1006-44 A Prognostic Factor in Coronary Artery Disease (CAD): Platelet-Dependent Thrombin Generation in Patients with CAD

We examined platelet-dependent thrombin generation in patients with coronary artery disease (CAD). Thrombin generation was measured according to the method of Aronson et al (Circulation, 1992). 0.5ml of platelet rich plasma (PRP, 15×104/ml) was prepared, and 40mM of CaCl, was added to start clotting. 0.5mM of S-2238 was added to each sample in a microtiter plate every 10min, and the plate was read kinetically at a wavelength of 405nm on a microtiter plate reader. The patients with CAD devided into 3 groups.Thrombin generation 20 min after CaCI2, additon is:Control (n=12)48±10(mOD)Stable angina (SAP) (n=15)79±27Unstable angina (UAP) (n=15)**562±155Acute myocardial infarct (AMI) (n=43)**440±269**p<0.01 compared to SAPThe patients with UAP and AMI showed marked increase in thrombin generation compared to SAP and control subjects. AMI patients with severe coronary artery disease (Group B) showed higher levels of thrombin generation (Group A, Gensini score<32: 382±248 mOD vs Group B, Gensini score> 31: 578±238, P<0.05). LVEF of group A is significantly higher than that of group B (P < 0.05). These findings indicate that patients with UAP and AMI have an evidence of hypercoagulable states and that platelet-dependent thrombin generation may play an important role in pathophysiology of UAP or AMI, and may be a prognostic factor in CAD

Psychosocial functioning in patients with treatment-resistant depression after group cognitive behavioral therapy

<p>Abstract</p> <p>Background</p> <p>Although patients with Treatment Resistant Depression (TRD) often have impaired social functioning, few studies have investigated the effectiveness of psychosocial treatment for these patients. We examined whether adding group cognitive behavioral therapy (group-CBT) to medication would improve both the depressive symptoms and the social functioning of patient with mild TRD, and whether any improvements would be maintained over one year.</p> <p>Methods</p> <p>Forty-three patients with TRD were treated with 12 weekly sessions of group-CBT. Patients were assessed with the Global Assessment of Functioning scale (GAF), the 36-item Short-Form Health Survey (SF-36), the Hamilton Rating Scale for Depression (HRSD), the Dysfunctional Attitudes Scale (DAS), and the Automatic Thought Questionnaire-Revised (ATQ-R) at baseline, at the termination of treatment, and at the 12-month follow-up.</p> <p>Results</p> <p>Thirty-eight patients completed treatment; five dropped out. For the patients who completed treatment, post-treatment scores on the GAF and SF-36 were significantly higher than baseline scores. Scores on the HRSD, DAS, and ATQ-R were significantly lower after the treatment. Thus patients improved on all measurements of psychosocial functioning and mood symptoms. Twenty patients participated in the 12-month follow-up. Their improvements for psychosocial functioning, depressive symptoms, and dysfunctional cognitions were sustained at 12 months following the completion of group-CBT.</p> <p>Conclusions</p> <p>These findings suggest a positive effect that the addition of cognitive behavioural group therapy to medication on depressive symptoms and social functioning of mildly depressed patients, showing treatment resistance.</p

Quantitative Evaluation of Pain during Electrocutaneous Stimulation using a Log-Linearized Peripheral Arterial Viscoelastic Model

In clinical practice, subjective pain evaluations, e.g., the visual analogue scale and the numeric rating scale, are generally employed, but these are limited in terms of their ability to detect inaccurate reports, and are unsuitable for use in anesthetized patients or those with dementia. We focused on the peripheral sympathetic nerve activity that responds to pain, and propose a method for evaluating pain sensation, including intensity, sharpness, and dullness, using the arterial stiffness index. In the experiment, electrocardiogram, blood pressure, and photoplethysmograms were obtained, and an arterial viscoelastic model was applied to estimate arterial stiffness. The relationships among the stiffness index, self-reported pain sensation, and electrocutaneous stimuli were examined and modelled. The relationship between the stiffness index and pain sensation could be modelled using a sigmoid function with high determination coefficients, where R2 ≥ 0.88, p < 0.01 for intensity, R2 ≥ 0.89, p < 0.01 for sharpness, and R2 ≥ 0.84, p < 0.01 for dullness when the stimuli could appropriately evoke dull pain.This work was supported by the Center of Innovation Program from Japan Science and Technology Agency.Supplementary information accompanies this paper at https://doi.org/10.1038/s41598-018-21223-1

DLPFC and KYN in MDD treatment response

Aim: To establish treatment response biomarkers that reflect the pathophysiology of depression, it is important to use an integrated set of features. This study aimed to determine the relationship between regional brain activity at rest and blood metabolites related to treatment response to escitalopram to identify the characteristics of depression that respond to treatment. Methods: Blood metabolite levels and resting-state brain activity were measured in patients with moderate to severe depression (n = 65) before and after 6–8 weeks of treatment with escitalopram, and these were compared between Responders and Nonresponders to treatment. We then examined the relationship between blood metabolites and brain activity related to treatment responsiveness in patients and healthy controls (n = 36). Results: Thirty-two patients (49.2%) showed a clinical response (>50% reduction in the Hamilton Rating Scale for Depression score) and were classified as Responders, and the remaining 33 patients were classified as Nonresponders. The pretreatment fractional amplitude of low-frequency fluctuation (fALFF) value of the left dorsolateral prefrontal cortex (DLPFC) and plasma kynurenine levels were lower in Responders, and the rate of increase of both after treatment was correlated with an improvement in symptoms. Moreover, the fALFF value of the left DLPFC was significantly correlated with plasma kynurenine levels in pretreatment patients with depression and healthy controls. Conclusion: Decreased resting-state regional activity of the left DLPFC and decreased plasma kynurenine levels may predict treatment response to escitalopram, suggesting that it may be involved in the pathophysiology of major depressive disorder in response to escitalopram treatment

Effects of behavioural activation on the neural circuit related to intrinsic motivation

[Background] Behavioural activation is an efficient treatment for depression and can improve intrinsic motivation. Previous studies have revealed that the frontostriatal circuit is involved in intrinsic motivation; however, there are no data on how behavioural activation affects the frontostriatal circuit. [Aims] We aimed to investigate behavioural activation-related changes in the frontostriatal circuit. [Method] Fifty-nine individuals with subthreshold depression were randomly assigned to either the intervention or non-intervention group. The intervention group received five weekly behavioural activation sessions. The participants underwent functional magnetic resonance imaging scanning on two separate occasions while performing a stopwatch task based on intrinsic motivation. We investigated changes in neural activity and functional connectivity after behavioural activation. [Results] After behavioural activation, the intervention group had increased activation and connectivity in the frontostriatal region compared with the non-intervention group. The increased activation in the right middle frontal gyrus was correlated with an improvement of subjective sensitivity to environmental rewards. [Conclusions] Behavioural activation-related changes to the frontostriatal circuit advance our understanding of psychotherapy-induced improvements in the neural basis of intrinsic motivation. [Declaration of interest] None.This work was supported by a Grant-in-Aid for Scientific Research on Innovative Areas from Japan Society for the Promotion of Science, JSPS (grants 16H06395 and 16H06399), and grant 23118004 from the Ministry of Education, Culture, Sports, Science and Technology, Japan. This work was partially supported by the programme for Brain Mapping by Integrated Neurotechnologies for Disease Studies (Brain/MINDS) by Japan Agency for Medical Research and Development, AMED (grant 15dm0207012h0002) and Integrated Research on Depression, Dementia and Development Disorders by AMED (grant 16dm0107093h0001). The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation or review of the manuscript or decision to submit the manuscript for publication

Prevalence and associated factors of chronic constipation among Japanese university students

BackgroundChronic constipation (CC) is one of the most frequently reported gastrointestinal disorders in the general population and a prominent problem among university students. The study aimed to evaluate the prevalence and the associated factors of CC among Japanese university students.MethodsThis cross-sectional study was conducted among university students at Hiroshima University, Japan. Students answered the web questionnaire when making a web reservation for the health checkup (April 1 to May 31, 2023). The web questionnaire consisted of four sections, including baseline characteristics, lifestyle factors, family history of CC, and three scales to assess depression and eating disorders: the Beck Depression Inventory (BDI), Eating Attitudes Test (EAT)-26 and Bulimic Investigatory Test (BITE). CC was diagnosed using Rome IV criteria. The multivariate logistic regression model was used to determine CC-related factors.ResultsOut of 10,500 individuals who participated in the annual health checkup, 7,496 participants answered the web questionnaire, of whom 5,386 answered all the survey questions. The mean age of the students was 21.1 ± 4.1 years. The male-to-female ratio was 1:1.17. The prevalence of CC was 13.7%. Factors significantly associated with CC in the multivariate model were first-degree family members with CC [Odd ratio (OR): 2.77, 95% confidence interval (CI): 2.31–3.31], severe depression according to BDI scale (OR: 2.59, 95% CI: 1.96–3.43), female sex (OR: 2.00, 95% CI: 1.69–2.36), and short sleep duration of 6 hours or less per day (OR: 1.28, 95% CI: 1.09–1.50). Lack of physical exercise tended to be associated with CC (OR: 1.19, 95% CI: 1.00–1.40).ConclusionsCC is prevalent among Japanese university students. Significant risk factors for CC included the first-degree family history of CC, severe depression, female sex, and short sleep duration. Lack of physical exercise tended to be associated with CC. This may contribute to implementing suitable education health programs, health care professionals, and public health policies to identify individuals at risk for CC to prevent and treat CC effectively

Effect of spinal cord stimulation for thermal noxious stimulus pain threshold in Parkinson's disease

Background: Parkinson's disease (PD)-related pain or PD pain is a frequent non-motor symptom and is treated with pharmacotherapy and non-pharmacologic therapies such as deep brain stimulation (DBS) and spinal cord stimulation (SCS). The mechanism of PD pain relief by DBS is thought to involve increased pain threshold to nociceptive stimulation, whereas the mechanism of SCS has not been elucidated. Objective: PD pain relief by SCS may involve modulation of the pain thresholds in the spinal cord segments and supra-spinal actions. Therefore, we investigated the effect of SCS in patients who underwent SCS for intractable PD pain in the lower extremities by measuring pain thresholds to thermal nociceptive stimulation of the lower (leg) and upper (hand) parts of the stimulated spinal segment during SCS-off and SCS-on using quantitative sensory testing to determine the pain threshold. Methods: Seven PD patients with SCS in the lower thoracic spinal cord underwent measurements of cold sensory threshold, warm sensory threshold, cold pain threshold (CPT), and heat pain threshold (HPT). Results: In upper part of the stimulated spinal segment, CPT was significantly decreased during SCS-on compared to SCS-off (p < 0.01); whereas HPT was not significantly different. In lower part of the stimulated spinal segment, CPT was significantly increased during SCS-on compared to SCS-off (p < 0.05); and HPT was also increased (p < 0.05). Conclusion: This study shows that SCS raises the pain threshold to thermal nociception in PD patients. The primary mechanism of pain relief by SCS is thought to be segmental inhibition at the level of the stimulated spinal segments

Investigation of factors that contribute to the outcome of endoscopic transsphenoidal surgery as reviewed from our own cases

In order to improve the treatment outcome of endoscopic transsphenoidal surgery (eTSS), it is important to identify the factors that contribute to the tumor resection rate and/or post-operative complications, and to devise a surgical strategy for each case. In the present study, we retrospectively evaluated our own experience of eTSS for primary pituitary adenoma (PA), and sought the factors that are related to patients’ surgical outcomes. Thirty-three cases of primary PA operated on by eTSS at our institution in a recent 5-year period were investigated. The patients’ data for age, sex, Knosp grade, operating time, sellar floor opening rate, tumor resection rate and post-operative complications were evaluated. The median rate of tumor resection was 91.3%, and the tumor resection rate demonstrated significant linear relationships with age (Z = −0.41, p = 0.02), sex (Z = −0.42, p = 0.01) and sellar floor opening rate (Z = 0.47, p = 0.01). A significant linear relationship was also found between sex and sellar floor opening rate (Z = −0.51, p < 0.01). However, post-operative cerebrospinal fluid (CSF) leakage occurred in 2 cases where the sellar floor was opened widely. We reviewed the details of these 2 cases in this article. The gender difference observed in this study results was thought to be due to the difference in size of the nostril; however, further verification is required. Although wide sellar floor opening can contribute positively to aggressive PA resection in eTSS, this may increase the risk of CSF leakage. If a case requires a higher resection rate, especially in functional PA invading the cavernous sinus, the surgeon should adopt and perform advanced techniques of sellar floor reconstruction according to those carried out in the expanded endonasal approach for the frontal skull base or clivus area