Bullous Pemphigoid Triggered by Thermal Burn Under Medication With a Dipeptidyl Peptidase-IV Inhibitor: A Case Report and Review of the Literature

Bullous pemphigoid (BP) is a common autoimmune blistering disease in which autoantibodies mainly target the hemidesmosomal component BP180 (also known as type XVII collagen) in basal keratinocytes. Various triggering factors are known to induce BP onset, including radiotherapy, burns, ultraviolet exposure, surgery, and the use of dipeptidyl peptidase-IV inhibitors (DPP4i), which are widely used antihyperglycemic drugs. Here, we present a case of BP triggered by a thermal burn under medication with DPP4i. A 60-year-old man with type II diabetes had been treated with the DPP4i linagliptin for 1 year. After the right forearm experienced a thermal burn, blisters developed around the burned area and gradually spread over the whole body with the production of autoantibodies targeting the non-NC16A domain of BP180. The diagnosis of BP was confirmed by immunohistopathological examination. Upon withdrawal of linagliptin and treatment with topical steroid and minocycline, complete remission was achieved after 4 months. Previously, 13 cases of BP that developed after thermal burns have been reported, and our case shared some of the clinical features of these thermal burn-induced BP cases. Interestingly, the present case also showed the typical clinical, histopathological, and immunological features of the non-inflammatory type of DPP4i-associated BP (DPP4i-BP). Although the pathogenesis of BP remains uncertain, the present case suggests that DPP4i may trigger the onset of BP similarly to a thermal burn. In addition, the clinical and histopathological features of DPP4i-BP may be distinct from other types of BP.

Emergency obstetric care in Pakistan: Potential for reduced maternal mortality through improved basic EmOC facilities, services, and access

OBJECTIVE

To ascertain and compare compliance with UN emergency obstetric care (EmOC) recommendations by public health care centers in Pakistan's Punjab and Northwest Frontier Province (NWFP) provinces.

METHOD

Cross-sectional data were collected from July through September 2003 using UN process indicators. From each province, 30% of districts (n=19); were randomly selected; all public health facilities providing EmOC services (n=170) were included.

RESULTS

The study found that out of 170 facilities only 22 were providing basic and 37 comprehensive EmOC services in the areas studied. Only 5.7% of births occurred in EmOC health facilities. Met need was 9% and 0.5% of women gave birth by cesarean section. The case fatality rate was a low 0.7%, probably due to poor record keeping. Access and several indicators were better in NWFP than in Punjab.

CONCLUSION

Almost all indicators were below UN recommendations. Health policy makers and planners must take immediate, appropriate measures at district and hospital levels to reduce maternal mortality.

Periodic structures and diurnal variation in blood pressure and heart rate in relation to microgravity on space station MIR

Four Russian crew members were studied on space station MIR, and blood pressure (BP) and heart rate (HR) data were continuously collected. BP and HR data were collected on earth 1 day before orbital flight to the space station, then at weeks 8, 16 and 24 during space flight, and again 1 or 2 days after returning to earth. Time serial data for BP and HR were analyzed by spectral analysis with the MemCalc system (Suwa Trust, Sapporo, Japan). Periodic structures of diurnal variation in systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR were compared at 24-hour, 12-hour and 8-hour intervals, these being determined as the main periodic components for the assessment of BP and HR variability. The 24-h mean levels of SBP and HR during space flight were unchanged. Waking SBP was not different from pre-flight values. During sleep, in-flight changes in HR did not differ from pre-flight values. SBP during sleep in orbit increased to over pre-flight values. Waking DBP was reduced during flight. The SBP and HR phases over a 24-hour cycle were shortened with a more pronounced shortening in weeks 8 and 16 compared with pre-flight values, and at week 24 recovered to preflight values. The 12, 8-hour-cycle remained unchanged, and were similar to pre-flight values. At the space station, the astronauts' mission was carried out under strict control of sleeping and waking hours; therefore, their 24-hour schedule is an artificially constructed situation. Main periodicity structures were maintained by strict control of lifestyle during long-term space flight. The conclusions reached were as follows: 1) SBP levels during sleep in a space environment increased compared with those on earth; 2) the periodicity phase of BP and HR shifted toward to 24-hour cycle as a result of long-term space flight, even though these periods shortened after a few months compared with pre-space flight values.

Usefulness of switching to cabergoline from other dopamine agonists in patients with advanced Parkinson?s disease

Problems associated with long-term treatment of advanced Parkinson's disease (PD) include motor complications and psychotic and autonomic symptoms. We switched patients from bromocriptine (BR) or pergolide (PER) to cabergoline (CB) therapy and investigated CB's usefulness in alleviating such problems. Subjects were 30 patients (mean age 68.2 years; 13 receiving BR, 17 PER) with PD complicated by effects of long-term treatment but in whom their dose of dopamine (DA) agonist was contraindicated due to adverse reactions. Patients were switched to CB over a 2-4-week period. Hoehn-Yahr and Unified Parkinson Disease Rating Scale (UPDRS) I-IV "on" and "off" scores improved in both the BR and PER groups. CB was not discontinued due to adverse reactions in any patient. In conclusion, switching to CB is useful in patients in whom it is problematic to increase their dose of DA agonist due to motor complications or psychotic symptoms of advanced PD.

Child behavior problems: prevalence and correlates in rural minority areas of China

BACKGROUND

Ethnicity may possibly associate with different maternal child-rearing practices and child developmental problems. The aim of this study was to better understand epidemiological features and correlates of child behavior problems in a large sample of children in economically disadvantaged rural minority areas of China and to provide reference data for subsequent intervention of child developmental problems.

METHODS

A total of 1222 rural mother-child pairs belonging to Hani, Yi, Hui, Miao and Han were drawn from four economically disadvantaged minority counties in Yunnan Province of China. Well-trained investigators completed child physical examination and measurements (height and weight) in village clinics and interviews of mothers at respondents' homes using a structured questionnaire.

RESULTS

Child behavior problems were prevalent in children aged 2-6 years: 71.4% for temper tantrums; 48.2% for swearing; 36.0% for nocturnal bed-wetting; 29.9% for disobedience; 29.5% for difficulty initiating sleep; and 17.0% for picky eating. Child behavior problems significantly differed across Hani, Yi, Hui, Miao and Han ethnic groups. Logistic regression indicated that ethnicity of Hui compared with Han, younger children, prenatal risk factors, being a twin, ineffective child-rearing behaviors such as pampering, corporal punishment, swaddling, family disagreement among child-rearing contributed independently to the risk for child behavior problems.

CONCLUSIONS

The child behavior problems were prevalent in children aged 2-6 years in rural minority children of China. Ineffective family child-rearing practices increase risk for child behavior problems.

Direct tensile strength of visible light-cured restorative materials containing fluoride

The purpose of this study was to compare the fluoride release and direct tensile strength at 24 h, 1 month, and 3 months of two conventional glass-ionomers, two visible light-cured resin-modified glass-ionomers, a polyacid resin composite and two resin composites. The results were statistically analysed using ANOVA and Fisher's PLSD at alpha=0.05. The data on fluoride release indicated that the immersion period (24 h, 1 month, and 3 months) significantly influenced the cumulative amount of fluoride released (P < 0.001). The direct tensile strengths after 1 month of storage were significantly higher than those after 24 h or 3 months of storage (P < 0.001). Thus, the cements and resins were not weakened by the loss of fluoride. Conventional glass-ionomer cement showed the lowest direct tensile strength. Resin-modified glass-ionomer behaved in between the resin composites and conventional glass-ionomers in terms of all three testing times, however, the polyacid resin composites most closely resembled the resin composites. The polyacid resin composites had greatly enhanced direct tensile strength, however, this material also reduced the fluoride availability.

Lack of association between hepatocyte nuclear factor-1beta gene and common forms of type 2 diabetes in the Japanese population

Mutations in the hepatocyte nuclear factor-1beta (HNF-1beta) gene have been shown to be a cause of maturity-onset diabetes of the young (MODY). We studied the contribution of the HNF-1beta gene to susceptibility to common forms of Type 2 diabetes in the genetically homogeneous Japanese population, by investigating the allelic association of Type 2 diabetes with two markers in the HNF-1beta region. The frequency of a nonsense mutation, R177X, which was previously reported in a Japanese family, was also studied by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method using a mismatch primer. A total of 200 subjects were studied. There was no significant difference in allele frequencies of either of the two polymorphisms studied between patients with Type 2 diabetes and control subjects, or between subgroups of patients subdivided by the presence of mild or severe diabetic nephropathy. None of the subjects studied had R177X mutation, giving a frequency of less than 1.1% in common forms of Type 2 diabetes in Japan. These results suggest that mutations in the HNF-1beta gene derived from a limited number of founders are not a major cause of common forms of Type 2 diabetes, even in the genetically homogeneous Japanese population.

Sequence analysis of candidate genes for common susceptibility to type 1 and type 2 diabetes in mice

Although type 1 and type 2 diabetes are regarded as clinically distinct diseases, several lines of evidence have suggested common genetic factors between the two types of diabetes. The non-obese diabetic (NOD) mouse, an animal model of type 1 diabetes, and the Nagoya-Shibata-Yasuda (NSY) mouse, a model of type 2 diabetes, are derived from the same outbred colony, Jcl:HCR, suggesting a shared susceptibility between the two types of diabetes in mice. Genetic as well as functional studies have supported the possibility that Tcf2, which encodes the transcription factor, hepatocyte nuclear factor 1beta (HNF-1beta), is a candidate gene for the common susceptibility between NSY and NOD mice. Txn, encoding thioredoxin which is a redox (reduction/oxidation)-active protein, is also a positional and functional candidate for a common susceptibility gene. To investigate whether either of these two genes is a common susceptibility gene, the coding nucleotide sequences of these two genes were compared among the NSY, NOD and control C3H strains. The coding sequence of Tcf2 of the NOD mouse was identical to that of the C3H mouse, but was different from that of the NSY mouse. The coding sequence of Txn was identical in the three strains. These data suggest that neither of the two genes is a common susceptiblity gene between type 1 and type 2 diabetes in mice.

Fibroblast growth factor inhibits locomotor activity as well as feeding behavior of rats

The effects of acute and chronic intracerebroventricular (i.c.v.) administration of basic fibroblast growth factor (bFGF) on behavior were examined in free-feeding rats. An i.c.v. injection of bFGF induced behavioral changes, such as an increase in resting and decreases in grooming, moving, and food intake at a dose of 20 or 50 ng. These effects appeared at 4-5 h and lasted at least 11 h after the injection. These changes, as well as inhibition of body weight gain, were also found during a 6-day period of chronic i.c.v. infusion of bFGF at a dose of 20 ng/h. These results indicate that bFGF as both bolus i.c.v. injection and chronic i.c.v. infusion inhibits not only feeding behavior but also locomotor activity in rats. It is suggested that the inhibitory effect of bFGF on food intake may be in part ascribed to the suppression of behavior by bFGF.

Thoracoscopic lung biopsy for diffuse infiltrative lung disease

Thoracoscopic lung biopsy is becoming the procedure of first choice for the diagnosis of many localized and diffuse lung diseases. We have performed thoracoscopic lung biopsy for 17 patients with diffuse infiltrative lung disease, in Kurume University Hospital. There were 13 females and 4 males with a mean age of 48 years (range: 19-71 years). Thoracoscopic surgical biopsy was performed in the right lung in 12 and in the left lung in 5. Adequate lung tissue from each case was obtained for pathological examination. The mean surgical biopsy time was 49 min (range: 25-72 min) and bleeding was negligible. The mean duration for chest tube drainage was 2.6 days. No postoperative complication such as prolonged air leakage occurred. A specific diagnosis from the biopsy was achieved in 13 (76.4%) of the 17 cases. In only 6 (35.2%) of the 17 cases, the pathological diagnosis was the same as that from the thoracoscopic biopsy. In these 6 cases, the same diagnosis was obtained only in those with idiopathic interstitial pneumonitis or diffuse panbronchitis. Thoracoscopic lung biopsy was safe and useful for diagnosis for diffuse infiltrative lung disease.

Mineralization in bovine dentin adjacent to glass-ionomer restorations

OBJECTIVES

To assess the uptake of fluoride as well as the increase in mineralization by bovine dentin after restoring an experimentally made cavity with conventional glass-ionomer cement or a polyacid resin composite.

METHODS

Cylindrical cavities were prepared on the labial root surfaces in bovine dentin. The cavities were restored with the test material. The restored teeth were individually suspended in distilled water at 37 degrees C for 30 days. The teeth were sectioned and the superficial dentin cavity walls were analyzed for fluoride, calcium, and phosphorus by an EPMA device. The effects of the different fluoride-releasing materials on the hardness of the dentin were determined by indentation (20-microm intervals below the filled surface into the underlying sound dentin from the surface to a depth of 100microm).

RESULTS

Conventional glass-ionomer cement had a significant effect on fluoride uptake. In addition, the calcium and phosphorus scan revealed the elevation of calcium and phosphorus levels in a deeper zone corresponding to the locations of the fluoride uptake at the surface of axial wall. However, the polyacid resin composite did not exhibit a zone of calcium and phosphorus elevation. The average dentin hardness under conventional glass-ionomer cement in the studied five distances ranged from 84.3 to 61.3KHN, however, that of the polyacid resin composite ranged from 62.5 to 64.9KHN. Analysis of variance for these data demonstrated a significant difference in hardness between the 20-microm depth and the other depths (P<0.01, ANOVA Fisher's PSLD).

CONCLUSION

The present paper indicates that the fluoride penetrated deeper into the dentin with conventional glass-ionomer cement than the polyacid resin composite. Conventional glass-ionomer cement had a significant effect on fluoride uptake. In addition, hypermineralization occurred within the superficial dentin cavity wall region of conventional glass-ionomer cement.

Cyclin-dependent kinase inhibitors, p21(waf1/cip1) and p27(kip1), are expressed site- and hair cycle-dependently in rat hair follicles

In order to investigate the role of cyclin-dependent kinase (CDK) inhibitors in hair growth, we analyzed the expressions of p21(waf1/cip1) and p27(kip1) during the synchronized hair cycle of rat coat. The mRNAs of both p21(waf1/cip1) and p27(kip1) were detected in anagen hair follicles by reverse transcription and polymerase chain reaction and their localization was clearly demonstrated in the upper half portion of the hair bulb and the cortex by in situ hybridization. The dermal tissue containing hair follicles was then excised from the anterior dorsal skin of the 5-12-week-old rats at 0.5 week intervals and the expressions of p21(waf1/cip1) and p27(kip1) were analyzed by northern blot hybridization. The mRNA of both CDK inhibitors was expressed at relatively high levels during anagen than during telogen, a fact which correlated with the mRNA expression levels of hair differentiation markers, type I hair keratin (Ha3) and high sulfur protein B2. These results imply that CDK inhibitors, p21(waf1/cip1) and p27(kip1), are involved in the differentiation of follicular epithelial cells.

Cotesia kariyai teratocytes: growth and development

The growth and development of teratocytes was examined in the Cotesia kariyai-Pseudaletia separata system. Cotesia kariyai embryos released an average of 163 teratocytes at the time of hatching, 3.5 days after oviposition. The cells increased in diameter from 30 to 77 µm until 7 days post-parasitization, after which there was no significant increase in average diameter. However, there was significant variation in diameter within the population of teratocytes during the later developmental stages of the parasitoid larvae. The DNA contents increased up to day 7. The ploidy level of teratocytes increased 4-fold (2C to 8C) from days 4 to 7 and thereafter remained the same. Scanning electron microscopy (SEM) revealed that the surface of the teratocytes was covered with microvilli during all developmental stages, although on days 9 to 10 post-parasitization, bleb structures were also observed on a few. In vitro analysis of the proteins secreted from teratocytes following labeling with (35)S-methionine showed that many proteins were synthesized de novo and secreted by the cells until 9 to 10 days post-parasitization. These results indicate that teratocytes in later stages of development maintain their activity and regulate the physiological state of the host.

Age-related association of MHC class I chain-related gene A (MICA) with type 1 (insulin-dependent) diabetes mellitus

To assess the contribution of the HLA class I region to susceptibility to and heterogeneity of type 1 diabetes, we investigated the association of polymorphism of MHC class I chain-related gene A (MICA) with age-at-onset as well as susceptibility to type 1 diabetes. One hundred one Japanese patients and 110 healthy control subjects were studied. The frequency of A4 allele was significantly higher and that of A6 allele was significantly lower in patients than in control subjects. The frequency of A5.1 allele was highest in early-onset patients (23.0%), intermediate in intermediate-onset patients (9.2%) and lowest in late-onset patients (7.7%) (trend chi-squared test, p = 0.0098). A5. 1 allele was strongly associated with HLA-B7 and Cw7, suggesting that MICA*A5.1-B7-Cw7 haplotype contains a gene responsible for age-at-onset. A4 allele was associated with a susceptible haplotype, DR4-DQB1*0401, and A6 allele was associated with a protective haplotype, DR2-DQB1*0601, suggesting that the association of MICA with type 1 diabetes susceptibility may be due to linkage disequilibrium with class II haplotypes. These data suggest that MICA gene is associated with age-at-onset and that a gene (or genes) responsible for age-at-onset of type 1 diabetes is located in the HLA class I region, probably near the region of MICA-B-C.

[Anesthetic management of a patient with hypohidrotic ectodermal dysplasia]

We anesthetized a 10-year-old girl with hypohidrotic ectodermal dysplasia for an ophthalmic surgery. Ectodermal dysplasia involves the abnormalities of ectodermal tissues and has a triad; hypohidrosis, a lack of teeth, and the scarcity of hair. Hyperthermia may occur due to the defect of sweat glands. Therefore, the body temperature must be monitored continuously. Respiratory tract infection occurs frequently due to the absence of seromucosal glands. We recommend humidifying the inspired gases during the operation. Tracheal intubation may be difficult because of maxillary and/or mandibular abnormalities. We conclude that the particular care should be taken such as the management of the body temperature, preparation for the difficult airway and the humidification of respiratory tract.

A 6-day intracerebroventricular infusion of the growth hormone-releasing peptide KP-102 stimulates food intake in both non-stressed and intermittently-stressed rats

The effects of a 6-day intracerebroventricular (i.c.v.) infusion of KP-102, a growth hormone-releasing peptide (GHRP), on food intake and body weight gain were observed in free-feeding rats that were or were not subjected to intermittent electric footshock stress during the 6 days. Food intake and body weight were significantly lower in rats exposed to a 60-min period of footshock twice a day for 6 days compared to non-stressed rats. A 6-day, i.c.v. infusion of KP-102 significantly and steadily increased food intake and body weight in free-feeding non-stressed rats compared to control rats receiving saline i.c.v. In rats exposed to intermittent footshock stress during the 6-day infusion, KP-102 treatment stimulated feeding behavior and resulted in significantly higher body weight compared to stressed rats that received i.c.v. infusion of saline. These results indicate that during a 6-day continuous i.c.v. infusion of GHRP, KP-102, food intake and body weight steadily increased without attenuation of the GHRP effect in both non-stressed rats and those subjected to intermittent stress.

[Perceived distributions of opinions in young generation and their parents' generation regarding sex roles]

This study examined how people perceive the distributions of opinions about sex roles, in particular, how they saw generational differences in the opinions. Undergraduates and their parents were asked to estimate the opinion distributions in young generation as well as in their parents' generation. They were also asked to indicate their own opinions and the degree of their involvement with the issue. Main results were as follows: First, generation gaps were perceived; the respondents estimated that there would be stronger support for relatively liberal opinions in young generation than in their parents' generation, while the generation gaps were perceived in the reverse direction regarding relatively traditional opinions. Second, although this tendency was found for both sexes, it was more pronounced for female respondents. Third, fathers with higher personal involvement with the issue estimated stronger support for liberal opinions, while mothers with higher personal involvement estimated weaker support. This tendency in mothers was more salient in those who themselves supported relatively liberal opinions.

The relationship between bone turnover and body weight, serum insulin-like growth factor (IGF) I, and serum IGF-binding protein levels in patients with anorexia nervosa

Malnutrition is one of the risk factors for bone loss in patients with anorexia nervosa (AN). To clarify the effects of nutritional status on bone metabolism, we examined the relationship between serum levels of nutritional indicators [insulin-like growth factor I (IGF-I), IGF-binding protein-2 (IGFBP-2), and IGFBP-3] and markers for bone metabolism [serum osteocalcin and urinary excretion of C-terminal telopeptide of collagen type I (CrossLaps)] in 45 AN out-patients, including 8 severely malnourished patients who required hospitalization and iv hyperalimentation (IVH). Compared to healthy subjects, serum IGF-I and IGFBP-3 were lower, whereas IGFBP-2 was higher in out-patients who had a body mass index (BMI) less than 16.5 kg/m2. In these patients, urinary excretion of CrossLaps, a marker of bone resorption, was higher, whereas serum osteocalcin, a marker of bone formation, was lower than those in control subjects. All of these parameters were normal in patients whose BMI ranged from 16.5-18.5 kg/m2. Serum levels of osteocalcin correlated positively with BMI (r = 0.512; P<0.0001), IGF-I (r = 0.558; P<0.0001), and IGFBP-3 (r = 0.369; P<0.001) in AN out-patients. In the 8 severely malnourished AN patients, serum levels of IGF-I and osteocalcin significantly increased 3 and 7 days, respectively, after the start of a 5-week IVH therapy regimen and reached normal levels within 5 weeks, accompanied by still elevated urinary excretion of CrossLaps. The present study demonstrates that an improvement in nutritional status in AN patients during IVH therapy rapidly increases the serum IGF-I levels, followed by a progressive increase in osteocalcin, suggesting immediate start of bone formation. However, increased bone resorption appears to continue for at least 5 weeks.

Breast-feeding in Bangkok, Thailand: current status, maternal knowledge, attitude and social support

BACKGROUND

The promotion of breast-feeding is one of the essential interventions for reduction of infant mortality and improving infant development worldwide. The aim of the present study was to examine the current status of infant feeding and the influences of suspected family sociodemographic characteristics and social support as well as maternal knowledge, attitudes and behaviours in infant feeding since the Baby-Friendly Hospital Initiative was launched in Thailand.

METHODS

A total of 221 mother-infant pairs were randomly drawn from six health care centers in Bangkok from 20 April to 1 May 1998. Health care staff, using a structured questionnaire, interviewed the mothers in the health care centers.

RESULTS

Most sampled mothers believed that breast milk was the best food for their infants and knew that breast milk had many advantages for infants, mothers and families. Ninety-five percent of mothers breast-fed their infants up to 3 months postpartum, but the prevalence of exclusive breast-feeding was relatively low (62.4%). Multiple logistic regression analyses revealed that the following factors independently increased the risk of mixed or formula feeding during the first 3 months of life: (i) mothers with a full-time job; (ii) grandmothers and other people as the main child caretakers; (iii) mothers who did not have an antenatal plan of exclusive breast-feeding; and (iv) newborns' non-exclusive breast-feeding in hospitals after birth. However, the mother being a housewife, mother as the main child caretaker, an antenatal plan of exclusive breast-feeding and exclusive breast-feeding in hospital were more likely to improve exclusive breast-feeding.

CONCLUSION

The prevalence of exclusive breast-feeding was relatively low. Antenatal plans for exclusive breast-feeding and newborn feeding type in hospital after birth may play key roles in the duration of exclusive breast-feeding. These findings suggest the importance of strengthening implementation of the Baby-Friendly Hospital policy and prenatal health education regarding breast-feeding.

Decreased serum levels of acid-labile subunit in patients with anorexia nervosa

One of the observations in malnutrition is that serum insulin-like growth factor (IGF)-I levels are decreased, and this decrease is associated with an altered profile of IGF binding proteins (IGFBPs). In human circulation, IGFs are mostly present as an approximately 150-kDa ternary protein complex consisting of IGFs, IGFBP-3, and acid-labile subunit (ALS). In the present study, to clarify the effect of nutrition on serum ALS levels, we investigated 33 patients with anorexia nervosa. Serum levels of ALS were measured by RIA. Furthermore, we measured serum IGF-I, IGF-II, IGFBP-2, and IGFBP-3 levels in the patients. From these data, we investigated which was the best predictor of body mass index (BMI) as a nutritional status marker. In the patients with anorexia nervosa, the serum ALS levels ranged from 0.7-16.9, with a mean of 10.6 +/- 0.7 mg/L, and the levels were significantly lower than those of normal subjects (13.8 +/- 0.8 mg/L, P < 0.05). Serum ALS levels positively correlated with BMI (r = 0.41, P < 0.05), and the levels increased during treatment. The serum IGFBP-2 levels in the patients were increased (871 +/- 91 microg/L), and the levels inversely correlated with BMI (r = -0.52, P < 0.01). The serum IGF-I and IGFBP-3 levels were low (152 +/- 14 microg/L and 2.56 +/- 0.12 mg/L, respectively), and the levels positively correlated with BMI (r = 0.46, P < 0.01; and r = 0.39, P < 0.05, respectively). The serum IGFBP-2, IGF-I, and IGFBP-3 levels returned toward normal ranges as BMI in the patients improved during treatment. Serum IGF-II levels did not correlate with BMI (r = 0.24, P = 0.17). Stepwise regression analysis revealed that serum IGFBP-2 was the best marker of BMI among these variables. The present study suggested that ALS was regulated by nutritional status, the same as IGF-I, IGFBP-2 and IGFBP-3; but the serum IGFBP-2 was the best predictor of BMI as nutritional status marker among the parameters in patients with anorexia nervosa.

Corticotropin-releasing factor receptor type 1 mediates emotional stress-induced inhibition of food intake and behavioral changes in rats

We investigated whether corticotropin-releasing factor (CRF) receptor type 1 (CRFR1) is involved in emotional stress-induced inhibition of food intake and behavioral changes in rats. The inhibition of food intake and increase in locomotor activity induced by emotional stress using a communication box were reversed by both intracerebroventricular injection of alpha-helical CRF (9-41), a non-selective CRF receptor antagonist, and intraperitoneal injection of a selective non-peptidic CRFR1 antagonist. These results suggest that CRFR1 mediates at least in part the emotional stress-induced inhibition of feeding behavior and increase in locomotor activity.

Hypercalcemia in an euthyroid patient with secondary hypoadrenalism and diabetes insipidus due to hypothalamic tumor

A 20-year-old Japanese man with a hypothalamic tumor (most likely germ-cell tumor) which caused secondary hypoadrenalism, hypogonadism and diabetes insipidus developed hypercalcemia and acute renal failure. The serum levels of intact PTH (iPTH), PTH-related protein (PTH-rP), 1,25-dihydroxy vitamin D (1,25- (OH)2 D), ACTH, cortisol, gonadotropins and testosterone were decreased, but his serum levels of triiodothyronine (T3) and thyroxine (T4) were within the normal range at admission, with depressed TSH and slightly increased thyroglobulin. The hypercalcemia was refractory to extensive hydration and calcitonin, but was ameliorated by pamidronate. After irradiation of the hypothalamic tumor, panhypopituitarism gradually developed. The patient has been normocalcemic for the last 2 years and is doing well under replacement therapy with glucocorticoid, L-thyroxine, methyltestosterone and 1-desamino D arginine vasopressin (dDAVP). As to the mechanism of euthyroidism at admission, transient destructive thyroiditis associated with hypopituitarism or delayed development of hypothyroidism following the hypoadrenalism was suggested. This is the first reported case of hypercalcemia in secondary hypoadrenalism due to hypothalamic tumor. Hypercalcemia was most likely induced by increased bone resorption, which was probably elicited by the combined effects of deficient glucocorticoid and sufficient thyroid hormones in addition to hypovolemia and reduced renal calcium excretion. Furthermore, severe dehydration due to diabetes insipidus and disturbance of thirst sensation caused by the hypothalamic tumor aggravated the hypercalcemia, leading to acute renal failure.

Pancreatic beta cell-specific expression of thioredoxin, an antioxidative and antiapoptotic protein, prevents autoimmune and streptozotocin-induced diabetes

The cytotoxicity of reactive oxygen intermediates (ROIs) has been implicated in the destruction of pancreatic beta cells in insulin-dependent diabetes mellitus (IDDM). Thioredoxin (TRX), a redox (reduction/oxidation)-active protein, has recently been shown to protect cells from oxidative stress and apoptosis. To elucidate the roles of oxidative stress in the development of autoimmune diabetes in vivo, we produced nonobese diabetic transgenic mice that overexpress TRX in their pancreatic beta cells. In these transgenic mice, the incidence of diabetes was markedly reduced, whereas the development of insulitis was not prevented. Moreover, induction of diabetes by streptozotocin, an ROI-generating agent, was also attenuated by TRX overexpression in beta cells. This is the first direct demonstration that an antioxidative and antiapoptotic protein protects beta cells in vivo against both autoimmune and drug-induced diabetes. Our results strongly suggest that oxidative stress plays an essential role in the destruction of beta cells by infiltrating inflammatory cells in IDDM.