We examined the child-rearing environmental factors that affect the occurrence of sudden infant death syndrome (SIDS) using a nationwide survey. Infants who died due to SIDS between January 1996 and June 1997 in Japan were identified from death certificates. Controls of the same gender, birthplace, and birth months as the corresponding SIDS were chosen from birth certificates. Interviews of both cases and controls were undergone in January and February, 1998 by public health nurses. The following child-rearing factors exhibited a significant relationship with the occurrence of SIDS: Concerning the sleeping position, the prone position was associated with increased risk compared with the supine position, with an odds ratio of 3.02 (95% c.i. 2.07~4.65). Regarding the feeding method, artificial feeding alone demonstrated a higher risk than breast feeding alone, with an odds ratio of 4.92 (95% c.i. 2.78~9.63). With regard to smoking, infants with both parents who smoked exhibited a higher risk than infants where neither parent smoked, with an odds ratio of 3.50 (95% c.i. 1.74~8.32).
Sudden infant death syndrome ; occurrence ; Lower case sea ; Risk ; Affect

We report a 59-year-old chronic hemodialysis patient with a thoracoabdominal aortic aneurysm, in whom the entire aortic wall and visceral branches were severely calcified. Using a staged operation approach, the celiac trunk and superior mesenteric artery were first bypassed with a composite graft made from a saphenous vein Y-graft and ePTFE. Next, we inserted a custom-made stent-graft, however, there was poor attachment at both the proximal and distal ends due to the severely calcified aortic wall. As a result, we used additional two stent-grafts. His postoperative course was good, and the CT scan performed one year after operation showed no endoleak.

As a method of agility measurement under wide current use, the repeated side step is well-known. At present in Japan, a duration of 20 seconds is employed to test agility ; but it is often reported that the factor of endurance is included in this. When a diagnosis involving agility is made based on the performance of exercise, the duration of the time of measurement was controlled in order to avoid the mixing of other factors and to ensure measurement of as few factors as possible. The distance of step was made flexible according to the age. Since a constant distance makes the longitudinal tracing easier, the distance of step was also studied.
Side steps were tested and duration of measurement was examined based on determinations in 1857 subjects, Junior and Senior school boys and girls and male university students. During the 20 seconds of measurement, scores were recorded every 5 seconds to study the time course of the fluctuations of scores. Taking into consideration factors of endurance such as the endurance of the lower extremity system, the knee test was conducted to see the relationship between scores of the repeated side step and knee test values. As to the distance of the step, 200 high school girls were tested over a distance of 100cm ×2 and 120cm ×2, for 10 seconds each.
As to the time of measurement, the average score during the first 10-15 seconds after start tended to decrease. In the time course of fluctuations of the scores in each subject, a decrease in the fall of scorse was seen about 10 seconds after the start in approximately 55% of the test subjects.
Based on the assumption that the endurance of the lower extremity system participates in this, high and low groups with a significant difference in the endurance of the lower extremity at the level of P<0.001 were compared. While no difference was seen in the slope of the score increase over a 10-second period from the start, changes of scores were distinctly different between 10 and 20 seconds, the lower values in the low group being obvious. The endurance of the lower extremity system was then studied in the two groups with high and low scores in the side step between 10 and 20 seconds. In the group with high scores, the endurance of the lower extremity was high : and a significant difference at P<0.01 was noted in this index.
These results would definitely indicate that mixing of other factors is unavoidable under the current measurement duration of 20 seconds
As to the distance of the step, scores are apparently different even in the same test subject, depending upon the distance of the step. The scores are also different depending upon the body length.
In both of the two groups, however, the scores for each different distance of the step showed a high correlation between each other, giving a correlation coefficient of γ= 0.88 in the group with high body length and γ= 0.82 in the group with low body length, indicating a high correlation.
Based on the diagnosis of agility and performance of exercise, in order to obtain the results of measurement of as simple a factor as possible, the agility time measurement is corrected to 10 seconds ; and the distance of the step is made constant at 100cm×2 regardless of the age, to a distance without unnatural effort even by a primary school pupil, in order to obtain a better diagnosis and tolerance for exercise for the desirable development and maintenance of agility.
The influence of body height on the score should be studied in the future.

Concerning the bone structures of the mandible reconstructed by particular cellular bone and marrow (PCBM), platelet rich plasma (PRP) and tray, we have examined the possibility of implant insertion by clarifying the morphological conditions in each compact and cancellous bone on computed tomography (CT), and by observing the differences in their CT values.Using the computer software program Sim Plant (Materialize Dental, Leuven, Belgium), we morphologically observed 6 cases of implant inserted area after mandibular reconstruction and 11 cases of native bone, and examined the differences in their CT values. The osseointegration rate of each inserted implant was also evaluated.Compared with the native bone group, the PCBM reconstruction group had generally thin compact bone. In the over-3cm-length PCBM reconstruction group, the average CT value was 259.7 ± 94.4 HU (n = 3) in the cancellous bone, whereas in the native bone group, the average CT value was 528.9 ± 140.1 HU (n = 10). Therefore, the PCBM reconstruction group showed significantly lower CT value than the native bone group. However, in the under-3cm-length group, the PCBM reconstruction group showed no significant difference compared with the native bone group. The osseointegration rate of the inserted implants almost 6 months after insertion was 100% in the PCBM reconstruction group and 94.1% in the native bone group.Although the PCBM reconstructed bone had thinner cortical bone and showed lower CT value compared with the native bone, implant insertion was possible.

Since the introduction of vonoprazan, a potassium-competitive acid blocker (P-CAB), it has been demonstrated to reversibly inhibit gastric acid secretion by engaging in potassium-competitive ionic binding to H+/K+-ATPase. In contrast, proton pump inhibitors (PPIs) achieve H+/K+-ATPase inhibition through covalent binding to cysteine residues of the proton pump. Reported cases have indicated an emerging trend of P-CAB-related gastropathies, similar to those associated with PPIs, as well as unique gastropathies specific to P-CAB use, such as the identification of web-like mucus. Pathologically, parietal cell profusions, which show a positively correlated with hypergastrinemia, have a higher incidence in P-CAB users compared to PPI users. Thus, this review aims to summarize the endoscopic and pathological findings reported to date concerning P-CAB-related gastric mucosal lesions. Additionally, it seeks to discuss the differences between the PPIs and P-CABs in terms of the formation and frequency of associated gastropathies. This review highlights the evident differences in the mechanism of action and potency of acid inhibition between P-CABs and PPIs, notably contributing to differences in the formation and frequency of associated gastropathies. It emphasizes the necessity to distinguish between P-CAB-related and PPI-related gastropathies in the clinical setting.

In order to promote regional cooperation in palliative care, we developed a regional cooperation clinical pathway for home palliative care that offers simple support and is easy to use. We then administered a questionnaire survey to 14 healthcare professionals with various specialties who were involved in the introduction of the pathway, and we revised the pathway on the basis of the survey results. The revised pathway was then tested in 13 patients who were discharged from 3 designated cancer care hospitals in Toyama City to home care, and another questionnaire survey was conducted afterwards in the same manner. The mean overall score on the questionnaire was 2 in seven, 3 in seven (on a scale of 0 to 3) at the time of introduction, whereas the score after trial use was 1 in one, 2 in four, 3 in five. We believe that more innovative approaches to the implementation of such pathways are required.

Purpose and Methods: Aiming at the relief of suffering by the palliative care team and prompt information sharing between healthcare professionals with various specialties, We introduced new IT cloud system, carried out questionnaire survey and examined the usefulness to 11 persons of healthcare professionals. Five cases where the palliative care team was concerned during the hospitalize became a home palliative care to the tried half a year. Results: All the members were using the personal computer as an input device. Four persons were using the iPhone. Two persons had the experience inputted on the spot. Nine persons of the input time were 5 or less minutes. All the members were perusing at various places by various device. Urgently and vital mail was useful: 3 in six, 2 in three, 1 in one, 0 in one. Information content were suitable: 3 in nine, 2 in two. Cooperation were completed in the smooth: 3 in nine, 2 in two. Have you utilized EIR for the home palliative care?: 3 in nine, 2 in two. Conclution: To the support of information sharing and palliative care team by IT cloud system transduction, the useful probability was suggested in the home palliative care.

OBJECTIVESThe purpose of this study was to assess how changes from different baselines of activities of daily living (ADL) can be explained by marital status, living arrangement and healthcare.

METHODSUsing data from the Chinese Longitudinal Health Longevity Study conducted in 2002 and 2005, 8,099 surviving and 3,822 deceased elderly aged 65 years and over were evaluated using multinomial logistic regression.

RESULTSAfter adjusting for demographic, socioeconomic and health factors, elderly who were either married or living alone were less likely to encounter ADL decline compared to their counterparts. This was true only for those with fully independent ADL at baseline. Notably, once the functional status of the elderly declined from baseline and they became dependent on others, the status of living alone was no longer a significant predictor of the rate of future decline. On the other hand, elderly who had a spouse, children or other relatives as caregivers were more likely to experience a faster recovery and lower likelihood of death, compared to those who were cared by unrelated live-in caregivers. In addition, Chinese elderly with health insurance had a lower likelihood of death than their counterparts lacking health insurance, among those with ADL at the dependent baseline.

CONCLUSIONSAlthough there has been a change in family structure and living arrangements, the majority of Chinese elderly still rely on traditional forms of family support, especially after acquiring dependency status. As the elderly have different functional levels, healthcare policies in China should consider the need for both community and family support systems.

A simple method of evaluation and measurement of endurance of the whole body for exercise prescription for sportsmen was previously reported. In the present study, a method of loading for general population was deviced and is the subject of the present communication.
The site of loading was divided into relatively localized portions of the lower extremity, upper extremity and trunk.
By substituting the kneeling exercise with step test, individual difference in body height was corrected.

At Nippon Medical School, a "Basic Clinical Training Course" is provided as an introduction to clinical medicine. Medical students undergo initial clinical skills training with simulators. We describe the technique of effective training to acquire clinical skills and the results of student evaluations and a questionnaire survey.1) The training consisted of 8 practicums, including internal examination, funduscopic examination, otoscopic examination, breast examination, auscultation (heart sounds and lung sounds), and collection of blood samples. Medical students moved in rotation once per time period (45 minutes) and performed practical training in each unit, which comprised 2 practicums.2) The training with the prescribed number of 50 students in 4 time periods was efficiently performed for 2 days and required 9 trainers per day. Student evaluations and a questionnaire survey revealed the interest and enthusiasm of medical students and showed they thought highly of the training.3) The training was efficiently performed and was thought to help reduce the teaching load of instructors. The educational effect of the training can be strengthened by increasing the convenience of the clinical simulation laboratory, by reinforcing the education of clinical skills and attitudes in clinical clerkship, and by evaluating these factors after the completion of the clinical clerkship.