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Background Electrocardiogram abnormalities have been reported during electroconvulsive therapy (ECT). A corrected QT interval (QTc) prolongation indicates delayed ventricular repolarization, which can trigger ventricular arrhythmias such as torsade de pointes (TdP). We examined the QTc changes during generalized tonic-clonic seizures induced by ECT, and the effects of atropine sulfate on these QTc changes. Methods We analyzed heart rate, QT interval, and QTc in 32 patients with depression who underwent ECT (25 women, 67.4 ± 8.7 years of age). The QTc from -30 to 0 seconds prestimulation was used as baseline, which was compared with QTc at 20-30 seconds and 140-150 seconds poststimulus onset. Results QTc was significantly prolonged at 20-30 seconds poststimulus, then significantly decreased at 140-150 seconds poststimulus, compared with baseline. QTc prolongation induced by ECT was significantly decreased by atropine sulfate. Conclusions These data suggest that the risk of TdP may be enhanced by ECT. Further, the risk of cardiac ventricular arrhythmias, including TdP, may be reduced by administration of atropine sulfate.

OBJECTIVE The main purpose of this study was to translate the Calgary sleep apnea quality of life index (SAQLI) and to evaluate the reliability, validity and responsiveness of the Japanese version of the SAQLI (SAQLI-J). METHODS Translation of the SAQLI questionnaire into the SAQLI-J questionnaire was performed following the guidelines of cross-cultural adaptation of health-related quality of life (QOL) measures. All patients completed the following questionnaires both at baseline and three months later: the SAQLI-J, the medical outcome survey short form (SF-36) and the Epworth sleepiness scale (ESS). The SAQLI-J was conducted by an interviewer. PATIENTS One hundred and fifteen obstructive sleep apnea hypopnea syndrome (OSAHS) patients were recruited into the present study. RESULTS The internal consistency and test-retest reliability of the total SAQLI-J scores (SAQLI-J total) were both excellent. Regarding construct validity, the SAQLI-J was tested by measuring the inter-domain correlation between the SAQLI-J domains and the SF-36 domains. All of the SAQLI-J domains and the SAQLI-J total were found to be moderately to highly correlated with the domains of the SF-36. Moreover, the responsiveness of the SAQLI-J total measured according to the standardized response mean was found to be moderate, and the SAQLI-J was found to be more responsive than the SF-36 for detecting changes in the QOL after continuous positive airway pressure treatment. CONCLUSION The results suggest that the SAQLI-J is a valid, reliable and responsive health-related QOL questionnaire for use in Japanese OSAHS patients.

A gonad is formed from germ cells and somatic mesodermal cells through their interactions. Its development is coupled with the determination and differentiation of the sex and sex-associated traits. We carried out a large-scale screening of Medaka mutants in which gonadal development is affected. Screening was performed on larvae at 8 days posthatching for abnormal abundance and/or distribution of germ cells detected by the in situ hybridization for olvas (Medaka vasa). We describe here 16 mutants of 13 genes, which are classified into four groups. Group 1, consisting of four mutants of three genes kon, tot) characterised by an increase in germ cell number. An adult tot homozygote fish has the characteristic feature of possessing hypertrophic gonads filled with immature oocytes. Group 2, represented by a single gene (zen) mutant characterized by a gradual loss of germ cells. Group 3, consisting of four mutants of distinct genes (eko, eki, sht, ano) showing irregular clustering of germ cells. Group 4, consisting of seven mutants of five genes (arr, hyo, mzr, hdr, fbk) showing fragmented clusters of germ cells. In some mutants belonging to Groups 1, 3 and 4, the expression level of ftz-f1 (sf-1/Ad4BP) in gonadal somatic cells significantly decreased, suggesting that interaction between somatic and germ cells is affected.

The development of germ cells has been intensively studied in Medaka (Oryzias latipes). We have undertaken a large-scale screen to identify mutations affecting the development of primordial germ cells (PGCs) in Medaka. Embryos derived from mutagenized founder fish were screened for an abnormal distribution or number of PGCs at embryonic stage 27 by RNA in situ hybridization for the Medaka vasa homologue (olvas). At this stage, PGCs coalesce into two bilateral vasa-expressing foci in the ventrolateral regions of the trunk after their migration and group organization. Nineteen mutations were identified from a screen corresponding to 450 mutagenized haploid genomes. Eleven of the mutations caused altered PGC distribution. Most of these alterations were associated with morphological abnormalities and could be grouped into four phenotypic classes: Class 1, PGCs dispersed into bilateral lines; Class 2, PGCs dispersed in a region more medial than that in Class 1; Class 3, PGCs scattered laterally and over the yolk sac area; and Class 4, PGCs clustered in a single median focus. Eight mutations caused a decrease in the number of PGCs. This decrease was observed in the offspring of heterozygous mothers, indicating the contribution of a maternal factor in determining PGC abundance. Taken together, these mutations should prove useful in identifying molecular mechanisms underlying the early PGC development and migration.

In order to clarify the feature of attention disorders in schizophrenia, two tasks (X and AX) of the Continuous Performance Test (CPT) were given to 36 schizophrenic patients and 25 healthy controls. The schizophrenic patients performed considerably less well than normal controls. Performances were expressed in indices such as omission and commission errors, reaction time and discriminability. Among errors, omission in both the X and AX tasks was found to be an index that varied in reaction time, indicating difficulty in sustaining attention. Omission was found to act as a state-dependent index of schizophrenia in relation to inattentiveness in clinical settings and emotional disturbance in interpersonal situations. Commission, in contrast, differed between the two tasks, acting as an index of disinhibition of reaction in the X task, and of disturbance of the capacity and allocation of attention in the AX task. Commission was also thought to be an index related to thought disorder during episodes of acute schizophrenia, that is, it reflects an essential pathology in schizophrenia.

Latent structures of schizophrenic phenomenology were examined over the course of the illness in 100 newly-admitted patients. We compared the results of a confirmatory factor analysis (CFA) on ten competing models that had between zero and five dimensions using data assessed by the Positive and Negative Syndrome Scale (PANSS) at both the acute and chronic phases of the disease. The present findings did not support the two-dimensional construct of positive and negative symptoms in either the acute or the chronic phase of the illness. In the acute phase, a three- (positive, negative, and relational dimensions), four- (positive, negative, disorganization, and relational dimensions), and five-dimensional model (positive, negative, disorganization, excitement, and relational dimensions) fit the data relatively well. In contrast, in the chronic stable phase, only the five-dimensional model adequately fits the data. The present findings suggest that further investigation of the validity of the five-dimensional model over the course of the illness is necessary.

Prospective and longitudinal assessment of depressive, positive, and negative symptoms were performed on 86 newly admitted schizophrenic patients. The improvement of depressive symptoms was significantly correlated with the improvement in positive symptoms, but did not correlate with the improvement in negative symptoms. However, depressive symptoms were heterogeneous. Principal components analysis was used to subdivide depressive symptoms into five factors. The improvement of the depression-anxiety factor was significantly associated with improvement of positive symptoms. On the other hand, improvement of negative symptoms was significantly related to that of the reduced activity factor. The change in hypochondriasis had a significant positive correlation with the change in positive symptoms and had a significant negative correlation with the change in negative symptoms. Changes in the other factors of depressive symptoms did not appear to be associated with changes in positive or negative symptoms. The present findings suggest that the various depressive symptoms associated with acute schizophrenia may have different pathophysiological origins.

The IL-2 receptor beta-chain (IL-2R beta), a specificity-determining subunit in the IL-2R complex with a restricted tissue distribution pattern, is essential for signal transduction. Our previous studies demonstrate that the continuous treatment of mice with anti-IL-2R beta resulted in the complete disappearance of NK cells and Thy-1+ dendritic epidermal cells (Thy-1+ dEC), suggesting that signals through IL-2R beta are critically involved in development of these lymphocyte subsets. However, these lymphocyte subsets are reported to be apparently unaffected in the IL-2-deficient mice. To further examine the biological roles of the IL-2R beta, transgenic mice carrying the IL-2R beta transgene were generated. In these mice, high levels of the cell surface expression of the IL-2R beta were observed in essentially all hematopoietic lineage cells, and CD4+ T cells as well as CD8+ T cells showed vigorous cell proliferation upon IL-2 stimulation. Surprisingly, NK cells marked with a high expression of NK1.1 in the spleen and Thy-1+ dEC in the skin were completely absent in transgenic mice. However, the development of other lymphocyte subsets including conventional alpha beta TCR+ cells, gamma delta TCR+ cells and B cells remained apparently intact. From these observations together with previous data on IL-2-deficient mice, we speculate that factors, other than IL-2 that utilizes the IL-2R beta as its functional receptor subunit, may have a vital role in the development of NK cells and Thy-1+ dEC. Implications for possible in vivo functions of over-expressed IL-2R beta are discussed.

The authors surveyed the prevalence of depression and dementia in the elderly in Ohira town in Japan from 1989 to 1990. The total population of this town was 26,712, with 2,778 people aged 65 and above, constituting 10.4% of the total population. The prevalence of dementia (n = 128) was 6.1% and that of major depression (n = 9) was 0.4%, according to the DSM-III-R criteria. The prevalence of a depressive state which did not fulfill the criteria for major depression (n = 55) was 2.4%. The patients with multi-infarct dementia (n = 49) suffered from depression (42.8%) more frequently than those with dementia of the Alzheimer type (11.1%). The rate of depression coexisting with dementia increased with aging, while the rate of depression without dementia did not change in all the age groups.

The interleukin 2 receptor beta chain (IL-2R beta) is preferentially expressed in natural killer (NK) cells, but is not detected in a majority of resting T and B cells. We recently established a novel monoclonal antibody (mAb) to murine IL-2R beta and examined in vivo the effect of the mAb in mice. We found that intraperitoneal injection of the anti-IL-2R beta mAb into adult mice resulted in a selective in vivo elimination of splenic NK function in various mouse strains. The reduction of NK cell function is associated with complete disappearance of NK1.1+ cells in C57BL/6 mice. Other lymphocyte subsets in the thymus and spleen were uncompromised. T cell function was not affected by the mAb treatment as judged by allogeneic cytotoxic T cell induction. The single injection of anti-IL-2R beta mAb caused a long-term elimination of splenic NK cells, lasting for at least 5 wk. We also found that NK and/or NK precursor cells become susceptible to the mAb treatment only after birth, suggesting that functional maturation of NK cells in terms of IL-2R beta expression is a later event in the course of NK cell development. The use of the anti-IL-2R beta mAb will be useful in defining the physiological role of NK cells in host defense as well as dissecting their developmental pathway in vivo.

Electroconvulsive therapy (ECT) recovers the brain function through generalized convulsion induced by electrical stimulation of the brain. While the primary targets of ECT are psychiatric disorders such as depression, schizophrenia, and schizoaffective disorder, it has been well documented that ECT has therapeutic effects on muscular rigidity of Parkinson's disease and neuroleptics-induced malignant syndrome. Recently we demonstrated that ECT reduces intractable pain and allodynia associated with deafferentation pain disorders by recovering the function of the thalamic nucleus. ECT, if applied on appropriate clinical assessments, may contribute to the therapeutics of neuropsychiatric disorders.

The difference in symptomatology between the acute and post-acute phase of schizophrenia was examined in the present study using prospective and longitudinal assessment of 86 newly admitted schizophrenic patients. In the acute phase of illness, four symptom components emerged (negative symptoms, excited, delusional/hallucinatory, and thought disorder) and three components were evident (negative symptoms, mixed symptoms, and thought disorder) in the post-acute phase. The negative component in the post-acute phase had the same composition as that in the acute phase. The composition of thought disorder barely persisted over the phase of illness. These findings suggest that the negative symptom component is stable while the difference in the phase of illness has some effects on the symptom structure of schizophrenia.

An autopsy case of blue rubber bleb naevus syndrome (BRB-NS) is reported. There was the usual occurrence of cavernous haemangioma in the skin and intestine and cardiac involvement by a haemangiomatous lesion might have directly led to the patient's death. By light and electron microscopy, all the haemangiomatous lesions examined were cavernous with the exception of the cardiac tumour which was a mixed-vessel (capillary and cavernous) type of a haemangioma. These findings indicate that any vascular tumour-like lesions may occur in BRBNS. The principal combination of haemangiomas in the skin and intestine in BRBNS regardless of their type is the typical feature of this syndrome.