Remimazolam anaphylaxis confirmed by serum tryptase elevation and skin test.

Anaphylactic reactions during the induction of general anaesthesia are rare. Anaesthetists should determine the pathogenesis of anaphylaxis in order to establish appropriate treatment and prevent recurrence. Very little clinical information has been published to date about anaphylaxis induced by the recently launched drug remimazolam. A 78-year-old man, scheduled for elective surgery for colon cancer, became profoundly hypotensive and hypoxic shortly following the induction of general anaesthesia with remimazolam, remifentanil and rocuronium. His physiological derangement was successfully managed with adrenaline, vasopressors and intravenous fluid resuscitation. His serum tryptase level was significantly elevated and an intradermal test with diluted remimazolam revealed a positive reaction, confirming the diagnosis of anaphylaxis. We believe this is the first case report of remimazolam-induced anaphylactic shock diagnosed with a serum tryptase elevation and positive skin test.

Large perinephric abscess in a patient on maintenance hemodialysis diagnosed by positron emission tomography combined with computed tomography (PET-CT).

Perinephric abscesses in patients on maintenance hemodialysis (HD) have seldom been reported. The case of a maintenance HD patient with a left perinephric abscess is reported. Although the lesion could not be visualized using other imaging examinations, using FDG and positron emission tomography combined with computed tomography (PET-CT), the patient was diagnosed as having a left perinephric abscess and nephrolithiasis. At the patient's request, the perinephric abscess was treated conservatively with antibiotic therapy alone, and it eventually remitted. This is the first case report of a perinephric abscess diagnosed by FDG PET-CT in a patient on maintenance HD. FDG PET-CT appears to be useful for identifying perinephric abscesses in HD patients, resulting in early diagnosis and appropriate therapy for this severe infection.

Nucleotide sequence of the gene for phenylalanine ammonia-lyase of rice and its deduced amino acid sequence.

The whole structure of the gene for phenylalanine ammonia-lyase of rice, designated as GP-28, was determined. The gene included one intron located between nucleotides 557 and 2048, corresponding to the second and third letters, respectively, of the arginine codon at position 136 which is conserved in the genes of other plant species. The open reading frame was capable of encoding a 716 amino acid sequence, which showed 73.3% similarity with that of parsley. In the carboxyl-terminal region, an arginine-rich sequence common to the rice enzyme was found, which showed low similarity with those of dicot plants.

Nodule development induced by mutants of Bradyrhizobium japonicum defective in cyclic B-glucan synthesis.

The soybean response to inoculation with B. japonicum mutants defective in cyclic beta-(1-->3), beta-(1-->6) glucan synthesis was examined by electron microscopy and by monitoring the expression of early and late nodulin genes. Two mutants were examined. Strain AB-14 is an ndvB mutant and is unable to synthesize beta-glucans. Strain AB-1 is an ndvC mutant and produces cyclic glucans containing 95 to 100% beta-(1-->3) glycosidic linkages. Nodules formed by either mutant were defective in nitrogen fixation activity. Soybean plants inoculated with strain AB-14 formed nodules roughly at the same rate as the wild-type strain USDA110, but nodulation by strain AB-1 was significantly delayed. Microscopy of nodules formed by strain AB-14 showed an overall ultrastructure similar to nodules formed by the wild type. However, in some nodules bacteroids were limited to only one part of the infected cells and in others the few bacteroids present showed signs of degradation. Nodulelike structures were formed by strain AB-1 that showed some signs of cellular differentiation. For example, clear parenchyma and sclerenchyma tissue could be seen. However, no infection threads or bacteria were evident in these structures. The expression of early (e.g., ENOD2 and ENOD55) and late (e.g., NOD26 and leghemoglobin) nodulins was examined. Nodules formed by strain AB-14 expressed all of the nodulins tested but at a reduced level. Expression of late nodulins was delayed in strain AB-14-induced nodules. Nodules formed by strain AB-1 were more strongly affected in nodulin expression. Although leghemoglobin synthesis was not detected, infection-specific nodulin transcripts of GmN93 and ENOD55 were detected. However, expression of the early nodulins ENOD2 and ENOD55 was considerably delayed and only apparent when assayed 21 days postinoculation. A low level of expression of intermediate nodulin GmN70 and late nodulin NOD26 could also be detected by 21 days postinoculation. The microscopy data show that tissue differentiation occurs in these nodules even in the absence of active bacterial invasion. These results demonstrate the importance of cyclic beta-(1-->3), beta-(1-->6) glucan synthesis to symbiotic development in soybean.

Cooperative action of lipo-chitin nodulation signals on the induction of the early nodulin, ENOD2, in soybean roots.

Various lipo-chitin molecules were tested for their ability to induce the expression of the early nodulin, ENOD2, in Glycine soja roots. When inoculated separately onto G. soja roots, LCO-V (C18:1 delta 11,Mefuc), LCO-V (C18:1 delta 9,Mefuc), LCO-V (C16:0,Mefuc), and LCO-IV (C16:0) were unable to induce ENOD2 expression, even though these compounds had previously been shown to induce root hair curling, the formation of nodule-like primordia, and induction of the early nodulin, ENOD40. ENOD2 expression, however, was induced when any two of these molecules were inoculated in combination. Thus, the lipo-chitin nodulation signals appear to act cooperatively to induce ENOD2 expression. B. japonicum strains USDA110 and USDA135 and B. elkanii strain USDA61, all symbionts of soybean, were found to produce at least two distinct nod signals ([i.e., NodBj-V[C18:1,Mefuc] and NodBj-V[C16:0,Mefuc]). These two compounds were mixed in various ratios and tested for their ability to induce ENOD2 expression. The results indicate that the former compound must be present in equivalent or excess amount in order to obtain maximum ENOD2 expression. Additional nonspecific LCOs (e.g., LCO-IV[C16:2 delta 2,9; SO3]), incapable of inducing root hair curling or cortical cell division, were tested in combination with the four active LCOs listed above. It was found that any combination of one active LCO with a nonspecific LCO was sufficient to induce ENOD2 mRNA expression. The ENOD2 mRNA expression pattern detected by in situ hybridization closely resembled that found in bacterial-induced nodules with expression detected in cortical cells between primary and secondary meristems and around the vascular strands. These data demonstrate that the cooperative action of at least two LCO nodulation signals leads to a greater progression of nodule ontogeny as demonstrated by the expression of ENOD2, a marker gene for the differentiation of nodule parenchyma.

Effect of subject's family name on visual event-related potential in schizophrenia.

Visual event-related potentials (ERPs) were recorded from 15 schizophrenics and 15 age-matched and gender-matched controls, while they performed a modified version of the oddball paradigm. Each subject was required to detect target stimuli among a random sequence of stimuli under two conditions, name and color. In the name condition the stimulus sequence consisted of the subject's family name (deviant 18%), four other family names (standard 73%), and a city name (target 9%). In the color condition the respective stimuli were a pair of solid red circles, four white paired-arrows, and a pair of white plus and minus signs. ERPs elicited by stimuli contained triphasic potentials of P2, N2, and P3. In controls these waves were selectively enhanced for the subject's family name as compared with standards, whereas in schizophrenics no significant difference between the subject's family name and other names was observed. In contrast, selective enhancement for color deviants was observed in both subject groups. These results suggest that impairment of involuntary attention, especially for familiar and significant stimuli such as names in daily life, may underlie disturbances of attentionally controlled central processing in schizophrenia.

Role of the sympathetic nervous system in the nocturnal fall in blood pressure.

To evaluate mechanisms responsible for differences between patients showing a nocturnal fall in blood pressure ("dippers") and those showing no such fall in blood pressure ("nondippers"), we performed 24-hour (h) ambulatory blood pressure monitoring in 25 patients with untreated essential hypertension who were 37-49 years of age (16 men and 9 women). The diagnosis of essential hypertension was based on the patients' history, physical examination, routine laboratory tests, and intravenous pyelography. Blood pressure was measured by sphygmomanometer and by noninvasive ambulatory monitoring for 24 h. Exercise was performed on a supine bicycle ergometer. The initial workload was 50 W and was increased progressively by 25 W at 3-min intervals. Plasma and urinary norepinephrine levels were measured by high-performance liquid chromatography. Dippers were defined as patients with a difference of > 10 mmHg in the systolic BP or > 5 mmHg in the diastolic BP between daytime and nighttime. Eleven patients were dippers and 14 patients were nondippers. There was a positive correlation between the nocturnal fall in blood pressure and the rise in blood pressure during exercise (r = 0.54, p < 0.01), and the increase during exercise was greater in dippers than in nondippers. There was also a significant positive correlation between the urinary norepinephrine level and the fall in blood pressure at night (r = 0.75, p < 0.01). A significant increase in plasma norepinephrine during exercise was found in dippers, as compared with nondippers. These results suggest that in patients with hypertension a nocturnal fall in blood pressure is closely related to the blood-pressure response to exercise, and that the attenuation of sympathetic nervous activity might play an important role in the nocturnal decrease in blood pressure.

Efficacy of shitei-to, a traditional Chinese medicine formulation, against convulsions in mice.

The anticonvulsant effects of Shitei-To and its components on maximal electroshock seizures and chemical convulsions were examined. Shitei-To significantly prolonged the latency to bicuculline (2.0 mg/kg, s.c.)-induced clonic convulsions. Repeated treatment with Shitei-To also significantly prolonged the latency to strychnine (1.5 mg/kg, i.p.)- and pentylenetetrazol (90 mg/kg, i.p.)-induced clonic convulsions. On the other hand, Shitei-To had no effect on maximal electroshock seizures. Of the components of Shitei-To, Shitei had almost the same effect as Shitei-To against the clonic convulsions induced by the three chemical agents tested. These findings suggest that Shitei-To has anticonvulsant effects.

[Anatomical study of the levator labii superioris muscle]. / Estudo anatômico do músculo levantador do lábio superior.

UNLABELLED: The authors describe the anatomical characteristics of the levator labii superioris muscle by dissection in cadavers. PURPOSE: We describe the characteristics of these muscle, the details and relations, hopefully contributing to the study of muscle of the face. METHODS: Twenty faces of cadavers were dissected. The following features were studied: origin, insertion, length, width, thickness, relations, innervation and blood supply. RESULTS: In all cases the muscle originated from the inferior orbital margin. Two insertions were observed: via lateral fibers, superficial to the orbicularis oris muscle and via deep fibers than form part of the raphe at the corner of the mouth (70%); via superficial fibers to the orbicularis oris muscle (30%). The average of the length was 24.66 mm and the average of the thickness was 3.57mm. The width at its insertion was 11.2mm, and at the origin was 15.96mm. The levator labii superioris muscle was found to be anterior to the levator anguli oris; it was posterior to the distal portion of the zygomaticus minor (90%) and posterior to the mid portion of the zygomaticus minor (10%). The innervation was from the inferior branch of the zygomatic nerve (facial nerve) and from the infraorbital nerve (trigeminal nerve). The inferior portion of the muscle is supplied by branches of the angular artery and the superior part from branches of the infraorbital artery.

Atherosclerosis and cardiac function assessment in low-density lipoprotein receptor-deficient mice undergoing body weight cycling.

BACKGROUND: Obesity has become an epidemic in many countries and is supporting a billion dollar industry involved in promoting weight loss through diet, exercise and surgical procedures. Because of difficulties in maintaining body weight reduction, a pattern of weight cycling often occurs (so called 'yo-yo' dieting) that may result in deleterious outcomes to health. There is controversy about cardiovascular benefits of yo-yo dieting, and an animal model is needed to better understand the contributions of major diet and body weight changes on heart and vascular functions. Our purpose is to determine the effects of weight cycling on cardiac function and atherosclerosis development in a mouse model. METHODS: We used low-density lipoprotein receptor-deficient mice due to their sensitivity to metabolic syndrome and cardiovascular diseases when fed high-fat diets. Alternating ad libitum feeding of high-fat and low-fat (rodent chow) diets was used to instigate weight cycling during a 29-week period. Glucose tolerance and insulin sensitivity tests were done at 22 and 24 weeks, echocardiograms at 25 weeks and atherosclerosis and plasma lipoproteins assessed at 29 weeks. RESULTS: Mice subjected to weight cycling showed improvements in glucose homeostasis during the weight loss cycle. Weight-cycled mice showed a reduction in the severity of atherosclerosis as compared with high-fat diet-fed mice. However, atherosclerosis still persisted in weight-cycled mice as compared with mice fed rodent chow. Cardiac function was impaired in weight-cycled mice and matched with that of mice fed only the high-fat diet. CONCLUSION: This model provides an initial structure in which to begin detailed studies of diet, calorie restriction and surgical modifications on energy balance and metabolic diseases. This model also shows differential effects of yo-yo dieting on metabolic syndrome and cardiovascular diseases.

Complete structure of the gene for phosphoenolpyruvate carboxylase from maize.

Phosphoenolpyruvate carboxylase is a key enzyme in photosynthesis in some plants that exploit the C4 photosynthetic pathway for the fixation of CO2. We cloned the gene for this enzyme from maize genomic libraries and analyzed its complete primary structure. The sequence of the cloned gene spans 6781 bp and consists of 10 exons and 9 introns. The site of initiation of transcription is located 84 nucleotides upstream from the first nucleotide of the initiation codon (position -84), as determined by the method of primer-extension analysis. The analysis suggests that there is another initiation site located at position -81. The 5'-flanking region of the gene lacks typical TATA and CCAAT elements in the anticipated regions, but there is a TATA-similar sequence (TATTT) around the -30 regions as well as sequence homologous to the Sp-1 protein-binding site (CCGCCC). Six long, direct repeated sequences and a light-responsive element are also present in the 5'-flanking region. The results of Southern blot analysis indicated that the phosphoenolpyruvate carboxylase gene exists as a small multi-gene family, but the enzyme that is expressed at high levels in green leaves and is involved in C4 photosynthesis is encoded by a single-copy gene in the maize genome.

Thylakoid membranes: the translational site of chloroplast DNA-regulated thylakoid polypeptides.

Stromal ribosomes and those bound to thylakoid membranes were prepared from intact spinach chloroplasts which were purified on Percoll gradients. The products of read-out translation of these ribosomes supplemented with an Escherichia coli extract were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Striking similarity was found between the polypeptides labeled in the read-out translation of the chloroplastic ribosomes and those synthesized in isolated chloroplasts. Among the polypeptides translated on thylakoid-bound ribosomes, apoprotein of chlorophyll-protein complex I, alpha and beta subunits of coupling factor 1, and 32,000-Da membrane polypeptide were identified from their mobility on the polyacrylamide gel. The large subunit of ribulose-1,5-bisphosphate carboxylase/oxygenase and other several stromal proteins were translated exclusively from stromal ribosomes. However, when the translation was programmed in cell-free systems from either E. coli, wheat germ, or rabbit reticulocytes by RNAs isolated separately from stroma and thylakoids, no qualitative difference was found between the products from those RNAs. These results suggest that thylakoid-bound ribosomes are the main sites of synthesis of thylakoid proteins and stromal-free ribosomes are that of stromal proteins, and that thylakoids and stroma contain mRNAs for the stromal and the thylakoid proteins, respectively, in a form not functioning in the chloroplasts.

Synthesis and assembly of H+-ATPase complex by isolated "rough" thylakoids.

The synthesis and assembly of chloroplast H+-ATPase complex were studied by analyzing the incorporation of [35S]methionine into the constituent subunits with isolated intact chloroplasts and with thylakoid membranes that had been prepared from the chloroplasts so that they would retain ribosomes. The complex was isolated from thylakoids after labeling and identified by immunoprecipitation with an antiserum specific to CF1. The mechanism for the assembly of the complex was demonstrated to be active in the isolated chloroplasts by the following observations: the plastid genome-regulated subunits (alpha, beta, epsilon, I, and III) were labeled by in organello translation and recovered with the complex, and three other subunits (gamma, delta, and II) were labeled when intact chloroplasts were incubated with translation products from polyadenylated RNA. The two largest subunits, alpha and beta, were translated on thylakoid-bound ribosomes when the thylakoid membranes were incubated with soluble factors from Escherichia coli. They were recovered with the H+-ATPase complex, suggesting that they are translated on the bound ribosomes in the chloroplast, and that the isolated membranes retain the ability to assemble a complete complex. Provided that these observations are the result of de novo assembly of the complex, the imported and processed nuclear-coded subunits are presumed to be pooled not in stroma but on the membrane.

The effects of habitat fragmentation on persistence of source-sink metapopulations in systems with predators and prey or apparent competitors.

We consider systems with one predator and one prey, or a common predator and two prey species (apparent competitors) in source and sink habitats. In both models, the predator species is vulnerable to extinction, if productivity in the source is insufficient to rescue demographically deficient sink populations. Conversely, in the model with two prey species, if the source is too rich, one of the prey species may be driven extinct by apparent competition, since the predator can maintain a large population because of the alternative prey. Increasing the rate of predator movement from the source population has opposite effects on prey and predator persistence. High emigration rate exposes the predator population to danger of extinction, reducing the number of individuals that breed and produce offspring in the source habitat. This may promote coexistence of prey by relaxing predation pressure and apparent competition between the two prey species. The number of sinks and spatial arrangement of patches, or connectivity between patches, also influence persistence of the species. More sinks favor the prey and fewer sinks are advantageous to the predator. A linear pattern with the source at one end is profitable for the predator, and a centrifugal pattern in which the source is surrounded by sinks is advantageous to the prey. When the dispersal rate is low, effects of the spatial structure may exceed those of the number of sinks. In brief, productivity in patches and patterns of connectivity between patches differentially influence persistence of populations in different trophic levels.

Freeman-Sheldon syndrome: surgical correction of microstomia.

In this report, we describe a case of microstomia associated with club feet and ulnar deviation of the hands (Freeman-Sheldon syndrome) and the surgical technique for correction of the oral deformity.

Effect of shitei-to, a traditional Chinese medicine formulation, on pentylenetetrazol-induced kindling in mice.

This study measured the effects of Shitei-To (STT), a traditional Chinese Medicine, which is a mixture of extracts from three medicinal herbs, Shitei (SI, Kaki Calyx; calyx of Diospyros kaki L. f.), Shokyo (SK, Zingiberis Rhizoma; rhizome of Zingiber officinale Roscoe) and Choji (CJ, Caryophylli flos; flowerbud of Syzygium aromaticum [L.] Merrill et. Perry), has long been used for the treatment of hiccups in Japan and China, against fully pentylenetetrazol-kindled seizures and on the development of pentylenetetrazol kindling in mice. Repeated administration of STT (3.0 g/kg p.o.) mildly retards the development of pentylenetetrazol-induced kindling in mice. STT also decreased the number of tonic-clonic convulsions resulting from progression kindling. On the other hand, STT had no effect on convulsions in fully pentylenetetrazol-kindled mice. These findings suggest that STT protects against the development of convulsions, and that STT may have therapeutic effects in the prevention of secondarily generalized seizures.

Physarum polycephalum haemagglutinins: effect of nutrition on synthesis, and their possible role in nature.

The activity of haemagglutinins in plasmodia of Physarum polycephalum was measured under different culture conditions. The activity was markedly increased when the plasmodia were incubated in a non-nutrient salt medium. During starvation, significant amounts of haemagglutinins were found in the slime layer on the surface of the plasmodia. An increase in activity was not observed in the presence of actinomycin D or cycloheximide. Under starvation conditions, plasmodia are known to differentiate into either sclerotia (spherules) or fruiting bodies. Acceleration of haemagglutinin synthesis, however, was not always observed during spherulation and fruiting-body formation. Attempts to detect endogenous glycoconjugates that bind to the haemagglutinins were unsuccessful but we found that the haemagglutinins could bind to acidic polysaccharides produced by Escherichia coli K12. The bacterial glycoconjugates were purified and partially characterized. They contained N-acetylhexosamine residues which appeared to be important for binding with the haemagglutinins. It is possible that the haemagglutinins play a physiological role in the interaction with these organisms.

In vitro synthesis and assembly of photosystem II proteins of spinach chloroplasts.

The synthesis and assembly of photosystem II (PS II) proteins of spinach chloroplasts were investigated in three different in vitro systems, i.e., protein synthesis in isolated chloroplasts (in organello translation), read-out translation of thylakoid-bound ribosomes, and transport of translation products from spinach leaf polyadenylated RNA into isolated chloroplasts. Polyacrylamide gel electrophoresis of labeled thylakoid polypeptides in the presence of sodium dodecyl sulfate revealed that the first two systems were capable of synthesizing the reaction center proteins of PS II (47 and 43 kDa), the herbicide-binding protein, and cytochrome b559. The reaction center proteins synthesized in organello were shown to bind chlorophyll and to assemble properly into the PS II core complex. One of the reaction center proteins translated by the thylakoid-bound ribosomes (47 kDa) was also found to be integrated in situ into the complex but was lacking bound chlorophyll. Incorporation of radioactivity into the three extrinsic proteins of the oxygen-evolution system (33, 24, and 18 kDa) was detected only when intact chloroplasts were incubated with the translation products from polyadenylated RNA, showing that these proteins are coded for by nuclear DNA. The occurrence of a precursor polypeptide 6 kDa larger than the 33-kDa protein was immunochemically detected in the translation products.

Oral beta-stimulants can inhibit passive cutaneous anaphylaxis in rats through an indirect inhibitory mechanism: possible involvement of afferent and efferent nervous system via gastric beta2-adrenoceptor stimulation.

OBJECTIVE AND DESIGN: We previously demonstrated that oral l-ephedrine exerts an extremely rapid (within 20 s) inhibition of 48-h passive cutaneous anaphylaxis reaction (PCA) in rats by a possibly unidentified mode of action. In the present experiments, we elucidated the mechanism of the PCA inhibition by l-ephedrine using adrenoceptor agonists and antagonists. MATERIALS: Rat antiserum was prepared with dinitrophenylated Ascaris suum extract + Bordetella pertussis. TREATMENT: Passively skin-sensitised Wistar rats were mainly used. l-Ephedrine, and adrenoceptor agonists and antagonists were orally administered immediately before PCA provocation. Catecholamine depleting (6-hydroxydopamine, 6-OHDA), amine depleting (reserpine) or ganglion blocking (hexamethonium) agent was intraperitoneally or intravenously administered before the provocation. METHODS: The effects of the drugs on PCA were assessed by inhibition of the dye leakage. RESULTS: beta-(propranolol) and beta2-(butoxamine) blocking agents reduced the inhibition of PCA by l-ephedrine, while the inhibition was not altered by either an a-blocking agent (phentolamine) or a beta1-(atenolol) selective antagonist. On the other hand, beta-(isoproterenol) and beta2-selective (salbutamol) agonists showed extremely rapid inhibition of PCA. However, the beta-selective agonist (dobutamine) had no effect on the reaction. The pretreatment with hexamethonium, reserpine or 6-OH-DA substantially attenuated the inhibitory effect of l-ephedrine on PCA. CONCLUSIONS: The results strongly suggest that beta2-adrenoceptors locate in the stomach and that their receptor excitement finally may lead to the inhibition of PCA via the stimulation of the central and peripheral nervous systems.