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Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): H20–Junkankitou [Seishuu]–Ippan–013; H23–Junkankitou [Seishuu]–Ippan–005; H26-Junkankitou [Seisaku]-Ippan-001; H29–Junkankitou–Ippan–003 and 20FA1002 OnBehalf EPOCH-JAPAN Introduction Absolute risk of Lifetime risk (LTR) is useful estimate for risk communication compared with short term risk or relative risk especially for young people. Proteinuria is leading cause of end-stage kidney disease (ESKD) and independent risk factor for cardiovascular disease (CVD). Although nonproteinuric renal disease is global burden of ESKD, it has been poorly focused. To date, there have been no reports of impact of proteinuria and low eGFR on LTR with the outcome of CVD death in Asian population. Purpose We aimed to estimate LTR of CVD death stratified by the status of proteinuria and low eGFR. Methods We used modified Kaplan-Meier approach to estimate the remaining lifetime risk of cardiovascular death based on EPOCH-JAPAN(Evidence for Cardiovascular Prevention From Observational Cohorts in Japan) database. LTR was estimated at each index age starting from 40 years for those with proteinuria and without proteinuria stratified by low eGFR, which is defined as eGFR Results A total of 47,292 participants from 9 cohorts was included in the analysis. Mean follow-up period was 14.6 years with 690,463 person years and total CVD death was 1,075 in men and 1,193 in women. The LTRs at the index age of 40 years were as follows: 17.7% (95% confidence interval: 15.4 – 19.0%) in Proteinuria (-)/Low eGFR (-) group, 26.2% (20.2 – 31.1%) in Proteinuria (-)/low eGFR (+) group, 24.5% (15.1 – 29.3%) in Proteinuria (+) group for men; 15.3%(13.7 – 16.5%), 29.9%(14.7 – 46.8%) , 28.3%(19.4 – 34.7%) for women. Conclusions We observed that those without proteinuria with low eGFR have equivalently high LTR with those with proteinuria. These results indicate that even in the absence of proteinuria, low eGFR has high impact on LTR. Lifestyle modification from young age is necessary to prevent from renal dysfunction.

Chronic low back pain (CLBP) and knee pain (CKP) has been understood as aggravating factors for essential locomotive functions such as gait or stair climbing among old age population. Several studies in the western countries have indicated the association between CLBP and/or CKP and obesity, however these relationships have remained unclear in Asian countries, where the prevalence of obesity has been relatively low. The aim of the present study was to investigate the associations of CLBP and/or CKP with overweight among Japanese elderly. We performed a cross-sectional study of 2,270 people in two Japanese communities, aged 40 to 74 years in 2015–2016. CLBP and CKP were defined as pain which had been at least weekly recognized in the previous 4 weeks, and had persisted beyond three months. Overweight was defined as 25 kg/m2 or higher. Logistic regression analysis was used to calculate multivariable adjusted odds ratio (OR) for overweight status. The multivariable included age, sex, area, current smoker, current drinker, hyperglycemia, hypercholesterolemia, and depression. The prevalence of overweight among each pain pattern was as follow: Neither (n=1576), 26%; CLBP alone (n=332), 28%; CKP alone (n=209), 34% (P

Background Although associations between snoring and cardiovascular disease have been reported in several prospective studies, there is limited evidence from Asian populations. The objective of this study was to determine if there is an association between self-reported snoring frequency and the incidence of cardiovascular disease in Japanese. Methods The subjects were 2350 men and 4163 women aged 40 to 69 years who lived in 3 communities in Japan. All subjects were participants in the Circulatory Risk in Communities Study (CIRCS) and were followed for 6 years. Incidence of cardiovascular disease during the follow-up period comprised events of myocardial infarction, angina pectoris, sudden cardiac death and stroke. Results During the 6-year follow-up period, 97 participants (56 men and 41 women) had cardiovascular events. After adjustment for potential confounding factors, self-reported snoring frequency was associated with an increased risk of cardiovascular events among women but not men. The hazard ratios (95% CI) for cardiovascular events were 0.9 (0.4-2.0) for sometimes snoring and 2.5 (1.0-6.1) for everyday snoring in women and 0.7 (0.3-1.3) and 1.0 (0.5-2.1), respectively, in men. Further adjustment for body mass index attenuated the association in women; the respective hazard ratios for cardiovascular events were 0.9 (0.4-1.9) and 2.1 (0.9-5.4). Conclusions Self-reported habitual snoring was associated with increased risk of cardiovascular events among Japanese women. Overweight may partly mediate this association.

Aim: To examine the effects of a once-weekly laughter and exercise program on physical and psychological health among elderly people living in the community. As a regular exercise program can be difficult to maintain, we provided a more enjoyable program to enhance adherence to exercise. Methods: A total of 27 individuals aged 60 years or older, without disabilities, were randomly assigned to either an immediate treatment group (n = 14) or a delayed treatment group (n = 13). The intervention was a 120-min session consisting of laughter and exercise, carried out once a week for 10 consecutive weeks. Measurements taken at baseline, 3 and 6 months included bodyweight, height, body fat, lean mass, bone mineral density, hemoglobin A1c (HbA1c), glucose, high-density lipoprotein and low-density lipoprotein cholesterol, and triglycerides, as well as self-rated health and psychological factors. Results: All participants completed the 3-month program. Bone mineral density increased significantly in the immediate treatment group compared with the delayed treatment group during the first 3 months (P

Aim: The aim of this study was to identify the threshold level for non-high-density lipoprotein cholesterol (non-HDL-cholesterol) to raise the risk of coronary heart disease (CHD) incidence in a Japanese general population.Methods: A total of 8,132 men and women, aged 40 to 69 years with no history of stroke or CHD, completed the baseline risk factor surveys between 1975 and 1987. Systematic surveillance of cardiovascular disease incidence was performed through 2003 (the median follow-up period was 21.9 years), and 155 incidents of CHD were identified.Results: We found a statistically significant association between non-HDL-cholesterol levels and the risk of CHD with a threshold around 140 mg/dL. After adjustment for potential confounding factors, this association did not change materially. The multivariable hazard ratio of CHD compared with that for levels of < 100 mg/dL was 2.49 (95% confidence interval: 1.35 to 4.61) for 140-159 mg/dL and 3.13 (1.58-6.21) for ≥ 180 mg/dL. Setting the cut-off point at ≥ 140 mg/dL non-HDL-cholesterol resulted in the greatest improvement of integrated discrimination.Conclusions: Higher concentrations of non-HDL-cholesterol are associated with an increased risk of CHD with a threshold around 140 mg/dL, suggesting that the optimal cut-off point for healthy per-sons to prevent increasing the risk of CHD might be around 140 mg/dL non-HDL-cholesterol.

Aim: We investigated whether nocturnal intermittent hypoxia, a surrogate marker for obstructive sleep apnea, is associated with metabolic syndrome and its components among Japanese.Methods: We examined 1,710 male and 2,896 female community-dwelling Japanese aged 40 to 69, who participated in annual cardiovascular examinations and investigations of sleep. Nocturnal intermittent hypoxia was estimated based on a 3% oxygen desaturation index measured with pulse-oximetry during sleep. No, mild and moderate-to-severe nocturnal intermittent hypoxia were defined by

Background: Cigarette smoking is an important, aggravating factor in metabolic syndrome (MetS). In addition, some studies have reported that MetS is related to alcohol consumption irrespective of the amount consumed. However, the relationship of the combination of the 2 habits to MetS has not been fully described.Methods: In this cross-sectional survey, a questionnaire was used to collect information on cigarette smoking and alcohol consumption from 3904 Japanese men aged 20 years or older. MetS was defined according to Japanese criteria. Logistic regression analysis was used to analyze relationships of cigarette smoking and alcohol consumption with MetS, after adjustment for potential confounding factors.Results: Among the subjects, 581 (14.9%) had MetS. Daily cigarette and alcohol consumption were significantly associated with the prevalence of MetS (P < 0.0001, P = 0.030 for trend). The multivariate-adjusted odds ratio for the prevalence of MetS was 1.89 (95% confidence interval: 1.34–2.65) for subjects who smoked ≥30 cigarettes/day, as compared with nonsmokers; 1.54 (1.06–2.23) for those who consumed ≥69 grams of ethanol/day, as compared with nondrinkers; and 3.63 (1.91–6.90) for those who smoked ≥30 cigarettes/day and consumed ≥69 grams of ethanol/day, as compared with those who neither smoked nor drank. The interaction of smoking ≥30 cigarettes/day with drinking ≥69 grams/day was 2.03 (1.02–4.01, P = 0.043).Conclusions: Cigarette smoking and alcohol drinking had independent relations to the prevalence of MetS. In addition, the prevalence of MetS was higher among Japanese men who smoked and drank heavily.

AIM Aging and postmenopausal women are associated with increased risks of cardiovascular disease; however, epidemiological evidence concerning the relationship of aging and the menopause with vascular biological activity is limited. METHODS We investigated the relationship of aging and the menopause with urinary excretion of cyclic guanosine 3',5' monophosphate (cGMP) in 1,541 Japanese men and women aged 40 to 79 years. The 24-hour urinary excretion of cGMP was measured with a (125)I-labeled cGMP radioimmunoassay and was adjusted for urinary creatinine excretion (nmol/mmol creatinine). RESULTS Aging was positively associated with urinary excretion of cGMP for both sexes. Postmenopausal women excreted significantly less urinary cGMP than premenopausal women after adjustment for age and other cardiovascular risk factors: 48.3+/-0.04 nmol/mmol vs. 61.5+/-0.07 nmol/mmol, p=0.006. CONCLUSIONS Our data suggest that cGMP-related vasodilatation is impaired in postmenopausal women.

2008年度からメタボリックシンドロームに焦点を当てた特定健診・特定保健指導の制度が導入されることになった。今回の新しい健診制度は, これまでの健診・保健指導に比べて, 保健指導により重点を置き, 個別性を重視した結果を出す保健指導を目指している。この新しい健診制度の導入にあたり, 効果的な保健指導を実施するには, 1) 行動科学に基づいた指導, 2) 健診当日の働きかけの重要性, 3) ITの活用, 4) 喫煙者への禁煙の働きかけ, 5) ポピュレーションストラテジーとの連動, などがポイントとなる。特に健診当日の働きかけは重要である。健診に向けて生活習慣改善の動機が高まりやすく, 健診当日は生活習慣を見直す良い機会となる。これまで健診と保健指導は日を別にして実施されることが多かった。今後は, 受診者全員に働きかけが可能でかつ効果の出やすい健診当日から保健指導を始めることが重要であり, このことは保健指導の効果や実施率の向上につながるものと期待される。そのためには健診の実施方法に工夫が必要である。次に, 喫煙は独立した動脈硬化性疾患の危険因子であるだけでなく, メタボリックシンドロームの発症のリスクを高めることも明らかになってきている。メタボリックシンドローム対策において喫煙は避けて通れない問題であり, 特定健診・特定保健指導をはじめ広く健診において喫煙者に対して禁煙の働きかけを行うことが重要である。最後に, ハイリスクストラテジーと合わせて, ポピュレーションストラテジーのための効果的な方法論の開発と普及を進めることが大切である。

Low-frequency current oscillation (LFO) in semi-insulating (SI) GaAs has been precisely measured with the guard-ring method using three electrodes, in which the electric field is well defined and controlled, and furthermore the surface leakage current becomes low. It is found from the precise measurements of I-V characteristics. waveforms and frequencies of LFO that the LFO phenomenon is well explained by the electric field-enhanced electron capture model taking into account the ionized EL2 concentration. The temperature dependences of LFO are also quantitatively explained by the model.

Raman scattering (RS) experiments have been carried out to determine both residual strain and alloy composition in a bulk Si 1-x Ge x single crystal with compositional gradient, which can be used as a focusing and diffracting X-ray monochromator. Since RS results are influenced both by strain and by composition, it is difficult to determine them separately from the observed phonon position. By analyzing Strain effect on RS in connection with a strain model developed for bulk mixed crystals, both residual strain and alloy composition are evaluated. It is found that the alloy composition evaluated from the RS results is in good agreement with that measured by the standard chemical analysis. It is also found that the axial and radial strain components vary from -0.76 x 10 -3 to -1.2 x 10 -3 and 3.6 x 10 -4 to 5.7 x 10 -4 , respectively, for the almost linear variation in composition from 0.034 to 0.055.

Objective: To evaluate the relation between QT variables and disproportion of left ventricular wall hypertrophy in patients with hypertrophic cardiomyopathy. Design: Retrospective analysis of the results of echocardiography and electrocardiography. Setting: University hospital (tertiary referral centre). Patients: 70 patients with hypertrophic cardiomyopathy were divided into four groups according to the distribution of left ventricular wall hypertrophy on cross sectional echocardiography: group A—hypertrophy confined to the interventricular septum; group B—hypertrophy confined to the interventricular septum and left ventricular anterior wall; group C—hypertrophy confined to the interventricular septum, left ventricular anterior wall, and lateral free wall; group D—hypertrophy involving all portions of the left ventricle. Main outcome measures: QT intervals and QT dispersion in precordial six lead ECGs. Results: There were no significant differences in the maximum left ventricular wall thickness among the four groups, and maximum and minimum QTc intervals also did not differ. QTc dispersion was increased significantly in groups A and B compared with groups C and D. Dispersions of the interval from the J point to the end of the T wave (JTc dispersions) in groups A and B were also increased significantly compared with groups C and D. By linear regression analysis, QTc and JTc dispersions correlated with the ratio of the interventricular septal thickness to left ventricular posterior wall thickness (p = 0.0152 and p = 0.0075, respectively). Conclusions: QT dispersion may be affected by not only electrical inhomogeneity but also by morphological inhomogeneity of the left ventricle in patients with hypertrophic cardiomyopathy.

BACKGROUND The objective of this study was to examine the relation of high-density lipoprotein cholesterol (HDL-C) to coronary heart disease in Japanese men whose serum total cholesterol is low by Western standards. METHODS AND RESULTS A prospective, observational study based on 7.7 years of follow-up for incidence of coronary heart disease and stroke was conducted. The subjects were 6408 middle-aged male workers aged 40 to 59 years at baseline in urban companies in Osaka, Japan, whose mean serum total cholesterol was 5.10 mmol/L. Mean HDL-C adjusted for age, total cholesterol, systolic blood pressure, alcohol intake, cigarette smoking, and body mass index was 1.27 to 1.28 mmol/L for men who developed coronary heart disease (n = 46) or definite myocardial infarction (n = 21) compared with 1.46 mmol/L for those free of cardiovascular disease (n = 6256; difference, P < .01). There was no significant difference in mean HDL-C between stroke cases (n = 33) and those free of cardiovascular disease. The incidence rates of coronary heart disease and definite myocardial infarction, adjusted for the other risk factors, were three to four times higher in the lowest HDL-C quartile (< 1.24 mmol/L) than the highest quartile (> or = 1.66 mmol/L), and there was a significant dose response for definite myocardial infarction. Serum total cholesterol was positively and significantly associated with coronary heart disease incidence. Furthermore, the inverse association for HDL-C was apparent among men with total cholesterol < 5.69 mmol/L (mean total cholesterol, 4.76 mmol/L) and men with total cholesterol > or = 5.69 mmol/L (mean total cholesterol, 6.26 mmol/L). CONCLUSIONS Coronary heart disease incidence is inversely related to HDL-C in urban Japanese middle-aged men, whose mean total cholesterol (5.10 mmol/L) is relatively low.

Although the associations between obstructive sleep apnoea and type 2 diabetes mellitus have been reported in cross-sectional design studies, findings on the prospective association between the two conditions are limited. We examined prospectively the association between nocturnal intermittent hypoxia as a surrogate marker of obstructive sleep apnoea and risk of type 2 diabetes.A total of 4,398 community residents aged 40 to 69 years who had participated in sleep investigation studies between 2001 and 2005 were enrolled. Nocturnal intermittent hypoxia was assessed by pulse-oximetry and defined by the number of oxygen desaturation measurementsor =3% per h, with five to15 per h corresponding to mild and 15 events or more per h corresponding to moderate-to-severe nocturnal intermittent hypoxia, respectively. The development of type 2 diabetes was defined by: (1) fasting serum glucoseor =7.00 mmol/l (126 mg/dl); (2) non-fasting serum glucoseor =11.1 mmol/l (200 mg/dl); and/or (3) initiation of glucose-lowering medication or insulin therapy. Multivariable model accounted for age, sex, BMI, smoking status, current alcohol intake, community, borderline type 2 diabetes, habitual snoring, excessive daytime sleepiness, sleep duration and (for women) menopausal status.By the end of 2007, 92.2% of participants had been followed up (median follow-up duration [interquartile range] 3.0 [2.9-4.0] years) and 210 persons identified as having developed diabetes. The multivariable-adjusted hazard ratio (95% CI) for developing type 2 diabetes was 1.26 (0.91-1.76) among those with mild nocturnal intermittent hypoxia and 1.69 (1.04-2.76) among those with moderate-to-severe nocturnal intermittent hypoxia (p = 0.03 for trend).Nocturnal intermittent hypoxia was associated with increased risk of developing type 2 diabetes among middle-aged Japanese.

In this paper, we present a syntax error repair to decide spurious errors using dynamic valid length. When the compiler encounters a syntax error, it usually attempts to restart parsing to check the remainder of the input for any further errors. One common method of error repair is to repair the input by insertion or deletion or substitution. After repair, the repair method should decide whether the error is a spurious error or not. In order to decide this, Conventional methods adopt a fixed valid length. However it is insufficient. In our method, valid length isnpsilat fixed on ahead. Our method tries all candidates for an error and decides that the one which has longest length is not a spurious error. Since the effectivity of our method was shown, the benchmark program was executed by our method and the conventional method using a fixed valid length. Compared with the conventional method, the proposed method can reduce approximately 90% of non-correcting errors and increase 23.1% of correcting errors.

The atherosclerotic lesions of the coronary arteries and basal cerebral arteries in the circle of Willis were examined in the bodies of decreased men ages 30 and over who had been admitted to a local hospital in northeast Japan during 1966 to 1974 (243 men) and 1975 to 1984 (602 men). The autopsy rates during the two periods were 86% and 89%, respectively. The extent of atherosclerosis was determined blindly by one pathologist using a grading method of cross-sectional stenosis scoring for coronary arteries and Baker's method for basal cerebral arteries. The age-adjusted mean scores for atherosclerosis in the coronary arteries and basal cerebral arteries were 30% and 42% lower, respectively, in the 1975 to 1984 period than in the 1966 to 1974 period (p less than 0.001). There was also a fall in age-adjusted blood pressure levels at admission: 10 mm Hg for systolic and 4 mm Hg for diastolic blood pressure (p less than 0.001). The opposite trend was seen in mean serum cholesterol: a rise from 171 mg/dl to 177 mg/dl (p = 0.018). Linear regression analysis indicated that blood pressure was positively associated with both atherosclerosis scores, controlling for age and serum cholesterol in both time periods (p less than 0.001). The association of serum cholesterol with the atherosclerosis scores was positive in both periods and statistically significant in 1975 to 1984. Similar findings were obtained when the analyses were conducted for cardiovascular disease (myocardial infarction and stroke) and for noncardiovascular disease, separately.(ABSTRACT TRUNCATED AT 250 WORDS)

We have investigated the variation of threshold voltage (Vth) with regard to the resistivity (p) of the semi-insulating substrate, and have found that there is a good correlation between p and Vth. It has previously been reported that the uniformity of Vth (/spl sigma/Vth) has a relation to the uniformity of microscopic resistivity (/spl sigma/p/p) of the semi-insulating substrate. We have studied a correlation between /spl sigma/p/p and the Hall mobility of the semi-insulating substrate (/spl mu//sub H/). It has been found that a substrate with a higher /spl mu//sub H/ can produce better /spl sigma/Vth. These results suggest that the Vth can be controlled by substrate parameters such as resistivity and mobility.

High-electric-field properties such as sub-linear I-V characteristic and low-frequency oscillations (LFOs) have been measured in a low-dislocation-density semi-insulating GaAs crystal. It is found that the sub-linear I-V behaviours and LFO waveforms measured at the cathodes where no dislocations exist are very stable but those measured at the cathodes where several dislocations are observed are not stable but more complicated, which is confirmed from Fourier-transform spectra of LFOs. It is explained that the high-electric-field properties observed here depend on the electrical inhomogeneities induced by the dislocations.

In this work we investigate the mechanism of slip defect generation, using a simple heat flow simulation during an MBE process, a wafer heating apparatus, and a thermoelastic analysis from a crystallographic viewpoint. We find that the slip defect pattern predicted from the analysis agrees with the experiment and confirm that slip defects are prone to occur at orientation flat (OF) and notch edge.

The vertical boat (VB) method has advantages in the growth of substrates for epitaxial devices. Low residual strain and low dislocation four inch GaAs crystals are manufactured with good reproducibility. Low residual strain reduces slip line occurrence and low dislocation density enables growth of low defects in epitaxial layers. FETs fabricated on carbon doped high resistivity VB substrates show high breakdown voltage. Vth was stable at higher drain voltages. Six inch GaAs crystals are also grown by VB and show adequate characteristics.

The Vertical Boat (VB) method has an advantage in the manufacture of large diameter GaAs substrates because of the low dislocation density and the small residual strain. The electrical characterization of devices fabricated on VB GaAs substrates have been demonstrated in this work. The VB substrate shows the same or better properties compared with the LEC substrate. We conclude that the VB GaAs substrate is expected to be suitable for the ion-implantation device process with a large diameter.

Rapid thermal annealing (RTA) is useful for shallow channel device fabrication because of suppression of dopant diffusion. However, short RTA sequence easily causes slip formation due to thermal stress during the process, which is more serious in the case of larger diameter wafers. We investigated at what point slip generated during RTA by monitoring temperature distribution within a wafer and successfully suppress slip formation by introducing a waiting step in the cooling process while maintaining the high cooling rate and the abrupt doping profile.

The study was carried out to collect basic data on exposure of mucous cells of the large intestine to mutagens by investigating the genotoxicity of fecal samples from the urban population. Simultaneously, relations with food intake (food groups and nutritive components), lifestyle factors and fecal metal content was investigated.A total of 199 self-collected fecal samples from middle aged healthy volunteer living in urban areas of Osaka city were freeze-dried and ground in a mill. The mutagenicity of aqueous extracts of the ground samples was measured by the umu-test. Metal content of the feces was analysed by atomic absorption spectrophotometlly. On the day previous to the feces collection, the contents of meals were recorded and confirmed by interview with a dietitian. Quantification of nutritive components was carried out using the 4th edition of the Japan Food Standard Vomposition Table.Mutagenicity of feces was higher in males than in females, and in those aged 40-49 years than 50-69 years in males but not females. Large differences were found for content of 8 metals in the feces; concentrations were in the decreasing order of calcium, potassium, magnesium, sodium, zinc, iron, manganese and copper, the highest being 20.4 mg for calcium and the lowest was 53.5 micrograms for copper. Between the metal contents and mutagenicity, values for zinc and iron showed positive correlations and for sodium a negative correlation under S9(+) conditions. A weak but significant correlation was observed between the numbers of cigarettes smoked per day and S9 (+) mutagenicity. However we could not find any relation with food groups or nutritive components.It is well known that human feces contain many mutagens and carcinogens and that these can act directly on the mucous membrane of large intestine. Therefore, it is very important to estimate exposure levels. From the present data we can conclude that relations between mutation-activity of the feces and diet are complex. Their elucidation will require a large number of volunteers who have similar living conditions to obtain appropriate data.

Introduction To investigate whether nocturnal intermittent hypoxia (NIH), a surrogate marker for sleep apnoea, is associated with cardiovascular risk factors, we conducted epidemiological studies. Methods The CIRCS is a prospective cohort study across Japan since 1963 to examine risk factors for cardiovascular disease. Subjects aged 40–69 years were recruited to the sleep study in three communities. NIH was estimated by hourly occurrences of oxygen desaturation of ≥3% (3% oxygen desaturation index [3% ODI]) by a pulse-oximeter during a night9s sleep in the participant9s own home. We defined no, mild and moderate-to-severe NIH by 3% ODI as Results Compared with no NIH, the multivariable OR of hypertension was 1.63 (95% CI 1.1 to 2.5) for moderate-to-severe NIH. The prevalence of a high CRP (≥1.0 mg/l) was 1.4 to 1.7-fold higher for mild to severe NIH in both sexes. The multivariable ORs of metabolic syndrome was 3.2 (2.2 to 4.7) for moderate-to-severe NIH among men and 5.8 (3.4 to 9.8) among women, respectively. The multivariable-adjusted HRs of developing type 2 diabetes was 1.3 (0.9 to 1.8) among those with mild NIH and 1.7 (1.0 to 2.8) among those with moderate-to-severe NIH. Conclusion NIH was associated with hypertension, elevated serum CRP levels, the accumulation of metabolic risk factors, and increased risk of developing type 2 diabetes among middle-aged Japanese.

To examine long-term trends in the incidence of coronary heart disease, stroke, and their risk factors among Japanese populations, we explored 32 years of surveillance data for male residents in urban and rural areas in Japan.The surveyed populations were 40-79 year-old male residents in M community (population over 40 years old in 1995 was 11,121) of Y City in Osaka (urban area; Osaka) and I town (n = 3,571) in Akita prefecture (rural area; Akita). Incidence rates of coronary heart disease (myocardial infarction, angina pectoris), sudden cardiac death, percutaneous transluminal coronary angioplasty (PTCA) and stroke per 1,000 person-years were calculated for 1964-71, 1972-79, 1980-87 and 1988-95. Risk factors were evaluated by cross-sectional surveys conducted in the median years for each period. Dietary intake was examined by the 24-hour recall method in the latter three periods.Age-adjusted incidence of coronary heart disease per 1,000 men increased progressively from 0.27 in 1964-71 to 0.90 in 1988-95 (P = 0.222 for trend) among 40-59 year old residents in Osaka. Among their 60-79 year old counterparts, though the incidence was 2.62-3.11 and did not change over the periods studied, the combined rates for coronary heart disease and men who had a PTCA reached 3.79 in 1988-95. In contrast, the incidence of coronary heart disease among Akita residents did not change over time and stroke declined 70 percent between 1964-71 and 1988-95 (P0.001) in both 40-59 and 60-79 year age group: The decrease in cerebral infarction was less marked between 1980-87 and 1988-95 among 60-79 year old individuals. Significant increases in diastolic blood pressure, total serum cholesterol, body mass index, salt intake and total fat percent of total energy in Osaka, were associated with the elevation in the incidence of coronary heart disease. In Akita, blood pressure leveled off over the study period, but decreased less during the last decade whereas the prevalence of obesity increased.Trends in cardiovascular diseases and their risk factors differ among different geographical areas. The present long-term study, in particular, demonstrated an increase in the incidence of coronary heart disease among urban Japanese male residents in Osaka between the 1960s and the 1990s.

A 65-year-old man had been followed by a family doctor for the treatment of hypertension and chronic hepatitis (type C) for about 20 years. Although he was pointed out to have impaired glucose tolerance and primary aldosteronism in 1995, he refused an adrenal tumor operation. He was admitted to our hospital on December, 1997 for further evaluation of general malaise, pitting edema of the legs, and positive urinary protein. A diagnosis of nephrotic syndrome was made on admission and a renal biopsy was performed. Histological findings indicated that he was at the early phase of diabetic nephropathy and hypertensive renal sclerosis. It is commonly believed that diabetic nephropathy develops after ten years of diabetic history and under poor control conditions. The diabetic history of this patient was only several years and the disease was under good control. In contrast to blood glucose, hypertension was not well-controlled with any antihypertensive drug, because he had a primary aldosteronism. Unfortunately, he could not take a spironolactone because of side effects. After removal of his adrenal tumor, his blood pressure was normalized gradually, and concomitantly his urinary protein was reduced and plasma protein and albumin were restored. Hypokalemia also disappeared. These findings suggest that uncontrolled hypertension may have accelerated the condition of diabetic nephropathy. The data indicates that the control of hypertension is important for inhibiting the progression of diabetic nephropathy.

We conducted an epidemiological study of survival and disability in stroke in three Japanese communities to seek community strategies for improvement in survival and disability.A total of 297 first-ever strokes were identified between 1988 and 1992 in three rural communities (total population = 47,000) located in Akita and Ibaraki. We analyzed survival rates and activity of daily living by sex, age-group and stroke subtypes. Successful review of computed tomography (CT) for 84 percent of the strokes (249 out of 297) was possible and the data were used for subtype analyses.For all strokes (n = 297) survival rates were 85% for 30 day, 70% for one year, 62% for three year. The rates tended to be lower in women than in men. The rates were lowest in ages less than 60 at thirty day, and in ages 80 and older at the end of the first and third year. Intracerebral hemorrhage with ventricular rupture, subarachnoid hemorrhage and cortical cerebral infarction had lower survival rates than intracerebral hemorrhage without ventricular rupture and lacunar infarction. Based on Cox's proportional hazard model, risk ratio for death was 2.07 in ages 70-79, and 3.80 in ages 80 and older compared with ages 60-69. The risk ratio was 3.46 for intracerebral hemorrhage with ventricular rupture, 3.38 for subarachnoid hemorrhage and 2.46 for cortical cerebral infarction compared with lacunar infarction. The proportion of stroke survivors who need assistance from others in the first and third years tended to be higher in women than in men. The proportion was higher in older patients than in the younger, and higher for intracerebral hemorrhage with ventricular rupture and cortical cerebral infarction than in other subtypes of stroke. From logistic regression analysis, the odds ratio for disability in the first year was 6.55 for ages 80 and older compared with ages 60-69. The odds ratio was 5.61 for intracerebral hemorrhage with ventricular rupture, 4.53 for cortical cerebral infarction compared with lacunar infarction. In the third year the odds ratio was significant for ages 70-79, and decreased for intracerebral hemorrhage with ventricular rupture (odds ratio = 2.98), and increased for cortical cerebral infarction (odds ratio = 6.06).Survival and disability in stroke depended on age and stroke subtypes. Even after age adjustment, stroke subtypes with large cerebral involvement had worse prognosis than stroke subtypes. Community-based hypertension control programs are important to prevent any subtypes of stroke. Stroke subtypes as well as age should be taken into account to develop effective care and medical treatments for strokes.

There has been a substantial decline in physical activity in Japan due to mechanization and motorization, and also a decline in blood pressure levels. These trends are more evident in rural populations than in urban. The potential effects of these changes on left ventricular echocardiographic findings were studied among Akita men (rural area) and Osaka men (urban area). Results of a ten-year follow-up study performed between 1975-85 and 1988-1994 on 296 men aged 30-65 without antihypertensive medication use at base line were as follows: Among Akita men, left ventricular diastolic dimension did not change but mean wall thickness decreased, resulting in a decline in mean left ventricular mass. Among Osaka men, there was a small increase in mean left ventricular diastolic dimension, but no significant changes in either mean wall thickness or mean left ventricular mass. A decline in mean wall thickness and mean left ventricular mass among Akita men was primarily observed in men who were involved in heavy manual work at baseline. Among Osaka men, mean wall thickness or mean left ventricular mass did not change in either men involved in heavy manual work or men not involved. Among Akita men, decline in mean wall thickness and mean left ventricular mass was seen in both hypertensives and normotensives. Among Osaka men, mean wall thickness or mean left ventricular mass did not change in either subgroup. According to multiple regression analysis controlling for age, body mass index, alcohol intake, and diastolic blood pressure, heavy manual work was significantly associated with ventricular mass among Akita men in 1975-85, but no more significant in 1988-94, while heavy manual work was not related to left ventricular mass among Osaka men in either time period. These results indicate that a decline in physical activity caused a decline in mean wall thickness and mean left ventricular mass among Akita men.

Background In Japan, many clinical nurses experience ethical dilemmas in daily nursing practice that cannot be resolved easily. Nurses feel strong regret in particular in cases in which the patient is at the end of life. Accordingly, based on one end-of-life case we elucidated the aspects of the patient9s condition and the thoughts and disorientation of the nurses. Aim To consider ethical issues for clinical nurses in end-of-life care. Methods We surveyed seven nurses on the nursing team involved in this case, through group interviews. The interviews concerned topics including nursing policies and plans, the content of conferences, and the dilemmas nurses experienced. Results Through data analysis, we identified 63 codes, 25 subcategories, and six core categories. While admitted, the patient constantly used the nurse-call for various reasons. She made particularly many calls during the postoperative acute stage and the postoperative recovery stage. In the postoperative acute stage, the nurses anticipated a danger when hearing the nurse-call, immediately answered the call, and went to her room to take appropriate action. However, during the postoperative recovery stage, the nurses were not aware of her sense of anxiety and were confused by the patient9s frequent nurse-calls, even during recovery. Discussion Gaps developed between the patient9s thoughts and the ethical assumptions of nurses in end-of-life care. This gap was due to differences in each other9s goals. Conclusion This study will support promotion, from the nurse9s point of view, of the provision of medical care that satisfies patients, which has not advanced smoothly in Japan.

To investigate associations of alcohol intake to constitutional and biochemical variables, cross-sectional studies of men aged 40-59 years from six geographical and occupational populations with varied lifestyles were conducted in the 1990's. Systolic and diastolic blood pressures, glutamic oxaloacetic transaminase, gamma glutamyl transpeptidase, HDL-cholesterol, and uric acid were linearly associated with alcohol intake in all six populations. Drinkers of 2+ drinks (46 g ethanol or more) per day showed higher levels of triglyceride, glutamic pyruvic transaminase than never-drinkers. In two urban occupational populations, men who mainly drank beer had higher uric acid levels; men mainly drinking sake had higher blood pressures and lower serum total cholesterol; men mainly drinking whiskey had higher obesity indices. These differences in constitutional and biochemical variables related to type of alcoholic beverage consumed may be due to differences in lifestyles such as diet and physical activity.

To clarify characteristics of participants in community-based rehabilitation programs provided by local municipalities (cities, towns, and villages) and effect of the program on their levels of independence in activities of daily living (ADL), a cross-sectional study was performed on 422 participants in 49 municipalities in Kochi Prefecture. 1. Mean age of participants was 68.3 +/- 9.0, and 77.7% of them were stroke patients. 2. The mean interval between disease onset and program participation was 40.4 months, and the mean duration of program participation was 54.5 months. 3. At the start of rehabilitation programs and at the time of the investigation (December 1993), about 90% of the participants had good levels of independence in ADL (Rank A and over according to the standard of the Ministry of Health and Welfare). 4. The frequency of rehabilitation programs and the presence of occupational therapists were positively associated with the improvement of levels of independence in ADL. In particular, the frequency of rehabilitation programs was associated with improvement of quality of life in self-supporting participants (Rank J2), and the presence of occupational therapists was associated with the improvement of ADL in semi-bed-ridden participants (Rank A). 5. After adjusting for age and sex, using multiple logistic regression analysis, type of diseases (non-stroke), hospital rehabilitation immediately after onset, higher levels of independence in ADL at the start of rehabilitation programs, and higher frequency of rehabilitation programs were significantly associated with improvements in levels of independence in ADL. Shorter interval between disease onset and program participation, and the presence of occupational therapists were also associated with improvements in levels of independence in ADL, although the relation did not reach statistical significance.

A 60-year-old female presented with a very rare spontaneous dissection in the common carotid artery manifesting as disturbance of consciousness and left dense hemiparesis immediately after swimming. Cerebral angiography showed complete obstruction of the right common carotid artery. Endarterectomy was performed to remove the subintimal thrombus and dissected intima. Blood flow was re-established 4 hours after onset of symptoms. Her disturbance of consciousness was resolved and left dense hemiparesis disappeared completely 12 hours after onset.

Introduction To examine whether the accumulation of obesity-related eating behaviours such as eating quickly, eating until full, eating right before bedtime and breakfast skipping are associated with incidence of type 2 diabetes mellitus (T2DM) among middle-aged Japanese men and women. Methods The 2840 subjects (890 men and 1950 women) who were aged 40–69 year and free of T2DM were enrolled at baseline survey from 2003 to 2006 in a community-based longitudinal study, the CIRCS. The subjects were asked following four eating behaviours by questionnaire at baseline: “speed of eating”, “eating until full”, “eating right before bedtime” and “breakfast skipping”. T2DM was defined as fasting serum glucose ≥7.0 mmol/l, non-fasting serum glucose ≥11.1 mmol/l or medication for T2DM. We followed up to March 2010, and calculated HR and 95% coefficient interval (95% CI) of T2DM by using Cox proportional hazard model after adjustment for potential risk factors. Results During 7-year follow-up period, 155 cases (70 men and 85 women) had an onset of T2DM. We calculated multivariate HR (95% CI) of T2DM for each number of eating behaviours among both men and women. Compared with persons without any eating behaviours, the multivariable HR (95% CI) of persons with 1, 2 and ≥3 of eating behaviours were 2.35 (1.06 to 5.19), 1.54 (0.65 to 3.63) and 3.24 (1.29 to 8.13), p for trend=0.09 in men and 0.92 (0.52 to 1.62), 0.67 (0.35 to 1.30) and 1.97 (0.92 to 4.22), p for trend=0.67 in women. Conclusion Our finding suggests that the accumulation of obesity-related eating behaviours raise the risk of T2DM for middle-aged Japanese men.

Introduction The purpose of this study was to examine trends in the prevalence of diabetes (DM) and diabetic retinopathy (DR) between 2001 and 2009 years among Japanese population in Osaka, urban area in Japan. Methods This study was a population-based study including 10 companies9 employees and 1 community residents in Osaka, aged in 30–79 years, who underwent cardiovascular routine health examination at 2001–2003 (7186 participants), 2004–2006 (6908 participants) and 2007–2009 (7530 participants). We compared the prevalence of DM and DR among these three periods. DM was defined as HbA1c≥6.5% (Japan Diabetes Society9s unit) or patients taking medication, and pre-DM was defined as HbA1c≥5.6% and HbA1c Results Age-adjusted prevalence of DM was also significantly increased from 2001 to 2003 (2.6%) to 2007–2009 (3.9%) in men and women (p for trend Conclusion A significant increase in the prevalence of DM and pre-DM implies the importance of prevention and early detection for DM and DR in urban Japanese populations.

Background Information on the impact of fatty acid composition on dementia has not yet been elucidated. Methods We performed a nested case-control study based on a cohort of approximately 12 000 Japanese people from two communities in the CIRCS, aged 45–85 at baseline (1984–1994). Fatty acid compositions were measured for 350 dementia cases and 700 controls (age, sex, community and baseline-year matched). The subjects were followed-up from 1999 through 2008, and incident disabling dementia was defined as dependent individuals who had moderate to severe dementia-related behavioural disturbance and/or cognitive impairment. This criterion was previously validated with 5-cog test (specificity 90%, positive predictive value 71%). The conditional OR and 95% CI for disabling dementia was calculated according to one SD increment of each fatty acid with adjustment for body mass index, smoking status, alcohol consumption, systolic blood pressure, antihypertensive medication use, serum total cholesterol and diabetes. Results Serum α-linolenic acids were inversely associated with disabling dementia (OR=0.82 [0.70–0.95] for 1-SD increment). No associations were observed for other fatty acids: OR=1.07 [0.91–1.26] for saturated fatty acids, 0.99 [0.84–1.17] for monounsaturated fatty acids, 0.98 [0.83–1.15] for n−6 polyunsaturated fatty acids, 1.00 [0.87–1.16] for eicosapentaenoic acid, and 1.03 [0.87–1.22] for docosahexaenoic acid. Conclusions We found a significant inverse association between serum α-linolenic acid and incident disabling dementia.

Introduction To examine whether dietary folate, vitamin B 6 and B 12 intakes are associated with the risk of sudden cardiac death (SCD) among Japanese men and women. Method We conducted a nested case-control study. For each case of SCD entered between 1973 and 2001 in the CIRCS, two controls were randomly selected for each case and matched for age (±3 years), sex and community from among participants without history of SCD. The 77 cases and 154 controls aged 30–84 years were enrolled. Dietary folate, vitamin B 6 and B 12 intakes were assessed by 1 day 24 h dietary recall. We calculated conditional OR and 95% CI of each nutrients for risk of SCD adjusted for potential confounding factors. Result Higher intake of folate was associated with lower risk of SCD. The multivariable adjusted OR (95% CI) of highest quartile was 0.32 (95% CI 0.12 to 0.82), p for trend=0.06 compared with lowest quartile. However, vitamin B 6 and B 12 intakes were not associated with risk of SCD. The multivariable adjusted OR (95% CI) of highest quartile of vitamin B 6 and B 12 intakes were 1.25 (95% CI 0.49 to 3.21), p for trend=0.64 and 0.83 (95% CI 0.34 to 1.98), p for trend=0.86 compared with lowest quartiles, respectively. Conclusion Our findings suggest that higher dietary folate intake is associated with lower risk of SCD among Japanese men and women.

A case of metastatic spinal tumor from renal cancer reduced by interferon-alpha is reported. A 54-year-old man was admitted to Tane General Hospital on April 12, 1990, with the complaint of difficulty in walking. Abdominal CT scan revealed right renal carcinoma, and MRI demonstrated metastatic spinal tumor at Th6, which was mainly occupying the entire lamina, spinous process and right pedicle of Th6. Nephrectomy was performed and, instead of operating on the spinal lesion, the patient was given follow-up treatment with administration of interferon-alpha (5 million units twice a week) and steroid. 1 year and 6 months later the patient's walking ability began to deteriorate and paraparesis progressed, although the size of the metastatic spinal tumor had gradually reduced. This was thought to be because of atrophy of the legs due to prolonged bed rest and steroid administration. Laminectomy with total removal of the tumor was performed on January 16, 1992. In the 12 months postoperatively, there has been neither recurrence nor remote metastasis seemingly due to the administration of interferon-alpha. This appears to be the first report of metastatic spinal tumor from renal cancer reduced by interferon-alpha.

Risk factors for intracerebral hemorrhage (ICH) and cerebral infarction (CI), were studied by a prospective study of 7,390 men and women aged 40-69 without a history of stroke living in three rural populations in Japan. Baseline examinations were done for populations in Akita-Ikawa and Akita-Ishizawa in 1975-1979, and for Ibaraki-Kyowa in 1981-1987, and followed until 1989 for Akita-Ikawa and Ibaraki-Kyowa and 1987 Akita-Ishizawa. There were 246 stroke cases diagnosed by clinical criteria during the follow-up period in which 74 percent (n = 181) had data from computed tomography (CT) performed within three weeks of the onset. According to these CT-findings, 181 stroke were classified as 48 with ICH, 50 with CI in penetrating artery regions (penetrating artery infarction), 33 with CI in cortical artery regions (cortical artery infarction), and 31 with subarachnoid hemorrhage while there were 19 with stroke without any evident CT abnormality. Cortical artery infarction was further classified as embolic type (n = 17) and thrombotic type (n = 9) according to clinical findings of the onset and presence of possible embolic sources such as atrial fibrillation, congenital heart disease, myocardial infarction and heart valve diseases. Using a nested case-control design, risk variables at baseline examination were compared between 131 stroke cases, 48 ICH and 83 CI, with 655 controls matched for sex, age (+/- 3), and the follow-up year. Univariate analysis showed that high blood pressure was associated with all types of stroke. From conditional logistic regression analysis significant risk variables were found to be high blood pressure for ICH and penetrating artery infarction, while atrial fibrillation and ST-T abnormality in electrocardiogram (ECG) were risk variables for cortical artery infarction. Associations with hypertensive or arteriosclerotic changes in ocular fundus were stronger for penetrating artery infarction than ICH and cortical artery infarction. ST-T abnormality in ECG was associated with embolic type cortical artery infarction and high blood pressure was associated with the thrombotic type, although the number of cases were small. Compared to controls, cortical artery infarction showed a higher mean value of serum total cholesterol for thrombotic type cortical infarction, and lower mean values for embolic type and ICH, but none of them reached statistical significance. The present study also suggests that duration of hypertension varied with type of stroke. ICH may develop due to acute effects of hypertension, while penetrating artery infarction and cortical artery infarction develop by chronic effects of hypertension.

To investigate the proportion by type of stroke in communities, a stroke surveillance was conducted in three rural populations between 1979 and 1987. Among 411 stroke patients aged 40 and over determined by the modified Millikan's stroke criteria, the type of stroke was analyzed using computed tomography (CT) criteria for 273 patients who were examined by CT. 1. Incidence rates of stroke determined by the modified Millikan's criteria did not vary among the three populations in all age-sex groups except for men aged 60-69. 2. The proportion of stroke patients who had CT examinations was 84-88% for men and women aged 40-69 in the three communities. 3. According to the CT criteria, the proportion by type of stroke in patients aged 40-69 in the three communities was 32% for cerebral hemorrhage, 16% for subarachnoid hemorrhage, 42% for cerebral infarction and 10% for unspecified stroke without CT abnormalities. Among the total with cerebral infarction, the proportion with cerebral infarction in penetrating artery regions, mostly lacunar infarction, was 65% and that of infarction in cortical artery regions, mostly thromboembolic infarction, was 35% for patients aged 40-69. 4. Cerebral infarction in cortical artery regions was classified further into embolic, thrombotic and unspecified types based on CT findings, the presence of embolic origin, and symptoms at the onset. The proportion of these three types of infarction were similar in patients aged 40-69. Compared with hospital-based studies in Japan, the present population-based study showed a higher proportion of cerebral infarction and infarction in penetrating artery regions. This study also indicated that the proportion of cerebral hemorrhage and infarction in penetrating artery regions was higher and that of infarction in cortical artery regions lower in Japanese than in Caucasians.

A community-based education program was conducted for persons found to be hypercholesterolemic by screening during cardiovascular surveys, in an urban population, to evaluate the feasibility and effect of the program in primary prevention of coronary heart disease. The subjects were men and women aged 40-64 living in the suburbs of Osaka whose serum total cholesterol was between 240 and 299 mg/dl in both the 1988 and the 1989 surveys. Persons with hypothyroidism, those taking medication for hypercholesterolemia or hypertension, and with a history of stroke and coronary heart disease were excluded. Of the 111 persons who were eligible, 104 persons were recruited for the program on March, 1989. The 104 persons were randomly assigned to either an intensive education group (n = 51) or a usual education group (n = 53). For the intensive education group, seven education classes were held from April to November, 1989. Lectures, practice sessions, interviews, and spot cholesterol measurements were conducted in a local community center. The usual education group received a letter with results from the 1989 survey and dietary instruction in April 1989 and an education class in September 1989. Mean serum cholesterol in the intensive education group showed a 10.0 mg/dl greater reduction in September 1989 and a 9.0 mg/dl greater reduction in March 1990 than in the usual education group (p less than 0.05) while mean HDL-cholesterol did not change in either groups. The intensive education group reported a larger decrease in the dietary frequency of chicken egg, poultry skin and small fishes, foods which are rich in saturated fat and cholesterol. The frequency of fatty meat, butter and fish eggs was low in both groups and did not differ between the two groups after the one-year program. These results indicate that a population-based education program is feasible and effective in reducing serum total cholesterol of hypercholesterolemic persons.

Tethered cord syndrome is most often seen in children with a lumbosacral lipomyelomeningocele associated with occult spinal dysraphism, and often manifests as urinary bladder dysfunction, sensory disturbance, and motor weakness or deformity of the lower extremities. The aim of surgical treatment of a lipomyelomeningocele is to release the tethered spinal cord from the lipomatous tissue. Despite the satisfactory results obtained through surgical treatment for lumbosacral lipomyelomeningoceles without anorectal pressure monitoring [2], we found that untethering of the spinal cord was quite difficult to perform in some patients in which the lipoma involved the ventral part of the spinal cord [1, 4, 9]. We also found that appropriate repair of a lipomyelomeningocele at the time of initial surgery sometimes failed to prevent retethering of the spinal cord due to postoperative adhesion between the cord and the surrounding structures [1, 5], and that dissection of the neural structure deeply embedded in dense scar tissue was much more difficult to perform in a repeat operation for reuntethering of the spinal cord than in the initial operation. In such cases, intraoperative monitoring for identification of the nerve root and the conus medullaris is necessary to un-tether the spinal cord completely and preserve the neural structures. During the operation, the lower lumbar and first sacral ventral roots were easily identified by applying electrical nerve stimulation and palpating contractions of the segmental muscle groups. Identification of the second, third, and fourth sacral roots, which have neurogenic control of the urinary bladder and also the anal sphincter, requires measurement of sphincter function [3, 7, 8].

A chemical robot capable of performing enzymatic reactions and extraction processes of DNA has been developed. The basic functions of this robot include handling of plastic tubes with caps, micropipetting, mixing, microcentrifuging and incubating. As a result, almost all of the pre-electrophoresis steps can be carried out. In addition, because these processes are automated, the working time of each process can be reduced. The reproducibility of the automated operation is equivalent to that of a skilled operator.