Detection of urinary antigen by a rapid immunochromatographic membrane test (Binax NOW) was widely accepted as a powerful tool for diagnosis of Streptococcus pneumoniae pneumonia. This is a qualitative kit, so the value of quantitative analysis of urinary antigen, especially correlation of antigen titers and severity of diseases, remained to be determined. We examined semi-quantitative antigen titer in urines collected from urinary antigen-proven S. pneumoniae pneumonia on admission, and analyzed the kinetics of antigen titer and its relation to severity of diseases. After serial 2-fold dilution of urine, the highest dilution for positive results was determined, and this was designated as maximum dilution factor (MDF). MDFs varied from 1 to 4096 in 29 patients examined (mean MDF, 317.8). Importantly, severe cases of S. pneumoniae pneumonia were higher values of MDFs (mean MDF: 760.5) than those of non-severe cases (mean MDF: 5.4). The patients with high MDFs (> or = 64) demonstrated higher values of LDH, CRP and lower values of WBC and PaO2 compared to those of low MDFs group (< or = 32). There was no clear correlation between CRP values and antigen titers, and conversely the majority of severe cases showed relatively weak CRP responses, despite high levels of bacterial antigen. Kinetic analysis of urinary and serum antigen titers in 4 cases of S. pneumoniae pneumonia exhibited consistently higher values of antigen titers in urine than those in serum. The half lives of urinary and serum antigen titers were calculated to be 1.0-3.4 and 1.1-2.3 weeks, respectively. These data suggest that quantitative analysis of urinary antigen may be a useful indicator for severity of disease and course of S. pneumoniae pneumonia. Our results demonstrate an application for S. pneumoniae antigen titer determination in urine and serum, which may be crucial not only for diagnostic measures, but also may provide a better understanding of the pathogenesis of S. pneumoniae infection.

The modulatory effect of Ca on [Arg8]vasopressin-dependent (AVP) cAMP metabolism was studied in medullary collecting tubules (MCT) and medullary ascending limbs (MAL) microdissected from rat kidney. In MCT segments incubated in vitro with AVP, the accumulation of cAMP was enhanced (delta +59%) when Ca was omitted from the incubation medium compared with a medium with 2 mM of ionized calcium (Ca2+). Ionophore A23187 caused a decrease in AVP-stimulated cAMP accumulation in MCT in the presence of 2 mM Ca2+ but not in a Ca2+-free medium. Diltiazem and verapamil enhanced the AVP-stimulated cAMP accumulation in MCT; PTH had no detectable effect. A23187 caused a dose-dependent inhibition of cAMP accumulation stimulated by AVP with forskolin in both MCT and in MAL. However, in MAL the A23187 concentration needed for half-maximum inhibition (6.3 X 10(-6) M) was higher than for MCT (3.9 X 10(-7) M). The maximum inhibition in MAL (-65%) was less than in MCT (-97%). In the presence of 3-isobutyl-1-methylxanthine, AVP-stimulated cAMP accumulation was inhibited by A23187 in MCT (-45%) but not in MAL. Naproxen or ibuprofen did not relieve the inhibitory action of A23187 in MCT. Added Ca2+ inhibited the AVP-stimulated adenylate cyclase in MCT and MAL (half-maximum approximately equal to 5 X 10(-4) M Ca2+) and stimulated cAMP phosphodiesterase (cAMP-PDIE) in both MCT and in MAL (half-maximum approximately equal to 9 X 10(-5) M Ca2+). Incubation of MCT and MAL with A23187 decreased (-50%) the content of ATP. Results suggest that increased influx of extracellular Ca2+ inhibits the AVP-stimulated cAMP accumulation in MCT and to a much lesser degree in MAL. Deceased cAMP accumulation in MCT is probably due to both stimulation of cAMP-PDIE and the inhibition of adenylate cyclase, whereas in MAL it is due to stimulation of cAMP-PDIE. The results suggest that Ca2+ influx exhibits a negative modulatory effect on AVP-dependent cAMP metabolism mainly in MCT.

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This study examined the influence of child-care support by elderly persons on mothers' child care-related stress in Japan. A cross-sectional study was conducted from February to April 2007 by using an anonymous questionnaire. This study focused on the "child-care salon" (hereafter referred to as "salon") as a type of parenting support activity by elderly persons in the community. For the analysis, 119 salon participants and a control group of 107 mothers who had not participated in a salon were recruited. As a result of a multiple regression analysis, participation or non-participation in the salon had no influence on the 'threat of loss of personal identity' stress, which was similar to a sense of social isolation because of child care. However, as a result of investigating the influence of the participation frequency on stress score for participants alone, mothers with less participation had a higher stress score than mothers with greater participation. That suggested the importance of intervention for a decrease of social isolation in mothers, especially in the initial stage of salon participation.

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