THE INCIDENCE OF PEPTIC ULCER SURGERY BEFORE AND AFTER THE INTRODUCTION OF H2-RECEPTOR ANTAGONISTS

Since the introduction of H2-receptor antagonists, the incidence of ulcer surgery has decreased markedly. Based on the number of patients who underwent ulcer surgery and upper gastrointestinal endoscopy in our hospital, the number of operations for peptic ulcer disease has decreased, although the number of peptic ulcer patients diagnosed by endoscopy has increased after the introduction of cimetidine (the first H2-receptor antagonist in Japan). The decreasing rate of surgical therapy before and after the administration of H2-receptor antagonists was 49.1%. The number of emergency operations has also decreased among ulcer patients diagnosed by endoscopy although the number of perforated and bleeding ulcer patients has increased. It is also reported that the most common operative procedure for both gastric and duodenal ulcer was distal gastrectomy reconstructed by gastroduodenostomy (Billroth Ⅰ)

Analysis of Charging of the HTV-4 Based on On-Orbit Data

After three H-II transfer vehicles (HTVs) had finished their mission to resupply the International Space Station (ISS), NASA requested data of the HTV\u27s potential to evaluate the charging/discharging process that occurs when the HTV docks to the ISS. To measure these data, a new instrument was installed on the fourth HTV. This instrument allows us to measure the HTV-4 surface potential relative to the surrounding plasma, and is called advanced technology on-orbit test instrument for space environment-mini (ATOTIE-mini). The ATOTIE-mini observed the HTV\u27s local potential in the orbit for more than one month. The measured potential during the HTV solo-flight phase varied between -30 and -60 V in sunlight and was about 0 V in eclipse conditions. The HTV\u27s potential during the time when it was docked to the ISS followed the ISS\u27s potential with an almost constant offset of about 10 V. The data measured by ATOTIE-mini are consistent with those measured by the floating potential measurement unit on the ISS, and thus are considered reliable. The HTV\u27s potential level itself was acceptable for ISS. Note that the solar array panels can generate up to approximately 120 V, which is much larger than the absolute potential range in sunshine. We analyze the potential distribution on the HTV surface by a multi-utility spacecraft charging analysis tool, because ATOTIE-mini can only observe one point on the HTV surface. The analysis results are discussed with respect to the flight attitude

Hedgehog Promotes Neovascularization in Pancreatic Cancers by Regulating Ang-1 and IGF-1 Expression in Bone-Marrow Derived Pro-Angiogenic Cells

http://creativecommons.org/licenses/by/2.0/ PublisherBackground: The hedgehog (Hh) pathway has been implicated in the pathogenesis of cancer including pancreatic ductal adenocarcinoma (PDAC). Recent studies have suggested that the oncogenic function of Hh in PDAC involves signaling in the stromal cells rather than cell autonomous effects on the tumor cells. However, the origin and nature of the stromal cell type(s) that are responsive to Hh signaling remained unknown. Since Hh signaling plays a crucial role during embryonic and postnatal vasculogenesis, we speculated that Hh ligand may act on tumor vasculature specifically focusing on bone marrow (BM)-derived cells. Methodology/Principal Findings: Cyclopamine was utilized to inhibit the Hh pathway in human PDAC cell lines and their xenografts. BM transplants, co-culture systems of tumor cells and BM-derived pro-angiogenic cells (BMPCs) were employed to assess the role of tumor-derived Hh in regulating the BM compartment and the contribution of BM-derived cells to angiogenesis in PDAC. Cyclopamine administration attenuated Hh signaling in the stroma rather than in the cancer cells as reflected by decreased expression of full length Gli2 protein and Gli1 mRNA specifically in the compartment. Cyclopamine inhibited the growth of PDAC xenografts in association with regression of the tumor vasculature and reduced homing of BM-derived cells to the tumor. Host-derived Ang-1 and IGF-1 mRNA levels were downregulated by cyclopamine in the tumor xenografts. In vitro co-culture and matrigel plug assays demonstrated that PDAC cell-derived Shh induced Ang-1 and IGF-1 production in BMPCs, resulting in their enhanced migration and capillary morphogenesis activity. Conclusions/Significance: We identified the BMPCs as alternative stromal targets of Hh-ligand in PDAC suggesting that the tumor vasculature is an attractive therapeutic target of Hh blockade. Our data is consistent with the emerging concept that BM-derived cells make important contributions to epithelial tumorigenesis

中山間地域に暮らす人々のソーシャル・キャピタルや生活習慣が認知機能に及ぼす影響 : 横断研究

中山間地域在住者における認知機能と生活習慣，ソーシャル・キャピタル（SC）の関係を明らかにすることを目的に， Shimane CoHRE Study のデータを用いた横断研究を行った。2011 年に島根県の中山間地域在住者で健康診査を受診した491 名を対象者とし，生活習慣，SC に関するデータを収集した。認知機能はCognitive Assessment for Dementia, iPad version（CADi）にて評価した。2 群化したCADi 得点を従属変数とし, 生活習慣等に関する5 項目を独立変数とする多変量ロジスティック回帰分析を行った。その結果，CADi 得点に対して，統計的に有意な正の関連が認められたのは食塩摂取量，教育年数，構造的SC，負の関連が認められたのは年齢，収縮期血圧であった

Inappropriate implantable cardioverter defibrillator shocks—incidence, effect, and implications for driver licensing

PurposePatients with implantable cardioverter defibrillators (ICDs) have an ongoing risk of sudden incapacitation that may cause traffic accidents. However, there are limited data on the magnitude of this risk after inappropriate ICD therapies. We studied the rate of syncope associated with inappropriate ICD therapies to provide a scientific basis for formulating driving restrictions.MethodsInappropriate ICD therapy event data between 1997 and 2014 from 50 Japanese institutions were analyzed retrospectively. The annual risk of harm (RH) to others posed by a driver with an ICD was calculated for private driving habits. We used a commonly employed annual RH to others of 5 in 100,000 (0.005%) as an acceptable risk threshold.ResultsOf the 4089 patients, 772 inappropriate ICD therapies occurred in 417 patients (age 61 ± 15 years, 74% male, and 65% secondary prevention). Patients experiencing inappropriate therapies had a mean number of 1.8 ± 1.5 therapy episodes during a median follow-up period of 3.9 years. No significant differences were found in the age, sex, or number of inappropriate therapies between patients receiving ICDs for primary or secondary prevention. Only three patients (0.7%) experienced syncope associated with inappropriate therapies. The maximum annual RH to others after the first therapy in primary and secondary prevention patients was calculated to be 0.11 in 100,000 and 0.12 in 100,000, respectively.ConclusionsWe found that the annual RH from driving was far below the commonly cited acceptable risk threshold. Our data provide useful information to supplement current recommendations on driving restrictions in ICD patients with private driving habits

Prognosis in patients with cardiogenic shock who received temporary mechanical circulatory support

Background: Temporary mechanical circulatory support (MCS) is often used in patients with cardiogenic shock (CS), and the type of MCS may vary by cause of CS. Objectives: To describe the causes of CS in patients receiving temporary MCS, the types of MCS used, and associated mortality. Methods We used a nationwide Japanese database to identify patients receiving temporary MCS for CS between April 2012 and March 2020. Results: Of the 65,837 patients, the cause of CS was acute myocardial infarction (AMI) in 77.4%, heart failure (HF) in 10.9%, valvular disease in 2.7%, fulminant myocarditis (FM) in 2.5%, arrhythmia in 4.5%, and pulmonary embolism (PE) in 2.0% of cases. The most commonly used MCS was an intra-aortic balloon pump (IABP) alone in AMI (79.2%) and in HF (76.5%), extracorporeal membrane oxygenation (ECMO) with IABP in FM (56.2%) and arrhythmia (43.4%), and ECMO alone in PE (71.5%). Overall in-hospital mortality was 32.4%; 30.0% in AMI, 32.6% in HF, 33.1% in valvular disease, 34.2% in FM, 60.9% in arrhythmia, and 59.2% in PE. Overall, in-hospital mortality increased from 30.4% in 2012 to 34.1% in 2019. After adjustment, valvular disease, FM and PE had lower in-hospital mortality than AMI: odds ratio [95%CI] for valvular disease 0.56 [0.50-0.64]; FM 0.58 [0.52-0.66]; PE 0.49 [0.43-0.56], whereas HF had similar in-hospital mortality (0.99 [0.92-1.05]) and arrhythmia had higher in-hospital mortality (1.14 [1.04-1.26]). Conclusion: In a Japanese national registry of patients with CS, different causes of CS were associated with different types of MCS and differences in survival