[Early malignant pleural mesothelioma; report of a case].

We report a case who had undergone operation of very early malignant pleural mesothelioma (MPM). A 58-year-old woman admitted to first visited hospital because of pleural effusion of the right side. She received a diagnosis of epithelial type MPM which had been confirmed from a pleural biopsy spacemen obtained by thoracoscopy under local anesthesia. An abnormal change of the pleura could not be detected on chest X-ray and thoracic computed tomography (CT) scan after chest drainage. She was referred to our hospital for surgery, and was undergone an extrapleural pneumonectomy followed by postoperative treatment with cisplatin puls gemcitabine. Pathologically, the disease was diagnosed as stage IA based on the classification of International Mesothelioma Interest Group (IMIG). There is a no evidence of the relapse 9 months after the operation. An early diagnosis of the MPM is very difficult. The thoracoscope with local anesthesia was very effective for early diagnose of a MPM.

[Uncommon procedure in tracheoplasty; thyrotracheal anastomosis and carinoplasty].

Both thyrotracheal anastomosis and carinoplasty are relative rare procedure in routine clinic. We reported each 2 cases of thyrotracheal anastomosis and carinoplasty in 51 cases of tracheobronchoplasty. Thyrotracheal anastomosis with partial cricoidectomy was performed in patients with subglottic stenosis for postintubation stenosis and thyroid cancer using suprahyoid release. Each case need re-intubation after surgery. Montage carinoplasty was performed in 2 patients with advanced lung cancer. Right upper lobe was end-to-side anastomosed to trachea in 1 case, and right basal segment was to left main bronchus in another. It was important both diameter in bronchus and mobilization of the residual lung for this procedure.

[Primary thyrotracheal anastomosis for subglottic stenosis with tracheostomy].

A case of 42-year-old man with postintubation subglottic stenosis underwent primary thyrotracheal anastomosis. Since trachea had been incised longitudinally for previous tracheostomy, tracheal resection came to be longer. Therefore, we had to anastomose the incised trachea with thyroid cartilage even after the suprahyoid release. After the operation, he suffered from the tracheal collapse at the incised portion of the trachea One week after intubation, tracheal patency was achieved. We recommend horizontal incision for tracheostomy in patient with subglottic stenosis, when the following surgical approach is considered.

Adolescent smoking behaviour and cigarette brand preference in Japan.

OBJECTIVES: As part of efforts to develop a smoking control strategy for Japanese adolescents, the results of two nationwide surveys on adolescent smoking behaviour were compared. DESIGN: Descriptive study on smoking behaviour among high school students was conducted. Self-reporting anonymous questionnaires were administered to 115,814 students in 1996 and 106,297 in 2000 through randomly sampled junior and senior high schools throughout Japan. MAIN OUTCOME MEASURES: Smoking prevalence, proportion of smokers by usual sources of cigarettes, national estimated cigarettes consumed by minors, share of cigarette brands smoked by high school students. RESULTS: The experiment rate among junior high school boys decreased in 2000 compared with that in 1996, whereas current and daily smoking rates did not. Although prevalence among Japanese girls was much lower than that among boys, prevalence among girls increased in 2000. The main source of cigarettes among high school smokers was vending machines. The proportion of smokers who usually purchased cigarettes from vending machines increased in 2000, in spite of the 1998 introduction of restrictions on night-time operations. Japanese adolescents were more likely than adults to smoke American cigarette brands, and the adolescent market share of American brands has increased rapidly, especially for menthol brands. CONCLUSIONS: This survey revealed the seriousness of the problem of smoking behaviour among Japanese high school students, and suggested that this behaviour may be influenced by social environmental factors, including the marketing strategies of the tobacco industry. Action should be taken to reduce the prevalence and impact of pro-tobacco marketing messages and to abolish cigarette vending machines.

Unusually high expression of N-acetylglucosaminyltransferase-IVa in human choriocarcinoma cell lines: a possible enzymatic basis of the formation of abnormal biantennary sugar chain.

Structural analysis of the sugar chains of human chorionic gonadotropin (hCG) has revealed that abnormal biantennary structures appear specifically on hCG in the urine of choriocarcinoma patients. However, the enzymatic and molecular mechanisms of the biosynthesis of abnormal biantennary sugar chains have not yet been elucidated. In this report, the enzyme activities and the expression levels of mRNAs of N-acetylglucosaminyltransferases (GnT)-I to -V, beta-1,4-galactosyltransferase, and alpha-mannosidase II in normal human placentae and three human choriocarcinoma cell lines were investigated. GnT-IV activities in choriocarcinoma cell lines were increased from 16- to 66-fold and GnT-III activity was increased from 15- to 25-fold as compared with those in human placentae, whereas other enzyme activities were not increased significantly. The mRNA expression levels generally correlated with their enzyme activities. Among the two GnT-IV genes found in human tissues only GnT-IVa gene was strongly expressed in the cancer cells: from three to seven times as much as in the normal tissue, whereas that of GnT-IVb remained constant. On the basis of these results, we proposed that ectopic expression of GnT-IVa gene should occur along with the malignancy of trophoblastic tissues, and that the increased GnT-IV activity should be the main cause of the formation of abnormal biantennary sugar chains in choriocarcinoma. A possible enzymatic basis of the biosynthesis of abnormal biantennary sugar chains is discussed.

Differentiation dependent expression and distinct subcellular localization of the protooncogene product, PEBP2beta/CBFbeta, in muscle development.

The Pebpb2/Cbfb gene encodes the non-DNA binding subunit of the heterodimeric transcription factor, PEBP2/CBF. To examine the expression of the PEBP2beta/CBFbeta protein in vivo, we carried out immunohistochemistry using the tissues from adult mice as well as embryos. Although PEBP2beta/CBFbeta was detected in various tissues to various degrees, interesting features of expression were observed in the skeletal myogenic cells. Here PEBP2beta/CBFbeta was found mainly to occur as cytoplasmic staining and the intensity of this staining increased depending on the differentiation stage of the cells. In the undifferentiated myoblasts PEBP2beta/CBFbeta was undetectable, whereas moderate levels of PEBP2beta/ CBFbeta were detected in the elongated and aligned myocytes. PEBP2beta/CBFbeta appeared to accumulate further when the cells fused to each other to become multinucleated myotubes. Once the muscle fibers were established, PEBP2beta/CBFbeta was relocated onto or around the Z-lines. PEBP2beta/CBFbeta was also detected in the cytoplasm of cardiac myocytes and in the smooth muscle cells of the digestive tract. In all the above, the skeletal myotubes were the only case that showed both nuclear and cytoplasmic staining of PEBP2beta/CBFbeta. Thus, we could show differentiation dependent pattern of PEBP2beta/CBFbeta expression in muscle development and establish PEBP2beta/CBFbeta to be a cytoplasmic as well as nuclear protein in vivo.

[Schwannoma arising from brachial plexus with intrathoracic extension; report of a case].

We report a case of schwannoma arising from brachial plexus with intrathoracic extension. An 18-year-old man demonstrated a tumor shadow at the right pulmonary apex area. In the 2-months of follow-up, tumor size had been growing rapidly. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a giant tumor mass infiltrated right lung. We perfomed operation under the posterolateral incision approach. The pathological diagnosis was schwannoma. We resected this tumor safely and conserved with the seventh, eighth cervical nerve of the brachial plexus under posterolateral incision approach.

[Primary lung cancer incidentally diagnosed in lung biopsy for diffuse pulmonary disease].

UNLABELLED: We here presented 2 cases of interstitial pneumonia with lung adenocarcinoma incidentally diagnosed by partially resected lung for diffuse pulmonary disease. CASE 1: A 78-year-old female was admitted to the hospital complaining of productive cough and general fatigue. The chest computed tomography (CT) revealed diffuse honey comb pattern in bilateral lung field especially in the right lower lung. Video-assisted thoracoscopic lung biopsy was performed and was diagnosed as diffuse spreading well differentiated adenocarcinoma. CASE 2: A 59-year-old male was admitted to the hospital complaining of dyspnea and general fatigue. The chest X-ray revealed right pneumothorax and chest CT revealed diffuse honey comb pattern and bullae in bilateral lung field and fibrous tumor-like lesion in the right middle lung. Video-assisted thoracoscopic lung biopsy was performed and was diagnosed as pulmonary fibrosis with papillary adenocarcinoma. CONCLUSION: It is important to examine carefully the specimen obtained from thoracoscopic lung biopsy even if interstitial pneumonia is strongly suspected.

Characterization of the spontaneous elimination of streptomycin sensitivity (SmS) on high-copy-number plasmids: SmS-enforcement cloning vectors with a synthetic rpsL gene.

The strAS or rpsL+ gene, encoding a ribosomal protein, S12, expresses its streptomycin-sensitivity (SmS) phenotype dominantly over strAR or rpsL- gene. Therefore, strAR cells that harbor plasmids with strAS alleles are phenotypically SmS. It was found that the SmS phenotype is unstable, and such cells eventually switch to the Sm-resistance (SmR) phenotype, especially when the strAS gene was cloned on high-copy-number (HCN) plasmids. It seemed that the strA gene cloned on HCN plasmids was toxic to Escherichia coli host cells and, during prolonged cultivation, plasmids with an inactivated strAS gene, mostly carrying insertion sequence elements, such as IS1, IS5 and gamma delta, were selected. The instability of the strA gene was particularly enhanced when the Val51 residue in the middle of S12 protein was replaced by Leu, suggesting enhanced toxicity of the altered S12. Since the strAS gene was stably maintained throughout approx. 100 cell doublings when its expression was abolished, most probably it is the gene product rather than the nucleotide sequence itself that is responsible for the instability of strA gene on HCN plasmids. To improve the stability of the SmS phenotype, the previously reported ampicillin-resistance-conferring and SmS-enforcing plasmid vector, pHSG670, was reconstructed. The resulting vector, pHSG683, confers chloramphenicol resistance, enforces SmS on strAR and supE- host bacteria, and has multiple cloning sites within the coding region of synthetic rpsL gene. When pHSG683 DNA was prepared from strAR and sup+ cells grown in tryptophan-rich medium with Cm and Sm, less than 10(-6) plasmids failed to enforce SmS on strAR and supE- cells in tryptophan-less medium with Cm.(ABSTRACT TRUNCATED AT 250 WORDS)

Recent results of health examinations on the general population in cadmium-polluted and control areas in Japan.

Health examinations by a revised method aimed at detecting renal tubular dysfunctions more effectively were conducted on the general population aged 50 years and over in cadmium-polluted areas (1826 persons) and control areas (1611 persons) in four prefectures in Japan in 1976. Although detailed analysis of the data is not yet completed, some of the results obtained are described here. The prevalence of glucosuria and low molecular weight proteinuria, frequency of decreased % TRP, and cadmium concentrations in urine are higher in the cadmium-polluted areas than in the controls. Clinically diagnosed cases with tubular dysfunctions seem to follow the same trend as above, though these cases are very few in number and they are limited to the advanced age group. When cadmium concentration in rice is taken as an index, a dose-response relationship is not necessarity explicit in the observations by prefecture. However, suggestive data are obtained in the observation by district in one cadmium-polluted area.

A case-control study of lung cancer with special reference to asbestos exposure.

A case-control study of lung cancer was carried out in Yokosuka City, Kanagawa Prefecture, the location of a pre-war Japanese Imperial naval factory and present site of a U.S. naval base. Cytologically or pathologically confirmed male fatal cases of lung cancer during the period of 1978 to 1982 in Yokosuka Kyosai Hospital were compared with a control group in the same hospital. Controls who died from causes other than cancer, pneumoconiosis, accident, or suicide were matched by age to the cases. Information that included occupational and smoking history was obtained by interviews with the families of the 96 cases and 86 controls. Major results were as follows: a) The relative risks of lung cancer associated with asbestos exposure and suspected exposure were 2.41 (p less than 0.05) and 1.56, respectively, after controlling for age and smoking history, and the relative risk associated with smoking was 6.01 (p less than 0.05) after adjusting for age and asbestos exposure. b) The age- and smoking-adjusted relative risks of lung cancer associated with asbestos exposure were 3.40 (p less than 0.01) and 1.72 for Kreyberg groups I and II, respectively. Significantly elevated relative risk associated with smoking history was demonstrated for Kreyberg group I, but not for group II, after controlling for age and asbestos exposure.

Diagnostic results before and after introduction of autofluorescence bronchoscopy in patients suspected of having lung cancer detected by sputum cytology in lung cancer mass screening.

For the purpose of early detection, we have conducted population-based mass screening for lung cancer by sputum cytology since 1982. Although detection of lung cancer in its early stage is important for a good prognosis, it is often difficult to localize lesions in roentgenographically occult cancer. To clarify the role of autofluorescence bronchoscopy in localizing tumors in patients with roentgenographically occult cancer, we analyzed our diagnostic results. Fifty patients who had been detected by sputum cytology were screened by the light-induced fluorescence endoscope (LIFE)-Lung System from November 1997 to April 1999. We compared the results according to the screening methods: conventional bronchoscopy alone versus LIFE with conventional white-light bronchoscopy (November 1997 to April 1999). Twenty-eight cancerous lesions and 39 borderline lesions were detected by LIFE. Of the 39 borderline lesions, nine were detected only by LIFE. Multicentric lesions including cancer or dysplasia were also detected in 21 of the 50 patients by LIFE. The sensitivity by white-light bronchoscopy alone was 85.3%, whereas that of the LIFE-Lung System with white-light bronchoscopy was 94.1% (P=0.078). There were no cancerous lesions in the area observed as normal by LIFE. We also compared the diagnostic results of two localization methods: brushing of all bronchi (September 1986 to December 1990) and the LIFE-Lung System (November 1997 to April 1999). Although this was a historical comparison, the number of detected borderline lesions increased, which led to a high detection rate in patients with suspected-positive sputum (P=0.0006) by the LIFE-Lung System. In conclusion, the LIFE-Lung System is a safe and non-invasive system for detecting small intraepithelial lesions of the tracheobronchial tree. Autofluorescence bronchoscopy is more efficacious for localizing intraepithelial lesions and places fewer burdens on the patient than brushing of all bronchi.

Autoregulation of the human D1A dopamine receptor gene by cAMP.

Stimulation of the D1A dopamine receptor increases intracellular cAMP concentration and down-regulates the receptor protein. We evaluated the possibility that this second messenger system could affect the expression of the D1A gene as a positive autoregulatory mechanism. Treatment of the D1A-expressing cells SK-N-MC with 100 microM dopamine resulted in an initial increase in steady-state levels of the D1A mRNA beginning at 30 min, followed by decline below the baseline and then recovery by 24 hr. Forskolin/IBMX (100 microM each) treatment also resulted in a decline followed by recovery. To determine if these changes in D1A message levels are due to transcriptional control, transient expression assays were done using reporter gene constructs of the human D1A gene 5'-flanking region. Forskolin/IBMX treatment for 19 hr resulted in a four- to seven-fold increase in trans-activation of the human D1A gene promoter. Two cAMP-responsive regions in exon 1 of this gene with nuclear protein binding sites within both regions were identified. The segment of the D1A gene between these two cAMP-responsive regions contained two additional DNA-protein interaction sites, one of which bound to nuclear factors considerably stronger following forskolin/IBMX treatment. Several consensus sequences for classical transcription factors known to mediate the cAMP response, such as CREB, AP2, and AP1, are found in the human D1A gene. However, the location of all but one AP2 site in other parts of this gene and lack of AP2 expression in SK-N-MC cells suggest that these factors are unlikely to transduce this response. Thus, dopamine treatment results in delayed cAMP-mediated trans-activation of the D1A gene via an indirect mechanism.

Mortality rates for farmers and fishermen in Japan compared with England and Wales.

Life tables for all causes of death for farmers and fishermen in Japan have been compared with those for England and Wales. Considering all causes of death, there are no occupational differences between farmers and fishermen in Japan. On the other hand, there are large occupational differences indicating that fishermen are worse off than farmers in England and Wales. Standardized mortality ratios (SMR) for each disease in terms of occupation have also been compared in the two countries. The SMRs for leading causes of death in Japan, such as cerebrovascular disease, are significantly lower for fishermen than for farmers in Japan. On the contrary, SMRs for leading causes of death in England and Wales, such as ischemic heart disease and lung cancer, are significantly higher for fishermen than for farmers in England and Wales. However the SMRs for ischemic heart disease and lung cancer are significantly higher for fishermen than for farmers in both countries.

Geographical distribution of cerebrovascular disease mortality and food intakes in Japan.

The present study focuses on an analysis of the relationship between cerebrovascular disease mortality and food intake. For this purpose, standardized mortality ratios(SMRs) from cerebrovascular disease were calculated for 3341 basic administrative units (wards, cities, towns and villages) between 1969 and 1978 in Japan. The major nutrient intakes and 30 selected food items were obtained from the 1974-1974 Ministry of Health and Welfare, National Nutrition Surveys in 1040 randomly sampled census tracts in 600 areas (18% of the nation). Our analysis demonstrates that the geographical pattern of cerebrovascular disease SMRs in Japan vary from higher in East Japan to lower in the West, and higher in the less urbanized areas, and lower in the more urban ones. Foods positively associated with cerebrovascular disease were rice and other starchy foods, pork, algae (seaweed), and salty foods such as miso (soybean paste), pickled vegetables, soy sauce and salted fish. All of these foods, with the exception of pork, are part of the traditional Japanese diet. On the contrary, mortality was negatively associated with intakes of wheat, butter and margarine, beef and eggs, items considered to be representative of a European diet. Using a stepwise multiple regression analysis, miso and salted fish were selected as positive, and beef and eggs as negative correlates of cerebrovascular disease mortality. According to these results, it is suggested that these four foods are useful as negative and positive indicators of improvement in dietary intakes as related to the reduction in the occurrence of cerebrovascular disease.

Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects.

Subjective sleep quality has been identified as an important clinical construct in psychiatric disordered patients. The Pittsburgh Sleep Quality Index (PSQI), one of the most widely used standardized measures to assess subjective sleep quality, generates a global score and scores seven components. The present study psychometrically assessed clinical profiles of subjective sleep quality in 82 control and 92 psychiatric disordered subjects (primary insomnia, n=14; major depression, n=30; generalized anxiety disorder, n=24; and schizophrenia, n=24), using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J). The overall reliability coefficient of the PSQI-J was high (Cronbach's alpha=0.77). Correlation coefficients between the PSQI-J global and component scores were statistically significant. The PSQI-J global and component mean scores were significantly higher in psychiatric disordered subjects than control subjects, except for the component of sleep duration. Using a cut-off point of 5.5 in the PSQI-J global score, estimations of sensitivity and specificity provided 85.7 and 86.6% for primary insomnia, 80.0 and 86.6% for major depression, 83.3 and 86.6% for generalized anxiety disorder, and 83.3 and 86.6% for schizophrenia, respectively. The present study supports the utility of the PSQI-J as a reliable and valid measure for subjective sleep quality in clinical practice and research.

Sleep loss and daytime sleepiness in the general adult population of Japan.

There are few epidemiological studies on sleep loss and daytime sleepiness in the general adult population of Japan. A total of 4000 adult people, aged 20 and over, were randomly drawn from five areas of Japan, and 3030 individuals were interviewed and completed a questionnaire including information about sleep duration and sleep problems. Overall, 29% slept less than 6 h at night, 23% reported having insufficient sleep, and 6% took sleep enhancing medications. The prevalence rates were 21% for symptoms of insomnia and 15% for excessive daytime sleepiness. Symptoms of insomnia were more prevalent in the elderly, whereas young people were more likely to report short sleep duration, subjective insufficient sleep and excessive daytime sleepiness. A multiple logistic regression model revealed that excessive daytime sleepiness had significant associations with young people, short sleep duration, insomnia symptoms, subjective insufficient sleep and sleep enhancing medication use. Short sleep duration was the strongest predictor of excessive daytime sleepiness. The findings indicate that sleep loss and excessive daytime sleepiness in the Japanese adult population are common, and comparable to those reported in Western countries. Excessive daytime sleepiness in the general adult population seems more likely to be attributed to short sleep duration.

Properties of high-molecular-mass placental alkaline phosphatases in normal pregnancy sera.

We examined the appearance of high-molecular-mass placental alkaline phosphatases (HPLAPs) in the serum of normal pregnant women by means of polyacrylamide gel electrophoresis (PAGE) in the presence of Triton X-100. The HPLAPs were undetectable or only slightly detectable by PAGE in the absence of Triton X-100. The HPLAPs were detected in all sera sampled during the last trimester of pregnancy. The catalytic activities of total placental alkaline phosphatase (TPLAP) and HPLAPs were correlated (r = 0.96) and the ratio of HPLAPs/TPLAP catalytic activity was 0.20 (0.06) (mean and SD) in 40 serum samples from pregnant women. The HPLAPs appear to be formed from a common dimeric placental alkaline phosphatase (PLAP) (common-PLAP), as judged by the fact that they were formed again after removal of HPLAPs from serum by gel filtration. The formation of HPLAPs was more prominently observed with the faster fractions of gel filtration. The apparent molecular mass of the HPLAPs in pregnancy serum was 720 KDa by gel filtration. HPLAPs were not converted to common-PLAP by phosphatidylinositol-specific phospholipase (PIPL) C and PIPL-D treatments. The HPLAPs were selectively incorporated into liposomes consisting of phosphatidylcholine/cholesterol, and most of the PIPL-D-treated PLAP could from HPLAPs, while a small amount of PLAP could not form HPLAPs. On the other hand, HPLAPs in pregnant women's sera and HPLAPs prepared from partially purified PLAP in vitro could be converted to common-PLAP by brief treatment with subtilisin. However, the highly purified PLAP could not form HPLAPs in the presence of Triton X-100. These results suggest that PIPL-D-resistant and PLAP-associated serum protein may regulate the conversion of PLAP to HPLAP in the presence of Triton X-100.

Cigarette smoking among junior and senior high school students in Japan.

PURPOSE: To estimate the smoking prevalence among junior and senior high school students in Japan. METHODS: We conducted a nationwide survey of adolescent smoking habits in 1990. Sample schools were selected by single random sampling. Self-administered anonymous questionnaires were sent to sample schools for all students to fill out. Seventy junior high schools and 33 senior high schools responded. A total of 57,189 students responded. RESULTS: The current smoking rate (the proportion of students who had smoked at least once during the previous month) was much higher among boys than girls. The current smoking rate among seventh graders was 4.0% for boys and 1.5% for girls, and it increased with age to reach 25.5% for boys and 4.9% for girls in the twelfth grade. The percentage of regular smokers in the seventh grade was less than 1% for both sexes, but it increased to 20.3% for boys and 2.2% for girls in twelfth grade. Among current smokers, the proportion of boys smoking 1-9 cigarettes per day decreased, and the proportion of boys smoking 10 or more cigarettes per day increased, as age increased. Most current smokers buy their cigarettes from cigarette vending machines or tobacconist shops. CONCLUSIONS: Since this survey reveals that smoking prevalence among students is not low even in junior high school, health education about smoking must start earlier and carry a greater emphasis within the curriculum. These results also indicate the importance of urging families to have greater concern for the smoking behavior of their children, of banning cigarette vending machines, and of preventing illegal sale of cigarettes to anyone under the age of 20 years.

[Smoking behavior of nurses in Mie Prefecture, Japan].

Nurses who work in hospitals and clinics belonging to a regional medical association in Mie prefecture were surveyed regarding their smoking behavior and several related factors. The results are summarized as follows: 1) Smoking prevalence in male and female nurses was 75.5% and 14.6% respectively. In the present study the rate of female nurses was almost equal to results reported in a national survey. 2) Smoking prevalence was higher among licensed practical nurses than registered nurses, and it was highest among psychiatric nurses. 3) Smoking prevalence among hospital and clinical nurses was 15.7% and 9.1% respectively. Smoking prevalence was lower among clinical nurses, even though, they have a higher number of licensed practical nurses. Also smoking prevalence was higher in hospitals with a smaller nursing staff than in hospitals with a larger nursing staff. 4) Among smokers, 44.5% seriously had attempted to quit smoking, and 34.1% had considered quitting but never tried. Therefore, the results suggest the importance of providing smoking cessation programs for nurses.