Effects on coagulation factor production following primary hepatomitogen-induced direct hyperplasia

AIM： To investigate the molecular mechanisms involved in coagulation factor expression and/or function during direct hyperplasia （DH）-mediated liver regeneration. METHODS： Direct hyperplasia-mediated liver regeneration was induced in female C57BL/6 mice by administering 1,4-bisr2-（3,5-dichloropyridyloxy）] benzene （TCPOBOP）, a representative hepatomitogen. Mice were weighed and sacrificed at various time points [Day 0 （D0： prior to injection）, 3 h, D1, D2, D3, and D10] after TCPOBOP administration to obtain liver and blood samples. Using the RNA samples extracted from the liver, a comprehensive analysis was performed on the hepatic gene expression profiling of coagulation-related factors by real-time RT-PCR （fibrinogen, prothrombin, factors Ⅴ, Ⅶ, Ⅷ, Ⅸ, Ⅹ, Ⅺ, Ⅻ, ⅩⅢβ , plasminogen, antithrombin, protein C, protein S, ADAMTS13, and VWF）. The corresponding plasma levels of coagulation factors （fibrinogen, prothrombin, factors Ⅴ, Ⅶ, Ⅷ, Ⅸ, Ⅹ, Ⅺ, Ⅻ, ⅩⅢ, and VWF） were also analyzed and compared with their mRNA levels. RESULTS： Gavage administration of TCPOBOP （3 mg/kg body weight） resulted in a marked and gradual increase in the weight of the mouse livers relative to the total body weight to 220% by D10 relative to the DO （control） ratios. At the peak of liver regeneration （D1 and D2）, the gene expression levels for most of the coagulationrelated factors （fibrinogen, prothrombin, factors Ⅴ, Ⅶ, Ⅷ, Ⅸ,Ⅺ, Ⅻ, ⅩⅢβ, plasminogen, antithrombin, protein C, ADAMTS13, VWF） were found to be downregulated in a time-dependent manner, and gradually recovered by D10 to the basal levels. Only mRNA levels of factor X and protein S failed to show any decrease during the regenerative phase. As for the plasma levels, 5 clotting factors （prothrombin, factors Ⅷ, Ⅸ, Ⅺ, and Ⅻ） demonstrated a significant decrease （P 〈 0.05） during the regeneration phase compared with DO. Among these 5 factors, factor Ⅸ and factor Ⅺ showed the most dramatic decline in their activities by about 50% at D2 compared to the basal levels, and these reductions in plasma activity for both factors were consistent with our RT-PCR findings. In contrast, the plasma activities of the other coagulation factors （fibrinogen, factors Ⅴ, Ⅶ, ⅩⅢ, and VWF） were not significantly reduced, despite the reduction in the liver mRNA levels. Unlike the other factors, FX showed a temporal increase in its plasma activity, with significant increases （P 〈 0.05） detected at DI. CONCLUSION： Investigating the coagulation cascade protein profiles during liver regeneration by DH may help to better understand the basic biology of the liver under normal and pathological conditions.

Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery

Sister Mary Joseph’s nodule(SMJN)is a rare umbilical nodule that develops secondary to metastatic cancer.Primary malignancies are located in the abdomen or pelvis.Patients with SMJN have a poor prognosis.An 83-year-old woman presented to our hospital with a1-month history of a rapidly enlarging umbilical mass.Endoscopic findings revealed advanced transverse colon cancer.computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon,umbilicus,right inguinal lymph nodes,and left lung.The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels.Imaging findings of the left lung tumor allowed for identification of the primary lung cancer,and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was made.The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection.Intra-abdominal dissemination to the mesocolon was confirmed during surgery.Histopathologically,the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma.We suspect that SMJN may occur via a hematogenous pathway.Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled,the patient and her family desired home hospice.Seven months after surgery,she died of rapidly growing lung cancer.

Evaluation of whole body reaction time and one leg with eye closed balance in elderly Japanese

We evaluated whole body reaction time and one leg with eye closed balance in elderly Japanese. A total of 2059 elderly Japanese (730 men and 1329 women), aged 60 - 79 years, were enrolled in the cross-sectional investigation study. Anthropometric parameters, whole body reaction time and one leg with eye closed balance were measured. Whole body reaction time was significantly higher and one leg with eye closed balance was significantly lower in 70’s than those in 60’s in both sexes. Two hundred twenty seven men (31.1%) and 533 women (40.1%) were having no medications. In men, whole body reaction time was significantly higher and one leg with eye closed balance was significantly lower in subjects with medications than those in subjects without in 60’s. However, significant differences of whole body reaction time and one leg with eye closed balance between subjects with and without medications in men with 70’s and women with 60’s and 70’s were not noted. This standard mean value may provide a useful reference database for evaluating whole body reaction time and one leg with eye closed balance in Japanese elderly subjects.

Air temperature was associated with ambulance transports in Osaka area, Japan

We investigated the link between ambulance transports and meteorological parameters of summer by using daily data in Osaka area, Japan. Daily observations for ambulance transports (from July 1 to September 30, 2009) were obtained from Fire Department Service in Osaka. Data of meteorological parameters in Osaka area, Japan (from July 1 to September 30, 2009) were also obtained from Japan Meteorological Agency. Effect of meteorological parameters on ambulance transports was analyzed. A total of 49,526 ambulance transports were observed from July 1 to September 30, 2009 in Osaka, Japan. Ambulance transports were significantly correlated with mean air temperature (r = 0.298), the highest air temperature (r = 0.347), the lowest air temperature (r = 0.209) and daylight hours (r = 0.301). The higher air temperature was associated with higher ambulance transports of summer in Osaka area, Japan.

Factors associated with psychological distress of medical doctor in Kagawa prefecture, Japan: a pilot study

Objective: We evaluated the psychological distress of medical doctor using a 6-item instrument (the K6) in Kagawa prefecture, Japan. Methods: A total of 284 medical doctors (236 men and 48 women) were analyzed in a cross-sectional investigation study. The association between psychological distress and clinical factors were evaluated by the K6 instrument, with psychological distress defined as 13 or more points out of a total of 24 points. Results: A total of 17 doctors (6.0%) as defined as psychological distress. The significant relationships between the K6 score and age, experience duration as clinician were not noted. The K6 score in subjects with consciousness of suicide was significantly higher than that without. In addition, the K6 score in subjects without cooperation with specialists was higher than those without, but not at a significant level. Conclusions: Some factors i.e. consciousness of suicide and cooperation with specialists might be associated with psychological distress, as assessed by the K6 instrument, in medical doctor in Kagawa prefecture, Japan.

Disease-wide accessibility of the elderly in primary care setting: The relationship between geographic accessibility and utilization of outpatient services in Tokushima prefecture, Japan

In Japan, a rapid pace of aging coupled with the lower birth rates causes the decrease of the population especially in rural area, which leads to the problems with the delivery of healthcare services. We investigated the relationship between the geographical accessibility (time and distance) and the utilization rate of outpatient services in the elderly by major disease groups in Tokushima prefecture, Japan. Distances and driving times to the nearest facilities from residential sites in major disease categories were measured by using geographic information system. Utilization data was obtained from the claim data. In diseases of the musculoskeletal system and connective tissue (M00-M99), diseases of the digestive system (K00-K93), endocrine, nutritional and metabolic diseases (E00-E90), diseases of the eye and adnexa (H00-H59) and diseases of the respiratory system (J00-J99), there were moderate negative correlations (around –0.4 to –0.6) both in distance and time. Distance and time to the nearest facilities were important factors for the utilization of outpatient services of major disease categories in Japanese elderly. Comprehensive approach which include socio- economic factors is needed to mitigate access problems in aging Japanese society.

Factors associated with psychological distress of Public Health Nurse in Kagawa prefecture, Japan: A pilot study

We evaluated the psychological distress using a scale of the K6, the 6-item scale of psychological distress on public health nurse in Kagawa prefecture, Japan. We send the questionnaire to all public health nurses (n = 419) in Kagawa prefecture. Then, a total of 256 public health nurses (1 man and 255 women), had completely answered the questionnaires, were analyzed in a cross-sectional investigation study. The association between psychological distress and considerable factors were evaluated by using the K6, with psychological distress defined as 13 or more points out of a total of 24 points. A total of 15 public health nurses (5.9%) were defined as psychological distress. Clear relationships between the K6 score and age, experience duration as public health nurse were not noted. The K6 score in subjects with anxiety of preventing suicide was significantly higher than that without. In addition, the K6 score in subjects who feel their own mental status was excellent was also lower than that in subjects without that. In conclusion, some factors might be associated with psychological distress, as assessed by the K6, in public health nurse in Kagawa prefecture, Japan.

Daily step counts were associated with suicide in all 47 prefectures of Japan

The link between suicide and daily step counts was evaluated in all 47 prefectures of Japan by ecological study. The crude rate of suicide was significantly and negatively correlated with daily step counts. However, the association between the age-adjusted rate of suicide and daily step counts was noted only in men. These results suggest that increasing daily step counts may be useful for preventing suicide, especially in men, in Japan.