Use of prostaglandin E1 (lipo-PGEi) to treat Raynaud's phenomenon associated with connective tissue disease: thermographic and subjective assessment

Four patients with connective tissue disease who had been suffering from severe Raynaud's phenomenon were treated with an intravenous infusion of prostaglandin E1 (PGE1) and its effectiveness was assessed by thermography and a questionnaire approach. PGE1 in a lipid microsphere formulation (lipo-PGE1) produced a significantly greater increase in lesional skin temperature compared with treatment with PGE1 clathrated in α-cyclodextrin 12 months previously in the same group of patients. These results were supported by the subjective assessment obtained from the patients by questionnaire.

Development and validation of a 15-item Japanese Health Knowledge Test

Background

Health literacy affects the acquisition of health knowledge and is thus linked to health outcomes. However, few scales have been developed to assess the level of health knowledge among the general public.

Methods

The 15-item Japanese Health Knowledge Test (J-HKT) was developed by using item response theory to score an item pool. We examined the construct validity of the J-HKT in relation to health literacy items, and analyzed the sociodemographic and behavioral factors associated with poor health knowledge.

Results

We enrolled 1040 adult participants (mean age, 57 years; women, 52%). The 15 items that best identified people with poor health knowledge were selected. For all items on the J-HKT, the information function curves had a peak in the negative spectrum of the latent trait. As compared with participants reporting high levels of income, educational attainment, and literacy, those with low levels of income, education, and literacy had a lower total score on the J-HKT. As compared with non/light drinkers, moderate and heavy drinkers had lower total scores on the J-HKT.

Conclusions

The J-HKT may prove useful in measuring health knowledge among the general public, and in identifying and characterizing those with poor health knowledge.

[Detection of the point of communication by pneumoperitoneum at the surgery for pleuroperitoneal communication]

A 53-year-old male was admitted to our hospital because of dyspnea. Chest radiograph showed a massive right-sided hydrothorax. He was suffering from chronic renal failure and had undergone continuous ambulatory peritoneal dialysis (CAPD) for 8 months. The diagnosis of pleuroperitoneal communication (PPC) was made using injection of indigocarmine into the peritoneal cavity with subsequent pleural detection by thoracocentesis. Injection of contrast media into the peritoneal cavity showed a dome shaped radio-opaque shadow which is located on the diaphragmatic dome followed by the movement of contrast media into the thoracic cavity. Video-assisted thoracic surgery (VATS) was performed under general anesthesia. To identify the point of communication, the method of detecting air leakage was employed. A bleb like lesion on which the hole existed was observed at the center of the diaphragm, and air leakage was identified by filling the thoracic cavity with saline. The pressure in the peritoneal cavity was maintained at 10 mmHg by continuous CO2 inflation. Direct closure was performed to repair the PPC, which succesfully stopped the air leakage. CAPD could be restarted immediately after surgery. No recurrence of hydrothorax has been detected for more than 14 months after surgery.

Population-level preferences for primary care physicians' characteristics in Japan: a structural equation modeling

OBJECTIVE

Primary care has potential to play a role for improving the patient care in Japanese health care system; however, little information is available about how patients perceive the roles of primary care physicians (PCPs) within the Japanese health care system. We aimed to assess population-level preferences for PCPs and investigated the extent to which preferences vary in relation to different population groups in Japan.

METHODS

Data were extracted from a cross-sectional questionnaire survey in October 2003. An 18-item questionnaire was used to measure the preferences for PCPs. Exploratory factor analysis was performed to identify latent factors, while confirmatory factor analysis was used to evaluate the fit of the structure using structural equation modeling (SEM).

PATIENTS

Nationally representative sample of the adult Japanese general population was chosen by controlling for age, sex, and the size of cities.

RESULTS

A total of 2,453 adults>or=18-years-old were analyzed. SEM provided a 4-factor structural model of the population-level preference for PCPs, such as clinical competence (path coefficient (pc)=0.72), gate-keeping (pc=0.64), communication with patients or specialists (pc=0.49) and high education (pc=0.25) and demonstrated the best goodness-of-fit. Those who were middle aged, have a high family income, and a high level of education, placed more importance on gate-keeping characteristics, and the rural residents emphasized communication rather than clinical competence.

CONCLUSION

Our results indicate that the preferences for PCPs are divided into four main factors and underscore the variation among preferences according to different population groups, such as age, socioeconomic and educational status, and places of living. These variations should be considered to improve the primary care system in Japan.

Professionalism Mini-Evaluation Exercise for medical residents in Japan: a pilot study

CONTEXT

Assessing medical professionalism among medical residents is of great importance. The Professionalism Mini-Evaluation Exercise (P-MEX) is a tool for assessing professionalism that was developed, tested for reliability and validated in Canada. Prior to the present study, no Japanese version of the P-MEX had been tested.

METHODS

We modified the P-MEX for use in Japan and tested it on medical residents in a Japanese teaching hospital. For each resident, eight evaluators completed the P-MEX forms. A total of 184 P-MEX forms were completed on 23 senior residents. The construct validity of the P-MEX was analysed by confirmatory factor analysis through structural equation modelling. The reliability of the P-MEX was tested using generalisability theory and a decision study. After performing the assessment and providing feedback to the residents, we conducted a survey on the residents' perceptions of the assessment.

RESULTS

Results indicate content and construct validity. A confirmatory factor analysis revealed that factor loadings ranged from 0.58 to 0.96, indicating good construct validity except for one item (P12: Maintained appropriate boundaries with patients and colleagues). Structural equation modelling showed that adding new items developed in Japan to the P-MEX provided adequate factor validity. A decision study showed confidence intervals sufficiently narrow with as few as 10 evaluations, slightly more than the eight forms verified in Canada. Most residents stated that the items were reasonable and appropriate, the results of the assessment were consistent with their own self-evaluation and the assessment enhanced their motivation.

CONCLUSIONS

Our study demonstrated good evidence of adequate reliability and validity of the P-MEX for the assessment of professionalism among Japanese residents. Moreover, the addition of new items developed in Japan provided adequate factor validity.

Assessing items on the SF-8 Japanese version for health-related quality of life: a psychometric analysis based on the nominal categories model of item response theory

OBJECTIVES

The Short Form-8 (SF-8) questionnaire is a commonly used 8-item instrument of health-related quality of life (QOL) and provides a health profile of eight subdimensions. Our aim was to examine the psychometric properties of the Japanese version of the SF-8 instrument using methodology based on nominal categories model.

METHODS

Using data from an adjusted random sample from a nationally representative panel, the nominal categories modeling was applied to SF-8 items to characterize coverage of the latent trait (theta). Probabilities for response choices were described as functions on the latent trait. Information functions were generated based on the estimated item parameters.

RESULTS

A total of 3344 participants (53%, women; median age, 35 years) provided responses. One factor was retained (eigenvalue, 4.65; variance proportion of 0.58) and used as theta. All item response category characteristic curves satisfied the monotonicity assumption in accurate order with corresponding ordinal responses. Four items (general health, bodily pain, vitality, and mental health) cover most of the spectrum of theta, while the other four items (physical function, role physical [role limitations because of physical health], social functioning, and role emotional [role limitations because of emotional problems] ) cover most of the negative range of theta. Information function for all items combined peaked at -0.7 of theta (information = 18.5) and decreased with increasing theta.

CONCLUSION

The SF-8 instrument performs well among those with poor QOL across the continuum of the latent trait and thus can recognize more effectively persons with relatively poorer QOL than those with relatively better QOL.

Epithelial stem/progenitor cells in lung postnatal growth, maintenance, and repair

The adult lung consists of a trachea leading into a system of branched airways ending in millions of alveolar sacs. It contains many different epithelial cell types arranged in precise patterns along the proximodistal axis. Each region of the lung has the capacity to repair through the proliferation of different epithelial cell types. However, the precise identity of the cells mediating repair is not fully resolved. To address this problem, we are using genetic lineage-labeling techniques in the mouse. The tools we have made will also be useful for understanding how progenitor cell behavior is regulated under normal and pathological conditions.

[Non-chondromatous hamartoma]

A 69-year-old female visited our hospital because of dyspnea. Chest X-ray showed an abnormal shadow in the right lower lung field. Chest computed tomography (CT) showed a round, well-circumscribed, homogenous subpleural nodle of 8 mm in diameter in the right lower lobe, which had no calcification and no pleural indentation. Bronchofiber scope, abdominal CT, brain magnetic resonance imaging (MRI), bone scintigraphy could not establish definitive diagnosis. Scince the possibility of malignancy could not be excluded throughout, video-assisted thoracoscopic surgery was performed to obtain confirmed diagnosis. Pathological examination revealed non-chondromatous hamartoma of the lung. Non-chondromatous hamartoma should be considered in the differential diagnosis of pulmonary nodles. We report a rare case of non-chondromatous hamartoma.

Bacillus cereus nosocomial infection from reused towels in Japan

It was noticed that there was an increase in Bacillus cereus nosocomial infections in the summer from 2000 to 2005. In 2005, five bloodstream infections occurred in five patients related to catheter use. The causative strains were distinct from each other and belonged to novel multilocus sequence types (ST): ST365, ST366, ST367 and ST368. Two ST365 strains from two patients were further distinguished by pulsed-field gel electrophoresis. B. cereus contamination was observed with reused (dried and steamed) towels (>10(6)cfu/towel) and washing machines in hospital linen rooms. B. cereus strains from towels belonged to ST167, ST365, ST380 and ST382, and a proportion of these were the same, or similar, to strains from patients. All the hospital strains of B. cereus were distinct from those from food-poisoning strains (ST26, ST142, ST381). Ciprofloxacin resistance was observed only in hospital strains. Neither emetic toxin nor cytotoxin K gene, usually present in food poisoning strains, were found in the hospital strains, except for one patient isolate. The data suggest that specific B. cereus strains are circulating within a hospital, with genotypes, antibiotic susceptibilities and virulence gene patterns generally distinct from those of food poisoning, and that in Japan, towels are an important source of contamination, especially in summer.

Ferroelectric and magnetic properties of multiferroic BiFeO(3)-based composite films

BiFeO(3)-based composite films were fabricated onto the Pt/Ti/SiO(2)/Si(100) substrates by a chemical solution deposition (CSD) method using the precursor solutions with various excess iron composition followed by annealing at 923 K for 30 minutes under oxygen gas flow. Coexistence of spontaneous magnetization and remanent polarization could be obtained in the BiFeO(3)-based composite films with high excess iron composition. The remanent magnetization of almost 20 emu/cm(3) and the magnetic coercive field of 1.5 kOe were obtained at the iron composition ratio of Fe/Bi = 1.25. In this specimen, the remanent polarization at 90 K was approximately 10 microC/cm(2) at the electric field of 1500 kV/cm. Structural analysis suggested that the remanent polarization has a possibility to increase by suppressing the formation of the secondary phases of Bi(2)Fe(4)O(9) and alpha-Fe(2)O(3), these are the nonferroelectric material as well as antiferromagnetic phase.

Brain abscess caused by Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus in Egypt, April 2007

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increasingly been noted as an emerging pathogen worldwide

Randomized controlled trial for an effect of green tea-extract powder supplementation on glucose abnormalities

OBJECTIVE

We examined whether green tea-extract powder supplementation improves glucose abnormality.

METHODS

The study was conducted for volunteers who resided in eastern communities of Shizuoka Prefecture and who had fasting blood glucose levels of >or=6.1 mmol/l or nonfasting blood glucose levels of >or=7.8 mmol/l in a recent health check-up. Sixty subjects aged 32-73 years (49 males and 11 females) participated in the trial. The Early intervention group consumed a packet of green tea-extract powder containing 544 mg polyphenols (456 mg catechins) daily for the first 2 months and then entered the 2-month nonintervention period. The Later intervention group was observed for the first 2 months and then consumed green tea-extract powder as described above for the subsequent 2 months. Using the two-period crossover design, we analyzed the changes in fasting hemoglobin A1c level and other biomarkers in blood samples collected at baseline, 2 months and 4 months.

RESULTS

A significant reduction in hemoglobin A1c level and a borderline significant reduction in diastolic blood pressure were associated with the intervention. The intervention caused no significant changes in weight, body mass index, body fat, systolic blood pressure, fasting serum glucose level, homeostasis model assessment index, serum lipid level or hypersensitive C-reactive protein.

CONCLUSION

Daily supplementary intake of green tea-extract powder lowered the hemoglobin A1c level in individuals with borderline diabetes.

Cardioprotective effect of edaravone against ischaemia-reperfusion injury in the rabbit heart before, during and after reperfusion treatment

The free radical scavenger edaravone is able to stimulate prostacyclin release and inhibit the lipoxygenase pathway in the arachidonic acid cascade. The effect of edaravone administration on myocardial damage in rabbit hearts subjected to ischaemia-reperfusion was examined at different times relative to reperfusion. All rabbits underwent sustained coronary artery occlusion for 30 min followed by 3 h of reperfusion. Rabbits were divided into the following groups: control; early (3 mg/kg edaravone IV 10 min before reperfusion); immediate (3 mg/kg edaravone IV immediately after the start of reperfusion); and late (3, 6 or 10 mg/kg edaravone IV 5 min after the start of reperfusion). Single bolus administration of edaravone 10 min before reperfusion or immediately upon initiation of reperfusion appears to be associated with reductions in infarction size and the percentage of apoptotic cells, but treatment with edaravone 5 min after initiation of reperfusion does not appear to have this protective effect.

AIDS-related cerebral toxoplasmosis with hyperintense foci on T1-weighted MR images: A case report

The neuroradiological findings are helpful for the diagnosis of toxoplasmic encephalitis. The T1 hypersignal intensity foci on brain magnetic resonance (MR) images without contrast enhancement are presented and can be a pathognomonic sign of this disease.

Magnetic resonance imaging and diffusion tensor analysis of lymphomatoid granulomatosis of the brain

We present the case of a 56-year-old man suffering from acquired immune deficiency syndrome associated with lymphomatoid granulomatosis. Magnetic resonance imaging performed because of convulsions revealed an ill-defined frontal mass showing hypointense on T1WI and slightly hypointense on T2WI with surrounding edema. An elevated uptake was found on T1-201 single photo emission computed tomography consistent with a central nervous system lymphoma. However, the apparent diffusion coefficient ratio calculated from diffusion-tensor acquisitions was 1.53 and was higher than that of lymphomas in previous reports. Stereotactic brain biopsy was performed and lymphomatoid granulomatosis was confirmed.

Decrease in herbicide concentrations and affected factors in lagoons located around Lake Biwa

The contamination levels and changes in the concentrations in four lagoons around Lake Biwa of paddy-use herbicide were studied. Four lagoons, Sone-numa (52 days of HRT (hydraulic residence time) estimated from the lagoon volume and the average discharge at the outlet, 21 ha area), Yanagihira-ko (40 days, 5.0 ha), Noda-numa (11 days, 6.0 ha), and Iba-naiko (2 days, 55.5 ha), were selected as monitoring sites. Intensive water sampling was carried out once a week from May to June at the outlet of each lagoon. Although twelve of the monitored herbicides were detected, the maximum concentrations did not exceed the guidelines for water-supply law in Japan. The relation between half-lives in herbicide concentrations and characteristics of a lagoon such as HRT and chlorophyll-a concentrations were examined. The shorter half-lives of herbicide concentrations in lagoons with shorter HRT means that replacement by influent water effectively decreased the pesticide concentrations. Shorter half-lives in lagoons with high chlorophyll-a concentrations between the lagoons with similar HRT suggest that biological degradation during the residence time worked more efficiently in the lagoon with high chlorophyll-a concentrations.

A randomized double blind placebo-controlled clinical trial of Hochuekkito, a traditional herbal medicine, in the treatment of elderly patients with weakness N of one and responder restricted design

OBJECTIVE

To evaluate the effects of Hochuekkito, a traditional Japanese and Chinese medicine, in the treatment of elderly patients with general weakness. To devise a suitable study design for assessing the clinical effectiveness of traditional herbal medicines.

METHODS

Fifteen elderly patients (mean +/- SD: age 78.4 +/- 7.8; m/f 3/12) participated in this study. A multicenter, prospective, randomized, double-blind, placebo-controlled study with N of one and responder restricted design was performed. After the run-in period, the patients were divided into responders and non-responders. Only responders were entered in the study, and were randomized into three groups: an active-placebo group, a placebo-active group and an active-active group. The study consisted of two 6-week terms with a 2-week washout period in between. We assessed the Short Form 36 Health Survey (SF-36) and Profile of Mood States (POMS) as an endpoint of quality of life (QOL). In addition, we assessed the biodefense status by measuring the natural killer cytolytic activity (NK activity), IL-2 producing activity of peripheral lymphocytes, lymphocyte proliferating activity and lymphocyte cell-surface antigens.

RESULTS

The physical component summary of the SF-36 analysis significantly improved in the Hochuekkito-treated group. Four components (A-H: anger-hostility, F: fatigue, T-A: tension-anxiety, C: confusion) out of six improved in the Hochuekkito-treated group in the POMS analysis. Lymphocyte proliferating activity improved in the Hochuekkito-treated group but not significantly. Concerning the surface antigens of peripheral lymphocytes, the population of CD3 positive cells and CD3CD4 double positive cells increased in the Hochuekkito-treated group.

CONCLUSION

We revealed that Hochuekkito improved the QOL and immunological status of elderly patients with weakness by randomized controlled trial. Our study design might be useful for assessing the efficacy of traditional herbal medicine in the future.

Detection of non-papillary, non-invasive transitional cell G1 carcinoma as revealed by increased DNA instability and other cancer markers

The method to reveal DNA-instability as demonstrated by immunohistochemical staining with anti-cytidine antibody after acid hydrolysis (DNA-instability test) was used as a marker of malignancy. The test was applied to paraffin-embedded sections taken from 15 urinary bladders, renal pelvic cavities, and ureters bearing multiple carcinoma in situ (CIS) and totally 31 papillary urothelial cancers. The serial sections of the same tissues were also subjected to immunohistochemical staining for PCNA, p53, DFF45, and VEGF. The DNA-instability test was positive in 100% cancer lesions irrespective of the grades, and apparently normal urothelium, and hyperplastic and dysplastic urothelial lesions also showed the areas with clones positively stained with DNA-instability testing, and the percent numbers of positive areas in them were 28.3%, 37.7%, and 61.5%, respectively. These clones, which were present in apparently normal urothelium and in hyperplastic and dysplastic urothelial lesions, showed higher percent values of PCNA-positive-cells, in comparison to the values estimated in the areas with negatively stained DNA-instability testing, and the former values were statistically not different from those in carcinoma lesions. Furthermore, the percent numbers of areas positive for p53, DFF45, and VEGF, with positive DNA-instability testing were also much higher than those with negative DNA-instability testing in apparently normal urothelium, and hyperplastic and dysplastic urothelial lesions, and the former values were again comparable to those in cancer lesions with no statistical differences. These clones were regarded as already being malignant and should be the direct precursors of progressed cancer lesions. They will make progression through two different pathways, one to papillary non-invasive G1 cancers by neovascularization induced by paracrine secretion of VEGF, and another to flat CIS G2 without secretion of VEGF; thus the clones should be regarded as non-papillary, non-invasive Gl TCC, or CIS G1. It should be always taken into account that the probability for apparently normal urothelium, and hyperplastic and dysplastic urothelial lesions to contain cancer clones, will be high already, especially in tumor-bearing bladders.

[Primary right ventricular malignant fibrous histiocytoma; report of a case]

Primary malignant fibrous histiocytoma located in the right side of the heart is extremely rare. We reported a case with literal reviews. A 71-year-old woman was admitted of faintness due to hypotension and marked edema of her lower extremity. With no time she was deteriorated into cardiogenic shock. Echocardiography demonstrated a tumor like mass which occupied her whole right ventricular cavity. Emergency tumor resection was carried out because of her status. Histological and immunohistochemical studies revealed the tumor was malignant fibrous histiocytoma. She died of pulmonary failure on nineteenth day after surgery.

Estimation of estrogenic and antiestrogenic activities of selected pesticides by MCF-7 cell proliferation assay

Estrogenic activities of 20 selected pesticides-which are used for agricultural production as insecticides, fungicides and herbicides-were examined by estrogen receptor (ER)-dependent MCF-7 cell proliferation assay. Among them, chlordecone, dicofol, methoxychlor, gamma-HCH, fenarimol, EPN, triadimefon, and triadimenol had estrogenic activities, all of which were suppressed by the addition of pure antiestrogen ICI 182,780. The first 5 compounds exhibited binding capacities to ERalpha. The antiestrogenic activity of a compound was examined by estimating its suppressive effect on cell proliferation induced by 30 pM 17beta-estradiol. Strongly suspected antiestrogens were captan and myclobutanil, both of which were found to have the capacity to bind to ERalpha and which might exert their activities by competing at the level of ERalpha. Antiestrogenic activities of nitrofen, fenitrothion, fenarimol and triadimefon were also suggested. Affinities of the compounds for ERalpha and/or androgen receptor (AR) were lower than those of synthetic estrogen (diethylstilbestrol) and testosterone (mibolerone), respectively. Fenitrothion had the highest affinity to AR. Chlordecone, dicofol, methoxychlor, nitrofen, fenarimol, myclobutanil and pyridate had capacities to bind both ERalpha and AR. Chlordecone and pyridate were much more effective as competitors of estrogen binding to ERalpha than androgen binding to AR and, conversely, nitrofen was a more effective competitor of androgen binding to AR.