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Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease in which non-cell-autonomous processes have been proposed as its cause. Non-neuronal cells that constitute the environment around motor neurons are known to mediate the pathogenesis of ALS. Perivascular macrophages (PVM) are immune cells that reside between the blood vessels of the central nervous system and the brain parenchyma; PVM are components of the neurovascular unit and regulate the integrity of the blood-spinal cord barrier (BSCB). However, it is not known whether regulation of BSCB function by PVM is involved in the pathogenesis of ALS. Here, we used SOD1 G93A mice to investigate whether PVM is involved in the pathogenesis of ALS. Immunostaining revealed that the number of PVM was increased during the disease progression of ALS in the spinal cord. We also found that both anti-inflammatory Lyve1 + PVM and pro-inflammatory MHCII + PVM subtypes were increased in SOD1 G93A mice, and that subtype heterogeneity was shifted toward MHCII + PVM compared to wild-type (WT) mice. Then we depleted PVM selectively and continuously in SOD1 G93A mice by repeated injection of clodronate liposomes into the cerebrospinal fluid and assessed motor neuron number, neurological score, and survival. Results showed that PVM depletion prevented the loss of motoneurons, slowed disease progression, and prolonged survival. Further histological analysis showed that PVM depletion prevents BSCB collapse by ameliorating the reduction of extracellular matrix proteins necessary for the maintenance of barrier function. These results indicate that PVM are involved in the pathogenesis of ALS, as PVM degrades the extracellular matrix and reduces BSCB function, which may affect motor neuron loss and disease progression. Targeting PVM interventions may represent a novel ALS therapeutic strategy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Adachi, Miyata, Chida, Hirose, Morisaki, Yamanaka and Misawa.)

High-entropy alloys (HEAs) have attracted considerable attention to improve performance of various electrocatalyst materials. A comprehensive understanding of the relationship between surface atomic-level structures and catalytic properties is essential to boost the development of novel catalysts. In this study, we propose an experimental study platform that enables the vacuum synthesis of atomic-level-controlled single-crystal high-entropy alloy surfaces and evaluates their catalytic properties. The platform provides essential information that is crucial for the microstructural fundamentals of electrocatalysis, i.e., the detailed relationship between multi-component alloy surface microstructures and their catalytic properties. Nanometre-thick epitaxially stacking layers of Pt and equi-atomic-ratio Cr-Mn-Fe-Co-Ni, the so-called Cantor alloy, were synthesised on low-index single-crystal Pt substrates (Pt/Cr-Mn-Fe-Co-Ni/Pt(hkl)) as a Pt-based single-crystal alloy surface model for oxygen reduction reaction (ORR) electrocatalysis. The usefulness of the platform was demonstrated by showing the outperforming oxygen reduction reaction properties of high-entropy alloy surfaces when compared to Pt-Co binary surfaces., (© 2023. The Author(s).)

Predicting the calving time in dairy cattle can help in avoiding calving accidents and reducing burdens on animal caretakers. In this study, we analyzed the behavior of pregnant dairy cattle for 7 days prior to calving, to assess the feasibility of predicting the calving time. Eleven Holstein cows were divided into two groups based on their calving times, that is, in the morning (the Morning Parturition Group) or the evening (the Evening Parturition Group). Their behavior was recorded on video. An analysis was conducted of the daily occurrences of each type of behavior and the number of switches of behavior during the day and at night. A statistical analysis was conducted, using a two-way factorial analysis. The behavioral sequence was analyzed using an adjacency matrix. Hierarchical structure charts were created, using Interpretive Structural Modeling. The results suggest that feeding and exploratory behaviors are associated with the calving time period and thus can be useful when predicting that period. The hierarchical structure charts suggest that the Morning Parturition Group had no definite behavioral sequence pattern, unlike the Evening Parturition Group. The detection of an unstable behavioral sequence pattern might predict the calving time period., (© 2023 The Authors. Animal Science Journal published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Animal Science.)

Background: Knee osteoarthritis (KOA) is associated with reduced quality of life due to knee pain and gait disturbance. However, the evaluation of KOA is mainly based on images and patient-reported outcome measures (PROMs), which are said to be insufficient for functional evaluation. Recently, gait analysis using an accelerometer has been used for functional evaluation of KOA patients. Nevertheless, evaluation of the entire body motion is insufficient. The aim of this study was to clarify the gait characteristics of KOA patients using the distribution of scalar products and the interval time of heel contact during spontaneous walking and to compare them with healthy subjects., Methods: Participants wore a three-axis accelerometer sensor on the third lumbar vertebra and walked for 6 min on a flat path at a free walking speed. The sum of a composite vector (CV) scalar product and a histogram for distribution were used for body motion evaluation. The CV consisted of a synthesis of acceleration data from three axes. In addition to the summation of the CV, a histogram can be created to evaluate in detail the magnitude of the waves. The amount of variation was measured in the left-right and front-back directions. Variability was evaluated from the distribution of heel contact duration between both feet measured from the vertical acceleration., Results: KOA patients showed a smaller sum of CV that converged to small acceleration in the distribution when compared with healthy subjects. In the KOA group, the amount of variation in the forward and backward directions was greater than that in the forward direction. The variability of heel-ground interval time was greater in the KOA group than in healthy subjects., Conclusion: KOA patients walked with less overall body movement, with limited movable range of the knee joint and pain-avoiding motion. The gait of the KOA group was considered unstable, with long time intervals between peaks. The increase in the amount of forward variation was thought to be due to the effect of trunk forward bending during walking. The clinical relevance of this study is that it was possible to evaluate KOA patients' gait quantitatively and qualitatively., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

A 76-year-old man who had been bathing in a hot spring was taken to the hospital in a coma. PCR assay performed on the eschar revealed a serotype Hirano/Kuroki of Orientia tsutsugamushi . Coexisted heatstroke superimposed on multiple underlying risk factors likely led to a fatal clinical course.

We report our experience with blow-out type left ventricular free wall rupture after acute myocardial infarction, treated by a sutureless technique using Hydrofit (a viscous diisocyanate prepolymer). A 70-year-old woman suddenly experienced cardiopulmonary arrest during gastrointestinal endoscopic examination. Computed tomography revealed cardiac tamponade, loss of contrast in the posterolateral wall of the left ventricle and contrast medium leakage into the pericardial cavity from the lateral wall of the left ventricle. Under cardiopulmonary resuscitation, the patient was transferred to our hospital. Percutaneous cardiopulmonary support was initiated in the operating room, and median sternotomy was immediately performed. The myocardial tear and necrotic area were sealed with Hydrofit and further covered with BioGlue and TachoSil under cardioplegic heart arrest. Hemostasis was completely achieved, and cardiopulmonary bypass (CPB) was discontinued under intraaortic balloon pumping (IABP) support. At 5 years after surgery, echocardiography showed no pseudoaneurysm formation. This sutureless repair technique using Hydrofit may be useful for a selected case of blow-out type left ventricular free wall rupture.

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Purpose: Temperature monitoring in the perioperative periods is important in order to avoid both hyperthermia and hypothermia. In our pilot study, we evaluated the usefulness of Bair Hugger™ temperature monitoring system (BHTMS), a forehead deep temperature monitoring system, in the neck and chest under general anesthesia., Methods: After approval from the Sapporo Medical University Research Ethics Board, 30 female patients scheduled for laparoscopic surgery were enrolled in this study. Patients were divided into three groups, depending on the attachment regions of BHTMS sensor. Temperatures obtained from the three regions and each esophageal temperature (T Eso ) were monitored and analyzed., Results: A Bland-Altman plot showed that the mean bias between temperature obtained from the neck and T Eso was + 0.05 °C above T Eso (2SD ± 0.35 °C), and that between temperature obtained from the chest and T Eso was - 0.55 °C above T Eso (2SD ± 0.55 °C)., Conclusion: By using the BHTMS sensor in the neck region, it is possible to monitor core body temperature seamlessly and with high reliability. These results may suggest that the use of BHTMS has high versatility in measuring perioperative core body temperature., Trial Registration: This study was approved by the Sapporo Medical University Research Ethics Board (2015: No. 262-149) and registered with UMIN Clinical Trial Registry ( UMIN000016802 Registered 15 March 2015).

Red Cross Pharmaceutical Association conducted a questionnaire-based survey to evaluate the status of implementation of pharmaceutical intervention as well as personal counseling for outpatients with cancer undergoing chemotherapy. Based on the survey results from 93 hospitals across the country, it was found that pharmacists performed an intervention on outpatients receiving chemotherapy in 68 hospitals(73.1%)and conducted personal counseling for outpatients with cancer in 48 hospitals(51.6%). Out of the 68 hospitals, 20 did not conduct personal counseling for outpatients with cancer. This was attributable to the fact that 14 hospitals did not have a qualified pharmacist, 3 did not have sufficient manpower, and 3 did not have the required system. The results of a logistic regression analysis showed that the number of pharmacists significantly affected implementation of pharmaceutical intervention as well as personal counseling for outpatients with cancer undergoing chemotherapy(p=0.042, p=0.023, respectively). The pharmacists can receive a fee for medical services only after conducting personal counseling for outpatients with cancer undergoing chemotherapy. However, in hospitals with a small number of pharmacists, they could not claim their fees owing to lack of manpower. This survey found that lack of manpower is currently the most important issue.

Demand has been increasing recently for an automated monitoring system of animal behavior as a tool for the management of livestock animals. This study investigated the association between the behavior of dairy cattle and the acceleration data collected using three-axis neck-mounted accelerometers, as well as the feasibility of improving the precision of behavior classifications through machine learning. In total 38 Holstein dairy cows were used, and kept in four different farms. A logger was mounted to each collar to obtain acceleration data for calculating the activity level and variations. At the same time the behavior of the cattle was observed visually. Characteristic acceleration waves were recorded for eating, rumination, and lying, respectively; and the activity level and variations were significantly different among these behaviors (p < 0.01). Decision tree learning was performed on the data set from Farm A and validated its precision; which proved to be 99.2% in cross-validation, and 100% in test data sets from Farms B to D. This study showed that highly precise classifications for eating, rumination, and lying is possible by using decision tree learning to calculate the activity level and variations of cattle based on the data obtained by three-axis accelerometers mounted to a collar., (© 2019 Japanese Society of Animal Science.)

Competing Interests: Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Competing Interests: Conflicts of Interest: None declared.

This randomized controlled trial aimed to examine the effect of the Happy Science doctrine-based group psychotherapy on depressive symptoms in 118 Japanese mental disorder outpatients. The treatment group (n = 58) took part in five 90-min sessions at one-week intervals, while the control group (n = 60) received standard care including medication. Depressive symptoms were assessed before the intervention, 5 weeks after the intervention, and at 3-month follow-up. Compared to the control group, the treatment group showed a significant reduction in depressive symptoms both at post-intervention and at 3-month follow-up. In conclusion, this group psychotherapy might be of benefit in treating depressive symptoms.

Background: A reduction in medical staff such as occurs in hospitals during nights and weekends (off hours) is associated with a worse outcome in patients with several unanticipated critical conditions. Although difficult airway management (DAM) requires the simultaneous assistance of several appropriately trained medical caregivers, data are scarce regarding the association between off-hour presentation and endotracheal intubation (ETI)-related adverse events, especially in the trauma population. The aim of this study was to determine whether off-hour presentation was associated with ETI complications in injured patients with a predicted difficult airway., Methods: This historical cohort study was conducted at a Japanese community emergency department (ED). All patients with inhalation burn, comminuted facial trauma (Abbreviated Injury Scale Score Face ≥3), and penetrating neck injury who underwent ETI from January 2007 to January 2016 in our ED were included. Primary exposure was off-hour presentation, defined as the period from 6:01 PM to 8:00 AM weekdays plus the entire weekend. The primary outcome measure was the occurrence of an ETI-related adverse event, including hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, cuff leak, and mainstem bronchus intubation., Results: Of the 123 patients, 75 (61.0 %) were intubated during off hours. Crude analysis showed that off-hour presentation was significantly associated with an increased risk of ETI-related adverse events [odds ratio (OR), 2.5; 95 % confidence interval (CI), 1.1-5.6; p = 0.033]. The increased risk remained significant after adjusting for potential confounders, including operator being an anesthesiologist, use of a paralytic agent, and injury severity score (OR, 3.0; 95 % CI, 1.1-8.4; p = 0.034)., Conclusions: In this study, off-hour presentation was independently associated with ETI-related adverse events in trauma patients with a predicted difficult airway. These data imply the need for more attentive hospital care during nights and weekends.

We study the effect of network size on synchronized activity in living neuronal networks. Dissociated cortical neurons form synaptic connections in culture and generate synchronized spontaneous activity within 10 days in vitro. Using micropatterned surfaces to extrinsically control the size of neuronal networks, we show that synchronized activity can emerge in a network as small as 12 cells. Furthermore, a detailed comparison of small (∼20 cells), medium (∼100 cells), and large (∼400 cells) networks reveal that synchronized activity becomes destabilized in the small networks. A computational modeling of neural activity is then employed to explore the underlying mechanism responsible for the size effect. We find that the generation and maintenance of the synchronized activity can be minimally described by: (1) the stochastic firing of each neuron in the network, (2) enhancement in the network activity in a positive feedback loop of excitatory synapses, and (3) Ca-dependent suppression of bursting activity. The model further shows that the decrease in total synaptic input to a neuron that drives the positive feedback amplification of correlated activity is a key factor underlying the destabilization of synchrony in smaller networks. Spontaneous neural activity plays a critical role in cortical information processing, and our work constructively clarifies an aspect of the structural basis behind this.

Several elective surgical managements have been reported regarding giant inguinal hernias (GIH), but no case of death. We here present a fatal case of bilateral GIHs in an extremely obese man with dyspnea. Bilateral GIHs are difficult to recognize in extreme obesity. Moreover, operation is recommended when GIH is diagnosed.

A 63-year-old man presented to a nearby doctor with fever and lumbago. Enhanced computed tomography showed a thoracoabdominal aortic aneurysm and enhancement of soft tissue around the aneurysm. He was diagnosed with an infected thoracoabdominal aortic aneurysm and given antibiotics. After 2 weeks, the infection was controlled and he underwent in situ replacement with a bovine pericardial roll graft. A week after the operation, the inflammatory reaction was increased, but the bovine pericardial roll graft was not infected. This suggests that a bovine pericardial roll graft is a suitable material for use in patients with bacterial infections.

Introduction: Polytetrafluoroethylene is ubiquitous in materials commonly used in cooking and industrial applications. Overheated polytetrafluoroethylene can generate toxic fumes, inducing acute pulmonary edema in some cases. However, neither the etiology nor the radiological features of this condition have been determined. For clarification, we report an illustrative case, together with the first comprehensive literature review., Case Presentation: A previously healthy 35-year-old Japanese man who developed severe dyspnea presented to our hospital. He had left a polytetrafluoroethylene-coated pan on a gas-burning stove for 10 hours while unconscious. Upon admission, he was in severe respiratory distress. A chest computed tomographic scan showed massive bilateral patchy consolidations with ground-glass opacities and peripheral area sparing. A diagnosis of polytetrafluoroethylene fume-induced pulmonary edema was made. He was treated with non-invasive positive pressure ventilation and a neutrophil elastase inhibitor, which dramatically alleviated his symptoms and improved his oxygenation. He was discharged without sequelae on hospital day 11. A literature review was performed to survey all reported cases of polytetrafluoroethylene fume-induced pulmonary edema. We searched the PubMed, Embase, Web of Science and OvidSP databases for reports posted between the inception of the databases and 30 September 2014, as well as several Japanese databases (Ichushi Web, J-STAGE, Medical Online, and CiNii). Two radiologists independently interpreted all chest computed tomographic images. Eighteen relevant cases (including the presently reported case) were found. Our search revealed that (1) systemic inflammatory response syndrome was frequently accompanied by pulmonary edema, and (2) common computed tomography findings were bilateral ground-glass opacities, patchy consolidation and peripheral area sparing. Pathophysiological and radiological features were consistent with the exudative phase of acute respiratory distress syndrome. However, the contrast between the lesion and the spared peripheral area was striking and was distinguishable from the common radiological features of acute respiratory distress syndrome., Conclusion: The essential etiology of polytetrafluoroethylene fume-induced pulmonary edema seems to be increased pulmonary vascular permeability caused by an inflammatory response to the toxic fumes. The radiological findings that distinguish polytetrafluoroethylene fume-induced pulmonary edema can be bilateral ground-glass opacity or a patchy consolidation with clear sparing of the peripheral area.

Cryopreservation refers to the long-term storage of mammalian cells. Mammalian serum is generally used as a cryoprotectant, but is associated with problems including the risk of contamination by pathogens and quality control issues. Therefore, a serum-free cryopreservation method needs to be established. In this study, we focused on rakkyo fructan, a fructose polymer, derived from the Japanese shallot as an alternative factor to serum. Fructan contributes to tolerance to frost and dehydration in plants by stabilizing the plant membrane. However, whether fructan protects mammalian cells against freezing stress remains unknown. The ability of rakkyo fructan to be an alternative cryoprotectant to fetal bovine serum (FBS) was examined in the present study. 2E3-O, a mouse hybridoma, was preserved in rakkyo fructan, was highly viable after being defrosted, and then proliferated rapidly. When rakkyo fructan was combined with dimethylsulfoxide (DMSO), its ability to protect the hybridoma against freezing stress was improved. The rakkyo fructan and DMSO mixture was used in the cryopreservation of the mammalian cell lines CHO-DP12, a producer of recombinant antibodies, and HepG2, human hepatoma cells frequently tested in bio-artificial livers. Following the freezing and thawing processes, CHO-DP12 cells retained their ability to produce recombinant antibodies and as did HepG2 cells for albumin and mRNA expression of cytochrome P450 enzymes. These results indicate that rakkyo fructan is a promising cryoprotectant that prevents mammalian cells from freezing stress similar to FBS., (Copyright © 2014 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.)

We previously conducted a multicenter study enrolling 101 dialysis patients with hyperphosphatemia in which lanthanum carbonate (LC) was administered for 2 years. In this study, the administration has been continued for an additional year, and we have evaluated the long-term (a total of 3 years) effects of LC. The average serum phosphorus (P) level was 6.05 mg/dL at the start and decreased to 5.84 mg/dL after 3 years, but no significant differences were observed at both points. The average serum corrected calcium (Ca) level significantly reduced after 3 years (P < 0.001). As results of evaluating the achievement rates with the management target values of serum P, Ca and intact parathyroid hormone (PTH) stated in the Japanese guideline, the achievement rates increased after 3 years. From these results, LC is considered to be a useful P binder that can be used for long-term treatment of hyperphosphatemia, without causing a Ca load., (© 2014 The Authors. Therapeutic Apheresis and Dialysis © 2014 International Society for Apheresis.)

Macrocyclic compounds consisting of three 2,6-pyridylene and three 3,5-pyridylene units linked by acetylene bonds were synthesized by a Sonogashira reaction. The X-ray structures showed π-stacked pairs of two macrocycles, in which a 2,6-pyridylene unit of the one molecule overlaps a 3,5-pyridylene of the other molecule because of dipole-dipole interaction. Atomic force microscope (AFM) measurements revealed fibril structures indicating the stacking of the rigid planar macrocycles. Hydrogen-bonding ability of the macrocyclic inside was demonstrated by the addition of octyl β-D-glucopyranoside.

Mammalian cells are extensively used for production of biopharmaceuticals. Most cells used in industry have infinite proliferative capacity, which provides a high number of cells and corresponding productivity. However, infinite cells will continue to multiply even after cell density reaches sufficient levels. This excess proliferation aggravates the culture environment and induces low productivity. Therefore, after cell density reaches sufficient levels, downregulation of proliferation would prevent such aggravation and extend the culture period and improve productivity. To realize such suitable proliferation, we aimed to establish a novel cell line whose proliferation was spontaneously downregulated after reaching a sufficient population level. Mutagenesis using high-energy beam irradiation was used. CHO-DP12 cells were irradiated with 2.5 Gy X-rays and screened with hydroxyurea and 5-fluorouracil to eliminate any cells multiplying after confluence and to concentrate desired mutants. One clone was established and named CHO-M1. Cell cycle analysis indicated that CHO-M1 cells had a similar cell cycle profile in the exponential growth phase, but cells rapidly accumulated in G1 phase just before confluence and did not progress through the cell cycle. This suggested that until confluence, proliferation of CHO-M1 was similar to parental CHO, but after confluence, it was inhibited and under G1 arrest. The specific antibody production rate of CHO-M1 was kept high, even after confluence, while that of parental CHO was drastically decreased in stationary phase. These results suggest that the desired cell line was successfully established and that high-energy beam irradiation could be an efficient mutagenic technique for breeding industrial cells.

Background: About 39,000 patients were newly prescribed renal replacement therapy in Japan in 2011, resulting in a total of more than 300,000 patients being treated with dialysis. This high prevalence of treated end stage kidney disease (ESKD) patients is an emergent problem that requires immediate attention. We launched a prospective cohort study to evaluate population specific characteristics of the progression of chronic kidney disease (CKD). In this report, we describe the baseline characteristics and risk factors for cardiovascular disease (CVD) prevalence among this cohort., Methods: New patients from 16 nephrology centers who were older than 20 years of age and who visited or were referred for the treatment of CKD stage 2-5, but were not on dialysis therapy, were recruited in this study. At enrollment, medical history, lifestyle behaviors, functional status and current medications were recorded, and blood and urine samples were collected. Estimated glomerular filtration rate (eGFR) was calculated by a modified three-variable equation., Results: We enrolled 1138 patients, 69.6% of whom were male, with a mean age of 68 years. Compared with Western cohorts, patients in this study had a lower body mass index (BMI) and higher proteinuria. The prevalence of CVD was 26.8%, which was lower than that in Western cohorts but higher than that in the general Japanese population. Multivariate analysis demonstrated the following association with CVD prevalence: hypertension (adjusted odds ratio (aOR) 3.57; 95% confidence interval (CI) 1.82-7.02); diabetes (aOR 2.45; 95% CI 1.86-3.23); hemoglobin level less than 11 g/dl (aOR 1.61; 95% CI 1.21-2.15); receiving anti-hypertensive agents (aOR 3.54; 95% CI 2.27-5.53); and statin therapy (aOR 2.73; 95% CI 2.04-3.66). The combination of decreased eGFR and increased proteinuria was also associated with a higher prevalence of CVD., Conclusions: The participants in this cohort had a lower BMI, higher proteinuria and lower prevalence of CVD compared with Western cohorts. Lower eGFR and high proteinuria were associated with CVD prevalence. Prospective follow up of these study patients will contribute to establishment of individual population-based treatment of CKD.

We develop a simplified light source at 461 nm for laser cooling of Sr without frequency-doubling crystals but with blue laser diodes. An anti-reflection coated blue laser diode in an external cavity (Littrow) configuration provides an output power of 40 mW at 461 nm. Another blue laser diode is used to amplify the laser power up to 110 mW by injection locking. For frequency stabilization, we demonstrate modulation-free polarization spectroscopy of Sr in a hollow cathode lamp. The simplification of the laser system achieved in this work is of great importance for the construction of transportable optical lattice clocks.

The effects of lanthanum carbonate on MBD parameters were investigated in 59 hemodialysis patients who were taking calcium carbonate. Lanthanum carbonate (initial dosage: 750 mg/day), as a replacement for or in combination with calcium carbonate and/or sevelamer hydrochloride, was administered for 12 months with increase/decrease of dosages. Lanthanum carbonate replaced calcium carbonate for 21 cases and was co-administered in 38 cases. It replaced sevelamer hydrochloride in 20 cases and was co-administered in 10 cases. Both the number of cases to which calcium carbonate was administered and their dosages decreased to about 70-80% 12 months after the initiation, and cases administered sevelamer decreased to about 30%. In the cases for which lanthanum carbonate was co-administered, the dosages of calcium carbonate and sevelamer slightly decreased. A significant decrease in serum calcium level was observed. In the serum phosphorus levels (P levels), significant decrease compared with the initial level was observed only at six and nine months. Intact parathyroid hormone (iPTH) level remained stable at around 230 pg/mL without significant change. The dosage of vitamin D and cinacalcet remained without significant change. The results of this trial suggest that, if dosages of vitamin D and cinacalcet are adequately controlled, a switch to lanthanum carbonate and its concomitant use are effective to control the Ca and P levels without changing iPTH levels., (© 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.)

Long-term efficacy of lanthanum carbonate on hyperphosphatemia was examined in multicenter dialysis patients. Outcome and efficacy after 2 years was investigated in 101 patients who had undergone lanthanum carbonate administration. Thirty-three cases dropped out by the 2-year point; patients undergoing at least 2 years of administration totaled 68. Reasons for dropping out were as follows: improvement of hyperphosphatemia, nine cases; changing hospitals, seven cases; medical complications, five cases; digestive symptoms, four cases; poor compliance, four cases; parathyroidectomy, two cases; death, two cases. The mean dosage was increased from initial daily dosage of 744 mg to 1266 mg after 1 year, and to 1246 mg after 2 years. Serum phosphate concentration decreased significantly from the initial 6.15 mg to 5.57 mg/dL after 1 year, and to 5.45 mg/dL after 2 years. Although a lowering trend was observed in corrected calcium levels, the difference was not significant. Parathyroid hormone was unchanged. Achievement rate of Japanese Society for Dialysis Therapy (JSDT) management target values for both phosphorus and calcium improved from 32.7% to 50.0% after 1 year, and to 56.5% after 2 years. Lanthanum carbonate is useful as a therapeutic tool for hyperphosphatemia over long durations., (© 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.)

The Great East Japan Earthquake was the first disaster we experienced after the administration of oncology care had mostly shifted from hospitals to outpatient departments in Japan. Disaster medical assistance teams(DMATs)were deployed immediately after the disaster, and actively assisted during the acute phase of the catastrophe. After experiencing the earthquake, we realized the necessity of medical support teams, even for chronic disease. Here we report a multicenter trial of regional medical cooperation for cancer chemotherapy. First, soon after the earthquake, representatives from the regional hospitals discussed the proper roles for each institution. As agreed to in the discussion, cancer patients were redistributed from a disaster base hospital to a local general hospital, and oncologists supported the other regional hospitals on a regular basis. This broad regional network functioned well and patients resumed their treatment as soon as the situation allowed. Second, we performed a survey of the patients and found that the most important problem was patients' lack of understanding of their own illnesses. Third, we conducted an opinion survey of medical professionals on regional medical cooperation. Based on the trial, we found it important in disasters to establish regional cooperation and solid communication systems, and to promote patient education.

Although the white matter lesions, so called leuko-araiosis, often seen in elderly people have been gaining attention due to their association with cognitive dysfunction (CD) and high risk of incident stroke, the pathological significance of these lesions still remains controversial. Therefore, in the present study, we investigated the alterations in oligodendrocytes (OLG), including oligodendrocytes progenitor cells (OPCs), myelin, and CD following chronic cerebral ischemia in rats. SD rats were subjected to bilateral common carotid artery occlusion. Immunohistochemical staining was performed at 2, 4, 6, 8, and 12weeks after the induction of ischemia with anti-NG2 (OPCs), anti-GST-π (OLG), and anti-MBP antibodies in paramedian corpus callosum (CC). CD was assessed by the Morris water maze test. There was a significant decrease in the number of GST-π positive cells at 2weeks after the start of ischemia compared with that seen in the sham group. There was a significant increase of the number of NG2 positive cells at 4weeks in the ischemia group compared with the sham group. In the ischemic group, the amount of MBP was observed to have decreased significantly at each time point compared with the sham group. CD was observed in the ischemic group than that in the sham group at all time points. Our results indicate that remyelination is strongly correlated with the recovery of cognitive dysfunction following chronic cerebral ischemia., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Rupture of an iliac artery aneurysm is rare but could be catastrophic unless it is treated with an appropriate strategy. We reviewed our 10-year institutional experience in treating iliac artery aneurysms to elucidate the effectiveness of open surgical repair strategies for ruptured iliac artery aneurysms in terms of short- and long-term postoperative results., Methods: A total of 26 patients (men/women = 22/4), with a mean age of 72 years, underwent open repair of iliac artery aneurysm with or without rupture (unruptured/ruptured = 15/11) between January 2001 and April 2010. There was no difference in the distribution of aneurysm morphology between the unruptured and ruptured groups, and 20 (76.9%) of the 26 patients had aneurysms involving unilateral or bilateral internal iliac arteries. Long-term event-free survival rates and freedom from secondary intervention were analyzed using the Kaplan-Meier method (follow-up: 55 ± 39 and 40 ± 25 months in the unruptured and ruptured groups, respectively)., Results: There was no difference in the time of surgery between the two groups (351 ± 118 and 348 ± 152 minutes in the unruptured and ruptured groups, respectively), but the ruptured group showed greater blood loss/min (time of surgery) and transfusion volume than the unruptured group. The early postoperative mortality was 6.7% in the unruptured group and 0% in the ruptured group (p = 0.557). There was no difference in the number of postoperative morbidities between the two groups, but the ruptured group showed significantly greater C-reactive protein, lactate dehydrogenase, and total bilirubin levels than the unruptured group. The cardiovascular event-free survival rate at 5 years was 93.3% and 100.0% in the unruptured and ruptured groups, respectively. The secondary intervention-free rate at 5 years was 100.0% and 90.0% in the unruptured and ruptured groups, respectively., Conclusions: The short- and long-term postoperative mortality rates after open repair for iliac artery aneurysms were satisfactorily low and similar in unruptured and ruptured groups. This suggests that open repair strategies remain as a reliable treatment option to obtain successful postoperative results in patients with rupture of an iliac artery aneurysm., (Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

A macrocyclic host molecule having pyridine-pyridone-pyridine modules for saccharide recognition was prepared by Cu(II)-mediated oxidative homocoupling of a tandem diethynyl precursor. In CH(2)Cl(2), the host molecule associated with dodecyl β-maltoside much more strongly (K(a) = 1.4 × 10(6) M(-1)) than with octyl monohexosides (K(a) = ca. 2 × 10(3) to 1 × 10(4) M(-1)), accompanied with induced CDs. An all-pyridine macrocyclic host was also studied, and its binding strength with saccharides was weaker than that for the pyridine-pyridone-pyridine host., (© 2011 American Chemical Society)

Psychosocial stress has been strongly implicated in the biology of adiposity but epidemiological studies have produced inconsistent results. The aim of this analysis was to bring together results from published, longitudinal, prospective studies examining associations between psychosocial stress and objectively measured adiposity in a meta-analysis. Searches were conducted on Medline, PsycINFO, Web of Science, and PubMed (to January 2009) and reference lists from relevant articles were examined. Prospective studies relating psychosocial stress (general life stress (including caregiver stress), work stress) to BMI, body fat, body weight, waist circumference, or waist-to-hip ratio were included. Analyses from 14 cohorts were collated and evaluated. There was no significant heterogeneity, no evidence of publication bias, and no association between study quality and outcomes. The majority of analyses found no significant relationship between stress and adiposity (69%), but among those with significant effects, more found positive than negative associations (25 vs. 6%). Combining results in a meta-analysis showed that stress was associated with increasing adiposity (r = 0.014; confidence interval (CI) = 0.002-0.025, P < 0.05). Effects were stronger for men than women, in analyses with longer rather than shorter follow-ups, and in better quality studies. We conclude that psychosocial stress is a risk factor for weight gain but effects are very small. Variability across studies indicates there are moderating variables to be elucidated.

Macrocycles consisted of pyridine rings and acetylene bonds were prepared by Eglinton coupling from a tandem precursor bearing two terminal alkynyl groups. The composition of molecular size in the cyclized products changed by the reaction solvent. In pyridine, 9-meric and bigger macrocycles were obtained, while that of 6-mer was not. On the other hand, in pyridine/THF mixed solvent, the 6-mer was obtained as a major product.

An increasing number of studies has tested whether greater cardiovascular responses to acute mental stress predict future cardiovascular disease, but results have been variable. This review aimed quantitatively to evaluate the association between cardiovascular responses to laboratory mental stress and subsequent cardiovascular risk status in prospective cohort studies. We searched general bibliographic databases, PsycINFO, Web of Science, and PubMed, up to December 2009. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. There were 169 associations (36 articles) of stress reactivity and 30 associations (5 articles) of poststress recovery in relation to future cardiovascular risk status, including elevated blood pressure, hypertension, left ventricular mass, subclinical atherosclerosis, and clinical cardiac events. The overall meta-analyses showed that greater reactivity to and poor recovery from stress were associated longitudinally with poor cardiovascular status (r=0.091 [95% CI: 0.050 to 0.132], P<0.001, and r=0.096 [95% CI: 0.058 to 0.134], P<0.001, respectively). These findings were supported by more conservative analyses of aggregate effects and by subgroup analyses of the methodologically strong associations. Notably, incident hypertension and increased carotid intima-media thickness were more consistently predicted by greater stress reactivity and poor stress recovery, respectively, whereas both factors were associated with higher future systolic and diastolic blood pressures. In conclusion, the current meta-analysis suggests that greater responsivity to acute mental stress has an adverse effect on future cardiovascular risk status, supporting the use of methods of managing stress responsivity in the prevention and treatment of cardiovascular disease.

Background: The clinical relevance of very highly increased high-sensitivity C-reactive protein (hsCRP) concentrations (>10 mg/L) is incompletely understood. We examined the association between very highly increased hsCRP and risk of incident cardiovascular disease (CVD) events and all-cause mortality., Methods: We recruited 5248 participants free from overt CVD and acute infection [mean age 53.5 (SD 12.4) years, 55.5% women] from the Scottish Health Survey, a representative sample of community-dwelling adults. hsCRP and other conventional risk factors were measured at baseline., Results: Over an average of 7 years' follow-up, there were a total of 259 incident CVD events (including myocardial infarction, coronary artery bypass, percutaneous coronary angioplasty, stroke, heart failure) and 357 all-cause deaths. Very highly increased hsCRP was associated with CVD events after adjustment for Framingham risk score (FRS), body mass index (BMI), central obesity, and hormone replacement therapy (HRT) (hazard ratio 2.40, 95% CI 1.51-3.81) and also with all-cause death (hazard ratio 3.64, 95% CI 2.57-5.15). With the addition of CRP scores to the conventional Framingham model, 7.4% of participants were reclassified into a high-risk (>20% FRS) CVD category. Very highly increased hsCRP was also associated with several modifiable risk factors, including smoking, HDL cholesterol, and central obesity., Conclusions: hsCRP >10 mg/L was a stronger predictor of clinical events than a conventional cut point of 3 mg/L. Very highly increased hsCRP may provide clinically meaningful prognostic information.

Background: Raised levels of C-reactive protein (CRP), a marker of low grade systemic inflammation, is common in ageing populations although the relevance of very highly elevated CRP (>10mg/L) remains unclear. We examined cross-sectional associations of very high CRP with psychosocial, behavioural, and cardiovascular risk factors., Methods: Participants were 5307 men and women from the English Longitudinal Study of Ageing, a study of community dwelling older adults (46.0% men, aged 66.5+/-10.1 years). Psychosocial (social status, marital status, depressive symptoms), behavioural (smoking, physical activity, alcohol), and cardiovascular risk factors (blood pressure, cholesterol, glycated haemoglobin, body mass index, waist) were assessed in relation to CRP., Results: A very high CRP concentration was recorded in 7.5% of the sample. After adjustments for age, sex, acute infection and chronic inflammatory conditions, very high CRP was associated with lower social position, depressive symptoms, physical inactivity, smoking, and alcohol abstinence. There was a linear trend for increased prevalence of cardiovascular risk factors across CRP categories representing low (<1mg/L), medium (1 to <3mg/L), high (3-10mg/L), and very high (>10mg/L), although little differences in risk between high and very high groups were observed., Conclusions: Very high levels of CRP in elderly participants might reflect chronic health and psychosocial adversity, independently of acute infection.

Previous psychological studies have paid extensive attention to the association between psychosocial stress and symptomatic herpes simplex virus (HSV) recurrence, but subsequent research has been conducted and conflicting findings have been published. We aimed to quantify the longitudinal association between psychosocial stress and recurrent HSV in the contemporary literature. We searched Medline; PsycINFO; Web of Science; PubMed up to March 2009, and included prospective studies that investigated associations between psychosocial stress and symptomatic HSV recurrence. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. The overall meta-analysis examining 11 articles (17 psychosocial and disease related relationships) exhibited a robust positive association between psychosocial stress and symptomatic HSV recurrence (correlation coefficient as combined effect size 0.083, 95% confidence interval 0.025-0.141, p=0.005). This finding was supported by more conservative analysis of aggregate effects and by sensitivity analysis of the methodologically strong studies. There were indications of publication bias in some analyses. Intriguingly, sensitivity analyses demonstrated that psychological distress was more strongly associated with symptomatic HSV recurrence than stress stimuli per se, and that psychosocial stress tended to be more strongly associated with oral than genital herpes recurrence. In conclusion, the current review reveals a robust relationship between psychosocial stress and symptomatic HSV recurrence, justifying further research in this field, especially clinical trials evaluating the efficacy of stress reduction interventions on HSV recurrence.

The relative utility of conventional and novel risk factors in predicting cardiovascular disease (CVD) in relation to age remains unclear. We examined the discriminative ability of C-reactive protein (CRP) and Framingham risk score across young (35 to 50 years), middle (51 to 65 years), and older (> or =65 years) aged participants from the Scottish Health Surveys (n = 5,944, 44.5% men). CRP data and conventional risk factors were collected at baseline. During an average follow-up of 7.1 years, 308 CVD events (a composite of fatal and nonfatal events incorporating acute myocardial infarction, coronary artery bypass surgery, percutaneous coronary angioplasty, stroke, and heart failure) occurred. The log CRP/SD predicted the risk of CVD events in middle-age (hazard ratio 2.20, 95% confidence interval 1.34 to 3.61) and older (hazard ratio 1.85, 95% confidence interval 1.23 to 2.78) participants, after adjustment for the Framingham risk score. Using receiver operating characteristic (ROC) curves, the area under the curve for the Framingham risk factor model for predicting CVD events was greater in the younger (ROC 0.78) and middle-age (ROC 0.72) participants than in the older participants (ROC 0.59), although the discriminative ability was not substantially improved by adding the CRP data. In conclusion, our results have demonstrated the steadily decreasing predictive value of conventional risk factors with advancing age, although CRP has limited additive value for CVD risk stratification. Our results provide validation of the recently devised Framingham risk factor algorithm for use in primary care in participants <65 years old.

A 74-year-old woman with massive hemoptysis and shock who had been diagnosed with thoracic aortic rupture underwent in situ replacement of the thoracic aorta using an equine pericardial roll graft. The lower lobe of the left lung was resected because of a massive hematoma and adhesion to the wall of the thoracic aorta. Intraoperative microscopic examination of the resected aortic wall revealed Gram-positive bacteria (alpha-streptococcus in bacterial cultivation). Histology of the resected aorta revealed abscess formation in the media and adventitia of the aortic wall associated with disruption of the media (dissection). Postoperative computed tomography revealed no fluid collection around the graft 1 month after surgery, and magnetic resonance imaging showed no significant graft dilation 20 months after operation. The equine pericardium can be an option of alternative graft materials for in situ replacement of the thoracic aorta in patients with an aortobronchial fistula due to aortic rupture.

There is a growing epidemiological literature focusing on the association between psychosocial stress and human immunodeficiency virus (HIV) disease progression or acquired immunodeficiency syndrome (AIDS), but inconsistent findings have been published. We aimed to quantify the association between adverse psychosocial factors and HIV disease progression. We searched Medline; PsycINFO; Web of Science; PubMed up to 19 January 2009, and included population studies with a prospective design that investigated associations between adverse psychosocial factors and HIV disease progression or AIDS. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. The overall meta-analysis examined 36 articles including 100 psychosocial and disease related relationships. It exhibited a small, but robust positive association between adverse psychosocial factors and HIV progression (correlation coefficient as combined size effect 0.059, 95% confidence interval 0.043-0.074, p<0.001). Notably, sensitivity analyses showed that personality types or coping styles and psychological distress were more strongly associated with greater HIV disease progression than stress stimuli per se, and that all of the immunological and clinical outcome indicators (acquired immunodeficiency syndrome stage, CD4+ T-cell decline, acquired immunodeficiency syndrome diagnosis, acquired immunodeficiency syndrome mortality, and human immunodeficiency virus disease or acquired immunodeficiency syndrome symptoms) except for viral load exhibited detrimental effects by adverse psychosocial factors. In conclusion, the current review reveals a robust relationship between adverse psychosocial factors and HIV disease progression. Furthermore, there would appear to be some evidence for particular psychosocial factors to be most strongly associated with HIV disease progression.

Objectives: This review aimed to evaluate the association between anger and hostility and coronary heart disease (CHD) in prospective cohort studies using quantitative methods., Background: The harmful effect of anger and hostility on CHD has been widely asserted, but previous reviews have been inconclusive., Methods: We searched general bibliographic databases: MEDLINE, PsycINFO, Web of Science, and PubMed up to November 2008. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations., Results: There were 25 studies (21 articles) investigating CHD outcomes in initially healthy populations and 19 studies (18 articles) of samples with existing CHD. Anger and hostility were associated with increased CHD events in the healthy population studies (combined hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.05 to 1.35, p = 0.008) and with poor prognosis in the CHD population studies (HR: 1.24; 95% CI: 1.08 to 1.42, p = 0.002). There were indications of publication bias in these reports, although the fail-safe numbers were 2,020 and 750 for healthy and disease population studies, respectively. Intriguingly, the harmful effect of anger and hostility on CHD events in the healthy populations was greater in men than women. In studies of participants with CHD at baseline that controlled fully for basal disease status and treatment, the association of anger and hostility with poor prognosis persisted., Conclusions: The current review suggests that anger and hostility are associated with CHD outcomes both in healthy and CHD populations. Besides conventional physical and pharmacological interventions, this supports the use of psychological management focusing on anger and hostility in the prevention and treatment of CHD.

Background: Psychological distress, such as ongoing depression and anxiety-related symptomatology, has been associated with a higher risk of incident cancer and poorer survival, although previous studies have not compared prognostic and etiological effects within the same sample. We examined the association between psychological distress and cancer mortality in a sample comprising participants with and without previous cancer admissions., Methods: Data were collected from a community-based sample of 15,453 men and women (including 295 people with cancer history) and prospectively linked to a patient-based database of cancer registry and deaths during an average follow-up of 7.0+/-3.3 years. Psychological distress was assessed using the 12-item version of the General Health Questionnaire (GHQ-12)., Results: There were 425 incident cancer deaths. Psychological distress (GHQ-12 > or =4) was associated with increased cancer mortality in participants with cancer history [age, gender, social status, marital status, body mass index, smoking, alcohol, and physical activity; adjusted hazard ratio (HR)=1.97; 95% confidence interval (95% CI)=1.05-3.71; P=.035], but not in participants without cancer history. Among participants without cancer history, there was, however, an association between distress and lung cancer death (age- and gender-adjusted HR=2.04; 95% CI=1.36-3.06; P=.001), although adjustment for covariates attenuated this association., Conclusions: Psychological distress was a predictor of cancer mortality, especially in lung cancer. The presence of participants with cancer history in community-based cohorts may overestimate the association between psychological distress and subsequent cancer mortality.

The magnitude of the cortisol awakening response, a relatively new indicator of hypothalamic-pituitary-adrenocortical (HPA) axis activation, has been related to a number of psychosocial factors. But findings have been inconsistent across studies. We systematically reviewed previous studies investigating the association between the cortisol awakening response and psychosocial factors. 147 eligible studies from 62 articles were identified. Separate analyses were carried out on the increase in cortisol following waking (CARi), and the integrated volume of cortisol released over the waking period (CARauc). We found that the CARi was positively associated with job stress and general life stress. It was negatively associated with fatigue, burnout, or exhaustion. There were less reliable negative associations between the CARi and positive affects. The CARauc was positively related to general life stress and negatively related to posttraumatic stress syndrome. This review concludes that different psychosocial factors are associated with an enhanced or reduced cortisol awakening response.

Background: The relationship between religiosity/spirituality and physical health has been the subject of growing interest in epidemiological research. We systematically reviewed prospective observational cohort studies of the association between this potentially protective psychological factor and mortality using meta-analytic methods., Methods: We searched general bibliographic databases: Medline, PsycINFO, Web of Science and PubMed (up to 20 March, 2008). Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. Random effects meta-analyses, subgrouping, and sensitivity analysis were performed., Results: There were 69 studies (28 articles) and 22 studies (11 articles) investigating the association between religiosity/spirituality and mortality in initially healthy populations and diseased populations, respectively. The results of the meta-analyses showed that religiosity/spirituality was associated with reduced mortality in healthy population studies (combined hazard ratio = 0.82, 95% CI = 0.76-0.87, p <0.001), but not in diseased population studies (combined hazard ratio = 0.98, 95% CI = 0.94-1.01, p = 0.19). Notably, the protective effect of religiosity/spirituality in the initially healthy population studies was independent of behavioral factors (smoking, drinking, exercising, and socioeconomic status), negative affect, and social support. We divided studies according to the aspects of religiosity/spirituality measure examined, and found that organizational activity (e.g. church attendance) was associated with greater survival in healthy population studies. Multi-dimensional aspects were related to survival in both the healthy and diseased populations. Religiosity/spirituality was negatively associated with cardiovascular mortality in healthy population studies., Conclusions: The current review suggests that religiosity/spirituality has a favorable effect on survival, although the presence of publication biases indicates that results should be interpreted with caution., (2009 S. Karger AG, Basel.)

This meta-analysis included 729 studies from 161 articles investigating how acute stress responsivity (including stress reactivity and recovery of hypothalamic-pituitary-adrenal [HPA] axis, autonomic, and cardiovascular systems) changes with various chronic psychosocial exposures (job stress; general life stress; depression or hopelessness; anxiety, neuroticism, or negative affect; hostility, aggression, or Type-A behavior; fatigue, burnout, or exhaustion; positive psychological states or traits) in healthy populations. In either the overall meta-analysis or the methodologically strong subanalysis, positive psychological states or traits were associated with reduced HPA reactivity. Hostility, aggression, or Type-A behavior was associated with increased cardiovascular (heart rate or blood pressure) reactivity, whereas anxiety, neuroticism, or negative affect was associated with decreased cardiovascular reactivity. General life stress and anxiety, neuroticism, or negative affect were associated with poorer cardiovascular recovery. However, regarding the sympathetic nervous system and parasympathetic nervous system, there were no associations between the chronic psychosocial factors and stress reactivity or recovery. The results largely reflect an integrated stress response pattern of hypo- or hyperactivity depending on the specific nature of the psychosocial background.

Background: Marital status has been clearly linked to subsequent health outcomes in those with established coronary heart disease (CHD). This robust association may be because of both pathophysiological and behavioural mechanisms., Design: We employed meta-regression to examine the association between marital status and attendance at outpatient cardiac rehabilitation (CR) in published studies., Methods: We searched electronic databases, for example, Medline and Science Citation Index, for published studies that reported an association between a measure of marital or partnered status and CR attendance in patients with diagnosed CHD., Results: Eleven studies were identified which incorporated 6,984 CHD patients. Being married/partnered was associated with significantly higher odds of attending CR. Using a fixed effects model, the pooled odds ratio of CR attendance was 1.72 [95% confidence interval (CI) 1.50-1.97] for those who were married/partnered. There was no evidence of heterogeneity of effects (P=0.42) or publication bias (P=0.12)., Conclusion: CHD patients who are married or have a partner are between 1.5-2 times more likely to attend CR. Associations between marital status and CR attendance may partly explain CHD outcomes.