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Formation of synaptic connections between nerve cells is the key to understanding neuronal development. Despite the wealth of in vitro information, fundamental questions regarding how synapses are formed in the mammalian brain remain unanswered. Glutamate receptor (GluR) δ 2 selectively expressed in cerebellar Purkinje cells is essential for synaptic formation in vivo. We showed that the trans-synaptic interaction of postsynaptic GluR δ 2 and presynaptic neurexins through secreted cerebellin precursor protein 1 (Cbln1) mediates cerebellar synapse formation. We also demonstrated that GluR δ 2 triggers synapse formation by tetramerization of neurexins through Cbln1. These finding provide a molecular insight into the mechanism of synapse formation in the brain. [ABSTRACT FROM AUTHOR]

This review article is intended to introduce clinicians in Japan to the four types of medical procedures associated with the right to die in the United States and their ethical background. The four types of procedures are as follows: forgoing life-sustaining medical treatment, palliative sedation and intensive symptom management, physician-assisted suicide, and euthanasia. This article discusses the difference between negative and positive rights and how they apply to these four procedures. In addition, it discusses the reason why withdrawing ventilation is considered ethically equal to its withholding. Other topics that are covered include the principle of double effect and proportionality in palliative sedation, the practice of physician-assisted suicide in the US, and controversies regarding euthanasia. Additionally, this article mentions the voluntary stopping of eating and drinking (VSED) as another category of the right to die. Ethics and laws are specific to the region and the culture. The author encourages Japan, where the withdrawal of life-sustaining treatments is still not part of usual practice, to advance ethical discussions among its population so that more options for the right to die will be available to the patients in its society.