Socioeconomic inequalities in toothbrushing behaviours in young children: a children's lifestyle survey in a representative population of A city, Okinawa prefecture, Japan.

PURPOSE: We have less understanding of which socioeconomic status (SES) indicators may be reflective of latent socioeconomic inequalities in toothbrushing behaviours, especially finishing-toothbrushing by parents in young children. The aim of this study was to reveal the socioeconomic inequalities in children's toothbrushing and finishing-toothbrushing by parents and if it varies by SES indicators. METHODS: We used data from 'Survey on Children's Life' conducted by A city of Okinawa Prefecture, Japan. The multiple imputed data of 902 (boys, 453) included self-reported children's toothbrushing behaviour and finishing-toothbrushing by parents in three-to six-year-old children. SES was assessed using self-reported household income and parental educational attainment. Absolute and relative inequalities in toothbrushing behaviours were quantified using the slope index of inequality (SII) and relative index of inequality (RII), respectively. RESULTS: There were significant absolute and relative inequalities of children's toothbrushing for household income (SII and RII were 0.241 and 2.73, respectively), of finishing-toothbrushing by parents for household income (SII and RII were 0.133 and 3.28, respectively), and educational attainment (SII and RII were 0.166 and 5.55, respectively). The same inequality trends were observed after adjusting for covariates (child's age and sex, family structure, breakfast and dinner frequency, and sleep duration). CONCLUSION: Socioeconomic inequalities in children's toothbrushing and finishing-toothbrushing by parents varied according to SES indicators.

Extraordinary high rate of HTLV type II seropositivity in intravenous drug abusers in south Vietnam.

Serum specimens (n = 1899) were assayed for infections with HTLV-I, HTLV-II, and HIV-1 in seven classified groups of normal healthy controls, children, pregnant women, prostitutes, intravenous drug abusers, patients under going hemodialysis, and hemophiliacs in South and North Vietnam. Surprisingly, 125 of 954 samples from South Vietnam exhibited seropositivity for HTLV-II and 119 of these belonged to the group of IVDAs (n = 200). The remaining six positives were a healthy control, a prostitute, two children, and two patients under going hemodialysis. Two IVDAs who were seropositive for HTLV-I and 10 of 15 seropositives for HIV-1 were also positive for HTLV-II in this population. In contrast, no seropositives to any of the viruses were detected in the North Vietnamese samples (0 of 945). The HTLV-II-seropositive IVDAs exhibited increased seropositivity with age compared with HIV-1 seropositivity in the population, and there was no statistical relation between seropositivity for HTLV-II and HIV-1. The HTLV-IIs in South Vietnam IVDAs appeared, by subtype-specific peptide ELISA, to be a mixture of both subtypes a and b, with subtype a predominant. It seems possible that HTLV-II may have been introduced into this population from IVDAs from the United States during the Vietnam conflict, but in a period prior to, or early in, the introduction of HIV-1 to IVDAs.

Presence of multiple HIV type 1 subtypes among mothers and children in Japan.

We collected blood samples from 70 HIV-1-infected pregnant women and 76 babies born to HIV-1-infected women in Japan, from 1989 to 1999. To analyze the genetic diversity of HIV-1 among mothers and children, we sequenced the C2-V3 regions of HIV-1 gp120. Phylogenetic tree analysis of these regions revealed that multiple HIV-1 subtypes, A, B, D, E, and G, were circulating among mothers and children in Japan. Thus, the genetic heterogeneity of HIV-1 among mothers and children in Japan is steadily increasing, although the number of cases remains small. Perhaps the longest term survivor, an 11-year-old child with a vertical HIV-1 subtype G infection in Japan, is one of our subjects.

Correlation of titer of antibody to principal neutralizing domain of HIVMN strain with disease progression in Japanese hemophiliacs seropositive for HIV type 1.

With the use of the principal neutralizing determinant (PND) peptide-based ELISA to measure anti-PND antibodies that specifically bound synthetic peptides derived from HIVIIIB, HIVMN, HIVRF, HIVSC, HIVWJM-2, HIVAf1l.con, or HIVAf2.con, type-specific antibodies to the HIVMN peptide were studied in 350 serum specimens from Japanese with hemophilia A who had been injected with known unheated factor VIII concentrates until 1985 and had been infected with HIV-1 subtype B. These antibodies were not found in any of the seronegative sera of hemophiliacs, patients with autoimmune diseases, or normal healthy controls. Further, all hemophiliacs rapidly progressing to AIDS and death among the 95 hemophiliacs in a restricted Nara area had antibody titers of less than 20 and their low levels preceded the rapid progression to the disease state. In contrast, slowly progressing hemophiliacs maintained an antibody titer of more than 100 from the initial stages of viral infection and remained asymptomatic. Sequence analysis of the V3 regions of HIV-1 indicated that the hemophiliacs who maintained a high anti-PNDMN antibody level showed a conserved MN sequence. In contrast, the HIV-infected hemophiliacs with nonreactivity in the ELISA showed sequence changes in the neutralizing epitopes of HIVMN. The dynamic of the serum anti-PNDMN antibody titer appear to be a characteristic indicator of the progression of the HIV-infected status in Japanese hemophiliacs seropositive for HIV-1.

[Tuberculosis among health care workers in Okinawa Prefecture].

In health care setting, transmission of M. tuberculosis (TB) is considerable risk not only to patients but to health care workers (HCWs). The total number of registered TB cases in Okinawa prefecture was 1,202 in 1993-1995 (incidence rate 28.3 per 100,000 in 1995) and that of HCWs was 23. Using data from TB registration system, relative risk of tuberculous disease of nurses was estimated to be 2.3 higher than general population. Nosocomial transmission of TB to HCWs in a general hospital was occurred in 1993. After 2 nurses in the same ward were diagnosed as active pulmonary TB by routine screening chest X-ray, a contact investigation was performed in their family, friends and the ward staffs. On the result of initial evaluation of PPD test, 22 of 26 HCWs were suspected to be infected and preventive therapy with isoniazid were given to 16 HCWs. Follow-up chest radiographs for 3 years revealed 5 HCWs were active TB. According to RFLP analysis of M. tuberculosis isolates, 3 HCWs and 1 patient had identical RFLP pattern to 65-year-old female SLE patient, who was admitted for fever in Nov. 1993 and was diagnosed as miliary tuberculosis after 2 weeks admission. As she had no cough and sputum, the infectiousness of the case was suspected to be increased by cough-inducing procedure. The following TB infection control measures were conducted in the hospital; (1) Education and training to all HCWs for early identification of TB patient and adequate treatment (2) Surveillance and reporting system of TB patient from laboratory and ward to infection-control committee (3) Introduction of PPD test program for HCWs (4) Use of HEPA masks as personal respiratory protection. We need further evaluation of engineering controls e.g. ventilation and isolation room.

[Relationship between neuronal size and axonal length in chick propriospinal neurons].

In order to investigate the relationship between neuronal size and axonal length, we compared the size of chick propriospinal neurons in several segmental levels. As the index of neuron size, the cross sectional areas of somata were measured. After unilateral implantation of solidified HRP into the lumbar enlargement (2 cases) or the cervical enlargement (1 case) in the 2-4 day post-hatch chick under Nembutal anesthesia, propriospinal neurons projecting to the enlargement were visualized by TMB method. Labeled cells found in complete serial transverse sections were all traced onto tracing papers put on photomicrographs under examination with the microscope (Fig. 2). In several successive sections in the cervical cord, the cervical enlargement, the lumbar and the sacral cord, the cross sectional areas of their 3601 somata were measured on traced drawings of final magnification X243 by means of a computer system graphic analyzer (Cosmo Zone, Nikon) (Fig. 1). As a control case, cross sectional areas of somata were also measured in Nissl preparations in laminae V-VIII, where vast majority of propriospinal neurons are located, and also lamina IX. In Nissl preparations, the cross sectional areas of neurons in laminae V-VIII had a wide range distribution from 50 to 1600 micron 2. Over 90% of them were distributed from 50 to 600 micron 2. Among them, the neurons with somata of 150-250 micron 2 were most numerous. The distribution pattern was almost the same in all segments examined. The cross sectional areas of neurons in lamina IX were also distributed in a wide range from 150 to 1600 micron 2 (Fig. 3).(ABSTRACT TRUNCATED AT 250 WORDS)

[Synaptogenesis and axon collaterals coming from the white matter in the upper cervical cord of the 10 day (stage 36) chick embryo--Golgi and electron microscopic studies].

Our previous study with 3H-thymidine autoradiography showed that neurons of the zona spongiosa, the nucleus proprius of the dorsal horn, the zona intermedia and the ventralhorn differentiated earlier than those of the substantia gelatinosa and the neck and the base of the dorsal horn, and that neurons of the substantia gelatinosa which were the last to differentiate reached their final position at stage 36 (Fig. 1). In the upper cervical cord of chick embryos at stage 36 when all spinal neurons finished cell migration and the cytoarchitecture similar to that of the cat spinal cord (Rexed, 1952) could be recognized (cf. Figs. 1, 3B), we studied the distribution of synapses by the electron microphotomontage (Fig. 3 A) and the morphology of axon collaterals coming from the white matter by the Golgi method (Fig. 4), in order to examine i) which spinal neurons have synaptic contacts at this stage and ii) what part of the axon collateral makes synaptic contacts. In the white matter, synapses were numerous around the gray matter and they were few in the peripheral part along the external surface of the cord. The paucity of synapses in the peripheral part was explained by a finding that dendrites reaching the external surface of the cord were few in number at this stage (cf. Fig. 3 C). In the gray matter, synapses were more numerous and denser in the zona intermedia and the ventral horn than in the dorsal horn.(ABSTRACT TRUNCATED AT 250 WORDS)

[Adult T-cell leukemia with massive melena due to marked gastrointestinal involvement].

A 60-year-old man born in Okinawa was admitted to our hospital because of epigastralgia. Physical examination revealed general lymphadenopathy, mild hepatomegaly and skin eruption. The peripheral blood leukocyte count was 168,600/microliters, with 93% abnormal lymphocytes showing convoluted or lobulated nuclei. Anti HTLV-1 antibody was positive with titer of 1: 1280 (PA). Leukemic cells had typical ATL cells' surface markers (OKT3; 97.2%, T4; 93.3%, T8; 2.8%, OKIA1; 39.6%, IL-2R; 41.8%) and complete monoclonal HTLV-1 provirus DNA. Endoscopic examination with biopsy revealed massive involvement of ATL cells into gastric mucosa. In the course of the treatment, he had extremely massive melena, and was saved by emergency operation. Multiple ulcers were found in the resected colon. Histological examination showed the marked infiltration of the ATL cells into the mucous or submucous membrane. Thereafter, he was treated well with ALG (Anti Lymphocyte Globulin), until hypercalcemia occurred. He died of acute renal failure after hypercalcemia.

[A case of spontaneous ruptured of the esophagus managed with pedicled omental covering].

We experienced a case of spontaneous rupture of the esophagus which was successfully managed by suture of the ruptured site and pedicled omental covering. A 47-year-old male was referred to our department in unstable condition 60 hours after the onset of acute symptoms. Upon presentation to the hospital, the patient was in shock and complained of severe chest pain and dyspnea, the onset of which followed vomiting after consumption of alcohol. A diagnosis of spontaneous rupture of the esophagus was made on the basis of the history of the episode and chest X-ray and chest CT findings. After construction of a pedicled omentum created during laparotomy, left-sided thoracotomy and debridment of the mediastinum was performed, which was seen to contain necrotic tissue and purulental fluid. The site of esophageal rupture, nearly 3 cm in length, was sutured shut and reinforced with a pedicled omental covering, the postoperative course was uneventful, and oral intake was resumed 20 days following the surgery. The pedicled omental covering procedure was useful for reinforcing sutures at the site of rupture and for control of infection in this patient for whom institution of surgical therapy for spontaneous esophageal rupture was delayed following the acute onset of symptoms.

[A case of pulmonary carcinoma presenting flow cytometrical heterogeneity of the nuclear DNA content between its primary focus and the metastatic foci].

We have experienced case involving a 63-year-old patient with a pulmonary carcinoma, who was given an enterectomy following a lobectomy, due to minimal intestinal metastasis. In this case, using flow cytometry, the cancer cell nuclear DNA content was analyzed for the primary tumor focus, the mediastinal lymph node metastatic focus, and the small intestinal metastatic focus. For the primary focus, a cancer cellular population of polyploidy with 2 ploidies of DNA content was observed, while for both the metastatic foci, only a single cancer cellular population was observed, indicating the heterogeneity of the nuclear DNA content between the primary focus and metastatic foci. These 2 metastatic foci had DNA contents completely corresponding to that for a ploidy with a high DNA content in the primary focus, suggesting a metastasis of only the above population from the primary focus. The present case apparently formed metastatic foci in other organs than the lungs but only by cancer cells more susceptible to metastasis among the cancer cells found in the primary focus.

Vertical transmission of human immunodeficiency virus type 1 in Japan, 1989-1997: presence of two subtypes B and E with subtype E predominance. National Cooperative Study Investigators on Vertical Transmission of HIV-1.

A collaborative group for studying vertical transmission of human immunodeficiency virus (HIV)-1 in pregnant women and their babies was established in Japan in 1989. Forty-two infants, including 13 HIV-1-infected, 25 uninfected and four of undetermined status and 15 control children born to HIV-1 negative mothers were diagnosed and followed from birth to 1.5 years. All strains from HIV-positive infants were either clade E (eight infants, 61.5%) or B (five infants, 38.5%) according to DNA sequencing specific for the HIV-1 C2-V3 region. The 42 mothers with HIV-1 were women with sexual-risk behavior from all regions, but were concentrated in the Kanto District. In this group of HIV-infected children, there was no significant difference between the transmissibility of their mother's clade E and B viruses. Eight (61.5%) of the 13 virus-infected babies were Japanese and five (62.5%) of the eight were positive for HIV-1 clade E. The V3 loop region of the clade E virus of the babies was conserved but approximately 60% of the sequences which showed a substitution of aspartic acid by asparagine at position 29. The results suggest that HIV-1 clade E may be predominant in vertical transmissions and are phenotypically different from HIV-1 in persons with various other risk behaviors in Japan.

Quintuple deglycosylation mutant of simian immunodeficiency virus SIVmac239 in rhesus macaques: robust primary replication, tightly contained chronic infection, and elicitation of potent immunity against the parental wild-type strain.

We previously generated a mutant of simian immunodeficiency virus (SIV) lacking 5 of a total of 22 N-glycans in its external envelope protein gp120 with no impairment in viral replication capability and infectivity in tissue culture cells. Here, we infected rhesus macaques with this mutant and found that it also replicated robustly in the acute phase but was tightly, though not completely, contained in the chronic phase. Thus, a critical requirement for the N-glycans for the full extent of chronic infection was demonstrated. No evidence indicating reversion to a wild type was obtained during the observation period of more than 40 weeks. Monkeys infected with the mutant were found to tolerate a challenge infection with wild-type SIV very well. Analyses of host responses following challenge revealed no neutralizing antibodies against the challenge virus but strong secondary responses of cytotoxic T lymphocytes against multiple antigens, including Gag-Pol, Nef, and Env. Thus, the quintuple deglycosylation mutant appeared to represent a novel class of SIV live attenuated vaccine.