Objective : To find methods to minimize ‘lost to follow-up’ in the long-term follow-up in a pilot study of Prescription-Event Monitoring in Japan (J-PEM) where hypertensive subjects who took losartan or a control drug and gave informed consent to the study were directly followed by researcher for years.
Design : Cohort Study
Methods : We conducted the follow-up survey twice, in which questionnaires were sent to hypertensive patients who had consented to being involved in the survey and returned it by mail. In the questionnaire, we asked about the use of the monitoring drug, change of medical institutions for the treatment of hypertension, significant health-related events. In the second survey, we reminded the non-responders by a letter of reminder and by telephone. When no information was obtained from the subject, we sent a letter, together with a copy of the informed consent given by the subject, to the municipal office where the subject's home was registered to inquire about the subject's current address and related information including the vital status. We calculated Standardized Mortality Ratio (SMR) using the information on death obtained from the mailed questionnaires, telephone and information in the municipal office.
Results : In a pilot study of J-PEM on losartan, 4344 and 3517 questionnaires were sent to pharmacists and doctors, respectively. The doctors handed the informed consent form to the patients and 422 patients agreed to participate the study and sent back the signed form to the study office. In the first and second surveys, a questionnaire was mailed to the subject approximately 1 and 5 years after the first prescription of losartan or a control drug, respectively. The response rate was 73 and 60% in the 1 st and 2 nd survey, respectively. In the manuscript, the results of the 2 nd survey were mainly presented. The reminders by mail and telephone increased the response rate from 60 to 81% and provided the information on the vital status for 86% of the subjects. The response rate was further increased to 84% and the vital status was known for 99% when the information in the municipal office was used. SMR was estimated to be 0.59 (95% CI : 0.34-1.01) before reminding subjects, 0.78 (0.52-1.17) after reminding subjects by a letter and telephone and 0.92 (0.65-1.31) after further addition of the information from the municipal office. During the 5 years of the observation, 21% of 343 subjects who sent back a filled questionnaire did and 70% did not change the clinic/hospital where they received the care for hypertension, while 9% did not answer the relevant question.
Conclusion : The method of the systematic survey may be useful in minimizing the ‘lost to follow-up’ subjects in the long-term pharmacoepidemiology studies in Japan where a patient can change the clinic/hospital for his/her own health care without any letter of reference. In the systematic survey, the researchers may try to follow the subjects by using several methods including reminders like a letter or telephone as well as the use of the information in the municipal office. To facilitate better follow-up, a careful design of the study including the proper design of the informed consent form is essential to maximize the amount and quality of the available information, particularly when the subject has a serious event or dies in a hospital or institution apart from that where the patient has been registered.

Medicine, Kampo ; Metabolic ; Therapeutic procedure ; Syndrome

The patient was a 68-year-old woman with chief complaints of severe lumbago, left lateral abdominal pain and high fever. Computer tomography (CT) at a local hospital showed a left psoas abscess and a low density area around the terminal aorta. Blood tests indicated a high inflammatory response and MSSA was detected in a blood culture. Control of the infection was first attempted with antibiotics, but CT showed a pseudoaneurysm at the terminal aorta, and therefore she was transferred to our hospital. We diagnosed infected abdominal aortic and left common iliac aneurysms complicated by an MSSA psoas abscess, and performed extra-anatomic reconstruction with axillo-bifemoral bypass, aneurysmectomy and omentopexy in the psoas abscess cavity. Because of massive intestinal edema and mesentery, we attempted temporary abdominal closure with the vacuum-assisted closure (VAC) technique, and finally succeeded in closing without abdominal infection in the 6th operation, 42 days after the first operation. Infected abdominal aortic aneurysm complicated by psoas abscess is extremely rare and life threatening. The VAC technique is very effective not only in avoiding abdominal compartment syndrome but also in avoiding abdominal infection.

Many researchers report that cigarette smoking by parents adversely affects their children. We carried out a survey about cigarette puffing by distributing questionnaires to mothers of sucklings and little children. The survey found that mothers and family members were not well aware of the health consequences of passive smoking. It was also found that children frequently exposed to smoking are at high risk of contracting infections of the respiratory tract. The average weight at birth was less in babies borned by smoking mothers than by those who do not smoke. Furthermore, it was revealed that a larger number of smoking mothers had given birth to low birth weight infants than nonsmoking mothers had.
These findings suggested that passive cigarette smoking is linked to low birth weight and respiratory tract infection. We think it is incumbent on us, health-care professionals, to bring home to mothers and the rest of the family members how serious the consequences of passive smoking are.

Twenty endurance-trained athletes (five male speed-skaters, eleven male and four female cross-country skiers, 16-18 years) ran on a treadmill by a protocol of incremental graded increase in workload until exhaustion during an endurance training period in off-season summer. Immediately after exercise, all developed peripheral leukocytosis (1.9 times; p<0.01) due mainly to lymphocytosis (2.6 times; p<0.01) with a predominant effect on large granular lymphocyte (natural killer cell) count (5.9 times ; p<0.01) . Monocyte count was also enhanced 2.3 times (p<0.01) . These increases were transitory and returned to the pre-exercise levels 1 h later. Peripheral neutrophilia was also observed by 43% (p<0.01) immediately after exercise and remained elevated by 25% (p<0.01) 1 h after exercise, but a shift to the left did not take place. The capacity of isolated neutrophils to produce reactive oxygen species was assessed by luminol-dependent chemiluminescence which detects mainly myeloperoxidase (MPO) -mediated formation of such hyperreactive oxidants as HOCl. The maximum intensity of chemiluminescence (peak height) upon stimulation with opsonized zymosan was significantly enhanced following exercise (p<0.05) . Similar results were obtained when phorbol myristate acetate was employed as nonphagocytic soluble stimulus (p<0.01), suggesting that the capacity of neutrophils to degranulate MPO rather than phagocytosis was enhanced following exercise. In addition, the enhancements of chemiluminescence were positively correlated with the increase in segmented neutrophil count. These data indicate that maximal exercise not only mobilized mature neutrophils from the marginated pool into the circulation, but also augmented their capacity to generate reactive oxygen species of higher reactivity.

Objectives : In this study, we assessed the muscle contraction pattern of each toe by stimulating the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles in patients with claw foot deformity caused by spasticity in the lower extremity in order to increase the benefit of their botulinum toxin treatments. Subjects and Methods : Fifteen post-stroke patients (11 male and 4 female ; mean age, 62.3 years) were recruited for the study. In this observational study, the muscle contraction patterns of the hallux and digits on electrical stimulation of the FHL or FDL were examined by two doctors, and the data was then analyzed. In addition, the FHL and FDL were identified in 6 feet from 3 cadaver specimens below the ankle to near the end of each muscle on each toe. Results : In muscles that could be observed, muscle contraction was observed in the hallux in every subject and in the second digit in 92.3% subjects when the FHL was stimulated electrically. Muscle contraction was not observed in the second digit in 64.3% of the subjects when the FDL was stimulated electrically. In the cadaver dissections, the tendons of the FHL sent fibers to the FDL tendons in all 6 feet examined. Conclusion : In conclusion, when botulinum toxin is to be injected into the FHL or FDL muscle for treating claw foot deformity in patients with lower extremity spasticity, especially when the treatment target is the second digit, the injection should be performed not only in the FDL muscle, but also in the FHL muscle to increase the effectiveness of the treatment.

We investigated both the acute effects of maximal exercise and the chronic effects of training on nonspecific immunity in 15 winter-sports athletes during different periods of training : (a) before the athletic season, in summer, when the athletes were undertaking extensive endurance training to enhance aerobic capacity, (b) during the winter sports season, in early winter, when endurance and athletic training were being undertaken, and (c) after the winter sports season, in spring, when the athletes were resting (detraining for a month) . The mean value of the maximal oxygen uptake in each training period was (a) 65.4 (SD 4.6) mL·kg^-1·min^-1, (b) 63.1 (SD 5.5) mL· kg^-1·min^-1, and (c) 58.3 (SD 5.8) mL·kg^-1·min^-1, respectively. Following maximal exercise, acute peripheral leukocytosis due to lymphocytosis and neutrophila was observed in every period. The capacity of isolated neutrophils to produce reactive oxygen species upon stimulation with opsonized zymosan measure by luminol-dependent chemiluminescence (LDCL) was significantly enhanced after maximal exercise before and during the athletic season. However, the degree of enhancement was smaller during after-season detraining, suggesting that the conditioning state affected the exercise-induced changes in neutophil functional status. Serum opsonic activity also showed a similar pattern. As for the chronic effects of training, the resting values of the neutrophil count, especially the segmented neutrophil count, the neutrophil LDCL response and the serum IgG level, declined significantly in the pre-season training period. Since the subjects were engaged in exhaustive endurance training under heat exposure at that time, the nonspecific immune status might have been partially compromised due to chronic overload.

A 62-year old man was referred to our hospital with endocarditis. Although the infection was improved by antibiotic therapy, he underwent surgery because of severe aortic and mitral valve regurgitation. Preoperative computed tomography revealed a pseudoaneurysm of 20 mm in diameter at the posterior wall of the ascending aorta. The non-coronary cusp was infected and there was a punched-out pseudoaneurysm at the ascending aorta adjacent to the sino-tubular junction. After resection of the aortic wall and the aortic valve, a modified Bentall operation with a composite graft and mitral valve plasty was performed. Postoperative whole body computed tomography revealed no other pseudoaneurysms. In case of endocarditis, we have to consider the possibility of aneurysm formation throughout the body.

BACKGROUND/OBJECTIVES: Poor oral health has been predicted the development of frailty and sarcopenia as well as the subsequent need for long-term care. This cross-sectional study examined the relationships among tooth loss, prefrailty, and dietary patterns in communitydwelling older Japanese females. SUBJECTS/METHODS: Information on the number of teeth, food consumption, and lifestyle factors was collected from 271 participants aged ≥ 65 yrs using a questionnaire. The number of teeth was self-reported and classified into 2 groups: natural teeth ≥ 20 and natural teeth < 20. Prefrailty was assessed using the Japanese version of the Cardiovascular Health Study. Three dietary patterns (“vegetables and dairy products” [VD], “rice and fish and shellfish” [RF], and “bread and beverages”) were adopted from a cluster analysis of the intakes of 20 foods evaluated using the Food Frequency Questionnaire. The odds ratios (ORs) for prefrailty and dietary patterns were calculated using a binary logistic regression analysis. RESULTS: A total of 267 participants were analyzed, excluding those with frailty (n = 4). The rates of natural teeth < 20 and prefrailty were 57.3 and 37.4%, respectively. Natural teeth < 20 was positively correlated with prefrailty (OR, 4.66; 95% confidence interval [CI], 2.54–8.52) and inversely correlated with VD pattern (OR, 0.43; 95% CI, 0.27–0.69). Furthermore, both VD (OR, 0.38; 95% CI, 0.16–0.91) and RF (OR, 0.26; 95% CI, 0.11–0.62) patterns were inversely correlated with prefrailty. CONCLUSIONS Maintaining the number of natural teeth ≥ 20 into old age plays an important role in preventing a prefrailty. The promotion of VD and RF dietary patterns has potential as an effective nutritional strategy for preventing tooth loss and prefrailty.

BACKGROUND/OBJECTIVES: Poor oral health has been predicted the development of frailty and sarcopenia as well as the subsequent need for long-term care. This cross-sectional study examined the relationships among tooth loss, prefrailty, and dietary patterns in communitydwelling older Japanese females. SUBJECTS/METHODS: Information on the number of teeth, food consumption, and lifestyle factors was collected from 271 participants aged ≥ 65 yrs using a questionnaire. The number of teeth was self-reported and classified into 2 groups: natural teeth ≥ 20 and natural teeth < 20. Prefrailty was assessed using the Japanese version of the Cardiovascular Health Study. Three dietary patterns (“vegetables and dairy products” [VD], “rice and fish and shellfish” [RF], and “bread and beverages”) were adopted from a cluster analysis of the intakes of 20 foods evaluated using the Food Frequency Questionnaire. The odds ratios (ORs) for prefrailty and dietary patterns were calculated using a binary logistic regression analysis. RESULTS: A total of 267 participants were analyzed, excluding those with frailty (n = 4). The rates of natural teeth < 20 and prefrailty were 57.3 and 37.4%, respectively. Natural teeth < 20 was positively correlated with prefrailty (OR, 4.66; 95% confidence interval [CI], 2.54–8.52) and inversely correlated with VD pattern (OR, 0.43; 95% CI, 0.27–0.69). Furthermore, both VD (OR, 0.38; 95% CI, 0.16–0.91) and RF (OR, 0.26; 95% CI, 0.11–0.62) patterns were inversely correlated with prefrailty. CONCLUSIONS Maintaining the number of natural teeth ≥ 20 into old age plays an important role in preventing a prefrailty. The promotion of VD and RF dietary patterns has potential as an effective nutritional strategy for preventing tooth loss and prefrailty.