Correlation between aquaporin and water permeability in response to vasotocin, hydrin and {beta}-adrenergic effectors in the ventral pelvic skin of the tree frog Hyla japonica.

The ventral pelvic skin of the tree frog Hyla japonica expresses two kinds of arginine vasotocin (AVT)-stimulated aquaporins (AQP-h2 and AQP-h3), which affect the capacity of the frog's skin to absorb water. As such, it can be used as a model system for analyzing the molecular mechanisms of water permeability. We investigated AQP dynamics and water permeability in the pelvic skin of H. japonica following challenge with AVT, hydrins (intermediate peptides of pro-AVT) and beta-adrenergic effectors. In the in vivo experiment, both AQP-h2 and AQP-h3 proteins were translocated to the apical plasma membrane in the principal cells of the first-reacting cell (FRC) layer in the pelvic skin following challenge with AVT, hydrin 1 and hydrin 2, thereby increasing the water permeability of the pelvic skin. The beta-adrenergic receptor agonist isoproterenol (IP) and its anatagonist propranolol (PP) in combination with AVT or hydrins were used as challenge in the in vitro experiment. IP increased water permeability whereas PP inhibited it, and both events were well correlated with the translocation of the AQPs to the apical membrane. In the PP+AVT-treated skins, labels for AQP-h2 and AQP-h3 were differentially visible among the principal cells; the apical plasma membrane of some cells was labeled while others were not, indicating that the response of PP or AVT is different from cell to cell. These results provide morphological evidence that the principal cells of the FRC layers may have two kinds of receptors: a V2 receptor and beta-adrenergic receptor.

Internet medical usage in Japan: current situation and issues.

Internet use by physicians and patients has become very popular in Japan. Fifty percent of physicians use the Internet to search for medical and other information. Over the past year, 22% of patients used the Internet to obtain medical information. Because there are no restrictions within Japan on using Web sites to advertise medical treatment, information can be freely sent out, and over the past two or three years this practice has increased dramatically. Internet medical information provides information about illnesses and medications, and it helps improve the quality of life of patients and families. Yet, depending on the content of the information provided and the way this information is used, there is a potential negative side as well. On principle, users are responsible for the way information is used, but there is a need for information providers to consider users safety and to make the information effective for use. Because there is no absolute standard for evaluating the value of medical information, it is necessary to establish a system that opens a dialogue with society and that continuously accumulates high-quality information through the collection of various evaluations, rather than rely on an established authority. For industries and organizations related to commercial pursuits, in particular, it is most effective to establish their own codes for ethical conduct, rather than rely on governmental regulations. At the same time, it is important to have a confirmation function to evaluate how goals set by the outside are being implemented. Aiming at establishing a framework for the Internet medical usage, the Japan Internet Medical Association (JIMA) was founded in 1998 by medical professionals, lawyers, researchers, consumer representatives, patients and their families. We propose a system that would combine feedback from users, who would take on the role of evaluators of the implementation of an ethical code, with a displayed mark that verifies the identity of the Web site. Objective evaluation of information is needed to ensure that users have the power to make choices. Medical experts or patient and family groups would assist in this task. The development of medical care will be promoted through patients and physicians working together in the accumulation of shared resources for good medical care information.

The current status of medicolegal issues surrounding telepathology and telecytology in Japan.

The medicolegal issues surrounding telepathology and telecytology in Japan have been partly resolved since the government declared that telediagnosis in these fields using a microscope is essentially a medical practice between doctors. Thus it does not contravene article 20 of the law pertaining to medical practice in Japan, which states that there must be an actual face-to-face encounter between the doctor performing any diagnostic or treatment episode and the patient. It is, however, only beginning to be recognized that the medicolegal issues surrounding telepathology and telecytology depend on factors such as the type of system used (e.g. active versus passive). In an active diagnostic system, the telepathologist or telecytopathologist can control a robotic microscope at the remote site, while in a passive diagnostic system the telepathologist or telecytopathologist makes the diagnosis based on the microscope images that have been selected, and transmitted, by someone in the remote hospital. In the former case the interpreting telepathologist or telecytopathologist must assume most of the responsibility for the diagnostic process, while in the latter more responsibility must be assumed by those at the remote site. The duties and responsibilities of all participants in the telediagnostic process, whatever the system employed, must be determined. We have established working guidelines for telepathological and telecytological diagnoses to help achieve this and hence ensure safe and effective clinical practice.

Disaster drills and continuous medical education using satellite-based Internet.

We designed and evaluated a satellite-based Internet system for use in medical applications. Many experimental telemedicine projects use satellites, but we combined digital satellite communication with an ordinary telephone network to realize an economical countrywide network for emergency medicine and continuous medical education. The system appears to be a useful and practical technology for daily clinical activities.

Is interest in art effective in health-related quality of life? Results of a cross-sectional survey on lifestyle and health promotion.

The objective of this survey was to examine whether lifestyle and health practices can change the health-related quality of life (HRQOL), and how much weight should be placed on each item. A cross-sectional survey by self-administered questionnaires using the SF-36 and questions of our own on lifestyle was conducted in Japan on November 5 to 7, 1999. Volunteers consisted of 147 men and 152 women over 20 years of age. Gender, age, living alone, and lifestyle items such as eating breakfast, regular sleep, and drinking alcohol were significantly associated with the SF-36 profiles. The trends corresponded to those obtained with the previous studies conducted in other countries. Interest in art and regular sleep showed the highest significance (P<0.001) in MANCOVA of eight domains. From the results of multiple regression analysis, drinking alcohol and regular sleep was closely related to physical health status. In the mental component summary and related domains, the important factors were regularity of sleep, not living alone, eating breakfast, interest in art, and drinking alcohol. We concluded that the SF-36 is an appropriate measure to determine effects of lifestyle improvement and assess health promotion programs.

Application of telepsychiatry: a preliminary study.

Telemedicine is the provision of professional medical services from sites removed from the patient. This study was conducted in order to assess the reliability of psychiatric evaluations via video-consultation. The inter-rater reliability was determined for each interviewing condition by employing the reliability-testing paradigm in which the brief psychiatric rating scale (BPRS) and the interclass correlation coefficient (ICC) are used. The inter-rater reliability scores between face-to-face interviews and interviews conducted by video at two different levels of image qualities were compared by the authors. Reliability was found to be in perfect agreement in each of the interviewing conditions. This study verifies that telepsychiatry is a reliable method of assessing patient conditions. It may be used to provide much needed mental health-care services to patients whose access to them is restricted.

Status and perspective of hospital information systems in Japan.

Questionnaire surveys were sent to hospital managers, designed to shape the policy for future hospital information systems in Japan. The answers show that many hospitals use dedicated management systems, especially for patient registration and accounting, and personnel, food control, pharmacy and financial departments. In many hospitals, order-entry systems for laboratory tests and prescriptions are well developed. Half of the hospitals have patient databases used for inquiries of basic patient information, history of outpatient care and hospital care. The most obvious benefit is the reduction of office work, due to effective hospital information system. Many hospital managers want to use the following sub systems in the future for automatic payment, waiting time display, patient records search, automatic prescription verification, drug side-effect monitoring, and graphical display of patient record data.

Availability of Japanese subsidies for international telemedicine projects.

In this article, the authors report the methods for obtaining subsidies for overseas telemedicine projects from Japanese sources based on their own personal experiences. The Japanese Government is already subsidizing such specialized NGOs (Non-Governmental Organizations) as the Telemedicine Society of Japan and Basic Human Needs and, Japanese trading companies are also hiring telemedicine experts. Prospective methods for obtaining subsidies are outlined as under the following headings: Assistance without compensation, Technology transfer, Grass-roots grant assistance, the Telecommunications Advancement Organization, Postal Savings for International Voluntary Aid, Venture business development funds provided by the Ministry of International Trade and Industry, Mission demonstration satellites by the National Space Development Agency of Japan, the Sasakawa Pacific Island Nations Fund, and International Communications Foundation. Key points of the applications are noted under (1) Degree of contribution to local residents, (2) Significance of project continuation and (3) Novelty and economic impact.

A review of Japanese telemedicine research and global co-operation.

We can trace 229 telemedicine trials in Japan. Of these, 150 were active in 1998, including 73 in radiology, 24 in home care, 22 in medical imaging, 20 in pathology, 5 in ophthalmology, and 3 in dentistry. Some of them have been reformed into practical daily activities. However, activities using the same method work in some local areas but not in others. Typical successful cases will be presented and discussed. We are constructing Japan-Canada cooperation in numerous areas using several communicative methods: ordinary telephone, ordinary Internet, ISDN (2B/6B), and an offline network using optical memory cards (which patients carry). We have introduced successful domestic cases into global cooperation. Some of them will be useful for exchanging medical information among developing countries.

Development and evaluation of regional health database systems.

We have developed information systems for regional public health in some areas. These systems have the following functions: (1) to register results of examinations, life style, follow-up data, diseases, (2) to output some reports and statistics for daily jobs, (3) to make a personal health database, (4) to display stored data by character, trend graph, radar chart or bar chart, (5) to analyze regional health problems, (6) to extract dada about persons with some conditions, (7) to compare data among some examinations, (8) to analyze risk factors. Each database can be transferred to mini-notebook type personal computers. So, they can be used anywhere and any time. Some access controls are performed for security. The systems are used in routine works, health consultation for persons and health education for groups. We have evaluated the systems and got some useful results. Using the systems, daily jobs can be performed with good accuracy and less labor, each subject can understand one's health status easily and clearly, grasps of health problems can be made quantitatively and health projects can be planned by scientific methods.

Lifestyle and colorectal cancer: A case-control study.

A case-control study has been conducted to investigate the relationship between lifestyle and risk of colorectal cancer. Cases are one hundred patients diagnosed with colon and rectal cancer in Tokai University Hospital between 1986 and 1994. Three controls per case were individually matched by age, sex, local areas and date of health checkups at the Automated Multi-phasic Health Testing and Services (AMHTS ) Center of the hospital. The results were analyzed by multi-factorial logistic regression models. Positive history of maternal cancer, large consumption of alcohol, frequent consumption of potato products and white-collar job were predominant risk factors while frequent intake of seaweed was a protective factor. Frequent intakes of dairy foods and lack of exercise showed no significant tendency to increase risk of colorectal cancer. Smoking habits, intakes of meat and egg were shown not to be related to this disease. These findings suggest that family history of cancer and dietary factors play a key role in causation and prevention of colorectal cancer.

Health and welfare data on optical memory cards in Isehara city.

An off-line network system of health and welfare for elderly people using optical memory cards has been established in Isehara city (Japan) since 1991. 2775 citizens have the cards and 24 offices have the terminals. It covers almost one third of people aged over 65 in Isehara city and almost all of the offices concerned with their health and welfare. About a half of holders use optical memory cards every time they visit these offices. The optical memory card holds data including basic data for health and welfare, health check data over 5 years, medical images with scripts and history of welfare services. All the data are used for medical care, health consultation and management of health and welfare services. A card can hold health and welfare data for a lifetime, and it is easy to expand the system. It has been a good experience for us, because the optical memory card system needs co-operation among citizens, medical association and local government, and the experience will help us to expand the system in the future.

Regional medical information network using optical memory cards and integrated services for digital network.

Since 1986, we have been developing a regional health and welfare system using optical memory cards. We have expanded the system and performed model experiments and evaluations this time. There are approximately 3000 card-holders and 23 card-reader terminals in use. They cover 50 percent of the medical facilities in the city of Isehara. Two medical clinics within neighboring cities have joined our project. Standard Deviation Index (SDI) has been introduced to standardize the numeric results of examinations. The terminals are connected with Integrated Services for Digital Network (ISDN) allowing remote access to the optical memory cards. This enhanced connectivity has allowed greater cooperation in delivering quality medical services.

Expression of an Endopeptidase (EP-C1) in Phaseolus vulgaris Plants.

Endopeptidase activity increases continually in pods of maturing fruits of French bean (Phaseolus vulgaris L. cv Goldstar) plants and is thought to participate in the protein mobilization in pods during the development of seeds (M. Endo, T. Minamikawa, D. Yamauchi, W. Mitsuhashi [1987] J Exp Bot 38: 1988-1995). In the present studies, one of the major endopeptidase forms, designated EP-C1, was purified as a 34-kD polypeptide from pods of maturing French bean fruits. EP-C1 was found to be immunologically distinguished from other forms in extracts from pods, but homologous to SH-EP, the major cysteine endopeptidase expressed in cotyledons of germinating Vigna mungo seeds (W. Mitsuhashi, T. Minamikawa [1989] Plant Physiol 89: 274-279). The level of endopeptidase that reacted with the antiserum to EP-C1 increased in pods as the fruit maturation proceeded. EP-C1 was also immunologically detected in stems of French bean plants bearing fruits of later maturation stages. Protein immunoblotting showed that a 34-kD polypeptide corresponding to EP-C1 in molecular mass occurred in extracts from 7- to 9-d cotyledons of germinating French bean seeds. In addition, two other polypeptides with slightly higher molecular masses were observed in extracts from 3- to 5-d cotyledons. We suggest that these two polypeptides are intermediates involved in posttranslational processing of EP-C1. RNA blot hybridization with EP-C1 cDNA as a probe showed that EP-C1 mRNA occurred in pods of fruits at later maturing stages and also in cotyledons of 3- to 7-d germinating seeds.

A computerized standard flow-generator for spirometer calibration.

We analyzed the dynamic characteristics of a newly designed standard flow generator (SFG) to be used for spirometer calibration. The SFG consisted of a computer, large-bore cylinder, and piston driven by a high torque motor. The computer develops numerical equations to simulate a flow-volume pattern with different convexities of the descending limb. The excursion of the piston was processed according to the computer-developed equation. The computer's numerical solutions were compared to those of the SFG and agreement of the values of the peak flow, forced expiratory volume, and flow-volume pattern was satisfactory in repeated trials. Application of an external resistive load (3.5 cm H2O/sec) did not change the flow output. However, there were several minor disagreements due to the dynamic characteristics of the SFG. In an emphysema pattern the ascending limb of the generated flow-volume curve flattened and the descending limb was less convex compared to the preset pattern. When the SFG was generating sinusoidal waves of high frequency (e.g., 10.0 Hz) the flow output was deformed. The newly designed SFG was used to examine the dynamic characteristics of rolling-seal spirometers. There was an overshoot of the peak flow, over-convection, and oscillations of the descending limb in the spirometer output. These deformations were more prominent with the severe emphysema pattern. It is concluded that the SFG can be very useful in the examination and calibration of spirometers.