Awareness of atrial fibrillation in Japan: A large‐scale,nationwide Internet survey of 50 000 Japanese adults

Aim

Atrial fibrillation (AF) is the most common underlying cause of cardiogenic cerebral embolism. To prevent cardiogenic cerebral embolism, it is important to determine the level of awareness of AF in Japan.

Methods

We used survey monitor attribute data to sample 172 824 Japanese adults aged ≥50 years from all 47 Japanese prefectures. Next, we carried out an Internet survey to determine these individuals’ level of awareness of AF.

Results

We obtained valid responses from 53 128 respondents. There were 13 119 respondents (27.5%) spanning all age groups who had never heard the term AF (no prior knowledge), just 1791 respondents (3.8%) who knew AF well and 27 351 respondents (57.3%) who knew the name of the condition, but did not understand the disease or its treatment. No prior knowledge was highest in Kochi Prefecture (36.0%) and lowest in Yamanashi Prefecture. Knowing AF well was highest in Kyoto Prefecture (5.1%) and lowest in Tottori Prefecture, and knowing only the name was highest in Aomori Prefecture (63.0%). Factors contributing significantly to having “no prior knowledge” of AF included younger age, male sex and smaller population size (rural region), but not the numbers of arrhythmia or stroke specialists.

Conclusions

Currently, 3.8% of Japanese adults had high awareness of AF, and we find this value very low. We also noted age‐, sex‐ and region‐related differences in awareness level. We believe that awareness initiatives that take into account age‐ and sex‐related differences and prioritize prefectures with lower awareness of AF will be important for preventing cardiogenic cerebral embolism in the future. Geriatr Gerontol Int 2018; 18: 1100–1107 .     

Effect of intestinal ischaemia/reperfusion on P‐glycoprotein‐mediated ileal excretion of rhodamine 123 in the rat

Objectives We have shown that ischaemia/reperfusion in the small intestine at an early phase, such as 1 h after reperfusion, induced not only functional changes in the membrane, such as P‐glycoprotein (P‐gp) dysfunction, but also decreased expression of P‐gp protein and mdr1a mRNA. In the present study we examined whether intestinal ischaemia/reperfusion modifies the P‐gp‐mediated ileal excretion transport system in rats beyond 1 h after reperfusion. Methods To evaluate the contribution of P‐gp‐mediated transport to the ileal excretion of rhodamine 123, we used Western blotting to measure the expression of P‐gp protein levels isolated from the ileum at different reperfusion times after 60 min of ischaemia. We also measured the expression of inducible nitric oxide synthase (iNOS) mRNA using real‐time RT‐PCR. Key findings Ileal excretion of rhodamine 123 decreased at 3 h after reperfusion and had recovered at 24 h. Changes in villi structure at 3 h and its recovery at 24 h were also observed. Verapamil, a competitive inhibitor of P‐gp, significantly inhibited ileal clearance of rhodamine 123 to the lumen at 24 h after reperfusion, suggesting that P‐gp was working at this time. These results suggest that intestinal ischaemia/reperfusion‐induced decrease in P‐gp‐mediated ileal excretion of rhodamine 123 was probably due to impaired P‐gp‐mediated transport. Levels of P‐gp protein and iNOS mRNA in the ileum decreased 3 h after ischaemia/reperfusion and returned to control levels after 24 h. Conclusions These findings suggest that intestinal ischaemia/reperfusion markedly decreases P‐gp‐mediated ileal excretion of rhodamine 123, probably by decreasing the expression of P‐gp protein, which is likely to be due to increased lipid peroxidation via iNOS.     

Aminophilline suppress the release of chemical mediators in treatment of acute asthma

BACKGROUND: The control of airway inflammation is crucial for management of asthma. Theophylline has been demonstrated to have an anti-inflammatory effect as a long-term-medication for asthma in various studies. In the present study we attempted to clarify if aminophylline, a theophylline derivative, could act as an anti-inflammatory agent as well as a bronchodilator in the treatment for acute asthma exacerbations. METHODS: Patients are initially treated either with an intravenous infusion of aminophylline or with inhalation of salbutamol. Pro-inflammatory mediators such as eosinophil cationic protein (ECP), histamine, serotonin, thromboxane B2, leukotriene C4 were measured before and one hour after the initial treatment. Clinical parameters such as peak expiratory flow (PEF) and SpO2 were also checked during the studies. RESULTS: Significant improvements of PEF and SpO2 with both aminophylline and salbutamol treatment were seen. Furthermore, significant decreases of ECP, histamine, and serotonin were observed with aminophylline but not with salbutamol. CONCLUSIONS: Suppressing the release of pro-inflammatory mediators may play a role, at least in part, in the beneficial effects of aminophylline in the treatment of acute exacerbations in asthma. Additionally, this study indicated that treatment with aminophylline is at least as beneficial as nebulized salbutamol in the restoration of lung function.     

Migraine Treated Using a Prophylactic Combination of Candesartan and Hydrochlorothiazide (ECARD® Combination Tablets LD)

We describe the use of the antihypertensive, candesartan, with hydrochlorothiazide (ECARD^® Combination Tablets LD) as a preventive therapy that decreased the frequency of migraine accompanied by premonitory leg edema. Two women (aged 26 and 50 years) presented to hospital with an increasing frequency of migraine without aura accompanied by leg edema. We prescribed ECARD^® half tablet (candesartan, 2 mg and hydrochlorothiazide, 3.125 mg), and the migraines and leg edema disappeared. The use of ECARD^® to treat a series of migraines by controlling premonitory leg edema has not been reported. ECARD^®_, combined with a low‐dose diuretic, may have been helpful in these patients with the premonitory migraine symptom of leg edema.     

Effects of pharmaceutical excipients on membrane permeability in rat small intestine

Pharmaceutical excipients should not disturb the effects of drug therapy. In recent years, however, it has been reported that excipients induce some changes to the tight junction (TJ) and P-glycoprotein (P-gp), which can affect drug disposition. In this study, we examined the effects of 20 common pharmaceutical excipients from different classes on mucosal membrane and the differences of such effects among regions of the small intestine. We used the in vitro sac method in rat jejunum and ileum to study the effects of excipients on the membrane permeation of 5(6)-carboxyfluorescein (5-CF). 5-CF was used as a model of water-soluble compounds. In some dosage conditions of methyl-β-cyclodextrin, the membrane permeability of 5-CF was significantly increased in the jejunum, but such change was not observed in the ileum. Similarly, in the cases of sodium carboxymethyl starch, low-substituted hydroxypropyl cellulose and croscarmellose sodium, the membrane permeability of 5-CF was significantly increased in the jejunum, but no change was observed in the ileum. On the other hand, in both the jejunum and the ileum, the membrane permeation of 5-CF was decreased with 0.02% (w/v) hydroxypropyl cellulose, but significantly increased with it at 0.20% (w/v). It was shown that excipients affected the membrane permeability of water-soluble compounds via the paracellular route, and these effects on absorption differed among regions of the small intestine. Moreover, in the case of 20 excipients, not only an increase in membrane permeability but also a decrease was observed. Therefore, it was suggested that a more effective formulation could be designed by changing the combination of excipients.     

Nerve conduction study of lower extremities in cutaneous arteritis patients with neurological manifestations

Some patients originally diagnosed with cutaneous arteritis (CA) could develop additional disease manifestations, including peripheral neurological involvement. We evaluated the biological neurological parameters among CA patients who underwent nerve conduction studies for neurological involvement in the lower extremities. We reviewed 164 patients who were originally diagnosed with CA at our dermatology department between 2004 and 2015. Seventeen (10.4%) of the CA patients underwent further nerve conduction studies to determine their peripheral neurological manifestations, primarily in the lower extremities, in our neurology division. The frequency of low compound muscle action potential (CMAP) was significantly higher compared with that of delayed latency in both the peroneal nerve and sural nerve based on nerve conduction studies. The frequency of low CMAP was significantly higher compared with that of prolonged distal latency in both the peroneal and sural nerves. We suggest that impairment of the nerve axon pathways in the peroneal and sural nerves could result in the peripheral neurological manifestations in the lower extremities in CA patients.     

Esophageal intramural pseudodiverticulosis associated with esophageal perforation

We report a rare case of esophageal intramural pseudodiverticulosis with lower esophageal stricture which perforated into the peritoneal cavity after the patient vomited. A 61-year-old man was admitted with severe chest and epigastric pain after dysphagia and vomiting. Under a diagnosis of upper gastrointestinal perforation, laparotomy was performed. The anterior wall of the abdominal esophagus was found to have ruptured, and proximal gastrectomy with abdominal esophagectomy was performed. His-tological examination revealed esophageal intramural pseudodiverticulosis with esophageal stricture distal to the site of rupture, and postoperative endoscopy showed diffuse pseudodiverticulosis in the remaining esophagus. The patient is free of symptoms 5 years after the surgery. This case suggests that careful treatment may be indicated in patients with esophageal intramural pseudodiverticulosis with stricture and elevated intraluminal pressure, to minimize the possibility of severe complications such as esophageal perforation. Received: June 7, 1999 / Accepted: January 28, 2000     

Detection of Increased Fecal Carcinoembryonic Antigen and Its Characterization as a Membrane-bound Form in Colorectal Carcinoma and Other Gastrointestinal Disorders

The levels and character of carcinoembryonic antigen (CEA) in feces were investigated by sandwich radioimmunometric assay using anti-CEA monoclonal antibodies NCC-CO-411 and NCC-CO-432. Mean CEA concentration was significantly higher ( P < 0.001) in the feces from patients with colorectal carcinoma and other gastrointestinal disorders as compared to normal adults. More than 90% of the fecal CEA was trapped by a 0.22 μ m membrane filter and solubilized by treatment with 1% Triton X-100 or phosphatidyl-inositol specific phospholipase C. In hydrophobic chromatography, most of the fecal CEA was eluted at the lowest (NH₄)₂SO₄ concentration while serum CEA appeared in the more hydrophilic fractions. These results suggest that the majority of CEA exists in feces as an amphiphilic molecule or a membrane-bound form. The increase of fecal CEA may reflect the destruction and abrasion of epithelial cells in various gastrointestinal disorders.