Personality and breast cancer risk and survival: the Miyagi cohort study.

It has long been hypothesized that personality is associated with breast cancer risk and survival. The present population-based prospective cohort study in Japan tested this hypothesis. To investigate the association of personality with breast cancer risk, a total of 15,107 women aged 40-64 years who completed the Eysenck Personality Questionnaire-Revised (EPQ-R) Short Form were followed from 1990 to 2007. To assess the association of personality with survival after breast cancer, 250 identified cases were further followed up from the date of diagnosis to 2008, and 45 all-cause deaths were documented. Study subjects were categorized into four groups based on the quartile points of scores ranging between 0 and 12 on each EPQ-R subscale (extraversion, neuroticism, psychoticism, and lie), and the hazard ratio (HR) for each category was computed using the lowest category as reference. Multivariate analysis revealed no association between any of the four personality subscales and the risk of breast cancer. In the analysis on survival, no significant association was found between any of these subscales and the risk of death, although breast cancer cases with a higher score of extraversion tended to have a lower risk of death (P for trend = 0.07; HR for highest score level = 0.38). Exclusion of 32 cases diagnosed in the first 3 years of follow-up did not largely change the results with regard to either breast cancer risk or survival. The present findings suggest that personality does not impact significantly on the development and progression of breast cancer.

Impacts of prenatal exposures to polychlorinated biphenyls, methylmercury, and lead on intellectual ability of 42-month-old children in Japan.

BACKGROUND: The age-specific impacts of perinatal exposures to polychlorinated biphenyls (PCB), methylmercury (MeHg), and lead on child neurodevelopment remain controversial. Since we have already reported the prenatal effects of these chemicals on neurodevelopment in 3-day-old and 30-month-old children of a birth cohort, the following effects were analyzed in the 42-month-old children in the same cohort. METHODS: The Kaufman Assessment Battery for Children (K-ABC), comprised of four scales, was used to assess their intelligence and achievement. The relationships between the chemicals and K-ABC scores were analyzed using multivariate analyses. RESULTS: The median values of chemicals in cord blood of 387 children were 46.5 (5th and 95th percentiles, 16.7-115.7)ng/g-lipid for total PCB, 10.1 (4.3-22.2)ng/g for total mercury (THg), and 1.0 (0.5-1.8) µg/dL for lead. Of the highly chlorinated PCB homologs, 9 CBs was negatively correlated with the sequential and mental processing score of the K-ABC (p<0.05). There were no significant correlations between any K-ABC score and either THg or lead. The negative effect of 9 CBs remained even after adjusting for THg, lead, and other confounders. The K-ABC scores were significantly lower in the boys than in the girls, and the standardized ß of 9 CBs for the sequential and mental processing scores in multiple regression analysis was statistically significant in boys. CONCLUSIONS: These findings suggest that intellectual ability in the developmental stage may be impaired by prenatal exposures to highly chlorinated PCB homologs, especially in Japanese boys.

"The eyes are the windows of the soul": Portable automated pupillometry to monitor autonomic nervous activity in CO2 narcosis: A case report.

RATIONALE: Altered autonomic responses can be observed in patients in the intensive care unit (ICU), and these changes in abnormal autonomic responses are known to be associated with patient prognosis. Therefore, it is important to monitor autonomic nervous system activity in these critically ill patients. While the utility of monitoring critically ill patients using heart rate (HR) variability measurements has been reported, portable automated pupillometers are small, lightweight, and easy-to-operate medical devices that may be more easily evaluated for autonomic nervous system function. PATIENT CONCERNS: An unconscious 80-year-old female patient with chronic obstructive pulmonary disease was brought to the medical emergency department after a call from her caregiver. DIAGNOSIS: On arrival, the patient's Glasgow coma scale score was 7, her blood pressure was 140/80 mm Hg, her HR was 114 bpm, and her respiratory rate was 27 breaths/minutes with increased breathing effort. Oxygen saturation was 90% on a venturi mask (3 L of supplemental oxygen). The arterial blood gas analysis showed a pH of 7.196, a partial pressure of carbon dioxide (CO2) of 89.6 mm Hg, a partial pressure of oxygen of 87.5 mm Hg, and a bicarbonate level of 29.4 mmol/L. Other than CO2 narcosis, there were no abnormal findings to induce impaired consciousness. The patient did not respond to support with a bag-valve mask and was intubated. One hour after intubation, her impaired consciousness improved. The patient was extubated 20 hours later and discharged on Day 3. INTERVENTIONS: The patient was admitted to the ICU after being intubated, where vital signs and blood gas analysis were monitored every 2 hours, and consciousness was assessed using the Glasgow coma scale. Using a portable automated pupillometer (NeurOptics NPi™-200, Neuroptics Inc., Irvine, CA), pupillary responses, including pupil size or light reflex, were measured every 2 hours during ICU stay. OUTCOMES: Changes in respiratory rate and partial pressure of CO2 values correlated with pupil size and constriction velocity, but HR changes were contrary. LESSONS: Pupillary responses exhibited by automated pupillometers observed in patients with CO2 narcosis may be linked to vital signs and allow for autonomic evaluation.

Relationship between brain volume reduction during the acute phase of sepsis and activities of daily living in elderly patients: A prospective cohort study.

Brain damage in acute sepsis may be associated with poor long-term outcomes that impair reintegration into society. We aimed to clarify whether brain volume reduction occurs during the acute phase of sepsis in patients with acute brain damage. In this prospective, noninterventional observational study, brain volume reduction was evaluated by comparing head computed tomography findings at admission with those obtained during hospitalization. We examined the association between brain volume reduction and performance of the activities of daily living in 85 consecutive patients (mean age, 77 ± 12.7 years) with sepsis or septic shock. The bicaudate ratio increased in 38/58 (65.5%) patients, Evans index increased in 35/58 (60.3%) patients, and brain volume by volumetry decreased in 46/58 (79.3%) patients from the first to the second measurement, with significant increases in the bicaudate ratio (P < 0.0001) and Evans index (P = 0.0005) and a significant decrease in the brain volume by volumetry (P < 0.0001). The change rate for brain volume by volumetry was significantly correlated with the Katz index (ρ = -0.3790, P = 0.0094). In the acute phase of sepsis in this sample of older patients, 60-79% of patients showed decreased brain volumes. This was associated with a decreased capacity for performing activities of daily living.

Prenatal exposures to environmental chemicals and birth order as risk factors for child behavior problems.

OBJECTIVES: To assess whether polychlorinated biphenyls (PCBs), methylmercury, lead, or parental child-rearing attitudes was most crucial for maladaptive behavior problems, we examined Japanese 30-month-old children followed up from pregnancy. METHODS: The Child Behavior Checklist (CBCL) was used to assess the behavior problems in 306 children. The associations of cord-blood total PCBs (ΣPCB), total mercury (THg), and lead with each CBCL subscale were examined by multivariate analyses. RESULTS: The median values in cord blood of the 306 children were 48.3 (5 and 95 percentiles, 18.6-116.3) ng/g-lipid for ΣPCB, 10.2 (4.1-24.5)ng/g for THg, and 1.0 (0.5-1.7)µg/dl for lead. The internalizing score of the CBCL was significantly correlated with ΣPCB (r=0.113) in the children, though no significant correlation was seen between any CBCL score and either THg or lead. The significant correlation disappeared when conducting multiple regression analysis with possible confounders; at that time, the birth order, home environment, and maternal intelligence quotient were significantly related to the internalizing score. Three CBCL scores and ΣPCB levels were significantly higher in the first-born children than in the second-born or following children, and the partial correlation coefficient with the adjustment for all confounders except birth order was significant between the internalizing score and ΣPCB in the latter children (r=0.175). CONCLUSIONS: Internalizing behavior appears to be affected by prenatal exposure to PCBs at low levels. Under lower-level exposures, however, behavior problems may be more strongly associated with parental child-rearing attitudes involved in birth order, than with such hazardous chemicals.

Association between white matter hyperintensity and lacunar infarction on MRI and subitem scores of the Japanese version of mini-mental state examination for testing cognitive decline: the Ohasama study.

We assessed whether subitem scores on the Mini-Mental State Examination (MMSE) associated independently with cerebral white matter hyperintensity (WMH) and lacunar infarction (LI). Magnetic resonance imaging (MRI) and neuropsychological evaluation (MMSE) were performed in 1008 elderly individuals from the Ohasama Study (348 men, 660 women [65.5%]; age 68.0 ± 6.0 [mean ± SD] years; MMSE score, 26.5 ± 2.9). The relationships between MRI findings and MMSE subitem scores were analyzed by logistic regression. Significant associations were observed between the MMSE subitems "Orientation to place" and WMH, and "Copy a figure" and LI. Pathological changes were detected by brain MRI associated with a decrease in cognitive function in healthy elderly individuals.

The Characteristics of Patients with Severe COVID-19 Pneumonia Treated with Direct Hemoperfusion Using Polymyxin B-Immobilized Fiber Column (PMX-DHP).

Purpose: The characteristics of patients with severe COVID-19 pneumonia who underwent direct hemoperfusion using polymyxin B-immobilized fiber column (PMX-DHP), in addition to steroids and immunomodulators, remain unclear. Patients and Methods: We conducted a retrospective observational study on 31 patients with severe COVID-19 pneumonia treated with PMX-DHP in an intensive care unit (ICU) from December 2020 to September 2021. Results: Outcomes 28 days after admission to the ICU were 20 in the survival group and 11 in the death group. Parameters significantly different between the survival and death group before PMX-DHP were percentage of invasive mechanical ventilation (25% vs 72.7%, P = 0.0209), PaO2/FIO2 (P/F) ratio (104.5 vs 75, P = 0.0317), and sequential organ failure assessment (SOFA) score (2 vs 3, P = 0.0356). Invasive mechanical ventilation avoidance rate was significantly different between the survival (100%) and death group (0%) (P = 0.0012). P/F ratio, respiratory ratio (RR), and lymphocyte counts improved significantly after PMX-DHP for all patients. The lymphocyte counts changed significantly in the survival (P < 0.0001), but not the death group (P = 0.7927). Conclusion: PMX-DHP, in addition to steroids and immunomodulators, may improve oxygenation and alleviate tachypnea by modulating the lymphocyte numbers and levels of various mediator against severe COVID-19 pneumonia. It may be better to perform PMX-DHP before multi organ dysfunction and lung injury has progressed. Furthermore, the early increase in lymphocyte counts after PMX-DHP might be an indicate a positive outcome.

Neurobehavioral effects of prenatal exposure to methylmercury and PCBs, and seafood intake: neonatal behavioral assessment scale results of Tohoku study of child development.

As factors affecting neonatal neurodevelopment, methylmercury, polychlorinated biphenyls (PCBs), and maternal seafood intake reflecting n-3 polyunsaturated fatty acids (PUFAs) are believed to have adverse or beneficial effects, but there are a few reports addressing such factors simultaneously. We carried out a birth cohort study to clarify the effects of these three factors on the Neonatal Behavioral Assessment Scale (NBAS), administered 3 days after birth. In a total of 498 mother-neonate pairs, the total mercury level (median, 1.96microg/g) in maternal hair at parturition and the summation operatorPCB level (45.5ng/g-lipid) in cord blood were analyzed, and maternal seafood intake was estimated using a semi-quantitative food frequency questionnaire. A negative relationship between the hair mercury level and the motor cluster of NBAS was observed, even after adjusting for PCBs, maternal seafood intake, and possible confounders such as maternal age, birth weight, and parity. The summation operatorPCB level was negatively correlated with the motor cluster, but this association was attenuated after adjusting for mercury and the confounders. There was seen to be a positive association between maternal seafood intake and the motor cluster when considering the effects of mercury and PCBs. In conclusion, our data suggest that prenatal exposure to methylmercury adversely affects neonatal neurobehavioral function; in contrast, maternal seafood intake appears to be beneficial. The neurobehavioral effect of prenatal exposure to PCBs remains unclear in our study. Further research is necessary to elucidate interactive effects of methylmercury, PCBs, and n-3 PUFAs, originating from fish, on child neurodevelopment.

[Construction of Maladaptive Behavior Scale in Japanese].

OBJECTIVES: To evaluate child development, social competence, like intellectual ability, is an important aspect. The social competence of a child is prescribed by behaviors suitable for the society (adaptive behaviors) and behaviors not suitable for the society (maladaptive behaviors). The Vineland Adaptive Behavior Scales (VABS) have been widely administered to children in a semi-structural interview to evaluate social competence. The Social Competence test (S-M test) widely used in Japan is a translated version of the Vineland Social Maturity Scale for adaptive behaviors. Since only the region of adaptive behaviors was translated into Japanese, we attempted to develop a Maladaptive Behavior Scale in Japanese based on the VABS to evaluate the social competence of children. METHODS: The Maladaptive Behavior Scale of the VABS was translated into Japanese and back-translated to ensure appropriate translation. It was administered to children belonging to the birth cohort of the Tohoku Study of Child Development at the age of 66 months. The subjects for analysis in this study were 451 children (230 boys, 221 girls). RESULTS: To assess internal consistency, we used the standardized Cronbach alpha coefficient and the result was 0.81. The correlation coefficient between the scores of the S-M test and those of the Maladaptive Behavior Scale was -0.15. The correlation coefficient between the scores of the Child Behavior Checklist at 30 months and those of the Maladaptive Behavior Scale was 0.44. CONCLUSION: These results suggest that the Maladaptive Behavior Scale may be a reliable instrument for assessing maladaptive behavior in Japanese children.

Is processing emotional signals necessary for performance on tasks requiring understanding a "theory of mind".

In this case study, HY had lived in a persistent vegetative state for 6 years after onset of encephalitis at age 10. His processing of emotionally and socially meaningful information was impaired by the age of 20, as it is in individuals with amygdala damage; however, his performance on tasks requiring understanding a "theory of mind" improved by age 22. A series of responses to photographs of facial expressions and to a gambling task were obtained to evaluate his functioning related to the amygdala. He was particularly impaired in recognizing fear. One may tentatively suggest that processing emotional signals, i.e., functioning related to the amygdala, may not play an important role in the neural systems supporting development of understanding a "theory of mind".

Recognition and its impairment regarding autobiographical memories in a patient with hippocampal amnesia.

Autobiographical memories of one case (Y.K.) were assessed before and after onset of hippocampal amnesia. He was a 56-yr.-old male patient who used to work in an office. The findings can be described as follows. First, Y.K.'s recognition performance regarding his premorbid and postmorbid personal semantics along with premorbid autobiographical incidents was significantly greater than chance, and recognition of premorbid autobiographical incidents was within chance. Given information before onset, a relationship was suspected between frontal lobe dysfunction and Y.K.'s autobiographical problem. The possibility that an amnesic patient could acquire semantic information after onset is discussed.

Introversion associated with large differences between screening blood pressure and home blood pressure measurement: The Ohasama study.

OBJECTIVE: To explore the effect of personality on screening blood pressures measured in clinical settings and home blood pressure measurements. METHODS: From 1997 to 1999, 699 participants underwent screening and home blood pressure measurements and completed the Japanese version of the short-form Eysenck personality questionnaire. An increased screening blood pressure was defined as screening blood pressure > or = 140/90 mmHg and an increased home blood pressure was defined as home blood pressure > or = 135/85 mmHg. RESULTS: Participants with lower extroversion scores (i.e., introversion) showed a greater difference between screening and home systolic blood pressure. The association between introversion and differences was statistically significant, even after adjustment for other possible factors (younger age, female, wide screening pulse pressure, never smoked, and no antihypertensive medication). The adjusted means of SBP differences were 7.3 and 4.4 mmHg among the lowest and highest extroversion quartiles, respectively (P for trend = 0.02). Other personality scores (psychoticism or neuroticism) were not associated with screening and home blood pressure differences. The incorporation of an extroversion score in the basic model consisting of the above factors that affected the difference between screening and home blood pressure slightly improved the prediction of a high home blood pressure. The area under the receiver operating characteristic curve increased by 0.037 among participants with high screening blood pressure and 0.006 for those with normal screening blood pressure compared with the basic model. CONCLUSION: Physicians may need to be aware of 'introverted' patients who have high blood pressure in clinic settings, because they have the potential for 'white-coat' hypertension.

Developmental order driving the relationship between executive functions and theory of mind: a case study.

Several studies have suggested there is a developmental link between executive functions and theory of mind. However, the developmental order driving the relationship is not well understood. The main reason is that the development of executive function parallels the development of theory of mind in normally developing children. In this paper, a case (H.Y.) is reported. H.Y. had lived in a persistent vegetative state for 6 years after encephalitis at the age of 10. He showed a developmental order driving the relationship between executive functions and theory of mind. These findings are consistent with recent suggestions that development of executive function might be important as a predecessor of either the ability to understand false beliefs or the ability to express that understanding.

A Japanese short form of the Swanson Cognitive Processing Test to measure working memory: reliability, validity, and differences in scores between primary school children of the United States and Japan.

The purpose of this study was to examine the reliability and validity of a Japanese short form of the Swanson Cognitive Processing Test, which assesses capacity of working memory. Test-retest reliability was acceptable (r = .76). Concurrent validity was suggested through comparison of scores on the Reading Span Task (r = .55). Means on the Japanese short form were comparable with means for the 3 subtests for the older group and 2 subtests for the younger group. With the exception of the Auditory Digit Sequence, results suggested that both the Japanese short form and the initial Swanson Cognitive Processing Test measured comparably the working memory in the two samples of children.

Association of maternal smoking during pregnancy and infant neurobehavioral status.

The association of maternal smoking during pregnancy with neurobehavioral status was examined in 344 Japanese infants. Based on a questionnaire, their mothers were classified into three groups, Nonsmokers, Exsmokers, and Smokers. The Neonatal Behavioral Assessment Scale was administered three days after birth. Among the three groups, on the seven clusters and their 28 behavioral subscales there were no significant differences. The infants of Smokers had lower scores than those of Exsmokers and Nonsmokers on two behavioral items, general tone and peak of excitement. General tone remained significant after adjustment for covariates.

Day-to-day variability in home blood pressure is associated with cognitive decline: the Ohasama study.

Although an association between high blood pressure and cognitive decline has been reported, no studies have investigated the association between home blood pressure and cognitive decline. Home blood pressure measurements can also provide day-to-day blood pressure variability calculated as the within-participant SD. The objectives of this prospective study were to clarify whether home blood pressure has a stronger predictive power for cognitive decline than conventional blood pressure and to compare the predictive power of the averaged home blood pressure with day-to-day home blood pressure variability for cognitive decline. Of 485 participants (mean age, 63 years) who did not have cognitive decline (defined as Mini-Mental State Examination score, <24) initially, 46 developed cognitive decline after a median follow-up of 7.8 years. Each 1-SD increase in the home systolic blood pressure value showed a significant association with cognitive decline (odds ratio, 1.48; P=0.03). However, conventional systolic blood pressure was not significantly associated with cognitive decline (odds ratio, 1.24; P=0.2). The day-to-day variability in systolic blood pressure was significantly associated with cognitive decline after including home systolic blood pressure in the same model (odds ratio, 1.51; P=0.02), whereas the odds ratio of home systolic blood pressure remained positive, but it was not significant. Home blood pressure measurements can be useful for predicting future cognitive decline because they can provide information not only on blood pressure values but also on day-to-day blood pressure variability.

[Normative study of the Boston naming test in 7-year-old Japanese children].

OBJECTIVES: The Boston Naming Test (BNT) has been used to assess the language development of children in many epidemiology studies, and its usefulness is confirmed. The BNT consists of 60 black and white line drawings of objects and animals. There are no normative data available for this test for Japanese children. The purpose of this study was to collect normative information in Japan and to examine the correlation between the score of the BNT and Intelligence Quotient (IQ) of the Wechsler Intelligence Scale for Children third edition (WISC-III). METHODS: The BNT was translated into Japanese and administered in children registered to the birth cohort of the Tohoku Study of Child Development at the age of 84 months. The participants for analysis in this study were 449 children (237 boys, 212 girls). RESULTS: There were four items with percentage scores below 1%; Igloo, Knocker, Muzzle, and Yoke. Many Japanese children could answer 'abacus' and 'compass', which are difficult for US children. Although the score of the BNT correlated with IQ of the WISC-III (p<0.001), as compared with the previous studies, the correlation coefficient was low. CONCLUSIONS: The BNT is quick and easy to use and valuable for researchers in evaluating language ability in children. Since the BNT was developed in the United States, the cultural values of that country are reflected in the BNT score. This implies that the BNT should be modified to fit Japanese population.

Self-face recognition in children with autism spectrum disorders: a near-infrared spectroscopy study.

It is assumed that children with autism spectrum disorders (ASD) have specificities for self-face recognition, which is known to be a basic cognitive ability for social development. In the present study, we investigated neurological substrates and potentially influential factors for self-face recognition of ASD patients using near-infrared spectroscopy (NIRS). The subjects were 11 healthy adult men, 13 normally developing boys, and 10 boys with ASD. Their hemodynamic activities in the frontal area and their scanning strategies (eye-movement) were examined during self-face recognition. Other factors such as ASD severities and self-consciousness were also evaluated by parents and patients, respectively. Oxygenated hemoglobin levels were higher in the regions corresponding to the right inferior frontal gyrus than in those corresponding to the left inferior frontal gyrus. In two groups of children these activities reflected ASD severities, such that the more serious ASD characteristics corresponded with lower activity levels. Moreover, higher levels of public self-consciousness intensified the activities, which were not influenced by the scanning strategies. These findings suggest that dysfunction in the right inferior frontal gyrus areas responsible for self-face recognition is one of the crucial neural substrates underlying ASD characteristics, which could potentially be used to evaluate psychological aspects such as public self-consciousness.

Scanning strategies do not modulate face identification: eye-tracking and near-infrared spectroscopy study.

BACKGROUND: During face identification in humans, facial information is sampled (seeing) and handled (processing) in ways that are influenced by the kind of facial image type, such as a self-image or an image of another face. However, the relationship between seeing and information processing is seldom considered. In this study, we aimed to reveal this relationship using simultaneous eye-tracking measurements and near-infrared spectroscopy (NIRS) in face identification tasks. METHODOLOGY/PRINCIPAL FINDINGS: 22 healthy adult subjects (8 males and 14 females) were shown facial morphing movies in which an initial facial image gradually changed into another facial image (that is, the subject's own face was changed to a familiar face). The fixation patterns on facial features were recorded, along with changes in oxyhemoglobin (oxyHb) levels in the frontal lobe, while the subjects identified several faces. In the self-face condition (self-face as the initial image), hemodynamic activity around the right inferior frontal gyrus (IFG) was significantly greater than in the familiar-face condition. On the other hand, the scanning strategy was similar in almost all conditions with more fixations on the eyes and nose than on other areas. Fixation time on the eye area did not correlate with changes in oxyHb levels, and none of the scanning strategy indices could estimate the hemodynamic changes. CONCLUSIONS/SIGNIFICANCE: We conclude that hemodynamic activity, i.e., the means of processing facial information, is not always modulated by the face-scanning strategy, i.e., the way of seeing, and that the right IFG plays important roles in both self-other facial discrimination and self-evaluation.

Personality and mortality from ischemic heart disease and stroke.

BACKGROUND: The role of personality in the causation of circulatory diseases has been controversial. METHODS: From June through August 1990, 41,442 residents of Miyagi Prefecture in northern Japan completed the Japanese version of the short-form Eysenck Personality Questionnaire-Revised and another questionnaire on various health habits. During 11 years of follow-up until March 31, 2001, we identified 90 deaths from ischemic heart disease (IHD) and 131 deaths from stroke. We used Cox regression to estimate the relative risk of IHD and stroke according to the three levels of four personality subscales (extraversion, neuroticism, psychoticism, and lie), with adjustment for sex, age, and other potentially confounding variables. RESULTS: Multivariate relative risks of IHD for the highest verses the lowest level of personality subscales were 0.7 for extraversion, 1.1 for neuroticism, 1.3 for psychoticism, and 0.8 for lie. Multivariate relative risks of stroke for the highest verses the lowest level of personality subscales were 1.0 for extraversion, 0.9 for neuroticism, 1.2 for psychoticism, and 1.2 for lie. CONCLUSIONS: This prospective study does not support the hypothesis that personality is a risk factor for mortality from IHD and stroke.