A rare case of Lemierre`s syndrome caused by Porphyromonas asaccharolytica.

Lemierre's syndrome is only very rarely caused by Porphyromonas asaccharolytica. Here, we report the case of a 35-year-old man who developed a left peritonsillar abscess, thrombophlebitis of the left internal jugular vein, and septic embolization of both lungs. Anaerobic P. asaccharolytica was isolated in the blood cultures, and we subsequently confirmed the diagnosis as Lemierre's syndrome. Our case indicates that although P. asaccharolytica is not commonly found in oral cavities, this organism may still cause Lemierre's syndrome. Consequently, when it is detected in blood cultures, the treating physician should perform the medical examination while keeping in mind the possibility that the patient could have Lemierre's syndrome.

Large scale replication analysis of loci associated with lipid concentrations in a Japanese population.

BACKGROUND: Recent genome wide association studies discovered seven novel loci that influence plasma concentrations of triglycerides, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol in Europeans. To date, large scale replication studies using populations with known differences in genome-wide linkage disequilibrium (LD) pattern have not been undertaken. METHODS: To address this issue, we tested associations between single nucleotide polymorphisms (SNPs) within the seven novel loci and plasma lipid profiles in 21 010 Japanese individuals. RESULTS: Multiple linear regression analyses showed that the rs3812316 in MLXIPL was strongly associated with triglyceride concentrations (p approximately 3.0x10(-11), 7.1 mg/dl decrease per minor C allele) and that rs599839 in CELSR2/PSRC1/SORT1 was strongly associated with LDL cholesterol concentrations (p approximately 3.1x10(-11), 4.7 mg/dl decrease per minor G allele) in the Japanese population. SNPs near ANGPTL3, TRIB1 and GALNT2 showed evidence for associations with triglyceride concentrations (3.6x10(-6)

cDNA cloning, mapping and polymorphism of the porcine Rhesus (RH) gene.

The Rhesus (Rh) gene superfamily in humans and mice contains four independent genes, RH, RHAG, RHBG, and RHCG/GK. Heretofore, only the RHBG cDNA has been cloned in pig. We have isolated the porcine RH cDNA; its complete open reading frame of 1269 nucleotides encoded 423 amino acids. Porcine RH protein shared 67.6% amino acid identity with bovine RH, 61.0% with human RhCE and 60.8% with human RhD. The RT-PCR revealed RH transcripts in the spleen and bone marrow, but not in the heart, kidney, or lung. In RH intron 4, a deletion of 17 nucleotides distinguished the shorter allele (allele 1) from the longer. As determined in 115 unrelated pigs from five breeds - Landrace (L, n = 23), Large White (LW, n = 28), Duroc (D, n = 24), Hampshire (H, n = 20) and Piétrain (n = 20) - allele 1 frequencies were 1.0 (L, H), 0.77 (LW), 0.70 (P) and 0.25 (D). Somatic cell hybrid mapping localized the porcine RH and RHBG genes to pig chromosomes 6q22-q23 and 4q21-q22, respectively. Genetic mapping suggested RH-(FUT1, S, GPI, EAH, A1BG)-PGD as the most probable locus order. Sequence homology, mapping data, and haematopoietic tissue expression suggest that this cDNA may indeed encode the porcine RH homologue.

Hypertension control and medication increase in primary care.

Over half of treated patients with hypertension are not well controlled. However, little is known about physicians' prescribing behaviour for these patients. Our objective was to clarify whether physicians increase antihypertensive medication in patients with poorly controlled hypertension and what characteristics are predictors of medication increase. This was a retrospective cohort study by surveying medical records in primary care clinics in Tochigi, Japan. Twenty-nine of 79 randomly selected physicians agreed to select 20 consecutive hypertensive patients. This resulted in 547 patients (women 60%; mean (s.d.) age, 68 (12) years) who had blood pressure measurements taken in 1998 and prescription of antihypertensive medication in 1998 and 1999. Mean (s.d.) systolic/diastolic blood pressure was 142 (12)/81 (9) mm Hg and the percentage of patients in good control (<140/90 mm Hg), fair (140-159/90-94) and poor (> or =160/95) were 42%, 47%, and 11%, respectively. Physicians increased medication in 28% of poorly controlled patients (95% confidence interval (CI), 17-41%), which was more than those in fair (12%, 95%CI 8-16%) or good control (7%, 95%CI 4-12%). Multivariate logistic regression analysis showed that systolic and diastolic blood pressures were positively, and the number of kinds of antihypertensive medications and the age of the physician were negatively, associated with an increase in medication. In conclusion, primary care physicians did not increase antihypertensive medication adequately for patients with uncontrolled hypertension. Attempts to understand and to change physicians' prescription behaviour could reduce the burden of uncontrolled hypertension among treated hypertensive patients.

[Prevalence, awareness, treatment, and control of hypertension in Japanese rural communities].

BACKGROUND: In Japan, a national survey indicated that only 7% of hypertensive patients had a blood pressure less than 140/90 mmHg. There have been no reports of studies investigating all of the prevalence of hypertension, the percentage of subjects who are aware of hypertension, the percentage being treated, and the percentage that are well-controlled (awareness, treatment and control, respectively) among hypertensives in the Japanese general population. OBJECTIVE: To investigate the prevalence of hypertension, and awareness, treatment and control of hypertension among hypertensives in a Japanese rural population. DESIGN: A cross-sectional analysis of base-line data of the Jichi Medical School Cohort Study. SETTING: Twelve rural communities is 8 prefectures in Japan. PARTICIPANTS: Community-dwelling people who participated in the health examination program in 1992-1995. MAIN OUTCOME MEASURES: Blood pressure (BP) measured once in the sitting position after a 5-minute rest using oscillometric automatic BP monitors (BP203RV-II; Nippon Colin, Japan), and history of hypertension assessed using a self-administered questionnaire. RESULTS: We analyzed data from 11,302 subjects (4,415 men and 6,887 women). The mean (standard deviation) age was 55(12) years for men and 55(11) years for women. Mean systolic BP and diastolic BP levels were, respectively, 131(21) mmHg and 79(12) mmHg for men and 128(21) mmHg and 76(12) mmHg for women. Prevalence of hypertension (systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or on antihypertensive medication) was 37% for men and 33% for women. Percentages for awareness (on medication or present past history), treatment and control (both systolic BP < 140 mmHg and diastolic BP < 90 mmHg) were, respectively, 39%, 27% and 10% for men and 46%, 38% and 13% for women. CONCLUSIONS: About one third of the study popUlation were hypertensive, and awareness, treatment and control of hypertension among the hypertensives were 43%, 34% and 12%, respectively. Less than half of the hypertensives were well-controlled even when measurement bias was considered. In the rural Japanese population, improvements are required with regard to awareness, treatment and control of hypertension.

Reactivity of autoantibodies of autoimmune hemolytic anemia with recombinant rhesus blood group antigens or anion transporter band3.

The specificity of autoantibodies in autoimmune hemolytic anemia (AIHA) has been studied using the serological procedure and immunoprecipitation technique with rare phenotype red cells. We attempted to analyze specificity using recombinant rhesus (Rh) blood group and band3 antigens expressed on erythroleukemic cell lines, KU812E. The autoantibody eluates were isolated by the acid elution procedure from the red cells of 20 AIHA patients. The recombinant Rh antigens, RhD, cE, ce, CE, and chimera antigens CE-D and D-CE, were obtained by retroviral cDNA transduction into KU812E cells, and the cell line expressing the antigens was cloned. Band3 cDNA was also obtained and introduced into KU812E and cloned KU812 expressing RhcE. The reactivities of AIHA eluates with recombinant Rh and band3 antigens were studied by flow cytometry. Fifteen eluates reacted with at least one of the RhcE, ce, or CE antigens, and four eluates reacted with RhD. Seven eluates with strong Rh specificity were studied further using chimera antigen. Five eluates showed reduced or lost reactivity, although two eluates reacted identically with the chimera antigens as wild type. These results indicated that conformational epitopes constituted by RhD or CE specific exofacial peptide loops are important for autoantibodies in most cases. Seven eluates reacted with band3, five exclusively. The coexpression study of RhcE and band3 did not enhance the expression of either antigen nor the reactivity with patient eluates, indicating that association of Rh and band3 was not involved in the appearance of autoantigen.

Direct-antiglobulin-test-negative immune haemolytic anaemia and thrombocytopenia in a patient with Hodgkin's disease.

A case of direct-antiglobulin-test (DAT)-negative auto-immune haemolytic anaemia (AIHA) and immune thrombocytopenia (ITP) associated with Hodgkin's disease (HD) is reported. A 52-year-old male was admitted with anaemia, thrombocytopenia, and lymphadenopathy. The patient was DAT negative, although he exhibited the clinical features of warm-type AIHA and elevated levels of red-blood-cell-associated IgG (RBC-IgG). The serum level of platelet-associated IgG (PA-IgG) was markedly increased. A biopsy specimen of the inguinal lymph nodes showed HD of mixed cellularity. Marked improvement of subjective symptoms, normalization of haematological values and a decrease in the level of both RBC- and PA-IgG were observed after the start of combination chemotherapy for HD. Although the association of HD, ITP, and/or AIHA has been infrequently reported, the measurement of RBC-IgG is recommended in cases of HD with anaemia even though DAT is negative, since HD is known to be associated with various protean immunological abnormalities.

Accidents associated with bathing in home care services for the aged in Japan.

OBJECTIVES: To reveal what kinds of accidents happen associated with bathing in home care services for the aged in Japan. METHODS: The study was cross-sectional in design. In November 1999, a postal questionnaire survey was conducted of 828 councils selected from the list of the National Council of Social Welfare of Japan by a systematic sampling method (extraction rate was 25%). The main outcome measures were characteristics of cases of accidents associated with bathing service for the aged, including patient age, sex, time of occurrence, symptoms, and results of accidents. RESULTS: Replies were received from 683 (82%) councils. Of the councils that replied, 430 (63%) reported providing bathing service for the aged. Of these 430 councils, 108 (25%) have experienced accidents, and 130 cases were analyzed. Affected patients had a mean age of 80.7 years (SD: 9.0 years), and 71 were females (55%). Sixty-two (48%) had symptoms of a disease or had accidents after bathing, and 42 (32%) presented with loss of consciousness. In results of accidents, 14 (11%) were reported to have died. CONCLUSION: This study revealed that there were not a few accidents associated with bathing in home care services for the aged in Japan, the most frequent symptom was loss of consciousness, most accidents occurred after bathing, and that some patients died as a result of bathing provided by home care services.

Distribution of serum C-reactive protein and its association with atherosclerotic risk factors in a Japanese population : Jichi Medical School Cohort Study.

The distribution of serum C-reactive protein (CRP) levels and their association with age, sex, and atherosclerotic risk factors were studied in a large Japanese population between 1992 and 1995. The subjects consisted of 2,275 males and 3,832 females aged 30 years and over. CRP was measured by nephelometry. The distribution of CRP was highly skewed toward a lower level than that of previous studies and seemed to be a combination of two separate distribution curves. The increase in CRP with age was statistically significant, and males had higher CRP levels than did females. Males who were current smokers had higher CRP levels than did nonsmokers. Age, systolic blood pressure, diastolic blood pressure, triglycerides, fibrinogen, and body mass index were all positively associated with CRP in both sexes, while total cholesterol and blood glucose were positively related in females only. High density lipoprotein cholesterol was inversely related in both sexes. Multiple logistic regression analysis showed that sex, age, systolic pressure, high density lipoprotein cholesterol, triglycerides, fibrinogen, and body mass index were significant independent variables. In conclusion, the distribution of CRP among the Japanese was quite different from that among Westerners, although CRP levels correlated with other atherosclerotic risk factors, similar to those in Westerners.

Complementary medicine education in Japanese medical schools: a survey.

OBJECTIVES: To evaluate the present state of complementary medicine (CM) education in Japanese medical schools. DESIGN: This investigation consisted of two studies: (1) a telephone survey to curricular office workers in September 1998; and (2) a self-completed questionnaire to representatives of sponsoring departments in July 1999. SETTINGS: All 80 medical schools for Western medicine. MAIN OUTCOME MEASURES: Presence of a CM course and sponsoring department. Titles of courses and teaching methods. RESULTS: The response rate to the telephone survey and self-completed questionnaire was 100 and 95%, respectively. Of 80 medical schools, CM was officially taught in 16 schools (20%). Of these 16 schools, there were 19 CM courses and the anesthesia department sponsored the most courses (six courses). All courses had oriental medicine titles such as acupuncture and Kampo except for one course. CONCLUSION: Twenty per cent of Japanese Medical Schools taught CM with predominantly oriental medicine themes.

Words of Tohkaku Wada: medical heritage in Japan.

The origins of Japan's medical ideas, which are deeply rooted in its religion, culture and history, are not widely understood in medical societies of other countries. We have taken up the task of summarising this tradition here so that some insight can be gained into the unique issues that characterise the practice of medicine in Japan. We borrow from the sayings of Tohkaku Wada, a medical philosopher of late eighteenth-century Japan, for a look at Japanese medical tradition. Wada's medical thought was very much reflective of the Buddhism, Zen, and swordsmanship that informed eighteenth-century philosophy in Japan. His central concepts were "chu" and "sei", that is, complete and selfless dedication to the patient and the practice of medicine. This paper explores Wada's thought, explaining it mainly from the standpoint of Japanese traditional culture.

Rural practice evaluation: how do rural physicians evaluate their working conditions?

Evaluating the quality of rural doctors' working conditions is essential for retaining physicians in rural areas. We carried out a trial to investigate those aspects of working conditions that are important to rural physicians and with which aspects they are satisfied or dissatisfied. Questionnaires were mailed to 204 doctors who were working in rural clinics in Japan. The professional conditions of rural clinic practices were classified into 17 items. The doctors were then asked to evaluate the importance of and degree of satisfaction with each item. Among the 17 items, the clinic's equipment, the municipal government's attitude and the base hospital were evaluated to be more important than the overall average. With regard to satisfaction, the distance to major cities, the municipal government's attitude and locum availability were rated significantly lower than that overall. There were some items where there was a discrepancy between the importance and the degree of satisfaction. Identifying these discrepancies may contribute to creating an environment that will raise the level of rural physicians' satisfaction.

[Blood group genes].

Blood group antigens are surface markers on the red blood cell membrane. Biochemical analysis of blood group antigens has shown that these antigens divide into two types of proteins and carbohydrates attached to lipids or proteins. Protein determinants are directly coded on blood group genes, while carbohydrate determinants are controlled through the expression of glycosyltransferase enzymes. For the past ten years, considerable information has been gained from molecular studies of many blood group systems, thereby clarifying several aspects of these genes, genetic backgrounds of variants, and molecular evolution. Additionally, it has become possible to genotype blood groups and to genetically engineer the expression of protein antigens and the activity and specificity of enzymes. ABO system on the carbohydrate and Rh system on the protein are the most important systems in transfusion medicine. In this paper, we will review recent progress in the field of blood grouping; mainly ABO and Rh.

Molecular characterization of weak D phenotypes by site-directed mutagenesis and expression of mutant Rh-green fluorescence protein fusions in K562 cells.

BACKGROUND AND OBJECTIVES: Mutations detected in 161 weak D samples from Caucasians have been classified into 16 types. Because flow cytometry using monoclonal anti-D antibodies (mAbs) has shown that weak D red cells display type-specific antigen density, these mutations in transmembranous regions have been assigned weak D phenotypes. The present study attempts to confirm or refute this assignment. MATERIALS AND METHODS: We amplified DNA from four Japanese weak D samples using the polymerase chain reaction (PCR), and directly sequenced the amplified DNA. Using site-directed mutagenesis, we constructed three vectors expressing mutant RHDs-- G212C, V270G (weak D type 1) and G358A (type 2)--in K562 cells. The expression of RhD antigens was examined by flow cytometry using mAbs. RESULTS: A new mutation resulting in a conversion at amino acid residue 212 (Gly to Cys) was detected in a Japanese weak D sample. K562 cells transduced with mutant RhD cDNA reacted weakly in a type-specific manner with mAbs. CONCLUSIONS: The mutations--G212C (new weak D type), V270G (weak D type 1) and G358A (type 2)-- in transmembranous regions had obvious effects on the D epitopes recognized by mAbs. The results of this study provide direct evidence that these mutations can account for weak D phenotypes.

RHC/c genotyping based on polymorphism in the promoter region of the RHCE gene.

Designing of PCR tests for the RHC allele is difficult because of the high DNA sequence homology between RHC and RHD genes, which differ by only a one-nucleotide substitution at position 48 in exon 1 of the RHCE gene. We sequenced the promoter region of the RHCE gene, and compared our results with the reported sequence. Genomic DNA was prepared from blood samples collected from 656 Japanese donors. The DNA segment encompassing the promoter region and exon 1 of the RHCE gene from 30 donors was amplified by PCR and analyzed by DNA sequencing. Four nucleotide differences between RHC/c and RHD were found at positions -468, -304, -58, and -46. On the basis of the nucleotide differences at positions -468 (RHCE vs. RHD) and -292 (RHC vs. RHc), we then developed a novel polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method for RHC/c genotyping. Analysis of the genomic DNA from the 656 donors revealed that this method could discriminate RHC from RHc, irrespective of the RHD genotype, with only a few exceptions. The combination of our system and the intron 2-based PCR-RFLP method previously reported may prove to be more accurate than either of the methods alone, and therefore, useful and valuable for RHC/c genotyping.

The analysis of nucleotide substitutions, gaps, and recombination events between RHD and RHCE genes through complete sequencing.

We determined the entire nucleotide sequences of all introns within the RHD and RHCE genes by amplifying genomic DNA using long PCR methods. The RHD and RHCE genes were 57,295 and 57,831 bp in length, respectively. Aligning both genes revealed 138 gaps (insertions and deletions) below 100 bp, 1116 substitutions in all introns and all exons (coding region), and 5 gaps of over 100 bp. Homologies (%) between the RH genes were 93.8% over all introns and coding exons and 91.7% over all exons and introns. Various short tandem repeats (STRs) and many interspersed nuclear elements were identified in both genes. The proportions of Alu sequences in the RHD and RHCE genes were 25.9 and 25.7%, respectively and these Alu sequences were concentrated in several regions. We confirmed multiple recombinations in introns 1 and 2. Such multiple recombination, which probably arose due to the concentrations of Alu sequences and the high level of the homology (%), is one of most important factors in the formation and evolution of RH gene. The variability of the Rh system may be generated because of these features of RH genes. Apparent mutational hotspots and regions with low of K values (the numbers of substitutions per nucleotide site) caused by recombinations as well as true mutational hotspots may be found in human genome. Accordingly, in searching for and identifying single nucleotide polymorphisms (SNPs) especially in noncoding regions, apparent mutational hotspots and areas of low K values by recombination should be noted since the unequal distribution of SNPs will reduce the power of SNPs as genetic maker. Combining the complete sequences' data of both RH genes with serological findings will provide beneficial information with which to elucidate the mechanism of recombination, mutation, polymorphism, and evolution of other genes containing the RH gene as well as to analyze Rh variants and develop new methods of Rh genotyping.

Japanese paediatricians' judgement of the appropriateness of bathing for children with colds.

OBJECTIVES: This study investigated the decisions which Japanese paediatricians make regarding bathing a child with a common cold. METHODS: A total of 486 printed questionnaires were mailed to paediatricians systematically sampled from the list of members of the Japanese Pediatric Association. The questionnaire included two main questions. (i) Do you permit a 2- to 4-year-old child with a common cold to take a bath? (ii) If the answer to (i) was 'yes', what conditions should limit bathing of such children, and if the answer was 'no', why do you forbid bathing? In addition, the questionnaire included the age and sex of the practitioner, and the type and location of the practice. RESULTS: A total of 269 paediatricians returned questionnaires (response rate 55%); of these, 88% permitted a child with a cold to take a bath. Of these paediatricians, 5% permitted it without any conditions. The main conditions for taking a bath indicated by these paediatricians were 'no fever' (72%), 'not in a severe physical condition' (27%) and 'after 2 or 3 days from onset' (19%). Thirty-nine paediatricians indicated a specific body temperature at which bathing was appropriate. One-third of these paediatricians did not permit bathing at body temperatures above 38 degrees C. Of the 31 paediatricians (12%) who answered that a child with a cold should not take a bath, 61% were concerned for the physical well-being of the child. However, 29% provided no supporting evidence. CONCLUSIONS: Japanese paediatricians' judgements concerning bathing of a child with a cold are related to the effects of bathing on physical condition. Bathing immersed up to the neck does not always affect physical conditions. It is necessary to establish appropriate parental and patient education concerning bathing of children with colds.