Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
Volume 54, Issue 2
Displaying 1-23 of 23 articles from this issue
Contents
  • KO OKUMURA
    2008 Volume 54 Issue 2 Pages 110-115
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    1) Anergic T cells generated ex vivo are reported to have immunosuppressive effects in vitro and in vivo. Here, we tested this concept in nonhuman primates. Alloreactive T cells were rendered anergic ex vivo by coculture with donor alloantigen in the presence of anti-CD80/CD86 mAbs before adoptive transfer via renal allograft to rhesus monkey recipients. Rejec-tion-free survival was prolonged in all treated recipients, and 3 of 6 animals showed longterm survival (two years at study's end). We conclude that the anergic T cells generated can suppress renal allograft rejection after adoptive transfer in nonhuman primates. 2) Tumor-cell apoptosis is the basis of many cancer therapies, and tumor-specific T cells are the principal effectors of successful antitumor immunotherapies. Here we show that induction of tumor-cell apoptosis by an agonistic monoclonal antibody to DR5, the apoptosisinducing receptor for TNF-related apoptosis-inducing ligand (TRAIL), combined with T-cell activation by agonistic monoclonal antibodies to the costimulatory molecules CD40 and CD137, potently and rapidly atimulated tumor-specific effector CD8+T cells capable of eradicating preestablished tumors. These findings in mice indicate that a rational monoclonal antibody-based therapy that both causes tumor-cell apoptosis through DR5 and activates T cells may be an effective strategy for cancer immunotherapy in humans.
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  • YUTAKA INABA
    2008 Volume 54 Issue 2 Pages 116-120
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    It has been 40 years since I graduated from the School of Medicine. On retirement from the University, I would like to reflect upon the past and try to assess my role in the current trends in epidemiology and hygiene. In epidemiological study, the focus has turned from acute communicable diseases to life-style related diseases, and the methodology has progressed to more complex multivariate analyses through the rapid advance of computer technology. The Japan Epidemiological Association was founded in 1991, and as the protection of personal information has been received increasing public a Hention, ethical guidelines for epidemiological study were published by the government in 2002. While the study and education of hygiene have encountered problems of their identity in the many universities since the 1970s, I played a certain role in this area through the Japanese Society for Hygiene and in the Japanese Association of Directors of Departments of Hygiene and Public Health at Medical Schools. In this area, ethical problems and normative consciousness have received increased attention. As a Protestant Christian, I feel a strong sense of responsibility in approaching these issues.
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  • RYUZO KAWAMORI
    2008 Volume 54 Issue 2 Pages 121-132
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    In healthy subjects, nutrients are rapidly absorbed after meals and, as soon as blood glucose concentrations start to rise, there is a rapid pulsatile insulin release. Portal insulin concentrations are increased and there is an immediate uptake of glucose by the liver while hepatic glucose output ceases, preventing excessive post-meal glycaemia. Subsequently, the glucose that passes through the liver raises blood glucose levels, and blood glucose is taken up by the muscle and adipose tissue in response to the raised insulin level. Therefore, glucose excursions are maintained within a narrow range due to the interaction between insulin and its target organs. Overnight blood glucose concentrations are also maintained within a narrow normal range since the rate of hepatic glucose output matches the rate of wholebody glucose utilisation, both rates being regulated by basal insulin secretion. In type 2 diabetes, glucose fluctuations are deranged due to impairment of the rapid pulsatile secretion of insulin in response to a rise in blood glucose, and a decline in the action of insulin on various insulin-sensitive tissues. In the early stages of diabetes even a small increase in insulin resistance, particularly in the liver, causes raised post-prandial blood glucose levels. The author has been investigating the factors promoting hepatic glucose uptake after mealintake, and seeking modalities to augment this process in order to facilitate strict glycemic regulation even after meal-intake. The ultimate goal of diabetes treatment is to prevent the progression of atherosclerotic changes. Furthermore, we have been investigating the molecular and cellular background of the natural history of type 2 diabetes mellitus. The author would like to express sincere gratitude to entire the staff of the Department.
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  • MASAHIKO TSURUMARU
    2008 Volume 54 Issue 2 Pages 133-138
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    The esophagus is a simple organ located between the pharynx and the stomach but it sometimes causes many difficulties when it is involved by disease. Here is my frank impression as an esophageal surgeon with experience spannins more than thirty years. After graduation from Tokyo University, I worked at Takeda General Hospital in Aizuwakamatsu City and encountered a couple of cases of esophageal diseases, which led me to become an esophageal surgeon. I studied hepatofugal collaterals in portal hypertension at the second Department of Tokyo University Hospital. I analyzed intraoperative radiographies of the portal system and collaterals in the thorax and concluded that the paraesophageal veins communicating with the hypertensive portal system should be perfectly separated from the esophageal wall to prevent the recurrence of esophageal varices after an esophageal transection. Since 1977, I worked in Toranomon Hospital for 21 years under the supervision of a world famous esophageal surgeon, Prof. Akiyama. While there, I treated 1344 cases by esophageal resection for cancer. Cancer recurrence to the lymph nodes developed in the superior mediastinum or neck region at considerable rate after 2-field lymph node dissection. Analysis of the mode of postoperative cancer recurrences concluded that precise lymph node dissection should be performed in 3 fields to improve the 5-year survival rate. Consequently we adopted the 3-field lymph node dissection as a routine procedure for cancer of the thoracic esophagus. I moved to Juntendo University in 1998 and have since performed 925 esophagectomies. Some improvement of therapeutic modalities and surgical procedures provided a better 5-year survival rate of 55.2 %. My team performed more than one hundred esophageal cancer resections every year during the last four years and we were the highest volume center for esophageal cancer resection in Japan in 2005. I feel this level of excellence was achieved by well-harmonized cooperation with my colleagues. I would like to take this opportunity to express my sincere gratitude to them and to Juntendo University.
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  • TADAYUKI MAEHARA
    2008 Volume 54 Issue 2 Pages 139-144
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    This paper is to introduce how state-of-the-art 3T MRI demonstrates fine brain structures. The 3T MRI has an advantage over the 1.5T MRI in demonstrating smaller structures much more clearly. An important factor of this advantage is the high magnetic field strength that results in higher signal to noise ratio, increased magnetic susceptibility effect and elongation of T1 relaxation time.
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  • AKIRA YANAI
    2008 Volume 54 Issue 2 Pages 145-151
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    I have worked at Juntendo University for 22 years until I retired in March 2008. I was a professor at Juntendo for the last 15 years. Since I've retired, I feel content with the opportunities that I was given and with what I was able to contribute to Juntendo. My speciality was Plastic and Reconstructive Surgery. My work has mostly focused on clinical study and research, as well as teaching. I also contributed to hospital management. My development of a surgical technique to treat facial palsy by hemihypoglossal-facial nerve anastomosis remains the most interesting experience in my life as a scholar. I also filled an administrative post for the last ten years. This post dealt with various problems, such as air quality in the animal lab environment, risk management, infection control, and other is sues. I would like to summarize what I have done during my work at Juntendo.
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  • YASUO HAYASHIDA
    2008 Volume 54 Issue 2 Pages 152-157
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    This paper reflects on the couse I have followed for thirty-nine years at Juntendo University. During that time, I participated in three themes, first: digestive surgery and digestive endoscopy, especially, developing new endoscopes and then improving these items and developing a new diagnostic procedure (brushing cytodiagnosis of pancreatic cancer); second: medical insurance; third: general medical treatment and diagnosis in the department of general medicine, in this department, I encountered and treated many diseases.
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  • comparison with lacunar infarction
    SHINJI KOMURA, YUTAKA OZAKI
    2008 Volume 54 Issue 2 Pages 158-165
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    Purpose: This study evaluated the incidence of MR findings showing a hyperintensity rim surrounding multiple sclerosis (MS) plaque on T1-weighted images using image analysis software. We also evaluate the efficacy of this MR finding for differentiating between MS and lacunar infarction. Subject and Method: We reviewed T1-weighted images in clinically diagnosed MS patients who underwent MR imaging between February 2006 and July 2007. Two hundred and thirtynine nodular low signal intensities over 5mm in minimal diameter were observed in 39 MS patients. To compare the incidence of MR findings, we also reviewed T1-weighted images in randomly selected lacunar infarction patients who underwent MR imaging during the same period. There were 51 nodular low signal intensities over 5mm in shortest diameter in 34 lacunar infarction patients. After standardization of MR images, we calculated each signal intensity at the plaque margin (M.I.) and surrounding white matter (Wh.I.) using plot-profile analysis. We judged that hyperintensity rim sign was positive when the M.I/ Wh.I. ratio was over 1.05. Results: Among 239 T1 low intensity plaques in 39 MS patients, hyperintensity rim sign was positive for 81 (33.9 %) plaques in 21 (53.8 %) patients. Among 51 T1 low intensity lesions in 34 lacunar infarction patients, hyperintensity rim sign was positive for only one lesion in one patient. There were significant differences in the incidence of hyperintensity rim sign between the two patients groups (p<0.0001). Conclusion: On quantitative analysis using imaging standardization and plot-profile analysis, hyperintensity rim sign was observed in one-third of T1 low intensity MS plaques. This finding seems to be useful to differentiate multiple sclerosis from lacunar infarction.
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  • MEIHUA WANG, KAYOKO KATAYAMA, KAZUHIKO MATIDA, MITIKO KUROSAWA, YUTAKA ...
    2008 Volume 54 Issue 2 Pages 166-175
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    Objective: With China's rapid economic development, the incldeuce of lifestyle-related diseases has increased and a high prevalence of metabolic syndrome (MS) has been reported. This study investigated the relationship between metabolic syndrome and steps/ day among urban elderly in China by collecting 365 days of continuous self-monitored pedometer data. Materials: We recruited 200 elderly subjects to participate in our study among 9167 community residents aged 65 or more years old who were registered at a community hospital-「WangDingTi Hospital」 in the NANKAI distract in Tianjin City, China. Of these 200 elderly subjects, we analyzed 90 participants who completed questionnaires on lifestyle factors in March 2004, underwent repeated medical checkups in March 2004 and February 2005 as well as recorded pedometer data through out 2004. Methods: All participants received a pedometer (OMRON HJ_002) and were instructed to record total steps per day during their usual activity for any three days per week during waking hours throughout one year. We summed the total steps on any three days per week for one year and then divided the recorded data to determine the average dailylife steps/ day (steps/ day) in this study. MS was diagnosed using the Chinese Diabetes Society 2004 (CDS) criterion. In our study, we called the MS group (50 participants) who were diagnosed as having MS either in March 2004 or in February 2005 and the NON-MS group (40 participants) who were not diagnosed as having MS on either of the two medical checkups. We used SPSS11.0J for statistical analysis. Result: Ninety participants (49 men, 41 women), with a mean age ±SD of 70.2 ±4.6 years showed a mean value of 5509 ±3480 steps/ day, There was a significant difference between the MS group (4811 ±2580 steps/ day) and the NON-MS group (6380 ±4226 steps/ day) (p =0.043). Compared to the number of steps/ day by subjects without any component of MS, that of those with 1-4 MS components was significantly lower (p =0.004). In addition, the steps/ day in the obesity group (BMI ≥25 (Kg/ m2)) was less than that in the normal weight group (BMI <25 (Kg/m2)) (P =0.004), the steps/ day in the high diastolic blood pressure (DBP ≥90mmHg) group was less than that in the DBP <90mmHg group (P =0.045). When we performed categorical analysis using cut off points of 5000, 6000, 7000 and 8000 steps/ day, a cut off point over 6000 steps/ day showed a significant difference between normal weight and obesity group, and a cut off point of 8000 steps/ day showed significant difference between the normal weight and obesity group as well as between the high diastolic blood pressure and normal diastolic blood pressure group, respectively. After using sex and the age-adjusted logistic regression model, the risk of obesity was significantly lower over 5000 steps/ day and the risk of obesity and high diastolic blood pressure were significantly lower over 8000 steps/ day. Moreover, the more components of MS other than BMI, the higher the average BMI became. Conclusion: This study showed that metabolic syndrome was closely associated with the number of daily-life steps/ day among urban elderly in China. In subjects with over 5000 steps/ day, BMI was lower, and in those with over 8000 steps/ day, both BMI and DBP were significantly lower.
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  • HIROYUKI KOBAYASHI, HISASHI NAITO
    2008 Volume 54 Issue 2 Pages 176-183
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    Objective: Heat shock proteins (HSPs) are now known as important physiological elements that promote adaptation to cellular stressors such as exercise in the skeletal muscle. Chronic exercise training is reported to induce HSP72 in both young and old rat skeletal muscle, and aging is associated with a blunted expression of HSP72. The diaphragm, which is primary respiratory muscle that constantly contracts and relaxes, is closely related to pulmonary function. However, the effects of chronic exercise training on HSP72 expression in the diaphragm have not been evaluated. Therefore, this study investigates the effects of chronic endurance training on HSP72 expression in the diaphragm of both young and old rats. Materials and methods: Young adult (12weeks) and old (100weeks) female Fisher 344 rats were assigned to four groups ; young untrained control, young training, old untrained control, and old training (n =6 for each group). The training groups performed treadmill exercise for 10 weeks (75-80% Vo2max, 5 days/week). The costal diaphragm was removed and analyzed for HSP72 expression, myosin heavy chain (MHC) composition, and citrate synthase (CS) activity after completion of training. Results: Diaphragm type I MHC concentration was significantly increased (p<0.05) and type II d/x MHC concentration was significantly decreased (p<0.05) in old rats ; however, training did not alter the diaphragm MHC phenotype. Citrate synthase activity was significantly increased (p<0.05) in the young training group. Diaphragm HSP72 expression in the old control group (70.7±11.0) did not show any significant difference compared to that in the young control group (100±16.4). Diaphragm HSP72 expression was increased in both the young training group (197.8±59.7, p<0.05) and the old training group (113.0±40.4,p<0.05) compared to those in the young and old control groups, respectively. Thus, endurance training resulted in altered levels of HSP72 expression by +98% in the young training group and by +60% in the old training group, indicating a blunted response of HSP72 in the old training group. Conclusion: The present study demonstrated that chronic endurance training induced rat diaphragm HSP72 expression in both young and old rats and a blunted expression of HSP72 was associated with aging.
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  • ZHIXIONG MA, YOSHINORI KANAI, YOSHINARI TAKASAKI
    2008 Volume 54 Issue 2 Pages 184-191
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    Objective : Glucocorticoid-induced osteoporosis (GIO) can occur when patients with autoimmune disease are treated with steroids. In this study, we evaluated the efficacy of active vitamin D3 (VitD) alone (without Bisphosphonates) in patients receiving GIO treatment. Materials and Methods : Fifty-one outpatients with GIO were divided into 2 groups : 39 patients (35 females and 4 males) were treated with VitD, and 12 patients without VitD were included as the control group. Bone mineral density (BMD) was serially, measured by dual energy X-ray absorptiometry before the administration of VitD, and after 6, 12, 18, 24 and 30 months, respectively. We then analyzed the efficacy of VitD. Results : 1) In the VitD group, BMD was increased while that in the controls was decreased. 2) When treated with a lower dose of steroid, the BMD of patients was liable to be higher after treatment with VitD. 3) BMD in younger patients was higher than that in older patients, and was also increased after treatment with VitD. BMD in elderly patients showed a downward tendency after VitD was used. Conclusions : When bisphosphonate use is contraindicated for patients with GIO, it is effective to use VitD alone. However, with large doses of steroids or elderly patients, VitD needs to be considered earlier along with other treatments.
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  • College age group and older age group
    AYUMI HORIKOSHI, MASARU HORIKOSHI
    2008 Volume 54 Issue 2 Pages 192-199
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    Objective: Hardiness has been hypothesized as a stress-resistance resource in maintaining mental health, and has been studied extensively in overseas. Because of a limited number of hardiness researches in Japan, its scales are not investigated enough. The present study will examine the validity and reliability of the 15-item hardiness scale constructed by Tada & Hamano which is most internally consistent among the existing hardiness scales in Japan, yet has been utilized on college students only. Participants: An older age sample (N=750) included the magazine subscribers, their friends, and family members, and a college student sample (N=164) included the students from a university in Tokyo metropolitan area. Methods: 15-item hardiness scale, constructed by Tada & Hamano was used to measure hardiness, and GHQ 12 to measure the level of mental health. Results: The factor analysis on both age groups and both sex groups indicated that three factors were appropriate. The results on multiple regression analysis indicated control and commitment had negative effects on GHQ score, and challenge had positive effects on GHQ score. Conclusions: 15-item Hardiness scale was confirmed its validity and reliability. Control and commitment contribute to mental health, and challenge deteriorates mental health.
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  • ICHIRO KOYANAGI, CHIEKO HAMADA, HIROAKI IO, YUUKI, RO (DECEASED), MASA ...
    2008 Volume 54 Issue 2 Pages 200-207
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    Objective : Characteristic peritoneal alterations in long-term peritoneal dialysis (PD) patients include loss of mesothelial cells and marked submesothelial fibrotic thickening with severe vasculopathy. Although cessation of PD treatment may induce functional and morphologic alterations of the peritoneum in long-term PD patients, controversial results concerning prognosis after cessation of PD treatment have been reported. Hepatocyte growth factor (HGF) is a well-known inducer of tissue remodeling and an anti-fibrotic factor. The present study examined serial morphologic changes in injured peritoneum after cessation of intraperitoneal chlorhexidine gluconate (CH) injection and the role of HGF in peritoneal remodeling in mice with CH-induced peritoneal sclerosis (PS). Methods : Fifty-seven male BL/6 mice were intraperitoneally injected for 2 /days with 0.5ml of 15 % ethanol dissolved in saline as a control or with 0.5ml of CH containing 15 % ethanol dissolved in saline as the CH group. The mice were sacrificed and the parietal peritoneum was harvested on days 0, 7, 21 and 35 after the final CH injection. Peritoneal tissues were also examined immunohistologically. Results : Severely fibrotic thickened peritoneum with marked angiogenesis recovered to almost normal after cessation of CH administration in PS mice. However, peritoneal remodeling was not observed linearly over time. The thickened peritoneum and increase in infiltrating monocytes persisted for 21 days at the peak of HGF expression in the peritoneum. After a marked increase in HGF expression, tissue remodeling rapidly progressed, and injured peritoneum had recovered to almost normal at day 35 in CH-induced peritoneal fibrosis mice. Conclusion : It appears that cessation of peritoneal dialysis may allow tissue repair via activation of HGF expression in the peritoneum. Stimulation of intrinsic HGF production in the peritoneum may be an important strategy for human encapsulating peritoneal sclerosis (EPS).
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  • CHIYO IGARASHI
    2008 Volume 54 Issue 2 Pages 208-213
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    In the field of occupational health, health guidance concerning obesity is often conducted in order to prevent lifestyle-related diseases. With recent awareness of the concept of metabolic syndrome, measurement of the visceral fat area (VFA) by CT has been useful for health guidance, but it is difficult in workplace health screening. Presently, the BMI (Body Mass Index), body fat percentage measured by the bioelectrical impedance method, and waist girth at the umbilical level (abdominal girth) are practical indices of obesity used in such health screening. In this study, VAF was measured in 590 clerical or sales workers in the manufacturing industry using a body fat meter capable of a visceral fat measurement by the bioelectrical impedance method. The relationship of this value to the results of biochemical tests and lifestyle was then evaluated using analysis of covariance structures. Analysis indicated that the risk of lifestyle-related disease was closely related to the degree of obesity. Among indices of the degree of obesity, VFA was more closely related than BMI or body fat percentage, and only slightly less closely related than abdominal girth to the risk of lifestyle-related diseases. Since VFA is effective in screening for latent obesity, health guidance based on digital data, and the subjects' body imaging, its measurement by the bioelectrical impedance method is considered useful for workplace health management.
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  • HIROSHI MIYAMOTO, MOMOKO CHIBA, MASAHIRO HASIZUME, OSAMU KUNII
    2008 Volume 54 Issue 2 Pages 214-221
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    Objectives: The gradually diminishing Aral Sea has decreased to 25% its original size, and people living east of the Aral Sea have complained of health problems that are probably related to this shrinkage. Therefore, we conducted a related epidemiological survey that commenced in 2000. Here, we focus on the relationship between the respiratory function of school-age children in this area and the environmental conditions. Method: Kazalinsk County was selected as the study area and Zhanakorgan County, as the reference area. From each area, we randomly selected 486 children aged 6-15 years. Respiratory function was tested in 337 children from the study area and 417 children from the reference area. As environmental samples, dust fall and soil were analyzed by scanning electron microscopy, ion chromatography, and gas chromatography-mass spectrometry. Result: The incidence of restrictive pulmonary dysfunction was higher in the study area than in the reference area; however, the incidence of obstructive pulmonary dysfunction was low in both areas. The percentage of Suspended Particulate Matter ranged from 81.7%-97.7% in Kazalinsk and from 89.4 %-97.4 % in Zhanakorgan. In this study area, the soil samples demonstrated high levels of chloride, sodium, and sulfate ions. Residual agricultural chemicals were also detected in the surface soil. These findings suggest that these environmental conditions affected respiratory dysfunction in children.
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  • An evaluation 2 years and 6 months after establishment
    SEIICHIRO KUMAKURA, KEISUKE YAMAGUCHI, HIROKO NISHIHARA, MIYUKI AIZAWA ...
    2008 Volume 54 Issue 2 Pages 253-258
    Published: June 30, 2008
    Released on J-STAGE: November 12, 2014
    JOURNAL FREE ACCESS
    Juntendo University Nerima Hospital was established on July 1, 2005 and is the first hospital of the school to adopt an electronic medical records system, making documentation of all medical services paperless. Systems were established for each section of the hospital, and then all the sections were integrated via a local area network (LAN). Anesthesia-recording within the operating rooms was also computerized. Thereby, accounting data during the operation could be transmitted electronically to the accounting department. When services are made paperless, it is necessary for each section to have a server to maintain the medical records electronically, and a strong structure that links everything. However, our hospital does not allow the section servers (made by another company) to accept personal patient and doctor information. As a result, the employee database and medication database is not connected to the databases of each section server. Data is entered by the doctors, nurses, and operators of the individual sections, while new or modified employee or medication records are manually entered by system engineers into the electronic medical records (EGMAIN-FX) developed by Fujitsu. This situation has not changed, and this work must be done each time an employee or medication change occurs. Therefore, for smooth functioning of the operating sections, a system that connects the electronic medical records system, the operation ordering system, and the automated computerized anesthesia-recording system must be developed. This would play a significant role in facilitating operating room function in the long run.
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