Kazuhiro Ohwaki

Blood Pressure Management in Acute Intracerebral Hemorrhage Relationship Between Elevated Blood Pressure and Hematoma Enlargement

Background and Purpose— The association between elevated blood pressure (BP) and hematoma enlargement in acute intracerebral hemorrhage (ICH) has not been clarified. We investigated the association between maximum systolic BP (SBP) and hematoma enlargement, measuring SBP between a baseline and a second CT scan in patients with hypertensive ICH. Methods— We assessed 76 consecutive patients with hypertensive ICH retrospectively. We usually attempted to lower SBP below targets of 140, 150, or 160 mm Hg. Recordings of serial BP from admission until the second CT scan were assessed. A neuroradiologist, who was not informed of the aim of this study, reviewed CT films. Hematoma enlargement was defined as an increase in volume of ≥140% or 12.5 cm3. Results— Hematoma enlargement occurred in 16 patients. Maximum SBP was significantly associated with hematoma enlargement (P = 0.0074). A logistic regression model for predicting hematoma enlargement was constructed with the use of maximum SBP, hematoma volume, and Glasgow Coma Scale score at admission. After adjustment for these factors, maximum SBP was independently associated with hematoma enlargement (odds ratio per mm Hg, 1.04; 95% CI, 1.01 to 1.07). Target SBPs of ≥160 mm Hg were significantly associated with hematoma enlargement compared with those of ≤150 mm Hg (P = 0.025). Conclusions— Our findings suggest that elevated BP increases the risk of hematoma enlargement. Efforts to lower SBP below 150 mm Hg may prevent this risk.

Relationship between shunt-dependent hydrocephalus after subarachnoid haemorrhage and duration of cerebrospinal fluid drainage

Subarachnoid haemorrhage (SAH) patients in Fisher group 3 have a high risk of vasospasm and chronic hydrocephalus. We have provided cisternal irrigation combined with a head-shaking method for preventing vasospasm in SAH patients. We investigated 76 SAH patients in Fisher group 3 who received cisternal irrigation with head-shaking to evaluate the relationship between the occurrence of hydrocephalus and various clinical factors, including duration of cerebrospinal fluid (CSF) drainage. Chronic hydrocephalus occurred in 25 patients (33%). The occurrence of hydrocephalus was associated with longer duration of CSF drainage (median, 13 days versus 9 days). By logistic regression analysis using significant factors, including age, preoperative neurological grade and Glasgow Outcome Scale, only the duration of drainage was independently associated with the occurrence of hydrocephalus (Odds ratio = 1.18 per day; 95% confidence interval, 1.02 – 1.36). These results indicate that long duration of CSF drainage for preventing vasospasm may increase the occurrence of hydrocephalus.

Factors associated with attitude and hypothetical behaviour regarding brain death and organ transplantation : Comparison between medical and other university students

Abstract:  The aim of this study was to investigate the factors, including knowledge, that determine an individuals attitudes and behaviours regarding brain death and organ transplantation using questionnaires among medical and other university students. A total of 522 students (388 medical and 134 other) answered a questionnaire. The survey included the individuals knowledge about brain death, attitudes towards brain death and organ transplantation, and hypothetical behaviours assuming their willingness to donate their own or their familys organs. Medical students were more likely to have knowledge about brain death and to accept brain death and organ transplantation compared with other students, while there was no difference in their willingness to donate their own or their familys organs. Logistic regression analysis was used to assess the effects of various factors on the attitudes and behaviours. In both medical and other students, confidence in brain‐death diagnosis by doctors was independently associated with their willingness to donate their own organs after the adjustment for other factors, including knowledge (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.15 to 2.97 and OR, 4.97; 95% CI, 1.01 to 24.39, respectively). An increase in knowledge may cause positive attitudes towards brain death and organ transplant. Meanwhile, reducing uncertainty about the brain‐death diagnostic process might have a beneficial effect on the willingness to donate organs.

Association of sleep duration with untreated diabetes in Japanese men

OBJECTIVE We assessed the cross-sectional association between sleep duration and untreated diabetes in Japanese men. METHODS Participants included 20,744 men aged 30-64 years who first visited the general hospital in Tokyo for routine health assessments during 2003-2007. Untreated diabetes was defined as not being under diabetes treatment and fasting blood glucose of ≥126 mg/dL or hemoglobin A(1c) of ≥6.5%. Sleep duration (≤5, 6, 7, or ≥8 h) and confounders were assessed using a questionnaire. Logistic regression was used to calculate odds ratios (ORs) for diabetes after adjustment for confounders. RESULTS The prevalence of untreated diabetes was 3.4% in all men. The prevalence of untreated diabetes by sleep duration was as follows: ≤5 h: 3.5%; 6 h: 3.3%; 7 h: 3.2%; and ≥8 h: 5.1%. Men who reported sleeping for ≤5 h (OR: 1.52, 95% confidential interval [CI]: 1.22-1.90) and ≥8 h (OR: 1.39, 95% CI: 1.05-1.85) were significantly more likely to have untreated diabetes compared with those who reported sleeping for 7 h. In stratified analyses by obesity (body mass index ≥25.0 kg/m(2)), the association between long sleep duration (≥8 h) and untreated diabetes remained significant only in obese men. CONCLUSION Short sleep duration was significantly associated with untreated diabetes in both nonobese and obese men. Regarding long sleep duration, a significant association was observed in obese men only.

Relationship Between Prostate-specific Antigen and Hematocrit: Does Hemodilution Lead to Lower PSA Concentrations in Men With a Higher Body Mass Index?

OBJECTIVES To examine whether a lower hematocrit was associated with a lower prostate-specific antigen (PSA), when stratifying by body mass index (BMI) in healthy men. PSA test is widely used in screening for prostate cancer. Many studies have found that PSA levels inversely correlate with BMI. It remains unclear whether hemodilution causes this inverse relationship. METHODS We investigated 19,367 men who visited a hospital for a routine health checkup in 2007. We obtained information on age, BMI, PSA, hematocrit, and smoking status. BMI was categorized as < 18.5, 18.5-22.0, 22.0-25.0, 25.0-30.0, and > or = 30.0 kg/m(2). RESULTS In all subjects, older age and lower BMI were weakly correlated with a higher PSA (r = 0.20, P <.001 and r = -0.05, P <.001, respectively). A multiple regression model for predicting PSA was constructed using age, current smoking status, and hematocrit for each BMI category. After controlling for age and smoking, PSA increased significantly with increasing hematocrit in participants with BMIs of 18.5-30 kg/m(2) (all P <.001). For example, in men with a BMI of 22-25 kg/m(2), slight increases (1.4% increase; 95% confidence interval, 1.0%-1.9%) were observed in PSA with a 1-unit increase in hematocrit. CONCLUSIONS In healthy men with a BMI of 18.5-30 kg/m(2), a lower hematocrit was significantly associated with a lower PSA. Hemodilution may explain the lower PSA levels observed in men with a higher BMI, resulting in an inverse relationship between BMI and PSA.

Subclinical ischemia verified by somatosensory evoked potential amplitude reduction during carotid endarterectomy: negative effects on cognitive performance

OBJECT Although the mechanisms underlying neurocognitive changes after carotid endarterectomy (CEA) are poorly understood, intraoperative ischemia and postoperative hemodynamic changes may play a role. METHODS Data from 81 patients who underwent unilateral CEA with routine shunt use for carotid artery stenosis were retrospectively evaluated. These patients underwent neuropsychological examinations (NPEs), including assessment by the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised before and 6 months after CEA. results of NPEs were converted into z scores, from which pre- and postoperative cognitive composite scores (CSpre and CSpost) were obtained. The association between the change of CS between pre- and postoperative NPEs (that is, CSpost - CSpre [CSpost - pre]) and various variables was assessed. These latter variables included ischemic or hemodynamic parameters such as 1) intraoperative hypoperfusion detected by somatosensory evoked potential (SSEP) change-that is, an SSEP amplitude reduction more than 50% and longer than 5 minutes (SSEP< 50%, > 5 min); 2) new lesions on postoperative diffusion-weighted imaging studies; and 3) preexisting hemodynamic impairment. Paired t-tests of the NPE scores were performed to determine the net effect of these factors on neurocognitive function at 6 months. RESULTS A significant CSpost - pre decrease was observed in patients with SSEP< 50%, > 5 min when compared with those without SSEP< 50%, > 5 min (-0.225 vs 0.018; p = 0.012). Multiple regression analysis demonstrated that SSEP< 50%, > 5 min independently and negatively correlated with CSpost - pre (p = 0.0020). In the group-rate analysis, postoperative NPE scores were significantly improved relative to preoperative scores. CONCLUSIONS Hypoperfusion during cross-clamping, as verified by SSEP amplitude reduction, plays a significant role in the subtle decline in cognition following CEA. However, this detrimental effect was small, and various confounding factors were present. Based on these observations and the group-rate analysis, the authors conclude that successful unilateral CEA with routine shunt use does not adversely affect postoperative cognitive function.

Blood lead and erythrocyte protoporphyrin levels in association with smoking and personal hygienic behaviour among lead exposed workers

Aims: To investigate the effects of smoking and personal hygienic behaviour on blood lead (BPb) and free erythrocyte protoporphyrin levels (FEP) in lead exposed workers. Methods: Subjects were 105 lead exposed male workers in a battery recycling plant during the years 2000–03. BPb and FEP were measured as part of the ongoing occupational surveillance. Each worker completed a questionnaire for assessment of smoking and four measures of personal hygienic behaviour (glove and mask use, hand and face washing before meals during working hours). Results: Statistically significant decreases in mean BPb and FEP occurred during the three years. The proportion of BPb reduction in the non-smoking workers was significantly higher (mean 24.3%) than in the smoking workers (15.3%). When the workers were classified into three groups (excellent, good, and poor) based on the four personal hygienic behavioural indicators, the greatest decreases of BPb and FEP were observed in the non-smoking workers of the excellent group. Conclusions: The consistent use of protection devices and cleanliness at work appeared to contribute to the lowering of BPb and FEP. Cessation of smoking in the workplace was also of importance.

Abdominal obesity, hypertension, antihypertensive medication use and biochemical recurrence of prostate cancer after radical prostatectomy

BACKGROUND The aim of this study was to determine whether abdominal obesity, including visceral adipose tissue (VAT) measured by computed tomography and blood pressure (BP) were associated with biochemical recurrence of prostate cancer after prostatectomy. METHODS We investigated 283 patients who underwent radical prostatectomy for prostate cancer retrospectively. We obtained information on body mass index (BMI), waist circumference (WC), VAT, BP, antihypertensive drug use, pretreatment prostate-specific antigen levels, pathological Gleason scores and postoperative surgical margin status. Hypertension was defined as systolic BP (SBP)⩾130mmHg or diastolic BP⩾85mmHg. RESULTS Among 283 patients, 41 (14%) developed biochemical recurrence subsequently. We performed a Cox proportional hazard regression analysis to assess the association of each obesity measurement and SBP with biochemical recurrence using clinical predictors as potential confounders. No association was observed between any obesity measurement assessed and biochemical recurrence. Adjusting for each of BMI, WC and VAT, a higher SBP was associated significantly with biochemical recurrence (hazard ratio [HR], adjusted for VAT=1.04; 95% confidence interval [CI]=1.02-1.07). Adjusting for obesity (BMI⩾25kg/m(2)), hypertension was also associated significantly with biochemical recurrence (HR=2.08; 95% CI=1.09-3.97). Compared with normotensive patients, those with untreated and uncontrolled hypertension had a significantly increased risk of biochemical recurrence (HR=2.45; 95% CI=1.06-5.66). CONCLUSIONS A higher BP and untreated, uncontrolled hypertension were independent risk factors for biochemical recurrence after prostatectomy. Control of hypertension could be an important treatment strategy for preventing biochemical recurrence.

Factors that allow elderly individuals to stay at home with their families using the Japanese long‐term care insurance system

This study examined the factors that allow elderly individuals to stay at home continuously by considering the roles of the family caregiver, the use of services and characteristics of the elderly individual.

Relationship between body mass index and infertility in healthy male Japanese workers: a pilot study.

Our aim was to evaluate the relationship between men’s body mass index (BMI) and infertility and to examine the effects of factors related to metabolic syndrome such as hypertension, dyslipidaemia, and impaired glucose tolerance. Our sample comprised 74 healthy Japanese workers at a company who were married between 2003 and 2005. The outcome variable was whether a baby was born during the study period (median follow‐up period, 20 months; range, 8–42 months). Data for BMI and other factors were obtained from the results of an annual health checkup in the year of each employee’s marriage. Forty‐seven men (64%) did not father a baby. Having a baby was significantly associated with a low BMI (21.4 versus 23.2 kg m−2; P = 0.006). A Cox proportional hazard regression model was performed to assess the association of BMI with fathering a baby. Adjusting for age, systolic and diastolic blood pressure, low density lipoprotein cholesterol, triglycerides, and haemoglobin A1C, higher BMI was significantly associated with not fathering a baby (hazard ratio, 0.80; 95% confidence interval, 0.67–0.95; P = 0012). High BMI in men was independently associated with an increased risk of not siring a child.