Caring for people with dementia from culturally and linguistically diverse backgrounds in nursing homes: A scoping review

BACKGROUND

With continued increase in global migration, older people population in most countries is culturally diverse. Despite lesser preference for nursing home placement, people with dementia from culturally diverse backgrounds with higher needs and acuity do access nursing homes, however, little is known about care provision.

OBJECTIVE

The aims of this review were to map and synthesise available literature on care provision amongst people with dementia from culturally and linguistically diverse backgrounds in nursing homes and identify literature gaps that could inform future research.

DESIGN

A scoping review was conducted guided by the six-step scoping review methodology of Levac and colleagues.

METHODS

A literature search was conducted from August to September 2022 and updated in June 2023 using six databases: Medline, CINAHL, Embase, Cochrane Library, PsycINFO, and Scopus. Screening of articles, data extraction, and quality appraisal was performed independently by two authors. Articles included were primary empirical studies that explored care provision to people with dementia from culturally and linguistically diverse backgrounds living in nursing homes. Critical appraisal was conducted using the Joanna Briggs Institute Critical Appraisal Tool. Data were analysed using thematic analysis. Results were presented in a table and narrative format.

RESULTS

Of the 1149 articles identified, 25 were included. A majority of the articles were qualitative (n = 17) and conducted in Western countries such as those in Europe (n = 11), as well as Australia (n = 5) and the United States (n = 4). Data analysis led to the development of three themes: (1) maintaining a sense of home; (2) fostering communication and interaction; (3) barriers and facilitators to providing care. Most articles did not specify the model underpinning the approaches to care provision.

CONCLUSIONS

Care provision for people with dementia from culturally and linguistically diverse backgrounds living in nursing homes entails an environment which enables them to live up to the standards of what "home" means to them, communicate their needs, and engage in meaningful interactions. Predominant barriers to care provision relate to language and the facility's resources and capacity to deliver culture-specific care. Methodological quality of the studies that explored care provision for people with dementia from culturally and linguistically diverse backgrounds in the nursing home context is mostly limited. To strengthen the evidence base, there is a need for more rigorous research that informs care provision approaches and development of an inclusive model of culturally appropriate care to people with dementia from culturally diverse backgrounds in the nursing home context.

TWEETABLE ABSTRACT

A scoping review synthesised evidence on care provision amongst people with dementia from CALD backgrounds in nursing homes.

Exploration of Mental Health Issues of Students among University Health Science Academics in Japan

Academic educators in universities are well positioned to detect early signs and symptoms of unexplained behaviour change in students that could be the beginning of mental health issues. The purpose of this research was to explore the attitudes, beliefs, knowledge and practices of university academics in Japan towards health science students with psychological/mental health issues. This study used a qualitative descriptive design. Three focus groups using a semi-structured interview guide were conducted with 15 academics teaching health science students. Data were collected between March to October 2019. Themes revealed three areas of interest: 1) Reflection on mental health issues in Japan with sub-themes "family issues"; "society expectations and changes", and "stigma"; 2) Reflection on students' mental health issues with sub-themes "student behaviors", "staff involvement", "barriers encountered"; and, 3) Potential supports with sub-themes "university assistance", "communication and connection", and "interventions and prevention." The findings provide insight and can benefit student populations across diverse cultural university settings. Further research to investigate academic staff support with early recognition of mental ill-health and ability to provide information and advice to students is warranted. Recommendations include mental health education for academics and for students to encourage healthy university campuses and well-being within the community.

Nurses' health beliefs about paper face masks in Japan, Australia and China: a qualitative descriptive study

Aim

To explore the health beliefs of clinical and academic nurses from Japan, Australia and China regarding wearing paper masks to protect themselves and others, and to identify differences in participants' health beliefs regarding masks.

Background

The correct use of face masks and consensus among health professionals across the globe is essential for containing pandemics, and nurses need to act according to policy to protect themselves, educate the public and preserve resources for frontline health workers. Paper masks are worn by health professionals and the general public to avoid the transmission of respiratory infections, such as COVID‐19, but there appear to be differences in health beliefs of nurses within and between countries regarding these.

Methods

This qualitative descriptive study used content analysis with a framework approach.

Findings

There were major differences in nurse participants’ beliefs between and within countries, including how nurses use paper masks and their understanding of their efficacy. In addition, there were cultural differences in the way that nurses use masks in their daily lives and nursing practice contexts.

Conclusion

Nurses from different working environments, countries and areas of practice hold a variety of health beliefs about mask wearing at the personal and professional level.

Implications for nursing policy and health policy

The COVID‐19 pandemic has sparked much discussion about the critical importance of masks for the safety of health professionals, and there has been considerable discussion and disagreement about health policies regarding mask use by the general public. Improper use of masks may have a role in creating mask shortages or transmitting infections. An evidence‐based global policy on mask use for respiratory illnesses for health professionals, including nurses, and the general public needs to be adopted and supported by a wide‐reaching education campaign.

Evaluating the impact of an assertiveness communication training programme for Japanese nursing students: A quasi-experimental study

AIM

To examine the impact of an assertiveness communication training programme on Japanese nursing students' level of assertiveness and intention to speak up when concerned about patient safety.

DESIGN

A quasi-experimental design with two parallel groups was used.

METHODS

Third-year nursing students from two Japanese educational institutions were allocated to an intervention and control group. The intervention group completed the Theory of Planned Behaviour-Assertive Communication Questionnaire and the Japanese version of the Rathus Assertiveness Schedule after attending assertive communication workshops. The second group completed the surveys before attending the workshop and were referred as the control group. Data were collected in December 2017-January 2018.

RESULTS

A total of 123 out of 150 nursing students completed the surveys. Following the assertiveness communication training programme, a higher percentage of students from the intervention group demonstrated the intention to speak up. The intervention group also displayed higher levels of assertiveness, although the results were not statistically significant.

Value and protection of geographical indications by the Japanese Wine Law

Recently, Japanese wine law has changed dramatically. In October 2015, the definition of “Japan wine” and the labelling rules were introduced, and the registration guidelines for the geographical indication (GI) were formulated. Up to now, the Commissioner of the National Tax Agency has designated two wine GIs: “Yamanashi” and “Hokkaido”. However, it is not easy for Japanese consumers to understand the value and the role of GI. The National Tax Agency, prefectures, municipal authorities and winery associations organise from time to time promotional events of GI wines to spread the notion of GI. Even though the majority of “Japan wine”, including GI wine, is consumed in the internal market, it is necessary to protect the Japanese GIs in foreign countries. Due to the EU-Japan EPA that ensures the mutual protection of GIs, it is quite probable that the GI will play an important role in the export of Japanese wine, liquor and agricultural products.

Exploring Japanese nurses' perceptions of the relevance and use of assertive communication in healthcare: A qualitative study informed by the Theory of Planned Behaviour

BACKGROUND

The hierarchical nature of healthcare environments presents a key risk factor for effective interprofessional communication. Power differentials evident in traditional healthcare cultures can make it difficult for healthcare professionals to raise concerns and be assertive when they have concerns about patient safety. This issue is of particular concern in Japan where inherent cultural and social norms discourage assertive communication.

AIM

The aim of this study was to (a) explore nurses' perceptions of the relevance and use of assertive communication in Japanese healthcare environments; and (b) identify the factors that facilitate or impede assertive communication by Japanese nurses.

DESIGN

A belief elicitation qualitative study informed by the Theory of Planned Behaviour was conducted and reported according to the COnsolidated criteria for REporting Qualitative research.

SETTINGS AND PARTICIPANTS

Twenty-three practicing Japanese registered nurses were recruited by snowball sampling from October 2016 to January 2017.

METHODS

Individual face-to-face semi-structured interviews were conducted and transcribed in Japanese and then translated into English. Two researchers independently conducted a directed content analysis informed by the Theory of Planned Behaviour. Participants' responses were labelled in order of frequency for behavioural beliefs about the consequences of assertive communication, sources of social pressure, and factors that facilitate or impede assertive communication in Japanese healthcare environments.

FINDINGS

Although person-centred care and patient advocacy were core values for many of the participants, strict hierarchies, age-based seniority, and concerns about offending a colleague or causing team disharmony impeded their use of assertive communication. Novice nurses were particularly reluctant to speak up because of their perception of having limited knowledge and experience.

CONCLUSION

This study identified Japanese nurses' behavioural, normative, and control beliefs in relation to assertive communication. The findings will be used to inform the development of a culturally appropriate assertiveness communication training program for Japanese nurses and nursing students.

Cultural factors influencing Japanese nurses' assertive communication: Part 2 - hierarchy and power

Hierarchy and power characterize health-care relationships around the world, constituting a barrier to assertive communication and a risk to patient safety. This issue is more problematic and complex in countries such as Japan, where deep-seated cultural values related to hierarchy and power persist. The current paper is the second of two that present the findings from a study exploring Japanese nurses' views and experiences of how cultural values impact assertive communication for health-care professionals. We conducted semistructured interviews with 23 registered nurses, following which data were analyzed using directed content analysis. Two overarching themes emerged from the analysis: hierarchy/power and collectivism. In the present study, we focus on cultural values related to hierarchy and power, including differences in professional status, gender imbalance, seniority/generation gap, bullying, and humility/modesty. The findings from our research provide meaningful insights into how Japanese cultural values influence and constrain nurses' communication and speaking up behaviors, and can be used to inform educational programs designed to teach assertiveness skills.

Cultural factors influencing Japanese nurses' assertive communication. Part 1: Collectivism

Culture influences the way health-care professionals communicate with each other and their ability to relate to colleagues in an assertive manner. Cultural barriers can also make it difficult for nurses to speak up even when they have concerns about patient safety. An understanding of the potential impact of cultural factors is therefore needed when developing assertiveness communication training programs. This paper presents the findings from a study that explored Japanese nurses' perceptions of how culture and values impact assertive communication in health care. Semistructured interviews with 23 registered nurses were undertaken, and data were analyzed using directed content analysis. Two major themes were identified: collectivism and hierarchy/power. In the present study, we discuss the cultural values related to collectivism that included four categories of "wa" (harmony), "uchi to soto" (inside and outside), implicit communication/ambiguity, and "nemawashi" (groundwork). The findings highlight the impact of culture on nurses' assertive communication behaviors and can be used to inform the design of culturally-appropriate assertiveness communication training programs for Japanese nurses working both within their own country or internationally.

Measuring the impact of an interprofessional multimedia learning resource on Japanese nurses and nursing students using the Theory of Planned Behavior Medication Safety Questionnaire

Interprofessional communication and teamwork are essential for medication safety; however, limited educational opportunities for health professionals and students to develop these skills exist in Japan. This study evaluated the impact of an interprofessional multimedia learning resource on registered nurses' and nursing students' intention to practice in a manner promoting medication safety. Using a quasi-experimental design, Japanese registered nurses and nursing students (n = 203) were allocated to an experimental (n = 109) or control group (n = 94). Behavioral intentions of medication safety and the predictor variables of attitudes, perceived behavioral control, and subjective norms were measured using a Japanese version of the Theory of Planned Behavior Medication Safety Questionnaire. Registered nurses in the experimental group demonstrated a greater intention to collaborate and practice in a manner that enhanced medication safety, evidenced by higher scores than the control group on all predictor variables. The results demonstrate the potential for interprofessional multimedia learning resources to positively impact the behaviors of Japanese registered nurses in relation to safe medication practices. Further research in other contexts and with other cohorts is warranted.

Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy for gingival carcinoma

PURPOSE

The aim of this study was to review the efficacy and toxicity of radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy in the treatment of gingival carcinoma.

METHODS AND MATERIALS

In all, 34 patients (21 men and 13 women) with squamous cell carcinoma of the gingiva underwent radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy. Treatment consisted of daily external irradiation and concurrent retrograde superselective intra-arterial infusion with cisplatin and docetaxel. A median total dose of 60 Gy in 30 fractions was delivered to tumors.

RESULTS

Of the 34 patients, 29 (85 %) achieved a complete response (CR) and 5 had residual tumors. Of the 29 patients with a CR, 2 had local recurrences and 1 had distant metastasis 1-15 months after treatment. Twenty-six of the 36 patients had survived at a median follow-up time of 36 months (range 12-79 months); 4 died of cancer and 4 died of non-cancer-related causes. At both 3 and 5 years after treatment, the overall survival rates were 79 % and the cause-specific survival rates were 85 %. Osteoradionecrosis of the mandibular bone only developed in 1 patient after treatment.

CONCLUSION

Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy was effective and safe in the treatment of gingival carcinoma. This treatment may be a promising curative and organ-preserving treatment option for gingival carcinoma.

Histamine H(4) receptor antagonist ameliorates chronic allergic contact dermatitis induced by repeated challenge

BACKGROUND

The present study observed effects of the histamine H(4) receptor on chronic allergic contact dermatitis induced by repeated challenge in mice.

METHODS

Acute contact dermatitis was induced by single epicutaneous challenge of 2,4,6-trinitro-1-chlorobenzene (TNCB) to the ear. Chronic allergic contact dermatitis was developed by repeated epicutaneous challenge using TNCB on the dorsal back skin. H(4) receptor antagonist JNJ7777120 was administered to wild-type mice, while H(4) receptor agonist 4-methylhistamine was administered to histidine decarboxylase (HDC) (-/-) mice that synthesized no histamine.

RESULTS

HDC (-/-) mice did not differ phenotypically from HDC (+/+) mice, and H(4) receptor antagonist/agonist did not have clinical effects in terms of acute contact dermatitis reactions. H(4) receptor antagonist ameliorated skin eczematous lesions induced by repeated TNCB challenge in HDC (+/+) mice. On the contrary, H(4) receptor agonist exacerbated skin lesions exclusively in HDC (-/-) mice. Application of H(4) receptor agonist induced migration of mast cells and eosinophils in skin lesions, and H(4) receptor antagonist suppressed these changes. H(4) receptor was immunohistochemically detected on mast cells in eczematous lesions. Levels of interleukin (IL)-4, -5, and -6 in lesions were decreased, whereas levels of interferon-gamma and IL-12 were increased by H(4) receptor antagonistic activity. Serum Immunoglobulin E levels rapidly increased with repeated challenge, but decreased with H(4) receptor antagonist.

CONCLUSION

Because chronic allergic contact dermatitis is developed by H(4) receptor stimulation, H(4) receptor antagonists might represent new candidate drugs for treating chronic allergic contact dermatitis.

Recognition profiles of microsporidian Encephalitozoon cuniculi polar tube protein 1 with human immunoglobulin M antibodies

Microsporidian Encephalitozoon cuniculi has a unique organelle called a polar tube (PT), the extrusion of which is absolutely required to invade a host cell. We recently detected anti-E. cuniculi PT immunoglobulin (Ig) M antibodies in sera from many healthy individuals. The present one-dimensional (1-D) immunoblot analysis predominantly detected a band at 52 kDa in all of the examined human sera with anti-PT IgM. The use of mouse monoclonal antibody confirmed that the 52-kDa band detected in 1-D immunoblots was an antigen derived from the PT, which represents a glycoprotein nature. In addition, from changes in the immunoreactivity of the 52-kDa band before and after treatment with NaOH, we determined that the 24 human serum samples with anti-PT IgM activities could be roughly grouped into three types: (i) sera containing antibodies against only a saccharic determinant (n=3); (ii) sera containing antibodies against only a proteinic determinant (n=11); and (iii) sera showing dual recognition of saccharic and proteinic determinants (n=10). Further two-dimensional (2-D) immunoblot analysis followed by proteomic analysis confirmed that human sera with anti-PT IgM reacted with E. cuniculi polar tube protein 1 (PTP1). Such circulating IgM antibodies may be important in the first line of defence against E. cuniculi infection.

Networking possibilities for waste recycling in Miyagi prefecture, Japan

Successful case studies for waste recycling in Japan have not been evaluated. The evaluation of economic efficiency and environmental effects were lacking at the time the actual network was established. A waste/resource input/output (I/O) coincidence retrieval system called ZENESYS was developed to examine the usefulness of a waste-exchange network in a nonmanufacturing district. We analyzed data from the Miyagi prefecture, a region without heavy industry. The data were collected from 77 companies using a questionnaire and interviews. A total of 33 possible waste exchange links arose after analysis using ZENESYS. However, these were frail networks that relied heavily on the construction industry. Two waste recycling technologies were selected from the ZENESYS database: reclaiming fuel from waste plastic and making construction materials from bottom ash. Evaluation of the environmental effects and economics of these two technologies showed they were both suitable for the environment, but no profit was made from reclaiming fuel from waste plastics. We concluded that in an area with no heavy industry, it may be difficult to adopt recycling technologies that have high environmental and economic performance. Materials are difficult to circulate among manufacturing industries even if a waste-exchange network exists, and resources are consumed during transportation and recycling.

Performance of the improved version of monte Carlo code A3MCNP for large-scale shielding problems

A3MCNP (Automatic Adjoint Accelerated MCNP) is a revised version of the MCNP Monte Carlo code, which automatically prepares variance reduction parameters for the CADIS (Consistent Adjoint Driven Importance Sampling) methodology. Using a deterministic 'importance' (or adjoint) function, CADIS performs source and transport biasing within the weight-window technique. The current version of A3MCNP uses the three-dimensional (3-D) Sn transport TORT code to determine a 3-D importance function distribution. Based on simulation of several real-life problems, it is demonstrated that A3MCNP provides precise calculation results with a remarkably short computation time by using the proper and objective variance reduction parameters. However, since the first version of A3MCNP provided only a point source configuration option for large-scale shielding problems, such as spent-fuel transport casks, a large amount of memory may be necessary to store enough points to properly represent the source. Hence, we have developed an improved version of A3MCNP (referred to as A3MCNPV) which has a volumetric source configuration option. This paper describes the successful use of A3MCNPV for a concrete cask neutron and gamma-ray shielding problem, and a PWR dosimetry problem.

Laparoscopic adrenalectomy: comparison of transperitoneal and retroperitoneal approaches

OBJECTIVE

To compare the effectiveness and efficiency of transperitoneal anterior laparoscopic adrenalectomy with that of retroperitoneal posterior laparoscopic adrenalectomy.

PATIENTS AND METHODS

A retrospective comparison was undertaken of 28 patients who underwent transperitoneal anterior laparoscopy with 22 patients who underwent retroperitoneal posterior laparoscopy between April 1994 and November 2000. There were 18 men and 32 women (mean age 51.0 years, range 23-68) with varying diagnoses. Of the 50 patients, 31 had primary aldosteronism, eight had Cushing's syndrome, three had phaeochromocytoma, one had an 18-hydroxydeoxycorticosterone-induced adenoma and seven had non-functioning adrenal adenoma. Adrenal tumours were confirmed by hormonal assays, biochemical tests and computed tomography. To determine the site of the functioning adenoma, hormones were assayed from adrenal vein sampling. Thirty adrenal tumours were located on the right and 20 on the left.

RESULTS

There were no significant differences in general demographic variables between the transperitoneal and retroperitoneal groups. The mean duration of surgery for transperitoneal and retroperitoneal laparoscopy was 202 and 221 min, respectively, and the mean blood loss 113 and 192 mL, respectively. The time to first oral intake, days to full diet, time until ambulatory and duration of hospitalization did not differ significantly between the two approaches. As the body mass index increased, the duration of surgery increased for both approaches. As more procedures were performed the duration of surgery decreased for both approaches.

CONCLUSIONS

There were no significant differences between the transperitoneal and retroperitoneal approaches for laparoscopic adrenalectomy.

Effects of the D(3) dopamine receptor antagonist, U99194A, on brain stimulation and d-amphetamine reward, motor activity, and c-fos expression in ad libitum fed and food-restricted rats

RATIONALE

Previous studies indicate that the D(3) dopamine (DA) receptor is preferentially expressed in limbic forebrain DA terminal areas and may mediate functional effects opposite those of the D(1) and D(2) receptor types. However, the locations of the D(3) receptors that regulate behavior, and the range of behavioral functions regulated, are not clear.

OBJECTIVE

The objective of this study was to evaluate behavioral and cellular effects of the preferential D(3) dopamine receptor antagonist, U99194A.

METHODS

In experiment 1, the rewarding effect of U99194A (5.0, 10.0 and 20.0 mg/kg, SC) was measured in terms of its ability to lower the threshold for lateral hypothalamic self-stimulation (LHSS) in ad libitum fed rats. To amplify a possibly weak reward signal, testing was also conducted in food-restricted rats. The ability of U99194A to alter the threshold-lowering effect of d-amphetamine was also assessed. In experiment 2, effects of U99194A on horizontal and vertical motor activity were compared in ad libitum fed and food-restricted rats. In experiment 3, effects of a behaviorally active dose of U99194A (5.0 mg/kg) on brain c-fos expression were measured and compared to those produced by d-amphetamine (0.5 mg/kg, IP). In experiment 4, the motor and cellular activating effects of U99194A were challenged with the D(1) dopamine receptor antagonist, SCH-23390 (0.1 mg/kg).

RESULTS

U99194A displayed no rewarding efficacy in the LHSS paradigm. U99194A did, however, augment the rewarding effect of d-amphetamine. U99194A also produced a motor activating effect, reversible by SCH-23390, which was greater in food-restricted than ad libitum fed rats. The pattern and intensity of fos-like immunoreactivity (FLI) induced by U99194A was similar to that produced by d-amphetamine and was blocked, in caudate-putamen and nucleus accumbens, by SCH-23390.

CONCLUSIONS

These results indicate that U99194A has psychostimulant-like effects on motor activity and striatal c-fos expression that are dependent upon the D(1) DA receptor. However, doses of U99194A that are adequate to stimulate motor activity and c-fos expression in striatal and limbic structures do not possess direct rewarding effects in the LHSS paradigm. Overall, these results seem consistent with the hypothesis that D(3) antagonism enhances D(1)/D(2) mediated signaling with behavioral effects dependent on both the density of D(3) receptors and the prevailing level of DA transmission in particular brain regions.

Prophylactic cranial irradiation of acute lymphoblastic leukemia in childhood: outcomes of late effects on pituitary function and growth in long-term survivors

It is well known that prophylactic cranial irradiation is highly effective in preventing central nervous system (CNS) relapse of acute lymphoblastic leukemia (ALL). Nevertheless, there have been very few reports on the late effects, especially pituitary function and growth, in long-term survivors who were treated with 18 Gy cranial irradiation in childhood. The subjects consisted of 35 children with ALL who were treated with prophylactic 18 Gy cranial irradiation at Kanagawa Children's Medical Center between October 1981 and February 1995. All patients received cranial irradiation after first attaining complete remission with induction chemotherapy, according to the treatment protocols prescribed by the Tokyo Children's Leukemia Study Group (TCLSG) and Tokyo Children's Cancer Study Group (TCCSG). Their ages at the time of cranial irradiation ranged from 2.2-15.0 years (mean 6.8). We evaluated their pituitary functions by measuring their pituitary hormone values 0.7-11.3 years (mean 6.0) after cranial irradiation and their growth by analyzing their height standard deviation score (SDS) at diagnosis of ALL and their final height SDS at the mean follow-up period of 8.2 years after cranial irradiation. Height SDS is defined as the difference between the patient's height and the mean height of their age and sex, divided by the standard deviation of their age and sex. Eight of 35 patients had ALL relapse, involving the bone marrow in seven patients and the CNS in only one. Six of the eight patients with relapse died 1.5-6.6 years after cranial irradiation and the other two patients were salvaged by further intensive therapies. The remaining 27 relapse-free patients have survived for 1.4-15.8 years (mean 10.1) after cranial irradiation. Twenty-six of the 29 survivors are long-term survivors of more than 5 years. Although there was one patient with an abnormal result in each value of growth hormone (GH), adrenocorticotropic hormone (ACTH), and prolactin (PRL), and two patients with abnormal results in thyroid-stimulating hormone (TSH) values, none of the patients had clinical symptoms of pituitary hormone abnormality and none required hormone supplements. The final height SDS decreased significantly compared with the height SDS at diagnosis of ALL in the long-term survivors (P = 0.001) and the height SDS of the patients who had received cranial irradiation at a young age tended to decrease gradually (P = 0.019). However, no patient showed severe growth failure. It is considered that prophylactic 18 Gy cranial irradiation plus chemotherapy for ALL in childhood can effectively prevent CNS relapse and is unlikely to produce clinically significant late effects, although it may cause slight pituitary hormone abnormality.

Elevated serum levels of interleukin-10 in children with acute rubella infection

Interleukin-10 (IL-10) is known to be an anti-inflammatory cytokine which inhibits cell growth and cytokine production of both Th1 and Th2 cells. Using a human IL-10 ELISA kit we investigated whether serum IL-10 levels increased during the acute and convalescent stages in 45 children with rubella infections. Serum levels of IL-10 were markedly elevated in rubella patients during the acute stage, compared with those at the convalescent stage and those in healthy age-matched children (mean +/- SEM): 18.5 +/- 3.4 vs. 6.0 +/- 0.6 vs. 7.9 +/- 1.3 pg/ml. IL-10 levels determined 5 d after the onset of the disease had returned to the normal range. In patients with rubella, there were significant negative correlations between serum IL-10 levels and both rubella virus-specific IgM and IgG antibodies. These findings suggest that IL-10 may play a role in the pathogenesis of acute rubella infections.

[Determination of 2,4,6-tri-tert-butylphenol and related compounds in foods]

An analytical method has been developed for the determination of 2,4,6-tri-tert-butylphenol (TTBP) in foods. TTBP was determined by GC/MS (SIM) after extraction from food samples using a steam distillation technique. The developed method was able to determine simultaneously 2,4-di-tert-butylphenol (2,4-DTBP), 2,6-di-tert-butylphenol (2,6-DTBP), 3,5-di-tert-butylphenol (3,5-DTBP) and 2,4-di-tert-pentylphenol (2,4-DTPP). The method was applied to analyze the residues of the 5 phenolic compounds in 101 food samples purchased from markets. TTBP was found in some samples of meat, liver and fish (muscle) at the levels of trace (tr)-0.50 ng/g, tr and tr-1.83 ng/g, respectively. 2,4-DTBP was found in some samples of vegetables, meat, liver, fish (muscle) and fish (viscera) at the levels of 1.4-10.6 ng/g, 2.7-26.4 ng/g, tr-34.2 ng/g, tr-21.6 ng/g and tr, respectively. 2,6-DTBP was found in some samples of fish (muscle) and fish (viscera) at the levels of tr-3.9 ng/g and tr, respectively. 3,5-DTBP and 2,4-DTPP were not found in any of the analyzed samples.

Two-generation reproductive toxicity study of tributyltin chloride in male rats

A 2-generation reproductive toxicity study of tributyltin chloride (TBTCl) was conducted in male rats using dietary concentrations of 5, 25, and 125 ppm TBTCl to evaluate its effect on sexual development and the reproductive system. F1 males were killed on postnatal day 119 and F2 males were killed on postnatal day 91. TBTCl affected the male reproductive system of rats. The weights of the testis and epididymis were decreased and homogenization-resistant spermatid and sperm count were reduced mainly in the 125 ppm TBTCl group. Histopathologic changes were also observed in the testis of this group and included vacuolization of the seminiferous epithelium, spermatid retention, and delayed spermiation. However, the changes were minimal in nature. The weight of the ventral prostate was decreased to 84% of the control value in the 125 ppm group in the F1 generation and decreased to 84 and 69% of the control value in the 25 ppm and 125 ppm TBTCl groups, respectively, in the F2 generation. The serum 17beta-estradiol concentration was also decreased to 55% of the control value in the 125 ppm group in the F1 generation and decreased to 78 and 57% of the control value in the 25 ppm and 125 ppm TBTCl groups, respectively, in the F2 generation. However, the serum concentrations of luteinizing hormone (LH) and testosterone were not decreased in these groups. These changes corresponded with those caused by aromatase inhibition and therefore TBTCl might be a weak aromatase inhibitor in male rats.

3',5'-Di-C-beta-glucopyranosylphloretin, a flavonoid characteristic of the genus Fortunella

Dihydrochalcone derivative, 3',5'-di-C-beta-glucopyranosylphloretin (1), is present in the genus Fortunella, (F. crassifolia, F. japonica, F. margarita, F. polyandra and F. hindsii). These species accumulate a large quantity of 1 in their fruits (peel, 6.5-15.2 mg/g in dry wt; juice sac, 1.5-10.5 mg/g) and in their leaves (21.3-60.2 mg/g). Twenty-seven Tanaka's Citrus species examined lack 1, but C. madurensis and C. halimii contain 1 in large quantities in their peels (25.1 and 33.6 mg/g) and juice sacs (4.1 and 4.2 mg/g). Poncirus species do not contain 1. Fortunella-citrus hybrids, the Orangequat [C. unshiuxF. crassifolia], the Thomasville citrangequat [Fortunella sp.x(C. sinensisxPoncirus trifoliata)], and seven hybrid progenies [F. margaritaxC. junos], contain large amounts of 1 in their peels (17.0-7.9 mg/g) and juice sacs (2.0-9.9 mg/g). These facts suggest that accumulation of 1 is a generic trait of the genus Fortunella and that the inheritance of the trait among the intergeneric hybrids is controlled by a dominant allele. Thus C. madurensis and C. halimii are thought to originate from natural hybrids between the genera Citrus and Fortunella. Phloridzin, which has the same aglycon as 1, was not detected in the citrus plants examined.

Horizontal transmission of Toxoplasma gondii in squirrel monkeys (Saimiri sciureus)

The possibility of horizontal transmission of T. gondii was examined in squirrel monkeys. After three monkeys were inoculated perorally with 1.1-2.1 x 10(3) cysts of the T. gondii ME49, the animals were divided into two cages and maintained with one normal monkey for each cage as a cagemate. Two out of the three T. gondii-inoculated monkeys died, and the remaining one monkey was sacrificed in a moribund state one week after infection because of acute toxoplasmosis. Many T. gondii tachyzoites were recovered from broncho-alveolar lavages and were also found histopathologically in the lung, liver, spleen, kidney and lymph nodes and impression smears of tissues from the three T. gondii-inoculated monkeys by Giemsa staining. Anti-T. gondii antibody was examined by immunoblot assay in these animals, and the antibody to T. gondii major surface membrane protein (p30) could be detected after the start of experiment. Furthermore, a specific band of T. gondii NTPase gene was observed by PCR in the liver and lung of infected and cagemate monkeys, and the sequence of the second PCR products obtained from the cagemates, which were clinically normal but gave a positive result in immunoblotting assay, was exactly the same as the sequence of the NTPase gene of T. gondii ME49. These findings suggested that transmission of T. gondii from the infected monkeys to cagemates occurred easily, and since many T. gondii tachyzoites were recovered from the bronchoalveolar lavages of the three T. gondii-inoculated monkeys, we suggest that aerosol infection plays an important role for the enzootic toxoplasmosis in colonies of squirrel monkeys.

Cloning and expression of CitPDS1, a gene encoding phytoene desaturase in citrus

A cDNA clone encoding phytoene desaturase (PDS) was isolated from citrus (Citrus unshiu Marc.). The transcript of the isolated PDS (CitPDS1) was not detected by conventional RNA gel-blot analysis; instead, it was detected by a sensitive reverse transcription-PCR (RT-PCR). The CitPDS1 transcript in the juice sacs/segment epidermis (edible part) was at a low level in the young fruit, and it increased toward maturation like citrus phytoene synthase (CitPSY1). In the peel, in contrast to CitPSY1, the transcript of which was induced toward maturation, the level of the CitPDS1 transcript remained constant after an increase in July, indicating non-coordinate regulation of CitPDS1 and CitPSY1 in the peel.

Two-generation reproductive toxicity study of tributyltin chloride in female rats

A two-generation reproductive toxicity study of the effects of tributyltin chloride (TBTCl) was conducted in female rats using dietary concentrations of 5, 25, and 125 ppm TBTCl. Reproductive outcomes of dams (number and body weight of pups and the percentage of live pups) and the growth of female pups (the day of eye opening and body weight gain) were significantly decreased in the 125 ppm TBTCl group. A delay in vaginal opening and impaired estrous cyclicity were also observed in the 125 ppm TBTCl group. However, an increase in anogenital distance was found in all TBTCl groups on postnatal d 1. A dose-effect relationship was observed in TBTCl-induced changes in anogenital distance. These results indicate that the whole-life exposure to TBTCl affects the sexual development and reproductive function of female rats. In addition, the TBTCl-induced increase in anogenital distance seems to suggest it may exert a masculinizing effect on female neonates. However, the concentrations of TBTCl used in this study are not environmentally relevant.

Exposure to bisphenol A during the fetal and suckling periods disrupts sexual differentiation of the locus coeruleus and of behavior in the rat

This study tested the effect of exposure to bisphenol A (BPA) early in life on the sexual differentiation in the brain and behavior in Wistar rats. We administered BPA only to mother rats during pregnancy and lactation at a dosage of approximately 1.5 mg/kg per day far less than the no-observed-adverse-effect level (NOAEL; 50 mg/kg per day). Control female offspring showed a higher activity, a lower avoidance memory, and larger locus coeruleus than the male controls, while the BPA-exposed group did not show any sexual dimorphism. BPA did not affect the reproductive organs or sex hormones. Our results suggest that the current methods to determine the NOAEL of artificial industrial chemicals may not be sufficient to detect a disruption of the sexual differentiation in the brain.

Eicosapentaenoic acid (EPA) induces Ca(2+)-independent activation and translocation of endothelial nitric oxide synthase and endothelium-dependent vasorelaxation

Eicosapentaenoic acid (EPA), but not its metabolites (docosapentaenoic acid and docosahexaenoic acid), stimulated nitric oxide (NO) production in endothelial cells in situ and induced endothelium-dependent relaxation of bovine coronary arteries precontracted with U46619. EPA induced a greater production of NO, but a much smaller and more transient elevation of intracellular Ca(2+) concentration ([Ca(2+)]i), than did a Ca(2+) ionophore (ionomycin). EPA stimulated NO production even in endothelial cells in situ loaded with a cytosolic Ca(2+) chelator 1,2-bis-o-aminophenoxythamine-N',N',N'-tetraacetic acid, which abolished the [Ca(2+)]i elevations induced by ATP and EPA. The EPA-induced vasorelaxation was inhibited by N(omega)-nitro-L-arginine methyl ester. Immunostaining analysis of endothelial NO synthase (eNOS) and caveolin-1 in cultured endothelial cells revealed eNOS to be colocalized with caveolin in the cell membrane at a resting state, while EPA stimulated the translocation of eNOS to the cytosol and its dissociation from caveolin, to an extent comparable to that of the eNOS translocation induced by a [Ca(2+)]i-elevating agonist (10 microM bradykinin). Thus, EPA induces Ca(2+)-independent activation and translocation of eNOS and endothelium-dependent vasorelaxation.

Neutrophilia associated with anaplastic carcinoma of the thyroid: production of macrophage colony-stimulating factor (M-CSF) and interleukin-6

Cancers associated with marked neutrophilia are relatively rare. We report here two cases of anaplastic thyroid carcinoma associated with neutrophilia. We measured the concentrations of granulocyte colony-stimulating factor (G-CSF), macrophage CSF (M-CSF), granulocyte-macrophage CSF (GM-CSF), interleukin-1alpha (IL-1alpha), IL-1beta, IL-6, and tumor necrosis factor-alpha (TNF-alpha) in sera, pleural effusion, cyst fluid of the thyroid carcinoma region, or culture supernatants of carcinoma cells. Maximum levels of elevated white blood cell counts reached 106.1 x 10(9)/L (neutrophils 103.0 x 10(9)/L) in case 1 and 62.3 x 10(9)/L (neutrophils 57.9 x 10(9)/L) in case 2. Acute-phase reactants were elevated to various degrees, and hypercalcemia was found in both cases. IL-6, G-CSF, and M-CSF seemed to play the principal roles in neutrophilia in case 1, and the elevated levels of IL-6 and M-CSF seemed to mainly contribute to neutrophilia in case 2. Immunohistochemical staining revealed that carcinoma cells themselves produce IL-6 regardless of the types of carcinoma cells. To our knowledge, this is the first report describing the contribution of M-CSF to neutrophilia in patients with thyroid carcinoma.

Seasonal changes in the hypothalamo-pituitary-testes axis of the Japanese wood mouse (Apodemus speciosus)

Seasonal changes in the hypothalamo-pituitary-testes axis of the Japanese wood mice (Apodemus speciosus) were studied. The testes, epididymis, pituitary and hypothalamus were compared between mice in the breeding season (July) and non-breeding season (October) using morphological techniques, and the plasma testosterone level was evaluated by enzyme immunoassay. Significant differences in these tissues were observed between the breeding season and the non-breeding season. Specifically, differences in the non-breeding season included 1) a decline in testicular and epididymal weights, arrest of spermatogenesis and decrease of serum testosterone concentration; 2) a decrease in the number of luteinizing hormone (LH)-, follicle stimulating hormone (FSH)-, prolactin (PRL)-, and growth hormone (GH)-immunoreactive cells, and decrease in the size of FSH, PRL, and GH-immunoreactive cells; and 3) an increase in the size of gonadotropin-releasing hormone (GnRH)-immunoreactive neurons. Our findings indicate that the male adult Japanese wood mouse exhibits unique seasonal changes in the hypothalamo-pituitary-testes axis which are not found in laboratory mice.

Chemical constituents of Clausena excavata: isolation and structure elucidation of novel furanone-coumarins with inhibitory effects for tumor-promotion

A study of the chemical constituents of the leaves of Clausena excavata cultivated in a greenhouse led to the isolation and identification of 10 new furanone-coumarins named clauslactones A (1), B (2), C (3), D (4), E (5), F (6), G (7), H (8), I (9), and J (10), together with a known carbazole, clauszoline M, and a coumarin, umbelliferone. The new coumarins contain a C(10) terpenoid side chain with a furanone (gamma-lactone) moiety. Further, in clauslactones A-D (1-4), the terpenoid side chain was shown to be linked to the 7,8-dioxygenated coumarin skeleton through a 1, 4-dioxane ring system. This is the first example of coumarins with these structural characteristics in nature. These furanone-coumarins were found to exhibit inhibitory activity against 12-O-tetradecanoylphorbol-13-acetate-induced Epstein-Barr virus early antigen activation in Raji cells.

Magnetic resonance imaging of a non-pigmented adenoma of the ciliary epithelium

PURPOSE

A non-pigmented adenoma of the ciliary epithelium is rare. No good documentation has been reported in which magnetic resonance imaging (MRI), histological examination, and immunohistological evaluation have all been conducted. We showed how this tumor differed from ciliary body melanoma.

METHODS

We evaluated the ciliary body tumor by MRI, histological examination, and immunohistochemical examination. The data was compared with previously reported cases.

RESULT

The tumor was classified as an adenoma of the non-pigmented ciliary epithelium with extracellular pools of hyaluronidase-sensitive mucopolysaccharide. The MRI appearance of the vitreous in our patient showed hyperintensity on T1, isointensity on T2 and marked enhancement with gadolinium. None of 3 other reported patients exhibited the same signals.

CONCLUSION

MRI appearance is most variable in adenomas and no microscopical diagnosis can be based on that. Our patient showed isointensity on T2 with marked enhancement by gadolinium when compared to malignant melanoma.

Onset of spermatogenesis is accelerated by gestational administration of 1,2,3,4,6,7-hexachlorinated naphthalene in male rat offspring

We treated pregnant rats with 1 microg/kg body weight/day 1,2,3,4,6,7-hexachlorinated naphthalene (1,2,3,4,6,7-HxCN) on days 14-16 of gestation and examined the effects on the reproductive systems of their male offspring at various phases of sexual maturation. Sperm count in the cauda epididymidis did not change in 1,2,3,4,6, 7-HxCN-treated rats on postnatal day 89, the age of sexual maturity, but the sperm count in the cauda epididymidis did increase to approximately 180% of the control value on postnatal day 62. In addition, homogenization-resistant testicular spermatids increased to approximately 160% of the control value on postnatal day 48, and the percent of postmeiotic tubules increased to approximately 190% of the control value on postnatal day 31 in this group. These results indicate that the onset of spermatogenesis was accelerated in the 1,2,3,4,6,7-HxCN rats. Serum concentrations of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) had already reached the maximum level on postnatal day 31 in the 1,2,3,4,6, 7-HxCN group, suggesting that the onset of LH and FSH secretions from the pituitary gland was also accelerated and that this endocrine disruption was the cause of early onset of spermatogenesis in this group. In the fat of 1,2,3,4,6,7-HxCN-treated dams, 5.75+/-2.81 ppb 1,2,3,4,6,7-HxCN was detected when offspring were weaned. This concentration was 5-10 times higher than that found in human adipose tissue.

Clinical characteristics of primary aldosteronism: its prevalence and comparative studies on various causes of primary aldosteronism in Yokohama Rosai Hospital

We studied 1,020 patients with hypertension visiting our outpatient clinic during a five-year period, from 1995 until 1999. Those subjects were screened by determining plasma renin activity (PRA) and plasma aldosterone concentration (PAC) after testing routine laboratory examinations in order to differentiate secondary hypertension from essential hypertension. All patients with low-reninemic hypertension were examined by furosemide plus the upright test. This led to an increase in diagnoses of primary aldosteronism (PA) (confirmed by captopril-loading test). Our studies demonstrated that the incidence of PA is 5.4%, and also that the plasma potassium level is not always beneficial for suspecting the presence of PA, because 28% of the patients with PA show only hypokalemia. We would like to emphasize that adrenal venous sampling plays a critical role in establishing the optimal management for patients with PA, because CT imaging is limited to detection of adrenal masses.