The number of organ transplantation surgeries has increased particularly in the last decade due to technological and scientific advances in medicine. Despite this increase, many patients, however, remain in waiting lists for transplantation surgery. Main reasons for these waiting lists are that there are limited number of organ donations and specifically problems in the management of organ transplantation activities. An efficient management of the allocation and transportation of organs (in other words, logistics management of organ transplantation) are thus extremely important. The aim of the paper is to review current practices of logistics management in the procurement phase of organ transplantation. It initially reviews the organizational structures of the international and national coordination centres, which are founded to coordinate organ transplantation activities and to enhance collaboration among physicians and medical staff. The paper, then, focuses on the possible managerial problems encountered during the procurement phase of organ transplantation. With this respect, common transportation difficulties from global and local perspective are also analyzed. This paper tries to take attention to a systematic regard of the organ transplantation from logistics point of view, thus providing applicable solutions to managerial problems in terms of allocation and transportation of organs.
During recent decades, the incidence of gynecologic cancers, i.e., cancers of the cervix, endometrium and ovary, has increased in Japan. However, risk factors of gynecologic cancers have not been fully clarified in Japan. To investigate common and site-specific risk factors among gynecologic cancers, we conducted a hospital-based case-control study. The cases, i.e., 151 cervical, 103 endometrial and 141 ovarian cancer cases and the controls (n = 2016) were selected from female patients aged 30 and over, who were admitted to a single hospital in Miyagi Prefecture from 1997 to 2003. Information on reproductive factors, exogenous hormone use, and lifestyles including smoking was collected using a self-administered questionnaire. Smoking was significantly associated with an increased risk of cervical cancer. A dose-response relationship with the number of cigarettes per day was also observed (p for trend = 0.004). Older age at menarche was associated with a decreased risk of endometrial and ovarian cancers. For these cancers, the decreased risk was detected with increasing parity number (endometrium, p for trend = 0.0001; ovary, p = 0.0002). There was no significant association between exogenous hormone use and gynecologic cancer risk. The results indicate that smoking is a major risk factor of cervical cancer. In addition, hormonal factors, which are related to early onset of menarche and low parity, are common risk factors for endometrial and ovarian cancers. The increase in female smokers and the decrease in fertility rate may contribute to the increase in gynecologic cancer incidence in Japan.
Considerable evidence indicates that apoptosis plays a critical role in acute myocardial infarction. We have previously shown that Guan-Xin-Er-Hao (GXEH), a Chinese medicine formula, attenuates postischemia myocardial apoptosis. The present study was designed to determine the mechanisms by which GXEH exerts its antiapoptotic effect. Adult male Sprague−Dawley rats were randomized to receive vehicle or GXEH (5 or 15 g/kg) orally 30 min before ischemia and subjected to myocardial ischemia of 3 h (apoptosis peak) or 24 h (necrosis peak) for determination of infarct size. Compared with rats receiving vehicle, those rats treated with GXEH (15 g/kg) showed significantly reduced infarct size, the reduced myocardial apoptosis, as judged by the decreases in TUNEL-positive staining (22.40 ± 5.68% vs. 40.31 ± 10.58%, p < 0.01), and the decrease in the degree of caspase-3 activation (82.97 ± 10.54 vs. 159.95 ± 9.16 μmol cleaved acetyl-Asp-Glu-Val-Asp-p-nitroanilide/mg protein, p < 0.01). Treatment with GXEH (15 g/kg) significantly reduced the release of mitochondrial cytochrome c, a primary mediator of apoptosis, the degree of caspase-9 activation, and the Bax/Bcl-2 ratio. Caspase-9 cleaves and activates caspase-3. Bax promotes apoptosis, while Bcl-2 inhibits apoptosis. Thus, the antiapoptotic mechanisms of GXEH may involve the mitochondrial cytochrome c-mediated caspase-3 activation in cardiomyocytes after acute myocardial infarction. Taken together, GXEH tilted the balance between Bax and Bcl-2 toward an antiapoptotic state, decreased mitochondrial cytochrome c release, reduced caspase-9 activation, and attenuated subsequent caspase-3 activation and postischemic myocardial apoptosis in rats. GXEH may be used as a promising agent for future treatment of cardiovascular diseases.
The non-volitional sudden discontinuation of motor activity, called motor block (MB) or freezing is most commonly associated with Parkinson's disease (PD). MB extends beyond the classical manifestations of PD: akinezia, bradykinezia, rigidity, tremor, and postural instability. MB has been observed and quantified in internally cued repetitive movements such as gait, speech, handwriting, and manual tapping tasks as a distinct feature of PD. We present a simple measurement system for objective evaluation of MB during point-to-point hand movements in patients with PD. Hand trajectories were evaluated in eight PD patients based on values obtained from a digitizing tablet (DT) score. 50 trials per day were recorded in seven consecutive working days. Subjects were instructed to consciously prepare and self-initiate movements between arbitrarily fixed starting and target points without lifting a wireless magnetic mouse. MB was identified as the time interval during movement with no change in coordinates. We analyzed three kinematic parameters: duration, start and number of MBs. If MBs were documented, the DT score was 1, if not, 0. Results were then compared with the ratings of the question in motor section related to freezing of hands from the Unified Parkinson's Disease Rating Scale (UPDRS). For all patients, DT score was in agreement with the UPDRS. Present results indicate that DT is useful for assessing MBs during volitional planar hand movement. This low-cost instrument may be included in a clinical test battery because of short testing time and trouble-free preparation of patient.
Acromegaly is characterized by the somatic disfigurement and excessive production of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Here we report a patient with aromegaly and diabetes mellitus, who showed normal IGF-1 levels in spite of elevated GH levels. The patient was a 52-year-old woman with acromegalic manifestations. Serum GH level was elevated (32.4 ng/mL) with hyperglycemia (fasting plasma glucose, 277 mg/dL) and an extremely high level of glycosylated hemoglobin (HbA1c 17.7%), whereas serum IGF-1 level was within normal range (110 ng/mL, normal range 37-266). Brain magnetic resonance imaging detected a pituitary tumor, with involvement of the right cavernous sinus. Oral glucose tolerance test (OGTT) showed no suppression of serum GH. Thyrotropin-releasing hormone test showed paradoxical increases in serum GH. We therefore diagnosed acromegaly accompanied with diabetes mellitus. A large amount of insulin (34 units/day) was required to control the blood glucose level. The patient was treated with octreotide, a somatostatin analogue, followed by transsphenoidal surgery. After the surgery, serum GH levels were suppressed by OGTT, although basal serum GH levels remained to be high. Basal serum GH levels, however, were normalized 5 months later. Blood glucose became well controlled by the diet alone. In contrast, serum IGF-1 increased to the range of 219-233 ng/mL. Pre-operative serum IGF-1 levels were low probably due to poorly controlled diabetes mellitus. In conclusion, the presence of normal serum IGF-1 levels cannot exclude the diagnosis of acromegaly especially when the patient is accompanied by diabetes mellitus.
Heme oxygenase-1 (HO-1) is the rate-limiting enzyme of heme catabolism and has been assumed to be important in cellular response against oxidative stress through modification of the pro-oxidant heme into less toxic catabolites that behave as antioxidants. However, the precise mechanisms involved and the physiological significance of such activity remain to be clarified. To elucidate roles HO-1 plays in vivo, hepatocyte-specific conditional knockout (CKO) mice of HO-1 gene were generated by site-specific recombination using albumin-promoter-driven Cre-loxP system. In livers of HO-1 CKO mice HO-1 protein level decreased to approximately 30% of control mouse livers. The HO-1 CKO mice are viable, exhibit normal growth curves over six months, and show no histological and serological abnormalities. We found that several cytoprotective genes, such as NAD(P)H dehydrogenase quinone 1 and glutathione S-transferase P1, showed markedly elevated expression, suggesting the increase of oxidative stress in HO-1 CKO mice even under quiescent conditions. In vivo electron paramagnetic resonance studies demonstrated that signal decay times of nitroxyl radicals were significantly longer in livers of HO-1 CKO mice than that of control mice, indicating that radical scavenging activity was significantly compromised in the mutant liver. HO-1 CKO mice were susceptible to carbon tetrachloride hepatotoxicity. These results provide the first in vivo evidence that HO-1 acts to protect cells against the oxidative stress in both basal conditions and upon chemical insult.
Impaired lipid metabolism is an important health problem in postmenopausal women with insufficient estrogens, because dyslipidemia is a risk factor for development of atherosclerosis and the incidence of cardiovascular disease markedly increases after menopause. Pueraria mirifica (PM), a Thai herb, has been noticed as a source of phytoestrogens, estrogen-mimicking plant compounds. However, the clinical effects of PM on lipid metabolism and the underlying molecular mechanisms remain undetermined. Therefore, we examined the effects of PM on serum lipid parameters in a randomized, double-blind, placebo-controlled clinical trial. Nineteen postmenopausal women were randomly assigned to receive oral administration of PM powder or placebo. After 2 months of treatment, the PM group showed a significant increase in serum concentrations of high-density lipoprotein (HDL) cholesterol and apolipoprotein (apo) A-1 (34% and 40%, respectively), and a significant decrease in low-density lipoprotein (LDL) cholesterol and apo B (17% and 9%, respectively), compared with baseline measurements. Moreover, significant decreases were observed in the ratios of LDL cholesterol to HDL cholesterol (37%) and apo B to apo A-1 (35%). Next, we determined the effects of PM phytoestrogens on the activation of estrogen receptor (ER)-mediated transactivation by transient expression assays of a reporter gene in cultured cells. Among PM phytoestrogens, miroestrol and coumestrol enhanced both ERα- and ERβ-mediated transactivation, whereas other phytoestrogens, including daidzein and genistein, preferentially enhanced ERβ-mediated transactivation. In conclusion, PM has a beneficial effect on lipid metabolism in postmenopausal women, which may result from the activation of gene transcription through selective binding of phytoestrogens to ERα and ERβ.
Hypertension and obesity are likely the most common disease in Japan. It has been reported that subjects with prehypertension (systolic blood pressure [SBP] 120-139 mmHg and/or diastolic blood pressure [DBP] 80-89 mmHg) have also an increased risk of cardiovascular disease; however, only limited data are available on the prevalence of prehypertension and its association with body weight. We performed a cross-sectional study to examine whether the status of body weight was associated with prehypertension. Study participants aged 19 to 90 years [1,207 men aged 60 ± 15 (mean ± standard deviation) years and 1,634 women aged 63 ± 12 years] were randomly recruited for a survey at the community-based annual medical check-up. The prevalence of prehypertension was 27.3% in men and 23.9% in women. The levels of SBP and DBP increased, as body mass index (BMI) increased in both genders. In a multivariate-adjusted model, increasing BMI categories were positively associated with prehypertension. Especially in men, compared to participants with BMI of < 21.0 kg/m2 (referent), the multivariate-odds ratio (95% CI) of prehypertension was 1.90 (1.17-3.09) in the 21.0-23.4 kg/m2 group, 2.38 (1.31-4.34) in the 23.5-24.9 kg/m2 group, and 3.79 (2.03-7.09) in the ≥ 25.0 kg/m2 group. In conclusion, even subjects with mildly increased BMI (21.0-24.9 kg/m2) had an increased risk of prehypertension in community-dwelling persons. It is time to pay more attention to excess bodyweight in preventing high blood pressure.
An association between diabetes mellitus and tuberculosis has been implicated for a long time. We have previously reported that Goto Kakizaki type 2 diabetic rats are highly susceptible to Mycobacterium (M.) tuberculosis infection. As a next step, we attempted to clarify whether type 1 diabetic rats are more susceptible to M. tuberculosis than non-diabetic wild-type (WT) rats. Here, we used the Komeda diabetes-prone (KDP) rat, as a model of type 1 diabetes mellitus. The infected KDP rats developed large granulomas without central necrosis in their lungs, liver or spleen. This was consistent with a significant increase in the number of colony-forming units (cfu) of M. tuberculosis in the lungs and spleen (p < 0.01). Insulin treatment resulted in significant reduction of tubercle bacilli in the infected KDP rats (p < 0.01). Pulmonary levels of interferon-γ, tumor necrosis factor-α and interleukin-1β mRNAs were higher in the infected diabetic rats than in WT rats. Alveolar macrophages from KDP rats were not fully activated by M. tuberculosis infection because the macrophages did not secrete nitric oxide (NO) that can kill M. tuberculosis (p < 0.01), but no significant difference in phagocytosis of tubercle bacilli by alveolar macrophages was observed between KDP and WT rats. Taken together, our findings indicate that type 1 diabetic rats are more susceptible to M. tuberculosis that WT rats.
Secular changes in growth have been well documented in various world populations, with secular increase especially noticeable in the developed countries. Accordingly, we have been monitoring the secular changes in growth status among the 6th year children in primary schools (6thPS, 11-12 years old) and 3rd year children in junior high schools (3rdJHS, 14-15 years old) in the city of Sendai since 1934. After World War II, both primary school children and junior high school students showed marked increases in height and weight up to the early 1970s. Acceleration and the subsequent reduction in the degree of acceleration in growth were observed in 1965-1974 and 1975-1984, respectively, and were followed by reacceleration in 1985-1994. The aim of this study was to assess the growth changes among Sendai schoolchildren in 1994-2003. The period between 1994 and 1999 was characterized by positive trends both in height and weight among schoolchildren. However, the degree of the increases in height and weight was diminished between 1999 and 2003. The linear regression analysis revealed the significant increases in mean weight during the 10-year study period in 6thPS boys and 3rdJHS boys and girls. In contrast, there was no significant increase in mean height in any group. These findings suggest the leveling-off of the mean body height and weight among schoolchildren in Sendai at the end of the 20th century. Additional study is needed to examine possible explanations and consequences of these secular trends.