Objective (1)To study the change of fetal middle cerebral artery pulsatility index (PI_MCA) in twin pregnancy; (2)To compare the singleton and twin pregnancies with regard of changes in PI_MCA over the course of the pregnancy. Methods Fetal middle cerebral artery flow velocity waveforms were measured in 34 cases of normal twin pregnancies and 176 cases of normal singleton pregnancies from 23～35 gestational weeks. Results PI_MCA in twin pregnancies exhibited a decrease trend toward the gestation. Before 29 weeks' gestation the PI_MCA in twin pregnancies was lower than that of the singleton pregnancies,and it was rather higher than that of the singleton pregnances after 29 weeks'gestation. Conclusions The vascular resistance in middle cerebral artery after 29 weeks of gestation was higher in twin pregnancies than that of the singleton pregnancies.

Objective: To investigate the perception of the prevalence of mental diseases in breast cancer patients and the therapeutic approach to depression undertaken by oncologists. Method: Self-reported questionnaires were sent to 352 breast cancer specialists. The survey contains 11 categories to elicit the perception and identification of mental illnesses in patients, diagnostic procedure, and details of antidepressant prescribed. Logistic regression was used to explore the association of oncologists' characteristics and management of depression in breast cancer patients. Results: Survey response rate was 31.3%. Ninety percent of the oncologists perceived the prevalence of depression to be less than 20%, while half believed that the proportion was less than 5%. The most commonly-used medication for the treatment of depression was BZDs (41.5% [n=39]), followed by Selective Serotonin Reuptake Inhibitors (SSRIs) (30.9% [n=29]). Benzodiazepines (BZDs) were most frequently prescribed (41.5%) despite its known ineligible dependency, followed by Selective Serotonin Reuptake Inhibitors (SSRIs) (30.9%). Choice of BZDs was significantly associated with the career length of oncologists (Odds Ratio [OR]=8.20), and safety of drug (OR=5.57). Contrarily, prescription of SSRIs was associated with efficiency of drug (OR=7.07). Conclusion: Relative to anxiety and insomnia, a lower awareness regarding depression was common among study oncologists. In addition, the quality of care varied among these oncologists. It is necessary to improve both the awareness and management of mental illnesses in order to enhance the total clinical care of breast cancer patients.

In this study, the states of obesity, physical activity, and diet of 4 th-6 th graders were examined in an agricultural area of the Tohoku region, where many pupils are driven to and from school. The physique (height, weight), physical activity level (Select 2 ; Kenz), and nutritional intake were investigated in 32 elementary school pupils for one week.The subjects showed the following characteristics : 1) A high percentage of obese pupils, 2) a small number of walking steps, and 3) a lower percentage of obese pupils than non-obese pupils participating in sports activities. Therefore, efforts to increase the physical activity level are considered to be necessary for the prevention of obesity. For this purpose, in addition to administrative measures to increase exercise opportunities in the community such as the establishment of a general sports club, local movements such as encouraging pupils to walk to school may be effective.

An Elderly Health and Fitness Promotion Program was carried out in the 32 on areas of Ichihazama Town (now Kurihara City), Miyagi Prefecture to promote the health of the elderly population by making as many townspeople as possible aware of their health and fitness levels, and develop active lifestyles. We evaluated the effectiveness of this program on the basis of the results during the past 4 years.In 2001, the Elderly Health and Fitness Promotion Program was started in each of the town's 32 administration areas. The number of participants continued to increase until it exceeded 600 in 2004, with increases in the percentages of males, those aged 80 years or above, and those withlimited ADL among the participants. While the results of fitness tests varied widely and were very low in some participants, changes in the fitness level were small in regular participants.

Objective: Currently, Risk Management Plans (RMPs), plan that provide new risk information about drugs, are published on the Pharmaceutical and Medical Devices Agency (PMDA) website.  The aim of this study was to compare enumerated risks in RMPs to the product labeling (PL) of the drug package insert.
Methods: The risks listed in RMPs on the PMDA website were assessed on February 10, 2014.  We investigated the documentation of these risks on the PL.
Results: Seven-hundred and eighty-five risks were enumerated in the RMPs of 77 drugs.  The enumerated risks were classified as “important identified risks” (66%), “important potential risks” (22%), and “important missing information” (12%).  Ninety-four percent of risks listed in RMPs were documented on the PL.  A portion of both the “important identified risks” and “important potential risks” groups were not documented on the PL.
Conclusion: This study was clearly the relation between risks listed in RMPs and documents on the PL.  Because a portion of the risks listed in RMPs was not documented on the PL, RMPs provide more safety information.  It is necessary to better understanding their characteristics, considering RMPs are a new source of drug information.

We report a case of ulcerative colitis (UC) after mitral valve replacement (MVR) surgery due to infective endocarditis (IE). A 59-year-old woman underwent MVR for mitral regurgitation due to IE. Six days after the surgery, melena was observed suddenly, and she received a blood transfusion. Ulcer and erosion were observed in the rectum 5 to 10 cm from the anal ring by endoscopy. We changed her antibiotic treatment and stopped warfarin potassium. Heparin sodium was started 2 days after melena. We diagnosed ulcerative colitis from the finding of the rectal lesion and biopsy. We gave mesalazine and betamethasone as treatment for UC. The patient's condition improved and her general condition stabilized. She was discharged 36 days after surgery.

We experienced a difficult case which had multiple impairments caused by antiphospholipid syndrome. This disease is a thrombophilic disorder in which venous or arterial thrombosis, or both, may occur in patients with antiphospholipid antibodies (e.g. anticardiolipin antibody, lupus anticoagulant). This disease is well demonstrated as a cause of ischemic stroke in young adults. But the optimal treatment of these patients is unclear, and their prognosis is not good. Antiphospholipid syndrome causes recurrent multiple ischemic strokes, induces severe impairments and the disturbance of various higher brain functions, and shows resistance against rehabilitation. To address these difficulties we should, as rehabilitation experts, conduct chronic disease-management with the cooperation of the neurologists, and devise a rehabilitation approach that takes into consideration the nature and severity of this disease. In other words, a diversified approach, which is characteristic to rehabilitation, is no less important than medical remedies in treating antiphospholipid syndrome patients.

PURPOSE: Peripheral artery disease (PAD) is a form of arteriosclerosis that occurs in the extremities and involves ischemia. Previous studies have reported that patients with periodontitis are at high risk for PAD. However, the relationship between these 2 diseases has not yet been fully elucidated. In this cross-sectional study, we investigated this relationship by comparing patients with PAD to those with arrhythmia (ARR) as a control group. METHODS: A large-scale survey was conducted of patients with cardiovascular disease who visited Tokyo Medical and Dental University Hospital. We investigated their oral condition and dental clinical measurements, including probing pocket depth, bleeding on probing, clinical attachment level, and number of missing teeth; we also collected salivary and subgingival plaque samples and peripheral blood samples. All patients with PAD were extracted from the whole population (n = 25), and a matching number of patients with ARR were extracted (n = 25). Simultaneously, ARR patients were matched to PAD patients in terms of age, gender, prevalence of diabetes, hypertension, dyslipidemia, obesity, and the smoking rate (n = 25 in both groups). Real-time polymerase chain reaction was performed to measure the bacterial counts, while the enzyme-linked immunosorbent assay method was used to measure anti-bacterial antibody titers and proinflammatory cytokine levels in serum. RESULTS: PAD patients had more missing teeth (18.4±2.0) and higher serum levels of C-reactive protein (1.57±0.85 mg/dL) and tumor necrosis factor-alpha (70.3±5.7 pg/mL) than ARR patients (12.0±1.7, 0.38±0.21 mg/dL, and 39.3±4.5 pg/mL, respectively). Meanwhile, no statistically significant differences were found in other dental clinical measurements, bacterial antibody titers, or bacterial counts between the 2 groups. CONCLUSIONS: Our findings suggested that PAD patients had poorer oral and periodontal state with enhanced systemic inflammation.
Arrhythmias, Cardiac ; Arteriosclerosis ; Bacterial Load ; C-Reactive Protein ; Cardiovascular Diseases ; Cross-Sectional Studies ; Dyslipidemias ; Enzyme-Linked Immunosorbent Assay ; Extremities ; Hemorrhage ; Humans ; Hypertension ; Inflammation ; Ischemia ; Methods ; Obesity ; Periodontitis ; Peripheral Arterial Disease ; Prevalence ; Real-Time Polymerase Chain Reaction ; Smoke ; Smoking ; Tooth ; Tumor Necrosis Factor-alpha

Purpose: The aim of this study was to clarify the factors contributing to the evaluation of perceived care in inpatient palliative care services from the aspect of informal caregiver after their loss of the patient to cancer. Method: A questionnaire was mailed to 9,684 bereaved subjects who had lost family members at one of 103 palliative care units in Japan to evaluate their sociodemographic characteristics and the evaluation of perceived care. An institution survey was performed to collect organization-related variables. The evaluation of perceived care was rated by the Care Evalutaion Scale (CES), the Good Death Inventory (GDI) and single item of overall satisfation. Result: A total of 5,810 responses were analyzed (response rate＝60％). Uni-variate and multivariate analysis was performed to clarify the determinants of each scale. Significant determinants of the score in the evaluation of care identified were: the rate of private room (100％), independent facility, palliative care physician being night-time duty, the number of nurses at night (＞0.1 per bed), sending a letter to every bereaved family, holding a memorial services for every bereaved family and having a religious background. Conclusion: In conclusion, the evaluation of palliative care from the aspect of informal caregiver was influenced by various organization-related variables.