Relevance of the processed blood volume per granulocyte and monocyte apheresis session to its clinical efficacy in patients with ulcerative colitis

Granulocyte/monocyte adsorption (GMA) has been introduced as an adjunct intervention for active ulcerative colitis (UC) patients. The processed blood volume (PV) per GMA session is an important factor for its efficacy because depletion of elevated/activated myeloid leukocytes is its main action. Hitherto, this aspect of GMA has been largely ignored. Thirty-three patients were enrolled for remission induction therapy with five weekly GMA sessions at a standard PV of 1800 mL, regardless of patients' bodyweight (BW). The patients were divided into three groups: high (H)BW (≥ 65 kg, n = 11), 50 kg ≤ medium (M)BW < 65 kg (n = 12), and low (L)BW (≤ 50 kg, n = 10). UC clinical activity index (CAI) was according to Lichtiger, and the clinical efficacies were evaluated at both one week post 3(rd) GMA (Week 4) and one week post 5(th) GMA (Week 6). The average BW was 70.9 ± 6.2 kg in HBW, 55.8 ± 4.5 kg in MBW, and 46.8 ± 1.2 kg in LBW, indicating the mean PV/BW in the three groups being 25.6 ± 2.12, 32.5 ± 2.50, and 38.7 ± 1.0 (mL/kg, P < 0.05), respectively. The LBW group consisted of female patients only. Significant improvements of CAI were seen before treatment at either Week 4 or Week 6 in all groups. A significantly higher remission rate was achieved in the LBW (80.0%) vs. MBW (33.3%) or HBW (27.3%) at Week 6 (P < 0.03). According to this GMA evaluation, the lower-limit of optimum PV/kg should be higher than 38.7 mL/kg for its potential clinical efficacy to be significantly greater than the routine GMA method. Additional BW-oriented GMA studies in larger and gender controlled cohorts of patients should strengthen our findings.     

Depressive Symptoms and Past Lifestyle Among Japanese Elderly People

In order to develop an effective preventive intervention for depression, this cross-sectional study aimed to analyze the relationship between past lifestyle, social activity, and depressive symptoms among community-dwelling elderly people in Japan (n = 887). The Geriatric Depression Scale was used for assessing depressive symptoms. The lifestyle of middle-aged people was assessed using a recall report. The prevalence of depressive symptoms among the subjects was 12.9%. Logistic regression analyses showed that physical exercise, daily intake of well-balanced meals and milk products, and the presence of hobbies were related to the absence of depressive symptoms among both men and women. Among men, avoidance of excess salt and fat was related to the absence of depressive symptoms, while among women, moderate alcohol consumption and good relationships with neighbors were related. Physical exercise, dietary education, and promotion of social activities among middle-aged people were recommended for prevention of depressive symptoms.     

Children with attention deficit/hyperactivity disorder and pervasive developmental disorder:attention and response inhibition in the kiddie continuous performance test

Continuous Performance Test (CPT) is widely used to assess the attention function and response inhibition in both children and adults. This study attempts to examine the performances of boys with attention deficit/hyperactivity disorder (AD/HD) and pervasive developmental disorder (PDD) with and without comorbid AD/HD using a CPT. Among the various versions of the CPT available, we used the Kiddie CPT (K-CPT) modified for younger children. The K-CPT was administered to children with AD/HD (n=22), those with PDD (n=19), and typically developing children (n=41) from 7 to 12 years of age. All children were drug free at the time of examination. The performances were examined in 6 measures:total number of omission errors (OE), total number of commission errors (CE), mean hit reaction time (HRT), hit reaction time standard error (HRTSE), perceptual sensitivity (d'), and response style (beta). Significantly lower scores in d' and a tendency to more errors in CE were found in the AD/HD group compared with the control group. Significantly lower scores in d' and significantly more errors in CE were also found in the PDD group with AD/HD symptoms compared with the control group. Moreover the AD/HD group showed significantly more errors in OE and higher scores in HRTSE compared with the control group. There were no significant group differences between the PDD group without AD/HD symptoms and the control group on all measures. Less favorable scores in AD/HD suggest inadequate selective attention, sustained attention and/or response inhibition. Results of the PDD group with comorbid AD/HD may reflect a basis of AD/HD impairment. Our findings may provide an understanding of neuropsychological characteristics underlying developmental disorders.     

Activation syndrome in the Japanese court

Since the February 2004 FDA advisory's warning of activation syndrome involving antidepressants, growing concerns have emerged over aggression and violence reported in subjects prescribed these drugs. However, activation syndrome remains poorly defined, and controversy regarding the nature of this syndrome continues in the field of psychiatry. Here, we present four medico-legal cases involving activation syndrome, in which one of us served as an expert witness. Analysis of the court's decisions indicated that the court appeared to focus on whether the acts were associated with the subjects' personality or not, leaving the controversy over activation syndrome as an open question. These cases highlighted the need for joint examination by jurists and psychiatrists, since society is likely to continue to be faced with cases of behavioral problems associated with the use of antidepressants.     

Case in which renal function improved following stent-graft placement in the aorta two months after the onset of stanford type B acute aortic dissection

A 48-year-old man was admitted to the Department of Cardiovascular Surgery in our hospital after developing Stanford type B acute aortic dissection with a patent false lumen in July 2008. Conservative treatment involving rest and antihypertensive therapy was provided following admission. Urine volume decreased from day 9, and serum creatinine increased to 7.7 mg/dL. As it was suspected that the reduced renal blood flow was caused by progression of aortic dissection, contrast-enhanced computed tomography (CT)was performed. The left kidney showed reduced enhancement and the right kidney was heterogeneously enhanced. The dissection had extended to the left renal artery, and the reduced renal blood flow caused by narrowing of the left renal artery was thought to have caused the renal dysfunction. As elevated urea nitrogen and serum creatinine levels and hyperkalemia persisted, hemodialysis was performed a total of four times. Although the patient was subsequently withdrawn from dialysis, he continued to display severe renal dysfunction and was transferred to our department on day 28 for the treatment of renal failure. Conservative treatment was continued, but the maximum diameter of the thoracic aorta gradually increased, and stent placement at the entry of aortic dissection was indicated. On day 86, two stent-grafts were placed for entries at the distal site of the descending aorta and the distal site of the aortic arch. Postoperative abdominal contrast-enhanced CT showed expansion of the true lumen, and blood flow and contrast enhancement improved in both kidneys. Postoperatively, serum creatinine gradually decreased, improving to 1.16 mg/dL on day 96. Renography in the third month after stent-graft placement showed improved renal function in both kidneys. These findings suggest that even at approximately 2 months after the onset of acute renal failure associated with aortic dissection, renal function can be improved by restoring blood flow in the renal arteries.     

Four-Year Hospital Resource Utilization After Bariatric Surgery: Comparison with Clinical and Surgical Controls

Background  

Consumption of healthcare has been shown to diminish after bariatric treatment, but utilization of hospital services has not been well documented. Aiming to assess this question, a retrospective study with females was designed.     

The effects of topiroxostat on vascular function in patients with hyperuricemia

Xanthine oxidoreductase (XOR) inhibitors, such as allopurinol and febuxostat, inhibit the catalysis of serum uric acid (SUA) synthesis. In doing so, they are thought to improve vascular endothelial function in patients with hyperuricemia and cardiovascular risk by reducing increases in SUA and reactive oxygen species levels. We performed a retrospective cohort study to evaluate the effects of topiroxostat, a novel XOR inhibitor, on vascular function measured by flow‐mediated dilation (FMD) on ultrasonography. In total, 23 patients with hyperuricemia were enrolled. After approximately 8 weeks, topiroxostat was associated with a significant increase in the peak percentage change in diameter (∆FMD) from 4.53% ± 2.09% to 5.54% ± 3.08% (P = .045). It also significantly reduced the SUA levels from 7.31 ± 1.43 to 5.44 ± 1.11 mg/dL (P < .001). Although further studies are needed to validate these results, it appears that topiroxostat improves vascular endothelial function in patients with hyperuricemia.