The behaviour of red cells in narrow tubes in vitro as a model of the microcirculation

To investigate the behaviour of red cells in the microcirculation, we established a new capillary method using narrow fluorinated ethylenepropylene copolymer tubes with internal diameters of 12.5 and 25.0 μm. Red cell flow in the tubes under a given range of pressure was analysed through a video system connected to a microscope. The experimental condition was adjusted so that the velocity of the control normocytes would be compatible with that in corresponding vessels in vivo , 0.5–1.5 mm/s. In the 12.5 μm tube, normocytes obtained from 12 young normal volunteers ran in an axisymmetric edge-on orientation with a folded shape at higher pressures, but rolled along freely without deformation at lower pressures. Deformation during the passage of the microcytes obtained from four patients with polycythaemia vera complicated with iron-deficient microcytosis and 10 patients with iron deficiency anaemia was relatively mild, whereas that of the macrocytes obtained from eight patients with refractory anaemia was marked. Even after the screening effect at the tube entrance was taken into consideration, the velocities of both microcytes and macrocytes were found to be significantly lower than the control normocytes. Therefore this method may be a new way to investigate the flow properties of red cells in the microcirculation.     

Different Antiphospholipid Antibody Specificities are Found in Association with Early Repeated Pregnancy Loss Versus Recurrent IVF-Failure Patients

PROBLEM: Patients having in vitro fertilization and embryo transfer (IVF-ET) failures show an increased incidence of antiphospholipid (aPL) antibodies; but controversy exists whether aPL can induce IVF-failure. This study was designed to compare aPL specificities between recurrent IVF-failure patients versus repeated early pregnancy loss (RPL) patients. METHOD OF STUDY: Anticardiolipin (aCL), lupus anticoagulant (LA), antiphosphatidylserine (aPS), antiphosphatidylethanolamine (aPE), and antinuclear antibodies (ANA) were measured in 74 recurrent IVF-ET failure patients and compared with 273 early RPL patients ( < 10 weeks). RESULTS: An increased incidence of IgG-aPE and ANA was observed for both groups in comparison with controls. Patients with recurrent IVF-ET failure showed a significantly higher prevalence of IgG-aPS (P = 0.02) and IgG-aCL (P = 0.02) when compared with early RPL patients or controls. CONCLUSIONS: IgG-aPS and IgG-aCL may be responsible for some IVF-failures. Additional studies are needed to clarify the pathogenic role of IgG-aPS and IgG-aCL on IVF-ET failure.     

Catheter Ablation of Ventricular Tachycardias Due to Forward and Reverse Propagation Across a Reentrant Circuit Inside a Nonischemic Biventricular Aneurysm

Ablation of Bidirectional VT. A 64‐year‐old recipient of implantable cardioverter defibrillator presenting with a 4.7 × 3.3 cm nonischemic, biventricular aneurysm developed multiple electrical storms due to ventricular tachycardia (VT) with 2 distinct QRS morphologies. Endocardial electroanatomical mapping revealed the presence of a low‐voltage area corresponding to the aneurysm, where multiple delayed potentials were recorded. Activation mapping and entrainment pacing of both VT revealed the, respectively, forward and reverse propagation of the wavefront across a single reentrant circuit inside the ventricular aneurysm. Delivery of 3 applications of radiofrequency energy to a critical segment of the reentrant pathway eliminated both VT and the electrical storms. (J Cardiovasc Electrophysiol, Vol. 22, pp. 467‐467)     

Incidence of hypertrophic pulmonary osteoarthropathy associated with primary lung cancer

Background and objective: Although the association of hypertrophic pulmonary osteoarthropathy (HPO) with lung cancer was investigated in the 1960s, the recent incidence of clinically apparent HPO is not known. Data from a large series of patients with lung cancer were analysed, in order to assess the incidence of possible HPO, based on bone scintigraphy, as well as the incidence of clinically confirmed HPO. The clinical features of confirmed HPO were also evaluated. Methods: The medical records of patients admitted with lung cancer between January 1986 and August 2004 were reviewed. Bone scintigraphy showing symmetrical, abnormally high uptake in joints and/or long bones was considered to be suggestive of HPO. Patients who also had finger clubbing and joint pain were considered to have a confirmed diagnosis of HPO. Clinical histories and hormone levels were then investigated in these patients, to identify possible causal factors. Results: Among the 1226 lung cancer patients, 55 (4.5%) demonstrated abnormally high uptake on bone scintigraphy, suggesting possible HPO. Ten (0.8%) patients had clubbed fingers and joint pain and were eventually confirmed as having HPO. Serum hormone concentrations were abnormally high in the patients with confirmed HPO. Conclusions: This retrospective study indicated that 4.5% of lung cancer patients showed findings suggestive of HPO, a frequency similar to that reported previously. However, patients with HPO rarely showed the complete triad of signs. Although increased hormone concentrations may have caused the HPO, further investigation is required to confirm this.     

M-Dot-ELISA检测麻风家内接触者血清中麻风杆菌特异性抗原

用改良酶联免疫斑点１５试验（简称 Ｍ－Ｄｏｔ－ＥＬＩＳＡ）对麻风家内接触者（ＨＣ）血清进行了麻风杆菌特异性酚酚糖脂Ｉ（ＰＧＬ－Ｉ）抗原检测。７５例ＨＣ均经麻风杆菌明胶微粒凝集试验（ＭＬＰＡ）和酶联免疫吸附试验（ＥＬＩＳＡ）证实为麻风杆菌特异性抗体阳性者。结果表明：①７５例ＨＣ中抗原阳性者１６例，阳性率为２１％。接触多菌型麻风（ＭＢ）者的抗原阳性率（２８％）明显高于接触少菌型麻风（ＰＢ）者（０％），两者之间有极显著性差异（ Ｐ ＜０．０１ ）。②抗体弱、强阳性组的抗原阳性率和抗原量之间亦有极显著差异（Ｐ＜０．０１）。③４０例正常人及１０例经ＭＬＰＡ和ＥＬＩＳＡ检测证实特异性抗体阳性的非麻风患者血清标本，抗原检测均阴性。     

A vesicular variant of bullous pemphigoid with autoantibodies against unidentified 205- and 150-kDa proteins at the basement membrane zone

Summary We describe a 75-year-old man who developed a vesicular variant of bullous pemphigoid with a distinctive result of immunoblot analysis. Characteristic symptoms consisted of vesiculopapular eruptions with erythematous patches on the arms and legs, many of which fused to form irregularly outlined areas of erythema varying in size. Direct immunofluorescence revealed a linear deposition of IgG at the basement membrane zone of the skin, and indirect immunofluorescence detected circulating IgG autoantibodies at a titre of 1: 160. which reacted with the antigens located on the epidermal side of skin split with 1 mol/L, NaCI. Immunoblot analysis using epidermal extracts demonstrated the presence of IgG antibodies directed to 150, 205, 240 and 280 kDa proteins as well as to the 180kDa bullous pemphigoid antigen (BPAG2). All antibodies eluted from nitrocellulose membrane imprints of individual bands with molecular weights of 150, 180 and 205 kDa were found by indirect immunofluorescence to react with the basement membrane zone, whereas those elutcd from the bands with molecular weights of 240 and 280 kDa did not. These findings suggest that antibodies directed not only to the 180kDa BPAG2, but also to 150 and 205 kDa proteins, are involved in the pathogenesis of bulla formation in this patient.     

Dilemmas facing Japanese nurses regarding the physical restraint of elderly patients

Aim: The purpose of this study was to clarify the meaning of “dilemma” regarding the use of physical restraint on elderly persons as described by nurses in general wards at community hospitals. The questions asked included: to what extent has the dilemma of nurses regarding the restraint of elderly persons in the general ward been clarified?, which factor/s compose the dilemma?, what are the psychometric properties of the factors?, and how should nurses deal with the dilemma with regard to restraining elderly persons? Methods: The participants were 1477 nurses (12 male, 1463 female, and two: no answer) at 54 wards (excluding the emergency wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms, and intensive care units). The dilemma was measured by using a questionnaire consisting of 20 items previously developed by the author. Results: An explanatory factor analysis revealed four dilemma factors among 17 items investigated. These were “execution of treatment and security”, “characteristics in nursing of elderly patients”, “a cooperative relationship”, and “priorities in nursing”. The cumulative contribution ratio was 68.3%. In respect to the dilemma where nurses are faced with the physical restraint of elderly persons, four factors in the clarification of the dilemma were extracted: “execution of treatment and security”, “characteristic features in nursing”, “a cooperative relationship in nursing”, and “priorities in nursing”. Conclusions: Based on the psychometric properties, the Dilemma scale is a valid and reliable tool. The construction of four systems to cope with these dilemmas is suggested. These systems would enable practising nurses to communicate with comedical workers in order to reach a consensus about the elderly’s care, avoid restraining the elderly by allocating care specialists to the elderly, establish institutional policies and safety standards that establish the nurses’ responsibilities for patients’ decision‐making, and receive continuous and timely ethical education.     

Measurement of prostate specific antigen complexed to α1-antichymotrypsin to avoid unnecessary biopsy in patients with serum prostate specific antigen levels 4–20 ng/mL

AIM: To investigate whether measuring prostate specific antigen complexed to alpha1-Antichymotrypsin (PSA-ACT) can increase sensitivity and specificity in detecting prostate cancer. METHODS: In this prospective study, we measured serum total PSA, PSA-ACT, free PSA, prostate volume and transition zone volume on 210 patients with total PSA level of 4-20 ng/mL. From fitted curves between positive predictive values for prostate cancer and age, prostate volume, transition zone volume, total PSA, PSA-ACT or F/T ratio, each function predicting prostate cancer was determined. Relative probabilities for prostate cancer (RPpca) which were defined by combined functions of age, F/T ratio, prostate volume or transition zone volume, and total PSA or PSA-ACT were calculated. Furthermore, using logistic regression, analysis was performed to determine the probability of prostate cancer. Receiver-operating characteristic analysis was performed to clarify the areas under the curve (AUC) for conventional single parameters, RPpca and logistic regression probability. RESULTS: F/T ratio showed the largest AUC among conventional parameters. The AUC of RPpca was larger than those of F/T ratio and logistic regression probability. RPpca using the functions of age, transition zone volume, PSA-ACT and F/T ratio showed the largest AUC and highest specificity at sensitivity 95% level, however, specificities at sensitivity 90% and 85% were identical to those of RPpca using the functions of age, prostate volume, total PSA and F/T ratio. CONCLUSIONS: RPpca using the functions of age, transition zone volume, PSA-ACT and F/T ratio was the best way to detect prostate cancer, however, the usefulness of PSA-ACT appears limited, considering the cost.     

The prevalence and pattern of insomnia in Japanese industrial workers: Relationship between psychosocial stress and type of insomnia

We examined the prevalence of insomnia among Japanese male industrial workers and analyzed the effect of psychosocial stress on the prevalence of three types of insomnia: `difficulty in falling asleep', `frequent sleep interruption' and `early morning arousal'. The study population consisted of male day workers (n = 319) in a manufacturing heavy industry company located in Nagasaki City, Japan. The subjects answered a questionnaire consisting of six sleep-related items and 24 questions related to occupational and private life conditions. A total of 271 men (average age 40.9 years) completed the questionnaire; a response rate of 85%. Insomnia within the month preceding the survey was present in 27.7% of the workers (75/271). Multiple logistic regression analysis demonstrated that different psychosocial stressors were associated with different types of insomnia. Visual display terminal (VDT) work overload was significantly associated with all types of insomnia, while `over-involvement in the job' was associated with difficulty in falling asleep and early morning arousal. Our results demonstrated that the prevalence of insomnia in Japanese workers is similar to that reported among European and American general adult population. Our results also indicate that the use of VDT in the workfield is associated with insomnia.