A 68-year-old woman received aortic valve replacement (AVR) with a Freestyle stentless valve using a subcoronary technique for aortic stenosis and regurgitation in September 2000. She complained of chest pain, had low grade fever and findings of inflammation and was admitted to our hospital with a diagnosis of acute myocardial infarction in December 2000. She suffered from repetitive or recurrent myocardial infarction. Transesophageal echocardiogram revealed no abnormal findings of the Freestyle stentless valve, but her blood culture was positive for methicillin-resistant coagulase negative Staphylococcus aureus (MRCNS) and she underwent an emergency operation. The Freestyle stentless valve was removed and replaced with a mechanical valve. The patient's intraoperative tissue grew MRCNS and parenteral antibiotics were administered for 8 weeks after surgery. Her condition was complicated with multiple cerebral infarction, however she was discharged on the 113th postoperative day and is doing well without recurrence of infection 12 months after the operation.

Objectives: The first objective of this study was to classify men aged 40-74 yrs with metabolic syndrome (MetS) according to daily rice intake, and the second was to investigate physical measurements, physiological examinations, blood biochemical assays, intake of food other than rice and lifestyle and environmental factors in the study group.
Methods: We analyzed data from 6095 men aged 40-74 yrs who had undergone full medical examinations. The men were classified into 3 age groups: (1) 40-49 yrs, (2) 50-59 yrs, and (3) 60-74 yrs. The men were classified further into 3 groups according to daily rice intake: group 1 (≤300 g), group 2 (300-450 g), and group 3 (≥450 g). The relationship between daily rice intake and the following factors was analyzed in the three age brackets: (1) physical measurements including waist circumference, (2) physiological measurements, (3) serum biochemical indices, (4) whether or not the person was taking medication for hypertension, diabetes mellitus or serum lipid abnormalities, (5) lifestyle, and (6) consumption of foods other than rice.
Results: Daily rice intake was related strongly to the occurrence of MetS in all three age brackets. Multiple logistic regression analysis showed (1) a significant increase in the odds ratio for MetS (1.461 times) for group 3 compared with group 1 in men aged 40-49 yrs and (2) a significant increase in the odds ratio for MetS (1.501 times) for group 3 compared with group 1 in men aged 50-59 yrs. However, there was no significant difference in the odds ratio for MetS among rice intake groups in the 60-74 age bracket.
Conclusion: In men aged 40-59 yrs, daily rice intake strongly influenced the incidence of MetS, whereas in men aged 60-74 yrs, there was no relationship between daily rice intake and MetS.

Objective: The purpose of this study was to investigate regional differences in the standard mortality ratio (SMR) and risk factors (including dietary habits) for stroke across the three regions of Ehime Prefecture - Toyo (east), Chuyo (central), and Nanyo (south).
Participants and methods: We obtained medical records derived from 956,979 medical examinations carried out at JA Ehime Kouseiren Medical Examination Centers between April 1994 and March 2006. We analyzed data from 132,090 subjects (Toyo - 47,654, Chuyo - 38,435, Nanyo - 46,001) who underwent their first medical examination during this period. To analyze differences between the three regions, we first calculated the SMR for stroke based on data from the Basic Residential Registers and Health Statistics Bureau. Secondly, we calculated significant differences in body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (Glu), and total cholesterol (T-CHO). Thirdly, we used the Chi-square test to calculate significant differences in the percentage of subjects who consumed the following foods on a daily basis: rice, bread, eggs, fish, meat, vegetables, dairy products, and fruit juice.
Results: Despite the fact that regional differences in the SMR for stroke have been decreasing, in both men and women in Nanyo, the mean values for SBP and DBP were significantly higher and the mean value for T-CHO was significantly lower than in Toyo and Chuyo. In Nanyo, the percentage of subjects who consumed rice and fish (men and women), meat (men), and juice (women) on a daily basis was higher than in Toyo and Chuyo.
Conclusion: In Nanyo, higher SMR for stroke may be related to high SBP and DBP and low T-CHO. As background to these results, it is also thought that regional differences in dietary habits may have an influence.

The purpose of this study was to examine the effects of crocetin on the pupillary response during accommodation induced by visual display terminal (VDT) work. This clinical study was conducted as a randomized, double-blind, placebo-controlled, crossover trial in healthy adult volunteers with subjective symptoms of eye fatigue. In this study, the pupillary response during accommodation was evaluated using pupil constriction ratio (PCR). PCR was measured before and after VDT work, after rest at baseline, and at each intervention period. Following analysis of variations in PCR, the variation in PCR after rest significantly increased in the crocetin group. According to the visual analog scale questionnaire, subjective symptoms of eye fatigue significantly improved. These results show that ingestion of crocetin for 4 weeks is effective in mitigating the pupillary response during accommodation associated with VDT work.

Objective : This study aimed to investigate the changes in the functioning of users of visiting rehabilitation services and related factors. Methods: Among 107 users in 22 visiting rehabilitation centers, we analyzed the data of 80 who completed the 6-month study. Their Functional Independence Measure (FIM), Life-Space Assessment (LSA), and level of caregiver burden (J-ZBI_8) were compared at the commencement of this study, and at 3 and 6 months afterwards. A multiple linear regression analysis was performed to examine the factors related to the variables, which changed over 6 months. Results : Over a period of 6 months from the commencement of the study, we found that FIM and LSA scores significantly improved from 82.4 to 87.3 (p=0.016) and from 9.9 to 12.3 (p=0.05), respectively, in the group who were still within 1 year from the time since onset/injury. A multiple regression analysis revealed that the period of time since onset/injury, independence degree of daily living for the demented elderly, and presence of goal setting for activities of daily living/domestic work significantly influenced changes in total FIM scores (p=0.001, R²=0.32). Furthermore, the change in LSA scores was significantly influenced by gender, presence of cerebrovascular diseases, period of time since onset/injury, number of occupations involved in visiting rehabilitation services, and J-ZBI_8 scores (p=0.0001, R²=0.36). Conclusion : Effective visiting rehabilitation requires having appropriate goals set for daily living activities and the establishment of interprofessional collaboration within visiting rehabilitation centers.

Objective: Despite the fact that the total energy intake of Japanese peoplehas decreased, the percentage of obese people has increased. This suggests that the timingof meals is related to obesity. The purpose of the study was to investigate therelationship between the timing of meals and obesity, based on analyses of physicalmeasurements, serum biochemical markers, nutrient intake, and lifestyle factors in thecontext of Chrononutrition.
Participants and Methods: We analyzed data derived from 766 residents ofToon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medicalexaminations between 2011 and 2013. These medical examinations included. (1) physicalmeasurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers(total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors suchas family structure and daily habits (22 issues), exercise and eating habits (28 issues),alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups(FFQg); and (5) a questionnaire concerning the times at which meals and snacks areconsumed.
Results: The values for body mass index (BMI) and waist circumference werehigher for participants who ate dinner less than three hours before bedtime (<3-hgroup) than those who ate more than three hours before bedtime (>3-h group). TheChi-square test showed that there was a significant difference in eating habits, e.g.,eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after9 p.m., between the <3-h group and the >3-h group. Multiple linear regressionanalysis showed that skipping breakfast significantly influenced both waist circumference(β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed onlyinfluenced BMI (β = 0.581).
Conclusion: Skipping breakfast had a greater influence on both waistcircumference and BMI than eating dinner <3-h before going to bed.

Objectives: Despite the fact that the total energy intake of Japanese people has decreased, the percentage of obese people has increased.This suggests that the timing of meals is related to obesity.
The purpose of the study was to investigate the relationship between the timing of meals and obesity, based on analyses of physical measurements, serum biochemical markers, nutrient intake, and lifestyle factors in the context of Chrononutrition.
Participants and Methods: We analyzed data derived from 766 residents of Toon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medical examinations between 2011 and 2013. These medical examinations included. (1) physical measurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers (total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors such as family structure and daily habits (22 issues), exercise and eating habits (28 issues), alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups (FFQg);and (5) a questionnaire concerning the times at which meals and snacks are consumed.
Results: The values for body mass index (BMI) and waist circumference were higher for participants who ate dinner less than three hours before bedtime (<3-h group) than those who ate more than three hours before bedtime (>3-h group). The Chi-square test showed that there was a significant difference in eating habits, e.g., eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after 9 p.m., between the <3-h group and the >3-h group.
Multiple linear regression analysis showed that skipping breakfast significantly influenced both waist circumference (β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed only influenced BMI (β = 0.581).
Conclusion: Skipping breakfast had a greater influence on both waist circumference and BMI than eating dinner <3-h before going to bed.

Objective: This study aimed to examine the relationship between mortality risk and health-related factors and sense of coherence (SOC) in a cohort study of residents from a rural area of Japan.Materials and Methods: We followed-up with 3,416 baseline respondents over 3.76 years. Residents were subdivided into three groups based on SOC score: low, middle, and high. We used the total SOC score of the low-level SOC group as the standard, and calculated the standardized mortality ratio (SMR) for the middle- and high-level SOC groups. For all three SOC groups, health-related factors were analyzed by one-way analysis of variance, and lifestyle and history were analyzed using the χ2 test. Results were also analyzed by gender and age.Results: For men in the low-level SOC group, the SMR value was defined as 1, and for men in the high-level SOC group (0.44; 95% confidence interval: 0.11–0.77), the SMR value was significantly lower. There was a statistically significant reduction in the percentage of smokers in the men in the high-level SOC group.Conclusion: In this study, high-level SOC was associated with low mortality risk. This finding was particularly pronounced in the men.

Background/Aims: There are few published registry studies from Asia on pediatric inflammatory bowel disease (IBD). Registry network data enable comparisons among ethnic groups. This study examined the characteristics of IBD in Japanese children and compared them with those in European children. Methods: This was a cross-sectional multicenter registry study of newly diagnosed Japanese pediatric IBD patients. The Paris classification was used to categorize IBD features, and results were compared with published EUROKIDS data. Results: A total of 265 pediatric IBD patients were initially registered, with 22 later excluded for having incomplete demographic data. For the analysis, 91 Crohn’s disease (CD), 146 ulcerative colitis (UC), and 6 IBD-unclassified cases were eligible. For age at diagnosis, 20.9% of CD, 21.9% of UC, and 83.3% of IBD-unclassified cases were diagnosed before age 10 years. For CD location, 18.7%, 13.2%, 64.8%, 47.3%, and 20.9% were classified as involving L1 (ileocecum), L2 (colon), L3 (ileocolon), L4a (esophagus/stomach/duodenum), and L4b (jejunum/proximal ileum), respectively. For UC extent, 76% were classified as E4 (pancolitis). For CD behavior, B1 (non-stricturingon-penetrating), B2 (stricturing), B3 (penetrating), and B2B3 were seen in 83.5%, 11.0%, 3.3%, and 2.2%, respectively. A comparison between Japanese and European children showed less L2 involvement (13.2% vs. 27.3%, P< 0.01) but more L4a (47.3% vs. 29.6%, P< 0.01) and L3 (64.8% vs. 52.7%, P< 0.05) involvement in Japanese CD children. Pediatric perianal CD was more prevalent in Japanese children (34.1% vs. 9.7%, P< 0.01). Conclusions Upper gastrointestinal and perianal CD lesions are more common in Japanese children than in European children.