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Background: Previous reports have documented ground-glass opacities (GGOs), followed by appearance of the crazy pavement pattern and consolidation as the typical findings on chest computed tomography (CT) in patients with Coronavirus Disease-2019 (COVID-19) Case: A 69-year-old man with chronic renal failure and diabetes mellitus presented with a 2-day history of fever and fatigue, without cough or sputum production Chest auscultation revealed coarse crackles at the right base Laboratory findings included a normal leukocyte count, normal serum procalcitonin level, and a slightly elevated serum C-reactive protein level Chest CT performed on day 2 after symptom onset revealed consolidation in the right lower lobe with an air bronchogram The patient was tentatively diagnosed as having bacterial pneumonia, however, antibiotic treatment with ampicillin/sulbactam yielded no improvement of the symptoms, respiratory status, or laboratory findings A repeat chest CT revealed changes in the findings of the right lower lobe from areas of focal consolidation to GGOs GGOs and areas of consolidation were also detected in the other lung lobes A polymerase chain reaction test for Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) returned a positive result Discussion: Focal areas of lung consolidation is an atypical radiological presentation of coronavirus pneumonia It is possible that the initial findings of CT represented those of bacterial pneumonia which responded to the antibiotic therapy, and that the GGOs that developed subsequently reflected new-onset SARS-CoV-2 pneumonia However, the symptom of fatigue without cough or sputum, a normal leukocyte count, and a poor response to antibiotics are not typical findings of bacterial pneumonia Our experience suggests that it is important to consider other or concomitant diseases when the initial treatment is followed by a deteriorating clinical course in patients with pneumonia Moreover, it is essential to prevent the spread of hospital-acquired infection, especially if epidemic diseases need to be included in the initial differential diagnosis

Coronavirus disease 2019 (COVID-19) is a recently-emerged infectious disease that has caused millions of deaths, where comprehensive understanding of disease mechanisms is still unestablished. In particular, studies of gene expression dynamics and regulation landscape in COVID-19 infected individuals are limited. Here, we report on a thorough analysis of whole blood RNA-seq data from 465 genotyped samples from the Japan COVID-19 Task Force, including 359 severe and 106 non-severe COVID-19 cases. We discover 1169 putative causal expression quantitative trait loci (eQTLs) including 34 possible colocalizations with biobank fine-mapping results of hematopoietic traits in a Japanese population, 1549 putative causal splice QTLs (sQTLs; e.g. two independent sQTLs at TOR1AIP1), as well as biologically interpretable trans-eQTL examples (e.g., REST and STING1), all fine-mapped at single variant resolution. We perform differential gene expression analysis to elucidate 198 genes with increased expression in severe COVID-19 cases and enriched for innate immune-related functions. Finally, we evaluate the limited but non-zero effect of COVID-19 phenotype on eQTL discovery, and highlight the presence of COVID-19 severity-interaction eQTLs (ieQTLs; e.g., CLEC4C and MYBL2). Our study provides a comprehensive catalog of whole blood regulatory variants in Japanese, as well as a reference for transcriptional landscapes in response to COVID-19 infection., 「コロナ制圧タスクフォース」COVID-19患者由来の血液細胞における遺伝子発現の網羅的解析 --重症度に応じた遺伝子発現の変化には、ヒトゲノム配列の個人差が影響する--. 京都大学プレスリリース. 2022-08-23.

To elucidate the host genetic loci affecting severity of SARS-CoV-2 infection, or Coronavirus disease 2019 (COVID-19), is an emerging issue in the face of the current devastating pandemic. Here, we report a genome-wide association study (GWAS) of COVID-19 in a Japanese population led by the Japan COVID-19 Task Force, as one of the initial discovery GWAS studies performed on a non-European population. Enrolling a total of 2,393 cases and 3,289 controls, we not only replicated previously reported COVID-19 risk variants (e.g., LZTFL1, FOXP4, ABO, and IFNAR2), but also found a variant on 5p35 (rs60200309-A at DOCK2) that was significantly associated with severe COVID-19 in younger (-8 (odds ratio = 2.01, 95% confidence interval = 1.58-2.55). This risk allele was prevalent in East Asians, including Japanese (minor allele frequency [MAF] = 0.097), but rarely found in Europeans. Cross-population Mendelian randomization analysis made a causal inference of a number of complex human traits on COVID-19. In particular, obesity had a significant impact on severe COVID-19. The presence of the population-specific risk allele underscores the need of non-European studies of COVID-19 host genetics.

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

Obstructive sleep apnea (OSA) is an established factor in the pathogenesis and exacerbation of fatty liver disease. However, randomized controlled trials have failed to demonstrate decreases in liver fat content in OSA patients by continuous positive airway pressure (CPAP) performed for several months. The aim of this study is to investigate the impact of long-term CPAP therapy on liver fat content in OSA patients with fatty liver. Liver fat content in 61 male OSA patients was evaluated by computed tomography performed because of abdominal obesity before and after CPAP initiation. At baseline, there were 25 participants with fatty liver. Their apnea–hypopnea index and percent sleep time with oxygen saturation

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.

Background No studies have addressed the relationship between obstructive sleep apnea (OSA) and abdominal aortic calcification (AAC), a marker for subclinical atherosclerosis and future cardiovascular events. Objectives To investigate 1) the association between OSA severity and AAC, and 2) whether OSA can impact the extent of AAC independent of comorbid atherogenic risk factors. Methods 390 participants aged 40–70 years underwent polysomnography and abdominal computed tomography. AAC was separately quantified in the upper and lower abdominal aorta using the modified Agatston scoring method, and the total AAC score was calculated as a sum of the two scores. OSA was defined as none/mild (apnea-hypopnea index [AHI] Results Log-transformed total AAC score adjusted for age and body mass index (BMI) was greater in participants with an elevated AHI (3.4 for none/mild OSA, 3.7 for moderate OSA, and 4.2 for severe OSA, p = 0.04). Multivariate linear regression analysis including age and BMI as covariates showed that severe OSA was associated with higher scores for the lower and total AAC (β = 0.15 and 0.14, p = 0.01 and 0.01, respectively). The association did not persist after additionally adjusting for traditional atherogenic risk factors including visceral fat, smoking, hypertension, dyslipidemia, and diabetes. Conclusions Severe OSA was associated with a greater extent of AAC, which was dependent on coexisting atherogenic risk factors. Comorbid cardiometabolic disorders may largely mediate the association of OSA with subclinical atherosclerosis.

BACKGROUND Visceral obesity, low adiponectin, and severe obstructive sleep apnea (OSA) are associated with cardiovascular diseases, but the interactions among these factors on endothelial dysfunction are not well known. METHODS AND RESULTS Endothelial function in 133 patients after polysomnography was evaluated as reactive hyperemia index (RHI) on reactive hyperemia peripheral arterial tonometry. Visceral obesity was defined as visceral fat area ≥100 cm(2)on computed tomography. RHI was significantly correlated with apnea hypopnea index (AHI), visceral fat area, and serum adiponectin (r=-0.24, P=0.0055, r=-0.19, P=0.031, and r=0.20, P=0.019, respectively). RHI in patients with visceral obesity was significantly decreased in the presence of severe OSA (AHI ≥30; P=0.042). On multivariate regression analysis, only severe OSA remained as an independent predictive factor of RHI (P=0.024, R(2)=5.4%). RHI in patients with severe OSA (n=44) was significantly improved after 3 months of continuous positive airway pressure (CPAP) treatment (1.78±0.40 before CPAP vs. 2.00±0.53 after CPAP, P=0.013), similarly to those with AHI

Background and objective Obesity hypoventilation syndrome (OHS) prevalence was previously estimated at 9% in patients with obstructive sleep apnoea (OSA) in Japan. However, the definition of OSA in that study was based on an apnoea-hypopnoea index (AHI) of ≥ 20/h rather than ≥ 5/h. Therefore, the prevalence of OHS in OSA was not measured in the same way as for Western countries. Our study objectives were to investigate the characteristics of Japanese patients with OHS. Methods Nine hundred eighty-one consecutive patients investigated for suspected OSA were enrolled. At least 90% of them were from urban areas, including 162 with obese OSA (body mass index (BMI) ≥ 30 kg/m2 and AHI ≥ 5/h). Results The prevalence of OHS (BMI 36.7 ± 4.9 kg/m2) in OSA and that in obese OSA were 2.3% and 12.3%, respectively. Multiple regression analysis revealed that independent of age and BMI, arterial oxygen pressure (contribution rate (R2) = 7.7%), 4% oxygen desaturation index (R2 = 8.9%), carbon monoxide diffusing capacity/alveolar volume (R2 = 8.3%), haemoglobin concentration (R2 = 4.9%) and waist circumference (R2 = 4.9%) were independently associated with arterial carbon dioxide pressure. After 12.3 ± 4.6 months of CPAP treatment, more than 60% of OHS patients no longer had hypercapnia. Conclusions The prevalence of OHS in OSA in Japan was 2.3%. The mean BMI of patients with OHS in Japan was lower than that in Western countries (36.7 kg/m2 vs 44.0 kg/m2).

Although obesity has been reported to be a potential risk factor for abdominal aortic dilatation, the impact of obstructive sleep apnea (OSA) on the abdominal aortic diameter remains unknown. We retrospectively reviewed 427 patients aged45 years who underwent polysomnography and abdominal computed tomography from November 2008 to February 2012. Aortic diameters were measured at 3 locations: upper, infrarenal, and lower abdominal aorta. OSA was defined as non-OSA (apnea-hypopnea index [AHI]10, n = 58), mild to moderate (AHI 10 to 30, n = 167), and severe (AHI ≥30, n = 202). Adjusted diameter was not significantly different among OSA severity categories at the upper (21.0, 21.3, and 21.4 mm, respectively) and infrarenal aorta (19.5, 20.2, and 19.9 mm, respectively) but was significantly different at the lower abdominal aorta (17.3, 18.2, and 18.2 mm, respectively, p = 0.006) with larger diameters in patients with OSA. Multivariate linear regression analyses revealed that risk profiles for aortic dilatation varied according to the location and gender and that OSA (AHI ≥10) was an independent risk factor for infrarenal and lower abdominal aortic dilatation only in men (β = 0.10 and 0.18, p = 0.049 and 0.001, respectively). In conclusion, OSA may enhance dilatation of the distal abdominal aorta in men.

Both periodic limb movements during sleep (PLMS) and obstructive sleep apnea (OSA) are major causes of sleep disorders and have been associated with systemic inflammation and cardiovascular events. However, it is uncertain whether in combination they promote a higher inflammatory response and greater risk of cardiovascular events than each condition alone.To investigate whether the presence of PLMS is associated with increased inflammation in patients suspected of having OSA.In 342 patients who underwent polysomnography to diagnose OSA, plasma C-reactive protein (CRP) and fibrinogen levels were measured.OSA was found in 254 patients, with 46 also having PLMS. Among the 88 patients who did not have OSA, 8 had PLMS. Plasma CRP and fibrinogen levels in the group with both PLMS and OSA were higher than in patients with neither OSA nor PLMS and in patients with OSA only (CRP: 0.20 ± 0.48 vs. 0.09 ± 0.15 vs. 0.13 ± 0.18 mg/dl, P = 0.03; fibrinogen: 298.2 ± 76.1 vs. 269.0 ± 57.1 vs. 270.0 ± 52.6 mg/dl, P0.01). Multivariate analysis showed that the presence of PLMS was associated with higher plasma CRP levels (β = 0.1401, P0.01) and fibrinogen levels (β = 0.1359, P = 0.01) independently from other clinical variables such as body mass index and the severity of OSA.PLMS were positively associated with plasma CRP and fibrinogen levels in patients suspected of having OSA. Because plasma levels of these proteins have been established as predictive factors of future cardiovascular events, the presence of PLMS may be a useful clinical sign to identify patients with OSA at high risk of cardiovascular events.

The difference in mortality from obstructive sleep apnea (OSA) by sex is an important issue. Visceral fat, a significant risk factor for cardiovascular disease, was reported to be closely related to OSA.To assess the different associations between OSA and visceral fat area (VFA) by sex, which might account for the different prognosis in men and women with OSA.Participants were 271 men and 100 women consecutively hospitalized for examination of OSA from October 2008 to December 2010. Among the 371 participants, relationships were analyzed between fat areas by computed tomography, comorbidity, polysomnographic data, arterial blood gas, pulmonary function, and venous blood data. Multiple regression analyses were performed to identify variables independently associated with VFA and subcutaneous fat area for each sex.Despite similar body mass index (BMI) and waist circumference, men had larger VFA, more severe OSA, and more severe dyslipidemia than women. Multiple regression analyses revealed that in men, not only age and BMI but also minimal oxygen saturation (contribution rate [R(2)], 4.6%) during sleep, and alveolar-arterial oxygen difference (R(2) = 7.6%) were independently associated with VFA. Conversely, VFA was associated only with BMI in women.Only in men was OSA independently associated with VFA. The lesser associations between OSA and visceral fat in women might account for the lower impact of OSA on cardiovascular disease or mortality in women.

Background: There are few reports about sleep disturbances in patients with chronic obstructive pulmonary disease (COPD) in Asian countries. Objectives: To investigate the associations between sleep-disordered breathing (SDB) with hypoxemia and sleep quality, including sleep duration, in patients with COPD, we measured SDB and sleep quality including the objective sleep duration determined by an actigraph and portable monitoring. Methods: A cross-sectional epidemiological health survey of 303 male employees (means ± SD: age 43.9 ± 8.2 years; BMI 24.0 ± 3.1) was conducted. Sleep quality was measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A respiratory disturbance index (RDI) ≥5 indicated SDB. Results: Nineteen subjects (6.3%) had COPD. Among these, 11 (3.6%) had COPD with SDB (overlap syndrome). Sleep duration, ESS, and PSQI scores were not significantly different between COPD patients and normal control subjects. However, COPD patients had significantly longer sleep latency (p = 0.019), a lower sleep efficiency (p = 0.017), and a higher sleep fragmentation index (p = 0.041) and average activity (p = 0.0097) during sleep than control subjects. They also had a significantly higher RDI and more severe desaturation during sleep than control subjects (p < 0.01). The differences remained after adjustment for age and BMI but disappeared following adjustment for RDI. Conclusions: COPD patients with even mild-to-moderate airflow limitations had nocturnal desaturation and RDI-related impaired sleep quality without significant symptoms.

Incretin hormones, namely glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide/glucose-dependent insulinotropic polypeptide (GIP), and dipeptidyl peptidase-4 (DPP-4) activity are important factors in glucose metabolism and have not been investigated in patients with obstructive sleep apnea (OSA).The objective of this study was to investigate the association between OSA and incretin and DPP-4 activity.This study included 96 consecutive patients without diabetes who were suspected of having OSA. We investigated the fasting and post-prandial incremental area under the curve (IAUC) of GLP-1, GIP serum levels, and serum DPP-4 activity levels, as well as their association with OSA. Changes in clinical variables were evaluated in the 43 patients who continued continuous positive airway pressure therapy for 3 months.Apnea-hypopnea index was an independent determining factor for fasting GLP-1 (β = 0.31; P = 0.0019) and IAUC GIP (β = -0.21; P = 0.037) after adjusting for known confounding factors. In those with very severe OSA (apnea-hypopnea index ≥50), the IAUCs for GLP-1 and GIP were significantly decreased, while fasting GLP-1 and fasting GIP were significantly increased. DPP-4 activity had no relation to OSA parameters or severity, while body mass index was significantly higher in those with severe OSA. Although significant changes in incretin secretion were not seen for 3 months after onset of continuous positive airway pressure therapy, the fasting GLP-1 level in the treated patients with severe OSA decreased to the same level as in untreated patients with normal to moderately severe OSA.OSA is associated with elevated serum levels of the incretin hormones GLP-1 (fasting) and GIP (post-prandial) in patients without diabetes. A significant association between body mass index and DPP-4, which is said to exist in healthy persons, was not found in the patients with OSA. Fasting GLP-1 in patients without diabetes with OSA may influence fasting glucose levels.

We report a 35-year-old man who presented with pulmonary hemorrhage induced by an epileptic seizure. He had experienced recurrent episodes of massive hemoptysis after epileptic seizures since the age of 28 years. He was admitted to Kyoto University Hospital with massive hemoptysis and hypoxia after an epileptic seizure of a few minutes' duration. Radiographic signs of infiltrations and hemorrhagic bronchoalveolar lavage fluid were observed. He was intubated and successfully treated with anti-epilepsy drugs and corticosteroids. Epileptic seizures may have induced increased pulmonary vascular permeability and structural damage to the blood-gas barrier, which may have caused pulmonary hemorrhage. Pulmonary hemorrhage could be in the list of differential diagnoses of hemoptysis in patients with epilepsy.

Polylactic acid has received much attention because of its biodegradable characteristics. However, to produce the polylactic acid, enormous energy is required at the current purification processes developed up to now. In this work, in order to reduce energy consumption, we proposed a novel purification method which combines lactic acid extraction and enzyme esterification instead of the dehydration and the chemical esterification which are conventionally used. As a result, the new purification method is found to be excellent as the solvents used in this work. It revealed that some solvents (diethyl ether, tert-butyl methyl ether, and methy isobuthyl ketone) have excellent abilities for both lactic acid extraction and enzymatic esterification.

The paper is tried to make a suspect of movement that how to reduce and change the purpose at the productive green land with succession. The suspect of farm movement is analyzed by real movement data of the urban farmlands. As a result of the analysis, it is difficult to continue a small scale farmland at near of the urban area. The results hope for measures to the productive green land that don't use inheritance tax grace. This paper's meaning is a pioneer that to suspect of movement of urban farmland by succession.

BACKGROUND: Lipase-catalyzed esterification of lactic acid with ethanol was investigated; however, some difficulties exist with such a system. Because of its high polarity, lactic acid is immiscible with non-polar organic solvents, which have generally been used for non-aqueous enzyme reactions. In addition, the strong acidity of lactic acid causes acid inactivation of enzymes and acid-catalyzed, non-enzymatic esterification. RESULT: In the present study, particular polar organic solvents, such as 1,4-dioxane, were found to suppress the enzyme inactivation and non-enzymatic esterification caused by the acidity. The magnitude of this effect varied with solvents and strongly correlated with the Kamlet-Taft parameter β, which indicates the basicity of the solvents in non-aqueous systems. An immobilized lipase from Candida antarctica was found to be the most active and stable enzyme for the reaction. Based on the findings, lipase-catalyzed esterification of lactic acid (1.0 mol L−1) could be continued for up to 4 weeks without any loss of enzyme activity. CONCLUSION: In addition to miscibility with lactic acid, the effect of these polar solvents, which is to suppress the acidity of lactic acid and is presumably due to the basicity, appears to play a very important role in the efficient enzymatic reaction of lactic acid. Copyright © 2008 Society of Chemical Industry

Lipase-catalyzed esterification of lactic acid has thus far achieved only limited success due to high acidity and polarity of lactic acid: acid inactivation of enzymes, and immiscibility of lactic acid with hydrophobic organic solvents that are commonly used for non-aqueous enzyme reactions. Herein, we investigated enzymatic esterification of lactic acid with ethanol by using hydrophobic ethers and ketones as reaction media. Both of the solvents are miscible with lactic acid, and have the basicity to suppress the acid inactivation of enzymes, as well as polar solvents. Nevertheless, these solvents would be less harmful to enzymes rather than polar solvents because of their high hydrophobicity. Using the ethers and ketones, ethyl lactate was successfully synthesized enzymatically even at higher lactic acid concentrations, and the enzyme activity was effectively stabilized even in repeated batch-wise reactions (2.0 M lactic acid, 4 weeks). This effect of some ethers and ketone to stabilize the enzyme was significantly higher than that of polar solvents in the presence of polar alcohols, the other substrate. In addition, more various kinds of lipase could esterify 1.0 M lactic acid in the hydrophobic ether and ketone rather than those in hydrophobic solvents, polar solvents, and a solvent-free system.

In order to lower the price of polylactic acid, it is necessary to reduce the energy required to produce energy lactic acid, which is its main material. In this work, we focused on a lactic acid recovery system after lactic acid fermentation, and proposed a new recovery process which combines the reverse osmosis (RO) method with ammonia removal method. Results shows that more than 90% of the glucose and ammonia were removed.

In order to develop a new process for the production of polylactic acid by adopting rice as material, it is important to find the optimal operational conditions to produce lactic acid as much as possible. In this work, effective liquefaction and saccharification of starch were investigated for the lactic acid fermentation. The states of a sample under the pretreatment were roughly evaluated by measuring the power consumption of an impeller to agitate a solution and the molecular weight of starch.

In the lactic acid fermentation, the lactic acid bacterium does not grow in a culture containing only sugar. In order for the normal growth of lactic acid bacteria, nutrients such as nitrogen source and vitamin are usually required. In general, both yeast extract and peptone are used as nutrients for lactic acid fermentation, but they are not economical. In this work, we adopted typical food wastes as the nutrients instead of yeast extract and peptone, and the lactic acid fermentation was performed. As a result, it was found that the lactic acid production on the sakekasu (sake filter cake) addition was more than that on the addition of the yeast extract and peptone.

There are reports suggesting that obstructive sleep apnea (OSA) may itself cause weight gain. However, recent reports showed increases in body mass index (BMI) following continuous positive airway pressure (CPAP) treatments. When considering weight changes, changes in humoral factors that have significant effects on appetite such as acyl (AG) and desacyl ghrelin (DAG), leptin, insulin, and glucose and their interactions, examples of which are AG/DAG and AG/insulin, are important. The aim of this study was to test the hypothesis that some appetite-related factors had a specific profile before and after CPAP treatment.Metabolic parameters were measured cross-sectionally while fasting and 30, 60, 90, and 120 min following breakfast in no or mild OSA (apnea-hypopnea index15, n = 15) and moderate-to-severe OSA (apnea-hypopnea index ≥ 15, n = 39) participants in a single institute. There were no differences in age, sex, BMI, or visceral fat accumulation between the two groups. Twenty-one patients with moderate-to-severe OSA who received CPAP treatment also prospectively underwent the same testing following 3 months of CPAP treatment.Although fasting and postprandial glucose, insulin, and leptin levels did not differ between no or mild OSA and moderate-to-severe OSA participants, AG and DAG, including AG/DAG and AG/insulin, under fasting and postprandial conditions were significantly increased in the moderate-to-severe OSA patients (p0.01). After 3 months of CPAP treatment in 21 of the moderate-to-severe OSA participants, AG/DAG did not change significantly, but other ghrelin-related parameters including AG/insulin significantly decreased compared with values before treatment but remained higher than in no or mild OSA.Among several important metabolic factors, ghrelin-related factors had the strongest associations with moderate-to-severe OSA. These results indicate that continuous changes in ghrelin secretion in OSA patients existed at least within 3 months of CPAP treatment. Methods to prevent OSA as well as treatment in its early stage may be recommended.

Obesity hypoventilation syndrome (OHS) prevalence was previously estimated at 9% in patients with obstructive sleep apnoea (OSA) in Japan. However, the definition of OSA in that study was based on an apnoea-hypopnoea index (AHI) of ≥ 20/h rather than ≥ 5/h. Therefore, the prevalence of OHS in OSA was not measured in the same way as for Western countries. Our study objectives were to investigate the characteristics of Japanese patients with OHS.Nine hundred eighty-one consecutive patients investigated for suspected OSA were enrolled. At least 90% of them were from urban areas, including 162 with obese OSA (body mass index (BMI) ≥ 30 kg/m(2) and AHI ≥ 5/h).The prevalence of OHS (BMI 36.7 ± 4.9 kg/m(2) ) in OSA and that in obese OSA were 2.3% and 12.3%, respectively. Multiple regression analysis revealed that independent of age and BMI, arterial oxygen pressure (contribution rate (R(2) ) = 7.7%), 4% oxygen desaturation index (R(2) = 8.9%), carbon monoxide diffusing capacity/alveolar volume (R(2) = 8.3%), haemoglobin concentration (R(2) = 4.9%) and waist circumference (R(2) = 4.9%) were independently associated with arterial carbon dioxide pressure. After 12.3 ± 4.6 months of CPAP treatment, more than 60% of OHS patients no longer had hypercapnia.The prevalence of OHS in OSA in Japan was 2.3%. The mean BMI of patients with OHS in Japan was lower than that in Western countries (36.7 kg/m(2) vs 44.0 kg/m(2) ).

There are many villedges suffered from floods of Chngjiang. It has been tried to reconstruct by moving the suffered villedges to safe zone. The characteristics of those are as follows; 1. By this opportunity of moving, there is a plan to integrate villedges and to construct villedges providing facilities. 2. Yhe constructed house are not for temporary purpose, but for parmanent use. 3. The whole plan was made first, and then phased building. 4. In order to raise quality of construction, it is strictly supervised. 5. Construction was standardised and simplified, in order to build as soon as possible.

Background We evaluated postoperative respiratory management of living donor lobar lung transplantation (LDLLT). Methods Perioperative variables were reviewed in 21 patients who underwent LDLLT at our institution. Recipients were kept intubated for at least two d after LDLLT to maintain optimal expansion of the implanted lobes. Subsequently, if weaning from artificial ventilation could be tolerated, extubation was considered with the assistance of non-invasive ventilation (NIV). If this could not be tolerated, early tracheostomy was considered. Results All 21 recipients were weaned from artificial ventilation. Twelve patients underwent tracheotomy 4.4 ± 1.8 d after LDLLT and were weaned from artificial ventilation 24.3 ± 17.0 d after LDLLT. Eleven patients were extubated 3.6 ± 1.7 d after LDLLT with NIV, but two of them were reintubated, and finally weaned from artificial ventilation via tracheostomy. Excluding these two patients, NIV was required for 3.8 ± 3.9 d after extubation. The early postoperative course was significantly eventful in patients with tracheostomies, and artificial ventilation, ventilatory support, and intensive care unit stays were longer. Twenty patients (95%) showed survival at 24.4 ± 13.4 months of follow-up. Conclusions Postoperative respiratory management with NIV and early tracheostomy were useful after LDLLT.

A 65-year-old man was admitted due to rapidly progressing dyspnea experienced over a 3-day period. Chest radiography and computed tomography conducted upon admission showed diffuse bilateral interstitial infiltrate. Bronchoalveolar lavage fluid contained blood and siderophores, which suggested pulmonary alveolar hemorrhage. Laboratory data showed that the serum MPO-ANCA level was elevated, and so ANCA-associated pulmonary hemorrhage was diagnosed. Although aggressive immunosuppressive agents were administered, including steroids and cyclophosphamides, the patient's condition worsened. Plasmapheresis using fresh frozen plasma was performed on day 5, after which his symptoms improved dramatically. Plasmapheresis was done 6 times, and the pulmonary lesions resolved. The patient was discharged 6 months later. This case report suggests that plasmapheresis may be an effective treatment for ANCA-associated vasculitis with diffuse alveolar hemorrhage that is resistant to aggressive immunosuppressive therapy.

Rationale: Associations between obstructive sleep apnea (OSA) and liver fat accumulation have been frequently investigated because both morbidities are common. Visceral fat was reported to be closely related to OSA and liver fat accumulation. Recently, sex differences in the association between OSA and mortality have gained much attention. Objectives: To investigate the associations among OSA, liver fat accumulation as determined by computed tomography, and visceral fat area and their sex differences. Methods: Studied were 188 males and 62 females who consecutively underwent polysomnography and computed tomography. Results: Although the apnea-hypopnea index was positively correlated with liver fat accumulation in the total males, none of the OSA-related factors was independently associated with liver fat accumulation in either the total male or female participants in the multivariate analyses. When performing subanalyses using a specific definition for Japanese of obesity or visceral obesity (body mass index (BMI) ≥25 kg/m2 or visceral fat area ≥100 cm2), in only males without visceral obesity, percent sleep time with oxygen saturation 2 = 15.1%, P

[Background]Both obstructive sleep apnea (OSA) and a novel lipocalin, neutrophil gelatinase associated lipocalin (Ngal), have been reported to be closely linked with cardiovascular disease and loss of kidney function through chronic inflammation. However, the relationship between OSA and Ngal has never been investigated. [Objectives]To evaluate the relationship between Ngal and OSA in clinical practice. [Methods]In 102 patients, polysomnography was performed to diagnose OSA and plasma Ngal levels were measured. The correlations between Ngal levels and OSA severity and other clinical variables were evaluated. Of the 46 patients who began treatment with continuous positive airway pressure (CPAP), Ngal levels were reevaluated after three months of treatment in 25 patients. [Results]The Ngal level correlated significantly with OSA severity as determined by the apnea hypopnea index (r = 0.24, p = 0.01) and 4% oxygen desaturation index (ODI) (r = 0.26, p = 0.01). Multiple regression analysis showed that the Ngal level was associated with 4%ODI independently of other clinical variables. Compliance was good in 13 of the 25 patients who used CPAP. Although the OSA (4%ODI: 33.1±16.7 to 1.1±1.9/h, p

In the agricultural villages of the Province of Zhejiang, China, a very positive improvement can be seen. In this study, the detailed process of the housing improvement which has been carried out so far is analyzed, and from this analysis, the authors try to plot the future direction of housing improvement. As a result of the investigation, the following aspects become clear. Under the housing improvement, the area of the houses is enlarged and great progress can be seen in the condition of the dwellings. But problems persist concerning the layout and use of the available space. For example, in a house, living space and working space are not separated, neither are public space and private space. The space “dOya” has to serve many functions. In addition to these points, it becomes clear that the improvement of the toilet, bath room, kitchen, and so on, has been delayed in spite of the enlargement of housing areas. Also it seems that in future useful improvements could be the separation of the dining area from the “dOya” and that the“dOya” cease to be a thoroughfare .

This report intends to make clear the characteristics of improvement policy and the development course in planning.Main results of the survey are as follows: 1. The authorities do not provide guidelines for the planning of villages but plan each village separately on a case by case basis, because the land is vast and there are different characteristics in each community in China.2. The planning is by the people and the improvement is carried out according to the economic capacity of the group to which they belong.3. The planning is divided into two stages, a basic, overall plan and a more detailed version which shows the definite contents of the plan.4. There has been a change from complete to more limited reconstruction; on the other hand, the improvement of the environment has come to be considered important.5. Because of the introduction of a productive duty system and the growth of industry in agricultural areas, there is an increased demand for the expansion of productive space, so often the improvement plan must be reviewed.

Research was carried out on agricultural villages and residences in the Ningsho Plain of Zhejiang Sheng, China, obtaining co-operation from the Chinese Architecture Society and Zhejiang Sheng Architecture Society. This paper is one of the reports of the joint research done by Japan and China. The present report follows that of 1983, which looked at the case ofYantai, Shangdong. As the first part of a report of Zhejiang Sheng, in this paper we will show some of the characteristics and structures of the investigated agricultural villages, in addition to an outlineof farming products and local industries. In addition, the findings concerning the present situation insix agricultural villages in a riverside district are also included. With regard to facilities in local communities, the relative position of the facilities, their quality and quantity, users' behaviour within and outside the community were investigated. As a result the following points are clarified. There are great differences in the degree of the improvement of facilities in respective local areas, because of the differences of opinion on the priority of the items requiring improvement. In addition, increasing relations and interchanges between villagers andurbanites is another cause of the differences. We also found that some service systems, etc., as well as somearrangements of facilities, which have been established step by step, are now not necessarily functioning well. We have come to realize that in the development of agricultural village facilities emphasis is still placed mainly on the quantity, rather than on the quality of facilities. Besides these problems we have discussed, we found many other problems concerning the planning of facilities

1. The water-soluble arsenic compounds were purified frorn a flatfish Limanda herzensteini , sea squirt Halocynthia roretzi , and sea cucumber Stichopus japonicus . 2. In the cases of flatfish and sea cucumber the major arsenic compound was judged to be arsenobetaine. 3. The sea squirt contained one acidic and two basic arsenic compounds differing from arsenobetaine.