Relationship between having a home doctor and outpatient utilization

While universal insurance coverage should eliminate or substantially reduce financial and certain structural barriers to medical care, inequity in utilization of care may continue to exist. We conducted a questionnaire survey of a national random sample of 4500 Japanese age 16 or over in October, 1995. Separate analyses were conducted to predict the physician visit rates for the entire respondents (N=3395) and for those with chronic conditions (N=777). Forty-three percent of the total subjects reported an ambulatory physician visit within the past three months. About 17% of subjects with one chronic condition and 14% of those with two or more chronic conditions did not have any physician visits within recent three months. The regression model demonstrated that having a home doctor, as well as comorbidity and perceived health status, is significantly associated with outpatient visit both among all subjects (p < 0.0001) and among those with chronic conditions (p < 0.01). The Japanese health system still has unevenness in outpatient resource utilization. This mainly pertains to whether they have their own regular physician. The failure of some persons with chronic diseases to be seen requires further investigation.     

Effect of interleukin-12 level augmented by Kakkon-to,a herbal medicine,on the early stage of influenza infection in mice

Oral administration of Kakkon-to (KT) (5.0 mg per mouse three times daily), a herbal medicine, for 8 days from 1 day before influenza virus infection exhibited therapeutic efficacy in the infected mice. The effect of KT-treatment on the levels of cytokines, especially interleukin (IL)-12, was evaluated in the early phase of infection. KT was significantly effective in reducing the weight loss of infected mice, prolonging their survival times and reducing mortality. In infected mice administered with KT, virus yield in the bronchoalveolar lavage fluid (BALF) of lungs was significantly lower than that in the control on day 3 after infection. On day 2 after infection, only the level of IL-12 in the BALF increased significantly in KT-administered mice as compared with the control. Thus the significant enhancement of IL-12 correlated with the reduction of virus yields in BALF in the early phase of infection. This suggested a key role of IL-12 in the alleviation of influenza in the KT-treated mice.     

Suppressive effects of the antiandrogen flutamide on adrenal androgens in advanced prostate cancer patients

PURPOSE AND METHODS: We investigated the influence of flutamide on plasma adrenal androgens in advanced prostate cancer patients treated with dietylstilbestrol diphosphate (DES-DP) followed by luteinizing hormone-releasing hormone agonist (LH-RH agonist). Nine patients were enrolled in this study and they were divided into the following two treatment groups; group A: LHRH agonist mono-therapy (n = 4) and group B: LHRH agonist with flutamide (n = 5). For prevention of flare up, all patients were treated with DES-DP. RESULTS: Two-week DES-DP administration led to reduction of plasma adrenal androgen levels. These levels were kept lower for 16 weeks in group B in contrast with group A in which the levels returned to the pretreatment levels. Basal ACTH levels in group B were significantly lower than those in group A. CONCLUSION: From our observations, we found that flutamide reduced adrenal androgen levels in prostate cancer patients treated with LH-RH agonist. ACTH suppression might be related to this phenomenon.     

Cloning of rodent megsin revealed its up-regulation in mesangioproliferative nephritis

BACKGROUND: We recently cloned a new human mesangium-predominant gene, megsin. Megsin is a novel member of the serine protease inhibitor (serpin) superfamily. To elucidate functional roles of this gene, we cloned megsin in rodents and investigated its role in a rat nephritis model. METHODS: Megsin homologues were cloned from cultured rat and mouse mesangial cDNAs utilizing polymerase chain reaction (PCR) with degenerative primers. Expression of megsin in three different types of resident glomerular cells was investigated by PCR. Levels of megsin mRNA expression at various time points in the anti-Thy1 rat nephritis model were studied by semiquantitative PCR and Northern blotting analysis. In order to investigate megsin protein expression in anti-Thy1 nephritis rats, we raised antibody against rat megsin-specific synthetic peptide, with which immunohistochemical studies were performed. RESULTS: Rat and mouse megsins were composed of 380 amino acids, which revealed 75.3 and 73.9% identity, respectively, with human megsin at the amino acid level. Characteristic features as an inhibitory serpin were conserved in both rat and megsin megsins. PCR analysis revealed expression of megsin in cultured mesangial cells but not in glomerular epithelial or endothelial cells. In anti-Thy1 nephritis rats, semiquantitative PCR and Northern blotting showed that expression of megsin mRNA was up-regulated in glomeruli at day 8. Immunohistochemical studies demonstrated the prominent accumulation of megsin in glomeruli at the same time point. Megsin was mainly localized in mesangial area. The megsin expression level returned to the basal level at day 28. CONCLUSION: Sequences of megsin were well conserved among different species. Rat megsin was also predominantly expressed in mesangial cells. Expression of megsin was up-regulated at the peak of hypercellularity and matrix accumulation in the mesangioproliferative glomerulonephritis model, suggesting that megsin may participate in the process of glomerulosclerosis by modulating extracellular matrix deposition or cell survival.     

Ventricular enlargement in schizophrenia spectrum patients with prodromal symptoms of obsessive-compulsive disorder

We hypothesized that male patients with schizophrenia spectrum disorders who have prodromal symptoms of obsessive-compulsive disorder (OCD) have ventricular enlargement compared with non-psychotic OCD patients, and that the difference in the ventricular size would offer a clue to the early detection of schizophrenia spectrum disorders. The ventricle-brain ratios (VBRs) in eight male patients with schizophrenia or schizotypal personality disorder (SPD) who had prodromal symptoms of OCD were compared with eight male patients with non-psychotic OCD and 14 normal male comparison subjects using three-dimensional magnetic resonance imaging (MRI). The VBR of the schizophrenia spectrum group was significantly larger than those of the OCD group or comparison subjects. Even the minimum VBR in the schizophrenia spectrum group was larger than the maximum VBR in the OCD group. These results may suggest the usefulness of three-dimensional MRI for early detection of patients with schizophrenia spectrum disorders who manifest OCD symptoms early in the course of the illness.     

Initial experience of using the filter protection device during carotid artery stenting in Japan

PURPOSE: No filter protection devices for carotid artery stenting (CAS) have been formally approved for use in Japan; however, as of April 2008, the Angioguard XP (AGXP) was approved. This article describes our initial results using the AGXP during CAS for the treatment of carotid artery stenosis. MATERIAL AND METHODS: A group of 15 patients (14 men) with a mean age of 72.3 years (range 53-81 years) were treated by CAS using the AGXP. Among them, 10 were symptomatic with >50% stenosis of the common or internal carotid artery (ICA), and 5 were asymptomatic with >70% stenosis. The rates of technical success, periprocedural stroke, ICA flow impairment, filter movement, and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed. RESULTS: CAS using the AGXP was successful in all cases. There was one minor stroke, and flow impairment occurred in six patients. Filter movement averaged 1.9 vertebral bodies. DWI showed new ipsilateral ischemic lesions in eight of the patients. CONCLUSION: Initial clinical experience using the AGXP for CAS has been generally sufficient. However, attention must be paid to three problems when using the AGXP: the filter may move after placement; the filter may disturb blood flow in the ICA; and debris may pass around the filter.     

A case of paraneoplastic cerebellar degeneration with resting tremor]

A 65-year-old woman was operated for gastric adenocarcinoma in 1989. Six years later, peritonitis carcinomatosa, swelling of periaortic lymphnodes and high serum CA-125 were discovered. She received chemotherapy with 5-FU and cisplatin resulting in reduction of ascites. In September, 1998, the swelling of left supraclavicular lymphnodes and the elevation of serum CA-125 reappeared. Pathological diagnosis of supraclavicular lymphnodes was adenocarcinoma. Serum CA-125 was normalized by chemotherapy using cisplatin, farumorubicin and endoxan. However, unsteadiness appeared since December 10, 1998 followed by dysarthria and involuntary movement of neck and upper limbs. These symptoms progressed subacutely. The physical examination on admission revealed swelling of left suraclavicular lymphnodes, nystagmus on lateral gaze, saccadic eye movement on smooth pursuit and severe cerebellar ataxia. In addition, resting tremor of 3-4 Hz was observed at right hand, left wrist and neck which tended to increase amplitude by calculation. Similar movements were seen in the left first toe, though the frequency was lower. Brain MRI revealed mild cerebellar atrophy. She was diagnosed as paraneoplastic cerebellar degeneration (PCD) by serum anti Yo antibody and clinical course. The study of HLA showed positive link to A4 without A24. The primary focus of adenocarcinoma in cervical lymphnodes was suggested to be ovary rather than stomach due to the pattern of immunostaining for cytokeratin, CEA and CA125, although no carcinoma was found in ovarium clinically. The feature of this case is a PCD with resting tremor of frequency of 3-4 Hz and negative link to HLA-A24 in Japanese.     

Cytokeratin and filaggrin expression in nevus comedonicus

To elucidate the pathogenesis of abnormal keratinization in nevus comedonicus, we performed an immunohistochemical study using antikeratin and antifilaggrin (filament-aggregating protein) antibodies. There were no significant differences between nevus comedonicus and normal skin in cytokeratin expression. Although filaggrin was only detected in the granular layer in open comedones, filaggrin was detected in both superficial cells and also intermediate cells in closed comedones, suggesting that filaggrin is involved in the formation of closed comedones. The disorder of terminal differentiation related to filaggrin may play a role in the pathogenesis of abnormal keratinization in nevus comedonicus.     

A new targeted blue light phototherapy for the treatment of acne

BACKGROUND: The effects of blue light phototherapy on inflammatory acne lesions were recently investigated. Many reports have used high-intensity, narrow-band 420 nm UV-free blue light delivery systems. The aim of this study was to evaluate a new blue light system (MultiClear) for targeted blue light phototherapy. METHOD: Ten Japanese patients with acne on the face or back were treated with targeted blue light once or twice a week. Acne severity was graded according to the acne severity score suggested by Allen and Smith (1982). If the acne was prevalent on the back or chest, the acne severity score of Burton et al. (1971) was adopted. The new targeting blue light system is equipped with a flexible optical light guide as a delivery system and the treatment device is placed directly only on the affected area. RESULT: Of the 10 patients, eight had a significantly reduced acne severity score without any side effects. Although two patients discontinued the study because of unsatisfactory results, none of the patients showed any harmful side effects from the targeted blue light phototherapy. CONCLUSION: Targeted blue light phototherapy with MultiClear is effective for the treatment of inflammatory acne lesions. This new irradiation device offers some advantages over previous blue light systems.     

In situ hybridization of connective tissue growth factor mRNA in IgA nephropathy

Connective tissue growth factor (CTGF) is a member of the new family of growth regulators. It plays an important role of the pathogenesis of mesangial matrix accumulation and progressive glomerulosclerosis in IgA nephropathy (IgAN).
We investigated the expression and localization of CTGF mRNA in renal tissues of patients with IgAN and normal human kidneys (NHK), using in situ hybridization with digoxigenin-labelled oligonucleotide. Open renal biopsy tissues were obtained from 16 patients with IgAN. The renal pathology was categorized into four grades by light microscopic findings. The expression level of CTGF mRNA was quantified by counting all nuclei, as well as nuclei surrounded by CTGF mRNA-positive cytoplasm in randomly selected non-sclerotic glomeruli and expressing the results as the percentage of total cells.
Connective tissue growth factor mRNA was mainly expressed in glomerular mesangial and epithelial cells in both IgAN and NHK, and cells of Bowman's capsule. In IgAN, CTGF mRNA-positive cells were increased in tubulointerstitial fibrotic areas. The percentage of positive cells for CTGF mRNA was significantly higher in IgAN than in NHK. The percentage of positive cells for CTGF mRNA in each IgAN grade was significantly higher than that in NHK. Furthermore, the percentage of positive cells for CTGF mRNA was significantly greater in IgAN with moderate mesangial proliferative lesions (grade 2, grade 3) than in IgAN with mild mesangial proliferative lesions.
Our study suggests that CTGF may play an important role in the development and progression of glomerulosclerosis and tubulointerstitial fibrosis in IgAN.