[Feasibility study of locomotion training in a home-visit preventive care program].

AIM: To evaluate the feasibility of locomotion training (single-leg standing and squats) in a home-visit preventive care program for the elderly. METHODS: We invited 246 people who were not attending any preventive care programs within the long-term care insurance system. Among these, 60 participated in the current program. We administered a hearing survey, measured the single-leg stance time with eyes open, and subjects underwent locomotion training. Each participant was asked to repeat 1 set of training exercises 3 times per day at home. One set consists of standing on each leg for 1 minute and squatting 5 to 6 times. We telephoned the participants regularly during the 3 month program (locomo call). At the end of the program, we visited the participants and measured the single-leg stance time with eyes open. RESULTS: A total of 60 elderly adults participated in the program (15 men, 45 women). Among subjects secondary prevention of musculoskeletal (n=313), 67 were participating in site-visit preventive care programs conducted by the local authorities (21.4%). Among these 313, 127 were participating in site-visit preventive care programs or locomotion training (40.6%). It shows the increasing of the participation rate 21.4% to 40.6%. The continuance rate was 91.7%. The single-leg stance time improved for both men (16.2±17.7 sec, p<0.05) and women (57.2±79.7 sec, p<0.01) compared to the baseline. Similarly, improvement was observed in the single-leg stance time for both the young-old (62.2±67.9 sec, p<0.01) and the old-old (39.2±73.8 sec, p<0.01). CONCLUSIONS: We consider that the locomotion training program which we introduced in the current home-visit preventive care program was effective and highly feasible for the elderly who have not previously responded conventional site-visit preventive care programs.

A novel protein found in the I bands of myofibrils is produced by alternative splicing of the DLST gene.

BACKGROUND: It is not known if the dihydrolipoamide succinyltransferase (DLST) gene, a mitochondrial protein, undergoes alternative splicing. We identified an uncharacterized protein reacting with an anti-DLST antibody in the I bands of myofibrils in rat skeletal muscle. METHODS: Immunocytochemical staining with an anti-DLST antibody, the purification and amino acid sequence analysis of the protein, and the isolation and sequencing of the protein's cDNA were carried out to clarify the properties of the protein and its relationship to the DLST gene. RESULTS: A pyrophosphate concentration >10 mM was necessary to extract the protein from myofibrils in the presence of salt with a higher concentration than 0.6 M, at an alkaline pH of 7.5-8.0. The protein corresponded to the amino acid sequence of the C-terminal side of DLST. The cDNAs for this protein were splicing variants of the DLST gene, with deletions of both exons 2 and 3, or only exon 2 or 3. These variants possessed an open reading frame from an initiation codon in exon 8 of the DLST gene to a termination codon in exon 15, generating a protein with a molecular weight of 30 kDa. CONCLUSIONS: The DLST gene undergoes alternative splicing, generating the protein isolated from the I bands of myofibrils. GENERAL SIGNIFICANCE: The DLST gene produces two different proteins with quite different functions via alternative splicing.

Histopathological characteristics of luteal hypertrophy induced by ethylene glycol monomethyl ether with a comparison to normal luteal morphology in rats.

Ethylene glycol monomethyl ether (EGME) is a known reproductive toxicant that induces luteal hypertrophy in rat ovaries. In this study, we characterized the histopathological features of corpora lutea (CL) from EGME-treated rats and compared them with normal CL formation and regression. Normally cycling female Sprague-Dawley rats were treated with 5-bromo-2'-deoxyuridine (BrdU) intraperitoneally on the morning of estrus and their ovaries were examined 1 (metestrus), 4 (estrus), 8 (estrus), or 12 (estrus) days later to observe the transition of BrdU-labeled cells within in the CL. CL at each time point of estrus stage were classified into 4 types: Type I (newly formed CL), Type II (mature CL), Type III (regressing CL), and Type IV (residual CL). CL almost fully regressed within 4 estrus cycles. In contrast, in female rats given EGME orally (30, 100, or 300 mg/kg for 2 or 4 weeks), luteal cells were hypertrophic with abundant cytoplasm. Although the size of CL varied, all CL in EGME-treated rats had histological features similar to Type II CL, but they were more hypertrophic with less apoptosis. These results suggest that EGME has a luteal hypertrophic effect on all CL phases, including regression.

Hydrogen peroxide mobilizes Ca2+ through two distinct mechanisms in rat hepatocytes.

AIM: Hydrogen peroxide (H2O2) is produced during liver transplantation. Ischemia/reperfusion induces oxidation and causes intracellular Ca2+ overload, which harms liver cells. Our goal was to determine the precise mechanisms of these processes. METHODS: Hepatocytes were extracted from rats. Intracellular Ca2+ concentrations ([Ca2+](i)), inner mitochondrial membrane potentials and NAD(P)H levels were measured using fluorescence imaging. Phospholipase C (PLC) activity was detected using exogenous PIP2. ATP concentrations were measured using the luciferin-luciferase method. Patch-clamp recordings were performed to evaluate membrane currents. RESULTS: H2O2 increased intracellular Ca2+ concentrations ([Ca2+](i)) across two kinetic phases. A low concentration (400 micromol/L) of H2O2 induced a sustained elevation of [Ca2+](i) that was reversed by removing extracellular Ca2+. H2O2 increased membrane currents consistent with intracellular ATP concentrations. The non-selective ATP-sensitive cation channel blocker amiloride inhibited H2O2-induced membrane current increases and [Ca2+](i) elevation. A high concentration (1 mmol/L)of H2O2 induced an additional transient elevation of [Ca2+](i), which was abolished by the specific PLC blocker U73122 but was not eliminated by removal of extracellular Ca2+. PLC activity was increased by 1 mmol/L H2O2 but not by 400 micromol/L H2O2. CONCLUSIONS: H2O2 mobilizes Ca2+ through two distinct mechanisms. In one, 400 micromol/L H2O2-induced sustained [Ca2+](i) elevation is mediated via a Ca2+ influx mechanism, under which H2O2 impairs mitochondrial function via oxidative stress,reduces intracellular ATP production, and in turn opens ATP-sensitive, non-specific cation channels, leading to Ca2+ influx.In contrast, 1 mmol/L H2O2-induced transient elevation of [Ca2+](i) is mediated via activation of the PLC signaling pathway and subsequently, by mobilization of Ca2+ from intracellular Ca2+ stores.

[Health practice and total mortality among middle-aged and elderly residents in Sukagawa, Japan].

PURPOSE: The present study aimed to clarify the relationship of total mortality with the HPI (health practices index: the additive index of five health practices) and lifestyle among elderly residents in a Japanese cohort. METHODS: A population-based prospective study was conducted in Sukagawa City of Fukushima Prefecture, Japan. Self-administered questionnaires were distributed and collected via mail. One-third of the city residents aged 40-69 years and over 70 years were randomly selected. Baseline surveys were conducted in February 2001 for the '40-69 cohort' and in July for the 'over 70 cohort'. Among 8746 subjects in the '40-69 cohort' and 2718 in the 'over 70 cohort', 5,657 (64.7%) and 2,019 (74.3%) responded, respectively. The questionnaires consisted of items on 'Alameda seven health practices' (weight, sleeping, smoking, drinking, breakfast, exercise, snacking), medical history, perceived health status, and home bound status of the 'over 70 aged cohort'. We followed the younger cohort for 3 years and 7 months and the elderly cohort for 3 years and 3 months until the end of October 2004, and checked their survival status using a municipal resident registry. Analysis of factors associated with total mortality one year after the baseline survey employed a simple chi2 test, Kaplan-Meier survival analysis, and the Cox proportional-hazards model to compute relative risks (RRs). The HPI was the additive index of five health practices: weight, sleeping, smoking, drinking, exercise. RESULTS: 1. No significant association was observed between lifestyle and total mortality in the '40-69 cohort'. However, there were significant links between total mortality in the 'over 70 cohort' and HPI and exercise. 2. The Kaplan-Meier curves for the 'over 70 cohort' showed higher survival for the group with higher HPI scores. Again, results of the Cox proportional-hazards model showed no factor significantly associated with the total mortality of the '40-69 cohort'. For the 'over 70 cohort', HPI, age, sex, subjective health and housebound status were associated. Medical history did not show any significant influence. For each of 'the Alameda 7 health practices', exercise was associated with all-cause mortality. CONCLUSION: 1. Maintaining good health practices improves life prognosis of the elderly. 2. The HPI is an useful indicator of life prognosis. 3. Promotion of exercise and prevention of becoming housebound are important for improving life prognosis.

Pertussis toxin-sensitive pathway inhibits glucose-stimulated Ca2+ signals of rat islet beta-cells by affecting L-type Ca2+ channels and voltage-dependent K+ channels.

A role of pertussis toxin (PTX)-sensitive pathway in regulation of glucose-stimulated Ca2+ signaling in rat islet beta-cells was investigated by using clonidine as a selective agonist to alpha2-adrenoceptors which link to the pathway. An elevation of extracellular glucose concentration from 5.5 to 22.2 mM (glucose stimulation) increased the levels of [Ca2+]i of beta-cells, and clonidine reversibly reduced the elevated levels of [Ca2+]i. This clonidine effect was antagonized by yohimbine, and abolished in beta-cells pre-treated with PTX. Clonidine showed little effect on membrane currents including those through ATP-sensitive K+ channels induced by voltage ramps from -90 to -50 mV. Clonidine showed little effect on the magnitude of whole-cell currents through L-type Ca2+ channels (ICa(L)), but increased the inactivation process of the currents. Clonidine increased the magnitude of the voltage-dependent K+ currents (IVK). These clonidine effects on ICa(L) and IVK were abolished in beta-cells treated with PTX or GDP-betaS. These results suggest that the PTX-sensitive pathway increases IVK activity and decreases ICa(L) activity of islet beta-cells, resulting in a decrease in the levels of [Ca2+]i elevated by depolarization-induced Ca2+ entry. This mechanism seems responsible at least in part for well-known inhibitory action of PTX-sensitive pathway on glucose-stimulated insulin secretion from islet beta-cells.

Intracellular Ca(2+) modulation of ATP-sensitive K(+) channel activity in acetylcholine-induced activation of rat pancreatic beta-cells.

We investigated the mechanism by which acetylcholine (ACh) regulates insulin secretion from rat pancreatic beta-cells. In an extracellular solution with 5.5 mM glucose, ACh increased the rate of insulin secretion from rat islets. In islets treated with bisindolylmaleimide (BIM), a PKC inhibitor, ACh still increased insulin secretion, but the increment was lower than that without BIM. In the presence of nifedipine, an L-type Ca(2+) channel blocker, on the other hand, ACh did not increase insulin secretion. In isolated rat pancreatic beta-cells, ACh caused depolarization followed by action potentials. This ACh effect was observed even in cells treated with BIM. In the presence of nifedipine, ACh caused only depolarization. These ACh effects were prevented by atropine. In the perforated whole-cell configuration, ramp pulses from -90 to -50 mV induced membrane currents mostly through ATP-sensitive K(+) channels (K(ATP)). These currents were reduced in size by ACh in cells either treated or untreated with BIM; whereas the loading of cells with U-73122 (a phospholipase C inhibitor) or BAPTA/AM (a Ca(2+) chelator) abolished the ACh effect. In the standard whole-cell configuration, ACh reduced the currents through K(ATP) with 0.5 mM EGTA, but not with 10 mM EGTA, in the pipette solution. Intracellular application of GDPbetaS or heparin also inhibited the ACh effect. In the inside-out single-channel recordings, elevation of the Ca(2+) concentration inside the membrane from 10 nM-10 microM decreased K(ATP) activity only in the presence of ATP. The affinity of ATP to K(ATP) became 4.5 times higher with the higher concentration of Ca(2+). These results suggest that Ca(2+) from ACh receptor signaling modulates the sensitivity of K(ATP) to ATP. A positive-feedback mechanism of intracellular Ca(2+)-dependent Ca(2+) influx was also demonstrated.

Isolation and sequence analysis of the rat dihydrolipoamide succinyltransferase gene.

The dihydrolipoamide succinyltransferase (DLST) gene of the alpha-ketoglutarate dehydrogenase complex (alpha-KGDC) was isolated from a rat genomic DNA library and sequenced. This gene was composed of 15 exons and 14 introns like the human DLST gene. Sequence analysis of the promoter-regulatory region of the rat DLST gene-(Dlst) showed the possible presence of a CAAT box-sequence and of the sequences for an AP-2 site and three Sp1 sites, but no TATA box-sequence was evidenced. The nucleotide sequences of introns 1 and 4 of the rat Dlst were significantly homologous to those of introns 1 and 4 of the human DLST gene. The sequence analysis of the rat Dlst suggested that the exon coding for the E3- and/or E1-binding domain may have been lost from the gene during evolution in eukaryotic DLST, possibly after mitochondrial symbiosis because prokaryotic DLST possesses the E3- and/or E1-binding domain.

[A survey of infection control among community home care service providers].

PURPOSE: This study aimed to explore the current situation of infection control by community home care providers. METHODS: We investigated an area managed by one of 6 municipal social welfare offices in Fukushima. Two questionnaires were sent to all home care agencies providing home help services, visiting bathing care and visit-nursing: one to the 82 chiefs of the agencies (response rate of 90.2%) and the other to 1024 health care workers working for them (57.2%). The questionnaire covered health checkups of employees, maintenance and management of devices, infection control education and manuals, and hand hygiene. RESULTS: 1. Medical checkups were organized once a year or more at 94.6% of the agencies and employee participation of once a year or more was 87.6%. 2. Regarding the management of health care devices, personnel were assigned and a registration system was introduced at 43.2% and 20.8% of the agencies, respectively. Most agencies (94.6%) provided disposable gloves and 82.6% of the employees used them when handling body fluids or excretions. However, not many agencies provided hand-washing equipment (43.2%) and paper towels (39.2%). 3. Infection control educational programs were organized at 40.3% of the agencies and attended by 30.2% of the employees. Among the agencies without such programs, 76.2% gave employees' time constraint as a reason for not giving training. On the other hand, 78.5% of non-attendants of the program answered that they were not given a chance to participate. 4. Infection control manuals were available at 68.9% of the agencies, but only 69.4% of their employees were aware of them and only 44.3% utilized them. Agencies were aware of the situation and only 42.9% answered that their manuals were fully utilized. Among the agencies currently without manuals, 47.8% are developing manuals. 5. When and how to wash hands and how to use towels in home care settings were specified in 73.0%, 78.4% and 35.1% of the agencies, respectively. As high as 92.0% of employees washed their hands after caring for clients and 74.6% after handling body fluids or excretions, but 52.2% did so before caring. It was noted that although 82.7% of the employees washed their hands with water and soap (and antiseptic agents), only 7.5% used paper towels to dry their hands. CONCLUSION: The chiefs of home care providers should be required to develop and implement better infection control strategies with the support of local governmental agencies.

[Relationships between participation of national-health-insurance members in a health education program and exercise habits, medical expenses and other related parameters].

PURPOSE: This study was conducted with the aim of multi-faceted evaluation of a health education program, "Genki-jaya", run at Fukushima City Health and Welfare Center. METHODS: "Genki-jaya" is a health education program including individual health instructions combined with group education on exercises as well as diet. A total of 55 participants completed the program through December 1999 to March 2001. Twenty-six were under the medical care covered by national-health-insurance when the program started, and 19 of these, whose medical expenses for one month prior to the program were zero, were studied. The program was evaluated using the following: 1. Results of questionnaire surveys to examine self-care ability and perceived health conducted at the end of the program and three months after it finished. 2. Physical measurement items (blood pressure, weight, body fat rate, and BMI) and physical fitness items (maximum-oxygen-uptake, muscle-strength of legs, etc.) at the start of, and three months after the program. 3. Change in the total medical expenses between one year prior to and after the program, and its relationship with physical measurements and satisfaction with the program. Comparison of the mean three-month medical expenses before, during, and after the program. Comparison of medical expenses three months before, at the beginning and end of, and three months after the program. 4. Follow-up of continuous activities among graduates of the program. RESULTS: 1. Regarding self-care ability, dietary habits, and exercise habits, these continued to improve after the program and all participants were satisfied. Regarding perceived health, subjective symptoms improved. 2. Physical measurements improved through the program. Both mean diastolic pressure and body fat rate at the end of the program were significantly lower than at the beginning. Moreover, mean systolic and diastolic pressures significantly decreased from the end of the program through three months thereafter. 3. The medical expenses before and after the program did not change significantly, and differences did not correlate with physical measurements and satisfaction with the program. 4. Three self-supporting associations among the graduates had been organized to continue instructed exercises were active at the end of March 2001. CONCLUSION: Although Genki-jaya had no significant impact on medical expenses, improvement in self-care ability, perceived health, physical measurements and formation self-supporting associations was observed. Multi-faceted evaluation of the program will now be continued to examine larger numbers of newly enrolled trainees for a longer period of time.

Prevalence of Social Isolation in Community-Dwelling Elderly by Differences in Household Composition and Related Factors: From a Social Network Perspective in Urban Japan.

OBJECTIVE: The aim of this study was to measure the prevalence of social isolation in community-dwelling elderly and related factors based on household composition differences. METHOD: We used the six-item Lubben Social Network Scale to measure social isolation in 2,000 individuals. Multiple logistic regression analysis was performed to examine factors related to social isolation with household composition after adjusting for gender and age. RESULTS: The prevalence of social isolation was 31.0% for elderly living alone and 24.1% for those living with family. For both, poor mental health and lack of social support from nonfamily members were associated with social isolation risk. For elderly living with family, low intellectual activities and poor health practice were associated with social isolation risk. DISCUSSION: This study showed high prevalence of social isolation. For prevention, promoting mental health and encouraging them to make friends may be important. For elderly living with family, promoting intellectual activities and good health practice is recommended.

Pregnancy and birth survey after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant accident in Fukushima prefecture.

BACKGROUND: On 11 March 2011, the Great East Japan Earthquake followed by a powerful tsunami hit the Pacific Coast of Northeast Japan and damaged Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant, causing a radiation hazard in Fukushima Prefecture. The objective of this report is to describe some results of a questionnaire-based pregnancy and birth survey conducted by the Radiation Medical Science Center for the Fukushima Health Management Survey. MATERIALS AND METHODS: Questionnaires were sent to women who received maternal and child health handbooks from municipal officers in Fukushima Prefecture between 1 August 2010 and 31 July 2011, with the aim of reaching those who were pregnant at the time of the disaster. Mailing began 18 January 2012. Data were analyzed separately for six geographic areas in Fukushima Prefecture. RESULTS: The total number of women meeting survey criteria was 15,972. The number of responses received to date is 9,298 (58.2%). Data from 8602 respondents were analyzed after excluding 634 invalid responses and 5 induced and 57 spontaneous abortions (less than 22 gestational weeks). The incidences of stillbirth (over 22 completed gestational weeks), preterm birth, low birth weight and congenital anomalies were 0.25%, 4.4%, 8.7% and 2.72%, respectively. These incidences are similar to recent averages elsewhere in Japan. CONCLUSION: Considering the pregnancy and birth survey data in aggregate, our disaster seemed to provoke no significant adverse outcomes over the whole of Fukushima prefecture. But post-disaster prenatal care and support intended for patients' safety and security should be coupled with ongoing surveillance and rigorous data analysis.

Community-based exercise program reduces chronic knee pain in elderly Japanese women at high risk of requiring long-term care: a non-randomized controlled trial.

AIM: To estimate the prevalence of low back pain and/or knee pain among the elderly at high risk of requiring long-term care, and to determine the effectiveness of a community-based exercise program provided in accordance with the Motor Function Improvement Program for improving low back and/or knee pain. METHODS: The target population of this study was 320 residents aged ≥65 years who were eligible for the exercise program. For the intervention group, weekly exercise classes of 120 min duration were held 12 times over 3 months. The main outcome measures were changes between the baseline and 3-month follow up in visual analog scale (VAS) scores for pain and in the Western Ontario McMaster Osteoarthritis Index (WOMAC) pain for severity of knee pain. RESULTS: The number of participants reporting chronic low back and/or knee pain was 252 with a prevalence of 78.8%. Among them, 68 who were allocated to the intervention group and 125 to the control group completed the study, and were stratified by sex. In women, change in the VAS scores of low back pain was -17.5±23.2 for the intervention group and -7.2±23.4 for the control group (between-group differences P=0.03). For knee pain, significant changes in the VAS scores (between-group differences P=0.04) and WOMAC pain (P<0.001) were observed; -14.9±24.9 and -0.6±3.1 for the intervention group, and -0.2±28.5 and 2.2±3.2 for the control group, respectively. No significant difference was observed in men. CONCLUSION: Community-based exercise programs might reduce prevalent knee pain in elderly women at high risk of requiring long-term care.

Hypoallergenicity of various miso pastes manufactured in Japan.

Miso paste (miso), a fermented soybean food, is popular in Japan and other Asian countries. However, the soybean is known to induce an allergenic response in some individuals. In the present study, we evaluated the allergenicity of various kinds of miso available in Japan. Total proteins were extracted from Amakuti-kome miso, Karakuti-kome miso, Mugi-miso and Mame-miso, and the protein profiles were analyzed. The major protein bands detected in the intact soybean extract were not present in any of the miso samples, which instead showed various low molecular weight protein bands of approximately 10-25 kDa. The existence levels of six major soybean allergens were determined by Western blotting using specific antibodies. We found that the allergen levels varied among miso and allergen types; however, allergen levels were consistently lower in miso than in the soybean extract. We obtained similar results for IgE-ELISA experiments using serum IgE from soybean allergy patients. Taken together, these results indicate that compared to soybean extract, various types of miso contain small quantities of intact soybean allergens. Additionally, several lines of evidence indicated that the allergen levels were exceptionally low in the dark-colored Karakuti-kome miso and Mame-miso, which are produced with relatively long fermentation periods, suggesting that the duration of fermentation might be a key factor in the hypoallergenicity of miso.

Prediction of functional disability by depressive state among community-dwelling elderly in Japan: a prospective cohort study.

AIM: We carried out a prospective cohort study to evaluate the risk factors of functional disability by depressive state. METHODS: A total of 783 men and women, aged 70 years and over, participated in this study. We followed the participants in terms of the onset of functional disability by using a public long-term care insurance database. The Geriatric Depression Scale (GDS) was used to measure depressive state. Age, sex, history of chronic disease, living alone, fall experience, cognitive impairment, instrumental activities of daily living (IADL), the Motor Fitness Scale (MFS), frequency of going out and social support at baseline were used as the main covariates. The Cox regression analysis was used to examine the difference in functional disability stratified according to depressive state. RESULTS: The incidence of functional disability was 38 persons in the non-depression group and 42 persons in the depression group (RR 2.34; 95% CI 1.46-3.79). The results of the depression group showed a significant difference in cognitive impairment (HR 3.51; 95% CI 1.39-8.85), MFS (HR 5.60; 95% CI 1.32-23.81) and IADL (HR 3.37; 95% CI 1.65-6.85). The results of the non-depression group showed a significant difference in MFS (HR 2.97; 95% CI 1.47-6.96), and frequency of going out (HR 3.21; 95% CI 1.47-6.96). CONCLUSIONS: In conclusion, risk factors for functional disability were found to differ on the basis of whether or not community-dwelling elderly individuals experience depressive state. The type of support offered must be based on whether or not depressive state is present.

Spontaneous gingivitis related to hair penetration in rats.

Maxillary gingivae from male and female Crl:CD(SD) rats at 12, 16, 21, and 34 weeks of age were examined histologically. The incidence of gingivitis was approximately 40%, with no age or sex predilection, and was most frequent between the first and second molar. Lesions were characterized by acute focal neutrophilic infiltration into the gingival mucosa, occasionally with inflammatory exudate. In severe cases, inflammation extended to the periodontal ligament with abscess formation, and adjacent alveolar bone destruction/resorption. The most characteristic finding was the presence of hair shafts associated with the lesion, which was observed in approximately 80% of the rats with gingivitis. These findings suggest that molar gingivitis occurs in rats from an early age and persists thereafter, and that the main cause of gingivitis in rats is hair penetration into the gingiva. It would be prudent to keep these background lesions in mind as potential modifiers in toxicity studies.

Proteomic analysis for neuronal vacuolation induced by MK-801 in rat retrosplenial cortex.

Proteomic analysis was carried out for neuronal vacuolation in rat retrosplenial cortex (RSC) induced by MK-801, a N-methyl-D-aspartate (NMDA) receptor antagonist. Female rats were given a single subcutaneous (sc) injection of either MK-801 (9 mg/kg in saline) or saline. Comparison of changes in proteins in the RSC region between MK-801- and saline-treated groups revealed that MK-801 induced changes in six proteins involved in vesicular transport (vesicle-fusing ATPase) and glycolysis (fructose-bisphosphate aldolase C, triosephosphate isomerase, and glyceraldehyde-3-phosphate dehydrogenase).

Development of a simplified Short-Term Memory recall Test (STMT) and its clinical evaluation.

BACKGROUND AND AIMS: The early detection and prevention of dementia is attracting attention. We therefore developed an easily performed protocol to identify patients with memory impairment which may progress to dementia, and evaluated its validity. METHODS: We focused on short-term memory impairment alone, and named the test, consisting of 3 tasks, the simplified Short-Term Memory recall Test (STMT; with a maximum score of 8). Patients were classified into a memory impairment group of 26 subjects and a control group of 23 subjects. At the first examination, subjects underwent the STMT, MMSE and ADAS-Jcog. as cognitive function tests. Follow-up observations were performed for 2 years at 6-month intervals. RESULTS: There were significant differences in the mean scores for all tests, except for MMSE memory items between the 2 groups. When the cut-off value of STMT was established as 4 points, and scores lower than this value were defined as memory impairment, the sensitivity and specificity were highest, 73.1% and 82.6%, respectively. Sensitivity and specificity also rose to 92.3% and 95.7%, respectively, when STMT scores were added together with those of ADAS-Jcog. Results of logistic regression analysis indicated that development into Alzheimer's disease 2 years later was significantly correlated with STMT scores at first examination. The incidence of progression to Alzheimer's disease in patients with scores < or =4 (cut-off value) was about 5 times higher than that of patients with scores > or =5. CONCLUSIONS: This study suggests the usefulness of the STMT for identifying memory impairment as a pre-dementia state.

Central tegmental tract lesion in a girl with holoprosencephaly presenting with West syndrome.

We described a 16-month-old female patient who developed West syndrome at 3 months of age. MRI revealed a holoprosencephaly with incomplete fusion of the cerebrum, associated with central tegmental tract (CTT) lesions. At 1 year of age, the CTT lesion was still present on T2-weighted MRI. The CTT represents an important projection pathway of the extrapyramidal tract and the CTT lesions have rarely been reported using MRI in patients with neonatal hypoxic-ischemic encephalopathy and several inborn errors of metabolism. Although the exact mechanism remains obscure, we suggest that disturbances in midbrain fibers that connect to the basal ganglia, may have contributed to the etiology of West syndrome in this patient.