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Background: For patients with ischemic stroke, rapid reperfusion therapy is extremely important. In April 2015, our medical center introduced a rapid response-type doctor car (RRC) system. Here, an emergency medical team, including a physician, is dispatched to the patient's prehospital location. The team then assesses the patient and, if necessary, initiates infusion therapy, excluding thrombolytic therapy. Before arriving at the hospital, a prehospital physician orders the preparation of diagnostic tools and conducts an early consultation to a neurologist in order to begin thrombolytic therapy more swiftly. This study aimed to determine whether the RRC system shortened the time to commence intravenous reperfusion therapy in patients with ischemic stroke. This was a retrospective observational study conducted at a tertiary emergency center in Japan. Cases of patients with ischemic stroke who underwent intravenous thrombolytic therapy from January 2015 to December 2018 were enrolled. They were divided into two groups: RRC group (intervened by RRC system) and non-RRC group (not intervened by RRC system). The groups' door-to-needle (DTN) time was compared. Results: During the study period, 140 patients received intravenous thrombolytic therapy. Among those, 28 were in the RRC group and 28 received the usual prehospital care. Of 56 patients, the median age was 82 years old, and 42.9% of patients were male. The median NIHSS was 14 (IQR 10–21). As for demographics, there were no significant differences between the two groups. Median DTN time was 67 min (IQR 55–79) in RRC group vs. 81 min (IQR 69–107) in usual care group, respectively (P < 0.05). Conclusion: In this study, patients with ischemic stroke in RRC group received intravenous thrombolytic therapy in a shorter time compared to the group that received usual care. [ABSTRACT FROM AUTHOR]

Background. Streptococcal toxic shock-like syndrome (TSLS) is a severe infection caused by group A hemolytic streptococcus. It is clinically characterized by rapidly progressive septic shock and multiple organ failure within just a few hours. TSLS presenting as primary peritonitis is rare, especially in a male. Herein, we report a case of TSLS in a male presenting with primary peritonitis, with a review of 25 cases in Japan. Case Presentation. A 51-year-old male was referred to our hospital with abdominal pain and hypotension. We made a preoperative diagnosis of peritonitis with septic shock and performed an emergency operation. Intraoperative findings indicated no marked origin of the peritonitis. Preoperative blood culture showed the presence of group A hemolytic streptococcus. The patient required intensive care involving artificial respiration, abdominal drainage and cytokine absorption therapy, and was discharged on postoperative day 25. Conclusion. TSLS in a male presenting as primary peritonitis is rare. Although this condition is a severe infection, it can be treated by multimodal therapy. [ABSTRACT FROM AUTHOR]

Improvement of the nutritive value of timothy ( Phleum pratense L.) through breeding should result in enhanced livestock productivity. This study investigated the extent of genotype × crop interaction (G × C) between the first and second crops, and the extent of genotype × year interaction (G × Y) and narrow-sense heritability ( h) of the second crop of the nutritive value of timothy. Twenty-six clones were used to evaluate these interactions in 2007 and 2008, and 17 clones and their half-sib progeny were used to evaluate the h in 2010 in Kunneppu, Japan by analyzing their nutritive value. The content of water-soluble carbohydrate (WSC) was significantly correlated between the two crops in 12 clones with many internode elongation stems (IES) in the second crop and the 2 years, with non-significant effects of G × C in these clones and G × Y. However, the low-digestible fiber (Ob) content and the ratio of Ob to organic cell wall showed weak to medium correlations between the two crops, regardless of IES ratio or the elapsed time of 2 years, with significant effects shown for the two interactions. The h of the three traits was medium to high. These results suggest that, in the second crop, selections for WSC content through the first crop in genotypes with many IES in the second crop, and under multiple environments in other traits are potentially useful; and that recurrent selection which utilizes an additive genetic variance is likely to be effective for the three traits. [ABSTRACT FROM AUTHOR]

Objective: To find out the appropriate dye laser output and frequency for each kind of stone experimentally, and to use flashlamp-excited dye laser for impacted biliary stones. Design: Prospective study. Setting: University hospital, Japan. Subjects: 12 patients undergoing lithotripsy for both intrahepatic and extrahepatic impacted biliary stones. Main outcome measures: Appropriate dye laser output and frequency, histological changes in the bile duct wall, and outcome. Results: Stones were pulverised, and required a median 155 pulses (range 80-205) at 40 mJ for bilirubin stones and 355 pulses (range 205-405) at 50 mJ for cholesterol stones. At the standard energies used, the laser caused only superficial damage to the serosa of the common bile duct. It was successful in fragmenting 133/135 stones (99%), and in addition pulverised 125/135 stones (93%). No patients complained of pain during laser lithotripsy even under local anaesthesia. All patients were discharged from the hospital after an uneventful recovery, and no recurrent stones have been found at outpatient follow-up ranging between 2 and 85 months. Conclusion: Flashlamp-excited dye laser with a small choledochoscope seems to be safe and painless way of treating biliary stones, even if they are impacted in the peripheral biliary tree and patients are at high risk. [ABSTRACT FROM AUTHOR]

Clostridioides difficile (C. difficile) produces three kinds of toxins: toxin A (enterotoxin), toxin B (cytotoxin), and C. difficile transferase (CDT), a binary toxin. Some strains show positivity only for toxin B. These strains reportedly possess a gene for toxin A, tcdA. However, toxin A production is inhibited due to a mutated stop codon and/or deletion within the tcdA gene. Here for the first case in Japan, we describe toxin genomes and proteins of a strain possessing only toxin B and lacking a complete tcdA gene, along with clinical manifestations. C. difficile was isolated from the bloody stool of a 60-year-old female patient treated with meropenem. Although a rapid detection kit of toxins (C. DIFF QUIK CHEK COMPLETE®, TechLab, Blacksburg, VA, USA) showed positivity, Western blotting detected no toxins. Therefore, we explored the strain's toxin genes and their sequences to determine whether the strain possessed a toxin. Polymerase chain reaction did not identify toxin genes. Whole-genome sequencing analysis showed that a gene for toxin A, tcdA , was completely deleted in the strain. Moreover, 701 mutations and some deletions/insertions were identified on the tcdB gene. We isolated a rare strain of C. difficile producing only toxin B and lacking a complete tcdA gene herein Japan. The possibility of a false negative needs to be considered with a genetic method for a diagnose of C. difficile infection. [ABSTRACT FROM AUTHOR]

Numerous accidents in HRSs have been reported worldwide in accident databases; therefore, many researchers have performed quantitative risk assessments (QRAs) of HRSs to enable risk-informed decision making in determining the safety distances or risk mitigation measures. The HRSs, located in urban areas such as Tokyo in Japan, are situated in congested areas with tall buildings and high population density; thus, they have relatively narrow station areas. However, the QRAs are generally suitable for large plants such as nuclear power plants or chemical plants; therefore, relatively small plants or installations, such as HRSs, have not yet been considered as QRA objects. Hence, it is necessary to conduct detailed QRAs with risk analyses and reduce the applied uncertainties for relatively small plants or installations. We applied a model-based approach of risk assessment to model the HRS process using multi-physics system-level modeling and simulated a target system using Modelica—an equation-based, object-oriented modeling language that allows acausal modeling of complex cyber-physical systems The primary aim of this study was to conduct a QRA of an HRS based on multi-physics system-level modeling. First, we modeled the HRS components and physical relationships between the components using basic physical equations. Then, we elucidate a QRA based on the constructed model. The difference in the leakage rates due to the leak positions and dynamic behavior of the model parameters were calculated using the constructed model. Finally, we estimated the individual risks of all the scenarios and compared the resulting risk contours based on the constructed model that includes the hydrogen-fuel dynamic behavior with those based on the traditional model. These results indicate that it is possible to assess whether the risks around the station boundary are acceptable based on the scenario information obtained by evaluating the risks near the station. • A dynamic physical model of a hydrogen refueling station process was developed. • Hydrogen leakage rates estimated by the physical model are obtained. • Individual risks from the physical model and the traditional model were compared. • The risks were refined due to considering the real physical behavior of the process. [ABSTRACT FROM AUTHOR]

Although hydrogen refueling stations (HRSs) are becoming widespread across Japan and are essential for the operation of fuel cell vehicles, they present potential hazards. A large number of accidents such as explosions or fires have been reported, rendering it necessary to conduct a number of qualitative and quantitative risk assessments for HRSs. Current safety codes and technical standards related to Japanese HRSs have been established based on the results of a qualitative risk assessment and quantitative effectiveness validation of safety measures over ten years ago. In the last decade, there has been much development in the technologies of the components or facilities used in domestic HRSs and much operational experience as well as knowledge to use hydrogen in HRSs safely have been gained through years of commercial operation. The purpose of the present study is to conduct a quantitative risk assessment (QRA) of the latest HRS model representing Japanese HRSs with the most current information and to identify the most significant scenarios that pose the greatest risks to the physical surroundings in the HRS model. The results of the QRA show that the risk contours of 10−3 and 10−4 per year were confined within the HRS boundaries, whereas the risk contours of 10−5 and 10−6 per year are still present outside the HRS. Comparing the breakdown of the individual risks (IRs) at the risk ranking points, we conclude that the risk of jet fire demonstrates the highest contribution to the risks at all of the risk ranking points and outside the station. To reduce these risks and confine the risk contour of 10−6 per year within the HRS boundaries, it is necessary to consider risk mitigation measures for jet fires. • A model representing Japanese hydrogen refueling stations under current Japanese laws and regulations was constructed. • A quantitative risk assessment of the model was conducted. • This assessment visualized individual risks of the hydrogen refueling station model. • Jet fire risks are the highest contribution to the individual risks in the outside of the station. [ABSTRACT FROM AUTHOR]

Background: Statins are generally used for patients with coronary artery disease. However, the impact of statins in patients with vasospastic angina (VSA) is not fully understood., Methods: In a multicenter registry study of the Japanese Coronary Spasm Association (n = 1429), patients with or without statins were compared. The primary endpoint was major adverse cardiac events (MACEs), defined as cardiac death, non-fatal myocardial infarction, unstable angina, heart failure, and appropriate implantable cardioverter defibrillator shock. Propensity score matching and a multivariable Cox proportional hazard model were used to adjust for selection bias in treatment and potential confounding factors., Results: In the whole population, 469 patients received statins, while 960 patients did not receive statins. Patients with statins had a greater prevalence of comorbidities, including hypertension, diabetes, dyslipidemia, and smoking, in comparison to those without statins. The prevalence rates of previous myocardial infarction, significant organic stenosis, and medication use (including calcium channel blockers, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, and beta blockers) were greater in patients with statins than in those without statins. After propensity matching (n = 211 for both groups), a Kaplan-Meier curve analysis revealed that the incidence of MACE was comparable between patients with and without statins (p = 0.686). MACEs occurred in 6.0% of patients with statins and in 5.9% of those without statins (p = 0.98)., Conclusion: In this multicenter registry study, statin therapy did not reduce clinical events in VSA patients., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The revision of International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification guidelines for lupus nephritis (LN) was suggested by a working group, who recommended a modified National Institute of Health (NIH) activity and chronicity scoring system to evaluate active and chronic LN lesions. However, whether this approach was useful for estimating long-term prognosis for LN patients is unclear., Methods: We conducted a retrospective cohort study in Japanese subjects with biopsy-proven LN, between 1977 and 2018. Pathologic lesions were evaluated based on ISN/RPS 2003 classifications and the modified NIH scoring system. Patients were grouped by activity index (low, 0-5; moderate, 6-11; high, 12-24), and chronicity index (low, 0-2; moderate, 3-5; high, 6-12). The primary outcome was a composite of end-stage kidney disease (ESKD) or all-cause death, and the secondary outcome was ESKD alone., Results: Sixty-six subjects with a median age of 31 years were included. During median follow-up (11.5 years), 15 patients reached the primary outcome: 10 had ESKD, four had died, and one had ESKD and died. Kaplan-Meier analysis showed that the cumulative primary outcome incidence increased with a higher chronicity index (log-rank trend p  < 0.001). From multivariable survival analysis, moderate (hazard ratio [HR] 6.17, 95% confidence interval [CI] 1.14 to 33.20; p  = 0.034) and high chronicity indices (HR 20.20, 95% CI 1.13 to 359.82; p  = 0.041) were risk factors for the primary outcome., Conclusion: Moderate and high chronicity indices were associated with an increased ESKD risk for LN.

Coronary spasm is an established cause for angina pectoris. Ethnic differences have been suggested among Asian compared to Caucasian patients regarding prevalence, gender distribution, and angiographic patterns of coronary spasm. The aim of this study was to compare contemporary German and Japanese patients with coronary spasm. Between 2011 and 2015, 149 patients with resting angina and unobstructed coronary arteries with acetylcholine-induced epicardial spasm were enrolled in Stuttgart, Germany (n = 69) and Sendai, Japan (n = 80). All patients underwent intracoronary acetylcholine testing according to a standardized protocol. Comprehensive analysis included type of spasm (focal/diffuse), dose of acetylcholine leading to spasm, and frequency of multivessel spasm. Patients in this study were 61 ± 11 years old, predominantly female (54%), and had normal left ventricular ejection fraction (73 ± 9%). Diffuse spasm was the most prevalent type of spasm (85%) whereas focal spasm was found in the remaining 15% of patients. 31% of patients had multivessel spasm. Comparing the German with the Japanese patients, distribution of spasm type (focal/diffuse, p = 0.19) and frequency of multivessel spasm (p = 0.22) were comparable. Moreover, when Japanese patients were compared with German patients and diffuse spasm with focal spasm patients, respectively, no significant differences were observed regarding the acetylcholine dose required to induce spasm (p = 0.078 and p = 0.46, respectively). In conclusion, diffuse epicardial coronary spasm is the most frequent finding among German and Japanese patients with resting angina, unobstructed coronary arteries, and epicardial spasm on acetylcholine testing. Japanese and German patients share several similarities including comparable types of spasm and frequency of multivessel spasm.

Percutaneous endoscopic gastrostomy (PEG), which is frequently used for nutrition management in patients having difficulty with oral intake, is considered a safe procedure. However, serious complications may occur depending on site of the puncture. This study aimed to clarify whether push method PEG construction at the posterior wall (PW) of the greater curvature (GC) had a higher risk of complications. We retrospectively investigated the relationship between puncture site at the PW of the GC and early acute complications in 540 patients receiving PEG. Early acute complications were defined as bleeding or perforation within 30 days after the PEG procedure. PEG-related complications were observed in 80 patients in total, with early acute complications detected in 42 patients. PEG construction at the PW of the GC in 12 cases exhibited a significantly higher occurrence of early acute complications versus PEG at other sites (41.7% vs. 7.0%, p = 0.001). Further, multivariate analysis revealed PW at the GC to be independently associated with early acute complications (OR 9.59, 95% CI 2.82-32.61; p = 0.0003). It may be desirable to avoid PEG at the PW of the GC. If performed, clinicians should pay careful attention to early acute complications.

Background: Along with the global aging, the number of geriatric patients with acute myocardial infarction (AMI) has been increasing. However, temporal trends in the prevalence and outcomes of geriatric patients with AMI, with a special reference to heart failure (HF) on admission, remain to be elucidated., Methods: The Miyagi AMI Registry is a prospective, multicenter, and observational study. This registry was established in 1979 and has been continued for 40 years. We examined a total of 6,596 AMI patients aged ≥70 years (male/female 4,141/2,455) registered in this registry from 2005 to 2016 and divided them into 3 groups according to age [70-79 (n = 3,485), 80-89 (n = 2,601), and ≥90 years (n = 510)]., Results: Of those, 17.6% had HF (Killip class ≥ II) on admission, for which age, female sex, diabetes, and previous MI were identified as independent predictors. Importantly, the prevalence of HF on admission significantly increased in all ages during the study period (all p for trend <0.01). Despite the presence of HF on admission, primary percutaneous coronary intervention (PCI) was performed in about 70% of patients aged in their 80 s and about half of those aged ≥90 years. In each group, performance rate of primary PCI also progressively increased (all p < 0.05) irrespective of concomitant HF. However, in-hospital mortality remained unchanged. Multivariable analysis demonstrated that, even for patients with HF on admission, primary PCI was associated with improved in-hospital mortality in the younger 2 groups [adjusted odds ratios (ORs), 95% confidence intervals (CI) 0.58 (0.36-0.93) for 70s, 0.64 (0.43-0.95) for 80s, and 0.99 (0.44-2.21) for ≥90s], whereas PCI was ineffective to reduce long-term hospitalization ≥30 days in all groups [adjusted ORs (95%CI) 0.90 (0.52-1.54), 0.66 (0.38-1.14), and 0.38 (0.07-2.10)]., Conclusions: These results demonstrate that increasing prevalence of HF on admission and increasing performance of primary PCI counteract each other with resultant unchanged in-hospital outcomes in geriatric AMI patients in Japan., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Esophageal squamous cell carcinoma (ESCC) is common in East Asia and also is often deadly. We sought to determine whether measuring the discoidin domain receptor-1 (DDR1)-both total and phosphorylated proteins-could improve our ability to predict recurrence in ESCC., Materials and Methods: Total DDR1 and phosphorylated DDR1 (pDDR1) were measured using semiquantitative immunohistochemistry in a cohort of 60 patients with ESCC. Association between these immunohistochemical measurements and standard clinical-pathological variables such as patient recurrence-free survival was examined using univariate and multivariate analyses., Results: Six patients (10.0%) had regional recurrence and eight patients (13.3%) had distant recurrence. In univariate analysis, early disease recurrence correlated with intense staining of total DDR1 (P = 0.03) as well as intense staining of pDDR1 (P < 0.001). On multivariate analysis, only regional lymph node metastasis (P = 0.04, HR = 4.20) and intensity of pDDR1 immunohistochemistry (P = 0.03, HR = 4.27) emerged as significant independent prognostic factors for recurrence., Conclusions: This study suggests that immunohistochemical measurements of both the DDR1 protein and pDDR1 can provide prognostic value in ESCC, even when other clinical and pathological factors are also being considered., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aim: Postprandial hypotension (PPH) is recognized as a clinical problem, constituting a potential risk for cerebral and cardiovascular events, as well as mortality. The present study was designed to test the hypothesis that PPH is prevented by slowing the infusion rate of enteral nutrition through tube feeding and by avoiding the administration of antihypertensive drugs just before the start of tube feeding., Methods: Participants were older people receiving tube feeding through gastrostomy who used a geriatric health services facility (n = 12; mean age 79.8 years). Changes in blood pressure during and after enteric nutrient infusion lasting for 1 or 2 h were investigated with or without the administration of antihypertensive drugs just before the start of tube feeding., Results: When enteric nutrient was infused for 1 h, after the administration of antihypertensive drugs, nine of 12 participants showed PPH with a maximal reduction in systolic blood pressure of 37.6 ± 6.5 mmHg. Although PPH was not prevented by avoiding drug administration before infusion (maximal blood pressure reduction 30.2 ± 5.0 mmHg) or by extending the infusion time to 2 h (26.5 ± 7.5 mmHg), the combination of the two actions prevented PPH and reduced the postprandial fall in systolic blood pressure to 17.6 ± 5.8 mmHg., Conclusions: The prevalence of PPH in older people receiving tube feeding was 75%. Slowing the enteric nutrient infusion rate combined with avoiding antihypertensive drugs just before the infusion was useful for preventing PPH. Geriatr Gerontol Int 2018; 18: 1474-1478., (© 2018 Japan Geriatrics Society.)

Annual retrospective surveys of 20 to 31 medical centers performing endovascular treatment of cerebral aneurysms in Japan from 1997 to 2008 were performed to analyze technical and clinical outcomes of endovascular treatment for ruptured cerebral aneurysm. Patients treated with dome embolization using bare platinum coils within 14 days after onset were retrospectively selected, and clinical features, and technical and clinical outcomes at discharge were studied. Retrospective Endovascular Subarachnoid Aneurysm Treatment (RESAT) 1 covers patients treated from 1997, when the Guglielmi detachable coil was introduced, to 2002, just after International Subarachnoid Aneurysm Trial was reported. RESAT 2 to RESAT 7 were conducted annually between 2003 and 2008. Among 5,624 patients with ruptured aneurysms treated within 14 days after onset, 4,782 patients were treated by dome embolization using platinum detachable coils. The patients in this large retrospective survey included 35.8% aged over 70 years, 36.6% with posterior circulation aneurysms, and 29.3% with poor grades (Hunt and Kosnik grades IV and V). The proportion of patients aged over 70 years tended to increase each year from 33.4% in RESAT 1 to 39.8% in RESAT 7, and the proportion of those with posterior circulation aneurysms decreased from 44.2% in RESAT 1 to 23.8% in RESAT 7 (p<0.001). Overall technical success was obtained in 4,666 patients (97.6%), and favorable clinical outcome (good recovery and moderate disability) at discharge was obtained in 88.0% of grade I-III cases and 73.6% of grade I-V cases. Procedure-related morbidity was 2.9% and mortality was 0.8%. Despite this survey involving high proportions of aged, posterior circulation, and poor-grade patients, the technical success rate and immediate clinical results were relatively favorable. The patient prognosis and aneurysm changes must be investigated over a longer period, together with the effects of the introduction of new endovascular devices for cerebral aneurysms.

Increased B-type natriuretic peptide (BNP) expression precedes the development of hypertension in spontaneously hypertensive rats. We therefore tested the hypothesis that elevated plasma BNP levels predict the onset of hypertension in normotensive subjects. Japanese normotensive participants who were at our hospital for a yearly physical check-up (mean age 52.7 years, 35.9% women, n=5,026) were enrolled in the study. Blood pressure and BNP were measured at baseline and subjects were followed up for 5 years (median 1,114 d), with the endpoint being the development of hypertension. We evaluated the relationship between plasma BNP levels at baseline and the incidence of hypertension during the follow-up period. Hypertension was defined as systolic or diastolic blood pressure > or =140 or > or =90 mmHg, respectively, or the use of antihypertensive medications. During the follow-up period, hypertension developed in 23.4% (77.0 per 1,000 person-years) and 14.9% (51.0 per 1,000 person-years) of male and female subjects, respectively. Cox proportional hazard regression analysis demonstrated that after adjustment for known risk factors, the risk of hypertension was increased from the first to fourth quartiles of baseline BNP levels. However, after additional adjustment for baseline blood pressure, BNP did not predict the new onset of hypertension. Baseline BNP levels are closely associated with the risk of hypertension in individuals with normal blood pressure, but the prediction of hypertension with BNP is largely dependent on baseline blood pressure. Measurements of BNP may serve as a complementary method for the prediction or confirmation of hypertension.

Each component of the metabolic syndrome is not necessarily clustered coincidentally. Thus, subjects who have obesity, dyslipidemia or impaired glucose tolerance may be at high risk for the development of hypertension. We studied the predictive value of the following for the development of hypertension: obesity (body mass index > or =25.0 kg/m2), dyslipidemia (high-density lipoprotein-cholesterol <40 mg/dL, triglyceride > or =150 mg/dL, or use of anti-dyslipidemic drugs), high normal blood pressure (130 mmHg < or = systolic <140 mmHg, or 85 mmHg < or = diastolic <90 mmHg), and impaired glucose tolerance (fasting plasma glucose > or =110 mg/dL or use of anti-diabetic agents). This observational study included 5,785 subjects without hypertension recruited from participants in our health checkup program. They were followed up for 1,097+/-365 d, with the endpoint being the development of hypertension. During the follow-up, hypertension developed in 1,168 subjects (74.1 per 1,000 person-years). The incidence of hypertension was higher in subjects who had obesity (106.2 vs. 67.8), dyslipidemia (96.1 vs. 69.0), high normal blood pressure (166.0 vs. 40.1), or impaired glucose tolerance (130.5 vs. 65.3 per 1,000 person-years) than in those without these disorders at baseline. The risk of hypertension was increased as the number of metabolic disorders in an individual increased. Multiple regression analysis indicated that obesity, high normal blood pressure, and impaired glucose tolerance remained independent predictors of the onset of hypertension. Thus, the presence of individual components of the metabolic syndrome predicts the development of hypertension. Prediction of the development of hypertension may lead to effective prevention of both hypertension and resulting cardiovascular diseases.

Background: Inflammation and oxidative stress play a key role in the pathogenesis of atherosclerosis. This study was designed to examine the interrelationships among C-reactive protein (CRP), oxidative stress, and traditional cardiovascular risk factors., Methods: We conducted a cross-sectional analysis among 551 apparently healthy Japanese subjects not receiving medication (mean age, 53+/-11 years; males/females, 400/151). Subject underwent laboratory assessment of cardiovascular disease risk factors, and CRP and 8-isoprostane, a marker of oxidative stress, were measured., Results: In unadjusted analyses, CRP was positively correlated with age, male gender, body mass index, blood pressure, smoking habit, creatinine, uric acid, triglycerides, an index of insulin resistance, and 8-isoprostane, and inversely correlated with high-density lipoprotein-cholesterol. 8-Isoprostane was positively correlated with age, pulse pressure, smoking habit, brain natriuretic peptide, and CRP. In multiple regression analyses, body mass index (r=0.177), high-density lipoprotein-cholesterol (r=-0.162), uric acid (r=0.141), and 8-isoprostane (r=0.097) were independently correlated with CRP (P<0.001), whereas smoking (r=0.341), age (r=0.217), and pulse pressure (r=0.091) remained independently correlated with 8-isoprostane (P<0.001)., Conclusions: CRP levels are associated not only with clinical cardiovascular risk factors but also with oxidative stress. There are significant interrelationships among inflammation, oxidative stress, and traditional cardiovascular risk factors.

To validate a modified version of AOAC official method of analysis 995.10 as an official standard in Japan for determination of patulin in apple juice, an inter-laboratory study was performed in 11 laboratories using a non-contaminated sample, 2 naturally contaminated samples and 2 spiked samples of apple juice. For naturally contaminated apple juices, the relative standard deviations for repeatability and reproducibility were 3.2, 7.1% and 10.0, 21.7%, respectively. HORRAT values were 0.4, 0.9. The average recovery of patulin from spiked sample was 83.7%. The limit of quantification was calculated as 10 microg/kg. From these results, the method was thought to be suitable as an official standard for determination of patulin in apple juice in Japan.