The present study investigated smoking prevalence and attitudes toward smoking in student and staff nurses, and activities to promote tobacco intervention by staff nurses. A total of 743 student nurses in 2 colleges and one university and 490 staff nurses in the university hospital in Niigata, Japan participated in the study and filled in self-administered anonymous questionnaires focused on smoking habits, attitudes toward smoking, and activities to promote tobacco intervention. The smoking prevalence among student nurses was 6% and increased with the year of study, whereas that of among staff nurses was 16% and increased by employment up to 3-5 years. Almost half of the student nurse smokers started the habit before admission to higher education facilities, and more than half of staff smokers also started smoking in their school years, in high school or college. Nicotine dependence, as defined by over 11 cigarettes per day and the first cigarette within 30 min after getting up, was high in smokers who started smoking before admission to college or university, but not in those who took up the habit thereafter. Thirty-six percent of student nurses and 25% of staff nurses agreed with the statement that “nurses should not smoke.” Only 12% of staff nurses were involved in anti-tobacco interventions routinely, partly due to lack of broad knowledge and the necessary skills. Greater efforts are needed as a high priority to educate student and staff nurses systematically and comprehensively about the range of tobacco interventions available in Japan.
The shortage of pediatricians and emergency medical care for children is an issue of great concern in Japan. This study attempts to identify the problems in children's medical care and their causes. With multiple secondary data sources, we found that over 80% of outpatient pediatric services were provided by clinics, that over 95% of clinics were closed on holidays, Sunday, and Saturday night, that among the children's illnesses respiratory ailments were dominant and were generally acute and required immediate treatment or consultation, and that the revenue rates from providing services for children were lower than those for adults. That fewer clinics are open on Saturday night, Sunday and holidays, and workday evenings may be the main reason why it is difficult for children to find pediatric services outside of normal working hours. Lower revenue rates may be one of the key reasons why the number and rate of clinics and hospitals providing pediatric services continue to decline, and fewer physicians are willing to provide services for children. The findings in this research would provide important information of multiple dimensions for the governments to make efforts to improve pediatric services in Japan. Our proposition is to prompt pediatric specialists and internists who can treat pediatric cases in clinics to provide pediatric service systematically and alternatively at night, and to adjust the fee-for-service scales of pediatric services.
Intestinal intraepithelial lymphocytes (IEL), one of the major effector components in the mucosal immune system, are phenotypically and functionally distinct from thymic and peripheral T cells. To investigate the effect of repeated stress on the number and function of IEL, we exposed male C3H/HeN mice to mild electric foot shock for 30 min/day for 5 consecutive days. Immediately after the final foot shock stress, the blood, spleen, thymus and small intestine of each of the mice were obtained. As a functional measure, we evaluated interferon (IFN)- γ production by IEL, since IFN-γ is a key immunomodulating cytokine in mucosal immune responses. Serum corticosterone level was elevated immediately after foot shock stress. There were no significant changes in the number of whole IEL and CD3+ IEL subsets after the stress. In contrast, the stress led to a significant decrease in the total number of thymocytes, particularly the reduction in the number of CD4+CD8+ thymocytes. Thymocytes expressed the highest level of intracellular glucocorticoid receptor (GR), followed by splenocytes and IEL. The foot shock stress induced a marked suppression of IFN-γ production by IEL, when stimulated with immobilized anti-CD3 monoclonal antibody. Furthermore, corticosterone suppressed the IFN-γ production by cultured IEL, which was prevented by Mifepristone (RU486), a GR antagonist. In summary, repeated foot shock stress did not alter the numbers of IEL and CD3+ IEL subsets, but suppressed IFN-γ production by IEL, which was probably mediated by the elevated corticosterone. We therefore propose that stress influences host defense by suppressing the production of IFN-γ in IEL.
Many studies have been conducted on physiological responses of music, yielding controversial results. In the present study, we examined whether music affects the exercise-induced changes in the autonomic nervous system activity in twelve healthy female college students. On the first day, the subjects were asked to rest, exercise, and then rest for 15 min, respectively. On the second day, they were asked to rest with music, exercise, and then rest with music for 15 min, respectively. Heart rate variability was measured for the pre- and post-exercise periods. Music was given according to subjects' preferences using a vibroacoustic apparatus (body sonic system), i.e. a chair on which subjects laid and felt low-pitch sounds by their body in addition to listening music. With music, ratio of low frequency to high frequency component of heart rate variability (LH/HF) was significantly increased after exercise as compared with before exercise (p < 0.01). By contrast, the changes in LH/HF were not significant without music (p > 0.05). It is suggested that after exercise in which sympathetic nerve activity is dominant, preferred music synchronizes with the activated physical response, further promoting the response and increasing sympathetic nerve activity. Combining music with exercise is therefore not only enjoyable in terms of mood but also may promote physiological excitation and enhance physical activation.
Hyperlipidemia is a cardiovascular risk factor. In patients with idiopathic dilated cardiomyopathy (IDC), prognostic roles of endogenous lipoproteins are not fully clarified. It has been known that there is a direct relationship between the levels of cytokines (tumor necrosis factor-α [TNF-α] and interleukin-6 [IL-6]) and deteriorating functional classes of heart failure and mortality. The present study compared the levels of circulating TNF-α, IL-6, lipoproteins, and apolipoproteins in patients with stable IDC (n = 28) with those of patients with unstable IDC (n = 26) and controls (n = 24). Mean serum total cholesterol (TC) was significantly lower in stable IDC patients than controls (p < 0.05). In unstable IDC patients, mean serum TC was also lower than controls but not statistically significant. The IDC patients had significantly higher concentrations of IL-6 and TNF-α than the controls (p < 0.01). Serum IL-6 and Apo AI levels were significantly different between stable and unstable IDC patients (p = 0.021 and p = 0.012, respectively). Increased levels of IL-6 were associated with decreased levels of TC (r = −0.266, p = 0.019), LDL-C (r = −0.376, p = 0.001) and apolipoprotein AI (apo AI) (r = −0.495, p < 0.001) in all IDC patients. TNF-α was also inversely related to apo AI (r = −0.455, p < 0.001) and LDL-C (r = −0.364, p = 0.001) in all patients. Thus, elevated serum levels of cytokines in patients with IDC are associated with decreased lipoprotein concentrations, which may indicate impaired prognosis.
Homocysteine is an essential amino acid required for the growth of cells and tissues in the human body. Maternal hyperhomocysteinemia is associated with a number of placenta-mediated diseases such as preeclampsia. The aim of this study was to evaluate the plasma level of homocysteine and its association with severity of preeclampsia. A case-control study was performed with 32 mild preeclamptic patients, 25 severe preeclamptic patients, 16 eclamptic patients and 34 controls. Maternal plasma homocysteine concentration was measured prospectively at antenatal period by high-performance liquid chromatography. There were no significant differences in demographic characteristics between the study and control groups. Mean plasma levels of homocysteine in women with severe preeclampsia (16.7 ± 10.1 μmol/l, mean ± S.D., n = 25) and eclampsia (16.5 ± 9.6 μmol/l, mean ± S.D., n = 16) were significantly higher than those in mild preeclampsia (7.7 ± 2.4 μmol/l, mean ± S.D., n = 32) and controls (6.7 ± 1.6 μmol/l, mean ± S.D., n = 34) (p < 0.0001). It should be noted that plasma levels of homocysteine are not significantly different between mild preeclampsia and controls. In conclusion, plasma homocysteine concentrations are increased in severe preeclampsia and eclampsia, but not in mild preeclampsia.
Leptin, a hormone produced by the adipose tissues, reduces appetite and food intake, and increases energy expenditures by sending signals to the brain cells. As human obesity is associated with hyperleptinemia and increased systemic oxidative stress, we investigated whether leptin affects lipid peroxidation and antioxidant status in the brain. Leptin was intraperitoneally administered to adult male BALB/c mice (n = 6) at a dose of 40 μg/animal for 5 days, while control mice (n = 6) received phosphate buffered saline. All animals were decapitated one hour after the last injection, and the brain tissues were removed. Total brain tissues were homogenized with phosphate buffered saline. Lipid hydroperoxide and glutathione levels were measured by enzyme immunoassays. Data were statistically analysed by using Mann Whitney's U-test. Lipid hydroperoxide levels were significantly higher in the brain tissue of leptin-treated mice (3.44 ± 0.36 nmol/g tissue, mean ± S.E.M.) than those of the control mice (2.20 ± 0.38 nmol/g tissue, p < 0.01). In contrast, leptin-treated mice had significantly lower glutathione levels in the brain tissue compared to the control (12.97 ± 1.32 and 17.91 ± 0.82 nmol/g tissue, respectively, p < 0.05). These results indicate that exogenous leptin increases lipid peroxidation and inhibits antioxidant system in the mouse brain. We therefore suggest that leptin may augment oxidative stress in the brain.
Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the estrogen and placebo groups were 4.4 ± 0.7 and 3.7 ± 0.7 mm, respectively (p < 0.01). Mean time required for dilatation of cervix was 44.4 ± 16.2 seconds for the estrogen group and 61.4 ± 18.3 seconds for the placebo group (p < 0.01). As a conclusion, misoprostol treatment alone is not effective to get cervical priming in postmenopausal women, and as shown in our study, pretreatment with local estrogen overcome the failure. To get a beneficial effect of misoprostol on cervical ripening, estrogenic activity is necessary and when pretreated with local estrogen, misoprostol ameliorates cervical priming in postmenopausal women.
Although many patients with coronary artery disease are being treated by coronary stents, in-stent restenosis is the major limitation of percutaneous coronary stenting procedures. Most stents are made of stainless steel, and that, allergic reactions to nickel ions released from coronary stainless-steel stents may be one of the triggering mechanisms for in-stent restenosis. We aimed to evaluate the relationship between in-stent restenosis and nickel allergy in a prospective study. For this purpose, we applied epicutaneous patch test for nickel in 43 patients who had undergone elective intracoronary stent placement for stable angina pectoris in the day following stent placement and evaluated the presence of nickel allergy. Control angiography was performed at 6 months to determine in-stent restenosis. Three (6.9%) patients had allergic reaction to nickel and 16 (37%) patients had developed in-stent restenosis. One of the 3 patients with nickel allergy had diffuse in-stent restenosis and the others not. The present study therefore does not support the proposed relationship between nickel allergy and development of in-stent restenosis in patients having stainless steel stents. Large scale studies are needed to reach a final conclusion.
Remote organ injury represents the oxidative damage, which occurs in various organs away from the tissues exposed to ischemia-reperfusion insult. Hypothesizing that the eye may be susceptible to this type of tissue damage, we investigated the effect of splanchnic ischemia-reperfusion on the chorio-retinal tissue in Sprague-Dawley rats. Four groups, each consisting of 10 male rats, were designed for the study. Ischemia-reperfusion was introduced by clamping superior mesenteric artery for 1 hour, followed by reperfusion for 90 min (IR group). In another group, the same operation was performed except that zinc aspartate (50 mg/kg) was given intra-peritoneally 15 min before the opening of the clamp (Zn-IR group). As control (sham group), the abdomen was opened without any intervention on superior mesenteric artery. The other group was given Zn after opening of abdomen without any intervention on superior mesenteric artery (Zn-sham group). After the choroid and the retina were dissected from the eye, malondialdehyde, superoxide dismutase, catalase and nitric oxide (NO) were measured in the collected eye tissues. We found that the levels of malondialdehyde, an indicator for lipid peroxidation, were higher in the chorio-retinal tissue of IR group compared to Zn-IR, Zn-sham or sham group (p < 0.05). The oxidative stress in Zn-IR group was not higher than that of sham group. Treatment with zinc decreased NO levels but had no noticeable effect on the level of antioxidant enzymes. Our study indicates that remote organ injury is induced in the eye during splanchnic ischemia-reperfusion and that zinc may be beneficial to ameliorate remote ocular injury.
Shwachman-Diamond syndrome (SDS) is a rare hereditary disorder characterized by pancreatic exocrine insufficiency, bone marrow dysfunction and skeletal changes. Recently, the cause of SDS was identified as mutations of Shwachman-Bodian-Diamond syndrome gene (SBDS) and most mutations are caused by gene conversion between SBDS and its highly homologous pseudogene. Clinical variations especially in skeletal and bone marrow abnormalities are well known in this syndrome. To study the relationship between SBDS mutation and its clinical features, we analyzed 9 Japanese patients including one sibling and detected the three different SBDS mutations in 7 patients: a mutation that disrupts the donor splice site of intron 2, deletes 8bp of the exon 2 and produces premature termination (258+2 T > C), a dinucleotide change that replaces a lysine at 62nd amino acid to a termination codon (183-184 TA > CT), and a 4-bp deletion that causes premature termination by frameshift (292-295 delAAAG). The 5 patients represent compound heterozygotes of the 258+2 T > C and 183-184 TA > CT mutations. One patient is a compound heterozygote of the 258+2 T > C and 292-295 delAAAG mutations, and in the remaining one case only a 258+2 T > C mutation could be detected. Thus, the 258+2 T > C and 183-184 TA > CT mutations are prevalent among Japanese patients. No mutations were found in two cases, despite the clinical features. Of the 7 patients with SBDS mutations, persistent hematologic abnormalities and skeletal changes were not observed in 3 and 2 patients, respectively. Notably, clinical variations are present even among the patients with the identical genotype: compound heterozygotes of the 258+2 T > C and 183-184 TA > CT mutations. Further study will be required to explain the clinical heterogeneity.
Ectopic pregnancy developing in a previous Cesarean section scar is rare and is associated with catastrophic complications, such as uterine rupture and uncontrollable bleeding, which may lead to loss of the uterus. The operative treatments that have been reported for cesarean scar pregnancy are dilatation and curettage and excision of trophoblastic tissues using either laparotomy or laparoscopy. Recently, conservative treatment of scar pregnancy with locally and/or systemically administered methotrexate (MTX) has been reported. However, recent reports demonstrated that cases treated with MTX sometimes required laparotomy later because of excessive bleeding. In this series of cases we have demonstrated that viable cesarean scar pregnancies can be treated safely by selective transarterial embolization in combination with subsequent dilatation and curettage and local or systemic injections of MTX. In these three cases, uterine artery embolization proved to be a useful procedure for preventing uncontrollable bleeding and unnecessary uterine loss.
The term “papillomatosis” indicates the tendency towards multicentricity and recurrence that these tumors exhibit (Snyder et al. 1972). A typical squamous papilloma arises from the nasal vestibule and is characterized by the epithelial proliferation growing an exophytic manner. We report a rare case of squamous papillomatosis of the bilateral nasal cavities. A 65-year-old man presented with a 2-year-history of bilateral nasal obstruction. Computed tomographic (CT) scans revealed a soft density mass in the bilateral nasal cavities and ethmoid sinuses. Because the tumors were limited to the nasal cavities and anterior ethmoid sinuses, total removal of the tumors was performed endoscopically. On the basis of the clinicopathological findings, the tumors were diagnosed as squamous papillomas. His post-operative course was uneventful, and he is currently free from disease 13 months after surgery. Nasal papillomas usually arise from the unilateral nasal cavity or paranasal sinus. While some cases of inverted (inverting) papillomas arising from the bilateral nasal cavities have been reported, bilateralism of the nasal squamous papillomas is quite rare. Diagnosis, clinical behavior and treatment of squamous papillomatosis of the bilateral nasal cavities are reviewed.
We report on a very rare case of peritoneal clear cell adenocarcinomas. A 49-year-old Japanese woman underwent hysterectomy and bilateral salpingo-oophorectomy for endometrial endometrioid adenocarcinoma grade III, which was composed of undifferentiated carcinoma cells (98%) and tubular carcinoma cells (2%). No clear cell adenocarcinoma elements were noted in this tumor. Two peritoneal cystic tumors were detected by imaging modalities around the stomach and spleen, 15 months and 21 months after the follow-up period of the endometrial carcinoma, respectively. These two tumors were surgically resected. They were cystic tumors encapsulated by fibrous capsules and showed the same morphologies. They showed proliferation of carcinoma cells arranged in solid nest, tubular, and papillary patterns. They showed clear cytoplasm positive for periodic acid-Schiff stain, hobnail cells, and occasional hyaline globules. The morphologies fulfilled the criteria of clear cell adenocarcinoma. The morphologies and immunohistochemical findings of the two peritoneal clear cell adenocarcinomas were different from those of endometrial carcinoma. We believe that the two clear cell adenocarcinomas are not metastatic lesions from the endometrial carcinoma of the uterus, and that they are primary clear cell adenocarcinomas of the peritoneum. Our case was characterized by cyst formations and encapsulation in addition to the common histological features of clear cell adenocarcinoma of the uterus and ovary.
Superior hypogastric plexus block has been advocated for the treatment of cancer related pelvic pain. Neurolysis is usually established using the classical posterolateral approach in the prone position, in which correct placement of the needle is sometimes difficult due to vertebral anatomy and the patient's inability to lie prone. We describe an alternative posteromedian transdiscal approach under fluoroscopic guidance for the treatment of intractable pelvic pain in three patients, in whom the classical approach was not possible. The L5-S1 interdiscal space was identified with fluoroscopy. The needle was then introduced through the disc and advanced under lateral fluoroscopic control. After verifying correct needle placement, neurolysis was performed with 8 ml of 10% phenol solution. All patients had significant pain relief immediately after the block, lasting from 6 to 12 months, and their pain severity scores and opioid consumption were reduced by more than 50%. There were no complications such as discitis, disc rupture or nerve injury. Since this new posteromedian transdiscal approach provides easy access to the superior hypogastric plexus with a single puncture and with any patient position, it may be an alternative to the classical approach.