Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 54, Issue 3
Displaying 1-24 of 24 articles from this issue
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Contents
  • Notes on current progress in autophagy research
    TSUYOSHI FURUYA
    2008 Volume 54 Issue 3 Pages 282-286
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.282
    JOURNAL FREE ACCESS
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    Autophagy is a catabolic process involved in cellular events including development, aging, immunity and cell death. It is evolutionarily conserved and ubiquitous among eukaryotic cells. In higher eukaryotes, autophagic dysfunction has been associated with cancer, certain muscular diseases and neurodegeneration. Autophagic pathways differ in the way that cytosolic components and organelles are delivered to the lysosome or vacuole. In recent years, morphological, genetic, biochemical and cell biological approaches have begun to provide insight into the molecular mechanisms underlying autophagy. I received on opportunity to study cell biology, especially autophagy, with Prof. Junying Yuan in Harvard Medical School. This time, I would like to outline the recent autophagy progress and show my current data in autophagy.
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  • Benefits of presenting clinical case reports
    -- Staff development in the field of clinical neurology --
    YASUYUKI OKUMA
    2008 Volume 54 Issue 3 Pages 287-293
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.287
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    Since 2000, I have worked with 30 senior neurology residents at Juntendo University Shizuoka Hospital. Under clinical and educational supervision, they were asked to present clinical reports at a regional meeting of the Japanese Society of Neurology and to prepare a clinical case report. Twenty-five of 30 case reports have already been accepted for publication ; 13 articles have been published in various international journals for neurological sciences, and 12 have been published in Japanese journals for neurology or internal medicine. There are many benefits in presenting case reports from both educational and clinical perspectives. Both residents and their supervisors can gain basic medical knowledge and understand its clinical application. The supervisors can also develop their abilities to communicate with journal editors and reviewers. By promoting these regular educational activities, the faculty and staff will develop.
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  • Innate immunity of human corneal stroma
    NOBUYUKI EBIHARA
    2008 Volume 54 Issue 3 Pages 294-298
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.294
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    First, we examined the normal human corneal stroma for the presence of bone marrow-derived cells (BMCs). CD45-positive cells were mainly found in the anterior stroma of the central and paracentral cornea as well as all stromal layers of the peripheral cornea. CD45-positive cells isolated with magnetic beads accounted for 6.0 % of all stromal cells (n=20). Second, we investigated the factors regulating the constitutive distribution of BMCs in normal human corneal stroma. Keratocytes /corneal epithelial cells and BMCs selected from normal human donor corneas expressed MCP-1 /CCL2 and CCR2 protein, respectively. BMCs isolated from human corneal stroma showed a chemotactic response to MCP-1/CCL2 in the Boyden chamber assay. The chemotactic effect of keratocyte supernatant was inhibited by blockade of MCP-I or CCR2mAb. Our findings suggest that the interaction between MCP-1/CCL2 and CCR2 determines the distribution of constitutive BMCs in normal human corneal stroma. Third, we demonstrated that TLR-3 and -9 were detected in corneal myofibroblasts at the mRNA and protein levels, but not in freshly isolated keratocytes. Stimulation of corneal myofibroblasts with poly (I : C) or CpG-DNA enhanced the production of IL-6, IL-8, GRO, ENA-78, and RANTES compared with that by untreated cells. Phagocytic activity of myofibroblasts was upregulated by signaling via TLR-3 and -9. These findings suggest that BMCs and corneal myofibroblasts may have an important role in bacterial and viral clearance in corneal stroma.
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  • Method of screening the esophagus and detection of early esophageal cancer
    MASAHIRO NAGANO, TOYOHIKO YUKI
    2008 Volume 54 Issue 3 Pages 299-307
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.299
    JOURNAL FREE ACCESS
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    In Japan, early esophageal cancer is now completely treated by endoscopy. Therefore, detection of Early Esophageal Cancer is very important. Dye endoscopy is useful for detection of early esophageal cancer. And the newest NBI (Narrow Band Imaging) method is very useful for detection of early esophageal cancer.
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  • Effect of endurance exercise training on nitrative stress of the heart after the emergence of hypertension in spontaneously hypertensive rats
    SATOSHI FURUKAWA, HIROKO KIMURA, MASAHIRO MUKAIDA, FUMIYUKI YAMAKURA, ...
    2008 Volume 54 Issue 3 Pages 308-317
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.308
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    Objective: We investigated the effects of exercise training starting after emergence of hypertension (15-week-old) on nitrative stress and protein levels and activities of nitrative stress-related enzymes in the hearts of spontaneously hypertensive rats (SHR). Material and Methods: We examined the hearts of 25-week old (wk) SHR that performed either 10 wk of voluntary exercise training (Ex) or remained intact (Cont). We also analyzed 5 wk and 15 wk SHR in order to determine basal alterations of nitrative stress and enzymes. Starting at 15 weeks old, 25 wk Ex SHR exercised by voluntary running in a wheel-cage for 10 weeks. At the end of the breeding or training period, rats were anesthetized and hearts were collected. We measured the level of nitrotyrosine by the time-resolved fluoroimmunoassay method, the amount of manganese-containing (Mn-) and copper/zinc-containing (Cu, Zn-) superoxide dismutase (SOD), and endothelial nitric oxide synthase (eNOS) in the heart by the western blotting method. Furthermore Mn- and Cu, Zn-SOD and total NOS activity were measured by the spectrometry method. Result: Systolic blood pressure was elevated at 15 wk and remained high until 25 wk Cont SHR. Exercise did not affect the blood pressure. Although there was no significant increase in 3-nitrotyrosine (3-NT) concentration in 100,000g precipitate fractions (P2) of heart homogenate of 15 wk SHR, a significant in crease in 3-NT concentration was observed in that of 25 wk Cont SHR. This increase in 3-NT concentration was significantly attenuated in that of 25 wk Ex SHR. The same alterations of 3-NT levels were observed by immunohistochemical analysis using specific antibody for 3-NT. Protein levels of endothelial nitric oxide synthase (eNOS) in the membrane fractions were reduced in 15 wk and 25 wk Cont SHR compared with those of 5 wk SHR, but not affected by Ex. This evidence was supported by the measurements of total NOS activity in the same fractions. Protein levels of Cu, Zn-SOD were reduced to a greater degree in 25 wk Ex and Cont SHR than in those of 5 wk and 15 wk SHR, but there was no significant effect observed by Ex. The same results were obtained upon measurement of Cu, Zn-SOD activity. However, protein of Mn-SOD increased significantly in 15 wk SHR, compared to that of 5 wk SHR. Although there was no significant difference in Mn-SOD levels between 25 wk Cont SHR and 15 wk SHR, significant increases in Mn-SOD levels and activity were observed in 25 wk Ex SHR, compared with those of 25 wk Cont SHR. This evidence accounts for the significant attenuation of 3-NT formation in the P2 fraction of 25 wk Ex SHR. Conclusion: We conclude that 10 weeks of exercise training after the emergence of hypertension could reduce nitrative stress in the organelle fractions of the heart as a result of the increase in Mn-SOD.
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  • An overview of dialysis treatment in Juntendo Koto Geriatric Medical Center (KGMC) for the first five years of operation.
    --Comparison with the findings of a nationwide statistical survey at the end of 2005--
    KAZUHIKO FUNABIKI, KEIKO OKAZAKI, HIROTAKA NAKAMOTO, SEIKI ARUGA, MASA ...
    2008 Volume 54 Issue 3 Pages 318-323
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.318
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    Objective: Since the founding of Juntendo Koto Geriatric Medical Center (KGMC) on June 1, 2002, we have always strived to achieve ultramodern geriatric medicine. We analyzed and reviewed hemodialysis patients admitted to KGMC for the past five years, and compared the results with a nationwide statistical survey performed at the end of 2006. Patients and Methods : The subjects were 431 patients undergoing maintenance hemodialysis (265 men and 166 women) between June 2002 and May 2007. We evaluated patients statistically every year and analyzed the underlying diseases and causes of death during hospitalization. Results: The number of patients increased threefold. The mean age of all hemodialysis patients was 70.8 years (69.4 for men vs 73.4 for women) and that of 89 patients who underwent dialysis in KGMC each year was 71.6 years (66.7 for men vs 76.4 for women). The number (percentage) distribution of patients who underwent dialysis according to the underlying disease showed that 46 (51.7 %) had diabetic nephropathy, 17 (19.1 %) had nephrosclerosis and 7 (7.9 %) had chronic glomerulonephritis. The most frequent cause of death during hospitalization was infection (14 patients, 30.4%). The mean level of alubumin in the bood was 2.4mg/ dl in 5 patients who died of cachexia /uremia. Conclusions: The mean age of patients who underwent dialysis in 2006 at KGMC was 7.2 years older than that of the total dialysis population at the end of 2006 in Japan. The recent increase in aged patients undergoing hemodialysis was attributed to the high incidence of diabetic nephropathy and rapidly progressive glomerulonephritis. As more elderly patients receive hemodialysis, they present with a variety of problems including immune deficiency, which appears to be linked to an increase in infectious diseases such as aspiration pneumonia and sepsis. Malnutrition associateded with hypoalubuminemia is prevalent among hemodaialysis patients, and elderly long-term hemodaialysis patients must be given adequate nutrition.
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  • Seroprevalence of IgG anti-Cytomegalovirus antibody in Japanese patients infected with human immunodeficiency virus
    SHUKUKO SAITO, TOSHIO NAITO, MIZUE SAITA, NOBUHIRO IKEDA, EIICHIRO SUG ...
    2008 Volume 54 Issue 3 Pages 324-327
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.324
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    Background: Cytomegalovirus (CMV) is an important opportunistic infective agent in patients already infected with human immunodeficiency virus (HIV). However, the seroprevalence of CMV in HIV-infected Japanese patients has not been described. Objective: To investigate the prevalence of antibodies to CMV in HIV-infected Japanese patients in Tokyo, Japan. Patients and Methods : The seroprevalence of IgG antibodies to CMV was assessed in 72 adult Japanese patients infected with HIV. Sera were obtained from non-hemophiliac HIV-infected Japanese and tested for CMV IgG antibodies using enzyme-linked immunosorbent assay. All patients were free of AIDS. Results: The seroprevalence of CMV infection was 86.1 %, which was higher than that reported for non HIV-infected controls (81.7%). The prevalence of CMV IgG antibody was highest among young HIV-infected men who had sex with other men (MSM). Conclusion: The higher seroprevalence in young HIV-infected MSM partially reflects their higher risk for contracting sexually transmitted infections. Young people, especially MSM, should consider not only infection with HIV, but also that with CMV.
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  • Determination of antimicrobial susceptibility and detection of the frequency of heterogeneous vancomycin-intermediate S. aureus (hetero-VISA) in Japanese MRSA clinical isolates
    MAYUMI AMINAKA, KYOKO KUWAHARA, KATSUKO OKUZUMI, SHIGEHIRO SATO, NAOHI ...
    2008 Volume 54 Issue 3 Pages 328-336
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.328
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    Objective: This study investigated the trend of antibiotic susceptibility of Japanese MRSA clinical isolates, especially that of heterogeneous vancomycin-intermediate MRSA (heteroVISA) in the years 2005-2006 and 1999. Materials: In Japanese hospitals, 138 MRSA strains and 477 MRSA strains isolated in 1999 and 2005-2006, respectively. Methods: Antimicrobial susceptibility testing was done according to guideline recommendations of the Clinical and Laboratory Standards Institute (CLSI). All strains were screened for hetero-VISA using Brain Heart Infusion agar containing 4mg/L vancomycin. The presence of strains that were hetero-VISA was confirmed by population analysis. Results: The susceptibility pattern of MRSA clinical isolates to 10 antimicrobial agents did not change markedly between the two time periods. However, the rate of arbekacin resistance in 2005 2006 was significantly lower than that in 1999 (p=0.003). Curiously, the detection rate of hetero-VISA decreased to 0.6 % in 2005-2006 from 5.1 % in 1999. Conclusions: The reason for the decrease in hetero-VISA is unknown but it may have been due to a modern practice of therapeutic drug monitoring (TDM) for vancomycin treatment and the reduction of the use of beta-lactam antibiotics after the clinical introduction of vancomycin in 1991.
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  • Changes of serum IgA /C3 ratio in patients with IgA nephropathy
    FUMIKO KODAMA, ISAO OHSAWA, KENJI YAMAJI, YUKO INAMI, HIROYUKI OHI, SA ...
    2008 Volume 54 Issue 3 Pages 337-343
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.337
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    Objective: In the present study, we analyzed changes in serum IgA/C3 ratio and the relationship with clinical data such as histological diagnosis, urinalysis, serum creatinine and treatment in patients with IgA nephropathy. Materials: Eighty-one patients were diagnosed with IgA nephropathy b renal biopsy at Juntendo University. Method: Serum IgA/C3 ratio, serum IgA, serum C3 and other clinical markers were determined these in 81 patients 6.82±2.07 years after diagnosis. Measurement & Results: Serum IgA/C3 ratio of all patients decreased significantly from 4.33±1.67 to 3.32±0.97 (p<0.0001). In detail, serum IgA decreased from 367.89±129.03 mg/ dl to 328.69±100.36mg/ dl (p<0.0001) and serum C3 increased from 88.27±18.57mg/dl to 100.14±16.69mg/ dl (p<0.0001). Regardless of histological diagnosis, the existence of hematuria and/or proteinuria and history of steroid therapy, the serum IgA/C3 ratio significantly decreased but remained at 3.01 or higher. At the same time, serum IgA levels decreased and C3 levels increased. Only in the deteriorating renal function group, serum C3 level did not increase and was lower than that of the immutable renal function group (p=0.0207). Conclusions: In IgA nephropathy patients, acceleration of serum IgA production is considered to decrease with progression. The fluctuation of serum C3 level suggested that C3 consumption might occur at disease onset and reflect disease activity. It appears that the serum IgA/C3 ratio became 3.01 or higher with time and might be useful in predicting the course of renal function with IgA nephropathy.
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  • Changes in the use of health, medical and welfare services among patients with Parkinson's disease
    a comparison of elderly care in Japan between 2000 and 2007
    HIROKO SUKETOMO, YOSHIO YAMAJI, WAKAHA IKEDA, MICHIKO KUROSAWA, YUTAKA ...
    2008 Volume 54 Issue 3 Pages 344-351
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.344
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    Objective: To ascertain the use of health, medical, and welfare services among patients with Parkinson's disease in Japan, and to assess changes in the use these services from the introduction of Japan's public nursing care insurance system between 2000 and 2007. Methods: Two surveys sent by mail were conducted in 2000 and 2007, both targeting members of the Japan Parkinson Disease Association (JPDA). Researchers collected and adjusted the data for analysis regarding attributes, care level, and service use. Relationships between 2000 and 2007 were analyzed using t-tests and x 2 tests for both male and female patients. Results: There were responses from 3459 persons (62.7% of all surveyed) in 2000 and 1813 (52.0%) in 2007. Applicants for care authorization significantly increased among both male and female patients between 2000 and 2007. Services that demonstrated a significant increase in use included rehabilitation and visiting nursing. Services that demonstrated a significant decrease in use included visiting dental examinations, bathing services, daytime care, and short stays for both male and female patients. Discontinued services significantly increased in rehabilitation, and significantly decreased in bathing services, among both male and female patients. Discontinued services also significantly decreased for visiting medical examinations, visiting dental examinations, and short stays among male patients. Patients of both genders in these years received information about care services primarily from their family doctor, and secondarily through the JPDA. Patients' self-assessment of their quality of life improved from 2000 to 2007 among male patients. Conclusions: Insured care use among patients with Parkinson's disease has increased significantly since the introduction of Japan's public nursing care insurance system. Furthermore, males tended to use institutionally-based services while females tended to use home-based services. The elderly should be informed about available services through various social resources.
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  • Research on Hospital Design for the Best Infection Control with Special Reference to Initial Triage in Out Patient Area (OPA)
    AKIRA ITO, YUICHI SAKIMURA, SYOICHI MORIMOTO, MAYUMI AMINAKA, SATOSHI ...
    2008 Volume 54 Issue 3 Pages 352-357
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.352
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    The requirement of provisions for thorough infection control of hospitals has increased with the prevalence of influenza and various unknown infectious diseases. Especially, the outpatient area is one of the key areas in which prompt triage of patients with infectious diseases should be considered. To accumulate information regarding the best hospital design to facilitate prompt triage in OPA, first we conducted a questionnaire survey for doctors and nurses working in Juntendo University Hospital. Then, data were compared to that obtained by review of other hospitals in and outside Japan. The usage conditions of OPA, the consideration to architectural space and infection control, the improvement of the environment and the building services has been extracted from the investigation result. At domestic and overseas hospitals there have been many reports, in which separation of the clean route and dirty route were unclear methods for handling infectious diseases have not been appropriate even, though some isolation spaces were available. It proposes a new triage model plan by thinking that the design and the construction of OPA where infection control was considered necessary based on this questionnaire survey result. This new outpatient triage plan functions flexibly during periods when infectious diseases are not prevalent and during those when the incidence of infectious diseases has expanded. The separation of a clean route and dirty route for persons and materials is clearly set. The specifications for suitable interior and building services for infection control are shown. It is thought to be important to practice this outpatient triage plan not only from the perspectives of functionality, flexibility, and space-saving that are concepts underlying good hospital design but also from the consideration of always attempting to maintain efficient operation.
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  • The first success in preventing maternal-fetal transmission in a pregnant HIV-infected woman at Juntendo University Hospital
    MIZUE SAITA, TOSHIO NAITO, NAOMI MATSUMOTO, HIROKO OHSHIMA, HIROSHI IS ...
    2008 Volume 54 Issue 3 Pages 377-381
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.377
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    Introduction: New cases of HIV infection are increasing in Japan. Most of this increase has been seen among male homosexuals, but a report in 2007 also showed an increase among females. We have recently achieved the first success in preventing maternal-fetal transmission in a pregnant HIV-infected woman at Juntendo University Hospital. Case: This report describes a 40-year-old female infected with HIV. Discussion: Prevention of maternal-fetal HIV transmission requires specific management at each stage of pregnancy. The Department of Health and Human Service guidelines recommend starting anti-HIV therapy, including zidovudine (AZT), at gestational week 14 to effectively prevent maternal-fetal infection. We were the first to successfully prevent maternal-fetal transmission with anti-HIV therapy in this pregnant HIV-infected woman at Juntendo University Hospital.
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  • Waon therapy in severe heart failure patients with continuous catecholamine infusion: a report of two cases
    YOSHIYUKI MASAKI, KAZUNORI SHIMADA, ATSUMI KUME, MIHO NISHITANI, KOHSU ...
    2008 Volume 54 Issue 3 Pages 382-386
    Published: September 30, 2008
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.54.382
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    It has been reported that Waon therapy, using a far infrared ray dry sauna, improves vascular endothelial function and various endogenous hormones and cytokines by raising the patients deep-body temperature by 1.0-1.2°C. We treated two patients with severe chronic heart failure (CHF), who could not discontinue catecholamine infusion without Waon therapy. After Waon therapy, endothelial function and cytokinelevels were improved, resulting in successful discontinuation of catecholamine infusion. Waon therapy may be an effective strategy to improve the general condition of patients with CHF.
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