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We examined osteoporosis medication use and factors affecting persistence in 497 patients with fragility hip fractures. Only 25.5% of patients received continuous medication for 3 years, and 44.1% of patients received no treatment. Low Barthel index at discharge was a risk factor for both non-treatment and non-persistence to osteoporosis medication. Fragility hip fractures (FHF) caused by osteoporosis decrease the quality of life and worsen life expectancy. Use of osteoporosis medication may be an efficient method in the prevention of secondary FHF. However, previous studies have reported low rates of osteoporosis medication and persistence after FHF. This study aimed to evaluate osteoporosis medication use and factors affecting persistence in patients with FHF in the northern Kyushu area of Japan. A total of 497 FHF patients aged ≥ 60 years with a 3-year follow-up were included. We prospectively collected data from questionnaires sent every 6 months regarding compliance with osteoporosis medication. We compared baseline characteristics among three groups: no treatment (NT), no persistence (NP), and persistence (P), and conducted multivariable regression models to determine covariates associated with non-treatment (NT vs. NP/P) and non-persistence (NP vs. P). There were 219 (44.1%), 151 (30.4%), and 127 (25.5%) patients in the NT, NP, and P groups, respectively. Factors associated with non-treatment were male sex, chronic kidney disease, no previous osteoporosis treatment, and low Barthel index (BI) at discharge. The only factor associated with non-persistence was a low BI at discharge. Factors associated with a low BI at discharge were male sex, older age, trochanteric fracture, and surgical delay. Low BI at discharge is a risk factor for both non-treatment and non-persistence to osteoporosis medication. Therefore, appropriate interventions to improve BI may result in persistence to osteoporosis medication.

Osteoporosis has become a worldwide public health problem, in part due to the fact that it increases the risk of fragility hip fractures (FHFs). The epidemiological assessment of FHFs is critical for their prevention; however, datasets for FHFs in Japan remain scarce. This was a multicenter, prospective, observational study in the northern district of Kyushu Island. Inclusion criteria were age > 60 years with a diagnosis of FHF and acquisition of clinical data by an electronic data capture system. Of 1294 registered patients, 1146 enrolled in the study. Nearly one third of patients (31.8%) had a history of previous fragility fractures. The percentage of patients receiving osteoporosis treatment on admission was 21.5%. Almost all patients underwent surgical treatment (99.1%), though fewer than 30% had surgery within 48 h after hospitalization. Bone mineral density (BMD) was evaluated during hospitalization in only 50.4% of patients. The rate of osteoporosis treatment increased from 21.5% on admission to 39.3% during hospitalization. The main reasons that prescribers did not administer osteoporosis treatment during hospitalization were forgetfulness (28.4%) and clinical judgment (13.6%). Age and female ratio were significantly higher in patients with previous FHFs than in those without. There was a significant difference in the rate of osteoporosis treatment or L-spine BMD values in patients with or without previous FHFs on admission. In conclusion, this study confirmed that the evaluation and treatment of osteoporosis and FHFs is still suboptimal in Japan, even in urban districts.

Purpose: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. Methods: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. Results: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8–12.0%, n = 45). Log-rank test revealed that previous fractures ( p = 0.003), Barthel index (BI) at discharge ( p = 0.011), and place-to-discharge ( p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking ( p = 0.007), length of hospital stay (LOS; p = 0.009), and BI ( p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI 2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS Conclusions: Previous vertebral fractures and BI 2, TCCI ≥5, smoking history, LOS

Radiation in the millimeter range with a broad spectrum was observed in laser plasma interaction experiments. The spectral region range of the radiation is from 26.5 to 325 GHz, which is the upper limit of the present detector, with a pulse duration of 200 ps. The direction of the radiation is symmetrical from 30 to 60° with respect to the laser direction, and its poralization is in the radial direction, i.e., the TM01 mode. This suggests that the radiation is generated by the radial oscillation of plasma electrons under the electric field of a laser generated immovable ion column. The frequency of the radiation depends on the initial electron velocity that is accelerated by the laser-generated ponderomotive force at the focal spot. To explain the angular distribution of the radiation, the radiation is emitted from the plasma column. The numerical calculation of the distribution is in good agreement with the experimental data.

シンナー常用者に発症した重症急性肝障害の1例を経験したので報告する.症例は16歳男性で,輸血歴・飲酒歴・薬物乱用歴はない.平成元年4月頃よりシンナーの吸入を始めていたが,同年6月吸入した直後より悪心・嘔吐・発熱を来して来院.入院時,比較的重症の肝障害を認めたが,各種ウイルスマーカーは陰性であった.経過は良好で,約3週間後には肝機能は正常化した.腹部超音波検査にて肝腎コントラストの増強がみられたが,肝機能の正常化とともに改善した.尿中より馬尿酸及びメチル馬尿酸を検出し,吸入したシンナーの主成分はトルエンであると推定された.第18病日に施行した肝生検では,小葉中心性の壊死及び出血が特徴的で,門脈域には著変を認め得なかった.有機溶剤により重篤な肝障害を来した報告は稀であり,興味ある症例と考え報告した.

This article reviews the electromagnetic waves generated by the interaction of ultrashort laser pulses with plasma. Linearly polarized radiation in the range between 100 to 200 GHz is radiated from the magnetized plasma. The effect of the uniform of the experimental condition is studied by comparing the results of gas nozzle and gas‐filled chamber. Radiation which is no longer linearly polarized is radiated from the non‐magnetized plasma. To enhance the radiation and improve the detection range, capillary discharge laser‐waveguide and terahertz time‐domain system are setup.

A 53-year-old man was admitted with impairment of breathing following laryngeal edema. Serum levels of CH50 (22 U/ml), C4 (3 mg/dl), C1-INH protein (10.6 mg/dl) and C1-INH activity (LT 25%) were low. Complement study of the patient's family members revealed that he was one of 5 patients in 3 generations with hereditary angioneurotic edema (HANE). Administration of the androgen derivatives Danazol (600 mg/day) and Oxymetholone (30 mg/day) effectively increased serum levels of C1-INH activity and C4. Though eruption and hepatic dysfunction attributable to administration of the drugs appeared, these side effects improved after withdrawal of the drugs. Subsequently, the treatment with Danazol at a low dose (100 mg/day) was resumed, and the patient has had no episodes of edema for the past 3 years. Regarding the familial cases of HANE, fewer than 20 have been reported in Japan.

We experienced a patient in whom coronary spasms were induced by an ergonovine provocation test during coronary angiography at the sites of coronary artery ectasia. The patient was a 45-year-old male with chest pain at rest, which promptly disappeared when given sublingual nitroglycerin. Similar attacks occurred frequently even with the administration of drugs after admission, but no significant changes were observed in electrocardiography (ECG) during the attacks or by repeated Holter ECG. The results of exercise ECG and provocation tests such as Valsalva maneuver, hyperventilation, and cold pressor test were negative. Coronary angiography showed ectatic changes in the left coronary artery, and the coronary spasms were induced by ergonovine administration at the ectatic portion of the left anterior descending artery and left circumflex artery, and right coronary artery with chest symptoms similar to those observed during spontaneous attacks. However, there were no significant changes in ECG. This rare case suggests an involvement of spasms in the pathogenic mechanism of myocardial ischemia in coronary artery ectasia.

Although the incidence of ventricular arrhythmias following myocardial ischaemia lessens as ischaemia improves, it is not clear whether this is correlated with a reduction in the degree of ST segment elevation. To explore this further we examined the effects of change in heart rate and the administration of the calcium antagonist diltiazem, 0.02 mg·kg−1·min−1, on ST segment elevation and the alternans of ST segment elevation (STA) and on serious ventricular arrhythmia induced by 10 min occlusion of the left anterior descending coronary artery in 86 mongrel dogs. The dogs were divided into three groups: 26 dogs paced at a rate of 180 beats·min−1 (group A); 44 dogs paced at a rate of 120 beats·min−1 (group B); and 16 dogs paced at a rate of 180 beats·min−1 and given diltiazem intravenously from 25 min before the coronary occlusion (group C). The degree of ST segment elevation and STA within 3 min of ischaemia was significantly lower in group B than in group A. There was no marked difference in the degree of ST segment elevation between groups A and C, but the STA was lower in group C than in group A. Incidence of ventricular tachycardia and ventricular fibrillation was significantly lower in groups B and C than in group A, and the timing of their first appearance was 4.5(SEM 0.6), 4.2(0.9) and 3.0(0.4) min, respectively. We suggest that the reduction in serious ventricular arrhythmias associated with the decrease in heart rate was caused by the improvement of STA secondary to the improvement of ST segment elevation. However the reduction in these arrhythmias after diltiazem may be related to STA improvement due to other factors, such as the reduction of cellular damage, rather than to improved ST segment elevation.

The combination of the systolic anterior motion of the anterior leaflet of the mitral valve and/or the mitral annular calcification in the case of asymmetrical septal hypertrophy has been fully recognized. However, in concentric left ventricular hypertrophy the systolic anterior motion of the anterior mitral valve and the massive posterior submitral calcification have not been commonly reported. We present a case with mild concentric left ventricular hypertrophy and massive posterior submitral calcification which displace the entire mitral ring anteriorly, namely, toward the left ventricular outflow tract. In this case, typical left ventricular outflow obstruction with systolic anterior motion of the anterior mitral valve was seen. Thus, we considered that this rare condition may have contributed to the formation of the systolic anterior motion of the anterior mitral leaflet in this case. We have provided additional information regarding the possible causes of systolic outflow obstruction in hypertrophic obstructive cardiomyopathy.

The effects of 9, 11-epihio-11, 12-methano-thromboxane A2 (STA2), a stable analogue to thromboxane A2, on platelet aggregation and its interaction with α blockers (phentolamine, prazosin and yohimbine) were studied in both mongrel dogs and healthy male volunteers in vitro.The results were as follows; (1) In dogs, though STA2 did not have a potency of inducing platelet aggregation, STA2 revealed enhancing effect on platelet aggregation induced by epinephrine, and this effect of STA2 was inhibited by α blockers, especially α2 blockers, (2) In healthy volunteers, STA2 itself induced platelet aggregation, and this effect of STA2 was also inhibited by α blockers, but dominancy of α1 or α2 blocker was unclear.It was concluded from these data that STA2 was a potent platelet aggregatory agent in human and this activity was inhibited by α blockers.

Vectorcardiographic, electrocardiographic, and hemodynamic changes in isolated infarction (infarct confined to the right ventricular free wall) were studied in 19 mongrel dogs. An isolated right ventricular infarction was produced by embolizing the right coronary artery with Spongel under closed chest conditions. The size of the infarct, identified by TTC staining, accounted for 6-65% (35.9 +/- 22.0%, mean +/- SD) of the right ventricular free wall. The STx, STy, STz, and the spatial magnitude of the ST segment (STM) were continuously recorded with an automated, real-time vectorcardiographic ST-segment analyzer (ST-monitor) using the Frank lead system. The cardiac index (CI) ratio (CI after embolization/CI before embolization) of all dogs with larger infarcts (infarct greater than 35% of the right ventricle) was below 1.0. In dogs with smaller infarcts (% RVI less than or equal to 35%), there were no differences in the hemodynamic data before and 4 h after embolization. In dogs with larger infarcts, however, pulmonary arterial pressure and heart rate 4 h after embolization were significantly decreased compared with those before embolization. In addition, right atrial pressure 4 h after embolization in the larger infarct group was significantly elevated compared with that in the smaller infarct group. In dogs with larger infarcts, STx, STy, and STM were significantly larger than in those with smaller infarcts both 15 min and 4 h after embolization. There were no significant correlations between infarct size and change in vectorcardiographic ST segments in the smaller infarct group.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of early perfusion after intracoronary infusion of urokinase (PTCR) in patients with acute myocardial infarction was assessed. Coronary perfusion was reestablished in 7 of 10 patients receiving intracoronary urokinase. We compared the recanalized group after intracoronary urokinase (n = 7) with the standard therapy group (n = 32). Left ventricular end-diastolic pressure, cardiac index, angiographic ejection fraction, radionuclide ejection fraction, defect score by Thallium-201 scintiscan and regional ejection fraction by the left ventriculogram, measured at about one month after the onset of acute myocardial infarction, were compared according to the site of the main coronary lesion (right coronary artery or left anterior descending coronary artery). No statistically significant differences between the recanalized group after the administration of intracoronary urokinase and the control group were found at each coronary lesion. On the other hand, the comparison between two patients with and without PTCR, who matched the clinical and coronary angiographic findings, showed that PTCR on acute myocardial infarction might be of value. However, evaluation of the long-term effects of coronary thrombolysis on survival and myocardial function will require controlled randomized trials of a large number of patients.