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A new method, which accurately predicts cutting force in ball end milling considering cutting edge around center web, has been proposed. The new method accurately calculates the uncut chip thickness, which is required to estimate the cutting force by the instantaneous rigid force model. In the instantaneous rigid force model, the uncut chip thickness is generally calculated on the cutting edge in each minute disk element piled up along the tool axis. However, the orientation of tool cutting edge of ball end mill is different from that of square end mill. Therefore, for the ball end mill, the uncut chip thickness cannot be calculated accurately in the minute disk element, especially around the center web. Then, this study proposes a method to calculate the uncut chip thickness along the vector connecting the center of the ball and the cutting edge. The proposed method can reduce the estimation error of the uncut chip thickness especially around the center web compared with the previous method. Our study also realizes to calculate the uncut chip thickness discretely by using voxel model and detecting the removal voxels in each minute tool rotation angle, in which the relative relationship between a cutting edge and a workpiece, which changes dynamically during tool rotation. A cutting experiment with the ball end mill was conducted in order to validate the proposed method. The results showed that the error between the measured and predicted cutting forces can be reduced by the proposed method compared with the previous method.

Background: There are few reports about sleep disturbances in patients with chronic obstructive pulmonary disease (COPD) in Asian countries. Objectives: To investigate the associations between sleep-disordered breathing (SDB) with hypoxemia and sleep quality, including sleep duration, in patients with COPD, we measured SDB and sleep quality including the objective sleep duration determined by an actigraph and portable monitoring. Methods: A cross-sectional epidemiological health survey of 303 male employees (means ± SD: age 43.9 ± 8.2 years; BMI 24.0 ± 3.1) was conducted. Sleep quality was measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A respiratory disturbance index (RDI) ≥5 indicated SDB. Results: Nineteen subjects (6.3%) had COPD. Among these, 11 (3.6%) had COPD with SDB (overlap syndrome). Sleep duration, ESS, and PSQI scores were not significantly different between COPD patients and normal control subjects. However, COPD patients had significantly longer sleep latency (p = 0.019), a lower sleep efficiency (p = 0.017), and a higher sleep fragmentation index (p = 0.041) and average activity (p = 0.0097) during sleep than control subjects. They also had a significantly higher RDI and more severe desaturation during sleep than control subjects (p < 0.01). The differences remained after adjustment for age and BMI but disappeared following adjustment for RDI. Conclusions: COPD patients with even mild-to-moderate airflow limitations had nocturnal desaturation and RDI-related impaired sleep quality without significant symptoms.

Dyslipidemia is often comorbid with obstructive sleep apnea (OSA), but few population-based studies have investigated their relationship. Short sleep duration is associated with hypertension and diabetes; however, its association with dyslipidemia is not well known. We investigated relationships among OSA, sleep duration, and the lipid profile in a community-based study.We measured the respiratory disturbance index (RDI) and sleep duration by a type 3 portable device and actigraph in 275 men in a Japanese company. Fasting blood parameters were obtained from periodic inspection data.According to Japanese criteria, 143 subjects had dyslipidemia. Percent sleep time of oxygen saturation as measured by pulse oximetry (SpO2)lt; 90% and prevalence of severe OSA were greater and sleep duration and mean SpO2 during sleep were lower in subjects with dyslipidemia than in those without. Univariate analysis showed that the RDI was positively correlated with serum triglyceride (TG) levels (ρ = 0.20, Plt; .01), and sleep duration was negatively correlated with serum total cholesterol (TC) levels (γ = -0.13, P = .03) and serum low-density lipoprotein cholesterol levels (γ = -0.12, P = .04). Stepwise multiple regression analysis revealed that TG was correlated with RDI (β = 0.14, P = .02), BMI (β = 0.20, Plt; .01), and alcohol intake (β = 0.20, Plt; .01), and that TC was correlated with sleep duration (β = -0.13, P = .03), age (β = 0.15, P = .02), and waist/hip ratio (β = 0.15, P = .02).Short sleep duration was associated with TC levels and RDI was positively associated with TG levels among working-aged men in an urban Japanese company. Correcting the status of OSA and/or short sleep duration might improve the lipid profile and cardiovascular consequences.

Multi-walled carbon nanotube (MWNT) and vapor grown carbon fiber (VGCF) were blended into poly (vinylidene fluoride) (PVDF) to enhance the piezoelectricity of the neat polymer. The PVDF composite films were prepared by solution casting method, stretched uniaxially and poled in silicon oil. The nanofiller contents range from 0.05 to 0.3 wt.%. Open circuit output voltage and energy harvesting tests indicate that both the PVDF/MWNT and PVDF/VGCF composite films approached the maximum output at the nanofiller content of 0.05 wt.%. Compared to the neat PVDF films, the maximum increasing rates of open circuit voltage and harvested power density are 24% and 47% for the PVDF/MWNT films and 15% and 78% for the PVDF/VGCF films, respectively. X-ray diffraction analysis showed an increase in content of the β phase in the PVDF composites; thus, the piezoelectric properties, which are dependent on β phase content, were enhanced. Stretching of the films leads to the transformation of PVDF from α phase to β phase form. M...

Improvement of color rendering spectrum is required because the high-intensity discharge (HID) lamp is used as a large-scale illumination for emergency. The HID lamp is high lamp efficiency and the low color rendering spectrum because it uses the combination of line spectrum. The broad spectral distribution is needed for improvement of the color rendering spectrum. The energy balance to achieve both the color rendering spectrum and lamp efficiency is important. The energy balance is changed by controlling the temperature distribution. It is necessary to control the temperature distribution with controlling the current and radius. The wall-stabilized arc of water-cooled vortex type with small caliber was developed for improvement of the color rendering and lamp efficiency. In addition, the pulsed arc changes the temperature distribution because the pulsed current changes with time. The temperature distribution is changed by controlling the current change ratio. In this paper, the general color rendering index as function of the current change ratio in the wall-stabilized arc of water-cooled vortex type with small caliber was measured. As a result, the general color rendering index had the peak with increasing the current change ratio. Therefore, the temperature distribution plays important role for the color rendering spectrum.

Obstructive sleep apnoea is common in patients with diabetes. Recently, it was reported that short sleep duration and sleepiness had deleterious effects on glucose metabolism. Thereafter, several reports showed relationships between glucose metabolism and obstructive sleep apnoea, sleep duration or sleepiness. But the interrelationships among those factors based on recent epidemiological data have not been examined. We analysed data on 275 male employees (age, 44±8years; body mass index, 23.9±3.1kg m(-2) ) who underwent a cross-sectional health examination in Japan. We measured fasting plasma glucose, sleep duration using a sleep diary and an actigraph for 7days, and respiratory disturbance index with a type 3 portable monitor for two nights. Fifty-four subjects (19.6%) had impaired glucose metabolism, with 21 having diabetes. Of those 21 (body mass index, 25.9±3.8kgm(-2) ), 17 (81.0%) had obstructive sleep apnoea (respiratory disturbance index≥5). Regarding the severity of obstructive sleep apnoea, 10, four and three had mild, moderate and severe obstructive sleep apnoea, respectively. The prevalence of obstructive sleep apnoea was greater in those with than without diabetes (P=0.037). Multiple regression analyses showed that the respiratory disturbance index independently related to fasting plasma glucose only in the diabetic subjects. In patients with diabetes, after adjustment for age, waist circumference, etc. sleep fragmentation had a greater correlation with fasting plasma glucose than sleep duration, but without significance (P=0.10). Because the prevalence of obstructive sleep apnoea is extremely high in patients with diabetes, sufficient sleep duration with treatment for obstructive sleep apnoea, which ameliorates sleep fragmentation, might improve fasting plasma glucose.

The reinforcement effects of two nanofillers, i.e., multi-walled carbon nanotube (MWCNT) and vapor grown carbon fiber (VGCF), which are used at the interface of conventional CFRP laminates, and in epoxy bulk composites, have been investigated. When using the two nanofillers at the interface between two conventional CFRP sublaminates, the Mode-I interlaminar tensile strength and fracture toughness of CFRP laminates are improved significantly. The performance of VGCF is better than that of MWCNT in this case. For epoxy bulk composites, the two nanofillers play a similar role of good reinforcement in Young’s modulus and tensile strength. However, the Mode-I fracture toughness of epoxy/MWCNT is much better than that of epoxy/VGCF.

Obstructive sleep apnoea (OSA) plays a significant role in increasing blood pressure. Significant decreases were reported in blood pressure of hypertensive OSA patients with sleepiness who underwent continuous positive airway pressure (CPAP) treatment, but not in non-sleepy hypertensive OSA patients. More recently, however, significant decreases in blood pressure in non-sleepy hypertensive OSA patients following CPAP were shown. Effects of sleepiness on hypertension in OSA patients have been investigated, but not the effects of hypertension on sleepiness in OSA patients. We investigated the relationships between hypertension and sleepiness in patients with OSA. We analysed data on 275 middle-aged male subjects from a cross-sectional epidemiological health survey. We measured blood pressure and sleep duration objectively using an actigraph for 7 days and the respiratory disturbance index (RDI) with a type 3 portable device for 2 nights, and assessed sleepiness using the Epworth Sleepiness Scale (ESS). The RDI correlated significantly with ESS scores in the 88 hypertensive subjects (r = 0.33, P = 0.0024), but not in the 187 non-hypertensive subjects (r = -0.01, P = 0.91). Short sleep duration correlated significantly with ESS scores in both groups. Both the RDI and short sleep duration were related independently to sleepiness in only hypertensive subjects. Furthermore, the RDI was related negatively significantly to sleep duration in hypertensive subjects. Although short sleep duration was related significantly to sleepiness in both groups, hypertension may be important for the sleepiness in OSA patients. Detailed mechanisms of the difference in the relationship between sleepiness and the severity of OSA with or without hypertension should be studied further.

It is shown how to remove nitrate ions from aqueous solution by electrosorption in a way that has a low environmental impact and is energy saving. In order to elucidate adsorption/desorption mechanism of nitrate ions, ion removal using flow through capacitor and cyclic voltammetry measurements were investigated. Characterization of suitable electrodes for electroadsorption was determined. The static attraction by surface charges of carbon electrodes had a profound effect on adsorption of nitrate ions. It is difficult for nitrate ion to desorb from the electrode, therefore an electrode with pHPZC (point zero of charge) of a weak acid is appropriate. Due to the overlapping effect of diffusion layers in pores, it is thought that large mesopores (>20 nm) and the voids between particles are effective in dilute solution for nitrate ion removal.

Although many researches have been conducted on contouring control for machine tool feed drive systems, to the best of authors’ knowledge, its effectiveness has been verified only through comparative experiments with industrial non-contouring (independent axial) controllers, or conventional contouring controllers such as the cross-coupling controller. Because control performance largely depends on controller gains, such comparisons involve some difficulties in demonstrating the effectiveness of contouring control. In other words, a similar control performance can be achieved if the non-contouring controller gains are appropriately assigned. This paper discusses the effectiveness of contouring controllers both analytically and experimentally. A new contouring controller design for three-dimensional machining is presented, which is extended from the authors’ biaxial design based on coordinate transformation. The contouring controller is concluded to be effective through an analysis of the proposed design, in that it provides performance comparable to non-contouring controllers with less control input variance. This property reduces the damage to machine tool systems and saves control energy. In addition, because an inherent contour error exists in the coordinate transformation approach, a method for reducing this error is presented to enhance the effectiveness of the contouring controller. Experimental results support the claims of this paper.

背景．肺原発淡明細胞癌は組織学的に明るい胞体を有する腫瘍細胞が多数を占める癌で，発生頻度は全肺癌に対して0.3∼3.4%である．症例．66歳，男性．慢性腎不全で維持透析中に左片麻痺が出現し，頭部CTで多発腫瘤，胸部単純X線写真で左肺尖腫瘤を認めた．左片麻痺で低下したactivity of daily livingの改善と診断の目的で脳腫瘍を摘出した．脳腫瘍はhematoxylin and eosin染色で明るい胞体を有し，免疫組織化学的に腎癌で高率に発現するcluster of differentiation 10（CD 10）が一部発現していた．病理組織，免疫組織学的検討の結果から淡明細胞性腫瘍の病理組織像を呈する腎癌の脳転移と考えたが画像上腎腫瘤は明らかでなかった．interferon治療を開始したが左肺尖腫瘤は増大し，CTガイド下経皮肺生検を行い組織学的に再検討したところ肺原発淡明細胞癌と考えた．第102病日に永眠され，剖検では肺腫瘍が肉眼的に最も大きく，腎腫瘍は認めなかった．肺腫瘍，遠隔転移病巣の病理組織像は，明るい胞体を伴った腫瘍細胞が大部分を占め，癌真珠，細胞間橋形成，腺管構造形成などの分化傾向は認めず，大細胞癌の特殊型である肺原発淡明細胞癌と診断した．結論．我々は剖検所見から大細胞癌の特殊型である淡明細胞癌と診断した1剖検例を報告した．

Contouring control is an effective method for computer numerical controlled machining, and various such designs have been proposed to date. However, the compliance of the transmission mechanism is not considered in most existent contouring controller designs. This paper presents a new contouring control system design considering the compliance of a transmission mechanism based on a fourth-order model of feed drive dynamics. First, we present a controller design that enables the controller gain assignment for reducing the error component orthogonal to the desired contour curve, independent of the tangential error component. Although this design provides better control performance with small control input variance, there exists an inherent contour error because of the difficulty in calculating the exact contour error for any contour curve in real time. To address this problem, a reference adjustment method is used to estimate the actual contour error. The effectiveness of the proposed design is experimentally verified by comparing the control performance with a design based on a plant model that neglects the compliance.

SLEEP-RELATED HEALTH PROBLEMS AND THEIR IMPACT ON SOCIETY AND ON INDIVIDUALS ARE A MAJOR SOCIAL ISSUE. PEOPLE WITH SLEEP-DISORDERED breathing (SDB) are at increased risk for hypertension,1,2 cardiovascular diseases,3 and mortality.3,4 However, SDB and obstructive sleep apnea syndrome (OSAS) are prevalent but largely undiagnosed in adults.5 In spite of this wide population of undiagnosed patients, in-laboratory sleep-recording capacity has remained limited. This current situation presents an urgent need to move toward the use of portable monitors in home settings. Epidemiologic studies for SDB and OSAS have been conducted not only in Western countries,1–5 but also in Asian countries.6,7 However, sound estimates of SDB prevalence in Japan are lacking: previous Japanese studies have been limited by use of nonprobability samples, low response rates, small samples, and other methodologic problems. All previous Japanese epidemiologic studies on SDB and OSAS were performed with type 4 portable monitors.8–10 In our current study, a cardiorespiratory monitoring device (also referred to as a type 3 portable monitoring device) was used together with actigraphy at home to analyze SDB. Type 3 portable monitors are defined as devices with a minimum of 4 channels monitored,11 including ventilation or airflow (at least 2 channels of respiratory movement or respiratory movement and airflow), heart rate or electrocardiogram, and oxygen saturation, whereas portable monitors that do not meet these criteria are designated as type 4.11 Attended type 3 sleep studies are thought to be a standard method and an alternative for polysomnography in the diagnosis and follow-up for SDB and OSAS.12 On the other hand, type 4 portable monitors are not recommended for diagnosis because they have a higher percentage of false-positive results and high rates of false negatives or conflicting results.11 Most epidemiologic studies have been performed with polysomnography in laboratory settings. Using in-laboratory polysomnography as the gold standard has limitations in validity, partly because subjects tend to sleep more poorly in the laboratory than at home.11 In this study, participants were asked to follow their usual lifestyles, and sleep recordings were performed at home. Home monitoring that more closely reflects the subjects' usual drinking and sleeping habits may present a different prevalence or different outcomes than those from previous reports in the laboratory settings. Recently, obesity has become a major social problem in Japan. The prevalence of obesity (body mass index: [BMI] ≥ 25) in 1983, 1993, and 2003 was 26.7%, 24.5% and 34.4%, respectively, among the Japanese male general population aged 40 to 49 years.13 Obesity and weight gain are positively associated with SDB.14 Thus, SDB may become more prevalent than has been previously reported in Japanese. The primary goal of this paper was to examine the prevalence of home-monitored SDB and OSAS in a Japanese working population. The secondary goal was to test the hypotheses that home monitoring with a type 3 portable monitor and actigraphy can produce reliable data to analyze SDB in usual lifestyles. Here, we report the first epidemiologic study in Japan with a type 3 portable monitor and actigraphy at home to examine the prevalence and related factors of SDB.

This study is intended to get an answer to the question that the adding of side walls to old RC columns is effective to enhance their seismic performance or not. For this purpose, ten half-scale model specimens simulating columns designed by the pre-1971 codes with/without side walls were tested until they collapsed. The tests revealed the side-wall adding increased lateral strength but decreased deformability. Then the earthquake response analyses were conducted for three-story model buildings consisting of the tested columns with/without side walls, where the observed load-deflection relations until collapse were used. The side-wall adding was judged as “advantageous” if the ratio of maximum response drift to drift at collapse became smaller than that of the case without side walls. The side-wall adding was “advantageous” in most examples.

Objectives Effective treatment of obstructive sleep apnoea (OSA) with nasal continuous positive airway pressure (nCPAP) lowers blood pressure (BP). The long-term effects of nCPAP treatment on BP in OSA patients are not well known. The time period of such treatment sufficient to lower BP in OSA patients is also not known. We investigated compliance with long-term nCPAP therapy and its effects on BP. Methods This observational study involved 66 OSA patients [59 men, seven women; mean age, 51 (48-54) years; body mass index (BMI), 28.7 (27.7-29.7) kg/m 2 ; apnoea and hypopnoea, 50.3 (45.6-55.0)/h; 95% confidence intervals]. BP and BMI were measured before the study and at two checkpoints after usage of nCPAP [620 (552-688) and 1071 (1000-1143) days]. Results The different times between the first and second checkpoints for detecting objective compliance were 17 (4-30) min (P = 0.003). Diastolic BP decreased by 5.9 (3.1 -8.7) mmHg after 600 days nCPAP treatment and by 4.6 (2.0-7.2) mmHg after 1000 days (P = 0.0006). Systolic BP and BMI did not change significantly. Usage of nCPAP treatment for a daily average of 3 h was needed to achieve a significant decrease in diastolic BP [7.4 (4.3-10.6) mmHg, P< 0.0001]. Diastolic BP of normotensive OSA patients did not change significantly by nCPAP treatment, but that of hypertensive OSA patients decreased significantly within 1 month-3 years of nCPAP treatment whether or not medication was used. Conclusions In patients with severe OSA, the use of nCPAP for a daily average of 3 h would be sufficient to decrease the diastolic BP of hypertensive OSA patients.

Elevated heart rate (HR) is a risk factor for cardiovascular disease. The effects of obstructive sleep apnoea-hypopnoea syndrome (OSAHS) on HR are controversial.To investigate the effect of nasal continuous positive airway pressure (nCPAP) therapy on HR in OSAHS patients.Sixty-two OSAHS patients underwent 24-h electrocardiographic recording, both before and 3 or 4 days after instigation of nCPAP.After nCPAP was started, HR significantly decreased (mean +/- SD 71.8 +/- 10.6 vs. 67.5 +/- 9.4 bpm, p0.0001), both in the daytime (0600-2200 h, 76.3 +/- 12.2 vs. 72.2 +/- 10.2 bpm, p0.0001) and at night-time (2200-0600 h, 64.5 +/- 9.1 vs. 60.0 +/- 8.9 bpm, p0.0001). HR was significantly reduced in both periods in the 44 patients with hypertension and/or diabetes mellitus, but only during the night-time in the 18 with neither condition. Before nCPAP treatment, HR was positively correlated with percentage time of arterial O2 saturation90% during sleep (p = 0.008) and with the apnoea-hypopnoea index during sleep (p = 0.003). In 15 patients undergoing HR for 2 days before starting nCPAP, the mean HRs for the two periods were similar (p = 0.95).nCPAP therapy appears to decrease HR in OSAHS patients, and may thereby reduce their risk of cardiovascular disease.

Asthma is characterised by chronic inflammation of the airways, but the relevance of high-sensitivity assays for C-reactive protein (hs-CRP), which are known to be a sensitive marker of low-grade systemic inflammation, has not been fully studied in asthma. The objective was to examine serum hs-CRP levels in patients with asthma and their relationship to clinical characteristics and degree of airway inflammation. Serum hs-CRP levels were cross-sectionally examined in steroid-naive (n = 22) and steroid-inhaling (n = 23) adult patients with asthma and healthy controls (n = 14). All were nonsmokers. Serum hs-CRP levels were significantly increased in steroid-naive patients (mean+/-sd 1.33+/-1.48 mg.L(-1)) compared with controls (0.21+/-0.30 mg.L(-1)), but not in patients on inhaled corticosteroid. Among steroid-naive patients, serum hs-CRP levels significantly negatively correlated with indices of pulmonary function (forced expiratory volume in one second/forced vital capacity and forced mid-expiratory flow) and positively with sputum eosinophil count. Among patients on inhaled corticosteroid, hs-CRP levels did not correlate with any indices. In conclusion, an increase in serum C-reactive protein levels measured by high-sensitivity assays may be associated with airflow obstruction and airway inflammation, and may serve as a surrogate marker of airway inflammation in asthma.

Study objectives: Hypoxemia increases corrected QT dispersion (QTcD), which is the difference between the maximum and minimum QT intervals and is a strong risk factor for cardiovascular mortality. The aim of this study was to investigate the QTcD in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and the relationship between the QTcD and 123 I-metaiodobenzylguanidine (MIBG) cardiac imaging, which reflects cardiac sympathetic activity. Setting: A university hospital. Patients: Forty-eight OSAHS patients without cardiac diseases (mean [ SD] age, 45.9 10.8 years; apnea-hypopnea index [AHI] 51.9 18.5 events per hour) who underwent polysomnography before treatment and on the first night of nasal continuous positive airway pressure (nCPAP) treatment. Methods: Before and after nCPAP treatment was started, we measured the QTcD with computer software, before, during, and after sleep, as well as the washout rate of the MIBG administered for cardiac imaging. As a control, QTcD was also measured in the morning from 26 healthy subjects. Results: Before treatment, the mean QTcD during sleep (65.0 14.6 ms) was greater than that before sleep (57.0 13.5 ms; p < 0.0001). Meanwhile, after 1 night of nCPAP therapy, the QTcD during sleep (50.6 11.4 ms) decreased from that before treatment (p < 0.0001) and was smaller than the QTcD before sleep (56.2 13.3 ms; p 0.003). Before treatment, the QTcD during sleep correlated with the AHI (r 0.38; p 0.009) and the percentage of time that SaO2 was < 90% (SaO2 < 90% time) [r 0.34; p 0.018]. The QTcD did not correlate with the body mass index or the washout rate of MIBG. However, the washout rate of MIBG correlated with the AHI and the SaO2 < 90% time. Conclusions: Nocturnal QTcD is increased in OSAHS patients but is decreased by nCPAP therapy independently of cardiac sympathetic function. (CHEST 2004; 125:2107–2114)

In Japan, the seismic performance of existing RC buildings is evaluated by computing the seismic capacity index, Is, using the Standard for Seismic Evaluation of Existing RC Buildings, while the damage level of RC buildings that undergo earthquakes is assessed by the Standard for Post-Earthquake Inspection and Guidelines for Repair and Strengthening Technology. This paper reports the results of investigation of the relation between the Is value and the damage level for low-rise RC buildings designed according to the old code by conducting dynamic analysis on model buildings with a variety of Is values. The effects of the deformability type of columns and the number of stories on the relation between the Is value and the damage level were studied. Two levels of ground motions, the original level of past earthquake records and the design standard level, were considered. In the analysis, column hysteresis was derived from test results. Strength deterioration after shear failure and axial collapse that are commonly associated with hysteretic behavior of old columns, were considered. The method presented in this study enables assessment of the damage level of buildings and the damage condition of columns if the deformability type of columns, number of stories, Is value and ground motion are given. In addition, the assessed damage level of buildings are compared with the observed damage level from past earthquakes and the Is value required to prevent collapse of buildings is discussed.

Purpose Obesity has been associated with obstructive sleep apnea and hepatic steatosis. We investigated the effects of obstructive sleep apnea and treatment with nasal continuous positive airway pressure (CPAP) on serum aminotransferase levels in obese patients. Methods We studied 40 obese men with obstructive sleep apnea syndrome. None had hepatitis B antigen or C antibody, autoimmune disease, or an excessive intake of alcohol. Serum levels of aspartate aminotransferase, alanine aminotransferase, triglyceride, glucose, insulin, and leptin were determined in the afternoon and in the morning immediately after sleep, before and after nasal CPAP treatment. Results Aminotransferase levels were abnormal in 35% (n = 14) of patients. Before treatment, mean (± SD) aspartate aminotransferase levels were higher in the morning than in the previous afternoon (presleep, 34 ± 20 IU/L; postsleep, 39 ± 28 IU/L; P = 0.006). The overnight mean increases in aminotransferase levels were less marked after the first night of nasal CPAP treatment (aspartate aminotransferase: from 6 ± 11 IU/L to 2 ± 6 IU/L, P = 0.0003; alanine aminotransferase: from 5 ± 9 IU/L to 2 ± 6 IU/L, P = 0.006). Leptin levels (n = 23) decreased significantly after treatment ( P = 0.0002), whereas insulin resistance (calculated by the homeostasis model assessment method) and triglyceride levels were unchanged. Improvements in aspartate and alanine aminotransferase levels were maintained after 1 and 6 months of nasal CPAP treatment. Conclusion Nasal CPAP therapy may have beneficial effects on serum aminotransferase abnormalities in obese patients who have obstructive sleep apnea.

During the 1995 Kobe earthquake, dozens of concrete buildings suffered complete collapse at an interme-diate story. Such collapse is believed to have occurred due to the gravity load collapse follo...

Obstructive sleep apnoea syndrome (OSAS) is a very common disorder. Patients with OSAS are at an increased risk for cardiovascular events. It has also been reported that a 25% rise in factor VII clotting activity (FVIIc) is associated with a 55% increase in ischaemic heart disease death during the first 5 years. We examined the effects of nasal continuous positive airway pressure (NCPAP) treatment on FVIIc in patients with OSAS. FVIIc was investigated prospectively in 15 patients with OSAS before (mean +/- SEM apnoea and hypopnoea index (AHI) 61.5 +/- 4.2 and after (AHI 3.0 +/- 0.9) NCPAP treatment for immediate relief, at 1 month after treatment and at over 6 months. FVIIc levels gradually decreased after NCPAP treatment. After 6 months of NCPAP treatment, FVIIc levels had decreased significantly (before 141.1 +/- 11.7% vs. after 6 months 110.7 +/- 6.2%; p < 0.01). Six of the seven patients whose FVIIc levels were over 140% before the NCPAP treatment had FVIIc levels below 130% after 6 months or 1 year of NCPAP treatment. This decrease in FVIIc after long-term NCPAP treatment could improve mortality in OSAS patients. If patients, especially obese ones, present with high FVIIc of unknown origin, it would be prudent to check for OSAS.

We assessed 12 patients with hyperventilation syndrome (HVS) who had experienced hypoxaemia (PaO260 Torr or SaO290%) despite the lack of any other organic disease and variability in their blood gas data. Hypoxic and hypercapnic ventilatory responses were measured in nine. Eight of the 12 patients had been referred from other hospitals to our institution for hypoxaemia of unknown origin. Mean PaO2 (n = 12) at rest (non-attack stage) was 87.3 +/- 7.5 Torr (mean +/- SD). Their (n = 9) hypoxic (-0.53 +/- 0.32 l/min/%; range 0.12-0.99) and hypercapnic (2.01 +/- 0.76 l/min/Torr; range 0.69-3.17) ventilatory responses were both within the normal range in our laboratory. The patients with HVS had variable blood gas data, and some of them also exhibited hypercapnia (PaCO245 Torr). Clinicians who treat patients with HVS should be aware of the possibility of hypoxaemia, even when ventilatory responses are normal. Physicians should also consider HVS as a diagnosis when treating patients with hypoxaemia of unknown origin.

SummaryHepatic hydrothorax is defined as pleural effusion with liver cirrhosis but no primary cardiopulmonary disease. Hepatic hydrothorax is often resistant to various therapeutic interventions. The most likely cause is the transfer of ascites fluid from the abdomen to the pleural space via the diaphragm because of a negative intrathoracic pressure gradient. A 62-year-old man was diagnosed with hepatoma and cirrhosis. After a partial hepatectomy, he suffered with hepatic hydrothorax. He had snoring without obvious sleep apnea. The patient's hepatic hydrothorax markedly improved following nasal continuous positive airway pressure (nCPAP) treatment during sleep. The mechanism for the improvement may have been the intrathoracic positive pressure during sleep induced by the nCPAP treatment during sleep. nCPAP treatment may provide a new therapy for resistant hepatic hydrothorax.

A 16-year-old male with exertional heat stroke (EHS) had extensive hepatocellular damage, severe rhabdomyolysis, renal failure, and coma. Hemodiafiltration was started on day 2 and living donor liver transplantation was performed on day 3. He received continuous mechanical ventilation with intubation before and after the surgery. As his mental status improved, he could not tolerate intubation, and he was extubated on postoperative day (POD) 26. He received facial noninvasive positive pressure ventilation until POD 50. Hemodiafiltration was discontinued on POD 52. He was discharged on POD 67 and is currently well more than a year after transplantation. A literature search indicates that this patient is the first long-term survivor (>1 year) after liver transplantation for exertional heat stroke.

A 66-year-old man with hepatocellular carcinoma (HCC) and suspicion of lung metastasis consulted us because of an abnormal chest shadow as seen on a radiograph. He had been treated with sorafenib for 2 months. A chest CT scan showed cavitating nodules in the left upper lobe that were present before therapy with sorafenib, and infiltrative shadows in the subpleural areas of the right upper lobe. The shadows were diagnosed, at least in part, as pulmonary tuberculosis by using a nucleic acid amplification test for Mycobacterium tuberculosis in the sputum that yielded a positive result. Treatment with antituberculosis drugs resulted in a good clinical response. However, the patient died of HCC. We concluded that the nodule in the right upper lobe was old pulmonary tuberculosis, because it did not change during the course of the disease and because the cavities in the left upper lobe were active lesions. Sorafenib is a molecularly targeted agent that has been proven effective for treating advanced HCC with extrahepatic metastasis. It may also cause necrosis within lung metastases as an anti-tumor effect. Therefore, pulmonary tuberculosis, including reactivation, should be considered in the differential diagnosis when treating a patient with sorafenib.

The unique properties of carbon nanotube (CNT) have made it very attractive as reinforcement in polymer nanocomposites in the hope of effectively improving the mechanical properties. In order to explore the effects of three appealing influencing factors, i.e., acid treatment, pressured curing, and liquid rubber (LR) on mechanical properties of nanocomposites, tensile tests, and single-edge notched bending (SENB) tests are carried out for four types of CNT-reinforced nanocomposites. Compared with type I of nanocomposites using pristine multiwalled carbon nanotube (MWCNT) as reinforcement for epoxy, which are termed as Epoxy/MWCNT, type II of Epoxy/MWCNT-COOH nanocomposites with acid-treated MWCNTs as reinforcement, show obvious improvement on tensile properties and fracture toughness. This positive effect of acid treatment can be attributed to better dispersion of CNTs and stronger interface based on the corresponding fracture surfaces. For type III of P-Epoxy/MWCNT-COOH nanocomposites under pressured curing, although the voids in samples are decreased effectively and the interface is strengthened, there is no expected positive results because of severe CNTs agglomeration. For type IV of P-Epoxy/LR/MWCNT-COOH nanocomposites, addition of LR results in at least around a threefold increase in fracture toughness compared with that of P-Epoxy/MWCNT-COOH, indicating the amazing effect of LR. The present work provides much more choices for fabricating specific CNT-reinforced nanocomposites with desired properties by reasonably combining proper fabrication conditions including acid treatment, pressured curing, liquid rubber with polymer matrix, and reinforcement loading.

Obstructive sleep apnoea (OSA) plays a significant role in increasing blood pressure. Significant decreases were reported in blood pressure of hypertensive OSA patients with sleepiness who underwent continuous positive airway pressure (CPAP) treatment, but not in non-sleepy hypertensive OSA patients. More recently, however, significant decreases in blood pressure in non-sleepy hypertensive OSA patients following CPAP were shown. Effects of sleepiness on hypertension in OSA patients have been investigated, but not the effects of hypertension on sleepiness in OSA patients. We investigated the relationships between hypertension and sleepiness in patients with OSA. We analysed data on 275 middle-aged male subjects from a cross-sectional epidemiological health survey. We measured blood pressure and sleep duration objectively using an actigraph for 7 days and the respiratory disturbance index (RDI) with a type 3 portable device for 2 nights, and assessed sleepiness using the Epworth Sleepiness Scale (ESS). The RDI correlated significantly with ESS scores in the 88 hypertensive subjects (r = 0.33, P = 0.0024), but not in the 187 non-hypertensive subjects (r = -0.01, P = 0.91). Short sleep duration correlated significantly with ESS scores in both groups. Both the RDI and short sleep duration were related independently to sleepiness in only hypertensive subjects. Furthermore, the RDI was related negatively significantly to sleep duration in hypertensive subjects. Although short sleep duration was related significantly to sleepiness in both groups, hypertension may be important for the sleepiness in OSA patients. Detailed mechanisms of the difference in the relationship between sleepiness and the severity of OSA with or without hypertension should be studied further.