[Detection of Residual Solvents in Commercial Supplements Using Headspace (HS)-GC-MS].

In order to understand the actual state of residual solvents contained in commercial supplements, we performed a simultaneous analysis of residual solvents by headspace (HS)-GC-MS with reference to the Japanese Pharmacopoeia's "Residual Solvents", for 29 products selected from among commercial supplements (e.g., revitalizers, weight loss pills) that are deeply colored or contain coating agents and extract powder. As a result, benzene (class 1) was detected in eight black-colored supplements, and hexane (class 2B) was also detected in one of those products. On the other hand, methanol (class 2A) was detected in four products containing coating agents and extract powders, such as citrus peel extract. None of these residual solvents exceeded the concentration limits set by the Japanese Pharmacopoeia. Benzene was detected at 1.7 µg/g, which was near the concentration limit, in some products. As raw materials used for the manufacture of the black-colored supplements from which benzene was detected commonly included activated carbon, we analyzed the residual solvents contained in activated carbon commercially available for use as food additive and in food production and medicine. As a result, benzene was detected at high concentrations in activated carbon made from hemp (approximately 29 µg/g) and bamboo (approximately 140 µg/g).

Headspace GC/MS Analysis of Residual Solvents in Dietary Supplements, Cosmetics, and Household Products Using Ethyl Lactate as a Dissolution Medium.

BACKGROUND: The static headspace technique is one of the most popular techniques for residual solvent analysis and dimethyl sulfoxide (DMSO) and N,N-dimethylformamide (DMF) are widely use as the dissolution media. OBJECTIVE: This study aims to establish ethyl lactate (EL), a solvent with low toxicity and less environmental impact, as an alternative dissolution medium to DMSO and DMF for the static headspace analysis of toxic residual solvents in food, cosmetics, and similar complex organic matrices. METHODS: Samples (a sample of dietary supplement and two samples each of cosmetics and household products) spiked with benzene, carbon tetrachloride, 1,2-dichloroethane, 1,1-dichloroethene, and 1,1,1-trichloroethane were dissolved in EL, DMSO, and DMF. Static headspace GC/MS and the standard addition method were used to detect and quantify the residual solvents. RESULTS: The dissolution and dispersion of these samples, especially the ones which were water-insoluble, were better than those in DMSO and DMF. The recoveries, except that of benzene in an aerosol spray, in EL ranged from 77 to 110%. The relative SDs in EL ranged from 2.5 to 11% and were better or equivalent to those in DMSO and DMF. CONCLUSIONS: EL was suitable as the dissolution medium for such samples, which may contain large amounts of organic solvents or various ingredients, in static headspace GC/MS analysis of residual solvents.

Minimally Invasive Direct Coronary Artery Bypass for the management of Anomalous Left Coronary Artery from the Right Coronary Sinus.

OBJECTIVE: Anomalous left coronary artery from the right coronary sinus (ALCA) is a known cause of sudden death. Surgical correction is recommended for all patients with interarterial course. We describe two patients who underwent surgical correction through an off pump- minimally invasive direct coronary artery bypass (MIDCAB) approach with good short- and mid-term results.

Mass Spectrometric Analysis of Synthetic Organic Pigments.

Though synthetic organic colorants are used in various applications nowadays, there is the concern that impurities by-produced during the manufacturing and degradation products in some of these colorants are persistent organic pollutants and carcinogens. Thus, it is important to identify the synthetic organic colorants in various products, such as commercial paints, ink, cosmetics, food, textile, and plastics. Dyes, which are soluble in water and other solvents, could be analyzed by chromatographic methods. In contrast, it is difficult to analyze synthetic organic pigments by these methods because of their insolubility. This review is an overview of mass spectrometric analysis of synthetic organic pigments by various ionization methods. We highlight a recent study of textile samples by atmospheric pressure solid analysis probe MS. Furthermore, the mass spectral features of synthetic organic pigments and their separation from other components such as paint media and plasticizers are discussed.

Analysis of Primary Aromatic Amines Derived from Azo Colorants in Textile Products and Determination of Their Source Colorant.

Twenty-four primary aromatic amines (PAAs) derived from azo colorants, which are controlled by the Act on Control of Household Products Containing Harmful Substances by the Japan Ministry of Health, Labour and Welfare, aniline and 1,4-phenylendiamine were analyzed in 86 samples of 40 textile products by GC-MS. Even though these PAAs detected in the samples did not exceed the regulation value (30 µg/g), 14 kinds of PAAs were detected that exceeded the limit of quantification. 4,4'-Methylenedianiline, in amounts that exceeded the limit of quantification, was detected in 20 textile samples containing synthesis fiber (16 samples made from polyurethane, two samples made from polyester, and two samples made from acryl); however, it was not detected in natural fiber textile samples. Of these samples, 4,4'-methylenedianiline was detected in 16 out of 19 samples (84%) made from polyurethane fiber. This suggests that 4,4'-methylenedianiline is formed from polyurethane. The origin of 3,3'-dichlorobenzidine was investigated in three samples releasing more than 3 µg/g (3.9-15 µg/g) of 3,3'-dichlorobenzidine using atmospheric pressure solids analysis probe-mass spectrometry and Pigment Orange 13 was identified as the orange colorant in the textile printing parts. This result suggests that 3,3'-dichlorobenzidine detected in these three samples was generated by the reduction of Pigment Orange 13.

Identification of indicator components for the discrimination of Cassia plants in health teas and development of analytical method for the components.

Components that could be used as indicators for the discrimination of senna (Cassia angustifolia) from other cassia plants contained in health teas were identified, and an analytical method for the components was developed. Our results revealed two components in senna that were not found in other Cassia spp. widely used in health teas, such as C. alata, C. corymbosa, C. obtusifolia, and C. occidentalis. Structural elucidation of the two components showed that they were isorhamnetin-3-O-gentiobioside and tinnevellin glucoside. We analyzed commercial health teas using the HPLC method developed in this study. The two indicator components were detected at 366 nm using an RP C18 column and gradient elution with a mixture of water and acetonitrile (with formic acid), as the mobile phase. Our analytical method by HPLC enabled the differentiation of senna from other Cassia plants present in health teas in which sennosides A and B were detected. Moreover, this method allowed us to predict the parts of senna in health teas from the amounts of isorhamnetin-3-O-gentiobioside and tinnevellin glucoside contained in the teas.

Percutaneous tracheostomy can be safely performed in patients with uncorrected coagulopathy after cardiothoracic surgery.

OBJECTIVE: It is a common situation after cardiothoracic surgery that a tracheostomy is required for patients who are coagulopathic or on therapeutic anticoagulation. We present our results of percutaneous tracheostomy with uncorrected coagulopathy. METHODS: Between 2007 and 2012, a total of 149 patients in our Cardiothoracic Surgical Intensive Care Unit underwent percutaneous tracheostomy using the Ciaglia Blue Rhino system (Cook Medical, Bloomington, IN USA). The patients were divided into coagulopathic (platelets, ≤50,000; international normalized ratio of prothrombin time, ≥1.5; and/or partial thromboplastin time, ≥50) and noncoagulopathic groups. Coagulopathy, if present before percutaneous tracheostomy, was not routinely corrected. RESULTS: A total of 75 patients (49%) were coagulopathic. Twenty-one patients (14%) had two or more criteria. The coagulopathic patients had a lower platelet count [108 (106) vs 193 (111) (thousands), P < 0.001], with the lowest of 10; higher international normalized ratio of prothrombin time [1.7 (0.6) vs 1.2 (0.1), P < 0.001], with the highest of 5.3; longer partial thromboplastin time [40 (13) vs 33 (7) seconds, P < 0.001], with the longest of 85; and higher total bilirubin [4.6 (7.3) vs 1.9 (3.3) mg/dL, P = 0.005]. Patient demographics and comorbidities were comparable between the groups. No patients had overt bleeding. One coagulopathic patient (1.3%) had clinical oozing treated with packing, as opposed to zero in the noncoagulopathic patients (P = 1.00). There were no patients with posttracheostomy mediastinitis or late tracheal stenosis. CONCLUSIONS: Uncorrected coagulopathy and therapeutic anticoagulation did not increase bleeding risk for percutaneous tracheostomy in our cardiothoracic surgical patients.

Cardiac surgery in a patient with pemphigus vulgaris: anesthetic and surgical considerations.

Pemphigus vulgaris is an autoimmune disorder that causes blistering of the skin and mucous membranes. We present a patient with pemphigus vulgaris who required combined coronary artery bypass grafting and mitral valve repair. The challenges that we faced and modifications to the technique required in this situation are described and reviewed.

Early and mid-term results of off-pump endarterectomy of the left anterior descending artery.

OBJECTIVES: Many patients referred for coronary artery bypass surgery (CABG) today have diffusely diseased coronary vessels, and some of them may require coronary endarterectomy to provide adequate revascularization. Most reports of coronary endarterectomy describe an on-pump procedure. As off-pump coronary artery bypass graft has become safer and more routine, there is renewed interest in off-pump coronary endarterectomy. We report on our series of patients who underwent off-pump coronary endarterectomy of the left anterior descending (LAD) artery using an open endarterectomy technique. METHODS: All patients undergoing open heart surgery at The Mount Sinai Medical Center are entered into a state-mandated, audited database. A retrospective review of this database revealed 12 patients between January 2008 and June 2012 who underwent off-pump endarterectomy of the LAD as part of their coronary revascularization. Additional data were collected from a review of the patients' charts. RESULTS: There were a total of 12 patients, with a mean age of 72 ± 4 years. Nine (75%) were male and 3 (25%) were female. Comorbidities included hypertension in 11 (92%) patients, dyslipidaemia in 10 (83%), diabetes in 8 (67%), renal failure in 6 (50%) and stroke in 1 (8%). The mean number of diseased coronary territories was 3 ± 0.4 (range 2-3), and the mean number of coronary bypass grafts performed was 4 ± 0.8 (range 2-5). Eight patients required transfusion with packed red blood cells (67%). One (8%) patient was converted from off-pump to on-pump. The mean intensive care unit stay was 3 ± 2.8 (range 1-8 days), and the mean hospital length of stay was 15 ± 13 (range 4-54 days). Postoperative follow-up (mean 24 ± 19 months, range 1-53) is complete, and no ischaemic events have occurred in the early and mid-term follow-up period. CONCLUSIONS: We conclude that off-pump endarterectomy of the LAD is a viable option for patients with diffuse LAD disease.

Anomalous right coronary artery from the left sinus: a minimally invasive approach.

OBJECTIVE: Anomalous right coronary artery arising from the left sinus (ARCA) is a known cause of sudden cardiac death, particularly in young athletes. Surgery is recommended for all adult patients who are symptomatic or who have evidence of exercise-induced myocardial ischemia. Surgical options include coronary artery bypass grafting (CABG) and anatomic correction by unroofing the ostium or by reimplanting the ostium into the right sinus of Valsalva. We describe the rationale and technique of a minimally invasive right thoracotomy approach for correction of ARCA. METHODS: We reviewed all patients with coronary artery disease operated upon at Mount Sinai Medical Center. Between March 2008 and September 2010, 17 patients underwent surgery for anomalous coronary origin from the opposite sinus of Valsalva. Nine of these patients had ARCA. We describe four adult patients with ARCA who were operated upon using a small right anterior thoracotomy incision to perform a right internal mammary artery (RIMA) to right coronary artery (RCA) bypass with ligation of the proximal RCA. This was performed under direct vision and without cardiopulmonary bypass. RESULTS: There were two male and two female patients. Mean age was 55.3 ± 4.8 years (range 50-61 years). Three of the patients manifested chest pain and one each syncope, dyspnea, and palpitations. Two patients had preoperative stress testing that was positive for ischemia. Postoperative follow-up (mean 14 months and range 5-37 months) is complete. All patients are alive and asymptomatic. CONCLUSIONS: ARCA can be managed with good early and midterm results using a minimally invasive right thoracotomy approach.

[Community participation is associated with life satisfaction in elderly people with diabetes mellitus].

METHODS: Comprehensive questionnaires encompassing physical, psychological, and social aspects were administered by interview to 56 elderly outpatients with diabetes mellitus. Life satisfaction was assessed using the Life Satisfaction Index K (LSIK) . We also assessed the emotional and instrumental social support provided by the families living along with the participants or living separately from the participants. The Index of Social Interaction (18 items) was used to assess the social relationships and the environmental social resources, which were classified into 5 domains: 1) independence, 2) social curiosity, 3) relationships with other people, 4) participation in the community, and 5) feelings of safety. RESULTS: In a univariate analysis, the presence of diabetic neuropathy and pain in the lower back or knee joints were associated with low LSIK scores. Community participation, social curiosity, relationships with other people, and instrumental support from families living together with the participants positively correlated with high LSIK scores. The LSIK scores of the leaders of the diabetes patient group were higher than the scores of those who only participated in the diabetes patient group. In a multiple linear regression analysis, community participation, instrumental support from families living along with the participants, and the absence of neuropathy were independently associated with high LSIK scores. CONCLUSION: Community participation is an important factor associated with life satisfaction in elderly people with diabetes mellitus.

Increasing Asian American women's research participation: the Asian grocery store-based cancer education program.

BACKGROUND: Research study participants with diverse characteristics produce the most generalizable outcomes, but recruiting heterogeneous samples is difficult. METHODS: This pilot study tests whether Asian women (N=1079) with diverse language proficiencies, who were personally recruited to one study by a linguistically and culturally aligned recruiter, would enroll in another study with a single mailed invitation in English. RESULTS: The 134 participants in the second study represented 17.2% of those 779 women who had completed both baseline and follow-up surveys in the original study, making this characteristic the best predictor of future study participation. Of the 303 women in the first study who said they would be willing to participate in future studies, 17% (51) participated in the second study. Of the 733 who said they would not be willing to participate in future studies, 11% (83) participated. However, given the larger size of this group, researchers may recruit a greater absolute number of participants from it. While this rate of participation was less than the 25% rate achieved in the first study, the second study's single, mailed English language invitation was likely a barrier to participation. CONCLUSION: Securing IRB-approval to invite prior study participants from traditionally underrepresented communities to a new study is a strategy investigators can use to increase the diversity of their samples. Further research is warranted to determine whether Asian women who have participated in one study might also become effective recruiters for future studies.

Hexamethylene bisacetamide can convert nonpermissive human cells to a permissive state for expressing the major immediate-early genes of human cytomegalovirus by up-regulating NF-kappaB activity.

Expression of the major immediate-early (MIE) genes of human cytomegalovirus (HCMV) in the human thyroid papillary carcinoma cell line TPC-1 is repressed at the transcriptional level. However, treatment of these cells with hexamethylene bisacetamide (HMBA), a chemical inducer of differentiation, for 12 to 24 h before infection enabled the cells to support IE1 and IE2 gene expression and consequently HCMV replication. In HMBA-treated cells the transcription factor NF-kappaB was induced and the MIE promoter (MIEP) was activated. The presence of a NF-kappaB inhibitory peptide SN-50 or expression of a dominant negative IkappaBalpha protein during the HMBA pretreatment period efficiently prevented the HMBA-induced MIEP activation and MIE protein synthesis. Moreover, introduction of mutations into the NF-kappaB binding sites in the MIEP in a plasmid expressing the IE1 protein diminished its ability to express the protein in HMBA-treated cells. Therefore, the NF-kappaB activity previously induced in HMBA-treated cells and the NF-kappaB sites in the MIEP were shown to be essential for HCMV to respond to HMBA action and to express the MIE genes. Investigation of the mechanisms by which HMBA activates NF-kappaB revealed that degradation of IkappaBalpha and translocation of the phosphorylated NF-kappaB p65 subunit to the nucleus, both of which are known to be critical steps in NF-kappaB activation, are stimulated in the HMBA-treated cells. These results indicate that treatment of nonpermissive TPC-1 cells with HMBA induces MIE gene permissiveness by up-regulating NF-kappaB activity.

[Study on processed senna found in health teas].

Sennoside A and B were detected in 21 commercial health tea products surveyed in 2000-2007, but there were 8 products in which the leaves could not be identified as senna because the leaves had become discolored. The results of assay of sennoside levels and TLC chromatograms suggested that processed senna had been used in these products. Next, with reference to tea and health tea manufacturing methods, pharmaceutical senna was roasted or wet-processed experimentally. The results indicated that the discolored leaves contained in commercial health tea were most likely derived from senna leaves. Moreover, sennosides in medicinal doses were detected in some processed senna samples, and were determined to have a cathartic action in mice. Based on morphological confirmation and the results of component analysis, including sennoside, the discolored leaves found in commercial health teas were therefore determined to be senna leaves. There may be possible health risks, including diarrhea.

Accumulation and localization of cesium in edible mushroom (Pleurotus ostreatus) mycelia.

The characteristics of Cs accumulation and localization in edible mushrooms were examined using the mycelia of Pleurotus ostreatus-Y1. Scanning electron microscope images revealed the existence of white spots, and energy dispersive X-ray microanalyzer analysis indicated the presence of larger amounts of Cs and P in these spots in mycelia cultured on medium containing 25 mM CsCl. The (137)Cs activities in the mycelia were approximately 4-6 times higher than those in water used for (137)Cs elution. Higher Cs concentrations in the sediment fraction including vacuolar pellets were obtained compared to the upper fractions. It was observed that yellowish spots caused by the fluorescence of 4',6-diamidino-2-phenylindole (DAPI)-stained polyphosphate were localized in the mycelia. The higher fluorescence intensity of the yellowish-grained spots was measured in comparison with other regions in the mycelium. These results suggested that Cs in the mycelia was trapped by polyphosphate in vacuoles or other organelles.

Japanese American women: behaviors and attitudes toward breast cancer education and screening.

Moores University of California, San Diego, Cancer Center's Asian Grocery Store-Based Cancer Education Program trained bilingual, bicultural student health educators to provide breast cancer information to Japanese American women. A subset consented to help evaluate the program by completing baseline and follow-up surveys. Study participants reported high adherence to mammography screening guidelines, but lower than optimal adherence to clinical breast examination (CBE) and monthly breast self-examination (BSE) guidelines. While less than half of the women felt they had enough knowledge about breast cancer, nearly all indicated that they would be willing to share any knowledge they gained with loved ones and that their loved ones would be receptive to their information. A limitation of the study is its small sample.

[Development of a new method for simple dietary education in elderly individuals with diabetes mellitus].

Some elderly diabetic patients find it difficult to understand conventional dietary and nutritional education using a Japanese food exchange list. We developed a new method for simple dietary education including several dietary instructions. We compared the effects of simple dietary education on food intake, nutritional components, and glycemic control with conventional dietary education, using a randomized control trial. We randomly allocated 30 new elderly diabetic outpatients and 38 outpatients who had been visiting our clinic for a long time to the simple education group and the conventional education group. Before, and 2 or 3 months after simple or conventional education, we assessed food intake and nutritional components for a week using Yoshimura's food frequency questionnaire. In the new diabetic patients, simple and conventional nutritional education similarly reduced HbA1c levels as well as intakes of total energy, sweets, and fruits after the education. However, patients who had been visiting for a long time had no significant differences in total energy intake and HbA1c levels between before and after education in both the simple and conventional groups. Our results suggest that simple dietary education is useful and effective for elderly diabetic patients on their first visit.