The relationship between changes in normal-range systolic blood pressure and cognitive function in middle-aged healthy women.

Little is known about the effect of normal-range blood pressure (BP) on cognitive function. In previous studies investigating the relationship between BP and cognitive function in elderly subjects, underlying cerebrovascular damage has complicated the interpretation of results. To reveal the relationship between BP levels that were within an absolutely normal range and cognitive function, we examined cognitive function in normotensive, healthy middle-aged women. BP levels were measured on three separate occasions at 1-month intervals, and the subjects exhibiting normotension (< 140/90 mmHg) throughout the evaluation period were recruited as normotensive subjects. Cognitive function was assessed using subtests of the Wechsler Adult Intelligence Scale-Revised. The study demonstrated that, among the subtests examined, the scores on the Digit Symbol Test, an index of psychomotor performance, had a significant correlation with normotensive-range systolic blood pressure (SBP) (r=-0.51, p<0.05); this relation was negative-that is, higher but still normal-range SBP levels were associated with impaired Digit Symbol Test scores. In addition, the relationship adjusted by age and educational level was also significant (partial correlation = -0.56, p<0.05). In contrast, diastolic BP was not related to the Digit Symbol Test (r = -0.33, p = 0.13). Furthermore, the Digit Symbol Test was not influenced by blood glucose or serum cholesterol levels. These findings suggested that, even within the normotensive range, lower levels of SBP might be protective against impairment of psychomotor speed in middle-aged women.     

Efficacy of atorvastatin for the treatment of nonalcoholic steatohepatitis with dyslipidemia

Nonalcoholic steatohepatitis (NASH) is the hepatic manifestation of the metabolic syndrome. Currently, there is no established therapy for NASH. The aim of the present study was to evaluate the efficacy of atorvastatin in the treatment of NASH associated with hyperlipidemia. This prospective study included 31 patients with biopsy-proven NASH with hyperlipidemia. Body mass index, serum lipids, liver function tests, fibrosis markers, and adipocytokines (adiponectin, leptin, tumor necrosis factor-α) were measured periodically during an open-label study of atorvastatin (10 mg daily) for 24 months. Standard weight-loss counseling was continued during the treatment period. Oral glucose tolerance test and liver density assessed by computerized tomography were performed before and after treatment. Follow-up liver biopsy was performed in 17 patients. All 31 patients had high cholesterol levels at baseline, and 20 also presented high triglyceride levels. The body mass index and serum glucose levels did not change during the treatment. After treatment, 23 patients (74.2%) presented normal transaminase levels. Adiponectin levels were significantly increased, and the levels of tumor necrosis factor-α were significantly decreased. However, leptin levels were not changed significantly. The concentration of long-chain fatty acids was decreased; and significant decreases were observed in C18:2,n-6 (linoleic acid, −21%) and C20:4,n-6 (arachidonic acid, −22%). Liver steatosis and nonalcoholic fatty liver disease activity score were significantly improved, whereas 4 patients had increased fibrosis stage. The NASH-related metabolic parameters improved with therapy, including fibrosis in some patients. However, 4 of 17 patients had progression of fibrosis over the 2-year period, with 3 of them progressing to stage 3. It is unclear whether this divergent response represents sampling error, heterogeneity in the population, or untreated postprandial hyperglyceridemia. Controlled trials are needed to further investigate and resolve this.     

Reduction of orthodontic tooth movement by experimentally induced periodontal inflammation in mice

Orthodontic therapy is known to have an aggravating effect on the progression of destructive periodontitis if oral hygiene is not maintained. However, it is largely unknown how active periodontitis affects the velocity of orthodontic tooth movement. In this study, we examined the effect of periodontal inflammation on orthodontic tooth movement using a mouse model. Orthodontic force was applied on the maxillary first molar of mice, with or without ligature wire to induce experimental periodontitis. The distance moved by the first molar was significantly reduced by the ligature-induced experimental periodontitis. Tartrate-resistant acid phosphatase staining revealed that the number of osteoclasts present during orthodontic treatment was lower in the pressure zone of alveolar bone in the presence of periodontal inflammation. Consistently, the expression level of receptor activator of nuclear factor-κB ligand (RANKL) in the pressure zone was decreased in the ligature group. By contrast, experimental periodontitis increased the expression of cyclooxygenase-2 mRNA in the periodontal tissues, while in vitro treatment with prostaglandin E₂ decreased extracellular signal-regulated kinase phosphorylation and RANKL expression induced by mechanical stress in osteoblasts. Taken together, these results suggest that the orthodontic force-induced osteoclastogenesis in alveolar bone was inhibited by the accompanying periodontal inflammation, at least partly through prostaglandin E₂, resulting in reduced orthodontic tooth movement.     

Effects of compressive loading on biomechanical properties of disc and peripheral tissue in a rat tail model

Intervertebral disc degeneration induced by mechanical compression is an important issue in spinal disorder research. In this study, the biomechanical aspect of the rat tail model was investigated. An external loading device equipped with super-elastic TiNi springs was developed to apply a precise load to the rat tail. By using this device, rat tail discs were subjected to compressive stress of 0.5 or 1.0 MPa for 2 weeks. Discs in the sham group received an attachment of the device but no loading. After the experimental period, first the intact tail with peripheral tissues (PT) such as tendon and skin and then the retrieved disc without PT were subjected to a uniaxial tension–compression test; biomechanical characteristics such as range of motion (ROM), neutral zone (NZ), and hysteresis loss (HL) were evaluated. Furthermore, the load-bearing contribution of PT in the intact tail was estimated by comparing the load–displacement curves obtained by the mechanical tests performed with and without PT. The experimental findings revealed that the continuous compressive stress induced reduction in disc thickness. The intact tail demonstrated decreases in ROM and NZ as well as increases in HL. On the other hand, the retrieved disc demonstrated increases in ROM, NZ, and HL. Further, a significant increase in the load-bearing contribution of PT was indicated. These findings suggest that the load-bearing capacity of the disc was seriously deteriorated by the application of compressive stress of 0.5 or 1.0 MPa for 2 weeks.     

Urinary excretion of cyclic nucleotides and principal electrolytes in healthy humans of different ages

Urinary excretion of cyclic AMP, cyclic GMP, inorganic phosphorus, calcium, sodium, potassium and creatinine was measured in 138 healthy male and 104 healthy female humans from 2 to 68 years old. The range of cyclic nucleotide excretion was as follows: cyclic AMP (μmol/day), 1.01–10.89; cyclic GMP (μmol/day), 0.13–2.00; cyclic AMP (Mmol/g creatinine), 1.52–8.93; cyclic GMP (μmol/g creatinine), 0.11–1.87. The 242 volunteers were grouped into seven classes according to age: A, 2–9 years old; B, 10–19; C, 20–29; D, 30–39; E, 40–49; F, 50–59 and G, 60–68. Average excretion (μmol/day) of cyclic AMP in class A (2.62 ± 0.29 for males and 2.30 ± 0.18 for females) was significantly smaller than that in other classes (4.59 ± 0.12 for males and 3.90 ± 0.13 for females) (p < 0.01). Such a significant difference was not observed in cyclic GMP excretion. In terms of μmol/g creatinine, however, average excretion of both cyclic AMP and cyclic GMP in class A was greater than that in other classes.

The amounts of urinary cyclic AMP and cyclic GMP (μmol/day) were correlated with age in the subjects from 2 to 16 years. A reverse correlation between the amounts of both nucleotides (μmol/g creatinine) and age was found in the young subjects. No correlation between the excretion of either urinary cyclic nucleotide and age was found in adults.

A significantly positive correlation between cyclic AMP (μmol/day) and inorganic phosphorus (g/day) was found (r = 0.50 for males and 0.56 for females) (p < 0.01). This correlation suggests that urinary cyclic AMP might reflect the activity of parathyroid hormone in normal humans. There was no significant correlation between cyclic GMP and electrolytes tested. The above results are considered to provide basic data for clinical evaluation of relevant disorders.     

Contralateral adrenal width predicts the duration of prolonged post‐surgical steroid replacement for subclinical Cushing syndrome

Objectives

To identify pre‐treatment factors affecting the duration of post‐surgical steroid replacement in patients undergoing adrenalectomy for subclinical Cushing syndrome.

Methods

The present retrospective analysis included 64 patients who underwent unilateral laparoscopic adrenalectomy for subclinical Cushing syndrome. Adrenal tumor and contralateral adrenal sizes together with various clinical factors were studied in association with the duration of post‐surgical steroid replacement. Adrenal tumor and contralateral adrenal size were measured at the level of the maximum transverse plane of the adrenal glands using computed tomography scan or magnetic resonance imaging. Cox's proportional hazards model was used for the statistical analysis.

Results

All 64 patients were treated with post‐surgical steroid replacement after adrenalectomy. The median duration of the steroid treatment was 6 months. When assessing the duration of post‐surgical steroid replacement, contralateral adrenal volume <0.745 cm³, contralateral adrenal width <6.15 mm and serum cortisol after a 1‐mg dexamethasone suppression test >2.65 μg/dL were significant predictors of prolonged post‐surgical steroid treatment on univariate analysis. On multivariate analysis, contralateral adrenal width <6.15 mm was the only independent predictive factor for the prolonged post‐surgical steroid replacement.

Conclusions

Contralateral adrenal width seems to represent a significant predictive factor for the duration of post‐surgical steroid replacement in subclinical Cushing syndrome patients. Pre‐surgical assessment of image findings might help clinicians determine the total duration of steroid therapy after adrenalectomy.

     

Inhibition of IgE-dependent mouse triphasic cutaneous reaction by a boiling water fraction separated from mycelium of Phellinus linteus

Phellinus linteus, a mushroom, contains constituents that exhibit potent antitumor effects through activating immune cells. Recently, anti-inflammatory and anti-allergic properties of P. linteus extracts have also been implicated. In the present study, therefore, we separated the constituents of mycelium of P. linteus into five fractions-chloroform-soluble (CF), ethyl acetate-soluble (EA), methanol-soluble (AE), water-soluble (WA) and boiling water-soluble (BW) fractions-and examined their suppressive effects on the IgE-dependent mouse triphasic cutaneous reaction. The triphasic reaction was induced in the ear of BALB/c mice passively sensitized with anti-dinitrophenol IgE by painting with 2,4-dinitrofluorobenzene 24 h later. Ear swelling appeared triphasically with peak responses at 1 h, 24 h and 8 days after the challenge. ME, WA and BW given orally at a dose of 100 mg kg significantly inhibited the first and second phase ear swelling, and BW also inhibited the third phase response. CF only inhibited the second phase. The inhibition by BW was the most potent and almost dose-dependent at doses of 30-300 mg kg. BW also inhibited vascular permeability increase caused by passive cutaneous anaphylaxis and histamine, and ear swelling caused by tumor necrosis factor-alpha. In contrast, BW apparently potentiated the production of interleukin-4 and interferon-gamma from anti-CD3-stimulated mouse splenocytes. These results indicate that BW derived from mycelium of P. linteus contains some constituents with anti-allergic as well as immunopotentiating properties.     

Rehabilitation training using a single-joint type hybrid assistive limb for the knee after anterior cruciate ligament reconstruction: an initial case report indicating safety and feasibility

[Purpose] The aim of this report was to describe the safety, feasibility, and efficacy of rehabilitation by knee extension and flexion training using the knee single-joint hybrid assistive limb in a patient after anterior cruciate ligament reconstruction. [Participant and Methods] A 33 year-old male underwent an arthroscopic procedure for anatomic single-bundle anterior cruciate ligament reconstruction with a semitendinosus tendon autograft. Rehabilitation training using the knee single-joint hybrid assistive limb was initiated at postoperative week 18 and repeated weekly for 3 weeks. The patient performed five sets of the knee single-joint hybrid assistive limb-assisted knee-extension-flexion exercises per session at a frequency of 10 exercises/set. [Results] The peak extension torque at all velocities with the limb symmetry index was higher after the hybrid assistive limb intervention (post-intervention) than before using it (pre-intervention). Peak flexion torques at 60°/s and 300°/s of limb symmetry index were higher post-intervention than pre-intervention. The range of motion in extension and flexion improved from −2° (pre-intervention) to −1° (post-intervention) and from 124° to 133°, respectively. The Lysholm score increased from 58 (pre-intervention) to 94 (post-intervention). [Conclusion] The knee single-joint hybrid assistive limb can be used safely for anterior cruciate ligament reconstruction training, without any adverse events. Our results indicate that the knee single-joint hybrid assistive limb training may improve muscle function, effectively overcoming dysfunction.Key words: The single-joint type hybrid assistive limb for the knee joint (knee HAL-SJ), Anterior cruciate ligament reconstruction, Muscle dysfunction