bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement in excessive daytime sleepiness after surgical treatment for obstructive sleep apnea syndrome
Authors: YAMADERA WATARU
Published: March 2008

Abstract The author's goal was to investigate the effects of surgical treatment on psychophysiological measurements in 17 patients with obstructive sleep apnea syndrome (OSAS) and also to clarify the improvement process of each evaluation. Given the changes in respiratory disturbance and sleep architecture, it was obvious that surgical treatment had therapeutic effects on OSAS patients a few months after the surgery. In that process, a dissociation between objective and subjective sleepiness was observed. The improvement in objective sleepiness [multiple sleep latency test (MSLT)] was more delayed than the improvement in subjective sleepiness (Stanford Sleepiness Scale, Spaceaeromedicine fatigue checklist). The improvement of MSLT was associated with an improvement in sleep fragmentation. This finding suggests that the disruption of sleep continuity accompanied by respiratory disturbance might be responsible for the occurrence of objective sleepiness. It can be concluded that the effective management of OSAS needs to address the full range of psychophysiological manifestations, especially objective measurement of daytime sleepiness.
Current topics in tardive dyskinesia in Japan
Authors: INADA TOSHIYA , YAGI GOHEI
Published: March 2008

Abstract This article reviews current topics in tardive dyskinesia (TD), a movement disorder associated with the prolonged use of neuroleptic agents, especially therapeutic and preventive strategies which have been or are now being studied in Japan. Tardive dyskinesia has become a major problem in the clinical psychiatric field since the early 1970s in Japan, lagging behind Western countries by more than 10 years. The average prevalence rate of TD has been estimated as 7.7% in Japan, while it has been reported in the English literature at around 15 to 20%. Clinical trials of treatments for TD have been or are now being performed in Japan with a number of novel compounds, such as ceruletide, meclofenoxate, and rolipram; however, no effective treatment has yet been established and measures to prevent TD have therefore been emphasized. These include (i) the development of new antipsychotic drugs which are free from TD, (ii) the identification of risk factors from prospective longitudinal studies, and (iii) the investigation of genetic variations that could act as a marker to identify especially vulnerable patients within the whole population of patients who need neuroleptic therapy.
Psychopathology and psychotherapy in the dying AIDS patient
Authors: O'DOWD MARY ALICE
Published: March 2008

Abstract AIDS is not yet the problem in Japan that it is in North American, Europe and Africa, but at the recent 10th International AIDS Conference held in Japan, it was estimated that more Asians will become infected with HIV in the coming year than any other population worldwide. Although the majority of these infections will occur in Thailand and India, it was estimated that there may be as many as 15 000 HIV positive individuals in Japan, a number expected to rise to 26 000 over the next 3 years. Although AIDS is arriving in Japan later, this may give society in general and the medical profession in particular, time to learn from the experiences and mistakes of those who had a head start in dealing with the epidemic.

Although this paper deals with the dying AIDS patient, some of the issues faced by the therapist working with any population of dying patients will be reviewed before focusing more specifically, on some of the particular issues seen in working with AIDS patients.
Grief education and bereavement support in Japan
Authors: DEEKEN ALFONS
Published: March 2008

Abstract This paper introduces the activities of the Japanese Association for Death Education and Grief Counseling, highlighting especially its grief education and bereavement support program. Because of greater life expectancy, most women in Japan will one day experience the death of their husbands, therefore pre‐widowhood education programs are offered to married women in order to prepare them for widowhood. Memorial services, Buddhist, Christian and non‐religious, are offered for bereaved persons. The search for a new self‐identity after bereavement, the role of volunteer work, and the search for meaning in loss and bereavement are discussed. The issues of disenfranchised grief and grief after death from overwork are important themes in grief education.
Dignified death: A German perspective
Authors: MUNDT CHRISTOPH
Published: March 2008

Abstract After discussing some defining questions concerning dignified death, active and passive euthanasia, assisted suicide and the criteria for free will and informed consent, the juridical situation in Germany is reported. Passive euthanasia according to the patients' free will is accepted, assisted suicide, active euthanasia, and passive euthanasia without informed consent are not accepted. The ethical discussion on these topics in Germany reveals a spectrum of opinions. There is somewhat more emphasis on the cons than on the pros. Humanistic and economic arguments merge in the debate. The philosophy of consequentialistic utilitarianism is heavily criticized by many authors who warn that respect even for the unproductive life must not fade. After some remarks on empirical studies on attitudes towards death and the history of attitudes towards euthanasia the conclusion lists the arguments, pros and cons, and gives a personal view.
Ultra‐low‐field magnetic resonance imaging in upper airways obstruction in sleep apnea syndrome
Authors: OKADA TAMOTSU , FUKATSU HIROSHI , ISHIGAKI TAKEO , YASUMA FUMIHIKO , KAYUKAWA YUHEI
Published: March 2008

Abstract The hypothesis that the sites of upper airways obstruction (U AO) are varied in a patient with obstructive sleep apnea syndrome (OSAS) among different sleep stages is studied. Four patients with OSAS underwent ultra‐low‐field magnetic resonance imaging (MRI) with a field strength of 0.064 Tesla provided real‐time images and generated less noise and necessitated less strict magnetic isolation compared with conventional high‐field MRI. After the fixed end‐apneic sleep stage was determined, the polysomnogram was switched off and ultra‐low‐field MRI was commenced. The effects of continuous positive airway pressure (CPAP) on the upper airway patency in the deepest sleep stage obtained for each patient was assessed. Upper airway obstruction was found at the level of the palatopharynx (PP) at sleep onset extended to the glossopharynx (GP) during rapid eye movement (REM) sleep in two cases and during NREM sleep in one case. This combined PP and GP obstruction was observed from sleep onset and remained unchanged in one case. The patent upper airways were observed during treatment with CPAP during REM sleep in two patients and during stage two of NREM sleep in the other two patients. It can be concluded that the sites of UAO vary in a patient with OSAS in different sleep stages. The results also suggest the use of the ultra‐low‐field MRI in order to visualize the dynamic and real‐time behaviors of the upper airways during sleep in patients with OSAS.
Recovery of high speed memory scanning after transient global amnesia: A case report
Authors: OKURA MASAO , TOMOTAKE MASAHITO , MORI KEIJIRO , IKUTA TAKUMI
Published: March 2008

Abstract We described the case of a 59 year old female with transient global amnesia (TGA) who had been examined neuropsychologically using Sternberg's paradigm and a random number generation (RNG) task on the following day, 1 week and 4 weeks after a TGA episode. The slope value of the linear function, a measure of cognitive memory scanning speed, decreased with time and showed a marked decrease 1 week after TGA, suggesting that the stage of serial and exhaustive scanning recovered within 1 week. The zero‐intercept value, on the other hand, increased during 1 week but decreased 4 weeks later and was not related directly to recovery from TGA. The performance in RNG task improved 1 week later, but deteriorated 4 weeks after the episode. Such a change in RNG was in accordance with that of the zero‐intercept value, predicting a relationship. It is concluded that the subclinical memory deficit, detected with these tasks, persisted longer than clinical recovery from TGA.
Two cases of panic disorder treated with autogenic training and in vivo exposure without medication
Authors: SAKAI MAKOTO , TAKEICHI MASASHI
Published: March 2008

Abstract The aim of this study was to use autogenic training in combination with in vivo exposure in the behavioral treatment of panic disorder without medication. Two cases of panic disorder with agoraphobic avoidance were presented. Case 1 was a 33 year old married female who exhibited mild panic symptoms, and case 2 was a 23 year old single male who had severe panic symptoms. Both subjects were successfully treated with the combination of these two techniques. Treatment effects were maintained for 9 years as a follow up in case 1, and for 4 years in case 2.
Studies on relapse, course and outcome of schizophrenia in Japan
Authors: UTENA HIROSHI
Published: March 2008

Abstract Studies of the long‐term outcome of schizophrenia in Japan are reviewed. In nine studies over a 10 year period, recent reports on three patient cohorts show that the liability to relapse is the major difficulty in the treatment and care of schizophrenia. Other research on relapse‐related problems in schizophrenia are also reviewed. Relapses appear mainly in the first decade after onset of the condition; in stressful situations related to a family or larger social context; and on cessation of psychotropic drugs. Relapse liability develops during the course of schizophrenia, but the characteristics of the relapses vary with both the duration and the episodic nature of the schizophrenic condition. Two types of unique treatments that are specifically aimed at coping with relapses, and which were developed in Japan, are described: ‘Seikatsu‐Rinsho’ (clinical guidance to the way of life) and ‘Soegi‐Ryoho’ (splint therapy).
The relationship of DSM‐III‐R personality disorder to clinical variables in patients with major depression: Possible difference between personality disorder clusters
Authors: SATO TETSUYA , SAKADO KAORU , NISHIOKA KAZUO , UEHARA TORU , SATO SATOSHI , KASAHARA YOMISHI
Published: March 2008

Abstract The relationship of DSM‐III‐R personality disorder (PD) to demographic and clinical variables was investigated based on 96 consecutive outpatients with major depression. No significant difference in the variables was found between those with and those without PD. Those with PD from each cluster were compared with those without PD in terms of the variables. In these comparisons many relationships of PD to the variables were found, and these relationships were different between the three PD clusters detailed in DSM‐III‐R. Patients with cluster B PD demonstrated a prominent uniqueness in his/her relationship to the variables. This uniqueness was similar to what had been reported previously with regard to patients with PD. There was no significant difference in the variables between those with cluster C PD and those without PD. Those with cluster A PD may have a negative family history of affective disorders.
Attitudes of medical students towards persons with mental disorders: A comparative study between Japan and Thailand
Authors: YAMAMOTO KAZUYOSHI , RANDALL MAXINE , TAKEDA MASATOSHI , LEELAMANIT WICHIT
Published: March 2008

This study was conducted at three universities, two in Japan and one in Thailand, in order to elucidate the effects of medical education, especially with regard to contact experience on medical students' attitudes toward persons with mental disorders. Questionnaires, which included the Attitudes Towards Disabled Persons Scale (ATDP) and the Contact with Disabled Persons Scale (CDP), were distributed to 1st year students prior to the commencement of their medicine/psychiatry studies and distributed to 6th (or 5th) year students who had completed their psychiatric curriculum. The ATDP scores were lower for 6th year students at all universities, suggesting that post‐education students had a more unfavorable attitude than pre‐education students. Thai students indicated more unfavorable attitudes than did the Japanese students. Three factors were extracted from the ATDP scale and termed: negation of character, negation of ability and affirmation of normality. Four factors from the CDP scale were extracted and labeled intimate contact experience, ordinary contact experience, unpleasant contact experience and pleasant contact experience. Greater negative attitudes of post‐education students than pre‐education students were thought to attribute mainly to an increase in factor score of negation of ability and this result was correlated with an increase in factor score of ordinary contact experience in post‐education students. Of the three ATDP factor scores, the higher score of Thai students for negation of character contributed to their overall unfavorable attitude scores. The cross‐national similarities and differences of students' attitudes towards and contact experience with mentally disordered persons were discussed from the viewpoint of medical education.
Echographia as a symptom of interictal state in an epileptic patient: A case report
Authors: KAN RUMIKO , YASHIMA YUKO , TAKAHASHI YUKIO , TAKAHASHI RURIKO , WATABE MANABU , HAGIWARA MARIKO , NIWA SHIN‐ICHI
Published: March 2008

Abstract Echographia is a phenomenon in which a patient continuously translates verbal stimuli into writing. We encountered a patient with epilepsy who developed visual echographia during interictal periods. In this case, echographia was observed during two different periods, namely the period of disturbed consciousness after the epileptic seizure and the period of clear consciousness after suppression of the seizures. Disinhibition due to disturbance of the consciousness is considered to have been the cause of echographia in the former period. In the latter period, it is considered that echographia was caused by the release of lower function from suppression of upper function by brain dysfunction, as the after effect of status epilepticus. As echographia can be observed in epileptic patients, attention and careful observation by epileptologists is needed.
Recurrent paroxysmal episodes characterized by perceptual alteration in three schizophrenic patients on neuroleptic medication
Authors: HIGUCHI HISASHI , SHIMIZU TETSUO , HISHIKAWA YASUO
Published: March 2008

Abstract A suddenly occurring episode characterized by perceptual alteration (SEPA), mainly of visual and/or auditory modalities, which repeatedly occurred in three schizophrenic patients on long‐term neuroleptic medication, is described. Perceptual alteration showed some distinct features that were different from acute symptoms of schizophrenia, and was accompanied by mood changes such as severe anxiety and agitation and, in one of the patients, also by extrapyramidal symptoms. Perceptual alteration, as well as mood changes and extrapyramidal symptoms, responded well to an anticholinergic drug, biperiden. Recent studies have shown that SEPA occurred not only in schizophrenic patients but also in patients on long‐term neuroleptic medication for treating other mental disorders. These findings suggest that SEPA is associated with dopaminergic hypoactivity in the brain, which is induced by long‐term neuroleptic medication.
Identification of monocyte chemoattractant protein‐1 in senile plaques and reactive microglia of Alzheimer's disease
Authors: ISHIZUKA KOKO , KIMURA TAKEMI , IGATA‐YI RURIKO , KATSURAGI SHOICHI , TAKAMATSU JUNICHI , MIYAKAWA TAIHEI
Published: March 2008

Abstract It has been shown that human monocytes express monocyte chemoattractant protein‐1 (MCP‐1), an inflammatry factor, in response to non‐fibrillar β‐amyloid protein. Reactive microglia and inflammatory factors were reported to be present in β‐amyloid deposits (senile plaques) in Alzheimer's disease, suggesting the presence of MCP‐1 in senile plaques. To address this issue, we examined MCP‐1‐immunoreactivity in senile plaques using a mouse monoclonal anti‐MCP‐1 antibody. Monocyte chemoattractant protein‐1 was found immunohistochemically in mature senile plaques and reactive microglia but not in immature senile plaques of brain tissues from five patients with Alzheimer's disease. These findings suggest that MCP‐1‐related inflammatory events induced by reactive microglia contribute to the maturation of senile plaques.
Nuclear polyadenylate polymerase activity in the brain of seizure‐prone EL mice
Authors: KIOKA TETSURO , YAMAGAMI SAKAE , MUI KOJI , ONISHI HIROSHI
Published: March 2008

Abstract Nuclear polyadenylate polymerase form I activity in the brains of seizure‐prone EL mice was significantly higher than in seizure‐non‐susceptible progenitor ddY mice. This finding may be essential in acquiring susceptibility to seizures, since there was no significant difference between EL(S) mice and those that did not receive stimulation, EL(NS) mice. Lower form II enzymatic activity was observed in both groups of EL mice but not in ddY mice. Moreover, significantly lower activities of form II 7 days after seizures were found in EL(S) mice compared with EL(NS) mice, suggesting that this is a consequence of repeated seizures. The activity of form I enzyme decreased immediately and at 30 and 60 min after seizures, then returned to control levels at 100 min. Form II enzymatic activity was significantly decreased only at 30 min after seizures, implying that seizures exerted a later effect on form II enzyme. These changes may cause a decrease in the rate of polyadenylation in the brain; thus, alteration of post‐transcriptional events, including messenger RNA processing and transport, may occur during epileptic seizures.
Season of birth of schizophrenics in a recent Japanese sample
Authors: KUNUGI HIROSHI , NANKO SHINICHIRO , HAYASHI NAOKI , SAITO KAORU , HIROSE TETSUYA , KAZAMATSURI HAJIME
Published: March 2008

Abstract  An excess of schizophrenic births in winter or early spring is a well replicated finding in studies on Western populations. However, there are few studies on Asian populations, and their results are not consistent. We examined the seasonality of schizophrenic births in Japanese subjects (n= 1024) born between 1955 and 1960. Our results showed a significant inverse relationship between temperature and number of schizophrenic births, which is in line with the findings in Western populations. In our data, observed reduction of schizophrenic births in summer was more marked than excess births in winter. We suggest the possibility that birth in summer may have some advantage in brain growth early in life, which results in reducing the risk of developing schizophrenia.
Prediction of drug responses in schizophrenia: A method using a test dose of chlorpromazine
Authors: MINAMI HIDEO , NAKAHARA TADAHIKO , MIYAHARA AKIO , NAKANE YOSHIBUMI
Published: March 2008

Abstract  Thirty‐seven newly admitted schizophrenic patients were treated with an open and flexible dosage of chlorpromazine for 3 months after receiving a test dose. Levels of chlorpromazine, demethylated chlorpromazine and chlorpromazine sulfoxide 3 h after the test dose were measured. Twenty‐three patients responded to long‐term chlorpromazine treatment but 14 did not, a rate of 62.2%. A discriminant function analysis was performed using variables relating to the patients' backgrounds added to the ratios of plasma drug levels separately by sex to increase predictability over the level of previous studies. The obtained equations were applied to 23 newly admitted schizophrenic patients, with the prescription of chlorpromazine for designated responders and haloperidol for designated non‐responders for 4 weeks. The patients in the latter study responded better than those of the former with chlorpromazine alone; 71.4 and 88.9% of chlorpromazine‐and haloperidol‐treated groups improved, respectively, for an overall rate of 78.3%. However, the chlorpromazine‐treated group had a lower level of positive symptoms than the haloperidol‐treated group before treatment and this and other differences between the groups should be further examined.
Bus hijacking by a pre‐schizophrenic: From a viewpoint of criminal romance
Authors: SATOH SHINJI , OBATA SHUGO , TANAKA HAYASHI , ITO SHINJI , ISHIZUKA CHIAKI , MINOSHITA SEIKO , MORITA NOBUAKI
Published: March 2008

Abstract  There are cases in which no clear symptoms of schizophrenia are observed in a person at the time of a crime but are diagnosed to have schizophrenia after the crime due to the appearance of typical symptoms. We present psychiatric evidence of a patient who saw a bus hijacking incident on TV during several years of isolation at home after graduation from junior high school, and was then determined to hijack a bus, and carried out the crime 6 months later. The patient exhibited clear symptoms of schizophrenia 3 days after the crime. This case of a crime committed before the appearance of clear symptoms of schizophrenia was evaluated from the viewpoint of verbrecherromantik or ‘criminal romance’.
Prognosis and clinical features of intractable epilepsy: A prospective study
Authors: WADA KAZUMARU , KIRYU KAZUHIRO , KAWATA YUKO , CHIBA TAKESHI , MIZUNO KAZUHISA , OKADA MOTOHIRO , TASAKI HIROICHI , FUKUSHIMA YUTAKA , SAITO FUMIO , KANEKO SUNAO
Published: March 2008

Abstract  Of the epileptic patients who were treated for ≥ 5 years until the end of 1990 and had more than four seizures in 1990, 63 patients had been treated without interruption until the end of 1995. We analyzed their clinical courses from 1990 to 1995 prospectively. More than half the subjects were diagnosed with temporal lobe epilepsy. Twenty cases had presumed etiology, and 32 had neuropsychiatric complications. Of the subjects whose seizures were not controlled with conventional antiepileptic drugs (AED), 11 cases demonstrated significant improvement when new AED; that is, lamotrigine, vigabatrin, clobazam, topiramate, tiagabine or CGP33101 were added. However, 10 patients did not respond to new AED. Presumed etiology, neuropsychiatric complications, multiple epileptic foci in EEG and abnormalities on head CT or MRI were characteristics of the patients whose seizures were resistant to new AED.
Metabolite changes with age measured by proton magnetic resonance spectroscopy in normal subjects
Authors: FUKUZAKO HIROSHI , HASHIGUCHI TOMO , SAKAMOTO YASUHIRO , OKAMURA HISATAKA , DOI WATARU , TAKENOUCHI KAORU , TAKIGAWA MORIKUNI
Published: March 2008

Abstract  To determine whether there are metabolite changes in the left medial temporal and frontal lobes with aging, we performed proton magnetic resonance spectroscopy in 36 normal subjects. The N‐acetylaspartate/creatine‐phosphocreatine ratio in the medial temporal lobe tended to be decreased in subjects over 60 years of age. The ratio decrease in the frontal lobe related to aging was lower than that in the medial temporal lobe. There were no significant differences in the metabolite ratios between males and females. These findings suggest that structures in the medial temporal lobe may be more susceptible to neuronal dysfunction associated with aging than those in the frontal lobe.
Schizophrenic disorder and social functioning
Authors: VUKŠIĆ‐MIHALJEVIĆ ŽELJKA , MANDIĆ NIKOLA , BARKIĆ JELENA , LAUFER DAVOR
Published: March 2008

Abstract Social functioning is assessed according to 84 questioned subjects with schizophrenic disorder and their 84 key figures. Schizophrenic subjects showed significant dysfunction in all reviewed areas of behaviour and social roles. Key figures of all schizophrenic subjects most often showed a positive attitude in regard to the future of the schizophrenic members of their family. In relation to social functioning of the schizophrenic subject and the attitude of family key figures there is a statistically significant difference as well as a relationship. Results of assessment confirmed the impact of family life on social functioning of the schizophrenic patient and stresses the importance of active family support in rehabilitation programs.
Changes in sleep patterns during He‐O2 saturation dives
Authors: SEO YOOJIN , MATSUMOTO KAZUYA , PARK YOUNG MAN , MOHRI MOTOHIKO , MATSUOKA SHIGEAKI , PARK KWANG PAK
Published: March 2008

Abstract During simulated hyperbaric saturation diving experiments of He‐02 mixture at the depths of 150, 180 and 230 m the standard polysomnography of four divers, as well as their subjective feelings of fatigue, were recorded for 268 nights. In all three diving conditions, during the bottom period and the decompression period, wakes after sleep onset and Stage 1 sleep increased while Stage 4 sleep decreased. In deeper diving conditions stage 4 sleep tended to decrease and subjective feelings of fatigue increased. When the results are considered it can be assumed that the deeper the diving depths, the increased sleep disturbances and fatigue. However, it is believed that a fundamental sleep pattern will be maintained.
Prolonged polysomnography in a case with recurrent hypersomnia
Authors: TANABE EIICHI , YARA KAZUO , MASTUURA MASATO , TAKAHASHI SAKAE , SAKAI TEIICHIRO , KOJIMA TAKUYA
Published: March 2008

Abstract An 18‐year‐old male patient with recurrent hypersomnia (RH) was evaluated using prolonged polysomnography (PSG). During symptomatic period (SMP), the patient showed both ‘dissociated stage REM’ (DREM), REM sleep without muscle atonia and ‘dissociated stage 1’ (DSt‐1), and stage 1 sleep with rapid eye movement. These stages were observed in the morning or following daytime record. They decreased during asymptomatic period (ASMP). It has been said that RH is caused by dysfunction of the hypothalamus and midbrain limbic system. The present result suggests also that RH involves dysfunction of the brain stem.
A case of sub wakefulness syndrome
Authors: HISANAGA AKITO , TSUTSUMI MANABU , YASUI SHINICHI , FUKUDA HIDEMICHI , TACHIBANA HIROYUKI , HAGINO HIROFUMI , OKABE AKIHITO , MITA TATSUO , SAITOH OSAMU , KURACHI MASAYOSHI
Published: March 2008

Abstract We report a patient, a 30‐year‐old male Japanese‐Brazilian migrant construction worker, suffering from excessive daytime sleepiness for at least 6 months. Electroencephalogram recordings during his waking states showed that 10‐Hz and 60‐µV alpha activity was present prominently in the occipital regions. From the multiple sleep latency test, it was found that stages 1–2 NREM sleep episodes appeared repetitively without any REM episodes, and that the mean sleep latency was 10.2 min. These findings support the diagnosis that this patient suffers from subwakefulness syndrome.
A case of Arnold‐Chiari Type I malformation presenting with dysrhythmic breathing during sleep
Authors: MIYAMOTO MASAYUKI , MIYAMOTO TOMOYUKI , HIRATA KOICHI , KATAYAMA SOICHI
Published: March 2008

Abstract A 43‐year‐old woman presented with dull headache, left tinnitus and dizziness. Neurological examination revealed down‐beat gaze nystagmus, left tinnitus, positive Romberg sign, poor standing on the left foot, poor tandem gait, left spastic gait and positive pathological reflexes in the bilateral upper and lower extremities. Plain X‐ray of the skull and cervical vertebrae demonstrated basilar impression and atlantoaxial fusion. Magnetic resonance imaging of the brain and cervical spine showed cerebellar tonsil descent and syringomyelia located in the left side of the spine at the II‐III vertebral level which communicated with the fourth ventricle. The patient was diagnosed as having cervical syringomyelia, Arnold‐Chiari type I malformation and basilar impression. Preoperative polysomnography showed dysrhythmic breathing and bradypnea during sleep. Abnormal breathing improved after suboccipital decompression craniotomy and upper cervical laminectomy. It was suggested that dysrhythmic breathing was caused by a disorder of the medullary respiratory center. Herniation of the cerebellar tonsil and syringomyelia might have compressed the medulla.
Effectiveness of prosthetic mandibular advancement for obstructive sleep apnea:Analysis by sleep position
Authors: ITASAKA YOSHIAKI , MIYAZAKI SOICHIRO , TADA HIROYUKI , ISHIKAWA KAZUO , TOGAWA KIYOSHI
Published: March 2008

Abstract Fifteen patients with obstructive sleep apnea were treated using prosthetic mandibular advancement (PMA). Each patient was evaluated in the supine and lateral decubitus positions with and without PMA. After PMA treatment, the mean intraesophageal pressure (Peso) in the supine position improved from ‐42.6 to ‐27.3 cmH2O and the mean apnea + hypopnea index (AHI) decreased from 48.8/h to 23.7/h. The mean Peso in the lateral decubitus position improved from ‐27.9 to ‐18.6 cmH2O and the mean AHI decreased from 9.6/h to 6.6/h. With PMA, respiratory disturbance during sleep further improved by changing the body position from the supine to lateral decubitus position.
Continuous measurement of temperature in non‐24 hour sleep‐wake syndrome
Authors: SHIBUI KAYO , OKAWA MASAKO , UCHIYAMA MAKOTO , OZAKI SHIGERU , KAMEI YUICHI , HAYAKAWA TATSUROU , URATA AND JUJIROU
Published: March 2008

Abstract The onset of the low temperature (LT) zone which was defined as a period when the rectal temperature was below its daily mean is a convenient circadian phase marker. In this study, we document three cases of non‐24 h sleep‐wake syndrome in which identification of the LT zone as an evening circadian phase marker contributed to clinical judgments. We found that the LT zone was correlated well with dim light melatonin onset. Moreover, calculating the LT zone was useful in determining phase position in irregular sleep pattern and in determining the timing of bright light therapy.
Chronological changes in brain MRI, SPECT, and EEG in neurosarcoidosis with stroke‐like episodes
Authors: MATSUMOTO KAZUNORI , AWATA SHUICHI , MATSUOKA HIROO , NAKAMURA SHOZO , SATO MITSUMOTO
Published: March 2008

Abstract  Neurosarcoidosis with recurrent stroke‐like episodes has been reported only rarely in the literature. We repeatedly measured brain magnetic resonance images (MRI), SPECT, and electroencephalograms (EEG) in a 32‐year‐old male patient with this condition. In the acute stage of the episodes, he showed semi‐coma followed by severe dysphasia; left‐frontal EEG delta wave activities and left‐sided hyperperfusion SPECT were noted. Gadolinium diethylenetriaminepentaacetic acid (Gd‐DTPA) MRI findings were aggravated diffusely in the convalescent stage of the disease rather than in the acute stage. The EEG and SPECT findings were clearly reflective of an early stage of acute encephalomeningitis caused by the neurosarcoidosis, and thus are more useful than MRI for evaluation of the acute inflammatory process in this condition.
Neuroendocrine differentiation in stage D2 prostate cancers
Authors: Kamiya Naoto , Suzuki Hiroyoshi , Kawamura Koji , Imamoto Takashi , Naya Yukio , Tochigi Naobumi , Kakuta Yukio , Yamaguchi Kunio , Ishikura Hiroshi , Ichikawa Tomohiko
Published: March 2008

Objectives:  Chromogranin A (CgA) and neuro‐specific enolase (NSE) are gaining acceptance as markers of several types of neuroendocrine tumors and the concentration of CgA and NSE have been reported to be elevated in relation to neuroendocrine differentiation of prostate cancer. The aim of the present study was to examine the correlation between the immunohistochemical (IHC) findings and serum value for CgA and NSE in untreated stage D2 prostate cancer patients.

Methods:  Immunohistochemistry was carried out using antibodies against CgA and NSE in 58 patients and, pretreatment serum CgA and NSE levels were measured by monoclonal immunoradiometric assay in 18 patients with stage D2 prostate cancer treated by androgen ablation. We examined the relationship of the pretreatment serum level to IHC findings for CgA and NSE in prostate cancer patients to clinicopathological parameters, and prognosis. Also, we evaluated the correlation of IHC findings to serum levels for CgA and NSE.

Results:  There was a statistically significant correlation between CgA positivity and serum CgA level (P = 0.0421). However, there was no statistically significant correlation between NSE positivity and serum NSE level (P > 0.05). We divided stage D2 patients into three groups according to IHC positivity of CgA and NSE. The cause‐specific survival was significantly poorer in patients with strongly positive (++) patients for independent CgA and combined CgA with NSE (P = 0.0379). Multivariate analysis of cause‐specific survivals in patients with stage D2 prostate cancer demonstrated that strong IHC stain was considered as independent variable associated with greater risk of death (P = 0.0142).

Conclusion:  Neuroendocrine differentiation in stage D2 prostate cancer has attracted considerable attention as a potentially findings prognosis. Thus, CgA had a stronger relationship between serum levels and IHC positivity in contrast to NSE, suggesting clinical usefulness as a tumor marker in predicting the extent of neuroendocrine differentiation in prostate cancer.
Botulinum neurotoxin type A in urology: Antibodies as a cause of therapy failure
Authors: Schulte‐Baukloh Heinrich , Bigalke Hans , Miller Kurt , Heine Gert , Pape Daniela , Lehmann Jan , Knispel Helmut H
Published: March 2008

Objectives:  Botulinum toxin type A (BoNT/A) proved very effective in therapy for hyperactive detrusor or sphincter dysfunction of neurogenic and non‐neurogenic origin. However, therapy may fail. In a search for possible reasons, we investigated the presence of BoNT/A antibodies (BoNT/A‐AB) in patients who were treated more than once and correlated the presence of antibodies with clinical findings.

Methods:  In 25 patients (aged 11–75 years; average, 48.3 years) who had experienced at least one previous BoNT/A detrusor and/or sphincter injection, BoNT/A‐AB was detected with the mouse diaphragm assay before and within 3 months after the current injection. Clinically, subjective and objective outcomes of this injection session were determined on an efficacy scale.

Results:  In eight patients, BoNT/A‐AB was detected; titers were clearly positive in four patients and were borderline in four patients. The subjective and objective outcomes indicated complete therapy failure in three of four patients who were positive for BoNT/A‐AB. In two patients, BoNT/A‐AB developed after just one injection session.

Conclusions:  Botulinum toxin type A antibodies can develop after injection of BoNT/A for urologic disorders and the antibodies can lead to therapy failure. In patients with clinically complete therapy failure in whom no obvious other causes can be determined (such as a progressive disease in a patient with multiple sclerosis), screening for BoNT/A‐AB should be carried out.
Role of endogenous cannabinoids in ischemia/reperfusion injury following testicular torsion in rats
Authors: Beheshtian Azadeh , Salmasi Amirali Hassanzadeh , Payabvash Seyedmehdi , Kiumehr Saman , Nezami Behtash Ghazi , Rahimpour Sina , Rabani Razieh , Tavangar Seyed Mohammad , Dehpour Ahmad Reza
Published: March 2008

Objectives: The role of endogenous cannabinoids in ischemia/reperfusion induced germ cell apoptosis in rats was investigated.

Methods: Baseline group was for basal normal values. The Sham operated group served as a control group. The torsion/detorsion (T/D) group underwent torsion (1 h) and detorsion; AN1, AN2, and AN3 groups received anandamide (10 mg/kg) 30 min before torsion, 30 min after torsion, and just after detorsion, respectively. In the AM251 group, AM251 (0.5 mg/kg) was injected 45 min before torsion and in the AN/AM group, AM251 and anandamide were injected 45 and 30 min before torsion, respectively. Lipid peroxidation, antioxidant enzymes, and germ cell apoptosis was determined.

Results: Malondialdehyde (MDA) levels in the T/D group were significantly higher than the control group. Moreover, MDA values in the AN1, AN2, and AN3 groups were significantly lower than T/D. There were significant decreases in catalase and superoxide dismutase activities in the T/D group versus the control group. These values in the AN1, AN2, and AN3 groups were significantly higher than T/D. It was also shown that MDA levels in the AN/AM group were significantly higher than the AN1 group. In the AN/AM group, catalase and superoxide dismutase activities were significantly lower versus the AN1 group. The mean germ cell apoptosis scores in all animals with testicular T/D were significantly higher than the control group. There was no difference between the apoptotic indices in the AN1, AN2, AN3, and T/D groups. Apoptosis scores in AM251 and AN/AM were significantly higher compared with the T/D and AN1 groups.

Conclusions: Although anandamide increased antioxidant markers, it failed to reduce germ cell apoptosis. AM251 worsened the antioxidant defense system, which is reflected as higher germ cell apoptosis.
A system for the construction of targeted unmarked gene deletions in the genus Burkholderia
Authors: Flannagan Ronald S. , Linn Thomas , Valvano Miguel A.
Published: March 2008

Burkholderia species are extremely multidrug resistant, environmental bacteria with extraordinary bioremediation and biocontrol properties. At the same time, these bacteria cause serious opportunistic infections in vulnerable patient populations while some species can potentially be used as bioweapons. The complete DNA sequence of more than 10 Burkholderia genomes provides an opportunity to apply functional genomics to a collection of widely adaptable environmental bacteria thriving in diverse niches and establishing both symbiotic and pathogenic associations with many different organisms. However, extreme multidrug resistance hampers genetic manipulations in Burkholderia. We have developed and evaluated a mutagenesis system based on the homing endonuclease I‐SceI to construct targeted, non‐polar unmarked gene deletions in Burkholderia. Using the cystic fibrosis pathogen Burkholderia cenocepacia K56‐2 as a model strain, we demonstrate this system allows for clean deletions of one or more genes within an operon and also the introduction of multiple deletions in the same strain. We anticipate this tool will have widespread environmental and biomedical applications, facilitating functional genomic studies and construction of safe strains for bioremediation and biocontrol, as well as clinical applications such as live vaccines for Burkholderia and other Gram‐negative bacterial species.
Resting spore formation of aphid‐pathogenic fungus Pandora nouryi depends on the concentration of infective inoculum
Authors: Huang Zhi‐Hong , Feng Ming‐Guang
Published: March 2008

Resting spore formation of some aphid‐pathogenic Entomophthorales is important for the seasonal pattern of their prevalence and survival but this process is poorly understood. To explore the possible mechanism involved in the process, Pandora nouryi (obligate aphid pathogen) interacted with green peach aphid Myzus persicae on cabbage leaves under favourable conditions. Host nymphs showered with primary conidia of an isolate (LC50: 0.9–6.7 conidia mm−2 4–7 days post shower) from air captures in the low‐latitude plateau of China produced resting spores (azygospores), primary conidia or both spore types. Surprisingly, the proportion of mycosed cadavers forming resting spores (Pcfrs) increased sharply within the concentrations (C) of 28–240 conidia mm−2, retained high levels at 240–1760, but was zero or extremely low at 0.3–16. The Pcfrs–C relationship fit well the logistic equation Pcfrs = 0.6774/[1 + exp(3.1229–0.0270C)] (r2 = 0.975). This clarified for the first time the dependence of in vivo resting spore formation of P. nouryi upon the concentration of infective inoculum. A hypothesis is thus proposed that some sort of biochemical signals may exist in the host–pathogen interaction so that the fungal pathogen perceives the signals for prompt response to forthcoming host‐density changes by either producing conidia for infecting available hosts or forming resting spores for surviving host absence in situ.
Tyrant flycatchers coming out in the open: phylogeny and ecological radiation of Tyrannidae (Aves, Passeriformes)
Authors: Ohlson Jan , Fjeldså Jon , Ericson Per G. P.
Published: March 2008

Tyrant flycatchers constitute a substantial component of the land bird fauna in all South American habitats. Past interpretations of the morphological and ecological evolution in the group have been hampered by the lack of a well‐resolved hypothesis of their phylogenetic interrelationships. Here, we present a well‐resolved phylogeny based on DNA sequences from three nuclear introns for 128 taxa. Our results confirm much of the overall picture of Tyrannidae relationships, and also identify several novel relationships. The genera Onychorhynchus, Myiobius and Terenotriccus are placed outside Tyrannidae and may be more closely related to Tityridae. Tyrannidae consists of two main lineages. An expanded pipromorphine clade includes flatbills, tody‐tyrants and antpipits, and also Phylloscartes and Pogonotriccus. The spadebills, Neopipo and Tachuris are their closest relatives. The remainder of the tyrant flycatchers forms a well‐supported clade, subdivided in two large subclades, which differ consistently in foraging behaviour, the perch‐gleaning elaeniines and the sallying myiarchines, tyrannines and fluvicolines. A third clade is formed by the genera Myiotriccus, Pyrrhomyias, Hirundinea and three species currently placed in Myiophobus. Ancestral habitat reconstruction and divergence date estimation suggest that early divergence events in Tyrannida took place in a humid forest environment during the Oligocene. Large‐scale diversification in open habitats is confined to the clade consisting of the elaeniines, myiarchines, tyrannines and fluvicolines. This radiation correlates in time to the expansion of semi‐open and open habitats from the mid‐Miocene (c. 15 Mya) onwards. The pipromorphine, elaeniine and myiarchine–tyrannine–fluvicoline clades each employ distinct foraging strategies (upward striking, perch‐gleaning and sallying, respectively), but the degree of diversity in morphology and microhabitat exploitation is markedly different between these clades. While the pipromorphines and elaeniines each are remarkably homogenous in morphology and exploit a restricted range of microhabitats, the myiarchine–tyrannine–fluvicoline clade is more diverse in these respects. This greater ecological diversity, especially as manifested in their success in colonizing a wider spectrum of open habitats, appears to be connected to a greater adaptive flexibility of the search‐and‐sally foraging behaviour.
Fatty liver is an independent risk factor for the development of Type 2 diabetes in Korean adults
Authors: Kim C.‐H. , Park J.‐Y. , Lee K.‐U. , Kim J.‐H. , Kim H.‐K.
Published: March 2008

Aims  To investigate whether fatty liver per se is an independent risk factor of incident type 2 diabetes mellitus (T2DM) in Koreans.

Methods  We examined the clinical and laboratory data of 5372 non‐diabetic participants (3670 men and 1702 women; age 46.8 ± 8.4 years, range 20–79 years) who underwent voluntary medical check‐ups in 2000 and follow‐up examinations in 2005.

Results  Two hundred and thirty‐three participants (4.3%) developed T2DM after 5 years. Univariate analysis showed that the development of diabetes was associated with: male sex; family history of diabetes; smoking; older age; higher body mass index (BMI), systolic and diastolic blood pressure, fasting plasma glucose (FPG), hepatic enzymes, total cholesterol and triglycerides; lower HDL cholesterol; and the presence of fatty liver on ultrasonography at baseline. In multiple logistic regression models, after adjusting for age, sex and alcohol consumption, patients with fatty liver were at significantly higher risk of developing T2DM compared to those without fatty liver [relative risk (RR) 3.92, 95% confidence interval (CI) 2.89–5.31]. After further adjustment for smoking, BMI, triglycerides, HDL cholesterol, FPG, alanine aminotransferase and ultrasonographer, fatty liver remained significantly associated with the development of T2DM (RR 1.51, 95% CI 1.04–2.20). Patients with moderate to severe fatty liver had higher risk ratios than patients with mild fatty liver. Exclusion of frequent drinkers did not attenuate the association.

Conclusions  Fatty liver on ultrasonography is associated with the development of T2DM, independently of classical risk factors, in Korean adults.
Relationship between γ‐glutamyltransferase and metabolic syndrome in a Korean population
Authors: Lee M. Y. , Koh S. B. , Koh J. H. , Nam S. M. , Shin J. Y. , Shin Y. G. , Kong I. D. , Ryu S. Y. , Lee T. Y. , Park J. K. , Chung C. H.
Published: March 2008

Aims  To investigate associations between γ‐glutamyltransferase (GGT) and components of metabolic syndrome (MS), insulin resistance and inflammatory markers in the Korean population.

Methods  The 3508 subjects enrolled in this survey participated in the Korean Rural Genomic Cohort (KRGC) study. Written consent was obtained from the local ethical committee. Of these participants, 1437 were men (mean age 56.9 ± 7.9 years) and 2071 were women (mean age 55.8 ± 8.1 years). We measured GGT levels and various biochemical markers. To examine insulin resistance status, we used the homeostasis assessment method for insulin resistance (HOMA‐IR). For inflammatory marker, we used C‐reactive protein (CRP) levels.

Results  Serum GGT levels were significantly higher in the MS group compared to the healthy patient group [23 (5–1403) vs. 19 (5–1920) IU/l; P = 0.01]. The prevalence of MS and adjusted relative risk were both significantly increased from the lowest to highest GGT quartiles; these results persisted after adjustments for multiple confounders. Positive correlations were established between GGT and HOMA‐IR or CRP.

Conclusion  These results suggest that GGT levels may be a surrogate marker of insulin resistance, inflammation and MS.
Health utility values associated with diabetic retinopathy
Authors: Lloyd A. , Nafees B. , Gavriel S. , Rousculp M. D. , Boye K. S. , Ahmad A.
Published: March 2008

Aims  Different estimates exist regarding the impact of diabetic retinopathy (DR) on health utility. A previously reported prospective observational study has reported much larger decrements in self‐reported utility than generic utility data from the UK Prospective Diabetes Study and the Lipids in Diabetes Study. The present study was designed to estimate utility loss using multiple methods.

Methods  Detailed health state descriptions reflecting declining DR (five different visual acuity levels), neuropathy and nephropathy were validated with patients and used to elicit utility values from people with DR, people with diabetes and members of the UK general public using standard gamble. In addition, a larger sample of people with retinopathy completed different health‐related quality of life measures in an interview [EuroQoL (EQ‐5D), Health State Utilities Index (HUI)‐3, and National Eye Institute Visual Functioning Questionnaire‐25].

Results  The utility scores from the standard gamble interviews were not significantly different between the three groups. There was a decline in utility from 6/6 vision to counting fingers of −0.244. The utility data derived from the generic measures revealed an equivalent decline of −0.41 on both the EQ‐5D single index and the HUI‐3.

Conclusions  This study has re‐examined the utility decrements associated with DR and has identified much larger declines in utility than previously reported. The study has also reported the utility values of patients with retinopathy as assessed by standard gamble. We believe that this may be the first study to report utility values for health states associated with vision loss which have been elicited from patients with vision loss.