Occurrence of paralytic shellfish poison (PSP) in the starfish Asterina pectinifera collected from the Kure Bay, Hiroshima Prefecture, Japan.

Assays were made for paralytic toxicity of marine invertebrates inhabiting at the coasts of Hiroshima Bay, where the infestation of bivalves such as cultured oysters with paralytic shellfish poison (PSP) has been occurred. The starfish Asterina pectinifera collected at the estuary of Nikoh River, Hiroshima Bay, was found to contain moderate levels of paralytic toxicity. Its highest toxicities as PSP found on July 30, 1999 were 12.5 MU/g for whole body, 11.0 MU/g for integument tissues and 3.9 MU/g for viscera, respectively. The toxicity of integument was changed from 3.6 to 11.0 MU/g in 1 year. Its paralytic toxin principles were identified as PSP toxins, composing mainly from saxitoxin (STX) group toxins such as carbamoyl-N-hydroxy neosaxitoxin (hyneoSTX), and STX, by HPLC and LC-MS, accounting for over 90 mol%. The PSP toxins contained in the starfish A. pectinifera considered to be transferred from bivalves or detritus living in the same area, which were contaminated with PSP. However, the involved pathway may be different from that of Asterias amurensis which was infested directly through food chain from its food bivalves, for its toxin pattern.     

Monosynaptic projections from the nucleus retroambiguus to motoneurons supplying the abdominal wall, axial, hindlimb, and pelvic floor muscles in the female rhesus monkey

The nucleus retroambiguus (NRA) consists of premotor neurons in the caudal medulla. It is involved in expiration, vomiting, vocalization, and probably reproductive behavior by means of projections to distinct motoneuronal cell groups. Because no information is available about the NRA and its efferent pathways in primates, the present study examines NRA projections to the lumbosacral spinal cord in female rhesus monkeys. To identify the NRA, wheat germ agglutinin-horseradish peroxidase (WGA-HRP) was injected into the lumbosacral cord in three monkeys. To study the distribution of NRA axons in the lumbosacral cord, WGA-HRP injections were made into the NRA in seven monkeys. To identify motoneuronal cell groups receiving input from the NRA, the same seven monkeys also received cholera toxin subunit b (CTb) injections into different hindlimb, axial, and pelvic floor muscles. The results show that NRA neurons projecting to the lumbosacral cord are mainly located between 1 to 4 mm caudal to the obex. They send numerous axons to external oblique and pelvic floor motoneurons, whereas projections to iliopsoas and axial motoneurons are less numerous. The projections are bilateral, but show a clear contralateral predominance in the iliopsoas, axial, and pelvic floor motoneuronal cell groups. At the ultrastructural level, NRA-terminal profiles make asymmetrical contacts with labeled and unlabeled dendrites in these motoneuronal cell groups and contain large amounts of spherical and a few dense core vesicles. It is concluded that the NRA is well developed in the monkey and that there exists a direct pathway from the NRA to lumbosacral motoneurons in this species. The finding that the NRA projects to a somewhat different set of motoneuronal cell groups compared with other species fits the concept that it is not only involved in expiration-related activities but also in species specific receptive and submissive behavior.     

Characteristics of incidentally detected renal cell carcinoma by ultrasonography at health check-up

BACKGROUNDS: The prognosis of patients with incidentally detected renal cell carcinoma is better than that of patients with symptomatic renal cell carcinoma. These incidentalomas include those discovered by ultrasonography at health check-up and those found during examinations for unrelated disease. In this study, we investigated the prognosis of the patients of the health check-up group and the unrelated disease group. METHODS: From April 1987 to March 1997, 263 patients with renal cell carcinoma were treated in our department including 166 incidentalomas (63.1%). The occasion of incidental detection was divided into 2 groups; 90 cases as health check-up group and 76 cases as unrelated disease group. RESULTS: The mean age was 52.9 +/- 9.7 years for health check-up group and 65.1 +/- 11.4 years for unrelated disease group (p < 0.01). The mean evaluated tumor size was 3.6 +/- 1.6 cm for health check-up group and 4.4 +/- 2.6 cm for unrelated disease group (p < 0.05). The survival rates were significantly different in the two groups (p < 0.01); the 5- and 10-year survival rate for health check-up group was 91.5% and 55.9%, respectively and for unrelated disease group 79.4% and 66.1%, respectively. CONCLUSION: These results suggested that examination by ultrasonography at health check-up lead to detection of smaller renal cell carcinoma and improve the prognosis further.     

Acute promyelocytic leukemia: an unusual cause showing prolonged disseminated intravascular coagulation after placental abruption

Background Disseminated intravascular coagulation (DIC) caused by placental abruption usually improves rapidly after prompt delivery and adequate anti-DIC treatment. Case A 30-year-old nulliparous woman suffered from placental abruption at the 25th week of pregnancy, and emergent cesarean section was done immediately. She exhibited DIC, which continued even after termination of the pregnancy and anti-DIC treatment. She also showed neutropenia. We closely observed her, and at the 58th day postpartum, blast cells appeared in the peripheral blood and she was diagnosed with acute promyelocytic leukemia (APL). Induction chemotherapy was done successfully. The close observation after delivery enabled us to make the prompt diagnosis/treatment, leading to the complete remission. Conclusion APL should be added to the list of differential diagnosis when DIC persists even after prompt delivery and appropriate anti-DIC treatment after placental abruption.     

Research on Fall Prevention and Protection from Heights in Japan

The high frequency of fall accidents is a serious problem in Japan. Thus, more stringent countermeasures for preventing falls from scaffolds were developed and incorporated into institutional guidelines. These countermeasures aim to decrease deaths caused by falls from scaffolds. Despite the improvements in such measures, however, the rate of accidental fall deaths remains high in Japan’s construction industries. To improve the rigor of the countermeasures, a committee was established in our institute by the Japan Ministry of Health, Labour, and Welfare. This committee investigated the regulations applied in other countries and evaluated construction industry compliance with existing fall prevention guidelines. After considerable research and discussion, the Occupational Safety and Health Regulations and Guidelines were amended in 2009. The effects of the amended regulations have recently been investigated on the basis of accident reports. This paper describes the investigation and its results. The paper also discusses other research and workplace safety countermeasures for preventing falls and ensuring fall protection from heights.     

Comparative efficacy of first-line therapies for advanced-stage chronic lymphocytic leukemia: A multiple-treatment meta-analysis

Since the introduction of chlorambucil as a treatment for chronic lymphocytic leukemia (CLL) in the 1960s, several alternative treatment regimens have been explored. We performed a multiple-treatment meta-analysis using direct and indirect data based on all available head-to-head randomized controlled trials (RCTs) to compare the benefits and harms of first-line treatments for untreated advanced-stage CLL. Two reviewers independently identified RCTs comparing overall survival and progression-free survival between two or more first-line treatments. Twenty-five trials involving 7926 patients were included. Of the 25 eligible RCTs, 30 (n = 7741 patients) and 12 (n = 3910 patients) treatment pairs were included in the multiple-treatment meta-analysis of overall and progression-free survival, respectively. Trials generally enrolled younger and less complicated patients than actual clinical practice. There was no evidence for inconsistency between direct and indirect data. Based on combined direct and indirect data, no single treatment showed significantly better overall survival than any other, and credible intervals were wide. Among six newer treatments with longer progression-free survival compared with chlorambucil, fludarabine-rituximab-based chemoimmunotherapy (HR = 0.24, 95% CrI: 0.13–0.51) and bendamustine (HR = 0.23, 95% CrI: 0.13–0.42) had the largest PFS benefit. Limited data on treatment-related mortality precluded multiple-treatment meta-analysis. In conclusion, published randomized evidence on overall survival is insufficient to recommend any particular first-line treatments. Any progression-free survival differences may be applicable to relatively young uncomplicated patients.     

Cavernous hemangioma of the stomach: A case report and review of the literature

A cavernous hemangioma of the stomach in a 41-year-old Japanese man was reported. The patient had numerous hemorrhagic telangiectasias in the skin and was also diagnosed as having a submucosal tumor of the stomach by an incidental upper gastrointestinal X-ray study. Wedge resection of the stomach was performed. The tumor was located in the submucosal, proper muscular and subserosal layers. The resected specimen showed proliferation of vascular spaces lined with a layer of endothelial cells and filled with red blood cells together with a partially calcified thrombus. The histopathologic diagnosis was cavernous hemangioma of the stomach with calcified thrombus. The patient has been doing well for twenty years. We report the case and briefly review the literature. This study is supported in part by a Grant from Federation of National Public Service and Affiliated Personnel Mutual Aid Association, Tokyo, Japan.     

Rotavirus infections in traveler's diarrhea

We tried to isolate rotaviruses from travelers with diarrhea arriving at Nagoya International Airport. 1. Ten cases revealed positive for rotavirus out of 334 diarrheal patients tested during a period from 1985 to 1988. 2. Most of the rotavirus positive cases were in their forties or in their fifties. 3. Geographic distribution of the infected area of the cases was not concentrated with specific countries. 4. Diarrhea was the most frequent clinical manifestations of the cases. 5. There was no cluster in seasonal distribution of the cases.