Japanese 17q12 Deletion Syndrome with Complex Clinical Manifestations.

17q12 deletion syndrome is a rare chromosomal anomaly with variable phenotypes, caused by the heterozygous deletion of chromosome 17q12. We herein report a 35-year-old Japanese patient with chromosomal 17q12 deletion syndrome identified by de novo deletion of the 1.46 Mb segment at the 17q12 band by genetic analyses. He exhibited a wide range of phenotypes, such as maturity-onset diabetes of the young (MODY) type 5, structural or functional abnormalities of the kidney, liver, and pancreas; facial dysmorphic features, electrolyte disorders; keratoconus, and acquired perforating dermatosis. This case report provides valuable resources concerning the clinical spectrum of rare 17q12 deletion syndrome.

Factors associated with healthcare providers' satisfaction with end-of-life care in the intensive care unit: A systematic review.

BACKGROUND: We aimed to synthesize published data on and identify factors associated with healthcare providers' satisfaction with end-of-life care for critically ill adults. METHODS: Electronic databases were searched from inception to January 23, 2023. We included trials involving adults admitted to intensive care units (ICUs) or high-dependency units to evaluate palliative care interventions. STUDY SELECTION: The inclusion criteria were as follows: 1) Adult patients (age ≥18 years) or their family members admitted to the ICU or a high-dependency unit; 2) ICU palliative care interventions; 3) Randomized and non-randomized controlled trials; and 4) Full-text, peer-reviewed articles published in English. Two reviewers screened and extracted the data and assessed bias risk. The primary outcome was an improvement in the healthcare providers' satisfaction based on the validated scales. RESULTS: Out of 12 studies, 9 investigated combined dimension intervention. Healthcare providers' satisfaction improved in 6/7 (85.7%) of the studies testing educational intervention, 5/7 (71.4%) studies testing the effectiveness of palliative care team involvement, 4/5 (80%) of studies testing communication interventions, while 0/2 (0%) study testing ethic consultations. CONCLUSIONS: Most of the tested palliative care interventions were associated with improved healthcare provider satisfaction in intensive care units. The impacts of such intervention on mental health and burden remain to be investigated in this field.

Association of plasminogen activator inhibitor-1 and fibroblastic growth factor 21 in 3 groups of type 2 diabetes: Without overweight/obesity, free of insulin resistance, and without hepatosteatosis.

The physiological effects of fibroblast growth factor 21 (FGF21), leading to beneficial metabolic outcomes, have been extensively revealed in recent decades. Significantly elevated serum levels of FGF21 in obesity and type 2 diabetes mellitus (T2DM) are referred to as FGF21 resistance. However, Asian population tend to develop metabolic disorders at a lesser degree of obesity than those of Western. This study aimed to explore factors potentially related to serum FGF21 according to the severity of metabolic disorders in patients with T2DM. This cross-sectional study included 176 T2DM patients. The patients were categorized according to whether they had hepatic steatosis (fatty liver index [FLI] ≥ 60), insulin resistance (homeostasis model assessment of insulin resistance [HOMA-R] ≥ median), and/or overweight/obesity (body mass index [BMI] ≥ 25.0 kg/m2). Independent predictors of serum FGF21 were determined using multiple linear regression analysis in these 3 groups of T2DM patients. Circulating FGF21 levels were correlated positively with BMI, abdominal fat areas, leptin, and plasminogen activator inhibitor-1 (PAI-1). After adjustment for potential confounders, multiple linear regression analysis identified leptin as a factor strongly associated with serum FGF21 levels in all patients. Moreover, PAI-1 was a significant predictor of FGF21 in those with FLI < 60, BMI < 25.0 kg/m2, and HOMA-R < median, while leptin was the only independent factor in each of their counterparts. The factors related to serum FGF21 differ according to the severity of metabolic disorders. FGF21 appears to be independently associated with PAI-1 in T2DM patients: without overweight/obesity, those free of insulin resistance, and those without hepatic steatosis.

Effect of a systematic lung-protective protocol for COVID-19 pneumonia requiring invasive ventilation: A single center retrospective study.

The benefits of introducing a systematic lung-protective protocol for coronavirus disease 2019 (COVID-19) pneumonia requiring invasive ventilation in the intensive care unit (ICU) are unknown. Herein, we aimed to evaluate the clinical effects of introducing such a protocol in terms of mortality, duration of ventilation, and length of ICU stay. In this single-centre, retrospective, quality comparison study, we identified patients with COVID-19 pneumonia who received invasive ventilation in our ICU between February 2020 and October 2021. We established a systematic lung-protective protocol for the pre-introduction group until March 2021 and the post-introduction group after April 2021. Patients who did not receive invasive ventilation and who underwent veno-venous extracorporeal membrane oxygenation in a referring hospital were excluded. We collected patient characteristics at the time of ICU admission, including age, sex, body mass index (BMI), comorbidities, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, and Murray score. The study outcomes were ICU mortality, length of ICU stay, and duration of ventilation. The pre-introduction and post-introduction groups included 18 and 50 patients, respectively. No significant differences were observed in sex, BMI, SOFA score, APACHE II score, and Murray score; however, age was lower in the post-introduction group (70 vs. 56, P = 0.003). The introduction of this protocol did not improve ICU mortality. However, it reduced the ICU length of stay (26 days vs. 11 days, P = 0.003) and tended to shorten the duration of ventilation (15 days vs. 10 days, P = 0.06). The introduction of the protocol was associated with a decrease in the length of ICU stay and duration of ventilation; however, it did not change mortality. The application of the protocol could improve the security of medical resources during the COVID-19 pandemic. Further prospective multicentre studies are needed.

Corynebacterium ulcerans pneumonia treated with venovenous extracorporeal membrane oxygenation: a case report.

We report the first case of airway obstruction due to toxin-producing Corynebacterium ulcerans, successfully managed with venovenous extracorporeal membrane oxygenation (V-V ECMO). A woman aged 73 years who was living with companion animals was intubated for pneumonia of unknown origin and treated with an empirical antimicrobial agent. Corynebacterium species were detected in the sputum and treated as commensal bacteria. Subsequently, the patient suddenly could not ventilate because of central airway obstruction caused by pseudomembrane formation. Therefore, V-V ECMO was initiated. Additional mass spectrometry identified the Corynebacterium species as C. ulcerans. After treatment with antitoxin, the patient was successfully weaned from V-V ECMO. Hence, in patients in contact with companion animals who present with respiratory failure and pseudomembrane formation, C. ulcerans pneumonia should be suspected and treated with antitoxin. C. ulcerans pneumonia may result in an inability to ventilate due to pseudomembrane formation. Therefore, treatment strategies including V-V ECMO should be considered in such cases.

Risk factors for mechanical ventilation and ECMO in COVID-19 patients admitted to the ICU: A multicenter retrospective observational study.

BACKGROUND: The primary purpose of this study was to investigate risk factors associated with the need for mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) in COVID-19 patients admitted to the intensive care unit (ICU). METHODS: We retrospectively enrolled 66 consecutive COVID-19 patients admitted to the ICUs of three Japanese institutions from February 2020 to January 2021. We performed logistic regression analyses to identify risk factors associated with subsequent MV and ECMO requirements. Further, multivariate analyses were performed following adjustment for Acute Physiology and Chronic Health Evaluation (APACHE) II scores. RESULTS: At ICU admission, the risk factors for subsequent MV identified were: higher age (Odds Ratio (OR) 1.04, 95% Confidence Interval (CI) 1.00-1.08, P = 0.03), higher values of APACHE II score (OR 1.20, 95% CI 1.08-1.33, P < 0.001), Sequential Organ Failure Assessment score (OR 1.53, 95% CI 1.18-1.97, P < 0.001), lactate dehydrogenase (LDH) (OR 1.01, 95% CI 1.00-1.02, p<0.001) and C-reactive protein (OR 1.09, 95% CI 1.00-1.19, P = 0.04), and lower values of lymphocytes (OR 1.00, 95% CI 1.00-1.00, P = 0.02) and antithrombin (OR 0.95, 95% CI 0.91-0.95, P < 0.01). Patients who subsequently required ECMO showed lower values of estimated glomerular filtration rate (OR 0.98, 95% CI 0.96-1.00, P = 0.04) and antithrombin (OR 0.94, 95% CI 0.88-1.00, P = 0.03) at ICU admission. Multivariate analysis showed that higher body mass index (OR 1.19, 95% CI 1.00-1.40, P = 0.04) and higher levels of LDH (OR 1.01, 95% CI 1.01-1.02, P < 0.01) were independent risk factors for the need for MV. Lower level of antithrombin (OR 0.94, 95% CI 0.88-1.00, P = 0.03) was a risk factor for the need for ECMO. CONCLUSION: We showed that low antithrombin level at ICU admission might be a risk factor for subsequent ECMO requirements, in addition to other previously reported factors.

Cross-sectional associations between the types/amounts of beverages consumed and the glycemia status: The Japan Public Health Center-based Prospective Diabetes study.

Background: The associations between the types/amounts of beverages consumed in daily life and measures of the glycemia status were investigated in a Japanese population-based cohort. Methods: Data from the baseline survey of the Japan Public Health Center-based Prospective Diabetes cohort were used. A cross-sectional analysis was performed in 3852 men and 6003 women who were evaluated under the fasting condition. The daily consumptions of coffee, green tea, oolong tea, black tea, soft drinks, fruit juices, or plain water were assessed using a self-reported questionnaire. Multivariable-adjusted linear regression analyses were performed using measures of the glycemia status (fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) ) as dependent variables and the types/amounts of beverages consumed as the independent variables, to calculate the differences according to the types/amounts of beverages consumed. Results: In the multivariable-adjusted models, coffee consumption of ≥240 mL/day was significantly associated with a change of the FPG level by -1.9 mg/dL in men (p = 0.013) and -1.4 mg/dL in women (p = 0.015), as compared to coffee consumption of 0 mL/day. No significant association of the FPG level was observed with any of the other types/amounts of beverages consumed. On the other hand, significant associations were found between the HbA1c levels and consumption of several types of beverages. Conclusions: High coffee consumption was associated with lower FPG levels in this Japanese population. Some unexpected associations of the HbA1c levels with the consumption of some types of beverages were observed, which need to be further investigated.

Identification and Analysis of a Novel NR0B1 Mutation in Late-Onset Adrenal Hypoplasia Congenita and Hypogonadism.

OBJECTIVE: X-linked adrenal hypoplasia congenita (AHC) is a rare disorder characterized by primary adrenal insufficiency and hypogonadotropic hypogonadism (HHG) caused by mutations of the NR0B1/DAX1 gene. We aimed to search for the presence of any NR0B1/DAX1 gene mutations in a referred patient and to further characterize the phenotypes of the identified mutation. CASE PRESENTATION: Herein, we report a Japanese patient with a novel missense mutation of the NR0B1/DAX1 gene resulting in adult-onset AHC and HHG. The patient was referred with diffuse skin pigmentation at 28 years of age, presented partial adrenal insufficiency and had undiagnosed incomplete HHG. Urological examination revealed severe oligospermia and testicular microlithiasis. RESULTS: The NR0B1/DAX1 gene mutation was identified by exome sequencing as a novel missense mutation (c.884A>T, p.Leu295His). We conducted in silico modeling of this mutant NR0B1/DAX1 protein (p.Leu295His) which affected the conserved hydrophobic core of the putative ligand-binding domain (LBD). In addition, functional analysis revealed that this mutant showed a decreased ability as a transcriptional repressor to suppress target genes, such as STAR and LHB. Furthermore, this mutant showed functionally impaired repression of steroidogenesis in human adrenocortical H295R cells. CONCLUSIONS: We identified a novel missense mutation of the NR0B1/DAX1 gene in a patient suffering from late-onset AHC and HHG, who presented with oligospermia and testicular microlithiasis. This mutant NR0B1/DAX1 protein was found to have reduced repressor activity, according to in vitro studies, clinically consistent with the patient's phenotypic features.

Phytoavailability of 137Cs and stable Cs in soils from different parent materials in Fukushima, Japan.

Weathered micaceous minerals (micas) are able to release potassium ion (K+) and fix caesium-137 (137Cs), both of which reduce soil-to-plant transfer of 137Cs. Among micas, trioctahedral micas such as biotite is expected to have a stronger ability to supply nonexchangeable K+ and a higher amount of Cs fixation sites than dioctahedral micas such as illite. Although biotite is predominant in granitic soils (G soils), illite is mainly dominant in sedimentary rock soils (S soils). Therefore, we hypothesized that G soils have a lower 137Cs transfer risk than S soils because of this difference in mineralogy. The objective of the present study was to determine the transfer factor (TF) of 137Cs and stable Cs (SCs) and to elucidate the determinant factors of TFs for G and S soils in Fukushima, Japan. Pot experiments were carried out with rice (Oryza sativa L. cv. Hokuriku 193) in G and S soils to determine the TF of 137Cs (TF-137Cs) and stable Cs (TF-SCs) under K-deficient conditions. TF-137Cs and TF-SCs were highly correlated, and both were significantly lower for G soils than for S soils. Higher TF values were shown for soils with lower amounts of exchangeable and nonexchangeable K or with higher percentages of exchangeable 137Cs (ex137Cs). The percentage of ex137Cs was negatively correlated with the amount of Cs fixation sites, represented by the radiocaesium interception potential. Thus, we concluded that smaller TF values for G soils were caused by a stronger ability to supply nonexchangeable K+ and a higher amount of Cs fixation sites. These findings will contribute to the establishment of soil screening techniques based on 137Cs transfer risk in Fukushima prefecture.

Changes in Antidiabetic Drug Prescription and Glycemic Control Trends in Elderly Patients with Type 2 Diabetes Mellitus from 2005-2013: An Analysis of the National Center Diabetes Database (NCDD-03).

Objective To analyze the changes in the pharmacotherapy and glycemic control trends in elderly patients with type 2 diabetes mellitus (T2DM) in Japan. Methods We extracted the data of 7,590 patients (5,396 men and 2,194 women; median year of birth: 1945) with T2DM registered in the National Center Diabetes Database for the years 2005 to 2013, and conducted age-stratified (<65, 65-74, and ≥75 years of age) analyses. Results The hemoglobin A1c (HbA1c) levels declined from 2005 to 2013, and for those who received antihyperglycemic drug prescription, the HbA1c levels were lower in the older age group than in the younger age group. In the ≥75 age group, dipeptidyl peptidase-4 inhibitors (DPP4i) became the most frequently prescribed drug (49.1%) in 2013, and sulfonylureas remained the second-most frequently prescribed drug (37.8%) with decreased prescribed doses. The prescription ratio of oral drugs associated with a risk of hypoglycemia was higher in patients ≥75 years of age than in those <75 years of age (40.5% and 26.4%, respectively in 2013), although it showed a downward trend. The prescription rates of insulin for patients ≥75 years of age increased during the study period. Conclusion The pharmacotherapy trends for elderly patients with T2DM changed dramatically in Japan with the launch of DPP4i in 2009. Glycemic control in a considerable portion of the ≥75 age group in Japan was maintained at the expense of potential hypoglycemia by the frequent, although cautious, use of sulfonylureas, glinides and insulin.

Association of epicardial adipose tissue with serum level of cystatin C in type 2 diabetes.

OBJECTIVE: Accumulation of epicardial adipose tissue (EAT) is considered to be a cardiovascular risk factor independent from visceral adiposity, obesity, hypertension and diabetes. We explored the parameters related to EAT accumulation, aiming to clarify the novel pathophysiological roles of EAT in subjects with type 2 diabetes (T2DM). METHODS: We examined the laboratory values, including cystatinC, and surrogate markers used for evaluating atherosclerosis. EAT was measured as the sum of the adipose tissue area, obtained by plain computed tomography scans in 208 subjects with T2DM but no history of coronary artery disease. RESULTS: EAT correlated positively with age, body mass index (BMI), visceral fat area, leptin, cystatin C and C-peptide, while correlating negatively with adiponectin, estimated glomerular filteration rate (eGFR) and the liver-to-spleen ratio. Multiple linear regression analysis revealed serum cystatin C (ß = 0.175), leptin (ß = 0.536), BMI (ß = 0.393) and age (ß = 0.269) to be the only parameters showing independent statistically significant associations with EAT. When cystatin C was replaced with eGFR, eGFR showed no significant correlation with EAT. In reverse analysis, serum cystatin C was significantly associated with EAT after adjustment in multivariate analysis. DISCUSSION: EAT accumulation and elevated cystatin C have been independently regarded as risk factors influencing atherosclerosis. The strong association between EAT and cystatin C demonstrated herein indicates that EAT accumulation may play an important role in Cystatin C secretion, possibly contributing to cardiometabolic risk in T2DM patients.

A positive family history of hypertension might be associated with an accelerated onset of type 2 diabetes: Results from the National Center Diabetes Database (NCDD-02).

Type 2 diabetes, which is characterized by a combination of decreased insulin secretion and decreased insulin sensitivity, can be delayed or prevented by healthy lifestyle behaviors. Therefore, it is important that the population in general understands their personal risk at an early age to reduce their chances of ever developing the disease. A family history of hypertension is known to be associated with insulin resistance, but the effect of a family history of hypertension on the onset of type 2 diabetes has not well been examined. We performed a retrospective study examining patient age at the time of the diagnosis of type 2 diabetes by analyzing a dataset of 1,299 patients (1,021 men and 278 women) who had been diagnosed as having type 2 diabetes during a health checkup. The mean ± standard deviation of the patient age at the time of the diagnosis of diabetes was 49.1 ± 10.4 years for patients with a family history of hypertension and 51.8 ± 11.4 years for patients without a family history of hypertension (p < 0.001). A multivariate linear regression analysis showed a significant association between a family history of hypertension and a younger age at the time of the diagnosis of type 2 diabetes, independent of a family history of diabetes mellitus and a male sex, suggesting that a positive family history of hypertension might be associated with the accelerated onset of type 2 diabetes.

Body mass index and the risk of cancer incidence in patients with type 2 diabetes in Japan: Results from the National Center Diabetes Database.

AIMS/INTRODUCTION: Both type 2 diabetes and obesity increase the risk of some types of cancers, and underlying mechanisms are thought to be, at least in part, common. In the present study, we carried out a retrospective cohort study of the relationship between body mass index (BMI) categories and cancer development in Japanese type 2 diabetic patients. MATERIALS AND METHODS: A total of 113 incident cancers including 35 cancers whose incidence was reported to be increased by obesity (27 colorectal cancers, two breast cancers in postmenopausal women, one endometrial cancer, four renal cancers and one gallbladder cancer) were identified in 2,334 type 2 diabetic patients (1,616 men and 718 women) over an average observation period of 5.1 years. RESULTS: In men, there was no significant association between the BMI categories at the start of the observation period and the development of any cancer. In contrast, the incidence of all of the cancers in the women was significantly higher in the group with a BMI of less than 22.0 kg/m2 (hazard ratio 3.07, 95% CI 1.01-9.36). In either sex, there was no significant relationship between the BMI categories and the development of cancers whose risk is known to be increased by obesity. CONCLUSIONS: The findings of the present study were limited by the relatively small number of patients in the cohort, which posed a danger of not finding significance. However, the results suggested that obesity did not become an additional risk factor for cancer in Japanese type 2 diabetic patients.

Visualization of sphingolipids and phospholipids in the fundic gland mucosa of human stomach using imaging mass spectrometry.

AIM: To analyze the lipid distribution in gastric mucosae. METHODS: Imaging mass spectrometry (MS) is a useful tool to survey the distribution of biomolecules in surgical specimens. Here we used the imaging MS apparatus named iMScope to identify the dominant molecules present in the human gastric mucosa near the fundic glands. Five gastric specimens were subjected to iMScope analysis. These specimens were also analyzed by immunohistochemistry using MUC5AC, H(+)-K(+)-ATPaseß Claudin18 antibodies. RESULTS: Three major molecules with m/z 725.5, 780.5, and 782.5 detected in the gastric mucosa were identified as sphingomyelin (SM) (d18:1/16:0), phosphatidylcholine (PC) (16:0/18:2), and PC (16:0/18:1), respectively, through MS/MS analyses. Using immunohistological staining, SM (d18:1/16:0) signals were mainly co-localized with the foveolar epithelium marker MUC5AC. In contrast, PC (16:0/18:2) signals were observed in the region testing positive for the fundic gland marker H(+)-K(+)-ATPaseß. PC (16:0/18:1) signals were uniformly distributed throughout the mucosa. CONCLUSION: Our basic data will contribute to the studies of lipid species in physical and pathological conditions of the human stomach.

Association of Advanced Glycation End Products with coronary Artery Calcification in Japanese Subjects with Type 2 Diabetes as Assessed by Skin Autofluorescence.

AIM: Advanced glycation end products (AGE) are considered to be among the critical pathogenic factors involved in the progression of diabetic complications. Skin autofluorescence (AF), a noninvasive measurement of AGE accumulation, has been recognized as a useful and convenient marker for diabetic vascular diseases in Caucasians. This study aimed to evaluate the association of tissue AGE, assessed using skin AF, with coronary artery calcification in Japanese subjects with type 2 diabetes. METHODS: In total, 122 Japanese subjects with type 2 diabetes enrolled in this cross-sectional study underwent multi-slice computed tomography for total coronary artery calcium scores (CACS) estimation and examination with a skin AF reader. RESULTS: Skin AF positively correlated with age, sex, diabetes duration, pulse wave velocity, systolic blood pressure, serum creatinine, and CACS. In addition, skin AF results negatively correlated with BMI, eGFR, and serum C-peptide concentration. According to multivariate analysis, age and systolic blood pressure showed strong positive correlation and eGFR showed negative correlation with skin AF values. Multiple linear regression analyses revealed a significant positive correlation between skin AF values and logCACS, independent of age, sex, diabetes duration, HbA1c, BMI, IMT, and blood pressure. However, skin AF showed no association with serum levels of AGE, such as Nε-(carboxymethyl) lysine and 3-deoxyglucosone. CONCLUSION: Skin AF results positively correlated with CACS in Japanese subjects with type 2 diabetes. This result indicates that AGE plays a role in the pathogenesis of diabetic macrovascular disease. Measurement of skin AF values may be useful for assessing the severity of diabetic complications in Japanese subjects.

Time Spent Walking and Risk of Diabetes in Japanese Adults: The Japan Public Health Center-Based Prospective Diabetes Study.

BACKGROUND: The association between time spent walking and risk of diabetes was investigated in a Japanese population-based cohort. METHODS: Data from the Japan Public Health Center-based Prospective Diabetes cohort were analyzed. The surveys of diabetes were performed at baseline and at the 5-year follow-up. Time spent walking per day was assessed using a self-reported questionnaire (<30 minutes, 30 minutes to <1 hour, 1 to <2 hours, or ≥2 hours). A cross-sectional analysis was performed among 26 488 adults in the baseline survey. Logistic regression was used to examine the association between time spent walking and the presence of unrecognized diabetes. We then performed a longitudinal analysis that was restricted to 11 101 non-diabetic adults who participated in both the baseline and 5-year surveys. The association between time spent walking and the incidence of diabetes during the 5 years was examined. RESULTS: In the cross-sectional analysis, 1058 participants had unrecognized diabetes. Those with time spent walking of <30 minutes per day had increased odds of having diabetes in relation to those with time spent walking of ≥2 hours (adjusted odds ratio [OR] 1.23; 95% CI, 1.02-1.48). In the longitudinal analysis, 612 participants developed diabetes during the 5 years of follow-up. However, a significant association between time spent walking and the incidence of diabetes was not observed. CONCLUSIONS: Increased risk of diabetes was implied in those with time spent walking of <30 minutes per day, although the longitudinal analysis failed to show a significant result.

Non-Islet Cell Tumor Hypoglycemia Is Caused by Big IGF-II in a Patient with a Carcinosarcoma of the Uterus.

We report a 72-year-old Japanese woman with severe hypoglycemia. The laboratory data, which revealed the suppression of serum insulin, suggested the existence of non-islet cell tumor hypoglycemia (NICTH). Abdominal computed tomography demonstrated the presence of a huge uterine tumor. The patient was treated with a continuous infusion of glucose, but died of sepsis on day 46. An autopsy revealed the pathological diagnosis to be a carcinosarcoma of the uterus. Interestingly, an immunohistochemical study discovered the expression of insulin-like growth factor (IGF)-II in both the carcinoma and sarcoma cells. In addition, an immunoblot analysis of blood samples revealed the presence of circulating big IGF-II. Therefore, this is a novel case of NICTH that was caused by a uterine carcinosarcoma.

Influence of the nonexchangeable potassium of mica on radiocesium uptake by paddy rice.

A pot cultivation experiment was conducted to elucidate the influence of the nonexchangeable potassium (K) of mica on radiocesium ((137)Cs) uptake by paddy rice (Oryza sativa L. cv. Koshihikari), and to evaluate the potential of mica application as a countermeasure to reduce radiocesium transfer from soil to paddy rice. The increase in the exchangeable K concentrations of soils, measured before planting, due to mica (muscovite, biotite, and phlogopite) application was negligible. However, in trioctahedral mica (biotite and phlogopite)-treated soil, the release of nonexchangeable K from the mica interlayer maintained the soil-solution K at a higher level during the growing season in comparison to the control, and consequently decreased the (137)Cs transfer factor for brown rice (TF). The sodium tetraphenylboron (TPB)-extractable K concentration of the soils, measured before planting, was strongly negatively correlated with the TF, whereas the exchangeable K concentration of the soils, also measured before planting, was not correlated with the TF. Therefore, we conclude that TPB-extractable K is more reliable than exchangeable K as a basis of fertilizer recommendations for radiocesium-contaminated paddy fields. Phlogopite-treated soils exhibited higher TPB-extractable K concentrations and lower TF values than biotite-treated soils. We thus conclude that phlogopite application is an effective countermeasure to reduce radiocesium uptake in paddy rice.

Hemoglobin a1c levels and the risk of cardiovascular disease in people without known diabetes: a population-based cohort study in Japan.

High hemoglobin A1c (HbA1c) levels are strongly associated with an increased risk of cardiovascular disease (CVD) in people with and without diabetes. However, information regarding the relationship between low HbA1c levels and the risk of CVD among people without known diabetes is limited. The aim of this large-scale, prospective, population-based cohort study was to clarify the association between HbA1c levels and CVD risk among people without known diabetes.We followed-up 10,980 men and 18,079 women (46-80 years old and free of CVD and cancer at baseline) in the Japan Public Health Center-based Prospective Study. Using Cox models, we estimated the hazard ratios for CVD risk with adjustments for age, sex, geographic areas, body mass index, smoking status, sports and physical exercise, alcohol intake, systolic blood pressure, non-high-density lipoprotein cholesterol, and high-density lipoprotein cholesterol.During the median follow-up of 9.4 years, 935 CVD events (770 strokes and 165 coronary heart diseases) occurred. We observed a nonlinear association between HbA1c levels and CVD risk in participants without known diabetes. Compared with HbA1c levels of 5.0 to 5.4% (31-36 mmol/mol), the hazard ratios for CVD in participants without known diabetes were 1.50 (95% confidence interval: 1.15-1.95), 1.01 (0.85-1.20), 1.04 (0.82-1.32), and 1.77 (1.32-2.38) for HbA1c levels of <5.0% (<31 mmol/mol), 5.5 to 5.9% (37-41 mmol/mol), 6.0 to 6.4% (42-47 mmol/mol), and ≥6.5% (≥48 mmol/mol), respectively (P value for nonlinear trend: <0.001). In addition, the hazard ratio for CVD was 1.81 (1.43-2.29) in patients with known diabetes compared with participants with HbA1c levels of 5.0 to 5.4% and without known diabetes. This nonlinear relation persisted after excluding people with kidney dysfunction, liver dysfunction, anemia, body mass index <18.5 kg/m, or early events within 3 years of follow-up (P value for nonlinear trend: <0.01 for all tests).In conclusion, both low and high levels of HbA1c were associated with a higher risk of CVD in a Japanese general population without known diabetes.