The purpose of this report is to clarify urologic problems in rural districts. The number of patients who visited our clinic for these 10 years were 7, 313 as new outpatient and 1802 as inpatient. Three main diseases of rural area were acute inflammation of lower urinary tract, benign prostatic hypertrophy and lithiasis of upper urinary tract. Infection of lower urinary tract and aggravation of malignant tumors might be influenced by rural works and bad circumstances. Monthly distribution of patients was also under the influence of rural works.

Koumimachi Clinic attached to Saku Central Hospital is located in an underpopulated rural area. We have annually performed a close medical examination by upper gastrointestinal endoscopy since 1982. Since 1986, it has been done early in the morning. In 1995, a total of 1, 513 radiographic examinations were performed and 555 cases were examined by upper gastrointestinal endoscopy. Two cases of gastric cancer-one being early stage and the other, advanced stage-were detected. Despite the busy season all the farmers who had been advised to have the endoscopic examination attended because it was performed early in the morning. The early morning examination was performed in cooperation with Saku Central Hospital, Naganoken Kouseiren Health Screening Center, and public health nurses of local governments. Without such cooporation, any health care project could not be carried out a rural area.

Left-ventricular dysfunction is diagnosed when the heart rate performance curve (HRPC) of patients deflects upwards during incremental exercise. The aim of this study was to investigate the effect of exercise training on the upward deflection of the HRPC in patients with cardiovascular disease.This study comprised 11 patients who had cardiovascular disease and showed an upward deflection of the HRPC. The patients underwent exercise training (aerobic training, AT intensity: 30-40 minutes, 2-3 sessions/week, and 3-month follow-up). The HRPC of the patients was measured before and after exercise training. We used a method described by Pokan for evaluating the HRPC; the performance curve (PC) index ([PC1 - PC2] × [1 + PC1 × PC2]^-1) was calculated from PC1 and PC2. PC1 and PC2 refer to the heart rate response before and after the O₂ pulse deflection point, respectively. The PC index indicates the following: PC > 0.1, downward deflection; -0.1 ≤ PC ≤ 0.1, linear time course; PC < -0.1, upward deflection.The PC index significantly increased after exercise training (from -0.22 ± 0.09 to -0.14 ± 0.07; p < 0.05). In addition, the HRPC of 4 patients (37%) changed in linear time course.These results suggest that an upward deflection of the HRPC in patients with cardiovascular disease may shift to a linear time course after exercise training.

Objective: To investigate the impact of body mass index (BMI) and exercise habits on readmission rates among older patients with heart failure. Methods: Ninety-seven older patients admitted for heart failure (median age: 81 years; 57.7% male) were included in the study. Patients were categorized into four groups based on the presence or absence of lower BMI and/or the absence of exercise habits. Lower BMI was defined as BMI<20.3 kg/m2 at discharge and exercise habits were defined as engaging in 30 or more minutes of moderate or vigorous exercise at least once a week. The primary outcome was all-cause readmission during the 1-year follow-up period. Results: The patients were distributed across four groups: lower BMIon-exerciser (n=24, 24.7%), lower BMI/exerciser (n=22, 22.7%), non-lower BMIon-exerciser (n=21, 21.6%), and non-lower BMI/exerciser (n=30, 30.9%). Forty-six patients (47.4%) experienced readmission during the 1-year follow-up period. In a cox proportional hazard analysis, non-lower BMI/exerciser remained an independent prognostic factor even after adjusting for confounding factors (non-lower BMI/exerciser vs. lower BMIon-exerciser: hazard ratio, 0.26; 95% confidence interval, 0.08–0.83; p=0.022). Conclusion The coexistence of non-lower BMI and regular exercise habits may reduce readmission during the 1-year in older patients with heart failure. Therefore, it is imperative to conduct appropriate nutritional assessments for patients with lower BMI at discharge. Additionally, promoting and monitoring sustained physical activity after discharge is crucial for older patients with heart failure.

Objective: To investigate the impact of body mass index (BMI) and exercise habits on readmission rates among older patients with heart failure. Methods: Ninety-seven older patients admitted for heart failure (median age: 81 years; 57.7% male) were included in the study. Patients were categorized into four groups based on the presence or absence of lower BMI and/or the absence of exercise habits. Lower BMI was defined as BMI<20.3 kg/m2 at discharge and exercise habits were defined as engaging in 30 or more minutes of moderate or vigorous exercise at least once a week. The primary outcome was all-cause readmission during the 1-year follow-up period. Results: The patients were distributed across four groups: lower BMIon-exerciser (n=24, 24.7%), lower BMI/exerciser (n=22, 22.7%), non-lower BMIon-exerciser (n=21, 21.6%), and non-lower BMI/exerciser (n=30, 30.9%). Forty-six patients (47.4%) experienced readmission during the 1-year follow-up period. In a cox proportional hazard analysis, non-lower BMI/exerciser remained an independent prognostic factor even after adjusting for confounding factors (non-lower BMI/exerciser vs. lower BMIon-exerciser: hazard ratio, 0.26; 95% confidence interval, 0.08–0.83; p=0.022). Conclusion The coexistence of non-lower BMI and regular exercise habits may reduce readmission during the 1-year in older patients with heart failure. Therefore, it is imperative to conduct appropriate nutritional assessments for patients with lower BMI at discharge. Additionally, promoting and monitoring sustained physical activity after discharge is crucial for older patients with heart failure.

Objective: To investigate the impact of body mass index (BMI) and exercise habits on readmission rates among older patients with heart failure. Methods: Ninety-seven older patients admitted for heart failure (median age: 81 years; 57.7% male) were included in the study. Patients were categorized into four groups based on the presence or absence of lower BMI and/or the absence of exercise habits. Lower BMI was defined as BMI<20.3 kg/m2 at discharge and exercise habits were defined as engaging in 30 or more minutes of moderate or vigorous exercise at least once a week. The primary outcome was all-cause readmission during the 1-year follow-up period. Results: The patients were distributed across four groups: lower BMIon-exerciser (n=24, 24.7%), lower BMI/exerciser (n=22, 22.7%), non-lower BMIon-exerciser (n=21, 21.6%), and non-lower BMI/exerciser (n=30, 30.9%). Forty-six patients (47.4%) experienced readmission during the 1-year follow-up period. In a cox proportional hazard analysis, non-lower BMI/exerciser remained an independent prognostic factor even after adjusting for confounding factors (non-lower BMI/exerciser vs. lower BMIon-exerciser: hazard ratio, 0.26; 95% confidence interval, 0.08–0.83; p=0.022). Conclusion The coexistence of non-lower BMI and regular exercise habits may reduce readmission during the 1-year in older patients with heart failure. Therefore, it is imperative to conduct appropriate nutritional assessments for patients with lower BMI at discharge. Additionally, promoting and monitoring sustained physical activity after discharge is crucial for older patients with heart failure.

Objective: To investigate the impact of body mass index (BMI) and exercise habits on readmission rates among older patients with heart failure. Methods: Ninety-seven older patients admitted for heart failure (median age: 81 years; 57.7% male) were included in the study. Patients were categorized into four groups based on the presence or absence of lower BMI and/or the absence of exercise habits. Lower BMI was defined as BMI<20.3 kg/m2 at discharge and exercise habits were defined as engaging in 30 or more minutes of moderate or vigorous exercise at least once a week. The primary outcome was all-cause readmission during the 1-year follow-up period. Results: The patients were distributed across four groups: lower BMIon-exerciser (n=24, 24.7%), lower BMI/exerciser (n=22, 22.7%), non-lower BMIon-exerciser (n=21, 21.6%), and non-lower BMI/exerciser (n=30, 30.9%). Forty-six patients (47.4%) experienced readmission during the 1-year follow-up period. In a cox proportional hazard analysis, non-lower BMI/exerciser remained an independent prognostic factor even after adjusting for confounding factors (non-lower BMI/exerciser vs. lower BMIon-exerciser: hazard ratio, 0.26; 95% confidence interval, 0.08–0.83; p=0.022). Conclusion The coexistence of non-lower BMI and regular exercise habits may reduce readmission during the 1-year in older patients with heart failure. Therefore, it is imperative to conduct appropriate nutritional assessments for patients with lower BMI at discharge. Additionally, promoting and monitoring sustained physical activity after discharge is crucial for older patients with heart failure.

We studied possible factors to cause left ventricular rupture after mitral valve replacement and the prevention in eight patients of 1, 046 receiving mitral valve replacement between September, 1965 and August, 1991. The age at operation ranged from 43 to 67 years old (average 58 years old), and there were one man and seven women. According to the Treasure and Miller's classification, the type of rupture was type I in 5, type II in 2, and type III in 3. The onset time of rupture was immediately after cardiopulmonary bypass in 3 and at the time of chest closure in one. In four patients it occurred 11 hours, 14 hours, 18 hours and 25 hours after operation, respectively. In 8 patients, repair was performed with external closure under heart beating and in five patients with both internal and external closure during cardiac arrest under cardiopulmonary bypass. Two patients under cardiopulmonary bypass were successful for hemostasis, however, they died with low cardiac output syndrome, following to multiple organ failure 2 or 44 days after operation, respectively. The repair was not successful in 6 patients. In four patients the left ventricular rupture occurred immediately after hypertension and pathological findings showed severe myocardial degeneration of left ventricular muscle in all of them. These findings may suggest that hypertension after the operation is one of major factors to cause left ventricular rupture and thus the careful management of the systemic blood pressure after mitral valve replacement is effective to prevent the left ventricular rupture.

Liver fibrosis reflects tissue scarring in the liver due to the accumulation of excessive extracellular matrix in response to chronically persistent liver injury. Hepatocyte cell death can trigger capillarization of liver sinusoidal endothelial cells, stimulation of immune cells including macrophages and Kupffer cells, and activation of hepatic stellate cells (HSCs), resulting in progression of liver fibrosis. Liver cirrhosis is the terminal state of liver fibrosis and is associated with severe complications, such as liver failure, portal hypertension, and liver cancer. Nevertheless, effective therapy for cirrhosis has not yet been established, and liver transplantation is the only radical treatment for severe cases. Studies investigating HSC activation and regulation of collagen production in the liver have made breakthroughs in recent decades that have advanced the knowledge regarding liver fibrosis pathophysiology. In this review, we summarize molecular mechanisms of liver fibrosis and discuss the development of novel anti-fibrotic therapies.