A method for the determination of free, active insulin in the sera of insulin-treated diabetics is described. This involved radioimmunoassay after extraction of free insulin with polyethylene glycol. Recovery tests with cold insulin showed 73 per cent recovery of free insulin and no recovery of bound insulin.The fasting free insulin levels were slightly lower in the patients than in normal persons; exceptions were some patients with complications expected to cause insulin resistance at the peripheral tissue level. Free insulin levels did not correlate with total insulin levels, antibody titers, insulin requirements or conditions of insulin treatment.A very slight increase of insulin was observed after glucose loading in insulin-treated patients, but a marked increase of the free insulin level followed by an exaggerated increase in the total insulin level was observed in a patient with the insulin autoimmune syndrome.The diurnal changes of the free insulin suggested the dynamic states of this fraction and its usefulness for determining control of diabetes with insulin. DIABETES 22: 590-600, August, 1973.Since Berson and Yalow introduced the radioimmunologic method for the determination of plasma insulin, 1 their original method and modifications have been widely used and the method's reliability generally accepted. The plasma insulin level in patients previously treated with insulin, however, cannot be determined by the original method or most of its modifications, due to the presence of human anti-insulin antibody in the plasma which combines with the added radioinsulin and interferes with the reaction between radioinsulin, endogenous insulin and guinea pig antiinsulin antibody.By Grodsky and Forsham's method in which the plasma insulin is extracted with acid ethanol prior to the immunoassay, 2 the presence of human antibody causes no interference in the radioimmunoassay. However, the obtained insulin level represents total insulins, including antibody-bound inactive insulin. For the study of insulin dynamics in patients treated with insulin, the determination of free, active insulin is required. In this report, a simple method for the determination of free insulin in serum containing insulin antibodies is described. MATERIALS AND METHODSExtraction of free insulin. To 1 ml. of plasma chilled in an ice water bath, 1 ml. of cold 25 per cent (w/w) polyethylene glycol solution was added with an automatic syringe, and the mixture was immediately agitated with a vortical mixer for one minute and centrifuged at 3,000 r.p.m. for forty-five minutes in a refrigerated centrifuge. The supernatant was used for the radioimmunoassay.Extraction of total insulin. A 1 ml. quantity of plasma and 0.2 ml. of 1.0 N HC1 were mixed and, after one hour at room temperature, 1.4 ml. of 25 per cent polyethylene glycol solution was added. After mixing with a vortical mixer, 0.2 ml. of 1.0 N NaOH was added and the mixture was again agitated with a vortical mixer. After centrifugation at 3,000 r.p.m. for forty-five minutes, the supernatant was...

Au/zeolite catalysts prepared with a deposition-precipitation method were characterized with quick XAFS (QXAFS) in combination with IR. The data were correlated with the catalytic performance in the CO-O(2) reaction conducted at 273 K. On the basis of the XANES analysis of Au loaded on H-Y, the deposited Au(2)O(3) was observed at the initial stage. The transformation of Au(2)O(3) to form metal Au clusters was observed at 473 K in a H(2) atmosphere. The fact was supported by the IR measurement of adsorbed CO and the subsequent reaction with O(2). Detailed clustering process of Au supported catalysts could be directly followed by EXAFS analysis. The growth of metal Au proceeded via the formation of a Au(55) cluster at 473 K. Then it agglomerated to give metal Au with diameter of 2 nm at 723 K. The addition of H(2) was effective to retard the sintering of Au clusters. A similar phenomenon was observed over Au loaded on USY zeolite. In marked contrast to the H-Y and USY supports, significantly agglomerated Au particles generated on Na-Y zeolite, indicating the importance of the presence of acid sites in keeping the Au clusters with highly dispersed form. The performance of 5 wt % Au loaded on H-Y and USY in the CO-O(2) reaction was remarkably sensitive to the pretreatment temperature and the gas atmosphere. The catalyst pretreated with hydrogen showed a two-spike pattern with respect to the pretreatment temperature. Namely, the optimum activity was observed after the pretreatment at 373 and 723 K, where the temperatures corresponded to the generation of Au(2)O(3) and metal Au clusters with 2 nm diameter as evidenced by QXAFS analysis, respectively. The reason for enhancement of the activity of Au/H-Y by the addition of H(2) in the pretreatment step could be attributed to the formation of metal Au with appropriate size. In contrast to the H-Y and USY support, Au loaded on Na-Y prepared under the same condition was almost inactive in the reaction due to the formation of aggregated metal Au.

Transcranial magnetic stimulation (TMS) has been used to describe cortical plasticity after unilateral cerebral lesions. The objective of this study was to find out whether cortical plasticity occurs after bilateral cerebral lesions. We investigated central motor reorganization for the arm and leg muscles in cerebral palsy (CP) patients with bilateral cerebral lesions using TMS. Seventeen patients (12 with spastic diplegia, 1 with spastic hemiplegia, and 4 with athetoid CP) and 10 normal subjects, were studied. On CT/MRI, bilateral periventricular leukomalacia was observed in all spastic patients with preterm birth. In two normal subjects, motor responses were induced in the ipsilateral tibialis anterior, but no responses were induced in any normal subject in the ipsilateral abductor pollicis brevis (APB) or biceps brachii (BB). Ipsilateral responses were more common among CP patients, especially in TMS of the less damaged hemisphere in patients with marked asymmetries in brain damage: in 3 abductor pollicis brevis, in 6 BBs, and in 15 tibialis anteriors. The cortical mapping of the sites of highest excitability demonstrated that the abductor pollicis brevis and BB sites in CP patients were nearly identical to those of the normal subjects. In patients with spastic CP born prematurely, a significant lateral shift was found for the excitability sites for the tibialis anterior. No similar lateral shift was observed in the other CP patients. These findings suggest that ipsilateral motor pathways are reinforced in both spastic and athetoid CP patients, and that a lateral shift of the motor cortical area for the leg muscle may occur in spastic CP patients with preterm birth.

Twenty hemiplegic patients were studied with transcranial magnetic stimulation (TMS). Motor evoked potentials (MEPs) of the biceps brachii (BB) and the abductor pollicis brevis muscles (APB) were recorded on both sides simultaneously. TMS was carried out with an 8-shaped coil over different scalp positions in the intact hemisphere. Bilateral MEPs of BB were elicited in patients with later childhood lesions as well as early lesion, but those of APB were only elicited in the latter (up to 2 years). In patients with prenatal or birth lesion on BB and in all patients on APB, cortical maps of MEP amplitude of paretic and non-paretic sides showed similar distributions. There were no remarkable differences in mean latency between both sides, and correlation coefficients of MEP amplitude between both sides were high in these patients. In patients with postnatal lesion on BB, MEP maps of both sides showed different distributions, ipsilateral MEP latencies were delayed and correlation coefficients were low. We suspect that ipsilateral MEPs after early lesion derive from axonal sprouting both in the proximal and the distal muscles. After postnatal lesion, other mechanisms of ipsilateral motor projection take place in the proximal muscles, but not in the distal ones.

We report characteristic and morphometric changes of cranial computed tomography (CT) with increasing age in 56 patients with Down's syndrome aged from 0 month to 37 years. Patients were compared with 142 normal controls aged 0 to 59 years. Width of ventricles, Sylvian fissures, posterior fossa, pons and cisterna magna were measured on CT. The incidences of the cavum septi pellucidi, cavum vergae and cavum veli interpositi and high density in the basal ganglia were examined. There was high incidence (10.7%) of bilateral calcification of basal ganglia in Down's syndrome, although that of pineal body and choroid plexus calcification was similar in Down's syndrome and controls. Basal ganglia calcification is more frequently seen in young Down's syndrome and may be related to the premature aging characteristic of Down's syndrome. The CT in Down's syndrome showed relatively small posterior fossa, small cerebellum, small brain stem and relatively large Sylvian fissures in those under one year of age. There was a high frequency of midline cava and large cisterna magna. There were no significant atrophic changes on CT except after the fifth decade comparing with controls.