The outcome of Japanese anorexia nervosa patients treated with an inpatient therapy in an internal medicine unit.

OBJECTIVE: To investigate the outcome of Japanese anorexia nervosa (AN) patients who were treated with the standard Japanese inpatient therapy. METHOD: Of the 88 female AN patients treated with our inpatient therapy between January 1997 and December 2002, 67 (76.1%) who agreed to cooperate in this study were assessed by the Global Clinical Score (GCS) at admission and follow-up, 6.3±1.8 years after discharge. Their clinical characteristics at admission and discharge were also examined. RESULTS: Four (6.0%) patients had died before follow-up. BMI was significantly increased during inpatient therapy. At follow-up, excellent, much improved, symptomatic, and poor outcomes on GCS were 57.1%, 14.3%, 14.3% and 14.3%, respectively. Younger age at admission and larger BMI at discharge were significantly associated with a better outcome. DISCUSSION: This study shows the potential for the use of this method for the treatment of AN patients in countries without specialized eating disorder units.

Predictors of menstrual resumption by patients with anorexia nervosa.

OBJECTIVE: To investigate which factors predict the resumption of menstruation by patients with anorexia nervosa (AN). METHODS: Participants were AN patients who, even after weight recovery by inpatient treatment, had prolonged amenorrhea (N=11), AN patients who resumed menstruation after weight recovery (N=9), and age-matched healthy controls (N=12). Anthropometric data and the serum levels of leptin, insulin-like growth factor I (IGF-1), cortisol, luteinizing hormone (LH), estradiol (E2), and other hormones were measured at the beginning of the inpatient treatment and after weight recovery. RESULTS: Of the baseline anthropometric and hormonal factors, logistic regression analysis extracted a high serum cortisol level as a predictor of the inhibition of the resumption of menstruation. After weight recovery, the E2 and leptin levels were significantly higher for eumenorrheic patients than for amenorrheic patients. CONCLUSION: The baseline serum cortisol level was a predictor of the prolonged inhibition of menstrual recovery.

Barriers to compliance with the Daily Food Guide for Children among first-grade pupils in a rural area in the Philippine Island of Mindanao.

BACKGROUND/OBJECTIVE: To identify and address caregivers' perceived barriers to compliance with dietary guidelines for children. SUBJECTS/METHODS: Information on family socioeconomic status, child's consumption frequency of nine food items, and caregiver's attitudes and behaviors regarding meal preparation were collected through structured interviews with caregivers (70 mothers, four grandmothers and one father) of first-grade children (39 boys and 36 girls) living in five barangays of New Corella, Mindanao Island, Philippines. If the child's intake did not reach the level recommended in the dietary guidelines, the reasons were investigated from the economic, social, cultural and environmental viewpoints. RESULTS: Their diet relied heavily on rice and others. The percentages of children who did not consume each of the food items on a daily basis were 77.3% for eggs; 57.3% for milk; 41.3% for fish/meat/poultry/dried beans/nuts (FMPDBN); 42.7% for fruits; 17.4% for green, leafy and yellow (GLY) vegetables; and 38.5% for other vegetables. The most reported reasons for the infrequent consumption of FMPDBN (87.1%), milk (81.4%) and eggs (36.2%) were 'no money to buy,' that of fruits (59.4%) was 'out of season' and that of GLY (61.5%) and other vegetables (55.2%) was 'child's dislike.' CONCLUSIONS: The expansion of homestead food production and the national feeding program contribute to increased animal food consumption. Nutrition education aimed at overcoming food preferences and increasing the awareness of micronutrient intake are perhaps the most effective means to promote vegetable intake.

Insulin-like growth factor-I (IGF-I) system during follicle development in the bovine ovary: relationship among IGF-I, type 1 IGF receptor (IGFR-1) and pregnancy-associated plasma protein-A (PAPP-A).

Insulin-like growth factor-I (IGF-I) system that is exerted mainly through the type 1 IGF receptor (IGFR-1) and releasing of free IGF-I is regulated by the proteases of IGF-binding proteins (IGFBPs), an important factor in follicle development of bovine ovary. The aims of the present study were to examine the mRNA expressions of IGF-I, IGFR-1 and pregnancy-associated plasma protein-A (PAPP-A) in granulosa cells and theca tissues during bovine follicular development and the effects of follicle-stimulating hormone (FSH) and estradiol (E2) on the expression of these genes in cultured bovine granulosa cells. Follicles were classified into four groups such as small follicle (SF), estrogen inactive dominant follicle (EID), estrogen active dominant follicle (EAD) and preovulatory follicle (POF). The concentration of free IGF-I in follicular fluid of POF was significantly higher than those in EID, whereas the total IGF-I in follicular fluid did not change at all developmental stages. The expression of IGF-I mRNA was not detected in the granulosa cells at all at any developmental stages but the expression was detected in the theca tissues. The amount of IGFR-1 mRNA in granulosa cell showed the constant level at all developmental stages except EID. The expressions of IGFR-1 and PAPP-A in cultured bovine granulosa cells were stimulated with FSH but not with E2. The PAPP-A mRNA expression was stimulated by FSH in presence of 1 ng/ml E2. These results indicate that IGF-I in follicular fluid is mainly derived from the circulation and that FSH is an inducer for the expression of IGFR-1 and PAPP-A genes in granulosa cells. Therefore, we suggest that PAPP-A stimulated with FSH play a crucial role for IGF-I system in bovine follicular development.

Gender differences in dietary intake among adults of Hindu communities in lowland Nepal: assessment of portion sizes and food consumption frequencies.

OBJECTIVE: To elucidate gender differences in dietary intake among adults in lowland Nepalese communities. SUBJECTS AND METHODS: For 122 male and 195 female subjects aged 20 years and over from 94 randomly selected households, interviews using a 19-item food frequency questionnaire were conducted. To determine the portion sizes of these foods, the samples consumed by 56 subjects in a full 1-day period were weighed. Energy expenditure was estimated by time spent on daily activities. RESULTS: Gender differences in per-day energy and protein intakes were related to sex differences in body size and energy expenditure. Apparent gender differences in the crude intakes disappeared when they were expressed by nutrient density (mg or microg/MJ) since micronutrient intakes were significantly correlated with energy intake. However, males' iron intake was larger even after adjustment for energy intake, attributing to their larger portion sizes of commonly consumed staple foods and higher frequencies of consuming luxury foods (fish and tea). CONCLUSION: The intrahousehold unequal distribution of food incurs risk of iron deficiency among female subjects. SPONSORSHIP: This study was financially supported by the Ajinomoto Foundation for Dietary Culture and the Alliance for Global Sustainability Program.

A change in objective sleep duration is associated with a change in the serum adiponectin level of women with overweight or obesity undergoing weight loss intervention.

BACKGROUND: Although the serum adiponectin level is inversely correlated to body mass index and closely associated with obesity and related diseases, neither the impact of weight loss on the adiponectin level nor other factors that might influence the adiponectin level during weight loss intervention are well documented. OBJECTIVE: The objective of the study is to assess the change in the serum adiponectin level during weight loss intervention and to determine if sleep parameters affect the serum adiponectin level. METHODS: Ninety women with overweight or obesity aged 25 to 65 years completed a 7-month cognitive behavioural therapy based weight loss intervention that included dieting, exercise and stress management. Serum adiponectin level, body fat percent, symptoms of depression and anxiety and objective sleep parameters, assessed by actigraphy, were measured at baseline and at the end of the intervention. RESULTS: The serum adiponectin level was significantly increased after the weight loss intervention (P < 0.001). In a multiple regression analysis, the change of the adiponectin level was positively associated with the magnitude of body fat loss (ß = -0.317, P < 0.001) and an increase of sleep minutes (ß = 0.210, P = 0.043). CONCLUSION: An increase in objective sleep duration was related to a significantly increased serum adiponectin level independently of the change of body fat during the weight loss intervention.

Augmented Ca2+ influx is involved in the mechanism of enhanced proliferation of cultured vascular smooth muscle cells from spontaneously diabetic Goto-Kakizaki rats.

To investigate whether augmented calcium influx is involved in the mechanism of the enhanced proliferation of vascular smooth muscle cells (VSMCs) in diabetes, we studied the association between proliferation and cytosolic free calcium concentration ([Ca2+]i) in cultured aortic VSMCs from spontaneously diabetic Goto-Kakizaki (GK) and Wistar rats. Serum, angiotensin II and Bay K 8644, a voltage-dependent Ca2+ channel (VDC) agonist, stimulated the proliferation of VSMCs; the magnitude was greater in VSMCs from GK than Wistar rats. VDC blockers, verapamil and nicardipine, inhibited Bay K 8644-induced cell proliferation, and the difference in the proliferation of VSMCs between GK and Wistar rats disappeared. Angiotensin II-induced proliferation was only partially inhibited by VDC blockers, and enhanced proliferation of GK-VSMCs was still observed. Bay K 8644 and angiotensin II increased [Ca2+]i, and the increase was augmented in GK-VSMCs. Bay K 8644-induced [Ca2+]i increase was completely inhibited by pretreatment with verapamil or removal of extracellular Ca2+, suggesting that VDC is associated with this increase. Although angiotensin II-induced [Ca2+]i increase was not affected by verapamil, removal of extracellular Ca2+ slightly but significantly attenuated angiotensin II-induced [Ca2+]i increase, suggesting that VDC blocker-insensitive receptor-activated Ca2+ influx is involved. These results indicate that augmented Ca2+ influx via VDC and a receptor-activated pathway may be involved in the mechanism of the enhanced proliferation of VSMCs from GK rats.

The restraint stress-induced reduction in lymphocyte cell number in lymphoid organs correlates with the suppression of in vivo antibody production.

In this study, we examined the effects of restraint stress on some immune parameters such as the in vivo antibody levels, cytokine production, and lymphocyte cell number in the spleen or mesenteric lymph node (MLN). BALB/c mice were thus injected intraperitoneally 2-times with OVA absorbed into alum on days 0 and 21. Before the first injection, the animals were either restrained for 12 h (stress group) or returned to their home cage (control group). Exposure to stress resulted in a reduction in the serum levels of anti-OVA IgE, IgG1, and IgG2a. In addition, stress also caused a decrease in the IL-4 and IFN-gamma levels in the spleen or mesenteric lymph node cell culture supernatants. Furthermore, exposure to stress resulted in a decrease in the splenic and mesenteric lymphocyte cell number when examined immediately after the cessation of stress. This decrease persisted for at least 12 h after the termination of stress and thereafter disappeared 24 h after stress. The stress-induced reductions in antibody and cytokine production occurred only when antigen was given either immediately or 6 h after stress, but not when antigen was given 24 h post stress. These results thus suggest that the restraint stress-induced change in lymphocyte cell number in the spleen or MLN closely correlates with the altered antibody and cytokine levels.

Restraint stress elevates the plasma interleukin-6 levels in germ-free mice.

Several recent reports demonstrated that restraint stress elevates plasma IL-6 levels; however, the precise mechanism whereby stress stimuli trigger the production of IL-6 remains to be clarified. In this study, in order to elucidate whether or not the intestinal microflora contribute to the stress-induced IL-6 elevation, the plasma IL-6 response of germ-free (GF) mice, which are indeed devoid of indigenous microflora, was compared to that of specific pathogen-free (SPF) mice. The plasma IL-6 level increased after 1 h of restraint stress and thereafter gradually decreased in GF mice as well as in SPF mice. In addition, such a stress-induced IL-6 elevation was also found in the mice reconstituted with SPF feces. The expression levels of IL-6 mRNA in the liver increased after 1 h of stress in both GF and SPF mice based on the findings of a semiquantitative RT-PCR method, although no such increase was observed in the spleen and kidney of both groups of mice. These results thus indicate that restraint stress is capable of elevating the plasma IL-6 levels independently of the intestinal microflora and the liver is one of the main sources responsible for the increased plasma IL-6 during stress.

Dehydroepiandrosterone attenuates the spontaneous elevation of serum IgE level in NC/Nga mice.

Dehydroepiandrosterone (DHEA) and its sulfate derivatives are known to affect host immune function; however if such hormones influence the development of atopic dermatitis has not yet been clarified. In this study, we examined the effects of DHEA on the allergic process using NC/Nga mouse, a model animal of human atopic dermatitis. The administration of DHEA profoundly suppressed the spontaneous elevation of both serum IgE and interleukin-6 levels in NC/Nga mice during the observation period. These results indicate that DHEA promotes a shift in Thl/Th2 balance toward Th1-dominant immunity, and thus may be one of the effective alternatives in treating atopic dermatitis.

Evaluation of 3-minute semiquantitative test kit for urinary estrogens of pregnant women.

A 3-minute rapid slide assay of total urinary estrogens is available for testing in pregnant women. This is a semiquantitative, immunologic competitive latex agglutination inhibition slide test, which is reported in levels (level 1: less than 5 mg/liter, level 2: greater than or equal to 5 mg/liter, level 3: greater than or equal to 10 mg/liter, level 4: greater than or equal to 20 mg/liter). With the use of this kit, the results of 100 samples of pregnancy urine were compared with the results from a chemical colorimetric assay procedure. There was 94% agreement between these 2 methods. There was no 2-step difference in grading. The probable future usefulness of this kit is described because of its rapidity and simplicity in testing. Its limitations are also discussed.

Obstetric aspects of the Guillan-Barré syndrome.

Two additional cases of Guillain-Barre syndrome complicating pregnancy are reported and the 25 previously published cases reviewed. While fetal prognosis is generally favorable, the occurrence of the disease in late pregnancy is a high-rish maternal condition. Respiratory failure and aspiration pneumonitis may result in premature labor and maternal mortality.

Central and peripheral catecholamines regulate the exercise-induced elevation of plasma interleukin 6 in rats.

Several recent reports indicate that exercise elevates the plasma interleukin 6 levels; however, the precise regulation of such an elevation still remains to be clarified. In this study, in order to clarify the requirements of central and peripheral catecholaminergic system for this exercise-induced interleukin 6 elevation, rats were either intraperitoneally or intracerebroventricularly injected with 6-hydroxydopamine which depletes the catecholamine in the central or peripheral tissues. As a result, our exercise protocol elevated the plasma interleukin 6, ACTH, and corticosterone levels in response to exercise. All such exercise-induced increases in the interleukin 6, ACTH, and corticosterone levels were significantly inhibited by pretreatment with an intracerebroventricular injection of 6-hydroxydopamine. In the intraperitoneal 6-hydroxydopamine-treated animals, the exercise-induced interleukin 6 elevation was significantly suppressed compared with the vehicle-treated animals, although no significant difference was found in either the ACTH level or the corticosterone level between both groups of animals. These results thus suggest that central and peripheral catecholamines are involved in the regulation of the exercise-induced interleukin 6 elevation.

Effects of length change on intracellular Ca2+ transients in ferret ventricular muscle treated with 2,3-butanedione monoxime (BDM).

Quick release of the right ventricular papillary muscle of ferrets, injected with aequorin, from Lmax (initial length) to 92% Lmax during twitch response produced an extra-light signal of aequorin. 2,3-Butanedione monoxime (BDM) at 10 mM decreased the peak tension to less than 10% of that in control and the light signal to 70%. In the BDM-treated muscle, the extra-light in response to the quick release did not occur. A quick stretch from Lmax to 103% Lmax, in the presence and absence of BDM, did not cause any changes in the light signal. The results indicate that the extra-light signal in the quick release is tension dependent. The tension reduction by the quick release decreases the affinity of troponin-C (Tn-C) for Ca2+ without affecting Ca2+ handling system in intact cardiac muscle.

Effect of anti-inflammatory drugs on collagen-induced autoimmune inner ear disease.

Animals that had collagen-induced autoimmune inner ear disease were treated with anti-inflammatory drugs: Solu-Medrol (steroid), sulindac (nonsteroid), or a combination of both. Temporal bones from drug-treated animals were examined for histopathologic and immunohistochemical changes, and sera were examined for levels of circulating antibody to type II collagen. Therapy was beneficial to the animals whether the drugs were administered alone or in combination; however, fewer lesions were observed in animals given either drug alone. Further, animals treated with steroid alone showed the least amount of inner ear damage. Immunohistochemical changes and serum levels of antibodies against type II collagen correlated with the pathologic changes. These findings suggest that both steroidal and nonsteroidal anti-inflammatory drugs may have potential therapeutic value in the treatment of autoimmune ear disease.

Collagen components of bovine fetal and guinea pig cochlear bone and human stapes.

Collagenous components were isolated chemically from fetal bovine or guinea pig cochlear bone and human stapes after stapedectomy, and the purified protein was characterized by immunoblot assay and amino acid analysis. The results of this study suggest that these are mixtures of type I and type II collagens. The presence of type II collagen in the human stapes also was demonstrated by immunohistologic methods using monoclonal antibody. The presence of type II collagen in these tissues is significant, since it has been postulated as an autoantigen in autoimmune inner ear disease.

Multivariate analysis of prognostic factors in patients with ovarian cancer stage I and II.

OBJECTIVE: To evaluate prognostic factors such as surface capsular invasion, rupture of the capsule and intraperitoneal cytology in patients with stage I or II ovarian cancer. METHOD: Multivariate analysis was performed using 11 clinicopathologic prognostic factors obtained from 183 cases of stage I and II ovarian cancer, which had been surgically treated between 1983 and 1993. RESULTS: Significant prognostic factors determined by the Kaplan-Meier method were rupture and invasion of the capsule in stage II ovarian cancer. Multivariate analysis showed that spontaneous rupture of the capsule was the only significant factor, and intrapelvic cytology was an important factor without significance. Although capsular rupture caused by the surgeon showed poor prognosis by the Kaplan-Meier method, no significance was observed for this factor by multivariate analysis. CONCLUSION: Multivariate analysis showed that capsular rupture caused by the surgeon did not affect the prognosis in stage I and II ovarian cancer.

Type II collagen induced autoimmune salpingitis in the rat.

Previous studies showed type II collagen induced autoimmune salpingitis in Wistar rats. In this study we increased the number of animals and investigated whether or not type II collagen induced salpingitis is transferable by immune sera. Histopathological observations of salpingitis in the serum transferred rats were similar to those observed in the immunized rats but the degree of otopathological changes was less than that of immunized rats. Electronmicroscopic findings indicate an increased permeability in the capillaries and intercellular space and cellular infiltration in the submucosa of the immunized rats.

Type II collagen mediated autoimmune middle ear disease: eustachian tube disease, otitis media with effusion and tympanosclerosis.

Intact Eustachian tube and tympanic cavity functions are essential for normal middle ear physiology. Type II collagen is an essential component of ear tissue. Autoimmune response to this type II collagen produces sensorineural hearing loss, vestibular dysfunction, endolymphatic hydrops, otospongiosis-like lesions, Eustachian tube inflammation and Eustachian tube chondritis. In addition, these autoimmune responses occasionally produce otitis media with effusion (not infectious). Tympanosclerosis, which is a frequent sequelae of otitis media with effusions, was also induced by type II collagen immunization together with surgical incision of the tympanic membrane. The exact mechanisms of this type II collagen autoimmune mediated middle ear disease are not clear. However, the animals thus induced have higher antibody titers and cell mediated immune responses to type II collagen. The tympanic membrane showing tympanosclerosis also had C3 and Ig deposits. All the animals with otitis media with effusion induced by type II collagen immunization also had Eustachian tube disease. This could be due to a malfunction of the Eustachian tube. Thus, this model might provide a rational approach for the study of otitis media with effusion associated with vasculitis. Further studies are needed to elucidate the immunologic mechanism involved in the pathogenesis of otitis media with effusion.

[Use of a micturition-monitoring device in elderly inpatients].

More than 100,000 people suffer from functional urinary incontinence in Japan. To improve the quality of life of these people, we tested a device for monitoring micturition by means of a thin-layer membrane sensor in a diaper. The device was tested in elderly inpatients, and associated changes in the wordload of the nursing staff were also recorded. The device was beneficial because the precise micturition time was easily obtained and thus the daily pattern of micturition became obvious. With the use of this device, the time during which the patients wore wet diapers was shorter than with the conventional system of scheduled changes. However, the increase in the frequency of diaper changed doubled the workload of the nursing staff. In conclusion, improving the quality of life with regard to urinary incontinence entails an increase in the workload of the nursing staff; efficient distribution of that work may require some staff members to devote all their time to changing diapers.