Validation of the relationship consciousness of Japanese Patients with type 2 diabetes scale.

OBJECTIVES: The management of type 2 diabetes mellitus can be improved for individuals by developing relationships with other patients with diabetes. We created the Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale to measure the relationship consciousness of type 2 diabetes mellitus patients for other patients based on the Health Belief Model. METHODS: This was a cross-sectional study of Japanese patients with type 2 diabetes mellitus (n = 289). Data were analyzed via exploratory factor analyses, reliability tests, concurrent validity. RESULTS: The final scale obtained for the Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale comprised a six-factor structure with 36 items. All 36 items had a Cronbach's α coefficient of 0.893 and explained 59.38% of the total variance. The scale was significantly correlated with a related reciprocity consciousness scale. CONCLUSIONS: The Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale may be an important tool for nurses to assess the relationship consciousness of patients with type 2 diabetes mellitus. In addition, by understanding patients' relationship consciousness for others who share their disease, nurses can begin to recommend ways to establish relationships between patients that suit patients' particular relationship. consciousness levels and to provide better care in their clinical practice.

Intra- and interspecies comparison of EYS transcripts highlights its characteristics in the eye.

Inherited mutations in the eyes shut homolog (EYS) gene cause retinitis pigmentosa. Although knock out of eys in zebrafish is pathogenic, the molecular function of EYS in vertebrate photoreceptors is poorly understood. Here, we show that the 5' portion of EYS is eye-specific across vertebrates. We previously determined that a 3' fragment of EYS with an unknown transcription start site is expressed in human dermal fibroblasts (HDF). To obtain insights into the molecular function of EYS in vertebrate photoreceptors, we extensively analyzed EYS (eys) expression in the human fibroblast cell line HDF-adult (HDF-a), the Y79 retinoblastoma cell line, and in zebrafish eyes using rapid amplification of cDNA end, cap analysis of gene expression, RNA sequencing, and RT-PCR. In HDF-a cells, we identified a novel transcript variant (tv), tv5, transcribed from exon 37. In Y79 cells and zebrafish eyes, EYS (eys) was predominantly transcribed from exon 1 or 2, whereas it was transcribed exclusively from exon 37 in HDF-a cells. In the zebrafish eye, there were splice variants that introduced stop codons, resulting in complete loss of the 3' portion of the RNA. These comparative approaches indicate that the 5' portion of the EYS (eys) mRNA appears to be photoreceptor-specific and that the compositions of the deduced EYS proteins in the eye are well-conserved across vertebrates.-Takita, S., Miyamoto-Matsui, K., Seko, Y. Intra- and interspecies comparison of EYS transcripts highlights its characteristics in the eye.

The Concept of Sleep Ability and its Effect on Diabetes Control in Adults With Type 2 Diabetes.

OBJECTIVES: Few published studies have examined the effects of various components of sleep on the control of type 2 diabetes. This study aimed to construct a concept of sleep ability and examine its effect on diabetes control in adults with type 2 diabetes. METHODS: Participants were 37 outpatients, 41 to 73 years of age, who had type 2 diabetes. Participants monitored their sleep for 14 days using a sleep meter, and they completed questionnaires concerning quality of life (Problem Areas in Diabetes), self-care (Self-Care Agency Questionnaire) and sleep quality (Pittsburgh Sleep Quality Index). Data on glycated hemoglobin levels and body mass index were also collected. Canonical correlation analysis and exploratory selection were used to investigate the relationships between the variables involved in diabetes control and sleep ability. RESULTS: Using canonical correlation analysis and exploratory selection, sleep ability was found to be composed of the Pittsburgh Sleep Quality Index score, objective total sleep time, wake after sleep onset, bedtime standard deviation, wake-up time standard deviation and the absolute value of the difference between subjective and objective sleep efficiency. A significant correlation was found between components of diabetes control (glycated hemoglobin levels, body mass index, quality-of-life evaluation from Problem Areas in Diabetes and self-care evaluation from the Self-Care Agency Questionnaire) and sleep ability (canonical correlation coefficient [RC] =0.755, p=0.006). CONCLUSIONS: The significant elements of sleep ability represented the quality, quantity, maintenance, regularity and recognition of sleep, and each element made a large contribution to diabetes control. We conclude, therefore, that improving sleep ability may lead to good diabetes control.

The manner of decay of genetically defective EYS gene transcripts in photoreceptor-directed fibroblasts derived from retinitis pigmentosa patients depends on the type of mutation.

BACKGROUND: Generation of induced photoreceptors holds promise for in vitro modeling of intractable retinal diseases. Retinitis pigmentosa is an inherited retinal dystrophy that leads to visual impairment. The EYS gene was reported to be the most common gene responsible for autosomal recessive retinitis pigmentosa (arRP). arRP with defects in the EYS gene is denoted by "EYS-RP". We previously established a "redirect differentiation" method to generate photosensitive photoreceptor-like cells from commercially available human dermal fibroblasts. In this study, we produced photoreceptor-like cells from dermal fibroblasts of EYS-RP patients as a replacement for the degenerative retinas using "redirect differentiation". We analyzed defective transcripts of the EYS gene in these cells to elucidate phenotypes of EYS-RP patients because decay of transcripts was previously suggested to be involved in phenotypic variation associated with diseases. METHODS: Using "redirect differentiation" by CRX, RAX, NeuroD and OTX2, we made photoreceptor-directed fibroblasts derived from three normal volunteers and three EYS-RP patients with homozygous or heterozygous mutations. We tested inducible expression of the photoreceptor-specific genes (blue opsin, rhodopsin, recoverin, S-antigen, PDE6C) in these cells. We then analyzed transcripts derived from three different types of the defective EYS gene, c.1211dupA, c.4957dupA and c.8805C > A, expressed in these cells by RT-PCR and sequencing. RESULTS: Photoreceptor-specific genes including the EYS gene were up-regulated in all the photoreceptor-directed fibroblasts tested. However, expression levels of defective transcripts were markedly different depending on the type of mutation. Transcripts derived from these three defective genes were scarcely detected, expressed at a lower level, and expressed at almost the same level as in normal volunteers, respectively. CONCLUSIONS: Expression levels of genetically defective EYS gene transcripts in photoreceptor-directed fibroblasts of EYS-RP patients vary depending on the type of mutation. Variation in expression levels in transcripts having c.1211dupA, c.4957dupA and c.8805C > A suggests that almost complete nonsense-mediated mRNA decay (NMD), partial NMD and escape from NMD occurred for these transcripts, respectively. To determine the relationship with phenotypic variations in EYS-RP patients, more samples are needed. The present study also suggests that the redirect differentiation method could be a valuable tool for disease modeling despite some limitations.

[Diabetes and clinical laboratory tests: team medicine].

The presentation at this symposium is from the following two perspectives: 1. Indispensability of team medicine for diabetes treatment: Once diabetes has been diagnosed, long-term treatment is essential. Diabetes is often due to a combination of unhealthy lifestyle factors, and treatment therefore requires patients to improve their lifestyles, a certain amount of stoicism also being needed. Patients also have to overcome events in their lives while suffering from diabetes, at the same time as controlling the diabetes, and such events cause stress for the patients, affecting them both psychologically and in terms of lifestyle, so patients' blood sugar levels are disturbed by interactions between stress and lifestyle factors. Medical personnel monitor the progression of numerous diabetic patients, and take different approaches to treatment on the basis of their experience and specialist knowledge. From various perspectives, maintenance of patients' will to continue with treatment is an important aspect of "team medicine". Enabling patients to be treated while feeling themselves to be supported by the treatment team is important, and is linked to empowerment of patients, which is the ultimate objective of the treatment guidelines. 2. Importance of team medicine, illustrated by diabetic nephropathy: If diabetic nephropathy progresses to Stage II or further, deterioration of the patient's condition is unavoidable. Medical personnel often think that the patients also will be concerned about the nephropathy, and will therefore not forget about having been told they have nephropathy. However, it has been found that, when subjective symptoms are absent, patients often do not fully understand the explanation, and forget about the nephropathy. It is therefore essential for medical personnel to appreciate that the risk of nephropathic progression is increased if patients do not remember about having nephropathy.

Functional expression of sodium-dependent vitamin C transporter 2 in human endothelial cells.

Since oxidative stress plays an important role in dysregulation of the microcirculation as well as the pathogenesis of atherosclerosis, therapeutic intervention with antioxidants has been speculated to prevent cardiovascular diseases. Ascorbic acid (AA) has been reported to improve endothelial function; however, its intracellular metabolic pathway has not been fully determined. Sodium-dependent vitamin C transporter (SVCT) types 1 and 2 were recently cloned. In the present study, we investigated whether SVCT-2 is functionally expressed in vascular endothelial cells and, if so, what factors modulate its activity. The uptake of AA into human umbilical vein endothelial cells (HUVECs) was examined by incubation with radiolabeled AA (14C-AA). AA was transported into HUVECs in a dose- and time-dependent manner. Replacement of sodium chloride with choline chloride in the medium suppressed the uptake of AA. RT-PCR revealed that HUVECs expressed SVCT-2 mRNA, but not SVCT-1. Transfection of HUVECs with the antisense oligonucleotide of SVCT-2 significantly suppressed the uptake of AA. Furthermore, tumor necrosis factor-alpha and interleukin-1beta inhibited the transport activity of AA. Thus, SVCT-2 is functionally expressed in human endothelial cells, and its activity is negatively regulated by inflammatory cytokines. Our findings might provide a new insight into understanding the treatment of cardiovascular diseases with AA.

Interaction of oxidative stress and inflammatory response in coronary plaque instability: important role of C-reactive protein.

OBJECTIVE: C-reactive protein (CRP), a predictor of cardiovascular events, localizes in atherosclerotic arteries and exerts proinflammatory effects on vascular cells. Reactive oxygen species (ROS) have been implicated in atherogenesis and plaque instability. METHODS AND RESULTS: Expressional pattern of CRP in directional coronary atherectomy specimens from 39 patients was examined. Characteristics of histological plaque instability and higher levels of serum CRP and fibrinogen were associated with the CRP immunoreactivity. In situ hybridization revealed the presence of CRP mRNA in coronary vasculature. Furthermore, the expression of CRP mRNA and protein was detected in cultured human coronary artery smooth muscle cells (CASMCs) by reverse transcriptase-polymerase chain reaction and Western blotting. In addition, CRP was frequently colocalized with p22phox, an essential component of NADH/NADPH oxidase, which is an important source of ROS in vasculature. Moreover, the incubation of cultured CASMCs with CRP resulted in the enhanced p22phox protein expression and in the generation of intracellular ROS. CONCLUSIONS: The expression of CRP in coronary arteries was associated with histological and clinical features of vulnerable plaque, and it had a prooxidative effect on cultured CASMCs, suggesting that it might play a crucial role in plaque instability and in the pathogenesis of acute coronary syndrome via its prooxidative effect.