Skipping breakfast and 5-year changes in body mass index and waist circumference in Japanese men and women.

OBJECTIVE: This study investigated the relationship between frequency of skipping breakfast and annual changes in body mass index (BMI) and waist circumference (WC). METHODS: The participants were 4,430 factory employees. BMI and WC were measured repeatedly at annual medical examinations over a 5-year period. The association between frequency of skipping breakfast at the baseline examination and annual changes in anthropometric indices was evaluated using the generalized estimating equation method. RESULTS: The mean (standard deviation) BMI was 23.3 (3.0) kg m-2 for men and 21.9 (3.6) kg m-2 for women; and the mean WC was 82.6 (8.7) cm for men and 77.8 (9.8) cm for women. During the follow-up period, mean BMI increased by 0.2 kg m-2 for men and women, and mean WC increased by 1.1 cm for men and 1.0 cm for women. The annual change in the BMI of men who skipped breakfast four to six times per week was 0.061 kg m-2 higher, and that of those who skipped breakfast seven times per week was 0.046 kg m-2 higher, compared with those who did not skip breakfast. Annual changes in the WC of male participants who skipped breakfast seven times per week was 0.248 cm higher than that of those who did not skip breakfast. Skipping breakfast was not associated with changes in BMI or WC in women. CONCLUSIONS: Skipping breakfast was closely associated with annual changes in BMI and WC among men, and eating breakfast more than four times per week may prevent the excessive body weight gain associated with skipping breakfast.

Neural processes in pseudo perceptual rivalry: an ERP and time-frequency approach.

Necker cube is one of the ambiguous figures that is physically a static image but can be alternately perceived in two different perspectives. A great deal of debate exists regarding ambiguous figures that induce spontaneous switching between rival percepts. To investigate the time course of neural processes underlying such perceptual rivalry, we recorded electroencephalograms associated with participants' perceptions of a Necker cube under ambiguous and unambiguous conditions, using a modified discontinuous-presentation method. Each condition consisted of two stimuli presented consecutively, starting with an unambiguous stimulus in both conditions. The second stimulus was either ambiguous (ambiguous condition) or unambiguous (control condition). We compared endogenous reversal activity of ambiguous stimuli with exogenous reversals. As a result, we found that the right-occipital beta-band activity (16-26 Hz) increased 100-150 ms and 350-450 ms after the onset of the ambiguous stimulus only when the perception of the ambiguous stimulus differed from that of the first stimulus. These results indicate that activity in the right-occipital total beta band reflects endogenous switching between rivaling percepts.

Sugar-sweetened beverage and diet soda consumption and the 7-year risk for type 2 diabetes mellitus in middle-aged Japanese men.

PURPOSE: This cohort study investigated the association between sugar-sweetened beverage (SSB) and diet soda consumption and the incidence of type 2 diabetes in Japanese men. METHODS: The participants were 2,037 employees of a factory in Japan. We measured consumption of SSB and diet soda using a self-administered diet history questionnaire. The incidence of diabetes was determined in annual medical examinations over a 7-year period. Hazard ratios (HRs) with 95 % confidence intervals (CIs) for diabetes were estimated after adjusting for age, body mass index, family history, and dietary and other lifestyle factors. RESULTS: During the study, 170 participants developed diabetes. The crude incidence rates (/1,000 person-years) across participants who were rare/never SSB consumers, <1 serving/week, ≥ 1 serving/week and <1 serving/day, and ≥ 1 serving/day were 15.5, 12.7, 14.9, and 17.4, respectively. The multivariate-adjusted HR compared to rare/never SSB consumers was 1.35 (95 % CI 0.80-2.27) for participants who consumed ≥ 1 serving/day SSB. Diet soda consumption was significantly associated with the incident risk of diabetes (P for trend = 0.013), and multivariate-adjusted HRs compared to rare/never diet soda consumers were 1.05 (0.62-1.78) and 1.70 (1.13-2.55), respectively, for participants who consumed <1 serving/week and ≥ 1 serving/week. CONCLUSIONS: Consumption of diet soda was significantly associated with an increased risk for diabetes in Japanese men. Diet soda is not always effective at preventing type 2 diabetes even though it is a zero-calorie drink.

Serum gamma-glutamyltransferase and the risk of hyperuricemia: a 6-year prospective study in Japanese men.

We conducted a longitudinal study to investigate whether increased serum gamma-glutamyltransferase independently predicts subsequent development of hyperuricemia. The study participants included 3,310 Japanese men without hyperuricemia, aged 20-54 years. The participants had annual heath examinations for 6 years to assess incident hyperuricemia (defined as serum uric acid>416.4 µmol/l and/or taking medication for hyperuricemia). The risk of incident hyperuricemia was compared in participants grouped according to their baseline serum gamma-glutamyltransferase level. During follow-up, there were 529 incident cases of hyperuricemia. A positive, dose-response relationship was observed between serum gamma-glutamyltransferase and the risk of incident hyperuricemia. The hazard ratios (95% confidence intervals) for hyperuricemia, compared with a serum gamma-glutamyltransferase level ≤19 U/l, were 1.32 (1.05-1.67) for 20-39 U/l, 1.28 (0.90-1.83) for 40-59 U/l, 1.56 (0.98-2.47) for 60-79 U/l, and 1.57 (1.02-2.41) for ≥80 U/l after adjustment for baseline serum uric acid, creatinine, total cholesterol, and glycated hemoglobin levels, ln(serum alanine aminotransferase), age, systolic blood pressure, medications for hypertension, hypercholesterolemia, and diabetes, body mass index, and smoking and exercise habits. A similar positive relationship was observed regardless of the presence or absence of alcohol drinking, obesity, metabolic disorders (any combination of hypertension, hypercholesterolemia and/or diabetes), or clinically high serum aminotransferases, without evidence of a significant interaction between increased serum gamma-glutamyltransferase and risk factors for incident hyperuricemia. These findings indicate that increased serum gamma-glutamyltransferase is an independent predictor of subsequent development of hyperuricemia.

Alcohol intake and the risk of hyperuricaemia: a 6-year prospective study in Japanese men.

BACKGROUND AND AIMS: Since there is little information derived from prospective studies on the amount of alcohol drinking required to induce hyperuricaemia, we attempted to address this issue in a Japanese population. METHODS AND RESULTS: A total of 3310 Japanese men aged 20-54 years that were free of hyperuricaemia were classified according to their alcohol intake per week at baseline. Incident hyperuricaemia, defined as >7.0 mg/dl and/or taking medication for hyperuricaemia, was assessed through annual heath examinations for 6 years after the baseline examination. During follow-up, 529 incident cases of hyperuricaemia occurred. There was a positive, dose-response relationship between alcohol intake and the risk of incident hyperuricaemia. The hazard ratio (95% confidence interval) for hyperuricaemia in drinkers compared with non-drinkers was 1.10 (0.85-1.42) for <10.0 drinks/week, 1.40 (1.07-1.84) for 10.0-19.9 drinks/week, 1.64 (1.23-2.21) for 20.0-29.9 drinks/week and 1.98 (1.40-2.80) for ≥30.0 drinks/week (one drink contained 11.5 g of ethanol) after adjusting for age, baseline serum uric acid, body mass index, smoking habits, exercise habits, serum creatinine, blood pressure, serum cholesterol and blood glucose. The fraction of hyperuricaemia in the population attributable to alcohol intake was 21.6%. A clear dose-response pattern was observed for both beer and sake, when the consumption of these two beverages was analysed separately. CONCLUSION: Habitual alcohol intake significantly contributed to the development of hyperuricaemia in Japanese men, regardless of type of alcoholic beverage consumed. Therefore, it is essential to reduce excessive alcohol intake to prevent and manage hyperuricaemia.

[Preparation for cardiopulmonary bypass].

This article introduces our standard method of cannulation for extracorporeal circulation. The ascending aorta is used in most operations for arterial cannulation. Bicaval cannulation for venous return is performed through the right atrium. In order to accomplish venting the heart, we introduce a vent catheter to the left atrium through the right superior pulmonary vein. Cardioplegic solution may be administered antegradely through the aortic root or retrogradely through the coronary sinus for myocardial protection. Adequate cardiopulmonary bypass is the key to successful cardiovascular operations.

Homeostasis model assessment of insulin resistance and the risk of cardiovascular events in middle-aged non-diabetic Japanese men.

AIMS/HYPOTHESIS: Little is known about the relationship between the HOMA of insulin resistance (HOMA-IR) and the risk of cardiovascular events in Asian populations, which have lower levels of HOMA-IR than Western populations. Accordingly, we determined the predictive value of HOMA-IR for cardiovascular risk in a Japanese population that was apparently free of diabetes, addressing whether insulin resistance itself increases cardiovascular risk independently of other relevant metabolic disorders. METHODS: We followed 2,548 non-diabetic men aged 35 to 59 years for 11 years. The hazard ratios for the incidence of cardiovascular events due to increased HOMA-IR were estimated using a Cox proportional hazards model that was adjusted for potential confounding factors. RESULTS: The multivariate-adjusted hazard ratio for cardiovascular events compared with the first quartile of HOMA-IR (or=1.52). The hazard ratio associated with a one SD (0.61) increment in log-transformed HOMA-IR was 1.51 (1.13-2.02). A similar positive relationship was observed for coronary events and stroke. In addition, the relationship between HOMA-IR and cardiovascular risk was broadly similar in participants with and without hypertension, dyslipidaemia (elevated triacylglycerol and/or reduced HDL-cholesterol), abdominal obesity and current smoking. CONCLUSIONS/INTERPRETATION: Increased HOMA-IR predicted subsequent cardiovascular events in non-diabetic Japanese men. The association was independent of traditional cardiovascular risk factors and other relevant metabolic disorders.

J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes: an 8-year follow-up of relatively lean Japanese individuals.

AIMS: This study investigated the relationship between waist circumference and the subsequent incidence of Type 2 diabetes and the association with insulin resistance and pancreatic B-cell function in relatively lean Japanese individuals. METHODS: The study participants were 3992 employees (2533 men and 1459 women, aged 35-55 years) of a metal-products factory in Japan. The incidence of diabetes was determined in annual medical examinations during an 8-year follow-up. We calculated age- and sex-adjusted hazard ratios (HRs) according to the sex-specific quintile of waist circumference at baseline. Differences in baseline insulin resistance [homeostatis model assessment (HOMA)-IR] and pancreatic B-cell function (HOMA-B) were compared between participants who developed diabetes and those who did not. RESULTS: During the follow-up, 218 participants developed diabetes. Age- and sex-adjusted HRs across the quintiles of waist circumference were 1.78, 1.00 (reference), 1.59, 3.11 and 3.30, respectively (P for trend, < 0.0001). The HR for the lowest quintile was significantly higher than that for the second quintile. Among participants with waist circumference of the lowest quintile, HOMA-B was lower in those who developed diabetes than in those who did not [33.1 (24.1-45.0) vs. 54.3 (37.9-74.6) median (interquartile range), P < 0.0001], but HOMA-IR did not differ between these groups. CONCLUSIONS: There was a J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes in relatively lean Japanese individuals; lower pancreatic B-cell function may also increase the risk of diabetes in very lean Japanese people. Diabet. Med. 26, 753-759 (2009).

[Coronary artery bypass grafting in patients with carotid artery disease; indication and early clinical outcome of coronary artery bypass grafting concomitant with carotid endarterectomy].

The purpose of this study is to assess the clinical results of coronary artery bypass grafting (CABG) in patients with carotid artery disease, especially concomitant with carotid endarterectomy (CEA). Between April 1993 and April 2008, 77 patients (aged 69.5 +/- 7.1 years, 77.9% male) with carotid artery stenotic disease underwent CABG. Cerebral hemodynamics in all patients was examined with single photon emission computerized tomography (SPECT). Treatment course was decided after through diagnostic evaluation and strategic discussion with brain surgeons. Among these, 12 patients required CEA simultaneously, because both coronary and carotid artery diseases were too serious for safe staged operation. Hospital death occurred in 3 patients (3.9%). Two patients (2.6%) had postoperative stroke, but were discharged without neurological deterioration. In 12 patients receiving CABG and CEA simultaneously, there was no intraoperative stroke or hospital death. One patient had hyperperfusion syndrome after CEA, and required adequate rehabilitation exercise. CABG concomitant with CEA is an acceptable and feasible procedure in patients with significant coronary and carotid artery diseases. In order to improve surgical outcome of combined cases, it is important to prevent occurrence or aggravation of cerebral hyperperfusion syndrome.

[Off-pump coronary artery bypass grafting using in-situ right internal thoracic artery extended with radial artery as I-composite graft].

OBJECTIVE: The purpose of this study is to assess the feasibility of utilizing the proximal right internal thoracic artery (RITA) extended with the radial artery (RA) as I-composite graft (RITA-RA graft) in off-pump coronary artery bypass grafting (OPCAB), which preserves the left internal thoracic artery to the left anterior descending artery as an isolated graft and the ascending aorta no-touch technique. METHODS: Between January 2002 and August 2006, 37 patients (aged 67.4+/-7.5 years, 86.5% male) underwent OPCAB using RITA-RA graft. All grafts were harvested in a skeletonized fashion. RITA transected at the middle portion was extended with entirely dissected RA. RITA-RA graft was anastomosed to 1 or 2 lateral artery in a parallel sequential pattern. RESULTS: The total number of distal anastomoses of RITA-RA graft was 48. The early graft patency rate was 97.9%. Five cases (13.5%) needed intra-aortic balloon pumping support during operation. Only 1 patient (2.7%) required ventilator support longer than 24 hours. The percentage of patients requiring homologous blood transfusion was 13.5%. There was no cerebrovascular accident or mediastinitis in the postoperative course. All patients were discharged from hospital. CONCLUSIONS: OPCAB using RITA-RA graft is feasible and safe. It provides satisfactory early clinical and angiographic outcomes.

Electric-field-temperature phase diagram of an antiferroelectric liquid crystal.

We present a precise electric-field-temperature phase diagram of an antiferroelectric liquid crystal with a short pitch Sm-Calpha* phase. This was obtained by using a photoelastic modulator. A unique field-induced phase was found inside the Sm-Calpha* phase, which displayed low birefringence. Two tricritical points related to the phase were also observed. In addition, numerical calculations were made based on the discrete phenomenological model. The numerical results reproduced the experimental ones and it was clarified that the phase has a three-layer structure without spatial modulation.

[Indication and strategy of on-pump coronary artery bypass grafting in elderly patients].

As elderly people are increasing nowadays, so is coronary artery bypass grafting (CABG) for these older patients. The risk of on-pump CABG for elderly patients is thought to be higher than that for younger patients. We assessed 12 patients, 80 years of age or older, who underwent on-pump CABG, and compared them with 1,988 patients younger than 80 years old. In the elderly patient group, there were no in-hospital mortality and no postoperative complications. There was no statistical difference in the pre- and postoperative factors between the 2 groups except for the cardiopulmonary bypass time. We also compared the pre- and postoperative factors of 341 patients, 70 years of age or older, who underwent on-pump CABG with those of 1,659 patients under 70 years of age. The preoperative factors of elderly patients indicated that they were more severely ill than younger patients. In the analysis of postoperative factors, the rate of postoperative complications were similar between the 2 groups, despite the significantly higher rate of in-hospital mortality in the elderly group. The risk of on-pump CABG for elderly patients is higher than that for younger patients, but with careful management of the pre-, intra-, and postoperative procedures, we can perform on-pump CABG safely even in the elderly patients.

[Fungal endocarditis found at onset of lower limb acute aortic occlusion; report of a case].

Fungal endocarditis caused by Candida species is associated with high morbidity and mortality. A combination of surgical resection and antifungal drug therapy is the golden standard for treatment. We reported a case of fungal endocarditis due to Candida lusitaniae found at onset of lower limb acute aortic occlusion cured by emergency operation. This case suggests that Candida endocariditis can be managed medically with antifungal drug therapy in life time.

Mitral stenosis due to fibrous tissue overgrowth after mitral valve repair.

We report an extremely rare case of fibrous tissue overgrowth 3 years after mitral valve repair using a mitral annuloplasty ring in a 53-year-old woman who underwent mitral valve replacement for mitral stenosis. Whitish fibrous tissue had overgrown from the ring on the atrial side of the annulus, and had severely reduced the valvular area. However, the motion of the mitral leaflets was not restricted. Considering the presence of concomitant aortitis syndrome, it is strongly suggested that the overgrowth of fibrous tissue was promoted as a reaction to chronic inflammation.

A cross-sectional study on association of calcium intake with blood pressure in Japanese population.

To investigate the association of calcium intake independently of other nutrients already known as predictors of hypertension, a cross-sectional study was carried out on the same population in Japan as used for the INTERSALT study. Dietary calcium intake was estimated from a 1-day 24-h recall. Sodium and potassium intakes were evaluated by 24-h urinary excretion. Data from 476 subjects aged 20-59 years, 230 men and 246 women, were analysed. The mean dietary calcium intake ranged from 557 to 608 mg/day among men, and from 528 to 639 mg/day among women. Among men, the pooled estimate of the regression coefficients of blood pressure (mm Hg) per 100 mg increase of calcium intake, adjusted for age and body mass index (BMI), were -0.42 mm Hg for systolic blood pressure (SBP) and -0.35 mm Hg for diastolic blood pressure (DBP), but there was no statistical significance. Among women, the pooled estimates of regression coefficients adjusted for age and BMI were -0.92 mm Hg for SBP and -0.83 mm Hg for DBP with statistical significance. After adjustment for age, BMI, alcohol intake and urinary excretion of sodium and potassium, the pooled estimate of calcium intake was -0.66 mm Hg for DBP with statistical significance and -0.70 mm Hg for SBP. A significant negative association of calcium intake with blood pressure was observed among the subjects in Osaka. Our study suggests that increased calcium intake may provide a benefit of lowering blood pressure independently of other minerals such as sodium and potassium.

The relationship between new stroke onset and serum thiocyanate as an indicator to cigarette smoking.

The case subjects were 67 stroke patients (27 males and 40 females, mean age 65.7+/-7.1), who suffered from stroke attack and had participated in annual medical check-up between 1987 and 1988 at Oyabe Public Health Center. The controls, which were adjusted for sex, age and blood pressure level with the case subjects, were selected from participants attending their annual medical check-up in 1987-1988. The serum thiocyanate level of case subjects were significantly higher than that of controls (p<0.05). The usefulness of measurement of serum thiocyanate level as an indicator of smoking status was assessed by using multiple logistic regression analysis adjusting for body mass index, mean blood pressure, and serum cholesterol was found. An odds ratio of 3.00 (95% confidence interval: 1.06-8.48, p<0.05) in cerebral infarction. It is considered that serum thiocyanate may be useful as an indicator of smoking status to assess the relationship with stroke onset, especially for cerebral infarction.

Cell-type non-selective transcription of mouse and human genes encoding neural-restrictive silencer factor.

Neural-restrictive silencer (NRS) has been identified in at least twenty neuron-specific genes, and its nuclear DNA-binding factor, NRSF (also known as RE1-silencing transcription factor (REST)), has been cloned from human and rat, and was shown to repress transcription by recruiting corepressors mSin3 and/or CoREST via its N- and C-terminal domains, leading to chromatin reorganization by mSin3-associated histone deacetylase, HDAC. However, it is largely unknown how NRSF gene expression is regulated. To elucidate the mechanisms for gene expression of NRSF, we isolated the transcriptional unit of the NRSF gene from mouse and human, identified three 5'-non-coding exons in addition to three coding exons, determined transcription start sites, and identified two basal promoter activities in the upstream of the first two non-coding exons. Both promoters functioned equally in neuronal and non-neuronal cells, suggesting that levels of initial transcripts of NRSF gene are similar in neuronal and non-neuronal cells. These results suggest that the level of NRSF gene expression is not determined by transcription per se, and rather is modulated at the post-transcriptional level, e.g. splicing, mRNA stability, and/or post-translational modifications, in a cell-specific manner. Consistent with this idea, NRSF protein was apparently present even in neuronal cells and tissues, but was unable to bind to the NRS element, suggesting that NRSF is regulated at least in part post-translationally.

Localization of neuronal growth-associated, microtubule-destabilizing factor SCG10 in brain-derived raft membrane microdomains.

Raft is a mobile membrane subdomain enriched in sphingolipid and cholesterol and also various signaling molecules. Previous observation suggested that brain-derived rafts contain tubulin but that rafts of non-neural origin do not. We hypothesized that SCG10, one of the neuronal growth-associated proteins (nGAPs), might be a neuron-specific molecule that anchors tubulin to neuronal rafts, and we explored biochemically its subcellular localization, interaction with tubulin, and effects on microtubule dynamics. In postnatal rat brain extracts, SCG10 was recovered mostly in membrane-associated fractions, and at least half was included in the raft fraction that was also enriched in GAP-43 and NAP-22. SCG10-enriched brain rafts also contained tubulin, and chemical cross-linking experiments revealed that SCG10 was closely associated with tubulin. In addition, SCG10 was able to inhibit polymerization of tubulin. These results indicate that SCG10 is a component of neuronal rafts as are other nGAPs, and suggest that SCG10 may be involved in signaling events in membranes for cytoskeletal reorganization around neuronal rafts.

Coronary artery bypass grafting in patients with dialysis-dependent renal failure.

This study identified preoperative characteristics of dialysis patients undergoing coronary artery bypass grafting (CABG) and determined the early and long-term results. We retrospectively analyzed the data of 60 patients (mean age 60.8 +/- 7.6 years) with end-stage renal disease who underwent CABG between 1982 and 1999. Seventeen (28%) patients underwent CABG for unstable angina, and 9 (15%) patients required preoperative intraaortic balloon pumping. The incidence of congestive heart failure (18%) and diseased aorta (42%) was higher in the dialysis group. In-hospital mortality in the dialysis group was 13% (8/60). The estimated survival rate at 5 and 10 years in the dialysis patients was 55.6 +/- 8.8% and 31.8 +/- 11.6%, respectively. The cardiac event-free rate, excluding the in-hospital mortality, was 62.5 +/- 9.9% at 5 years. Although the early and long-term results of CABG in dialysis patients were inferior to those of nondialysis patients, CABG in dialysis-dependent patients allows the patients to continue their dialysis therapy and to improve their functional status.