Na and K Intake from Lunches Served in a Japanese Company Cafeteria and the Estimated Improvement in the Dietary Na/K Ratio Using Low-Na/K Seasonings and Dairy to Prevent Hypertension.

The excessive intake of sodium (Na) and insufficient intake of potassium (K) are major concerns in the prevention of hypertension. Using low-Na/K seasonings (reducing 25% of the NaCl and adding K salt) may improve the dietary Na/K ratio and help prevent hypertension. To devise an intervention study using low-Na/K seasonings at a company cafeteria, we calculated the Na and K contents of the meals served at the cafeteria and estimated changes in the intakes when suitable low-Na/K seasonings were used. We also considered using milk as a good source of K. We used an ingredient list of a company cafeteria and calculated Na and K contents in each dish. The average amounts of NaCl and K per use were 5.04 g and 718 mg, respectively. Seasonings contributed 70.9% of the NaCl. With the use of low-Na/K seasonings, an estimated reduction in NaCl of 0.8 g/day and an estimated increase in K of 308 mg/day was achieved. With an additional serving (200 mL) of milk, NaCl was reduced by 0.57 g/day and K was increased by 610 mg/day, with an overall decrease in the dietary Na/K ratio from 3.20 to 2.40. The use of low-Na/K seasonings and dairy may improve the dietary Na/K ratio among cafeteria users and help prevent hypertension.

Ion Tracks and Nanohillocks Created in Natural Zirconia Irradiated with Swift Heavy Ions.

Natural monoclinic zirconia (baddeleyite) was irradiated with 340 MeV Au ions, and the irradiation-induced nanostructures (i.e., ion tracks and nanohillocks) were observed using transmission electron microscopy. The diameter of the nanohillocks was approximately 10 nm, which was similar to the maximum molten region size calculated using the analytical thermal spike model. Ion tracks were imaged as strained regions that maintained their crystalline structure. The cross-sections of most of the ion tracks were imaged as rectangular contrasts as large as 10 nm. These results strongly indicated that the molten region was recrystallized anisotropically, reflecting the lattice structure. Furthermore, low-density track cores were formed in the center of the ion tracks. The formation of low-density track cores can be attributed to the ejection of molten matter toward the surface. A comparison of the ion tracks in the synthetic zirconia nanoparticles and those in larger natural zirconia samples showed that the interface between the strained track contrast and the matrix was less clear in the former than in the latter. These findings suggest that the recrystallization process was affected by the size of the irradiated samples.

Prospective study of the relationship between patient falls and caregiver burden in home health care: A pilot study.

AIM: To investigate the relationship between caregiver burden and patient falls, and the incidence of falls in patients receiving home health care. METHODS: A prospective cohort study was conducted on patients receiving home health care provided by 3 home-care support clinics and their primary caregivers from November 2015 to February 2016. Cox proportional hazards analysis was performed on the Burden Index of Caregivers (BIC) and the presence of falls. RESULTS: Of the eligible 114 subjects, 47 were included in the final analysis. Nineteen subjects (40.4%) reported falls in the 3-month observation period. The incidence of falls was 1120 per 1000 person-years. The unadjusted hazard ratios for BIC score, patient gender (female), fall assessment score, and lack of physical barriers within the home were 1.46, 1.39, 0.52, and 0.52, respectively, and differences were not statistically significant. Adjusted hazard ratios were 1.56, 1.44, 0.65, and 0.62, respectively, and were also not statistically significant. CONCLUSION: The incidence of falls was found to be roughly 5 times more than that in the general community elderly population. No causal relationship was found between caregiver burden and patient falls.

Safety and efficacy of a fixed versus unfixed brinzolamide/timolol combination in Japanese patients with open-angle glaucoma or ocular hypertension.

BACKGROUND: The purpose of this study was to assess the safety and efficacy of fixed-combination brinzolamide 1%/timolol 0.5% (BRINZ/TIM-FC) compared with concomitant brinzolamide 1% and timolol 0.5% (BRINZ + TIM) in Japanese patients with open-angle glaucoma (primary open-angle, exfoliation, pigmentary) or ocular hypertension. METHODS: This randomized, double-masked, multicenter, parallel-group, positive-control, Phase III study was conducted in Japan and included patients aged ≥20 years. Baseline intraocular pressure was assessed after 4 weeks of treatment with timolol 0.5%. Patients were randomized to twice-daily BRINZ/TIM-FC or BRINZ + TIM for 8 weeks (treatment phase). The primary endpoint was mean intraocular pressure reduction from baseline to week 8 at 11 am, at which time noninferiority of BRINZ/TIM-FC versus BRINZ + TIM was evaluated. Data were analyzed using repeated-measures analysis of covariance and t-tests. Adverse events and ophthalmic/physiologic variables were assessed. RESULTS: In total, 319 patients of mean age 64±12 years were enrolled in the treatment phase. BRINZ/TIM-FC and BRINZ + TIM were associated with reductions in mean intraocular pressure from baseline throughout the study (ranges -2.5 to -3.4 mmHg and -2.7 to -3.3 mmHg, respectively). Mean between-group differences in intraocular pressure reduction ranged from 0 to -0.3 mmHg; the upper limit of the 97.5% confidence interval for week 8 at 11 am was <1.1 mmHg, indicating noninferiority of BRINZ/TIM-FC. Treatment-related adverse events were observed in 3% and 12% of patients receiving BRINZ/TIM-FC and BRINZ + TIM, respectively. No substantial changes in other safety parameters were reported. CONCLUSION: Twice-daily BRINZ/TIM-FC reduced intraocular pressure by levels similar to concomitant BRINZ + TIM in Japanese patients with open-angle glaucoma or ocular hypertension and was noninferior to BRINZ + TIM. Both treatments were well tolerated.

Quality of life in patients with narcolepsy with cataplexy, narcolepsy without cataplexy, and idiopathic hypersomnia without long sleep time: comparison between patients on psychostimulants, drug-naïve patients and the general Japanese population.

OBJECTIVE: To assess the quality of life of patients with narcolepsy with cataplexy (NA-CA), narcolepsy without cataplexy (NA w/o CA), and idiopathic hypersomnia without long sleep time (IHS w/o LST) who were taking psychostimulant medication, and to ascertain which factors (including psychosocial and environmental variables) influence quality of life in this population. METHODS: In total, 185 patients who had received regular treatment were enrolled in the study (NA-CA, n=83; NA w/o CA, n=48; IHS w/o LST, n=54). Patients were asked to complete questionnaires including the Short Form-36 Health Survey (SF-36), the Epworth Sleepiness Scale (ESS), and items concerning psychosocial and environmental variables. RESULTS: All three diagnostic groups had significantly lower scores for most SF-36 domains compared with the Japanese normative data, and the ESS score was significantly reduced with treatment. Multiple logistic regression analyses revealed that several SF-36 domains were associated with the ESS score; autonomy in controlling own job schedule, experience of divorce or break up with a partner due to symptoms, experience of being forced to relocate or being dismissed due to symptoms, and perception of support from others. CONCLUSIONS: The severity of subjective sleepiness and psychological and environmental variables influenced quality of life in patients with these hypersomnias of central origin.

[Long-acting carteolol hydrochloride 2% ophthalmic solution phase IV study--investigation of the effectiveness, safety and plasma concentration].

PURPOSE: We investigated the effectiveness, safety and plasma concentration of long-acting carteolol hydrochloride 2% ophthalmic solution (LA) as compared with the original carteolol hydrochloride 2% ophthalmic solution(CA). METHODS: Patients with primary open angle glaucoma and ocular hypertension were randomized to 62 patients of LA group (LA once a day) and 62 patients of CA group (CA twice a day) in this multicenter, open-label trial. The intraocular pressure (IOP), pulse rate, blood pressure and plasma concentration were examined for 8 weeks. RESULTS: The IOP reduction and reduction rate were not significant at any point between the two groups. Systolic blood pressure decreased significantly in both groups, however, diastolic blood pressure decreased only in the CA group. The plasma concentration of the LA group was significantly lower than that of the CA group. CONCLUSIONS: The IOP reduction effect of the LA group was the same as the CA group. This study suggests that long-acting treatment with alginic acid can be useful for reducing systemic side effects.

Acute effects of diesel emission from the urea selective catalytic reduction engine system on male rats.

Short-term inhalation experiments were performed using Fischer 344 rats exposed to emission from the urea selective catalytic reduction (SCR) diesel engine system to identify health effects and compare them to those of the conventional diesel engine system. Rats were exposed to high-, middle-, or low-concentration emission (dilution ratio 1:29, 1:290, or 1:580) or clean air (control) for 1, 3, or 7 days (6 h/day), under driving conditions at a speed of 1320 rpm and a torque of 840 Nm. For the high-concentration group, the major components of the urea SCR emission were 0.04 mg/m(3) particulate matter (PM) and 0.78 ppm nitrogen dioxide (NO(2)); those of the conventional emission were 0.95 mg/m(3) PM and 0.31 ppm NO(2). The authors evaluated the respiratory effects of each emission on rats. Lymphocytes for 3-day exposure of both emissions significantly increased in bronchoalveolar lavage fluid, but there were slight differences. With an increase in potential antioxidant (PAO), 8-hydroxy-2'-deoxyguanosine for the urea SCR emission was significantly decreased, but that of the conventional emission was highest among all groups and did not show a response to PAO. In lungs, heme oxygenase (HO)-1 and tumor necrosis factor (TNF)-alpha mRNA expressions for the urea SCR emission showed a tendency to increase compared to those of the conventional emission. Thus, gene analysis results suggested that NO(2) from the urea SCR emission affected the expressions of mRNAs in lungs. However, as a whole, the results suggested that the health effects of the urea SCR emission might be less than the conventional emission on rats.

Toxicological evaluation of diesel emissions on A549 cells.

To evaluate the health effects of diesel emissions (DE) using an in vitro experiment, A549 cells were exposed to emission from a diesel engine on an engine dynamo, using a culture-cell-exposure device. Three groups were set according to cell exposure to high concentrations of particulate matter (PM) and/or nitrogen dioxide (NO(2)). The emissions of each group was dilution rate 1:100 and 1:10, and PM was 0.8mg/m(3) and/or NO(2) was 80ppm at dilution rate 1:10. After 1h, exposed cells were analyzed for cell viability and gene expression. Fifty percent of cell viability in the high-PM/high-NO(2) exposure group occurred at a dilution rate of 1:14, based on the concentration of CO(2). Heme oxygenase-1 mRNA expression significantly increased at 1:100 dilution of the high-PM/high-NO(2) group and 1:100 and 1:10 dilutions of the high-PM/low-NO(2) group, compared to background air. By DNA microarray, all gene expressions at a dilution rate of 1:10 in each group were observed to be higher than those at 1:100, and some cancer-related genes up-regulated. We concluded that screening methods for evaluating health effects could be established using this cell-exposure system because the effects of DE on A549 cells were shown by cell viability and gene expression.

Health-related quality of life among drug-naïve patients with narcolepsy with cataplexy, narcolepsy without cataplexy, and idiopathic hypersomnia without long sleep time.

OBJECTIVE: To evaluate the health-related quality life (HRQOL) of drug-naïve patients with narcolepsy with cataplexy (NAwith CA), narcolepsy without cataplexy (NA without CA) and idiopathic hypersomnia without long sleep time (IHS without LST), and to explore the factors influencing the HRQOL. Factors associated with the occurrence of automobile accidents are also discussed. METHODS: A total of 137 consecutive drug naïve patients who met the criteria of the 2nd edition of the International Classification of Sleep Disorders (NA with CA, n = 28; NA without CA, n = 27; IHS without LST, n = 82) were enrolled. The patients were asked to fill out questionnaires, including the SF-36, Epworth Sleepiness Scale (ESS), sociodemographic variables, and items regarding driving habits and the experiences related to automobile accidents. RESULTS: All 3 diagnostic groups had significantly lower scores in most SF-36 domains compared with Japanese normative data. Significant differences among the 3 diagnostic groups were not observed. Specific factors in SF-36 domains were not found with multiple linear regression analyses, while disease duration was positively correlated with mental health among all subjects. Among the patients reporting driving habits, ESS score (> or =16) was positively associated with the experience of automobile accidents. CONCLUSIONS: Our results indicated that HRQOL decreases in drug-naïve patients with hypersomnia, but neither disease category nor severity of the disorder appears as an associated factor. Increased severity of hypersomnia, however, was thought to play an important role in the occurrence of automobile accidents.

Abdominal aortic pseudoaneurysm caused by prolonged methicillin-resistant Staphylococcus aureus sepsis.

The mechanism of pseudoaneurysm formation caused by prolonged sepsis is thought to be related to the vascular endothelium being directly invaded and broken by bacteria. Moreover, matrix metalloproteinases (MMPs) which are up-regulated by chronic inflammation have been reported to be implicated in the pathogenesis of aneurysm development through increased proteolysis of extracellular matrix proteins. An effective treatment for infected pseudoaneurysm remains unsettled. Surgery is generally performed, however, because the patients in most of these cases are in very poor physical condition, the operation is associated with high morbidity and mortality. A more successful alternative is endovascular treatment. Recent reports indicate low morbidity and mortality rates with this treatment. If the patient in this case had been in better condition, we could have selected endovascular stent-grafting for her treatment.

Clinical significance and correlates of behaviorally induced insufficient sleep syndrome.

BACKGROUND AND PURPOSE: The aim of this study was to investigate the demographic variables and clinical characteristics of behaviorally induced insufficient sleep syndrome (BIISS) and to compare it with the other major hypersomnia disorders. PATIENTS AND METHODS: One-thousand two-hundred forty-three consecutive patients referred to the outpatient clinic for complaint of excessive daytime sleepiness (EDS) were retrospectively investigated. RESULTS: The rate of BIISS in patients with EDS was 7.1%, predominant in males. The mean age of initial visit was younger than that for obstructive sleep apnea syndrome (OSAS), while the mean age of onset of symptoms was older than that for idiopathic hypersomnia, narcolepsy, and circadian rhythm sleep disorders. The mean Epworth sleepiness scale (ESS) score before treatment was lower than that for narcolepsy but higher than that for both OSAS and circadian rhythm sleep disorders. Twenty-two percent of BIISS cases reported having accidents or near-miss accidents during the five-year period preceding the investigation, and this group showed higher ESS scores than the group without accidents. CONCLUSIONS: Our findings showed that an unignorably large number of people suffer from BIISS, and that people with severe cases of the disorder are at high risk for getting into an accident. Characteristics and demographic information could be helpful for making a differential diagnosis of BIISS.

Takayasu arteritis evaluated by multi-slice computed tomography in an old man.

In the case of patients with Takayasu arteritis (TA), they consult a doctor for the first time when they have a slight fever, shoulder pain, chest pain, back pain, or headache, or when they are pointed out to have high CRP or anemia by chance in medical check-up. In TA, they are usually young women. In our case, the very old patient had bilateral massive pleural effusion and aortic aneurysm with a 64-slice computed tomography (CT). TA commonly affects primarily large elastic arteries such as the aorta and its main branches. Steroid was very effective for suppression of inflammatory symptom being dose-dependent. His pleural effusion had been decreasing without reducing the size of aortic aneurysm. Multi-slice CT was a very useful tool to detect unexpected lesion in Takayasu arteritis in a non-invasive manner.

[Depression and sleep].

More than 80% of depressive patients have complaints about sleepiness and insomnia. Physiological researches demonstrate changes in sleep architecture and circadian rhythm in depressive patients. These researches suggest the enhancement of arousal function in daytime and nighttime and circadian changes in cholinergic and catecholaminergic neural system. Pharmacological therapy might be selected in considering the mechanism of these neural changes. The research about sleep deprivation therapy may give us the new advances in the further treatment.

Transferring images via the wireless messaging network using camera phones shortens the time required to diagnose acute coronary syndrome.

BACKGROUND: Clear images can be sent via e-mail using camera phones. We examined whether camera phones are useful to transmit electrocardiogram (ECG) images. METHODS AND RESULTS: ECG images were taken of 20 patients suspected to have acute coronary syndrome. Ten images were sent to a cardiologist by fax. The other 10 images were transmitted using a camera phone. The total time elapsed between image transmission to diagnosis by cardiologists was shorter in the camera phone group than in the fax group. CONCLUSIONS: ECG image transmission by camera phone can be efficiently used in the diagnosis of acute coronary syndrome.

Coronary aneurysm reduced after coronary stenting.

We describe as case of a 70-year-old man who underwent a percutaneous coronary intervention with stenting, for a severe stenosis complicated by a coronary aneurysm just distal to the stenotic site. Notably, coronary angiogram showed an immediate and progressive reduction in the size of coronary aneurysm. Curved planar reconstruction images of the enhanced CT showed no thrombus and no dissection of the coronary aneurysm. We speculate that coronary stenting might decrease the velocity of coronary flow through the stenosis. Consequently, stenting might attenuate the hydrodynamic wall stress on the aneurysm, and, in addition, improve the degradation of the extracellular matrix structure through the regulation of matrix metalloproteinases. Regression of coronary aneurysm after stenting requires further investigations, because stenting may become a potential means for treating post-stenotic aneurysms.

Time-course changes in the expression of heme oxygenase-1 in human subcutaneous hemorrhage.

To determine the time-course of human subcutaneous hemorrhage, heme oxygenase (HO)-1 expression and macrophage infiltration were observed using an immunohistochemical technique and semiquantitative analysis. The number of immunoreactive cells and the number of all infiltrating cells of each microscopic field were counted, and the ratio of the former to the latter was calculated as the positive cells ratio. An increase in the HO-1-positive cells ratio was observed starting at 3 h after injury, and the maximum ratio was observed 3 days after injury. The pattern of the increase in the macrophage ratio was similar to that of the HO-1-positive cells ratio in the early period after injury. Observation of serial sections revealed that the expression of HO-1 in the cells corresponded to the localization of macrophage. The present results suggest that the determination of HO-1 expression, as derived from macrophages, might be useful for the estimation of the time-course of subcutaneous hemorrhage.

Effect of zolpidem on sleep architecture and its next-morning residual effect in insomniac patients: a randomized crossover comparative study with brotizolam.

This study was conducted to determine the effect of zolpidem (ZOL) 10 mg orally on the sleep architecture and the next-morning residual effect in patients with non-organic insomnia (ICD-10) as compared to the effect of brotizolam (BTM) 0.25 mg orally, a widely used short-acting benzodiazepine (BZD) hypnotic in Japan, in a randomized, crossover comparative study. Fourteen patients with non-organic insomnia (3 males and 11 females; mean age of 54.9+/-S.D. 8.9 years). First three nights with placebo, middle three nights with either ZOL 10 mg or BTM 0.25 mg, and last three nights again with placebo in each session (a total of two sessions). Primary endpoints were polysomnography findings of sleep stages, sleep parameters, and sleep latency (SL) in the morning to examine calculable sleepiness as a residual effect. Secondary endpoint was sleep quality assessed by self-assessment questionnaire. At 150 min after Tmax, both ZOL and BTM significantly increased stage 2 (S2), and ZOL showed significantly longer slow wave sleep (SWS; stage 3+4) as compared to BTM. Stage wake was significantly increased by ZOL at the first withdrawal night and by BTM at the second withdrawal night. ZOL did not affect SL after rising, whereas BTM showed significantly shorter SL. Both drugs reduced the number of nocturnal awakenings and improved subjective sleep quality. The common adverse drug reaction (ADR) was sleepiness (3 patients) in each treatment. All events were mild. No serious adverse events occurred. ZOL is as effective as BTM in improving subjective sleep quality in patients with psychophysiological insomnia (PPI). ZOL has advantages over BTM in having a unique profile of increasing SWS with less next-morning residual effect.

Effect of benzodiazepine hypnotic triazolam on relationship of blood pressure and Paco2 to cerebral blood flow during human non-rapid eye movement sleep.

We sought to clarify the effect of short-acting benzodiazepine hypnotic on the relationship of arterial blood pressure and arterial partial pressure of carbon dioxide (Paco2) to regional cerebral blood flow (rCBF) during human non-rapid-eye-movement (non-REM) sleep. Nine young normal volunteers were treated in a randomized, crossover design with triazolam or placebo and underwent positron emission tomography at night. During wakefulness and stage 2 and slow wave (stages 3 and 4) sleep, we measured mean arterial blood pressure (MAP), Paco2, and absolute CBF. With triazolam compared to placebo, MAP reduced gradually. During stage 2 sleep, Paco2 increased and whole-brain mean CBF decreased. With triazolam, relative rCBF of the left orbital basal forebrain decreased more during stage 2 than slow wave sleep, whereas absolute CBF of the occipital cortex and cerebral white matter remained constant. During triazolam-induced stage 2 sleep, absolute CBF of the cerebral white matter correlated more strongly to both MAP and Paco2 than during placebo sleep and also correlated more strongly to both MAP and Paco2 than absolute CBF of the occipital cortex. In the frontal white matter, during triazolam-induced stage 2 sleep compared to wakefulness, absolute CBF was significantly better correlated to MAP, but not to Paco2. During triazolam-induced stage 2, the cerebral white matter may receive a modulated CBF regulation having the strengthened relationship of Paco2 to CBF and, more locally, the frontal white matter may depend precariously on CBF regulation.