Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 57, Issue 3
Displaying 1-15 of 15 articles from this issue
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Contents
  • Comparative biochemistry of parasites and hosts, pyrimidine-biosynthetic (pyr) gene cluster, and trypanosomal molecular strategy
    TAKASHI AOKI
    2011 Volume 57 Issue 3 Pages 203-215
    Published: June 30, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.203
    JOURNAL FREE ACCESS
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    Our comparative studies of Ascaris and mammalian hosts revealed, for the first time, the occurrence of a de novo pyrimidine biosynthetic pathway in a helminth parasite, together with the very low and unstable activity of carbamoyl-phosphate synthetase II (CPS II), the first, rate-limiting and regulatory enzyme of the pathway. A prominent feedback inhibition by UDP is characteristic of Ascaris and trypanosomatid CPS II, while UMP and UTP are the most potent inhibitors against Escherichia and mammalian enzyme, respectively. Amino acid residues at UMP-, UDP-, and UTP-binding sites are lysine (hydrophilic;Escherichia CPS II), glutamine (trypanosomatid CPS II), and tryptophan (hydrophobic;mammalian CPS II), respectively. Another comparative study showed a significant correlation between the CPS II activities and a series of Morris hepatomas with increasing growth rates, implying that the enzyme activity is linked with tumor transformation and progression. In Trypanosoma cruzi and Leishmania mexicana, intracellular protozoan parasites classified as trypanosomatids, all 6 enzymes of de novo pyrimidine biosynthesis are encoded by a compact pyr gene cluster containing pyr1-pyr6;the order of these genes from the 5 -terminus is : pyr1-pyr3-pyr6/5 (fused gene) -pyr2-pyr4. This is the first report for the eukaryotic organism possessing such a unique gene cluster of all the genes involved in the metabolic pathway. The trypanosomatid pyr gene cluster may provide a basis for nucleic acid-precursor synthesis, highly probably supporting protozoan growth and eventually causing pathogenicity. T. cruzi causes a marked inhibition of apoptosis in the infected human cell, resulting in parasite survival and thus likely leading to the Chagas' disease. The pathogen up-regulates and exploits cFLIP, only one inhibitor known to specifically inhibit Fas-mediated apoptosis in mammalian cells. This up-regulation or accumulation of cFLIP results from the blockage of Itch, a ubiquitin ligase, of host origin;that is, T. cruzi infection markedly decreases the interaction of the host cFLIP and Itch, yielding a lowered proteasomal degradation of cFLIP. In contrast to some viruses carrying their own genes for inhibition of host cell apoptosis, trypanosomes exploit the host molecules, cFLIP and Itch, for their survival, a unique mechanism employed by a eukaryotic intracellular microbial pathogen. Further, we found an important effector molecule SPRING (secretory protein with a RING finger domain) in T. cruzi, but neither in Trypanosoma brucei nor in Leishmania major. T. cruzi secretes SPRING;the signal sequence-deleted SPRING is localized in the host cell nucleus, has a ubiquitin ligase activity and interacts with a number of host proteins. These findings indicate that SPRING may affect and modify the host proteins. Studies of trypanosomatid effector molecules and host-cell interactant molecules may be promising approaches for deepening our understanding of T. cruzi and Chagas' disease.
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  • Role of the physician in medical care of inflammatory bowel disease
    TOSHIHIDE MARUYAMA
    2011 Volume 57 Issue 3 Pages 216-225
    Published: June 30, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.216
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    Clinical experience with inflammatory bowel disease in the same hospital over 23 years is reviewed in order to define the important role of the physician. The rate of long-term follow-up for patients with inflammatory bowel disease over 10 years was unexpectedly low (47.2% in ulcerative colitis and 58.1% in Crohn's disease), but there was no significant difference in the long-term prognoses of these two entities between our results and several other Japanese reports. In ulcerative colitis, the treatment strategy for maintenance of remission has not yet been established. In Crohn's disease, there are several problems that remain to be resolved, including unknown natural history, early detection of small bowel Crohn's disease and revision of Crohn's Disease Activity Index. In the diagnosis of small bowel disorders, physicians not only select the diagnostic modalities, but also determine the possible pathological condition by careful interview and physical examination. Recent progress in small bowel endoscopy has been remarkable, but x-ray examination remains one of the useful diagnostic modalities for small bowel Crohn's disease showing a variety of mucosal alterations and involved bowel loops, because it can document all aspects of the small bowel on the same image.
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  • The pathogenesis of bone destruction in patients with RA
    NOBORU IIDA
    2011 Volume 57 Issue 3 Pages 226-231
    Published: June 30, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.226
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    Objective : To measure hand mineral density (MCP Juxta articular area) by dual x-ray absorptiometry (DEXA) and to determine the relationship between hand BMD and clinical parameters. Methods : Twenty patients with non steroid treated disease were assessed at baseline and at month 12, for hand (MCP Juxta articular area) BMD and for disease activity and cytokines. Hand (MCP Juxta articular area) BMD in patient was compared with that in a control group of 20 normal volunteers, and the rate of bone loss in patients was compared with that in twenty normal volunteers. Results : At the initial assessment, patients with RA had lower hand (MCP Juxta articular area) BMD than controls. After one year, there was further loss of hand (MCP Juxta articular area) BMD, but normal controls did not demonstrate a significant change in their hand (MCP Juxta articular area) BMD. Hand (MCP Juxta articular area) BMD did not correlate with CRP or LAL (Lansbury index) but hand (MCP Juxta articular area) BMD loss did correlate with TNFα. Conclusions : Patients with RA had lower hand (MCP Juxta articular area) BMD than normal controls, even within 2 years of disease onset. The rate of loss was highest in patients with early disease and correlated with a higher level of circulating TNFα. It is possible that TNFα mediates the progression of bone damage in RA.
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  • MHC analogues found in Staphylococcus aureus affect phagocytosis and other immune responses by human white-blood cells
    MIWA SEKINE, TADASHI BABA, YUKI KATAYAMA, KEIICHI HIRAMATSU
    2011 Volume 57 Issue 3 Pages 232-242
    Published: June 30, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.232
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    We previously identified four genes encoding major histocompatibility complex (MHC) class II analogs (mhc1-4) in the Staphylococcus aureus genome1) . Their sequence similarity to human MHC suggests that the gene products should presumably have some effects on human immune systems. Indeed, MHC3 (Eap) is known to play some part in adherence of S.aureus to host tissue components, such as fibronectin, fibrinogen and intercellular adhesion molecule-1 (ICAM-1) on the surface of endothelial cells. However, the functions of other MHC analogs in S.aureus remain unknown. In this study, we constructed a series of knockout mutants of mhc1-4 by employing the MW2 strain, a highly virulent community-acquired methicillin-resistant S.aureus, in order to investigate the role of MHC analog genes during infection. MW2 and its deletion mutants were evaluated using a mouse infection model as well as by co-incubation with human white-blood cells. Our results demonstrated that MHC1 stimulates both T cell proliferation and proinflammatory cytokine secretion. However, MHC3 is likely to inhibit T cell proliferation and affect antigen presentation ability on dendritic cells when assessed by expressions of HLA and CD86 co-stimulatory molecules. In addition, bacterial phagocytosis by human neutrophils was drastically increased with MW2Δmhc1-4 as compared to wild-type MW2, indicating that gene products decelerate staphylococcal phagocytosis. These findings suggested that MHC analogs function to evade phagocytosis by human neutrophils and also affect subsequent responses mediated by acquired immune responses.
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  • Usability and asepticism of a 2-port type half-kit preparation of isotonic saline with double-ended needles during intravenous preparation
    YASUO SUMOMOZAWA, HIDEKO AIDA, TAKEHIKO YUKISHITA, YUU YUMOTO, KEIKO L ...
    2011 Volume 57 Issue 3 Pages 243-250
    Published: June 30, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.243
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    Objective : Among the most frequently used isotonic saline for intravenous injections, we selected a saline kit with double-ended needles to determine its usability in comparison to the 2-port type and 1-port type half-kit preparations using a questionnaire as well as aseptic testing. Methods : The questionnaire survey was conducted among 50 ward nurses who routinely prepared intravenous drips of injectable drugs. We also implemented a cultivation-test of these intravenous drip solutions and environments. Results : The results of the questionnaire showed that the 2-port type preparation obtained a significantly higher rating (p<0.01) than the 1-port preparation on five survey items : “ease of confirming drug dissolution”, “use in emergency situations”, “ease of monitoring drug at dosing time”, “likelihood of injuring fingers or other body parts at time of disposal”, “feeling that the procedures were shortened”, “risk of mis-administering infusion”, “ease of confirming contents of the infusion”, “danger of injury at abandonment”, “discretion regarding timing of abandonment” and “comprehensive evaluation”. The results of an aseptic testing showed that in vitro cultures detected microbes derived from the nurses' hands, whereas microbes were not detected in aseptically prepared lysate. Conclusions : Isotonic saline kit with double-ended needles was considered useful, especially the 2-port type preparation, which received a higher overall rating for usability than the 1-port type preparation.
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  • Analysis of nasal carriages of Methicillin-Resistant Coagulase-Negative Staphylococci (MRCNS) in admitted patients
    MAI SUZUKI, AKIHIRO INUI, YUKI UEHARA, KYOKO KUWAHARA, HIROSHI FUKUDA, ...
    2011 Volume 57 Issue 3 Pages 251-256
    Published: June 30, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.251
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    Objective : Methicillin-resistant coagulase-negative staphylococci (MRCNS) have become an increasingly frequent pathogen in healthcare-associated infections. However, the details of its spread remain elusive. To further clarify this problem, a survey of the nasal carriages of coagulase negative staphylococci (CNS) in admitted patients was conducted. Patients : Sixty-eight patients who were admitted to the Department of General Medicine, Juntendo University Hospital between January and September 2009 were examined. Method : Nasal swab samples were collected on admission and 2 weeks later and CNS strains were isolated. In all CNS-positive cases, PCR was conducted to amplify the mecA gene and sequencing of the sodA gene was performed. Patient risk factors were also determined based on age, underlying diseases, treatment, duration of admission and the ward that the patient was admitted to. Results : MRCNS was positive in 17% and 38% of the cases on admission and 2 weeks later, respectively. Patients who had either sepsis or diabetes mellitus demonstrated a significantly higher risk for MRCNS colonization. Patients treated with antibiotics and/or steroid also showed a high risk of becoming MRCNS carriers, although significance was not attained. Conclusions : Our findings suggested that a compromised host might demonstrate a higher risk for colonization by MRCNS. As MRCNS can cause healthcare-associated infections including catheter-related bloodstream infection (CRBSI), high-risk patients should receive special attention regarding MRCNS colonization.
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  • Investigation of factors influencing home discharge of stroke patients in Kaifukuki rehabilitation
    Multivariate analysis of 1,505 stroke patients by pathology
    TOMOTAKA INOUE, YOSHIO YAMAJI, MAKOTO ISHIKAWA, EIJI MARUI
    2011 Volume 57 Issue 3 Pages 257-262
    Published: June 30, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.257
    JOURNAL FREE ACCESS
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    In this study, 1505 stroke patients in kaifukuki rehabilitation at our hospital were divided into patients who were discharged home and those discharged elsewhere. Logistic regression analysis was performed using discharge home or elsewhere as the result variable, while patient age, gender, duration of hospitalization, length of the transition period from onset of pathology to the start of kaifukuki rehabilitation, and the functional independence measure (FIM) at both hospitalization and discharge as target variables. Next, analysis was performed again using the same result and target variables for specific types of stroke pathology : cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage. Length of transition period, FIM at discharge, and patient age were identified as factors that influence home discharge among all patients. There were no differences in the home discharge rate was observed by stroke pathology. For cerebral infarction, gender (male), FIM at discharge, and length of the transition period were identified;for cerebral hemorrhage, length of the transition period and FIM at discharge were identified;and for subarachnoid hemorrhage, FIM at discharge was identified. For all pathologies, the younger the patient, the higher the FIM at discharge;and the shorter the transition period, the greater the rate of home discharge. For cerebral infarction and cerebral hemorrhage, the shorter the transition period and the higher the FIM value at discharge, the greater the rate of home discharge. Gender (male) was identified only for cerebral infarction.
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  • A case of cerebral artery dissection that occurred after the patient washed her face
    KEISUKE OMOTE, NORIYOSHI KOBAYASHI, KISARA ONDA, ISAO OHSAWA, SATOSHI ...
    2011 Volume 57 Issue 3 Pages 263-268
    Published: June 30, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.263
    JOURNAL FREE ACCESS
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    We encountered a 46-year-old woman diagnosed as having systemic lupus erythematosus (SLE) at 29 years of age, who presented with dizziness and severe headache that occurred after she washed her face. Based on the neurological findings and those of MRI and MRA, she was diagnosed as having lateral medullary infarction due to cerebral artery dissection. Although severe headache and dizziness are associated with numerous underlying disorders, it is important to establish a differential diagnosis based on information such as age, focus of headache and clinical course. Cerebral artery dissection is one of the important diseases causing severe headache at a younger age.
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