The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 57, Issue 1
Displaying 1-6 of 6 articles from this issue
COMMEMORATIVE LECTURE
REVIEW
  • Kenneth J. Aitken
    2008 Volume 57 Issue 1 Pages 15-36
    Published: 2008
    Released on J-STAGE: April 04, 2008
    JOURNAL FREE ACCESS
    Intersubjectivity is an approach to the study of social interaction viewed from a perspective which rejects the view that reducing any such analysis to study at the level of the individual is adequate to address the issues of social functioning. It also stresses the view that social processes cannot be reduced to cognitive ones - most of the important questions in the study of developmental psychopathology deal with issues which have commonality with many other species and are patent well before the ontological emergence of ‘cognitive’ abilities. In this paper we review the evidence in this area, and discuss a range of issues relevant to autistic spectrum disorders. We focus in particular on social interaction; the role of the Intrinsic Motive Formation and recent work on mirror neurons in autism; genetic and teratogenic factors in the genesis of autism; and the role of a number of biological factors in pathogenesis - tryptophan; vitamin B12; sterol metabolism; glutamate and GABA; and the Fragile-X expansion.
    Download PDF (833K)
  • Suzanne Shale
    2008 Volume 57 Issue 1 Pages 37-44
    Published: 2008
    Released on J-STAGE: April 04, 2008
    JOURNAL FREE ACCESS
    This paper derives from a grounded theory study of how Medical Directors working within the UK National Health Service manage the moral quandaries that they encounter as leaders of health care organizations. The reason health care organizations exist is to provide better care for individuals through providing shared resources for groups of people. This creates a paradox at the heart of health care organization, because serving the interests of groups sometimes runs counter to serving the needs of individuals. The paradox presents ethical dilemmas at every level of the organization, from the boardroom to the bedside. Medical Directors experience these organizational ethical dilemmas most acutely by virtue of their position in the organization. As doctors, their professional ethic obliges them to put the interests of individual patients first. As executive directors, their role is to help secure the delivery of services that meet the needs of the whole patient population. What should they do when the interests of groups of patients, and of individual patients, appear to conflict? The first task of an ethical healthcare organization is to secure the trust of patients, and two examples of medical ethical leadership are discussed against this background. These examples suggest that conflict between individual and population needs is integral to health care organization, so dilemmas addressed at one level of the organization inevitably re-emerge in altered form at other levels. Finally, analysis of the ethical activity that Medical Directors have described affords insight into the interpersonal components of ethical skill and knowledge.
    Download PDF (370K)
  • Akihiko Noguchi
    2008 Volume 57 Issue 1 Pages 45-49
    Published: 2008
    Released on J-STAGE: April 04, 2008
    JOURNAL FREE ACCESS
    Premature birth rate and low birth weight rate are increasing in industrialized countries including USA and Japan. The Infant mortality rate (IMR) is three times and 50-75 times greater for infants born at 32-36 weeks and <32 weeks respectively than term-born counterparts. In the U.S., the IMR is greater than in Japan particularly among black infants and simply the "lower socioeconomic class" is not the answer. Premature birth is heterogeneous in origin and idiopathic in 70% of the cases. Increased utilization of assisted reproductive technology only accounts for a part of the recent trend. Evidence suggests environmental factors play a significant role, and genetic-environmental interaction is plausible. A chronic psychosocial stress of pregnant women has been postulated to be modifying the endocrine milieu thereby influencing pregnancy outcomes. In a preliminary observation in St. Louis, homeless pregnant women with high behavioral and social risks, when accommodated in a shelter home designed for these women, produced significantly less numbers of premature and low birth weight infants as compared with the general population. Furthermore, in a randomized controlled study in Washington DC, psychobehavioral intervention specifically targeting smoking (primary and secondary), intimate partner violence (IPV), and depression among black pregnant women significantly decreased the rate of miscarriage and low birth weight. These reports may have significant implication to the Japanese situation. Increasing number of Japanese women at reproductive age are exposed to smoking, may have underling psychosocial stress and may suffer from subclinical depression and/or from IPV. Detailed epidemiological studies of women before and during the reproductive age with regard to risk factors can lead to an effective intervention strategy against premature birth in Japan.
    Download PDF (342K)
ORIGINAL ARTICLE
  • Yoshihisa Masakado, Jens Bo Nielsen
    2008 Volume 57 Issue 1 Pages 50-56
    Published: 2008
    Released on J-STAGE: April 04, 2008
    JOURNAL FREE ACCESS
    Cortico-muscular coherence was compared during ramp-and-hold isometric and quasi-isotonic contraction of the ankle joint in human subjects. EEG was recorded from the leg area of the motor cortex. EMG was recorded from the tibialis anterior (TA) muscle. The subjects were requested to maintain a steady low level of dorsiflexion and at intervals of 10 s to increase the contraction level within 1 s, maintain this level for 4 s and then decrease the level of contraction again within another 1 s.
    In seven subjects coherence in the 15-35 Hz frequency band was seen between EEG and TA EMG during low-level tonic dorsiflexion. In all subjects coherence disappeared during the ramp phase for both isometric and quasi-isotonic contraction. Coherence at other frequencies was also not observed in any of the subjects during the ramp phase. During the hold phase at the stronger level of contraction coherence reappeared quickly and had the same size as at the low level of contraction. However, a significantly larger level of coherence was found during quasi-isotonic than during the isometric contraction.
    This demonstrates that cortico-muscular coherence in the 15-35 Hz frequency band is phase- and task-related. The decrease in 15-35 Hz coherence during the ramp phase may be related to event-related desynchronization of EEG activity. The larger level of coherence during quasi-isotonic contraction may reflect a higher demand of precise control of the joint position. It may also reflect a greater need for binding of functionally related cortical pyramidal tract neurons.
    Download PDF (750K)
LECTURE
  • Peter Arenberger, Monika Arenbergerova, Olga Vohradnikova, Jaromir Kre ...
    2008 Volume 57 Issue 1 Pages 57-64
    Published: 2008
    Released on J-STAGE: April 04, 2008
    JOURNAL FREE ACCESS
    Standard screening of melanoma patients is a useful tool for predicting outcome of patients, however, an instant methodology for exact detection of subclinical disease or monitoring treatment response is under investigation.
    Detection of circulating melanoma cells is, therefore, a possible novel promising staging method. However, inconsistent data on method sensitivity and on the predicted patient outcome has been shown repeatedly.
    Recently, a multimarker real-time RT-PCR methodology for quantification of five melanoma markers Melan-A, gp 100, MAGE-3, MIA and tyrosinase was described by our group. In the current prospective trial, blood specimens of 65 patients with AJCC stage IIB-III cutaneous melanoma after surgery were periodically examined. In the above group, 27 % of subjects relapsed during the study. Prior to the disease progression we could observe a statistically significant tumor marker elevation in previous 0 to 9 months in all patients with clinical relapse. MAGE-3 became the most sensitive progression marker. During progression, three concordant positive markers were seen in 39 % of patients, followed by two concordant positive markers in 28 % and 1 marker in 33 %.
    This study supports the use of a multimarker real-time RT-PCR as a disease progression predictor. The dynamic assessment of serially obtained blood specimens represents a useful method for early metastasis detection and treatment response of melanoma patients.
    Download PDF (402K)
feedback
Top