Although body mass is known to be related to bone mass, defined as bone mineral density (BMD) and bone mineral content (BMC), little is known about the effects of body mass reduction programs on bone mass. This study assessed bone mass changes in response to four body mass reduction programs that utilized diet and/or exercise. Ninety-four obese or overweight women (age 49.3±7.1 years, body mass 68.5±7.7 kg) were randomly assigned 4 groups (2 intervention forms × 2 trials) : diet in trial 1 (D₁, n=27), diet plus exercise in trial 1 (DE₁, n=28), diet in trial 2 (D₂, n=21), and diet plus exercise in trial 2 (DE₂, n=18) . Body mass, body mass index (BMI), absolute and relative (%fat) fat mass, lean mass, BMC, and BMD were measured by dual energy X-ray absorptiometry before and after the 3-month intervention program. Body mass loss was similar in DI (-9.7%) and D₂ (-11.6%), and in DE₁ (-13.8%) and DE₂ (-12.2%) . However, BMC loss was different (P<0.05) between trial 1 and trial 2 for each intervention form (D₁: -3.2% vs D₂ ; -0.9%, DE₁: -4.5% vs DE₂: -0.8%) . With this in mind, multiple regression analyses were applied, with either change in BMC or BMD as the dependent variable, and other physical characteristics measured before and after the intervention program as independent variables. Results indicated that multiple correlation coefficients were statistically significant (R=0.61 with BMC, R=0.49 with BMD) . BMI after the intervention program and change in body mass were identified as the significant contributors to the change in BMC, while change in %fat and age were identified as the significant contributors to the change in BMD. These results suggest that, during body mass reduction, (1) physical characteristics are the significant contributors to changes in BMC and BMD and (2) exercise may not prevent the loss of bone mass.

We developed a problem-oriented simulation system for medical diagnosis which works on personal computers without special equipment. In this simulation system the history of illness can be presented by voice, and physical findings are presented audiovisually through the student's actions, in a manner that closely resembles an actual medical examination. The laboratory findings are also presented through the student's actions. Students compile a database with information that they collect, create a problem list, and devise an initial diagnostic plan for the patient's most important problem. This computer-assisted system will help medical students learn diagnostic strategies in a simulated clinical setting. We believe that this system is a promising method that will facilitate problem-oriented learning in the virtual multimedia environment with special convenience for medical students to share time and facilities and to lower costs.

As a management improvement tool useful for cost containment and adaptable to the trend of reform in recent years, we introduced the SPD system of medical materials. Since there had been no precedent for the introduction of the SPD system in the hospitals affiliated with Kouseiren and even for the dealer it was the first trial, an original system was built. The quantity of materials in stock was fixed by entrusting, so-called the shelf control system. This system has been left in charge of one hospital employee and one individual employed by the dealer.The condition at the time when this system was introduced was not to increase personnel but to lower costs. The maintenance costs of this system were as cheap as 137,700 yen per month on a five-year lease. As a result, the quantity of inventory at the time of the term-end settlement of accounts reduced by about 18 million yen. Moreover, in marked contrast with increased income, the amount of money expended in the purchase of medical materials decreased from that in the pervious year. Though the number of items used in each department has increased by 480 items now from the start, the inventory is 0 yen.This system is very useful especially for the inventory management of specific insurance medical materials, because it can take in insurance claim data on MO (Magneto Optical Disk), compare it with the purchase data of materials and check the income-and-expenditure balance of specific insurance medical materials immediately. The sum of the amount of temporary stock curtailment for the past two years and six months and the annual purchase curtailment amount was 93,380,000 yen.It is concluded that the introduction of the SPD system has contributed much to the improvement of inventory management.
Insurance ; System ; Reduction - action ; Effective ; Original

The practical use of abdominal examination is a major characteristic of Kampo medicine. Although most Kampo medical texts describe an abdominal examination for a Kampo formula, comparative studies between texts have not contributed to any standardized descriptions for such examinations. We investigated descriptions of 147 prescription Kampo extract formulations in Kampo texts written after the Showa Era, and obtained the following results. Abdominal examinations were described differently by authors, even for the same prescription. Additionally, we examined the descriptions for anchusan (安中散) and kososan (香蘇散), which are called the Gosei school formulae (後世方). Descriptions of abdominal examinations for these drugs were not quoted from an original Chinese medical text, but were empirically constituted in Japan. As knowledge was accumulated, these various descriptions were created through limited personal connections, and/or the opinions of particular authorities. We suggest that a consensus on abdominal examinations would further studies on the viability of traditional medicines, and better characterize Kampo medicine.

A cross-sectional study was carried out to investigate the effect of physical exercise in daily lives of healthy women on the aging process in terms of maximal aerobic capacity (VO₂max), body fat tissue mass (FTM), lean tissue mass (LTM), bone mineral density (BMD), serum triglyceride (TG), total cholesterol (TC), HDL-C and LDL-C concentrations, and systolic (SBP) and diastolic blood pressure (DBP) . These parameters are considered as risk factors of cerebrovascular disease and/or osteoporosis, which are the main causes of becoming bedridden and demented in middle-aged and older women. One hundred sixty-five healthy female volunteers aged 20 to 76 years participated in the study, 82 of whom were postmenopausal with a mean age at menopause of 49.7±3.1 years. Eighty-two of the subjects had been exercising regularly by jogging, swimming, aerobic dancing, or playing tennis more than twice a week for 2 years (Ex group), whereas 83 individuals had not been engaging in regular exercise (Cont group) . Serum lipid concentrations, SBP and DBP measurements at rest and treadmill VO₂max and HRmax measurements were determined in the morning after an overnight fast. Whole-body BMD (TBMD), head, lumbar, arm and leg BMD, FTM and LTM were measured by dual-energy X-ray absorptiometry one to two hours after a light lunch. The mean and SD of each measurement were calculated for five-year age groups between 40 and 60 years and one group each under 40 and over 60 years.
The results were as follows:
1, VO₂max (r=-0.590) and HRmax (r=-0.632) decreased significantly with age. The VO₂max of the Ex group was significantly higher than that of the Cont group in all each age groups. However, no differences in the aging process in terms of HRmax were found between the two groups.
2, Resting SBP (r=-0.391) and DBP (r=0.315) increased significantly with age. However, no hypertensive individuals (160/95 mmHg-) were found among the 165 subjects.
3. Only serum TC (r=0.346) and LDL-C (r=0.339) among the blood constituents measured changed with age. No changes in serum HDL-C were detected with age. Lower TC (189.2±23.3 mg/dl) and higher HDL-C (72.2±10.9 mg/dl) were observed in eleven runners (49.7±7.7 years) among the subjects who participated frequently in official races than in subjects of the same ages in the Cont group. The highest serum HDL-C (75.8±15.8 mg/dl) and HDLC/TC ratios (0.362) were noticed among the subjects (n=26) who both regularly exercised and consumed alcoholic beverages.
4. A tendency for FTM to increase and LTM to decrease with age were observed in both groups, and a lower %FTM (percentage of FTM to body weight) and higher %LTM were evident in the Ex group. Differences in %FTM and %LTM between the Ex and Cont groups at 40-45 years were significant.
5. Partial and whole BMDs decreased significantly with age (TBMD-Age ; r=- 0.527) . Significantly higher leg BMDs in both the 20-39-year and 40-45-year groups, and spine and TBMD in the 20-39 years in the Ex group, who were premenopausal women, were shown. No significant differences in BMDs between the two groups were observed in postmenopausal women, but the Ex group tended to have higher partial and whole BMDs. The postmenopausal official race runners (n=5.52.6-1.5years) also had higher TBMD and leg BMD values than subjects of the same ages in the Cont group.
6. Investigation of correlations between VO₂max, LTM, FTM, BMDs and serum lipid concentrations, yielded a significantly higher correlation (r=0.669) between LTM (kg) and absolute VO₂max (1/mm) . Although VO₂max per LTM (VO₂max/LTM) decreased with age (r=-0.595), VO₂max/LTM in the Ex group was significantly higher than in the Cont group in each age group. The VO₂max per body weight (ml/kg/min) was negatively correlated with %FTM (r=-0.442) and positively correlated with

　　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.

Consultations with patients who bring drugs, especially on the high risk drug list, to a hospital is an important role of pharmacists. However, many incident reports occur though pharmacists generally make an effort to check such medications. In Japan, incidents are mostly reported just in terms of numbers but not in terms of the prevalence of a target group. We aim to reveal the prevalence of incidents related to medicine brought-in by patients undergoing surgery in National Hospital Organization (NHO) hospitals. For our study, we extracted patients undergoing surgery who were prescribed antidiabetic agents from the Medical data bank (MIA) in NHO. Chart reviews were performed on patients to evaluate the number of incidents in relation to brought-in medicine. The prevalence of incidents of interest was 4.4% (41/931, 95%CL : 3.2-5.9%). Pre-avoidable incidents represented 56.1% (23/41, p<0.0001). We found that pharmacists play a role in making incidents less severe.

The use of the radial artery (RA) for coronary artery bypass grafting (CABG) is increasing. This study describes mid-term results of the use of RA for CABG. Between March 1996 and March 1999, we performed 134 CABGs using RA or saphenous vein graft (SVG) for the left circumflex branch area or diagonal branch area. The mean age was 62.6±9.6 years in the RA group and 65.0±7.8 years in the SVG group. The average number of anastomoses was 2.7per patient. RA was anastomosed with the postero-lateral branch (PL) in 69 cases, with the obtuse marginal branch (OM) in 29 cases and with the diagonal branch (DB) in 10 cases. SVG was anastomosed with PL in 26 cases, with OM in 14 cases and with DB in 2 cases. The proximal anastomosis was made with the ascending aorta in all cases. No sequential bypass anastomosis was used in any case. The early patency rate of the grafts was 97.9% (93/95) in RA and 91.7% (33/36) in SVG. The clinically negative rate in the treadmill test (TMT) performed later was 99.0% (102/103) in RA and 90.9% (30/33) in SVG. The late patency rate of the grafts was 92.9% (13/14) in RA and 50.0% (3/6) in SVG. Perioperative death occurred in 5 cases. Late cardiac death occurred in 2 cases (0.02%) of the RA group and 1 case (0.03%) of the SVG group. The 3 year-survival rate free of cardiac events was 92.8% in the RA group and 80.9% in the SVG group. The use of RA for CABGs is not only effective for myocardial revascularization, but also can be expected to bring about good patency as a late result.