In vitro production of bilirubin photoisomers by light irradiation using neoBLUE

BACKGROUND: The light-emitting diode is used as one of the new light sources for phototherapy. NeoBLUE (Atom Medical, Tokyo, Japan) incorporates blue light-emitting diodes for the treatment of neonatal hyperbilirubinemia. The authors compared the in vitro efficacy of neoBLUE with conventional phototherapy devices. METHODS: The three light devices used included neoBLUE and two conventional phototherapy devices with six blue-white (BW) or six green (GR) fluorescent tubes. A bilirubin/human serum albumin solution (15 mg/dL) in 200 x 300 mm elliptical bag was irradiated with each three light device. The average light intensity of neoBLUE, BW and GR was 22.5, 10.2 and 2.6 microW/cm(2) per nm, respectively, for the irradiated area. Bilirubin photoisomers and native bilirubin were measured by high-performance liquid chromatography. RESULTS: In neoBLUE, BW and GR, the respective production rate of cyclobilirubin was 6.0, 3.7 and 3.9 x 10(-2) mg/dL/min, and the respective (4Z, 15E)-bilirubin/(4Z, 15Z)-bilirubin ratio after irradiation was 0.44, 0.33 and 0.12; the (4Z, 15Z)-bilirubin reduction rate at 20 min after irradiation was 60, 68 and 82%, respectively. The reduction rate of (4Z, 15Z)-bilirubin correlated with the (4Z, 15E)-bilirubin/(4Z, 15Z)-bilirubin ratio. CONCLUSION: Phototherapy using the neoBLUE under high level may be clinically more effective than therapy using the conventional light source from the results of the production rate of cyclobilirubin.     

Infantile Hypercalcemia with Subcutaneous Fat Necrosis

ABSTRACT. A case of hypercalcemia in neonatal subcutaneous fat necrosis, which was successfully treated with a low Ca and vitamin D-free formula, is described. Low l,25(OH)₂D and severe calciuria, which were considered to result from hypercalcemia itself as well as parathyroid suppression, were noted during the hypercalcemic phase. The oral Ca load test was repeatedly normal, suggesting that intestinal hyperabsorprion of Ca was not a cause of the hypercalcemia. Later recurrence of calciuria without hypercalcemia was noted concomitant with softening of indurated calcified necrotic tissue. In this patient, cerebral infarction on the left side was detected by CT scanning.     

PSEUDOHYPOALDOSTERONISM: DECREASED ALDOSTERONE LEVELS WITH AGE WITHOUT SIGNIFICANT CHANGE IN URINARY SODIUM EXCRETION

To clarify age-related changes in the plasma renin activity (PRA)-aldosterone (ALDO) system in relation to urinary sodium (Na) excretion in pseudohypoaldosteronism type I (PHA), we followed a patient with PHA serially by measuring the hormonal balance and urinary electrolyte excretion for 5 years. The patient was diagnosed as PHA mainly on the basis of extremely high PRA (170 ng/ml/h) and ALDO (1670 ng/dl) despite massive urinary Na excretion, a normal ALDO/PRA ratio (mean value = 11), and the ineffectiveness of 9 alpha-fluorocortisol (Florinef) to reduce urinary Na excretion and PRA-ALDO. The pattern of reduction in PRA-ALDO with age in this patient was almost identical with that of normal infants and children and was most remarkable during the first 18 months of life. During this period, there were statistically significant correlations between age and each of the following values: PRA (r = -0.753, n = 9, P less than 0.05), ALDO (r = -0.736, n = 11, P less than 0.01) and urinary ALDO excretion (r = -0.840, n = 9, P less than 0.01). But the reduction of PRA-ALDO in this patient was not the result of increased urinary Na excretion with age. Although PRA and ALDO values in this patient did decrease with age, they were still high compared with age-matched controls, suggesting a marginal state of Na balance. Thus, we conclude that PRA-ALDO levels in PHA decrease with age in the same pattern as in normal infants and children without a significant change in urinary Na excretion, possibly through increased renal conservation of Na, the mechanism of which should be clarified in a future study.     

Marked improvement in delirium with ramelteon: five case reports

Delirium is a common and serious acute neuropsychiatric syndrome characterized by inattention and global cognitive dysfunction. Delirium is associated with higher morbidity, higher mortality and longer hospitalization, but its aetiology remains unclear. We successfully treated five cases of delirium within 1 day with ramelteon, a novel selective melatonin receptor agonist. This suggests that correction of the circadian rhythm disturbance, one of the main symptoms of delirium, plays a crucial role in its treatment and sheds new light on a therapeutic strategy for treatment of delirium.     

Endoscopic Resection of Tumor of Papilla Vater: Our Experiences

Endoscopic papillectomy has become common in recent years as a non‐invasive therapeutic procedure for tumor of the papilla of Vater, although the lesions, which indicate endoscopic papillectomy, are very rare. In order to decide the indication for this procedure, intraductal ultrasonography (IDUS) is useful to obtain the correct diagnosis. For the successful and safe procedure of papillectomy, it is important to use the cutting mode of generator. and it is sometimes useful to inject the saline into the submucosal layer of the duodenum and to place the plastic stent into the bilio‐pancreatic ducts.     

Age-dependent induction and maintenance of sensitization to methamphetamine-induced hyperactivity in mice

Abstract Repeated administrations of methamphetamine (2 mg/kg, s.c), 10 times at 3-day intervals, induced ambulatory sensitization in all groups of mice that were 13-, 15-, 19-, 23- and 36-weeks-old at the start of methamphetamine administration. The most prominent sensitization was observed in the 19-week-old mice. Among five groups of mice, even though the mice of 36 weeks old showed the highest sensitivity to methamphetamine at the first administration, they exhibited the lowest sensitization during the latter stage of repeated methamphetamine administration. Methamphetamine sensitization once established was well reproduced by the post-sensitization period of 8 weeks. Furthermore, the group of mice given methamphetamine with post-sensitization interval of 8 weeks (19-week-old mice) exhibited further enhancement of the sensitization. In contrast, the groups of mice given methamphetamine with post-sensitization intervals of 12 and 25 weeks (the 23- and 36-week-old, respectively) showed a significant reduced sensitization, and the latter group failed to reach the level of sensitization previously established. These results suggest that the induction of and maintenance of methamphetamine sensitization are dependent on the age of the mice, and that methamphetamine sensitization once established completely persists for up to 8 weeks.     

Hepatocyte apoptosis and hepatic expression of transforming growth factor-β1 mRNA during involution of hyperplastic rat liver induced by hepatocyte growth factor

Hepatocyte apoptosis occurs during involution of hyperplastic liver induced by administration of xenobiotic compounds in rats. With this hyperplasia and involution, hepatic transforming growth factor (TGF)-β₁ is reported to be expressed to stimulate hepatocyte apoptosis. In regenerating liver after partial resection showing no hyperplasia, such expression of TGF-β₁ is also seen. However, no hepatocyte apoptosis develops despite the high levels of TGF-β₁. When rats received an intravenous injection of human hepatocyte growth factor at 12 h intervals for 14 days, the hepatic DNA content was increased 12 h after the last injection to 140% of control. This DNA content was significantly decreased at 108 and 180 h after discontinuation of treatment. At 60 h after the last injection, the number of apoptotic bodies positive for nick end-labelling of DNA in hepatocytes was significantly greater in treated rats than in control rats. Hepatocyte apoptosis was also identified electron micrographically. Hepatic TGF-β₁ mRNA levels in treated rats were significantly lower than in control rats at 12 h and then gradually increased towards control levels. We conclude that hyperplastic liver induced in normal rats by hepatocyte growth factor regresses with hepatocyte apoptosis and suppressed hepatic TGF-β₁ mRNA levels.     

Pain and other cardinal TMJ dysfunction symptoms: a longitudinal survey of Japanese female adolescents

summary Longitudinal data were obtained for 4 years from 361 Japanese high school girls between the ages of 12 and 16. The data were analysed for the occurrence of pain and its associations with the occurrence of other cardinal TMJ dysfunction symptoms and occlusal states. It was determined that even if pain or noise or jaw-deviation symptoms appeared, those symptoms did not necessarily last thereafter. The symptoms were not persistent but rather appeared and disappeared repetitively. Those who exhibited noise during at least one of the surveys of the 4-year survey period showed a significantly higher prevalence of pain than those who did not exhibit noise at all (P < 0.05). Those who exhibited noise by the age of 13 showed a significantly higher prevalence of pain than those who exhibited noise after age 14 (P < 0.1). The temporal occurrence of pain depended upon the appearance of noise and the age at which noise first appeared. On the other hand, the occurrence of pain symptoms was not necessarily related to specific types of malocclusions, which suggests the significance of multifactorial contributions in understanding the aetiology of pain rather than the occlusal factor.     

Effects of Bis-diamine to Cardiac Mesenchymal Cell Migration of the Chick Embryo

Summary Bis-diamine is a teratogen which induces conotruncal anomalies in rats and chicks. Bis-diamine induces endocardial cushion defects in rats but it does not induce in chicks. In the present study, we examined effects of bis-diamine to chick embryonic cardiac mesenchymal cells. Chick embryos of 3 days incubation (E3, H. H. stage 17–28) were treated with 100 μg of bis-diamine dissolved in 50 μl dimethylsulfoxide. The conotruncal and atrioventricular cushions of the E6 embryos treated with bis-diamine were cultured with chicken serum. After 48 h of incubation, the culture was fixed with 4% formaldehyde. The area of grown out mesenchymal cells from the transplanted tissue was measured, and then the migration distance of mesenchymal cells was computed from the area.
In the group treated with bis-diamine, the migration distance of conotruncal cushion mesenchymal cells was significantly shorter than that of controls. However, the migration distance of atrioventricular cushion mesenchymal cells was not diminished. By scanning electron microscopy, the superior endocardial cushion of E4.5 or E5 embryos treated with bis-diamine was slightly hypoplastic compared with the inferior endocardial cushion. In spite of hypoplasia of the superior and inferior endocardial cushions, these cushions fused in E6 embryos treated with bis-diamine.
These results have shown that bis-diamine affects migration activity of conotruncal cushion mesenchymal cells but it does not severely affect that of the atrioventricular cushion in chicks. This portionally different effect of bis-diamine can explain that bis-diamine does not frequently induce endocardial cushion defects in chicks.