Delaying the third dose of Japanese aluminum-free hepatitis A vaccine Aimmugen elicits effective immune responses against hepatitis A in adults.

Inactivated aluminum-adsorbed hepatitis A vaccines such as Havrix, Vaqta, and Avaxim are commonly used worldwide. These vaccines are typically administered in a two-dose series (at 0 and 6-12 months). However, a lyophilized inactivated aluminum-free hepatitis A vaccine, Aimmugen, which is approved in Japan, is typically administered in a three-dose series (at 0, 2-4, and 24 weeks). Hence, individuals visiting endemic hepatitis A areas receive the primary two doses of Aimmugen before traveling and the third booster dose much later. It is currently uncertain whether boosting with a delayed third dose of Aimmugen is effective, or whether a new vaccination schedule should instead be initiated. Therefore, we investigated the anti-hepatitis-A viral immune response of adult travelers who received the third dose of Aimmugen more than 24 weeks after the first dose. Participants were vaccinated with the third dose of Aimmugen more than 2 years after the first two doses. Antibody titers were measured at Day 0 (prevaccination) and at 28-42 days after the third dose of Aimmugen. Twenty-nine adult participants were enrolled in the study (14 men and 15 women; mean age ± standard deviation age, 36.2 ± 8.1 years). The interval between the first two doses and the third dose was 3-14 years. The seroprotection rate (i.e., the percentage of participants with anti-hepatitis A virus antibody titers ≥ 10 mIU/mL) was 96.6 % (28/29) at Day 0 and increased to 100 % (29/29) at Days 28-42. Geometric mean concentration increased from 105 to 4,013 mIU/mL. We demonstrated that delaying the third dose of Aimmugen still elicited effective immune responses after priming with two doses of the vaccine. Trial registration: UMIN Clinical Trials Registry (UMIN-CTR): MIN000013624. Registered 03 April 2014. https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000015906.

Roles of Macrophages in Advanced Liver Fibrosis, Identified Using a Newly Established Mouse Model of Diet-Induced Non-Alcoholic Steatohepatitis.

Macrophages play critical roles in the pathogenesis of non-alcoholic steatohepatitis (NASH). However, it is unclear which macrophage subsets are critically involved in the development of inflammation and fibrosis in NASH. In TSNO mice fed a high-fat/cholesterol/cholate-based diet, which exhibit advanced liver fibrosis that mimics human NASH, we found that Kupffer cells (KCs) were less abundant and recruited macrophages were more abundant, forming hepatic crown-like structures (hCLS) in the liver. The recruited macrophages comprised two subsets: CD11c+/Ly6C- and CD11c-/Ly6C+ cells. CD11c+ cells were present in a mesh-like pattern around the lipid droplets, constituting the hCLS. In addition, CD11c+ cells colocalized with collagen fibers, suggesting that this subset of recruited macrophages might promote advanced liver fibrosis. In contrast, Ly6C+ cells were present in doughnut-like inflammatory lesions, with a lipid droplet in the center. Finally, RNA sequence analysis indicates that CD11c+/Ly6C- cells promote liver fibrosis and hepatic stellate cell (HSC) activation, whereas CD11c-/Ly6C+ cells are a macrophage subset that play an anti-inflammatory role and promote tissue repair in NASH. Taken together, our data revealed changes in liver macrophage subsets during the development of NASH and shed light on the roles of the recruited macrophages in the pathogenesis of advanced fibrosis in NASH.

Energy Intake from Healthy Foods Is Associated with Motor Fitness in Addition to Physical Activity: A Cross-Sectional Study of First-Grade Schoolchildren in Japan.

Childhood motor fitness is important for the physical and mental health of children and the prevention of future lifestyle diseases. This study aimed to investigate how energy intake from healthy foods and physical activity are associated with motor fitness among first-grade children. First-grade children (aged 6-7 years) attending three public elementary schools in Tokyo, Japan (n = 884), participated in this cross-sectional study. Self-administered questionnaires were distributed, which focused on lifestyle habits and required completion of a 1-day dietary record of meals that children ate at home. School lunch consumption was also assessed. Motor fitness was assessed by the New Physical Fitness Test (NPFT). Multiple regression analysis was used to investigate the association of the amount of energy from healthy foods and physical activity with NPFT scores. NPFT scores were positively correlated with involvement in after school exercise classes, playing outside (in boys only), and total energy intake. Energy intake from healthy foods showed a positively associated with NPFT scores (boys, ß = 0.120, p = 0.011; girls, ß = 0.140, p = 0.004), while energy intake from unhealthy foods did not. Energy intake from healthy foods was associated with motor fitness in children in addition to physical activity.

Collateral artery bypass in the infrapopliteal segment.

A 74-year-old man with diabetes and end-stage renal failure on regular dialysis required revascularization for gangrene of multiple toes and a heel ulcer on the right foot with chronic limb-threatening ischemia. However, the anterior tibial artery, posterior tibial artery, and peroneal artery, which are the usual targets below the knee, showed obstruction or calcification and were considered inappropriate bypass targets. Instead, a collateral artery developed along the area of the posterior tibial artery, and bypass surgery was performed with this artery. This is a case report showing successful collateral artery bypass grafting in the distal infrapopliteal segment.

Surgical treatment of multiple coronary-to-pulmonary artery fistulas with severe coronary artery stenosis.

A coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a cardiac chamber or a great vessel. CAF draining into the main pulmonary artery, called coronary-to-pulmonary artery fistula (CPAF), is one of the common variations of CAF. Although there is no definitive surgical indication of CPAF, it is treated concomitantly during other cardiac surgeries. Here, we present the case of a patient who underwent surgical closure of multiple CPAFs and coronary artery bypass grafting under cardiopulmonary bypass.

Distal Bypass Grafting Using the Basilic-Cephalic Loop Vein for Chronic Limb-Threatening Ischemia under Peripheral Nerve Blockades in a Patient with Severely-Reduced Heart Function and End-Stage Renal Disease.

A 51-year-old man with severe comorbidities required redo revascularization due to left chronic limb-threatening ischemia caused by a previous vein graft occlusion. The saphenous veins were not available due to previous surgeries. Femoro-posterior tibial artery bypass surgery was successfully performed using the basilic-cephalic loop vein under peripheral nerve blockades. This anesthesia allowed a series of surgical revascularizations without general anesthesia, and the postoperative courses were uneventful. The patient survived for 4 years with ambulatory status. In conclusion, loop graft can be an alternative single vein material for distal bypass when no saphenous veins are available.

Laser speckle flowgraphy can also be used to show dynamic changes in the blood flow of the skin of the foot after surgical revascularization.

OBJECTIVES: Laser speckle flowgraphy is a new method that enables the rapid evaluation of foot blood flow without contact with the skin. We used laser speckle flowgraphy to evaluate foot blood flow in peripheral arterial disease patients before and after surgical revascularization. MATERIALS AND METHODS: A prospective single-center study. Thirty-one patients with 33 limbs that underwent surgical revascularization for peripheral arterial disease were included. Pre- and postoperative foot blood flows were measured on the plantar surface via laser speckle flowgraphy and skin perfusion pressure. The laser speckle flowgraphy device was used to visualize the blood flow distribution of the target skin and processed the pulse wave velocity of synchronized heart beats. The mean blood flow, which was expressed as the area of the pulse wave as the beat strength of skin perfusion on laser speckle flowgraphy converted into a numerical value, was assessed as dynamic changes following surgery. Beat strength of skin perfusion was also investigated in non-peripheral arterial disease controls (23 patients/46 limbs). RESULTS: The suitability of beat strength of skin perfusion in non-peripheral arterial disease controls was achieved; the beat strength of skin perfusion value was significantly higher in every area of interest in non-peripheral arterial disease controls compared to that in peripheral arterial disease limbs at the preoperative stage (105.8 ± 8.2 vs. 26.3 ± 8.2; P < 0.01). Although the pulse wave before surgery was visually flat in peripheral arterial disease patients, the pulse wave was remarkably and immediately improved through surgical revascularization. Beat strength of skin perfusion showed a dynamic change in foot blood flow (26.3 ± 8.2 at preoperation, 98.5 ± 6.7 immediately after surgery, 107.6 ± 5.7 at seven days after surgery, P < 0.01 for each compared to preoperation) that correlated with an improvement in skin perfusion pressure. CONCLUSIONS: Laser speckle flowgraphy is a noninvasive, contact-free modality that is easy to implement, and beat strength of skin perfusion is a useful indicator of foot circulation during the perioperative period. Further analysis with a larger number of cases is necessary to establish appropriate clinical use.

Higher energy intake at dinner decreases parasympathetic activity during nighttime sleep in menstruating women: A randomized controlled trial.

BACKGROUND: Previous studies have found more frequent increases in dietary intake and nonrestorative nocturnal sleep during the luteal phase than in the follicular phase, but few studies have investigated how increased energy intake at dinner influences sleep by considering the correlation between female hormone and cardiac autonomic nervous system (ANS) activity. This study examined the effects of energy intake at dinner on ANS activity during nighttime sleep in order to evaluate restorative sleep in healthy women. We also examined whether ANS activity is associated with female hormone dynamics. METHODS: Twenty-four healthy collegiate women participated in this randomized crossover trial. Each was assigned to receive a High Energy Dinner (HED) or Low Energy Dinner (LED) treatment. Energy ratios of each test meal (breakfast, lunch, and dinner) to total energy intake were 1:1:2 and 1:2:1 for HED and LED treatments, respectively. Each participant wore an ECG recorder before dinner and removed it upon waking the next morning. Power spectral analysis of heart rate variability was used to calculate low frequency (LF), high frequency (HF), and total spectral power (TP). Cardiac sympathetic (SNS) and parasympathetic (PNS) nervous system activity were evaluated as LF/HF and HF/TP, respectively. RESULTS: Mean HF/TP for the entire sleeping period was lower with HED treatment compared to LED treatment (41.7 ±â€¯11.4 vs. 45.0 ±â€¯12.13, P = .034). Intergroup comparisons of the initial 3-h sleeping period revealed that LF/HF (0.87 ±â€¯0.82 vs. 0.66 ±â€¯0.82, P = .013) and HF/TP (45.6 ±â€¯13.9 vs. 51.5 ±â€¯11.8, P = .002) were higher and lower, respectively, with HED treatment compared to LED treatment. Progesterone levels were positively correlated with LF/HF with LED treatment, and negatively correlated with HF/TP with both HED and LED treatments. CONCLUSION: Higher energy intake at dinner increases and decreases SNS and PNS activities, respectively, resulting in nonrestorative nocturnal sleep. In addition, a negative correlation was observed between progesterone and PNS activity, highlighting the difficulty of increasing PNS activity during sleep in the luteal phase compared to the follicular phase.

The Impact of Menstrual Cycle Phases on Cardiac Autonomic Nervous System Activity: An Observational Study Considering Lifestyle (Diet, Physical Activity, and Sleep) among Female College Students.

Studies examining the impact of menstrual cycle phases on the cardiac autonomic nervous system have produced inconsistent results. This study aimed to investigate this relationship, controlling for the confounding effects of diet, physical activity, and sleep, which can be affected by the menstrual cycle. Fifteen female college students with regular menses were enrolled. Data regarding 24-h heart rate variability (HRV), dietary intake, eating behavior, menstrual distress, and sleep and activity parameters were obtained during the follicular and luteal phases. Power spectral analysis of HRV was used to calculate low-frequency (0.04-0.15 Hz, LF), high-frequency (>0.15 Hz, HF), and total spectral power (TP). Cardiac sympathetic and parasympathetic nervous system activity indicators were evaluated as LF/HF and HF/TP, respectively. Intake of protein and fat, as well as total sleep time and number of awakenings, were higher in the luteal phase than in the follicular phase (p<0.05). Tendencies for increased mean activity counts, emotional eating scores, and behavioral change scores in the Menstrual Distress Questionnaire were observed in the luteal phase (p<0.10). Although LF/HF was higher in the luteal phase (p=0.036), the relationship was weakened after controlling for diet, physical activity, and sleep (p=0.113). Our findings suggest that altering sympathetic nervous system activity during the menstrual cycle was not independent from major lifestyle factors (diet, physical activity, and sleep). Menstrual cycle phase and changes of these parameters should be considered when assessing the cardiac autonomic function among menstruating woman.

Habitual dietary protein intake affects body iron status in Japanese female college rhythmic gymnasts: a follow-up study.

BACKGROUND: Many rhythmic gymnasts stay lean by reducing their body weight (BW); however, this may result in iron deficiency (ID). Our previous cross-sectional study reported an association between ID incidence and protein intake in gymnasts during the pre-season. The present study aimed to examine the association between dietary protein intake and ID incidence in a 2-year follow-up study. METHODS: Elite Japanese female college rhythmic gymnasts [mean age ± standard deviation (SD): 18.4 ± 0.5 years] were recruited on a voluntary basis every August for 9 years. Anthropometric, dietary intake, and hematological parameters were measured at baseline and 2 years later. A total of 20 participants without ID at baseline were divided into either a lower (L, n = 11) or higher (H, n = 9) protein group based on median protein intake (1.3 g protein/kg BW). RESULTS: Participants consumed 1.08 ± 0.16 and 1.55 ± 0.14 g/kg BW of protein in the L and H groups, respectively. No significant changes in the intake of protein and other nutrients were observed between baseline and 2-year follow-up in both groups. ID was observed in a total of eight (72.8 %) participants in the L group and one (11.2 %) in the H group at follow-up. The incidence of ID was significantly lower in the H group than the L group (Fisher's exact test, odds ratio, 0.043; 95 % CI 0.004-0.552; p = 0.010). CONCLUSIONS: During the pre-season weight loss period, habitually higher protein intake may reduce ID incidence among elite college female rhythmic gymnasts.

Relationship Between Dietary Factors and Bodily Iron Status Among Japanese Collegiate Elite Female Rhythmic Gymnasts.

This cross-sectional study explored the prevalence of iron deficiency (ID) and associations between dietary factors and incidence of ID in female rhythmic gymnasts during preseason periods. Participants were 60 elite collegiate rhythmic gymnasts (18.1 ± 0.3 years [M ± SD]) who were recruited every August over the course of 8 years. Participants were divided into 2 groups according to the presence or absence of ID. Presence of ID was defined either by ferritin less than 12 µg/L or percentage of transferrin saturation less than 16%. Anthropometric and hematologic data, as well as dietary intake, which was estimated via a semiquantitative food frequency questionnaire, were compared. ID was noted in 48.3% of participants. No significant group-dependent differences were observed in physical characteristics, red blood cell counts, hemoglobin, hematocrit, haptoglobin, or erythropoietin concentrations. The ID group had a significantly lower total iron-binding capacity; serum-free iron; percentage of transferrin saturation; ferritin; and intake of protein, fat, zinc, vitamin B2, vitamin B6, beans, and eggs but not iron or vitamin C. The recommended dietary allowance for intake of protein, iron, zinc, and various vitamins was not met by 30%, 90%, 70%, and 22%-87% of all participants, respectively. Multiple logistic analysis showed that protein intake was significantly associated with the incidence of ID (odds ratio = 0.814, 95% confidence interval [0.669, 0.990], p = .039). Participants in the preseason's weight-loss periods showed a tendency toward insufficient nutrient intake and were at a high risk for ID, particularly because of lower protein intake.

Association of body mass index with lifestyle and rotating shift work in Japanese female nurses.

OBJECTIVE: Higher body mass index (BMI) values have been reported in rotating shift workers compared with regular daytime workers. This study examines the relationship between work schedule and BMI, and considers whether lifestyle habits could explain the relationship. METHODS: Japanese female nurses (1179 day workers and 1579 rotating shift workers, aged 20-59) were studied using self-administered questionnaires. The questionnaires assessed height, weight, and dietary intake, physical activity, and sleep (lifestyle) habits. RESULTS: The BMI of shift workers was significantly higher than that of day workers. Shift workers consumed significantly higher amounts of sugar-sweetened beverages and slept for significantly shorter durations on nights between days on the day shift compared with day workers-factors which were also independently associated with higher BMI. In addition, multivariable linear regression coefficients for BMI showed a significant correlation with rotating shift work (ß = 0.051), after controlling for lifestyle habits. CONCLUSIONS: Higher consumption of sugar-sweetened beverages and shorter sleep duration were associated with rotating shift work and higher BMI. This should be taken into consideration in preventing obesity in real-life shift work situations. Other shift work-related factors, such as abnormal timing of meals and/or sleep, should also be identified.

Relationship of dietary intake and lifestyle factors to health-related quality of life in the community-dwelling elderly.

Quality of life (QOL) encompasses a broad notion of health and is increasingly used to evaluate the effectiveness of health care services. The purpose of this cross-sectional study was to assess health-related quality of life (HR-QOL) in the community-dwelling elderly (mean age, 72.7±0.3 y; female 46.4%, n=179) in Japan and to explore diminished factors. We assessed HR-QOL by the 36-Item Short-Form Health Survey (SF-36), maximum walking speed, step counts, Tokyo Metropolitan Institute of Gerontology (TMIG) index, dietary intake and blood biochemistry. Two summary scores of the SF-36 were calculated (physical component score: PCS, mental component score: MCS). We divided participants into two groups based on the standard values of PCS and MCS classified by age (high and low group), which was further stratified into a high PCS and high MCS (BH) group and a low PCS and low MCS (BL) group. Mean maximum walking speed and daily step counts were 207.7±2.8 cm/s and 7,008±289. Eighty-one percent of the participants had full scores in the TMIG index. Daily intake of energy and protein were 2,081±33 kcal and 74.5±0.9 g. The maximum walking speed, TMIG index, alcohol consumption and chewing ability were significantly higher in the BH group than those in the BL group, but not dietary intake. Stepwise logistic regression analysis indicated that maintaining maximum walking speed might be associated with sustaining HR-QOL in the healthy elderly.

[Tuberculosis control in Kawasaki City--promoting the DOT program].

Kawasaki City initiated the DOT (Directly Observed Therapy) program in 2000 to improve tuberculosis (TB) control in the homeless persons and individuals living in temporary subsidized housing. The program was implemented as an additional program to the city's control policy of mass TB screenings for these groups. The DOT program was implemented through participation of numerous agencies sharing common goals. Through coordination and cooperation, a strategy suitable for the regional level was developed. Sectors involved were not only the TB control staff within the public health centers but also the entire public health centers, the welfare administrative division, the city's TB task force and homeless task force, and regional medical institutions. With the implementation of the DOT program, proper medical treatment, improved patient care, and various other measures were performed, and this led to the strengthening of TB control not only in designated DOT-implemented areas but also in the entire city. As a result, the treatment outcomes improved, and incidence rate of TB began to decrease.