A Case of Pancreatic Neuroendocrine Tumor with Liver Metastases Demonstrating the Possibility of Enhanced ACTH Production by the SACI Test.

Objective: ACTH-producing pancreatic NETs have a propensity to metastasize, and in patients with metastases, there is no established method yet to precisely determine if the excess ACTH is produced by the primary or the metastatic tumors. Localizing the source of production of ACTH in such cases is important for devising suitable treatment strategies and evaluating the benefit of local therapies from the viewpoint of control of Cushing's syndrome. Methods: We performed the selective arterial calcium injection (SACI) test combined with selective portal and hepatic venous sampling in a 32-year-old female patient with ectopic ACTH-producing pancreatic NET and liver metastases. Results: The blood level of ACTH after Ca loading was significantly elevated only in the vessels thought to be directly feeding the pancreatic tumor, and Ca loading from any artery did not significantly increase ACTH concentrations in the hepatic veins compared to the main trunk of the portal vein. Conclusions: The present case demonstrates that there might be an ACTH-producing p-NET that responds to Ca loading. Further in vitro studies are required to validate this possibility.

Decline in independence after three years and its association with dietary patterns and IADL-related factors in community-dwelling older people: an analysis by age stage and sex.

BACKGROUND: Few studies have shown age stage and sex differences in the association among dietary patterns and various health factors related to disability in older people. This study aimed to reveal the differences of characteristics, including several dietary patterns, associated with a decline in independence over 3 years in community-dwelling independent older people. Specifically, we examined data by age stage, for people between 65 and 75 years (earlier-stage) and people aged 75 years or above (later-stage), and sex. METHODS: We conducted a nationwide longitudinal study of 25 Japanese prefectures from 2013 to 2016; 2250 participants' complete data (1294 men and 956 women) were analyzed. Independence was evaluated based on instrumental activities of daily living (IADL) scores (maximum = 12). Dietary patterns were derived from a principal component analysis of the seven food groups. Baseline IADL-related factors linked to independence 3 years later were selected. Multiple logistic regression analysis for having low independence-without a full score of IADL 3 years after baseline-was conducted, adjusted for baseline IADL scores. Finally, to compare differences among age stage and sex groups, we used Multiple-Group Path Analysis. RESULTS: Participants with a full IADL score 3 years later were classified as high independence (69.6%), and those without the full score were classified as low independence (30.4%). Only the later-stage older peoples' proportion of low independence 3 years later was significantly higher than those at baseline. A high meat frequency pattern was associated with a significantly higher risk of decline in independence 3 years later in later-stage older women. The earlier-stage older people showed that 18.5 ≤ BMI < 25 was associated with a lower risk, referring to BMI < 18.5. In the later-stage, exercising three or more times a week with enjoyment and fulfillment was associated with a significantly lower risk. CONCLUSIONS: The IADL disability in older people aged 75 and over showed a rapid change. The different characteristics associated with the risk of decline in independence among age stage and sex were revealed. Targeting age stage and sex separately for community-based comprehensive supportive strategies would be necessary for a long life globally.

[Association between feelings of happiness among community-dwelling, independent, elderly individuals in an Okinawan farm village and survival three years later].

Objectives　As an indicator of subjective wellbeing, feelings of happiness assessed based on simple items have not been fully elucidated in terms of its relation to survival during old age. The purpose of this study was to examine whether the predictive validity of feelings of happiness assessed using a 4-item measure is high as an indicator of assessing survival three years later, using a variety of factors as adjustment variables among independent, elderly individuals living in a farm village in Okinawa, wherein a spirit of mutual help is prevalent among the residents.Methods　From a longitudinal study conducted in 2012, a total of 1,471 respondents (638 men, 833 women), excluding participants who needed long-term care and non-respondents of their feelings of happiness, completed a detailed questionnaire. A 4-item measure of feelings of happiness and other indicators of subjective wellbeing, including a 5-item measure of cooked food consumption, were considered as ordinal scales. From the results of the principal component (PC) analysis, we named the first PC "diet variety," of which cooked food was less consumed. The Cox proportional hazard model was used for 734 subjects' data, excluding missing values, to examine comprehensive associations among feelings of happiness, survival times, and health indicators in a multivariate model that adjusted for age, sex, and body mass index, among others. A correlation analysis between survival after three years was performed to select indicators used simultaneously in the analysis. Kaplan-Meier analysis was also conducted to examine the cumulative survival rate over three years.Results　A total of 1,387 participants (94.3%) survived during the three-year follow-up. The survival rate was significantly higher in those who indicated "very happy" items (95.9%) than in those who indicated "unhappy" items (86.4%). Meanwhile, the mortality rate was significantly higher in those who indicated "unhappy" items (13.6%) than in those who indicated "very happy" items (4.1%). Within the multivariate model, the hazard ratio (HR) for mortality three years later was significantly reduced in those with feelings of happiness (HR=0.56, 95% confidence interval [CI]: 0.32-0.99), in those who did not experiences falls and fractures (HR=0.26, 95% CI:0.11-0.62), and in those who were non-smokers (HR=0.44, 95% CI:0.25-0.77). The cumulative survival rate in those who experienced good feelings of happiness was significantly higher than in the others.Conclusion　The predictive validity of feelings of happiness assessed by a 4-item measure might be high as an indicator to assess survival three years later among independent, elderly individuals living in a farm village in Okinawa.

Bone SPECT/CT Localizes Increased Bone Metabolism and Subsequent Bone Resorption in Reflex Sympathetic Dystrophy.

A 64-year-old man with lung cancer with a history of revascularization of the occluded right femoral artery underwent bone scintigraphy, which showed intense uptake in the distal side of the right leg. The additional SPECT/CT clarified that the uptake was predominantly increased in the epiphyses of the right ankle and foot with possible osteopenia. One month later, follow-up SPECT/CT showed the manifestation of periosteal resorption in the hypermetabolic sites with slight decrease in bone metabolism. Radiological correlation between bone metabolism and subsequent bone resorption in addition to clinical symptoms in this patient suggested the diagnosis of reflex sympathetic dystrophy.

Dietary quality and its structural relationships among equivalent income, emotional well-being, and a five-year subjective health in Japanese middle-aged urban dwellers.

BACKGROUND: Although dietary quality in middle-age and the prime age of a person's work career might be determined by positive emotional well-being based on socioeconomic status (SES), causation among determinants of dietary quality still remains unclear. Our purpose was to elucidate the structural relationships among five-year prior dietary quality, equivalent income, emotional well-being, and a five-year subjective health by sex and age group separately. METHODS: In 2003, 10,000 middle-aged urban dwellers aged 40-64 years, who lived in ward A in the Tokyo metropolitan area, were randomly selected and a questionnaire survey was conducted by mail. In 2008, we made a follow-up survey for dwellers, and were able to gather their survival status. A total of 2507, middle-aged men (n = 1112) and women (n = 1395), were examined at baseline. We created three latent variables for a structural equation modeling (SEM), five-year subjective health reported in 2003 and in 2008, dietary quality of principle food groups diversity and eating behavior in 2003, and emotional well-being constructed by enjoyment & ikigai (meaning of life) and by close people in 2003. Equivalent income in 2003 was calculated as SES indicator. RESULTS: In the SEM analysis of both men and women, there was an indirect effect of the equivalent income on dietary quality and on five-year subjective health, via emotional well-being explained by ikigai and having comforting people close to the individuals, significantly. There tended to be a larger direct effect of emotional well-being on the dietary quality in men than in women, and also a larger effect accompanying with aging. In women, there was a large direct effect of equivalent income on dietary quality than in men. When examined comprehensively, there appeared to be a larger effect of five-year prior equivalent income on subjective health during five-year in men than in women. CONCLUSION: This study suggests that it is necessary to support the improvement of dietary quality in middle age by considering the characteristics of sex and age group and also by providing supportive environment to enhance emotional well-being based on equivalent income, cooperating different field professionals to provide such as employment or community support program.

Speciation of iodine in solid environmental samples by iodine K-edge XANES: application to soils and ferromanganese oxides.

A method was developed for speciation of iodine in solid materials using X-ray absorption near-edge structure (XANES). This method was used to identify the iodine species (mainly inorganic iodine) in environmental samples. It was shown that the XANES spectra of iodide and iodate sorbed within solid materials can be simulated by the linear combination of the spectra of iodide and iodate ions in water. The distribution coefficient (Kd) between soil and water was obtained independently for iodide and iodate, based on iodine speciation both in the solid phase, by XANES, and in the aqueous phase, by HPLC-ICP-MS. It was found that the Kd of iodate is larger than that of iodide by a factor of more than six, showing the more soluble nature of iodide. It was suggested that iodate can form in soil even when iodide is injected into the soil-water system under conditions within the iodide-stable field of the Eh-pH diagram of iodine. This is caused by the much higher affinity of iodate for solid surfaces than iodide. In soil samples under various water saturation conditions, or various Eh conditions, the iodide fraction in water increases with decreasing Eh, which results in an increase in the dissolved total iodine fraction in soil water. The speciation method using XANES was also applied to iodine in a natural soil sample and marine ferromanganese oxides. It is suggested that iodine K-edge XANES is a promising tool for determining the iodide/iodate ratio in natural solid samples, which contributes to better understanding of the behavior of iodine at the Earth's surface.