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Introduction: During the application of non-invasive positive pressure ventilation (NPPV) therapy in home mechanical ventilation (HMV), leaks in the NPPV mask may occur owing to the position of the mask due to conditions such as skin disorders. Methods: To investigate whether such a leak affects FiO2 supplied to the alveoli, we simulated a patient with chronic obstructive pulmonary disorder during NPPV in HMV. In addition, FiO2 was measured in the portion assumed to be the mouth and lungs while setting the flow of the oxygen concentrator and leak amount based on a previous study. Results: FiO2 supplied to the lungs increased statistically significantly upon increasing the amount of leak (P < 0.001). Moreover, values measured for the mouth were similar. However, our results were different from those of a previous study. Conclusions: We observed that FiO2 supplied to alveoli can be reduced by a leak in the NPPV mask. Because our results differ from those previously reported, we believe that further studies should reassess the selection of respirators and oxygen concentrators.

Intratracheal aspiration in a patient on ventilation is generally performed using a catheter. Of late, closed suction systems have been used more frequently than open systems. To remove tracheal secretions through the intratracheal tube, catheter suction is used, and the suction catheter may be of the closed- or open-type. The catheters are cleaned by flushing with sterile 0.9% saline, resulting in dropping of dew. This phenomenon is caused by some factors: influence of flow, clogging of the suction tube, problem of manipulation of flushing and angle between the intubation tube and the connection port. But this dropping has not yet been investigated. In this study, we focused at this angle and we used the test lung which is simulated machine on behalf of patient. We consider two situations adult and child, also two types of catheters Eco-Cath and Ty-care. In child case we consider elbow-type suction catheters and Y-connector type. The angle was set at 0°, 20°, 40°, 60°, and 90°, and we observed the difference between Eco-Cath and Ty-care. In adults difference is significant (p 0.001), In 90° between Tracheal intubation and Tracheotomy (p ≈ 0.26). In child difference is significant (p 0.001), In 90° between Tracheal intubation and Tracheotomy (p ≈ 0.15). In child case we observed dependency of angle on various conditions too. The relation of the angle and dew was clarified.

Background & Aims The transient receptor potential ankyrin 1 (TRPA1) channel is highly expressed in the intestinal lamina propria, but its contribution to gut physiology/pathophysiology is unclear. Here, we evaluated the function of myofibroblast TRPA1 channels in intestinal remodeling. Methods An intestinal myofibroblast cell line (InMyoFibs) was stimulated by transforming growth factor-β1 to induce in vitro fibrosis. Trpa1 knockout mice were generated using the Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 (Cas9) system. A murine chronic colitis model was established by weekly intrarectal trinitrobenzene sulfonic acid (TNBS) administration. Samples from the intestines of Crohn’s disease (CD) patients were used for pathologic staining and quantitative analyses. Results In InMyoFibs, TRPA1 showed the highest expression among TRP family members. In TNBS chronic colitis model mice, the extents of inflammation and fibrotic changes were more prominent in TRPA1-/- knockout than in wild-type mice. One-week enema administration of prednisolone suppressed fibrotic lesions in wild-type mice, but not in TRPA1 knockout mice. Steroids and pirfenidone induced Ca2+ influx in InMyoFibs, which was antagonized by the selective TRPA1 channel blocker HC-030031. Steroids and pirfenidone counteracted transforming growth factor-β1–induced expression of heat shock protein 47, type 1 collagen, and α-smooth muscle actin, and reduced Smad-2 phosphorylation and myocardin expression in InMyoFibs. In stenotic intestinal regions of CD patients, TRPA1 expression was increased significantly. TRPA1/heat shock protein 47 double-positive cells accumulated in the stenotic intestinal regions of both CD patients and TNBS-treated mice. Conclusions TRPA1, in addition to its anti-inflammatory actions, may protect against intestinal fibrosis, thus being a novel therapeutic target for highly incurable inflammatory/fibrotic disorders., Graphical abstract

Intestinal fibrosis is an intractable complication of Crohn's disease (CD), and, when occurring excessively, causes severe intestinal obstruction that often necessitates surgical resection. The fibrosis is characterized by an imbalance in the turnover of extracellular matrix (ECM) components, where intestinal fibroblasts/myofibroblasts play active roles in ECM production, fibrogenesis and tissue remodeling, which eventually leads to the formation of stenotic lesions. There is however a great paucity of knowledge about how intestinal fibrosis initiates and progresses, which hampers the development of effective pharmacotherapies against CD. Recently, we explored the potential implications of transient receptor potential (TRP) channels in the pathogenesis of intestinal fibrosis, since they are known to act as cellular stress sensors/transducers affecting intracellular Ca2+ homeostasis/dynamics, and are involved in a broad spectrum of cell pathophysiology including inflammation and tissue remodeling. In this review, we will place a particular emphasis on the intestinal fibroblast/myofibroblast TRPC6 channel to discuss its modulatory effects on fibrotic responses and therapeutic potential for anti-fibrotic treatment against CD-related stenosis.

We report here a 70 year-old male on maintenance hemodialysis who presented non-paralytic pontine exotropia. Brain MRI showed new right pons infarct. Transthoracic and transesophageal echocardiography revealed a mobile calcification at posterior mitral leaflet with rapid growing compared to 14 days ago. Neurological symptoms disappeared at least 10 days by a treatment with aspirin. Calcification reduced by a follow-up transthoracic echocardiography after 90 days from the beginning of neurological symptoms. We diagonosed him with cerebral infarction during the course of mobile mitral annular calcification-related calcified amorphous tumor. Mobile mitral annular calcification-related calcified amorphous tumor would be a cause of cerebral infarction, we need to be careful to check a transthoracic echocardiography regularly because of necessity.

Background Although obesity-related type 2 diabetes mellitus (T2DM) and sarcopenia in the elderly have been increasing worldwide, the associations among visceral fat accumulation, skeletal muscle indices (mass, strength, and quality) and cardiovascular diseases in T2DM remain poorly investigated. Methods We enrolled 183 Japanese T2DM inpatients (126 men, 57 women; mean age 64.7 ± 12.6 years, ± SD). The estimated-visceral fat area (eVFA) and skeletal muscle mass were measured by each device using bioelectrical impedance analysis method. We also measured grip strength by dynamometer and motor nerve conduction velocity (MCV). We analyzed the difference in skeletal muscle indices between T2DM patients with and without visceral fat accumulation, and examined the impact of skeletal muscle indices on cardiovascular diseases in patients with visceral fat accumulation. Results The prevalence of sarcopenia defined by the Consensus of Asian Working Group for Sarcopenia and low skeletal muscle mass were both lower in the visceral fat accumulation (+) group than in (−) group. However, the prevalence of weak hand grip strength was similar in the visceral fat accumulation (−) and (+) groups, indicating that considerable patients with visceral fat accumulation had weak grip strength in spite of fair skeletal muscle mass. Muscle quality [grip strength (kg)/arm muscle mass (kg)] was significantly lower in patients with visceral fat accumulation. Multiple regression analysis identified eVFA, MCV and sex as significant and independent determinants of muscle quality. In visceral fat accumulation (+) group, the patients with low muscle quality had longer duration of diabetes, lower eGFR, higher serum adiponectin, lower MCV and higher prevalence of cardiovascular diseases, compared to the patients with high muscle quality. Finally, sex- and age-adjusted models showed significant association between low muscle quality and cardiovascular diseases in all subjects (odds ratio 2.28, p = 0.012), especially in patients with visceral fat accumulation (odds ratio 2.72, p = 0.018). Conclusions T2DM patients with visceral fat accumulation had low muscle quality, and patients with low muscle quality were more affected with cardiovascular diseases. Electronic supplementary material The online version of this article (10.1186/s12933-018-0755-3) contains supplementary material, which is available to authorized users.

活性型ビタミンD静注製剤である, マキサカルシトールとカルシトリオールの透析患者の二次性副甲状腺機能亢進症に対する効果を比較検討した. また, 新たに開発された1-84副甲状腺ホルモン (PTH) のみを測定するwhole PTHの測定を行い, whole PTHおよびC端の不活性フラグメント7-84 PTHへの効果についても比較検討した. 対象は年齢, 透析歴, PTHをマッチングさせた, 各群10例の二次性副甲状腺機能亢進症を有する透析患者である. PTHの値に応じて, マキサカルシトール5あるいは10μgを週3回各透析後に (マキサカルシトール群), また, カルシトリオールを0.5あるいは1.0μgを週3回 (カルシトリオール群) より開始し, intact PTH, whole PTH, 7-84 PTH, 骨型アルカリフォスファターゼ (BAP), インタクトオステオカルシン (iOC), I型プロコラーゲンNプロペプチド (PINP), 補正カルシウム (Ca), リン (P) に及ぼす影響について, 24週間にわたり前向きに比較検討した.両群ともに, 4週後にwhole PTHの有意な低下が認められた. カルシトリオール群では, 8週-12週においてPTHの低下が少ない傾向であったが, 薬剤の増量により, 16週以後, マキサカルシトール群と同様に低下した. Intact PTH, 7-84 PTHは, whole PTHと同様の経過を示した. BAP, iOC, PINPも同様の傾向を示したが, カルシトリオール群では有意な低下ではなかった. また, 補正Caは両群ともに増加, Pは変動が大きいが有意な変化を認めなかった. これらの検査値は24週後において, 両群間に有意な差を認めなかった. 薬剤の投与量を調節した結果, 24週後の投与量の比は約7:1であった. 以上より, マキサカルシトールとカルシトリオールは投与量を調節すれば, ほぼ同等の二次性副甲状腺機能亢進症に対する効果が得られ, その効力比はマキサカルシトールを1とするとカルシトリオールで約7に相当すると考えられた.

血液透析患者130名 (男:女=79:51, 年齢59.8±13.3歳, 透析期間9.6±7.6年, 糖尿病31例) の心機能を心エコー図を用いて検討し, 左心機能障害の頻度とそれに寄与する因子を解析した. 左室肥大は102例 (78%) にみられ, 収縮期高血圧が独立した危険因子であった. 左室腔の拡張は5例 (3.8%) にみられたが, 危険因子は認められなかった. 左室収縮障害は13例 (10%) にみられ, 透析間体重増加, 虚血性心疾患が危険因子であった. 左室拡張障害は48/111例 (43%) にみられ, 高齢が危険因子であった. 血液透析患者では心肥大, 収縮障害, 拡張障害などの左心機能障害が高頻度にみられ, 高血圧, 透析間体重増加, 虚血性心疾患, 高齢などが危険因子となる. したがって, 循環器疾患による死亡率の高い透析患者では, 高血圧治療や食事・水分管理を含めた日常生活の指導が極めて重要である.

近年腎性骨異栄養症のなかで低回転骨症の頻度が増加しており, その成因として副甲状腺機能低下症が注目されている. しかし, 透析患者の副甲状腺機能低下症の原因や臨床的意義については不明の点が少なくない. 今回, 我々は当施設における血液透析患者の副甲状腺機能低下症例の臨床的特徴について横断的および縦断的に検討した. 対象は, 当院に通院透析中の副甲状腺摘除術を受けていない, 安定した外来血液透析患者80例で, アレグロインタクトPTH (i-PTH) により, 50pg/ml未満のlow PTH群 (34例), 50pg/ml以上150pg/ml未満のmedium PTH群 (23例), 150pg/ml以上のhigh PTH群 (23例) に分類した. 3群間に年齢, 性比に有意差を認めなかったが, 透析歴はlow PTH群でhigh PTH群より有意に短かった (p

Mortality rates associated with cardiovascular disease (CVD) are high in long-term dialysis patients. Increased levels of plasma fibrinogen (FBG), coagulation factor VII (FVII), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) as well as hyperlipidemia are regarded as important risk factors for CVD. To investigate whether there are differences in the risk of CVD between chronic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, serum lipid levels and plasma FBG, FVII, t-PA, and PAI-1 levels were measured in 17 patients on HD and 17 patients on CAPD. FBG was measured by the thrombin time method, FVII activity (FVIIc) by the chromogenic prothrombin time method, and t-PA and PAI-1 activity by the chromogenic substrate assay. No difference was found in body mass index (BMI) between HD and CAPD patients. Total cholesterol (TC), TC/high-density lipoprotein (HDL)-C ratio, low-density lipoprotein (LDL)-C, and triglycerides (TG) were significantly increased, and HDL-C was significantly decreased in CAPD patients compared with HD patients. FBG and FVIIc were significantly elevated in CAPD patients compared with controls or HD patients. T-PA activities were significantly higher in HD and CAPD patients than in controls. CAPD patients showed significantly higher PAI-1 activities than controls or HD patients. Significant positive correlations were found between FBG or FVIIc and TC, between FBG and LDL-C or TG, and between FVIIc and LDL-C in these patients. T-PA showed significant negative correlations with FBG, PAI-1, TC, LDL-C, and TG. There was a significant positive correlation between PAI-1 and TG and a significant negative correlation between PAI-1 and HDL-C. We conclude that CAPD patients may have a greater risk of CVD than do HD patients, and that coagulation and fibrinolytic activity are correlated with lipid disorders in these patients.

Two structurally reinforced chiral 15-membered azamacrocycles (2S, 14S)-2,14-diisobutyl-10-methyl-1,4,7,10,13 -pentaazabicyclo[11.2.2]heptadecane and (2S,14S)-2,14-diisobutyl-7,10-dimethyl-1,4,7,10,13-pentaazabicyclo[11.2.2] heptadecane as a new type of ligand were conveniently synthesized by LiA1H4 reduction from their corresponding macrocyclic pseudopeptides cyclo[(2S,3′S)-2-(3′-isobutyl-2′-oxopiperazine-1′-yl)-4-methyl-pentanoyl-glycyl-glycyl-sarcosyl] and cyclo[(2S, 3′S)-2-(3′-isobutyl-2′-oxopiperazine -1′-yl)-4-methyl-pentanoyl-glycyl-sarcosyl-sarcosyl], respectively. Their copper(II) complexes were also prepared and characterized.

Reactions of [Ni(tren)(H(2)O)(2)]X(2) (tren = tris(2-aminoethyl)amine; X = Cl (1a), Br (1b); X(2) = SO(4) (1c)) with mannose-type aldoses, having a 2,3-cis configuration (D-mannose and L-rhamnose), afforded {bis(N-aldosyl-2-aminoethyl)(2-aminoethyl)amine}nickel(II) complexes, [Ni(N,N'-(aldosyl)(2)-tren)]X(2) (aldosyl = D-mannosyl, X = Cl (2a), Br (2b), X(2) = SO(4) (2c); aldosyl = L-rhamnosyl, X(2) = SO(4) (3c)). The structure of 1c was confirmed by X-ray crystallography to be a mononuclear [Ni(II)N(4)O(2)] complex with the tren acting as a tetradentate ligand (1c.2H(2)O: orthorhombic, Pbca, a = 15.988(2) A, b = 18.826(4) A, c = 10.359(4) A, V = 3118 A(3), Z = 8, R = 0.047, and R(w) = 0.042). Complexes 2a,c and 3c were characterized by X-ray analyses to have a mononuclear octahedral Ni(II) structure ligated by a hexadentate N-glycoside ligand, bis(N-aldosyl-2-aminoethyl)(2-aminoethyl)amine (2a.CH(3)OH: orthorhombic, P2(1)2(1)2(1), a = 16.005(3) A, b = 20.095(4) A, c = 8.361(1) A, V = 2689 A(3), Z = 4, R = 0.040, and R(w) = 0.027. 2c.3CH(3)OH: orthorhombic, P2(1)2(1)2(1), a = 14.93(2) A, b = 21.823(8) A, c = 9.746(2) A, V = 3176 A(3), Z = 4, R = 0.075, and R(w) = 0.080. 3c.3CH(3)OH: orthorhombic, P2(1)2(1)2(1), a = 14.560(4) A, b = 21.694(5) A, c = 9.786(2) A, V = 3091 A(3), Z = 4, R = 0.072, and R(w) = 0.079). The sugar part of the complex involves novel intramolecular sugar-sugar hydrogen bondings around the metal center. The similar reaction with D-glucose, D-glucosamine, and D-galactosamine, having a 2,3-trans configuration, resulted in the formation of a mono(sugar) complex, [Ni(N-(aldosyl)-tren)(H(2)O)(2)]Cl(2) (aldosyl = D-glucosyl (4b), 2-amino-2-deoxy-D-glucosyl (5a), and 2-amino-2-deoxy-D-galactosyl (5b)), instead of a bis(sugar) complex. The hydrogen bondings between the sugar moieties as observed in 2 and 3 should be responsible for the assembly of two sugar molecules on the metal center. Reactions of tris(N-aldosyl-2-aminoethyl)amine with nickel(II) salts gave the tris(sugar) complexes, [Ni(N,N',N"-(aldosyl)(3)-tren)]X(2) (aldosyl = D-mannosyl, X = Cl (6a), Br (6b); L-rhamnosyl, X = Cl (7a), Br (7b); D-glucosyl, X = Cl (9); maltosyl, X = Br (10); and melibiosyl, X = Br (11)), which were assumed to have a shuttle-type C(3) symmetrical structure with Delta helical configuration for D-type aldoses on the basis of circular dichroism and (13)C NMR spectra. When tris(N-rhamnosyl)-tren was reacted with NiSO(4).6H(2)O at low temperature, a labile neutral complex, [Ni(N,N',N"-(L-rhamnosyl)(3)-tren)(SO(4))] (8), was successfully isolated and characterized by X-ray crystallography, in which three sugar moieties are anchored only at the N atom of the C-1 position (8.3CH(3)OH.H(2)O: orthorhombic, P2(1)2(1)2(1), a = 16.035(4) A, b = 16.670(7) A, c = 15.38(1) A, V = 4111 A(3), Z = 4, R = 0.084, and R(w) = 0.068). Complex 8 could be regarded as an intermediate species toward the C(3) symmetrical tris(sugar) complexes 7, and in fact, it was readily transformed to 7b by an action of BaBr(2).

血液透析患者における血清1,25-水酸化ビタミンD (1,25D) 濃度の臨床的意義を明らかにするために, 血清Caおよび橈骨骨塩量との関連を, 活性型ビタミンD3治療をしていない血液透析患者21例と1α水酸化ビタミンD3 (1αD) を投与されている透析患者50例, 計71例で検討した. 血清1,25D濃度と血清Caは正の相関関係を示し, 特に, intact-PTH 100pg/ml未満の群で関連が深い傾向を認めた. 1αDの投与量に変更のあった10例では, 血清1,25D濃度の変化量と血清Caの変化量の間に良好な正相関を認めた. 一方, 血清1,25D濃度とDXA法にて計測した橈骨遠位1/3端の骨塩量との間には関連が認められなかった. intact-PTH 100pg/ml, 血清1,25D 15pg/mlを境とし, その組み合わせで4群に分けて橈骨骨塩量を比較検討すると, PTH, 血清1,25D濃度いずれも低い組み合わせの群で橈骨骨塩量が最も良好に保たれる傾向を認めた. 以上より, 血清1,25D濃度を正常に保つことは, 高Ca血症が必発であり, 実現は非常に困難である. 一方, 血清1,25D濃度と橈骨骨塩量との関連は明らかでなく, 血清1,25D濃度を持続的に高く保つことが, 必ずしも良好な橈骨骨塩量にはつながらないことが示唆された.

血液透析中の白血球減少, 補体活性化, 線溶亢進, 血管内皮刺激が少ないとされるポリエチレングリコール鎖グラフト膜 (PC膜) を用いた血液透析中における白血球接着分子の動態について, 同一仕様の再生セルロース膜 (OC膜) と比較検討した. 対象は安定した血液透析患者8名で, OC膜とPC膜をクロスオーバーで用い, 3種類の白血球接着分子 (LFA-1, Mac-1, p 150, 95) の発現をフローサイトメトリーにて測定し, その透析中の経過を比較検討した. OC膜で, LFA-1は軽度増加, Mac-1は最大で約5倍に達する著明な増加, p 150, 95は最大で約3倍に達する増加を認めた. 一方, PC膜もOC膜と相似の経過を示したが, LFA-1の15分の動脈側, Mac-1の15分, 60分の動脈側, p 150, 95の15分の動・静脈側で, いずれもOC膜より有意な低値を示し, 透析中の白血球接着分子の発現の亢進が少ない傾向であった.以上より, 透析中の白血球接着分子の発現亢進は, PC膜がOC膜に比して少なく, 透析中の白血球減少や血管内皮刺激が少ないことに関与していることが示唆された.

血液透析患者におけるアミロイドーシスの指標としての血清ヒアルロン酸 (HA) 濃度の臨床的意義を明らかにする目的で股関節超音波検査との関連について検討した. 26例の維持血液透析患者について, 血清HA濃度をサンドイッチ法にて測定した. また, 股関節超音波検査によりhead capsular distance (HCD), neck capsular distace (NCD) を測定し, 相互の関連や他の因子との相関について検討した. 血清HAは手根管症候群 (CTS) を有する群で1,458.3±1,724.4 (平均値±SD) ng/ml, CTSのない群で393.8±539.7ng/mlでCTSを有する群でCTSのない群より有意な高値を示した (p

透析患者の予後を考える上で心血管病変の評価は極めて重要である. 心エコー図法で認められる大動脈弁の輝度増強は冠動脈硬化を示唆する所見の一つと考えられている. そこで心エコー図法を用いて, 血液透析 (HD) 患者と持続性自己管理腹膜透析 (CAPD) 患者の大動脈弁輝度増強の頻度を比較し, 動脈硬化促進因子について検討した.対象はHD患者17例 (男性6例, 女性9例, 平均年齢48.1歳, 平均透析期間153.9か月) とCAPD患者16例 (男性10例, 女性6例, 平均年齢40.7歳, 平均透析期間49.5か月) で全員に心エコー図を施行するとともに, 血清カルシウム, リン, 総コレステロール, 中性脂肪, HDLコレステロール, β-リポ蛋白, リポ蛋白 (a) [Lp(a)] を測定した.大動脈弁輝度増強はHD患者58.5%, CAPD患者87.5%に認められ, CAPD患者の方が頻度が高かった (p

A new type of viscometer for measuring human blood viscosity is made by using a vacuum glass tube and a capillary needle. This new viscometer needs a volume of only about 5 × 10–6–8 × 10–6 m3 of blood. Simple handling, quick measurement and accurate results in a wide shear rate range are its superior features. Additionally, the whole measuring set with the viscometer is easy to use and to carry, and it is not expensive.By using various standard-viscosity Newtonian liquids, it is confirmed experimentally that this viscometer is sufficiently accurate in the range of less than about 10–2 Pa·s. The viscosity of fresh human blood collected in a hospital is measured by the new viscometer and it is confirmed that the viscosity value obtained is reasonable by comparing it with that by a traditional measuring method. Further, it is shown that the new viscometer can measure the viscosities of other liquids which have complex properties.

The aim of this study was to assess the effectiveness of an early predischarge exercise therapy, started 2 weeks following acute myocardial infarction (AMI), to working functional capacity. Seventeen AMI patients (10 males, 7 females, mean age 62 +/- 11 years) were examined in this study. Six, serious clinical symptoms and complications, were excluded, while the remaining 11 patients completed, the whole exercise therapy protocol (2 weeks). Patients performed exercise performed for 20-30 min twice daily at a target heart rate (90% level of heart rate at AT) on the basis of anaerobic threshold (AT) determined using treadmill ramp exercise with our protocol. Heart rates (HR) at rest, warming-up and AT point decreased significantly (p less than 0.05) after exercise therapy, although peak HR remained unchanged. O2 pulse at the AT point and endpoint, after exercise therapy, improved significantly (p less than 0.05), when compared to that before therapy. Moreover, AT and peak VO2 improved remarkably (p less than 0.05), as did exercise time to the AT point and endpoint after exercise therapy (p less than 0.05), when compared to that before therapy. These results indicate that the predischarge early exercise therapy begun 2 weeks after AMI will be effective and beneficial in improving working capacity with improvement of physical deconditioning. Additionally, it is necessary that patients with severe clinical symptoms and complications be excluded.

Acute effects of oral isosorbide dinitrate on exercise capacity were evaluated in 14 patients with chronic heart disease measuring the anaerobic threshold and left ventricular function during exercise. A symptom-limited exercise test was performed on a bicycle ergometer with work rates increased by 1W every 6 seconds. Left ventricular function was continuously monitored with a computerized cadmium telluride detector following the intravenous injection of technetium-labeled red blood cells. Thirty minutes after the control exercise test, patients were given isosorbide dinitrate, 5 mg orally. The second exercise test was performed 30 min later. Isosorbide dinitrate improved the anaerobic threshold from 715.4 +/- 172.9 to 774.9 +/- 173.5 ml/min (p less than 0.01) and ejection fraction at peak exercise from 36.7 +/- 11.6 to 39.9 +/- 12.3% (p less than 0.05). However, there was no significant change in maximum work rate or peak oxygen uptake. Those patients for whom isosorbide dinitrate resulted in a 10% or greater improvement in the anaerobic threshold had both higher pre-treatment ejection fractions and greater increases in peak exercise ejection fraction following isosorbide dinitrate. Measurements of the anaerobic threshold and left ventricular function during exercise may be useful in the evaluation of the efficacy of vasodilators in cardiac patients.

Configurational switch around the seven-coordinate manganese(II) center ligated by a cage-type N-glycoside ligand was found to depend on its counter anion by X-ray crystallographic analyses of [Mn(aldose3-tren)]X2 (2: aldose = D-mannose, X = Br; 4: aldose = L-rhamnose X = 1 2 SO 4 ), where aldose3-tren is tris(N-aldosyl-2-aminoethyl)amine.

We have succeeded in the isolation and X-ray crystal structure determination of the octahedral nickel(II) complex [Ni((L-Rha)3-tren)(SO4)]·H2O·3CH3OH (tren = tris(2-aminoethyl)amine; Rha = rhamnose) containing an N-glycoside derived from the reaction of L-Rha and tren. Crystal data: C27H62N4O20SNi, Mi = 853.56, orthorhombic, space group P2 1 2 1 2 1 , a = 16.035(4), b = 16.670(7), c = 15.38(1) A , Z = 4 .

Reactions of MnX2.nH2O with tris(N-(D-mannosyl)-2-aminoethyl)amine ((D-Man)3-tren), which was formed from D-mannose and tris(2-aminoethyl)amine (tren) in situ, afforded colorless crystals of [Mn((D-Man)3-tren)]X2 (3a, X = Cl; 3b, X = Br; 3c, X = NO3; 3d, X = 1/2SO4). The similar reaction of MnSO4.5H2O with tris(N-(L-rhamnosyl)-2-aminoethyl)amine ((L-Rha)3-tren) gave [Mn((L-Rha)3-tren)]SO4 (4d), where L-rhamnose is 6-deoxy-L-mannose. The structures of 3b and 4d were determined by X-ray crystallography to have a seven-coordinate Mn(II) center ligated by the N-glycoside ligand, (aldose)3-tren, with a C3 helical structure. Three D-mannosyl residues of 3b are arranged in a delta(ob3) configuration around the metal, leading to formation of a cage-type sugar domain in which a water molecule is trapped. In 4d, three L-rhamnosyl moieties are in a delta(lel3) configuration to form a facially opened sugar domain on which a sulfate anion is capping through hydrogen bonding. These structures demonstrated that a configurational switch around the seven-coordinate manganese(II) center occurs depending on its counteranion. Reactions of 3a, 3b, and 4d with 0.5 equiv of Mn(II) salt in the presence of triethylamine yielded reddish orange crystals formulated as [[Mn((aldose)3-tren)]2Mn(H2O)X3.nH2O (5a, aldose = D-Man, X = Cl; 5b, aldose = D-Man, X = Br; 6d, aldose = L-Rha, X = 1/2SO4). The analogous trinuclear complexes 6a (aldose = L-Rha, X = Cl), 6b (aldose = L-Rha, X = Br), and 6c (aldose = L-Rha, X = NO3) were prepared by the one-pot reaction of Mn(II) salts with (L-Rha)3-tren without isolation of the intermediate Mn(II) complexes. X-ray crystallographic studies revealed that 5a, 5b, 6c, and 6d have a linearly ordered trimanganese core, Mn(II)Mn(III)Mn(II), bridged by two carbohydrate residues with Mn-Mn separations of 3.845(2)-3.919(4) A and Mn-Mn-Mn angles of 170.7(1)-173.81(7) degrees. The terminal Mn(II) atoms are seven-coordinate with a distorted mono-face-capped octahedral geometry ligated by the (aldose)3-tren ligand through three oxygen atoms of C-2 hydroxyl groups, three N-glycosidic nitrogen atoms, and a tertiary amino group. The central Mn(III) atoms are five-coordinate ligated by four oxygen atoms of carbohydrate residues in the (aldose)3-tren ligands and one water molecule, resulting in a square-pyramidal geometry. In the bridging part, a beta-aldopyranosyl unit with a chair conformation bridges the two Mn(II)Mn(III) ions with the C-2 mu-alkoxo group and with the C-1 N-glycosidic amino and the C-3 alkoxo groups coordinating to each metal center. These structures could be very useful information in relation to xylose isomerases which promote aldose-ketose isomerization by using divalent dimetal centers such as Mn2+, Mg2+, and Co2+.

A 43-year-old female, admitted because of acute infero-posterior myocardial infarction, showed angiographic findings of 100% occlusion of left circumflex artery. Echocardiographic findings showed inferior hypokinesis, while a large left intraatrial tumor was also observed. The coronary angiography on the 17th hospital day showed complete reperfusion of the culprit lesion without stenosis. On the 21st hospital day, the removal operation of the tumor was performed. Pathological findings showed typical cardiac myxoma, and the etiology of the occlusion at the culprit vessel was presumed to be closely related to the existence of the left atrial tumor.

Reactions of [Ni(tren)(H(2)O)(2)]X(2) (tren = tris(2-aminoethyl)amine; X = Cl (1a), Br (1b); X(2) = SO(4) (1c)) with mannose-type aldoses, having a 2,3-cis configuration (D-mannose and L-rhamnose), afforded {bis(N-aldosyl-2-aminoethyl)(2-aminoethyl)amine}nickel(II) complexes, [Ni(N,N'-(aldosyl)(2)-tren)]X(2) (aldosyl = D-mannosyl, X = Cl (2a), Br (2b), X(2) = SO(4) (2c); aldosyl = L-rhamnosyl, X(2) = SO(4) (3c)). The structure of 1c was confirmed by X-ray crystallography to be a mononuclear [Ni(II)N(4)O(2)] complex with the tren acting as a tetradentate ligand (1c.2H(2)O: orthorhombic, Pbca, a = 15.988(2) Å, b = 18.826(4) Å, c = 10.359(4) Å, V = 3118 Å(3), Z = 8, R = 0.047, and R(w) = 0.042). Complexes 2a,c and 3c were characterized by X-ray analyses to have a mononuclear octahedral Ni(II) structure ligated by a hexadentate N-glycoside ligand, bis(N-aldosyl-2-aminoethyl)(2-aminoethyl)amine (2a.CH(3)OH: orthorhombic, P2(1)2(1)2(1), a = 16.005(3) Å, b = 20.095(4) Å, c = 8.361(1) Å, V = 2689 Å(3), Z = 4, R = 0.040, and R(w) = 0.027. 2c.3CH(3)OH: orthorhombic, P2(1)2(1)2(1), a = 14.93(2) Å, b = 21.823(8) Å, c = 9.746(2) Å, V = 3176 Å(3), Z = 4, R = 0.075, and R(w) = 0.080. 3c.3CH(3)OH: orthorhombic, P2(1)2(1)2(1), a = 14.560(4) Å, b = 21.694(5) Å, c = 9.786(2) Å, V = 3091 Å(3), Z = 4, R = 0.072, and R(w) = 0.079). The sugar part of the complex involves novel intramolecular sugar-sugar hydrogen bondings around the metal center. The similar reaction with D-glucose, D-glucosamine, and D-galactosamine, having a 2,3-trans configuration, resulted in the formation of a mono(sugar) complex, [Ni(N-(aldosyl)-tren)(H(2)O)(2)]Cl(2) (aldosyl = D-glucosyl (4b), 2-amino-2-deoxy-D-glucosyl (5a), and 2-amino-2-deoxy-D-galactosyl (5b)), instead of a bis(sugar) complex. The hydrogen bondings between the sugar moieties as observed in 2 and 3 should be responsible for the assembly of two sugar molecules on the metal center. Reactions of tris(N-aldosyl-2-aminoethyl)amine with nickel(II) salts gave the tris(sugar) complexes, [Ni(N,N',N"-(aldosyl)(3)-tren)]X(2) (aldosyl = D-mannosyl, X = Cl (6a), Br (6b); L-rhamnosyl, X = Cl (7a), Br (7b); D-glucosyl, X = Cl (9); maltosyl, X = Br (10); and melibiosyl, X = Br (11)), which were assumed to have a shuttle-type C(3) symmetrical structure with Delta helical configuration for D-type aldoses on the basis of circular dichroism and (13)C NMR spectra. When tris(N-rhamnosyl)-tren was reacted with NiSO(4).6H(2)O at low temperature, a labile neutral complex, [Ni(N,N',N"-(L-rhamnosyl)(3)-tren)(SO(4))] (8), was successfully isolated and characterized by X-ray crystallography, in which three sugar moieties are anchored only at the N atom of the C-1 position (8.3CH(3)OH.H(2)O: orthorhombic, P2(1)2(1)2(1), a = 16.035(4) Å, b = 16.670(7) Å, c = 15.38(1) Å, V = 4111 Å(3), Z = 4, R = 0.084, and R(w) = 0.068). Complex 8 could be regarded as an intermediate species toward the C(3) symmetrical tris(sugar) complexes 7, and in fact, it was readily transformed to 7b by an action of BaBr(2).

A 79-year-old male, admitted because of severe dyspnea on exertion, showed echocardiographic findings of a large tumor in the dilated right ventricle. The right ventricular outflow tract was nearly occluded by the tumor mass, and the mass was attached to the interventricular septum by a pedicle. The tumor removal operation was successful. The size of the tumor was 40 mm x 90 mm, and the weight 70 g. Microscopic findings showed typical myxomatous tissue with high cellularity, and no malignancy was observed. This is the oldest reported patient with right ventricular myxoma which was cured by operation.

To evaluate the efficacy of enoximone on exercise tolerance in patients with mild to moderate heart failure, 33 patients underwent cardiopulmonary exercise tests before and 3 hours after placebo or after receiving 25 or 100 mg of enoximone administered randomly in a double-blind manner. The electrocardiogram was monitored and blood pressure measured every minute throughout cycle ergometer exercise testing with a ramp protocol in which the work rate increased 1 W every 6 seconds after a 4-minute 20-W warm-up. Minute ventilation, oxygen uptake (VO2), and carbon dioxide output were measured every 10 seconds in order to determine anaerobic threshold (AT) and peak VO2. Five patients were excluded from evaluation before breaking the double-blind key because of insufficient data. Heart rate increased and systolic blood pressure decreased throughout the testing only in the group taking 100 mg (n = 10). Significant increases in AT (14.4 to 16.2 ml/min/kg) and peak VO2 (20.8 to 22.9 ml/min/kg) were observed in the group taking 100 mg. The increases in AT showed a dose response, namely +0.7% in the placebo (n = 9), +6.9% in the 25-mg (n = 9) and 12.5% in the 100-mg group. The work rates at the AT point increased in the 25- and 100-mg groups. These results indicate that a single oral administration of enoximone improves exercise tolerance in patients with mild to moderate heart failure.

The purpose of this study was to evaluate the time course of cardiac function during recovery from upright bicycle exercise in patients with coronary artery disease. Twelve patients with coronary artery disease performed a symptom-limited exercise test on a cycle ergometer. Left ventricular function was continuously monitored during exercise and recovery with a computerized cadmium telluride detector following the intravenous injection of technetium-labeled red blood cells. Although the end-diastolic volume (153.4 ± 76.1 ml) and end-systolic volume (100.5 ± 67.3 ml) at the end of exercise were significantly higher than the respective resting values, stroke volume (52.8 ± 16.1 ml) and ejection fraction (38.0 ± 12.2%) were not different from the respective resting values. The recovery of cardiac output was relatively slow compared with that of heart rate, because stroke volume rose sharply early in recovery. The rise in stroke volume was chiefly a result of a significant decrease in end-systolic volume between 1 and 4 minutes of recovery. These changes may result from an immediate afterload reduction coupled with a relatively slow decrease in sympathetic stimulation. The time course of cardiac function during recovery from exercise in cardiac patients is substantially different from that of normal subjects and may be a sensitive way to evaluate the peripheral vascular function and deteriorated cardiac function in cardiac patients.

Reaction of manganese(II) salts (MnX 2 ·nH 2 O, X = Cl, Br, NO 3 ) with tris[(N-aldosyl)aminoethyl]amines L n , prepared by the reaction between tris(aminoethyl)amine (tren) with aldose [D-mannose (D-man) (L 1 )] or L-rhamnose [L-rha = 6-deoxy-L-man) (L 2 )] in situ, affords red–orange crystals formulated as [(MnL n ) 2 Mn(H 2 O)]X 3 (n = 2, X = Cl 1; n = 2, X = Br 2; n = 2, X = NO 3 3; n = 1, X = Cl 4), complexes 3 and 4 are characterized by X-ray crystallography.

Paramecia cells, like human diploid cells cultured in vitro, provide a useful model system for understanding the mechanism that limits division potential. The reported maxima of the clonal lifespan of Paramecium tetraurelia fall into two ranges: from 220 to 258 fissions and from 310 to 325 fissions. We found that neither the selection of vigorous lines nor the cryptic occurrence of autogamy offers a plausible explanation for the much longer lifespans in the latter range. We found the sporadic occurrence of very long clonal lifespans, such as 330 fissions, without selection and autogamy. Selection, which was evaluated by using different methods to maintain lines, had little effect on the extension of the maximal clonal lifespan, whereas it did have a marked effect on the extension of the mean clonal lifespan. Autogamy, which was checked with two closely linked marker genes, was frequent, but only during the period when lines were terminating. Statistical analysis on the mean clonal lifespans of two groups of subclones cultured at 25 and 20 degrees C or with rich and poor nutrition showed that the clonal lifespan that was fission-related under favourable conditions tended to dissociate from fissions under less favourable conditions. We discuss mechanisms that determine the clonal lifespan, programmed events contributing to the maximum clonal lifespan and random events contributing to the mean clonal lifespan.

The effect of mechanochemical treatment on some neodymium phosphates was investigated. It is worth noting that on mechanochemical treatment NdPO4·0.5H2O (hexagonal) is gradually transformed into NdPC4 (monoclinic) at room temperature, while thermal change of NdPO4·0.5H2O to NdPO4 (monoclinic) happens at above 600 °C. Condensed phosphates, meta- and ultraphosphates, easily turned to X-ray amorphous structure by grinding.

The effect of mechanochemical treatment on some neodymium phosphates was investigated. It is worth noting that on mechanochemical treatment NdPO4·0.5H2O (hexagonal) is gradually transformed into NdPC4 (monoclinic) at room temperature, while thermal change of NdPO4·0.5H2O to NdPO4 (monoclinic) happens at above 600 °C. Condensed phosphates, meta- and ultraphosphates, easily turned to X-ray amorphous structure by grinding.