[HVPG minimally invasive era: exploration based on forearm venous approach].

Objective: The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient (HVPG) measurement in current practice. This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach. Methods: Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020. Patients' clinical baseline information and HVPG measurement data were collected. The right median cubital vein or basilic vein approach for all enrolled patients was selected. The HVPG standard process was used to measure pressure. Research data were analyzed using SPSS 22.0 statistical software. Quantitative data were used to represent medians (interquartile ranges), while qualitative data were used to represent frequency and rates. The correlation between two sets of data was analyzed using Pearson correlation analysis. Results: A total of 43 cases were enrolled in this study. Of these, 41 (95.3%) successfully underwent HVPG measurement via the forearm venous approach. None of the patients had any serious complications. The median operation time for HVPG detection via forearm vein was 18.0 minutes (12.3~38.8 minutes). This study confirmed that HVPG was positively closely related to Child-Pugh score (r = 0.47, P = 0.002), albumin-bilirubin score (r = 0.37, P = 0.001), Lok index (r = 0.36, P = 0.02), liver stiffness (r = 0.58, P = 0.01), and spleen stiffness (r = 0.77, P = 0.01), while negatively correlated with albumin (r = -0.42, P = 0.006). Conclusion: The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

Coffee consumption and mortality in Japan with 18 years of follow-up: the Jichi Medical School Cohort Study.

OBJECTIVE: Coffee consumption can be expected to reduce mortality due to cardiovascular diseases and cancer. This study tested the hypothesis of an inverse association between coffee intake and all-cause mortality and mortality due to cancer, coronary heart disease, or stroke. STUDY DESIGN: Prospective cohort study. METHODS: We analyzed data from the Jichi Medical School Cohort Study, Japan, enrolling 9946 subjects (men/women: 3870/6,076, age: 19-93 years) from 12 communities. A food frequency questionnaire assessing the subjects' daily coffee consumption was used. RESULTS: During an average follow-up of 18.4 years, the total number of deaths was 2024, including 677 for cancer, 238 for coronary heart disease, and 244 for stroke. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality and cause-specific mortality due to cancer, coronary heart disease, and stroke. Overall, no significant association was shown between coffee consumption and all-cause mortality. In the cause-specific mortality analyses, stroke mortality was significantly lower in those who consumed 1-2 cups of coffee daily (HR [95% CI]: 0.63 [0.42-0.95]) than in those who do not consume coffee, and this association occurred only in men. CONCLUSION: This study showed no significant association between coffee consumption and all-cause mortality. A U-shaped association between coffee consumption and stroke mortality with a 37% lower stroke mortality, only significant in men who consume 1-2 cups of coffee daily was observed. It is necessary to examine the possibility of intervention studies to reduce stroke mortality through coffee consumption.

Kimura's disease: effects of age on clinical presentation.

BACKGROUND: Kimura's disease (KD) is known to be dominant among young Asian men, but it can also occur in middle- and advanced-aged people. The clinical characteristics of KD, especially by age, are not well known. AIM: This study was performed to investigate the effects of age on the clinical characteristics of KD. DESIGN: We conducted a case series study. METHODS: All case studies of patients diagnosed with KD were collected via a PubMed search of studies published until August 2018. The data were analyzed by age group. RESULTS: In total, 215 studies were reviewed (238 patients; mean age of 36 years). The male:female ratio was 4:1 overall, 17:1 in patients aged <20 years, 4:1 in patients aged 20-39 years and 2:1 in patients aged ≥40 years (P = 0.01). The percentage of patients with pruritus was 15.4% overall, 3.8% in patients aged <20 years, 15.5% in patients aged 20-39 years and 21.7% in patients aged ≥40 years (P = 0.02). The time to diagnosis was 5.3 years overall, 3.2 years in patients aged <20 years, 4.7 years in patients aged 20-39 years and 7.1 years in patients aged ≥40 years (P < 0.01). CONCLUSIONS: The proportion of female patients affected the incidence of pruritus, and the time to diagnosis increased as the patients' age increased. There were no significant age-related differences in region/race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, immunoglobulin E level, initial treatment, recurrence or outcomes. This may be useful information for the diagnosis of KD.

Pedometer- and accelerometer-based exercise in subjects with diabetes mellitus.

AIM: Pedometers and accelerometers have recently become applicable for not only monitoring but increasing level of physical activity (PA). We summarize the effects of pedometer- and accelerometer-based exercise interventions on glucose metabolism in subjects with diabetes mellitus (DM). METHODS: We searched intervention studies that investigated the effects of step-defined exercise interventions using pedometers and accelerometers on the levels of glucose metabolism markers, such as plasma glucose and hemoglobin A1c (HbA1c), in adult subjects with type 2 DM. The study characteristics and findings of glucose metabolism markers were reviewed. RESULTS: Of 16 eligible studies reviewed, significant improvements in glucose metabolism markers were found in the intervention group compared to that observed in the control group in six studies: the HbA1c level in four studies, both the HbA1c and plasma glucose levels in one study and continuous glucose monitoring in one study. Four of these six studies emphasized a significance of PA intensity in addition to PA amount. Five studies found a significant increase in the number of steps, but only one of these studies showed significant reductions in glucose metabolism markers. No studies demonstrated a dose-response relationship between changes in the number of steps and glucose metabolism markers. CONCLUSION: Limited studies showed significant improvements in glucose metabolism markers and steps among subjects with type 2 DM. Future studies are needed regarding how to use pedometers and accelerometers to achieve improvements in glucose metabolism with increases in PA in such subjects, especially more focus on PA intensity.

Extraction of response waveforms of heartbeat and blood pressure to swallowing. Using mixed signal processing of time domain and respiratory phase domain.

BACKGROUND: Evaluating the accurate responses of the cardiovascular system to external stimuli is important for a deeper understanding of cardiovascular homeostasis. However, the responses should be distorted by the conventional time domain analysis when a frequency of the effect of external stimuli matches that of intrinsic fluctuations. OBJECTIVES: The purpose of this study is to propose a mixed signal processing of time domain and respiratory phase domain to extract the response waveforms of heartbeat and blood pressure (BP) to external stimuli and to clarify the physiological mechanisms of swallowing effects on the cardiovascular system. METHODS: Measurements were conducted on 12 healthy humans in the sitting and standing positions, with each subject requested to swallow every 30 s between expiration and inspiration. Waveforms of respiratory sinus arrhythmia (RSA) and respiratory-related BP variations were extracted as functions of the respiratory phase. Then, respiratory effects were subtracted from response waveforms with reference to the respiratory phase in the time domain. RESULTS: As a result, swallowing induced tachycardia, which peaked within 3 s and recovered within 8 s. Tachycardia was greater in the sitting position than during standing. Furthermore, systolic BP and pulse pressure immediately decreased and diastolic BP increased coincident with the occurrence of tachycardia. Subsequently, systolic BP and pulse pressure recovered faster than the R-R interval. CONCLUSIONS: We conclude that swallowing-induced tachycardia arises largely from the decrease of vagal activity and the baroreflex would yield fast oscillatory responses in recovery.

An inverse relation between the Simplified Menopausal Index and biological antioxidant potential.

BACKGROUND: Inasmuch as female sex hormones can exhibit antioxidative activity, the oxidative-antioxidative imbalance is mechanistically postulated to be involved in menopausal symptoms. OBJECTIVES: The objectives of this study were to investigate the correlation between the established menopausal index and blood levels of the in vivo antioxidative potential in women. METHOD: Blood antioxidant levels were examined by the biological antioxidative potential (BAP) test and menopausal-like symptoms were determined using the Simplified Menopausal Index (SMI) in 160 healthy Japanese women (mean age 52 years). RESULTS: A correlation analysis revealed a significant inverse relationship between the BAP and SMI levels, independent of age and the body mass index. CONCLUSIONS: The data suggest that menopausal symptoms may be associated with a decrease in antioxidant potential as assessed by the BAP test.

Circulating soluble receptor for advanced glycation end products is inversely correlated to oxidized low-density lipoproteins in asymptomatic subjects.

OBJECTIVE: There is growing evidence that circulating soluble receptor for advanced glycation end products (sRAGE) exerts antiatherogenic effects as a decoy receptor that abolishes RAGE signalling. A previous study reported that oxidized low-density lipoprotein (oxLDL) can be one of the RAGE ligands. The present cross-sectional study investigated the clinical association between sRAGE and oxLDL in humans. METHODS: Serum levels of the conventional atherosclerotic risk factors, sRAGE and malondialdehyde-modified low-density lipoprotein (MDA-LDL) were analysed in asymptomatic subjects; MDA-LDL was measured as a biomarker of oxLDL. RESULTS: Mean serum levels of sRAGE and MDA-LDL were 1101 ng/l and 57.6 IU/l, respectively, in 33 subjects of mean age 65 years. Simple linear regression analysis showed a significant inverse correlation between sRAGE and MDA-LDL. Stepwise multiple linear regression analysis confirmed MDA-LDL to be independently, significantly and inversely correlated with sRAGE. CONCLUSIONS: An independent, significant and inverse correlation was shown to exist between circulating levels of sRAGE and oxLDL (MDA-LDL), which suggests that part of the antiatherosclerotic effects of sRAGE may be related to oxLDL quenching.

Paraoxonase-1 gene Q192R polymorphism and reactive oxygen metabolites.

OBJECTIVE: Paraoxonase-1 (PON1) is a high-density lipoprotein-associated antioxidant enzyme. The Q192R polymorphism of the PON1 gene can protect against oxidative conditions, but the relationship between Q192R polymorphism and oxidative stress-related markers remains controversial. In this study, the diacron reactive oxygen metabolites (d-ROMs) test was used to investigate the relationship between Q192R polymorphism and oxidative stress-related markers in Japanese subjects. METHODS: Patients without a history of overt cardiovascular disease who were not receiving antioxidant medication were enrolled in a cross-sectional clinic-based study. An allele-specific polymerase chain reaction method was used to assess the PON1 Q192R polymorphism and compare the level of d-ROMs between genotypes. RESULTS: A total of 103 subjects were analysed. The RR genotype was associated with a significantly lower level of d-ROMs than the RQ and QQ genotypes. After multivariate analysis the relationship between the genotypes and level of d-ROMs remained independently significant. CONCLUSIONS: The RR genotype may be protective against oxidative stress in cardiovascular diseasefree Japanese subjects. In addition, the d-ROMs test can be useful for examining the role of the PON1 Q192R polymorphism under oxidative conditions.

C-reactive protein and reactive oxygen metabolites in subjects with metabolic syndrome.

OBJECTIVE: This cross-sectional study investigated the correlation between diacron reactive oxygen metabolites (d-ROMs) and high-sensitivity C-reactive protein (hs-CRP) in subjects with or without metabolic syndrome. METHODS: Cardiometabolic risk factors, d-ROMs and hs-CRP were determined in 457 women: 123 with metabolic syndrome and 334 without metabolic syndrome. The correlation between d-ROMs and hs-CRP levels was compared between the two groups. RESULTS: The group with metabolic syndrome had significantly higher d-ROMs and hs-CRP levels than the group without metabolic syndrome. While the d-ROMs level was significantly and positively correlated with the hs-CRP level in both groups, the correlation level between the two groups was significantly different. Multiple linear regression analysis adjusted for other cardiometabolic risk factors also showed significant positive correlation between dROMs and hs-CRP levels in both groups. CONCLUSION: Subjects with metabolic syndrome may have a closer relationship between inflammation and oxidative stress than subjects without metabolic syndrome, possibly reflecting their increased predisposition to atherosclerosis. Further studies are necessary to confirm the observed relationship.

A gene polymorphism in acetyl-coenzyme A carboxylase beta may be associated with the C-reactive protein level in a prediabetic and diabetic population.

A recent study reported a significant association between the T-allele in intron 18 of the acetyl-coenzyme A carboxylase beta (ACACB) gene (C>T polymorphism) and nephropathy caused by diabetes mellitus (DM). Considering the involvement of chronic inflammation in the pathophysiology of DM, the present study investigated an association between the ACACB gene polymorphism and high-sensitivity C-reactive protein (hsCRP) in a prediabetic and diabetic population. Anthropometric and biochemical variables including hsCRP were measured among 91 Japanese subjects (mean age: 69 years) with a hemoglobin A1c level of ≥5.6% and no history of cardiovascular disease. All subjects were genotyped by an allele-specific DNA assay. The subjects with the T-allele (n=32) showed significantly higher hsCRP levels than those without the T-allele (median level: 0.17 vs. 0.14 mg/dL, P≤0.05). Similarly, the hsCRP levels continued to differ significantly, independently of the other variables, between the subjects with and without the T-allele after adjusting for multiple variables. The present data suggest that the ACACB gene C>T polymorphism may therefore be associated with chronic inflammation in this population.

Serum amyloid A low-density lipoprotein levels and smoking status in obese Japanese patients.

Serum amyloid A low-density lipoprotein (SAA-LDL) is formed by an oxidative interaction and is considered to be a new marker related to oxidative modification of LDL. As the effect of smoking on oxidized LDL is of concern, this study investigated the association between SAA-LDL and smoking status. A total of 578 Japanese obese outpatients (mean ± SD age 50.5 ± 14.3 years) were studied. Smoking status was examined via a self-reported questionnaire. Cardio metabolic variables, including high-sensitivity Creactive protein (hsCRP), were analysed in addition to SAA-LDL. There was an increasing trend in SAA-LDL levels from non- to ex- to current smokers, and significantly higher SAA-LDL levels were observed in current smokers versus non-smokers (median SAA-LDL level 36 µg/ml versus 28 µg/ml, respectively). This significant difference was reduced after adjusting for multiple confounders, including lipid levels. Smoking may be associated with increased levels of SAA-LDL in an obese Japanese population, but further studies are needed.

Correlation between ischaemia-modified albumin and intermediate-density lipoprotein in haemodialysis patients with end-stage renal disease.

This study investigated the association between ischaemia-modified albumin (IMA), a biomarker of cardiac ischaemia, and increases in the levels of intermediate-density lipoprotein (IDL), an atherogenic particle that can cause oxidative stress, in haemodialysis patients with end-stage renal disease (ESRD). Fasting levels of serum IMA and lipids/lipoproteins were analysed in 15 patients and 15 healthy control subjects. There was a close positive correlation between IMA and IDL levels in ESRD patients but no significant correlation between IMA and lipids/lipoproteins in control subjects. This suggests a possible link between the characteristic dyslipoproteinaemia found in ESRD and levels of IMA and, if confirmed in studies with larger sample sizes, may lead to further studies on the potential of the relationship between IMA and IDL as a biomarker in haemodialysis patients with ESRD.

[Squamous cell carcinoma of the chest wall in a patient with chronic empyema].

We report a rare case of squamous cell carcinoma of the chest wall in a patient with chronic empyema. The patient was a 74-year-old male who had been treated by closed chest drainage for empyema for 20 years until the development of carcinoma. He received chest wall resection followed by radiation therapy because of disseminated lesions comfirmed at surgery. However, his condition worsened gradually, and he died 2 months postoperatively. In the treatment of chronic empyema, we must pay attention to the possible association of malignant tumor for treating as early as possible, because the associated malignant tumor usually has a poor prognosis.

The association between circulating secreted protein acidic and rich in cysteine (SPARC) and glycosylated haemoglobin (HbA(1c)) during lifestyle-modified weight reduction intervention in obese male subjects.

The physiological role and clinical relevance of circulating secreted protein acidic and rich in cysteine (SPARC, or osteonectin) is still poorly understood. This study investigated the correlation between circulating SPARC and metabolic variables, including glucose and glycosylated haemoglobin (HbA(1c)), during a diet and exercise modified weight reduction intervention programme. Changes in plasma SPARC levels and several metabolic variables were analysed in asymptomatically obese, nondiabetic, male subjects before and after weight reduction intervention. Body mass index and blood pressure, serum cholesterol and HbA(1c) levels were all significantly reduced after weight reduction intervention. Multiple regression analysis demonstrated that changes in SPARC levels were significantly and positively correlated with HbA(1c). The relationship between SPARC and HbA(1c) may merit further investigation with regard to its association with postprandial or long-term glucose variation in obese male subjects.

Adiponectin gene single-nucleotide polymorphisms and treatment response to obesity.

BACKGROUND: In the adiponectin gene polymorphisms, single-nucleotide polymorphism (SNP)-45 and SNP276 have reportedly been associated with obesity, Type 2 diabetes, and other features of metabolic syndrome. AIM: Whether these adiponectin SNP affect obesity-related parameters during caloric restriction in obese subjects. SUBJECTS AND METHODS: Thirty- two obese Japanese women were treated by meal replacement with a low calorie diet for 8 weeks and asked to maintain their habitual lifestyle. Obesity-related parameters were measured before and after the treatment period. We determined four SNP (T45G, I164T, G276T, and C-11377G) using a fluorescent allele-specific DNA primer assay systemand FRET probe assay system. RESULTS: After the treatment, the extent of decrease in waist circumference was greater in the subjects with the G/G or G/T genotype of SNP276 than in those with the T/T genotype (p=0.026). As for SNP45, the extent of decrease in triglyceride levels was greater in the subjects with the T/T genotype than in those with the T/G genotype (p=0.003). For SNP-11377, the extent of decrease in systolic blood pressure and fasting plasma glucose was greater in the subjects with the C/G or G/G genotype than in those with the C/C genotype (p=0.044). CONCLUSION: Our findings indicate that each SNP in the adiponectin gene might modify the change in obesity-related parameters during meal replacement with a low calorie diet.

[Bilateral pneumothorax of an amyotrophic lateral sclerosis patient under mechanical ventilation].

Amyotrophic lateral sclerosis (ALS) is a progressive and fatal disease. To support breathing of some patients with ALS in its severe condition, mechanical ventilation is indispensable. However, mechanical ventilation has been known to induce pneumothorax by the damage of lung cells in response to mechanical stretch. An ALS 50-year-old male on mechanical ventilation was referred to our department for left pneumothorax. After an unsuccessful drainage for a couple of weeks, he underwent a partial resection of the left lung. On 3rd postoperative day (POD) the left lung collapsed again. Moreover, on 6th POD, the right pneumothorax occurred. Regarding the right pneumothorax, drainage was effective with a continuous pressure of -10 cm H2O, and the chest tube was removed soon. An air leak from the left chest tube persisted, and the left lung expansion was not enough with its apex line around the clavicle. On 42nd POD, a drainage pressure was increased up to -15 cm H2O. Then an air leak disappeared, and the lung expansion was obtained. The adjustment of a chest tube drainage pressure seems to be important, especially when a pneumothorax patient on mechanical ventilation is treated.

Effect of horizontal position of the computer keyboard on upper extremity posture and muscular load during computer work.

The distance of the keyboard from the edge of a work surface has been associated with hand and arm pain; however, the variation in postural and muscular effects with the horizontal position have not been explicitly explored in previous studies. It was hypothesized that the wrist approaches more of a neutral posture as the keyboard distance from the edge of table increases. In a laboratory setting, 20 adults completed computer tasks using four workstation configurations: with the keyboard at the edge of the work surface (NEAR), 8 cm from the edge and 15 cm from the edge, the latter condition also with a pad that raised the work surface proximal to the keyboard (FWP). Electrogoniometers and an electromagnetic motion analysis system measured wrist and upper arm postures and surface electromyography measured muscle activity of two forearm and two shoulder muscles. Wrist ulnar deviation decreased by 50% (4 degrees ) as the keyboard position moved away from the user. Without a pad, wrist extension increased by 20% (4 degrees ) as the keyboard moved away but when the pad was added, wrist extension did not differ from that in the NEAR configuration. Median values of wrist extensor muscle activity decreased by 4% maximum voluntary contraction for the farthest position with a pad (FWP). The upper arm followed suit: flexion increased while abduction and internal rotation decreased as the keyboard was positioned further away from the edge of the table. In order to achieve neutral postures of the upper extremity, the keyboard position in the horizontal plane has an important role and needs to be considered within the context of workstation designs and interventions.

Liver cancer risk, coffee, and hepatitis C virus infection: a nested case-control study in Japan.

We examined hepatocellular carcinoma mortality in relation to coffee consumption and anti-hepatitis C virus (HCV) antibody seropositivity in a nested case-control study involving 96 cases. The multivariate-adjusted odds ratios (95% confidence interval) for daily coffee drinkers vs non-drinkers were 0.49 (0.25-0.96), 0.31 (0.11-0.85), and 0.75 (0.29-1.92) in all cases, in HCV-positive and in HCV-negative individuals, respectively.