Editorial
Toward a New Era of the Nagoya Journal of Medical Science: Message from the New Editor-in-Chief
SHINYA TOYOKUNI
pg(s) 107-109
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Invited Review Article
Tissue-Engineering Bone from Omentum
YUZURU KAMEI, KAZUHIRO TORIYAMA, TORU TAKADA and SHUNJIRO YAGI
pg(s) 111-117
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Tissue engineering of bone is an interesting field of research. Many approaches to bone tissue engineering such as from bone marrow stromal cells in vitro have been reported. Furthermore, a model of vascularized tissue-engineered bone flap has been reported. However, there has been no report of bone tissue engineering using omentum. We present a study of tissue engineering of bone from omentum in a rabbit model. The omentum, which was elevated based on the right gastroepiploic vessels, was wrapped by the periosteum from cranial bone in the abdomen of rabbits. We harvested the omentum thus wrapped 1, 2, 4, 6, 8, 12, or 24 weeks after surgery. Within 1 week after surgery, woven bone was formed and clusters of osteoblasts were observed. At 8 weeks, medullization, including the presence of granulocytes, was confirmed. This technique might prove useful for creating tissue-engineered bone flaps for reconstructive surgery.
Original Papers
Risk Factors of Recipient Receiving Living Donor Liver Transplantation in the Comprehensive Era of Indication and Perioperative Managements
MASATOSHI ISHIGAMI, YOSHIAKI KATANO, KAZUHIKO HAYASHI, AKIHIRO ITO, YOSHIKI HIROOKA, YASUHARU ONISHI, TARO NAKAMURA, TETSUYA KIUCHI and HIDEMI GOTO
pg(s) 119-127
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Living donor liver transplantation (LDLT) has become one of the chief methods of saving patients with end-stage liver disease due to liver cirrhosis. Accumulation of knowledge about indication and perioperative managements improve outcome of this treatment. In this study, we elucidate the risk factors of LDLT, which still exist today. Sixty-one patients received LDLT in our institute between 2003 and 2009 were included in this study. Recipient age and sex, donor age and sex, etiology, preoperative model of end-stage liver disease (MELD) score, hepatocellular carcinoma (HCC), graft versus recipient weight ratio (GRWR), cold and warm ischemic time, operation time, blood loss, ABO compatibility, rejection, cytomegalovirus (CMV) infection, biliary stricture, and calcineurin inhibitor (FK506 or cyclosporin A) were the factors investigated.
Effects of Daily Mechanical Horseback Riding on Insulin Sensitivity and Resting Metabolism in Middle-Aged Type 2 Diabetes Mellitus Patients
YOSHIYUKI HOSAKA, MASARU NAGASAKI, GUSTAVO BAJOTTO, YOUICHI SHINOMIYA, TAKAHISA OZAWA and YUZO SATO
pg(s) 129-137
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The present study was conducted to investigate the effect of daily passive exercise using a horseback riding machine (Joba®) on insulin sensitivity and resting metabolism in middle-aged, diabetic patients. Participants were 24 type 2 diabetes mellitus patients aged 59 ± 8 years (mean ± SD; range from 43 to 75 years of age). Patients were randomly divided into control (normal lifestyle) and Joba® exercise groups. The latter group was instructed to perform one 30-min session of Joba® riding per day, 7 times per week, for 3 months. Compared with baseline values, serum immunoreactive insulin (IRI) concentrations decreased and HOMA-IR was improved by Joba® training. In addition, exercise duration per day significantly correlated (r = –0.65) with changes in serum IRI, and 3-month mechanical horseback riding significantly increased the resting metabolic rate of the patients. These results suggest that daily Joba® passive exercise is potentially useful as a means to improve insulin sensitivity and resting metabolism in diabetic patients. The Joba® fitness equipment can prove especially useful as an alternative exercise therapy for aged individuals incapable of performing independent exercise or for those who suffer from knee-joint disorders.
Disruption of Cell Spreading by the Activation of MEK/ERK Pathway is Dependent on AP-1 Activity
FENG XU, SATOKO ITO, MICHINARI HAMAGUCHI and TAKESHI SENGA
pg(s) 139-144
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We previously reported that the disruption of cell spreading by v-Crk was dependent on the activation of the MEK/ERK pathway. Here we demonstrate that the activation of that pathway is sufficient to suppress cell spreading. The MEK/ERK pathway regulates the activity of various proteins including AP-1, which is a transcriptional factor composed of heterodimeric proteins. To examine whether AP-1 activity is required for the suppression of cell spreading by the activation of the MEK/ERK pathway, we expressed BATF, which is a negative regulator of AP-1. The expression of BATF clearly restored cell spreading that was suppressed by the activation of MEK/ERK pathway. In addition, a disrupted formation of stress fibers and focal adhesions by such activation was restored by the suppression of AP-1. Our results define an essential role of the MEK/ERK/AP-1 pathway in the disruption of actin cytoskeleton and cell spreading.
A Prospective Randomized Study for Postoperative Pain Relief of Lower Extremity Fractures: Efficacy of Intrathecal Morphine Administration
MASAAKI MACHINO, YASUTSUGU YUKAWA, TETSURO HIDA, YOSHIHARU OKA, TERUO TERASHIMA, SUSUMU KINOSHITA and FUMIHIKO KATO
pg(s) 145-150
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Systemic opioids are known to be effective for controlling postoperative pain. Intrathecal morphine administration can be performed in a simple manner concurrently with spinal anesthesia. The purpose of this study was to investigate the efficacy of intrathecal morphine administration for the postoperative analgesia of lower extremity fractures. A prospective randomized study for postoperative pain relief was conducted. Fifty consecutive patients with a lower extremity fracture who underwent osteosynthesis under spinal anesthesia were enrolled. The patients were divided into two groups for comparative results. No baseline variable differences between the groups were observed. Twenty-two patients were assigned to a morphine group and were administered intrathecal bupivacaine combined with a single intrathecal injection of morphine. The other 28 patients were assigned to a control group and administered intrathecal bupivacaine alone. Pain intensity was assessed using the Visual Analog Scale (VAS). The use of supplemental analgesics, time of first request for supplemental analgesics, and side effects were investigated. During the initial 12 h after surgery, the VAS score was significantly lower in the morphine group (p<0.05). The use of supplemental analgesic drugs was significantly less in the morphine group (p<0.05). The time of first request of the control group was shorter than that of the morphine group (p<0.001). Side effects were seen more frequently in the morphine group though there was no significant difference. Although the use of morphine requires appropriate postoperative care, an intrathecal morphine injection can be an attractive analgesic for the postoperative pain of lower extremity fractures.
Smoking Rates and Attitudes to Smoking Among Medical Students: A 2009 Survey at the Nagoya University School of Medicine
YUTO TAKEUCHI, EMI MORITA, MARIKO NAITO and NOBUYUKI HAMAJIMA
pg(s) 151-159
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Since smoking is implicated in many diseases, medical professionals are expected to contribute to the reduction of smoking rates in their practice. Medical students are also expected to learn the importance of practical measures against smoking. This study surveyed the smoking rates and attitudes to smoking among medical students of the Nagoya University School of Medicine. Out of 612 students in their 1st to 6th year in 2009, 31 students answered “yes” to the question “Did you smoke one or more cigarettes this past month?” and eight students did not respond. The maximum smoking rate was 6.4% (39/612). The respective rates of students to accept smoking by doctors, co-medical personnel, patients in general, and terminally ill patients were 50.8% in males and 38.9% in females, 51.3% in males and 41.6% in females, 41.4% in males and 23.0% in females, 80.5% in males and 84.1% in females. This survey demonstrated that though smoking rates among medical students were relatively low, many accepted smoking, especially for terminally ill patients.
Role of Insulin Resistance in Non-Obese Adolescents
REIZO BABA, MASAAKI KOKETSU, MASAMI NAGASHIMA, AKIKO TAMAKOSHI and HIROSHI INASAKA
pg(s) 161-166
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Insulin resistance in the obese is closely related with cardiovascular diseases and their risk factors not only in adults but also in children and adolescents. We aimed to elucidate whether insulin resistance in non-obese adolescents is related with these conditions. A total of 74 non-obese high-school students (38 boys and 36 girls) were recruited. Anthropometry, blood pressure, fasting serum chemistry and insulin activity were measured. Subjects with a homeostasis model assessment-insulin resistance (HOMA-IR) level greater than the 75th percentile (> 2.25 for boys and > 2.89 for girls) were defined as insulin resistant. Non-obese boys with impaired insulin sensitivity had higher systolic blood pressure, lower HDL-cholesterol concentration, and fewer hours of vigorous exercise during weekdays, while non-obese girls with impaired insulin sensitivity had higher systolic blood pressure than their peers with normal insulin sensitivity. By multiple stepwise regression analysis, systolic blood pressure (p<0.001) and the hours of vigorous exercise during weekdays (p<0.03) were independently associated with HOMA-IR in boys, while systolic blood pressure (p<0.0001) and serum concentrations of HDL-cholesterol (p<0.01) were found in girls. In nonobese adolescents, insulin sensitivity is related with cardiovascular risk factors.
Helicobacter Pylori Infection and Cytokines Gene Polymorphisms in Uzbeks
SHAVKAT ABDIEV, KYN SOU AHN, ABDUKHAKIM KHADJIBAEV, YUSUF MALIKOV, SAIDKARIM BAHRAMOV, BAKHODIR RAKHIMOV, JUNICHI SAKAMOTO, YASUHIRO KODERA, AKIMASA NAKAO and NOBUYUKI HAMAJIMA
pg(s) 167-172
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Recent studies have reported that Helicobacter pylori (H. pylori) persistent infection and gastric atrophy development were associated with genetic polymorphisms of cytokines. This study aimed to determine possible associations of host genotypes with the seropositivity of anti-H. pylori IgG and anti-CagA IgG, as well as gastric atrophy measured with serum pepsinogens (PG) among an Uzbek population. Subjects were 84 patients with peptic ulcer disease, 35 with other miscellaneous diseases, and 48 healthy persons, for a total of 167 participants. Using a polymerase chain reaction with confronting two-pair primers, their DNA was genotyped for polymorphisms of interleukins (IL) (IL-1B C-31T, IL-2 T-330G, IL-4 C-33T, IL-8 T-251A, IL-10 T-819C, and IL-13 C-1111T) and tumor necrosis factor A (TNF-A) (C-857T and T-1031C). Among 167 participants, 124 (74.9%) were anti-H. pylori IgG seropositive, 142 (85.6%) were anti-CagA IgG seropositive, and 44 (26.3%) exhibited gastric atrophy (PG1<70 ng/ml and PG1/PG2<3). The adjusted odds ratio (OR) of IL-4 -33CT for anti-H. pylori IgG seropositivity was significant; OR=2.33 (95% confidence interval (CI), 1.04–5.19), relative to -33CC. In addition, those with TNF-A-1031TC had a significantly increased risk for anti-H. pylori IgG seropositivity; OR=2.82 (95%CI, 1.05–7.57), relative to -1031TT. No alleles were associated with the risk of anti-CagA IgG seropositivity or gastric atrophy. The significant associations with cytokine polymorphisms indicated that genetic traits might play a role in the persistent infection of H. pylori among Uzbeks. In addition to confirming the above associations, lifestyle interactions with the genotypes also remain to be elucidated.
Short Communication
Preliminary Study on Spontaneous Hepatitis in Long-Evans Cinnamon Rats: A Blood Exchange May Improve the Fetal Hepatitis
JUN UEYAMA, SHINYA WAKUSAWA, YASUYUKI TATSUMI, AI HATTORI, MOTOYOSHI YANO and HISAO HAYASHI
pg(s) 173-177
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Long-Evans Cinnamon rats are a Wilson disease model highly susceptible to fulminant hepatitis around the age of 20 weeks, and hepatoma over the age of one year. Although prophylaxis has been established for the otherwise fatal hepatitis, effective treatment remains unknown. A blood exchange was tested to determine whether the prognosis of spontaneous hepatitis could be modified in icteric female rats. When bilirubinuria appeared, the rats immediately underwent surgery. Rats under anesthesia were first cannulated into the right atrium via the carotid vein, followed by 2.5 mL of blood exchange with heparinized fresh blood from Long-Evans agouti rats. Treated rats and controls were then observed for 2 months. Compared to the 50% mortality of untreated rats, all icteric rats that received a blood exchange survived the acute episode. We confirmed that Wilson disease animals are highly susceptible to acute hepatitis and show a poor prognosis. However, a single blood exchange improved spontaneous hepatitis in this animal model. This would serve as a first step for establishing a treatment for fatal hepatitis in animals. A blood exchange may improve fulminant hepatitis of Wilson disease model rats.
