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Biomedical subjects

O Tochikubo

Publications and source records attributed to O Tochikubo.

At least 19 recordsLinked to original sources
PubMed2006

Relationship between base blood pressure during sleep and health-related quality of life in healthy adults.

There are many reports indicating that night time blood pressure (BP) is closely associated with target organ damage. However, BP in the waking period is influenced by physical activity and also by the psychological status. Recently, base BP (BP0: minimum and stable BP during sleep) has been reported to correlate with organ damage in hypertensives. However, little is known about the implications of BP0. We examined how BP0 is associated with BP, heart rate variability and health-related quality of life (HRQOL) in healthy subjects. One hundred and thirty-five participants, composed of 88 male and 47 female (age: 21-33 years) underwent a 24-h ambulatory BP monitoring (ABPM). Sympathetic nervous activity (ratio of low-frequency to high-frequency component: LF/HF) and parasympathetic nervous activity (high-frequency component: HF) were calculated by electrocardiogram monitoring. BP0 was calculated as previously reported. HRQOL was assessed by Medical Outcome Study Short-Forum 36-Item Health Survey. Base systolic BP (SBP0) positively correlated with 24-h systolic BP (SBP) (r=0.662, P<0.0001) and night time SBP (r=0.810, P<0.0001). SBP0 positively correlated with 24-h LF/HF (r=0.214, P<0.02) and night time LF/HF (r=0.326, P<0.001). Moreover, SBP0 negatively correlated with the scores of body pain (r=-0.223, P<0.02). Multiple linear regression analysis showed that SBP0 correlated with gender (P<0.01), night time LF/HF (P<0.04) and the scores of body pain (P<0.04). In conclusion, SBP0 correlated with BP, LF/HF and the scores of body pain (HRQOL). SBP0 may be a useful indicator for assessing 24-h BP, sympathetic nervous functions and HRQOL in healthy subjects.

Adult↗
PubMed2006

Self-monitoring of home blood pressure with estimation of daily salt intake using a new electrical device.

We investigated a simple device to monitor daily salt intake at home and examined the relationship between salt excretion and morning blood pressure in order to enable patients to better manage daily salt intake and hypertension. The correlation between 24-h urinary salt excretion and measured value with salt monitor from overnight urine was significant (n = 224, r = 0.72, P < 0.001). A total of 46 volunteers participated for more than 3 weeks by measuring daily salt intake and morning blood pressure. The relationship between predicted daily salt excretion and blood pressure was examined with use of 3-day moving average. Mean salt excretion and systolic blood pressure (SBP) significantly decreased by the end of the trial (i.e., salt excretion decreased from 158+/-31 to 149+/-30 mmol/day and SBP from 137+/-17 to 133+/-16 mm Hg). Of 46 participants, 18 (39%) had a significant correlation between predicted daily salt excretion and blood pressure (r > 0.4, P < 0.05, n > 21), indicating sodium sensitivity. An additional 17% had a positive correlation that did not reach statistical significance (0.2 < r < or = 0.4), and the remaining 44% had no correlation (r < or = 0.2). Mean decrease in blood pressure per decrease in salt (g) (17 mmol) intake in the 18 participants with a significant correlation was 3.3 mm Hg (SBP) and 1.5 mm Hg (diastolic blood pressure), which was higher than that reported for other studies. Hypertensive patients not using medication showed the largest decrease. We conclude that daily monitoring of salt intake and morning blood pressure will be useful for management of hypertension.

Blood Pressure Determination↗
PubMed2005

Effects of agar (kanten) diet on obese patients with impaired glucose tolerance and type 2 diabetes.

AIM: The aim of this study was to evaluate the efficacy of agar diet in combination with a conventional diet (traditional Japanese food) for obese patients with impaired glucose tolerance and type 2 diabetes. METHODS: After a 4-week run-in period on their habitual diets, 76 patients were randomly assigned to have conventional diet or conventional diet with agar. Both groups were on these diets for 12 weeks. Body weight, body mass index (BMI), glycaemic control, blood pressure, insulin resistance, total body fat, fat distribution and lipids were assessed before and after the experimental period. RESULTS: In both groups, after 12 weeks, mean body weight, BMI, fasting glucose levels, homeostasis model assessment-insulin resistance, and systolic and diastolic blood pressures had decreased significantly from their baseline values. HbA(1)c, visceral fat area, subcutaneous fat area, total body fat, insulin area under the curve after oral glucose tolerance test and total cholesterol decreased significantly in the agar-diet group. After 12 weeks, mean changes of body weight (-2.8 +/- 2.7 kg vs. -1.3 +/- 2.3 kg, p = 0.008), BMI values (-1.1 +/- 1.1 kg/m(2) vs. -0.5 +/- 0.9 kg/m(2), p = 0.009) and total cholesterol (-7.6 +/- 27.5 mg/dl vs. + 2.4 +/- 23.4 mg/dl, p = 0.036) were significantly greater in the agar-diet group than in the conventional diet group. CONCLUSIONS: The agar diet resulted in marked weight loss due to the maintenance of reduced calorie intake and to an improvement in metabolic parameters.

Agar↗
PubMed2005

Effects of doxazosin on ambulatory blood pressure and sympathetic nervous activity in hypertensive Type 2 diabetic patients with overt nephropathy.

AIMS: Few studies have reported the effect of alpha(1)-adrenergic antagonists on 24-h blood pressure (BP) and sympathetic nervous activity in hypertensive patients with diabetic nephropathy. We assessed the effects of doxazosin on 24-h BP and spectral analysis of heart rate variability in hypertensive Type 2 diabetic patients with macroalbuminuria and compared the results with those in hypertensive Type 2 diabetic patients with normoalbuminuria and non-diabetic patients with essential hypertension. METHODS: Thirty-three patients in the macroalbuminuric group, 24 patients in the normoalbuminuric group, and 34 patients with essential hypertension underwent ambulatory BP monitoring before and after doxazosin treatment. Spectral analysis was performed to calculate the high-frequency (HF) components, a marker of parasympathetic nervous activity, and the low-frequency (LF) components, a marker of sympathetic nervous activity. RESULTS: Doxazosin decreased waking (from 158 +/- 17/88 +/- 10 to 148 +/- 15/80 +/- 7 mmHg, P = 0.001 for systolic and P < 0.001 for diastolic BP) and sleeping BP (146 +/- 20/79 +/- 10 to 137 +/- 17/72 +/- 9 mmHg, P < 0.001 and P < 0.001) in the macroalbuminuric group, but only decreased waking BP in the essential hypertension group (157 +/- 16/91 +/- 9 to 145 +/- 15/84 +/- 11 mmHg, P < 0.001 and P < 0.001) and normoalbuminuric group (159 +/- 15/89 +/- 9 to 150 +/- 16/82 +/- 10 mmHg, P = 0.014 and P < 0.001). Doxazosin decreased waking (from 1.48 +/- 0.11 to 1.42 +/- 0.12, P = 0.001) and sleeping (1.46 +/- 0.11 to 1.40 +/- 0.13, P = 0.001) LF components [unit: log(ms(2)/Hz)] only in the macroalbuminuric group without changing HF components. The normoalbuminuric and essential hypertension groups showed no differences (P = 0.637 and 0.492) in LF components during sleep. CONCLUSIONS: Doxazosin may be an antihypertensive agent that decreases both waking and sleeping BP through inhibiting sympathetic nervous activity in macroalbuminuric diabetes patients.

Adrenergic alpha-Antagonists↗
PubMed2003

Infection of macaques with an R5-tropic SHIV bearing a chimeric envelope carrying subtype E V3 loop among subtype B framework.

To establish simian/human immunodeficiency virus (SHIV) clones bearing a chimeric envelope carrying subtype E V3 loop among subtype B envelope, four subtype E V3 sequences were substituted into SHIV(MD14), a SHIV clone bearing an envelope derived from a CXCR4 (X4)/CCR5 (R5)-dual tropic subtype B HIV-1 strain. SHIV-TH09V3, an only V3-chimera clone capable of replicating in human and macaque peripheral blood mononuclear cells (PBMCs), was propagated in pig-tailed macaque PBMCs and in cynomolgus macaque splenic mononuclear cells. The propagated virus stocks were intravenously inoculated into respective macaque species. SHIV-TH09V3 infected both macaque species as shown by plasma RNA viremia, isolated viruses from PBMCs and plasma, and antibody production against viral proteins. To assess how the substituted V3 sequence affected coreceptor usage, SHIV-TH09V3 stocks propagated in vitro and after isolation from macaques were verified for their corecepor usage by GHOST cells assay. SHIV-TH09V3 maintained R5-tropic phenotype both in vitro and after isolation from macaques, in contrast to the X4/R5-dual tropic SHIV(MD14). This indicates the substituted V3 sequence among the backbone of SHIV(MD14) governs coreceptor usage. Future study of infecting macaques with SHIV-TH09V3 and SHIV(MD14) will focus on differences of the outcome caused by the different V3 sequences in connection with coreceptor usage.

Amino Acid Sequence↗
PubMed2001

Electrocardiographic criteria for predicting total occlusion of the proximal left anterior descending coronary artery in anterior wall acute myocardial infarction.

BACKGROUND: Patients with occlusion of the left anterior descending coronary artery (LAD) proximal to both the first septal branch and the first diagonal branch may benefit most from early reperfusion therapy due to extensive area at risk. HYPOTHESIS: The aim of the study was to examine whether 12-lead electrocardiograms (ECGs) in the acute phase of acute myocardial infarction (AMI) could identify total occlusion of the LAD proximal to both the first septal and the first diagonal branch. METHODS: A 12-lead electrocardiogram was recorded on admission in 128 patients with anterior AMI within 12 h from symptom onset. Patients were divided into three groups according to the culprit lesion: 33 patients had total occlusion of the LAD proximal to both the first septal perforator and the first diagonal branch (Group P), in 51 it was proximal to either the first septal perforator or the first diagonal branch (Group D-a), and in 44 it was distal to both the first septal perforator and the first diagonal branch (Group D-b). RESULTS: Sensitivity and specificity of a greater degree of ST-segment depression in lead III than that of ST-segment elevation in lead aVL were 85 and 95%, respectively, which was better than the results derived by all other ECG criteria (p< 0.001). CONCLUSIONS: We conclude that a greater degree of ST-segment depression in lead III than that of ST-segment elevation in lead aVL is a useful predictor of proximal LAD occlusion in patients with anterior AMI.

Adult↗
PubMed2001

Implications of the absence of ST-segment elevation in lead V4R in patients who have inferior wall acute myocardial infarction with right ventricular involvement.

BACKGROUND: ST-segment elevation of > or = 1.0 mm in lead V4R has been shown to be a reliable marker of right ventricular involvement (RVI), a strong predictor of a poor outcome in patients with inferior acute myocardial infarction (IMI). However, patients with no ST-segment elevation in lead V4R despite the presence of RVI have received little attention. HYPOTHESIS: The study was undertaken to study the clinical features of patients with no ST-segment elevation in lead V4R despite the presence of RVI, which means false negative, as such patients have received little attention in the past. METHODS: We studied 62 patients with a first IMI, who had total occlusion of the right coronary artery (RCA) proximal to the first right ventricular branch and successful reperfusion within 6 h from symptom onset, to examine the implications of the absence of ST-segment elevation in lead V4R despite the presence of RVI. RESULTS: A standard 12-lead electrocardiogram (ECG) and right precordial ECG (lead V4R) were recorded on admission, and three posterior chest ECGs (leads V7 to V9) were additionally recorded in 34 patients. Patients were classified according to the absence (Group 1, n = 18) or presence (Group 2, n = 44) of ST-segment elevation of > or = 1.0 mm in lead V4R on admission. Patients in Group 1 had a greater ST-segment elevation in leads V7 to V9 (2.9+/-2.4 vs. 1.4+/-3.0 mm. p < 0.05), a higher frequency of a dominant RCA (defined as the distribution score > or = 0.7) (72 vs. 11%, p < 0.001), and a higher peak creatine kinase level (3760+/-1548 vs. 2809+/-1824 mU/ml, p < 0.05) than those in Group 2. CONCLUSIONS: In patients with IMI caused by the occlusion of the RCA proximal to the first right ventricular branch, no ST-segment elevation in lead V4R can occur because of concomitant posterior involvement. In such patients, the incidence of RVI may be underestimated on the basis of ST-segment elevation in lead V4R.

Aged↗
PubMed2001

Optimal atrioventricular delay setting determined by evoked QT interval in patients with implanted stimulus-T-driven DDDR pacemakers.

Cardiac function is improved by optimizing the atrioventricular (AV) delay. An automatic optimizing function of AV delay may be necessary to achieve the most favourable haemodynamic state in paced patients. The QT interval may change when cardiac function is improved by optimizing the AV delay. The QT or stimulus-T interval is used as a sensor for rate-responsive pacemakers. Evoked (e) QT interval is measured as the time duration from the ventricular pace pulse (stimulus) and the T-sense point that is the steepest point of the intracardiac T wave (stimulus-T interval). The relationship between AV delay, eQT interval and cardiac function was studied in 10 patients (73 +/- 10 (SD) years old) with an implanted stimulus-T-driven DDDR pacemaker. Cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) were measured by Swan-Ganz catheter. The AV delay was prolonged stepwise by 30 ms. Electrocardiogram event markers which indicated ventricular spike and sensed T wave were recorded, and the interval between two event markers was measured as eQT interval. When AV delay was changed from 240 ms to the AV delay at which CO was maximal (172 +/- 33 ms), eQT interval prolonged from 346 +/- 60 to 353 +/- 62 ms (P < 0.01). There was a significant positive correlation between the optimal AV delay at which CO was maximal (172 +/- 33 ms) and the optimal AV delay which was predicted from the maximum eQT interval (179 +/- 37 ms, r = 0.92, P < 0.001). When AV delay was changed from 240 ms to the predicted optimal AV delay, CO increased from 4.2 +/- 0.7 to 4.5 +/- 0.81.min-1 (P < 0.001) and PCWP was decreased from 7.1 +/- 4.0 to 5.7 +/- 3.1 mmHg (P < 0.05). In conclusion, the optimal AV delay can be predicted from the eQT interval which is sensed by an implanted pacemaker. Automatic setting of the optimal AV delay may be achieved by the QT sensor of an implanted pacemaker.

Aged↗
PubMed2001

Early peak creatine kinase activity is not always a marker of successful reperfusion with myocardial salvage in patients with reperfused anterior acute myocardial infarction.

BACKGROUND: Although early peak creatine kinase activity (peak CK) is considered a reliable marker of coronary reperfusion in patients with acute myocardial infarction (AMI), whether early peak CK indicates good myocardial salvage is unclear. Moreover, some patients have late peak CK despite successful reperfusion, and its clinical implication remains to be elucidated. METHODS AND RESULTS: We examined the association of the time to peak CK with predischarge left ventricular function in 124 patients with a first AMI who had successful reperfusion within 6 hours from symptom onset. Patients were classified according to the time from reperfusion to peak CK: group A, 61 patients with peak CK < 6 hours; group B, 42 with peak CK from 6 to 12 hours; and group C, 21 with peak CK > 12 hours. There were no differences among the 3 groups in age, sex, method of reperfusion, time from symptom onset to reperfusion, collateral circulation, or the extent of risk area estimated by number of leads with ST-segment elevation. Left ventricular ejection fraction measured by predischarge left ventriculography was lowest in group A, followed by group B, and highest in group C (median values, 43%, 52%, and 60%, P < .01). Left ventricular dysfunction (left ventricular ejection fraction < or = 40%) occurred in 26 (43%) patients in group A, 8 (19%) in group B, and none in group C (P < .01). CONCLUSIONS: We conclude that compared with early peak CK, late peak CK consistently reflects good myocardial salvage in patients with anterior AMI who had successful reperfusion within 6 hours from symptom onset.

Adult↗
PubMed2001

ST-segment depression in lead aVR predicts predischarge left ventricular dysfunction in patients with reperfused anterior acute myocardial infarction with anterolateral ST-segment elevation.

BACKGROUND: Patients with an anterolateral acute myocardial infarction (AMI) have a worse prognosis, and those with additional inferolateral wall involvement might be higher risk because of more extensive area at risk. Lead -aVR obtained by inversion of images in lead aVR has been reported to provide useful information for inferolateral lesion. METHODS: We examined the relation between ST-segment deviation in lead aVR on admission electrocardiogram (ECG) and left ventricular function in 105 patients with an anterolateral AMI undergoing successful reperfusion < or = 6 hours after onset. Patients were classified according to ST-segment deviation in lead aVR on admission ECG: group A, 23 patients with ST elevation of > or = 0.5 mm; group B, 47 patients without ST deviation; and group C, 35 patients with ST depression of > or = 0.5 mm. RESULTS: There were no differences among the 3 groups in age, sex, or site of the culprit lesion. In groups A, B, and C, the peak creatine kinase level was 3661 +/- 1428, 4440 +/- 1889, and 6959 +/- 2712 mU/mL, and the left ventricular ejection fraction (LVEF) measured by predischarge left ventriculography was 54% +/- 9%, 48% +/- 7%, and 37% +/- 9%, respectively(P < .01). During hospitalization, congestive heart failure occurred more frequently in group C than in groups A or B (P < .05). ST-segment depression in lead aVR had a higher predictive accuracy than other ECG findings in identifying patients with predischarge LVEF < or = 35%. CONCLUSIONS: We conclude that in patients with an anterolateral AMI, ST-segment depression in lead aVR on admission ECG is useful for predicting larger infarct and left ventricular dysfunction despite successful reperfusion.

Adult↗
PubMed2001

Base heart rate during sleep in hypertensive and normotensive subjects.

OBJECTIVE: Many studies have reported that the resting heart rate (HR) is intimately related to the prognosis of cardiovascular disease. However, HR in the waking state is influenced by psychological and physical activity and has low reproducibility. To measure the base HR (minimum and stable HR during sleep) with ease, we developed a wristwatch-type HR recorder. We then investigated the pathophysiological significance of the base HR. SUBJECTS AND METHODS: The subjects were 158 patients (82 men and 76 women) with essential hypertension (HT) on no medication and 204 normotensive (NT) subjects (105 men and 99 women, matched for age). On the basis of pulse waves from the wristwatch-type photoelectric plethysmograph, using a blue sensor with a wavelength of 450 nm, HR was recorded easily minute by minute during sleep time. In addition, 40 (23 men and 17 women) of the HT patients were hospitalized. Their cardiac index (CI) and stroke volume index (SVI) were measured by means of the cuvette method during waking time and night-time deep sleep when their HR had reached a minimum level. RESULTS: Mean base HR (HRo) in NT subjects was 49+/-4 beats per minute (bpm) and tended to rise with increasing age (r = 0.51, P < 0.01). In HT patients, HR0 was significantly higher: 60+/-7 bpm (P < 0.01). CI of HT patients, measured during night-time deep sleep, maintained a stable value of 2.45+/-0.36 l/min per m2. SVI in patients whose HR0 was above 60 was significantly lower than that in patients whose HR0 was below 60 (37+/-4.5: 45+/-4.8 ml/m2, P < 0.01). Corresponding differences in mean HR and SVI during waking or night-time, became smaller. CONCLUSIONS: These findings suggest that there is a close relation between base HR and cardiac function caused by such conditions as age and hypertension. This relation became indistinct during waking time. Moreover, the wristwatch-type HR recorder appears to be a useful tool for measuring base HR.

Adult↗
PubMed2001

Recent advances in blood pressure measurement technology: normalized blood pressure measurement with a double-cuff sphygmotonometer.

BACKGROUND: In our previous studies of 24-h blood pressure measurement, basal blood pressure (minimum sleep-time blood pressure) showed the strongest correlation with hypertensive target-organ damage. We have currently devised a new accurate method of blood pressure measurement that entails recording casual blood pressure waves by means of a double-cuff sphygmotonometer, and attempted to normalize casual blood pressure to basal blood pressure. METHODS: The double-cuff sphygmotonometer records the arterial pressure wave, from which, using the formula (P0 = phi(-1)(i) x Pi), we attempted a normalization of casual blood pressure (Pi) to values close to those of the basal blood pressure (P0). True basal blood pressure was measured by an indirect ambulatory blood pressure monitoring device (TM2425, A&D Co. Ltd., Tokyo, Japan). The subjects were 54 normotensive volunteers and 156 out-patients with essential hypertension [63 with World Health Organization (WHO)-II stage and 93 with WHO-I stage, including 47 subjects with white-coat hypertension] not receiving medication. RESULTS: The coefficient of correlation (r) between normalized diastolic blood pressure (Pd0') and true diastolic basal blood pressure (Pd0) was 0.82 (mean difference = 1 +/- 9.8 mmHg), that between normalized systolic blood pressure (Ps0') and true systolic basal blood pressure (Ps0) being 0.78 (1 +/- 13 mmHg) in 210 subjects. When an office mean blood pressure (MBP) of 116 mmHg was taken as the standard for identifying the WHO-I group, the sensitivity was 70% (65/93) and the specificity 67% (42/63), but when an MBP0 [MBP0' = (Ps0'-Pd0')/3 + Pd0'] of 89 mmHg was the standard, the sensitivity was 82% (76/93) and the specificity 90% (57/63), both significantly higher than the corresponding values for office MBP (P < 0.05). CONCLUSION: We devised a new double-cuff sphygmotonometer and normalizing function (phi(-1)) and, using these methods, calculated the normalized blood pressure in hypertensive out-patients, which may make it possible to identify degrees of severity of hypertension in terms of WHO stages.

Algorithms↗
PubMed2001

Task Force I: methodological aspects of blood pressure measurement.

OBJECTIVE: To reach a consensus on important methodological aspects of blood pressure measurement. METHODS: A Task Force on the methodological aspects of blood pressure measurement wrote this review after the Eighth International Consensus Conference on Blood Pressure Monitoring, in Sendai, Japan (28-31 October 2001). This consensus paper is based on the papers presented by Task Force I and on the discussion sessions, and is therefore representative of a broad spectrum of expert opinion. POINTS OF CONSENSUS: Consensus was reached on the following five issues: (1) there is an urgent need for a simplified protocol for the validation of blood pressure measuring devices; (2) there is a need for a means of updating the "state of the market" for validated devices so that users can have easy access to this information; (3) new devices must be validated independently, and existing devices that have not been validated must be reappraised; (4) manufacturers should confirm when new models use algorithms which have been validated previously; (5) the Food and Drug Administration now accepts that when ambulatory blood pressure measurement is used in clinical short-term trials in which side-effects are not being assessed, a placebo arm is not required.

Algorithms↗
PubMed2001

Relationship between myocardial damage and C-reactive protein levels immediately after onset of acute myocardial infarction.

The present study investigated the relationship between myocardial damage and C-reactive protein (CRP) levels, with no increase in creatine kinase (CK) activity, immediately after the onset of acute myocardial infarction (AMI) in 85 patients with their first reperfused anterior AMI without CK elevation on admission and no ischemic events during hospitalization. Patients were classified into those with low levels (<0.3 mg/dl) of CRP (Group L; n=67) and those with high levels (> or =0.3 mg/dl) of CRP (Group H; n=18). Group H had a higher proportion of patients with a history of preinfarction angina (89 vs 55%, p<0.01), especially unstable angina. SigmaST in leads V1-6 on admission ECG was lower in Group H than in Group L (14+/-7 vs 21+/-13 mm, p<0.05). Predischarge left ventriculography showed that the left ventricular global ejection fraction (55+/-11 vs 48+/-10%, p<0.01) and SD/chord at the left anterior descending artery lesion (-1.7+/-0.9 vs -2.3+/-0.9, p<0.01) were better in Group H. Multivariate analysis demonstrated that both CRP on admission (p=0.011) and preinfarction angina (p=0.002) were independently associated with better regional wall motion (SD/chord >-2.0) before discharge. These results suggest that the clinical situation of elevated CRP immediately after onset is associated with less myocardial damage and better left ventricular function in reperfused anterior AMI.

Aged↗
PubMed2001

Differences in inflammatory activity at the onset of acute myocardial infarction according to the clinical presentation of preinfarction angina.

It is unknown whether the pathogenetic mechanisms underlying acute myocardial infarction (AMI) differ according to the clinical presentation of preinfarction angina, so the present study measured plasma levels of C-reactive protein (CRP) in 280 patients with AMI in whom serum creatine kinase levels were normal on admission and increased subsequently. Patients were classified into 3 groups according to the type of preinfarction angina: no angina (n=95), stable angina (n=48), and unstable angina (n= 137). Patients with unstable angina were subdivided according to the Braunwald classification: class IB (n=39), class IIB (n=22), and class RIB (n=76). There were no differences among the 5 groups in baseline characteristics. CRP on admission was significantly higher and the level of physical activity at symptom onset was significantly lower in the Braunwald class RIB group than in the other groups, but no differences were observed among the other groups. Patients with preinfarction Braunwald class IIB unstable angina had higher CRP levels on admission and symptom onset at a lower level of physical activity. In such patients, the pathogenetic mechanisms may differ from those in other subsets of patients with AMI and active inflammation may play a more important role in AMI onset.

Acute-Phase Reaction↗
PubMed2001

A new double cuff sphygmotonometer for accurate blood pressure measurement.

Accurate measurement of blood pressure (BP) is essential in the diagnosis and treatment of hypertension, but neither auscultatory nor oscillometric methods measure intra-arterial BP accurately in all circumstances. Algorithms for automatic BP-measuring devices differ from manufacturer to manufacturer, and no clear authorized algorithm criteria have yet been established. We have devised a double-cuff sphygmotonometer to measure BP on the basis of clear algorithms, and investigated the accuracy of this new method by comparing it with the photo-oscillometric method, which is the most accurate method for non-invasive measurement of intra-arterial BP. In the new method, a small cuff (3x6 cm) replaces the photo-sensor in the brachial cuff (13x24 cm) of the photo-oscillometric device, and BP is determined by means of the oscillation within the small cuff. The comparison based on procedures of AAMI-protocol was performed in 136 hypertensive patients and 54 normotensive subjects. The difference in systolic BP between the photooscillometric and double-cuff methods was -2.26+/-2.31 mmHg (89% under 5 mmHg), and the corresponding difference in diastolic BP was 1.9+/-2.50 mmHg (94% under 5 mmHg). In conclusion, we have devised a new double-cuff method which improves on the photo-oscillometric method, and although it seems to be less accurate than the photo-oscillometric method, the clarity of its algorithm makes it superior to the conventional oscillometric and auscultatory methods employing only one cuff.

Algorithms↗
PubMed2001

[Utilization of emergency ambulances in Yokohoma City, Japan].

OBJECTIVE: In recent years, the annual number of emergency ambulance (EA) calls has increased in Yokohama city, Japan. A questionnaire study was carried out to describe behavioral features of the users in Yokohama city, and to investigate their relationship with the increase in EA utilization. METHODS: We randomly recruited 2,910 citizens, aged 15 years or older, for the questionnaire study and a total of 2,294 (78.8%) replied. The questionnaire included questions about their demographic characteristics, history of EA use, existence of family doctors, and knowledge of emergency medical services and emergency medical information centers. Additionally, respondents who had used EA previously were asked about their reasons for this. RESULTS: A total of 513 (22.4%) respondents answered that they had used EA previously. A slightly higher rate of EA use was shown among elderly people, 65 years old or over (a rate of 26.2%). The major reason for requesting EA use was the urgency of the disease or the injury (61.8%). 182 respondents answered that they requested EA as a means of transportation. However, most of them also mentioned that the urgency of the disease or the injury was one of the reasons for their request. This survey showed no evidence that the citizens of Yokohama have used EA improperly. Elderly people, among whom the annual number of EA uses has increased rapidly over the years, tended to employ EA in a way more in line with regulations than other generations. CONCLUSION: This study suggested that the basic reason for the increase of EA utilization in Yokohama city was not due to inappropriate demand but to the aging of the population.

Adolescent↗