Supplementation with cumulus cell masses improves the in vitro meiotic competence of porcine cumulus-oocytes complexes derived from small follicles.

The present study was conducted to examine the supplemented effect of cumulus cell masses (CCMs) derived from middle follicle (MF; 3-6 mm diameter) on the morphology and the meiotic or developmental competence of oocytes from small follicles (SF; 1-2 mm diameter). The number of cumulus cells surrounding oocytes just after collection was also lower in cumulus-oocyte complexes (COCs) from SF than MF. The ooplasmic diameter of oocytes was significantly smaller in SF-derived oocytes than MF-derived ones before and after in vitro maturation (IVM), whereas the diameter significantly increased during the culture. Co-culture of SF-derived COCs with MF-derived CCMs during IVM significantly improved the meiotic competence of the oocytes to the metaphase-II stage. Furthermore, the ooplasmic diameter of SF-derived COCs during IVM was increased to the similar size of MF-derived those in the presence of MF-derived CCMs. The abilities of oocytes to be penetrated, to form male pronuclear formation and to cleave or develop to the blastocyst stage were not affected by the co-culture with CCMs. Electrophoretic analysis of CCM secretions clearly showed the presence of more protein(s) approximately 27.6 kDa in the conditioned medium when supplemented with MF-derived CCMs. In conclusion, we demonstrate that supplementation with MF-derived CCMs improves the ooplasmic diameter and meiotic competence of SF-derived oocytes.

IgA pemphigus with paraneoplastic pemphigus-like clinical features showing IgA antibodies to desmoglein 1/3 and desmocollin 3, and IgG and IgA antibodies to the basement membrane zone.

A 79-year-old Japanese woman presented with severe recalcitrant erosions on her oral mucosa, resembling paraneoplastic pemphigus. Using indirect immunofluorescence, we detected IgA antibodies against the cell surface, and both IgG and IgA antibodies against the basement membrane zone. Immunoblotting showed that the IgG antibodies reacted weakly with bullous pemphigoid 230 and periplakin, whereas the IgA antibodies did not react with any antigen. IgA antibodies to both desmoglein (Dsg)1 and Dsg3 were detected by ELISA. IgA antibodies to desmocollin (Dsc)3 were also detected by using cDNAs for human Dsc1-3 transfected into COS-7 cells. Despite treatment with oral prednisolone, high-dose intravenous immunoglobulin and double-filtration plasmapheresis, the skin lesions remained active, and the patient died from bronchiolitis obliterans-like respiratory failure. Despite extensive investigations and postmortem examination, no underlying neoplasms were found. The complex immunopathological findings probably played an important role in the development of the patient's unusual clinical features.

Prophylactic procedure for inguinal hernia after radical retropubic prostatectomy.

PURPOSE: The incidence of inguinal hernias (IH) after radical retropubic prostatectomy (RRP) has been reported to range from 10 to 50 %, but no prophylaxis for IH has yet been established. We proposed a prophylaxis for IH after RRP. METHODS: A total of 180 patients underwent RRP at our hospital between 2000 and 2011. In January 2008, we started to perform a prophylaxis involving the dissection of the processus vaginalis. This procedure was performed in 73 patients. We then compared the incidence of IH between the patients that did (prophylaxis group) and did not (no prophylaxis group) undergo the prophylaxis. We also studied the risk factors for IH after RRP. RESULTS: In the no prophylaxis group, 25 (23 %) of the 107 patients developed IH, and the IH-free rate at one postoperative year was 86 %. In contrast, only 3 (4.1 %) of the 73 patients in the prophylaxis group developed IH, resulting in IH-free rate of 96 % at one postoperative year (P = 0.0235). Among the patients in the no prophylaxis group, the mean body mass index of the hernia group was significantly lower than that of the no hernia group (P = 0.006). CONCLUSION: Our results suggest that our prophylaxis is useful for preventing IH after RRP.

Serum N-acetyl-beta-D-gulucosaminidase activity increases in association with insulin resistance in patients with coronary artery disease.

N-acetyl-beta-D-glucosaminidase (NAG) is released from lysosomes, but the clinical significance of its serum activity in the pathogenesis of coronary artery disease has not been well understood. We measured serum NAG activity by a colorimetric method in consecutive 168 patients suspected of having coronary artery disease who underwent diagnostic coronary angiography. In addition, we evaluated the relationship between the activity and severity of coronary artery disease, as well as various coronary risk factors. Serum NAG activity was higher in the multi-vessel disease group than in the no stenotic lesion group (9.2+/-2.3 vs. 7.8+/-1.8 U/l, P<0.01) and in the single-vessel disease group (vs. 8.2+/-2.2 U/l, P<0.05). In all patients, Gensini score was closely correlated with the serum NAG activity (r = 0.39, P<0.001). Multiple regression analysis showed that serum NAG activity was correlated with plasma insulin level (r = 0.49, P<0.01), but not correlated with other coronary risk factors. In 126 patients without apparent diabetes mellitus, serum NAG was also correlated with plasma insulin level (r = 0.37, P<0.01) and additionally with insulin resistanc determined by homeostasis model assessment (r = 0.47, P<0.01). Our results suggested that serum NAG activity correlates with the severity of coronary artery disease in relation to plasma insulin level and insulin resistance, and thus can be an indicator of coronary artery disease based upon abnormalities of glucose metabolism.

Impaired endothelium-dependent acetylcholine-induced coronary artery relaxation in patients with high serum remnant lipoprotein particles.

Acetylcholine (Ach)-induced vascular relaxation is mediated by nitric oxide released from the endothelium. Hence, impaired Ach-induced relaxation reflects endothelial dysfunction. The action of lipoprotein lipase on chylomicrons and very low density lipoproteins produces remnant lipoproteins (RLP) rich in triglycerides (TG), cholesterol (C) and apolipoprotein E (apo E). Apo E on RLP serves as a ligand for uptake of RLP by macrophages, endothelial cells and other cells expressing the LDL receptor or the remnant receptor; uptake of RLP by vascular wall cells can promote atherosclerosis. Serum C, TG, Lp(a), apo E, apo A-I, apo B, HDL-C and RLP-C were measured in 652 patients who underwent diagnostic coronary angiography. Of these, 48 (32 males and 16 females, age 59 +/- 10 years) were suspected of having ischaemic heart disease because they had chest pain, but without angiographic evidence of atherosclerotic coronary artery disease defined as a discrete stenosis or intimal irregularity, and without any other known underlying heart disease. These were selected for acetylcholine provocation test in the left coronary artery. Nineteen of 48 patients had high RLP-C ( > or = 5 mg/dl, mean 8.7 +/- 3.1 mg/dl), 29 had normal RLP-C ( < or = 5 mg/dl, mean 2.4 +/- 0.4 mg/dl, P < 0.0001). The percent change (-, constriction, or +, dilation) in coronary artery diameter after intracoronary injection of Ach was smaller in the high RLP-C group, compared with the normal RLP-C group thus, in the left anterior descending artery, -33 +/- 23 vs -8 +/- 25 in the proximal segment (P <0.01), -30 +/- 37 vs -3 +/- 29 in the mid segment (P < 0.01), -17 +/- 47 vs 16 +/- 43 in the distal segment (P < 0.001); in the left circumflex artery, -29 +/- 46 vs -9 +/- 28 in the proximal segment (P < 0.01), -29 +/- 43 vs -5 +/- 34 in the mid segment (P < 0.01), -26 +/- 43 vs 10 +/- 31 in the distal segment (P < 0.001). There were no significant differences in other lipid levels. These results suggest that there is an association between high serum RLP-C and coronary vascular endothelial cell dysfunction and that RLP-C may be taken as a marker of early stage coronary artery atherosclerosis not detectable by angiography.

An IDDM patient who complained of chest oppression with ischemic changes on ECG in insulin-induced hypoglycemia.

A 34-year-old female IDDM patient complained of chest oppression in hypoglycemic episodes and electrocardiograms revealed reversible ischemic changes occurring concomitantly with hypoglycemia. The ECG changes improved and the chest oppression disappeared following increasing blood glucose level by glucose intake. Master's double load test and treadmill load test were positive for ischemic changes. Radioisotopic myocardial scintigraphy by thallium and BMIPP did not show any filling defects and coronary angiography revealed no remarked stenosis in the coronary arteries. She had no mitochondrial tRNA(Leu) (A-->G) gene mutation at nucleotide position 3243, but both the patient and her mother had a G-to-A transition within the replication origin of the light strand at nucleotide position 5744 of the mitochondrial gene. As the patient's maternal family had no history of ischemic heart disease, it is not clear whether mitochondrial gene mutation at nucleotide position 5744 reflects the occurrence of cardiac ischemia. Some disorders of microcirculation in capillary vessels in cardiac muscles may occur in such patients.

Rhytidectomy employing a two-layered closure: improved results with hidden scars.

The goal of a face-life procedure should be to obtain the maximal improvement with minimal morbidity. The author's technique is presented as an alternative technique to accomplish this goal. It is based on 427 face-lift patients from 1973 to 1979. The technique employs defatting of the superficial musculoaponeurotic system and platysma muscle (which is not dissected free) and use of multiple plication sutures to create a second-layer closure. This is in contrast to the standard face-lift procedure, which employs a single-layer closure whereby all the retraction tension is sustained by the skin flaps. With the author's technique, the complication rates are markedly reduced and satisfactory cosmetic results are obtained with "hidden" face-lift incisions.

Tricuspid valve infectious endocarditis associated with dental treatment.

A 52-year-old man with neither congenital heart disease nor history of drug abuse had a spiking fever after dental treatment and was diagnosed with pneumonia at a local clinic. He was treated with antibiotics and his fever went down. Ten months later, he had again pyrexia and suffered from congestive heart failure. He admitted to our hospital and tricuspid valve endocarditis was proved by echocardiography. He was treated with penicillin. However, during the treatment, he developed a pulmonary embolism. So he underwent surgical treatment. We should take dental treatment into account one of predisposing causes of tricuspid endocarditis.

Six-year survival of unoperated ventricular septal rupture following myocardial infarction.

We present the case of a patient who survived for 6 years without surgical repair of a ventricular septal rupture that followed an acute myocardial infarction. To the best of our knowledge, only 3 other cases have been reported in which the patient survived for more than 5 years.

[Studies on iodinated compounds. X. Isolation and purification of iodoglycyltyrosines].

The methods for the isolation and purification of iodoglycyltyrosines [glycyl-3-iodotyrosine (Gly-MIT) and glycyl-3,5-diiodotyrosine (Gly-DIT)] from a reaction mixture were examined by the use of high-performance liquid chromatography (HPLC). Glycyltyrosine (Gly-Tyr) was iodinated with iodine monochloride (ICl) (the molar ratio of Gly-Tyr to ICl was 1:1.5) in 0.1 M NaOH. The synthesized Gly-MIT and Gly-DIT were separated on a mu Bondapak C18 column employing stepwise gradient systems of a 0.1% trifluoroacetic acid/acetonitrile mixture and a water/acetonitrile mixture. Chemically pure Gly-MIT and Gly-DIT were obtained in 30.2% and 28.2% yields, respectively.

[Imipenem/cilastatin sodium and other beta-lactams for respiratory tract infections: clinical benefit and treatment days for cure].

Therapeutic efficacy and the treatment days for cure of imipenem/cilastatin sodium (IPM/CS) in treatment of pulmonary infections were prospectively determined in comparison with those of beta-lactams other than carbapenems mainly ceftazidime (CAZ) or sulbactam/cefoperazone (SBT/CPZ). The overall response rate was 84.9% (62/73) in the IPM/CS group and 74.7% (56/75) in the beta-lactam group, the difference not being significant. In the subjects having underlying respiratory diseases, the response rate was 91.1% (41/45) and 73.9% (34/46) in the IPM/CS and beta-lactam groups, respectively. In patients with infections secondary to chronic respiratory disease, the rate was 91.2% (31/34) in the former group and 66.7% (24/36) in the latter group, respectively. The differences were significant for both stratified analyses. The treatment days for cure judged by the attending physician were 12.9 +/- 0.6 days in the IPM/CS group, and 14.5 +/- 0.7 days in the beta-lactam group. The difference was not, however, significant. In patients with mild to moderate infections, the treatment days for cure was 12.0 +/- 0.6 days (n = 64) in the IPM/CS group and 14.3 +/- 0.7 days (n = 70) in the beta-lactam group. In patients with underlying respiratory disease, the treatment days for cure were 11.8 +/- 0.7 days (n = 45) and 14.7 +/- 0.9 days (n = 46) in the IPM/CS and beta-lactam groups, respectively. In patients with infections secondary to chronic respiratory disease, the days were 11.1 +/- 0.7 days (n = 34) and 14.7 +/- 1.1 days (n = 36), respectively. Thus, IPM/CS therapy significantly reduced the number of treatment days until cure. There was, however, no significant difference between the two therapy groups in treatment of the patients with severe infections, those without underlying respiratory disease, or those with pneumonia and/or lung abscess. The treatment days for cure were also assessed by the members of review committee taking into consideration of body temperature, leukocyte count, and C-reactive protein. As the result, it was 6.9 +/- 0.5 days in the IPM/ CS and 10.3 +/- 0.7 days in the beta-lactam groups; respectively, and the difference was significant. Time (days) until cure was also compared between the two groups using survival time analysis, confirming a more rapid response in the IPM/CS group. Although IPM/CS therapy was associated with a shorter response time as assessed by both the attending physicians and the review committee, there were considerable differences between the results of these judgements. Thus, the duration of treatment with injectable antibiotics requires reevaluation in the future. No significant differences were observed between the groups with respect to parameters indicating side effects and laboratory abnormalities. There were no severe symptoms or laboratory findings, and symptoms and changes in laboratory values, if any resolved during the course of therapy or after the withdrawal of treatment. In conclusion, IPM/CS seems to be very useful as first-line therapy for respiratory tract infections and for shortening the duration of treatment.

[A case of coronary artery embolism associated with combined valvular heart disease].

A 53-year-old-man afflicted with combined valvular heart disease and atrial fibrillation was admitted to our department complaining of chest pain. ST elevation on ECG (II, III, aVF) and elevated CPK value were recognized. He was diagnosed as having acute myocardial infarction, and percutaneous transluminal coronary recanalization was performed immediately. The coronary angiogram showed occlusions at the proximal left branch (#12). But these lesions could not be recanalized by 960000 IU urokinase administration. The cineangiogram after one month revealed perfect recanalization of these occlusions. Mitral stenosis with neovascularity to the left atrium and aortic regurgitation were recognized. We supposed this infarction caused by coronary embolism originated from left atrial thrombi. Acute myocardial infarction associated with mitral stenosis has been reported in fifteen cases previously in Japan, but only three cases revealed coronary occlusion in the acute phase with normal coronary artery in the chronic stage. However, there has been no report, except for this case, demonstrating occlusion in two coronary arteries at the same time. So, our case is the first report of the involvement of two coronary artery occlusions.

Quantum Faraday and Kerr rotations in graphene.

Graphene, a monolayer sheet of carbon atoms, exhibits intriguing electronic properties that arise from its massless Dirac dispersion of electrons. A striking example is the half-integer quantum Hall effect, which endorses the presence of Dirac cones or, equivalently, a non-zero (π) Berry's (topological) phase. It is curious how these anomalous features of Dirac electrons would affect optical properties. Here we observe the quantum magneto-optical Faraday and Kerr effects in graphene in the terahertz frequency range. Our results detect the quantum plateaus in the Faraday and Kerr rotations at precisely the quantum Hall steps that hallmark the Dirac electrons, with the rotation angle defined by the fine-structure constant. The robust quantum Hall plateaus in the optical regime, besides being conceptually interesting, may open avenues for new graphene-based optoelectronic applications.

Westernization of the Asian eyelid.

Westernization of the Asian eyelid has become a topic of considerable interest in the Western world in recent years due to the increasing number of surgeons being consulted to perform this procedure. This demand is attributable to the great influx of Asian immigrants who are influenced by Western culture, design, and esthetics. After performing over 2,000 cases of westernizing Asian eyelids, I have developed a method of surgically creating a "double eyelid" as well as a method for removing the epicanthal web. The techniques result in a marked improvement of the narrow, puffy Asian eye and greater patient satisfaction. With these two separate techniques, improved cosmetic results can be achieved over those techniques that are commonly performed today, either in the Western world or in the Orient.

Determination of free and total phenylacetic and p- and m-hydroxyphenylacetic acids in human urine by liquid chromatography with fluorimetric detection.

A highly sensitive and rapid liquid chromatographic method for the determination of free and total phenylacetic and p- and m-hydroxyphenylacetic acids in human urine is described. After extraction of urine with diethyl ether, these acids and phenylpropionic acid (internal standard) are converted into the corresponding fluorescent derivatives by treatment with 3-bromomethyl-6,7-dimethoxy-1-methyl-2(1H)-quinoxalinone in the presence of potassium hydrogen carbonate and 18-crown-6 in acetonitrile. The derivatives are separated on a reversed-phase column (Radial-Pak cartridge C18) with aqueous 65% (v/v) methanol and detected fluorimetrically. The detection limits for phenylacetic and p- and m-hydroxyphenylacetic acids are 5, 30 and 100 fmol, respectively, at a signal-to-noise ratio of 5 in a 20-microliter injection volume. This sensitivity permits precise determination of the free and total acids in 20 microliter of normal human urine.

Simplified protocol for management of malar fractures.

Our simplified protocol for the management of malar complex fractures of facial bones has shortened the operating time by one third to one fourth, produced consistent, satisfactory results, and reduced intraoperative and postoperative complications. In addition, with moderate training of residents, it has been installed as the primary method of treatment of this type of facial fracture in a residency training program that has a heavy load of these patients.

Simplified protocol for treatment of malar fractures. Based on a 1,220-case, eight-year experience.

A simplified protocol of approach has evolved from the treatment of approximately 1,200 malar fractures in an eight-year period in the private practice of one of us (R.S.M.) and at the Los Angeles County/University of Southern California Medical Center. The method begins with the Gillies incison for reduction and routinely uses internal wire pin fixation tailored to the mechanical requirements of the malar fracture. It advances only if necessary to brow and infraorbital incisions, direct wiring, orbital exploration, or Caldwell-Luc. Antrostomy with antral packing. Occasionally, a transcutaneous wire or small bone screw may be inserted for headcap or halo vector traction if indicated by the judgment of the surgeon. The internal wire pin protocol has produced hundreds of satisfactory reductions and fixations of malar fractures in our experience, with shortened operating time and reduced complications. It has been installed as the primary method of treatment for this type of facial fracture in a residency program that has many of these patients.

Highly sensitive determination of free fatty acids in human serum by high-performance liquid chromatography with fluorescence detection.

A highly sensitive and rapid high-performance liquid chromatographic method for the determination of free fatty acids in human serum is described. The fatty acids are converted into the corresponding fluorescent derivatives by the reaction with 3-bromomethyl-6,7-dimethoxy-1-methyl-2(1H)-quinoxalinone in the presence of potassium carbonate and 18-crown-6 in acetonitrile. The derivatives are separated simultaneously within 44 min on a reversed-phase column (YMC-Pack C8) with a gradient elution of aqueous methanol and detected fluorimetrically. The detection limits are 0.5-2 fmol in a 10-microliters injection volume. This sensitivity permits precise determination of free fatty acids including lauric, myristoleic and linolenic acids, which occur in serum at very low concentrations, in 5 microliters of sera from healthy subjects and patients with diabetes.