Doctors’ Opinion Papers in Long-term Care Need Certification in Japan: Comparison between Clinic and Advanced Treatment Hospital Settings

The Doctor’s Opinion Paper (DOP) in long-term care insurance addresses the patient’s chronic conditions of daily life. It is expected to be written by a doctor who knows the patient well. However, DOPs are sometimes written by doctors at advanced treatment hospitals (ATHs) who might not know the patient well. Japanese government is promoting functional differentiation of medical care. We discuss appropriateness that specialists of ATH who have to provide a higher medical care take on a role to write DOP which addresses the patient’s chronic conditions of daily life. The purpose of this study is to compare DOPs completed by clinic doctors with those completed by ATH doctors, in order to examine who should write a DOP. Data: The DOPs which were used at the Care Need Certification Committee meeting held in March 2012 in Tokyo. Subjects: 403 DOPs for patients aged 65 or older. Results indicated that DOPs written by doctors in ATHs included less information than DOPs written by doctors in clinics. We need to discuss who would be appropriate doctors to write DOPs and how to educate older adults to choose the right health care facility and their doctors for their health condition. Keywords: Doctor’s opinion paper, certification of need for long-term care, long-term care insurance, advanced treatment hospital, clinic, family doctor, Japa

Reactions to Bioabsorbable Suture Thread Embedded in Rat Subcutaneous Tissue

We examined the subcutaneous tissue reactions in rats to bioabsorbable suture thread using histopathological methods. Using Wister rats, Vicryl®, a bioabsorbable suture thread, was embedded into the subcutaneous tissue and histopathological examination was carried out after 4 weeks. Cholesterin crystals were used for the control. Furthermore, immunohistochemistry for CD68 was done. Histopathological examination showed proliferation of granulation tissues inboth experimental and control groups. The majority of cells in the granulation tissues were macrophages and giant cells. Fibroblasts were also observed in the proliferating granulation tissues surrounding the embedded bioabsorbable suturethread. Immunohistochemistry revealed that macrophages and giant cells were positive to CD68. The results suggest that the embedded bioabsorbable suture thread is not only fabricated to undergo absorption but also for phagocytosis bymacrophages and foreign body giant cells

Genomic Organization of the Human Arpp Gene

A novel ankyrin-repeated protein, Arpp, is specifically expressed in skeletal and cardiac muscles. Arpp protein is homologous, in its amino acid sequences (52.7% identity), to Carp protein which is proposed to be a putative genetic marker for cardiac hypertrophy. In this study, we isolated the human Arpp gene by screening a human genomic library and analyzed the genomic structure and its 5' flanking region. The Arpp gene was found to encompass a sequence of 11 kb and to consist of 9 exons. The translational initiation site and the stop codon were found to be located at exon 1 and exon 9, respectively. Each exon from 5 to 8 was found to encode 1 of the 4 ankyrin-like domains, respectively. The 2.7 kb upstream of exon 1 was sequenced. The TATA box was identified 29 bp upstream of the transcriptional start site, and multiple putative regulatory elements including the E box and upstream stimulating factor-1 were distributed within the proximal promoter regions. Since these elements were also found in the promoter region of the mouse Arpp gene, they may play an important role in the transcriptional regulation of both human and murine Arpp genes

Long-term Follow-up of Orthodontic Patient with Cervical Lymphangioma

Aim: To report a treatment case of mandibular deviation caused by congenital cervical lymphangioma with traditional orthodontic techniques, following-up by 10-year retention. Background: Lymphangiomas, developmental anomalies, can induce various disturbances of swallowing, mastication, speech, breathing, and skeletal deformities as well as psychological stress and anxiety for the patient and their family. Lymphangiomas are benign with virtually no possibility of turning into a malignant lesion, so clinical management aims to treat the patient functionally. Case description: A girl, aged 6 years and 4 months, complained about facial asymmetry and anterior crossbite caused by congenital cervical lymphangioma. Her facial profile was the straight type with an adequate lip position. Anterior and right-side posterior crossbites were observed. On the frontal cephalogram, the menton shifted 3.0 mm to the right. A functional appliance with an expander was placed to correct her dental midline deviation and posterior crossbite. After 2-year treatment, the anterior and right-side posterior crossbites were improved. Multibracket treatment began after the growth spurt. After 44-month active treatment, a functional occlusion, including a Class I molar relationship with a proper interincisal relationship, was achieved. A functional occlusion was maintained during a 10-year retention period, while a mandibular downward growth was observed through the retention period. Conclusion: Conventional orthodontic techniques enable functional and stable occlusion even in patients with mandibular deviation caused by congenital cervical lymphangioma, although only using early orthodontic management by itself may have some limitations. Clinical significance: The hybrid technique combining functional appliance and intermaxillary elastics proves to be an effective therapy for correcting occlusal cant and mandibular deviation caused by cervical lymphangioma

Transcriptional activation of a hybrid promoter composed of cytomegalovirus enhancer and β-actin/β-globin gene in glomerular epithelial cells in vivo

Transcriptional activation of a hybrid promoter composed of cytomegalovirus enhancer and β-actin/β-globin gene in glomerular epithelial cells in vivo. The aim of this study was to seek a promoter, transactivated selectively in renal cells in vivo by using transgenic (tg) mouse technology. We generated two kinds of tg mouse lines carrying a green fluorescence protein (GFP) cDNA driven either by cytomegalovirus enhancer and β-actin/β-globin promoter (CX-GFP) or by elongation factor la promoter (EF-GFP), and investigated the expression of GFP in the kidney. Microscopic examination of the renal tissues in CX-GFP-tg mice revealed that GFP was expressed only in glomeruli, mainly epithelial cells, but not in tubules, arteries and interstitium. Moreover, in situ hybridization demonstrated that GFP mRNA expression was localized in the glomerular cells. In contrast, GFP was not detectable in the kidney in any of the lines of EF-GFP-tg mouse. To exclude the possible involvement of the GFP cDNA as an enhancer, we constructed tg mice carrying the CX promoter driving a human CD4 cDNA. It was confirmed that the expression patterns of human CD4 in the kidney were quite similar to those of GFP in the kidney of CX-GFP-tg mice. These results strongly suggest that CX promoter could be transactivated in glomerular epithelial cells in vivo

Efficacy of Norethisterone in Patients with Ovarian Endometrioma

Endometriosis is a chronic inflammatory disorder associated with pelvic pain and infertility. Because surgical and medical therapies control symptoms, but it is hard to cure completely endometriosis, long term of pharmacologic management is necessary. Norethisterone (NET), one of progestins, has safety profile and advantage that allow long-term use. In this preliminary report, we showed the efficacy of NET in 6 patients with endometriosis. The size of ovarian endometrioma was decreased after treatment with NET for 6 months, and all patients were relieved from dysmenorrhea pain within 6 months, suggesting that NET would be a suitable medication to treat endometriosis

Fetal and Neonatal Goiter in Cynomolgus Monkeys Following Administration of the Antithyroid Drug Thiamazole at High Doses to Dams During Pregnancy

To evaluate morphologic alterations in the thyroid gland in the second generation in cynomolgus monkeys, pregnant dams were exposed to high doses of thiamazole. In Experiment A, dams received thiamazole intragastrically via a nasogastric catheter from gestation day (GD) 50 to GD 150 or on the day before delivery. Initially, the dose level was 20 mg/kg/day (10 mg/kg twice daily); however, the dose level was subsequently decreased to 5 mg/kg/day (2.5 mg/kg twice daily), since deteriorated general conditions were observed in two dams. Six out of seven neonates died on the day of birth. The cause of neonatal death was tracheal compression and suffocation from goiter. The transplacental exposure to thiamazole affected the fetal thyroid glands and induced goiter in all neonates. The surviving neonate was necropsied 767 days after discontinuation of thiamazole exposure and showed reversibility of the induced changes. In Experiment B, dams were intragastrically administered thiamazole at 5 mg/kg/day (2.5 mg/kg twice daily) for treatment periods from GDs 51 to 70, 71 to 90, 91 to 110, 111 to 130 and 131 to 150. All fetuses showed enlarged thyroid glands but were viable. Histopathologically, hypertrophy and/or hyperplastic appearance of the follicular epithelium of the thyroid gland was observed at the end of each treatment period. The most active appearance of the follicular epithelium, consisting of crowded pedunculated structure, was demonstrated at end of the treatment period from GD 131 to 150. This is the first report on the morphology of fetal and neonatal goiter in the cynomolgus monkey