Reliability and Validity of the Japanese Version of the Coping Inventory for Adults for Stressful Situations in Healthy People

The present study examined the validity and reliability of the Japanese version of the Coping Inventory for Stressful Situations-2nd Edition™ (CISS; hereafter the CISS–J). The participants were 1,268 healthy Japanese individuals. The factor analyses yielded three major scales (task-, emotion-, and avoidance-oriented coping) corresponding to the original version. In addition, the avoidance-oriented scale of the CISS–J contained two subscales (Distraction and Social diversion), as in the original version. Cronbach's α coefficient was found to be .75–.89 for the three scales and two subscales. Results show that the CISS–J is useful for assessing the coping strategies among this sample of Japanese individuals.

Changing trends in prognostic factors for patients with multiple myeloma after autologous stem cell transplantation during the immunomodulator drug/proteasome inhibitor era

We evaluated the clinical significance of prognostic factors including the International Staging System (ISS) and modified European Group for Blood and Marrow Transplantation response criteria in 1650 Japanese patients with multiple myeloma (MM) who underwent upfront single autologous stem cell transplantation (ASCT). We categorized patients into two treatment cohorts: pre-novel agent era (1995–2006) and novel agent era (2008–2011). The combined percentage of pre-ASCT complete response and very good partial response cases (463 of 988, 47%) significantly increased during the novel agent era compared with the pre-novel agent era (164 of 527, 31%; P < 0.0001). The 2-year overall survival (OS) rate of 87% during the novel agent era was a significant improvement relative to that of 82% during the pre-novel agent era (P = 0.019). Although significant differences in OS were found among ISS stages during the pre-novel agent era, no significant difference was observed between ISS I and II (P = 0.107) during the novel agent era. The factors independently associated with a superior OS were female gender (P = 0.002), a good performance status (P = 0.024), lower ISS (P < 0.001), pre-ASCT response at least partial response (P < 0.001) and ASCT during the novel agent era (P = 0.017). These results indicate that the response rate and OS were significantly improved, and the ISS could not clearly stratify the prognoses of Japanese patients with MM who underwent upfront single ASCT during the novel agent era.

Development of a compact label-free small molecule measurement system using a periodically nanostructured sensor substrate

Compact label-free small molecule measurement system with visible light.

Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial

IMPORTANCE

Prevention of atherosclerotic cardiovascular diseases is an important public health priority in Japan due to an aging population.

OBJECTIVE

To determine whether daily, low-dose aspirin reduces the incidence of cardiovascular events in older Japanese patients with multiple atherosclerotic risk factors.

DESIGN, SETTING, AND PARTICIPANTS

The Japanese Primary Prevention Project (JPPP) was a multicenter, open-label, randomized, parallel-group trial. Patients (N = 14,464) were aged 60 to 85 years, presenting with hypertension, dyslipidemia, or diabetes mellitus recruited by primary care physicians at 1007 clinics in Japan between March 2005 and June 2007, and were followed up for up to 6.5 years, with last follow-up in May 2012. A multidisciplinary expert panel (blinded to treatment assignments) adjudicated study outcomes.

INTERVENTIONS

Patients were randomized 1:1 to enteric-coated aspirin 100 mg/d or no aspirin in addition to ongoing medications.

MAIN OUTCOMES AND MEASURES

Composite primary outcome was death from cardiovascular causes (myocardial infarction, stroke, and other cardiovascular causes), nonfatal stroke (ischemic or hemorrhagic, including undefined cerebrovascular events), and nonfatal myocardial infarction. Secondary outcomes included individual end points.

RESULTS

The study was terminated early by the data monitoring committee after a median follow-up of 5.02 years (interquartile range, 4.55-5.33) based on likely futility. In both the aspirin and no aspirin groups, 56 fatal events occurred. Patients with an occurrence of nonfatal stroke totaled 114 in the aspirin group and 108 in the no aspirin group; of nonfatal myocardial infarction, 20 in the aspirin group and 38 in the no aspirin group; of undefined cerebrovascular events, 3 in the aspirin group and 5 in the no aspirin group. The 5-year cumulative primary outcome event rate was not significantly different between the groups (2.77% [95% CI, 2.40%-3.20%] for aspirin vs 2.96% [95% CI, 2.58%-3.40%] for no aspirin; hazard ratio [HR], 0.94 [95% CI, 0.77-1.15]; P = .54). Aspirin significantly reduced incidence of nonfatal myocardial infarction (0.30 [95% CI, 0.19-0.47] for aspirin vs 0.58 [95% CI, 0.42-0.81] for no aspirin; HR, 0.53 [95% CI, 0.31-0.91]; P = .02) and transient ischemic attack (0.26 [95% CI, 0.16-0.42] for aspirin vs 0.49 [95% CI, 0.35-0.69] for no aspirin; HR, 0.57 [95% CI, 0.32-0.99]; P = .04), and significantly increased the risk of extracranial hemorrhage requiring transfusion or hospitalization (0.86 [95% CI, 0.67-1.11] for aspirin vs 0.51 [95% CI, 0.37-0.72] for no aspirin; HR, 1.85 [95% CI, 1.22-2.81]; P = .004).

CONCLUSIONS AND RELEVANCE

Once-daily, low-dose aspirin did not significantly reduce the risk of the composite outcome of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction among Japanese patients 60 years or older with atherosclerotic risk factors.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00225849.

Peptide Inhibitors for Angiotensin I-Converting Enzyme from Thermolysin Digest of Dried Bonitot

Dried bonito (Katsuobusi), a Japanese traditional seasoning made of bonito muscle was hydrolyzed by various proteases and the inhibitory activity of the hydrolyzates for angiotensin I-converting enzyme (ACE) [EC 3.4.15.1] was measured. Among the digests, thermolysin digest showed the most potent inhibitory activity. Eight inhibitory peptides were isolated from the digest using HPLC. The amino acid sequences of inhibitory peptides were Ile-Lys-Pro-Leu-Asn-Tyr, Ile-Val-Gly-Arg-Pro-Arg-His-Gln-Gly, Ile-Trp-His-His-Thr, Ala-Leu-Pro-His-Ala, Phe-Gln-Pro, Leu-Lys-Pro-Asn-Met, Ile-Tyr, and Asp-Tyr-Gly-Leu-Tyr-Pro. By searching for the sequence homology in many proteins, four of them were found in the primary structure of actin. Asp-Met-Ile-Pro-Ala-Gln-Lys was obtained from the boiling water extract of dried bonito and this peptide was found in the primary structure of creatine kinase. Fragments of these peptides were prepared by further enzymatic digestion or chemical synthesis and their ACE-inhibitory activities were measured. Among them, Ile-Lys-Pro, Ile-Trp, Leu-Lys-Pro, and Leu-Tyr-Pro had higher inhibitory activity than their parental peptides. Ile-Lys-Pro suppressed the hypertensive activity of angiotensin I.

High-dose chemotherapy with autologous stem cell transplantation for elderly patients with relapsed/refractory diffuse large B cell lymphoma: a nationwide retrospective study

The number of elderly patients with diffuse large B cell lymphoma (DLBCL) continues to increase but the data regarding autologous stem cell transplantation (ASCT) for elderly patients are limited. We analyzed 484 patients, ages 60 years or over, diagnosed with relapsed/refractory DLBCL who received ASCT from 1993 to 2010 in the Japan Society for Hematopoietic Cell Transplantation database. Median age was 64 years (range, 60 to 78). To evaluate the impact of age at ASCT, patients were classified into 3 groups: those between the ages of 60 to 64, 65 to 69, and 70 years or over. Overall nonrelapse mortality (NRM) at day 100, 1 year, and 2 years was 4.1%, 5.9% and 7.7%, respectively. NRM did not significantly differ among age groups (P = .60). Two-year progression-free survival (PFS) and overall survival (OS) were 48% and 58%, respectively. PFS and OS were significantly longer in patients 60 to 64 years old; however, the survival rate was acceptable even in those 70 or over, with a 2-year OS of 46%. ASCT is feasible in selected elderly patients and age alone should not be a contraindication for ASCT. Eligibility should be individualized and identification of a subset of elderly patients at high risk of treatment-related morbidity or mortality warrants investigation.

[Pneumonia in maintenance hemodialysis patients: detection rate of causative organisms in sputum varies with time of sampling and quality]

PURPOSE

Previous studies have demonstrated that almost half the deaths caused by infection in hemodialysis patients are due to pneumonia. Causative organisms in pneumonia are not defined. We assessed the positive rate of blood and sputum cultures in a cohort of dialysis patients admitted with pneumonia.

METHODS

We retrospectively enrolled 44 consecutive pneumonia patients on maintenance hemodialysis attending on outpatient clinic at a single department of nephrology between October 2005 and March 2013. Pneumonia was defined by the chest computed tomography findings and clinical status. The severity of pneumonia was scored using the pneumonia severity index (PSI) and the presumed causative organisms were identified.

RESULTS

Among the 44 subjects, median age was 74 (interquartile range, 68-78) years, 90.9% were men, 28.4% had chronic obstructive pulmonary disease, and 61.4% had diabetes mellitus. Almost all patients (95.5%) were class IV or V on PSI. Blood cultures were all negative, but 36.4% of sputum cultures were positive for causative organisms. The most common pathogens were Staphylococcus aureus (13.6%), Pseudomonas aeruginosa (6.8%), Escherichia coli (4.5%), and Chlamydophila pneumonia (4.5%). The detection rate of causative organisms was related to the quality of the sputum (Group 4 and 5 of the Geckler classification) and was 61.5% in samples collected before dialysis on a day of dialysis, and 36.8% in samples collected on the day before a day of dialysis. In contrast, the detection rate was low (16.7%) when the samples were collected after dialysis on a day of dialysis.

CONCLUSION

In hemodialyis patients, the detection rate of causative organisms is elevated if sputum samples are collected before undergoing dialysis on a day of dialysis. Prospective confirmation in a larger number of patients is warranted.

[Emergency surgery for coronary ostial occlusion and aortic root aneurysm associated with Takayasu's arteritis; report of a case]

We report a case of Takayasu's arteritis who underwent emergency surgery. A 39-year-old female presented with severe back pain. Electrocardiogram demonstrated complete atrio-ventricular (AV) block and acute inferior myocardial infarction. Coronary angiography revealed ostial occlusion of the right coronary artery. Aortography and contrast-enhanced computed tomography revealed dilated and bizarre-shaped aortic root. The remainder of the aorta and its branches appeared normal. She underwent emergency aortic root replacement with valved conduit. Coronary artery bypass grafting to right coronary artery( RCA) using saphenous vein graft was performed concomitantly. Histologic findings of the aortic root were compatible with Takayasu's arteritis. Postoperative angiography showed graft patency. Takayasu arteritis should be considered for differential diagnosis of acute myocardial infarction in young woman.