Donepezil in the treatment of patients with Alzheimer's disease.

Alzheimer's disease (AD) is the most common cause of dementia and is characterized by an insidious onset and slow deterioration in cognition, activities of daily living (ADL), mood stability and social functioning. The cholinesterase inhibitors (ChEIs), developed based on the cholinergic hypothesis, are currently considered to be the best established treatment for AD, although the significant advances in the symptomatic pharmacotherapy of AD may be followed by disease-modification treatments. Donepezil is a mixed competitive and noncompetitive acetylcholinesterase inhibitor that shows a relative selectivity for acetylcholinesterase inhibitor compared with butyrylcholinesterase.

Is encapsulating peritoneal sclerosis a threatening issue in continuous ambulatory peritoneal dialysis? The Japanese experience.

Encapsulating peritoneal sclerosis (EPS) is undoubtedly the most serious complication of continuous ambulatory peritoneal dialysis treatment in Japan, with a mortality rate ranging from about 39% to 49% in reported series. Cases of EPS have been linked to long-term peritoneal dialysis, and limitations on renal transplantation in Japan mean that most Japanese patients have to accept long-term dialysis therapy, which is a critical problem. Treatment alternatives for EPS include total parenteral nutrition, prednisolone administration, and surgical approaches, all of which have varying success rates.

[Feature of food allergy developed during infancy (2)--acquisition of tolerance against hen's egg, cow's milk, wheat, and soybean up to 3 years old].

Background: Once food elimination is introduced, it is important to know for doctors when patients generally develop oral tolerance against eliminated food. To clarify the point, following study was conducted.

Methods: We analyzed 304 patient profiles with food allergy in our division between 1994 and 2001.

[Feature of food allergy developed during infancy (1)--relationship between infantile atopic dermatitis and food allergy].

Background: Most of food allergy (FA) cases during childhood start as infantile atopic dermatitis (AD) at the ages of a few months old. We tried to clarify the association between infantile AD and FA during infancy.

Methods: We analyzed relationship between AD and FA during infancy among patients with 208 cases, who had visited our outpatient clinic with chief complaint of "eczema" from 1998 to 2000.

Encapsulating peritoneal sclerosis is a separate entity: Con.

There is controversy with respect to the issue that encapsulating peritoneal sclerosis (EPS) is a separate entity from simple sclerosis (SS), which is the uniform change of the peritoneum on peritoneal dialysis. These following ideas support the notion that the development of EPS is connected with pathology that is not the same as that responsible for SS: (1) EPS is a rare disorder, (2) certain factors are involved with the etiology, (3) the clinical background of the patients is not uniform, and (4) the histopathological findings of EPS are different from those of SS. There are pitfalls in these concepts and they need be revised.

High iron storage levels are associated with increased DNA oxidative injury in patients on regular hemodialysis.

Background: Accumulating evidence suggests that oxidative stress is enhanced in patients on regular hemodialysis (HD). Iron supplementation is essential for the treatment of renal anemia, but there is a possibility that it could enhance oxidative stress by inducing the Fenton reaction. Here, we report our investigation of the relation between iron storage and DNA oxidative injury in HD patients.

Enzyme replacement therapy in Japanese Fabry disease patients: the results of a phase 2 bridging study.

Fabry Disease (alpha-galactosidase A deficiency) is an X-linked hereditary disorder leading to the pathological accumulation of globotriaosylceramide (GL-3) in lysosomes, particularly in the vascular endothelium of the kidney, heart and brain. We report the results of an open-label phase 2 study that was undertaken to evaluate whether ethnic differences exist that would affect agalsidase beta (Fabrazyme) treatment of Fabry patients in the Japanese population, relative to safety and efficacy. The study design mirrored the design of the completed phase 3 clinical trial that led to approval of the product agalsidase beta.

[The role of hyperphosphatemia in the pathogenesis of secondary hyperparathyroidism].

Renal phosphate handling plays key role in phosphate metabolism. Kidney dysfunction induced hyperphosphatemia. The phosphatemia with renal insufficiency, especially uremia, indirectly progresses into secondary hyperparathyroidism via suppression of vitamin D/Ca system.

[The pathophysiology of adynamic bone disease].

Adynamic bone disease was first noted in the early 1980s. It now represents the predominant bone lesion in peritoneal dialysis patients and is nearly as prevalent as osteitis fibrosis in hemodialysis patients. Bone turnover is markedly reduced in this disorder but, A in contrast to osteomalacia, there is no increase in osteoid formation.

Oxidative stress is enhanced in correlation with renal dysfunction: examination with the redox state of albumin.

Background: Cardiovascular disease is known to be the most important complication among patients with renal failure, and oxidative stress has been proposed to play a major role as the source of such complications. Human serum albumin (HSA) is composed of human mercaptoalbumin (HMA) with cysteine residues having reducing powers, of reversibly oxidized human non-mercaptoalbumin-1 (HNA-1), and strongly oxidized human non-mercaptoalbumin-2 (HNA-2).

Methods: We used the "redox state of HSA" as a marker to investigate the current status of oxidative stress in predialysis patients with renal failure.

Fluctuations of source locations of EEG activity during transition from alertness to sleep in Alzheimer's disease and vascular dementia.

Vascular dementia (VaD) differs from Alzheimer's disease (AD) in larger fluctuations of cognitive impairment, hypothetically because of deteriorated vigilance control. Vigilance levels are reflected by locations of EEG sources. Transition from alertness to sleep might be particularly sensitive to degradations of vigilance control.

Hyper-vascular change and formation of advanced glycation endproducts in the peritoneum caused by methylglyoxal and the effect of an anti-oxidant, sodium sulfite.

Objective: Methylglyoxal (MGO) in a heat-sterilized conventional PD solution may damage peritoneal cells directly and/or indirectly by producing advanced glycation endproducts (AGEs). This study was conducted to (a) examine the acute effect of MGO on the peritoneum (including AGE formation) and (b) study the possible AGE suppressive effect of an anti-oxidant, sodium sulfite.

Method: (1) Human serum albumin (HAS) was continuously incubated with MGO (50 mM) at 37 degrees C for as long as 14 days and the fluorescence intensity (FI) was determined (em.

Risk factors and preventive measures for encapsulating peritoneal sclerosis--Jikei experience 2002.

A growing incidence of encapsulating peritoneal sclerosis (EPS) has been reported recently in Japan, and it is now urgent to establish preventive measures against EPS development. In the present paper, we describe our observational results regarding the risk of EPS development and the characteristic features of patients with EPS, in terms of peritoneal morphology and peritoneal function as determined by peritoneal equilibration test. The ongoing working protocol for EPS prevention at Jikei University Hospital is also discussed.

[Clinical study of bladder injury].

Since bladder injury has no specific clinical symptoms, accurate diagnosis at first consultation is relatively difficult. To elucidate the clinical characters type of injury, clinical symptoms, laboratory findings, methods of therapy and diagnosis, we reviewed 15 patients with bladder injury over a 9-year-period 1990-1998 (10 were traumatic injuries and 5 spontaneous injuries). We found no specific clinical symptom of bladder injury.

Novel treatment for neuronopathic lysosomal storage diseases--cell therapy/gene therapy.

Most lysosomal storage diseases (LSD) exhibit neurological symptoms and there has been limited success in their treatment. Innovative treatments employing novel therapy or gene therapy may offer the prospect of improvement. Recent attempts to treat the neurological forms of LSD include neural stem cell therapy, mesenchymal stem cell therapy, hematopoietic stem cell therapy and gene therapy.

Epidemiology, prevention and countermeasures against severe traumatic brain injury in Japan and abroad.

On the basis of accurate statistical reports in regard to traffic accidents and safety in Japan, it is clear that traffic accidents on the road, injured victims and all other losses due to these accidents have been increasing since around 1980. Nevertheless, the number of deaths due to traffic accidents has been gradually declining over the last six years. More detailed analysis of data revealed that the most significant factor for the recent reduction of traffic accident deaths was the marked reduction of deaths related to head injury.