Trends in incidence and mortality of tuberculosis in Japan: a population-based study, 1997-2016.

Japan is still a medium-burden tuberculosis (TB) country. We aimed to examine trends in newly notified active TB incidence and TB-related mortality in the last two decades in Japan. This is a population-based study using Japanese Vital Statistics and Japan Tuberculosis Surveillance from 1997 to 2016. We determined active TB incidence and mortality rates (per 100 000 population) by sex, age and disease categories. Joinpoint regression was applied to calculate the annual percentage change (APC) in age-adjusted mortality rates and to identify the years showing significant trend changes. Crude and age-adjusted incidence rates reduced from 33.9 to 13.9 and 37.3 to 11.3 per 100 000 population, respectively. Also, crude and age-adjusted mortality rates reduced from 2.2 to 1.5 and 2.8 to 1.0 per 100 000 population, respectively. Average APC in the incidence and mortality rates showed significant decline both in men (-6.2% and -5.4%, respectively) and women (-5.7% and -4.6%, respectively). Age-specific analysis demonstrated decreases in incidence and mortality rates for every age category, except for the incidence trend in the younger population. Although trends in active TB incidence and mortality rates in Japan have favourably decreased, the rate of decline is far from achieving TB elimination by 2035.

Relationship between U83 gene variation in human herpesvirus 6 and secretion of the U83 gene product.

The betaherpesvirus human herpesvirus 6 (HHV-6) has two variants. The U83 gene product of strain HST is a chemoattractant for monocytes. Here, we describe U83 gene variations that accumulated in variants A and B. A gene-variation hot spot was examined in 36 different strains and one donor DNA sample. U83 gene variations accumulated in variant A and in reactivated variant B after transplantation. None of the variant-A viruses encoded the signal peptide found in the B variant. U83 gene sequencing suggested that the variant A and B groups were separate, and that the variant B viruses could be further divided into the HST-Z29 type and another type with a shorter signal peptide. In a eukaryotic expression system, the HST-Z29 type of U83 gene product was secreted into the medium, a frame-shifted HST-Z29 type was partially secreted, and the variant-A type and a first-methionine knockout of the HST-Z29 type were not secreted.

Psychological and behavioral mechanisms influencing the use of complementary and alternative medicine (CAM) in cancer patients.

BACKGROUND: This study explored the psychological and behavioral mechanisms of complementary and alternative medicine (CAM) use in Japanese cancer patients using two applied behavioral models, the transtheoretical model (TTM), and theory of planned behavior (TPB). PATIENTS AND METHODS: Questionnaires were distributed to 1100 patients at three cancer treatment facilities in Japan and data on 521 cancer patients were used in the final analysis. The questionnaire included items based on TTM and TPB variables, as well as three psychological batteries. RESULTS: According to the TTM, 88 patients (17%) were in precontemplation, 226 (43%) in contemplation, 33 (6%) in preparation, 71 (14%) in action, and 103 (20%) in maintenance. The model derived from structural equation modeling revealed that the stage of CAM use was significantly affected by the pros, cons, expectation from family, norms of medical staff, use of chemotherapy, period from diagnosis, and place of treatment. The primary factor for the stage of CAM use was the expectation from family. CONCLUSIONS: The findings revealed the existence of a number of psychologically induced potential CAM users, and psychological variables including positive attitude for CAM use and perceived family expectation greatly influence CAM use in cancer patients.

Screening of the Men1 gene and discovery of germ-line and somatic mutations in apparently sporadic parathyroid tumors.

Hyperparathyroidism is the first manifestation in a majority of multiple endocrine neoplasia (MEN1) patients. To discriminate between sporadic and hereditary parathyroid tumors and characterize MEN1 somatic mutations, we examined MEN1 gene mutations in patients who had undergone surgery for sporadic parathyroid tumors. DNA was extracted from fresh frozen parathyroid tumor specimens from 112 patients as well as from peripheral blood leukocytes from 64 of the 112 patients. Sequence analysis was performed to examine exons 2-10 of the MEN1 gene for mutations. Loss of heterozygosity (LOH) was also examined by an analysis of codon 418 and 541, which lie within a polymorphic region of MEN1. Somatic MEN1 mutations were found in 25 of the 112 patients (22%). Two patients had two point mutations (508del33 and Y341X and 363insT and 1767delT, respectively). A total of 27 mutations were characterized, 20 of which have not been reported previously. There were 7 nonsense mutations, 10 frameshift mutations, 2 splice site deletions, 5 missense mutations, and 3 in-frame mutations. Nineteen mutations (70%) predicted truncation of the menin protein. Germ-line MEN1 mutations were found in 3 of 64 patients (5%) who had no family history of endocrine tumors associated with MEN1, and these patients were identified as MEN1 gene probands. LOH at the MEN1 locus was detected in three parathyroid tumors showing germ-line mutation. LOH was significantly frequent in parathyroid tumors with somatic MEN1 mutations (15 of 22 tumors, 68%) but not in those without germ-line or somatic MEN1 mutations (14 of 51 tumors, 28%; P = 0.0011). Our findings suggest that alterations of both alleles of the MEN1 gene may be associated not only with endocrine tumors of affected MEN1 patients but also with sporadic parathyroid tumors. Germ-line MEN1 gene analysis can distinguish heritable from nonheritable parathyroid tumors, and MEN1 gene evaluation of patients with apparently sporadic parathyroid tumor is recommended before parathyroid surgery.

Intragenic homozygous deletion of the WT1 gene in Wilms' tumor.

One example of intragenic homozygous deletion of the WT1 gene on chromosome 11p13 was found after screening 42 samples of Wilms' tumor DNA from Japanese patients. After construction of a restriction map for the genomic sequence covering the 3' half of the gene, the deletion was analysed at the nucleotide sequence level. The deletion occurred in the patient's germline on his paternal chromosome, and most of the short arm of his maternal chromosome 11 was subsequently lost in the tumor. The size of the deletion was about 8 kb, removing exons 6 and 7 and resulting in premature termination. The deletion seemed to be created by recombination between short homologous sequences found in an Alu repeat, with a 16-bp duplication left at the junction. This case conforms to a two-hit model for the genesis of a certain group of tumors, and supports the hypothesis that WT1 is one of the recessive oncogenes responsible for Wilms' tumor.

Nuclear binding and sedimentation properties of two activated forms of glucocorticoid-receptor complexes from rat mammary glands.

Mammary cytoplasmic glucocorticoid-receptor complexes, which had been exposed to a high concentration of ammonium sulfate, were found to be separated into two receptor forms, consisting of DNA-cellulose-bound and non-DNA-cellulose-bound receptors. Experiments under cell-free conditions revealed that not only the DNA-cellulose-bound receptor but also the non-DNA-cellulose-bound receptor have binding abilities to nuclei and to nuclear chromatin. In sucrose density gradient centrifugation, the non-DNA-cellulose-bound receptor sedimented at higher sedimentation coefficients than the DNA-cellulose-bound receptor under all the salt conditions tested. These data strongly suggest that in the mammary glucocorticoid receptor system there exist at least two activated receptor forms with different conformations.

Structure and function of the F plasmid genes essential for partitioning.

The F plasmid in Escherichia coli has its own partition mechanism controlled by the sopA and sopB genes, and by the cis-acting sopC region. The DNA sequence of the entire partition region and its flanking regions is described here. Two large open reading frames coding for 43,700 Mr and 35,400 Mr proteins correspond to sopA and sopB, respectively. The sopB reading frame is located immediately downstream from the sopA reading frame. Twelve 43 base-pair direct repeats exist in the sopC region without any spacer regions, and one pair of seven base-pair inverted repeats exists in each of the direct repeats. Analysis of deletions in the sopC region showed that the direct repeats play an important role in plasmid partition and IncD incompatibility. IncG incompatibility is exhibited by pBR322 derivatives carrying the sopB gene alone. When compared with the partition genes parA and parB of plasmid P1, homology in amino acid sequence was found between the SopA protein of F and the ParA protein of P1, and also between SopB protein of F and ParB protein of P1. In addition, homology was found between Rep proteins of F and P1.

Production and characterization of recombinant human anti-HBs Fab antibodies.

Recombinant human Fab antibodies were generated with different reactivities against the hepatitis B virus surface (HBs) antigen. To isolate the antibodies, a method was used that combined transformation of human B cells by Epstein-Barr virus (EBV) infection with a primer-vector system developed for isolating DNA fragments of human Ig Fab portions. With this method, monoclonal and oligoclonal cell lines producing anti-HBs antibodies were established and three anti-HBs Fab antibodies were isolated from two of these cell lines. From analysis of affinity characteristics, immunohistochemical activity, and cytolysis activity, these three Fab antibodies were classified into three different groups. The first group had high affinity for HBs, the second had the ability to kill HBV-infected cells, and the third was applicable to immunohistochemical staining with HBV-infected cells. The combined effect of these antibodies was also investigated by complement-dependent cytotoxicity assay.

Formation of antigenic quinolone photoadducts on Langerhans cells initiates photoallergy to systemically administered quinolone in mice.

Quinolone antibacterial agents are well known to cause photoallergy as a side-effect. Murine photoallergy to fluoroquinolones is a T cell-mediated immune response, evoked either by systemic fluoroquinolone and subsequent exposure of skin to ultraviolet A light or by subcutaneous injection of fluoroquinolone-photomodified epidermal cells. In this photosensitivity, epidermal Langerhans cells may be photomodified initially with the drug and thus present photohaptenic moieties to sensitize and restimulate T cells. Although we have shown that Langerhans cells photocoupled in vitro with fluoroquinolones are capable of stimulating sensitized T cells, it remains unclear whether systemically given fluoroquinolone photomodifies Langerhans cells upon ultraviolet A irradiation of the skin and the Langerhans cells become photohapten-bearing, T cell-stimulatory cells. In a murine model of fleroxacin photoallergy induced by intraperitoneal injection of the drugs plus ultraviolet A irradiation of skin, we found that Langerhans cells as well as keratinocytes are photoderivatized with fleroxacin as demonstrated with a fluoroquinolone-specific monoclonal antibody. Langerhans-cell-enriched epidermal cells prepared from mice treated with fleroxacin and ultraviolet A induced proliferation of sensitized T cells, indicating that photomodified Langerhans cells are functional. There was an optimal range of ultraviolet A dose to quantitatively and qualitatively form fleroxacin-photomodified Langerhans cells, as excess ultraviolet A rather reduced the photoantigen-presenting capacity of Langerhans cells presumably because of drug phototoxicity. Our study suggests that Langerhans cells serve as photoantigen-presenting cells in drug photoallergy.

Expression of type II collagen at the middle stages of chick embryonic and human fetal skin development.

Using in situ hybridization techniques and RNase protection assays, type II collagen mRNA was transiently detected in the epidermis of chick embryonic skins during days 9-15 after fertilization, with a maximum expression at day 11. Immunohistochemical studies demonstrated that deposition of type II collagen was also transiently localized at the subepidermal region during days 10-15. Type II collagen gene and gene product concomitantly started to decline preferentially at the region where feather buds were being formed on day 12, and thereafter diminished at the region between feather buds. Using immunohistochemical methods, type II collagen was also detected in human fetal scalp skin at 17-23 fetal weeks at the subepidermal region, excluding the region beneath the hair follicles. These results indicate that the lack of type II collagen expression is related to the development of feather and hair at a certain stage of chick embryonic and human fetal skin development.

Changes in serum thyroid hormone, thyrotropin and thyroglobulin concentrations during thyroxine therapy in patients with solitary thyroid nodules.

We studied the effect of therapy with 0.1 mg/day T4 for 3 months on goiter size in 49 patients with solitary thyroid nodules. The nodule volume in 18 patients (responders) decreased by more than 50%. In this group the mean serum thyroglobulin (Tg) levels decreased significantly (from 425 to 61 micrograms/L; P less than 0.01). In the nonresponders the mean serum Tg levels did not change significantly (145 vs. 250 micrograms/L). The mean serum T4, free T4, free T3, and rT3 concentrations increased significantly in both groups during T4 therapy, serum T3 levels did not change, and serum TSH decreased. These findings demonstrate that serum Tg levels decrease when T4 therapy is effective. Thus, serum Tg measurements may prove a useful indicator of the efficacy of T4 therapy in patients with solitary nodules.

Sequencing of cDNA encoding serum albumin and its extrahepatic synthesis in the Mongolian gerbil, Meriones unguiculatus.

We have sequenced serum albumin cDNA from liver of the Mongolian gerbil, Meriones unguiculatus. The deduced amino acid sequence showed 82.6% and 73.6% identity with the corresponding proteins from rats and humans, respectively. Identical cDNA was detected in pancreas by reverse transcription followed by polymerase chain reaction (RT-PCR). Further amplification of cDNA by nested PCR revealed the presence of the same cDNA in the brain and kidney. These results indicate that serum albumin is expressed in some extrahepatic tissues. In rats, an albumin-related 70-kDa protein (P70) has been proposed to be associated with cobalt-induced epilepsy (Onozuka et al. (1995) Neurochem. Res., 20, 901-905). We intensively searched for a P70-like protein in the brain of an epilepsy-prone gerbil strain, MGS/Idr, by the RT-PCR and nested PCR using several pairs of primers based on the albumin cDNA sequence. However, we found only mRNA for albumin itself.

A tightly regulated expression system in Escherichia coli with SP6 RNA polymerase.

A tightly regulated gene-expression system was developed using SP6 RNA polymerase (RpoSP6). The RpoSp6-encoding gene (rpoSP6) was inserted into a mini-F plasmid (mini-F) and expression was controlled by the lactose promoter (P(lac)) and operator (O(lac)) on the plasmid. Therefore, a controlled expression system for the target genes can easily be constructed in various host strains by co-transformation of the system plasmid pFSP6 with other vector plasmids containing the genes linked to the SP6 promoters (P(SP6)). Using the lac gene linked to P(SP6) as a reporter, we evaluated the regulation of expression in this system in various host strains. Low-level expression of lac was detected in Escherichia coli harboring this expression system when RpoSP6 was uninduced, although very low activities of beta-galactosidase (beta-Gal) were observed which were independent of the presence of pFSP6. This basal level of beta-Gal activity was possibly derived, because the P(SP6) element has very weak activity for E. coli RNA polymerase (Rpo). These results showed that RpoSP6 seemed to be produced at very low levels in uninduced cells. Beta-GAl activity increased about 18-32-fold when the expression of rpoSP6 was induced, as compared with the beta-Gal activity when uninduced. The tight regulation of this system is superior to that of other known systems and it has a considerable advantage for gene expression in E. coli.

Lateral motion of fluorescent molecules embedded into cell membranes of clonal myogenic cells, L6, changes upon cell maturation.

The lateral motion of fluorescent molecules embedded into cell membranes of myogenic cell line, L6, was measured. The motion of S-F-ConA became faster at cell fusion stage, and became slower after fusion. On the other hand, the motion of lipid analog, F18, was not changed at cell fusion stage. However, after fusion when myotubes were formed, the motion of F18 became slower. At cell fusion stage, there was a large variation in the motion of S-F-ConA. This means that at this stage the properties of myoblasts change drastically and rapidly.

Calmodulin and calbindin localization in retina from six vertebrate species.

Calmodulin is abundant in the central nervous system, including the retina. However, the localization of calmodulin in the retina has not been described in detail. We therefore decided to investigate calmodulin localization in retinae from six vertebrate species, by using immunohistochemical labeling with four different rabbit polyclonal antibodies against calmodulin. The localization of calbindin-D28k, another calcium-binding protein already well described in retina, was compared. We found that calmodulin distribution is more highly conserved among species, contrasting with calbindin variability. The most striking result emerging is that calmodulin could not be detected in photoreceptors although other layers are intensely calmodulin-immunoreactive, casting doubt about a direct role of calmodulin in phototransduction. Horizontal cells are weakly calmodulin-immunoreactive, bipolar cells are calmodulin-immunoreactive except in turtle retina, numerous amacrine and ganglion cells are labeled in all species, and the fiber layer is always labeled. These data demonstrate that, while the calmodulin distribution in retina is similar among vertebrate species, selective differences in localization can be detected not only among the same cell types in different species but also among different cell types in the same species. The results showing differences in calmodulin immunoreactivity among cell types also provide further evidence that calmodulin expression in eukaryotes is not constitutive, in the sense that not every cell expresses similar levels of calmodulin.

Comparison of chemotherapy with or without medroxyprogesterone acetate for advanced or recurrent breast cancer.

The usefulness of CAF [cyclophosphamide (CPA)/doxorubicin (ADR)/5-fluorouracil (5-FU)] + medroxyprogesterone acetate (MPA) therapy for advanced/recurrent breast cancer was studied in a randomised trial at 56 institutions. Patients received CAF therapy [CPA: 100 mg, orally, days 1-14; ADR: 30 mg/m2, intravenously (i.v.), days 1 and 8; 5-FU: 500 mg/m2, i.v., days 1 and 8) in arm I, or CAF + MPA therapy (CAF + MPA 1200 mg, daily) in arm II. The response rate was significantly higher (P = 0.041) in arm II (53.5%, 46/86) than arm I (36.6%, 30/82). The response rate by tumour site was significantly higher for lymph node and bone lesions in arm II. Partial response duration and overall response duration were significantly longer in arm II. Incidences of anorexia and nausea/vomiting were significantly higher in arm I but in arm II, moon face, oedema and vaginal bleeding were significantly higher. Many patients in arm II demonstrated improvement in performance status and weight loss, suggesting a beneficial effect of MPA. The chemoendocrine therapy with CAF + MPA appears to be more beneficial than CAF alone in the treatment of advanced/recurrent breast cancer.

Multifocal electroretinograms in patients with branch retinal artery occlusion.

PURPOSE: To investigate the usefulness of second-order multifocal electroretinograms (MERGs) for detecting inner retinal disorders. METHODS: The MERG from 5 patients with branch retinal artery occlusion (BRAO) was recorded. Twelve eyes of 12 normal subjects were also tested. MERGs were recorded using 61 hexagons. Bright flash ERGs were also recorded to measure the oscillatory potentials (OP). Root mean square (RMS) measures of the local first- and second-order MERGs (fMERG and sMERG) were compared in the affected and unaffected areas. The first negative trough (N1) and first positive peak (P1) were also used for measuring the amplitudes and latencies of the fMERG. RESULTS: The fMERG RMS-amplitudes decreased significantly (r = 0.56, P: < 0.05) in the affected area compared with normal values. The fMERG latencies of N1 and P1 increased significantly (P: < 0.05) in the affected area. Furthermore, the sMERG RMS-amplitudes decreased almost to the noise level (r = 0.28, P: < 0.001) in the affected areas. The interocular ratio of the sMERG RMS-amplitudes (affected/normal) significantly correlated with that of the fMERG (r = 0.69, P: < 0.001). The fMERG latencies significantly correlated with the sMERG RMS-amplitude (r = 0.37 approximately 0.69, P: < 0.05 approximately 0.001), but only began to increase after a 30% to 50% loss of the sMERG amplitude. The summed OP amplitude decreased to the same extent as the sMERG in the affected eye (0.5 of the normal eye). CONCLUSIONS: Although the fMERG amplitude and latency were significantly changed, the sMERG was much more affected by BRAO. The marked reduction of the sMERG in the affected area strongly suggested its main source was from the more inner layers of the retina compared to the fMERG. The sMERG appeared to be a sensitive indicator of inner retinal dysfunction.

Roxithromycin down-modulates antigen-presenting and interleukin-1 beta-producing abilities of murine Langerhans cells.

The immunomodulatory effect of the macrolide antibiotic, roxithromycin (RXM) on Langerhans cells (LC) was studied in mice. RXM inhibited the ability of LC to present superantigen and hapten to T cells at 100 microM. The superantigen-presenting activity of LC was more profoundly abrogated by RXM than the hapten-presenting activity. This functional reduction was partly attributed to an RXM-induced decrease in promotion of the expression of major histocompatibility complex class II molecules on LC. On the other hand, RXM down-modulated the production of interleukin-1 beta by LC at a lower concentration of 10 microM than concentrations that inhibited antigen presentation. These results imply that RXM exerts therapeutic effectiveness via not only bacteriocidal action but also inhibitory effect on the LC ability in T-cell-mediated cutaneous diseases that can be exacerbated by skin-colonized Staphylococcus aureus.

Lymphocyte stimulation test with drug-photomodified cells in patients with quinolone photosensitivity.

Quinolone antibacterial agents, known to elicit photosensitive dermatitis as an adverse effect, have both phototoxicity and photoallergenicity. The latter potency is mainly derived from their photohaptenic moiety; quinolones covalently bind to protein and cells upon exposure to ultraviolet A (UVA) light. Our previous study has shown the in vivo and in vitro antigenicity of quinolone-photomodified cells in mice. Here, we examined the presence of sensitized lymphocytes that react with quinolone-photomodified autologous cells in patients with photosensitivity to quinolones. A flow cytometric analysis using a monoclonal antibody specific to quinolone photoadducts demonstrated that peripheral blood mononuclear cells (PBMC) were successfully photomodified with quinolones upon exposure to UVA. PBMC from quinolone-photosensitive patients were cocultured with autologous PBMC photomodified with the causative drug. Modest but significant proliferative responses of responder lymphocytes were found in patients photosensitive to lomefloxacin, fleroxacin, and enoxacin, indicating photoallergic mechanism in these patients. On the other hand, sparfloxacin-photosensitive patients exhibited negative lymphocyte stimulation test, suggesting that its photosensitivity is mainly phototoxic. When UVA-preirradiated quinolones were used as stimulators, only fleroxacin exceptionally stimulated patients' PBMC, indicating its prohaptenic as well as photohaptenic properties. These findings suggest the presence of circulating sensitized T cells in patients with photosensitivity to certain quinolones.

Phospholipid reverse micelles as a milieu of an enzyme reaction in an apolar system.

Alkaline phosphatase was entrapped in reverse micelles formed in n-heptane with surfactants (bis(2-ethylhexyl)sodium sulfosuccinate, phosphatidylcholine, phosphatidylethanolamine, or phosphatidic acid) and water. The entrapped enzyme could express its activity in the reverse micelles of the above surfactants only when the substrate, p-nitrophenylphosphate, was within the reverse micelles of bis(2-ethylhexyl)sodium sulfosuccinate. The optimum pH of activity in the reverse micelles was higher by about one pH unit than that determined in bulk water. Regardless of water content (mol water/mol surfactant = 10 or 14.8), the Km value was about 30 mM, while Vmax at the higher water content (14.8) was 2-4 times greater than that at 10. Activation energy of the reaction depended on the kind of reverse micelles. Differences in carbon chain length of solvents showed no effect on the kinetic properties of the enzyme.