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Duration of fever and virus persistence after baloxavir administration were investigated in 81 outpatients, 16 with A(H1N1)pdm09 and 65 with A(H3N2) in the Japanese 2018-2019 influenza season. Only eight cases of A(H3N2) viruses were detected post-dose. PA/I38T-substituted viruses were detected in four (6.2%) of 65 A(H3N2) patients, at days 3 and 4, constituting 50% (4/8) of A(H3N2) detected post-dose. The median duration of fever was 26.0 h for A(H1N1)pdm09 and 20.3 h for A(H3N2). The median duration of fever for patients with PA/I38T-substituted viruses was 22.0 h, without significant difference to that of the patients in whom the mutated virus was not detected. Emergence of PA/I38T-substituted viruses after treatment with baloxavir was confirmed, but no significant prolongation of fever was observed in the four patients with PA/I38T-substituted virus emergence., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest. The authors alone are responsible for the content in and writing of the paper., (Copyright © 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Stereotactic body radiotherapy (SBRT) delivers high-dose radiation to tumor tissues in few fractions, thereby reducing radiation damage to at-risk organs. There are more potential effects of SBRT owing to the higher biological equivalent dose delivered. Herein, we retrospectively analyzed its effectiveness and toxicity at our institution., Methods: Data from patients with hepatocellular carcinoma (HCC; n = 10) and liver metastases (n = 10) who underwent SBRT (total dose of 30-50 Gy in 5-10 fractions) between 2013 and 2016 were analyzed. Adverse events were recorded at the end of RT, 6 months after treatment, or upon death. Overall survival (OS) was calculated according to the biological effective dose (BED α/β = 10) and liver function (Child-Pugh [CP] classification 5 or 6 vs. 7 or 8) after SBRT, using Kaplan-Meier analyses., Results: Of the 20 patients, 6 declined the CP classification score after SBRT; grade 3 adverse events were not seen in any patient. A higher OS rate was seen in patients receiving a higher BED and in those with better CP classification after SBRT. Kaplan-Meier survival analysis yielded a median OS of 401 days and 1- and 2-year OS of 45% and 15%, respectively., Conclusion: The higher BED was significantly associated with tumor control, and there were no differences in the tumor control rate between HCC and metastatic tumors. Changes in CP scores after SBRT also affected the survival rate. Good liver function may permit multiple rounds of SBRT., (© 2019 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Background and Purpose: Lateral medullary infarction (LMI) sometimes causes long-lasting dizziness. Although the precise mechanism of chronic post-LMI dizziness is unknown, a cerebellar control disorder of the vestibulo-ocular reflex (VOR) has been reported in such patients. We conducted a proof-of-principle cohort study to assess the potential efficacy of cerebellar repetitive transcranial magnetic stimulation (rTMS) as treatment for chronic post-LMI dizziness., Methods: We first applied cerebellar rTMS in healthy volunteers (n = 11) and showed that cerebellar intermittent theta burst stimulation (iTBS) affected vestibulocerebellar neural activity. Then, between September and December 2015, we enrolled six patients (aged≥20 years) with chronic post-LMI dizziness (duration≥6 months), applied cerebellar rTMS (iTBS for 5 days), and followed these patients up for up to 25 months for clinical symptoms (Dizziness Handicap Inventory [DHI]), signs (nystagmus), and VOR gain., Results: Four of the six patients completed the study without complications. After rTMS, DHI scores were reduced (mean pre-rTMS DHI score minus post-rTMS DHI score was 13.0 [P = 0.036]) with disappearance of the ipsilesional nystagmus characteristic of the post-LMI dizziness. Reduction in the absolute VOR gain (mean pre- rTMS gain minus post-rTMS gain in the ipsilesional direction was 0.135 [P = 0.036] and that in the contralesional direction was 0.137 [P = 0.031]) were also associated with reduced DHI scores. Relative cerebellar blood flow to the brainstem was increased in four of five patients. The effects of cerebellar rTMS did not always persist, and three of four patients elected to undergo more than one rTMS series. The repeat cerebellar rTMS treatments had same beneficial effects., Conclusion: Our study showed, for the first time, the potential efficacy of cerebellar rTMS for treatment of chronic post-LMI dizziness. The short duration of the cerebellar rTMS effects can be compensated for by repeating the rTMS treatment every few months. Further large-scale randomized studies are warranted to confirm our findings., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background and Purpose: Repetitive transcranial magnetic stimulation (rTMS) is reported to improve chronic post-stoke hemiparesis. However, application of rTMS during the acute phase of post-stroke has not fully been investigated. We investigated the safety and the efficacy of intermittent theta-burst stimulation (iTBS) of the affected motor cortex and 1-Hz stimulation of the unaffected hemisphere during the acute phase in patients with hemiparesis due to capsular infarction., Methods: Twenty one patients who met the study criteria were randomly assigned to receive, starting within 7days after stroke onset and for a period of 10days, iTBS of the affected motor cortex hand area (n=8), 1-Hz stimulation of the unaffected motor cortex hand area (n=7), or sham stimulation (n=6). Upper limb motor function was evaluated before rTMS and 12weeks after onset of the stroke. Evaluation was based on the Fugl-Meyer Assessment (FMA), Stroke Impairment Assessment Set (SIAS), Modified Ashworth Scale (MAS), grip strength, and motor evoked potential (MEP) amplitude in the first dorsal interosseous (FDI) muscle., Results: Both iTBS applied to the affected motor cortex hand area and 1-Hz stimulation applied to the unaffected motor cortex hand area enhanced motor recovery. In comparison to sham stimulation, iTBS increased the SIAS finger-function test score, and 1-Hz stimulation decreased the MAS wrist and finger score., Conclusions: Ipsilesional iTBS and contralesional 1-Hz stimulation applied during the acute phase of stroke have different effects: ipsilesional iTBS improves movement of the affected limb, whereas contralesional 1-Hz stimulation reduces spasticity of the affected limb., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background and Purpose: Lateral medullary infarction (LMI) sometimes causes long-lasting dizziness. However, the characteristics of nystagmus in patients with post-LMI dizziness are unknown. We undertook a prospective, comparative study of nystagmus in patients with and without post-LMI dizziness to determine the characteristic pattern of nystagmus of chronic post-LMI dizziness., Methods: We evaluated and compared nystagmus under spontaneous, head-shaking, and positional testing conditions in 12 patients with post-LMI dizziness and in 6 patients without post-LMI dizziness., Results: In the dizziness group, contralateral spontaneous nystagmus, ipsilateral head-shaking nystagmus, and horizontal direction-changing geotropic positional nystagmus were observed in patients in whom the LMI had occurred <60days previously (subacute period). In patients with dizziness in whom the LMI had occurred >90days previously (chronic period), the nystagmus was ipsilateral under all conditions. In the non-dizziness group, ipsilateral nystagmus was observed in 1 of the 2 subacute patients only after head-shaking and in 1 of the 4 chronic patients only during positional testing., Conclusions: Ipsilateral nystagmus observed under all spontaneous, head-shaking, and positional testing conditions characterizes chronic post-LMI dizziness., (Copyright © 2016 Elsevier B.V. All rights reserved.)

ATP-sensitive K(+) (K(ATP)) channel subunits SUR2A and SUR2B in the rat brain were investigated by RT-PCR assay, western blot analysis, in situ hybridization histochemistry, and immunohistochemical staining. The results show that the mRNA and protein of SUR2A and SUR2B are expressed in whole rat brain extracts and selected regions. SUR2 mRNA is widely expressed in many neurons and glial cells as revealed by in situ hybridization histochemistry. Immunohistochemical staining shows SUR2A to be widely expressed in neurons of the brain, especially in the large pyramidal neurons and their main dendrites in the neocortex and in the Purkinje cells of the cerebellar cortex. In contrast to SUR2A, SUR2B is potently expressed in small cells in the corpus callosum and cerebellar white matter, but is also weakly expressed in some neurons. Double immunostaining shows SUR2B to be localized in astrocytes and oligodendrocytes, while SUR2A is only localized in oligodendrocytes. These results suggest that SUR2A might be mainly a regulatory subunit of the K(ATP) channel in most neurons and part of oligodendrocytes, while SUR2B might be mainly a regulatory subunit of the K(ATP) channel in astrocytes, oligodendrocytes, and some neurons., (Copyright © 2012 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.)

Comparison of the viral persistence of pandemic H1N1 (H1N1pdm) and seasonal H1N1 with or without H275Y mutation after oseltamivir therapy has not been adequately done. Virus was isolated before and on days 4-6 from the start of oseltamivir treatment for 158 cases of seasonal (2007-2008 and 2008-2009 seasons) or pandemic (2009-2010 season) H1N1 influenza. Sequence analysis was done for each season and NA inhibition assay (IC(50)) was done in the 2009-2010 season. H275Y mutation before therapy was 0% in the 2007-2008 and 2009-2010 seasons, but 100% in the 2008-2009 season. Fever and other symptoms were noticeably prolonged after oseltamivir therapy for children with H275Y mutated seasonal H1N1 (2008-2009 season), but not in patients with seasonal H1N1 without mutation (2007-2008) or H1N1pdm (2009-2010). The viral persistence rate was significantly higher for patients 15 years or younger than for those 16 years and older with H275Y mutated seasonal H1N1 (46.2% and 10.5%, respectively) or with H1N1pdm (43.3% and 11.5%, respectively). The H275Y mutation emerged after oseltamivir treatment in 2.4% (2/82) of all patients with H1N1pdm. In two children, the H275Y mutation emerged after therapy and the IC(50) increased more than 200 fold; however, the prolongation of fever was not so prominent. In conclusion, oseltamivir was effective for fever and other clinical symptoms; however, the virus persisted longer than expected after treatment in H1N1pdm influenza-infected children in the 2009-2010 season, similar to seasonal H1N1 with H275Y mutation in the 2008-2009 season.

Introduction: This study aimed to assess the effect of clinical exposure on the surface morphology, dimensions, and frictional behavior of metallic orthodontic brackets., Methods: Ninety-five brackets, of 3 commercial brands, were retrieved from patients who had finished orthodontic treatment. As-received brackets, matched by type and brand, were used for comparisons. Surface morphology and precipitated material were analyzed by optical and scanning electron microscopy and x-ray microanalysis. Bracket dimensions were measured with a measuring microscope. Resistance to sliding on a stainless steel wire was assessed., Results: Retrieved brackets showed surface alterations from corrosion, wear, and plastic deformation, especially in the external slot edges. Film deposition over the alloy surface was observed to a variable extent. The main elements in the film were carbon, oxygen, calcium, and phosphorus. The as-received brackets showed differences (P <0.05) in the slot sizes among brands, and 1 brand showed a 3% increase in the retrieved brackets' slots. The frictional behavior differed among brands. Retrieved brackets of 2 brands showed 10% to 20% increases in resistance to sliding., Conclusions: Metallic brackets undergo significant degradation during orthodontic treatment, possibly with increased friction. At present, it is difficult to predict the impact of these changes on the clinical performance of orthodontic components., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

The clinical symptoms and effectiveness of neuraminidase inhibitors (NAI) have not been adequately compared among pandemic H1N1 2009 patients, seasonal H1N1 patients, and patients with H1N1 with the H275Y mutation. The data of 68 seasonal H1N1 patients in 2007-2008, 193 seasonal H1N1 patients in 2008-2009, and 361 pandemic H1N1 2009 patients diagnosed by PCR who received an NAI were analyzed. The duration of fever (body temperature ≥ 37.5 ºC) after the first dose of NAI and from onset was calculated. The H275Y neuraminidase mutation status was determined for 166 patients. Significantly lower mean age (18.4 ± 13.2 years) and a higher percentage of teenagers (53.7%) were found for pandemic 2009 influenza than for seasonal influenza (P < 0.001). The peak body temperature was equivalent (mean, 39.0 ºC) in the three seasons, and the frequency of symptoms was the same or lower for pandemic influenza compared with seasonal H1N1. None of the 34 analyzed pandemic H1N1 virus isolates contained the H275Y mutation, which was commonly detected in the 2008-2009 season. The duration of fever after the start of oseltamivir therapy was significantly shorter for patients with pandemic (23.0 ± 11.6 h) than with seasonal H1N1 in both the 2008-2009 (49.7 ± 32.3 h) and 2007-2008 seasons (32.0 ± 18.9 h). The mean duration of fever after the first dose of zanamivir was not different among the three seasons (26.9-31.5 h). Clinical symptoms were the same or somewhat milder, and oseltamivir was more effective, for pandemic 2009 than for seasonal H1N1 influenza with or without H275Y mutation.

Background: We conducted and reported the first (1982; 55,388 subjects), and second (1992; 45,674 subjects), epidemiological surveys conducted on bronchial asthma in elementary students across 11 prefectures in western Japan. The 2 surveys were conducted in the same regions using the same methodology employing a modified Japanese version of the American Thoracic Society-Division of Lung Diseases (ATS-DLD) Epidemiology Questionnaire. We conducted the third survey in 2002, and compared the findings to those of previous studies., Methods: In the third survey, 37,036 students attending the same schools as in previous surveys (in 11 prefectures) were given the questionnaire. A total of 35,582 responses (96.1%) were collected. An ATS-DLD Epidemiology Questionnaire was also used in this study, and the findings were compared to those of previous studies., Results: 1. The prevalence of bronchial asthma (BA) in boys, girls, and all students was 3.8%, 2.5%, and 3.2%, respectively, for the first survey; 5.6%, 3.5%, and 4.6% for the second survey; and 8.1%, 4.9%, and 6.5% for the third survey. 2. A decline in the BA prevalence in older subjects which could be seen in the first survey was absent in the second and third surveys. There were no regional differences in the third survey. 3. The boys-to-girls ratio in the first, second, and third surveys was 1.5, 1.6, and 1.6, respectively. 4. BA was more prevalent among subjects with a past history of respiratory disease in infancy and those with a family history of allergic disease. 5. The prevalence of asthma symptoms and wheezing in the first, second, and third surveys was 7.1%, 9.8%, and 11.8%, respectively. 6. A comparison of the prevalence of other allergic diseases between the second and third surveys revealed a decrease in atopic dermatitis and an increase in allergic rhinitis, allergic conjunctivitis, and cedar pollinosis., Conclusions: BA prevalence in the third survey increased 2.1 and 1.4 times respectively compared to the first survey and second survey, indicating an upward trend in all regions and age groups surveyed.

Introduction: This study was developed to evaluate in vitro the properties related to sliding resistance of esthetic ligatures., Methods: Frictional force of 6 ligatures--2 conventional, 2 specially coated elastomeric, Teflon-coated (Dupont, Wilmington, Del) stainless steel, and stainless steel (control) ligatures--were studied by sliding 0.019 x 0.025-in stainless steel wire through the 0.22-in slot of stainless steel bracket. Elastomeric ligatures were tested for frictional and tensile forces under 3 experimental conditions: recent stretching, after 21 days of simulated stretching in artificial saliva, and a demineralizing/remineralizing regimen. Statistical analysis was conducted with ANOVA and Games-Howell tests., Results: There was high correlation between frictional and tensile forces of elastomeric ligatures, with reduction of both after 21 days. The demineralizing/remineralizing regimen reduced the frictional forces of ligatures to the same level as the ligatures in artificial saliva. Teflon-coated and stainless steel ligatures showed the lowest initial frictional forces, but there was no difference in friction of stainless steel and post-stretched elastomeric ligatures., Conclusions: Frictional forces generated by esthetic elastomeric ligatures under simulated oral environments are not stable and are more related to tensile force than to surface characteristics of the ligatures.

Background: The aim of this study was to investigate the presence of bacteria in the bloodstream immediately after removing Haas palatal expanders; this could be considered an invasive procedure., Methods: Eight patients (18.5 +/- 3.9 years old) wearing Haas palatal expanders had 5-mL blood samples taken immediately before and 10 minutes after removal of the apparatus. The blood was aseptically inoculated into hemoculture bottles and incubated at 37 degrees C for 7 days. Medium alterations suggesting bacterial growth were investigated by using Gram staining., Results: Bottles containing blood taken before apparatus removal did not show bacterial growth. However, 4 of the 8 postremoval blood samples showed turbidity after 5 days, and bacterioscopy analysis showed Gram-positive cocci. Subsequent cultures in blood-agar medium plates allowed classifying the bacteria as viridans streptococcus., Conclusions: There is a strong possibility that trauma after removing Haas expanders might be correlated to transitory bacteremia, thereby implying the need for a more careful approach when dealing with special patients, such as those at risk of cardiopathic complications.

A 65-year-old man with multiple hepatocellular carcinomas in the liver with type C viral hepatitis had a solitary mediastinal lymph node metastasis in the right paratracheal to tracheobronchial region. Surgical resection for the mediastinal metastasis was undertaken based on magnetic resonance (MR) imaging findings, suggesting its radicality. We assess the MR imaging findings and presumable pathways of lymphatic metastasis from the liver to mediastinal lymph nodes in this report.

Objectives: The goal of our study was to evaluate the efficacy and safety of a new type of automated cutting needle for tissue-core lung biopsy under real-time CT fluoroscopic guidance., Design: Observational, Materials and Methods: One hundred ten percutaneous needle tissue-core lung biopsies were performed with the Auto Surecut needle (Create Medic; Yokohama, Japan) under CT fluoroscopic guidance, and the specimens obtained underwent histopathologic evaluation. A final diagnosis was confirmed by independent surgical pathology., Results: The rate of success for the diagnosis for specimens that were adequate for histopathologic analysis was 94.5% (104 of 110 specimens). The sensitivity, specificity, and accuracy in diagnosing malignancy were 95.1%, 100%, and 96.2%, respectively. A specific cell type could be characterized in 95.2% of those 104 lesions (99 lesions; malignant, 76 lesions; benign, 23 lesions). The specific cell type was precisely diagnosed, and was confirmed after surgery in 65 malignant lesions and 23 benign lesions. The biopsy-induced complications encountered were pneumothorax in 34.5% (38 of 110 patients) and hemoptysis in 6.4% (7 of 110 patients). No patient had a serious complication., Conclusion: CT fluoroscopy-guided lung biopsy using the Auto Surecut needle provides a high degree of diagnostic accuracy, allows for the specific characterization of lung nodules, and can be performed safely.

Unlabelled: In a double-blind parallel-group study, serum lipids and visceral fat/total fat ratio in young women (n=49) with variants of lipid transporters, i.e., fatty acid binding protein 2 (FABP2) and microsomal triglyceride transfer protein (MTP), were analyzed by substituting dietary triacylglycerol (TAG) with sn-1,3-diacylglycerol (DAG). All subjects, including some with the hyperlipidemia-prone genotypes Ala54Thr of FABP2 and c-493g of MTP, received DAG or TAG (20 g/day) for 8 weeks. Reductions of serum lipids from weeks 4 to 8 in FABP2-Ala54Thr heterozygotes and MTP -493g homozygotes were significantly different between the DAG and TAG groups (p<0.05, p<0.01). Visceral fat/total fat (%), as determined by computed tomography (CT), was lower in FABP2-Ala54Thr heterozygotes (p<0.05) of the DAG group. The apoCII/CIII ratio was higher in the DAG group than in the TAG group (p<0.01). Other variants of lipid metabolism, including peroxisome proliferator activated receptors (PPARs) alpha and gamma and SREBP cleavage-activating protein (SCAP), were only slightly affected by dietary DAG., Conclusion: improvement of serum lipid profiles and visceral fat/total fat ratio (CT) was potentiated by DAG intake in subjects with hyperlipidemia-prone genotypes (Ala54Thr heterozygotes of FABP2 and -493g homozygotes of MTP).

Amoebosis is one of the most common protozoal diseases of reptiles, but has rarely been reported in tortoises. Six cases of amoebosis were identified in flat-shelled spider tortoises immediately after their importation from Madagascar to Japan. Necropsy revealed an extensive green pseudomembrane of ulceration along the length of the thickened wall of the colon, and disseminated green foci in the liver. Histologically, the colonic wall was severely ulcerated and covered with a fibrinonecrotic pseudomembrane, and many amoebic trophozoites were seen in the submucosa. Multifocal necrosis with intralesional amoebic trophozoites corresponded to the disseminated green foci in the liver. Amoebic trophozoites invaded many blood vessels in the colon and liver. All tortoises exhibited severe colonic lesions, but the severity of the hepatic lesions varied. These findings suggest that amoebic colitis was the primary lesion with spread of amoebae to the liver via the portal system., (Copyright 2000 Harcourt Publishers Ltd.)

Background: Exact clinical staging before treatment of esophageal cancer has become increasingly important in the evaluation and comparison of the results of different treatment modalities, including surgery, chemotherapy, and radiotherapy., Methods: The accuracy of preoperative tumor staging by using an esophagography, esophagoscopy, percutaneous and endoscopic ultrasonography, and computed tomography was assessed in 224 patients with resectable esophageal cancer. The results of tumor staging by these tests were compared prospectively with the pathologic stage of the esophagectomy specimens with respect to the T and N categories defined by the International Union Against Cancer TNM classification., Results: For the T category, the overall accuracy was 80%. For the N category, overall accuracy was 72%, with a sensitivity of 78%, a specificity of 60%, and a positive predictive value of 78%. Overall, the accuracy of stage grouping was 56%., Conclusions: Either the T or N categories can be predicted reliably by clinical staging techniques. However, the preoperative stage grouping might not be valid in resectable, localized esophageal cancer.

Background: Paravalvular leakage is one of the most serious complications of aortic valve replacement in patients with aortitis syndrome. The purpose of this study was to compare the effectiveness of the intravalvular implantation technique in preventing paravalvular leakage with that of the conventional technique., Methods: Since 1982, 14 patients with aortic regurgitation caused by aortitis syndrome have undergone aortic valve replacement at our institute. An intravalvular implantation technique was applied in 7 of the 14 patients. The technique consists of suturing a prosthetic valve to the aortic annulus and sandwiching the leaflets between exogenous felt pledgets and the inflamed aortic annulus., Results: Paravalvular leakage occurred in 3 of 7 patients in the conventionally treated group and in none of 7 in the intravalvular implantation group., Conclusions: The intravalvular implantation technique is effective in preventing paravalvular leakage in patients with aortitis syndrome.

We evaluated 56 consecutive patients with newly diagnosed lymphoma including 48 with non-Hodgkin's lymphoma (NHL) and 8 with Hodgkin's disease to determine the clinical and prognostic significance of magnetic resonance imaging (MRI) of the femoral marrow. MR images of the femoral marrow were obtained by the T1-weighted spin echo method and the short TI inversion recovery technique. Abnormal "positive" images were seen in 29 of the 56 patients (52%). All 17 patients with positive biopsy results showed abnormal images on their femoral marrow MRI. Three "positive" MRI patterns-scattered (72%), uniform (21%), and nodular (7%)-were observed. The overall survival of the patients with a positive MRI pattern was significantly poorer than that of patients with a normal pattern (P = .0129). Survival did not differ significantly according to MRI pattern. The 3-year survival rate in the patients with a normal MRI pattern was 89.9% and in the patients with a positive MRI pattern, it was 41.0%. This difference was statistically significant (P = .0279) when we evaluated only the patients with NHL. Patients with positive MRI patterns, but a normal bone marrow histology, showed a significantly shorter survival than those with a normal MRI pattern (P = .016). These results indicate that abnormal MR images of the femoral marrow are associated with a significantly poorer survival in patients with malignant lymphoma, regardless of histologic findings in the marrow.

We evaluated magnetic resonance imaging (MRI) of femoral marrow in 85 untreated adult patients with myelodysplastic syndromes (MDS) (N = 27), aplastic anemia (N = 9), and leukemia (N = 49). Images of femoral marrow were obtained using a T1-weighted spin-echo (SE) method and a short T1 inversion recovery (STIR) technique. In patients with MDS, the change in MRI pattern from a fatty or nodular pattern to a uniform pattern correlated with disease progression. Evolution to acute leukemia in MDS patients was associated with a higher signal intensity on STIR images (lower signal intensity on T1-weighted SE images) and an extended area of involvement. The femoral marrow in patients with de novo acute myeloid leukemia (AML) showed increased signal and varied patterns (scattered to uniform) on STIR images. However, the faint pattern (grade 4a) was characteristic of M2 AML. In patients with chronic myelogenous leukemia (CML) in the chronic phase, increased leukemic mass was represented by replacement of the femoral marrow with a region of abnormal signal intensity. The extent of involved areas in these CML patients correlated with the spleen size. This study indicates that MRI of femoral marrow is an important tool for the accurate diagnosis and management of patients with MDS and leukemia that may function as an adjunct to bone marrow aspiration and biopsy.

From the roots of Phlomis younghusbandii collected in Tibet, new furanolabdane-type diterpenoid glycosides named phlomisosides III and IV were isolated together with a known sweet furanolabdane-type diterpenoid glycoside, phlomisoside I. The structure of the common aglycone of phlomisosides III and IV, which we have named phlomisoic acid, was established as 15,16-epoxy-8,13(16),14-labdatrien-19-oic acid by MS and NMR spectroscopy. Phlomisosides III and IV are tasteless and the structures of these were determined to be the beta-D-xylopyranosyl(1-->2)-beta-D-glucopyranosyl and the alpha-L-rhamnopyranosyl(1-->2)-beta-D-glucopyranosyl ester of phlomisoic acid by chemical and spectroscopic methods, respectively. The diterpenoid glycoside constituents of the roots of P. medicinalis collected in Tibet were also elucidated, and baiyunoside and phlomisosides II and III were isolated and identified.

Two complementary DNA (cDNA) clones (pTK-1 and -2) encoding two distinct isotypes of mouse Mg(2+)-dependent protein phosphatase beta (MPP beta-1 and -2, respectively) were isolated from a melanocyte cDNA library. Although mouse pTK-1 is orthologous to the rat cDNA (JW5) reported previously [Wenk, J., Trompeter, H.I., Pettrich, K.G., Cohen, P.T.W., Campbell, D.G., and Mieskes, G. (1992) FEBS Lett. 297, 135-138], pTK-2 is a novel cDNA clone. It was strongly suggested that the pTK-1 and -2 cDNAs are splicing variants of a single pre-mRNA. The difference in the amino acid sequences between MPP beta-1 and -2 was observed only at the carboxy-terminal regions. Both the recombinant MPP beta-1 and -2 expressed in Escherichia coli cells were immunoreactive to an anti-MPP beta antibody and exhibited Mg(2+)-dependent and okadaic acid-insensitive protein phosphatase activities with similar substrate specificities. Although the mRNA of MPP beta-1 was expressed ubiquitously in various mouse tissues, that of MPP beta-2 was expressed exclusively in brain and heart. These results suggest the difference in the physiological roles of these two enzyme isotypes.

From the roots of Glycyrrhiza yunnanensis, collected in Yunnan, China, six new oleanane-type triterpene glycosides named yunganosides A1, B1, C1, D1, E2 and F2 were isolated together with hypaphorine. The structures of these glycosides were established by spectroscopic and chemical means.

Study Objective: To evaluate the efficacy of prostaglandin E1 in attenuating the hypertensive response to laryngoscopy and intubation., Design: Controlled, comparative, and randomized study., Setting: Induction of anesthesia for elective surgery at a university hospital., Patients: Thirty normotensive patients (ASA physical status I) undergoing elective surgery divided into three groups. Each group consisted of ten patients., Interventions: Anesthesia was induced with thiopental sodium 5 mg/kg intravenously, and tracheal intubation was facilitated with vecuronium 0.2 mg/kg. Either 0.3 micrograms/kg of prostaglandin E1, 0.6 micrograms/kg of prostaglandin E1, or saline (control) was injected 15 seconds before starting direct laryngoscopy (within 30 seconds), which was attempted 2 minutes after administration of thiopental sodium and vecuronium., Measurements and Main Results: Patients receiving saline showed a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. These increases following tracheal intubation were significantly less in prostaglandin E1-treated patients than in the control group (p less than 0.05)., Conclusions: A single rapid intravenous administration of prostaglandin E1 is a practical pharmacologic and safe method to attenuate the hypertensive response to tracheal intubation. The use of 0.6 micrograms/kg of prostaglandin E1 as a supplement during induction is recommended for reducing the pressor response to intubation on the basis of rate-pressure product and mean arterial pressure following intubation as an index.

High-performance liquid chromatography on a column of newly developed hard spherical hydroxyapatite was applied to the separation of a variety of glycosides of tri- and diterpenes including Ginseng saponins and Stevia sweet glycosides, affording satisfactory results by using a simple solvent system, aqueous acetonitrile. This normal phase chromatography is superior to chromatography on a silica gel column for the separation of water-soluble glycosides.