Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 55, Issue 1
Displaying 1-15 of 15 articles from this issue
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Contents
  • Topics in obesity and metabolic syndrome in children
    HIROKO KODAMA
    2009 Volume 55 Issue 1 Pages 16-21
    Published: March 31, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.16
    JOURNAL FREE ACCESS
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    In Japan, obesity has been increasing in children. About 10% of school children are suffering from obesity, and 15-20% of obese children are suffering from metabolic syndrome. Fatty liver and high serum levels of triglyceride and insulin are observed in 23-43%, 30% and 42-55% of obese children, respectively. About 70 % of obese children at puberty become obese adults. Obesity is caused by intrauterine malnutrition, early adiposity rebound, excess intake of energy, fat and animal protein, bad dietary habits, limited physical exercise and shortage of sleep. Skipping breakfast is strongly associated with obesity. About 15% of Japanese teenagers skip breakfast. To treat and prevent obesity, nutritional education, called Shokuiku, of children is needed. Recent efforts regarding nutritional education are ongoing in elementary schools. Pediatricians should work together in nutritional education.
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  • Developmental Origins of Health and Disease
    environmental influences during development and their later consequences for health and disease
    KAZUO ITABASHI
    2009 Volume 55 Issue 1 Pages 22-26
    Published: March 31, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.22
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    Barker developed the fetal origins of adult disease (FOAD) hypothesis based on evidence suggesting both additive and interactive effects of prenatal and infant growth on the risk of subsequent coronary heart disease. The concept of developmental origins of health and disease (DOHaD) grew from the earlier concept of FOAD hypothesis, and this concept has been accepted throughout the world. The fundamental assumption underlying the DOHaD model is developmental plasticity in which environmental factors in early life have consequences which become manifest as an altered disease risk in later life. In Japan, the birth weight has fallen rapidly. This has been associated with maternal constraint due to several factors such as decreased maternal pregnancy BMI resulting from dieting and aggressive management of weight gain in pregnancy, and increased maternal smoking, increased multiple births, and higher maternal age at first pregnancy. Maternal constraint in a critical window may induce developmental plasticity. A mismatch between nutritional restriction in utero arising from maternal constraint and the postnatal environment may be associated with the high prevalence of metabolic syndrome in Japan.
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  • Nutrition, growth and neurophysiological maturation in very preterm infants
    MASAHIRO HAYAKAWA
    2009 Volume 55 Issue 1 Pages 27-33
    Published: March 31, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.27
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    During the fetal and early neonatal periods, optimal nutrition is very important because nutrients regulate brain development ; therefore, an undernourished and/or malnourished status influences not only physical development, but also central nervous system development in the fetal and early neonatal periods. Recently, some studies have indicated that postnatal growth is significant for neurodevelopment in later life ; postnatal growth restriction is closely associated developmental delay. Neonatal EEG is a powerful, non-invasive tool for the assessment of brain maturation as well as brain insult in preterm infants. In particular, serial EEG recordings beginning immediately after birth are useful to elucidate the pathogenesis in very preterm infants. We evaluated electrophysiological maturation in infants with intrauterine growth restriction and extrauterine growth restriction using serial EEG recordings immediately after birth. The findings indicated that delayed electrophysiological maturation was associated with postnatal undernourishment and postnatal physical growth restriction. Many studies have been conducted to clarify the relation between under/malnourished states and neurological sequelae. Serial neonatal EEG recordings might be useful tools to elucidate the pathophysiology of brain damage in infants with under/malnourishment.
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  • Establishing Sox10-VENUS transgenic mice utilizing BAC recombination in E. coli for analyses of neural crestopathy
    CHIHIRO AKAZAWA, KENSAKU SHIMURA, KUNIHIRO ISHII, NOZOMI MATSUO
    2009 Volume 55 Issue 1 Pages 34-39
    Published: March 31, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.34
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    SOX proteins are a family of transcription factors with high mobility that define diverse developmental processes. SOX10 regulates early neural crest development, specification of neural crest-derived lineages, and terminal differentiation of oligodendrocytes in the central nervous system. It has been difficult to raise transgenic (Tg) mice that express reporter genes because of the size of the SOX10 promoter region. Here, we utilized a bacterial artificial chromosome (BAC) Tg method to raise mice in which VENUS was replaced with SOX10. The expression of VENUS was observed in the neural crest cells in a manner identical with that of endogenous SOX10.
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  • Correlation between progression of scoliosis and position of the cerebellar tonsils
    DAISHI NAKAHARA, IKUHO YONEZAWA, TAKATOSHI OKUDA, JUNTA SAKODA, HIDETO ...
    2009 Volume 55 Issue 1 Pages 40-44
    Published: March 31, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.40
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    Objective: To investigate variations in the position of the cerebellar tonsils in outpatients with scoliosis of less than 50°, and to assess the correlation between tonsillar position and the progression of scoliosis. Study Design: A prospective study of magnetic resonance imaging findings in outpatients with idiopathic scoliosis. Summary of Background Data : Some patients with presumed idiopathic scoliosis have underlying cerebellar tonsillar herniation, such as the Chiari I malformation or tonsillar ectopia. With the development of magnetic resonance imaging (MRI), the detection of tonsillar herniation has increased. Materials and Methods: A total of 118 girls with a primary diagnosis of idiopathic scoliosis (Cobb angle less than 50° in a standing position) underwent MRI to examine the position of the cerebellar tonsils. Inferior displacement of the tonsils by ? 5 mm below the foramen magnum was defined as Chiari I malformation, and displacement by < 5 mm was defined as tonsillar ectopia. The definition of curve progression was increment of the Cobb angle by 6° or more on any two consecutive occasions. All patients were followed longitudinally until skeletal maturity or until curve progression occurred. The association between the position of the tonsils and progression of scoliosis was then analyzed. Results: The incidence of the Chiari malformation was 3.4 % (4/118 patients) and that of tonsillar ectopia was 8.5 % (10/ 118 patients). Two patients had a Chiari I malformation combined with syringomyelia. Patients with the Chiari malformation showed a significantly higher incidence of curve progression (p=0.006), but no significant correlation was found between tonsillar ectopia and curve progression ; however, tonsillar ectopia patients with displacement of > 2 mm below the foramen magnum showed a significantly higher incidence of curve progression (p=0.048). Conclusions: The Chiari I malformation might be associated with the progression of scoliosis. Furthermore, tonsillar ectopia with displacement of > 2mm below the foramen magnum is associated with a higher incidence of curve progression than ectopia with displacement of < 2mm. Based on these findings, tonsillar ectopia of > 2mm is the pathologic position of the cerebellar tonsils for the progression of scoliosis, and should be followed up as carefully as Chiari I malformation. It was previously reported that with growth of the skull bones, brain stem compression decreases, and scoliosis improves or stabilizes. With tonsillar ectopia or Chiari I malformation, the position of the tonsils might improve, and if the tonsils become less than 2mm below the foramen magnum, there is some possibility of improvement or stabilization of curve progression.
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  • A cross-sectional study of magnetic resonance imaging findings with the radiographic stage and clinical findings
    MITSUAKI KUBOTA, HISASHI KUROSAWA, HIROSHI IKEDA, YUJI TAKAZAWA, TAKAY ...
    2009 Volume 55 Issue 1 Pages 45-53
    Published: March 31, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.45
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    Background: Bone marrow abnormalities (BMAs) are frequently found in osteoarthritis (OA) of the knee with magnetic resonance imaging (MRI). Some reports have suggested BMA was correlated with the X-ray stage of OA and also with knee pain, but the reports depended on two-dimensional images without considering the spatial expansion of BMAs. Objectives: To determine whether three-dimensional expansion of a BMA with MRI in patient with medial-type OA of the knee is correlated with the radiographic stage of OA and clinical findings using a semiquantitative method. Design: Cross-sectional study Materials and Methods: This study enrolled 238 patients with medial-type OA. Radiography and MRI of the knee were taken in all participants. X-rays were graded using the Kellgren-Lawrence (K/L) grade (1-4). T2-weighted fat-suppressed MRI images were used to score the size of the BMA according to the whole-organ MRI score (WORMS). A new scoring system defined as the spatial BMA score (s-score), which specifically addressed the spatial expansion of BMAs, was examined to assess the size of the BMA. BMA frequency was examined in subdivisions of the articular surfaces of the knee according to the X-ray stages of the K/L grade and the correlation of the s-score to the clinical findings. Results: BMA frequency in the medial femorotibial joint (MFTJ ; 74%) was significantly higher than in the lateral femorotibial joint (LFTJ ; 14%) and patellofemoral joint (PFJ ; 14% ; P < 0.01). The s-score of the MFTJ was strongly correlated with the X-ray stage assessed by the K/L grade. The s-score of the MFTJ was also correlated with the clinical findings. Conclusion: The frequency and spatial expansion of BMAs in the MFTJ are strongly correlated with the X-ray stage of medial-type OA as well as the clinical findings.
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  • Cross-sectional association between urinary type II collagen C- terminal telopeptide concentration and radiographic spinal disc degeneration
    JUNTA SAKODA, MUNEAKI ISHIJIMA, HISASHI KUROSAWA
    2009 Volume 55 Issue 1 Pages 54-59
    Published: March 31, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.54
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    Introduction: When degraded, type II collagen, which is contained in large quantities in the cartilage and intervertebral discs, produces a C-terminal peptide (type II collagen C terminal telopeptide, CTX-II), which is excreted in the urine. It has been reported that CTX-II is useful for evaluating the severity of cartilage degeneration and abrasion in the hip and knee joints, but shows no correlation with the severity of degeneration of intervertebral discs, which are mostly composed of type II collagen. The present study was performed to clarify whether urinary CTX-II was correlated with intervertebral X-ray findings. Objectives: A cross-sectional study was performed to clarify correlations between urinary CTX-II and the progression of degeneration of each intervertebral disc on lumbar X-P films. Materials and Methods: The subjects of this study were 100 patients (400 intervertebral discs) aged?40 years. They visited this hospital for the first time because of low backache. Intervertebral disc height, osteophyte length and Kellgren-Lawrence classification were measured to evaluate the degree of lumbar disc degeneration on X-ray films. The second freshly voided urine was used for measuring urinary CTX-II. The measurement results were investigated for correlations with disc height, osteophyte length, age, sex, BMI, and lumbar MRI findings by cross-sectional analysis. The t-test and Kruskal-Wallis-test were used for statistical analysis of data. Results: Urinary CTX- II was not correlated with age or BMI but was significantly higher in females than in males. It was only correlated with the degeneration of L2/ 3 and 3/ 4 discs and showed a significant difference between lower, medium, and higher disc groups. It was not correlated with osteophyte length or lumbar MRI findings. Discussion: Urinary CTX-II was only correlated with L2/ 3 and 3/ 4 disc degeneration. This was presumably ascribable to the focus and distance during radiography. Osteophyte formation is a phenomenon secondary to intervertebral disc degeneration, and so it might not be correlated with the severity of disc degeneration. Since MRI might also detect changes before the occurrence of structural changes in intervertebral disc protein, MRI findings may not show a correlation with the severity of disc degeneration Conclusion: These results indicate that urinary CTX-II has the potential to reflect the severity of intervertebral disc degeneration on lumbar X-P films.
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