Genetic polymorphisms in the surfactant proteins in systemic sclerosis in Japanese: T/T genotype at 1580 C/T (Thr131Ile) in the SP-B gene reduces the risk of interstitial lung disease

OBJECTIVES

To investigate the association between single-nucleotide polymorphisms (SNPs) in the pulmonary surfactant protein (SP) genes and the presence or absence of interstitial lung disease (ILD) in SSc patients.

METHODS

We studied 127 Japanese patients with SSc and 206 normal subjects. Investigated SNPs were C/T within amino acid (aa) 219, Arg219Trp in the SP-A1 gene (rs4253527), C/T within aa 131 (at nucleotide 1580) and Thr131Ile of the SP-B gene (rs1130866). Genotypes were determined by the TaqMan method.

RESULTS

Genotype frequencies were not different between the SSc patients and normal controls for both loci. The patients were subsequently divided into two groups based on presence or absence of ILD. In the SNP in the SP-B gene, the frequency of the T/T genotype was significantly lower in the patients with ILD than in those without ILD. Limited in the patients who were positive for anti-Scl-70 antibody, the difference in the frequency of the T/T genotype between the ILD-positive and ILD-negative groups became more apparent. On the other hand, in the SNP in the SP-A1 gene, there was no significant skewing for a certain genotype.

CONCLUSION

In SSc, where massive fibrosis occurs, possession of the T/T genotype in the SP-B gene would reduce the risk of ILD in Japanese.

Recovery of high purity phosphorus from municipal wastewater secondary effluent by a high-speed adsorbent

High purity phosphorus was recovered from municipal wastewater secondary effluent as phosphate, using a newly developed phosphorus adsorption and recovery system. A high-speed adsorbent having a unique porous structure was used in this system. The secondary effluent, showing total phosphorus (TP) of 0.1-2.1 mg P/L, was passed through an adsorbent packed column at high space velocity (SV) of 15 h(-1). The TP of the treated water was as low as 0.02-0.04 mg P/L, indicating that 97% of phosphorus in the secondary effluent was removed. The removed phosphorus was desorbed from the adsorbent by passing a sodium hydroxide aqueous solution through the column. Calcium hydroxide was added to this solution to precipitate the phosphorus as calcium phosphate. This precipitate was neutralized with hydrochloric acid aqueous solution, washed with water, and then solid-liquid separation was performed for the phosphorus recovery. The main constituent of the recovered phosphorus was apatite-type calcium phosphate, with 16% phosphorus content, which matched that of high-grade phosphorus ore. The hazardous elements content of the recovered phosphorus was exceedingly low. Therefore the recovered phosphorus can be applied to an alternative for phosphorus ore, or to a phosphate fertilizer.

Hop bract polyphenols reduced three-day dental plaque regrowth

Previous research has shown the inhibitory effects of hop bract polyphenols (HBP) on cariogenic streptococci in vitro, but their effects in humans have not been investigated. This double-blind, crossover clinical study tested the hypothesis that HBP delivered in a mouthrinse suppresses plaque regrowth in humans. Twenty-nine healthy male volunteers had all plaque removed, and refrained from all oral hygiene for 3 days, except for rinsing with a mouthrinse containing 0.1% HBP or a placebo. The results showed that the mean amount of plaque assessed by the Patient Hygiene Performance score after the volunteers used the HBP mouthrinse was significantly less than that after they used the placebo (p < 0.001). The number of mutans streptococci in the plaque samples after volunteers used the HBP mouthrinse was significantly lower than that after they used the placebo (p < 0.05). These findings suggested that HBP, delivered in a mouthrinse, successfully reduced dental plaque regrowth in humans.

Fatty liver and obesity: phenotypically correlated but genetically distinct traits in a mouse model of type 2 diabetes

AIMS/HYPOTHESIS

Obesity and fatty liver are commonly associated with type 2 diabetes, but the genetic and functional bases linking fatty liver with obesity and diabetes are largely unknown. Our aim was to investigate the association of fatty liver with obesity and other diabetes-related phenotypes and to define the genetic control of obesity and fatty liver.

MATERIALS AND METHODS

We established 306 F2 mice by crossing Nagoya-Shibata-Yasuda (NSY) mice, an animal model of type 2 diabetes, with control C3H mice, and analysed their phenotypes. Whole-genome screening of F2 mice was performed to identify the loci responsible for fatty liver and obesity.

RESULTS

A strong association of fatty liver with obesity, hyperinsulinaemia and hyperglycaemia was observed in F2 mice. Using whole-genome screening in 306 F2 mice, we mapped a new locus for fatty liver (Fl1n) on chromosome 6 (maximum logarithm of odds score [MLS] 10.0) and one for body weight (Bw1n) on chromosome 7 (MLS 5.1). Fl1n was linked to epididymal fat weight as well as fatty liver, but its effects were opposite in the two tissues in that the NSY allele increased liver fat but decreased epididymal fat, suggesting a role of Fl1n in partitioning of fat mass. The sequence of peroxisome proliferator-activated receptor gamma (Pparg), a candidate for Fl1n, showed allelic variation between NSY and C3H mice.

CONCLUSIONS/INTERPRETATION

These data suggest that fatty liver and obesity are phenotypically related but genetically independent. Loci homologous to Fl1n and Bw1n are good candidate genes for susceptibility to fatty liver and obesity in humans.

Targeting EGFR and HER-2 with cetuximab- and trastuzumab-mediated immunotherapy in oesophageal squamous cell carcinoma

We previously reported that oesophageal squamous cell carcinoma (SCC) had a relatively high incidence of EGFR and HER-2 overexpression. Thus, anti-HER family targeting may become a promising approach to treat oesophageal SCC. In the present study, we investigated (a) the distribution of EGFR and HER-2 expression in oesophageal SCC (n=66) detected by immunohistochemistry and (b) cetuximab- and/or trastuzumab-mediated biological activity (antiproliferative effect by the MTT assay, apoptosis-inducing activity by the annexin V/propidium iodide assay, and antibody-dependent cellular cytotoxicity (ADCC) by the ⁵¹Cr-release assay) against oesophageal SCC cell lines with various levels of EGFR and HER-2. Twelve of the 66 patients (18%) showed both EGFR- and HER-2 expression. Out of both EGFR- and HER-2-positive cases, nine cases (75%) showed EGFR and HER-2 expression in individually distinct regions. Furthermore, the combination of cetuximab and trastuzumab could induce synergistic antiproliferative effects and additional ADCC activities against not all, but several oesophageal SCC cell lines with EGFR and HER-2 expression. The combination of cetuximab and trastuzumab may be useful in the treatment of oesophageal SCC with EGFR and HER-2 expression.

Expression of the gene for a membrane-bound fatty acid receptor in the pancreas and islet cell tumours in humans: evidence for GPR40 expression in pancreatic beta cells and implications for insulin secretion

AIMS/HYPOTHESIS

G protein-coupled receptor 40 (GPR40) is abundantly expressed in pancreatic beta cells in rodents, where it facilitates glucose-induced insulin secretion in response to mid- to long-chain fatty acids in vitro. However, GPR40 gene expression in humans has not been fully investigated, and little is known about the physiological and pathophysiological roles of GPR40 in humans. The aim of this study, therefore, was to examine GPR40 expression and its clinical implications in humans.

METHODS

GPR40 mRNA expression in the human pancreas, pancreatic islets and islet cell tumours was analysed using TaqMan PCR.

RESULTS

GPR40 mRNA was detected in all human pancreases collected intraoperatively. It was enriched approximately 20-fold in isolated islets freshly prepared from the pancreases of the same individuals. The estimated mRNA copy number for the GPR40 gene in pancreatic islets was comparable to those for genes encoding sulfonylurea receptor 1, glucagon-like peptide 1 receptor and somatostatin receptors, all of which are known to be expressed abundantly in the human pancreatic islet. A large amount of GPR40 mRNA was detected in insulinoma tissues, whereas mRNA expression was undetectable in glucagonoma or gastrinoma. The GPR40 mRNA level in the pancreas correlated with the insulinogenic index, which reflects beta cell function (r=0.82, p=0.044), but not with glucose levels during the OGTT, the insulin area under the OGTT curve or the index for the homeostasis model assessment of insulin resistance (HOMA-IR).

CONCLUSIONS/INTERPRETATION

The present study provides evidence for GPR40 gene expression in pancreatic beta cells and implicates GPR40 in insulin secretion in humans.

High-dose-rate brachytherapy combined with long-term hormonal therapy for high-risk prostate cancer: Results of a retrospective analysis

PURPOSE

High-dose-rate (HDR) brachytherapy combined with hormonal therapy (HTx), without the addition of external beam radiation therapy (EBRT) for high-risk prostate cancer was evaluated retrospectively.

MATERIALS AND METHODS

Between May 1995 and April 2002, 35 patients with prostate cancer [Stage > or = T2b (UICC 1997) or tumor grading=3 or prostate-specific antigen (PSA) level > or = 20 ng/mL] were treated with HDR brachytherapy combined with HTx. Most patients (74%) had two or more of these factors. All patients received Iridium-192 HDR brachytherapy with a total dose of 54 Gy/9 fractions/5 days (48 Gy/8 fractions/5 days for the first 6 cases) in one implant session. The median neoadjuvant HTx [luteinizing hormone-releasing hormone (LH-RH) agonist and antiandrogen] period was 7 months. The median adjuvant HTx (ATH) (LH-RH agonist) period was 40 months, and median follow-up was 57 months (range, 23-117 months).

RESULTS

The 5-year actuarial biochemical control, local control, and disease-free rates were 62%, 96%, and 76% respectively. No patients experienced local and/or regional relapse without distant progression. The 5-year actuarial cause-specific survival and overall survival rates were 89% and 87%, respectively. The acute and late toxicity were moderate and well tolerated.

CONCLUSION

HDR brachytherapy plus long-term HTx is at least as effective as conventional EBRT plus long-term HTx.

Differential expression of a Bombyx mori AHA1 homologue during spermatogenesis

The AHA1 (activator of Hsp90 ATPase) family of proteins were exclusively conserved from yeast to humans, but little is known about their tissue distribution or biological function. In this study, a cDNA for a Bombyx mori AHA1 homologue, BmAHA1, was isolated from the testes of larvae on day 3 of the fifth instar using an mRNA differential display method. This cDNA encodes a protein with 341 amino acid residues. Gene expression studies revealed that BmAHA1 mRNA occurred prominently in the testes. In situ hybridization and immunostaining showed that the BmAHA1 mRNA signals were strongly detected in spermatogonial cells and primary spermatocytes at the fifth larval instar stage, whereas the BmAha1 protein was abundant in round and elongated spermatids at the pupal stage. The localization pattern of the accumulated protein in the elongated spermatids was reminiscent of that reported previously for microtubules, but the BmAha1 protein showed a decrease in apparent concentration during maturation process. The stage- and cell-specific expression indicated that BmAha1 might play a role in silkworm spermatogenesis, especially in postmeiotic differentiation.

Psychological well-being and perceptions of stress amongst Japanese dental students

The purpose of this study was to investigate the relationship between Psychological General Well Being (PGWB) and perceived sources of stress amongst dental students in Japan. Second to sixth year dental students of Tokyo Medical and Dental University were invited to participate in the questionnaire survey. The questionnaire collected information on demographic and social background, lifestyle behaviours, the PGWB index and the Dental Environment Stress (DES) questionnaire. A total of 320 students (56% male) participated, with a response rate of 91%. Male students had significantly higher PGWB scores and lower DES scores than female students (P < 0.05). There were no significant differences in the year of study for DES mean score and PGWB total score. Students whose first choice of admission was dentistry experienced less stress than those whose first choice was another discipline (P < 0.05). Students who regularly exercised showed significantly lower stress levels and higher well-being status than those students who did not exercise (P < 0.01). Correlational analysis showed an inverse relationship between PGWB and DES scores (r = -0.544, P < 0.001). Multiple regression analysis revealed that DES mean score was significantly related to gender, first choice of admission and PGWB total score. It is suggested that perception of stress amongst Japanese dental students is influenced by gender, dentistry as first choice for admission and students' general well-being.

Histopathological studies of bacterial haemorrhagic ascites of ayu, Plecoglossus altivelis (Temminck & Schlegel)

A histopathological study was carried out on ayu, Plecoglossus altivelis, with bacterial haemorrhagic ascites. The fish were obtained from culture ponds in Wakayama Prefecture in 2003. The causative agent was identified as Pseudomonas plecoglossicida by a slide agglutination test using anti-P. plecoglossicida FPC941 serum. Histopathological studies revealed lesions in spleen, kidney, liver, intestine, heart and gills. Lesions in the spleen and haematopoietic tissue were prominent and invaded by P. plecoglossicida. Necrotic lesions accompanied by haemorrhage, fibrin deposition and oedema occurred in the splenic pulp and sheathed tissue, and in the kidney. The liver also had necrotic lesions and abscess formations. However, the intestine, heart and gills were only slightly invaded by P. plecoglossicida. No lesions or bacteria were observed in the brain.

Multiple lymphomatous polyposis of the colon originating from T-cells: a case report

Multiple lymphomatous polyposis is an unusual form of non-Hodgkin's lymphoma characterised by myriad polyps throughout the alimentary tract. Most multiple lymphomatous polyposis cases are derived from B-cell, and there has been little information on multiple lymphomatous polyposis of T-cell origin. A 67-year-old Japanese man presented with lower abdominal pain and diarrhoea of 4-week duration. Colonoscopy revealed numerous small umbilicated polyps and several raised erosions in the colorectum. Biopsy specimens showed diffuse proliferation of lymphoma cells negative for B-cell markers but positive for T-cell markers. Polymerase chain reaction using extracted chromosomal deoxyribonucleic acid from paraffin-embedded samples identified T-cell receptor gamma and delta gene recombination. The patient was treated with combined chemotherapy, leading to complete resolution of the lesions.

Collective oscillations of vortex lattices in rotating Bose-Einstein condensates

The complete low-energy collective-excitation spectrum of vortex lattices is discussed for rotating Bose-Einstein condensates by solving the Bogoliubov-de Gennes equation, yielding, e.g., the Tkachenko mode recently observed at JILA. The totally symmetric subset of these modes includes the transverse shear, common longitudinal, and differential longitudinal modes. We also solve the time-dependent Gross-Pitaevskii equation to simulate the actual JILA experiment, obtaining the Tkachenko mode and identifying a pair of breathing modes. Combining both approaches allows one to unambiguously identify every observed mode.

Serum nitric oxide (NO) levels in systemic sclerosis patients: correlation between NO levels and clinical features

Vascular damage in systemic sclerosis (SSc) may be a factor in the abnormal regulation of several vasoactive agents. It has been well confirmed that plasma endothelin-1, as a vasoconstrictive factor, is elevated in patients with SSc. However, it is still controversial whether the levels of serum nitric oxide (NO), a strong vasodilator, are increased or decreased in SSc patients compared to healthy donors. In this study, we measured the levels of serum NO metabolites in SSc patients and determined the contribution of the excessive production of NO synthase (NOS)-2 by skin fibroblasts to NO synthesis. Serum NO levels of 45 patients with SSc were significantly higher than those of 20 healthy volunteers. In addition, some clinical features of SSc (the extent of skin fibrosis, short disease duration, and the complication of active fibrosing alveolitis) were all correlated positively with the levels of NO metabolites in SSc patients. To evaluate the levels of NOS-2 produced by skin fibroblasts, skin fibroblast cultures were established from SSc patients and healthy volunteers. Reverse transcription-polymerase chain reaction indicated that NOS-2 mRNA was spontaneously expressed in cultured fibroblasts derived from SSc patients, but not in those derived from healthy normal controls. Immunohistochemical staining also showed that NOS-2 proteins were detected in SSc fibroblasts but not in normal fibroblasts. The production of NO by cultured fibroblasts was visualized directly by a reagent (DAF-2 DA) used for the fluorescent detection of NO. Cultured SSc fibroblasts were capable of NO synthesis in culture media containing L-arginine, whereas normal fibroblasts (with no expression of NOS-2) did not synthesize detectable NO. These observations indicate that NO production is increased markedly in early-stage diffuse cutaneous SSc patients with active fibrosing alveolitis, and that constitutive NOS-2 expression in SSc fibroblasts may contribute to increased NO production.

High-sensitivity analysis of serum C-reactive protein in young patients with lumbar disc herniation

We measured the serum concentration of C-reactive protein (CRP) by a high-sensitive method in patients with lumbar disc herniation. There were 48 patients in the study group and 53 normal controls. The level and type of herniation were evaluated. The clinical data including the neurological findings, the angle of straight leg raising and post-operative recovery as measured by the Japanese Orthopaedic Association (JOA) score, were recorded. The high-sensitive CRP (hs-CRP) was measured by an ultrasensitive latex-enhanced immunoassay. The mean hs-CRP concentration was 0.056 +/- 0.076 mg/dl in the patient group and 0.017 +/- 0.021 mg/dl in the control group. The difference was statistically significant (p = 0.006). There was no other correlation between the hs-CRP concentration and the level and type of herniation, or the pre-operative clinical data. A positive correlation was found between the concentration of hs-CRP before operation and the JOA score after. Those with a higher concentration of hs-CRP before operation showed a poorer recovery after. The significantly high concentration of serum hs-CRP might indicate a systemic inflammatory response to impingement of the nerve root caused by disc herniation and might be a predictor of recovery after operation.

Association between adult-onset Still's disease and interleukin-18 gene polymorphisms

Recently, we reported that serum concentration of IL-18 is strikingly high in patients with adult-onset Still's disease (AOSD). The aim of the present study was to screen for genetic polymorphisms in the human IL-18 (hIL-18) gene and to determine the association of polymorphisms with susceptibility to AOSD. We investigated the 6.7 kb region upstream of exon 2 of hIL-18 gene, in which a promoter activity had been reported. Sixteen AOSD patients, 144 rheumatoid arthritis (RA) patients and 92 healthy control individuals were studied. We found seven single nucleotide polymorphisms and a single 9 bp insertion which were frequently present in the AOSD patients. Three haplotypes including a unique combination of these polymorphisms were also determined. Of them, haplotype S01 contained all eight of these polymorphisms. The frequency of individuals carrying a diplotype configuration, ie a combination of two haplotypes, of S01/S01 was significantly higher in the AOSD patients than in the healthy controls (P=0.00059, Fischer's exact probability test, odds ratio [OR]=7.81, 95% confidence interval [95% CI]=2.48-24.65) and the RA patients (P=0.015, Fischer's exact probability test, OR=4.0, 95% CI=1.39-11.54). We therefore conclude that possession of the diplotype configuration of S01/S01 is a major genetic risk factor for susceptibility to AOSD.

Halitosis prevention campaign: a report of oral health promotion activities in Japan

A local dental association, Hakodate Dental Association, has been conducting an oral health promotion campaign, 'Good-bye Bad Breath', in a local community since April 1998. The purpose of this campaign was not only to prevent oral malodour but also to raise people's awareness about oral health. Oral health education has been provided at schools and through television commercials, radio programmes and newspaper articles. Campaign posters and leaflets on bad breath have also been distributed to drug stores, medical clinics and schools, as well as dental clinics. It has been emphasised that oral malodour is a preventable condition and that the dentist can provide adequate advice and suitable treatment. Medical and pharmaceutical associations have cooperated with the Dental Association in running the campaign. Dental care was provided free of charge to the local residents. The free services provided included the assessment of oral malodour using a portable sulphide detector, instructional programmes, and consultations with dentists. This campaign offered a good opportunity to encourage people to visit the dentist for regular check-ups. The number of regular check-ups and halitosis patients has increased in 70% of the clinics belonging to the Dental Association.

Slow synchronized bursts of inhibitory postsynaptic currents (0.1-0.3 Hz) by cholinergic stimulation in the rat frontal cortex in vitro

Cholinergic inputs from the basal forebrain to cortex exert profound effects on cortical activities, such as a rhythmic synchronization. For these modulatory effects inhibitory interneurons could play crucial roles within the cortical circuitry. To study cholinergic modulation of GABA-mediated inhibition, we recorded inhibitory postsynaptic current (IPSC) during application of cholinergic agonists in the rat frontal cortex in vitro. Both carbachol and muscarine caused two temporally different patterns of IPSC modulation in both pyramidal cells and inhibitory interneurons: tonic or periodic increase of GABA-A receptor-mediated inhibition. The tonic pattern showed a continuous increase of IPSC frequency, while the periodic increase manifested itself as rhythmic (0.1-0.3 Hz, mean 0.2 Hz) bursts of IPSC (frequency: 6-69 Hz, mean 24 Hz; burst duration: 1.2-4.3 s, mean 2.2 s). Both types of increase were suppressed by atropine or pirenzepine, muscarinic-receptor antagonists. The periodical IPSC bursts were not affected by antagonists for ionotropic glutamate receptors. Following cholinergic stimulation, periodic IPSC bursts in nearby cells were synchronized as a whole, but individual inhibitory events within the bursts were not always temporally correlated, suggesting synchronized depolarizations of several presynaptic interneurons. It has been revealed that slow rhythmic depolarizations accompanying spike firing can be generated within the cortex. In addition to this periodic excitation of cortical circuits, these results indicate that cortical inhibitory interneurons have their own acetylcholine-dependent mechanism generating the slow rhythm independent of the excitatory circuits.

Prediction of neurologic outcome in patients with spinal cord injury by using hyperbaric oxygen therapy

The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patients with spinal cord injury was evaluated. HBO has been used to treat spinal cord injury, but HBO does not appear to greatly alter the neurological outcome. This is the first report of the use of HBO as a diagnostic tool to evaluate neurological recovery after spinal cord injury. The study group consisted of 22 patients, aged 21-73 years, with spinal cord injuries. The effect of HBO was evaluated on admission and categorized as one of four grades (excellent, good, fair, or poor). The neurological status was evaluated on admission and at the time of follow-up, according to Frankel grade and the American Spinal Injury Association (ASIA) motor score. Correlations between the HBO effect and Frankel grade recovery and correlations between the HBO effect and recovery rate of the ASIA motor score were evaluated. The recovery in Frankel grade from admission to the final follow-up became better as the effectiveness of HBO increased (r = 0.445; P = 0.0414). The Frankel grade (r = 0.036; P = 0.871) and ASIA motor score (r = 0.029; P = 0.893) on admission did not correlate with the recovery in Frankel grade. There was a significant correlation between the HBO effect and the recovery rate of the ASIA motor score (r = 0.586; P = 0.0072), but this correlation was weaker than that for the ASIA motor score on admission (r = 0.752; P = 0.0006). We conclude that HBO can be employed to assess the status of spinal cord function recovery after spinal cord injury.

Calcium-sensing receptor gene polymorphism affects the parathyroid response to moderate hypercalcemic suppression in patients with end-stage renal disease

AIM

The basic mechanism of secondary hyperparathyroidism is still unclear, but a change in Ca2+ sensing by parathyroid cells is possibly involved in this uremic complication. A rightward shift of the calcium set-point and an increase of the minimum secretion rate have been found in secondary hyperparathyroidism, indicating abnormal calcium sensing.

METHODS

We evaluated the effect of calcium sensing receptor (CaR) gene polymorphism (codon G990R) on the response of the parathyroid gland to moderate hypercalcemic suppression in 77 ESRD patients on regular hemodialysis (HD using 2.5 mEq/l Ca2+ dialysate). All patients underwent an HD session with 3.0 mEq/l Ca2+ dialysate to suppress parathyroid hormone (PTH). Then we investigated the effect of CaR gene polymorphism on the parathyroid response to hypercalcemic stimulation.

RESULTS

Patients were divided into 3 groups on the basis of genotype (GG = 33 patients (42.9%), GR = 39 patients (50.6%), RR = 5 patients (6.5%)). Baseline intact PTH levels in patients without the R allele were not significantly different from those in patients with the R allele (GG group, 181.4 +/- 31.1 pg/ml vs. GR and RR groups, 230 +/- 51.2 pg/ml: mean +/- SEM). The significant effect of moderate hypercalcemic suppression on the intact PTH level was observed in the GG group (p < 0.01) but not in the GR and RR groups, despite the identical increase in Ca2+.

CONCLUSION

Our results suggest that CaR gene polymorphism (codon G990R) influences the responsiveness of the parathyroid gland to changes of extracellular Ca2+ in ESRD patients. The glands of patients with the GG genotype of the CaR gene may be more sensitive to extracellular Ca2+ changes.

[Statistical analysis of a dental care program for homebound elderly patients in Shinjuku-ku]

A dental care service program for homebound elderly patients has been operating since 1988 in Shinjuku-ku, Tokyo. The purpose of this study was to clarify the characteristics of patients who received this dental care service. Based on a survey questionnaire and treatment card from April 1995 to March 1999, we analyzed the characteristics of patients. The following conclusions were obtained. 1. We studied 301 patients (males, 124; females, 177). The average age of the patients was 81.2 +/- 9.0 years. Eighty-four percent of the patients had a medical history. 2. Oral hygiene was practiced by 68% of the subjects: 78% by themselves, and 22% by caregivers. Half of the patients (53%) brushed their teeth every day, and one-third (32%) did not. 3. The mean number of DMF teeth was 25.4 (DT, 1.6; MT, 20.5; FT, 3.3). 4. About eighty percent (79%) of the patients had removable dentures, and one-third of them were upper and lower complete dentures. 5. The chief complaint of homebound elderly was the denture problem (73%). Therefore, the care provided at the bedside was mainly denture-related treatments. 6. Average times for visiting were 5.1. 7. Sixty-eight percent of the patients requested home dentist's visitation for dental care service, and 80% of the requested dentists performed such treatment. 8. Seventy-eight percent of the elderly patients were satisfied with the service program. This dental care program for homebound elderly patients seemed to work well. However, to meet needs for the expanding number of aged persons and to make it coincide with the new health and welfare scheme, reform of the program might be necessary.

Progression of ossification of the posterior longitudinal ligament following en bloc cervical laminoplasty

BACKGROUND

Ossification of the posterior longitudinal ligament often causes compressive myelopathy. Ossification is a progressive disease, and it has been reported that the area of ossification increases after decompressive surgery. However, it is uncertain how the progression of ossification affects the long-term outcome after cervical laminoplasty. This study was performed to clarify the relationship between the progression of ossification of the posterior longitudinal ligament and the clinical results following en bloc cervical laminoplasty.

METHODS

Forty-five patients who were followed for more than ten years after laminoplasty participated in this study. Radiographs and tomograms of the cervical spine of each patient were made before and after the operation and at the time of the latest follow-up. The extent of ossification in the longitudinal and sagittal axes was evaluated. Neurological function was graded with use of the Japanese Orthopaedic Association scoring system. The relationship between the progression of ossification and the score-based rate of recovery was analyzed.

RESULTS

Thirty-three (73%) of the patients had progression of ossification of the posterior longitudinal ligament after laminoplasty. Progression was frequent in patients with the mixed type of ossification and in those with the continuous type, whereas it was rare in patients with the segmental type. The patients with progression of the ossification were significantly younger than those without progression (p = 0.018). The Japanese Orthopaedic Association score improved rapidly within one year and continued to improve up to five years after surgery. The score tended to decrease thereafter. For thirteen patients, the score had worsened at the time of the latest follow-up. Three patients had neurological deterioration following an increase in the thickness of the ossification.

CONCLUSIONS

Progression of ossification of the posterior longitudinal ligament was often observed during the long-term follow-up period after laminoplasty. Young patients with mixed and continuous types of ossification had the greatest risk for progression. Preventive measures, such as the use of a wider laminar opening during the laminoplasty, should be considered for patients who are at risk for progression of ossification.

Mechanism of intramedullary high intensity area on T2-weighted magnetic resonance imaging in osteoid osteoma: a possible role of COX-2 expression

To study the mechanism and pathophysiology of the development of intramedullary high intensity areas on T2-weighted magnetic resonance images (MRI) in cases of osteoid osteoma, we examined the expression of cyclooxygenase-2 (COX-2) in the nidus and surrounding bone tissues. In all six cases showing a marked intramedullary high intensity area adjacent to the nidus before surgery, neoplastic osteoblasts inside the nidus showed strong and diffuse COX-2 immunoreactivity. On the other hand, the osteoblasts rimming the surrounding reactive bone were COX-2 negative. In two cases examined by reverse transcription-polymerase chain reaction (RT-PCR), COX-2 mRNA was detected in abundance in the nidus. Histologically, vascular dilatation together with intramedullary edema was observed in all cases, which was probably reflected as a high intensity area on T2-weighted MRI. From our study, a high level of COX-2 expression in neoplastic osteoblasts in the nidus of osteoid osteomas may cause the secondary changes depicted by MRI.

[Dental treatment in the north area of Ishigaki Island in Okinawa]

Dental treatment and oral health care were performed on inhabitants in the north area of Ishigaki Island in Okinawa. There are no dentists in the area at present. One hundred sixty-six patients received treatment taking 528 man-days, during the period from November 9 to December 8, 2000. The area has 2 primary schools and 1 junior high school. The average DMFT of the children in the primary schools was 1.31, and in the junior high school it was 4.98. Compared with Japanese national survey data, the children in the area had a higher DMFT. Among the treatment procedures, the rate of conservative treatment was 62%, most of which was composite resin filling. Preventive measures for dental disease were offered to the inhabitants by means of topical fluoride application or oral health education. The period of this promotion was too short to perform complete dental treatment and to prevent caries and periodontal disease. It seems that primary prevention and higher dental hygiene education are needed for inhabitants in no-dentist areas, because the inhabitants do not have access to dental service easily.

[Perioperative management of a patient with systemic lupus erythematosus, myasthenia gravis, and pemphigus foliaceous]

A 38-year-old female with systemic lupus erythematosus (SLE), myasthenia gravis (MG), and pemphigus foliaceous (PF) was scheduled to undergo total hysterectomy and lymphadenectomy. Preanesthetic examination revealed anemia, a prolonged activated partial thromboplastin time, and a reduced percent vital capacity. Antiphospholipid antibody was not positive. After treating the bullous lesions of PF and the muscle weakness due to MG (noted on admission for surgery) with oral prednisolone, the patient was scheduled for surgery. To avoid the use of a muscle relaxant and the potential complications of the airway manipulation involved in using a laryngeal mask or endotracheal tube, since the patient had MG and PF, a regional anesthetic technique was selected. This involved continuous epidural anesthesia, achieved using 1% or 2% mepivacaine, with sedation by a combination of propofol infusion (3 mg.kg-1.hr-1) and nitrous oxide (60% in oxygen). The patient breathed spontaneously under the mask throughout the 3.5-hr operation. The intraoperative surgical and anesthetic course was uneventful. After a benign postoperative course, the patient was discharged on the 16th postoperative day.

Insulin secretion to glucose as well as nonglucose stimuli is impaired in spontaneously diabetic Nagoya-Shibata-Yasuda mice

To clarify the mechanisms of impaired insulin secretion in Nagoya-Shibata-Yasuda (NSY) mice, an inbred strain of mice with spontaneous development of type 2 (non-insulin-dependent) diabetes mellitus, the insulin response to glucose (5.5 to 27.8 mmol/L) and nonglucose stimuli (glibenclamide, arginine, and BayK8644, a Ca-channel opener) was studied in vitro using isolated islets from male NSY and control C3H/He mice at 36 weeks of age by the batch incubation method. Insulin response to 5.5 mmol/L glucose was not significantly different between NSY and C3H/He mice, but insulin response to a high concentration of glucose (> or = 11.1 mmol/L) was significantly smaller in NSY mice than in control C3H/He mice. The dose-response curve of insulin secretion showed a markedly reduced maximum response, but almost normal glucose sensitivity in NSY islets. Insulin responses to glibenclamide (1 mmol/L), arginine (20 mmol/L), and BayK8644 (0.1 mmol/L) were also significantly smaller in NSY mice than in C3H/He mice. Insulin content of islets, in contrast, was significantly higher in NSY mice than in C3H/He mice. The impaired insulin response to glucose and nonglucose stimuli together with higher insulin content in islets in the NSY mouse suggest that a defect in voltage-dependent Ca(2+)-channel or thereafter in the cascade of insulin secretion may be responsible for impaired insulin secretion in NSY mice. NSY mice, therefore, could be a novel animal model of type 2 diabetes with a defect in insulin secretion at a different site from that in previously known animal models.

Vitamin D receptor gene polymorphism detected by digestion with Apa I influences the parathyroid response to extracellular calcium in Japanese chronic dialysis patients

BACKGROUND

To play its physiological role, 1,25(OH)2D3 must bind to a specific vitamin D receptor (VDR) in the nucleus. We have previously reported that VDR gene polymorphism influences the parathyroid function in patients with end-stage renal disease (ESRD). In the present study, we have investigated the relationship between the parathyroid responsiveness and VDR gene polymorphism, as detected by the Apa I restriction enzyme, by changing the concentration of Ca2+ in the dialysate.

METHODS

58 Japanese ESRD patients undergoing renal replacement therapy in our institution were evaluated. Genomic DNA was extracted from peripheral leukocytes and digested at the intron between exon 8 and exon 9 of the VDR gene using Apa I enzyme. Then alleles were classified into genotype A (undigested allele) and genotype a (digested allele). Extracellular ionized calcium ([Ca2+]e), serum phosphate, and intact parathyroid hormone (PTH) were measured before and after each hemodialysis (HD) session with dialysates having different concentrations of Ca2+ (1.5 or 1.25 mmol/l). The significance of differences in statistical analyses was defined within confidence limits of 5.0%.

RESULTS

The AA, Aa, and aa genotypes were observed in 7/58 patients (12.1%), 23/58 patients (39.6%), and 28/58 patients (48.3%), respectively. The PTH reduction after HD with the 1.5-mmol/l Ca dialysate did not differ significantly between group AA+Aa and group aa. On the other hand, the PTH increase was significantly higher in group aa than in group AA+Aa after HD with the 1.25-mmol/l Ca dialysate (p = 0.0107), despite a similar PTH level before HD. Similarly, the percent increase of PTH after HD with the 1.25-mmol/l Ca dialysate was significantly higher (p = 0.0112) in group aa (50.2 +/- 9.4%) than in group AA+Aa (19.7 +/- 7.2%). There were no significant differences between the two groups in [Ca2+]e nor in serum phosphorus (Pi) before and after HD with either dialysate. Group AA+Aa and group aa did not show statistically significant differences in age, female/male ratio, ratio of diabetic nephropathy, or dialysis period.

CONCLUSIONS

The study results showed that the patients in group aa were more sensitive to changes in [Ca2+]e than those in group AA+Aa. Moreover, they suggested that the VDR gene polymorphism may affect parathyroid responsiveness to changes in [Ca2+]e, which in turn may influence onset and progression of hyperparathyroidism in ESRD patients.

The fate of autogenous free-fat grafts after posterior lumbar surgery: part 2. Magnetic resonance imaging and histologic studies in repeated surgery cases

STUDY DESIGN

Histologic changes of free-grafted fat were investigated from surgical specimens taken at repeated lumbar surgery in 18 patients with degenerative spinal disease who previously had undergone posterior lumbar decompression and free fat graft.

OBJECTIVE

To clarify the clinical usefulness of free-grafted fat by histologic analysis.

SUMMARY OF BACKGROUND DATA

The clinical postoperative serial magnetic resonance imaging studies in Part 1 showed that the size of grafted fat was reduced, and that the shape changed along with the shape of the dura mater. The shape of the grafted fat was remodeled in relation to the postoperative transient shrinkage and reexpansion of the dura mater.

METHODS

From repeated surgery cases, the status of the previously grafted fat tissue in the virgin operation was analyzed. Sections from the specimens resected surgically during repeated surgery were stained with hematoxylin and eosin or osmium. The size and quality of the grafted fat globules were analyzed by computer.

RESULTS

In all cases, grafted fat tissue was identified as a survival. Hematoxylin and eosin staining showed increased collagen fiber and hyperplasia of blood vessels entering the fat tissue that survived. From osmium staining, the size of fat globules was reduced. The shape and quality of the fat globules were analyzed by original staging. They showed various sizes, polymorphism, and vacuolar degeneration.

CONCLUSIONS

Finding showed that the grafted fat used in posterior lumbar surgery reduced the size and quality of the fat globules, as compared with normal fat tissue. However, the grafted fat tissues were confirmed to be alive over the long term. This study clarified the fate of the grafted fat as observed by magnetic resonance imaging and histology from repeated surgery cases.

The fate of autogenous free-fat grafts after posterior lumbar surgery: part 1. A postoperative serial magnetic resonance imaging study

STUDY DESIGN

Time-related changes in free-grafted fat were investigated by postoperative serial magnetic resonance imaging in 22 patients with degenerative spinal disease who underwent posterior lumbar decompressive surgery.

OBJECTIVES

To analyze the size and quality of the grafted fat on magnetic resonance imaging after posterior lumbar surgery.

SUMMARY OF BACKGROUND DATA

Epidural fat grafts have been used to prevent epidural and perineural fibroses. Evaluations of changes in grafted fat have been reported, as observed on computed tomography scans. However, there are no published reports of clinical serial magnetic resonance imaging observations of grafted fat after posterior lumbar surgery.

METHODS

Axial T1- and T2-weighted magnetic resonance imaging was performed at 3, 7, 21, and 42 days as well as 1 year after surgery. The signal intensity of the fat was classified on the T1-weighted image as Grade 1 (almost equal to subcutaneous fat tissue), Grade 2 (low-signal intensity as compared with subcutaneous fat tissue), Grade 3 (speckled intensity), or Grade 4 (signal void, suggesting the change to scar tissue. The time-related, cross-sectional area of the subarachnoidal space was measured from the T2-weighted image.

RESULTS

The size of the grafted fat was reduced to approximately 57% after 42 days, and to about 33% after more than 1 year, as compared with the condition 3 days after surgery. In time, the shape of the grafted fat was changed along the shape of the dura mater. During the early stage (within 6 weeks after surgery), the signal intensity of the grafted fat was lower than that of normal subcutaneous fat tissue (Grades 2-4: 40.9-59.1%). However, the intensity had recovered to normal status (Grade 1) by 1 year after surgery.

CONCLUSIONS

The total amount of grafted fat used in posterior lumbar surgery is reduced. However, as observed on magnetic resonance imaging, it is alive and remodeled along the shape of the dura mater in relation to its shrinkage and reexpansion. This remodeling of the grafted fat is meaningful and effective in protecting the spinal nerve. This report clarifies the fate of the grafted fat from the findings of postoperative serial magnetic resonance imaging after lumbar decompressive surgery.

[Therapeutic effect of multimodal therapy, such as cryosurgery, locoregional immunotherapy and systemic chemotherapy against far advanced breast cancer]

A total of 6 breast cancer patients, 5 with local recurrent tumors on their anterior chest wall and 1 with far advanced primary breast tumor, underwent multimodal therapy in which cryosurgery was performed in combination with local injection of the non-specific immunopotentiator OK-432. This multimodal therapy was repeated as many times as possible. In addition, 3 patients whose general condition was relatively good were treated with mild chemotherapy. In every patient who underwent cryosurgery combined with locoregional immunotherapy, eradication or reduction of tumor was observed for several months. Of 3 patients who underwent cryosurgery, locoregional immunotherapy and systemic chemotherapy, the tumor burden decreased markedly in 2 patients and rapid tumor growth was suppressed in 1 patient, even though the diameter of tumor was over 5 cm in all cases. There were no side effects caused by either cryosurgery or locoregional immunotherapy. Little toxicity was observed throughout the mild chemotherapy. These results indicated that cryosurgery in combination with local injection of OK-432 should be a feasible modality against unresectable breast cancer on the chest wall, and that this therapeutic effect might be augmented by mild chemotherapy.