The control of the arm's equilibrium position.

To generate a force, the brain activates muscles that act like springs to pull the arm toward a new equilibrium position. The equilibrium position (EP) is central to our understanding of the biological control of viscoelastic muscles. Although there is evidence of the EP during the control of limb posture, EPs have not been directly identified when the limb exerts a force against the environment. Here, we asked participants to apply a constant force in one of eight directions against a point-like constraint. This constraint was released abruptly to observe the final position to which the arm converged. Importantly, the same force magnitude was maintained while changing the arm's stiffness by modulating the strength of the hand's power grasp. The final position moved further away from the constraint as the arm became less stiff and was inversely proportional to the arm's stiffness, thereby confirming that the final position was the arm's EP. These results demonstrate how the EP changes with the arm's stiffness to produce a desired force in different directions.NEW & NOTEWORTHY According to numerous theories, the brain controls posture and movement by activating muscles that attract the limb toward a so-called equilibrium position, but the universality of this mechanism has not been shown for different motor behaviors. Here, we show that even when pushing or pulling against the environment, the brain achieves the desired force through an equilibrium position that lies beyond the physical constraint.

Characteristics of successful termination of atrial fibrillation by atrial antitachycardia pacing in patients with cardiac implantable electronic devices.

Asymptomatic paroxysmal atrial fibrillation (AF) is often found in patients implanted with cardiac implantable electronic devices (CIEDs). Second-generation atrial antitachycardia pacing (A-ATP) is effective in managing AF in patients implanted with CIEDs. The purpose of this study was to evaluate the efficacy and safety of A-ATP in patients implanted with CIEDs. This was a single-center retrospective study involving 91 patients (male 46 patients, mean age 74 ± 9 years) implanted with Reactive A-ATP equipped devices (84 patients with pacemakers, 6 with ICDs, and 1 with a CRT-D). The AF burden, rate of AF termination, and details of the activation of the A-ATP were analyzed in each patient. During a mean follow-up period of 21 ± 13 months, A-ATP was activated in 45 of 91 patients (49.5%). No patients had adverse events. Although the efficacy of the A-ATP varied among the patients, the median rate of AF termination was 44%. In comparison to the A-ATP start time, "0 min" had a higher AF termination rate by the A-ATP (39.4% vs. 24.4%, P = 0.011). The rate of termination by the A-ATP was high for AF with a long cycle length and a relatively regular rhythm. A-ATP successfully terminated AF episodes in some patients implanted with CIEDs. The optimal settings of the A-ATP will be determined in future studies.

Physically interacting humans regulate muscle coactivation to improve visuo-haptic perception.

When moving a piano or dancing tango with a partner, how should I control my arm muscles to sense their movements and follow or guide them smoothly? Here we observe how physically connected pairs tracking a moving target with the arm modify muscle coactivation with their visual acuity and the partner's performance. They coactivate muscles to stiffen the arm when the partner's performance is worse and relax with blurry visual feedback. Computational modeling shows that this adaptive sensing property cannot be explained by the minimization of movement error hypothesis that has previously explained adaptation in dynamic environments. Instead, individuals skillfully control the stiffness to guide the arm toward the planned motion while minimizing effort and extracting useful information from the partner's movement. The central nervous system regulates muscle activation to guide motion with accurate task information from vision and haptics while minimizing the metabolic cost. As a consequence, the partner with the most accurate target information leads the movement.NEW & NOTEWORTHY Our results reveal that interacting humans inconspicuously modulate muscle activation to extract accurate information about the common target while considering their own and the partner's sensorimotor noise. A novel computational model was developed to decipher the underlying mechanism: muscle coactivation is adapted to combine haptic information from the interaction with the partner and own visual information in a stochastically optimal manner. This improves the prediction of the target position with minimal metabolic cost in each partner, resulting in the lead of the partner with the most accurate visual information.

Haptic communication between humans is tuned by the hard or soft mechanics of interaction.

To move a hard table together, humans may coordinate by following the dominant partner's motion [1-4], but this strategy is unsuitable for a soft mattress where the perceived forces are small. How do partners readily coordinate in such differing interaction dynamics? To address this, we investigated how pairs tracked a target using flexion-extension of their wrists, which were coupled by a hard, medium or soft virtual elastic band. Tracking performance monotonically increased with a stiffer band for the worse partner, who had higher tracking error, at the cost of the skilled partner's muscular effort. This suggests that the worse partner followed the skilled one's lead, but simulations show that the results are better explained by a model where partners share movement goals through the forces, whilst the coupling dynamics determine the capacity of communicable information. This model elucidates the versatile mechanism by which humans can coordinate during both hard and soft physical interactions to ensure maximum performance with minimal effort.

Safety and Efficacy of Low-Dose Prasugrel as Part of Triple Therapy With Aspirin and Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention　- From the TWMU-AF PCI Registry.

BACKGROUND: Using the standard maintenance dose of prasugrel (10 mg/day) as part of triple therapy with aspirin and an oral anticoagulant (OAC) is not recommended in the current guidelines because it increases the risk of bleeding compared with clopidogrel. However, the safety and efficacy of low-dose prasugrel (3.75 mg/day) as part of triple therapy has not been reported. Methods and Results: We registered 816 consecutive patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) from January 2011 to June 2016 at 8 hospitals in Japan. We examined the clinical outcomes of patients who received either low-dose prasugrel (n=57) or clopidogrel (n=451) as part of triple therapy after PCI. The incidences of bleeding (TIMI major and minor) and major adverse cerebrocardiovascular events (MACCE; all-cause death, nonfatal myocardial infarction, stent thrombosis, unplanned revascularization, and stroke) were evaluated. The cumulative 1-year incidence of bleeding was not significantly different (prasugrel 5.6% vs. clopidogrel 8.1%, log-rank P=0.55). In addition, the cumulative 1-year incidence of MACCE was also not significantly different (prasugrel 11.5% vs. clopidogrel 12.3%, log-rank P=0.88). CONCLUSIONS: Low-dose prasugrel, as part of triple therapy, did not increase the risk of bleeding compared with clopidogrel. Therefore, it can be an alternative to clopidogrel for patients with AF undergoing PCI.

Results of a nationwide epidemiologic survey of autosomal recessive congenital ichthyosis and ichthyosis syndromes in Japan.

BACKGROUND: Autosomal recessive congenital ichthyosis (ARCI) and ichthyosis syndrome (IS) are rare genetic skin disorders. OBJECTIVE: To estimate the number of patients with ARCI and IS in Japan and clarify the clinicoepidemiologic features of these diseases. METHODS: We performed a nationwide survey of patients treated for ARCI or IS during January 2005-December 2009. We developed diagnostic criteria and conducted a primary survey in a stratified random sample of Japanese hospitals to quantify the number of outpatients and inpatients with ARCI or IS. We performed a secondary survey of clinicoepidemiologic features in positive cases. RESULTS: The estimated number of patients receiving treatment for ARCI and IS during 2005-2009 was 220 (95% confidence interval [CI] 180-260). The estimated disease distribution was as follows: 95 (95% CI 80-110) patients with nonbullous congenital ichthyosiform erythroderma, 30 (95% CI 20-40) with lamellar ichthyosis, 15 (95% CI 10-20) with harlequin ichthyosis, and 85 (95% CI 50-120) with IS. LIMITATIONS: Patients with a mild case of the disease might not have visited a dermatology department, potentially causing underestimation of affected patients. CONCLUSION: We report the estimated number of patients with ARCI and IS in Japan and sex differences in the age distribution.

The Ameliorating Effect of Lactobacillus gasseri OLL2716 on Functional Dyspepsia in Helicobacter pylori-Uninfected Individuals: A Randomized Controlled Study.

BACKGROUND/AIMS: Probiotics appear to improve Helicobacter pylori-associated dyspepsia via an inhibitory effect on H. pylori; however, uncertainty exists regarding their effects in H. pylori-uninfected individuals. We evaluated the efficacy of Lactobacillus gasseri OLL2716 (L. gasseri OLL2716) on H. pylori-uninfected individuals with functional dyspepsia (FD). METHODS: A double-blind, parallel-group, placebo-controlled, randomized, controlled trial was performed. Participants were randomly assigned to ingest L. gasseri OLL2716-containing yogurt (L. gasseri OLL2716 group) or L. gasseri OLL2716-free yogurt (placebo group) for 12 weeks. Participants completed questionnaires that dealt with a global assessment as well as symptom severity. The per-protocol (PP) population was evaluated for efficacy in accordance with a plan prepared beforehand. RESULTS: Randomization was performed on 116 individuals; the PP population consisted of 106 individuals (mean age 42.8 ± 9.0). The impressions regarding the overall effect on gastric symptoms were more positive in the L. gasseri OLL2716 group compared to that in the placebo group (statistical trend; p = 0.073). The elimination rate for major FD symptoms was 17.3 and 35.3% in the placebo and L. gasseri OLL2716 groups respectively (p = 0.048). CONCLUSION: L. gasseri OLL2716 has beneficial effects on FD without H. pylori involvement.

Yogurt Containing Lactobacillus gasseri Mitigates Aspirin-Induced Small Bowel Injuries: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Although there is evidence about the beneficial effects of probiotics, their effects on aspirin-induced small bowel injuries have not been well examined. We evaluated the effects of the probiotic Lactobacillus gasseri OLL2716 (LG) on aspirin-induced small intestinal lesions, such as ulcers, erosions, reddened lesions, and bleeding. SUMMARY: This study enrolled 64 patients who received aspirin for more than 1 month and provided written informed consent to be part of the study. The patients received 112 ml of yogurt containing LG or placebo twice daily for 6 weeks. Small bowel injuries were evaluated by capsule endoscopy before and after consuming the yogurt. The effect of LG on patient symptoms was also assessed using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires before and after 6 weeks of treatment. There was no significant difference in any baseline characteristics and the number of small bowel mucosal breaks between the 2 groups. In contrast with the placebo group, the LG group had significantly fewer small bowel mucosal breaks and reddened lesions after 6 weeks (p < 0.01). The FSSG and GSRS scores were also significantly improved in the LG group but not in the placebo group. Key Messages: This double-blind, placebo-controlled study found that LG may be useful in reducing aspirin-induced small bowel injuries and in mitigating gastrointestinal symptoms.

Current characteristics and management of ST elevation and non-ST elevation myocardial infarction in the Tokyo metropolitan area: from the Tokyo CCU network registered cohort.

Limited data exists on ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) managed by a well-organized cardiac care network in a metropolitan area. We analyzed the Tokyo CCU network database in 2009-2010. Of 4329 acute myocardial infarction (AMI) patients including STEMI (n = 3202) and NSTEMI (n = 1127), percutaneous coronary intervention (PCI) was performed in 88.8 % of STEMI and 70.4 % of NSTEMI patients. Mean onset-to-door and door-to-balloon times in STEMI patients were shorter than those in NSTEMI patients (167 vs 233 and 60 vs 145 min, respectively, p < 0.001). Coronary artery bypass graft surgery was performed in 4.2 % of STEMI and 11.4 % of NSTEMI patients. In-hospital mortality was significantly higher in STEMI patients than NSTEMI patients (7.7 vs 5.1 %, p < 0.007). Independent correlates of in-hospital mortality were advanced age, low blood pressure, and high Killip classification, statin-treated dyslipidemia and PCI within 24 h were favorable predictors for STEMI. High Killip classification, high heart rate, and hemodialysis were significant predictors of in-hospital mortality, whereas statin-treated dyslipidemia was the only favorable predictor for NSTEMI. In conclusion, patients with MI received PCI frequently (83.5 %) and promptly (door-to-balloon time; 66 min), and had favorable in-hospital prognosis (in-hospital mortality; 7.0 %). In addition to traditional predictors of in-hospital death, statin-treated dyslipidemia was a favorable predictor of in-hospital mortality for STEMI and NSTEMI patients, whereas hemodialysis was the strongest predictor for NSTEMI patients.

Effect of Hemodialysis on 7-Year Clinical Outcomes After Sirolimus-Eluting Stent Implantation.

BACKGROUND: Hemodialysis (HD) patients are reported to show poor clinical outcomes after percutaneous coronary intervention (PCI) with sirolimus-eluting stent (SES) compared with non-HD patients and their long-term prognosis remains unclear. METHODS AND RESULTS: We prospectively enrolled 489 consecutive patients undergoing PCI with SES and performed a retrospective analysis focusing on HD patients. Median follow-up was 7.0 years (interquartile range, 4.2-7.9) and the follow-up rate was 100%. At the 7-year follow-up, the cumulative incidences of all-cause death, target lesion revascularization (TLR) and major adverse cardiac events (MACE) were significantly higher in HD patients than in non-HD patients (HD vs. non-HD=34.7% vs. 9.6%, 42.6% vs. 10.2% and 75.3% vs. 24.4%, respectively; log-rank P<0.001). Cox-proportional hazard analysis revealed that independent predictors of all-cause death were HD (hazard ratio [HR] 2.88, 95% confidence interval [CI]: 1.39-6.00), insulin-treated diabetes mellitus (HR 2.19, 95% CI: 1.17-4.11), heart failure (HR 2.58, 95% CI: 1.25-5.32) and older age (HR 1.06/1-age, 95% CI: 1.02-1.10). Moreover, HD was an independent predictor of TLR (HR 3.63, 95% CI: 1.85-7.11) and MACE (HR 3.54, 95% CI: 2.19-5.73). CONCLUSIONS: In the present study, Japanese HD patients undergoing PCI with SES showed poorer long-term clinical outcomes than non-HD patients. HD was a strong predictor of long-term adverse events after SES implantation.

Temporal analysis of regional strain rate during adenosine triphosphate stress before and after percutaneous coronary interventions.

Regional myocardial ischemia is thought to be characterized by diastolic dysfunction. We aimed to clarify whether temporal analysis of strain rate (SR) index derived from two-dimensional speckle-tracking echocardiography (2DTE) can assess the regional myocardial ischemia or not. Forty-two patients with significant coronary stenoses were referred for percutaneous coronary intervention (PCI). 2DTE was performed before and a day after PCI. Time from aortic valve closure to peak early diastolic longitudinal SR ∆(TAVC-E SR) was measured both at baseline and during adenosine triphosphate (ATP) infusion. TAVC-E SR was calculated as TAVC-E SR during ATP infusion subtracted by TAVC-E SR at baseline. In forty-five target ischemic regions, TAVC-E SR at baseline was significantly longer than that of control regions (166 ± 28 vs. 136 ± 32 ms, P < 0.0001). TAVC-E SR in target ischemic regions significantly prolonged during ATP stress to 221 ± 37 ms (P < 0.0001), while it did not change in control regions. Immediately after PCI, TAVC-E SR in target regions significantly decreased to 135 ± 27 ms, P < 0.0001 without prolongation during ATP stress. Receiver operating characteristic curves demonstrated that ∆TAVC-E SR could assess regional myocardial ischemia by a cutoff criterion of 14 ms with sensitivity of 93% and specificity of 95%. 2DTE-derived TAVC-E SR significantly increased during ATP stress only in ischemic myocardium. This phenomenon disappeared immediately after PCI. Temporal analysis of TAVC-E SR appeared to be useful to assess the regional myocardial ischemia.

Left atrial appendage flow velocity and time from P-wave onset to tissue Doppler-derived A' predict atrial fibrillation recurrence after radiofrequency catheter ablation.

BACKGROUND: Atrial fibrillation (AF) is associated with atrial remodeling. We investigate the abilities of preprocedural echocardiographic parameters reflecting atrial remodeling to predict AF recurrence after radiofrequency catheter ablation (RFCA) for paroxysmal AF (PAF). METHODS: Preprocedural echocardiographic parameters were measured during sinus rhythm in 105 patients with PAF undergoing RFCA. Electrical remodeling was assessed by the time from the onset of the P-wave to the peak A'-wave on the tissue Doppler imaging (PA-TDI), functional remodeling was assessed by the left atrial appendage flow velocity (LAAFV), and structural remodeling was assessed by the left atrial volume index (LAVI). PA-TDI, LAAFV, and LAVI values were divided into tertiles, and their abilities to predict AF recurrence were assessed using Cox regression analysis. RESULTS: AF recurrence occurred in 39/105 (37.1%) patients. After adjustment for confounders, the rate of AF recurrence was significantly higher in the highest tertile of PA-TDI compared with the lowest tertile (≥151.3 msec vs. <131.0 msec; hazard ratio [HR]: 2.477, 95% confidence interval [CI]: 1.031-5.950; P = 0.042), and in the lowest tertile of LAAFV compared with the highest tertile (<48.5 cm/sec vs. ≥64.9 cm/sec; HR: 2.680, 95% CI: 1.136-6.318; P = 0.024). The risk of AF recurrence was also higher in the highest tertile of LAVI (≥34.2 mL/m(2) ) compared with the lowest tertile, but this difference was not significant (HR: 2.146, 95% CI: 0.834-5.523; P = 0.113). CONCLUSIONS: LAAFV (reflecting functional remodeling) and PA-TDI (reflecting electrical remodeling) are independent predictors of AF recurrence after RFCA for PAF.

Periostin contributes to epidermal hyperplasia in psoriasis common to atopic dermatitis.

BACKGROUND: Epidermal hyperplasia is a histological hallmark observed in both atopic dermatitis (AD) and psoriasis, although the clinical features and the underlying immunological disorders of these diseases are different. We previously showed that periostin, a matricellular protein, plays a critical role in epidermal hyperplasia in AD, using a mouse model and a 3-dimensional organotypic coculture system. In this study, we explore the hypothesis that periostin is involved in epidermal hyperplasia in psoriasis. METHODS: To examine expression of periostin in psoriasis patients, we performed immunohistochemical analysis on skin biopsies from six such patients. To investigate periostin's role in the pathogenesis of psoriasis, we evaluated periostin-deficient mice in a psoriasis mouse model induced by topical treatment with imiquimod (IMQ). RESULTS: Periostin was substantially expressed in the dermis of all investigated psoriasis patients. Epidermal hyperplasia induced by IMQ treatment was impaired in periostin-deficient mice, along with decreased skin swelling. However, upon treatment with IMQ, periostin deficiency did not alter infiltration of inflammatory cells such as neutrophils; production of IL-17, -22, or -23; or induction/expansion of IL-17- and IL-22-producing group 3 innate lymphoid cells. CONCLUSIONS: Periostin plays an important role during epidermal hyperplasia in IMQ-induced skin inflammation, independently of the IL-23-IL-17/IL-22 axis. Periostin appears to be a mediator for epidermal hyperplasia that is common to AD and psoriasis.

Risk stratification of patients with non-ST-elevation acute coronary syndromes by assessing global longitudinal strain.

Noninvasive detection of left main/three-vessel diseases (LM/3VD) among patients with non-ST-elevation acute coronary syndromes (NSTEACS) has been difficult using echocardiography. However, two-dimensional (2D) strain/strain-rate analysis is more sensitive in quantitatively assessing contractile abnormality. Accordingly, we aimed to clarify the usefulness of 2D strain/strain-rate analysis for risk stratification of NSTEACS. A total of 50 patients with NSTEACS underwent echocardiography and coronary angiography. We evaluated global longitudinal peak strain (global PS), peak systolic strain rate (global SSR), early diastolic global peak strain rate (global ESR), time from aortic valve closure to peak strain (TAVC-global PS), and global ESR (TAVC-global ESR) in apical four-, two-, and three-chamber views. Patients were divided into two groups according to coronary angiographic findings, the high-risk group (n = 15) with either of left main or three-vessel disease, and the low-risk group (n = 35). There were no significant differences in global SSR and global ESR between the two groups. The amplitude of global PS was significantly reduced in high-risk patients with LM/3VD in comparison with low-risk patients (-17.5 ± 2.4% vs -19.8 ± 2.7%, P = 0.007, respectively). TAVC-global PS and TAVC-global ESR were significantly prolonged in high-risk patients with LM/3VD in comparison with low-risk patients (15.3 ± 25.7 ms vs -36.8 ± 32.7 ms, P < 0.0001 and 162.8 ± 32.7 ms vs 135.7 ± 41.5 ms, P < 0.03, respectively). Receiver-operating characteristic analysis demonstrated that TAVC-global PS most strongly detected high-risk patients with sensitivity of 100% and specificity of 74.3% (area under the curve = 0.938, 95 % confidence interval 0.832-0.986, P = 0.0001). Temporal analysis of 2D strain appeared to be useful in detecting high-risk patients with LM/3VD among patients with NSTEACS.

A 10-year retrospective cohort study on the risk factors for peritoneal dialysis-related peritonitis: a single-center study at Tokai University Hospital.

BACKGROUND: Common outcomes of peritoneal dialysis (PD)-related peritonitis include catheter removal and transition to hemodialysis (HD). According to recent data, the incidence of PD-related peritonitis in Japan is not low, and peritonitis is the most common cause of withdrawal from PD. Against this backdrop, the purpose of this study is to determine the incidence of PD-related peritonitis at the Outpatient Nephrology Clinic of Tokai University Hospital (hereafter "the Clinic") and to examine causative bacteria and the risk factors related to the development of peritonitis. METHODS: We investigated all PD-related peritonitis episodes of 192 PD patients who visited the Clinic during the period from April 1, 2001 to March 31, 2011 and established the incidence of PD-related peritonitis, along with culture-negative peritonitis rates. Regarding the risk factors that are associated with the development of peritonitis, we examined patient backgrounds, whether an automated peritoneal dialysis (APD) device was used, and which type of connection system was employed. RESULTS: The incidence of peritonitis was one episode per 64.5 patient-months, and the culture-negative peritonitis rate was 16.4 %. Of the cultured bacterial isolates 71.3 % were Gram-positive cocci, including 25.0 % of coagulase-negative staphylococci, 13.2 % of methicillin-susceptible Staphylococcus aureus (MSSA), and 6.6 % of methicillin-resistant Staphylococcus aureus (MRSA). Gram-negative rods were 19.1 %. Risk factors associated with the development of peritonitis included age at the start of PD [odds ratio 1.042, 95 % confidence interval (CI) 1.016-1.069, p value = 0.001], diabetes mellitus nephropathy (DMN) (odds ratio 22.003, 95 % CI 2.101-230.452, p value = 0.010), and the use of a sterile tubing welder device (STWD) (odds ratio 2.399, 95 % CI 1.043-5.521, p value = 0.040). CONCLUSIONS: Regarding the situation of peritonitis at a single center during the 10-year period of this study, risk factors associated with the development of peritonitis included age at the start of PD, DMN, and the use of an STWD.

Disseminated mucormycosis infection after the first course of dose-modified R-EPOCH for advanced-stage lymphoma.

We report the case of a 63-year-old man who presented at our hospital after experiencing fever and dyspnea for more than 1 month. Because his general condition was deteriorating, he was referred to our intensive care unit. He needed critical care and was treated with vasopressors, artificial ventilation, and continuous hemodialysis. Considering his systemic condition, hematological malignancy was suspected. Bone marrow and skin biopsies were performed, and the condition was diagnosed as diffuse large B-cell lymphoma. On the 15th day, suspecting infectious lung disease, we performed bronchoscopy, which showed Rhizopus infection. Thus, the patient was administered high- dose liposomal amphotericin B (10 mg/kg) therapy. On the 54th day, he died of a massive pulmonary hemorrhage. Autopsy revealed mucormycosis infection in multiple organs, including the lungs and liver. Vigilance regarding possible mucormycosis infection is required, even after initial chemotherapy in patients whose bone marrow is significantly affected by lymphoma cells and leukemic changes.

Distribution of control during bimanual movement and stabilization.

In two-handed actions like baseball batting, the brain can allocate the control to each arm in an infinite number of ways. According to hemispheric specialization theory, the dominant hemisphere is adept at ballistic control, while the non-dominant hemisphere is specialized at postural stabilization, so the brain should divide the control between the arms according to their respective specialization. Here, we tested this prediction by examining how the brain shares the control between the dominant and non-dominant arms during bimanual reaching and postural stabilization. Participants reached with both hands, which were tied together by a stiff virtual spring, to a target surrounded by an unstable repulsive force field. If the brain exploits each hemisphere's specialization, then the dominant arm should be responsible for acceleration early in the movement, and the non-dominant arm will be the prime actor at the end when holding steady against the force field. The power grasp force, which signifies the postural stability of each arm, peaked at movement termination but was equally large in both arms. Furthermore, the brain predominantly used the arm that could use the stronger flexor muscles to mainly accelerate the movement. These results point to the brain flexibly allocating the control to each arm according to the task goal without adhering to a strict specialization scheme.

Adverse clinical events after percutaneous coronary intervention in very elderly patients with acute coronary syndrome.

The number of very elderly patients with acute coronary syndrome (ACS) is increasing. Therefore, owing to the need for evidence-based treatment decisions in this population, this study aimed to examine the clinical outcomes during 1 year after percutaneous coronary intervention (PCI) in very elderly patients with ACS. This prospective multicenter observational study comprised 1337 patients with ACS treated with PCI, classified into the following four groups according to age: under 60, <60 years; sexagenarian, ≥60 and <69 years; septuagenarian, ≥70 and <80 years; and very elderly, ≥80 years. The primary endpoint was a composite of the first occurrence of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and bleeding within 1 year after PCI. We used the sexagenarian group as a reference and compared outcomes with those of the other groups. The incidence of the primary endpoint was significantly higher in the very elderly group than in the sexagenarian group (36 [12.7%] vs. 24 [6.9%], respectively; hazard ratio, 1.94; 95% confidence interval: 1.16-3.26; p = 0.012). The higher incidence of the primary endpoint was primarily driven by a higher incidence of all-cause death. When the multivariable analysis was used to adjust for patient characteristics and comorbidities, no difference was observed in the primary endpoint between the very elderly and sexagenarian groups (p = 0.96). The incidence of adverse events after PCI, particularly all-cause death, in very elderly patients with ACS was high. However, if several confounders are adjusted, comparable outcomes may be expected within 1 year after PCI among this population.

Association analysis of the HLA-C gene in Japanese alopecia areata.

Alopecia areata (AA) is an organ-specific and cell-mediated autoimmune disease involving hair loss, but its pathogenesis remains poorly understood. Many autoimmune diseases are genetically associated with alleles of the human leukocyte antigen (HLA) genes within the major histocompatibility complex. Associations between AA and HLA genes were previously observed in some different ethnic groups. However, the results were inconsistent, and a primary susceptibility HLA gene and/or region has not yet been assigned for AA. The aim of this study was to evaluate whether an allele of the HLA-C locus, HLA-C*07:04, which was strongly associated with AA in Chinese Hans, could be replicated in the Japanese population. The HLA-C locus was genotyped by the SSO method using 156 AA patients and 560 healthy controls. As a consequence, among the 17 alleles detected, only two alleles, C*04:01 (OR = 2.25, CI 95 % = 1.35-3.75, P = 1.84E-03) and C*15:02 (OR = 2.52, CI 95 % = 1.37-4.64, P = 2.90E-03), were significantly associated with AA after Bonferroni correction. Further, the stratification analysis suggested that C*04:01, C*07:02, and C*15:02 represented different AA genetic risk factors in each sub-phenotype.

Epidemiology and clinical characteristics of bullous congenital ichthyosiform erythroderma (keratinolytic ichthyosis) in Japan: results from a nationwide survey.

BACKGROUND: Detailed nationwide surveys of the epidemiologic and clinical characteristics of bullous congenital ichthyosiform erythroderma (BCIE) (novel synonym: keratinolytic ichthyosis) in a large population have not been performed previously to our knowledge. OBJECTIVE: We sought to estimate the number of patients with BCIE who visited dermatology departments in Japan in 2002 and to clarify the clinical and epidemiologic features of the disease. METHODS: A nationwide mail survey was sent to dermatology departments and consisted of an initial survey to estimate the number of individuals with BCIE and a second survey to obtain data on the clinical characteristics of these patients. RESULTS: The total number of patients with BCIE in Japan was estimated to be 55 (95% confidence interval, 35-75). Clinical data were able to be collected from 28 cases. Clinical manifestations included rash in 27 cases (96.4%), erythroderma in 19 cases (67.9%), and generalized blistering in 15 cases (57.7%). Approximately 75% of patients younger than 20 years showed generalized blistering. Hystrixlike scales were present in 8 female patients (57.1%), whereas large scales were present in 8 male patients (57.1%). Among the 19 patients for whom histopathological information was available, 17 (89.5%) showed granular degeneration. LIMITATIONS: Patients with BCIE who have few subjective symptoms may not have visited a dermatology department, potentially resulting in an underestimation of the number of patients with BCIE. CONCLUSION: Important epidemiologic and clinical information on characteristics of BCIE in Japan was obtained, including an estimate of the total number of patients with BCIE in Japan.