SARS-CoV-2 Infection in Wrestlers after International Tournaments, April 2021.

Epidemiologic and genomic investigation of SARS-CoV-2 infections in members of Japan's national wrestling team after participation in international tournaments in 2021 revealed multiple lineages of SARS-CoV-2 not reported in Japan. The attack rate among wrestlers was high. Results suggest possible transmission during matches. We recommend early case detection and response practices.

Psychological and traumatic stress and the risk of developing diabetes and psychiatric disorders after a disaster-relief mission: An eight-year longitudinal study of Japan Maritime Self-Defense Force personnel dispatched for the 2011 Great East Japan Earthquake disaster-relief mission.

The Great East Japan Earthquake caused triple disasters-the earthquake itself, tsunamis, and nuclear leakage. Japan Maritime Self-Defense Force (JMSDF) personnel engaged in disaster-relief suffered various degrees of psychological stress, which is associated with psychiatric as well as physical disorders, such as diabetes. This study aimed to assess the effect of mission-related stress on the development of diabetes and psychiatric disorders in these personnel using JMSDF annual physical check-up data from 2010 to 2018 and Impact of Events Scale-Revised (IES-R) and Kessler Psychological Distress Scale (K-10) questionnaire data. Cox proportional hazard models were used to assess the hazard ratios (HRs) of developing diabetes and psychiatric disorders in the dispatched (N = 3686) vs. non-dispatched (N = 13,953) groups and high IES-R (score ≥25) vs. low IES-R score and high K-10 (score ≥25) vs. low K-10 score subgroups. We found a significantly higher HR of developing diabetes in the high IES-R score subgroup (2.02; 95% confidence interval [CI], 1.08-3.80). However, the HRs were not significant when comparing dispatched vs. non-dispatched groups and high vs. low K-10 score subgroups. Although the HR of developing psychiatric disorders was significantly lower in the dispatched group (0.64; 95% CI, 0.48-0.84), it was significantly higher in the high IES-R (7.95; 95% CI, 3.38-18.74) and high K-10 (8.76; 95% CI, 4.34-17.68) score subgroups. Thus, this study indicates the importance of paying closer attention to the risk of diabetes and psychiatric disorders in individuals with high IES-R or K-10 scores after disaster-relief activities.

Psychological and physical condition of Japan maritime self-defense force personnel who performed disaster-relief missions after the 2011 great east Japan earthquake.

The Great East Japan Earthquake, which occurred on March 11, 2011, was the most powerful earthquake ever recorded in Japan. In the present study, we examine personnel from the Japan Maritime Self-Defense Force who performed disaster relief in the earthquake's aftermath, focusing on the associated psychological and physical impacts. Overall, 8733 personnel were examined. In both July-August 2011 (M1) and July 2012 (M2), these personnel answered the Impact of Events Scale-Revised, the Kessler Psychological Distress Scale, and the Disaster Relief Questionnaire. We also analyzed the sample's physical examination records for the periods before and after the earthquake, using as controls a sample of peers who were not dispatched to the disaster area (N = 32,270). The psychological examinations showed that, in M1, holding the rank of private/sergeant (odds ratio [OR] = 2.13), performing body-recovery duties (OR = 1.94), and having disaster-affected family members (OR = 2.13) were significant risk factors for high post-traumatic stress response (PTSR). In M2, performing body-recovery duties (OR = 1.45) and having disaster-affected family members (OR = 2.60) were significant risk factors for high PTSR. Also, being woman (OR = 2.18) and having disaster-affected family members (OR = 1.68) were significant risk factors for high general psychological distress. For the physical examinations, the mean alanine transaminase in the dispatched group (31.73 ± 25.21) was significantly higher than that in the non-dispatched group (29.56 ± 21.03). These findings suggest that personnel involved in disaster relief experience psychological impacts in the subacute stage, but that these impacts attenuate one year after the event.

Sulforaphane Augments Glutathione and Influences Brain Metabolites in Human Subjects: A Clinical Pilot Study.

Schizophrenia and other neuropsychiatric disorders await mechanism-associated interventions. Excess oxidative stress is increasingly appreciated to participate in the pathophysiology of brain disorders, and decreases in the major antioxidant, glutathione (GSH), have been reported in multiple studies. Technical cautions regarding the estimation of oxidative stress-related changes in the brain via imaging techniques have led investigators to explore peripheral GSH as a possible pathological signature of oxidative stress-associated brain changes. In a preclinical model of GSH deficiency, we found a correlation between whole brain and peripheral GSH levels. We found that the naturally occurring isothiocyanate sulforaphane increased blood GSH levels in healthy human subjects following 7 days of daily oral administration. In parallel, we explored the potential influence of sulforaphane on brain GSH levels in the anterior cingulate cortex, hippocampus, and thalamus via 7-T magnetic resonance spectroscopy. A significant positive correlation between blood and thalamic GSH post- and pre-sulforaphane treatment ratios was observed, in addition to a consistent increase in brain GSH levels in response to treatment. This clinical pilot study suggests the value of exploring relationships between peripheral GSH and clinical/neuropsychological measures, as well as the influences sulforaphane has on functional measures that are altered in neuropsychiatric disorders.

Decoupling of Brain Temperature and Glutamate in Recent Onset of Schizophrenia: A 7T Proton Magnetic Resonance Spectroscopy Study.

BACKGROUND: Converging evidence suggests that cerebral metabolic and cellular homeostasis is altered in patients with recent onset of schizophrenia. As a possible marker of metabolic changes that might link to altered neurotransmission, we used proton magnetic resonance spectroscopy to estimate brain temperature, and we evaluated its relationship to a relevant metabolite, glutamate, within this study population. METHODS: Using proton magnetic resonance spectroscopy at 7T, 20 patients with recent onset (≤24 months after first psychotic symptoms) of schizophrenia and 20 healthy control subjects were studied. We measured levels of N-acetylaspartate and glutamate and estimated brain temperature in a noninvasive manner. RESULTS: Healthy control subjects showed a significant negative correlation between glutamate and brain temperature in the anterior cingulate cortex. In contrast, the physiological correlation between glutamate and brain temperature was lost in patients with recent onset of schizophrenia. CONCLUSIONS: This study supports the hypothesized disrupted relationship between brain metabolism and neurotransmission in patients with recent onset of schizophrenia. The findings include mechanistic implications that are to be followed up in both preclinical and clinical studies.

Intraoperative Anatomical and Hemodynamic Analysis of Intracerebral Arteriovenous Malformations by Semi-quantitative Color-coded Indocyanine Green Videoangiography.

OBJECTIVE AND BACKGROUND: To evaluate possible roles for indocyanine green (ICG)-based FLOW 800 software in surgical treatment of cerebral arteriovenous malformations (AVMs). METHODS: We perform ICG videoangiography several times for each step of AVM resection to elucidate feeders, drainers, and cerebral perfusion. RESULTS: Since 2010, 22 AVM surgeries in our department have been conducted using FLOW 800 intraoperatively. We demonstrated ICG angiograms, color-coded images, and semi-quantitative curves for AVMs. By reviewing all these modalities, we would define vascular structure of the AVM, proceed with resection, and finally recheck for any remnant. CONCLUSIONS: ICG FLOW 800 software helps the surgeon to recognize feeding and draining vessels of an AVM intraoperatively. Further studies to evaluate semi-quantitative acquired data regarding blood flow and tissue perfusion are warranted.

Infection and inflammation in schizophrenia and bipolar disorder.

The present study investigated the relationship between exposure to infectious agents and inflammation markers in individuals with schizophrenia (SZ), bipolar disorder (BP), and controls without a psychiatric disorder. We measured plasma levels of antibodies and innate immune markers and correlated them with clinical symptoms and cognitive function. In both SZ and BP, we found an increase in soluble CD14, and in BP an increase in C-reactive protein, IgM class antibodies against cytomegalovirus (CMV), and IgG class antibodies against herpes simplex virus 2. Furthermore in BP, we observed a negative relationship between IgG antibodies against CMV and scores for cognitive function.

Reduced superoxide dismutase-1 (SOD1) in cerebrospinal fluid of patients with early psychosis in association with clinical features.

Oxidative stress is implicated in the underlying pathophysiology of psychosis from studies of animal models and of tissues obtained from patients. Superoxide dismutase 1 (SOD1) is an antioxidant responsible for reducing free radicals. SOD1 levels in cerebrospinal fluid (CSF) reportedly correlate with those in brain. We hypothesized that patients in early-stages of psychotic disease may have altered SOD1 in CSF compared to healthy controls. We previously reported in a pilot study that SOD1 levels in CSF of patients with recent onset schizophrenia (SZ) were lower compared to healthy controls. Building on that work, in the present study we examined SOD1 levels in CSF acquired from two additional cohorts. Specifically, we studied SOD1 levels in CSF from a cohort of 15 patients with recent-onset psychosis and 18 healthy controls, as well as the second cohort of 18 antipsychotic-naïve patients with SZ and 20 healthy controls. In the first cohort, recent onset of illness was defined as within five years of onset of psychotic symptoms, and performance on neuropsychological testing as well as symptom severity were assessed. We observed 26.5% lower SOD1 in CSF from patients across both cohorts compared to controls (P=0.045) that was consistent with our previous report (30%). Among the cohort of patients with recent onset of SZ, SOD1 in CSF was positively correlated with composite performance on neuropsychological testing. Our results support further study of the relationship between cognitive deficits and oxidative stress in the central nervous system of patients with psychosis, including through study of SOD1.

A critical period of vulnerability to adolescent stress: epigenetic mediators in mesocortical dopaminergic neurons.

The molecular basis of vulnerability to stress during the adolescent period is largely unknown. To identify potential molecular mediators that may play a role in stress-induced behavioral deficits, we imposed social isolation on a genetically vulnerable mouse model. We report that 3-week (5-8 weeks of age) adolescent stress in combination with disrupted-in-schizophrenia 1 (Disc1) genetic risk elicits alterations in DNA methylation of a specific set of genes, tyrosine hydroxylase, brain-derived neurotrophic factor and FK506 binding protein 5. The epigenetic changes in the mesocortical dopaminergic neurons were prevented when animals were treated with a glucocorticoid receptor (GR) antagonist RU486 during social isolation, which implicates the role for glucocorticoid signaling in this pathological event. We define the critical period of GR intervention as the first 1-week period during the stress regimen, suggesting that this particular week in adolescence may be a specific period of maturation and function of mesocortical dopaminergic neurons and their sensitivity to glucocorticoids. Our study may also imply the clinical significance of early detection and prophylactic intervention against conditions associated with adolescent social stress in individuals with genetic risk.

Affective temperaments play an important role in the relationship between childhood abuse and depressive symptoms in major depressive disorder.

Previous studies have shown that various factors, such as genetic and environmental factors, contribute to the development of major depressive disorder (MDD). The aim of this study is to clarify how multiple factors, including affective temperaments, childhood abuse and adult life events, are involved in the severity of depressive symptoms in MDD. A total of 98 participants with MDD were studied using the following self-administered questionnaire surveys: Patient Health Questionnaire-9 measuring the severity of depressive symptoms; Life Experiences Survey (LES) measuring negative and positive adult life events; Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego auto-questionnaire (TEMPS-A) measuring affective temperaments; and the Child Abuse and Trauma Scale (CATS) measuring childhood abuse. The data were analyzed using single and multiple regression analyses and structural equation modeling (SEM). The neglect score reported by CATS indirectly predicted the severity of depressive symptoms through affective temperaments measured by TEMPS-A in SEM. Four temperaments (depressive, cyclothymic, irritable, and anxious) directly predicted the severity of depressive symptoms. The negative change in the LES score also directly predicted severity. This study suggests that childhood abuse, especially neglect, indirectly increases the severity of depressive symptoms through increased scores of affective temperaments in MDD.

[Threshold of Application of Antidepressant Drugs for Treatment of Depressive Disorder].

In recent years, along with the expansion of medical care for depressive disorder, there has been much controversy regarding the application of antidepressant drugs for its treatment. The aim of this paper is to consider critical issues concerning the threshold of application of antidepressant drugs for the treatment of depression. It was formerly important to diagnose the 'quality' of depression (melancholia or non-melancholia) in order to choose antidepressant treatment, whereas an assessment of the 'quantity' of depression (severity of symptoms) is crucial today to decide on the threshold. Recent guidelines for the treatment of major depressive disorder do not positively recommend the use of medication for the treatment of mild depression. The guidelines published by the Japanese Society of Mood Disorders also state that doctors have to give priority to treatments avoiding medication, although the effectiveness of antidepressant drugs for mild depression is controversial. Actually, in a clinical setting, doctors have to understand the conditions of individual cases and cope with many issues, such as a risk of suicide, comorbidity of other psychiatric disorders, target symptoms of pharmacotherapy, and choices of classes and doses of antidepressant drugs. The threshold of application of antidepressant drugs for the treatment of depression may vary according to the doctor-patient relationship and surrounding conditions. Doctors are required to provide treatment options other than pharmacotherapy.

The structural equation analysis of childhood abuse, adult stressful life events, and temperaments in major depressive disorders and their influence on refractoriness.

BACKGROUND: Previous studies have shown the interaction between heredity and childhood stress or life events on the pathogenesis of a major depressive disorder (MDD). In this study, we tested our hypothesis that childhood abuse, affective temperaments, and adult stressful life events interact and influence the diagnosis of MDD. PATIENTS AND METHODS: A total of 170 healthy controls and 98 MDD patients were studied using the following self-administered questionnaire surveys: the Patient Health Questionnaire-9 (PHQ-9), the Life Experiences Survey, the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire, and the Child Abuse and Trauma Scale (CATS). The data were analyzed with univariate analysis, multivariable analysis, and structural equation modeling. RESULTS: The neglect scores of the CATS indirectly predicted the diagnosis of MDD through cyclothymic and anxious temperament scores of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire in the structural equation modeling. Two temperaments - cyclothymic and anxious - directly predicted the diagnosis of MDD. The validity of this result was supported by the results of the stepwise multivariate logistic regression analysis as follows: three factors - neglect, cyclothymic, and anxious temperaments - were significant predictors of MDD. Neglect and the total CATS scores were also predictors of remission vs treatment-resistance in MDD patients independently of depressive symptoms. LIMITATIONS: The sample size was small for the comparison between the remission and treatment-resistant groups in MDD patients in multivariable analysis. CONCLUSION: This study suggests that childhood abuse, especially neglect, indirectly predicted the diagnosis of MDD through increased affective temperaments. The important role as a mediator of affective temperaments in the effect of childhood abuse on MDD was suggested.

The influences of working memory representations on long-range regression in text reading: an eye-tracking study.

The present study investigated the relationship between verbal and visuospatial working memory (WM) capacity and long-range regression (i.e., word relocation) processes in reading. We analyzed eye movements during a "whodunit task", in which readers were asked to answer a content question while original text was being presented. The eye movements were more efficient in relocating a target word when the target was at recency positions within the text than when it was at primacy positions. Furthermore, both verbal and visuospatial WM capacity partly predicted the efficiency of the initial long-range regression. The results indicate that WM representations have a strong influence at the first stage of long-range regression by driving the first saccade movement toward the correct target position, suggesting that there is a dynamic interaction between internal WM representations and external actions during text reading.

Outcomes of surgical versus endovascular repair of unruptured brain aneurysms in individuals aged ≥ 75 years.

AIM: Therapeutic intervention to repair unruptured aneurysms (UA) has not been strongly recommended for the elderly, because of their limited life expectancy and low annual bleeding rate. However, physically and mentally healthy older adults with seemingly high risk of aneurysmal bleeding might benefit from having their UA repaired. METHODS: A single-center retrospective study was carried out. Among 1078 patients admitted for treatment of UA between 2007 and 2011, the number of patients aged ≥ 75 years who underwent surgical and endovascular repair of UA was 30 and 31, respectively. The operative and mid-term outcomes were compared between the two groups. For evaluation of the operative outcomes, frequency and types of adverse events that occurred within 30 days of intervention (operative morbidity) were described. For assessment of the mid-term outcomes, activities of daily living (ADL) at 24 months after intervention were evaluated with the modified Rankin Scale (mRS). RESULTS: The operative morbidity rate was 6.7% in the open surgery group and 6.5% in the endovascular surgery group, and they did not differ significantly. The frequency of patients with mRS 0-2 at 24 months after intervention was 85.7% in the open surgery group and 82.8% in the endovascular surgery group, and they did not differ significantly. The adverse event rate of patients with middle cerebral artery aneurysms treated endovascularly was high (80%). CONCLUSIONS: The outcomes of individuals aged ≥ 75 years who underwent repair of UA were generally favorable in either treatment group, with more than 80% living an independent life at 24 months after intervention.

Transvenous embolization for carotid-cavernous fistula in a patient with vascular type of Ehlers-Danlos syndrome--direct superior ophthalmic vein approach: case report.

The vascular type of Ehlers-Danlos syndrome (vEDS) is an autosomal dominant hereditary disease characterized by connective tissue fragility throughout the body, including the arteries, viscera, and gastrointestinal tract. We report a case in which we performed transvenous embolization (TVE) via direct superior ophthalmic vein (SOV) approach to treat a direct carotid-cavernous fistula (CCF) in a patient with Ehlers-Danlos syndrome (EDS). The patient was a 37-year-old woman who developed tinnitus in her left ear and a headache during examination in the outpatient clinic of another hospital in order to make a definitive diagnosis of vEDS, and she was referred to our hospital and examined. Based on the results of all of the studies she was diagnosed with a CCF. Conservative treatment was attempted, but was not very effective. Because of progressing aphasia, TVE was performed via the SOV direct cut. There were no intraoperative or postoperative complications. It has been reported that cerebral angiography is generally contraindicated in vEDS and that the morbimortality associated with endovascular treatment is very high. When performing treatment it is necessary to be sufficiently aware of the risks it entails.

Decompressive hemicraniectomy for malignant hemispheric stroke in the elderly: comparison of outcomes between individuals 61-70 and >70 years of age.

BACKGROUND: Malignant hemispheric infarction is a life-threatening condition with a high mortality rate. Decompressive hemicraniectomy (DHC) is frequently a life-saving procedure that has shown the highest grade of evidence for patients 18 to 60 years of age. However, the efficacy of DHC in patients>60 years of age has rarely been investigated. METHODS: A retrospective study was conducted in a single academic institution. Surrogates of patients with clinical signs of impending brain herniation despite standard medical therapy were offered the option of DHC regardless of age or the side of the lesion. The clinical data from 18 patients>60 years of age who underwent DHC for malignant hemispheric infarction in our institution were analyzed. Patients were classified into the following 2 groups: 61-70 and >70 years of age, and their demographics and surgical outcomes were compared. The variables compared included the male:female ratio, side of the lesion, type of stroke, site of vascular occlusion, use of thrombolytic therapy, National Institutes of Health Stroke Scale score, stroke onset-to-DHC interval, duration of hospital stay, infectious complications, and 90-day mortality rate. RESULTS: There were no significant intergroup differences in any of the demographic variables evaluated. However, the 30-day mortality rate was significantly higher in the group that was >70 years of age (0% v 60%; P=.01) than in the group that was 61 to 70 years of age. CONCLUSIONS: We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients>70 years of age would benefit from DHC.

Highly efficient near-infrared-emitting lanthanide(III) complexes formed by heterogeneous self-assembly of Ag(I), Ln(III), and thiacalix[4]arene-p-tetrasulfonate in aqueous solution (Ln(III) = Nd(III), Yb(III)).

Heterogeneous self-assembly of thiacalix[4]arene-p-tetrasulfonate (TCAS), Ag(I), and Ln(III) (= Nd(III), Yb(III)) in aqueous solutions conveniently afforded ternary complexes emitting Ln(III)-centered luminescence in the near-infrared (NIR) region. A solution-state study revealed that the Ag(I)-Nd(III)-TCAS system gave a complex Ag(I)(4)·Nd(III)·TCAS(2) in a wide pH range of 6-12. In contrast, the Ag(I)-Yb(III)-TCAS system gave Ag(I)(2)·Yb(III)(2)·TCAS(2) at a pH of around 6 and Ag(I)(2)·Yb(III)·TCAS(2) at a pH of approximately 9.5. The structures of the Yb(III) complexes were proposed based on comparison with known Ag(I)-Tb(III)-TCAS complexes that show the same self-assembly behavior. In Ag(I)(2)·Yb(III)(2)·TCAS(2), two TCAS ligands sandwiched a cyclic array of a Ag(I)-Ag(I)-Yb(III)-Yb(III) core. In Ag(I)(2)·Yb(III)·TCAS(2), Yb(III) was accommodated in an O(8) cube consisting of eight phenolate O(-) groups from two TCAS ligands linked by two S-Ag-S linkages. Crystallographic analysis of Ag(I)(4)·Nd(III)·TCAS(2) revealed that the structure was similar to Ag(I)(2)·Yb(III)·TCAS(2) but that it had four instead of two S-Ag-S linkages. The number of water molecules coordinating to Ln(III) (q) estimated on the basis of the luminescent lifetimes was as follows: Ag(I)(4)·Nd(III)·TCAS(2), 0; Ag(I)(2)·Yb(III)(2)·TCAS(2), 2.4; and Ag(I)(2)·Yb(III)·TCAS(2), 0. These findings were compatible with the solution-state structures. The luminescent quantum yield (Φ) for Ag(I)(4)·Nd(III)·TCAS(2) was 4.9 × 10(-4), which is the second largest value ever reported in H(2)O. These findings suggest that the O(8) cube is an ideal environment to circumvent deactivation via O-H oscillation of coordinating water. The Φ values for Ag(I)(2)·Yb(III)(2)·TCAS(2) and Ag(I)(2)·Yb(III)·TCAS(2) were found to be 3.8 × 10(-4) and 3.3 × 10(-3), respectively, reflecting the q value. Overall, these results indicate that the ternary systems have the potential for a noncovalent strategy via self-assembly of the multidentate ligand, Ln(III), and an auxiliary metal ion to obtain a highly efficient NIR-emissive Ln(III) complex that usually relies on elaborate covalent linkage of a chromophore and multidentate ligands to expel coordinating water.

Therapeutic effect of paroxetine on stress-induced gastric lesions in mice.

Compared to the well-known anti-ulcerogenic properties of tricyclic antidepressants, the impact of selective serotonin reuptake inhibitors (SSRIs) on gastric mucosa is less clear. Human clinical trials have shown that SSRIs and non-steroidal anti-inflammatory drugs (NSAIDs) act synergistically and promote stomach ulcer formation and upper gastrointestinal tract bleeding. Acute SSRI treatment confers an additional risk for the formation of NSAID-induced gastric ulcers through increase in gastric acid secretion. Stress, which is often experienced by depressed patients, also deteriorates the gastric environment. Thus the potential for exacerbating stress-induced gastric lesions must be considered before prescribing SSRIs. Therefore, we evaluated the effects of paroxetine by using a water-immersion stress-induced stomach ulcer model of mice, by examining single vs. repeated paroxetine treatments for 8 and 22 days before stress induction. Repeated administration of paroxetine significantly decreased the area of stress-induced stomach lesions. Although stress significantly increased the serum corticosterone concentrations, the levels were not affected by the 8-day paroxetine treatment. We confirmed the anxiolytic and antidepressive effects of 8-day paroxetine treatment at 1 and 5 days after stress induction by using the elevated plus-maze and tail-suspension tests. We concluded that repeated paroxetine treatment significantly attenuates the stress-induced ulcerogenic process in the stomach.

Transvenous embolization in spontaneous direct carotid-cavernous fistula in childhood.

Carotid cavernous fistula (CCF) is an abnormal arteriovenous communication in the cavernous sinus. Direct CCF results from a tear in the intracavernous carotid artery. Typically, it has a high flow and usually presents with oculo-orbital venous congestive features such as exophthalmos, chemosis, and sometimes oculomotor or abducens cranial nerve palsy. Indirect CCF generally occurs spontaneously with subtle signs. We report a rare case of spontaneous direct CCF in childhood who did not have the usual history of craniofacial trauma or connective tissue disorder but presented with progressive chemosis and exophthalmos of the right eye. This report aims also to describe the safety and success of transvenous embolization with coils of the superior ophthalmic vein and cavernous sinus through the inferior petrosal sinus.