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介護施設や家庭において，認知症の方が発症する行動・心理症状（BPSD）は，家族・介護者に大きな負担を課しているだけでなく本人にも負の影響を与えている．本研究では，IOTの技術を用い複数の介護施設で環境センサ・バイタルセンサの情報を収集し，そのデータに基づき，機械学習の手法である勾配ブースティング木とDNNの一種CNNを利用してBPSDの予測を行う．約5か月間のデータを用いて評価実験を行った結果，勾配ブースティングを使った手法において，BPSD発症推定の可能性を示すことができた．In nursing homes and homes, Behavioral and Psychological Symptoms of Dementia (BPSD) that developed by people with dementia not only impose a heavy burden on family members and caregivers but also give the individuals themselves negative impacts. In this study, we used IOT technology to collect data from environmental and vital sensors at multiple nursing homes, and based on the data, we estimated BPSD using gradient boosting decision trees (GBTD), a machine learning technique, and CNN, a type of DNN. As a result of evaluation experiments using approximately five months of data, we were able to demonstrate the possibility of estimating the onset of BPSD for the method using GBDT.

Endoscopists' abilities to diagnose early gastric cancers (EGCs) vary, especially between specialists and nonspecialists. We developed an artificial intelligence (AI)-based diagnostic support tool "Tango" to differentiate EGCs and compared its performance with that of endoscopists.The diagnostic performances of Tango and endoscopists (34 specialists, 42 nonspecialists) were compared using still images of 150 neoplastic and 165 non-neoplastic lesions. Neoplastic lesions included EGCs and adenomas. The primary outcome was to show the noninferiority of Tango (based on sensitivity) over specialists. The secondary outcomes were the noninferiority of Tango (based on accuracy) over specialists and the superiority of Tango (based on sensitivity and accuracy) over nonspecialists. The lower limit of the 95% confidence interval (CI) of the difference between Tango and the specialists for sensitivity was calculated, with-10% defined as noninferiority and0% defined as superiority in the primary outcome. The comparable differences between Tango and the endoscopists for each performance were calculated, with10% defined as superiority and0% defined as noninferiority in the secondary outcomes.Tango achieved superiority over the specialists based on sensitivity (84.7% vs. 65.8%, difference 18.9%, 95% CI 12.3-25.3%) and demonstrated noninferiority based on accuracy (70.8% vs. 67.4%). Tango achieved superiority over the nonspecialists based on sensitivity (84.7% vs. 51.0%) and accuracy (70.8% vs. 58.4%).The AI-based diagnostic support tool for EGCs demonstrated a robust performance and may be useful to reduce misdiagnosis.

The application of artificial intelligence (AI) using deep learning has significantly expanded in the field of esophagogastric endoscopy. Recent studies have shown promising results in detecting and differentiating early gastric cancer using AI tools built using white light, magnified, or image-enhanced endoscopic images. Some studies have reported the use of AI tools to predict the depth of early gastric cancer based on endoscopic images. Similarly, studies based on using AI for detecting early esophageal cancer have also been reported, with an accuracy comparable to that of endoscopy specialists. Moreover, an AI system, developed to diagnose pharyngeal cancer, has shown promising performance with high sensitivity. These reports suggest that, if introduced for regular use in clinical settings, AI systems can significantly reduce the burden on physicians. This review summarizes the current status of AI applications in the upper gastrointestinal tract and presents directions for clinical practice implementation and future research.

Oil with a chlorinated extremely-pressure additive (EP-additive) is effective to prevent galling in cold forming for stainless steel. However environmental issues have pressured the manufacture to replace this oil with high performance oil without chloride. Particularly, sulfur-based EP-additives are accepted as a practicable replacement for chlorinated EP-additives. Thus, the authors analyzed the structures of organic-sulfur compounds. Moreover, the effects of the molecular structures on the anti-galling performance are estimated by a cup internal ironing test. This test has been devised to classify the performance of sample oils by the ironing load and the damage on the workpiece after the test. Consequently, sulfurized olefin was superior to sulfurized ester and sulfurized fatty oil in cold ironing for stainless steel. It was also clarified that sulfur EP-additives generated iron sulfide and sulfate on the surface of stainless steel by using the surface analyses of X-ray photoelectron spectroscopy.

Near-dry machining attracts increasing attentions for environmental and economical benefits, and MQL machining has been recognized as the most representative near-dry method. It is highly successful in machining of most ordinary steels, and synthetic biodegradable polyol esters play a significant role as an effective cutting fluid with a very small amount. Recent concern for environmentally friendly manufacturing further encourages the attempts at applying near-dry operations to machining of difficult-to-cut materials. Since titanium alloys are typical difficult-to-cut materials, this paper investigates the cutting performance of various near-dry methods in turning of a titanium alloy from the view point of elongating the tool life. Those near-dry methods include regular MQL and hybrid mist supply operations, where the hybrid mist is a mixture of MQL mist and coolant mist which is atomized water-soluble cutting fluid. The regular MQL operation provided considerably long tool life compared with that of dry machining and the hybrid mist operation showed the possibility of making the tool life longer. The cutting performance was largely influenced by the type of MQL lubricants. In particular, a synthetic polyol ester lubricant having low viscosity indicated the successful cutting performance when it was combined with the coolant mist supply in the hybrid mist application.

The perioperative immune status of colorectal robotic surgery (RS), laparoscopic surgery (LS), and open surgery (OS) patients has not been compared. Our aim was to evaluate perioperative stress and immune response after RS, LS and OS. This prospective study included 46 colorectal surgery patients from the Department of Surgical Oncology of the University of Tokyo Hospital. Peripheral venous blood samples were obtained preoperatively and on postoperative days 1, 3, and 6. We evaluated expression of HLA-DR (marker of immune competence), C-reactive protein (CRP) levels, and lymphocyte subset counts (natural killers, cytotoxic T cells and helper T cells). Fifteen, 23, and 8 patients underwent RS, LS and OS, respectively. HLA-DR expression was the lowest on day 1 and gradually increased on days 3 and 6 in all the groups. There was no significant difference in postoperative HLA-DR expression between the RS and LS group. However, on day 3, HLA-DR expression in the RS group was significantly higher than in the OS group (p = 0.04). On day 1, CRP levels in the LS group were significantly lower than in the RS group (p = 0.038). There were no significant perioperative changes in the lymphocyte subset cell count between the three groups. Perioperative surgical stress, as evaluated by immunological parameters, was comparable between robotic and laparoscopic surgery and higher with open surgery. Robotic surgery may be an alternative to laparoscopic surgery, as a minimally invasive surgery option for colorectal cancer.

Background Recent studies have shown that fibroblast growth factor-23 (FGF-23) is elevated not only in chronic kidney disease (CKD), but also in acute illnesses such as acute kidney injury, septic shock, and acute heart failure. FGF-23 would be not only a simple biomarker but also a direct toxic factor in acute illness. Therefore, lowering circulating FGF-23 levels in clinical practice would be an exciting and valuable interventional strategy. Continuous hemodiafiltration (CHDF) is often performed for the treatment of the aforementioned acute illnesses. We have previously reported that an acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST) membrane has a greater capacity for in vitro FGF-23 adsorption than polysulfone and polymethyl methacrylate membranes. However, reports related to the influence of AN69ST-CHDF on serum FGF-23 levels in acute illness are lacking. In this study, we investigated the effect of AN69ST-CHDF on circulating FGF-23 concentrations in clinical practice. Methods Subjects comprised six inpatients who underwent AN69ST-CHDF for an acute illness. Blood samples for the measurement of serum FGF-23 were collected at 0, 3, and 12 hours post-treatment. Blood samples were also drawn from the extracorporeal circuit at the inlet and outlet of the hemofilter 3 hours after CHDF initiation, in order to calculate the clearance of serum FGF-23. Results Three and 12 hours after the start of AN69ST-CHDF, circulating FGF-23 levels decreased from baseline values with a marginal statistical significance (p = 0.0625 and 0.0938, respectively). An FGF-23 clearance of 27.5 [interquartile range: 19.4 - 29.2] mL/minute 3 hours after the initiation of AN69ST-CHDF was achieved. Conclusions Our results suggest that AN69ST-CHDF can be a novel FGF-23 lowering therapy for acute illnesses requiring acute blood purification.

Background We present a case of asynchronously occurring adenocarcinomas 29 and 36 years after ureterosigmoidostomy for bladder cancer, respectively, at both anastomosis sites. Case presentation A colonoscopy that was performed on a 69-year-old man because of bloody stool and an elevated carcinoembryonic antigen (CEA) level revealed a polypoid lesion at the right ureterosigmoid anastomosis site 29 years after the patient’s ureterosigmoidostomy. Endoscopic resection was performed, and the lesion was diagnosed as adenocarcinoma. Seven years later (36 years after ureterosigmoidostomy), an elevated lesion was detected at the left ureterosigmoid anastomosis site by colonoscopy performed after detection of high CEA levels. Biopsy revealed an adenocarcinoma that was immunohistologically positive for CDX2; sigmoidectomy and ureterectomy were subsequently performed. The pathological diagnosis of the second tumor was adenocarcinoma arising in the ureterosigmoid anastomosis site and invading the left ureter. Conclusions Diligent long-term follow-up of patients who underwent ureterosigmoidostomy is essential.

MQL technique has been recognized as the most representative method of environmentally friendly near-dry machining. In machining of aluminum and its alloys, since they have highly adhesive characteristics, effective lubrication is often necessary and MQL machining sometimes finds difficulty. This paper therefore investigates the lubricating action of MQL media with various compositions in machining of aluminum. Detailed examination regarding the contents of carrier gases has demonstrated oxygen leads to the low cutting performance and its concentration in carrier gases has to be kept below the level between 1% and 10% to attain successful MQL machining of aluminum. Further, increasing the amount of MQL lubricant supply by boosting the air pressure is the efficient and convenient way to make MQL drilling of aluminum satisfactory.

In the cold rolling of aluminum foil, coolants made with nonaromatic base oils provide poor lubricity compared with coolants made with conventional base oils. But there is no clear difference in lubricity between nonaromatic and conventional base oils in the case of the rolling of aluminum sheet. In evaluations of the adsorption activity of model base oil components, alkylbenzene with a longer alkyl chain shows the potential to enhance the adsorption activity of alcohol onto the nascent aluminum surface. In experimental rolling, furthermore, the lubrication performance of coolants using nonaromatic base oils can be improved with the addition of dodecylbenzene. The addition of 10 mass% of dodecylbenzene into a nonaromatic coolant is sufficient for practical lubrication performance in the cold rolling of aluminum.

This study aimed to clarify differences in prognostic factors, metastatic features, and recurrence rates between histologic types in patients with stage 4 colorectal cancer (CRC) who had undergone curative resection. The data from 1131 patients with stage 4 colorectal cancer from the databases of referral institutions were analyzed. The patients were divided into two groups according to histologic types as follows: patients with poorly differentiated adenocarcinoma, mucinous adenocarcinoma, or signet-ring cell carcinoma (Por/Muc/Sig) and patients with well-differentiated or moderately differentiated adenocarcinoma (Wel/Mod). Differences in clinicopathologic features, relapse-free survival (RFS) rates, and cancer-specific survival (CSS) rates between the groups were evaluated. Although RFS did not differ between the Por/Muc/Sig and Wel/Mod groups, CSS was significantly shorter in the Por/Muc/Sig group’s than in the Wel/Mod group, and survival after recurrence was significantly worse in the Por/Muc/Sig group than in theWel/Mod group. The incidence of peritoneal or local recurrence was significantly higher for the Por/Muc/Sig patients, whereas the resection recurrence rate was 16.4 %. Multivariate analysis suggested that histologic type was an independent prognostic factor for survival after recurrence. The patients with Por/Muc/Sig CRC synchronous metastasis had significantly shorter survival times than the patients with other CRC histologies, even if the metastases were curatively resected.

A tiny hollow space on the interface between the approach and the machining path may cause critical damage during superfine machining by wire-cut electrical discharge machine (WEDM). This paper points out that this space is caused by the reduction of the machined volume near the approach point. To resolve this problem, a compensation method for the mark using offtime control based on the machining volume model is proposed. It is found that the accuracy of this method can be increased if the influence of offtime control on wire vibration is taken into account. It appears that the mark can be lost in the surface roughness by using this method. The method is practical because it can be applied according to the variation in workpiece thickness without any tuning of parameters. In addition, it is shown that the proposed method does not only reduce the mark, but also easily changes it from concave to convex. This feature is advantageous because the volume of polishing after the WEDM process is greatly reduced. Therefore, the proposed method is proven to be quite useful in precision processing by WEDM.

In this paper, it is shown that upstream digital signals are affected by the ingress noise in the upstream band of a two-way CATV system. The carrier-to-noise ratio of the digital data signal may be reflected by the immunity characteristics of each subscriber's unit, which consists of a CATV protector connected to a coaxial cable. It was found by bit-error-rate measurement in the two-way CATV model system that the value of the relative operating level is smaller in the UHF upstream band than the value in the HF to VHF one.

Most deaths from acute myocardial infarction (AMI) occur before the patient arrives at the hospital. In the previous symposium at Sapporo, it was emphasized that in order to reduce mortality from AMI, it was extremely urgent to increase public education concerning ischemic heart disease (IHD) and the popularization of by-stander cardiopulmonary resuscitation, and to establish a rapid patient transport system.

One of the most challenging issues in the metal hard mask (MHM) process is controlling the residual stress in TiN mask. This becomes more important as the feature sizes of trenches and vias continue to shrink and the low k-value dielectrics are introduced to Cu interconnect. It is found that the deformation of trenches due to the residual stress in TiN results in Cu voids forming. To overcome this problem, the correlation between the residual stress and the film property of TiN has been investigated. The residual stress in TiN is found to strongly correlate with both the grain size and the crystal structure of TiN, and low residual stress in TiN is accomplished by suppressing the grain growth of TiN. By applying TiN that has a quite fine needle-like structure, the trench deformation can be suppressed and thus the gap filling is perfectly achieved. The MHM process using TiN film that has a needle-like structure is a promising technology for 32-nm node Cu interconnect and beyond.

We encountered a patient with spontaneous coronary artery dissection complicated by acute inferior myocardial infarction. A 58-year-old male was admitted to our hospital due to acute inferior myocardial infarction in 1979. Coronary angiography performed 4 weeks after the onset showed a double lumen divided by a linear intimal flap in the right coronary artery, suggesting coronary artery dissection, but no apparent occlusion. Subsequently, he had been medicated with nitrates without any recurrent infarction. In February, 1989, 10 years after the first examination, coronary angiography was again performed and showed that the dissection had remained unchanged. Acetylcholine infusion into the right coronary artery induced coronary spasm. The prognosis of this condition seems to be better than has been generally considered, particularly in patients such as ours in whom the involvement of coronary spasm in the development of coronary artery dissection and myocardial infarction is suggested. When coronary spasm in controlled by treatment with nitrates or calcium antagonists, an uneventful course may be expected.

Coronary arteriography was performed in 1, 029 consecutive patients with ischemic heart disease and the relationship between the arteriographic features of coronary atherosclerosis and coronary risk factors was analyzed by case control studies. Patients were divided into four groups according to coronary arteriographic findings. Patients with normal or near normal coronary arteriograms (Group I) showed a high prevalence of smoking habit and a higher value of serum uric acid compared with the control group, so smoking and hyperuricemia were considered to be the risk factors for coronary atherosclerosis in patients of group . Four selected variables: smoking, hyperuricemia. hypertension and hyperlipidemia. were identified to be risk factors for the patients with minor plaques in the coronary arteries (Group II). As in Group I. smoking and hyperuricemia had a close relationship to solitary tight plaque in a branch of the coronary artery (Group III). Multiple tight stenoses in the coronary arteries (Group IV) correlated closely with smoking. hyperuricemia, hypertension, hyperlipidemia and diabetes mellitus. Thus, there were many strong risk factors for patients with diffuse, extended coronary atherosclerosis (Group II and Group IV), while only two factors. smoking and hyperuricemia, were considered to be risk factors for the patients with near normal coronary arteries ies or a solitary plaque in a branch of the coronary artery. These findings suggest that the role of the coronary risk factors on the pathogenesis of coronary atherosclerosis is not uniform but variable depending on the morphologic variability of the coronary atherosclerosis and on the pathophysiology of the ischemic heart disease.

This research intends to build up the probabilistic models of three heterogeneous sensors, Camera, Range sensor and RFID for dealing with objects localization problems, and also aims to fulfill the sensor fusion with these models. In this paper, we describe the mathematical significance for the sensor models, and define concrete models. Then we show the effectiveness of sensor fusion with these models from the simulation.

Position estimation and tracking of multiple objects by vision sensors is one of the most fundamental technologies. While the vision sensors provide high accuracy measurements for position estimation, they require suitable features of objects for accurate recognition and detection as prior knowledge. Especially, learning of appearance based features of objects requires large quantities of training data, which makes development costs. This paper proposes a method for learning appearance based features of objects using auxiliary data of RFID. In this method, the RFID device is used as a supervisor to semi-automatically construct the training data set for each objects. Since it is difficult to observe what ID does an object image correspond to, this problem comes down to supervised learning using incompletely labeled features. This paper proposes a learning method using Kernel PCA and EM Algorithm, and verifies the effectiveness and robustness of this method.

In this paper, we describe a formulation and EM method to fuse heterogeneous sensor data for localizing and identifying objects. The heterogeneous sensors are such as cameras, RFID readers and range finders. They are different from each other in degree of accuracy of localizing and identifying objects. Errors in identifying objects is a problem which makes localization difficult. We formulate a localization and identification problem with a hidden variable R which describes associations between objects and observed values. We estimate objects' positions and the asssociation vector R by an EM algorithm. We illustrate the algorithm in a case of using simulated cameras and RFID readers. Experimental results show that our method can localize and identify objects more accurately than other methods without the R.

Two thousand, seven hundred and thirty-three patients with acute myocardial infarction (AMI) who were admitted to our 11 institutions between 1983 and 1988, examined by coronary arteriography and discharged alive, were followed for an average of 2.9 years. During the follow-up period, 212 patients (7.6%) died. The factors that governed the prognosis of myocardial infarction after discharge were advanced age, female gender, obesity, previous infarction, angina pectoris more than 1 month before the onset of AMI, post-infarction angina, multiple-vessel diseases, advanced stage by Killip's and/or Forrester's classification on admission, elevated pulmonary capillary arterial pressure, decreased cardiac index, decreased left ventricular ejection fraction, increased left ventricular end-diastolic volume and left ventricular aneurysm before hospital discharge. Patients with ventricular tachycardia or ventricular fibrillation during hospitalization showed a poor prognosis. In contrast, patients who received intracoronary thrombolysis, or emergent and/or elective percutaneous transluminal coronary angioplasty showed a favorable prognosis.

One hundred and nineteen patients with acute myocardial infarction (AMI) were examined to establish the correlation between clinical and hemodynamic status. Patients were divided into 5 groups: uncomplicated AMI (Group A, 34 cases), congestive heart failure (Group B, 56 cases), cardiogenic shock (Group C, 14 cases), right ventricular dysfunction in cases with acute inferior infarction (Group D, 7 cases), and rupture of the interventricular septum (Group E, 8 cases). Hemodynamic classification of the first three groups with 18 mmHg for pulmonary arterial diastolic pressure (PADP) or pulmonary capillary pressure (PCW), 2.0 L/min/m2 for cardiac index (CI), and 20 g·m/beat/m2 for left ventricular stroke work index (LVSWI) correlated well with our clinical classification. In addition to hemodynamic measurements, monitoring of the temperature difference between the core and the periphery of the body reflects both cardiac function and clinical status of peripheral circulation and has been useful in selecting the appropriate therapy for AMI. Mortality rates were similar in the clinical and hemodynamic subset classifications, averaging 2.9% in Group A, 7.1% in Group B, 57.1% in Group C, 42.9% in Group D, and 62.5% in Group E. The hemodynamic effects of intravenous nitroglycerin (TNG), TNG ointment, and molsidomine were studied in 54 patients. All three vasodilators significantly reduced PADP or PCW and systemic vascular resistance (SVR), and increased CI in patients with elevated PADP or PCW. Also, TNG was effective in decreasing PADP or PCW, SVR, and left-to-right shunt ratio, and increasing forward cardiac output in Group E. However, in cases with severe pump failure in which CI was less than 2.1 L/min/m2, LVSWI was less than 20 g·m/beat/m2 and PADP or PCW was more than 18 mmHg, dopamine and a combination of dopamine and phentolamine produced beneficial hemodynamic responses. The overall early mortality rate of the AMI at our CCU decreased from 22.9% during 1974 to 1976, when no such therapy was applied, to 15.9% after therapy. A marked reduction in the mortality rate due to left ventricular failure from 33.3% to 13.5% was observed. Both hemodynamic and clinical data indicate that a new therapy employing vasodilators and a combination of vasodilators and catecholamines can be applied effectively in patients with pump failure following AMI.

We made a clinical and statistical evaluation of the occurrence of acute myocardial infarction with respect to the relation between its occurrence and the meterology of the cold inland area of Hokkaido (the Kamikawa Basin) over a period of 10 years (1976-1985). A total of 581 cases were studied. Monthly fluctuation of incidence was not found to be statistically significant. A cold period in the Kamikawa Basin was defined in this study as the period when ordinary mean atmospheric temperatures were below 0 degree C (from 7 Nov. to 16 Apr.). Canonical discriminant analysis was applied to 10 meterological factors between the days with occurrences and those without occurrences (245 days vs 245 days) in the cold periods of the investigated 10 years, and between the days with outdoor occurrences and those without occurrences (37 days vs 37 days). In order to compare the regional difference, this analysis was done on the same 10 factors for the cold periods over 3 years in Yamagata (46 days vs 46 days). The F values of 0.0003, 0.0155 and 0.0098 respectively in the above 3 analyses were small (much less than F 1(9) (0.25) = 1.51). A circadian rhythm of 2 cycles/day was recognized concerning the time of occurrence by power spectral analysis of the data of 562 patients for whom the time of the onset of myocardial infarction was known. Subdividing the patients into 2 groups according to physical activity just before the occurrence, the group who experienced an occurrence at rest showed a rhythm of 1 cycle/day, and the group who experienced an occurrence on effort showed a rhythm of 2 cycles/day. Therefore, the 10 meterological factors could not discriminate the probabilities between the days with occurrences and the days without occurrences of myocardial infarction in the cold periods. On the other hand, it was suggested that biological intrinsic rhythm participates in triggering the occurrence of myocardial infarction.

Shiritus Asahikawa Hospital received a total of 922 patients with acute myocardial infarction (AMI) from 1961 through 1985. the numbers of AMI patients and deaths during 1981-1985 were 2.8 times and 2.3 times, respectively, those observed during 1971-1975. However, decreasing trends were noted in the overall and age-adjusted mortality due to ischemic heart disease (IHD) per population of 100, 000 Asahikawa residents between 1975 and 1984, suggesting a discrepancy between our CCU data and the city's records. We investigated the prehospital condition, out-of-hospital cardiac arrest, and the mechanism of early deaths in patients hospitalized with AMI. It was found that the increase of AMI patients admitted to our hospital was due to an increase in the hospitalization rate of AMI patients and the establishment of the coronary care unit (CCU) which allowed the admittance of patients who might have been declared dead out-of-hospital in the past. On the other hand, the declining trends in IHD mortality in the entire city of Asahikawa were attributable to reductions in the in-hospital and out-of-hospital fatality rates of patients with AMI, to improved hospital fatality rates of patients with AMI, and to improved survival rates in AMI patients who developed ventricular fibrillation (Vf) or who experienced out-of-hospital cardiac arrest episode. In order to further decrease the case-fatality rate of patients with AMI, it is essential to continuously educate residents on emergency treatment to be given at the onset of AMI.

Problems and limitations of medical management for infective endocarditis were studied and surgical indications were discussed based on the retrospective analysis of 55 episodes. Since perioperative complications still occur during highly active infection, antibiotic treatment was suggested as the primary management. Intractable or progressing heart failure appeared to be a definite indication for emergency surgery, but medical therapy was recommended for mild to moderate heart failure. For uncontrolled infection of more than one month duration despite the best available antibiotics, surgical debridement of the infected tissue was indicated. Occurrence of peripheral or fatal emboli was difficult to predict from clinical features and echocardiogram and therefore presented a therapeutic dilemma. Since major or fatal emboli frequently occurred during highly active infection, early initiation of effective antibiotic therapy was considered to be of primary importance. Demonstration of vegetation by echocardiography alone did not seem to justify urgent surgery. In addition, disseminated intravascular coagulation appeared to be a serious complication and thus sedimentation rate should be followed carefully. In the healed stage, prophylactic surgery seemed unnecessary for prevention of recurrent infection or embolization, as they were relatively rare.

To clarify the patho-etiologic factors of Japanese myocardial infarction, a comparative pathological study of myocardial infarction in the Osaka, Akita, Wakayama, and Hokkaido districts, and an extensive histopathological study of 94 autopsy cases with acute myocardial infarct (AMI) in less than 4 weeks at Osaka were carried out. Although AMI in Akita was highly complicated by hypertension, AMI in Osaka was associated with a history of diabetes mellitus and hypercholesterolemia, especially in the young generation (under 59 years of age); hypercholesterolemia was related to the occurrence of AMI. Moreover, in spite of increases in transmural myocardial infarct (TMI) in Osaka, Hokkaido and Wakayama, Akita showed an equal ratio of TMI and subendcardial myocardial infarct. In AMI in Osaka, significant stenosis (more than 75% stenosis) of the coronary artery was of the same grade between the proximal and distal portions in the epicardial coronary artery. AMI in Akita, however, showed more severe stenosis in the proximal than the distal portion. A high incidence (88.3%) of thrombosis formation corresponding to the site of infarction was observed in AMI in Osaka. Moreover, ruptured atheromatous plaques were identified as being responsible for 62.6% of the coronary thrombosis cases, and a high incidence (70.0%) of foamy cell infiltration was disclosed. Thus, it can be concluded that ruptured atheromatous plaque is a major factor in the progression of coronary atherosclerosis and/or thrombosis, which might be due to the process of plaque softening.

There have been a few reports of cardiac involvement in the Kugelberg-Welander syndrome. We presented a case of this syndrome complicated with cardiomegaly and conduction disturbance. The patient, a 21-year-old woman, had atrial standstill and A-V junctional rhythm. The chest X-ray film showed marked cardiomegaly. The His bundle electrogram revealed that H-V interval was 40 msec. She was treated with implantation of cardiac pacemaker.