Relationship between mortality and rice cadmium concentration in inhabitants of the polluted Jinzu River basin,Toyama, Japan: A 26 year follow‐up

The aim of this study was to investigate the relationship between mortality and rice cadmium (Cd) concentration in inhabitants of a polluted area in Japan. The target subjects were inhabitants of the Jinzu River basin who participated in health examinations for screening of renal dysfunction from 1979 to 1984. The mean rice Cd concentration in each hamlet was used as an index of the Cd exposure. We conducted a 26 year follow‐up survey in 3281 inhabitants (1544 men and 1737 women) whose data regarding the rice Cd concentration were available. Mortality risk ratios for all and specific causes were estimated after adjustments for age at baseline, smoking status and history of hypertension using a Cox hazard model or Fine and Gray competing risks regression model. The mortality risk ratios of rice Cd concentration (+0.1 ppm) for all causes in women were significantly increased (risk ratio: 1.04). Furthermore, the relative risks of rice Cd concentration for kidney and urinary tract disease, renal diseases, renal failure and toxic effects of cadmium were significantly increased in both sexes. These findings indicated that increased rice Cd concentration decreased the prognosis for life over a long‐term observation in women. This result provides important information for determining the worldwide standard for allowable rice Cd concentration.     

Girl with a PRRT2 mutation and infantile focal epilepsy with bilateral spikes

This paper documents the case of a female Japanese patient with infantile focal epilepsy, which was different from benign infantile seizures, and a family history of infantile convulsion and paroxysmal choreoathetosis. The patient developed partial seizures (e.g., psychomotor arrest) at age 14 months. At the time of onset, interictal electroencephalography (EEG) showed bilateral parietotemporal spikes, but the results of neurologic examination and brain magnetic resonance imaging were normal. Her seizures were well controlled with carbamazepine, and she had a normal developmental outcome. EEG abnormalities, however, persisted for more than 6 years, and the spikes moved transiently to the occipital area and began to resemble the rolandic spikes recognized in benign childhood epilepsy. Her father had paroxysmal kinesigenic dyskinesia, with an onset age of 6 years, and her youngest sister had typical benign infantile seizures. Genetic analysis demonstrated that all affected members had a heterozygous mutation of c.649_650insC in the proline-rich transmembrane protein-2 (PRRT2) gene. This case indicates that the phenotypic spectrum of infantile seizures or epilepsy with PRRT2-related pathology may be larger than previously expected, and that genetic investigation of the effect of PRRT2 mutations on idiopathic seizures or epilepsy in childhood may help elucidate the pathological backgrounds of benign childhood epilepsy.     

Perforation and Tumor Formation of the Intestine in Primary Amyloidosis

We report a case of primary amyloidosis with repeated bowel perforations. This patient also had localized amyloid deposition creating a tumorous region mimicking malignancy in the rectum. Perforation of the intestine is common in systemic amyloidosis. The ischemic change due to amyloid infiltration into the vessel wall may lead to perforation of the affected bowel. Amyloid tumors occur more often in localized amyloid than in systemic amyloidosis. Macroscopically, it is difficult to distinguish amyloid tumor of the intestine from neoplasia.     

Predictors of hyperglycaemic individuals who do not follow up with physicians after screening in Japan: A cohort study

Aims

Although people screened as being hyperglycaemic often fail to follow up with physicians for clinical assessment, epidemiologic findings on the frequency and predictors of not following up (hereafter, “no follow-up”) are lacking. The purpose of this study was to examine the no follow-up rate with physicians after screening for diabetes and predictors of no follow-up.

Methods

We assessed cases of no follow-up with physicians within six months after screening based on medical claims data from employee-based social health insurance programs in Japan, for people aged 20 to 68 years from 2005 to 2010.

Results

Among 3878 screened participants with hyperglycaemia, 2527 (65%) did not follow up with their physicians within six months after screening. Multiple logistic regression analysis revealed that younger age and lower blood glucose level predicted no follow-up among both men and women, while lower body mass index and negative proteinuria also predicted no follow-up among men. Treatment for dyslipidaemia facilitated follow-up among both genders, and treatment for hypertension or depression facilitated follow-up among men.

Conclusions

Approximately two thirds of individuals screened as having hyperglycaemia did not follow up with their physicians within six months after screening. Predictors of no follow-up were younger age and milder hyperglycaemia. Being on treatment for co-morbidities tended to facilitate follow-up.     

Low-dose radioiodine therapy for patients with intermediate- to high-risk differentiated thyroid cancer

Annals of Nuclear Medicine - The efficacy of low-dose radioiodine therapy (RIT) for intermediate-risk or high-risk differentiated thyroid cancer (DTC) patients is controversial. Because of the...     

Pharmacokinetics and tissue distribution of 3,4‐diaminopyridine in rats

Lambert‐Eaton myasthenic syndrome (LEMS) is characterized by muscle weakness, amyotrophy, easy fatigability, and depressed tendon reflexes. 3,4‐Diaminopyridine (3,4‐DAP) is the recommended therapy for the treatment of LEMS. However, estimations of 3,4‐DAP pharmacokinetics in human and animals, such as rats, are rarely reported because 3,4‐DAP is an orphan drug for the treatment of a very rare disease (LEMS). In particular, little is known about its tissue distribution. Therefore, the pharmacokinetics of 3,4‐DAP were studied, with particular focus on tissue distribution, in rats. After intravenous administration of 3,4‐DAP to rats, the half‐life of 3,4‐DAP was 15.9 ± 3.9 min and the volume of distribution at steady‐state was 2.8 ± 0.7 L/kg. The tissue‐to‐plasma partition coefficient (Kp) was high in the kidney, heart, and muscle. In addition, with increased steady state plasma concentration (Css), a tendency toward increased Kp was found in most tissues. In the muscle, a likely target region of 3,4‐DAP in LEMS patients, the Kp was higher than in the plasma. Furthermore, more than 68% of 3,4‐DAP was distributed to the muscle as determined by the ratio of 3,4‐DAP distribution calculated from the apparent volumes of distribution. Hence, 3,4‐DAP may provide for more effective and long‐lasting effects.     

Possible Neoangiogenesis in Achilles Tendon Xanthoma with Familial Hypercholesterolemia: A Novel Approach to Achilles Tendon Xanthoma

Achilles tendon xanthoma (ATX) is one of the typical features of familial hypercholesterolemia (FH). The morphological evaluation of ATX by X-ray radiography is widely recognized; however, the utility of other imaging modalities remains unclear. We herein report two cases of FH in which Doppler ultrasound imaging demonstrated a microvascular flow in ATX that only rarely could be observed in normal Achilles tendons. Neoangiogenesis accompanies chronic inflammation and it may play an important role in the deposition of cholesterol crystals leading to ATX. In addition to the morphological evaluation of ATX, the assessment of neoangiogenesis may therefore be essential for the evaluation of ATX.     

Decreases in postural change of finger blood flow in ceramic painters chronically exposed to low level lead

To elucidate the effect of low level lead (Pb) exposure on somatic and automatic peripheral nerve functions in ceramic painters, 58 males and 70 females, aged 29–75 years (mean 53.3 years), with lead concentrations in blood (Pb-B) ranging from 2.1 to 69.5 μg/dl (geometric mean 13.3 μg/dl), were examined for median nerve maximal conduction velocity as a measure of motor nerve function, the coefficient of variation of R-R interval on electrocardiography as a measure of parasympathetic function, and postural changes in finger blood flow volume (ΔFBF), and changes in finger blood flow drop velocity (FDV) from the supine to standing position as a measure of sympathetic function. No significant association was found between Pb-B levels and the results of the neurophysiological tests, however, except for that between Pb-B and ΔFBF. ΔFBF was decreased linearly with increasing Pb-B levels. However, this association could not be concluded to be a reflection of sympathetic nerve dysfunction due to Pb exposure in the subjects, since ΔFBF was not a specific parameter of sympathetic nerve function. The possibility that the decrease in ΔFBF is a reflection of the atherosclerotic effect of chronic low level Pb exposure should be further investigated. © 1996 Wiley-Liss, Inc.     

Infrequent alterations of the p16INK4A gene in liver cancer

We examined the genomic status of the p16^INK4A (inhibitor of cyclin-dependent kinase 4 A) and cyclin-dependent kinase 4 (CDK4) genes in 62 human hepatocellular carcinomas (HCCs), 5 cholangiocellular carcinomas and 6 cell lines derived from human liver cancers. Although no samples showed the homozygous deletion of the p16^INK4A gene, we detected intragenic mutations of the p16^INK4A gene in 3 HCCs and one HCC cell line, which led to an amino-acid substitution or a frameshift. In 2 HCC samples with mis-sense mutations of the p16^INK4A gene, loss of heterozygosity on 9p22 was also detected, suggesting that the loss of function of p16 was induced during hepatocarcinogenesis. On the other hand, amplification or rearrangement of the CDK4 gene was not detected in any samples examined in this study. These results indicated that the mutations or deletions of the p16^INK4A gene are not frequent, but may play a role in a sub-set of human HCC. © 1996 Wiley-Liss, Inc.