Age-related differences in the delivery of cardiac management to women versus men with acute myocardial infarction in Japan: Tokai Acute Myocardial Infarction Study: TAMIS

It is of concern that women are more likely to undergo fewer diagnostic tests and receive less treatment for acute myocardial infarction (AMI) than men. However, it is still unclear whether gender differences exist according to age groups. Therefore, we studied the influence of gender on the delivery of cardiac management according to two age groups (< 65, >or= 65) in Japan. Data from the Tokai Acute Myocardial Infarction Study (TAMIS) sample were used. This is a retrospective study of all consecutive patients admitted to the 13 acute care hospitals in the Tokai region of Japan, which includes Aichi and Shizuoka Prefectures, with a diagnosis of AMI from 1995 to 1997. A total of 143 younger women, 822 younger men, 391 older women, and 611 older men were included. Information concerning patient demographics, in-hospital course, comorbid conditions, electrocardiography (ECG), ultrasound-echocardiography (UCG), treadmill test (TMT), coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), intra-aortic balloon pump (IABP), mechanical ventilation, and in-hospital or discharge medication (thrombolytics, vasopressors, aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, nitrates) were collected. Among the young, after controlling for these baseline variables, women were significantly less likely to undergo PTCA compared to men (OR, 0.54, 95%CI, 0.35-0.82). After controlling for these baseline variables, only lipid-lowering therapy tended to be more frequent in women than in men among the elderly (OR, 2.79, 95%CI, 1.47-2.58). The findings suggest that younger women with AMI are less likely than younger men to undergo PTCA, and that older women with AMI are more likely to receive lipid-lowering therapy.     

Association of serum NO x level with clustering of metabolic syndrome components in middle-aged and elderly general populations in Japan

Objectives The aim of this study was to determine whether the serum nitrite plus nitrate (NO _x ) level correlates with biomarkers that are known components of the metabolic syndrome (MetS). Methods Serum NO _x levels were measured using a commercial kit in 608 Japanese men and women between the ages of 39 and 85 years. Multivariate adjustments for age, smoking status, alcohol consumption and exercise were made in the analysis of covariance (ANCOVA). The components of the metabolic syndrome were defined based on the following criteria: body mass index (BMI) ≥25.0 kg/m², glycated hemoglobin (HbA1c) ≥5.6%, systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, high-density lipoprotein-cholesterol (HDL-C) ≤1.03 mmol/l for men and ≤1.29 mmol/l for women and triglyceride ≥1.69 mmol/l. Results The logarithmically transformed age-adjusted serum NO _x (lnNO _x ) value was significantly higher in the low HDL-C group (1.76 ± 0.05 μmol/l; p < 0.05) than MetS component groups (1.65 ± 0.01 μmol/l) in men, but no difference was found in women. The means of serum lnNO _x after multivariate adjustment were 1.64, 1.65, 1.64, 1.66, and 1.81 μmol/l for 0, 1, 2, 3, and 4–5 MetS components for all subjects, respectively. The results of ANCOVA confirmed that the serum lnNO _x level was significantly correlated with the clustering of MetS components in both men and women (p < 0.0001 for trend). Conclusion Our results suggest that an increase in the clustering of MetS components was associated with the increase in serum NO levels in our general population.     

Comparative study of PCR-based Cryptosporidium discriminating techniques with a review of the literature

We identified the species or genotypes of the six Cryptosporidium isolates from patients and C. parvum strain HNJ-1 using the seven previously described species-differentiation and genotyping PCR protocols for detection of Cryptosporidium parasites. In addition, we also discussed about the usefulness of these PCR-based protocols on the basis of the reports previously published. Cryptosporidium diagnostic fragment was amplified by PCR with each primer pair, targeting the 18S ribosomal RNA (18SrRNA), Cryptosporidium oocyst wall protein (COWP). Heat shock protein 70 (HSP70), Polythreonine (Poly-T), Thrombospondin related adhesive protein of Cryptosporidium-1 (TRAP-C1), and unknown gene locus, in all isolates from patients and the strain HNJ-1. The RFLP profiles of 18SrRNA, COWP, HSP70, Poly-T, and TRAP-C1 PCR products in all isolates from patients were found to be the same among isolates, and were correspondent to those of C. parvum human genotype. While the RFLP profiles of HNJ-1 were strictly different from those of isolates from patients, and were correspondent to C. parvum cattle genotype. In addition, nucleotide sequences in 18 SrRNA gene of all isolates from patients and HNJ-1 were found to be identical to that of C. parvum, human or cattle genotype, respectively. Therefore, the isolates from patients and HNJ-1 were identified as C. parvum human and cattle genotype, respectively. According to the reports related to the PCR-based protocols applied in the present study, RFLP profiles targeting the HSP70, Poly-T, TRAP-C1 genes had been revealed in only a few species or genotypes, but those of 18SrRNA and COWP genes were in all species and genotypes. However, we supposed that it was difficult to distinguish between human or cattle genotype and other species or genotypes by RFLP profiles of 18SrRNA or COWP because the RFLP profiles of human or cattle genotype were identical or similar to those of other species or genotypes. On the other hand, it has been known that the nucleotide sequences in 18SrRNA or COWP gene are different among Cryptosporidium species and/or genotypes. Therefore, the direct sequencing method targeting the variable regions which can be used to distinguish among Cryptosporidium species, as well as the genotypes within C. parvum in either 18SrRNA or COWP gene is the most useful tool for accurate identification of Cryptosporidium isolates.     

Laparoscopic wedge resection of gastric submucosal tumors

Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors (SMTs) of the stomach can be resected using laparoscopic techniques. Between 1993 and 1997, laparoscopic wedge resection was performed in 34 patients with an SMT of the stomach. The tumors ranged from 8 to 60 mm in diameter. All surgical margins were clear. The average operative time was 131 minutes. Most of the patients began eating on the first postoperative day and were discharged within 5 to 7 days. Histopathologic examination of the tumors showed gastrointestinal stromal tumor (n = 14), ectopic pancreas (n = 7), leiomyosarcoma (n = 4), schwannoma (n = 3), carcinoid (n = 2), leiomyoma (n = 2), an inflammatory lesion caused by parasites (n = 1), and cyst (n = 1). No recurrences were observed over the 5-year follow-up period. A solid SMT of the stomach larger than 20 mm in diameter can be treated using laparoscopic wedge resection.