Studies on Bile Pigments VIII. A Form of Direct Reacting Bilirubins Appearing in Jaundiced Urine

Separation of the urinary ester-form bilirubin was attempted, and the results obtained may be summarized as follows: 1. A brown pigment was obtained from jaundiced urine by the following procedures; namely, salting out, methanol extraction, chloroform flocculation, and separation on cellulose column. The pigment has been found to be easily soluble in water, displaying the absorption maximum at 420 - 410 m&#956; at pH 7.0, and it also gave a positive reaction both to GMELIN's and EHRLICH's diazo reagents within a minute without the addition of alcohol. These characteristics agree well with those of the socalled ester-form bilirubin. 2. On the basis of the results of paper chromatography and paper electrophoresis, the pigment has been determined to contain no amino acid, steroid, nor reducing substance. Moreover, no glucuronic acid could be detected whether examined in vitro or by paper chromatography together with paper electrophoresis, either.</p

ERP evidence of attentional somatosensory processing and stimulus-response coupling under different hand and arm postures

We investigated (1) the effects of divided and focused attention on event-related brain potentials (ERPs) elicited by somatosensory stimulation under different response modes, (2) the effects of hand position (closely-placed vs. separated hands) and arm posture (crossed vs. uncrossed forearms) on the attentional modulation of somatosensory ERPs, and (3) changes in the coupling of stimulus- and response-related processes by somatosensory attention using a single-trial analysis of P300 latency and reaction times. Electrocutaneous stimulation was presented randomly to the thumb or middle finger of the left or right hand at random interstimulus intervals (700–900 ms). Subjects attended unilaterally or bilaterally to stimuli in order to detect target stimuli by a motor response or counting. The effects of unilaterally-focused attention were also tested under different hand and arm positions. The amplitude of N140 in the divided attention condition was intermediate between unilaterally attended and unattended stimuli in the unilaterally-focused attention condition in both the mental counting and motor response tasks. Attended infrequent (target) stimuli elicited greater P300 in the unilaterally attention condition than in the divided attention condition. P300 latency was longer in the divided attention condition than in the unilaterally-focused attention condition in the motor response task, but remained unchanged in the counting task. Closely locating the hands had no impact, whereas crossing the forearms decreased the attentional enhancement in N140 amplitude. In contrast, these two manipulations uniformly decreased P300 amplitude and increased P300 latency. The correlation between single-trial P300 latency and RT was decreased by crossed forearms, but not by divided attention or closely-placed hands. Therefore, the present results indicate that focused and divided attention differently affected middle latency and late processing, and that hand position and arm posture also differently affected attentional processes and stimulus–response coupling

Sivelestat Sodium Hydrate ト エンドトキシン キュウチャク リョウホウ トノ ヘイヨウ リョウホウ ガ ユウヨウ デ アッタ ARDS ノ イチレイ

We report here a case of Acute Respiratory Distress Syndrome（ARDS）due to perforation of the sigmoid colon, for which therapy with Sivelestat Sodium Hydrate（SSH, Elaspol）and Polymyxin B-immobilized Direct Hemoperfusion（PMX-DHP）was shown to be effective. An 88-yearold woman was admitted to our hospital because of abdominal pain. Abdominal computed tomography showed free air present in the liver and near the sigmoid colon. These results suggested sigmoid colon perforation, and we performed Hartmann’s operation and drainage. After operation, her blood pressures and the PaO2/FiO2 ratio decreased. The patient was then diagnosed septic shock and ARDS ; and PMX-DHP was performed, followed by the initiation of SSH administration. After therapy, she showed improvements in her conditions of septic shock and ARDS. It is inferred that therapy with PMX-DHP and SSH is effective for ARDS in view of an observed two-fold suppression in vascular endothelial cell damage

ダイチョウ センコウ ショウレイ ニ タイスル エンドトキシン キュウチャク リョウホウ ノ ケントウ

The aim of this retrospective study was to investigate the therapeutic results of Polymyxin Bimmobilized Direct Hemoperfusion（PMX-DHP）for colorectal perforation. The study subjects were 40 patients with colorectal perforation surgically treated from 1993 through 2004, of whom 18 underwent PMX-DHP after operation（P group）and 22 underwent operations only（N group）. Although there was no significant difference between the two groups in the overall mortality rate, the mortality rate for ARDS was significantly lower in the P group than in the N group. There was a statistically significant correlation between the P/F ratio and the time interval from the disease onset（r=－0.590, p=0.0009<0.001）. The time lag from disease onset to operation and the length of PMX-DHP period were significantly longer in the death group than in the survivor group. We anticipate that PMX-DHP for colorectal perforation proves effective in reducing deaths from ARDS. For an effective facilitation of PMX-DHP, the procedure should be started as soon as possible from the onset of the disease

False-negative coagulation factor activity results due to the presence of antiphospholipid antibodies in a case of autoimmune hemolytic anemia

An 88-year-old female was admitted with autoimmune hemolytic anemia (AIHA). Coagulation test revealed severe prolongation of activated partial thromboplastin time (APTT). APTT cross-mixing test with patient plasma and normal plasma demonstrated an inhibitory pattern. Several intrinsic coagulation factor activities, particularly factor IX, showed remarkable decreases, and the inhibitor titers for coagulation factors VIII and IX were elevated. Although AIHA with existing antiphospholipid (aPL) antibodies was diagnosed initially, purpura developed on extremities intermittently during the clinical course. Considering the possibility of coexisting acquired hemophilia, APTT cross-mixing test with patient’s plasma and equal amount of the recombinant factor VIII product instead of normal plasma was performed. The APTT value on equal mixing samples with patient plasma and recombinant factor VIII product was decreased to within the normal range, and coagulation factor IX activity was restored. These results indicate that the recombinant factor VIII product had a neutralizing effect on aPL antibodies. We concluded that recombinant factor VIII product may lead to the repair of incorrect results from the APTT-dependent diagnostic system in the presence of aPL antibodies

Geometry of the Philippine Sea plate subducting beneath the westernmost Nankai Trough

SSS035-06発表要旨 / 日本地球惑星科学連合2011年大会（2011年5月22日～5月27日, 幕張メッセ国際会議場） / 日本惑星科学連合の許諾に基づき本文ファイルを掲

Newly Diagnosed Atrial Fibrillation in Acute Myocardial Infarction

[Background] It remains controversial whether long‐term clinical impact of newly diagnosed atrial fibrillation (AF) in the acute phase of acute myocardial infarction (AMI) is different from that of prior AF diagnosed before the onset of AMI. [Methods and Results] The current study population from the CREDO‐Kyoto AMI (Coronary Revascularization Demonstrating Outcome Study in Kyoto Acute Myocardial Infarction) Registry Wave‐2 consisted of 6228 patients with AMI who underwent percutaneous coronary intervention. The baseline characteristics and long‐term clinical outcomes were compared according to AF status (newly diagnosed AF: N=489 [7.9%], prior AF: N=589 [9.5%], and no AF: N=5150 [82.7%]). Median follow‐up duration was 5.5 years. Patients with newly diagnosed AF and prior AF had similar baseline characteristics with higher risk profile than those with no AF including older age and more comorbidities. The cumulative 5‐year incidence of all‐cause death was higher in newly diagnosed AF and prior AF than no AF (38.8%, 40.7%, and 18.7%, P<0.001). The adjusted hazard ratios (HRs) for mortality of newly diagnosed AF and prior AF relative to no AF remained significant with similar magnitude (HR, 1.31; 95% CI, 1.12–1.54; P<0.001, and HR, 1.32; 95% CI, 1.14–1.52; P<0.001, respectively). The cumulative 5‐year incidence of stroke decreased in the order of newly diagnosed AF, prior AF and no AF (15.5%, 12.9%, and 6.3%, respectively, P<0.001). The higher adjusted HRs of both newly diagnosed AF and prior AF relative to no AF were significant for stroke, with a greater risk of newly diagnosed AF than that of prior AF (HR, 2.05; 95% CI, 1.56–2.69; P<0.001, and HR, 1.33; 95% CI, 1.00–1.78; P=0.048, respectively). The higher stroke risk of newly diagnosed AF compared with prior AF was largely driven by the greater risk within 30 days. The higher adjusted HRs of newly diagnosed AF and prior AF relative to no AF were significant for heart failure hospitalization (HR, 1.73; 95% CI, 1.35–2.22; P<0.001, and HR, 2.23; 95% CI, 1.82–2.74; P<0.001, respectively) and major bleeding (HR, 1.46; 95% CI, 1.23–1.73; P<0.001, and HR, 1.36; 95% CI, 1.15–1.60; P<0.001, respectively). [Conclusions] Newly diagnosed AF in AMI had risks for mortality, heart failure hospitalization, and major bleeding higher than no AF, and comparable to prior AF. The risk of newly diagnosed AF for stroke might be higher than that of prior AF