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Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), is an enveloped, single-stranded RNA virus. Favipiravir is an orally administrable antiviral drug whose mechanism of action is to selectively inhibit RNA-dependent RNA polymerase. A preliminary trial in COVID-19 patients reported significant improvements across a multitude of clinical parameters, but these findings have not been confirmed in an adequate well-controlled trial. We conducted a randomized, single-blind, placebo-controlled Phase III trial assessing the efficacy and safety of favipiravir in patients with moderate pneumonia not requiring oxygen therapy. Methods COVID-19 patients with moderate pneumonia (SpO2 ≥ 94%) within 10 days of onset of fever (temperature ≥ 37.5 °C) were assigned to receive either placebo or favipiravir (1800 mg twice a day on Day 1, followed by 800 mg twice a day for up to 13 days) in a ratio of 1:2. An adaptive design was used to re-estimate the sample size. The primary endpoint was a composite outcome defined as the time to improvement in temperature, oxygen saturation levels (SpO2), and findings on chest imaging, and recovery to SARS-CoV-2-negative. This endpoint was re-examined by the Central Committee under blinded conditions. Results A total of 156 patients were randomized. The median time of the primary endpoint was 11.9 days in the favipiravir group and 14.7 days in the placebo group, with a significant difference (p = 0.0136). Favipiravir-treated patients with known risk factors such as obesity or coexisting conditions provided better effects. Furthermore, patients with early-onset in the favipiravir group showed higher odds ratio. No deaths were documented. Although adverse events in the favipiravir group were predominantly transient, the incidence was significantly higher. Conclusions The results suggested favipiravir may be one of options for moderate COVID-19 pneumonia treatment. However, the risk of adverse events, including hyperuricemia, should be carefully considered. Trial registration Clinicaltrials.jp number: JapicCTI-205238. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00517-4.

The Japanese species of the genus Strigiphilus Mjöberg, 1910 (Insecta: Phthiraptera: Philopteridae) are revised. Six species are recorded, including a new species belonging to the cursitans species-group: Strigiphilus stenocephalus new species, described from the type host Otus bakkamoena semitorques and based on specimens originally identified and reported by Uchida (1949) as Strigiphilus rostratus (Burmeister, 1838). A lectotype for Strigiphilus laticephalus (Uchida, 1949) (type host: Strix aluco yamadae) is designated and redescribed, and this louse species is synonymized under Strigiphilus cursor (Burmeister, 1838). Strigiphilus ceblebrachys (Denny, 1842), S. heterogenitalis Emerson & Elbel, 1957 and S. tuleskovi Balát, 1958 are recorded for the first time in Japan. Also, Strix uralensis and Otus sunia japonicus are recorded as new hosts for Strigiphilus heterogenitalis and S. tuleskovi respectively.

Dropout from medical attendance is a well-recognized issue among patients with human immunodeficiency virus (HIV) infection. We interviewed 23 HIV-positive patients and used text mining methods to analyse the risk factors for dropout. Fifteen patients continued medical attendance and eight patients dropped out of medical attendance. Categories were extracted from the interview data of the patients who continued medical attendance (i.e., the continuity group) and the patients who dropped out of medical care (i.e., the discontinuity group). Categories of the continuity group included needing to take a day off for medical attendance, scheduling each appointment, writing down medical appointments, being grateful for the medical care, and 12 additional categories. Categories of discontinuity group included forgetting the dates of medical appointments, not needing to get a day off for medical attendance, allowing aid for medical care to expire, and 10 additional categories. The discontinuity group had poorer schedule management than the continuity group, which caused them to forget their next medical appointments and delay the renewal of aid for medical care. Thus, medical staff may be able to prevent dropouts by ensuring that patients record the dates of their medical appointments.

Three species of chewing lice—Eucolpocephalum femorale (Piaget, 1880) (Amblycera: Menoponidae), Ibidoecus plataleae (Denny, 1842) (Ischnocera: Philopteridae) and Ardeicola plataleae (Linnaeus, 1758) (Ischnocera: Philopteridae)—are reported from the black-faced spoonbill (Platalea minor Temminck & Schlegel, 1849) in Japan. These three louse species are new records for this host. The black-faced spoonbill is classified as a “Critically Endangered” species in the IUCN Red List; although its species of lice are known to infest other species of spoonbills, these lice are endangered at the population level.

This study aimed to evaluate medication adherence and associated factors among patients with chronic viral hepatitis. A cross-sectional questionnaire survey was conducted in 171 outpatients receiving antiviral treatment of chronic viral hepatitis at 6 national/regional liver disease treatment centers in Japan. Medication adherence was calculated as the subject-reported number of antiviral tablets taken in the past 2 weeks compared with the prescribed number of tablets. Subjects were divided according to 100% adherence or nonadherence. The impact of items pertaining to everyday experiences and perceptions regarding medication adherence were examined. Factors associated with medication adherence were identified via multiple logistic regression. The mean medication adherence rate was 95.8% ± 9.5% (range = 0%-100%), although a smaller proportion (95 subjects; 55.6%) was 100% adherent. Multiple logistic regression indicated a greater "lack of understanding of need for medication" (1 point: odds ratio (OR) = 1.51, 95% confidence interval (CI) [1.30, 1.76], p ≤ .01) and greater "restriction in life due to medication" (1 point: OR = 1.26, 95% CI [1.03, 1.54], p = 0.03) as associated with nonadherence. In conclusion, to improve medication adherence, healthcare professionals should improve patients' understanding of the need for medication and minimization of life restrictions.

The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. The morphology of the LAA correlates with stroke in patients with atrial fibrillation. In this study, we evaluated the correlation between LAA morphology and cardiac function by transthoracic echocardiography in patients with sinus rhythm. We studied 55 patients (36 men, 70 ± 11 years) who underwent cardiac computed tomography and transthoracic echocardiography. The following 4 different morphologies were used to categorize LAA by computed tomography: chicken wing (CW), windsock, cactus, and cauliflower. These morphologies were also classified into CW and non-CW (nonCW) types. There were no significant differences in the left ventricular ejection fraction (63% vs 62%), left atrial (LA) volume (22.2 vs 25.5 ml/m2), and LAA volume (4.3 vs 4.7 ml/m2) between nonCW and CW. Patients with nonCW showed a lower A′ velocity (8.0 vs 9.3 cm/s, p

Osteoclasts (OCLs) are multinucleated bone-resorbing cells that are differentiated by stimulation with receptor activator of nuclear factor kappa-B ligand (RANKL) and macrophage colony-stimulating factor. We recently demonstrated that regulation of heme-oxygenase 1 (HO-1), a stress-induced cytoprotective enzyme, also functions in OCL differentiation. In this study, we investigated effects of fisetin, a natural bioactive flavonoid that has been reported to induce HO-1 expression, on the differentiation of macrophages into OCLs. Fisetin inhibited the formation of OCLs in a dose-dependent manner and suppressed the bone-resorbing activity of OCLs. Moreover, fisetin-treated OCLs showed markedly decreased phosphorylation of extracellular signal-regulated kinase, Akt, and Jun N-terminal kinase, but fisetin did not inhibit p38 phosphorylation. Fisetin up-regulated mRNA expression of phase II antioxidant enzymes including HO-1 and interfered with RANKL-mediated reactive oxygen species (ROS) production. Studies with RNA interference showed that suppression of NF-E2–related factor 2 (Nrf2), a key transcription factor for phase II antioxidant enzymes, rescued fisetin-mediated inhibition of OCL differentiation. Furthermore, fisetin significantly decreased RANKL-induced nuclear translocation of cFos and nuclear factor of activated T cells cytoplasmic-1 (NFATc1), which is a transcription factor critical for osteoclastogenic gene regulation. Therefore, fisetin inhibits OCL differentiation through blocking RANKL-mediated ROS production by Nrf2-mediated up-regulation of phase II antioxidant enzymes. Keywords:: osteoclast, fisetin, reactive oxygen species (ROS), NF-E2–related factor 2 (Nrf2), nuclear factor of activated T cells cytoplasmic-1 (NFATc1)

The differentiation of osteoclasts is regulated by several essential cytokines, such as receptor activator of nuclear factor κB ligand (RANKL) and macrophage colony-stimulating factor. Recently, high mobility group box 1 (HMGB1), a chromatin protein, also has been identified as one of these osteoclast differentiation cytokines. However, the molecular mechanisms that control HMGB1 release from osteoclast precursor cells are not known. Here, we report that RANKL-induced suppression of heme oxygenase-1 (HO-1), a heme-degrading enzyme, promotes HMGB1 release during osteoclastogenesis. In contrast, induction of HO-1 with hemin or curcumin in bone marrow-derived macrophages or RAW-D murine osteoclast precursor cells inhibited osteoclastogenesis and suppressed HMGB1 release. Since an inhibitor for p38 mitogen-activated protein kinase (MAPK) prevented the RANKL-mediated HO-1 suppression and extracellular release of HMGB1, these effects were p38 MAPK-dependent. Moreover, suppression of HO-1 in RAW-D cells by RNA interference promoted the activation of caspase-3 and HMGB1 release, whereas overexpression of HO-1 inhibited caspase-3 activation as well as HMGB1 release. Furthermore, these effects were regulated by redox conditions since antioxidant N-acetylcysteine abolished the HO-1/HMGB1/caspase-3 axis. These results suggest that RANKL-dependent HO-1 suppression leads to caspase-3 activation and HMGB1 release during osteoclastogenesis.

This retrospective cohort study was conducted to demonstrate how allocation of nurses specialized in HIV care influences clinical outcomes of antiretroviral therapy (ART) for people living with HIV (PLWH). Methods: The medical records of 116 PLWH who started ART between January 2002 and December 2004 were analyzed. Occurrence of viral suppression and viral relapse after suppression achievement and their time from baseline were observed as clinical outcomes related to ART. Clinical outcomes were obtained from medical records between January 2002 and December 2006. PLWH were classified into two groups according to allocation (n = 95, nurse allocated group) or nonallocation (n =21, nurse nonallocated group) of nurses specialized in HIV. Results: Survival analysis showed that HIV viral load was suppressed more rapidly and continuously in nurse allocated group than nonallocated group (p < .0001). Viral relapse after suppression achievement occurred easily in nurse nonallocated group than allocated group (p = .003). Conclusions: The present findings demonstrated that the role of specialized nurses is critically important from the viewpoint of clinical outcome.

The synthesis of composite microgels consisting of pH-responsive latexes with gold nanoparticles was investigated along with the optical properties of the products. The gold nanoparticles were deposited by wet chemical reduction from gold ions adsorbed in cross-linked poly(2-vinylpyridine) latexes, by which the mean particle size of the gold nanoparticles could be systematically controlled over a range of 10-30 nm simply by varying the reduction rate. Microscopic analysis showed that the gold nanoparticles were formed only on the surface of the microgels, resulting from diffusion of the gold ions from the interior to the surface of the microgels during reduction treatment. The resulting nanocomposites preserved the pH-responsive properties of the pure latexes. The degree of plasmon coupling, originating from dipole interactions among the gold nanoparticles, was dependent on the size of the nanoparticles and could be reversibly controlled by varying the pH of the aqueous solution. The process allowed independent control of the size and interparticle distance among gold nanoparticles, an ability that is important in increasing the fundamental understanding of the structure-dependent properties of gold nanoparticles and also for biological applications using functionalized composite latexes/microgels.

本研究は、中国で学ぶ中国語母語話者を対象に、日本語聴解テストにおける選択肢提示形式の影響を考察したものである。研究の目的は、1)選択肢を文字で提示したテストと音声で提示したテストとでは、結果に違いが生じるか、2)文字提示形式と音声提示形式との間で正答率について有意差が確認された項目は、どのような特徴があるか、という点について考察することである。 調査協力者は、文字提示形式のテストを受験した63名と音声提示形式のテストを受験した63名である。テスト項目のうち、実験項目は24項目であった。統計的分析の結果、文字提示形式と音声提示形式、それぞれの得点の平均値には有意差がないことが明らかになった。しかし、実験項目の各項目について統計的分析を行った結果、文字提示形式のほうが正答率が高い項目が4項目、音声提示形式のほうが高い項目が1項目認められた。そこで、この5項目について、その要因を探るために、4名の協力者を対象にインタビュー調査を実施した。その結果、文字条件が有利となる項目は、a)学習者になじみのない語が正答選択肢に含まれている、b)設問から推測される選択肢内容と実際の選択肢内容が異なる、という特徴を有していた。音声提示形式のほうが有利となる項目については、その要因は特定できず、可能性を指摘するにとどまった。本研究の結果は、中国語母語話者にとっては、文字による選択肢が有利に働くであろうという予測を覆すものであった。これは、中国の学習者は、文字を読みながら聞くという言語行動に慣れていない、日本語能力試験の対策を行っているため音声提示形式の聴解問題に慣れている、などの理由が考えられる。, This study aims to investigate the effect of multiplechoice option presentation style in written and recorded formats on the results of a Japanese listening comprehension test for native speakers of Chinese studying in China. Sixty-three examinees underwent a listening test consisting of twenty-four items with written response options, and sixty-three examinees underwent a listening test consisting of twenty-four items with recorded response options. The results showed that there was no significant difference in the mean scores of the two styles. However, an analysis of each item revealed that four items appeared less difficult when the response options were printed and one item was perceived as less difficult when the options were presented in a recorded format. Four participants underwent a test comprising these five items and were asked to answer each question after listening to it. The results of the analysis were as follows: (a) items whose correct answer included a word unfamiliar to the examinees were less difficult in the written format and (b) items whose answer students could not discern after listening to the question were less difficult in the written format. The reason for one item being less difficult in the recorded format was not found. Contrary to the hypothesis, the result indicated that the style in which the options were presented in the written format was not less difficult for Chinese learners. A possible explanation for this is that Chinese studying in China are not familiar with listening andreading simultaneously, and are used to listening comprehension tests whose options are presented in a recorded format as practice for the Japanese-Language Proficiency Test.

9,10-Phenanthraquinone (PQ), a component of airborne particulate matter, causes marked cellular protein oxidation and cytotoxicity through a two-electron reduction to 9,10-dihydroxyphenanthrene (PQH2), which is associated with the propagation of reactive oxygen species (K. Taguchi et al., Free Radic. Biol. Med. 43:789-799, 2007). In the present study, we explored a biotransformation pathway for the detoxification of PQ. Exposure of human pulmonary epithelial A549 cells to PQ resulted in a time-dependent appearance of an unknown metabolite in the medium that was identified as the monoglucuronide of PQH2 (PQHG). Whereas a variety of isozymes of uridine 5'-diphosphate glucuronosyltransferase (UGTs) are responsible for PQHG formation, UGT1A10 and UGT1A6 were particularly effective catalysts for glucuronide conjugation. In cell-free systems, PQ exhibited a rapid thiol oxidation and subsequent oxygen consumption in the presence of dithiothreitol, whereas PQHG did not. Unlike the parent compound, PQHG completely lost the ability to oxidize cellular proteins and cause cell death in A549 cells. In addition, deletion of the transcription factor Nrf2 decreased PQHG formation and increased PQ-mediated toxicity of mouse primary hepatocytes. Thus, we conclude that PQHG is a metabolite of PQ, generated through PQH2, that terminates its redox cycling and transports it to extracellular space.

Antiviral therapy is essential for HIV/AIDS patients, but many variables impede patients' adherence to therapy. To facilitate adherence, trained registered nurses in Japan provided consultation by phone at the AIDS Clinical Center. This study describes the process and content of this intervention and explores the predictors for length of time of phone consultations. The study was completed over 1 month using a time study, checklist, and medical record inquiry. A total of 175 consultations were described. Mean time was 4.8 +/- 3.8 min, and longer for patients with complications or comorbidity. Although the contents of conversations differed according to the phase of highly active antiretroviral therapy, major identified themes included need for medical consultation, symptom control, provision of information, and active listening. The results are useful for those trying to find ways to use telephone consultation effectively to reinforce adherence.

本研究は、具体的な言語使用場面における日本語能力を自己評定方式で測定する Can-do-statements調査を用いて、日本語能力試験受験者が具体的にどのようなことができるかを明らかにすることを目的として実施した。まず、Can-do-statements 調査が日本語能力に関する尺度として有効に機能することを確認するため、Can-do-statements 調査の結果と日本語能力試験及び日本語プレイスメントテストの各結果との関連性について検討した。その結果、日本語能力試験の結果を反映する尺度としての有効性が確認された。次に、Can-do-statements 各項目を分析した結果、日本語試験との関連が弱く、試験の結果から自己評定結果を予測することが困難な項目が4項目認められた。それらの項目は、1)日本語以外の能力・知識に依存する程度の大きい項目、2)回答者によって言語行動場面の判断が異なる可能性のある項目、3)経験の有無が日本語能力の判定に影響を与えている項目に分類することができる。最後に、その4項目を除外した56項目の言語行動について、日本語能力試験の成績別受験者群がそれぞれどの程度達成できるかを示し、1級及び2級合格者の日本語能力の典型的なパタンについて考察した。, This study aims to determine the performance of the examinees of the Japanese Language Proficiency Test in real-life situations. This study uses a self-assessed “Can-do-statements” questionnaire (Cds). We firststudied the results of the Cds in relation to the results of the Japanese Language Proficiency Test; later, we studied the results of the Cds and the Japanese Placement Test. As a result, we found that the results of the Cds coincided with the results of the Japanese Proficiency Test. Next, we analyzed each Cds item in isolation. Four items with a weak relation with the results of the Japanese Placement Test were found. The items are classified into (1) items depending on ability in or knowledge of something other than Japanese, (2) items which, depending on the test-takers, are open to various inter-pretations, and (3) items that depend on the examinees' experience. Lastly, we outline the tasks that the examinees of the Japanese Language Proficiency Test can perform, swell as patterns of the typical Japanese language ability of the examinees who passed levels 1 and 2 of the test.

Rab27A regulates transport of lysosome-related organelles (LROs) and release of secretory granules in various types of cells. Here, we identified up-regulation of Rab27A during differentiation of osteoclasts (OCLs) from bone-marrow macrophages (BMMs), by DNA microarray analysis. Rab27A deficiency in OCLs, using small interfering RNA (siRNA) knockdown in RAW-D cell line or BMMs derived from ashen mice, which display genetic defects in Rab27A expression, induced multinucleated and giant cells. Upon stimulation with macrophage-colony stimulating factor (M-CSF) and receptor activator of nuclear factor kappa-B ligand (RANKL), essential cytokines for OCL differentiation, phosphorylation levels of extracellular signal-regulated kinase (Erk), proto-oncogene tyrosine-protein kinase (Src) and p-38 were slightly enhanced in ashen BMMs than in wild-type BMMs. The cell surface level of c-fms, an M-CSF receptor, was slightly higher in ashen BMMs than in wild-type BMMs and down-regulation of RANK, a RANKL receptor, was delayed. In addition to receptors, OCLs derived from ashen mice exhibited aberrant actin ring formation, abnormal subcellular localization of lysosome-associated membrane protein (LAMP2) and cathepsin K (CTSK) and marked reduction in resorbing activity. Thus, these findings suggest that Rab27A regulates normal transport of cell surface receptors modulating multinucleation and LROs in OCLs.

In developed countries, human immunodeficiency virus (HIV) has become a chronic disease. The aims of this study were to clarify the physical, social, and psychological factors affecting Japanese HIV patients in a stable condition and to identify factors related to mental health of employed and unemployed HIV patients. The target subjects were people with HIV infection who were treated as outpatients at core hospitals for acquired immune deficiency syndrome (AIDS) treatment in Japan. A questionnaire including items from the Hospital Anxiety and Depression Scale (HADS) was sent to each medical facility with a request for participation from the HIV-infected outpatients. Responses from 1199 patients were analyzed. Mental health was reportedly better in the employed patients than in the unemployed patients. The unemployed patients were more likely to have resigned from their jobs because of poor health, to have resigned voluntarily, or to have been unfairly dismissed. Once the patients stopped working because of HIV, returning to work became difficult. In the employed patients, a good workplace environment was strongly related to lower scores on HADS. Higher HADS scores were recorded for employed patients infected with HIV for six years or more. For the unemployed patients, a relationship was observed between strong feelings of stigmatization and HADS scores. Quitting a job because of an experience related to HIV status may be related to feelings of stigmatization.

EAT/mcl-1 (EAT), a bcl-2-related immediate early gene, is up-regulated at an early stage of differentiation of human embryonal carcinoma cells. Recent studies have revealed that EAT inhibits apoptosis both in vitro and in vivo. In the present study, we demonstrated that the EAT gene was up-regulated in the early stage of rat myocardial infarction. This pattern of up-regulation was apparently different from that of another immediate early gene, c-fos. EAT, an anti-apoptotic molecule, was strongly up-regulated in the non-ischemic region. In contrast, the expression of c-fos was induced in both ischemic and non-ischemic regions, and was higher in the ischemic region. Apoptosis of cardiomyocytes is currently thought to significantly contribute to acute myocardial infarction. We detected cardiomyocyte apoptosis by gel electrophoresis of genomic DNA and in situ nick end labeling in the ischemic region, but not in the non-ischemic region. As an inhibitor of apoptosis, EAT may play a role in the protection of cardiomyocytes in the early stage of acute myocardial infarction.

The present study investigated whether regional ventricular dyskinesia (ie, systolic bulging) is a direct cause of ST-segment elevation in canine hearts in vivo. Regional ventricular dyskinesia was induced in 33 anesthetized open-chest dogs by injection of negative inotropic agents into the left anterior descending coronary artery (LAD) without disruption of coronary blood flow. Regional myocardial contraction was assessed in terms of the percent systolic shortening (%SS) and percent systolic bulging (%bulging), which were measured using ultrasonic crystals. The ST-segment elevation of the LAD-perfused area was measured with a unipolar electrode. Lidocaine, a sodium channel blocker, nicorandil, a potassium channel opener, propranolol, a beta-adrenergic blocker, or verapamil, a calcium channel blocker, was administered by intracoronary injection during maximal vasodilation induced by adenosine. All drugs induced dose-dependent ST-segment elevation in association with a parallel reduction in %SS and a parallel increase in %bulging. The absence of myocardial ischemia was confirmed by the absence of NADH fluorescence. It was concluded that regional ventricular dyskinesia had an important role in ST-segment elevation not associated with myocardial ischemia.

本稿は、日本で働く外国人ビジネス関係者と在日企業の日本語に対するニーズについて扱うものである.調査は在日企業の人事担当者及び外国人ビジネス関係者を対象に、調査票により実施した.回答を分析した結果 、次のことが明らかになった.1) 日本・合弁企業か外資系企業かによって、日本語の使用状況にかなりの差がある.日本・合弁企業が社内のほとんどのコミュニケーションを日本語で行なっているのに対し、外資系企業における日本語の使用は社内活動の種類によって違いが見られた.会話、読み、書き、いずれも外資系企業のほうが「日本語は使用しない」と回答した割合が高い.2) 日本語使用の実際と今後の希望は、会話力については上昇指向があるが、それ以外の技能に関しては差が見られない.3) 日本語力が採用条件になっているか否かは、外国人ビジネス関係者の母語、採用者側の企業形態によって違う.4) 企業は外国人社員に、顧客とのやりとりよりも、まず社内での日本語運用力を求めている.また、外資系企業の日本語に対する要求度は、日本・合弁企業のそれより大幅に低く、要求の内容にも差異がある.5) 会話、読み、書き、いずれの場合も、企業が期待する日本語力以上の力を外国人社員は発揮している., This paper analyzes how necessary Japanese language skills are at companies in Japan. Two types of questionnaires were prepared. One was for Japanese companies and foreign-affiliated firms, and the other was for non-Japanese businesspeople working in Japan. The following points were investigated, based on the replies to the questionnaire. 1) In which areas do non-Japanese businesspeople use Japanese? What is the difference between their present use of Japanese and their hopes for the future? 2) In which situations do companies expect non-Japanese businesspeople to use Japanese? 3) Is there any difference between the present condition of Japanese use by non-Japanese businesspeople and the expectations of companies? The results are: 1) Japanese language use depends greatly on the type of company for which one works. For example, almost all of the businesspeople in Japanese companies use Japanese for in-house communication, however, language usage in foreign-affiliated firms differs according to the type of work been carried out. In the case of conversation skills only, was there a difference between present conditions and future hopes. 2) Companies expect non-Japanese businesspeople to use Japanese for in-house communication first and then for communicating with customers. Japanese companies expect more non-Japanese businesspeople to use Japanese than foreign-affiliated firms do. 3) For all skills?\conversation, reading, writing-non-Japanese businesspeople use more Japanese than their companies expected.

Cognitive behavioral therapy (CBT) is widely regarded as an effective treatment for obsessive-compulsive disorder (OCD) and is usually provided on an outpatient basis. A minority of individuals need a more intensive/ inpatient service, which is particularly important for patients who cannot be managed as outpatients owing to the nature or extent of their symptoms. Inpatient treatment is generally provided by a multidisciplinary team and psychiatric nurses play a specific and prominent role as they are afforded a unique assessment and intervention opportunity by virtue of their 24-hour presence on the unit. However, there are few facilities, reports of multidisciplinary approaches, or descriptions of the role of nursing staff as cotherapists for CBT-oriented treatment of inpatients with OCD. The present paper therefore reports the developed nursing guidelines for inpatients with OCD in line with the progress of CBT at Chiba University Hospital in the context of Japan being a country in which CBT is under development. In addition, availability of the guidelines, better means of managing severe OCD and key issues for dissemination of CBT in Japan are discussed.

The purpose of this study was to evaluate ST-segment elevation induced by regional myocardial stretch without myocardial ischemia in canine hearts. A strain gauge arch (TH-601T) was sutured to the left ventricular epicardium, parallel to the short axis, to shorten the end-diastolic length of the myocardium beneath the arch (stretch zone; SZ) and to produce regional myocardial stretch in each of 6 dogs. An increase in preload caused by altering the height of a saline-filled reservoir affected prolongation or shortening of the myocardium both in the SZ and outside the arch (normal zone; NZ) to increase myocardial stretch. An epicardial electrocardiogam was recorded in both the SZ and the NZ. After suture of the strain gauge arch, the ST segment was elevated in the SZ. An increase in preload augmented stretch during systole in the SZ, resulting in additional ST-segment elevation. These results suggest that regional myocardial stretch itself plays an important role in ST-segment elevation. (Jpn Circ J 1997; 61: 921 - 926)

We report a patient with Brugada syndrome who developed sustained monomorphic ventricular tachycardia (SMVT). The patient was a 29-year-old man who experienced recurrent episodes of palpitation and syncope after drinking alcohol. Electrocardiogram showed right bundle branch block and ST-segment elevation in precordial leads V1-3 without Q-Tc prolongation. Organic heart disease and coronary artery disease were excluded by noninvasive and invasive tests. Ventricular fibrillation was induced by the application of a single extra-stimulus to the right ventricular outflow tract. During isoproterenol infusion, SMVT of left bundle branch block morphology (240/min) was induced by the application of a single extrastimulus to the right ventricular apex. SMVT also developed spontaneously. Pace mapping disclosed that SMVT originated at the free wall of the right ventricular outflow tract. Head-up tilt test and an alcohol provocation test both induced similar SMVT that was associated with hypotension and near syncope. SMVT was not terminated by intravenous administration of lidocaine, procainamide or adenosine triphosphate (10 mg), but was terminated by propranolol. Thus, a beta-adrenoceptor-mediated mechanism appears to play an important role in SMVT in this patient. The site of origin of SMVT might be closely related to the lesion that causes ST-segment elevation.

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This report describes an unusual case of ruptured pseudoaneurysm (PSA) of mitral-aortic intervalvular fibrosa (MAIVF) caused by infective endocarditis. The PSA ruptured into the left sinus of Valsalva in addition to the left atrium, resulting in complicated shunting among the aorta, left ventricle and left atrium, leading to refractory heart failure. The transesophageal echocardiography provided the precise information concerning the anatomical detail of the PSA, which is crucial for the surgical repair. This is the first report describing a patient with PSA of MAIVF with two rupture sites.

Apoptosis of cardiomyocytes plays an important role in reperfusion injury following myocardial infarction. Conversely, interleukin-6 (IL-6)--a potent cytokine--inhibits myeloma cell apoptosis by activating GP130 through the IL-6 receptor (IL-6R). We hypothesized that the IL-6/soluble IL-6R complex can inhibit myocardial apoptosis, and limit infarct size in reperfused acute myocardial infarction. Anesthetized rats were randomly divided into five groups: sham, coronary occlusion and reperfusion rats administered IL-6/soluble IL-6R complex, IL-6 alone, soluble IL-6R (sIL-6R) alone, or a control vehicle. Rats were subjected to 30 min occlusion of the left coronary artery followed by 3 h reperfusion. After reperfusion, the hearts were excised. For detection and quantification of apoptosis, gel electrophoresis of extracted genomic DNA and TUNEL method of paraffin sections were performed. The percentage of the infarct area was measured using tetrazolium chloride staining. The cardiomyocyte apoptosis analysis revealed that apoptosis in the reperfused myocardium was inhibited only in the complex group. Furthermore, the percentage of the infarct area out of the area at risk was remarkably reduced in the complex group (23.8+/-1.8%), compared with that in the vehicle (37.9+/-3.7%), the IL-6 (40.7+/-1.0%), or the sIL-6R (37.5+/-2.4%) groups (P=0.0002). No significant differences were observed among the vehicle, IL-6, and sIL-6R groups. The IL-6/soluble IL-6 receptor complex inhibits cardiomyocyte apoptosis in reperfused acute myocardial infarction. It possibly reduces irreversible reperfusion injury.

The high cost of digital echocardiographs and the large size of data files hinder the adoption of remote diagnosis of digitized echocardiography data. We have developed a low-cost digital filing system for echocardiography data. In this system, data from a conventional analog echocardiograph are captured using a personal computer (PC) equipped with an analog-to-digital converter board. Motion picture data are promptly compressed using a moving pictures expert group (MPEG) 4 codec. The digitized data with preliminary reports obtained in a rural hospital are then sent to cardiologists at distant urban general hospitals via the internet. The cardiologists can evaluate the data using widely available movie-viewing software (Windows Media Player). The diagnostic accuracy of this double-check system was confirmed by comparison with ordinary super-VHS videotapes. We have demonstrated that digitization of echocardiography data from a conventional analog echocardiograph and MPEG 4 compression can be performed using an ordinary PC-based system, and that this system enables highly efficient digital storage and remote diagnosis at low cost.

We report a case of a 79-year-old woman with an unusual salivary gland tumor that developed at the junction between the soft and hard palates. The tumor consisted of sialadenoma papilliferum (SP) with areas of an epithelial-myoepithelial carcinoma (EMC) component and a high-grade carcinoma component. There were also transitional regions among the SP, the EMC and the high-grade carcinoma components. The high-grade carcinoma component, which was similar to invasive micropapillary carcinoma of the breast, infiltrated into the right parapharyngeal space and metastasized to the lungs and cervical vertebrae. The high-grade carcinoma cells were positively immunostained for p53 protein. SP has been considered to be a benign tumor with exceptionally good prognosis, and, to the best of our knowledge, there has never been a confirmed case of malignant SP. This is the first report of SP with a definite malignant component.

Cardiac manifestations of the CREST syndrome or limited systemic sclerosis (ISSc) are very rare. We report a case of CREST syndrome associated with sick sinus syndrome. Histopathology of cardiac muscle revealed fibrotic changes, suggesting that such changes may be pathogenetically related to CREST syndrome.

Aim To characterise the clinical significance of M2-muscarinic acetylcholine receptor autoantibodies (M2-AAB) in patients with dilated cardiomyopathy (DCM). Methods and results Sera from 104 patients with DCM, age-matched with 104 patients with idiopathic atrial fibrillation (Af) and 104 healthy control subjects, were screened for M2-AAB by enzyme-linked immunosorbent assay (ELISA). IgG purified by Protein-A column was also used as a primary antibody in ELISA. In DCM, M2-AAB were detected in 40% of patients using whole sera and in 36% of patients using purified IgG. M2-AAB were also found in several patients with idiopathic Af (23%, 23%), and these frequencies were significantly higher than those in healthy subjects (8%, 8%). Af was more common in AAB-positive than in AAB-negative patients with DCM. Multivariable analysis confirmed that M2-AAB were independent predictors of the presence of Af in such patients. We determined electrophysiological changes by adding patient purified M2-AAB to chick embryos. Purified IgG from both Af and DCM patients exhibited negative chronotropic effects and induced supraventricular arrhythmias. Conclusion M2-AAB may play a role in mediating the development of Af in patients with DCM.

The clinical implications of autoantibodies (Abs) were investigated as upstream indicators of paroxysmal atrial fibrillation in patients with congestive heart failure.Circulating Abs against myosin (M-Abs) detected by immunofluorescence, Abs against beta 1-adrenergic receptors (Beta 1-Abs) detected by enzyme-linked immunosorbent assay (ELISA), and Abs against NA-K-ATPase (NKA-Abs) detected by ELISA were screened in 95 congestive heart failure patients withor = 45% left ventricular ejection fraction (coronary artery disease, n = 48; dilated cardiomyopathy, n = 47) and 48 age-matched control patients with hypertension. No patient received antiarrhythmic therapy. All patients were enrolled with angiotensin converting enzyme inhibitors in the chronic stable state. Relationship of the presence of paroxysmal atrial fibrillation to other clinical variables were assessed by 48-hour Holter monitoring.No control patient had Abs. However, M-Abs, Beta 1-Abs, and NKA-Abs were detected in 22%, 26% and 16% of patients with congestive heart failure (coronary artery disease; 8%, 10%, and 4%, dilated cardiomyopathy; 36%, 43%, and 28%, respectively). Paroxysmal atrial fibrillation was more frequent in patients with dilated cardiomyopathy than in those with coronary artery disease (47% vs 15%, p0.01). Multivariate analysis suggested that NKA-Abs was an independent risk factor for the occurrence of paroxysmal atrial fibrillation (p0.01), although there were no differences in other clinical factors: age, sex, New York Heart Association functional class, concomitant medication, left ventricular ejection fraction, left atrial diameter, severity of mitral regurgitation, serum potassium, plasma norepinephrine, and atrial natriuretic peptide concentration.Autoantibodies against sarcolemmal Na-K-ATPase were closely related to the occurrence of paroxysmal atrial fibrillation in patients with congestive heart failure, so an autoimmune process may be an upstream factor in atrial fibrillation.

Few previous reports have comprehensively screened all the anti-myocardial autoantibodies (AMCA) in relation to other clinical profiles in patients with idiopathic dilated cardiomyopathy (IDC), so the present study used both immunohistochemistry (FITC) and immunoblotting (IB) for screening patients with IDC in order to characterize the clinical significance of AMCA. Sera were collected from 100 patients with IDC and age-matched 100 healthy control subjects (CTL). For FITC, an unfixed frozen section of human myocardium was used for the standard indirect immunofluorescence; for IB, total cardiac homogenates of the same myocardium were blotted to serum at 2 sets of dilution (1:200 and 1:10,000). The positive rates of AMCA detection for each method were as follows (IDC vs CTL); 39% vs 6% for FITC, 38% vs 4% for IB (1:200), and 10% vs 0% for IB (1:10,000). Fifty-nine patients with IDC and 8 CTL were positive for AMCA by either method, and 18 patients with IDC and 2 CTL were positive for AMCA by both methods. IB-positivity at 1:200 was an independent predictor by multiple logistic regression analysis of non-sustained ventricular tachycardias as well as left ventricular end-diastolic diameter and plasma norepinephrine concentration.