Relationship between blood pressure repeatedly measured by a wrist-cuff oscillometric wearable blood pressure monitoring device and left ventricular mass index in working hypertensive patients.

This study sought to evaluate the relationship between blood pressure (BP) taken by a new wrist-cuff oscillometric wearable BP monitoring device and left ventricular mass index measured by cardiac magnetic resonance imaging (cMRI-LVMI) in 50 hypertensive patients (mean age 60.5 ± 8.9 years, 92.0% men, 96% treated for hypertension) with regular employment. Participants were asked to self-measure their wearable BPs twice in the morning and evening under a guideline-recommended standardized home BP measurement, and once each at five predetermined times and any additional time points under an ambulatory condition for a maximum of 7 days. In total, 2105 wearable BP measurements (home BP: 747 [morning: 409, evening: 338], ambulatory condition: 1358 [worksite: 942]) were collected over 5.5 ± 1.2 days. The average of all wearable systolic BP (SBP) readings (129.8 ± 11.0 mmHg) was weakly correlated with cMRI-LVMI (r = 0.265, p = 0.063). Morning home wearable SBP average (128.5 ± 13.8 mmHg) was significantly correlated with cMRI-LVMI (r = 0.378, p = 0.013), but ambulatory wearable SBP average (132.5 ± 12.7 mmHg) was not (r = 0.215, p = 0.135). The averages of the highest three values of all wearable SBPs (153.3 ± 13.9 mmHg) and ambulatory wearable SBPs (152.9 ± 13.9 mmHg) were 16 mmHg higher than that of the morning home wearable SBPs (137.0 ± 15.9 mmHg). Those peak values were significantly correlated with cMRI-LVMI (r = 0.320, p = 0.023; r = 0.310, p = 0.029; r = 0.451, p = 0.002, respectively). In conclusion, an increased number of wearable BP measurements, which could detect individual peak BP, might add to the clinical value of these measurements as a complement to the guideline-recommended home BP measurements, but further studies are needed to confirm these findings.

Quantitative stability of the folates highly accumulated in a non-Kyokai sake yeast.

Pressed sake cake, a by-product of sake brewing, is a rich dietary source of folates, which are important vitamins for humans. However, considerable losses of folates occur during storage and cooking. We have previously reported that Km67, the house sake yeast strain of Kiku-masamune sake brewery, can accumulate high folate levels. In this study, we found that the folate content of pressed sake cakes produced with Km67 remained at approximately their maximum level after the fermentation activity stopped. To elucidate the mechanisms of high folate accumulation in Km67, we analyzed the expression of 23 folate-metabolizing genes. The expression of ABZ1 and FOL3 was almost always higher in Km67 than in Kyokai no. 701 yeast (K701), which suggested that enhanced expression of the genes involved in folate biosynthesis was a mechanism of high folate accumulation in Km67. We found that the folates of Km67 pressed sake cakes were quantitatively stable at 4°C under refrigerated storage conditions. In addition, the homocysteine content of Km67 pressed sake cakes was almost always higher than that of K701 pressed sake cakes. This result suggests that a reason for high folate accumulation in Km67 yeast is the need to reduce the intracellular concentration of homocysteine. Our results provide biologically meaningful information on folate metabolism in yeast.

The sake yeast YHR032W/ERC1 allele contributes to the regulation of the tetrahydrofolate content in the folate synthetic pathway in sake yeast strains.

To elucidate the mechanism underlying tetrahydrofolate (THF) accumulation in sake yeast strains compared with that in laboratory yeast strains, we performed a quantitative trait locus (QTL) analysis. The results revealed that the sake yeast ERC1 allele contributes to an increase in the ratio of THF to the total folate content in sake yeast.

Mechanism of high folate accumulation in a sake yeast other than Kyokai yeasts.

Folates are important vitamins in human nutrition. Pressed sake cake, a brewing by-product of sake, is a rich dietary source of folates derived from sake yeast (Saccharomyces cerevisiae). The National Research Institute of Brewing investigated 106 samples of pressed sake cake and revealed that three samples containing large amounts of folates were produced by Km67 yeast derived from the house sake yeast strain of Kiku-Masamune sake brewery. In this study, we performed sake brewing tests using Km67 and Kyokai no. 7 group strains and confirmed that Km67 yeast contributed to the production of pressed sake cake containing large amounts of folates. To elucidate the mechanisms of high folate accumulation in Km67, we performed whole-genome sequence analysis in Km67 and then screened 10 folate-metabolizing genes showing different sequences in Km67 and K7 strains. By folate analysis of each gene-disrupted strain derived from strain BY4743, we also selected four genes having significant effects on folate content in yeast from 10 candidate genes. Folate analysis of gene-disrupted yeast strains complemented with either Km67-type genes or K7-type genes revealed that the Km67-type HMT1 gene was related to high folate accumulation not only in laboratory yeast but also in sake yeast. In this gene, Leu63Phe was present in the methyltransferase motif I of Hmt1p, which was essential for the methyltransferase activity of Hmt1p. Our results and previous reports suggested that the methyltransferase activity of Km67-Hmt1p was higher than that of K7-Hmt1p, leading to enhanced production and high accumulation of folates in Km67 yeast.

Breeding of a cordycepin-resistant and adenosine kinase-deficient sake yeast strain that accumulates high levels of S-adenosylmethionine.

Adenosine kinase (ADO1)-deficient mutants can be obtained from cordycepin-resistant strains, and the disruption of ADO1 causes S-adenosylmethionine (SAM) accumulation. To breed a high-SAM-accumulating yeast strain without genetic manipulation for industrial purposes, we bred a cordycepin-resistant strain using sake yeast kyokai No. 9 as the parent strain with a mutation in adenosine kinase (ADO1) and acquired high-SAM-accumulating strain. In the bred strain (NY9-10), a single mutation (T258I) was present in the ADO1, and this mutation site is an ATP binding site and is highly conserved during evolution. Moreover, it was suggested that high accumulation of SAM and cordycepin resistance in NY9-10 was due to functional deficiency of ADO1 by this mutation. This strain is not a genetically-modified organism and can be employed for use in the food and medicine industry such as mass production and sake making.

Pneumatosis cystoides intestinalis induced by the α-glucosidase inhibitor miglitol.

Pneumatosis cystoides intestinalis (PCI) is a rare condition in which pneumocysts develop in the submucosa or subserosa of the colon. We report herein a case of PCI induced by the alpha-glucosidase inhibitor (alphaGI) miglitol. There have been 9 recorded cases of PCI induced by other alphaGIs, but this is the first report of miglitol causing PCI. The PCI lesions in our case were smaller than those induced by voglibose or acarbose. The possibility of PCI should be considered in diabetic patients on alphaGI therapy who complain of gastrointestinal symptoms, and the gastrointestinal tract should be thoroughly investigated in these patients.

Novel angiotensin-converting enzyme (ACE) inhibitory peptides derived from boneless chicken leg meat.

Four peptides that inhibit angiotensin-converting enzyme (ACE) were separated from the hydorlysate of boneless chicken leg meat digested with artificial gastric juice (pepsin). Two peptides were identified as the peptides encrypted in myosin heavy chain. The peptide P1 (MNVKHWPWMK) corresponds to the amino acid sequence from amino acids 825 to 834 of myosin heavy chain, and the peptide P4 (VTVNPYKWLP) corresponds to the amino acid sequence from amino acids 125 to 135 of myosin heavy chain. They are novel ACE inhibitory peptides derived from chicken, and IC(50) values of P1 and P4 were determined as 228 and 5.5 microM, respectively. Although these values were much larger than 0.022 microM for captopril, a typical synthetic ACE inhibitor, they are comparable to IC(50) values reported for various ACE inhibitory peptides derived from foods. Because the peptide P4 has a relatively low IC(50) value, it is a good starting substance for designing food supplements for hypertensive patients.

Evaluation of vaccination strategies to suppress a novel influenza pandemic using an individual-based model.

OBJECTIVES: In this study, we aimed to evaluate vaccination strategies with regard to the impact of prioritization, coverage, and a delay in the vaccination program against a novel influenza pandemic with high-level fatality equivalent to Spanish flu using an individual-based model (IBM). Vaccination is one of the main measures to prevent infection, a serious condition, or death. METHODS: We constructed an IBM for the transmission of a novel influenza virus utilizing personal information on the basis of demographic data from Sapporo City, thereby resulting in a more realistic model. We designed simulations for scenarios along the guidelines of the Ministry of Health, Labour and Welfare of Japan, which requests the prioritization of vaccination of pregnant women and persons with underlying diseases, among whom influenza would cause higher fatality than among healthy persons, infants, or their parents, as well as school-aged and old-aged persons. RESULTS: A vaccination program fully taking into account the ordered priority groups would more effectively reduce the number of deaths in the priority groups and also the total number of deaths in comparison with a program shortening the transition time to the next priority or a non-priority group. A delay in the vaccination program would lower the effectiveness of reducing the numbers of patients and deaths. CONCLUSIONS: According to the simulation-based results, when vaccination programs scheduled on the basis of priority groups start 90 and 150 days after outbreak, the total numbers of patients would be reduced to one-third-one-half, and two-thirds, respectively, in comparison with baseline of no vaccination, which leads to the necessity to conduct a vaccination program as soon as possible.

Assessment of intervention strategies against a novel influenza epidemic using an individual-based model.

OBJECTIVES: The objective of this study was to assess intervention strategies against a novel influenza epidemic through simulations of various scenarios in Sapporo city, Hokkaido, Japan. A series of interventions were examined: administration of antiviral drugs by two approaches [targeted antiviral prophylaxis (TAP) and school-age targeted antiviral prophylaxis (STAP)], school closure, restraint, and combinations of these four interventions. METHODS: In order to generate a more realistic situation, we constructed an individual-based model (IBM) for the transmission of influenza in which each individual was assigned personal information on the basis of the National Census and Employment Status Survey of Sapporo city. In addition, data on high-risk casual contact groups commuting in crowded trains and buses were obtained from a census on transportation modes and introduced into the model. Observational data from previous pandemics were used for the epidemiological parameters. RESULTS: Both TAP and STAP interventions were highly effective in suppressing the spread of infection during the early period of an outbreak, but STAP was inferior to TAP in terms of the ripple effect of the administration of antiviral drugs. School closure and restraint were able to bring about a delay in the peak of infection. The combination of TAP, school closure, and restraint interventions were highly effective in decreasing the total number of patients and shortening the epidemic period. CONCLUSIONS: Based on the simulation results, we recommend implementing TAP together with both school closure and restraint as strategies against a future novel influenza outbreak.

[Case of cardial varices rupture due to danaparoid sodium with portal venous thrombosis].

A 54-year-old man had been admitted to Nara city hospital because of hematemesis and dyspnea caused by physical exertion, and was given a diagnosis of esophago-cardial varices and portal venous thrombosis. He was transferred to our hospital for further examinations and treatments. Ultrasonography (US) and computed tomography (CT) revealed the progression of portal venous thrombosis. Danaparoid sodium was administered to treat the portal vein thrombus. 5 days later, the patient was found to have hematemesis resulting from a cardial varices rupture. After endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) was performed, danaparoid sodium was administered for 2 weeks. After the treatment, portal vein thrombus had almost disappeared. Due to an increased risk of bleeding, cases of esophago-cardial varices with portal venous thrombosis must be treated with care. This is the first report of upper gastrointestinal bleeding due to danaparoid sodium. Danaparoid sodium must be carefully administered when patients have portal venous thrombosis with delicate varices.

Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects.

BACKGROUND: Proper screening of depression among older adults depends on accurate cut-off scores. Recent articles have recommended the Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD) for this screening. However, there has been no investigation of the sensitivity and specificity of either scale using Japanese subjects. The purpose of the present study was to identify appropriate GDS and CSDD cut-offs for Japanese older adults. METHODS: The GDS and the CSDD were interview-administered to nondepressed Japanese older adults (n = 74) and to Japanese older adults with a SCID-IV diagnosis of major or minor depression (n = 37). Depressed subjects were also administered the Hamilton Depression Rating Scale (HDRS). Data were also collected on demographic variables, mental status, health status, and medication use. RESULTS: ROC curve analysis identified a cut-off score of 6 for the GDS which had a sensitivity of 0.973, a specificity of 0.959, a False Positive Rate (FPR) of 0.894, and a False Negative Rate (FNR) of 0. A cutoff score of 5 for the CSDD yielded a sensitivity of 1, a specificity of 0.919, a FPR of 0.942, and a FNR of 0. Comparisons indicate current HDRS cut-offs may overlook subthreshold depression. The GDS cut-off score identified among Japanese subjects was the same as that reported for Western subjects. CONCLUSIONS: Due to the substantial prevalence of psychiatric disorders found in false-negative subjects, the above cut-off scores were chosen to optimize the potential for true positives. These scores are recommended for alerting physicians and other caregivers as to when more intensive depression evaluation is needed.

Caregiver burden and health-related quality of life among Japanese stroke caregivers.

OBJECTIVE: the present study had two main purposes: 1. To examine the relationship between caregiver burden and health-related quality of life in family caregivers of older stroke patients in Japan; and 2. To examine which characteristics of the caregiving situation significantly relate to increased burden. METHODS: subjects (n=100) were recruited from seven randomly selected neurological hospitals with out-patient rehabilitation clinics in western Japan and interviewed using the Zarit Burden Interview, the Modified Barthel Index, the Geriatric Depression Scale and the SF-12 Health Survey for health-related quality of life. RESULTS: increased caregiver burden was significantly related to worsening health-related quality of life, particularly worsening mental health (Geriatric Depression Scale and SF-12 items), even after controlling for caregiver age, sex, chronic illness, average caregiving hours/day, and functional dependence of the care-recipient. DISCUSSION: findings indicate that increased burden significantly relates to decreased health-related quality of life among stroke caregivers. In addition, the prevalence of depressive symptoms among caregivers was twice that of community dwelling older people. Roughly 52% of caregivers had Geriatric Depression Scale scores that warranted further evaluation. Despite the prevalence of depressive symptoms only one caregiver had received any psychiatric care during their caregiving tenure.

The relationship between mastery and depression among Japanese family caregivers.

The present study examined the relationship between caregiver mastery and depressive symptoms among family stroke caregivers in western Japan (N = 100). Family caregivers were identified from a sample of rehabilitation hospitals; participation rate was 100 percent for all eligible caregivers. Caregivers with high mastery were found to have significantly fewer depressive symptoms than low mastery caregivers and were significantly more likely to use a respite caregiver. They also reported significantly less burden, yet paradoxically were significantly more likely to rate their care-recipients as more functionally dependent on them. Caregiver age, health status, and caregiving duration did not relate to mastery. However, men had a significantly higher sense of mastery. In general, findings parallel those for Western family caregivers, although mean mastery scores for Japanese caregivers were lower than those reported for American family caregivers.

Factor structure of the Cornell Scale for Depression in Dementia among Japanese poststroke patients.

BACKGROUND: the present study reports on the first translation and use of the Cornell Scale for Depression in Dementia (CSDD) (Alexopoulos, Abrams, Young, & Shamoian, 1988) among poststroke patients (n = 101) in Japan. OBJECTIVES: the study had three main purposes: 1. To examine the factor structure of the CSDD among Japanese poststroke patients; 2. To compare this with the factor structure identified for Anglo-American Alzheimer's (AD) patients; and 3. To examine the prevalence and covariates of depressive symptoms among the Japanese stroke survivors. METHODS: poststroke patients and their caregivers (n = 202), at a random sample of neurological hospitals in western Japan, were interviewed using the study instruments. Data was also collected from patient charts. All subjects at each site who met the study criteria participated in the study. RESULTS: the four-factor solution for poststroke subjects was analogous to that found among AD patients with 2 main exceptions. In contrast to AD patients: 1. Physical complaints were unrelated to depressed mood in stroke patients; and 2. Agitation and psychosis loaded with depressed mood in stroke patients rather than as a separate unique factor as in AD patients. However, in the exploratory 5-factor model, agitation and suicidal ideation comprised a unique factor. Using standard cutoff scores for the CSDD, 58.2% of poststroke patients had scores suggesting possible depression. CSDD scores were not related to functional ability, or stroke characteristics such as aphasia or right or left-sided paralysis. However, scores were significantly higher among subjects < or = 2 years poststroke. Feelings of irritability, anxiety, sadness, and sleep problems were most prevalent. DISCUSSION: despite the prevalence of depressive symptoms, none of the subjects were currently receiving any mental health treatment. Findings suggest that symptoms differ by poststroke duration, which may necessitate different treatment approaches.