Associations of fat mass index with hot flashes and lean mass index with insomnia in middle-aged women.

OBJECTIVE: This cross-sectional study examined the relationship between body composition and physical and mental symptom severity in middle-aged women. METHODS: The first-visit records of 554 women aged 40-64 years were examined. The fat mass index (FMI) and lean mass index (LMI) were defined as fat mass and lean mass divided by the height squared, respectively. The participants were divided into two groups according to their median values. RESULTS: The only menopausal symptom with significantly different severity between the high and low FMI groups was hot flashes (HF) on the Menopausal Health-Related Quality of Life Questionnaire. The factors associated with severe HF were investigated using multiple logistic regression analysis. After adjusting, the FMI (kg/m2) was independently positively associated with severe HF (odds ratio, 1.08; 95% confidence interval, 1.02-1.15). Insomnia was the only menopausal symptom with significantly different severity between the LMI groups (defined as Athens Insomnia Scale score ≥10 points). The factors associated with moderate-to-severe insomnia were investigated using multiple logistic regression analysis. After adjusting, the LMI (kg/m2) was independently negatively associated with moderate-to-severe insomnia (odds ratio, 0.72; 95% confidence interval, 0.55-0.94). CONCLUSIONS: The FMI was positively associated with severe HF, whereas the LMI was negatively associated with moderate-to-severe insomnia in middle-aged women.

Chilliness in Japanese middle-aged women is associated with anxiety and low n-3 fatty acid intake.

Objective: This cross-sectional study investigated chilliness, which is the most prevalent sexual-vasomotor symptom in middle-aged Japanese women.Methods: First-visit records of 475 Japanese women (age 40-65 years) enrolled in the health and nutrition education program at a menopause clinic were analyzed. Chilliness was estimated based on responses to the Menopausal Symptom Scale. Effects of age, menopausal status, body composition, cardiovascular parameters, resting energy expenditure, physical fitness, menopausal symptoms, lifestyle, and estimated daily intake of nutrients were assessed using a multivariate logistic regression analysis.Results: Severe chilliness was found in 28.4% of women. It was not related to age, menopausal status, body mass index, or body fat percentage. The anxiety subscale score of the Hospital Anxiety and Depression Scale was the sole background characteristic independently associated with severe chilliness (adjusted odds ratio, 1.09; 95% confidence interval, 1.04-1.15 per point). Daily intakes of vitamin D and n-3 fatty acids were significantly lower in women with severe chilliness. Daily intake of n-3 fatty acids was negatively associated with severe chilliness after adjustment (odds ratio, 0.54; 95% confidence interval, 0.29-0.95 per g/1000 kcal intake).Conclusions: Chilliness is associated with anxiety and low intake of n-3 fatty acids.

Severity of hot flushes is inversely associated with dietary intake of vitamin B6 and oily fish.

Objectives: This study investigated the links between the severity of vasomotor symptoms (VMS) and the dietary consumption of a variety of nutrients. Method: A cross-sectional analysis of the first-visit records of 262 women aged 40-65 years was conducted. The severity of their hot flushes (HF) and night sweats (NS) and their dietary consumption of nutrients were evaluated using the Menopausal Health-Related Quality of Life Questionnaire and the brief-type self-administered Diet History Questionnaire, respectively. The relationships between severity of HF/NS and dietary intake were analyzed separately for 43 major nutrients. We then evaluated different food items as sources of the nutrients. Results: After adjustment for age, body mass index, menopausal status, and background factors significantly related to VMS, only vitamin B6 (VB6) was significantly related to severity of HF (adjusted odds ratio per 10 µg/MJ in VB6 intake, 0.92; 95% confidence interval, 0.86-0.97). Moreover, a significant inverse relationship was found between the consumption of oily fish as a source of VB6 and the severity of HF. Conclusions: VB6 and oily fish intake is inversely associated with the severity of HF in middle-aged women. Therefore, increased intake of VB6 could help attenuate HF.

Feelings of unattractiveness in peri- and postmenopausal women are associated with depressed mood, poor memory and unsatisfactory sexual relationships.

OBJECTIVES: This study aimed to investigate the prevalence of, and risk factors associated with, the feeling of unattractiveness in peri- and postmenopausal women. METHODS: The records of 351 women aged 40-76 who enrolled in a health and nutrition education program at a menopause clinic were analyzed in a cross-sectional manner. Perceptions of unattractiveness were estimated according to responses for the item 'feeling less attractive than before' on the Menopausal Health-Related Quality of Life Questionnaire. Age, menopausal status, body composition, cardiovascular parameters, physical fitness, and genitourinary, physical, and psychological symptoms of menopause were assessed for associations with feeling unattractive. RESULTS: The percentage of women who felt they were less attractive than before for more than half of the previous week was 33.6%. Multivariate logistic regression analysis revealed that independent risk factors for feeling unattractive included depression (adjusted odds ratio (OR) 1.35; 95% confidence interval (CI) 1.24-1.47), dissatisfaction with sexual relationship (adjusted OR 1.74; 95% CI 1.21-2.57), and poor memory (adjusted OR 1.89; 95% CI 1.46-2.49). CONCLUSIONS: Feelings of unattractiveness are highly prevalent in peri- and postmenopausal women. Such feelings are associated with depressed moods, poor memory, and unsatisfactory sexual relationships, rather than with age or body composition.

Association of IRF5 polymorphism with MPO-ANCA-positive vasculitis in a Japanese population.

Interferon regulatory factor 5 (IRF5) and signal transducer and activator of transcription 4 (STAT4) are shared susceptibility genes for various autoimmune diseases. In this study, we investigated whether these genes also contribute to susceptibility to anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in a Japanese population. A case-control study was carried out on IRF5 rs10954213 and STAT4 rs7574865 in 232 Japanese myeloperoxidase (MPO)-ANCA-positive AAV patients, including 177 microscopic polyangiitis and 710 healthy controls. IRF5 rs10954213G was significantly increased in MPO-ANCA-positive AAV (additive model, P=0.023, odds ratio=1.27, 95% confidence interval=1.03-1.57). The risk allele was previously shown to be associated with lower mRNA level of IRF5. On the other hand, significant association of STAT4 rs7574865T with AAV was not detected. These observations suggested that IRF5 may contribute to susceptibility to MPO-ANCA-positive AAV in a Japanese population.

Systemic lupus erythematosus with cytophagic histiocytic panniculitis successfully treated with high-dose glucocorticoids and cyclosporine A.

A 37-year-old male with systemic lupus erythematosus (SLE) presented with high fever, subcutaneous indurations, anemia, thrombocytopenia, elevated liver enzymes and hyperferritinemia. Skin biopsy revealed hemophagocytic histiocytes in the adipose tissues. The patient was diagnosed with SLE with cytophagic histiocytic panniculitis (CHP). Treatment with high-dose glucocorticoids and cyclosporine A induced remission of SLE and CHP. CHP is generally a systemic disorder affecting subcutaneous adipose tissues with a high mortality rate. However, based on the present and previously reported cases, we believe that intensive immunosuppression can ameliorate CHP that occurs as a skin manifestation of SLE.

Discontinuation of infliximab after attaining low disease activity in patients with rheumatoid arthritis: RRR (remission induction by Remicade in RA) study.

BACKGROUND: Tumour necrosis factor (TNF) inhibitors enable tight control of disease activity in patients with rheumatoid arthritis (RA). Discontinuation of TNF inhibitors after acquisition of low disease activity (LDA) is important for safety and economic reasons. OBJECTIVE: To determine whether infliximab might be discontinued after achievement of LDA in patients with RA and to evaluate progression of articular destruction during the discontinuation. METHODS: 114 patients with RA who had received infliximab treatment, and whose Disease Activity Score, including a 28-joint count (DAS28) was <3.2 (LDA) for 24 weeks, were studied. RESULTS: The mean disease duration of the 114 patients was 5.9 years, mean DAS28 5.5 and mean modified total Sharp score (mTSS) 63.3. After maintaining LDA for >24 weeks by infliximab treatment, the drug was discontinued and DAS28 in 102 patients was evaluated at year 1. Fifty-six patients (55%) continued to have DAS28<3.2 and 43% reached DAS<2.6 at 1 year after discontinuing infliximab. For 46 patients remission induction by Remicade in RA (RRR) failed: disease in 29 patients flared within 1 year and DAS28 was >3.2 at year 1 in 17 patients. Yearly progression of mTSS (DeltaTSS) remained <0.5 in 67% and 44% of the RRR-achieved and RRR-failed groups, respectively. The estimated DeltamTSS was 0.3 and 1.6 and Health Assessment Questionnaire-Disability Index was 0.174 and 0.614 in the RRR-achieved and RRR-failed groups, respectively, 1 year after the discontinuation. CONCLUSION: After attaining LDA by infliximab, 56 (55%) of the 102 patients with RA were able to discontinue infliximab for >1 year without progression of radiological articular destruction.

Long-term safety and efficacy of tocilizumab, an anti-IL-6 receptor monoclonal antibody, in monotherapy, in patients with rheumatoid arthritis (the STREAM study): evidence of safety and efficacy in a 5-year extension study.

OBJECTIVES: To evaluate the safety and efficacy of 5-year, long-term tocilizumab monotherapy for patients with rheumatoid arthritis. METHODS: In an open-label, long-term extension trial following an initial 3-month randomised phase II trial, 143 of the 163 patients who participated in the initial blinded study received tocilizumab monotherapy (8 mg/kg) every 4 weeks. Concomitant therapy with non-steroidal anti-inflammatory drugs and/or oral prednisolone (10 mg daily maximum) was permitted. All patients were evaluated with American College of Rheumatology (ACR) improvement criteria, disease activity score (DAS) in 28 joints, and the European League Against Rheumatism response, as well as for safety issues. RESULTS: 143 patients were enrolled in the open-label, long-term extension trial and 94 (66%) patients had completed 5 years as of March 2007. 32 patients (22%) withdrew from the study due to adverse events and one patient (0.7%) due to unsatisfactory response. 14 patients withdrew because of the patient's request or other reasons. The serious adverse event rate was 27.5 events per 100 patient-years, with 5.7 serious infections per 100 patient-years, based on a total tocilizumab exposure of 612 patient-years. Of the 88 patients receiving corticosteroids at baseline, 78 (88.6%) were able to decrease their corticosteroid dose and 28 (31.8%) discontinued corticosteroids. At 5 years, 79/94 (84.0%), 65/94 (69.1%) and 41/94 (43.6%) of the patients achieved ACR20, ACR50, and ACR70 improvement criteria, respectively. Remission defined as DAS28 less than 2.6 was achieved in 52/94 (55.3%) of the patients. CONCLUSION: In this 5-year extension study, tocilizumab demonstrated sustained long-term efficacy and a generally good safety profile.

A case of polyarteritis nodosa with periurethralaseptic abscesses and testicular lesions.

We describe a 54-year-old man presenting with cutaneous ulcerations, livedo reticularis, numbness of the legs, and skin histological findings compatible with the diagnosis of polyarteritis nodosa (PAN). Initial treatment with 50 mg/day of prednisolone (PSL) was effective. However, the symptoms and signs recurred, and the patient developed multiple periurethral aseptic abscesses, urethra-cutaneous fistula, and testicular lesions after tapering of PSL therapy. The condition improved with PSL and cyclophosphamide administration. Since penile and testicular vasculitis could be associated with PAN, although rarely, we should carefully distinguish such an involvement from infection and malignancy.

Reliability of recalled self-report on headache intensity: investigation using ecological momentary assessment technique.

Recalled evaluation of headache intensity is often affected by several factors. Recently, computerized ecological momentary assessment (EMA) has been developed to avoid such problems as recall bias. Here, we compared recalled headache intensity with momentary headache intensity using EMA in tension-type headache (TTH). Forty patients with TTH wore watch-type computers for 1 week to record momentary headache intensity and also rated their headache intensities by recall. We calculated intraclass correlation coefficients between recalled headache intensity and indices from EMA recordings in the whole study population and in two subgroups divided by variability of momentary headache intensity. The results showed that consistency and agreement of momentary and recalled headache intensity were low, and this was especially marked in the subjects whose headache varied widely. These observations suggested that variability of headache intensity may affect recall of headache intensity and this should be taken into consideration in both clinical and research settings.

Favorable outcomes with tacrolimus in two patients with refractory interstitial lung disease associated with polymyositis/dermatomyositis.

Two cases of progressive interstitial lung disease associated with polymyositis/dermatomyositis are presented. Both patients were refractory to conventional therapy with high-dose corticosteroids, cyclosporine, and intermittent pulse cyclophosphamide, and thus a therapeutic trial of tacrolimus was instituted. Tacrolimus was markedly effective in achieving subjective, laboratory and radiographic improvement in both patients.

Dipeptidyl peptidase IV on activated T cells as a target molecule for therapy of rheumatoid arthritis.

The extracellular domain of the T cell co-stimulatory molecule CD26 possesses dipeptidyl peptidase IV (DP IV) enzyme activity. Activated T cells are known to increase expression of cell surface DP IV and some specific inhibitors of this enzyme have been reported to suppress T cell function. Previously we have identified a DP IV inhibitor, designated TMC-2, found in culture supernatant of Aspergillus oryzae. Administration of TMC-2 to rats with adjuvant arthritis caused marked suppression of paw swelling. To elucidate the mechanism of TMC-2 antiarthritic activity, we have studied its effects on T cell function. Here we show that TMC-2 inhibited DP IV activity of CD26 immunoprecipitated from T cell lysates, and also inhibited proliferative responses of T cells to specific antigen or anti-CD3 antibody. Suppression of IL-2 production was demonstrated at both the mRNA and protein levels. TMC-2 did not alter the PTPase activity of pure CD45, but when this molecule was co-precipitated from T cell lysates together with associated CD26, its PTPase was virtually completely abolished by TMC-2. These results suggest that modulation of CD45 PTPase activity might be responsible for functional suppression of T cells by TMC-2. Because the effects of TMC-2 on T cells were reversible and it was not toxic at the concentrations used, TMC-2 may be a candidate novel therapeutic agent for rheumatoid arthritis.

Two cases of acute respiratory distress syndrome resulting from adult-onset Still's disease.

Abstract Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown origin. Acute respiratory distress syndrome (ARDS) is a rare complication of AOSD, with only nine cases having been reported in the literature. Here, we describe two cases of AOSD complicated with ARDS that were successfully treated with immunosuppressive therapy, including corticosteroids. Although ARDS is a life-threatening complication in AOSD, early commencement of high-dose corticosteroids and mechanical ventilation improve the prognosis.

Recovery of apparent diffusion coefficient after embolic stroke does not signify complete salvage of post-ischemic neuronal tissue.

BACKGROUND AND PURPOSE: It has been shown in previous studies that recovery of apparent diffusion coefficient (ADC) of water is not necessarily associated with a reversal of tissue damage. We examined the relationships between temporal ADC change and histological outcome after embolic stroke in rat using an experimental MRI scanner. SUBJECTS AND METHODS: Male Wistar rats underwent embolization of the right middle cerebral artery with autologous clot. ADC and relative cerebral blood flow (rCBF) were measured consecutively for 3 hours after embolization. The brains were prepared for histological examination. RESULTS: Transient decline of ADC was observed during the initial 2 hours after embolization. In these areas, serial rCBF measurement revealed incomplete recovery. In some other areas, ADC decrease without rCBF recovery was observed during 3 hours postischemia. Histological examination revealed infarction in areas with persistent ADC decrease. Scattered neuronal death was noticeable in areas with a transient--in some areas less than 0.5 hour--ADC decrease. CONCLUSION: Consecutive MRI analysis demonstrated postischemic transient ADC decrease in an embolic stroke model of rat. The normalization of ADC does not signify normalization of postischemic tissue, since the areas often evolve postischemic neuronal death at a later time.

Temporal evolution of apparent diffusion coefficient and T2 value following transient focal cerebral ischemia in gerbils.

We examined the time course of apparent diffusion coefficient (ADC) and T2 values in gerbils subjected to transient focal cerebral ischemia and compared them with histopathologic changes. Ten gerbils were subjected to two times 10-min occlusions of the left common carotid artery and examined with diffusion-weighted and T2-weighted MR imaging, at the interocclusion period and 1 hour, 2 hours. 1 day, 2 days, 4 days, and 7 days after the second occlusion. Immediately after the last MR imaging, their brains were examined histopathologically. ADC values decreased 1 hour after the second occlusion and continued to decrease up to 1 or 2 days later. ADC values remained lowered up to 4 days and slightly recovered at 7 days. T2 values were normal at 1 and 2 hours and began to increase at 1 day. T2 values began to recover at 4 days. Histopathologically, infarction was confined in the fronto-parietal cortex, dorsolateral caudate nucleus and dorsolateral thalamus, and neuronal necrosis was found in the pyramidal cell layer of the hippocampus. This study indicates that sequential ADC and T2 studies of gerbils subjected to transient focal cerebral ischemia provide a useful tool for evaluating temporal evolution of ischemic brain injury and edema, including cytotoxic and vasogenic edema.

Histological findings after placement of a self-expanding stent in rectal carcinoma with complete obstruction--case report.

Patients with acute obstruction due to colorectal carcinomas frequently require emergency surgery. However, such emergency procedures are associated with various complications, a high mortality rate and a poor prognosis. If the obstruction could be immediately relieved, the patient could later undergo an elective operation with a much better prognosis. Recently, expanding metallic stents have been used to treat obstruction due to colorectal carcinoma. In the case reported here, we initially inserted a colonoscopic retrograde bowel drainage tube per anus to achieve decompression. We then placed a self-expanding metallic stent, since we anticipated a prolonged preoperative period due to high fever, congestive heart failure, cerebral infarction, and persistent high blood sugar concentrations. The patient had no complications for 57 days after placement of the stent, and eventually underwent an elective operation. Histologically, the side of the cancerous lesion compressed by the stent was thin and consisted solely of a serosal layer. Implantation of a metallic stent is safe for the treatment of acute malignant obstruction. Stent placement is indicated not only as a palliative treatment for inoperable or recurrent cases, but also as a preoperative procedure before elective surgical resection.