The role of inflammatory markers and calculated osmotic pressure in the classification of febrile seizures.

OBJECTIVE: Systemic inflammatory response may contribute to the onset of febrile seizures (FSs). The neutrophil-to-lymphocyte ratio (NLR) has been reported to be useful for differentiating simple and complex FSs in children with a first FS. This study aimed to determine whether easily measurable inflammatory markers were useful for distinguishing between the types of FSs in children with FSs not limited to the first FS. PATIENTS AND METHODS: We conducted a retrospective study of children aged 6-60 months who were presented to the Atsugi City Hospital in Japan for the treatment of FSs between December 2018 and February 2020. A complex FS was defined as a seizure with multiple seizures during the same febrile illness, prolonged seizures and/or focal seizures. A simple FS was defined as a seizure without the characteristics of complex FS. We assessed complete blood count, C-reactive protein, and calculated osmotic pressure. RESULTS: A total of 205 children with FSs (simple, 139; complex, 66) fulfilled the inclusion criteria. None of the inflammatory markers, including NLR, could predict the FS type. The median osmotic pressure was 279.0, 278.8, 283.3, and 278.3 mOsm/kg H2O for children with simple, multiple, prolonged, and focal seizures, respectively. Children with prolonged seizures had a significantly higher calculated osmotic pressure than those with simple FSs (p<0.001) and multiple seizures during the same febrile illness (p=0.004). CONCLUSIONS: Easily measurable inflammatory markers, including NLR, were not useful for distinguishing between types of FSs in children. Large multicenter studies are needed to evaluate the association between osmotic pressure and FS.

Concanavalin A: its action in inducing Oocyte maturation-inducing substance in starfish follicle cells.

Maturation of starfish oocytes is induced by 1-methyladenine produced in follicle cells under the influence of a gonad-stimulating hormonal peptide released from the nervous system. Concanavalin A stimulates isolated follicle cells to produce 1-methyladenine, which suggests that it has the same capacity as the peptide hormone to indirectly induce oocyte maturation.

Relationship between the MRI and EMG measurements.

The purpose of this study was to investigate the effect of intensive eccentric exercise on hamstring muscles by using magnetic resonance imaging (MRI) and to elucidate the relationships between the changes in the electromyographic (EMG) parameters and in the transverse relaxation time (T2) of the hamstring muscles. Seven male volunteers performed eccentric knee flexion exercise, and the EMG activity of the hamstring muscles was simultaneously measured. Before and immediately after the exercise, the maximum isometric knee flexion torque was measured and MR images of the hamstring muscles were obtained. For all hamstring muscles, the EMG activity of the fifth set was significantly lower than that of the first set. For each subject, a significant correlation was detected between the percentage change in the value of the post-exercise T2 value and those of EMG signals during the exercise only for the semitendinosus (ST) muscle and not for the biceps femoris (BF) and the semimembranosus (SM) muscles. These results suggested that the EMG-activity reductions in the BF, ST, and SM muscles were due to neuromuscular fatigue, and moreover the reduction in the ST muscle was due to a failure in the E-C coupling, which was caused by excessive muscle-fiber damage.

Effect of joint position on the electromyographic activity of the semitendinosus muscle.

The semitendinosus (ST) muscle has a tendinous intersection within the muscle belly that separates the ST muscle into distinct proximal and distal compartments. Thus far, no study has compared the electromyographic (EMG) activities between the proximal and distal compartments of the human ST muscle. This study aimed to investigate the intramuscular EMG activity patterns of the proximal and distal compartments of the ST muscle by altering the hip and knee joint positions. The study population comprised eight healthy male volunteers. They performed ramp isometric knee flexion tasks form the relaxed state to the maximal voluntary contraction (MVC) state with (1) the hip and knee at 90 degrees and 0 degrees, respectively (90-0 position), (2) both the hip and knee at 00 (0-0 position), and (3) the hip and knee at 0 degrees and 90 degrees, respectively (0-90 position). Fine-wire electrodes were inserted into the proximal and distal compartments of the ST muscle and the individual EMG activities were recorded. In the 90-0 position, the EMG activity of the distal compartment was higher than that of the proximal compartment at 60%, 80%, and 90% MVC. Moreover, in the 0-90 position, the EMG activity of the proximal compartment was higher than that of the distal compartment at 60% MVC. These results indicated that the lengthened or shortened muscle conditions induced regional differences in the EMG activity patterns, while the two compartments showed equivalent activity when the muscle length was moderate.

Alternative angiotensin II formation in rat arteries occurs only at very high concentrations of angiotensin I.

Contrary to previous reports, recent enzymatic assays showed the predominance of chymase-like activity in rat arteries. We determined the existence and significance of such alternative pathways in rat carotid arteries by measuring contraction of arterial rings in organ baths and blood pressure in conscious rats. Hamster aorta served as a positive control for chymase. Temocapril (30 micromol/L) inhibited the contractions to angiotensin (Ang) I (10(-9) to 10(-5) mol/L) except at high concentrations of Ang I (>10(-7) mol/L). Addition of chymostatin (100 micromol/L) to temocapril exerted a synergistic inhibitory effect. Hamster aorta gave similar results, except that temocapril was 30-fold less effective than in rat arteries. [Pro(11), D-Ala(12)]Ang I (10(-8) to 10(-5) mol/L), a chymase-specific substrate, provoked similar responses in rat and hamster arteries; chymostatin, but not temocapril, attenuated the responses. CV 11974 (30 micromol/L), an Ang II type 1 receptor antagonist, abolished the responses to both peptides. In conscious rats, Ang I (0.03 to 30 microg/kg) and [Pro(11),D-Ala(12)]Ang I (7 to 700 microg/kg) produced similar pressor responses. Not only CV 11974 (1 mg/kg) but also temocapril (2 mg/kg) abolished Ang I-induced responses in vivo. CV 11974, but not temocapril, inhibited responses to [Pro(11), D-Ala(12)]Ang I. Our results showed the presence of the alternative pathway in rat arteries, but it did not play a major role. Arteries with the opposing characteristics of chymase responded equally to [Pro(11),D-Ala(12)]Ang I. These findings suggest that biochemical and [Pro(11),D-Ala(12)]Ang I-derived results may not reflect the functional significance of chymase.

Effects of lisinopril upon cardiac hypertrophy, central and peripheral hemodynamics and neurohumoral factors in spontaneously hypertensive rats.

OBJECTIVE: Left ventricular function (LVF) after reversal of left ventricular hypertrophy (LVH) with antihypertensive therapy is still controversial. The present study was undertaken in spontaneously hypertensive rats (SHR) to determine whether LVF of the regressed heart with lisinopril is normally maintained. DESIGN: We compared cardiac function of SHR after reversal of LVH induced by lisinopril with that observed in control SHR and also with effects after a 4-week washout period. METHODS: Administration of lisinopril began at 15 weeks of age and continued for 20 weeks. Cardiac index, renal blood flow, leg muscle blood flow, plasma renin activity, atrial natriuretic peptide level, and norepinephrine concentration were determined. RESULTS: Lisinopril decreased body weight, blood pressure and left ventricular weight and increased leg muscle blood flow; cardiac index and renal blood flow were unaltered. Although norepinephrine concentration was unchanged, plasma renin activity increased and atrial natriuretic peptide decreased in treated SHR. Peak left ventricular pumping ability during volume loading was comparable in the two groups. After a 4-week washout period, left ventricular mass and blood pressure increased but remained lower than controls; cardiac index at rest and during volume loading was similar in the two groups. CONCLUSIONS: These data indicate that LVF of the regressed heart induced by lisinopril was well preserved at rest, during volume loading and also after spontaneous recurrence of hypertension in SHR.

A new approach for the enzymatic estimation of infarct size: serum peak creatine kinase and time to peak creatine kinase activity.

The relations of several creatine kinase (CK) variables to angiographic left ventricular ejection fraction and abnormally contracting segments in the chronic phase were examined in 2 groups of patients with a first anterior acute myocardial infarction. In group A (n = 22), emergency coronary angiography was performed and nonsurgical early reperfusion was attempted. Such an early revascularization, which was considered partially present in group B (n = 16), which received conventional therapy, shifted the CK time-activity curve to the left and altered its relation to angiographic cardiac function. At similar levels of peak CK, myocardial damage was significantly smaller in patients with successful thrombolysis than in those with unsuccessful reperfusion and conventional therapy (p less than 0.01). In patients whose infarct was considered to be moderate according to peak CK (1,000 to 3,000 U/liter), there was significant correlation between time to peak CK and left ventricular ejection fraction or percent abnormally contracting segments irrespective of their group. The results suggest that one should take into account rapid washout and shorter time to peak CK when estimating enzymatic infarct size in humans. The multivariate analysis of cardiac function with peak CK and time to peak CK resulted in a closer correlation in all patients. Such a correction in the time to peak CK may be a clinically useful approach for better interpretation of infarct size.

REM sleep deprivation effect on apomorphine-induced gnawing is reversed by dexamethasone.

Glucocorticoid feedback was manipulated in rats deprived of REM for six days or left undisturbed in their home cages. One half of each group received concurrent dexamethasone (400 micrograms/kg), while the other half received corn oil. On test day, rats were observed for 5 min, injected with apomorphine (0.8 mg/kg, i.p.), and again observed. Dexamethasone revealed REM-deprivation-enhanced stereotypical gnawing, but had no effect on REM-deprivation-reduced rearing, suggesting the involvement of catecholamine depletion by non-specific stress-related factors in the former REM deprivation effect.

Lisinopril reduces cardiac hypertrophy and mortality in rats with aortocaval fistula.

We evaluated the effects of lisinopril (1 mg/kg per day) on hemodynamics, cardiac hypertrophy, and neurohumoral factors in Wistar rats with an abdominal aortocaval fistula. After 4 weeks of treatment, the results were compared with values obtained for untreated rats with a fistula and for sham-operated rats. Volume loading induced biventricular hypertrophy, hemodynamic signs of high-output heart failure (increased cardiac output, left ventricular end-diastolic pressure, and pulse pressure), and impaired renal function (decreased renal blood flow and kidney weight; increased blood urea nitrogen). Lisinopril did not affect these cardiorenal hemodynamics, but decreased left ventricular mass and mortality rate (both P < 0.05). Lisinopril attenuated the increase in plasma norepinephrine, and increased plasma renin activity (both P < 0.05). Thus, lisinopril reduced left ventricular mass and mortality in rats with high-output heart failure without changing the cardiorenal hemodynamics. Neurohumoral inhibition may play a role in the beneficial effects of lisinopril.

Cardioprotective effects of quinapril after myocardial infarction in hypertensive rats.

Although angiotensin-converting enzyme inhibitors are beneficial for patients with congestive heart failure, the appropriate timing and dosage in acute myocardial infarction are still controversial. We examined the hemodynamic effects of quinapril administered before acute myocardial infarction in spontaneously hypertensive rats (SHR). Quinapril (10 mg/kg per day in drinking water) was started 1 week before infarction and continued for 4 weeks after infarction (total duration 5 weeks). The hemodynamic parameters were evaluated by cardiac catheterization 4 weeks after coronary ligation. Sham-operated SHR served as controls. After infarction, left ventricular end-diastolic and right atrial pressures were increased (P < 0.01) and blood pressure and cardiac index were decreased (P < 0.01); the magnitude of blood pressure reduction was similar in the treated and untreated rats with infarction. Quinapril improved these hemodynamic parameters significantly and decreased left and right ventricular weight. These results suggest that a prior treatment with quinapril in SHR with acute myocardial infarction is hemodynamically beneficial.

Deficiency of holo-, but not apo-, ceruloplasmin in genetically copper-intoxicated LEC mutant rat.

Long-Evans Cinnamon(LEC) mutant rats exhibited less than 5% of normal levels of serum ceruloplasmin oxidase activity, but immunoblot analysis showed normal levels of immunologically detectable ceruloplasmin protein in sera from the mutant rats. Immunostaining of cryosections from the liver tissues with anti-ceruloplasmin antibody showed no significant difference between normal and LEC rats. Results from pulse labeling of ceruloplasmin for 3 hours with [35S]methionine in primary hepatocyte culture, followed by immunoprecipitation, SDS-PAGE and fluorography, showed only minor changes in ceruloplasmin protein synthesis and secretion. These results suggest that the mutation(s) does not affect ceruloplasmin gene expression, but results in a failure in the mechanism whereby copper is incorporated into newly synthesized apoceruloplasmin to produce oxidase active holoform.

Nitric oxide mediates inhibitory effect of losartan on angiotensin-induced contractions in hamster but not rat aorta.

We investigated a possible contribution of nitric oxide (NO) and prostaglandins to the inhibitory effect of losartan on contractions to Ang I (10(-6) M) and Ang II (10(-7) M) with or without L-NAME (10(-4) M) or indomethacin (10(-5) M) in the aorta of WKY, SHR and hamster (n=7 each). Rings of thoracic aorta (2-mm long) were placed in a myograph (5 ml). Endothelium-dependent vasodilations were evaluated with acetylcholine (10(-8) to 10(-6) M). After a 45-minute incubation with L-NAME under a resting tension of 2 g, only hamster aorta contracted (p<0.01). The SHR aorta showed impaired relaxations to acetylcholine compared with the WKY and hamster aorta (p<0.05). Despite the difference in the stimulated NO release, losartan completely abolished the responses to Ang I and Ang II both in WKY and SHR vessels irrespective of the presence of L-NAME. In contrast to the rat aorta, the inhibitory effect of losartan was attenuated in the presence of L-NAME in the hamster aorta (78% vs 99% inhibition, p<0.05). Indomethacin did not alter the effect of losartan in any vessels. Our results suggest that the presence of NO, particularly a basal secretion of NO, is necessary for the full expression of the inhibitory effect of losartan in the hamster, but not in WKY or SHR, aorta. Unlike NO, prostaglandins do not appear to play a role in the effect of losartan.

Transesophageal echocardiographically guided atrial transseptal catheterization in patients with normal-sized atria: incidence of complications.

The incidence of cardiac complications from atrial transseptal catheterization has never been quantified in patients with normal-sized atria. Series defining the complication rate are derived from diseased hearts with structural changes that may alter the complication rate of the procedure. The generation of a standardized incidence of perforation in a population of structurally normal atria has important implications. A total of 46 atrial transseptal catheterizations guided by transesophageal echocardiography (TEE) for radiofrequency ablation of left-sided accessory pathways was performed in 42 patients during a 3-year period (1990-1993). Clinical and echocardiographic data were analyzed, with special attention given to TEE reports pre- and post-transseptal catheterization. Only one complication occurred in the 46 procedures (2.2%): a perforation of the left atrium that led to pericardial effusion and cardiac tamponade. In a small series of patients with normal sized atria, we have demonstrated that TEE-guided transseptal catheterization in a procedure with a low complication rate.

Imaging flaws in soldered joints of integrated circuits using an ultrasound electronic scanning technique.

An electronic scanning c-scopic 25-MHz ultrasonic imaging system has been developed for high-speed precise testing of electronic parts such as ICs. Two-dimensional scanning is performed, one axis being electronic and the other mechanical. A focused beam is formed so as to be a longitudinal wave in solid samples. Voids equal to or larger than 0.2 mm in diameter in the solder are accurately detected and their sizing data agree within 0.1 mm with those measured visually through an optical microscope after destruction. The imaging performance was examined for fatigue cracks in soldered joints. In 1000 heat cycles between -55 and +150 degrees C, cracks resulted in the soldered joints of most samples, and their growth was clearly visible. By comparing the images with those observed by a scanning electron microscope, minimum cracks of 1-mum separation were found to be detectable. The c-scan imaging of a 14x14 mm area of the joints was completed in 1.2 s by the system.

Ultrafast CT scoring system for assessing bronchopulmonary dysplasia: reproducibility and clinical correlation.

PURPOSE: To evaluate the reproducibility of the Ultrafast CT (UFCT) scoring system and assess its usefulness in monitoring clinical severity in infants with bronchopulmonary dysplasia (BPD). MATERIALS AND METHODS: UFCT scoring was done in 22 infants (15 boys and 7 girls aged 1 to 37 months) with BPD. A total of 258 lung fields were evaluated for the presence of hyperaeration, linear opacities, triangular subpleural opacities, and bronchovascular bundle distortion or thickening, and UFCT scores were given. Intraobserver and interobserver agreement and reproducibility of UFCT scores were statistically analyzed. In 12 patients, UFCT scores were linearly correlated with clinical severity scores based on respiratory dysfunction and complexity of care. RESULTS: "Hyperaeration," which was the most frequent (18 of 22, 81.8%) finding, showed high concordance (kappa = 0.73, p < 0.001, kappa = 0.59, p < 0.001), and its UFCT scores significantly correlated with intraobserver and interobserver analyses (r = 0.94, p < 0.001, r = 0.82, p < 0.001, respectively). UFCT scores for hyperaeration significantly correlated with clinical scores (r = 0.75, p < 0.01), whereas those for the others did not. CONCLUSION: UFCT is useful for assessing BPD. Hyperaeration was the most common and reproducible finding, and its extent significantly correlated with clinical severity.

[Reconstruction of the large scalp defect by free flap transplantation].

The reconstruction of a large scalp defect is extremely difficult on many occasions and repeated operations or a long-term hospitalization is often required. In addition, unsatisfactory results are not unusual. However, it is now possible to perform reconstruction by a one-stage operation of free tissue transplantation (free flap) using microsurgical vascular anastomosis which has rapidly developed in the past ten years. We performed reconstructions applying latissimus dorsi musculocutaneous, greater omentum, groin and scapular flaps. The advantages with the free flap are: (1) one-stage reconstruction is possible; (2) no restrictions on the postoperative position, (3) the flap, which is independent of the blood supply from the recipient, well survives on the recipient with an insufficient blood supply and (4) the damage at the donor site can be minimized. On the other hand, its disadvantages are as follows: (1) the operation requires microsurgical vascular anastomoses; and (2) recipient vessels should be normal. The above report was based on favorable results we obtained in 6 cases of reconstruction with free flap applying microvascular techniques.

[A study of trientine therapy in Wilson's disease with neurological symptoms].

D-penicillamine, an orally-administered chelating agent, is effective for Wilson's disease (WD). However 25% of WD patients showed serious adverse reactions to D-penicillamine cause this drug to be discontinued after months or years of treatment. For these cases, trientine-2HCl and trientine-4HCl, less toxic agents, are investigated. Three patients with WD, associated with neurological symptoms, were given either trientine-2HCl or trientine-4HCl. These patients had been on therapy with D-penicillamine. Severe adverse reactions had developed during the course of therapy, and D-penicillamine was discontinued, pancytopenia in case 1, nephrotic syndrome in case 2, and myasthenia gravis in case 3. Trientine-2HCl for case 1, and trientine-4HCl for cases 2 and 3 were instituted and continued. The neurological findings in all patients were extremely improved without side effects by trientine therapy. Though the chelating action on copper is weaker than that of D-penicillamine, it is efficient in improvement of the clinical neurological symptoms.