Firmness of purpose in life significantly influences emotional state and autonomic nervous activity

The present study was performed to clarify the influence of having a firm purpose in life (PIL) on psychological and physical stresses. Participants were 59 subjects (19 males and 40 fe- males) with a mean age of 30.9 years (standard deviation, 12.1;range, 18 - 68 years). We used a mental arithmetic (MA) test as a goaloriented stressor;the test was supposed to be finished before a time limit expired without using pencil and paper. We used a PIL test to assess the intensity of personal meaning in one’s life, an interest in mental arithmetic test (IMAT) to assess the intensity of interest in the MA test, and an anxiety inventory (AI) to assess the anxiety level of before and during the MA test. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and nose tip temperature (NTT) were recorded before and after MA. We used logistic regression modeling to estimate the odds ratio (OR) of independent variables of age, sex, PIL test score, AI score, HR, SBP, DBP, and NTT before the MA test. Multivariate-adjusted models showed that PIL test scores prior to the MA test significantly predicted the observed changes in AI score and HR. Other variables were not significant predictors. In conclusion, we found that a firm PIL decreased anxiety under psychological stress as measured with the MA test, even with objective evaluation by others. Having a firm PIL also lowered the response of the sympathetic nervous system to psych0logical stress.

Multicentric occurrence of hepatocellular carcinoma with nonalcoholic steatohepatitis

AIM:To reveal the manner of hepatocellular carcinoma (HCC) development in patients with nonalcoholic steatohepatitis(NASH) focusing on multicentric occurrence (MO) of HCC.METHODS:We compared clinicopathological characteristics between patients with and without MO of HCC arising from NASH background.The clinical features were implicated with reference to the literature available.RESULTS:MO of HCC was identified with histological proof in 4 out of 12 patients with NASH-related HCC(2 males and 2 females).One patient had synchronous MO;an advanced HCC,two well-differentiated HCCs and a dysplastic nodule,followed by the development of metachronous MO of HCC.The other three patients had multiple advanced HCCs accompanied by a well-differentiated HCC or a dysplastic nodule.Of these three patients,one had synchronous MO,one had metachronous MO and the other had both synchronous and metachronous MO.There were no obvious differences between the patients with or without MO in terms of liver function tests,tumor markers and anatomical extent of HCC.On the other hand,all four patients with MO of HCC were older than 70 years old and had the comorbidities of obesity,type 2 diabetes mellitus(T2DM),hypertension and cirrhosis.Although these conditions were not limited to MO of HCC,all the conditions were met in only one of eight patients without MO of HCC.Thus,concurrence of these conditions may be a predisposing situation to synchronous MO of HCC.In particular,old age,T2DM and cirrhosis were suggested to be prerequisite for MO because these factors were depicted in common among two other cases with MO of HCC under NASH in the literature.CONCLUSION:The putative predisposing factors and necessary preconditions for synchronous MO of HCC in NASH were suggested in this study.Further investigations are required to clarify the accurate prevalence and predictors of MO to establish better strategies for treatment and prevention leading to the prognostic improvement in NASH.