In situ XAFS experiments using a microfluidic cell: application to initial growth of CdSe nanocrystals.

The design and performance of a compact fluorescense XAFS apparatus equipped with a microfluidic cell for in situ studies of nanoparticles are described. CdSe nanoparticles were prepared by solution reaction starting from trioctylphosphine-Se. Time-resolved experiments were performed by precisely controlling the reactor coordinates (x,y), allowing the synchrotron X-ray beam to travel along a reactor channel, covering nucleation and initial growth of nanoparticles. Detailed analysis of EXAFS data combined with UV-vis spectra allow reliable estimation of particle size and density in the initial growth that cannot be accessible by conventional optical techniques based on a long-range order. The Se K-XANES spectra are interpreted by multi-scattering calculations providing bond formation kinetics consistent with the EXAFS data.

X-ray Detection of the Period-Four Cycling of the Manganese Cluster in Photosynthetic Water Oxidizing Enzyme.

X-ray absorption near-edge structure spectra of the manganese (Mn) cluster in physiologically native intermediate states of photosynthetic water oxidation induced by short laser flash were measured with a compact heat-insulated chamber equipped with an x-ray detector near the sample surface. The half-height energy of the Mn Kedge showed a period-four oscillation dependent on cycling of the Joliot-Kok's oxygen clock. The flash number-dependent shift in the Mn K-edge suggests that the Mn cluster is oxidized by one electron upon the S(0)-to-S(1), S(1)-to-S(2), and S(2)-to-S(3) transitions and then reduced upon the S(3)-to-S(0) transition that releases molecular oxygen.

Prognostic significance of polysialic acid expression in resected non-small cell lung cancer.

Polysialic acid (PSA) is a carbohydrate attached mainly to the neural cell adhesion molecule. Because PSA is composed of a linear homopolymer of alpha-2-8-linked sialic acid residues and has a large negative charge, the presence of PSA attenuates the adhesive property of neural cell adhesion molecule and increases cellular motility. In an earlier study, we demonstrated that PSA and STX, a polysialyltransferase, were associated with tumor progression in non-small cell lung cancer (NSCLC) (F. Tanaka et al., Cancer Res., 60: 3072-3080, 2000). Therefore, in the present study, to assess the prognostic significance of PSA in resected NSCLC, a total of 236 patients who underwent complete resection for pathological (p)-stage I-IIIa disease were reviewed retrospectively. PSA was expressed in 44 of 236 (18.6%) patients, and the expression was correlated with p-stage disease. For all p-stage patients, 5-year survival rates for those with PSA-positive and PSA-negative tumors were 52.1% and 71.3%, respectively, demonstrating a significantly worse prognosis for the PSA-positive patients (P = 0.012). Analysis for only p-stage I patients also demonstrated a significantly worse prognosis for the PSA-positive patients; 5-year survival rates of the PSA-positive and the PSA-negative patients were 45.1% and 83.5%, respectively, (P < 0.001). In addition, there proved to be no difference in the postoperative survival among p-stage I, II, and IIIa patients when PSA expression was positive. Multivariate analysis confirmed that PSA expression was an independent factor to predict poor prognosis in resected NSCLC. These results suggested that PSA could be an important clinical marker and that preoperative induction and/or postoperative adjuvant therapies should be performed for PSA-positive NSCLC, even if the disease is classified as p-stage I.

Structural and electronic characterization of heme moiety in oxygenated hemoproteins by using XANES spectroscopy.

Iron K-edge X-ray absorption near edge structure (XANES) spectra were measured for oxy-forms of cytochrome P-450cam (P-450cam), horseradish peroxidase (HRP) and myoglobin (Mb) by using Synchrotoron Radiation of Photon Factory (Tsukuba). A pronounced 1s-4p transition and some fine structures were well-resolved in the spectra obtained. Comparing the spectra, the features at the fine structures termed P, C and D, were similar among the three hemoproteins, suggesting a similar site-symmetry around the heme iron and the same Fe-O-O bond angle (about 115 degrees). On the other hand, absorption features at the edge region (7115-7135 eV) were slightly but significantly different from one another; the absorption intensity at 7115-7125 eV region increased in the order of Mb, HRP and P-450cam, while that at 7125-7135 eV decreased in the same order. A similar absorption feature was also obtained with their deoxy (ferrous high spin) forms. We assumed that the absorption at the lower energy region (7115-7125 eV) reflects the pi-character in the Fe-ligand bond, whereas that at the higher energy region (7125-7135 eV) does the sigma-character, on the basis of the previous and comprehensive studies of the XANES spectroscopy of the adsorbed molecules on the metal surface (McGovern et al. (1989) Handbook on Synchrotoron Radiation, Vol. 2, pp. 467-539). According to our assumption, our XANES results indicated that the pi-character of the Fe-ligand bond increases in the order of Mb, HRP and P-450cam, and that the pi-electron of the thiolate S- in P-450cam is donated to the Fe-O-O moiety, most probably to the antibonding pi* orbital of O2. Such an interpretation is consistent with the experimental findings or data accumulated so far by other methods, such as the resonance Raman spectroscopy.

Evidence against the importance in the disease process of antibodies to bovine thyroid-stimulating hormone found in some patients with Graves' disease.

The antibody to TSH (TSH-Ab) found in some patients with Graves' disease may be either an antiidiotype (anti-id-Ab) to the TSH receptor antibody (TRAb) or the antigen (idiotype) for which the anti-id-Ab is in fact TRAb. Four groups have found antibodies to bovine TSH (bTSH-Ab) in Graves' disease patients in a TSH binding-inhibiting immunoglobulin (TBII) RRA that uses [125I]bTSH. In this assay serum samples containing bTSH-Ab give highly negative TBII values. The purpose of this study was to look for any clinical significance of potential idiotypic-antiidiotypic network regulation related to bTSH-Ab. Twenty-one (0.49%) of 4285 Graves' disease patients had TBII values less than the mean -4 SD of normal subjects. In all 21, bTSH-Ab was found by incubation of [125I]bTSH with the patient's serum, and significant inhibition of binding of bTSH-Ab to bTSH by human TSH was found in only 3 of these serum samples. We investigated next whether the binding site of the anti-TSH-Ab mimicked the TSH receptor-binding site. Binding of [125I]bTSH to bTSH-Ab-positive serum was not inhibited by bTSH-Ab-negative, thyroid-stimulating immunoglobulin-positive [(+)], and/or TBII(+) immunoglobulin G. In one patient with human TSH-Ab, TSH-Ab appeared and disappeared, and when TSH-Ab was negative, TBII was positive. Inhibition of [125I]bTSH binding to TSH-Ab by the same patient's serum when that patient was serum thyroid-stimulating immunoglobulin(+), TBII(+), and TSH-Ab-negative was sought but not found. Changes in serum TSH-Ab activity and disease activity were not correlated in this patient. In six untreated patients with Graves' hyperthyroidism with bTSH-Ab, the serum T3 and T4 concentrations and the time required to become euthyroid during antithyroid drug treatment were not significantly different from those in 52 such patients without bTSH-Ab. These data suggest that bTSH-Ab is not an anti-id-Ab to TRAb and that TSH-Ab does not directly modulate the activity of Graves' disease.

Flash induced XANES spectroscopy for the Ca-depleted Mn-cluster in the photosynthetic O2-evolving enzyme.

Flash-induced changes of the Mn K-edge absorption spectra have been studied in the oxygen-evolving complex depleted of Ca. The Mn K-edge energy for the Ca-depleted S1-state was lower by 1.5 eV than that for the normal S1-state. The K-edge energy upshifted by 1 eV after one flash, indicative of an oxidation of Mn. After two flashes, the K-edge was elevated as well by 0.4 eV, and then reached a steady-state high level after continuous illumination where the K-edge energy was higher by 0.9 eV than that after one flash. The results indicate that the Mn-cluster and/or its direct ligand could be oxidized up to two electrons but further events are blocked.

Mn K-edge XANES spectroscopy of a photosynthetic O2-evolving complex. High-quality pre-edge features and distinct fine structures in the S1- and S2-states.

High-resolution XANES (X-ray Absorption Near Edge Structure) spectroscopy for Mn in the S1 and S2 states of the spinach photosynthetic O2-evolving complex revealed distinct features in K-edge spectra, when a high signal-to-noise (S/N) ratio of ca. 80 with a low and constant background-to-signal (B/S) ratio of 0.15 to 0.18 was attained. Six features resolved in each S-state spectrum involve a pre-edge feature due to 1s----3d transitions, a main-edge feature possibly due to 1s----4s transitions and four fine structures superimposed on the principal absorption bands due to 1s----4p* transitions. The high-quality pre-edge features were analyzed according to a parametric ligand-field theory in comparison with those of some typical authentic Mn complexes. It was deduced that i) all of the four Mn ions in the S1-state are octahedrally coordinated and two of them constitute a di-mu-oxo bridged Mn(III, III) dimeric subunit; ii) the bridged Mn(III) ions are further bridged by a deprotonated water dimer, (HOHOH)-, and coordinated by imidazole-N and carboxylate-O- on the opposite side of the Mn atom from the di-mu-oxo bridge; iii) the other two Mn ions exist in the form of Mn(III) monomeric subunits; and iv) upon the S1----S2 transition, only the bridged Mn(III,III) is oxidized to Mn(III,IV). The distinct change in the principal absorption band shape upon the S1----S2 transition is briefly discussed to obtain the XANES evidence for a tetrameric Mn-cluster.

Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis.

OBJECTIVE: To evaluate the effect of enteral nutrition (EN) in attenuating bacterial and/or endotoxin translocation, maintaining immune responsiveness, and improving outcome in early acute pancreatitis (AP) in Wistar male rats. DESIGN: Acute pancreatitis was induced in rats receiving total parenteral nutrition (TPN) (AP/TPN group) (n=34) and EN (AP/EN group) (n=35) by pressure injection of 1% deoxycholate into the biliopancreatic duct (0.6 mg/kg of body weight). Rats in the sham/TPN and sham/EN groups (n=10 each) underwent laparotomy without induction of AP. Catheters for TPN and EN were placed into the external jugular vein and jejunum, respectively. Rats were infused with Ringer lactate solution for 48 hours followed by TPN in the AP/TPN and sham/TPN groups, and EN in the AP/EN and sham/EN groups until day 7. The fluid volume and energy (calories) intake were similar in all groups. SETTING: Medical school research laboratory. MAIN OUTCOME MEASURES: Survival, blood endotoxin level, villus height, 5-bromo-2'-deoxyuridine (BrdU) uptake in the jejunum and ileum, bacterial culture of mesenteric lymph nodes, and CD4/CD8 ratio of T cells in mesenteric lymph nodes, spleen, and peripheral blood. RESULTS: There was no difference in survival and pancreatic healing between the AP/TPN and AP/EN groups. Colony-forming units of the mesenteric lymph nodes and the endotoxin level were significantly lower in the AP/EN group than in the AP/TPN group (P<.05). Villus height and BrdU intake was significantly higher in the AP/EN group than in the AP/TPN group (P<.05). The CD4/CD8 ratio of T cells in spleen and peripheral blood was higher in the AP/EN group than in the AP/TPN group (P<.05), whereas there was no difference in mesenteric lymph nodes. CONCLUSIONS: Jejunal administration of EN is well tolerated in early AP, maintains immune responsiveness and gut integrity, and reduces bacterial and/or endotoxin translocation. However, compared with TPN, EN does not improve outcome. These results suggest that factors other than bacterial and/or endotoxin translocation may be responsible for mortality in this rat model of early AP. However, additional studies of both early bacterial and/or endotoxin translocation and late assessment of outcome are indicated.

Hypertrophic cardiomyopathy and thyroid diseases.

The incidence ratio of thyrotoxicosis among 14 patients with thyroid diseases associated with hypertrophic cardiomyopathy was compared with that in 7686 patients with thyroid diseases, to find the possible correlation between thyrotoxicosis and hypertrophic cardiomyopathy. Thyrotoxicosis did not predominate over other thyroid diseases in the 14 patients with hypertrophic cardiomyopathy. Thus, the occurrence of hypertrophic cardiomyopathy does not appear to be associated with thyrotoxicosis.

High maintenance rate of sinus rhythm after cardioversion in post-thyrotoxic chronic atrial fibrillation.

We performed rhythm conversion on 33 euthyroid patients with post-thyrotoxic atrial fibrillation who do not revert spontaneously to sinus rhythm from atrial fibrillation. The duration of atrial fibrillation ranged from 9 to 59 months (mean 25 +/- 14). The protocol of rhythm conversion was to first attempt pharmacological conversion with disopyramide and then to perform electrical cardioversion on the non-converters. Of 33 patients, 25 were converted to sinus rhythm (6 by disopyramide and 19 by electrical cardioversion), resulting in 8 non-converters. However, it was later discovered that cardioversion had been applied to 4 of the 8 non-converters when these patients had had a recurrence of thyrotoxicosis. These 4 patients were subjected to a second electrical cardioversion after attaining the euthyroid state. Sinus rhythm was restored in all 4 patients, giving a cardioversion rate of 88%. The sinus rhythm was maintained in 25 of the total 29 converters (86%) at the time of follow-up (10-68 months, mean 35 +/- 19 months). Our studies suggest that cardioversion should be encouraged for thyrotoxic atrial fibrillation, even if the duration of atrial fibrillation is long-standing, since there is excellent maintenance of sinus rhythm and even delayed application of cardioversion may improve its success rate.

Intratumoral necrosis of lung carcinoma: a potential diagnostic pitfall in incremental dynamic computed tomography analysis of solitary pulmonary nodules?

The authors determined the pattern and enhancement range of necrotic lung carcinoma using incremental dynamic computed tomography (CT). Thirty-seven pathologically proven lung cancers (range, 8-57 mm in diameter) were evaluated using incremental dynamic CT. Scans were obtained before and 30 seconds, 2 minutes, and 5 minutes after the onset of contrast material injection. Computed tomography numbers in circular regions of interest (60% of tumor diameter) were calculated, and the difference in CT number between nonenhanced and the scan showing maximum attenuation was determined. In cavitary necrotic carcinomas, regions of interest were established excluding areas of cavitation. Nine (24%) of 37 lung carcinomas had intratumoral necrosis; four (11%) had noncavitary necrosis, and five (14%) had cavitary necrosis. Maximum attenuation of four noncavitary necrotic carcinomas (mean 31 +/- standard deviation 25 HU; range, -3-56 HU) was lower than cavitary necrotic carcinomas (42 +/- 8 HU; range, 35-51 HU; p = 0.36) and non-necrotic carcinomas (48 +/- 17 HU; range, 25-91 HU; p = 0.07). All carcinomas showed maximum attenuation > or = 25 HU except for one noncavitary necrotic carcinoma (maximum attenuation = -3 HU; 36 mm in diameter). Noncavitary necrosis was recognized as low attenuation on noncontrast scan in two of four cases and as an unenhanced area on enhanced scan in four of four cases. Although noncavitary necrotic lung carcinoma may rarely show maximum attenuation < or = 15 HU, necrotic material is recognized as unenhanced area on enhanced scan.

Surgical intervention for emphysematous pulmonary regions in a postoperative infant with congenital diaphragmatic hernia.

A postoperative infant with congenital diaphragmatic hernia (CDH) developed extrinsic obstruction of the trachea by the innominate artery that ensued from unequal expansion of the lungs followed by left mediastinal shift. Septation of the anterior mediastinum prevented unequal expansion of the lungs, and elongation of the innominate artery improved proximal airway obstruction. Prolonged artificial ventilation, however, resulted in the emphysematous bullae in the left lung. Lung volume reduction surgery (LVRS), at 3 years of age, ameliorated the respiratory distress and resulted in good weight gain. Surgical intervention, including LVRS, should be considered to improve respiratory disturbance caused by difference in compliance of the lungs in children.

Total parenteral nutrition-associated intrahepatic cholestasis in infants: 25 years' experience.

BACKGROUND/PURPOSE: There are few long-term chronological reviews examining the incidence of total parenteral nutrition (TPN)-associated intrahepatic cholestasis (TPNAC) in infants. The authors therefore reviewed TPNAC in their 25-year series, and also looked at the current problems associated with TPN in infants. METHODS: Two hundred seventy-three surgical neonates who received TPN for more than 2 weeks were divided into 3 groups chronologically: group A (1971 through 1982, n = 77), group B (1983 through 1987, n = 72), and group C (1992 through 1996, n = 124). TPNAC was defined as serum direct bilirubin (DB) level greater than 2.0 mg/dL during the neonatal period. RESULTS: The incidence of TPNAC in groups A, B and C was 57%, 31%, and 25% (P< .01), respectively, and the mortality rate from TPN-associated complications was 13%, 3%, and 3% (P< .05), respectively. Over the last 5 years, severe TPNAC developed in 20 patients (16%). Four of 20 died of TPN-associated sepsis with hepatic failure; 2 had hypoganglionosis with intractable stagnant enteritis and subsequent sepsis, and 2 had fatal respiratory or cardiac disease. CONCLUSIONS: The incidence of TPNAC in surgical neonates and TPN-associated mortality rates have decreased significantly. The mortality rate, however, still remains at 3%. Two of 4 fatal cases had hypoganglionosis, which were totally dependent on TPN. In patients who require long-term TPN, TPN still has unsolved problems, and small bowel transplantation may be indicated.

Two cases of persistent hyperinsulinemic hypoglycemia that showed spontaneous regression and maturation of the Langerhans islets.

Near-total pancreatectomy has been recommended as the treatment for persistent hyperinsulinemic hypoglycemia (PHH) in infants. However, recently there has been a report described that one third of 95% pancreatectomy failed to prevent hypoglycemia and more than two thirds had diabetes ultimately. The authors experienced 2 cases of PHH, which raise a query about the extensive pancreatectomy. Case 1: A female patient who manifested PHH shortly after birth underwent less extensive pancreatectomy twice at age 2 months and 8 years. After each operation, her clinical symptoms regressed, and she became free from the disease eventually. Histologic findings showed nesidioblastosis in which the islets clearly matured. Case 2: A male infant with PHH had an absolute indication for pancreatectomy. However, after a meticulous control of the blood glucose level with parenteral nutrition followed by continuous enteral nutrition feeding combined with medication, he became free from the disease. The current cases show there exist cases of PHH in which the islets mature and symptoms regress spontaneously. Therefore, we conclude near-total pancreatectomy is not always the treatment of choice. As an alternate strategy, long-term controlled feeding and medication combined with or without less extensive pancreatectomy should be considered with the expectation of spontaneous regression.

Clinicopathologic relationship of hypoganglionosis.

BACKGROUND/PURPOSE: Congenital motor dysfunction of the intestine associated with a morphologically abnormal myenteric nervous plexus (MP) is known as Hirschsprung's disease allied disorder (HAD). However, the clinicopathologic features of HAD are not well understood, partially because a standardized method of histologic evaluation of MP has not been established. To elucidate the clinicopathologic relationship of HAD the authors reviewed 6 cases of HAD using a newly devised histologic evaluation method. METHODS: Flat-mounted frozen sections of the ileum were stained for S-100 protein by fluorescent immunohistochemistry. Quantitative evaluation of MP was performed by measuring the fluorescence-positive area (MP ratio), and the results were compared with those of age-matched normal controls. RESULTS: All of 6 patients required laparotomy within 1 month after birth and enterostomy between 23 days and 10 months. Three died of intractable enteritis by the age of 2.2 years and were totally dependent on parenteral nutrition (PN) throughout their lives. The other 3 have survived for 6 to 10 years but have required PN occasionally. MP ratio in controls was more than 0.34 at all ages, whereas that in HAD was significantly lower than that in controls according to the clinical severity. CONCLUSION: MP size measured on 2-dimensional demonstration is suggested to be an indicator of clinical severity of HAD. J Pediatr Surg 36:898-900.

Takayasu's disease associated with ulcerative colitis.

A 14-year-old female with ulcerative colitis developed right anterior cervical pain and high fever. Cervical contrast-enhanced computed tomography (CE-CT) showed a wall thickness of the right common carotid artery which suggested aortitis. Her pulmonary angiography demonstrated a narrowing of the pulmonary arteries and she was diagnosed as having Takayasu's disease associated with ulcerative colitis. HLA analysis showed Bw52 and DR2 haplotype, which is frequently found in patients with Takayasu's disease associated with ulcerative colitis.

Ulcerative colitis associated with Takayasu's disease.

A 25-year-old Japanese woman had both ulcerative colitis and Takayasu's disease and was positive for HLA-A24, BW52, and DR2. She was found to have thickening of the wall of the carotid artery on contrast-enhanced computerized tomography of the neck and chest. Prednisolone, beraprost, and sulfapyridine achieved rapid remission of both diseases.

Laparoscopic ovarian cystectomy using a single umbilical puncture method.

To establish a minimally invasive technique to perform ovarian cystectomy, the authors applied a single umbilical puncture method. A 2-month old female infant was admitted to the hospital because of an ovarian cyst that showed no spontaneous shrinkage after her birth. An umbilical semicircular incision was made to insert a 10-mm trocar, into which a 3-mm laparoscope was inserted. The ovarian cyst was grasped using forceps inserted through an operating channel of the scope, and the cyst was removed through the incision. After aspiration of the cyst, the free cyst wall was resected, leaving the intact ovarian tissue. The operation was performed without difficulty or complication. The postoperative course was uneventful. The wound was inconspicuous, and the result was cosmetically excellent. The case demonstrated the feasibility of the minimally invasive technique using a single umbilical puncture for ovarian cystectomy in an infant.

[The long-term results of isolated aortic valve replacement with 19 mm prostheses].

Twenty-five patients underwent isolated aortic valve replacement with 19 mm valves (8 cases with St. Jude Medical prostheses, 7 cases with Carpentier Edwards Pericardial prostheses and 10 cases with Björk-Shiley prostheses). Postoperative echocardiography revealed data as follows. Peak pressure gradients (mmHg) were 40.4 +/- 14.4 (mean +/- S.D.) in the SJM group, 23.4 +/- 9.8 in the CEP group and 50.5 +/- 16.7 in the BS group. End-diastolic left ventricular dimension in the BS group and interventricular septum thickness in the CEP group was reduced significantly. All but one case were in NYHA functional class I or II, and clinical improvement was almost satisfactory in all groups. However, in the BS group, 4 cases showed peak pressure gradients more than 50 mmHg. We conclude that 19 mm aortic prostheses in this study can provide satisfactory results. However, as for mechanical valve, it may be undesirable to choose BS prosthesis.

[Clinical significance and problems in parenteral nutritional care].

The clinical indications for and types of intravenous nutritional support are reviewed from the standpoint of their advantages and disadvantages. Total parenteral nutrition (TPN, also known as intravenous hyperalimentation) improves and maintains not only nutritional status but immunocompetence in patients with restricted food intake, because almost all essential nutritional substrates can be administered in the parenteral root alone to meet energy requirements. In surgical fields, TPN reduces perioperative risk and complication rates and enhances postoperative recovery of patients with severe stress such as those under going thoracic esophagectomy or pancreatoduodenectomy. In addition to calory administration, another type of parenteral nutrition a the disease-specific formulation has been attempted to improve directly such pathophysiologic conditions as renal failure, hepatic failure, or sever acute pancreatitis. Despite the great benefits of TPN, it is associated with several complications related to the indwelling catheter or to inadequate substrates administered, Disuse atrophy of the intestinal mucosa in patients receiving TPN to decreases the host defense against bacterial infection. To avoid the abuse of TPN, the indications for it should be selected rigorously. Moderate calory administration of a maximum of 15-20 cal/kg/day via a peripherally inserted catheter has been reevaluated in patients on short-term fasts.