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Although the Epworth Sleepiness Scale (ESS) is a scoring system commonly used to assess daytime sleepiness (DS), the association between ESS and motor vehicle accidents (MVAs) remains unclear. Therefore, we conducted a cross-sectional study to examine the association between an increase in the Japanese version of the ESS (JESS) scores and MVAs among Japanese male taxi drivers. The study participants were 1384 Japanese male taxi drivers. DS was assessed using the JESS, and the total JESS scores were categorized into quartile groups. MVA experience during the past five years was assessed using a self-administered questionnaire. A multivariable generalized linear model was used to examine the association between JESS and MVAs after adjusting for age, body mass index, smoking status, snoring, sleep duration, driving experience, driving distance per year, hypertension, and diabetes mellitus. The proportion of MVAs was 59.7%. The multivariable-adjusted prevalence ratio (95% confidence interval) of MVAs for the highest quartile of the JESS score was 1.16 (1.04–1.29) compared to the lowest quartile, and for continuous JESS score was 1.01 (1.002–1.02). Thus, we found a significant association between an increase in JESS scores and MVAs among Japanese male taxi drivers after adjusting for potential confounders. Stratification by sleep duration and snoring status revealed a significant association among long sleepers and non-snorers. Our findings suggest that ESS evaluation methods be reconsidered in relation to MVA among commercial drivers. • The association between Epworth Sleepiness Scale (ESS) and motor vehicle accidents (MVAs) remains unclear. • We examined the association between ESS and MVAs among Japanese male taxi drivers. • Increasing ESS scores was associated with the experience of MVAs. • Higher ESS scores, not the presence or absence of excessive daytime sleepiness, might be associated with MVAs. • ESS evaluation methods will be reconsidered in relation to MVA among commercial drivers. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the validity and reliability of the Japanese version of the severity hierarchy score (J-SHS) in the screening of pediatric obstructive sleep apnea (OSA) among Japanese community children. A total of 922 children from elementary schools in Tokyo were recruited. Their parents completed the J-SHS questionnaire, and the children underwent an overnight Tracheal Sound (TS) recording. The reliability of the J-SHS was assessed by Cronbach's alpha coefficients and Spearman's correlation. Construct validity was determined by factor analysis. The discriminative ability to diagnose OSA was evaluated by constructing ROC curves. Five hundred and seventeen children (51.8% male, mean age 7.1 ± 0.7 years) were included. Cronbach's alpha coefficient was 0.80. Factor analysis resulted in a two-factor structure, with factor loadings all above 0.4. A J-SHS score of >1.88 exhibited a 60% sensitivity, 93% specificity, and an area under the curve (AUC) of 0.78 for detecting an apnea-hypopnea index (AHI) of ≥5/h; a J-SHS score of >2.06 exhibited a 75% sensitivity, 84% specificity and AUC of 0.84 for detecting an AHI of ≥3/h among the children with a snoring frequency above two nights/wk. The J-SHS exhibits good performance as a screening tool providing a quick and straightforward approach for identifying Japanese children at risk for OSA. • The severity hierarchy score (SHS) is a good screening performance for identifying children at risk for OSA. • The Japanese version of the SHS (J-SHS) revealed favourable performance in Japanese community-dwelling children. • There was a remarkably discriminative ability of J-SHS for moderate to severe OSA screening. [ABSTRACT FROM AUTHOR]

Summary Objectives Community-acquired pneumonia (CAP) is associated with high mortality when initial treatment fails. Early identification of these patients allows physicians to modify treatments earlier, increasing survival. Methods Ninety-one hospitalized patients with CAP were studied. Serum soluble ST2 levels were measured at diagnosis and at 3, 7, and 14 days (days 0, 3, 7, and 14) after the initiation of antimicrobial treatment. The predictive value of all-cause in-hospital mortality and the additive effect of soluble ST2 on the pneumonia severity index (PSI) were evaluated. Results In univariate analysis, high serum levels of soluble ST2 at days 0, 3, 7, and 14 were predictive of death (hazard ratios: 3.1, 10.0, 12.0, and 22.6, respectively). In multivariate analysis, a combination of soluble ST2 at day 3 (above 2700 pg/ml) and PSI were predictive of death with higher accuracy than PSI alone (net reclassification improvement, 0.44; integrated discrimination improvement, 0.17; P = 0.001 for both). Specifically, simultaneous presence of high soluble ST2 (day 3) and a PSI of 5 was suggestive of higher mortality risk than a PSI of 5 alone (mortality 78% vs. 39%, respectively). Conclusions Soluble ST2 is prognostic indicator of CAP and can add to the predictive value of the PSI. [ABSTRACT FROM AUTHOR]

The effect of erythromycin on the inflammation caused by exposure to cigarette smoke was investigated in this study. Mice were exposed either to cigarette smoke or to environmental air (control), and some mice exposed to cigarette smoke were treated with oral erythromycin (100 mg/kg/day for 8 days). Pulmonary inflammation was assessed by determining the cellular content of bronchoalveolar lavage (BAL) fluid. The messenger RNA (mRNA) levels of various mediators, including keratinocyte-derived chemokine (KC), macrophage inflammatory protein (MIP)-2, surfactant protein (SP)-D, granulocyte macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor (TNF)-α, interleukin (IL)-6 in lung tissue were determined using quantitative reverse transcription polymerase chain reaction (qRT-PCR) assays. The exposure to cigarette smoke increased significantly the numbers of neutrophils (P = 0.029), macrophages (P = 0.029), and lymphocytes (P = 0.029) recovered in BAL fluid. Moreover, mRNA levels of KC (P = 0.029), MIP-2 (P = 0.029), SP-D (P = 0.029), and GM-CSF (P = 0.057) in the lung tissue were higher in mice exposed to cigarette smoke than in mice exposed to environmental air. In the erythromycin-treated mice that were exposed also to cigarette smoke, both neutrophil and lymphocyte counts were significantly lower in the BAL fluid than those in the vehicle-treated mice (P = 0.029). Erythromycin-treated mice exposed to cigarette smoke showed a trend of lower mRNA levels of KC and TNF-α in the lung tissue than those in the vehicle-treated mice, although the statistical significance was not achieved (P = 0.057). Our data demonstrated that erythromycin prevented lung inflammation induced by cigarette smoke, in parallel to the reduced mRNA levels of KC and TNF-α. [ABSTRACT FROM AUTHOR]

The Fukushima Nuclear Energy Workers' Support study showed the Fukushima nuclear disaster caused psychological distress in the workers, with higher rates of post-traumatic stress responses (PTSR). To understand how the type and duration of emergency recovery work performed immediately following this disaster impacted workers' psychological status, a longitudinal analysis was conducted with 4-year follow-up data since 2011. Fukushima Daiichi nuclear power plant workers were assessed annually with general psychological distress (GPD) and PTSR questionnaires between 2011 and 2014. Combined, 697 Fukushima Daiichi plant workers provided baseline GPD and PTSR in 2011 and their record of working days for approximately one month immediately following the disaster. The relationship between type of emergency recovery work, working days immediately following the disaster, and psychological distress over four years was analyzed using a mixed effects logistic regression model. At baseline, GPD and PTSR scores were significantly higher in nuclear power plant workers who worked 3–5 days immediately following the disaster compared to those who worked only 0–2, particularly in the field engineer subgroup. The effect of working days on GPD remained for over a year, and the impact on PTSR remained significant throughout the four years of observation after the disaster. The Fukushima Daiichi plant field engineers showed significantly higher psychological distress than other workers. The impact of emergency recovery work on psychological distress persisted for over one year, but PTSR in field engineer workers remained significantly elevated four years after the disaster. [ABSTRACT FROM AUTHOR]

Polymer-coated fibrous material has been introduced as the extraction medium for a miniaturized sample preparation method being coupled with microcolumn liquid chromatography. The preconcentration and the subsequent liquid chromatographic separation of tricyclic antidepressants (TCAs) drugs, amitriptyline, imipramine, nortriptyline and desipramine, was carried out with the hyphenated system. Several basic experimental parameters, such as extraction and separation conditions, were investigated along with the applicability of the method for the analysis of biological fluids. The results clearly showed that the on-line coupled system could be a powerful tool for the analysis of complex mixtures in biological matrix without a large solvent consumption and specially designed instruments. The lowest limit of quantification was quite acceptable for the analysis of TCAs in clinical and forensic situations. [Copyright &y& Elsevier]