Risk factors of frontotemporal dementia compared with Alzheimer disease: Single psychiatric hospital-based research in Japan

AIM

The objective of this study was to reveal risk factors for incident of frontotemporal dementia (FTD) compared with Alzheimer disease (AD) in Japan.

METHOD

Fifty consecutive subjects diagnosed with FTD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) under 75 years old were included retrospectively. As a control group, 48 subjects who were diagnosed with AD according to the DSM-5 and matched by age, sex, educational history, and Mini-Mental State Examination were also included. In order to examine the distinctive risk factors of FTD, we compared the relationship between symptomatologic features, Clinical Dementia Rating, clinical factors, and sociopsychological factors in the two groups.

RESULT

Patients with FTD were more likely than patients with AD to have meticulous premorbid personality and less likely to have a history of diabetes than patients with AD. Although the regression analysis was not significant, a history of psychiatric disorders tends to affect the incidence of FTD.

CONCLUSIONS

These findings regarding the risk of FTD are expected to lead to early diagnosis and care of FTD. Geriatr Gerontol Int 2023; 23: 932-937.

Education level is associated with neuropsychiatric symptoms in patients with amnestic-mild cognitive impairment

BACKGROUND

We examined differences in the severity of neuropsychiatric symptom (NPS) subsyndromes according to education level among patients with amnestic-mild cognitive impairment (a-MCI) with the aim of identifying patient demographics related to NPS subsyndromes.

METHODS

Overall, 140 patients with a-MCI were included. We divided the patients into three groups according to their educational level (primary education, middle education, and high education) and compared their demographics. To explore the severity of NPS subsyndromes according to educational level, we used the Neuropsychiatric Inventory (NPI) after adjustments for the Mini-Mental State Examination (MMSE) score. Finally, NPS subsyndromes that were identified as being related to educational level were further explored using a general linear model (GLM).

RESULTS

Significant differences in several demographics were observed among the three groups. Among the NPS subsyndromes, the scores for aggressiveness were significantly higher in the primary and high education groups than in the middle education group, while the apathy/eating problem scores were significantly higher in the primary education group than in the other groups. The GLM analyses showed that aggressiveness was related to marital status and the Zarit Caregiver Burden Interview (ZBI-J) score, while apathy/eating problems were related to the instrumental activities of daily living (IADL) percentage, the ZBI-J score, and the education level in years.

CONCLUSIONS

Among NPS subsyndromes, aggressiveness and apathy/eating problems differed according to education level in patients with a-MCI. A GLM analysis suggested that not only education level, but also various other factors should be considered when determining the need for NPS interventions.

Clinicodemographic and Psychosocial Factors Related to Presentation or Severity of Delusions of Theft among Females with Amnestic Mild Cognitive Impairment and Alzheimer's Disease

Objectives: We examined the clinicodemographic and psychosocial factors that relate to the presentation and severity of delusions of theft among female patients with amnestic mild cognitive impairment (a-MCI) and Alzheimer's disease (AD).Methods: We enrolled a total of 177 female patients with a-MCI or AD, of whom 40 presented with delusions of theft. We compared the differences in clinicodemographic and psychosocial factors of the 40 patients (delusions of theft group) with 50 age- and Mini-Mental State Examination (MMSE)-matched controls without delusions (control group). Furthermore, we identified the factors associated with the presentation of delusions of theft using a general linear model (GLM). The severity of delusions of theft was calculated using the Neuropsychiatric Inventory Questionnaire, and correlations between the clinicodemographic and psychosocial factors were examined.Results: Between the two groups, the delusions of theft group had lower scores on the Physical Self-Maintenance Scale and instrumental activities of daily living (IADL) and higher scores on the Japanese version of the Zarit Caregiver Burden Interview (ZBI-J) than the control group. GLM analysis revealed that the IADL score was related to the presentation of delusions of theft. The severity of delusions of theft correlated with the MMSE and the ZBI-J scores in the delusions of theft group.Conclusions: The two groups had several differences regarding clinicodemographic and psychosocial factors. Furthermore, lower IADL scores were related to symptom presentation. Symptom severity correlated with cognitive functioning and caregiver burden.Clinical Implications: In the determination of treatment or care, differences in these factors should be considered.

Associations between parental bonding during childhood and functional recovery in patients with schizophrenia

Introduction

Schizophrenia is believed to be etiologically associated with environmental factors. Poor parental bonding, especially arising from “low care” and “overprotection,” may contribute to the prognosis in patients with psychosis. In the present study, we investigated the associations between the aforementioned two different parental bonding types and the prognosis, in terms of the functional recovery, of patients with schizophrenia.

Methods

A total of 89 patients with schizophrenia were recruited, and 79 patients were registered for the study. After the parental bonding types and representative childhood adverse events were assessed, specific items on the PANSS were assessed at 0 and 24 weeks of the study period to define the functional prognosis.

Results

At the end of the 24-week follow-up period, 36% of the patients were judged as showing recovery from schizophrenia. The score for “overprotective attitude,” but not that for “low care,” was found to be significantly higher in the non-recovery (defined below) group. Exploratory logistic regression analysis identified only “overprotective attitude” of the parents as being predictive of non-recovery. Moreover, a significant negative correlation was found between “low care” and “overprotective attitude” only in the non-recovery group.

Conclusion

In the present study, we showed that an overprotective attitude of the parents was associated with non-recovery in patients with schizophrenia.

Effects of neuropsychiatric symptoms of dementia on reductions in activities of daily living in patients with Alzheimer's disease

AIM

In patients with Alzheimer's disease (AD), cognitive impairments cause a progressive reduction in Activities of Daily Living (ADL). Neuropsychiatric symptoms (NPS) also appear in most patients; however, the association between NPS and reductions in ADL remains unclear. The present study evaluated whether NPS influence such reductions using two different ADL measures in patients with AD.

METHODS

Among 546 consecutive outpatients who visited the memory clinic at the Jikei University Kashiwa Hospital, we recruited 208 patients with AD and investigated the correlations between either the Physical Self-Maintenance Scale (PSMS) score or the Instrumental ADL (IADL) level, and each of the Behavioral Pathology in AD (Behave-AD) subscales. To clarify the causal relationships of these correlations, we then verified the associations between statistically significant demographic variables and the Behave-AD subscales as well as the two ADL scales (PSMS score and IADL percentage) using a general linear model.

RESULTS

Neither the PSMS nor the IADL results were significantly influenced by the aberrant motor behaviors score. However, the IADL was significantly influenced by the Mini-Mental State Exam (MMSE) score. Furthermore, diurnal rhythm disturbances and the interaction between diurnal rhythm disturbances score and the MMSE score significantly influenced the PSMS results.

CONCLUSION

Basic ADL reductions may be influenced by diurnal rhythm disturbances, in addition to cognitive impairments in patients with AD. Furthermore, the interaction between the diurnal rhythm disturbances score and cognitive function may also influence basic ADL. Geriatr Gerontol Int 2020; ••: ••-••.

Sex differences in the severity of neuropsychiatric symptoms and their relationship with clinico-demographic and psychosocial factors in patients with amnestic mild cognitive impairment and mild Alzheimer's disease

Objectives: We examined differences in the severity of neuropsychiatric symptoms (NPS) according to sex and identified NPS-related clinico-demographic and psychosocial factors among community-living patients with amnestic-mild cognitive impairment (a-MCI) or mild Alzheimer's disease (AD).Method: Overall, 111 patients (44 males, 67 females) with mild a-MCI (n = 64) or mild AD (n = 47) were included. We divided the patients according to sex and compared their clinico-demographic and psychosocial factors, explored the severity of NPS using the subscales from the Neuropsychiatric Inventory-Questionnaire (NPI-Q), and further identified variables related to NPS.Results: Significant differences in several clinico-demographic and psychosocial characteristics were observed between the sexes. The severity of delusions was higher among females (mean, 0.48; SD, 1.60) than males (mean, 0.23; SD, 1.07; p = .02), while the severity of irritability was higher among males (mean, 0.97; SD, 1.92) than females (mean, 0.49; SD, 1.40; p = .03). The severity of delusions among females was related to the duration of cognitive decline (B = 0.37, p = .03), while the severity of irritability among males was related to general cognition (B = -0.40, p = .003).Conclusion: The severity of NPS among patients with a-MCI or mild AD differed according to sex. We identified NPS-related clinico-demographic factors among these patients. Sex differences should be considered when determining the need for NPS interventions.

Anosognosia in mild Alzheimer's disease is correlated with not only neural dysfunction but also compensation

BACKGROUND

Anosognosia in Alzheimer's disease (AD) is a complicated, non-unitary phenomenon. In a clinical setting, patients with mild AD often preserve their awareness partially. We hypothesized that compensation, as well as neural dysfunction, could be correlated with anosognosia in mild AD.

METHODS

The severity of anosognosia was evaluated using the Anosognosia Questionnaire for Dementia in 37 subjects with mild AD or mild cognitive impairment due to AD. The subjects also underwent single-photon emission computed tomography with N-isopropyl-p-[¹²³ I]iodoamphetamine. Correlation between the severity of anosognosia and perfusion was assessed, and anosognosia (+) and (-) groups were compared.

RESULTS

The severity of anosognosia was relatively mild; the mean Anosognosia Questionnaire for Dementia score was 6.76 ± 14.16. Subjects were divided into two groups: anosognosia (+) (n = 11) and anosognosia (-) (n = 26). In the single-photon emission computed tomography data analysis, the severity of anosognosia was correlated with both lower regional cerebral blood flows of the right prefrontal cortex and higher regional cerebral blood flows of the parietal cortex, especially the left temporo-parietal junction.

CONCLUSIONS

Our results suggest that anosognosia in mild AD could be correlated with compensation as well as neural dysfunction. We speculate that this compensation may be related to the retrieval of outdated autobiographical memory.

Correlation between cognition and symptomatic severity in patients with late-life somatoform disorders

OBJECTIVES

Various aging associated factors, such as functional decline, psychosocial problems, and cognitive dysfunction, are risk factors for somatoform disorders (SDs) in the elderly. The aim of the present study was to evaluate how cognition is correlated with the severity of late-life SDs from a neuropsychological viewpoint.

METHODS

Fifty-three patients over 60 years of age who had been diagnosed as having SDs were examined in this study. The severity of the somatic symptoms was assessed using the Hamilton Anxiety Rating Scales (HAMA). Cognitive functions were assessed using the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB), and the Japanese version of the Neurobehavioral Cognitive Examination (J-COGNISTAT).

RESULTS

The J-COGNISTAT subtest score for attention was below the cutoff point (8 points) but was not correlated with the severity of the somatic symptoms in the patients with late-life SDs. The severity of anxiety as assessed using the HAMA was significantly correlated with the calculation scores (P < 0.005) among the J-COGNISTAT subtests, the FAB total (P < 0.05), and the FAB subtest scores (similarities and motor series) (P < 0.01). Other factors, including the benzodiazepine dosage, antidepressant dosage, the duration of illness, and the onset age, were not significantly correlated with the symptomatic severities.

CONCLUSION

Patients with late-life SDs showed attention deficits, but no correlation was seen between the attention deficits and symptomatic severities. Attention deficits might be associated with the appearance of symptoms. Executive dysfunction and working memory might be associated with the severity of symptoms.

White matter hyperintensities are associated with the severity of late-life somatoform disorders and executive functions

BACKGROUND

Medically unexplained symptoms are often seen in the elderly. Recently, correlations between medically unexplained symptoms and somatoform disorders (SDs) have been reported. The existence of many interactive psychiatric aetiologies is known among SDs. Late-life SDs might be influenced by some aetiological factors caused by ageing processes, such as structural changes in the brain and cognitive dysfunctions.

AIMS

Under such circumstances, we investigated the presence of subcortical white matter hyperintensities (WMHs), which increase with ageing, and hypothesized that subcortical WMHs are related to the disease severity of late-life SDs. Furthermore, we confirmed whether cognitive dysfunction influences this process.

METHODS

To evaluate these hypotheses, we examined patients with medically unexplained symptoms who met the criteria for undifferentiated somatoform disorder and divided the patients into three groups according to the degree of subcortical WMHs: grade 0, grade 1, and grade 2. The subcortical WMHs were rated using Fazekas grading. Differences in symptom severity and cognitive functions were compared among the three groups.

RESULTS

The grade 2 group had the severest symptoms. Furthermore, the grade 2 group had lower cognitive function scores than the other groups.

CONCLUSIONS

The present study showed that the presence of subcortical WMHs in patients with late-life SDs was a predictor of disease severity. Moreover, cognitive dysfunction appeared to play a role in the advancement of disease severity.

Correlation between both morphologic and functional changes and anxiety in Alzheimer's disease

INTRODUCTION

Although anxiety symptoms are often observed in Alzheimer's disease (AD), little attention has been paid to this symptom compared with other neuropsychiatric symptoms.

METHODS

Twenty-six patients with mild AD underwent both magnetic resonance imaging and single photon emission tomography with technetium-99m ethyl cysteinate dimer. Neuropsychiatric symptoms were evaluated using the Behavioral Pathology in Alzheimer's Disease Scale (Behave-AD). We investigated the relationship between anxiety and neuroimaging using Statistical Parametric Mapping 8 software.

RESULTS

The Behave-AD anxiety score was correlated with hyperperfusion in the bilateral anterior cingulate cortices and a reduction in the gray matter volume in the right precuneus and inferior parietal lobule.

CONCLUSION

Our results suggest that anxiety in AD could overlap with the neural correlates of anxiety disorders, and that the specific degeneration associated with AD might be associated with anxiety.

Medical physics aspects of cancer care in the Asia Pacific region

Medical physics plays an essential role in modern medicine. This is particularly evident in cancer care where medical physicists are involved in radiotherapy treatment planning and quality assurance as well as in imaging and radiation protection. Due to the large variety of tasks and interests, medical physics is often subdivided into specialties such as radiology, nuclear medicine and radiation oncology medical physics. However, even within their specialty, the role of radiation oncology medical physicists (ROMPs) is diverse and varies between different societies. Therefore, a questionnaire was sent to leading medical physicists in most countries/areas in the Asia/Pacific region to determine the education, role and status of medical physicists.Answers were received from 17 countries/areas representing nearly 2800 radiation oncology medical physicists. There was general agreement that medical physicists should have both academic (typically at MSc level) and clinical (typically at least 2 years) training. ROMPs spent most of their time working in radiotherapy treatment planning (average 17 hours per week); however radiation protection and engineering tasks were also common. Typically, only physicists in large centres are involved in research and teaching. Most respondents thought that the workload of physicists was high, with more than 500 patients per year per physicist, less than one ROMP per two oncologists being the norm, and on average, one megavoltage treatment unit per medical physicist.There was also a clear indication of increased complexity of technology in the region with many countries/areas reporting to have installed helical tomotherapy, IMRT (Intensity Modulated Radiation Therapy), IGRT (Image Guided Radiation Therapy), Gamma-knife and Cyber-knife units. This and the continued workload from brachytherapy will require growing expertise and numbers in the medical physics workforce. Addressing these needs will be an important challenge for the future.

Transgenic mice aberrantly expressing pyruvate dehydrogenase complex E2 component on biliary epithelial cells do not show primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is an autoimmune disorder that specifically destroys biliary epithelial cells (BECs). In patients with PBC, the immunodominant pyruvate dehydrogenase complex E2 component (PDC-E2), identified as an antigen for disease-specific anti-mitochondrial antibody, is expressed aberrantly in the BEC cytoplasm. The present study focused on the pathophysiological role of aberrant PDC-E2 in the development of PBC. The BEC-specific cytokeratin-19 promoter and PDC-E2 gene were cloned from a mouse cDNA library. The constructed transgene was microinjected into fertilized eggs of mice, and the offspring were identified by Southern blotting and reverse transcriptase-polymerase chain reaction. The protein expression was confirmed by immunoprecipitation, immunoblotting and immunohistochemical staining. Five founder lines were identified as carrying the PDC-E2 gene, and one of these lines expressed PDC-E2 mRNA. The protein expression of exogenous PDC-E2 was detected in the liver. The transgenic mouse line showed diffuse expression of PDC-E2 in the BEC cytoplasm. Biochemical, serological and histological features of PBC were not detected. We established transgenic mice that constitutively express PDC-E2. The results indicated that aberrant PDC-E2 expression in the cytoplasm of BECs is not sufficient for the initiation of autoimmunity. Additional factors may be required to establish a model of PBC.

An algorithm for mapping the catheter tip position on a fluorograph to the three-dimensional position in magnetic resonance angiography volume data

This paper proposes an algorithm which maps the position of a catheter tip on a fluorograph to the 3D position in magnetic resonance angiography (MRA) data. This algorithm was assessed for its accuracy. We designed an algorithm consisting of a registration step and a recognition step. The registration step registers MRA and fluorography data using a digital subtraction angiography (DSA) image. The recognition step recognizes the position in the MRA data corresponding to the catheter tip position on a fluorograph. We checked the accuracy of the recognition step by employing an artificial data set consisting of 3D image data (64 x 64 x 64 matrix) and its projection image (92 x 92 matrix) and the accuracy of the registration step with the aid of three of the 3D time-of-flight MRA data sets (256 x 256 matrix and 60 slices) and their projection images in the form of DSA images. The accuracy of the recognition step depended upon that of the registration. When there was no misregistration, all of the mean errors were less than 0.2 mm. The mean errors of the registration step were 0.273 mm and 0.226 mm, respectively, for the longitudinal shift along the X and Y axes, 0.478 degrees, 1.203 degrees and 0.208 degrees, respectively, for the rotation angles around the X, Y and Z axes and 0.020 times for the magnification. The mean image error between the projection image of the registered MRA data and that of the MRA data which were employed as the DSA image was 0.034 mm.

Response to ADP-ribose by activation of TRPM2 in the CRI-G1 insulinoma cell line

The response to intracellular ADP-ribose in the rat CRI-G1 insulinoma cell line was studied using a patch-clamp method. Dialysis of ADP-ribose into cells induced a response in a dose-dependent manner. The reversal potentials in various solutions showed that the ADP-ribose-gated channel was a Ca2+-permeable nonselective cation channel. In inside-out recordings, ADP-ribose and b-NAD induced responses in the same patch. The single-channel current-voltage relationships for ADP-ribose- and b-NAD-induced responses were almost identical, indicating that ADP-ribose and b-NAD activated the same channel. The physiological properties of the ADP-ribose-gated channel are similar to those we reported previously for the cloned transient receptor potential channel TRPM2. Moreover, RT-PCR analysis showed that TRPM2 was abundantly expressed in CRI-G1 cells, suggesting that the ADP-ribose-gated channel represents the native TRPM2 channel in CRI-G1 cells. These results suggest that ADP-ribose can be an endogenous modulator of Ca2+ influx through the TRPM2 channel into CRI-G1 cells.

Prognosis is predicted by early hearing improvement in patients with idiopathic sudden sensorineural hearing loss

The time-course of the recovery of the hearing level after treatment in 90 patients with idiopathic sudden sensorineural hearing loss was examined. The improvement rate calculated relative to the hearing level of the opposite ear was investigated to estimate the hearing recovery. Follow-up audiograms were performed once per week for 1 month after treatment and once per month thereafter. There were two groups that differed with respect to the characteristics of hearing recovery. One group showed an improvement rate of over 50% at 1-2 weeks and a good improvement rate at 3 months after treatment. In the other group, the improvement rate did not reach 50% at 1-2 weeks, and the improvement rate was poor at 3 months after treatment. The patients with improvement rates of over 50% at 1-2 weeks had earlier initial visits and had mild hearing loss, whereas the patients with profound hearing loss had improvement rates under 50% and poor long-term prognosis. We conclude that the improvement rate at 1-2 weeks after treatment predicts the long-term prognosis for recovery of hearing level in patients with sudden sensorineural hearing loss.

Role of the sympathetic nervous system in the generation of one-minute wave in body fluid volume during upright standing

In clarifying the role of sympathetic nerve outflow to the muscles in the genesis of one-minute waves in body fluid volume, power spectral analysis of muscle sympathetic nerve activity (MSNA) was performed. MSNA was recorded by microneurography in an upright standing position simultaneously with the measurements of body circumference, venous pressure at the dorsum pedis veins, intrathoracic fluid volume, soleus EMG, and calf fluid volume. Subjects were seven healthy male volunteers aged 18 to 32 years. Spectral analysis revealed the one-minute oscillation in MSNA as well as in other variables. Cross spectral analysis between the soleus EMG and each variable revealed a phase order of the one-minute oscillations. It was as follows: 1) an increase in calf fluid volume; 2) a decrease in intrathoracic fluid volume; 3) an increase in venous pressure at the dorsum pedis veins; 4) an increase in the soleus EMG activation; 5) an activation of MSNA; 6) a decrease in calf fluid volume; and 7) an increase in intrathoracic fluid volume. It is concluded that sympathetic nerve activity as well as cardiovascular variables have a cyclic rhythm with a duration of one minute to maintain hemodynamic homeostasis in humans in an upright standing position.

PACS linked to EPR

We developed a new PACS linked to Electronic Patient Record system (EPR). It was a hospital-wide PACS storing all the radiological examinations. The images and reports were linked on EPR. The concept of navigation servers and segment servers was introduced for prefetchig and quick displaying. After the start of operation, increasing retrieval indicated its effectiveness on practical work in spite of remaining delivery of radiographs.

Cloning and characterization of the 5'-flanking region of human cytokeratin 19 gene in human cholangiocarcinoma cell line

BACKGROUND/AIMS

The regulatory mechanism of cell-specific gene expression in cholangiocytes has not been sufficiently evaluated. In this study, we characterized the 5'-flanking region of the cytokeratin 19 gene expressed specifically in cholangiocytes.

METHODS

We cloned a 2952-bp fragment in the 5'-flanking region of cytokeratin 19 and evaluated the regulatory mechanism of gene expression in this region by assaying transient expression of reporter gene and DNA footprinting.

RESULTS

This segment of the 5'-flanking region of the human cytokeratin 19 gene shows an intense transcriptional activity in the cholangioma cell line KMBC, which was about 10 times its activity in the osteosarcoma cell line Saos-2, which does not express cytokeratin 19. From the results of reporter assays, important transcription regulatory elements are considered to be located in the segments from -2249 to -2050 bp and from -732 bp to the first ATG, and six protein-binding sites were detected in the segment from -732 bp to the first ATG by the DNA footprinting technique.

CONCLUSIONS

Sp1 site, CCAAT box, and TATA box were present in the segment from -374 to the first ATG, and they are considered to constitute a cholangiocyte-specific promoter.

Immunocyte Ca2+ influx system mediated by LTRPC2

We characterized an activation mechanism of the human LTRPC2 protein, a member of the transient receptor potential family of ion channels, and demonstrated that LTRPC2 mediates Ca2+ influx into immunocytes. Intracellular pyrimidine nucleotides, adenosine 5'-diphosphoribose (ADPR), and nicotinamide adenine dinucleotide (NAD), directly activated LTRPC2, which functioned as a Ca2+-permeable nonselective cation channel and enabled Ca2+ influx into cells. This activation was suppressed by intracellular adenosine triphosphate. These results reveal that ADPR and NAD act as intracellular messengers and may have an important role in Ca2+ influx by activating LTRPC2 in immunocytes.

Status of PACS and technology assessment in Japan

The situation of PACS installations in Japan from 1987 to 1999 has been investigated. By 1999, 751 PACS units have been installed. Of these, 613 are small-size PACS with less than four image display terminals, 96 are medium-size with 5-14 terminals and 42 are large-size with 15 up to 300 terminals. The 42 hospitals with large sized PACS have been retrospectively investigated from 1984 for PACS experiments and from 1989 for PACS operation. Most of these 42 hospitals have increased the number of PACS terminals by installing additional PACS units instead of reinforcing the existing single PACS. Some (23%) PACS installations have obviously not been successful because of low image transfer speed and inadequate image quality. The use of DICOMM interfaces has increased the number of modalities connected to PACS and influenced the spread of PACS installations in Japan. The status of HIS and RIS coupling to PACS and the use of PACS in primary diagnosis or in image referral are discussed. Assessment of PACS is now in a very early stage. Baseline studies of HIS/RIS/PACS effectiveness have been carried out to assess quantitatively the PACS merit. Radiologists' answers to the questionnaire on PACS usage do not fully support the finding that the number of PACS installations is growing in Japan.

Detection of subtle pulmonary disease on CR chest images: monochromatic CRT monitor vs color CRT monitor

To clarify the diagnostic efficacy of color soft-copy computed radiographic (CR) images of the chest in the detection of subtle pulmonary abnormalities. Twenty observers compared 87 soft-copy CR images on four types of CRT monitor (nonmagnified monochromatic CRT, magnified monochromatic CRT, nonmagnified color CRT, and magnified color CRT). Of 87 test images, 45 (including two identical sets of 12 images to test intraobserver variability) were abnormal and 42 (including two identical sets of 12 images) were normal. Of the 45 abnormal images, 15 showed subtle abnormalities, 15 showed mild abnormalities, and 15 showed obvious abnormalities. In the receiver operating characteristic (ROC) analyses, there were no statistically significant differences among the four types of CRT display formats in the detection of subtle abnormalities. Color CRT monitors can replace monochromatic CRT monitors without any loss in the ability to detect subtle interstitial lung disease.

Inward current responses to urinary substances in rat vomeronasal sensory neurons

No study has yet demonstrated an inward current in response to pheromonal substances in vomeronasal sensory neurons. Using female rat vomeronasal sensory neurons, we here successfully recorded inward currents in response to urine from various sources. Of the neurons that responded to urine, 77% responded to only one type of urine. Male Wistar urine induced responses preferentially in the apical layer of the sensory epithelium, whilst male Donryu and female Wistar urine induced responses mainly in the basal layer of the epithelium. The amplitude of inward currents induced by application of male Wistar urine was voltage-dependent with average amplitude of -47.1+/-6.2 pA at -74 mV. The average reversal potential for male Wistar urine was -9.3 +/-6.1 mV, which was not apparently different from the reversal potentials for urine from different species. It is likely that the urine-induced inward currents in response to different types of urine are mediated via a similar channel. The simultaneous removal of Na+ and Ca2+ from extracellular solution eliminated the response. The magnitude of the urine-induced inward current in Cl--free external solution was similar to that in normal solution, suggesting that the urine-induced current is cation selective. Removal of external Ca2+ enhanced the amplitude of the urine-induced current and prolonged the response. Application of the constant-field equation indicated a very high permeability coefficient for Ca2+. This study first demonstrated that substances contained in urine elicited inward currents, which induce an excitatory response in vomeronasal sensory neurons, through cation-selective channels.

Increases in Fos-immunoreactivity after exposure to a combination of two male urinary components in the accessory olfactory bulb of the female rat

Exposure to either the dialyzed urine preparation (<500 Da) or the remaining substances (>500 Da) did not induce expression of Fos-immunoreactive cells in the mitral/tufted cell layer of the accessory olfactory bulb (AOB), whereas exposure to a mixture of these preparation did induce expression. These results suggest that a combination of low and high molecular weight substances is necessary for the increases in Fos-immunoreactivity in the AOB.

The effects of erythromycin on human peripheral neutrophil apoptosis

Erythromycin is reported to have an anti-inflammatory action, which may account for its clinical effectiveness in treating chronic inflammatory diseases of the respiratory tract such as diffuse panbronchiolitis (DPB) and chronic sinusitis. The evaluate the anti-inflammatory action of erythromycin, we examined apoptosis of isolated neutrophils incubated with and without erythromycin. As a result, erythromycin augmented neutrophil apoptosis in a dose-dependent manner, with a maximal effect at 10 micrograms/ml and above. The percentage of neutrophil apoptosis at 12 h was 79.2 +/- 2.3% in medium with 10 micrograms/ml of erythromycin compared with 51.2 +/- 4.1% in control medium (p < 0.005). In a manner similar to that of erythromycin, another macrolide antibiotic, roxithromycin, also increased neutrophil apoptosis. However, there was no effect on apoptosis induced by treatment with josamycin (macrolide antibiotic), ampicillin (beta-lactam.) and cefazolin (cephalosporin antibiotic), or gentamycin (aminoglycoside). These findings suggest that erythromycin shortens neutrophil survival by accelerating neutrophil apoptosis.

Inhibition of fos-immunoreactivity in response to urinary pheromones by beta-adrenergic and serotonergic antagonists in the rat accessory olfactory bulb

The vomeronasal organs of female Wistar rats after the intraperitoneal administration of ketanserin and propranolol prior to sacrifice were exposed to sprayed urine of male Wistar rats. To explore the effects of these antagonists, we studied Fos-immunoreactive (Fos-ir) structures, which correlate with cellular activity, in the accessory olfactory bulb of female rats after the vomeronasal organ was exposed to urine. After the administration of 3 mg/kg ketanserin, the expression of Fos-ir cells in the periglomerular cell layer in response to male Wistar urine was inhibited, while that in the mitral/tufted cell and granule cell layers was not changed. The administration of 20 mg/kg propranolol inhibited the expression of Fos-ir cells in all three layers. These results suggest that serotonin and noradrenaline are likely involved in the modulation of the expression of Fos-ir cells in response to the urine in the accessory olfactory bulb.

Cluster of proliferating cells in rat vomeronasal sensory epithelium

We investigated the properties of small cells in the vomeronasal sensory epithelium of adult rats. The sensory neurons in the sensory epithelium were stained by antibodies to G(i2alpha) and G(oalpha) in their cell bodies and dendrites, while the small cells, which formed a cluster in the epithelium, were not stained at all. Voltage-activated inward currents were not detected by patch-clamp recordings, but outward currents were induced by the application of voltage step pulses. These results suggest that the small cells are different from the vomeronasal sensory neurons. Bromodeoxyuridine (BrdU) labeling indicated that dividing cells existed in the cluster of small cells.

Immunization of RANTES expression plasmid with a DNA vaccine enhances HIV-1-specific immunity

Cytokines play important roles in regulating immune response. This study evaluated the adjuvant effect of an expression plasmid encoding RANTES (regulated on activation normal T-cell expressed and secreted) chemokine on the immunity induced by a DNA vaccine. This vaccine consists of expression plasmids encoding the env and rev genes of human immunodeficiency virus type 1 (HIV-1). DNA vaccination with RANTES plasmid induced significantly higher titers of serum HIV-1-specific IgG and IgG2a antibodies than DNA vaccination alone on both intramuscular and intranasal immunization. This combination also increased HIV-1-specific cytotoxic T lymphocyte activity and delayed-type hypersensitivity. Intranasal immunization induced a higher titer of fecal secretory IgA antibody than intramuscular immunization. These results demonstrate that coadministration of RANTES plasmid dominantly induced HIV-1-specific cell-mediated immunity.

Regionalization of Fos immunostaining in rat accessory olfactory bulb when the vomeronasal organ was exposed to urine

The distribution of Fos-immunoreactive (Fos-ir) cells in the accessory olfactory bulb (AOB) of rats following vomeronasal organ exposure to urine was studied. Following exposure to male and female Wistar rat urine, Fos-ir cells were found in the mitral/tufted cell layer, granule cell layer and periglomerular cell layer of the AOB of female Wistar rat, with the highest number in the granule cell layer. Exposure to water or removal of the vomeronasal organ suppressed the expression of Fos-ir cells. These results suggest that female Wistar rats specifically detect urinary substances derived from male or female Wistar rats via the vomeronasal organ. Exposure of the vomeronasal organ of female Wistar rats to male Wistar urine induced the appearance of many more Fos-ir cells in all layers of the AOB than exposure to female Wistar urine. As for the mitral/tufted cell layer, the density of Fos-ir cells in the rostral portion (Gi2alpha-positive) of all regions of the AOB was about twice as high as that in the caudal portion when male urine was given. The distribution pattern of Fos-ir cells in response to female urine was not identical to that in response to male urine. That is, the density of Fos-ir cells in the caudal portion was slightly larger than that in the rostral portion in the lateral region, while in other regions the density in the rostral portion was higher than that in the caudal portion. It is likely that information from different pheromones is transmitted to the higher brain regions through the different regions of the AOB.

Laminar distribution of pheromone-receptive neurons in rat vomeronasal epithelium

1. Responses of vomeronasal sensory neurons to urine excreted from rats, mice and hamsters were studied by the on-cell patch clamp method in slices of sensory epithelium from female Wistar rats. 2. The urine excreted from male and female Wistar rats, male Donryu rats and male C57BL/6 mice induced relatively large responses, while urine from male Sprague-Dawley rats and male Syrian hamsters induced small responses. 3. Of the 62 neurons responding to urine, 57 responded to only one of the urine preparations. 4. The sensory neurons that responded to the male Wistar urine were localized in the apical position of the epithelium where one type of GTP-binding protein, Gi2alpha, is selectively expressed. The neurons in the basal position of the epithelium, which express Goalpha, responded to urine from the other animals. 5. This study demonstrates that sensory neurons responsive to different urinary pheromones are localized in a segregated layer in the rat vomeronasal sensory epithelium.

A new experimental system for irradiating tumors in mice using a linear accelerator under specific pathogen-free conditions

We developed a reliable system for the irradiation of xenografted tumors in mice which allows for accurate local irradiation under specific pathogen-free conditions. The system presented here consists of acrylic supports for mice and an acrylic box connected to a pump through 0.22 microns pore-sized filters. Mice with xenotransplanted tumors growing on their right hind legs were set on the supports and put into the box in a laminar flow hood. The tumors of 7 mice were irradiated simultaneously with X-rays of 6 and 10 MV generated by a linear accelerator at a dose rate of 3.1-4.7 Gy/min. The air was ventilated through filters during irradiation in the closed box. Microorganism tests confirmed that no bacteria entered or left the box. One of the significant characteristics of this setup is that it allows for irradiation under conditions of acute hypoxia, which is obtained using an integrated tourniquet. The dose variation among 7 tumors was less than 1%. The rest of the mouse's body was shielded effectively by a half-field technique and a lead block. As a result, the whole body dose for the mice was 0-4% of the total dose absorbed by the tumor. Due to the high dose rate and the ability to irradiate 7 mice simultaneously under specific pathogen-free conditions, this new system can be considered a time-saving and valuable tool for radiation oncology research.

Inositol-1,4,5-trisphosphate accumulation induced by urinary pheromones in female rat vomeronasal epithelium

The mechanisms involved in pheromone-induced responses in the vomeronasal neurons, especially in mammals, are still unclear. In the present study, we examined the effects of rat urine samples containing various types of pheromones regulating gonadal functions on the accumulation of cAMP and inositol 1,4,5-trisphosphate (IP3) in a vomeronasal membrane preparation from the female Wistar rat. Stimulation of the preparation with forskolin induced cAMP accumulation, but stimulation with urine samples excreted from the male Wistar rat, the female Wistar rat, and the male Donryu rat did not change cAMP levels. These results were consistent with the electrophysiological results showing that dialysis of a high concentration of cAMP into the vomeronasal neuron does not induce currents. Stimulation with the three urine samples induced the accumulation of IP3 in the membrane preparation. These results are consistent with previous electrophysiological results [K. Inamura, M. Kashiwayanagi, K. Kurihara, Inositol-1,4,5-trisphosphate induces responses in receptor neurons in rat vomeronasal sensory slices, Chem. Senses 22 (1997) 93-103; K. Inamura, M. Kashiwayanagi, K. Kurihara, Blockage of urinary responses by inhibitors for IP3-mediated pathway in rat vomeronasal sensory neurons, Neurosci. Lett. 233 (1997) 129-132]. After the treatment with Pertussis toxin (PTX), the male Wistar urine did not induce IP3 accumulation significantly. Application of the male Wistar urine decreased ADP-ribosylation of Gi with PTX, while that of the male Donryu urine decreased ADP-ribosylation of Go. Thus, the present results support a mechanism by which the responses of the rat vomeronasal neurons to urinary pheromones are mediated by IP3, Gi and/or Go.

Consistency of variables in PCS and JASTRO great area database

PURPOSE

To examine whether the Patterns of Care Study (PCS) reflects the data for the major areas in Japan, the consistency of variables in the PCS and in the major area database of the Japanese Society for Therapeutic Radiology and Oncology (JASTRO) were compared.

METHODS AND PATIENTS

Patients with esophageal or uterine cervical cancer were sampled from the PCS and JASTRO databases. From the JASTRO database, 147 patients with esophageal cancer and 95 patients with uterine cervical cancer were selected according to the eligibility criteria for the PCS. From the PCS, 455 esophageal and 432 uterine cervical cancer patients were surveyed. Six items for esophageal cancer and five items for uterine cervical cancer were selected for a comparative analysis of PCS and JASTRO databases.

RESULTS

Esophageal cancer: Age (p=.0777), combination of radiation and surgery (p=.2136), and energy of the external beam (p=.6400) were consistent for PCS and JASTRO. However, the dose of the external beam for the non-surgery group showed inconsistency (p=.0467). Uterine cervical cancer: Age (p=.6301) and clinical stage (p=.8555) were consistent for the two sets of data. However, the energy of the external beam (p<.0001), dose rate of brachytherapy (p<.0001), and brachytherapy utilization by clinical stage (p<.0001) showed inconsistencies.

CONCLUSION

It appears possible that the JASTRO major area database could not account for all patients' backgrounds and factors and that both surveys might have an imbalance in the stratification of institutions including differences in equipment and staffing patterns.

Effects of cGMP and sodium nitroprusside on odor responses in turtle olfactory sensory neurons

The effects of cGMP and sodium nitroprusside (SNP) on odor responses in isolated turtle olfactory neurons were examined. The inward current induced by dialysis of a mixture of 1 mM cAMP and 1 mM cGMP was similar to that induced by dialysis of 1 mM cAMP or 1 mM cGMP alone. After the neurons were desensitized by the application of 1 mM cGMP, 3 mM 8-(4-chlorophenylthio)-cAMP, a membrane-permeable cAMP analog, did not elicit any current, indicating that both cAMP and cGMP activated the same channel. Extracellular application of SNP, a nitric oxide (NO) donor, evoked inward currents in a dose-dependent manner. However, application of SNP did not induce any currents after desensitization of the cGMP-induced currents, suggesting that SNP-induced currents are mediated via the cGMP-dependent pathway. Application of the cAMP-producing odorants to the neurons induced a large inward current even after neurons were desensitized to a high concentration of cGMP or SNP. These results suggest that the transduction pathway independent of cAMP, cGMP, and NO also contributes to the generation of odor responses in addition to the cAMP-dependent pathway.

HIS/RIS contribution to image diagnosis and maximization of efficacy of PACS when coupled with HIS/RIS

To maximize the efficacy of the PACS coupled with the HIS/RIS and to clarify the effectiveness of the PACS itself, the amount of contribution of the HIS/NS to image diagnosis was measured beforehand. Video-tape recorders were used to record the CRT display of the HIS/RIS terminals and the simultaneous conversation between a patient and his physician in the clinics of our hospital. Consultation time and entry time for image examination order were measured for each case by replay of the tape. Consultation time was approximately 10 min, while order time was 2-3.5 min depending on whether the physician was an internist or an orthopedist. Detailed description on an order was closely related to detailed reports. The HIS/RIS contributed to image diagnosis even before the PACS was coupled. Concrete methods of efficacy maximization of the PACS were pointed out by internists and orthopedists in terms of modalities, outpatient clinics and wards.

Development and evaluation of PC-based HIS-RIS-modality-PACS coupling: the results of evaluation of initial stage with personal computer application

A PC-based HIS/RIS/Modality/PACS coupling was developed and operated where hospital-wide PACS was closely cooperated with the HIS and RIS. Three workstations with a magneto-optical disk (MOD) juke-box for each one were used as PACS servers to collect images from eight computed radiography systems and three CT scanners. An implementation of JPEG compression reduced network load and storage volume. Twenty PACS-terminals can be connected to the PACS servers and get images from them. Functions of the terminals are magnification, tone scale modification and mensuration. The physicians can also get images on HIS-terminals employing improved HIS-terminal functions. This system has many advantages: (1) inexpensive; (2) close cooperation with the HIS and RIS which makes them easy to manage and retrieve images automatically; and (3) it is an open system, which enables us to apply new technologies. As a matter of fact the introduction of a new PC and a new OS made it possible to decrease displaying response time.

[Selection of clinical evaluation criterion and method of measurement]

The criterion for clinical evaluation of radiotherapy is defined by the authors as follows: Cost-effectiveness = Quality adjusted life year of a patient divided by the expenditure for the patient. Here, quality adjusted life year is calculated by estimating transition probabilities employing the Malkov process model. An expression model for estimation of radiotherapy effectiveness of the patient was proposed and applied. The actual cost of radiotherapy for the patient was calculated by carrying out a Care Map Study in a radiotherapy facility. The time study measures, the hours spent treating the patient by the kind of medical staff. Then, cost-effectiveness was calculated using these two variables in 2,926 patients from 147 radiotherapy facilities collected from a multi-institutional radiation oncology database developed and operated for the five years. A worksheet composed of 55 items of radiotherapy record for one site of a patient. Another worksheet for patient follow-up was composed of 14 items. Six retrospective and prospective data collections and three follow-up investigations were carried out. This study intended to determine the cost-effectiveness of radiotherapy in terms of cancer sites, diseases and treatment modalities. A further target is to expand this method to evaluate new technologies of health care at large as well as radiation oncology.