Measurement of family-centered care in the neonatal intensive care unit and professional background.

OBJECTIVE: The aims of this study were to examine the validity and reliability of the Measure of Processes of Care for Service Providers (MPOC-SP) for multidisciplinary teams in neonatal intensive care units (NICUs) and to examine differences among professions. STUDY DESIGN: A Japanese language version of the MPOC-SP questionnaire was distributed among the professionals employed at three perinatal medical centers. RESULT: A total of 83 multidisciplinary team members completed the questionnaire. The construct validity was examined by a confirmative analysis of each scale structure. The MPOC-SP showed adequate internal consistency. The test-retest analysis showed that the MPOC-SP, except the 'providing general information' scale, is a reliable tool. The results suggest that professional background affects the attitude and behavior of professionals involved in family-centered care. CONCLUSION: The MPOC-SP has good psychometric properties and can be used to identify areas for improvement in the family-centered care provided by multidisciplinary teams in the NICUs.

Measurement of family-centred care: translation, adaptation and validation of the Measure of Processes of Care (MPOC-56 and -20) for use in Japan.

BACKGROUND: The Measure of Processes of Care (MPOC) that was developed in Canada is a widely used quantitative measure of parents' perceptions of the extent to which family-centred care is conducted. The purpose of this study was to assess the validity and reliability of the Japanese version of the MPOC. METHODS: The translation of the MPOC was performed according to international standards for translation of questionnaires. The Canadian validation procedures were followed, consisting of concurrent validity, construct validity and test-retest reliability. The Japanese version of the MPOC was completed by 261 families with children receiving rehabilitation services. RESULTS: The Japanese version of the MPOC showed adequate internal consistency with Cronbach's alpha, varying between 0.76 and 0.94. The construct validity was examined with confirmative analysis of each scale structure. Correlations between the MPOC scale scores and satisfaction questions scores were positive, and that to a question about parents' stress was negative. For test-retest reliability, the intraclass correlation coefficients were between 0.76 and 0.89. CONCLUSIONS: The Japanese version of the MPOC has good psychometric properties and can be recommended for evaluation of the processes of child rehabilitation in Japan.

Multiple inhibitory pathways for lipopolysaccharide- and pro-inflammatory cytokine-induced nitric oxide production in cultured astrocytes.

We previously showed that lipopolysaccharide (LPS) and pro-inflammatory cytokines utilized different mechanisms for the production of nitric oxide (NO) by inducible nitric oxide synthase (iNOS) in cultured rat astrocytes. To further characterize these regulatory pathways, we tested the effects of inhibitory factors (anti-inflammatory cytokines, cellular cAMP, and glucocorticoid) on aspects of iNOS expression (from transcription to enzyme activity) during LPS- and cytokine-induced astrocyte NO production. Anti-inflammatory cytokines (transforming growth factor-beta and interleukin-4) suppressed both LPS- and cytokine-induced NO production by reducing iNOS protein expression without affecting mRNA levels. Increased cellular cAMP levels, induced by noradrenaline or forskolin, suppressed LPS-induced, but not cytokine-induced, NO production without affecting iNOS protein expression. The glucocorticoid analog, dexamethasone, suppressed LPS-induced, but not cytokine-induced, NO production by reducing iNOS promoter activity. These different mechanisms would allow the fine control of NO concentration in the brain, as well as accounting for the multiple roles of NO in brain physiology and pathology. Moreover, these mechanisms provide useful therapeutic targets for the treatment of neurodegenerative diseases.

The gene mutated in ataxia-ocular apraxia 1 encodes the new HIT/Zn-finger protein aprataxin.

The newly recognized ataxia-ocular apraxia 1 (AOA1; MIM 208920) is the most frequent cause of autosomal recessive ataxia in Japan and is second only to Friedreich ataxia in Portugal. It shares several neurological features with ataxia-telangiectasia, including early onset ataxia, oculomotor apraxia and cerebellar atrophy, but does not share its extraneurological features (immune deficiency, chromosomal instability and hypersensitivity to X-rays). AOA1 is also characterized by axonal motor neuropathy and the later decrease of serum albumin levels and elevation of total cholesterol. We have identified the gene causing AOA1 and the major Portuguese and Japanese mutations. This gene encodes a new, ubiquitously expressed protein that we named aprataxin. This protein is composed of three domains that share distant homology with the amino-terminal domain of polynucleotide kinase 3'- phosphatase (PNKP), with histidine-triad (HIT) proteins and with DNA-binding C2H2 zinc-finger proteins, respectively. PNKP is involved in DNA single-strand break repair (SSBR) following exposure to ionizing radiation and reactive oxygen species. Fragile-HIT proteins (FHIT) cleave diadenosine tetraphosphate, which is potentially produced during activation of the SSBR complex. The results suggest that aprataxin is a nuclear protein with a role in DNA repair reminiscent of the function of the protein defective in ataxia-telangiectasia, but that would cause a phenotype restricted to neurological signs when mutant.

A double mutation in a patient with X-linked myotubular myopathy.

In this report a double mutation was identified in a patient with X-linked myotubular myopathy. The mutations present in the patient were a C-->T substitution of nucleotide 163, which led to an Arg 55 stop codon (nonsense mutation), and an "A" insertion at nucleotide 440, which caused a shift of the reading frame and a premature stop at codon 153 (frameshift mutation). The nonsense mutation was heterozygously present in the mother but not identified in the father or in normal controls. The frameshift mutation was not identified in either parent or normal controls (de novo mutation). These mutations are predicted to truncate the myotubularin protein.

Expression of peripheral myelin protein zero in sural nerve of patients with Charcot-Marie-Tooth disease 1B.

A Charcot-Marie-Tooth disease 1B (CMT1B) family with a mutation of the Po gene is presented. A to G substitution of nucleotide 389 in exon 3 resulted in Lys 131 Arg substitution. Immunostaining for Po in biopsied sural nerve from one family member with CMT1B was expressed in a small number of myelinated fibers. Immunoblot analysis for Po revealed that it was of normal molecular weight (29 kDa) although significantly reduced in amount. This heterozygous mutation could lead to a reduction in the total amount of normal protein in peripheral nerves through a mechanism of loss of function.

Homozygosity mapping of Portuguese and Japanese forms of ataxia-oculomotor apraxia to 9p13, and evidence for genetic heterogeneity.

Ataxia with oculomotor apraxia (AOA) is characterized by early-onset cerebellar ataxia, ocular apraxia, early areflexia, late peripheral neuropathy, slow progression, severe motor handicap, and absence of both telangiectasias and immunodeficiency. We studied 13 Portuguese families with AOA and found that the two largest families show linkage to 9p, with LOD scores of 4.13 and 3.82, respectively, at a recombination fraction of 0. These and three smaller families, all from northern Portugal, showed homozygosity and haplotype sharing over a 2-cM region on 9p13, demonstrating the existence of both a founding event and linkage to this locus, AOA1, in the five families. Three other families were excluded from this locus, demonstrating nonallelic heterogeneity in AOA. Early-onset cerebellar ataxia with hypoalbuminemia (EOCA-HA), so far described only in Japan, is characterized by marked cerebellar atrophy, peripheral neuropathy, mental retardation, and, occasionally, oculomotor apraxia. Two unrelated Japanese families with EOCA-HA were analyzed and appeared to show linkage to the AOA1 locus. Subsequently, hypoalbuminemia was found in all five Portuguese patients with AOA1 with a long disease duration, suggesting that AOA1 and EOCA-HA correspond to the same entity that accounts for a significant proportion of all recessive ataxias. The narrow localization of AOA1 should prompt the identification of the defective gene.

Hereditary cerebellar ataxia with peripheral neuropathy and mental retardation.

We present here 5 patients with hereditary cerebellar ataxia with peripheral neuropathy and mental retardation as determined by clinical, pathological, and molecular studies. The most characteristic features of this disorder, in contrast to Friedreich's ataxia, were early onset of ataxic gait, mental retardation, and a marked atrophy of the cerebellum. Sural nerve biopsy showed a reduction of myelinated fibers. The expansion of a GAA triplet repeat within the first intron of the frataxin gene, which causes Friedreich's ataxia, was not identified in any of the patients. Hereditary cerebellar ataxia with peripheral neuropathy and mental retardation represents a specific clinical entity that so far has only been described in Japan.

Charcot-Marie-Tooth disease type 1A duplication by PCR analysis.

By generating new junctional fragments from the recombinant Charcot-Marie-Tooth (CMT) 1A-REPs in CMT1A patients, a 3.2-kb recombination hot spot is observed in three quarters of CMT1A patients. By a polymerase chain reaction (PCR) method the authors analyzed eight patients CMT1A duplication, confirmed by Southern blot, to detect a recombination hot spot. Four patients had a novel 3.2-kb junctional fragment by PCR analysis. These four patients with a novel 3.2-kb junctional fragment had an abnormal 1789-bp fragment in addition to 1986-bp fragment after NsiI digestion (type 1). One patient who demonstrated no novel 3.2-kb junctional fragment had an abnormal 336-bp fragment in addition to 265 bp (type 2). Three patients with CMT1A duplication were not diagnosed as having CMT1A on the basis of PCR analysis. The PCR-based DNA test is valuable for screening to detect CMT1A duplication.

A small direct tandem duplication of the myelin protein zero gene in a patient with Dejerine-Sottas disease phenotype.

We present a male patient with Dejerine-Sottas disease phenotype, who had a small direct tandem duplication of the Po gene. The pathology of the sural nerve showed hypomyelinated fibers with absence of active demyelination and onion-bulb formations composed of two parallel layers of basement membrane, consistent with congenital hypomyelination neuropathy (CHN). However, his clinical features were more severe than those of previously reported CHN patients. A GGCA insertion was identified at the position of nucleotide 560 in the myelin protein zero (Po) gene. This insertional mutation was located in exon 4 coding for the transmembrane domain of the Po gene and caused a shift of reading frame, creating a stop codon. The mutation of the transmembrane domain probably has the largest impact on Po function. The mutation was not identified in both parents.

De novo mutation of Charcot-Marie-Tooth disease type 1A.

Charcot-Marie-Tooth disease type 1A (CMT 1A) is an autosomal dominant demyelinating polyneuropathy associated with a 1.5-Mb duplication of the p11.2-p12 region of chromosome 17, including the peripheral myelin protein-22 (PMP-22) gene (CMT 1A duplication). We report a male patient with a de novo CMT 1A diagnosed on clinical, electrophysiologic, and molecular grounds. Motor nerve conduction velocity (MCV) of the patient was 10.9 m/s in the ulnar nerve. The MCV of both his parents was within the normal range. Southern blot analysis of BamHI digestion showed reduced intensity rate of SF85/PMP-22, indicating CMT 1A duplication. Haplotype analysis with pVAW4093a, demonstrated that the de novo CMT 1A duplication was of paternal origin.

Detection of the mutation in facioscapulohumeral muscular dystrophy patients.

The gene responsible for facioscapulohumeral muscular dystrophy (FSHD) was mapped to chromosome 4q35 by linkage analyses. Recently, the probe p13E-11 derived from the cosmid clone 13E, which has been mapped to 4qter, detected a polymorphic EcoRI fragment, usually greater than 28 kb in normal individuals. In sporadic and familial FSHD patients, a specific shorter fragment, usually smaller than 28 kb, was found to cosegregate with FSHD. Two FSHD patients are presented here. Patient 1 is a sporadic case of FSHD with healthy parents. He had a de novo mutation identified by Southern blot analysis using the above-mentioned probe. Patient 2 is a typical familial FSHD patient clinically and histologically. A rearranged and shortened EcoRI fragment was identified by molecular analysis. Southern blot analysis using the probe p13E-11 also indicated a rearranged EcoRI fragment in both patients.

Tomaculous neuropathy in Charcot-Marie-Tooth disease with myelin protein zero gene mutation.

Mutation of the myelin protein zero (MPZ) gene is associated with a small number of Charcot-Marie-Tooth (CMT) patients. We present a patient with Lys 130 Arg substitution in the extracellular domain who showed tomacula formation in biopsied sural nerve. CMT patients with mutations Ly 96 Glu, Lys 130 Arg and Ile 135 Leu showed tomaculous neuropathy. Present and previously reported investigations suggest that the pathological phenotypes of peripheral nerve are probably related to the mutations of the MPZ gene.

CTG repeat size and histologic findings of skeletal muscle from patients with congenital myotonic dystrophy.

An approximate correlation has been demonstrated between the degree of CTG repeat expansion and clinical severity among myotonic dystrophy patients. Congenital myotonic dystrophy, which is the most severe form of the disease, has the largest size of CTG repeat. Muscle immaturity is a characteristic finding in congenital myotonic dystrophy muscle. We compared the CTG repeat size and histologic findings of skeletal muscle from patients with congenital myotonic dystrophy. An 8.6 kb or 9.8 kb plus an expanding band ranging from 15 kb to 17.5 kb was observed in muscle from five patients with congenital myotonic dystrophy by Southern blot analysis using EcoRI-digested DNAs probed with p5B1.4. There was no correlation between immaturity of skeletal muscle and the degree of CTG repeat expansion on skeletal muscle. Undetermined maternal factors may have an important role in the cause of immaturity of muscle in congenital myotonic dystrophy patients.

Immunocytochemical localization of myotonin protein kinase on muscle from patients with congenital myotonic dystrophy.

Using a polyclonal anti myotonin-protein kinase (M-PK) antibody against synthetic M-PK peptides corresponding to part of the amino acid sequence, and the immunohistochemical analysis of indirect immunoperoxidase, we have investigated localization of M-PK on muscle from patients with congenital myotonic dystrophy. In congenital myotonic dystrophy (MD) patients, one month and 3 months old, M-PK was weakly expressed at sarcolemma of muscle fibers. In congenital MD patients from 2 to 9 years of age, M-PK was clearly expressed at sarcolemma of muscle fibers. M-PK of immature muscle is weakly expressed at sarcolemma. With aging, M-PK is clearly expressed at sarcolemma of muscle from MD patient and normal control.

A new mutation of the Po gene in patients with Charcot-Marie-Tooth disease type 1B: screening of the Po gene by heteroduplex analysis.

Most of Charcot-Marie-Tooth (CMT) 1 families are associated with a duplication in chromosome 17p11.2-p12, which includes the gene encoding peripheral myelin protein-22 (PMP-22). Point mutations of the Po gene have been identified in a few of the CMT 1 families in whom no duplication was found. We investigated a new mutation of the Po gene in one of those families. A to G substitution of nucleotide 389 in exon 3 resulted in Lys 131 Arg substitution. This structural change of extracellular domain of Po would alter the function of Po and result in an impairment of peripheral myelin compaction.

Expression of myotonic dystrophy protein kinase in biopsied muscles.

We present expression of myotonic dystrophy protein kinase (DM-PK) on biopsied muscles by immunocytochemistry using antibody against synthetic DM-PK peptide antigen. Immunolocalization of DM-PK was observed in neuromuscular junctions, muscle spindle, and sarcoplasm on both normal and DM muscles. DM-PK expression of sarcoplasm was present in adult normal and DM muscles. In Duchenne and Becker muscular dystrophies, DM-PK was intensively expressed in cytoplasm on immature regenerating fibers. DM-PK is initially produced in cytoplasm of regenerating fibers and migrates toward sarcoplasm with maturity of muscle cell.

MRI of peripheral nerves and pathology of sural nerves in hereditary motor and sensory neuropathy type III.

We investigated two patients with hereditary motor and sensory neuropathy type III, one with Déjérine-Sottas disease and the other with congenital hypomyelination neuropathy based on nerve pathology and MRI of the sciatic nerve. On biopsy of the sural nerve of the patient with Déjérine-Sottas disease, myelin debris, indicating demyelination, was observed in an onion-bulb pattern surrounding myelinated fibres. In the patient with congenital hypomyelination neuropathy, onion bulbs were formed of two parallel layers of basement membrane. There was no evidence of myelin breakdown. On axial T2-weighted MRI, a severely hypertropied sciatic nerve containing multiple rounded lesions, suggesting inflammation or demyelination, was observed in the patient with Déjérine-Sottas disease. In contrast, the sciatic nerve of the patient with congenital hypomyelination neuropathy showed slight hypertrophy without demyelination. MRI of the sciatic nerve may represent a useful tool for characterisation of demyelinating disease and its prognosis.