What prevents Japan from establishing a clinical service of sleep medicine: experience gained at a local hospital

We opened a mini-sleep disorders clinic in a local general hospital in rural Japan, and have been operating it for more than 3 years. We encountered many difficulties during this period when we tried to provide proper clinical service. Problems ranged from lack of sleep specialists and polysomnography technicians, shortage of funding, non-existence of an educational system to obtain comprehensive knowledge about sleep medicine, and also lack of cooperation among different departments necessary for maintaining clinical service. Through our experience, we analyzed various factors that prevent Japan from establishing a clinical service of sleep medicine.

Genetic polymorphism of aldehyde dehydrogenase 2 in patients with upper aerodigestive tract cancer

BACKGROUND

Alcohol consumption is one of the major risk factors of the upper aerodigestive tract (UADT) cancers, and combined cancers are frequently discovered in the patients with UADT cancer. The association between esophageal cancer and alcohol-related metabolizing enzymes is well studied, but only a few examinations about the association between head and neck cancer and the enzymes were performed.

METHODS

Fifty-two patients with UADT cancer (head and neck cancer in 25, esophageal cancer in 19, and multiple cancers in 8) were examined in the alcohol habit and in the polymorphisms of aldehyde dehydrogenase 2 (ALDH2) and cytochrome P-4502E1.

RESULTS

Patients with multiple cancers had significantly higher ethanol consumption than the other two groups (p < 0.001). The frequency of ALDH2*1/2*2 heterozygote was significantly lower (p = 0.009) in patients with head and neck cancer (5/25) than patients with esophageal cancer (11/19). The allele frequency of P-4502E1 did not show a significant difference between the groups (p = 0.700).

CONCLUSIONS

These results demonstrated the difference in the frequency of ALDH2 heterozygote between the patients with esophageal cancer and patients with head and neck cancer.

[Japanese version of the Short-Memory Questionnaire and Mini-Mental State Examination in relation to demographic variables: community survey of elderly healthy residents in Nakayama, Japan]

BACKGROUND AND PURPOSE

The Short-Memory Questionnaire (SMQ) developed by Koss et al. is a standardized, validated reliable informant-based scale to assess everyday memory problems. In the previous study, we prepared its Japanese version and validated the reliability in assessing patients with Alzheimer Disease. In the present study, we examined the relations between the performance evaluated by the Japanese version of the SMQ combined with the Mini-Mental State Examination (MMSE) and demographic variables (age, sex, and education).

SUBJECTS AND METHODS

Subjects were a total of 613 elderly healthy individuals living in the rural residency of Nakayama, Japan. They consisted of 287 males and 326 females and ranged from 65 to 94 years in age and from 0 to 16 years in education. The MMSE was conducted by neuropsychiatrists to assess the severity of cognitive impairment, and the SMQ was conducted by public health nurses, who asked a family member of each subject. The effects of age, sex and education on the MMSE and SMQ scores were analyzed by analysis of variance (ANOVA) using post-hoc Scheffé test.

RESULTS

The mean MMSE and SMQ scores (+/- SD) were 27.6 (+/- 2.5) and 44.5 (+/- 2.1), respectively. The post-hoc Scheffé test revealed significantly higher MMSE scores for individuals with 8 years or more in education than for those with less than 8 education years. Between males, no significant differences were observed in MMSE score; however, among females, significantly higher scores were noted in those aged 69 or younger than in those aged 70-74 or those aged 80 or older. Of individuals aged 80 or older, males showed significantly higher scores than females, whereas no significant differences were observed between sex in other age groups. As to the SMQ, higher scores were shown by persons with longer education years and by females than males.

CONCLUSION

Low MMSE scores were related to low education level and older females. Low SMQ scores were not related to aging, but linked to low education level and males. Both the MMSE and SMQ, which can be easily administered, are affected by education years and sex. In addition, MMSE score depends on age. Therefore, careful consideration should be paid to age, education level and sex for future execution of the MMSE and SMQ.

Polymorphisms of the human homologue of the Drosophila white gene are associated with mood and panic disorders

The Drosophila white gene is a member of the ATP-binding cassette (ABC) transporter superfamily and is involved in the cellular uptake of tryptophan. Its human homologue gene (hW) has been mapped to chromosome 21q22.3. Tryptophan is the precursor for the neurotransmitter serotonin, which has been implicated in the regulation of mood and anxiety. The locus 21q22.3 has also been reported to be associated with mood disorders. The 3'-untranslated region (3'-UTR) in the hW gene has been shown to contain a polymorphic poly(T) region. We have identified a new polymorphism G2457A in the 3'-UTR in the present study. We examined the relationship between these polymorphisms and mood and panic disorders, and a significant association between the poly(T) polymorphisms and mood disorders was detected (P=0.039 (allele frequency)). Associations were found between the polymorphisms and mood (poly(T) polymorphism: P=0.047 (allele frequency), G2457A: P=0.040 (allele frequency), P=0.044 (genotype frequency)) and panic disorders (G2457A: P=0.026 (allele frequency), P=0.011 (genotype frequency)) in males, but not in females. These findings suggest that the hW gene may be an important gene in the control of mood and anxiety as well as one of the genetic factors related to mood disorders and panic disorder in males. The statistical significance of the association remains relatively low and larger materials facilitating further dissection of the clinical phenotype will be needed to confirm and independently validate this finding and to evaluate its significance.

[Report of three cases of emergency operation for acute pulmonary embolism]

Three successful surgical cases of acute pulmonary embolism with severe cardiopulmonary impairment were reported. Currently, thrombolysis is widely accepted as the front-line treatment for most patients with pulmonary embolism. However, treatment failure is high and can lead to death in the most severe cases. If these patients have severe cardiopulmonary impairment, pulmonary embolectomy should be done immediately.

Localization of syndecan-1 in human gastric mucosa associated with ulceration

Syndecans, cell surface heparan sulphate proteoglycans, are known to function as cell adhesion molecules and as a co-receptor for heparin-binding growth factors that have important roles in tissue homeostasis and repair, but the localization of syndecans in gastric mucosa and their role in gastric ulcer healing are not known. The licalization of syndecan-1, a subfamily protein of syndecans expressed on epithelial cells, was studied in 12 surgically resected human stomachs containing an ulcer or early scar tissue. Localization of syndecan-1 was detected both by immunohistochemistry and by in situ hybridization In non-ulcer sites of gastric mucosa, syndecan-1 protein was expressed at the basolateral surface of foveolar epithelial cells and the cells of intestinal metaplasia, and at the cell surface of stromal plasma cells. In addition, positive dots of syndecan-1 were found in the cytoplasmic area of parietal cells. Foveolar epithelial cells at active stage ulcer margins showed nearly the same intensity of staining as those at non-ulcer site mucosa. By contrast, enhanced staining was obtained in elongated regenerative foveolar cells at the healing ulcer margins and the early scar tissues. The migrating cells on ulcer floors also expressed syndecan-1 protein. The expression sites of syndecan-1 mRNA mostly coincided with those of syndecan-1 protein. These results suggest that syndecan-1 participates in cell adhesion mainly at the foveolar epithelium and plays a role in the healing of gastric ulcers by interacting with heparin-binding growth factors.

Spectra of gpt mutations in ethylnitrosourea-treated and untreated transgenic mice

We have established a new transgenic mouse mutagenicity assay for the efficient detection of point mutations and deletions in vivo (Nohmi et al. [1996] Env. Mol. Mutagen. 28:465-470). In this assay, the gpt gene of Escherichia coli is used as a reporter for the detection of point mutations. Treatment of mice with ethylnitrosourea (ENU, 150 mg/kg) enhances by several-fold the mutant frequency of gpt in bone marrow. Here, we report the mutation spectra of the gpt gene recovered from bone marrow of ENU-treated and untreated transgenic mice. In the gpt mutants rescued from ENU-treated mice, more than 90% of the mutations were base change mutations; the predominant types were A:T to T:A transversions and G:C to A:T transitions. On the contrary, in the mutants rescued from untreated mice, 54% were base substitutions and the remainders were short deletions and insertions. Among untreated mice, the most frequently observed base substitution was G:C to A:T transitions (7/14 mutants). Three of these occurred at 5'-CpG-3' sites. Interestingly, the mutation spectra of the gpt gene were different from those of the gpt gene in ENU-treated and untreated E.coli, whereas they were similar to those of the lacZ and lacI genes in ENU-treated and untreated other transgenic mice or cultured mammalian cells. We also report the establishment of homozygous transgenic mice that have transgene lambdaEG10 DNA in both chromosome 17 of C57BL/6J mouse.

Amelioration of hippocampal neuronal damage after global ischemia by neuronal overexpression of BCL-2 in transgenic mice

BACKGROUND AND PURPOSE

Reports suggesting the involvement of apoptosis in ischemic neuronal damage have been accumulating, and protection against apoptotic death by BCL-2 has been shown in many types of cells. Overexpression of BCL-2 has been shown to reduce infarct size after focal ischemia. The purpose of the present study was to assess whether BCL-2 exerted its effect on selective neuronal vulnerability after transient global ischemia.

METHODS

Transgenic mice overexpressing BCL-2 in neurons and their littermates were subjected to transient forebrain ischemia for 12 minutes, and the hippocampus was examined 7 days later with conventional histology, immunohistochemistry, and in situ terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling of fragmented DNA.

RESULTS

Although both types of mice showed a similar degree of ischemic insult, transgenic mice showed a lesser degree of neuronal death together with DNA fragmentation in the hippocampus than their littermates.

CONCLUSIONS

Overexpression of BCL-2 in neurons mitigates selective neuronal vulnerability in the hippocampus of transgenic mice after transient global ischemia.

"Disproportion theory" of the cervical spine and spinal cord in patients with juvenile cervical flexion myelopathy. A study comparing cervical magnetic resonance images with those of normal controls

BACKGROUND

Cervical flexion myelopathy is quite a rare condition affecting mainly adolescent males who present with muscular atrophy of the upper extremities. Its etiology is still unknown, as is the cause of its marked male preponderance. Disproportion of the cervical spine and spinal cord is suspected to be one of the etiological causes, however, this has yet to be confirmed.

METHODS

We performed a comparative study of the cervical magnetic resonance (MR) images of six male patients with juvenile cervical flexion myelopathy and of 34 young, normal controls.

RESULTS

In normal controls, the cervical spines and spinal cords were significantly straighter in tall than in short males and in females than in males. In these patients, the cervical spine and spinal cord shapes were straighter, and the cervical spine length/height and cervical spinal cord length/height ratios were significantly higher than those of the height-matched male group. In the female group, the cervical spine and cervical spinal cord shapes were similar to the patient group; however, the cervical spine length/height and spinal cord length/height ratios as well as the heights were significantly smaller than those of the patients.

CONCLUSIONS

The cervical spinal cords of the patients were considered to be stretched even with the neck in neutral position, reflecting disproportion of the cervical spine and spinal cord. The shorter length of the cervical spine and spinal cord in females was suspected to be one of the reasons for the marked male preponderance.

Detection of human herpesvirus 7 (HHV-7) DNA in breast milk by polymerase chain reaction and prevalence of HHV-7 antibody in breast-fed and bottle-fed children

Twenty-nine breast milk mononuclear cell samples were analyzed for human herpesvirus 7 (HHV-7) DNA, human herpesvirus 6 (HHV-6) DNA, and human cytomegalovirus (HCMV) DNA by polymerase chain reaction (PCR). In addition, peripheral blood mononuclear cell samples from 13 puerperants were analyzed for HHV-7 DNA by PCR, and seropositivity of HHV-7 was also analyzed in breast-fed and bottle-fed children. HHV-7 DNA was detected in 3 of 29 breast milk samples. HCMV DNA was also detected in 3 of 29 breast milk samples, but HHV-6 DNA was not detected. HHV-7 DNA was detected in 11 of 13 samples of peripheral blood mononuclear cells. Though the seropositivity rate for HHV-7 in breast-fed children was slightly higher than that in bottle-fed children at 18 and 24 months old, the difference was not statistically significant. From these results, we speculate that breast-feeding may be one of the transmission routes of HHV-7, although this is not the main route.

Newly synthesized dihydropyridine derivatives as modulators of P-glycoprotein-mediated multidrug resistance

Newly synthesized 1,4-dihydropyridine derivatives possessing alkyl chains at the 4-position screened whether they could overcome P-glycoprotein-mediated multidrug resistance in cultured cancer cells and also leukemia-bearing animals. Of these derivatives, some could overcome drug resistance to doxorubicin and vincristine in multidrug resistant human cancer cell lines. Combined administration of vincristine and some of the derivatives significantly increased the life span of P-glycoprotein overexpressing multidrug-resistant P388 leukemia-bearing mice. The calcium antagonistic activities, an undesirable effects, were weaker than that of verapamil. These results suggested that the introduction of alkyl groups at the 4-position were effective for both overcoming multidrug resistance and reducing the calcium antagonistic activity.

[Releasing phenomenon of learned movements]

Involuntary movements that resembled the shooting of a basketball and piano playing were observed after brain damage in a 13-year-old female and a 74-year-old female, respectively. The movements were characterized as involuntarily triggered movements that occurred in the presence and absence of exteroceptive stimuli, movements had been practiced repeatedly just before the occurrence of the brain damage, and that could be stopped on command. According to the MRI findings, the lesions extended into the pre-supplementary motor area (pre-SMA). The characteristics of the patients movements were different from previously reported involuntary movements such as compulsive manipulation of tools, utilization behavior, and imitation behavior. Hikosaka et al (1996) reported the role of the pre-SMA in learning new sequential procedures. We speculate that damage to the pre-SMA may be associated with the etiology of these movements.

[Japanese version of the Short-Memory Questionnaire: memory evaluation in Alzheimer's disease]

BACKGROUND AND PURPOSE

Memory deficit is a common sign of Alzheimer's disease (AD), which appeared generally in the early stage of the disease. Therefore, evaluation of memory is important for management of patients and for clinical research of AD. The Short-Memory Questionnaire (SMQ), an easily administered, informant-based scale, which was developed by Koss et al. (1993), is a standardized, validated, and reliable tool to assess everyday memory problems. In the present study, we prepared a Japanese version of the SMQ and examined its reliability and validity in assessing AD patients.

SUBJECTS AND METHODS

The subjects consisted of 42 patients with NINCDS-ADRDA probable AD whose diagnosis was made on the basis of the results of comprehensive examinations including cranial CT/MRI and SPECT and age- and education-matched 53 healthy controls. Patients had no history of stroke, head injury, or any other prior neurological events. Patients and controls were between the ages of 51 and 90 years, and they had from 6 to 16 years education. The Japanese version of the SMQ was given to a family member by either neuropsychiatrist, public nurse or case worker. To evaluate test-retest reliability of the test, interview was repeated in 16 randomly selected patients by two different examiners (neuropsychiatrist and another) in two weeks interval. The Mini-Mental State Examination (MMSE) was used to assess the severity of cognitive impairment.

RESULT

The test-retest reliability was acceptably high with intraclass correlation coefficients. There was a high correlation between scores of SMQ and MMSE. The SMQ had excellent specificity and sensitivity in discriminating patients from controls. Caregiver appraisals of memory deficits significantly correlated with generalized cognitive dysfunction.

CONCLUSIONS

Similarly to the original version, the present Japanese version of the SMQ is a reliable and valid tool in assessing memory function in AD, which can be effectively used in clinical settings and epidemiologic studies to screen out persons with memory problems.

The first cooperative living-related donor liver transplantation performed by two separate institution teams: The Kanagawa Liver Transplantation Program

With the cooperation of surgeons in two separate institutes, living-related donor liver transplantation was safely performed at the Kanagawa Children's Medical Center. The donor operations were carried out at Kanagawa Cancer Center by surgeons of the hepatobiliary division and the liver grafts were immediately transported to Kanagawa Children's Medical Center by ambulance, and transplanted orthotopically. Since January 1995, five children with biliary atresia have been given partial liver grafts obtained from their mothers. The liver grafts were transported within 20 min, and functioned immediately after transplantation. The development of a pediatric liver transplantation program requires a multidisciplinary approach that can be provided only in a large tertiary referral children's medical center. Preparation for the clinical program involves training of surgical and nursing team members, both in an animal laboratory and at an established liver transplantation center. Special support for the program by the institute is essential and involves medical, nursing, and administrative divisions as well as social services, operating room personnel, and intensive care unit facilities. After careful planning, and with the invaluable help of the donor operating team, the Kanagawa Liver Transplantation Program has been realized, and its first transplantations conducted safely and successfully.

Death-signalling cascade in mouse cerebellar granule neurons

Molecular mechanisms of neuronal cell death are still largely unknown. In the present study, the signal transduction pathway of cell death in cerebellar granule neurons was examined by employing various death-preventative agents. When death was induced by the depletion of serum and a depolarizing level of potassium, transient increase in active c-Jun, mitochondrial membrane potential (deltapsi) loss, activation of caspase-3 (-like) proteases, and nuclear condensation and fragmentation were observed. The protein synthesis inhibitor cycloheximide blocked all these phenomena, whereas RNA synthesis inhibitor actinomycin-D, survival factor such as insulin-like growth factor-1, brain-derived neurotrophic factor, high K+ (25 mM) and overproduced antiapoptotic protein Bcl-2, prevented deltapsi, loss, caspase activation, and nuclear change, but not an increase in active c-Jun. The caspase inhibitor z-Asp-CH2-DCB (carbobenzoxy-L-aspartyl-alpha-[(2,6-dichlorobenzoyl) oxy]methane) only inhibited activation of caspases and nuclear change. These results suggest that the death signal in cerebellar granule neurons is sequentially transduced in the order of c-Jun activation, de novo RNA synthesis, mitochondrial deltapsi loss, activation of caspase-3 (-like) proteases and nuclear change.

Aberrant muscle activation in patients after resection of non-primary motor areas: demonstration by surface electromyography

Two patients presented with a tumor involving mainly the supplementary motor area or the premotor cortex. Shortly after tumor resection, each developed transient impairment of voluntary movements. An electromyogram, with the skin electrodes placed over the muscles of the upper arms and forearms, demonstrated aberrant ipsilateral, contralateral or bilateral muscle activation during unilateral motor tasks in both patients. The bilateral activation was more prominent in the patient who had an intact dominant hemisphere. The present study suggests for the first time the importance of non-primary motor areas of the human brain in activating the proper set of muscles on the proper side of the body.

Identification of the promoter region and the transcriptional regulatory sequence of the evgAS operon of Escherichia coli

The evgAS operon of Escherichia coli encodes the EvgA response regulator and the EvgS sensory kinase, which are members of one of the two-component signal transduction systems of Escherichia coli. In this study, we identified the evg promoter and the EvgA-responsive element. Primer extension analysis found two evg transcriptional initiation sites, designated P1 (+1) and P2 (-10), and placed them 114 bp and 124 bp upstream of evgA, respectively. A gel retardation assay demonstrated that EvgA specifically bound to an inverted repeat located between -102 and -128 counting from P1. We also did a beta-galactosidase induction experiment using a promoter-probing vector and found that the EvgA-binding sequence was important to stimulate the evg promoter. These results suggest that the expression of evgAS is positively regulated by its own product, EvgA.

Binding of the protein from Thermus aquaticus ISLtaq1 to its inverted repeat in vitro

We have isolated from Thermus aquaticus an insertion-sequence-like genetic element (ISLtaq1) that induces thermotolerance and has a high sequence similarity to IS150 belonging to the IS3 family. An open reading frame on ISLtaq1, termed ORF1, encodes the ORF1 protein, which carries a DNA-binding motif. In this study, we found an imperfect inverted repeat in ISLtaq1. We next overproduced and purified a His-tagged ORF1 protein. Gel retardation analysis demonstrated that this protein specifically bound to an DNA fragment containing the inverted repeat in ISLtaq1. These results suggest that ISLtaq1 and the ORF1 protein are an insertion sequence and part of the transposase encoded by ISLtaq1, respectively.

Molecular interaction between proteins involved in EvgAS signal transduction of Escherichia coli

EvgA and EvgS constitute one two-component signal transduction system in Escherichia coli. Although probable signaling domains of these proteins have been estimated, the molecular mechanism of their interaction remains to be elucidated. Here, we investigated protein to protein interactions between EvgA and EvgS and also between the EvgAS system and other related signaling pathways by means of surface plasmon resonance. EvgA and EvgS interacted directly and inhibition of phosphorylation of their functional domains abolished formation of the EvgAS complex. No interaction was observed either between EvgA and Bordetella BvgS or BvgA and EvgS. OmpR, a response regulator for the osmoregulative gene expression of E. coli, had similar but not identical behavior towards EvgS to that of EvgA. These results indicate that interaction between the signaling proteins is closely related to phosphorylation of the functional domain of the proteins.

Morphologic study of the mandibular fossa and the eminence of the temporomandibular joint in relation to the facial structures

To clarify the relationship between the temporal component of the temporomandibular joint and facial bone structure, we measured anthropologic craniometric points and the structure of the mandibular fossa, including the eminence in 33 Japanese male dry skulls, with a three-dimensional apparatus. The length from the articular tubercle to the medial glenoid tubercle is correlated with skeletal variables such as the length of the fossae, the width of the masseter origin, and the mandibular length. Therefore it appears that the frontal dimension is related to the facial development, which is attributable to bite force. Goniometrically, the angle between the line deepest point of the fossa--the midpoint of the eminence and the Frankfort horizontal plane (middle angle)--was negatively correlated only with the ANB angle, suggesting that a steeper middle angle of the eminence is related to a retrusive maxilla or protrusive mandible.

[Automatic-voluntary dissociation in apraxia]

Automatic-voluntary dissociation in apraxia was discussed and the following two points were noted 1) This phenomenon is observed for praxis with procedural memory, i.e., learned or skilled movements such as brushing teeth and dressing, but not observed for praxis without procedural memory such as tasks used for testing constructional apraxia. 2) This phenomenon may be understood by dual motor act systems, i.e. implicit and explicit motor systems. Presumably, the former is mainly mediated by medial premotor system that involitionally drives motor procedural memory, while the latter is mainly mediated dorsolateral premotor system that volitionally drives motor procedural memory.

Effects of the isocarbacyclin methyl ester clinprost incorporated into lipid microspheres, in focal ischemia of stroke-prone spontaneously hypertensive rats

The effects of TTC-909, the isocarbacyclin methyl ester clinprost (CAS 88931-51-5), incorporated into lipid microspheres, on ischemia-induced decrease in norepinephrine (NE) contents in stroke-prone spontaneously hypertensive rats (SHR-SP) with an occluded middle cerebral artery (MCA) were examined. Occluding of MCA led to infarction limited to the cerebral cortex and also a severe decrease in NE contents in peripheral regions of the infarction. TTC-909 was injected immediately after MCA occlusion, and then daily for 6 consecutive days. As TTC-909 in a dose of 200 ng/kg significantly (p < 0.05) prevented decreases in NE contents, TTC-909 may have cytoprotective effects on neuronal damage related to ischemia in humans.