Rapid increase in the prevalence of obesity in elementary school children.

OBJECTIVE: Three critical periods have been suggested for the development of obesity during childhood: fetal, ages 4-6 y, and adolescence. The prevalence of obesity in elementary school children is increasing in Japan, and the present study examines whether this rising prevalence occurs during the elementary school period (age 6-11 y) or is occurring prior to entry into elementary school. DESIGN: Repeated cross-sectional sampling of cohorts of children for the prevalence of obesity. SETTING AND PARTICIPANTS: The data from 81 264 first grade and 87 849 seventh grade children (94 and 87% of the total populations, respectively) between 1989 and 2002 in Kagoshima City were analyzed. Data were also obtained from nationwide surveys published by the Ministry of Japan between 1989 and 2001. MEASUREMENTS: Obesity was defined by the body mass index for an age- and sex-specific 95th percentile cutoff point in Japanese children. Trends in obesity and odds ratios of the prevalence of obesity were also determined. RESULTS: The period 1989-2001/2 showed significant increases in the prevalence of obesity for both genders, in both first and seventh grades, and in both Kagoshima City and nationwide. The odds ratios for the prevalence of obesity of 12-y-old children calculated against the prevalence of obesity within the same cohort at 6 y old revealed that a significant risk for development of obesity during the elementary school years applied only to boys from around 1993 onward in Kagoshima City and applied throughout the study period in nationwide Japan. CONCLUSION: Obesity prevalence increases for boys during elementary school years but does not significantly increase for girls. A rising trend for becoming obese before starting elementary school was present for both boys and girls over the period 1989-2001. Educational programs to improve nutrition and physical activity, especially for boys, are becoming increasingly necessary.

Who is becoming overweight during the elementary school years?

OBJECTIVE: To determine the risk of becoming overweight for every first grader during the elementary school years and to determine whether the overall risk of becoming overweight for first graders is increasing. STUDY DESIGN: A descriptive study using school-based surveys of 12,588 boys and 12,264 girls who entered elementary school between 1989 and 1994. Six years later, the follow-up survey was conducted. Overweight was defined using the BMI percentile cut-off points. MEASUREMENTS: For every 5th percentile rank of first graders, the odds ratio for becoming overweight at seventh grade was calculated. A hockey stick regression analysis and the yearly trend of the risk for becoming overweight at 7th grade were also investigated. RESULTS: For overweight children in first grade, the odds ratio for staying at the same level was extremely high in both boys (35.0) and girls (63.9). The threshold effects of the BMI percentile value at first grade for becoming overweight were the 81st and 87th percentiles for boys and girls, respectively, according to the hockey stick model. The overall risk for becoming overweight significantly increased in boys during the study period (P=0.009). CONCLUSION: The present study determined the exact level of the risk for becoming overweight for every first grader at a different BMI percentile rank. The risk of overweight children in first grade who stayed at the same level at seventh grade was higher in girls than in boys. On the other hand, the trend of the entire population for becoming overweight presents only in boys. The different pattern of the trend of population for becoming overweight by sex during elementary school period may provide evidence to understand and predict overweight in adolescents and adults.

[Efficacy and safety of intramuscular imipenem/cilastatin (IPM/CS) for complicated urinary tract infections].

An intramuscular preparation of imipenem/cilastatin (IPM/CS, 500 mg/500 mg) was administered to 59 patients with complicated urinary tract infections (UTI; cystitis and pyelonephritis) to evaluate its efficacy and safety. The obtained results are summarized as follows: In patients with cystitis, evaluations based on daily frequencies of administration were also performed. 1) According to the treating doctors, the drug showed an overall efficacy rate of 80% (45/56 patients). The efficacy rate was 89% in patients with cystitis treated by a u.i.d. regimen. Among patients treated by a b.i.d. regimen, the efficacy rate was 67% for cystitis cases and 84% for pyelonephritis cases. 2) When clinical efficacy was assessed according to the criteria for UTI drug efficacy evaluation, the drug was 'markedly effective' in 14 patients, 'effective' in 23, and ineffective in 11 patients, for an efficacy rate of 77% (37/48 patients). 3) The microbiological eradication rate was 88% (59/67 strains). The rate was 95% (20/21 strains) for Gram-positive bacteria and 85% (39/46 strains) for Gram-negative bacteria. The efficacy for Enterobacter faecalis and Pseudomonas aeruginosa was 100% and 73%, respectively. 4) As side effects, pain at the injection site was reported by one patient and abnormal laboratory test values were observed in 2 patients. All of these reactions were mild and resolved shortly after the completion of treatment. Based on these findings, it is concluded that this intramuscular preparation of IPM/CS is effective for treating complicated urinary tract infections.

Intravascular leiomyomatosis with uterine lipoleiomyoma.

A very rare case of uterine lipoleiomyomata with intravascular leiomyoma in a 48-year-old woman is described. Located in the corpus of the uterus, the lipoleiomyomata showed proliferation of leiomyocytes intermingling with mature adipocytes. Intravascular leiomyoma was present in the broad ligament. It exhibited only spindle cells, and was reactive for HHF35 actin, without adipocytes. No continuity was detected between these tumors. Immunohistochemical studies revealed that the same portion of the intravascular leiomyoma was positive for S-100 alpha protein, NSE, factor VIII-related antigen, and HHF35 actin. These findings suggest that the leiomyomatous tumor components arise from multipotent undifferentiated mesenchymal stem cells.

The effect of the autonomic nervous system on cell proliferation of the gastric mucosa in stress ulcer formation.

The role of the autonomic nervous system in cell proliferation of the gastric mucosa during restraint water immersion stress was investigated utilizing the spontaneously hypertensive rat (SHR) and its progenitor, the Wistar-Kyoto rat (WKY). Three hours of water-immersion restraint induced gastric lesions more frequently in WKY than in SHR, although there were few visual lesions in either strain in two hours of stress. The number of 5-bromo-2'-deoxyuridine (BrdU) positive cells in the corpus ventriculi mucosa markedly decreased in the WKY, but did not change in the SHR after two hours of water-immersion restraint stress. The acetylcholine content in the mucosa significantly decreased and the density of acetylcholinesterase (ACh-E) containing fiber of mucosa remarkably increased in only WKY after two hours stress exposure. On the other hand, there was no significant difference in either the responsiveness or the content of norepinephrine and epinephrine, which indicates sympathetic nervous function, after stress exposure in WKY and SHR. Similarly, the response of serum gastrin was not significantly different between the two strains. These results strongly suggest that the parasympathetic nerve plays an essential role in cell proliferation of the gastric mucosa in the pathogenesis of stress ulcer.

Phlegmonous enteritis in alcoholic fatty liver.

Phlegmonous enteritis is a rare inflammatory bowel disease. A 52-yr-old man with a history of alcoholic abuse was admitted to the hospital for an acute abdomen and died of septicemia and its complications. Autopsy revealed phlegmonous inflammation of the ileum and severe fatty liver. Numerous Gram-negative rod bacilli were demonstrated in the ileal mucosa. Shortened villi and decreased lysozyme activity of Paneth cells in the small intestine might be results of chronic alcohol ingestion. The relationship between phlegmonous enteritis and alcoholic abuse was strongly suggested in this case.

Biochemical and allergenic properties of the house dust mite extract, Dermatophagoides pteronyssinus.

A further study has been made on the house dust mite extract, Dermatophagoides pteronyssinus, with emphasis on gel-filtrated fraction 2 (F2). The crude mite extract showed at least nine discs on polyacrylamide disc electrophoresis and contained less than 0.25% sialic acid and less than 0.5 mM hexosamine and no detectable uronic acid. From gel filtration of the crude extract a No 2 fraction (F2) with allergenic activity showed at least five components on SDS disc electrophoresis covering a molecular weight range of between 15,000 and 70,000. The major allergenic activity of F2 dissolved in pH 7-8 and 4-5 on an isoelectric focusing column. Affinity chromatography and lectins showed that allergenic activity did not relate to structures of N-acetyl-D-glucosamine or N-acetyl-D-galactosamine. Allergenic activity of the crude extract was no affected by peptic digestion and the mite digest prepared by trypsin and pronase showed a similar fractionation and activity profile as crude extract.

Longitudinal study on Schistosoma japonicum infections in the Philippines. Incidence and prevalence among school children in Dagami Area, Leyte.

The annual incidence of Schistosoma japonicum infection was calculated from the record of the yearly examination among school children of Dagami Area, Leyte, Philippines. Data were processed mainly by the computer. Children were examined for eggs by the merthiolate formalin concentration technique and by the circumoval precipitin test (COPT) once a year in 3 consecutive school years (SY), SY 1974/75, 1975/76 and 1976/77. About 600 to 700 children were examined yearly and the ratios of cases rechecked after 1 year were about 30%. A method to calculate the overall incidence in children who were examined at different intervals, was newly established. The incidence appeared to rise rapidly in the survey period, being 25.59% and 41.30% by fecal examination and 10.74% and 21.27% by COPT in SY 1975/76 and 1976/77, respectively. From the combined results of fecal examination and COPT, the reliable values of incidence, however, were shown to be stable during 2 years such as 22.06% and 24.21%, respectively. The incidence estimated by the age prevalence data was 20.25% in SY 1976/77 by the combined results and was found to be lower than the directly calculated value.

Laboratory and field assessment of the molluscicidal activity of gogo (Entada phaseoloides) against the amphibious snail intermediate host of Schistosoma japonicum.

A molluscicidal fraction occurs naturally in the bark of a vine (gogo in Tagalog), Entada phaseoloides, which grows indigeneously and abundantly in the Philippines. Butanol fraction of the methanol extracts of the bark was most toxic against Oncomelania quadrasi with the LC50 of 3.6-5.8 ppm. Analytical work on the butanol fraction by thin layer chromatography indicated that the active molluscicidal agents contained at least two kinds of saponins. The potency of E. phaseoloides remained rather stable over a wide range of pH values, in the presence of minerals and yeast cells and after ultraviolet irradiation of solutions. Our preliminary field trials, however, showed that doses as higher than 40 g per square meter would be needed to produce a satisfactory molluscicidal effect under field conditions.