Objectives: The reliability of surveys on smoking habits based on questionnaires was investigated, using the urinary cotinine content as an objective index. Methods: The subjects tested were 2,849 office workers of middle age, who responded to questions concerning their smoking status, and also their urinary cotinine was measured by the HPLC method. Results: The boundary value between smokers and non-smokers, determined by the histogram independent of the questionnaire, was 63.1 and 79.4 ng/mg of creatinine for males and females, respectively. The rate of misclassification of the non-smokers and former smokers as smokers was 1.3% for males and 1.8% for females, whereas that of current smokers as non-smokers was 6.3% and 2.1%. We also assessed the effect of smoke inhalation on the urinary cotinine value, and found a significant difference for males in the cotinine value by the presence of inhalation and also its depth. Conclusions: The rate of misclassification in this study was considered to be comparatively low. Several studies have also assessed the reliability of the questionnaire on smoking habits, and found different misclassification rates, indicating the dependence on the race and number of subjects tested. To our knowledge, there were only a few surveys on smoking among large groups, particularly in Japan, such as this one, therefore the results obtained in this study are meaningful.
Smoking ; Cotinine ; Indexes ; seconds ; Urine

In order to investigate the effects of the concentration of chemical components of sea water on thermoregulatory functions, rectal, skin and mean body temperatures were measured continuously before, during total body bathing as well as during recovery period on land.
Eight healthy young men were subjected in the experiment. Their physical characteristics were in average 19.8±1.0yrs in age, 169.2±5.0cm in height, 57.1±3.1kg in weight and 14.0±2.6% in body fat fraction, respectively. Each subject bathed in sea water or in tap water for 15 minutes in the long-sitting position at 38.5°C of water temperature during bathing and took recovery on land for 60 minutes. Water bathing was conducted in individual subject with the concentration of chemical components of sea water at 0, 1, 3.5 and 7%, respectively.
The rectal temperature increased during bathing and decreased gradually during recovery period on land. Statistically significant difference (p<.05) between 0 and 7% of the concentration of sea water was detected in the rectal temperature during bathing and recovery period. The mean skin temperature showed a continuous increase during bathing and showed a rapid decrease during 20 minutes in recovery, and a gradual decrease after then. Statistically significant difference (p<.05) between 0 and 7% of the concentration of sea water was detected in the mean skin temperatures during recovery period. The mean body temperature also showed a continuous increase during bathing and rapid decrease during the first 20 minutes in the recovery period, and decreased gradually thereafter. Statistically significant difference (p<.01) between 0 and 7% of the concentration of sea water was detected in the mean body temperature during bathing and recovery period.

Purpose: The purpose of this study was to clarify the state of eating -related distress and struggle in the daily lives of cancer outpatients in cancer center hospital. Methods: Cancer outpatients who consented to participate in the study filled out self-administered questionnaires regarding eating distress and the means of coping with them. The data were qualitatively analyzed via content analysis method. Results: Data from 176 patients who responded that they experienced eating difficulties were analyzed. A total of 222 codes were extracted for eating-related distress, and these were classified into five categories, which included eating-related symptoms accompanying the disease and its treatment, difficulties related to food preparation, and concerns about eating outside food. A total of 224 codes were extracted for eating-related struggle made by the patients, and these were classified into eight categories, which included adjusting eating methods to make food easier to eat, controlling one’s feelings when unable to eat certain foods, and adjustments related to food preparation. Conclusions: The study results suggested that cancer outpatients require care not only at early stages after treatment for eating-related symptoms but also related to food preparation and concerns when eating outside food.

Today, well over 160, 000 patients undergo dialysis throughout Japan. The number of patients who are newly required to receive it is increasing year by year. Given that situation, our hospital has annually held a seminar since October 1994 for patients with renal diseases. The purpose is to slow the deterioration of renal function and to delay the introduction of dialysis by encouraging the patients to acquire a habit of taking high calory, low protein food.
This seminar must have help the patients get more knowledgeable about morbidity and learn the benefit of low protein rice-based diet. Now that three years have passed since the opening of the course, we reviewed the outcome, comparing the effects of old and new restrict diets.
A difference began to appear 9-2 months after the lst seminar between the seminar participants and the non-participants (control group) who received guidance only at the outpatient ward. The average rate of decrease in the serum creatine level of those participants who eated lowprotein rice was 0.029 and that of those participants who did not eat the restricted food was 0.166 (p<0.05), compared with 0.262 in the control group. We concluded that the difference is ascribable to the effect of the seminar. We would like to contribute to the well-being of the patients by enriching the content of the seminar and continuing to hold it.

 Our hospital comprises nine departments of internal medicine that specialize in different organs, and the Department of General Internal Medicine is one of these departments. The inpatient department has 30 beds for providing medical care, and education is provided for junior and senior residents. We examined the diagnoses in 593 cases (289 men, 304 women ; mean age, 64.2±21.2 years old) who were hospitalized in the Department of General Internal Medicine at this hospital between April 2007 and March 2008. The major diseases included pneumonia, 111 cases ; urinary tract infections, 44 cases ; infectious enteritis, 34 cases ; bronchial asthma, 24 cases ; fever of unknown origin, 12 cases ; heart failure, 11 cases ; viral infections 9 cases, diverticulitis, 8 cases ; malignant lymphoma, 7 cases ; infectious mononucleosis, 7 cases ; polymyalgia rheumatica, 6 cases ; and others. In order to provide diagnoses and treatments for cases in which no diagnosis could not be obtained on the first outpatient visit, for example, it is necessary to have a ward for general internal medicine as a location for providing medical care that is not limited to any specialized field.

A decline in the immunopotential of the host plays an essential role in the occurrence of infections with methicillin-resistant Staphylococcus aureus (MRSA) or other multi-drug resistant microorganisms. In the present study, mytomycin C (MMC)-treated mice with or without the infection of MRSA were used to examine the bacteriostatic action as well as the immunopotentiating action of the promising herbal medicine, Hochu-ekki-to (HET). Basic experimental data showed the drug to be effective in the treatment of MRSA infection. Eight to ten week old male C57BL mice were injected with MMC at a dosage of 5mg/kg/day to inhibit the bone marrow, thus creating a mouse model with reduced immunopotential. A powder extract of HET was administered orally at a dosage of 500mg/kg/day for seven consecutive days. For the infection of MRSA 1×10⁹ cell were injected intraperitoneally. Peritoneal macrophages were prepared by the adherence technique. Macrophage migration, phagocytic activity, and the bactericidal activity were examined by the Boyden chamber method, by the phagocytosis for fluorescent-activated latex beads, and by the nitroblue tetra zolium (NBT) reduction test, respectively.
After the administration of HET, the number of white blood cells in the MMC-treated mice recovered to 80% of the normal value. In addition, the phagocytic activity of macrophages increased to 50%, although that of the non-treated group was only 20%. The bactericidal activity also recovered to a level close to the normal value. The ratio of neutrophils in the HET administered MMC-treated group increased to 2.2% (normal mice, 2.6%) whereas that of the MMC-treated control group was 0.5%. Concerning the function of the immunological cells, IL-1beta and IFNgamma levels were recovered by treatment with HET, as observed by IL-1beta, IL-2 and IFNgamma monitoring. The bacterial count in the liver of the MRSA challenged mice, with or without HET administration peaked 6 hours after the challenge. The number of the group with HET administration was, however, much greater than that of the group without HET administration. The bacteria count in the blood showed an increase 12 and 24 hours after the challenge. Even 24 hours after the challenge, a significant number of bacterial cells existed in the blood of the group without HET administration, whereas only a small number of cells were detected 6 hours after the challenge. All of the control mice died 8 days after the MRSA challenge, whereas the survival rates were 60% for HET treatment, 40% for the vancomycin treatment, and 80% for the HET plus vancomycin treatment, respectively.
As we move towards a society with a high percentage of elderly people, the authors believe Chinese herbal medicine, which activates the immunopotential, will be very helpful in the treatment of opportunistic infections that are common among elderly patients.

Resistance to facultative intracellular bacterial pathogens depends on acquired cell-mediated immunity and activation of macrophages by T- lymphocytes. Gamma interferon (IFN-gamma) is believed to be an important mediator of acquired cell-mediated immunity. In the present study, we evaluated the effect of Hochu-ekki-to (HET) on the survival rate and cytokine production with Salmonella infection model by using EL-4-bearing C57BL/6 mice. 1) When HET was administered orally to the tumor-bearing mice, it extended the survival time compared with non-treated controls in experimental infection by virulent strain 116-54. 2) The effect of HET on production of IFN-gamma in cultured splenocytes was tested by using the tumorbearing mice immunized with attenuated live SER strain. Spleen cells prepared from the mice treated with HET produced high levels of IFN-gamma compared with non-treated controls.
The results indicated that orally administered-HET enhanced protective ability to primary Salmonella infection and production of IFN-gamma accompanied by vaccination in EL-4-bearing C57BL/6 mice.

OBJECTIVESThe reliability of surveys on smoking habits based on questionnaires was investigated, using the urinary cotinine content as an objective index.

METHODSThe subjects tested were 2,849 office workers of middle age, who responded to questions concerning their smoking status, and also their urinary cotinine was measured by the HPLC method.

RESULTSThe boundary value between smokers and non-smokers, determined by the histogram independent of the questionnaire, was 63.1 and 79.4 ng/mg of creatinine for males and females, respectively. The rate of misclassification of the non-smokers and former smokers as smokers was 1.3% for males and 1.8% for females, whereas that of current smokers as non-smokers was 6.3% and 2.1%. We also assessed the effect of smoke inhalation on the urinary cotinine value, and found a significant difference for males in the cotinine value by the presence of inhalation and also its depth.

CONCLUSIONSThe rate of misclassification in this study was considered to be comparatively low. Several studies have also assessed the reliability of the questionnaire on smoking habits, and found different misclassification rates, indicating the dependence on the race and number of subjects tested. To our knowledge, there were only a few surveys on smoking among large groups, particularly in Japan, such as this one, therefore the results obtained in this study are meaningful.

OBJECTIVEThe food consumption and serum nutritional status of people living in the Kathmandu valley, Nepal, were examined to obtain actual data for comparison with our previous findings.

METHODSA dietary survey of 45 males and 60 females was carried out in March 1997 by the 24-hr dietary recall method and nutrient intake was calculated from food tables of India and Japan. Fasting venous blood samples were obtained and serum biochemical parameters were measured using clinical kits.

RESULTSThe mean body mass index values was at about the same level in both sexes, although the mean percentage body fat of females was higher than that of males, and vice versa for packed red cell volume. The main foods consumed by both sexes, were rice, potatoes, meats, milk & dairy products and vegetables, with a difference in the amounts consumed. Females did not drink alcoholic beverages. The mean daily intakes of energy, protein, lipids, iron and vitamin B group for the males were higher than those for the females, while those of vitamins A and C for the males were lower than those for the females. The mean values of serum biochemical parameters for both sexes were generally at the normal levels, but those of ALT and TG were at the higher end of the normal range. Differences of correlation between food groups and between serum parameters were observed depending on the sex, however, no clear relationship between food and nutrient intake and serum biochemical parameters were observed.

CONCLUSIONSThe present food intake study revealed that the amounts of food consumption for both sexes, especially for the females, were mostly insufficient although the serum parameters were at the normal levels. The energy intake of both sexes was lower than that of estimated requirements and those in Terai region. The relatively high serum TG level of the subjects may be due to the consumption of large amounts of cereals containing much carbohydrate. Our findings suggested a marked influence on food consumption by food price and income in spite of the easier food availability in the city, and also lack of knowledge about nutrients and health, thus there is need for improvement of the nutritional status of this group of people.

Background/Aims: The efficacy and safety of tofacitinib for the treatment of refractory ulcerative colitis (UC) has been demonstrated in clinical trials. Although, a series of reports with real-world evidence of its short-term efficacy and safety profiles have already been published, reports of long-term real-world data have been limited. We aimed to show our 3-year evidence on the clinical use of tofacitinib for the treatment of UC, focusing on its efficacy and safety profiles. Methods: A retrospective observational study was conducted on patients who started tofacitinib for active refractory UC at our hospital. The primary outcome was the retention rate until 156 weeks after initiating tofacitinib. The secondary outcomes were short-term efficacy at 4, 8, and 12 weeks; long-term efficacy at 52, 104, and 156 weeks; prognostic factors related to the cumulative retention rate; loss of response; and safety profile, including adverse events. Results: Forty-six patients who were able to be monitored for up to 156 weeks after tofacitinib initiation, were enrolled in this study. Continuation of tofacitinib was possible until 156 weeks in 54.3%, with > 50% response rates and > 40% remission rates. Among patients in whom response or remission was achieved and tofacitinib was deescalated after 8 weeks of induction treatment, 54.3% experienced relapse but were successfully rescued by and retained on reinduction treatment, except for 1 patient. No serious AEs were observed in the study. Conclusions Tofacitinib is effective and safe as long-term treatment in a refractory cohort of UC patients in real-world clinical practice.