Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

Background/Aims: Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS.The aim of this study is to determine this issue in young people. Methods: A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria.Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire. Results: The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15-1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018). Conclusion Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population.

Background/Aims: Functional dyspepsia (FD) may be a common digestive disease worldwide and reduces the quality of life of patients. However, only a few studies have investigated the association between eating behavior and FD. The purpose of this cross-sectional study is to examine the association between eating behavior and prevalence of FD in a young Japanese cohort. Methods: In this study, we enrolled 8923 Japanese university students. FD is diagnosed based on the Rome III criteria. Eating habits and frequency of meals were investigated using a self-administered questionnaire. Results: The FD subjects had a younger mean age, a lower body mass index, and a lower proportion of men compared to the non-FD subjects.An independent positive association between skipping breakfast and/or lunch and FD was found (adjusted ORs were 1.60 [95% CI, 1.10-2.32] for breakfast and 2.52 [95% CI, 1.04-5.18] for lunch). Skipping dinner, extra meals (snacks) or midnight snacks was not associated with FD. The prevalence of FD in subjects eating 1, 2, and 3 meals per day was 4.8%, 2.2%, and 1.7%, respectively. The frequency of meals was independently inversely associated with prevalence of FD (adjusted ORs were 1 per day: 2.72 [95% CI, 1.19-5.42], and 2 per day: 1.69 [95% CI, 1.16-2.43], P for trend = 0.001). Conclusions In the young Japanese people, the frequency of meals may be independently inversely associated with prevalence of FD. In particular, skipping breakfast and/or lunch was associated with the prevalence of FD.

Background/Aims: Evidence regarding the association between body mass index (BMI) and functional dyspepsia (FD) in the Asian population is limited.Further, no study has evaluated this issue in young people in Asian and Western populations. Thus, we aim to investigate this issueamong young Japanese people. Methods: The study subjects comprised of 8923 Japanese university students. BMI was divided into 4 categories (quartiles) on the basis of thestudy subjects’ distribution (lowest, low, moderate, and high [reference]). The definition of lean, normal, overweight, and obesewas BMI < 18.5 kg/m2 , 18.5 ≤ BMI < 25 kg/m2 (reference), 25 kg/m2 ≤ BMI < 30 kg/m2 , and 30 kg/m2 ≤ BMI, respectively. The definition of FD was based on the Rome III criteria. Results: The prevalence of FD was 1.9% in this cohort. The lowest BMI was independently associated with FD after adjustment (adjusted odds ratio [OR], 2.88; 95% confidence interval [CI], 1.46-3.67); P for trend = 0.001). The lowest BMI was independently associated with FD in women but not in men (OR, 2.94; 95% CI, 1.59-5.77; P for trend = 0.001). Leanness was independently associated with FD in total and in women but not in men (total: adjusted OR, 2.01; 95% CI, 1.40-2.86) and women (OR, 2.19; 95% CI, 1.35-3.45). However,interaction analysis showed no significant difference for sex. Conclusions Among young Japanese people, BMI may be independently inversely associated with FD. Leanness may be an independent associated factor for FD in the young Japanese women.

  [Purpose] Acral coldness is a condition in which the fingers and/or toes are cold despite normal central body temperature. Regardless of the presence or absence of disease, many people suffer from acral coldness, especially elderly people. One method of relieving acral coldness is to heat the hands with a disposable warmer called “Kairo,” but this method interferes with daily work. We investigated whether or not heating other upper-limb parts with a pair of warmers can relieve acral coldness.   [Methods] After obtaining informed consent, 30 people who usually had acral coldness without other diseases received the Kairo holders for their necks, elbows, and wrists. Eighteen participants used a pair of Kairo warmers for each area for one week, respectively. The remaining participants wore only the holder to know the heat retention effect of the holders. All participants separately evaluated their acral coldness of the upper limbs and the cumbersomeness of holders and/or Kairo by using a 10cm visual analog scale (VAS). To measure the therapeutic effect of the Kairo, the temperature and blood flow of the surface of both hands were examined by thermography and laser speckle contrast analysis (LASCA) at the day after finishing each warming period. These evaluations were conducted after a 20-minute adaptation at 24°C.  [Result] The VAS of acral coldness of upper limbs decreased during the periods of warming on the neck and elbows with Kairo compared to the period without Kairo. There was no difference in the VAS value of the cumbersomeness among the neck, elbows, and wrists areas. The hand temperature on the day after the end of warming decreased slightly after elbow warming.  [Conclusion] We found that the coldness of the hand was improved by warming other parts, even if the hand was not warmed, but the effect varied depending on the warming area. No therapeutic effect was detected, but this was considered to be a problem in setting the measurement conditions. We believe these results will lead to new ways to improve acral coldness.

Objective: Poor R wave progression in right precordial leads is a relatively common electrocardiogram (ECG) finding that indicates possible prior anterior myocardial infarction (MI); however, it is observed frequently in apparently normal individuals. In contrast, reversed R wave progression (RRWP) may be more specific to cardiac disorders; however, the significance of RRWP in daily clinical practice is unknown. The purpose of this study was to clarify the significance of RRWP in clinical practice.Materials and Methods: We analyzed consecutive ECGs obtained from 12,139 patients aged ≥20 years at Mito Kyodo General Hospital in Ibaraki between November 2009 and August 2012. Our setting is a secondary emergency hospital in the community, and the study participants were inpatients or patients who visited the general or emergency outpatient departments. RRWP was defined as RV2 < RV1, RV3 < RV2, or RV4 < RV3. Regarding ECGs considered to show RRWP, we confirmed the presence or absence of an abnormal Q wave and whether ultrasound cardiography, contrast-enhanced computed tomography, coronary angiography, and/or left ventriculography were performed to obtain detailed information.Results: RRWP was identified in 34 patients (0.3%). Among these patients, 29 (85%) had undergone cardiac evaluation. The final diagnosis was previous anterior MI in 12 patients (41%) and ischemic heart disease (IHD) without MI in 5 patients (17%). All 17 patients with IHD had left anterior descending (LAD) artery stenosis. The other patients were diagnosed with dilated (two patients, 7%) and hypertrophic (one patient, 3%) cardiomyopathy, left ventricular hypertrophy (one patient, 3%), or pulmonary embolism (one patient, 3%). Only seven patients (24%) were normal.Conclusions: RRWP is rare in daily clinical practice; however, it is a highly indicative marker for cardiac disease, particularly IHD with LAD artery stenosis.

STUDY DESIGN: Retrospective case series. PURPOSE: To examine the efficacy of TachoSil for vessel injury in 6 patients who underwent anterior lumbar fusion surgery (ALF). OVERVIEW OF LITERATURE: ALF for the lumbar spine has a high rate of success, although intraoperative concerns and iatrogenic complications are known, and injury of a major vessel is sometimes a complication. The efficacy of TachoSil, a fibrin-based hemostat, has been reported for several types of surgery; however, use of TachoSil for ALF surgery has not been described. Here, we report on the efficacy of TachoSil in 6 patients, who underwent ALF after vascular surgeons having difficulty in repairing vessels. METHODS: Two man and 4 women with average age of 50.8±10.9 (mean±standard deviation) were diagnosed with a vertebral tumor (2 patients), L4 degenerative spondylolisthesis (2 patients), and L5 spondylolytic spondylolisthesis (2 patients) and underwent ALF. The blood vessels injured included the common iliac vein in 2 patients and a branch of a segmental artery from the aorta in 4 patients. We consulted a vascular surgeon to suture or repair the vessels during surgery, and although the vascular surgeon attempted to address the injuries, suturing or repair was not possible in these cases. For this reason, we used TachoSil to repair the injury in the vessels walls or to stop the bleeding. RESULTS: Time to pressure hemostasis using TachoSil was 34±12 minutes, and total blood loss was 1,488±1,711 mL. Nevertheless, all vessel injuries were controlled by the use of TachoSil. CONCLUSIONS: We recommend the use of TachoSil for vessel injuries that vascular surgeons cannot suture or repair during ALF surgery.
Aorta ; Arteries ; Blood Vessels ; Female ; Hemorrhage ; Hemostasis ; Humans ; Iliac Vein ; Retrospective Studies ; Spine* ; Spondylolisthesis ; Surgeons ; Sutures

Background: Japan has an extremely large number of hot spring facilities, with more than 27,000 natural spring sources across the country. Despite the high usage of hot springs for leisure in Japan, almost no studies have investigated the general public’s utilization of hot springs at non-medical facilities as a form of alternative medicine. The aim of this study was therefore to elucidate the current status, including frequency and purpose, of hot spring utilization as an alternative medicine. Methods: In January 2011, we conducted an online self-administered questionnaire survey on balneotherapy utilization of 10,400 ordinary citizens (men and women, 5,200 each) aged 20 to 69 years who were registered as consumer reviewers with an Internet survey company. Results: Among 10,400 Internet consumer reviewers, 3,227 responded to the survey (response rate, 31.0%), of whom 3,212 provided unambiguous survey responses and were subsequently included in this study. The results revealed that 177 subjects (5.5%; 85 men, 5.3%; 92 women, 5.7%) had utilized balneotherapy (in the form of bathing, drinking, and/or inhalation) at a non-medical facility in the previous month. Among participants who had consulted a physician in the previous month, 51 (9.1%) had utilized balneotherapy, compared to 41 (3.9%) among those who had not, revealing significantly higher utilization of balneotherapy among those who had consulted a physician (p<0.001). Only 7 men (8.2%) and 1 woman (1.1%) consulted a physician prior to balneotherapy, and 8 men (9.4%) and 2 women (2.2%) received a physician referral. Conclusions: This online survey of balneotherapy utilization among the general public in Japan revealed that among those in the study population with recent experience of balneotherapy, few had consulted or obtained a referral from a physician prior to utilization.

The relationship between body fat growth and physical fitness and motor ability development in school age children is not well understood. We determined the similarities and differences in body fat growth and physical fitness and motor ability development curves by applying cross correlation functions, and attempted to show the structure of growth and development between these attributes. The subjects were 647 boys aged 7 to 15 years. The measurements were height, weight, body mass index and body fat percentage as physical characters; and 20-m sprint, Pro Agility test, side steps, standing long jump, vertical jump, and rebound jump (RJ) index as physical fitness and motor ability. The wavelet interpolation method was applied to growth and distance values for physique, body fat and physical fitness and motor ability, and growth and development curves were derived. Cross correlation functions were then applied to the respective pairs of the compared velocity curves. There were large changes in the behavior of the growth velocity curve around the take off age for height, and so the relationship between body fat percentage and physical fitness and motor ability was investigated using the respective cross correlation functions around the take off age. Before the take off age, positive correlations were seen between body fat percentage and physical fitness and physical fitness and motor ability except for the RJ index. After the take off age, in contrast, there were negative correlations between body fat percentage and physical fitness and motor ability except for the RJ index. These results show the new finding that after the take off age in boys, there are contrary similarity between body fat and speed, agility, and instantaneous force.

We have developed a new gait assisting device for patients with hemiplegia, by which a single therapist alone can work with : 1) swing of the paretic limb, 2) stance of the paretic limb, and 3) alternate lateral weight-shift during gait. This device (ASSWS : Assistance of Swing, Stance and Weight Shift) imitates the kinesiological complex (patellar ligament, quadriceps, iliotibial ligament and gluteus maximus) to maintain a standing posture for the lower extremities. We compared the results of a gait analysis using a motion analyzer for gait with ASSWS and gait without ASSWS. With ASSWS, the walking speed was faster, stride length was longer, and stride duration was shorter. No differences in floor reaction force were identified. With ASSWS, the flexion peak of the hip joint became larger and the knee joint was in a more flexed position throughout the walking cycle. Also, the joint moment of hip extension, hip flexion and knee extension all increased with use of the ASSWS.