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Our previous cross-sectional study showed that periodic limb movements during sleep (PLMS) were frequently found in patients with obstructive sleep apnea (OSA) and that both OSA and PLMS were associated with higher plasma fibrinogen levels. We explored the longitudinal relationships among these factors. Plasma fibrinogen levels were measured in 333 consecutive patients who underwent polysomnography to diagnose OSA. Patients who initiated continuous positive airway pressure (CPAP) underwent follow-up polysomnography after 3 months of CPAP use. They were categorized into groups with good or poor adherence (% days with ≥ 4 h/night of CPAP use ≥ 70% or

Background: Cerebral venous thrombosis is an uncommon type of stroke that sometimes affects young to middle-aged patients. Various conditions can cause CVT, including drugs, infection, dehydration, pregnancy, malignancies, and acquired and congenital thrombophilia. Hereditary thrombophilia caused by genetic mutation, such as antithrombin, protein C (PC) and protein S (PS), requires warning about the risk and signs of thrombosis recurring. Because CVT itself is a rare disease, it’s sometimes difficult to diagnosis the hereditary thrombophilia in each case. This study describes the clinical features and causes related to CVT in Japan, and elucidates the characteristics of CVT caused by hereditary thrombophilia. Methods: We enrolled 40 patients (24 males, 16 females, age: 18-81 years) diagnosed CVT confirmed by either magnetic resonance venography, enhanced computed tomography, or angiography. Demographic data and clinical features were recorded and compared. Results: Eleven patients (6 males, 5 females, age: 27-71 years) were diagnosed CVT due to congenital thrombophilia, and the other twenty-nine patients (18 males, 11 females, age: 18-81 years) were not. Congenital thrombophilia included five patients with PS gene mutation, three with PC gene mutation, two with antithrombin gene mutation, and one alpha fibrinogen gene mutation. Although we failed to detect a significant statistical difference between congenital thrombophilia patients and others with regards to age, sex, symptoms, vein of occlusion, d-dimer levels, activity levels of PS and PC were significantly decreased in congenital thrombophilia patients. Discussion: Cerebral venous thrombosis in Japanese patients is frequently associated PS or PC gene mutations. This study showed CVT caused by congenital thrombophilia had low activity of PS and PC. Clinicians should aware the presence of PS or PC gene mutations during the treatment of CVT and check the PS and PC activity.

The aims were to evaluate the relationship between idiopathic hyperaldosteronism (IHA) and grade of vascular function in the macrovasculature and microvasculature. Vascular function, including reactive hyperemia index (RIH), flow-mediated vasodilation (FMD), and nitroglycerine-induced vasodilation (NID) were evaluated in 52 patients with IHA, 53 patients with aldosterone-producing adenoma (APA), and 52 age-, sex-, and blood pressure-matched patients with essential hypertension (EHT). Log RHI was lower in the IHA and APA groups than in the EHT group (0.54 ± 0.25 and 0.55 ± 0.23 versus 0.79 ± 0.28; P

It is well known that the prevalence of sleep disordered breathing (SDB) is increased in patients with obesity or metabolic comorbidities. However, the way in which the prevalence of SDB increases in relation to comorbidities according to the severity of obesity remains unclear.This cross-sectional study evaluated 7713 community participants using nocturnal oximetry ≥2 nights. SDB was assessed by the 3% oxygen desaturation index corrected for sleep duration obtained by wrist actigraphy (acti-ODI3%). SDB severity was defined by acti-ODI3%. Obesity was defined as body mass index ≥25 kg·m−2.The prevalence of SDB was 41.0% (95% CI 39.9–42.1%), 46.9% (45.8–48.0%), 10.1% (9.5–10.8%) and 2.0% (1.7–2.3%) in normal, mild, moderate and severe SDB, respectively, with notable sex differences evident (males>post-menopausal females>premenopausal females). Comorbidities such as hypertension, diabetes and metabolic syndrome were independently associated with the prevalence of moderate-to-severe SDB, and coincidence of any one of these with obesity was associated with a higher probability of moderate-to-severe SDB (hypertension OR 8.2, 95% CI 6.6–10.2; diabetes OR 7.8, 95% CI 5.6–10.9; metabolic syndrome OR 6.7, 95% CI 5.2–8.6). Dyslipidaemia in addition to obesity was not additively associated with the prevalence of moderate-to-severe SDB. The number of antihypertensive drugs was associated with SDB (p for trend Metabolic comorbidities contribute to SDB regardless of the degree of obesity. We should recognise the extremely high prevalence of moderate-to-severe SDB in patients with obesity and metabolic comorbidities.

Detailed investigation on fracture toughness and destruction process was made on acrylic adhesive joints. Tapered double cantilever beam (TDCB), end notched flexure (ENF), and lap shear test were measured using acoustic emission (AE) and digital image correlation (DIC). Two types of secondary generation acrylic adhesives (SGA) were compared. Under lap shear and TDCB measurements, cumulative AE energy reflects the difference between elastomer and acrylic composition in existence form observed under transmission electron microscope (TEM) images. The mode 2 energy release rate G2c, was a smaller value than the mode 1 energy release rate G1c, when derived using linear fracture mechanics. Nonlinear effect is necessary to determine an accurate G2c value. The AE source location analysis, performed in an ENF test, detected the relationship between an actual crack length and an AE generation position. The result of this research is useful to understand the fracture process in a SGA bonded joint.

Although reactive hyperemia-peripheral arterial tonometry (RH-PAT) is widely used for assessment of endothelial function, RH index (RHI) cannot be measured in some cases when pulse wave amplitude (PWA) is very low. Decrease in PWA is mainly caused by proper palmar digital artery (PPDA) stenosis. The purpose of this study was to evaluate the relationship between PWA measured by RH-PAT and stenosis of the PPDA measured by digital subtraction angiography and to evaluate the limitation of assessment of endothelial function measured by RHI in patients with PPDA stenosis.We measured baseline PWA in 51 fingers including the first to third fingers of both hands in 10 patients who had PPDA stenosis and in 66 fingers that were the first fingers of both hands in 33 subjects who had no PPDA stenosis. Severe stenosis was defined as over 75% by lower percent diameter stenosis between two PPDAs in a finger.PWA was significantly correlated with stenosis of the digital artery (r=-0.55; P0.0001). A PWV value of 300mV was the optimal cut-off value for severe stenosis (sensitivity, 84.0%; specificity, 88.5%). Log RHI was significantly lower in patients with PPDA stenosis than in subjects without PPDA stenosis (0.33±0.27 versus 0.73±0.27, P=0.007).RH-PAT may be useful for assessment of not only endothelial function but also PPDA stenosis. RHI may be underestimated in patients with PPDA stenosis. We should pay attention to low baseline PWA when measuring RHI.URL for clinical trial: http://UMIN; registration number for clinical trial: UMIN000003409.

We explored the relationship between abdominal vein thromboses, including portal vein thrombosis (PVT) and superior mesenteric vein thrombosis (SMVT), and thrombophilia. The frequency of thrombophilia, such as antithrombin (AT), protein C (PC), or protein S (PS) gene mutations, was examined in 21 patients with PVT, 6 patients with SMVT, and 6 patients with both PVT and SMVT. Low levels of AT, PC, or PS were frequently detected in patients with PVT or mesenteric vein thrombosis, and 4 mutations in the PS gene, 3 mutations in the PC gene, and 2 mutations in AT the gene were detected. Protein S Tokushima was detected in 3 of 4 patients with a PS gene mutation and was associated with 2 other PS gene mutations. The onset of PVT or SMVT was almost idiopathic in patients with congenital thrombophilia. Both PVT and SMVT were frequently caused by an AT, a PC, or a PS mutation, and the onset of these thromboses due to thrombophilia was frequently idiopathic.

Purpose: Fetal growth restriction (FGR) is a concerning health issue. However, studies on FGR management are limited due to its rarity. We aimed to evaluate the efficacy of the contraction stress test (CST) for FGR management.Materials and methods: A case-control retrospective study design. Our institute innovated CST in FGR management in 2017. We included women in their 33rd–40th week of pregnancy with a diagnosis of FGR and retrospectively divided them into groups: the CST group (FGR management with CST) and no CST group (FGR management without CST) before and after CST development. Neonatal outcome, pH, and pO2 of umbilical artery (UA) were compared between the two groups.Results: No significant differences in the rate of birth weight, Apgar score

The combination of the redox-active mesogenic anion [NiII (Bdt)(BdtSQ)]- (Bdt=1,2-benzenedithiolato; BdtSQ=1,2-dithia-semi-benzoquinonato) with alkyl-substituted ammonium cations afforded a series of redox-active ionic complexes of the type [NR4 ][NiII (Bdt)(BdtSQ)] [R=nC16 H33 (NC164 Ni) and C8,10 (NC8,104 Ni); C8,10=6-octylhexadecyl] or [NMe2 R2 ][NiII (Bdt)(BdtSQ)] [R=nC16 H33 (NMe2 C162 Ni) and C8,10 (NMe2 C8,102 Ni)]. X-ray crystallographic analyses of NMe2 C162 Ni and NC164 Ni revealed the formation of cation-dependent integrated ionic layers separated by interdigittated alkyl chains. Complexes NMe2 C162 Ni and NC164 Ni commonly form crystalline phases at room temperature, whereas complexes NMe2 C8,102 Ni and NC8,104 Ni, which contain branched alkyl chains, form a metastable mesophase and an amorphous phase at the same temperature, respectively. Furthermore, complexes NMe2 C162 Ni, NMe2 C8,102 Ni, and NC164 Ni commonly form a smectic A phase (SmA) at 375, 317, and 342 K, respectively. For the four complexes, well-defined cyclic voltammetry responses, derived from ligand-based oxidation and reduction, were observed in solution and the condensed phases, that is, upon casting these complexes on an indium-doped tin oxide working electrode. The present study demonstrates the tunability of the mesomorphism of ionic molecular assemblies composed of alkyl-substituted quaternary ammonium cations, while maintaining the well-defined redox responses of the anions even in the condensed phases.

The usefulness of the waveform of activated partial thromboplastin time (APTT) in various diseases has been evaluated in recent years. The APTT waveform was examined in patients with hemophilia and patients positive for lupus anticoagulant (LA). The correlation with the FVIII activity was highest for the height of acceleration peak. The peak time of acceleration, velocity, and ½ fibrin formation, and the width of acceleration and velocity were significantly long and the height of acceleration was significantly low in patients with hemophilia. The height of velocity was significantly low in patients with hemophilia with inhibitor. There were no significant differences in the APTT waveform between patients with hemophilia and patients with LA, but the peak of acceleration and ½ fibrin formation were significantly longer and the height of acceleration and velocity were significantly lower in patients with hemophilia with inhibitor than in the patients with LA. Wave changes in the APTT were observed in all 22 patients positive for LA, while a biphasic waveform was observed in patients with hemophilia with FVIII activity

Baseline brachial artery (BBA) diameter has been reported to be a potential confounding factor of flow-mediated vasodilation (FMD). The purpose of this study was to evaluate the relationships between BBA diameter and cardiovascular risk factors and compare the diagnostic accuracy of BBA diameter in subjects without cardiovascular risk factors and patients with cardiovascular disease (CVD) with that of FMD.We measured BBA diameter and FMD in 5695 male subjects. In addition, we retrospectively investigated the incidence of cardiovascular events using another population sample consisting of 440 male subjects, to compare the accuracy of BBA diameter with that of FMD in predicting cardiovascular events.BBA diameter and FMD significantly correlated with age, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and glucose as well as Framingham risk score. The prevalence of cardiovascular risk factors and CVD increased with the increase in BBA diameter and FMD. Area under the curve (AUC) value of the receiver operating characteristic (ROC) curve for BBA diameter to diagnose subjects without cardiovascular risk factors (0.59 vs. 0.62, p = 0.001) or patients with CVD (0.58 vs. 0.64, p 0.001) was significantly lower than that for FMD. In the retrospective study, the AUC value of the ROC curve for BBA diameter to predict first major cardiovascular events was significantly lower than that of FMD (0.50 vs. 0.62, p = 0.03).In men, BBA diameter was inferior to FMD for assessment of cardiovascular risk.

Purpose The purpose of this study was to evaluate acute effects of coffee with a high content of chlorogenic acids and different hydroxyhydroquinone contents on postprandial endothelial dysfunction. Methods This was a single-blind, randomized, placebo-controlled, crossover-within-subject clinical trial. A total of 37 patients with borderline or stage 1 hypertension were randomized to two study groups. The participants consumed a test meal with a single intake of the test coffee. Subjects in the Study 1 group were randomized to single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone or coffee with a high content of chlorogenic acids and a high content of hydroxyhydroquinone with crossover. Subjects in the Study 2 group were randomized to single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone or placebo coffee with crossover. Endothelial function assessed by flow-mediated vasodilation and plasma concentration of 8-isoprostanes were measured at baseline and at 1 and 2 h after coffee intake. Results Compared with baseline values, single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone, but not coffee with a high content of chlorogenic acids and high content of hydroxyhydroquinone or placebo coffee, significantly improved postprandial flow-mediated vasodilation and decreased circulating 8-isoprostane levels. Conclusions These findings suggest that a single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone is effective for improving postprandial endothelial dysfunction. Clinical Trial Registration URL for Clinical Trial: https://upload.umin.ac.jp; Registration Number for Clinical Trial: UMIN000013283.

This study aimed to examine the hemostatic abnormalities in patients with systemic sclerosis (SSc) and the relationship between these abnormalities and thrombotic events (THEs), focusing on the difference in diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc). The plasma levels of ADAMTS-13 (a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13), von Willebrand factor (VWF), VWF propeptide (VWFpp), d-dimer, and soluble fibrin (SF) were measured in 233 patients with SSc. The relationship between their levels and organ involvement, including THEs and interstitial lung disease (ILD), was evaluated. The plasma levels of VWF and VWFpp were significantly elevated and ADAMTS-13 activity was significantly decreased in patients with SSc compared to healthy participants. The VWFpp in dcSSc was significantly higher than in lcSSc. Twelve patients with SSc were complicated with acute THE, and 25 patients with SSc were complicated with past THE. The plasma levels of d-dimer and SF were significantly elevated in patients with SSc having THE. The plasma levels of VWF and VWFpp were significantly elevated in patients with SSc having ILD. The plasma levels of d-dimer were elevated in patients with SSc having other connective tissue diseases (CTDs). The plasma levels of ADAMTS-13 were significantly decreased and VWF, VWFpp, and SF were increased in patients with a d-dimer level of ≥1 μg/mL. Systemic sclerosis carries a high risk of THE, especially in patients with other CTDs. Plasma hemostasis-related markers are closely related to ILD and THE. These markers are important as markers of organ involvement as well as THE.

A palladium(0)-catalyzed ring-opening cross-coupling reaction between tert-cyclobutenols and aryl halides produces γ-arylated β,γ-unsaturated ketones. In the case of aryl halides bearing functional groups at the ortho position, the resulting ring-opened ketones undergo intramolecular condensation to afford bicyclic aromatic compounds.

Hypertension is associated with endothelial dysfunction. Blood pressure significantly correlates with endothelial function in antihypertensive drug-naive subjects. The purpose of this study was to determine whether treatment status affects the relationship between blood pressure and endothelial function. We measured flow-mediated vasodilation (FMD) in 2297 subjects, including 1822 antihypertensive drug-naive subjects and 475 treated hypertensive patients. FMD significantly decreased in relation to increase in systolic blood pressure (8.2±3.1% in subjects with systolic blood pressure of P P =0.77). Propensity score matching analysis revealed that the prevalence of endothelial dysfunction defined as FMD of less than the division point for the lowest tertile, and the middle tertile of FMD was significantly higher in treated hypertensive patients than in untreated subjects in all systolic blood pressure categories. Endothelial function assessed by FMD was impaired regardless of the level of blood pressure achieved by antihypertensive drug treatment in hypertensive patients.

We investigated the involvement of CXCL12–CXCR4 interactions in human lymphohematopoiesis by coculture with telomerized human stromal cells. CXCR4 expression was low in CD34+CD38−CD45RA−CD10−CD7−CD19− immature hematopoietic stem/precursor cells (HSPCs) but higher in CD34+CD38−CD45RA+CD10+CD7+/−CD19− early lymphoid precursors and even higher in CD34+CD38+CD45RA+CD10+CD7−CD19+ pro-B cells. Inhibition of the effect of stromal cell–produced CXCL12 by an anti-CXCR4–blocking Ab suppressed the generation of CD45RA+CD10−CD7+CD19− early T lymphoid precursors (ETPs) and CD45RA+CD10+CD7−CD19+/− B lymphoid precursors on stromal cells, but it did not affect the generation of ETPs in conditioned medium of stromal cell cultures. Replating assays showed that contact with stromal cells was critical for HSPC-derived CD45RA+CD10+CD7−CD19− B lineage–biased precursors to differentiate into CD19+ pro-B cells, which was suppressed by the anti-CXCR4 Ab. Conversely, HSPC-derived ETPs possessed T and B lymphoid and monocytic differentiation potential; stromal cell contact was not required for their growth but rather promoted B lymphoid differentiation. The anti-CXCR4 Ab did not affect the growth of ETPs in conditioned medium, but it suppressed their B lymphoid differentiation on stromal cells. CD14−CD11c−HLA-DR+CD123highCD303+ plasmacytoid dendritic cells developed from HSPCs and ETPs exclusively in contact with stromal cells, which was suppressed by the anti-CXCR4 Ab. These data indicate that CXCL12 plays an essential role in stromal cell contact–mediated B lymphoid and plasmacytoid dendritic cell differentiation from immature hematopoietic and early T lymphoid precursors with a multilineage differentiation potential, but it does not participate in contact-independent generation of early T lymphoid precursors.

Computed tomography (CT) is the standard method to evaluate Lipiodol deposition after transarterial embolization (TAE) for a long period. However, iodine but not Lipiodol can be observed on CT. A minimally invasive other method to detect Lipiodol has been needed to evaluate accurate evaluation after procedure. The purpose of this study was to evaluate the efficacy of using the rate of change in sound velocity caused by ultrasonic heating to reflect Lipiodol accumulation after TAE in a rat liver tumor model. We analyzed the association of this developed technique with CT images and histological findings. Eight rats bearing N1S1 cells were prepared. After confirmation of tumor development in a rat liver, Lipiodol was injected via the hepatic artery. Seven days after TAE, CT scan and sound velocity changes caused by ultrasonic heating were measured, and then the rats were sacrificed. An ultrasonic pulse-echo method was used to measure the sound velocity. The temperature coefficient of the sound velocity in each treated tumor was evaluated and compared with the mean CT value and the histological Lipiodol accumulation ratio. Pearson's correlation coefficients were calculated to assess the correlation between the measured values. The correlation coefficient (r) of the mean CT value and histological Lipiodol accumulation ratio was 0.835 (p = 0.010), which was considered statistically significant. Also, those of the temperature coefficient of the sound velocity and the histological Lipiodol accumulation ratio were statistically significant (r = 0.804; p = 0.016). To our knowledge, this is the first study that reported the efficacy of ultrasonic heating to detect Lipiodol accumulation in rat liver tumors after TAE. Our results suggest that the rate of change in sound velocity caused by ultrasonic heating can be used to evaluate Lipiodol accumulation in liver tumors after TAE, and thus could represent an alternative to CT in this application. This new innovative technique is easy to treat and less invasive in terms of avoiding radiation compared with CT., 博士（医学）・甲第836号・令和4年3月15日, © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

The reaction of N,N'-bis(diisopropylphosphoniumacetyl)-o-phenylenediamide dibromide (H4L·2Br) with NiII[ClO4]·6H2O in the presence of Et3N resulted in the formation of N,N'-bis(diisopropylphosphinoacetyl)-o-phenylenediamidate nickel(II) ([NiII(L)]). The single-crystal X-ray diffraction analysis of [NiII(L)] revealed that each pair of N and P atoms in L2- coordinates in a tetradentate fashion to afford a distorted square-planar Ni(II) amide complex. On the other hand, N,N'-bis(diisopropylphosphinoacetyl)-o-phenylenediamide copper(I) bromide ([CuI(H2L)Br]) was isolated by the reaction of H4L·2Br with [CuI(MeCN)4][PF6] in the presence of Et3N. The structural analysis revealed that the two P atoms in H2L coordinate in a bidentate fashion to afford a trigonal-planar Cu(I) complex, in which the amide moieties remain in free form. Complex [NiII(L)] showed reversible deprotonation processes on the amidate ligand (L2-), whereas the protonated state of the N atoms of the amide ligand (H2L) in [CuI(H2L)Br] was maintained, even in the presence of excess Et3N, suggesting substantial stability for the protonated state.

To harvest for T cell therapy, a 1.6-fold higher number of CD3+ T cells was collected with MNC mode (N = 10) compared with Auto PBSC mode (N = 5) in COBE Spectra cell separator, but the blood product volume was increased by 3.5-fold. For therapeutic angiogenesis therapy, apheresis was initially performed using Auto PBSC mode (N = 4) to fine tune the blood product volume to omit cell concentration, but the collected number of mononuclear cells was lower than expected. However, an increase of the harvest cycle number from 3.8 ± 0.5 to 7.4 ± 2.0 cycles (N = 19) resulted in a 2.1-fold higher number of collected mononuclear cells (8.7 ± 4.1 × 109 vs. 4.1 ± 1.0 × 109 cells, P

The design of redox-active metal-organic frameworks and coordination networks (CNs), which exhibit metal- and/or ligand-centered redox activity, has recently received increased attention. In this study, the redox-active metalloligand (RML) [Me4N]3fac-[CrIII(mp)3] (1) (mp = 2-mercaptophenolato) was synthesized and characterized by single-crystal X-ray diffraction analysis, before its reversible ligand-centered one-electron oxidation was examined by cyclic voltammetry and spectroelectrochemical measurements. As complex 1 contains OS coordination sites in three directions, complexation with K+ ions led to the formation of a two-dimensional honeycomb sheet-structured [K3fac-{CrIII(mp)3}(H2O)6]n (2·6H2O), which is the first example of a redox-active CN constructed from a RML with o-disubstituted benzene ligands. Herein, we unambiguously demonstrate the ligand-centered redox activity of the RML, which is incorporated in the redox-active CN 2·6H2O in the solid state.

We quantitatively investigated nanoparticle deposition (density: 1.0 g/cm3, diameter: 0.1–1.0 μm) in a pulmonary acinus using computational fluid dynamics. We assumed that acinar flow was induced by the expansion and contraction of the acinar model, with the volume changing sinusoidally with time as the boundary condition. We based the complicated acinar model and volume change on a mammalian lung, and evaluated the distribution of particle depositions through acinar generation based on three dimensional thinning. The maximum Reynolds numbers at the inlet and terminal alveoli were 0.191 and 1.93 × 10−3, respectively. With only gravitational force, particle deposition was strongly affected, except for the 0.1- and 0.2-μm particles, and the 0.8- and 1.0-μm particles were deposited around the inlet due to sedimentation after the beginning of inflation. We found that the 0.1- to 0.4-μm particles were deposited at the distal alveoli and that the deposition was enhanced by both the gravitational and Brownian forces, despite the small terminal velocity. For the 0.1- and 0.2-μm particles in particular, the particles were deposited throughout the acinus. The maximum deposition fraction of each acinar segment reached 1.2% after a single breath, and was higher in the middle generations and at the terminal alveoli.

[abstFig src='/00290002/03.jpg' width='300' text='Proposed ankle joint pushing mechanism for the movement of the talus' ] An ankle joint pushing system that absorbs the horizontal movement of the talus is proposed, and the effects of the horizontal movement absorbing mechanism in the system are examined. The bending of the ankle joint is an important medical treatment that physical therapists (PTs) utilize to help their patients recover their ability to walk and to prevent contracture. However, since the ankle treatment requires a large amount of force (nearly equal to the subject’s weight) plus precise angle and power control, manual treatment by PTs has not been replaced by mechanical treatment systems. In order to realize the mechanization of the ankle joint pushing treatment, the system developed here uses two features. (1) The proposed device fixes the ankle joint position correctly by making contact with the Achilles tendon, the back of the calf, and the hip. (2) The bucket rotation center shifts its position horizontally with the movement of the talus when the foot is pushed back. This mechanism can push the toes or any part of the foot strongly and stably without causing the patient any pain. It can also stretch the biceps femoris and gastrocnemius muscles simultaneously, which could previously only be done by a physical therapist. During 73 N stretching treatment tests done on four subjects, 22.2 mm (S.D. 6.4 mm) horizontal (ventral direction) movements of the ankle joint were observed due to the movement of the talus, and our proposed device mechanism successfully suppressed the movement to a 1.8 mm (S.D. 1.3 mm) horizontal (ventral) movement in the same 73 N stretching treatment.

The coordinative interactions of o-phenylenediamine and alkali or alkaline earth metals like Li+, Na+, Mg2+, or Ca2+, were investigated by X-ray structural analyses and IR, UV–vis, and 1H NMR spectroscopies. These studies revealed that the coordinative interactions of o-phenylenediamine with metal ions through amino groups depend on the ratio of the charge and the ionic radius of the metal ions both in the solid state and in THF solution.

Endogenous carbon monoxide (CO) levels are recognized as a surrogate marker for activity of heme oxygenase-1, which is induced by various factors, including hypoxia and oxidative stress. Few reports have evaluated endogenous CO in patients with obstructive sleep apnea (OSA). Whether OSA more greatly affects exhaled or blood CO is not known. Sixty-nine patients with suspected OSA were prospectively included in this study. Exhaled and blood CO were evaluated at night and morning. Blood and exhaled CO levels were well correlated both at night and morning ( r = 0.52, P < 0.0001 and r = 0.61, P < 0.0001, respectively). Although exhaled CO levels both at night and morning significantly correlated with total sleep time with arterial oxygen saturation < 90% (ρ = 0.41, P = 0.0005 and ρ = 0.27, P = 0.024, respectively), blood CO levels did not correlate with any sleep parameter. Seventeen patients with an apnea and hypopnea index (AHI) < 15 (control group) were compared with 52 patients with AHI ≥ 15 (OSA group). Exhaled CO levels at night in the OSA group were significantly higher than in the control group (3.64 ± 1.2 vs. 2.99 ± 0.70 ppm, P < 0.05). Exhaled CO levels at night decreased after 3 mo of continuous positive airway pressure (CPAP) therapy in OSA patients ( n = 36; P = 0.016) to become nearly the same level as in the control group ( P = 0.21). Blood CO levels did not significantly change after CPAP therapy. Exhaled CO was positively related to hypoxia during sleep in OSA patients, but blood CO was not. Exhaled CO might better correlate with oxidative stress associated with OSA than blood CO. NEW & NOTEWORTHY Endogenous carbon monoxide (CO) levels are recognized to be a surrogate marker of oxidative stress. No study has evaluated both exhaled and blood CO at the same time in obstructive sleep apnea (OSA) patients. Here we provide evidence that exhaled CO levels positively correlated with hypoxia during sleep in OSA patients, but blood CO levels did not, and that continuous positive airway pressure therapy significantly decreased exhaled CO levels in the OSA group, but did not significantly affect blood CO.

After the talc pleurodesis, CT showed the tract made from the chest tube even after its removal. The unexpanded thoracic space might also contribute to it; thus, gathering specific medical history is important to understand this rare phenomenon.

Objective We evaluated the modified diagnostic criteria for disseminated intravascular coagulation (DIC), which was published by the Japanese Society of Thrombosis and Hemostasis (JSTH), in 274 suspected DIC patients with hematopoietic injury. Materials and methods The diagnoses of the patients were as follows: DIC (n = 125); pre-DIC (n = 42) and non-DIC (n = 107). The efficacy of the diagnostic criteria for DIC was evaluated using a receiver operating characteristic (ROC) analysis. Results The area under the curve (ARC) and odd's ratio for the global coagulation test (GCT) scores in the diagnosis of “DIC” were high, while those for the diagnosis of “DIC and pre-DIC” were low, suggesting that the addition of antithrombin (AT) and soluble fibrin (SF)/thrombin antithrobin complex (TAT) was required to diagnose “DIC and pre-DIC”. Although the addition of the AT and SF/TAT values to the GCT did not increase its ability to predict a poor outcome, the JSTH's modified diagnostic criteria scores were correlated with the odds ratio for death. Discussion and conclusion The JSTH's modified diagnostic criteria for DIC, which included the GCT score, and the AT, and TAT/SF values, were useful for diagnosing DIC and pre-DIC, and predicting a poor outcome.

As the glucose tolerance of patients with diabetes worsens, autonomic nervous system (ANS) function decreases. Only a few studies, using plasma glucose, have reported on this relationship in large general populations that include people with wide range of glycemia. This study aimed to examine correlates of ANS function with special reference to HbASpectral analysis was performed to assess heart rate variability (HRV) using 1-minute electrocardiogram RR interval data recordings from 7690 residents aged 35-79 years in Nagahama City, Japan. HRV parameters were log-transformed. Multiple regression analysis was performed using potential correlates.lnLF decreased with age (regression coefficient, -0.025; P 0.001), BMI (-0.010; P = 0.035), and HbAAlthough the associations were weak, age, BMI and HbA

Background The usefulness of the activated partial thromboplastin time (APTT) waveform has been reported in hemophilia, acquired hemophilia and monitoring for anticoagulants. Material and methods The APTT waveform was examined in patients suspected of having disseminated intravascular coagulation (DIC) to analyze its usefulness for the diagnosis of DIC or the prediction of the outcome or bleeding risk. Results DIC with fibrinogen

Nocturia in older adults has been reported to be a risk factor for cardiovascular outcomes, and the stiffening of large arteries might be an underlying mechanism. To clarify the possible association between nocturia and arterial stiffness, we analyzed a dataset from the Japanese general population. Study participants consisted of 5928 community residents (mean age: 60.0 ± 11.8 years). The frequency of nocturnal urination was recorded for 1 week using a sleep diary. Arterial stiffness was assessed by brachial-to-ankle pulse wave velocity (baPWV). Sleep blood pressure was measured automatically at 0000, 0200, and 0400 hours by wearing a cuff on the upper arm during sleep. The mean baPWV was 1278 ± 227 cm/s. The frequency of nocturnal urination showed a linear positive association with baPWV (P 0.001). The association between a sleep diary-based nocturnal urination frequency 1.5 times/night (corresponding to a ≥ 2 times/night frequency obtained by the questionnaire) and baPWV remained significant after adjusting for major covariates, including office blood pressure (β = 0.051, P 0.001) and sleep blood pressure (β = 0.040, P 0.001). This association was more prominent in men (β = 0.069, P 0.001) than in women (β = 0.023, P = 0.013), particularly in older (β = 0.068, P = 0.006) compared with younger (β = 0.029, P = 0.270) men. Frequent nocturnal urination was independently associated with baPWV in older men. Nocturia may be a marker for cardiovascular disease risks that cannot be assessed by conventional risk factors such as blood pressure.

Nocturia is a common phenomenon in older individuals, and is associated with poor quality of life. Nocturia is a multifactorial disorder, wherein the frailty of skeletal muscles, particularly muscle weakness in the lower trunk and hip regions, might be a risk factor in women. We analyzed a dataset of the general Japanese population to clarify the hypothesis.Study participants included 1207 older women (mean age 67.4 ± 5.2 years). The frequency of nocturnal urination was assessed using a sleep diary for 1 week, and associations with lower muscle strength, skeletal muscle index, sarcopenia and physical performance (one-leg standing time and Timed Up and Go test) were investigated.The frequency of nocturnal urination more than one voiding per night was 28.1%; this frequency was inversely associated with hip abduction strength quartiles (Q1: 37.0, Q2: 30.5, Q3: 25.1 and Q4: 19.9%, P 0.001). When a sleep diary-based nocturnal urination frequency 1.5 times/night (corresponding to a ≥2 times/night frequency obtained by questionnaire) was considered as nocturia, logistic regression analysis adjusted for major covariates identified hip abduction strength as an independent inverse determinant of nocturia (odds ratio 0.75, 95% CI 0.52-0.90, P = 0.002). In contrast, no significant association was observed with knee extension (P = 0.322) and hip flexion (P = 0.603) strengths. Physical performance, skeletal muscle index and sarcopenia did not show significant associations with nocturia.Weak hip abduction strength might be a factor associated with nocturnal urination frequency in older women. Geriatr Gerontol Int 2019; 19: 1010-1016.

In this paper, we present a technique to automatically adjust Register-transfer level (RTL) implementation for Engineering Change Order (ECO) in high level. Our method focuses on the datapath structure, where circuit topologies are mostly, and only partial portions are replaced by programmable datapath. Exploring the correct configuration of the datapath is formulated as Quantified Boolean Formula (QBF) problem, and can be solved by using Satisfiability (SAT) /Satisfiability Modulo Theories (SMT) solver in an incremental way automatically. The experimental results with several example cases have confirmed that effectiveness of the proposed method.

The global population of the aged is escalating. The need of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in patients older than 80 years is on the rise. The aim of this study was to retrospectively evaluate the safety and the prognosis of TACE in octogenarians with HCC. From January 2007 to January 2018, 86 octogenarians with HCC initially treated with TACE, who were treatment naive or had a recurrence after surgery and/or radiofrequency ablation, were enrolled in this study. The adverse events were evaluated. The overall survival (OS) after TACE and causes of death were investigated. The prognostic factors for OS were analyzed using Cox proportional hazard models. Grade 4 adverse events (according to the Common Terminology Criteria for Adverse Event version 4.0) of AST, ALT and tumor rupture were found in 8, 4 and 1 patients, respectively. There were no treatment-related deaths. The 1-, 3- and 5-year overall survival rates were 84.1%, 61.1% and 27.6%, respectively. The overall median survival time was 38.3 months (HR 2.854, 95% CI 32.7–43.8). 56.9% causes of death were HCC or liver dysfunction. Multivariate analysis revealed that performance status (ECOG: 0) was an independent prognostic significant factor (95% CI 1.103–4.573; P = .026). TACE is safe and could improve survival of octogenarians with HCC. Performance status is an important prognosis factor predicting the OS.

ObjectivesThe association of obstructive sleep apnea (OSA) with hypothalamic pituitary adrenal (HPA) axis activation has not been fully understood from results of previous studies using hormonal assessments. We aimed to investigate the relationship between adrenal size, a potential marker reflecting HPA axis activity, and sleep parameters related to OSA.MethodsWe retrospectively reviewed data on 284 consecutive adult patients aged 20 to 80 y who had undergone polysomnography and abdominal computed tomography (CT). OSA was defined as none/mild (apnea-hypopnea index [AHI] ResultsAdrenal size was greater in participants with severe OSA than in those with none/mild or moderate OSA (adrenal body width: 6.03 mm, none/mild OSA; 6.09 mm, moderate OSA; 6.78 mm, severe OSA; p ConclusionsResults indicated that adrenal glands may enlarge in response to longstanding sleep fragmentation, suggesting the involvement of OSA in HPA axis augmentation.

BACKGROUND The effects of dipeptidyl peptidase 4 (DPP-4) inhibitors on blood pressure in patients with diabetes mellitus (DM) are controversial. There is no information on the effect of DPP-4 inhibitors on blood pressure and arterial stiffness in hypertensive patients with DM. We evaluated the effects of alogliptin on blood pressure and arterial stiffness in hypertensive patients with type 2 diabetes mellitus (T2DM). METHODS Blood pressure and brachial-ankle pulse wave velocity (baPWV) were measured before and after 3, 6, and 12 months of treatment with alogliptin in 22 hypertensive patients with T2DM. RESULTS After 3, 6, and 12 months, alogliptin treatment decreased hemoglobin A1c from 7.0 ± 0.97% to 6.4 ± 0.61%, 6.3 ± 0.58%, and 6.3 ± 0.75% (P < 0.01, respectively), glucose from 8.6 ± 4.39 mmol/l to 7.05 ± 2.16, 7.05 ± 2.28, and 6.44 ± 1.50 mmol/l (P < 0.01, respectively), systolic blood pressure from 137 ± 18 mm Hg to 127 ± 13, 125 ± 15, and 120 ± 17 mm Hg (P < 0.01, respectively), diastolic blood pressure from 79 ± 13 mm Hg to 74 ± 8, 74 ± 10, and 70 ± 8 mm Hg (P < 0.01, respectively) and baPWV from 1,947 ± 349 cm/second to 1,774 ± 259, 1,856 ± 361, and 1,756 ± 286 cm/second (P < 0.01, respectively). A baseline baPWV value of 1,643 cm/second was the optimal cut-off value for patients who had reduced blood pressure after treatment with alogliptin (sensitivity of 83.3% and specificity of 75.0%). CONCLUSIONS Alogliptin was associated with improvements not only in glucose metabolism but also in blood pressure and arterial stiffness in hypertensive patients with T2DM. The cut-off value of baPWV may enable identification of responders of decrease in blood pressure by alogliptin in hypertensive patients with T2DM. CLINICAL TRIALS REGISTRATION Registration Number for Clinical Trial: UMIN000007722.

Pulmonary actinomycosis reportedly forms 15% of all cases of actinomycosis, and pulmonary Actinomyces odontolyticus is particularly rare. A 60-year-old man with a hoarse voice was referred to our hospital. Lung squamous cell carcinoma was diagnosed at the clinical tumor-node-metastasis stage of cT2N2M0, and concurrent chemoradiotherapy was initiated. Further, a small cavity was also detected in the left upper lobe, but it was observed. During chemoradiotherapy, the small cavity lesion rapidly increased accompanying infiltration, and administration of short-term antibiotics did not improve the patient's condition. Bronchoscopy did not show any diagnostic results. Although a rapidly progressive malignant lesion could not be excluded and surgical management was considered, resection could not be performed because of the tight adhesion of the mass. Therefore, bronchoscopy was performed again, and the bronchial lavage culture showed a positive smear for the Actinomyces species. Further, using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), the bacteria was identified as A. odontolyticus. After long-term administration of amoxicillin, the lung cavity with infiltration gradually improved. To the best of our knowledge, there have been nine cases of pulmonary A. odontolyticus (excluding those with only empyema or pleural mass without lung lesions), which can occur in immunocompetent patients with persistent lung shadow. None of the cases showed drastic deterioration; therefore, the present case is the first to highlight that A. odontolyticus possibly produce drastically progressive lung cavity lesion. Further, repeated bronchoscopy and MALDI-TOF MS could help to diagnose pulmonary actinomycosis. Keywords: Pulmonary actinomycosis, Immunocompromised, Bronchoscopy, Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

The Ninth Symposium on Polar Science/Ordinary sessions: [OG] Polar Geosciences, Wed. 5 Dec. / Entrance Hall (1st floor), National Institute of Polar Research