The platelet counts documented in most of the studies using the fully automated hematology analyzer XE-5000 are values measured by impedance technology (PLT-I). If blood specimens showing an anomalous particle-size distribution curve in the area where platelet counts are low are used (exceptionally low platelet count samples), the counting method is automatically switched over to an optical method (PLT-O). In the present study, we examined the usefulness of the XE-5000 by comparing PLT-I with PLT-O, using blood samples with low platelet counts collected from patients who visited our hospital between January 1 and March 31, 2012. Dilution linearity left nothing to be desired in either of the two, but simultaneous reproducibility was higher in PLT-O than in PLT-I. The correlations of PLT-I and PLT-O with visual counts were high, working out at r＝0.889～0.984. In the exceptionally low platelet count samples, the correlation coefficient was high in PLT-O than in PLT-I. The cases showing low platelet counts frequently presented giant platelets and/or red cell fragments. Therefore, measuring the samples with low platelet counts requires a high degree of precision. In the samples with exceptionally low platelet counts, PLT-O exceeded PLT-I in simultaneous reproducibility and correlation with visual counts. Thus, our study demonstrated the usefulness of the XE-5000 that could enumerate PLT-O automatically and speedily.

The liver mitochondrial redox state (the liver mitochondrial free NAD+/NADH ratio), which indicates hepatic energy charge, is known to parallel the ketone body ratio (acetoacetate/3-hydroxybutyrate) in liver tissue. Since the ketone body ratio in arterial blood was reported to correlate with that in liver tissue; the arterial ketone body ratio (AKBR) has been widely accepted as a useful measure of the liver function reserve. The liver mitochondrial redox state is known to decrease with the oxidation of ethanol in alcohol abusers. To evaluate whether AKBR reflected the effect of alcohol intake on the liver, AKBR was measured in normal controls (n=8), and patients with alcoholic liver injuries (n=14) and chronic active hepatitis (n=15). The mean AKBRs in the normal control subjects, in patients with chronic active viral hepatitis, and in those with alcoholic liver disease were 1.68±0.77, 2.22±1.02, and 1.55±0.79, respectively. Though the AKBR in patients with alcoholic liver disease tended to be lower than the other groups, there was no significant difference in AKBR among those three groups. In conclusion, this study demonstrated that AKBR was doubtful as an accurate parameter to estimate the changes in the liver mitochondrial redox state by alcoholic intake.

A survey was made of the state of home care for healthy old folks and those elderly patients who have been disabled by illness or injury, and the care provided by institutions in six areas throughout the nation.
The number of healthy old people was larger in women than in men. However, men had the edgeon women in Activity Daily Living (ADL). Compared to the healthy aged people, many ill or disabled elderly patients receiving home care were found to be suffering from anemia, low cholesterol level, hypoproteinemia, and poor glucose-tolerance. The major cause of disability was cerebral apoplexy. Recently, the cases of cerebral hemorrhage have decreased in number, and the rate of death in acute stage has notability declined ; however, the incidence of cerebral infarction is on the increase among the aged.
There are limits to care for disabled elderly patients at home by the family because of the aging of their spouses and the increasing trend toward the nuclear family. Many of those who look after the sick persons are crying for expert help and services capable of coping with a sudden change in the patient's condition. Hence the need to establish a 24-hour home care providing system. It is desirable to establish old people's homes, as residential care institusion, in alignment with hospitals. This system would facilitate hospitalization in case of emergency. To execute care programs more effectively, close collaboration will be necessary among hospital, home care services, clinics, local governments, agricultural cooperatives, and neighborhood associations.

A check of the health of residents in their twenties and thirties in Nagano Prefecture's rural communities indicates that the rate of hypertensives and the incidence of cholesterolemia were low in those age groups. There were signs that the prevalence of obesity is somewhat high among males but low among females. Virtually no incidence of anemia was observed among men but the incidence was fairly high among women. The number of persons with hepatic dysfunction was relatively large among men. In terms of the intake of nutrients, there were not a few men for whom the meals were imbalanced, and the intake of alcoholic beverages was high.
It is necessary that women should refrain from taking in confectionary and taken in fishmeat, meat, milk, egg, soybeans and other proteins. In Nagano Prefecture's rural communities, there remain signs that the intake of salt is high even in young generation, so that it is important to take measures for the prevention of hypertension.

Cerebral stroke in rural areas is a very important disease both from medical and social aspects. Among strokes, infarction which occurs most frequently in elderly persons is liable to result from atherosclerosis. And for the development of atherosclerosis, essential hypertension is the most important predisposing factor. Other than hypertension, aging, diabetes mellitus, hyperlipemia, esp. low HDL/Tch ratio, increased hematocrit values, coronary insufficiency, cardiac failure, arythmia, esp. atrial fibrillation, are also accepted important risk factors. Affirmative of such findings, the authors are convinced of the fact that atrial fibrillation which is increasing recently is closely related to both cerebral thrombosis and embolism.
But, in regard to cerebral infarction no signifying or trigger factor, similar to very high blood pressure, that trigger cerebral hemorrhage, is clarified as yet. It is made clear in this connection that cardiac failure predisposed by hypertensive heart disease in old age, assisted by pathophysiological and other environmental conditions, is the important factor. The authors also studied the clinical predisposing parameters and preventive measures about strokes.

Conducted in the Saku district (pop: 105, 000) of Nagano Prefecture, a WHO collaborative study and a district survey on the onset of stroke (994 respondents), it is evident that the past history of hypertension was extremely significant both for patients with cerebral hemorrhage and cerebral thrombosis. Among patients with cerebral hemorrhage and those, 69 years old and under, with cerebral thrombosis, the group which undid or suspended hypertension treatment was evidently larger than that who continued to undergo treatment. But among those, 70 years old and over, with cerebral thrombosis, no significant statistical difference was noted between the two groups.
In Yachiho, a mountain village in the Saku district, hypertension control has been carried out since 1959. As a result of the adequate control of blood pressure, strokes as a whole have dropped by about 30% and cerebral hemorrhage has halved. But there are signs of an increase in the prevalence of cerebral infarction, and multiple cerebral infarction in particular, among the elderly.
In recent years, the Westernization of the dietary pattern has been in progress in rural communities, thereby raising the serum total cholesterol level among their residents. An epidemiological study of strokes in 1964-71 demonstrated minus correlations between serum total cholesterol and the incidence of cerebral thrombosis, but no such correlations are observed at present. Nor is any correlation observed between serum total cholesterol and cerebral infarction.

Cerebrovascular disease is still considered a serious health problem in Japanese rural areas. The rate of death from the disease is very high. Many clinical and epidemiological studies have been conducted so far. However, they have failed to come up with answers effective for prediction and prevention of the scourge.
As part of the agricultural coop commissioned research project entitled “Study of Cerebral Apoplexy: Its Prediction and Prevention, ” we took a questionnaire survey in 1985-86, to obtain data as regards patients' subjective symptoms, electrocardiographic observations, hematological findings and many others before the onset of cerebral apoplexy. Five medical research institutes affiliated with the national welfare federation of agricultural cooperatives responded to our questionnaire.
As a result, the subjective symptoms that showed stochastically significant increases from one year to three months before the onset of the disease as a whole were fatigue, forgetfulness and insomnia. When it comes to cerebrovascular infarction, shortness of breath, angina, forgetfulness, and nocturia were particularly notable.
All these symptoms are not peculiar to cerebral apoplexy, but it should be noted that these are the warning signals of the killer disease.

A total of 194 cases of liver cirrhosis, which had been treated in our hospital during the past 5 years, were calssified by the causes into the following four groups:(I) hepatitis B virus, (II) alcoholic, (III) special origins, and (IV) reasons unknown. They each accounted for 23.2%, 35.6%, 1.5% and 39.7%, of the total.
Their clinical features and prognosis were examined. To be noted is the finding that many patients in group IV had had blood transfusions. This suggests that non A non B hepatitis viruses might be involved in the occurrence of the liver disease. On the whole, the five-year survival rate was 45.6%. There was not any significant difference among the four groups. However, prognoses were poor in groups II, I and IV, in that order.
As regards the cause of death, rupture of esophageal varice and hepatic failure showed a gradual decline, but complications of hepatocellular carcinomas sharply increased. Especially, in group I, this mortality was as high as 31.1%.

In the last 20 years since 1960, the population of Yachiho Village in Nagano Prefecture had decreased by 1, 089 (17.5%). In the same period, the share of people, 70 years old and over, had increased from 4.5% to 10.4 percent, suggesting that depopulation and aging are in progress. By type of farm management, farming families with sideline jobs share 87.4% of the population and there is a conspicuous increase in the number of farming families for which the non-agricultural income is greater than the agricultural income. Agricultural mechanization began to make rapid progress in or 1970: power cultivators are owned by all farming families and power sprayers and harvesters by about half of them.
Due to the increase in income from non-agricultural work and the development of merchandise distribution systems, the intake of animal food, which used to be significantly small in the rural communities, has increased. In the last 20 years, the intake has increased by 6.3 times for meat, 1.4 times for fish and 4.7 times for eggs.
A health care program for all residents of Yachiho Village has been instituted since 1954. The disease the prevalence of which was found to be highest in the past annual mass health screenings is hypertension. A check of the prevalence of stroke and myocardial infarction, which is an important parameter to assess effects from hypertension control, indicates that the prevalence of strokes was down 30.7% in 1971-82, the latter half of the control perind, from 1959-70, the former half. Howevre, there was a slight rise is the prevalence of myocardial infarction. The prevalence of strokes to myocardial infarction was 16: 1 in the former half and 9: 1 in the latter half, suggesting that prevalence of strokes was overwhelmingly high.
There has been an increase in the number of healthy old people under the village's comprehensive health care program. They work till they reach a considerably high age and their health condition is good.
Due to changes in the dietary pattern and a drop in the burdening of farm work, however, the obesity rate has increased among residents of Yachiho Village, and the cholesterol level, which used to be low, has risen. Particularly conspicuous are the rises in the numbers of obese persons and patients with cholesteremia among females in their 50s and 60s and among males in their 40s.
In order to further decrease the prevalence of strokes and prevent an increase in that of myocardial infarction, there is a need for an elaborate guidance and control program by vocation, sex and age.

Of the patients with cerebral stroke admitted to the Saku Central Hospital from April 1972 to October 1977, we surveyed 60 people, aged 49 and under.
1) By type of disease, cerebral hemorrhage accounted for 40%, cerebral infarction 30%, and subarachnoid hemorrhage 30%. The prevalence of cerebral hemorrhage and subarachnoideal hemorrhage in this age group was higher than those in all ages.
2) Even in this age bracket, there were many with histories of hypertension and long periods of affection. The onset was observed among many of those who had not undergone or had discontinued treatment.
3) Abnormal ECG findings were observed in 35%.
4) Patients with a cardio-thoracic ratio of 51% and over in chest X-ray findings accounted for 64% of all patients.
5) Abnomally high hematocrit, serum and total cholesterol values were noted for few cases.
6) In respect to the prognosis of life and sequela, patients with cerebral infarction in this age bracket were better than those of all ages, but no statistically significant difference was observed between patients with ceberal hemorrhage in this age bracket and those in all ages.