Microalbuminuria (MA) is a well-known predictor of cardiovascular disease and mortality in adults. However, these relationships remain unclear in adolescents. A few studies on association between MA and obesity have been conducted in adolescents. However, the association between MA and growth parameters such as height has not been studied, despite the fact that adolescence is a period of rapid physiological change. We, therefore, aimed to evaluate the association between MA and growth parameters, and the association between MA and obesity related cardiovascular risk factors after adjusting for growth. The study included 1,459 adolescents (847 boys and 612 girls) aged 12-18 years who participated in the Korean National Health and Nutrition Examination Survey (2011-2013). A urine albumin/creatinine ratio (UACR) of 30-299 mg/g in a morning urine sample was considered to reflect MA. MA was detected in 53 (3.6%) including 24 girls. Height z-score of adolescents with MA was greater than that of normoalbuminuric adolescents (0.87 vs. 0.38; P < 0.01). Upon multiple regression analysis, UACR was associated with lower weight z-score (β = –0.100, P < 0.01) and higher height z-score (β = 0.069, P < 0.01). In term of cardiovascular risk factors, the UACR was not associated with fasting glucose, high-density-lipoprotein cholesterol, or triglyceride levels. Adolescents with MA tend to be thin and tall. MA is not a useful screening method for obesity-related cardiovascular risk in adolescents, but instead MA is associated with taller height and lower weight, growth-related parameters in adolescence.
Interleukin-18 (IL-18) is a proinflammatory cytokine that plays an important role in periodontitis and its polymorphisms might modulate the individual susceptibility to periodontitis. Only a limited number of studies on the association between IL18 single-nucleotide polymorphisms (SNPs) and the risk of periodontitis have been realized, however. The aim of this case-control study among young post-partum Japanese women (18 to 45 years) was to determine the impact of SNPs, rs1946518 (–607 C/A) and rs187238 (–137G/C), on periodontitis. The two SNPs may be located within a transcription factor-binding element, thereby influencing transcription from the IL18 promoter. Subjects were 131 cases who had at least one tooth with a probing pocket depth of ≥ 4.0 mm and 1,017 periodontally healthy controls. Probing pocket depth measurements were performed between 1 and 12 months post-partum. In this population, the A allele of rs1946518 and the C allele of rs187238 are more common. After adjustment for age, education, smoking, and use of an interdental brush, compared with subjects with the AA or AC genotype of SNP rs1946518, those with the CC genotype had a significantly reduced risk of periodontitis (adjusted odds ratio = 0.54, 95% confidence interval = 0.29-0.97). No significant association was observed between rs187238 and the risk of periodontitis. Our study did not reveal any evidence of interaction between the IL18 polymorphisms and smoking. Our findings indicate that the IL18 promoter SNP, rs1946518, is a potential risk factor of periodontitis among young Japanese women.
Cervical cancer remains one of the most common causes of gynecological cancer-associated death. Long non-coding RNA Loc554202 (lncRNA Loc554202) has been reported to be involved in the development of several types of cancer. However, the role of Loc554202 in cervical cancer remains unclear. In this study, we measured the expression levels of Loc554202 in cervical cancer tissues from 120 patients. The quantitative real-time PCR analysis showed the expression levels of Loc554202 were significantly higher in cervical cancer tissues compared with the adjacent non-tumor tissues. Elevated expression levels of Loc554202 were significantly associated with tumor size (p = 0.006), FIGO stage (p = 0.015), HPV (p = 0.001), and lymph node metastasis (p = 0.002). Kaplan-Meier analysis clearly illustrated that patients with high expression levels of Loc554202 had a lower overall survival rate compared to patients with lower expression (p = 0.0013). Furthermore, we show that Loc554202 is an independent poor prognostic factor through multivariate analysis. Subsequently, using cervical cancer cell lines, HeLa and ME-180, we decreased the expression levels of Loc554202 with siRNA. As results, the proliferation ability of cervical cancer cells was inhibited and apoptosis was induced after Loc554202 knockdown, as judged by viability assay, colony formation, and flow cytometry. Moreover, knockdown of Loc554202 expression down-regulated Bcl-2 expression and conversely up-regulated Bax expression in cervical cancer cells using Western blotting analysis. In conclusion, elevated levels of Loc554202 are predictive of poor prognosis in cervical cancer. We suggest that Loc554202 may serve as a potential therapeutic target for cervical cancer.
Elbow or shoulder injuries are common in overhead sports. Because energy derived from the lower extremity passes through the trunk to the upper extremity in overhead motion, a break in such a kinetic chain could lead to arm injuries. However, there is only limited information about the role of the trunk and lower extremity support in preventing elbow or shoulder injuries. This study aimed to explore the association of trunk and lower extremity pain with elbow/shoulder pain among young overhead athletes. We conducted a cross-sectional study using self-reported questionnaires mailed to young athletes belonging to the Miyagi Amateur Sports Association. The final study population comprised 2,215 young athletes playing baseball (n = 1,422), volleyball (n = 546), softball (n = 14), handball (n = 28), tennis (n = 110), or badminton (n = 95). The median age of the participants was 11 years (range: 6 to 15 years). Multiple logistic regression analysis revealed the higher prevalence of elbow and/or shoulder pain in athletes with back pain (OR = 5.52, 95% CI = 3.51-8.69), hip pain (OR = 6.13, 95% CI = 3.35-11.22), knee pain (OR = 2.28, 95% CI = 1.48-3.51), and foot pain (OR = 3.03, 95% CI = 1.95-4.72), compared with those without pain. We propose that trunk or lower extremity pain is significantly associated with elbow or shoulder pain among young overhead athletes. Assessing for pain in trunk or lower extremity, as well as elbow and/or shoulder pain, may help prevent serious injuries in young overhead athletes.
Carbon monoxide (CO) and nitrogen oxide (NO) affect vasodilation and cause hemodynamic change. Hemodynamic instability due to liver transplantation may result in poor prognosis of graft. This study investigated the hemodynamic implications of CO and NO levels measured using carboxyhemoglobin (COHb) and methemoglobin (MetHb) during living donor liver transplantation (LDLT). The hemodynamic instability with a pressor dose (norepinephrine equivalent) was estimated 1 hour after graft reperfusion. COHb and MetHb were used as indexes of CO and NO, and were measured using an arterial blood gas analyzer. One hundred and ten recipients who underwent LDLT from May 2011 to July 2013 were selected. Recipients were divided into high (≥ 1.9%) and low (< 1.9%) COHb groups with COHb concentrations at 5 minutes after reperfusion. Recipients were also divided into high (≥ 0.4%) and low (< 0.4%) MetHb groups with MetHb concentrations at 30 minutes after reperfusion. Data are presented as mean ± standard deviation or number (percentage). Model for End-stage Liver Disease (MELD) scores were different for the two COHb groups (low: 13.4 ± 9.0 vs. high: 19.7 ± 10.6, p < 0.001), and pressor doses adjusted by MELD scores were also different between the two COHb groups (low: 0.09 ± 0.01 μg/kg/min vs. high: 0.14 ± 0.01 μg/kg/min, p = 0.029). By contrast, pressor doses and MELD scores were not different between the two MetHb groups. In conclusion, CO rather than NO has hemodynamic implications during LDLT. Therefore, the increase in COHb during LDLT is predictive of hemodynamic instability.
Acute lung injury (ALI) is one of the complications of severe sepsis, causing sudden deaths. However, information regarding predictive factors for the onset of ALI in severe sepsis is limited. Growth arrest-specific gene 6 (Gas6) is secreted by endothelial cells and is important for the activation of endothelium during inflammation. This study aimed to investigate the predictive effect of plasma Gas6 in patients with severe sepsis. Collection of plasma samples was carried out from 129 participants with severe sepsis following with or without ALI development. We found that the elevated levels of Gas6, interleukin-6 and -8 (IL-6 and IL-8) in plasma were associated with the ALI development (P = 0.003, 0.002, and 0.004, respectively). We also observed the robust correlation between the plasma level of Gas6 and the following ALI development to adjustment for sepsis and administration of vasopressor. Between patients with ALI (n = 18) and those without ALI (n = 111), Gas6 and the Lung Injury Prediction Score (LIPS) showed promising discrimination (AUROC, 0.74 and 0.68, respectively), and in combination with these two indexes, the AUROC was increased to 0.86 (vs. 0.74, P = 0.05), while soluble receptor for advanced glycation end products (sRAGE) and Willebrand factor (vWF) in plasma showed no predictive value for of ALI. Collectively, our findings indicate that higher levels of Gas6 in plasma are obviously correlated with ALI development. An early increase in the plasma Gas6 level suggests that endothelial injury is a key link in the pathogenesis of ALI.
Patient falls are common adverse medical events in hospitals. The objectives of this study were to clarify the factors of patient falls at hospitalization or transfer to another ward, which could be assumed that patients experience new environment. Patients who were hospitalized or transferred to another ward at a hospital in Japan, between January 14 and February 14, 2014 were included. We used a risk assessment sheet and applied stepwise regression analysis to identify factors of patient falls. We also investigated changes in patient conditions on the risk assessment sheet by the chi-square test. A total of 1,362 patients (53.2% female; mean age, 57.1 ± 18.0 years) were eligible for analysis, and 38 (2.8%) fell during the study period. The fallers were significantly older than the non-fallers (63.8 ± 18.0 vs. 56.9 ± 18.7 years, P = 0.03), but no significant difference was seen in sex (55.3% vs. 53.1% female). “History of falls”, “Tubes inserted”, “Need assistance/supervision for toileting” and “Excretion more than two times per night” were significantly related to patient falls (adjusted odds ratios [95% confidence interval]: 2.41 [1.05-5.53], 3.64 [1.57-8.43], 4.52 [2.00-10.23] and 3.92 [1.38-11.09]). Among 30 fallers, “Overestimation or non-understanding of own physical abilities” was significantly more frequent after falls (30.0%) than before falls (6.7%, P = 0.02). The factors found in this study might be useful for identifying patients at higher risk of falls.
Japan is still designated as a medium incidence country, worldwide. Although the definitive diagnosis of tuberculosis is made by detecting pathogen from tissue specimens, collecting those from children is physically difficult. Therefore, we must frequently depend on the results of tuberculin skin test (TST) or interferon-gamma release assay (IGRA). However, the value of IGRA in diagnosing tuberculosis in infants remains unclear. We implemented TST and IGRA concurrently and examined the significance of combining these two tests by analyzing cases where conflicting results were evident from other tests. Subjects included 52 children (24 boys, 28 girls) age 15 years or younger (4.0 ± 3.4 years) who visited our hospital for close examination after medical checkup for tuberculosis contact tracing. The children underwent TST, T-SPOT®.TB, chest plain radiography, and chest computed tomography with a view to tuberculosis diagnosis during a 26-months period from January 2013 to March 2015. T-SPOT results were positive in 9/52 cases (17.3%), and TST results were positive in 12/52 cases (23.1%). Conflicting results were observed in 7/52 cases (13.5%), and all cases were treated as latent tuberculosis infection or incident cases of tuberculosis. The value of T-SPOT in tuberculosis diagnosis in children is still being established. However, there are a number of cases where conflicting results for T-SPOT and TST are indicated. Thus, it is currently desirable to use T-SPOT and TST concomitantly for children at an early age, especially for children below the age of 5 years, as a diagnostic measure in complementing other techniques.
Enterococcus faecium has high levels of resistance to multiple antibiotics, and the mortality due to E. faecium bacteremia is high. Accordingly, E. faecium strains with low susceptibility to daptomycin are a concern in clinical practice. This study assessed the predictive factors and prognosis of patients with bacteremia due to E. faecium as well as the antimicrobial susceptibility, particularly to daptomycin, among E. faecium isolates. The medical records of patients admitted to Osaka City University Hospital with E. faecalis (n = 60) and E. faecium (n = 48) bacteremia between January 2011 and March 2016 were retrospectively reviewed. The E. faecalis group (mean age: 62.0 years) included 22 women, and the E. faecium group (mean age: 59.1 years) included 19 women. Predictive factors for infection, prognosis, and isolate antimicrobial susceptibilities were evaluated. The mean Sequential Organ Failure Assessment score and mortality rate did not differ between the two groups. The independent predictors of E. faecium bacteremia in multivariate analysis included quinolone use (p = 0.025), malignancy (p = 0.021), and prolonged hospitalization (p = 0.016). Cardiovascular disease was associated with a reduced risk of E. faecium bacteremia (p = 0.015). Notably, the percentage of E. faecium isolates with low daptomycin susceptibility was higher than that of E. faecalis (8.5% vs. 0%, p = 0.036). Thus, E. faecium should be considered when administering antibiotic therapy to patients with a history of these predictors. Furthermore, the use of daptomycin should be avoided in case of E. faecium with low susceptibility to daptomycin.
SET and MYND domain-containing protein 3 (SMYD3) is a kind of histone lysine methyltransferase, responsible for transcriptional activation as a member of an RNA polymerase complex. The ectopic expression of SMYD3 is proved to promote the progress of many kinds of cancers. In hepatocellular carcinoma (HCC), SMYD3 was demonstrated to promote the proliferation and metastasis of HCC cell lines, but the clinical significance of SMYD3 has not been elucidated. In the present study, we detected the expression of SMYD3 in 100 HCC tissues with immunohistochemistry and divided these tissue specimens into high-expression group and low-expression group according to the immunohistochemical score of SMYD3. Importantly, the intensity of SMYD3 immunoreactivity was significantly stronger in HCC tissues than that in adjacent normal tissues. Moreover, high expression levels of SMYD3 were significantly associated with larger tumor size (P = 0.043), suggesting that SMYD3 could promote the proliferation of HCC. Moreover, patients with positive hepatitis B virus infection had higher expression levels of SMYD3 (P = 0.013). With univariate and multivariate analysis, we explored the prognostic significance of SMYD3 in HCC. As a result, high expression levels of SMYD3 were significantly correlated to the poorer clinical outcome of HCC patients (P = 0.009) and were identified as an independent risk factor of HCC for predicting the unfavorable prognosis. In conclusion, overexpression of SMYD3 is an independent prognostic risk of unfavorable prognosis of HCC. We propose that the anti-SMYD3 therapy may be a potential approach to treat HCC.