What was happening in the collaboration between general practitioners and public health nurses in the community: A qualitative study

Background

Interprofessional collaboration in the community is becoming essential in primary care, particularly collaboration between public health nurses and general practitioners. However, the precise value of such collaboration has not been sufficiently studied. The purpose of this study was to conduct a qualitative analysis of collaboration between general practitioners and public health nurses in the community to explore the details of the phenomenon and its possible impact on the community.

Methods

Since 2015, The University of Toyama has been implementing the Collaborative Health Activities Project, in which general practitioners and public health nurses work together to promote community health. Focus group and individual interviews were conducted with participating staff, and the data were analyzed qualitatively.

Results

Fifteen themes were generated, in six categories. The categories were as follows: enhanced roles of public health nurses and physicians in the community, new perspectives on the community, public health nurses' sense of trust and empathy toward physicians, bonds of solidarity between public health nurses and physicians, proactive change in residents, and supporting "hangout places".

Conclusion

The collaboration between general practitioners and public health nurses familiar with the same community fostered a sense of trust and empathy and created the bonds of solidarity between staff and residents. The results also suggest the collaboration may have a positive impact on the local community by inspiring residents to change proactively and supporting "hangouts" where residents and professionals can informally connect.

Long-term effect of pulmonary rehabilitation in idiopathic pulmonary fibrosis: a randomised controlled trial

BACKGROUND

Idiopathic pulmonary fibrosis (IPF) is characterised by worsening dyspnoea and exercise intolerance.

RESEARCH QUESTION

Does a long-term pulmonary rehabilitation improve exercise tolerance in patients with IPF treated with standard antifibrotic drugs, which are expected to reduce disease progression?

METHODS

This open-label randomised controlled trial was performed at 19 institutions. Stable patients receiving nintedanib were randomised into pulmonary rehabilitation and control groups (1:1). The pulmonary rehabilitation group underwent initial rehabilitation which included twice-weekly sessions of monitored exercise training for 12 weeks, followed by an at-home rehabilitation programme for 40 weeks. The control group received usual care only, without pulmonary rehabilitation. Both groups continued to receive nintedanib. The primary and main secondary outcomes were change in 6 min walking distance (6MWD) and change in endurance time (using cycle ergometry) at week 52.

RESULTS

Eighty-eight patients were randomised into pulmonary rehabilitation (n=45) and control (n=43) groups. Changes in 6MWD were -33 m (95% CI -65 to -1) and -53 m (95% CI -86 to -21) in the pulmonary rehabilitation and control groups, respectively, with no statistically significant difference (mean difference, 21 m (95% CI -25 to 66), p=0.38). Changes in endurance time were significantly better in the pulmonary rehabilitation (64 s, 95% CI -42.3 to 171)) than in the control (-123 s (95% CI -232 to -13)) group (mean difference, 187 s (95% CI 34 to 153), p=0.019).

INTERPRETATION

Although pulmonary rehabilitation in patients taking nintedanib did not improve 6MWD in the long term, it led to prolonged improvement in endurance time.

TRIAL REGISTRATION NUMBER

UMIN000026376.

Physical activity in idiopathic pulmonary fibrosis: Longitudinal change and minimal clinically important difference

BACKGROUND AND OBJECTIVE

Reference values of physical activity to interpret longitudinal changes are not available in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to define the minimal clinical important difference (MCID) of longitudinal changes in physical activity in patients with IPF.

METHODS

Using accelerometry, physical activity (steps per day) was measured and compared at baseline and 6-months follow-up in patients with IPF. We calculated MCID of daily step count using multiple anchor-based and distribution-based methods. Forced vital capacity and 6-minute walk distance were applied as anchors in anchor-based methods. Effect size and standard error of measurement were used to calculate MCID in distribution-based methods.

RESULTS

One-hundred and five patients were enrolled in the study (mean age: 68.5 ± 7.5 years). Step count significantly decreased from baseline to 6-months follow-up (-461 ± 2402, p = .031). MCID calculated by anchor-based and distribution-based methods ranged from 570-1358 steps.

CONCLUSION

Daily step count significantly declined over 6-months in patients with IPF. MCID calculated by multiple anchor-based and distribution-based methods was 570 to 1358 steps/day. These findings contribute to interpretation of the longitudinal changes of physical activity that will assist its use as a clinical and research outcome in patients with IPF.

Temporal patterns of increased growth hormone secretion in mice after oral administration of L-ornithine: possible involvement of ghrelin receptors

l-Ornithine is known to stimulate growth hormone (GH) release in mammals. Here, we demonstrated that increases in plasma GH levels after oral administration of l-ornithine were first observed 150 min after administration, and the elevated levels were sustained for more than 90 min in mice. The increase was significantly delayed compared with the reported timing of plasma and tissue levels of l-ornithine after administration. The l-ornithine-induced increase in GH release was completely blocked by [D-Lys³]-GHRP-6, a ghrelin receptor antagonist, but not by cyclosomatostatin or JV-1-38, antagonists of somatostatin and GH-releasing hormone, respectively. These results suggest the involvement of ghrelin receptor-mediated pathways in l-ornithine-induced increases in GH release.

Determination of cobalamin and related compounds in foods

The microbiological assay of total cobalamin (vitamin B₁₂) by Lactobacillus delbrueckii subsp. lactis ATCC7830 is now used worldwide in food analysis because of its high sensitivity, low running cost, and no expensive instruments. It has been recently reported that some foods contain a substantial number of inactive corrinoid compounds, some of which are active in this bacterium. These results indicate that the microbiological method must be replaced with high-performance liquid chromatography or liquid chromatography/electrospray ionization-tandem mass spectrometry as there can specifically determine biologically active cobalamin. Nowadays, powerful tools, such as immunoaffinity columns, purify cobalamin simply and specifically. In this chapter, we summarized the determination methods of cobalamin and related compounds in foods. Various inactive corrinoids found in foods were also characterized.

Pulmonary rehabilitation for idiopathic pleuroparenchymal fibroelastosis: A retrospective study on its efficacy, feasibility, and safety

BACKGROUND

The beneficial effects of pulmonary rehabilitation (PR) for patients with idiopathic pleuroparenchymal fibroelastosis (IPPFE) remain unknown. This study aimed to examine the efficacy, feasibility, and safety of PR for IPPFE.

METHODS

We retrospectively investigated 25 patients with IPPFE referred for PR between April 2007 and March 2017. The PR mainly consisted of a 10-week exercise training program. The primary outcome was a change in 6-min walk distance (6MWD). Secondary outcomes included changes in dyspnea (transition dyspnea index [TDI]), anxiety and depression (hospital anxiety and depression scale [HADS]), and health-related quality of life (HRQoL) (St George's respiratory questionnaire [SGRQ]).

RESULTS

Thirteen patients participated in the PR program (PRP). Recurrent pneumothorax was the most common reason for patients not participating in the PRP. Four patients discontinued the PRP due to the recurrence of pneumothorax, new onset of pneumomediastinum, stroke, and another reason, respectively. Nine patients completed the PRP. Significant improvement was observed in 6MWD (median [interquartile range], 90 m [55-116 m]; P = 0.033). Clinically important improvements in the 6MWD, and TDI, HADS-anxiety, HADS-depression, and SGRQ total domain scores were observed in seven (78%), five (56%), four (44%), four (44%), and five (56%) of the nine patients, respectively.

CONCLUSIONS

Patients with IPPFE benefited from PR in terms of exercise capacity, dyspnea, anxiety, depression, and HRQoL. Pneumothorax and pneumomediastinum may impede the implementation of a PRP for patients with IPPFE. While careful patient selection is required, PR may be an efficacious non-pharmacological approach for managing disabilities in patients with IPPFE.

Protocol for long-term effect of pulmonary rehabilitation under nintedanib in idiopathic pulmonary fibrosis

Background

Pulmonary rehabilitation causes short-term improvement in exercise capacity, dyspnoea and health-related quality of life in idiopathic pulmonary fibrosis (IPF); however, long-term maintenance of the improvement is difficult. Nintedanib, an antifibrotic drug, has been shown to delay the worsening of pulmonary function in IPF. Therefore, the concomitant use of nintedanib with pulmonary rehabilitation is anticipated to contribute to the long-term maintenance of the pulmonary rehabilitation effects. The long-term effect of pulmonary rehabilitation under nintedanib treatment in IPF (FITNESS) study is a multicenter, randomised, prospective, parallel-group, open-label trial.

Methods

The study will enrol 84 patients with IPF who have been treated with nintedanib. Patients in the pulmonary rehabilitation group will receive a programmed short-term induction pulmonary rehabilitation programme, followed by a maintenance home-based pulmonary rehabilitation programme, while patients in the control group will receive usual outpatient care. Patients in both groups will continue to receive nintedanib treatment throughout the study period. The primary end-point of the study is to compare the change in the 6-min walk distance from the baseline to 12 months between the pulmonary rehabilitation and control groups. The main secondary end-point is endurance exercise time, measured using a bicycle ergometer.

Discussion

FITNESS is the first randomised controlled study to evaluate the long-term effects of pulmonary rehabilitation in IPF treated with nintedanib. This study will address the hypothesis that concomitant use of nintedanib contributes to the maintenance of long-term effects of pulmonary rehabilitation, thus leading to a comprehensive therapeutic approach of "nintedanib and pulmonary rehabilitation" in the antifibrotic era.

Comparison between tools for measuring breathlessness: Cross-sectional validation of the Japanese version of the Dyspnoea-12

INTRODUCTION

The Dyspnoea-12 (D-12) is a brief, easy to complete questionnaire for measuring breathlessness.

OBJECTIVES

To facilitate further efforts to measure dyspnoea in real clinical settings, the authors aimed to develop and validate a Japanese version of the D-12 and also compare the D-12 with the Baseline Dyspnea Index (BDI) and the Activity component of the St. George's Respiratory Questionnaire (SGRQ).

METHODS

The standardized procedure in accordance with international guidelines was used to create the translation. A validation study with a cross-sectional observational design was conducted on 122 subjects with stable chronic obstructive pulmonary disease (COPD).

RESULTS

The internal consistency of the D-12 was high (Cronbach's coefficient α = 0.883) and similar to that of the BDI (α = 0.824) and SGRQ Activity (α = 0.872). The relationships between tools were statistically significant (|R_s | = 0.53 to 0.66). Although the scores obtained from all three tools were skewed toward the milder end of the respective scales, this deviation was most prominent in the D-12 with a floor effect of 48.4%.

CONCLUSION

The Japanese version of the D-12 was successfully validated, but we should be careful of any floor effect and marked skew to the mild end of the scale, especially in subjects with mild COPD.

Cutoff Points for Step Count to Predict 1-year All-Cause Mortality in Patients with Idiopathic Pulmonary Fibrosis

BACKGROUND

Although physical activity is associated with mortality in patients with idiopathic pulmonary fibrosis (IPF), reference values to interpret levels of physical activity are lacking.

OBJECTIVES

This study aimed to investigate the prognostic significance of physical activity assessed by step count and its cutoff points for all-cause mortality.

METHODS

We measured physical activity (steps per day) using an accelerometer in patients with IPF at the time of diagnosis. Relationships among physical activity and mortality, as well as cutoff points of daily step count to predict all-cause mortality were examined.

RESULTS

Eighty-seven patients (73 males) were enrolled. Forty-four patients (50.1%) died during the follow-up (median 54 months). In analysis adjusting for Gender-Age-Physiology stage and 6-min walk distance, daily step count was an independent predictor of all-cause mortality (hazard ratio (HR) = 0.820, 95% confidence interval (CI) = 0.694-0.968, p = 0.019). The optimal cutoff point (receiving operating characteristic analysis) for 1-year mortality was 3,473 steps per day (sensitivity = 0.818 and specificity = 0.724). Mortality was significantly lower in patients with a daily step count exceeding 3,473 steps than in those whose count was 3,473 or less (HR = 0.395, 95% CI = 0.218-0.715, p = 0.002).

CONCLUSIONS

Step count, an easily interpretable measurement, was a significant predictor of all-cause mortality in patients with IPF. At the time of diagnosis, a count that exceeded the cutoff point of 3,473 steps/day more than halved mortality. These findings highlight the importance of assessing physical activity in this patient population.

Citicoline and Memory Function in Healthy Older Adults: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

BACKGROUND

Supplementation of citicoline (CDP-choline), a naturally occurring mononucleotide, has shown beneficial effects on memory function and behavior in populations with a wide range of impairments. However, few studies have investigated its effect in healthy older populations.

OBJECTIVE

The objective of this study was to investigate the effects of citicoline (Cognizin®), on memory in healthy elderly populations with age-associated memory impairment (AAMI).

METHODS

A total of 100 healthy men and women aged between 50 and 85 y with AAMI participated in this randomized, double-blind, placebo-controlled trial. Participants were randomized to receive placebo (n = 51) or citicoline (n = 49; 500 mg/d) for 12 wk. Memory function was assessed at baseline and end of the intervention (12 wk) using computerized tests (Cambridge Brain Sciences, Ontario, Canada). Safety measurements included adverse events query, body weight, blood pressure, and hematology and metabolic panel. Intent-to-treat analysis was conducted using ANCOVA for the primary and secondary outcome variables with Bonferroni correction for multiple comparisons.

RESULTS

A total of 99 out of 100 participants completed the study in its entirety. After the 12-wk intervention, participants supplemented with citicoline showed significantly greater improvements in secondary outcomes of episodic memory (assessed by the Paired Associate test), compared with those on placebo (mean: 0.15 vs. 0.06, respectively, P = 0.0025). Composite memory (secondary outcome), calculated using the scores of 4 memory tests, also significantly improved to a greater extent following citicoline supplementation (mean: 3.78) compared with placebo (mean: 0.72, P = 0.0052).

CONCLUSIONS

Dietary supplementation of citicoline for 12 wk improved overall memory performance, especially episodic memory, in healthy older males and females with AAMI. The findings suggest that regular consumption of citicoline may be safe and potentially beneficial against memory loss due to aging. This trial was registered at clinicaltrials.gov as NCT03369925.

The Influence of Orally Administered N-Docosahexanoylethanolamine (Synaptamide) on Cognitive Function in Mice

Objectives

Docosahexaenoic acid (DHA) is an omega-3 fatty acid that is essential for normal brain development and cognitive function, and also consumed as a dietary supplement in worldwide. Recently, N-Docosahexanoylethanolamine (synaptamide) has been reported as an endocannabinoid-like metabolite endogenously synthesized from DHA, which produces neuritogenic and synaptogenic effects in vitro studies. These suggest synaptamide plays crucial roles in brain function and can be a novel dietary intervention to prevent cognitive dysfunction. The purpose of this study was to investigate how orally administered synaptamide act on cognitive function in mice.

Methods: Exp1. Male ICR mice were oral ingested synaptamide (100 or 500 mg/kg body weight (BW) and measured synaptamide concentration in blood flow. Exp2. Male ICR mice at 4 weeks of age, and male C57BL/6 J mice at 54 weeks of age were orally administered vehicle (corn oil), or synaptamide (100 or 500 mg/kg BW) for 4 weeks. After that, we performed the Y-maze test and Object Recognition test (ORT) to evaluate cognitive function. Only ICR mice were intraperitoneally injected scopolamine just before 30 minutes performing Y-maze test or ORT. Hippocampal gene expression was analyzed by qPCR, and hippocampal phosphoprotein profiles were analyzed using the Phospho Explorer Antibody Array.

Results

Synaptamide level in plasma was increased by oral administration of synaptamide. Behavioral performance in the Y-maze test were comparable irrespective of administration. On the other hand, in the ORT, synaptamide-administered mice spent significantly more time exploring the novel object compared to familiar object in a dose dependent manner, while control mice did not discriminate between the objects. Furthermore, in hippocampus from aged mice administered synaptamide, expression of PSS2 gene was increased and several phosphoprotein profiles modification involved in inflammatory signal such as Nf-κB were observed.

Conclusions

We found that oral administration of synaptamide ameliorates cognitive function in scopolamine-administered mice and aged mice, and increases PSS2 gene expression which is involved in memory formation, in hippocampus of aged mice. Our results suggest that supplementation with synaptamide could improve hippocampal-dependent memory formation.

Funding Sources

Kyowa Hakko Bio Co., Ltd.

Effect of Citicoline on Memory Function in Healthy Order Adults: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Objectives

Subtle deficits in memory in healthy elderly adults are considered to be a normal consequence of aging [i.e., age-associated memory impairment (AAMI)]. The prevalence of cognitive impairment without dementia in the elderly is estimated at 5.4 million, and every year roughly 12% of these individuals go on to develop dementia. Supplementation of citicoline (CDP-choline), a naturally occurring mononucleotide, has shown beneficial effects on memory function and behavior in populations with a wide range of impairments. Unfortunately, few studies have investigated the effects of citicoline supplementation on memory in healthy elderly adults with memory loss due to aging. Thus, the objective of this study was to investigate the effects of Cognizin®, a citicoline supplement, on memory in healthy elderly populations with AAMI.

Methods

A total of 100 healthy men and women between 50 to 85 years of age with AAMI participated in this randomized, double-blind, placebo-controlled trial. Subjects were randomized to receive placebo (n = 51) or Cognizin® (n = 49; 500 mg/day) for 12 weeks. Memory functions were assessed at baseline and end of the intervention (12 weeks) using computerized tests (Cambridge Brain Sciences, Ontario, Canada). Safety measurements included adverse events query, hematology and clinical chemistry.

Results

A total of 99 out of 100 subjects completed the study in its entirety. After the 12 week intervention, subjects supplemented with Cognizin® showed significantly greater improvements in episodic memory (assessed by the Paired Associate test) compared to those on placebo. Scores for composite memory, calculated using the scores of four memory tests (Spatial Span, Monkey Ladder, Paired Associate, and Digit Span) also improved to a greater extent following Cognizin® supplementation compared to placebo. There were no adverse events related to a study product and hematology and clinical chemistry were stable throughout the intervention.

Conclusions

Dietary supplement of Cognizin® for 12 weeks improved overall memory performance, especially episodic memory, in healthy males and females with AAMI. The findings suggest that regular consumption of Cognizin® may be safe and potentially beneficial against memory loss due to aging.

Funding Sources

Kyowa Hakko Bio Co., Ltd.

Interstitial chromosomal deletion of the tuberous sclerosis complex 2 locus is a signature for radiation-associated renal tumors in Eker rats

Ionizing radiation can damage DNA and, therefore, is a risk factor for cancer. Eker rats, which carry a heterozygous germline mutation in the tumor-suppressor gene tuberous sclerosis complex 2 (Tsc2), are susceptible to radiation-induced renal carcinogenesis. However, the molecular mechanisms involved in Tsc2 inactivation are unclear. We subjected Fischer 344 × Eker (Long Evans Tsc2+/- ) F1 hybrid rats to gamma-irradiation (2 Gy) at gestational day 19 (GD19) or postnatal day 5 (PND5) and investigated the patterns of genomic alterations in the Tsc2 allele of renal tumors that developed at 1 year after irradiation (N = 24 tumors for GD19, N = 10 for PND5), in comparison with spontaneously developed tumors (N = 8 tumors). Gamma-irradiation significantly increased the multiplicity of renal tumors. The frequency of LOH at the chromosome 10q12 region, including the Tsc2 locus, was 38%, 29% and 60% in renal carcinomas developed from the nonirradiated, GD19 and PND5 groups, respectively. Array comparative genomic hybridization analysis revealed that the LOH patterns on chromosome 10 in renal carcinomas were classified into chromosomal missegregation, mitotic recombination and chromosomal deletion types. LOH of the interstitial chromosomal deletion type was observed only in radiation-associated carcinomas. Sequence analysis for the wild-type Tsc2 allele in the LOH-negative carcinomas identified deletions (nonirradiated: 26%; GD19: 21%) and base-substitution mutations (GD19: 4%). Reduced expression of Tsc2 was also observed in the majority of the LOH-negative carcinomas. Our results suggest that interstitial chromosomal deletion is a characteristic mutagenic event caused by ionizing radiation, and it may contribute to the assessment of radiation-induced cancer risk.

Combined citicoline and docosahexaenoic acid treatment improves cognitive dysfunction following transient brain ischemia

Phospholipids are structural components of cellular membranes that play important roles as precursors for various signaling pathways in modulating neuronal membrane function and maintenance of the intracellular environment. Phosphatidylcholine (PtdCho) is the most abundant cellular phospholipid. Citicoline and docosahexaenoic acid (DHA) are essential intermediates in the synthesis of PtdCho. Both PtdCho intermediates have independently shown neuroprotective effects in cerebral ischemia, but their combined effect is unknown. This study aimed to investigate the combined effect of oral citicoline and DHA treatment on improvement of cognitive deficits following cerebral ischemia using a 20-min bilateral common carotid artery occlusion (BCCAO) mouse model. BCCAO ischemic mice were treated for a total of 11 days with a combination of citicoline (40 mg/kg body weight/day) and DHA (300 mg/kg body weight/day) or each alone. Combined citicoline and DHA synergistically and significantly improved learning and memory ability of ischemic mice compared with either alone. Further, citicoline and DHA treatment significantly prevented neuronal cell death, and slightly increased DHA-containing PtdCho in the hippocampus, albeit not significantly. Taken together, these findings suggest that combined citicoline and DHA treatment may have synergistic benefits for partially improving memory deficits following transient brain ischemia.

Spontaneous pneumomediastinum in young women: Comparison between anorexia nervosa and nonanorexic patients

Spontaneous pneumomediastinum is a benign, self‐limited condition that mainly affects young people. In this report, we present four cases of this uncommon condition and a review of the current literature. Two cases had no prior significant medical history: one had a history of asthma and the other underwent regular outpatient treatment for anorexia nervosa. The three patients who were not anorexic spontaneously improved within a few days. However, the patient with anorexia nervosa took 2 months to recover. It appears that spontaneous pneumomediastinum is an intractable complication of anorexia nervosa, and the improvement of nutritional status in the patient is essential to manage this condition.

Pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis: comparison with chronic obstructive pulmonary disease

Background: While the efficacy of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) has been well established, emerging evidence also suggests its benefit in idiopathic pulmonary fibrosis (IPF). However, the differences and similarities between how PR affects diseases with different physiologies remain unknown. Objective: This study aimed to compare the efficacy of PR in COPD and IPF patients by performing multifactorial evaluation with various exercise capacity measurements, and dyspnea and health-related quality of life (QoL) assessment. Methods: Twenty-two IPF patients (%vital capacity: 72%) and 27 COPD patients (%forced expiratory volume₁: 43%) were recruited. Subjects who completed a 10-week outpatient PR program were analyzed. We assessed five exercise capacity indicators (6-minute walking distance, incremental shuttle walking distance, endurance time, peak work rate, and peak values for oxygen uptake [peak VO₂]), dyspnea (Baseline Dyspnea Index: BDI), and health-related QoL (St. George's Respiratory Questionnaire: SGRQ) at baseline and immediately following completion of the PR program. Results: After 10 weeks of PR, all exercise capacity measurements, except VO₂, as well as BDI and SGRQ score improved significantly (p<0.05) in both disease groups. The magnitude of the observed changes in each outcome, assessed by the effect size, was comparable between IPF and COPD patients. This was also true for endurance time, the measurement most responsive to PR, with a large effect size. Conclusions: PR can result in comparable improvements in exercise capacity, including endurance time, and dyspnea and HRQoL in both IPF and COPD patients after 10 weeks of exercise training. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 283-289).

The COPD assessment test and St George's Respiratory Questionnaire: are they equivalent in subjects with COPD?

Background

The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a short questionnaire that has facilitated health status measurements in subjects with COPD. However, it remains controversial as to whether the CAT can be used as a suitable substitute for the St George’s Respiratory Questionnaire (SGRQ). This study investigated the reliability and score distributions of the CAT and SGRQ and evaluated which factors contributed to health status for each questionnaire.

Methods

A total of 109 consecutive subjects with stable COPD from a single center were enrolled in this study. Each subject completed pulmonary function tests, exercise tests, and the following self-administered questionnaires: the Baseline Dyspnea Index, the Hospital Anxiety and Depression Scale, the CAT, and SGRQ.

Results

Internal consistencies of CAT and SGRQ total scores were both excellent (Cronbach’s α coefficients =0.890 and 0.933). Statistically significant correlations were observed between CAT and SGRQ total scores (R=0.668, P<0.001). Correlations of CAT scores with parameters related to pulmonary function, dyspnea, exercise performance, and psychological factors were inferior to correlations with those parameters with SGRQ total scores. Both multiple regression analyses and principal component analyses revealed that there were slight differences between SGRQ total scores and CAT scores.

Conclusion

The CAT is similar to SGRQ in terms of discriminating health status. However, we demonstrated that what is assessed by the CAT may differ slightly from what is measured by SGRQ.

Skin-whitening and skin-condition-improving effects of topical oxidized glutathione: a double-blind and placebo-controlled clinical trial in healthy women

Purpose

Glutathione is a tripeptide consisting of cysteine, glycine, and glutamate and functions as a major antioxidant. It is synthesized endogenously in humans. Glutathione protects thiol protein groups from oxidation and is involved in cellular detoxification for maintenance of the cell environment. Reduced glutathione (GSH) has a skin-whitening effect in humans through its tyrosinase inhibitory activity, but in the case of oxidized glutathione (GSSG) this effect is unclear. We examined the skin-whitening and skin-condition effects of topical GSSG in healthy women.

Subjects and methods

The subjects were 30 healthy adult women aged 30 to 50 years. The study design was a randomized, double-blind, matched-pair, placebo-controlled clinical trial. Subjects applied GSSG 2% (weight/weight [w/w]) lotion to one side of the face and a placebo lotion to the other side twice daily for 10 weeks. We objectively measured changes in melanin index values, moisture content of the stratum corneum, smoothness, wrinkle formation, and elasticity of the skin. The principal investigator and each subject also used subjective scores to investigate skin whitening, wrinkle reduction, and smoothness. Analysis of variance was used to evaluate differences between groups.

Results

The skin melanin index was significantly lower with GSSG treatment than with placebo from the early weeks after the start of the trial through to the end of the study period (at 10 weeks, P<0.001). In addition, in the latter half of the study period GSSG-treated sites had significant increases in moisture content of the stratum corneum, suppression of wrinkle formation, and improvement in skin smoothness. There were no marked adverse effects from GSSG application.

Conclusion

Topical GSSG is safe and effectively whitens the skin and improves skin condition in healthy women.

Low-dose menaquinone-4 improves γ-carboxylation of osteocalcin in young males: a non-placebo-controlled dose-response study

Background

Menaquinone-4 is a type of vitamin K that has a physiological function in maintaining bone quality via γ-carboxylation of osteocalcin. However, little is known about the beneficial effect of intake of dosages below1500 μg/day.

Findings

Fifteen healthy males aged 25.0 years (median) participated in a non-placebo-controlled dose-examination study. They received menaquinone-4 daily for 5 weeks at 0, 300, 600, 900, and 1500 μg/day in weeks 1, 2, 3, 4, and 5, respectively. Compared with baseline, serum γ-carboxylated osteocalcin levels were significantly greater at an intake of 900 μg/day or more; serum undercarboxylated osteocalcin levels and the ratio of serum undercarboxylated osteocalcin to γ-carboxylated osteocalcin were significantly lower than baseline at doses of 600 μg/day or more.

Conclusions

This preliminary graded-dose study suggested that menaquinone-4 supplementation at 600 μg/day or more is likely to be important in terms of vitamin K requirements for bone health.

Low-dose vitamin K2 (MK-4) supplementation for 12 months improves bone metabolism and prevents forearm bone loss in postmenopausal Japanese women

Menaquinone-4 (MK-4) administered at a pharmacological dosage of 45 mg/day has been used for the treatment of osteoporosis in Japan. However, it is not known whether a lower dose of MK-4 supplementation is beneficial for bone health in healthy postmenopausal women. The aim of this study was to examine the long-term effects of 1.5-mg daily supplementation of MK-4 on the various markers of bone turnover and bone mineral density (BMD). The study was performed as a randomized, double-blind, placebo-controlled trial. The participants (aged 50-65 years) were randomly assigned to one of two groups according to the MK-4 dose received: the placebo-control group (n = 24) and the 1.5-mg MK-4 group (n = 24). The baseline concentrations of undercarboxylated osteocalcin (ucOC) were high in both groups (>5.1 ng/ml). After 6 and 12 months, the serum ucOC concentrations were significantly lower in the MK-4 group than in the control group. In the control group, there was no significant change in serum pentosidine concentrations. However, in the MK-4 group, the concentration of pentosidine at 6 and 12 months was significantly lower than that at baseline. The forearm BMD was significantly lower after 12 months than at 6 months in the control group. However, there was no significant decrease in BMD in the MK-4 group during the study period. These results suggest that low-dose MK-4 supplementation for 6-12 months improved bone quality in the postmenopausal Japanese women by decreasing the serum ucOC and pentosidine concentrations, without any substantial adverse effects.

Effects of Oral L-Citrulline Supplementation on Lipoprotein Oxidation and Endothelial Dysfunction in Humans with Vasospastic Angina

BACKGROUND

Decreased nitric oxide (NO) bioavailability and increased lipid oxidation are associated with progressive endothelial dysfunction. L-Citrulline, the effective precursor of L-arginine which is essential as a substrate for endothelial NO synthase (eNOS), is effective in enhancing NO-dependent signaling. However, little is known about the efficacy of L-citrulline supplementation on lipoprotein oxidation and endothelial dysfunction.

METHODS

Twenty-two patients (aged 41 - 64 years old) diagnosed with vasospastic angina with flow-mediated dilation (FMD) of the brachial artery (< 5.5 %) received 800 mg/day of L-citrulline for 8 weeks. FMD (%), blood NOx, asymmetric dimethylarginine (ADMA), small dense LDL, oxidized lipids, amino acids concentrations were measured before and after supplementation.

RESULTS

Compared with baseline values, FMD (%) was significantly improved at 4 and 8 weeks as well as at 4 weeks after the end of intake. L-Citrulline supplementation caused a significant lowering of plasma ADMA levels. Plasma L-arginine/ADMA ratio and NOx levels rose markedly throughout the study period. Moreover, significant reductions of serum oxidized LDL and lectin-like oxidized LDL receptor 1 (LOX-1) ligand containing ApoB (LAB), an indicator of the biological activity of oxidized lipoprotein binding to LOX-1, were observed after L-citrulline intake.

CONCLUSIONS

L-Citrulline supplementation improves endothelial dysfunction, probably due to potentiating NO-dependent reactions and decreasing the state of lipoprotein oxidation in humans.

Endurance time is the most responsive exercise measurement in idiopathic pulmonary fibrosis

BACKGROUND

Although pulmonary rehabilitation (PR) has been reported to improve exercise capacity in patients with idiopathic pulmonary fibrosis, it is unknown which exercise measurement is the most responsive for evaluation of PR efficacy. The purpose of this study was to compare the responsiveness of 5 exercise measurements by evaluating the efficacy of PR in subjects with idiopathic pulmonary fibrosis.

METHODS

We conducted a prospective observational study in which 53 subjects with idiopathic pulmonary fibrosis were enrolled. The PR group underwent a 10-week out-patient PR program. The control group was observed without any additional intervention, including PR. Five exercise measurements (endurance time [ET], peak work rate, peak oxygen consumption [V̇O2 ], 6-min walk distance, and incremental shuttle walk distance) were evaluated at baseline and after 10 weeks. The effect size was used for the assessment of responsiveness.

RESULTS

In each group, 24 subjects completed the 5 measurements at baseline and after 10 weeks. The changes in ET (PR: 181.6%; control: -8.2%), peak V̇O2 (PR: 7.6%; control: -5.4%), peak work rate (PR: 15.1%; control: -5.1%), 6-min walk distance (PR: 6.0%; control: -3.8%), and incremental shuttle walk distance (PR: 9.1%; control: -5.1%) were significantly different between the groups after 10 weeks (P < .05). In the PR group, ET showed the most striking improvement among the 5 measurements (P < .05), and its effect size was as large as 2.96, whereas those of the others were all < 0.5.

CONCLUSIONS

ET is the most responsive exercise measurement for evaluating PR efficacy in patients with idiopathic pulmonary fibrosis.

Health-related quality of life does not predict mortality in idiopathic pulmonary fibrosis

BACKGROUND

Although health-related quality of life (HRQL) has recently been considered to be an important outcome in clinical trials of idiopathic pulmonary fibrosis (IPF), its relationship with survival is unknown.

OBJECTIVE

To determine the prognostic significance of HRQL scores in IPF assessed with the SGRQ.

DESIGN

Eighty-seven consecutive patients with IPF, who had undergone evaluations and completed the St. George's Respiratory Questionnaire (SGRQ) at diagnosis were included in this study, as is the general practice. Cox proportional hazards analyses were performed to examine the relationship between HRQL scores and survival.

RESULTS

The mean observation period was 44.2 +/- 29.6 mo, in the course of which 54 patients (62.0%) died. Univariate analysis revealed that the activity scores in the SGRQ(HR: 1.016, 95% CI: 1.004-1.029, P = 0.01) were significantly predictive of survival, although the symptoms, impacts, and total scores were not significantly related to mortality from all causes. However, multivariate analysis revealed that only the forced vital capacity percent predicted was a significant predictor of survival, and that the activity score in the SGRQwas not significantly related to mortality.

CONCLUSIONS

There was no significant relationship between HRQL evaluated with the SGRQ and the subsequent mortality in IPF. The present negative result might suggest that HRQL is measuring an aspect other than one from physiological and functional impairment or disability.

Simple statistical inference algorithms for task-dependent wellness assessment

Stress is a key indicator of wellness in human beings and a prime contributor to performance degradation and errors during various human tasks. The overriding purpose of this paper is to propose two algorithms (probabilistic and non-probabilistic) that iteratively track stress states to compute a wellness index in terms of the stress levels. This paper adopts the physiological view-point that high stress is accompanied with large deviations in biometrics such as body temperature, heart rate, etc., and the proposed algorithms iteratively track these fluctuations to compute a personalized wellness index that is correlated to the engagement levels of the tasks performed by the user. In essence, this paper presents a quantitative relationship between temperature, occupational stress, and wellness during different tasks. The simplicity of the statistical inference algorithms make them favorable candidates for implementation on mobile platforms such as smart phones in the future, thereby providing users an inexpensive application for self-wellness monitoring for a healthier lifestyle.

[Relationship between intermittent negative pressure level and tidal volume during biphasic cuirass ventilation in normal subjects]

The aim of this study was to investigate the effects of inspiratory negative pressure by biphasic cuirass ventilation on tidal volume and the relationship between pressure level and tidal volume in 15 normal subjects. We measured tidal volume during inspiratory negative pressures of -5, -10, -20 and -30 cm H2O. An inspiratory negative pressure of -30 cm H2O was necessary to increase tidal volume. We conclude that -30 cm H2O of biphasic cuirass ventilation significantly increases tidal volume in normal subjects.

[Resection of a metastatic left ventricular tumor with an aid of thoracoscopy]

A 61-year-old woman who complained of chest pain and cough was admitted to our hospital. She was diagnosed with multiple metastasis of breast or lung cancer, and a cardiac tumor was detected by echocardiography during chemotherapy. The tumor was located on the papillary muscle near the apex, had a smooth surface, and was well mobile. Emergency operation was performed because the tumor was considered to be a cause of cerebral infarction. Under cardiopulmonary bypass, resection of the tumor was performed by trans-mitral-valve approach. By using a thoracoscope, we could share information and obtain the details of the tumor during the operation. Resection using a trans-mitral-valve approach with an aid of thoracoscopy is considered useful.

From mobile phones to personal wellness dashboards

The paradigm of wellness mobiles will enable health-care professionals to have access to comprehensive real-time patient data at the point of care and anywhere there is cellular network coverage. More importantly, users can continuously and frequently track their health on the go and receive real-time user assistance when needed to alter their lifestyles. Recently, there has been a growing interest in developing proactive wellness products and health-related smartphone applications. However, developing quantifiable measures of wellness for continuous tracking and designing compliant-monitoring systems is quite challenging. This article motivates future research in this emerging field by presenting a ringside view of the recent developments and trends favoring this technology and the challenges facing the next generation of telemedicine.

Improvements in quadriceps force and work efficiency are related to improvements in endurance capacity following pulmonary rehabilitation in COPD patients

BACKGROUND AND OBJECTIVE

The endurance time has been reported to be the most sensitive measure of improved exercise capacity in response to a variety of interventions for COPD. The aim of the present study was to determine whether the improvements in quadriceps force and measures obtained from a symptom-limited maximal test contributed to the improvements in endurance time following pulmonary rehabilitation.

METHODS

Fifty-seven consecutive COPD subjects completed a 10-week pulmonary rehabilitation program. The subjects completed a symptom-limited incremental cycle ergometry test and a constant work rate test before and after pulmonary rehabilitation. Peripheral and respiratory muscle strength was also measured. The relationships between the change in endurance time and the changes obtained from the incremental test and muscle strength test were investigated.

RESULTS

The endurance time showed the greatest improvement among the exercise capacity indices. The changes in endurance time were significantly correlated to changes in quadriceps force, peak work rate, anaerobic threshold and work efficiency on the incremental load test. In the multiple stepwise regression analysis, changes in quadriceps force and work efficiency measured on the maximal exercise test were selected.

CONCLUSION

These findings suggest that the improvements in endurance time after pulmonary rehabilitation may be explained by increased quadriceps force and improvements in peak work rate and work efficiency.

Short-term effects of L-citrulline supplementation on arterial stiffness in middle-aged men

BACKGROUND

Nitric oxide (NO) plays a key role in the maintenance of vascular tone, contributing to the functional regulation of arterial stiffness. Although oral L-citrulline could become the effective precursor of L-arginine (substrate for endothelial NO synthase) via the L-citrulline/ L-arginine pathway, little is known about the efficacy of L-citrulline application on arterial stiffness.

OBJECTIVE

We examined the short-term effects of L-citrulline supplementation on arterial stiffness in humans.

METHODS

In a double-blind, randomized, placebo-controlled parallel-group trial, 15 healthy male subjects (age: 58.3 ± 4.4 years) with brachial-ankle pulse wave velocity (baPWV; index of arterial stiffness >1400 cm/sec) were given 5.6g/day of L-citrulline (n=8) or placebo (n=7) for 7 days. baPWV and various clinical parameters were measured before (baseline) and after oral supplementation of L-citrulline or placebo.

RESULTS

Compared with the placebo group, baPWV was significantly reduced in the L-citrulline group (p<0.01). No significant differences in blood pressure (BP) were found between the two groups, and no correlation was observed between BP and baPWV. The serum nitrogen oxide (NOx, the sum of nitrite plus nitrate) and NO metabolic products were significantly increased only in the L-citrulline group (p<0.05). Plasma citrulline, arginine and the ratio of arginine/asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase (arginine/ADMA ratio) were significantly increased in the L-citrulline group compared with the placebo group (p<0.05, p<0.01, p<0.05, respectively). Moreover, there was a correlation between the increase of plasma arginine and the reduction of baPWV (r=-0.553, p<0.05).

CONCLUSION

These findings suggest that short-term L-citrulline supplementation may functionally improve arterial stiffness, independent of blood pressure, in humans.

Observation of reversed-shear Alfvén eigenmodes excited by energetic ions in a helical plasma

Reversed-shear Alfvén eigenmodes were observed for the first time in a helical plasma having negative q₀'' (the curvature of the safety factor q at the zero shear layer). The frequency is swept downward and upward sequentially via the time variation in the maximum of q. The eigenmodes calculated by ideal MHD theory are consistent with the experimental data. The frequency sweeping is mainly determined by the effects of energetic ions and the bulk pressure gradient. Coupling of reversed-shear Alfvén eigenmodes with energetic ion driven geodesic acoustic modes generates a multitude of frequency-sweeping modes.

A simple assessment of dyspnoea as a prognostic indicator in idiopathic pulmonary fibrosis

The prognosis in idiopathic pulmonary fibrosis (IPF) is poor. No therapy has been shown to prolong survival. The objective of this study was to examine the prognostic significance of dyspnoea in daily living at baseline in IPF using a simple assessment tool. 93 consecutive patients with IPF, who had undergone evaluation at diagnosis, were included. The level of dyspnoea was assessed using the modified Medical Research Council (MRC) scale. The relationship between data at baseline and survival was examined. A univariate Cox proportional-hazard model showed that forced vital capacity % predicted (hazard ratio (HR) 0.965, 95% CI 0.948-0.982; p<0.0001), diffusing capacity of the lung for carbon monoxide % predicted (HR 0.978, 95% CI 0.963-0.993; p = 0.0041), baseline arterial oxygen tension (HR 0.963, 95% CI 0.938-0.989; p = 0.0060) and modified MRC score (HR 2.402, 95% CI 1.495-3.858; p = 0.0003) were significantly predictive of survival. All variables of the 6-min walk test, including walk distance (HR 0.995, 95% CI 0.992-0.998; p = 0.0020), the lowest arterial oxygen saturation measured by pulse oximetry (S(p,O(2))) (HR 0.944, 95% CI 0.918-0.972; p<0.0001) and the Borg scale (HR 1.285, 95% CI 1.091-1.514; p = 0.0027), were also significant. With stepwise, multivariate Cox proportional analysis, the modified MRC score (HR 2.181, 95% CI 1.333-3.568; p = 0.0019) and the lowest S(p,O(2)) during the 6-min walk test (HR 0.952, 95% CI 0.924-0.981; p = 0.0014) were the most significant. Dyspnoea in daily living, assessed with the modified MRC scale at baseline, provides additional prognostic information for patients with IPF.