An Attempt to Assess the Replacement Dose of Human Growth Hormone in the Treatment of Growth Hormone Deficient Children

Hibi, I., Tanaka, T., Yano, H., Umezawa, S., Kagawa, J., Tanae, A. and Ishikawa, E. (National Children's Medical Research Center, Tokyo, the National Children's Hospital, Tokyo and the Department of Biochemistry, Miyazaki Medical College, Miyazaki, Japan). Acta Paediatr Scand [Suppl] 337:87, 1987.
In 25 patients with hGH deficiency, who had been treated long-term with hGH, the mode of hGH administration was switched from the conventional method (0.3–0.5 IU/kg/week, in two or three divided doses, intramuscularly) to daily subcutaneous injection at 1900–2100 hours with a dose of 0.46 ± 0.07 IU/kg/week (equivalent to 14.7 ± 2.0 IU/m²/week). After 1–3 months of this new mode of hGH administration, blood and urine were sampled at 0900 hours after overnight fasting. Blood glucose, plasma insulin, plasma IGF-1 and plasma total IGF (after extraction) were analysed in blood samples. IGF-1 and hGH were measured in urine samples. These measurements indicated that the dose studied was close to a replacement one, but might be slightly higher than the exact replacement dose.     

Potentiations of N-Methylcarbamate Toxicities by Organophosphorus Insecticides in Male Mice

Potentiations of N-Methylcarbamate Toxicities by OrganophosphorusInsecticides in Male Mice. TAKAHASHI, H., KATO, A., YAMASHITA,E., NAITO, Y., TSUDA, S., and SHIRASU, Y. (1987). Fundam. Appl.Toxicol. 8, 139–146. A N-methylcarbamate insecticide,2-sec-butylphe-nyl N-methylcarbamate (BPMC), is markedly potentiatedby low-dose treatments of P=S type organophosphorus insecticides.As a mechanism of this potentiation, the increase of plasmaBPMC concentrations due to the inhibited metabolic degradationhas been suggested. In this study, acute toxicities of fiveN-methylcarbamates structurally related to BPMC were studiedafter low-dose treatments of three P=S type organophosphorusinsecticides (cyanophos, feni-trothion, and malathion) and oneP=O type organophosphorus insecticide (dichlorvos), and therole of plasma concentrations of N-methylcarbamates in the potentiationswas examined. Acute toxicities of five N-methylcarbamates werepotentiated by the treatments of the P=S types, among whichthe potentiation of BPMC was strongest. BPMC toxicity was notpotentiated by the treatment of the P=O type. Plasma concentrationsof BPMC were increased by the treatments of the P=S types, butnot by the treatment of the P=O type. The acute toxicity andplasma concentrations of BPMC were increased by SKF 525-A (aninhibitor of mixed-function oxidase). These results suggestthat the increase of plasma BPMC concentrations may be relatedto the potentiation of BPMC toxicity. The treatment of fenitrothionincreased plasma concentrations of other N-methylcarbamatesmore than those of BPMC, although the potentiation of BPMC toxicitywas strongest. SKF 525-A and fenitrothion treatments increasedplasma BPMC concentrations to a similar degree, but the potentiationof BPMC toxicity by SKF 525-A was significantly less than thatby fenitrothion. Thus, some other mechanism(s) may be responsiblefor the potentiations of the N-methylcarbamate toxicities.     

Neonatal alloimmune thrombocytopenia involving HPA-5b (Bra): A rare Japanese Case

Neonatal alloimmune thrombocytopenia (NAIT) is caused by platelet antigen incompatibility between the mother and fetus. The frequency of NAIT varies among ethnic groups. In Caucasians, HPA-5b (Br^a) is the antigen that is second most frequently implicated. In Japan, NAIT due to anti-HPA-5b antibody is quite rare. The present case is the second case of Br^a-NAIT in Japanese and the first case serologically confirmed by monoclonal antibody-specific immobilization of platelet antigens.     

Respiratory inhibition after crying in infants

BACKGROUND: Among full-term neonates, the authors discovered infants who showed respiratory inhibition after crying which involved a marked decrease in SpO2. The infants were found to present increased echogenicity or a cyst in a cranial region termed the ganglionic eminence, or to have a subependymal cyst. The authors prospectively examined the relationship between respiratory inhibition after crying and these changes to examine the prevention and treatment of the episode. METHODS: The authors conducted cranial ultrasonography to screen 381 full-term neonates who showed no abnormalities at birth and whose parents requested ultrasonographic screening of the head, followed by polygraphy of infants who showed increased echogenicity or a cyst in ganglionic eminence, or had a subependymal cyst. The authors similarly conducted polygraphy for 50 neonates without cranial ultrasound abnormalities; the former constituted the control group. Respiratory inhibition was defined to be central apnea immediately after crying with a decrease in SpO2 to <60%. RESULTS: Among 381 neonates examined, 104 showed cranial ultrasound abnormalities; 60 of the 104 neonates indicated respiratory inhibition after crying. Oxygenation failed to improve the episode in 17 neonates with severe respiratory inhibition. However, theophylline alleviated the episode, and SpO2 no longer decreased to <60%. Theophylline was discontinued successfully by 6 months after birth, while 50 neonates in the control group showed no respiratory inhibition after crying. CONCLUSION: Respiratory inhibition after crying which involved a marked decrease in SpO2 was observed in full-term neonates who showed no abnormalities after birth. These neonates could be screened by cranial ultrasonography.     

Ganglioneuroma of left adrenal gland in a patient with Turner syndrome during growth hormone therapy

We report on a Japanese girl with Turner syndrome (45,XO) who developed ganglioneuroma of the left adrenal gland during growth hormone (GH) therapy. She had received GH replacement therapy from the age of 6.8 years. At the age of 10.3 years, abdominal ultrasonography revealed a mass which occupied the upper area of her left kidney. Computed tomography and magnetic resonance imaging of the abdomen showed a low density mass with a smooth surface located between the upper portion of the left renal vein and the pancreas. Microscopic examination resulted in a diagnosis of ganglioneuroma of the left adrenal gland. At present we cannot conclude that patients who have received GH replacement therapy are at higher risk for developing tumors compared to those without GH replacement therapy.     

Predicting the incidence of human campylobacteriosis in Finland with time series analysis

Sumi A, Hemilä H, Mise K, Kobayashi N. Predicting the incidence of human campylobacteriosis in Finland with time series analysis. APMIS 2009; 117: 614–22. Human campylobacteriosis is a common bacterial cause of gastrointestinal infections. In this study, we tested whether spectral analysis based on the maximum entropy method (MEM) is useful in predicting the incidence of campylobacteriosis in five provinces in Finland, which has been accumulating good quality incidence data under the surveillance program for water‐ and food‐borne infections. On the basis of the spectral analysis, we identified the periodic modes explaining the underlying variations of the incidence data in the years 2000–2005. The optimum least squares fitting (LSF) curve calculated by using the periodic modes reproduced the underlying variation of the incidence data. We extrapolated the LSF curve to the years 2006 and 2007 and predicted the incidence of campylobacteriosis. Our study suggests that MEM spectral analysis allows us to model temporal variations of the disease incidence with multiple periodic modes much more effectively than using the Fourier model, which has been previously used for modeling seasonally varying incidence data.     

Decreased L-selectin expression in CD34-positive cells from patients with chronic myelocytic leukaemia

Abnormal adhesive interaction between bone marrow stroma and progenitors, one of the causes of unregulated proliferation in chronic myelocytic leukaemia (CML), may be caused by some alterations in adhesion molecules on CML progenitors. We investigated the expression of adhesion molecules (CD44, VLA-5, VLA-4, LFA-1, ICAM-1, L-selectin and c-kit) on bone marrow CD34⁺⁺ cells from 16 CML patients by three-colour flow cytometry. The mean percentage of cells expressing L-selectin in the CD34⁺⁺CD38^{+  ∼  ++} fraction from untreated CML patients was significantly lower, and that in the CD34⁺⁺CD38⁻ fraction tended to be lower than that from normal controls. Among 11 CML patients treated with interferon-α (IFN-α), the mean percentage of the cells expressing L-selectin in the CD34⁺⁺CD38⁻ fraction from three patients with a low percentage of Ph¹(+) cells in bone marrow was significantly higher than that from five patients with a high percentage of Ph¹(+) cells. In addition, L-selectin expression rate was inversely correlated to the percentage of Ph¹(+) cells. There was no significant difference between the untreated patients and normal controls with regard to the expression rates of the other adhesion molecules in each CD34⁺⁺ fraction except LFA-1. These data suggest that decreased L-selectin expression in CML CD34⁺⁺ cells reflects one of the features of malignant CML progenitors.     

Development of nurses with specialties: the nurse administrators’ perspective

Aim This study clarified how Japanese nurse administrators consider the current status and future prospects of development and utilization of nurses with specialties. Background The demand for specialized nurses is not satisfied throughout the country. Methods Nine nurse administrators participated in three focus‐group discussions. Data were analyzed using qualitative content analysis technique. Results On development of specialized nurses, four categories were abstracted: offering opportunities for career development; establishing an environment of life‐term continuous learning; providing well‐balanced support for the needs of organizations and individual nurses; and support for career development as a specialist. Conclusions To develop specialized nurses effectively it is important to focus more attention on qualitative aspects of nurses’ professional experience in in‐service education and to support appropriate personnel for strategic human resource development. Implications for Nursing Management Facilitating frequent contacts between specialized and general nurses should be highly valued as making an environment where nurses can face career goals daily leads to steady preservation of human resources. It is necessary for nurse administrators to keep human resources quantitatively and to clarify the developmental process after nurses obtain special roles to plan for continuous education.     

Suppression of Natural Killer Cell Activity and Interleukin-2 Concentration of Serum Obtained from In Vitro Fertilization-Embryo Transfer Patients

PROBLEM: The effect of serum obtained from in vitro fertilization-embryo transfer (IVF-ET) patients on healthy volunteers' natural killer (NK) cell activity was evaluated. We also measured interleukin (IL)-2 concentration with IVF-ET patients' serum and clarified the relationship between IL-2 levels and the suppressive effect on NK cell activity. METHOD OF STUDY: A retrospective nonrandomized clinical study was performed. The suppressive effect on NK cell activity and IL-2 concentrations was measured with serum obtained from 30 pregnant and 30 nonpregnant women during an IVF-ET procedure. The suppressive effect of the serum on NK cell activity was evaluated by the formula that we defined in our previous study. RESULTS: The suppression of NK cell activity was significantly higher in the nonpregnant women than in the pregnant women (P < 0.05); however, IL-2 concentration did not differ. There was a positive correlation between the suppression of NK cell activity and IL-2 levels in the pregnant women, but no significant correlation in the nonpregnant women. CONCLUSIONS: These results suggest that the suppression of NK cell activity may be one of the prognostic factors for IVF-ET. In addition, we speculate that an unidentified humoral factor other than IL-2, which could increase NK cell activity, might exist in the serum of the nonpregnant patient.