In 115 normal children (3 to 14 years old) and 143 children with insulin-dependent diabetes mellitus (6 to 15 years old), the urinary C-peptide (C-peptide immunoreactivity) was measured for evaluation of the pancreatic B cell function.
The urinary C-peptide excretions during O-GTT corresponded to the change of serum C-peptide levels in normal children (n=27) and the mean value of the excretions in younger children was significantly low. Age did not significantly affect basal serum C-peptide levels (ng/ml) and urinary C-peptide excretions (μg/h) before O-GTT, but significant differences in serum ΣC-peptide (ng/ml) and urinary C-peptide (μg/3 h) during O-GTT were noted between the younger group and the older group (p<0.01).
In 39 normal children on an inactive routine, mean values of the 24 h urinary C-peptide for children aged from 3 to 6, 7 to 10 and from 11 to 14 years old, were 28.2±12.6 μg/day, 32.3 ± 8.4 μg/day and 37.6±10.6 μg/day (mean±SD) respectively with significant differences according to age (younger group vs older group, p<0.05). The effects of daily routine on 24 h urinary C-peptide were studied in normal children. In children on an active routine, the C-peptide excretion was significantly less than in the same individuals on an inactive routine (26.9±9.9 μg/day vs 34.3±14.5 μg/day, p<0.01).
In children with insulin-dependent diabetes mellitus, 24 h urinary C-peptide excretion was studied to evaluate residual pancreatic B cell function. Urinary C-peptide was measurable in 47 of the 143 diabetic children, suggesting that most of the pancreatic B cells had deteriorated in the other 96 patients. In the 96 patients without B cell function, the averages of daily dose of insulin and 24 h-U·glucose/TAG ratio were significantly higher than those in the 47 patients who had pancreatic B cell function estimated by measuring urinary C-peptide (p<0.001).
In additional studies on the 43 diabetic children with residual pancreatic B cell function, who had had the disease for five years or less, the 24 h urinary C-peptide excretion (μg/day) correlated weakly but significantly with the duration of the disease (r=-0.28, p<0.05).
Patients who had had the disease longer and who were controlled with larger doses of insulin had less of the 24 h urinary C-peptide. 44 of the 48 patients who had had the disease longer than 5 years had no measurable urinary C-peptide.
24 h urinary C-peptide measurement is only a non-invasive method for determining an integrated measure of physiological insulin secretion.
On the other hand, in children with insulin-dependent diabetes mellitus, it seems clinically very important for diabetic control to assess the residual pancreatic B cell function measured by urinary C-peptide excretion.

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A new technique of barium enema examination and its clinical usefulness are reported. Routine colonography 300 (RCG 300), a disposable instrument filled with 300 ml of 75 w/v% barium sulfate, was devised to simplify and quicken the procedures of barium enema examination. For preparation of the colon, patients took either favorite or a proprietary low residue diet and a dose of 125 ml of magnesium citrate and either 15 mg or 37.5 mg of sodium picosulfate as laxatives the day before examination, but they did not receive either bisacodyl suppository or glycerin enema. There were 486 patients with suspected lesions of the large intestine examined by barium enema using RCG 300 over a period between January, 1984 and June, 1985 while 456 patients underwent barium enema examination by the conventional enema syringe (ES) method during the same period of time.
The quality of X-ray films after barium enema by the RCG 300 technique was mostly satisfactory and comparable to that by the conventional ES technique irrespective of the four methods of colon preparation. The mean time for examination was 9.4 ± 3.0 min (± SD) for the RCG 300 method, and was significantly shorter than 11.7 ± 3.2 min for the conventional ES method (p<0.01). Comparison with the results of colonoscopic examination revealed that accuracy of the RCG 300 method in the detection of polyp and cancer in the large intestine did not differ significantly from that of the conventional ES method.

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This study examined the effect of exercise on liver function in patients with chronic liver disease (CLD).
1) Twenty-five patients with CLD (21 with chronic hepatitis (CH) and 4 with liver cirrhosis (LC)) and 10 healthy subjects were administered an exercise test employing a treadmill. The load applied was 6.5 Mets and was administered for a period of 10 min. The serum levels of S-GOT, S-GPT, LDH, CPK, triglyceride, GOTm and GLDH were measured before exercise and 1 h, 24 h and 7 days after exercise in the patients with CLD, and before and 24 h after exercise in the healthy subjects.
i. The patients with CLD showed an increase in GLDH 24 h after exercise (p<0.005), a decline in LDH 1 h (p<0.05) and 24 h (p<0.01) after exercise, and a decrease in triglyceride 24 h after exercise (p<0.005) as compared with pre-exercise values. No significant changes were observed in S-GOT, S-GPT, CPK or GOTm levels.
ii. The mean values and standard deviations (SD) of S-GOT and S-GPT during the 3-month period immediately preceding the study were calculated for all 25 patients. Increases in S-GOT of more than 1 SD were observed after exercise in 5 patients (20%); another 5 patients (20%) showed similar increases in S-GPT. The number of overlapping cases in which increases in both S-GOT and S-GPT were observed was 2 (8%).
iii. No significant differences were found in mean HR during exercise/predicted max HR, or mean BP during exercise between patients with increased S-GOT and those without, or between patients with increased S-GPT and those without.
iv. In the healthy subjects, there was a significant increase in GOTm (p<0.05) following exercise, but no such increase in S-GOT, S-GPT, CPK or GLDH.
2) The number of steps taken per day measured by a pedometer was selected as a parameter of daily exercise and examined in 14 patients with CLD (9 with CH and 5 with LC). No significant correlation was found between mean number of walking steps and S-GOT and S-GPT levels for patients with either type of CLD.
The results of this study indicate that moderate exercise was well tolerated in the majority of patients with CLD. Elevation of GLDH after exercise could be explained by the hypoxic effect of exercise on the liver, but this hypoxia was not of sufficient severity to induce elevation of S-GOT and S-GPT.

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Presence of transferrin in digestive juices and its possible role in iron absorption of rats were examined.
Transferrin concentrations in saliva, bile, pancreas juice and intestinal fluid obtained from adult rats of the Wistar strain were measured by Rocket immunoelectrophoretic assay. Transferrin concentration in pancreas juice was the highest (approximately 0.28 mg/ml) in the collected digestive juices and the concentration in iron deficient rats was 4 times higher than that of normal rats. The iron saturation rate of transferrin in pancreas juice was approximately 40%.
The participation of transferrin in iron absorption was investigated by the absorption through the intestinal segment of rats, into which ⁵⁹Fe labeled diferric transferrin was injected. The rate of iron absorption was more efficient in duodenal and proximal segments compared to the distal segment of the small intestine. The value was approximately 20% in the duodenal segment but less than 2% in the ileal segment. Iron absorption from diferric transferrin in the duodenal segment was inhibited by 1 mM monodansylcadaverine, the inhibitor of endocytosis, or addition of 20 times the normal amounts of nonradioactive transferrin in the test material. These data indicated that the process of iron absorption through diferric transferrin was not a passive phenomenon. Furthermore, one hour after the absorption of diferric ¹²⁵I-labeled transferrin in the proximal segment of the small intestine, ¹²⁵I-labeled transferrin was detected from the mucosal tissue of the segment, the luminal surface of which had been treated by 0.25% pronase E before the mucosal scranine.
These results suggested a possibility that transferrin in digestive juices was able to combine with dietary iron and the iron was internalized into mucosal cells of the small intestine through the receptor mediated transport of diferric transferrin.

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In an attempt to define the pancreatic B cell function in the elderly, we subjected 88 non-obese individuals (aged between 21 and 88) to an oral glucose tolerance test (OGTT), a simple glucagon test (SGT) and OGTT-glucagon test, in which the plasma glucose, insulin and serum C-peptide (CPR) were measured. We investigated heterogeneity in glucose intolerance in the elderly and its relationship to atherosclerosis.
In the OGTT and SGT test, the insulin responses (SIRI/SPG ratios) for normal, borderline and DM, (fasting plasma glucose<140 mg/dl and 2 h-PG≥200 mg/dl) groups of the elderly (60 and above) were not significantly different from those for normal group of young and middle-aged (below 60) and were significantly higher for elderly group than for the young and middle-aged group in each glucose tolerance group. But the insulin responses for the DM₂ (fasting plasma glucose≥140 mg/dl and 2 h-PG≥200 mg/dl) group of the elderly were not significantly different from those for the DM₁ and DM₂ groups of young and middle-aged.
The insulin responses of normal, borderline and DM₄ groups of the elderly with atherosclerosis were significantly higher than those of the comparable groups without atherosclerosis, while the insulin responses of the borderline and DM₁ groups of the elderly with atherosclerosis were similar to those of the control group of the young.
In the OGTT-glucagon test, there were no differences in the insulin response or serum CPR response among the normal, borderline and DM₁ groups of the elderly, and these responses were significantly higher for the elderly group than the for young and middle-aged group in each glucose tolerance group. But these responses for the DM₂ group of the elderly were not significantly different from those for the DM₁ and DM₂ groups of the young and middle-aged.
These results indicate that the pancreatic B cell function of the normal group in the elderly remains favorable while mildly impaired glucose tolerance was exhibited by the borderline and DM₁ groups, who are comparable with the normal group of the young and middle-aged. But this function was clearly reduced in the DM₂ group of the elderly.
These findings suggest that there is a subgroup in the elderly, which has clinically evident atherosclerosis, mild glucose intolerance and high insulin response. Their pancreatic B cell function remains favorable.

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Urine specimens were sampled from toluene exposed persons (2 painters, 2 plasterers and 1 addict of organic solvent), who were admitted to the critical care center of our medical school and the urinary hippuric acid (HA; the metabolite of toluene) was monitored every one hour after admission for 10-12 hours and thence-forth every 4 hours for more than 40 hours. The hourly (t) excretion pattern of HA(Y) was simulated with multiexponential functions; Y=ΣAi·exp(-Bit)……(1), i=1 to 3. The HA (Y) level during the term before the admission was estimated by equation (eq.) (1) for the respective cases. The consciousness level was evaluated according to the Japan Coma Scale on the following time points; on the telephone call to the emergency center (t₁), on the arrival of the ambulance (t₂) and on admission (t₃). We related the differential change of the consciousness level (w) per time (between t, and t₂); Δw/Δt to one of the regression coefficients (B_i) of eq. (1) expressing the elimination of toluene from the body. A set of B_i whose scale parameter A; is positive and whose absolute value is the minimum in the individual eq. (1) has the highest correlation coefficient with the value of dw/At (r=-.870, p<.05). We calculated the toluene elimination equivalent (X) from the brain by applying this B_i to the equation; X=exp(-B_it) on the respective time point, t₁, t₂ and t₃, and related this X to W by simulating a logistic eq.; W=3.0/[1+exp{α(X-β)}]……(2), as to each respective case. The calculated values by eq. (2) for the occupationally toluene exposed cases revealed that the scale parameter (α) and the location parameter (β) correlated well with the integral HA excretion value for 48 hours computed by eq. (1), and the elimination rate equivalent (B_i), respectively.
But the calculated data of the solvent addict using eq. (2) indicated that there is a tolerance mechanism against toluene exposure; the scale parameter is larger and the location parameter is smaller than the respective ones from the painters and the plasterers.

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Synovial fluid lymphocytes and paired peripheral blood lymphocytes from 29 patients with rheumatoid arthritis (RA) were analyzed using two-dimensional flow cytometry. The lymphocytes of peripheral blood from 20 normal subjects were served as control.
In the RA patients, the composition of the lymphocyte population was different in the synovial fluid and peripheral blood. Compared with the peripheral blood, the synovial fluid contained higher populations of Ia+ (Leu 4+Leu HLA-DR+) T cells, especially Leu 2a+Leu HLA-DR+ (activated suppressor/cytotoxic) T cells, and of Leu 2a+Leu 15-(cytotoxic T) cells and Leu 3a + Leu 8- (helper T) cells. Contrary, the synovial fluid contained lower populations of Leu 2a + Leu 15+ (suppressor T) cells and Leu 3a + Leu 8+(inducer T) cells.
Compared with the lymphocytes of the normal peripheral blood, the RA patients had an elevated ratio of helper T/suppressor T cells (Th/Ts) in both the synovial fluid and peripheral blood, incidentally the former group showed striking elevation. The ratio of Th/Ts in the synovial fluid showed considerable variation, with a significant inverse correlation with the disease activity (Lansbury index).
These findings suggest that patients with rheumatoid arthritis show more specific changes in their synovial fluid lymphocytes than in their peripheral blood lymphocytes.

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Mycobacterium intracellulare Mino strain (Mino) grows progressively in the organs of susceptible mice, such as C57BL/6, C57BL/10 or BALB/c. It is very difficult to induce acquired immunity against M. intracellulare in those susceptible mice. C57BL/6 (B6) mice show no or very weak delayed type hypersensitivity (DTH) to partially purified Mino antigens when sensitized with 10⁷ living Mino subcutaneously.
B6 mice pretreated with cyclophosphamide (CY) showed enhanced DTH to Mino, suggesting that suppressor mechanism exists in this system. Whether or not such a suppressor mechanism exists in the induction phase of DTH (A) and/or in the expression phase of DTH (B) was examined by cell transfer experiments. Recipients for testing (A) were B6 mice receiving CY 2 days before an immunization, and those for (B) were B6 mice receiving both CY and subcutaneous injections of Mino 3 weeks before the cell transfer. B6 mice which were intravenously injected with Mino a week or 6 weeks before preparing spleen cell suspension, were used as the donors. Single cell suspensions of the spleens were plated on tissue cluture dishes and non-adherent cells were harvested after incubating for 60 min at 37-C. These cells were used for cell transfer.
In the induction phase experiment, recipient mice received the cells before sensitization, while they received the cells after sensitization in the expression phase experiment. DTH were markedly suppressed in the cell transferred groups as compared with the non-transferred groups. This activity disappeared by treatment of the transferred cells with antibody (a Thy-1 Ab) and complement. It was confirmed that the spleens in an early stage of Mino infection contain suppressor T cells which inhibit the induction of DTH (Ts-aff), while the spleen in the late stage of Mino infection have suppressor T cells which inhibit the expression of DTH (Ts-eff) as well as Ts-aff.
Surface markers of Ts were Thy-1⁺, Lyt-2⁺ and I -J⁺. Mice immunized with Mino showed DTH to Mino-antigens but not to BCG-antigens, and visa versa. However, in the transfer experiments, Ts from mice injected with Mino suppressed DTH of BCG-immuned mice to PPD, while an antigenic cross-reaction was not observed between Mino and sheep erythrocytes. It is speculated that the existence of crossreactive antigenicity among mycobacteria. It is likely that these suppressor T cells may play a critical role in the suppression of cell-mediated immunity to M. intracellulare, resulting in the continuous growth of the bacteria in the host.

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