Dynamics of depressive states among university students in Japan during the COVID-19 pandemic: an interrupted time series analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic was reported to have increased depression among university students which was associated with impairments in their campus lives. This study examined changes in depressive states among Japanese university students during the COVID-19 pandemic. METHODS: A secondary data analysis from a factorial randomized controlled trial involving smartphone-based cognitive-behavioral therapy was performed. Six cohorts (N = 1626) underwent an 8-week intervention during the spring or autumn of 2019-2021, with a 9-month follow-up. We evaluated participants' depressive states weekly using the Patient Health Questionnaire-9 (PHQ-9) during the intervention, with monthly evaluations thereafter. The follow-up periods included Japan's four states of emergency (SOEs) to control COVID-19. Hypothesizing that SOEs caused a sudden worsening of depressive states, Study 1 compared the cohorts' PHQ-9 scores, and Study 2 employed time series analysis with a mixed-effects model to estimate identified changes in PHQ-9 scores. RESULTS: Although no changes in depressive states were observed in relation to the SOEs, Study 1 identified sudden increases in PHQ-9 scores at the 28-week evaluation point, which corresponded to the beginning of the new academic year for the three autumn cohorts. In contrast, the three spring cohorts did not exhibit similar changes. Study 2 showed that, for all three autumn cohorts (n = 522), the 0.60-point change was significant (95% CI 0.42-0.78; p < .001) at 28 weeks; that is, when their timeline was interrupted. CONCLUSIONS: While the results do not indicate any notable impact of the SOEs, they highlight the influence of the new academic year on university students' mental health during COVID-19. Trial registration UMIN, CTR-000031307. Registered on February 14, 2018.

Comparison of neurological outcomes following witnessed out-of-hospital ventricular fibrillation defibrillated with either biphasic or monophasic automated external defibrillators.

BACKGROUND: Biphasic waveform defibrillation results in higher rates of termination of fibrillation than monophasic waveform defibrillation but has not been shown to improve survival outcomes. OBJECTIVE: To compare the effectiveness of a biphasic automated external defibrillator (AED) with a monophasic AED for witnessed out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF). METHODS: In a prospective population-based cohort study, adults with witnessed VF OHCA were treated with either monophasic or biphasic waveform AED shocks. The primary outcome measure was neurologically favourable 1-month survival, defined as a Cerebral Performance Categories score of 1 or 2. RESULTS: Of 366 adults with witnessed OHCA of presumed cardiac aetiology, 74 (20%) had VF. Termination of VF with the first shock tended to occur more frequently after biphasic AED shocks (36/44 (82%) vs 20/30 (67%), p = 0.14). Return of spontaneous circulation (ROSC) occurred more frequently after biphasic AED shocks (29/44 (66%) vs 8/30 (27%), p = 0.001). Neurologically favourable 1-month survival was also more frequent in the biphasic group (10/44 (23%) vs 1/30 (3%), p = 0.04). The median time interval from the first shock to the second shock was 67 s in the monophasic group and 24 s in the biphasic group (p = 0.001). CONCLUSIONS: Treatment with biphasic AED shocks improved the likelihood of ROSC and neurologically favourable 1-month survival after witnessed VF compared with monophasic AED shocks. In addition to waveform differences, a shorter time interval from the first shock to the second shock could account for the better outcomes with biphasic AED.

Iodine-123-MIBG imaging in pheochromocytoma with cardiomyopathy and pulmonary edema.

We encountered a patient with pheochromocytoma associated with a catecholamine-induced cardiomyopathy that developed recurrently bilateral and unilateral pulmonary edema. The diagnosis of pheochromocytoma was made by elevated plasma catecholamine levels and the intense tumor [123I]MIBG uptake and was confirmed at the time of surgery. The patient showed reduced myocardial [123I]MIBG uptake with left ventricular dysfunction, and endomyocardial biopsy findings were consistent with the diagnosis of catecholamine-induced cardiomyopathy. After tumor resection, plasma levels of catecholamine were normalized, and pulmonary edema never recurred, although cardiac dysfunction did not show an improvement on echocardiography. Myocardial and lung [123I]MIBG uptake increased when compared to uptake levels on preoperative scans, but myocardial uptake was still below normal. These findings indicated that over-secreted catecholamines influenced both the heart and lungs. Pheochromocytoma can induce cardiac and lung injuries, and [123I]MIBG scanning may contribute not only to tumor characterization but also to assessing and monitoring the influence of catecholamines on the heart and lungs.

Eosinophil counts and plasma fibrinogen in patients with vasospastic angina pectoris.

Epidemiologic studies have suggested a relation between white blood cell (WBC) counts and the incidence of coronary heart disease. However, the relation between vasospastic angina pectoris (VAP) and WBC counts remains to be elucidated. To clarify the relation between differential and WBC counts in VAP, we compared the hematologic values, blood chemical values, plasma fibrinogen levels, C-reactive protein levels, and coronary risk factors in patients with spontaneous attacks of VAP (n = 39) with those in patients with stable effort angina pectoris (EAP, n = 35) and in control subjects (n = 19). Patients with VAP were further divided into mild VAP (n = 22) and severe VAP groups (n = 17). There were no differences in the coronary risk factors, body temperature, total WBC counts, and C-reactive protein levels among the control, EAP, mild VAP, and severe VAP groups, except that the high-density lipoprotein cholesterol in the EAP group was significantly lower than that in the control group (p <0.01). In contrast, the eosinophil counts were significantly higher in the severe VAP group than in the other 3 groups (p <0.01). Plasma fibrinogen levels were also significantly higher in the severe VAP group than in the other 3 groups (p <0.05). The follow-up study for differential and WBC counts in patients with VAP (n = 23) demonstrated that, after medical therapy, the eosinophil counts were significantly decreased to the some level as those in the control group (p <0.0001). Thus, the eosinophil counts and plasma fibrinogen levels could predict the severity of VAP. Furthermore, a follow-up study in patients with VAP suggests that coronary vasospasm could result in an increase in eosinophil counts.

Importance of left anterior descending coronary artery curvature in determining cross-sectional plaque distribution assessed by intravascular ultrasound.

We assessed the relation between the circumferential distribution of coronary atherosclerotic plaques and the structure of the epicardial coronary arteries in patients with coronary artery disease using intravascular ultrasound in vivo. Coronary atherosclerosis preferentially formed at the inner arc of the curved coronary vessels, and greater vessel curvatures were associated with greater distributions of atherosclerotic lesions along the inner coronary artery wall.

A case of acute eosinophilic pneumonia. Evidence for hypersensitivity-like pulmonary reaction.

We examined an 86-year-old man with acute respiratory failure. A chest roentgenogram showed diffuse reticular shadows. Transbronchial biopsy revealed thickening of the alveolar septa accompanied by moderate eosinophil infiltration. After admission to the hospital, the patient's symptoms immediately improved without any medication. Clinical course and pathologic findings suggested acute eosinophilic pneumonia caused by a hypersensitivity reaction.

Cyclophosphamide-induced diabetes in Long-Evans Tokushima Lean rats: influence of ovariectomy on the development of diabetes.

We studied the effect of treatment with cyclophosphamide (CY) on the incidence of diabetes in Long-Evans Tokushima Lean (LETL) rats, a newly established strain of spontaneously type I diabetic rats. The overall incidence of diabetes among 356 LETL rats treated with CY was 25.6%, which was significantly higher than the 10.5% among 857 untreated LETL rats at 27 weeks of age, and there was no significant sex difference. The incidence of CY-induced diabetes in adult (> 16 weeks of age) female LETL rats was 7.7% (10/130), which was significantly lower than that in other CY-treated groups of LETL rats. No diabetes mellitus was induced by administration of CY to 23 diabetes-resistant LETO rats. There were no significant differences in the degrees of hyperglycemia or hyperketonemia in spontaneously and CY-induced diabetic LETL rats, but the plasma glycated albumin level of CY-induced diabetic rats (10.3% +/- 2.1%) was significantly higher than that of spontaneously diabetic rats (8.2% +/- 1.3%), suggesting that plasma glucose levels increased more rapidly in the latter. More than half of the diabetic rats showed type C or D morphological changes of the islets, ie, atrophic change with little mononuclear cell infiltration or almost complete loss of the islets. However, distributions of various types of morphological changes in the islets were not significantly different in the two groups. Ovariectomy (OVX) significantly increased the incidence of CY-induced diabetes in adult female rats from 7.7% to 20.8%. The number of CD8+ cells was significantly increased in noncastrated adult female LETL rats and decreased to the level of other groups after OVX.(ABSTRACT TRUNCATED AT 250 WORDS)

Is exercise training effective in preventing diabetes mellitus in the Otsuka-Long-Evans-Tokushima fatty rat, a model of spontaneous non-insulin-dependent diabetes mellitus?

We determined whether exercise training is effective in preventing the development of diabetes mellitus in a model rat (Otsuka-Long-Evans-Tokushima Fatty [OLETF]) with non-insulin-dependent diabetes mellitus (NIDDM). Thirty male OLETF rats aged 5 weeks were assigned to one of the following three groups: trained rats placed individually in an exercise wheel (EW) cage, EW-control rats housed in the same cages equipped with a fixed rotatory wheel, and sedentary rats maintained two or three to a conventional cage. Eight male diabetes-resistant Long-Evans rats were used as nondiabetic controls. At 24 weeks of age, the trained, EW-control, sedentary, and nondiabetic control rats weighed an average of 445, 559, 621 and 513 g and had abdominal fat deposits of 16, 55, 67, and 23 g, respectively. The mean amount of exercise of trained rats was 5,243 m/d. At 24 weeks of age, the cumulative incidences of diabetes mellitus in sedentary and EW-control rats were 78% and 50%, respectively, while neither trained nor nondiabetic control rats became diabetic. Fasting and 120-minute plasma immunoreactive insulin (IRI) levels after oral glucose administration were significantly lower in the trained group than in the other groups. In vivo insulin-stimulated glucose uptake as measured with a euglycemic clamp was reduced 37% in sedentary rats and increased 35% in trained rats compared with that in nondiabetic control rats. Morphological studies on the pancreas of sedentary and EW-control rats showed enlarged multilobulated fibrotic islets, whereas sections of islets from trained rats appeared normal but slightly enlarged.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation between residual beta-cell function and age at onset of spontaneous diabetes in Long Evans Tokushima lean rats.

We studied the natural course of disease in spontaneously diabetic rats, Long Evans Tokushima Lean (LETL) rats, to determine whether it showed similar pathogenetic heterogeneity to that of patients with insulin-dependent diabetes mellitus (IDDM) with regard to the relationships between age at onset, rapidity of disease progress, and degree of beta-cell function at the time of its manifestation. Type 1 diabetes developed in 35 rats (6.3%) between 40 and 140 days of age. Eight rats that became diabetic at age 69 days or less were more severely ketotic at the time of first detection of glycosuria and showed more rapid deterioration than seven rats that became diabetic later after birth (mean plasma 3-hydroxybutyrate levels, 4,707 +/- 1,215 pmol/L v 1,390 +/- 859 pmol/L; mean +/- SEM, P < .01). The mean plasma levels and pancreatic content of immunoreactive insulin (IRI) of the early onset rats, 47 +/- 13 pmol/L and 19 +/- 12 pmol/g tissue weight, were significantly lower (P < .01) than the corresponding values of the late-onset rats, 262 +/- 52 pmol/L and 348 +/- 87 pmol/g tissue weight, respectively. Both values were markedly lower than the mean values of 25 nondiabetic LETL rats, 976 +/- 122 pmol/L and 3,488 +/- 628 pmol/g tissue weight. Plasma immunoreactive glucagon (IRG) levels were significantly increased in the diabetic groups (early onset, 57 +/- 13 pmol/L; late-onset, 51 +/- 12 pmol/L; nondiabetic, 18 +/- 1 pmol/L; P < .01). These changes in pancreatic hormone levels of the early onset and late-onset rats were compatible with the histological features of their pancreatic islets.(ABSTRACT TRUNCATED AT 250 WORDS)

Stereopsis-processing regions in the human parieto-occipital cortex.

We performed fMRI on the human parieto-occipital cortex in order to identify the neural processing regions of stereopsis. Visual stimulation for stereopsis was performed with a random-dot stereogram displayed in the image guides of a new binocular visual stimulation device that we developed. Interestingly, regions from the dorsal portion of the occipital lobe to the superior parietal lobule were activated by binocular disparity, while the inferior parietal lobule was not activated. Moreover, these regions were shown as dominant in the right hemisphere. Functional brain mapping revealed that the processing regions of stereopsis were dorsally located in parieto-occipital cortex, and that the superior parietal lobule is an important region for neural processing of human stereopsis.

N-2 acetylation of 2'-deoxyguanosine by coffee mutagens, methylglyoxal and hydrogen peroxide.

Coffee shows direct-acting mutagenicity in Salmonella typhimurium TA100 and most of this mutagenicity is due to the synergistic effects of methylglyoxal and hydrogen peroxide. The modifications of deoxyribonucleosides by methylglyoxal plus hydrogen peroxide were studied in vitro. When 2'-deoxyguanosine (6.25 mumole) was treated with methylglyoxal (125 mumole) and hydrogen peroxide (125 mumole) in 5 ml of 0.1 M phosphate buffer (pH 7.4) at 37 degrees C for 3 h, N2-acetyl-2'-deoxyguanosine was formed with a yield of 1.1%. Its formation increased time-dependently. By contrast, no appreciable modification of other deoxynucleosides was detected after their incubation with methylglyoxal and hydrogen peroxide under similar conditions. N2-Acetyl-2'-deoxyguanosine was also formed during incubation of 2'-deoxyguanosine with instant coffee.

Pre-clinical Cushing's syndrome with body weight loss and normal circadian rhythm of blood pressure.

A 68-year-old woman was referred for evaluation of an incidentally discovered left adrenal mass. Her chief complaint was body weight loss. She showed no symptoms or signs suggestive of Cushing's syndrome. The circadian rhythm of blood pressure was also normal. Hormonal assessment revealed an abnormal diurnal variation in serum cortisol levels, suppressed baseline plasma adrenocorticotrophic hormone, and nonsuppression of serum and urinary cortisol with the dexamethasone suppression test. Adrenal scintigraphy with (131)I-6-beta-iodomethyl-norcholesterol showed uptake on the left adrenal and inhibition of the contralateral adrenal gland. She was diagnosed as pre-clinical Cushing's syndrome. Due to the lack of clinical symptoms and the risks of surgery, we emphasize the importance of careful assessment of the cortisol metabolism and scintigraphic scanning under dexamethasone suppression to avoid post-surgical Addisonian crisis.

Stimulation of cholesterol metabolism in pyridoxine-deficient rats.

The effect of pyridoxine deficiency on cholesterol catabolism was studied in rats. The concentrations of bile lipid components were higher in pyridoxine-deficient rats than in controls. A decreased ratio of taurine to glycine conjugates was observed in the deficient rats. No change in the neutral sterol content, but an increase in the bile acid content of the feces was observed in the deficient rats. Increased cholesterol catabolism in pyridoxine-deficient rats was also shown by the shorter half-life of the [14C] cholesterol injected into these animals.

Effect of pyridoxine deficiency on cholesterogenesis in rats fed different levels of protein.

Hepatic cholesterol contents in rats fed a 70% or 20% casein diet with or without pyridoxine was determined. In the case of the 70% casein group, pyridoxine-deficient rats showed a higher content than the control. The increment was mainly due to the accumulation of an ester form of the cholesterol. On the other hand, pyridoxine-deficient rats in the 20% casein group showed a slightly lower content. The cholesterol content in liver microsomal fractions was lower in the 20% casein pyridoxine-deficient group and serum cholesterol level was lower in the 70%-casein pyridoxine-deficient group than those in respective control groups. Incorporation of [14C]acetate into cholesterol was studied using liver slices, and significant stimulation was observed in pyridoxine-deficient rat fed a 20% or 70% casein diet. There was no difference in intestinal cholesterogenesis between the control and the deficient groups.

Factors affecting liver lipid content in pyridoxing-deficient rats. I. Dietary protein levels.

Effects of choline fortification and various dietary protein levels on liver lipid content in pyridoxine-deficient rats were studied. Choline fortification did not prevent the accumulation of liver lipids in pyridoxine-deficient rats. Considerable accumulation of liver lipids was observed in the 70% casein pyridoxine-deprived group. Reducing the protein level in the diet decreased the extent of lipid accumulation. A highly negative correlation was found between liver lipid content and liver GPT activity, indicating that the fatty infiltration of the liver may be intimately related to the pyridoxine deficiency state. The time course of fatty liver induction upon feeding of a 70% casein pyridoxine-deficient diet was also studied. The liver lipid content increased gradually and reached the highest value by the third week with a concomitant decrease in food intake. Effect of change of dietary compositions on fatty liver caused by 70% casein pyridoxine-free diet was examined. Feeding of a 70% casein pyridoxine-supplemented diet or a 20% casein pyridoxine-free diet caused decreases in the liver lipids.

A new diet-exercise therapy in our obese-child clinic.

Because a large percentage of childhood obesity may persist into adulthood and cause a hotbed of so-called seijin-byoh (adult diseases), its treatment should also be considered from the viewpoint of seijin-byoh prophylaxis. Most obese children, however, are awkward in their movements, in spite of binge eating or bulimia, and unable to carry out any severe exercise-diet therapy. For such subjects, we have designed a new practicable procedure, and obtained excellent results for the last five years. The main principle of our procedure is that the control of caloric intake is relaxed as much as possible after due consideration of a child's growth in height: no restriction for mild, 10-15% of the requirement for moderate, and 20-25% for severe obese children, respectively. The ratio of protein/energy is established at a higher level than usual, while that of fat/energy at a lower level. For exercise, walking is the most easy and important exercise and the proper speeds for individuals are converted from the same amount of movement determined at the 1st increase point of serum lactate values, where the proportion of movement-energy originating from body fat reaches the highest percentage at about 75%. Our new procedure is supported also by the fact that the reduction in body weight combines with the improvement in measurement values of fatty metabolites without any change in values of proteins.

Campylobacter enteritis in childhood.

Bacteriological examinations of faecal samples, obtained from 321 infants and children with acute enteritis, were carried out in the pediatric clinic of the University of Occupational and Environmental Health, Japan from January 1983 to December 1985. Campylobacter jejuni were isolated in 48 infants and children (15%), while Salmonella species in 6 (1.9%), and enteropathogenic Escherichia coli in 11 (3.4%). Of 48 infants and children with Campylobacter enteritis (C. enteritis), 20 cases (42%) were under 2 years old, 17 (35%) from 2 to 6 years old, 8 (17%) from 7 to 12 years old, and 3 (6%) above 13 years old, suggesting the higher incidence in the younger infants and children. There were 30 males and 18 females, male:female ratio of 5:3. No seasonal variations in the frequency of C. enteritis were noticed. Major symptoms were diarrhea (94%), fever (50%), bleeding in stools (44%), abdominal pain (31%), and vomiting (10%). All strains of C. jejuni were highly sensitive to gentamicin, amikacin, kanamycin, erythromycin, josamycin, and chloramphenicol. We also report two typically mild cases of C. enteritis, a newborn infant with monosymptomatic bleeding in stools and diarrhea, and another 11-month-old, Wiskott-Aldrich syndrome infant with asymptomatic bloody stools.

[Diagnosis of magnetic resonance imaging (MRI) for blowout fracture--three advantages of MRI].

INTRODUCTION: Magnetic resonance imaging (MRI) gives a much more detailed picture of the soft tissue than computerized tomography (CT). In blowout fracture cases, it is very easy to observe the incarcerated orbital tissue. SUBJECTS: We performed MRI in 19 blowout fracture cases. RESULTS: After evaluating the images, we found three advantages of MRI. The first is that even small herniation of the orbital contents can easily be detected because the orbital fatty tissue contrasts well around the other tissues in MRI. The second is that the incarcerated tissues can be clearly differentiated because a clear contrast between the orbital fatty tissue and the extraocular muscle can be seen in MRI. The third is that the running images of the incarcerated muscle belly can be observed because any necessary directional slies can be taken in MRI. CONCLUSION: These advantages are very important in the diagnosis of blowout fractures. MRI should be employed in blowout fracture cases in addition to CT.

Effect of exercise training on insulin and glucagon release from perfused rat pancreas.

The effect of physical training on insulin and glucagon release in perfused rat pancreas was examined in the spontaneously exercised group running in a wheel cage an average of 1.4 km/day for 3 weeks and in the sedentary control group kept in the cage whose rotatory wheel was fixed on purpose. Pancreatic immunoreactive insulin (IRI) responses to glucose and arginine were reduced by 28% and 47.8% respectively in trained rats compared with untrained rats, while IRI content of the pancreas was similar in these two groups. The demonstrated decrease in insulin secretion of the beta-cell of the trained rats, in response to the glucose and arginine stimulations, may be functional in nature. On the other hand, neither pancreatic glucagon immunoreactivity (GI) response to glucose and arginine nor GI content of the pancreas was modified by exercise training. These results demonstrate that exercise training reduces IRI responses to glucose as well as to arginine stimulations, but does not modify any secretory response of pancreatic GI.