Association between Vitamin D and Heart Failure Mortality in 10,974 Hospitalized Individuals

A broad range of chronic conditions, including heart failure (HF), have been associated with vitamin D deficiency. Existing clinical trials involving vitamin D supplementation in chronic HF patients have been inconclusive. We sought to evaluate the outcomes of patients with vitamin D supplementation, compared with a matched cohort using real-world big data of HF hospitalization. This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). After exclusion criteria, we identified 93,692 patients who were first hospitalized with HF between April 2012 and March 2017 (mean age was 79 ± 12 years, and 52.2% were male). Propensity score (PS) was estimated with logistic regression model, with vitamin D supplementation as the dependent variable and clinically relevant covariates. On PS-matched analysis with 10,974 patients, patients with vitamin D supplementation had lower total in-hospital mortality (6.5 vs. 9.4%, odds ratio: 0.67, p < 0.001) and in-hospital mortality within 7 days and 30 days (0.9 vs. 2.5%, OR, 0.34, and 3.8 vs. 6.5%, OR: 0.56, both p < 0.001). In the sub-group analysis, mortalities in patients with age < 75, diabetes, dyslipidemia, atrial arrhythmia, cancer, renin-angiotensin system blocker, and β-blocker were not affected by vitamin D supplementation. Patients with vitamin D supplementation had a lower in-hospital mortality for HF than patients without vitamin D supplementation in the propensity matched cohort. The identification of specific clinical characteristics in patients benefitting from vitamin D may be useful for determining targets of future randomized control trials.     

Effectiveness of the Imugard E Leukocyte Removal Filter for Preparation of Leukocyte-Poor Concentrated Red Cells

Concentrated red cells (CRC) were filtered through a new leukocyte removal filter, the Imugard E, which consists of a polyvinyl alcohol porous sheet. CRC were filtered through the Imugard E with neither priming before filtration nor rinsing after filtration. Leukocyte removal was 99.1 +/- 0.6, 99.6 +/- 0.3 and 99.6 +/- 0.4% on the 1st, 5th and 10th day after blood collection, respectively. Platelet removal was 96 +/- 2, 81 +/- 6 and 85 +/- 3% on the 1st, 5th and 10th day, respectively. Red cell recovery was 86 +/- 2, 86 +/- 1 and 86 +/- 1% on the 1st 5th and 10th day, respectively. Filtration time was 3.9 +/- 0.8, 5.8 +/- 0.9 and 6.1 +/- 0.8 min on the 1st, 5th and 10th day, respectively. Direct filtration of CRC through the Imugard E resulted in no significant changes in the ATP or 2,3-DPG concentrations, and no hemolysis due to filtration was noticed. It may be concluded that the Imugard E is a good filter that is simple to use and effective in leukocyte removal.     

Hepatic Circulation and Hepatic Oxygen Consumption in Alcoholic and Nonalcoholic Fatty Liver

The purpose of this study was to determine the differences in hepatic circulation and oxygen consumption in two groups: those with nonalcoholic obesity-related fatty live and those with alcoholic fatty liver. Although the histological degree of fatty infiltration was equal in the two groups, the delta Er569-650, as an index of the regional liver blood flow estimated by spectrophotometric method, was significantly lower in alcoholic fatty liver than in nonalcoholic fatty liver, and the in vivo hepatic oxygen consumption (VO2), also determined by hepatic reflectance spectrophotometry during peritoneoscopy, tended to be lower in alcoholic fatty liver than in nonalcoholic fatty liver. The oxygen saturation of hemoglobin in local liver blood (SO2) was, however, significantly higher in alcoholic fatty liver than in nonalcoholic fatty liver. These results suggest that an increase in oxygen extraction to maintain oxygen consumption, which was indicated by the lowering of the SO2, was not found in alcoholic fatty liver, in spite of a reduction of oxygen supply to the liver. It is concluded that the impairment of hepatic circulation and hepatic oxygen consumption was more serious in alcoholic fatty liver than in nonalcoholic fatty liver, possibly contributing to a different prognosis for the two forms of fatty liver.     

Incidence and predictors of ischemic stroke during hospitalization for congestive heart failure

Heart failure (HF) increases the risk of ischemic stroke. Data regarding the incidence and predictors of ischemic stroke during hospitalization for HF are limited. The study population of this retrospective cohort study consisted of patients with congestive HF, consecutively admitted to our center from October 2010 to April 2014. We excluded patients complicated with acute myocardial infarction, infective endocarditis, and takotsubo cardiomyopathy. We also excluded those with dialysis or mechanical circulatory support. We investigated the incidence of ischemic stroke during hospitalization for HF. Thereafter, we divided the patients without oral anticoagulants at admission into two groups: patients with ischemic stroke and those without it, and explored the predictors of ischemic stroke. A total of 558 patients (287 without atrial fibrillation (AF), 271 with AF) were enrolled. The mean age was 76.8 ± 12.3 years, and 244 patients (44 %) were female. The mean left-ventricular ejection fraction was 47.4 %. Oral anticoagulants were prescribed in 147 patients (8 without AF, 139 with AF). During hospitalization (median length 18 days), symptomatic ischemic stroke (excluding catheter-related) occurred in 15 patients (2.7 % of the total, 8 without AF, 7 with AF). Predictors significantly associated with increased risk of ischemic stroke in patients without oral anticoagulants were as follows; short-term increases in blood urea nitrogen after admission (at day 3; odds ratio (per 1 md/dl): 1.06, 95 % confidence interval (CI) 1.01–1.11, p = 0.02, and at day 7; odds ratio: 1.03, 95 % CI 1.00–1.07, p = 0.03, respectively), and previous stroke (odds ratio; 3.33, 95 % CI 1.01–11.00, p = 0.04). The incidence of ischemic stroke during hospitalization for HF was high, even in patients without AF. Previous stroke and short-term increases in blood urea nitrogen was significantly associated with the incidence of ischemic stroke.     

Work and family characteristics as socioeconomic determinants in long sickness absence: the Japanese civil servants study

Long sickness absence is more common among low socioeconomic status (SES) groups than high SES groups. This study aimed to evaluate whether work and family characteristics contribute to SES and sex differences in long sickness absence (7 days or more). The participants were 3080 civil servants working for a local Japanese government. In both sexes, low-grade employees were likely to take long sickness absence, with a statistically significant association for men (age-adjusted OR of lowest-grade employees for long sickness absence: 2.30 (95% Confidence Interval (CI): 1.32–4.02)). After adjusting for all variables, SES differences in long sickness absence in men decreased to OR 1.98 (CI 1.10–3.55) but remained significant; in men, being without a spouse was significantly associated with long sickness absence. Employees working long hours had lower OR for long sickness absence after adjusting for all variables in both sexes. Conversely, poor sleep quality and longstanding illness significantly increased OR for long sickness absence. In conclusion, SES differences in sickness absence were explained partly by work and family characteristics, longstanding illness, and poor sleep quality; however, other factors that were not evaluated in this study may also be associated with SES differences.     

A meta-analysis of epidemiological studies on the relationship between occupational electromagnetic field exposure and the risk of adult leukemia

Since the first paper by Milham et al. suggested that occupational exposure to an electromagnetic field (EMF) could increase the risk of adult leukemia, many epidemiological studies on this problem have been published. In this report the method of meta-analysis was used to summarize the results from these papers quantitatively. The combined relative risk of all leukemia (RR=1.11), as well as acute lymphocytic leukemia (RR=1.38), acute myeloid leukemia (RR=1.07) and chronic lymphocytic leukemia (RR=1.14) increased but not significantly. So far, it is difficult to make a consistent conclusion about the relationship of the occupational exposure to EMF and adult leukemia. Further carefully designed case-control and cohort studies using the more valid means of exposure assessment are required.     

The validity of nursery teachers' report on the physical activity of young children

This study examined the validity of nursery teachers' report on the physical activity of young children. Subjects were twenty-one children aged 3 to 4 years (12 boys and 9 girls) at a nursery in Toyama Prefecture, Japan. Children were equipped with the Actiwatch (Mini-mitter Company Inc.) activity monitor and the Caloriecounter Select II (Kenz, Co, Ltd) for three consecutive weekdays to assess their daily physical activity levels. Nursery teachers completed a questionnaire containing questions on children's activity level during the measurement periods at the nursery. The results showed that subjects with a high frequency of physical activity were significantly associated with an increasing trend in total energy expenditure and activity counts per day. Children whose physical activity was rated as "very often" had a significantly higher activity level per day from the Actiwatch instrument, compared with peers whose physical activity was rated as "not often" (570.5 +/- 192.8 counts vs. 334.9 +/- 123.4 counts, p < 0.05). Regarding energy expenditure originating from physical activity and steps per day from the Caloriecounter, a significant difference was found between "very active" children and "inactive" children as rated by the nursery teachers (140.7 +/- 17.5 kcal vs. 78.2 +/- 17.4 kcal, p < 0.05; 16103 +/- 1896 steps vs. 10038 +/- 32 steps, p < 0.05). This study indicates that children's physical activity level as reported by their teachers in nursery surroundings is in accordance with the objective data from the Actiwatch and the Caloriecounter. The results suggest that nursery teachers' respondent for children in physical activity may be used as a valid measure to evaluate young children's physical activity levels, especially in nursery setting.