Retrospective Study of Prognostic Prediction Based Only on Objective Indicators in End-of-life Patients: A Study Using Biological Prognostic Score Version-2

Objective: We retrospectively studied the adaptation and limits of applying Biological Prognostic Score Version-2 composed only of blood test results to prognostic prediction in end-of-life non-cancer patients. Methods: The prognostic score was calculated from the cholinesterase, blood urea nitrogen, and white blood cell counts of hospitalized end-of-life non-cancer patients, divided into three groups with cutoff values, and prediction accuracy analysis, survival analysis, and simple regression analysis were performed. Results: Diagnostic accuracy of 204 non-cancer patients at the same cut-off value and predicted survival time as cancer was 79% accurate at 3 weeks survival and 63% at 9 weeks. Specificity and negative predictive value were highly accurate, sensitivity and positive predictive value were low. In the survival analysis, the discrimination between the 3 groups was significant (p<0.05), but the regression coefficient in the regression analysis was not significant (p=0.43). Conclusion: The prognostic prediction using this score for non-cancer patients has high prediction accuracy in the case of good prognosis. It is suggested that clinical use of this score is also possible if used cautiously.

Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.

Changes in activities of daily living (ADL) among elderly Chinese by marital status, living arrangement, and availability of healthcare over a 3-year period

<p><b>OBJECTIVES</b>The purpose of this study was to assess how changes from different baselines of activities of daily living (ADL) can be explained by marital status, living arrangement and healthcare.</p><p><b>METHODS</b>Using data from the Chinese Longitudinal Health Longevity Study conducted in 2002 and 2005, 8,099 surviving and 3,822 deceased elderly aged 65 years and over were evaluated using multinomial logistic regression.</p><p><b>RESULTS</b>After adjusting for demographic, socioeconomic and health factors, elderly who were either married or living alone were less likely to encounter ADL decline compared to their counterparts. This was true only for those with fully independent ADL at baseline. Notably, once the functional status of the elderly declined from baseline and they became dependent on others, the status of living alone was no longer a significant predictor of the rate of future decline. On the other hand, elderly who had a spouse, children or other relatives as caregivers were more likely to experience a faster recovery and lower likelihood of death, compared to those who were cared by unrelated live-in caregivers. In addition, Chinese elderly with health insurance had a lower likelihood of death than their counterparts lacking health insurance, among those with ADL at the dependent baseline.</p><p><b>CONCLUSIONS</b>Although there has been a change in family structure and living arrangements, the majority of Chinese elderly still rely on traditional forms of family support, especially after acquiring dependency status. As the elderly have different functional levels, healthcare policies in China should consider the need for both community and family support systems.</p>

Prevalence of non-alcoholic fatty liver disease in children and relationship to metabolic syndrome, insulin resistance, and waist circumference

<p><b>OBJECTIVES</b>To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) in children and its relationship to metabolic syndrome, insulin resistance, and waist circumference (WC).</p><p><b>METHODS</b>This was a population-based cross-sectional, case-control study. Cases were selected among students of a primary and junior high school, respectively, and age- and sex-matched control subjects were selected randomly (ratio of cases to control subject was 37:113).</p><p><b>RESULTS</b>Of the 846 students, aged between 6 and 15 years, enrolled in the study and screened by ultrasonography, 37 children were diagnosed as having NAFLD (score >/= 1). There was a significant sex difference in the prevalence of NAFLD(P = 0.003). The trend test revealed a strong dose-response relationship (P < 0.001) between pediatric NAFLD and the number of the proposed components of pediatric metabolic syndrome in Japan (MetS-JC), such as a clustering of the components of MetS-JC. Additionally, the linear trend of the odds ratios (ORs) with increasing percentile of the homeostasis model assessment-insulin resistance (HOMA-IR) was statistically significant (P < 0.001). However, when WC was added to the logistic model, the ORs were no longer significant, whereas WC turned out to be an independent risk factor for NAFLD regardless of the HOMA-IR index.</p><p><b>CONCLUSION</b>The prevalence of NAFLD in children and adolescents is closely related to metabolic syndrome, insulin resistance, and WC.</p>

A study on Knowledge, Attitude, and Behavior toward Severe Acute Respiratory Syndrome (SARS) among College-prep Students at Japanese Language Schools in Tokyo / 国際保健医療

<b>Introduction:</b> The outbreak of severe acute respiratory syndrome (SARS) began in Guangdong, China in November 2002 and spread to Hong Kong around March 2003. It stopped spreading in July of the same year. However, a sense of crisis toward potential new infections may exist in epidemic areas. “College-prep students” are regarded as a high-risk group as a source of infection because of certain factors, such as the differences in linguistic capabilities and their customs. The purpose of this study was to clarify the knowledge, attitude, and behavior toward SARS, and also to collect the information as baseline data for the control of emerging infectious diseases toward them.<br><b>Methods:</b> We conducted a self-administered questionnaire to 303 “college-prep students” from June 27 to July13, 2003. For statistical analyses, the chi-square test, t-test and factor analysis were used.<br><b>Results:</b> The average age of subjects was 22.8 years for males, and 22.6 years for females. The majority of subjects was from China (76.8%, n= 218), and had only stayed in Japan less than one year (70.9%, n= 205). Most subjects were knowledgeable of the symptoms of and preventative measures for SARS. There were no significant differences in knowledge, attitude, and behavior items between students from epidemic areas and those from non-epidemic areas. However, we observed a statistically significant difference in the proportion of subjects in the two groups stratified by information source: radio (p<0.01) and family (p<0.05), where the proportion was higher in epidemic areas than in non-epidemic areas. Three factors were extracted by factor analysis on information sources, which suggested an inverse correlation for language and frequency of communication.<br><b>Conclusions:</b> This study clarified the knowledge, attitude, and behavior toward SARS for “college-prep students”. These findings must be useful for the control against emerging infectious diseases.

Desirable Educational Environment for the Better Clinical Clerkship / 医学教育

In order to implement, or enhance the quality of clinical clerkship, it is necessary to develop good educational environment which will be appropriate to allow medical students participate in medical team services. Important things to be considered will be, (1) Systematic management of the individual department's program by the faculty of medicine, (2) Developing educational competency within the medical care team function, and (3) Nurturing students' awareness forself-diected learning and cooperative team work, and teaching- and medical staffs' awareness of their educational responsibilities. In this paper, to develop better educational environment for clinical clerkship, we propose a desirable situation of the educational organization, dividedly describing on the roles of dean, faculties, board of education, department of medical education, clerkship director, teaching physicians, residents and medical students.

Evaluation of the Model Core Curriculum for Clinical Clerkship / 医学教育

In March 2001, Research and Development Project Committee for Medical Educational Programs proposed a model core curriculum for undergraduate medical education. In this curriculum, implementation of the clinical clerkship is strongly recommended. Two similar curriculum models were later presented by other organizations, and some differences were observed among them. We, Undergraduate Medical Education Committee, have evaluated and compared themodel core curriculum 2001 with the Japanese newer proposals as well as those of USA and UK. Here is reported our proposals for a better rewriting of the learning objectives in the model core curriculum 2001, with some emphasis on the nurture of the competence of the case presentation and decision making process.

Antioxidants and cardiovascular disease: Still a topic of interest

Cardiovascular disease constitutes a major public health concern in industrialised nations. Over recent decades, a large body of evidence has accumulated indicating that free radicals play a critical role in cellular processes implicated in atherosclerosis. Herein, we present a mechanism of oxidative stress, focusing mainly on the development of an oxidised low density lipoprotein, and the results of a clinical trial of antioxidant therapy and epidemiological studies on the relationships between nutrient antioxidants, such as vitamin E, vitamin C, β-carotene, coenzyme Q, flavonoids and L-arginine, and coronary events. These studies indicated that a diet high in antioxidants is associated with a reduced risk of cardiovascular disease, but did not confirm a strong causality link. With regard to vitamin E, observational studies suggested that the daily use of at least 400 International Units of vitamin E is associated with beneficial effects on coronary events. However, it is apparently too early to define the clinical benefits of vitamin E for cardiovascular disease. From the results of several randomised interventional trials, it appears that no single antioxidant given to subjects at high doses has substantial benefits, and the question of whether nutrient antioxidants truly protect against cardiovascular disease remains open. This article provides an overview of the epidemiological and clinical studies related to antioxidants and cardiovascular disease.

Antioxidants and Cardiovascular Disease: Still a Topic of Interest

Cardiovascular disease constitutes a major public health concern in industrialised nations. Over recent decades, a large body of evidence has accumulated indicating that free radicals play a critical role in cellular processes implicated in atherosclerosis. Herein, we present a mechanism of oxidative stress, focusing mainly on the development of an oxidised low density lipoprotein, and the results of a clinical trial of antioxidant therapy and epidemiological studies on the relationships between nutrient antioxidants, such as vitamin E, vitamin C, β-carotene, coenzyme Q, flavonoids and L-arginine, and coronary events. These studies indicated that a diet high in antioxidants is associated with a reduced risk of cardiovascular disease, but did not confirm a strong causality link. With regard to vitamin E, observational studies suggested that the daily use of at least 400 International Units of vitamin E is associated with beneficial effects on coronary events. However, it is apparently too early to define the clinical benefits of vitamin E for cardiovascular disease. From the results of several randomised interventional trials, it appears that no single antioxidant given to subjects at high doses has substantial benefits, and the question of whether nutrient antioxidants truly protect against cardiovascular disease remains open. This article provides an overview of the epidemiological and clinical studies related to antioxidants and cardiovascular disease.

External causes of mortality during exercise in school, 1986-1998 / 体力科学

In order to elucidate factors associated with the external causes of mortality during exercise in school from 1986 to 1998, the frequencies and characteristics of mortality were investigated. We used from the booklet“Deaths and injuries under school supervision”published by the National Stadium and School Health Center of Japan. There were 295 deaths (22.7 deaths/year) from 1986 to 1998. The most common cause of mortality was injury (52%), and it also occurred in boys compared with girls in all causes of mortality. In more recent years, the incidence has decreased in injury and drowning, whereas it has increased in heat stroke. The incidence of injury and heat stroke was markedly higher during sports club training, while the incidence of drowning was high during physical education. In injury, most cases occurred during Judo. In drowning, most cases occurred during swimming. In heat stroke, most cases occurred during baseball. Among external causes of mortality in the ICD-10, “struck by thrown, projected or falling object” (W20) in injury, “drowning and submersion while swimming-pool” (W67) in drowning and“exposure to excessive natural heat” (X30) in heat stroke were the most frequent causes. Among the injury, Judo cases most occurred during W20, Rugby and American football cases most occurred during“striking against or bumped into by another person” (W51), and baseball, soccer cases most occurred during“striking against or struck by sports equipment” (W21) . As a result, more attention should be paid to circumstances related to a high incidence of death and the necessity of lecture on the protection and the prevention of external cause of mortality at school.

Seasonal variation of trace element loss to sweat during exercise in males

<p><b>OBJECTIVE</b>To clarify the seasonal differences of the trace element excretion in sweat, the trace element concentration in sweat and their loss during exercise were compared between summer and winter.</p><p><b>METHODS</b>Sweat samples were collected from ten healthy adult males. Bicycle ergometer exercise was conducted by each subject at a heart rate of 140 beats/min for 1 hour, in summer and in winter. Sweat was collected by the arm bag method.</p><p><b>RESULTS</b>Concentrations of major (Na, K, Ca, and Mg) and trace elements (Zn, Cu, Fe, Ni, Mn, and Cr) in sweat tended to be lower in summer than in winter, and significantly lower concentrations of Mg (p<0.01), Na, Cu, and Mn (p<0.05) were found in summer. The sweat volume in summer (0.90 L) was 1.7-fold larger than that in winter (0.52 L) (p<0.01). The amount of loss of each element to sweat calculated from the concentrations in sweat and sweat volume showed no significant difference between summer and winter.</p><p><b>CONCLUSIONS</b>It is suggested that there was no significant difference in the amount of loss of trace elements in sweat due to exercise between summer and winter.</p>

Seasonal Variation of Trace Element Loss to Sweat during Exercise in Males

Objective: To clarify the seasonal differences of the trace element excretion in sweat, the trace element concentrations in sweat and their loss during exercise were compared between summer and winter.Methods: Sweat samples were collected from ten healthy adult males. Bicycle ergometer exercise was conducted by each subject at a heart rate of 140 beats/min for 1 hour, in summer and in winter. Sweat was collected by the arm bag method.Results: Concentrations of major (Na, K, Ca, and Mg) and trace elements (Zn, Cu, Fe, Ni, Mn, and Cr) in sweat tended to be lower in summer than in winter, and significantly lower concentrations of Mg (p<0.01), Na, Cu, and Mn (p<0.05) were found in summer. The sweat volume in summer (0.90 L) was 1.7-fold larger than that in winter (0.52 L) (p<0.01). The amount of loss of each element to sweat calculated from the concentrations in sweat and sweat volume showed no significant difference between summer and winter.Conclusions: It is suggested that there was no significant difference in the amount of loss of trace elements in sweat due to exercise between summer and winter.

Sudden cardiac deaths during exercise in school (1986-1995) / 体力科学

In order to elucidate factors associated with sudden cardiac death during exercise in school from 1986 to 1995, the frequency and characteristics of death were investigated. The authors collected data from the booklet “Deaths and injuries under school supervision” published by the National Stadium and School Health Center of Japan. There were 480 cases of sudden cardiac death during exercise from 1986 to 1995, and boys accounted for 74% of these cases. In more recent years, the incidence per one hundred thousand persons has decreased in elementary and senior high schools ; whereas it has increased in junior high school. Regarding activity at the time of occurrence, 251 cases (52%) occurred during physical education ; 144 cases (30%) during sports club training; and 85 cases (18%) during school events. Incidence during sports club training in elementary school was significantly lower than that in junior and senior high school. Regarding past history, in most case, there was no past history of heart disease. Regarding types of exercise, incidence while running was highest (48%) . Among “running” cases, most occurred during training. Regarding past history, the incidence of cases showing a past history was high for light intensity running, and the incidence of cases without a past history was high during running that involved upper light intensity running. Regarding the stages of running, incidence was markedly higher in the first half of the running period among cases showing a past history, and during training and for light exertion, while the incidence was high in the latter half of the running period among cases without a past history, and also high during timed races and for upper light exertion. Among causes of death, acute heart failure was the most frequent cause. As a result, more attention should be paid to circumstances related to a high incidence of death and the necessity of teaching health care and the prevention of sudden death at school and at home.