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Thermoregulation is impaired in individuals with a spinal cord lesion (SCI), affecting sweat capacity, heat loss, and core temperature. This can be particularly problematic for athletes with SCI who exercise in hot and humid conditions, like those during the Tokyo 2020 Paralympic Games. Heat acclimation can support optimal preparation for exercise in such challenging environments, but evidence is limited in endurance athletes with SCI. We evaluated whether seven consecutive days of exercise in the heat would result in heat acclimation. Five elite para-cycling athletes with SCI participated (two females, three males, median (Q1-Q3) 35 (31–51) years, four with paraplegia and one with tetraplegia). All tests and training sessions were performed in a heat chamber (30°C and 75% relative humidity). A time-to-exhaustion test was performed on day 1 (pretest) and day 7 (posttest). On days 2–6, athletes trained daily for one hour at 50–60% of individual peak power (PPeak). Comparing pretest and posttest, all athletes increased their body mass loss (p=0.04), sweat rate (p=0.04), and time to exhaustion (p=0.04). Effects varied between athletes for core temperature and heart rate. All athletes appeared to benefit from our heat acclimation protocol, helping to optimize their preparation for the Tokyo 2020 Paralympic Games. [ABSTRACT FROM AUTHOR]

Since assessing aerobic capacity is key to enhancing swimming performance, a simple and widely applicable technology should be developed. Therefore, we aimed to noninvasively visualize real‐time changes in sweat lactate (sLA) levels during swimming and investigate the relationship between lactate thresholds in sweat (sLT) and blood (bLT). This prospective study included 24 university swimmers (age: 20.7 s ± 1.8 years, 58% male) who underwent exercise tests at incremental speeds with or without breaks in a swimming flume to measure heart rate (HR), bLT, and sLT based on sLA levels using a waterproof wearable lactate sensor attached to the dorsal upper arm on two different days. The correlation coefficient and Bland–Altman methods were used to verify the similarities of the sLT with bLT and personal performance. In all tests, dynamic changes in sLA levels were continuously measured and projected onto the wearable device without delay, artifacts, or contamination. Following an initial minimal current response, with increasing speed the sLA levels increased substantially, coinciding with a continuous rise in HR. The speed at sLT strongly correlated with that at bLT (p < 0.01 and r = 0.824). The Bland–Altman plot showed a strong agreement (mean difference: 0.08 ± 0.1 m/s). This prospective study achieved real‐time sLA monitoring during swimming, even with vigorous movement. The sLT closely approximated bLT; both were subsequently validated for their relevance to performance. Highlights: A new technique using a wearable device can measure sweat lactate (sLA) levels during swimming without artifacts or contamination.Lactate threshold assessed using sLA dynamics is consistent with that calculated from blood samples.The current novel measurement method is expected to promote a personalized training regimen and simultaneous multi‐person measurements. [ABSTRACT FROM AUTHOR]

Introduction: This study sought to elucidate the impact of vein of Marshall (VOM) chemical ablation on atrial fibrillation (AF) drivers by investigating the changes in CARTOFINDER mappings before and after VOM chemical ablation in patients with persistent AF. Methods: This study included 23 consecutive patients undergoing catheter ablation for long‐persistent AF (>18 months). VOM chemical ablation was performed following pulmonary vein isolation. CARTOFINDER and AF cycle length (AFCL) maps were created in the left atrium (LA) before and after VOM chemical ablation. The LA was divided into 8 segments, and the number of focal activation points with 6 or more repetitions was counted in each segment. Results: The number of focal activation points was largest in the LA appendage (LAA). After VOM chemical ablation, the number of focal activation points in the LA decreased significantly (37 [interquartile range, IQR: 19–55] vs. 15 [IQR: 7–21], p <.001), and median AFCL was significantly prolonged (159 [147–168] vs. 164 [150–173] ms, p <.001). In the assessment of each segment, significant decreases in focal activation points were observed in the inferior, lateral, and anterior segments and LAA. Among the focal activation points disappearing after chemical ablation, the number in the non‐ethanol‐affected area was significantly larger than that in the affected area (13 [8–25] vs. 4 [1–10], p <.001). Conclusions: VOM chemical ablation decreases AF drivers detected by CARTOFINDER. Mechanisms other than direct myocardial damage are considered to contribute the attenuation of AF drivers. [ABSTRACT FROM AUTHOR]

Landiolol is an ultra-short-acting, selective β1-adrenergic receptor blocker that was originally approved in Japan for the treatment of intraoperative tachyarrhythmias. It has gained attention for its use in the management of tachyarrhythmias and perioperative tachycardia, especially atrial fibrillation for both cardiac and non-cardiac surgeries. It can be the ideal agent for heart rate control due to its high β1-selectivity, potent negative chronotropic effect, a limited negative inotropic potential, and an ultrashort elimination half-life (around 4 min); moreover, it may have a potential therapeutic effects for sepsis and pediatric patients. Landiolol seems to be superior to other short-acting and selective beta-blockers such as esmolol. This review aims to provide a comprehensive overview of landiolol, a new ultra-short-acting β1 selective antagonist, including its pharmacology, clinical applications, efficacy, safety profile, and future directions in research and clinical data. [ABSTRACT FROM AUTHOR]

Hypoxic exercise, which can induce arterial and tissue deoxygenation, promotes physiological adaptations. However, reduced oxygen availability can lower the absolute training intensity (i.e., mechanical stress). Adding normoxic recovery to sprint interval exercise (SIE) is one potential approach to strike a balance between providing a hypoxic stimulus and maintaining the absolute training intensity. However, the effects of adding normoxic recovery to SIE on performance and physiological responses are uncertain. We tested the hypothesis that hypoxic SIE with normoxic recovery enhances arterial deoxygenation and muscle deoxygenation levels without impeding performance compared to an entirely normoxic condition. On separate days, seven male sprinters performed 4 × 30‐s 'all‐out' cycle sprints with 4.5‐min recovery with hypoxic exposure (FiO2: 12.7%O2) applied continuously (hypoxia, HYP), intermittently during sprint periods only (intermittent, INT), or not at all (normoxia, NOR). Power output, oxygen saturation, muscle oxygenation, surface electromyography (EMG) activity, heart rate, blood lactate concentration, and ratings of perceived exertion were measured. The total work significantly decreased in HYP than NOR (p < 0.05) and INT (p < 0.01). The aTrterial oxygen saturation was lower during HYP than NOR (∼86% vs. ∼97%; p < 0.001), while lower values were also obtained for INT than NOR during sprint periods (∼85% vs. ∼97%; p < 0.001) but not during recovery periods (∼96% vs. ∼97%). The heart rate differed (p < 0.05) between conditions (NOR: ∼164 bpm; INT: ∼160 bpm; HYP: ∼156 bpm). No other variables demonstrated significant differences between conditions. Adding hypoxia during exercise while recovering in normoxia did not compromise exercise capacity during SIE, despite inducing larger arterial deoxygenation levels compared to normoxia. Highlights: Utilizing severe hypoxia during exercise and normoxia during recovery induces a substantial hypoxic stimulus while safeguarding mechanical performance in sprinters.This approach maintains neuromuscular, metabolic, and perceptual parameters without any detrimental effects, ensuring athletes can perform at their best.Alternating hypoxia and normoxia during active and passive phases shows potential for optimizing hypoxic training, striking an ideal balance between the hypoxic stimulus and training intensity and load. [ABSTRACT FROM AUTHOR]

Background: Sleep on the first night in a sleep laboratory is characterized by a lower sleep quality and frequency of rhythmic masticatory muscle activity (RMMA) than that on the second night in moderate to severe sleep bruxism (SB) patients. Objective: The aims of this study was to clarify the physiological factors contributing to the first night effect on oromotor activity during sleep and investigate whether physiological factors involved in the first night effect differed between rhythmic and non‐rhythmic oromotor activities. Methods: Polysomnographic data collected on two consecutive nights from 15 moderate to severe SB subjects (F 7: M 8; age: 23.2 ± 1.3 [mean ± SD] years) were retrospectively analysed. Sleep variables, RMMA and non‐specific masticatory muscle activity (NSMA) were scored in relation to episode types (i.e. phasic or tonic and cluster or isolated), sleep architecture and transient arousals. The relationships between nightly differences in oromotor and sleep variables were assessed. The distribution of oromotor events, arousals, cortical electroencephalographic power, RR intervals and heart rate variability were examined in relation to sleep cycle changes. These variables were compared between the first and second nights and between RMMA and NSMA. Results: Sleep variables showed a lower sleep quality on Night 1 than on Night 2. In comparisons with Night 1, the RMMA index increased by 18.8% (p <.001, the Wilcoxon signed‐rank test) on Night 2, while the NSMA index decreased by 17.9% (p =.041). Changes in the RMMA index did not correlate with those in sleep variables, while changes in the NSMA index correlated with those in arousal‐related variables (p <.001, Spearman's rank correlation). An increase in the RMMA index on Night 2 was found for the cluster type and stage N1 related to sleep cyclic fluctuations in cortical and cardiac activities. In contrast, the decrease in the NSMA index was associated with increases in the isolated type and the occurrence of stage N2 and wakefulness regardless of the sleep cycle. Conclusion: Discrepancies in first night effect on the occurrence of RMMA and NSMA represent unique sleep‐related processes in the genesis of oromotor phenotypes in SB subjects. [ABSTRACT FROM AUTHOR]

A growing number of companies are developing or using wearable sensor technologies that can monitor, analyse and transmit data from humans in real time that can be used by the sporting, biomedical and media industries. To explore this phenomenon, we describe and review two high-profile sporting events where innovations in wearable technologies were trialled: the Tokyo 2020 Summer Olympic Games (Tokyo 2020, Japan) and the 2022 adidas Road to Records (Germany). These two major sporting events were the first time academic and industry partners came together to implement real-time wearable solutions during major competition, to protect the health of athletes competing in hot and humid environments, as well as to better understand how these metrics can be used moving forwards. Despite the undoubted benefits of such wearables, there are well-founded concerns regarding their use including: (1) limited evidence quantifying the potential beneficial effects of analysing specific parameters, (2) the quality of hardware and provided data, (3) information overload, (4) data security and (5) exaggerated marketing claims. Employment and sporting rules and regulations also need to evolve to facilitate the use of wearable devices. There is also the potential to obtain real-time data that will oblige medical personnel to make crucial decisions around whether their athletes should continue competing or withdraw for health reasons. To protect athletes, the urgent need is to overcome these ethical/data protection concerns and develop wearable technologies that are backed by quality science. The fields of sport and exercise science and medicine provide an excellent platform to understand the impact of wearable sensors on performance, wellness, health, and disease. [ABSTRACT FROM AUTHOR]

Many college students experience daytime sleepiness. Daytime sleepiness is reportedly associated with poor academic performance, suicide, depression, and traffic accidents. This parallel-group randomized controlled trial study aimed to examine the effect of self-care using transcutaneous vagus nerve stimulation (taVNS) in college students with sleepiness and depression. Thirty-four college students (age 21.5 ± 0.1 years, 21 men and 13 women) were assigned to a control or taVNS group. For taVNS, an electro-stimulator was used to deliver 100 Hz pulses at an intensity below each participant's pain threshold (3.0–8.0 mV) for 30 min. taVNS was performed 30 min before bedtime every day for 28 days. Daytime sleepiness, depression, study engagement, and sleep quality were measured using the Japanese version of the Epworth Sleepiness Scale (ESS-J), Japanese version of the Beck Depression Inventory-II (BDI-II-J), Japanese version of the Utrecht Work Engagement Scale for Students (UWES-S-J), Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J), and Silmee™ Bar Type Lite. Autonomic nervous system activities were measured using high-frequency (HF) and low-frequency (LF) components of heart rate variability. Parasympathetic and sympathetic nervous system activities were indicated by the HF value and LF/HF ratio, respectively. The change in each group from day 28 to day 1 was calculated and analysed. The ESS-J, BDI-II-J, UWES-S-J, and PSQI-J (sleep quality and daytime dysfunction) scores improved, and the LF/HF ratio decreased in the taVNS group compared with the control group. Self-care using taVNS suppresses the sympathetic nervous system during sleep, which may improve sleep quality, daytime sleepiness, depression, and study engagement. [ABSTRACT FROM AUTHOR]

Introduction: Electrophysiological characteristics of epicardial connections (ECs) in atria and pulmonary veins (PVs) are unclear despite their important contributions to atrial fibrillation (AF). Unidirectional conduction associated with source‐sink mismatch can occur in ECs due to their fine fibers with abrupt changes in orientation. We detailed the prevalence and electrophysiological characteristics of unidirectional conduction in the atria and investigated its association with the clinical manifestation of AF. Methods: This study retrospectively reviewed electrophysiological studies and radiofrequency catheter ablation in 261 consecutive patients with AF. Results: Unidirectional conduction was observed during ablation encircling the PVs in eight (3.1%) patients, and all occurred in the suspected (N = 4) or definitively (N = 4) recognized ECs. These ECs included three intercaval bundles, four septopulmonary bundles, and one Marshall bundle, and were first manifested in a second procedure in 6 (75%) patients. The unidirectional property was from PV to atrium (exit conduction) in all intercaval bundles and three septopulmonary bundles, and from atrium to PV (entrance conduction) in the remaining two bundles. Intercaval bundles acted as a limb of bi‐atrial macro‐reentrant tachycardia (50%, three of the six including previous cases). Ablation of the exit outside the PVs, including the right atrium, eliminated ECs in three (38%) patients. All patients remain free from arrhythmia recurrence after a mean 13‐month follow‐up. Conclusion: A unidirectional conduction property was closely associated with the EC, as estimated by histological findings. Recognition of this fact by electrophysiologists may help to clarify mechanisms for AF and atrial tachycardia and guide the creation of efficient and safe ablation lesion sets. [ABSTRACT FROM AUTHOR]

Hereditary transthyretin (ATTRv) amyloidosis is a rare and autosomal dominant disorder associated with mutations in the transthyretin gene. Patients present with diverse symptoms related to sensory, motor, and autonomic neuropathy, as well as gastrointestinal, ocular, cardiac, renal and orthopedic symptoms, resulting from the deposition of transthyretin amyloid fibrils in multiple organs. The progressive nature of ATTRv amyloidosis necessitates pre- and post-onset monitoring of the disease. This review article is primarily based on a collation of discussions from a medical advisory board meeting in August 2021. In this article, we summarize the best practices in amyloidosis centers in three major endemic countries for ATTRv amyloidosis (Japan, Brazil, and Portugal), where most patients carry the Val30Met mutation in the transthyretin gene and the patients' genetic background was proven to be the same. The discussions highlighted the similarities and differences in the management of asymptomatic gene mutation carriers among the three countries in terms of the use of noninvasive tests and tissue biopsies and timing of starting the investigations. In addition, this article discusses a set of practical tests and examinations for monitoring disease progression applicable to neurologists working in diverse medical settings and generalizable in non-endemic countries and areas. This set of assessments consists of periodic (every 6 to 12 months) evaluations of patients' nutritional status and autonomic, renal, cardiac, ophthalmologic, and neurological functions. Physical examinations and patient-reported outcome assessments should be also scheduled every 6 to 12 months. Programs for monitoring gene mutation carriers and robust referral networks can aid in appropriate patient management in pre- to post-onset stages. For pre- and post-symptom onset testing for ATTRv amyloidosis, various noninvasive techniques are available; however, their applicability differs depending on the medical setting in each country and region, and the optimal option should be selected in view of the clinical settings, medical environment, and available healthcare resources in each region. [ABSTRACT FROM AUTHOR]

Remimazolam, an ultra-short-acting benzodiazepine sedative, was first approved in 2020 in Japan as a general anesthetic for adults. However, its utilization in pediatric settings remains unexplored and, to date, is confined to isolated case reports due to a lack of specific pediatric labeling. The primary objective of our study was to evaluate the safety profile of remimazolam when used for procedural sedation in children following dosages established in adult protocols. Additional parameters, including dosage per kg of body weight, duration of the procedure, efficacy (measured as successful completion of the procedure), the necessity for supplemental medications, and changes in physiological parameters, such as the heart rate (HR) and mean arterial blood pressure (MAP), were assessed. Our study encompassed 48 children with an average age of 7.0 years. The objective Tracking and Reporting Outcomes of Procedural Sedation tool indicated no adverse events. In our cohort, propofol and ketamine were used as adjunctive treatments in 8 and 39 patients, respectively, with successful completion of all procedures. Notable hemodynamic variability was observed, with 88.4% of patients experiencing a ≥20% change (increase or decrease) and 62.8% experiencing a ≥30% change in MAP. Additionally, a ≥20% change in HR was observed in 54.3% of patients, and a ≥30% change was observed in 34.8% of patients. Nevertheless, none of the patients required pharmacological intervention to manage these hemodynamic fluctuations. Our findings suggest that remimazolam, when supplemented with propofol or ketamine, could offer a safe and effective pathway for administering procedural sedation in pediatric populations. [ABSTRACT FROM AUTHOR]

Introduction: Various stressors have been identified in patients in the intensive care unit (ICU), including postoperative pain, ventilatory management, and nursing care. However, sedated patients are less responsive, and nurses have difficulty capturing their stressors. Objective: To investigate patient stress caused by nursing care performed in the ICU on sedated patients based on changes in physiological indices. Methods: We observed nursing care performed on patients with postoperative esophageal cancer under sedation in the ICU. This included endotracheal suctioning and turning, the time required for the care, and the patients' behavioral responses. Information on arousal levels, autonomic nervous system indices, and vital signs were also obtained. The changes in indicators before and after care were then compared and analyzed. Results: There were 14 patients in the study. The mean age of the patients was 68 years. Ninety-nine scenes of nursing care were observed, and in six of these, additional bolus sedation was administered because of the patient's significant body movements. In endotracheal suctioning, no significant changes were observed in all indicators. In turning, vital signs changed significantly, and when both were continued, all indicators changed significantly. Conclusion: Our study found that different types and combinations of nursing care may cause different stresses to the patients. Moreover, the autonomic nervous system indices may be more likely to react to stresses in a variety of nursing care, while arousal levels may be more likely to react to burdensome stresses. If the characteristics of these physiological indicators can be understood and effectively utilized during care, it may be possible to better identify and reduce patient stress during sedation management. [ABSTRACT FROM AUTHOR]

Curling is a target‐based team sport played in a cold environment. The type of stress curling players face during a curling match remains to be determined. In the present study, 16 Japanese curling players performed a practice curling match (six ends lasting 90 min), wherein the following variables were documented: core and skin temperatures, heart rate, thermal sensation and comfort, urine‐specific gravity, body fluid loss, salivary cortisol, α‐amylase activity, salivary secretory immunoglobulin A (SIgA), and fractionated exhaled nitric oxide (FeNO, a respiratory stress marker). Pre‐match resting core temperature was 37.24 ± 0.31°C, which increased up to 37.73 ± 0.41°C during the match (p < 0.001). Facial skin temperatures decreased after the match (all p ≤ 0.015), whereas finger skin temperatures remained unchanged (p ≥ 0.375). Thermal discomfort increased following the match but thermal sensation remained unchanged. Following the match, players lost 0.29 ± 0.15 L body fluid (sweat, respiratory evaporation, and urine), which was nearly compensated by fluid ingestion of 0.22 ± 0.13 L (p = 0.119). Nevertheless, urine‐specific gravity increased from 1.021 ± 0.010 to 1.024 ± 0.008 after the match (p = 0.012), with 31% and 50% players being dehydrated at pre‐ and post‐match, respectively. Salivary cortisol decreased (p < 0.001) after the match without changes in salivary SIgA, α‐amylase activity, and FeNO (all p ≥ 0.113). Therefore, during a curling match, the core temperature and thermal discomfort increase, whereas the face skin temperature decreases. Additionally, players may undergo dehydration before the match, which could be exacerbated after the match. [ABSTRACT FROM AUTHOR]

Simple Summary: In Japan, cats are popular companion animals. However, the details of the effects of direct communication with cats on the psychological and physiological states of their owners remain unknown. In this study, we conducted a remote-format experiment with 32 cat owners in their homes. Owners were requested to interact with their cats for 10 min in a routine manner. The results showed that interactions with cats decreased the emotional arousal and parasympathetic activity of the owners and increased their heart rates. Positive correlations were also noted between heart rate and cortisol concentration as well as between cortisol and oxytocin concentration. The results of this study indicate that interactions with cats at home has an excitatory effect on the physiological aspects of owners, which is in contrast with findings of previous studies that proposed stress reduction. This explains a new aspect of the mechanism of the health-promoting effects of cat ownership. Interactions with animals, including cats, is believed to influence human health. However, studies that investigate the psychological and physiological effects of interacting with cats in their household environment are limited. In this remote study, 32 cat owners in Japan participated from June to October 2021. They completed two tasks, each on separate days in their homes: one simulating daily cat communication (Interaction condition) and another with no interactions (Rest condition). We quantified emotions (arousal level and pleasure level) before and after each condition using the Two-Dimensional Mood Scale Short-term as well as salivary cortisol and oxytocin levels of owners using enzyme-linked immune-sorbent assay. Autonomic nervous activity (sympathetic and parasympathetic) was also quantified by heart rate variability analysis. The free interaction with cats decreased emotional arousal and parasympathetic activity, and lead to increased heart rates in owners. There was a positive correlation between heart rate and cortisol concentration, and between cortisol and oxytocin concentration. Furthermore, the frequency of petting the cats was negatively correlated with the rate of change in the parasympathetic activity. In contrast, the parasympathetic nerves in the owners were activated under the Rest condition. Hence, the mechanism of health-enhancing effects of cat ownership includes an arousing effect, in contrast to the previously proposed stress-reduction effect. This result can aid in future developments in cat–human relationship studies. However, a detailed study with a larger sample size is needed to draw definite conclusions. [ABSTRACT FROM AUTHOR]

Aiming at the problems existing in the application of traditional power workers' work clothes, an early warning system for power transmission and distribution workers based on ZigBee is designed. The system completes the real‐time collection and monitoring of human body temperature information, heart rate information, blood pressure information and location information of power workers. It can give early warning according to human body information, and automatically dial 120 alarm telephone according to human heart rate signal to transmit location information, so that workers can be rescued as soon as possible. In order to increase the accuracy and reliability of transmission information, the system adopts distributed fusion algorithm for signal transmission, which makes the life safety of power workers better guaranteed. © 2023 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of essential oils mainly containing Eupatorium fortune Turcz (EFCO, E. fortune Turcz extract, water calamus extract, grapefruit extract, lavender extract, mixed in the ratio of 6:1:1:1:0.1 by volume) on heart rate variability (HRV), forced vital capacity (FVC), and salivary hormones in 33 scientific researchers. The experimental design was a quasi‐experimental study with pre‐ and post‐testing and no control group. Subjects were tested for four immediate indicators before and after essential oils inhalation, for 30 s before each meal for the next 30 days, and for body mass index (BMI) after 30 days. For immediate effects, we observed significant increases in HRV (31%), spirometry (12%) and salivary oxytocin (26%), and a decrease in salivary cortisol (4.5%). BMI decreased by 1% after 1 month of intervention. Based on the observed changes in physiological parameters, EFCO helped to reduce stress, improve exercise performance and mood, and even promote weight loss. © 2022 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Aim: This retrospective study was performed to investigate whether certain fetal heart rate patterns were associated with subsequent cerebral palsy (CP) in infants with chorioamnionitis at or near term. Methods: We used cases registered by the Japan Obstetric Compensation System for CP, which is a nationwide population‐based database. Among them, 133 infants with chorioamnionitis who were born at ≥34 weeks of gestation were enrolled. All infants underwent magnetic resonance imaging (MRI), and all fetal heart rate charts had been interpreted according to the National Institute of Child Health and Human Development criteria, focusing on antepartum and immediately before delivery. Results: The incidence of CP after chorioamnionitis at ≥34 weeks of gestation was 0.3 per 10 000 in Japan. Between the clinical (24%) and subclinical groups (76%), the incidence of abnormal fetal heart rate patterns did not differ. According to the MRI classification, 88% of the infants with CP showed hypoxic–ischemic encephalopathy. Half of the infants with CP experienced terminal bradycardia, leading to severe acidosis and exclusively to hypoxic–ischemic encephalopathy. In another half, who did not experience bradycardia, 80% had moderate acidosis (pH 7.00–7.20) resulting in hypoxic–ischemic encephalopathy, and the remaining 20% showed non‐acidosis resulting in brain damage other than hypoxic–ischemic encephalopathy. The fetal heart rate patterns before the terminal bradycardia showed that the incidence rates of late deceleration or decreased variability were high (>60%). Conclusion: Fifty percent of pregnant women with chorioamnionitis‐related CP had terminal bradycardia that exclusively resulted in hypoxic–ischemic encephalopathy. [ABSTRACT FROM AUTHOR]

Our previous study examined the neural effects of extremely low frequency electric field (ELF‐EF) using electroencephalogram (EEG) and heart rate variability (HRV) measurement and revealed that the theta power of EEG increases during 1‐min EF treatment (30 kV and 50 Hz). In the present study, the effects of a longer treatment duration were assessed. EF was applied between two electrodes, one above the head and the other under the feet, for 20 min to 10 healthy men sitting on a chair. Occipital EEG and HRV were measured in the eyes‐open condition. Power spectrum analysis showed that during the EF treatment, the power of alpha and theta rhythms as well as the low frequency component of HRV increased, and the heart rate decreased. These effects did not persist after the end of EF treatment. It is suggested that ELF‐EF treatment alters not only the brain activity but also the autonomic activity reflected in HRV. © 2022 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Objectives: To study age at death (AD) and its determinants in cohorts of middle-aged men followed-up until extinction. Material and methods: A total of 9063 middle-aged men enrolled in 10 cohorts of 6 countries (USA, Finland, the Netherlands, Italy, Greece and Japan) within the Seven Countries Study were examined and then followed up for 60 years until extinction. AD was computed and a small number of risk factors were tested through multiple linear regression as possibly related to attained AD. Results: AD ranged across cohorts from 71.8 years in East Finland and 80.5 years in Crete with levels roughly lower in the USA and Northern Europe and higher elsewhere. Across cohorts, the correlation coefficients of systolic blood pressure (R = −0.58) and of CVD prevalence (R = −0.65) versus average AD were the only significant ones. At the individual level in the pool of all cohorts, a multiple linear regression model showed that age, vigorous physical activity, never and ex-smokers were favorably related to AD, while the reverse was true for systolic blood pressure, heart rate, serum cholesterol, CVD prevalence and silent ECG abnormalities. BMI had a parabolic relationship with AD. The predicting power of single risk factors, expressed in years gained or lost, was relatively small, but arbitrary combinations of several of them produced large differences in AD. Conclusions: A small number of CVD risk factors were strongly associated with AD in a life-long follow-up. [ABSTRACT FROM AUTHOR]

This review summarizes my own involvement in heart rate variability (HRV) and HRV biofeedback studies, as a tribute to the late Dr. Evgeny Vaschillo. I first review psychophysiological studies on behavioral stress and relaxation performed in my laboratory using an assessment of cardiac parasympathetic activity. Although magnitude of high-frequency (HF) component of HRV corresponding respiratory sinus arrhythmia (RSA) is widely used as an index of cardiac parasympathetic function, a respiratory confound during stress or relaxation may have interfered with the proper assessment of the HF HRV. An enhanced method under frequency-controlled respiration at 0.25 Hz provided a reliable assessment of cardiac parasympathetic activity. I then review findings from HRV biofeedback research in my laboratory. Based on the hypothesis that RSA measured as an HF component of HRV represents cardiorespiratory resting function, it was demonstrated that HRV biofeedback before sleep enhanced the magnitude of HF HRV during sleep, a cardiorespiratory resting function. Moreover, by focusing on the spectral peak of the low-frequency (LF) component of HRV, paced breathing at the LF-peak frequency was shown to increase baroreflex sensitivity. Finally, I describe the potential of slow-paced abdominal breathing (i.e., Tanden breathing) performed in Zen meditation. The concept of Tanden breathing as described in a regimen from early modern Japan is introduced, and recent research findings on slow-paced abdominal breathing are summarized. Future research directions of slow-paced abdominal breathing are also discussed. [ABSTRACT FROM AUTHOR]

Impedance cardiography (ICG) and peripheral bioimpedance may be useful for monitoring several cardiovascular parameters such as cardiac output, stroke volume, blood pressure and heart rate. It is a noninvasive and low‐cost method and could be useful for diagnosis and treatment in different clinical situations. This study involved 100 volunteers and their age ranging from 18 to 26 years. The acquired bioimpedance signal was pre‐processed and used to estimate the heart rate. Thus, heart rates of each subject were calculated and then compared with actual measurement from FUZZY model MP3 digital blood pressure monitor. The results showed high precision with a 1.38 mean error a high sensitivity of 99.81% and a positive predictivity value of 99.63%, respectively. Compared with six other methods selected from the literature review and which are initially dedicated to ECG signals, the proposed method has been found to be more efficient and more precise with an error in determining the percentile HR = 1.78%. © 2022 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is a lack of studies that investigated the effect of a wide range of work environmental factors on stress and depression in Japan. OBJECTIVES: To examine the association of work environment factors with stress and depression among workers in Japan. METHODS: We conducted questionnaire surveys of workers that mainly engage in desk work in Japan. Stress was assessed through the Perceived Stress Scale (PSS), depression through the Patient Health Questionnaire-9 (PHQ-9), and work environment through physical and psychological workplace environment questionnaires. Workers were divided into low and high stress groups based on PSS score (median split), and divided into non-depressed and depressed groups based on their PHQ-9 score (< 5, and ≥5); these groups were then compared with their working environment. In addition, a multiple regression analysis was performed. RESULTS: Responses were obtained from 210 subjects. Multiple regression analysis showed that "Ability to work at one's own pace" and "Ability to apply personal viewpoint to work," etc., had effect on stress, while "Workplace harassment" and "Support from colleagues," etc., had effect on depression. CONCLUSIONS: The results suggest that stress and depression in Japanese workers are related to factors such as job demands, control of work, workplace harassment, and psychological safety. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In this case report we will describe a Japanese military U-125 Pilot who was found to have WPW syndrome during his annual aviation medical examination and returned to flight duties through catheter ablation. BACKGROUND: Wolff-Parkinson-White syndrome, or WPW syndrome, is a cardiac arrhythmia characterized by an abnormal electrical pathway in the heart. Normally, the heart's contractions are regulated by a specific pathway, but in WPW syndrome, an abnormal pathway known as an "accessory pathway" exists. This can lead to rapid and irregular heartbeats. One specific arrhythmia associated with WPW syndrome is called "pseudo ventricular tachycardia." In this condition, the abnormal pathway allows the ventricles to be excited prematurely, resulting in a faster heartbeat than usual. This pseudo ventricular tachycardia is distinct from regular ventricular tachycardia. When pseudo ventricular tachycardia occurs, the heart rate becomes very fast, and the rhythm becomes irregular. Symptoms may include dizziness, shortness of breath, and chest discomfort. In severe cases, loss of consciousness can occur. CASE PRESENTATION: The pilot was 46 years old when an electrocardiogram during an aviation medical examination showed ventricular tachycardia-like waveforms, and he was suspended from flight duties. He underwent cardiac electrophysiology testing, was diagnosed with WPW syndrome, and underwent catheter ablation. One month after the ablation, he underwent echocardiography, Holter ECG, and exercise stress ECG, none of which showed arrhythmia. Aeromedical Evaluation Board allowed him to return to flight duties on conditions. No further problematic arrhythmias were found. Another Aeromedical Evaluation Board was conducted, with arrythmia mitigated, he was returned to fly. DISCUSSION: At JASDF, the Aeromedical Evaluation Board determines whether a pilot who fails an aviation medical examination is allowed to return to flight duties. Ablation for WPW syndrome generally has a high success rate. However, in some patients with multiple abnormal conduction pathways, other conduction pathways may cause recurrence, so it is necessary to define appropriate evaluation criteria for each patient with WPW syndrome. This presentation will discuss the flight conditions imposed on pilots and the measures used by Japan, Iraq, and the US military for various arrhythmias. Learning Objectives 1. The audience will learn about the presentation, diagnosis, and/or treatment of an interesting Aerospace Medicine case. 2. The audience will learn about the similarities and differences in medical standards and pilot medical clearances for civilian, US and foreign military aviation professionals. [ABSTRACT FROM AUTHOR]

In this work, we propose a model that incorporates QT‐interval variability (QTV) by extending the synthetic electrocardiogram (ECG) model including heart rate variability (HRV). The model consists of three modified coupled ordinary differential equations and an equation to incorporate QTV by shifting the position of the T‐wave; in addition, RR and QT tachograms that have frequency characteristics composed of multiple Gaussian distribution peaks are used. An ECG signal can be generated by adapting a certain ECG waveform and by giving the means, standard deviations, and power spectral density parameters of HRV and QTV. This proposed model may reveal the neurophysiological mechanisms underlying the relationship between QTV and HRV and/or the autonomic activity, and it may solve problems in the measurement of QT‐interval. In conclusion, this proposed model is a very useful tool in medical education and experimental simulation. © 2022 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Cryptomeria japonica (sugi; Japanese cedar) and Chamaecyparis obtusa (hinoki; Japanese cypress) are woods widely used in Japan for building and/or interior materials, furniture, and tableware. The relaxation effects of these wood-derived aromas on humans have been reported. An example of the use of these materials is the square wooden cups (Masu) used for sake vessels, which are commonly used for sake consumption. However, no studies have investigated the subjective and physiological effects of the aroma emitted from the wooden cups when used to consume alcoholic beverages. This study examined the effects of putting alcohol in wooden cups through physiological measurements of heart rate variability, cerebral blood flow, core body temperature, and subjective assessments. Moreover, this study's result showed that the aroma of sake in all wooden cups and of shochu in C. japonica cups caused feelings of comfort and deliciousness. It was also found that the aroma of shochu in C. japonica cups and sake in Ch. obtusa cups could generate physiological relaxation. Ethyl caproate, ethyl caprylate, and ethyl caprate in alcoholic beverages and δ-cadinene and α-terpineol in wooden cups were determined as major compounds. The present results suggest that the beneficial effects of using sake vessels made from C. japonica and Ch. obtusa woods for alcoholic beverages increases the beverage's taste, and their combination improves relaxing effects. [ABSTRACT FROM AUTHOR]

This article provides an overview of the history of the Japanese Society of Biofeedback Research (JSBR) and presents some of its recent advances. Most of the research papers published in the JSBR journal (Biofeedback Kenkyu) have been written in Japanese, and therefore have had very few opportunities to reach global readers. We would like to present some of important findings previously published there. First, we present the history of the JSBR. Secondly, we will focus on paced breathing, which is instrumental in achieving relaxation in heart rate variability biofeedback (HRV-BF). We will look back on the origin of slow-paced breathing in Japan, that could be attributed to the concept of Tanden breathing (abdominal paced breathing) practiced in Zen meditation. Thirdly, we will introduce some of the current research progresses of JSBR, especially focusing on the development of a non-contact sensing technology and relaxation device. Finally, we will explain about a very recent trial, the "Suu-Haa" Relaxation Technique, which we hope may be useful for helping people cope with the SARS-CoV-2 (COVID-19) crisis. [ABSTRACT FROM AUTHOR]

Although there have been many investigations of the beneficial effects of both exercise and amino acids (AAs), little is known about their combined effects on the single-dose ingestion of AAs for lipid metabolism during exercise. We hypothesize that taking a specific combination of AAs implicated in glucagon secretion during exercise may increase fat metabolism. We recently developed a new mixture, d-AA mixture (D-mix), that contains arginine, alanine, and phenylalanine to investigate fat oxidation. In a double-blind, placebo-controlled crossover study, 10 healthy male volunteers were randomized to ingest either D-mix (3 g/dose) or placebo. Subjects in each condition subsequently performed a physical task that included workload trials on a cycle ergometer at 50% of maximal oxygen consumption for 1 hr. After oral intake of D-mix, maximum serum concentrations of glycerol (9.32 ± 6.29 mg/L and 5.22 ± 2.22 mg/L, respectively; p = .028), free fatty acid level (0.77 ± 0.26 mEq/L and 0.63 ± 0.28 mEq/L, respectively; p = .022), and acetoacetic acid levels (37.9 ± 17.7 µmol/L and 30.3 ± 13.9 µmol/L, respectively; p = .040) were significantly higher than in the placebo groups. The area under the curve for glucagon during recovery was numerically higher than placebo (6.61 ± 1.33 µg/L ⋅ min and 6.06 ± 1.23 µg/L ⋅ min, respectively;p = .099). These results suggest thatpreexercise ingestion of D-mix may stimulate fat metabolism. Combined with exercise, the administration of AA mixtures could prove to be a useful nutritional strategy to maximize fat metabolism. [ABSTRACT FROM AUTHOR]

Objective: We examined the impact of simulated Tokyo 2020 environmental condition on exercise performance, thermoregulatory responses and thermal perception among Dutch elite athletes. Methods: 105 elite athletes from different sport disciplines performed two exercise tests in simulated control (15.9 ± 1.2 °C, relative humidity (RH) 55 ± 6%) and Tokyo (31.6 ± 1.0 °C, RH 74 ± 5%) environmental conditions. Exercise tests consisted of a 20-min warm-up (70% HRmax), followed by an incremental phase until volitional exhaustion (5% workload increase every 3 min). Gastrointestinal temperature (Tgi), heart rate, exercise performance and thermal perception were measured. Results: Time to exhaustion was 16 ± 8 min shorter in the Tokyo versus the control condition (− 26 ± 11%, whereas peak power output decreased with 0.5 ± 0.3 W/kg (16 ± 7%). Greater exercise-induced increases in Tgi (1.8 ± 0.6 °C vs. 1.5 ± 0.5 °C, p < 0.001) and higher peak Tgi (38.9 ± 0.6 °C vs. 38.7 ± 0.4 °C, p < 0.001) were found in the Tokyo versus control condition. Large interindividual variations in exercise-induced increase in Tgi (range 0.7–3.5 °C) and peak Tgi (range 37.6–40.4 °C) were found in the Tokyo condition, with greater Tgi responses in endurance versus mixed- and skill-trained athletes. Peak thermal sensation and thermal comfort scores deteriorated in the Tokyo condition, with aggravated responses for power versus endurance- and mixed-trained athletes. Conclusion: Large performance losses and Tgi increases were found among elite athletes exercising in simulated Tokyo conditions, with a substantial interindividual variation and significantly different responses across sport disciplines. These findings highlight the importance of an individual approach to optimally prepare athletes for safe and maximal exercise performance during the Tokyo Olympics. [ABSTRACT FROM AUTHOR]

Background: Many family caregivers of patients with cancer feel guilty about self-care. A meaningful relationship with patients reduces such negative feelings and functions as self-care for family caregivers. Moreover, handholding improves autonomic functions in non-cancer patients. However, the effects of handholding on both patients with cancer and family caregivers remain unknown. Methods: We evaluated the effects of handholding on heart rate variability (HRV) in patients with cancer and their family caregivers. This randomized crossover study divided patients with cancer and their family caregivers into two trial groups: Handholding trial (the family caregiver holds the patient's hand for five minutes) and Beside trial (the family caregiver stays beside the patient without holding their hand). The study included 37 pairs of patients with cancer who received treatment in the cancer department of a university hospital in Japan and their family caregivers (n = 74). The primary end-point was the change in HRV before and during the intervention. Results: The median performance status of the patients was 3. An interaction was observed between trials in the standard deviation of the normal-to-normal interval (SDNN) of HRV for family caregivers (F = 7.669; p = 0.006), and a significant difference in time course was observed between the trials (before p = 0.351; during p = 0.003). No interaction was observed between trials in the SDNN for patients (F = 0.331; p = 0.566). Only a main effect in time course (F = 6.254; p = 0.014) was observed. SDNN increased significantly during the intervention in both trials (Handholding trial: p = 0.002, Beside trial: p = 0.049). Conclusions: Handholding improves autonomic functions of family caregivers and may function as self-care for family caregivers. Trial registration: UMIN000020557. Registered on January 15, 2016. [ABSTRACT FROM AUTHOR]

The effects of extremely low‐frequency (ELF) electric field (EF) exposure on brain activity remain poorly understood. This study sought to examine the acute effects of EF exposure on brain activity by analyzing electroencephalogram (EEG) basic rhythms. The heart rate variability (HRV) was also measured to evaluate autonomic activity. Using a system that enables measurement under EF exposure, occipital EEG and electrocardiogram signals were recorded in nine healthy male subjects during daytime in eyes‐open and eyes‐closed conditions, with or without EF exposure (applied voltage: 30 kV, 50 Hz for 1 min). The EEG power and frequency‐domain HRV indices were obtained by power spectrum analysis of EEG and the RR interval trend, respectively. Resulting data revealed that the theta power of EEG was significantly greater during EF exposure in eyes‐open and eyes‐closed conditions. Other EEG rhythms and HRV indices were not affected by EF exposure. These findings suggest that exposure to 50‐Hz EF for 1 min altered brain activity by increasing the theta power. © 2021 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to compare the effects of acupuncture treatment on arterial blood pressure (BP) and heart rate (HR) in patients with mild hypertension with high sympathetic tone with those of normotensive patients and to examine the effects on cardiac sympathetic nerve activity (CSNA) and vagal activity using heart rate variability (HRV) analysis. Design: Eight male patients with prehypertension or stage I hypertension and eight normotensive age-matched patients were included in this study. All patients had their systolic BP (SBP), diastolic BP (DBP), HR, and HRV measured. In addition, the ratio of low-frequency (LF) to high-frequency (HF) HRV and the power of the HF of the HRV were recorded. The study was conducted at Kansai University of Health Sciences in Japan. Interventions: Each patient underwent a single, 15-min-long acupuncture session. Acupuncture was applied to PC6, LI4, ST36, LR3 on both sides, and GV20. Results: SBP and HR decreased significantly in the hypertensive group during and after acupuncture compared with the baseline SBP and HR (p < 0.05). LF/HF was significantly reduced during acupuncture (p < 0.05), and HF was significantly increased after acupuncture in the hypertensive group (p < 0.05). However, there were no significant changes in LF/HF or HF in the control group. Conclusions: Acupuncture may reduce the BP and HR in patients with mild hypertension. An HRV analysis suggests that acupuncture may suppress the enhanced basal CSNA activity and increase the vagal nerve activity in patients with mild hypertension. Clinical Trial Registration number: UMIN000041249. [ABSTRACT FROM AUTHOR]

Purpose: Intravenous (IV) sedation is commonly used in dentistry. However, no report has yet been published regarding age, hypertension, and antihypertensive drugs during implant surgery and their relationship with changes in blood pressure (BP) and heart rate in implant surgery under IV sedation with propofol and midazolam. Materials and Methods: Medical records of 252 patients who underwent implant surgery were retrospectively analyzed. Patients were classified into four groups according to their age (in years) and hypertension status: A = ≤ 64, no hypertension; B = ≥ 65, no hypertension; C = ≤ 64, hypertension; or D = ≥ 65, hypertension. Hypertensive patients were further characterized by their antihypertensive medications: E = calcium channel blockers (CCBs), F = angiotensin II receptor blockers (ARBs), G = CCBs+ARBs, or H = no medication. IV sedation was administered in two stages. After midazolam injection to prevent angialgia, propofol was infused at the rate of 4 mg/kg/h, followed by a dose reduction. Systolic and diastolic BP and heart rate were recorded before, during, and after surgery. Results: Systolic BP increased significantly after patients were draped in groups A, C, and D, with group D showing the most pronounced increase. Sedatives decreased BP in all groups. Diastolic BP in group F decreased significantly compared to group H after induction and before infiltration of local anesthetic. After infiltration, systolic BP decreased more significantly in group G than in group H. Intraoperative hypotension was observed in 25% of patients. The incidence of intraoperative hypertension in group D was markedly higher than in group A (23% vs 4%). Conclusion: IV sedation using midazolam and propofol reduces hypertensive risks during implant surgery. Nevertheless, care must be taken, especially in older hypertensive patients and in hypertensive patients on ARBs or ARBs+CCBs. [ABSTRACT FROM AUTHOR]

Right ventricular (RV) failure is significantly associated with morbidity and mortality after left ventricular assist device (LVAD) implantation. However, it remains unclear whether LVAD implantation could worsen RV function. Therefore, we aimed to investigate the effect of LVAD implantation on RV function by comparing RV energetics derived from the RV pressure–volume curve between before and after LVAD implantation. This exploratory observational study was performed between September 2016 and January 2018 at a national center in Japan. Twenty‐two patients who underwent LVAD implantation were included in the analysis. We measured RV energetics parameters: RV stroke work index (RVSWI), which was calculated by integrating the area within the RV pressure–volume curve; RV minute work index (RVMWI), which was calculated as RVSWI × heart rate; and right ventriculo–arterial coupling, which was estimated as RV stroke volume/RV end‐systolic volume. We compared RV energetics between before and after LVAD implantation. Although RVSWI was similar [424.4 mm Hg · mL/m2 (269.5‐510.3) vs. 379.9 mm Hg · mL/m2 (313.1‐608.8), P = 0.485], RVMWI was significantly higher after LVAD implantation [29 834.1 mm Hg · mL/m2/min (18 272.2‐36 357.1) vs. 38 544.8 mm Hg · mL/m2/min (29 016.0‐57 282.8), P = 0.001], corresponding to a significantly higher cardiac index [2.0 L/min/m2 (1.4‐2.2) vs. 3.7 L/min/m2 (3.3‐4.1), P < 0.001] to match LVAD flow. Right ventriculo–arterial coupling was significantly higher after LVAD implantation [0.360 (0.224‐0.506) vs. 0.480 (0.343‐0.669), P = 0.025], suggesting that the efficiency of RV performance improved. In conclusion, higher RVMWI with higher cardiac index to match LVAD flow and improved efficiency of RV performance indicate that LVAD implantation might not worsen RV function. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary vein isolation (PVI) affects the ganglionated plexi (GP) around the atrium leading to a modification of intrinsic cardiac autonomic system (ANS). In animal models, GP ablation has the potential risk of QT prolongation and ventricular arrhythmias. However, the impact of PVI on QT intervals in human remains unclear. Methods and Results: We analyzed electrocardiograms of 117 consecutive patients with paroxysmal atrial fibrillation (AF) who underwent their first PVI procedures and maintained sinus rhythm without antiarrhythmic drugs at all evaluation points (4 h, 1 day, 1 month, and 3 months after PVI). Heart rate significantly increased at 4 h, 1 day, and 1 month. Raw QT interval prolonged at 4 h (417.1 ± 41.6 ms, p <.001) but shortened at 1 day (376.4 ± 34.1 ms, p <.001), 1 month (382.2 ± 31.5 ms, p < 0.001), and 3 months (385.1 ± 32.8 ms, p < 0.001) compared with baseline (391.6 ± 31.4 ms). Bazett‐corrected QTc intervals were significantly prolonged at 4 h (430.8 ± 27.9 ms, p <.001), 1 day (434.8 ± 22.3 ms, p <.001), 1 month (434.8 ± 22.3 ms, p <.001), and 3 months (420.1 ± 21.8 ms, p <.001) compared with baseline (404.9 ± 25.2 ms). Framingham‐corrected QTc intervals significantly prolonged at 4 h (424.1 ± 26.6 ms, p <.001) and 1 day (412.3 ± 29.3 ms, p <.01) compared with baseline (399.2 ± 22.7 ms). Multiple regression analysis revealed that female sex is a significant predictor of raw QT and QTc interval increase at 4 h after PVI. Conclusion: Raw QT and QTc were prolonged after PVI, especially in the acute phase. Female sex is a risk factor for QT increase. [ABSTRACT FROM AUTHOR]

Tachycardia and atrial fibrillation frequently occur in patients being treated for sepsis or septic shock and have a poor prognosis. Treatments for tachyarrhythmias are often ineffective or contraindicated in this setting. We aimed to investigate the efficacy and safety of landiolol, an ultra-short-acting β-blocker, for treating sepsis-related tachyarrhythmias. We did a multicentre, open-label, randomised controlled trial at 54 hospitals in Japan. Patients admitted to the intensive care units who received conventional treatment for sepsis, according to clinical guidelines for the management of sepsis, and who subsequently developed a tachyarrhythmia, were enrolled. The main inclusion criteria were 20 years of age or older, diagnosis of sepsis according to Third International Consensus Definitions for Sepsis and Septic Shock criteria, administration of catecholamine necessary to maintain mean arterial pressure at 65 mm Hg or more for at least 1 h, and heart rate of 100 beats per min (bpm) or more maintained for at least 10 min without a change in catecholamine dose with diagnosis of atrial fibrillation, atrial flutter, or sinus tachycardia. Only patients who developed these symptoms and signs within 24 h before randomisation, and within 72 h after entering an intensive care unit, were prospectively assigned to receive conventional sepsis therapy alone (control group) or conventional sepsis therapy plus landiolol (landiolol group) in an open-label manner. Landiolol hydrochloride was intravenously infused at an initial dose of 1 μg/kg per min within 2 h after randomisation and the dose could be increased per study protocol to a maximum of 20 μg/kg per min. Patients in both groups received conventional therapy (Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock 2016), including respiratory and fluid resuscitation, antimicrobials, and catecholamines. The treating physicians were required to stabilise the patient's haemodynamic status before randomisation. Randomisation was done using a central randomisation system and dynamic allocation with the minimisation method by institution, heart rate at randomisation (≥100 to <120 bpm or ≥120 bpm), and age (<70 years or ≥70 years). The primary outcome was the proportion of patients with heart rate of 60–94 bpm at 24 h after randomisation. Patients without heart rate data at 24 h after randomisation were handled as non-responders. The primary outcome was analysed using the full analysis set on an as-assigned basis, while safety was analysed using the safety analysis set according to the treatment received. This study was registered with the Japan Pharmaceutical Information Center Clinical Trials Information database, number JapicCTI-173767. Between Jan 16, 2018 and Apr 22, 2019, 151 patients were randomly assigned, 76 to the landiolol group and 75 to the control group. A significantly larger proportion of patients in the landiolol group had a heart rate of 60–94 bpm 24 h after randomisation than in the control group (55% [41 of 75] vs 33% [25 of 75]), with a between-group difference of 23·1% (95% CI 7·1–37·5; p=0·0031). Adverse events were observed in 49 (64%) of 77 patients in the landiolol group and in 44 (59%) of 74 in the control group, with serious adverse events (including adverse events leading to death) in nine (12%) of 77 and eight (11%) of 74 patients. Serious adverse events related to landiolol occurred in five (6%) of 77 patients, including blood pressure decreases in three patients (4%) and cardiac arrest, heart rate decrease, and ejection fraction decrease occurred in one patient each (1%). Landiolol resulted in significantly more patients with sepsis-related tachyarrhythmia achieving a heart rate of 60–94 bpm at 24 h and significantly reduced the incidence of new-onset arrhythmia. Landiolol was also well tolerated, but it should be used under appropriate monitoring of blood pressure and heart rate owing to the risk of hypotension in patients with sepsis and septic shock. Ono Pharmaceutical Co. [ABSTRACT FROM AUTHOR]

Characteristics of high frequency (HF) component based on heart rate variability (HRV) in a large general population remain unclear, particularly on the relationship with daily physical activity. We aimed to characterize the distribution of HF component and examine the association with daily physical activity among community residents. We performed spectral analysis of HRV from 10-second ECG recordings among 9135 residents aged 30 to 74 years in Nagahama City, Japan. HF components were log-transformed to consider the distribution. Simple correlations between HF and age were determined. Age-adjusted mean values of HF component were calculated for each questionnaire item related to daily physical activity. Multiple regression analysis was performed to examine the effect of daily physical activity on HF component value. Mean values of logarithmicallytransformed HF component (lnHF) were higher in women than in men (p < 0.001). lnHF was inversely associated with age (r = -0.40, -0.49 for men, women, respectively). Adjusted mean lnHF for physically active people was significantly higher than that in inactive people (p < 0.001). HF components from 10-second ECG recordings were moderately and negatively correlated with age in both sexes, and positively correlated with daily physical activity in the general adult population. Maintaining the level of daily physical activity, especially to exercise regularly could keep the parasympathetic function high. [ABSTRACT FROM AUTHOR]

Nonischemic heart failure (HF) is common in Japan. We evaluated the long-term outcome of Japanese patients with nonischemic HF receiving carvedilol based on left ventricular ejection fraction (LVEF) category. We conducted a single-center observation study of 1550 patients with nonischemic HF who were initiated with carvedilol between 2005 and 2015. Of these patients, 38% had an LVEF < 40% (HFrEF, median age 57 years, 28% female) and 62% had an LVEF ≥ 40% (HFpEF, 64 years, 38% female). The primary outcome was all-cause.death The secondary outcomes were cardiac death and sudden cardiac death (SCD). After a median follow-up of 5.5 [interquartile range, 2.9–8.8] years, the median daily maintenance doses of carvedilol in patients with HFrEF and HFpEF were 7.5 [5–12.5] mg and 7.5 [5–10] mg, respectively. The cumulative survival rates of HFrEF patients at 1, 3 and 5 years were 96.1%, 90.2% and 85.5%, respectively, and the cumulative survival rates of HFpEF patients at 1, 3 and 5 years were 97.8%, 94.4% and 90.7%, respectively. The cumulative cardiac death-free rates at 5 years were 94.4% in HFrEF patients and 97.7% in HFpEF patients, and the cumulative SCD-free rates at 5 years were 96.7% in HFrEF patients and 97.9% in HFpEF patients. The adjusted survival rate showed that a higher dose (≥ 7.5 mg daily) was associated with more favourable outcomes than a lower dose (< 7.5 mg daily) in HFrEF patients, but not in HFpEF patients. The adjusted survival rate showed that a lower heart rate (< 75 bpm) was associated with favourable outcomes than a higher heart rate (≥ 75 bpm) in HFrEF patients, but not in HFpEF patients. Long-term survival was good in Japanese patients with nonischemic HF receiving carvedilol. Higher doses and lower heart rates were associated with favourable survival for HFrEF patients, but not in HFpEF patients. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the present study was to clarify the effects of a hand massage with a warm hand bath on sleep, autonomic nervous activity, subjective sleep quality, and relaxation in elderly women with sleep disturbance. Methods: A crossover design was used. Participants were assigned to two groups: a structured control first and intervention second condition, or an intervention first and control second condition. The sleep index as assessed by actigraphy, autonomic nervous activity, subjective sleep quality, and relaxation was then recorded. Results: The mean age of the participants was 77.8 ± 6.8 years (n = 28). According to the actigraph, the intervention day showed significantly improved sleep efficiency (p =.048) and sleep onset latency (p =.015). Regarding autonomic nervous activity, heart rate decreased significantly after the intervention (p =.001), but no significant differences were seen in the other indexes. Subjective sleep quality, which was investigated using the middle‐age and aged version of the Oguri–Shirakawa–Azumi sleep questionnaire, was significantly higher after the intervention for four out of five factors. Subjective comfort and relaxation were significantly higher after the intervention for all items. Conclusions: A hand massage with a warm hand bath in the evening improved sleep efficiency and sleep onset latency in elderly women with sleep disturbance. These results suggest that a hand bath and massage may improve subjective sleep quality and relaxation. [ABSTRACT FROM AUTHOR]

Nursing and healthcare-associated pneumonia (NHCAP) is a category of healthcare-associated pneumonia modified for the healthcare system in Japan. To date, only a few studies have examined the prognostic factors of NHCAP in a prospective cohort. This study aimed to investigate the prognostic factors related to 30-day mortality in patients with NHCAP by analyzing prospective data. We analyzed patients hospitalized for NHCAP who were enrolled between October 2010 and February 2017. Age, sex, comorbidities, vital signs and laboratory findings were used as prognostic variables. The primary outcome was 30-day mortality. Of 817 NHCAP patients identified, the mean age was 78.0 ± 11.1 years, 580 (71.0%) were men and 30-day mortality was 13.1% (107/817). On multivariate analysis, male sex (odds ratio [OR]: 2.07, 95% confidence interval [CI]: 1.18–3.63), malignancy (OR: 2.35, 95%CI: 1.38–4.01), performance status (PS) (OR: 1.55, 95%CI: 1.23–1.96), body temperature (OR: 0.77, 95%CI: 0.61–0.97), heart rate (OR: 1.02, 95%CI: 1.01–1.03), respiratory rate (OR: 1.04, 95%CI: 1.01–1.08), serum albumin (Alb) (OR: 0.45, 95%CI: 0.30–0.66) and blood urea nitrogen (BUN) (OR: 1.02, 95%CI: 1.01–1.03) were significantly related to 30-day mortality. On the other hand, the risk factors for involvement by drug-resistant pathogens predicted a better prognosis (OR: 0.39, 95%CI: 0.19–0.82). Male sex, malignancy, poor PS, hypothermia, tachycardia, tachypnea, low serum Alb and high BUN are worse prognostic factors. Thus, the risk of drug-resistant pathogens is not necessarily related to poor prognosis. [ABSTRACT FROM AUTHOR]

BACKGROUND We hypothesized that the association between the dipping heart rate (HR) pattern and cardiovascular (CV) events differs according to the brain natriuretic peptide (BNP) level. METHODS We examined a subgroup of 1,369 patients from the Japan Morning Surge Home Blood Pressure study; these were patients who had CV risk factors and had undergone ambulatory blood pressure (BP) monitoring. HR non-dipping status was defined as (awake HR − sleep HR)/awake HR <0.1, and high BNP was defined as ≥35 pg/ml. We divided the patients into four groups according to their HR dipper status (dipping or non-dipping) and BNP level (normal or high). RESULTS The mean follow-up period was 60 ± 30 months. The primary endpoints were fatal/nonfatal CV events (myocardial infarction, angina pectoris, stroke, hospitalization for heart failure, and aortic dissection). During the follow-up period, 23 patients (2.8%) in the dipper HR with normal BNP group, 8 patients (4.4%) in the non-dipper HR with normal BNP group, 24 patients (9.5%) in the dipper HR with high-BNP group, and 25 patients (21.0%) in the non-dipper HR with high-BNP group suffered primary endpoints (log rank 78.8, P < 0.001). Non-dipper HR was revealed as an independent predictor of CV events (hazard ratio, 2.13; 95% confidence interval, 1.35–3.36; P = 0.001) after adjusting for age, gender and smoking, dyslipidemia, diabetes mellitus, chronic kidney disease, BNP, non-dipper BP, 24-h HR, and 24-h systolic blood pressure. CONCLUSIONS The combination of non-dipper HR and higher BNP was associated with a higher incidence of CV events. [ABSTRACT FROM AUTHOR]

Background: Ground golf is a popular sport among the elderly in Japan. Several types of exercise can reduce the body's mean arterial pressure (MAP), but little is known about how ground golf affects the MAP. We investigated the effects of ground golf on the MAP and the oxygen uptake ( V ̇ O 2 ) in a healthy elderly population. Participants and methods: Thirteen elderly Japanese people (3 males and 10 females, mean age of 66 years) participated. All participants played 8 holes of ground golf 6 times, as game (G)1 to G6. The MAP, heart rate (HR), and V ̇ O 2 were measured at rest and every 5 min during each game. Results: A linear trend analysis revealed that participants' MAP values progressively decreased as each game proceeded with marginal differences (p = 0.054). There were no significant differences in HR between at rest and any of the games. The V ̇ O 2 during the games (except for G6) were significantly higher than that at-rest (p < 0.05). The resting MAP values were negatively associated with the ground golf-induced changes in MAP (r = 0.786, p = 0.001). The participants with greater changes in V ̇ O 2 during the games showed significantly greater reductions in MAP (r = 0.276, p = 0.043). Conclusions: Playing ground golf reduced the participants' MAP and increased their V ̇ O 2 . Participants with higher resting MAP experienced greater reductions in MAP by playing ground golf, which suggests that ground golf can be a useful recreational sport for the elderly. [ABSTRACT FROM AUTHOR]

Background: Landiolol hydrochloride, a highly cardio-selective beta-1 blocker with an ultra-short-acting half-life of 4 minutes, was originally approved by Japan for treatment of intraoperative tachyarrhythmias. This review aims to provide an integrated overview of the current state of knowledge of landiolol hydrochloride in the management of arrhythmia in critical settings.Methods: We searched MEDLINE, EMBASE, and the Cochrane Library to retrieve relevant articles with a total of 65 records identified.Results: The high β1 selectivity (β1/β2 ratio of 255:1) of landiolol causes a more rapid heart rate (HR) decrease compared to esmolol while avoiding decreases in mean arterial blood pressure. Recently, it has been found useful in left ventricular dysfunction patients and fatal arrhythmia requiring emergency treatment. Recent random clinical trials (RCT) have revealed therapeutic and prophylactic effects on arrhythmia, and very low-dose landiolol might be effective for preventing postoperative atrial fibrillation (POAF) and sinus tachycardia. Likewise, landiolol is an optimal choice for perioperative tachycardia treatment during cardiac surgery. The high β1 selectivity of landiolol is useful in heart failure patients as a first-line therapy for tachycardia and arrhythmia as it avoids the typical depression of cardiac function seen in other β-blockers. Application in cardiac injury after percutaneous coronary intervention (PCI), protection for vital organs (lung, kidney, etc.) during sepsis, and stabilizing hemodynamics in pediatric patients are becoming the new frontier of landiolol use.Conclusion: Landiolol is useful as a first-line therapy for the prevention of POAF after cardiac/non-cardiac surgery, fatal arrhythmias in heart failure patients and during PCI. Moreover, the potential therapeutic effect of landiolol for sepsis in pediatric patients is currently being explored. As positive RCT results continue to be published, new clinical uses and further clinical studies in various settings by cardiologists, intensivists and pediatric cardiologists are being conducted. [ABSTRACT FROM AUTHOR]

Cardiogenic shock frequently leads to death even with intensive treatment. Although the leading cause of cardiogenic shock is acute coronary syndrome (ACS), the clinical characteristics and the prognosis of ACS with cardiogenic shock in the present era still remain to be elucidated. We analyzed clinical characteristics and predictors of 30-day mortality in ACS with cardiogenic shock in Japan. The Japanese Circulation Society Cardiovascular Shock registry was a prospective, observational, multicenter, cohort study. Between May 2012 and June 2014, 495 ACS patients with cardiogenic shock were analyzed. The primary endpoint was 30-day all-cause mortality. The median [interquartile range; IQR] age was 71.0 [63.0, 80.0] years. The median [IQR] value of systolic blood pressure (SBP) and heart rate were 75.0 [50.0, 86.5] mm Hg and 65.0 [38.0, 98.0] bpm, respectively. Multivariable analysis showed an odds ratio (OR) of 4.76 (confidence intervals; CI 1.97–11.5, p < 0.001) in the lowest SBP category (< 50 mm Hg) for SBP ≥ 90 mm Hg. Moreover, age per 10 years increase (OR 1.38, CI 1.18–1.61, p = 0.002), deep coma (OR 3.49, CI 1.94–6.34, p < 0.001), congestive heart failure (OR 3.81, CI 2.04–7.59, p < 0.001) and left main trunk disease (LMTD) (OR 2.81, CI 1.55–5.10, p < 0.001) were independent predictors. Severe hypotension, older age, deep coma, congestive heart failure, and LMTD were independent unfavorable factors in ACS complicated by cardiogenic shock in Japan. A prompt assessment of high-risk patients referring to those predictors in emergency room could lead to appropriate treatment without delay. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the effect of an LED lighting on endocrine and autonomic nervous system activity during sleep. In a within‐subject experimental design, participants, ten healthy male students, took a 6‐h sleep from 0:00–6:00 am in an environmentally controlled room during which they were exposed to an LED lighting of approximately 50 lx for 90 min from 1:30–3:00 am, whereas there was no light exposure under the control condition. Compared to the control condition, the heart rate (HR) during light exposure, 1 h before awakening, and 1 h after awakening, was significantly higher under the light exposure condition. Salivary melatonin under the light exposure was significantly higher than that under control condition, meanwhile there was no difference in salivary cortisol secretion. Light exposure during sleep may enhance the sympathetic nervous system activation but not give an impact on the hypothalamic–pituitary–adrenal pathway during sleep. © 2019 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc. [ABSTRACT FROM AUTHOR]

Match demands in international men's lacrosse have yet to be explored. Therefore, this investigation quantified positional match demands of international men's lacrosse. This study quantified activity profiles of 50 lacrosse players [attack (AT): 11, midfield (MD): 22, defense (DF): 17] on Japan's national team, using a global positioning system (GPS), players' acceleration, and a heart rate (HR) apparatus to investigate their movement and physiological load. The study revealed that in thirteen international matches, distance, walk distance, jog distance, low-intensity acceleration, and low-intensity deceleration for the AT and DF groups was significantly greater than for the MD group, but the MD group's average speed and sprint distance were the highest. Multiple comparison tests showed that measurements for the AT and DF groups were significantly greater than the MD group for distance, low-intensity acceleration, medium-intensity decelerations, and low-intensity deceleration. This data can become the physical data for helping coaches with strength and conditioning training at the international level. For MD players, anaerobic power and load condition (long rest, high intensity) should be emphasized. In addition, coaches can decide on tactics and a running- quantity target for the next game by acquiring continuous activity data. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the long‐term safety (primary objective) and efficacy (secondary objective) of antimuscarinic add‐on therapy in patients receiving mirabegron. Methods: During a 2‐week screening period, patients (aged ≥20 years, mirabegron treatment for ≥6 weeks, residual overactive bladder symptoms) received mirabegron 50 mg once daily. These patients were subsequently randomized to 52 weeks' treatment with mirabegron 50 mg/day plus an antimuscarinic (solifenacin 5 mg, propiverine 20 mg, imidafenacin 0.2 mg, or tolterodine 4 mg) with the potential to double the antimuscarinic dose (except for tolterodine) at week 8. Safety assessments included treatment‐emergent adverse events, vital signs, 12‐lead electrocardiograms, post‐void residual volume, and laboratory evaluations. Efficacy was assessed using changes from baseline in overactive bladder symptom score total score; overactive bladder questionnaire short form score; micturitions, urgency episodes, urinary incontinence episodes, and urgency urinary incontinence episodes/24 h; mean volume voided per micturition; and number of night‐time micturitions. Results: Overall, 80.2% of patients (88.1% women, mean age 65 years) experienced at least one treatment‐emergent adverse event, with similar rates for all treatments. The adverse events most commonly reported were dry mouth, nasopharyngitis, and constipation. No marked change was observed in systolic or diastolic blood pressure for any treatment, although pulse rate increased slightly in the mirabegron and propiverine, and mirabegron and tolterodine groups. For all treatments, significant improvements were observed in all efficacy parameters, including overactive bladder symptom score total and questionnaire short form scores. Conclusions: Antimuscarinic add‐on therapy is well tolerated and effective after initial treatment with mirabegron in patients with overactive bladder symptoms. [ABSTRACT FROM AUTHOR]

This study is concerned with the behavior of seismic noise in the period range of a few minutes based on records made by broadband IRIS stations before the catastrophic earthquake of March 11, 2011 in Japan. A formalized technique was used to identify discrete asymmetrical pulses whose amplitudes were an order of magnitude higher than the noise level and that were spaced at intervals longer than 30 minutes. The frequency of pulses at the MAJO station on Honshu 400 km of the earthquake epicenter increased on January 30, 2011 and remained high until March 2, 2011. No such phenomena have been observed at MAJO in the same periods during the preceding 15 years, when the station was in regular operation. The records of other similar stations farther than 1700 km from the epicenter were not found to contain increases in the rate of pulses. We believe that these asymmetrical pulses were due to dilatancy in shallow crustal layers beneath the MAJO station. [ABSTRACT FROM AUTHOR]

Aim: The present study was conducted in order to clarify the effects of a warm hand bath at 40°C for 10 min on the blood flow in the shoulder, skin and deep body temperature, autonomic nervous activity, and subjective comfort in healthy women. Methods: The study's participants were 40 healthy adult women who were randomly assigned to either a structured hand bath first and no hand bath second (Group A) or to no hand bath first and a hand bath second (Group B). The blood flow in the shoulder, skin and deep body temperature, autonomic nervous activity, and subjective comfort then were recorded in all the participants. Results: A repeated‐measures ANOVA revealed no significant difference in the blood flow in the right shoulder or deep body temperature between groups. The skin temperature of the hands, forearms, and arms was significantly increased, but not of the face and upper back. The skin temperature of the forearms was maintained at 0.5°C–1°C higher for 30 min in the hand bath group, compared with the no hand bath group. The hand bath group had a significantly higher heart rate while bathing and a significantly lower parasympathetic nerve activity level during bathing. No significant difference was seen in the sympathetic activity level between groups. The hand bath group had a significantly higher subjective comfort level. Conclusion: Hand baths can improve the level of subjective comfort and increase the heart rate and might affect autonomic nervous activity. The skin temperature of the forearms was maintained for 30 min in the hand bath group. [ABSTRACT FROM AUTHOR]