During the four year and three month period between October, 1975 and January, 1980, the author at the Department of Orthopedics, Nippon Medical School studied the post-operative results achieved in patients with digital nerve injuries.
Forty-one patients had undergone microsurgical suture in digital nerve injuries, with 57 nerves and 62 digital pulps having been operated on.
There are seven methods available for assessing the recovery of sensation after an operation. These are : the von Frey hair test, two-point discrimination test (2PD), moving two-point discrimination test (m2PD), ridge test, letter test, self-assessment test by patient and the finger volume test. With the above methods of evaluation, the results described below were obtained, allowing the following conclusions to be drawn :
1) It was possible to measure the 2PD on 50 nerves, but no 2PD measurement was possible on 12 nerves. As far as the cases of sutured nerves were concerned, 15 nerves (62.5%) out of 24 showed 2PD lower than 8 mm.
2) All the patients aged 15 years or less showed a complete recovery with a full return to normalcy.
3) Concerning those in whom it was possible to measure the 2PD response, it was found that there was a significant correlative relationship between (1) the 2PD results and von Frey hair test, (2) the 2PD results and the ridge test, (3) the 2PD results and the m2PD values, (4) the 2PD results and the finger volume test, respectively.
However, including the cases in which it was impossible to measure the 2PD, the von Frey hair test, the ridge test and the letter test were not suitable for assessing post-operative recovery of the digital nerves.
4) The finger volume test devised by the author was considered to be the only quantitave evaluation method among the techniques purporting to provide an objective assessment of sensory perception.
5) In the 2PD evaluation tests, it was possible to ascertain, though only in a small number of patients, that those patients who had shown favorable 2PD assessment results included a very few with a poor self-assessment of their recovery of sensation.
6) It is the author's contention that the recovery of the digital nerves should be assessed on the basis of an evaluation system integrating the following four test procedures : 2PD, m2 PD, patient's self-assessment and the finger volume test.

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A new hypolipidemic agent, 4-(cis-p-menthan-8-yloxy)benzanilide (YM-95831) and solid dispersed YM-95831 (sd-YM-95831, YM-95831/Excipient ratios=l:4) which was improved for its intestinal absorption were evaluated for their hypolipidemic activity in several hyperlipidemic animal models. The mode of the action was postulated.
1)The hypolipidemic effect of sd-YM-95831 was about 2 times more potent than YM-95831 (raw material) in hypercholesterolemic rats.
2)When sd-YM-95831 was given orally to normal rats for 5 weeks, the serum total cholesterol (TC) was decreased by 31% with a decrease in the atherogenic index (AI) by about 44% at a dose of 100 mg/kg. sd-YM-95831 decreased liver TC and triglycerides (TG) in dose-dependent manner up to 100 mg/kg in normal rats.
3)In the glycerol-induced hyperlipidemic rats, sd-YM-95831 decreased serum TC with a decrease in the Al. In the triton-induced hyperlipidemic rats, sd-YM-95831 was about 2 times more potent than clofibrate in the hypolipidemic activity.
4)sd-YM-95831 in a dose of 50mg/kg inhibited the incorporation of (1-¹⁴C) acetate but not of (2-¹⁴C)mevalonate into liver sterols in normal rats.
5)In rats with thoracic lymph-duct fistula which were fed a hypercholesterolemic diet, sd-YM-95831 did not modify intestinal absorption of (4-¹⁴C) cholesterol.
6)In rats with bile-duct fistula which were intravenously given (4-¹⁴C) cholesterol labeled lipoproteins, sd-YM-95831 significantly increased the excretion of the radioactivity in bile. Also, sd-YM-95831 significantly increased the fecal excretion of acidic sterols derived from (4-¹⁴C)-cholesterol which was orally administered.
7)In the partially hepatectomized rats which were fed a hypercholesterolemic diet, YM-95831 did not alter the level of serum TC and HDL-cholesterol (HDL-C). Whereas, YM-95831 decreased serum TC and increased serum HDL-C in rats with thoracic lymph-duct fistula.
8)YM-95831 inhibited noncompetitively acylCoA : cholesterol acyltransferase with the inhibition constant of 2.8μM in the aorta from atherosclerotic rabbits.
9)In the hypercholesterolemic monkeys, sd-YM-95831 significantly decreased serum TC and TG levels, and increased HDL-C levels. Also, sd-YM-95831 depressed the atherosclerotic lesions in dose-dependent manner and significantly decreased the content of esterified cholesterol in the aorta.
These results indicate that the hypolipidemic effect of sd-YM-95831 is associated with the inhibition of cholesterol biosynthesis and the stimulation of the catabolic rate of cholesterol to bile acids, and a prophylactic application of the drug to atherosclerotic subjects seems possible.

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Although orthopedic treatment of patients with deformed limbs have significantly advanced in recent years, the authentic treatment of cerebral palsy is yet to be worked out.
In order to. determine the muscular potency of the lower extremities in juvenile and adult patients with cerebral palsy, the postural muscles of these patients in easy supine and easy standing postures were electromyographically studied in comparison with those of normal subjects. Oxygen consumption was also observed.
Sixty patients with cerebral palsy were studied and 25 normal persons served as controls.EMG was recorded with surface electrodes in 10 muscles in each subject. EMG amplitude was then classified into five groups. Scores were given to EMG amplitude of each group. Total scores of each case were calculated by adding up the scores of all ten muscles. The total scores of standing and spine postures were computed separately and the values were compared.
Difference between spine and standing posture were 8.10 in patients with cerebral palsy, and were 10.64 in athetotic type, 7.51 in spastic type and 3.81 in hemiplegic type. Oxygen consumption in patients with cerebral palsy was 198.4 cc/min/m² in prone and 254.2 cc/min/² in standing. Its increasing ratio was 32.2296 in patients with cerebral palsy, whereas 11.83% in the control group. The values of hemiplegic type were closer to normal values, as compared to those of other types, not only in muscular activities, but also in oxygen consumption.
Based on these results, the pathological states of the patients were classified into four stages as with the L.M.A. (lowerextrimity motor age). The difference of scores was 2.7 in the control group, 13.0 in stage A, 8.3 in stage B, 4.2 in stage C and 2.4 in stage D. The increasing ratio of oxygen consumption was 11.8% in the control group, 53.6% in stage A, 32.8% in stage B, 14.3% in stage C, and 9.3% in stage D. It is thought that the prognosis of the patients in stages C and D were favorable regardless of disease type, provided that they were correctly treated. In these improved cases, the difference of scores was 10.0 and the increasing ratio of oxygen consumption was less than 50%.
Juvenile and adult patients with cerebral palsy have deformed or contracted joints, pathological or disuse atrophy of the muscle, and exhibit the signs of impaired reciprocal innervation as well as damaged central nervous system. It is possible that these pathological alterations are reflected in EMG activities and oxygen consumption. Then the above. described findings would point to the possibility of improving A.D.L. (activity of daily living) through relevant orthopedic treatment.

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The effects of disodium rhodizonate (rhodizonate), acetohexamide and glucose on the β-cells of the pancreas were studied by light and electron microscopy in rabbits.
Marked degranulation was observed in β-cells after injection of these compounds. The membraneous sac was observed margination to the plasma membrane and the basement membrane of capillary vessels. In addition, the basement membranes showed marked swelling. After injection of the rhodizonate, the microvillous-like digitations appeared frequently within capillary luminal surface and intracellular space. This observation confirms the activation of secretory activity in β-cell. After injection of the acetohexamide, markedly dilatation of the intracellular space and undulation of the plasma membrane were observed. These results suggest the injury of β-cell. After injection of the glucose, rough-surfaced endoplasmic reticulum and Golgi apparatus increased within β-cell. This observation indicates the activation of β-granule synthesis in β-cell.
The β-granules were released by the process of emiocytosis and diacrine secretion, in which the membraneous sac enclosing the granule fused with the plasma membrane or basement membrane, and rapidly dissolved into the intercellular space. In addition, the results in this communication suggest that insulin release induced by rhodizonate, acetohexamide and glucose may be mediated by microfilamentous component in the β-cell.

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Using the enzyme-linked immunosorbent assay technique, the antibody to a purified nephritis-strain associated protein (NSAP) of group A streptococcus, type 12 (A 374 strain) isolated from a patient with acute post-streptococcal glomerulonephritis (APSGN) was measured in the sera obtained from patients with APSGN and Impetigo without APSGN. In addition, the sera from patients with acute rheumatic fever (ARF), scarlet fever (SF) and normal individuals were also tested. The NSAP utilized in the studies was purified by preparative SDS-PAGE from the concentrated culture supernatant fluid of group A streptococcal strain (A 374).
The results obtained were as follows :
1) The NSAP was assayed for its purity by analytical SDS-PAGE and double gel diffusion test. SDS-PAGE pattern of the NSAP showed only a single protein band which corresponded to a mol. wt. of 46, 000 daltons and the serum of patient with APSGN gave a line with the NSAP of A 374 strain.
2) The ELISA test was performed using the antigen (NSAP) concentration of 5μg/ml and 1 : 4, 000 or 1 : 8, 000 dilution fluid of the patients' sera. There were no differences in antibody titers against the NSAP between the ARF and normal groups or the SF group and normal group of children. Antibody. titers, however, to the NSAP were significantly higher in the sera of patients with APSGN and Impetigo without APSGN than in the sera of normal individuals. Furthermore, when antibody titers against the NSAP in the sera of patients with APSGN were compared with those in the sera of Impetigo the titers of the former sera were significantly higher than those of the latter sera (p<0.001). Therefore, the measurement of an antibody to the NSAP by the ELISA test is considered a worthy tool for serological diagnosis of APSGN.

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Rat transferrin A and B which had been separated on DEAE-Sephadex A-50 chromatography of rat holo-transferrin were also separated on polyacrylamide disc gel electrophoresis without influencing the binding with Fe. These transferrin A and B were purified from rat plasma by ammonium sulfate precipitation, 0.4% acrinol treatment, Sephadex G-150 gel-filtration, Con A-Sepharose affinity chromatography and Sephadex G-150 gel-filtration. The purity of rat transferrin A and B were confirmed by immunoelectrophoresis against anti-rat whole serum and anti-rat transferrin.
Rat transferrin A and B were separated on polyacrylamide disc gel electrophoresis even after deferronization and sialidase treatment. Hence this isomer did not depend on the difference of the sialic acid content in rat transferrin. The molecular weights of these two tansferrins were 72, 000 by SDS-polyacrylamide disc gel electrophoresis. Each profile of rat transferrin A and B on isoelectric focusing was influenced by the binding with Fe and distributed between pI 5.95 and 6.23, therefore these two transferrins overlapped with each other on isoelectric focusing. Diferric, N-site monoferric, C-site monoferric and apo transferrin were identified on 6M urea polyacrylamide slab gel electrophoresis of transferrin A and B. The mobilities of diferric and apo forms of transferrin B were slightly faster than those of transferrin A.
Physiological functions of rat transferrin A and B to bind with Fe were investigated by three methods.
1) The ratio of total transferrin A and B in rat serum was almost identical between rats fed on a normal diet and on a Fe deficient diet for 2 weeks. Intraperitneal Fe injection into normal rat showed 50% increase of total transferrin B in whole transferrin of rat serum. While transferrin B in serum of rat fed with Fe deficient diet for 2 weeks was increased about twice after a Fe injection.
2) The analysis of holo-transferrin A and B fractions on DEAE-Sephadex chromatography of no Fe added serum of rats fed with normal diet showed that the ratio of holo-transferrin A to B was 1:1.3 and the similar experiment with that of no Fe added serum of the rats fed on a Fe deficient diet showed that the ratio of holo-transferrin A to B was 1:0.3. These results indicated that the contents of rat transferrin A and B were affected by the amount of Fe uptake and also that rat transferrin B had the biological function to carring iron in the blood.
3) In the experiment regarding Fe incorporation into reticulocyte from transferrin, rat transferrin A labelled with ⁵⁹Fe was a better iron donor to rat reticulocyte than transferrin B labelled with ⁵⁵Fe, but both of rat transferrin A and B showed competitive binding with rat reticulocyte, which had affinity with rat transferrin A more than rat transferrin B.

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The values of peripheral venous RBC, Hb, Hct, Reticulcytes and Serum Iron, UIBC, TIBC, and Fe-Saturation in normal mothers and neonates in the perinatal period were measured, and the relationship between, mothers and neonates was studied, In some infants, the change in values of peripheral venous Hb, over, . 1 year was followed up, and especially the relationship of feto-maternal transfusion was studied.
The results are as follows:
1) The mothers had lower values of the peripheral venous Hb on the pregnant women's last medical examination (average 12 days before delivery) than at postpartum(average 1 hr. after delivery) or 1 st month (average 30 days) after delivery. On the other hand, the serum iron values were lowest at postpartum.
2) The neonates had higher values of the peripheral venous Hb on the 2 nd day (average 47 hrs.) after birth than in the cord blood or the 1 st month (average 30 days) after birth. The serum iron values were higher for the cord blood than for the 2 nd day after birth.
3) In the feto-maternal correlation of peripheral venous Hb values and serum iron values, those of the cord blood and of neonates 2 days after birth, and the peripheral venous Hb of neonates 1 month after birth generally showed a higher positive correlation to those of maternal blood at the time of the pregnant women's last medical examination than to those of maternal blood immediately after delivery.
4) In comparative studies of the peripheral venous Hb values and the serum iron values between the mothers on the pregnant women's last medical examination and the babies in the 1st month after birth, the babies that were born from the mothers of low peripheral venous Hb and low serum iron values had significantly lower peripheral venous Hb values than the babies that were born from the mothers of high peripheral venous Hb values and high serum iron values.
5) Although various methods for measurement of feto-maternal transfusion exist, the maximum volume of feto-maternal transfusion that was found in measuring for minimum value by Kleihauer-Betke's method in the normal parturient women was 8.32 mι. Moderate-marked feto-maternal transfusion was frequently found in comparison with European and American reports. Besides, the relatively marked feto-maternal transfusion was more frequently seen in the group of multiparas and the compatible group on the hemotype (ABO) between mothers and babies than in the group of primiparas and the incompatible group.
6) In regard to the babies where anemias were not seen in the mothers at the time of their last medical examination or in the cord blood or that on the 2 nd day after birth and where a comparatively marked feto-maternal transfusion was seen, there was found lower Hb values (average 1.7-1.9 g/dι lower than the other group) of the peripheral veins at the 1 st and 3 rd month after birth in the compatible group (ABO hemotype) and the artificial feeding group. But, in conclusion, the neonates did not play a very important role in the etiology of the late onset of infantile anemia (subnormal anemia), in the actual environment of child care (include feeding) in this country, when they had no anemia due to the feto-maternal transfusion at birth.

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The T wave of Achilles tendon reflex was recorded in 30 patients with a lumbar herniated disc, and the H reflex was also recorded from the triceps surae muscle. In oder to study the relationship between the T wave, H wave and the operative findings of patients with lumbar herniated disc, the T wave and H wave were analysed with respect to their reflex latency, duration and amplitude. The following results were obtained.
1) The differences in reflex latency, duration, and amplitude between affected and non-affected limb recordings were proved to be statistically significant in the group of patients with L5-S1 disc hernia.
2) The differences were not proved to be statistically significant in the group of patients with L4-L5 disc hernia.
3) In patients with L 5-S 1 disc hernia and a T wave and H wave abnormality, operative findings revealed that a herniated nucleus pulposus had compressed S 1 radicle. Furthermore, in patients with L4-L5 disc hernia, a herniated nucleus pulposus was a relatively large mass and had protruded medially and centrally and there was also S 1 radiculopathy. In the case of L5 radiculopathy there were no changes in the T wave and H wave, whereas in the case of S 1 radiculopathy, there were shorter reflex latency, duration and lower amplitude.
4) According to operative findings, the radiculopathy in patients, in whom the T wave and H wave were absent, was of fibrotic type of Leyshon.

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