Left-sided approach for cardiac procedure and thoracoplasty in a patient with Marfan syndrome.

We present a case of a 20-year-old female in whom we successfully performed a simultaneous Bentall procedure and thoracoplasty by initially removing only the left side of the costal cartilages. This modified sternal elevation technique offered chest stability and an excellent surgical view, and the postoperative course was satisfactory.

Faithful qubit distribution assisted by one additional qubit against collective noise.

We propose a distribution scheme of polarization states of a single photon over a collective-noise channel. By adding one extra photon with a fixed polarization, we can protect the state against collective noise via a parity-check measurement and postselection. While the scheme succeeds only probabilistically, it is simpler and more flexible than the schemes utilizing decoherence-free subspace. An application to the Bennett-Brassard 1984 protocol through a collective-noise channel, which is robust to the Trojan horse attack, is also given.

Invertebrate connectin spans as much as 3.5 microm in the giant sarcomeres of crayfish claw muscle.

In crayfish claw closer muscle, the giant sarcomeres are 8.3 microm long at rest, four times longer than vertebrate striated muscle sarcomeres, and they are extensible up to 13 microm upon stretch. Invertebrate connectin (I-connectin) is an elastic protein which holds the A band at the center of the sarcomere. The entire sequence of crayfish I-connectin was predicted from cDNA sequences of 53 424 bp (17 352 residues; 1960 kDa). Crayfish I-connectin contains two novel 68- and 71-residue repeats, and also two PEVK domains and one kettin region. Kettin is a small isoform of I-connectin. Immunoblot tests using antibody to the 68-residue repeats revealed the presence of I-connectin also in long sarcomeres of insect leg muscle and barnacle ventral muscle. Immunofluorescence microscopy demonstrated that the two repeats, the long spacer and the two PEVK domains contribute to sarcomere extension. These regions rich in charged amino acids, occupying 63% of the crayfish I-connectin molecule, may allow a span of a 3.5 microm distance as a new class of composite spring.

[Treatment of cardial varicose bleeding by trans-ileocolic vein obliteration combined with endoscopic injection sclerotherapy].

In the past 4 years, 11 patients with cardial varix bleeding were experienced. The cardial varices were of 2 types, nodular and serpentine. The nodular varices were caused by gastro-renal shunt and the site of bleeding often existed on the posterior wall. The serpentine cardial varices were an extension of esophageal varices, and the site of bleeding was often on the lesser curvature. The nodular varices had an abundant blood flow. When EIS was performed to these varices independently, the time of contact with the sclerosing agent was so short that no therapeutic effect was obtained. For the purpose of decreasing the blood flow in these varices, TIO was performed first and then EIS was used in the treatment of four cases of nodular varix bleeding. Hemostasis was obtained in two of the four cases with TIO alone, and after the addition of EIS a good hemostatic and varix-reducing effect was noted in all four cases.

Profiles of carbohydrate-metabolizing enzymes in human hepatocellular carcinomas and preneoplastic livers.

Activities of key carbohydrate-metabolizing enzymes in biopsied human tissues of hepatocellular carcinoma and related conditions were determined by established methods. Among the enzymes analyzed, fetal-type liver enzymes (low-Km hexokinase, glucose 6-phosphate dehydrogenase, and pyruvate kinase-M2) showed increased activities, and adult-type liver enzymes [glucose 6-phosphatase, fructose 1,6-bisphosphatase, high-Km hexokinase (or glucokinase), and pyruvate kinase-L] showed decreased activities, resulting in undifferentiated enzyme patterns not only in fetal livers and hepatocellular carcinomas but also in livers of acute and chronic hepatitis and liver cirrhosis with or without tumors. Hepatocellular carcinomas showed a general tendency of having greater enzyme deviations than hepatitic and cirrhotic livers. The extent of the enzyme deviation in hepatocellular carcinomas varied considerably from one enzyme to another for each tumor tissue as compared with that in the benign liver diseases. Thus, the phenotypic heterogeneity was important for discriminating between the neoplastic and inflammatory changes in differentiation markers. The enzyme patterns of tumors and their corresponding host cirrhotic livers were unrelated, suggesting that the cirrhotic liver has a significance as preneoplastic state only in terms of having a high incidence of evolving hepatocellular carcinoma.

Responses of plasma cyclic AMP, serum immunoreactive insulin, C-peptide immunoreactivity and blood sugar levels to glucagon in patients with liver diseases.

Levels of plasma cyclic AMP, serum immunoreactive insulin (IRI), serum c-peptide immunoreactivity (CPR) and blood sugar (BS) were determined 0, 15, 30, 45 and 60 min after a glucagon injection (0.01 mg per kg body weight) in normal controls, patients with acute hepatitis and liver cirrhosis. Plasma cyclic AMP responses to glucagon in liver disease patients varied widely in peak value, and only in patients with fulminant hepatitis and decompensated liver cirrhosis with poor prognosis was the response suppressed. The peak response of BS was found significantly later in liver cirrhosis patients than in normal controls. IRI and CPR responses to glucagon were lower in acute hepatitis patients than in normal controls and liver cirrhosis patients. IRI levels and their sum were also lower in acute hepatitis patients, although CPR levels were not significantly different. Thus, the ratio of the sum of CPR from 0 to 60 min to that of IRI was significantly higher in acute hepatitis, indicating impaired pancreatic secretion of insulin to glucagon stimulation as well as increased uptake of insulin by the liver in acute hepatitis.

Increased excretion of urinary cyclic GMP in primary hepatoma and preneoplastic liver.

Urinary excretion of cyclic GMP (cGMP) and the plasma level of cyclic AMP (cAMP) were determined in patients with liver diseases. The urinary excretion of cGMP, expressed on the basis of creatinine excreted per day, was at significantly higher levels not only in primary hepatoma but also in liver cirrhosis, while the plasma level of cAMP was higher only in liver cirrhosis. Thus, the ratio of urinary cGMP excretion to plasma cAMP level in primary hepatoma was significantly higher than that in liver cirrhosis. In cirrhotic patients studied by catheterization, the level of cGMP in the hepatic vein was significantly lower than that in the superior mesenteric or portal vein, indicating the uptake of cGMP by the liver. Since cGMP excretion correlated with KICG both in liver cirrhosis and primary hepatoma, the increased cGMP excretion appeared to be explained by a reduced uptake of cGMP by the liver.

Procedural variations in group contingencies: effects on children's academic and social behaviors.

There has been little research on the effects of the many procedural variables in applied group contingencies. In the present study, an individualized contingency and three group contingencies with different "responder" criteria (e.g., reward based on the group average, reward based on the work of a designated, low-achieving student, or reward based on the work of a randomly selected student) were applied to the academic work of primary grade children in a learning disabilities classroom. Group social interaction during each contingency was measured systematically. Although there were large individual differences in students' academic and social responses to the different contingencies, some consistent effects were observed. Two of the four low-achieving target students did their best academic work during the group contingency which focused on their performance as a designated responder. This type of contingency also produced high levels of positive social interaction in three of four groups of children observed.

Tumor-associated hyperamylasemia.

Studies were made in eight patients with hyperamylasemia associated with cancer of the lung, pancreas or colon. Isoamylase analysis, conducted in seven of the eight patients revealed that the dominant isoamylase component was S-type in three and P-type in three; in one patient both isoamylases were elevated about equally. Examination of the serum or urine of the same seven patients for subcomponent isoamylase disclosed the presence in two of the seven of an unusual isoamylase designated "Y-type". This subcomponent isoamylase was also found in some samples of human milk, but not in normal persons or in patients with a variety of disorders other than cancer. The significance of hyperamylasemia occurring in association with cancers, the factors responsible for the variability in isoamylase pattern in those with hyperamylasemia, and the relationship, if any, of the "Y" isoamylase form to cellular growth and replication are all presently obscure and remain to be elucidated.

Assay of amylase and isoamylase activities in serum and urine. Modifications in methods and range of normal values.

Certain modifications are described in assay methods previously reported from this laboratory for total amylase and isoamylase activities. These modifications provided more consistent results and achieve superior separation of pancreatic and salivary type (P- and S-type) isoamylases. The estimated range of values in the serum and urine of normal subjects using the modified assay procedures is presented for total amylase as well as for P- and S-type isoamylases.

Unusual isomaylase in cancer-associated hyperamylasemia.

Hyperamylasemia and hyperamylasuria were found in two patients with carcinoma of the pancreas and in two other patients with carcinoma of the lung. Detailed isoamylase analyses were conducted on the serum amylase of three and the urine amylase of all four of these patients, using a modified chromatographic procedure. The studies demonstrated the existence, in one of the lung cancer patients and in one of the patients with pancreatic cancer, of an unusual component of amylase given the designation "Y." This component had also been noted in some human milk samples. In one of the lung cancer patients, an isoamylase was found in the serum and urine after radiation treatment that was close to but not identical to the Y isoamylase in chromatographic position. Although a relationship of isoamylase component Y to generating tissue is suggested by these findings, such a relationship of isoamylase component Y to generating tissue is suggested by these findings, such a relationship remains to be proven.

Nonpancreatic-type hyperamylasemia associated with pancreatic cancer.

Isoamylase analysis of the serum and urine of a patient with anaplastic spindel cell carcinoma of the pancreas revealed that virtually all of the serum amylase and almost all of the urine amylase behaved chromatographically as the salivary (S) type. Both the serum and urine amylases were bound by a substance derived from a macroamylase complex which had been shown to bind only salivary amylase and to lack any affinity for pancreatitis (P) type amylase. The ratio of amylase to creatinine clearance was markedly increased (12.5%) without evidence of acute pancreatitis at autopsy and despite the presence of only a minute amount of P-type isoamylase in the serum.

Undifferentiated patterns of key carbohydrate-metabolizing enzymes in injured livers. II. Human viral hepatitis and cirrhosis of the liver.

Activities of key carbohydrate-metabolizing enzymes were determined on biopsied liver tissues obtained from patients with acute and chronic viral hepatitis and postnecrotic cirrhosis of the liver. The results indicated that the activities of fetal or prototype enzymes, low-Km hexokinases, glucose-6-phosphate dehydrogenase and pyruvate kinase type M2 increased, while those of adult type liver enzymes, glucokinase, glucose-6-phosphatase, fructose-1, 6-diphosphatase and pyruvate kinase type L decreased in livers of these cases. Phosphofructokinase activity tended to increase only acute hepatitis. Principal component analysis revealed that the enzyme patterns of acute hepatitis and liver cirrhosis were most deviated from the control and closely resembled those of hepatocellular carcinomas.

Does human pancreas contain salivary-type isoamylase?

Amylase isoenzyme analysis was made of extracts of normal human pancreatic tissue by first conducting ion exchange chromatography of the purified material. This gave evidence of only pancreatic type (P-type) isoamylase for all purposes. However, when effluent fractions in which salivary type isoamylase would ordinarily be expected to be present were harvested, pooled, concentrated, and rechromatographed, the pancreatic extracts were found to contain some salivary type (S-type) isoamylase. The latter accounted for approximately 0-8 to 1-7% of the total recovered amylase activity. This finding of S-type isoamylase in normal human pancreas potentially has important bearing on the interpretation of isamylase analysis.