Functional bladder capacity as predictor of response to desmopressin and retention control training in monosymptomatic nocturnal enuresis

OBJECTIVE: To evaluate the efficacy of intranasal desmopressin (DDAVP) and retention control training (RCT) for monosymptomatic nocturnal enuresis in childhood and to assess the predictive value of daytime functional bladder capacity for both methods. MATERIALS AND METHODS: A total of 114 children with monosymptomatic nocturnal enuresis, of whom 99 (86.8%) wetted the bed every night, were treated with 1 of the 2 methods: intranasal DDAVP in 54 and RCT in 60 subjects. RESULTS: Twenty-one of 54 patients (38.9%) and 14 of 60 patients (23.3%) in the DDAVP group and the RCT group, respectively, achieved strong improvement (p = 0.061). Forty-five of 54 (90.0%) in the DDAVP and 35 of 60 (58.3%) in the RCT group had a more than 50% decrease in wet nights (p = 0.004). In the DDAVP group, the functional bladder capacities at baseline in responders and nonresponders were 82+/-22% and 56+/-20% of the predicted bladder capacity for their age (p<0.001). In the RCT group, responders and nonresponders did not differ in functional bladder capacity at baseline. CONCLUSION: DDAVP treatment is more effective than RCT in decreasing the number of wet nights in childhood nocturnal enuresis, but not so effective in children with a low functional bladder capacity. Daytime functional bladder capacity is a valuable predictor of response to DDAVP, but not so to RCT.     

Pharmacokinetic study of low- versus high-dose medroxyprogesterone acetate (MPA) in women

The present study was conducted to compare the pharmacokinetics (PK) of low-dose versus high-dose medroxyprogesterone (MPA) as a once-daily oral administration. Of 32 patients, all women, enrolled in this PK study, 18 received 600 mg MPA daily and 14 received 1200 mg daily. Detailed PK data were obtained on day 1 and after more than 4 weeks of MPA treatment. In addition, multiple data for the minimum steady-state concentration (Css min) were analyzed. The MPA serum concentrations were measured by high-performance liquid chromatography. Wide interpatient variability was found in the PK parameters obtained both on day 1 and after more than 4 weeks. There were no clear relationships between the oral dose and the MPA peak concentration (Cmax), area under the time versus concentration curve (AUC), or mean Css min. Weight gains of 10% or more were demonstrated more frequently in the high-dose group (P<0.01). Liver dysfunction (n=5) did not influence the PK of MPA. Five patients demonstrated extremely low AUC and Cmax (<10 ng/ml) values on day 1. Phenobarbital, dexamethasone and betamethasone were being taken concomitantly with the MPA each by one patient. The serum MPA concentrations were markedly increased after the discontinuation of phenobarbital in that patient, suggesting a drug interaction. At present we cannot recommend the high dose of MPA, except in clinical studies, from a PK or a pharmacodynamic points of view. Received: 2 May 1997 / Accepted: 13 October 1997     

Prognostic predictive values of serum cytochrome c, cytokines, and other laboratory measurements in acute encephalopathy with multiple organ failure.

AIMS: To evaluate the prognostic predictive values of cytochrome c, cytokines, and other laboratory measurements in serum collected during neurological onset in acute encephalopathy with multiple organ failure. METHODS: In addition to general laboratory examinations, the concentrations of cytochrome c (apoptosis marker) and cytokines (inflammatory markers) were measured in serum samples collected at the initial phase in 29 patients with acute encephalopathy. The obtained values were evaluated as predictors for the development of severe encephalopathy. RESULTS: Cytochrome c, tumour necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), soluble TNF-receptor 1 (sTNF-R1), and aspartate aminotransferase (AST) concentrations at the initial phase were high and correlated well with patient outcome. High concentrations of serum cytochrome c (>45 ng/ml), sTNF-R1 (>2000 pg/ml), AST (>58 IU/dl), IL-6 (>60 pg/ml), and TNF-alpha (>15 pg/ml) predicted an unfavourable prognosis (sequelae and death) at 93%, 79%, 82%, 77%, and 60%, respectively. The specificity of those markers was 100%, 89%, 83%, 100%, and 100%, respectively. CONCLUSIONS: Serum cytochrome c is the most sensitive and specific predictor for the development of severe encephalopathy at the initial phase. Results suggest that this marker might be used to guide decisions regarding the start of the initial treatment and further intensive care.     

Involvement of catalase in the endometrium of patients with endometriosis and adenomyosis

OBJECTIVE: To determine the distribution of catalase in eutopic and ectopic endometria in patients with endometriosis or adenomyosis. DESIGN: Retrospective randomized study. SETTING: Department of obstetrics and gynecology in a university hospital. PATIENT(S): Thirty-three patients with endometriosis, 36 with adenomyosis, and 47 fertile controls (total, 116 women). MAIN OUTCOME MEASURE(S): Semiquantitative immunostaining of endometrial cells obtained by biopsy sampling, followed by calculation of an evaluation nomogram score. RESULT(S): The score of catalase in the glandular epithelium of controls group fluctuated during the menstrual cycle; it was lowest in the early proliferative phase and peaked in the late secretory phase. In patients with endometriosis, catalase scores did not fluctuate during the cycle, and scores were high compared with controls throughout the menstrual cycle. Catalase scores did not vary in patients with adenomyosis, and scores in this group were consistently higher than those in patients with endometriosis throughout the cycle. CONCLUSION(S): Abnormal expression of catalase in the eutopic and ectopic endometrium strongly suggests pathologic involvement of free radicals in endometriosis and adenomyosis.     

Clinical outcomes of coronavirus disease 2019 and seasonal influenza in patients with hematological disorders: a retrospective study

Objective: The differences in clinical outcomes in hospitalized patients with hematological disorders (HD) who developed either coronavirus disease 2019 (COVID-19) or seasonal influenza (SI) are not fully understood. To examine these differences, we retrospectively analyzed the baseline characteristics and clinical outcomes of hospitalized patients with HD admitted from 2016 to 2021.Patients and Methods: Patients with HD who developed COVID-19 (in the past 1 year) (n=21) or SI (in the past 5 years) (n=23) in the Department of Hematology/Oncology, Asahikawa Kosei General Hospital were evaluated.Results: The median ages of the patients with HD with either COVID-19 or SI were 80 and 68 years, respectively (P=0.03). The groups showed no significant differences in sex ratio, body mass index, or Eastern Cooperative Oncology Group performance status. In the COVID-19 and SI groups, the most common primary diseases were diffuse large B-cell lymphoma (43%) and multiple myeloma (39%), respectively. The median numbers of days of oxygen administration (8 vs. 0 days), quarantine (25 vs. 6 days), and hospitalization (72 vs. 21 days) were significantly higher in HD patients with COVID-19 than those in HD patients with SI (all P<0.001). The overall 90-day survival of patients with HD and COVID-19 was significantly shorter than that of patients with HD and SI (P=0.019). Moreover, patients with HD and COVID-19 had a higher risk of in-hospital mortality (43% vs. 9%; odds ratio, 7.50; 95% confidence interval, 1.26–82.4; P=0.01) compared to patients with HD and SI.Conclusion: Patients with HD and COVID-19 required longer periods of in-hospital medical and showed poorer survival than those with SI. During the COVID-19 pandemic, hematologists should closely monitor the condition of patients with COVID-19 to closely monitor their condition to prevent deaths.     

Total syntheses of ent-hypocoprin A and ent-hypocoprin B

This study reports the stereoselective total syntheses of the antipodes of the unique 3/10 bicyclic skeletal sesquiterpenoids, namely, hypocoprin A and hypocoprin B. The synthesis involved conjugate addition accelerated by trimethylsilyl chloride, construction of the ten-membered ring via the intramolecular S_N2 reaction promoted by 1,8-diazabicyclo[5.4.0]undec-7-ene, and osmium-mediated π-facial selective dihydroxylation to functionalize the 1,1-disubstituted alkene.

This study reports the stereoselective total syntheses of the antipodes of the unique 3/10 bicyclic skeletal sesquiterpenoids, namely, hypocoprin A and hypocoprin B.     

The impact of traumatic brain injury on family members living with patients: a preliminary study in Japan and the UK

Purpose: To ascertain the views of families living with TBI patients about the nature of the problems experienced as a result of TBI, and to compare the views of Japanese family members (J-FM) and British family members (B-FM) in order to find out whether there were cultural differences in family response to TBI. Methods: Family members involved in providing care were identified by the patients. Face to face interviews were conducted with all 18 carers in B-FM and four carers in J-FM. The remaining eight carers in J-FM participated in the postal questionnaire. Questionnaires were developed to explore the nature of problems and the involvement of family such as social embarrassment. Results: Problems arising in families were almost the same reported from both groups. However families in B-FM were likely to know more about how to cope with these problems. Family members in J-FM reported more statistically significant increases in social embarrassment than those in B-FM. Conclusion: The preliminary results showed that family members living with TBI patients in both groups had experienced problems. Appropriate rehabilitation services should be developed to help families as well as TBI patients in Japan.     

Mechanical efficiency of the left ventricle as a function of preload,afterload, and contractility

Summary We have recently shown that the mechanical efficiency of the contractile machinery of the canine left ventricle is constant at 30%–50%, independent of its loading, heart rate, and inotropic conditions. In contrast, the conventional mechanical efficiency of the ventricle is known to vary between 0 and 30%, depending on these conditions. In this study, we derived an equation for the conventional mechanical efficiency as a function of ventricular preload, afterload, and contractility, based on the constant mechanical efficiency of the contractile machinery. In deriving this equation, we fully utilized our new concept of the total mechanical energy of the left ventricle, i.e., systolic pressure-volume area, and our recent findings of the linear relationship between left ventricular oxygen consumption and the systolic pressure-volume area as well as the dependence of this relation on the ventricular inotropic state. As a result, the conventional mechanical efficiency of the left ventricle was found to change between 0 and 25% as an explicit function of these cardiodynamic and inotropic conditions. Using this function, we obtained combinations of loading and inotropic conditions to maximize the conventional mechanical efficiency of the left ventricle.