The effectiveness of dance movement therapy for individuals with Down syndrome: a pilot randomised controlled trial.

BACKGROUND: Individuals with Down syndrome (DS) exhibit deficits in static and dynamic balance abilities and maladaptive functions. This study aimed to determine the effectiveness of dance movement therapy (DMT) group intervention in individuals with DS. METHODS: The 31 participating individuals with DS, aged 5-29 years, were randomly divided into intervention (n = 16) and control (n = 15) groups. Posturography was used for static balance measurement, timed up and go test for dynamic balance measurement and the Achenbach System of Empirically Based Assessment (ASEBA) questionnaire for adaptive function and behavioural problem measurement in participants before and after the DMT interventions. The intervention group underwent 60-min DMT intervention once a week for 10 times, while the control group had usual daily activities. RESULTS: The results revealed a statistically significant difference and large effect sizes in dynamic balance [(f(1, 29) = 4.52, P = 0.04, ηp 2 = 0.14)] in the intervention group compared with the control group. There were no statistically significant differences in static balance and ASEBA scores between the groups. CONCLUSIONS: This study found that the DMT interventions helped to improve the dynamic balance in individuals with DS.

Myositis with sarcoplasmic inclusions in Nakajo-Nishimura syndrome: a genetic inflammatory myopathy.

AIMS: Nakajo-Nishimura syndrome (NNS) is an autosomal recessive disease caused by biallelic mutations in the PSMB8 gene that encodes the immunoproteasome subunit ß5i. There have been only a limited number of reports on the clinicopathological features of the disease in genetically confirmed cases. METHODS: We studied clinical and pathological features of three NNS patients who all carry the homozygous p.G201V mutations in PSMB8. Patients' muscle specimens were analysed with histology and immunohistochemistry. RESULTS: All patients had episodes of typical periodic fever and skin rash, and later developed progressive muscle weakness and atrophy, similar to previous reports. Oral corticosteroid was used for treatment but showed no obvious efficacy. On muscle pathology, lymphocytes were present in the endomysium surrounding non-necrotic fibres, as well as in the perimysium perivascular area. Nearly all fibres strongly expressed MHC-I in the sarcolemma. In the eldest patient, there were abnormal protein aggregates in the sarcoplasm, immunoreactive to p62, TDP-43 and ubiquitin antibodies. CONCLUSIONS: These results suggest that inflammation, inclusion pathology and aggregation of abnormal proteins underlie the progressive clinical course of the NNS pathomechanism.

Positive association of free triiodothyronine with pancreatic ß-cell function in people with prediabetes.

AIM: To analyse the effects of thyroid hormones on ß-cell function and glucose metabolism in people with prediabetes who are euthyroid. METHODS: A total of 111 people who were euthyroid underwent 75-g oral glucose tolerance tests, of whom 52 were assigned to the normal glucose tolerance and 59 to the prediabetes groups. Homeostatic model assessment of ß-cell function, insulinogenic index and areas under the curve for insulin and glucose were evaluated as indices of pancreatic ß-cell function. RESULTS: In both groups, BMI, fasting insulin, homeostasis model assessment ratio and HDL cholesterol correlated significantly with all indices of pancreatic ß-cell function. Free triiodothyronine correlated positively with all insulin secretion indices in the prediabetes group. Multiple linear regression analysis showed that free triiodothyronine was an independent variable that had a positive correlation with all indices of ß-cell function in the prediabetes group. By contrast, no such correlation was found in the normal glucose tolerance group. CONCLUSIONS: Free triiodothyronine is associated with both basal and glucose-stimulated insulin secretion in people with prediabetes who are euthyroid; therefore, the regulation of insulin secretion by thyroid hormones is a potentially novel therapeutic target for the treatment of diabetes.

Regional cerebral blood flow changes in patients with idiopathic REM sleep behavior disorder.

BACKGROUND: Recent studies have shown an association between rapid eye movement sleep behavior disorder (RBD) and neurodegenerative disorders, especially alpha-synucleinopathies. OBJECTIVE: We investigated regional cerebral blood flow (rCBF) changes using single photon emission computed tomography (SPECT) in patients with idiopathic RBD (iRBD), to determine functional brain alterations associated with the disorder. METHODS: The SPECT data of 24 patients with iRBD were compared with those of 18 age-matched normal controls using statistical parametric mapping 2. RESULTS: We found decreased rCBF in the parietooccipital lobe (precuneus), limbic lobe, and cerebellar hemispheres in patients with iRBD, which is commonly seen in patients with Lewy body disease (Parkinson's disease and dementia with Lewy bodies) or multiple system atrophy. CONCLUSION: Our SPECT study suggests that iRBD can be a presymptomatic stage of alpha-synucleinopathies.

Association of life habits and fermented milk intake with stool frequency, defecatory symptoms and intestinal microbiota in healthy Japanese adults.

Few studies have examined the effects of smoking habit, the frequency of alcohol drinking, exercise, and fermented milk consumption on defecatory symptoms and gut microbiota composition, and particularly their interactive effects. We examined the effect of these lifestyle factors on bowel movements and gut microbiota composition in 366 healthy Japanese adults by analysis of covariance. Smoking did not affect defecatory symptoms but was negatively correlated with total bacteria and Enterococcus counts. Drinking frequency was significantly positively correlated with a feeling of incomplete evacuation and counts of the Bacteroides fragilis group and Acidaminococcus groups. Exercise frequency tended to be negatively correlated with the Bristol Stool Form Scale score and was significantly negatively correlated with the counts of Enterobacteriaceae and positively correlated with the Prevotella counts in the faeces. The frequency of fermented milk consumption was not significant but tended to be positively correlated with stool frequency. The frequency of fermented milk consumption was significantly positively correlated with the counts of the Atopobium cluster, Eubacterium cylindroides group, Acidaminococcus group, Clostridium ramosum subgroup, and Lactobacillus in the faeces. The frequency of consumption of probiotic Lactobacillus casei-containing fermented milk was significantly positively correlated with stool frequency. The counts of probiotic Lactobacillus casei in the stool was positively correlated with the counts of Bifidobacterium and total Lactobacillus. These results suggest that smoking, alcohol drinking, exercise, and consumption of fermented milk, particularly containing probiotic L. casei, differently affect bowel movements and gut microbiota composition in healthy Japanese adults.

The effects of aspirin on antioxidant defences of cultured rat gastric mucosal cells.

BACKGROUND: Helicobacter pylori-associated inflammation leads to exposure of the gastric epithelium to reactive oxygen species (ROS) generated in the gastric mucosa. In some pathological conditions, such as those induced by nonsteroidal anti-inflammatory drugs, the gastric mucosa may become more susceptible to ROS. AIM: To examine the effects of aspirin on antioxidant defenses as well as on oxidant injury in cultured rat gastric mucosal cells. METHODS: Primary monolayer cultures of rat gastric fundic mucosa were exposed to an ROS-generating system, hypoxanthine/xanthine oxidase (XOD). Cytotoxicity was quantified by measuring 51Cr release from prelabelled cells. The effects of aspirin on antioxidants and on cellular injury brought about by the ROS-generating system were determined. RESULTS: XOD, in the presence of hypoxanthine, caused a dose-dependent increase in specific 51Cr release, which corresponded to the ability of XOD to produce ROS (as assessed by the production of uric acid from hypoxanthine). Incubation of cells with aspirin (1-100 microM) produced a dose-dependent increase in XOD-induced 51Cr release. Aspirin did not affect cellular glutathione content or activity of glutathione peroxidase, glutathione reductase or endogenous catalase. By contrast, aspirin caused a dose-dependent reduction in mucus synthesis. as assessed by incorporation of [3H]-glucosamine hydrochloride into the cells. CONCLUSIONS: Aspirin at therapeutically relevant concentrations rendered cultured gastric cells more susceptible to subsequent exposure to ROS. Aspirin affected neither the glutathione redox cycle nor catalase activity. Thus, the enhancement of ROS-induced injury by aspirin may be accomplished through diminished gastric mucus synthesis, since mucus is a potent scavenger of ROS. These findings provide insight into how gastric inflammation and injury (such as that induced by H. pylori infection) in human gastric mucosa is modulated by the administration of nonsteroidal anti-inflammatory drugs.

Polaprezinc protects gastric mucosal cells from noxious agents through antioxidant properties in vitro.

BACKGROUND: Polaprezinc has been shown to exert an anti-oxidant property in a tube experiment, protect gastric mucosa from experimental ulcerations in vivo, and accelerate the healing of gastric ulcer in humans. AIM: To examine a possible protective effect of polaprezinc on oxidant-mediated injury in primary monolayer cultures of rat gastric fundic mucosa. METHODS: Cytotoxicity was quantified by measuring 51Cr release. Whether or not polaprezinc exerts an antioxidant property was investigated by determining the effect of this agent on hydrogen peroxide (H2O2)-induced injury. The effects of polaprezinc on superoxide (O2-. ) generation as well as on ethanol (EtOH)-induced injury were also examined. Generation of O2-. was assessed by the reduction in cytochrome c. RESULTS: H2O2 caused a time- and dose-dependent increase in 51Cr release. The dose-response curve of 51Cr release by H2O2 shifted to the right in the presence of polaprezinc. Polaprezinc, at submillimolar concentrations, prevented H2O2-induced 51Cr release. EtOH also caused a dose-dependent increase in 51Cr release, which was prevented by the addition of polaprezinc. The incubation of cells with EtOH caused an increase in cytochrome c reduction, as the concentrations of EtOH increased. Polaprezinc inhibited EtOH-induced cytochrome c reduction. Protection by polaprezinc was microscopically associated with the prevention of monolayer disruption. CONCLUSIONS: Polaprezinc is antioxidative and directly protects gastric mucosal cells from noxious agents through its antioxidant properties in vitro. This finding may provide the theoretical basis for the usage of an antiulcer drug with antioxidant properties for the treatment of gastric inflammation, such as that induced by ethanol.

Combination therapy with cisplatin, 5'-deoxy-5-fluorouridine (5'-DFUR) and mitomycin (MMC) in patients with inoperable, advanced gastric cancer.

The optimal dose of cisplatin (CDDP) for combination chemotherapy for the treatment of inoperable, advanced gastric cancer has yet to be established. We therefore performed a randomized study to compare the therapeutic usefulness of two dose levels of cisplatin. 5'-deoxy-5-fluorouridine (5'-DFUR 1,400 mg/m(2)/d) was given orally on days 1 to 4 and 15 to 18. Mitomycin C (MMC, 5.75 mg/m(2)/d) was injected intravenously on day 5. In addition, 80 mg/m2/d of CDDP (regimen A) or 60 mg/m(2)/d of CDDP (regimen B) was given by 2-h intravenous drip infusion on day 5. This treatment cycle was repeated every four weeks. Fifty-six patients were enrolled. Clinical response was evaluated in 32 patients (regimen A, 16 patients; regimen B? 16 patients) with measurable lesions. The response rate was significantly higher with regimen A (9 PR/16, 56.3%) than with regimen B (3 PR/16, 18.9%) (p=0.028, chi(2) test). Median survival was slightly but not significantly longer with regimen A (7.4 months) than with regimen B (6.3 months). Drug toxicity included myelosuppression and gastrointestinal symptoms, but there were no serious adverse reactions or differences in safety between the treatment regimens. Regimen A was associated with a high response rate and low toxicity. The optimal dose of CDDP in combination with 5'-DFUR and MMC for the treatment of advanced gastric cancer is regarded to be 80 mg/m(2).

Magnetic resonance imaging of human mandibular elevator muscles after repetitive maximal clenching exercise.

Exercise can enhance the signal intensity (SI) of skeletal limb muscles on T2-weighted magnetic resonance imaging (MRI). The purpose here was to evaluate the effects of repetitive maximal clenching exercises involving the mandibular elevator muscles with T2-weighted MRI. Seven normal volunteers were imaged before and immediately after performing repetitive maximal clenching and at 3, 6, 9, 12, 15, 20 min after the exercise in a 1.5 T GE magnet with spin-echo sequences. SI in the masseter, medial pterygoid and temporalis increased significantly (p < 0.001) and the cross-sectional area (CSA) of masseter increased 10.11% on T2-weighted MRI after exercise. The increased SI and CSA declined approximately to the pre-exercise level in about 20 min after exercise. No SI and CSA changes were found in the inactive neck muscle and no SI changes in the mandibular bone marrow (p > 0.05). The findings suggest that the use of exercise-enhanced MRI might be helpful in the study of the function and dysfunction of muscles in the orofacial region.

A unique case of desmoplastic ameloblastoma of the mandible: report of a case and brief review of the English language literature.

A unique case of desmoplastic ameloblastoma is reported from the clinical, radiographic, and histologic viewpoints. The patient was a 56-year-old man who complained of a painless swelling on the buccal aspect of the left mandible. Periapical and panoramic radiographs revealed a rounded, slightly radiolucent area with blurred osteosclerotic margins. Occlusal radiograph and computed tomography images disclosed buccal bone expansion outlined by thinned cortices. Computed tomography images exhibited an enhanced area in the anterior portion of the lesion. Interestingly, the coronal computed tomography images revealed a close relationship between the periodontal membrane of the left mandibular second premolar and the enhanced area. Biopsy specimens from the anterior portion of the lesion displayed typical histologic features of the desmoplastic variant of ameloblastoma. However, those from the posterior portion disclosed a large cystic formation. Oxytalan fibers were identified in the stromal tissue of the tumor, which suggested that the tumor arose from the epithelial rests of Malassez in the periodontal membrane of the related tooth. We also reviewed previously reported 41 cases. In 36 of 38 cases in which the location was specified, the tumor was found in the anterior to premolar region of the maxilla or mandible. A radiographic description was given in only 29 previous cases, 28 of which involved multilocular lesions. No cyst as large as the one in the present case was found among the previously reported desmoplastic ameloblastomas. Although the present case deviates from the usual desmoplastic variant of ameloblastoma in terms of locus, radiologic appearance, and cyst formation, it still meets the histologic criteria for this variant in both the stromal and epithelial components.

[Treatment and etiology of spontaneous hemopneumothorax].

The incidence of spontaneous hemopneumothorax is reported to be 1-12% of all cases of spontaneous pneumothorax. We treated 152 cases of spontaneous pneumothorax in the past 8 years and hemopneumothorax occurred in 4 cases which is 2.6% of all cases of spontaneous pneumothorax. All the patients were male and the age ranged from 17 to 30. The total amount of blood loss ranged from 1,200-3,200 mliters and surgical treatment was carried out within 2 days after admission. The bleeding point was visceral pleura of raptured bulla in 2 cases, parietal pleura of the torn adhesion in 1 case, and both visceral and parietal pleura in 1 case. Postoperative course was satisfactory and discharged within 2 weeks after admission in all cases. The authors concluded that early thoracotomy is recommended for spontaneous hemopneumothorax.

[Mediastinal lymph-node carcinoma with no apparent primary lesion].

To determine the clinical characteristics of cases of hilar or mediastinal lymph-node cancer in which the primary lesion was not found; reports of 36 such cases were identified. The patients in those cases comprised 29 men and 7 women, whose average age was 58.4 years. The malignancies were found in hilar lymph nodes in 15 patients, mediastinal lymph nodes in 16, and both hilar and mediastinal lymph nodes in 4; 14 were adenocarcinomas, 4 were squamous-cell carcinomas, and 4 were small-cell carcinomas. The average length of cancer-free survival after surgery was 28.9 months, and the maximum was 9 years. After the affected hilar and mediastinal lymph nodes had been resected the clinical appearance of these patients was the same as if the primary tumor had been removed. We therefore believe that many patients given a diagnosis of cancer with metastases to hilar or mediastinaly lymph nodes and in whom the primary tumor cannot be located in fact have primary cancer of the lymph nodes, and that this condition should be called "primary mediastinal lymph-node carcinoma".

[A case report of thoracic foreign body resembling fungus ball on chest X-P].

A case of a foreign body tumor resembling fungus ball pre-operatively diagnosed by bronchofiberscopic examination is reported. A 54-year-old male was referred with a complaint of fever. Chest X-ray and tomography showed a mass shadow with meniscus sign resembling fungus ball in the right lower lung field. Trans-bronchial lung biopsy revealed sulfur-granule of actinomycosis. In spite of local injection of sensitive antibiotics (ABPC) once a week for two months the mass shadow remained unchanged on X-ray. Bronchofiberscopic examination was performed again and a small piece of fibrous substance was obtained, which had been left in previous operation done 17 years before. Re-thoracotomy assured that the mass was a foreign body tumor caused by a gauze.

[Treatment of thoracic malignancy accompanied with cardiovascular disease].

We treated 10 cases of thoracic malignancy accompanied with cardiovascular disease. Among thoracic malignancy, 7 cases were lung cancer and 3 were esophageal cancer. Accompanied cardiovascular diseases were ischemic heart disease (2 cases), valvular disease (3 cases), WPW syndrome (1 case), aortic aneurysm (4 cases). The mean age was 66, ranged from 51 to 79. The simultaneous occurrence of the two lesions were observed in 6 cases and thoracic malignancy was diagnosed after a varying interval of time following surgery of cardiovascular disease in 4 cases. In cases of thoracic malignancy accompanied with heart disease, the treatment of heart disease should precede the operation of malignant disease to reduce the risk of surgery. For the patient with esophageal cancer, posterior mediastinal esophagostomy should be applied who may have heart surgery in future. In cases of coexisting malignancy and aortic aneurysm, the priority of treatment should be determined considering the size of aneurysm. If the transverse diameter of aneurysm is larger than 7 cm, there is a high risk of rupture, so surgery for the aneurysm precedes operation of malignant diseases. It is desirable to avoid concomitant operation of malignancy and cardiovascular disease.

[Management of pain after thoracotomy: experience of intercostal nerve block with alcohol during operation].

Post-thoracotomy wound pain in 11 patients who underwent thoracic operation was controlled by intercostal nerve block with alcohol and thoracic epidural anesthesia. The intercostal nerve block was performed just before the closure of the thoracotomy wound. Epidural anesthesia was employed from the 1st to 5th post operative day. This method alleviated post-thoracotomy pain and obviated postoperative pulmonary complication in all patients in early post operative periods. In late post operative periods after discharge, intercostal nerve block could maintain excellent analgesia in 9 of 11 patients, only 2 patients required analgesic drugs or re-block of the intercostal nerve. Thus, intercostal nerve block with alcohol is an effective and simple option to control recalcitrant post-thoracotomy wound pain in thoracic surgery.

[Surgical treatment of metastatic lung cancer arising from the colon and rectum].

Ten cases of surgically resected pulmonary metastases arising from colorectal cancer were analyzed. Five year survival rate of these patients was 14%. Only one patient survived more than five years, whose primary and metastatic lesions were not so progressive without lymph node metastasis. The rate of regional lymph node metastasis was 25% and the patients with positive nodes died or had recurrence within 2 years. Serum CEA level was useful as a tumor marker and high-level of serum CEA after operation suggested remnant disease.

[The treatment of traumatic chylothorax].

Traumatic chylothorax is classified as follows; postoperative and nonsurgical. We have encountered 5 cases of traumatic chylothorax, 2 after resection of lung cancer, 2 after repair of congenital heart disease and 1 after blunt chest injury. The incidence of this complication was 0.2% after surgery for cardiovascular diseases, and 0.6% for lung cancer in our institute. We carried out operation two cases successfully, one after resection for lung cancer and the other for Tetralogy of Fallot. The treatment should be determined according to the condition of the underlying diseases. We choose conservative therapy at first which is generally recommended. When chylous discharge continues, conservative therapy should be carried out when new operative skin incision is necessary for the treatment of chylothorax. Operative therapy is desirable in cases with pulmonary resection which makes dead space in pleural cavity.

[UFTPM (UFT + CDDP + MMC) therapy for progressive stomach cancer. Research Association of Progressive Stomach Cancer].

We organized a cooperative research group consisting of 10 institutions and UFTPM therapy was given patients with unresectable and postoperatively relapsed stomach cancer. As the result, 20 cases were registered and the ratio of PR according to the criteria of stomach cancer chemotherapy was 4 out of 17 complete cases (23.5%), excluding 3 incomplete cases. The efficacy for the cases treated with more than 2 courses was 36.4% (4/11) and that for cases with 3 courses was 75% (3/4). One case with 3 courses was resectable and the cancer cells disappeared. Adverse effects of grade 3 or more according to the WHO criteria were observed in 20% of the cases.

[Combination chemotherapy with tegafur-uracil (UFT) and cisplatin (CDDP) for advanced gastric cancer. UFTP Study Group].

An early phase II study of tegafur-uracil (UFT) combined with cisplatin (CDDP) was conducted in patients with advanced gastric cancer. UFT was administered orally for 28 consecutive days at a dose of 400 mg/m2 and CDDP was injected intravenously for 3 day at a dose of 30 mg/m2 over 8 hours every 4 weeks. This treatment cycle was repeated every 4 weeks. Sixteen patients were enrolled in this study and 14 patients could be evaluated for clinical response and toxicity. Based on the results of extramural review, 6 of 14 patients achieved a partial response and the response rate was 42.9%. High grade toxicities (WHO grade 3 or 4), specifically anorexia, nausea and vomiting, diarrhea, and leukocytopenia, were seen in 5, 2, 3 and 2 patients, respectively. The overall median survival time was 347 days (11.4 months) for evaluated patients. Although these results are preliminary, this regimen does appear to be effective in terms of tumor response and survival. Larger patient numbers in a Phase II study and further studies to evaluate survival are awaited.

[UFT + MMC and UFT + ACNU therapy in advanced gastric cancer].

The effects of UFT + MMC and UFT + ACNU therapy on advanced gastric cancer were compared by randomized controlled trial in 12 institutions. Unresectable and postoperatively recurrent patients were divided into PS 0-2 and 3-4 groups. After classification according to cancer spread, such as localized type, hepatic metastatic type, ascitic type and distant metastatic type, regimens of (A) UFT 375 mg/m2/day + MMC 5 mg/m2 for 1-2 W or (B) UFT + ACNU 60 mg/m2/W/x2 (with a 4-week interval) were administered for as long as possible. As a result, among a total of 104 cases, responses were recognized in 7 out of 32 cases (21.9%) treated with regimen A and in 5 out of 25 cases (20.0%) treated with regimen B, giving a total of 57 evaluable cases excluding 33 incompletely evaluated cases and 14 ineligible cases. This study therefore demonstrated no significant difference between the two regimens. The median survival of patients treated with regimen A was 120 days, and that of patients treated with regimen B, 155 days. There was no significant difference between the two regimens. As side effects, UGI symptoms were recognized in 35.4% of regimen A patients and in 37.1% of regimen B patients. Bone marrow suppression appeared in 39.6% of regimen A patients and in 54.3% of regimen B patients.