Relationships between blood pressure lowering therapy and cardiovascular events in hypertensive patients with coronary artery disease and type 2 diabetes mellitus: The HIJ-CREATE sub-study.

OBJECTIVE: The effects of intensive blood pressure (BP) lowering for hypertensive patients with coronary artery disease (CAD) and diabetes mellitus on their clinical outcomes have not been fully evaluated. The aim was to explore the optimal systolic BP target in such patients in a substudy of a prospective, randomized trial. METHODS: Of a total of 2049 hypertensive patients with CAD who were enrolled in the HIJ-CREATE study, type 2 diabetes was diagnosed in 780 (38.1%). Titration of antihypertensive agents was performed to reach the target BP of <130/85 mmHg. The primary endpoint was the occurrence of a first major adverse cardiovascular event (MACE). Achieved BP was defined as the mean value of systolic BP in patients who did not develop MACEs and as the mean value of systolic BP prior to MACEs in those who developed MACEs during follow-up. RESULTS: During a median follow-up of 4.2 years, the primary outcome occurred in 259 (33.2%) diabetic patients and in 293 (23.1%) non-diabetic patients (p < 0.0001). The diabetic patients were divided into quartiles based on the mean systolic BP during follow-up. The relationships between achieved BP and the incidence of MACEs did not follow a J-shaped curve. Intensive systolic BP lowering to less than 120 mmHg did not correlate with an increased risk of MACEs. CONCLUSIONS: Our results suggest that the intensive BP lowering may not impair patients' clinical courses even in a high-risk population. The establishment of an optimal management strategy for hypertensive patients with diabetes and CAD is essential.

Immunomodulating activity of exopolysaccharide-producing Leuconostoc mesenteroides strain NTM048 from green peas.

AIMS: The present work was aimed to find novel probiotics to enhance the mucosal barrier function of humans. The effectiveness was evaluated in vitro and in vivo. METHODS AND RESULTS: Stimulation of IgA production in mucosal surfaces is one of the most beneficial traits of lactic acid bacteria (LAB) for enhancing the barrier. Therefore, 173 LAB strains were evaluated for the ability to induce IgA production using murine Peyer's patch cells. Strain NTM048 isolated from green peas showed the highest activity and was identified as Leuconostoc mesenteroides subsp. mesenteroides. This strain was found to tolerate gastrointestinal digestion and produce large amounts of exopolysaccharides, which possess IgA-inducing activity. Dietary supplementation with NTM048 induced a significant increase in the faecal IgA content and plasma IgA levels of BALB/cA mice. A gene expression analysis of Peyer's patch cells revealed that the transforming growth factor-ß and activation-induced cytidine deaminase genes were upregulated by NTM048 intake. CONCLUSIONS: Strain NTM048 stimulates Peyer's patch cells to induce intestinal and systemic immune response, revealing the potential of NTM048 as a probiotic for enhancing the mucosal barrier function. SIGNIFICANCE AND IMPACT OF THE STUDY: This report demonstrates a food-applicable Leuconostoc mesenteroides strain secreting exopolysaccharide that shows high IgA-inducing ability.

Ferroelectric and magnetic properties of multiferroic BiFeO(3)-based composite films.

BiFeO(3)-based composite films were fabricated onto the Pt/Ti/SiO(2)/Si(100) substrates by a chemical solution deposition (CSD) method using the precursor solutions with various excess iron composition followed by annealing at 923 K for 30 minutes under oxygen gas flow. Coexistence of spontaneous magnetization and remanent polarization could be obtained in the BiFeO(3)-based composite films with high excess iron composition. The remanent magnetization of almost 20 emu/cm(3) and the magnetic coercive field of 1.5 kOe were obtained at the iron composition ratio of Fe/Bi = 1.25. In this specimen, the remanent polarization at 90 K was approximately 10 microC/cm(2) at the electric field of 1500 kV/cm. Structural analysis suggested that the remanent polarization has a possibility to increase by suppressing the formation of the secondary phases of Bi(2)Fe(4)O(9) and alpha-Fe(2)O(3), these are the nonferroelectric material as well as antiferromagnetic phase.

Pentax-AWS, a new videolaryngoscope, is more effective than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck movements: a randomized comparative study.

BACKGROUND: We studied whether laryngoscopy and tracheal intubation were easier when using the Pentax-AWS (Tokyo, Japan), a new videolaryngoscope, than when applying the Macintosh laryngoscope, during manual in-line neck stabilization. METHODS: In 203 anaesthetized patients with manual in-line neck stabilization, we inserted the Pentax-AWS and a Macintosh laryngoscope, in turn, and recorded the view of the glottis and time taken to laryngoscopy. The success rate of tracheal intubation (within 120 s) and time to intubation were also recorded. RESULTS: The view of the glottis was significantly better with the Pentax-AWS than with the Macintosh laryngoscope (P<0.001). For the Macintosh laryngoscope, the view was obscured in 22 of 203 patients (11%) (Grade 3 in 21 patients and Grade 4 in one patient), whereas for the Pentax-AWS, the glottis was always clearly seen (Grade 1). Time taken to see the glottis with the Pentax-AWS [mean (sd): 6.0 (3.1) s] was significantly shorter than with the Macintosh laryngoscope [11.0 (5.0) s] (95% CI for difference: 4-6 s). The success rate of tracheal intubation with the Pentax-AWS (all of 99 patients) was significantly higher than with the Macintosh laryngoscope (93 of 104 patients) (P=0.001). Time taken for intubation was similar between the Macintosh laryngoscope [51 (27) s] and the Pentax-AWS [54 (14) s] (95% CI for difference: -9 to 3 s). CONCLUSIONS: In patients with stabilized neck, the Pentax-AWS provided a better view of the glottis and a higher success rate of tracheal intubation, compared with the conventional Macintosh laryngoscope.

Macrophage migration inhibitory factor (MIF) in bronchial asthma.

BACKGROUND: Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine favouring the secretion of TNFalpha and IL-8 and counteracts anti-inflammatory effects of corticosteroids. Airways inflammation is a central feature of bronchial asthma and is characterized by the accumulation of eosinophils. OBJECTIVE: The aim of this study was to investigate whether MIF is related to asthma symptoms and eosinophil accumulation in the airways. METHODS: Serum MIF levels were measured by an enzyme-linked immunosorbent assay in 44 healthy subjects and 44 asthmatics. Levels of MIF in induced sputum were measured in 10 healthy subjects and 15 asthmatics. Levels of eosinophil cationic protein (ECP) in induced sputum were measured by a radioimmunosorbent assay. Fluorescence double immunostaining was conducted to examine cellular source and localization of MIF. RESULTS: Serum MIF levels were significantly increased in asthmatic patients compared with age and sex-matched control subjects. Symptomatic patients had a higher MIF level than asymptomatic patients. Induced sputum obtained from asthmatics contained higher levels of MIF than those from control subjects. MIF levels in induced sputum were correlated with ECP levels in induced sputum. MIF was colocalized with eosinophil peroxidase staining in the cytoplasm of sputum cells. CONCLUSION: Increased MIF levels are associated with asthma symptoms and one of the cellular sources of MIF in the airways are eosinophils.

[Acute respiratory failure caused by inhalation of waterproofing spray fumes].

A 25-year-old woman was admitted to our hospital because of dry cough, slight fever, and severe dyspnea 5 hrs after inhalation of waterproofing spray. She had used the spray indoors near an oil heater, and then had smoked with spray-contaminated fingers. Chest roentgenograms revealed diffuse interstitial shadows mixed with patchy alveolar infiltration, and computed tomographic (CT) scans confirmed diffuse infiltration in both lungs. Marked leukocytosis and severe hypoxemia were noted. A transbronchial lung biopsy performed 4 days later demonstrated extensive alveolitis characterized by edema in alveolar septa and marked neutrophil migration into alveoli as well as alveolar septa. Oxygen therapy and the administration of methylprednisolone (1 g/day) achieved a complete recovery in about 1 week. We speculated that acute lung injury in this patient may have been induced by direct inhalation not only of the waterproofing spray itself, but also of spray by-products resulting from heat-decomposition. When using waterproofing spray, precautions should be taken to avoid inhaling the spray fumes or the more toxic by-products of thermal degradation.

[A mesenchymal malignant mesothelioma that changed from mixed type to purely sarcomatous type].

A 65-year-old man was admitted to the hospital because of an abnormal shadow on a chest roentgenogram. A diagnosis of mixed-type malignant mesothelioma was made after transcutaneous needle biopsy and thoracoscopic biopsy. The tumor was considered to be inoperable because it had diffusely invaded surrounding tissue, and therefore the patient was treated with chemotherapy only. About one year later, he died of acute pneumonia. At autopsy, a mesenchymal malignant mesothelioma that did not have an epithelial component was found. We know of no previous report of a case in which a tumor with a biopsy-proven epithelial component apparently changed to a purely sarcomatous type. No satisfactory explanation for this phenomenon has been offered.

Magnetic resonance tomographic angiography: diagnostic value in trigeminal neuralgia.

A combination of MRI, MR angiography and MR tomographic angiography (MRTA) was used to study the relationship of the root exit zone of the trigeminal nerve to surrounding vascular structures in seven patients with trigeminal neuralgia (TN) and ten patients with no evidence at a lesion in this region. MRTA is the technique for showing the relationship between vessels, cranial nerves and brain stem. MRTA clearly demonstrated the presence of a vessel at the root exit zone of the trigeminal nerve in all patients with TN. In the ten other patients, examination of 20 trigeminal nerves revealed that only one nerve (5%) was in contact with a vessel at the root exit zone. This study supports vascular compression of trigeminal nerves as a cause of TN, and demonstrates the value of MRTA as noninvasive technique for demonstrating compression.

Recent trend on the prevalence of tardive dyskinesia in Japan.

An epidemiological study was undertaken, taking a survey of 2,274 chronic schizophrenic patients hospitalized for 2 years or more in 17 mental institutions in Japan. The overall prevalence of tardive dyskinesia (T.D.) was 19.1%. The prevalence of TD differs considerably from one institution to the other, with a range of 0 to 36.1%. The longer the history of institution was, the higher the prevalence of TD. The prevalence showed a tendency to increase with increasing age. Long-term hospitalization concomitant with continuous neuroleptic medication seemed to play a role in the prevalence of TD. TD occurred with higher frequency in patients with somatic complications than in those without complications. Past drug history, including duration of treatment and responsible neuroleptics, has been considered to play an important role in the prevalence of TD. But, results of the present investigation showed that the present drug status might also influence on the appearance of TD. The facts obtained from the present study are of value to establish regimens mainly based on medical treatment for prediction and prevention of TD.

Stature, lung height, and spontaneous pneumothorax.

Relationship between stature and roentgenologically determined lung sizes were examined in 48 patients (mean age = 24.6 +/- 6.2 years) with spontaneous pneumothorax, 46 male patients (mean age = 24.6 +/- 3.8 years) with various diseases not related to the cardiopulmonary system, and 48 healthy male students (mean age = 24.3 +/- 2.2 years). Patients with spontaneous pneumothorax were slender compared to the control groups but the body height was not different. The patients had significantly longer lungs than the controls, although width and depth of the lungs were similar between the three groups. Mean differences for the lung height between patients and healthy students were so small (mean = 1.2-1.7 cm, which is equivalent to 0.3-0.7 cm H2O) that stress alone does not appear to be a major contributor to the pathogenesis of spontaneous pneumothorax.

Familial aggregation of abnormal ventilatory control and pulmonary function in chronic obstructive pulmonary disease.

A sex-, age-, obesity, and protease inhibitor-matched study of pulmonary function and ventilatory control was performed on 26 sons of 19 patients with chronic obstructive pulmonary disease (COPD) and 26 control subjects. Mean values for FEV1/FVC and V25 were significantly lower and CV/VC was significantly higher in sons of patients than in the controls. VC, airway resistance, static pulmonary compliance. delta N2, arterial blood gases and pH were not different between sons and controls. When the sons of patients were divided into two groups according to the arterial blood gases of their parents, sons of hypoxemic, hypercapnic parents showed significantly lower hypoxic ventilatory responses than sons of normoxemic, normocapnic parents. Hypercapnic ventilatory responses were not different between sons and controls. Abnormal pulmonary function and low ventilatory responses were more frequently detected in sons than in controls. The association of smoking with abnormalities of pulmonary function was not clearly seen in sons. These results suggest that familial factors (either genetic or environmental) play a significant role in determining the pathogenesis and clinical types of COPD.