Assessment of associations between ischaemic attacks in patients with type 2 diabetes mellitus and air concentrations of particulate matter <2.5 µm.

OBJECTIVE: To investigate the relationship between air concentrations of fine particulate matter <2.5 µm in diameter (PM2.5) and ischaemic attacks in high-risk elderly patients (aged ≥60 years). METHODS: This retrospective data analysis study extracted clinical data from an electronic medical chart system and environmental air quality data from the Ministry of the Environment Atmospheric Environmental Regional Observation System. Patients were stratified into four groups according to whether or not they had type 2 diabetes mellitus (T2DM) and/or an ischaemic attack (i.e. cerebral infarctions and myocardial infarctions) during the 2-year study period. Analysis of the combined clinical and environmental data produced the odds ratio for the likelihood of experiencing an ischaemic attack. RESULTS: Clinical data were collected from 94 647 patients. On days when the air temperature was ≥25℃ and PM2.5 concentration was ≥20µg/m(3), an ischaemic attack was more likely to occur in the T2DM group than in the group without T2DM. An ischaemic attack was more likely to occur 2 days after an increase in the PM2.5 concentration compared with the same day as and 3-6 days after the increase. CONCLUSION: The results of this study confirmed an association between PM2.5 and ischaemic attacks in high-risk patients.

"Quartile" screening method to analyze the relationship between HIS and "AEROS" in Japan.

Atmospheric pollution affects the health through complex mechanisms and to varying degrees. However, even by secondary usage of retrospective HIS and "AEROS" data, screening can be performed for specific ICD10 diseases caused by environmental factors. Our screening method showed good agreement with doctors' common knowledge on the relationship between atmospheric data and disease. Examples include the higher incidence of influenza at low temperatures and dry skin caused by low humidity, etc. We need to examine the method further in order to make it simpler, easier and more robust.

Relationship between environment factors and the number of outpatient visits at a clinic for nonallergic rhinitis in Japan, extracted from electronic medical records.

BACKGROUND: The objective of this study was to evaluate the influence of the environmental factors (meteorological factors, air pollutant levels, etc.) on the number of clinic consultations for nonallergic rhinitis (NAR). METHODS: Among the 9056 outpatients visiting a general internal medicine clinic in Japan between August 2012 and the end of July 2013 (counting return visitors as multiple cases), the total daily number of first visits for NAR plus the number of extraordinary visits by patients with NAR for acute exacerbation of the disease was investigated using electronic medical records and analyzed. RESULTS: Major parameters with significant Spearman's correlation coefficients and significant correlation coefficients also in the multiple regression analysis were the mean vapor pressure (coefficient of determination 27.3 %) throughout the year, mean vapor pressure (58.4 %), mean temperature (44.4 %), maximum 10-min precipitation (12.0 %) only during the autumn-winter period, and temperature difference (13.3 %) only during the spring-summer period. CONCLUSIONS: The mean vapor pressure is the most important environmental factor associated with acute exacerbation of NAR.

In long-term bedridden elderly patients with dietary copper deficiency, biochemical markers of bone resorption are increased with copper supplementation during 12 weeks.

BACKGROUND: Although the effect of copper on bone has been tested in animals and healthy subjects, no studies concerning the effect of copper supplementation on bone metabolism in patients with copper deficiency have been reported because of the rarity of these patients. This study was conducted to investigate the effect of copper supplementation on bone metabolism in copper-deficient patients. METHOD: This study included 10 patients (83.7 +/- 8.3 years) with dietary copper deficiency under long-term bed rest for more than 12 months. They had their diets supplemented with copper sulfate (3 mg/day) over 12 weeks in addition to their diet of only one kind of enteral food with a low concentration of copper. Serum copper and ceruloplasmin, urinary deoxypyridinoline (DPD) and collagen-type 1 N-telopeptide (NTX) (biomarkers of bone resorption), serum osteocalcin (OC) and bone-specific alkaline phosphatase (Bone ALP) (biomarkers of bone formation) were analyzed at baseline, 4 and 12 weeks after copper supplementation. RESULTS: DPD and NTX excretion were significantly increased 4 weeks after copper supplementation (p = 0.009 and p = 0.013, respectively). Serum bone ALP and OC were not significantly changed 12 weeks after copper supplementation (p = 0.051 and p = 0.594). CONCLUSIONS: In patients with nutritional copper deficiency, bone resorption markers are increased with copper supplementation.

Beneficial effect of complementary alternative medicine on lymphedema with rheumatoid arthritis.

Lymphedema of the limbs can be an added complication in a small number of rheumatoid arthritis cases, becoming a long-standing problem even when there is good control of inflammatory joint disease. In the present article, we describe a patient with RA who developed lymph-edema of the forearms successfully treated with TJ-48 (Juzentaihoto) as a complementary alternative medicine (CAM). This kind of edema does not seem to show any consistent relationship with the severity of arthritis in the literature surveyed. In contrast, lymphedema in this case improved in parallel with RA disease activity. We discuss the utility of CAM treatments and review the literature.

[Relationships among urine pH, serum uric acid and pyuria in hospitalized elderly patients].

To identify risk factors of urinary tract infection (UTI) in geriatric patients, the levels of serum uric acid, serum creatinine, and urine pH were compared between pyuria-positive and -negative patients in a geriatric ward. The level of serum uric acid was higher with lower urine pH level in the pyuria-negative patients than in positive patients. The level of serum creatinine was relatively higher in the pyuria-negative patients than in the positive patients. Even after matching for serum creatinine, serum uric acid was significantly higher in the pyuria-negative male patients. The results in the present study proposed an interesting hypothesis about backgrounds for UTI in geriatric patients. The relationships among serum uric acid, serum creatinine, urine pH, and pyuria should be examined further in a larger population and in experimental studies.