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Excessive alcohol intake complicated by liver dysfunction has been presumed to affect skeletal muscles. This study aimed to examine the association between excessive alcohol intake, liver fibrosis, and loss of skeletal muscle mass in elderly men. The study participants comprised 799 community-dwelling elderly men (age, 71 ± 3 years) with no history of treatment for liver disease. Bioelectrical impedance analysis was performed to estimate the appendicular skeletal muscle mass (ASM) of each participant. The ASM values were also normalized for height (ASM index). Liver fibrosis was evaluated using the Fib4 index, which was calculated using participant age, AST level, ALT level, and platelet count. Usual alcohol intake was estimated based on the type of alcohol, frequency of drinking, and amount of alcohol consumed per day. Among the excess drinkers (≥ 20 g/day), the ASM index of the subgroup with liver fibrosis (Fib4 index ≥ 2.67) was significantly lower than that of the subgroup with no liver fibrosis (Fib4 index

Objectives: In occupational therapy, occupations refer to everyday activities that people perform as individuals, in families, and with communities to live a meaningful life. Thus far, there has been no large-scale survey conducted using quantitative data to study deterioration of self-rated health from an occupational perspective. This large-scale study therefore aimed to clarify the associations between deterioration of self-rated health and occupational form, performance, and satisfaction using quantitative data. Study design: One-year prospective cohort study. Methods: Subjects included 438 community-dwelling individuals (175 males and 263 females; mean age, 66.3 ± 10.5 years) who participated in the study during 2017–2018. We administered to patients a questionnaire on self-rated health and occupational form (number, frequency, and duration), occupational performance, and occupational satisfaction. A multi-level Poisson regression analysis was performed, wherein deterioration of self-rated health was the dependent variable and occupational form, performance, and satisfaction were the independent variables. In Model 1, the independent variables were adjusted for each other; in Model 2, sex, living alone, and alcohol consumption were added to Model 1; and in Model 3, disease was added to Model 2. Results: The frequency of occupation monthly/yearly was associated with deterioration of self-rated health compared to that daily/weekly among those aged

Aims/Introduction The prevalence of clinical polyneuropathies (ClinPNs) or nerve conduction abnormality (NCA) in the groups stratified by glucose tolerance, individual components of metabolic syndrome (metabolic syndrome [MetS] components: hypertension, dyslipidemia, obesity) and MetS defined by the International Diabetes Federation consensus was investigated in the Japanese general population. Factors associated with ClinPN and NCA were also identified. Materials and Methods A total of 625 examinees of regional medical checkup programs were recruited to this cross‐sectional study. ClinPNs were diagnosed by the Toronto Consensus. NCA was judged by at least one bilateral abnormality of sural nerve action potential amplitude or conduction velocity measured by a point‐of‐care nerve conduction device (DPNCheck). Clinical factors associated with ClinPNs or NCA were examined by multiple logistic regression analysis. Deteriorating factors of sural nerve action potential amplitude or conduction velocity values were also investigated in participants without diabetes (n = 550). Results As for glucose tolerance, ClinPNs or NCA significantly increased only in known diabetes patients compared with other groups. There was no difference between prediabetes and the normal group. The prevalence of ClinPNs and NCA was not significantly related to MetS or MetS’ components, except for frequent NCA in obesity. The factors significantly associated with both NCA and ClinPNs were smoking and known diabetes. In non‐diabetic participants, aging, tall height and hypertension were significant deteriorating factors of nerve conduction functions. Conclusions In Japan, ClinPNs and NCA were increased in known diabetes patients, but did not increase in participants with prediabetes, MetS and MetS’ components. Smoking and known diabetes were factors significantly associated with ClinPNs or NCA. Hypertension might be a modifiable deteriorating factor of nerve function.

We examined the associations of obesity and high salt intake with blood pressure (BP) in a cross-sectional sample of 1679 healthy Japanese adolescents (827 females and 852 males) aged 12-18 years (mean age: 14.9 years) who had no history of treatment for hypertension, diabetes mellitus, or renal disease. Brachial arterial BP of the subject was measured at the left arm using a digital BP monitor with an appropriate cuff size. The weight status was evaluated by body mass index (BMI), and obesity was determined according to the age- and sex-specific cut-off values for adolescents. All subjects were interviewed by dietitians using a food frequency questionnaire to obtain data on their average daily salt intake. In the study subjects, obesity and high salt intake were associated with a significantly increased BP except for diastolic BP in females. In multiple regression analyses, both BMI (z-score) and salt intake were found to be major determinants of systolic BP and diastolic BP after adjustment for potential confounders, including age, sex, and serum lipid and glucose parameters. The association between salt intake and BP values was more pronounced among individuals with obesity than among those with normal weight. These results suggest that high salt intake is associated with BP elevation in healthy adolescents, and the association may become stronger by the presence or severity of obesity.

OBJECTIVES Recently, attention has been paid to the impact of cigarette smoking on skeletal muscles, as its underlying pathophysiological mechanism has been gradually elucidated. In this study, we aimed to examine whether cigarette smoking is associated with muscle mass reduction and low muscle strength in elderly men. METHODS The study participants comprised 417 community-dwelling elderly men (aged 73±6 years) without severe glucose intolerance, chronic kidney disease, or liver disease. Bioelectrical impedance analysis was performed to estimate appendicular skeletal muscle mass (ASM), which was normalized for height (ASM index, kg/m2). Handgrip strength (HGS) was measured using a Smedley grip dynamometer. Cumulative smoking exposure level during a lifetime was expressed in pack-years, which is a product of the average number of packs of cigarettes smoked per day and smoking duration in years. RESULTS When the participants were stratified on the basis of cumulative smoking exposure (

Objectives: We aimed to examine the prevalence of orthostatic dysregulation among newly graduated female nurses after employment and its associations with autonomic nervous function, stress, and depressive symptoms. Methods: This follow-up study included 48 newly graduated female nurses (aged 22 ± 3 years) employed in acute care hospitals. The orthostatic dysregulation symptoms were evaluated using a screening checklist. A sit-to-stand test was conducted to assess the autonomic nervous function. Subjective stress and depressive symptoms were determined using a self-administered questionnaire. The data were collected at baseline on the first month and on the seventh month of employment. Statistical differences within groups were analyzed using paired t-test and McNemar’s test. The independent associations of orthostatic dysregulation status with stress and depressive symptoms were analyzed using a multivariate logistic regression model. Results: The percentage of individuals who were diagnosed with orthostatic dysregulation increased from 25.0% at baseline to 35.4% at follow-up. Logistic regression analyses revealed that stress and depressive symptoms were closely associated with orthostatic dysregulation status at follow-up, despite a weak association reported at baseline. The participants were categorized according to their orthostatic dysregulation status: among individuals without orthostatic dysregulation at baseline but with orthostatic dysregulation at follow-up, the increase in autonomic nervous activity, as assessed by the coefficient of variation of the R-R intervals, in response to the postural changes was significantly attenuated at follow-up. Furthermore, this group exhibited a significant increase in stress and depressive symptoms. Conclusions: At 7 months after employment, newly graduated nurses showed a higher prevalence of orthostatic dysregulation in combination with autonomic nervous system modulation, which was accompanied by an increase in stress and depressive symptoms. These observations suggest that the orthostatic dysregulation is associated with poor mental and physical health among newly graduated nurses in the early phase of employment.

Aims/Introduction As the extensor digitorum brevis muscle is a small muscle in the most distal part of the legs, its atrophy (EDBA) might reflect symmetric polyneuropathy (SPN). We aimed to clarify the EDBA‐related factors and the usefulness of bilateral EDBA detection for diagnosing SPN, especially diabetic SPN (DSPN). Materials and Methods In 1,893 participants from the Japanese general population (investigation I) and 133 established diabetes patients (investigation II), relationships between EDBA and various factors including the traditional sitting style called “seiza’” (kneeling and sitting on one’s heels) were investigated. Analyses were carried out by univariate and multivariate analysis, and SPN or DSPN was diagnosed by the criteria of “Probable DSPN” of the Toronto Consensus. The validity of EDBA detection for diagnosing SPN/DSPN was also evaluated. Results Investigation I: EDBA was more prevalent in women than men (44% vs 20%). Significant EDBA‐related factors were aging and seiza habit regardless of sex. Male‐specific EDBA‐related factors were SPN and known diabetes. In men without seiza habit, EDBA was significantly associated with SPN regardless of diabetes, so EDBA seemed to be a useful sign for diagnosing SPN/DSPN. Investigation II: In men, DSPN was more prevalent in the EDBA group than the non‐EDBA group (71% vs 33%). Sensitivity, specificity, positive predictive value and kappa coefficient of EDBA detection for diagnosing DSPN were 44, 87, 67% and 0.323, showing fair agreement. Conclusions EDBA detection might be a useful method to screen for distal symmetric polyneuropathy, such as DSPN in men, although the exclusion of individuals with seiza habit is necessary to improve accuracy., Extensor digitorum brevis atrophy detection might be a useful method to screen for distal symmetric polyneuropathy, such as diabetic symmetric polyneuropathy in men, although the exclusion of individuals with seiza habit is necessary to improve accuracy.

OBJECTIVES In this study, we aimed to examine the possible association between liver fibrosis and loss of skeletal muscle mass (SM) in community-dwelling older adults with no history of liver diseases. METHODS A total of 2,028 older adults (mean age, 69.8 ± 5.2 years) who had not received any treatment for liver diseases and had participated in a comprehensive health survey for community residents in Wakayama, Japan were included in this study. We carried out bioelectrical impedance analysis to estimate the SM of the whole body including the arms, legs, and trunk of the subjects. Liver fibrosis was evaluated by calculating the Fib4 index based on the subject's age, AST level, ALT level, and platelet counts. RESULTS The subjects were divided into three groups according to cutoff values of the Fib4 index (low

The influence of T-786C polymorphism in the promoter region of endothelial nitric oxide synthase (eNOS) on arteriosclerotic parameters by age and gender were examined. Brachial-ankle pulse wave velocity (baPWV), heart-rate adjusted augmentation index (AIx@75), pulse pressure (PP) and albumin–creatinine ratio (ACR) were assessed as arteriosclerotic parameters in addition to non-high-density lipoprotein cholesterol (non-HDL-C) to HDL-C (non-HDL-C/HDL-C) ratio in 1499 participants. T-786C polymorphism (rs2070744) was screened using a TaqMan allelic discrimination assay. Analyses of covariance were carried. Women with the non-C allele showed significantly lower AIx@75 in participants aged

Key Clinical Message This report highlights an interesting case of an osteolytic lesion (actinomycosis) after fulminant liver failure induced by autoimmune hepatitis (AIH). When treating patients with fulminant liver failure due to AIH using immunosuppressive drugs, such as steroids, the possibility of such rare occurrences should be kept in mind.

Background Using a simple standing-up test in normotensive subjects, we evaluated orthostatic upright postural blood pressure (BP) changes and autonomic nervous function, as well as the relationship between orthostatic BP changes and subclinical markers of atherosclerosis. Methods A total of 515 normotensive subjects aged 35-75 years (58.4±10.0 years) were enrolled. We measured body mass index (BMI), systolic BP (SBP) and diastolic BP (DBP), serum lipids, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and urinary albumin-to-creatinine ratio. Brachial to ankle pulse wave velocity (baPWV) and carotid mean intima-media thickness (IMT) were measured. Participants underwent a simple standing-up test involving sitting then standing for 2 minutes each, followed again by sitting. To evaluate autonomic fluctuations, we calculated the coefficient of variation of the R-R interval, the ratio of low to high frequency heart rate variability (LF/HF), and the coefficient of component variance of high frequency. Results SBP and DBP decreased when standing, with a reduction of SBP when changing position of -8.0±10.2mm Hg. Orthostatic hypotension (OH) produced a significantly higher SBP than without OH. The baPWV was significantly higher in OH than in without OH. Stepwise regression analysis adjusted for age, sex, BMI, baseline SBP, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting glucose, HbA1c, hs-CRP, IMT, late systolic peak of the pressure wave form (SBP2), and baPWV confirmed that baPWV, SBP2, and triglycerides were independently related to orthostatic BP changes. Multiple regression analyses showed that a decrease in SBP as well as baseline SBP, age, BMI, and fasting glucose were independent determinants of PWV. Conclusions We have shown that increased arterial stiffness was associated with OH during a standing-up test. Arterial stiffness may contribute to greater BP responses to postural changes from standing.

This study examined the association between job-related behavioral characteristics and the risk of coronary heart diseases (CHD) in Japanese male police officers. Compared to office clerks, police officers exhibited greater age-related increases of the prevalence of CHD risk factors, and a clustering number of CHD risk factors was significantly higher in the group of those over 45 yr of age. Among the police officers, coronary-prone behavior was more frequent than that seen in office clerks. The police officers with coronary-prone behavior tended to engage in shift work and to work overtime more; yet they were less likely to perceive job stress and to express the relevant physical and psychological symptoms than those without coronary-prone behavior. The subjects with such behavioral characteristics had a significantly greater number of CHD risk factors. In a multiple regression analysis, coronary-prone behavior together with age, social support, walking hours per day, and amount of alcohol consumption were selected as significant determinants of a cluster of CHD risk factors. These results suggest that coronary-prone behavior may contribute to the higher prevalence of CHD risk factors in police officers via leading the long working hours and the work-related unfavorable lifestyles, such as alcohol drinking and physical inactivity.

Metabolic syndrome (MS) may influence vascular reactivity and might cause an excessive increase in blood pressure (BP) during dynamic exercise. We examined this hypothesis in 698 normotensive men (mean age: 43 years) free of cardiovascular disease, diabetes mellitus and renal disease. The response of BP to exercise was assessed by the mean arterial pressure (MAP) during bicycle ergometry. The MAP values were expressed as z-scores normalized to the relative increases in heart rate. High-normal BP, dyslipidemia and hyperglycemia were diagnosed according to the Japan-specific MS criteria. The z-score of MAP was significantly higher in subjects with high-normal BP (+0.57, P

AIM The morbidity of hypertension increases with aging although the exact relationship between hypertension and menopause has not been clearly elucidated. Therefore we set out to clarify the effects of aging and menopause upon women's vascular systems. METHODS We divided 151 elderly and middle-aged women into 3 groups (premenopause group, menopause group and post-menopause group). We measured height, weight, blood pressure (BP), total cholesterol (T-chol), HDL-cholesterol (HDL-chol), LDL-cholesterol (LDL-chol), high sensitivity C-reactive protein (hsCRP), creatinine (Cr), triglyceride (TG), fasting blood glucose (FPG), IRI, HOMA-R, brachial-ankle pulse wave velocity (baPWV), augmentation index (AI), percentage of flow-mediated dilatation (%FMD), and echocardiography. RESULTS In the post-menopause and menopause groups systolic BP and AI were significantly higher than those in the pre-menopause group. There was a significant difference in systolic BP between the post-menopause group and menopause group. In the post-menopause group, baPWV, Cr, and hsCRP were significantly higher than those in the pre-menopause group. There was significant difference in baPWV between the post-menopause group and menopause group. In the post-menopause group, %FMD and eGFR were significantly lower than those in other 2 groups. In the post-menopause group and the menopause group, E/A was significantly lower than in the pre-menopause group. There was also a significant difference in E/A between the post-menopause group and the menopause group. CONCLUSIONS Elevated blood pressure, atherosclerosis and endothelial dysfunction were associated with aging and menopause in their present study. These results suggest that understanding women's cardiovascular changes which accompany aging are important for women's health care and prevention of cardiovascular events.

The purpose of this study was to examine the effect of the intervention by college students on QOL, especially the morale, for the older old living in solitude. Twenty-one community dwellers in rural town (their age ranged from 75 to 92 years old) participated in Study 1. In Study 1, college students helped the participants do farming and keeping their house, had a chat with them and did recreation activities for them as the intervention for improving their QOL. The results showed that the score on PGC morale scale in the post-intervention session was higher than in the pre- intervention session. On the other hand, the intervention did not change the score of IADL. Sixty community dwellers in rural town (their age ranged from 75 to 92 years old) participated in Study 2. To examine a regional difference, IADL and PGC morale scale scores of the participants in Study 1 were compared to those of the older old living in another rural town. The results showed that there was no regional difference on scores of IADL and PGC morale scale, and that the results in Study 1 were not dependent on the peculiarity of participants. From these findings, it is clear that the intervention by college students improves QOL of the older old living in solitude.

OBJECTIVES To clarify the antioxidative effects of kakisu (persimmon vinegar), plasma antioxidant power and urinary oxidative stress level in healthy subjects were measured using enzyme immunological assays. METHODS Eighty-one subjects (age 30-69, 58.4 +/- 0.8) were randomly divided into two groups using a crossover design. Group A drank kakisu for 56 days starting in March, whereas group B drank kakisu for 54 days starting in June. Copper reducing equivalent level in plasma was measured as antioxidant power, and urinary 8-isoprostane (8-iso-prostaglandin F2alpha) level was measured as oxidative stress marker. RESULTS Baseline plasma antioxidant power and urinary 8-isoprostane level showed no significant correlation among the subjects in this study. By drinking kakisu for 8 weeks, total antioxidant power significantly increased, and urinary 8-isoprostane level decreased. Total antioxidant power increased more markedly in group A than in group B. In contrast, urinary oxidative stress level decreased more markedly in group B than in group A. Smoking habits significantly correlated with urinary 8-isoprostane level. Males were more sensitive to the antioxidative effects of kakisu than females. CONCLUSIONS Kakisu has antioxidative effects that increase plasma antioxidant power and reduce urinary 8-isoprostane level. Further study is needed to clarify the influence of season and gender on such antioxidative effects.

Many East Asians have the genetic polymorphisms rs1229984 in alcohol dehydrogenase 1B (ADH1B) and rs671 in aldehyde dehydrogenase 2 (ALDH2). Here we analyzed the relationships of the two genotypes with alcohol sensitivity, drinking behavior and problem drinking among older and younger men living in rural areas of Japan. The subjects were 718 Japanese men aged 63.3 ± 10.8 (mean ± SD), categorized into the older (≥65 years, n = 357) and younger (

A 51-year-old female with chronic hepatitis B treated by Lamivudine (LAM) and Adefovir Dipivoxil (ADV) because of breakthrough hepatitis developed hypophosphatemia. She was diagnosed with Fanconi’s syndrome caused by the long-term administration of ADV. Since her symptoms did not improve after decreasing the ADV dosage and administering vitamin D, she was given L-carnitine. This led to a gradual improvement of her symptoms and the hypophosphatemia. These results indicate that a decrease in the ADV dose combined with supplementation with L-carnitine led to an improvement of Fanconi’s syndrome acquired by a patient with chronic hepatitis B while taking ADV.

The purposes of this paper were to evaluate the serum leptin levels in healthy adolescents and to establish standard age variation curves.Nine hundred six (414 boys and 492 girls) healthy adolescents were investigated. The maximum increment age in height (MIA) was identified in 124 boys and 130 girls. The menarcheal age (MA) was obtained for 130 girls. Fasting leptin levels were measured by enzyme immunoassay. The MIA was calculated by proportional allotment of yearly height increments.Serum leptin levels did not change in boys and girls from the ages of 9 to 11. They decreased after the age of 11 in boys, while they increased in girls. Stepwise multiple regression analysis revealed that serum leptin levels were closely related to pubertal stage. The levels decreased remarkably after MIA in boys and increased remarkably after MA in girls. We drew standard age variation curves of serum leptin levels by calculating the 25th, 50th and 75th percentiles for each age in both boys and girls. The percentile curves for boys were divided into pre-MIA and post-MIA curves. Those for girls were divided into pre-MA and post-MA curves.We have devised a potentially useful method for evaluating serum leptin levels in adolescents considering the effects of gender and growth.

The relationship between blood pressure (BP) and cardiovascular morbidity has been appreciated for many years. Casual BP may not be representative of the pressure at other times. It is recognized that BP during exercise may be a more accurate predictor than casual BP. There is, however, little information about the effects of antihypertensive drugs on the BP during exercise. This study was designed to investigate the effects of various antihypertensive agents on BP during exercise. Sixty-four patients (age, 49+/-10 years) with untreated essential hypertension (WHO I, II) were studied during a supine ergometric exercise regimen. A graded exercise test was started at a workload of 50 W, and the load was increased by 25 W every 3 min. The hemodynamic responses to exercise were evaluated by changes in systolic and diastolic BP (SBP, DBP) and heart rate (HR). Plasma norepinephrine (NE) levels were measured at rest and during submaximal exercise, and before and after 4 weeks of treatment with metoprolol (METO), doxazosin (DOXA), trichlormethiazide (TCTZ), nifedipine (NIFE), amlodipine (AMLO) and temocapril (TEMO) between left ventricular mass index (LVMI) and BP values at rest, during exercise, and during the recovery period after exercise were assessed by multiple regression analysis. The stepwise selection (forward conditional) method showed that LVMI was significantly associated with SBP during submaximal exercise and during the recovery period. All antihypertensive treatments decreased SBP and DBP (p

OBJECTIVES This study was designed to assess the clinical usefulness of an exaggerated blood pressure (BP) response to exercise (EBPR) in predicting the development of hypertension from a high-normal state. BACKGROUND Exaggerated BP response during both dynamic and isometric exercises are associated with increased risk of future hypertension, while the significance of these responses concerning the identification of individuals with high-normal BP who are prone to develop hypertension is unknown. METHODS The study population comprised a sample of 239 men with high-normal BP (aged 42.3 ± 5.9 years) who underwent a symptom-limited bicycle ergometer exercise testing at baseline and then were followed for 5.1 years. RESULTS The Kaplan-Meier survival analysis showed that the subjects in the upper quartile of BP response to exercise had a significantly higher cumulative incidence of hypertension on follow-up than those in the middle two and lower quartiles (log-rank test, p CONCLUSIONS These findings suggest that an EBPR is an important risk factor for new-onset hypertension from a high-normal state and, thus, exercise testing can provide valid information that may help identify individuals with high-normal BP at a greater risk of future hypertension.

We investigated the effects of walking 10, 000 steps/day or more on blood pressure and cardiac autonomic nerve activity in mild essential hypertensive patients. All subjects were males aged 47.0±1.0 (mean±SEM) years old. The original cohort consisted of 730 people in a manufacturing industry who measured the number of steps they walked each day using a pedometer. Eighty-three of these subjects walked 10, 000 steps/day or more for 12 weeks. Thirty-two of these were hypertensives with systolic blood pressure (SBP) greater than 140mmHg and/or diastolic blood pressure (DBP) greater than 90mmHg. Thirty of these hypertensive subjects (HT) were examined twice, once during the pre- and once during the post-study period, for body mass index (BMI), maximal oxygen intake (VO2max), blood pressure, heart rate (HR), and autonomic nerve activity by power spectral analysis of SBP and HR variability. In the HT group, walking 13, 510±837 steps/day for 12 weeks lowered blood pressure (from 149.3±2.7/98.5±1.4 to 139.1±2.9/90.1± 1.9mmHg; p

This study was carried out to evaluate the effect of a new long-acting calcium-channel antagonist, azelnidipine, on hemodynamic and neural responses to exercise. Ten patients (age, 36-69 years) with mild essential hypertension were enrolled in this study. A randomized, double-blind, crossover treatment of azelnidipine at a dose of 8.0 mg once daily for 4 weeks was performed. After a 4-week placebo period, the patients exercised in a submaximal test by using an ergometer with azelnidipine or placebo treatment. The changes caused by exercise in arterial blood pressure (BP), heart rate, cardiac output (CO), and systemic vascular resistance were evaluated. In addition, the plasma norepinephrine (NE), epinephrine (E), plasma renin activity, and plasma aldosterone concentration were determined at rest, at peak exercise, and at the recovery period. Both the SBP and diastolic (D) BP were decreased at rest by azelnidipine treatment (from 158 +/- 10/97 +/- 7 to 145 +/- 14/90 +/- 9 mm Hg). Azelnidipine significantly decreased both SBP and DBP during exercise (SBP, F = 6.09, p < 0.05, Fi = 0.612, NS; DBP, F = 17.78, p < 0.001, Fi = 0.298, NS). No significant changes in the resting heart rate and CO were observed, and the exercise-induced increase of these parameters was also not affected by azelnidipine. Azelnidipine produced no significant change of the resting plasma NE and E levels and an exercise-induced increase of plasma NE. In conclusion, these results indicate that azelnidipine, different from another dihydropyridine-type calcium channel antagonists, does not produce any changes in the hemodynamic and neurohumoral response to exercise, and it may be beneficial for patients with mild essential hypertension.

Several studies show that hypertension in midlife is also related to cognitive impairment in old age. However, the associations between blood pressure and cognitive functions have been inconclusive. In this study, we examined this association in the sexagenarian and the septuagenarian separately to test our hypothesis that different risk factors were related to cognitive decline in each generation respectively. Participants were 1476 community-dwelling persons without dementia (708 men and 768 women). Resting systolic and diastolic blood pressures were measured in the seated position using an automated sphygmomanometer (HEM-907; Omron). The cognitive functions were measured by means of logical memory test, D-CAT (digit cancellation test; neuropsychological test for attention) and verbal fluency test. We asked participants about their use of antihypertensive drug and collected their data about blood pressure measured at a health examination conducted ten years ago. We constructed a series of multiple linear regression models to examine the association of blood pressure with each cognitive function. Separate analyses were conducted for each combination of predictor (SBP, DBP, past SBP, past DBP, and use of antihypertensive drug) and dependent value (logical memory test, D-CAT, and verbal fluency test). Regression models included the following covariates: age, education, gender, and body mass index. Results indicated the following two points: (1) Higher levels of past DBP (β = -.121, p < .05) was associated with decline in logical memory test and higher level of past SBP (β = -.127, p < .05) was associated with decline in verbal fluency test in the sexagenarian, (2) The use of antihypertensive drug was associated with decline in D-CAT (β = -.194, p < .001) and verbal fluency test (β = -.196, p < .05) in the septuagenarian. Our findings suggest that high blood pressure in the past decade is risk factor for cognitive decline in the sexagenarian but is not risk factor in the septuagenarian. The treatment of high blood pressure in midlife is important for the maintenance of cognitive functions. Early control of high blood pressure might reduce the risk of cognitive impairment in old age.

Introduction: Patients with many cardiovascular risk factors develop the carotid artery plaques(CAP) at the early atherosclerotic change. In this study, we performed the comparison between the individuals with CAP and without CAP and investigated the characteristics of cardiovascular risk factors. Subjects and methods: A total of 310 individuals matched-age(mean age 67.6± 3.7 years) underwent the comprehensive health examination such as Body mass index(BMI), AIP75, blood pressure(BP), Sodium ingestion, Pulse wave velocity(PWV) and serum data. Carotid artery ultrasound was done to all individuals and CAP and the intima-media thickness(IMT) were shown. Results: The prevalence of CAP was 20%(62/310) and that of CAP in men and women was 24.6%(35/142) and 16.1%(27/168), respectively. PWV and IMT of the individuals with CAP (CAP group) was significantly higher, compared with those without CAP (not CAP group). BMI and sodium ingestion of CAP group was significantly lower, compared with those of not CAP group. In addition, systolic BP and G-GTP of CAP group showed the high tendency (p=0.085, p=0.056, respectively) and diastolic BP and HDL-C of CAP group showed the low tendency (p=0.097, p=0.052, respectively), compared with those of not CAP group. PWV of CAP group in man was significantly higher, compared with that of not CAP group in man. However, HDL-C of CAP group in woman showed the low tendency, compared with that of that of not CAP group in woman. Conclusion: It has been suggested that the development of CAP is associated with the cardiovascular risk factor such as PWV, IMT, HDL-C , G-GTP and BP.

OBJECTIVES Compared to other public employees, police officers have higher absence rates due to heart diseases, and ischemic heart disease (IHD) is one of the most frequent causes of death in their occupational life. The aim of this study was to investigate the prevalence of the risk factors for IHD among police officers and to examine its association with working conditions and lifestyles. METHODS First, 58 male police officers who developed IHD from 1996 to 2011 and 116 age- and rank-matched controls who were free from cerebro- and cardiovascular diseases were compared with respect to the prevalence of traditional risk factors five years before the onset of IHD. Then, the prevalence of IHD risk factors, and the frequency of metabolic syndrome (MetS) by age group, working condition and lifestyle were investigated in a cross-sectional survey of data of 1,539 male police officers and 153 male office workers in a prefectural police force. RESULTS In the case control study, the IHD cases had significantly higher prevalences of hypertension (p

This study aims to investigate factors that contribute to the differences in incidence of hypertension between different regions in Japan, by accounting for not only individual lifestyles, but also their living environments. The target participants of this survey were individuals who received medical treatment for hypertension, as well as hypertension patients who have not received any treatment. The objective variable for analysis was the incidence of hypertension as data aggregated per prefecture. We used data (in men) including obesity, salt intake, vegetable intake, habitual alcohol consumption, habitual smoking, and number of steps walked per day. The variables within living environment included number of rail stations, standard/light vehicle usage, and slope of habitable land. In addition, we analyzed data for the variables related to medical environment including, participation rate in medical check-ups and number of hospitals. We performed multiple stepwise regression analyses to elucidate the correlation of these variables by using hypertension incidence as the objective variable. Hypertension incidence showed a significant negative correlation with walking and medical check-ups, and a significant positive correlation with light-vehicle usage and slope. Between the number of steps and variables related to the living environment, number of rail stations showed a significant positive correlation, while, standard- and light-vehicle usage showed significant negative correlation. Moreover, with stepwise multiple regression analysis, walking showed the strongest effect. The differences in daily walking based on living environment were associated with the disparities in the hypertension incidence in Japan.

The effects of amlodipine, a Ca2+-channel blockade, on hemodynamic and hormonal responses to exercise were evaluated in patients with essential hypertension. In 7 patients (WHO stage, I, II), the exercise by bicycle ergometer was done before and after amlodipine treatment (5mg/day, 2-4wk). The hemodynamic responses to exercise were evaluated by changes in systolic and diastolic blood pressure, heart rate, cardiac output measured by UCG, and total peripheral resistance. In addition, plasma norepinephrine concentration (PNE) and renin activity (PRA) were measured at rest and peak exercise. A significant rise in systolic and diastolic blood pressure associated with tachycardia was observed during exercise. An increase in cardiac output was also observed, but the total peripheral resistance decreased by exercise. The PNE and PRA were increased by exercise. Amlodipine reduced both basal blood pressure and exercise-induced rise in blood pressure. On the other hand, the basal heart rate and exercise-induced increase in heart rate were not affected by amlodipine treatment. These changes were similar to those in pretreatment of amlodipine. Amlodipine did not produce any significant changes in PNE both at rest and during exercise. Although the PRA at rest was increased by amlodipine treatment, the increase in PRA induced by exercise was unaffected by amlodipine. These findings indicate that amlodipine might have some different effects on hemodynamics and hormones compared with the other Ca2+-channel blockades which produce an enhanced response of hemodynamics and hormonal system to exercise.

Measurement of brachial-ankle pulse wave velocity (baPWV) is recognized as a simple and practical method for assessing arterial stiffness. We determined whether the baPWV of adolescents is affected by obesity and its associated metabolic risk variables. A cross-sectional sample of 754 apparently healthy adolescents (383 men and 371 women), aged 15-17 years, was recruited for this study. baPWV was measured by a simple automatic oscillometric technique. Adiposity measures, blood pressure, serum lipoproteins, fasting glucose and insulin were evaluated. The baPWV of the adolescents was significantly higher in men than in women and increased with age in both genders. After being statistically adjusted for age and gender, baPWV was significantly correlated with body mass index, percent body fat, waist-to-height ratio, systolic and diastolic blood pressures, mean arterial pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), atherogenic index, glucose, insulin, and homoeostasis model assessment of insulin resistance (HOMA-IR). In the multivariate regression analysis, mean arterial pressure, atherogenic index, HOMA-IR, systolic blood pressure and age were found to be significant determinants of baPWV (P0.001). An increasing number of clustered risk variables, including high values (gender-specific top quartiles) of waist-to-height ratio, mean arterial pressure, atherogenic index and HOMA-IR showed a graded association with baPWV (P0.001 for trend). These results suggest that obesity and its associated metabolic abnormalities are important factors in the increased baPWV of adolescents and that baPWV may be useful in investigating early arterial wall changes in this population.

The benefits of a systolic blood pressure (BP) below 150-160 mmHg are well established; whether a systolic BP of less than 140 mmHg provides additional benefits remains controversial. This study was designed to compare the 2-year effect of a strict treatment to maintain systolic BP below 140 mmHg (group A) and that of a mild treatment to maintain systolic BP at between 140 and below 160 mmHg (group B). The study design followed the Prospective Randomized Open Blinded End-point (PROBE) study. The subjects were elderly patients (65-85 years old) who consistently had a systolic BP of 160 mmHg or higher. The baseline drug was efonidipine hydrochloride (efonidipine), a long-acting dihydropiridine calcium antagonist. The primary endpoints were stroke, cardiac disease, vascular disease, and renal failure. After a run-in period of 2 to 4 weeks, 2,165 patients were assigned to group A and 2,155 patients to group B. There were no significant differences between the groups in sex, age, baseline BP, or other cardiovascular risk factors. The systolic BP was 7.2 mmHg lower (p0.0001) and the diastolic BP 2.4 mmHg lower (p0.0001) in group A than in group B after 12 months of treatment. As of this interim analysis, primary endpoints have occurred in 87 patients (stroke in 58 patients, cardiac disease in 27 patients, occlusive arterial disease in 1 patient, and renal failure in 1 patient). Five patients have died of stroke and 2 patients of myocardial infarction. The primary-endpoint-related morbidity rate was 20.9/1,000 patient-years, and the mortality rate was 1.7/1,000 patient-years. Currently available results indicate that this study, one of the largest randomized trials of antihypertensive therapy in elderly patients in Japan, was conducted safely. The final results are expected to provide important and practical information for the management of hypertension in elderly patients.

Background: Regular physical exercise may improve a variety of physiological and psychological factors in depressive persons. However, there is little experimental evidence to support this assumption for adolescent populations. We conducted a randomized controlled trial to investigate the effect of physical exercise on depressive state, the excretions of stress hormones and physiological fitness variables in adolescent females with depressive symptoms. Methods: Forty-nine female volunteers (aged 18–20 years; mean 18.8 ± 0.7 years) with mild-to-moderate depressive symptoms, as measured by the Centre for Epidemiologic Studies Depression (CES-D) scale, were randomly assigned to either an exercise regimen or usual daily activities for 8 weeks. The subjects were then crossed over to the alternate regimen for an additional 8-week period. The exercise program consisted of five 50-min sessions per week of a group jogging training at a mild intensity. The variables measured were CES-D rating scale, urinary cortisol and epinephrine levels, and cardiorespiratory factors at rest and during exercise endurance test. Results: After the sessions of exercise the CES-D total depressive score showed a significant decrease, whereas no effect was observed after the period of usual daily activities (ANOVA). Twenty-four hour excretions of cortisol and epinephrine in urine were reduced due to the exercise regimen. The training group had a significantly reduced resting heart rate and increased peak oxygen uptake and lung capacity. Conclusions: The findings of this study suggest that a group jogging exercise may be effective in improving depressive state, hormonal response to stress and physiological fitness of adolescent females with depressive symptoms.

It is claimed that exaggerated blood pressure (BP) reactivity to behavioral stress may play a role in hypertension. This study aimed to clarify whether exaggerated BP reactivity during physical exercise is associated with any other abnormalities in ambulatory BP, autonomic nervous control, and target organ damage among middle-aged normotensive men.A total of 54 sedentary men (39+/-4 years old) with normal BP were enrolled in this study. Twenty-seven with exaggerated BP reactivity to exercise (ER) were compared with 27 age-matched controls with normal BP reactivity (NR). The subjects underwent 24-hour ambulatory BP monitoring, short-term Finapres recordings, a bicycle ergometry test, and M-mode and pulsed-Doppler echocardiography.The ambulatory BP measurements were significantly higher in the ER group than in the NR group averaged over a 24-hour period, during daytime and nighttime. Power spectral analysis from continuous Finapres data revealed increased systolic BP variability in the low frequency band in the ER group. During graded exercise, the ER group showed remarkable elevations in systolic and diastolic BP compared to the NR group without a difference in heart rate increments. Although the plasma epinephrine showed similar levels, yet the exercise-induced increase in plasma norepinephrine in the ER group was significantly greater than in the NR group. In echocardiographic dimensions, left ventricular internal diameter and mass index were not different, whereas the ER group presented significantly greater posterior wall thickness. Doppler functional data showed significant increase in the late to early flow velocity ratio in the ER group.Even in the absence of hypertension, exaggerated BP reactivity to physical exercise suggests greater BP elevation during daily activity as well as enhanced sympathetic nervous tonus, which may be considered a risk factor promoting hypertension, and these hemodynamic and neurohumoral behaviors are associated with a tendency to develop target organ abnormalities in the heart.

An exaggerated blood pressure (BP) response to physical exertion among normotensive subjects is considered a significant risk factor for future hypertension. The purpose of this study was to examine whether regular aerobic exercise can lead to a reduction in hypertensive risks in patients with such a high-risk profile. Thirty-five sedentary men (46±2 years old) with normal BP at rest but an exaggerated BP response during exercise were randomly assigned to an exercise or control group for 12 weeks followed by an 8-week washout period. The subjects were then crossed over to the alternate group for an additional 12-week period. The exercise training consisted of 3 days per week of stationary bicycling for 45 min at 50-60% of the heart rate reserve. The treatment effects were evaluated using the method of Hills and Armitage. The training-induced reduction in resting BP was not statistically significant. In ambulatory BP monitoring, the averages of 24-h and daytime systolic and diastolic BP were significantly lower, but nighttime BP remained unchanged after training. During ergometric exercise, significant decreases were observed in systolic and diastolic BP and plasma norepinephrine concentration measured at the submaximal workloads. M-mode echocardiographic and Doppler-derived left ventricular variables were not significantly affected by training. These findings suggest that regular aerobic exercise attenuates BP elevations during physical exertion and daytime activities mainly as a result of the reduction in enhanced sympathetic nervous tonus, which may in turn play a role in lowering the risk for hypertension in normotensive subjects with an exaggerated BP response to exercise. (Hypertens Res 2002; 25: 507-514)

Previous works have shown that exaggerated blood pressure response to exercise is a valid risk marker for future hypertension, yet the use of an exercise test as a means of early prediction of hypertension still requires methodological development and confirmation. The purpose of this study was to determine abnormal ranges of blood pressure responses in relation to heart rate increase during exercise and to examine the clinical utility of exercise blood pressure measurement in evaluating individual risk for developing hypertension. We examined exercise test data from a population-based sample of 1033 nonmedicated normotensive men (mean age, 42.9±8.5 years; range, 20 to 59 years). Percentile curves of systolic and diastolic blood pressure responses to relative heart rate increments during submaximal exercise were constructed using a third-order polynomial model with multiple regression analysis. Of the original study sample, a cohort of 726 subjects was followed for hypertensive outcome for an average period of 4.7 years. Progression to hypertension, defined as a blood pressure of ≥140/90 mm Hg or the initiation of antihypertensive therapy, was found in 114 subjects (15.4%). Kaplan-Meier survival estimates showed that the cumulative incidence of hypertension increased progressively with higher percentiles of systolic and diastolic blood pressure response (both, P

In the present study, ascorbic acid weakly inhibited the multiplication of viruses of three different families: herpes simplex virus type 1 (HSV-1), influenza virus type A and poliovirus type 1. Dehydroascorbic acid, an oxidized form of ascorbic acid and hence without reducing ability, showed much stronger antiviral activity than ascorbic acid, indicating that the antiviral activity of ascorbic acid is due to factors other than an antioxidant mechanism. Moreover, addition of 1 mM Fe 3+ , which oxidizes ascorbic acid to dehydroascorbic acid and also enhances the formation of hydroxyl radicals by ascorbic acid in the culture media, strongly enhanced the antiviral activity of ascorbic acid to a level significantly stronger than that of dehydroascorbic acid. Although both ascorbic acid and dehydroascorbic acid showed some cytotoxicity, the degree of cytotoxicity of the former was 10-fold higher than the latter, suggesting that the observed antiviral activity of ascorbic acid with and without ferric ion is, at least in part, a secondary result of the cytotoxic effect of the reagent, most likely due to the free radicals. However, the possibility that oxidation of ascorbic acid also contributed to the antiviral effects of ascorbic acid exists, in particular in the presence of ferric ion, since dehydroascorbic acid exhibited a very strong antiviral activity. Characterization of the mode of antiviral action of dehydroascorbic acid revealed that the addition of the reagent even at 11 h post infection almost completely inhibited the formation of progeny infectious virus in the infected cells, indicating that the reagent inhibits HSV-1 multiplication probably at the assembly process of progeny virus particles after the completion of viral DNA replication.

We evaluated the clinical characteristics of 297 consecutive patients who underwent permanent pacemaker implantation. Their mean age was 67 +/- 13 years; those at least 75 years old accounted for 30.9%. The underlying diseases were sick sinus syndrome in 36.7%, atrioventricular block in 58.9%, and atrial fibrillation with bradycardia in 4.4%. There was no association between age and either the voltage threshold or the R wave amplitude at the time of implantation. When pacemakers were exchanged, only patients aged 75 years or less had voltage thresholds that were higher and lead resistances that were lower than those measured at the time of initial implantation. No clear differences were observed in the R wave amplitude, regardless of age. With careful long-term management, permanent pacemaker implantation and follow-up clinical care can be safe, even in aged patients.

We present the case of a 35-year-old woman whose pregnancy was complicated by the rare condition of transient pheochromocytoma-related myocardial damage. Short-duration left ventricular dysfunction was apparently caused by acute non-transmural myocardial infarction provoked by coronary artery vasospasm rather than catecholamine-induced cardiomyopathy. Forty-eight days after onset, a 50 x 55 x 35 mm tumor was excised and histologically confirmed to be a pheochromocytoma.