We investigated whether elderly patients treated for a proximal femoral fracture who lived together with an elderly spouse were able to return home and walk after treatment. Subjects were 85 patients aged > 65 years with a proximal femoral fracture that were treated between January 2007 and December 2013 and who lived at home with their spouse. We recorded the number (proportion) of patients who were directly discharged home from the hospital. We also analyzed their activities of daily living (ADL) using the Barthel index before the injury and again at the time of discharge. We investigated whether there was a sex difference in the ability to return home. Seventy patients (80%) returned home directly from the hospital or from a rehabilitation hospital. The Barthel index before injury and at the time of discharge was 90 points and 81 points in female patients and 84 points and 70 points in male patients, respectively. Forty women (85%) and 30 men (75%) returned home.

A total of 206 residents (76 males and 130 females) of a rural area of Hokkaido, Japan, attending a health check in August, 1997, were studied to assess the relationship between serum carotenoids and atrophic gastritis (AG). Of the participants, 91 had AG, as indicated by their serum levels of pepsinogen I and pepsinogen II. Logistic regression analysis, after adjusting for gender and age, revealed that the odds ratios for serum carotenoid levels were lower for subjects with high serum levels of α-carotene (odds ratio, 0.41; 95% C.I., 0.19−0.88) and β-carotene (odds ratio, 0.41; 95% C.I., 0.18−0.91) than for those with low serum carotenoid levels. In addition, the odds ratios of subjects with high serum levels of β-cryptoxanthin (odds ratio, 0.60; 95% C.I., 0.28−1.31), provitamin A (odds ratio, 0.38; 95% C.I., 0.17−0.85), and retinol (odds ratio, 0.67; 95% C.I., 0.31−1.48) were found to be lower than the odds ratios for those with low serum levels. Odds ratios for subjects with high serum zeaxanthin/lutein levels were higher than odds ratios for those with low serum levels. These results suggest that frequent intake of foods rich in carotenoids with provitamin A activity may reduce the risk of AG.
Serum ; Carotenoids ; Carbon ion ; Hokkaido ; Silver

Objectives: Bony impingement of the proximal femur on the pelvis is an important factor for dislocation after total hip arthroplasty (THA). We evaluated bony impingement after THA using the rotation matrix derived from postoperative computed tomography (CT) images.
Patients and Methods: One hundred and seven hip joints were subjected to primary THA via a posterolateral approach. We used the rotation matrix derived from CT images to calculate internal rotation (IR) limit prior to bony impingement, and compared this limit with the intraoperative limit.
Results: The average calculated IR limit was 63 degrees (range: 30 to 85 degrees). The average intraoperative IR limit was 49 degrees (range: 20 to 70 degrees). The correlation between the intraoperative IR limit (Y) and the calculated IR limit (X) was expressed as Y=8.9+0.66X (R=0.73; p < 0.0001).
Conclusions: We could show a patient´s safe range of motion prior to bony impingement, and this will be a good indicator for dislocation not occurring during postoperative rehabilitation.

　　It is known that uterine cervical cancer is caused by persistent infection with high-risk type of HPV (human papilloma virus). We have run HPV genotyping tests on patients since November, 2011. In 111 cases so far examined, HPV types 16, 52 and 58 were detected with high frequency, but type 18 was with low frequency. This trend was comparable to nationwide tendency. Type 52, 56 and 58 were detected from the patients of advanced age frequently. There weredifferences in HPV infection rate between cytology-negative cases and positive cases, but there was not the difference in HPV typing by cytology-negative and positive patients. Furthermore, it was made clear that the superinfection of HPV who significantly related to the development of tumor. In the cytology negative patients who were followed up because of dysplasia, there are many who are negative for high risk HPV. Therefore, HPV genotyping examination may help physicians determine the relative priority for treatment.

We compared the effects on clinical clerkships of an electronic medical record (EMR) system and a standard medical record system. Using an EMR system, students described medical records with a problem-oriented medical record system/subject objective assessment, and plan that was much better than the standard medical record system. In the EMR system, students cannot see physicians' medical records, including laboratory data and X-ray films. Instead, students themselves must obtain the patient history and request examinations as physicians do. This system helps supervisors give suitable comments and provide data that students have requested. Directors can also evaluate supervisors by reviewing their comments. Therefore, an EMR system has the advantage of problem-oriented medical record system-based learning for students and is also useful for clinical clerkships.

The efficacy of acupuncture-moxibustion for hypertension is often experienced by many clinicians. Nevertheless the mechanism whereby the therapy improves the symptoms has been scarcely elucidated. Our present study was designed to examine some effects of acupuncture upon the organism, especially upon the renal function which is implicated in hypertension.
Experiment I
Acupuncture therapy was undertaken four times on a patient with essential hypertension who was given no hypotensive drugs. In each therapy, needles (No. 2, Seirin) were perpendicularly inserted to the depth of 1.5cm at V₂₀ Fengchi, VU₂₁ Weishu, and G₃₆ Zusanli and left there for 15 minutes. The blood samples and urine were collected three times: before the insertion, 15min. and 60min. after withdrawing the needles. At the same time, blood pressure, pulse, and the amount of urine were measured. The amount of Na, K, Cl, kallikrein, catecholamines, etc. was measured in urine. The renin activity and the concentration of aldosterone, catecholamines, and BUN were determined in the blood. Result: a marked increase was seen in the excretion of urine, Na, and Cl. An upward tendency of kallikrein excretion which is correlated with urine volume, and a downward tendency of renin in the blood were found. Blood pressure and pulse showed a slight tendency to decline. However, neither catecholamines in the blood, nor K in urine changed significantly.
Experiment II
Subjects were two healthy adult men. Urine was collected once an hour for twenty-five times by means of a balloon inserted in the bladder. Immediately after the twenty-first collection, acupuncture stimulation was given to VU₂₁ Weishu in the same manner as Exp. I. With the same measurements and determinations undertaken, a marked increase of urine, Na, and Cl excretion was observed 15min. after withdrawing the needle.
Experiment III
Subjects were three healthy adult men. Urine was collected for two days. The amount of urine and the electrolyte content were calculated on a per hour basis. Without having breakfast after rising, the subjects were given a transfusion of glucose-electrolyte solution, equivalent to the calculated urinary output, every hour for four hours. The VU₂₁ Weishu was stimulated in the same manner two hours after the onset of the first transfusion. Result: a marked increase was seen in the excretion of urine, Na, and Cl.
Conclusion
It can be seen from the above that acupuncture stimulation to the VU₂₁ Weishu facilitates the selective excretion of Na and Cl in the urinary tubule.

We report a case of idiopathic thrombocytopenic purpura (ITP) accompanied by steroid-induced avascular necrosis of the femoral head in a 68-year-old woman. Extremely low platelet counts of ITP patients prohibit any surgical interventions. Her platelet count was 25,000/μL. We performed a total hip arthroplasty with high-dose immunoglobulin therapy and transfusion of platelet concentrates. Her platelet count increased to 94,000/μL just before the operation. No hemostatic complications were encountered perioperatively, and the postoperative course was uneventful. She left the hospital 20 days after the operation with a T-cane. Her platelet count decreased to 34,000/μL on the day she left the hospital. Three years after the operation, she had no groin pain and could walk without ambulatory assistive devices. We did not observe implant loosening.

There is a theory that excessive treament for terminally ill patients is one of the factors in soaring medical costs. To evaluate this theory, we examined the changes in medical expenditures for our inpatients: 41 patients with lung cancer and 69 patients with liver cancer hospitalized for treatment of the department of internal medicine, and 90 patients with stomach cancer and 100 patients with colon cancer hospitalized for surgery from July to December 1997. They were divided to two groups: the patients of group A received active treatment, and the patients of group B received conservative treatment. We selected 10 people randomly from each group, and compared the changes in medical costs.
The cost was significantly low in group B compared with group A. We examined the change in the cost every 5 days. Until 6 days before leaving our hospital, the cost is high sugnificantly in group A compared with group B. The difference between group A and group B in the cost of treatment for lung cancer, and stomach cancer patients disappeared in 5 days before leaving hospital. The cost of treatment for lung and liver cancer patients of group A was a little higher than the average hospitalization fee of internal medicine. Also, the cost of group A stomach cancer patients was a little higher than the averge hospitalization fee of surgery, though there was no difference between the cost of treatment for group A colon cancer patients and the average hospitalization feeof surgery. The fee of group B of either disease was half or less of an average fee for medical treatment.
From this study, no evidence was found that the excessive life prolongation treatment for terminally ill patients was done. So, using authentic data, we should discuss the justifiability of the theory that the excessive treatment for terminally ill patients is one of the factors contributing to a boost in medical costs.

　　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.