Deletion of signaling molecule genes resembling the cytoplasmic domain of Igbeta in autoimmune-prone mice

The P8.6 gene is encoded upstream of the mouse TCR Valpha1 gene in the anti-sense strand and its gene product contains the proline-rich region and tyrosine-isoleucine (Y-I) motif, which are consensus sequences for the SH2 and SH3 binding motifs respectively. It was found that this protein is highly homologous to Igbeta. We also found that the P8.6 protein associates with a 170 kDa phosphorylated protein in vivo. To examine the polymorphism of the P8.6 gene, we carried out a single-strand conformation polymorphism analysis and found that the P8.6 gene comprises a family of at least 13 independent genes arising from single or multiple mutations. The mutated P8.6 gene with the Y-L motif was deleted, especially in NZW and BXSB mice, whereas normal BALB/c mice have a P8.6 gene bearing both the Y-I and Y-L motifs, suggesting a dysregulation in signaling through the B cell receptor or TCR in these two autoimmune mice. Functional analysis using transfectant cells carrying P8.6-1 (Y-I motif) and P8.6-3 (Y-L motif) clearly demonstrated that P8.6-3 gene inhibited the signal transduction upon the stimulation of ionomycin and cell growth. The TANYSNI sequence has been proposed as the immunoreceptor tyrosine-based inhibitory motif, this motif is replaced by AANYSNI in the NZW mice. In conclusion, some P8.6 are deleted in particular autoimmune-prone mice.

Purine nucleoside phosphorylase. 1. Structure-function studies

To probe the catalytic mechanism of human purine nucleoside phosphorylase (PNP), 13 active-site mutants were constructed and characterized by steady-state kinetics. In addition, microtiter plate assays were developed for both the phosphorolytic and synthetic reactions and used to determine the kinetic parameters of each mutant. Mutations in the purine binding site exhibited the largest effects on enzymatic activity with the Asn243Ala mutant resulting in a 1000-fold decrease in the kcat for inosine phosphorolysis. This result in combination with the crystallographic location of the Asn243 side chain suggested a potential transition state (TS) structure involving hydrogen bond donation by the carboxamido group of Asn243 to N7 of the purine base. Analogous to the oxyanion hole of serine proteases, this hydrogen bond was predicted to aid catalysis by preferentially stabilizing the TS as a consequence of the increase in negative charge on N7 that occurs during glycosidic bond cleavage and the associated increase in the N7-Asn243 hydrogen bond strength. Two residues in the phosphate binding site, namely His86 and Glu89, were also predicted to be catalytically important based on their alignment with phosphate in the X-ray structure and the 10-25-fold reduction in catalytic activity for the His86Ala and Glu89Ala mutants. In contrast, catalytic efficiencies for the Tyr88Phe and Lys244Ala mutants were comparable with wild-type, indicating that the hydrogen bonds predicted in the initial X-ray structure of PNP [Ealick, S. E., et al. (1990) J. Biol. Chem. 265, 1812-1820] were not essential for catalysis. These results provided the foundation for studies reported in the ensuing two manuscripts focused on the PNP catalytic mechanism [Erion, M. D., et al. (1997) Biochemistry 36, 11735-11748] and the use of mutagenesis to reverse the PNP substrate specificity from 6-oxopurines to 6-aminopurines [Stoeckler, J. D., et al. (1997) Biochemistry 36, 11749-11756].

Purine nucleoside phosphorylase. 3. Reversal of purine base specificity by site-directed mutagenesis

Human purine nucleoside phosphorylase (PNP) is highly specific for 6-oxopurine nucleosides with a catalytic efficiency (kcat/KM) for inosine 350000-fold greater than for adenosine. Crystallographic studies identified Asn243 and Glu201 as the residues largely responsible for the substrate specificity. Results from mutagenesis studies demonstrated that the side chains for both residues were also essential for efficient catalysis [Erion, M. D., et al. (1997a) Biochemistry 36, 11725-11734]. Additional mechanistic studies predicted that Asn243 participated in catalysis by stabilizing the transition state structure through hydrogen bond donation to N7 of the purine base [Erion, M. D., et al. (1997b) Biochemistry 36, 11735-11748]. In an effort to alter the substrate specificity of human PNP, mutants of Asn243 and Glu201 were designed to reverse hydrogen bond donor and acceptor interactions with the purine base. Replacement of Asn243 with Asp, but not with other amino acids, led to a 5000-fold increase in kcat for adenosine and a 4300-fold increase in overall catalytic efficiency. Furthermore, the Asn243Asp mutant showed a 2.4-fold preference for adenosine relative to inosine and a 800000-fold change in substrate specificity (kcat/KM) relative to wild-type PNP. The double mutant, Asn243Asp::Glu201Gln, exhibited a 190-fold increase in catalytic efficiency with adenosine relative to wild-type PNP, a 480-fold preference for adenosine relative to inosine, and a 1.7 x 10(8)-fold change in preference for adenosine over inosine relative to wild-type PNP. The Asn243Asp mutant was also shown to synthesize 2,6-diaminopurine riboside with a catalytic efficiency (1.4 x 10(6) M-1 s-1) on the same order of magnitude as wild-type PNP with its natural substrates hypoxanthine and guanine. The Asn243Asp mutants represent examples in which protein engineering significantly altered substrate specificity while maintaining high catalytic efficiency.

Purification and characterization of recombinant human 5'-methylthioadenosine phosphorylase: definite identification of coding cDNA

5'-Methylthioadenosine phosphorylase gene maps on the 9p21 chromosome, strictly linked to the important tumor suppressor gene p16INK4A. Chromosomal deletions encompassing both the phosphorylase and p16INK4A genes cause the complete absence of the enzymatic activity in a large number of tumors, thus resulting in well-defined metabolic differences between malignant and normal cells. Recently, the cloning of the phosphorylase gene has been reported on the basis of indirect evidence. In order to demonstrate definitely the identification of 5'-methylthioadenosine phosphorylase gene, we have cloned the putative enzyme coding sequence in a prokaryotic expression vector and expressed the protein in bacteria. The recombinant phosphorylase has been purified to homogeneity and its physicochemical, immunological and kinetic features have been characterized. The results obtained allowed the conclusive demonstration of 5'-methylthioadenosine phosphorylase gene cloning and the use of recombinant protein for further characterization.

Genomic cloning of methylthioadenosine phosphorylase: a purine metabolic enzyme deficient in multiple different cancers

5'-Deoxy-5'-methylthioadenosine phosphorylase (methylthioadeno-sine: ortho-phosphate methylthioribosyltransferase, EC 24.2.28; MTAP) plays a role in purine and polyamine metabolism and in the regulation of transmethylation reactions. MTAP is abundant in normal cells but is deficient in many cancers. Recently, the genes for the cyclin-dependent kinase inhibitors p16 and p15 have been localized to the short arm of human chromosome 9 at band p21, where MTAP and interferon alpha genes (IFNA) also map. Homozygous deletions of p16 and p15 are frequent malignant cell lines. However, the order of the MTAP, p16, p15, and IFNA genes on chromosome 9p is uncertain, and the molecular basis for MTAP deficiency in cancer is unknown. We have cloned the MTAP gene, and have constructed a topologic map of the 9p21 region using yeast artificial chromosome clones, pulse-field gel electrophoresis, and sequence-tagged-site PCR. The MTAP gene consists of eight exons and seven introns. Of 23 malignant cell lines deficient in MTAP protein, all but one had complete or partial deletions. Partial or total deletions of the MTAP gene were found in primary T-cell acute lymphoblastic leukemias (T-ALL). A deletion breakpoint of partial deletions found in cell lines and primary T-ALL was in intron 4. Starting from the centromeric end, the gene order on chromosome 9p2l is p15, p16, MTAP, IFNA, and interferon beta gene (IFNB). These results indicate that MTAP deficiency in cancer is primarily due to codeletion of the MTAP and p16 genes.

Inhibition of TNF-alpha expression by adenosine: role of A3 adenosine receptors

Adenosine agonists inhibit TNF-alpha production in macrophage and monocytes, but the mechanism is unknown. Therefore, we studied the human macrophage cell line U937 to determine the adenosine receptor subtypes responsible and the intracellular signaling mechanisms involved. The A1/A3 agonist N6-(4-amino-3-iodobenzyl)adenosine (I-ABA) decreased LPS-stimulated TNF-alpha protein production by 79 +/- 5% (p = 0.003). The mechanism was pretranslational, as adenosine receptor stimulation caused a marked decrease in TNF-alpha mRNA. IL-1 beta, IL-6, and IL-8 mRNA were not changed by adenosine agonists. The rank order of agonists as TNF-alpha inhibitors suggested that the A3 receptor might be involved (N6-(3-iodobenzyl)-9-[5-(methylcarbamoyl)-beta-D-ribofuranosyl] adenosine > 2-chloroadenosine > or = I-ABA > N6 benzyl 5'-N-ethylcarboxamidoadenosine (NECA) > NECA > CGS21680 > N6-cyclohexyladenosine), and this was supported by the fact that a mixed A1/A3 antagonist (xanthine amine congener) reversed the effect, whereas A1-specific (1,3-dipropyl-8-cyclopentylxanthine) and A2-specific (3,7-dimethyl-1-propargylxanthine) antagonists did not. Receptor signaling did not involve cAMP or protein kinase A, nor did it alter the activation and binding characteristics of the transcription factor NF-kappa B. However, the composition of the AP-1 transcription complex was altered by I-ABA. These data suggest that stimulation of the A3 adenosine receptor can alter the cytokine milieu by decreasing TNF-alpha. Adenosine agonists or adenosine regulating agents have potential therapeutic uses in acute and chronic inflammatory diseases.

Gene cloning and characterization of Pseudomonas putida L-methionine-alpha-deamino-gamma-mercaptomethane-lyase

Methionine dependency has been reported in cancer cell lines and primary tumors. Thus, L-methionine deprivation might have potential value for the treatment of human cancers with a methionine requirement. L-Methionine-alpha-deamino-gamma-mercaptomethane-lyase has been reported to decrease plasma methionine levels and to inhibit tumor growth in experimental animals but has not been studied extensively because sufficient homogeneous enzyme was not available. In this study, we cloned the L-methioninase gene from Pseudomonas putida and isolated pure and abundant recombinant enzyme. Both L-methionine and L-cysteine in culture medium were completely degraded by 1 unit/ml purified enzyme. Two hundred and fifty units/kg L-methioninase administered i.v. to mice yielded 0.7 unit/ml of plasma concentration and lowered total plasma sulfur-containing amino acids by more than 75%. Although sensitivity to enzymatic methionine depletion differed among cell lines, leukemia cell lines were generally more sensitive than solid tumor cell lines. The availability of pure recombinant L-methioninase will allow in vivo studies on the antitumor activity and the potential toxicity of enzymatic methionine depletion.

Inhibition of TNF-alpha expression by adenosine: role of A3 adenosine receptors

Adenosine agonists inhibit TNF-alpha production in macrophage and monocytes, but the mechanism is unknown. Therefore, we studied the human macrophage cell line U937 to determine the adenosine receptor subtypes responsible and the intracellular signaling mechanisms involved. The A1/A3 agonist N6-(4-amino-3-iodobenzyl)adenosine (I-ABA) decreased LPS-stimulated TNF-alpha protein production by 79 +/- 5% (p = 0.003). The mechanism was pretranslational, as adenosine receptor stimulation caused a marked decrease in TNF-alpha mRNA. IL-1 beta, IL-6, and IL-8 mRNA were not changed by adenosine agonists. The rank order of agonists as TNF-alpha inhibitors suggested that the A3 receptor might be involved (N6-(3-iodobenzyl)-9-[5-(methylcarbamoyl)-beta-D-ribofuranosyl] adenosine > 2-chloroadenosine > or = I-ABA > N6 benzyl 5'-N-ethylcarboxamidoadenosine (NECA) > NECA > CGS21680 > N6-cyclohexyladenosine), and this was supported by the fact that a mixed A1/A3 antagonist (xanthine amine congener) reversed the effect, whereas A1-specific (1,3-dipropyl-8-cyclopentylxanthine) and A2-specific (3,7-dimethyl-1-propargylxanthine) antagonists did not. Receptor signaling did not involve cAMP or protein kinase A, nor did it alter the activation and binding characteristics of the transcription factor NF-kappa B. However, the composition of the AP-1 transcription complex was altered by I-ABA. These data suggest that stimulation of the A3 adenosine receptor can alter the cytokine milieu by decreasing TNF-alpha. Adenosine agonists or adenosine regulating agents have potential therapeutic uses in acute and chronic inflammatory diseases.

[Public health nurse staffing requirements for health examination of infants and children in municipalities of Japan]

In accordance with the Maternal and Child Health Service Act, public health centers and municipalities offer health education, health counseling, health examinations, and home visits for children and their mothers in their jurisdiction. On the basis of the new Maternal and Child Health Service Act, municipalities will have the responsibility to effectively promote health examination for three-year-old children beginning in 1997. To provide health examinations to infants and children, establishing a health personnel system, especially the public health nurse program, is extremely important. The purpose of this study is to determine fundamental facts concerning health manpower development among public health nurses in the municipalities, by reviewing research on health examinations for both infants and children. To determine personnel staffing requirements necessary for health examinations of infants and children in the municipalities of Japan, pertinent references were systematically reviewed. The main results are as follows; 1) The correlation coefficients between the total working hours of the public health nurse for MCH and the population per area and number of birth per year were significantly positive. 2) Total working hours for health examination of three-year-old children per 100 births per year, by the public health nurse were 143 hours, of which 79% were spent just for performing the examination itself. 3) Due to the lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, most often public health nurses from prefectural Health Centers. For example, in those areas with a population of less than 3,000, 43% of the total volume of work performed by public health nurses during the health examinations of three-year-old children required the assistance of prefectural public health nurses. 4) On the other hand, in those areas with populations more than 10,000, 88% of the total volume of work required to be performed by public health nurses during the health examinations for three-year-old children was covered by municipal public health nurses. 5) When the total number of working hours of the public health nurse for Maternal and Child Health was divided into the four parts of planning, implementation, evaluation and training, 86.7% of working hours were spent on implementation itself. 6) In those cities designated by the Government, the health personnel system was sufficient to carry out these health examinations. 7) It was found that in towns and villages with small populations, the health examinations for infants and children can be better carried out in combination with assistance by prefectural public health nurses. 8) The review of the findings suggests that it is important to clarify by further studies not only the relationship between the health manpower system and implementation of the health examination but also the relationship between this system and the effectiveness of the health examination in near future.

Cloning of human adenosine kinase cDNA: sequence similarity to microbial ribokinases and fructokinases

Adenosine kinase catalyzes the phosphorylation of adenosine to AMP and hence is a potentially important regulator of extracellular adenosine concentrations. Despite extensive characterization of the kinetic properties of the enzyme, its primary structure has never been elucidated. Full-length cDNA clones encoding catalytically active adenosine kinase were obtained from lymphocyte, placental, and liver cDNA libraries. Corresponding mRNA species of 1.3 and 1.8 kb were noted on Northern blots of all tissues examined and were attributable to alternative polyadenylylation sites at the 3' end of the gene. The encoding protein consists of 345 amino acids with a calculated molecular size of 38.7 kDa and does not contain any sequence similarities to other well-characterized mammalian nucleoside kinases, setting it apart from this family of structurally and functionally related proteins. In contrast, two regions were identified with significant sequence identity to microbial ribokinase and fructokinases and a bacterial inosine/guanosine kinase. Thus, adenosine kinase is a structurally distinct mammalian nucleoside kinase that appears to be akin to sugar kinases of microbial origin.

[Lupus anticoagulants in patients with systemic lupus erythematosus]

Lupus anticoagulants (LA) and anticardiolipin antibodies (aCL) are known as thrombosis-related antiphospholipid antibodies. LA is not as well characterized as aCL, and the relation between LA and aCL is not clarified. Since standardized method for the detection of LA has not been established, we measured LA activities in outpatients with SLE by using two different methods (KCT and dRVVT), and analyzed the characteristics of LA in SLE. LA was detected in 29.8% of all samples (14.3% in both methods, 15.5% in one method). IgG-aCL and IgM-aCL was detected in 38% and 20%, respectively, of all LA positive samples. Though a good correlation was observed between LA activities and IgG-aCL levels, a considerable number of LA positive samples were negative for aCL. This indicated the presence of factors with LA activity other than aCL. On the contrary there was also a high percentage of LA negative samples with positive aCL (42.4% in IgG-aCL, 47.4% in IgM-aCL), suggesting the presence of aCL with poor or low LA activity. These findings showed the heterogeneity of antiphospholipid antibodies both in LA and in aCL. The platelet function tests showed increased platelet adhesiveness and normal platelet aggregation in LA positive patients with SLE even in the inactive phase. The serum levels of factors such as protein C, protein S, antithrombin III and thrombomodulin were within normal range. Clinical features such as hemolytic anemia, thrombosis and abortion were more frequently observed in LA positive population than in LA negative population. The clinical features tend to be different between patients with dRVVT-LA and those with KCT-LA, though not significant. Because of the heterogeneity in LA, a combination of more than two different methods including dRVVT was recommended for the detection and the evaluation of LA.

Effects of monoclonal anticardiolipin antibody on pregnant mice

OBJECTIVE

To clarify the effects of anticardiolipin antibodies (aCL) on pregnancy.

METHODS

Monoclonal aCL obtained from MRL/lpr mice was administered to pregnant BALB/c mice and changes in the outcome of pregnancy were evaluated.

RESULTS

The pregnant BALB/c mice injected with monoclonal aCL showed a higher intrauterine fetal death rate than controls, but there were no significant differences in platelet counts. We observed signs of placental infarction only in the placenta of the treated pregnant BALB/c mice.

CONCLUSION

The intrauterine fetal deaths may have been due to thrombosis.

Investigation of EB virus and cytomegalovirus in rapidly progressive interstitial pneumonitis in polymyositis/dermatomyositis by in situ hybridization and polymerase chain reaction

In polymyositis/dermatomyositis (PM/DM), a rapidly progressive interstitial pneumonitis (RPIP) which is a fatal complication of unknown etiology has received increasing attention. We have encountered 9 RPIP cases among 150 PM/DM cases in the past 10 years. To investigate the pathogenic role of viruses in RPIP, we examined lung specimens from patients with RPIP in PM/DM for the presence of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) using polymerase chain reaction (PCR) and in situ hybridization (ISH). We analyzed 21 specimens from RPIP in PM/DM (n = 9), collagen diseases (n = 6; 4 had interstitial lung disease), and controls (n = 6). EBV was frequently detected in RPIP (7/9 by PCR 3/9 by ISH), but was also detected in other collagen diseases of the lungs. In lung specimens from both patients with RPIP in PM/DM and those with collagen diseases, EBV was significantly detected (13/15 by PCR, 5/15 by ISH, P < 0.005) compared to controls (1/6 by PCR, 0/6 by ISH). CMV was detected by ISH in 2 RPIP patients but in none of he others, though by PCR CMV was detected equally in the three groups studied. These findings indicate that a direct involvement of EBV or CMV in RPIP of PM/DM is unlikely, although it is possible that an immune response to latent viruses or viral products in PM/DM may have a role in the pathogenesis of the RPIP.

Limited TCR repertoire of infiltrating T cells in the kidneys of Sjögren's syndrome patients with interstitial nephritis

To analyze the mechanism of interstitial nephritis in patients with Sjörgren's syndrome (SS), we examined the TCR repertoire of infiltration T cells in kidney, labial salivary glands, and PBLs using a PCR. The repertoire of the TCR V beta gene on infiltrating T cells from the kidneys of SS patients was more restricted than those on infiltrating T cells in labial salivary glands and PBL. The TCR V beta 2 gene was expressed predominantly in six of seven (86%) SS patients. Junctional sequences of cDNAs encoding the V beta 2 gene on infiltrating T cells in the kidneys of five SS patients showed that some of the cells expanded clonally, indicating Ag-driven stimulation rather than superantigen-induced proliferation. The same V beta 2 clones in the kidney were not detected in labial salivary glands of the same SS patients; the conserved amino acid (arginine at position 96) in the CDR3 region of the V beta 2 gene was found at a frequency of 48.0% in the kidney, whereas it was detected in only 15.4% of the clones in lips. In conclusion, these findings suggest the possibility that T cells that infiltrate the kidneys of SS patients with interstitial nephritis might recognize different autoantigens than those that infiltrate labial salivary glands.

Limited TCR repertoire of infiltrating T cells in the kidneys of Sjögren's syndrome patients with interstitial nephritis

To analyze the mechanism of interstitial nephritis in patients with Sjörgren's syndrome (SS), we examined the TCR repertoire of infiltration T cells in kidney, labial salivary glands, and PBLs using a PCR. The repertoire of the TCR V beta gene on infiltrating T cells from the kidneys of SS patients was more restricted than those on infiltrating T cells in labial salivary glands and PBL. The TCR V beta 2 gene was expressed predominantly in six of seven (86%) SS patients. Junctional sequences of cDNAs encoding the V beta 2 gene on infiltrating T cells in the kidneys of five SS patients showed that some of the cells expanded clonally, indicating Ag-driven stimulation rather than superantigen-induced proliferation. The same V beta 2 clones in the kidney were not detected in labial salivary glands of the same SS patients; the conserved amino acid (arginine at position 96) in the CDR3 region of the V beta 2 gene was found at a frequency of 48.0% in the kidney, whereas it was detected in only 15.4% of the clones in lips. In conclusion, these findings suggest the possibility that T cells that infiltrate the kidneys of SS patients with interstitial nephritis might recognize different autoantigens than those that infiltrate labial salivary glands.

[Health personnel staffing requirements for health examination for the age of 1 1/2 in municipalities in Japan]

Municipalities in Japan offer health education, health counseling, health examination, and home visit services for each development stage of children and for their mothers. In order to determine personnel staffing requirements for the health examination for the age of 1 1/2 as of 1989, data from a questionnaire survey in 1990 conducted by the Ministry of Health and Welfare, was analyzed. Questionnaires were sent to all municipalities and there were 3,198 responses for the response rate of 97.9%. Results showed that in 1989, 98.9% of the 3,012 municipalities were able to independently perform health examinations for 1 and half year old, and in only 0.9% these examination were performed by clinical hospitals. In the large cities designated by the Government, the health personnel system adequately supported these health examination. However due to lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, such as health workers or volunteers. And particularly they required help by public health nurses from prefectural Health Centers. For example, in those areas with populations less than 3,000, 53% of the total volume of the work required to be performed by public health nurses during the health examination had to be covered by assistance from prefectural public health nurses. While in cities with more than 300,000 population large numbers of health personnel were assigned to examinations of children, the large number of children processed resulted in inadequate time for each child/mother pair. Further study of quality levels of the examinations need to be performed.

[The structural analysis of inpatient medical cost of the aged in 81 secondary medical areas of 12 Prefectures in Japan]

In order to understand the structure of the per capita medical care expenditure of inpatients aged 70 years and over, correlational and principal component analyses were performed using several medical cost indices for fiscal 1991 in 81 secondary medical areas of 12 prefectures. Requests were sent to all of 777 municipalities in the 12 prefectures, and there were 763 responses for the response rate of 98.2%. A total of 1,647,187 residents who had been inpatients based on receipts for inpatient medical care expenditure were surveyed. There were 389,456 who responded that they had been inpatients at least once in the preceding 12 months, in 1991. The main results were as follows: 1) Of the residents aged 70 and over, 32.0% of men and 29.7% of women surveyed had at least one episode of hospital admission in the preceding 12 months in 1991. 2) Large differences in the medical care expenditure per inpatient per year for those aged 70 years and over exist in the secondary medical areas in 12 prefectures. 3) In both sexes, per capita expenditures for inpatient care per year are positively correlated with the bed-days in hospitals per inpatient per year, the bed days per receipt, the medical care expenditure per receipt, and the number of receipts per inpatient per year. On the other hand, for women it is negatively correlated with per capita medical care expenditure per day, but it is not statistically significant. 4) The medical care expenditure per inpatient per day is significantly negatively correlated with bed-days in hospital per receipt, the number of receipts per inpatient per year, bed-days in hospital per inpatient per year for both sexes. On the other hand, it is significantly positively correlated with medical care expenditure per receipt for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Personnel requirements for health examination for 6 month and 9 mont-old children in municipalities in Japan]

Based on the Maternal and Child Health Law, municipalities offer health education, health counseling, health examination, and home visitation service for children and their mothers. In order to determine the personnel staffing requirements for the health examinations of 6 and 9 month-old children conducted independently by municipalities in Japan in 1989, data from the questionnaire survey executed by the Ministry of Health and Welfare in 1990 was analyzed. Questionnaires were sent to all municipalities and there were 3,198 responses for a response rate of 97.9% Results showed that in 1989, 27.5% of the 3,198 municipalities were able to perform health examinations for 6 month-old children and 24.7% for 9 month-old children. In the case of those cities which had populations over 10,000 but under 20,000, about 30% were able to perform the health examinations for 6 and 9 month-old children independently. In those cities which had health Centers, the health personnel system most adequately supported these health examinations. Due to the lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, most often public health nurses from prefectural Health Centers. For example, in those areas with populations less than 3,000, about 42-45% of the total volume of the work required to be performed by public health nurses during the health examinations for 6 and 9 month-old children had to be covered by assistance from prefectural public health nurses.

[Prevalence of urinary incontinence among institutionalized persons aged 60 and over in Japan]

In order to estimate the prevalence of persons experiencing urinary incontinence among the institutionalized aged 60 and over in Japan, a questionnaire survey was conducted in 16 prefectures in February 1991. The questionnaires were distributed and collected by the nurses in hospitals and in other facilities. A total of 10,022 residents were asked to answer a questionnaire on their urinary incontinence condition and 9,798 responses were analysed. The main results were as follows; 1) The prevalence rate of urinary incontinence occurring almost daily in hospitalized persons aged 60 and over was 23.3% for men, 23.8% for women. 2) The prevalence rate of urinary incontinence occurring almost daily in institutionalized persons aged 60 and over in special nursing homes was 64.2% of the aged 60 and over for men, 67.9% for women. 3) The prevalence of urinary incontinence increased with age for both sexes especially in hospitalized persons. 4) The 95% confidence interval estimate for the number of the hospitalized over 60 years old suffering from almost daily urinary incontinent incidents was estimated to be from 31,000 to 113,000 in men and from 60,000 to 182,000 in women. 5) The 95% confidence interval estimate for the number of the institutionalized in special nursing home over 60 years old suffering from almost daily urinary incontinent incidents was estimated to be from 34,000 to 50,000 in men and from 97,000 to 119,000 in women. 6) The 95% confidence interval estimate for the number of the institutionalized over 60 years old suffering from almost daily urinary incontinent incidents was estimated to be from 318,800 to 570,600 in both sexes. 7) A random sampling survey is required to elucidate the actual state of prevalence in all generations. 8) Future research should emphasize the assessment of preventive and medical interventions, as incontinence is preventable and medical and surgical treatment options are available.

Single photon emission computed tomography in systemic lupus erythematosus with psychiatric symptoms

Single photon emission computed tomography (SPECT) with n-isopropyl-p-[123I]iodoamphetamine (IMP) was performed on 20 patients with systemic lupus erythematosus (SLE). Fifteen of the patients showed areas of hypoperfusion. All nine patients who had florid psychiatric manifestations at the time the SPECT was performed had hypoperfusion areas. Four patients who had abnormal SPECT findings during psychiatric remission had psychiatric exacerbation one to six months after the SPECT. Four patients who had no hypoperfusion during psychiatric remission had good psychiatric prognoses. Two patients who had no history of psychiatric abnormality but showed hypoperfusion had psychiatric manifestations one month after the SPECT. The IMP-SPECT may be useful as a biological marker that represents the activity of cerebral involvement underlying psychiatric manifestations and the presence of subclinical CNS involvement.

[Effects of fluconazole on onychomycosis in the patients with collagen diseases]

Thirty-four patients with collagen diseases suffering from onychomycosis were treated with fluconazole and showed remarkable improvement. Thirty-one patients showed improvement while only four patients showed adverse reactions. More than half of the cases with onychomycosis in their fingers showed improvement within four weeks and complete recovery within 20 weeks after the administration of fluconazole. Patients with collagen diseases are liable to have onychomycosis as an opportunistic infection which is recalcitrant and resistant disease from the previous therapy. In this trial it became obvious that fluconazole was not only effective on onychomycosis but also a safe drug for the patients with collagen diseases.