Malignant transformation in craniopharyngioma after radiation therapy: a case report and review of the literature.

OBJECTIVE: Craniopharyngioma is a benign epithelial tumor that is thought to arise from the remnant of the Rathke pouch. Malignant transformation in craniopharyngioma is extremely rare. Herein, we report a case of malignant transformation in craniopharyngioma after radiation therapy. MATERIALS AND METHODS: Histopathological and immunohistochemical analyses were carried out for specimens of the suprasellar tumor (from three resections, with the third surgery performed after radiation therapy). RESULTS: The resected tumors from the first and second surgeries comprised islands of loosely cohesive aggregates of epithelial cells, so-called stellate reticulum. At the periphery of the nests, palisaded columnar epithelium was observed. Wet keratins were scattered, and few mitotic figures were seen. The third surgical specimen was composed of irregular large nests of basaloid cells that had large, round to oval nuclei with prominent nucleoli, and mitotic figures were frequently seen (21/10 high power fields). In the center of the nests, eosinophilic ghost cells, resembling wet keratin, were observed. Accordingly, the diagnosis of malignant transformation in craniopharyngioma was made. Immunohistochemical studies revealed that the p53 protein was over-expressed in the malignant component, whereas its expression was much lower in the benign component. CONCLUSIONS: Similar to the ten previously reported cases of malignant transformation in craniopharyngioma, the present case occurred after radiation therapy. p53 protein overexpression was also observed in the earlier cases of malignant craniopharyngioma as well as in the present case (6/6 cases). We concluded that radiation therapy and p53 mutations could be involved in malignant transformation in craniopharyngioma.

Roughness analysis of the skin as a secondary evaluation criterion in addition to visual scoring is sufficient to evaluate ethnic differences in wrinkles.

Visual scoring has been used to evaluate ethnic differences in skin wrinkling, but it is not sufficient to fully evaluate those differences in wrinkles. We examined whether both the roughness analysis of the skin and visual scoring are sufficient to characterize ethnic differences in wrinkles in Japanese, Chinese and German women. One hundred and five Japanese, 96 Chinese and 90 German age-matched women participated in this study. The severity of their wrinkles in the skin at two sites at the periphery of the eye was evaluated by visual scoring using a photoscale and by roughness values obtained from three-dimensional analysis of skin replicas. Slight but significant differences were scarcely observed between Japanese and Chinese women as well as between Japanese and German women at the same age group using the visual scoring method. However, significant and clearer differences among those ethnic groups were observed using the roughness analysis of skin replicas. Below the eye, significant differences among those ethnic groups were observed using both visual wrinkle scoring and roughness analysis. However, the extent of increased roughness values with age was relatively small compared with the increased wrinkle scores. These results show that roughness analysis is more sensitive than the visual scoring method when comparing ethnic differences in wrinkles. We conclude that roughness analysis of the skin is an important secondary evaluation criterion to visual scoring necessary to evaluate ethnic differences of wrinkles.

Global and systematic demonstration for the practical usage of a direct in vivo measurement system to evaluate wrinkles.

The global and systematic demonstration for the practical usage of a direct three-dimensional in vivo measurement system (PRIMOS) to evaluate wrinkles was investigated. Ten repetitive measurements of the corner of the eye of a subject showed that the coefficient of variation (CV)% value was 7.0% in a typical line-length roughness parameter R(a) (the arithmetic mean of roughness), and that the CV% value in a typical surface area roughness parameter S(a) was 2.4%. The relationships between the roughness values obtained from the corners of the eye and the age or wrinkle scores of Japanese women aged 10-70 years was examined. The values of several roughness parameters within the evaluation line length or surface area increased with age and showed a good correlation coefficient (r > 0.743). Similar relationships between the wrinkle scores and the values of roughness parameters were observed (r > 0.699). The roughness values were widely distributed even in the same wrinkle score because the measurement areas were limited and the values of skin roughness, including the microreliefs and/or small warts, were included in the calculation. However, changes in roughness values are considerable following treatment with potent active ingredients such as retinoic acid, so that this in vivo evaluation method is sufficient to objectively evaluate wrinkles. We conclude that the direct three-dimensional analysis of wrinkles in vivo should become a popular method to objectively evaluate wrinkles in clinical tests of wrinkle-smoothing ingredients or following cosmetic surgery to provide evidence of quantitative results.

Emergency obstetric care in Pakistan: potential for reduced maternal mortality through improved basic EmOC facilities, services, and access.

OBJECTIVE: To ascertain and compare compliance with UN emergency obstetric care (EmOC) recommendations by public health care centers in Pakistan's Punjab and Northwest Frontier Province (NWFP) provinces. METHOD: Cross-sectional data were collected from July through September 2003 using UN process indicators. From each province, 30% of districts (n=19); were randomly selected; all public health facilities providing EmOC services (n=170) were included. RESULTS: The study found that out of 170 facilities only 22 were providing basic and 37 comprehensive EmOC services in the areas studied. Only 5.7% of births occurred in EmOC health facilities. Met need was 9% and 0.5% of women gave birth by cesarean section. The case fatality rate was a low 0.7%, probably due to poor record keeping. Access and several indicators were better in NWFP than in Punjab. CONCLUSION: Almost all indicators were below UN recommendations. Health policy makers and planners must take immediate, appropriate measures at district and hospital levels to reduce maternal mortality.

Usefulness of switching to cabergoline from other dopamine agonists in patients with advanced Parkinson's disease.

Problems associated with long-term treatment of advanced Parkinson's disease (PD) include motor complications and psychotic and autonomic symptoms. We switched patients from bromocriptine (BR) or pergolide (PER) to cabergoline (CB) therapy and investigated CB's usefulness in alleviating such problems. Subjects were 30 patients (mean age 68.2 years; 13 receiving BR, 17 PER) with PD complicated by effects of long-term treatment but in whom their dose of dopamine (DA) agonist was contraindicated due to adverse reactions. Patients were switched to CB over a 2-4-week period. Hoehn-Yahr and Unified Parkinson Disease Rating Scale (UPDRS) I-IV "on" and "off" scores improved in both the BR and PER groups. CB was not discontinued due to adverse reactions in any patient. In conclusion, switching to CB is useful in patients in whom it is problematic to increase their dose of DA agonist due to motor complications or psychotic symptoms of advanced PD.

Periodic structures and diurnal variation in blood pressure and heart rate in relation to microgravity on space station MIR.

Four Russian crew members were studied on space station MIR, and blood pressure (BP) and heart rate (HR) data were continuously collected. BP and HR data were collected on earth 1 day before orbital flight to the space station, then at weeks 8, 16 and 24 during space flight, and again 1 or 2 days after returning to earth. Time serial data for BP and HR were analyzed by spectral analysis with the MemCalc system (Suwa Trust, Sapporo, Japan). Periodic structures of diurnal variation in systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR were compared at 24-hour, 12-hour and 8-hour intervals, these being determined as the main periodic components for the assessment of BP and HR variability. The 24-h mean levels of SBP and HR during space flight were unchanged. Waking SBP was not different from pre-flight values. During sleep, in-flight changes in HR did not differ from pre-flight values. SBP during sleep in orbit increased to over pre-flight values. Waking DBP was reduced during flight. The SBP and HR phases over a 24-hour cycle were shortened with a more pronounced shortening in weeks 8 and 16 compared with pre-flight values, and at week 24 recovered to preflight values. The 12, 8-hour-cycle remained unchanged, and were similar to pre-flight values. At the space station, the astronauts' mission was carried out under strict control of sleeping and waking hours; therefore, their 24-hour schedule is an artificially constructed situation. Main periodicity structures were maintained by strict control of lifestyle during long-term space flight. The conclusions reached were as follows: 1) SBP levels during sleep in a space environment increased compared with those on earth; 2) the periodicity phase of BP and HR shifted toward to 24-hour cycle as a result of long-term space flight, even though these periods shortened after a few months compared with pre-space flight values.

Child behavior problems: prevalence and correlates in rural minority areas of China.

BACKGROUND: Ethnicity may possibly associate with different maternal child-rearing practices and child developmental problems. The aim of this study was to better understand epidemiological features and correlates of child behavior problems in a large sample of children in economically disadvantaged rural minority areas of China and to provide reference data for subsequent intervention of child developmental problems. METHODS: A total of 1222 rural mother-child pairs belonging to Hani, Yi, Hui, Miao and Han were drawn from four economically disadvantaged minority counties in Yunnan Province of China. Well-trained investigators completed child physical examination and measurements (height and weight) in village clinics and interviews of mothers at respondents' homes using a structured questionnaire. RESULTS: Child behavior problems were prevalent in children aged 2-6 years: 71.4% for temper tantrums; 48.2% for swearing; 36.0% for nocturnal bed-wetting; 29.9% for disobedience; 29.5% for difficulty initiating sleep; and 17.0% for picky eating. Child behavior problems significantly differed across Hani, Yi, Hui, Miao and Han ethnic groups. Logistic regression indicated that ethnicity of Hui compared with Han, younger children, prenatal risk factors, being a twin, ineffective child-rearing behaviors such as pampering, corporal punishment, swaddling, family disagreement among child-rearing contributed independently to the risk for child behavior problems. CONCLUSIONS: The child behavior problems were prevalent in children aged 2-6 years in rural minority children of China. Ineffective family child-rearing practices increase risk for child behavior problems.

Lack of association between hepatocyte nuclear factor-1beta gene and common forms of type 2 diabetes in the Japanese population.

Mutations in the hepatocyte nuclear factor-1beta (HNF-1beta) gene have been shown to be a cause of maturity-onset diabetes of the young (MODY). We studied the contribution of the HNF-1beta gene to susceptibility to common forms of Type 2 diabetes in the genetically homogeneous Japanese population, by investigating the allelic association of Type 2 diabetes with two markers in the HNF-1beta region. The frequency of a nonsense mutation, R177X, which was previously reported in a Japanese family, was also studied by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method using a mismatch primer. A total of 200 subjects were studied. There was no significant difference in allele frequencies of either of the two polymorphisms studied between patients with Type 2 diabetes and control subjects, or between subgroups of patients subdivided by the presence of mild or severe diabetic nephropathy. None of the subjects studied had R177X mutation, giving a frequency of less than 1.1% in common forms of Type 2 diabetes in Japan. These results suggest that mutations in the HNF-1beta gene derived from a limited number of founders are not a major cause of common forms of Type 2 diabetes, even in the genetically homogeneous Japanese population.

Direct tensile strength of visible light-cured restorative materials containing fluoride.

The purpose of this study was to compare the fluoride release and direct tensile strength at 24 h, 1 month, and 3 months of two conventional glass-ionomers, two visible light-cured resin-modified glass-ionomers, a polyacid resin composite and two resin composites. The results were statistically analysed using ANOVA and Fisher's PLSD at alpha=0.05. The data on fluoride release indicated that the immersion period (24 h, 1 month, and 3 months) significantly influenced the cumulative amount of fluoride released (P < 0.001). The direct tensile strengths after 1 month of storage were significantly higher than those after 24 h or 3 months of storage (P < 0.001). Thus, the cements and resins were not weakened by the loss of fluoride. Conventional glass-ionomer cement showed the lowest direct tensile strength. Resin-modified glass-ionomer behaved in between the resin composites and conventional glass-ionomers in terms of all three testing times, however, the polyacid resin composites most closely resembled the resin composites. The polyacid resin composites had greatly enhanced direct tensile strength, however, this material also reduced the fluoride availability.

Sequence analysis of candidate genes for common susceptibility to type 1 and type 2 diabetes in mice.

Although type 1 and type 2 diabetes are regarded as clinically distinct diseases, several lines of evidence have suggested common genetic factors between the two types of diabetes. The non-obese diabetic (NOD) mouse, an animal model of type 1 diabetes, and the Nagoya-Shibata-Yasuda (NSY) mouse, a model of type 2 diabetes, are derived from the same outbred colony, Jcl:HCR, suggesting a shared susceptibility between the two types of diabetes in mice. Genetic as well as functional studies have supported the possibility that Tcf2, which encodes the transcription factor, hepatocyte nuclear factor 1beta (HNF-1beta), is a candidate gene for the common susceptibility between NSY and NOD mice. Txn, encoding thioredoxin which is a redox (reduction/oxidation)-active protein, is also a positional and functional candidate for a common susceptibility gene. To investigate whether either of these two genes is a common susceptibility gene, the coding nucleotide sequences of these two genes were compared among the NSY, NOD and control C3H strains. The coding sequence of Tcf2 of the NOD mouse was identical to that of the C3H mouse, but was different from that of the NSY mouse. The coding sequence of Txn was identical in the three strains. These data suggest that neither of the two genes is a common susceptiblity gene between type 1 and type 2 diabetes in mice.

Fibroblast growth factor inhibits locomotor activity as well as feeding behavior of rats.

The effects of acute and chronic intracerebroventricular (i.c.v.) administration of basic fibroblast growth factor (bFGF) on behavior were examined in free-feeding rats. An i.c.v. injection of bFGF induced behavioral changes, such as an increase in resting and decreases in grooming, moving, and food intake at a dose of 20 or 50 ng. These effects appeared at 4-5 h and lasted at least 11 h after the injection. These changes, as well as inhibition of body weight gain, were also found during a 6-day period of chronic i.c.v. infusion of bFGF at a dose of 20 ng/h. These results indicate that bFGF as both bolus i.c.v. injection and chronic i.c.v. infusion inhibits not only feeding behavior but also locomotor activity in rats. It is suggested that the inhibitory effect of bFGF on food intake may be in part ascribed to the suppression of behavior by bFGF.

Mineralization in bovine dentin adjacent to glass-ionomer restorations.

OBJECTIVES: To assess the uptake of fluoride as well as the increase in mineralization by bovine dentin after restoring an experimentally made cavity with conventional glass-ionomer cement or a polyacid resin composite. METHODS: Cylindrical cavities were prepared on the labial root surfaces in bovine dentin. The cavities were restored with the test material. The restored teeth were individually suspended in distilled water at 37 degrees C for 30 days. The teeth were sectioned and the superficial dentin cavity walls were analyzed for fluoride, calcium, and phosphorus by an EPMA device. The effects of the different fluoride-releasing materials on the hardness of the dentin were determined by indentation (20-microm intervals below the filled surface into the underlying sound dentin from the surface to a depth of 100microm). RESULTS: Conventional glass-ionomer cement had a significant effect on fluoride uptake. In addition, the calcium and phosphorus scan revealed the elevation of calcium and phosphorus levels in a deeper zone corresponding to the locations of the fluoride uptake at the surface of axial wall. However, the polyacid resin composite did not exhibit a zone of calcium and phosphorus elevation. The average dentin hardness under conventional glass-ionomer cement in the studied five distances ranged from 84.3 to 61.3KHN, however, that of the polyacid resin composite ranged from 62.5 to 64.9KHN. Analysis of variance for these data demonstrated a significant difference in hardness between the 20-microm depth and the other depths (P<0.01, ANOVA Fisher's PSLD). CONCLUSION: The present paper indicates that the fluoride penetrated deeper into the dentin with conventional glass-ionomer cement than the polyacid resin composite. Conventional glass-ionomer cement had a significant effect on fluoride uptake. In addition, hypermineralization occurred within the superficial dentin cavity wall region of conventional glass-ionomer cement.

Cyclin-dependent kinase inhibitors, p21(waf1/cip1) and p27(kip1), are expressed site- and hair cycle-dependently in rat hair follicles.

In order to investigate the role of cyclin-dependent kinase (CDK) inhibitors in hair growth, we analyzed the expressions of p21(waf1/cip1) and p27(kip1) during the synchronized hair cycle of rat coat. The mRNAs of both p21(waf1/cip1) and p27(kip1) were detected in anagen hair follicles by reverse transcription and polymerase chain reaction and their localization was clearly demonstrated in the upper half portion of the hair bulb and the cortex by in situ hybridization. The dermal tissue containing hair follicles was then excised from the anterior dorsal skin of the 5-12-week-old rats at 0.5 week intervals and the expressions of p21(waf1/cip1) and p27(kip1) were analyzed by northern blot hybridization. The mRNA of both CDK inhibitors was expressed at relatively high levels during anagen than during telogen, a fact which correlated with the mRNA expression levels of hair differentiation markers, type I hair keratin (Ha3) and high sulfur protein B2. These results imply that CDK inhibitors, p21(waf1/cip1) and p27(kip1), are involved in the differentiation of follicular epithelial cells.

Cotesia kariyai teratocytes: growth and development.

The growth and development of teratocytes was examined in the Cotesia kariyai-Pseudaletia separata system. Cotesia kariyai embryos released an average of 163 teratocytes at the time of hatching, 3.5 days after oviposition. The cells increased in diameter from 30 to 77 µm until 7 days post-parasitization, after which there was no significant increase in average diameter. However, there was significant variation in diameter within the population of teratocytes during the later developmental stages of the parasitoid larvae. The DNA contents increased up to day 7. The ploidy level of teratocytes increased 4-fold (2C to 8C) from days 4 to 7 and thereafter remained the same. Scanning electron microscopy (SEM) revealed that the surface of the teratocytes was covered with microvilli during all developmental stages, although on days 9 to 10 post-parasitization, bleb structures were also observed on a few. In vitro analysis of the proteins secreted from teratocytes following labeling with (35)S-methionine showed that many proteins were synthesized de novo and secreted by the cells until 9 to 10 days post-parasitization. These results indicate that teratocytes in later stages of development maintain their activity and regulate the physiological state of the host.

[Perceived distributions of opinions in young generation and their parents' generation regarding sex roles].

This study examined how people perceive the distributions of opinions about sex roles, in particular, how they saw generational differences in the opinions. Undergraduates and their parents were asked to estimate the opinion distributions in young generation as well as in their parents' generation. They were also asked to indicate their own opinions and the degree of their involvement with the issue. Main results were as follows: First, generation gaps were perceived; the respondents estimated that there would be stronger support for relatively liberal opinions in young generation than in their parents' generation, while the generation gaps were perceived in the reverse direction regarding relatively traditional opinions. Second, although this tendency was found for both sexes, it was more pronounced for female respondents. Third, fathers with higher personal involvement with the issue estimated stronger support for liberal opinions, while mothers with higher personal involvement estimated weaker support. This tendency in mothers was more salient in those who themselves supported relatively liberal opinions.

[Anesthetic management of a patient with hypohidrotic ectodermal dysplasia].

We anesthetized a 10-year-old girl with hypohidrotic ectodermal dysplasia for an ophthalmic surgery. Ectodermal dysplasia involves the abnormalities of ectodermal tissues and has a triad; hypohidrosis, a lack of teeth, and the scarcity of hair. Hyperthermia may occur due to the defect of sweat glands. Therefore, the body temperature must be monitored continuously. Respiratory tract infection occurs frequently due to the absence of seromucosal glands. We recommend humidifying the inspired gases during the operation. Tracheal intubation may be difficult because of maxillary and/or mandibular abnormalities. We conclude that the particular care should be taken such as the management of the body temperature, preparation for the difficult airway and the humidification of respiratory tract.