Background :There have been only a few comparative observational studies on the safety and effectiveness of drugs in Japan. Comparative observational studies would provide important information to address these issues and thus we need to establish a means to facilitate such studies. In comparative studies, it is important to prevent the distortion of results due to selection bias. Though we do not yet have a claims database for use in pharmacoepidemiological studies, recently many hospitals and pharmacies have computerized prescription data which may be used to minimize selection bias. Good standardized procedures for the identification of patients prescribed one of two or more drugs to compare in a study using computerized prescription data would serve as a basis for a variety of pharmacoepidemiological studies in Japan.
Methods :We carried out a questionnaire survey in 2753 hospitals and 909 community pharmacies to estimate the fraction of hospitals where computerized data can be used to identify all eligible patients who used a specific drug.
Results :Questionnaires were returned by 1942 (71%) of 2753 hospitals and 632 (70%) of 909 pharmacies. From among those which responded, patients were identified, the patient list was printed, and the electronic file of the patient list was generated in 75%, 64% and 36% of the 1942 hospitals and in 100%, 93% and 49% of the 632 pharmacies respectively.
Conclusion :With procedures using computerized prescription data, the cohort for observational comparative studies may be identified with a minimal selection bias in a majority of hospitals and pharmacies.

Spinal cord injury after successful operation of the thoraco-abdominal aorta is an unpredictable complication which negatively affects the patient's quality of life. The main cause of spinal cord injury has been reported to be peroxidation of lipids. Edaravone, a free radical scavenger, has been used in the acute phase of cerebral infarction to ameliorate the brain damage. The aim of the present study was to evaluate the protective effect of edaravone on the neurological and histological outcome, and to examine the method of its administration so as to obtain the better effect, using animal models with ischemic spinal cord. Three groups of rabbits underwent surgical exposure of the abdominal aorta that was clamped for 20min to achieve spinal cord ischemia. Group A (n=6, control group) was given no medication. In group B (n=6), edaravone (3mg/ml saline/kg body weight) was administered intravenously 30min after reperfusion. In group C (n=6), the same dose of edaravone was administered at 30min, 24h and 48h after reperfusion. Neurological status was clinically assessed, using Tarlov's score, at 24h, 48h and 1week after reperfusion. Somatosensory evoked potential was measured preoperatively, at 20min after ischemia, at 30min after reperfusion, and at 24h, 48h and 1week after operation. Spinal cord sections were examined histologically to determine the degree of neuronal damage given by ischemic-reperfusion. Group A presented paraplegia with marked neuronal necrosis. Groups B and C maintained better neurogical function than Group A (p<0.001), and Group C was much better than Group B (p<0.05). In the model rabbits with 20min of ischemia-reperfusion, systemic repetitious administration of edaravone was found to have a more protective effect than a single administration on the spinal cord neurons and glia cells both neurologically and histologically.

Granulocyte-colony stimulating factor (G-CSF) is a naturally occurring glycoprotein that stimulates the proliferation and maturation of precursor cells in the bone marrow into fully differentiated neutrophils. Several reports of G-CSF-producing malignant tumors have been published, but scarcely any in the hepatobiliary system, such as in hepatocellular carcinoma (HCC). Here, we encountered a 69-yr-old man with a hepatic tumor who had received right hepatic resection. He showed leukocytosis of 25,450/microL along with elevated serum G-CSF. Histological examination of surgical samples demonstrated immunohistochemical staining for G-CSF, but not for G-CSF receptor. The patient survived without recurrence for four years, but ultimately passed away with multiple bone metastases. In light of the above, clinicians may consider G-CSF-producing HCC when encountering patients with leukocytosis and a hepatic tumor. More cases are needed to clarify the clinical picture of G-CSF-producing HCC.
Aged ; Bone Neoplasms/secondary ; Carcinoma, Hepatocellular/*metabolism/pathology ; Fatal Outcome ; Granulocyte Colony-Stimulating Factor/*metabolism ; Humans ; Liver Neoplasms/*metabolism/pathology ; Male ; Receptors, Granulocyte Colony-Stimulating Factor/metabolism

Exercise has been well known to a fundamental treatment of diabetes mellitus, as well as diet therapy. Nevertheless, its therapeutic use and clinical effects are still unknown in details. The aim of this study is the establishment of practical exercise therapy for the patients with diabetes mellitus. The present study shows the acute exercise effects on blood metabolites and the effects of long term physical training in diabetics.
The following results were obtained.
1) Although no significant change of blood glucose level was observed in normals, the decrease of blood glucose and triglyceride levels were observed in diabetics in acute exercise. Moreover marked elevation of FFA level was also observed after acute exercise in diabetics.
2) Significant decrease of blood glucose and increase of HDL-cholesterol levels were found in diabetics by long term regular physical training.
3) Body weight reduction without loss of lean body mass and the improvement of physiological response to exercise test were achieved after long term physical training.
These results suggest that the regular physical training leads to the better control of diabetes mellitus and keeps good condition in patients with diabetes mellitus, and that it may have a important role of the prevention for the diabetic vascular complication.

Cystic adventitial disease of the popliteal artery is an uncommon disorder. 58-year-old male complained of left intermittent calf claudication and couldn't sit straight. He preferred playing baseball and jogging. Digital subtraction angiograms revealed a smooth extrinsic compression on the proximal left popliteal artery. Surgical procedure was performed with posterior approach. The left popliteal artery was confirmed to be surrounded by two adventitial cysts at operation. After the evacuation and removal of these cystic wall, peripheral popliteal artery pulse was improved. Postoperative course was smooth and calf claudication was completely disappeared, post operative angiogram showed no stenosis. Histological examination of the resected specimen showed degenerated elastic fiber and inflammatory granulation. We have found 40 cases previously reported in Japan and the present case was 2nd one in our institute.

We performed mitral valvuloplasty for 25 months old infant with endocardial fibroelastosis (EFE) and 21 months old infant with endomyocardial fibrosis (EMF). These two patients showing good post operative cause, have been followed up during 10 and 1 years respectively. The EFE and EMF are severe and progressive restrictive cardiomyopathy of unknown etiology. Most of cases with EFE and EMF have an enlarged left ventricle with incompetent atrioventricular valve. The prognosis of these patient is usually poor. We believe that the surgical treatment in early phase may be able to improve heart failure and also to protect the progression of these disease. This case with EMF is the first report of successfull surgical treatment for the patients with severe congestive heart failure whithin one year after birth in Japan.

OBJECTIVES: Sarcopenia, decreased muscle volume and muscle weakness in the elderly is a serious risk of various adverse outcomes. Current diagnostic procedure for sarcopenia includes gait speed, grip strength, and percentage of skeletal muscle volume. However, lower leg muscle strength decreases much faster than grasp power, and we have evaluated the usefulness of its measurement using a recently developed instrument (Locomoscan). METHODS: Forty-three institutionalized elderly subjects were evaluated for their anthropometrical parameters, body composition, grasp and lower leg muscle strength, and gait speed. They were categorized into 2 groups; gait speed equal to or higher than 0.8 m/s and that below 0.8 m/s. RESULTS: Leg muscle strength per body weight was significantly greater in those with their gait speed equal to or higher than 0.8 m/s, whereas there was no significant difference in other parameters. Receiver operator characteristics analysis has shown that leg muscle alone significantly predicted the greater gait speed. CONCLUSIONS: Lower leg muscle strength can be useful for predicting gait speed.
Aged* ; Body Composition ; Body Weight ; Gait* ; Hand Strength* ; Humans ; Leg* ; Muscle Strength* ; Muscle Weakness ; Muscle, Skeletal ; Sarcopenia

OBJECTIVES: One of the important risk factors of falling is decreased muscle mass and muscle strength. Recently, there has been an increasing concern on the role of vitamin D in muscle strength and physical activity. Aim of our study is to examine the relationships between vitamin D status and muscle mass and muscle strength in middle-aged healthy adults. METHODS: Subjects were 40 healthy volunteers aged 42.0 ± 10.6 years old. Evaluation was made for serum vitamin D₃ metabolites including 25-hydroxyvitamin D₃ [25(OH)D₃] and 24,25-dihydroxyvitamin D₃ [24,25(OH)₂D₃] concentrations, lower limb muscle strength, and dietary intake by food frequency questionnaire. Body composition was measured by dual-energy X-ray absorptiometry (DXA), and appendicular skeletal mass index (ASMI) was calculated as skeletal muscle mass/squared height. RESULTS: 70% of the subjects had vitamin D insufficiency/deficiency (serum total 25(OH)D < 20 ng/mL), and female subjects had significantly lower serum total 25(OH)D level compared with males. Vitamin D insufficiency/deficiency group had significantly higher body fat, lower SMI and muscle strength, probably reflecting higher percentage of female subjects. Serum vitamin D₃ metabolites levels were significantly correlated with whole and site-specific ASMI, and lower limb muscle strength, except for the correlation between serum 24,25(OH)₂D₃ concentration and lower limb muscle strength. In addition, serum 25(OH)D₃ level was a positive significant predictor for both ASMI and lower limb muscle strength, while serum 24,25(OH)₂D₃ level was not their significant predictor. CONCLUSIONS: Serum 25(OH)D₃ level was significantly correlated with both skeletal muscle mass and lower limb muscle strength.
Absorptiometry, Photon ; Accidental Falls ; Adipose Tissue ; Adult ; Asian Continental Ancestry Group* ; Body Composition ; Calcifediol* ; Female ; Healthy Volunteers ; Humans ; Lower Extremity* ; Male ; Motor Activity ; Muscle Strength* ; Muscle, Skeletal* ; Risk Factors ; Vitamin D ; Vitamins

Clinical training programs play an extremely important role in the new postgraduate clinical training system introduced in 2004 because facilities for clinical training now include various health-related institutions in addition to the university hospitals and special hospitals for clinical training used in the previous system. Although educational goals have been established by the Ministry of Health, Labour and Welfare, trainees may have difficulty achieving these goals, even under the guidance of staff at the various facilities. There are differences in the function and quality of health-related institutions in the community. For the practical and convenient application of educational goals, we have attempted develop a “model program” to supplement the objectives indicated by the learning goals with more specific objectives. These supplementary objectives can be modified by individual institutions. We hope that this “model program” contributes to the development of objectives for each institution and helps improve the quality of the postgraduate training system in Japan.