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Home blood pressure (HBP) variability is an important factor for cardiovascular events. While several studies have examined the effects of individual attributes and lifestyle factors on reducing HBP variability, the effects of living environment remain unknown. We hypothesized that a stable home thermal environment contributes to reducing HBP variability. We conducted an epidemiological survey on HBP and indoor temperature in 3785 participants (2162 households) planning to have their houses retrofitted with insulation. HBP was measured twice in the morning and evening for 2 weeks in winter. Indoor temperature was recorded with each HBP observation. We calculated the morning-evening (ME) difference as an index of diurnal variability and the standard deviation (SD), coefficient of variation (CV), average real variability (ARV) and variability independent of the mean (VIM) as indices of day-by-day variability. The association between BP variability and temperature instability was analyzed using multiple linear regression models. The mean ME difference in indoor/outdoor temperature (a decrease in temperature overnight) was 3.2/1.5 °C, and the mean SD of indoor/outdoor temperature was 1.6/2.5 °C. Linear regression analyses showed that the ME difference in indoor temperature was closely correlated with the ME difference in systolic BP (0.85 mmHg/°C, p p

Aim This study aimed to assess whether CogEvo, a computerized cognitive assessment and training tool, could distinguish patients with mild Alzheimer's disease and mild cognitive impairment from cognitively normal older people. Methods This cross‐sectional study enrolled 166 participants with Alzheimer's disease, mild cognitive impairment and cognitively normal older people. In CogEvo, five types of cognitive tasks were carried out, and the z‐scores were used as a composite score. Logistic regression and receiver operating characteristics analyses were then carried out to evaluate the usefulness of CogEvo in distinguishing between the three groups. Results CogEvo and Mini‐Mental State Examination scores showed excellent correlation, and could significantly differentiate between the Alzheimer's disease, mild cognitive impairment and cognitively normal older people groups (Mini‐Mental State Examination 20.4 ± 3.5, 25.5 ± 1.6 and 27.6 ± 2.0, respectively; CogEvo: −1.9 ± 0.9, −0.8 ± 0.8 and 0.0 ± 1.0, respectively; both P

An 84‐year‐old man was admitted to our hospital. His blood glucose level was 20 mg/dL. Since laboratory tests showed high titers of insulin antibodies, insulin autoimmune syndrome (IAS) was diagnosed. In order to avoid hypoglycemia, steroids can be effective in the long‐term management of IAS in elderly patients., Prednisolone can be effectively used in long‐term management of hypoglycemia in elderly patients with Insulin Autoimmune Syndrome. Scatchard analysis for insulin autoantibodies revealed that an affinity constant and binding capacity of the autoantibodies were also improved.

A patient with underlying Hashimoto's thyroiditis developed amiodarone-induced thyrotoxicosis type 1 that was successfully treated using methimazole in combination with potassium iodide. A 35-year-old woman admitted for perinatal care of twin-to-twin transfusion syndrome was given amiodarone for 7 days for paroxysmal ventricular contraction following pulseless ventricular tachycardia 1 day after delivery. She developed thyrotoxicosis one month after the discontinuation of amiodarone therapy and was negative for thyroid-stimulating hormone receptor antibody. An increased peak velocity of the superior thyroid artery suggested amiodarone-induced thyrotoxicosis type 1. Her thyroid function recovered after combination therapy with methimazole and potassium iodide.

Background Excess winter mortality caused by cardiovascular disease is particularly profound in cold houses. Consistent with this, accumulating evidence indicates that low indoor temperatures at home increase blood pressure. However, it remains unclear whether low indoor temperatures affect other cardiovascular biomarkers. In its latest list of priority medical devices for management of cardiovascular diseases, the World Health Organization (WHO) included electrocardiography systems as capital medical devices. We therefore examined the association between indoor temperature and electrocardiogram findings. Methods We collected electrocardiogram data from 1480 participants during health checkups. We also measured the indoor temperature in the living room and bedroom for 2 weeks in winter, and divided participants into those living in warm houses (average exposure temperature ≥ 18 °C), slightly cold houses (12–18 °C), and cold houses ( Results The average temperature at home was 14.7 °C, and 238, 924, and 318 participants lived in warm, slightly cold, and cold houses, respectively. Electrocardiogram abnormalities were observed in 17.6%, 25.4%, and 30.2% of participants living in warm, slightly cold, and cold houses, respectively (p = 0.003, chi-squared test). Compared to participants living in warm houses, the odds ratio of having electrocardiogram abnormalities was 1.79 (95% confidence interval: 1.14–2.81, p = 0.011) for those living in slightly cold houses and 2.18 (95% confidence interval: 1.27–3.75, p = 0.005) for those living in cold houses. Conclusions In addition to blood pressure, living in cold houses may have adverse effects on electrocardiogram. Conversely, keeping the indoor thermal environment within an appropriate range through a combination of living in highly thermal insulated houses and appropriate use of heating devices may contribute to good cardiovascular health. Trial registration The trial was retrospectively registered on 27 Dec 2017 to the University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR, https://www.umin.ac.jp/ctr/, registration identifier number UMIN000030601).

Introduction:Insulin is synthesized in the β-cells from preproinsulin. Preproinsulin becomes proinsulin after leaving the signal peptide. Proinsulin is separated into C-peptide and insulin by 2 enzymes. Hyperproinsulinemia is suspected to be a pancreatic β-cell defect that is augmented by the increased demand placed on the β-cell by hyperglycemia.Case presentation:A 39-year-old Japanese man visited to Shin-suma hospital in May 2013. Liver dysfunction, dyslipidemia, and hyperuricemia had been found in medical checkups in his workplace. Therefore, he visited Shin-suma hospital in order to receive intensive examination. Diet and exercise therapy were initiated. In November 2013, intact proinsulin and proinsulin per insulin (PI/I) ratio were evaluated as part of an ongoing study. His intact proinsulin level and PI/I ratio were markedly elevated. A 75 g oral OGTT revealed that his glucose tolerance was impaired. His glycosylated hemoglobin was 6.9%. He was diagnosed as having type 2 diabetes mellitus. Although, diet and exercise therapy continued, his hyperproinslinemia and diabetes mellitus remained. Therefore, aloguliptin was started in order to recover insulin secretion in November 2014. Thereafter, pioglitazone was added to improve insulin resistance. Finally, luseogliflozin was commenced to expect glucose-lowering effects. His HbA1c was stabilized. To the best of our knowledge, there have been few reports of patients with hyperproinsulinemia.Conclusion:When the physicians face treatment resistance in diabetes mellitus, we emphasize that evaluation of proinsulin should be considered as one of the methods.

Variant hemoglobin is often detected during the diagnosis and treatment of diabetes mellitus. We here describe a case of α2-chain variant hemoglobin (Hb Chad) that was identified as a result of differences in HbA1cs values determined by different assays. HbA1c measured by immunoassay was thus falsely high, whereas that measured by high-performance liquid chromatography (HPLC) was slightly low. Sequencing analysis revealed a heterozygous GAG (glutamic acid) → AAG (lysine) mutation at amino acid position 23 of the α2-globin gene. This residue is located at the surface of the α-chain in the crystal structure of hemoglobin. The high HbA1c value determined by immunoassay might have been the result of increased antigenicity of the variant hemoglobin, whereas the low value measured by HPLC reflected differential fractionation of the variant relative to the wild-type protein. Hb Chad has been reported in only three cases to date, and HbA1c was measured for the first time. This is the first case where falsely high HbA1c measured by immunoassay due to increased antigenicity in α-chain variant hemoglobin. This case highlights the importance of comparison with other parameters related to plasma glucose such as glycated albumin if an HbA1c abnormality is suspected. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13340-021-00529-y.

Mortality due to cardiovascular disease rises sharply in winter. Known as excess winter mortality, this phenomenon is partially explained by cold exposure-induced high blood pressure. Home blood pressure, especially in the morning, is closely associated with cardiovascular disease risk. We conducted the first large nationwide survey on home blood pressure and indoor temperature in 3775 participants (2095 households) who intended to conduct insulation retrofitting and were recruited by construction companies. Home blood pressure was measured twice in the morning and evening for 2 weeks. The relationship between home blood pressure and indoor temperature in winter was analyzed using a multilevel model with 3 levels: repeatedly measured day-level variables (eg, indoor ambient temperature and quality of sleep), nested within individual-level (eg, age and sex), and nested within household level. Cross-sectional analyses involving about 2900 participants (1840 households) showed that systolic blood pressure in the morning had significantly higher sensitivity to changes in indoor temperature (8.2 mm Hg increase/10°C decrease) than that in the evening (6.5 mm Hg increase/10°C decrease) in participants aged 57 years (mean age in this survey). We also found a nonlinear relationship between morning systolic blood pressure and indoor temperature, suggesting that the effect of indoor temperature on blood pressure varied depending on room temperature range. Interaction terms between age/women and indoor temperature were significant, indicating that systolic blood pressure in older residents and women was vulnerable to indoor temperature change. We expect that these results will be useful in determining optimum home temperature recommendations for men and women of each age group. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/index.htm . Unique identifier: UMIN000030601.

Aims/Introduction Hyperglycemia impairs energy substrate oxidation as a result of glucotoxicity. We examined whether the reduction of plasma glucose using a sodium–glucose cotransporter 2 inhibitor, in inpatient diabetes management, has any effect on: (i) treatment period and basal–bolus dosage of insulin that achieve euglycemia; (ii) fasting/postprandial energy expenditure (EE); and (iii) energy substrate oxidation. Materials and Methods This was a randomized, open‐label, 7‐day prospective study. Participants were type 2 diabetes patients with hyperglycemia, aged >20 years, with glycated hemoglobin >10%, daily mean preprandial blood glucose >11 mmol/L (200 mg/dL) and no previous antidiabetic medication. A total of 18 type 2 diabetes patients were randomized (1:1) to basal–bolus insulin titration algorithm (INS) alone or INS + dapagliflozin 5 mg/day (INS/DAPA). The main outcome measures were total daily insulin dose to achieve euglycemia, as well as EE and respiratory quotient during fasting and postprandial states, measured by indirect calorimetry. Results The rate of euglycemia was higher in the INS/DAPA compared with INS group (100 vs 55.6%, P = 0.04), whereas the total daily dose of insulin was 19% lower and was accompanied by a decreased basal–bolus ratio (P = 0.02). Fasting and postprandial EE elevation were similar in both groups. The post‐treatment fasting respiratory quotient significantly increased in the INS/DAPA group (0.72 ± 0.05 vs 0.79 ± 0.08, P = 0.04), and the postprandial respiratory quotient elevation was abolished; the opposite trend was observed in the INS group (P

While some studies show improved outcomes in clinical trial participants as compared to non-participants, existence of such a trial effect has not been proved precisely. This was a prospective cohort study to compare the prognoses for participants in the randomized controlled trial (SELECT BC) and non-participants. SELECT BC compared S-1 and taxane as first-line treatment for metastatic breast cancer. Non-participants were all patients who met the eligibility criteria of SELECT BC and who had been requested to participate in that trial by attending doctors and declined. The study aimed to compare the prognoses between participants and non-participants. The primary endpoint was median overall survival. The median OS in participants was significantly superior to that in non-participants with a statistically significant difference (36.8 months vs. 25.2 months. HR 1.48, p = 0.022). A similar result was obtained when only patients who received the same chemotherapy (S-1 or taxane) used in SELECT BC after declining participation were assumed as non-participants (36.8 months vs. 22.0 months. HR 2.03, p = 0.006). This study may suggest the existence of a trial effect, in which, for a given treatment, participation in a clinical trial is associated with a better outcome.

The lack of empirical data demonstrating the relationship between influencing factors and building energy performance is one of the primary barriers in energy efficiency management. A citywide residential energy information database and the data-based analytical methodology help increase the knowledge about the local real estate situation, explore energy efficiency opportunities and measures, financial investment, and market trend in the local building stocks, and make the reasonable policies as well. Few databases were established in USA and Europe only covering the building information and energy use, while there are lack of an indices system and database of building energy efficiency information in China. Therefore, in this study, a definition of urban residential energy information system is suggested, covering the parameters of building characteristics, household characteristics, possession and operation of domestic appliances, indoor thermal environment, climate condition, energy market, economic level, municipal infrastructure, and energy use consequence. Consequently, a database is developed to collect the raw data in seven typical cities in China. A classification model is established by Quantitative Theory III to classify and characterize the urban residential energy use systems into three different city groups, and suggestions are made to guide the energy efficiency work for different city groups. The case study is a good example to demonstrate the methodology and the analysis provided a helpful reference for the citywide building energy efficiency management.

Objective: The WHO's Housing and health guidelines (2018) listed ‘low indoor temperatures and insulation’ as one of five priority areas, and indicated insulation retrofitting to help mitigate the effect of low indoor temperatures on health. However, there is still not enough evidence for the effect of insulation retrofitting based on an objective index. Methods: We conducted a nonrandomized controlled trial comparing home blood pressure (HBP) between insulation retrofitting (942 households and 1578 participants) and noninsulation retrofitting groups (67 households and 107 participants). HBP and indoor temperature were measured for 2 weeks before and after the intervention in winter. To examine the influence of insulation retrofitting on HBP, we used multiple linear regression analysis. Results: The analyses showed that indoor temperature in the morning rose by 1.4°C after insulation retrofitting, despite a slight decrease in outdoor temperature by 0.2°C. Insulation retrofitting significantly reduced morning home SBP (HSBP) by 3.1 mmHg [95% confidence interval (95% CI): 1.5–4.6], morning home DBP (HDBP) by 2.1 mmHg (95% CI: 1.1–3.2), evening HSBP by 1.8 mmHg (95% CI: 0.2–3.4) and evening HDBP by 1.5 mmHg (95% CI: 0.4–2.6). In addition, there was a dose–response relationship between indoor temperature and HBP, indicating the effectiveness of a significant improvement in the indoor thermal environment. Furthermore, there was heterogeneity in the effect of insulation retrofitting on morning HSBP in hypertensive patients compared with normotensive occupants (–7.7 versus –2.2 mmHg, P for interaction = 0.043). Conclusion: Insulation retrofitting significantly reduced HBP and was more beneficial for reducing the morning HSBP of hypertensive patients.

Exposure to environmental tobacco smoke (ETS) is an important modifiable risk factor for child hospitalization, although its contribution is not well documented in countries where ETS due to maternal tobacco smoking is negligible. We conducted a birth cohort study of 1999 neonates between May 2009 and May 2010 in Nha Trang, Vietnam, to evaluate paternal tobacco smoking as a risk factor for infectious and non-infectious diseases. Hospitalizations during a 24-month observation period were identified using hospital records. The effect of paternal exposure during pregnancy and infancy on infectious disease incidence was evaluated using Poisson regression models. In total, 35.6% of 1624 children who attended follow-up visits required at least one hospitalization by 2 years of age, and the most common reason for hospitalization was lower respiratory tract infection (LRTI). Paternal tobacco smoking independently increased the risk of LRTI 1.76-fold (95% CI: 1.24-2.51) after adjusting for possible confounders but was not associated with any other cause of hospitalization. The population attributable fraction indicated that effective interventions to prevent paternal smoking in the presence of children would reduce LRTI-related hospitalizations by 14.8% in this epidemiological setting.

This paper presents concentrations of common SVOCs in house dusts from urban dwellings with schoolchildren in six typical Chinese cities in winter and summer. Among the detected SVOCs, DBP and DEHP have a higher detection rate. The levels of these two substances contribute an average proportion of over 90% of the total SVOCs' levels, and show a significant correlation in most cities. Based on measured concentrations, schoolchildren's non-dietary exposures to DBP and DEHP at homes are estimated. Due to a longer time spent in child's bedrooms, children's non-dietary exposures to phthalates in child's bedrooms are greatly higher than that in living rooms. As for DBP non-dietary exposure, the most significant pathway is dermal absorption from air, accounting for >70%, whereas, the most predominant pathway for DEHP non-dietary exposure is dust ingestion, contributing from 61.5% to 91.9%. Based on estimated exposure doses, child-specific reproductive and cancer risk are assessed by comparing the exposure doses with DBP and DEHP benchmarks specified in California's Proposition 65. Owing to the high DBP exposure, nearly all of target schoolchildren appear to have a severe reproductive risk, although only non-dietary exposures at home are considered in this study. The average risk quotient of DBP exposure for child-specific MADL in all cities is 31.27 in winter and 10.35 in summer. Also, some schoolchildren are confronted with potential carcinogenic risk, because DEHP exposure exceeds child-specific NSRLs. The maximum DEHP exposure exceeds the cancer benchmark by over 6 times. These results also indicate that controlling indoor phthalates pollution at home is urgent to ensure the healthy development of children in China. Keywords: SVOCs, House dust, Phthalates, Schoolchildren, Exposure estimation, Risk assessment

Introduction We comprehensively evaluated the effects of combination therapy with insulin glargine and the incretin-based drugs lixisenatide or vildagliptin in Japanese patients with type 2 diabetes. Methods In this 12-week, randomized, open-label, parallel-group, multicenter study (GLP-ONE Kobe), the incretin-based drug sitagliptin was randomly switched to lixisenatide (20 μg/day, n = 18) or vildagliptin (100 mg/day, n = 20) in patients with inadequate glycemic control despite combination therapy with insulin glargine and sitagliptin. The dose of insulin glargine was titrated after the switch to maintain fasting blood glucose at approximately 110 mg/dL. The primary end points of the study were the change in glycosylated hemoglobin (HbA1c) level between before and 12 weeks after the treatment switch, the proportion of patients achieving an HbA1c level below 7.0%, and the postprandial increase in glucose concentration as assessed by self-monitoring of blood glucose. Results The change in HbA1c level from baseline to 12 weeks did not differ significantly between the lixisenatide and vildagliptin groups (− 0.6 ± 0.7% and − 0.6 ± 1.2%, respectively, P = 0.920). Neither the proportion of patients achieving an HbA1c level below 7.0% nor the postprandial increase in glucose concentration was different between two groups. Body weight and serum low density lipoprotein (LDL) cholesterol level decreased significantly in the lixisenatide and vildagliptin groups, respectively. Both drugs were associated with mild gastrointestinal symptoms but not with severe hypoglycemia. Vildagliptin was associated with elevation of serum aspartate transaminase. Treatment satisfaction as assessed with the Diabetes Treatment Satisfaction Questionnaire did not differ significantly between the two groups. Conclusion The combinations of basal insulin and either lixisenatide or vildagliptin have similar efficacies with regard to improvement of glycemic control. Trial Registration This trial has been registered with UMIN (No. 000010769). Electronic supplementary material The online version of this article (10.1007/s13300-018-0505-2) contains supplementary material, which is available to authorized users.

AIM The present study was carried out to examine whether the insulin secretory mechanism deteriorates during the aging process using the new intact proinsulin assay system in non-diabetic and diabetic individuals. METHODS A total of 172 participants were separated into four groups according to their age ( 65 years) and an association of type 2 diabetes; that is, 46 older diabetics (mean age 74.5 ± 6.2 years, glycated hemoglobin [National Glycohemoglobin Standardization Program] 7.5 ± 1.3%), 27 older non-diabetics (mean age 76.9 ± 7.5 years), 48 middle-aged diabetics (mean age 50.8 ± 10.4, glycated hemoglobin 7.8 ± 1.5%) and 51 middle aged non-diabetics (mean age 46.6 ± 13.0 years) participants were enrolled. RESULTS The proinsulin/insulin (PI/I) ratio of the diabetic group was higher than that of the non-diabetic group in the older group (0.19 ± 0.12 vs 0.11 ± 0.06, P = 0.002). In the middle-aged groups, the PI/I ratio of the diabetic group was higher than that of the non-diabetic group (0.16 ± 0.15 vs 0.09 ± 0.09, P = 0.003). Simple regression analysis showed that male sex (95% CI 0.02-0.01, P = 0.004), age (95% CI 0.00-0.002, P = 0.03), lower body mass index (95% CI -0.06 to 0.00, P = 0.02) and the presence of diabetes mellitus (95% CI 0.04-0.012, P

One of the most significant barriers to achieving deep building energy efficiency is a lack of knowledge about the factors determining energy use. In fact, there is often a significant discrepancy between designed and real energy use in buildings, which is poorly understood but are believed to have more to do with the role of human behavior than building design. Building energy use is mainly influenced by six factors: climate, building envelope, building services and energy systems, building operation and maintenance, occupants’ activities and behavior, and indoor environmental quality. In the past, much research focused on the first three factors. However, the next three human-related factors can have an influence as significant as the first three. Annex 53 employed an interdisciplinary approach, integrating building science, architectural engineering, computer modeling and simulation, and social and behavioral science to develop and apply methods to analyze and evaluate the real energy use in buildings considering the six influencing factors. Outcomes from Annex 53 improved understanding and strengthen knowledge regarding the robust prediction of total energy use in buildings, enabling reliable quantitative assessment of energy-savings measures, policies, and techniques. © 2017. This is the authors’ accepted and refereed manuscript to the article. LOCKED until 18.7.2109 due to copyright restrictions. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/

Introduction Optimal adjustment of basal insulin to overcome hypoglycemia and glycemic variability (GV) depends on its duration of action and peak-less profile. Owing to the ability of long-acting basal insulin to avoid hypoglycemia, we titrated pre-meal glucose to normal fasting blood glucose, 80–110 mg/dL (4.5–6.1 mmol/L), and post-meal glucose to 80–140 mg/dL (4.5–7.8 mmol/L). The purpose of this study was to evaluate two basal insulin analogues degludec (IDeg) and glargine (IGlar), injected in the morning, for GV using continuous glucose monitoring (CGM) in type 1 diabetes (T1DM). Methods In this crossover study, 20 Japanese patients with T1DM (age 54 ± 16 years, disease duration 16 ± 8 years, BMI 24 ± 4 kg/m2, HbA1c 7.4 ± 0.8%) were randomized into one of two different starting regimens, and CGM was conducted on three consecutive days during the last week of each 12-week titration period. Treatment satisfaction was assessed at the end of each treatment period using the Diabetes Therapy-Related Quality of Life Questionnaire (DTR-QOL). Results There were no differences in HbA1c, total insulin dosage, body weight changes, and basal to bolus ratio between the IDeg and IGlar arms. The day-to-day variability in fasting interstitial GV on the CGM curves was significantly less in the IDeg than IGlar treatment period (25.9 ± 22.0 vs. 43.8 ± 30.1 mg/dl, p = 0.04). Other markers of GV, calculated by the EasyGV software, including mean amplitude of glycemic excursions (MAGE), J-index, total and nocturnal hypoglycemia were not different between the two treatment periods. The score of “satisfaction with treatment”, a subdomain of the DTR-QOL system, was higher in the IDeg period. Conclusion Thus, the morning injection of the two long-acting insulin analogues seemed similar with regard to the magnitude of hypoglycemia in T1DM, but treatment with IDeg was associated with lower day-to-day variation in glucose level. These results suggest that IDeg is safe with minimal morning GV in patients with T1DM. Clinical trial registration Japanese Clinical Trials Registry, UMIN000012358. Electronic supplementary material The online version of this article (doi:10.1007/s13300-017-0269-0) contains supplementary material, which is available to authorized users.

Key Clinical Message Acute suppurative thyroiditis (AST) accompanied by an abscess is a rare clinical case. Hemodialysis patients are at risk for infections. Sepsis mortality was from 100 to 300 times higher for chronic dialysis patients than that for the general public. Thus, special care should be taken against infection in patients under hemodialysis.

The investigation was carried out in typical wintertime (January 2016) of China. Relationships between health discomforts, which includes physiological effects to the nervous system, digestive system, respiratory system, skin and mucous membranes, and temperature steps were analyzed with the adjustment of subjects' anthropometric information. The Odds Ratio (OR) was applied to evaluate the possibility of suffering from certain kinds of discomforts for different groups of people in comparison to the control group. If the OR is higher than 1.0 (P 1) since the rates of 8 kinds of discomforts for people who use air-conditioning both at their offices and homes were significant higher than the control group (people use air-conditioning neither in their homes nor offices) with OR ranging from 1.455 to 2.276. Adaptability also has significant impact on human discomforts, showing as people whose residential period are less than 10 years have higher relative risks in several discomforts than people living here for more than 10 years (OR varying from 1.342 to 1.954), especially the psychological and nervous system effects. Body mass index, gender and age are also remarkable factors associated with human discomforts in winter.

In 2013, a comprehensive investigation of environmental conditions was carried out in schoolchildren's houses during winter and summer in Beijing, China. The houses were divided into two Groups (Group A: unhealthy children's houses; Group B: healthy children's houses). According to the field measurement, inappropriate thermal environment contributed by indoor low temperatures and RHs in winter and dampness in summer could affect childhood health. The beyond standard (1000 ppm) situations of CO2 concentration revealed poor ventilation in houses of Group A, which could increase the risk of children's asthma and respiratory infections. Indoor carbonyls and VOCs levels in almost all the homes did not exceed the guideline. However, the integrated influence of these compounds should be noted for possible adverse health effects, especially in child's bedroom where children spent more time. Dibutyl phthalate (DBP) and Di (2-ethylhexyl) phthalate (DEHP) were most frequently detected SVOCs in house dust. In summer, the average child's daily intake of phthalates from house dust in homes of Group A was significantly higher (p

The clinical entity idiopathic normal pressure hydrocephalus (iNPH) is characterized by dementia, urinary incontinence, gait ataxia. An 80-year old man with a past history of Type 2 diabetes mellitus admitted to our hospital. Combination of twice Aspart and Aspart premixed30/70 insulin were used. Although, he was unable to inject insulin by himself recently. On physical examination, he walked in a mildly wide based manner. According to his family, urinary incontinence was existed. Laboratory data were as follows: Postrandial blood glucose 243 mg/dl and glycated hemoglobin 8.0% (NGSP). Brain magnetic resonance imaging (MRI) scans showed thinning of the corpus callosum with enlargement of the lateral ventricles on a colonal image. Evan's ratio was 0.29. The revised version of Hasegawa's Dementia scale (HDS-R) was 10. The patient showed no evidence a related antecedent event, such as head trauma, intracerebral hemorrhage and meningitis. Thus, he was diagnosed as having possible Idiopathic normal pressure hydrocephalus (iNPH). The following several psychological tests and walking test were applied. Before and after the tap, he was evaluated using the HDS-R, Mini mental state examination (MMSE), Timed Up and Go test (TUG). Insulin was replaced by glargine, and Sitagliptin was added. On the 31 day, the patient underwent Ventriculo-perioneal shunt. Laboratoly data and memory impairment were also improved. 8 month's later, HbA1c was 7.5%. iNPH occurs in the elderly and is characterized by a clinical triad of gait disturbance, urinary incontinence and dementia. In the present case, thinning of the corpus callosum with enlargement of the lateral ventricles was detected by MRI. 49% of iNPH patients had Diabetes mellitus. However, we were unable to detect a relationship iNPH and Diabetes mellitus. Cognitive impairment may interfere with the insulin therapy. In the present case, failure of insulin self-injection was the first clinical sign to appear. We were able to reduce dose of insulin. We conclude that iNPH is a treatable disorder, especially when treatment is started early in the course of the disease.

To study the association between the cardiovascular disease (CVD) and old people’s living environment in rural Shanghai in winter, questionnaires and interviews were first conducted in 60 households in rural Shanghai in winter to investigate the living environment and habits of the elderly persons. Field measurement was followed in 5 typical households, including continuously monitoring indoor and outdoor temperature, relative humidity, and CO2 concentration for a whole week; the elderly’s blood pressure in this week; and PM1, PM2.5, PM10, CO and NOX concentration at the end of this week. The conclusion is that the temperature of a room in the morning is significantly lower than evening (p

Cavernous hemangioma is a rare, non-functional, benign adrenal tumor. Adrenal cavernous hemangioma is often diagnosed after surgery with a histologic examination. A 70-year-old man complaining of appetite loss was admitted to our hospital. An incidental large left adrenal mass was found by computed tomography (CT). There were no clinical signs of adrenogenital syndrome, Cushing's syndrome or primary aldosteronism. Total resection was carried out. The pathological diagnosis was cavernous hemangioma. The differentiation of adrenal tumor is necessary in cases of large tumors, and resection is desirable given the risks of hemorrhaging and rupture.

After the establishment of energy conservation standards in 1979 and the subsequent revisions in Japan, the requirement for airtight performance of new houses increased, and the problem of the sick house syndrome became apparent from around 1990 due to the lack of natural ventilation. Based on the investigations of sick houses, the Ministry of Health, Labour and Welfare (MHLW) announced in 1997 the value of the indoor concentration guideline of formaldehyde which mainly caused the sick house syndrome. On the other hand, the Building Standard Law was revised in 2002 to prevent the sick house. Afterwards, the problem of the sick house was considerably settled, but the resident who is troubled with sick house syndrome is still remaining at present.

Appropriately designing buildings in hot and humid climates is challenging when environmental factors and the needs of the building’s occupants are considered thoroughly. Because of the serious issue of climate change, coupled with a scarcity of conventional energy sources and a high demand for better indoor environments, advancements in the design of buildings so that they are environmentally friendly and occupant-friendly houses are indispensable. The application of new building technologies intended for tropical climates is especially needed. Outdoor environmental considerations of available on-site and off-site renewable energy sources must be taken into account when designing buildings. An evaluation of comfortable and healthy indoor environments is also important factors. The optimized utilization of available energy sources is necessary for hybrid building operation. Increasing the energy efficiency of buildings makes operating the building significantly cheaper by lowering the energy consumption which could be sourced on-site. When a building is designed to take advantage of alternative energy sources, the building is energy independent from grid-connected electricity and, thus, is not prone to power failure. Such a building can rely on different energy sources to make the building work as an energy generator. Having energy-efficient and renewable energy-supported building in hot and humid climates reduces the conventional energy consumption of the area in which these buildings are located. It also lowers the energy required from the grid line, thus minimizing grid line stress. From this, greenhouse gas emissions, which contribute significantly to climate change, can be minimized.

Germline pathogenic ETV6 variants have been discovered in families with inherited thrombocytopenia and predisposition to hematological and solid malignancies. We present a patient with short stature who was initially diagnosed with chronic immune thrombocytopenia. Subsequently, the patient developed acute lymphoblastic leukemia, followed by mammary analog secretory carcinoma. Sequencing analysis identified an ETV6 c.641C > T (p.Pro214Leu) germline variant. The variant protein exhibited attenuated nuclear localization, increased protein degradation, and reduced transcription repression function. Our findings suggest that the ETV6 gene should be sequenced in patients with inherited thrombocytopenia and malignancy, and emphasize the importance of careful follow-up to identify secondary cancer in patients with pathogenic ETV6 variants.

Insulin autoimmune syndrome (IAS) involves not only fasting hypoglycemia, but also postprandial hyperglycemia. In the present study, we hypothesized that glycated albumin (GA) levels and the GA/HbA1c ratio, which reflect fluctuations in plasma glucose levels, are elevated in IAS patients. Four IAS patients were enrolled in the present study. Thirty-two non-diabetic subjects matched for gender, age, and BMI were used as the control group. The fasting plasma glucose levels in the IAS patients were significantly lower than in the control group. However, the oral glucose tolerance test (OGTT) revealed impaired glucose tolerance or diabetes mellitus in all the IAS patients, and thus the OGTT 2-h plasma glucose levels were significantly higher than in the control group. The GA levels and the GA/HbA1c ratio in the IAS patients were significantly higher than in the control group, despite no significant difference in the HbA1c levels between the two groups. In one case in which IAS spontaneously went into remission, there was a significant correlation between anti-insulin antibodies and GA, but not HbA1c. Improvement in glucose fluctuations was observed by continuous glucose monitoring in another patient along with improvement in the clinical symptoms. Furthermore, anti-insulin antibodies, GA, and the GA/HbA1c ratio decreased, but HbA1c did not change significantly in three IAS patients along with the improvement in clinical symptoms. These results suggest that GA and the GA/HbA1c ratio are useful indicators for determining the level of disease activity in IAS patients.

An overall investigation of children’s health status, residential thermal environment, and pollutants was conducted in the homes primary school children during winter and summer in Shanghai, China. The houses were divided into Group A (unhealthy child living) and Group B (healthy child living). During a two-week monitoring period in winter, indoor temperatures in Group A were significantly lower than in Group B (1–2 °C; p 70% of Group A was around 0.6 in winter. Bad thermal environment in Group A was a risk factor for children’s health. Average winter CO 2 concentrations were 758 ppm in Group A and 701 ppm in Group B, and the houses had poor ventilation during nighttime. Indoor concentrations of formaldehyde (HCHO), acetaldehyde and TVOC generally satisfied the Chinese national standards. However, indoor PM2.5 and PM10 concentrations in Group A were higher than those of Group B, and PM concentrations in all investigated houses exceeded the Chinese national standards in winter. Dibutyl phthalate (DBP) and Di (2-ethylhexyl) phthalate (DEHP) in house dust of four living rooms showed very high concentrations (3–4 times the EU recommended limit of 1000 μg/g). Aspergillus and Cladosporium in room air and house dust were linked to high RH, and could be suspected association with poor children’s health. This study provides comprehensive information on indoor thermal and environmental conditions in houses in Shanghai, and their exposures of primary schoolchildren to these health risks.

Japanese Government is formulating new energy policies in the utilization of alternative energy sources to reduce reliance on nuclear and fossil-powered energy sources. This study shows the numerical evaluation of utilizing alternative energy sources for the demonstration single family detached house. The study shows that utilization of different alternative energy sources both off-site and on-site could reduce the house’s dependency on grid line electricity and fossil fuel. The installation of photovoltaic roof tiles, excess generated electricity could be sold through the feed-in tariff scheme. The utilization of a biomass fuel water heater could reduce the carbon dioxide emission. The combination of photovoltaic roof tiles and solar thermal collector with biomass fueled water heater allows the house to sell excess electricity produced, and eliminates the carbon dioxide emission.

In recent years, prevalence rate of children's allergic diseases gradually increases, children's health problems are not optimistic. Epidemiological cross-sectional survey method was used in this study. 120 school-age children of Grade Four and Five were selected to do the questionnaire on living environment and health problem in Dalian. Then 10 residents were selected to detect indoor environmental information. This study explored the correlation of living environment and children's allergic diseases by some hypothesis testing methods and analyzed exposure levels of various pollutants. Living in the surrounding road, re-decoration, updating ventilation equipment, moist sensation, milk feeding in lactation, usually light sleep were risk factors of certain allergic diseases. SVOC, planktonic fungi, accumulated fungi had a positive effect on disease group, while adherent fungi had a negative effect. The average level of exposure of diseases group is higher than control groups.

Many technical solutions have been developed to reduce buildings’ energy consumption, but limited efforts have been made to adequately address the role or action of building occupants in this process. Our earlier investigations have shown that occupants play a significant role in buildings’ energy consumption: It was shown that savings of up to 20% could be achieved by modifying occupant behavior thorough direct feedback and recommendations. Studying the role of occupants in building energy consumption requires an understanding of the interrelationships between climatic conditions; building characteristics; and building services and operation. This paper describes the development of a systematic procedure to provide building occupants with direct feedback and recommendations to help them take appropriate action to reduce building energy consumption. The procedure is geared toward developing a Reference Building (RB) (an energy-efficient building) for a specific given building. The RB is then compared against its given building to inform the occupants of the given building how they are using end-use loads and how they can improve them. The RB is generated using a data-mining approach, which involves clustering analysis and neural networks. The framework is based on clustering similar buildings by effects unrelated to occupant behavior. The buildings are then grouped based on their energy consumption, and those with lower consumption are combined to generate the RB. Performance evaluation is determined by comparison of a given building with an RB. This comparison provides feedback that can lead occupants to take appropriate measures (e.g., turning off unnecessary lights or heating, ventilation, and air conditioning (HVAC), etc.) to improve building energy performance. More accurate, scalable, and realistic results are achiveable through current methodology which is shown through comparison with existing literature.

Indoor thermal environments in residential buildings vary due to differences in the outdoor climates, the envelope thermal properties of the buildings, the types of heating and cooling systems, and adaptive behaviors such as the operation of air conditioners and windows by dwellers. This study comprehensively investigated the thermal environments in 46 apartments in nine cities across five climate zones in China via on-site monitoring of the indoor air temperature, the relative humidity, and the air conditioner and window use for one year. The results demonstrate large variations in the thermal environments among the cities. During the heating period, the interior air in Urumqi and Shenyang was overheated (>24 °C) 43% and 59% of the time, respectively, while the indoor air temperature in Chongqing can be lower than 10 °C. As the outdoor climate became warmer, the temperature difference between indoors and outdoors decreased due to the increased window-opening duration. In summer, the indoor humidity ratio was higher than 12 g/kg for a long time in all cities except Urumqi. A clear linear positive correlation between the indoor and outdoor humidity ratios was identified until the indoor humidity reached 18 g/kg, which was due to the increased use of air conditioners. The results of this study provide an updated overall picture of the thermal environments in Chinese residential buildings.

AIMS To explore the effects of intermittent use of empagliflozin, a sodium-glucose co-transporter-2 inhibitor, on dietary self-management and glycaemic control in patients with inadequately controlled type 2 diabetes. MATERIALS AND METHODS We conducted a prospective, randomized, open-label, blinded-endpoint, parallel-group, comparative clinical trial of 50 patients with type 2 diabetes, treated with no more than three oral antidiabetic drugs (glycated haemoglobin [HbA1c] ≥52 mmol/mol but

Recently, we have published a book containing evidence-based public health guidelines and a practical manual for the prevention of sick house syndrome. The manual is available through the homepage of the Ministry of Health, Labour and Welfare (http://www.mhlw.go.jp/file/06-Seisakujouhou-11130500-Shokuhinanzenbu/0000155147.pdf). It is an almost completely revised version of the 2009 version. The coauthors are 13 specialists in environmental epidemiology, exposure sciences, architecture, and risk communication. Since the 1970s, health problems caused by indoor chemicals, biological pollution, poor temperature control, humidity, and others in office buildings have been recognized as sick building syndrome (SBS) in Western countries, but in Japan it was not until the 1990s that people living in new or renovated homes started to describe a variety of nonspecific subjective symptoms such as eye, nose, and throat irritation, headache, and general fatigue. These symptoms resembled SBS and were designated "sick house syndrome (SHS)." To determine the strategy for prevention of SHS, we conducted a nationwide epidemiological study in six cities from 2003-2013 by randomly sampling 5,709 newly built houses. As a result 1,479 residents in 425 households agreed to environmental monitoring for indoor aldehydes and volatile organic compounds (VOCs). After adjustment for possible risk factors, some VOCs and formaldehyde were dose-dependently shown to be significant risk factors. We also studied the dampness of the houses, fungi, allergies, and others. This book is fully based on the scientific evidence collected through these studies and other newly obtained information, especially from the aspect of architectural engineering. In addition to SHS, we included chapters on recent information about "multi-chemical sensitivity."

Currently, China is undergoing a rapid economic development, and as a result, the standard of living and energy consumption are subsequently increased. Residential energy consumption is deduced to be 11% of the total; however, due to the improvement of indoor environment and the prevalence of adoption of electronic products, the energy consumption is expected to be increased significantly in the future. Given the enormous size of the Chinese population, the effect of increase in residential energy consumption on the global warming is estimated to be very large. Therefore, it is necessary to improve the standard of living without increasing the energy consumption. For this purpose, it is important to apply a variety of energy-saving measures to form a sustainable living environment, but the data of indoor environment and energy consumption is still scarcely available at the moment.

One significant obstacle improving the energy efficiency of buildings is a lack of understanding the occupant behavior in buildings. There is a need for systematic definitions to describe occupant behavior for different research purposes. To achieve this, three-levels of definitions for behavioral parameters for residential buildings were developed. The three levels – simple, intermediate and complex – serve three research purposes—statistical analysis, case studies and detailed diagnostics/simulation, respectively. For statistical analysis, a few parameters related to the schedule of occupancy and appliances are defined. More parameters are defined at the intermediate level, where definitions for the operation schedule and the set point of appliances for case studies are provided. For the complex level, subschemas are defined to describe the schedule, set points and control rules of three kinds of occupant behavior, namely occupancy, appliance operation, and window/shading operation. A statistical survey of occupant behavior in residential buildings in a city and a one-year monitoring of occupant behavior in a family were conducted to verify the simple-level definitions and the complex-level definitions. The result indicates the different levels of definitions can apply to different research purposes and reveals the main features and energy saving potential related to occupant behavior.

This paper presented the exergoeconomic evaluation of the developed desiccant-evaporative air-conditioning system. The developed system was evaluated based on the steady-state conditions at different regeneration and reference temperatures. The exergoeconomic evaluation method was implemented to the system components and the whole system to evaluate the exergy efficiency, exergy destruction ratios, cost rates, relative cost differences and exergoeconomic factors. The regeneration and reference temperatures affected the exergy efficiencies, exergy destruction ratios, cost rates, relative cost differences and exergoeconomic factors. The desiccant wheel, heating coil and evaporative cooler had a high cost rate (investment cost, operation and maintenance cost, and exergy destruction cost). The exit air fan, outdoor air fan and evaporative cooler had a high relative cost difference. The exit air fan, outdoor air fan and secondary heat exchanger had a high exergoeconomic factor. Replacement of the desiccant wheel with a higher dehumidification performance could decrease the high cost rate. A higher efficiency evaporative cooler and heating coil were needed. Cheaper air fans (outdoor air fans and exit air fans) were needed.

Hygroscopic materials have been widely used to alleviate humidity variation in buildings. Nevertheless, research efforts are so far scarce on the conditioning mechanisms of these materials on the envelope structure, indoor temperature, humidity, and air flow distribution. In this paper, a semi-conjugate approach (CFD–HAM) which couples CFD model with simultaneous transfer model of heat and moisture in hygroscopic material was proposed. The proposed model could be used for the assessment of moisture buffering effect of hygroscopic materials and humidity-induced envelope problems such as energy lost, condensation, and moulding. In addition, the validity of the proposed CFD–HAM model was verified by the consistency between the simulated and experimental results of an air-conditioned test chamber experiment.

House dust contamination has recently become an important issue in the residential indoor environment. This study evaluated ventilation systems for removing house dust efficiently in a full...