bluuebunny/crossref_metadata_2025 huggingface dataset:
Hereditary dentatorubral–pallidoluysian atrophy
Authors: Oyanagi Shinsaku
Published: March 2003

Pathology and associated clinical symptoms of hereditary dentatorubral–pallidoluysian atrophy (H‐DRPLA) which was established as a new inherited neurodegenerative disease in 1982 are described. Obligatory lesions in the central nervous system combine with degeneration of the dentatorubral and pallidoluysian pathway, and occasional degenerative lesions are found in the cerebral white matter, putamen, Goll's nucleus of the medulla oblongata, and lateral corticospinal and Goll's tract of the spinal cord. The main clinical symptoms are myoclonus, epilepsy, dementia or mental retardation, cerebellar ataxia and choreoathetosis. Furthermore, newly developing aspects in the pathology of H‐DRPLA following the discovery of the gene locus of H‐DRPLA in 1994 are briefly described.
Spatial correlations between the vacuolation, prion protein deposits, and surviving neurons in the cerebral cortex in sporadic Creutzfeldt–Jakob disease
Authors: Armstrong Richard A , Lantos Peter L , Cairns Nigel J
Published: March 2003

In the cerebral cortex of cases of sporadic Creutzfeldt– Jakob disease (sCJD), the vacuolation (spongiform change) and PrP deposits are aggregated into clusters which are regularly distributed parallel to the pia mater. The objective of the present study was to determine the spatial relationships between the clusters of the vacuoles and PrP deposits and between the pathological changes and variations in the density of surviving neurons. In areas with low densities of pathological change, clusters of vacuoles were spatially correlated with the surviving neurons and not with the PrP deposits. By contrast, in more significantly affected areas, clusters of vacuoles were spatially correlated with those of the PrP deposits and not with the surviving neurons. In addition, areas with a high density of vacuoles and a low density of PrP deposits exhibited no spatial correlations between the variables. These data suggest that the spatial relationships between the vacuolation, PrP deposits and surviving neurons in sCJD depend on the density of lesions present. Differences in the pattern of correlation may reflect the developmental stage of the pathology in particular cortical areas.
Extracellular signals and intracellular pathways in diabetic nephropathy
Authors: CHUANG1 Lea‐yea , GUH2 Jinn‐Yuh
Published: March 2003

SUMMARY: The pathogenesis of diabetic nephropathy (DN) includes genetic, haemodynamic and metabolic factors and oxidative stress as well as renal hypertrophy. Among them, hyperglycaemia is necessary, but not sufficient, for the development of DN. The toxicity of hyperglycaemia results from glucose overutilization and multiple secondary effects. Renal cells respond to extracellular signals [high glucose, glycated proteins, mechanical strain, cytokines/growth factors, especially angiotensin II (AII) and transforming growth factor‐β (TGF‐β)] by way of cell‐surface receptors and activating or inhibiting intracellular pathways. These pathways form a complex network with extensive interactions. Intracellular pathways relevant in DN are polyol, protein kinase C (PKC, especially the PKCβ isoform), reactive oxygen species (ROS, associated with many pathways), nitric oxide (NO; through increased expression of endothelial constitutive NO synthase), mitogen‐activated protein kinase (MAPK) cascade (extracellular signal‐regulated kinase and p38 MAPK may act as glucose transducers), calcium, Janus kinase (JAK)/signal transducers and activators of transcription (STAT), NF‐κB (an inflammatory transcription factor), Smads (transcription factors activated by TGF‐β superfamily), cell cycle regulatory proteins (retinoblastoma protein phosphorylation; cdc2 kinase; p16INK4, p21Cip1 and p27kip1 cyclin‐dependent kinase inhibitors), AP‐1 (a heterodimer of Fos and Jun transcription factors) and transcriptional co‐activators (e.g. CBP/p300, which binds to NF‐κB, STATs, Smads and AP‐1, thereby enabling the interactions among these signals). The therapeutic effects of AII inhibition are mediated by haemodynamic and non‐haemodynamic factors. In fact, because AII induces TGF‐β and many DN‐related intracellular pathways (e.g. PKC, ROS, MAPK, JAK/STAT, NF‐κB and AP‐1), many of the non‐haemodynamic effects of AII inhibition may be mediated by inhibiting these pathways. While some extracellular signals (mechanical strain, hyperglycaemia, AII and TGF‐β) have fulfilled Koch's postulates, none of the intracellular pathways have. However, many inhibitors of these intracellular pathways are being actively researched. These inhibitors may be useful in future therapy for DN.
Nocardia peritonitis and abdominal abscess complicating continuous ambulatory peritoneal dialysis
Authors: Dwyer Karen M , Daffy John R , Murphy Brendan F
Published: March 2003

Peritonitis is a common problem in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and represents the most frequent cause of peritoneal catheter loss and discontinuation of CAPD. The incidence of peritonitis remains less than one episode per patient year of treatment. Common bacteria, particularly staphyloccal species, are the usual causative agents. Fungi and higher bacteria such as Nocardia as aetiological agents have been infrequent in patients undergoing CAPD. We report a case of Nocardia nova peritonitis complicated by an intra‐abdominal abscess requiring surgical drainage and a protracted course of antibiotics.
Cytokines, T cells and proliferative glomerulonephritis
Authors: KITCHING A Richard
Published: March 2003

SUMMARY: The glomerulus, by virtue of its functional role as a filter, is vulnerable to injury in the context of inflammatory responses, with the potential involvement of a number of different inflammatory processes. Recent work has provided insights into the role of T cells in proliferative glomerulonephritis, particularly in determining patterns of injury and outcomes in cresentic forms of glomerulonephritis. Experimental models have shown that in proliferative glomerulonephritis, cytokines play important roles both in determining T helper cell phenotype (particularly in the context of T helper cell 1 responses) and (from T cell themselves) in activating effectors of injury. Conversely, some cytokines regulate T cell responses to limit injury. There is an emerging role in other areas of the inflammatory response for cytokines traditionally thought to be involved predominantly in the injurious T cell response. These include regulatory T cells, the interaction between resident renal cells and leukocytes and the development of renal fibrosis. Cytokine‐based therapies are entering clinical practice in other diseases. However, a number of challenges and questions remain to be answered before translating basic understanding into clinical practice in immune glomerular injury.
A peritoneal dialysis patient with fatal culture‐negative peritonitis
Authors: JOHNSON DAVID W , GRAY NICK , SNELLING PAUL
Published: March 2003

SUMMARY: Culture‐negative peritoneal inflammation accounts for between 5 and 20% of cases of peritonitis in peritoneal dialysis patients. Diagnostic yields may be enhanced considerably by reculturing dialysate effluents using appropriate collection methods and optimal laboratory techniques (including prolonged low‐temperature and anaerobic incubations). In patients with persistent culture‐negative peritonitis, consideration should be given to the possibilities of unusual or fastidious microorganisms (especially fungi and mycobacteria) and non‐infective causes (especially drug reactions, malignancy, visceral inflammation and retroperitoneal inflammation). In this paper, an illustrative case of persistent culture‐negative peritonitis is presented followed by a discussion of the investigative approach to such patients, with particular emphasis on differential diagnosis and the limitations of currently available tests.
Role of transforming growth factor‐β/Smad signalling pathway in enhanced production of glomerular extracellular matrix in IgA nephropathy of high‐serum‐IgA ddY mice
Authors: Kanamaru Yutaka , Nakao Atsuhito , Ra Chisei , Okumura Ko , Muso Eri , Ogawa Hideoki , Kobayashi Ikei , Horikoshi Satoshi , Tomino Yasukiko
Published: March 2003

SUMMARY:
The high‐IgA inbred strain (HIGA) of ddY mice, an animal model of human IgA nephropathy, shows consistently high serum IgA levels, progressive mesangial sclerosis and IgA deposition, and elevated renal expression of transforming growth factor (TGF)‐β. In the present study the role of the TGF‐β/Smad signalling pathway in extracellular matrix (ECM) production was assessed in cultured mesangial cells derived from HIGA mice. The production of type I and type IV collagens in response to TGF‐β1, expression of Smad2, Smad4, Smad7, and Sp1 and p300, and phosphorylation of Smad2 by TGF‐β1 were assessed in cultured mesangial cells derived from HIGA mice at the age of 10 weeks by comparison with age‐matched C57BL/6 mice as controls. In addtion, the expression of p300 and type I and type IV collagens in renal tissues of HIGA mice at the age of 60 weeks was determined. The production of type I and type IV collagens by cultured mesangial cells in HIGA mice was markedly upregulated compared with that in C57BL/6 mice. Although protein expression levels of Smad2, Smad4, Smad7, and Sp1 in the mesangial cells were similar in the two mouse strains, upregulation of p300 was marked in HIGA mice. Expression of p300 in renal tissues of HIGA mice was also enhanced in HIGA mice when compared with C57BL/6 mice. In HIGA mice, p300 expression was upregulated in the mesangial cells both in vitro and in vivo. It appears that the upregulation of p300 may be related to glomerular sclerosis associated with IgA nephropathy in HIGA mice.
Pathogenic role of the IgA molecule in IgA nephropathy
Authors: Lai Kar Neng , Leung Joseph CK
Published: March 2003

SUMMARY:
Deposits of IgA together with complement in different body tissues support the hypothesis that IgA can trigger inflammatory mechanisms. IgA nephropathy (IgAN) is characterized by predominant mesangial IgA1 deposits of a polymeric nature. So far, the mechanism of polymeric IgA1 deposition in the kidney mesangium is poorly understood in IgAN. The exact pathophysiological sequel preceding renal fibrosis following the mesangial deposition of IgA immune complexes remains speculative. Recent in vitro studies revealed that binding of IgA to mesangial cells led to increased expression of growth factors, cytokines, and integrins. The release of these proinflammatory factors is likely to enhance inflammatory injury. In addition, the local renin–angiotensin system present in renal tissues also contributes to renal fibrosis through the activation of transforming growth factor‐β. The question of whether polymeric IgA isolated from patients with IgAN exerted any upregulatory effect on the synthesis of macrophage migration inhibitory factor (MIF) and components of the renin–angiotensin system in human mesangial cells was explored. The in vitro studies revealed that polymeric IgA from IgAN patients upregulated the gene expression of renin and MIF in human mesangial cells in a dose‐dependent manner. These findings further support the notion that glomerular deposition of IgA is not only a pathological epiphenomenon of IgAN, but that polymeric IgA exerts a pathophysiologic effect on the mesangial cells leading to renal fibrosis.
T‐cell receptor repertoire in IgA nephropathy renal biopsies
Authors: Knight John F , Clarkson Anthony R , Wu Huiling
Published: March 2003

SUMMARY:
Renal biopsies from patients with IgA nephropathy (IgAN) were studied to determine whether the presence of αβ and γδ T cells is correlated with disease progression in IgAN. The αβ and γδ T‐cell receptor (TCR) repertoire was further analysed in these renal biopsies. Immunohistochemical staining using mAb (TCRβ and TCRδ) and molecular studies using reverse transcription–polymerase chain reaction (RT‐PCR) with primers specific for TCR families were undertaken. CDR3 length spectratyping and sequencing of TCR chains were used to analyse the diversity of the CDR3 region of these receptors. It was demonstrated that the presence of γδ T cells is associated with progressive IgAN while αβ T cells are found in both stable and progressive disease. Analysis of the TCR variable (V)β repertoire showed the preferential use of Vβ8 with marked similarities in the CDR3 region by some renal infiltrating T cells in the kidney of some IgAN patients, although T cells infiltrating the renal interstitium of patients with IgAN express heterogeneous T cell receptors. The data from analysis of γδ T‐cell repertoire showed that γδ T cells infiltrating the kidneys of IgAN patients use a restricted subset of γδ T cells with a feature of recurrent junctional amino acid motifs in Vδ1 T cells. The results suggest that both αβ and γδ T cells are involved in the progression of IgAN to renal failure and also that there is clonal expansion of individual αβ or γδ T cells in the kidneys of some IgAN patients. The conserved amino acid in the TCR CDR3 region of Vβ8 and the feature of recurrent junctional amino acid motifs in Vδ1 T cells may indicate antigen‐driven selection.
Reactivity of mesangial cells with aberrantly glycosylated IgA: modulation by angiotensin converting enzyme inhibitors
Authors: Amore Alessandro , Cirina Paola , Chiesa Monica , Coppo Rosanna
Published: March 2003

SUMMARY:
The aim of the present study was to evaluate the modulating effect of angiotensin‐converting enzyme inhibitors (ACE‐I) on the reactivity of mesangial cells (MC) challenged with aberrantly glycosylated IgA. In vitro prepared desialylated and degalactosylated IgA (deSia/deGal IgA) were incubated with cultured MC in the presence or absence of enalapril 10–100 ng/mL. DeSia/deGal IgA significantly depressed the MC proliferation rate, simultaneously enhancing the apoptotic rate. A negative control on vascular endothelial growth factor synthesis was found which was mediated by enhanced inducible macrophage‐type nitric oxide synthase activity. The coincubation with enalapril 100 ng/mL significantly reversed these effects. Aberrantly glycosylated IgA induced clear expression of α‐smooth muscle cell actin in MC, suggesting an acquisition of miofibroblast‐like phenotype. The ACE‐I, again, significantly inhibited this effect. In order to evaluate the intracellular mechanisms activated by ACE‐I, the authors aimed to investigate the modulating activity of aberrantly glycosylated IgA and ACE‐I on the nuclear factor (NF)‐κB transcriptional factor system. In MC treated with aberrantly glycosylated IgA, the activation of the NF‐κB/IκB complex leading to translocation of NF‐κB into the nucleus, was detected. The phenomenon was significantly blunted by the co‐incubation with ACE‐I. The present study indicates that ACE‐I may limit the effects on MC of the altered glycosylation of circulating IgA molecules in patients with IgA nephropathy via the inhibition of the transcriptional factor NF‐κB. These in vitro results might add further support to the possible benefit of ACE‐I therapy in progressive IgA nephropathy.
Emotional labor and nursing: an under‐appreciated aspect of caring work
Authors: Henderson Angela
Published: March 2003

Emotional labor and nursing: an under‐appreciated aspect of caring work

This paper describes one component of the findings of a larger research study entitled ‘Nurses’ social construction of self: Implications for work with abused women’. One of the most consistent themes arising from that study involved nurses’ views regarding the relevance of emotional engagement/detachment in pursuit of excellence in their practice. In this article this theme is examined in the light of work on emotional labor and the emotional work of nursing. Nurses’ high degree of satisfaction in the emotional rewards of their work with clients is described and contrasted with their dissatisfaction in relation to nursing education and their views of the lack of valuing of nurses’ work by others within the healthcare system. The importance of supporting them in relation to the emotional aspects of their work is explored.
Positive influence of a liaison program on the rate of psychiatric consultation referrals for cancer patients
Authors: Uchitomi Yosuke , Akechi Tatsuo , Okamura Hitoshi , Kugaya Akira , Zensho Hidenobu , Kagaya Akira , Saeki Toshinari , Okamoto Yasumasa , Nishida Akira , Takebayashi Minoru , Yamawaki Shigeto
Published: March 2003

To improve access to psychiatric consultation for cancer patients as well as non‐cancer patients with psychiatric disorders, a psychiatric liaison programme to communicate closely with physicians and ward staff regarding anticipated psychiatric morbidity in patients, was introduced in each ward of a general hospital. The rate of psychiatric consultation referrals for cancer patients was significantly higher after the psychiatric liaison programme was established. The programme had a greater impact on the rate of psychiatric consultation in a unit with cancer patients who were informed of their diagnoses. The greater consultation rates in cancer patients after the liaison programme might be, in part, associated with the physicians’ attitude toward the more open disclosure of the cancer diagnosis.
Effects of three principal constituents in chewing gum on electroencephalographic activity
Authors: Masumoto Yasuhiro , Morinushi Takanobu , Kawasaki Hirotoki , Ogura Tadashi , Takigawa Morikuni
Published: March 2003

The effects of three principal constituents (sugar, spearmint, and gumbase) in chewing gum on EEG findings in 20 normal subjects were investigated. After they chewed the gumbase, theta activity decreased significantly at Fp2, O1, T3, T4, F4, P3, and Pz; alpha activity increased significantly at O1 and decreased significantly at Fp1, and beta activity increased significantly at Fp1, Fp2, O1, T3, T4, P3 and Pz. After they inhaled the spearmint, alpha activity decreased significantly at 02, F3, P4, and Fz, and beta increased significantly at 02, F3, P4, and Fz. The mean frequency of the alpha band was significantly higher than after 1 min at rest without inhalation. After the subjects chewed the gumbase with sucrose, theta activity increased at Fp2 and Fz; alpha activity increased significantly at T3; and beta activity decreased significantly at Fpl, Fp2, F4, P3, P4, Fz, and Pz. The mean frequency of the alpha band was significantly lower than after 1 min at rest without it at almost all the positions. These results suggest that the gumbase with sucrose induced relaxed concentration effects while inhalation of spearmint induced arousal effects. The chewing of gumbase showed arousal tendency.
A newly developed assay for melatonin using cells expressing human mel‐1a receptor
Authors: Ozeki Yuji , Yamada Naoto , Aoki Harusuke , Yokoyama Tetsuo , Shirono Hiroyuki , Koga Jyunichi , Kato Nobumasa
Published: March 2003

We have developed a radioreceptor binding assay (RRA) method for melatonin using membranes from Chinese hamster ovary cells that can stably express human mel‐1a receptors. We measured melatonin levels in plasma samples collected every 4 h for 24 h using the RRA and radioimmunoassay (RIA) methods, simultaneously. There was a statistically significant correlation between the melatonin levels measured by the two methods, this newly developed method providing a sensitive bioassay. As it is possible to circumvent the cross‐reactivity usually occurring in the RIA method, this method may be an important tool for detecting bioactive substances relative to the mel‐1a receptor.
A case report on EEG nocturnal sleep in visually impaired persons aged in their 30s and 50s
Authors: Hono Takahiro , Hiroshige Yosgiharu , Miyata Yo
Published: March 2003

To determine the EEG sleep structure in visually impaired persons, EEG sleep recordings were made over two or three consecutive nights on five subjects in their 30s and 50s in the laboratory or in the Welfare Center for the Blind. Sleep variables were compared to the normative data of sighted persons of comparable ages. The results indicated that the percentages of slow wave sleep in four of the five blind individuals were much less than the values of the normative data, which is in agreement with Krieger and Glick’s results (1971).
Epworth Sleepiness Scale and sleep studies in patients with obstructive sleep apnea syndrome
Authors: Furuta Hisakazu , Kaneda Reizo , Kosaka Kazuto , Arai Hideki , Sano Joh , Koshino Yoshifumi
Published: March 2003

Excessive daytime sleepiness (EDS) is the major symptom of patients with obstructive sleep apnea syndrome (OSAS). In this study, we examined the relationship between subjective EDS scored with the Epworth Sleepiness Scale (ESS), objective EDS measured with the multiple sleep latency test (MSLT) and sleep variables evaluated with polysomnography for patients with OSAS. Subjects were 10 patients (51.7 ± 19.0 years old). The average ESS and MSLT scores were 10.6 ± 5.6 and 7.7 ± 5.6, respectively. There was no significant relationship between ESS and MSLT. The Multiple Sleep Latency Test had a significant negative relationship with the number of awakenings and the apnea/hypopnea index. No relationship was found between nocturnal hypoxia and either ESS or MSLT. Our findings suggest that objective EDS in OSAS is related with fragmentation of sleep, and that several patients are not aware of their EDS.
Regional cerebral blood flow abnormalities in chronic solvent abusers
Authors: Okada Shin‐Ichi , Yamanouchi Naoto , Kodama Kazuhiro , Uchida Yoshitaka , Hirai Shinji , Sakamoto Tadashi , Noda Shingo , Komatsu Naoya , Sato Toshio
Published: March 2003

This study aimed to reveal regional abnormalities of cerebral blood flow (CBF) and their relation to amotivational syndrome which causes poor social prognosis in solvent abusers. Sixteen chronic solvent abusers (12 males and four females) along with five normal subjects underwent single photon emission computed tomography with N‐isopropyl‐p[123I]iodoamphetamine. The patients received a clinical evaluation with the Scale for the Assessment of Negative Symptoms. Using a semiquantitative method (normalized by the parietal cortex count), patients showed a statistically significant decrease in regional cerebral blood flow (rCBF) in the bilateral prefrontal cortices (P < 0.01). In addition, the severity of hypoperfusion in the bilateral prefrontal cortices was related to the degree of severity of the avolition–apathy scale on SANS (left; P < 0.05, right; P < 0.01) even after excluding the effect of antipsychotics. These results suggest that rCBF abnormalities, especially in the prefrontal cortex, develop in chronic solvent abusers, and that this frontal hypoperfusion may be a biological basis of amotivational syndrome.
Mental health problems after stroke
Authors: Ueki Hirofumi , Washino Kaei , Fukao Taku , Inoue Masato , Ogawa Naoshi , Takai Akihiro
Published: March 2003

We investigated the mental health of 47 subjects (30 men, mean age 63.8 ± 7.7; 17 women, mean age 68.9 ± 8.7) with the 60‐item General Health Questionnaire (GHQ). All the subjects lived at home in a Japanese rural community and were examined from 2 to 3 years after suffering a stroke. Among the subjects, 18 (38.3%) had GHQ scores of 17 or more, which indicated a mental health problem (MHP). The following variables were included in multiple logistic regression analysis: age, sex (men/women), grade of motor paralysis (no/slight/moderate/severe), side of motor paralysis (no/left side/right side/both sides: in analysis, we used dummy variables), paresthesia (no/yes), rehabilitation (need no rehabilitation or participate in rehabilitation/fail to participate in rehabilitation), social support (not needed or sufficient/insufficient) and overall physical recovery (1/2/3: 1 = 67–100, 2 = 34–66, and 3 = 0–33 on a visual analog scale 100 mm long, 100 meaning full recovery). In univariate analysis all variables except age and sex showed statistically significant associations with MHP. In multivariate analysis, only one variable, ‘overall physical recovery’, had a statistically independent association with the status of MHP (Odds ratio 4.39, 95% confidence interval 1.46–13.19). The results of logistic regression analysis indicate that the presence of an MHP is more strongly dependent upon subjective assessment about overall physical recovery after stroke than upon physical impairments and the other psychosocial variables. Therefore, in the community setting, the visual analog scale of overall physical recovery is considered to be a simple, valid method for assessing MHP following stroke.
Delusional disorder: Retrospective analysis of 86 Chinese outpatients
Authors: Hsiao Mei‐Chun , Liu Chia‐Yih , Yang Yong‐Yi , Yeh Eng‐Kun
Published: March 2003

Patients who visited the psychiatric outpatient service of Chang Gung Medical Centre, Tao‐Yuan, Taiwan during an 8‐year period were studied retrospectively. Among the 10 418 outpatients, 86 (0.83%) were diagnosed as having DSM‐IV delusional disorder (DD), including 61 (70.9%) with persecutory type, 12 (14.0%) with the mixed type, seven (8.1%) with jealous type, two (2.3%) with somatic type, two (2.1%) with unspecified type, one (1.2%) with erotomanic type, and another one with grandiose type. The ratio of women to men was 0.86. The mean age at onset was 42.4 ± 15.41 years, with women being older than men. Thirty‐seven cases (43.0%) presented with depressive symptoms at their first visit. Subjects were divided into four groups: persecutory type, jealous type, mixed type and others. There were no significant differences between the four groups in terms of gender, age at onset, time‐lapse before seeking psychiatric help, the presence of hallucination or the presence of depression.
Improvement of subjective work performance among obstructive sleep apnea patients after treatment with continuous positive airway pressure
Authors: Ulfberg Jan , Jonsson Roine , Edling Christer
Published: March 2003

Obstructive sleep apnea syndrome (OSAS) is a significant problem for some patients presenting with snoring and excessive daytime sleepiness. The ‘golden standard’ therapy in OSAS is considered to be nasal continuous positive airway pressure (CPAP). The effects of CPAP on work performance in sleep apnoics has not been studied previously. One hundred and fifty‐two patients with OSAS participated in an open label study. The patients were diagnosed as suffering from severe OSAS after they underwent overnight polysomnography showing that their apnea indexes were at least 20. The participants answered four questions concerning self‐perceived work performance prior to and after using CPAP during 6 months. There were highly statistically significant decreases (P < 0.000001) in work performance difficulties as graded by the patient. The results of this study indicate that CPAP treatment improves subjective work performance in patients suffering from OSAS.
Comparative study of quality of life between the Chinese and Japanese adolescent populations
Authors: Wang Xiangdong , Matsuda Nobuko , Ma Hong , Shinfuku Naotaka
Published: March 2003

Researchers from Japan, China and Singapore have initiated a collaborative project, with the aim of comparing adolescent quality of life (QOL) internationally. This study presents the primary results of the investigation conducted in Beijing, China, and Kobe, Japan. The 70‐item Quality of Life Questionnaire for Adolescents (QOLQA) was developed and evaluated in Japan and China. In total, 1114 Japanese and 613 Chinese junior high school students, aged 12–15 years, completed the questionnaire. Chinese students scored significantly higher than the Japanese students in overall QOL scores and in most domains. For both groups, subjects had highest score in the independence domain and lowest in psychological domain. In terms of overall QOL score, Chinese male students ranked first, followed by Chinese girls, Japanese boys, and Japanese girls. In the Japanese group, a continuing decrease of QOL scores with age was observed without exception, but no such tendency was present in their Chinese counterparts. No parallel relationship was observed between the higher level of economic development and better quality of life. The results also suggest that mental health promotion should be a priority in improving overall quality of life of adolescents both in Japan and China.
A narcoleptic patient exhibiting hallucinations and delusion
Authors: Takeuchi Noboru , Mukai Masaki , Uchimura Naohisa , Satomura Takeshi , Sakamoto Tetsurou , Maeda Hisao
Published: March 2003

A female narcoleptic patient with persistent auditory hallucinations and delusion is reported. These psychotic symptoms appeared before the diagnosis of narcolepsy and before the use of pemoline and clomipramine. On admission to the Department of Neuropsychiatry at the Kurume University school of Medicine, the patient’s auditory hallucinations were almost the same as the previous hallucinations. The patient’s delusional state improved smoothly after haloperidol administration. After that, the patient related well socially. The persistent auditory hallucinations were correlated with rapid eye movement sleep symptoms during her disease process so that we concluded that her persistent auditory hallucinations and delusion of observation were due to narcoleptic symptoms.
Case of a mentally retarded child with non‐24 hour sleep–wake syndrome caused by deficiency of melatonin secretion
Authors: Akaboshi Shinjiro , Inoue Yu‐Ichi , Kubota Norika , Takeshita Kenzo
Published: March 2003

Abstract A case of a 5‐year‐old boy with non‐24 hour sleep–wake syndrome and mental retardation is reported. His free‐running sleep–wake rhythm was remarkably improved by the oral administration of melatonin. The circadian variation in melatonin secretion was extremely low, and circadian rhythm of cortisol secretion was noted. It was speculated that his non‐24 hour sleep–wake syndrome was due to a congenital deficiency of melatonin secretion, and supplemental melatonin therapy proved effective for treating his condition.
Late onset X‐linked hydrocephalus with normal cerebrospinal fluid pressure
Authors: Katsuragi Shoichi , Teraoka Kazuhiro , Ikegami Ken , Amano Koichiro , Yamashita Kensho , Ishizuka Koko , Miyakawa Taihei
Published: March 2003

Abstract A family with X‐linked hydrocephalus with normal cerebrospinal fluid (CSF) pressure and in which three brothers and a grandson of case 1, a proband, were affected is reported. The symptoms at onset were epileptic attacks that started in adulthood in the three brothers and at the age of 6 years in the grandson. In the three brothers, from 10 to 27 years after the onset of epileptic episodes, disorganization of intelligence and psychiatric deterioration were gradually noticed by their families. At the same time, they showed occasional urinary incontinence. Brain computed tomography (CT) scans revealed dilatation of the ventricular systems. Based on the results of the measurement of CSF pressure and radioactive‐iodinated human serum albumin (RISA)‐cysternography, two of the brothers were diagnosed as having normal pressure hydrocephalus (NPH), and they were treated neurosurgically. However, no obvious improvement in clinical symptoms was observed. Although the grandson had shown normal psychomotor development during his early childhood, temporal epilepsy and temper tantrums started at the age of 6 years. Computed tomography‐scanning revealed dilatation of the ventricular system similar to the other three cases at the age of 8 years. With the diagnosis of NPH, the patient underwent a shunt operation, which resulted in no obvious effects. As it is reasonable to surmise that the pathological gene would have been transferred via the daughter of the proband to the grandson, it is suggested that the inheritance manner might be X‐linked recessive. The cases presented here are different from the cases of hydrocephalus due to stenosis of the aqueduct Sylvius (HSAS) and other types of X‐linked hydrocephalus reported previously in terms of the age of onset, course, symptoms, and CT findings. Thus, it is suggested that the present cases might be a new type of X‐linked hydrocephalus.
Hallucination of soliloquy: Speaking component and hearing component of schizophrenic hallucinations
Authors: Kobayashi Toshiyuki , Kato Satoshi
Published: March 2003

Abstract In the present paper, two cases of schizophrenia with hallucinatory soliloquy are presented, and the concept of the symptom, hallucination of soliloquy is proposed. In hallucination of soliloquy, while having the experience of hearing his own voice, the patient has a conviction that he speaks out aloud, without actually vocalizing. It is an abnormal experience of both speaking and hearing; that is, a combination of auditory hallucination and motor hallucination. It is considered that hallucination of soliloquy is an exemplar of schizophrenic hallucinations.
Psychiatric symptoms related to interferon therapy for chronic hepatitis C: Clinical features and prognosis
Authors: Hosoda Shinji , Takimura Hiroshi , Shibayama Masatoshi , Kanamura Hajime , Ikeda Kenji , Kumada Hiromitsu
Published: March 2003

Abstract Psychiatric symptoms during interferon (IFN) therapy for viral hepatitis have been a crucial problem in consultation‐liaison psychiatry. However, there have been few studies on psychiatric management for these symptoms and their prognosis. Among 943 patients who were treated with IFN for chronic hepatitis C between 1991 and 1995, 43 patients (4.6%) developed psychiatric symptoms during IFN treatment. Three patients (0.3%), with pre‐existing psychiatric disorders showed aggravated symptoms and were excluded from the study. All three patients were able to finish the IFN therapy with psychiatric management. Forty patients (4.2%) manifested psychiatric symptoms induced by IFN. Thirteen patients (1.4%) were diagnosed as anxiety disorder and 21 patients (2.2%) revealed mood disorder with depressive features. There were other psychiatric disorders in six patients (0.6%), including psychotic disorder with delusions/hallucinations in four patients (0.4%), mood disorder with manic features in one patient (0.1%) and delirium in one patient (0.1%). Women developed psychiatric symptoms significantly more than men. Ten of 40 patients (25%) stopped IFN treatment because of manifesting psychiatric symptoms induced by IFN. Twelve patients (30%) required psychiatric treatment for more than 24 weeks after ceasing IFN, and seven patients still had anxiety, insomnia and mild hypothymia at the end of the present study. Statistical analysis revealed that IFN‐β therapy and psychiatric manifestations including psychotic symptoms, delirium and manic symptoms were significantly related to long‐term psychiatric problems. There are considerable numbers of patients who have required long‐term psychiatric management even after cessation of IFN treatment.
Reactive psychosis: A classical category nearing extinction?
Authors: Ungvari Gabor S. , Leung Henry C. M. , Tang Wai‐Kwong
Published: March 2003

Abstract By presenting two illustrative case histories, the authors stress the importance of the classical category of reactive psychosis which has disappeared from recent international classifications as a distinct nosological entity. Reactive psychosis is essential in the differential diagnosis of acute psychoses as the diagnosis of reactive psychosis has far‐reaching therapeutic implications. Clinical and conceptual issues concerning reactive psychosis are briefly reviewed with respect to major classical and modern papers.
Estimated sleep debt and work stress in Japanese white‐collar workers
Authors: Kageyama Takayuki , Nishikido Noriko , Kobayashi Toshio , Kawagoe Hiromi
Published: March 2003

Sleep debt on weekdays in Japanese white‐collar workers, estimated using a questionnaire, was associated with age, overtime, and self‐rated workload.
Comparison of Ricketts analysis and Downs‐Northwestern analysis for the evaluation of obstructive sleep apnea cephalograms
Authors: Higurashi Naoki , Kikuchi Makoto , Miyazaki Soichiro , Itasaka Yoshiaki
Published: March 2003

To determine which analysis is suitable to examine the dentofacial skeletal pattern characteristics of the obstructive sleep apnea syndrome (OSAS), we took lateral cephalograms of 44 Japanese OSAS patients and 34 Japanese non‐OSAS controls. By Ricketts analysis, we found significant differences between OSAS patients and non‐OSAS controls on facial axis, lower facial height and total facial height, which showed that Japanese OSAS patients have dolico facial patterns. However, by Downs‐Northwestern analysis, we did not find any significant difference between OSAS patients and non‐OSAS controls using the same cephalograms as the Ricketts analysis.
Effects of bright light exposure on heart rate variability during sleep in young women
Authors: Kohsaka Masako , Kohsaka Shinobu , Fukuda Noriko , Honma Hiroshi , Sakakibara Satoshi , Kawai Ikuko , Miyamoto Tamaki , Kobayashi Riko
Published: March 2003

To investigate the effects of evening bright light on the autonomic nervous system, heart rate variability (HRV) during sleep was analyzed in dim light (DL) and bright light (BL) conditions. We recorded polysomnography in nine healthy young women aged 20–21 years. Time series of % delta power was calculated in the 0.49–2.20 Hz band. Heart rate variability was analyzed from a 10‐min segment of slow wave sleep. The low‐ to high‐frequency ratio and the low‐frequency component decreased significantly in the BL conditions compared with the DL conditions. However, the power of the high‐frequency component did not change in the two conditions. These results indicate that evening BL affects the autonomic nervous system during slow wave sleep.
Efficacy and safety of olanzapine, an atypical antipsychotic, in patients with schizophrenia: Results of an open‐label multicenter study in Japan
Authors: Ishigooka Jun , Murasaki Mitsukuni , Miura Sadanori ,   THE OLANZAPINE EARLY‐PHASE II STUDY GROUP
Published: March 2003

Abstract This first clinical study of olanzapine in Japanese patients with schizophrenia was conducted to investigate the efficacy and safety of olanzapine. Eighty‐one patients were included in the analysis set. Mean modal dose for those patients were 9.4 ± 3.6 mg/day. For the primary efficacy measure (Final Global Improvement Rating score), 14.8% of patients had remarkable improvement, 59.3% of patients had moderate improvement or better, and 86.4% of patients had slight improvement or better. Results from the Brief Psychiatric Rating Scale showed improvement from baseline in all clusters including positive psychotic symptoms (thought disturbance) but also against negative symptoms (anergia). The most commonly reported treatment‐emergent signs and symptoms with ≥10% incidence, were insomnia, weight increase, excitement, sleepiness, and anxiety. There was a low incidence of extrapyramidal treatment‐emergent signs and symptoms, and events reported were tremor (6.2%), muscle rigidity (3.7%), and akathisia (2.5%). The most commonly reported treatment‐emergent laboratory changes, with ≥ 20% of incidence, were prolactin elevations (24.3%) followed by increases in triglycerides (20.4%). However, mean prolactin values tended to be normalized during the study. This study result suggests that olanzapine is an ‘atypical’ antipsychotic.
Cognitive function and frontal lobe atrophy in normal elderly adults: Implications for dementia not as aging‐related disorders and the reserve hypothesis
Authors: Meguro Kenichi , Shimada Masumi , Yamaguchi Satoshi , Ishizaki Junichi , Ishii Hiroshi , Shimada Youichi , Sato Mari , Yamadori Atsushi , Sekita Yasuyoshi
Published: March 2003

Abstract We examined the relations between cognitive function and age and education in the normal elderly population. As per the community‐based stroke, dementia, and bed confinement pre‐vention in the town of Tajiri, neuropsychological assessments, including the Cognitive Ability Screening Instrument (CASI), were performed for 99 randomly selected normal elderly subjects. We assessed the frontal function (working memory, word fluency, Trail‐Making Tests, CASI subitems of list‐generating fluency, attention, and concentration/mental manipulation), language function (proverbs, CASI subitem language), non‐language function (the digit symbol test of the Wechsler Adult Intelligence Scale‐Revised (WAIS‐R), CASI subitem visual construction), memory (Alzheimer's Disease Assessment Scale recall/recognition, story recall, CASI subitems short and long‐term memory, the Rey‐Osterrieth Complex Figure Test), and the global function (CASI subitems orientation and abstraction and judgment). We found that the only test affected by age was the digit symbol test of the WAIS‐R. The effects of education were distributed among various tests. There was a significant correlation between age and the frontal lobe atrophy in the lower educated group. The present findings suggest that cognitive function is spared by the aging process itself and dementia should be considered as age‐related, not aging‐related disorders, and that education might have a protective effect on cognitive change, supporting the reserve hypothesis.
Depressive mixed state: Testing different definitions
Authors: Benazzi Franco
Published: March 2003

Abstract The aim of this study was to test different definitions of depressive mixed state (DMX) (major depressive episode (MDE) with some concurrent hypomanic symptoms), to find which one could better define DMX. Unipolar and bipolar II MDE outpatients (n = 168) were interviewed with the DSM‐IV Structured Clinical Interview. Depressive mixed state was defined as a MDE with two or more (DMX2), and as a MDE with three or more (DMX3) concurrent hypomanic symptoms. DMX2 was present in 71.8% bipolar II patients, and in 41.5% unipolar (P < 0.01). DMX3 was present in 46.6% of bipolar II, and in 7.6% unipolar patients (P < 0.01). DMX2 and DMX3 had almost the same significant and non‐significant associations with study variables (diagnosis, gender, age, age at onset, illness duration, MDE recurrences, axis I comorbidity, MDE severity, depression chronicity, hypomanic, MDE, psychotic, melancholic, and atypical symptoms and features). DMX3 was more strongly associated with bipolar II than DMX2 (odds ratio 10.4 vs 3.5). Findings suggest that DMX3 may be a better definition of DMX due to its stronger association with bipolar II disorder. Findings have important clinical and treatment implications because antidepressants may worsen DMX, and the presence of DMX may induce clinicians to assess systematically and carefully the history of past hypomania.
The relationship between regional cerebral blood flow and the Wisconsin Card Sorting Test in negative schizophrenia
Authors: Liu Zhening , Tam Wai‐Cheong Carl , Xie Yaning , Zhao Jingping
Published: March 2003

Abstract The purpose of this study was to explore the relationship between regional cerebral
blood flow (rCBF) and problem‐solving thinking in negative schizophrenia. Twenty‐one
negative schizophrenic patients and 12 normal controls were studied with single photon
emission computed tomography (SPECT). Measures of regional cerebral blood flow (rCBF)
were taken both at rest and during a prefrontal activation task using Wisconsin Card
Sorting Test (WCST). Compared with controls, poor performances on the WCST of total
trials category (TT), perseverative errors (PE) and non‐perseverative errors (NE)
were found in negative schizophrenic (P < 0.05). During WCST activation,
patients showed interhemispheric differences in the prefrontal region, but under
rest conditions, no such differences manifested. The negative schizophrenia group
had a significantly lower rCBF change rate in profrontal lobe during stimulant WCST
than those in normal controls (P < 0.05). The negative schizophrenic patient has executive function deficits and lower rCBF perfusion in left profrontal lobes, which suggest that the negative schizophrenic patient has dysfunction of the left profrontal region.
Short naps and exercise improve sleep quality and mental health in the elderly
Authors: TANAKA HIDEKI , TAIRA KAZUHIKO , ARAKAWA MASASHI , URASAKI CHISAE , YAMAMOTO YUKARI , OKUMA HIROMI , UEZU EIKO , SUGITA YOSHIRO , SHIRAKAWA SHUICHIRO
Published: March 2003

Abstract The effects of short naps and exercise on the sleep quality and mental health of elderly people was investigated. ‘Interventions’ by short naps after lunch and exercise of moderate intensity in the evening were carried out for 4 weeks. After the ‘intervention’, awake time after sleep onset decreased significantly and sleep efficiency increased significantly, demonstrating that sleep quality had improved. Also, the frequency of nodding in the evening decreased significantly. These results demonstrate that proper awakening maintenance in the evening was effective in improving sleep quality. After the ‘intervention’, mental health and volition and physical health had also improved with improving sleep quality.
Comparison of the event‐related potentials between tonic and phasic periods of rapid eye movement sleep
Authors: TAKAHARA MADOKA , NITTONO HIROSHI , HORI TADAO
Published: March 2003

Abstract The event‐related potentials (ERP) of eight young healthy volunteers were recorded during wakefulness and rapid eye movement (REM) sleep using an auditory discrimination task. REM sleep was classified into phasic and tonic periods according to the presence or absence of REM. In wakefulness, deviant stimuli elicited a P300 that was maximal over parieto‐central areas. During the tonic period of REM sleep, deviant stimuli elicited a P200 and a P400. The P200 was distributed more anteriorly and the P400 was distributed more posteriorly than the P300; however, no prominent ERP components were observed during the phasic period. The study’s findings suggest that the brain is less sensitive to external stimuli during the phasic period than during the tonic period of REM sleep.
Comparative study on sleep health and lifestyle of the elderly in the urban areas and suburbs of Okinawa
Authors: ARAKAWA MASASHI , TANAKA HIDEKI , TOGUCHI HIROKI , SHIRAKAWA SHUICHIRO , TAIRA KAZUHIKO
Published: March 2003

Abstract The sleep health and lifestyles of the elderly living in the urban and suburban areas of Okinawa prefecture, which is well known for the longevity of its inhabitants, were compared. The study revealed that sleep health and activities of daily living (ADL) were significantly better among the elderly living in suburban areas. There were more complaints of sleep problems from the elderly living in urban areas and their bedtimes were significantly later, indicating that a nocturnal lifestyle was related to sleep deterioration. In the suburbs, a significantly greater number of elderly people regularly took short naps and exercised in the evening. The study also suggested that daily habits such as short naps and taking appropriate exercise in the evenings contributed to good sleep, and that sleep health was related to the ADL of the elderly.