[Differences between first and second appraisal in a new social insurance system covering long-term care service--the Nakayama Study].
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Biomedical subjects
Publications and source records attributed to M Ikeda.
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Using 351 one-day weighted diet records, we selected foods providing vitamins, minerals and dietary fiber according to contribution analysis (CA) and multiple regression analysis (MRA). Vitamin C was supplied by various vegetables and fruits, and carotene was specifically derived from green-yellow vegetables based on MRA as well as CA. Vitamin A was provided by green-yellow vegetables, fruits, chicken egg and milk (whole) according to CA; whereas chicken liver and pork liver were major sources according to MRA. Vitamin E was mainly of vegetable origin as determined by CA, and largely of spinach, safflower oil and pumpkin as determined by MRA. Vitamin D was mainly derived from chicken egg, fish and mushroom based on CA, and particularly from fish based on MRA. Calcium was supplied by milk (whole), soy products and chicken egg as determined by CA; while milk, tofu and various small fishes were the main contributors to variance. Magnesium was provided by soy products, well-milled rice and spinach according to both analyses, and iron by chicken egg, spinach and soy products. Zinc was largely derived from well-milled rice, followed by chicken egg and milk (whole) as determined by CA, and copper was provided by well-milled rice, soy and wheat products. Dietary fiber was supplied by vegetable sources, whether water soluble or insoluble, based on both analytic methods.
Eleven patients (12 ears) with acute otitis media associated with raised bone conduction were studied. The patients were from 19 to 70 years old and came to our hospital between November 1996 through May 1997. Pure tone audiometry revealed mixed hearing loss, but there was no bullous myringitis in all cases. They were treated by oral or intravenous antibiotics, steroids, and myringotomy. Bacteriological examination was done in seven cases, and revealed penicillin resistant Streptococcus pnumoniae in three cases. Complete recovery of hearing loss was obtained in 10 of 12 ears, but sensorineural hearing loss remained in 2 patients. Bacteriological examination and pure tone audiometry in acute otitis media are important for detecting the severity of the disease, determining the administration of steroids, and for the selection of antibiotics.
Three cases of calcifying epithelioma observed in the anterior auricular region are reported. The ages were 9 to 15 years, and all were females. The size of the tumors ranged from 20 x 20 mm to 22 x 34 mm. One case showed elevated (4.1 ng/ml) SCC antigen preoperatively, however, the value was reduced within the normal range (1.3 ng/ml) after removal of the tumor. One case showed a fistula with brownish and serous discharge on the epithelial surface of the tumor. In the same case, mitotic change of basophilic cells in the tumor was observed, however, distinctly malignant changes such as cell invasion into the surrounding tissue were not observed. Although the head and neck region are the most common areas where calcifying epithelioma occur otolaryngologists do not have sufficient understanding of this disease. Therefore, epidemiology, clinical findings, clinical examination, pathology, therapy and prognosis of calcifying epithelioma were discussed.
Effects of marital communication and friendship- and job-related social activities on emotional support and alienation among married women and men were examined. Causal analyses of questionnaire responses by 259 women and 185 men indicated that for both women and men, richness of marital communication made the spouse more important as the agent of emotional support, and at the same time decreased alienation. Job-related activities decreased women's alienation, while they tended to increase men's alienation. Men's social activities had a negative influence on their marital relation. In short, women and men appeared to seek different psychological functions in social activities, which in turn determined their levels of alienation.
BACKGROUND AND PURPOSE: The Short-Memory Questionnaire (SMQ) developed by Koss et al. is a standardized, validated reliable informant-based scale to assess everyday memory problems. In the previous study, we prepared its Japanese version and validated the reliability in assessing patients with Alzheimer Disease. In the present study, we examined the relations between the performance evaluated by the Japanese version of the SMQ combined with the Mini-Mental State Examination (MMSE) and demographic variables (age, sex, and education). SUBJECTS AND METHODS: Subjects were a total of 613 elderly healthy individuals living in the rural residency of Nakayama, Japan. They consisted of 287 males and 326 females and ranged from 65 to 94 years in age and from 0 to 16 years in education. The MMSE was conducted by neuropsychiatrists to assess the severity of cognitive impairment, and the SMQ was conducted by public health nurses, who asked a family member of each subject. The effects of age, sex and education on the MMSE and SMQ scores were analyzed by analysis of variance (ANOVA) using post-hoc Scheffé test. RESULTS: The mean MMSE and SMQ scores (+/- SD) were 27.6 (+/- 2.5) and 44.5 (+/- 2.1), respectively. The post-hoc Scheffé test revealed significantly higher MMSE scores for individuals with 8 years or more in education than for those with less than 8 education years. Between males, no significant differences were observed in MMSE score; however, among females, significantly higher scores were noted in those aged 69 or younger than in those aged 70-74 or those aged 80 or older. Of individuals aged 80 or older, males showed significantly higher scores than females, whereas no significant differences were observed between sex in other age groups. As to the SMQ, higher scores were shown by persons with longer education years and by females than males. CONCLUSION: Low MMSE scores were related to low education level and older females. Low SMQ scores were not related to aging, but linked to low education level and males. Both the MMSE and SMQ, which can be easily administered, are affected by education years and sex. In addition, MMSE score depends on age. Therefore, careful consideration should be paid to age, education level and sex for future execution of the MMSE and SMQ.
BACKGROUND AND PURPOSE: The clinical usefulness of MR cisternography of the cerebellopontine angle, applying 2D or 3D fast spin-echo sequences, has been reported recently. Our purpose was to investigate the cause of signal loss in CSF in the prepontine or cerebellopontine angle cistern on 2D FSE MR images and to compare the cisternographic effects of 2D and 3D FSE sequences. METHODS: Preliminary experiments were performed in four volunteers to assess the causes of signal loss. Initially, using a 2D cardiac-gated cine phase-contrast method with a velocity encoding value of 6 cm/s, we measured the velocity and flow pattern of CSF. Comparisons were made to assess the effects of intravoxel dephasing, amplitude of the section-selecting gradient, echo time (TE), and section thickness. Four healthy subjects and 13 patients with ear symptoms were examined, and multisection 3-mm-thick 2D images and 30-mm-slab, 1-mm-section 3D images were compared qualitatively and quantitatively. Then, 3D MR cisternography was performed in 400 patients with ear symptoms, and qualitative evaluation was performed. RESULTS: In volunteers, the average peak velocity of CSF was 1.2 cm/s. With TE = 250, CSF may move an average of 3 mm, and can be washed out of a 3-mm-thick 2D section volume. The CSF signal relative to that of a water phantom decreased gradually as TE increased on single-section 3-mm-thick 2D images. The CSF signal relative to that of the water phantom increased gradually as section thickness increased. No significant differences were noted in intravoxel dephasing and amplitude of the section-selecting gradient. The contrast-to-noise ratio (CNR) between CSF and the cerebellar peduncle, and the visibility of the cranial nerves and vertebrobasilar artery were significantly improved on 3D images in 17 subjects. In images from 400 patients, no significant signal loss in the cistern was observed using 3D FSE. CONCLUSION: CSF signal loss in thin-section 2D MR cisternography is mainly attributable to the wash-out phenomenon. 3D acquisition can reduce this phenomenon and provide thinner sections. The scan time for 3D acquisition is not excessive when a long echo train length and half-Fourier imaging are used. MR cisternography should be performed using a 3D acquisition.
Lidocaine is well known to have toxic effects on the central nervous system including the induction of electroencepharographic seizures and convulsions at high doses. Although lidocaine was reported to induce electroencepharographic seizures and behavioral convulsions by decreasing the strength of GABAergic synaptic inhibition, detailed mechanisms underlying the lidocaine-induced seizures remain unclear. To determine whether lidocaine decreases GABAergic inhibition or increases the cellular excitability instead of reducing GABAergic inhibition, in the present study, we examined effects of lidocaine on monosynaptic field potentials in the hippocampal dentate gyrus of urethane-anesthetized rats. Lidocaine (10-15 mg.kg-1, i.v.) decreased significantly the threshold for action potential generation instead of producing a significant decrease in GABAergic paired-pulse inhibition. The results suggest that lidocaine first produces the hyperexcitability of hippocampal neurons, which then decreases the hippocampal GABAergic inhibition by the so-called inhibition failure leading to the induction of seizures.
Emergency CABG for acute coronary syndrome (ACS) was studied. Sixty patients had CABG for medically refractory UAP, 78 patients for AMI and 8 patients for post-infarction angina (PIA). In UAP group 7 patients (12%) died postoperatively, mainly due to perioperative myocardial infarction (PMI) and operative complications. In AMI group, 26 patients (33%) died, 14 of them due to myocardial failure. The operative mortality was extremely high in shock-state patients group (48%) and cardiac pulmonary arrest state patients group (85%). Operative result was poor in those patients whose infarct-related artery was not recanalized preoperatively. Operative mortality was 13% in PIA group. It was concluded that the reduction of mortality of those patients required much refined myocardial preservation technique and powerful mechanical assist system to support the postoperative myocardial failure.
Front-temporal dementia (FTD), advocated by Lund and Manchester groups, includes Pick type corresponding to the conventional frontal Pick's disease, motor-neuron type associated with neural symptoms, and frontal lobe degeneration type. In Japan, however, there have been few case reports of the frontal lobe degeneration type. Here we examined clinical characteristics and imaging findings of 2 cases of FTD frontal lobe degeneration type. Neurological examinations were normal. CT and MRI scans revealed no obvious frontal lobar atrophy, while HMPAO-SPECT scans demonstrated remarkable hypoperfusion in anterior hemisphere. Neuropsychological examination revealed frontal symptoms, including personality change, stereotypes, and disinhibition. These symptoms can not be distinguished from the cases of FTD Pick type, because those cases of FTD Pick type have obvious lobar atrophy.
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Pulmonary embolism is a leading cause of death and morbidity in the perioperative period. To obtain a contemporary overview of the epidemiology of acute pulmonary embolism, a questionnaire was mailed to anesthesia department chair-persons at 179 hospitals in Japan. The 158 cases were reported from the 88 hospitals. The cause of embolism was thromboembolism 127, gas 13, fat 9, amniotic fluid 4 and tumor 3. The mortality rate for patients with thromboembolism was high (29%). Dyspnea was the most frequent symptom (60%) and hypotension was the most frequent clinical sign (54%). The signs which suggested massive pulmonary embolism, such as hypotension, cyanosis (53%), syncope (39%) and cardiac arrest (29%) were frequently seen. Most of the pulmonary embolisms occurred during the operation and within 7 days after the operation. The high risk factors associated with thromboembolism were age, malignancy, obesity and the type of surgery performed. Treatment performed included anticoagulation 81%, catecholamine infusion 66%, thrombolysis 14%, surgical embolectomy 8% and extra-corporeal circulation 4%. This study indicates that the perioperative pulmonary embolism is still associated with high mortality and requires an immediate diagnosis and intensive therapy.
Hepatocellular carcinoma (HCC) is likely to be detected as multiple intrahepatic metastases, and trans-arterial embolization (TAE) is the treatment of choice. However, other therapy is needed when TAE is not effective for a tumor. We performed partial liver resection with small skin incision in two such patients. One patient had two HCCs of segment 6 (S6) and S7, and TAE was performed twice. However, HCC of S7 was viable, and we partially resected the tumor of S7. In the other patient, HCC was multiple in segment 6 and 7. TAE was performed three times, and in segment 6 we detected a tumor which grew into the extrahepatic space and seemed uneffected by TAE. We performed a partial resection of liver segment 6. After 3 months, TAE was repeated in the latter. The operation time was about three hours, and no blood transfusion was performed. Two of the patients were discharged on the 13th postoperative day. We concluded that partial liver resection with small skin incision was useful for one case of multidisciplinary treatment for hepatocellular carcinoma.
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Triplet surveys were conducted in the city of Xi' an and two villages (one in the vicinity and the other at a distance) in Shaanxi Province in China in October-November (when agricultural activities were low), 1997, to elucidate nutrient intakes with a focus on possible urban-rural differences. Total food duplicate samples were collected from non-smoking and non-habitually drinking adult healthy women (about 50 subjects per site and 149 in total). The nutrient intakes were estimated from the weight of food items in reference to national food composition tables. On average, the women took 1873 kcal energy, 54 g protein and 37 g lipid per day, with a lipid energy ratio of 18.4%. Both excess and insufficient energy intake was observed as a result of food intake analysis and body mass index determination. With regard to minor nutrient intakes, insufficiency was serious in the case of calcium, vitamin A and vitamin B2, but not with iron. Whereas dependency on plant foods for sources of energy and protein was common to the three regions, Xi' an people consumed more animal foods than those in the villages. Intake of fish and shellfish was quite low throughout the three regions. Among the four types of cereals, wheat was consumed most substantially in the three regions and in three meals (except for the village where people essentially did not take lunch in reflection of low agricultural activities), whereas rice was consumed more in Xi' an than in the two villages. Maize consumption was higher in the two villages (especially for breakfast) than in the city. In contrast, foxtail millet (although in small amounts) was taken primarily in Xi' an and only at the time of breakfast.
To clarify whether BMAL1 is involved in the photic signal transduction in the mammalian circadian clock, we examined the effects of a single light pulse on the level of BMAL1 mRNA in the suprachiasmatic nucleus (SCN) of rats by in situ hybridization. Rats were exposed to 30 min light of ca. 300 lux at six different phases in constant darkness and decapitated 60 min later. BMAL1 transcripts in the SCN of the control animals showed a robust circadian oscillation with the highest expression at ZT (Zeitgeber time) 18 and the lowest at ZT2. The light pulse slightly increased the level of BMAL1 transcripts in the SCN. However, the increment did not depend on the phase of light pulse. There was no significant change in the BMAL1 mRNA level up to 120 min after a light pulse at ZT14 and ZT22. These results indicate that BMAL1 transcription is not involved in the photic signal transduction responsible for non-parametric entrainment of the circadian clock in rats.
Effects of drug content and medium pH on the release of papaverine (PAP) from biodegradable poly(l-lactic acid) [P(L)LA] matrix were investigated to reveal the predominant factors affecting the two-stage diffusion-controlled release mechanism. A drug-dissolved cylindrical matrix (rod; 10 mmx1 mm diameter) was prepared by heat compression method. In the case of a PAP content below 10%, pH was found to have a strong effect on the release rate, and drug content was found to have no effect on the release profile. The release profile consisted of two sequential diffusion stages due to P(L)LA transformation from amorphous to the semicrystalline state prior to release. In the first release stage PAP diffused through the swollen matrix. The release accelerated with increasing medium pH due to an increase in water content in the acidic P(L)LA rod. In the second release stage PAP diffused through the water-filled micropores developed as a result of the polymer crystallization. On the assumption that the drug partition between the polymer and the medium in the micropores affects the diffusion and the partition is controlled by pH, we derived a modified diffusion kinetic equation. The observation that the release decelerated with increasing medium pH can be explained by the derived equation as resulting from the increase in the drug partition to the polymer. In the case where the rods contained more than 15% of PAP, the drug precipitated out as crystals during release. Accordingly, these rods showed a slower release.