Objectives-Urinary dysfunction and orthostatic hypotension are the prominent autonomic features in multiple system atrophy (MSA). A detailed questionnaire was given and autonomic function tests were performed in 121 patients with MSA concerning both urinary and cardiovascular systems. Methods-Replies to the questionnaire on autonomic symptoms were obtained from 121 patients including three clinical variants; olivopontocerebellar atrophy (OPCA) type in 48, striatonigral degeneration (SND) type in 17, and Shy-Drager type in 56. Urodynamic studies comprised measurement of postmicturition residuals, EMG cystometry, and bethanechol injection. Cardiovascular tests included head up tilt test, measurement of supine plasma noradrenaline (norepinephrine,NA), measurement of R-R variability (CV R-R), and intravenous infusions of NA and isoproterenol. Results-Urinary symptoms (96%) were found to be more common than orthostatic symptoms (43%) (p<0.01) in patients with MSA, particularly with OPCA (p<0.01) and SND (p<0.01) types. In 53 patients with both urinary and orthostatic symptoms, patients who had urinary symptoms first (48%) were more common than those who had orthostatic symptoms first (29%), and there were patients who developed both symptoms simultaneously (23%). Post-micturition residuals were noted in 74% of the patients. EMG cystometry showed detrusor hyperreflexia in 56%, low compliance in 31%, atonic curve in 5%, detrusor-sphincter dyssynergia in 45%, and neurogenic sphincter EMG in 74%. The cystometric curve tended to change from hyperreflexia to low compliance, then atonic curve in repeated tests. Bethanechol injection showed denervation supersensitivity of the bladder in 19%. Cardiovascular tests showed orthostatic hypotension below -30 mm Hg in 41%, low CV R-R below 1.5 in 57%, supine plasma NA below 100 pg/ml in 28%, and denervation supersensitivity of the vessels ( in 73%; 2 in 60%) and of the heart ( 1 in 62%). Conclusion-It is likely that urinary dysfunction is more common and often an earlier manifestation than orthostatic hypotension in patients with MSA, although subclinical cardiovascular abnormalities appear in the early stage of the disease. The responsible sites seem to be central and peripheral for both dysfunctions. (J Neurol Neurosurg Psychiatry 2000;68:65-69) Keywords: autonomic dysfunction; multiple system atrophy; orthostatic hypotension; urinary incontinence; urodynamic study Multiple system atrophy (MSA)c is known to have urinary disturbance.1 2 Some male patients with MSA have undergone urological surgery for prostatic hypertrophy before the correct diagnosis had been made. The results of the surgery are often transient or unfavourable because of the progressive nature of this disease. Previously we investigated urinary function in 86 patients with MSA considering three clinical variants; striatonigral degeneration (SND), sporadic olivopontocerebellar atrophy (OPCA), and the Shy-Drager syndrome. 3 The study showed that 4% of the patients with OPCA type, 16% with SND type, and 5...

No abstract

The patterns of autonomic involvement are qualitatively different between AIDP and AMAN. Acute inflammatory demyelinating polyneuropathy is characterized by cardio-sympathetic hyperactivity, excessive or reduced sudomotor function and preserved skin vasomotor function, while AMAN is not necessarily generally associated with marked autonomic dysfunction except for the sudomotor hypofunction seen in patients with severe neurological deficits.

Initially light and gradually increasing force induced tooth movement without the lag phase and showed smooth recruitment of osteoclasts and inhibition of hyalinization.

No abstract

No abstract

Firefly luciferase emits a burst of light when mixed with ATP and luciferin (L) in the presence of oxygen. This study compared the effects of long-chain n-alcohols (1-decanol to 1-octadecanol) and fatty acids (decanoic to octadecanoic acids) on firefly luciferase. Fatty acids were stronger inhibitors of firefly luciferase than n-alcohols. Myristyl alcohol inhibited the light intensity by 50% (IC50) at 13.6 microM, whereas the IC50 of myristic acid was 0.68 microM. According to the Meyer-Overton rule, fatty acids are approximately 12,000-fold stronger inhibitors than corresponding alcohols. The Lineweaver-Burk plot showed that myristic acid inhibited firefly luciferase in competition with luciferin, whereas myristyl alcohol inhibited it noncompetitively. The differential scanning calorimetry (DSC) showed that an irreversible thermal transition occurred at approximately 39 degrees C with a transition DeltaHcal of 1.57 cal g-1. The ligand effects on the transition were evaluated by the temperature where the irreversible change is half completed. Alcohols decreased whereas fatty acids increased the thermal transition temperature of firefly luciferase. Koshland's transition-state theory (Science. 1963. 142:1533-1541) states that ligands that bind to the substrate-recognition sites induce the enzyme at a transition state, which is more stabilized than the native state against thermal perturbation. The long-chain fatty acids bound to the luciferin recognition site and stabilized the protein conformation at the transition state, which resisted thermal denaturation. Eyring's unfolding theory (Science. 1966. 154:1609-1613) postulates that anesthetics and alcohols bind nonspecifically to interfacial areas of proteins and reversibly unfold the conformation. The present results showed that alcohols do not compete with luciferin and inhibit firefly luciferase nonspecifically by unfolding the protein. Fatty acids are receptor binders and stabilize the protein conformation at the transition state.

This paper describes a method to evaluate daily physical activity by means of a portable device that determines the type of physical activity based on accelerometers and a barometer. Energy consumption of a given type of physical activity was calculated according to relative metabolic ratio (RMR) of each physical activity type that reflects exercise intensity of activities. Special attention was paid to classification algorithms for activity typing that identify detailed ambulatory movements considering vertical movements, such as stair/ slope climbing or use of elevators. A portable measurement device with accelerometers and a barometer, and a Kalman filter was designed to detect the features of vertical movements. Furthermore, walking speed was calculated by an equation which estimates the walking speed as a function of signal energy of vertical body acceleration during walking. To confirm the usefulness of the method, preliminary experiments were performed with healthy young and elderly subjects. The portable device was attached to the waist. A standard accelerometer based calorie counter was also attached for comparison. Experimental results showed that the proposed method feasibly classified the type of ambulatory physical activities; level walking, stair going up and down and elevator use. It was suggested that the consideration of vertical movements made a significant improvement in the estimation of energy consumptions, and the proposed method provides better estimation of physical activity compared to the conventional calorie counter.