Assessment of the F wave technique for motor unit number estimation in normal dogs.

Motor unit number estimation (MUNE) is an electrophysiological technique to quantify the number of motor units in a muscle. A previous study examining MUNE in dogs used an incremental method. The purpose of this study was to examine the use of the F wave method in dogs and to provide information about this technique. Seven healthy laboratory dogs were examined using the F wave method by stimulating either a single site or multiple sites. In the multiple site stimulation F wave (MSS-F) method, the nerve was stimulated at several close sites along the deep peroneal nerve innervating the extensor digitorum brevis muscle. Test-retest was performed with a 1 week interval in all dogs using both techniques. In this preliminary study, median MUNE values were 88 (range 27-187) using the single site stimulation F wave (SSS-F) method and 68.5 (range 47-106) using the MSS-F method. The intra-class correlation coefficients between the two sets of data for each method were 0.20 and 0.09 for left and right SSS-F, respectively, and 0.77 and 0.69 for left and right MSS-F, respectively. MSS-F had less intra-individual variability of MUNE values and was more reproducible. These results indicate that MSS-F can be performed in dogs. MUNE using MSS-F might help with quantitative evaluation of motor neurone dysfunction and progression of diseases affecting motor neurones.

Appropriate dosing of antiarrhythmic drugs in Japan requires therapeutic drug monitoring.

OBJECTIVE: In general, drugs are used in accordance with an approved dosage regimen in expectation of an appropriate balance between efficacy and toxicity. However, dose control of drugs with a narrow therapeutic range and marked intersubject variability in pharmacokinetics should be established through individualization of dosing based on therapeutic drug monitoring (TDM). The purpose of this study was to examine differences between the approved dosage regimen and the doses of antiarrhythmic drugs and digoxin used in clinical practice and to examine the influence of TDM on dosing. METHODS: Prescription research of antiarrhythmic drugs was performed at five national hospitals in Japan. Prescriptions for antiarrhythmic drugs (cibenzoline, disopyramide, pirmenol, mexiletine, aprindine, flecainide, pilsicainide, amiodarone and digoxin) were counted for the study period. The mean dose and dose distribution of the drugs were determined in each hospital. Comparisons were made of mean dose obtained in the study with the dosage approved by the authority. In addition, the percentage of patients that received TDM was determined. RESULTS: A difference was seen between the approved dosage and the actual dose. For all drugs except flecainide, the mean dose was smaller than the approved dosage. For all drugs except digoxin, remarkable variations were seen in the dose distribution among the hospitals. Digoxin showed a similar dose distribution among the five hospitals. Overall, the percentage of patients that received TDM was low except for Hospital A. However, TDM of digoxin was relatively common at four of the hospitals. CONCLUSIONS: It is concluded that, with the exception of digoxin, the appropriate dosing regimen for antiarrhythmic drugs is not yet established. The establishment of appropriate dosing regimens for antiarrhythmic drugs requires the more widespread adoption of TDM.

Sonographic assessment of the cervix before, during and after a uterine contraction is effective in predicting the course of labor.

OBJECTIVE: To investigate whether the degree of change in cervical length during a uterine contraction is predictive of subsequent progression of labor. METHODS: The subjects were 73 uncomplicated parturient women at term. We observed the cervix before, during and after a uterine contraction by transvaginal ultrasound in the first stage of labor and determined the degree of cervical shortening during the contraction relative to the cervical length before contraction. We related the degree of cervical shortening to labor patterns at the time of the ultrasound examination, which were retrospectively determined by reviewing the partogram. RESULTS: The cervix was shortened in length by about 50% on average during a uterine contraction in the normal course of labor. The degree of cervical shortening was significantly greater in the normal latent and active phases than it was in the prolonged latent phase, protracted active phase and false labor, whereas there were no differences between the former two phases nor between the latter three phases. Nulliparous and parous women exhibited almost the same degree of shortening in the normal latent and active phases. CONCLUSIONS: Real-time ultrasound observation of the cervix during uterine contraction could help differentiate inefficient uterine contractions from normal ones and thus predict the subsequent course of labor.

[Difference in strategy for breast cancer between western countries and Japan].

The history of breast cancer treatment has been largely that of western countries. Although Japan has had its own technological development, it does not have its own strategy for cancer treatment, especially for breast cancer. Thus the difference between western countries and Japan is obvious: USA and European countries are superior because of their scientific way of clinical research, such as "prospective randomized study", which has never been performed in Japan. We need to review our medical system in order to develop our own more effective types of therapy.

[Factors which allow elderly persons living alone to continue living at home--analysis of the situation of elderly people living alone who are served by the Higashi Sapporo Hospital Home Care Support Center and Higashi Sapporo Visiting Nurse Station].

Amid the rapid ongoing shift from treating the elderly in hospitals to treating them at home, self-care by elderly people living alone is a serious and complicated problem. To investigate the support system that enables elderly living alone to maintain social independence and a high quality of life at home, the main factors which allow the person to continue living at home were sought through an analysis of the current situations of 44 elderly-persons living alone, who use the services of our home care support center and visiting nurse station. From this analysis, the elderly person who continue to live alone at home were ranked from J-A for degree of independence in daily life, and the degree of independence of in daily life of elderly suffering from dementia was normal rank I and II. It was also found that such people use multiple services and that their health is stable. In the future it will be necessary to develop systems and networks which function to coordinate multiple services and make possible the smooth transition between home and hospital or institution. The practice of informed consent must also be improved. Finally, it will be important to promote the appropriate management of disease and local rehabilitation services.

Priming of anesthesia circuit with xenon for closed circuit anesthesia.

Xenon is an inert gas with a practical anesthetic potency (1 MAC = 71%). Because it is very expensive, the use of closed circuit anesthesia technique is ideal for the conduction of xenon anesthesia. Here we describe our methods of starting closed circuit anesthesia without excessive waste of xenon gas. We induce anesthesia with intravenous agents, and after endotracheal intubation, denitrogenate the patient for approximately 30 min with a high flow of oxygen. This is done to minimize accumulation of nitrogen in the anesthesia circuit during the subsequent closed-circuit anesthesia with xenon. Anesthesia is maintained with an inhalational anesthetic during this period. Then, we discontinue the inhalation agent and start xenon. For this transition, we feel it is unacceptable to simply administer xenon at a high flow until the desired end-tidal concentration is reached because it is too costly. Instead we set up another machine with its circuit filled in advance (i.e., primed) with at least 60% xenon in oxygen and switch the patient to this machine. To prime the circuit, we push xenon using a large syringe into a circuit, which was prefilled with oxygen. Oxygen inside the circuit is pushed out before it is mixed with xenon, and xenon waste will thus be minimized. In this way, we can achieve close to 1 MAC from the beginning of xenon anesthesia, and thereby minimize the risk of light anesthesia and awareness during transition from denitrogenation to closed-circuit xenon anesthesia.

Evaluation of 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino]-2-deoxy-D-glucose, a new fluorescent derivative of glucose, for viability assessment of yeast Candida albicans.

A new fluorescent derivative of D-glucose, 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino]-2-deoxy-D-glucose (2-NBDG), which had been previously developed for the analysis of glucose uptake activity by living cells, was investigated to evaluate its applicability for assaying the viability of yeast Candida albicans. Lineweaver-Burk plots showed to uptake of 2-NBDG to be competitively inhibited by D-glucose and not by L-glucose, which suggested the involvement of the glucose transporting system of C. albicans in the uptake of 2-NBDG. A good correlation was obtained between the yeast viability, determined by the plate-count method, and the 2-NBDG uptake activity of yeast cells (correlation constant: r = 0.97). This is expected to lead to the development of a new fluorescent probe for the determination of yeast cell viability.

An assessment of docosahexaenoic acid (DHA) intake with special reference to lipid metabolism in rats.

In order to determine the appropriate intake of docosahexaenoic acid (22:6n-3, DHA), the potential changes in lipid peroxidation and antioxidant defense in serum and tissue as well as the changes in serum lipid levels were examined in rats by giving them diets containing graded levels of purified DHA (0, 1.0, 3.4 and 8.7 energy % in the diets) for 2 weeks. Serum alpha-tocopherol concentration decreased slightly but significantly even at the 1.0 energy %. Liver lipid peroxide levels as assessed by the thiobarbituric acid (TBA) value and chemiluminescence intensity augmented at the 3.4 energy % and more, and the alpha-tocopherol content significantly decreased in response to the increase in lipid peroxide levels. In the kidney, a slight but significant increase in TBA value was observed even at 1.0 energy % and higher. All the serum lipid levels as analyzed by total cholesterol, HDL-cholesterol, triacylglycerol (TG) and phospholipids (PLs) decreased as the dietary DHA level increased. These experimental results suggest that the dietary intake of DHA should be less than 1 energy % to avoid promoting deleterious influences such as serum and tissue lipid peroxidation and to ameliorate serum lipid levels.

Experiencia piloto en el uso de una ficha de evaluación geriátrica ambulatoria / Pilot experience with an ambulatory geriatric assessment questionnaire

Ten percent of the chilean population is over 60 years old and general practitioners need an instrument to assess the degree of disability and multiple ailments of elders. Aim: to develop and use an instrument to assess elders consulting in primary care outpatient clinics. An instrument to be used by general practitioners, aimed to assess bio-psico-social risk of elders was devised by the Geriatrics Program at the Faculty of Medicine of the Catholic University of Chile. The instrument was used in 100 elders (82 female) aged 71ñ8 years old consulting in a primary care outpatient clinic. The instrument took less than 5 minutes to be used. The most frequent risk factors found were living alone in 62 percent of subjects, falls in the last year in 47 percent, memory disturbances in 62 percent, overweight in 76 percent, visual impairment in 76 percent, urinary incontinence in 26 percent and depression in 76 percent. Thirty percent had difficulties to climb stairs and 4 percent had no support in case of severe disability. The applied instrument is fast to apply, easily understood by patients and detects problems associated with old age, that will help to plan primary care health programs

A novel fluorescent derivative of glucose applicable to the assessment of glucose uptake activity of Escherichia coli.

A novel fluorescent derivative of glucose was synthesized by reacting D-glucosamine and NBD-Cl. The TLC analysis of the reaction mixture showed the generation of a single spot with intense fluorescence (lambda Ex = 475 nm, lambda Em = 550 nm). The obtained novel fluorescent product, which was identified as 2-(N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino)-2-deoxyglucose (2-NBDG) by 1H-NMR and FAB-MS spectrometries, was applied to the assessment of the glucose uptake activity of Escherichia coli B. 2-NBDG accumulated in living cells and not in dead cells. The uptake of 2-NBDG was competitively inhibited by D-glucose and not by L-glucose, which suggested the involvement of the glucose transporting system in the uptake of 2-NBDG. 2-NBDG taken into the cytoplasma of E. coli cells was supposedly converted into another derivative in the glucose metabolic pathway.

[Interferon treatment for chronic hepatitis C--assessment of 3 regimens in patients received more than 500MU interferon treatment and their effect predictive factors for interferon treatment using multivariate analysis with the logistic regression model].

Chronic hepatitis C patients (n = 115) were treated with interferon (IFN). Total dose employed was more than 500 MU. The response rate was assessed among the three treatment groups: 2W continuous+TIW, 4W continuous+TIW, 8W continuous+TIW. The IFN treatment effect predictive factors were also assessed. Complete response (CR) rate, CR with serum HCV-RNA disappearance rate, responders' histology activity index score changes between before and after treatment, and responders' hepatocytes HCV-RNA disappearance rate did not differ among the three treatment regimens. CR to IFN treatment was dependent on serum HCV-RNA and HCV serotype. Patients of low serum HCV-RNA and serotype II were responsive to IFN treatment.

Confirmation study, using nitrobenzene, of the Combined Repeat Dose and Reproductive/Developmental Toxicity Test protocol proposed by the Organization for Economic Cooperation and Development (OECD).

A confirmatory familiarization study of the Combined Repeat Dose and Reproductive/Developmental Toxicity Screening (ReproTox) test protocol proposed by the Organization for Economic Cooperation and Development (OECD) was performed using nitrobenzene, a testicular toxicant. The agent was given daily by gavage to groups of 10 male and 10 female Sprague-Dawley rats at doses of 100, 60, 20 and 0 mg/kg body weight. Some of the high dose animals exhibited neurological signs, and two males and 9 females died. Hemolytic anemia due to methemoglobin formation was evident in treated males. Histopathologically, treated males showed atrophy of seminiferous tubules of the testis, reactive changes secondary to hemolytic anemia in the hematopoietic organs, and hepatocellular swelling. Cerebral gliosis was observed in middle and high dose males. Male fertility was not affected. The body weights of pups from treated dams were lowered, and their postnatal loss was increased. Most of the known toxicological properties of this chemical was demonstrated in the present study, with the exception of reduced fertility. Therefore, the ReproTox protocol was concluded as being useful as a screening test of existing high production volume chemicals. It should be noted that while the reproductive toxicity test alone is insensitive for detection of male fertility disturbances associated with testicular toxicity, the latter easily be distinguished on morphological grounds.

MRI assessment of myelination patterns in high-risk infants.

Magnetic resonance imaging (MRI) was used in high-risk infants to assess the myelination process and its relationship with neurologic outcome. The time period when delayed myelination is best detected by MRI was also studied. MRI was performed in 39 high-risk infants (i.e., preterm infants, infants with respiratory distress syndrome, or with neonatal convulsions and asphyxia). In 10 of 11 infants with normal development, MRI revealed a normal myelination pattern before 2 months of age, and in 11 of 13 infants after 2 months of age. Conversely, in infants with poor outcomes, MRI demonstrated delayed myelination patterns in only 1 of 4 infants before 2 months of age but in 9 of 11 infants after 2 months of age. In patients with poor outcomes, delayed myelination was found more frequently after rather than before 2 months of age. These findings demonstrate that delayed myelination detected by MRI is useful in predicting the neurologic outcome of high-risk infants, especially after 2 months of age.

Evaluación del sistema de fibra óptica para el monitoreo de la presión cerebral / Assessment of fiber optic system for intracraneal pressure monitoring

Con la aparición de los nuevos sistemas de fibra óptica para la medición de la presión intracerebral se ha producido un aumento en el abanico de indicaciones para el monitoreo de la PIC. Se analizan 15 procedimientos en 14 pacientes seguidos en forma prospectiva a los que se les instaló una fibra óptica intracerebral para el monitoreo de la PIC. Se revisan las indicaciones y características de los pacientes. No se presentaron complicaciones atribuíbles al sistema y se constató una buena calidad en el registro. La única contraindicación de éstos sistemas son las coagulopatías

Quality control program on biological monitoring by Japan Federation of Occupational Health Organizations.

Since 1980, the Japan Federation of Occupational Health Organizations has been conducting an external quality control survey for biological monitoring under a contract with the Ministry of Labour of the Japanese Government. The number of participating organizations has increased from 91 in 1980 to 179 in 1987. The items in the program were lead and free erythrocyte protoporphyrin concentrations in blood, and lead, coproporphyrin, delta-aminolevulinic acid, chromium, hippuric acid, methylhippuric acid, total trichloro-compounds, mandelic acid, and phenol concentrations in urine. Evaluation was based on a scoring system. The scores were on the slope of major axis for probable ellipse, the slope of regression line, square root of error mean square for regression, performance indices, and the difference between 'true' and observed values of each sample. There was a gradual improvement in the evaluation scores as a function of time. The improvement was paralleled by the adoption of modern analytical methods such as flameless atomic absorption spectrometry for blood-lead measurement and high-performance liquid chromatography for urinary hippuric acid determination in many participants. These methods are simple in operation and reliable in performance. It was considered very probable that the program promoted the adoption.

Assessment of tubular function in neonates using urinary beta 2-microglobulin.

Renal proximal tubular function was assessed in neonates by measuring urinary beta 2-microglobulin (beta 2M) concentrations on days 1, 4, 7, 14 and 28. Values were elevated in stable preterm low-birthweight (LBW) neonates but not in stable term LBW neonates, suggesting that proximal tubular maturation is related to gestational age rather than birthweight. The urinary beta 2M was significantly increased on day 1 in neonates with the meconium aspiration syndrome but was not significantly different from normal subsequently. This indicated that although the proximal tubular cells may be susceptible to perinatal hypoxia, they maintain a remarkable capacity to recover in a relatively short period. Neonates with transient tachypnoea of the newborn had normal urinary levels of beta 2M indicating their renal tubular function was not impaired.