Associations Between Lifestyle Factors and Constipation Among Survivors After the Great East Japan Earthquake: A 9-year Follow-up Study.

BACKGROUND: Disaster survivors experience deterioration in lifestyles and an increase in constipation. After the Great East Japan Earthquake in 2011, some survivors were evacuated for a long term, even after moving to temporary housing and public reconstruction housing. However, annual changes in constipation and the association between lifestyles and constipation among the survivors are still unknown. METHODS: Overall, 9,234 survivors aged 18 years or older participated in this 9-year follow-up survey after the disaster. Information about the prevalence of constipation and lifestyle factors (diet, physical activity, and mental health) was collected using a self-reported questionnaire. Their dietary intake was categorized into the following two dietary patterns: prudent (fish and shellfish, soybean products, vegetables, fruits, and dairy products) and meat (meat and eggs). Odds ratios for constipation according to lifestyle factors were calculated using a generalized linear mixed model. RESULTS: In women, the prevalence of constipation was the highest at baseline (8.7%) and remained around 5% afterward. In both men and women, older age, poor mental health, and poor physical activity were significantly associated with higher odds ratios of constipation. Moreover, a lower frequency of meals and a lower prudent dietary score were significantly associated with women's constipation. CONCLUSION: The prevalence of constipation was the highest at baseline and remained around 5% in women. Lifestyle factors, such as poor mental health, physical inactivity, and low frequency of meals were associated with constipation. Our findings suggest continuous support for the survivors with constipation for medium- to long-term after disasters.

Utility of human epidermal growth factor 2 heterogeneity as a prognostic factor in triple-negative breast cancer.

In some cases of human epidermal growth factor 2 (HER2)-negative breast cancer, including triple-negative breast cancer, HER2 expression is sporadically and strongly upregulated, a condition known as HER2 heterogeneity. We investigated the clinicopathological features of patients with HER2 heterogeneity in triple-negative breast cancers treated with neoadjuvant chemotherapy. Thirty-nine patients with triple-negative breast cancer who had undergone preoperative chemotherapy participated in this study. To assess for HER2 heterogeneity, we used dual in situ hybridization slides. We evaluated the association between HER2 heterogeneity and clinicopathological factors such as rates of pathologic complete response (pCR) and of recurrence-free survival. Of the 39 patients, 15 (38.5%) had cancers with HER2 heterogeneity. The pCR rates were 13.3% among patients with HER2 heterogeneity and 20.8% among those with HER2 nonheterogeneity, but the difference was not significant. The recurrence-free survival rate was significantly lower in patients with HER2 heterogeneity than in those without (P = 0.025). HER2 heterogeneity is a significant predictor of poor prognosis in patients with triple-negative breast cancer treated with neoadjuvant chemotherapy.

Psychological Distress in Responders and Nonresponders in a 5-year Follow-up Health Survey: The RIAS Study.

BACKGROUND: People with poor health or mental conditions are generally unwilling to participate in the health examinations, and no studies have directly examined the relationship of psychological distress among disaster survivors with participation status to date. The present study thus examined psychosocial differences according to the respondent status in a 5-year follow-up survey among participants in the prospective health surveys on survivors of the Great East Japan Earthquake and Tsunami Disaster study in Iwate Prefecture, Japan. METHODS: We analyzed data from 10,203 Japanese survivors aged ≥18 years (mean age, 65.6 years; 38.0% men) and who underwent health examinations at baseline in 2011. Participants were classified into responders and nonresponders according to their 2015 health examination participation status. Psychological distress was evaluated using the Kessler 6 scale and categorized as none, mild, and severe. Multinominal logistic regression was used to examine the risk of psychological distress in relation to participation status. RESULTS: In the 2015 survey, 6,334 of 6,492 responders and 1,686 of 3,356 nonresponders were analyzed. The most common reasons for nonparticipation in the survey were participated in other health examinations, examined at a hospital, and did not have time to participate. Nonresponse in males was associated only with mild psychological stress, whereas nonresponse in females was associated with mild and severe psychological distress. CONCLUSION: Nonresponders in the follow-up survey had a higher risk of psychological distress than responders. Continuous monitoring of the health of nonresponders and responders may help to prevent future health deterioration.

Psychological distress in children and adolescent disaster survivors.

BACKGROUND: This study aimed to clarify the association between mental and behavioral changes and subsequent psychological distress among children and adolescents living in areas affected by the 2011 Great East Japan Earthquake. METHODS: We conducted a two-wave study, with waves 1 and 2 occurring in 2011 and 2014, respectively. Data of 462 respondents aged 9-14 years during wave 1 and who participated in both surveys were used in the present analysis. A factor analysis was performed using the mental and behavioral changes reported by respondents in wave 1. Psychological distress was defined as a score of ≥5 on the six-item Kessler Psychological Distress Scale, as measured in wave 2. With the factors generated in this analysis set as independent variables, the odds ratios (OR) (95% confidence intervals, 95% CIs) for psychological distress were calculated using logistic regression, adjusting for age, sex, house damage, living environment, and loss of family or friends. RESULTS: Psychological distress was present in 108 (23.4%) of the respondents. The factor analysis yielded three factors describing mental and behavioral changes: interpersonal issues, brain fog, and anxiety and panic. Of these, interpersonal issues were significantly associated with subsequent psychological distress, with an OR of 2.59 (95% CI 1.58-4.25). This association did not change even when stratified by age and sex. CONCLUSIONS: This study suggests that interpersonal issues are a significant predictor of psychological distress in children and adolescents living in areas affected by a large-scale disaster.

Blood Pressure Level and Variability During Long-Term Prasugrel or Clopidogrel Medication After Stroke: PRASTRO-I.

BACKGROUND AND PURPOSE: High blood pressure increases bleeding risk during treatment with antithrombotic medication. The association between blood pressure levels and the risk of recurrent stroke during long-term secondary stroke prevention with thienopyridines (particularly prasugrel) has not been well studied. METHODS: This was a post hoc analysis of the randomized, double-blind, multicenter PRASTRO-I trial (Comparison of Prasugrel and Clopidogrel in Japanese Patients With Ischemic Stroke-I). Patients with noncardioembolic stroke were randomly assigned (1:1) to receive prasugrel 3.75 mg/day or clopidogrel 75 mg/day for 96 to 104 weeks. Risks of any ischemic or hemorrhagic stroke, combined ischemic events, and combined bleeding events were determined based on the mean level and visit-to-visit variability, including successive variation, of systolic blood pressure (SBP) throughout the observational period. These risks were also compared between quartiles of mean SBP level and successive variation of SBP. RESULTS: A total of 3747 patients (age 62.1±8.5 years, 797 women), with a median average SBP level during the observational period of 132.5 mm Hg, were studied. All the risks of any stroke (146 events; hazard ratio, 1.318 [95% CI, 1.094-1.583] per 10-mm Hg increase), ischemic stroke (133 events, 1.219 [1.010-1.466]), hemorrhagic stroke (13 events, 3.247 [1.660-6.296]), ischemic events (142 events, 1.219 [1.020-1.466]), and bleeding events (47 events, 1.629 [1.172-2.261]) correlated with increasing mean SBP overall. Similarly, an increased risk of these events correlated with increasing successive variation of SBP (hazard ratio, 3.078 [95% CI, 2.220-4.225] per 10-mm Hg increase; 3.051 [2.179-4.262]; 3.276 [1.172-9.092]; 2.865 [2.042-4.011]; 2.764 [1.524-5.016], respectively). Event rates did not differ between the clopidogrel and prasugrel groups within each quartile of SBP or successive variation of SBP. CONCLUSIONS: Both high mean SBP level and high visit-to-visit variability in SBP were significantly associated with the risk of recurrent stroke during long-term medication with either prasugrel or clopidogrel after stroke. Control of hypertension would be important regardless of the type of antiplatelet drugs. Registration: URL: https://www.clinicaltrials.jp; Unique identifier: JapicCTI-111582.

Increase in Body Weight Following Residential Displacement: 5-year Follow-up After the 2011 Great East Japan Earthquake and Tsunami.

BACKGROUND: Previous studies have linked residential displacement as a result of the 2011 East Japan Earthquake to increases in body weight. However, no study has examined longer-term trajectories of body weight among displaced survivors. We compared body weight change between survivors relocated to temporary housing (TH) group versus other types of accommodation for up to 5 years after the Great East Japan Earthquake. METHODS: Longitudinal follow-up was conducted from 2011 to 2015 in a cohort of 9,909 residents of 42,831. We compared trends in body weight in the TH group (n = 3,169) and the non-TH group (n = 6,740) using a mixed linear regression model stratified by sex (mean age, 61.0 years old; male, 38.9%). RESULTS: In age-adjusted analysis, the body weight in the 2011 survey was not significantly different between two groups for either sex. In men, the TH group significantly increased body weight compared to the non-TH group since 2012. In women, body weight sharply increased in the TH group while body weight did not change in the non-TH group during survey time points. The interaction of living conditions and survey years was statistically significant in both sexes (men; F-value, 6.958; P < 0.001: women; F-value, 19.127; P < 0.001). CONCLUSION: Survivors relocated to temporary housing had an increased risk of weight gain. The weight gain in this group is a potential risk factor for metabolic syndrome in the post-disaster period.

[A Case of Hepatocellular Carcinoma Complicated by Liver Metastasis of Colon Cancer during the Course of Treatment].

A 72‒year‒old man with hepatocellular carcinoma(HCC)was treated with transarterial chemoembolization(TACE)and radiofrequency ablation(RFA). Six months after RFA, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd‒ EOB‒DTPA)‒enhanced magnetic resonance imaging(MRI)revealed multiple metastatic recurrences in the liver. TACE was performed for the recurrent HCC. However, the treatment response on the Gd‒EOB‒DTPA‒enhanced MRI showed that the lesions had advanced and that the liver metastatic nodules had ring‒shaped contrast effects. We suspected metastatic liver cancer based on the MRI findings and performed colonoscopy. Finally, we diagnosed the patient with multiple hepatic metastases of sigmoid colon cancer based on the results of the endoscopic colon biopsy and percutaneous liver tumor biopsy. In conclusion, we had a teachable case of the treatment of HCC.

Safety and Efficacy of Prasugrel in Elderly/Low Body Weight Japanese Patients with Ischemic Stroke: Randomized PRASTRO-II.

INTRODUCTION: The safety of prasugrel in elderly and/or low body weight Japanese patients with ischemic stroke who have a relatively high bleeding risk with antiplatelet therapy remains unknown. OBJECTIVE: We aimed to investigate the safety and efficacy of long-term prasugrel monotherapy for stroke prevention compared with clopidogrel in elderly and/or low body weight Japanese patients with non-cardioembolic ischemic stroke. METHODS: In this randomized, double-blind, comparative, phase III study, elderly (age ≥75 years) and/or low body weight (≤50 kg) Japanese patients with a previous history of non-cardioembolic ischemic stroke were assigned to a prasugrel 3.75 mg (PRA3.75) group, a prasugrel 2.5 mg (PRA2.5) group, or a clopidogrel 50 mg (CLO50) group and followed up for 48 weeks. The primary safety endpoint was the combined incidence of primary safety events, defined as life-threatening, major, and other clinically relevant bleeding. The efficacy endpoint was a composite of ischemic stroke, myocardial infarction, and death from other vascular causes. RESULTS: A total of 654 patients (age 76.4 ± 7.3 years, body weight 55.6 ± 9.3 kg, women 43.9%) from 74 medical institutions within Japan were enrolled. The combined incidence (95% CI) of primary safety events was 4.2% (1.9-7.8%), 1.9% (0.5-4.7%), and 3.6% (1.6-6.9%) in the PRA3.75 group (n = 216), PRA2.5 group (n = 215), and CLO50 group (n = 223), respectively (hazard ratios [HR] PRA3.75/CLO50, 1.13 [0.44-2.93]; PRA2.5/CLO50, 0.51 [0.15-1.69]). The incidences of bleeding leading to treatment discontinuation (95% CI) were 2.3% (0.8-5.3%), 0.9% (0.1-3.3%), and 2.2% (0.7-5.2%) in the PRA3.75, PRA2.5, and CLO50 groups, respectively (HRs PRA3.75/CLO50, 1.01 [0.29-3.48]; PRA2.5/CLO50, 0.41 [0.08-2.12]). There was no significant difference in all bleeding events between groups. The incidence of ischemic stroke, myocardial infarction, and death from other vascular causes was lower, but not significantly so, in patients treated with prasugrel than in patients treated with clopidogrel: PRA3.75, 0.0% (0/216); PRA2.5, 3.3% (7/215); and CLO50, 3.6% (8/223; HRs PRA3.75/CLO50, 0.00 [0.00-0.00]; PRA2.5/CLO50, 0.90 [0.32-2.47]). CONCLUSIONS: Elderly and/or low body weight -Japanese patients with previous non-cardioembolic ischemic stroke who received PRA3.75 showed similar results in terms of primary safety endpoint, and a numerically lower incidence of ischemic stroke, myocardial infarction, and death from other vascular causes, compared with those who received CLO50.

Effects of the long octyl chain on complex formation of nickel(ii) with dimethyl sulfoxide, methanol, and acetonitrile in ionic liquid of [C8mim][TFSA].

In the room-temperature ionic liquid (IL) of 1-methyl-3-octylimidazolium bis(trifluoromethylsulfonyl)amide ([C8mim][TFSA]), the complex formation of Ni2+ with molecular liquids (MLs), dimethyl sulfoxide (DMSO), methanol (MeOH), and acetonitrile (AN), has been examined using ultraviolet (UV)-visible spectroscopy. The overall stability constants log ßn, enthalpies , and entropies of the equilibria have been determined to elucidate the mechanism of complex formation. From a comparison of such thermodynamic parameters of the present [C8mim][TFSA] systems with those of the previous systems of 1-ethyl-3-methylimidazolium-based IL, [C2mim][TFSA], the effects of the octyl chain of the imidazolium cation, [C8mim]+, on the complex formation of Ni2+ with MLs have been demonstrated. In [C8mim][TFSA]-ML systems, more stable complexes are formed with MLs in the sequence of AN > DMSO ≫ MeOH. This sequence differs from that of DMSO ≫ AN > MeOH in [C2mim][TFSA]. For the AN systems, the stabilities of [Ni(an)n] in [C8mim][TFSA] are higher as compared to those in [C2mim][TFSA]. In contrast, for the DMSO systems, [Ni(dmso)n] is less stable in the IL with the longer alkyl chain than that in the IL with the shorter chain. The dependence of the alkyl chain length on the stabilities of [Ni(meoh)n] is the least significant among the three MLs. These varieties of the stabilities of Ni2+ complexes with the MLs have been interpreted from the thermodynamic parameters, together with the static interactions in the [C8mim][TFSA]-ML and [C2mim][TFSA]-ML solvents observed by means of 1H and 13C NMR, small-angle neutron scattering (SANS), and infrared (IR) with an ATR diamond prism.

Social Capital and Dietary Intakes Following the 2011 Great East Japan Earthquake and Tsunami.

BACKGROUND: Previous studies have identified poor dietary intake as a health risk affecting survivors of the 2011 Great East Japan Earthquake and Tsunami. We examined the association between different social factors (eg, living conditions and perceptions of community social capital) and dietary intakes among disaster-affected survivors. METHODS: We studied 6,724 survivors in four municipalities of Iwate Prefecture 3 years after the disaster. Social capital was assessed via four items inquiring about respondents' perceptions of social cohesion in their communities. Good dietary intake was defined according to the following criteria: intake of staple food ≥three times a day; intake of meat, fish and shellfish eggs, or soybean products ≥twice a day; vegetable intake ≥twice a day; and intake of fruit or dairy products ≥once a day. An individual who did not meet any of these criteria was defined as having poor dietary intake. We adjusted for covariates, including socioeconomic status, marital status, and residential area. RESULTS: Poor dietary intake was reported by 31.6% of respondents. Poisson regression analyses revealed that the following factors were related to poor dietary intake: age <65 years (men: prevalence ratio [PR] 1.48; 95% confidence interval [CI], 1.29-1.71 and women: PR 1.55; 95% CI, 1.36-1.77), difficulties in living conditions (men: PR 1.18; 95% CI, 1.00-1.39 and women: PR 1.19; 95% CI, 1.01-1.40), and low perceptions of community social capital (women: PR 1.20; 95% CI, 1.04-1.38). CONCLUSIONS: Our findings suggest that social capital plays a role in promoting healthy dietary intake among women in disaster-affected areas.

Circulating microRNAs (miR-126, miR-197, and miR-223) are associated with chronic kidney disease among elderly survivors of the Great East Japan Earthquake.

BACKGROUND: A recent study has reported that incidence of chronic kidney disease (CKD) is higher in evacuees, but the molecular mechanism still remains unclear. One plausible hypothesis is a change in vascular function following to psychological distress. In order to assess molecular mechanisms underlying this association, we examined whether cardiovascular disease (CVD)-associated miRNAs (miR-126, miR-197, and miR-223) were associated with CKD among Japanese elderly survivors after an earthquake. METHODS: We analyzed 1385 individuals (670 men and 715 women) who participated in a post-disaster health check-up after the Great East Japan Earthquake, which occurred in 2011. The check-up involved collection of information about lifestyle, clinical history, the degree of housing damage, and baseline measurement of the estimated glomerular filtration rate. Expression levels of miRNAs were determined using real-time polymerase chain reaction. Estimated glomerular filtration rate (eGFR) was calculated using sex, age, and serum creatinine. CKD was defined as eGFR < 60 ml/min/1.73m2. The multivariable regression analyses were performed to examine the associations between CVD-associated miRNAs and CKD after adjusting potential confounders. RESULTS: Mean age (standard deviation) of participants with normal kidney function and CKD was 62.7 (10.6) and 71.9 (8.1) years, respectively. Expression levels of these miRNAs in participants with CKD were significantly lower than normal kidney function (all p < 0.001). Even after adjusting for lifestyle, clinical profiles, and psychological distress, significant associations between three miRNAs and CKD still remained. A significant linear association between the cumulative score of these miRNAs and CKD was found (p = 0.04). CONCLUSIONS: This cross-sectional study suggested that CVD-associated miRNAs were an important factor of CKD in an elderly Japanese population after earthquake. Future studies need to examine this association in longitudinal dataset.

Influence of cytochrome P450 polymorphisms on the antiplatelet effects of prasugrel in patients with non-cardioembolic stroke previously treated with clopidogrel.

This randomized double-blind crossover study aimed to investigate the influence of cytochrome P450 (CYP) 2C19 polymorphisms on the antiplatelet effects of prasugrel in patients with non-cardioembolic stroke treated with clopidogrel. Patients received clopidogrel 75 mg/day for > 4 weeks. Subsequently, patients received prasugrel 3.75 mg/day (group A; n = 64) or 2.5 mg/day (group B; n = 65) for 4 weeks followed by a 4 week switched-dose regimen. To assess the influence of CYP2C19 polymorphisms, patients were classified as extensive metabolizers (EMs), intermediate metabolizers (IMs), and poor metabolizers (PMs). The primary endpoint was P2Y12 reaction units (PRU) at the end of each 4 week treatment. A significant reduction in PRU was noted after treatment with prasugrel 3.75 mg/day compared with the pre-dose value (after treatment with clopidogrel) (p < 0.0001). By CYP2C19 phenotypes, a significant reduction in PRU was noted in IMs and PMs after treatment with prasugrel 3.75 mg/day and in PMs after treatment with prasugrel 2.5 mg/day, as compared with the pre-dose value (p < 0.0001). The plasma concentration of the active metabolite of clopidogrel was relatively low in PMs compared to EMs and IMs; prasugrel was similar across all CYP2C19 phenotypes. No major or clinically significant hemorrhagic adverse events occurred. By CYP2C19 phenotype, the antiplatelet effects of prasugrel were greater with 3.75 mg/day in IMs and PMs, and with 2.5 mg/day in PMs compared with clopidogrel 75 mg/day, without safety concerns. CYP2C19 polymorphisms did not affect the plasma concentration of the active metabolite of prasugrel or its antiplatelet effects. (JapicCTI-101044).

Initially Missed or Delayed Diagnosis of Subarachnoid Hemorrhage: A Nationwide Survey of Contributing Factors and Outcomes in Japan.

BACKGROUND: Subarachnoid hemorrhage (SAH) remains a significant cause of mortality in Japan. The Japan Stroke Society set out to conduct a nationwide survey to identify contributing factors and outcomes of SAH misdiagnosis. METHODS: We initially surveyed 737 training institutes and 1259 departments in Japan between April 2012 and March 2014 for the presence of misdiagnosed SAH. Clinical information was then sought from respondents with a positive misdiagnosis. Information on 579 misdiagnosed cases was collected. RESULTS: Most initial misdiagnoses occurred in nonteaching hospitals (72%). Of those presenting with headache, 55% did not undergo a computed tomography (CT) scan. In addition, SAH was missed in the patients who underwent CT scans. The clinically diagnosed rerupture rate was 27%. Mortality among all cases was 11%. Institutes achieving a final diagnosis were staffed by neurologists or neurosurgeons. Multivariate logistic regression analysis indicated that age (≥65), consciousness level (Japan Coma Scale score at correct diagnosis), rerupture of an aneurysm, and no treatment by clipping or coiling were significantly associated with poor clinical outcome. CONCLUSIONS: The prognosis of misdiagnosis of SAH is severe. Neuroradiological assessment and correct diagnosis can prevent SAH misdiagnosis. When there is a possible diagnosis of SAH, consultation with a specialist is important.

Strokes Associated With Pregnancy and Puerperium: A Nationwide Study by the Japan Stroke Society.

BACKGROUND AND PURPOSE: The incidence and cause of strokes associated with pregnancy and the puerperium are still not fully understood. The aim of this study was to characterize pregnancy-related strokes in Japan using a large-scale survey with current imaging techniques. METHODS: A retrospective analysis was conducted based on clinical chart reviews in 736 stroke teaching hospitals certified by the Japan Stroke Society between 2012 and 2013, using a web-based questionnaire requesting the detailed clinical course without any personally identifying information. The collection rate of this questionnaire was 70.5%, with 151 pregnancy-associated strokes extracted. RESULTS: Hemorrhagic strokes were observed in 111 cases (73.5%), ischemic strokes in 37 (24.5%), and mixed type in 3 cases (2.0%). The estimated incidence of pregnancy-associated stroke was 10.2 per 100 000 deliveries. Major causes of hemorrhage were aneurysm (19.8%), arteriovenous malformation (17.1%), pregnancy-induced hypertension (11.7%), and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) (8.1%). Preexisting cerebrovascular diseases responsible for hemorrhage were detected in 59 cases (53.1%). Among the ischemic strokes, 28 (75.7%) were arterial and 9 (24.3%) were venous infarctions. The most frequent cause of arterial infarctions was reversible cerebral vasoconstriction syndrome. Hemorrhagic stroke showed much poorer prognosis than ischemic stroke. CONCLUSIONS: The incidence of pregnancy-associated stroke in Japan did not seem higher than that in other Asian and Western countries. The proportion of hemorrhagic stroke among Japanese women was much higher than that in white women. Preexisting cerebrovascular diseases and reversible cerebral vasoconstriction syndrome play a key role in hemorrhagic and ischemic stroke, respectively.

Prevalence of Candida albicans and non-albicans on the tongue dorsa of elderly people living in a post-disaster area: a cross-sectional survey.

BACKGROUND: Candida species are normal commensal organisms of the mouth. However, they can cause oral mucosal and severe systemic infections in persons with reduced immune function, which is common in the very elderly. In post-disaster areas, the number of elderly residents rapidly increases due to the outflow of younger generations. Hence, we examined the prevalence of Candida albicans and non-albicans in association with oral and systemic conditions, life style, medications, and living conditions. METHODS: This study was performed in 2014. Participants of this study were 266 community dwellers aged 60 years or older in Otsuchi town, which was severely damaged by the Great East Japan Earthquake and Tsunami in 2011. Oral specimens were collected from tongue dorsa by swabbing. After 48 h incubation on CHROMagar™ medium, C. albicans and non-albicans were identified by the morphology and pigmentation of the colonies. Oral and systemic health check-ups were performed to assess the following: number of remaining teeth and periodontal status, oral hygiene, use of dentures, obesity, hypertension, hyperlipidemia, and hyperglycemia. A questionnaire addressed lifestyle, medications, and living conditions. Using the variables above, the relative factors involved in the colonization and the amounts of each type of Candida were determined. RESULTS: C. albicans and non-albicans were detected in 142 (53.4%) and 63 (23.7%) participants, respectively. Multinomial logistic regression analyses revealed that the significant factors of colonization by C. albicans were "having decayed teeth" and "relocation from home". Factors related to non-albicans colonization were "age over 80 years", "number of remaining teeth", "use of dentures", and "obesity". On the contrary, none of the parameters were related to the amount of non-albicans in the carrier, and the amount of C. albicans was significantly associated with "number of teeth" and "hypertension". CONCLUSIONS: Prevalence-related factors differed between C. albicans and non-albicans colonization. In addition, other than oral status, systemic and living conditions affected the prevalence of both C. albicans and non-albicans in elderly people living in a post-disaster area.

A wax ester promotes collective host finding in the nematode Pristionchus pacificus.

Survival of nematode species depends on how successfully they disperse in the habitat and find a new host. As a new strategy for collective host finding in the nematode Pristionchus pacificus, dauer larvae synthesize an extremely long-chain polyunsaturated wax ester (nematoil) that covers the surface of the animal. The oily coat promotes congregation of up to one thousand individuals into stable 'dauer towers' that can reach a beetle host more easily.

Brain temperature measured by 1H-magnetic resonance spectroscopy in acute and subacute carbon monoxide poisoning.

INTRODUCTION: Brain temperature (BT) is associated with the balance between cerebral blood flow and metabolism according to the "heat-removal" theory. The present study investigated whether BT is abnormally altered in acute and subacute CO-poisoned patients by using (1)H-magnetic resonance spectroscopy (MRS). METHODS: Eight adult CO-poisoned patients underwent 3-T magnetic resonance imaging in the acute and subacute phases after CO exposure. MRS was performed on deep cerebral white matter in the centrum semiovale, and MRS-based BT was estimated by the chemical shift difference between water and the N-acetyl aspartate signal. We defined the mean BT + 1.96 standard deviations of the BT in 15 healthy controls as the cutoff value for abnormal BT increases (p < 0.05) in CO-poisoned patients. RESULTS: BT of CO-poisoned patients in both the acute and subacute phases was significantly higher than that of the healthy control group. However, BT in the subacute phase was significantly lower than in the acute phase. On the other hand, no significant difference in body temperature was observed between acute and subacute CO-poisoned patients. BT weakly correlated with body temperature, but this correlation was not statistically significant (rho = 0.304, p = 0.2909). CONCLUSIONS: The present results suggest that BT in CO-poisoned patients is abnormally high in the acute phase and remains abnormal in the subacute phase. BT alteration in these patients may be associated with brain perfusion and metabolism rather than other factors such as systemic inflammation and body temperature.

Co-option of the hormone-signalling module dafachronic acid-DAF-12 in nematode evolution.

Morphological novelties are lineage-specific traits that serve new functions. Developmental polyphenisms have been proposed to be facilitators of phenotypic evolution, but little is known about the interplay between the associated genetic and environmental factors. Here, we study two alternative morphologies in the mouth of the nematode Pristionchus pacificus and the formation of teeth-like structures that are associated with bacteriovorous feeding and predatory behaviour on fungi and other worms. These teeth-like denticles represent an evolutionary novelty, which is restricted to some members of the nematode family Diplogastridae but is absent from Caenorhabditis elegans and related nematodes. We show that the mouth dimorphism is a polyphenism that is controlled by starvation and the co-option of an endocrine switch mechanism. Mutations in the nuclear hormone receptor DAF-12 and application of its ligand, the sterol hormone dafachronic acid, strongly influence this switch mechanism. The dafachronic acid-DAF-12 module has been shown to control the formation of arrested dauer larvae in both C. elegans and P. pacificus, as well as related life-history decisions in distantly related nematodes. The comparison of dauer formation and mouth morphology switch reveals that different thresholds of dafachronic acid signalling provide specificity. This study shows how hormonal signalling acts by coupling environmental change and genetic regulation and identifies dafachronic acid as a key hormone in nematode evolution.

Relationships between social factors and physical activity among elderly survivors of the Great East Japan earthquake: a cross-sectional study.

BACKGROUND: Physical inactivity is a health issue that often occurs after serious disaster. Social factors, which can be disrupted by disaster, are important determinants of physical activity levels in everyday living. This study was designed to confirm the association between social factors and physical activity among elderly survivors of the Great East Japan Earthquake. METHODS: From September 2011 to February 2012, 4316 males and females aged 65 or older participated in a health survey of Great East Japan Earthquake survivors. Multiple logistic regression analyses were performed with the dichotomous dependent variable of physical activity (high versus low) and working status, social network, and place of residence (one's own home versus elsewhere) as independent variables. RESULTS: Participants who had been displaced from their homes were more likely to have low physical activity (odds ratio [OR], 95% confidence interval [CI] for men: 1.37, 1.12 to 1.68; for women: 1.30, 1.09 to 1.55). Non-working status was significantly associated with low physical activity (men: 2.03, 1.65 to 2.49; women: 1.94, 1.60 to 2.34). Detriments to the social network were significantly associated with low physical activity (men: 1.71, 1.41 to 2.08; women: 1.79, 1.51 to 2.13). CONCLUSION: Place of residence and social factors were associated with physical activity levels in elderly survivors of the Great East Japan Earthquake. The findings suggest a need for improvement of social factors to encourage increases in physical activity for elderly persons after disaster.

[A Case of Rectal Neuroendocrine Carcinoma with Metachronous Liver Metastasis Treated with Multimodality Therapy].

A 6 2-year-old woman visited our hospital with a complaint of anal bleeding and was diagnosed with rectal cancer. She underwent low anterior resection and D3 lymphadenectomy. The pathological diagnosis was shown as follows: Ra, Circ, type 2, por1, pSS, ly3, v1, pN2, pStage III b, and KRAS wild type. UFT/UZEL with polysaccharide K(PSK)was initiated as adjuvant chemotherapy after the operation. However, multiple liver metastases were found on CT after 3 courses of UFT/UZEL with PSK, and pathological reexamination revealed that the primary tumor was a neuroendocrine carcinoma. She underwent chemotherapy with CBDCA combined with CPT-11, but bone marrow suppression was observed after 4 courses of the treatment. As second-line chemotherapy, FOLFOX4 plus panitumumab(Pmab)was administered. Although the disease remained stable through 10 courses of FOLFOX4 plus Pmab, Grade 3 peripheral neuropathy was observed. Hence, FOLFIRI plus bevacizumab(Bmab)was administered as third-line chemotherapy. Twenty-eight courses of FOLFIRI plus Bmab were administered, and transcatheter arterial chemoembolization(TACE)was performed during chemotherapy. However, her general condition worsened after the therapies, and she died 2 years 3 months after the initial chemotherapy.