Association between patient education and health-related quality of life in patients with Parkinson's disease.

BACKGROUND: Providing patients with disease- and treatment-related information is an important role of medical staff and is now reimbursed in Japan by the national health insurance system under the rubric 'patient education'. Evaluation of the effectiveness of patient education programs is necessary to ensure that limited health care resources are used efficiently. OBJECTIVE: The objective is to determine whether educating patients with Parkinson's disease (PD) is related to better health-related quality of life (HRQOL). DESIGN: A cross-sectional study was conducted. SETTING: Members of the Japan Association of Patients with Parkinson's disease were randomly selected. PARTICIPANTS: A total of 1200 patients with PD were asked to fill in written questionnaires and replies from 762 (63.5%) were analyzed. MEASUREMENTS: The questionnaire inquired about clinical characteristics, comorbidity, symptoms of PD, complications of therapy, HRQOL, and patient education. SF-36 was used to assess HRQOL. The section on patient education comprised one question each on patient-perceived satisfaction with information provided on (1) disease condition and pathophysiology, (2) effectiveness of drug therapy, (3) adverse drug reactions, (4) publicly available financial and social resources, and (5) rehabilitation and daily activities. Patient education score was defined as the sum of the individual scores for these five questions. The relationships between scores on the SF-36 subscales and the patient education score were examined. RESULTS: More satisfaction with patient education was associated with higher scores in all SF-36 subscales except physical functioning and bodily pain. The difference in score between the most satisfied and the least satisfied patients ranged from 8.4 points on the subscales of general health and 16.7 points on the subscale of role limitation due to emotional problems. CONCLUSION: The conclusion that patient education is associated with better HRQOL in patients with PD is drawn.

Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy.

BACKGROUND: Thoracoscopic esophagectomy for esophageal cancer has been performed as an alternative to open surgery to reduce surgical trauma. However, its effect on pulmonary function, exercise tolerability, and quality of life is unknown. METHODS: Fifty-one patients with esophageal cancer underwent thoracic esophagectomy with radical lymphadenectomy by posterolateral thoracotomy (29 cases) or thoracoscopic surgery (22 cases). Patients performed spirometry and exercise tolerance testing and completed a quality-of-life questionnaire before and 3 months after surgery. RESULTS: Pre-to-postoperative change in vital capacity was 74.3 +/- 10.6% in the thoracotomy group and 84.9 +/- 10.4% in the thoracoscopy group (p = 0.021). Maximum oxygen uptake was similar, but dyspnea was the more common factor limiting exercise tolerance postoperatively in the thoracotomy group. Change in pre-to-postoperative performance status was 1.20 +/- 0.62 in the thoracotomy group and 0.55 +/- 0.51 in the thoracoscopy group (p = 0.0003). CONCLUSIONS: Thoracoscopic esophagectomy for esophageal cancer has better preservation of pulmonary function and quality-of-life.

Immunologic effects of allogeneic versus autologous blood transfusion in patients undergoing radical oesophagectomy.

Blood transfusion is often required in patients undergoing radical oesophagectomy, and is associated with immunosuppression that may worsen postoperative and long-term outcomes. However, the immunologic effects of allogeneic versus autologous transfusion have not been studied in this group of patients. We analyzed 103 patients who underwent radical oesophagectomy for oesophageal cancer, including 45 patients who received allogeneic transfusions (Allo), 16 patients who donated autologous blood but were not transfused (Auto-1) and 42 patients who received autologous transfusions (Auto-2). Peripheral blood lymphocyte subsets and natural killer (NK) cell activity were analyzed for 2 weeks postoperatively. Furthermore, the rate of infectious complications such as pneumonia and wound infection was compared. Patients receiving blood transfusion had decreased CD4+ lymphocyte counts and NK cell activity postoperatively, compared to Auto-1 patients. However, these abnormalities were corrected by day 14 in the Auto-2 group, but not in the Allo group. CD8+ lymphocyte counts were decreased in all groups postoperatively, returning to normal by 14 days in the Auto-1 group only. The rate of infectious complications was significantly higher in the Allo than in the Auto group. Blood transfusion is associated with adverse immunologic effects in patients undergoing radical oesophagectomy. However, autologous blood transfusion is favourable compared to allogeneic transfusion. Autologous transfusion programs should be employed when possible in this group of patients.

Cancer chemoprevention by ginseng in mouse liver and other organs.

Oral administration of red ginseng extracts (1% in diet for 40 weeks) resulted in the significant suppression of spontaneous liver tumor formation in C3H/He male mice. Average number of tumors per mouse in control group was 1.06, while that in red ginseng extracts-treated group was 0.33 (p<0.05). Incidence of liver tumor development was also lower in red ginseng extracts-treated group, although the difference from control group was not statistically significant. Anti-carcinogenic activity of white ginseng extracts, besides red ginseng extracts, was also investigated. In the present study, the administration of white ginseng extracts was proven to suppress tumor promoter-induced phenomena in vitro and in vivo. It is of interest that oral administration of the extracts of Ren-Shen-Yang- Rong-Tang, a white ginseng-containing Chinese medicinal prescription, resulted in the suppression of skin tumor promotion by 12-o-tetradecanoylphorbol-13-acetate in 7,12-dimethylbenz[a]anthracene-initiated CD-1 mice. These results suggest the usefulness of ginseng in the field of cancer prevention.

Characterization of a novel gene encoding a putative single zinc-finger protein, ZIM, expressed during the reproductive phase in Arabidopsis thaliana.

By differential screening of an arrayed normalized cDNA library from the inflorescence apex in Arabidopsis, a cDNA clone having a deduced amino acid sequence with a motif for a zinc finger was isolated as one of the genes expressed specifically in the reproductive phase. The deduced protein has a modular structure with a putative single C2-C2 zinc-finger motif distantly related to a GATA-1-type finger, a basic region with a sequence resembling a nuclear localization signal, and an acidic region. The gene seemed to have been formed by the exon-shuffling during its molecular evolution, since individual domains are encoded by discrete exons. RNA gel blot analysis showed its expression in shoot apex and flowers in the reproductive phase. The gene was named ZIM for Zinc-finger protein expressed in Inflorescence Meristem. The nuclear localization of ZIM was detected using GFP as a reporter. These results suggest that ZIM is a putative transcription factor involved in inflorescence and flower development.

Somatosensory cortex stimulation-evoked analgesia in rats: potentiation by NO synthase inhibition.

Clinical and immunohistochemical evidence suggests the possible significance of electrical stimulation of the secondary somatosensory cortex (S-II) as an analgesic therapy. The aim of the present study was to gain behavioral evidence for S-II stimulation-induced antinociception in conscious rats and to evaluate if the evoked antinociception can be potentiated by the neuronal NO synthase inhibitor 7-nitro-indazole. S-II stimulation produced a weak antinociception in the formalin-induced nociception test, but not in the thermal or mechanical nociception tests. This effect was remarkably potentiated by systemic administration of 7-nitro-indazole at a small dose that had no effect by itself. Thus, our data provide behavioral evidence for S-II stimulation-induced analgesia and may also predict a novel therapeutic strategy in combination with NO synthase inhibitors.

Probing stimulants from the rice plant towards the smaller brown planthopper, Laodelphax striatellus (FALLEN) (Homoptera: Delphacidae).

When adult males of the smaller brown planthopper, Laodelphax striatellus were fed on 2% crude rice (leaf and stem) extract containing 15% sucrose there were characteristic stylet sheaths deposited on parafilm membrane. Further bioassays with the butanol-soluble fr. of the extract revealed that it is highly effective for the insects. When the butanol fr. was charged on an ODS open column and eluted in sequence with 20, 40 and 100% methanol in water, the ODS-40% methanol fr. was shown as the most effective one. Further separation of the ODS-40% methanol fr. resulted in six effective components. These components acted to stimulate very high probing response on L. striatellus only when they are combined. This activity was found to be similar to those of the ODS-40% methanol fr. and the original crude rice plant extract. Two of the active components were identified as tricin 5-O-glucoside and tricin 7-O-glucoside, respectively, through spectroscopic analyses.

The cyanogenic glucoside, prunasin (D-mandelonitrile-beta-D-glucoside), is a novel inhibitor of DNA polymerase beta.

A DNA polymerase beta (pol. beta) inhibitor has been isolated independently from two organisms; a red perilla, Perilla frutescens, and a mugwort, Artemisia vulgaris. These molecules were determined by spectroscopic analyses to be the cyanogenic glucoside, D-mandelonitrile-beta-D-glucoside, prunasin. The compound inhibited the activity of rat pol. beta at 150 microM, but did not influence the activities of calf DNA polymerase alpha and plant DNA polymerases, human immunodefficiency virus type 1 reverse transcriptase, calf terminal deoxynucleotidyl transferase, or any prokaryotic DNA polymerases, or DNA and RNA metabolic enzymes examined. The compound dose-dependently inhibited pol. beta activity, the IC(50) value being 98 microM with poly dA/oligo dT(12-18) and dTTP as the DNA template and substrate, respectively. Inhibition of pol. beta by the compound was competitive with the substrate, dTTP. The inhibition was enhanced in the presence of fatty acid, and the IC(50) value decreased to approximately 40 microM. In the presence of C(10)-decanoic acid, the K(i) value for substrate dTTP decreased by 28-fold, suggesting that the fatty acid allowed easier access of the compound to the substrate-binding site.

L-tryptophan-kynurenine pathway metabolite 3-hydroxyanthranilic acid induces apoptosis in macrophage-derived cells under pathophysiological conditions.

Accumulation of L-kynurenine and 3-hydroxyanthranilic acid (3HAA) occurs in the monocyte-derived cells following immune stimulation, and may derive from L-tryptophan following induction of indoleamine-2,3-dioxygenase. In the present study, we evaluate the possibility that 3HAA acts as an endogenous inducer of monocyte/macrophage apoptosis. Supplementation with 200 microM of 3HAA, but not other L-tryptophan metabolites tested, significantly increased the number of apoptotic cells in both THP-1 and U937 cells. Catalase, superoxide dismutase and manganese ions markedly enhanced apoptosis in the presence of 3HAA in these cells. The present results suggest that 3HAA induces the macrophage/monocyte apoptosis under certain conditions, which may be relevant to pathophysiology of inflammatory conditions.

The herbal medicine sho-saiko-to inhibits the growth of malignant melanoma cells by upregulating Fas-mediated apoptosis and arresting cell cycle through downregulation of cyclin dependent kinases.

The anti-tumor effect and its mechanism of the herbal medicine sho-saiko-to were investigated on a murine malignant melanoma cell line (Mel-ret). Sho-saiko-to induced apoptotic cell death of Mel-ret cells with a definite increase of cell surface Fas antigen and Fas ligand (FasL). Sho-saiko-to arrested Mel-ret cells in G1 phase by decreasing the expression of cyclin-dependent kinase (cdk) 4 and its homologue cdk6. Kinase activities of cdk4 and cdk6 were identified to be downregulated by sho-saiko-to. Ingredient analysis revealed that baicalin is likely the main active constituent in the upregulation of Fas antigen and Fas ligand, while glycyrrhizin is the main constituent in the inhibition of cdks.

Nitric oxide in the rat spinal cord in Freund's adjuvant-induced hyperalgesia.

To elucidate the involvement of nitric oxide in spinal nociceptive processing, the correlation of thermal withdrawal latency with nitric oxide synthase-stained neurons in the rat lumbar dorsal horn was analyzed after adjuvant-induced inflammation. From 4 hr through 5 days after subcutaneous injection of complete Freund's adjuvant into the hind paw, a marked thermal hyperalgesia was observed for heat stimulus applied to the affected region. NADPH-diaphorase- and nitric oxide synthase-positive neurons increased significantly in the superficial layers of the dorsal horn ipsilateral to the inflamed hind paw at day 3 of adjuvant-induced inflammation. No change in NADPH-diaphorase-positive neurons was observed at 1 hr and 1 day of adjuvant-induced inflammation. The intravenous administration of N omega-nitro-L-arginine methyl ester (L-NAME, 50 mg/kg), an inhibitor of nitric oxide synthase, significantly blocked the adjuvant-induced thermal hyperalgesia at day 3 of inflammation, but not at day 1; and it had no effect in non-inflamed rats. This anti-hyperalgesic effect of L-NAME at day 3 of inflammation was reversed by the prior administration of L-arginine (600 mg/kg, i.p.), a substrate of nitric oxide synthase. These data suggest that nitric oxide producing neurons in the spinal dorsal horn are involved in maintaining and facilitating the hyperalgesia associated with chronic nociception.

Hyperthermia reduces the occurrence of proliferative vitreoretinopathy in a rabbit model.

The effects of hyperthermia on experimental proliferative vitreoretinopathy (PVR) in rabbits were studied. Heat treatment (42.4 degrees C for 30 min) of the retinal surface (as estimated from temperature measurement of the retrobulbar space) 2 to 3 hr after fibroblast injection reduced the occurrence of traction retinal detachment compared with control rabbits (P less than 0.02), but the incidence of pucker formation plus traction detachment was not significantly different between the two groups. In a separate experiment, heat treatment applied to normal rabbit eyes showed only reversible elongation in the latency of the electroretinographic b-wave without affecting the amplitude. Histologic examination revealed no significant changes in the heat-treated normal rabbit retina. Hyperthermia may be used as a new therapeutic tool for PVR.

The simultaneous use of autologous blood transfusion and hypotensive anesthesia to the radical hysterectomy for uterine carcinomas.

A homologous blood transfusion is often required to replace intraoperative blood loss in a radical hysterectomy. Recently, we have tried the simultaneous use of autotransfusion (predonation and transfusion of autologous blood) and hypotensive anesthesia to eliminate the homologous blood transfusion. Radical hysterectomy was done in 27 cases with uterine cancer from June 1986 to March 1987 at the Kure National Hospital. A homologous blood transfusion was required in 1 of 5 cases with only autotransfusion, none of 5 cases with a simultaneous use of autotransfusion and hypotensive anesthesia, and 6 of 17 cases with neither autotransfusion nor hypotensive anesthesia. The simultaneous use of autotransfusion and hypotensive anesthesia seemed to be effective in reducing the need for homologous blood transfusions.

Inhibition of histamine release from rat hypothalamic slices by omega-conotoxin GVIA, but not by nilvadipine, a dihydropyridine derivative.

Histamine release in response to 40 mM high K+-stimulation from the rat hypothalamic slice preparations perifused in vitro was significantly inhibited by 1.0 nM-1.0 microM omega-conotoxin GVIA, a peptide modulator of N- and L-type voltage-sensitive calcium channels, but not by similar concentrations of nilvadipine, a dihydropyridine derivative of L-type calcium channel antagonist. These results indicate that the voltage-sensitive calcium channel controlling histamine release from hypothalamic slices is omega-conotoxin-sensitive but dihydropyridine-insensitive.

[The application of autologous blood transfusion and hypotensive anesthesia for radical hysterectomy in uterine cancer].

The homologous blood transfusion is often required for the replacement of intraoperative blood loss in the radical hysterectomy. Recently, we have tried elective autologous blood transfusion and hypotensive anesthesia to eliminate the complications caused by homologous blood transfusion. This study reports our experience at Kure National Hospital. Radical hysterectomy has been done in 27 cases with uterine cancer from June, 1985 to March, 1987. Homologous blood transfusion was required to one of 5 cases with autologous blood transfusion, none of 5 cases with autologous blood transfusion and hypotensive anesthesia, and 6 of 17 cases without either procedures. Autologous transfusion and hypotensive anesthesia seemed to be effective in reducing homologous blood transfusion.