Integrated Predictors by Propensity Scoring With Tumor Markers and Plasma Levels of microRNA-21-5p, IL-17, and IL-10 Complement Early Detection of Hepatocellular Carcinoma in Patients With Liver Cirrhosis.

Objectives: The clinical usefulness of tumor markers alpha-fetoprotein (AFP) and des-gamma carboxyprothrombin (DCP) in the early detection of hepatocellular carcinoma (HCC) in patients with liver cirrhosis (LC), including those with marker decline after antiviral therapy, is limited. MicroRNAs (miRNAs) are expected to complement detection; however, their details remain unknown. Our prospective pilot study aimed to improve the surveillance of HCC high-risk LC patients by propensity scoring with tumor markers and additional predictors. Methods: Tumor markers and plasma levels of cytokines and miRNAs were observationally measured and statistically evaluated with propensity scoring in 85 eligible patients: 43 with current HCC (cHCC) including 8 with early-HCC, 22 with previous HCC cured (pHCC), and 20 with intact LC (iLC). Results: The analysis of the area under the receiver operating characteristic curve (AUC) showed that the best single predictor was AFP (0.794 for cHCC-discrimination and 0.771 for pHCC-discrimination). AFP-DCP integrated with miR-21-5p for cHCC-discrimination was 0.896; with IL-10 for pHCC-discrimination was 0.872, these were significantly better than those of AFP alone, independently (P < .01). The best single predictor for iLC-discrimination was IL-17 level (0.756). IL-17 integrated with AFP-DCP was 0.882, which was significantly better than that of IL-17 alone (P < .01). The positive likelihood ratio (pLR) for cHCC-discrimination by integration of AFP-DCP and miR-21-5p was 32.2. Preliminary validation analysis of early-HCCs compared to conventional AFP and DCP showed the combinations of AFP-DCP and 3 integrated predictors, miR-21-5p for cHCC-discrimination, IL-10 for pHCC-discrimination, and IL-17 for iLC-discrimination, sensitivity, specificity, and pLR, improved from 37.5% to 62.5%, 55.8% to 83.1%, and 0.85 to 3.70, respectively. Conclusion: The predictors of AFP-DCP combined with iR-21-5p, IL-10, and IL-17 by propensity scoring achieved higher discrimination of cHCCs, pHCCs, and iLCs, may be beneficial for the surveillance of early-HCCs, improving prediction of early-HCCs over conventional methods. However, further validation is required.

Herpes Simplex Virus Pneumonia Mimicking Legionella Pneumonia in an Elderly Patient With Heart and Liver Failure.

The diagnosis of viral pneumonia is often difficult because of its varied presentations. Regarding the serological diagnosis of viral infections, it is difficult to perform a viral DNA test in general medical facilities, especially in rural settings. Among viral pneumonia cases, herpes simplex virus (HSV) pneumonia can occur in immunocompromised hosts. However, when the clinical course of HSV pneumonia is acute, and the features of pneumonia are not distinct, the diagnosis can be challenging. We report the case of a 69-year-old man who visited the hospital with complaints of dyspnea and cough for two days. Although the patient had no fever and the urine was negative for Legionella antigen, we suspected Legionella pneumonia based on the clinical course, Gram stain of sputum, and CT findings. After undergoing treatment with antibiotics, his condition worsened, with dyspnea and an increase in the demand for oxygen at 5 L. The patient also had complications related to the heart and liver. The sputum culture was negative, and the HSV serum test revealed that HSV IgM level was elevated to 1.16 (reference value: ≤0.80) and IgG level at admission and at follow-up 21 days later was elevated to 28.1 and 60.0 respectively (reference value: ≤2.0); accordingly, the patient was diagnosed with HSV pneumonia. In cases of pneumonia with atypical courses, the coexistence of multiple diseases, and immunosuppression, HSV pneumonia should be included in the differential diagnosis. In rural settings, viral pneumonia should be investigated using antibodies against viruses due to the limited availability of other medical resources. When a patient is judged to be immunosuppressed in the treatment of pneumonia of unknown cause, it is important to consider the possibility of HSV infection and take prompt action. Furthermore, it is essential to consider the possibility of multi-organ failure secondary to HSV infection, which requires systemic management.

[Approach to Starting Clinical Pharmacy Practice Experience Based on the Model Core Curriculum for Pharmacy Education (2013 Version) in Hokkaido Prefecture].

The Model Core Curriculum for Pharmacy Education was revised in 2013 and has been applied to all pharmaceutical universities throughout Japan since 2015. Based on this revised core curriculum for pharmaceutical education, Pharmacy Practice Experiences began in February 2019. This Model Core Curriculum focuses on application of outcome-based education in order to achieve "professional competencies for pharmacists". The Model Core Curriculum for Pharmacy Practice Experiences addressed two main points: the eight common diseases that trainees should learn about, and collaboration between universities, pharmacies, and hospitals to conduct effective training for students. In Hokkaido, the Pharmacy Education Council Hokkaido District Coordination Agency, organized by the Hokkaido Pharmaceutical Association, the Hokkaido Society of Hospital Pharmacists, Hokkaido University, and Hokkaido University of Science, and Health Sciences University of Hokkaido has worked to improve practical pharmacy education since four-year pharmacy education programs. Additionally, the agency is central to coordinating and responding to various issues and working toward the implementation of practical pharmacy training. I contributed as chair of the working group to implement pharmacy practice experiences based on revisions of the core curriculum. In particular, we formulated evaluation standards based on sample evaluations presented at a liaison conference on the practical aspects of pharmacy. In addition, in order to convey the changes in pharmacy practice experiences based on this revised core curriculum for pharmacists, I contributed to the implementation of new pharmacy practices as an instructor at seminars in Hokkaido.

Effects of angiotensin II receptor blockers on serum levels of epoxyeicosatrienoic acids and dihydroxyeicosatrienoic acids in patients admitted to a cardiovascular center.

PURPOSE: Several clinical studies have demonstrated that angiotensin-converting enzyme inhibitors, but not angiotensin II receptor blockers (ARBs), reduce the risk of non-fatal myocardial infarction and cardiovascular mortality. We found that ARBs inhibited the activity of various cytochrome enzymes in arachidonic acid metabolism, resulting in decreased in vitro production of epoxyeicosatrienoic acids (EETs), which exhibit vasodilation and anti-inflammatory effects, and their subsequent metabolites, dihydroxyeicosatrienoic acids (DHETs). The present study examined the effects of ARBs on serum levels of EETs and DHETs in patients admitted to a cardiovascular center. METHODS: A total of 223 patients were enrolled, of which 107 were exposed to ARBs in this study. ARB-free individuals were defined as the control group (n = 116). Serum levels of EETs and DHETs were measured by liquid chromatography-tandem mass spectrometry. Multiple linear regression analyses were carried out to identify covariates for total serum levels of EETs and DHETs. RESULTS: A significant negative association was observed between ARB use and serum EET and DHET levels (p = 0.034), whereas a significant positive association was observed between the estimated glomerular filtration rate (eGFR) and serum EET and DHET levels (p = 0.007). The median serum total EET and DHET level in the ARB group tended to become lower than that in the control group, although the difference was not significant. CONCLUSION: ARB use and eGFR were significantly associated with total serum levels of EETs and DHETs. Our results suggest that ARBs could affect the concentration of EETs in vivo.

Convective meniscus splitting of polysaccharide microparticles on various surfaces.

In contrast to convective self-assembly methods for colloidal crystals etc., "convective meniscus splitting method" was developed to fabricate three-dimensionally ordered polymeric structures. By controlling the geometry of evaporative interface of polymer solution, a deposited membrane with uniaxial orientation and layered structures can be prepared. Here it is demonstrated that xanthan gum polysaccharide microparticles with diameter ~ 1 µm can bridge a millimeter-scale gap to form such a membrane because the capillary force among the particles is more dominant than the gravitational force on the evaporative interface. This method is applicable for various substrates with a wide range of wettability (water contact angle, 11°-111°), such as glass, metals, and plastics. The specific deposition can be also confirmed between frosted glasses, functional-molecules-modified glasses, and gold-sputtered substrates. By using such a universal method, the membrane formed on a polydimethylsiloxane surface using this method will provide a new strategy to design a functional polysaccharide wall in microfluidic devices, such as mass-separators.

Selective Intracellular Delivery of Ganglioside GM3-Binding Peptide through Caveolae/Raft-Mediated Endocytosis.

Glycosphingolipids are major components of the membrane raft, and several kinds of viruses and bacterial toxins are known to bind to glycosphingolipids in the membrane raft. Since the viral genes and pathogenic proteins that are taken into cells are directly delivered to their target organelles, caveolae/raft-mediated endocytosis represents a promising pathway for specific delivery. In the present study, we demonstrated the ability of an artificial pentadecapeptide, which binds to ganglioside GM3, to deliver protein into cells by caveolae/raft-mediated endocytosis. The cellular uptake of a biotinylated GM3-binding peptide (GM3BP)-avidin complex into HeLa cells was observed, and the cellular uptake of this complex was inhibited by an incubation with sialic acid or endocytic inhibitors such as methyl-ß-cyclodextrin, and also by an incubation at 4 °C. These results indicate that the GM3BP-avidin complex bind to GM3 in membrane raft, and are taken into cell through caveolae/raft-mediated endocytosis. The GM3BP-avidin complex was transported into cells and localized around the nucleus more slowly than a human immunodeficiency virus type 1 TAT peptide. Furthermore, the uptake of a green fluorescent protein (GFP) linked with GM3BP into HeLa cells was similar to that of the GM3BP-avidin complex, and the localization of the GM3BP-GFP fusion protein was markedly different with that of the TAT-GFP fusion protein. The uptake and trafficking of GM3BP were distinguished from conventional cell-penetrating peptides. GM3BP has potential as a novel peptide for the selective delivery of therapeutic proteins and materials into cells in addition to being a cell-penetrating peptide.

[Introduction and Evaluation of an Integrated Program to Develop Pharmacotherapeutic Management Skills].

Pharmacists must be able to select and collect important information for patient care, to accurately assess and monitor the status of patients, to develop care plans, propose optimal formulations, and provide advice to patients about pharmacotherapy. The core curriculum of Japan's pharmacy education model was revised in 2013 based on the "Basic competencies required of a pharmacist" that should be developed by the time of a student's graduation. Specific behavioral objectives to be acquired include competency in "The ability to implement pharmacotherapeutic management", which involves gaining the ability to understand patient information, to design and propose prescriptions, and to conduct pharmacotherapeutic assessments. We thus introduced an integrated program for fifth-year students at Hokkaido Pharmaceutical University using problem-based learning and role-playing with simulated patients to teach clinical communication skills and the ability to design pharmaceutical care plans for patients. A survey of students who completed the program after pharmacy practical training revealed that most of them realized the value of the program: they were able to develop precise care plans for medical problems and learned good communication skills to collect information about patients.

Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy.

BACKGROUND: Mixtures of various local anesthetics, such as lidocaine and ropivacaine, have been widely used. However, their efficacy and safety for scalp nerve blocks and local infiltration during awake craniotomy have not been fully elucidated. METHODS: We prospectively investigated 53 patients who underwent awake craniotomy. Scalp block was performed for the blockade of the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with a mixture containing equal volumes of 2% lidocaine and 0.75% ropivacaine, including 5 µg/mL of epinephrine. Infiltration anesthesia was applied at the site of skin incision using the same mixture. The study outcomes included changes in heart rate and blood pressure after head pinning and skin incision, and incidence of severe pain on emergence from anesthesia. Total doses and plasma concentrations of lidocaine and ropivacaine were measured at different time points after performing the block. RESULTS: The heart rate and blood pressure after head pinning were marginally, but significantly, increased when compared with baseline values. There were no significant differences in heart rate and blood pressure before and after the skin incision. Nineteen percent of the patients (10/53) complained of incisional pain at emergence from anesthesia. The highest observed blood concentrations of lidocaine and ropivacaine were 1.9±0.9 and 1.1±0.4 µg/mL, respectively. No acute anesthetic toxicity symptom was observed. CONCLUSIONS: Scalp block with a mixture of lidocaine and ropivacaine seems to provide effective and safe anesthetic management in patients undergoing awake craniotomy.

Effects of Angiotensin II Receptor Blockers on Metabolism of Arachidonic Acid via CYP2C8.

Arachidonic acid (AA) is metabolized to epoxyeicosatrienoic acids (EETs) via cytochrome enzymes such as CYP 2C9, 2C8 and 2J2. EETs play a role in cardioprotection and regulation of blood pressure. Recently, adverse reactions such as sudden heart attack and fatal myocardial infarction were reported among patients taking angiotensin II receptor blockers (ARBs). As some ARBs have affinity for these CYP enzymes, metabolic inhibition of AA by ARBs is a possible cause for the increase in cardiovascular events. In this study, we quantitatively investigated the inhibitory effects of ARBs on the formation of EETs and further metabolites, dihydroxyeicosatrienoic acids (DHETs), from AA via CYP2C8. In incubations with recombinant CYP2C8 in vitro, the inhibitory effects were compared by measuring EETs and DHETs by HPLC-MS/MS. Inhibition of AA metabolism by ARBs was detected in a concentration-dependent manner with IC50 values of losartan (42.7 µM), telmisartan (49.5 µM), irbesartan (55.6 µM), olmesartan (66.2 µM), candesartan (108 µM), and valsartan (279 µM). Losartan, telmisartan and irbesartan, which reportedly accumulate in the liver and kidneys, have stronger inhibitory effects than other ARBs. The lower concentration of EETs leads to less protective action on the cardiovascular system and a higher incidence of adverse effects such as sudden heart attack and myocardial infarction in patients taking ARBs.

Simultaneous Determination Method of Epoxyeicosatrienoic Acids and Dihydroxyeicosatrienoic Acids by LC-MS/MS System.

Epoxyeicosatrienoic acids (EETs) are produced primarily by CYPs from arachidonic acid (AA) and then further metabolized to the corresponding dihydroxyeicosatrienoic acids (DHETs). EETs play important roles in physiological processes such as regulating vasodilation and inflammation. Thus, the drug inhibition of CYP-mediated AA metabolism could reduce production of EETs, potentially resulting in adverse cardiovascular events. The aim of this study was to develop a simple method to simultaneously determine the concentrations of both EETs and DHETs using a conventional LC-MS/MS system to evaluate drug-endogenous substance interactions, including eicosanoids. Eight eicosanoids (5,6-EET, 8,9-EET, 11,12-EET, 14,15-EET, 5,6-DHET, 8,9-DHET, 11,12-DHET, and 14,15-DHET) were detected with their corresponding deuterium-labeled eicosanoids as internal standards. The samples were purified by solid-phase extraction columns. Liquid chromatographic separation was achieved on a C18 column. DHETs and EETs were eluted at 4-7 and 18-26 min, respectively. The weighted (1/y(2)) calibration curves were linear over a range of 5-2000 nmol/L for EETs and 2-2000 nmol/L for DHETs. In quality control (QC) samples, the recoveries of eicosanoids were 95.2-118%. The intra-day precisions were within 6% in all three QC samples, and the inter-day precisions were <16.7% at 50 nmol/L, <8.6% at 200 nmol/L, and <9.8% at 1000 nmol/L. We have applied this method for the determination of the eicosanoid levels in samples from incubation studies of AA by using human recombinant CYP enzyme (rCYP), and confirmed that the method has sensitivity sufficient for assessment of rCYP incubation study.

Preparation of polypseudorotaxanes composed of cyclodextrin and polymers in microspheres.

We prepared polypseudorotaxanes (PPRXs) composed of cyclodextrin (CyD) and polyethylene glycol (PEG) inside microspheres (MSs) by an emulsifying process using polypropylene glycol (PPG) that shows temperature-dependent hydrophilicity changes; PPG is hydrophobic at high temperatures but hydrophilic at low temperatures. An aqueous solution of CyD and PEG was dispersed as droplets in PPG at 60°C then cooled to 0°C to allow water of droplets to transfer into PPG. On removal of water in the droplets, CyD and PEG were left behind as a CyD/PEG PPRX inside the solid-state MSs. Examination of α-, ß-, and γ-CyD revealed that α-CyD was suitable for the formation of PPRX containing PEG in this MS preparation procedure. Interestingly, a new PPRX composed of α-CyD and PPG was formed in the α-CyD MSs when they were prepared in the absence of PEG from the aqueous solution of α-CyD. This MS fabrication procedure can control the size and shape of PPRX particles, and will contribute to the production of new types of CyD inclusion complexes.

Overestimation of the second time interval replaces time-shrinking when the difference between two adjacent time intervals increases.

When the onsets of three successive sound bursts mark two adjacent time intervals, the second time interval can be underestimated when it is physically longer than the first time interval by up to 100 ms. This illusion, time-shrinking, is very stable when the first time interval is 200 ms or shorter (Nakajima et al., 2004, Perception, 33). Time-shrinking had been considered a kind of perceptual assimilation to make the first and the second time interval more similar to each other. Here we investigated whether the underestimation of the second time interval was replaced by an overestimation if the physical difference between the neighboring time intervals was too large for the assimilation to take place; this was a typical situation in which a perceptual contrast could be expected. Three experiments to measure the overestimation/underestimation of the second time interval by the method of adjustment were conducted. The first time interval was varied from 40 to 280 ms, and such overestimations indeed took place when the first time interval was 80-280 ms. The overestimations were robust when the second time interval was longer than the first time interval by 240 ms or more, and the magnitude of the overestimation was larger than 100 ms in some conditions. Thus, a perceptual contrast to replace time-shrinking was established. An additional experiment indicated that this contrast did not affect the perception of the first time interval substantially: The contrast in the present conditions seemed unilateral.

Peach (Prunus persica) extract inhibits angiotensin II-induced signal transduction in vascular smooth muscle cells.

Angiotensin II (Ang II) is a vasoactive hormone that has been implicated in cardiovascular diseases. Here, the effect of peach, Prunus persica L. Batsch, pulp extract on Ang II-induced intracellular Ca(2+) mobilization, reactive oxygen species (ROS) production and signal transduction events in cultured vascular smooth muscle cells (VSMCs) was investigated. Pretreatment of peach ethyl acetate extract inhibited Ang II-induced intracellular Ca(2+) elevation in VSMCs. Furthermore, Ang II-induced ROS generation, essential for signal transduction events, was diminished by the peach ethyl acetate extract. The peach ethyl acetate extract also attenuated the Ang II-induced phosphorylation of epidermal growth factor receptor and myosin phosphatase target subunit 1, both of which are associated with atherosclerosis and hypertension. These results suggest that peach ethyl acetate extract may have clinical potential for preventing cardiovascular diseases by interfering with Ang II-induced intracellular Ca(2+) elevation, the generation of ROS, and then blocking signal transduction events.

[Preparation of water in oil type cream with high content of water containing Kochia scoparia fruit and Cnidium monnieri fruit].

Kikisui is a herbal lotion containing Kochia scoparia Fruit and Cnidium monnieri Fruit that is clinically used as an antipruritic for itchy dry skin. However, this formulation is unsuitable for inducing a prolonged effect. Here, we attempted to change the formulation from a lotion to a cream. The cream we chose was a water-in-oil (W/O) type emulsion for enhancing skin compatibility. In addition, the high water content imparts a sensation of coolness. However, it is difficult to prepare a stable W/O type cream with high water content using a mechanical mixing method. Instead, we prepared the W/O type emulsion using liquid crystals. Water containing cocamidopropyl betaine was added to a dispersed phase comprising an oil phase of oleic acid and liquid paraffin that was constantly stirred. Addition of an aqueous solution containing Kochia scoparia Fruit and Cnidium monnieri Fruit decreased the stability of the cream. However, addition of glycerin as a humectant, and ethyl p-hydroxybenzoate/n-butyl p-hydroxybenzoate as preservatives enhanced the stability of the cream. The stability of the emulsion was correlated with the apparent viscosity of the cream. The final W/O type cream had a water content of 83% and was stable for more than 6 months at 4°C. Furthermore, ostol, which is one of the main biologically active herbal compounds, was also stable for more than 6 months.

[A case of clopidogrel-induced eosinophilic pneumonia].

An 83-year-old man had been prescribed clopidogrel for pontine infarction since 8 months previously, and had had a cough for the last 2 weeks of this period. Laboratory examinations on admission showed a marked increase in eosinophils and elevated serum immunoglobulin E levels. Chest radiography showed bilateral ground-glass opacities, mild reticulation, and interlobar pleural effusion in the minor fissure. After clopidogrel was discontinued his symptoms resolved, and his laboratory tests showed normal results. Bronchoalveolar lavage also showed an increase in eosinophils, and transbronchial biopsy revealed infiltration of eosinophils in the subepithelium of the bronchial mucosa. On the basis of these findings, we diagnosed eosinophilic pneumonia induced by clopidogrel. Reports on cases of lung diseases caused by anti-platelet drugs are rare. To the best of our knowledge, this case is the first report on clopidogrel-induced eosinophilic pneumonia.

Intrafractional gastric motion and interfractional stomach deformity during radiation therapy.

BACKGROUND AND PURPOSE: To evaluate intrafractional gastric motion and interfractional variability of the stomach shape during radiation therapy (RT) for gastric lymphoma. MATERIALS AND METHODS: For 11 patients with gastric lymphomas, we undertook fluoroscopic examinations at the time of the simulation, and once a week during RT to evaluate inter- and intrafractional gastric variations. We recorded anteroposterior and left to right X-ray images at inhale and exhale in each examination. We gave coordinates based on the bony landmarks in each patient, and identified the most superior, inferior, lateral, ventral, and dorsal points of the stomach on each film. The interfractional motion was assessed as the distance between a point at inhale and the corresponding point at exhale. We also analyzed interfractional variation based on each point measured. RESULTS: The intrafractional gastric motion was 11.7+/-8.3, 11.0+/-7.1, 6.5+/-6.5, 3.4+/-2.3, 7.1+/-8.2, 6.6+/-5.8mm (mean+/-SD) for the superior, inferior, right, left, ventral and dorsal points, respectively, which was significantly different between each point. The interfractional variability of stomach filling was -2.9+/-14.4, -6.0+/-13.4, 9.3+/-22.0mm for the superior-inferior (SI), lateral (LAT), and ventro-dorsal (VD) directions, respectively, and the differences of variabilities were also statistically significant. Thus, the appropriate treatment margins calculated from both systematic and random errors are 30.3, 41.0, and 50.8mm for the SI, LAT, and ventro-dorsal directions, respectively. CONCLUSIONS: Both intrafractional gastric motion and interfractional variability of the stomach shape were considerable during RT. We recommend regular verification of gastric movement and shape before and during RT to individualize treatment volume.

Manic/hypomanic switch during acute antidepressant treatment for unipolar depression.

A significant proportion of patients with unipolar depression clinically develop manic or hypomanic switch during acute antidepressant treatment. Elucidation of its prevalence and predicting factors is of clinical relevance during acute antidepressant treatment of such patients. We retrospectively studied patients with unipolar depression who were admitted to our department during the 6-year period from 1997 to 2002 and who had fewer than 3 previous episodes before admission. The clinical background of the consecutive patients with manic/hypomanic switch (n = 37) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria was compared with that of patients without manic/hypomanic switch (n = 245). The prevalence rate of manic/hypomanic switch was 13.1%. The switch group was composed of 23 men and 14 women, whose average age was 48.8 +/- 12.3 years (range, 26-78 years). Manic/hypomanic switch was most frequently observed between 2 and 3 weeks after the antidepressant was increased to the ongoing dose. Antidepressants were decreased in 13 patients and discontinued in 23. Manic/hypomanic episodes lasted from 1 to 8 weeks. The patients in the switch group included a greater proportion of male subjects and had a higher frequency of family history of bipolar disorders than those in the nonswitch group. The mean doses of antidepressants were not significantly different between these groups. The higher frequency of manic/hypomanic switch occurring around the period when antidepressants begin to show clinical effects and the higher frequency of family history of bipolar disorders might suggest a biological susceptibility to antidepressants in patients of the switch group.

[Assessment of "self and other perception" of parents in family court disputes based on the Giessen Test]. / Untersuchung des "Selbst- und Fremdbildes" bei Elternteilen in familiengerichtlichen Auseinandersetzungen anhand des Giessen-Tests.

30 couples were assessed using the Giessen-Test in regard to their self-images and how they were perceived by their partners. All couples were examined in the course of domestic proceedings at the Department of Psychiatry and Psychotherapy in Childhood and Adolescence (University of Tübingen). Differences between self-image and the partners perception as well as self-image and rating of the partner were worked out. The degree of symmetry and correspondence regarding gender positions and the degree of confirmation/negation of the position were pointed out. No sex differences could be found in regard to role attribution. Sings of sex-specific role perception could not be shown amongst the couples being part of the domestic proceedings. Sex-specific differences in regard to the image as perceived by the other parent do not exist any more. The exact complementary role of ones own role-perception is being attributed to the former partner. The role-characteristics attributed to the former partner can be described as dominant, under-controlled, hypomanic, and inaccessible. Family- and psychodynamic aspects of these results are discussed.