Validação da escala curta do questionário de impacto da incontinência urinária (IIQ-7) e do inventário de angústia urogenital (UDI-6) em pacientes com esclerose múltipla

Cross-cultural adaptation and validation of the Impact Questionnaire of Urinary Incontinence(IIQ-7) and Urogenital Distress Inventory (UDI-6) - short scale - in the Brazilianpopulation with multiple sclerosis. The IIQ-7 and UDI-6 were translated intoPortuguese, called IIQ-7-BR and UDI-6-BR. The questionnaires were administered in 211individuals selected randomly. Of these, 140 had MS according to McDonald criteria and 71 wereincluded in the control group. In both questionnaires, the Cronbach’s alpha coefficientwas above 0.7. The IIQ-7-BR showed 94.31% concordance between the evaluated studies andUDI-6-BR, 93.33%. Thus, the instruments of this study were presented according to thestandards proposed by the Instrument Review Criteria, reliability, validity and sensitivity,maintaining the original scales characteristics.Adaptação transcultural e validação da escala curta do Questionáriode Impacto de Incontinência Urinária (IIQ-7) e do Inventário daAngústia Urogenital (UDI-6) na população brasileira com esclerosemúltipla (EM). O IIQ-7 e o UDI-6 foram traduzidos para a língua portuguesa,obtendo-se IIQ-7-BR e UDI-6-BR. Os questionários foram aplicados em 211indivíduos selecionados aleatoriamente. Destes, 140 apresentavam EM nos critérios deMcDonald, e 71 foram incluídos no grupo controle. Em ambos os questionários aplicadonos grupos, o coeficiente alpha de Cronbach apresentou-se acima de 0,7. O IIQ-7-BRapresentou 94,31% de concordância entre os estudos avaliados e o UDI-6-BR, 93,33%.Sendo assim, os instrumentos desse estudo apresentaram-se, segundo as normas propostas pelo Instrument Review Criteria, confiabilidade, validade e sensibilidade,mantendo as características das escalas originais.Santa Casa de São Paulo Faculdade de Ciências MédicasUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

左前下行枝冠動脈周囲の局所心外膜脂肪厚は簡便な冠動脈疾患の予測因子である : フラミンガムリスクスコアと組み合わせた新しい予測モデル

Background: Compared with global cardiac adiposity, the local accumulation of fat surrounding coronary arteries might have a more direct impact on coronary artery disease (CAD). Here, we compared the local epicardial adipose tissue (EAT) thickness and global cardiac adiposity volumes for predicting CAD. Methods and Results: A total of 197 consecutive subjects underwent 320-slice multi-detector computed tomography coronary angiography and were segregated into CAD (≥1 coronary artery branch stenosis ≥50%) and non-CAD groups. EAT thickness was measured at the right coronary artery (EATRCA), the left anterior descending artery (EATLAD), and the left circumflex artery (EATLCX). Although EATRCA and EATLCX were similar between the 2 groups, EATLAD was larger in the CAD group than in the non-CAD group (5.45±2.16 mm vs. 6.86±2.19 mm, P<0.001). EATLAD, after correcting for confounding factors, was strongly associated with CAD (r=0.276, P<0.001) and Gensini score (r=0.239, P<0.001). On multiple regression analysis, Framingham risk score combined with EATLAD was a strong predictor of CAD (adjusted R2=0.121; P<0.001). Conclusions: The local fat thickness surrounding the LAD is a simple and useful surrogate marker for estimating the presence, severity, and extent of CAD, independent of classical cardiovascular risk factors

Canagliflozin reduces epicardial fat in patients with type 2 diabetes mellitus

Background: It is unknown whether canagliflozin, a selective sodium glucose co-transporter 2 inhibitor, reduces epicardial adipose tissue (EAT) thickness, which is associated with insulin resistance and is a risk factor for coronary artery disease. Methods and results: We administered 100 mg of canagliflozin for 6 months to 13 patients with type 2 diabetes mellitus. We evaluated glycemic control, visceral adipose tissue (VAT) area and subcutaneous adipose tissue (SAT) area, and skeletal muscle mass by using impedance methods, and EAT thickness by using echocardiography. Canagliflozin treatment for 6 months decreased hemoglobin A1c level from 7.1 ± 0.5% to 6.7 ± 0.6% (P < 0.05) and decreased EAT thickness from 9.3 ± 2.5 to 7.3 ± 2.0 mm (P < 0.001), along with a trend of decreasing VAT and SAT area. No association was found between any of these changes. Conclusion: Canagliflozin reduced EAT thickness in patients with type 2 diabetes mellitus independent of its effect on lowering blood glucose, suggesting that canagliflozin may have an effect in preventing cardiovascular events in these patients (UMIN000021327)

ゲンパツセイ アルドステロンショウ ノ シンダン ニ ユウヨウナ リンショウ ショケン ノ ケントウ

Primary aldosteronism（PA）is known as a secondary hypertension. Hypertensive patients are screened by the plasma aldosterone concentration（PAC）／plasma renin activity（PRA）ratio as a case-detection test for PA. However, clinical parameters for screening patients with primary aldosteronism who need adrenalectomy have not been fully elucidated. We report a case of PA who received endoscopic adrenalectomy and evaluated the clinical parameters for screening patients with primary aldosteronism who need adrenalectomy, retrospectively. We evaluated４３patients with PAC/PRA＞２００as a screening test for PA. Thirty-three（７７％） patients were diagnoses as PA after confirmation test. In１８patients who received adrenal vein sampling, １０ patients were diagnoses as unilateral adrenal adenoma. We compared clinical parameters between PA and non-PA. The level of PAC was lower in patients with PA compared to that in patients with non-PA. There were no significant change in the level of PAC, PAC/PRA, serum potassium, and blood pressure. PAC and PAC/PRA were higher and serum potassium was lower in patients who received adrenalectomy compared to those in patients without adrenalectomy. ROC curve showed that PAC＞２００ pg/mL and serum potassium ＜３．５mEq/L were useful parameters to predict diagnosis of PA who need adrenalectomy. In conclusion, PA patients with PAC＞２００pg/mL and serum potassium ＜３．５mEq/L should be considered as candidates for adrenorectomy

Gender and coronary artery bypass graft surgery

Background Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Methods Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery (non-CABG). Results In men, EATV, EATV index (EATV/body surface area) and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP) and type 2 diabetes mellitus (Corrected R2 = 0.262, p < 0.0001), while in women, type 2 diabetes mellitus is a single strong predictor for CABG, excluding EATV Index (Corrected R2 = 0.266, p = 0.005). Conclusions Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms

Brain natriuretic peptide and cancer

Background Natriuretic peptides have been proposed as biomarkers of cardiovascular disease, especially heart failure. Brain natriuretic peptide (BNP) has also been shown to be upregulated at the transcriptional and translational levels by pro-inflammatory cytokines in cardiac myocytes. Although we often measure plasma BNP levels in cancer patients, it remains unknown whether cancer-related inflammation affects the plasma BNP levels. We investigated the relationship between the BNP and human cancers. Methods We retrospectively studied 2,923 patients in whom the plasma BNP levels and serum C-reactive protein (CRP) were measured and echocardiography was performed. Patients with clinically evident heart failure (NYHA II or higher), heart disease requiring medical treatment or surgery, renal dysfunction, and inflammatory disease were excluded. There were 234 patients in the final analysis. Blood sampling was performed before surgery and chemotherapy. In addition, we evaluated the relationship between the inflammation and plasma BNP levels in mouse models of colon cancer. Results Of the 234 patients, 80 were diagnosed with cancer. Both the plasma BNP and serum CRP levels were significantly higher in cancer patients than those without. There were no significant differences in the echocardiographic parameters. There was a significant positive correlation between the plasma BNP and serum CRP levels in cancer patients (r = 0.360, P<0.01) but not in those without. In cancer patients, only the CRP correlated with the BNP independent of the age, creatinine level, hypertension, and body mass index. In addition, in nude mice with subcutaneous colon cancer, the plasma BNP level was elevated compared with that in non-cancer mice, and there was a significant relationship between the plasma BNP and serum levels of the inflammatory markers. Conclusions In cancer patients, as well as colon cancer model mice, the plasma BNP levels were elevated, possibly due to cancer-related inflammation. The effect of cancer on the BNP levels should be considered when using BNP as an indicator of heart failure in cancer patients

Hidden Periodicities for Time Series Data of Hourly Air Temperature around East Asia Region

Correlations between time series data of hourly air temperature from 1991 to 2010 observed at Kobe station and Niigata station are discussed. For time series data of hourly air temperature in 1996, 2000, 2009, and 2010, power spectra with periodic peaks are calculated by using Fourier transform, respectively. A first peak of power spectra is determined and time intervals between nearest neighbor peaks are evaluated. As a result, hidden periodicities are observed. In addition, the features of power spectra for the ratio of cloud covers and space packing exponents by image analysis and time series analysis for MTSAT-2 images covering East Asia region of channels IR1 in 2009 and 2010 are described and similarities between the hidden periodicities for time series data of hourly air temperature are suggested