Biomedical subjects
Publications and source records attributed to R Takeda.
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We developed a new rating scale, Kohnan Vegetative Score, to measure severity and small clinical changes in vegetative state patients. It has 7 items corresponding to the conditions of vegetative state by Japanese Society of Neurosurgery: motor function, food ingestion, urination and defecation, eye movement, vocalization, communication, and facial expression. Each item is rated in 5 ordinal categories: slight (score = 1), mild(2), moderate(4), and extreme(5). The sum of the scores is used as the summary score, which ranges from 7 to 35, and high score means 'severe'. We examined the reliability and the factorial structure of the Kohnan Vegetative Score. The subjects were 10 patients who met the conditions of vegetative state. Four neurosurgeons rated the subjects, and then 2 of them repeated the rating after one week interval. As a measure of reliability, the (weighted) Kappa coefficient proposed Cohen (1960, 1968) was calculated for each item, and the intraclass correlation coefficient (ICC) was calculated for the summary score. To analyze the factorial structure, the factor analysis was carried out. The minimum and the maximum weighted Kappa values were 0.44 and 0.64 for intra-rater reliability, and 0.37 and 0.69 for inter-rater reliability, respectively. Concerning the factorial structure, the contribution of the first factor was 91.5% which indicated the unidimensionality of the scale. The ICC's estimate for the summary score were 0.90 (95% C.I.: 0.766-0.970). On the basis of these results, the Kohnan Vegetative Score has unidimensionality and high reliability enough for a practical use.
1. In the vagotomized cat, blockade of NMDA receptors by dizocilpine (MK-801) produces an apneustic pattern of respiration characterized by a large increase in the duration of inspiration. 2. To identify dizocilpine-induced disfacilitations and disinhibitions in respiratory neurones generating the respiratory rhythm, membrane potential and input resistance of augmenting inspiratory (I; n = 11) and post-inspiratory (PI; n = 9) neurones were examined in the ventral respiratory group area, before and after administration of dizocilpine (0.1-0.3 mg kg-1 i.v.) in decerebrate, vagotomized, paralysed and artificially ventilated cats. 3. In I neurones, dizocilpine decreased the ramp depolarization and an 82% increase in input resistance was observed during inspiration. The inspiratory phase was prolonged, leading to a sustained level of depolarization during apneusis. The amplitude of stage 1 expiratory hyperpolarization decreased and its decay, which is normally slow, was faster. Throughout the remainder of expiration (stage 2) the membrane potential levelled off and the input resistance increased slightly (by 15%). 4. In PI neurones, dizocilpine depressed depolarization and suppressed firing in eight out of nine cells during the stage 1 expiratory phase. This was associated with a large (91%) increase of input resistance. The membrane potential switched quickly to stage 2 expiratory repolarization, during which a slight (19%) increase in input resistance occurred. 5. The hyperpolarization of PI neurones during early inspiration was reduced in amplitude by dizocilpine and input resistance was increased by 75% during inspiration, indicating that dizocilpine reduced the activity of the presynaptic inhibitory early-inspiratory (eI) neurones. 6. We conclude that NMDA receptor blockade in the respiratory network disfacilitates eI, I and PI neurones during their active phase. Decreased inhibitory processes during the inspiratory phase probably play a major role in the prolongation of inspiration.
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Intracellular recordings of bulbar inspiratory and post-inspiratory neurons, combined with extracellular iontophoresis of antagonists of putative neurotransmitters, were performed in decerebrate cats. Inhibitory postsynaptic potentials (IPSPs) evoked by stimulation of the superior laryngeal nerve or vagus nerve were depressed by bicuculline in all 22 neurons tested, but not modified by strychnine. The non-N-methyl-D-aspartate (NMDA) glutamate antagonist 6,7-dinitroquinoxaline-2,3-dione (DNQX) decreased the neurally evoked excitatory postsynaptic potentials (EPSPs) in 23 out of 26 neurons tested, while the NMDA antagonist dizocilpine had no notable effect. The present results suggest that the peripherally induced IPSPs are mediated through gamma-aminobutyric acid (GABA)A receptors and the EPSPs through non-NMDA glutamate receptors in bulbar respiratory neurons.
123I 15-(p-iodophenyl)-3(R,S)-methylpentadecanoic acid (BMIPP) myocardial scintigraphy and exercise stress thallium (TI)-201 myocardial scintigraphy were performed in 17 patients with hypertrophic cardiomyopathy (HCM) to evaluate the existence of abnormal fatty acid metabolism in the myocardium and the relationship between this abnormality and myocardial ischemia. On the BMIPP scintigraphy, abnormalities were found in 12 of 17 patients (71%). Five patients showing no abnormalities on the BMIPP scintigraphy had well preserved exercise tolerance and had longer exercise duration than the others showing BMIPP scintigraphic abnormalities (P < 0.001). On the evaluation of the segmental abnormalities, TI scintigraphic abnormalities were found in 15 (50%) of 30 segments showing decreased accumulation of BMIPP. On the other hand, BMIPP scintigraphic abnormalities were found in all segments showing decreased accumulation of TI. The sites of decreased accumulation of BMIPP and TI were in good agreement with the sites of wall hypertrophy. Four patients showing BMIPP scintigraphic abnormalities and no T1 scintigraphic abnormalities were in higher New York Heart Association functional classes, had shorter exercise duration (P < 0.05) than the 5 patients showing no abnormalities on either scintigraphy. It is concluded that abnormalities of fatty acid metabolism in the heart are detected at a high rate in patients with HCM, and may be due in part to factors other than myocardial perfusion disturbance.
Intracellular recordings were made from bulbar respiratory neurones of decerebrate cats, together with iontophoretic application of acetylcholine and its specific antagonists to assess cholinergic mechanisms involved in the central respiratory network in vivo. Of 126 respiratory-related neurones impaled in the ventral respiratory group, iontophoresis of acetylcholine produced depolarization in 67 cells (53%), hyperpolarization in 36 cells (29%), and no effect in the remaining 23 cells (18%). Depolarization occurred predominantly in laryngeal motoneurones (31/40) and bulbo-spinal neurones (4/5), while a comparable number of non-antidromically-activated respiratory neurones displayed either depolarization (33/81) or hyperpolarization (31/81). Acetylcholine had no significant effect on excitatory and inhibitory postsynaptic potentials in all types of neurones tested. Both depolarizing effects of acetylcholine were antagonized by co-iontophoresis of atropine, but not by hexamethonium. Input resistance was increased (7/9) or unchanged (2/9) in depolarized cells, whereas it was unaltered in all hyperpolarized cells tested (n = 6). The present results suggest that the distribution and functions of cholinergic muscarinic receptors are different for the laryngeal and bulbo-spinal types of respiratory neurones and the non-antidromically-activated respiratory neurones in the cat.
To evaluate the clinical significance of HLA class II matching in living-related liver transplantation, the genotypes of HLA class II including DPB1 were determined by the PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) method and their matching was compared to the postoperative course. Conventional serotypes included 15.6% and 13.6% errors in DR and DQ, respectively. Among 42 consecutive cases that were followed up over 1 year after transplant, rejection occurred in seven cases. There was no correlation between the matching for each locus and the frequency of rejection episodes. In this study, rejection-free cases were investigated in terms of the potency of immunosuppressive therapy and graft function during 1 year after operation. The doses of tacrolimus in unmatched cases tended to be larger than those in matched cases for every locus except for DQA1. Its trough levels in matched cases were lower than those in unmatched cases, especially at 9-12 months after operation for DRB1 (p < 0.05). The termination of steroid administration tended to be postponed in unmatched cases for every locus. Serum levels of asparatan transaminase, alanine transaminase gamma-glutamyltranspeptidase (gamma-GTP) and total bilirubin were generally lower in matched cases than in unmatched ones for DRB1, DQB1 and DPB1, while in DQA1 the tendency was the opposite, especially total bilirubin and gamma-GTP, which were p < 0.02 and p < 0.05, respectively, at 6 months after operation. Investigation of subclinical immune responses other than rejection episodes showed that DRB1, DQB1 and DPB1 matching had a beneficial effect on graft function, while DQA1 matching seemed to have a varied effect.
A rare injury, a traumatic false aneurysm of ulnar proper digital artery of the left thumb in a softball catcher, is described. Noninvasive ultrasonographic evaluation led to an accurate diagnosis of the aneurysm, which was caused by blunt trauma by a softball.
Among proglucagon-derived peptides, the truncated form of glucagon-like peptide-1, GLP-1(7-36)amide (tGLP-1), is known as the most likely physiological humoral incretin. To examine whether there exists any relationship between tGLP-1 levels in the portal vein and activities of the hepatic and pancreatic vagal system, changes of the impulse discharge rate in the hepatic afferent vagus and the pancreatic efferent vagus upon intraportal tGLP-1 injection were measured in situ in rats anesthetized with urethan and chloralose. First, a 1-min bolus tGLP-1 injection at a periphysiological dose of 0.2 pmol or a pharmacological dose of 4.0 pmol, but not the vehicle injection, significantly facilitated the hepatic vagal afferents for > 90 min, showing weaker facilitation at the 0.05 pmol dose. Notably, the injection of noninsulinotropic full-length GLP-1 failed to facilitate the afferents at the 4.0 or 40.0 pmol dose. Second, the intraportal tGLP-1 injections at the 0.05 and 0.2 pmol dose facilitated marginally and significantly the pancreatic vagal efferents in normal rats, respectively, but had no effect on the hepatic vagotomized rats, even at the 40.0 pmol dose. The present results indicate that an intraportal appearance of tGLP-1 is specifically recognized by the hepatic vagal nerve, and this recognition further augments the pancreatic vagal efferent activity in a reflex way, suggesting another nature of tGLP-1 as neuroincretin in the enteroinsular axis.
11 beta-Hydroxysteroid dehydrogenase (11 beta-HSD) modulates the access of corticosteroids to their receptors and is important in blood pressure control. The excretion of renal 11 beta-HSD (ie, NAD(+)-dependent isoform) is thought to protect renal mineralocorticoid receptors from cortisol. To examine whether endogenous renal 11 beta-HSD inhibitory factor(s) may be involved in the pathophysiology of hypertension, we studied the urinary excretion of such inhibitors in 30 patients with low-renin essential hypertension and 20 normotensive control subjects. The effect of sodium restriction on the urinary excretion of the inhibitors wa also evaluated in six normotensive control subjects. Urine was extracted with Sep-Pak cartridges and high-performance liquid chromatography. Endogenous renal 11 beta-HSD inhibitors were measured by the inhibition of 11 beta-HSD bioactivity in microsomes from the human kidney. The urinary excretion of the inhibitors was significantly increased in patients with low-renin essential hypertension (1280 +/- 88 nmol/d, mean +/- SEM) compared with normotensive control subjects (704 +/- 56 nmol/d) (P < .05). Ratios of urinary tetrahydrocortisol+allo-tetrahydrocortisol to tetrahydrocortisone did not differ significantly. Sodium restriction reduced the urinary excretion of the endogenous renal 11 beta-HSD inhibitors but did not affect the ratio of urinary tetrahydrocortisol+allo-tetrahydrocortisol to tetrahydrocortisone. Endogenous renal 11 beta-HSD inhibitory factors may contribute to the pathogenesis of low-renin essential hypertension by modulating the activity of 11 beta-HSD. Sodium intake may directly or indirectly regulate the inhibitory factors.
The hormone, 19-noraldosterone, which was recently shown to be synthesized and produced in the human adrenal gland, exhibits potent mineralocorticoid and hypertensinogenic activities. This hormone is controlled in part by the renin-angiotensin system. We studied the effects of ACTH stimulation on the synthesis of 19-noraldosterone in vitro and in six normal men. 19-Noraldosterone was measured by a specific RIA after the urine extract or incubation medium was purified by high performance liquid chromatography. The 24-h urinary excretion of 19-noraldosterone increased approximately 4-fold during the administration of ACTH (40 U, injected im twice daily for 3 days). Virtually identical responses were observed with aldosterone, 18-hydroxycorticosterone, 18,19-dihydroxycorticosterone, and 18-hydroxy-19-norcorticosterone. Glomerulosa cells isolated from human adrenals were incubated with angiotensin II (10(-7), 10(-8), and 10(-9) mol/L) or ACTH (10(-8), 10(-9), and 10(-10) mol/L). Angiotensin II and ACTH increased the production of 19-noraldosterone dose-dependently from isolated glomerulosa cells. The secretion of aldosterone, 18-hydroxycorticosterone, 18,19-dihydroxycorticosterone, and 18-hydroxy-19-norcorticosterone in response to angiotensin II and ACTH was identical to that of 19-noraldosterone. These observations suggest that 19-noraldosterone is stimulated by the renin-angiotensin system as well as ACTH.
Mineralocorticoids have been suggested to act on blood vessels, leading to increased vasoreactivity and peripheral resistance. Aldosterone is synthesized locally in blood vessels and participates in the hypertrophy of vascular smooth muscle cells. In this study we examined the effects of angiotensin II (ANG II), potassium, and ACTH on the production of aldosterone, the activity of aldosterone synthase, and the expression of CYP11B2 and CYP11B1 messenger ribonucleic acid (mRNA) in cultured human vascular endothelial cells. Human vascular endothelial cells were incubated with ANG II, potassium, or ACTH with or without [14C]deoxycorticosterone ([14C]DOC). Incubation medium was collected, and chromatography was preformed in a reverse phase high performance liquid chromatography system. The concentration of aldosterone in the incubation medium was measured using RIA after separation with the high performance liquid chromatography system. The activity of aldosterone synthase was estimated by the conversion of [14C]DOC to [14C]aldosterone. The levels of CYP11B2 and CYP11B1 mRNA were determined by competitive PCR. ANG II, potassium, and ACTH increased the production levels of aldosterone in a dose-dependent fashion. Both ANG II and potassium increased the conversion of [14C]DOC to [14C]aldosterone, but ACTH did not significantly increase the conversion. Both ANG II and potassium increased the concentration of CYP11B2 mRNA, but not that of CYP11B1 mRNA. Tumor necrosis factor reduced ANG II- and potassium-induced aldosterone synthesis and CYP11B2 mRNA levels. ACTH did not influence the expression of CYP11B2 mRNA. These results suggest that vascular aldosterone synthase is controlled by ANG II and potassium at the transcriptional level.
By an indirect immunofluorescence method with In-111 cells (hamster insulinoma cell line), circulating islet cell surface antibodies (ICSA) were detected in 7 (20%) out of 36 patients with non-insulin dependent diabetes mellitus (NIDDM), 9% of 68 chronic thyroiditis (CT) patients, or 16% of 19 NIDDM patients associated with CT, but not in 18 normal subjects. Sera from five out of nine ICSA-positive patients examined further also showed cell-surface immunofluorescence on TPC-1 cells (human thyroid papillary adenocarcinoma cell line), and prior absorption of the sera with In-111 cells abolished the immunofluorescence. The 64 kDa protein from In-111 cells or human thyroid follicular cells was immunoprecipitated with ICSA-positive sera. In one case of NIDDM associated with CT, 64 kDa protein was detected in both cells. The results indicate that some ICSA in NIDDM patients recognize the same or a very closely-related autoantigen(s) in both islet beta-cells and thyroid follicular cells, suggesting an explanation, at least in part, for the autoimmune mechanism(s) in clinical association of NIDDM and CT.
The use of transesophageal pulsed Doppler echocardiography provides an ideal approach for determining both pulmonary venous flow and transmitral flow. This approach thus provides information about the flow of blood into and out of the left atrium. We designed a new method for separately evaluating left atrial functions on the basis of the time-velocity integrals of pulmonary venous flow and transmitral flow using transesophageal pulsed Doppler echocardiography, assuming that the cross-sectional areas of the mitral ring during the left ventricular diastolic phase and of the four pulmonary venous orifices throughout a cardiac cycle were constant and that the blood flows of the four pulmonary veins exhibited identical velocity profiles. Good correlation was observed between the indices of left atrial function (i.e. left atrial reservoir, conduit and forward contractile volume) using this new method of analysis of Doppler echocardiographic data and those of a conventional method using contrast angiography. In conclusion, transesophageal pulsed Doppler echocardiography provided satisfactory information about left atrial function, and our new method may be one of the most practical techniques for estimating individual left atrial functions.
Isoaspartyl protein carboxyl methyltransferase (PIMT) is implicated in the repair of age-damaged proteins by converting altered aspartic acid residues to normal L-aspartic acid residues. Northern blot and reverse transcription (RT)-PCR analyses have revealed that PIMT gene expression in the human lens is detected exclusively in epithelial cells, and that the mRNA levels in cataractous lens epithelia are significantly lower than those in normal age-matched lens tissue. These results suggest that PIMT may play a vital role in maintaining the clarity of the lens and preventing cataract formation.
The incidence of vascular complications in 224 patients with aldosterone-producing adenoma (APA) which was proven on adrenal surgery, was compared to that in 224 sex- and age-matched patients with essential hypertension (EHT). The incidence of cerebral hemorrhage was significantly higher (p < 0.05) in the patients with APA when compared to the EHT group. On the other hand, the incidence of myocardial infarction and/or congestive heart failure in the APA group was lower, although this difference did not reach statistical significance. Diastolic blood pressure in the APA group was significantly higher (p < 0.001) in the EHT group. However, a significant difference in diastolic blood pressure was not detected between the APA groups with and without vascular complications, whereas in the EHT group diastolic blood pressure was significantly higher (p < 0.001) in cases with vascular complications as compared to those without complications. As a possible factor contributing to the higher incidence of cerebral hemorrhage in the APA group, proteinuria was suggested. It was recommended that patients with primary aldosteronism should undergo operation when localization of the APA is established.
In view of the hypothetical possibility that the vascular renin-angiotensin system (RAS) might include aldosterone biosynthesis and action in the vasculature, we have undertaken a study to identify aldosterone released into the perfusion circuit from the rat mesenteric artery, and to investigate the effects of an angiotensin converting enzyme inhibition (ACEI) on aldosterone production from the vasculature. After 30 min equilibration, 240 mL of perfusate was collected and subjected to reverse-phase HPLC and subsequent mass spectrometry. Mass spectra corresponding to authentic corticosterone and aldosterone were obtained from the samples of mesenteric artery perfusate. Production of aldosterone in the mesenteric artery was not changed by adrenalectomy, although it was reduced in the arterial perfusate from rats pretreated with ACEI. By RT-PCR the expression of CYP 11B2 and mineralocorticoid receptor genes were demonstrated in both vascular endothelial and smooth muscle cells. These studies constitute indirect evidence supporting our hypothesis that locally produced aldosterone in the vascular tissue acts on vascular tone and remodeling via a paracrine or autocrine manner.