Retinal vessel diameters in a Japanese population: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study

PURPOSE

To describe the relationship between retinal vascular calibre and cardiovascular risk factors in a Japanese population.

METHODS

The Locomotive Syndrome and Health Outcome in Aizu Cohort Study is a population-based, cross-sectional survey that included 2346 persons (56.1% of the eligible population) aged 40 to 74 years old. Retinal vascular calibre was measured from digital retinal photographs using a validated standardized protocol. Data on major cardiovascular risk factors were collected from all participants.

RESULTS

Of the 1787 participants with available retinal vascular calibre data, the mean retinal arteriolar calibre (CRAE) was 141.6 ± 18.6 μm, the mean venular calibre (CRVE) was 209.3 ± 26.1 μm, and the mean arteriole-to-venule ratio was 0.68 ± 0.08. A smaller CRAE was associated with male sex, increasing quartiles of systolic blood pressure and diastolic blood pressure, history of hypertension, current alcohol intake and higher quartiles of serum creatinine. A larger CRAE was associated with increasing quartiles of total cholesterol. A larger CRVE was associated with current cigarette smoking. Multivariate analyses showed that a smaller CRAE was associated with male sex, elevated mean arterial blood pressure and a history of hypertension; and a larger CRVE was associated with cigarette smoking.

CONCLUSIONS

The results of this study suggest that a narrowed diameter of the retinal arteriole in Japanese people is related to hypertension and sex (male) and that an enlarged retina venular diameter is related to a history of smoking. The pattern of these associations is similar to that in white populations and other Asian populations.

Glucose Uptake Is Decreased in Affected Lower Leg Muscles of Hemiparetic Persons during Level Walking

Stroke patients suffer from gait disturbance due to altered leg muscle actions. Many kinesiological studies have investigated muscle actions, but the metabolic activity of muscles in stroke patients remains to be investigated. We therefore evaluated energy consumption in lower extremity muscles during level walking in hemiparetic individuals. Glucose uptake was measured by positron emission tomography (PET) using (18)F-fluorodeoxyglucose ((18)F-FDG) in eight hemiparetic (mean age: 56 years) and 11 healthy (mean age: 26 years) participants. Standardized uptake ratio (SUR) was computed in each muscle to express the (18)F-FDG-uptake level. SUR was compared across gluteal, thigh, and lower leg muscles and across individual muscles within each muscle group. For each muscle, SUR was compared among the paretic limb of hemiparetic participants, the non-paretic limb of hemiparetic participants, and the right limb of healthy participants. In paretic limbs, mean SUR did not differ between the three muscle groups, or between individual muscles within each muscle group. SURs of paretic lower leg muscles and gluteus minimus muscle were significantly smaller than those of non-paretic limb and healthy participants (p < 0.05). In the non-paretic limb of hemiparetic participants, SUR of the lower leg muscles was larger than that of the thigh muscles (p < 0.05). Unexpectedly, SURs of medial hamstring and posterior tibial muscles were larger in the non-paretic limb of hemiparetic participants, compared to the right limb of healthy participants (p < 0.05). (18)F-FDG PET is useful to evaluate energy consumption levels of lower extremity muscles during level walking in hemiparetic individuals.

HLA-DPB1*0501 is not uniquely associated with opticospinal multiple sclerosis in Japanese patients. Important role of DPB1*0301

Apart from its unique lesion distribution pattern, the opticospinal form of multiple sclerosis (OSMS) is distinct among Japanese patients who satisfy the diagnostic criteria of MS. OSMS has been suggested to be strongly associated with HLA-DPB1*0501 in Japanese. However, association of DPB1*0301 with non-OSMS and lack of DPB1*0301 in OSMS were also reported. To verify the role of DPB1*0501 and DPB1*0301 in Japanese MS patients we determined the frequencies of these alleles in 26 patients with OSMS, 167 with non-OSMS and 156 normal subjects, who were all residents of Hokkaido, the northernmost island of Japan. All (100%) OSMS were negative for DPB1*0301 while 32 (19%) of the non-OSMS were positive for the allele. In DPB1*0301-negatives, the frequencies of DPB1*0501 in OSMS (85%) and non-OSMS (82%) were similar, but both were higher than in the controls (66%). In DPB1*0301-positives, the frequency of DPB1*0501 was low but similar in non-OSMS (12/32; 38%) and controls (6/14; 43%). Periventricular white matter lesions (PVL) were noted in 31 of 32 (97%) DPB1*0301-positive non-OSMS patients but in only 22 out of 135 (16%) DPB1*0301-negative non-OSMS patients and two out of 26 (8%) OSMS patients. Our findings indicate that DPB1*0501 plays an important role in the development of MS in general, but not in OSMS. The strong association of DPB1*0501 with OSMS may be due to the over-representation of the DPB1*0301 allele among individuals in the non-OSMS group. In addition, DPB1*0301 might be relevant to the development of periventricular lesions in Japanese patients with MS.

Limited reduction of ferrihydrite encrusted by goethite in freshwater sediment

Many physical and chemical processes control the extent of Fe(III) oxyhydroxide reduction by dissimilatory Fe(III)-reducing bacteria. The surface precipitation of secondary Fe minerals on Fe(III) oxyhydroxides limits the extent of microbial Fe(III) reduction, but this phenomenon has not yet been observed in nature. This paper reports the observation of secondary Fe-mineral (goethite) encrustation on ferrihydrite surface within freshwater sediment up to 10 cm deep. The sediment surface was characterized by the predominance of ferrihydrites with biogenic stalks and sheaths. An Fe(II)-oxidizing bacterium (Gallionellaceae) was detected by 16S rRNA gene analysis at sediment depths of 1 and 2 cm. Fe(2+) concentration in the sediment pore water was relatively higher at 2-4 cm depths. The 16S rRNA genes affiliated with dissimilatory Fe(III)-reducing bacteria were detected at 1, 2, and 4 cm depths. The results of the Fe K-edge extended X-ray absorption fine structure (EXAFS) analysis suggested the presence of goethite and siderite at depths below 3 cm. However, the change in the Fe-mineral composition was restricted to sediment depths between 3 and 4 cm, despite the presence of abundant ferrihydrite at depths below 4 cm. An increase in CH4 concentration was observed at deeper than 6 cm. Stable isotopic analysis of CH4 in the pore water indicated that acetoclastic CH4 occurred at depths below 7 cm. Transmission electron microscope observations suggested the presence of goethite and siderite on stalks and sheaths at depths below 3 cm. Results from conversion electron yield EXAFS analysis suggested that goethite dominated at 10 cm depth, thereby indicating that ferrihydrite was encrusted by goethite at this depth. Moreover, the incomplete reduction of ferrihydrite below depths of 4 cm was not due to the lack of organic carbon, but was possibly due to the surface encrustation of goethite on ferrihydrite.

Chronic hyperglycemia increases the risk of lateral epicondylitis: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS)

Background

Although humeral epicondylitis is a common health problem, there have been no reports that describe its prevalence in Japanese general population, and relatively little is known about its etiology and associated risk factors.

Questions/purposes

This study aimed to clarify the prevalence of humeral epicondilitis in Japanese general population, and investigate the associated risk factors using the data from a cross-sectional study of the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS).

Methods

A total of 1,777 participants who participated in health checkups conducted at rural area in Japan in 2010 were enrolled. The prevalence of lateral and medial epicondylitis was investigated. Logistic regression models were performed to examine the relationship between lateral epicondylitis and correlated factors such as occupational status, smoking and alcohol preferences, and medical characteristics.

Results

The overall prevalence of lateral and medial epicondylitis was 2.5 % and 0.3 %, respectively. A shortened version of the disabilities of the arm, shoulder and hand (The QuickDASH) score was significantly higher in subjects with lateral epicondylitis than in those without (15.0 ± 12.7 vs 8.5 ± 11.1). Subjects with definite chronic hyperglycemia (HbA1c ≥ 6.5) showed a 3.37-times higher risk of lateral epicondylitis than those with favorable glycemic control (HbA1c < 5.5) (95 % confidence interval (CI) 1.16–8.56). Age and sex, as well as occupational status, smoking and alcohol preference, and other metabolic factors were not significantly related to higher risk of lateral epicondylitis.

Conclusions

Lateral epicondylitis influences activities of daily living. Chronic hyperglycemia might be one of the risk factor for lateral epicondylitis.

Clinical relevance

Chronic hyperglycemia is significantly associated with lateral epicondylitis.

Reduced preoperative serum albumin and absence of peritoneal dissemination may be predictive factors for long-term survival with advanced gastric cancer with positive cytology test

BACKGROUND

Peritoneal lavage cytology cancer-positive (CY1) is a critical prognostic factor and is taken as representing stage IV in gastric cancer. There is no consensus treatment strategy for CY1-gastric cancer, and the detailed clinicopathological features remain obscure.

PATIENTS AND METHODS

Among 790 gastric cancer patients between 2005 and 2009, 52 cases of CY1 were identified (6.6%). A multivariate prognostic model was applied to the univariate prognostic factors to identify independent prognostic factors and factors associated with long-term survival in CY1-gastric cancer.

RESULTS

(1) Five-year overall survival (OS) was 17.6% in CY1-gastric cancer as compared with 93.9% in CYX and 77.7% in CY0 (77.7%), where tumors with pT2 or beyond were included in 11% of CYX, 73% of CY0, and 98% of CY1 cases. (2) On univariate analysis, factors associated with a negative prognosis were the presence of peritoneal dissemination (p = 0.029) and high preoperative serum albumin (p = 0.011) in CY1-gastric cancer. The multivariate Cox proportional hazards and logistic regression model using propensity score identified preoperative albumin as a critical independent prognostic indicator. (3) Long-term survivors were identified and, were often characterized by long-term postoperative adjuvant treatment.

CONCLUSION

Reduced preoperative serum albumin and absence of peritoneal dissemination may be predictive factors for long-term survival in patients with advanced gastric cancer with positive cytology test. Long-term postoperative adjuvant therapy might improve survival of patients with CY1.

Patient-reported disability in the general Japanese population was associated with medical care visits for low back pain, regardless of pain intensity

BACKGROUND

Race/ethnicity is known to affect pain severity and the emotional aspects of pain, with medical care visits also reported to differ according to race/ethnicity. It has been hypothesized that there is an interactive relationship between pain intensity and patient-reported disability and that the interactive relationships are related to medical care visits. However, it remains unclear whether the association between patient-reported disability and medical care visits for low back pain (LBP) are dependent on the pain intensity. The aims of this study were to examine the prevalence of medical care visits among members of the Japanese general population and to analyze the association between patient-reported disability and medical care visits for LBP patients, regardless of the pain intensity.

METHODS

From a random sample of the general Japanese population (n = 2962), we focused on those who experienced LBP within the past month. Subjects were asked about the number of medical care visits (medical clinic or complementary/alternative medical clinic) for LBP. Patient-reported disability was assessed using the Roland-Morris disability questionnaire (RDQ). Pain intensity of LBP was assessed by visual analog scale. To examine the association between RDQ and medical care visits among people with LBP, we used multiple logistic regression analysis and the trend analysis for the RDQ.

RESULTS

Of 841 reporting LBP in the past month, 285 (33.9 %) visited a medical care facility. After adjusting for pain intensity and other confounding factors, the odds ratios for the RDQ categories 1-5, 6-10, 11-15, and ≥ 16 were compared with the RDQ categories 0, 1.13 (95 % CI 0.73-1.73), 2.05 (95 % CI 1.17-3.60), 2.21 (95 % CI 1.06-4.62), and 4.0 (95 % CI 1.60-9.98), respectively (p for trend <0.01).

CONCLUSIONS

Patient-reported disability was associated with medical care visits for LBP, regardless of the pain intensity, with the results similar to those obtained for other races/ethnicities.

Class IIa HDAC inhibition enhances ER stress-mediated cell death in multiple myeloma

Histone deacetylase (HDAC) inhibitors have been extensively investigated as therapeutic agents in cancer. However, the biological role of class IIa HDACs (HDAC4, 5, 7 and 9) in cancer cells, including multiple myeloma (MM), remains unclear. Recent studies show HDAC4 interacts with activating transcription factor 4 (ATF4) and inhibits activation of endoplasmic reticulum (ER) stress-associated proapoptotic transcription factor C/EBP homologous protein (CHOP). In this study, we hypothesized that HDAC4 knockdown and/or inhibition could enhance apoptosis in MM cells under ER stress condition by upregulating ATF4, followed by CHOP. HDAC4 knockdown showed modest cell growth inhibition; however, it markedly enhanced cytotoxicity induced by either tunicamycin or carfilzomib (CFZ), associated with upregulating ATF4 and CHOP. For pharmacological inhibition of HDAC4, we employed a novel and selective class IIa HDAC inhibitor TMP269, alone and in combination with CFZ. As with HDAC4 knockdown, TMP269 significantly enhanced cytotoxicity induced by CFZ in MM cell lines, upregulating ATF4 and CHOP and inducing apoptosis. Conversely, enhanced cytotoxicity was abrogated by ATF4 knockdown, confirming that ATF4 has a pivotal role mediating cytotoxicity in this setting. These results provide the rationale for novel treatment strategies combining class IIa HDAC inhibitors with ER stressors, including proteasome inhibitors, to improve patient outcome in MM.

Visible-light-controlled homo- and copolymerization of styrenes by a bichromophoric Ir–Pd catalyst

Visible-light-controlled polymerization was achieved by a bichromophoric organopalladium catalyst which possesses a naphthyl-substituted cyclometallated Ir(iii) light-absorbing moiety.

Association between kyphosis and subacromial impingement syndrome: LOHAS study

BACKGROUND

Kyphosis is a cause of scapular dyskinesis, which can induce various shoulder disorders, including subacromial impingement syndrome (SIS). This study aimed to clarify the impact of kyphosis on SIS with use of cross-sectional data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS).

METHODS

The study enrolled 2144 participants who were older than 40 years and participated in health checkups in 2010. Kyphosis was assessed by the wall-occiput test (WOT) for thoracic kyphosis and the rib-pelvic distance test (RPDT) for lumbar kyphosis. The associations between kyphosis, SIS, and reduction in shoulder elevation (RSE) were investigated.

RESULTS

Age- and gender-adjusted logistic regression analysis demonstrated significant association between SIS and WOT (odds ratio, 1.65; 95% confidence interval, 1.02, 2.64; P < .05), whereas there was no significant association between SIS and RPDT. Multivariable logistic regression analysis demonstrated no significant association between SIS and both WOT and RPDT, whereas there was significant association between SIS and RSE.

CONCLUSION

RSE plays a key role in the development of SIS, and thoracic kyphosis might influence the development of SIS indirectly by reducing shoulder elevation induced by the restriction of the thoracic spine extension and scapular dyskinesis.

IL-22 produced by cancer-associated fibroblasts promotes gastric cancer cell invasion via STAT3 and ERK signaling

BACKGROUND

Interleukin-22 (IL-22) has been recently highlighted owing to its biological significance in the modulation of tissue responses during inflammation. However, the role of IL-22 in carcinogenesis has remained unclear. Here, we investigated the pathophysiological significance of IL-22 expression in gastric cancer tissues and examined the mechanism by which IL-22 promotes gastric cancer cell invasion.

METHODS

Human gastric cancer specimens were analysed by immunohistochemistry for expression of IL-22 and IL-22 receptor 1 (IL-22R1). The effects of IL-22-induced STAT3 and ERK signalling on invasive ability of gastric cancer cells were examined using a small-interfering RNA system and specific inhibitors. AGS cells were co-cultured with cancer-associated fibroblasts (CAFs) from human gastric cancer tissues and assessed by invasion assay.

RESULTS

Interleukin-22 and its receptor were expressed in α-smooth muscle actin-positive stromal cells and tumour cells at the invasive front of gastric cancer tissues, respectively. The expression of IL-22 and IL-22R1 was significantly related to lymphatic invasion. Interleukin-22 treatment promoted the invasive ability of gastric cancer cells through STAT3 and ERK activation. The invasive ability of gastric cancer cells was significantly enhanced by co-culture with IL-22-expressing CAFs.

CONCLUSIONS

Interleukin-22 produced by CAFs promotes gastric cancer cell invasion via STAT3 and ERK signalling.

In vivo evaluation of lateral lipid chain packing in human stratum corneum

BACKGROUND/AIMS

The matrix of intercellular lipids (ICL) of stratum corneum (SC) plays an important role in the barrier function of SC. It is important to understand the structure of the ICL matrix for dermatology and cosmetic science. Several methods exist for the analysis of the structure; however, it is difficult to conduct these analyses noninvasively.

METHODS

We have developed a method for the analysis of the lateral packing of ICL using Raman spectroscopy. As a proof-of-principle experiment, we prepared a human SC sheet sample and analyzed its structure by the proposed method and by a conventional method involving X-ray diffraction. We compared the results of both methods. In addition, we applied the proposed method to living human skin, and we analyzed the lateral packing of ICL of SC taken from three separate body sites.

RESULTS

The results of our method corresponded to those of the conventional method. We detected regional differences of ICL lateral packing using our method in vivo. The results indicated that the packing of ICL in SC taken from the forearm and upper arm are more ordered than that taken from the cheek.

CONCLUSION

The results verify that our developed method allows the evaluation of the lateral packing of ICL inside the SC layer of the skin in vivo. Using this method, we can detect regional differences of SC samples taken from various body sites.

Characterization of biogenic iron oxides collected by the newly designed liquid culture method using diffusion chambers

We designed a new culture method for neutrophilic iron-oxidizing bacteria using liquid medium (i) to study the formation and mineralogical characteristics of biogenic iron oxides (BIOS) and (ii) to apply BIOS to various scientific and engineering applications. An iron-oxidizing bacterium, Mariprofundus ferrooxydans PV-1(T) (ATCC, BAA-1020), was cultured using a set of diffusion chambers to prepare a broad anoxic-oxic interface, upon which BIOS formation is typically observed in natural environments. Iron oxide precipitates were generated in parallel with bacterial growth. A scanning electron microscopy analysis indicated that the morphological features of the iron oxide precipitates in the medium (in vitro BIOS) were similar to those of BIOS collected from natural deep-sea hydrothermal environments in the Northwest Eifuku Seamount field in the northern Mariana Arc (in situ BIOS). Further chemical speciation of both the in vitro and in situ BIOS was examined with X-ray absorption fine structure (XAFS). A bulk XAFS analysis showed that the minerals in both BIOS were mainly ferrihydrite and oligomeric stages of amorphous iron oxyhydroxides with edge-sharing octahedral linkages. The amount of in vitro BIOS produced with the diffusion-chamber method was greater than those produced previously with other culture methods, such as gel-stabilized gradient and batch liquid culture methods. The larger yields of BIOS produced with the new culture method will allow us to clarify in the future the mineralization mechanisms during bacterial growth and to examine the physicochemical properties of BIOS, such as their adsorption to and coprecipitation with various elements and substances.

Overexpression of cyclooxygenase-2 in malignant peripheral nerve sheath tumor and selective cyclooxygenase-2 inhibitor-induced apoptosis by activating caspases in human malignant peripheral nerve sheath tumor cells

Background

Cyclooxygenase-2 (COX-2) is a key enzyme in the conversion of arachidonic acid to prostanoids, and its activation is associated with carcinogenesis as well as inflammation. The antitumor effect of selective COX-2 inhibitors has been noted in various malignancies. Malignant peripheral nerve sheath tumor (MPNST) is a rare and aggressive soft tissue sarcoma for which effective treatments have not yet been established. The purpose of this study was to investigate a potential therapeutic role of COX-2 in MPNST.

Methods

We evaluated the expression of COX-2 in 44 cases of high-grade MPNST using immunohistochemical staining and compared the staining results with the characteristics and outcome of the patients. We also investigated the antitumor effect of etodolac, a selective COX-2 inhibitor, on MPNST cells in vitro using the MPNST cell line, FMS-1.

Results

Overexpression of COX-2 (≥50% positive cells) was observed in 29 cases (65.9%), was significantly associated with a poor overall survival (P = 0.0495), and was considered an independent risk factor for a poor outcome by the results of both univariate and multivariate analysis. Etodolac induced apoptosis of FMS-1 cells through the activation of caspase-8, -9, and -3. Moreover, several caspase inhibitors significantly inhibited etodolac-induced apoptosis.

Conclusions

Selective COX-2 inhibitors including etodolac had an antitumor effect on MPNST cells, and their use holds promise as a novel therapeutic strategy for patients with MPNST to improve their prognoses.

FOXC2 mutations in familial and sporadic spinal extradural arachnoid cyst

Spinal extradural arachnoid cyst (SEDAC) is a cyst in the spinal canal that protrudes into the epidural space from a defect in the dura mater. Most cases are sporadic; however, three familial SEDAC cases have been reported, suggesting genetic etiological factors. All familial cases are associated with lymphedema-distichiasis syndrome (LDS), whose causal gene is FOXC2. However, FOXC2 mutation analysis has been performed in only 1 family, and no mutation analysis has been performed on sporadic (non-familial) SEDACs. We recruited 17 SEDAC subjects consisting of 2 familial and 7 sporadic cases and examined FOXC2 mutations by Sanger sequencing and structural abnormalities by TaqMan copy number assay. We identified 2 novel FOXC2 mutations in 2 familial cases. Incomplete LDS penetrance was noted in both families. Four subjects presented with SEDACs only. Thus, SEDAC caused by the heterozygous FOXC2 loss-of-function mutation should be considered a feature of LDS, although it often manifests as the sole symptom. Seven sporadic SEDAC subjects had no FOXC2 mutations, no symptoms of LDS, and showed differing clinical characteristics from those who had FOXC2 mutations, suggesting that other gene(s) besides FOXC2 are likely to be involved in SEDAC.

Factors associated with severe effects following acute glufosinate poisoning

CONTEXT

In acute glufosinate poisoning, sudden respiratory arrest and convulsion can occur after a latent period of 4-60 h. There is still no factor that accurately predicts the occurrence of these symptoms.

OBJECTIVE

To elucidate the predictors of severe effects following acute glufosinate poisoning.

MATERIALS AND METHODS

This study is a retrospective observational case series. The subjects were 16 patients who had acute glufosinate poisoning. They were divided into a group with respiratory arrest or convulsion during hospitalization (severe group) and a group without (non-severe group). The following characteristics (or predictors) were compared between the groups: age, sex, calculated amount of glufosinate (volume of ingested poison (glufosinate-containing herbicide) × glufosinate concentration of the product), time duration from poison ingestion to arrival at our hospital, use of gastric lavage, use of whole bowel irrigation, Glasgow Coma Scale, laboratory parameters, PaO₂/FiO₂ ratio (P/F ratio), shock index, and presence or absence of systemic inflammatory response syndrome (SIRS) on arrival.

RESULTS

The P/F ratio was significantly lower in the severe group than in the non-severe group (median, 287.5 vs. 409.0; P = 0.049). The receiver operating characteristic (ROC) curve was plotted for the predictor of increasing severity based on the P/F ratio. The area under the curve was 0.714, and the optimal cutoff point for increasing severity was 374.0. The sensitivity was 75.0%, specificity of 71.4%, and accuracy of 75.0%. The shock index was significantly higher (median, 0.52 vs. 0.41; P = 0.031). Significantly more patients had SIRS in the severe group than in the non-severe group (P = 0.015). Logistic regression analysis was performed with a backward elimination procedure. SIRS was selected as the independent predictor of increasing severity (odds ratio, 29.810; 95% confidence interval, 1.011-878.952; P = 0.049).

DISCUSSION AND CONCLUSION

Severe effects following acute glufosinate poisoning were associated with two positive SIRS criteria. A low P/F ratio may be useful for predicting the occurrence of respiratory complications.

Risk factors for early re-bleeding and associated hospitalization in patients with colonic diverticular bleeding

AIM

The annual incidence of colonic diverticular bleeding is increasing, but treatments are not yet well established. Here we aimed to identify the risk factors for early re-bleeding and to determine the associated duration of hospitalization.

METHOD

Records of 90 emergent patients with colonic diverticular bleeding between 1999 and May 2012 were retrospectively reviewed. They were divided into an early re-bleeding within 1 month group (n = 24) and a no re-bleeding group (n = 66) and we investigated the risk factors for early re-bleeding. In the former group, we calculated the time from the first haemostasis to early re-bleeding and the associated duration of hospitalization.

RESULTS

Univariate analysis showed that there were significantly more patients with signs of shock (P = 0.00055) and active bleeding on the first colonoscopy after admission (P = 0.020) in the early re-bleeding group. Multivariate conditional logistic regression analysis using stepwise variable selection showed that signs of shock on admission (odds ratio, 5.23; 95% confidence interval, 1.84-14.90; P = 0.0019) remained statistically significant. All patients who re-bled without signs of shock (n = 7) and 16 of 17 with signs of shock re-bled within 126 h (5.25 days) of initial hospitalization.

CONCLUSION

Shock was an independent risk factor for early re-bleeding. The associated duration of hospitalization was 6 days.

Effects of long-term corset wearing on chronic low back pain

There are few studies of the therapeutic effects of long-term corset wearing in patients with chronic low back pain. The aim of this study was to evaluate the effects of long-term corset wearing on chronic low back pain and to examine the myoelectrical activities of the paravertebral muscles. Forty subjects with chronic low back pain were enrolled and randomly divided into two groups: a group wearing corsets for 6 months (CW) group and a group not wearing corsets (NW). The treatment effects were measured using the Japanese Orthopaedic Association (JOA) score. Muscle endurance was evaluated during the Biering-Sorensen test (S-test), and the degree of muscle fatigue was evaluated by the change in percent mean power frequency (%MPF) of the paravertebral muscles. Corset treatment for chronic low back pain improved low back pain and increased muscle endurance for a short period of time. Paravertebral muscle fatigue was not increased by long-term corset wearing for chronic low back pain, and weakening of the paravertebral muscles was not observed up to 6 months after the start of corset wearing.

Dietary patterns and risk of cardiovascular deaths among middle-aged Japanese: JACC Study

BACKGROUND AND AIMS

Little evidence showed the association between dietary patterns and cardiovascular disease among Japanese. The objective of this study was to examine whether dietary patterns are associated with cardiovascular disease among middle-aged Japanese.

METHODS AND RESULTS

At baseline (1988-1990), 26,598 men and 37,439 women aged 40-79 years enrolled in the Japan Collaborative Cohort (JACC) Study. During the follow-up through 2003, 578 men and 499 women died from stroke, and 272 men and 207 women died from coronary heart disease. We identified three major dietary patterns, 'vegetable', 'animal food' and 'dairy product', by factor analysis for both sexes. The multivariable hazard ratio (HR) and 95% confidence intervals of mortality from total cardiovascular disease in the highest versus lowest quintiles of the vegetable pattern were 0.93 (0.78-1.13), p for trend=0.73 for men and 0.82 (0.67-1.00), p for trend=0.04 for women. The respective HRs of mortality from stroke in the highest versus lowest quintiles of the dairy product pattern were 0.65 (0.49-0.86), p for trend=0.01 for men and 0.70 (0.51-0.97), p for trend=0.02 for women, and those of total cardiovascular disease were 0.89 (0.74-1.08), p for trend=0.23 for men and 0.76 (0.61-0.94), p for trend=0.01 for women. The animal food pattern was not associated with mortality from stroke, coronary heart disease or total cardiovascular disease for either sex.

CONCLUSION

We found that 'vegetable' and 'dairy product' patterns were associated with lower morality from cardiovascular disease, while the 'animal food' pattern was not associated with mortality from cardiovascular disease among Japanese.

Prevalence of pterygium in a population in Northern Japan: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study

Purpose

The aim of the study was to determine the prevalence and risk factors for pterygium in a population aged 40–74 years in Fukushima Prefecture, Japan.

Methods

Of 4185 citizens of the towns of Minamiaizu-machi and Tadami-machi, 2312 (55.2%) gave consent to an ocular examination during a health examination. Pterygium was diagnosed when a radially oriented fibrovascular lesion growing over the limbus into the cornea was observed. Eyes with a history of pterygium excision were also diagnosed with pterygium. Prevalence and factors associated with pterygium were investigated.

Results

Of the 2312 subjects, 101 (4.4%; 95% confidence interval, 3.6–5.3%) had pterygium in at least 1 eye. The average age (±SD) of the subjects was 64.3 ± 8.0 years. Gender, age, outdoor job history and smoking history were examined as possible associated factors, but only age was found to be significantly associated with pterygium in logistic regression analysis.

Conclusion

The prevalence of pterygium was 4.4% in the study population. This low rate may be due to the northern latitude of these towns. Age was associated with a risk of pterygium, but gender and outdoor job history were not associated with onset of pterygium in this study.

Remitting seronegative symmetrical synovitis with pitting edema syndrome caused by crystal-induced arthritis of the wrist: a case report

OBJECTIVE

To describe a rare case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome caused by gouty arthritis.

CLINICAL PRESENTATION AND INTERVENTION

A 76-year-old man presented with swelling and pain in the dorsum of feet and hands bilaterally. From the laboratory and radiologic findings, the diagnosis of gout-induced RS3PE syndrome was made. Conservative therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular corticosteroid injection in the wrist joint completely and rapidly resolved all symptoms. The patient was successfully treated with oral administration of NSAIDs and a one-time intra-articular corticosteroid injection in the left wrist joint.

CONCLUSION

This case demonstrated the importance of considering the possibility of crystal-induced arthritis such as gout and pseudogout, as well as malignant disease, when diagnosing the primary disease responsible for RS3PE syndrome.

Numerical Calculations of Heating Patterns around a Coaxial-Slot Antenna for Microwave Hyperthermia - Aiming at Treatment of Brain Tumor and Bile Duct Carcinoma-

Hyperthermia is one of the modalities for cancer treatment, utilizing the difference of thermal sensitivity between tumor and normal tissue. The authors have developed a coaxial-slot antenna for microwave hyperthermia. In this paper, calculated results of temperature distributions around the coaxial-slot antenna for the treatment of brain tumor and bile duct carcinoma are described.

Stromal cells expressing hedgehog-interacting protein regulate the proliferation of myeloid neoplasms

Aberrant reactivation of hedgehog (Hh) signaling has been described in a wide variety of human cancers including cancer stem cells. However, involvement of the Hh-signaling system in the bone marrow (BM) microenvironment during the development of myeloid neoplasms is unknown. In this study, we assessed the expression of Hh-related genes in primary human CD34⁺ cells, CD34⁺ blastic cells and BM stromal cells. Both Indian Hh (Ihh) and its signal transducer, smoothened (SMO), were expressed in CD34⁺ acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS)-derived cells. However, Ihh expression was relatively low in BM stromal cells. Remarkably, expression of the intrinsic Hh-signaling inhibitor, human Hh-interacting protein (HHIP) in AML/MDS-derived stromal cells was markedly lower than in healthy donor-derived stromal cells. Moreover, HHIP expression levels in BM stromal cells highly correlated with their supporting activity for SMO⁺ leukemic cells. Knockdown of HHIP gene in stromal cells increased their supporting activity although control cells marginally supported SMO⁺ leukemic cell proliferation. The demethylating agent, 5-aza-2′-deoxycytidine rescued HHIP expression via demethylation of HHIP gene and reduced the leukemic cell-supporting activity of AML/MDS-derived stromal cells. This indicates that suppression of stromal HHIP could be associated with the proliferation of AML/MDS cells.

Headache prevalence and long working hours: the role of physical inactivity

OBJECTIVES

Headaches and long working hours are important issues for workers. This study investigated the association between hours worked and the prevalence of headaches, and how that association varies with physical activity.

STUDY DESIGN

Cross-sectional study with two-stage cluster sampling.

METHODS

Using data from a nationally representative sample of households in Japan, people aged 20-65 years who worked ≥35 h/week were studied, and the cross-sectional association between the number of hours worked per week (35-45, 46-55 and >55 h/week) and the prevalence rates of headaches of different severity was evaluated.

RESULTS

Of 721 workers, 307 reported experiencing at least one headache per month. Compared with working 35-45 h/week, the prevalence ratios of severe or disabling headaches among individuals working >55 h/week were 1.38 [95% confidence interval (CI) 1.06-1.78] and 1.63 (95% CI 1.09-2.43), respectively. After stratification by the level of physical activity, the prevalence ratios were greater in the low-physical-activity group: 1.56 (95% CI 1.11-2.19) for severe headaches and 2.20 (95% CI 1.31-3.68) for disabling headaches. The number of hours worked was not associated with headaches in the high-physical-activity group.

CONCLUSIONS

Among workers in the general population, long working hours were associated with the prevalence of headaches, and the association may depend on a lack of physical activity.

Impact of screening with thyroid ultrasonography in myasthenia gravis patients

OBJECTIVES

This study was conducted to screen thyroid abnormality evaluated with ultrasonography (US) in patients with myasthenia gravis (MG) and investigate further when malignancy is suspected.

METHODS

Thyroid screening using US was conducted in 162 patients with MG. In cases where malignancy was suspected, further investigations were performed.

RESULTS

Abnormal US findings were detected in 125 of 162 patients with MG (72 patients with nodules, 74 patients with cysts, 27 patients with diffuse findings such as enlargement, atrophy, a hypoechoic pattern or a heterogenous echoic pattern, and 28 patients with calcification). From among these 125 subjects, 30 patients underwent further examinations such as needle aspiration cytology. As a result, six patients (3.7% of 162 cases) were positive for papillary carcinoma. The size of the carcinoma in three patients was <10 mm, yet the stage of thyroid carcinomas was high (stage III or IVa) in all six cases.

CONCLUSIONS

Our data suggest that the prevalence of thyroid carcinoma in cases of MG may be higher than that of the general population. Furthermore, in patients with MG, there is a possibility that the stage of the carcinoma is higher even when the carcinoma is of a very small size. Patients with MG, when diagnosed, should be advised to undergo US screening of the thyroid because most cases of thyroid carcinoma are highly curable.

Mesoscopic models of neurotransmission as intermediates between disease simulators and tools for discovering design principles

Two grand challenges have been declared as premier goals of computational systems biology. The first is the discovery of network motifs and design principles that help us understand and rationalize why biological systems are organized in the manner we encounter them rather than in a different fashion. The second goal is the development of computational models supporting the investigation of complex systems, in particular, as simulation platforms in personalized medicine and predictive health. Interestingly, most published systems models in biology contain between a handful and a few dozen variables. They are usually too complicated for systemic analyses of organizing principles, but they are at the same time too coarse to allow reliable simulations of diseases. While it may thus appear that the modeling efforts of the past have missed the declared targets of systems biology, we argue in this article that midsized mesoscopic models are excellent starting points for pursuing both goals in computational systems biology.

Intraosseous spindle cell hemangioma of the calcaneus: a case report and review of the literature

Spindle cell hemangioma, a rare benign tumor characterized by cavernous blood vessels and spindled areas, typically arises in the subcutis of the distal extremities, particularly the hand. The case of intraosseous spindle cell hemangioma is extremely rare, and only 1 case arises in the frontal bone has been reported previously. We describe herein a case of intraosseous spindle cell hemangioma occurring in the left calcaneus in a 65-year-old woman. The patient was successfully treated by the operation. The present case is instructive especially in the differential diagnosis of primary bone tumor structured by spindle cells, for which the possibility of spindle cell hemangioma should be considered.

A randomized, controlled trial of fingolimod (FTY720) in Japanese patients with multiple sclerosis

BACKGROUND

Fingolimod (FTY720) has previously shown clinical efficacy in phase II/III studies of predominantly Caucasian populations with multiple sclerosis (MS).

OBJECTIVES

To report six-month efficacy and safety outcomes in Japanese patients with relapsing MS treated with fingolimod.

METHODS

In this double-blind, parallel-group, phase II study, 171 Japanese patients with relapsing MS were randomized to receive once-daily fingolimod 0.5 mg or 1.25 mg, or matching placebo for six months. The primary and secondary endpoints were the percentages of patients free from gadolinium (Gd)-enhanced lesions at months 3 and 6, and relapses over six months, respectively; safety outcomes were also assessed.

RESULTS

147 patients completed the study. Higher proportions of patients were free from Gd-enhanced lesions at months 3 and 6 with fingolimod (0.5 mg: 70%, p = 0.004; 1.25 mg: 86%, p < 0.001) than with placebo (40%). Odds ratios for the proportions of relapse-free patients over six months favoured fingolimod versus placebo but were not significant. Adverse events related to fingolimod included transient bradycardia and atrioventricular block at treatment initiation, and elevated liver enzyme levels.

CONCLUSIONS

This study demonstrated the clinical efficacy of fingolimod for the first time in Japanese patients with MS, consistent with the established effects of fingolimod in Caucasian patients.

Biodegradation of bisphenol A and 4-alkylphenols by Novosphingobium sp. strain TYA-1 and its potential for treatment of polluted water

We investigated the use of Novosphingobium sp. strain TYA-1 for the simultaneous removal of bisphenol A (BPA) and 4-alkylphenols (4-APs) from complex polluted waters. Strain TYA-1 degraded BPA and utilized it as a sole carbon and energy source via oxidative skeletal rearrangement involving the cytochrome p450 monooxygenase system. Strain TYA-1 also degraded 4-APs with branched side alkyl chains (4-tert-butylphenol [4-tert-BP], 4-sec-butylphenol, 4-tert-pentylphenol, 4-tert-octylphenol [4-tert-OP], and branched nonylphenol mixture) via 4-alkylcatechols but could not degrade 4-APs with linear side alkyl chains. Degradation of 4-APs, like that of BPA, involved the cytochrome p450 monooxygenase system in strain TYA-1. A sequencing batch bioreactor (100 mL of polluted water [50 mg/L BPA, 50 mg/L 4-tert-BP, and 5 mg/L 4-tert-OP]; 6 h of reaction time/cycle; 12 cycles in total) containing alginate-immobilized TYA-1 cells (15 mg dry cells) simultaneously removed BPA, 4-tert-BP, and 4-tert-OP from complex polluted waters. These immobilized TYA-1 cells could be reused for a total of 9 cycles without any loss of degradation activity. Our results support the potential of using immobilized TYA-1 cells for the simultaneous removal of BPA and 4-APs from complex polluted waters.

Development and validation of a quality of life scale specific for lumbar spinal stenosis

STUDY DESIGN

A cross-sectional study.

OBJECTIVE

To develop a reliable and valid instrument to measure quality of life (QOL) specifically targeting patients with lumbar spinal stenosis (LSS).

SUMMARY OF BACKGROUND DATA

Studies on LSS have investigated the effectiveness of various types of treatments using health-related QOL. However, patients with LSS have various symptoms, and these symptoms change with posture, typical activities of daily living, etc. Thus, an LSS-specific scale to measure QOL is needed.

METHODS

We postulated 7 subdomains for LSS-specific QOL and accordingly, item pool was developed, focus group interviews of patients with LSS and qualitative analysis were conducted, resulting in preliminary version of QOL scale. Then, 189 patients with a diagnosis of LSS completed this preliminary version. Exploratory factor analysis was conducted to examine the factorial validity. Cronbach alpha coefficient and the test-retest method were used to assess the reliability. The criterion-based validity was determined using walking capacity, recommended treatment level judged by orthopedists, and LSS symptom scale scores.

RESULTS

Qualitative study confirmed the 7 domains but showed needs of addition and deletion of some items, resulting in 31 items. With factor analysis, after exclusion of 3 items, the remaining 28 items demonstrated strong unidimensionality. Cronbach alpha was 0.96. The coefficient of test-retest reliability was 0.86. Walking capacity, recommended treatment level, and LSS symptom scale scores were significantly correlated with the QOL scale scores.

CONCLUSION

A 28-item QOL scale specifically targeting patients with LSS was developed, and its reliability and validity were confirmed.

Effects of dopamine and glutamate on synaptic plasticity: a computational modeling approach for drug abuse as comorbidity in mood disorders

Major depressive disorder (MDD) affects about 16% of the general population and is a leading cause of death in the United States and around the world. Aggravating the situation is the fact that "drug use disorders" are highly comorbid in MDD patients, and VICE VERSA. Drug use and MDD share a common component, the dopamine system, which is critical in many motivation and reward processes, as well as in the regulation of stress responses in MDD. A potentiating mechanism in drug use disorders appears to be synaptic plasticity, which is regulated by dopamine transmission. In this article, we describe a computational model of the synaptic plasticity of GABAergic medium spiny neurons in the nucleus accumbens, which is critical in the reward system. The model accounts for effects of both dopamine and glutamate transmission. Model simulations show that GABAergic medium spiny neurons tend to respond to dopamine stimuli with synaptic potentiation and to glutamate signals with synaptic depression. Concurrent dopamine and glutamate signals cause various types of synaptic plasticity, depending on input scenarios. Interestingly, the model shows that a single 0.5 mg/kg dose of amphetamine can cause synaptic potentiation for over 2 h, a phenomenon that makes synaptic plasticity of medium spiny neurons behave quasi as a bistable system. The model also identifies mechanisms that could potentially be critical to correcting modifications of synaptic plasticity caused by drugs in MDD patients. An example is the feedback loop between protein kinase A, phosphodiesterase, and the second messenger cAMP in the postsynapse. Since reward mechanisms activated by psychostimulants could be crucial in establishing addiction comorbidity in patients with MDD, this model might become an aid for identifying and targeting specific modules within the reward system and lead to a better understanding and potential treatment of comorbid drug use disorders in MDD.

Discovery of a Highly Potent and Selective MEK Inhibitor: GSK1120212 (JTP-74057 DMSO Solvate)

Inhibition of mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK) represents a promising strategy for the discovery of a new generation of anticancer chemotherapeutics. Our synthetic efforts, beginning from the lead compound 2, were directed at improving antiproliferative activity against cancer cells as well as various drug properties. These efforts led to the discovery of N-{3-[3-cyclopropyl-5-(2-fluoro-4-iodophenylamino)-6,8-dimethyl-2,4,7-trioxo-3,4,6,7-tetrahydro-2H-pyrido[4,3-d]pyrimidin-1-yl]phenyl}acetamide dimethylsulfoxide solvate (GSK1120212, JTP-74057 DMSO solvate; 1), a selective and highly potent MEK inhibitor with improved drug properties. We further confirmed that the antiproliferative activity correlates with cellular MEK inhibition and observed significant antitumor activity with daily oral dosing of 1 in a tumor xenograft model. These qualities led to the selection of 1 for clinical development.

Pseudogout of the acromioclavicular joint: report of two cases and review of the literature

Although calcium pyrophosphate dehydrate (CPPD) deposition disease, including pseudogout, is a relatively common disease affecting the major joints, especially the knee, pseudogout in the acromioclavicular (AC) joint is very uncommon. We describe two cases of acute pseudogout attacks of the AC joint in elderly patients. Radiological findings showed chondrocalcinosis in the AC joints. Microscopically, aspirated articular synovial fluid demonstrated CPPD crystals. Conservative therapy with non-steroidal anti-inflammatory drugs completely resolved all symptoms within 1 week.

Intramuscular Castleman's disease of the deltoid: a case report and review of the literature

Castleman's disease (CD), a rare benign disease characterized by lymphoid hyperplasia, typically arises in the mediastinum as a solitary tumor. We describe herein a rare case of intramuscular CD occurring in the left deltoid in a 28-year-old woman. The present case is instructive in the differential diagnosis of primary soft tissue tumors, for which the possibility of CD should be considered.

Chance fracture of the lumbar spine in an amateur snowboarder: a case report

"Chance fracture" is an unusual type of spinal fracture caused by flexion-distraction of the back. We describe herein a rare case of a male amateur snowboarder who suffered lumbar Chance fracture caused by a fall after freestyle jumping. Radiological findings of plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) showed a loss of vertebral height in the anterior L1 vertebral body with a horizontal splitting fracture extending across the vertebral body, bilateral pedicles, and lamina. On the basis of the aforementioned findings, the diagnosis of Chance fracture of the L1 vertebra was established. The fracture healed without any subsequent disabilities following conservative medical management with a thoracolumbar orthosis, and no impairments to activities of daily living were encountered, including job or sports performance. Although Chance fracture caused by a fall is rare, particularly in sports, the possibility of this fracture should be considered when diagnosing spinal injuries in snowboarders.

Establishment and characterization of a novel human malignant peripheral nerve sheath tumor cell line, FMS-1, that overexpresses epidermal growth factor receptor and cyclooxygenase-2

Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma. We established a new human MPNST cell line (designated FMS-1) from MPNST of the right brachial plexus of a 69-year-old woman with NF1. The cell line has been maintained for >24 months with >100 passages. FMS-1 cells showed a fibrosarcoma-like or epithelioid pattern in the heterotransplanted tumor, compared with a fascicular growth pattern of short-spindle tumor cells in the primary tumor. Immunophenotypically, FMS-1 cells showed almost the same characteristics as the primary tumor. Cytogenetic and molecular analyses revealed a deletion in exons 5-8 of the p53 gene. Epidermal growth factor receptor (EGFR) and cyclooxygenase (COX)-2 were expressed in FMS-1 cells. To improve the highly aggressive course and poor prognosis and establish new therapeutic methods, molecular genetic and biological characterizations of MPNST are required. Thus, FMS-1 cells might be useful for investigating biological behaviors and developing new molecular-targeting antitumor drugs for MPNST expressing EGFR or COX-2.