[Deterrent factors in rehabilitation training following cerebral vascular disease--comparison of elderly and non-elderly patients]

The purpose of the present study was to clarify the deterrent factors for rehabilitation training (rehab) of chronic cerebral vascular disease (CVD) patients, and also to evaluate the influence of age on these factors. Sixty-five CVD impatients with sequelae treated at the Cerebral Vascular Center of Nanasawa Hospital were included in the study. Patients were classified into two groups using the Barthel index score: good effect group (n = 21) or no effect group (n = 22). The following factors were compared between the two groups in order to investigate which factor most affects the results of rehab: age, sex, the site of brain damage, extent of motor paralysis, character (Type A character or not), aphasia, hemispacial neglect, depression, and positive attitude toward training. A possible association between depression, and the site of brain damage and Type A character was investigated. Also, the difference in mood disorders was compared between elderly and non-elderly stroke patients. In the elderly group, hemispacial neglect, a negative attitude toward training, and depression all adversely affected the outcome of the rehab. In the non-elderly group, aging, hemispacial neglect, and a negative attitude toward training influenced the effect of the rehab, but there was no correlation with depression. Depression was seen in 64% of the patients (38/59). Of the 38 patients in a depressed state, 24 (63%) had right hemisphere brain damage, 13 (34%) had left hemisphere brain damage, and 1 (3%) had brain stem damage. Twenty-seven of the 38 depressed patients (71%) were Type A character, significantly more than in the non-depressed group (92/21, 43%). In addition, 14 of the 27 Type A patients were aged over 65 years (52%), which was more than in the non-depression group (11/38, 29%).

[Double autologous peripheral blood stem cell transplantation (double APBSCT) for lymphoblastic lymphoma]

A 24-year-old male was admitted to our hospital, complaining of right back pain, in May 1995. Chest X-ray films showed an abnormal mass in the mediastinum. Computed tomography revealed massive effusion in the pleural and pericardial space. A biopsy specimen of the pleural lesion demonstrated lymphoblastic lymphoma of T cell type. After the completion of intensive chemotherapy by our original protocol, he entered into partial remission. Peripheral blood stem cells (PBSC) were harvested using a high-dose cytarabine (Ara-C) followed by granulocyte-colony stimulating factor (G-CSF) mobilization regimen. The total number of collected PBSC was enough to perform two courses of PBSCT. In January 1996, following the conditioning regimen of nimustine hydrochloride, etoposide (VP-16), Ara-C, thiotepa, he received PBSCT. Complete remission was achieved after the 1st PBSCT. In March 1996, he received the 2nd PBSCT following the conditioning regimen of carboplatin, VP-16, ifosfamide. No regimen-related toxity or delayed engrafment was observed. Subsequently, he received irradiation to his neck and mediastinum, the primary site of the disease. As of February 1997, he has no evidence of the disease.

An immunohistochemical study of thrombomodulin in oral squamous cell carcinoma and its association with invasive and metastatic potential

Thrombomodulin (TM) is a glycoprotein that was originally identified on vascular endothelium and characterized as a natural endothelial anticoagulant. We reported previously that TM was also expressed at cell-cell boundaries of squamous epithelium, except in the basal layer cells and upper granular layer cells. The expression pattern of TM in the squamous cells implies that this molecule might be associated with keratinocyte differentiation, as well as being a potent anticoagulant. In the present study we examined TM expression immunohistochemically in biopsy specimens from 65 patients with primary oral squamous cell carcinoma (OSCC), and compared the results with the biological behavior of the carcinomas. The patients with intense TM expression in the carcinoma showed a significantly lower frequency of lymph node metastasis and significantly more favorable survival than those with negative TM expression. The TM expression was a better marker than the other prognostic factors, such as differentiation degree, tumor size and invasion mode. When TM expression was compared between the primary and metastatic lesions in the 36 patients who had lymph node metastasis, 14 (39%) showed decreased TM expression, 19 (53%) showed no change, and 3 (8%) showed an increase in the metastatic lesions. Wilcoxon's signed-rank test indicated that tumor cells positive for TM expression were significantly rarer in the metastatic lesions than in the primary tumors (P < 0.05). These results indicate that reduced expression of TM is associated with metastasis of carcinoma cells. The reduction of TM expression seems to play an important role in the metastatic process of OSCC, and to be related with a poor outcome for the patients.

Photic and circadian regulations of melatonin rhythms in fishes

Photic and circadian regulations of melatonin rhythms in the pineal organ and the retina of several teleosts were studied to investigate the regulatory mechanisms of melatonin rhythms in fishes. In the eyecup preparations of the goldfish, Carassius auratus, both time of day and lighting conditions affected melatonin production, with high melatonin production observed only in the dark-treated group incubated during the 'subjective' night. Thus, in the goldfish retina, local photoreceptors and an ocular circadian clock seem to regulate melatonin production, as in the zebrafish retina and in the pineal organ of a number of teleosts, including the goldfish. However, this circadian regulation of melatonin rhythms is not universal among fishes. Although the superfused pineal organ of the masu salmon Oncorhynchus masou secreted melatonin in a rhythmic fashion under light-dark (LD) cycles, the rhythm disappeared under constant darkness (DD), as in the rainbow trout, with a large amount of melatonin released both during the subjective day and the subjective night. These results suggest that all salmonids lack circadian regulation of melatonin rhythms. Furthermore, when ocular melatonin rhythms were compared in two cyprinids, the ugui Tribolodon hakonensis and the oikawa Zacco platypus occupying different ecological niches, ocular melatonin contents exhibited daily variations, with higher values during the dark phase of LD cycles in both species. The rhythmic changes persisted in the ugui under DD, with higher levels at subjective midnight than at subjective midday; however, ocular melatonin levels in the oikawa were consistently high under DD. Thus, the circadian regulation of melatonin rhythms in fishes is influenced not only by phylogeny, but also by the ecological niches of the animals. These results suggest that the physiological functions of melatonin in the circadian and photoperiodic systems differ among fishes.

Ischaemic heart disease deaths in a Japanese rural area evaluated by clinical records

A community-based survey to examine the actual number of ischaemic heart disease (IHD) deaths was undertaken in the western area of Toyama, a rural area with a population of 209,000. IHD deaths (International Classification of Diseases [ICD], ninth revision, codes 410-414) and heart failure (HF) deaths (ICD code 428) according to the death certificate aged 15 to 74 in 1987 to 1990 were reevaluated from medical records using the criteria of the multinational monitoring of trends and determinants in cardiovascular disease (MONICA). Of 97 subjects with IHD and of 170 subjects with HF according to the death certificate, 85 cases (87.6%) and 143 cases (84.1%) could be examined, respectively. Using the MONICA criteria, of 85 subjects with IHD, 18 (21.2%) were reevaluated as "definite acute myocardial infarction (AMI)" and 30 (35.3%) as "possible AMI". On the other hand, of 143 subjects with HF, 1 (0.7%) were reevaluated as "definite AMI" and 12 (8.4%) as "possible AMI". From these results, the number of deaths as reevaluated IHD was estimated 104.5 in the study period, and it was 7.7% increase at least compared with the number of deaths judged from the death certificate.

Growth inhibitory effects of antifolates against an adriamycin-resistant human small cell lung cancer cell line

We have established an Adriamycin (ADM)-resistant small cell lung cancer (SCLC) cell line, SBC-3/ADM 100, which shows multifactorial mechanisms of resistance to ADM, such as over-expression of P-glycoprotein, an enhanced detoxifying system and a decrease in topoisomerase II activity. In the present study, we confirmed that SBC-3/ADM 100 showed collateral sensitivity to methotrexate and TNP-351, a new antifolate, though this cell line showed a typical multidrug resistance (MDR) pattern. We also demonstrated a faster uptake and higher accumulation (1.3-fold) of TNP-351 in the SBC-3/ADM 100 cells than those in the parent SBC-3 cells. These results explain one of the mechanisms for collateral sensitivity in the resistant cells. Furthermore, this cell line was found to have no cross-resistance to edatrexate and minimal cross-resistance to trimetrexate, 254-S (cisplatin analog), 5-fluorouacil and 4-hydroperoxyifosfamide. These drugs will have clinical importance in patients with SCLC who were previously treated with an ADM-containing regimen. Thus, antifolates, especially TNP-351 and edatrexate, can be expected to eradicate residual multidrug resistant SCLC cells selected by ADM.

Unusual responses to light and darkness of ocular melatonin in European sea bass

Regulation by light and darkness of melatonin rhythms in the plasma and eye of the European sea bass (Dicentrarchus labrax) was studied. During light-dark cycles, plasma and ocular melatonin exhibited day-night changes with higher levels at mid-dark and at mid-light, respectively. Circulating melatonin levels were low in constant light but high in constant darkness (DD); ocular melatonin levels showed the reverse pattern. Plasma melatonin exhibited circadian rhythm for 1 cycle but the rhythm was no longer apparent on day 2. There was no circadian rhythm in ocular melatonin. Acute light exposure in DD decreased plasma melatonin but increased ocular melatonin. These results suggest that circulating melatonin may be used as a signal for darkness but ocular melatonin is used as a signal for the light phase.

[Small cell lung cancer with acute monocytic leukemia after combined chemotherapy including etoposide]

Small cell lung cancer (stage IIIB) developed in a 61-year-old woman. She was treated with chemotherapy in which the cumulative dose of carboplatin was 662 mg/m2 and that of etoposide was 2,000 mg/ m2, and with concurrent irradiation in which the total dose of X-rays was 44.8 Gy. The response to chemotherapy and irradiation was very good. Radiation pneumonitis developed after discharge, but it resolved after steroid therapy. Nine months after the diagnosis of lung cancer the patient was readmitted because of bleeding and leukocytosis. Acute monocytic leukemia (M5a) was diagnosed after examination of a bone-marrow aspirate. The patient was treated with chemotherapy, but she died of severe bone-marrow suppression and multiple organ failure 3 months after the diagnosis of acute monocytic leukemia. Although chromosome analysis could not be done, we strongly suspect that this leukemia was induced by etoposide, because of the clinical course.

Ocular melatonin rhythms in the goldfish, Carassius auratus

Ocular melatonin rhythms in the goldfish were studied and compared to those in the pineal organ and plasma. Under light:dark (LD) of 12 h light:12 h dark, melatonin contents in the eye as well as the pineal organ and plasma exhibited clear day-night changes with higher levels at mid-dark than at mid-light. However, melatonin contents in the eye at mid-light and mid-dark were approximately 100 and 9 times greater than those in the pineal organ, respectively. Day-night changes of ocular melatonin persisted after pinealectomy, which abolished those in plasma melatonin under LD 12:12. Ocular melatonin contents in the pinealectomized fish at mid-light were significantly higher than those in the sham-operated control. Under constant darkness (DD), circadian melatonin rhythms were observed in the eye but damped on the 3rd day, whereas plasma melatonin rhythms generated by the pineal organ persisted for at least 3 days. Under constant light, ocular melatonin contents exhibited a significant fluctuation with a smaller amplitude than that under DD, whereas plasma melatonin remained at low levels. These results indicate the involvement of LD cycles, a circadian clock, and the pineal organ in the regulation of ocular melatonin rhythms in the goldfish.

Importance of the transitional zone between the cervical stroma and the parametrium in the treatment of cervical carcinoma

OBJECTIVES

Parametrial invasion is an important risk factor in cervical carcinoma. Because the vessels of the parametrium start in the zone between the cervical compact stromal layer and the parametrium, which we have defined as the parametrial initial zone (PIZ) or transitional zone, the invasion of a carcinoma into this part of the cervix is also important. Our objectives in this study were find a characteristic index of the transitional zone and to clarify the relationship between a transitional-zone invasion and the prognosis in a case.

METHODS

Thirty-three cases of carcinoma in situ were available to use for the morphological examination of the cervix. The cervix was divided into 8-12 sections. In each section, the outer diameters of the short axis of the arteries were measured with a light microscope and a micrometer. Using the arterial diameter as the characteristic index of the transitional zone, we performed epidemiological studies on 312 patients with clinical Stage Ib-III squamous-cell carcinoma of uterine cervix.

RESULTS

The arteries with an axis exceeding 300 microns were concentrated in the transitional zone at a rate of 94.6%. Therefore, arteries of this size are used as the characteristic index of the transitional zone. Patients with invasion to transitional zone only had lymph node metastasis at the rate of 28.1%, compared with 0% for patients who had no permeation to the zone (p < 0.001). The 5-year survival rate of patients with invasion to the transitional zone only was 87.3%, which is significantly lower than those without invasion (99.2%) (p < 0.01).

CONCLUSIONS

Measuring the short axis (300 microns < or = ) of the artery is the best method by which to pinpoint the transitional zone. The invasion of a carcinoma into the transitional zone in the cervix should be treated as a parametrial involvement.

Megastigmane glycosides from Salvia nemorosa

From the aerial parts of Salvia nemorosa, three new megastigmane glycosides, salvionosides A-C, were isolated, along with the known compounds, (6S,9R)- and (6S,9R)-roseosides, (6R,9R)- and (6R,9S)-3-oxo-alpha-ionol glucosides and blumeol C glucoside. The structures of the new compounds were elucidated on the basis of spectral and chemical evidence.

Regulation by guanine nucleotides and cations of melatonin binding sites in the goldfish brain

Effects of nucleotides and cations on 2-[125I]iodomelatonin binding sites in the goldfish brain were examined. Nucleotides (10(-6)-10(-3) M) dose-dependently inhibited the specific binding with the following order of potency: guanosine 5'-O-(3-thiotriphosphate) (GTP gamma S) > GTP = GDP > GMP = ATP > cyclic GMP. Cyclic AMP was ineffective. The treatment of membranes with GTP gamma S induced rapid dissociation of 2-[125I]iodomelatonin from membranes when added at the steady state, increased the Kd and decreased the Bmax values as revealed by saturation analysis, and increased the IC50 value of melatonin to inhibit the specific binding. The treatment decreased the specific binding to membrane preparations obtained from six brain regions as well. Inorganic salts (5-200 mM) dose-dependently inhibited the specific binding with the following order of potency: CaCl2 > MgCl2 > LiCl > NaCl > choline chloride > KCl, except for 5 mM MgCl2, which enhanced the specific binding. Saturation experiments demonstrated that 75 mM CaCl2, 100 mM MgCl2 and 200 mM NaCl increased the Kd and decreased the Bmax while 5 mM MgCl2 increased the Bmax value. These results imply that G protein and physiological concentrations of cations are involved in the regulation of melatonin binding sites in the goldfish brain.

Ten-year follow-up study on the relation between the development of non-insulin-dependent diabetes mellitus and occupation

To investigate the relation between occupation and the development of non-insulin-dependent diabetes mellitus (NIDDM), we undertook a 10-year follow-up survey of male employees of a zipper and aluminum sash factory in Japan. Of 1,218 employees we followed 1,087 subjects. We classified the subjects into five occupations: managers, technical workers, clerical workers, workers in transport, and laborers. NIDDM incidence was 3.1% for 10 years. The age-adjusted incidence of the workers in transport was the highest and that in laborers was the lowest. We used a multiple logistic analysis for adjustment with baseline characteristics such as age, BMI, fasting plasma glucose, and family history of diabetes mellitus. Adjusted relative risk of the workers in transport compared with the laborers was significantly high (3.95). Our work suggests that occupation is related to the development of NIDDM.

[Chemotherapy for small-cell lung cancer]

Here we review the current treatments for small-cell lung cancer. Cisplatin and etoposide, combined with concurrent or alternating thoracic irradiation, have been considered to be the standard therapy for patients with limited disease. Dose-intensive weekly chemotherapy and high-dose chemotherapy with autologous stem cell transplantation have failed to increase survival in patients with extensive disease. Promising new drugs such as irinotecan and taxol may improve survival in patients with extensive disease.

Ultrasonographic assessment of intragastric volume in neonates: factors affecting the relationship between intragastric volume and antral cross-sectional area

Measuring antral cross-sectional area by ultrasonography can be an ideal way to evaluate intragastric milk volume in infants. Technical details, however, remain to be established before its clinical application. We investigated the effects of posture and ultrasonographic plane on the correlation between milk volume and antral cross-sectional area. After gastric aspiration through a nasogastric tube, healthy newborns were fed 0, 10, 20, and 40 ml of milk cumulatively, and antral cross-sectional area was measured in either upright, sitting, or right lateral position. To determine the best sonographic plane, subjects were put in the right lateral position and antral cross-sectional area was measured in the plane of the aorta and either the superior mesenteric artery, the superior mesenteric vein, the midline of the abdominal surface, 1 cm right of midline, or 2 cm right of midline. The results showed that antral cross-sectional area reflects intragastric milk volume most accurately, with minimal gas interference when measured in the right lateral position. The area correlates well with milk volume in the plane of the aorta and either the superior mesenteric artery, the superior mesenteric vein, or the midline. Next, we studied the effect of intragastric gas on the antral cross-sectional area in subjects who were given 40 ml of milk followed by an injection of air. More than 20 ml of intragastric gas increases antral cross-sectional area significantly. Ultrasonographic evaluation of intragastric volume requires attention to the above factors.

Circadian rhythms of locomotor activity in the goldfish Carassius auratus

Locomotor activities in the goldfish Carassius auratus were recorded under light-dark (LD) and constant light regimens. Under LD 12:12, all goldfish adjusted to given LD cycles. Activity patterns were classified into three types: L-type activity during the photophase (83%), LD-type activity both during the photophase and the scotophase (10%), and D-type activity during the scotophase (7%). However, these patterns were not fixed, but flexible. Under constant conditions, goldfish exhibited circadian locomotor activities: The proportions of appearance of circadian rhythms and tau values under constant darkness (DD), constant light (LL, 500 lx) and constant dim light (dimLL, 20 lx) were 57% (24.4 +/- 1.6 h, [mean +/- SE], n = 34), 57% (25.2 +/- 2.5 h, n = 35) and 67% (26.0 +/- 3.4 h, n = 10), respectively. These results indicate that the goldfish exhibit flexibility in phasing of locomotor activity rhythms under LD 12:12. In addition, the coupling between circadian clocks and locomotor activities does not seem strong, although the diel locomotor activity in the goldfish is regulated, in part, by a circadian clock. These results are discussed in context with the structure of the teleostean circadian system.

cDNA cloning, characterization, and functional expression of 4S-(-)-limonene synthase from Perilla frutescens

A molecular biological study on limonene synthase that catalyzes the cyclization of geranyldiphosphate to yield the olefin 4(S)-limonene, an intermediate in the biosynthesis of a monoterpenoid, perillaldehyde, in Perilla frutescens Britton has been carried out. We isolated and characterized 10 cDNAs homologous to spearmint limonene synthase cDNA from an expression library constructed from cotyledons of a Perilla strain homozygous for two pairs of dominant genes, G and H, which are responsible for the formation of 4(S)-limonene. Two of these cDNA clones were functionally expressed in Escherichia coli, yielding enzymes which were catalytically active in generating 4(S)-limonene from geranyldiphosphate. The longest open reading frame in the representative cDNA clone PFLC1 consisted of 1812 nucleotides corresponding to 603 amino acids. Its identity to the ORFs of spearmint limonene synthase, tobacco 5-epi-aristolochene synthase, and castor bean casbene synthase were 65, 35, and 30%, respectively. Genomic Southern blot analyses of various genotypes (GGHH, GGhh, ggHH, and gghh) of P. frutescens suggested that more than one copy of the PFLC1 DNA exists in strains having the HH genotype. In contrast, no PFLC1 DNA sequences were found in the genomes of strains with the hh genotype that are incapable of producing cyclohexanoid monoterpenes for lack of limonene synthase activity. Northern blot analysis, using a PFLC1 3'-flanking region as a hybridization probe, showed that PFLC1 mRNA accumulated in all the aerial parts of the GGHH plants, particularly in the leaves. In the ggHH plants, on the other hand, PFLC1 mRNA was detected only in minute amounts in the stem and calyx.

Traditional medicine in Turkey. VI. Folk medicine in west Anatolia: Afyon, Kütahya, Denizli, Muğla, Aydin provinces

Two hundred and one folk remedies of West Anatolia derived from 91 plant species in 40 families and 2 animal species are presented, each with vernacular names, method of preparation of drugs and traditional uses.

Demand feeding and locomotor circadian rhythms in the goldfish, Carassius auratus: dual and independent phasing

In contrast to the common diurnal and nocturnal ways of life, some fish species have been shown to have a dual phasing behaviour. Therefore, the daily pattern of behaviour is not always rigidly confined to the light or dark phase and a diurnal fish may become nocturnal and vice versa. In the present study, the locomotor and feeding activities of single goldfish were simultaneously investigated to examine the existence of such dual behaviour. Nineteen goldfish weighing 97.2 g on average were placed individually in 35-1 glass tanks equipped with an infrared sensor and a newly developed self-feeding device. Fish were exposed to a light:dark (LD) 12:12 h cycle, constant darkness (DD), and 45:45 min LD pulses to study endogenous rhythmicity. Under LD 12:12, the daily pattern of behaviour differed between individual fish; some goldfish were diurnal and others were nocturnal. Furthermore, some of them displayed an extraordinary flexibility in phasing because they were light active but dark feeding, and vice versa. Generally, goldfish tended to be day active, although their feeding habits appeared equally distributed between light and dark phases. Under DD, goldfish showed free-running rhythms that averaged 25.3 +/- 1.8 h and 24.4 +/- 1.7 h for locomotor activity and feeding, respectively, but that were slightly shorter under LD pulses. These results indicate that the type of phasing of locomotor activity did not necessarily decide the feeding phase; much of this is explained by the fact that goldfish were self-fed. Flexibility in phasing and a certain degree of independence between locomotor and feeding activities could be seen as an adaptative response of the highly adaptable circadian system of fish.

Relationship between job stress and plasma fibrinolytic activity in male Japanese workers

Psychosocial job stress has been shown to be associated with the development of cardiovascular disease. However, the pathophysiological mechanisms underlying this relationship remain unclear. The aim of the present study was to elucidate whether marked job stress affects the parameters of blood coagulation and fibrinolysis, such as plasma fibrinogen concentration, tissue plasminogen activator (t-PA), and plasminogen activator inhibitor 1 (PAI-1) activities, in 213 middleaged male workers in a computer-producing factory. Job stress was measured using a Japanese version of the Job Content Questionnaire (JCQ) developed by Karasek. The mean t-PA activity in workers with lower and higher job demands was 0.23 and 0.18 IU/ml respectively, and this difference was significant (P < 0.05). The mean plasma fibrinogen in workers with lower and higher job decision latitude was 224.8 and 236.3 mg/dl respectively, and the mean PAI-1 activity in workers with lower and higher job strain was 14.9 and 17.7 U/ml respectively, though these differences remained at a borderline level of significance (0.05 < P < 0.10). Multiple regression analyses showed that the parameters of blood coagulation and fibrinolysis were closely associated with the cardiovascular risk factors of age, obesity, blood pressure, elevated serum lipids, and smoking, but that high job demands were significantly related to decreases in t-PA activity, independently of the traditional risk factors. These results suggest that psychosocial job stress may be related, at least partly, to the development of cardiovascular disease via changes in plasma fibrinolytic activity.

Blood pressure and urinary C-peptide excretion in subjects with varying degrees of glucose tolerance

To determine whether blood pressure is associated with 24-h urinary C-peptide excretion in subjects with varying degrees of glucose tolerance, we studied 247 Japanese men aged 30-69 who had never been treated with antihypertensive medications or with insulin. Plasma glucose and insulin responses during a 75-g oral glucose tolerance test, blood pressure and body mass index were obtained and urinary C-peptide excretion, in total and per kg body weight, were examined by 24-h urine collection. In monovariate analyses, urinary C-peptide excretion per kg body weight increased significantly as the blood pressure level rose (p < 0.05). After adjustment for age and body mass index by analysis of covariance, this relationship remained significant (p < 0.05), where adjusted mean values (+/- SEM) of urinary C-peptide per kg body weight were 1.56 +/- 0.05 microgram/24h/kg in the normotensive group and 2.04 +/- 0.17 microgram/24h/kg in the hypertensive (stage 2-4) group. When stratified simultaneously by glucose tolerance status and blood pressure level, adjusted mean values of urinary C-peptide per kg body weight were significantly higher in diabetic hypertensives than in diabetic normotensives. These results suggest that increase in 24-h urinary C-peptide excretion, i.e. 24-h insulin secretion, might contribute to an elevation of blood pressure both in normal and diabetic individuals.