To evaluate the energy metabolism of peripheral skeletal muscle during exercise in patients with chronic respiratory impairment, the 31P-nuclear magnetic resonance (NMR) spectra of forearm muscle were investigated in nine patients and nine age-matched control subjects. We calculated the phosphocreatine (PCr) to PCr + inorganic phosphate (PI) ratio, the time constant of PCr recovery and the intracellular pH. The exercise consisted of repetitive hand grips against a 2-kg load every 3 s for 6 min (0.33 W). The patients showed a marked decrease in the PCr/(PCr + PI) ratio and pH in the muscle during exercise in contrast to the control subjects whose PCr/(PCr + PI) showed a minor decrease without any change in pH. The relationship between PCr utilization and pH demonstrated that anaerobic glycolysis switched on earlier in patients with chronic respiratory impairment. A split PI peak was observed in five of nine patients during exercise. The PCr/(PCr + PI) ratio during the last minute of exercise correlated significantly with the vital capacity (% predicted), with the FEV1/FVC, with the body weight, with the maximum strength of hand grip, and with the muscle mass. The results indicate impaired oxidative phosphorylation and the early activation of anaerobic glycolysis in the muscles of patients with chronic respiratory impairment. Several factors related to chronic respiratory impairment, such as disuse, malnutrition and dysoxia, would contribute to the metabolic changes observed in the muscles examined.
Myelopathy is a rare central nervous system manifestation in systemic lupus erythematosus (SLE). We present a case of SLE, who developed motor paralytic bladder and various other neurological abnormalities. A 29-year-old female with SLE was admitted to our hospital because of complete dysuria without any troubles on defecation. Accelerated hypertension had been noticed 2 weeks before the admission. Physical examinations revealed that she had muscle weakness in right brachial biceps, bilateral carpal extensor and flexor, and flexor muscles of bilateral lower extremities. Slight sensory disturbance was present on her soles. Bilateral Chaddok and Babinski's signs were positive. Electromyographic studies including nerve conduction velocities of her limbs were normal, however, neurogenic discharges were observed in anal sphincter muscles. Cystometry demonstrated atonic bladder, but any pathological findings such as lupus cystitis and interstitial cystitis were not observed in the biopsied specimens from her bladder. Antibodies to single-stranded DNA, U1 RNP, Sm and SS-A/Ro were positive in her serum, and lupus anticoagulant and anticardiolipin antibodies (IgG) were also detected. In her cerebral spinal fluid (CSF), elevated protein level and albuminocytologic dissociation were recognized, while glucose level was low. Magnetic resonance imaging (MRI) study detected high signal intensities in the inner part of medulla oblongata and in the spinal cord at second lumbar spine level. After two courses of methyl-prednisolone pulse therapy, the patient's neurological symptoms including dysuria had completely recovered and abnormal findings previously observed on MRI had also disappeared. After 7 months of the episode, she became normotensive. The proteins and glucose levels in her CSF had gradually returned to normal. Among patients with SLE, correlations of antiphospholipid antibodies with myelitis/myelopathy or accelerated hypertension have been reported. Therefore, possible roles of antiphospholipid antibodies were considered in the pathogenesis of neurologic abnormalities observed in our patient. In addition, low glucose level in CSF might be a good indicator for the diagnosis of lupus-associated myelopathy.
The house dust mite, Dermatophagoides farinae, was fractionated by a Sephadex G-200 column. Its allergenic (IgE-reacting) and immunogenic (IgG-reacting) components were investigated. By means of skin test, the molecular weight (MW) of major allergenic components of mite was found to be approximately 9,000 to 21,000 daltons. Immunogenic components were investigated by enzyme linked immunosorbent assay using each fraction as an antigen and mice plasma and human serum as antibodies. With mouse plasma, high IgG antibody titers were observed in fractions that contained the part of the mite with high MW (greater than 150,000). With human sera, high IgG antibody titers were observed in fractions that contained the part of the mite with MW more than 30,000. Heterogeneity of human IgG antibody responses against mite antigen was also suggested.
Onset as well as many symptoms of asthma are said to be related to autonomic dysfunction which often appear as a result of actual daily stress of the patients. Minor tranquilizers and anti-depressants are often successful in treating such symptoms, though precise effect of these drugs on asthma is not yet available, while many still hesitate to use these drug for fear of the anticholinergic effect which may hinder the efficient expectoration of sputum which could be critical during severe asthma attacks. In this study, these drugs were evaluated by the asthma score, peak flow, acetylcholine provocation test and the suppressive effect on lymphocytes. They could be beneficial in increasing the quality of asthma therapy if employed with necessary care.
We used magnetic resonance imaging to differentiate residual and recurrent lung cancer from the surrounding radiation pulmonary fibrosis in a 62-year-old patient. The cancer's signal intensity was greater than the fibrotic lung tissue's intensity in an ECG-gated image with relatively short repetition and echo times and, also, in images with long repetition and echo times.
We investigated the effect of alcohol on muscle energy metabolism by using 31P magnetic resonance spectroscopy in 12 chronic alcoholics [6 with neurological signs and symptoms (such as cerebellar ataxia or diplopia) and 6 without neurological signs or symptoms], compared with five healthy subjects who also received acute alcohol loading. Intracellular pH and phosphocreatine (PCr) index [PCr/ (PCr + Pi)] were measured during rest, exercise, and recovery in the left flexor digitorum superficialis muscle. In healthy subjects, acute alcohol loading did not influence the changes of muscle pH and PCr index. Alcoholics with neurological signs showed marked decreases in muscle intracellular pH and PCr index during exercise and a marked delay of pH recovery after exercise. There was no delay of PCr index recovery. Alcoholics without neurological signs showed slight decreases in intracellular pH and PCr index, but rapid recovery of both intracellular pH and PCr index was observed. Marked decrease and delayed recovery in pH, but rapid recovery of PCr index, indicate that the muscle of patients with neurological signs produced lactate during and after exercise to maintain the ATP level, which implies that anaerobic metabolism is favored over aerobic metabolism in these patients.
PURPOSE: The effects of aging on muscle metabolism and oxygenation have not yet been elucidated. We evaluated the effects of aging on energy metabolism and oxygenation in sedentary healthy subjects by simultaneously measuring 31P-magnetic resonance spectroscopy (MRS) and near-infrared spectroscopy (NIRS). METHODS: Nine young (28.1 +/- 5.0 yr) and nine older (61.4 +/- 4.6 yr) healthy subjects were studied. The 31P-MR spectrum was obtained every 15 s during and after hand gripping exercise. Intracellular pH (pHi) and PCr/(PCr+Pi) [PCr: phosphocreatine, Pi: inorganic phosphate] were calculated as an index of energy metabolism. The time constant of the PCr/(PCr+Pi) recovery (tau PCr) was calculated. With NIRS, we evaluated the recovery rates of oxygenated (RHbO2) and deoxygenated hemoglobin (RHb) during the initial 10 s of recovery. RESULTS: The PCr/(PCr+Pi) and pHi at rest and at completion of the exercise and tau PCr did not differ between young and older subjects. However, RHbO2 and RHb were significantly slower in older subjects than in young subjects. CONCLUSIONS: The results suggest that muscle energy metabolism in the forearm muscle was not affected by aging. The slower RHbO2 and RHb in older subjects suggested impaired O2 supply, which was probably due to impaired peripheral circulation caused by the process of aging.
We conducted an electron spin resonance (ESR) study on human pleural effusions obtained from patients (n = 15) with and without cancer at 77 K. We detected two kinds of signals which are considered to be due to transition metal ions in metalloproteins such as Fe3+ in transferrin and Cu2+ in ceruloplasmin from their g values (g = 4.2 and 2.049) and line shapes. We found a significant difference in the signal intensity ratio, Cu2+/Fe3+, of the pleural effusions between cancer and noncancer patients by the Mann-Whitney U test (P