Mitsubishi Corporation (Norway)

A stress-buffering hypothesis for parenting was tested in a county-representative sample of 218 divorced fathers. Social support for parenting (emergency and nonemergency child care, practical support, financial support) was hypothesized to moderate effects of stress (role overload, coparental conflict, and daily hassles) on fathers' quality parenting. No custody fathers relied more on relatives compared with custodial fathers, who relied more on new partners for parenting support. No differences by custody status were found on levels of support or parenting over time. Parenting support buffered effects of change in role overload and coparenting conflict on coercive parenting and buffered effects of change in daily hassles on prosocial parenting. Buffer effects were more predictive over time. Implications for practice and preventive intervention strategies are discussed.

1. The aim of the study was to assess the effect of glycopyrrolate on drooling in an adult male patient with cerebral palsy. 2. After a thorough medical examination and consent in writing by the responsible guardian, a baseline sum score for frequency and seriousness of drooling was established over a 2 week period in addition to data on shifts of handkerchiefs, urination, defecation and observation of behaviour. Glycopyrrolate (1 mg) tablets were then administered, starting with one tablet daily the third week and increasing the daily dose by one tablet per week until a maximum of four tablets during week six and 4 days of week seven when the daily dose was reduced to two tablets for 3 days. For the four weeks 8-11 three tablets were given daily. In week 12 the dose was reduced to two tablets and for the weeks 13-15 no tablets of glycopyrrolate were given. 3. For as long as the patient received three to four tablets of glycopyrrolate daily, drooling was markedly reduced and handkerchiefs were not necessary on some days. After the tablets were withdrawn drooling increased to approximately the same level as it was before treatment. No adverse medical, psychological, or social effects were observed. 4. For shorter periods, glycopyrrolate can be given in controlled doses provided that an adequate medical assessment has been undertaken.

ABSTRACT The Gauss-Newton method has good convergence properties when used for the solution of seismic and electromagnetic inversion problems. One main issue is the high numerical cost. The numerical cost can be reduced if the optimization domain can be decoupled from the simulation domain such that the number of optimization parameters is much smaller than the number of grid nodes required for accurate simulation results. Overparameterization can be avoided. The decoupling can be achieved in a rigorous manner with the use of node-based basis functions. We provide a generic derivation of the method that is easily specialized for seismic and electromagnetic problems. The transformations between the optimization domain and the simulation domain are most effective if both domains can be described by rectilinear grids. A variable seabed depth causes difficulty. We introduce a transform from the true bathymetry to a flat seabed that solves this problem. The method is validated by application to synthetic and real electromagnetic data sets. The real data are acquired at the slow spreading Mohns Ridge located east of Greenland and southwest of Svalbard. We provide a discussion on the interpretation of these data for an inverse scheme using the transverse isotropy with a vertical symmetry axis approximation. We offer some insights on how to interpret inversion results in the case of exploration for marine minerals. The interpretation differs from a hydrocarbon exploration setting owing to the presence of vertical conductors due to the formation water circulation and vertical resistors due to volcanic intrusions.

Backgrounds: Cheyne-Stokes respiration (CSR) is frequently observed in chronic heart failure (CHF) patients and is associated with adverse prognosis. Although it has been reported that cardiac resynchronization therapy (CRT) partly improves CSR, CSR often persists after CRT implantation. Therefore, we examined whether adaptive servo ventilation (ASV) improves cardiac function and prognosis of CHF patients with CSR after CRT. Methods: Polysomnography was performed at 12 months after CRT defibrillator (CRTD) implantation. Twenty two patients with CSR post CRTD implantation (mean age 62.0 years, AHI 36.3±19.2 /h) were enrolled in this study and randomly assigned into 2 groups: 11 patients treated with ASV (ASV group) and 11 patients without ASV (Non-ASV group). Plasma B-type natriuretic peptide (BNP) levels, estimated right ventricular systolic pressure (RVPs), and the ratio of early transmitral flow velocity to mitral annular velocity (E/E') were determined before and 6 months later in each group. Patients were followed up to register cardiac events (cardiac deaths and rehospitalization due to worsening heart failure). Results: In ASV group, indices for apnea-hypopnea, central apnea, and oxyhemoglobin saturation were improved on ASV. Levels of plasma BNP (Figure A), RVPs (38.1±16.8 vs. 27.4±18.4 mmHg, P<0.05) and E/E' (16.5±6.5 vs. 9.2±4.1, P<0.01) were improved with ASV treatment for 6 months, but not in Non-ASV group. Importantly, event free rate was significantly higher in ASV group than in Non-ASV group (91% vs. 45%, P<0.05) as shown in Figure B. Conclusions: ASV improved CSR, cardiac overload, diastolic function, and prognoisis of CHF patients with CRTD. CHF patients with CSR and post CRTD implantation would get benefits by treatment with ASV.

Objectives: We previously reported excellent findings of X-ray phase-contrast tomography (PCX) for visualization of the formalin-fixed human aortic wall samples, and PCX enabled to demonstrate changes of tunica media in acute type A aortic dissection (AADA) . This study evaluates quantitative and dynamic measurements of fresh aortic wall samples of AADA with this modality. Methods: Fresh human aortic samples of the ascending aorta (n=7) were obtained during emergent aortic repair for AADA. Formalin-fixed human aortic walls of AADA (n=15) and normal aorta (n=15) were also investigated. PCX is approximately 1000 times more sensitive than absorption-contrast X-ray imaging and effective resolution of PCX is 11.7 μm. Quantitative and dynamic measurement has been developed to visualize changes in imaging of fresh aortic wall under various tensile force to simulate physiological condition, in which aortic wall is stretched according to blood pressure. Results: In normal aorta, quantitative measurement of density of the media was 1.095±0.003(g/cm3), and no different between intimal side (1.083±0.002) and adventitial side (1.085±0.003). On contrast, in formalin-fixed aorta of AADA, the medial density was 1.063±0.027, significantly lower than normal aorta (Figure-1), and different between intimal side and adventitial side (1.061±0.008 vs 1.081±0.011, respectively; p<0.005). In fresh sample of AADA, distribution of the medial density was equal to that of formalin-fixed aorta and differences of the medial density were clearly observed with elevation of tensile force of the aortic wall (Figure-1). These differences in density within tunica media were well correlated with distribution of elastic fibers and existence of cystic medial necrosis in pathological analysis. Conclusions: X-ray phase-contrast tomography was a strong modality to understand aortic structures and pathogenesis of acute type A aortic dissection.

Introduction: Transmural thermal injury (TTI), such as esophageal erythema and periesophageal nerve injury leading to gastric hypomotility, is an important complication associated with pulmonary vein isolation (PVI). Esophagus is surrounded with a small distance by left atrium (LA) posterior wall, descending aorta and left inferior PV (LIPV) in infero-posterior portion of LA. However, the predictor of this complication associated with anatomical situation among these structures has not been fully established. Methods: The consecutive 133 patients (61±9 years, 111 men) who underwent PVI for drug refractory atrial fibrillation and gastrointestinal endoscopy on the day following PVI were investigated. With echocardiography data, LA dimension and LA volume index in each patient were measured. We measured the angle of LA posterior wall to descending aorta (LA-Ao angle), the branching angle of LIPV to coronal plane (LIPV angle), and the minimum distance between descending aorta and LA posterior wall sandwiching esophagus with computed tomography. The relationships of TTI with clinical and anatomical parameters were examined. Results: All patients had left-sided or central location of esophagus, which overlay the posterior ablation line of left PV. Radiofrequency energy was delivered with a maximum output of 20 watts, and contact force was maintained between 10-20 g in left posterior ablation line. TTIs were occurred in 24 patients after PVI (erythema in 5 and gastric hypomotility in 19). The parameters including age, gender, body mass index, LA diameter and LA volume index in echocardiography were not associated with the prevalence of TTI. However, LIPV angle was larger (33.2±13.6 ° vs. 20.7±10.2 °, P< 0.0001) and LA-Ao distance was shorter (4.3±1.4 mm vs. 6.2±2.4 mm, P= 0.0002) in TTI (+) group compared to TTI (-) group. LA-Ao angle tended to be smaller in TTI (+) group (25±10 degrees vs. 29±10 degrees, P= 0.08), and was significantly correlated with LA-Ao distance (R= 0.321, P= 0.0002). Conclusion: The anatomical proximity of LA posterior wall, LIPV and descending aorta surrounding esophagus is strongly associated with the prevalence of TTI.

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Objective: The coming obesity epidemic in elderly persons necessitates the establishment of new and easy-to-use cardiometabolic markers to identify individuals most likely to develop atherosclerosis among elderly hypertensive patients. Methods: We measured plasma high-molecular-weight (HMW) adiponectin and des-acyl ghrelin levels, and carotid artery intima-media thickness (cIMT) in 263 elderly hypertensive patients (mean 72.6 years; 37% men). Other cardiometabolic markers, including lipid and glucose metabolites, inflammation (high-sensitivity C-reactive protein: hs-CRP), and hemostasis (plasminogen activator inhibitor-1: PAI-1), were also measured. Results and conclusion: Both HMW adiponectin and des-acyl ghrelin levels were inversely correlated with obesity (both P <0.01). The HMW adiponectin level was favorably associated with glucose and lipid metabolites, PAI-1(all P <0.05), and hs-CRP ( P <0.07) after adjustment for age, sex, and BMI; however, it had no correlations with cIMT. In contrast, although there were no correlations between des-acyl ghrelin and any cardiometabolic markers, except for a positive association with the nitrite/nitrate (NOx) level ( P =0.002), des-acyl ghrelin had a significant inverse correlation with cIMT ( P =0.003). A multivariable regression analysis showed that des-acyl ghrelin, but not HMW adiponectin, was significantly associated with cIMT after adjusting for age, obesity, sex, smoking, 24-hour BP, and other cardiometabolic factors ( β =−0.178, P=0.001). Moreover, receiver-operator curves to predict a high level of cIMT (above median) demonstrated that des-acyl ghrelin was the best predictor (area under the curve=0.622, P =0.001). The increased risk of cIMT among those with abdominal obesity compared with non-obesity (0.833±0.185mm vs. 0.782±0.163mm, P =0.019) was explained by the elevated 24-hour BP and reduced des-acyl ghrelin level, but not by other cardiometabolic parameters. These associations were unchanged after adding NOx to the model. In conclusion, the des-acyl ghrelin level is a useful cardiometabolic marker for predicting atherosclerosis in elderly hypertensive patients, and the pathologic pathway linking these factors is independent of its NO bioactivity.

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Aims: Little is known about the relation of blood pressure (BP) control with left atrial (LA) remodeling and clinical outcome after atrial fibrillation (AF) ablation. Methods: A 101 symptomatic paroxysmal AF patients (85 males, 62.2±8.4 years) undergoing successful pulmonary vein isolation (PVI) were enrolled. Uncontrolled hypertension (HT) was defined as BP more than 140/90 mmHg calculated as mean value being recorded at least 5 different days before PVI. LA wall thickness along ablation line was measured using computed tomography before PVI. LA dimension was measured by echocardiography before and 6 months after PVI. The recurrence was determined by the documentation of AF or atrial tachycardia lasting more than 30 sec. In case of the recurrence, the second procedure was performed based on the patient’s consent. At the second procedure, if AF sustained or was induced after the pulmonary vein (PV) re-isolation or when PV was still isolated, substrate modification such as linear ablation or complex fractionated atrial electrogram ablation was performed. Patients were classified into 3 groups: group 1 (no HT, n = 48), group 2 (controlled HT, n = 34) and group 3 (uncontrolled HT, n = 19). The comparisons of the data among the groups were performed by using ANOVA and the recurrence rate of each group was analyzed by the Kaplan-Meier method. Results: LA wall thickness in groups 2 and 3 were greater than that of group 1. However, LA wall thickness between groups 2 and 3 did not differ. During the follow up periods of 9±4 months, LA dimension of only group 3 increased after the procedure (38.2±5.6 mm to 41.3±6.2 mm, P=0.02). Thirty-one patients showed the recurrence. The recurrence rate was significantly higher in group 3 than in groups 1 and 2 (48% vs. 26% and 22%, P<0.05, respectively). Out of 31 recurrence patients, 18 underwent the second procedure. The patients in group 3 needed substrate modification more frequently than those in group 1 (100% vs. 25%, P < 0.05). Conclusion: The existence of HT causes LA hypertrophy, regardless of whether HT is controlled or not. On the other hand, the uncontrolled BP induced the anatomical and electrical remodeling of LA, resulting in adverse long-term outcome after PVI.

Background: Membrane type 1-matrix metalloproteinase (MT1-MMP) functions not only as a proteolytic enzyme but also as a signaling molecule. Lectin-like oxidized-LDL receptor-1 (LOX-1) is a major receptor for oxidized LDL (ox-LDL). RhoA and Rac1 play crucial roles in endothelial dysfunction including eNOS downregulation and NADPH oxidase-dependent reactive oxygen species (ROS) generation. Hypothesis: MT1-MMP modifies ox-LDL-triggered RhoA- and Rac1-dependent endothelial dysfunction and atherosclerosis. Methods: GTP-loading of RhoA and Rac1 were assessed by pull-down assays. The activity of MT1-MMP was evaluated by fluorescent assay. A neutral antibody to LOX-1 (TS92) was used for inhibition of LOX-1, while MT1-MMP was silenced by siRNA. NADPH oxidase activity was determined by lucigenin-enhanced chemiluminescence. Fluorescent immunohistochemistry and immunoprecipitation were performed using the cultured endothelial cells (ECs) and the aortae of myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits. Results: Ox-LDL activated RhoA and Rac1 within 5 and 15 minutes, as well as the MT1-MMP activity of membrane fractions after 15 minutes in ECs, which was inhibited by TS92. Ox-LDL-induced activation of RhoA and the downstream events including endothelial cell invasion and eNOS downregulation were blocked by silencing of MT1-MMP. Knockdown of MT1-MMP also markedly attenuated ox-LDL-triggered Rac1 activation, NADPH oxidase activity and ROS generation. Interestingly, LOX-1 and MT1-MMP were partly co-localized in ECs by fluorescent immunohistochemistry, and immunoprecipitation demonstrated that MT1-MMP formed a complex with LOX-1. Furthermore, immunohistochemistry revealed that the two molecules were co-localized in ECs and in the aortic atherosclerotic lesions of WHHLMI rabbits. In addition, immunoprecipitation demonstrated that MT1-MMP and LOX-1 formed a complex in cultured ECs and in the atherosclerotic aortae of WHHLMI rabbits. Conclusions: We show new insights into modulation of endothelial dysfunction and atherosclerosis by an MT1-MMP-LOX-1 axis, suggesting that MT1-MMP is a cell surface modifier of ox-LDL-triggered RhoA and Rac1-activated signaling pathways through LOX-1.

Purpose: Several studies have reported gender difference in presentation, management and outcome in patients with acute myocardial infarction (AMI). In this study, we focused the impact of age on gender difference in mortality after AMI. Methods: Between July 2012 and March 2014, 3283 patients were admitted to the 28 hospitals participating to the J-MINUET group within 48 hours after the onset of AMI. AMI was diagnosed by universal definition (type 1 or type 2). Patients were divided into 5 strata according to their age: those with age <55 years, 55-64 years, 65-74 years, 75-84 years and ≥85 years. Results: There were 813 women (24.8%). Women were significantly older than men (74.5±11.8 years vs 66.6±12.3 years, P<0.001). Women had longer time from onset to admission, more NSTEMI, atypical symptom other than chest pain, Killip class ≥2, CKD and type 2 MI. They also had less diabetes and current smoking habits. Although most of the patients received urgent angiography (93.1%), it was less frequent in women (90.4% vs 94.0%, P<0.001). Among patients who underwent primary PCI (85.1%), achievement of final TIMI-3 flow was similar (91.2% vs 92.0%, P=0.53). In-hospital mortality was significantly higher in women than men (9.6% vs 5.5%, P<0.001). When patients were stratified according to their age, there was a liner increase in the prevalence of women as age advanced: 10.6% in <55 years, 15.1% in 55-64 years, 19.8% in 65-74 years, 35.6% in 75-84 years and 53.6% in ≥85 years (P<0.001). There was no significant gender difference in mortality in each stratum (Figure). Multivariate analysis showed that women was no more an independent predictor of death after adjusting age (OR 1.29, 95%CI 0.95-1.75, P=0.10), or age and other variables (OR 1.19, 95%CI 0.79-1.76, P=0.40). Conclusions: Women had higher in-hospital mortality than men after AMI even in the contemporary troponin era. However, their high mortality was mostly explained by their advanced age.