Human rights and Japanese bioethics: a report from Japan

The main contentions of this paper are twofold. First, there is a more than century-old Japanese tradition of human rights based on a fusion of Western concepts of natural rights and a radical reinterpretation of Confucianism, the major proponent of which was the Japanese thinker Nakae Chomin. Secondly, this tradition, although a minority view, is crucial for remedying the serious defects in the present Japanese medical system.
In the latter half of the nineteenth century, Nakae Chomin sought to reinterpret Chinese tradition, especially Confucianism, by injecting the concepts of popular sovereignty and democratic equality, drawn from Western sources. The resulting view maintained the Confucian commitment to a moral nexus for society, but replaced hierarchy with egalitarianism.
The pressing need for such an approach to patients' rights in present-day Japan is illustrated by two recent cases: the photographing and commercial exploitation of patients' genitals without serious response by authorities, and the attempt by physicians to manipulate the time of death and, possibly, to improperly pressure family members in order to transplant organs from the brain-dead victim of a criminal assault.
Such problems stem from hierarchy and paternalism, which seem to be a legacy of the rapid, state-sponsored introduction of Western medicine in the mid-nineteenth century, and in particular from the government's adoption of and support for German military medicine as a model for Japan.     

Zuttiyeh face: A view from the east

We analyze the phylogenetic position of the frontofacial fragment from Zuttiyeh, Israel. This specimen is dated to the Middle Pleistocene (the latest estimate is between 250 and 350 kyr) and is associated with the Acheulo-Yabrudian, which makes it the oldest cranium from the region. It has been previously regarded as a Neandertal, and early “anatomically modern Homo sapiens,” and a generalized specimen ancestral to both. These different phylogenetic interpretations of its features have a historic basis but in our view also result from a confusion of grade and intraspecies clade as valid sources of variation. We show here that generally the differences that distinguish Zuttiyeh from Neandertals are similarities it shares with the Zhoukoudian remains. These similarities involve a unique combination of features, and suggest the possibility of an ancestral relationship. It is less likely that Middle Pleistocene remains from Europe or sub-Saharan Africa are uniquely or significantly ancestral to Zuttiyeh. An accurate understanding of the relationship between populations of eastern and western Asia is important for resolving the more general questions surrounding the position of the Upper Pleistocene Levant populations in human evolution, including (1) whether there are significantly different contemporary Mousterian populations in the Upper Pleistocene, (2) whether Neandertals are clearly intrusive in the region, and (3) whether there is an early appearance of (what many workers call) “anatomically modern Homo sapiens.” The hypothesis of a recent unique African ancestry for all modern humans is disproved by our study, which shows Asia as a significant source area for at least some living populations. © 1993 Wiley-Liss, Inc.     

Abnormal measurements and disproportions in the face of Down's syndrome patients: preliminary report of an anthropometric study

Using 32 measurements taken from the surface of the cranial-orbital-facial-aural area, 9 proportion indices were calculated to detect the most striking locations of disfigurement in 52 Down's syndrome patients (29 males and 23 females), all white North Americans, aged between 3 and 31 years. A shallow upper-third of the face depth (between the nasal root and the ear's tragi) and a short right auricle were the most frequent subnormal findings (each 71.5 percent), with subnormal palpebral fissures in third place (68.8 percent). The most striking supernormality was the inclination of the palpebral fissure, which was greater than the maximum normal in 46.9 percent. The most striking and frequent (46.9 percent) disproportion was caused by the presence of markedly short palpebral fissures in the vicinity of normal-wide spaces between the eyes (enen), followed by hyperteloric orbits (40.4 percent) and disproportionately short noses (28.9 percent). Major (moderate or marked) epicanthi were found in a high percentage (42 percent) of the patients and aggravated the visual impression of the already damaged orbito-nasal area. Preliminary results of the analysis of the proportion indices in various age groups showed that some disproportions in the orbits and face decreased with age.     

Reproductive parameters of female Japanese macaques: Thirty years data from the arashiyama troops,Japan

Over a 30-year period from 1954 to 1983, 975 live births were recorded for Japanese macaque females at the Iwatayama Monkey Park, Arashiyama, Japan. Excluding unknown birth dates, primiparous mothers gave birth to 185 infants (182 cases with age of mother known) and multiparous mothers gave birth to 723 infants (603 cases with age of mother known). The peak month of birth was May with 52.3% of the total births occurring during the period. Multiparous females who had not given birth the previous year did so earlier than multiparous females who had given birth the previous year and also earlier than primiparous females. Among the females who had given birth the previous year, females whose infant had died gave birth earlier than females who had reared an infant the previous year. The offspring sex ratio (1:0.97) was not significantly different from 1:1, and revealed no consistent association with mother's age. Age-fecundity exhibited a humped curve. The annual birth rate was low at the age of 4 years but increased thereafter, ranging between 46.7% and 69.0%, at between 5 and 19 years of age, but again decreased for females between 20 and 25 years of age. Some old females displayed clear reproductive senescence. The infant mortality within the first year of age was quite low (10.3%) and the neonatal (less than 1 month old) mortality rate accounted for 49.0% of all infant deaths. There was no significant difference between the mortality rates of male and female infants. A female's rank-class had no apparent effect on the annual birth rate, infant mortality, and offspring sex ratio. These long-term data are compared with those from other primate populations.     

Partial duplication of the face: case report and review

Complete or partial facial duplication is a rare congenital malformation. A spectrum of structural abnormalities varying in degrees of severity has been described in affected individuals. We present discordance for facial duplication between monozygotic twins in which maxillary and mandibular duplication was present in one. The involved twin showed the following findings: ocular hypertelorism, bifidity of the nose, duplication of the maxilla, macrostomia, cleft of the lower lip, hamartoma of the vomer, supernumerary teeth, duplication of the mandibular teeth, bifidity of the tongue, and hamartoma of the floor of the mouth. Surgical management of the facial anomalies is discussed. A review of the literature and discussion of this rare malformation are presented.     

Polymorphism of red cell glutamic-pyruvic transaminase in Japanese: gene frequencies in samples from Northern Japan.

The genetic polymorphism of red cell GPT was investigated by starch-gel electrophoresis in four samples from northern Japan including a sample of the Ainu of Hokkaido. The distribution of the Gpt1 gene frequencies among 10 samples excluding the Ainu so far examined showed heterogeneity. The geographical cline of Gpt1 gene frequency reported in southern Japan was not observed in northern Japan.     

Reflections on the face of Japan: a multivariate craniofacial and odontometric perspective

Craniofacial variables for modern and prehistoric Japanese were subjected to multivariate analysis to test the relationships of the people of Japan with mainland Asian and Oceanic samples. The modern Japanese are tied to Koreans, Chinese, Southeast Asians, and the Yayoi rice agriculturalists who entered Japan in 300 B.C. Together they make up a Mainland-Asia cluster of related populations. The prehistoric Jomon foragers, the original inhabitants of the Japanese archipelago, are the direct ancestors of the modern Ainu, who made a recognizable contribution to the warrior class--the Samurai--of feudal Japan. Together, they are associated with Polynesians and Micronesians in a Jomon-Pacific cluster of related populations. Jomon-to-Ainu tooth size reduction proceeded at the same rate as that observable in the post-Pleistocene elsewhere in the Old World.     

Efficacy and safety of atovaquone-proguanil in treating imported malaria in Japan: the second report from the research group

Malaria remains an important health risk among travelers to tropical/subtropical regions. However, in Japan, only 2 antimalarials are licensed for clinical use - oral quinine and mefloquine. The Research Group on Chemotherapy of Tropical Diseases introduced atovaquone-proguanil in 1999, and reported on its excellent antimalarial efficacy and safety for treating non-immune patients with uncomplicated Plasmodium falciparum malaria (20 adult and 3 pediatric cases) in 2006. In the present study, additional cases of malaria were analyzed to confirm the efficacy and safety of this antimalarial drug. Fourteen adult and 2 pediatric cases of P. falciparum malaria and 13 adult cases and 1 pediatric case of P. vivax/ovale malaria were successfully treated with atovaquone-proguanil, including 3 P. falciparum cases in which the antecedent treatment failed. Two patients with P. vivax malaria were treated twice due to primaquine treatment failure as opposed to atovaquone-proguanil treatment failure. Except for 1 patient with P. falciparum malaria who developed a moderate liver function disturbance, no significant adverse effects were observed. Despite the intrinsic limitations of this study, which was not a formal clinical trial, the data showed that atovaquone-proguanil was an effective and well-tolerated therapeutic option; licensure of this drug in Japan could greatly contribute to individually appropriate treatment options.     

Bone and Joint Disorders in Wild Japanese Macaques from Nagano Prefecture,Japan

I studied bone and joint disorders in wild Japanese macaques (Macaca fuscata fuscata) in order to discern some aspects of their life history from the skeletal material. The specimens comprise 107 nearly complete skeletons of subadults and adults that were killed as crop-raiding monkeys between 1997 and 1998 in Nagano Prefecture, Japan. The most frequent disorder is angular deformity due to fractures: 80 healed fractures in 31 of 52 males and 71 healed fractures in 26 of 55 females. Secondary osteoarthritis due to fractures is rare. Two males have osteochondritis dissecans bilaterally on the posterior surface of the lateral femoral condyles. Degenerative changes are common in the aged individuals. Fractures of the trunk—clavicle, scapula, vertebrae, ribs or hip—are frequent in the males. Contrarily, the majority of fractures in females are in the hands and feet. While most fractures in males appear to have occurred during adulthood, those in females occurred during childhood and senescence. Interindividual violence should not be regarded as a principal cause for fractures in males and females because there is no bite wound except perhaps for one case of an amputated digit. Fractures of the trunk in males were probably caused by impact forces against their shoulders or hips or both caused by rolling down a steep slope or falling out of trees, perhaps during intertroop transfers.