Relationship between body composition indices and changes in body temperature due to hot pack use.

BACKGROUND: Hot pack application is used to reduce pain and muscle stiffness at the treated site. However, the effects of hot pack application on the whole body have not been clarified. We investigated the relationship between body composition indices and the hot pack-induced increase in body temperature. METHODS: We recruited 17 healthy men (age, 22.0 ± 3.3 years) who participated in the study on five different days and applied "dry" hot packs at four different sites (the most frequently used sites): right shoulder, lower back, both popliteal areas, and lower back plus popliteal areas. The study protocol involved the measurement of body composition followed by 10 min of bed rest, 15 min of warming with a hot pack, and 20 min of subsequent rest. Heart rate and body temperature were measured continuously, and blood pressure was recorded at 5-min intervals. Body temperature was measured at the right upper arm, precordium, abdomen, lumbus, right hallux, right femur, and right auditory canal. RESULTS: Skin temperature increased significantly at and near the hot pack application site, but this finding showed no relationship with body composition indices. The warmability distal to the application site was negatively correlated with the body water content index. The auditory canal temperature did not change in any of the sessions. CONCLUSIONS: Hot pack usage alone did not increase the deep-body temperature and only increased the temperature around the application area. Moreover, higher body water content may allow for easier dissipation of heat from the peripheral extremities.

Perinatal Management in a Pregnant Woman with Ureteropelvic Junction Obstruction: Case Report and Literature Review.

Although giant hydronephrosis (GH) associated with ureteropelvic junction obstruction (UPJO) is extremely rarely detected in pregnant women, diagnostic methods, therapeutic approaches, and perinatal management have not been established. A 31-year-old Japanese primipara had a 15 cm × 12 cm multi-cystic mass in the right abdomen detected by transabdominal ultrasound at gestational week 26. Magnetic resonance imaging revealed that the mass was right renal GH. She underwent serial ultrasound-guided transretroperitoneal drainage as conservative treatment. She delivered vaginally at gestational week 36. Since she had flank pain and a documented non-functional right kidney, laparoscopic nephrectomy was conducted 22 months after delivery. UPJO with fewer smooth muscle cells and fibrosis was histologically diagnosed in the surgical specimen. Her postpartum and postoperative courses were uneventful for 10 months. We performed a literature review of diagnostic methods, clinical characteristics, and perinatal management in pregnant women with GH due to UPJO.

Novel approach to evaluating granulation and segregation level considering the contribution of hydroxypropyl cellulose to the surface property change of granules.

The granulation process is critical to the uniformity of not only the active ingredient (API) but also other excipients in granules. Insufficient granulation results in unexpected product quality, e.g. delayed dissolution and lack of uniformity of API. Therefore, evaluating the granulation and segregation level of granules helps secure the uniformity of drug product quality. Here, we found that the polar surface free energy (SFE) of studied granules increased as granulation by a high shear granulator proceeded. Among the excipients formulated in the studied granules, only hydroxypropyl cellulose (HPC) showed a higher specific free energy of adsorption (ΔGsp) of chloroform, which is a parameter used to calculate polar SFE. This indicates that the ΔGsp of chloroform in granules helps detect the level of contribution of HPC to the granulation progress by inverse gas chromatography (IGC). We concluded that the ΔGsp of chloroform in a granulated sample is a novel critical material attribute (CMA) in relation to granulation level. In addition, we propose a novel approach to evaluating the quantitative granulation and segregation level based on the ΔGsp of chloroform in a granulated sample by focusing on the distribution of HPC in the granulated sample.

New approach to optimizing risk management of the sticking problem using scale-independent critical material attributes and the quantitative process parameter.

In pharmaceutical manufacturing of solid formulations, blending with a lubricant is a key process in preventing sticking during compression. Sticking not only results in tablets with a disfigured appearance but also brings about the interruption of continuous operations. The aim of our study was to identify blending scale-independent critical material attributes (CMAs) in relation to the sticking problem to appropriately define the end-point of the blending process with magnesium stearate as lubricant. Results showed that the dispersive surface free energy (SFE) and the specific free energy absorptions (ΔGsp) of ethanol decreased during blending with magnesium stearate. As the two parameters decreased, the sticking problem was improved. In conclusion, we propose that the dispersive SFE and ΔGsp of ethanol are scale-independent CMAs, and that the minimum blending time (BTmin), which can be calculated from the two CMAs, of the quantitative process parameter show the minimum blending time required to achieve higher risk assessment of the sticking problem.

Data on chemical compositions and fermentation quality of silages made from low-market-value vegetables supplemented with potato protein concentrate, a byproduct of starch production.

This data article reports the chemical compositions (protein, fat, fiber, ash, lactic acid, acetic acid, propionic acid, butyric acid and valeric acid) and fermentation quality, represented by V-value determined from the proportion of ammonia nitrogen in total nitrogen and volatile fatty acid contents, in silages prepared from low-market-value vegetables (carrot roots, cabbage leaves, and radish leaves). Potato protein concentrate, a byproduct of starch production from potato tuber, was used to supplement the protein contents in the silages. The first type of silage was produced by fermentation of a mixture of wheat bran and either carrot, cabbage, or radish without supplemental potato protein. The second type of silage was produced by fermentation of a mixture of wheat bran and either carrot, cabbage, or radish with supplemental potato protein. The third type of silage was produced by mixing the first silage type with unfermented potato protein. Chemical compositions and fermentation quality of the three silage types are provided in table formats.

Use of Mixer Torque Rheometer to Clarify the Relationship between the Kneading States of Wet Mass and the Dissolution of Final Product in High Shear Granulation.

The properties of wet mass, which indicate the progress of high shear granulation processes, usually have an effect on final product properties, such as tablet dissolution. The mixer torque rheometer (MTR) is a useful tool for quantitatively measuring the 'kneading state' of wet mass and detecting differences in granules. However, there have been no studies of the relationship between the MTR torque and the final product properties to date. In this study, we measured the MTR torque of wet granules at different kneading states, which were prepared by changing the granulation conditions. We then evaluated the relationship between the MTR torque and the dissolution rate of the final product properties. The amperage of the high shear granulator is usually monitored during granulation, but we could not detect a difference in the kneading state through the amperage. However, using MTR torque we were able to quantify the difference of the wet mass. Moreover, MTR torque showed a high correlation with dissolution, compared with the correlations with other intermediate properties, such as granules particle size and tablet hardness. These other properties are affected by following processes and are not properties that directly relate to the kneading state. Thus, MTR torque is a property of wet mass after granulation, and it can be used to directly evaluate differences of the kneading state, and as a result, dissolution. These results indicate the importance of controlling the kneading state, i.e., the progress of granulation, and the utility of MTR for detecting differences in wet mass.

Follicular thyroid carcinoma characterized by abundant stromal components with chondroid and osseous metaplasia in a dog.

A dog developed a cervical mass, and computed tomography verified a mass surrounding the trachea with some pulmonary masses. Histopathologically, the cervical mass was composed of malignant neoplastic cells showing follicular appearance which reacted positive for thyroglobulin on immunohistochemistry. A characteristic feature of the tumor was abundant and metaplastic stromal components. Anastomosed collagenous tissues connecting to capsule of the tumor were abundant in the stroma. In parts of the collagenous tissues, mature cartilages and bones were continuously formed. There was no cellular atypia or invasion in the components. We diagnosed this case as follicular thyroid carcinoma with metaplastic stroma. This is the first case report that characterizes stromal components with chondroid and osseous metaplasia in a canine thyroid carcinoma.

The "Senobi" breathing exercise ameliorates depression in obese women through up-regulation of sympathetic nerve activity and hormone secretion.

Obese individuals have an increased risk of developing depression. This study aimed to determine whether the "Senobi" breathing exercise (SBE), a stretching-breathing exercise that we have established, could relieve depression, especially in obese women. Forty premenopausal women, aged 40 to 49 years, participated in the present study. Twenty were healthy, and the other 20 were obese (body mass index > 25 and body fat > 30%) and in a depressive state (OWD). Sympathetic nerve activity determined by analyzing heart rate variability, and the hormone levels in the urine were investigated before and 30 min after one minute of SBE. The relative proportion of sympathetic nerve activity among healthy women in the daytime was 79.2 ± 2.3%, whereas that in OWD group was 30.4 ± 1.9%. After one minute of SBE, significant up-regulation of sympathetic nerve activity and increased concentrations of catecholamines, estradiol, and growth hormone (all P values < 0.001) were observed in OWD group. After 30 days of SBE, the sympathetic nerve activity and hormone levels had recovered in OWD group, and the depressive state, as evaluated by the Hamilton Depression Scale, had ameliorated. The "Senobi" breathing exercise was found to be effective for amelioration of depression in obese women possibly through up-regulation of sympathetic nerve activity and hormone secretion.

"Senobi" stretch ameliorates asthma symptoms by restoring autonomic nervous system balance.

The number of asthmatic patients is increasing in Japan. It is conceivable that changes in lifestyle (eg, lack of exercise and high-energy diet) may be associated with this phenomenon. The resulting factor seems to be altered activity of autonomic nervous system of these patients. When this activity was estimated by the measurement of heart rate variability, asthmatic patients (n = 11) showed a tendency for parasympathetic nerve dominance in comparison with healthy controls (n = 10). We recommend the patients engage in the "Senobi" stretch exercise, which involves stretching the arms and body upward while standing. After 1 month of regularly performing this exercise, most patients showed a decrease in the frequency of asthma rescue medication use. They also showed a recovery of forced expiratory volume in 1 second. These results suggest that the Senobi stretch is a useful exercise for asthmatic patients to perform to achieve a desirable improvement in symptoms.

The "Senobi" breathing exercise is recommended as first line treatment for obesity.

Neuroadrenergic abnormalities, including a predominant activity of parasympathetic nerve and blunted hormone secretion, are recognized in the overweight patients. This study aimed to examine whether the "Senobi" breathing method, a stretch-breathing exercise that we have developed, could activate or recover sympathetic nervous system activity that leads to the loss of body weight. Forty pre-menopausal women, aged 40 to 50 years, participated in this study. Twenty were healthy and the other 20 were overweight (body mass index>25 and body fat>30%). Sympathetic nerve activity was assessed using equipment that analyzes cardiac-beat variation, and several urinary hormone levels were examined before and 30 min after performing the "Senobi" breathing exercise. The average proportion of sympathetic nerve among healthy women during daytime hours (10:00 AM to 12:00 PM) was 62.6%±2.6%. On the other hand, that of overweight women was 33.5%±0.4%. After 1 min of the "Senobi" breathing, substantial up-regulation of sympathetic nerve activity and increased urinary hormone secretion were observed in the overweight women but not in the healthy controls. Moreover, after repeating the exercise for a month, the obese patients showed significant loss of body fat. The "Senobi" breathing exercise was found to be effective for weight loss in obesity possibly by regulating the autonomic nervous system and the hormone secretion.

Bone marrow-derived cells mobilized by granulocyte-colony stimulating factor facilitate vascular regeneration in mouse kidney after ischemia/reperfusion injury.

Bone marrow-derived cells (BMDC) play crucial roles in tissue regeneration. Granulocyte-colony stimulating factor (G-CSF) mobilizes BMDC and may facilitate the repair of kidney tissues after ischemia/reperfusion (I/R) injury. The tissue protective action of resveratrol, an antioxidant, might modify the regenerating potential of BMDC in I/R renal injury. This study examined whether G-CSF and/or resveratrol affect the recruitment of BMDC into vascular endothelial cells and renal tubular cells and the kidney function after I/R injury. I/R renal injury was induced in female mice that had been lethally irradiated and transplanted with male bone marrow cells. The mice were given saline, resveratrol or G-CSF, daily for 7 days. Non-irradiated and non-bone-marrow-transplanted female mice, which underwent the same kidney injury, were included as control. White blood cell (WBC) count and serum creatinine were monitored. Immunohistologic evaluation for renal tubular cells (cytokeratin) and endothelial cells (factor VIII-related antigen), and fluorescence in situ hybridization for mouse Y chromosome were performed. Although WBC was significantly higher in the G-CSF group, there was no significant difference in creatinine levels among all groups. Factor VIII-related antigen-positive cells with a Y-chromosome signal were identified in the capillary wall between renal tubuli and most frequently seen in the G-CSF group (p < 0.0001). Resveratrol did not affect kidney recovery in this model. No cytokeratin-positive renal tubular cells having a Y-chromosome signal were identified. In conclusion, BMDC are recruited into endothelial cell in I/R renal injury without apparent renal tubular cell regeneration, and G-CSF facilitates the endothelial cell regeneration.

[Reassessment of T classification system cutoff value for renal cell carcinoma].

PURPOSE: The 1997 T staging classification for renal cell carcinoma (RCC) defined T1 as tumors measuring up to 7 cm in size and T1 is subdivided into T1a and T1b with a 4 cm cutoff value in the 2002 TMN classification. We evaluated the validity of these cutoff values by assessing the cancer-specific survival of patients with non-metastatic RCC according to a series of alternative size cutoff values. In addition, we calculated how these size cutoffs affected the disease specific survival rates. MATERIALS AND METHODS: A database containing the records of 200 patients with RCC who underwent open radical nephrectomy for N0M0 disease between 1985 January and 2004 January was evaluated. Tumors were stratified by cutoff values ranging from 3 to 9 cm with the 1 cm increments in order to evaluate whether the 7 cm cutoff value is appropriate. Next, T1 RCC were stratified by cutoff values ranging from 3 to 6 cm with the 1 cm increment in order to verify whether the 4 cm cutoff is appropriate. Lastly, tumors over 7 cm diameter were stratified by cutoff values ranging from 9 to 14 cm with the 1 cm increments in order to verify whether the present T2-3a categories could be divided according to tumor size. RESULTS: As for the T1-2 classification, a cutoff value at 7 cm or 8 cm shared the greatest prognostic power. Although there was no significant difference in T1a/T1b subclassification, a 4 cm or 5 cm cutoff value resulted in a greatest separation of survival curves for T1a and T1b. As for tumors from 9-14 cm in diameter, only a 13 cm cutoff value provided a significant difference in survival. CONCLUSIONS: Our results indicate that the present 7 cm cutoff value in the TMN system is valid in terms of prognostic value. The 4 cm cutoff value may not reflect the survival when total nephrectomy is considered, thus indicating that tumors at 4 cm cutoff value may be valid when nephron sparing surgery is considered. The 13 cm cutoff value seems to be most appropriate in N0M0 tumors with over 7 cm in diameter.

Hand assisted retroperitoneoscopic living donor nephrectomy in elderly donors.

PURPOSE: We assessed the influence of HARDN on residual donor kidney and allograft function, invasiveness and morbidity in elderly living donors. MATERIALS AND METHODS: A total of 89 living donors underwent nephrectomy before September 2004 at our institution. The 18 donors who were 65 years or older included 4 of 27 with ODN and 14 of 62 with HARDN. RESULTS: In older (65 years or older) donors mean operative time, mean blood loss and warm ischemia time in the HARDN group did not differ from those in the ODN group. None of the donors had major complications. Older donors with HARDN had a tendency toward a shorter hospital stay than those with ODN. Postoperative serum creatinine in older donors with HARDN was higher than that in younger donors with HARDN, while there was no difference in postoperative serum creatinine between older donors with HARDN and those with ODN. The frequency of allograft losses tended to be higher in older than in younger kidneys (4 of 18 vs 5 of 71, p = 0.054). However, most allograft losses did not seem to be related to surgical technique. CONCLUSIONS: Although further studies, especially with long-term followup, are necessary, HARDN is suggested to be safe and minimally invasive surgery even in elderly donors and to be comparable to open surgery in terms of morbidity, the residual donor kidney and allograft function.

Successful renal transplantation in the right iliac fossa 2 years after serious deep venous thrombosis in a patient with systemic lupus erythematosus.

Deep venous thrombosis (DVT) possibly occurs in the perioperative period, and induces serious complications such as a pulmonary embolism. On the other hand, allograft renal vein thrombosis leads to a high incidence of graft loss. We experienced a case in which a serious DVT occurred prior to renal transplantation; however, a successful renal transplantation in the right iliac fossa was performed after 2 years of anticoagulant therapy. It is suggested that the external iliac vein even after suffering from DVT can be anastomosed to an allograft vein successfully, when enough blood fl ow or a lower venous pressure is confirmed. However, one should be aware of the risk factors and the adequate management of thrombosis in renal transplantation because of the serious complications of DVT and the poor prognosis of allograft vein thrombosis.

[A case of giant epidermoid cyst occupying the testis].

A case of a giant epidermoid cyst of the testis is presented. A 65-year-old man was incidentally pointed out to have left scrotal painless swelling. Physical examination revealed an over hen-egg sized enlargement of the left scrotal contents. Ultrasonography revealed a 7.5 X 5.5 X 4.0 cm solid tumor with heterogeneous echogenicity. No other abnormal findings were observed including tumor markers. Since preoperative examination did not rule out malignancy, we performed left high orchiectomy. Pathological diagnosis was a epidermoid cyst of the testis with a small portion of atrophic testis. Although the preoperative diagnosis of testicular epidermoid cyst is possible, it may be considerably difficult when a giant epidermoid cyst is occupying the testis.

[A case of fibroepithelial polyp of the ureter resected ureteroscopically].

A case of a giant fibroepithelial polyp of the ureter is presented. A 76-year-old woman was pointed out to have a tumorus lesion in the urinary bladder by ultrasonography. Intravenous pyelography showed a filling defect in the lower portion of the left ureter and bladder. Cystoscopy revealed a tumor with a smooth surface sticking out of the left ureteral orifice. After demonstration of benign ureteral polyp without malignancy by biopsy, ureteroscopic resection was performed. The stalk of the polyp was coagulated and removed with biopsy forceps under ureteroscopy. Pathological diagnosis was a fibroepithelial polyp. There were no findings of polyp recurrence or ureteral stenosis at 9 months after the operation. The diagnosis and management of fibroepithelial polyp are discussed.

[Active combination immunochemotherapy with interferon-alpha, interleukin-2 and gemcitabine for four patients with metastatic renal cell carcinoma].

Immunochemotherapy consisting of interferon-alpha (IFN-alpha), interleukin-2 (IL-2), and gemcitabine (GEM) for metastatic renal cell carcinoma. A partial response maintained for 15 months, was obtained in one case resistant to IFN-alpha and IL-2 of para-aortic lymph node metastases (case 1). A minor response with 30% reduction of lung metastasis was obtained in one IFN-alpha resistant case, and the duration was 6 months (case 2). In one case, in contra-lateral renal metastasis, no disease progression was obtained for 6 months (case 3). One case with resistance to IFN-alpha and IL-2, and who had preoperative abnormalities of corrected serum calcium, serum c-reactive protein and hemoglobin, had progressive disease and died of cancer after 6 months (case 4). Grade 3 toxicity was noted in leucopenia (4/4), anemia (1/4), and nausea/ vomiting (1/4). Although the response duration was short, the combination immunochemotherapy consisting of IFN-alpha, IL-2 and GEM may be a promising salvage regimen for the patients with metastatic renal cell carcinoma.

A retrospective study of the treatment of locally advanced prostate cancer by six institutions in eastern and north-eastern Japan.

OBJECTIVE: To investigate patients with locally advanced prostate cancer treated at six academic institutions in eastern and north-eastern Japan from 1988 to 2000, to facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer. PATIENTS AND METHODS: The study included 391 eligible patients with locally advanced prostate cancer who were treated by radical prostatectomy (RP), radiotherapy and/or primary hormone therapy. Disease-specific survival rates for these patients were assessed in relation to their clinicopathological characteristics and the types of treatment they received. The Mann-Whitney U-test, Kruskal-Wallis, chi-square and log-rank test were used for statistical analysis, as appropriate. RESULTS: In all, 128 patient with lower prostate-specific antigen levels (P = 0.023) and/or better performance status (P = 0.001) had RP. Neoadjuvant hormone therapy before RP was the treatment in 68 (53%) of these 128 patients; 66 (52%) received immediate adjuvant hormone therapy. Of 87 patients treated with radiotherapy, 75 (86%) had external beam radiotherapy (EBRT) as the primary treatment with no brachytherapy, and 12 (14%) had brachytherapy as the primary method. Neoadjuvant hormone therapy was given to 56 of the 87 patients (64%); 48 (55%) received immediate adjuvant hormone therapy. Of the 176 patients treated with primary hormone therapy alone, combined androgen blockade and surgical or medical castration was the treatment in 76 (43%) and 85 (48%), respectively. Disease-specific survival rates at 5 years for patients treated with RP, EBRT and primary hormone therapy were 90%, 98%, and 89%, respectively. CONCLUSION: The treatments provided by the participating institutions did not differ significantly from those set out in European and American guidelines, and short-term disease-specific survival rates for each treatment did not differ significantly from those of historical controls. Further investigation may facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer.

CA repeat polymorphism in the insulin-like growth factor-I gene is associated with increased risk of prostate cancer and benign prostatic hyperplasia.

Insulin-like growth factor-I (IGF-I) plays an important role in prostate growth, hyperplasia, and carcinogenesis. Circulating IGF-I levels may be modulated by a genetic cytosine-adenine (CA) repeat polymorphism in the promoter region of IGF-I. The association of the polymorphism with the risk of prostate cancer and benign prostatic hyperplasia (BPH) was explored in 303 patients with prostate cancer, 219 patients with BPH and 262 controls. The number of CA repeats ranged from 15 to 22 in case and control subjects. The 19-CA-repeat allele (19-allele) was more frequently observed in both the prostate cancer and BPH patients compared with the controls (prostate cancer versus control: P<0.001; BPH versus control: P=0.001). Compared with non-carriers of the 19-allele, men homo-zygous for the 19-allele had a significantly increased risk of prostate cancer [age-adjusted odds ratio (aOR) = 3.36, 95% confidence intervals (CI) = 1.30-8.67, P=0.012] or BPH (aOR = 3.53, 95% CI = 1.32-9.46, P=0.012), and those heterozygous for the 19-allele also had an intermediate increased risk of prostate cancer (aOR = 1.78, 95% CI = 1.25-2.53, P=0.001) or BPH (aOR = 1.66, 95% CI = 1.14-2.43, P=0.009). A gene dosage effect for the aORs was found with an increasing number for the 19-allele (P<0.001 in prostate cancer and P=0.001 in BPH). No significant association was found between the presence of the 19-allele and the tumor stage and grade at the time of diagnosis. In conclusion, the 19-allele of IGF-I appears to increase the risk of prostate cancer and BPH with a gene dosage effect in the Japanese population.

Influence of CYP3A5 and MDR1 (ABCB1) polymorphisms on the pharmacokinetics of tacrolimus in renal transplant recipients.

BACKGROUND: A body-weight-based dose of tacrolimus often results in marked individual diversity of blood drug concentration. Tacrolimus is a substrate for cytochrome P450 (CYP) 3A5 and p-glycoprotein encoded by CYP3A5 and MDR1 (ABCB1), respectively, having multiple single nucleotide polymorphisms. In this study, we genotyped CYP3A5 A6986G, MDR1 G2677(A/T), and C3435T polymorphisms and investigated the association between these polymorphisms and the pharmacokinetics of tacrolimus in renal transplant recipients. METHODS: Thirty consecutive recipients were enrolled in this study. The pharmacokinetics of tacrolimus was analyzed on day 28 after transplant, when the daily dose was adjusted to the target trough level of 10-15 ng/mL. The polymerase chain reaction-restriction fragment length polymorphism and direct sequence method were used for genotyping the CYP3A5 and MDR1 polymorphisms, respectively. RESULTS: The single tacrolimus dose per body weight was significantly higher in CYP3A5 *1 carriers than CYP3A5 *3/*3 carriers (0.143+/-0.050 vs. 0.078+/-0.031 mg/kg, P<0.001). The dose-adjusted trough level and the area under the concentration-time curve (AUC0-12) were significantly lower in CYP3A5 *1 carriers than CYP3A5 *3/*3 carriers (0.040+/-0.014 vs. 0.057+/-0.024 ng/mL/mg/kg, P=0.015 and 0.583+/-0.162 vs. 0.899+/-0.319 ng.hr/mL/mg/kg, P=0.004), respectively. The MDR1 polymorphism was not associated with any pharmacokinetic parameters. CONCLUSIONS: Kidney transplant recipients with the CYP3A5 *1 allele required a higher daily tacrolimus dose compared with those with the CYP3A5 *3/*3 genotype to maintain both the target trough level and AUC0-12, suggesting that this polymorphism is useful for determining the appropriate dose of tacrolimus.