C-Reactive protein (CRP) is widely used as a marker of infection, but there is insufficient evidence as to its usefulness in patients with community-acquired pneumonia (CAP). In the present study, we investigated the clinical usefulness of CRP in a retrospective study of 242 patients aged ≥ 14 years who were hospitalized with CAP. Patients were classified into three groups according to the number of days between disease onset and the initial measurement of CRP as follows: Group 1, 0-1 day; Group 2, 2-4 days; Group 3, ≥ 5 days. Patients in Groups 2 and 3, who had more severe pneumonia, had higher CRP levels. Over time, CRP levels decreased in the responders in Groups 2 and 3; specifically, in Group 2, median CRP levels on Days 0, 3, and 7 were 9.85, 5.33, and 0.81mg/dL, respectively, compared with 9.99, 4.29, and 0.70mg/dL, respectively, in Group 3. In patients not responding to initial treatment, median CRP levels increased from Day 0 to Day 3 (4.32 vs. 11.70mg/dL, respectively). In all non-responders, CRP levels on Day 3 were>50% of levels on Day 0. In conclusion, when measured approximately 48 h after disease onset, CRP is useful for evaluating the severity of pneumonia and predicting the response to treatment. A good clinical outcome is likely when CRP levels on Day 3 are ≤ 50% of those on admission.

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The present study investigated the effects of subconjunctival injections of an anti-rat vascular endothelial growth factor (anti-VEGF) antibody on oxygen-induced retinopathy (OIR) in a neonatal rat model. OIR was induced by daily cycles of 80% oxygen (20.5h), room air (0.5h), and a progressive return to 80% oxygen (3h) for 12 days [until postnatal day (P) 12]. On P12, rats received subconjunctival injections in their right eye of 0.1 or 1.0μg anti-VEGF antibody (or 1.0μg goat IgG as a control). No injections were made into the left eye. On P18, rats were killed and their retinas were removed and flat-mounted before being stained with adenosine diphosphatase. Retinal neovascularization (NV) was scored and the extent of avascular areas, as a percentage of total retinal area (%AVA), was determined using image analysis. Although there was a tendency for lower mean NV scores in eyes injected with 0.1 and 1.0μg anti-VEGF compared with control (4.3±1.1, 2.3±1.0, and 6.7±1.3, respectively; n=10–13), the difference failed to reach statistical significance. Similarly, although there was a tendency for mean %AVA to be lower in the injected eyes for both the 0.1 and 1.0μg anti-VEGF groups compared with control (15±3%, 13±3%, and 25±4%, respectively; n=10–13), the differences were not significant. Similar tendencies were observed in the contralateral eyes. Although further studies using larger numbers of rats are needed to obtain statistically significant results, the results of the present study suggest that the subconjunctival injection of anti-VEGF antibody may prove to be a useful route of administration in conjunction with intravitreal injections, which are the generally used method at present. However, careful attention should be paid to the possibility of systemic side effects.

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Rapidly destructive coxarthropathy (RDC) is a clinical concept propounded by Postel and Kerboull. RDC is characterized by joint destruction progression within a year, although the etiology of this disorder remains unknown. We evaluated 21 hips in 20 patients radiologically diagnosed with RDC. All patients underwent a total hip arthroplasty. The average age at surgery was 75 years. The affected side was more osteoporotic in all patients, and the pelvic angle, which indicates the spinopelvic alignment, was distributed below the normal range, i.e., the posterior tilt was more than the normal range. The affected side showed a higher center-edge (CE) angle and anterior-acetabular head index (AAHI) than the unaffected side, possibly due to severe head collapse. Our result supported that osteoporosis and/or mechanical factors influence the course of RDC. More investigations such as biochemical and immunopathological analyses would be necessary to clarify the etiology of RDC, which could be a terminal stage of some lesions.

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We investigated the usefulness of the urinary myoinositol index (UMI) for identifying postmeal hyperglycemia in type 2 diabetics undergoing a meal tolerance test. Fifty-eight patients (18 males, 40 females) were enrolled, fasted overnight and blood collected prior to and 1 and 2 hours following the test meal. Urine was collected 2 hours after the test meal. Plasma 1,5-anhydroglucitol (1,5-AG) was measured enzymatically, and UMI with an improved enzymatic cycling method. Simple and multiple regression analyses were employed to determine correlations between plasma glucose (PG) and three PG markers; HbA_1C (Japan Diabetes Society), 1,5-AG and UMI. Study population characteristics were age 67.6±7.9 years, body mass index 24.9±3.8kg/m² and waist circumference 90.2±10.4cm. Mean concentrations for PG were 130±23mg/dL (fasting), 179±46mg/dL (1h postmeal) and 150±49mg/dL (2h postmeal), HbA1C (6.3±0.6%), 1,5-AG (11.9±5.7μg/mL) and 2h UMI (52.0±35.9mg/gCr). Correlation coefficients were calculated between 1h postmeal PG and HbA_1C (r=0.558), 1,5-AG (r=0.256), and 2h UMI (r=0.496), and 2h postmeal PG HbA_1C (r=0.605), 1,5-AG (r=0.306), and 2h UMI (r=0.606). Two hour UMI and HbA_1C (Japan Diabetes Society) were significant determinants of 2h postmeal PG. As HbA_1C reflects PG excursion during the previous 1-3 months, UMI may be a useful marker for monitoring and management of postmeal hyperglycemia in type 2 diabetics.

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In the present study, we investigated how pain perception by migraine (MG) patients may differ from that of normal subjects. We simultaneously measured respiration and used an electroencephalogram to find inspiration-related (I-α) potentials during pain stimuli, which are usually observed in normal subjects during emotional arousal. There were no differences in pain threshold levels, maximum pain levels, scales of the level of pain, state, and trait anxiety, or respiratory rate during rest and stimulation between normal and MG subjects. When anticipating a pain stimulus, respiratory rate increased in both MG and normal subjects. However, I-α potentials were only found in normal subjects. We suggest that the absence of I-α potentials in MG patients may be due to the fact that pain-induced pervasive cortical excitability may not be sufficient to concentrate the brain rhythms to phase-lock. Hypersensitivity towards light, sound, and various sensations is often reported in MG. Thus, there may be a tendency in MG subjects to avoid concentrating on one external stimulus to protect against increased hypersensitivity. It may be that MG patients intuitively know that decentralizing their attention can avoid triggering an MG attack.

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Alzheimer's disease (AD) manifests early with prominent olfactory dysfunction. The olfactory symptoms appear long before cognitive impairment and other typical AD symptoms. Here, we tested odor detection and recognition acuity in AD patients and in age-matched controls to determine the relationships between olfactory test scores and anxiety level, cognitive function, and disease and therapy duration.
We found that while AD patients had the same odor detection sensitivity as healthy subjects, most patients exhibited impaired odor recognition. AD patients had significantly lower cognitive function and trait anxiety scores than healthy subjects according to our assessments using the Mini-Mental State Examination (MMSE). Trait anxiety scores are thought to be lower in AD patients because of atrophy of the limbic system, particularly the amygdala (AMG). It has been reported that trait anxiety level is dependent on amygdala activity, therefore, the low activation of the AMG is linked to reduced trait anxiety in AD.
However, we found that trait anxiety correlated positively with odor detection ability in AD patients. Although the function of the AMG is reduced in AD patients, it still contributes to odor detection in AD patients with high trait anxiety.

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Herein we report our experience with a C-arm cone beam computed tomography (CBCT)-guided abscess drainage procedure. We retrospectively examined the medical records and imaging results of patients whose abscesses were drained between 2005 and 2010 employing this system. We analyzed the technical success rate and incidence of procedure-related complications. Percutaneous abscess drainage using C-arm CBCT was performed using a flat-panel detector digital subtraction angiography (DSA) system on 104 lesions in 97 patients (55 men, 42 women) with a mean age of 64.7 (30-88) years. The drainage procedure was performed twice in 6 patients and 3 times in 2 patients, and 6 patients received 2 or more punctures at the same time. The technical success rate with this procedure was 98.1% (102 of 104 lesions). Placement of the drainage tube was abandoned in 2 patients due to difficulty in inserting a wire into the abscess cavity in 1 case and difficulty looping the wire in the other. The incidence of procedure-related complications was 3.85% (4 of 104 lesions). Our retrospective study and review of the relevant literature revealed that the C-arm CBCT-guided abscess drainage procedure examined was generally safe for patient use, showed a high technical success rate and low incidence of procedure-related complications, and was useful for abscesses that were inaccessible using other instruments. Although C-arm CBCT has limited contrast resolution, this disadvantage is easily overcome by comparing images with those obtained using other modalities.

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In the present study we investigated whether the emotional state induced by music can change respiratory rate (RR), tidal volume (V_T), minute ventilation (V_E), and end-tidal CO₂ concentration (ETCO₂). In a pioneering study investigating the effect of music on respiration, the music of Stockhausen and Chopin was used. In the present study, we examined the effects of the same musical stimuli used in that study on respiration. Each stimulus (Stockhausen, Chopin, and silence) was delivered for 30 s and each stimulus was presented five times in random order. Subjects reported feeling uncomfortable listening to Stockhausen's music, but comfortable during Chopin's music and silence. The respiratory response during exposure to Stockhausen's music was rapid and shallow breathing, resulting in an increase in RR. Although the RR was decreased during silence and Chopin's music by Chopin compared with that during Stockhausen's music, there was no significant difference in RR in response to Chopin's music and Stockhausen's music. Although subjects reported feeling comfortable while listening to Chopin's music, the decrease in RR was not significant. The lack of a significant decrease in RR in response to Chopin's music may be due to a mixture of various emotions that may be interconnected to physiological responses, and this higher processing may be peculiar to humans.

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