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Commissioning of a linear accelerator (Linac) and treatment planning systems (RTPs) for clinical use is complex and time-consuming, typically 3-4 months in total. However, based on clinical needs and economics, hospitals desire early clinical starts for patients, and various studies have been conducted for shortening the preparation period. One of the methods to shorten the period is using golden beam data (GBD). The purpose of this study was to shorten the commissioning period without reducing accuracy and to simplify commissioning works while improving safety. We conducted commissioning of the RTPs before installing the Linac using GBD, and carried out verification immediately after the acceptance test. We used TrueBeam STx (Varian Medical Systems) and Eclipse (ver. 13.7, Varian Medical Systems) for RTPs and anisotropic analysis algorithm (AAA) and AcurosXB (AXB) for calculation algorithms. The difference between GBD and the measured beam data was 0.0 ± 0.2% [percentage depth dose (PDDs) ] and -0.1 ± 0.2% (Profiles) with X-ray, and -1.2 ± 1.3% (PDDs) with electrons. The difference between the calculated dose and the measured dose was 0.1 ± 0.3% (AAA) and 0.0 ± 0.3% (AXB) under homogeneous conditions, and 0.7 ± 1.4% (AAA) and 0.6 ± 1.1% (AXB) under heterogeneous conditions. We took 43 days from the end of the acceptance test to the start of clinical use. We found that the preparation period for clinical use can be shortened without reducing the accuracy, by thinning out the number of measurement items using GBD.

Vitamins are defined as essential organic micronutrients that are not synthesized by mammals. Coenzymes are defined as organic compounds with low molecular weight that are required to show enzyme activities by reversibly binding with their apoenzymes. Most of vitamins and coenzymes show various biofunctions besides their functions as vitamins and coenzymes. Accordingly, it is more appropriate to understand both as effective biofactors. Various retinoid derivatives synthesized bind to retinoid binding proteins to regulate gene expressions and show other biofunctions. Pyridoxal phosphate serves as an inhibitor of catepsins, and regulates the gene expression. Several novel built-in coenzymes such as topaquinone and lysyltyrosylquinone have been demonstrated in mammalian and microbial enzymes.

Objective: To describe epidemiological features of HIV prevalence among female commercial sex workers (CSWs) in Cambodia, a cross-sectional study using a questionnaire study and serological tests was carried out from December 1997 to January 1998. We report the main results of the analyses of serological tests in this article., Methods: Two hundred ninety six CSWs working in Sisophon and Poi Pet, located in northwest Cambodia, Bantey Mean Chey province, were recruited for interview based on a questionnaire on sexual behavior, and serological tests. The blood samples were examined for HIV antibody, Chlamydia trachomatis IgG antibody, TPHA, Hepatitis B surface antigen, and Hepatitis B surface antibody. The relationship between HIV and the other STD's was analyzed by using logistic regression analysis., Results: The HIV seroprevalence rate was 43.9% (130 out of 296). The seropositive rate of Chlamydia trachomatis IgG antibody (C.T.-IgG-Ab) was 73.3% (217 out of 296). Logistic regression analysis showed a significant association between C.T.-IgG-Ab positive and HIV prevalence. (Odds Ratio: 5.33; 95% Confidence Interval, 2.82-10.07)., Conclusions: This study suggests that the existence of Chlamydia trachomatis is closely related with HIV prevalence among CSWs in Cambodia. Other STDs may also increase susceptibility to male-to-female sexual transmission of HIV. This suggests that appropriate prevention against STDs will be needed for the control of HIV prevalence in Cambodia.

To study the relationship between dietary calcium intake and bone mineral density (BMD) among young Japanese females, we recruited 1298 females under 40 years living in Yokohama city for BMD measurement by Computed X-ray densitometer (CXD method) and dietary questionnaire. 1. The average of BMD was 2.75 mm/AI and was highest in the 35 to 39 year old group. 2. Calcium intake (Ca) and protein intake (Protein) were highest in 35 to 39 year old group. 3. BMD, Ca, and Protein were significantly higher in those who had regular dietary habits than those with irregular habits. 4. Among those who had lower Ca, (less than 600 mg per day), the amount of small fish consumed whole was negatively correlated with BMD (p = 0.035), and those with higher consumption of small fish than average had significantly (p = 0.018) lower BMD than those with lower small fish consumption adjusting for age and Ca and protein intake. These findings imply a possibility that small fish accompanied by higher salt intake may influence BMD adversely in this population by an interaction with calcium urinary excretion, which has been suggested by experimental and epidemiologic studies. Dietary composition of Ca may be important for prevention of osteoporosis.

In cooperation with the Chinese Academy of Preventive Medicine and Yunnan Province Provincial Office for AIDS Control and Prevention, we studied the current status of HIV infection intravenous drug users (IVDUs) and other high risk groups in Yunnan province of China. As of the end of 1995, 1,807 HIV cases were officially reported (Positive rate was 0.6%), of which 1,278 (77.9%) were IVDUs, and 24 were their spouses. The majority of cases were found among the Dai minority male farmers near Ruili which borders on Myammar, but HIV also appears to be spreading among the Han people. HIV antibody positive rates among commercial sex workers, pregnant women and blood donors were 0.2%, 0.07% and 0.04%, respectively. A system for surveillance of HIV has been developed, but preventive strategies to cope with HIV epidemic are not sufficient. As HIV/AIDS is now a global issue, (1) the integration and coordination of such preventive strategies in cooperation with community health workers, (2) general health education for condom use promotion and (3) care of psychological vulnerable person such as IVDUs, should be developed.

We investigated the incidence of atopic dermatitis and related factors at infant physical examination at health centers. Subjects were 900 infants (290 four-month-old infants, 298 one-year and six month-old infants, 312 three-year-old infants) who participated in infant physical examinations in Kanazawa-ku, Yokohama City. Overall, we analyzed 696 infants whose mothers had cooperated with the survey by completing questionnaires during physical examinations, and who submitted to examination by consulting dermatologists. The incidence of atopic dermatitis was 11.6% in 4-month-old infants, 12.2% in 1.5-year-old infants, and 12.1% in 3-year-old infants. The following were found to be related to the atopic dermatitis of infants. 1. Family history of atopic dermatitis in their mothers and older siblings. 2. Mothers' limited diet during pregnancy (avoiding some food which are suspected allergens). 3. Past history of molluscum contagiosum. 4. The frequency of taking bath. While epidemiological surveys of atopic dermatitis have previously been performed, the criteria at each survey was not identical and results could not be compared precisely. In this survey, 1. Dermatologists specializing in atopic dermatitis performed examinations. 2. All diagnoses were made according to standardized criteria which are applied nationwide. 3. All subjects were from a specific region. Because of this approach, this survey provides important information that can form the basis of comparison for future epidemiological surveys of atopic dermatitis.

In December 1995 and March 1996, we visited institutes which were conducting epidemiological studied of HIV/AIDS in Cambodia, and obtained data for further collaborative study between Japan and Cambodia. Data included information on AIDS patients and HIV infected persons, and behavioral epidemiology of CSWs (Commercial Sex Workers). The cumulative reported number of AIDS patients and HIV infected persons in Cambodia was 86 and 2,536 cases respectively in 1995. The cause of infection was mostly heterosexual contact with very few cases from injecting drug use (IDU) and other causes. The seroprevalence rate of HIV antibody among donated blood rapidly increased from 0.08% in 1991 to 4.47% in 1995, and those among CSWs and pregnant women were 37.9% and 2.6%, respectively, in 1995. The average rate of condom use among CSWs was 66%, but the rate of usual usage was only 14%. These results indicate that the HIV/AIDS epidemic had spread rapidly through CSWs, that it had been spread among peoples in communities, and that usage of condoms among CSWs was insufficient in Cambodia. Without strong countermeasures against HIV/AIDS in this country, HIV/AIDS epidemic may spread significantly to not only peoples in this country but also those in neighbouring countries in the future.

We here describe activation mechanisms of three characteristic metalloenzymes by metals. The copper-containing amine oxidase contains a topaquinone residue at the active site. The inactive precursor form of the enzyme, which contains a tyrosine residue at the position corresponding to topaquinone of the matured protein, was isolated and converted to the matured form by incubation with cupric ions through self-processing of the protein. The selenocysteine residue of selenium-containing formate dehydrogenase is synthesized cotranslationally through a process directed by a UGA codon that normally functions as a stop codon. We describe the mechanism of recognition of UGA and specific incorporation of selenium into the protein. Vanadium-containing haloperoxidases afford stable apo forms lacking vanadium. Reconstitution of holo forms by vanadium ions are also described.

HIV/AIDS surveillance in Japan experienced a sharp and transient rise in 1991-92 in the number of foreign HIV positives but not of AIDS cases, for reasons of which remain unclear. Using the national HIV/AIDS surveillance data base the cause of the increase was studied by comparing the trends of foreign cases diagnosed in 1991-92 with those in 1985-90 in terms of gender, age, nationality, clinical stage, possible route of infection, possible place where the case contracted HIV and the place where the case was identified. Present analysis revealed: (1) In 1991-92 there was a large increase in the number of heterosexually-infected female HIV positive aged below 30 years reported from the areas surrounding Tokyo, of which the majority was of Asia origin. (2) A similar but moderate change was also seen in foreign males infected heterosexually but not in those infected homosexually. These were predominantly of U.S./Europe origin, aged > or = 30 and reported from Tokyo. (3) Although most of the foreign cases reportedly contracted HIV outside of Japan, those infected in Japan began being reported in 1991-1992. These results suggest that change in foreign cases seen in 1991-1992 was not only in number but also in gender, age, nationality, route of infection and geographical distribution. This should be taken into consideration in considering the HIV/AIDS prevention strategy in Japan.

To explore the recent situation of the human immunodeficiency virus (HIV) epidemic in foreign residents in Japan, a survey of medical records between 1989-1992 was performed in a clinic located in a small district of Tokyo metropolitan area where foreign prostitutes were relatively concentrated. From medical records results of laboratory tests for HIV, syphilis, gonorrhea and chlamydial infection were collected. The present study revealed (1) that more than 1000 foreigners, of whom the majority were Thai, with a female to male ratio over 10, visited the clinic during the 4 years with a marked increase from 1990 to 1991, (2) that among the laboratory tests only anti-HIV testing rate markedly increased by 2-3 fold from 1990 to 1991 in both sexes (3) that anti-HIV seropositives were 41 in total (F = 39, M = 2), around 4% in both sexes, with a slight increasing trend in females and particularly high infection rate (14.0%) in females aged < 20 and (4) that no significant correlation was observed between HIV infection and other sexually transmitted diseases. These results suggest that the remarkable increase witnessed by the recent AIDS surveillance in Japan could have been influenced at least in part by the sudden increase in the testing rate for anti-HIV as well as by the increase in the number of foreigners visiting clinics. It also suggests the critical importance of targeting foreign females of high risk behaviour in the AIDS prevention strategies in Japan since HIV infection rates were high among foreign females, especially in teenagers.

It has been reported that antibodies to HIV-1 could be detected in saliva of patients with AIDS. We studied whether saliva is potentially useful for screening of HIV-1 infected persons. Pairs of serum and saliva were collected from both 19 HIV-1 seropositive outpatients (CDC type, II:15, III:1, IV:3) of AIDS clinic in our hospital and 4 controls. Multiple saliva collection was done from seropositives periodically for 8 months after the first sampling. Serum and saliva were tested with ELISA and Western blot (WB) methods by using kits of diagnostics Pasteur (ELAVIA MIXT and LAV Blot-1). All pairs of serum and saliva from controls were clearly negative by ELISA. Nineteen sera of proven seropositive cases and paired 18 saliva samples were confirmed to be positive in ELISA test employed, but O.D. value of 1 saliva sample was below the cut-off level. However, in the follow-up study, samples taken from the same individuals after the first sampling showed positive results. Forty-seven saliva samples from seropositives were served for the WB test. Clearly positive bands were observed in 43 samples. In each of the remaining 5 samples, the final decision was "indeterminate", although a strong reactive band was observed at GP-160. The results mentioned above suggested that saliva was useful for screening of antibodies to HIV-1 in epidemiological studies, though it is necessary to improve the sensitivity of ELISA and WB for tests of saliva.

Current status and future trends of HIV infection and AIDS in Japan were estimated based on AIDS surveillance data up until 1992, excluding HIV infection from blood products and blood-borne transmission. The coverage rate of reports of HIV infection was estimated as the proportion of the reported AIDS cases who are also included in reports of HIV infection. Current numbers of HIV infected persons were then estimated to be the reported numbers divided by the coverage rate. Future numbers of HIV infected persons were predicted by extrapolation. Future numbers of AIDS cases were predicted based on the predicted numbers of HIV infected persons and the incubation distribution. The results were as follows: 1) The coverage rate of the reports of HIV infection was estimated to be 11.5%. 2) The numbers of HIV infected persons were estimated to be 2,900 in Japanese and 4,500 in foreigners by the end of 1992, and are predicted to be 7,700 in Japanese and 15,500 in foreigners by the end of 1997. 3) The numbers of AIDS cases were reported to be 125 in Japanese and 52 in foreigners by the end of 1992, and are predicted to be 1,100 in Japanese and 1,600 in foreigners (including AIDS cases developed after return to home country) by the end of 1997.

We investigated the correlation between the components of spontaneous eye movement (EOG) and EEG in six healthy individuals. The study was conducted in three periods; from the resting to drowsy stage, from the drowsy to spontaneous awakening stage, and in the forced waking stage. EEG, as registered from bipolar electrodes attached between the left parietal region (P3) and the left occipital region (O1), was monitored continuously by the FFT method with a segment of 12.8 seconds. Rapid eye movement and slow eye movement were observed simultaneously. In conclusion, even when the arousal level varies considerably, there is a close correlation between frequency of rapid eye movement and EEG patterns of 10.16 integral of 10.94 Hz & 17.97 integral of 19.53 Hz (simple correlation p < 0.01). Additionally, during the forced waking period (after stage 2), delta and theta bands increased in cases along with sleepiness. Even if the depth of sleep was the same, one's mood upon awakening was determined by the frequency of slow waves before awakening.

To investigate the incidence of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection in Japanese sexual workers, 191 out of 194 female prostitutes working in a certain district of the Tokyo metropolitan area were tested for anti-HCV, anti-hepatitis B virus (HBV), anti-HIV and anti-Treponema pallidum (TP). They were also interviewed with regard to their past history of blood transfusion, vaccination against HBV, liver diseases and repeated skin piercing treatments such as tattooing, acupuncture and intravenous drug use. Sera from 300 female blood donors (aged 20 s-40 s), of the same district, collected during the same year, were assessed for comparison. Incidence of seropositives for anti-HCV and anti-TP were found to be significantly high in the prostitute group (11.0% and 16.2%, respectively) compared to the control (0% for both). Anti-HBV seropositives were 14.1% in the prostitute group and 12.7% in the control group without significant difference and none of our subjects were found to be anti-HIV positive. Among HCV infected only 5 experienced repeated skin-piercing treatment and none underwent blood transfusion. From these results it is concluded that HCV has a potential for being transmitted by heterosexual contact, although the exact risk for infection needs to be determined by further investigation.

In order to determine whether or not the lidocaine metabolism, monoethylglycinexylidide (MEGX) formation, could be used as a liver function test, we measured the serum levels of MEGX in 38 patients. There were significant correlations between values of MEGX (MEGX15, MEGX30, AUC15-30, AUC0-180) and conventional liver function tests (ICG R15, AT III, T. Bil). It appeared that value of MEGX 30 had maximum factor loading on conventional liver function tests by using principal component analysis. The advantage of adapting the MEGX formation as a liver function test of drug metabolism is simplicity of the method. MEGX formation could be useful index of the total liver function.

To evaluate the methods and criteria of judgement for the bronchial antigen inhalation challenge test, the test was performed with culture filtrate antigen of serotype I and II of Trichosporon cutaneum in 18 patients with summer-type hypersensitivity pneumonitis from 15 families. The quantity of 15 mg of culture filtrate antigen was adequate, and had no side effects. In the tests, 17 of 18 patients showed a positive reaction to both or either, serotype of antigen. In 36 performances of inhalation, there were 21 positive reactions and 15 negative reactions. According to the criteria of judgment for inhalation challenge test, the positive response rates of observation items were 75% for symptoms and signs, and 51% for laboratory data. Items with a high positive rate were cough, crepitant rales, and decrease of PaO2. On the other hand, low positive rates were observed for decrease of DLco, VC and positive CRP. Items with both high sensitivity and high specificity were cough, crepitant rales and decrease of PaO2. The low positive rate of decreased DLco was due to insufficient improvement before inhalation challenge. It was concluded that our methods and criteria of judgment for bronchial inhalation challenge test are useful.

A 34-year-old male patient was admitted to our hospital because of progressive exertional dyspnea and weight loss (8 kg in one year). Twelve years previously, he had had an episode of uveitis accompanied with bilateral hilar lymphadenopathy. Scalene node biopsy at that time revealed non-caseating epithelioid granulomas. Four years later, a follow-up chest radiograph showed bilateral fine nodular lesions. The bilateral parenchymal lesions gradually increased in density, and eventually, formed a confluent air-space consolidation containing multi-ocular cavities. On physical examination, the patient was emaciated (Ht 165 cm, Wt 40 kg). Nodular cutaneous lesions were present on his face and elbows. Hypoxemia with hypercapnea (PaO2 56 Torr, PaCO2 51 Torr) was noted. Repeated sputum cultures yielded negative results for acid-fast bacilli, fungi, and other pathological organisms. A transbronchial lung biopsy specimen obtained from near the cavitary lesion revealed non-caseating granulomas compatible with sarcoidosis. Skin lesion biopsy showed similar findings. The cavitation, was therefore considered to be due to ischemic necrosis of confluent sarcoid granulomas. Prednisolone (40 mg daily) was given with a prompt improvement of symptoms including dyspnea, as well as the radiographic abnormalities. We conclude that uncomplicated pulmonary sarcoidosis may rarely develop into an aggressive parenchymal disease with cavitation. It is of importance to differentiate such cases from infectious diseases (tuberculosis, mycosis etc.) because of the need for corticosteroid treatment.

In Japan, the AIDS (Acquired Immunodeficiency Syndrome) epidemic among haemophiliacs has been the most urgent issue, because of the large number of haemophiliacs with AIDS. However, after governmental approval of the production of heated coagulating agents in 1985 and 1986, the prime object of prevention against the AIDS epidemic shifted from transmission through coagulation agents to that through sexual contacts. In order to investigate the most appropriate countermeasures against the AIDS epidemic among homosexuals in Japan, the numbers of HIV (Human Immunodeficiency Virus)-infected cases and AIDS cases in the future were estimated, and changes of the future numbers of HIV-infected persons and AIDS cases by behavior of homosexuals were compared using a systems analytical method. The methods of estimation and comparison are similar to those of R. M. Anderson and others, using numerical analysis of a mathematical model consisting of differential equations. They assumed a closed homosexual group whose members seldom have contact with members of other homosexual groups, but we assumed an open homosexual group whose members are being infected by other groups, because this assumption was more appropriate to the situation of homosexual society in Japan. The results showed that the prevalence number of HIV-infected cases would be about 1,800, that the prevalence number of AIDS cases would be about 100 among 100,000 homosexuals at 20 years after the beginning of the AIDS epidemic, and that the most effective countermeasure was reducing the frequency of sexual contacts among members or taking prophylactic measures during sexual contacts. These prevalence numbers of HIV-infected cases and AIDS cases would be reduced to between 1/4 and 1/2 of the above-mentioned calculated values by promotion of that countermeasure.