Changes in Attitudes of Japanese Doctors toward Complementary and Alternative Medicine—Comparison of Surveys in 1999 and 2005 in Kyoto

We surveyed the attitudes of Japanese medical doctors toward complementary and alternative medicine (CAM) in 1999. It is supposed that the situation concerning CAM has been changing recently. The aim of the present study is to survey the attitude of doctors toward CAM again, and to examine changes in attitude over the last 6 years. The attitudes of medical doctors belonging to the Kyoto Medical Association toward CAM were surveyed by a structured, self-administered questionnaire in 1999 and 2005. The results showed that the doctors familiar with the term “CAM”, practicing CAM therapies, and attending meetings or training courses related with CAM, increased significantly from 1999 to 2005. The doctors who possessed knowledge of CAM also increased significantly from 1999 to 2005. Almost all doctors believed in the effectiveness of Kampo (Japanese traditional herbal medicine) and acupuncture. The number of doctors who believed in the effectiveness of aromatherapy and ayurveda increased significantly in 2005, compared with 1999. In the near future, 58% of doctors desired to practice CAM therapies. In conclusion, the numbers of doctors who practice CAM therapies, possess CAM knowledge and desire to practice such therapies have increased over the last 6 years in Japan

Hepatic infarction following abdominal interventional procedures.

To clarify the incidence, background, and progress of hepatic infarction following interventional procedures, cases of hepatic infarction following interventional procedures at our department during the last decade were identified by reviewing the clinical records of 1982 abdominal angiography and interventional procedures and records of abdominal CT. Nine episodes (0.5%) in 8 patients were identified as hepatic infarction following an interventional procedure. Five episodes were preceded by embolization of the hepatic or celiac artery at emergency angiography for postoperative bleeding with hemorrhagic shock. Three episodes followed the elected interventional procedure for hepatocellular carcinoma, and the remaining episode occurred after 12 months of chemoinfusion through an indwelling catheter in the hepatic artery and portal vein. Hepatic arterial occlusion in all episodes and portal venous flow abnormality in 5 episodes were observed on angiography. Four patients whose liver function was initially impaired died of hepatic infarction, although the extent of the disease on CT did not appear to be related to the mortality. Multiple risk factors, including arterial insufficiency, were observed in each patient. The incidence of hepatic infarction following interventional procedures in this series was low but sometimes fatal, and occurred most frequently in emergency embolization in hemorrhagic shock.</p

Expression of a lymphocyte adhesion molecule (CD44) in malignant lymphomas: relevance to primary site, histological subtype and clinical stage.

Lymphocyte adhesion molecules defined by anti-CD44 antibody (Hermes-3) may be involved in lymphocyte binding to high endothelial venules at sites where lymphocytes exist the blood. CD44 expression was immunohistochemically examined in 167 well characterized cases of malignant lymphomas (MLs). None of 12 nodal follicular lymphomas (FLs) were CD44+, whereas 3 of 4 extranodal ones showed distinct CD44 expression. In contrast to nodal FLs, 28 of the 38 (74%) nodal diffuse B-cell lymphomas were CD44+ (p < 0.0001). T-cell lymphomas showed a significantly higher expression of CD44 antigen than diffuse B-cell lymphomas in the nodal cases (p < 0.04), but not in the extranodal ones. In nodal diffuse lymphomas, 3 of 5 stage I lymphomas (60%) were CD44+ in contrast to 53 of 63 stage II-IV lymphomas (84%), but the difference was not statistically significant. Of 14 Hodgkin's diseases, 9 cases were CD44+ with no significant correlation with clinical stage. The data of flow cytometric analysis confirmed the results of immunohistochemical analysis. In conclusion, CD44 expression is relevant to primary sites of distinctive MLs originating in the mucosal regions (MALToma) and some histological subtypes, but the relation with clinical stage was not defined. Some other adhesion molecules or different mechanisms must also be taken into account concerning the genesis and the expansion of MLs.</p

Distribution of Lectin Receptors in the Human Hyperplastic Tonsil: Histochemical and Flow Cytometric Analyses

The distribution of lectin receptors in the human tonsil was studied using 16 biotinylated lectins. The avidin-biotin-peroxidase complex (ABC) method was used on frozen and paraffin-embedded tissue sections. Cell suspensions were also analysed by dual flow cytometry using respective fluorescein isothiocyanate-conjugated lectins and phycoerythrin-labeled anti-CD3 and anti-human immunoglobulin. Frozen sections fixed with acetone and paraffin-embedded materials fixed in three solutions were compared for lectin affinity; ethanol-fixed sections gave best results followed by frozen and buffered formalin-fixed ones, then nonbuffered formalin. Con-A, RCA-1, LcH, WGA, MPA, PHA, PSA, PNA, SJA and GSA-1 reacted with all tissue components of the tonsil in immunohistochemical studies, but binding intensity was fixative dependent. Binding of Lotus and BPA to lymphocytes was limited to germinal center lymphocytes. Other tissue components were also reactive but staining intensity was weaker in Lotus compared with BPA. SBA and DBA did not react with lymphocytes, but reacted with macrophages/histiocytes, vascular endothelia, and epithelial cells. LBA and LPA were constantly negative with all tissue components irrespective of fixatives. Flow cytometric analyses showed that all but three (DBA, LBA and LPA) partially or totally stained lymphocyte surfaces. Lotus receptors were expressed exclusively on B-lymphocytes.</p

Percutaneous sclerotherapy for venous malformations using polidocanol under fluoroscopy.

This retrospective study evaluated the safety and efficacy of using polidocanol with X-ray fluoroscopy for percutaneous sclerotherapy of venous malformations of the limbs, head, and neck. The subjects were 16 of 18 patients who presented to our department with venous malformations. Two patients were excluded because they were unlikely to benefit from the treatment. Of the 16 included in the study, 1 could not be treated because of inaccessibility, and another was lost to follow-up. Among the 14 cases that we were able to follow-up, 11 cases had had pain as their primary symptom. Following treatment, this symptom remained unchanged in 1 patient, was improved in 4, and had disappeared in 6; however, there was a recurrence of pain for 3 of these patients. Two patients had sought treatment for cosmetic purposes; following treatment, the lesion disappeared in one and showed a significant reduction in the other. The remaining patient presented with a primary symptom of mouth bleeding, which disappeared following treatment. There were no critical complications. Percutaneous sclerotherapy of venous malformations using polidocanol is safe and effective, and permits repeat treatments. The efficacy is especially good for resolving pain, and complications are minor. It is desirable to use fluoroscopy for these procedures</p

Radiofrequency Ablation of Lung Cancer at Okayama University Hospital: A Review of 10 Years of Experience

The application of radiofrequency ablation for the treatment of lung cancer by our group at Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences began in June 2001, and in the present report, we review our 10-year experience with this treatment modality at Okayama University Hospital. The local efficacy of radiofrequency ablation for the treatment of lung cancer depends on tumor size and the type of electrode used, but not on tumor type. An important factor for the prevention of local failure may be the acquisition of an adequate ablative margin. The combination of embolization and radiation therapy enhances the local efficacy. Local failure may be salvaged by repeating the radiofrequency ablation, particularly in small tumors. Survival rates after radiofrequency ablation are quite promising for patients with clinical stage I non-small cell lung cancer and pulmonary metastasis from colorectal cancer, hepatocellular carcinoma, and renal cell carcinoma. The complications caused by radiofrequency ablation can be treated conservatively in the majority of cases. However, attention should be paid to rare but serious complications. This review shows that radiofrequency ablation is a promising treatment for patients with lung cancer

Radiofrequency ablation followed by radiation therapy for large primary lung tumors

We report the clinical experience of radiofrequency ablation followed by radiation therapy for large primary lung tumors. Two patients with large primary lung tumors were treated with combined radiofrequency ablation and radiation therapy, and good local control was observed. Combined radiofrequency ablation and radiation therapy that involves minimally invasive techniques appears to be promising for the treatment of large lung tumors

Structures and mechanisms of actin ATP hydrolysis

The major cytoskeleton protein actin undergoes cyclic transitions between the monomeric G-form and the filamentous F-form, which drive organelle transport and cell motility. This mechanical work is driven by the ATPase activity at the catalytic site in the F-form. For deeper understanding of the actin cellular functions, the reaction mechanism must be elucidated. Here, we show that a single actin molecule is trapped in the F-form by fragmin domain-1 binding and present their crystal structures in the ATP analog-, ADP-Pi-, and ADP-bound forms, at 1.15-Å resolutions. The G-to-F conformational transition shifts the side chains of Gln137 and His161, which relocate four water molecules including W1 (attacking water) and W2 (helping water) to facilitate the hydrolysis. By applying quantum mechanics/molecular mechanics calculations to the structures, we have revealed a consistent and comprehensive reaction path of ATP hydrolysis by the F-form actin. The reaction path consists of four steps: 1) W1 and W2 rotations; 2) PG–O3B bond cleavage; 3) four concomitant events: W1–PO3− formation, OH− and proton cleavage, nucleophilic attack by the OH− against PG, and the abstracted proton transfer; and 4) proton relocation that stabilizes the ADP-Pi–bound F-form actin. The mechanism explains the slow rate of ATP hydrolysis by actin and the irreversibility of the hydrolysis reaction. While the catalytic strategy of actin ATP hydrolysis is essentially the same as those of motor proteins like myosin, the process after the hydrolysis is distinct and discussed in terms of Pi release, F-form destabilization, and global conformational changes