Drain outlets in patient rooms as sources for invasive fusariosis: an analysis of patients with haematological disorders

BACKGROUND

Invasive fusariosis (IF) is a frequently fatal disease as there are few antifungals to treat it, making the prevention of IF crucial. However, fusarium infections have not been as thoroughly studied as other common pathogenic fungi such as Aspergillus or Candida.

AIM

To investigate the epidemiology of IF in patients with haematological diseases in Japan and to elucidate the infectious route of fusarium infection.

METHODS

We retrospectively analysed 29 IF cases in patients with haematological diseases from 2009 to 2019 in Japan. To discover the infectious source of IF, we performed an indoor environment survey targeted at indoor air and drain outlets in medical institutions and residences using culture-based and metagenomic methods. Finally, we performed aerosol- and droplet-mediated dispersion studies.

FINDINGS

The epidemiological study showed that the primary pathogen of IF was Fusarium solani species complex (FSSC), and the most common species was Fusarium petroliphilum. Most patients were likely to develop IF during hospitalization. A fusarium culture was positive in 26 of 72 drain samples. Few fusarium were detected from air samples; by contrast, 29 of 108 isolates from the drain outlets were identified as fusarium. Furthermore, similar results were obtained in the metagenomic analysis. Interestingly, species belonging to FSSC were isolated from indoor drain outlets, which was similar to those of the IF patients. In the droplet-mediated dispersion study, eight to 17 colonies of fusarium were isolated.

CONCLUSION

Our study indicates that causative Fusarium spp. could inhabit drain outlets in hospitals or residences, and droplet-mediated fusarium dispersion is a potential cause of IF.

Multiple Penetrating Atherosclerotic Ulcers of the Aorta: Report of a Case

A 69-year-old hypertensive man who had 7 pseudoaneurysms caused by penetrating atherosclerotic ulcers underwent 2-staged endovascular grafting in the thoracic and thoracoabdominal aorta and a conventional graft replacement of the abdominal aorta. He had an uneventful postoperative course; follow-up computed tomography demonstrated that all aneurysmal lesions treated by endovascular grafting completely disappeared. He has been free from any aortic events 20 months after the last surgery.

Gamma geometry dependency of efficiency functions in the 4πβ-γ coincidence measurements of complex decaying nuclides

In order to clarify the γ-efficiency dependency of 4πβ-γ efficiency functions, a series of 4πβ-γ efficiency extrapolation measurements of a (134)Cs source were carried out for a wide variety of γ-geometries using a 4πβ(PS)-4πγ detector configuration. As the source is situated in the plastic scintillator (PS) β-detector, the γ-efficiency of the system can be readily changed by extracting the β-detector from the well-hole in a series of stages. For data acquisition and analyses, a list-mode two-parameter data acquisition system was employed. The forms of the extrapolation curves were monitored with decreasing γ-geometry, eventually exhibiting a similar behavior to those obtained in a usual 4πβ-γ coincidence counting system. The experimental results and considerations suggested that the γ-geometry dependency of the efficiency functions were due to summing effects in the γ-channel, and some qualitative remarks on the form of the extrapolation functions are given.

Absorption and backscatter of internal conversion electrons in the measurements of surface contamination of ¹³⁷Cs

We measured 4π and 2π counting efficiencies for internal conversion electrons (ICEs), gross β-particles and also β-rays alone with various source conditions regarding absorber and backing foil thickness using e-X coincidence technique. Dominant differences regarding the penetration, attenuation and backscattering properties among ICEs and β-rays were revealed. Although the abundance of internal conversion electrons of (137)Cs-(137)Ba is only 9.35%, 60% of gross counts may be attributed to ICEs in worse source conditions. This information will be useful for radionuclide metrology and for surface contamination monitoring.

A simple and versatile data acquisition system for software coincidence and pulse-height discrimination in 4πβ-γ coincidence experiments

A simple but versatile data acquisition system for software coincidence experiments is described, in which any time stamping and live time controller are not provided. Signals from β- and γ-channels are fed to separately two fast ADCs (16 bits, 25 MHz clock maximum) via variable delay circuits and pulse-height stretchers, and also to pulse-height discriminators. The discriminating level was set to just above the electronic noise. Two ADCs were controlled with a common clock signal, and triggered simultaneously by the logic OR pulses from both discriminators. Paired digital signals for each sampling were sent to buffer memories connected to main PC with a FIFO (First-In, First-Out) pipe via USB. After data acquisition in list mode, various processing including pulse-height analyses was performed using MS-Excel (version 2007 and later). The usefulness of this system was demonstrated for 4πβ(PS)-4πγ coincidence measurements of (60)Co, (134)Cs and (152)Eu. Possibilities of other extended applications will be touched upon.

Controlled low-flow reperfusion after warm brain ischemia reduces reperfusion injury in canine model

Background: Acute occlusion of the carotid artery caused by acute type A aortic dissection (AAD) induces on-going warm brain ischemia. The purpose of this study was to elucidate the hypothesis that low-flow reperfusion could mitigate reperfusion injury after warm ischemic damage to the brain.

Methods: Experiments were performed using a canine global brain ischemia model, with 15 minutes of ischemia followed by 3 hours reperfusion, which was established by a simple brain reperfusion circuit with a roller pump. The right common carotid artery (RCCA) flow ratio was determined as the mean RCCA flow during reperfusion divided by the mean RCCA flow during pre-ischemia. Animals were divided into two groups according to the RCCA flow ratio; low RCCA flow ratio of 0.3 to 0.6 (Group L, n=5) and control RCCA flow ratio of 1.0 to 1.4 (Group C, n=5). At the 3-hour reperfusion time point, physiological and histopathological assessments were performed in both groups.

Results: Electroencephalographic activity recovered in four of five animals (80%) animals in Group L, whereas no recovery (0%) in activity was observed in Group C. Brain water content in Group L animals was significantly less than that in Group C. Apoptosis, number of perivascular edematous regions and NFκB expression were apparently suppressed in Group L compared with Group C. There were significant positive correlations of RCCA flow with brain water content, apoptosis and number of perivascular edematous regions.

Conclusions: Controlled low-flow reperfusion mitigated reperfusion-induced brain edema and apoptosis, leading to rescue of brain function in the canine model.

Standardization of 99mTc and 99Mo by the use of a 4pibeta-4pigamma counter

Technetium-99m is widely used for many diagnostic investigations in nuclear medicine, thus the standardization of this nuclide is important. In classical 4pibeta-gamma coincidence counting of (99m)Tc, the steep slope of the efficiency function and the large extrapolation range may cause a large measurement uncertainty. In order to overcome these difficulties, we apply the 4pibeta+4pigamma sum counting technique for the standardization. Furthermore, we adopt both the 4pibeta-4pigamma coincidence counting method and the 4pibeta+4pigamma sum counting technique for the standardization of its parent nuclide (99)Mo. High efficiencies for both nuclides were easily achieved by the use of our 4pibeta-4pigamma counter. All the results were consistent with the reference value obtained by the conventional method obtained by NMIJ.

Minimally invasive video-assisted thoracoscopic lobectomy for better clinical outcomes in peripheral T1NO lung cancer

It is an unresolved issue whether various thoracotomies affect clinical outcomes. In addition, a wide variety of technical approaches of video-assisted thoracic surgery depend on the facility. We reviewed 152 consecutive patients with clinical T1N0M0 lung cancer that underwent three types of lobectomy with systematic mediastinal lymphadenectomy in a single institute: 46 conventional thoracotomies (OPEN), 50 anterolateral small thoracotomies mainly using the thoracoscope as a light guide (ASSIST), and 56 minimum thoracotomies in which only a thoracoscope view was used (PURE). Total discharge from the chest drainage tube, length of hospital stay, and post-thoracotomy pain were significantly less in PURE than in OPEN and ASSIST. The results of mediastinal lymphadenectomy were equivalent. The 3-year survival rates were also similar among the three groups. We conclude that good clinical outcomes, especially reduced post-thoracotomy pain, seemed to correlate with the lesser degree of destruction of the chest wall with the identical quality as an acceptable cancer operation in PURE.

Perforation of the Valsalva Sinus After Implantation of Medtronic Freestyle Aortic Bioprosthesis

We report on structural valve deterioration in patients with the Medtronic Freestyle aortic bioprosthesis (Medtronic, Inc, Minneapolis, MN), including spontaneous perforation of the Valsalva sinus. These occurred in four prosthesis in 3 patients using the modified subcoronary method or full root technique. One patient died of ruptured pseudoaneurysm and the others survived reoperation well. Careful follow-up is required after Freestyle bioprosthesis implantation.

Surgical treatment for rupture of left ventricular free wall after acute myocardial infarction

Left ventricular (LV) free wall rupture particularly in blow-out type is still one of the fatal complications after myocardial infarction. Seven patients had LV rupture following acute myocardial infarction. LV rupture was divided into two categories: blow-out type (true rupture) in 5 cases, or oozing type (incipient rupture) in 2 cases. All patients were in deep shock condition and underwent surgery on emergency basis. Patch and glue (fibrin glue) technique was applied for oozing type patients, while direct closure using buttress sutures with additional sutured patch and glue (including GRF glue) technique for blow-out type patients. Surgery was performed on heart beating without cardioplegic arrest. Complete homeostasis and circulatory recovery were obtained in all cases. One blow-out type patient (14.3%), who had preoperative cardiopulmonary arrest (CPA), died of multiple organ failure. Four patients (57.1%) who had preoperative CPA or were in prolonged deep shock resulted in vegetative condition regardless of rupture type. Two patients (28.5%) of blow-out type were successfully rescued without any severe brain complications. No recurrence of free wall rupture was demonstrated during follow-up in all cases. Fifty-seven percent of patients had postoperative vegetative condition because of inadequacy of cardiopulmonary resuscitation including delayed circulatory support. Our surgical procedure provided sufficient circulatory recovery and survival without recurrence, even in patients with blow-out type rupture, as long as prompt resuscitation was performed.

Surgical intervention for isolated dissecting aneurysm of the superior mesenteric artery--a case report

A 44-year-old man with abdominal pain was diagnosed as having a spontaneous isolated dissection of the superior mesenteric artery. The patient was successfully treated with endoaneurysmorrhaphy 5 months after the onset and has been symptom free 15 months after surgery. In view of the excellent surgical outcome in the literature, surgical intervention for this rare pathology should be considered.

Oxidative stress in the pathogenesis of thoracic aortic aneurysm: protective role of statin and angiotensin II type 1 receptor blocker

OBJECTIVE

The pathogenesis of thoracic aortic aneurysms (TAA) is still unclear. A recent investigation indicated that angiotensin II, a potent activator of NADH/NADPH oxidase, plays an important role in aneurysmal formation. We investigated the potential role of p22phox-based NADH/NADPH oxidase in the pathogenesis of TAA.

METHODS

Human thoracic aneurysmal (n=40) and non-aneurysmal (control, n=39) aortic sections were examined, and the localization of p22phox, an essential component of the oxidase, and its expressional differences were investigated by immunohistochemistry and Western blot. In situ reactive oxygen species (ROS) generation was examined by the dihydroethidium method, and the impact of medical treatment on p22phox expression was investigated by multiple regression analysis.

RESULTS

In situ production of ROS and the expression of p22phox increased markedly in TAA throughout the wall, and Western blot confirmed the enhanced expression of p22phox. The expression was more intense in the regions where monocytes/macrophages accumulated. In these inflammatory regions, numerous chymase-positive mast cells and angiotensin converting enzyme-positive macrophages were present. Their localization closely overlapped the in situ activity of matrix metalloproteinase and the expression of p22phox. Multiple regression analysis revealed that medical treatment with statin and angiotensin II type 1 receptor blocker (ARB) suppressed p22phox expression in TAA.

CONCLUSION

Our findings indicate the role of p22phox-based NADH/NADPH oxidase and the local renin-angiotensin system in the pathogenesis of TAA. Statin and ARB might have inhibitory effects on the formation of aneurysms via the suppression of NADH/NADPH oxidase.

Thoracic aneurysm expansion secondary to collateral supplies via thyrocervical trunk and intercostal arteries in a patient after thromboexclusion

A case of thoraco-abdominal aortic aneurysm complicated after permanent clamping of the descending aorta (thromboexclusion) is reported. Angiographic and operative findings were: (1) a pseudo-aneurysm right at the distal anastomosis of previous intrathoracic bypass for pseudo-coarctation of the aorta filled by left ninth intercostal artery, which was supplied by the left internal thoracic artery; and (2) the cervical and thoracic spinal cord were supplied by the left vertebral artery and the mediastinal branch of the left thyrocervical trunk. This rare cause of a thoraco-abdominal aortic aneurysm and the significance of the subclavian artery as a source of spinal cord blood supply are discussed.

Complications of cerebrospinal fluid drainage in thoracoabdominal aortic aneurysm repair

Spinal cord ischemia resulting in postoperative paraplegia is a devastating complication of thoracoabdominal aortic aneurysm repair, and has been attributed to many causes. To prevent spinal cord compartment syndrome, cerebrospinal fluid drainage has been used as an adjunct to thoracoabdominal aortic aneurysm repair, with procedure-related complications generally occurring infrequently. We present two case reports of serious complications from CSF drainage.

Transbrachial arterial insertion of aortic occlusion balloon catheter in patients with shock from ruptured abdominal aortic aneurysm

OBJECTIVE

Of 125 surgical patients with abdominal aortic aneurysm (AAA) treated from 1999, 11 patients with deep shock from ruptured AAAs who underwent aortic occlusion balloon catheter (AOBC) insertion before laparotomy were studied.

METHODS

With the patients under local anesthesia, the brachial artery was exposed and the balloon catheter was inserted into the thoracic aorta. The balloon was inflated halfway and pulled back gently to the orifice of the left subclavian artery, and was advanced with the aid of blood flow down to the abdominal aorta. After full inflation of the balloon, the catheter was pulled until the balloon was fixed at the proximal shoulder of the AAA.

RESULTS

AOBC insertion was completed within 16.1 +/- 5.1 minutes. Systolic blood pressure at presentation was 84.1 +/- 31.7 mm Hg, deteriorated to 60.9 +/- 15.4 mm Hg on arrival in the operating room, and increased significantly (P <.0001) to 123.4 +/- 25.3 mm Hg after AOBC insertion. The balloon burst in three patients. Embolic complications were observed in two patients. There were three deaths, two associated with the balloon bursting. In nine patients whose shock was successfully controlled by AOBC, operative mortality was 11%.

CONCLUSION

Transbrachial arterial insertion of an AOBC may be useful to ameliorate hemorrhagic shock in patients with ruptured AAAs.

Endovascular stent-graft repair for penetrating atherosclerotic ulcer in the infrarenal abdominal aorta

PURPOSE

Penetrating atherosclerotic ulcer (PAU) is an ulceration of an atherosclerotic plaque penetrating through the intima, which may lead to intramural hematoma, aneurysm formation, or rupture. This disease is predominantly found in the thoracic aorta and is uncommon in the infrarenal aorta. The effectiveness of endovascular repair of PAU in the infrarenal aorta was retrospectively investigated.

METHODS

From 1999 to 2002, PAU was diagnosed with computed tomography and magnetic resonance imaging in the abdominal aorta in four patients. All patients were men; their average age was 78 years. All four patients had hypertension, and two patients had concomitant coronary artery disease. Three patients had abdominal pain or lumbago.

RESULTS

All patients underwent endovascular grafting with a Gianturco Z-stent covered with thin-wall woven Dacron graft. Indications for endovascular intervention were aneurysm formation with or without intramural hematoma in two patients and contained rupture with extraaortic hematoma in two patients. The postoperative course was uneventful in all cases, and no endoleak or aneurysm expansion was recognized during follow-up (4-32 months; average, 14 months).

CONCLUSIONS

Infrarenal aortic lesions caused by PAU were generally localized, and endovascular grafting appears to be a feasible alternative to surgical repair.

Rib-cross thoracotomy for replacement of the thoracoabdominal or total descending aorta

We describe the use of rib-cross thoracotomy and costal coaptation pins made with bioabsorbable poly-L-lactide for rib approximation. This thoracotomy provided an excellent intraoperative exposure of the entire descending aorta and thoracoabdominal aorta in patients with extended thoracoabdominal aortic aneurysm without increase in postoperative morbidity.

Reconstruction of right ventricular outflow tract with stentless xenografts in Ross procedure

To investigate whether the use of a stentless porcine aortic xenograft can be an alternative for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure, 9 patients underwent the Ross procedure and RVOT reconstruction with a stentless xenograft since January 2000. After the aortic valve was replaced with a pulmonary autograft, a stentless xenograft with a xeno- pericardial roll was implanted in the RVOT. One patient required subsequent aortic valve replacement because of severe regurgitation of the pulmonary autograft. All patients recovered well from the operation. The right ventricle-pulmonary arterial pressure gradient was 18 +/- 7 mm Hg at discharge and was not significantly increased during the 2-year follow-up period. Although 1 patient died of ventricular arrhythmia 5 months after, his cardiac function was normal, and transpulmonary valve pressure was 19 mm Hg in the follow-up. The other 7 patients are currently in New York Heart Association functional Class I. Although long-term follow-up is required to explain the durability, the stentless xenograft with a pericardial roll is considered to be an alternative for reconstruction of the RVOT within 2 years after the Ross procedure.

[Mid-term results of the surgery for aortic arch aneurysm]

One-hundred-one surgeries for aortic arch aneurysm were divided into 2 groups: 52 aortic dissection cases (AD) and 49 non-dissecting aneurysm (TA). In group AD, 30 cases were operated in acute phase (acute AD) and 22 were in chronic phase (chronic AD). Preoperative shock were observed in 21 cases (15 in acute AD mostly due to cardiac tamponade, 1 in chronic AD and 5 in TA due to rupture). Through median sternotomy, 59 total arch replacement and 25 hemi-arch replacement were carried out under deep hypothermia (16 degrees C:DH) and retrograde (RCP) or selective (SCP) cerebral perfusion or arch-first technique. Through thoracotomy, distal arch replacement were carried out with DH + RCP in 8 cases and with partial bypass in 9. Early mortality were observed in 7 patients (6.9%) and 24 months survival rates (Kaplan-Meier) were 86.1% overall, 76.1% in acute AD, 95.5% in chronic AD, 87.8% in TA. The survival rates in patients with preoperative shock was 61.2%, however, without shock, 92.9% in acute AD, 95.2% in chronic AD, and 91.4% in TA. Other than mortality, 4 re-operations for aortic arch, 4 operations for descending to abdominal aorta and 1 late hemiplegia were observed. Aortic event free ratio at 24 months was 55.4% in acute AD, 94.4% in chronic AD, and 75.7% in TA. For the further improvement of aortic arch surgery, early mortality and residual false lumen in acute aortic dissection and atherosclerotic aneurysm in descending to abdominal aorta are focused.

Distribution of tetracaine and its metabolite in rabbits after high versus normal spinal anesthesia

High spinal anesthesia is one cause of sudden death associated with the spinal anesthesia. We did animal experiments to verify high spinal anesthesia by analyzing tetracaine and its metabolite, p-butylaminobenzoic acid in tissue samples. Tetracaine (0.25% in 10% glucose solution) 0.21-0.28 mg/kg was administered to two groups of rabbits to induce high and normal spinal anesthesia. Tetracaine and the metabolite in rabbit tissues were analyzed by gas chromatography-mass spectrometry, as a free base for tetracaine and as tert-butyldimethylsilyl derivative for the metabolite. In the group given high spinal anesthesia, levels of the metabolite in the brain stem were higher than in the cerebrum, cerebellum and whole blood. On the other hand, in the group given normal spinal anesthesia, the opposite results were obtained. Therefore, high spinal anesthesia induced by tetracaine can be diagnosed by comparing the concentrations of metabolite in whole blood, cerebrum, cerebellum and brain stem.

Deep vein thrombosis caused by congenial interruption of the inferior vena cava--a case report

Congenital interruption of the inferior vena cava is an uncommon vascular anomaly. In this setting, the appearance of deep vein thrombosis is very rare because associated azygous or portal continuation develops as a collateral system for venous return. The authors present a case of infrahepatic interruption of the inferior vena cava in a 21-year-old man who presented with symptoms of deep vein thrombosis. Clinical features and prognosis of this entity are discussed.

Complete genome sequence of an aerobic thermoacidophilic crenarchaeon, Sulfolobus tokodaii strain7

The complete genomic sequence of an aerobic thermoacidophilic crenarchaeon, Sulfolobus tokodaii strain7 which optimally grows at 80 degrees C, at low pH, and under aerobic conditions, has been determined by the whole genome shotgun method with slight modifications. The genomic size was 2,694,756 bp long and the G + C content was 32.8%. The following RNA-coding genes were identified: a single 16S-23S rRNA cluster, one 5S rRNA gene and 46 tRNA genes (including 24 intron-containing tRNA genes). The repetitive sequences identified were SR-type repetitive sequences, long dispersed-type repetitive sequences and Tn-like repetitive elements. The genome contained 2826 potential protein-coding regions (open reading frames, ORFs). By similarity search against public databases, 911 (32.2%) ORFs were related to functional assigned genes, 921 (32.6%) were related to conserved ORFs of unknown function, 145 (5.1%) contained some motifs, and remaining 849 (30.0%) did not show any significant similarity to the registered sequences. The ORFs with functional assignments included the candidate genes involved in sulfide metabolism, the TCA cycle and the respiratory chain. Sequence comparison provided evidence suggesting the integration of plasmid, rearrangement of genomic structure, and duplication of genomic regions that may be responsible for the larger genomic size of the S. tokodaii strain7 genome. The genome contained eukaryote-type genes which were not identified in other archaea and lacked the CCA sequence in the tRNA genes. The result suggests that this strain is closer to eukaryotes among the archaea strains so far sequenced. The data presented in this paper are also available on the internet homepage (http://www.bio.nite.go.jp/E-home/genome_list-e.html/).

Sensitive and simple determination of mannitol in human brain tissues by gas chromatography-mass spectrometry

A simple, reliable and sensitive gas chromatographic-mass spectrometric method was devised to determine the level of mannitol in various human brain tissues obtained at autopsy. Mannitol was extracted with 10% trichloroacetic acid solution which effectively precipitated brain tissues. The supernatant was washed with tert.-butyl methyl ether to remove other organic compounds and to neutralize the aqueous solution. Mannitol was then derivatized with 1-butaneboronic acid and subjected to GC-MS. Erythritol was used as an internal standard. For quantitation, selected ion monitoring with m/z 127 and 253 for mannitol and m/z 127 for internal standard were used. Calibration curves were linear in concentration range from 0.2 to 20 microg/0.1 g and correlation coefficients exceeded 0.99. The lower detection limit of mannitol in distilled water was 1 ng/0.1 g. Mannitol was detected in control brain tissues, as a biological compound, at a level of 50 ng/0.1 g. The precision of this method was examined with use of two different concentrations, 2 and 20 microg/0.1 g, and the relative standard deviation ranged from 0.8 to 8.3%. We used this method to determine mannitol in brain tissues from an autopsied individual who had been clinically diagnosed as being brain dead. Cardiac arrest occurred 4 days later.

[Effect of latanoprost on the barrier function of corneal epithelium]

PURPOSE

We evaluated the effect on corneal epithelium barrier function of instillation of prostaglandin F2 alpha ophthalmic solution (latanoprost) for one month.

MATERIALS AND METHODS

Ten healthy volunteers and nine glaucoma patients were enrolled in this study. The barrier function was determined as uptake of topically applied sodium fluorescein by the central cornea measured with an anterior fluorophotometer(FL-500, Kowa Co. Ltd). Healthy volunteers and glaucoma patients received 0.005% latanoprost instillation once daily for one month. We measured the uptake of fluorescein by the cornea of each subject before and one month after instillation.

RESULTS

Fluorescein uptake before the instillation was 22.2 +/- 16.0 ng/ml (mean +/- standard deviation) and 26.4 +/- 15.1 ng/ml one month after the treatment in the normal group, and it was 55.0 +/- 25.0 ng/ml before treatment and 57.8 +/- 37.0 ng/ml after treatment in the glaucoma group. There was no significant difference in the uptake of fluorescein before and after treatment in either of two groups.

CONCLUSION

These results suggested that the barrier function of corneal epithelium was not compromised after the instillation of latanoprost for at least one month.

Inhibition of insulin-induced activation of Akt by a kinase-deficient mutant of the epsilon isozyme of protein kinase C

Akt, also known as protein kinase B, is a protein-serine/threonine kinase that is activated by growth factors in a phosphoinositide (PI) 3-kinase-dependent manner. Although Akt mediates a variety of biological activities, the mechanisms by which its activity is regulated remain unclear. The potential role of the epsilon isozyme of protein kinase C (PKC) in the activation of Akt induced by insulin has now been examined. Expression of a kinase-deficient mutant of PKCepsilon (epsilonKD), but not that of wild-type PKCepsilon or of kinase-deficient mutants of PKCalpha or PKClambda, with the use of adenovirus-mediated gene transfer inhibited the phosphorylation and activation of Akt induced by insulin in Chinese hamster ovary cells or L6 myotubes. Whereas the epsilonKD mutant did not affect insulin stimulation of PI 3-kinase activity, the phosphorylation and activation of Akt induced by a constitutively active mutant of PI 3-kinase were inhibited by epsilonKD, suggesting that epsilonKD affects insulin signaling downstream of PI 3-kinase. PDK1 (3'-phosphoinositide-dependent kinase 1) is thought to participate in Akt activation. Overexpression of PDK1 with the use of an adenovirus vector induced the phosphorylation and activation of Akt; epsilonKD inhibited, whereas wild-type PKCepsilon had no effect on, these actions of PDK1. These results suggest that epsilonKD inhibits the insulin-induced phosphorylation and activation of Akt by interfering with the ability of PDK1 to phosphorylate Akt.

Revascularization of left subclavian artery for coronary subclavian steal syndrome

We have experienced 2 patients with coronary subclavian steal syndrome which progressed each to a different prognosis. Both cases received percutaneous transluminal angioplasty for subclavian artery stenosis after coronary artery bypass grafting. Although one case is doing well without any symptoms, the other case required axilloaxillary artery bypass grafting for the subclavian artery restenosis.

Blood concentrations of tetracaine and its metabolite following spinal anesthesia

Blood concentrations of tetracaine and its metabolite, p-butylaminobenzoic acid, were measured after spinal anesthesia with tetracaine which had been administered to patients under going orthopedic surgery. Tetracaine, an ester anesthetic, was given to 10 patients, the dose was 8-14mg, and blood samples were collected 1, 2 and 6h after the injection of tetracaine. We used gas chromatography/mass spectrometry for purposes of analysis. Tetracaine was not detected in any blood sample, but the metabolite was detected in each sample with the mean concentrations of 126.5, 97.9 and 43.3ng/ml at 1, 2 and 6h, respectively. This data will be useful in determination of the cause of death after spinal anesthesia with tetracaine.

Bypass graft material and myocardial protective procedure in combined coronary artery bypass grafting and valve surgery

OBJECTIVE

The aortic cross clamping time is prone to be longer when coronary artery bypass grafting (CABG) is combined with valve surgery. Therefore, the myocardium that is revascularized by in-situ internal thoracic artery graft is at risk to ischemia, and, myocardial protection is especially important in such operation. In this study, the effect of myocardial preservation of combined antegrade, retrograde and terminal warm blood cardioplegia during combined valve surgery and CABG using the internal thoracic artery as a bypass conduit was evaluated.

METHODS

From November 1992 to August 1999, 15 patients received combined CABG and valve surgery. Among these 15 patients, 13 patients who did not need hemodialysis were divided into 2 groups, and a comparative study was done. In Group I (n = 5), only the saphenous vein graft was employed for combined CABG and valve surgery, and myocardial protection was done by combined antegrade and terminal warm blood cardioplegia. In Group II (n = 8), at least 1 in-situ internal thoracic artery graft was employed for CABG and valve surgery, and myocardial protection was done by combined antegrade, retrograde and terminal warm blood cardioplegia.

RESULTS

Despite longer aortic cross clamping time in Group II, the peak creatine kinase-MB of Group II was significantly lower. In addition, the postoperative administration of dopamine tended to be less in Group II.

CONCLUSION

Myocardial protection by combined antegrade, retrograde and terminal warm blood cardioplegia may be an effective adjunct to combined valve surgery and CABG employing the in-situ internal thoracic artery graft.

[Risk factors of anastomotic leak following operations for gastric cancer in the elderly]

The risk factors of anastomotic leak in the elderly following operations for gastric cancer were evaluated by multiple logistic model analysis. Data were taken from 705 operations over a 14-year period. The mean age of patients was 75.8 +/- 7.6 years. The significant risk factors for anastomotic leak were amounts of intra-operative bleeding and male gender. No other factors were significant, including age, preoperative associated diseases, preoperative nutritional states and postoperative complications, some of which were, however, significant factors by univariate analyses. We conclude that we should make every endeavor to lower the amount of intra-operative bleeding in order to prevent postoperative anastomotic leaks in the elderly, especially in male patients.

Sensitive and selective determination of tetracaine and its metabolite in human samples by gas chromatography-mass spectrometry

A sensitive and reliable method was developed for the determination of tetracaine and its metabolite, p-butylaminobenzoic acid, in human samples. Tetracaine and the metabolite, effectively extracted using a liquid-liquid extraction procedure from 0.5 g of sample, were analyzed by gas chromatography-mass spectrometry. Tetracaine was analyzed without derivatization, and the metabolite was analyzed after tert-butylolimethylsilyl derivatization. Dibucaine and p-dimethylaminobenzoic acid were used as internal standards for tetracaine and the metabolite, respectively. The calibration curve for each compound was linear in the concentration range from 10 to 1,000 ng/0.5 g, and the lower limits of detection were 10 ng/g for tetracaine and 0.6 ng/g for the metabolite in whole blood and tissues. The accuracy and precision of the method were evaluated in whole blood and brain at the concentrations of 50 ng/0.5 g and 500 ng/0.5 g for tetracaine and 10 ng/0.5 g and 100 ng/0.5 g for the metabolite. The coefficients of variation ranged from 0.8 to 3.0% for tetracaine and 2.4 to 9.8% for the metabolite. We used this method to determine tetracaine and its metabolite in human whole blood and tissues of an autopsied patient who died during spinal anesthesia induced by tetracaine.

Effects of word frequency and spelling-to-sound regularity in naming with and without preceding lexical decision

The effects of word frequency and spelling-to-sound regularity were examined using standard naming, standard lexical-decision, go/no-go naming, and go/no-go lexical-decision tasks. In both the standard and go/no-go naming tasks, tasks requiring phonological coding, a significant Frequency x Regularity interaction was observed. That is, the regularity effect was limited to low-frequency words. In the standard and go/no-go lexical-decision tasks, tasks not requiring phonological coding, no Frequency x Regularity interaction was observed. These results indicate not only that the Frequency x Regularity interaction is a product of phonological coding processes but also that these processes are similar in the standard and go/no-go naming tasks. Results are discussed in terms of the dual-route and the parallel distributed processing frameworks.

Effects of word frequency and spelling-to-sound regularity in naming with and without preceding lexical decision

The effects of word frequency and spelling-to-sound regularity were examined using standard naming, standard lexical-decision, go/no-go naming, and go/no-go lexical-decision tasks. In both the standard and go/no-go naming tasks, tasks requiring phonological coding, a significant Frequency x Regularity interaction was observed. That is, the regularity effect was limited to low-frequency words. In the standard and go/no-go lexical-decision tasks, tasks not requiring phonological coding, no Frequency x Regularity interaction was observed. These results indicate not only that the Frequency x Regularity interaction is a product of phonological coding processes but also that these processes are similar in the standard and go/no-go naming tasks. Results are discussed in terms of the dual-route and the parallel distributed processing frameworks.

[Insulin signalling system and mechanism of insulin resistance]

Insulin exerts wide variety of biological effects through interaction with its specific receptor, which belongs to a large family of receptor tyrosine kinases. The activated insulin receptor phosphorylates the intracellular substrate IRS protains, which then bind various signalling molecules that contain Src homology 2 domains. The first downstram molecule that was shown to associate with IRS protains is PI3-kinase. PI3-kinase contributes to a wide variety of biological actions. Both Akt(PKB), a serine-threonine kinase with a PH domain, and atypical PKC(PKC zeta, PKC lambda) have been implicated as downstream effectors of PI3-kinase. Insulin resistance contributes to the pathogenesis of NIDDM. Both primary, genetically, and secondary, environmentally factors are important for insulin resistance. The secondary factors include hyperglycemia, hyperlipidemia, obesity, TNF alpha, FFA(free fatty acid).

[The effective smoking corner in an office]

We installed an effective, practical and low-cost smoking corner in an office to protect against passive smoking. The smoking corner was separated from the non-smoking area with transparent, nonflammable screens. Four exhaust fans were installed in the smoking corner so that there was no leakage of environmental tobacco smoke. The required exhaust air rate in the smoking corner was pre-calculated from the volume of the smoking corner and the rate of consumption of cigarettes. The suspended airborne particle concentration definitely decreased in the non-smoking area after installation of the smoking corner. The result of a questionnaire survey also revealed the improvement in the air quality in this office.

Workplace exposure to environmental tobacco smoke and high density lipoprotein cholesterol among nonsmokers

There are few epidemiologic studies among adult nonsmokers on the effects of workplace environmental tobacco smoke on high density lipoprotein cholesterol (HDL-C). The authors investigated this relation, using data from health examinations conducted in 1995 on 3,062 Japanese nonsmokers in a total of 27 municipal offices with few smoking restrictions. Multiple regression analysis with adjustments for age, body mass index, alcohol drinking, and sports activities showed that in women, and in men lacking both alcohol consumption and sports activities characteristics, there were inverse linear relations between workplace smoking indices and HDL-C levels. Multivariate logistic regression showed that nonsmoking women in the upper two thirds of offices ranked by smoking intensity had an increased risk of low HDL-C levels (<45 mg), taking those in the lowest third of offices as reference (the medium third: odds ratio = 1.7; 95% confidence interval: 1.2, 2.5; the highest third: odds ratio = 1.6; 95% confidence interval: 1.1, 2.4). The results indicated that workplace environmental tobacco smoke exposure is associated with HDL-C among nonsmokers. However, the lack of data on home exposure limits causal inferences about the effects of workplace exposure.

Orthographic neighborhood effects in perceptual identification and semantic categorization tasks: a test of the multiple read-out model

How should a word's orthographic neighborhood affect perceptual identification and semantic categorization, both of which require a word to be uniquely identified? According to the multiple read-out model (Grainger & Jacobs, 1996), inhibitory neighborhood frequency effects should be observed in these types of tasks, and facilitatory neighborhood size effects should not be. In Experiments 1 and 2 (perceptual identification), these effects were examined as a function of stimulus visibility (i.e., high vs. low visibility) to provide as full a test as possible of the model's predictions. In the high-visibility conditions, words with large neighborhoods were reported less accurately than words with small neighborhoods, but there was no effect of neighborhood frequency (i.e., whether the word had a higher frequency neighbor). In the low-visibility conditions, low-frequency words with large neighborhoods and low-frequency words with higher frequency neighbors showed superior identification performance. In the semantic categorization task (Experiment 3), words with large neighborhoods were responded to more rapidly than words with small neighborhoods, but there was no effect of neighborhood frequency. These results are inconsistent with two of the basic premises of the multiple read-out model--namely, that facilitatory neighborhood size effects are due to a variable response criterion (the sigma criterion), rather than to lexical selection processes, and that the lexical selection processes themselves produce an inhibitory neighborhood frequency effect (via the M criterion). Instead, the present results, in conjunction with previous findings, suggest that large neighborhoods (and perhaps higher frequency neighbors) do aid lexical selection.

Associations between self-assessed masticatory disability and health of community-residing elderly people

OBJECTIVE

To examine the relationship between the self-assessed masticatory disability and the health of community-residing older people.

METHODS

Of 1473 randomly selected people aged 65 years and older living in Settsu, Osaka Prefecture, in October 1992, data on general health status, history of health management, psychosocial conditions, and dental conditions were obtained from 1405 people by interviews made during home visits. Follow-up for 54 months was completed for 1306 subjects (93.0%; 1072 living, 234 deceased).

RESULTS

Being over 75 years of age, having poor general health and poor dental status, not using dental health checks, not using general health checks, not participating in social activities, not feeling that life is worth living (no "ikigai"), and feeling anxious about the future were univariately and significantly associated with self-assessed masticatory disability. Logistic regression analyses indicated that being older than 75 years, having poor general health and poor dental status, not using dental health checks, and not participating in social activities were independently associated with self-assessed masticatory disability. The Cox proportional hazards model showed that being male, over 75 years of age, and in poor general health, as well as not using general health checks, and not participating in social activities were independently associated with mortality. Self-assessed masticatory disability was univariately and significantly related to mortality, but by itself was not a significant risk factor for mortality, because of the potential influence of other variables.

CONCLUSIONS

Certain health and psychosocial factors are closely associated with self-assessed masticatory disability among older people. Further investigations are needed to determine whether masticatory disability is a significant risk factor for mortality.

Simultaneous determination of triazolam and its metabolites in human blood and urine by gas chromatography/mass spectrometry

A sensitive and selective method has been developed for simultaneous determination of triazolam and its major metabolites, alpha-hydroxytriazolam and 4-hydroxytriazolam, in human whole blood and urine. The drugs were effectively extracted using a 3-step solvent extraction procedure followed by tert- butyldimethylsilyl derivatization, and subjected to gas chromatography-mass spectrometry in the negative ion chemical ionization mode. Estazolam was used as an internal standard. The calibration curve for each compound was linear in the range from 0.5 to 100 ng/g, and the lower limit of detection was 0.1 ng/g for whole blood and 0.2 ng/g for urine. Within-day precision of this method was evaluated in whole blood and urine samples at the concentration of 10 ng/g; the coefficient of within-day variation ranged from 2.7 to 10.8%.

Death attributed to amobarbital and levomepromazine intoxication

A 29-year-old man, possibly a schizophrenic patient, was found dead 9 h after admission to a hospital. Autopsy revealed neither significant injuries nor diseases except for congestion of all organs. Microscopic examination revealed severe edema in the lung and slight centrilobular necrosis in the liver. Since amobarbital and levomepromazine were detected by drug screening, the concentrations of these drugs in the victim's body fluids and tissues were determined using gas chromatography-mass spectrometry. The whole blood concentrations of amobarbital and levomepromazine were 9.02 microg/ml and 231 ng/ml, respectively. These levels exceeded therapeutic ranges, but are not so toxic or fatal. However, on the basis of the findings in the literature and of the severe lung edema and centrilobular necrosis in the liver, the cause of his death was judged to be amobarbital and levomepromazine intoxication.

Insulin-induced phosphorylation and activation of cyclic nucleotide phosphodiesterase 3B by the serine-threonine kinase Akt

Cyclic nucleotide phosphodiesterase (PDE) is an important regulator of the cellular concentrations of the second messengers cyclic AMP (cAMP) and cGMP. Insulin activates the 3B isoform of PDE in adipocytes in a phosphoinositide 3-kinase-dependent manner; however, downstream effectors that mediate signaling to PDE3B remain unknown. Insulin-induced phosphorylation and activation of endogenous or recombinant PDE3B in 3T3-L1 adipocytes have now been shown to be inhibited by a dominant-negative mutant of the serine-threonine kinase Akt, suggesting that Akt is necessary for insulin-induced phosphorylation and activation of PDE3B. Serine-273 of mouse PDE3B is located within a motif (RXRXXS) that is preferentially phosphorylated by Akt. A mutant PDE3B in which serine-273 was replaced by alanine was not phosphorylated either in response to insulin in intact cells or by purified Akt in vitro. In contrast, PDE3B mutants in which alanine was substituted for either serine-296 or serine-421, each of which lies within a sequence (RRXS) preferentially phosphorylated by cAMP-dependent protein kinase, were phosphorylated by Akt in vitro or in response to insulin in intact cells. Moreover, the serine-273 mutant of PDE3B was not activated by insulin when expressed in adipocytes. These results suggest that PDE3B is a physiological substrate of Akt and that Akt-mediated phosphorylation of PDE3B on serine-273 is important for insulin-induced activation of PDE3B.

Alteration of perceived fragrance of essential oils in relation to type of work: a simple screening test for efficacy of aroma

The perceptional change of fragrance of essential oils is described in relation to type of work, i.e. mental work, physical work and hearing environmental (natural) sounds. The essential oils examined in this study were ylang ylang, orange, geranium, cypress, bergamot, spearmint and juniper. In evaluating change in perception of a given aroma, a sensory test was employed in which the perception of fragrance was assessed by 13 contrasting pairs of adjectives. Scores were recorded after inhaling a fragrance before and after each type of work, and the statistical significance of the change of score for 13 impression descriptors was examined by Student's t-test for each type of work. It was confirmed that inhalation of essential oil caused a different subjective perception of fragrance depending on the type of work. For example, inhalation of cypress after physical work produced a much more favorable impression than before work, in contrast to orange, which produced an unfavorable impression after physical work when compared with that before work. For mental work, inhalation of juniper seemed to create a favorable impression after work, whereas geranium and orange both produced an unfavorable impression then. From these studies, together with those conducted previously with lavender, rosemary, linalool, peppermint, marjoram, cardamom, sandalwood, basil and lime, we thus concluded that the sensory test described here might serve not only as a screening test for efficacy of aroma but also as a categorized table for aroma samples which can act as a reference to each other.

Dominant negative forms of Akt (protein kinase B) and atypical protein kinase Clambda do not prevent insulin inhibition of phosphoenolpyruvate carboxykinase gene transcription

Transcriptional regulation of phosphoenolpyruvate carboxykinase (PEPCK), the rate-limiting enzyme in hepatic gluconeogenesis, by insulin was investigated with the use of adenovirus vectors encoding various mutant signaling proteins. Insulin inhibited transcription induced by dexamethasone and cAMP of a chloramphenicol acetyltransferase (CAT) reporter gene fused with the PEPCK promoter sequence in HL1C cells stably transfected with this construct. A dominant negative mutant of phosphoinositide (PI) 3-kinase blocked insulin inhibition of transcription of the PEPCK-CAT fusion gene, whereas a constitutively active mutant of PI 3-kinase mimicked the effect of insulin. Although a constitutively active mutant of Akt (protein kinase B) inhibited PEPCK-CAT gene transcription induced by dexamethasone and cAMP, a mutant Akt (Akt-AA) in which the phosphorylation sites targeted by insulin are replaced by alanine did not affect the ability of insulin to inhibit transcription of the fusion gene. Akt-AA almost completely inhibited insulin-induced activation of both endogenous and recombinant Akt in HL1C cells. Furthermore, neither a kinase-defective mutant protein kinase Clambda (PKClambda), which blocked insulin-induced activation of endogenous PKClambda, nor a dominant negative mutant of the small GTPase Rac prevented inhibition of PEPCK-CAT gene transcription by insulin. These data suggest that phosphoinositide 3-kinase is important for insulin-induced inhibition of PEPCK gene transcription and that a downstream effector of phosphoinositide 3-kinase distinct from Akt, PKClambda, and Rac may exist for mediating the effect of insulin.