Burden of musculoskeletal pain in Japan

Based on the prevalence of musculoskeletal pain in the context of interference with daily activities (IDA) and treatment for musculoskeletal disorders in the study population (n = 3188), we estimated the prevalence and years lived with disability (YLD) of musculoskeletal pain in Japan. The total of 42287 thousand (41.2%) of Japanese adult people was estimated to suffer from musculoskeletal pain. Among them, 9127 thousand was estimated to interfere with daily activities due to the pain. Overall YLD for musculoskeletal pain in Japan were estimated at 1297843.7 (1263.6 per 100000). The YLD for Pain without IDA were 33159.3 (32.3 per 100000) and the YLD for Pain with IDA were 1264684.4 (1231.3 per 100000). One-way sensitivity analysis showed that the YLD of musculoskeletal pain might increase to 4421844.0 (4305.2 per 100000) with the increased disability weight for Pain without IDA of 0.1, while they might inversely decrease to 1018875.0 (992.0 per 100000) with the increased treatment rate in Pain with IDA of 100%. Musculoskeletal pain imposes a substantial burden on the Japanese adult population. To allow the population to keep their health-related quality of life, health professionals should pay more attention to musculoskeletal pain and make positive efforts to improve prevention and control of musculoskeletal pain.     

Cerebral metabolic reduction in severe malaria: fluorodeoxyglucose-positron emission tomography imaging in a primate model of severe human malaria with cerebral involvement

Cerebral metabolic changes in Japanese macaques (Macaca fuscata) infected with Plasmodium coatneyi, a primate model of severe human malaria with cerebral involvement, were directly evaluated by fluorodeoxyglucose-positron emission tomography (FDG-PET). We observed diffuse and heterogeneous reduction of metabolism in the cerebral cortex in the acute phase of malaria infection. Neuropathologic examination showed preferential sequestration of parasitized red blood cells in the cerebral microvasculature. However, hemorrhagic change or necrosis was not observed in hematoxylin and eosin-stained and Nissl-stained brain tissues. This suggests that reduction of cerebral metabolism occurs before parenchymal changes appear in the brain. This may be one reason why more than half of the patients with cerebral malaria have no neurologic sequelae after recovery.     

Vertebroplasty

Vertebroplasty for pseudoartrosis of vertebral fracture using PMMA (polymethylmetacrylate) or CPC (calcium phosphate cement) is a new less invasive surgical method providing sufficient pain relief and correction of kyphosis.     

Effects of insulin-like growth factors (IGF-I and -II) on growth hormone and prolactin release and gene expression in euryhaline tilapia,Oreochromis mossambicus

We investigated in vitro effects of insulin-like growth factors (IGF-I and -II) on growth hormone (GH) and prolactin (PRL) release and gene expression in euryhaline tilapia, Oreochromis mossambicus. Pituitaries were removed from freshwater-acclimated adult males and incubated for 2-24h in the presence of human IGF-I or -II at doses ranging from 1-1000 ng/ml (0.13-130 nM). IGF-I at concentrations higher than 10 ng/ml and IGF-II higher than 100 ng/ml significantly inhibited GH release after 8, 16, and 24h. No effect of IGFs was seen during the first 4h of incubation. IGFs at the same concentrations also significantly attenuated GH gene expression after 24h, although no effect was seen at 2h. By contrast, PRL(188) release was stimulated significantly and in a dose-related manner by IGF-I at concentrations higher than 10 ng/ml and by IGF-II at concentrations higher than 100 ng/ml within 2h. No stimulation was observed after 4h. Similarly, both IGFs at concentrations higher than 10 ng/ml increased PRL(177) release within 2h. However, no significant effect of IGF-I or -II was observed on mRNA levels of both PRLs after 2 and 24h at all concentrations examined. These results clearly indicate differential regulation of GH and PRL release and synthesis by IGFs in the tilapia pituitary, i.e., rapid-acting, stimulatory effects of IGFs on PRL release and slow-acting, inhibitory effects on GH release and synthesis.     

Netrin-1 inhibits leukocyte migration in vitro and in vivo

Cell migration plays important roles in embryonic development and inflammation, and this process is highly regulated to ensure tissue homeostasis. A number of barriers exist to prevent the inappropriate migration of leukocytes into healthy peripheral tissues, including retention of these cells in the inactive state and maintenance of the integrity and charge of the vascular endothelium. However, active signals also are likely to exist that can repulse cells or abolish existing cell migration. One such paradigm exists in the developing nervous system, where neuronal migration is mediated by a balance between chemoattractive and chemorepulsive signals. The ability of the guidance molecule netrin-1 to repulse or abolish attraction of neuronal cells expressing the UNC5b receptor makes it an attractive candidate for the regulation of inflammatory cell migration. Here, we show that netrin-1 is expressed on vascular endothelium, where it is regulated by infection and inflammatory cytokines. The netrin-1 receptor UNC5b is strongly expressed by leukocytes, upon which netrin-1 acts as a potent inhibitor of migration to different chemotactic stimuli both in vivo and in vitro. These data suggest that endothelial expression of netrin-1 may inhibit basal cell migration into tissues and that its down-regulation with the onset of sepsis/inflammation may facilitate leukocyte recruitment.     

Effects of hypophyseal,placental, hypophysiotropic,and steroid hormones on ovipositor elongation and ovulation in the rose bitterling, Rhodeus ocellatus ocellatus

Effects of various hypophyseal, placental, hypophysiotropic, and steroid hormones on ovipositor elongation and ovulation were investigated using the mature female rose bitterling, Rhodeus ocellatus ocellatus. Mammalian LH and HCG were effective at high doses whereas mammalian prolactin, FSH, ACTH, TSH, and neurohypophyseal hormones were ineffective. Synthetic LH-RH had some effects at very high doses. Fish pituitary extracts were much more potent than mammalian gonadotropins and a dose-response curve of elongation was obtained. This suggests that the ovipositor test is a good bioassay for fish gonadotropin. Some C₂₁-steroids, especially 17α-hydroxyprogesterone and 17α-hydroxy-20β-dihydroprogesterone, also had prominent effects on ovipositor elongation, indicating the effects of gonadotropins may be via some C₂₁-steroids. Hypophysectomy did not affect the sensitivity to gonadotropin but somewhat reduced the response to steroid. The relationship between the activity of steroids and their structure is discussed.     

Autoimmune hepatitis in a patient with systemic lupus erythematosus: a case report

A 48-year-old woman was admitted to our hospital because of ascites. Laboratory data indicated the presence of systemic lupus erythematosus (SLE) with nephrotic syndrome and elevated hepatic enzymes. Treatment with prednisolone resulted in a marked clinical improvement in renal and liver dysfunction. Histopathologic analysis of renal and liver tissues showed lupus nephritis and liver cirrhosis, respectively. According to the autoimmune hepatitis scoring system, the patient had both SLE and autoimmune hepatitis.     

Influence of diabetes on >10-year outcomes after percutaneous coronary intervention

There are few reports showing the relationship between diabetes and the long-term outcome following percutaneous coronary intervention (PCI) in Asians. As well, the association between glycosylated hemoglobin (HbA1c) level and outcome remains controversial. In this analysis, 748 Japanese patients including 298 with diabetes (DM) and 450 without diabetes (non-DM) who underwent PCI from 1984 to 1992 were evaluated over the long term. The mean follow-up was 12.0 +/- 3.6 years. There were 47 (15.8%) total deaths in DM and 41 (9.1%) in non-DM [hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.11-2.65, P = 0.013] and 28 (9.4%) cardiovascular deaths in DM and 19 (4.2%) in non-DM (HR 2.09, 95% CI 1.14-3.81, P = 0.016). Among DM, increased HbA1c was associated with both total (HR 1.25, 95% CI 1.03-1.53, P = 0.024) and cardiovascular (HR 1.30, 95% CI 1.00-1.69, P = 0.048) mortality. Even in Asians, DM showed an increased mortality following PCI. Among DM, increased HbA1c level was also associated with mortality.     

Diagnosis of pT2 gallbladder cancer by serial examinations with endoscopic ultrasound and angiography

Background. The prognosis of pT2 gallbladder cancer correlates with whether appropriate surgery for the spread of cancer has been performed. Therefore, accurate preoperative T staging is especially important. We carried out this study to evaluate the usefulness of serial examinations by endoscopic ultrasound (EUS) and angiography for the T staging of pT2 gallbladder cancer. Methods. Forty-eight patients with gallbladder cancer who underwent both EUS and surgery between 1983 and 1998 were included in this study. The accuracy of serial examination by both EUS and angiography in T staging, based on previously established diagnostic criteria, was retrospectively evaluated. First, the presence or absence of subserosal tumor invasion was assessed by EUS alone. Second, in equivocal cases, the depth of tumor invasion was further evaluated by angiographic findings. Results. Twenty-four patients were correctly diagnosed as having other than pT2 cancer by EUS alone. Angiographic findings were reviewed in 19 of the remaining patients, who had pT1, pT2, or a small number of pT3 lesions. The sensitivity, specificity, and overall accuracy in the T staging of pT2 gallbladder cancer was 81.8%, 90.6%, and 88.4%, respectively. Conclusions. Serial angiographic examination following adequate patient selection by EUS is effective and efficient for the diagnosis of pT2 gallbladder cancer. Received: March 19, 2001 / Accepted: September 14, 2001