Effect of taurine on acinar cell apoptosis and pancreatic fibrosis in dibutyltin dichloride-induced chronic pancreatitis.

The relationship between pancreatic fibrosis and apoptosis of pancreatic acinar cells has not been fully elucidated. We reported that taurine had an anti-fibrotic effect in a dibutyltin dichloride (DBTC)-chronic pancreatitis model. However, the effect of taurine on apoptosis of pancreatic acinar cells is still unclear. Therefore, we examined apoptosis in DBTC-chronic pancreatitis and in the AR42J pancreatic acinar cell line with/without taurine. Pancreatic fibrosis was induced by a single administration of DBTC. Rats were fed a taurine-containing diet or a normal diet and were sacrificed at day 5. The AR42J pancreatic acinar cell line was incubated with/without DBTC with taurine chloramines. Apoptosis was determined by using terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay. The expression of Bad and Bcl-2 proteins in the AR42J cells lysates was detected by Western blot analysis. The apoptotic index of pancreatic acinar cells in DBTC-administered rats was significantly increased. Taurine treatment inhibited pancreatic fibrosis and apoptosis of acinar cells induced by DBTC. The number of TUNEL-positive cells in the AR42J pancreatic acinar cell lines was significantly increased by the addition of DBTC. Incubation with taurine chloramines ameliorated these changes. In conclusion, taurine inhibits apoptosis of pancreatic acinar cells and pancreatitis in experimental chronic pancreatitis.

Measurement and correlates of empathy among female Japanese physicians.

BACKGROUND: The measurement of empathy is important in the assessment of physician competence and patient outcomes. The prevailing view is that female physicians have higher empathy scores compared with male physicians. In Japan, the number of female physicians has increased rapidly in the past ten years. In this study, we focused on female Japanese physicians and addressed factors that were associated with their empathic engagement in patient care. METHODS: The Jefferson Scale of Empathy (JSE) was translated into Japanese by using the back-translation procedure, and was administered to 285 female Japanese physicians. We designed this study to examine the psychometrics of the JSE and group differences among female Japanese physicians. RESULTS: The item-total score correlations of the JSE were all positive and statistically significant, ranging from .20 to .54, with a median of .41. The Cronbach's coefficient alpha was .81. Female physicians who were practicing in "people-oriented" specialties obtained a significantly higher mean empathy score than their counterparts in "procedure-" or "technology-oriented" specialties. In addition, physicians who reported living with their parents in an extended family or living close to their parents, scored higher on the JSE than those who were living alone or in a nuclear family. CONCLUSIONS: Our results provide support for the measurement property and reliability of the JSE in a sample of female Japanese physicians. The observed group differences associated with specialties and living arrangement may have implications for sustaining empathy. In addition, recognizing these factors that reinforce physicians' empathy may help physicians to avoid career burnout.

New large bowel segmentation on plain abdominal radiography in comparison with the conventional method.

Plain abdominal radiography is a very basic examination and plays an important role in primary care. The objectives of this study were to clarify colon distributions on plain abdominal radiographs. Forty-three healthy volunteers underwent gastric fluoroscopy, and 2 hours later, plain abdominal radiography in the supine position. A region of interest (ROI) was defined uniformly on each X-ray image to divide the image into 600 zones. The area corresponding to the large bowel within the ROI was divided into 4 segments (ascending colon, transverse colon, descending colon, and sigmoid colon + rectum). The percentage of barium in each segment relative to the total volume of barium used was calculated to evaluate the percent ROI occupancy. The large bowel covered 76.7% of the entire ROI, with the percent duplication being 55%. The duplicated area corresponded to the transverse colon region. When the method proposed by Arhan et al. was used, the percentage of the colon actually present in each segment relative to that determined theoretically was 99.6% for the right colon segment, 92.2& for the left colon segment, and 92.2% for the sigmoid/rectal segment. However, in cases in which the transverse colon descended partially from the fifth lumbar vertebra, the percentage occupied by the sigmoid colon + rectum decreased to 57.2%. We applied a new large bowel segmentation method especially for patients with ptosis, by devising a line joining the lateral side of the right lesser pelvis and the lower ends of both sacroiliac joints.

[Medical support on human resources and clinical laboratory in Myanmar].

I have been involved in medical cooperation programs between Myanmar and Japan for over 10 years. The purpose of the first visit to Myanmar was the investigation of hepatitis C spreading among thalassemia patients. I learned that the medical system was underdeveloped in this country, and have initiated several cooperation programs together with Professor Shigeru Okada, such as the "Protection against hepatitis C in Myanmar", "Scientist exchange between the Ministry of Health, Myanmar and Okayama University", and "Various activities sponsored by a Non-Profit Organization". As for clinical laboratories, the laboratory system itself is pre-constructed and the benefit of a clinical laboratory in modern medicine is not given to patients in Myanmar. The donation of drugs and reagents for laboratory tests is helpful, but it will be more helpful to assist the future leaders to learn modern medicine and develop their own various systems to support modern medicine. Our activity in the cooperation program is described.

Weber-Christian disease developing into mediastinitis and pleuritis with massive pleural effusion.

A 53-year-old man visited our hospital complaining of high fever. Chest computed tomography showed left pleural effusion and mediastinitis. He developed painful red subcutaneous nodules in his bilateral lower extremities. Thoracoscopy-assisted exploratory excision showed visceral pleura thickening; panniculitis in the periaortic area was histologically proven. The patient was treated with corticosteroid therapy which immediately reduced the fever. Subsequent imaging examinations after corticosteroid therapy showed improvement of mediastinitis and pleural effusion. This case reminds us that Weber-Christian disease (WCD) should be included in the differential diagnosis of mediastinitis although WCD is rarely associated with thoracic involvement.

Successful treatment of sepsis caused by Staphylococcus lugdunensis in an adult with 22q11.2 deletion syndrome.

A 27-year-old woman visited our hospital because of high fever. She had been diagnosed as 22q11.2 deletion syndrome (22q11.2DS) due to her cardiac history (tetralogy of Fallot), thymic hypoplasia and 22q11.2 deletion. She had a normal CD4/CD8 ratio, a slightly decreased lymphocyte count and normal serum immunoglobulin levels. Blood cultures were positive for Staphylococcus lugdunensis (S. lugdunensis). Infection route of S. lugdunensis in this case was unclear. The patient was successfully treated with several intravenous antibiotics. Infection should be considered when managing patients with 22q.11.2DS. regardless of whether their immune system is impaired.

Long-term Taenia saginata infection successfully treated with meglumine/diatrizoate sodium.

A 46-year-old Japanese man visited our hospital for chronic abdominal pain, persistent diarrhea and discharge of proglottids for 7 years. He had been living in Lao People's Democratic Republic. Ileography using meglumine/diatrizoate sodium (Gastrografin) revealed a long tapeworm. A Taenia saginata including the scolex was excreted through the intestinal tract by the administration of total 780 ml of Gastrografin. Taeniasis is an important disease in the differential diagnosis of imported diseases in Japan. Parasite infection should be suspected in patients with chronic abdominal pain or persistent diarrhea regardless of the findings for small bowel obstruction when there is a history of overseas travel.

Usefulness of the right parasternal approach to evaluate the morphology of atrial septal defect for transcatheter closure using two-dimensional and three-dimensional transthoracic echocardiography.

BACKGROUND: The aim of this study was to demonstrate the feasibility and usefulness of addition of the right parasternal approach to the conventional left parasternal and apical approaches using two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography (TTE) for morphologic evaluation in cases of transcatheter closure of atrial septal defects (ASDs). METHODS: In 112 consecutive patients with ASDs, the morphology of the defects was evaluated for transcatheter closure in the right parasternal view in addition to the conventional left views using 2D and 3D TTE. Measurements of the maximal ASD diameter and detection of deficient rim obtained on 2D TTE were compared with those obtained by 2D transesophageal echocardiography. The shapes and locations of ASDs visualized by 3D TTE were compared with those visualized by 3D transesophageal echocardiography. RESULTS: In 88 patients (80.0%), optimal images from the right parasternal approach for morphologic evaluation of ASDs were obtained. Although there was a significant difference in maximal ASD diameter obtained only in the conventional left approach compared with transesophageal echocardiographic measurements (P < .05), when the right parasternal approach was applied, a significant difference was not found (P = .18), and the diagnostic concordance of the rim deficiency was improved from 85.2% to 90.9%. Three-dimensional TTE from the right parasternal approach improved visualization of the shape and location of ASDs from 65.5% to 74.5%. CONCLUSIONS: Additional use of the right parasternal approach enables detailed morphologic evaluation for transcatheter closure of ASDs. In patients with suboptimal images on 3D TTE in the left conventional approach, additional 3D TTE in the right parasternal approach can improve the feasibility of obtaining optimal 3D images to evaluate the shapes and locations of ASDs.

Two novel mutations of lecithin:cholesterol acyltransferase (LCAT) gene and the influence of APOE genotypes on clinical manifestations.

Familial lecithin:cholesterol acyltransferase deficiency (FLD) is an autosomal recessive disorder characterized by corneal opacity, hemolytic anemia, low high-density lipoprotein cholesterol (HDL-C) and proteinuria. Two novel lecithin:cholesterol acyltransferase (LCAT) mutations[c.278 C>T (p.Pro69Leu); c.950 T>C (p.Met293Thr)] were identified in a 27-year-old man and in a 30-year-old woman, respectively. Both patients manifested corneal opacity, hemolytic anemia, low low-density lipoprotein cholesterol and HDL-C and proteinuria. Lipid deposits with vacuolar lucent appearance in glomerular basement membranes were observed in both cases. APOE genotype was also investigated: the first case results ϵ4/ϵ3, the second ϵ2/ϵ2; however, they shared a similar phenotype characterized by the presence of intermediate-density lipoproteins (IDL) remnant and the absence of lipoprotein-X. In conclusion, our findings suggest that APOE ϵ2/ϵ2 may not be the major determinant gene for the appearance of IDL in FLD patients.

Prevalence and factors associated with hepatitis C virus infection among Myanmar blood donors.

We studied the prevalence of hepatitis C virus infection among blood donors from 3 hospitals of Central Myanmar and 7 hospitals of Lower Myanmar in the Yangon area, and analyzed the factors associated with the infection. The study period was from November, 2005 to June, 2007. A pre-tested questionnaire was used to obtain information on age, ethnic group, marital status, tattooing, body piercing, history of receiving transfusions, and liver diseases in self and in sexual partners. Data on seropositivity to hepatitis C, hepatitis B and human immunodeficiency virus infections were recorded. A total of 65,240 blood donors participated in the study. Their ages ranged from 18 years to 60 years (mean±SD=29.5±9.3). The male-to-female ratio was 6:1. The prevalence of the antibody to hepatitis C was found to be 0.95% with varying rates (0.34 to 2.03) among hospitals. Females had a slightly higher rate (1.06%) than males (0.93%) (p=0.237). Multivariate analyses revealed the following factors to be related to HCV infection:HIV infection, odds ratio (OR)=3.0 (p=0.003); history of liver disease, OR=8.9 (p=0.001);and age 30 years and above, OR=2.6 (p=0.001). We discuss the varying prevalences of HCV around the world.

Long-term management of hepatitis C-seropositive subjects with AntiOxidant Biofactor (AOB), a fermented food supplement.

The efficacy of AntiOxidant Biofactor (AOB) for the management of apparently healthy subjects with chronic hepatitis C infection was investigated. A total of 60 subjects (35 males, 25 females) participated in the trial. AOB was given orally in 2 packs (3 g per pack) 3 times per day. 17 subjects had taken AOB for 3 years, 31 subjects up to 2 years, and 41 subjects up to one year. The initial mean (SD) serum alamine aminotransferase (ALT) level was 46.3+/-35.4 IU/L, and significant (p0.05, paired t-test) reductions in the mean serum ALT levels were observed at 6 months (38.6+/-21.5 IU/L), 18 months (31.9+/-18.1 IU/L), 2 years (31.2+/-14.6 IU/L), and 3 years (28.0+/-15.9 IU/L). Those presenting with high serum ALT levels (30 subjects) demonstrated significant levels (p0.05, paired t-test) of reduction in the mean serum ALT levels at 6, 12, 18, 24, and 36 months of treatment. No side effects were observed and the AOB treatment was well tolerated by all subjects.

[Effect of ISO15189 accreditation on Okayama University Hospital].

The evaluation of medical laboratories by a third person has recently become popular in Japan. Establishing a quality management system, putting it into practice, and maintaining and improving it are considered to achieve the standardization, efficacy improvement, and safety management of laboratory activities. The Departments of Clinical Laboratory and Blood Transfusion, Okayama University Hospital was awarded ISO15189 accreditation on July 6, 2007. In this paper, we describe the process of ISO15189 accreditation in our institute. As an outcome of ISO accreditation, the frequency of laboratory incidents was reduced through seeking the causes of incidents and performing continual improvement according to ISO 15189: "Plan, Do, Check, Action". Additionally the motivation and competence of laboratory staff concerned have also improved, consequently leading to a favorable influence on other laboratory staff members. Therefore, we conclude that ISO15189 is an effective tool for medical laboratory management.

Measurement of empathy among Japanese medical students: psychometrics and score differences by gender and level of medical education.

PURPOSE: To examine psychometric properties of a Japanese translation of the Jefferson Scale of Physician Empathy (JSPE), and to study differences in empathy scores between men and women, and students in different years of medical school. METHOD: The student version of the JSPE was translated into Japanese using back-translation procedures and administered to 400 Japanese students from all six years at the Okayama University Medical School. Item-total score correlations were calculated. Factor analysis was used to examine the underlying components of the Japanese version of the JSPE. Cronbach coefficient alpha was calculated to assess the internal consistency aspect of reliability of the instrument. Finally, empathy scores for men and women were compared using t test, and score differences by year of medical school were examined using analysis of variance. RESULTS: Factor analysis confirmed the three components of "perspective taking," "compassionate care," and "ability to stand in patient's shoes," which had emerged in American and Mexican medical students. Item-total score correlations were all positive and statistically significant. Cronbach coefficient alpha was .80. Women outscored men, and empathy scores increased as students progressed through medical school in this cross-sectional study. CONCLUSIONS: Findings provide support for the construct validity and reliability of the Japanese translated version of the JSPE for medical students. Cultural characteristics and educational differences in Japanese medical schools that influence empathic behaviors are described, and implications for cross-cultural study of empathy are discussed.

Prediction of number of apheresis procedures necessary in healthy donors to attain minimally required peripheral blood CD34+ cells.

BACKGROUND: Allogeneic peripheral blood stem cell (PBSC) transplantation is widely performed as a curative therapy for hematopoietic malignancies. Donors for PBSC harvest (PBSCH) are usually healthy subjects and undergo granulocyte-colony-stimulating factor treatment and apheresis procedures. A considerable proportion of donors experience poor mobilization, necessitating additional harvesting or marrow collection or remobilization. Although some characteristics have been reported to correlate with poor mobilization, they may not be taken into account in selecting PBSC donors. To protect healthy donors, it is preferable to predict the number of apheresis procedures needed for PBSCH before the procedure is initiated. STUDY DESIGN AND METHODS: A retrospective cohort study of 83 subjects was conducted, using statistical models to predict the probability of obtaining a sufficient number of CD34+ cells (>or=2.0 x 10(6)/kg) in the first to the third apheresis procedures and the probability of failure to obtain sufficient cells within three apheresis sessions. This study explored potential candidate factors in an ordinal probit regression analysis. RESULTS: Significant factors predicting successful PBSCH were donor age, donor sex, and body weight difference between donor and recipient. The predictive model showed good agreement with the observed number of apheresis sessions. Simulation tables are presented with this model. CONCLUSION: The statistical model developed to predict the number of apheresis procedures for PBSCH may be useful for planning PBSCH in clinical practice.