinogen I and II and gastrin using a radioimmunoassay technique, and underwent detailed histological assessment according to the updated Sydney System.

RESULTS

In the H. pylori-negative patients, mean serum pepsinogen I and II, I/II ratio and gastrin levels were 52.6 +/- 20.8 ng/mL, 9.2 +/- 4.2 ng/mL, 6.0 +/- 1.7 and 53.5 +/- 29.2 pg/mL, respectively. In H. pylori-positive patients with long-term eradication, pepsinogen I and II, I/II ratio and gastrin levels were 81.3 +/- 46.6 ng/mL, 25.9 +/- 17.1 ng/mL, 3.4 +/- 1.3 and 131.9 +/- 130.8 pg/mL, respectively, before treatment. At 1-3 months after eradication, serum pepsinogen I and II levels in the H. pylori-positive patients decreased to levels similar to those in the negative patients, whereas pepsinogen I/II ratio and gastrin levels remained lower and higher, respectively, than in the negative patients. Serum pepsinogen I/II ratio and gastrin levels then became similar between the groups at 12-15 months after eradication. In histological findings, inflammation and neutrophil activity decreased by 1-3 months, and atrophy in the corpus and metaplasia in the antrum decreased by 12-15 months.

CONCLUSION

The results suggest that atrophic corpus gastritis and superficial gastritis are reversible, as indicated by both histological and serological findings in a long-term follow-up study.

Effects of active recovery under a decreasing work load following intense muscular exercise on intramuscular energy metabolism

The effect of active recovery at a decreasing % of MVC following intense muscular exercise on intramuscular pH was investigated in vivo using 31P-MRS. Seven healthy men participated, and their right wrist flexor muscle group was examined. The subjects were asked to flex their right wrist at 60 % of the maximum voluntary contraction (MVC) every 2 s until the intracellular pH in the wrist flexor muscle decreased to 6.4. After the exercise period, the subjects underwent active or passive recovery for 10 min. For the active recovery (AR), the subject was asked to continue exercising at a decreasing % of MVC, decreasing from 25 to 5 % MVC every two min during AR. 31P-MR-spectra were obtained throughout the experiments, and from the spectra the intracellular pH (pHi) was calculated as an indicator of intracellular events. AR data were compared to data collected during passive recovery (PR). During AR, the pHi increased immediately after the exercise period; whereas in that of PR, it did not recover within 5 minutes after exercise. The results suggested that mild exercise was an effective manoeuver to promote recovery from intramuscular metabolic acidosis.

[Susceptibilities of bacteria isolated from patients with lower respiratory infectious diseases to antibiotics (1999)]

From October 1999 to September 2000, we collected the specimen from 430 patients with lower respiratory tract infections in 17 institutions in Japan, and investigated the susceptibilities of isolated bacteria to various antibacterial agents and antibiotics and patients' characteristics. Of 515 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in inflammation, 506 strains were investigated. The breakdown of the isolated bacteria were: Staphylococcus aureus 78, Streptococcus pneumoniae 101, Haemophilus influenzae 104, Pseudomonas aeruginosa (non-mucoid) 58, P. aeruginosa (mucoid) 11, Moraxella subgenus Branhamella catarrhalis 41, Klebsiella pneumoniae 18, etc. Of 78 S. aureus strains, those with 4 micrograms/ml or above of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) occupied 57.7%. Vancomycin and arbekacin showed the most potent activities against MRSA without detection of ABK-resistant strain (MIC: 64 micrograms/ml) and decrease of VCM-sensitive strains those were found in 1998. The frequency of S. pneumoniae exhibiting low sensitivity to penicillin (penicillin-intermediate S. pneumoniae: PISP + penicillin-resistant S. pneumoniae: PRSP) decreased to 34.7% from 46.0% in 1998. The frequency of PRSP was 3.0%, being the least number after 1991. Carbapenems showed strong activities against S. pneumoniae. Especially, panipenem inhibited the growth of all 101 strains with MIC of 0.063 microgram/ml. Generally, all drugs showed strong activities against H. influenzae with MIC80s of 4 micrograms/ml or below. MICs of ofloxacin ranged between 0.063 microgram/ml and 4 micrograms/ml in 1998, however, those were 0.125 microgram/ml or below in all H. influenzae in 1999 showing the strongest activity. Tobramycin and ciprofloxacin showed strong activities against P. aeruginosa (both mucoid and non-mucoid) with MIC80s of 1 microgram/ml. Number of isolated P. aeruginosa (mucoid) was little as 11, however, the susceptibilities to all drugs were better than P. aeruginosa (non-mucoid). K. pneumoniae showed good susceptibilities to all drugs except for ampicillin with decreasing of low-sensitive strains compared to those detected in 1998. Also, all drugs generally showed strong activities against M. (B.) catarrhalis. MIC80s of all drugs were 2 micrograms/ml or below. The drug which showed the strongest activity was imipenem inhibiting all 41 strains with MIC of 0.063 microgram/ml. On the patients' characteristics, the number of patients aged 80 years or older who had been increased was decreased in 1999 in the distribution by age. The percentage of the elderly patients aged 70 years or older was 47.0%, which occupied almost a half number of the total patients as in the last year. As for the incidence by disease, bacterial pneumonia and chronic bronchitis were the highest. They were noted in 37.9% and 30.5% of the patients, respectively. In 1999, bronchial asthma was frequently observed as compared in recent years. It was noted in about 10% of the patients which is the same % as in bronchiectasis. We examined the number of strains from these patients with infections before and after administration of antibiotics. In patients with bacterial pneumonia, the number of isolated strains was almost the same between those before and after administration. However, in patients with chronic bronchitis, the number of strains remarkably decreased to less than the half of the total after administration of antibiotics in the last year, but it decreased to 2/3 of the total in 1999. On the administration of antibiotics and isolated bacteria by the day of administration, the bacteria which were isolated more before administration were H. influenzae in 28.4%, S. pneumoniae in 25.7%, M. (B.) catarrhalis in 12.0% and S. aureus in 10.6%. The frequency of S. aureus after administration over 15 days was almost the same as that before administration, but the frequency of P. aeruginosa (both mucoid and non-mucoid) was 36.8% which was higher than that before administration. The frequency of isolated S. pneumoniae was decreased after administration and none of them was isolated after completion of administration. However, that of H. influenzae was decreased to 7.1% after administration within 3 days, and many H. influenzae were isolated after completion of administration as 21.4%.

[Superimposed high-frequency jet ventilation induced deterioration of oxygenation during whole lung lavage in a patient with pulmonary alveolar proteinosis]

A 39-year-old man suffering from pulmonary alveolar proteinosis underwent whole lung lavage of the right lung under one-lung ventilation with total intravenous anesthesia in the right lateral position. Superimposed high-frequency jet ventilation (SHFJV) was applied for approximately 10 minutes during lung lavage. The settings of HFJV were as follows: FIO2 = 1.0, rate = 150 bpm, driving pressure = 1 atm, inspiratory time = 30% of cycle. Since peak inspiratory pressure was high (29 cm H2O) during intermittent positive pressure ventilation (IPPV) due to severe bridle ventilation impairment, HFJV was performed only in the exhalation phase of IPPV. SpO2 and PaO2 at the time of unilateral lung filling declined following initiation of SHFJV, from 98% and 93 mmHg to 95% and 62 mmHg, respectively. Although pulmonary arterial pressure tended to be slightly elevated, little change in blood pressure, cardiac output and central venous pressure was observed. SpO2 was quickly restored after the end of SHFJV. The reason for deterioration of oxygenation might have been an increase in shunt due to shift of pulmonary blood flow from the ventilated lung to the nonventilated lung. These findings suggest that performance of SHFJV during lung lavage for a patient with advanced pulmonary alveolar proteinosis may cause pulmonary oxygenation capacity to deteriorate even when circulatory inhibition is minimal.

Laterally spreading tumor: clinicopathological study in comparison with the depressed type of colorectal tumor

AIM

To evaluate the difference between laterally spreading colorectal tumors (LSTs) with depression and depressed-type colorectal tumors.

METHODS

Sixteen LSTs showing the appearance of non-distinct, gently sloping central depressions were compared clinicopathologically with 14 depressed-type tumors that were larger than 10 mm in size.

RESULTS

The mean size of LSTs with depression was 13.5 +/- 3.4 mm, which was significantly larger than that of the depressed type colorectal tumors (11.2 +/- 1.5 mm). The invasion of the depressed-type colorectal tumors was significantly deeper than that of LSTs with depression, despite the larger size of the LSTs. The surface structures (pit patterns) of both types of tumors were apparently different; the pit patterns of LSTs with depression were almost of the type IIIL pit, while that of the depressed-type tumors were almost of type V pits (P < 0.01). Histologically, LSTs with depression appeared to grow in a superficial replacing manner on the edge of the lesions, while depressed-type tumors grew in an expanding manner.

CONCLUSION

It seems appropriate that these LSTs with depression should be distinguished from depressed-type colorectal tumors and regarded as constituting a new clinical entity.

[The Baxter AS 50 syringe pump: a comparison with propofol-specific syringe pumps]

We used a Baxter AS 50 syringe pump for intravenous anesthesia with propofol, and compared it with a Grasby 3500 and a Terumo STC-525 X pumps, which are specifically designed for propofol infusion. The AS 50 pump is a programmable syringe infusion pump, which allows us to register up to 70 drug names in 10 categories and various infusion modes for drugs. There are 14 types of continuous infusion mode, a custom dilution mode, and three types of time infusion modes. The continuous infusion mode in mg.kg-1.h-1 is available for propofol anesthesia. Operation of this pump is simple and user-friendly, as with for the other propofol-specific pumps. Although the AS 50 pump is limited to a maximum bolus rate of 438 ml.h-1, this restriction is not a serious problem in clinical practice. The AS 50 pump is also equipped with an RS-232 C digital interface port to allow external remote monitoring or automated control. On-line simulation of blood propofol concentration is possible with a simulation program such as Propofol-Mon. Our impression is that the AS 50 pump is compact, easy to use, accurate and reliable for propofol anesthesia.

[A case of agnosia for streets and houses unaccompanied by prosopagnosia of familiar faces due to the right occipital lobe infarction]

We reported a patient who showed agnosia for streets and homes unaccompanied by prosopagnosia of familiar faces following infarction in the right occipital lobe. A 70-years-old right-handed man admitted to our department because of sudden development of visual impairment. He had left hemianopsia, left unilateral spatial neglect and slight visual memory disturbance but no other neurological abnormalities. His verbal memory was maintained intact. He was, however, unable to distinguish the sceneries of buildings and streets regardless of their familiarities and often got lost in the hospital. His topographical abilities in map-sketching and route-description were partially impaired depending upon the familiarity of targets; the disability was observed toward unfamiliar targets. His ability in facial recognition was also partially impaired depending upon the familiarity of persons. The patient was unable to distinguish faces of unfamiliar persons, such as nurses and doctors whom he met following stroke, whereas he was able to distinguish faces of familiar persons, such as his family and friends. The brain MRI demonstrated infarction in the right medial occipital lobe including parahippocampal gyrus, lingual gyrus and fusiform gyrus. In general, the manifestation of agnosia for streets and houses is associated with prosopagnosia. The present case, however, exhibited only the former in association with the partial manifestation of the latter. The fact suggests that those two are independent syndromes. The present case also showed a dissociation in the abilities of topographical and facial recognition according to the familiarity of targets. The process for the retrieval and reference of acquired information and that for the acquirement of new visual information may work in an independent manner.

Hydrolysis of beta-galactosyl ester linkage by beta-galactosidases

p-Hydroxybenzoyl beta-galactose (pHB-Gal) was synthesized chemically to examine the hydrolytic activity of beta-galactosyl ester linkage by beta-galactosidases. The enzyme from Penicillium multicolor hydrolyzed the substrate as fast as p-nitrophenyl beta-galactoside (pNP-Gal), a usual substrate with a beta-galactosidic linkage. The enzymes from Escherichia coli and Aspergillus oryzae hydrolyzed pHB-Gal with almost the same rates as pNP-Gal. The enzymes from Bacillus circulans, Saccharomyces fragilis, and bovine liver showed much lower activities. pH-activity profiles, inhibition analysis, and kinetic properties of the enzymic reaction on pHB-Gal suggested that beta-galactosidase had only one active site for hydrolysis of both galactosyl ester and galactoside. The Penicillium enzyme hydrolyzed pHB-Gal in the presence of H218O to liberate galactose containing 18O. This result suggests the degradation occurs between the anomeric carbon and an adjacent O atom in the ester linkage of pHB-Gal.

[Susceptibilities of bacteria isolated from patients with lower respiratory infectious diseases to antibiotics (1998)]

The bacteria isolated from the patients with lower respiratory tract infections were collected by institutions located throughout Japan, since 1981. Ikemoto et al. have been investigating susceptibilities of these isolates to various antibacterial agents and antibiotics, and analyzed some characteristics of the patients and isolates from them each year. Results obtained from these investigations are discussed. In these 18 institutions around the entire Japan, 532 strains of presumably etiological bacteria were isolated mainly from the sputa of 438 patients with lower respiratory tract infections during the period from October in 1998 to September in 1999. MICs of various antibacterial agents and antibiotics were determined against 85 strains of Staphylococcus aureus, 100 strains of Streptococcus pneumoniae, 96 strains of Haemophilus influenzae, 75 strains of Pseudomonas aeruginosa (non-mucoid strains), 6 strains of Pseudomonas aeruginosa (mucoid strains), 38 strains of Moraxella subgenus Branhamella catarrhalis, 26 strains of Klebsiella pneumoniae etc., and the susceptibilities of 517 strains were assessed except for those strains that died during transportation. S. aureus strains for which MICs of oxacillin (MPIPC) were higher than 4 micrograms/ml (methicillin-resistant S. aureus: MRSA) accounted for 60.0%. Vancomycin (VCM) and arbekacin (ABK) showed the most potent activities against MRSA. But one of MRSA showed resistance to ABK with the MIC of 64 micrograms/ml. The sensitive strains of MRSA to VCM have decreased. The frequency of penicillin (PC)-intermediate S. pneumoniae (PISP) + PC-resistant S. pneumoniae (PRSP) have increased in 46.0% for 1998 comparatively from 30.9% of 1997's. But PRSP decreased, and PISP increased into 39.0% of 1998 years from 19.8% of 1997's. Panipenem (PAPM), imipenem (IPM) and faropenem (FRPM) showed the most potent activities against S. pneumoniae with MIC80s of 0.125 microgram/ml or below. Against H. influenzae and M. (B.) catarrhalis, almost all the drugs showed good activities. The sensitive strains of them against ceftazidime (CAZ) decreased in 1997, but those have increased in 1998. Inversely, the susceptibility of them against cefotiam (CTM) had been higher in 1997, but those have been lower in 1998. Tobramycin (TOB) showed the most potent activity against P. aeruginosa (both mucoid and nonmucoid strains). All drugs except ampicillin (ABPC) were active against K. pneumoniae. A quite few of K. pneumoniae showed low susceptibilities. Also, we investigated year to year changes in the characteristics of patients, their respiratory infectious diseases, and the etiology. The examination of age distribution indicated that the proportion of patients with ages over 70 years was 48.6% of all the patients showing a slight increase in every year. About the proportion of diagnosed diseases as follows: Bacterial pneumonia was the most frequent with 40.2%. The ratio of it has increased slightly, and the increased rate was 10% in patients with ages over 70 years compared with the results in 1997. Chronic bronchitis have decreased slightly with 27.6% in 1998. Number of strains isolated from patients before administration of antibiotics were more than those after administration of them in chronic bronchitis, but these were almost same number in bacterial pneumonia. Administration of antibiotics has changed the results of the frequency of isolation of bacterial species. Bacterial isolations before administration of antibiotics were as follows: S. pneumoniae 26.7%, H. influenzae 23.8%, S. aureus 13.3% and M. (B.) catarrhalis 10.8%. The frequencies of S. aureus decreased after antibiotics administration over 15 days, but the frequencies of P. aeruginosa (both mucoid and non-mucoid) was not affected. The frequencies of P. aeruginosa was 45.5% after administration over 15 days. The frequencies of S. pneumoniae decreased upon administration of antibiotics, these were only 4.5% over 15 days. The frequencies of H. (

Effects of external acidosis on HERG current expressed in Xenopus oocytes

We investigated effects of external acidosis on HERG current expressed in Xenopus oocytes. HERG current was rapidly and reversibly suppressed by external acidosis in a voltage-independent manner. The slope conductance was decreased from 143 +/- 11 to 93.4 +/- 6.8 microS by changing external pH (pH(o)) from 7.6 to 6.0 (P<0.05). Steady-state activation was shifted by about 20 mV in a depolarized direction with a change from pH(o) 7.6 to 6.0, while steady-state inactivation was not significantly changed. Activation time constants were increased, deactivation and recovery time constants were decreased, while those of inactivation showed no significant change. When external K(+) concentration ([K(+)](o)) was increased from 2 mM to 10 mM, a ratio of slope conductance at pH(o) 6.0 to pH(o) 7.6 was significantly smaller in 2 mM (pH(o) 6.0/pH(o) 7.6 = 0.65 +/- 0.04) than in 10 mM[K(+)](o) (0.83 +/- 0.06, P<0.05). The changes in activation, deactivation and recovery from inactivation were not affected by change in [K(+)](o). The results indicated that external acidosis suppressed HERG current mainly by shifting the voltage-dependence of the activation and deactivation kinetics, and partly by decreasing slope conductance. Moreover, the reduction of HERG current could be partly antagonized with increasing [K(+)](o).

Isolation of iso-grayanotoxin II from leaves of Leucothoe grayana Max. Its X-ray crystallographic analysis and acute toxicity in mice

The structure of iso-grayanotoxin II, a new diterpenoid from Leucothoe grayana MAX., has been determined as 3 beta,5 beta,6 beta,14 beta,16 alpha-pentahydroxygrayanotox-9(10)-ene by spectroscopic and X-ray crystallographic analysis. The lethal dosage level of iso-grayanotoxin II in mice was lower than that of grayanotoxin III.

Preoperative epidural morphine using double-catheter technique for esophagectomy

This study was undertaken to determine whether preoperative epidural morphine using double-catheter technique would improve postoperative analgesia in patients undergoing esophagectomy with or without continuous intraoperative epidural lidocaine in a randomized double-blind and controlled manner. Thirty patients undergoing esophagectomy for esophageal cancer received preoperative epidural morphine 2 mg at T 6-7 and 2 mg at L 3-4 through the catheters, respectively. Thereafter, continuous thoracic epidural infusion of either 1% lidocaine (lidocaine group, n = 15) or normal saline solution (control group, n = 15) at 6 ml/h was initiated. After surgery, mean verbal rating scale of pain (0 to 10) at rest was maintained below 4 and pain on deep breathing was maintained mild in all patients in both groups. There was no significant difference in these values between the groups. In conclusion, preoperative epidural morphine using double-catheter technique provided adequate analgesia following esophagectomy. The addition of intraoperative continuous epidural lidocaine did not improve analgesia.

How useful is the detection kit for antibody to Helicobacter pylori in urine (URINELISA) in clinical practice?

OBJECTIVE

Increased knowledge of the significance of Helicobacter pylori (H. pylori) infection in gastric disorders has accelerated the trend of screening patients with dyspepsia for its infection. Serological examination of antibody for H. pylori has been widely performed. Recently, a urine-based enzyme-linked immunosorbent assay (URINELISA) kit for detection of antibody for H. pylori has been developed. Accordingly, we evaluated its diagnostic accuracy in clinical practice.

METHODS

Subjects of this study were 132 patients who presented at our university hospital because of dyspeptic symptoms (81 men, 51 women; age, 41.5+/-1.4 yr). 13C urea breath test, blood drawing for serological antibody for H. pylori infection by four different kits, and urine collection for the URINELISA test for detection of the antibody were performed. Diagnostic accuracy of the commercially available antibodies in serum and in urine were investigated using the results of the 13C urea breath test as the gold standard.

RESULTS

Sensitivity, specificity, and accuracy of URINELISA were 86.3% (95% confidence intervals [CI], 76-93%), 91.5% (95% CI, 81-97%), and 88.6% (95% CI, 82-93%), respectively, which were comparable to those of imported serological kits.

CONCLUSIONS

The URINELISA kit for detecting anti-H. pylori antibody in urine provides diagnostic accuracy comparable to that of imported kits for detecting antibodies in serum and is considered to be clinically useful for the diagnosis of H. pylori infection.

[Apneic anesthesia for microsurgery of the larynx under propofol anesthesia]

Apneic anesthesia with intermittent ventilation (AAIV) under inhalational anesthesia has been reported to improve visualization of the larynx with lack of vocal cord motion in laryngeal microsurgery. In this study, we evaluated AAIV using total intravenous anesthesia with propofol and fentanyl instead of inhalational anesthesia in 11 patients undergoing microsurgery of the larynx, and examined the effects of AAIV on respiration and circulation. Anesthesia was maintained with infusion of propofol 4-10 mg.kg-1.h-1 and intermittent administration of fentanyl and vecuronium intravenously. The lungs were ventilated with 100% oxygen, and the endotracheal tube was removed during the apneic period. AAIV provided the otorhinolaryngologist sufficient room in which to operate and an immobile field without complications in any of the patients. The number of periods of apnea (mean +/- SD) was 3.3 +/- 1.3, and the duration of apnea was 292 +/- 23 seconds. Neither blood pressure nor heart rate changed during the apneic periods. Arterial oxygen saturation measured using pulse oxymetry (Spo2) changed in none of the patients except an obese patient whose Spo2 declined to 90%. End-tidal carbon dioxide level increased for 14.9 mmHg immediately after apneic periods. Propofol vielded stable and adequate levels of anesthesia during apneic periods. We conclude that AAIV using constant monitoring of Spo2 is a useful and safe technique, and that propofol is a suitable anesthetic agent for AAIV.

[A patient with pulmonary alveolar proteinosis who underwent whole lung lavage under total intravenous anesthesia with propofol]

A 32-year-old male suffering from pulmonary alveolar proteinosis underwent whole lung lavage under one-lung ventilation and total intravenous anesthesia with propofol and fentanyl. The lung lavage was initially performed for the right lung, and for the left lung two weeks later. Spo2 and Pao2 declined at the time of lung degassing and drainage of lavage fluid (minimum values; Spo2 = 83%, Pao2 = 55.9 mmHg), and recovered on filling with the lavage fluid. Although pulmonary arterial pressure and central venous pressure were slightly increased at the time of unilateral lung filling, there was no marked change in arterial pressure, heart rate or cardiac output for lavage of either lung. % VC, DLCO and PaO2 markedly improved after whole lung lavage, from 26.0%, 5.84 ml.min 1.mmHg-1, and 61.9 mmHg in room air to 41.6%, 9.96 ml.min-1.mmHg-1, and 89.3 mmHg in room air, respectively. Since propofol does not inhibit hypoxic pulmonary vasoconstriction and is able to maintain a stable level of anesthesia, it is a useful anesthetic agent for whole lung lavage.

[Assessment of postoperative pain using face scale judged by nurses: comparison between hepatectomy and esophagectomy]

The agreement between scores for observer-reported face scale (FS) and the self-reported visual analog scale (VAS) in postoperative pain assessment has not been compared for different types of surgery and for different times in the postoperative course. Five grade FS (1-5) judged by a nurse was compared with VAS (0-100 mm) reported by patients who had undergone hepatectomy (group H, n = 60) or esophageal cancer surgery by a thoracoabdominal procedure (group E, n = 50). Postoperative analgesia was mainly achieved by epidural morphine administration combined with lidocaine or bupivacaine in both groups. Pain measurement was performed at admission to the ICU, 1, 2, 6, and 10 hours later, and the following morning in group H, and 0.5, 1, 2, 6, 10, and 14 hours after tracheal extubation in group E. VAS scores (means +/- SD) were respectively 46 +/- 29 and 31 +/- 25 at ICU admission and one hour later in group H, and 41 +/- 36 and 36 +/- 33 thirty minutes and one hour after tracheal extubation in group E. FS values (means +/- SD) were respectively 2.6 +/- 1.2 and 2.1 +/- 1.1 at ICU admission and one hour later in group H, and 2.4 +/- 1.3 and 2.2 +/- 1.2 thirty minutes and one hour after tracheal extubation in group E. VAS and FS decreased in both groups over time postoperatively. A fair degree of agreement was found between VAS and FS scores in group H at ICU admission and one hour later (weighted kappa values = 0.29 and 0.28, respectively); on the other hand, good agreement between these two scores was found in group E thirty minutes and one hour after tracheal extubation (weighted kappa values = 0.67 and 0.62, respectively). Weighted kappa values decreased thereafter in group E, but did not change in group H over the postoperative course. We conclude that postoperative pain assessment based on facial expression is more useful early after extubation for patients who have undergone esophagectomy than for those who have undergone hepatectomy.