Daily light exposure profiles and the association with objective sleep quality in patients with Parkinson's disease: The PHASE study

STUDY OBJECTIVES

Light information crucially influences the sleep initiation and continuity. The purpose of this study was to compare daily light exposure between patients with Parkinson's disease (PD) and non-PD older adults and evaluate the association of daily light exposure with objective sleep measures in patients with PD.

METHODS

In this cross-sectional study of 189 outpatients with PD and 1101 community dwelling older adults (controls), daily light exposure was measured using wrist light meters during the daytime and light meters set in the bedrooms during the nighttime, and objective sleep quality was measured by wrist actigraphy.

RESULTS

The median duration of exposure to ≥1000 lux light was significantly shorter in patients with PD than in controls. The median nighttime light intensity was higher in patients with PD than in controls. Among patients with PD, multivariable analysis suggested that the highest quartile of exposure to ≥1000 lux light during the daytime was linked to significantly higher sleep efficiency by 8.0% and shorter wake after sleep onset (WASO) by 36.9 min than the lowest quartile. During the nighttime, the highest quartile of mean light intensity had significantly lower sleep efficiency by 6.8%, longer WASO by 24.1 min, longer sleep onset latency, and higher fragmentation index, than the lowest quartile. Importantly, daytime and nighttime light levels were independently associated with objective sleep measures.

CONCLUSION

The present study illustrated that greater daytime light exposure and lower nighttime light exposure are significantly associated with better objective sleep measures in patients with PD.

Blood pressure, pulse rate, and skin temperature during hot-water bathing in real-world settings among community-dwelling older adults: the HEIJO-KYO Study

BACKGROUND

Home hot-tub bathing substantially increases drowning mortality rates among older adults in Japan. Previous laboratory studies on hemodynamic responses during hot-tub bathing have been inconsistent depending on the thermal conditions. Furthermore, real-world hemodynamic changes that occur during bathing remain poorly understood. This study investigated the association between individual thermal states and hemodynamic parameters during hot-tub bathing among community-dwelling older adults.

METHODS

In this cross-sectional study conducted between January 2016 and April 2019, which involved 1,479 older adults (median [range] age, 68 [40-90] years), skin temperature on the abdominal surface was measured every minute. Ambulatory blood pressure and pulse rate were recorded at 15-min intervals for 24 h. Participants underwent simultaneous living room temperature measurements in their homes, and the time and methods of bathing were recorded. Associations between skin temperature and hemodynamic parameters during bathing and between the pre-bath living room temperature and in-bath maximum proximal skin temperature were evaluated using mixed-effects and linear regression models, respectively.

RESULTS

A 1 °C increase in skin temperature was significantly associated with a 2.41 mmHg (95% confidence interval [CI]: 2.03-2.79) increase in systolic blood pressure and a 2.99 bpm (95% CI: 2.66-3.32) increase in pulse rate, after adjusting for potential confounders, including age, sex, body mass index, antihypertensive medication use, dyslipidemia, diabetes, and living room and outdoor temperatures. Significant interactions were not observed between sex and skin temperature in relation to systolic blood pressure and pulse rate (P = 0.088 and 0.490, respectively). One standard deviation lower living room temperature before bathing was significantly associated with a 0.41 °C (95% CI: 0.35-0.47) higher maximum skin temperature during bathing.

CONCLUSIONS

Our findings suggest that pre-bath cold exposure may increase the skin temperature during hot-tub bathing, possibly resulting in excessive hemodynamic changes. This provides a framework for future interventions that utilize pre-bath thermal conditions and bathing environments to prevent bath-related deaths.

Effects of a violet-excitation light-emitting diode on melatonin secretion and sleepiness: preliminary findings from a randomized controlled trial

STUDY OBJECTIVES

A new type of lighting using violet-excitation light-emitting diodes (LEDs) with an action spectrum centered at approximately 405 nm was developed. Although violet-excitation LEDs can reduce melatonin suppression compared with blue-excitation LEDs, no studies have compared the effects of violet-excitation LEDs with those of blue-excitation LEDs on melatonin suppression. This study was designed to compare the effects of violet-excitation LEDs with those of blue-excitation LEDs on melatonin suppression, psychomotor vigilance, and sleepiness.

METHODS

Sixteen healthy Japanese males aged 20-39 years were exposed to violet- and blue-excitation LEDs for 3 hours in a crossover randomized manner. The primary outcome was changes in salivary melatonin levels compared with the baseline levels. The secondary outcomes were changes in psychomotor vigilance and the Karolinska Sleepiness Scale. Melatonin suppression was calculated from the difference in the area under the curves between the baseline and intervention.

RESULTS

Of the 16 participants, 15 completed the measurements. The baseline characteristics did not differ significantly between the 2 groups. After adjusting for age, a difference of 16.28 pg/mL in mean melatonin suppression was observed between the violet- and blue-excitation LED groups (-2.15 pg/mL vs -18.43 pg/mL; P = .006). The overall melatonin suppression by violet-excitation LEDs was 48.6% smaller than that by blue-excitation LEDs. No significant differences in psychomotor vigilance and sleepiness were observed between the 2 groups.

CONCLUSIONS

Melatonin suppression in healthy Japanese males exposed to violet-excitation LEDs was significantly smaller than that in those exposed to blue-excitation LEDs. Our preliminary findings indicate that violet-excitation LEDs may have the potential to reduce the magnitude of blue-excitation LED-induced melatonin suppression.

CITATION

Mitsui K, Saeki K, Sun M, Yamagami Y, Tai Y, Obayashi K. Effects of a violet-excitation light-emitting diode on melatonin secretion and sleepiness: preliminary findings from a randomized controlled trial. J Clin Sleep Med. 2024;20(1):101-109.

Association between circadian skin temperature rhythms and actigraphic sleep measures in real-life settings

STUDY OBJECTIVES

Skin temperature manipulation with little or no change in core body temperature affects sleep-wake states; however, the association of 24-hour skin temperature variation with sleep quality has not been investigated in a large-scale population. We examined the association between the circadian rhythm of distal skin temperature and sleep quality in real-life settings and aimed to provide additional evidence of the link between thermoregulation and sleep-wake states.

METHODS

In this cross-sectional study of 2,187 community-dwelling adults, we measured distal skin temperature at the ventral forearm at 3-minute intervals for 7 consecutive days to calculate nonparametric indicators of a circadian skin temperature rhythm, including intradaily variability, interdaily stability, and relative amplitude. Participants underwent simultaneous 7-day wrist actigraphy to objectively measure sleep quality. The association between nonparametric circadian skin temperature rhythm indicators and 7-day sleep measures was evaluated using multivariable linear regression models.

RESULTS

Lower intradaily variability and higher interdaily stability and relative amplitude of distal skin temperature were significantly associated with higher sleep efficiency, shorter wake after sleep onset, and longer total sleep time (all P < .001). After adjusting for demographic, clinical, and environmental factors, the coefficients for the linear trend of sleep efficiency were -1.20 (95% confidence interval: -1.53, -0.87), 1.08 (95% confidence interval: 0.80-1.36), and 1.47 (95% confidence interval: 1.04-1.89) per quartile increase in intradaily variability, interdaily stability, and relative amplitude, respectively (all P < .001).

CONCLUSIONS

Distal skin temperature with lower fluctuations and higher regularity and rhythm amplitudes was associated with better sleep quality. Our results could be applied in chronobiological interventions to improve sleep quality.

CITATION

Tai Y, Obayashi K, Yamagami Y, Saeki K. Association between circadian skin temperature rhythms and actigraphic sleep measures in real-life settings. J Clin Sleep Med. 2023;19(7):1281-1292.

Association between indoor noise level at night and objective/subjective sleep quality in the older population: a cross-sectional study of the HEIJO-KYO cohort

STUDY OBJECTIVES

Noise exposure could be an important risk factor for low sleep quality; however, evidence on indoor noise in large-scale populations is limited. We evaluate the association between indoor noise at night and objective and subjective sleep quality in the older population.

METHODS

In this cross-sectional study of 1076 participants (≥60 years), we measured indoor noise at night (A-weighted equivalent noise from bedtime to rising time [LAeq]) using a portable noise level meter set in bedrooms and sleep quality using actigraphy and a questionnaire for two nights. Using multivariable linear regression models, we examined the associations between indoor noise at night and objective and subjective sleep parameters independent of potential confounders such as age, body mass index, and sleep medication.

RESULTS

Increased indoor noise at night by 1 dB of LAeq was significantly associated with lower objective sleep quality, such as lower sleep efficiency (regression coefficient [β], -0.19%; 95% confidence interval [95% CI], -0.26 to -0.12; P < 0.001), longer log-transformed sleep onset latency (β, 0.02 log-min; 95% CI 0.01-0.03; P < 0.001) and wake after sleep onset (β, 0.66 min; 95% CI 0.40-0.92; P < 0.001), and higher log-transformed fragmentation index (β, 0.01; 95% CI 0.008-0.017; P < 0.001). These results remained consistent in the analysis using noise-event rate (≥45 dB) as an independent variable.

CONCLUSION

This study revealed the quantitative association between indoor noise at night and objective and subjective sleep quality in the older population. Reducing noise and improving sleep quality may prevent fatal diseases.

Associations between indoor light pollution and unhealthy outcomes in 2,947 adults: Cross-sectional analysis in the HEIJO-KYO cohort

Nighttime use of artificial light is usual and essential in these modern times. Although light exposure at night (LAN) is reportedly a risk factor of several diseases, epidemiological studies on indoor LAN levels are still limited. Hence, the present study aimed to measure bedroom LAN levels by using light meters in a larger sample than in previous studies, and to evaluate the associations with comprehensive health outcomes. Out of 3012 participants, 2947 (mean age, 69.3 years; female, 60.6%) completed the bedroom LAN intensity measurement. The median bedroom LAN intensity was 1.0 lux (interquartile range, 0.2-4.0 lux). In a multivariable analysis adjusted for potential confounding factors, the highest quartile group of bedroom LAN intensity had significantly higher body weight, body mass index, abdominal circumference, and low-density lipoprotein cholesterol than the lowest quartile group. The group with a median LAN intensity ≥10 lux had significantly higher white blood cell counts and had significantly lower high-density lipoprotein cholesterol levels than the group with a median LAN intensity <10 lux. In addition, the groups with median LAN intensities ≥3 and ≥10 lux had significantly higher odds ratios for sleep disturbances and depressive symptoms than the group with <3 and <10 lux, respectively. Therefore, the present study provided real-world data on bedroom LAN levels as a marker for indoor light pollution in a large sample and suggested that higher bedroom LAN levels are significantly associated with parameters of obesity, dyslipidemia, systemic inflammation, sleep disturbances, and depressive symptoms.

Breakfast Skipping and Declines in Cognitive Score Among Community-Dwelling Older Adults: A Longitudinal Study of the HEIJO-KYO Cohort

Previous studies outlined the correlation of adverse effects of breakfast skipping with cognitive function. However, the majority of these studies have focused on the short-term effects; to date, the long-term effect of breakfast skipping on cognitive function among older adults remains unclear. In this prospective cohort study of 712 older adults (mean age, 70.8 years), breakfast skipping was defined as skipping breakfast one or more times per week, and declines in cognitive score was defined as decreases in Mini-Mental State Examination (MMSE) score of two or more in the observed period. During follow-up (median, 31 months), 135 of 712 participants developed declines in cognitive score. Poisson regression models revealed that the incidence rate for declines in cognitive score was significantly higher in breakfast skipper (n = 29) than breakfast eaters (n = 683) [incidence rate ratio (IRR), 2.10; 95% CI, 1.28-3.44]. Additional propensity score adjustments related to breakfast skipping from baseline parameters (age, gender, smoking and drinking status, BMI, household income, educated level, depressive symptoms, hypertension, diabetes, sleep medication, physical activity, caloric intake, and baseline cognition) produced consistent results (IRR, 2.21; 95% CI, 1.33-3.68). Sensitivity analysis, when the cut-off value of decreases in MMSE score was changed to three points, suggested a significant and stronger association (IRR, 3.03; 95% CI, 1.72-5.35). Regarding daily intakes of food groups, breakfast skippers consumed a significantly lower amount of vegetables, fruits, and fish than breakfast eaters. In conclusion, our findings suggest that breakfast skipping is longitudinally associated with declines in cognitive score among older adults.

General anesthesia with remimazolam for a pediatric patient with MELAS and recurrent epilepsy: a case report

Background

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is a mitochondrial disease. We report here the safe use of remimazolam in a pediatric MELAS patient.

Case presentation

A 10-year-old girl (118 cm, 16 kg) was scheduled for an open gastrostomy to improve nutrition and epileptic seizure control. We induced and maintained general anesthesia with remimazolam, remifentanil, fentanyl, and rocuronium. We also performed a bilateral subcostal transversus abdominis plane block before the surgery. The surgery finished uneventfully. After we discontinued remimazolam administration, the patient woke up immediately but calmly without flumazenil. Epileptic seizures did not occur during intra- and early post-operative periods.

Conclusion

Remimazolam enabled us to provide a pediatric MELAS patient with general anesthesia without causing delayed emergence or epileptic seizures.

Inverse Association of Skin Temperature With Ambulatory Blood Pressure and the Mediation of Skin Temperature in Blood Pressure Responses to Ambient Temperature

BACKGROUND

The inverse association between ambient temperature and blood pressure (BP) has been investigated in the context of excess cardiovascular mortality in winter. However, the role of skin temperature (ST), which reflects our external and internal thermal environments, in BP regulation remains unclear. Therefore, we examined the association between ST and ambulatory BP and the mediation of ST in BP responses to ambient temperature in real-life settings.

METHODS

We conducted a longitudinal analysis using repeated measurements of ambulatory BP and ST for 48 hours (30 711 daytime readings and 17 382 nighttime readings) among 584 older adults between October and March (2012-2014). Linear mixed-effect models were used to examine the association of distal (mean of wrist and ankle) and proximal (abdomen) ST with systolic BP. The mediation of ST in BP responses to ambient temperature was examined using path analysis.

RESULTS

Distal and proximal STs were significantly associated with systolic BP during the daytime (regression coefficients: -4.27 mm Hg [95% CI, -4.58 to -3.96] and -2.74 mm Hg [95% CI, -3.14 to -2.56] per SD of ST, respectively), independent of potential confounders. The significant associations also existed during nighttime. The mediation effect of distal ST was 7.1 times higher than that of proximal ST during daytime, while those of distal and proximal STs during nighttime were almost identical.

CONCLUSIONS

ST, especially in distal regions, was inversely associated with ambulatory BP. Our results have the potential for application to interventional studies targeting ST regulation to reduce excess cardiovascular deaths in winter.

[Sleep quality and mental well-being of mothers caring for children with disabilities and requiring oxygen therapy and night care at home]

Objectives　This study aimed to 1) determine what kind of care for children with disabilities is related to the mothers' sleep and mental well-being and 2) objectively measure the sleep state of mothers responsible for children with disabilities.Methods　A self-administered questionnaire was distributed to 180 mothers of children enrolled in the Special Needs Education School in prefecture A. Amongst these, nine who provided consent underwent objective sleep measurements using actigraphy. The questionnaire investigated the lifestyle and the type of care needed for children with disabilities and their influence on the mothers. Subjective sleep quality (Pittsburgh Sleep Quality Index) and mental well-being status (General Health Questionnaire) of the mothers were also evaluated. Logistic regression analysis was performed to analyze the background factors affecting sleep quality and mental health.Results　Of the 180 participants, 84 (46.7%) provided valid responses. Fifty-two (64.2%) and 34 (42.0%) individuals subjectively reported poor sleep quality and poor mental well-being, respectively. Mothers having responsibilities of oxygen therapy and night care reported significantly poor sleep quality and mental well-being. Moreover, objective sleep measurements showed that the changes in the child's physical condition, such as ventilator management, epileptic seizures, and fever, resulted in prolonged waking times and affected the sleep efficiency of the mother.Conclusion　Responsibilities toward providing oxygen therapy and night care for their children with disabilities influenced the sleep quality and mental well-being of the mothers. Thus, it is important to provide support to mothers caring such disabled children.

Association between before-bedtime passive body heating and nocturia during the cold season among older adults

Background Cold exposure induces lower urinary tract symptoms including nocturia. Cold-induced detrusor overactivity can be alleviated by increasing skin temperature in rats. However, no study has shown an association between passive heating with hot-water bathing and nocturia among humans.Methods We included 1,051 Japanese community-dwelling older adults (mean age 71.7 years) in this cross-sectional study from 2010 to 2014. The number of nocturnal voids was recorded in a self-administered urination diary. Nocturia was defined as ≥2 nocturnal voids. We evaluated bathing conditions in the participants' houses.Results Hot-water bathing (n = 888) was associated with a lower prevalence of nocturia than no bathing (n = 163), independent of potential confounders including age, sex, obesity, income, physical activity, diabetes, medication (diuretics, nondiuretic antihypertensives, and hypnotics), depressive symptoms, indoor/outdoor temperature, and day length (odds ratio [OR]: 0.68, 95% confidence interval [CI]: 0.48-0.97; p = 0.035). Compared with the quartile group with the longest bath-to-bed interval (range: 161-576 min), the second and third quartile groups (range: 61-100 and 101-160 min, respectively) were associated with a lower prevalence of nocturia, after adjusting for water temperature and bathing duration besides the same covariates (OR: 0.60, 95% CI: 0.38-0.96; p = 0.031 and OR: 0.59, 95% CI: 0.37-0.94; p = 0.025, respectively).Conclusion Hot-water bathing, particularly with a bath-to-bed interval of 61-160 min, was significantly associated with a lower prevalence of nocturia among older adults.

Association Between Passive Body Heating by Hot Water Bathing Before Bedtime and Depressive Symptoms Among Community-Dwelling Older Adults

OBJECTIVE

Passive body heating can have an antidepressant effect by activating warm-sensitive neural pathways associated with affective functions. Interventional studies showed that patients with depression had reduced depressive symptoms after passive body heating. However, the effect of hot water bathing at home on depressive symptoms in the general population remains unclear. Thus, we evaluated the association between objectively measured hot water bathing and depressive symptoms among older adults.

DESIGN

Cross-sectional analysis.

SETTING

A baseline survey of community-based cohort study in Japan.

PARTICIPANTS

Community-dwelling older volunteers (n = 1,103; mean age: 72.0 years).

MEASUREMENTS

The authors evaluated bathing conditions and distal skin temperature for 2 consecutive days. Depressive symptoms were defined as the 15-item Geriatric Depression Scale score of ≥6.

RESULTS

Logistic regression showed that the no bathing group (adjusted odds ratio [OR] 2.60, 95% confidence interval [CI] 1.36-4.95, χ² = 8.40, degrees of freedom [df] = 1) and the either-day bathing group (adjusted OR 1.68, 95% CI 1.11-2.56, χ² = 5.89, df = 1) had higher odds of depressive symptoms than the both-day bathing group independent of potential confounders including age, sex, body mass index, alcohol intake, income, living alone, hypnotic use, diabetes, and physical activity. Shorter interval from bathing to bedtime was significantly associated with lower odds of depressive symptoms and higher nighttime distal skin temperature after adjusting for water temperature and duration.

CONCLUSION

A higher frequency of hot water bathing and shorter interval from bathing to bedtime were associated with lower odds of depressive symptoms.

Circadian activity rhythm in Parkinson's disease: findings from the PHASE study

OBJECTIVE

Circadian disruptions in Parkinson's disease (PD) are characterized as amplitude reduction rather than as phase shift; however, large-scale studies evaluating circadian rhythms between PD patients and non-PD older adults have not been performed. The present study aimed to compare the circadian activity rhythm (CAR) between PD patients and non-PD older adults.

METHODS

In this cross-sectional study on 157 PD outpatients and 1111 community-dwelling older adults (controls), physical activity was measured using actigraphy at 1-min intervals over 6 days in PD patients and 2 days in non-PD older adults. Data were base-10 log-transformed and regretted to the sigmoidally transformed cosine curve.

RESULTS

The mean amplitude (log counts/min) and acrophase were 1.85 (SD, 0.52) and 14:19 (SD, 1:15), respectively, in the controls (n = 1111); 1.42 (0.48) and 14:24 (1:20), respectively, in the early-stage (Hoehn-Yahr I and II) PD patients (n = 95); and 1.23 (0.54) and 13:41 (1:56), respectively, in the late-stage (Hoehn-Yahr III-V) PD patients (n = 62). Multivariable analysis revealed significantly lower amplitude in the early-stage and late-stage PD groups than in the controls. The acrophase significantly advanced in the late-stage PD group than in the controls. With the advancement of PD stage, amplitude and peak significantly decreased; trough increased; acrophase and active offset advanced; and robustness weakened.

CONCLUSIONS

Compared with non-PD older adults, PD patients exhibited a phase advance in CAR, along with amplitude reduction. With an advanced stage of PD, a phase advance in CAR also occurred, along with amplitude reduction and weakened robustness.

Hot-water bathing before bedtime and shorter sleep onset latency are accompanied by a higher distal-proximal skin temperature gradient in older adults

STUDY OBJECTIVES

Passive body heating in controlled settings could shorten sleep onset latency (SOL). The hypothesized mechanism is vasodilation-induced heat loss before bedtime. However, this evidence is based on small sample-sized studies in specific populations. Thus, we analyzed the association of hot-water bathing and its before-bedtime timing with SOL and heat loss in a large study population of older adults.

METHODS

We conducted a longitudinal analysis using repeated measurements of hot-water bathing and sleep among 1,094 older adults (mean age, 72.0 years). SOL was recorded using actigraphy and self-reported sleep estimates and was categorized into conditions (intervals of 1-60, 61-120, 121-180, and > 181 minutes between hot bath and bedtime) and compared with the control condition of no bathing. The heat-loss indicator, distal-proximal skin temperature gradient, was examined in the same categorization.

RESULTS

Mixed-effects linear regression models suggested that the bathing conditions of 61-120 minutes and 121-180 minutes showed significantly shorter log-transformed actigraphic SOL by 0.23 log-minutes (95% confidence interval (CI), 0.03-0.42) and 0.32 log-minutes (95% CI, 0.09-0.56), shorter self-reported SOL by 0.16 log-minutes (95% CI, 0.02-0.30) and 0.18 log-minutes (95% CI, 0.01-0.35), and higher distal-proximal skin temperature gradient for 30 minutes before bedtime by 0.49°C (95% CI, 0.22-0.75) and 0.51°C (95% CI, 0.20-0.83), respectively, independent of potential confounders.

CONCLUSIONS

Hot-water bathing before bedtime is significantly associated with shorter SOL and higher distal-proximal skin temperature gradient among the large-scale older population. This finding could enhance the generalizability of hot-water bathing habits for ameliorating sleep initiation difficulty.

Association between NT-proBNP and nocturia among community-dwelling elderly males and females: A cross-sectional analysis of the HEIJO-KYO study

AIMS

To investigate the association between B-type natriuretic peptide (BNP) and nocturia among community-dwelling males and females.

METHODS

A total of 1096 participants (mean age 71.9 ± 7.1 years, 518 [47.2%] males) were included in the study. The number of nocturnal voids was recorded in a self-reported urination diary, and nocturia was defined as two or more voids per night. Daytime serum concentration of the N-terminal fragment of BNP precursor (NT-proBNP) was measured. Multivariable logistic regression analysis was performed to determine the association between NT-proBNP and nocturia.

RESULTS

Nocturia was observed in 23.5% of females and 37.1% of males. Higher NT-proBNP (log pg/ml) was associated with nocturia in both gender groups (females: odds ratio [OR]: 1.67, 95% confidence interval [95% CI], 1.21-2.34, p = .002; males: OR: 1.26, 95% CI, 1.01-1.59, p = .046), independent of confounding variables including night-time blood pressure, mean voided volume, and chronic kidney disease. Although the increase in prevalence of nocturia with higher NT-proBNP was equivalent in both genders, some effect of gender on the relationship between NT-proBNP and nocturia was observed (p = .037). Nocturnal urine volume was also significantly and independently associated with NT-proBNP level (females: β = 32.9 ml, 95% CI, 5.63-60.2, p = .018; males: β = 34.6 ml, 95% CI, 9.40-59.9, p = .007).

CONCLUSIONS

This study revealed higher serum NT-proBNP is significantly and independently associated with the prevalence of nocturia in both males and females. This is an exploratory cross-sectional study and the analyses are post hoc, so further research works are needed to clarify the causality and clinical value.

Patient Position Affects Venodilation for Peripheral Intravenous Cannulation

BACKGROUND

Larger veins are associated with a higher rate of success of peripheral intravenous cannulation. Although patient position affects venodilation during central venous cannulation, the association between patient position and vein size for peripheral intravenous cannulation remains unclear.

PURPOSE

We examined the effect of seated versus supine positioning on vein size during peripheral intravenous cannulation before and after tourniquet application.

METHODS

In the present study, we recruited 81 participants (20-64 years) and included 80 in the analysis. We measured outcomes before and after tourniquet application in the seated and supine positions. The primary outcome was the cross-sectional area of the target forearm vein (ultrasonography by a blinded assessor). Subgroup analysis was used to test the effects of positioning combined with difficult peripheral intravenous cannulation (DPIVC) defined as poor visibility and/or palpability of the target vein.

RESULTS

Results of paired t tests demonstrated that the venous cross-sectional area significantly increased in the supine position with tourniquet application compared with the seated position with tourniquet application. Subgroup analysis with two-way repeated measures analysis of variance revealed that the venous cross-sectional area was significantly larger in the supine position than in the seated position despite DPIVC.

CONCLUSION

Vein size during tourniquet application was greater in the supine than in the seated position even in cases of DPIVC. We thus recommend the supine position over the seated position for peripheral intravenous cannulation.

Indoor light pollution and progression of carotid atherosclerosis: A longitudinal study of the HEIJO-KYO cohort

Exposure to light at inappropriate times in relation to the solar cycle can disturb circadian endocrine and metabolic rhythms. Previous studies have suggested an association between light exposure at night (LAN) and obesity, an important risk factor of atherosclerosis, although it remains unclear whether LAN associates with progression of atherosclerosis. To evaluate the longitudinal association between bedroom LAN intensity and progression of carotid atherosclerosis, light intensity in the bedroom at baseline and carotid artery intima-media thickness (IMT) at baseline and follow-up were measured in 989 elderly participants (945 at baseline and 780 at a median follow-up time of 34 months). The mean age of the participants was 71.4 ± 6.9 years. The average mean and maximal carotid IMT at baseline were 0.88 ± 0.15 and 1.10 ± 0.32 mm, respectively. The median intensity of bedroom LAN was 0.68 lx (IQR, 0.07-3.29). In multivariable analysis adjusted for potential confounders, the highest LAN group exhibited a significant increase in mean carotid IMT (adjusted β, 0.028; 95% CI, 0.005-0.052; P = 0.019) compared with the lowest LAN quartile group. A similar relationship was found between LAN and maximal carotid IMT (adjusted β, 0.083; 95% CI, 0.037-0.129; P < 0.001). In conclusion, we found a clear and significant association between bedroom LAN intensity and progression of subclinical carotid atherosclerosis, which was independent of known risk factors for atherosclerosis, including age, obesity, smoking, economic status, hypertension, and diabetes. Indoor light pollution may be a potential risk factor for atherosclerosis in the general population.

Quantitative associations between objective sleep measures and early-morning mobility in Parkinson’s disease: cross-sectional analysis of the PHASE study

Study Objectives

Previous studies have suggested associations between sleep measures and early-morning akinesia; however, objective evidence is limited. The purpose of this study was to evaluate the associations between objective sleep measures and morning mobility among patients with Parkinson’s disease (PD).

Methods

In this cross-sectional study, we measured objective sleep parameters and morning mobility in 157 patients with PD (mean age, 71.4 years) for six consecutive days using an actigraph placed on the nondominant wrist. Low morning mobility was defined as less than 100 counts/min within the first 2 hours after rising.

Results

The mean duration of low morning mobility was 55.7 minutes (SD, 23.8), and the mean sleep parameters were as follows: sleep efficiency (SE), 72.1% (13.6); wake after sleep onset (WASO), 104.7 minutes (57.9); total sleep time (TST), 343.6 minutes (104.0); and fragmentation index (FI), 3.5 (3.4). Multivariable linear regression analysis adjusted for potential confounders demonstrated significant associations between better objective sleep measures and shorter low morning mobility (SE per %: β, −0.419; 95% CI = −0.635 to −0.204; p &lt; 0.001; WASO per min: β, 0.056; 95% CI = 0.003 to 0.109; p = 0.039; and FI per unit; β, 1.161; 95% CI = 0.300 to 2.023; p = 0.009) but not TST (p = 0.78). These findings were not altered by different cutoff values of mobility (50 counts/min) or duration (1 h after rising).

Conclusions

In patients with PD, better objective sleep measures are significantly associated with shorter low morning mobility. Future studies investigating whether improved sleep reduces symptoms of low morning mobility are required.

Bedroom lighting environment and incident diabetes mellitus: a longitudinal study of the HEIJO-KYO cohort

OBJECTIVES

Light information received by the brain influences human circadian timing and metabolism; low-level light at night (LAN) significantly increased body mass and led to prediabetes in mice. We hypothesized that LAN exposure increases the diabetes risk in humans. The aim of the present study was to evaluate a longitudinal association between LAN exposure and the incidence of diabetes in a general population.

METHODS

In our prospective cohort study, bedroom light intensity was measured at 1-min intervals in 678 elderly participants without diabetes at baseline. The average light intensity recorded between bedtimes and rise times over two consecutive nights was used in the analysis.

RESULTS

During follow-up (median, 42 months), 19 of the 678 participants (mean age, 70.6 years) developed diabetes. Poisson regression models revealed that the incidence rate for diabetes was significantly higher in the LAN group (average ≥ 5 lux, N = 128) than the dark group (average < 5 lux, N = 550) (incidence rate ratio, 3.74; 95% confidence interval (CI), 1.55-9.05; p = 0.003). Further propensity score adjustments in relation to LAN produced consistent results (incidence rate ratio, 3.19; 95% CI, 1.38-7.35; p = 0.007). When the cut-off value of LAN was decreased to 3 lux, the relationship remained significant (incidence rate ratio 2.74; 95% CI, 1.19-6.33; p = 0.018).

CONCLUSIONS

Our findings suggest that LAN exposure increases the incidence of diabetes in a general elderly population. Further research involving a large cohort with new-onset diabetes is warranted to elucidate these findings.

Farming habit, light exposure, physical activity, and depressive symptoms. A cross-sectional study of the HEIJO-KYO cohort

BACKGROUND

Bright light therapy and exercise interventions are effective methods for treating seasonal and non-seasonal affective disorders. Synchronization of internal circadian rhythms with the external environment by light therapy and physical activity may partly explain its efficacy. In the present study, we objectively measured daytime light exposure and physical activity in real life situations with elderly participants, and investigated the association between farming habits and the prevalence of depressive symptoms.

METHODS

This cross-sectional was conducted among 1005 participants (mean age: 71.5) of a community-based cohort study. Depressive symptoms were assessed by the Geriatric Depression Scale (GDS score ≥ 6) and administration of antidepressant.

RESULTS

Farming habit with long duration (> 7.0 h/week) showed significantly lower odds ratios (OR) for depressive symptoms (adjusted OR 0.63, 95% confidential interval,0.41 to 0.96) compared with participants without farming habit independent of confounders such as age, gender, body mass index smoking, drinking, daytime ambulatory systolic blood pressure, diabetes, living alone, education, income, and daylength. Even in farming with short duration (≤ 7.0 h/week), we found significant association with lower OR for depressive symptoms (adjusted OR 0.64, 95%CI, 0.42 to 0.97). Light exposure and daytime physical activity measured by wrist actigraphy were significantly higher among participants with longer farming habits (p for trend < 0.01). Physical activity mediated 12.0% of association between farming habit and depressive symptoms.

LIMITATIONS

A cross-sectional association may be found because the participants with depressive symptoms tended to avoid farming. A longitudinal study is warranted to determine the direction of causality.

CONCLUSIONS

Participants with farming habit showed significantly lower OR for depressive symptoms than those without farming habit, and it was partly mediated by physical activity.

Gender differences in the association between melatonin secretion and diabetes in elderly: The HEIJO-KYO cohort

OBJECTIVE

Reportedly, melatonin protects the pancreatic islets and decreases insulin resistance; thus, it may contribute to preventing diabetes. Epidemiological data suggested that lower melatonin secretion is associated with higher incidence of diabetes in female nurses. Such associations are unknown in the general population. We evaluated the association between melatonin secretion and diabetes in a general population, including both genders.

DESIGN

Cross-sectional study.

PARTICIPANTS

A total of 1096 community-based elderly males (n = 519) and females (n = 577) (mean age, 71.8 years) were enrolled.

MEASUREMENTS

Overnight urinary 6-sulfatoxymelatonin excretion (UME) and diabetes prevalence were measured.

RESULTS

The median UME was 6.7 μg (interquartile range, 4.0-10.5); the prevalence of diabetes was 17.5% in males and 10.7% in females. The prevalence of diabetes decreased with increasing UME quartiles among males (P for trend = 0.009) but not among females (P for trend = 0.96). In a multivariable logistic regression analysis adjusting for potential confounding factors, such as age, smoking and drinking habits, economic status, caloric intake, and physical activity, the odds ratio (OR) for diabetes was significantly lower in the highest UME quartile group compared with the lowest quartile group among males (OR, 0.35; 95% CI, 0.17-0.70; P = 0.003) but not females (OR, 0.94; 95% CI, 0.45-1.95; P = 0.87). Consistent results were observed in the analysis after adjusting for clinical parameters or using continuous UME data.

CONCLUSIONS

Melatonin secretion was significantly and inversely associated with diabetes in males but not in females. This association was independent of several important confounding factors.

Pre-awake light exposure and sleep disturbances: findings from the HEIJO-KYO cohort

OBJECTIVES

To evaluate the associations between pre-awake light (PAL) exposure and subjective and objective measures of sleep quality.

METHODS

In this cross-sectional study of 1108 elderly participants (mean age, 71.9 years), we measured bedroom light intensity using a bedside light meter for two nights and sleep quality using actigraphy and a questionnaire. PAL was determined as the 2h-average light intensity before rise time, and sleep disturbance was defined as the Pittsburgh sleep quality index score ≥6.

RESULTS

Sleep disturbance prevalence increased with increased PAL exposure (P = 0.002). In multivariable models adjusted for potential confounders, the odds ratio (OR) for sleep disturbances was significantly higher in the highest quartile PAL group (Q4) than in the lowest quartile group (Q1) (OR, 1.65; 95% CI, 1.16-2.34). This association occurred independent of post-bedtime light exposure; and was stronger in the later chronotype group (n = 556) (OR, 1.80; 95% CI, 1.05-3.09) than in the earlier chronotype group (n = 552) (OR, 1.64; 95% CI, 1.01-2.64). Actigraphic sleep efficiency in the Q4 group was significantly lower by 2.6% (95% CI, 1.3-3.8) than that in the Q1 group. Moreover, longer wake after sleep onset by 7.5 min (95% CI, 2.8-12.2) and sleep onset latency by 0.2 log min (95% CI, 0.1-0.4) were observed in the Q4 group than the Q1 group.

CONCLUSIONS

Higher PAL exposure was significantly associated with a higher prevalence of sleep disturbances, independent of post-bedtime light exposure. Consistent results were observed in the actigraphy analysis.

Effectiveness of vibratory stimulation on needle-related procedural pain in children: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to identify, evaluate and synthesize evidence on the effectiveness of vibratory stimulation to reduce needle-related procedural pain in children aged 18 years and under.The review will address the following question: Is vibratory stimulation effective in reducing needle-related procedural pain in children aged 18 years and under, in comparison with no stimulation for needle-related procedures?

Effectiveness of ultrasound-guided peripheral intravenous cannulation in pediatric patients aged under three years: a systematic review protocol

REVIEW QUESTION

The objective of this systematic review is to identify, evaluate and synthesize evidence of effectiveness on ultrasound-guided peripheral intravenous cannulation in pediatric patients aged under three years.Specially, the review question is: In pediatric patients aged under three years, what is the effect of ultrasound-guided peripheral intravenous cannulation on the first attempt and on the overall success rate, time to cannulation and number of attempts for successful cannulation compared with the traditional blind approach?

Properties of Achromobacter xylosoxidans highly resistant to aminoglycoside antibiotics

We herein discovered a highly resistant clinical isolate of Pseudomonas aeruginosa with MICs to amikacin, gentamicin, and arbekacin of 128 μg/mL or higher in a drug sensitivity survey of 92 strains isolated from the specimens of Yoka hospital patients between January 2009 and October 2010, and Achromobacter xylosoxidans was separated from this P. aeruginosa isolate. The sensitivity of this bacterium to 29 antibiotics was investigated. The MICs of this A. xylosoxidans strain to 9 aminoglycoside antibiotics were: amikacin, gentamicin, arbekacin, streptomycin, kanamycin, neomycin, and spectinomycin, 1,024 μg/mL or ≥ 1,024 μg/mL; netilmicin, 512 μg/mL; and tobramycin, 256 μg/mL. This strain was also resistant to dibekacin. This aminoglycoside antibiotic resistant phenotype is very rare, and we are the first report the emergence of A. xylosoxidans with this characteristic.

Hypothalamo-pituitary hypothyroidism detected by neonatal screening for congenital hypothyroidism using measurement of thyroid-stimulating hormone and thyroxine

The optimal strategy in neonatal screening for congenital hypothyroidism is still a subject of controversy. In Kanagawa Prefecture in Japan, simultaneous thyroid-stimulating hormone (TSH) and T4/fT4 determination has been used, while the results of our program may provide valuable information. Cumulative findings were analysed to determine the type and frequency of thyroid disorders in infants detected by simultaneous TSH and T4/fT4 determination, and the TSH and T4/fT4 screening strategy was validated. A total of 1284130 neonates were screened between October 1979 and September 1997 and infants followed because of low T4/fT4 without elevated TSH (T4 < 51.5 nmol/L or fT4 < 9 pmol/L and TSH < 15 mU/L) were retrospectively analysed. The first survey was carried out within 6 mo of birth and the second in 1998; 258 infants were diagnosed with congenital hypothyroidism at the first medical evaluation, 15 of them with hypothalamo-pituitary hypothyroidism. However, in the second survey, only 8 children were confirmed as having hypothalamo-pituitary hypothyroidism, therefore the incidence detected by the present strategy was 1/160516. Of 8 children with hypothalamo-pituitary hypothyroidism, mental retardation was prevented in 3 owing to early treatment.

CONCLUSIONS

Simultaneous measurement of TSH and T4/fT4 is a useful strategy for detecting hypothalamo-pituitary hypothyroidism, but more studies are needed to show the cost-benefits of using this strategy.

Measurements of cosmic-ray low-energy antiproton and proton spectra in a transient period of solar field reversal

The energy spectra of cosmic-ray low-energy antiprotons ( *p's) and protons ( p's) have been measured by BESS in 1999 and 2000, during a period covering reversal at the solar magnetic field. Based on these measurements, a sudden increase of the *p/p flux ratio following the solar magnetic field reversal was observed, and it generally agrees with a drift model of the solar modulation.

Pemphigus vulgaris associated with silicosis

Pemphigus vulgaris has never before been associated with silicosis, although there are many reports of silicosis accompanied by several autoimmune diseases such as progressive systemic sclerosis, systemic lupus erythematosus, dermatomyositis or rheumatoid arthritis. We observed a patient with pemphigus vulgaris accompanied with silicosis. The patient was a 75-year-old man with a 2-month history of repeated oral erosions and blisters on the back, thighs and axillas. Histological examination showed suprabasal cleavage with acantholysis. Immunoblotting analysis demonstrated binding of the patient's serum to the 130-kD pemphigus vulgaris antigen (desmoglein 3) and the 160-kD pemphigus foliaceus antigen (desmoglein 1). The patient has radiographically been diagnosed as having silicosis. An elevated serum IgG, antinuclear antibody, anti-ssDNA, antimicrosomal antibodies and a biologically false-positive reaction to the Wassermann test were also detected. Although the clinical symptoms improved after treatment with systemic steroids, the patient died due to pneumonia. This is the first reported case in which the characteristics of both pemphigus vulgaris and silicosis could be detected.

Recurrent annular erythema in a case of seronegative Sjögren's syndrome

We describe a case of Sjögren's syndrome who repeatedly developed annular erythema on her extremities. Her anti-nuclear antibody, anti-SSA/Ro antibody, and anti-SSB/La antibody were all negative. Characteristics of the annular erythema included a tendency to appear on the extremities especially in summer, spontaneous regression after 1-2 weeks, and residual slight pigmentation. The histological findings revealed dermal perivascular lymphocytic infiltration admixed with some neutrophils. Slight exsudative changes were found in the upper dermis. There were no epidermal changes. This case suggests the existence of annular erythema which may not be related to the anti-SSA/Ro or anti-SSB/La antibody. Unknown factors other than those antibodies may be involved in the pathogenesis of the annular erythema.

[Difference of blood cell counts with reference blood cell counters in different makers: Part II]

This is the second report of evaluation on the difference of blood cell counting among different automated blood cell counters in Japan. We tested reference blood cell counters of 6 different companies: Coulter, Sysmex, Bayer-Sankyo, Nihon Kohden, Horiba and Dainabot. Forty ml of whole blood were taken from 3 healthy persons and EDTA-2K anticoagulated blood samples (Sample 1, 2 and 3) were sent to each company to determine blood cell counts with a reference automated counter. As a result, the following items showed more than 10% difference among makers: RBC between Dainabot and Horiba in Sample 3, hematocrit values between Coulter and Dainabot in Sample 2, WBC between Nihon Kohden and each of three makers (Sysmex, Horiba and Dainabot) in all 3 samples and that between Bayer-Sankyo and each of two makers (Sysmex and Horiba) in Sample 3 and platelet count between Dainabot and each of 3 makers (Bayer-Sankyo, Nihon Kohden and Horiba) in all 3 samples. The following items showed difference between 5 and 10%: MCV between Coulter and each of two makers (Bayer-Sankyo and Horiba), WBC between each of two makers (Coulter and Nihon Kohden) and each of other 4 makers, and platelet count between each of two makers (Nihon Kohden and Horiba) and each of 3 makers (Coulter, Sysmex and Bayer-Sankyo). Recently Japanese Committee for Clinical Laboratory Standards proposed minimum clinical allowance of blood cell count as follows: hemoglobin 3%, RBC 4%, MCV 4%, WBC 7% and platelet count 10%. It is suggested that all of the items showing the difference more than above allowance among makers should be improved for clinical use to have good external quality control in blood cell counting by automated instruments.

Chromosomal studies on 934 induced abortuses of middle-aged pregnant women

A total of 934 induced abortuses of middle-aged pregnant women (35-48 years old) were chromosomally surveyed. The mean gestational age was 7.6 +/- 2.0 (S.D.) weeks after the first day of the last menstrual period, and the mean maternal age was 39.6 +/- 2.7 (S.D.) years. There was a high incidence of chromosomally abnormal fetuses in induced abortions, which markedly increased with the advancing age of the women: 9.6% (40/418) for the 35-39-year-old age group, 20.7% (100/484) for the 40-44-year-old age group, and 43.8% (14/32) for the 45-48-year-old age group, averaging 16.5%.

Mineral contents in model diet samples for different age groups

Model diet samples of eight groups (3, 16, 40, and 70 years old for both sexes), were analyzed for sodium, potassium, phosphorus, calcium, magnesium, iron, zinc, manganese, aluminum, copper, barium, nickel and molybdenum by using inductively-coupled plasma atomic-emission spectrometry (ICP-AES). Mineral intakes for 3 year olds were lower than those of other age groups because total food consumption was less. The intake of major elements, Na, K, P, Ca, and Mg, varied within about 20% of each other. The intake of other elements except aluminum fluctuated within 30% or more of each other. For most of the elements studied, the mineral intakes of 40-year-old males agreed within 16% with results previously obtained by a duplicated portion study.

Effect of an aldose reductase inhibitor, CT-112, on healing of the corneal epithelium in galactose-fed rats

The effect of an aldose reductase inhibitor, CT-112 (5-(3-ethoxy-4-pentyloxyphenyl)2,4-thiazolidinedione), ophthalmic solution on wound healing in the corneal epithelium of rats fed on 50% galactose diet was investigated in correlation with CT-112 concentration. Rats were divided into 6 groups and those in 5 groups were fed on 50% galactose diet and 10 microliter of 0.1, 0.25, 0.5 and 1% CT-112 ophthalmic solutions or of their vehicle were instilled into both eyes 4 times a day. The animals in the remaining one group were fed on the regular diet and no treatment was given. After 18 days, the whole corneal epithelium was scraped off and the rate of reepithelialization was investigated over a 4-day period. Reepithelialization was delayed in galactosemic rats, but the instillation of CT-112 ophthalmic solutions improved the wound healing, although no differences in efficacy was found at the concentrations used. Moreover, the appearances of the cornea at 4 days after epithelial scraping were improved dose-dependently by the instillation of CT-112.

Enzyme-linked immunosorbent assay for 17 alpha-hydroxyprogesterone in dried blood spotted on filter paper

In this rapid, cost-effective, enzyme-linked immunosorbent assay for 17 alpha-hydroxyprogesterone (17-OHP) eluted from dried blood spotted on filter paper, second antibody is coated onto the microwell plate and horseradish peroxidase (EC 1.11.1.7) is the label enzyme. Antiserum to 17-OHP was prepared by using 4-(2-carboxymethylthio)-17-OHP-bovine serum albumin conjugate as immunogen. Enzyme conjugate was prepared from 4-(2-carboxymethylthio)-17-OHP and peroxidase. The blood spots are assayed in the microwells without extraction or centrifugation steps. The detection limit of the assay is 1 microgram/L, equivalent to 3.5 pg (10.6 fmol) per disc. Intra- and interassay CVs at two steroid concentrations (7.38 and 22.79 micrograms/L) ranged from 3.74 to 11.90% (n = 5), and 9.49 and 9.83% (n = 5), respectively. Results correlated well (r = 0.91) with those of a fluorescence enzyme immunoassay. The sensitivity, specificity, and precision of this method make it potentially useful in the mass screening of neonates for congenital adrenal hyperplasia.

Enzyme-linked immunosorbent assay for 17 alpha-hydroxyprogesterone in dried blood spotted on filter paper

In this rapid, cost-effective, enzyme-linked immunosorbent assay for 17 alpha-hydroxyprogesterone (17-OHP) eluted from dried blood spotted on filter paper, second antibody is coated onto the microwell plate and horseradish peroxidase (EC 1.11.1.7) is the label enzyme. Antiserum to 17-OHP was prepared by using 4-(2-carboxymethylthio)-17-OHP-bovine serum albumin conjugate as immunogen. Enzyme conjugate was prepared from 4-(2-carboxymethylthio)-17-OHP and peroxidase. The blood spots are assayed in the microwells without extraction or centrifugation steps. The detection limit of the assay is 1 microgram/L, equivalent to 3.5 pg (10.6 fmol) per disc. Intra- and interassay CVs at two steroid concentrations (7.38 and 22.79 micrograms/L) ranged from 3.74 to 11.90% (n = 5), and 9.49 and 9.83% (n = 5), respectively. Results correlated well (r = 0.91) with those of a fluorescence enzyme immunoassay. The sensitivity, specificity, and precision of this method make it potentially useful in the mass screening of neonates for congenital adrenal hyperplasia.

[2 cases simulating Tolosa-Hunt syndrome]

The Tolosa-Hunt syndrome is characterized by recurrent unilateral painful ophthalmoplegia which responds to systemic steroid therapy dramatically. The etiology appears to be a non-specific inflammation in the cavernous sinus and the superior orbital fissure. Two interesting cases similar to this syndrome are described. One is a 54-year-old man with moderate left exophthalmos who had no complaint of retro-orbital pain. CT scan demonstrated the left orbital tumor, and the orbital decompression surgery was performed. The white-yellowish tumor was found extending the orbit through the superior orbital fissure into the cavernous sinus. Histological examination revealed non-specific inflammatory granuloma. Despite the unusual clinical symptoms, the etiology of this case appeared to be identical with the Tolosa-Hunt syndrome. The other case is a 16-year-old girl who had a 2 years' history of recurrent left retro-orbital pain and the complete IIIrd nerve palsy. CT scan demonstrated a small enhancing lesion in the cavernous sinus. Corticosteroid treatment improved her IIIrd nerve palsy within 2 days, however the CT scan after the treatment revealed no change of the lesion size. Left frontotemporal craniotomy was performed and the whitish tumor in the cavernous sinus was partially removed. Histological examination revealed that the tumor was typical meningioma with whorl-formation. The anatomical structure of the cavernous sinus is so complicated that the diseases arising from this area show quite different appearances. For the differential diagnosis of these lesions, the carotid angiography and the cavernous sinus venography were said to be useful.(ABSTRACT TRUNCATED AT 250 WORDS)