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Context: Plantar intrinsic foot muscle strength training is difficult to master to a degree sufficient to elicit muscle hypertrophy in most individuals. It is possible that combining neuromuscular electrostimulation (NMES) and blood flow restriction (BFR) can elicit plantar intrinsic foot muscle hypertrophy regardless of the individual's technique. This study aimed to determine the effects of NMES training with BFR on acute muscle swelling in the abductor hallucis. Design: Randomized, controlled, single-blind trial design. Methods: Forty-eight participants were randomly allocated to the NMES + BFR, NMES, or Sham NMES + BFR groups. All participants received abductor hallucis NMES for 15 minutes. Participants in the NMES + BFR and Sham NMES + BFR groups received NMES with BFR. The intensity of NMES was the sensory threshold in the Sham NMES + BFR group. The cross-sectional area of the abductor hallucis was measured pretraining and posttraining using ultrasonography by a single investigator blinded to the participants' allocations. Results: After 15 minutes of training, the cross-sectional area of the abductor hallucis was significantly increased in the NMES + BFR (P<.001) and the Sham NMES + BFR (P = .004) groups. Moreover, the rate of increase was significantly higher in the NMES + BFR group than in the NMES or the Sham NMES + BFR groups (P<.001 and P = . 001, respectively). Conclusions: Since it is possible that the amount of muscle swelling immediately after training correlates with muscle hypertrophy when training is continued, the results of this study suggest that NMES training with BFR is a training method that can be expected to produce plantar intrinsic foot muscle hypertrophy. Further studies are needed to confirm the long-term effects of NMES training with BFR. [ABSTRACT FROM AUTHOR]

Left atrial (LA) enlargement frequently occurs in atrial fibrillation (AF) patients, and this enlargement is associated with the development of heart failure, thromboembolism, or atrial functional mitral regurgitation (AFMR). AF patients can develop LA enlargement over time, but its progression depends on the individual. So far, the factors that cause progressive LA enlargement in AF patients have thus not been elucidated, so that the aim of this study was to identify the factors associated with the progression of LA enlargement in AF patients. We studied 100 patients with persistent or permanent AF (aged: 67 ± 2 years, 40 females). Echocardiography was performed at baseline and 12 (5–30) months after follow‐up. LA size was evaluated as the LA volume index which was calculated with the biplane modified Simpson's method from apical four‐and two‐chamber views, and then normalized to the body surface area (LAVI). The deterioration of AFMR after follow‐up was defined as a deterioration in severity of mitral regurgitation (MR) by a grade of 1 or more. Multivariate regression analysis demonstrated that hypertension (p =.03) was an independently associated parameter of progressive LA enlargement, as was baseline LAVI. In addition, the Kaplan–Meier curve indicated that patients with hypertension tended to show greater deterioration of AFMR after follow‐up than those without hypertension (log‐rank p =.08). Hypertension proved to be strongly associated with progression of LA enlargement over time in patients with AF. Our findings provide new insights for better management of patients with AF to prevent the development of AFMR. [ABSTRACT FROM AUTHOR]

In recent years, the number of patients with heart failure (HF) has been increasing, and there is an urgent need to elucidate the mechanism and establish treatment methods. Although ejection fraction (EF) is one of the most used indices of cardiac function, some HF patients have preserved EF. Therefore, it is important to identify small changes that do not appear in indices such as EF to elucidate the mechanisms of HF and/or cardiac hypertrophy. In this study, we proposed a semi‐automatic method for extracting regions inside the ventricle for analysis. Furthermore, we proposed a data‐driven analysis method and applied it to mice with mild transverse aortic constriction (TAC) in which EF did not change much. We created a model that distinguishes the echo images of mice before and after mild TAC using bag‐of‐features and evaluated the differences in phase and position. After parameter optimization, the best models showed greater than 89% classification performance. In these models, end‐systolic phase and proximity to the ventricular boundary were found to be important in discriminating between the two types of mice. © 2023 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test the psychometric properties of the Japanese version of Frenchay Dysarthria Assessment (FDA-2) and to use this tool to describe the features of speech in patients with Duchenne muscular dystrophy (DMD). The Japanese version of FDA-2 was culturally adapted, and reliability and validity were examined in 22 and 50 patients, respectively. The Japanese version of FDA-2 was administered to 51 patients with DMD. Multiple regression analysis was performed to identify factors related to FDA-2 scores. Inter-/intra-rater reliabilities (ICCs) and internal consistency (Cronbach's α) for total scores were 0.76, 0.97, and 0.94 respectively. For construct validity, two-way ANOVA showed a significant interaction between the disorders and FDA-2 sections (p < 0.05). In DMD patients, the item of tongue at rest was most severely affected, reflecting tongue hypertrophy. Multiple regression analysis identified age, swallowing status, and ventilator use as significantly related. The results showed that the Japanese version of FDA-2 has satisfactory reliability and validity. The present study demonstrated the features of dysarthria and related factors in patients with DMD. In Duchenne muscular dystrophy (DMD), an absent or defective dystrophin protein causes progressive weakness of respiratory and oropharyngeal muscles, both of which are crucial contributors to speech production. This study shows that the Japanese version of FDA-2 has satisfactory reliability and validity compared to original version. The Japanese version of FDA-2 characterizes dysarthria in patients with DMD in this cohort. [ABSTRACT FROM AUTHOR]

Left ventricular hypertrophy commonly occurs in dialysis patients and is associated with a risk of developing cardiovascular disease events and all-cause mortality. Although hypertension treatment reduces left ventricular mass index (LVMI) in hemodialysis patients, the relationships of prescription pattern, dose, and changes in the dose of antihypertensive drugs with LVMI have not been completely elucidated. Here, we hypothesized that volume reduction would lead to a decrease in the antihypertensive drug dose and subsequently to a reduction in LVMI; conversely, fluid retention would lead to an increase in the antihypertensive drug use and, subsequently, to LVMI progression. To assess this hypothesis, we investigated the relationship between changes in the dose of antihypertensive drugs and subsequent changes in LVMI in 240 patients who had just started hemodialysis using a retrospective hemodialysis cohort in Japan. Using multiple linear regression analysis, we assessed the association between changes in the antihypertensive drug dose over 1 year after hemodialysis initiation and changes in LVMI during this period. A decrease and an increase in the antihypertensive drug dose were significantly associated with a reduction in LVMI (vs. no change; β = – 17.386, p <.001) and LVMI progression (vs. no change; β = 16.192, p <.001), respectively. In conclusion, our findings suggested that volume reduction, leading to a decrease in the use of antihypertensive drugs, is a therapeutic strategy in patients undergoing hemodialysis to prevent LVMI progression. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine whether long-term ingestion of low-dose milk protein supplementation causes a greater increase in muscle mass and strength of older adults during low-to-moderate intensity exercise training intervention than isocaloric carbohydrate. Methods: In a randomized, double-blind, and placebo-controlled design, 122 healthy older adults (60–84 year) received either an acidified milk protein drink containing 10 g of milk protein (MILK; n = 61) or an isocaloric placebo drink (PLA; n = 61) daily throughout 6 months of body weight and medicine ball exercise training. Measurements before and after the intervention included body composition, physical performance and blood biochemistry. Results: Lean body mass significantly increased in the MILK group (+ 0.54 kg, p < 0.001), but did not change in the PLA group (− 0.10 kg, p = 0.534). The increases in the MILK group were significantly greater than in the PLA group (p = 0.004). Fat mass (− 0.77 kg) and plasma uric acid levels (− 0.3 mg/dL) significantly decreased only in the MILK group (p < 0.001), with a significant group difference (p = 0.002 and p < 0.001, respectively). Most of the physical performance tests significantly improved in both groups, but no group differences were found. Conclusion: We conclude that low-dose milk protein supplementation (10 g of protein/day) combined with low-to-moderate intensity exercise training is associated with increased muscle mass, but not improved physical performance compared to carbohydrate combined with exercise in healthy older adults. This study was registered in the UMIN Clinical Trials Registry (UMIN000032189). [ABSTRACT FROM AUTHOR]

The European Society of Toxicologic Pathology organized an expert workshop in May 2018 to address adversity considerations related to thyroid follicular cell hypertrophy and/or hyperplasia (FCHH), which is a common finding in nonclinical toxicity studies that can have important implications for risk assessment of pharmaceuticals, food additives, and environmental chemicals. The broad goal of the workshop was to facilitate better alignment in toxicologic pathology and regulatory sciences on how to determine adversity of FCHH. Key objectives were to describe common mechanisms leading to thyroid FCHH and potential functional consequences; provide working criteria to assess adversity of FCHH in context of associated findings; and describe additional methods and experimental data that may influence adversity determinations. The workshop panel was comprised of representatives from the European Union, Japan, and the United States. Participants shared case examples illustrating issues related to adversity assessments of thyroid changes. Provided here are summary discussions, key case presentations, and panel recommendations. This information should increase consistency in the interpretation of adverse changes in the thyroid based on pathology findings in nonclinical toxicity studies, help integrate new types of biomarker data into the review process, and facilitate a more systematic approach to communicating adversity determinations in toxicology reports. [ABSTRACT FROM AUTHOR]

Twin to twin transfusion syndrome (TTTS) is a major complication of monochorionic diamniotic (MD) twins, and its onset is known to be associated with placental vascular anastomoses and blood flow imbalance. In a typical case of TTTS, the recipient develops polyhydramnios, weight gain, cardiomegaly and hydrops fetalis in the uterus. In contrast, the donor develops oligohydramnios and intrauterine growth restriction. Recently, the significance of the renin-angiotensin-aldosterone system (RAAS) that transfers from the donor to the recipient has attracted interest in the fetal circulation of TTTS. The donor has decreased renal blood flow due to decreased circulating blood volume. For this reason, the secretion of RAAS hormones is augmented in the fetal kidneys of the donor. In TTTS, these RAAS hormones from the donor transfer to the recipient through the anastomosed vessels. In addition to excess preload, the recipient heart is exposed to excess afterload due to systemic vasoconstriction through RAAS hormones. Commonly occurring complications in the recipient include myocardial hypertrophy, atrioventricular valve regurgitation, and pulmonary valve stenosis or pulmonary atresia. Fetoscopic laser photocoagulation (FLP) has been introduced recently because neither mortality nor neurological morbidity have been satisfactorily improved with conventional treatment. FLP is a curative method that may improve the prognosis of TTTS. In Japan, this procedure has been performed frequently, and positive neurological outcomes have been achieved. [ABSTRACT FROM AUTHOR]

Fabry disease is a hereditary disorder that occurs due to the reduction or absence of alpha-galactosidase A activity, which leads to cardiac involvement including left ventricular hypertrophy (LVH). Enzyme replacement therapy (ERT) provides better patient outcomes by preventing serious complications. However, there have been very few studies on the long-term effects of ERT on the cardiac manifestations in Japanese Fabry patients. We retrospectively analyzed the data from the medical records of 42 Fabry patients (male, n  = 17; female, n  = 25) who were followed at Jikei University Hospital, and in whom the long-term effects of ERT could be evaluated (median follow-up period: male, 11 years; female, 8 years). The slope of the left ventricular mass (LVM) increase was 3.02 ± 3.41 g/m 2 /year in males and 1.69 ± 2.73 g/m 2 /year in females. In a subgroup analysis, the slopes of males with and without LVH did not differ to a statistically significant extent; however, the slope in female patients without LVH was significantly smaller than that of female patients with LVH. We then compared our data to the natural historical data that have previously been reported. In comparison to the previously reported data, we found a significant reduction in the LVM changes (g/height 2.7 /year) of patients who received long-term ERT (male, 4.07 ± 1.03 to 1.25 ± 1.39; female, 2.31 ± 0.81 to 0.78 ± 1.23). Long-term ERT effectively prevents LVH in Fabry patients. This effect was also observed in the patients with LVH prior to the initiation of ERT. [ABSTRACT FROM AUTHOR]

To examine the effect of long-term daily training on athletes' skeletal muscle, this study determined the relation between their muscle thickness and passive muscle stiffness, and compared the muscle thickness and muscle stiffness between athletes and non-athletes. Participants were elite Japanese athletes (278 men, 200 women) from various sports and non-athletes (35 men, 35 women). Rectus femoris (RF) muscle thickness was measured using B-mode ultrasonography and was normalized to the total body mass (muscle thickness/body mass1/3). RF passive muscle stiffness (shear modulus) was assessed by ultrasound shear-wave elastography. There was a negligibly significant correlation between muscle thickness and muscle stiffness in male athletes (p = 0.003; r = -0.18) but not in female athletes (p = 0.764; r = 0.02). Among men, muscle thickness was significantly greater in athletes than non-athletes (p < 0.001), whereas muscle stiffness was significantly less in athletes than non-athletes (p = 0.020). Among women, muscle thickness was significantly greater in athletes than non-athletes (p < 0.001), whereas muscle stiffness did not differ significantly between athletes and non-athletes (p = 0.412). These results suggest that the effect of long-term daily training performed by athletes on muscle stiffness is more complicated than that on muscle thickness. [ABSTRACT FROM AUTHOR]

Influence of different load exercise to muscle activity during subsequent exercise with 75% of one repetition maximum (RM) load among trained and untrained individuals was verified. Resistance-trained men who were involved in resistance training (n = 16) and healthy young men who did not exercise regularly (n = 16) were recruited for this study. Each subject performed bench pressing with a narrow grip exercise using two different training set methods, the drop-set (DS) (3 sets x 2-10 repetitions with 95-75% of 1RM) and the reverse drop-set (RDS) (3 sets x 3-10 repetitions with 55-75% of 1RM). The mean concentric contraction power, root mean square (RMS) of electromyogra-phy (EMG), area under the oxygenated hemoglobin (Oxy-Hb) curve, and time constant for muscle oxygen consumption (TcVO2mus) values of the triceps brachii were measured during and after the DS and RDS. The trained group demonstrated significantly higher mean muscle power (242.9 ± 39.6 W vs. 215.8 ± 31.7 W), RMS of EMG (86.4 ± 10.4 % vs. 68.3 ± 9.6 %), and area under the Oxy-Hb curve (38.6 ± 7.4 % • sec vs. 29.3 ± 5.8 % • sec) values during the DS than during the RDS (p < 0.05). However, in the untrained group none of the parameters differed significantly for both the DS and RDS. Furthermore, a negative correlation was detected between the area under the Oxy-Hb curve and muscle thickness (r = -0.51, p < 0.01). Long-term effects of DS on muscle strengthening and hypertrophy will be explored in further research. [ABSTRACT FROM AUTHOR]

This study examined the effects of regular post-exercise cold application on muscular and vascular adaptations induced by moderate-intensity resistance training. 14 male subjects participated in resistance training: 5 sets of 8 wrist-flexion exercises at workload of 70-80% of the single repetition maximum, 3 times a week for 6 weeks. 7 subjects immersed their experimental forearms in cold water (10±1°C) for 20min after wrist-flexion exercises (cooled group), and the other 7 served as control subjects (noncooled group). Measurements were taken before and after the training period; wrist-flexor thickness, brachial-artery diameter, maximal muscle strength, and local muscle endurance were measured in upper extremities. Wrist-flexor thicknesses of the experimental arms increased after training in both groups, but the extent of each increase was significantly less in the cooled group compared with the noncooled group. Maximal muscle strength and brachial-artery diameter did not increase in the cooled group, while they increased in the noncooled group. Local muscle endurance increased in both groups, but the increase in the cooled group tended to be lower compared to the noncooled group. Regular post-exercise cold application to muscles might attenuate muscular and vascular adaptations to resistance training. [ABSTRACT FROM AUTHOR]

• Age-related heart changes in two groups of Japanese people were compared. • Of 400 sudden deaths during bathing, 136 cases (34%) had hypertension. • Cardiac hypertrophy was found in 30% of the people who died suddenly during bathing. • Elderly people, with or without heart disease, can die suddenly while bathing. • Elderly people should not be left totally unsupervised while they bathe. We analyzed 400 deaths that occurred in the bathtub during a 10-year period in the central area of Kanagawa prefecture in Japan. There were 72 (18%) medico-legal autopsy cases. The average age at death was 76.4 ± 11.9 years. Drowning (n = 21, 70.8%) was the most common cause of death in the 72 autopsy cases. The study examined the bodies of 40 cases within a postmortem interval of 3 days. The mean age of the 40 cases of sudden death during bathing was 68.6 ± 12.5 years. Results revealed cardiac hypertrophy in 12 cases (30%), lipofuscin deposition in 39 cases (97.5%), basophilic degeneration in 12 cases (30%), anisocytosis of the nucleus of myocardial cells in 18 cases (45%), perivascular fibrosis in 17 cases (42.5%), amyloid deposits in 1 case, and aortic valve calcification in 1 case. The hearts of control subjects who had lived to 20–99 years were also examined; the frequency of each change was higher in people older than 70 years. There was no statistically significant difference in age-related cardio-pathological changes between cases of sudden death during bathing in people in their 70s and controls in their 70s. It can be concluded that this age-related histopathological index is not related to sudden death during bathing. A large number of elderly people, including those without heart disease, have died during bathing. Preventive measures against sudden death during bathing are strongly recommended, e.g., elderly people should not be left totally unsupervised while they bathe. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare the temporal expression of myosin heavy chain (MyHC) isoforms, Pax7, and myogenic regulatory factors (MRF) between heavy weight (HW) and random bred control (RBC) Japanese quail lines during muscle development to better understand the mechanisms leading to increased skeletal muscle mass in the HW quail line selected for a greater BW at 4 wk of age separated from RBC quail. Expression of neonatal MyHC isoform began at 3 and 7 d posthatch in RBC and HW quail lines, respectively. In the RBC quail line, adult MyHC isoform, as a marker for muscle maturation, was expressed at 28 d posthatch with sustained expression through 75 d posthatch, whereas this protein was detected only at 75 d posthatch in the HW quail line. Moreover, Pax7 expression continued from embryonic ages to 14 d posthatch in the HW quail line and to 7 d posthatch in the RBC quail line. These expression patterns of MyHC isoforms and Pax7 in the HW quail line were accompanied by delayed muscle maturation and prolonged growth compared with the RBC quail line. Temporal expressions of the primary MRF showed that higher expression levels of MyoD and Myf-5 were observed at 9 and 11 d embryo in the HW quail line compared with the RBC quail line ( P < 0.05). The HW quail line exhibited approximately 2 times greater average levels of myogenin expression from 7 to 75 d posthatch (P < 0.05) than the RBC quail line. Prolonged upregulation of these primary and secondary MRF during muscle development is associated with delayed maturation and continued muscle growth, which consequently would permit muscle hypertrophic potentials in the HW quail line compared with the RBC quail line. [ABSTRACT FROM AUTHOR]

Aim To study whether there is an association between serum immunoglobulin G4 ( IgG4) concentration and cardiac function among cardiology inpatients. Methods This retrospective study included 91 patients who had sinus rhythm. Of 91 patients, 70 patients (77%) were aged ≥60 years (elderly group) and the remaining 21 patients (23%) were aged <60 years (younger group). Results Serum IgG4 concentrations were found to be negatively correlated with brain natriuretic peptide ( BNP) and with E/e′, an indicator for cardiac diastolic function in the elderly group, but not in the younger group. In contrast, IgG4 was significantly correlated with neither left ventricular mass nor ejection fraction in either group. Multivariate regression analysis showed that, in the elderly group, the association between IgG4 and E/e′, and that between IgG4 and BNP, were independent of age, sex, systolic blood pressure and renal function; log-transformed IgG4 showed a negative association with log-transformed E/e′ and log-transformed BNP, with a standardized correlation coefficient of −0.26 (95% confidence interval −0.49 to −0.03, P = 0.030 and −0.22 (95% confidence interval −0.44 to −0.11, P = 0.043), respectively. Conclusion Serum IgG4 concentration might be associated with cardiac diastolic function among elderly cardiology inpatients. Geriatr Gerontol Int 2014; 14: 582-588. [ABSTRACT FROM AUTHOR]

The article discusses research investigating the effects of training volume on upper limb muscular strength and hypertrophy. The team recruited eight sedentary, untrained young Japanese men. The men trained their elbow flexor muscles twice per week for 12 consecutive weeks using a crossover-like design in which their arms randomly assigned to training with one or three sets of weights. The impact of a three-set protocol for sedentary untrained individuals is discussed.

Conclusion: Rhinomanometry is a useful method for evaluating nasal airway patency in schoolchildren, and we could confirm the validity of the results it produces. Objective:Our purposewas to assess the validity nasal resistancemeasurements produced using anterior active rhinomanometry by comparing the resultswith thoseofour previous study andtodetermine anormal value of thenasal resistance. Methods: Nasal resistance was measured by rhinomanometry in 852 children using the active anterior method. Results: Mean nasal resistance was 0.45 ±0.70 Pa/cm3/s.Nasal diseases were noted in 358 (42%) children, and nasal condition was normal (the normal group) in 494 (58%) children. Nasal resistance was 0.57 ±1.05 Pa/cm3/s in the nasal disease group and 0.35 ± 0.16 Pa/cm3/s in the normal group, showing that resistance was significantly higher in the nasal disease group. In the normal nasal groups, nasal resistance tended to be lower in the children in higher grades (first grade, 0.44 ±0.17 Pa/cm3/s; second grade, 0.37 ± 0.11 Pa/cm3/s; third grade, 0.36 ±0.23 Pa/cm3/s; fourth grade, 0.36 ±0.14 Pa/cm3/s; fifth grade, 0.30 ±0.08 Pa/cm3/s; sixth grade, 0.29 ±0.11 Pa/cm3/s), and taller groups (<120 cm, 0.43 ±0.16 Pa/cm3/s; 120-130 cm, 0.37 ±0.19 Pa/cm3/s; 130-140cm, 0.34±0.12 Pa/cm3/s; >140 cm, 0.28±0.09 Pa/cm3/s).Results similar to those seen in our previous studywere obtained in each group [ABSTRACT FROM AUTHOR]

The GIFU substudy of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial was conducted to compare the long-term effects of candesartan and amlodipine on office- and home-measured blood pressure (BP), QTc dispersion and left ventricular mass index (LVMI) in high-risk Japanese patients with hypertension. We used a prospective, randomized, open-label design with blinded assessment of endpoints. Patients were assigned to candesartan-based therapy up to 12 mg/day ( n == 100) or amlodipine-based therapy up to 10 mg/day ( n == 101) and followed for 3 years. LVMI was assessed by echocardiography and QTc dispersion was obtained from electrocardiograms. Both candesartan and amlodipine lowered and controlled office- and home-measured BP levels with no significant between-treatment differences. In patients diagnosed with left ventricular hypertrophy (LVH) at baseline, both candesartan and amlodipine significantly regressed LVMI after 3 years. However, candesartan (41.7 ±± 15.1 ms at baseline vs 32.9 ±± 16.6 ms after 3 years, p < 0.01), but not amlodipine (41.4 ±± 13.5 ms at baseline vs 41.5 ±± 16.1 ms after 3 years), produced a significant reduction in QTc dispersion. Larger studies in patients treated for longer periods are needed to determine whether this candesartan effect will translate into improved prognosis in terms of cardiovascular mortality and morbidity. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents evidence for severe lead contamination among children of samurai families living in a castle town in Edo period Japan (1603–1867). Excavated rib bones were analyzed by atomic absorption, and soft X-ray roentgenograms of long bones were taken. The median values of lead concentration in the bones of children 3 years of age and under(1241.0 μg Pb/g dry bone) and 4–6 years of age (462.5 μg Pb/g dry bone) were significantly higher than those of adult males (14.3 μg Pb/g dry bone) and females (23.6 μg Pb/g dry bone) (p < 0.001). In addition, that of children over 6 years of age (313.0 μg Pb/g dry bone) was significantly higher than those of adult males (p < 0.01) and adult females (p < 0.05). The median value of lead in the bones of children 3 years of age and under was over fifty times higher than that of their mothers (adult females). Hypertrophy was seen in the long bones of five samurai children. In this area, lead lines or lead bands were distinguished by soft X-ray roentgenogram. Samurai children suffered from severe lead contamination in Edo period Japan. When the mothers were nursing their children, the children might have ingested their mother’s white lead non-selectively. [ABSTRACT FROM AUTHOR]

Recently we provided a new interpretation that increased serum ALP in dogs is not adverse if no hepatotoxic finding coexists in the analysis of toxicity studies of over 200 pesticides evaluated in Japan (Yokoyama et al., 2019). We also proposed a decision tree to evaluate the adversity of the increased ALP. The present analysis was conducted to validate the reliability of this interpretation with 129 pesticides more recently evaluated. Before applying, the decision tree was revised to be consistent in all steps. The pesticides showed similar characterization of increased ALP to the previous analysis in that the increase was more frequent than in rats and that liver hypertrophy and hepatotoxicity commonly coexisted with an increase in ALP in dogs. When short- and long-term studies of 58 pesticides inducing ALP activity in dogs were applied to the revised tree, the increased ALP in 8 pesticides was judged not adverse in either study. The revision of the tree did not affect the NOAEL judgment of these pesticides; however, the revised routes contributed to the judgment more robustly. This study showed the reliability of our interpretation and applicability of the decision tree to evaluate the adversity of increased ALP in dogs. • ALP increase coexisting hepatotoxicity was interpreted not to be adverse in dogs. • The interpretation was validated using 129 pesticides evaluated most recently. • A decision tree to evaluate the adversity was improved for consist validation. • The validation showed the interpretation was reliable in dogs. • The revised decision tree was applicable to evaluate the adversity of ALP increase [ABSTRACT FROM AUTHOR]

Three hundred Japanese patients with benign prostatic hyperplasia (BPH) who started an α1-adrenoceptor blocker, tamsulosin, between 1993 and 1996 were followed for 3.0 ± 3.3 years (mean ± SD) to determine whether an association existed between the disease severities measured prior to the tamsulosin treatment and the timing at which the invasive therapy was implemented. Patients with a lower quality of life (QOL) index or maximum urinary flow rate (Qmax) were transferred for invasive therapy earlier than those with less severe BPH. The International Prostate Symptom Score (I-PSS) was also associated, but apparently to a lesser extent, with the timing of the invasive therapy. Finally, the overall severity evaluated using all of the above three indices, I-PSS, QOL index, and Qmax, in accordance with the ‘Severity Criteria for BPH’ issued by the Japanese Urological Association, was found to be a good measure for predicting the prognosis of patients with BPH treated with tamsulosin. [ABSTRACT FROM AUTHOR]

Abstract Evidence-based diagnosis and treatment have been proposed recently in various medical fields. Evidence-based diagnostic and therapeutic guidelines for benign prostatic hypertrophy (BPH), one of the most common urological diseases, have been proposed in foreign countries. This paper examines common therapeutic drugs for BPH in Japan from the viewpoint of evidence-based medicine (EBM). The term ‘BPH’ and drugs indicated for BPH were used as key words to search related articles in the PubMed website. A total of 813 articles extracted as of October 2001 were examined. The articles were ranked in levels ranging from I–V, where Level I indicated a large randomized controlled trial and Level V indicated a non-controlled case accumulation study. Among the 813 articles extracted, 132 clinical articles were suitable for evaluation. There were many reliable articles on the effectiveness of α-blockers. However, it seemed necessary to examine further how to choose the optimum α-blocker for each clinical case and the combination of antiandrogen drugs with α-blockers. It was also considered necessary to evaluate the effectiveness of drugs, such as eviprostat and hachimi-jio-gan, that are available only in Japan. The present study evaluated the effectiveness of commonly available therapeutic drugs for BPH in Japan from a viewpoint of EBM. [ABSTRACT FROM AUTHOR]

Abstract Background Using the percentage (of total) of free prostate-specific antigen (PSA) in discriminating prostate cancer (CaP) from benign prostate hyperplasia (BPH) has not been fully delineated in Japanese men. To clarify the clinical significance of percent free PSA, various parameters, including total prostate volume, percent free PSA, PSA density (PSAD) and PSA density of transition zone volume (PSAT), were compared. Methods Ninety-seven patients who had visited one of three community-based hospitals, and whose total PSA value ranged from 4 to 20 ng/mL were prospectively enrolled in this study. Fresh sera were applied to measure the percent free PSA. Results Of the 97 patients, CaP and BPH were diagnosed in 24 (25%) and 73 patients, respectively. In discriminating CaP patients, the cutoff values of 17% for percent free PSA, 0.3 ng/mL per cm3 for PSAT, and 0.19 ng/mL per cm3 for PSAD yielded specificity levels of 56, 40 and 58% at sensitivity levels of 92, 92 and 79%, respectively. As for the 65 patients with intermediate PSA, range 4–10 ng/mL, and normal digital rectal examination, the percent free PSA and total prostate volume statistically discriminated CaP patients from BPH patients. A multiple logistic regression model proved percent free PSA to be the only significant discriminating factor (P = 0.045; odds ratio, 9.06). Conclusions This prospective study revealed percent free PSA to be a significant useful predictor in discriminating CaP from BPH in Japanese men. [ABSTRACT FROM AUTHOR]

To elucidate the etiology of hypertrophic cardiomyopathy (HC) in humans, we analyzed the delta-sarcoglycan gene (SG), which is reported to be the causal gene for HC in the Syrian hamster BIO14.6. We performed polymerase chain reaction (PCR) single-strand conformation polymorphism (SSCP) and nucleotide sequence analyses on the delta-SG in 102 patients with HC. SSCP was detected in exon 2 of the gene, but not in the other exons. The direct sequencing analysis of exon 2 revealed a C-->T substitution at nucleotide residue 84 (TAC-->TAT) with no amino acid alteration (Tyr-->Tyr). There were no significant differences in allele frequencies of C/T between the patients with HC and the control group. Patients with HC were classified into 4 subgroups: obstructive HC, nonobstructive HC, apical HC, and familial HC. The allele frequency of C/T polymorphism in each of these groups was compared with that of the control group. The obstructive HC group showed a significantly greater frequency of the allele T than in the control group (31.6% vs 15.1%, RR = 2.6, p = 0.023). No other significant differences were observed. Thus, amino acid alteration in delta-SG may not be a common cause of HC in Japanese patients. [ABSTRACT FROM AUTHOR]

Analyzes the sigma-sarcoglycan gene to elucidate the etiology of hypertrophic cardiomyopathy in Japanese patients. Detection of single-strand conformation polymorphism in exon 2 of the gene; Substitutions found in the direct sequencing analysis of exon 2; Allele frequency of polymorphism.

Objective To compare the efficacy and safety of an incremental‐dose regimen of terazosin (1–2 mg daily) and a fixed‐dose regimen of tamsulosin (0.2 mg daily), on Japanese patients with symptomatic benign prostatic hyperplasia (BPH). Patients and methods This multicentre, single‐blind, randomized trial compared terazosin and tamsulosin over 4 weeks, in 61 patients with symptomatic BPH randomly assigned to terazosin (n = 31) or tamsulosin (n = 30). Terazosin 0.5 mg twice daily was administered for 2 weeks, followed by 1 mg twice daily for 2 weeks. Tamsulosin (0.2 mg) was administered once daily for 4 weeks. Symptoms were evaluated using the International Prostate Symptom Score (IPSS), and quality of life (QOL) was assessed subjectively before treatment, and again after 2 and 4 weeks of treatment. Objective measurements taken before and after the treatment period were the maximum (Qmax) and average (Qave) urinary flow rates, and the percentage residual urine volume. Improvement was defined as a 25% decrease from baseline in IPSS, > 1 point increase in QOL score, and > 2.5 mL/s increase in Qmax. Adverse reactions potentially related to the study drugs were recorded throughout the treatment period. Results Both terazosin and tamsulosin produced statistically significant improvements in subjective and objective variables. Neither treatment affected systolic or diastolic blood pressure or pulse rate. Adverse reactions were noted in four patients (three in the terazosin group and one in the tamsulosin group). However, there was no statistically significant difference in the incidence of adverse effects between the groups. Conclusions Despite the limitations of small sample size and relatively short treatment periods, terazosin and tamsulosin were equally effective in the treatment of symptomatic BPH in Japanese patients, using relatively lower doses than those used in Western countries. [ABSTRACT FROM AUTHOR]

Mechanical circulatory support for acute biventricular failure is challenging. Given that durable VAD is available only for LV support as bridge-to-transplantation in Japan, the treatment options for this pathology are limited to extracorporeal biventricular assist device (BiVAD) support first, which can be subsequently upgraded to durable LVAD in cases having recovery of RV function and transplant candidacy. The purpose of this study was to review the outcomes of extracorporeal BiVAD and to explore factors associated with the outcomes. This study enrolled an institutional consecutive series of 39 cases who underwent extracorporeal BiVADs implantation for acute biventricular failure between April 2014 and October 2020. The etiological diagnosis was myocarditis in 27 cases, acute MI in 6 cases, and dilated cardiomyopathy (DCM) in 6 cases. The cases were assigned into the two groups according to the BiVAD support less than 7 days (n=18, Short group) or 7 days or more (n=21, Long group). The Long group consisted of 6 cases of acute MI (100%), 13 cases (48%) of myocarditis, two cases of DCM (33%). There was no case who deceased within 7 days after BiVAD implantation. In the Short group, extracorporeal LVAD was weaned-off in 11 cases (61%) or upgraded to durable LVAD in 6 cases after withdrawal of RV support within 7 days. The remaining one case deceased under extracorporeal LVAD. In the Long group, RV support was discontinued in 10 cases in the median support of 60 days (IQR; 24.2-76.8), while two cases were on BiVAD support at October 2020. The remaining nine cases (43%) deceased under BiVAD support in-hospital. Survival and VAD-free survival at 1 year were 79% and 56% in the Short group versus 48% and 20% in the Long group, respectively. Outcomes of extracorporeal BiVAD support for acute biventricular failure were dependent on recovery of RV function. Targeting approach for RV function would be warranted for poor biventricular function. [ABSTRACT FROM AUTHOR]

• Heart weight grows with age until the age of 20 years and remains stable thereafter. • Cutoff heart weight for cardiovascular death (CVD) is 407 g in men and 327 g in women, respectively. • Cutoff heart weight/body height was 2.38 g/cm in men and 2.15 g/cm in women, respectively. • Heart weight is a more useful predictor of CVD in men than in women. • Heart weight is a better predictor of CVD than body mass index. Cardiac hypertrophy is a clinical risk factor for cardiovascular death (CVD) frequently recorded in autopsy reports, but the diagnostic criteria for the condition have not been clearly-established for autopsy. This study aimed to estimate the cutoff value for hypertrophic heart weight that can efficiently assist the postmortem diagnosis of CVD. We analyzed accumulated autopsy data from 3534 individuals aged 0–101 years. We found that heart weight increased linearly with a person's age until 20 years, after which it remained stable. The mean heart weight in CVD cases was 473 g in men and 379 g in women. The mean heart weight in non-CVD cases was 385 g in men and 320 g in women. Receiver operating characteristic curve analysis for CVD assessment revealed that the cutoff value of heart weight was 407 g (odds ratio of 4.2) in men and 327 g (2.6) in women, and that of heart weight/body height was 2.38 g/cm (4.0) in men and 2.15 g/cm (2.6) in women, respectively. Overall, heart weight was a more useful predictor of CVD in men than in women. In logistic regression analysis, the predictive power of heart weight for CVD was higher than that of body mass index in both sexes. Thus, the criteria for hypertrophic heart weight are practical and useful for autopsy recordings, and it can be helpful for postmortem diagnosis of CVD. Our report is the first to reveal the cutoff value for hypertrophic heart weight in the Japanese population. [ABSTRACT FROM AUTHOR]

Background: The effect of aging on the components of the cardiothoracic ratio (CTR) in the chest roentgenogram in women remains obscure. There have been only a few reported studies that have investigated longitudinal changes of the CTR in women.Objective: To determine whether there is an effect of aging on the CTR in women.Methods: The study population consisted of 110 women who attended an annual health screening and underwent chest roentgenography both in 1981 and 1990 in a mountain village in Japan. We used the data obtained from an annual health screening in order to determine thoracic diameter (TD), cardiac diameter (CD), and lung height (LH) and then calculated the CTR. We analyzed CTR, TD, CD, and LH on the basis of the age of the participants.Results: In the cross-sectional analysis of the groups stratified by age in 1981, mean CD and CTR increased, and TD decreased in the advanced-age group. The percentage of radiographic cardiomegaly (CTR >50%) strikingly increased in the advanced-age group. In the longitudinal analysis between 1981 and 1990, the mean CD increased, and the mean TD decreased significantly. The mean CTR increased by 2.0% (95% CI 1. 2-2.8%). The changes of the CTR in 9 years were positively correlated with those of CD and negatively correlated with those of TD and LH. The longitudinal data generally accorded with the cross-sectional data, except LH.Conclusions: The CTR in women increases with aging as a result of the increase in CD, except in the case of advanced old age, and the decrease in TD. LH could be another major factor that has an influence on CTR. Caution should be exercised to avoid overestimating CTR when LH changes. The classical upper limit of 50% for CTR in our adopted method should not be applied to elderly women because of the possibility that changes with normal aging are misclassified as abnormal findings. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 20-month-old girl who was admitted to the hospital with compensated shock and hypoxia along with dyspnea and deteriorated respiration. It talks about the girl being diagnosed with non-typeable Haemophilus influenzae pericarditis which was detected through chest radiography.

72-year-old woman with a history of lower extremity weakness, pain, and sensory loss in the right thigh for the last 15 months had deteriorated during a period of 6 months. Magnetic resonance imaging of the lumbosacral spine revealed apparent nerve root thickening from L1 to S and spinal canal stenosis. An L1-L3 decompressive laminectomy and durotomy revealed multiple segmentally enlarged and congestive nerve roots. A 1-mm segment of nerve root was resected and submitted for pathological analysis. The pathological examination revealed hypertrophic neuropathy, with nonspecific inflammation. After steroid use, the patient's symptoms improved. HNCE is a rare disorder that can cause pain and lower extremity weakness, sensory loss, and hyporeflexia. One possible cause is chronic inflammatory demyelinating polyneuropathy (CIDP), but the intrathecal nerve roots are enlarged only patchily and canal stenosis is also present, so the diagnosis is unclear. As this case demonstrates, surgical management and administration of steroids are an effective treatment for some HNCE. [ABSTRACT FROM AUTHOR]

Study design:This is a case report of a patient with hypertrophy of the posterior longitudinal ligament (HPLL) in the thoracic spine. This patient was followed for 10 years after surgery.Objectives:The purpose of this study was to report the long-term outcome of HPLL in the thoracic spine.Setting:Department of orthopedic surgery, Hiroshima Red Cross and Atomic-bomb Survivors Hospital, Hiroshima, Japan.Methods:A 58-year-old-woman with thoracic HPLL was reported. Magnetic resonance image (MRI) and computed tomography (CT) showed the expanded spinal cord compression from Th4 to Th12 due to HPLL. Anterior decompression and fusion (Th10–12) was performed. Histological findings of the surgical specimens showed thickening of the posterior longitudinal ligament with proliferation of chondroid tissue. The clinical outcome and the radiological findings (CT and MRI) were evaluated 10 years after surgery.Results:The patient was asymptomatic postoperatively. However, the subsequent CT examination revealed ossification of the previously hypertrophied posterior longitudinal ligament.Conclusions:HPLL in the thoracic spine is a rare pathological condition causing myelopathy. The results of this study support the hypothesis that HPLL is one of the prodromal conditions of HPLL.Spinal Cord (2006) 44, 200–202. doi:10.1038/sj.sc.3101812; published online 2 August 2005 [ABSTRACT FROM AUTHOR]

Background: Transthyretin amyloidosis is a systemic disorder caused by extracellular deposition of insoluble amyloid fibrils in peripheral and autonomic nerves, heart, kidney, gastrointestinal tract, and other organs. Hereditary transthyretin amyloidosis is an autosomal dominant disease. More than 120 mutations have been reported in the transthyretin gene with considerable phenotypic heterogeneity and geographic diversity. Among them, a sporadic case of hereditary transthyretin amyloidosis with cardiac-predominant phenotype is very rare, progressive, and potentially fatal if left undiagnosed. However, a clinical diagnosis of cardiac amyloidosis still remains challenging due to non-specific symptoms, and less sensitivity and specificity of medical examinations.Case Presentation: A 60-year-old Japanese man with a history of embolic stroke and hypertrophic cardiomyopathy visited our department for heart failure. The present case exhibited only cardiomyopathy without any clinical signs of systemic amyloidosis manifested as carpal tunnel syndrome, polyneuropathy, or autonomic dysfunction. An echocardiogram revealed severe asymmetric left ventricular hypertrophy, biatrial dilatation, pericardial effusion, and preserved left ventricular ejection fraction of 50% with severe diastolic dysfunction. Technetium pyrophosphate scintigraphy indicated marked diffuse myocardial uptake of technetium pyrophosphate, strongly suggesting transthyretin cardiac amyloidosis, which was firmly confirmed by a left ventricular endomyocardial biopsy. Genetic analysis demonstrated a transthyretin C70T (Pro24Ser) heterozygous mutation. Tafamidis, a transthyretin stabilizer, was started. His cardiac symptoms remained unchanged for 12 months.Conclusions: Here we report the case of a patient with hereditary cardiac amyloidosis associated with a Pro24Ser mutation in transthyretin, which is the first case reported in Japan. Technetium pyrophosphate scintigraphy was extremely useful for definitive diagnosis. Thus, we propose that the nuclear imaging technique should be taken into account even for an exploratory diagnosis of transthyretin cardiac amyloidosis. [ABSTRACT FROM AUTHOR]

Introduction: Nighttime blood pressure (BP) measured by ambulatory BP monitoring (ABPM) is correlated with hypertensive target organ damage (TOD). Several recent studies had described an association between nighttime BP measured by home BP monitoring (HBPM), but there were few data comparing the association between TOD and nighttime BP measured by ABPM or HBPM. Hypothesis: We assessed the hypothesis that individuals who have ≥120 mmHg nighttime systolic BP (SBP) assessed HBPM and ABPM would be more likely to have TOD. Methods: We analyzed the data of 1,005 J-HOP study participants whose nighttime BP was measured by HBPM and ABPM. Nighttime home BP was automatically measured at 2, 3 and 4 a.m. by timer equipped device (HEM-5001, Omron Healthcare). Nighttime home BP was measured as many night as possible in 2 week study duration and mean of all values was used for the analysis. ABPM was measured every 30 min for 24 hour. Nighttime ambulatory SBP was calculated according to patient's diary. We classified the participants into four groups according to their nighttime SBP (mmHg): group 1, HBPM and ABPM <120; group 2, HBPM <120 and ABPM ≥120; group 3, HBPM ≥120 and ABPM <120; group 4, HBPM and ABPM ≥120. TOD as indicated by brachial ankle pulse wave velocity (baPWV), left ventricular mass index (LVMI) and carotid intima media thickness (IMT) were compared among 4 groups. Results: Mean age was 63±11 years; 49.9% were male. Nighttime home BP was measured 8.9±4.3 nights. For groups 1, 2, 3 and 4, respectively, baPWV were 1529±293, 1536±265, 1616±255 and 1710±322 cm/sec, LVMI were 91±23, 94±22, 101±26 and 101±28 g/m2, and IMT were 0.73±0.14, 0.72±0.18, 0.79±0.15 and 0.80±0.19 mm. After age, gender and clinic SBP were adjusted, baPWV, LVMI and IMT of groups 3 and 4 were significant higher than of group 1. In multivariate analyses, nighttime home SBP was an independent predictor of all TOD but nighttime ambulatory SBP was an independent predictor of only baPWV. Conclusions: Nighttime home SBP was more closely associated with TOD than nighttime ambulatory SBP. [ABSTRACT FROM AUTHOR]

The article discusses an epidemiological survey on hypertrophic pachymeningitis (HP) in Japan that causes thickening of the intracranial and spinal dura mater. Topics discussed include intracranial hypertension, cranial nerve palsy and spinal cord dysfunction. Clinical data is presented with the suggestion that causes of HP are ANCA-related disease and IgG4/MFS-related disease.

The article reports on the clinical features and natural history of Japanese heterozygous females with Anderson-Fabry disease (AFD). It states that acroparaesthesia and corneal opacities were the most common clinical manifestations, followed by proteinuria and left ventricular hypertrophy. It adds that as the clinical manifestations were found to develop increasingly with age, they underscore the need for monitoring as well as the introduction of enzyme therapy.

Reports on the medical case of an 11-year-old female who had lingual tonsil hypertrophy with difficult airway and uncontrollable bleeding in Japan. History of uncomplicated palatine tonsillectomy at age five; Presentation with dyspnea, sore throat, globus sensation, recurrent fever and sleep apnea; Complication of the airway management of lingual tonsil hypertrophy during and after surgery.