Chilliness in Japanese middle-aged women is associated with anxiety and low n-3 fatty acid intake

Objective: This cross-sectional study investigated chilliness, which is the most prevalent sexual-vasomotor symptom in middle-aged Japanese women.Methods: First-visit records of 475 Japanese women (age 40-65 years) enrolled in the health and nutrition education program at a menopause clinic were analyzed. Chilliness was estimated based on responses to the Menopausal Symptom Scale. Effects of age, menopausal status, body composition, cardiovascular parameters, resting energy expenditure, physical fitness, menopausal symptoms, lifestyle, and estimated daily intake of nutrients were assessed using a multivariate logistic regression analysis.Results: Severe chilliness was found in 28.4% of women. It was not related to age, menopausal status, body mass index, or body fat percentage. The anxiety subscale score of the Hospital Anxiety and Depression Scale was the sole background characteristic independently associated with severe chilliness (adjusted odds ratio, 1.09; 95% confidence interval, 1.04-1.15 per point). Daily intakes of vitamin D and n-3 fatty acids were significantly lower in women with severe chilliness. Daily intake of n-3 fatty acids was negatively associated with severe chilliness after adjustment (odds ratio, 0.54; 95% confidence interval, 0.29-0.95 per g/1000 kcal intake).Conclusions: Chilliness is associated with anxiety and low intake of n-3 fatty acids.

Severity of hot flushes is inversely associated with dietary intake of vitamin B6 and oily fish

Objectives: This study investigated the links between the severity of vasomotor symptoms (VMS) and the dietary consumption of a variety of nutrients. Method: A cross-sectional analysis of the first-visit records of 262 women aged 40-65 years was conducted. The severity of their hot flushes (HF) and night sweats (NS) and their dietary consumption of nutrients were evaluated using the Menopausal Health-Related Quality of Life Questionnaire and the brief-type self-administered Diet History Questionnaire, respectively. The relationships between severity of HF/NS and dietary intake were analyzed separately for 43 major nutrients. We then evaluated different food items as sources of the nutrients. Results: After adjustment for age, body mass index, menopausal status, and background factors significantly related to VMS, only vitamin B₆ (VB₆) was significantly related to severity of HF (adjusted odds ratio per 10 μg/MJ in VB₆ intake, 0.92; 95% confidence interval, 0.86-0.97). Moreover, a significant inverse relationship was found between the consumption of oily fish as a source of VB₆ and the severity of HF. Conclusions: VB₆ and oily fish intake is inversely associated with the severity of HF in middle-aged women. Therefore, increased intake of VB₆ could help attenuate HF.

Parameters of fetal pulmonary vascular health: baseline trends and response to maternal hyperoxia in the second and third trimesters

OBJECTIVES

Several parameters, including branch pulmonary artery (PA) diameter and Doppler-derived PA acceleration-to-ejection time ratio (AT/ET), peak late-systolic/early-diastolic reversed flow (PEDRF) and pulsatility index (PI) response to maternal hyperoxia, have been used to investigate fetal pulmonary health. Lower AT/ET, increased PEDRF and lack of PI response to hyperoxia have been observed in fetuses with severe lung hypoplasia and are considered markers of pulmonary vascular resistance. We sought to further define the evolution of PA diameter and Doppler parameters and their response to maternal hyperoxia in healthy fetuses.

METHODS

Fifty-four prospectively recruited women with healthy pregnancy underwent fetal echocardiography from 18-36 weeks of gestation. After baseline branch PA diameter and Doppler assessment, oxygen (8-10 L/min) was administered by non-reservoir facemask for 10 min and PA Doppler parameters were reassessed.

RESULTS

Branch PA diameters and AT/ET increased linearly with gestational age, while PEDRF increased quadratically (P < 0.001 for all) and PA-PI did not change. In response to maternal hyperoxia, although most fetuses demonstrated a significant decrease in PI for both branch PAs (right PA, P = 0.025; left PA, P = 0.040) ≥ 30 weeks, significant variability was observed in PI response with 31% of cases demonstrating either no response or a slight decrease. No other parameter demonstrated a measurable change in response to maternal hyperoxia.

CONCLUSIONS

From the mid-trimester, fetal branch PA diameters and AT/ET increase linearly and PEDRF increases quadratically, whereas PI remains unchanged. Although maternal hyperoxia triggers a significant decrease in PA-PI after 30 weeks, variability in this response may reduce its utility in clinical practice. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Subjective insomnia is associated with low sleep efficiency and fatigue in middle-aged women

OBJECTIVES

Many middle-aged women are affected by sleep disturbance. We investigated how subjective insomnia is associated with objective sleep parameters and other background characteristics.

METHODS

This cross-sectional study used baseline data obtained from 95 women aged 40-59 years who participated in another study assessing the effects of a dietary supplement. Participants wore an actigraph unit for 3 days to collect information concerning physical activities and objective sleep parameters and were then evaluated for body composition, cardiovascular parameters, and menopausal symptoms including insomnia and fatigue, and lifestyle factors. Stratifying Athens Insomnia Scale scores as low (0-5 points, control group) and high (≥ 6 points, subjective insomnia group), we sought to identify the parameters that are independently associated with subjective insomnia.

RESULTS

Women with subjective insomnia (n = 30) had lower sleep efficiency than did the controls. They were also older; had more live births, lower height, higher body mass index, lower ankle brachial index, and more severe menopausal symptoms including fatigue; took more naps; smoked more cigarettes; and more of them were full-time workers. Multivariate logistic regression analysis revealed that low sleep efficiency (adjusted odds ratio, 1.44 per 1% decrease in sleep efficiency; 95% confidence interval 1.06-2.05) and fatigue assessed with Brief Fatigue Inventory (BFI) (adjusted odds ratio, 1.57 per 1-point increase in BFI score; 95% confidence interval 1.19-2.13) were independent contributors to subjective insomnia.

CONCLUSIONS

Low sleep efficiency and feeling of fatigue were found to be independently associated with subjective insomnia in middle-aged women.

Effectiveness of antibacterial prophylaxis with non-absorbable polymyxin B compared to levofloxacin after allogeneic hematopoietic stem cell transplantation

BACKGROUND

Fluoroquinolones are widely used for antibacterial prophylaxis during neutropenia following hematopoietic stem cell transplantation (HSCT). Nevertheless, data are inadequate as to whether fluoroquinolones decrease mortality rate compared with other antibiotics.

METHODS

We retrospectively compared the efficacy of antibacterial prophylaxis using non-absorbable polymyxin B (PB) (n = 106) or systemic levofloxacin (LVFX) (n = 140) after allogeneic SCT at our institute between 2004 and 2013.

RESULTS

No significant difference was observed between the 2 groups in the cumulative incidences of failure of prophylaxis (P = 0.21), clinically documented infections (P = 0.70), or non-relapse mortality within the first 100 days after transplantation (P = 0.42). With bacteremia, the rate of resistance to LVFX was 82% in the PB group and 100% in the LVFX group (P = 0.41). Also, no significant difference was found in overall survival between the 2 groups (P = 0.78).

CONCLUSION

Our results indicate no difference in the effectiveness of antibacterial prophylaxis between systemic antibiotic LVFX and non-absorbable antibiotic PB.

Plasma current start-up by the outer ohmic heating coils in the Saskatchewan TORus Modified (STOR-M) iron core tokamak

A plasma current up to 15 kA has been driven with outer ohmic heating (OH) coils in the STOR-M iron core tokamak. Even when the inner OH coil is disconnected, the outer OH coils alone can induce the plasma current as primary windings and initial breakdown are even easier in this coil layout. This result suggests a possibility to use an iron core in a spherical tokamak to start up the plasma current without a central solenoid. The effect of the iron core saturation on the extension of the discharge pulse length has been estimated for further experiments in the STOR-M tokamak.

Changes in fetal cardiac axis between 8 and 15 weeks' gestation

OBJECTIVES

To document changes in the normal embryonic/fetal cardiac axis in the late first and early second trimesters of pregnancy.

METHODS

Images from 188 fetal echocardiograms performed prospectively between 8 and 15 weeks' gestation in 166 healthy pregnancies and in 10 pregnancies with severe fetal heart disease were reviewed. For each echocardiogram, three measurements of the cardiac axis were taken in the axial plane at the level of the four-chamber view. Differences in mean embryonic/fetal cardiac axis at different gestational ages in the healthy pregnancies were compared.

RESULTS

The mean ± SD embryonic/fetal cardiac axis was 25.5 ± 11.5° from 8 + 0 to 9 + 6 weeks (Group  1), 40.4 ± 9.2° from 10 + 0 to 11 + 6 weeks (Group  2), 49.2 ± 7.4° from 12 + 0 to 12 + 6 weeks (Group  3), 50.6 ± 5.7° from 13 + 0 to 13 + 6 weeks (Group 4) and 48.6 ± 7.3° from 14 + 0 to 14 + 6 weeks (Group 5). Groups 1 and 2 were significantly different from each other and all other groups (P < 0.05). The results for 22 cases with repeat measurements from 8 + 0 to 11 + 6 and 12 + 0 to 14 + 6 weeks confirmed that the embryonic/fetal cardiac axis increased significantly (P < 0.001). In the cases with severe congenital heart disease, the cardiac axis was > 90th centile in four cases and < 10th centile in two cases.

CONCLUSIONS

The embryonic cardiac axis is relatively midline at 8 weeks and levorotates in the late first trimester. By 12 weeks' gestation, the normal leftward fetal cardiac axis is established and remains stable until at least 14 + 6 weeks. Observation of an abnormal cardiac axis in some cases of severe congenital heart disease prior to 15 weeks' gestation may assist in prenatal detection.

Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow

OBJECTIVE

Decreased middle cerebral artery (MCA) pulsatility index (PI) is a marker of fetal brain-sparing in placental insufficiency and it is also found in fetuses with severe congenital heart disease. This study sought to explore the impact of anatomical subtypes in fetal heart disease on MCA-PI and head growth.

METHODS

We retrospectively reviewed fetal echocardiograms of pregnancies complicated by fetal hypoplastic left heart syndrome (HLHS; n = 42) with and without anatomic coarctation (n = 28 and n = 10, respectively), isolated severe aortic coarctation (n = 21), D-transposition of the great arteries (TGA; n = 11) and pulmonary outflow tract obstruction without forward flow across the pulmonary valve (POTO; n = 15), comparing observations with gestational age-matched controls (n = 89). No fetus had major extracardiac pathology or aneuploidy. MCA and umbilical artery (UA) PI, the cerebral placental ratio (CPR  =  MCA-PI/ UA-PI) and neonatal head circumference were obtained and expressed as Z-scores.

RESULTS

Lower MCA-PI, higher UA-PI and lower CPR were observed in fetal HLHS and isolated coarctation with reversed arch flow (n = 6) (P < 0.001) but not TGA, POTO or isolated coarctation with antegrade arch flow (n = 15) compared with controls. No difference was found between HLHS with anatomical coarctation and those without; however, MCA-PI correlated positively with neonatal head circumference in HLHS with reversed distal arch flow (r = 0.33, P < 0.05).

CONCLUSIONS

Severe left heart obstruction with reversed aortic arch flow is associated with altered fetal cerebral blood flow, and in these conditions, MCA-PI positively correlates with head growth. Anatomical arch obstruction itself may not be a contributing factor to altered MCA flow in fetal HLHS.

Direct coating adherent diamond films on Fe-based alloy substrate: the roles of Al, Cr in enhancing interfacial adhesion and promoting diamond growth

Direct CVD deposition of dense, continuous, and adherent diamond films on conventional Fe-based alloys has long been considered impossible. The current study demonstrates that such a deposition can be realized on Al, Cr-modified Fe-based alloy substrate (FeAl or FeCrAl). To clarify the fundamental mechanism of Al, Cr in promoting diamond growth and enhancing interfacial adhesion, fine structure and chemical analysis around the diamond film-substrate interface have been comprehensively characterized by transmission electron microscopy. An intermediate graphite layer forms on those Al-free substrates such as pure Fe and FeCr, which significantly deteriorates the interfacial adhesion of diamond. In contrast, such a graphite layer is absent on the FeAl and FeCrAl substrates, whereas a very thin Al-rich amorphous oxide sublayer is always identified between the diamond film and substrate interface. These comparative results indicate that the Al-rich interfacial oxide layer acts as an effective barrier to prevent the formation of graphite phase and consequently enhance diamond growth and adhesion. The adhesion of diamond film formed on FeCrAl is especially superior to that formed on FeAl substrate. This can be further attributed to a synergetic effect including the reduced fraction of Al and the decreased substrate thermal-expansion coefficient on FeCrAl in comparison with FeAl, and a mechanical interlocking effect due to the formation of interfacial chromium carbides. Accordingly, a mechanism model is proposed to account for the different interfacial adhesion of diamond grown on the various Fe-based substrates.

Serial hemodynamic assessment using Doppler echocardiography in a fetus with left ventricular aneurysm presented as fetal hydrops

A 22-week fetus presented with a large left ventricular aneurysm, 24 × 21 × 18 mm in size, detected by abnormal four-chamber view, and severe fetal hydrops with pericardial effusion, ascites and skin edema. The aneurysm was thin-walled, hypokinetic, and had enlarged with gestational age, causing compression of the lung. Although the left ventricular function had progressively impaired as expressed by increase in Tei index, hydrops had resolved by 32 weeks of gestation, probably because of maternal digoxin therapy and successful compensation by the right ventricle, as represented by retrograde blood flow in the distal aortic arch via the patent arterial duct. Because of the significant risk of severe cardiorespiratory failure, we transported the mother to a neonatal cardiac surgical center at 38 weeks of gestation. Indeed, the baby showed severe cardiopulmonary failure after birth, showing 100% of cardiothoracic ratio on the chest X-ray film, but was saved by the successful Dor procedure, including surgical resection of the aneurysm at 10 h of life. In this case, serial echocardiographic evaluation can allow us to monitor the hemodynamics and lead to successful postnatal management.

Hepatocyte destruction with enhanced collagen synthesis: characteristic feature of chronic hepatitis C patients on haemodialysis

Hepatitis C virus (HCV) infection is frequent among patients with end-stage renal disease on haemodialysis and is considered to be an independent risk factor for mortality in this setting. However, only a few of these patients are treated with anti-hepatitis virus treatment before the development of end-stage renal disease. Recent guidelines recommend identification of patients with good prognoses who are in need of interferon treatment, but we know little of patients who must be treated urgently. Ninety-eight patients on haemodialysis (48 anti-HCV-positive and 50 anti-HCV-negative patients) were enrolled in this study; HCV RNA was detected in 43 anti-HCV-positive patients. Univariate analysis and multivariate regression analysis were applied to identify variables independently associated with persistent HCV infection. Seven variables were proven to be associated with persistent HCV infection. Among them, type IV collagen 7S and N-terminal propeptide of type III procollagen (P-III-P) were defined as independent variables useful in distinguishing HCV RNA-positive patients from HCV RNA-negative patients with 0.91 sensitivity, 0.91 specificity, 0.89 positive predictive value and 0.93 negative predictive value. Our observations suggest that hepatocyte destruction with enhanced liver fibrosis is a characteristic clinical feature of persistent HCV infection. Type IV collagen 7S of ≥ 5 ng/mL and/or P-III-P of ≥ 5 U/mL would be useful markers to identify patients in need of interferon treatment, which supports the idea of the Kidney Disease: Improving Global Outcomes guidelines that a good prognosis in patients with HCV infection on haemodialysis should prompt consideration for IFN treatment when applicable.

Risk factors affecting cardiac left-ventricular hypertrophy and systolic and diastolic function in the chronic phase of allogeneic hematopoietic cell transplantation

Chronic impairment of cardiac function can be an important health risk and impair the quality of life, and may even be life-threatening for long-term survivors of allogeneic hematopoietic cell transplantation (HCT). However, risk factors for and/or the underlying mechanism of cardiac dysfunction in the chronic phase of HCT are still not fully understood. We retrospectively investigated factors affecting cardiac function and left-ventricular hypertrophy (LVH) in the chronic phase of HCT. Sixty-three recipients who survived for >1 year after receiving HCT were evaluated using echocardiography. Based on simple linear regression models, high-dose TBI-based conditioning was significantly associated with a decrease in left-ventricular ejection fraction and the early peak flow velocity/atrial peak flow velocity ratio, following HCT (coefficient=-5.550, P=0.02 and coefficient=-0.268, P=0.02, respectively). These associations remained significant with the use of multiple linear regression models. Additionally, the serum ferritin (s-ferritin) level before HCT was found to be a significant risk factor for LVH on multivariable logistic analysis (P=0.03). In conclusion, our study demonstrated that a myeloablative regimen, especially one that involved high-dose TBI, impaired cardiac function, and that a high s-ferritin level might be associated with the development of LVH in the chronic phase of HCT.

Immunoglobulin prophylaxis against cytomegalovirus infection in patients at high risk of infection following allogeneic hematopoietic cell transplantation

Reports on the efficacy of intravenous immunoglobulin (IVIG) prophylaxis against cytomegalovirus (CMV) infection after allogeneic hematopoietic cell transplantation (HCT) have often sparked controversy. In addition, we are not aware of any study that has examined whether prophylaxis with IVIG affects the incidence of CMV infection in high-risk patients--those who are elderly or have received human leukocyte antigen (HLA) mismatched HCT. In the present open-label, phase II study, we addressed this question. We enrolled 106 patients in the study. The cumulative incidences of CMV infection at 100 days after HCT were similar in the intervention and the control groups (68% and 64%, P=.89; 89% and 87%, P=.79, respectively, for patients 55 years or older and those who received HLA-mismatched HCT). In those who received HLA-mismatched HCT, 1-year overall survival after HCT was 46% in the intervention group and 40% in the control group (P=.31); for age≥55 years, the corresponding values were 46% and 40% (P=.27). Our data showed that prophylaxis with regular polyvalent IVIG did not affect the incidence of CMV infections or survival among older patients or those who receive HLA-mismatched HCT.

Determination of radial location of rotating magnetic islands by use of poloidal soft x-ray detector arrays in the STOR-M tokamak

A technique is presented for determining the radial location of the rotating magnetic islands in the STOR-M tokamak by use of soft x-ray (SXR) detector arrays. The location is determined by examining the difference in the integrated SXR emission intensities through two adjacent lines of sight. A model for calculating dependence of the line integrated SXR emission intensity on the radius, the mode numbers and the magnetic island geometry, has been developed. The SXR difference signal shows phase inversion when the impact parameter of the line of sight sweeps across the magnetic islands. Experimentally, the difference SXR signals significantly reduce noise and suppress the influence of background plasma fluctuations through common mode rejection when a dominant mode exists in the STOR-M tokamak. The radial locations of the m = 2 magnetic islands have been determined under several experimental conditions in the STOR-M discharges. With the decrease in the tokamak discharge current and thus the increase of the safety factor at the edge, the radial location of the m = 2 magnetic islands has been found to move radially inward.

A compact and continuously driven supersonic plasma and neutral source

A compact and repetitively driven plasma source has been developed by utilizing a magnetized coaxial plasma gun (MCPG) for diagnostics requiring deep penetration of a large amount of neutral flux. The system consists of a MCPG 95mm in length with a DN16 ConFlat connection port and an insulated gate bipolar transistor (IGBT) inverter power unit. The power supply consists of an array of eight IGBT units and is able to switch the discharge on and off at up to 10 kV and 600 A with a maximum repetitive frequency of 10 kHz. Multiple short duration discharge pulses maximize acceleration efficiency of the plasmoid. In the case of a 10 kHz operating frequency, helium-plasmoids in the velocity range of 20 km/s can be achieved.

Chemical reactions and applications of the reductive surface of porous silicon

The chemical reactivity of freshly prepared porous silicon is similar to that of a reducing agent on the surface of the nanocrystallites. Ag+ spontaneously reduces to form Ag0 granular coatings on the surface of porous silicon at the expense of the oxidation of silicon hydride and silicon. Atomic Force Microscopy shows that the thickness and topography of the Ag0 coating depend on the concentration of Ag+ with the porous silicon surface being the limiting reagent. In-situ Raman Spectroscopy shows an Ag layer on the silicon and Si:O layer immediately after etching and exposure to Ag+ and O2 respectively. Ag0 coated on the surface and in the pores of the porous silicon proves to be an excellent material for Surface Enhanced Raman Spectroscopy and the natural low electron affinity on the surface of porous silicon replaces the need for a negative bias to prepare very stable diamond coatings on the surface of silicon.

Ultrathin W-Al dual interlayer approach to depositing smooth and adherent nanocrystalline diamond films on stainless steel

The adherence of diamond coated on steel is commonly low and needs to be strengthened with thick intermediate layers. In this paper, a nanoscale W-Al dual metal interlayer has been applied on SS304 substrates to facilitate deposition of continuous, adherent and smooth diamond thin films. During the microwave plasma-enhanced chemical vapor deposition process, the Al inner layer 30 nm thick diffuses into steel surface inhibiting carbon diffusion and graphitization. The W outer layer 20 nm thick is transformed into W carbides, both preventing carbon diffusion and enhancing diamond nucleation. The diamond films synthesized are of high purity and have smooth surfaces and dense structures. Indentation and shear deformation tests indicate high delaminating tolerance of the diamond films.

Retarding field energy analyzer for the Saskatchewan Torus-Modified plasma boundary

The retarding field energy analyzer (RFA) is a simple and reliable diagnostic technique to measure the ion temperature in the scrape-off layer and edge of magnetic fusion devices. Design and operation features of a single-sided (facing the ion flow) RFA for ion temperature measurements in the Saskatchewan Torus-Modified (STOR-M) tokamak are described. Its compact size (21 x 15 x 20 mm3) allows RFA measurements without perturbing plasma significantly. Both ion and electron temperature have been measured by RFA in the STOR-M tokamak. A method is proposed to correct the effects of ion flow on the ion temperature using the simultaneously measured Mach number. The measured electron temperature is consistent with the previously reported Langmuir probe data. Abnormal behavior of the RFA has been observed in both ion and electron modes when RFA is inserted deep into the plasma.