Initial evaluation of a novel electrocardiography sensor-embedded fabric wear during a full marathon.

Sudden cardiac accident (SCA) during a marathon is a concern due to the popularity of the sport. Preventive strategies, such as cardiac screening and deployment of automated external defibrillators have controversial cost-effectiveness. We investigated the feasibility of use of a new electrocardiography (ECG) sensor-embedded fabric wear (SFW) during a marathon as a novel preventive strategy against SCA. Twenty healthy volunteers participated in a full marathon race. They were equipped with a SFW hitoe® with a transmitter connected via Bluetooth to a standard smartphone for continuous ECG recording. All data were stored in a smartphone and used to analyze the data acquisition rate. The adequate data acquisition rate was > 90% in 13, 30-90% in 3, and < 10% in 4 runners. All of 4 runners with poorly recorded data were female. Inadequate data acquisition was significantly associated with the early phase of the race compared with the mid phase (P = 0.007). Except for 3 runners with poor heart rate data, automated software calculation was significantly associated with manual analysis for both the mean (P < 0.001) and maximum (P = 0.014) heart rate. We tested the feasibility of continuously recording cardiac data during a marathon using a new ECG sensor-embedded wearable device. Although data from 65% of runners were adequately recorded, female runners and the early phase of the race tended to have poor data acquisition. Further improvements in device ergonomics and software are necessary to improve ability to detect abnormal ECGs that may precede SCA.

Remote vital signs data monitoring during home blood transfusion: A pilot study.

BACKGROUND AND AIMS: Our study aimed to establish safer methods to manage home blood transfusion by using a remote vital signs data monitoring system. Home care is administered for patients with various medical disorders; however, home blood transfusion remains challenging owing to the risk of transfusion-related complications. METHODS: We set up a remote vital signs data monitoring system to improve the safety of home blood transfusions. Using an Internet-based vital signs data monitoring system, the heart rate, electrocardiography, respiration rate, and percutaneous oxygen saturation (SpO2) were monitored and recorded during the entire home transfusion period. RESULTS: Ten transfusions in three patients were monitored; two of the patients had an abnormality in a single vital sign (decreased SpO2 decrease and increased respiratory rate); these were not transfusion-related complications. Vital sign anomalies also occur because of errors in using the measurement device and noise associated with body movements. The presence of abnormalities in at least two vital signs among SpO2 decrease, tachycardia, and increased respiratory rate that persisted for >5 minutes was defined as a complicated vital sign abnormality (CVSA). There were no severe transfusion-related complications with CVSA in the present study. CONCLUSION: This study indicates the feasibility and sustainability of real-time remote monitoring of vital signs for the safety of home transfusion. Although CVSA may function as an indicator of severe transfusion-related complications, these findings need to be confirmed with further studies.

A new approach to prevent critical cardiac accidents in athletes by real-time electrocardiographic tele-monitoring system: Initial trial in full marathon.

The majority of marathon deaths are caused by sudden cardiac arrest (SCA), which occur in approximately 1 in 57,000 runners. Such deaths are more common among older males and usually occur in the last 4 miles of the racecourse. Although prompt resuscitation, including early use of an automated external defibrillator (AED), improves survival, the deployment of enough trained medical staff and AEDs is difficult due to increased cost. Moreover, most victims of exercise-related SCA have no premonitory symptoms. Therefore, we tried to use a novel approach to prevent sudden cardiac deaths (SCD) related to SCA using real-time electrocardiographic tele-monitoring system, as an initial trial to assess operative possibility in a full marathon. As a result, 3 out of 5 runners had reasonable measurement results and sufficient tele-monitoring without complications related to this trial was possible. However, many investigations and improvements, such as improving cost-effectiveness, reducing noise, and automating the monitoring system, are needed for practical application of these devices for athletes. As a next step, we would establish a novel strategy to reduce SCDs in athletes using next-generation devices, which include an alarm system associated with early application of AED. .

Evaluation of psychological distress using the K6 in patients on chronic hemodialysis.

OBJECTIVE: The aim of this study was to evaluate psychological distress in patients on chronic hemodialysis. SUBJECTS AND METHODS: A total of 72 patients on chronic hemodialysis were enrolled in this study. We evaluated psychological distress by using the K6 questionnaire, health-related quality of life (HRQOL) by using the EQ-5D questionnaire, and clinical parameters. Among the 72 patients, we also evaluated changes in K6 scores in 58 patients at 1-year follow-up. RESULTS: The mean K6 score was 3.7 ± 3.7 and 2 subjects (2.8%) were defined as having psychological distress. K6 scores were significantly correlated with body fat percentage, albumin level, and EQ-5D scores in total subjects. K6 scores were also significantly and negatively correlated with EQ-5D scores in men and women. In the 1-year follow-up group, changes in K6 scores were weakly and negatively correlated with changes in EQ-5D scores. CONCLUSION: Psychological distress was closely associated with HRQOL in patients on chronic hemodialysis. Coping strategies for psychological distress might be useful in improving HRQOL in patients on hemodialysis.

The linkage among ambulance transports, death and climate parameters in Asahikawa City, Japan.

OBJECTIVE: The aim of this study was to investigate the linkage among climate parameters, total ambulance transports and the number of deaths in Asahikawa City in northern Japan. METHODS: Monthly data on total ambulance transports and the number of deaths from January 2004 to December 2011 were obtained from Asahikawa City Fire Department and the Asahikawa City official website. Climate parameters for the required period were also obtained from the Japan Meteorological Agency, Japan. To adjust for the population, we also used monthly population data on Asahikawa City. The linkage among climate parameters, total ambulance transports and the number of deaths was evaluated by ecological analysis. RESULTS: The mean air temperature in the Asahikawa area was 7.3 ± 10.1 °C. Total ambulance transports (/a hundred thousand people/day) and the number of deaths (/a hundred thousand people/day) were 10.0 ± 0.6 and 2.6 ± 0.3, respectively. Using quadratic curves, total ambulance transports and the number of deaths were weakly correlated with some climate parameters. The number of deaths was weakly and positively correlated with total ambulance transports. CONCLUSION: A weak linkage among climate parameters, total ambulance transports and the number of deaths was noted in Asahikawa City, Japan. However, these associations were not as high as expected.

Association of dietary fat and carbohydrate consumption and predicted ten-year risk for developing coronary heart disease in a general Japanese population.

We examined the relationships between dietary carbohydrate, protein, fat, and the ratio of n6/n3 fatty acid intakes with the predicted 10-year coronary heart disease (CHD) risk in a general Japanese population. We used the Framingham risk score to determine the 10-year CHD risk of the subjects, who were employees of 6 companies in a single prefecture in Japan. After excluding the subjects who reported any history of angina pectoris, myocardial infarction, diabetes, or cancer, and those with missing data resulting in the inability of estimation of 10-year CHD risk and food intakes, the final data analysis was carried out for 809 subjects. The logistic regression models revealed a significantly increased odds ratio of 10-year CHD risk in the subjects with the highest tertile of carbohydrate intake (% energy) (odds ratio 3.64, 95% CI, 2.07-6.40); after adjustment for other variables, the odds ratio for the 10-year CHD risk was also higher in the subjects with the highest tertile of carbohydrate intake (odds ratio 1.72, 95% CI, 0.70-4.25). We also found that fat intake and the ratio of n6/n3 fatty acids were inversely associated with the predicted 10-year CHD risk (p for trend<0.01). The present findings added evidence of a positive association of dietary carbohydrate and inverse associations of total fat and n6/n3 fatty acid ratio with the predicted 10-year CHD risk in a general Japanese population.

Comparison of serum ferritin and oxidative stress biomarkers between Japanese workers with and without metabolic syndrome.

OBJECTIVE: Metabolic syndrome (MS) is closely associated to life-style and is characterized by central obesity causing severe diseases such as diabetes mellitus (DM) or atherosclerosis. This study investigates the role of oxidative stress and inflammation in MS. SUBJECTS: Total of 685 workers stratified by gender (293 men and 392 women) with a mean age of 41.2 ± 10.4 in different offices in a city in Japan. METHODS: Fasting blood and urine tests for MS, oxidative and/or inflammatory biomarker analysis and blood pressure (BP) measurement were performed. MS was defined on the basis of the Japanese criterion. RESULTS: Serum ferritin and urinary hydrogen peroxide (H2O2) levels were significantly higher in subjects with MS than those without. Ferritin was positively correlated with 8-hydroxy-2'-deoxyguanosine (8-OHdG) in all subjects and it was negatively correlated with 8-isoprostane and H2O2 in men. In addition, there was a significant positive correlation between ferritin and homeostasis model assessment (HOMA-R) in men. By using multiple regression analysis, ferritin was closely correlated with HOMA-R, γ-GT, 8-OHdG, smoking value and amount of alcohol ingestion in men, and it was correlated with 8-OHdG, γ-GT, HOMA-R in women under 50 years old. CONCLUSIONS: Ferritin is a useful marker of MS including insulin resistance, reflecting the importance of oxidative stress as a cause of MS, especially in men.

Associations of serum retinol, α-tocopherol, and γ-tocopherol with biomarkers among healthy Japanese men.

Retinol, α-tocopherol, and γ-tocopherol are fat-soluble vitamins acting as antioxidants via the prevention of lipid oxidation. Little is known about circulatory levels in healthy individuals. The present cross-sectional study aimed at elucidating the relationship between these antioxidants and clinical biomarkers in 206 male (median age 41 years, range 23-67) employees from companies located in the Okayama Prefecture, Japan. Subjects younger than 40 years (n = 94) showed a positive association of the frequency of alcohol consumption with the circulating retinol (ß = 0.344, p = 0.001) and γ-tocopherol levels (ß = 0.219, p = 0.041), and an inverse association of fast insulin with serum retinol (ß = -0.301, p = 0.009). In participants older than 40 years (n = 112) we found that an inverse association of HOMA-R with serum retinol (ß = -0.262, p = 0.021), α-tocopherol (ß = -0.236, p = 0.035), and γ-tocopherol levels (ß = -0.224, p = 0.052); and cigarette smoking was inversely associated with the levels of serum α-tocopherol (ß = -0.286, p = 0.008) and γ-tocopherol (ß = -0.229, p = 0.040). We further found negative relationships between serum ferritin and the retinol (ß = -0.211, p = 0.032) and α-tocopherol levels (ß = -0.223, p = 0.022) in men over 40 years of age. The present study suggests that the circulatory levels of antioxidant vitamins may modulate the action of insulin and that higher levels of iron might decrease the levels of antioxidant vitamins in the blood.

Evaluation of physical activity and its relationship to health-related quality of life in patients on chronic hemodialysis.

OBJECTIVE: The aim of this study was to investigate the relationship between physical activity and health-related quality of life (HRQOL) in patients on chronic hemodialysis. METHODS: A total of 31 men (69.0 ± 11.1 years) and 17 women (66.9 ± 10.0 years) among 61 male and 30 female patients on chronic hemodialysis at Innoshima General Hospital, Onomichi, Japan, were enrolled in this cross-sectional study. Physical activity was evaluated using tri-axial accelerometers. HRQOL and psychological distress were also evaluated using the EuroQol questionnaire (EQ-5D) and the K6 questionnaire, respectively. RESULTS: Physical activity evaluated by Σ[metabolic equivalents × h per week (METs·h/w)] was 8.1 ± 6.0 METs·h/w, and EQ-5D score was 0.754 ± 0.177. Among all patients, EQ-5D scores were significantly correlated with physical activity over 4 METs on non-hemodialysis treatment days (r = 0.426, p = 0.003). In women, EQ-5D scores were also correlated with physical activity over 4 METs on hemodialysis treatment days and non-hemodialysis treatment days. By stepwise multiple regression analysis, physical activity over 4 METs on non-hemodialysis treatment days was a determinant factor of EQ-5D even after adjusting for age and K6 scores. CONCLUSION: Physical activity over 4 METs on non-hemodialysis treatment days might be associated with EQ-5D in patients on chronic hemodialysis, especially in women.

Combined effects of working hours, income, and leisure time on suicide in all 47 prefectures of Japan.

This study describes an ecological study that evaluated the combined effects of working hours, income, and leisure time on suicide in all 47 prefectures of Japan. In men, the age-adjusted rate of suicide (per 100,000 population) was significantly correlated with working hours (r=0.587, p<0.0001) as well as significantly and negatively correlated with income (r=-0.517, p=0.0002) and times for the leisure activities of self-education (r=-0.447, p=0.0016) and hobbies (r=-0.511, p=0.0002). In addition, a stepwise multiple regression analysis identified time for leisure social activities as a determining factor in suicide rate, even after adjusting for working hours and income. However, the impact of time for leisure social activities on suicide rate was smaller than that of working hours and income. In contrast, none of these factors affected suicide rate in women. These results suggest that increasing leisure time may be useful for preventing suicide among men in Japan.

Serum vaspin levels are associated with physical activity or physical fitness in Japanese: a pilot study.

AIM: To investigate the link between serum vaspin levels and physical activity and/or physical fitness in Japanese. METHODS: A total of 156 subjects (81 men and 75 women) was enrolled in this cross-sectional study. Serum vaspin levels, physical activity by uniaxial accelerometers, peak oxygen uptake, and metabolic risk parameters were evaluated. We also assessed anthropometric and body composition parameters. RESULTS: Serum vaspin levels were over the level of 10 ng/mL in 15 subjects (9.6 %: Vaspin High group). In Vaspin Low group (<5 ng/mL: 74 men and 67 women), serum vaspin levels were 0.12 ± 0.18 ng/mL in men and 0.39 ± 0.70 ng/mL in women. Peak oxygen uptake was significantly and positively correlated with serum vaspin levels even after adjusting for age, physical activity evaluated by Σ[metabolic equivalents × h per week (METs[Symbol: see text]h/w)], BMI, and other confounding factors in men. In turn, physical activity was significantly and positively correlated with serum vaspin levels even after adjusting for confounding factors in women. CONCLUSION: Serum vaspin levels were closely associated with physical fitness in men and physical activity in women independent of body composition in this Japanese cohort.

Serum interleukin-18 levels are associated with physical activity in Japanese men.

OBJECTIVE: To investigate the link between serum interleukin-18 (IL-18) levels and physical activity in Japanese men. METHODS: A total of 81 men (45.7±17.6 years old) was enrolled in this cross-sectional investigation study. We assessed anthropometric and body composition parameters. Serum IL-18 levels, physical activity by uniaxial accelerometers, peak oxygen uptake and metabolic risk parameters were also evaluated. RESULTS: Serum IL-18 levels were 179.4±84.7 pg/mL. Physical activity evaluated by Σ[metabolic equivalents × h per week (METs⋅h/w)]was significantly and negatively correlated with serum IL-18 levels (r = -0.252, p = 0.0235). These associations remained even after adjusting for age, peak oxygen uptake and other confounding factors. CONCLUSION: Serum IL-18 levels were closely associated with physical activity independent of peak oxygen uptake in Japanese men.

Evaluation of serum arginase I as an oxidative stress biomarker in a healthy Japanese population using a newly established ELISA.

OBJECTIVE: We reported previously that serum arginase I increased in asthmatic patients and was associated with oxidative stress in a small healthy population. However, the exact association of arginase I with oxidative stress is not known. The present study aimed to analyze the association of arginase I with oxidative stress in a larger healthy population by a newly established ELISA. DESIGN AND METHODS: The new ELISA for the measurement of human arginase I was established by generating recombinant arginase I protein in human arginase I gene-transfected Escherichia coli via an ARG1 cDNA fragment-inserted vector and -specific antibody in rabbits. Serum arginase I was evaluated in a cross-sectional study on a healthy population (n=721) by comparing a commercial ELISA kit with the new ELISA. RESULTS: The mean levels of serum arginase I were 20.3 ± 0.7 ng/mL and 4.7 ± 0.2 ng/mL using the commercial ELISA kit and the new ELISA, respectively. Arginase I was correlated with WBC, RBC, hs-CRP, 8-OHdG, HDL-c, ALT, and BMI. Logistic regression analysis showed independent positive associations of arginase I with WBC, RBC, and urinary 8-OHdG and inverse independent associations with serum insulin and age. The association of arginase I with hs-CRP was not independent. CONCLUSION: The independent associations of arginase I with urinary 8-OHdG and serum insulin may reflect its involvement in oxidative stress and diabetes mellitus.

Relationship between ceruloplasmin and oxidative biomarkers including ferritin among healthy Japanese.

Serum ceruloplasmin (CP), a marker relevant to copper metabolism, is one of famous inflammation markers with a reduction in Wilson's disease, whereas serum ferritin is a marker relevant to iron metabolism. Recently, ferritin is pointed out to be related with oxidative stress. However, there is still no population research which showed the relation of CP and ferritin. Therefore, we investigated the relationship between CP and ferritin including oxidative stress biomarkers among healthy Japanese (n = 389). We measured serum CP, ferritin, Fe, high-sensitivity C-reactive protein (hs-CRP), and urinary oxidative stress biomarkers [H2O2, 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-isoprostane] and so on. Subjects showed that age; 41.7 ± 10.0 (year), CP; 31.9 ± 6.8 (mg/dl), ferritin; 123.5 ± 121.0 (ng/ml), hs-CRP; 0.89 ± 2.53 (mg/l), 8-OHdG; 10.2 ± 4.4 [ng/mg creatinine (Cre)] and H2O2; 6.5 ± 10.9 (µM/g Cre), (All data mentioned above were expressed as mean ± SD). CP was significantly and positively correlated with hs-CRP and inversely correlated with ferritin, Fe and 8-OHdG. By a multiple logistic regression analysis, odds ratio of CP according to quartiles of hs-CRP was 4.86, and according to quartiles of 8-OHdG was 0.39 after adjusting for age and other confounding factors. In conclusion, our findings suggest that CP was an antioxidative biomarker which controls oxidative stress, whereas ferritin was a marker which may participate in the generation of oxidative stress.

Relationship between cigarette smoking and muscle strength in Japanese men.

OBJECTIVES: To investigate the link between cigarette smoking and muscle strength in Japanese men. METHODS: We used data on 4249 Japanese men, aged 43.3±13.9 years, in this cross-sectional investigation study. Grip strength and leg strength were measured as indicators of overall muscle strength. Meanwhile, subjects' cigarette smoking habits were recorded by trained medical staff. The effect of cigarette smoking on muscle strength was evaluated. RESULTS: A total of 1618 men (38.1%) were smokers and 1481 men (34.9%) exercised regularly. Significant differences in muscle strength were noted between men with and without a Brinkman index of 400 or greater, after adjusting for age. After adjusting for age, height, body weight and exercise habits, associations between the Brinkman index and leg strength and the ratio of leg strength to body weight were attenuated. CONCLUSIONS: Cigarette smoking might be negatively associated with muscle strength, especially grip strength in Japanese men.

Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures of Japan.

OBJECTIVES: Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures, in Japan were evaluated. METHODS: Data on air temperature were obtained from the Japanese Meteorological Agency. Data on ambulance transports due to heat stroke was directly obtained from the Fire and Disaster Management Agency, Japan. We also used the number of deaths due to heat stroke from the Ministry of Health, Labour and Welfare, Japan, and population data from the Ministry of Internal Affairs and Communications. Chronological changes in parameters of air temperature were analyzed. In addition, the relation between air temperature and ambulance transports due to heat stroke in August 2010 was also evaluated by using an ecological study. RESULTS: Positive and significant changes in the parameters of air temperature that is, the mean air temperature, mean of the highest air temperature, and mean of the lowest air temperature were noted in all 47 prefectures. In addition, changes in air temperature were accelerated when adjusted for observation years. Ambulance transports due to heat stroke was significantly correlated with air temperature in the ecological study. The highest air temperature was significantly linked to ambulance transports due to heat stroke, especially in elderly subjects. CONCLUSIONS: Global warming was demonstrated in all 47 prefectures in Japan. In addition, the higher air temperature was closely associated with higher ambulance transports due to heat stroke in Japan.

The new school absentees reporting system for pandemic influenza A/H1N1 2009 infection in Japan.

OBJECTIVE: To evaluate the new Japanese School Absentees Reporting System for Infectious Disease (SARSID) for pandemic influenza A/H1N1 2009 infection in comparison with the National epidemiological Surveillance of Infectious Disease (NESID). METHODS: We used data of 53,223 students (97.7%) in Takamatsu city Japan. Data regarding school absentees in SARSID was compared with that in NESID from Oct 13, 2009 to Jan 12, 2010. RESULTS: Similar trends were observed both in SARSID and NESID. However, the epidemic trend for influenza in SARSID was thought to be more sensitive than that in NESID. CONCLUSION: The epidemic trend for influenza among school-aged children could be easily and rapidly assessed by SARSID compared to NESID. SARSID might be useful for detecting the epidemic trend of influenza.

The relation between ambulance transports stratified by heat stroke and air temperature in all 47 prefectures of Japan in August, 2009: ecological study.

OBJECTIVE: Our aim was to investigate the link between ambulance transports stratified by heat stroke and air temperature in August 2009 in Japan. METHODS: Monthly observations for ambulance transports stratified by heat stroke in August 2009, in all 47 prefectures of Japan were obtained from the Ministry of Internal Affairs and Communications. Daily air temperature data from the Japan Meteorological Agency in August 2009 for all 47 prefectures in Japan were also used. The effect of high air temperatures on ambulance transports stratified by heat stroke was analyzed in an ecological study. RESULTS: Various air temperature parameters , i.e., the mean of the mean air temperature, mean of the highest air temperature, mean of the lowest air temperature, the highest air temperature, and the lowest air temperature in August 2009 were significantly and positively correlated with ambulance transports stratified by heat stroke (per total number of ambulance transports and per 10,000 persons) in the 47 prefectures of Japan. The correlation coefficient between the mean of the highest air temperature in August 2009 and ambulance transports stratified by heat stroke (per 10 000 persons) was the highest among the examined parameters (r = 0.799, p < 0.0001). CONCLUSION: Higher air temperatures were closely associated with higher numbers of ambulance transports stratified by heat stroke in August 2009 in Japan.

Relation between cigarette smoking and ventilatory threshold in the Japanese.

The link between cigarette smoking and ventilatory threshold (VT) was investigated. We used data for 407 men and 418 women not taking medication. Habits of cigarette smoking were obtained through interviews by well-trained staff. The influence of cigarette smoking on oxygen uptake, work rate, and heart rate at VT was evaluated. Oxygen uptake at VT in women and work rate at VT in men with cigarette smoking were significantly lower than in subjects without cigarette smoking after adjusting for age. The differences of parameters at VT did not reach significant levels after adjusting for age and exercise habits in both sexes. However, in women without exercise habits, there was significant difference of oxygen uptake at VT between women with and without cigarette smoking after adjusting for age [cigarette smoking (+): 11.5 ± 1.8 ml/kg/min, cigarette smoking (-): 12.4 ± 2.1 ml/kg/min, p = 0.0006]. The number of cigarettes smoked per day and the Brinkman Index were not clearly correlated with oxygen uptake at VT. A combination of promoting exercise habits and prohibiting cigarette smoking might be recommended for improving the aerobic exercise level, especially in women.