Self-reported sleep quality, job stress, and daytime autonomic activities assessed in terms of short-term heart rate variability among male white-collar workers

To investigate the relationships among the amount of job stressors, self-reported sleep quality, and daytime autonomic activities, a questionnaire survey was conducted for 223 healthy male white-collar workers, and their short-term heart rate variability (HRV) was also examined. Half of the subjects complained of nightly poor sleep quality. Self-reported poor sleep quality was associated with a qualitative aspect of job stressors characterized by high amounts of "job difficulty", less amounts of "achievement in job", and less amounts of "support by colleagues", and also with high amounts of personal distress and difficulty in changing their mood. Those who complained of poor sleep quality exhibited sympathetic predominance and reduced heartbeat intervals at standing rest, although job stressors was not correlated to HRV. These results suggest that their job stress disrupts nightly sleep, and also that their insufficient sleep at night causes daytime sympathetic predominance. However, the amount of job stressors was not directly associated with HRV. Further studies should focus on the relationships among chronic job stress, the satisfaction of sleep demands, and the daily and long-term variation in cardiac autonomic activities.

Molecular cloning, expression and characterization of an Ascaris inhibitor for pepsin and cathepsin E

Molecular cloning of a cDNA for a pepsin inhibitor in the round worm, Ascaris suum, was achieved. The ORF was found to encode a 20-residue potential signal peptide and a 149-residue inhibitor moiety. Northern analysis showed the mRNA for the inhibitor to be expressed in the body wall and not in the viscera. To obtain the active inhibitor, we constructed a yeast expression vector, pYES2API, containing the inducible galactosidase promoter and a DNA fragment encoding a fusion protein of the yeast alpha-factor leader and the Ascaris pepsin inhibitor. The active inhibitor was secreted in the culture medium, the yield being approximately 3 mg x l(-1) x day(-1), and purified by a two-step procedure that included HPLC. The inhibitor inactivated pepsin A and cathepsin E almost completely at amounts equimolar with the enzymes, but was 100-fold less effective against pepsin C and did not act on cathepsin D and renin. Ki values for the inhibition of pepsin A and cathepsin E were in the nanomolar range below pH 5. Since the inhibitor activity was lost by modification of specific Lys residues, including Lys110, an electrostatic interaction between these Lys residues and Asp/Glu residues of pepsin A or cathepsin E was thought to be essential for the inhibition.

[High-dose biweekly CHOP chemotherapy with granulocyte colony-stimulating factor support for patients with aggressive non-Hodgkin lymphoma]

A pilot study of high-dose biweekly cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) chemotherapy with granulocyte colony-stimulating factor support was carried out at 11 centers. Twenty-five patients with aggressive non-Hodgkin lymphoma under the age of 65 years old were registered. Lowest values of leukocytes and neutrophils scored grade 3 and 4 levels of Eastern Co-operative Oncology Group Toxicity Criteria in over 50% of the courses. Very rapid recovery of leukocytes and neutrophils was observed, and the duration of leukocytes under 1,000/microliter was less than 3 days in 72.2% of the courses. Leukocyte counts exceeded 2,000/microliter within 3 days in 69.1% of the courses. In most patients the hemoglobin and platelet count remained at grade 1 or 2 levels. Fever was seen in 15 out of 110 courses. In two-thirds of the 15 courses, fever disappeared within 3 days. Thus, administration of the CHOP protocol at biweekly intervals was feasible in 76.5% of the courses. Of 22 evaluable patients, there were 11 complete (CR) and 9 partial (PR) responses with an overall response rate of 90.9%. Among 13 high risk patients excluding 9 low and low-intermediate groups by International Prognostic Index, 7 CRs (53.8%) and 5 PRs (38.5%) were observed. This protocol is promising for aggressive chemotherapy of non-Hodgkin lymphoma.

A cell surface antigen that cross-reacts with My4, a monoclonal antibody to CD14, is expressed on human monoblastic cell line U937, B-lymphoma cells, and polymorphonuclear leukocytes

The CD14 antigen was originally identified on monocytes as a differentiation marker and usually detected by a panel of monoclonal antibodies, including My4 and LeuM3. Recent studies have shown that CD14 antigen is expressed on Langerhans cells, a subject of normal B-lymphocytes, neutrophils, and subtypes of B-cell non-Hodgkin's lymphomas. These antigens, however, react with My4, but not with LeuM3, and the reason for this has not been elucidated. In this study, we found that similar My4+/LeuM3- epitopes are expressed on the human monoblastic cell line, U937. Northern blotting demonstrated that the U937 cells express neither 1.4 kb CD14 transcripts nor possible alternative spliced forms of CD14 transcripts. The molecule was resistant to phosphatidylinositol specific phospholipase C, which effectively hydrolyzes glycosyl-phosphatidylinositol anchored protein, decay accelerating factor, on the same cells. Lipopolysaccharide, which down-regulates the expression of CD14 on monocytes, did not alter the expression of the molecule. We concluded that the My4+/LeuM3- molecule on U937 cells is not CD14 antigen but another surface protein. A similar molecule was also detected on B-lymphoma cells from a patient with non-Hodgkin's lymphoma and on polymorphonuclear leukocytes from healthy donors.

Prevalence of use of medically prescribed hypnotics among adult Japanese women in urban residential areas

Based on a population survey on insomnia among 3600 adult Japanese women living in urban areas, the prevalence of use of medically prescribed hypnotics is determined. The prevalence of use of medically prescribed hypnotics increases with an increase in age (<1.0% for those aged 49 or younger, while 14.3% for those aged 70 or older), in agreement with the results reported in many Western nations. The current sleep disturbance is mild in nearly half of these hypnotics users. More than one-third of the hypnotic users are receiving health care not for sleep problems but for depression, anxiety, or other reasons. More than one-third of the hypnotic users are found to be receiving hypnotics from non-psychiatrists. The percentage of this group is particularly high among those aged 60 or over, probably reflecting the fact that they are often consulting physicians for physical reasons. On the other hand, more than 80% of insomniacs are suggested to be untreated. Future public health research should focus on the quality of life and health care behaviors of untreated insomniacs and hypnotic users, especially among the elderly people, in order to assess the need for primary health care to prevent accidents, mortality, and psychiatric disorders related to sleep problems.

A population study on risk factors for insomnia among adult Japanese women: a possible effect of road traffic volume

In an effort to identify risk factors for insomnia and determine the contribution of nightime road traffic volume to insomnia in the general population, a questionnaire survey was carried out among 3,600 adult Japanese women living in eight urban residential areas. The crude prevalence rate of insomnia was 11.2%. Multivariate analysis revealed that aging, living with a child/children aged six or younger, undergoing medical treatment, experiencing major life events, having an irregular bedtime, having a sleep apnealike symptom, and living near a road with a heavy volume of traffic are risk factors for insomnia. Taking into account other risk factors, there was a level-response relationship between the nighttime traffic volume of main roads and the risk of insomnia in the subjects living in the zones 0-20 m from these roads. These results suggest that road traffic noise raises the sound level in bedrooms in such zones, and consequently the prevalence rate of insomnia among the residents, and that noise-induced insomnia is an important public health problem, at least in highly urbanized areas. To confirm this, a further study on noise exposure is needed.

Proliferation, differentiation and morphogenesis of fetal rat glandular stomach transplanted under the kidney capsule of syngeneic hosts

Undifferentiated glandular stomach tissue fragments from 16.5-day fetal rats were transplanted under the kidney capsule of syngeneic adult rats, and the proliferation, differentiation and morphogenesis of the transplanted tissues were investigated. Gastric epithelial cells began to invaginate 3-4 days after the transplantation and immature glands were formed after 1 week. During the period, there was a gradual increase in the expression of pepsinogen and cathepsin E, markers of cytodifferentiation of the stomach epithelia, both at protein and mRNA levels. Cathepsin E was weakly expressed in undifferentiated gastric epithelial cells at 16.5 days of gestation, and a higher level of the expression was observed in differentiated epithelia of the transplants. In contrast, the pepsinogen-producing cells first appeared around days 3-4 after transplantation and gradually increased in number to about 30% of the epithelial cells and became localized at the bottom of the gland. During the period of the experiment up to 1 month, the pepsinogen-producing cells were all positive for class III mucin and cathepsin E, indicating the immature character of these cells. In addition, no parietal cells were observed. When the tissue fragments were transplanted into adrenalectomized animals, the epithelial differentiation and morphogenesis was suppressed, but its proliferation was enhanced. The observed changes were reversed by hydrocortisone replacement. These results suggest that the development of the 16.5-day fetal stomach is regulated intrinsically to a certain extent by the genetic program of the cells involved and various gastric functions develop in the absence of luminal stimulation, stage-specific systemic hormonal change, neuronal regulation or other systemic influences, and that glucocorticoids modulate the developmental program of the fetal stomach tissues.

Increased frequency of somatic mutations at glycophorin A loci in patients with aplastic anaemia, myelodysplastic syndrome and paroxysmal nocturnal haemoglobinuria

Paroxysmal nocturnal haemoglobinuria (PNH), aplastic anaemia (AA) and myelodysplastic syndrome (MDS) are haemopoietic stem cell disorders. These disorders have some features in common, and a percentage of cases progress to acute leukaemia. We speculated that changes in gene stability are involved in the pathogenesis of these haemopoietic stem cell disorders. Therefore we investigated in vivo mutation frequencies in these disorders by erythrocyte glycophorin A (GPA) mutation assay. The assay enumerates NO or NN variant cells in 106 erythrocytes of the MN type using a flowcytometric technique. Patients undergoing chemotherapy known to be at risk of hypermutageneity were also studied. Events exceeding the 95th percentile of healthy donors (> or = 32 and 34 events, respectively for NO and NN variants) were defined as abnormal. Abnormal events in the NO variants were found in three out of seven patients undergoing chemotherapy, two out of nine patients with AA, two out of seven patients with MDS, and four out of nine patients with PNH. Abnormal events in the NN variants were found in three out of seven patients undergoing chemotherapy, two out of nine patients with AA, one out of seven patients with MDS, and two out of nine patients with PNH. These results suggest that not only PIG-A, but also other genes including the GPA gene, are hypermutable in haemopoietic stem cell disorders, and that mutagenic pressure and/or gene instability can contribute to the pathogenesis of these disorders.

Nucleotide sequence of cDNA and the gene expression of testis-specific protein Y in the Japanese monkey

We cloned the cDNA for Japanese monkey Testis-Specific Protein Y (TSPY). The cDNA contained an open reading frame of 246 amino acids. This coding fragment shared 89% nucleotide sequence identity and 81% amino acid sequence identity with the homologous fragment of previously isolated human TSPY cDNA. Monkey TSPY was assumed to be a molecular mass of 28 kDa and an isoelectric point of pH 5.35. This protein was hydrophilic and contained an Arg and Lys-rich region which was a potential DNA binding site. Expression of the TSPY gene examined by reverse transcription PCR showed that the transcript was detectable only in testis, suggesting that TSPY plays an important role in spermatogenesis of primates.

Relationship between degree of mitral protrusion assessed by use of B-mode echocardiography and degree of mitral regurgitation using an experimental model in dogs

We studied the relationship between the degree of mitral protrusion and degree of mitral regurgitation in an experimental model in which the degree of mitral protrusion could be adjusted. The model was developed by dissecting the dorsal papillary muscle through a left atriotomy in 5 dogs and re-attaching the papillary muscle to the original site using a single mattress suture threading through the epicardium under cardiopulmonary bypass. By manipulating the suture from a position outside the epicardium, the degree of mitral protrusion could be adjusted. The long-axis view of the mitral valve was imaged by B-mode echocardiography with the transducer placed directly over the surface of the right ventricular outflow tract. The height (H) from the coaptation point or tip of the protruded cusp in relation to the mitral annular plane was measured as an index of mitral protrusion. Mitral regurgitation as a result of the mitral protrusion decreased the left ventricular systolic pressure, and increased the heart rate, mean left atrial pressure (LAPm), and ratio of left ventricular end-diastolic dimension to body weight (LVEDD/BW). H was negatively correlated to LAPm and LVEDD/BW (r = -0.723 and -0.697, respectively). Our results indicated that H expresses not only the degree of mitral protrusion but also the degree of mitral regurgitation, and were in agreement with the previous findings obtained on dogs with spontaneous mitral regurgitation.

Autolytic activation mechanism of Bombyx acid cysteine protease (BCP)

Acid cysteine proteinase in the eggs of the silkmoth, Bombyx mori, exists as an inactive proenzyme. This 47-kDa pro-BCP1 zymogen molecule can be processed in vitro into an enzymatically active 39-kDa BCP molecule. In this current study, the maximum rate of processing in vitro was achieved at approximately pH 4.0, at a temperature of 37 degrees C under reducing conditions. The rate of conversion was not affected by increasing concentrations of pro-BCP. We prepared immobilized BCP bound to AH-Sepharose and examined the activation. Immobilized pro-BCP was autolysed, although the rate of processing was slow, indicating that the reaction might be an intramolecular one. Kinetic experiments suggest that the mechanism is likely to involve a stepwise reaction, in which pro-BCP is converted to an active enzyme through intermediate forms releasing small peptides stepwise. The results suggest that autocatalytic cleavage (intramolecular) is a major processing step in the early stage of pro-BCP activation.

Pepsinogens and pepsins from house musk shrew, Suncus murinus: purification, characterization, determination of the amino-acid sequences of the activation segments, and analysis of proteolytic specificities

Three pepsinogens, namely, pepsinogens A, C-1, and C-2, were purified from gastric mucosa of adult house musk shrew (Suncus murinus) by conventional chromatographic and gel filtration procedures. The molecular masses were 40, 39, and 41 kDa for pepsinogens A, C-1, and C-2, respectively. Pepsinogen C-2 contains an Asn-linked carbohydrate chain(s) of about 2 kDa. Each pepsinogen was converted to pepsin through an intermediate form under acidic conditions. By NH2-terminal sequence analysis of these protein species, the amino acid sequences of activation segments (proparts) of pepsinogens A and C-1 were determined to be LYKVPLVKKKSLRQNLIENGLLKDFLAKHNVNPASKYFPTE and KVTKVTLKKFKSIRENLREQGLLEDFLKTNHYDPAQKYHFGDF, respectively. The similarity of these two sequences is nearly 50%. Each pepsin cleaved preferentially peptide bonds between hydrophobic and aromatic amino acids, or bonds on either side of these amino acids. Although each activation segment had several sites susceptible to pepsin action, activation proceeded by limited cleavages of the segment, presumably due to the steric inflexibility of the segment in native pepsinogen. The activity of pepsin A was inhibited completely in the presence of a more than equimolar amount of pepstatin, while a hundred-molar excess amount of pepstatin was needed for the complete inhibition of the activity of pepsins C-1 and C-2.

A patient with paroxysmal nocturnal hemoglobinuria bearing four independent PIG-A mutant clones

Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by clonal blood cells that are deficient in the surface expression of glycosylphosphatidylinositol-anchored proteins due to somatic mutation in the X-linked gene PIG-A. In some patients, more than one abnormal clone may be present. Analysis of bulk DNA/RNA from granulocytes has been useful in identifying the predominant PIG-A mutation in each patient. However, it is often not useful in determining the presence of minor clones. Many patients have cells with partial deficiency. Here, we analyzed the PIG-A gene in two B-cell lines bearing complete or partial deficiencies, cells of hematopoietic progenitor colonies and peripheral blood granulocytes from the same patient. We found that two B-cell lines had different mutations, the granulocytes contained at least two mutants, and the hematopoietic progenitors contained four mutants. Three of the four were shared by B cells and/or granulocytes whereas the other one was found only in the hematopoietic progenitors. The partial deficiency was caused by a point mutation near an alternative splice site within exon 2 that resulted in partial decreases of activity and quantity of the full-length transcript. These results further show the oligoclonal nature of PNH and differences in extent of expansion among mutant clones.

Ekman-Westborg-Julin syndrome. A case report

A rare case of the Ekman-Westborg-Julin syndrome in a 15-year-old boy is presented. The patient had general macrodontia with gigantic mandibular third molars. Other dental anomalies, such as peak-shaped cuspids, central cusps, dens in dente, multituberculism, and single conical molar roots, were also present.

Substratum-dependent and region-specific control of attachment and proliferation of gastrointestinal epithelial cells in primary serum-free culture

A system for the primary serum-free culture of fetal rat gastrointestinal epithelial cells was used to examine the role of the extracellular matrix (ECM) in the attachment and proliferation of these epithelial cells. Forestomach epithelial cells (FSEC) were able to attach to and proliferate on plastic dishes without a substratum, while glandular stomach epithelial cells (GSEC) and duodenal epithelial cells (DEC) were unable to do so. The presence of a substratum promoted the attachment and proliferation of these epithelial cells. The effects of various components of the ECM differed depending on the type of cell. FSEC attached most efficiently to a substratum of fibronectin, while GSEC did so to laminin. DEC attached more efficiently to type I collagen and fibronectin than to any other substratum. FSEC proliferated most rapidly on laminin, while GSEC and DEC did so on collagen gels. These substrata induced the most efficient attachment and proliferation of FSEC, and they were effective in promoting the attachment and proliferation of GSEC and DEC in decreasing order of efficiency, indicating the existence of a head-to-tail gradient in the response of epithelial cells to substrata. The expression of c-myc mRNA in these cells differed depending upon the substratum on which they were cultured and the mRNA level was well correlated with the extent of the cell proliferation, indicating that the cell proliferation is mediated by c-myc gene expression, which is regulated by cell-ECM interactions. The results of the present study demonstrate that proliferation of gastrointestinal epithelial cells is regulated region-specifically not only by soluble factors but also by insoluble components of the ECM.

[Clinical evaluation of cefpirome sulfate for severe infections in patients with hematological disorders. Hanshin Study Group of Hematopoietic Disorders and Infections]

We investigated the therapeutic efficacy and safety of cefpirome sulfate (CPR) in treatment of hematopoietic disorder-associated infections. A total of 219 patients were admitted to 12 hospitals of Hanshin Study Group of hematopoietic disorders and infections between April 1994 and March 1996 and were enrolled in this study. Most patients received intravenously infused CPR at a dose of 1 or 2 g twice a day for 3 days or more. Twenty nine patients dropped out or were excluded and remaining 190 patients were adopted for the evaluation. A overall response rate was 58.4% (111/190). Among neutropenic patients, the response rate was 50% (8/16) in patients whose peripheral neutrophil counts (PNC) remained less than 100/microliter throughout the observation period and was 53.7% (22/41) in patients with PNC remained less than 500/microliter. In contrast, in patient whose PNC was below 500 before the treatment but exceeded 501/microliter during of at the end of the treatment, the response rate was as high as 78.4% (29/37). When G-CSF was combined, the response rate became significantly (P < 0.05) higher, 68.5% (50/73), as compared with that, 52.1% (61/117), in patients without it. In cases in which the causative organisms could be identified, the organisms were eliminated in 81.8% (9/11) of the patients infected with Gram-positive bacteria, whereas in 100% (12/12) in those infected with Gram-negative bacteria. Skin eruption developed in 6 patients during the treatment with CPR, and vascular pain and parosmia in one each other. These symptoms subsided soon after discontinuation or even without discontinuation of CPR. Abnormal laboratory findings, mainly liver dysfunction, i.e. elevation of slight degree of serum transaminase levels, were observed. The values, however, turned to normal immediately after the cessation or completion of the treatment. In conclusion, CPR is considered to be an antibiotic of value with high efficacy and safety in treatment of hematopoietic disorder-associated infections.

Effects of obesity, current smoking status, and alcohol consumption on heart rate variability in male white-collar workers

In order to examine the effects of mild to moderate obesity, moderate to heavy smoking, and moderate alcohol consumption on cardiac parasympathetic activities and systemic sympathetic activities, a cross-sectional survey was carried out in 282 healthy Japanese male white-collar workers. Their autonomic activities were assessed as amplitudes of spectral components of heart rate variability (HRV) which was measured in the annual physical examination at their work sites. Taking the effects of aging on HRV into account, the cardiac parasympathetic activity at supine rest and its response to a change in posture were reduced in mildly to moderately obese subjects with a body mass index of 21-36, whereas the sympathetic activity was not. The effects of smoking and alcohol consumption on HRV were not confirmed. The above results means that we should consider obesity as a covariate when we examine possible relationships between cardiac parasympathetic activity and other environmental factors. There is a need for further studies on the relationships among obesity, change in parasympathetic activity, and development of health problems. The dose-effect relationships between long-term smoking or alcohol consumption and chronic changes in autonomic activities also remain to be determined.

Stereoselectivity in bunitrolol 4-hydroxylation in liver microsomes from marmosets and Japanese monkeys

The stereoselectivity in 4-hydroxylation of bunitrolol (BTL), a beta-adrenoreceptor blocking agent, was examined in liver microsomes from monkeys (marmosets and Japanese monkeys) and compared with the results of human liver microsomes. The formation of (+)-4-OH-BTL from (+)-BTL from (+)-BTL was significantly higher than that of (-)-4-OH-BTL from (-)-BTL in the liver microsomal fractions from the two kinds of monkeys. The 4-OH-BTL-forming activity from racemic BTL was significantly lower than from enantiomeric BTL, indicating a possible metabolic interaction between BTL enantiomers. The in vitro profiles observed in the monkeys were very similar to those in humans, but the stereoselectivity in BTL metabolism [(+)-BTL > (-)-BTL] in the primates was found to be reverse to that in rats [S. Narimatsu et al., Anal. Biochem., 222, 256-261 (1994)]. The 4-OH-BTL-forming activity from BTL enantiomers was significantly suppressed by quinidine and quinine, while the former was more potent than the latter, and also by alpha-naphthoflavone. Furthermore, the activity was also suppressed by antisera against rat cytochromes P450-2D2 and -1A2 in concentration-dependent manners. However, kinetics showed that enantiomeric BTL 4-hydroxylation was monophasic in liver microsomes from marmosets of both genders and from male Japanese monkeys. These results suggest that cytochrome P450-2D and -1A enzymes with similar Km values are involved in BTL 4-hydroxylation in monkey liver microsomes.

Longitudinal change in youth suicide mortality in Okinawa after World War II: a comparative study with mainland Japan

Okinawa prefecture has a unique socio-cultural status in Japan including the experience of having been occupied by the USA from the end of World War II to 1972. In this study, the longitudinal change in youth suicide mortality for those aged 10-29 years in Okinawa (1960-90) was compared with that for the same sex-age groups in mainland Japan (1950-90). In contrast with mainland Japan, no dramatic change in the youth suicide mortality was observed in Okinawa in the 1960s. The rise and fall of teenage suicide mortality in Okinawa during the 1970-80s might be associated with 'reversion anxiety', rather than with the traumatic experience of World War II itself. This seems to be inconsistent with previous speculation regarding the change in youth suicide mortality in mainland Japan. The suicide mortality for men aged 20-29 in Okinawa was significantly higher than that for the same sex-age group in mainland Japan through the observed period. The possible effects of the USA occupation, economic anomie or migration on the suicide in Okinawa should be further examined.

The primary structure of the major pepsinogen from the gastric mucosa of tuna stomach

The complete primary structure of the major component of tuna pepsinogens was determined by conventional protein chemistry methods. It was composed of a prosegment of 37 residues and a pepsin moiety of 323 residues, having a relative molecular mass of 39,364. The essential aspartyl residues in the active site and the three disulfide bonds common to other pepsinogens were conserved; however, several unique substitutions and/or deletions characteristic of tuna pepsinogen were found at various positions, especially in the prosegment and subsite regions, as compared with the sequences of other pepsinogens, which may affect the rate of activation of the zymogen, and/or the catalytic function and substrate specificity of the enzyme. Tuna pepsinogen is the least acidic among pepsinogens. The sequence identity between tuna pepsinogen and other pepsinogens ranged from 45 to 52%. A phylogenetic tree based on the primary structures suggested that tuna pepsinogen diverged from the pepsinogen A and prochymosin groups in an early period of pepsinogen evolution.

[A case report of Erdheim-Chester disease]

Erdheim-Chester disease is a rare and distinctive lipid granulomatosis with characteristic pattern of radiographic changes in bone. The characteristic radiographic finding is an unusual symmetrical sclerosis at the diametaphyseal portions of many long bones. This study demonstrates a case of Erdheim-Chester disease and mainly documents radiographic findings.

[Disappearance of essential neck tremor after pontine base infarction]

Mechanism of essential tremor remains unknown. Central oscillators, postulated in thalamus, inferior olive, and spinal cord are thought to be important to form rhythmicity, and finally to stimulate spinal or medullary motor cells, leading trembling muscle contraction, tremor. Among several subtypes of essential familial tremor, including hand tremor, neck tremor, and voice tremor, essential neck tremor is a common disorder, and its pathophysiology seems different from that of typical essential hand tremor, since patients with essential hand tremor are responsive to beta blocker, whereas those with neck tremor are usually not. We experienced a 41-year-old left handed woman with essential neck tremor in whom neck titubation disappeared shortly after pontine base infarct. She was our patient in the outpatient clinic with the diagnosis of essential neck tremor. The tremor developed when she was teenage, and has been localized in the neck muscles. Alcohol intake had apparently diminished it transiently. Her mother also had the tremor in her neck. She was admitted to our hospital with sudden onset of right-sided limb weakness and speech disturbance. Neurological examination showed right hemiparesis including the ipsilateral face, scanning speech, and cerebellar limb ataxia on the same side. In addition, there was no tremor in her neck. Brain MR imaging revealed a pontine base infarct at the level of middle pons, which was consistent with paramedian artery territory. The hemiparesis and speech disturbance improved almost completely after treatment, and her neck tremor has never occurred in one year follow-up. In our patient, efficacy of alcohol imply that essential neck tremor and hand tremor had same central nervous pathway including central oscillator in common, and descending cortical fibers is seemingly associated with diminishing patient's tremor. Pathophysiology of essential neck tremor was discussed with reviewing previous literature.