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A 49-year-old woman with intellectual disability and a food preference for fried chicken entered a nursing home. After nursing home diet, she developed episodic attacks of hyperammonemic encephalopathy. Her characteristic food preference and the negative results for brain and liver imaging studies suggested urea cycle disorder. A high plasma citrulline level on amino acid analysis and a genetic test for citrine gene confirmed a citrine deficiency (adult-onset type II citrullinemia). Although a low-carbohydrate diet was insufficient, a combination therapy of a low-carbohydrate diet and a medium-chain triglyceride (MCT) oil was effective. MCT oil may be a promising treatment option.

It has been reported that medium-chain triglyceride (MCT) have various physiological functions, such as anti-obesity and hypolipidemic effects. They can also elicit increased disaccharidase activity and intestinal cell proliferation. However, a meta-analysis of randomized controlled trials, comparing the effects of MCT on weight loss and body composition, detected commercial bias. Additional research on the physiological functions is needed in order to have conclusive evidence. Thus, we sought to evaluate the various functions of MCT by conducting a feeding study in rats. Rats fed a diet containing 15% (w/w) MCT, had significantly lower visceral fat weight, plasma and liver lipid concentrations; they had significantly higher intestinal maltase and glucoamylase activities; and they had a greater number of Ki-67 positive cells/crypt, compared to the rats fed a diet containing 15% (w/w) lard. The effects of a diet containing 5% (w/w) MCT was observed only for plasma cholesterol levels and the number of Ki-67 positive cells/crypt; in which some results were found to be inconsistent with previous reports. These results indicate that physiological functions of MCT are numerous and need to be confirmed by additional research.

We report a novel regimen of nutritional management in 22-year-old woman with myopathic form of very-long-chain acyl-CoA dehydrogenase deficiency. This regimen is based on avoidance of fasting by frequent intake of carbohydrates and substitution of medium chain triglyceride for long- and very long-chain fatty acids. Oral intake of medium amount of long-chain fatty acid (300 kcal daily) was allowed, to facilitate compliance and to escape pigmentary retinopathy. After this nutritional management and lifestyle guidance about prevention of fatigue and starvation, the patient was free from severe rhabdomyolysis for more than three years, which had forced her to hospital management nine times in seven years.

Triacylglycerin in Palm Oil contains POP (1,3-dipalmitoyl-2-oleoyl-glycerol) at 30%, POO (1,2-dioleoyl-3-palmitoyl-glycerol) at 20% and PPP (tripalmitoylglycerol) at 5%. The crystallization temperature of PPP is high and the rates of crystal nuclear formation and growth are fast. It is thus considered that PPP may have some effect on the manner or mode of Palm Oil. Examination was thus made to clarify how PPP may affect the crystallization of POP and POO by differential scanning calorimetry (DSC) and X ray diffractometry (XRD) conducted on PPP/POP and PPP/POO mixtures. High and low temperature peaks were noted to appear on the DSC crystallization curve for either of these mixtures. The high temperature peak was considered possibly due to PPP, and the low temperature peak, to POP or POO. DSC isothermal analysis indicated the rate of crystal growth of either mixture to exceed that of pure of POP or POO. Crystal mixture structure was also seen to be complicated than either compound in pure form. The present findings thus clearly indicate that clarification should be made of the effects of high melting point triacylglycerin, such as PPP, on the crystallization of Palm Oil.

Background: Incidence and intensity of pain on intravenous injection of propofol were assessed with emulsion of long-chain/medium-chain triglycerides (LCT/MCT, 50: 50) and only long-chain triglycerides (LCT, 100) in patients undergoing different elective surgical interventions in this prospective, randomized, cross over and double-blinded study., Methods: 1) Forty six patients were assigned to two groups. One group received 0.2 mg x kg(-1) LCT/ MCT propofol prior to LCT propofol administration. The other group received 0.2 mg x kg(-1) LCT propofol prior to LCT/MCT propofol administration. Pain elicited upon questioning was assessed with each injection in the two groups. Patients were asked to grade the pain as VAS of 0 to 100 mm. 2) Fifty one patients were randomly assigned to two groups. One group received 0.4 mg x kg(-1) LCT propofol. The other group received 0.4 mg x kg(-1) LCT/MCT propofol. Patients were asked to grade the pain as VAS of 0 to 100 mm., Results: Pain of LCT propofol injection was stronger than LCT/MCT propofol. As incidence of 0.4 mg x kg(-1) propofol injection, VAS on LCT/MCT propofol and LCT propofol gave score as 0 and 23.5 (P=0.0019)., Conclusions: Propofol with emulsion of long- and medium-chain triglycerides appears to reduce the injection pain than with emulsion of only long-chain triglycerides.

Background: Incidence and intensity of pain on intravenous injection of propofol LCT were compared with those of propofol MCT/LCT., Methods: Eighty adult patients scheduled to receive general anesthesia were divided into two groups, propofol LCT (Group L, AstraZeneca) and propofol MCT/LCT (Group M, Maruishi Pharmaceutical). The peripheral vein was inserted with an 18 gauge intravenous catheter at the dorsal hand, the wrist, or the anterior brachial region. Propofol 2.0 mg x kg(-1) was injected at the speed of 5 mg x sec(-1). Noninvasive arterial blood pressure, heart rate, a BIS value and a degree of pain were measured. We used chi2 analysis and Wilcoxon t-test for statistical evaluation., Results: There was a significantly larger incidence of injection pain in the Group L than the Group M (70% vs. 30%). The pain at the brachial region was significantly less as compared with the wrist or the dorsal hand in both groups. The ratio of patients having the memory of pain on the next day to those complaing the injection pain was 50% in the Group L and 36% in the Group M. There were no significant differences between the two groups in changes in BIS values and doses of propofol necessary for the loss of consciousness., Conclusions: The results suggest that propofol MCT/LCT elicits less pain on injection than propofol LCT. The injection pain is less at the brachial region than the wrist or the hand. Amnesia of pain may be obtained both with propofol MCT/ LCT and propofol LCT.

We have recently developed an HPLC method able to separate five lipoproteins (HDL, LDL, IDL, VLDL and chylomicron) followed by cholesterol measurement on each lipoprotein. As an application of this method, this study focused on analyses of triglyceride (TG)-rich lipoproteins, one of risk factor for atherosclerosis. The appearance of midband on electrophoresis is conceivably implicated in atherogenesis. The present study revealed that cholesterol levels in VLDL, IDL and LDL were significantly higher in midband-positive sera than negative sera. Cholesterol levels in remnant-like proteins, another atherogenic indicator, were significantly related to those in VLDL and Chylomicron measured by the present HPLC method. In conclusion, this novel HPLC method can provide valuable information for analyses on TG-rich lipoproteins.

New types of diclofenac sodium suppositories known to control a drug release function for hospital preparations were developed based on a concept of the drug delivery system. Hard fat (Witepsol) used as a base of the suppository consists of a mixture of triglycerides, diglycerides and monoglycerides, and each Witepsol is characterized by its physicochemical properties. Authors disclosed that the amount of drug release measured in the commercially available diclofenac sodium suppositories decreased at a low temperature (36 degrees C). Mixed types of diclofenac sodium suppositories consisting of Witepsol W35 and Witepsol E85 as a base were also prepared and their drug release functions investigated in vitro and in vivo. The in vitro drug release properties changed with the mixing ratios of the two bases and with the temperature of the fluid tested. The amount of released diclofenac sodium increased with increases of both the ratio of Witepsol W35 in the suppository and the temperature of the test fluid. Moreover, several processes causing these phenomena were evidenced by the image analysis. The in vivo absorption of diclofenac sodium was found to be also influenced by these factors. Consequently, it is predicted that such factors as the ratio of Witepsol W35 in the suppository and the temperature will influence the drug absorption and the pharmacological effect of diclofenac sodium suppositories.

To clarify changes in triglyceride (TG) composition in diabetic status at a molecular level, the number of carbon and double bond which make up TG was analyzed in diabetic patients, experimentally-induced diabetic rats and normal controls. Serum TG was classified into subclasses by the number of carbon and double bond using a gas chromatography chemical ionization mass spectrometry (GC-CI-MS). In diabetic patients (n = 80), the ratio of TG consisting of 50 carbons (C50) among total TG subclasses was higher than that in normal controls (n = 20). In particular, C50 with a smaller number of double bond (C50: 0, C50: 1, C50: 2) was remarkably increased. Compared with well-controlled diabetics, poorly-controlled patients showed an increase in TG with less double bond in the composition of C48 and C50, and a decrease in double bond-rich C52 and C54. The increase in C50: 1 TG observed in poorly-controlled diabetics was returned to normal range with the improvement of control parameters including a decrease in body weight, fasting plasma glucose and serum TG levels, thereby suggesting that this TG subclass may be the best indicator of all TG compositions for diabetes control. The percentage of C50: 1 TG was higher in patients with lower HDL-C levels than those with normal or higher HDL-C levels. On the basis of these findings, we conclude that the analysis of serum TG composition with GC-CI-MS would be of clinical use in the evaluation of overall control status in diabetics.