Edutainment tools for initial education of type-1 diabetes mellitus: initial diabetes education with fun.

PURPOSE: Appropriate initial education for type-1 diabetes mellitus patients is important to prevent late complications. However, type-1 diabetic children have not appreciated traditional learning methods since they rarely contain the elements of fun and interactivity. In this study, we developed, implemented and evaluated a preliminary version of edutainment tools for initial education for type-1 diabetic children. METHODS: Three games running on either personal computer (PC) and GameBoy Advance were developed. All games were designed to educate patients about relationships among food (carbohydrate), plasma glucose level, exercise, and insulin dose. A total of 58 testers evaluated degree of entertainment, usability and clinical usefulness of the games. RESULTS: Generally, testers felt all games were intuitive and fun and the usability of games was highly scored. More than 90% of testers showed an interest in the edutainment approach, and approximately 60% agreed that these games could provide attractive educational environment compared to traditional education, especially for children. CONCLUSIONS: Our edutainment systems were accepted as attractive learning tools for type-1 diabetic children who need initial education.

Selective expression and functional characteristics of three mammalian hyaluronan synthases in oncogenic malignant transformation.

Malignant transformation of fibroblasts and epithelial cells is often accompanied by increased hyaluronan production and accumulation. Despite recent progress in the study of hyaluronan biosynthesis, the mechanisms underlying the transformation-induced overproduction of hyaluronan have not been elucidated. Here we report that activity and transcriptional levels of hyaluronan synthase (HAS) significantly increased after oncogenic malignant transformation of a rat 3Y1 fibroblast cell line. Of three HAS isoforms (HAS1, HAS2, and HAS3), only HAS2 gene expression was increased in the v-Ha-ras transformed 3Y1 cells, which show less malignancy. In contrast, both HAS1 and HAS2 expressions were elevated in the highly malignant cells transformed with v-src and/or v-fos. To assess the contribution of HAS expression to the oncogenic malignant transformation, we established stable cell transfectants expressing sense and antisense HAS genes. Antisense suppression of the HAS2 expression significantly decreased hyaluronan production in the cells transformed by the oncogenic v-Ha-ras and eventually led to a reduction in tumorigenicity in the rat peritoneum. The introduction of the HAS1 and HAS2 genes promoted the growth of subcutaneous tumors in a manner dependent on the levels of hyaluronan synthesis. Significant growth promotion was observed within a wide range of HAS1 expression. In contrast, the growth stimulation was only seen within a narrow range of HAS2 expression, and high levels of HAS2 expression even inhibited tumor growth. These results suggest that proper regulation of the expression of each HAS isoform is required for optimal malignant transformation and tumor growth.

Apocrine carcinoma of the vulva in a band-like arrangement with inflammatory and telangiectatic metastasis via local lymphatic channels.

BACKGROUND: Primary adenocarcinomas of the vulva have been classified as sweat gland carcinomas, extramammary Paget's disease, and primary breast carcinomas of the vulva. They share some common histopathologic features. METHODS: We describe a 72-year-old Japanese woman with apocrine carcinoma of the vulva and local lymphatic metastasis. RESULTS: The patient presented with a bruise on her inguinal area. Physical examination revealed a 4 cm x 7 cm, dark-red, irregularly elevated tumor on the left labium majora. Dome-shaped, flesh-colored, small papulovesicles were scattered on the abdomen, accompanied by erythema and induration. The lesion showed a band-like arrangement. General examination revealed multiple bone metastases, particularly in the spine. Microscopic examination revealed a moderately differentiated adenocarcinoma with signet ring cells. A few pagetoid clear cells were present in the hypertrophic epidermis. The peripheral papulovesicles demonstrated the same histopathologic view as in inflammatory and telangiectatic, metastatic breast carcinoma. Tumor cells were positive for various ductal and glandular markers. Estrogen and progesterone receptors were not expressed. Ultrastructural findings suggested differentiation towards apocrine or mammary glands because of the presence of an apocrine process and electron-dense mucous granules. The patient died in spite of combination chemotherapy and irradiation therapy. CONCLUSIONS: We report a rare case of apocrine carcinoma of the vulva in a band-like arrangement with local lymphatic metastasis which showed the clinical and histopathologic characteristics of inflammatory and telangiectatic carcinoma.

[A case of cutaneous tuberculosis under steroid & immunosuppressant therapy for dermatomyositis].

A 44-year-old man had been admitted for high fever and leg edema on November 1998. By the laboratory data, electromyography, and muscle biopsy, he was diagnosed as having polymyositis. Steroid (prednisolone 60 mg/day) and immunosuppressant (methotrexate 7.5 mg/week) therapy was administered and the symptoms were improved, so he had been followed up in out-patient clinic. After half a year, high fever and leg edema relapsed and erythema on the bilateral forearms appeared, so he was admitted again on January 2000. The symptoms, skin involvement and laboratory data suggested the disease of dermatomyositis. Steroid pulse therapy was administered again. But the symptoms were not improved. Skin biopsy was performed but it showed only inflammatory changes. Several antibiotics and cyclospolyn A were undertaken but they were not effective. On February 12th he passed away because of respiratory failure. The autopsy was undertaken and it revealed tuberculosis in the skin, subcutaneous tissues and muscles, however, pulmonary tuberculosis was not found. The patient with collagen disease is considered to be "compromised host", especially during corticosteroid therapy. We must keep in mind potential incidence of tuberculosis and do careful clinical observation for early diagnosis and be prepared for antituberculous chemotherapy. Chemoprophylaxis for tuberculosis seems to be desirable for higher risk patients.

Abnormal accumulation of hyaluronan matrix diminishes contact inhibition of cell growth and promotes cell migration.

Elevated hyaluronan biosynthesis and matrix deposition correlates with cell proliferation and migration. We ectopically expressed three isoforms of hyaluronan synthase (HAS1, HAS2, or HAS3) in nontransformed rat 3Y1 cells and observed a de novo, massive formation of a hyaluronan matrix that resulted in a partial loss of contact-mediated inhibition of cell growth and migration. All three HAS transfectants showed an enhanced motility in scratch wound assays, and a significant increase in their confluent cell densities. In high-density cultures, the HAS transfectants had a fibroblastic cell shape and markedly formed overlapping cell layers. This phenotype was more pronounced in the HAS2 transfectants than HAS1 or HAS3 transfectants, and occurred with significant alterations in the microfilament organization and N-cadherin distribution at the cell-cell border. Inhibition of a phosphatidylinositol 3-kinase (PI3-kinase) pathway resulted in reacquisition of the normal phenotype of HAS2 transfectants, suggesting that the intracellular PI3-kinase signaling regulates diminution of contact inhibition induced by formation of the massive hyaluronan matrix. Our observations suggest that hyaluronan and its matrix can modulate contact inhibition of cell growth and migration, and provide evidence for functional differences between hyaluronan synthesized by the different HAS proteins.