New Miyake-Apple View system using a nasal endoscope.

PURPOSE: To evaluate images and videos behind the anterior segment of cataract surgery with the porcine eye using a new Miyake-Apple View with a nasal endoscope. SETTING: Sugiura Eye Clinic, Fuji, Shizuoka, Japan. DESIGN: Laboratory study. METHOD: A hole was made in a commercially available wooden desk and the nasal endoscope was fixed under the desk. A tunnel for passing the probe of the nasal endoscope was opened on a Styrofoam human-faced base, and the probe was passed through. A 3 mm × 3 mm incision was made behind the globe, and a nasal endoscope probe was inserted to observe the posterior anterior segment of the eye. RESULT: The posterior part of the anterior segment of the eye could be clearly observed, and each procedure (hydrodissection, phacoemulsification, irrigation and aspiration, and insertion and fixation of intraocular lens [IOL]) in normal cataract surgery could be observed from the posterior. Lighting could be improved. CONCLUSIONS: The conventional Miyake-Apple View required a large-scale custom-made device, which was expensive and could not be taken easily, and required to cut the globe and a technique to fix it to the glass plate. However, this method made it easy to prepare for shooting, and the equipment was inexpensive. Furthermore, it had the great advantage of not having to cut the globe. Since the integrity of the globe was maintained, normal cataract surgery could be reproduced and dynamic observation from the back became possible. It was useful for practicing cataract surgery and examining the fixed state of new IOLs.

Quantitative and qualitative investigation of the stress experiences of intensive care unit patients mechanically ventilated for more than 12 hr.

AIM: The aim was to qualitatively and quantitatively clarify the stress experiences of patients who were mechanically ventilated in an intensive care unit (ICU) for more than 12 hr. METHODS: The participants were adult patients without cognitive impairment who were mechanically ventilated in a general ICU for more than 12 hr. The Japanese version of the ICU Stressful Experiences Questionnaire (ICU-SEQJ) survey was performed before subjects were discharged from the ICU to collect narratives about how they felt and what they thought during their ICU stay. The results were analyzed in a collective and complementary way by dividing ICU-SEQJ scores into quartiles and comparing the first (low stress experience group) and third quartiles (high stress experience group). RESULTS: A total of 96 subjects were enrolled in the study, with 25 scoring in the high stress experience group and 24 in the low stress experience group. The high stress experience group had significantly longer duration of intubation, higher amounts of analgesics and sedative drugs, higher C-reactive protein, lower level of deepest sedation and greater absence of medical history than the low stress experience group. Analysis of the subjects' narratives revealed "Unbearable holistic discomfort", "Pain of being unable to control myself as before" in the high stress experience group and "Responding by giving meaning" in the low stress experience group. CONCLUSIONS: Nurses must recognize that long intubation hours and invasive procedures are subjective stress experiences that may cause patients to suffer holistic discomfort and lose their sense of control.

Blood isoflavone levels during intake of a controlled hospital diet.

Isoflavones are reported to have an estrogenic activity to prevent prostate cancer. Therefore, it is necessary to analyze the factors influencing the absorption and metabolism of isoflavones using detailed and precise dietary information. We evaluated the relationship between the amount of intake of soybean isoflavones in the diet and its serum levels in 88 hospitalized patients (22 with prostate cancer, 66 without cancer) with a mean age of 67.0+/-9.3 y. The intake amount of genistein and daidzein was significantly lower in the hospital diet than that in the ordinary daily diet. The serum levels of isoflavones were related to the amount of intake consumed during the day before blood collection (r=0.27 for genistein, r= 0.33 for daidzein), but not to the last meal before blood collection. While little relationship was observed between the amount of intake and serum levels of isoflavones in the equol producers, a marked relationship was noted in the non-producers (r=0.52 for genistein, r=0.67 for daidzein). Blood isoflavone levels decreased when the duration of the hospitalization was longer than 1 wk. These observations indicate that the serum isoflavone levels are correlated with the amount of intake of isoflavones during the preceding 2 wk and serve as an effective biomarker in individuals during the intake of the hospital diet. Further investigations, including the mechanism of the metabolism on isoflavones, are necessary for the evaluation of the preventive effect of isoflavones.

Comparisons of percent equol producers between prostate cancer patients and controls: case-controlled studies of isoflavones in Japanese, Korean and American residents.

BACKGROUND: Our previous case-control study revealed that the Japanese residents in Japan could be divided into those who are able to degrade daidzein, a soybean isoflavone, to equol and those without this ability, and that the incidence of prostate cancer is higher in the latter group. METHODS: We recently conducted a similar case-control study involving not only Japanese residents in Japan but also Korean residents in Korea. The incidence of prostate cancer in Korean residents is known to be close to that of Japanese residents in Japan. On the other hand, American residents in the United States have a markedly higher incidence of prostate cancer as compared to Japanese residents in Japan. RESULTS: The number of subjects was 295 in Japan (133 patients and 162 controls), 122 in Korea (61 patients and 61 controls) and 45 in the United States (24 patients and 21 controls). The percentage of equol producers among patients and controls was 29% and 46% in Japan (P = 0.004) and 30% and 59% in Korea (P = 0.001), respectively. The active isoflavone level was markedly lower and the percentage of equol producers was also lower (17% for patients and 14% for controls) for Americans as compared to the Japanese and Koreans. CONCLUSIONS: These results suggest that the ability of producing equol or equol itself is closely related to the lower incidence of prostate cancer. The results also suggest that a diet based on soybean isoflavones will be useful in preventing prostate cancer.

A case-control study of diet and prostate cancer in Japan: possible protective effect of traditional Japanese diet.

The age-adjusted incidence of prostate cancer is low in Japan, and it has been suggested that the traditional Japanese diet, which includes many soy products, plays a preventive role against prostate cancer. We performed a case-control study on dietary factors and prostate cancer in order to assess the hypothesis that the traditional Japanese diet reduces the risk of prostate cancer. Four geographical areas (Ibaraki, Fukuoka, Nara, and Hokkaido) of Japan were selected for the survey. Average daily intake of food from 5 years before the diagnosis was measured by means of a semi-quantitative food frequency questionnaire. We studied 140 cases and 140 individually age ( +/- 5 years)-matched hospital controls for analysis. Estimates of age-adjusted odds ratios (ORs) and linear trends were calculated by conditional logistic regression models with adjustment for cigarette smoking and total energy intake as confounding factors. Consumption of fish, all soybean products, tofu (bean curds), and natto (fermented soybeans) was associated with decreased risk. ORs of the fourth vs. first quartile and 95% confidence intervals (95%CIs) were 0.45 (0.20-1.02) for fish, 0.53 (0.24-1.14) for all soybean products, 0.47 (0.20-1.08) for tofu, and 0.25 (0.05-1.24) for natto. Consumption of fish and natto showed significantly decreasing linear trends for risk (P < 0.05). Consumption of meat was significantly associated with increased risk (the OR of the second vs. first quartile was 2.19, 95%CI 1.00-4.81). Consumption of milk, fruits, all vegetables, green-yellow vegetables, and tomatoes showed no association. Our results provide support to the hypothesis that the traditional Japanese diet, which is rich in soybean products and fish, might be protective against prostate cancer.

Higher consumption of green tea may enhance equol production.

BACKGROUND: Our previous case-control study revealed that Japanese living in Japan and Koreans living in Korea can be divided into equol producers who have an ability to metabolize daidzein to equol and non-producers, and that the incidence of prostate cancer is higher in the latter group. In the present study, we examined relationships between type of food intake and the capacity for equol production in Japanese subjects. METHODS: The subjects were the individuals analyzed for the ability to produce equol in our previous study and newly registered cases. From December 2000 to December 2002, 276 hospitalized patients were interviewed face-to-face and blood samples were collected before breakfast. These included 122 patients with prostate cancer and 154 age-matched controls. RESULTS: The frequency of equol producers (0.5 ng/ml or more) among cases and controls was 29% and 45%, respectively (p = 0.004). The consumption of soybeans and green tea were significantly higher in equol producers than in the non-producers (p<0.05). By contrast, the consumption of selenium and fiber was significantly lower in equol producers (p<0.05). CONCLUSIONS: Our results suggest that higher consumption of soybean and green tea are strongly related to the establishment of a capacity for equol production.

Is daidzein non-metabolizer a high risk for prostate cancer? A case-controlled study of serum soybean isoflavone concentration.

BACKGROUND: It has been postulated that soybean isoflavones act as inhibitory factors in prostate cancer. However, to date there have been no case-controlled clinical studies carried out to compare the circulating concentrations of isoflavones in prostate cancer patients and control subjects. METHODS: The serum levels of genistein, daidzein and equol were determined and compared in 253 experimental subjects (141 prostate cancer patients and 112 cancer-free controls). RESULTS: The serum concentrations of isoflavones were compared in hospitalized and non-hospitalized subjects and for both the prostate cancer patients and the controls the concentrations were lower in the hospitalized subjects. The serum concentrations of genistein and daidzein were compared in subjects <70 years of age and subjects >/=70 years old and the levels were significantly lower in the younger group. Contrary to our expectation, comparison of the patient group and the control group revealed the serum concentrations of isoflavones to be higher in the patient group. Daidzein non-metabolizers were compared in the hospitalized experimental subjects of the patient group and the control group and they were significantly more common in the patient group. The poorly differentiated cancer patient group included a significantly lower percentage of daidzein metabolizers. CONCLUSIONS: The above findings revealed that equol itself or some unknown factor regulating the metabolism of daidzein is deeply involved in the biology of prostate cancer. Future studies are urgently needed to compare the incidence of daidzein metabolizers among various countries.