bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-BPP06-8: DIETARY SALT INTAKE PREDICTS FUTURE DEVELOPMENT OF METABOLIC SYNDROME IN THE GENERAL POPULATION
Authors: Takase Hiroyuki , Hayashi Kazusa , Kin Fumihiko , Nakano Suguru , Machii Masashi , Takayama Shin , Sugiura Tomonori , Dohi Yasuaki 
Published: January 2023

Objective:
Dietary salt consumption is one of the most important modifiable factors in our lifestyle and restriction of dietary salt results in the reduction of blood pressure in previous studies. Excessive salt intake causes cardiovascular diseases independently of its effects on blood pressure. Since metabolic syndrome also increases a risk of cardiovascular disease, there may be some association between salt intake and metabolic syndrome. Therefore, we investigated a possible relationship between salt intake and future development of metabolic syndrome in the general population.

Design and Methods:
Consecutive 12,256 subjects without metabolic syndrome (male = 7,053, 52.1 ± 12.3 year-old) who visited our hospital for an annual physical check-up from April 2010 to March 2018 were enrolled. After baseline examination, subjects were followed up until March 2019 (median 1,582 days) with the endpoint being the development of metabolic syndrome. Metabolic syndrome was diagnosed according to the Japanese criteria (2005). Individual salt intake was estimated using a spot urine by a previously reported Tanaka method.

Results:
Salt intake was 8.7 ± 1.9 and 8.4 ± 1.8 g/day in male and female subjects, respectively, at baseline. During the follow-up period, 1,669 subjects developed metabolic syndrome (29.9 per 1,000 person-year) with the incidence being more frequent in male than female subjects (41.8 vs. 14.2 per 1,000 person-year). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of salt intake for the development of metabolic syndrome was 1.192 (1.164–1.221). Kaplan-Meier analysis where subjects were divided into gender-specific quartiles according to the baseline salt intake revealed that the incidence of metabolic syndrome were increased across the quartiles (19.5, 24.2, 33.1, and 43.9 per 1,000 person-years; logrank p < 0.001). Multivariate Cox proportional hazard analysis adjusted for age, gender, body mass index, systolic blood pressure, heart rate, serum creatinine, uric acid, fasting plasma glucose, low-density lipoprotein cholesterol, triglyceride, hemoglobin and current smoking habit at baseline revealed that salt intake predicted the new onset of metabolic syndrome (HR:1.055, 95%CI:1.028–1.082).

Conclusions:
Excessive salt intake is significantly associated with the new development of metabolic syndrome in the general population. The results suggest that salt restriction prevents cardiovascular diseases through the prevention of not only hypertension but also metabolic syndrome.
PS-BPP06-9: ASSOCIATIONS BETWEEN SERUM AND DIETARY OMEGA-3 FATTY ACID AND COGNITIVE FUNCTION IN A POPULATION OF COMMUNITY-DWELLING JAPANESE. TANUSHIMARU STUDY
Authors: Fukami Ako , Adachi Hisashi , Enomoto Mika , Morikawa Nagisa , Nohara Yume , Sakaue Akiko , Yamamoto Maki , Sato Hiromi , Fukumoto Yoshihiro 
Published: January 2023

Objective:
Previous studies indicate that dietary omega-3 polyunsaturated fatty acids (PUFA) are modifiable risk factors for CVD and cognitive decline. This study aimed to investigate the association between serum and dietary omega-3 PUFA and cognitive function were measured in a general population.

Design and method:
A total of 976 residents (381 males, 595 females, mean age 62.6 years) underwent a physical examination, a nutrition survey and the mini-mental state examination as an evaluation of cognitive function in 2009 and followed up in 2018.

Results:
The serum omega-3/omega-6 ratio were significantly associated with age (p < 0.0001), sex (male, p < 0.0001), MMSE (p < 0.0001), LDL-c (inversely, p < 0.01), and salt intake (p < 0.05), using by multiple stepwise regression analysis.
The dietary intake of proteins from fish (p < 0.0001), trace elements, (p < 0.01), vitamin D, B6, B12 (p < 0.0001), and salt (p < 0.0001) showed dose dependent relationships with the serum omega-3/omega-6 ratio using analysis of covariance.
Subjects were divided into 4 groups according to their progression of cognitive decline in 10 years. Serum omega-3 levels of group with normal cognitive function (NC) were significantly higher than those of group with cognitive decline (CD) (p < 0.05). However, dietary intakes of omega-3 and omega-6 PUFA were not significant. Interestingly, salt intakes in group with CD were higher than those in group with NC (p < 0.05). The logistic regression analysis revealed that salt intakes was associated with cognitive decline 10 years later after adjustments for confounding factors (odds ratio, 1.1; 95% C.I., 1.01–1.13; p = 0.01)

Conclusion:
The present study demonstrated that omega-3 PUFA may preserve a cognitive function and excessive intakes of salt may have an adverse effect on cognitive function.
PS-BPR01-2: PHEOCHROMOCYTOMA WITH HYPERALDOSTERONISM-LINKED MUTATIONS IN THE POTASSIUM CHANNEL KCNJ5
Authors: Mai Xurong , Kometani Mitsuhiro , Kato Toshiaki , Mori Shunsuke , Aono Daisuke , Konishi Seigo , Karashima Shigehiro , Takeda Yoshiyu , Yoneda Mau , Furukawa Kenji , Yoneda Takashi 
Published: January 2023

Context:
Recent advances in genetic analysis techniques have led to the genetic analysis of adrenal tumors with hormone excess. In pheochromocytomas, many genetic abnormalities have been identified. Furthermore, several causative genes have been also reported in primary aldosteronism. We performed a comprehensive genetic analysis of functional adrenal tumors using next-generation sequencing. We report here a case of pheochromocytoma with KCNJ5 gene abnormality, which is considered to be specific for primary aldosteronism.

Case:
A 53-year-old woman with high blood pressure since age 48, excessive sweating and weight loss since age 52, and left ventricular hypertension noted on electrocardiogram during a medical checkup presented to her previous physician. A computed tomography scan of the abdomen showed a right adrenal tumor 30 mm in diameter, and an urinary test showed high levels of urinary metanephrine and normetanephrine (1.42 mg/day) and I-123 MIBG scintigraphy showed an accumulation at the tumor. Plasma renin activity was 0.2 ng/mL/hr, plasma aldosterone concentration was 73.9 pg/mL, and a positive captopril challenge test was performed. Adrenal scintigraphy using 131 I-adosterol showed bilateral adrenal accumulation, suggesting bilateral lesions. Laparoscopic right adrenalectomy was performed for pheochromocytoma. Histology showed focal proliferation of enlarged medullary-like cells and calcification of the adjacent adrenal tissue. The tumor tissue was positive for KCNJ5 gene mutation. A postoperative captopril challenge test was performed again, which was negative.

Conclusion:
KCNJ5 gene abnormality is considered specific for primary aldosteronism, but was also found in pheochromocytoma. However, the contribution of KCNJ5 gene abnormality to catecholamine production is not yet elucidated. This is a case of pheochromocytoma in which coexistence of primary aldosteronism is also suspected based on the captopril challenge test and imaging findings, and the finding of a gene mutation associated with primary aldosteronism in such a case is very interesting and will warrant further investigation.
PS-BPR02-2: ECULIZUMAB FOR RESCUE OF THROMBOTIC MICROANGIOPATHY IN MALIGNANT HYPERTENSION ASSOCIATED WITH MCTD
Authors: Date Ryosuke , Kajiwara Kengo , Johno Takamitsu , Ko Takehiro , Nakamura Tomofumi , Tomita Masao , Mizumoto Teruhiko , Kakizoe Yutaka , Izumi Yuichiro , Kuwabara Takashige , Adachi Masataka , Mukoyama Masashi 
Published: January 2023

Introduction:
Eculizumab is effective in atypical hemolytic uremic syndrome (aHUS) caused by complement abnormalities, but its effect on secondary thrombotic microangiopathy (TMA) is obscure. We here report a case of TMA associated with malignant hypertension, who was successfully treated with an ACE inhibitor, plasma exchange and eculizumab.

Case report:
The patient was a 40-year-old woman presenting with severe blood pressure elevation (BP 240/140 mmHg), nausea, fatigue, headache, and visual disturbances. She had a history of systematic lupus erythematosus (SLE) and had been stable by the treatment with 5 mg/day of prednisolone and 2 mg/day of tacrolimus for a long period. This time, she exhibited Raynaud's phenomenon, mild skin lesions, and heliotrope eruption on the eyelids, together with positive anti-U1-RNP antibodies. She was diagnosed with mixed connective tissue disease (MCTD), instead of SLE. Acute kidney injury (serum creatinine, 3.24 mg/dL), anemia (hemoglobin, 8.8 g/dL) and thrombocytopenia (platelets, 137,000/μL) were observed. LDH was elevated at 780 IU/L. The haptoglobin level was decreased to less than detection sensitivity and schistocytes were observed in her peripheral blood. The plasma renin activity was beyond the highest limit. On head MRI, posterior reversible encephalopathy syndrome (PRES) was suggested. A renal biopsy was performed, and a histological diagnosis of malignant hypertensive arteriolosclerosis was obtained. Based on these findings, she was diagnosed as accelerated malignant hypertension, possibly due to TMA with a background of MCTD. She was initially treated with nicardipine, enalapril and aliskiren, but this treatment failed to ameliorate the progression of kidney injury and TMA. Therefore, plasma exchange therapy was performed three days in a row, and then hemodialysis and administration of eculizumab were introduced. After weekly induction dose (900 mg once a week) was given four times, administration of 900–1200 mg of eculizumab every 2 weeks were continued. As the treatment was continued, her renal function was improved gradually. Fifteen months after her onset of AKI and TMA, the patient was withdrawn from dialysis and eculizumab therapy.

Conclusion:
A body of evidence is growing that activation of the complement system may be involved in scleroderma renal crisis. However, the efficacy of eculizumab in TMA, except for aHUS, remains controversial. Our case suggest a possible efficacy of eculizumab along with plasma exchange, as the treatment of malignant hypertension due to scleroderma that was caused by MCTD.
PS-BPR02-3: NOVEL PULSE WAVEFORM INDEX OBTAINED BY ABPM DEVICE COULD ESTIMATE CARDIAC FUNCTION IN A PATIENT WITH FULMINANT MYOCARDITIS
Authors: Narita Keisuke , Kario Kazuomi 
Published: January 2023

Introduction:
In this case report regarding a patient with fulminant myocarditis who underwent mechanical hemodynamic support including extracorporeal membrane oxygenation (ECMO), our developed novel hemodynamic index calculated from pulse waveform obtained by ambulatory blood pressure monitoring (ABPM) device was useful for estimation of the improvement of cardiac function. We obtained volumetric pulse waveform from diastolic phase of BP measurement by our recently developed device, a Multisensor-ABPM device (TM-2441, A&D Co., Tokyo). This pulse waveform is divided into ejection wave and reflex wave. The area of the ejection part is square forward pulse wave (Sf), which is related with cardiac ejection volume. Second, amplitude measured pulse wave (Am) of the pulse waveform is a parameter defined by central artery compliance, peripheral artery properties, and cuff compliance. We then calculated Sf/Am as follows: Sf was divided by Am to eliminate the effect of arterial and cuff compliance from the area of the ejection wave, which would indicate left ventricular ejective function.

Case report:
A 43-year-old Asian female presented dyspnea and fever and developed cardiogenic shock. She was transferred from the primary hospital to our intensive care unit. Laboratory test and chest x-ray revealed elevated c-reactive protein, creatine kinase MB, and N-terminal-pro-brain natriuretic peptide and pulmonary edema. Electrocardiogram showed an ST-elevation and there was no stenosis in coronary artery on cardiac catheter examination. Based on these findings, she was diagnosed as viral myocarditis. Her echocardiographic left ventricular ejection fraction (LVEF) decreased less than 20% and hemodynamics were disrupted. Then, she was urgently initiated mechanical support including management of ECMO and intraaortic balloon pumping (IABP). During six-days initiating these mechanical supports, her cardiac function was improved, i.e., LVEF was improved from 6% (almost akinesis) to 64%, and she was able to withdraw from ECMO. We prospectively assessed the changes in the cuff waveform index Sf/Am from during the management of ECMO and IABP. The values of Sf/Am increased in parallel with the improved of LVEF (Figure).

Conclusion:
This case report highlighted that the novel cuff pulse waveform index Sf/Am obtained by the recent our developed Multisensor-ABPM device was useful for estimation of cardiac function in a patient with fulminant myocarditis who had severe cardiac dysfunction and were needed full mechanical support including ECMO. This case indicated that BP measurement device using the cuff-oscillometric method is useful for evaluation of cardiac function even in intensive care settings.
PS-BPR02-6: NOT FOR THE FAINT OF HEART: A CASE REPORT OF BRADYCARDIA INDUCED HYPERTENSION
Authors: Mellor Kaitlyn , Khan Nadia , Iatan Iulia , Tran Karen 
Published: January 2023

Background:
Bradycardia is an underreported and often overlooked contributor to resistant hypertension. We present a case of refractory hypertension and bradycardia with atrial fibrillation and marked improvement in BP control following pacemaker implantation.

Case Presentation:
A 66-year-old asymptomatic Chinese male with a past history of hypertension with unilateral adrenalectomy (no hyperaldosteronism), remote myocardial infarction, treated obstructive sleep apnea, and type 2 diabetes presented with gradually increasing blood pressure (BP) and decreasing heart rate (HR). From 2019 to 2020, his 24-hour ambulatory BP average increased from 140/49 mmHg to 188/66 mmHg with a decrease in HR from 55 to 43 bpm; there was no significant nocturnal dipping. Home and office BPs were similar. Daily medications included candesartan 64 mg, amlodipine 20 mg, chlorthalidone 50 mg, spironolactone 50 mg, doxazosin 8 mg, hydralazine 300 mg, nitropatch 0.8 mg/hour, and kayexalate for persistent hyperkalemia.
Medication adherence was confirmed by a pharmacy database review. Secondary hypertension workup was negative for Cushing's Disease, pheochromocytoma, and renal artery stenosis. Plasma aldosterone was undetectable and plasma renin activity was 1.95 (normal 0.10–1.10ng/L/s) while taking the above medications. Serial 24-hour Holter monitors captured sinus bradycardia without pauses. Echocardiogram revealed concentric left ventricular (LV) hypertrophy, left atrial enlargement, and LV ejection fraction of 55%. Subsequent 2-week Holter monitoring revealed atrial fibrillation with average HR of 44 bpm and multiple prolonged ventricular pauses (longest 5.1 seconds). Following pacemaker insertion, BP normalized to an average of 130/80 mmHg with only 3 agents.

Conclusion:
There is a paucity of literature on severe bradycardia resulting in resistant hypertension; the English language PubMed database documents 3 reported cases. Severe bradycardia may impair cerebral and renal blood flow, increase LV filling pressures through prolonged diastole causing greater ventricular stretch and increased force of contraction, and may alter arterial stiffness. This case demonstrates a rare but important phenomenon of refractory hypertension and bradycardia with marked improvement in BP control following pacemaker insertion. It is important that physicians are aware of this potential phenomenon when evaluating patients with resistant hypertension and bradycardia.
PS-BPR02-8: THE EFFECTS OF AN ORAL FUNCTION IMPROVEMENT PROGRAM INVOLVING CHEWY KELP TEXTURE FOR LOCAL ELDERLY JAPANESE PEOPLE: A PILOT STUDY
Authors: Kawamura Atsuko , Araki Hinano , Shiragami Aya , Tsubota Mako , Yonemura Reiko , Nagata Chizuru , Tsutsumi Masae 
Published: January 2023

Objective:
The purpose of this study is to verify the efficacy and sustainability of an oral function improvement program involving chewy kelp texture in nutrition designed specifically for an elderly Japanese population.

Study Design:
A small pilot study

Method:
We developed a chewy kelp nutritional formula through the collaboration of geriatric nursing specialists and the professional staff of a seaweed processing company. The program to improve oral function consisted of a) salivary gland massage and swallowing exercises three times daily before each meal, followed by b) training to chew and eat chewy kelp. The program was conducted for two weeks, and such vital signs as blood pressure (BP), pulse, saliva secretion (relative value of average oral water content), tongue pressure, and occlusal force (glucose elution amount) were measured before and after the intervention.

Results:
10 participants (4 male / 6 female: mean age 74.7 ± 5.4 years) enrolled. The program implementation rate of the participants was 93.6%. Measurements before and after the intervention included mean systolic BP (before, after, p) (138.0 ± 20.0, 131.0 ± 16.4 mmHg, p = .177), mean diastolic BP (79.6 ± 12.6, 73.2 ± 6.6 mmHg, p = .075), mean pulse (75.7 ± 11.0, 74.1 ± 10.8 times / min., p = .577), average oral mucosal moisture relative value (28.2 ± 4.9, 25.9 ± 3.3, p = .160), mean tongue pressure (29.6 ± 6.7, 32.3 ± 7.1 kPa, p = .213), and occlusal force (199.7 ± 78.9, 183.2 ± 42.7 mg / dL, p = .254). Among the participants, in one case in which occlusal function had significantly reduced, both mean systolic and diastolic BP decreased, and both tongue pressure and occlusal force increased.

Conclusion:
The high implementation rate indicated the potential sustainability of this program. Nevertheless, this study had certain limitations. First, the number of participants in the pilot study was small, falling short of the customary statistical sample size. In addition, because the implementation period was limited, any long-term effects of the program were not yet possible to show. Among preliminary findings of the study, for participants with impaired occlusal function, oral function may be improved and BP stabilized. Since periodontal disease is highly associated with cardiovascular disease and such side effects of hypertension drugs as increased thirst, it can be expected that longer trials of this program may see increased saliva production and improved oral function in participants.
PS-BPR02-10: SYMPATHETIC NERVE TONE AND THE INDOOR ENVIRONMENT IN A HIGHLY INSULATED AND AIRTIGHT MODEL HOUSE DURING THE COLD WINTER SEASON
Authors: Nakagami Hironori , Takahashi Sho Adnas , Sawada Katsutoshi , Kobayashi Nobutoshi , Akiyama Hiroshi , Otsuka Hiroki , Iwamae Atsushi , Yamada Hidekazu 
Published: January 2023

While evidence for lifestyle modification such as salt reduction, weight loss, exercise, sobriety, and smoking cessation has accumulated for perfect blood pressure control, there is a lack of evidence on blood pressure fluctuations due to housing environments such as thermal protection and heating. In particular, blood pressure fluctuation due to the difference in room temperature between the living room and the dressing room, toilet, and bedroom is known to be a major risk during the winter season. Therefore, this study focused on the autonomic nervous system as one of the factors causing blood pressure fluctuations, and compared the fluctuations when the same subjects spent two days each at home and in a highly insulated, airtight model house.

JOURNAL/jhype/04.03/00004872-202301001-00877/figure1/v/2023-10-24T163949Z/r/image-jpeg

Subjects were 6 males and 5 females with 20–70 years old. Autonomic activity was measured and calculated using portable electrocardiography (Heartnote: JSR corporation, Tokyo) for the 8 subjects for whom it was possible to measure heart rate, CVRR (Coefficient of variation of R-R interval) and LF(low frequency)/HF(high frequency) ratio. An sympathetic hyperactivation was defined to show more than +2SD for distribution within an individual in LF/HF calculated every 10 seconds. The salivary amylase was measured at several times per day. The indoor environment temperatures were recorded by installing data loggers equipped with temperature sensors in various rooms and taking continuous measurements at 10-min intervals.
In the model house, room temperatures were kept constant at 18°C or more. However, in the home, there were large temperature differences between rooms, and in one case, a room temperature in the bedroom was recorded at 6.3°C.
In the overall analysis of heart rate and CVRR, there were large individual differences in both absolute values and diurnal variations, and no obvious differences by housing environment. In a detailed analysis focusing on early morning (2 hours after waking), two subjects showed excessive sympathetic activation in the early morning at home, but not in the model house. There was no correlation between this change and salivary amylase.
In terms of sleep quality, there were no differences by housing environment.
This case of early morning sympathetic activation in a residential setting suggests the importance of the residential setting in the management of early morning hypertension.
PS-BPR03-1: DIAGNOSIS OF MONOCLONAL IMMUNOTACTOID GLOMERULOPATHY WITH POSITIVE LAMBDA CHAIN BY IMMUNOELECTRON MICROSCOPY
Authors: Sugita Erina , Sonoda Homare , Ryuzaki Masaki , Hashiguchi Akinori , Tokuyama Hirobumi , Wakino Shu , Hayashi Kaori , Kanda Takeshi , Itoh Hiroshi 
Published: January 2023

We report a case of a 73 year old man who developed immunotactoid glomerulopathy (ITG). ITG is a rare disease characterized by proliferative glomerulonephritis and capillary wall deposits with a 10 to 60 nm diameter microtubular substructure. Recent reviews recommend distinguishing monoclonal ITG from polyclonal ITG because monoclonal ITG is associated with a higher incidence of hematological disorders and better responsiveness to clone-directed therapy and renal prognosis.
In monoclonal ITG, immunofluorescence analysis typically exhibits IgG with light chain restriction, most often kappa chain restriction. This is the first reported case of a monoclonal ITG, positive only for the lambda chain detected by immunoelectron microscopy. At 6 months after his renal biopsy, the IgG lambda chain was detected in the serum and urine, reflecting possible monoclonality. We would like to present the usefulness of immunoelectron microscopy using biopsy samples as well as protein electrophoresis/ immunofixation using serum and urine samples to diagnose monoclonal ITG, even when routine immunofluorescence shows negative or nonspecific findings.

Conclusions:
It is important to distinguish monoclonal ITG from polyclonal ITG. Immunoelectron microscopy is useful as a salvage technique to diagnose monoclonal ITG.