Prediction of ischaemic and haemorrhagic stroke by self-measured blood pressure at home: the Ohasama study

OBJECTIVE: To examine the predictive value of self-measured blood pressure values taken at home (home blood pressure) for risk of stroke and subtypes. METHODS: We obtained home blood pressure measurements from 1702 people, aged > or =40 years, without a history of stroke, in the general population in Japan, and continued follow-up after a mean period of 10.6 years. The prognostic significance of blood pressure for stroke risk was examined using the Cox proportional hazards regression model, which was adjusted for possible confounding factors. RESULTS: There was a linear relationship between home blood pressure and risk of stroke and subtypes. On average, each 10/5 mmHg elevation in home systolic/diastolic blood pressure respectively, was associated with an approximately 30/20% respectively, higher risk of total stroke. A similar relationship was observed for the risk of haemorrhagic stroke (intracerebral and subarachnoid haemorrhage), and the risk of ischaemic stroke [cerebral infarction and transient ischaemic attack (TIA)]. The risk of stroke and subtypes showed a significantly greater relation with home blood pressure values compared to conventional blood pressure values. CONCLUSIONS: This is the first study to demonstrate that home blood pressure is an independent predictor for haemorrhagic and ischaemic stroke, in the general population.     

Metal contents of liver parenchyma after percutaneous ethanol injection or radiofrequency ablation in patients with hepatocellular carcinoma before and after trientine hydrochloride therapy

We administered trientine hydrochloride, a drug used in the treatment of Wilson's disease, to patients with hepatocellular carcinoma after radical treatment with percutaneous ethanol injection or radiofrequency ablation, and examined its effect on the reduction of liver-tissue copper content. We enrolled 24 patients with 3 or fewer primary lesions of Child class A or B hepatocellular carcinoma with diameters of 3 cm or less who had undergone radical treatment with percutaneous ethanol injection or radiofrequency ablation. Trientine hydrochloride was orally administered in a single daily dose of 250 mg to 12 patients before a meal (at fasting, group 1) or at a total daily dosage of 750 mg, divided into 3 doses, to 12 patients (group 2). This study was a randomized between-groups comparative study of 12 weeks' duration. We used the particle-induced x-ray-emission method to determine liver-tissue mineral content. Urine copper and serum mineral levels were also measured, and transaminase levels were examined. Liver-tissue copper content decreased significantly, to 160.1 microg/g dry weight, after treatment, compared with the pretreatment level of 306.8 microg/g dry weight (P <.05). We detected no significant difference in iron or zinc content before and after treatment. The copper content was significantly reduced after treatment in both groups (P <.05). The urine copper level was significantly increased after 1 week of treatment but decreased thereafter. Serum copper levels were significantly reduced after treatment (P <.01). We detected no significant difference in transaminase level before and after treatment. Iron-deficiency anemia in 1 patient after 12 weeks' treatment was the only adverse reaction, and it was improved by the administration of an iron product. We noted no other overt adverse reactions. In patients with hepatocellular carcinoma, trientine hydrochloride therapy may significantly reduce copper content in liver tissue.     

Serum adiponectin concentrations in newborn infants in early postnatal life

Serum adiponectin levels were investigated in 28 small-for-gestational-age (SGA) and 34 appropriate-for-gestational-age (AGA) term neonates to examine how fetal growth correlates with adiponectin levels. A blood sample for determination of adiponectin was obtained during the first 24 h of life. The levels of serum adiponectin were significantly higher in all newborn infants than in healthy children (28.7 +/- 17.0 versus 9.3 +/- 6.1 microg/mL; p < 0.01). There was a significant difference in adiponectin levels between SGA and AGA infants (23.2 +/- 14.8 versus 33.2 +/- 17.5 microg/mL; p=0.02). For all of the newborn groups, serum adiponectin levels correlated positively with birth weight (r=0.27, p <0.05) and head circumference (r=0.30, p <0.05). There was no relationship between serum adiponectin levels and gestational age, birth length, blood glucose levels, or blood sampling time after birth. There was no gender difference in adiponectin levels in the entire newborn group (30.0 +/- 19.7 versus 28.0 +/- 15.5 microg/mL, in male and female infants). Our results suggest that hyperadiponectinemia and a positive relationship between the serum levels of adiponectin and birth weight in newborns cannot be explained by the low percentage of body fat alone. Lower adiponectin levels in SGA infants than in AGA infants are unlikely to suggest insulin resistance in intrauterine growth-retarded infants in early postnatal life but may be a predisposing factor in the future development of insulin resistance or type 2 diabetes.     

Rapid induction of Arc is observed in the granule cell dendrites in the accessory olfactory bulb after mating

The activity-regulated cytoskeleton-associated protein (Arc), encoded by the immediate early gene arc, is enriched in the brain and is hypothesized to play a role in the activity-dependent neuronal plasticity in the hippocampus. In the present study, the time course of Arc expression during the post-mating period was determined immunocytochemically, and the localization of Arc in the neurons in the accessory olfactory bulb (AOB) of female mice after mating was analyzed using immunocytochemical electron microscopy. Transient increases in the number of Arc-immunoreactive cells were observed in the glomerular, mitral/tufted cell and granule cell layers of the AOB after mating. In particular, the increase in the granule cell layer was remarkable, and larger than the increases in the other layers. In addition, electron microscopic observation revealed that Arc immunoreactivity was in the dendrites of the granule cells 1.5 h after mating. These results indicate that expression of Arc protein is induced rapidly and transiently in granule cell dendrites after mating. It is postulated that Arc protein has a role in the neuronal plasticity of the AOB after mating.     

The medicine of nurturing life energy--health creation and self-organization]

It is reality that human's body and mind are being created by life energy through every moment of life. As modern medicine does not consider this life energy itself, the most modern people hardly does not think it's intuitive meaning and use it to actualize their health and happiness in life. They can consider the outcome of life phenomena in the fields of physical, psychological, sociological and ethical sides, but they can not ask what life energy is, and subsequently can not use it in their life. Therefore, they live to make effort to actualize how to change life style considering of medical scientific facts (Evidence-Based-Medical Health Care). The intuitive life's action which can contact with the outer worlds, has the dynamic relationship with them and it creates new body and mind continuously. Modern medicine has not researched this dynamic life energy itself. What has life energy, single gene, single cell, single organ such as the brain and heart and single human beings, have been maintained their life by using their common and universal two life energies which are called self-organization, self-creativity and communicative ability. These two life energies of them were communicating with themselves or each others and their environments, and recreating their form and function continuously every moment of lives. It was conceptualized "Body-Mind-Spirit (Life-energy)-Life Dynamics". All of life phenomena which are not only diseases but also health, come from the results of "Body-Mind-Spirit-Life Dynamics". When we communicate with the outer worlds in "Real Self", human beings will keep the highest state of "Body-Mind-Spirit-Life Dynamics". We clarified that human beings can actualize the healthy and happy lives by themselves from understanding this idea, it also means for them to be able to create healthy personality through their lives and we clarified new assessment way of life energy simultaneously.     

A case of salvage combination chemotherapy of gemcitabine plus nedaplatin for squamous cell carcinoma of the ureter

A 46-year-old man complained of lower abdominal pain, and his abdominal and pelvic computed tomographic scan revealed left hydronephrosis and a huge tumor (9 X 9 cm) in the left distal ureter involving the left iliac vessel that was considered unresectable. Histological diagnosis showed squamous cell carcinoma, and histoculture drug response assay (HDRA) suggested the effectiveness of gemcitabine and nedaplatin. A cycle of adjuvant chemotherapy consisting of MEC (methotrexate 30 mg/ m2: day 1 and 15, epirubicin 50 mg/m2: day 1, and cisplatin 50 mg/m2: day 2 and 3) was performed as a first line chemotherapy, but the size of the ureteral tumor did not change. He was treated with 3 cycles of systematic combination chemotherapy consisting of gemcitabine (1,000 mg/m2: day 1 and 8) and nedaplatin (80 mg/m2: day 1). After 2 courses of chemotherapy, the tumor size was reduced by 50% (PR; RECIST guidelines) and the tumor markers (SCC, CYFRA, NSE, CEA, and CA19-9) dropped to within the normal range. There were no serious adverse events except for grade 3 neutropenia which spontaneously recovered. However, because the tumor size was not reduced after the third cycle of chemotherapy, we applied external beam radiation to the primary lesion and the metastatic retroperitoneal lymph node site. No evidence of residual tumor progression has been found for 6 months after radiation therapy. We concluded that GN chemotherapy may be useful for patients with squamous cell carcinoma of the ureter.     

Intra-operative monitoring of vagal nerve activity with wire electrodes

A monitoring system for tracking the electromyogram (EMG) of the vocal cords with wire electrodes embedded in an endotracheal tube was designed to identify the recurrent laryngeal nerve during thyroidectomy. Our recent experience in two cases suggests that vagal nerve activity can be correctly detected by recording of the EMG of the vocal cords using a special endotracheal tube embedded with wire electrodes.     

Randomized phase II study of carboplatin/gemcitabine versus vinorelbine/gemcitabine in patients with advanced nonsmall cell lung cancer: West Japan Thoracic Oncology Group (WJTOG) 0104

BACKGROUND: Combined gemcitabine and carboplatin (GC) and combined gemcitabine and vinorelbine (GV) are active and well tolerated chemotherapeutic regimens for patients with advanced nonsmall cell lung cancer (NSCLC). The authors conducted a randomized Phase II study of GC versus GV to compare them in terms of efficacy and toxicity. METHODS: One hundred twenty-eight patients with Stage IIIB or IV NSCLC were randomized to receive either carboplatin at an area under the curve of 5 on Day 1 combined with gemcitabine 1000 mg/m2 on Days 1 and 8 (n = 64 patients) or vinorelbine 25 mg/m2 combined with gemcitabine 1000 mg/m2 on Days 1 and 8 (n = 64 patients) every 3 weeks. RESULTS: Response rates were 20.3% for the GC patients and 21.0% for the GV patients. In the GC arm, the median survival was 432 days, and the a 1-year survival rate was 57.6%; in the GV arm, the median survival was 385 days, and the 1-year survival rate was 53.3% in the GV arm. The median progression-free survival was 165 days in the GC arm and 137 days in the GV arm. Severe hematologic toxicity (Grade 4) was significantly more frequent in the GC arm (45.3% vs. 25.8% in the GV arm; P = .022). Most notably, the incidence of Grade 3 or 4 thrombocytopenia was significantly higher in the GC arm (81.3% vs. 6.5% in the GV arm; P < .001). Conversely, severe nonhematologic toxicity (Grade 3 or 4) was more common in the GV arm (7.8% vs. 19.4% in the GC arm; P = .057). CONCLUSIONS: Although the GV and GC regimens had different toxicity profiles, there was no significant difference in survival among patients with NSCLC in the current study.     

Construction of scales to measure thematic tendencies of paranoid ideation

In order to measure thematic tendencies of paranoid ideation in non-clinical samples, Delusional Ideation Checklist (DICL) was developed. A wide range of items indicating themes of delusion were collected. From the results of factor analysis on the data of 308 college students, eight scales were constructed. They were: alienation, belittlement, persecution, other-harming, guardedness, self-conceit, favoredness, and other-manipulation. These scales could be classified in terms of emotion: positive versus negative, and direction: self versus others, and could deal with themes of paranoid ideation in a comprehensive and systematic way. Alpha coefficients of the scales were between .66 and .87, and test-retest reliability between .49 and .71. To examine content validity, ten psychiatrists were asked to rate diagnostic importance for each scale item. Six scales were rated as significantly more important in the diagnosis of paranoid schizophrenia than that of anxiety neurosis. Current data revealed that ordinary students experienced delusional ideation more frequently than psychiatrists would expect.