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Background Durability of different transcatheter heart valve (THV) is critical as the indication of transcatheter aortic valve replacement (TAVR) expands to patients with longer life-expectancy. Purpose We aimed to compare the durability of THV systems (balloon-expandable [BE] and self-expandable [SE]) and surgical aortic valve replacement (SAVR) prosthesis. Methods PUBMED and EMBASE were searched through February 2021 for randomized trials investigating parameters of valve durability after TAVR and/or SAVR in severe aortic stenosis. A network meta-analysis using random-effect model was performed. Synthesis was performed with 5-year follow-up data for echocardiographic outcomes and longest available follow-up data for clinical outcomes. Results Ten trials with a total of 9,388 patients (BE-THV: 2,562; SE-THV 2,863; SAVR:3,963) were included. Follow-up ranged from 1–6 years. SE-THV demonstrated significantly larger effective orifice area, lower mean aortic valve gradient (AVG), and less increase in mean AVG at 5-years compared to BE-THV and SAVR (Figure 1). Structural valve deterioration (SVD) was less frequent in SE-THV compared to BE-THV and SAVR (HR 0.14, 95% CI 0.07–0.27; HR 0.34, 95% CI 0.24–0.47, respectively) (Figure 1). Total moderate-severe aortic regurgitation and re-intervention was more frequent in BE-THV (HR 4.21, 95% CI 2.40–7.39; HR 2.22, 95% CI 1.16–4.26, respectively) and SE-THV (HR 7.51, 95% CI 3.89–14.5; HR 2.86, 95% CI 1.59–5.13, respectively) compared to SAVR. Conclusion TAVR with SE-THV demonstrated favorable forward-flow hemodynamics and lowest risk of SVD compared to BE-THV and SAVR at mid-term. However, both THV systems suffer an increased risk of aortic regurgitation and re-intervention, and long-term data from newer generation valve is warranted. Funding Acknowledgement Type of funding sources: None.

In coral reefs around the Okinawa Islands and Pacific Islands, waves are gentle by wave breaking caused by sudden change in water depth at the edge of coral reefs; therefore, coral reefs are called natural breakwaters. On the other hand, it has also been reported that wave overtopping damage occurred due to high waves behind coral reefs, when typhoons approach or pass through. Thus, it is necessary to understand the wave transformation characteristics on coral reefs in the design of wave overtopping countermeasures. The wave height change and wave setup are usually calculated using empirical formula proposed by the experiment (Takayama et al., 1977), the observation (Egashira et al., 1985), or the design manual (1999) and the guidebook (2003) for the fisheries infrastructures. Although in order to apply the empirical formula to various coral reefs, coastal topography and slope gradient should also be considered, present empirical formula are insufficient for considering the unique characteristics of the coral reef coasts. This study proposes an empirical formula of wave height estimation on coral reefs and the coefficients in the formula are determined using simulated results by Boussinesq wave model which can simulate wave transformation in shallow sea. The reef slope and gradient are not considered in the previous studies, but those were considered in the coefficients in this study. The applicability of proposed formula was confirmed through comparison with the observations and the simulated results by the other nonlinear wave model (KP wave model). The proposed equation agreed well with the results by the KP wave model when the wave height was high. When the wave height is small, the attenuation at the edge of reef is slightly overestimated, but the reproducibility of wave height over the reef was good. The accuracy of the estimated wave height on the reef by the present formula was higher than estimations by the other existing formulas. The proposed empirical formula can apply for estimation of design wave heights at arbitrary location over reefs.

A novel high-density microwave plasma utilizing a spokewise antenna was produced and applied for high-rate and low-temperature deposition of hydrogenated microcrystalline silicon (μc-Si : H) film. The plasma maintains a uniform state, i.e., high electron density, n e >10 11 cm −3 and low temperature, T e of 2–2.5 eV in pure Ar plasma over 20 cm in a diameter. High deposition rate was achieved of 47 A/s in the growth of highly crystallized and photoconductive μc-Si : H film at the axial distance, Z =6 cm from the quartz glass plate from SiH 4 and Ar without the use of H 2 dilution method at low substrate temperature, T s of 250°C. The effects of the total pressure, H 2 dilution ratio, flow rate of SiH 4 , Fr(SiH 4 ) and the axial distance, Z from the quartz glass plate on the μc-Si : H film deposition are discussed along with the plasma diagnostics.

A flywheel rotor having a main shaft, two flywheel disks and one permanent magnet for a SMB (superconducting magnetic bearing) was designed and manufactured. The flywheel was made of CFRP material which is light weight and has high tensile strength. The permanent magnet was hooped by CPRP in order to prevent centrifugal bursting. The rotor was levitated by a SMB in the axial direction. The radial vibration of the rotor was damped by active magnetic bearings. The superconducting magnetic bearing was made of YBa/sub 2/Cu/sub 3/O/sub 7-X/ which had a strong pinning force. The whole rotor system was stably accelerated up to 30000 rpm by an induction motor in a vacuum chamber, and then its energy storage value reached 479 Wh. In this paper, the rotor design, bearing and rotational properties of the rotor are discussed.

As the demand for electric power has been increasing steadily, the introduction of a flywheel energy storage system (FESS) using a superconducting magnetic bearing (SMB) is needed to level daily load as much as possible (daily load-leveling). We have studied rotation loss characteristics of SMBs with high Tc superconductors (YBCO) and permanent magnets (PM) for supporting a flywheel in FESS. We have designed and manufactured a testing machine for measuring rotation loss characteristics of SMBs. The rotor is suspended by two sets of radial active magnetic bearings (RaAMBs), a set of axial active magnetic bearings (AxAMB) and a set of SMB. Then, we obtained rotation loss characteristics of the rotor levitated by RaAMBs, AxAMB and SMB on this testing machine.

Recombinant phages that carry the human smooth muscle (enteric type) gamma-actin gene were isolated from human genomic DNA libraries. The amino acid sequence deduced from the nucleotide sequence matches those of cDNAs but differs from the protein sequence previously reported at one amino acid position, codon 359. The gene containing one 5' untranslated exon and eight coding exons extends for 27 kb on human chromosome 2. The intron between codons 84 and 85 (site 3) is unique to the two smooth muscle actin genes. In the 5' flanking region, there are several CArG boxes and E boxes, which are regulatory elements in some muscle-specific genes. Hybridization with the 3' untranslated region, which is specific for the human smooth muscle gamma-actin gene, suggests the single gene in the human genome and specific expressions in enteric and aortic tissues. From characterized molecular structures of the six human actin isoform genes, we propose a hypothesis of evolutionary pathway of the actin gene family. A presumed ancestral actin gene had introns at least sites 1, 2, and 4 through 8. Cytoplasmic actin genes may have directly evolved from it through loss of introns at sites 5 and 6. However, through duplication of the ancestral actin gene with substitutions of many amino acids, a prototype of muscle actin genes had been created. Subsequently, striated muscle actin and smooth muscle actin genes may have evolved from this prototype by loss of an intron at site 4 and acquisition of a new intron at site 3, respectively.

For electromagnetic (EM) disturbances in vehicle-mounted radios, the main source is known to be conducted noise currents flowing through wiring-harnesses from vehicle-mounted multi-layer printed circuit boards (PCBs). To investigate a design method that can suppress the conducted noise currents, we previously measured noise current outflows from four types of simple three-layer PCBs having two perpendicular signal traces and different ground patterns with/without slits, and showed that slits on a ground pattern allow conducted noise currents to flow out from PCBs, while the levels for the symmetric two slits ground types are smaller compared to the case for the asymmetric two slits ground types. In the present study, to further confirm the above finding, we fabricated six types of simple two-layer PCBs having two parallel signal traces and different ground patterns with/without slits, and measured the cross-talks between the traces to evaluate the noise current outflows from the PCBs. As a result, we found that the ground pattern with the slits perpendicular to the traces cause noise current outflows larger by 19-42 dB at 100 MHz than the ground pattern with no slits, while the ground patterns with the slits in parallel with the traces can provide current noise levels slightly smaller by 2.5-5 dB compared to the case for the no-slit ground pattern. These results were confirmed by the FDTD simulation, and were also qualitatively explained from an equivalent circuit model we previously proposed.

In this paper we present a grasping control system based on position control. The sliding mode control, which excels in robustness, is used as the position controller. Because the position control performs the grasping, it is not necessary to change the control rule accompanying the approach/grasp phase. The control system is, therefore, stable. Grasped objects may slip from fingertips when the mass of the objects and the posture of the robot's hands change. To avoid this problem, the friction coefficient is identified in real time. We believe that objects begin to slip when the friction coefficient value exceeds the maximum coefficient of friction. Using this coefficient as a threshold value, the grasping force is increased by increasing joint compliance. Our proposed control system was applied to a multifingered hand, and its efficacy and usefulness was verified.

A 20-year-old man noticed enuresis since the age of 18 years. He was also pointed out gait unsteadiness by his friends. Neurologic examination revealed spastic tetraparesis with mild cerebellar ataxia. The cerebrospinal fluid had mild pleocytosis containing neutrophils and brain magnetic resonance imaging showed mild pontocerebellar atrophy. Urodynamic study revealed uninhibited bladder and detrusor-sphincter dyssynergia. The diagnosis of neuro-Behçet's disease was made by the past history of recurrent genital and aphthous ulcers and positive HLA-B51. The frequency of enuresis was reduced by the oral administration of corticosteroid. We speculated the patient's enuresis was caused by the central nervous disinhibition at night together with uninhibited bladder.

A 56-year-old welder working for 30 years developed postural instability and writing clumsiness since October, 1998. Neurologic findings revealed dystonia of the bilateral shoulders and distal four limbs as well as parkinsonism such as masked face, bradykinesia, rigidity, and retropulsion. Brain MRI showed hyperintensity lesions on T1-weighted images in the bilateral globus pallidus, midbrain, pontine tegmentum, dentate nucleus and cerebral white matter, which reduced in size and density after ten months. The diagnosis of manganese poisoning was made by the high manganese levels of both serum and urine, and by the marked elevated urinary manganese level after administration of the cheleting agent. We pointed out the diagnostic significance of brain MRI in patients with chronic manganese exposure.

We presented a 70-year-old woman who developed unilateral visual loss due to central retinal vein occlusion caused by chronic hypertrophic cranial pachymeningitis. She had developed right blindness with optic atrophy due to chronic intracranial pachymeningitis one year before admission. In June 1999, she noticed visual loss of the left eye. On admission, neurological examination revealed left visual loss and sensory impairment in the first branch area of bilateral trigeminal nerves. Ophthalmological examination revealed central retinal vein occlusion of the left eye. Brain MRI showed dural thickening with gadolinium enhancement of the cavernous sinus near the left optic nerve and dilatation of the left supraorbital vein. There was no compression of the left optic nerve. We suggest that central retinal vein occlusion may be caused by compression of the supraorbital vein by dural thickening. This is the first case report of central retinal vein occlusion associated with chronic hypertrophic cranial pachymeningitis.

Background: Sentinel lymph node (SLN) biopsy guided by radioisotope (RI), blue dye or in combination methods is common. A high identification rate is reported for the RI-guided method. On the other hand, it has the demerits of radiation exposure, being expense, and it can only be used in a radiation-controlled area. The blue dye method, however, is safe and inexpensive, but the identification rate is lower compared with the RI method and requires training. The indocyanine green (ICG) fluorescent method involves the application of the fluorescing property. Lymph flow can be traced from outside the body with a photodynamic eye (PDE) camera simultaneously with an operation procedure. The ICG method is safe, inexpensive and requires little training, therefore its use will be widely permitted in any general hospitals. Recently, based on several retrospective clinical trials, the identification rate with the ICG fluorescent method has been reported to be equal to or greater than the RI method. The purpose of this multicenter study is to prospectively assess the diagnostic performance of SLN biopsy using the ICG fluorescence technique compared with RI. Materials and methods: In this validation study, the patients aged from 20 to 75 years-old with operable primary invasive breast cancer (cT1c-2N0M0) have been nominated and required the written informed consent. All candidates underwent SLN biopsy using the combined methods with RI and ICG fluorescence. The target sample size was 840 patients to evaluate the sensitivity of ICG method as a primary endpoint, and after 200 patients were enrolled we analyzed the identification rate and the SLN-positive rate of the RI and ICG methods respectively as the interim analysis planned beforehand. Results: Two hundred eligible patients were enrolled in this study from May 2011 to February 2012. Their median age was 53.0 years (range: 27-74 years). The number of patients with cT1c was 106 and that with cT2 was 94. The identification rate of the RI and the ICG method was 97% (194/200) and 96% (192/200) respectively. Of the 194 patients that were identified with the RI method, 186 (95.9%) were also identified with the ICG method. ICG identified 6 patients that were not identified by RI. On the other hand, RI identified 8 patients that were not identified by ICG. The SLN-positive rate was 25.5% (51/200). This rate was higher than we expected. Of the 51 patients with positive metastatic lymph nodes, 23 patients (21.7%) had cT1c breast cancer and 28 (29.8%) had cT2 breast cancer. The positive rate of the first SLN was 23.5% (47/200) and tumor cells skipped to the second or further tier in four cases (2%). Conclusions: The ICG-guided SLN biopsy procedure achieved a high identification rate almost equal to that with the RI method. Using this combination method, the identification rate was 100%. We will assess the sensitivity and the additive effect of combining the ICG fluorescence method with the RI method, etc., when all 840 patients have been enrolled (UMIN000005167). Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-03.

A 22-year-old man developed unconsciousness, severe quadriplegia and muscle atrophy, and had markedly elevated serum creatine kinase levels after using the high-dose steroid and nondepolarizing neuromuscular blocking agents during the course of sepsis and DIC. On neurological examination, he was lethargic. The patient had generalized muscle weakness and wasting, and diminished deep tendon reflexes. He weakly responsed to painful stimuli on the legs. The motor nerve conduction study demonstrated decreased CMAP (compound muscle action potential) amplitudes. Motor and sensory nerve conduction velocities and their distal latencies were normal. Muscle biopsy revealed marked muscle fiber atrophy predominantly in type 2 fibers and numerous basophilic and a few necrotic fibers. Some atrophic fibers had decreased to absent myosin adenosine triphosphatase activity in their center. Accordingly, he was diagnosed as having acute quadriplegic myopathy (AQM), which has been reported mainly in Western countries. The mechanism of muscle fiber degradation in this myopathy is still unknown. On immunohistochemical analysis to our patient, enzyme activities of various proteases such as calpain, cathepsin B, and proteasomes were increased in the sarcoplasm, especially in the atrophic fibers. We suggest that lysosomal cathepsin, nonlysosomal calpain, and ATP-ubiquitin-proteasome proteolytic pathways participate in muscle fiber degradation in AQM.

We determined the prevalence and clinical characteristics of elderly people with cognitively impaired but not demented (CIND) in the community.We examined 945 elderly residents (aged 65 years or more) in a cross-sectional study of a standardized clinical examination in 27 randomly selected communities in the town of Mifune, a standard farming town in Japan.The prevalence of CIND and dementia were 10.8% and 4.8%, respectively, with both rates increasing with age. The frequency of most neurological signs in CIND elderly was greater than that found in subjects with no cognitive impairment (NCI) and less than that in subjects with dementia. The mean ADL disability score in CIND subjects also lay between the mean values for those with NCI and those with dementia. There were no differences in lifestyles between the CIND group and the other groups.The results suggest that a majority of CIND elderly suffer from brain dysfunction due to chronic neurological disorders or aging itself.

We anesthetized a 47-yr-old man with end-stage hypertrophic cardiomyopathy for heart transplantation. This is the first case of heart transplantation from a patient with brain death, since the organ transplantation law had become valid in Japan. Anesthesia was induced and maintained with fentanyl and diazepam. Aseptic technique was used in inserting and securing all catheters. The patient was assisted by left ventricular assist system, and hemodynamic suppression at anesthetic induction was trivial. Since complete AV block was present at the termination of cardiopulmonary bypass (CPB), VVI pacing and infusion of isoproterenol were started. In addition, nitroglycerin was given for pulmonary vasodilation. The cardiovascular support used for weaning from CPB included dobutamine, isoprote-renol, dopamine and milrinone. Following weaning from CPB sinus rhythm appeared spontaneously and function of the transplanted heart was satisfactory. When the patient was transported to ICU reduction in doses of catecholamines was possible, and dopamine and milrinone were infused. The patient was extubated 10 hours after admission to ICU.

Because ethylene oxide (EO) gas is toxic to humans, restrictions have been imposed on its use for sterilization, specifying allowable levels of residual EO remaining in sterilized apparatus and materials. However, the aeration time that optimizes the removal of the remaining EO when a rigid sterilizing container is used for a vessel had not been identified. Therefore, polyvinyl chloride, which easily adsorbs EO, was placed in rigid sterilizing containers, and aeration was carried out after 1, 8, 12, 17, and 24 hours. After standard EO sterilization, the EO concentrations remaining in the air in the rigid containers were measured. The results indicate that a period of 17 hours of aeration is appropriate when a rigid sterilizing container is used.

The high-density and low temperature microwave plasma utilizing a spokewise antenna was successfully applied to fast deposition of highly crystallized and photconductive microcrystalline silicon (μ-Si:H) films at low temperatures. The deposition rate and film crytstallinity significantly depend on the axial distribution of the plasma parameters. Best crystallinity was obtained at the axial distance Z from the quartz glass plate, where the spread of the ion beam energy impinging to the growing surface was minimum. By optimizing the axial distance Z and total pressure, highly crystallized μ-Si:H films could be fabricated with a high deposition rate of ∼47Å/s in the SiH4 and Ar mixture plasma with no use of the H2 dilution. An intentional control of the ion beam energy is also attempted using a mesh grid electrode to suppress the ion bombardment to the growing surface.

We report two adult siblings with Chédiak-Higashi syndrome presenting as hyperpigmentation of the skin and the iris. Patient 1 was a 30-year-old man who had generalized hyperpigmentation from one month of age, developed mental deterioration at age 9 years, and gait difficulty at age 20 years. On admission, he showed hyperpigmentation of the skin and the iris without partial albinism. Skin pigmentation was predominated at the face and the extremities. Neurologic examinations revealed mental dysfunction with IQ of 60 by WAIS, cerebellar ataxia, pyramidal signs, extrapyramidal signs, and polyneuropathy. Hematologic examination revealed peroxidase-positive giant granules in leukocytes and decreased activity of natural killer cells, leading to the diagnosis of Chédiak-Higashi syndrome. Patient 2, a younger brother of patient 1, was a 28 year-old man who also had hyperpigmentation of the skin and the iris with similar neurologic findings with patient 1. Both had no episodes of systemic infections. In Japanese cases of Chédiak-Higashi syndrome, more than 50% of them showed hyperpigmentation of the skin from the early stage of the disease. We pointed out that hyperpigmentation of the skin may be a good diagnostic help of Chédiak-Higashi syndrome in Japanese cases.

A 52-year-old man was admitted to our hospital in 1997 because of high serum creatine kinase (CK) level. Neurologic findings revealed chorea on the trunk and extremities, mild weakness of proximal muscles, and absence of deep tendon reflexes in four extremities. Serum CK was elevated to 3,494 U/l (normal, below 235). A peripheral blood smear showed acanthocytes in approximately 1% of the red blood cells (RBCs). Very weak expression of the Kell antigens (K2, K4, K5, and K7) on his RBCs led us to make a final diagnosis of McLeod syndrome. Muscle biopsy from the left biceps showed increased variability in fiber diameter, a few regenerating fibers, scattered fibers with internal nuclei, and mild fiber type grouping. Immunohistochemical analyses of dystrophin. merosin, and adhalin were normal. Although McLeod syndrome is a rare X-linked recessive disorder, it is clinically important for differential diagnosis of chorea acanthocytosis and hyperCKemia.

A 64-year-old female had slowly progressive bilateral external ophthalmoplegia, blepharoptosis and muscle weakness of the extremities since age 30. Laboratory examination showed an elevation of serum CK level. Biopsied specimens from the left biceps and the left orbicularis oculi muscles revealed myopathic change with infiltration of mononuclear cells. In addition, some ragged-red fibers and a few cytochrome c oxidase-negative fibers, which are characteristic of mitochondrial myopathy, were observed. Polymerase chain reaction analysis of mtDNA in the muscles showed multiple mtDNA deletions. On administration of prednisolone (initial dose, 60 mg/day), blepharoptosis and muscular strength improved transiently and serum CK level was normalized but external ophthalmoplegia was not improved. We diagnosed our case as chronic progressive external ophthalmoplegia (CPEO). This is the first report of CPEO presenting as inflammatory myopathy.

Generalized osteoarthritis (OA) is a common disease, more often affecting women than men. Although genetic factors are known to be the major risk factor, the genes related to its development are as yet undetermined. We investigated the association between estrogen receptor gene polymorphisms and generalized OA.Pvu II and Xba I restriction fragment length polymorphisms (RFLP) of estrogen receptor gene were analyzed in 65 Japanese patients with generalized OA and in 318 healthy control women. The RFLP were represented as Pp(Pvu II) and Xx(Xba I), with capital and small letters signifying the absence and the presence of restriction sites, respectively.Estrogen receptor genotype PpXx, with the combination of the Pvu II and Xba I RFLP, is a significant risk factor for the disease subset (odds ratio 1.86, 95% confidence interval 1.03-3.24; p = 0.039). The association of this genotype was more obvious in patients with severe radiographic changes and in younger patients.Some variant of the estrogen receptor gene is a genetic marker for generalized OA. How this genotype affects development of the disease remains to be elucidated.

We present a 28-year-old man with isolated third nerve palsy as the initial manifestation of sarcoidosis. MRI demonstrated abnormal enhancement of the cisternal portion of the right third nerve. One month after steroid therapy, he showed almost complete recovery with resolution of the contrast enhancement on MRI. This patient illustrates the usefulness of enhanced MRI for detection of cranial nerve lesions of sarcoidosis.

18.9% of the patients with Kanemi Yusho showed an elevation of serum creatine kinase, however, the cause is still unknown. The relation between exercise, dehydration, thyroid hormone and concentration of PCB was studied. Dehydration, hyperexercise and PCB affected the elevation of creatine kinase. No relation between PCB and thyroid hormone or creatine kinase and thyroid hormone was observed. PCB may change the permeability of muscle plasma membrane.

The effects of polychlorinated biphenyls (PCB) on regenerating myelin of the peripheral nerves were investigated in rats. The sciatic nerves were crushed at the mid-thigh level on the last of 32 days of oral administration of PCB. The sciatic nerves were biopsied from the crushed regions at 4, 8 and 12 weeks after crushing. The nerves were fixed in 2.5% glutaraldehyde buffered with 0.1 M sodium cacodylate and embedded in epon 812. The ultrathin sections were analysed by JEOL JEM-1210 with EDAXDX-4. The chloride which was composed of PCB was increased in myeline on 4 weeks after crushing. Freeze fracture study of myelines of sciatic nerves on 8 and 12 weeks after crushing showed an increase of intramembranous particle on 12 weeks and an increase of caveolae on 8 weeks. These results suggest that PCB may affect the plasmamembrane of shwann cell and induce the disturbance of myeline.

We evaluated brainstem function by using electronystagmography in a 43-year-old woman with typical Bickerstaff brainstem encephalitis. She developed fever, drowsiness, total opthalmoplegia, swallowing disturbance, areflexia, and muscle weakness. On electronystagmography, eye-tracking test showed ataxic pattern with impaired smooth pursuit eye movement. The horizontal optokinetic nystagmus test showed diminished pattern. Caloric test revealed the vestibular hypofunction and the increase of caloric nystagmus on eye fixation. We considered these findings were attributed to the disturbance of pontine tegmentum, especially reticular formation. These findings were similar to those observed in patients with Fisher syndrome.

The species identification is of a great importance in the forensic field. The immunological techniques have been utilized to distinguish human from other animal samples, such as blood stain, saliva or seminal fluid, however a keen method for identification of the origin of a sample has not been established. We have previously reported that ABH(O) blood group substances are detected in various species and that the lectin- and immuno-histochemistry can be available for species identification from tissue particles (Nishi 1992). It is considered that some animals possess the genes homologous to those for human ABO blood group. We have also reported the determination of ABO genotypes with DNAs extracted from fresh blood or formalin-fixed, paraffin-embedded tissues by PCR amplification and restriction enzymes digestion (Yamada 1994), depending on the polymorphism of the gene encoding blood group A-transferase. Here we describe that the DNA analysis of the genes for ABO blood group might be a tool of species identification.

A large hepatoma was removed under isolated hepatic perfusion. Hepatic circulation was separated from systemic circulation by clamping inferior vena cava, potal vein and hepatic artery. Lactated Ringer solution at 4 degrees C was perfused through potal vein, and disposed through the isolated part of inferior vena cava. Blood in proximal part of potal vein and right femoral vein was shunted to right axillary vein using a centrifugal pump. Prothrombin time and activated partial thromboplastin time were prolonged to more than 200 seconds and 300 seconds, respectively, 50 minutes after the commencement of isolated hepatic circulation. They recovered to normal ranges 115 minutes after the declamping, by injection of fresh frozen plasma. On clamping of the inferior vena cava, superior vena cava pressure was elevated and cardiac output decreased. When declamped, an excessive hemorrhage from the cross section of the liver was observed. It took 30 minutes for the systolic blood pressure to recover to 80 mmHg by rapid blood transfusion (150 ml.min-1). The hepatic perfusion with chilled lactated linger solution reduced the peripheral body temperature to 29 degrees C. Hypocalcemia, which was probably due to the massive blood transfusion, was treated with calcium gluconate and calcium chloride.

Rat and mouse cDNAs for Zn-alpha 2-glycoprotein (Zn alpha 2gp) were isolated from liver libraries (lambda gt11) and compared with the human one. The lengths of cDNA inserts analyzed were 1,233 and 1,273 nucleotides for rat and mouse, respectively. The deduced amino acid sequences suggested that rat and mouse Zn alpha 2gp proteins consist of 279 and 290 amino acid residues in the mature form, respectively. They have 59.4% (rat) and 58.6% (mouse) identities in amino acid sequence with the human counterpart, and between rat and mouse the identity is 88.5%. Among the three domains, domain B is best conserved; the identities are 74.7, 73.6, and 95.6% between human and rat, human and mouse, and rat and mouse, respectively. Four cysteine and eight tryptophan residues are all conserved, and two of the three asparagine residues that carry a glycan in the human protein are conserved. Analysis of rat tissues by Northern blot suggested that its mRNA is expressed in liver, and, to a much lesser extent in submandibular gland, lung, kidney, and stomach. A more detailed study by in situ hybridization demonstrated that some epithelial cells of renal tubules and the isthmus and the neck zone cells of gastric fundic glands express Zn alpha 2gp mRNA.

Recombinant human erythropoietin was administered to 59 patients over 65 years of age receiving maintenance hemodialysis treatment in Kyoto and Shiga district, in order to evaluate its utility on renal anemia. After 6 months of administration, the hematocrit rose from 20.8 +/- 3.5% to 28.0 +/- 3.7% with concomitant improvement of subjective symptoms related to anemia. Twelve patients developed side effects, in 10 of whom elevation of blood pressure was observed. We found no clinically significant abnormalities in the laboratory data. In conclusion, recombinant human erythropoietin is highly useful in the treatment of renal anemia in elderly hemodialysis patients.

We report a case of renal cell carcinoma with metastasis to the pancreas, treated by radical nephrectomy and total pancreatectomy. A 56-year-old man visited our hospital because of macrohematuria and right low backache. An intravenous pyelography, ultrasonography and a CT scan of the abdomen revealed right renal tumor at the upper portion, about 11 cm in diameter, but no abnormal findings of the pancreas. Aortic and celiac angiograms demonstrated multifocal lesions, 1 or 2 cm in size, compatible with a metastatic tumor in the region of the pancreas. The patient underwent right radical nephrectomy and open biopsy of the pancreas. The right renal tumor was histologically revealed to be renal cell carcinoma without nodal or venous extension. Histological examination of the pancreas biopsy specimen confirmed it to be a renal cell carcinoma metastatic to the pancreas. Therefore, he underwent total pancreatectomy 1 month after the previous surgery. Three months after the second surgery, a CT scan of the brain revealed metastasis to the pituitary gland. He is still under therapy.

The neural crest gives rise to a variety of tissues, including peripheral neurons, Schwann cells, melanocytes and ectomesenchymal cells, which include the smooth muscle cells of large arteries. Cell lines derived from neuroblastoma (a neural crest tumor) have at least two distinct morphological cell types, a neuroblastic phenotype (N-type) and an epithelial-like phenotype (S-type) with characteristics of substrate-adhesiveness. We have analyzed 17 human neuroblastoma cell lines using a panel of monoclonal antibodies against cytoskeletal proteins. Three neuroblastoma cell lines (KP-N-SI, KP-N-YN and SMS-KCN) bound an alpha -smooth muscle actin antibody. In addition, one of these cell lines (KP-N-SI) bound anti-desmin monoclonal antibodies as determined by indirect immunofluorescence. A total of eight cloned cell lines were obtained from the above parent cell lines. These were composed of either N- or S-type cells and were confirmed to be the common neuroblastoma origin from each parent cell line by chromosomal analysis. Alpha-smooth muscle actin and desmin were demonstrated in the S-type cloned cells by indirect immunofluorescence, as well as by two-dimensional Western blot analysis. These results were confirmed by Northern blot analysis using a specific probe (pSH alpha SMA-3'UT) to human alpha-smooth muscle actin mRNA. This is the first report of the presence of alpha-smooth muscle actin and desmin in neuroblastoma cell lines. These data show that in addition to giving rise to cells with neural, Schwann cell and melanocyte markers, neuroblastoma can also give rise to the cells expressing smooth muscle cell markers.

This is a report of the thirteenth known case in Japan of emphysematous cystitis. A 70-year-old man visited our hospital because of pollakisuria and macrohematuria on November 21, 1989. The patient had been known to have familiar amyloid polyneuropathy for the previous 3 years. Urinalysis showed marked hematopyuria. The residual urine was 216 cc, and urine cultures yielded 10,000,000 colonies of Escherichia coli per ml. Laboratory studies revealed systemic inflammatory findings, but no diabetic change. A plain X-ray film of the abdomen and an excretory urogram (DIP) showed small linear and round gas collections in the bladder shadow. A CT scan revealed multiple gas locules within the bladder wall. A diagnosis of emphysematous cystitis was established. The patient was given antibiotics, and there was striking clinical improvement. Histological examination of the endoscopically obtained biopsy specimen of the bladder revealed amyloidosis. We believe that this patient had a cystitis emphysematosa precipitated neurogenic bladder due to amyloid polyneuropathy and amyloidosis of the bladder.

A 70-year-old man developed slowly progressive muscular atrophy in the lower limbs from age 28, followed by urinary disturbance from age 40. Neurological examination revealed bilateral severe muscular atrophy in the lower limbs with hypesthesia and hypalgesia, mild muscle wasting of both hands, urinary incontinence, and constipation. A sacral dimple was also recognized. A diagnosis of tethered cord syndrome with thick filum terminale was made by spinal magnetic resonance imaging (MRI). After the operation for untethering, urinary disturbance has been slightly improved. Although the adult-onset tethered cord syndrome with the thick filum terminale was extremely rare, the presence of congenital dermal abnormality and segmental distribution of the muscular involvement is often helpful for the clinical diagnosis of this disease. Spinal MRI is one of the most diagnostic method for this disease.

Twenty-two cases of Cesarean section due to fetal anomaly diagnosed prenatally were reviewed in terms of the anesthetic managements. In 6 cases, diazepam 0.3 mg.kg-1, which provides fetal anesthesia for surgery scheduled immediately after birth, was administered intravenously to the mothers with/without fentanyl (2 general anesthesia and 4 regional anesthesia). The diagnosis of their fetuses was congenital diaphragmatic hernia, congenital cystic adenomatoid malformation of the lung, gastroschisis or omphalocele. No fetal anesthesia was performed in the other 16 cases (15 spinal anesthesia and 1 general anesthesia). Seven of their fetuses were diagnosed as hydrops. Since the general condition of the diseased newborn is known to be deteriorated after receiving various stress and aerophagia, fetal anesthesia in Cesarean delivery has the advantage of stress reduction and prevention of aerophagia. When the newborn is considered to need immediate neonatal resuscitation or intensive care including surgery, fetal anesthesia may be a choice of anesthetic technique.

Povidone-iodine (PVP-I) is a widely used antiseptic because of its low toxicity and high germicidal effect. A one-year-old boy who had undergone Nissen's fundoplication developed a chemical burn on his back postoperatively. The lesion was exposed to the surgical sheet immersed with a large amount of 10% PVP-I solution for 4 hours. Patch test with PVP-I (small aluminum chamber keeps a wet paper with PVP-I) revealed positive response in the patient. The same patch tests were performed in 17 volunteers. Sixteen subjects showed positive and one negative, while direct painting of a small quantity of PVP-I on skin without the chamber produced negative responses. This may indicate that prolonged exposure to wet PVP-I is harmful. It is important to use PVP-I carefully for the prevention of contact dermatitis.

This is a report of the fifth case of pelvic lipomatosis in Japan. A 52-year-old man presented himself in our hospital with a complaint of left lower abdominal pain on August 28, 1988. At that time, physical examination was unremarkable with the exception of mild obesity. The excretory urogram and retrograde pyelogram revealed left hydroureteronephrosis with tapering of the left lower ureter. Urethrocystogram showed an elongated posterior urethra with anterior displacement and elevation of the bladder. Computed tomography revealed excess of diffuse fatty tissue in the pelvic space with bladder deformity and rectal compression. Pelvic arteriogram demonstrated no neovascularity. A diagnosis of pelvic lipomatosis was established. He lost 6 kg by diet therapy. Left lower abdominal pain disappeared, but excretory urogram after eight months showed no changes.

Abiesenonic acid methyl ester (AVB-I acid methyl ester), a triterpenoid compound prepared from abieslactone, suppressed tumor promoter-induced phenomena in vitro and in vivo; i.e., AVB-I acid methyl ester inhibited 12-o-tetradecanoylphorbol-13-acetate (TPA)-stimulated 32Pi-incorporation into phospholipids of cultured cells and the promoting action of TPA on skin tumor formation in mice initiated with 7,12-dimethylbenz[a]anthracene.