Showing papers in "The Kobe journal of the medical sciences in 2010"

Serum matrix metalloproteinase-3 as predictor of joint destruction in rheumatoid arthritis, treated with non-biological disease modifying anti-rheumatic drugs.

Abstract: Background: Rheumatoid factor (RF), anti-citrullinated peptide antibody (ACPA), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) have been studied extensively as prognostic markers of rheumatoid arthritis (RA). However, despite the fact that matrix metalloproteinase-3 (MMP-3) is linked to RA activity, few studies have evaluated MMP-3 as prognostic marker. Objective: To evaluate the performance of MMP-3 as predictor of joint destruction in RA treated with non-biological disease modifying anti-rheumatic drugs. Methods: In a retrospective study of 58 early to moderate stage RA patients who consulted the Department of Clinical Pathology and Immunology, Kobe University Hospital between May 2002 and April 2009, we evaluated the performance of MMP-3 and other biomarkers as predictors of joint destruction, by comparing them between radiographically progressive and non-progressive group. Results: Serum levels of RF at entry and ACPA, but not MMP-3 at entry, were significantly higher for the progressive group. Ratios of patients with MMP-3 levels higher than healthy control were not significantly different for the two groups. However, cutoff values determined through receiver operating characteristic analysis showed that the ratio of patients with elevated RF was significantly higher in the progressive group (p=0.001), while MMP-3 (p=0.092), ACPA (p=0.052), CRP (p=0.056), and ESR (p=0.069) tended to be more elevated in the progressive group. Multiple logistic regression analysis using the cutoff value identified MMP-3 positive and RF positive, but not ACPA, CRP or ESR, as significant factors for radiographic progression (OR 16.79 [95% CI: 1.34-414.19]). Conclusion: MMP-3 can be a useful marker for prediction of joint destruction. Rheumatoid arthritis (RA) is a systemic disorder that primarily affects the joints and is chronic and destructive in nature (1). It is well established that accumulation of joint destruction in RA leads to functional impairment, deterioration in quality of life, and work disability (2,3,4,5). The delay and minimization of joint destruction caused by RA is therefore a prudent strategy for the treatment of RA patients.

Alexithymia and its Relationships with Eating Behavior, Self Esteem, and Body Esteem in College Women

Abstract: of the TAS-20 was 28.7%, and the frequency of students with potential ED who scored 20 points or more of the EAT-26 was 8.7%. The prevalence of potential ED in the alexithymics (14.0%) was significantly higher than that in the non-alexithymics (6.5%). The mean values of the RSES and BES scores were significantly different between the alexithymic and non-alexithymic groups. The TAS-20 scores were unrelated to the age and body mass index, but were significantly correlated to the EAT-26 (total score (r = 0.12, p = 0.04), bulimia and food preoccupation (r = 0.14, p = 0.01)), the RSES (r = -0.44, p < 0.001), and BES (total score (r = -0.22, p < 0.001), appearance (r = -0.23, p < 0.001), and weight (r = -012, p = 0.04)). These results suggest that, in non-clinical college women, alexithymia is a common psychological characteristic that is strongly correlated with self esteem and body esteem and that may influence eating behavior.

Evaluation of the validity of the Autism Spectrum Quotient (AQ) in differentiating high-functioning autistic spectrum disorder from schizophrenia.

Abstract: The aim of this study is to examine the validity of the Autism Spectrum Quotient (AQ) to differentiate high-functioning autistic spectrum disorder (ASD) from schizophrenia (SCH). The AQ was developed by Baron-Cohen et al. to measure autistic traits. In addition to the original AQ items, we created self-administered questions about psychotic symptoms (S-scale). We administered the modified AQ to 51 ASD patients and 46 SCH patients, and we compared these two groups in terms of total AQ score, AQ subscale scores and S-scale score. We applied receiver operating characteristic (ROC) curves to examine the discriminating power of the AQ. The mean total AQ score of the ASD group (32.6; SD=6.8; range: 8-48) was significantly higher than that of the SCH group (21.8; SD=7.4; range: 10-39) (p<0.001). All AQ subscale scores of the ASD group were significantly higher than those of the SCH group. By using a cut-off score of 29 for the AQ total score, we were able to correctly classify 80% of the subjects. At this cut-off, the positive and negative predictive values were 0.83 and 0.78, respectively. Inclusion of additional questions of the S-scale did not increase the power of differentiation. These results indicate that the usefulness of the AQ in differentiating high-functioning ASD from SCH is limited.

Function of strawberry notch family genes in the zebrafish brain development.

Abstract: S We previously reported embryonic expression pattern of strawberry notch (sbno) family genes, suggesting involvement in brain development. However function of sbno genes in the vertebrate development has not been known yet. Utilizing zebrafish embryos, we experimentally examined function of sbno genes during brain development in this report. Knockdown experiments of sbno1 and sbno2a disrupted brain morphology, and delayed developmental alteration of gene expression. The earliest effect of loss of function of sbno genes on the zebrafish embryogenesis that we found here was downregulation of otx2 expression. Knockdown of sbno1 specifically affects regionalization along the anterior-posterior axis of the brain. These results suggest essential roles of sbno genes in vertebrate brain development. We carried out a microarray screening to identify novel mouse genes which are involved in brain morphogenesis, and identified Sbno1, a vertebrate strawberry notch (sbno) family gene (3). Subsequently we cloned three sbno genes (sbno1, sbno2a and sbno2b) of zebrafish (31). Expression pattern of Sbno1 (mouse) and sbno1 and sbno2a (zebrafish) suggested involvement of sbno genes in vertebrate brain development (3, 31), but their developmental function has not been examined yet. Because knockdown experiments of gene function can be easily carried out in zebrafish embryos by injection of morpholino antisense oligonucleotide, here we examined sbno function utilizing zebrafish embryos. Injection of morpholinos against sbno1 or sbno2a abnormalized brain morphology, and made delay in neural gene expression. Simultaneous knockdown of sbno1 and sbno2a basically caused severer abnormalities than that of single knockdown of either sbno1 or sbno2a, but some phenotypes were unique to one of these. These results suggest that sbno1 and sbno2a are involved in a molecular mechanism, which assures temporal regulation of gene expression during zebrafish brain development.

The Novel VEGF Receptor Antagonist, VGA1155, Reduces Edema, Decreases Infarct and Improves Neurological Function after Stroke in Rats

Abstract: Vascular endothelial growth factor (VEGF) is a major mediator of angiogenesis and also a strong vascular permeability factor. Blockade of VEGF may have a potential to treat cerebral edema after brain injury. We evaluated the effect of VGA1155 (5[N-Methyl-N-(4-octadecyloxyphenyl)acetyl]amino-2- methylthiobenzoic acid), a novel binding antagonist of VEGF, on cerebral edema after transient focal cerebral ischemia. Focal cerebral ischemia was induced with the suture occlusion method for 2 h. In the treatment group, a single dose of VGA1155 (1 ~ 50 mg/kg i.p.) was administrated 30 min before the induction of focal ischemia, and the vehicle group received phosphate buffer only. The brain water content, Evans blue extravasation, infarct volumes and neurological score were determined. Physiological parameters were not influenced by the administration of VGA1155. The brain water content at 24 h after cerebral ischemia was significantly reduced by intraperitoneal administration of VGA1155 and the dose of 10 mg/kg showed the maximum effect on brain water content (81.8 ± 0.5% in non treated group vs. 80.2 ± 0.6% in treated group). With this dose, VGA1155 also reduced vascular permeability from 2.2 ± 0.8 µg/g to 1.2 ± 0.5 µg/g studied at 6 h after the ischemia by intravenous injection of Evans blue. VGA1155 administration significantly reduced infarct volume and improved neurological scores at 1 week after ischemic injury. The data suggested that VGA1155 has antiedematous effect in acute phase after transient focal cerebral ischemia and improves neurological and histological outcomes 1 week after ischemic injury.

Signet-ring cell carcinoma of the stomach metastasizing to renal cell carcinoma: a case report and review of the literature.

Abstract: Metastasis of one neoplasm to another is also known as metastasis of "tumor to tumor", "cancer to cancer", "tumor in tumor", and "one to another" We describe the case of a 75-year-old woman with the metastasis of signet-ring cell carcinoma of the stomach to clear cell renal cell carcinoma Six years earlier, the patient had undergone gastrectomy for early gastric cancer She complained of lumbago, and a mass was found in her left kidney Examination of a partial nephrectomy revealed clear cell renal cell carcinoma containing signet-ring cells Morphological and immunohistochemical findings of the signet-ring cells found in kidney cancer and gastric cancer were identical Subsequent examinations revealed the patient had multiple bone metastases The diagnosis of carcinoma metastasizing to renal cell carcinoma can be challenging; therefore, additional clinical information and immunohistochemical panel studies are requisite

Results of 'two above- one below approach' with intermediate screws at the fracture site in the surgical treatment of thoracolumbar burst fractures.

Abstract: The aim of this retrospective clinical study was to evaluate and compare the results of the technique so called 'two above one below approach' with intermediate screws at the fracture site with long-segment posterior fusion in the surgical treatment of thoracolumbar burst fractures. For this purpose neurologically intact 27 patients having isolated one level thoracolumbar burst fracture underwent posterior instrumentation and fusion in our clinic via 'two above-one below approach' with intermediate screws at the fracture site. A control group consisting of 15 patients having one level thoracolumbar burst fracture treated with long segment posterior spinal fusion in our institute was formed. At the preoperative, postoperative and final follow up period, anterior body height loss, local kyphosis and sagittal index values of both groups were noted. At the final follow up Visual Analogue Pain Scale and Oswestry disability scores were noted. Retrospective data from both groups underwent statistical analysis. In both groups anterior body height loss, local kyphosis and sagittal index measurements improved at the final follow-up, but there was no significance between two groups in terms of radiological and clinical follow-up data. The loss of correction in local kyphosis of short-segment group in the interval between postoperative and follow-up period was also significant. No implant failure was noted. As a conclusion 'two above one below approach' with intermediate screws at the fracture site is associated with loss of correction radiographically, but favorable clinical outcomes in the presence of any implant failure can be achieved in the treatment of thoracolumbar burst fractures.

Cortical Layer V Neurons in the Auditory and Visual Cortices of Normal, reeler, and yotari Mice

Abstract: Both in the Reelin-deficient reeler and Dab1-deficient yotari mice, layer V corticospinal tract neurons in the sensory-motor cortex are radially spread instead of being confined to a single cortical layer. In the present study, we examined distribution pattern of cortical layer V neurons in the visual and auditory cortices of reeler and yotari mice with the injection of HRP into the superior and inferior colliculi of the adult animals, respectively. After the injection of HRP into the superior colliculus of the normal mouse, retrogradely labeled cells were distributed in layer V of the visual cortex, while the similar injection of HRP in the reeler and yotari mice produced radial dispersion of retrograde labeling through all of the depths of the visual cortex of these mutant mice. Next, we injected HRP into the inferior colliculus of the normal, reeler and yotari mice. Retrogradely labeled neurons were distributed in layer V of the normal auditory cortex, whereas they were again radially scattered in the auditory cortex of the reeler and yotari mice. Taken together with the previous and present findings, layer V cortical efferent neurons are radially scattered in the sensory-motor, visual and auditory cortices of the reeler and yotari mice.

Predictive factors for hospitalized and institutionalized care-giving of the aged patients with diabetes mellitus in Japan.

Abstract: To identify predictive factors for hospitalized and institutionalized care-giving among a group of aged patients with diabetes mellitus in Japan, retrospective chart review was performed in 288 diabetic subjects aged 65 years or older. Independent variables, based on the chart review, were age, sex, diagnosis, diabetic control and complications. Comprehensive geriatric assessment was performed to obtain information on the functional capacity and demographic variables, including physical and mental function, and socioeconomic status. 131 diabetic patients were considered as frail elderly and characterized for their higher age, longer duration of diabetes, higher frequency of insulin use, lower cognitive function, and lower QOL, in comparison with those of non-frail patients. All non-frail diabetic patients were independently treated at their homes, while 38 subjects out of 131 frail diabetic patients were hospitalized or institutionalized. Apparent clinical features of hospitalized/institutionalized patients were higher age, higher serum creatinine, and higher prevalence of stroke episodes, advanced cognitive decline and absence of key caregiver in the family members, in comparison with those of in-home frail diabetic patients. The predicted probabilities from the multivariate logistic regression analysis in predicting hospitalized and institutionalized care-giving were as follows: Log p/(1 - p) = -19.801x1 54.269x2 + 721.405; where x1 = cognitive function (score), x2 = social support (score). Receiver operating characteristic curve analysis revealed a satisfactory discrimination for hospitalized and institutionalized care-giving in frail diabetic elderly with 92.9% of sensitivity and 91.4% of specificity, when the cutoff point of the model was set at 0.992. We concluded that cognitive decline and low social support are the predictive for hospital and institutional care-giving, and that demographic and mental information as well as diagnostic data should be analyzed to predict the hospitalization/institutionalization among frail diabetic elderly.

Surveillance after colorectal polypectomy; comparison between Japan and U.S.

Abstract: Background Recently, early detection and early treatment of the colorectal cancer have been enabled by the improvement of endoscopic diagnosis and introduction of new techniques. In Japan, although Japan Polyp Study is running, there is no standard strategy concerning the post-polypectomy colonoscopic surveillance yet. Post-polypectomy colonoscopic surveillance is so far entrusted to each institute or each gastroenterologist at present. Material and method To analyze the present states of the surveillance after polypectomy in Japan, we performed questionary survey and compared them with the results in U.S. and U.S.Multisociety Task Force on colorectal Cancer. A simple random sample of 132 doctors who engaged in a digestive organ disease in plural institutes was obtained. Result Many doctors recommend surveillance every around 1 year regardless of the kind of the polyp. Doctors in Japan tend to recommend postpolypectomy colonoscopic surveillance more frequently than that recommended U.S. Multisociety Task Force on colorectal Cancer. Furthermore in all types of polyps except for 12 mm tubular adenoma with high grade dysplasia, the majority of doctors in Japan recommend post-polypectomy colonoscopic surveillance more frequently than American doctors. Significant difference was found in surveillance of hyperplastic polyp among doctors with 1 to 5 years experience and those with more than 6 years. Conclusion It has been shown that surveillance intervals varies substantially in each doctor. The agreement of the surveillance program in Japan is necessary to standardize the strategy for the post-polypectomy surveillance of the colon.

Effect of ultrasound irradiation on α-SMA and TGF-β1 expression in human dermal fibroblasts.

Abstract: Ultrasound therapy is used to promote pressure ulcer healing as an adjunctive therapy. However, the efficacy and the scientific basis of this treatment are unclear. We investigated the effect of ultrasound irradiation on alpha-smooth muscle actin (α-SMA) and transforming growth factor-beta1 (TGF-β1) expression in human dermal fibroblasts. These are important factors for acceleration of wound closure. We used pulsed ultrasound of 0, 0.1, 0.5, and 1.0 W/cm 2 . TGF-β1 and α-SMA mRNA was measured by quantitative real-time polymerase chain reaction, α-SMA protein was examined by western blot, and localization of α-SMA was evaluated by immunofluorescence staining. Expression of α-SMA and TGF-β1 mRNA was increased at 24 h but not at 48 h after ultrasound irradiation. There were significant differences between controls of 0 W/cm 2 and 0.1 W/cm 2 with a 1.34 ± 0.26 fold increase in α-SMA (P < 0.05) and a 1.78 ± 0.57 fold increase in TGF-β1 (P < 0.05). Protein levels of α-SMA were also increased and detected in ultrasound irradiated fibroblasts at 24 h. Ultrasound irradiation promotes α-SMA expression in human dermal fibroblasts and this suggests the biological mechanism of ultrasound efficacy on chronic wound treatment.

A Case of Malignant Melanoma of the Oral Cavity Alive with Liver Metastasis for a Long Period with Administration of a Biologic Response Modifier, OK432

Abstract: A patient with malignant melanoma of the oral cavity who lived for a long period despite developing liver metastasis is presented. An 81-year-old female was referred to our hospital because of a pigmented tumor of the lower gingiva. Under the clinical diagnosis of malignant melanoma, she underwent bilateral functional neck dissection and marginal mandiblectomy. Histological diagnosis of the operation material was malignant melanoma with regional lymph node metastasis. In spite of loco-regional control, liver metastasis developed at 7 months after the surgery. She then underwent combination chemotherapies with dimethyl triazeno imidazole carboxamide (DTIC), nimustine hydrochloride (ACNU) and vincristin (DAV therapy), or cisplatin, DTIC, ACNU and tamoxifen (DAC-tam), but no marked response was obtained. Considering the advanced age of the patient, immunotherapy with a biological response modifier, OK432, alone was started. After administration of OK432, the metastatic tumor gradually decreased, and she is alive without any clinical symptoms of tumor at 46 months after the detection of liver metastasis, although it is still present on ultrasonic and CT examinations.

Vitamin K2-derived compounds induce growth inhibition in radioresistant cancer cells.

Abstract: A strategy to overcome radioresistance in cancer treatment has been expected. To evaluate the strategy, appropriate experimental models are needed. Radioresistant tumour models were originally established from human colon cancer cells, and we evaluated their molecular basis. Next, the growth inhibitory effects of newly synthesized vitamin K2 (VK2)-related compounds were tested. Here, we showed that these novel compounds have growth inhibitory effects not only on cancer cells of various origins, but also on radioresistant cells, through the generation of reactive oxygen species (ROS). Human colon, lung, and breast cancer cell lines were used for testing the growth inhibitory activities of several chemical compounds. Radioresistant tumour models were established by fractionated radiation exposure. Irradiated cells were selected by a single cell cloning method, and their sensitivity to ionizing radiation was evaluated by a colony-forming assay. The VK2 derivatives (named MQ-1, MQ-2, and MQ-3) were chemically synthesized. To evaluate the generation of ROS, flow cytometer analyses were performed. A radioresistant tumour model was established from the HCT116 human colon cancer cell line. The radioresistant cells from HCT116 also showed resistance to cisplatin. In the radioresistant cells, NF-κB was highly activated. MQ-1, MQ-2, and MQ-3 showed greater growth inhibitory activities than VK2 not only in various cancer cells but also in radioresistant cells through the generation of ROS. In conclusion, a radioresistant tumour model was originally established from colon cancer cell lines through NF-κB activation, and it could be a useful tool for evaluating anti-tumour agents. Newly synthesized VK2 derivatives (MQ-1, MQ-2 and MQ-3) seemed to be potential anti-tumour agents in various cancers and radioresistant cancers. The efficacy of those compounds was related to the generation of ROS. These findings together might pave the way for the treatment of radioresistant or recurrent cancers.

De novo ring chromosome 6 in a child with multiple congenital anomalies.

Abstract: Ring chromosome 6, especially if it is de novo, is a rare occurrence. The phenotype of patients with ring chromosome 6 can be highly variable ranging from almost normal to severe malformations and mental retardation. The size and structure of the ring chromosome as well as the level of mosaicism are important factors in determining the clinical phenotype. Here we report an eight month-old child, a product of a non consanguineous marriage, who presented with developmental retardation, hypertelorism, microcephaly, flat occiput, broad nasal bridge, large ears, micrognathia, wide spaced nipples, protruding umbilicus, short stubby fingers, clinodactyly, single palmar crease, short neck with no obvious webbing, and congenital heart defect. Conventional karyotyping and Whole Chromosome Paint of the peripheral leukocytes showed 46,XY,r(6)(p25q27) karyotype with plausible breakpoints at p25 and q27 end. Conventional karyotyping of both parents showed normal karyotype. To the best of our knowledge, this is the first report of a Malay individual with ring chromosome 6, and this report adds to the collective knowledge of this rare chromosome abnormality.

Analysis of Neutralizing Antibodies against Hepatitis C Virus in Patients Who Were Treated with Pegylated-Interferon plus Ribavirin

Abstract: The role of neutralizing antibodies (NAb) in determining responses to antiviral therapy has not been defined well. By using hepatitis C virus (HCV) cell culture system with the J6/JFH1 strain of HCV genotype 2a, we analyzed NAb responses in patients with chronic hepatitis C who received pegylated-interferon plus ribavirin (PEG-IFN/RBV) antiviral therapy. A total of 65 patients chronically infected with HCV genotype 1b were enrolled in this study. Of all the 65 patients, 34 (52%) patients achieved early virological response (EVR), with the remaining 31 patients (48%) being Non-EVR. Twenty-seven patients (42%) achieved sustained virological response (SVR), with the remaining 38 patients (58%) being Non-SVR. Thus, NAb titers were significantly higher in sera of patients who achieved EVR and SVR than those of Non-EVR and Non-SVR, respectively. Rather unexpectedly, NAb titers did not significantly decrease when measured even one year after disappearance of HCV RNA. On the other hand, when change ratios of NAb titers before and after disappearance of HCV RNA were compared between patients with different treatment outcomes, we noticed that the change ratio of NAb titers of patients who achieved an EVR was significantly lower than that of Non-SVR. In conclusion, our present results suggest that NAb titers were significantly associated with clinical responses to PEG-IFN/RBV therapy.

Crystal structure of a PFU-PUL domain pair of Saccharomyces cerevisiae Doa1/Ufd3.

Abstract: Doa1/Ufd3 is involved in ubiquitin (Ub)-dependent cellular processes in Saccharomyces cerevisiae, and consists of WD40, PFU, and PUL domains. Previous studies showed that the PFU and PUL domains interact with Ub and Hse1, and Cdc48, respectively. However, their detailed functional interactions with Doa1 remained elusive. We report the crystal structure of the PFU-PUL domain pair of yeast Doa1 at 1.9 A resolution. The conserved surface of the PFU domain may be involved in binding to Ub and Hse1. Unexpectedly, the PUL domain consists of an Armadillo (ARM)-like repeat structure. The positively charged concave surface of the PUL domain may bind to the negatively charged C-terminal region of Cdc48. A structural comparison of Doa1 with Ufd2 revealed that they share a similar ARM-like repeat, supporting a model in which Doa1 and Ufd2 compete for Cdc48 binding and may dictate the fate of ubiquitinated proteins in the proteasome pathway.

How were the high-fever consultation center perceived by the officers who provided it in Kobe City, during swine-origin influenza A (H1N1) outbreak? A qualitative study utilizing SCQRM.

Abstract: Background For the preparation of pandemic influenza, Japan's government requested to set up a high-fever consultation center at each prefectural and city government. During the initial period of pandemic influenza A (H1N1) outbreak in Japan, high-fever consultation centers received a great number of calls. The effectiveness of this system, however, has not been fully evaluated. This study reports the result of a qualitative study, which explored officers who provided the high-fever consultation center during influenza outbreak. Methods A qualitative study, using semi-structured interviews (n=3), was conducted to the officers of a major city government in Japan, who provided the service. Theory construction was conducted with a use of structure construction qualitative research method. Results The officers expressed many difficulties during the outbreak. The uncertainty of the disease characteristics, rapidly changing situation, fear of bad outcome of patients due to wrong triage, and miscommunications among health care workers were among the difficulties extracted. While inefficiency was among the problems extracted, lessening anxiety of callers was one of the achievements they felt the high-fever consultation center provided. Development of practical manual made their provision of the service easier.

Brachydactylia associated with mitochondrial disorder in an octogenarian.

Abstract: In a 80yo female with acute pancreatitis, myopathy, polyneuropathy, short stature, diabetes mellitus, hypothyroidism, hypoacusis, atrial fibrillation, hepatopathy, and renal cysts, mitochondrial disease was diagnosed. The family history for the disease was negative. Interestingly, the patient additionally presented with brachydactylia, which was also found in her son and father and has not been reported in association with mitochondrial disease before. Whether the relation between brachydactylia and mitochondrial disease was causal or coincidental remains speculative.

Knockout of endothelin-1 in vascular endothelial cells protects against insulin resistance induced by high-salt diet in mice.

Abstract: The increased plasma Endothelin-1 (ET-1) level has been associated with development of insulin resistance in obese and hypertensive patients. However, the underlying mechanism remains elusive. Here we investigate the potential role of endothelial cell-derived ET-1 in mediating insulin resistance induced by high-salt diet. To address this issue, we used vascular endothelial cell-specific ET-1 knockout (VEETKO) mice and its littermates fed with a high-salt diet containing 8% NaCl for 3 weeks, and evaluated the metabolic parameters. High-salt diet increased systolic blood pressure similarly in both genotypes. We observed impairment of glucose tolerance in control mice despite comparable increase of serum insulin concentration with VEETKO mice. We further found that VEETKO mice showed preservation of circulating adiponectin level - an adipokine with insulin-sensitizing property - and prevention of the upregulation of the pro-inflammatory adipokine TNF-α, which lead towards better insulin sensitivity. These results provide evidence that blockade of endothelin signaling may be proven beneficial in preventing high-salt induced insulin resistance. Insulin resistance has been thought to play a causative role in development of metabolic syndrome, a cluster of phenotypes which is important to identify individuals at high risk of both type 2 diabetes and cardiovascular disease (3). Although several mechanisms such as dysregulation of adipocyte signaling and altered lipid homeostasis have been strongly reported to promote insulin resistance (13, 5); understanding the interactions among these mediators and identification of their upstream regulators that possess potential therapeutic property are needed. Endothelin-1 (ET-1) is a 21-amino acid peptide produced mainly by vascular endothelial cells, which has a potent vasoconstrictive activity in vascular smooth muscle cells (20). ET-1 and its receptors, termed ETA and ETB, are also expressed in other organs including the stromal vascular fraction of adipose tissue, suggesting that ET-1 has various biological effects (16). Previously, plasma ET-1 level has been reported to increase in obese, diabetes and hypertension patients (2, 17). ET-1 was shown to have an insulin-like effect that is mediated through ETA receptor in 3T3-L1 adipocytes in vitro, and treatment with exogenous ET-1 also caused heterologous desensitization of insulin signaling in the same cells (10, 19).

Efficacy of Combining Flexible and Rigid Ureteroscopy for Transurethral Lithotripsy

Abstract: ® system was used for lithotripsy. Five cases involved stones pushed up during surgery and 3 cases involved stones already in the kidney in detail. We pulled the stones down into the ureter in all cases and successfully completed lithotripsy or removed the stone, thus avoiding the performance of additional extracorporeal shock wave lithotripsy (ESWL). In conclusions, combined use of flexible ureteroscopy and rigid ureteroscopy for upper urinary tract stones pushed up into the kidney during TUL or renal stones could be useful for avoiding additional ESWL.

Comparison of capability of abdominal 320-detector row CT and of 16-detector row CT for small vasculature assessment

Abstract: The purpose of our study was to compare the capability of the 320-detector row CT (area-detector CT: ADCT) using the step-and-shoot scan protocol for small abdominal vasculature assessment with that of the 16-detector row CT using the helical scan protocol. Contrast-enhanced abdominal CT for preoperative assessment was administered to 25 patients, 18 of whom, suspected of having lung cancer, underwent ADCT using the step-and-shoot scan protocol, while the remaining 7, suspected of having renal cell carcinoma, underwent 16-MDCT using the helical scan protocol. Two experienced abdominal radiologists independently assessed renal interlobar and arcuate as well as mesenteric marginal (Griffith point) arteries by means of a 5-point visual scoring systems. Kappa analysis was used for evaluation of interobserver agreement. To compare the visualization capability of the two systems, the scores for each of the arteries were compared by using the Mann-Whitney U-test. Overall interobserver agreements for both systems were almost perfect (κ>0.78). Visualization scores for renal interlobar and arcuate, (p<0.0001) and mesenteric marginal (Griffith point) arteries (p<0.05) were significantly higher for ADCT than for 16-detector row CT. ADCT using the step-and-shoot scan protocol for small abdominal vasculature assessment can be considered superior to 16-detector row CT using the helical scan protocol.

Cellular fatty acid composition of stratified squamous epithelia after transplantation of ex vivo produced oral mucosa equivalent.

Abstract: PURPOSE We have fabricated, for clinical application, artificial oral mucosa that totally excludes both heterogenic protein interaction and xenotransplantation. The purpose of this study is to compare the fatty acid composition of cell membrane phospholipids related to post-transplantation epithelial regeneration. MATERIALS AND METHODS Cultured keratinocytes, keratinocytes at 2, 3, 4, and 9 weeks after transplantation, and normal oral keratinocytes were compared by gas chromatography for the composition of 23 fatty acids. The relation between the composition of cell membrane fatty acids, and the glucose metabolism was immunohistochemically analyzed. RESULTS 1. Even after transplantation, cultured keratinocytes retained the same ratio of palmitic acid as that of normal oral keratinocytes. 2. Essential fatty acids decreased markedly in cultured keratinocyte membranes to the same composition as that of normal oral mucosa 2 weeks after transplantation. 3. The percent composition of palmitoleic acid in cultured keratinocytes was significantly higher than that in post-transplanted keratinocytes; it decreased 2 weeks after artificial mucosa transplantation, but became similar to that in 3 weeks thereafter. 4. The entire population of stratified keratinocytes in EVPOME before transplantation expressed GLUT-1 protein. CONCLUSION Our findings suggest that post-artificial mucosa epithelialisation allows keratinocytes to proliferate while consuming palmitic acid, and then diet-provided essential fatty acids induce the keratinocytes to differentiate. Complete clinical epithelialisation of the transplant wound requires 4 weeks; however, within 3 weeks of transplantation, cultured cells of a specific metabolic mechanism change into or are replaced by keratinocytes of a normal metabolic mechanism similar to that of surrounding tissue.

Prevention of Mothers' Mental Illness Deterioration:Can Their Attitudes Toward Self-care and Childcare Prevent Mental Deterioration?

Abstract: Background: Women with severe mental illness experience many kinds of problems during childcare and have a high risk of relapse. Previous studies have not revealed methods for preventing deterioration of mothers’ illness. In this study, we retrospectively investigated mothers with severe mental illness, and we attempted to identify characteristics of mothers whose condition did not deteriorate and who did not require hospitalization during childcare. Methods: Data were collected from a self-administered questionnaire filled out by female outpatients who had experienced childcare and were diagnosed with schizophrenia, schizoaffective disorder, bipolar affective disorder or depression with psychotic symptoms. The questionnaire asked about attitudes toward childcare during the first three years following the first childbirth. It was composed of six sections on A) living situation, B) psychiatric medication, C) sleep, D) subjective symptoms of deterioration, E) resting time, and F) advice for other mothers with mental illness. The subjects were split into two groups: those that were admitted to a hospital within three years following the first childbirth (hospital group, n=16) and those that were not hospitalized (non-hospital group, n=19). Results: The two groups showed no significant differences in their responses to the questions in sections A-E of the questionnaire. In section F, the non-hospital group wrote significantly more comments than the hospital group. The non-hospital group described concrete ways for taking care of their mental health, while the hospital group did not. Discussion Our results suggest that whether or not mothers need admission during childcare depends on their assertiveness and ability to communicate. In the past few decades, women with severe mental illness have had more opportunities to be parents and raise children. A British study found that about 60% of women with psychotic disorders were mothers [6]. The increase in number of mothers with mental illness may be associated with deinstitutionalization, community-based rehabilitation and support

Effect of perceptual learning on motor skills of hands: a functional magnetic resonance imaging study.

Abstract: Our aim was to clarify the mechanism by which perceptual learning improves motor skills of hands. We included 18 healthy volunteers (age 21.3 ± 0.3 years, mean ± standard deviation) in the study with a crossover design. The subjects were randomly classified into 3 groups, and they performed a 2-ball quick rotation task with a hand. The role of perceptual learning in improving the ability to discern the length of a wooden stick held between the left thumb and index finger was studied between the first and second sessions of the task in group A, and between the second and third sessions in groups B and C with a period of rest interval between the first and second sessions. Functional magnetic resonance imaging (fMRI) was performed for each group during the perceptual learning session. The effect of intervention, in the form of perceptual learning, on the task performance was significantly greater than that of non-intervention in all subjects (p = 0.022). Among all the activated brain areas, the bilateral prefrontal cortices, right premotor area, right supplementary motor area, right primary sensory area, right primary motor area, right inferior parietal lobe, right thalamus, and left cerebellar posterior lobe showed positive correlations between the respective contrasts from the single-subject analysis and the behavioral data before and after the interventions (p < 0.001). This result indicates a pivotal role of the frontoparietal or frontocerebellar circuits in sensorimotor integration; a specific approach that activates these circuits should be developed for clinical rehabilitation of patients.

Effects of Mass and Momentum of Inertia Alternation on Individual Muscle Forces During Swing Phase of Transtibial Amputee Gait

Abstract: A computer simulation was carried out to investigate the forces of lower extremity muscles in the swing phase of a transtibial amputee gait. With each muscle as an ideal force generator, the lower extremity was simulated as a two-degrees of freedom linkage with the hip and knee as its joints. Kinematic data of hip and knee joints were recorded by a motion analysis system. Through a static optimization approach, the forces exerted by muscles were determined so that recorded hip and knee joint angles were produced. Simulation results showed that when the mass of prosthetic foot is increased, muscle forces increase, too. This result is in accord with experimental and theoretical studies that reported an increase in leg mass lead to higher electromyography activity of muscles, and energetic of walking. However, since prosthetic foot moment of inertia is smaller than that of thigh and prosthetic shank, its alternation does not have noticeable effect on muscle forces. To investigate the importance of the role played by muscles in the normal swing phase of gait, a lot of research activities have been carried out. Some of them suggest that the forces exerted by muscles in the swing phase may be neglected. For example, Mochon and McMahon (1) found a range of initial segment angular velocities that could achieve toe clearance without the action of muscles. Also, Mena et al. (2) found that without including moments applied by muscles, a near- normal swing can be simulated. McGeer (3) analyzed and built two- legged passive dynamic machines with knees that could walk down slight slopes without the activities of muscles. However, the excitations of some muscles in the swing phase are not zero (4). Therefore, it is reasonable to expect that muscles affect the motions of the swing leg. Piazza and Delp

Pyogenic granuloma in a finger of a rheumatoid arthritis patient.

Abstract: Pyogenic granuloma is benign soft tissue tumor which mainly occurs in gingiva, lips, tongue and finger. We report the patient of pyogenic granuloma in the distal phalanx of the index finger of the rheumatoid patient. The tumor enlarged rapidly and surgical excision was performed. Pathological examination showed lobular hyperplasia of capillary vessels and the expression of vascular endothelial growth factor at capillary vessels in inside of tumor.

Score of inattention subscale of ADHD rating scale-IV is significantly higher for AD/HD than PDD.

Abstract: Attention-deficit/hyperactivity disorder (AD/HD) and pervasive developmental disorder (PDD) must be differentiated because the respective treatments are different. However, they are difficult to distinguish because they often show similar symptoms. At our hospital, we have the rearer of a patient answer both the ADHD Rating Scale-IV (ADHD-RS) and the Autism Spectrum Screening Questionnaire (ASSQ), and use the results as an aid for the diagnosis of AD/HD or PDD. These results were compared with reference to PDD and AD/HD for an examination of the features of the two disorders. The subjects of our study were 45 children with AD/HD and 77 children with PDD. ADHD-RS score was significantly higher for AD/HD than PDD, but the total ASSQ score was significantly higher for PDD than AD/HD. Furthermore, for the inattention subscale of ADHD-RS, both total score and number of high-score items were significantly higher for AD/HD than PDD. As for the ASSQ score for PDD, it was significantly higher than for AD/HD in the domains of repetitive behavior, social interaction, and communication problems. In addition, PDD features many high-score items in the social interaction domain. We thought that these results about both ADHD-RS and ASSQ were useful for the differentiation of AD/HD or PDD.

Limited hydration may reduce intraoperative blood loss in retropubic radical prostatectomy

Abstract: Retropubic radical prostatectomy (RRP) may involve major intraoperative blood loss This study focuses on how limited intraoperative hydration, especially in the early part of the surgery, affects the total blood loss Fifteen prostate cancer patients were enrolled in this study in which the RRPs were performed by a single surgeon with limited (no more than 1500 ml as a rule) intraoperative hydration in the first 2 hours of the surgery when ligation of intrapelvic lymph node, dorsal vein complex (DVC), neurovascular bundle (NVB) and cut of urethra are assumed to be finished, and were compared with the control group in which no intervention of hydration was undertaken Intervention group (n=15) had significantly less intraoperative blood loss (p<005) compared with control group even though blood pressure at the first 2 hours was not significantly different Limited hydration did not cause apparent adverse events resulted from dehydration In conclusion, limited hydration especially in the first half of operation may reduce intraoperative blood loss without any side effects of dehydration This study could help to establish detailed guidelines for hydration methods for less blood loss during RRP

Assessment of dissociation symptoms in patients with mental disorders by the Dissociation Questionnaire (DIS-Q).

Abstract: Experience Scale (DES), dissociation, trauma, analysis of variance Aim: Dissociative symptoms are often found in psychiatric patients and have been implicated in psychotic trauma. We aimed to explore dissociative tendencies in psychiatric patients including dissociative disorders (DDs), obsessive-compulsive disorder (OCD), eating disorder (ED), and post-traumatic stress disorder (PTSD) by using the Dissociation Questionnaire Japanese version (DIS-Q-J). Methods: We evaluated the reliability and the validity of DIS-Q-J by comparing it with the Dissociative Experience Scale (DES). 107 patients (32 DDs, 28 OCDs, 24 PTSDs, 23 EDs) and 83 controls answered both the DIS-Q-J and the DES questionnaires. In addition, OCD patients were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), PTSD patients were assessed by the Impact of Event Scale-Revised (IES-R), and ED patients were assessed by the Bulimic Investigatory Test, Edinburgh (BITE). Results: The internal consistency of the total DIS-Q-J and DES scale was high in all groups (Cronbach’s alpha coefficients, DIS-Q-J; 0.922-0.975, DES; 0.934-0.957, p<0.01). The correlation between the total scores of the DIS-Q-J and the DES in all groups was significant (Spearman’s rank correlation, 0.613-0.777 (p<0.01)). An analysis of variance (ANOVA) showed that the mean total scores of the control and clinical groups were significantly different (p<0.05) for both the DIS-Q-J and DES. Conclusion: These results suggest that the DIS-Q-J is a useful tool for the assessment of dissociative symptoms.