bluuebunny/crossref_metadata_2025 huggingface dataset:
Transformative unlearning: safety, discernment and communities of learning
Authors: Macdonald Geraldine
Published: March 2003

Transformative unlearning: safety, discernment and communities of learning

This paper aims to stimulate awareness about the intellectual and emotional work of ‘unlearning’ in knowledge workers in the emerging learning age. The importance of providing a safe space for dialogue to promote transformative learning, through building ‘communities of learning’, is highlighted. Unlearning is conceptualized within a transformative education paradigm, one whose primary orientation is discernment, a personal growth process involving the activities of receptivity, recognition and grieving. The author utilizes the metaphor of an unfolding spiral path to explore her experience of needing to ‘unlearn’ a trusted nursing practice prior to ‘learning’ new best caring practices related to infant sleep positions. Macro and micro approaches to facilitating unlearning in organizations, in learners and in nurses are suggested.
Theorising culture and culture in context: institutional excellence and control
Authors: Beil‐Hildebrand Margitta B.
Published: March 2003

In this paper an attempt is made to focus on the ideological and practical implications of the new cultural forms of healthcare sector management variously described as institutional excellence, empowerment, total quality and human resource management. Thus, I look in detail at the managerial and academic claims concerning the mobilisation of corporate culture and go on to emphasise the impact which the literature of culture management has had on nursing employees and healthcare organisations. I also highlight the restrictions of the applied research approaches and argue that the managerial and poststructural literature is limited in that its conceptualisation of culture and change is incomplete. The focus switches then to a range of literature which has been used to study change with a labour process perspective and explains why an approach based upon the study of the disparity between the cultural rhetoric and the day‐to‐day practice, as well as how people experience and respond to that disparity, is to be preferred. Furthermore, I gain substance from a variety of viewpoints in order to discover a suitable way of putting the matter of interest into context. Drawing on the analytical framework of the sector model, which differentiates in the economy between private and state production sectors, it is possible to distinguish between the different modes of rationality governing each sector. As a basis for further contextualisation, the powerful and privileged positions of nursing as well as other healthcare professionals and the distinctive character of their employment relationships are considered. The paper concludes that an extended labour process analysis is necessary to challenge the way in which the concept of culture is applied by nursing academics and practitioners.
‘Patient satisfaction’: knowledge for ruling hospital reform — An institutional ethnography
Authors: Rankin Janet M.
Published: March 2003

‘Patient satisfaction’: Knowledge for ruling hospital reform — An institutional ethnography

Driven by funding restraint, Canadian health‐care has undergone over a decade of significant reform. Hospitals are being restructured, as text‐based practices of accountability bring a new business‐orientation into hospital and clinical management. New forms of knowledge, generated through records of various sorts, are a necessary resource for managing care in the new environment. This paper's research uses Canadian sociologist Dorothy E. Smith's institutional ethnographic methodology to critically analyse one instance of text‐based management. I analyse information about ‘patient satisfaction’ as it is generated through a patient survey (in which I was implicated through my involvement with a hospitalized family member). Subsequently, I have studied the management environment into which that information would be entered. I argue that in the instance analysed, the information becomes part of a dominant consumer oriented healthcare discourse that subordinates concerns about ‘what actually happened’ as a professional caregiver would have known it. On this basis, I contend that this sort of taken‐for‐granted approach to making decisions about quality care in hospitals may be seriously, even dangerously, flawed.
A polysomnographic study of sleep patterns in normal humans with low‐ or high‐anxiety personality traits
Authors: Kajimura Naofumi , Kato Masaaki , Sekimoto Masanori , Watanabe Tsuyoshi , Takahashi Kiyohisa , Okuma Teruo , Mizuki Yasushi , Yamada Michio
Published: March 2003

To clarify the effects of anxiety‐related personality traits on sleep patterns, polysomnographic examinations (PSG) were performed over 4 consecutive nights on normal humans who tested within the low‐ or high‐anxiety ranges. The subjects consisted of two groups of six male university students who scored either less than 45 points (low‐anxiety group) or more than 55 points (high‐anxiety group) on the Spielberger’s State Trait Anxiety Inventory. Compared to the levels of sleep change in the high‐anxiety group, the low‐anxiety group exhibited a greater change in REM sleep and stage 2 sleep. The REM sleep in the low‐anxiety group was shorter on the first and second nights compared to the third and fourth nights, and the stage 2 sleep was longer on the first night than on the remaining three nights. Thus, the low‐anxiety group showed a first‐night effect followed by partial recovery on the second night, while the high‐anxiety group exhibited no obvious first‐night effect. These results suggest that there is a difference in sleep patterns, assessed by consecutive PSG, between those with low‐ and high‐anxiety traits, and that anxiety‐related personality traits attenuate the occurrence of the first‐night effect, reflecting a lower adaptability to a novel environment.
The prevalence and pattern of insomnia in Japanese industrial workers: Relationship between psychosocial stress and type of insomnia
Authors: TACHIBANA HIROKI , IZUMI TAKASHI , HONDA SUMIHISA , TAKEMOTO TAI‐ICHIRO
Published: March 2003

We examined the prevalence of insomnia among Japanese male industrial workers and analyzed the effect of psychosocial stress on the prevalence of three types of insomnia: `difficulty in falling asleep', `frequent sleep interruption' and `early morning arousal'. The study population consisted of male day workers (n = 319) in a manufacturing heavy industry company located in Nagasaki City, Japan. The subjects answered a questionnaire consisting of six sleep‐related items and 24 questions related to occupational and private life conditions. A total of 271 men (average age 40.9 years) completed the questionnaire; a response rate of 85%. Insomnia within the month preceding the survey was present in 27.7% of the workers (75/271). Multiple logistic regression analysis demonstrated that different psychosocial stressors were associated with different types of insomnia. Visual display terminal (VDT) work overload was significantly associated with all types of insomnia, while `over‐involvement in the job' was associated with difficulty in falling asleep and early morning arousal. Our results demonstrated that the prevalence of insomnia in Japanese workers is similar to that reported among European and American general adult population. Our results also indicate that the use of VDT in the workfield is associated with insomnia.
Periodic fatigue symptoms due to desynchronization in a patient with non‐24‐h sleep–wake syndrome
Authors: SHIBUI KAYO , UCHIYAMA MAKOTO , IWAMA HISAYUKI , OZAKI SHIGERU , TAKAHASHI KIYOHISA , OKAWA MASAKO
Published: March 2003

A 43‐year‐old man complaining of recurrent fatigue symptoms and sleep disorders occurring periodically every 4 weeks was studied. Using a wrist worn actigraphy and an ambulatory rectal temperature monitoring apparatus, his sleep–wake cycle and rectal temperature were measured continuously for 4 months, while diagnostic evaluation and therapeutic interventions were conducted. It was found that after he gave up an attempt to keep to a 24‐h‐day, a free‐running sleep–wake pattern appeared but his fatigue symptoms disappeared. An analysis of the relationship between his sleep–wake cycle and the rectal temperature rhythm found that his fatigue symptoms did not appear when both rhythms were synchronized with each other. Artificial bright light therapy entrained him to a 24‐h day without relapsing of fatigue symptoms. Desynchronization between a 24‐h sleep–wake schedule and his circadian pacemaker may have caused his periodically appearing fatigue symptoms.
Circadian rhythm sleep disorders in adolescents: Clinical trials of combined treatments based on chronobiology
Authors: OKAWA MASAKO , UCHIYAMA MAKOTO , OZAKI SHIGERU , SHIBUI KAYO , ICHIKAWA HIRONOBU
Published: March 2003

Delayed sleep phase syndrome (DSPS) and non‐24‐h sleep–wake rhythm are circadian rhythm sleep disorders that are common in adolescents. Most patients have difficulty adjusting to school life, poor class attendance or refuse to go to school. Since a treatment has not been established, the present paper is presented to propose a strategy for treating circadian rhythm sleep disorders in adolescents, based on our clinical studies. Twenty subjects (12 males and eight females, mean age 16.2 ± 1.7 years) participated in the study. The onset of sleep disorder occurred between the ages of 11 and 17. The most common factors affecting the onset of disorders were changes in social environment. The subjects kept a sleep‐log for the periods before and during treatments. The treatments were based on chronobiology: resetting the daily life schedule, chronotherapy, regulation of the lighting environment, methylcobalamin, and/or melatonin. Bright light exposure was successful in 10 patients, of whom four were treated with methylcobalamin. Melatonin treatment was successful in two patients (one with and one without chronotherapy). Thirteen of the 20 patients were successfully, treated with therapies based on chronobiology. After consideration of these results, a step‐by‐step procedure of combined treatments for the circadian rhythm sleep disorders is proposed.
Recovery from psychological trauma
Authors: HERMAN JUDITH L.
Published: March 2003

Trauma destroys the social systems of care, protection, and meaning that support human life. The recovery process requires the reconstruction of these systems. The essential features of psychological trauma are disempowerment and disconnection from others. The recovery process therefore is based upon empowerment of the survivor and restoration of relationships. The recovery process may be conceptualized in three stages: establishing safety, retelling the story of the traumatic event, and reconnecting with others. Treatment of posttraumatic disorders must be appropriate to the survivor's stage of recovery. Caregivers require a strong professional support system to manage the psychological consequences of working with survivors.
The hypnotic effects of melatonin treatment on diurnal sleep in humans
Authors: Matsumoto Miki
Published: March 2003

This study investigated the hypnotic effects of 10 mg melatonin and placebo, which were administered at 10.00 h, according to a single‐blind crossover design, on an 8‐h diurnal sleep from 11.00 to 19.00 h, following a full night of sleep. The subjects were six healthy male students, each of whom underwent polysomnography and rectal temperature monitoring. Melatonin treatment significantly increased total sleep time in diurnal sleep (403.2 ± SD 72.8 min and 258.5 ± 118.3 min, P < 0.001). As to changes in rectal temperature during diurnal sleep, however, there were no significant differences between the melatonin and placebo conditions. Thus, these results indicated that melatonin administered at 10.00 h had direct hypnotic effects on diurnal sleep.
Validity of sleep log compared with actigraphic sleep–wake state II
Authors: Usui Akira , Ishizuka Yoshikazu , Obinata Ichio , Okado Tamio , Fukuzawa Hitoshi , Kanba Shigenobu
Published: March 2003

Twenty‐five young people (Y group), three elderly people and seven people with various sleep disorders (SD group) kept a sleep log for 2–7 days, and their wrist‐activity was monitored simultaneously. The sensitivity and specificity of the sleep log, and the ratio of agreement between the sleep log and actigraphic sleep‐wake state were calculated. The sensitivity and specificity in Y group were 87.93 ± 6.49% and 96.51 ± 2.37%, respectively. The sensitivity in SD group was significantly lower than in Y group. Even in Y group one‐hour agreement ratios dropped during the sleep onset period.
Effects of trazodone on polysomnography, blood concentration and core body temperature in healthy volunteers
Authors: Yamadera Hiroshi , Suzuki Hideaki , Nakamura Shuichi , Endo Shunkichi
Published: March 2003

Polysomnography, blood concentration and core body temperature recordings were performed on 12 healthy volunteers with administration of trazodone and placebo. Trazodone increased slow wave sleep (SWS), and decreased the average, the highest and lowest core body temperature significantly compared to placebo. The blood concentration of trazodone correlated positively with amplitude (the difference between the highest and lowest temperature) and %SWS during the first period of a sleep phase divided into three periods, and negatively with the lowest temperature. The appearance time of the lowest temperature correlated negatively with %SWS.
Demography of sleep disturbances associated with circadian rhythm disorders in Japan
Authors: Yazaki Mikako , Shirakawa Shuichiro , Okawa Masako , Takahashi Kiyohisa
Published: March 2003

To clarify the demography of delayed sleep phase syndrome (DSPS), non‐24‐h sleep–wake syndrome, and irregular sleep–wake pattern in Japan, a cross‐sectional nationwide epidemiological survey was conducted. 1525 adults (age: 15–59 years) were randomly sampled from telephone directories, and they received screening questions over the phone. Persons who were suspected of having the disorders were requested to fill out the second questionnaire, and asked to keep a sleep log for 4 weeks. Diagnoses were made according to the International Classification of Sleep Disorders criteria. As a result, the prevalence of DSPS was estimated to be 0.13%.
Epidemiological study on sleep habits and insomnia of new outpatients visiting general hospitals in Japan
Authors: Ishigooka Jun , Suzuki Makihiko , Isawa Shinano , Muraoka Hideo , Murasaki Mitsukuni , Okawa Masako
Published: March 2003

A large scale epidemiological survey of sleep habits, specifically for insominia, was conducted using 6277 new outpatients from 11 general hospitals in Japan. They were requested to answer a questionnaire newly designed for this study, which consisted of 34 questions concerning socio‐demographic characteristics, current medical conditions, sleep habits, current or past sleep complaints, symptoms of parasomnia, use of hypnotics/anxiolytics and other aspects of daily life. Insomnia was the focus of analysis using χ2 statistics and, additionally, logistic regression to explore the predictors of insomnia. Bedtime was 23:30 and wake‐up time was 6:35 on average, with a mean sleep time of 6.77 h on weekdays. The number of subjects with current sleep complaints was 1276, of which 735 (11.7% of the total sample) had insomnia lasting for 1 month or more. Only 37.6% of those were taking hypnotics and/or anxiolytics. Old age, female sex, neurology, psychiatry, early bedtime, late wake‐up time, living alone and dissatisfication with the bedroom environment for sleep were found to be associated with long‐term insomnia. This study helps to provide a framework for further studies using the general population.
General hospital psychiatry from the perspective of medical economics
Authors: Hosaka Takashi , Aoki Takayuki , Watanabe Toshiyuki , Okuyama Toru , Kurosawa Hisashi
Published: March 2003

The purpose of this study was to investigate the efficacy of consultation–liaison (C‐L) psychiatry from the perspective of medical economics, by comparing a part‐time and full‐time psychiatric department. One full‐time (5 days per week) psychiatrist began work at a general hospital (GH‐A), and one part‐time (once per week) psychiatrist had been working at another general hospital (GH‐B). Both general hospitals are teaching hospitals of the same size. The number of patients and the medical reimbursements were investigated each month and compared. This study demonstrated that the establishment of C‐L psychiatry was economically profitable in contrast with what was the common belief among general hospital administrators. Also, the differences in the total number of patients (GH‐A : GH‐B = 500 : 35–50 patients/month) and the total reimbursement (GH‐A : GH‐B = 3 million : 2–300 000 yen/month) was not explained by the number of working days (GH‐A : GH‐B = 5 : 1 day/week). The full‐time model of C‐L psychiatry has also indirect effects (i.e. educational and relieving effects) on the hospital staff. Promoting the establishment of C‐L psychiatry requires many evidence‐based studies that demonstrate the necessity for C‐L psychiatry and can directly persuade hospital directors.
The influences of family environment on personality traits
Authors: Nakao Kazuhisa , Takaishi Jyo , Tatsuta Kenji , Katayama Hisanori , Iwase Madoka , Yorifuji Kazuhiro , Takeda Masatoshi
Published: March 2003

In order to clarify the influences of family environment on the development of personality traits, 150 children (104 males and 46 females, mean age 13.2 ± 2.4 years) who had been interviewed at the Child Guidance Clinic in Osaka were investigated. From 13 behavioral characteristics (activity, talkativeness, sociability, social skills, rule‐keeping, will, aggression, emotional control, imagination, anxiety, maturity, intelligence, and neuroticism), factor analysis identified three personality traits: extraversion, maturity, and intellect. The effects of family environment (maternal and paternal participation in child rearing before and after 4 years of age, child‐rearing style, parental relationship, sibling relationship, number of siblings, birth order, and socioeconomic status) on these personality traits were examined based on a structural equation model. The results found, first, that extraversion was negatively associated with overprotection/interference and with maternal participation in child rearing. Maturity correlated with high socioeconomic status, appropriate child‐rearing style, and paternal participation in child rearing. Intellect was related to high socioeconomic status and maternal participation in child rearing. Second, path analysis with selected variables revealed that 8% of variance in extraversion, 14% in maturity, and 10% in intellect was due to family environment. Third, children with high introversion or high intellect had stronger influences from family environment than did those with high extraversion or low intellect.
Effects of prolactin‐releasing peptide (PrRP) on sleep regulation in rats
Authors: Zhang Shi‐Qing , Kimura Mayumi , InouÉ Shojiro
Published: March 2003

The present study examined in rats how prolactin‐releasing peptide (PrRP), a new hypothalamic hormone, infused centrally during the dark period affects sleep and plasma levels of prolactin (PRL). At a dose of 0.1 nmol, PrRP increased only rapid eye movement (REM) sleep, whereas with 1.0 nmol both non‐REM sleep and REM sleep were enhanced. However, 10.0 nmol of PrRP increased only non‐REM sleep with a febrile response. The levels of plasma PRL were elevated during the infusion of PrRP with 0.1 and 1.0 nmol. Consequently, the increased release of PRL correlated with significant increases in REM sleep, but not in non‐REM sleep.
Esophageal pressure and apnea hypopnea index in sleep‐disordered breathing
Authors: Watanabe Takuya , Mikami Akira , Shigedo Yoshihisa , Motonishi Masamichi , Honda Hideharu , Kyotani Kyoko , Uruha Shigehiko , Terashima Kiyoji , Teshima Yoshio , Sugita Yoshiro , Takeda Masatoshi
Published: March 2003

Severity of negative esophageal pressure (Pes) and apnea hypopnea index (AHI) were investigated in six cases of upper airway resistance syndrome (UARS) and 11 cases of obstructive sleep apnea syndrome (OSAS). The severity of negative Pes was represented by the highest peak (Pes Max) and the number of increased episodes (more than 13.5 cmH2O) per h (NPesI13.5). There was no significant correlation between Pes indices and AHI. Pes Max and NPesI13.5 were not different among severe OSAS (AHI > 30), mild OSAS (AHI < 30) and UARS. Apnea hypopnea index failed to represent the severity of negative Pes, which is an important aspect of the pathophysiology of sleep‐disordered breathing.
Effect of 3 mg melatonin on jet lag syndrome in an 8‐h eastward flight
Authors: Takahashi Toshiharu , Sasaki Mitsuo , Itoh Hiroshi , Ozone Motohiro , Yamadera Wataru , Hayshida Ken‐Ichi , Ushijima Sadanobu , Matsunaga Naoki , Obuchi Keita , Sano Hidetaka
Published: March 2003

In order to assess the effect of melatonin on jet lag a field study was undertaken. The process of re‐entrainment of circadian melatonin rhythm was investigated in six subjects. Except during 24‐h blood sampling, the subjects were exposed to natural zeitgeber (time giver) outdoors and given 3 mg melatonin at 23:00 h. The subjects were exposed to bright sunlight from 3000 to 12 000 lx. All of them showed orthodromic re‐entrainment with taking melatonin, while two out of the six did not show orthodromic re‐entrainment without taking melatonin. Melatonin accelerated the rate of the re‐entrainment of the circadian melatonin rhythm. Melatonin was useful to jet travel from Tokyo to Los Angeles.
Depression in multiple system atrophy: A case report
Authors: Goto Kyoko , Ueki Akinori , Shimode Hiroko , Shinjo Hidetaka , Miwa Chitoku , Morita Yoshio
Published: March 2003

Abstract A 53‐year‐old woman who developed depression as the first symptom of multiple system atrophy was treated. Depression was followed successively by autonomic failure, parkinsonism and cerebellar ataxia. Treatment with
L‐DOPA,
L‐threo‐DOPS, and thyroid releasing hormone was associated with improvement of autonomic failure and parkinsonism. As for depression, scores on the Zung scale and the Hamilton scale improved from 58 to 49 and from 30 to 22, respectively. This case is remarkable in that depression preceded neurologic dysfunction and was managed successfully by antiparkinsonian medication. A common underlying disturbance may be responsible for the depression and neurologic dysfunction in multiple system atrophy.
Effect on electroencephalogram of chewing flavored gum
Authors: Morinushi Takanobu , Masumoto Yasuhiro , Kawasaki Hirotoki , Takigawa Morikuni
Published: March 2003

Abstract The objective of the present study was to evaluate the effect on the electroencephalogram (EEG) of a chewing gum with and without our prepared new flavor. Electroencephalograms were obtained after the following three tests: chewing pure gumbase with sucrose (standard gumbase), chewing flavored standard gum and the inhalation of flavored aromatic oil. As the control, we used the pre‐stimulus control EEG record without a stimulus. We examined the relationship between the pre‐stimulus control record and the post‐stimulus record using the changes of power in four bands. Chewing the standard gumbase led to an increase in the alpha wave and a decrease in the beta wave. Chewing the flavored standard gum and inhaling the flavored aromatic oil each increased the alpha and beta waves. In addition, chewing the flavored standard gum led to a change in the ratio of theta wave in the frontal area. The difference in the theta, alpha and beta bands in chewing gum with and without the added flavor suggested that the flavor as well as chewing could induce concentration with a harmonious high arousal state in brain function.
Panic disorder cases in Japanese‐Brazilians in Japan: Their ethnic and cultural confusion
Authors: Tsuji Keisuke , Miyasaka Lincoln S. , Otsuka Koichiro , Honda Gyo , Kato Satoshi , Abe Yu
Published: March 2003

Abstract The comparatively high salaries made in Japan are attractive to many Japanese‐Brazilians. The number of individuals from this ethnic group being treated in Japanese mental hospitals has increased. We hypothesized that Japanese‐Brazilian patients with panic disorders adjusted better to Japanese society and culture than those with other mental disorders. The subjects in the present study are 40 Japanese‐Brazilian patients undergoing treatment at the Department of Psychiatry at Jichi Medical School, Japan, from May 1990 to September 1998. Patients were divided into a panic disorder group, a schizophrenic group, a mood disorder group and a neurosis group. Demographic data (Japanese language ability, duration of residence in Japan etc.) were collected. A comparison was made among the four groups. Patients in the panic disorder group showed a significant tendency to be fluent speakers of Japanese. Patients in the panic disorder group also had been in Japan for a significantly longer period of time than those in the other three groups. Japanese ability and length of residence in Japan rule out exacerbating factors due to a foreign living environment. Panic disorder patients usually have resolved the problems inherent in living and working in a foreign country. In general, Japanese‐Brazilians are more comfortable both financially and socially in Japan than other foreign laborers because of their cultural and family background. The emotional conflict experienced by such patients may result from concern over whether to live in Brazil or Japan in the future. Their ethnic and cultural identity may be confused, fluctuating between identifying with Brazil and with Japan, and this may cause vague feelings of anxiety.
Effects of short nap and exercise on elderly people having difficulty in sleeping
Authors: Tanaka Hideki , Taira Kazuhiko , Arakawa Masashi , Toguti Hiroki , Urasaki Chisae , Yamamoto Yukari , Uezu Eiko , Hori Tadao , Shirakawa Shuichiro
Published: March 2003

The purpose of the present study was to examine the effects of short nap and exercise on the sleep quality of elderly people who reported difficulty in sleeping. ‘Interventions’ such as short nap after lunch and moderate‐intensity exercise in the evening were carried out for 4 weeks. After the ‘interventions’, wake time after sleep onset significantly decreased and sleep efficiency significantly increased, which showed that sleep quality was improved. The frequency of nodding in the evening significantly decreased. These results demonstrated that the proper awakening maintenance in the evening was effective in improving sleep quality. After the ‘intervention’, mental health was also improved with improving sleep quality.
A survey of junior high school students’ sleep habit and lifestyle in Okinawa
Authors: Arakawa Masashi , Taira Kazuhiko , Tanaka Hideki , Yamakawa Kenji , Toguchi Hiroki , Kadekaru Hatuko , Yamamoto Yukari , Uezu Eiko , Shirakawa Shuichiro
Published: March 2003

A survey was made of the sleep and lifestyle activity patterns of 3754 students from 14 different junior high schools on Okinawa Island. The survey showed that bedtimes became progressively and significantly later as students ascended to higher grades, resulting in adolescent sleep debt. The later adolescents retired to sleep, there appeared significantly greater numbers suffering from insufficient sleep, who found difficulty in waking up, who arose later in the mornings, and who failed to eat breakfast. The study indicated that along with later bedtimes, staying up late resulted in deterioration of sleep health, poor dietary habits and feeling ill, contributing to sleepiness during class.
Subjective sleep quality and sleep problems in the general Japanese adult population
Authors: Doi Yuriko , Minowa Masumi , Uchiyama Makoto , Okawa Masako
Published: March 2003

To dimensionally describe subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and estimate the prevalence rate of sleep problems (PSQI global score > 5) in the general Japanese adult population, 1871 subjects randomly selected from the 1995 Census were examined. The PSQI component scores (mean ± SD) widely ranged (e.g. 0.04 ± 0.31 in hypnotic medication use for males aged 20–29 years, 0.03 ± 0.18 in hypnotic medication use for females aged 20–29 years, 1.10 ± 0.94 in sleep latency for males aged 80 or older, 1.52 ± 1.03 in sleep latency for females aged 80 or older). Statistical significance was found in each component score among age groups by gender. The PSQI global scores (mean ± SD) by age groups ranged from 4.00 ± 2.59 to 5.02 ± 3.89 for males (P < 0.39) and 4.30 ± 2.34 to 6.75 ± 4.10 for females (P < 0.001). The respective prevalence rates of sleep problems were 26.4% (95% CI = 23.6, 29.3) for males and 31.1% (95% CI = 28.1, 33.9) for females.
Amygdala kindling develops without mossy fiber sprouting and hippocampal neuronal degeneration in rats
Authors: Osawa Mariko , Uemura Shuji , Kimura Hiroshi , Sato And Mitumoto
Published: March 2003

Abstract Repeated electrical stimulation of limbic structures has been reported to produce the kindling effect together with morphological changes in the hippocampus such as mossy fiber sprouting and/or neuronal loss. However, to argue against a causal role of these neuropathological changes in the development of kindling‐associated seizures, we examined mossy fiber sprouting in amygdala (AM)‐kindled rats using Timm histochemical staining, and evaluated the hippocampal neuronal degeneration in AM‐kindled rats by terminal deoxynucleotidyl transferase‐mediated digoxigenin‐11‐dUTP nick end labelling (TUNEL). Amygdala kindling was established by 10.3 ± 0.7 electrical stimulations, and no increase in Timm granules (neuronal sprouting) was observed up to the time of acquisition of a fully kindled state. However, the density and distribution of Timm granules increased significantly in the dentate gyrus compared with unkindled rats after 29 after‐discharges or more than 10 kindled convulsions. In addition, no significant increase in TUNEL‐positive cells was found in the hilar polymorphic neurons or in CA3 pyramidal neurons of the kindled rats that had fewer than 29 after‐discharges. However, a significant increase of TUNEL‐positive cells was found in the granule cell layer in the dentate gyrus of the stimulated side after 18 after‐discharges or 10 kindled convulsions. Our result show that AM kindling develops without evidence of mossy fiber sprouting, and that mossy fiber sprouting may appear after repeated kindled convulsions, following death of the granule cells in the dentate gyrus.
Psychological characteristics of eating disorders as evidenced by the combined administration of questionnaires and two projective methods: the Tree Drawing Test (Baum Test) and the Sentence Completion Test
Authors: Mizuta Ichiro , Inoue Yoichi , Fukunaga Tomoko , Ishi Ryohei , Ogawa Asao , Takeda Masatoshi
Published: March 2003

Abstract The objective of this study is to examine psychological/psychopathological characteristics of eating disorders and their subtypes through a combined administration of questionnaires and projective tests. Three questionnaires (Eating Disorder Inventory – 2, Social Adaptation Scale, Southern California University Eating Disorder Inventory – Revised) and two projective tests (the Tree Drawing Test [TDT, Baum Test], and the Sentence Completion Test [SCT]) were administered to 126 female patients between the ages of 15 and 30 years, with eating disorders according to DSM‐IV criteria at our outpatient clinic, and to 54 sex‐ and age‐matched control subjects. The purging subtypes of eating disorders (anorexia nervosa – binge‐eating/purging type [ANBP] and bulimia nervosa – purging type [BNP]) were clearly differentiated from the controls, both by the questionnaires and the projective tests. Compared with the controls, ANBP/BNP showed more problematic profiles across the three questionnaires, drew smaller and poorer trees in TDT to a more left location on the drawing paper, and gave fewer positive, and more negative responses in SCT. In contrast, few significant differences were found between anorexia nervosa – restricting type (ANR) and the controls, and between ANBP and BNP. As a trend, however, ANR was consistently located between the controls and ANBP/BNP across the whole questionnaires and projective tests.
Cognitive resource model for the information‐processing of task‐irrelevant visual stimuli
Authors: Saito Masanori , Ishida Tetsuhiro
Published: March 2003

Abstract In order to elucidate possible factors that effect P3s to task‐irrelevant visual stimuli (non‐target P3s), we made a normative visual event‐related potential study with button‐press tasks in four different conditions in which two factors (the number of colors of non‐target stimuli, and the shape of the stimuli) were manipulated without any change in task nor target/non‐target ratio. The peak distributions of non‐target P3s (centrally peaking) were significantly different from those of task‐relevant P3s (parietally peaking) in all conditions. The amplitude of non‐target P3 decreased as the variety of colors of the non‐target stimuli increased. The amplitude of non‐target P3 to colored solid circles was larger than that of non‐target P3 to colored Stroop stimuli. Between each condition, task‐ relevant P3 and reaction time showed no significant difference. Both the variety of non‐target stimuli and the shape of the stimuli were shown to have effects on the amplitudes of non‐target P3s without any alteration in task‐relevant P3s. It is suggested that the amplitude behaviors of non‐target P3s partly reflect the amount of cognitive resource allocated for each different kind of task‐irrelevant visual stimuli.
Sleep‐related violence and low serum cholesterol: A preliminary study
Authors: Agargun Mehmed Yucel , Şekeroğlu M. Ramazan , Kara Hayrettin , Özer Ömer Akil , Tombul Temel , Kiran Ümit , Selvi Yavuz
Published: March 2003

Abstract To examine whether there is a relationship between serum cholesterol level and sleep‐related violence, we evaluated 15 patients with violent behavior during sleep (VBS) and 15 normal control subjects. The patient and control groups were matched for sex, age, and weight. There were 13 women and two men in each group. The patients with VBS had lower serum total cholesterol, triglyceride, and low‐density lipoprotein levels than the healthy subjects. Low cholesterol may effect serotonergic neuronal activity and some types of 5‐HT receptors, then may be related to violent behavior during sleep.
Relationships between serum magnesium levels and clinical background factors in patients with mood disorders
Authors: IMADA YUZO , YOSHIOKA SHIN‐ICHI , UEDA TOSHIYUKI , KATAYAMA SEIJI , KUNO YOSHIE , KAWAHARA RYUZO
Published: March 2003

Absract

We measured serum magnesium (Mg) levels in 71 in‐patients and out‐patients with mood disorders and in 30 healthy controls and investigated the relationships between serum Mg levels and clinical background factors. Serum Mg levels were found to be significantly higher in patients with mood disorders than in controls. Serum Mg levels showed no significant correlation with patient sex, age, diagnosed subtype and disease phase in the mood disorder group. Serum Mg levels in patients with major depressive disorder who were taking psychotropic drugs were not significantly different from levels seen in patients with major depressive disorder who were not taking psychotropic drugs. These results suggest that the high serum Mg levels noted in patients with mood disorder are related to the underlying disorder itself and are not influenced by clinical background factors.
Leiomyosarcoma of the heart and its pulmonary metastasis, both with prominent osteoclast‐like multinucleated giant cells expressing tartrate‐resistant acid phosphatase activity
Authors: Katoh Masahiro , Shigematsu Hidekazu
Published: March 2003

An autopsy case of cardiac leiomyosarcoma and its pulmonary metastasis, both with osteoclast‐like multinucleated giant cells (OMGC) mimicking the so‐called giant cell variant of malignant fibrous histiocytoma (MFH), is reported. The patient, a 70‐year‐old male, was admitted for sudden dyspnea. Extensive work‐up established only a left atrial tumor mass. Three months after admission, the patient developed multiple intracranial and pulmonary metastases, followed by a worsening clinical course characterized by semicoma and dyspnea, and subsequently died 6 months after the onset of his symptoms. At subsequent autopsy, the left atrial polypoid tumor was found to have invaded destructively to the left half of the cardiac wall. Histology of the cardiac tumor revealed a bimorphic sarcoma in which a poorly differentiated leiomyosarcoma comfirmed by histologic and immunohistochemical findings was juxtaposed to a small nodule with features closely mimicking giant cell MFH. The pulmonary metastatic nodules exhibited features that were entirely indistinguishable from giant cell MFH except for the fact that a minority of polymorphic cells manifested myogenic differentiation. We believe that such a MFH‐like pattern represents a pleomorphic form of leiomyosarcoma rather than a dedifferentiated one. The OMGC within the MFH‐like component coexpressed CD68 and tartrate‐resistant acid phosphatase activity.
Composite renal cell carcinoma and angiomyolipoma: A study of the histogenetic relationship of the two lesions
Authors: Mai Kien , Garth Perkins D. , Robertson Susan , Thomas Jane , Morrash Christopher , Collins John P.
Published: March 2003

The purpose of the present study was to investigate the possible histogenetic relationship of renal cell carcinoma (RCC) and angiomyolipoma (AMYL) occurring in the same renal nodule by examining two cases of composite RCC and AMYL in patients without stigmata of tuberous sclerosis and by reviewing the medical literature of similar cases. Case 1 represents an epithelioid variant of AMYL with multiple additional nodules of typical AMYL in a surgically removed kidney. The patient subsequently developed a lesion consisting of a mixture of epithelioid variant of AMYL and RCC 24 months later in the retroperitoneum and, an additional 4 months later, in the liver. The RCC cells resembled mononucleated epithelioid cells of the epithelioid AMYL except that they were focally reactive with epithelial membrane antigen (EMA) in the retroperitoneum and focally reactive with both EMA and cytokeratin (CK) in the liver. Case 2 consisted of a typical AMYL admixed with a chromophil cell RCC. A review of the medical literature revealed seven additional cases with histopathological findings similar to this case. All cases had multiple foci of typical AMYL. Immunostaining results are available in five tumors. Chromophil RCC showed variable reactivity with CK and EMA. In addition, RCC in the two cases in the present study also displayed a positive reaction with mucin staining and a positive reactivity with carcinoembryonic antigen. There appears to be a spectrum of histopathological and immunohistochemical changes from the epithelioid variant of AMYL through a mixed epithelioid AMYL/RCC to chromophil RCC in three successive specimens in case 1. Moreover, the intimate admixture of AMYL and RCC and the similar expression of epithelial markers of RCC in the two cases in the present study, as well as other cases in the literature, suggest that some RCC develop from the same precursor cell as AMYL or from a component of AMYL.
Origin of histiocyte‐like cells and multinucleated giant cells in malignant fibrous histiocytoma: Neoplastic or reactive?
Authors: Hatano Hiroshi , Tokunaga Kunihiko , Ogose Akira , Imaizumi Satoshi , Hayami Tadashi , Yamagiwa Hiroshi , Hotta Tetsuo , Endo Naoto , Takahashi Hideaki , Naito Makoto
Published: March 2003

The origin of histiocyte‐like cells in malignant fibrous histiocytoma (MFH) remains controversial. To determine whether histiocyte‐like cells and multinucleated giant cells show reactive or neoplastic proliferation, we transplanted human storiform‐pleomorphic MFH to nude mice and investigated the origin of histiocyte‐like cells using the DNA in situ hybridization (ISH) system. In addition, we analyzed the mRNA expression of mouse c‐fms and human colony stimulating factor‐1 (CSF‐1); immunohistochemical expression of markers detectable in cells of monocyte/macrophage lineage. The DNA ISH revealed neoplastic proliferation of fibroblastic cells and bizarre multinucleated giant cells of human origin. Monocyte/macrophage lineage cells were seen in parental tumors, whereas they did not participate in neoplastic proliferation in transplanted tumors. The parental tumors expressed human CSF‐1 mRNA and the histiocyte‐like cells in transplanted tumors expressed ‘mouse’c‐fms mRNA. These results suggest that MFH induce infiltration of monocyte/macrophage and CSF‐1 is one of the mediators involved in this phenomenon, because the human CSF‐1 can act as a ligand to the mouse c‐fms. Histiocyte‐like cells in MFH should be considered as a reactive monocyte/macrophage lineage rather than as an element of neoplasm.
Intravascular fasciitis of the forearm vein: A case report with immunohistochemical characterization
Authors: Ito Makoto , Matsunaga Kotaro , Sano Kenji , Sakaguchi Nobuki , Hotchi Masao
Published: March 2003

Intravascular fasciitis is a very unusual variant of nodular fasciitis. A unique case of this lesion occurring in the proximal portion of the superficial vein of the forearm in an otherwise healthy 26‐year‐old man is reported. The intravascular polypoid lesion grew longitudinally along the vascular lumen, was loosely attached to the intimal layer, and was partly anchored beyond the internal elastic lamina into the medial smooth muscle layer. However, extravascular involvement was absent. The histological features were identical to those observed in ordinary cellular nodular fasciitis. Because of its myofibroblastic phenotype exhibited by highly proliferative spindle cells, certain intimomedial myofibroblasts are thought to be the indigenous source of this unique fibroproliferative lesion. Unless the diagnosis of intravascular fasciitis is considered and appropriate differential markers examined, it may be confused with other intravascular lesions, such as intravascular leiomyoma, intravenous pyogenic granuloma, organized thrombus and, even, fibromuscular dysplasia if it arises in the arteries. A simple excision is considered curable. Even so, two recurrent cases have been documented to date.
Cutaneous ciliated cyst of the right lower leg
Authors: Yokozaki Hiroshi , Yanagawa Etsuro , Harada Masahiro , Tahara Eiichi
Published: March 2003

A 23‐year‐old Japanese woman with a cutaneous ciliated cyst on her right lower leg is reported. A subcutaneous cyst, measuring 2.5 cm in diameter with papillary projections into the lumen, was lined with ciliated cuboidal to columnar epithelia with partial stratification, histologically. These lining cells did not produce mucin. Immunohistochemically, the ciliated lining cells of the cyst were diffusely positive to epithelial membrane antigen and cytokeratin. In addition, positive immunoreaction with anti‐desmin monoclonal antibody was observed in the body of the cilia. Less than 10% of the epithelial cells revealed positive immunoreaction to S‐100 protein and estrogen receptor.
Villous tumor of the colon and rectum with special reference to roles of p53 and bcl‐2 in adenoma–carcinoma sequence
Authors: Yao Takashi , Kajiwara Masaaki , Kouzuki Toshio , Iwashita Akinori , Tsuneyoshi Masazumi
Published: March 2003

Villous tumors are rare and their histological diagnosis from biopsy specimens is often difficult. To ascertain its tumor progression, including the genetic events, would be useful for clinical treatment. Clinicopathological features and the expression of p53 and bcl‐2 proteins were investigated in 50 villous tumors from 49 patients. The patients’ ages ranged widely from 32 to 84 years (average, 61 years). Females were more frequently affected than males (male : female ratio, 20 : 29). Thirty‐six (72%) of the villous tumors were present within the sigmoid colon and rectum. Histologically, 17 (34%) of these contained carcinomas in villous adenomas (CIVA), while 24 (73%) of 33 villous adenomas (VA) contained high‐grade dysplasia. Most of the CIVA revealed well‐differentiated adenocarcinoma, often with focal or diffuse mucin pools. Three lesions of invasive carcinomas were composed of extremely well‐differentiated components. The average size of the CIVA (79 mm) was significantly larger than that of the VA (51 mm). Overexpression of p53 protein was recognized in 12% of VA, in 24% of mucosal components of CIVA and in 18% of invasive components of CIVA. Overexpression of bcl‐2 was recognized in 57% of VA, 33% of mucosal components of CIVA, and 7% of invasive components of CIVA. Several characteristic features were recognized in villous tumors, which comprised: (i) a high frequency of coexistence of carcinoma; (ii) multiple foci of carcinomas arising in adenomatous tumors; (iii) a lower histological grade of carcinomas, often with mucin pools; (iv) the existence of extremely well‐differentiated adenocarcinomas; and (v) less frequent expression of p53 protein in the carcinomatous components. According to these findings, the pathway of tumor progression in the villous tumors is possibly different from that of sporadic colorectal carcinomas. Because of the peculiarity of villous tumors, careful clinical management is required.
Spiradenocylindromas of the skin: Tumors with morphological features of spiradenoma and cylindroma in the same lesion: Report of 12 cases
Authors: Michal Michal , Lamovec Janez , Mukeňsnabl Petr , Pizinger Karel
Published: March 2003

Twelve cases of spiradenocylindromas, which revealed features of both spiradenoma and cylindroma in the same tumor mass, are presented. Nine female patients had multiple neoplasms occurring mostly on the scalp, and two female and one male patient had a solitary cutaneous lesion. Three of the female patients with multiple cutaneous tumors had a familial history of similar cutaneous neoplasms. In one of the patient’s family, the multiple cutaneous tumors were known to occur in multiple family members in four consecutive generations. One patient with multiple cutaneous lesions was known to have associated multiple kidney cysts as confirmed by computed tomography. Histologically, spiradenocylindromas are composed of intermixed areas that are either of typical spiradenoma in appearance or of typical cylindroma appearance. Apocrine and trichoepitheliomatous differentiation seen in two cases in the present series points to spiradenomas, as well as cylindromas, having complex hair follicle (folliculo‐ sebaceous apocrine) rather than eccrine differentiation. The presence of lymphoid tissue was a histological feature in the present series, which was prominent in all the spiradenomatous parts of the tumors and which was scanty or practically absent in all the cylindromatous parts. The selective presence of lymphocytes in spiradenoma and an absence in cylindroma suggest that spiradenomas have the unique property of attracting lymphocytes. The malignant tumors arising in three patients in the present series had the morphology of a poorly differentiated epithelioid neoplasm. Three patients died of the disease and the other patients were either free of disease or alive with disease 1–30 years on follow up.