Gastric cancer in Japan, previously the top killer cancer, has recently shown decreased incidence and mortality rates. Epidemiological studies have demonstrated that environmental factors are closely associated with stomach oncogenesis, as evident from the geographical differences seen throughout Japan in both incidence and mortality. Moreover, Japanese immigrant populations gradually exhibit the lower incidence and mortality rates of gastric cancer in their chosen country. Likewise, younger generations in Japan have lower mortality rates than older generations at the same age, which may be accounted by the dramatic lifestyle changes in Japan after World War II. In addition to exploring and learning from the impact of these environmental factors, deliberate strategies to further lower the incidence and mortality rates of gastric cancer must include aggressive eradication programs for Helicobacter pylori and dietary education in both school curricula and for the general adult population to lower the intake of causative agents such as salt and increase the intake of beneficial agents such as fruits, vegetables and seaweeds. The dietary education should be coupled with better motivation for the general population to undergo regular screening with improved techniques. In the future, changes in these environmental factors and progresses in the diagnosis of and therapeutic strategies for gastric cancer will lead to further decrease in the incidence and mortality rates of this disease in Japan.
The forearm rotation changes sensory inputs to the central nervous system, thereby providing orientation of the hand for grasping an object. Electrical activities of the muscles, induced by transcranial magnetic stimulation to the brain, i.e., motor evoked potentials (MEPs), are used for estimation of the excitability of motor neurons in the brain and spinal cord. It is well known that rotational positioning of the forearm influences MEPs of forearm muscles through modulation of excitability in the central nervous system. In the present study, we investigated whether such a posture-dependent change of MEPs could be found in upper arm and intrinsic hand muscles at three different rotational forearm positions: the most internal (pronation), neutral, and most external (supination) positions of rotation. MEPs were simultaneously recorded from the four muscles, biceps brachii (BB), triceps brachii (TB), abductor digiti minimi (ADM), and abductor pollicis brevis (AbPB). MEP amplitudes and latencies in BB, TB and ADM were significantly larger and shorter, respectively, in supination compared to the values in other positions. By contrast, MEP of AbPB in supination was lower in amplitude and longer in latency. Importantly, muscle lengths of TB, ADM and AbPB are constant in any rotational forearm positions, excluding the possibility of the muscle-length dependent change of spinal reflex. Therefore, these results might be attributable to the posture-dependent modulation of the motor cortex activity for the upper limb. The motor cortex probably changes the control strategy for the upper limb muscles in accordance with the sensory input from the forearm.
More than 4 million of the elderly receive long-term care services using the public long-term care insurance in Japan. In order to use the insurance system, the insured person needs to be classified in one of the six care levels according to his/her clinical status. Though each level is defined in terms of the total amount of estimated care time needed per day, the clinical status of each level is not precisely defined. This study aimed to compare the clinical status of the six levels in order to suggest indicators of deterioration for each care level. We analyzed the clinical status for 7,222 cases who applied for care-need certification in a rural area of Japan. Sixty-seven items were used to determine physical function, activities of daily living, and cognitive and sensory status. Even in the mildest care level (Support Required), more than 50% of the individuals were dependent with regard to standing and sitting, while weakness of the lower extremities and dependency in walking were identified in Care Level 1, dependency in dressing and toilet habits in Care Level 2, dependency in grooming and transferring in Care Level 3, dependency in communication and feeding in Care Level 4, and dependency in swallowing, orientation and limitations of joint movement in Care Level 5. Care providers should be tracking these changes to estimate and prevent the decline of care level because more than 20% of the individuals assessed in 2004 belonged to the worse care level one year later.
Benzodiazepines are useful and effective psychotropic agents used worldwide. However, the long term use of the drugs can lead to serious adverse health effects such as psychomotor and cognitive impairment, especially in the elderly. In Japan, there are very few reports concerning long-term use of benzodiazepines, and no countermeasures have been instituted. Thus, this study assessed the characteristics of long-term prescription of benzodiazepines at a university hospital in Japan. A cross-sectional study using the database of a computer ordering system examined 4,239 adult outpatients who were prescribed benzodiazepines at a university teaching hospital between July 2002 and June 2003. The patients were divided into two groups: those with long-term (≥ 3 months) and short-term (≤ 2 months) prescriptions. A logistic regression model was used to analyze the effect of patient age on long-term benzodiazepine prescription. Adjusting for patient gender, pharmacological half-life of the drug, and department group, a logistic regression model showed that long-term benzodiazepine prescription occurred more frequently in older patients (p < 0.0001 in trend tests) and varied according to the physician's specialty (p < 0.0001). Benzodiazepines were more frequently prescribed for long term in the elderly by internal medicine group (p = 0.003). Of the patients older than 71 years (n = 1,105), 86% were assigned to the long-term group and were more likely to have been prescribed benzodiazepines by an internist than a surgeon (p < 0.0001). The appropriate prescription of benzodiazepines in the elderly should be included in the educational programs at teaching hospitals, and rational prescribing needs to be monitored carefully.
Highway workers, such as policemen, automotive service companies, and toll collectors, are placed at risk of the accelerated atherosclerotic process, since recent studies have suggested that exposure to exhaust particles and ambient air pollution increases carotid intima-media thickness and reduces ocular blood flow velocity. Therefore, we assessed the relationship between serum homocysteine, a potential parameter for atherosclerosis, and the ocular blood flow velocity and the resistivity index in highway toll collectors. The peak systolic and end diastolic flow velocities and the resistivity index were measured in 22 toll collectors and 24 control subjects by color Doppler ultrasonography. The resistivity index, which is an indirect measure of the atherosclerotic process, was calculated: resistivity index = (peak systolic velocity - end diastolic velocity)/peak systolic velocity. Serum homocysteine levels were determined by fluorometric high-performance liquid chromatography. In the highway toll collectors, the serum homocysteine level (14.4 ± 4.8 μmol/l; p < 0.005) and the resistivity index of the ophthalmic artery (0.741 ± 0.015; p < 0.05) were higher and the ophthalmic blood flow velocity (33.0 ± 3.0 cm/s; p < 0.001) was lower than those in the controls (10.6 ± 3.1 μmol/l; 0.728 ± 0.023; 36.8 ± 2.2 cm/s; respectively). There were significant correlations between the serum homocysteine level and ophthalmic artery resistivity index in both highway toll collectors (p < 0.001) and controls (p < 0.005). Exposure to exhaust particles might increase the serum homocysteine level, which in turn could lead to the decreased ocular blood flow and the increased resistivity index.
Illegal substance use is a serious problem all over the world. In order to effectively combat substance abuse it is important that both the particular features of drug users and the culture-specific risk factors that go along with drug abuse be identified. The present study was carried out in Bursa, Turkey, in order to document annual changes in the frequency of felons arrested of narcotics offenses and to establish the socio-demographics of these narcotics felons. Among the 2,230 narcotics felons reviewed, 24.3% had been charged with drug dealing but not consumption (profit-driven felons [PDFs]), 19.0% were narcotics felons charged with both dealing and consumption ([hard core drug users HCDUs]), and 56.7% were narcotics felons charged only with consumption and possession (not so hard core drug users [NHCDUs]). The NHCDUs were younger (< 30 years) than both the HCDUs and PDFs, while most of the PDFs and HCDUs were married. Despite the fact that the male/female ratio of the Bursa population was nearly 1:1 for the past 30 years, 93.0%, 95.0% and 96.0% of the PDFs, HCDUs, and NHCDUs, respectively, were male. It was also found that the most commonly used illicit substance in Bursa over this period of time was cannabis. Over the course of the 30-year period examined, the annual incidence rate of narcotics felons arrested increased from 0.4257 per 10,000 to 1.2389 per 10,000. Determining the socio-demographic characteristics of HCDUs and NHCDUs would be useful in preventing substance use before substance users become addicted.
It has been well established that statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, reduce mortality from cardiovascular diseases. Statins, a class of cholesterol-lowering drug, may also affect mortality from various diseases by their pleiotropic effects of anti-inflammatory and anti-oxidative activities. However, there are only few reports concerning the effects of statins on diseases other than cardiovascular diseases. We therefore designed a population-based analysis, using the data from marketing surveys on statin sales and government reports on mortalities. We compared the statin use as expressed by statin sales per capita in the aged (≥ 65-year-old) population with mortality from major causes of death among 47 prefectures in Japan. As expected, there were significant negative correlations between statin sales per capita and mortality from cardiovascular diseases (p < 0.05). In addition, we found that there was a correlation between statin sales and the decrease in mortality from chronic obstructive pulmonary disease (COPD) (p < 0.0001), senility (p < 0.01), pneumonia (p < 0.05), accidents (p < 0.05), or all death causes (p < 0.05). However, statin sales were not associated with mortalities from renal failure, liver diseases, suicide, and malignant diseases. These results suggest a broad spectrum of beneficial effects of statins, including reduction of mortality rate of COPD as well as cardiovascular diseases. It will be worthy to confirm the protective effect of statins on COPD by prospective randomized clinical trials.
Vitamin D3 is known to be involved in neuroprotection and exert its neuroprotective effects by modulating neuronal calcium homeostasis and production of neurotrophins. The single nucleotide polymorphisms (SNP) in vitamin D receptor (VDR) gene which can influence the affinity of vitamin D3 to its receptor may be related to neurodegenerative diseases and neuronal damage by altering the vitamin D-mediated pathways. In this study, our aim was to determine whether there is an association between VDR gene and late-onset Alzheimer's disease (AD) in order to see if vitamin D contributes to AD or not. One hundred and four cases of dementia of Alzheimer type and 109 age-matched controls were genotyped according to ApaI (a: + restriction site and A: no restriction site) and TaqI (t: + restriction site and T: no restriction site) sites in intron 8 and exon 9 of the ligand-binding site of VDR gene. When the controls and patients were compared for their ApaI genotypes, the frequency of the patients with Aa genotype was significantly higher than the frequency of the healthy individuals with the same genotype (p = 0.008, χ2 = 9.577, OR = 2.30). Thus, the “Aa” genotype may increase the risk of developing AD 2.3 times when compared with the “AA” genotype. On the other hand, the “AT” haplotype was significantly higher in controls (p = 0.006) indicating a protective role of the “AT” haplotype in AD. Consequently, this study provides evidence for a possible link between AD and vitamin D.
In urban China, many non-clinically indicated cesarean sections (NCSs) are performed, resulting in an unnaturally high cesarean section (CS) rate. NCSs represent CSs without any specific medical indications. The demand for NCS may be due to women's preference for CS and their belief in its safety and comfortableness. In addition, CS is more profitable for the supply side than vaginal delivery, which results in a continued rise in delivery expenditures. As a result, the so-called “price transparency policy”, which forces hospitals to declare their average hospital charges, was adopted to control the delivery expenditures in the ongoing Chinese healthcare reform policy. The purpose of this study is to prove that the supply and demand factors affect the choice of delivery modes and more resources are consumed in NCS. The data of 680 live deliveries were collected from three hospitals in Beijing. Multinomial logistic regression analyses were conducted to identify the factors related to choosing NCS, and ANOVA and ANCOVA were used to compare the charges, proxy for resource utilization, among the delivery modes or hospitals. The results showed that the high NCS rate (37.7%) might be predicted not only based on the demand factors (region of residence, parity, maternal age and weight gain) but also on the supply factors (hospital dummy, revenue-staff ratio, bed turnover rate and obstetric medical staffs-delivery ratio), suggesting that such induced NCSs result in an unnecessarily high resource consumption. These data suggest that the present Chinese policy fails to control delivery expenditures.
Many factors may affect sleep in the neurosurgery intensive care unit (NSICU), including therapeutic and diagnostic procedures, medications, the underlying disease process, and noise generated in NSICU. This study was aimed to determine the factors and nursing interventions, which affect the patients' sleep in NSICU, and to ascertain future descriptive research studies in nursing. The sample consisted of 84 voluntary patients hospitalized at a university hospital. They were consecutively asked to fill out a questionnaire in face-to-face interviews, and on the same day they were transferred out of the NSICU to a neurosurgical ward. Sixty-six patients (78.6%) experienced sleep disturbances. In those patients, being kept immobile (63.6%) and being in a noisy environment (57.6%) were the factors, which most frequently disturbed sleep. Likewise, the nursing interventions were found to have profound influences on patients' sleep; namely, being asked to move an arm/leg or to keep them in the same position for neurological diagnostic reasons (43.9%), and being asked questions to determine the level of consciousness (40.9%) were identified as the common sleep disturbance factors. In conclusion, immobility, environmental noise factors, and the disturbances from implementing the nursing interventions should not be ignored. Sleep disturbance in NSICU should be addressed on the multidisciplinary care plan and in health team conference, and care should be planned to assure good quality of patients' sleep. Nurses, physicians, nursing and medical students should establish and evaluate the combined interventions required for neurological assessment to decrease the negative effects of various factors on patients' sleep.
Clinically, patients suffering from bronchial asthma are often treated transdermally with tulobuterol patches to dilate the bronchi. Tulobuterol, a synthetic β2 agonist, is also thought to act as a diaphragm muscle contractor, like other β2 sympathomimetic drugs. However, it has not been clarified that transdermal treatment with tulobuterol influences diaphragm muscle contractility. We therefore examined its effects on contractile properties of such muscles obtained from BALB/c mice. Two systems, a tulobuterol incubation group (in vitro) and a tulobuterol transdermal treatment group (in vivo), were employed. In both groups, the contractile properties of the dissected diaphragm muscles were measured by field stimulation in an organ bath. In the incubation group, the diaphragm muscle of untreated mice was incubated in an organ buffer at 10-7, 10-6, or 10-5 M tulobuterol for 1 hr and then measured for contractility. Tulobuterol significantly increased force-frequency curves at a concentration of 10-5 M at 1 (p < 0.01), 30, 50, 70, 100, and 120 Hz (p < 0.05, each) compared with the values at 0 M. In the transdermal treatment group, the diaphragm muscle was dissected from animals at 1, 4, 8, 12, or 24 hrs after treatment and measured for contractility, showing that the force-frequency curves were significantly increased and maintained from 4 to 24 hrs (each p < 0.01 as compared with the sham-treated group). We suggest that transdermal tulobuterol treatment in case of bronchial asthma is useful not only for bronchial dilatation, but also for increasing diaphragm muscle contractility.
Adenoid cystic carcinoma (ACC) is a common salivary gland malignancy characterized by slow but progressive clinical course, proclivity for hematogenous spread and perineural invasion (PNI) that exhibits inherent resistance to complete surgical resection, systemic chemotherapy and conventional radiotherapy. The molecular alterations that underlie its PNI are poorly characterized. We report the combined use of laser capture microdissection (LCM) and high-throughput cDNA microarray to monitor in vivo gene expression profile of salivary ACC and to correlate the profile with PNI. Consecutive section staining with hematoxylin & eosin was applied to 15 cancerous tissues, among which 6 were judged as PNI. Pure cancer cells adjacent to the nerve tracts from 6 cancerous tissues judged as PNI were laser captured, and pure cancer cells from the same 6 tumors distant from the nerve tracts were also procured. Total RNA was extracted, amplified and subjected to cDNA microarray-based expression analysis. The patterns of gene expression were verified by quantitative real-time PCR and immunohistochemistry. As to the result of 6 arrays, a total of 53 genes were identified as being 2-fold or more differentially expressed in PNI cancer cell group as compared to non-PNI cancer cell control. Out of the 53 genes found consistently differentially expressed, 38 were up-regulated and 15 down-regulated. The combined use of LCM and cDNA microarray analysis provides a powerful new approach to monitor the in vivo molecular events of PNI in salivary ACC. These identified novel genes deserve further investigations to elucidate their clinicopathological significance.
Since vitamin K2 (VitK2) syrup prophylaxis has become a routine measure for neonates and young infants, the incidence of vitamin K deficiency (VitK-D) in infancy has markedly decreased. However, we recently experienced 2 infantile cases of VitK deficiency, in whom intracranial hemorrhage (ICH) was the first clinical sign of CMV hepatitis. Case 1 is a breast-fed boy who received VitK2 syrup orally at birth and at the age of 1 month. He did not suckle well and developed a generalized tonic convulsion twice at the age of 8 weeks. Case 2 is a mixed-fed boy who also received VitK2 syrup twice but developed vomiting and drowsiness at the age of 4 months. In both cases, laboratory tests showed anemia, leukocytosis, liver dysfunction with cholestasis, and coagulopathy, consistent with VitK-D abnormality. Their serological analyses showed that cytomegalovirus (CMV) IgG and IgM were both positive. In case 1, CMV DNA was positive, as judged by the PCR method. In case 2, CMV antigenemia was positive. Hence we diagnosed these two patients as having VitK-D ICH caused by CMV hepatitis with cholestasis. CMV hepatitis is a risk factor of VitK-D ICH.