bluuebunny/crossref_metadata_2025 huggingface dataset:
Dural band pathology in syringomyelia with Chiari type I malformation
Authors: Nakamura Nishio , Iwasaki Yoshinobu , Hida Kazutoshi , Abe Hiroshi , Fujioka Yasunori , Nagashima Kazuo
Published: March 2003

Surgical material taken from the ‘outer layer’ of thickened dura mater (dural band) at the craniovertebral junction of eight cases of syringomyelia with Chiari type I malformation was histologically examined in comparison with four autopsy cases as controls. The dural band was thickened and there were increased numbers of collagen fibers which showed fiber splitting, hyalinous nodule, calcification and/or ossification. These changes were not observed in the four control cases. Thus, it is suggested that the thickening of the dura mater may be a causative factor of syringomyelia with Chiari type I malformation. In addition, the histology of the thickened dura mater suggests the condition may be a consequence of birth injury in these patients.
β‐Catenin expression in human neural cell lines following exposure to cytokines and growth factors
Authors: Satoh Jun‐ichi , Kuroda Yasuo
Published: March 2003

β‐Catenin acts as a key mediator of the Wnt/Wingless signaling pathway involved in cell proliferation, differentiation and survival. Recent studies have shown that an unstable interaction between β‐catenin and the mutant presenilin‐1 induces neuronal apoptosis, and that β‐catenin levels are decreased in the brains of patients with Alzheimer’s disease (AD). Since activated microglia and astrocytes play a role in the process of neuronal degeneration in AD, the cytokine/growth factor‐regulated expression of β‐catenin in human neural cell lines, including NTera2 teratocarcinoma‐derived differentiated neurons (NTera2‐N), IMR‐32 neuroblastoma, SKN‐SH neuroblastoma and U‐373MG astrocytoma, was studied quantitatively following exposure to epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), brain‐derived neurotrophic factor (BDNF), tumor necrosis factor‐α (TNF‐α), interleukin (IL)‐1β, IL‐6, interferon (IFN)‐γ, transforming growth factor (TGF)‐β1, dibutyryl cyclic adenosine 3′,5′‐cyclic monophosphate (cAMP) (dbcAMP) or phorbol 12‐myristate 13‐acetate (PMA). β‐Catenin mRNA expressed constitutively in all of these cell lines was unaffected by treatment with any factors examined. In contrast, β‐catenin protein levels were reduced markedly in NTera2‐N cells by exposure to dbcAMP, EGF or bFGF, and in U‐373MG cells by treatment with dbcAMP or PMA, but were unaffected in any cell lines by BDNF, TNF‐α, IL‐1β, IL‐6, IFN‐γ or TGF‐β1. These results indicate that β‐catenin is expressed constitutively in human neural cells and downregulated at a protein level by a set of growth factors in a cell type‐specific manner.
Biologic parameters that correlate with the prognosis of human gliomas
Authors: Lafuente JV , Alkiza K , Garibi JM , Alvarez A , Bilbao J , Figols J , Cruz‐Sánchez FF
Published: March 2003

Much clinical and biologic data have been processed in the search for useful objective parameters to predict brain tumor behavior. Seventy cases of astrocytic glioma collected by a single clinical team were studied using a full complement of clinical procedures: follow up (7 years), histologic analysis, DNA content estimation, and cell kinetics by flow cytometry. Proliferating cell nuclear antigen (PCNA) was determined by immunocytochemical‐coupling flow cytometry (PFC) and also by counting under light microscopy (PIHC). A statistical evaluation was carried out to establish the usefulness of several parameters for glioma prognosis. The cases were histologically classified as 14 low‐grade astrocytomas, 20 anaplastic astrocytomas, and 36 glioblastomas multiforme. The survival curve showed significant differences between his‐tologic groups. Diploid populations were more frequent in low‐grade astrocytomas, and aneuploid tumors often had increased S‐phase and proliferative fractions. The PCNA‐labeled index (PCNA‐LI) increased with malignancy and correlated with histologic grading (P = 0.01). The PCNA‐LI and age segregated low‐ from high‐grade astrocytomas (including anaplastic astrocytoma and glioblastoma multiforme), but none of the variables considered differentiated anaplastic astrocytoma from glioblastoma multiforme. The Cox regression test displayed significant values for age, histologic diagnosis, and PCNA determinations when considered in tandem. Discriminant analysis obtained a function integrating age and specifically PIHC‐LI to help in the prognosis of doubtful cases. The results emphasize the importance of parameters integrating different variables in an attempt to provide an accurate prognosis, the most significant being age, histopathologic diagnosis, and the proliferative fraction determined by PCNA.
JC virus large T protein transforms rodent cells but is not involved in human medulloblastoma
Authors: Hayashi Hiroe , Endo Shuichi , Suzuki Satoko , Tanaka Shinya , Sawa Hirofumi , Ozaki Yoshimaru , Sawamura Yutaka , Nagashima Kazuo
Published: March 2003

JC virus (JCV) together with Simian virus 40 (SV40) and BK virus (BKV), belong to the polyomavirus group and these viruses are neuro‐oncogenic to rodents by expression of large T antigen (LT), which binds to cellular p53 and pRB thus reducing the anticancer potential of the cell. The function of LT has not been clarified because small t antigen (st) is transcribed from the same start codon as the overlapping reading frame of LT, and is translated as a different protein with the same N‐terminal residues (1–81 amino acids) by a splice‐site variant of mRNA. To elucidate the function of LT without st, we constructed plasmids that express LT only by deleting the splicing region including the C‐terminus of st, and consequently stable cell lines were established that express only JCLT, SV40LT and BKLT. The growth rates of these cells were examined in colonies on soft agar and it was found that LT alone has a transforming capacity; the order of efficiency being SV40LT, BKLT and JCLT. In addition, to verify the involvement of JCV in human medulloblastoma, eight cases of medulloblastoma, six cases of frozen material and five cases of paraffin‐embedded tissues which included three cases of frozen tissues, were examined. PCR assay, genomic Southern blotting, and in situ hybridization were applied to detect the JCV genome, and LT and st were examined by immunohistochemistry; the results were compared with JCV‐infected tissues as a positive control. All methods failed to detect not only JCV genome but also LT protein in medulloblastoma and it was concluded that JCV LT has transforming activities in rodent cells, but is not related to human medulloblastoma.
An atypical case of sporadic Creutzfeldt–Jakob disease with Parkinson's disease
Authors: Iida Takashi , Doh‐ura Katsumi , Kawashima Toshiro , Abe Hirofumi , Iwaki Toru
Published: March 2003

We report here an autopsy case of a 64‐year‐old female with slowly progressive dementia and parkinsonism in a 4‐year‐long clinical course. Post‐mortem examination revealed a severely atrophic brain with spongiform degeneration, neuronal loss and gliosis in the gray matter. Many prion protein plaque deposits were present in the occipital lobe, amygdala and cerebellum. Additionally, Lewy bodies were observed in the brainstem. Prion protein gene analysis of the patient revealed polymorphism at the codon‐129 valine heterozygote. This genotype is known to sometimes accompany a missense mutation of the gene in uncommon hereditary prion diseases, but no mutation was found in the open reading frame. Thus, it might be suggested that this case showed simultaneously the features of both sporadic Creutzfeldt‐Jakob disease (CJD) with codon‐129 valine and Parkinson's disease. However, the predisposing factors for contracting both diseases simultaneously remain to be determined, because the incidence of Parkinson's disease accompanied by CJD is very low.
Autopsy case of aluminum encephalopathy
Authors: Shirabe Teruo , Irie Kohji , Uchida Masako
Published: March 2003

We report the case of a 59‐year‐old female aluminum encephalopathy patient who had chronic renal failure and took 3.0 g hydroxy‐aluminum gel per day for the control of serum phosphorus level during a 15‐year period. Nine months before her death she developed disorientation, memory disturbance, emotional incontinence, general convulsions and consciousness disturbance. Neuropathologically, the brain showed nerve cell atrophy and mild loss with stromal spongiosis, proliferation of astrocytes and microglia in the cerebral cortex, basal ganglia and thalamus. Some nerve cells were stained immunohistochemically by phosphorylated neurofilament, but apparent neurofibrillary tangles were not observed. Aluminum was detected in the nerve cells of the cerebral cortex by X‐ray microanalysis. Despite the long‐term intake of aluminum, there were no neuropathological findings of Alzheimer's disease. The findings in our case suggested that aluminum alone might not develop Alzheimer's disease.
Periventricular leukomalacia, inflammation and white matter lesions within the developing nervous system
Authors: Rezaie Payam , Dean Andrew
Published: March 2003

Periventricular leukomalacia (PVL) occurring in premature infants, represents a major precursor for neurological and intellectual impairment, and cerebral palsy in later life. The disorder is characterized by multifocal areas of necrosis found deep in the cortical white matter, which are often symmetrical and occur adjacent to the lateral ventricles. There is no known cure for PVL. Factors predisposing to PVL include birth trauma, asphyxia and respiratory failure, cardiopulmonary defects, premature birth/low birthweight, associated immature cerebrovascular development and lack of appropriate autoregulation of cerebral blood flow in response to hypoxic‐ischemic insults. The intrinsic vulnerability of oligodendrocyte precursors is considered as central to the pathogenesis of PVL. These cells are susceptible to a variety of injurious stimuli including free radicals and excitotoxicity induced by hypoxic‐ischemic injury (resulting from cerebral hypoperfusion), lack of trophic stimuli, as well as secondary associated events involving microglial and astrocytic activation and the release of pro‐inflammatory cytokines TNF‐α and IL‐6. It is yet unclear whether activated astrocytes and microglia act as principal participants in the development of PVL lesions, or whether they are representatives of an incidental pathological response directed towards repair of tissue injury in PVL. Nevertheless, the accumulated evidence points to a pathological contribution of microglia towards damage. The topography of lesions in PVL most likely reflects a combination of the relatively immature cerebrovasculature together with a failure in perfusion and/or hypoxia during the greatest period of vulnerability occurring around mid‐to‐late gestation. Mechanisms underlying the pathogenesis of PVL have so far been related to prenatal ischemic injury to the brain initiated within the third trimester, which result in global cognitive and developmental delay and motor disturbances. Over the past few years, several epidemiological and experimental studies have implicated intrauterine infection and chorioamnionitis as causative in the pathogenesis of PVL. In particular, recent investigations have shown that inflammatory responses in the fetus and neonate can contribute towards neonatal brain injury and development‐related disabilities including cerebral palsy. This review presents current concepts on the pathogenesis of PVL and emphasizes the increasing evidence for an inflammatory pathogenic component to this disorder, either resulting from hypoxic‐ischemic injury or from infection. These findings provide the basis for clinical approaches targeted at protecting the premature brain from inflammatory damage, which may prove beneficial for treating PVL, if identified early in pathogenesis.
Ischemic rat brain extracts induce human marrow stromal cell growth factor production
Authors: Chen Xiaoguang , Li Yi , Wang Lei , Katakowski Mark , Zhang Lijie , Chen Jieli , Xu Yongxian , Gautam Subhash C. , Chopp Michael
Published: March 2003

Intravenous administration of human bone marrow stromal cells (hMSCs) after middle cerebral artery occlusion (MCAo) in rats provides functional benefit. We tested the hypothesis that these functional benefits are derived in part from hMSC production of growth and trophic factors. Quantitative sandwich enzyme‐linked immunosorbent assay (ELISA) of hMSCs cultured with normal and MCAo brain extracts were performed. hMSCs cultured in supernatant derived from ischemic brain extracts increased production of brain‐derived neurotrophic factor (BDNF), nerve growth factor (NGF), vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF). These neurotrophins and angiogenic growth factors increased in a post‐ischemia time‐dependent manner. The hMSC capacity to increase expression of growth and trophic factors may be the key to the benefit provided by transplanted hMSCs in the ischemic brain.
Evaluation of coagulation and fibrinolysis in haemodialysis patients at different haematocrit levels: Comparison between patients with and without diabetes
Authors: SATO Mitsuhiro , OHGIYA Hiroshi , TAGUMA Yoshio
Published: March 2003

SUMMARY: There is an insufficient number of reports concerning the optimal haematocrit level for haemodialysis patients with diabetes. Although many reports have indicated that recombinant human erythropoietin (rHuEPO) therapy does not influence the incidence of intravascular thrombosis, no study has focused its attention on the difference of the coagulation‐fibrinolysis system between haemodialysis patients with and without diabetes. We studied eight patients with diabetes and seven patients without diabetes who had been undergoing regular haemodialysis. In all 15 patients, rHuEPO administration was started at a haematocrit level of 20% and toe haematocrit tevels were gradually increased from 20 to 30%. Coagulation and fibrinolysis functions, measured at haematocrit levels of 20,25 and 30%, respectively, were compared between the two groups. In the diabetic group, platelet count, fibrinogen, thrombin‐antithrombin III complex, frtmn/fibrinogen degradation products = D dimer, platelet factor 4 and platelet adhesion were statistically higher (P < 0.05), and plasminogen and α2‐plasmin inhibitor was statistically lower (P < 0.05) than those in the non‐diabetic group, even at the 20% level. These abnormalities at the baseline were extremely enhanced in connection with haematocrit increased by rHuEPO. the diabetic group, in particular, showed greater increases of platelet factor 4, platelet adhesion and thrombomodulin and a decrease of α2‐plasmin inhibitor from the 20% to the 30% level (P < 0.05) than the non‐diabetic group. These findings suggest that haemodialysis patients with diabetes generally have enhanced thrombotic parameters compared with haemodialysis patients without diabetes, and the increase of haematocrit makes the difference greater. Accordingly, the target level of haematocrit for patients with diabetes should be set separately from that of patients without diabetes.
Evaluation of serum cystatin C levels and 99mTechnetium‐mercaptoacetyltriglycine‐3 renal scintigraphy for the early detection of cisplatin‐induced renal toxicity in cancer patients
Authors: GÜNEL Nazan , COSKUN Ugur , YAMAÇ Deniz , ABAMOR Evrim , DEMIRTAS Selda , ATASEVER Tamer , KARACA Levent
Published: March 2003

SUMMARY: Cisplatin has a broad‐spectrum antineoplastic activity. Nephrotoxicity is a prominent component of the toxicity profile of cisplatin‐based chemotherapy. In recent years, several reports have confirmed that cystatin C (cys‐C) demonstrates a better correlation with the glomerular filtration rate than with serum creatinine. Scintigraphic techniques are also widely used in evaluating renal function. In the present study, serum cys‐C, serum creatinine concentrations and 99mTechnetium‐mercaptoacetyltriglycine‐3 (99mTc‐MAG‐3) scintigraphy were studied in 22 cisplatin‐naive cancer patients, 3 days before and 24 h after the first cycle of cisplatin‐based chemotherapy. Serum cystatin C and creatinine levels increased in cancer patients after chemotherapy (creatinine: from 68 ± 12 to 72 ± 17 nmol/L; cystatin‐C: from 0.064 ± 0.025 to 0.072 ± 0.033 jimol/L), but these differences were not statistically significant (P>0.05). Semiquantitative variables of 99mTc‐MAG‐S scintigraphy significantly elevated after chemotherapy (T½*: from 10.27 ± 5.00to 16.17 ± 9.40 min, R20/max*: from 0.40 ± 0.12 to 0.67+0.45, Tmax**: from 5.40 ± 4.01 to 7.59 ± 5.30 min; *P<0.001, **P<0.01, respectively). These results suggest that MAG‐3 scintigraphy is a highly sensitive method in the early detection of cisplatin‐induced nephrotoxicity. Serum cystatin C doesn't seem to play a role in the early detection of cisplatin‐induced nephrotoxicity. As a result, MAG‐3 scintigraphy may be used in selected patients who have a predisposition for renal toxicity.
Efficacy of cyclosporin in difficult‐to‐treat idiopathic membranous nephropathy
Authors: ALEXOPOULOS Efstathios , PAPAGIANNI Aikaterini , ECONOMIDOU Dominiki , VAINAS Andreas , MEMMOS Dimitrios , PAPADIMITRIOU Menelaos
Published: March 2003

SUMMARY: Poor tolerance and the potential long‐term toxicity have limited the widespread use of corticosteroids and cytotoxic drugs in the treatment of idiopathic membranous nephropathy (IMN). Cyclosporin A (CyA) has been proven to be a less toxic alternative, but its efficacy needs further confirmation. Cyclosporin A (2–3mg/kg per day) in combination with low‐dose methylprednisolone (4mg/day) was given to 28 nephrotic patients with IMN who had failed to respond, or tolerate, or to complete treatments with steroids and/or cytotoxic drugs. the mean duration of treatment was 11 ± 7 months. Seven patients (25%) showed a complete remission of proteinuria, 17 (60%) a partial one, and four (15%) did not respond at all. the average time to achieve optimal remission was 4.2 ± 1.4 weeks following the initiation of therapy. In those who responded completely or partially, plasma creatinine (Per) did not change significantly from pre CyA levels during follow up (1.0 ± 0.3 vs 1.2 ± 0.3mg/dL, P=NS). the remaining four patients who had renal insufficiency already before CyA (mean Per: 2.1 ± 0.8mg/dL), showed a rapid deterioration of renal function after the initiation of CyA (mean Per: 3.1 ± 1.5 mg/dL, P<0.01), and as a consequence, the drug was discontinued. A mul‐tivariate analysis on the clinical and histological features demonstrated that the degree of renal function impairment (P<0.02), the percentage of obsolete glomeruli (P<0.01), and the severity of interstitial fibrosis (P<0.005) independently predicted the response to therapy. Low dose CyA is an effective and safe alternative treatment for patients with IMN and normal renal function. However, the drug should be given with caution to patients with established renal insufficiency.
Impact of a multidisciplinary team approach upon patency rates of arteriove
Authors: TREACY P John , SNELLING Paul , RAGG Joe , CARSON Phillip , O'ROURKE Ian
Published: March 2003

SUMMARY: A team approach to fistula surgery, with a weekly ward round and elective fistula list, was introduced at the Royal Darwin Hospital in April 1999. This study has evaluated the impact of this team approach and assessed factors influencing fistula patency. Data was prospectively recorded on all patients who underwent fistula surgery between 1993 and August 2000. Three hundred and forty‐seven operations were performed in 161 patients, with 142 (41%) for revision of an established fistula. One hundred and nine operations (m 79 patients) were performed after the onset of the team approach. A 30‐day fistula patency rate was significantly greater for new operations than revision operations, at 86 and 77% (P= 0.047). Primary and secondary patency rates were 56 and 75%, respectively, at 1 year, and 38 and 42% at 3 years. Factors associated with reduced duration of fistula patency following any operation included operations before the team approach (P=0.0002), operations out‐of‐hours (P=0.020), use of an interposition graft (P=0.035), and persons NOT of aboriginal race (P=0.007). Diabetes was suggestive of reduced patency (P=0.065). the only factor associated with reduced secondary patency was the use of an interposition graft (P= 0.020). Factors not shown to influence primary or secondary patency included the artery or vein used, peripheral vascular disease, hypertension, cerebrovascular disease, and the particular surgeon who performed the operation. Out‐of‐hours surgery was reduced, from 37 to 28% by the dedicated theatre list We conclude that the team approach to fistula surgery, with a dedicated theatre list, prolongs fistula patency, plus allows the surgeon to steep at night. an interposition graft should be avoided whenever possible.
Role of β2 integrins in glomerular leucocytes in Henoch‐Schoenlein purpura nephritis: an age‐matched comparative study with immunoglobulin A nephropathy
Authors: JIN Shilan , OOTAKA Tetsuya , SOMA Jun , SATO Toshinbbu , SATO Hiroshi , ITO Sadayoshi , SAITO Takao
Published: March 2003

SUMMARY: A comparative immunohistological study was performed for the glomerular deposition of complements (C1q and C3c), fibrin/fibrinogen‐related antigen (FRA), the expression of intercellular adhesion molecule‐1 (ICAM‐1), and the infiltration of leucocytes bearing β2 integrins (leucocyte function associated antigen‐1 (LFA‐1), complement receptor 3 (CR3) and complement receptor 4 (CR4)) on renal biopsy specimens from 49 cases with Henoch‐Schoenlein purpura nephritis (HSPN), and 49 age‐matched cases with immunoglobulin A nephropathy (IgAN). the glomerular expression of ICAM‐1 was signifcantly correlated with the glomerular infiltration of leucocyte function associated antigen (LFA)‐1+ leucocytes in both diseases, and with that of CR3+ leucocytes in HSPN. the expression of ICAM‐1 was closely localized with the infiltration of LFA‐1+ leucocytes in the study with double immunostaining. the incidence and intensity of glomerular deposition of FRA were significantly higher in HSPN than in IgAN (P< 0.001), and those of C3c were significantly lower in HSPN than in IgAN (P< 0.001). the glomerular deposition of FRA was significantly correlated with the glomerular infiltration of CR4+ leucocytes in HSPN (P<0.05) but not in IgAN. In contrast, the glomerular deposition of C3c was significantly correlated with the glomerular infiltration of CR4+ leucocytes in IgAN (P<0.05), but not in HSPN. Studies with double immunostaining revealed a close association of CR4+ leucocytes with FRA deposition in HSPN and with C3c deposition in IgAN, respectively. the number of glomerular leucocytes bearing β2 integrins was significantly correlated with urinary protein at the time of renal biopsy in both diseases. These results suggested the differential roles of β2 integrins in the induction of glomerular injury in HSPN and IgAN. the ICAM‐1/LFA‐1 interaction may commonly be involved in the glomerular infiltration of leucocytes in both diseases. the ICAM‐1/CR3 interaction may be involved only in HSPN. Complement receptor 4 may function as a fibrin/fibrinogen receptor in HSPN, while CR4 may function as a complement receptor in IgAN.
Re‐framing the representation of women in advertisements for hormone replacement therapy
Authors: Whittaker Rosemary
Published: March 2003

This article examines and presents examples of contemporary advertising within the medical and health professions that continue the process and organisation of knowledge about women and their reproductive bodies. It draws on feminist and poststructural perspectives to inform a critical evaluation of the visual representations of menopausal women and hormone replacement therapy. These representations work to construct certain definitions of the feminine that sustain and support existing contradictory cultural meanings and values about menopause. I argue that the images continue to misrepresent and define what forms of femininity and sexual gender are desirable and acceptable for menopausal women. The article addresses the problems of gender discrimination and bias within the advertising industry, and illustrates the ways in which readers of visual texts may be influenced by stereotypic assumptions concerning a woman's lived experience of menopause. It illustrates how specific symbolic images directed towards men and women for hormone replacement therapy, testosterone deficiency and sexual dysfunction influence the viewer's decision making and action responses.
Understanding the prattle of praxis
Authors: Penney Wendy , Warelow Philip J.
Published: March 2003

Understanding the prattle of praxis

This paper will examine and discuss some of the strengths and weaknesses of conceiving nursing as a form of praxis, encompassing within this, the idea that in order to conceive nursing as a form of praxis, reflection has to be considered a key component. It will be argued that praxis can (and should) become a practical process and that, when applied to one’s own nursing practice, changes, reshapes and allows one to discover new meanings (or, draws out the meanings which were always there). Clearly there are many different forms, understandings and applications of the term praxis and this paper will examine some of the tensions and the nexus that exist. These claims will be supported by using personal–professional journal extracts as a catalyst, showing that there is potential for closing the theory–practice gap through more in‐depth reflection, and that this examination using reflective techniques will demonstrate that nurses, by using this process develop their own implicit personal nursing theories. Using one’s colleagues as a critical resource allows what might be described as ongoing reflection to occur, where critical friends in both theoretical and practice worlds act as a dialectical catalyst for growth and change, moving toward closing the theory–practice gap.
Please don’t call me ‘dear’: older women’s narratives of health care
Authors: Feldman Susan
Published: March 2003

This paper foregrounds some of the central themes that a group of older women in writing workshops identified as integral to their health and overall quality of life. In particular it looks at how these women felt about their relationship to professional health care providers, and the role that both play in the maintenance of the women’s health and well‐being. The research that it is based on comes from narratives and autobiographical stories written by these women, which aimed both to identify the issues and concerns that affect them as older women, and to position them centrally as agents and collaborators in intellectual work. Their challenging words disrupted conventional story lines about the experiences of growing older, and confronted the narrow range of negative images of ageing and the accompanying stereotypes that currently pervade our culture.
Dance events as a caregiver intervention for persons with dementia
Authors: Palo‐Bengtsson Liisa , Ekman Sirkka‐Liisa
Published: March 2003

Dance events as a caregiver intervention for persons with dementia

The aim of the study was to illuminate the phenomenon of dance events as a caregiver intervention for persons with dementia in one nursing home as described by the caregivers. Seven caregivers were interviewed. The interviews were unstructured and conducted while the caregivers were watching a video of dance events arranged in the nursing home. The analysis was carried out using the phenomenological method developed by Giorgi. The results are presented in five consistent themes: (1) prerequisites for dance events; (2) creating and preparing different kinds of activities related to the dance events; (3) emotional arousal; (4) caregivers’ situational understanding; and (5) dance events and contextual consequences and synthesis into a general structure. The meaning of the dance events as a caregiver intervention was founded not only on the dancing itself but also encompassed the ontological state of ‘being together’.
From personal reflection to social positioning: the development of a transformational model of professional education in midwifery
Authors: Phillips Diane , Fawns Rod , Hayes Barbara
Published: March 2003

A transformational model of professional identity formation, anchored and globalized in workplace conversations, is advanced. Whilst the need to theorize the aims and methods of clinical education has been served by the techno‐rational platform of ‘reflective practice’, this platform does not provide an adequate psychological tool to explore the dynamics of social episodes in professional learning and this led us to positioning theory. Positioning theory is one such appropriate tool in which individuals metaphorically locate themselves within discursive action in everyday conversations to do with personal positioning, institutional practices and societal rhetoric. This paper develops the case for researching social episodes in clinical education through professional conversations where midwifery students, in practice settings, are encouraged to account for their moment‐by‐moment interactions with their preceptors/midwives and university mentors. It is our belief that the reflection elaborated by positioning theory should be considered as the new epistemology for professional education where professional conversations are key to transformative learning processes for persons and institutions.
Activation of non‐primary motor areas during a complex finger movement task revealed by functional magnetic resonance imaging
Authors: Moriyama Toshihiro , Yamanouchi Naoto , Kodama Kazuhiro , Murakami Atsuhiro , Okada Shin‐Ichi , Noda Shingo , Komatsu Naoya , Sato Toshio , Kusaka Tadahumi , Kato Kouichi
Published: March 2003

We examined the brain activation induced by a complex finger movement task using functional magnetic resonance imaging (fMRI) with echo planar imaging (EPI). Imaging planes were set up for the observation of non‐primary motor areas. Among five normal males examined, four subjects naive to the task showed activations in contralateral primary and supplementary motor areas and the ipsilateral superior anterior part of the cerebellar hemisphere. Also, the bilateral premotor areas and the contralateral ventrolateral nucleus of thalamus were occasionally activated. No changes were observed in the putamen and globus pallidus. The subject accustomed to the task showed activation in the narrow areas of the contralateral primary motor and supplementary motor and premotor areas but not in the cerebellum. These results suggest that fMRI has nearly the same degree of detectability to that of positron emission tomography (PET) in regard to motor functions.
Effect of flunitrazepam on sleep and memory
Authors: Misaki Kiwamu , Nakagawa Hiroki , Koshino Yoshifumi , Kishi Hideo , Ota Tadaaki , Okuda Kyouko , Kanda Izumi , Isaki Kiminori , Ito Tatuhiko
Published: March 2003

Flunitrazepam’s (FNZ) effect on sleep and memory 1 mg and 2 mg was investigated in 6 healthy volunteers (mean age 21.5 ± 0.8 years) by polysomnography (PSG) and memory testing. A PSG was recorded on each study night. Memory testing was done before sleep (40 min after taking FNZ or placebo), and after waking (560 min after medication). Rapid eye movement (REM) latency was found to be prolonged on the FNZ 2 mg night (FNZ2N) compared to the baseline night (BN). Percentage of stage 2 sleep was increased in the FNZ2N as compared to BN, while REM percentage on both FNZ nights did not significantly differ from BN. The number of total REM and REM density were decreased in the FNZ2N compared to BN. Memory testing showed significant differences between before sleep and after waking on the FNZ2N. There was a significant correlation between the degree of impairment on memory testing and the rate of reduced REM density, but there was no significant correlation between degree of impairment on memory testing and the rate of increased non‐REM sleep on the FNZ2N. The results of this study suggest that impairments in memory result from the dose of FNZ, and that there is a possibility of a relationship between memory disturbance and REM sleep suppression caused by this benzodiazepine.
Mental health services in Asia: International perspective and challenge for the coming years
Authors: Shinfuku Naotaka
Published: March 2003

In contrast to European countries and the United States of America, there has been a steady increase in the psychiatric inpatient population in Japan between 1960 and 1993. Japan has the biggest number of psychiatric beds in the world, both in absolute and relative numbers per population. However, Japan now focuses on community based services and the human rights of patients. In other Asian countries, the number of psychiatric beds is relatively small; however, the numbers are increasing each year in China, the Republic of Korea, Philippines, Indonesia and in many other countries in Asia. These countries are still facing the challenge of increasing psychiatric services and to improve the quality of care with scarce mental health resources. Should Asian countries take the similar path to European countries and develop mental health services? This review provides an overview of Asian mental health services and discussing the following issues: how many psychiatric beds do we need in Asia?; public vs private psychiatric services?; financing scheme to promote community based care in Asia; mental health services in primary health care; family education and user involvement in Asia; and the challenge for psychiatrists in Asia.
Effects of trazodone hydrochloride and imipramine on polysomnography in healthy subjects
Authors: YAMADERA HIROSHI , NAKAMURA SHUICHI , SUZUKI HIDEAKI , ENDO SHUNKICHI
Published: March 2003

Polysomnography was performed on eight healthy men with trazodone hydrochloride, imipramine and placebo. Trazodone hydrochloride increased slow wave sleep significantly. Imipramine prolonged rapid eye movement (REM) latency and decreased the percentage of REM sleep significantly. Trazodone decreased stages 1 and 2 sleep, while imipramine increased it. These findings suggest that the antidepressive effect of trazodone might be different from that of imipramine with the suppression of REM sleep.
Electrolytes in erythrocytes of patients with depressive disorders
Authors: KAMEI KENJI , TABATA OSAMU , MUNEOKA KATSUMASA , MURAOKA SHIN‐ICHIRO , TOMIYOSHI RIKA , TAKIGAWA MORIKUNI
Published: March 2003

The concentrations of calcium, sodium, potassium and magnesium in the erythrocytes of patients were measured in the active and remission phases of depressive disorders. Twelve patients in the active phase and 19 patients in remission with major depression were studied and compared with 20 age‐matched healthy controls. Patients with major depression in both active and remission phases showed significantly lower calcium concentrations in the erythrocytes compared with controls, although no significant differences in sodium, potassium or magnesium concentrations were found among the three groups. In addition, no differences were found in the electrolyte concentrations between the active and remission phases in the same patients. This calcium concentration had no relationship to the age, gender, or medication drugs of the subjects. Low calcium concentrations were found in the erythrocytes of depressed patients, which may be a relevant marker for depression.
Rapid transcranial magnetic stimulation and normalization of the dexamethasone suppression test
Authors: Saxby Pridmore
Published: March 2003

Non‐suppression of post‐dexamethasone cortisol is a feature of endogenous/melancholic depression. Normalization of the dexamethasone suppresion test (DST) response is a feature of remission and antidepressant treatment. Twelve consecutive depressed non‐suppressers were treated with rapid transcranial magnetic stimulation (rTMS). Six demonstrated normalization and good clinical improvement which was sustained for at least 1 month. Thus, rTMS has some biological effects in common with other antidepressant treatments.
Changes in sleep–wake cycle during the period from late pregnancy to puerperium identified through the wrist actigraph and sleep logs
Authors: Shinkoda Harumi , Matsumoto Kazuya , Park Young Man
Published: March 2003

The purpose of this study was to understand the sleep–wake cycle during the period from late pregnancy to about 3 months of postpartum by evaluating the number of actigraphic activities in four women (one multipara and three primi gravidae), and to compare the results with the findings from sleep logs. An irregularity of the sleep–wake cycle with increased number of wakings at night was notable during about 1 month after delivery, compared to the late pregnancy period, and subsequently this number tended to decrease. These results were indicative of the association between the lactation cycle to neonates and the sleep–wake cycle.
A case of nocturnal polyuria in olivopontocerebellar atrophy
Authors: Miyamoto Tomoyuki , Miyamoto Masayuki , Yokota Noritsugu , Hirata Koichi , Katayama Soichi
Published: March 2003

We report a case of olivopontocerebellar atrophy without sleep apnea syndrome who presented nocturnal polyuria. It is considered that a disturbance in the circadian rhythm for arginine vasopressin secretion due to degeneration of suprachiasmatic nuclei and marked increase in the secretion of atrial natriuretic peptide due to abnormal diurnal variation in blood presssure may be involved in the mechanism of nocturnal polyuria.
Effect of trazodone in a single dose before bedtime for sleep disorders accompanied by a depressive state: Dose‐finding study with no concomitant use of hypnotic agent
Authors: Mashiko Hirobumi , Niwa Shin‐Ichi , Kumashiro Hisashi , Kaneko Yoshihiro , Suzuki Satoru , Numata Yoshihiko , Horikoshi Ryu , Watanabe Yoshinori
Published: March 2003

This was the first dose‐finding study of trazodone that was designed to be free of the concomitant use of hypnotics, in which the drug was administered in a single dose for sleep disorders combined with a depressive state. As a result, trazodone at the dosage of 50–100 mg/day improved sleep disorders, particularly at the 100 mg/day dosage. It was confirmed that trazodone improved sleep disorders combined with a depressive state when it was administered in a single dose before bedtime with no concomitant hypnotics.
The lower entrainable limit of rat circadian rhythm to sinusoidal light intensity cycles: A preliminary study
Authors: Usui Setsuo , Okazaki Terue , Takahashi Yasuro
Published: March 2003

The lower entrainable limit of the circadian behavioral rhythm was examined in rats exposed to sinusoidal light intensity cycles with maximum illuminance of 20 lux and the minimum of 0.01 lux. The period (T) of the light intensity cycle was initially kept at 23.5 h for 20 cycles, and then shortened to 23 h for 33 cycles. Thereafter the rats were released into constant darkness. Five out of 10 rats entrained their circadian rhythms to T = 23.5‐h cycle, and they also entrained to the T = 23‐h cycle. The phase angle of entrainment was almost unchanged when T was shortened from 23.5 h to 23 h. These results suggest that the T = 23‐h cycle was close to the lower limit of entrainment.
Effects of zolpidem and zopiclone on cognitive and attentional function in young healthy volunteers: An event‐related potential study
Authors: Nakajima Toru , Takazawa Satoru , Hayashida Seiki , Nakagome Kazuyuki , Sasaki Tsukasa , Kanno Osamu
Published: March 2003

The effects of zolpidem and zopiclone, non‐benzodiazepine ultra‐short‐acting hypnotics, on cognitive function and vigilance level were investigated in the morning following nocturnal administration using event‐related potentials (ERP) and a sleep latency test (SLT). Zopiclone significantly shortened the sleep latency the following morning, whereas zolpidem did not, perhaps due to the difference in the elimination half‐lives between the compounds. No significant effect was observed for either drug on the ERP indices, including the P3, mismatch negativity and negative difference components. At a clinically prescribed dosage these sleep inducers have no remarkable effect on cognitive or attentional functions but increase sleepiness of the subjects.
Tau protein is a potential biological marker for normal pressure hydrocephalus
Authors: Kudo Takashi , Mima Tatsuo , Hashimoto Ryouta , Nakao Kazuhisa , Morihara Takashi , Tanimukai Hitoshi , Tsujio Ichiro , Koike Yuko , Tagami Shinji , Mori Hiroshi , Nakamura Yu , Tanaka Toshihisa , Mori Koreaki , Takeda Masatoshi
Published: March 2003

A biological marker for normal pressure hydrocephalus (NPH) is beneficial for evaluation of its severity and of indications for shunt operation. Tau protein was initially considered as a biological marker in cerebrospinal fluid (CSF) from Alzheimer’s patients. Recently, it has been demonstrated that degeneration in the brain causes elevation of tau in CSF. Therefore, the tau level in CSF from NPH patients was evaluated. Tau levels in CSF from NPH patients were significantly higher than that in controls. The tau levels were correlated with the severity of dementia, urinary incontinence, and gait disturbance in NPH. These results suggest that CSF tau may be useful as a biological marker for NPH to determine the level of neuronal degeneration.
Analysis of the human sleep electroencephalogram by the correlation dimension
Authors: Kobayashi Toshio , Madokoro Shigeki , Ota Tadaaki , Ihara Hisataka , Umezawa Yumiko , Murayama Jyunichi , Kosaka Hirotaka , Misaki Kiwamu , Nakagawa Hiroki
Published: March 2003

Sleep electroencephalograms (EEG) of healthy male subjects were analyzed by the correlation dimension. The mean correlation dimensions significantly decreased from stage ‘awake’ to stages 1, 2 and 3 and increased during rapid eye movement sleep. The mean correlation dimensions of the sleep EEG in the second half of the night were significantly higher than those in the first half of the night. These significant changes were also seen during sleep stage 2.
A case study of temporal change in EEG alpha activity in a multiple sleep latency test
Authors: Hirano Shingo , Hiroshige Yoshiharu
Published: March 2003

The appearance of electroencephalogram (EEG) alpha activity in a multiple sleep latency test was quantitatively analysed using percentage time alpha. Two components were extracted from the temporal change in smoothed percentage time alpha: a general level showing a progressive decrease and a cyclic variation with a mean interval of 39.8 s. The cyclic variation of percentage time alpha was evident during the period of the general level below 50%. The arousal cycle in the drowsy state is discussed.
Two nap sleep test: An easy objective sleepiness test
Authors: Suzuki Hiroyuki , Moriguchi Kazuhiko , Matsuura Masato , Kojima Takuya , Matsuda Tetsuya , Noda Yuji , Minemura Hiroshi , Yamamoto Hitoshi , Akashiba Tsuneto , Horie Takashi
Published: March 2003

The two nap sleep test (TNST) was developed and its usefulness for detecting sleepiness in long‐distance drivers has been reported. This study’s authors attempted to apply the TNST as a clinical test of sleepiness. A normal control group (n = 29), an obstructive sleep apnea syndrome (OSAS) group (n = 9), and another sleep disorder group (n = 6) participated. As a result of polysomnography, the sleep latency and sleep time did not differ among the groups. In contrast, the frequency of micro‐arousal and movement arousal was significantly higher in the OSAS group than in the other groups. The TNST is thought to be useful for evaluating disturbance of sleep maintenance.
Depression among caregivers of the frail elderly in urban Japan
Authors: Matsuu Katsue , Washio Masakazu , Arai Yumiko , Ide Saburo
Published: March 2003

Abstract A cross‐sectional study was conducted in order to investigate the various factors related to the depression in caregivers of the elderly in need of care in urban Japan. The caregivers answered a self‐administered questionnaire about various factors that may affect their depression, and also completed a Center for Epidemiologic Studies Depression Scale evaluation (CES‐D). Compared with non‐depressed caregivers, depressed caregivers attended the elderly longer, while time spent for physical caregiving did not differ between the two groups. Even after controlling confounding factors, time of attending the elderly was an independent factor related to caregiver's depression.
Stimulus dose titration for electroconvulsive therapy
Authors: Chung Ka Fai , Wong Susan Joyce
Published: March 2003

Abstract Stimulus dose titration for electroconvulsive therapy (ECT), the method to determine seizure threshold accurately, has not been commonly practiced. We describe our early experience of dose titration in 22 Chinese patients and compare seizure thresholds measured by dose titration with values predicted by the formula‐based ‘half‐age’ method. Seizure thresholds, as measured by dose titration, varied fourfold among our sample and the average value was 105.5 mC or 16.7 J. At the titration session, 27% of patients had seizures after a single stimulation and 37% had seizures after two stimulations. Only one patient required four stimulations to induce a seizure. No patient had significant adverse events associated with the dose titration procedure. The ‘half‐age’ method in average overestimated seizure thresholds by 44% when compared with that measured by dose titration and in 23% of our sample, the overestimation was more than 100%. The pros and cons of dose titration and ‘half‐age’ prediction method will be discussed. Our early experience suggests that dose titration could be performed in the majority of patients receiving ECT.
Association of gastroesophageal reflux disease with weight gain and apnea, and their disturbance on sleep
Authors: Suganuma Nakamori , Shigedo Yoshihisa , Adachi Hiroyoshi , Watanabe Takuya , Kumano‐Go Takayuki , Terashima Kiyoji , Mikami Akira , Sugita Yoshiro , Takeda Masatoshi
Published: March 2003

Obesity is a common predisposition to gastroesophageal reflux disease (GERD) and obstructive sleep apnea syndrome (OSAS). By statistical analysis of the respondents to a questionnaire that was distributed to members of the Kansai Rugby Association, we examined whether weight gain increased the incidence of these diseases and whether GERD alone disturbs sleep. Prevalence distribution of GERD by age differed from another survey, which suggests that predispositions other than age may contribute to GERD. Weight gain tended to increase the incidence of GERD. In our epidemiological study, both GERD (particularly nocturnal reflux) and OSAS significantly contributed to sleep disturbance. Although GERD alone seemed to be one of several independent factors of sleep disturbance, it was not a weak factor.
Is DSM widely accepted by Japanese clinicians?
Authors: Someya Toshiyuki , Takahashi Makoto , Takahashi Makoto
Published: March 2003

Abstract The Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM‐III), a new standardized diagnostic system with multiaxial diagnosis, operational criteria and renewed definitions of mental disorders, was introduced in 1980 and prompted movements to reform conventions in Japanese psychiatry. This review overviews the initial response of Japanese clinicians to accept DSM‐III, and its effects on the development of systematic research of psychiatric diagnosis. These new research activities include those on reliability of psychiatric diagnosis, application of various evaluation tools, discussion on the concept of mental disorders, relation of personality disorders with depressive disorders, and Taijin‐kyofusho, or culturally distinctive phobia in Japan. A reference database search to survey the latest trend on psychiatric research indicated that the number of papers published by Japanese workers increased sharply after 1987, and DSM apparently greatly influenced their internationalization. Twenty years after the publication of DSM‐III, a questionnaire on the use of DSM‐IV was set out in 2000 to survey how widely DSM is utilized in clinical practice in Japan. Two hundred and twelve psychiatrists answered the questionnaire, and the results show that DSM has been accepted positively by the younger generation, while the older generation (over 40s) has still less interest in DSM, and DSM is used mainly for research purposes rather than in daily practice.