Search

Background Hypertension and diabetes mellitus frequently coexist; however, it has not yet been clarified if the bidirectional longitudinal relationships between arterial stiffness and hypertension are independent of those between arterial stiffness and diabetes mellitus. Methods In this 16-year prospective observational study, 3960 middle-aged employees of a Japanese company without hypertension/diabetes mellitus at the study baseline underwent annual repeated measurements of the blood pressure, serum glycosylated hemoglobin A1c levels (HbA1c), and brachial-ankle pulse wave velocity (baPWV). Results By the end of the study period, 664, 779, 154, and 406 subjects developed hypertension, prehypertension, diabetes mellitus, and prediabetes, respectively. Increased baPWV at the baseline was associated with a significant odds ratio (per 1 standard deviation increase) for new onset of prehypertension/hypertension with (2.45/3.28, P Conclusions In middle-aged employees of a Japanese company, in contrast to the bidirectional relationships that exist between arterial stiffness and hypertension, increased arterial stiffness preceding the development of diabetes mellitus may represent that associated with the development of hypertension, as it is observed only in cases of diabetes mellitus coexisting with hypertension. Therefore, arterial stiffness may be associated to a greater degree with the development of hypertension than with the development of diabetes mellitus. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Omron Health Care Company (Kyoto, Japan),Teijin Pharma Company (Tokyo, Japan)

Backgrounds While arterial stiffness and abnormal pressure wave reflection are independent cardiovascular risk, the difference of their association with alcohol intake have not been fully clarified. Aim This prospective observational study, which utilized repeated annual measurements performed over a 9-year period, applied mixed model analyses to examine age-related differences in longitudinal associations between alcohol intake and arterial stiffness, pressure wave reflection, and inflammation. Methods In 4016 middle-aged (43±9 years) healthy Japanese male employees, alcohol intake, brachial-ankle pulse wave velocity (baPWV), radial augmentation index (rAI), and serum C-reactive protein (CRP) levels were measured annually during a 9-year study period. Based on the questionnaire, alcohol intake was classified as non-drinker, mild-moderate drinker (ethanol 1–20 g/day) and heavy drinker (>20 g/day). Results The estimated marginal mean baPWV (non-drinkers = 1306 cm/s, mild-moderate drinkers = 1311 cm/s, and heavy drinkers = 1337 cm/s, P Conclusion In middle-aged male Japanese employees, alcohol intake may attenuate inflammatory activity. While alcohol intake may exacerbate the progression of arterial stiffening in a dose-dependent manner without mediating inflammation, especially in subjects under 50 years of age, it may promote pressure wave reflection abnormalities with aging at earlier ages without further exacerbation at older ages. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Omroncarpis

Background Recently, the concept of healthy vascular aging (HVA) and early vascular aging (EVA) phenotypes was proposed. Purpose We examined following issues; constancy of the vascular phenotypes over time; validity of assuming that constancy of the vascular phenotypes reflects the progression rate of structural arterial stiffening; and associations of vascular phenotype constancy with cardiovascular risk factors/their treatment, and the heart rate (HR). Methods Data on the brachial-ankle pulse wave velocity (baPWV) measured annually over a 16-year period in 4682 middle-aged Japanese employees were analyzed. Results Of all subjects, 30% showed constancy of the vascular phenotype during the study period. The estimated marginal mean of baPWV values and the slope of the annual increase of the baPWV were higher in the constant EVA group (EVA-EVA) than in the constant HVA group (HVA-HVA) (Figure 1). Elevated serum HbA1c levels, medication for hypertension, and high HR were significantly associated with constancy of the EVA phenotype, whereas a low HR was significantly associated with constancy of the HVA phenotype. Conclusions In middle-aged Japanese employees with the HVA/EVA phenotype at the study baseline, while the phenotype changed over time in most subjects, HVA/EVA phenotype constancy in the remaining subjects reliably reflected a low/high rate of progression of structural arterial stiffening. Hypertension and abnormal glucose metabolism were associated with constancy of the EVA phenotype, but treatment for these conditions failed to improve the phenotype. Low/high HR was a robust marker of the presence/constancy of the HVA/EVA phenotype. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Omron Health CareTeijin Pharma

Immune thrombocytopenia (ITP) is a frequent autoimmune manifestation among Inborn Errors of Immunity (IEI). This study analyzed immunoglobulin and complement levels and lymphocyte subsets proportions in children and adolescents with primary ITP to reassess underlying IEI and establish relations with disease features and outcomes. Sixty ITP patients had IgA, IgM, IgG, IgE, C3, and C4 levels measured by standard methods used by the hospital. CD3+, CD4+, CD8 + and CD19 + lymphocyte proportions were determined by flow cytometry. Overall, 23.3% of the reassessed ITP patients could be considered to have underlying IEI namely, IgA deficiency (1/60), IgM deficiency (2/60), C4 deficiency (1/60), low B cells (3/60), low T cells (2/60) and unclassified IEI (4/60). In addition, as a whole, 86.7% of ITP patients had at least one altered immunoglobulin or complement level or lymphocyte subset proportion specifically, low IgG (23.3%), low IgM (8.3%), high IgG (1.7%), high IgM (11.7%), and high IgE (18.3%). Moreover, 6.7% of ITP patients had an additional autoimmune disease namely, type 1 diabetes and thyroiditis; 56.7% had an allergy diagnosis; 20.0% had a positive family history of autoimmune disease, and 70.0% had a family history of allergy. Patients with low IgM levels underwent significantly more splenectomy (87.5% vs. 25.0%, p = 0.04). In conclusion, underlying IEI could be diagnosed in children and adolescents previously presumed as primary ITP, reinforcing the idea that immunoglobulin and complement levels and lymphocyte subset proportions should periodically be reassessed during follow-up. Further genetic analyses will be a cornerstone for unveiling additional IEI related to ITP.

Vitreous temperature has been reported to vary during intraocular surgery. We measured the temperature at three intraocular sites, just posterior to the crystalline lens (BL), mid-vitreous (MV), and just anterior to the optic disc (OD), and investigated temperature changes before and after different types of surgical procedures in 78 eyes. The mean temperature at the beginning was 30.1 ± 1.70 °C in the anterior chamber, 32.4 ± 1.41 °C at the BL, 33.8 ± 0.95 °C at the MV, and 34.7 ± 0.95 °C at the OD. It was lowest at the BL, and highest at the OD. The mean temperature after cataract surgery was slightly lower especially at an anterior location. Thus, the temperature gradient became slightly flatter. The mean temperature after core vitrectomy was even lower at all sites and a gradient of the temperature was not present. The mean temperature after membrane peeling was significantly higher than that after core vitrectomy, and there was no gradient. The mean temperature after fluid/air exchange was lower at the BL and higher at the MV and at the OD. Thus, a gradient of higher temperatures at the OD appeared. The intraocular temperature distribution is different depending on the surgical procedure which can then change the temperature gradient. The temperature changes at the different intraocular sites and the gradients should be further investigated because they may affect the physiology of the retina and the recovery process.

Autoantibodies are biomarkers for autoimmune disease diagnosis, monitoring, and prediction. Therefore, this study established the frequency of latent and overt polyautoimmunity in children and adolescents with >6 months of diagnosis of immune thrombocytopenia (ITP). Forty-seven patients with chronic or persistent disease had non-organ-specific and organ-specific autoantibodies assessed. Frequency of latent polyautoimmunity was 36.2%, and, of overt polyautoimmunity, it was 4.3%. Of ITP patients with latent polyautoimmunity, 52.9% were positive for antinuclear antibody (ANA), 47.1% for autoantibodies other than ANA, and 64.7% for multiple autoantibodies. In addition, patients with latent polyautoimmunity and those positive for ANA were significantly older at disease onset. Both ITP patients positive and negative for autoantibodies reported family members with autoimmune diseases. The autoantibodies observed were as follows: ANA, anti-dsDNA, anti-SSA/Ro, IgM aCL, anti-GAD, anti-IA2, anti-IAA, anti-TG, anti-TPO, anti-LKM1, and SMA. Of ITP patients with overt polyautoimmunity, 1 was diagnosed with type 1 diabetes mellitus and the other with thyroiditis. In conclusion, children and adolescents with ITP present high frequency of latent and overt polyautoimmunity even for autoantibodies other than ANA. Therefore, ANA and other non-organ-specific and organ-specific autoantibodies should be considered for assessment during ITP patients' follow-up.

Hypertension is one of the strongest risk factors for cardiovascular disease (CVD) worldwide. Recent studies suggested that prevention of hypertension effects not only prevention of CVD but also the management of other diseases, such as dementia, cancer, and periodontal disease. This article organizes the reported results that form the basis for the lifestyle modification recommendations for preventing and controlling hypertension that are provided in the major hypertension guidelines, and we indicate how these guidelines’ lifestyle modification recommendations resemble those of other countries’ guidelines.

SummaryObjective: The purpose of this study was to improve accessibility to nursing care by clari -fying the relationship between patient characteristics and the amount of nursing care for the Diagnosis Procedure Combination system (DPC).Method: The subjects included 528 lung cancer patients; 170 gastric cancer patients; and 91 colon cancer patients, who were hospitalized from July 1, 2008, to March 31, 2010, at a university hospital. The patients were categorized into groups according to factors that could affect the amount of nursing care. Next, the relationship between the patient characteristics and the amount of nursing care was analyzed. Then the results from this study were used to classify patient characteristics according to the patient type and the amount nursing care required.Results: The patient characteristics, which affected the amount of nursing care, varied according to each DPC code. The major factors affecting the amount of nursing care were whether the patient had received a surgical (under general anesthetics) treatment or a non-surgical treatment and the level of activities of daily living (ADL) of the hospitalized patients. For those who had received a surgical operation for colon cancer, the patient’s age also affected the amount of nursing care.Conclusions: The findings show that the method for the visualization of the amount of nursing care based on the classification of patient characteristics can be implemented into the electronic health record system. This method can then be used as a management tool to assure appropriate distribution of nursing resources.

The asymptotically distribution-free (ADF) test statistic was proposed by Browne (1984). It is known that the null distribution of the ADF test statistic is asymptotically distributed according to the chi-square distribution. This asymptotic property is always satisfied, even under nonnormality, although the null distributions of other famous test statistics, e.g., the maximum likelihood test statistic and the generalized least square test statistic, do not converge to the chi-square distribution under nonnormality. However, many authors have reported numerical results which indicate that the quality of the chi-square approximation for the ADF test is very poor, even when the sample size is large and the population distribution is normal. In this paper, we try to improve the quality of the chi-square approximation to the ADF test for a covariance matrix with a linear structure by using the Bartlett correction applicable under the assumption of normality. By conducting numerical studies, we verify that the obtained Bartlett correction can perform well even when the assumption of normality is violated.

To investigate formation of the three primary germ layers in mouse embryoid bodies (EBs), we observed changes in structure and gene expression over a 7-day culture period. We compared these changes using two methods for EB formation: hanging drop (HD) and static suspension culture (SSC). Light microscopy showed that a stratified columnar epithelial layer developed on the surface of EBs formed using the HD method. From Day 3 in culture, ultrastructural changes occurred in the aligned cellular membranes. Condensation of actin filaments was followed by formation of complicated adherent junctions and dilatation of intercellular canaliculi containing well-developed microvilli. These changes were more marked in EBs formed by the HD method than the SSC method. On Day 5 of culture, Brachyury gene expression, a marker for mesoderm formation, was detected only with the HD method. Nestin, an ectoderm marker, and Foxa2, an endoderm marker, were expressed with both methods. These results suggest that in EBs formed with the HD method, actin formation and Brachyury gene expression mark the transition from two to three primary germ layers. Additionally, the HD method promotes more rapid and complete development of mouse EBs than does the SSC method. While the SSC method is simple and easy to use, it needs improvement to form more complete EBs.

This paper describes large-scale and fast nonlinear magnetostatic field analyses by the magnetic moment method (MMM) with the adaptive cross approximation. In order to stabilize the convergence characteristic of the Newton-Raphson method, we apply a line search technique to the MMM. Some numerical results that demonstrate the validity of the developed method are also presented

We collected diarrhoea specimens in two hospitals in southern Thailand in 1999 to examine whether infection by the Vibrio parahaemolyticus pandemic clone is prevalent. V. parahaemolyticus was isolated from 317 specimens. Seventy-six per cent of the isolated strains had the pandemic clone-specific characteristics (tdh+, trh−, and an unique toxRS sequence detectable by GS-PCR) and an associated characteristic (the ORF8 sequence of f237 phage). These strains belonged to the three pandemic servovars with the O3[ratio ]K6 strains being dominant and three other serovars (O1[ratio ]K25, O1[ratio ]K41 and O4[ratio ]K12). We also found O1[ratio ]K25 and O1[ratio ]K41 strains with the pandemic clone-specific characteristics among the strains isolated from the international travellers who left Thailand and three other Asian countries between 1998 and 1999, verifying pandemic potential of these strains. The results demonstrate prevalence of infection by the pandemic clone in southern Thailand and suggest emergence of various serovariants in this area and their implication in international spread.

PURPOSE Valsalva hemorrhagic retinopathy is characterized by retinal hemorrhages that develop after a Valsalva maneuver that consists of a forcible exhalation against a closed glottis, thereby creating a sudden increase in the intrathoracic or intraabdominal pressure. We present a patient who developed retinal and vitreous hemorrhages with multiple retinal nonperfused areas after extreme physical training with shouting on a mountainous area. This exercise was part of his training as a member of a Japanese traditional cheerleading team. METHOD Case presentation. RESULTS A 19-year-old man developed an acute decrease in the vision to 0.3 in his left eye after running on hilly roads at approximately 800 m while shouting fight songs for several hours. Ophthalmoscopy showed a fresh vitreous hemorrhage that covered the entire macula and was connected to the optic disk in the left eye. The vitreous hemorrhage spontaneously resolved and an intraretinal hemorrhage and nonperfused area emerged. His visual acuity returned to 1.2. CONCLUSION Prolonged, strenuous physical exertion with shouting during training exercises can lead to Valsalva hemorrhagic retinopathy. Several other factors, such as hot weather, altitude, and dehydration, may have played an additive role in increasing the venous pressure and hypoxia in the retinal vessels, which then caused the retinopathy.

The authors evaluated the effectiveness and safety of "neo-metoro" or 'mini-metoro" metreurynters plus oxytocin for labor induction and assessed differences in parturition outcomes, according to the metreurynter used at induction initiation.The authors retrospectively reviewed 146 consecutive women with live singleton pregnancies, and who underwent induction. Parturition outcomes were vaginal delivery achieved within the planned schedule (VDPS), vaginal delivery finally achieved (VDF), and induction-to-delivery interval (IDI). Women were divided into neo-metoro, mini-metoro, and without metreurynter groups based on metreurynter use at induction initiation. The authors examined the relationships of metreurynter groups with factors, parturition outcomes, and adverse events. In 113 women who underwent two-day induction, the authors calculated IDI and adjusted odds ratio (AOR) for achieving delivery per unit time.VDPS rates were 65% in nulliparous and 81% in multiparous women. VDF rates were 78% in nulliparous and 96% in multiparous women. AORs for VDPS were 0.30 in nulliparous women and 0.18 in Bishop score (BS) 1-3 class. AORs for VDF were 0.04 in BS1-3 class and 0.14 in BS4-5 class. In 113 women undergoing two-day induction, AORs for achieving delivery per unit time were 0.45 in nulliparous women, 0.46 in obese women, and 0.48 in BS1-3 class. Neo-metoro use at induction initiation tended to reduce IDI.Labor induction using these metreurynters plus oxytocin is safe and effective. The advantages of neo-metoro over mini-metoro use at induction initiation remain unclear; neo-metoro use at induction initiation may reduce IDI.

Objective: Obstruction of the fetal esophagus does not always produce the expected polyhydramnios. This is because of increased intramembranous absorption of amniotic fluid into the fetal circulation. A possible mediator for this increased absorption is vascular endothelial growth factor (VEGF). The present objective was to explore whether VEGF gene expression and action would be induced in fetal membranes and placentas of ovine fetuses after esophageal ligation. Study Design: Five late-gestation fetal sheep underwent esophageal ligation and 5 served as control animals. On postoperative day 9, amnion, chorion, and placenta were collected for cellular localization and quantitation of VEGF messenger ribonucleic acid by in situ hybridization and Northern blot analysis. Reverse-transcription polymerase chain reaction was used to identify the VEGF molecular forms. Immunostaining with Ki-67 antibody was used to determine the proliferation of vascular endothelium in the fetal membranes and placentas. Results: VEGF messenger ribonucleic acid was localized in amniotic epithelium, chorionic cytotrophoblast, and cytotrophoblast of the placenta. VEGF 164 was the major transcript expressed in these tissues. The abundance of VEGF messenger ribonucleic acid in the amnion and chorion, but not in the placenta, was significantly increased in the ligated fetuses in comparison with the control fetuses. The proliferation of the intramembranous blood vessel endothelium was greater in the ligated fetuses than in the control fetuses. Conclusion: The levels of VEGF messenger ribonucleic acid and the proliferation of vascular endothelium in the amnion and chorion increased after fetal esophageal ligation. This provides a possible mechanism for the enhanced intramembranous absorption of amniotic fluid through increased vascularity and permeability of the fetal membranes, thus ameliorating the development of polyhydramnios. We speculate that the signal(s) that mediate the increase in VEGF expression is present in either the fetal urine or the fetal lung secretions, or both. (Am J Obstet Gynecol 2001;184:175-84.)

Time variabilities of the broad and skewed feature around 5–7 keV (so called “disk-line feature”) observed from the Seyfert galaxy, MCG—6-30-15 were studied based on the ASCA long observation of this source in 1999. The RMS variability, defined as the standard deviation divided by the mean for a sequence of X-ray counts in a time bin, was calculated as a function of energy, with changing the width of the time bin. An interesting finding is that the RMS variability in the disk-line energy band (5.0–6.6 keV) decreases more largely than those in the other energy bands as the bin width increases from ∼10 4 s to ∼10 5 s. This variability decrease in the 5.0–6.6 keV band in association with the bin-width increase is consistent with a presence of a random variation of the flux on a time scale around 10 4 s. Whereas, the RMS variabilities in the continuum bands other than 5.0–6.6 keV do not decrease so largely as in 5.0–6.6 keV. This suggests a presence of another time variation on a time scale longer than 10 5 s, which appears only in the continuum bands other than the disk-line band. This energy-dependent time variation could be interpreted by introducing a time variation of absorption on a time scale longer than 10 5 s. If the absorption changes in time, the time variability of the flux should become larger in the energy range suffering larger absorption. This predicts that an excess part (almost free from absorption) in the energy spectrum tends to be a depressed part in a plot of the RMS variability as a function of energy. In fact, the energy-resolved RMS variability on a time-bin of 2 × 10 5 s shows a depression around 5 – 7 keV and the degree of the depression as a function of energy is similar to the disk-line profile in the energy spectrum. This suggests, alternatively to the disk-line model, that the disk-line feature could be a combination of a fairly narrow line at 6.4 keV and a broad hump around 5 – 7 keV as a result of a transparent spectral-window of (warm) absorbers on the line of sight which change their column densities on a time scale longer than 10 5 s.

Background: The effects of pneumoperitoneum on the activity of the cardiac autonomic nervous system have not been completely understood. Methods: In this study, 45 unpremedicated adult patients who underwent laparoscopic cholecystectomy were anesthetized with either 3.5% sevoflurane, 2% isoflurane, or 8 mg/kg/h propofol (15 patients in each group). The status of cardiac autonomic nervous activity was evaluated by heart rate variability analysis three times: once when the patient was awake, once after induction of general anesthesia, and once after insufflation for pneumoperitoneum. Intra-abdominal pressure was maintained automatically at 10 mmHg by a carbon dioxide (CO2) insufflator. For each measurement, electrocardiogram was recorded for 256 s and played back offline to detect R-R intervals. Power spectral analysis of heart rate variability was applied, and the low-frequency (LF, 0.04–0.15 Hz) and high-frequency (HF, 0.15–0.40 Hz) bands of the spectral density of the heart rate variability were obtained from a power spectra of R-R intervals using the fast-Fourier transform algorithm. The HF/LF ratio also was analyzed. Results: Measurements of heart rate variability in the three groups showed similar change. Although the power of HF, which represents parasympathetic nervous activity, did not change, the power of LF, which represents both sympathetic and parasympathetic nervous activity, decreased during the anesthetized stage and increased during the insufflated stage. The HF/LF ratio, which represents the balance of parasympathetic and sympathetic activity, increased after induction of general anesthesia, and decreased after insufflation. Conclusions: Our results suggest that pneumoperitoneum increases sympathetic cardiac activity. The choice of general anesthetic did not seem to have a major influence on the change in the cardiac autonomic nervous system after induction of pneumoperitoneum for laparoscopic cholecystectomy.

Objective: Although the fetus normally swallows large volumes of amniotic fluid each day, it is unclear whether amniotic fluid volume increases after fetal esophageal obstruction or whether fetal urine production changes. Our objective was to determine the effects of fetal esophageal ligation on amniotic fluid volume and urinary flow rate over time. Study Design: Seven late-gestation fetal sheep underwent esophageal ligation, and 7 served as time control animals. The urachus was ligated to eliminate urine flow to the allantoic cavity. On days 1, 3, 5, 7, and 9 after surgery, we measured the composition of amniotic fluid, fetal urine, and fetal and maternal blood, as well as amniotic fluid volume and fetal urinary flow rate. A 3-factor analysis of variance was used for statistical analysis. Results: Amniotic fluid volume did not change with time in the control group, averaging 876 ± 142 mL (mean ± SEM), and it decreased in the esophageal ligation group ( P =.020), averaging 309 ± 75 mL on day 9. Fetal urinary flow rate was lower ( P =.0063) in the esophageal ligation group (431 ± 27 mL/d) than in the control group (631 ± 54 mL/d). There were no differences in fetal or maternal blood compositions between the two groups. Amniotic fluid sodium and chloride increased in the ligated animals. Conclusion: Polyhydramnios did not occur after esophageal ligation, even though the fetuses excreted approximately 4000 mL of urine over the 9-day study period. This suggests that intramembranous absorption is substantially increased. With only small changes in amniotic solute concentrations, intramembranous solute absorption must occur simultaneously with water, suggesting a near-zero reflection coefficient for solutes. We speculate that fetal urine, lung secretions, or both contain a factor that increases intramembranous permeability. (Am J Obstet Gynecol 2000;182:699-705.)

Acid protease inhibitor 1,2-epoxy-3-(p-nitrophenoxy)propane (ENPP) is commonly used in research as a substrate for glutathione-S-transferase activity (GST) and recently was found to inhibit human immunodeficiency virus 1 (HIV-1) protease. The question of DNA-adduct formation and mutagenicity was investigated and found that ENPP causes DNA damage and acts directly to induce mutagenicity in Salmonella. Using HPLC analysis, ENPP was shown to bind covalently to guanine residues. The Salmonella mutagenicity assay indicated that ENPP enhanced the mutation frequencies in the base-substitution strain TA00 by more than 20 times above the background. Its mutagenic potency was comparable to that of well-known carcinogens, N-methyl-N-nitrosourea (MNU) and aflatoxin B(1)-8,9-epoxide (AFB(1)-8,9-epoxide). The results suggest that ENPP should be classified as a mutagenic compound and a potential carcinogen.

Note: To appear in IEEE Trans. Nucl. Sci. vol. 45, no. 3, June 1998, 資料番号: SA8000248000

Objective: To determine if the calculated anion gap differs according to presence or absence of hypertension in pregnant women. Methods: Retrospective data were obtained for 1223 patients who delivered at a community hospital during a 6-month period. Fifty-six (4.6%) of these patients were considered to have proteinuric hypertension, 66 (5.4%) to have non-proteinuric hypertension, and 1101 (90%) to be normotensive. The Kruskal-Wallis and Mann-Whitney tests were used to compare these groups with respect to the anion gap and serum sodium, chloride, and bicarbonate. Results: Compared with the other two groups, proteinuric hypertensive patients tended to have lower values for serum sodium (P < .005) and the anion gap (P < .005). There were no statistically significant differences between the groups with respect to serum chloride or bicarbonate. Conclusion: The anion gap appears to be smaller with proteinuric hypertension than it is without.

Accepted: 1997-04-10, 資料番号: SA1002216000

Background: Atropine premedication is used as it possesses an anticholinergic effect on the cardiac autonomic nervous system (CANS). The aim of this study was to investigate the effect of atropine premedication on the CANS during thoracic epidural anesthesia (TEA) by assessing power spectral analysis of heart rate (HR) variability. Method: Female patients (n=28) undergoing elective mammary biopsy were randomly allocated into two groups; one received intramuscular premedication of 0.01 mg/kg of atropine 30 min before the procedure (group A: n=14), and the other did not (group N: n=14). Each electrocardiogram was digitally recorded before and during TEA, and played back off-line to detect R-R intervals. As a power spectrum required R-R intervals of 256 s, this was analysed before TEA and repeated thereafter for 25 min. The spectra were quantified by determining the peak areas of the spectral density by integrating low frequency (Lo: 0.04-0.15 Hz) and high frequency (Hi: 0.15-0.40 Hz) bands as they showed sympathetic and parasympathetic nervous activity in the CANS. The neural balance was assessed by calculating Hi:Lo ratio. Results: Decreases in Lo and increases in Hi:Lo ratio were observed, suggesting sympathectomy and vagotonia with TEA in both groups. For 10 min after commencement, TEA maintained Hi:Lo ratios lower in group A than in group N, suggesting a vagolytic effect of premedication with atropine. With TEA, cardiac slowing was observed, which was dependent on the level of dermal analgesia. Conclusion: Power spectral analysis revealed that TEA had the effect of making CANS relatively vagotonic, and that atropine premedication would attenuate the effect of TEA.

Objective: To document the incidence, source, and reasons for all complaints received by a large municipal emergency medical services (EMS) program. Methods: A retrospective review of all complaints received during three consecutive years (1990–1992) in a centralized EMS system serving a large municipality (population 2 million). All cases were categorized by year, source, and nature of the complaint. Results: In the three study years, EMS responded to 416, 892 incidents with nearly a half–million patient contacts. Concurrently, 371 complaints were received (incidence of 1. 12 per thousand); 132 in 1990, 129 in 1991, and 110 in 1992. Most complaints involved either: 1) allegations of “rude or unprofessional conduct” (34%), 2) “didn't take patient to the hospital” (19%), or 3) “problems with medical treatment” (13%). Only 1. 6% (n = 6) were response–time complaints. Other complaints included “lost/damaged property,” “taken to the wrong hospital,” “inappropriate billing,” and “poor driving habits.” The most common sources were patient's families (39%) and the patients themselves (30%). Only 7. 8% were from health care providers. Conclusion: Reviews of complaints provide information regarding EMS system performance and reveal targets for quality improvement. For the EMS system examined, this study suggests a future training focus on interpersonal skills and heightened sensitivities, not only toward patients, but also toward bystanders and family members.

Although progress has been made in intestinal transplantation, chronic inflammation remains a challenge. We have reported that the risk of immunological graft loss is almost 100-fold greater in recipients who carry any of the prevalent NOD2 polymorphisms associated with Crohn's disease, and have shown that the normal levels of a key antimicrobial peptide produced by the Paneth cells of the allograft, fall as the graft becomes repopulated by hematopoietic cells of the NOD2 mutant recipient. These studies are extended in this report. Within several months following engraftment into a NOD2 mutant recipient the allograft loses its capacity to prevent adherence of lumenal microbes. Despite the significantly increased expression of CX3CL1, a stress protein produced by the injured enterocyte, NOD2 mutant CX3CR1(+) myeloid cells within the lamina propria fail to exhibit the characteristic morphological phenotype, and fail to express key genes required expressed by NOD2 wild-type cells, including Wnt 5a. We propose that the CX3CR1(+) myeloid cell within the lamina propria supports normal Paneth cell function through expression of Wnt 5a, and that this function is impaired in the setting of intestinal transplantation into a NOD2 mutant recipient. The therapeutic value of Wnt 5a administration in this setting is proposed.

The metacarpal bone mineral density (BMD) and metacarpal index (MCI) of the second metacarpal bone were measured by computed X-ray densitometry (CXD) (Teijin Ltd., Tokyo), which we have established with the development of microdensitometry of radiographs. In this study, we evaluated the basic attributes of this CXD method and determined the age-related changes in both metacarpal measurements in normal Japanese women. The precision in vivo was measured in eight subjects. The precision errors [coefficient of variation (CV)] were 0.2–1.2% CV for metacarpal BMD and 0.4–2.0% CV for MCI, respectively. We have obtained low precision error and more rapid analysis, within 3 minutes respectively, compared with the previous methods. Age-related changes in the metacarpal measurements were evaluated in 1438 normal women. Both measurements showed the most significant decrease in the sixth decade of life. The rate of decrease in the sixth decade was 1.6%/year for metacarpal BMD and 1.5%/year for MCI. On comparison between metacarpal BMD by CXD and spine BMD using dual energy X-ray absorptiometry (DXA) in 248 normal women with and without menstruation, the two measurements were found to be similarly decreased in the subjects within 5 years after menopause. There was also no significant difference in the Z-score between metacarpal BMD and spine BMD within 5 years after menopause. These results indicate that early postmenopausal bone loss occurs not only in the spine but also in the metacarpal bone. The metacarpal BMD for patients with osteoporosis was significantly lower than that for age-matched normal controls, although the Z-score for spine BMD (-1.46) was significantly better than that for metacarpal BMD (-0.82). In conclusion, because CXD has excellent low precision error and is widely available at relatively low cost, it appears potentially to be applicable to problems in the diagnosis and management of osteoporosis, when used in association with DXA.

Intense pulsed electrics field are one of the agents to give physical stresses to biological systems which are the complex of dielectric materials. We have been using an intense burst sinusoidal electric field (IBSEF) as a narrow band field to discuss the biological effects of the field in the frequency domain. Our previous study demonstrated that the enhancement of proliferation activity of HeLa S3 cells is induced by the application of non-thermal, IBSEF with amplitudes of 300 kV/m and with frequencies between 3 and 100 MHz. Moreover, the application of the smaller number of the pulses enhanced the proliferation activity, whereas the cells were likely to be killed by the larger number of the pulses. According to calculation of the electric field distribution over the cell under AC field, the field strength of cell membrane is decreased with increasing the frequency in the range more than 1 MHz. The range of frequencies between 3–10 MHz, the distributed field strength on nuclear membrane became the maximum. This is because of the decrease in the electrical impedance of the membrane, which can be regarded as a dielectric film. The frequency dependence implies the proliferation activity might be associated with the electric field at the cell membrane and nuclear membrane. Here, we analyze expression of RNA gene related to cell growth including cell cycle and describe the mechanism of the enhancement of proliferation activity by means of reverse transcription polymerase chain reaction (RT-PCR) assays.

We present a case of prurigo pigmentosa associated with vesicles that we call 'vesicular prurigo pigmentosa'. The subject was treated using minocycline with good results and no recurrence of the lesions over a 2-year period.

The selection of generation projects is based on the amount of energy consumption in the expected growth of demand in the amount of operating reserves and needs to regulate the system. A viable solution to meet energy needs and expansion of systems is the Distributed Generation - DG. Single source of DG does not guarantee economic generation, reliability, flexibility and controllability in energy markets. This paper presents a methodology considering DG as an advantageous alternative in the energy markets and technical and economic benefits to distribution systems. It is proposed that the aggregation of sources in Central DG “Virtual” Power, making them economically competitive within the markets for electricity. The control and supervision of this plant will be conducted by the Operation Center of the concessionaires. The tool is a complement to programs for expansion of distribution systems.