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To investigate the mass mortality of the macrobenthos community, primarily asari clams, triggered by upwelling-driven hypoxia, we conducted continuous observations of temperature, salinity, and DO, and monthly macrobenthos monitoring on the Rokujo tidal flat in Mikawa Bay, central Japan, from 2014 to 2016. Additionally, laboratory experiments were conducted using sediments on a tidal flat containing macrobenthos to examine the possibility of hydrogen sulfide formation in tidal flats. The bottom layer at the offshore station was intermittently hypoxic, and the station of the tidal flat was occasionally hypoxic in August and September for three years. Hypoxia was mostly observed on the tidal flat when constant easterly winds were recorded offshore. The biomass of asari clams decreased considerably from September to October 2016 when hypoxia was intermittent. Hypoxia persisted for approximately one week from 20 September, which was associated with the calm weather and stagnation of tidal currents owing to the neap tide. Conversely, the hydrogen sulfide concentration in the water directly above the sediment exceeded 30 mg L−1 after 3 days of incubation in the laboratory experiment. Therefore, the possibility of oxygen consumption on tidal flats due to hydrogen sulfide formed by biological die-offs was considered in the long-term persistence of hypoxia. [ABSTRACT FROM AUTHOR]

For the treatment of osteosarcoma, cisplatin (CDDP) can be substituted by carboplatin (CBDCA) to reduce toxicity. We report a single institution experience of CBDCA-based regimen. Two to three cycles of CBDCA + ifosfamide (IFO) therapy (window therapy) were administered as neoadjuvant therapy for osteosarcoma. Depending on the response of window therapy, the subsequent protocols were determined; for good responders, surgery is performed, and postoperative therapies with CBDCA + IFO, adriamycin (ADM) and high-dose methotrexate (MTX) were administered; for stable disease, the postoperative regimens were advanced before surgery, and the remaining amount of postoperative chemotherapy is deduced; for progressive disease, CBDCA-based regimen is changed to CDDP-based regimen. From 2009 to 2019, seven patients were treated with this protocol. During the window therapy, two patients (28.6%) were assessed as good responders and completed the regimen as planned. Four patients (57.1%) had stable disease, and the chemotherapy schedules were modified. One patient (14.2%) with progressive disease was shifted to the CDDP-based regimen. At final follow-up, four patients showed no evidence of disease and three patients died of the disease. Since the efficacy during window therapy was limited, a CBDCA-based regimen in the neoadjuvant setting was considered insufficient for performing adequate surgery. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) has been shown to be more frequent in inflammatory bowel disease (IBD) than in the general population in Western studies. However, the actual state of VTE in Asian IBD remains poorly understood. Aims: To reveal the incidence of VTE in IBD patients in Japan. Methods: Eighty-five patients admitted to 3 gastroenterology centers were registered from 2013 to 2018. The incidence of VTE in patients with IBD (n = 42) was prospectively compared to that among patients with other digestive diseases (n = 43). The presence of VTE was surveyed using contrast-enhanced computed tomography and/or ultrasonography at admission and at 1–2 weeks after admission. The patient characteristics and laboratory data of IBD patients with or without VTE were compared to determine the risk factors for VTE. Results: The incidence of VTE with IBD was 16.7%, which was significantly more frequent than with other digestive diseases (2.3%; p = 0.0296). In IBD patients, VTE was detected in 6 of 22 patients with ulcerative colitis (27.2%) but in only 1 of 20 patients with Crohn's disease (5.0%). VTE was diagnosed at admission in 4 IBD patients and 2 weeks after admission in 3 IBD patients. The risk factors of VTE in IBD were the presence of an indwelling central venous catheter, a low level of total protein, a low activated partial thromboplastin time, and a high level of fibrinogen degradation products. Conclusion: VTE was frequently detected in Japanese IBD patients both at and after admission. Adequate screening and prophylaxis for VTE is deemed necessary in IBD. [ABSTRACT FROM AUTHOR]

In Japan, a housing plan has been established involving mainly high‐rise housing and standardization. However, there have been few analyses and studies of the relationship and harmony between people and the natural environment based on the relationship between the residence and the surrounding environment. This paper aims to grasp the environmental perception of residents formed by the arrangement and building plans of settlements, focusing on the resident's residential floor and the location of the dwelling unit, classified as inland side facing land or coastal side facing water. We also explore cognitive characteristics from the constituent and cognitive domain areas of each cognitive domain and perform comparative analysis. Furthermore, we analyze the changes in the cognitive domain caused by vertical displacement of residential floor, aiming to grasp the effect of dwelling unit location and residential floor on formation of environmental perception in high‐rise residences. [ABSTRACT FROM AUTHOR]

Though problematic hoarding is believed to be a universal human behavior, investigations of clinically-defined hoarding disorder (HD) have been confined almost exclusively to Western countries. The current investigation sought to describe and directly compare the features of individuals meeting diagnostic criteria for HD across four distinct cultural settings. Participants were 82 individuals meeting DSM-5 diagnostic criteria for HD, recruited and assessed by trained clinicians at one of four project sites: London, Barcelona, Fukuoka, and Rio de Janeiro. A series of semi-structured interviews and self-report scales were administered, including assessments of socio-demographic characteristics, psychiatric comorbidity, and severity of hoarding and related features. Results indicate that the severity and core features of HD, as well as the cognitions and behaviors commonly associated with this condition, are largely stable across cultures. However, some differences in patient demographics—in particular age, marital status, and clinical expression—as well as comorbid psychiatric features also emerged. These findings confirm that HD, as defined in DSM-5, exists and presents with similar phenomenology across the studied cultures. Future, more fine-grained, research will be needed to study the features of the disorder in additional cultures (e.g., non-industrialized nations) and to evaluate the impact of these cultural aspects on the design of interventions for the disorder. [ABSTRACT FROM AUTHOR]

The present study examined the effect of excessive application of farmyard manure (FM) on rice production and environmental pollution in paddy fields of Japan. A long-term field experiment was conducted during the period 1976–2006 to examine the trends of rice yield and yield components as affected by the excessive FM application (20 Mg ha−1 year−1containing 110 kg N, 180 kg P2O5, and 320 kg K2O). Rice growth, soil fertility, and surface water quality were also assessed in the final year (2006). The results obtained were compared with those of a conventional practice with recommended doses of inorganic fertilizer (IF), i.e. 85 kg N, 68 kg P2O5, and 53 kg K2O ha−1year−1, and an unfertilized control (CR). The excessive FM application resulted in a gradual decrease in grain yield, which was mostly explained by the reduction of grain fertility under the luxuriant rice growth. This reduction may have been due to the higher accumulation of soil nutrients such as N, P, and K. Moreover, the excessive FM application increased chemical oxygen demand, total P, and soluble K concentrations in the paddy surface water and their effluent loads compared to the conventional practice with the recommended IF application. [ABSTRACT FROM AUTHOR]

To better understand how plant-frugivore interactions change in relation to forest stand development, we investigated the abundance and species composition of frugivorous bird assemblages, and their fruit removal over several years in three warm-temperate forest stands. All stands were located in an urban forested area of western Japan, and each was at a different developmental stage: a secondary deciduous broad-leaved forest stand (DB), an evergreen broad-leaved forest stand where an evergreen oak became dominant recently (EB-I), and a well-developed evergreen broad-leaved forest stand (EB-II). Although the species richness and Shannon diversity indices of frugivorous birds did not vary among the three stands, the abundance of birds was almost always greatest in the EB-II stand, lowest in the DB stand, and intermediate in the EB-I stand. Generalized linear mixed model analyses using data on monthly fruit availability and the number of frugivorous birds observed in censuses showed that forest stand differences had a significant effect on the abundance of frugivorous birds, whereas fruit availability had no significant positive influence on bird abundance. Fruit removal was most intensive in the EB-II stand, where both fruit and bird abundance were highest, followed by the EB-I stand, where bird abundance was intermediate but fruit abundance was lowest. Our study demonstrates that increasing structural complexity during forest stand development likely had positive effects on the abundance of frugivorous birds, which in turn influenced fruit removal in this urban forested area. Hence, a positive feedback mechanism of plant-bird interactions would exist for the development of forest stands. [ABSTRACT FROM AUTHOR]

Purpose: Omeprazole has ( R)- and ( S)-enantiomers, which exhibit different pharmacokinetics (PK) among patients with cytochrome P450 (CYP) 2C19 genotype groups. The aim of this study was to investigate whether the 1-point, 4-h postdose ( R)-omeprazole hydroxylation index (HI) of racemic omeprazole reflects the three CYP2C19 genotype groups in Japanese individuals. Methods: Ninety healthy Japanese individuals were enrolled and classified into the three different CYP2C19 genotype groups: homozygous extensive metabolizers (hmEMs; n = 34), heterozygous EMs (htEMs; n = 44), and poor metabolizers (PMs; n = 12). Blood samples were drawn 4 h after the intake of an oral dose of omeprazole 40 mg, and plasma levels of omeprazole and its metabolites were analyzed by high-performance liquid chromatography (HPLC) using a chiral column. Results: Mean plasma concentrations of ( R)- and ( S)-omeprazole in PMs were significantly higher than those in hmEMs and htEMs, and similar results were obtained in the case of omeprazole sulfone. Additionally, there was a significant difference in plasma concentrations of ( R)-5-hydroxyomeprazole among CYP2C19 genotype groups, whereas no significant differences were observed in that of ( S)-5-hydroxyomeprazole. Similarly, ( R)-omeprazole HI in hmEMs, htEMs, and PMs were 5.6, 3.1, and 0.3, respectively, which were significantly different, but no significant difference was present in the ( S)-omeprazole HI. Conclusion: Our findings demonstrate that ( R)-omeprazole HI correlated better with CYP2C19 genotype groups than racemic-omeprazole HI, and these results may be useful for classification among patients in CYP2C19 genotype groups prior to omeprazole treatment. [ABSTRACT FROM AUTHOR]

Background: A subset of patients with hypertrophic cardiomyopathy (HCM) has been reported to progress into dilated-HCM (D-HCM), characterized by left ventricular (LV) systolic dysfunction and cav-ity dilatation, resembling idiopathic dilated cardiomyopathy (DCM). We compared the characteristics, treatments, and outcomes in patients with heart failure (HF) due to D-HCM vs. DCM by using national registry data in Japan. Methods and results: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) is a prospective observational study of patients hospitalized due to worsening HF with an average of 2.2 years of follow-up. Patients with D-HCM (n = 41) were more likely to be male, have prior stroke, atrial fibrillation, and sustained ventricular tachycardia or ventricular fibrillation compared with DCM (n = 486). Echocardiography demonstrated that D-HCM patients had smaller LV end-systolic diameter, higher ejec-tion fraction, and greater wall thickness. Treatments for HF including angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, ß-blocker, and spironolactone were similar between groups except for higher use of amiodarone, warfarin, and implantable cardioverter-defibrillator for D-HCM. Mortality was significantly higher in patients with D-HCM (29.7% vs. 14.4%; p < 0.05). Sudden death tended to be higher also in D-HCM (8.1% vs. 2.6%; p = 0.06), which, however, did not reach statistical significance. Conclusions: HF patients with D-HCM had higher mortality risk than those with DCM. Effective manage-ment strategies are critically needed to be established for D-HCM. [ABSTRACT FROM AUTHOR]

The number of native species growing at all altitudes on Mt. Daisen, which is the highest mountain in the Chugoku District of Japan, is seven. Since soil physical and chemical properties and climate vary due to differences of elevation and habitat, it is logical to assume that they have an adaptive strategy to cope with such changes in the environment. To understand the growth strategy in these species, in the period from July 26 to October 17, 2007, leaves of six herbaceous species (Athyrium vidalii (Fr. et Sav.) Nakai, Carex foliosissima Fr. Schm., Aruncus dioicus (Walt.) Fern., Polygonum cuspidatum Sieb. et Zucc., Artemisia princeps Pamp., and Plantago asiatica L.) were sampled at the different altitudes [Site A; 850 m, Site B; 1200 m, Site C; 1500 m above sea level (a.s.l.)] and nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), and magnesium (Mg) concentrations were determined. Soil chemical properties at sampling day and air and soil temperature during sampling periods at each site were also measured. As a result, we could classify adaptive strategies to the environment for those six species into three types. Type I: mineral accumulation in leaves depends on the habitat and is affected by growing environment with the exception of soil mineral concentration (Pteridophyta, A. vidalii). Type II: mineral accumulation in leaves hardly depends on the habitat and the autonomy of mineral absorption is high, although Ca and Mg concentrations in leaves are affected by soil mineral concentrations and cumulative air temperature (Magnoliophyta, monocotyledon, C. foliosissima). Type III: mineral accumulation in leaves strongly depends on the habitat and soil N concentration, but is also affected by the growing environment, and the autonomy of mineral absorption is weak (Magnoliophyta, dicotyledon, A. dioicus, P. cuspidatum, A. princeps, and P. asiatica). [ABSTRACT FROM AUTHOR]

We surveyed the distribution of colonies of polyps of Aurelia aurita sensu lato ( s.l.) in Mikawa Bay, Japan. First, we surveyed the distribution of ephyrae of A. aurita s.l. at 75 stations encompassing the whole of Mikawa Bay in early 2008. A total of 37 ephyrae were sampled mostly from fishing ports. Ephyrae were most abundant around the islands located near the mouth of the bay, and decreased from the western part to the eastern part of Mikawa Bay. Next, we selected five fishing ports in Mikawa Bay where ephyrae occurred and surveyed the underside of floating piers and underwater overhangs of wharfs. We found dense colonies of polyps of A. aurita s.l. under nearly all of the floating piers at the two islands located near the mouth of the bay. Fitting a logistic regression model to the dataset showed that the percentage coverage of Aurelia polyps was significantly greater at the two islands compared with the other locations. In addition, the coverage of Aurelia polyps was greater when the coverage of other fouling organisms was in the range of 65-90%, and the coverage of Aurelia polyps was lower on floating piers with a vinyl surface and on concrete wharfs. The combined distribution of polyp colonies of A. aurita s.l. in Ise Bay and Mikawa Bay suggested that A. aurita s.l. in the two bays probably forms a single population and shoals of medusae mainly originate from protected harbors along the mouth-part of the bays. [ABSTRACT FROM AUTHOR]

Reports the empirical studies of the bond risk premium in the Japanese government bond market similar to research in the United States Treasury market. Predictors of the excess bond returns; Performance of the dynamic strategy; Impact of forecast signal's strength on return predictability; Rolling yield maximization strategy.

What is the prevalence of triplet and quadruplet pregnancies after single embryo transfer (SET) in Japan. A retrospective observational study was conducted on 274,605 pregnancies after 937,848 SET cycles in registered assisted reproductive technology (ART) data from the Japanese ART national registry database between 2007 and 2014. A questionnaire survey of ART centres was also conducted. Data on pregnancies with embryo division into three or more after SET were analysed. According to the Japanese ART national registry database, SET resulted in 109 triplet pregnancies (0.04% of pregnancies), and the questionnaire reports from 31 centres revealed 33 triplet and one quadruplet pregnancies. After exclusion of 20 duplicated cases, 122 triplet and one quadruplet pregnancies included 46 monochorionic (one gestational sac [37.4%]), 18 dichorionic (two gestational sacs [14.6%]) and 59 trichorionic pregnancies (three gestational sacs [48.0%]). Compared with singleton pregnancies, patients with monozygotic triplet or quadruplet pregnancies were less frequently diagnosed with unexplained infertility (P = 0.004), more often received gonadotrophin injections for ovarian stimulation in 39 cases with information available (P = 0.021) and underwent more blastocyst transfers and assisted hatching (P = 0.002 and P < 0.001, respectively). The proportion of live birth, defined as at least one baby born, excluding induced abortion, was 64.6% (73/116 pregnancies) of monozygotic triplet or quadruplet pregnancies. Combined Japanese ART national registry and survey data revealed 122 triplet and one quadruplet pregnancies, the majority after cryopreserved embryo transfer. Most were conceived after blastocyst transfer and often after assisted hatching, which are potential risk factors for zygotic splitting. [ABSTRACT FROM AUTHOR]

• Cyclic tests were carried out on SHS columns under small amplitude loading. • Local buckling was observed in specimens subjected to small inelastic cycles. • Different deterioration behavior was found for cyclic small amplitude loading. • A stability limit representing the start of significant deterioration was proposed. • A method to predict the number of cycles until the stability limit was proposed. Structural components can be subjected to a limited number of cyclic large drifts during strong earthquakes (e.g., Northridge earthquake, 1994; Kobe earthquake, 1995), as well as many cyclic small amplitude loading during long-duration earthquake excitations (e.g., Tohoku earthquake, 2011). Traditional studies on cyclic behaviors of structural components mainly focused on large drifts and neglected small amplitude loading, rendering them inadequate to represent different seismic loading cases. Square hollow section (SHS) columns are widely used in low- and middle-rise steel building structures in Japan. The bottoms of the first story columns yield under severe earthquakes, even though the strong-column-weak-beam concept is adopted during building design. To better understand the deformation capacities and hysteretic behaviors of steel columns under cyclic small amplitude loading, tests on 26 SHS columns were carried out in this study. The width-to-thickness, axial force, shear span ratios, and loading history of the columns were the main test parameters. The loading histories consisted of monotonic loading, variable amplitude loading, and several constant small amplitude loadings. All specimens exhibited local buckling at the bottom of the columns. Under small amplitude loading, it was observed that the strength of the specimens deteriorated slightly within a certain number of cycles, while the restoring force decreased rapidly afterwards. The stability limit concept was proposed to represent the point when the column's strength starts to deteriorate rapidly; it is based on the axial deformation in the flange in the local buckling region. Accurate prediction methods for the stability limit values and the numbers of cycles until the stability limits were reached were also proposed. [ABSTRACT FROM AUTHOR]

• The design flow of exposed column base in Japan is introduced. • The strength of concrete decreased and stabilized after conical cracks emerged. • The number of effective column rebars in concrete breakout failure is clarified. • A stage-wise approach is proposed to explain the concrete breakout failure behavior. Exposed column bases are extensively used in low-to-medium rise steel structures. However, the stress transfer mechanism in the column base is extremely complicated at various failure modes. One of the failure modes mentioned in the Japanese design recommendations involves the yielding and fracture of anchor rods. To ensure this failure mode, the pull-out failure of the anchor rods—one of the reasons responsible for the concrete breakout failure—has to be prevented. However, in Japan, the current design recommendation regarding the concrete breakout failure is not clear, and the studies that have focused on this topic are limited in number. In this study, experiments were conducted to clarify: 1) the concrete breakout failure mechanism, and 2) the effects of the foundation beam reinforcement on the concrete breakout failure. A total of nine specimens, with varied configurations in anchor rods, foundation beam reinforcement, concrete strength, among others, were loaded to failure. According to the experimental results, the column rebar started to transfer strength after the tension of anchor reached the strength of concrete breakout failure. The current design recommendation overestimates the number of effective column rebars on the concrete breakout failure. As for the contribution of concrete, it decreased as the conical cracks occurred and became stable afterwards. Meanwhile, the foundation beam rebar exhibited negligible effect on the concrete breakout failure. Based on the experimental observations, a stage-wise approach is proposed to quantify the contributions of both the concrete and column reinforcement on the concrete breakout failure of an exposed column base. [ABSTRACT FROM AUTHOR]

A cyclic loading test of a steel moment-resisting frame (SMRF) with nonstructural components was conducted to evaluate the seismic performance of steel buildings subjected to multiple earthquakes. The specimen is a single-floor, one-span substructure of the intermediate story of typical current middle- or low-rise steel building in Japan. Two specimens were tested. The structural systems of these two specimens were the same, but the nonstructural components attached to the steel frame were different. The light gauge steel (LGS) partition wall and the autoclaved lightweight concrete (ALC) exterior wall were used as the nonstructural components of each specimen. One typical set of loading history that corresponds to one earthquake was created based on the response analysis results, and multiple sets of loadings with various levels were loaded to consider the effect of multiple earthquakes. Based on the observed visible damages, it was found that the structural component performed well under multiple earthquakes with a maximum story drift angle less than 1/50, while for the nonstructural component, the ALC wall performed better than the LGS wall. From the obtained load–deformation relationship, it was found that the strength of the structural component and the strength contribution of the LGS wall gradually decreased when subjected to multiple earthquakes, while the strength contribution of the ALC wall fluctuates within a close range. Moreover, the elastic stiffness of the structural component subjected to multiple earthquakes was almost constant, while the stiffness contribution of the nonstructural components decreased. [ABSTRACT FROM AUTHOR]

Background: Several studies have investigated hypopharyngeal cancer (HC) risk in combination with xenobiotic metabolism-related genetic polymorphisms and the burden of alcohol consumption and smoking in European countries but not in East Asian countries., Patients and Methods: This hospital-based case-control study involved 61 male patients with HC and 71 male cancer-free controls. Information on age, body mass index, and alcohol and cigarette consumption was obtained from medical records, a self-completion questionnaire, and a thorough interview by an otolaryngologist. Alcohol dehydrogenase 1B (ADH1B), aldehyde dehydrogenase 2 (ALDH2), cytochrome P450 A1 (CYP1A1) MspI, CYP1A1 Ile462Val, glutathione S-transferase (GST) M1, GSTT1, and GSTP1 gene polymorphisms were determined by polymerase chain reaction-based methods. Univariate and multivariate analyses were performed by adjustment for age by the Mantel-Haenszel method., Results: The burden of alcohol and cigarette consumption significantly increased the risk of HC and showed a synergistic effect. ADH1B*1/*1 (odds ratio [OR] 7.34) and ALDH2 *1/*2 (OR 13.22) were significant risk factors for HC. Individuals with ADH1B*1/*1 or ALDH2 *1/*2 who consumed alcohol were more susceptible to HC. However, polymorphisms of CYP1A1 gene and GSTs were not significant cancer risk factors in patients with HC., Conclusions: ADH1B*1/*1 and ALDH2 *1/*2 were significant risk factors for HC, while polymorphism of CYP1A1 gene and GSTs was not a significant risk factor for HC. These polymorphisms determined the effects of alcohol and cigarette smoke in addition to burden of alcohol and cigarettes intake on the risk of HC., Competing Interests: None

Regional hyperthermia is considered to enhance the antitumor effects of chemotherapy and radiotherapy. In this study, we confirmed the efficacy of concomitant radiotherapy, hyperthermia, and chemotherapy (RHC) for neoadjuvant treatment of malignant soft tissue sarcoma (STS). From 1994 to 2013, we performed RHC in 150 patients. This study was limited to 60 patients using the following exclusion criteria: salvage for recurrence or unplanned excision, trunk location, metastasis at initiation, non-STS, and no definitive surgery. As a control group, we collected data from 11,031 patients in the Bone and Soft Tissue Tumor Registry in Japan (BSTT). We performed multivariate logistic regression analysis, and propensity scores were created for comparisons between groups. The primary outcome of this study was to compare oncologic outcomes (5-year local control rate [LC] and overall survival rate [OS]). In the RHC group, two local recurrences (3.3%) occurred, and no patients underwent amputation. Margins of definitive surgery were not identical between groups [wide margins (60.0% vs. 85.3%), marginal margins (28.3% vs. 10.5%), and intralesional margins (7.4% vs. 4.2%), RHC and BSTT groups, respectively, P < 0.001]. After adjustment, the difference in OS was not significant between groups (HR = 1.26, P = 0.532); however, a statistically significant difference in LC was observed (HR = 4.82, P = 0.037). RHC resulted in a high LC at 5 years compared to the BSTT group, and amputation was averted in the RHC group, despite the wider margins in the BSTT group. This indicates that less invasive surgery might be achieved with effective neoadjuvant therapy., (© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Introduction: Effectiveness and safety of warfarin therapy for non-valvular atrial fibrillation (NVAF) patients are strongly associated with its stability presented such as time in therapeutic range (TTR) of PT-INR. However, the factors that affect TTR have not been fully elucidated in Japan where majority of patients are controlled within the range of 1.6-2.6 of PT-INR irrespective of the age., Methods: We retrospectively analyzed 163 NVAF patients taking warfarin to determine the factors that affect TTR including metabolic enzymes polymorphisms after TTR calculation with both the standard PT-INR range and the actual control range of 1.6-2.6., Results: Overall TTR calculated using Japanese Guideline was 69.7 ± 25.1% (<70 and ≥ 70 years; 49.6 ± 24.8% and 77.8 ± 20.3%, respectively). After confirming that PT-INR values in patients < 70 years distributed in the same range as in those ≥ 70 years, as in a Japanese large cohort, we recalculated TTR of those < 70 years with 1.6-2.6 of PT-INR and found that it was 79.5 ± 20.1%. Poor control of this new TTR were significantly associated with the lower height, the higher serum creatinine, the lower creatinine clearance, female gender, and presence of congestive heart failure, (p<0.05 respectively). Multivariate analysis revealed female gender and presence of congestive heart failure as independent predictor of the lower TTR (p<0.05, p<0.01, respectively). Polymorphism of CYP2C9 and VKORC1 were related to the dosage of warfarin but not determinant of TTR., Conclusions: When evaluated using a range of PT-INR actually used in Japan, TTR is generally well controlled and female gender and presence of congestive heart failure significantly affected the poorer TTR control., (© 2013.)

Aims: Overactive bladder (OAB) affects the daily life of many stroke victims. In contrast to urinary incontinence, little is known about the prevalence and risk factors for OAB among stroke patients. Therefore, we conducted a questionnaire survey and analyzed the results together with the clinical data and MRI findings., Methods: A total of 500 volunteer patients with chronic-phase stroke were enrolled. The overactive bladder symptom score (OABSS), Short Form 8 (SF-8) health survey questionnaire, and some key international questionnaires about urinary dysfunction were assessed., Results: We diagnosed 141 patients (28%) with OAB, among whom 103 (73%) had never been treated for their symptoms. Patients with OAB showed lower scores in both the physical and mental components of the SF-8, which suggested the burden of OAB on the quality of life of stroke patients. Advanced age and male gender were closely related to high OABSS. The modified Rankin Scale (mRS) was positively correlated with OABSS. Patients with cerebral infarction and those with intracerebral hemorrhage showed a similarly high OABSS. The severity of deep white-matter hyperintensity on MRI, classified by the 4-grade Fazekas scoring system, was significantly associated with high OABSS irrespective of presence of accompanying infarcts. Patients with cerebral infarcts in the region of anterior circulation showed a higher OABSS than those with cerebral infarcts in the posterior circulation., Conclusions: Based on the present risk analysis, patient care should be preferentially focused on the detection and treatment of OAB to improve the quality of life of stroke patients., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: A recent worldwide disease registration study has revealed a high prevalence of polyvascular diseases in stroke patients. However, although a poor clinical outcome of patients with polyvascular disease has been reported, there have been few reports on clinical features of peripheral artery disease (PAD) in stroke patients. We assessed the prevalence, demographics, characteristics, and risk factors of PAD in Japanese stroke patients., Methods: One hundred and one consecutive chronic stroke patients in an outpatient clinic underwent ankle-brachial index (ABI) screening tests. PAD was diagnosed when the ABI was <0.9., Results: Abnormal ABI was found in 19 patients (18.8%). Eleven patients were asymptomatic, and 8 patients had symptoms of intermittent claudication. Gender, prevalence of hypertension, and dyslipidemia and alcohol intake were not different between the patients with PAD and those without PAD. Prevalence of diabetes mellitus (63.6%) was higher in the patients with asymptomatic PAD. Among the clinical subtypes of stroke, the patients with atherothrombotic infarction had a higher prevalence of PAD., Conclusions: The prevalence of PAD in stroke patients was 18.8%. Approximately 60% of the patients had no symptoms related to PAD. Diabetes mellitus was associated with higher prevalence of asymptomatic PAD among Japanese stroke patients., (Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

A new species of the Macrochironidae Humes & Boxshall, 1996 (Copepoda: Cyclopoida), Pseudomacrochiron aureliae n. sp., is described based on adult specimens extracted from the gastrovacular cavity of the scyphistomae of Aurelia sp. (Cnidaria: Scyphozoa) collected in the Seto Inland Sea and Ise Bay off the coast of Japan. The new species differs from its congeners by having the following combination of characters: a caudal ramus with a length to width ratio of 3.1; an accessory flagellum on caudal setae II, III and VI; three apical setae on the maxillule; only setae I and II on the maxillary basis; two short spines on the female maxilliped claw (endopod); an armature of III, I, 4 on the terminal exopodal segment of leg 3; an armature of I, II, 2 on the terminal endopodal segment of leg 3; an armature of II, I, 4 on the terminal exopodal segment of leg 4; and a short free exopodal segment of leg 5 (length to width ratio of 1.4) armed with a long seta and short spine. P. aureliae n. sp. is the first member of the genus reported from off Japan and from the scyphistomae of its scyphozoan host.

Background: The recently developed real-time 3-dimensional echocardiography (RT3DE) is a promising imaging method to quantify cardiac chamber volumes and their functions in clinical practice. However, normal reference values of RT3DE parameters have not been fully investigated in a large, healthy Japanese population., Methods and Results: This study consisted of 410 healthy subjects aged from 20 to 69 years who had a RT3DE at one of the 23 collaborating institutions. All subjects had no history of cardiac disease and no risk factors. The mean values in men and women were as follows: 50 ± 12 ml/m(2) and 46 ± 9 ml/m(2) for left ventricular (LV) end-diastolic volume index, 19 ± 5 ml/m(2) and 17 ± 4 ml/m(2) for end-systolic volume index, 61 ± 4% and 63 ± 4% for ejection fraction, 64 ± 1 2 g/m(2) and 56 ± 11 g/m(2) for mass index, 23 ± 6 ml/m(2) and 24 ± 6 ml/m(2) for left atrial (LA) maximum volume index, 10 ± 3 ml/m(2) and 10 ± 3 ml/m(2) for minimum volume index, and 58 ± 6% and 58 ± 6% for percent volume change. LV sizes decreased with age, whereas LV mass index did not change. LA sizes slightly increased with age., Conclusions: This multicenter investigation determined normal reference values for LV and LA sizes, and their functional parameters on RT3DE in a large, healthy Japanese population. The results of the present study support the use of RT3DE for the diagnosis and management of cardiovascular disease.

Objectives: The aim of this study was to investigate the effects of surgical ventricular reconstruction (SVR) on cardiac efficiency as a surrogate marker for cardiac function and oxidative metabolism in patients with severe heart failure., Background: Our new integrated overlapping left ventriculoplasty, modified SVR, combined with mitral complex reconstruction, reduce left ventricular (LV) volume associated with improvement of symptoms of heart failure., Methods: Twelve consecutive patients with end-stage heart failure due to nonischemic dilated cardiomyopathy (DCM) (n = 6) and ischemic dilated cardiomyopathy (ICM) (n = 6) who underwent SVR were studied. Myocardial oxidative metabolism per gram of tissue was estimated by monoexponential clearance of (11)C-acetate positron emission tomography (K(mono)). Forward stroke volume at the LV outflow tract was measured by echocardiography. Cardiac efficiency was estimated by the ratio of external work (stroke volume at the LV outflow tract index × systolic blood pressure × heart rate) to K(mono) before and 1 month after SVR., Results: After SVR, medians of New York Heart Association functional class significantly improved from 3 to 1.5 (p < 0.01) in both DCM and ICM patients. End-systolic and end-diastolic volume and LV mass significantly decreased in both groups. Stroke volume at the LV outflow tract increased from 43 ± 8 ml to 52 ± 11 ml (p = 0.028) in DCM patients, but not in ICM patients (49 ± 21 ml to 59 ± 26 ml, p = 0.12). K(mono) × LV mass, as an index of global LV oxidative metabolism, decreased in DCM patients (13.6 ± 1.9 g/min vs. 8.6 ± 1.5 g/min, p = 0.03) and ICM patients (12.0 ± 3.4 g/min vs. 9.2 ± 1.0 g/min, p = 0.06). As a result, cardiac efficiency increased in all patients with DCM (3.34 ± 0.46 × 10E6 vs. 4.74 ± 0.88 × 10E6 mm Hg·ml·min/m(2), p = 0.03) and in 5 of 6 patients with ICM (4.54 ± 1.66 × 10E6 vs. 5.99 ± 2.11 × 10E6 mm Hg·ml·min/m(2), p = 0.12)., Conclusions: Combined surgery with SVR and mitral complex reconstruction reduced LV volume in association with improvement of cardiac efficiency in patients with severe heart failure., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Rice cake is a traditional but very popular food in Asia including Japan and has never been known as a cause of ileus. Rice cake is now becoming widespread in the United States and European countries along with other Japanese foods. We may encounter rice cake ileus all over the world. This study was aimed at characterizing the rice cake ileus., Methods: We consecutively encountered 14 patients with rice cake ileus from April 2003 to October 2010 in our hospital. All of the characteristics of the cases were reviewed and analyzed., Results: All patients had ingested rice cake by swallowing without chewing. It has most frequently occurred in January (57.1%). The main symptoms were abdominal colicky pain (100%) and nausea (85.7%) and physical findings included abdominal tenderness (100%) and muscular defense (28.6%). All patients improved by conservative therapy including fluid supply (100%), naso-gastric tube (28.6%) and long tube (28.6%) insertion. No patient needed emergency open surgery., Conclusion: Rice cake ileus which is caused by swallowing the rice cake without chewing, frequently occurs in January, has previous history of abdominal surgery and shows high density intestinal contents on CT and only needs conservative therapy. Globalism in food culture may provide a new disease entity. Therefore, we should be aware of this type of ileus and be prepared to manage it appropriately.

Background: Obesity is a risk factor for cardiovascular disease (CVD) and is also associated with an increased risk of death in subjects without CVD. However, in heart failure (HF), elevated body mass index (BMI) has been shown to be associated with better prognosis, but it is unknown whether this is the case in unselected HF patients encountered in routine clinical practice in Japan., Methods and Results: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) studied prospectively the characteristics and treatments in a broad sample of patients hospitalized with worsening HF and the outcomes were followed for 2.1 years. Study cohort (n=2,488) was classified into 3 groups according to baseline BMI: <20.3kg/m(2) (n=829), 20.3-23.49kg/m(2) (n=832), and ≥23.5kg/m(2) (n=827). The mean BMI was 22.3±4.1kg/m(2). Patients with higher BMI had lower rates of all-cause death, cardiac death, and rehospitalization because of worsening HF. After multivariable adjustment, the risk for all-cause death and cardiac death significantly increased with decreased BMI levels compared with patients with BMI ≥23.5kg/m(2). However, BMI levels were not associated with rehospitalization for worsening HF., Conclusions: Lower BMI was independently associated with increased long-term all-cause, as well as cardiac, mortality in patients with HF encountered in routine clinical practice in Japan.

Large-scale, placebo-controlled, randomized clinical trials have shown that angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) reduce mortality and hospitalization in patients with heart failure (HF) caused by left ventricular systolic dysfunction (LVSD). However, it is unknown whether ACE inhibitors and ARBs have similar effects on the long-term outcomes in HF patients encountered in routine clinical practice. The Japanese Cardiac Registry of Heart Failure in Cardiology enrolled HF patients hospitalized with worsening symptoms and they were followed during an average of 2.2 years. The outcome data were compared in patients with LVSD by echocardiography (ejection fraction, EF <40%) according to the predischarge use of ACE inhibitors (n=356) or ARBs (n=372). The clinical characteristics were similar between patients with ACE inhibitor and ARB use, except for higher prevalence of hypertensive etiology and diabetes mellitus. There was no significant difference between ACE inhibitor and ARB use in all-cause death (adjusted hazard ratio 0.958, 95% confidence interval 0.601-1.527, P=0.858) and rehospitalization (adjusted hazard ratio 0.964, 95% confidence interval 0.683-1.362, P=0.836). The effects of ACE inhibitor and ARB use on the outcomes were generally consistent across all clinically relevant subgroups examined, including age, sex, etiology, EF, hypertension, diabetes mellitus, and beta-blocker use. Discharge use of ARBs provided comparable effects with ACE inhibitors on outcomes in patients hospitalized for HF. These findings provide further support for guideline recommendations that ARBs can be used in patients with HF and LVSD as an alternative of ACE inhibitors.