Nocturnal blood pressure decrease is associated with increased regional cerebral blood flow in patients with a history of ischemic stroke

BACKGROUND: It remains controversial whether there is a J-shaped relationship between blood pressure and recurrent stroke among patients with a recent history of ischemic stroke. OBJECTIVE: To investigate the relationship between regional cerebral blood flow (rCBF) and the dipping of nocturnal blood pressure in patients receiving antihypertensive treatment after ischemic stroke. METHODS AND RESULTS: Forty-seven patients with a previous history of ischemic stroke and 37 patients with a history of non-ischemic stroke underwent 24-h ambulatory blood pressure monitoring and rCBF measurement with single photon emission computed tomography. Of the 47 patients with ischemic stroke, 30 were diagnosed as having suffered atheromatous or embolic stroke, and 37 had an ischemic lesion in the territory of the carotid artery. Systolic and diastolic blood pressures during daytime and night-time were controlled at less than 140/90 mmHg by a low-salt diet or long-acting antihypertensive agents, or both. In patients with ischemic stroke, there were significant negative correlations between the percentage change in nocturnal blood pressure and rCBFs in the thalamus (r = -0.33, P = 0.02), putamen (r = -0.34, P = 0.02) and cerebral cortex (r = -0.31, P = 0.03). Multivariate analysis revealed that only the percentage change in nocturnal blood pressure was related to rCBF. There was a significant positive correlation between rCBFs in the thalamus and the cerebral cortex (r = 0.74, P < 0.05). In patients with non-ischemic stroke, there was no significant correlation between the percentage change in nocturnal blood pressure and rCBFs. CONCLUSIONS: These findings indicate that the decrease in nocturnal blood pressure is associated with the increase in rCBF in patients with a history of ischemic stroke in the territory of the carotid artery.     

Torticollis secondary to posterior fossa and cervical spinal cord tumors: report of five cases and literature review

Torticollis is either congenital or acquired in childhood. Acquired torticollis is not a diagnosis but rather a sign of an underlying disorder. The causes of acquired torticollis include ligamentous, muscular, osseous, ocular, psychiatric, and neurologic disorders and may be a symptom of significant abnormalities of the spinal cord and brain, such as spinal syrinx or central nervous system neoplasia. Torticollis is rarely considered to be an initial clinical presentation of posterior fossa and cervical spinal cord tumors. We report five cases of pediatric tumors with torticollis at the onset: an astrocytoma originating from the medulla oblongata, another presumptive astrocytoma of the spinal cord located between C1 and C6 cervical vertebrae (not operated), an ependymoma located throughout the whole cervical spinal cord extending into the bulbomedullary junction, an astrocytoma originating from the bulbus and extending into the posterior fossa, and another case of a eosinophilic granuloma located extradurally through the anterior and posterior portions of the vertebral bodies from C3 to C7 producing the collapse of the sixth cervical vertebra. All five cases were seen in children, aged between 3 and 12 years. All these cases reflect the misinterpretation of this neurological sign and the lack of association with the possibility of spinal or posterior fossa tumor. This delay in the diagnosis of these diseases led to progressive neurological deterioration and to the increase in the tumor size, which made surgical intervention difficult and the prognosis unfavorable. Although torticollis secondary to tumors is rarely seen, it is necessary to be kept in mind in the differential diagnosis.     

The association between renal tubular damage and rapid renal deterioration in the Japanese population: the Takahata study

Background

Injury to renal tubules plays an important role in the development of various renal diseases; however, the prevalence and significance of renal tubular damage in the general population are unclear. To clarify this point, we conducted a community-based study, using urinary ??₂-microglobulin as a marker of tubular damage.

Methods

The subjects studied were 3,444 Japanese over the age of 40?years. The urinary ??₂-microglobulin?Ccreatinine ratio (UBCR) was assessed in morning spot urine samples.

Results

In this population, the distribution of the UBCR among these subjects was skewed towards higher values and a high UBCR (??300???g/g) was identified in 438 (12.7%) subjects. However, overlap with macroalbuminuria and renal insufficiency [estimated glomerular filtration rate (eGFR) <60?mL/min/1.73?m²] was observed in only 25 (5.7%) and 58 (13.2%) of these subjects, respectively. Multivariate analysis indicated that a high UBCR was positively associated with aging, hypertension, macroalbuminuria and increased urinary sodium excretion. A 5-year longitudinal analysis in 899 subjects indicated a greater decline in eGFR in parallel with the increase in baseline UBCR. After adjustment for possible confounders, a high UBCR was an independent risk factor for rapid decline in eGFR [2; odds ratio 1.79 (95% confidence interval 1.07?C2.99), P?=?0.026].

Conclusion

This study showed that renal tubular damage was common and was an independent risk factor for renal deterioration in the Japanese population. More attention should be paid to occult renal tubular damage in order to prevent end-stage renal disease.     

Association of high pulse pressure with proteinuria in subjects with diabetes, prediabetes, or normal glucose tolerance in a large Japanese general population sample

OBJECTIVE

To examine whether there is a difference in the association between high pulse pressure and proteinuria, independent of other blood pressure (BP) indices, such as systolic or diastolic BP, among subjects with diabetes, prediabetes, or normal glucose tolerance.

RESEARCH DESIGN AND METHODS

Using a nationwide health checkup database of 228,778 Japanese aged ≥20 years (mean 63.2 years; 39.3% men; none had pre-existing cardiovascular disease), we examined the association between high pulse pressure, defined as the highest quintile of pulse pressure (≥63 mmHg, n = 40,511), and proteinuria (≥1+ on dipstick, n = 12,090) separately in subjects with diabetes (n = 27,913), prediabetes (n = 100,214), and normal glucose tolerance (n = 100,651).

RESULTS

The prevalence of proteinuria was different among subjects with diabetes, prediabetes, and normal glucose tolerance (11.3 vs. 5.0 vs. 3.9%, respectively; P < 0.001). In subjects with diabetes, but not those with prediabetes or normal glucose tolerance, high pulse pressure was associated with proteinuria independently of significant covariates, including systolic BP (odds ratio 1.15 [95% CI 1.04–1.28]) or diastolic or mean BP (all P < 0.01). In patients with diabetes, a +1 SD increase of pulse pressure (+13 mmHg) was associated with proteinuria, even after adjustment for systolic BP (1.07 [1.00–1.13]) or diastolic or mean BP (all P < 0.05).

CONCLUSIONS

Among the Japanese general population, there was a significant difference in the association between high pulse pressure and proteinuria among subjects with diabetes, prediabetes, and normal glucose tolerance. Only in diabetes was high pulse pressure associated with proteinuria independent of systolic, diastolic, or mean BP levels.In the systemic circulation, the kidney has unique features: vascular resistance in the glomerular afferent arterioles is low, and the myogenic response of the glomerular arterioles is insensitive to changes in the other BP indices of systolic blood pressure (BP), including pulse pressure (1–3). These characteristics suggest that pressure pulsatility may contribute to barotrauma-induced renal microvascular injury, and in turn causes glomerular ultrastructural changes (e.g., podocyte loss and glomerular basement membrane thickness) (1–6).In fact, several cross-sectional studies performed in general or hypertensive populations have demonstrated a significant association between pulse pressure and albuminuria (7,8), and some longitudinal studies have underscored the importance of pulse pressure as a risk factor for increased albuminuria in general or hypertensive populations (9,10); however, few studies have directly examined the impact of high pulse pressure on albuminuria with adjustment for other BP components, such as systolic BP, diastolic BP, and/or mean BP levels. Since renal autoregulation is particularly impaired in patients with diabetes (1–3,11–13), we hypothesized that the association between high pulse pressure and albuminuria would be more prominent in patients with diabetes than in subjects without diabetes (14–16); as of yet, however, there have been no studies examining this hypothesis directly in a large database. Furthermore, the association of pulse pressure with albuminuria has never been explored in prediabetics, who are classified as being at an intermediate stage between normal glucose tolerance and diabetes (17), but prediabetics have been shown to have a significantly increased risk of developing not only diabetes but also cardiovascular disease (18).In the current study, therefore, we examined the association of high pulse pressure with proteinuria separately in each of subjects with diabetes, prediabetes, and normal glucose tolerance, using a large nationwide database of subjects recruited from the national health checkup system in Japan.     

The relationship between serum uric acid and spirometric values in participants in a health check: the Takahata study

Background: Tissue hypoxia induces the degradation of adenosine triphosphate, resulting in the production of uric acid (UA). Patients with chronic obstructive pulmonary disease (COPD) have been reported to have high serum levels of UA (sUA), compared with control subjects. However, the relationship between sUA levels and spirometric measures has not been investigated in detail in a general population.Methods: Subjects aged 40 years or older (n = 2,917), who had participated in a community-based annual health check in Takahata, Japan, in 2004 and 2005, were enrolled in the study. These subjects performed spirometry, their blood pressure was measured, and a blood sample was taken.Results: sUA levels were significantly higher in males than in females. Percent predicted forced vital capacity [FVC %predicted] (r = -0.13) and forced expiratory volume in 1 s [FEV₁ %predicted] (r = -0.118) were inversely correlated with sUA levels in females but not in males. Univariate regression analysis indicated that age, body mass index (BMI), ethanol intake, mean blood pressure (BP), and serum creatinine (sCr) were significantly associated with sUA levels in males. In females, age, BMI, mean BP, hemoglobin A1c, sCr, FVC %predicted, and FEV₁ %predicted were significantly associated with sUA levels. Multiple linear regression analysis showed that for both genders, FVC %predicted and FEV₁ %predicted were predictive for sUA levels, independently of the other clinical parameters. Subjects with lung restriction had higher sUA levels than subjects without lung restriction. In addition, subjects with moderate and severe airflow limitation had higher sUA levels than subjects without airflow limitation or those with mild airflow limitation.Conclusion: FVC %predicted and FEV₁ %predicted were significantly associated with sUA levels in a general population.     

The Effect of CKD on Associations between Lifestyle Factors and All-cause,Cancer, and Cardiovascular Mortality: A Population-based Cohort Study

Objective Results from previous studies on the dose-dependent effect of adhering to multiple lifestyle factors on all-cause mortality in patients with chronic kidney disease (CKD) are inconsistent, despite the reported dose-dependent effect in the general population. This study aimed to examine whether CKD modifies the dose-dependent effect of adhering to multiple lifestyle factors on mortality. Methods This population-based prospective cohort study targeted 262,011 men and women aged 40-74 years at baseline. Of these, 18.5% had CKD, which was defined as GFR <60 mL/min/1.73 m², ≥1+ proteinuria on urinalysis, or both. The following lifestyle behaviors were considered healthy: no smoking, body mass index <25 kg/m², moderate or lower alcohol consumption, regular exercise, and healthy eating habits. Healthy lifestyle scores were calculated by adding the total number of lifestyle factors for which each participant was at low risk. Cox proportional hazards models were used to examine associations between healthy lifestyle scores and all-cause, cancer, and cardiovascular mortality, and whether CKD modified these associations. Results During a median follow-up of 4.7 years, 3,471 participants died. The risks of all-cause and cancer mortality decreased as the number of five healthy lifestyle factors that were adhered to increased, irrespective of the CKD status. The risk of cardiovascular mortality, however, was modified by CKD (interaction p=0.07), and an unhealthy lifestyle and CKD synergistically increased cardiovascular mortality. Conclusion A healthy lifestyle can reduce the risk of all-cause and cancer death in patients with or without CKD, while the prevention of CKD is essential for reducing the risk of cardiovascular death.     

Infantile perineal protrusion: a statistical, clinical, and histopathologic study

BACKGROUND: Review of the literature of the peculiar nodule in the perineum of female infants disclosed that the analysis of incidence by gender, observation of the course, histopathologic assessment, and the pathogenesis of the abnormality was suboptimal. OBJECTIVE: We therefore planned to study a large number of children to analyze the incidence by gender, the course, and the pathogenesis of the peculiar perineal nodules. METHODS: Of 500 children (224 boys and 276 girls) who ranged from newborn to 11 years of age, occurrence of the perineal nodules was checked. When nodules were found, the site, shape, size, number, and the onset were examined. Histopathologic examination and observation of the course were carried out in some cases. RESULTS: None of the boys in our population had nodules, but 13% of the girls did. These lesions always occurred as a single peanut-, hen's crest-, or tongue tip-shaped nodule on the perineal midline, and 93% of the lesions had been present since birth. Histologically, the nodule was an outward projection of essentially normal, redundant skin, showing no evidence of lichen sclerosus et atrophicus. CONCLUSION: In view of these findings, we conclude that perineal nodules are a kind of developmental anomaly occurring mostly in girls.     

The distribution of eGFR by age in a community-based healthy population: the Japan specific health checkups study (J-SHC study)

Clinical and Experimental Nephrology - Renal function gradually declines with age. However, the association between changes in renal function and healthy aging has not been determined. This study...     

Weight loss reduces the incidence of dipstick proteinuria: a cohort study from the Japanese general population

Clinical and Experimental Nephrology - Though elimination of obesity is one of main therapeutic goal for lifestyle-related diseases, the impact of appropriate weight loss on reduction of the...     

Ziprasidone induces cytotoxicity and genotoxicity in human peripheral lymphocytes

It has been stated that some antipsychotic drugs might cause genotoxic and carcinogenic effects. Ziprasidone (ZIP) is commonly used an antipsychotic drug. However, its genotoxicity and carcinogenicity data are very limited. The cytotoxicity and genotoxicity of ZIP on human peripheral blood lymphocytes were examined in vitro by sister chromatid exchange (SCE), chromosome aberration (CA) and micronucleus (MN) tests in this study. Lymphocyte cultures were treated with 50, 75 and 100?μg/ml of ZIP in the presence and absence of a metabolic activator (S9 mix). Dimethylsulfoxide was used as a solvent control. While the cells were treated with ZIP for 24?h and 48?h in cultures without S9 mix, the cultures with S9 mix were exposed to ZIP for 3?h. ZIP and its metabolites can exert cytotoxic activities due to significant decreases in mitotic index, proliferation index and nuclear division index in the presence and absence of S9 mix. Statistically significant increases in CAs, aberrant cells and MN values in the presence and absence of S9 mix were found in cultures treated with ZIP. While ZIP significantly increased the SCE values in the absence of S9 mix at all concentrations, increased SCE values in cultures with S9 mix were not found to significantly at all concentrations tested. Our results indicated that both ZIP and its metabolites have cytotoxic, cytostatic and genotoxic potential on lymphocyte cultures under the experimental conditions. Further studies are necessary to make a possible risk assessment in patients receiving therapy with this drug.