Gastric cancer screening by combined assay for serum anti-Helicobacter pylori IgG antibody and serum pepsinogen levels — “ABC method”

The current status of screening for gastric cancer-risk (gastritis A, B, C, D) method using combined assay for serum anti-Helicobacter pylori (Hp) IgG antibody and serum pepsinogen (PG) levels, “ABC method”, was reviewed and the latest results of our ongoing trial are reported. It was performed using the following strategy: Subjects were classified into 1 of 4 risk groups based on the results of the two serologic tests, anti-Hp IgG antibody titers and the PG I and II levels: Group A [Hp(−)PG(−)], infection-free subjects; Group B [Hp(+)PG(−)], chronic atrophic gastritis (CAG) free or mild; Group C [Hp(+)PG(+)], CAG; Group D [Hp(−)PG(+)]), severe CAG with extensive intestinal metaplasia. Continuous endoscopic follow-up examinations are required to detect early stages of gastric cancer. Asymptomatic Group A, which accounts for 50–80% of all the subjects may be excluded from the secondary endoscopic examination, from the viewpoint of efficiency. Hp-infected subjects should be administered eradication treatment aimed at the prevention of gastric cancer

Efficacy of nondrug lifestyle measures for the treatment of nocturia.

PURPOSE: Nocturia has a major impact on quality of life and affects numerous aspects of health. Lifestyle modifications are expected to be helpful in improving nocturia. However, the efficacy of this strategy has not been established. We tested the efficacy of nondrug lifestyle measures as a first step in treating nocturia and found factors predictive of the efficacy of the intervention. MATERIALS AND METHODS: We conducted a prospective evaluation of 56 patients treated at 3 hospitals between 2005 and 2009 for symptomatic nocturia. The patients were advised to modify their lifestyle to improve nocturia. Lifestyle modifications consisted of 4 directives of 1) restriction of fluid intake, 2) refraining from excess hours in bed, 3) moderate daily exercise and 4) keeping warm in bed. The frequency volume chart, International Prostate Symptom Score, and Pittsburgh Sleep Quality Index before and 4 weeks after the intervention were used to evaluate the efficacy of the therapy. RESULTS: Mean nocturnal voids and nocturnal urine volume decreased significantly from 3.6 to 2.7 (p <0.0001) and from 923 to 768 ml (p = 0.0005), respectively. Of the 56 patients 26 (53.1%) showed an improvement of more than 1 episode. This treatment was significantly more effective in patients with a larger 24-hour urine production. CONCLUSIONS: Nondrug lifestyle measures were effective in decreasing the number of nocturia episodes and improving patient quality of life. Patients with polyuria showed a better response to the treatment

Association between Plasma Neutrophil Gelatinase Associated Lipocalin Level and Obstructive Sleep Apnea or Nocturnal Intermittent Hypoxia.

[Background]Both obstructive sleep apnea (OSA) and a novel lipocalin, neutrophil gelatinase associated lipocalin (Ngal), have been reported to be closely linked with cardiovascular disease and loss of kidney function through chronic inflammation. However, the relationship between OSA and Ngal has never been investigated. [Objectives]To evaluate the relationship between Ngal and OSA in clinical practice. [Methods]In 102 patients, polysomnography was performed to diagnose OSA and plasma Ngal levels were measured. The correlations between Ngal levels and OSA severity and other clinical variables were evaluated. Of the 46 patients who began treatment with continuous positive airway pressure (CPAP), Ngal levels were reevaluated after three months of treatment in 25 patients. [Results]The Ngal level correlated significantly with OSA severity as determined by the apnea hypopnea index (r = 0.24, p = 0.01) and 4% oxygen desaturation index (ODI) (r = 0.26, p = 0.01). Multiple regression analysis showed that the Ngal level was associated with 4%ODI independently of other clinical variables. Compliance was good in 13 of the 25 patients who used CPAP. Although the OSA (4%ODI: 33.1±16.7 to 1.1±1.9/h, p<0.01) had significantly improved in those with good compliance, the Ngal levels were not significantly changed (60.5±18.1 before CPAP vs 64.2±13.9 ng/ml after CPAP, p = 0.27). [Conclusions]Plasma Ngal levels were positively associated with the severity of OSA. However, the contribution rate of OSA to systemic Ngal secretion was small and changes in Ngal levels appeared to be influenced largely by other confounding factors. Therefore, it does not seem reasonable to use the Ngal level as a specific biomarker of OSA in clinical practice

Obesity hypoventilation syndrome in Japan and independent determinants of arterial carbon dioxide levels.

[Background and objective]Obesity hypoventilation syndrome (OHS) prevalence was previously estimated at 9% in patients with obstructive sleep apnoea (OSA) in Japan. However, the definition of OSA in that study was based on an apnoea-hypopnoea index (AHI) of ≥ 20/h rather than ≥ 5/h. Therefore, the prevalence of OHS in OSA was not measured in the same way as for Western countries. Our study objectives were to investigate the characteristics of Japanese patients with OHS. [Methods]Nine hundred eighty-one consecutive patients investigated for suspected OSA were enrolled. At least 90% of them were from urban areas, including 162 with obese OSA (body mass index (BMI) ≥ 30 kg/m2 and AHI ≥ 5/h). [Results]The prevalence of OHS (BMI 36.7 ± 4.9 kg/m2) in OSA and that in obese OSA were 2.3% and 12.3%, respectively. Multiple regression analysis revealed that independent of age and BMI, arterial oxygen pressure (contribution rate (R2) = 7.7%), 4% oxygen desaturation index (R2 = 8.9%), carbon monoxide diffusing capacity/alveolar volume (R2 = 8.3%), haemoglobin concentration (R2 = 4.9%) and waist circumference (R2 = 4.9%) were independently associated with arterial carbon dioxide pressure. After 12.3 ± 4.6 months of CPAP treatment, more than 60% of OHS patients no longer had hypercapnia. [Conclusions]The prevalence of OHS in OSA in Japan was 2.3%. The mean BMI of patients with OHS in Japan was lower than that in Western countries (36.7 kg/m2 vs 44.0 kg/m2)