A case of acute bromvalerylurea intoxication that was successfully treated with direct hemoperfusion.

Bromvalerylurea is included in over-the-counter analgesics and is known to cause chronic bromism. Patients can also present acute intoxication because of suicide attempts. The treatment consists of drug cessation and intravenous drip with furosemide. Few reports have described the efficacy of blood purification therapy in a critical case. We report a 21-year-old Japanese woman who was admitted to our hospital in an unconscious state after she had taken 388 tablets of NARON ACE. She was intubated and high flow continuous hemodiafiltration was initiated because her blood pressure remained low, despite continuous intravenous drip infusion. To remove unknown drugs, direct hemoperfusion was performed twice. NARON ACE contains bromvalerylurea, ibuprofen, ethenzamide, and anhydrous caffeine; only the amount of bromvalerylurea was thought to exceed a lethal dose. The plasma concentrations of bromvalerylurea on the first, second, third, and fourth days were 118.9, 45.1, 30.2, and 12.6 µg/mL, respectively. Her level of consciousness improved on the third day and she was extubated. She became stable and was transferred to the psychiatric department to continue medication on day 14. Her clinical course improved, and she was discharged on day 89. In a potentially fatal case, direct hemoperfusion combined with intravenous drip should be considered.

Correlation between human health and reactive oxygen species produced in blood: a long-term chemiluminescence and fluorescence analysis.

The previous slide-glass type system could simultaneously detect reactive and highly reactive oxygen species, i.e., superoxide radicals (O2-·) and hypochlorite ions (OCl-) elicited from leucocytes in sample blood, but had some drawbacks, i.e., signal noise from air-flow stirring, potential biohazard risks, etc. because of open samples placed on a slide glass. We overcame these drawbacks by adopting a fluidic-chip container in a new system, which resulted in higher sensitivity and more stable measurements. Using the new system, we conducted a pilot study on nominally healthy volunteers to find whether or not the monitored activities of leukocytes can distinguish more or less unhealthy conditions from healthy ones. At first, healthy volunteers of both genders and of various ages showed that the fluctuation magnitudes (%) of O2-· and OCl- were nearly similar to each other and to that of the neutrophil count fluctuation. These parameters sometimes exceeded the healthy fluctuation range. By comparing these large fluctuations with the data of an inflammation marker C-reactive protein (CRP), the neutrophil count fluctuation and the timings/symptoms of abnormalities found in questionnaire, we could gain information suggesting the factors causing the large fluctuations. The new system could detect bodily abnormalities earlier than CRP or self-aware symptoms.

Increasing Meal Frequency in Isoenergetic Conditions Does Not Affect Body Composition Change and Appetite During Weight Gain in Japanese Athletes.

For athletes to gain body mass, especially muscle, an increase in energy consumption is necessary. To increase their energy intake, many athletes consume more meals, including supplementary meals or snacks. However, the influence of meal frequency on changes in body composition and appetite is unclear. The aim of this study was to determine the effect of meal frequency on changes in body composition and appetite during weight gain in athletes through a well-controlled dietary intervention. Ten male collegiate rowers with weight gain goals were included in this study. The subjects were randomly classified into two groups, and dietary intervention was implemented using a crossover method. During the intervention period, all subjects were provided identical meals aimed to provide a positive energy balance. The meals were consumed at a frequency of either three times (regular frequency) or six times (high frequency) a day. Body composition was measured using dual energy X-ray absorptiometry, and the visual analog scale was used for the evaluation of appetite. In both trials, body weight, fat-free mass, and fat mass significantly increased; however, an interaction (Trial × Time) was not observed. Visual analog scale did not vary between trials. Our data suggest that partitioning identical excess dietary intakes over three or six meals does not influence changes in body composition or appetite during weight gain in athletes.

Rapid on-site dual optical system to measure specific reactive oxygen species (O2-• and OCl-) in a tiny droplet of whole blood.

Oxidative stress has been implicated in various disorders and controlling it would be important for healthy life. We have developed a new optical system for easily and accurately measuring oxidative stress in whole blood. It is optimized for simultaneously detecting reactive oxygen species (ROS) and highly reactive ROS (hROS), elicited mostly by white blood cells in a few microliters of blood. Results obtained by using this system show at least four important findings. 1) chemiluminescence of MCLA was confirmed to be attributable to O2-•. 2) PMA-stimulated cells released O2-• longer and more slowly than fMLP-stimulated ones. 3) fluorescence produced by APF oxidation was confirmed to be attributable to hROS, mostly OCl-, produced by myeloperoxidase. 4) the generation of OCl- was found to be a slower process than the O2-• generation. We also conducted pilot studies of oxidative stress in healthy volunteers.

Inhibition of neutrophil superoxide generation by shikonin is associated with suppression of cellular Ca(2+) fluxes.

Shikonin, an anti-inflammatory compound of "Shikon", inhibits the neutrophil superoxide (O2 (•-)) generation by NADPH oxidase 2 (Nox2); however, the mechanisms of how shikonin affects Nox2 activity remained unclear. We aimed to elucidate the relationship between the inhibition of Nox2 activity and influences on intracellular Ca(2+) concentration ([Ca(2+)]i) by shikonin. For this purpose, we used a simultaneous monitoring system for detecting changes in [Ca(2+)]i (by fluorescence) and O2 (•-) generation (by chemiluminescence) and evaluated the effects of shikonin on neutrophil-like HL-60 cells stimulated with N-formyl-l-methionyl-l-leucyl-l-phenylalanine (fMLP). Since fMLP activates Nox2 by elevation in [Ca(2+)]i via fluxes such as inositol 1,4,5-trisphosphate-induced Ca(2+) release (IICR) and store-operated Ca(2+) entry (SOCE), we also evaluated the effects of shikonin on IICR and SOCE. Shikonin dose-dependently inhibited the fMLP-induced elevation in [Ca(2+)]i and O2 (•-) generation (IC50 values of 1.45 and 1.12 µM, respectively) in a synchronized manner. Analyses of specific Ca(2+) fluxes showed that shikonin inhibits IICR and IICR-linked O2 (•-) generation (IC50 values: 0.28 and 0.31 µM for [Ca(2+)]i and O2 (•-), respectively), as well as SOCE and SOCE-linked O2 (•-) generation (IC50 values: 0.39 and 0.25 µM for [Ca(2+)]i and O2 (•-), respectively). These results suggested that shikonin inhibits the O2 (•-) generation by Nox2 in fMLP-stimulated neutrophils by targeting Ca(2+) fluxes such as IICR and SOCE.

EFFECTS OF LONG-TIME COMMUTING AND LONG-HOUR WORKING ON LIFESTYLE AND MENTAL HEALTH AMONG SCHOOL TEACHERS IN TOKYO, JAPAN.

The objective of this study was to investigate the effects of long-time commuting and long-hour working on lifestyle including sleeping, physical exercise, breakfast, smoking, alcohol intake and mental health. In this cross-sectional study, data were collected from 146 school teachers in Tokyo. The binary associations of commuting time and working hours with lifestyle, mental stress measured by the General Health Questionnaire (GHQ) and stress coping measured by the Sense of Coherence (SOC) scores were examined. The Chi-square test was used for statistical analyses. Our results indicated that the mean commuting time and working hours per week of the respondents were 42.1 (SD 22.5) minutes and 50.4 (SD 8.6) hours, respectively. Longer commuting time was significantly associated with shorter working hours (p = 0.023), less physical exercise (p < 0.001) and shorter sleeping hours (p = 0.001). Longer working hours were significantly associated with more frequent working on holidays (p = 0.001), higher SOC scores (p = 0.001) and more smoking (p = 0.028). The negative association between GHQ and SOC scores was also significant (p < 0.001). Our findings revealed that long-time commuters were more likely to sleep less, exercise less and work less long. Long-hour workers were more likely to commute shorter, work on holidays more frequently, smoke more and their stress coping potentials were higher. Some kinds of strategies are required to improve the healthy lifestyle for long-time com- muters or long-hour workers. Key words: stress; stress coping; general health questionnaire; sense of coherence

Cancer screening of healthy volunteers using whole-body 18F-FDG-PET scans: The Nishidai clinic study.

In order to evaluate the diagnostic performance of cancer screening using whole-body (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) scanning for asymptomatic subjects, we conducted a historical cohort study. The study group comprised 5807 individuals who underwent PET scanning from 2002 to 2003. Each subject had carried out a procedure with whole-body (18)F-FDG-PET scan with some other diagnostic tests. Out of 5807 participants, data from 4881 subjects were analysed. Among them, PET screening revealed abnormal FDG uptake in 562 subjects, and possible or probable malignancy in 324 subjects, and histological diagnosis of cancer in 36 subjects (16 thyroid, seven colon, four lung, five breast, two prostate, and two others) out of them. The overall cancer detection rate was 0.7%, and PET scanning had a sensitivity of 70.6% and a specificity of 94.0%. This result warrants further prospective cohort studies to evaluate the usefulness of PET cancer screening for cancer prevention.

Molecular dissection of a medicinal herb with anti-tumor activity by oligonucleotide microarray.

It is difficult to understand precisely the physiological actions of herbs because they contain a complex array of constituent molecules. In the present study we used DNA microarray data for 12600 genes to examine the anti-proliferative activity of the herb Coptidis rhizoma and eight constituent molecules against eight human pancreatic cancer cell lines. We identified 27 genes showing strong correlation with the 50% inhibitory dose (ID50) of C. rhizoma after 72-h exposure. Hierarchical cluster analysis with correlation coefficients between expression levels of these 27 C. rhizoma-related genes and the ID50 of each constituent molecule classified these test molecules into two clusters, one consisting of C. rhizoma and berberine and the other consisting of the remaining seven molecules. Our results suggest that one molecule, berberine, can account for the majority of the anti-proliferative activity of C. rhizoma and that DNA microarray analyses can be used to improve our understanding of the actions of an intact herb.

[Effect of Kampo medicines on the peripheral blood flow rate of betamethason-induced Oketsu syndrome mice by laser Doppler flow meter].

Stagnation of peripheral blood flow is the cause of various diseases. Changes in peripheral blood flow after oral administration of Kampo medicines in mice with betamethasone-induced oketsu syndrome and normal mice were examined using a laser Doppler blood flow meter. The Kampo medicines used were: Toki-shakuyaku-san; Kami-shoyo-san; Keishi-bukuryo-gan; Daio-botanpi-to; Tokaku-joki-to; Goshuyu-to; and Hange-koboku-to. In the oketsu mice, blood flow was improved by single-dose administration of Toki-shakuyaku-san, Kami-shoyo-san, Keishi-bukuryo-gan, Daio-botanpi-to, Tokaku-joki-to, and Goshuyu-to, but only Toki-shakuyaku-san increased blood flow significantly in normal mice. In addition, blood flow decreased after single-dose administration of Keishi-bukuryo-gan, Daio-botanpi-to, and Tokaku-joki-to in normal mice.

In vivo magnetic resonance evaluation of associations between aortic atherosclerosis and both risk factors and coronary artery disease in patients referred for coronary angiography.

BACKGROUND: Magnetic resonance imaging was recently reported to detect atherosclerotic plaques in thoracic and abdominal aortas. METHODS: Using magnetic resonance imaging, we investigated associations of risk factors and plasma inflammatory markers with plaques in both thoracic and abdominal aortas in 102 patients undergoing coronary angiography. Associations between coronary artery disease (CAD) and aortic plaques were also evaluated. RESULTS: Plaques in thoracic and abdominal aortas were detected in 61% and 90% of patients, respectively. Age and systolic blood pressure correlated with plaque extents in both the aortas. Serum LDL cholesterol level correlated with plaque extent in the thoracic aorta (r(s) = 0.42). The degree of smoking correlated with plaque extent in the abdominal aorta (r(s) = 0.43). In multivariate analysis, age and systolic blood pressure were associated with plaques in both the aortas. The LDL cholesterol and smoking were characteristically associated with plaques in the thoracic and abdominal aortas, respectively. Regarding inflammatory markers, fibrinogen and C-reactive protein levels correlated with total plaque extent in the aortas (r(s) = 0.50 and r(s) = 0.51). Compared with 24 patients without CAD, 78 with CAD more often had plaques in the thoracic (71% vs 29%) and abdominal (95% vs 75%) aortas. Although plaque extents in both the aortas correlated with the severity of CAD, only thoracic plaques were independently associated with CAD. CONCLUSIONS: The thoracic and abdominal aortas may have different susceptibilities to risk factors. However, plasma inflammatory markers appear to reflect total extent of aortic atherosclerosis. Although aortic plaques are common in patients with CAD, only thoracic plaques are an independent factor for CAD.

Success rate of endodontic treatment of teeth with vital and nonvital pulps. A meta-analysis.

OBJECTIVE: The purpose of this study was to use meta-analysis statistics to determine the influence of factors such as apical limit (short vs. overextension), status of the pulp (vital vs. nonvital), and periapical status (presence or absence of radiolucency) on endodontic prognosis. Study design The study-list was obtained by using a MEDLINE search and Japana Centra Revuo Medicina search. Only those papers in which the criteria for success or failure was exactly described were accepted. RESULTS: The cumulative success rate of 82.8 +/- 1.19% (average +/-95% confidence interval) was obtained for vital pulp; and 78.9 +/- 1.05%, for nonvital ones. There was a significant difference between the 2 groups.The cumulative success rates with overextension, flush, and underextension in vital teeth were 70.8 +/- 1.44, 86.5 +/- 0.88, and 85.5 +/- 0.98% respectively. There was a significant difference between flush and overextension and between flush and underextension. The rates for nonvital pulp were similar to those for vital ones. CONCLUSION: The root canal should be filled to within 2 mm of the radiographic apex.

Potential of noncontrast electrocardiogram-gated half-fourier fast-spin-echo magnetic resonance imaging to monitor dynamically altered perfusion in regional lung.

RATIONALE AND OBJECTIVES: The potential of a noncontrast, electrocardiography (ECG)-gated fast-spin-echo (FSE) MR imaging (MRI) to monitor dynamically altered regional lung perfusion was assessed in acute and temporal pulmonary embolic and airway obstruction dog models. MATERIALS AND METHODS: After acquisition of ECG-gated multiphase FSE MR images during one cardiac cycle, the two phase images of the minimal lung signal intensity (SI) during systole and the maximal SI during diastole were acquired in the lower lung levels in six normal dogs, in 13 dogs before and for 35 minutes after temporal microvascular embolization in regional lungs with gradually degradable starch microspheres of spherex, and in 12 dogs before and for 45 minutes after bronchial occlusion with a balloon catheter. In three of the 13 embolic models, the opposite lung areas, however, were permanently embolized with enbucrilate. Subtraction between the diastolic and systolic images yielded a perfusion-weighted image. The results were compared with a gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA)-enhanced dynamic perfusion MRI, which was subsequently performed after the ECG-gated MRI in each animal. RESULTS: The multiphase FSE images provided cardiac-dependent pulsatile lung SI changes, and the subtracted perfusion-weighted images provided a uniform perfusion map in normal lungs. In all the embolic models, the subtracted perfusion-weighted images showed gradual disappearance of the spherex-induced perfusion deficits, while the enbucrilate-induced perfusion deficits persistently remained in the three animals. In all airway obstruction models, these images showed gradually decreased perfusion in the hypoventilated areas. These results were consistent with the matched Gd-DTPA-enhanced pulmonary arterial perfusion phase images in each animal. CONCLUSION: This noncontrast perfusion MRI may have excellent potential for continuously monitoring dynamically changed regional lung perfusion within a short time on its high spatial resolution cross-sectional images.