Background：Aortic dissection is thought to develop and progress due to hypertension and atherosclerosis, but the detailed mechanisms of the onset and progression are still unknown. In this study, we investigated the relationship between type of aortic dissection and the atherosclerotic risk factors including obstructive sleep apnea (OSA) and discussed potential mechanisms. Methods：There were 52 consecutive patients with aortic dissection who were admitted to our hospital, and a sleep study was performed to look for OSA in 42 of them (27 men and 15 women, age: 67±12 years, BMI: 24±4, DeBakey type I: n=6, type IIIa: n=7, type IIIb: n=29). Results：In the 42 patients who had a sleep study, OSA was seen in 36 patients (86%). OSA was more frequent in type IIIb (n=27) than in type IIIa (n=4) aortic dissection (93% vs 57%, p=0.01). Univariate logistic regression analysis indicated that the presence of OSA could distinguish type IIIb from IIIa (odds ratio: 10.125, 95% confidence interval: 1.272-80.623, P=0.029). Conclusion：OSA was frequently associated with aortic dissection and its prevalence was higher in type IIIb than type IIIa, suggesting that OSA may be associated with the development and progression of aortic dissection.

Background: The purpose of this study was to investigate the influence of maintenance of Face-down positioning (FDP) on physiological and psychological responses of patients who require FDP after vitrectomy. Methods: The study included 22 healthy volunteers (21.9±2.6 years old) and two conditions: maintenance of FDP or maintenance of the sitting chair positioning (SCP). Study participants were evaluated for Profile of Mood States (POMS), subjective pain, blood pressure, heart rate, heart rate variability, shoulder muscle rigidity, skin temperature, and skin blood flow. Results: The change in POMS "fatigue" score before and after positioning was significantly greater in FDP than in SCP. Subjective pain increased over time in both FDP and SCP, but the increase was more pronounced in FDP and an interaction was observed between the neck and shoulders. Shoulder skin temperature decreased significantly over time in both FDP and SCP. In contrast, back skin temperature increased significantly in SCP, but decreased significantly in FDP. Conclusions: The psychological and physiological burdens are significant in FDP. Our results suggest that proactive support for relieving pain and promoting blood flow from the neck to the back region may be helpful in patients maintaining FDP.

Background: Recent reports suggest that central blood pressure (BP) may be instrumental in the diagnosis and management of hypertension. Several reports have shown an association between salt intake and central hemodynamics, especially central systolic BP; however, this relationship remains unclear in Japanese outpatients with hypertension. Therefore, this study investigated the relationship between central systolic BP and salt intake in Japanese outpatients with hypertension. Methods: We recruited 141 Japanese outpatients with hypertension. Their daily salt intake was estimated using spot urine samples. Their central systolic BP was measured using an Omron HEM-9000AI device. Results: The median estimated salt intake was 9.81 (range, 8.34-11.47) g/day. The mean brachial systolic/diastolic BP and central systolic BP were 131.2 ± 16.5 /78.1 ± 10.9 mmHg and 135.6 ± 17.3 mmHg, respectively. The estimated salt intake was divided into four quartiles, with central systolic BP significantly higher in Q3 and Q4 than that in Q1 (P < 0.01). A significant positive correlation was observed between central systolic BP and estimated salt intake (r=0.275, P=0.001). Multiple regression analysis of central systolic BP showed that the estimated salt intake and BMI were significant factors (P = 0.014 and P = 0.027, respectively). Conclusions: We found that our Japanese outpatients with hypertension consumed higher amounts of salt than the target value recommended by Japanese guidelines. In addition, there was a moderate relationship between central systolic BP and the estimated salt intake. Therefore, a decrease in salt intake is important, even in outpatients with hypertension receiving antihypertensive medication.

Background: D-dimer (DD) is useful for excluding diagnosis of venous thromboembolism (VTE) because of high sensitivity and high negative predictive value. Recently, soluble fibrin (SF) has been introduced for clinical use to examine coagulation status. However, the significance of SF in screening or diagnosis for VTE is uncertain. Thus, we examined DD and SF levels in incident VTE patients with ultrasonographic examination in their lower extremities. Subjects and Methods: We have conducted simultaneous measurement of DD and SF in 141 inpatients in our hospital between December 2013 and November 2014. Among them, we further selected 46 patients who were examined by lower extremity ultrasonography 1 month before or after the measurement of DD and SF. Incident VTE was diagnosed based on acute or subacute symptoms, the presence of thrombus in compression ultrasonography, and/or results from contrast-enhanced CT. Results: Incident VTE was found in 18 patients. SF levels were similar in VTE (+) and VTE (-) groups, while DD levels were significantly higher in VTE (+) group than those of VTE (-) group (17.7±30.4 μg/mL vs 5.1±5.2 μg/mL, p<0.05). When patients were classified based on surgical intervention, no significant difference in SF or DD levels was observed in peri-operative patients. However, DD levels in non-operative patients tended to be higher in VTE (+) group, compared to VTE (-) group. No such tendency was observed in SF levels. Conclusion: Measurement of DD but not SF may be beneficial for screening of incident VTE, especially in non-operative inpatients. Further study is necessary to determine the significance of DD and/or SF testing in VTE screening, diagnosis, and treatment in peri-operative patients.