Obstructive sleep apnea in preschool-aged Japanese children - efficiency of screening using lateral neck radiography.

Conclusions The prevalence of obstructive sleep apnea (OSA) in preschool-aged children diagnosed by the International Classification of Sleep Disorders (ICSD) version 3 criteria was relatively higher than that diagnosed by ICSD-2. Although the assessment of the upper airway by lateral neck radiography was effective for detecting OSA in this age group, this assessment is not recommended for all children as a screening method because of parental concern related to radiation exposure. Objective This study investigated the prevalence of OSA and the screening capacity of lateral neck radiography in community-based preschool-aged children. Methods Parents of 211 children aged 3-6 years were requested to complete the sleep-related questionnaire. Subjects who agreed to further investigations were invited to undergo home type 3 portable monitoring and clinical examination, including radiography. We estimated the prevalence of OSA and evaluated the detection power of radiography for predicting OSA. Results One hundred and eighty-eight (89.1%) subjects completed the questionnaire and 67 (31.8%) agreed to further examinations. The weighted prevalence was 7.3% and 12.8% by ICSD-2 and 3, respectively. Area under the receiver operator curve for the adenoidal/nasopharyngeal and tonsil/pharyngeal ratios measured using radiography was slightly larger than that for tonsil size graded by visual inspection.

A new modification of uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea syndrome.

OBJECTIVE: To evaluate objective and subjective improvement after applying a new surgical technique, two-piece palatopharyngoplasty (Two-P4), to the treatment of obstructive sleep apnea syndrome (OSAS). METHODS: Twenty-four patients with mild to severe OSAS underwent Two-P4 between January 2002 and November 2007. Polysomnography and Epworth Sleepiness Scale (ESS) score were used to evaluate surgical results. RESULTS: Mean apnea-hypopnea index (AHI) improved from 50.9 to 10.7 after Two-P4. Mean ESS score decreased significantly from 13.0 to 7.7. Body mass index was unchanged after surgery. Objective success as evaluated by a 50% reduction in AHI and by AHI <20 was obtained in 22 of 24 patients (91.7%). Mean reduction in AHI was 76.9% for all 24 patients, 86.2% for patients with Friedman's anatomical stage I, 78.9% for stage II, and 54.5% for stage III. CONCLUSION: Two-P4 is a novel surgical treatment for OSAS patients with a high success rate (91.7%) as evaluated by reductions in AHI. Two-P4 keeps the middle soft palate intact to form independent scars on both sides, which constrict to stretch the soft palate and widen the pharyngeal space.

Sleep, mental health status, and medical errors among hospital nurses in Japan.

Medical error involving nurses is a critical issue since nurses' actions will have a direct and often significant effect on the prognosis of their patients. To investigate the significance of nurse health in Japan and its potential impact on patient services, a questionnaire-based survey amongst nurses working in hospitals was conducted, with the specific purpose of examining the relationship between shift work, mental health and self-reported medical errors. Multivariate analysis revealed significant associations between the shift work system, General Health Questionnaire (GHQ) scores and nurse errors: the odds ratios for shift system and GHQ were 2.1 and 1.1, respectively. It was confirmed that both sleep and mental health status among hospital nurses were relatively poor, and that shift work and poor mental health were significant factors contributing to medical errors.

Influence of age or circadian time on Bcl-2 and Bax mRNA expression in the rat hippocampus after corticosterone exposure.

A rapid elevation in the level of endogenous corticosterone (CORT) functions in the stress response associated with the hypothalamus-pituitary-adrenal axis, and it has been well documented that high levels of CORT play neurotoxic roles in the hippocampus. Both aging and the circadian rhythm possibly affect the sensitivity to CORT, although their endogenous modifications in the CORT-mediated events remain unclear. To explore the influence of age or circadian time on hippocampal vulnerability to excess CORT, we examined the relative mRNA expression of bcl-2 and bax in the dentate gyrus (DG) and the CA1 subfield, compared with the CA3 as an internal standard, after acute CORT administration using in situ RT-PCR. Male rats aged 10 weeks (young) or 6 months (adult) were treated with CORT at 0800 or 2000 h. The bcl-2 to bax mRNA ratio in the dentate gyrus (DG) was significantly decreased 2h after CORT exposure in the young rats treated at 0800 or 2000 h. In the adult rats, the treatment with CORT at 0800 h significantly decreased the bcl-2 to bax ratio, whereas the treatment at 2000 h was ineffective; the discrepancy between the treatment time points was apparent in adult rats, but not in young rats. Our results emphasize the importance of circadian time as well as age as a factor influencing the stress paradigm.

A schizophrenia-associated mutation of DISC1 perturbs cerebral cortex development.

Disrupted-In-Schizophrenia-1 (DISC1), originally identified at the breakpoint of a chromosomal translocation that is linked to a rare familial schizophrenia, has been genetically implicated in schizophrenia in other populations. Schizophrenia involves subtle cytoarchitectural abnormalities that arise during neurodevelopment, but the underlying molecular mechanisms are unclear. Here, we demonstrate that DISC1 is a component of the microtubule-associated dynein motor complex and is essential for maintaining the complex at the centrosome, hence contributing to normal microtubular dynamics. Carboxy-terminal-truncated mutant DISC1 (mutDISC1), which results from a chromosomal translocation, functions in a dominant-negative manner by redistributing wild-type DISC1 through self-association and by dissociating the DISC1-dynein complex from the centrosome. Consequently, either depletion of endogenous DISC1 or expression of mutDISC1 impairs neurite outgrowth in vitro and proper development of the cerebral cortex in vivo. These results indicate that DISC1 is involved in cerebral cortex development, and suggest that loss of DISC1 function may underlie neurodevelopmental dysfunction in schizophrenia.

The relation between negative emotional suppression and emotional distress in breast cancer diagnosis and treatment.

Our objective was to investigate differences in emotional distress between negative emotional suppression and expression patients in the progress of medical treatment, including the operation. We studied the differences in affective response between patients who suppress negative emotion and those who express negative emotion by using Profile of Mood States (McNair, Lorr, & Droppleman, 1971) at four sessions: (a) at the first visit to the clinic, (b) immediately after being told the diagnosis of breast cancer, (c) after the operation, and (d) at 3 months after discharge. Our results showed that emotional suppression patients tended to report more emotional distress (in particular, anxiety, depression, and anger) than did emotional expression patients on 3 sessions, the exception being after the operation. Also, patients who suppress anger and anxiety felt strong psychological distress. We suggest that it is essential to encourage suppressive patients to express both negative and positive emotion clearly and appropriately.

Anxiety, emotional suppression, and psychological distress before and after breast cancer diagnosis.

The authors examined the influence of anxiety and emotional suppression on psychological distress in 21 patients with breast cancer and 72 patients with benign breast tumor. The patients with breast cancer who suppressed emotion and had chronically high levels of anxiety felt higher levels of emotional distress both before and after the diagnosis. Such patients need psychological interventions, including encouragement to express and communicate their emotions, immediately after disclosure of the diagnosis to help maintain psychological adjustment in the face of the disease.

Periodic leg movements during sleep in Japanese community-dwelling adults based on the assessments of their bed partners.

BACKGROUND: There is little known about epidemiologic evidence on periodic leg movements during sleep (PLMS) for the Japanese. The present study was a cross-sectional epidemiologic study to estimate the prevalence of PLMS and examine the associated factors of PLMS in Japanese community-dwelling adults. METHODS: The subjects were 884 with bed partners or bedroom mates of 1,889 Japanese adults aged 20 years and over randomly selected from the general population. The case ascertainment of PLMS was based on the assessments of their bed partners or bedroom mates using the Pittsburgh Sleep Quality Index. Multiple logistic regression analyses were used for investigating the associated factors. RESULTS: The age-adjusted prevalences (95% confidence interval) were 5.8% (4.7-6.8%) and 1.3% (0.8-1.9%) for 1 to 2-times, and 3-times or greater of PLMS per week during the preceding month, respectively. Those with PLMS were more likely to experience difficulty in initiating sleep, snore during sleep, be depressed, and suffer from peptic ulcer. Sex, age, difficulty in maintaining sleep, excessive daytime sleepiness, medication use to aid sleep, and any psychoactive substances (tobacco, alcohol, and caffeine) were not identified as significant associated factors of PLMS. CONCLUSIONS: The results suggest that the prevalence of PLMS in Japanese community-dwelling adults is not so high as those reported from Western countries, and that PLMS is correlated with some sleep and health disturbances.

Differences in emotional distress between breast tumor patients with emotional inhibition and those with emotional expression.

The differences in affective status between patients who restrain their negative emotion and those who express negative emotion after being given their breast cancer diagnosis were studied using the Profile of Mood States (POMS) at two sessions: (i) at the first visit to the outpatient surgery clinic, and (ii) immediately after being given the diagnosis of breast cancer. Eighty-seven patients completed the POMS and the Courtauld Emotional Control Scale (CECS) at the first visit to the outpatient surgery clinic at Shiga University of Medical Science Hospital. They also completed the POMS immediately after being given the diagnosis of breast cancer. Breast cancer patients who restrain their negative emotion (n = 8) were highly anxious, depressed and confused after being given the diagnosis compared to breast cancer patients who express negative emotion (n = 8). Emotional distress in benign breast tumor patients was reduced after being given the diagnosis regardless of the trend of emotional inhibition. That is, emotional distress in patients who restrain their emotions was considerably increased compared with that of patients who expressed their emotions when they were faced with a life-threatening disease. These results suggest that it may be therapeutic to advise breast cancer patients to express their negative emotion.

Disrupted-in-Schizophrenia-1 (DISC-1): mutant truncation prevents binding to NudE-like (NUDEL) and inhibits neurite outgrowth.

Disrupted-in-Schizophrenia-1 (DISC-1) is a gene whose mutant truncation is associated with major psychiatric illness with a predominance of schizophrenic symptomatology. We have cloned and characterized rodent DISC-1. DISC-1 expression displays pronounced developmental regulation with the highest levels in late embryonic life when the cerebral cortex develops. In yeast two-hybrid analyses, DISC-1 interacts with a variety of cytoskeletal proteins. One of these, NudE-like (NUDEL), is associated with cortical development and is linked to LIS-1, the disease gene for a form of lissencephaly, a disorder of cortical development. The disease mutant form of DISC-1 fails to bind NUDEL. Expression of mutant, but not wild-type, DISC-1 in PC12 cells reduces neurite extension. As schizophrenia is thought to reflect defects in cortical development that are determined by cytoskeletal protein activities, the cellular disturbances we observe with mutant DISC-1 may be relevant to psychopathologic mechanisms.

Lack of impact of CYP1A2 genetic polymorphism (C/A polymorphism at position 734 in intron 1 and G/A polymorphism at position -2964 in the 5'-flanking region of CYP1A2) on the plasma concentration of haloperidol in smoking male Japanese with schizophrenia.

The impact of genetic polymorphism of CYP1A2 that are related to the induction of the isozyme on the plasma levels of haloperidol (HAL) in 40 male smokers with schizophrenia was investigated. A point mutation from C to A in intron 1 at position 734 and a point mutation from G to A at position -2964 in the 5'-flanking region of CYP1A2 were identified by polymerase chain-reaction-restricted fragment length polymorphism method. Regarding C/A polymorphism in intron 1 at position 734, no significant difference was found in the plasma concentrations of HAL corrected for dose and weight among the subjects with A/A (n = 21), A/C (n = 14) and C/C (n = 5) genotypes (one-way analysis of variance: 63.1 +/- 18.5, 47.8 +/- 12.5 and 50.8 +/- 15.1 ng/ml/mg/kg, respectively, F(2,37) = 2.556, P = .09). Regarding G/A polymorphism at position -2964 in the 5'-flanking region, no significant difference was found in the plasma concentrations of HAL corrected for dose and weight between subjects with G/G (n = 24) and G/A (n = 15) (two-tailed t test: G/G and G/A = 51.2 +/- 16.6 and 59.0 +/- 17.6 ng/ml/mg/kg, respectively, df = 28, P = .22). The present study suggests that the genotyping of CYP1A2 cannot predict the steady state plasma levels of HAL in male smoking schizophrenics.