Takayoshi Kanematsu

Impact of real-world stress on cardiorespiratory resting function during sleep in daily life.

To examine if real-world stress affects the restorative function of sleep in daily life, we studied the impact of college examinations on cardiorespiratory resting function during sleep. In healthy college students, at 1 week before, the day before, and the first day of semester-end examinations pulse wave signal during sleep at their own residences was measured continuously with a wristband-shaped wireless transdermal photoelectric sensor. The cardiorespiratory resting function was assessed quantitatively as the power of a high-frequency component of pulse rate variability, a surrogate measure of respiratory sinus arrhythmia. Changes in anxiety were also evaluated with a state anxiety questionnaire. On the day before the examinations, compared with 1 week before, the score of state anxiety increased and the HF component of pulse rate variability decreased. Among college students, anxiety about college examinations may be accompanied by suppression of the cardiorespiratory resting function during sleep.

Lactobacillus in jelly enhances the effect of influenza vaccination in elderly individuals.

dictors of CHF decompensation were infections (hazard ratio (HR) = 4.74, 95% confidence interval (CI) = 2.80– 7.51, P < .01) and arrhythmias (HR = 3.85, 95% CI = 1.94–5.41, P < .001), whereas in younger participants, new myocardial ischemic events (HR = 3.48, 95% CI = 2.11–5.50, P < .001) and valve disease progression (HR = 4.20, 95% CI = 2.57–5.65, P = .06) were more predictive. Finally, the presence of multiple precipitating factors was more predictive of CHF decompensation in older (HR = 2.95, 95% CI = 1.65–5.52, P < .001) than in younger (HR = 1.34, 95 CI = 1.21–2.42, P = .02) adults with decompensated CHF. These results contrast with those of previous studies that reported nonadherence to medications and diet as the main precipitating factors for CHF in older adults. One hypothesis is that, in younger adults, adherence to diet and therapy may be underestimated despite the morefrequent presence of a caregiver in older adults with CHF. According to other studies, infections and hyperkinetic arrhythmias were more predictive of CHF decompensation in older than in younger adults. Both conditions alter diastolic function, which is compromised in the aging heart. In the current study, new ischemic events and valve disease progression were more predictive of CHF decompensation in younger than in older participants. One of the reasons could be that the significant progressive worsening of cardiac disease may significantly reduce cardiac performance in younger but not older adults, in whom the progression of cardiac disease may be irrelevant. Other classical precipitating factors such as hypertensive crisis, anemia, and depression are similar in younger and older adults with decompensated CHF. Finally, multiple identified factors were present in almost half of the older participants in the current study, indicating that comorbidities may play an important role in CHF decompensation in older adults.

Gastroesophageal and laryngopharyngeal reflux symptoms correlate with histopathologic inflammation of the upper and lower esophagus.

Background The presence of laryngopharyngeal reflux disease is controversial when abnormal sensation of the laryngopharynx is felt without heartburn. Goals The aims of this study were to investigate the relationship between abnormal sensation of the laryngopharynx and gastroesophageal reflux, and to elucidate the pathology of laryngopharyngeal reflux disease by investigating histopathologic findings of the upper and lower esophagus. Study Upper and lower esophageal tissues were biopsied by endoscopy in 300 consenting patients, excluding those with serious diseases. Results Fifty-seven patients (19.0%) reported reflux symptoms alone (reflux symptom group), 48 patients (16.0%) reported abnormal sensation of the laryngopharynx alone (abnormal laryngopharyngeal sensation group), and 74 patients (24.7%) reported both reflux symptoms and abnormal sensation of the laryngopharynx (complication group), whereas 121 patients (40.3%) did not report subjective reflux symptoms and abnormal sensation of the laryngopharynx (control group). Histopathologic inflammation of the upper esophagus was significantly greater in the complication and abnormal laryngopharyngeal sensation groups compared with the control group. Histologic inflammation of the lower esophagus was significantly higher in the complication and reflux symptom groups compared with the control group. Conclusions The histopathologic findings of the upper and lower esophagus elucidated an association between gastroesophageal reflux and abnormal sensation of the laryngopharynx.

Comparative evaluation of the Japanese diagnostic criteria for autoimmune pancreatitis.

Objectives: The aim of the study was to clarify the problems of the Japanese criteria for autoimmune pancreatitis (AIP) in comparison with the other criteria. Methods: We retrospectively investigated the clinical, imaging, serological, and histopathogic features, together with other organ involvement and response to steroid, in 50 patients with AIP diagnosed on the basis of the Japanese, Korean, HISORt, and Asian criteria. Thirty-five patients with pancreatic cancer were enrolled as a control group. Results: Forty (80%) of 50 patients received a diagnosis of AIP on the basis of the Japanese criteria. Imaging findings and serological parameters fulfilled the Japanese criteria in 40 (80%) and 50 (100%) of the patients. Pathological findings fulfilled the Japanese criteria in 6 (43%) of 14 patients. All of the 10 patients who did not have a diagnosis of AIP did not fulfill the imaging criteria. Serological parameters fulfilled the Japanese criteria in 8 (23%) of 35 patients with pancreatic cancer. The sensitivities of the Japanese, Korean, HISORt, and Asian criteria for AIP were 80%, 86%, 92%, and 82%, respectively. The specificities of those 4 criteria were 89%, 89%, 97%, and 89%, respectively. Conclusions: The low sensitivity of imaging criteria and low specificity of serological criteria were the problems in the Japanese criteria.

Percutaneous radio-frequency ablation therapy using a clustered electrode for malignant liver tumors.

Goals To examine the safety and effectiveness of percutaneous radio-frequency ablation therapy (PRAT) for malignant liver tumors, using a needle with cluster radio-frequency (RF) electrodes. Study The subjects were 13 patients with solitary malignant liver tumors: 10 had hepatocellular carcinoma and 3 had metastatic liver tumors. One session of PRAT with cluster RF electrodes was performed until roll-off occurred two times. Dynamic computed tomography (CT) and fine needle tumor biopsy under ultrasonographic guidance were conducted to assess the therapeutic efficacy. Aspartate aminotransferase, alanine aminotransferase, lactic dehydrogenase, and total bilirubin were evaluated before and 1, 3, and 7 days after PRAT. Results There were no serious complications. Aspartate aminotransferase, alanine aminotransferase, and lactic dehydrogenase levels peaked 1 day after PRAT and decreased thereafter. No icterus occurred. Of the 13 tumors, 12 showed complete necrosis on dynamic CT; however, one of them showed histologically incomplete necrosis in the tumor biopsy. In both of the ineffective cases, the tumors were located near relatively large vessels. There was no recurrence in the liver in all cases of PRAT that were effective (observation periods: 6–14 months; mean, 10 months). Conclusions Percutaneous radio-frequency ablation therapy using a clustered electrode is a safe and effective treatment of malignant liver tumors, if the tumor is not located near the large vessels.

Enhanced vaccination effect against influenza by prebiotics in elderly patients receiving enteral nutrition

We investigated the effect of prebiotics on the immunological response after influenza vaccination in enterally fed elderly individuals. The intervention group was given an enteral formula containing lactic acid bacteria‐fermented milk products. In addition, two different types of other prebiotics, galacto‐oligosaccharide and bifidogenic growth stimulator, were also given. The two prebiotics improved intestinal microbiota differently. In a control group, a standard formula without prebiotics was given.

Endoscopic injection sclerotherapy for esophageal varices using a transparent hood.

Lymphatic drainage of the testis is to the para-aortic nodes from where duodenal invasion occurs. Spread can also occur hematogenously and by direct invasion. Presenting symptoms were due to duodenal obstruction or chronic blood loss. Our patient is unusual in that initially there was no evidence of metastases or testicular mass prior to his presentation with massive hematemesis. In conclusion, testicular cancer may occasionally present with GI involvement. Hence, the presence of gastrointestinal bleeding or intestinal obstruction in the setting of metastasis in a young man should prompt the consideration of testicular cancer in the differential diagnosis.

The consciousness survey and the effect of educational intervention of Advance Care Planning (ACP) including post-mortem to elderly residents living in old New Town of big city

AIM Awareness reform aims to enable survival in an aging society, and ultimately, improve healthcare. An ideal way to achieve this is by implementing Advance directive (Ad) and Advance Care Planning (ACP), which do not usually include postmortem events. This study aims to create opportunities for Ad and ACP to include the postmortem period as a trigger for this awareness reform. METHODS We conducted an Ad/ACP enlightenment lecture, and a questionnaire survey pre- and post-lecture for the elderly in old New Town, which is known for its aging society. The questionnaire comprised 38 multiple-choice questions covering 6 themes assuming an advanced state of dementia. RESULTS There were 35 participants (7 men and 22 women) aged 40-89 years. Several people left during the lecture, making it difficult to capture the precise transformation effect with regard to changing of mind. However, the effect of enlightenment was identified as a result of the consciousness survey. A statistically significant change in consciousness occurred in response to social contribution after death. Furthermore, notably more people wanted emergency transportation compared to those wanting resuscitation and extension of life. CONCLUSIONS The medical treatment desired might vary over time. Even the desire for life extension may differ significantly among individuals. This survey indicated a divergent view between the general public and medical staff, regarding a series of medical actions. We must persistently promote opportunities for enlightenment in cooperation with the general public (i.e., the communities and families we serve).