The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 52, Issue 2
Displaying 1-10 of 10 articles from this issue
  • Koichi Tanaka
    2003 Volume 52 Issue 2 Pages 73-79
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
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  • Barry Marshall
    2003 Volume 52 Issue 2 Pages 80-85
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
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  • Stephen D. Mikolajczyk, Harry G. Rittenhouse
    2003 Volume 52 Issue 2 Pages 86-91
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The pPSA forms are more highly enriched in prostate tumors and are a more cancer specific marker of prostate cancer. The pPSA forms are especially useful in the 2.5-4 ng/ml PSA range, where the other PSA forms show little diagnostic utility. Serum pPSA, as a percentage of free PSA, has a higher specificity for cancer than the individual PSA assays or ratios of free, complexed or total PSA. The ratio of pPSA and FPSA may also provide a more stable parameter than indi-vidual measurements of FPSA or cPSA.42 In Fig. 3 the %[-2]pPSA is shown, but %pPSA, (the sum of all three pPSA forms) gave similar results that were superior to %FPSA and cPSA. Individual assays for the different pPSA forms have been employed in initial studies in order to determine if any of the individual pPSA forms has greater ultility than other pPSA forms. In some cases it may be desirable to measure only the sum of all pPSA forms and in this case a single research assay has also been developed that can measure all forms of pPSA.
    pPSA is a subform of free PSA and the probability of cancer increases as the percentage of pPSA in the FPSA increases. This may at first seem paradoxical since the free PSA is normally associated with benign disease, but upon closer examination the presence of pPSA may help explain why free PSA is not more benign-specific. For instance, 8% of men with %FPSA greater than 25% are predicted to have prostate cancer, while 44% of the men with less than 10% free PSA will still not have cancer.14 The presence of pPSA or BPSA in the FPSA may contribute to the misdiagnosis of benign disease or cancer in some patients with only a %FPSA measurement. Preliminary evidence indicates that pPSA is significantly elevated in men with greater than 25% FPSA who have been diagnosed with cancer. Therefore pPSA may help discriminate cancer in those men with high %FPSA who would normally not be biopsied. Another area of promise for pPSA is the discrimination of aggressive cancers from more indolent cancer. In summary, the current evidence indicates that pPSA is a more cancer specific form of PSA and extends the current utility of PSA to detect prostate cancer.
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  • Michisuke Yuzaki
    2003 Volume 52 Issue 2 Pages 92-99
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The ionotropic glutamate receptors (iGluRs) form ligand-gated ion channels that mediate the vast majority of excitatory neurotransmission in the mammalian brain. These receptors play central roles not only in normal neurodevelopmental and neurophysiological processes but also in certain neuropathological processes. Molecular cloning of genes for iGluRs in the past decade has advanced our understanding of the basic properties of iGluRs, such as ion selectivity, ligand binding, and anchoring at synapses. Although the gene for the δ2 glutamate receptor (GluRδ2) was cloned on the basis of homology screening, GluRδ2 has been referred to as an “orphan” receptor because it does not form functional glutamate-gated ion channels. However, ataxia in many types of mice is caused by spontaneous mutation of GluRδ2. Analysis of two such mutants, lurcher and hotfoot, has provided key insights into the GluRδ2 signaling in neurons. Furthermore, characterization of mutant GluRδ2 has revealed unexpected clues to two fundamental features regarding the structure and function of iGluRs gating and assembly. Studies have recently shown that the transmembrane region where the lurcher mutation is located probably plays a crucial role in channel gating. The mechanism that controls iGluR subunit assembly seems to involve the extracellular N-terminal domain where the hotfoot mutation is located. An understanding of mechanisms responsible for gating and assembly is essential for the comprehension of neuronal function and dysfunction. Although reverse genetics is useful in deciphering glutamate signaling, these findings demonstrate the power of classic approaches to forward genetics on mutant mice.
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  • Akio Kimura
    2003 Volume 52 Issue 2 Pages 100-106
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Recently, traumatic brain injury (TBI) is one of the major topics of rehabilitation medicine. In the USA, a nationwide research project has already been underway since 1987. However, interest in the rehabilitation of TBI patients became a matter of concern in Japan from the 1990s. TBI patients do not only have physical impairments, but also impairments of higher cortical functions such as cognitive impairment and abnormal behavior, so both physical and cognitive rehabilitation are very important for TBI patients. The purpose of this paper is to report on the current status of and problems with TBI rehabilitation in Japan, and also to introduce a new TBI evaluation system that we originally developed in Japan.
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  • Hiromi Chiba, Hidemichi Hamada, Aya Nishizono-Maher
    2003 Volume 52 Issue 2 Pages 107-112
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Changes in symptoms along the course of episodic and recurrent psychosis have yet to be fully elucidated. We investigated the long-term course, at least 5 years, of 40 patients suffering from episodic and recurrent psychosis. A total of 324 episodes observed in these patients were categorized, on the basis of their principal symptom, into three types; episodes of confusion, episodes with hallucinations and delusions, and those with affective symptoms. We divided the 40 patients into the favorable outcome group and the poor outcome group and compared the characteristics of the two groups. In the favorable outcome group, affective episodes were found to be more frequent in later episodes whereas in the poor outcome group, confusion episodes continued to be the most frequent throughout the course. We discuss diagnostic issues concerning episodic-recurrent psychosis and try to locate it within the domain of schizophrenia.
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  • Jun Iwamoto, Tsuyoshi Takeda, Shoichi Ichimura, Mitsuyoshi Uzawa
    2003 Volume 52 Issue 2 Pages 113-119
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The purpose of the present study was to examine the early response of lumbar bone mineral density (BMD), bone resorption, and back pain to alendronate after treatment with cyclical etidronate in postmenopausal women with osteoporosis. Forty postmenopausal women with osteoporosis, 60-83 years of age, without any vertebral fractures in the lumbar spine, were randomly divided into two groups with 20 patients in each group: 18 months of cyclical etidronate (200mg daily for 2 weeks every 3 months) group and 12 months of cyclical etidronate followed by 6 months of alendronate (5 mg daily) group. BMD of the lumbar spine (L1-L4) measured by DXA, urinary cross-linked Nterminal telopeptides of type I collagen (NTX) level measured by enzyme-linked immunosorbent assay, and back pain evaluated by face scale score were assessed at baseline and every 6 months. There were no significant differences in baseline characteristics including age, body mass index, years since menopause, lumbar BMD, urinary NTX level, and face scale score between the two groups. Cyclical etidronate significantly reduced urinary NTx level and face scale score over 12 months, but did not significantly increase lumbar BMD. After 12 months of treatment, the switch to alendronate significantly reduced urinary NTX level and face scale score, and significantly increased lumbar BMD, while continued cyclical etidronate did not significantly alter these parameters. These results suggest that switching to alendronate after treatment with cyclical etidronate produces a greater response of lumbar BMD, bone resorption, and back pain than continued cyclical etidronate in postmenopausal women with osteoporosis.
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  • Brian Alpert, Rolf Gutwald, Rainer Schmelzeisen
    2003 Volume 52 Issue 2 Pages 120-127
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Rigid internal fixation with plates and screws is now standard for the treatment of fractures, osteotomies and reconstruction of the craniomaxillofacial skeleton. The latest innovations are selfdrilling, self-tapping screws and locking miniplates. These screws offer the prospect of less instrumentation and faster application. Preclinical testing has shown them to be substantially more retentive in cancellous bone, a significant advance in cancellous block bone grafting. Locking 2.0 miniplates utilize double threaded screws which both lock to the bone and the plate creating a mini-internal fixator. This results in a more rigid construct with less distortion of the fracture or osteotomy, screws which do not loosen and less interference with bone circulation since the plate is not pressed tightly against the bone. Locking miniplates are designed for midface application in the repair of fractures, osteotomies and defects. Three configurations in a variety of shapes and lengths are available for mandibular surgery. The thinner and medium varieties are useful in transoral plating of fractures utilizing the Champy technique. The heavier, longer variety are used in unilateral edentulous fractures in the symphysis and parasymphysis as well as an aid to tumor resection and reconstruction with both free and vascularized grafts. They are not designed to replace the heavier 2.4 locking reconstruction plates designed for complex fractures or extensive reconstructions.
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  • Zhi Liu
    2003 Volume 52 Issue 2 Pages 128-133
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Bullous pemphigoid (BP) was first described by Lever in 1953 as a subepidermal blistering disease. Key immunohistological features of BP include dermo-epidermal junction (DEJ) separation, an inflammatory cell infiltrate in the upper dermis, and autoantibodies directed against two emidesmosomal antigens, BP230 and BP180. In 1993, an IgG passive transfer mouse model of BP was developed by administering rabbit anti-murine BP180 antibodies to neonatal mice. This model recapitulates the key features of human BP. Systematic dissection of this BP model has revealed that subepidermal blistering is initiated by anti-BP180 antibodies and mediated by complement activation, mast cell degranulation, and neutrophil infiltration. Proteinases and reactive oxygen species released by infiltrating neutrophils work together to damage the basement membrane zone (BMZ), causing a subepidermal blister. Recently, another novel mouse model for BP has been developed by active immunization. C57BL/6J mice actively immunized with murine BP180 develop BP-like skin lesions. The IgG passive transfer and active models of BP provide us with invaluable in vivo systems not only for dissecting cellular and humoral responses in BP but also for developing effective therapies for this disease.
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  • Irvin M. Modlin, Mark Kidd, Kevin D. Lye, Wright NA
    2003 Volume 52 Issue 2 Pages 134-137
    Published: 2003
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Cells of the gastric mucosa undergo constant renewal, the rate depending on the health of the tissue (inflammation, ulceration, carcinogenesis). While much attention has been focused on the mechanism of mucosal damage and the pathogenesis of ulceration, there has recently been the recognition that elucidation of the nature of the gastric stem cell lineages as well as the regulators of phenotype expression of this system may yield considerable biological information as well as open the door to the identification of areas of therapeutic relevance. Chimeric and X-inactivation studies in mice and humans demonstrate that each region of the gastric mucosa is morphologically diverse (antrum is different to the fundus), with its own repertoire of cell types and glandular structures. The current evidence suggests that a single stem cell in every gastric gland indirectly gives rise to a clone of all differentiated cells, by production of committed progenitor cells. It is also this multipotential cell that produces new crypts by crypt fission, repairs entire crypts when damaged, and gives rise to the ulcerassociated cell lineage and gastric carcinomas. It is likely that this stem cell occupies a niche in the isthmus composed of mesenchymal cells and extracellular matrix factors, which regulates the function of the cell via mesenchymal-epithelial cross talk. The molecular events (IGF-signaling) that regulate the development of the gastric gland in the mice have begun to be understood. Ultimately, the identification of these pathways will play an important role in identifying new molecular targets for the treatment of gastric disease.
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