OBJECTIVE: To investigate Japanese physicians' use of dialects related to geographic areas and to elucidate how physicians respond to dialect-using patients.
METHODS: We conducted a web-based open survey, to which 170 anonymous physicians reported. We examined the following 1) whether dialects are used during communication with patients; 2) how to communicate with patients using dialects; and, 3) reasons for having difficulty in communicating with patients who regularly use dialects. Geographical areas were divided into the following 8 areas Hokkaido-Tohoku, Kanto, Koshinetsu-Hokuriku, Tokai, Kinki, Chugoku, Shikoku and Kyushu-Okinawa.
RESULTS: Of 170 physicians, 61.2% (95% CI: 53.4-68.5%) reported using dialects. These proportions differed by geographic area (F= 8.141; p<0.001) . Physicians practicing in Shikoku and Chugoku used dialects most frequently, while those practicing in Kanto and Hokkaido-Tohoku used dialects least frequently. Many dialect-using physicians thought that physicians should use the same dialect as dialect-using patients. In addition, dialect-using physicians were more likely to think that a physician-related factor was responsible for having difficulty in garnering clinical information.
CONCLUSIONS: Use of dialects by Japanese physicians during communication with patients seems common and may differ by geographic areas. Physicians' use of dialects could be a useful tool for effective clinical communication.

Methods: The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75–84, and 65–74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications. Results: The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048). Conclusions Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.

Methods: The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75–84, and 65–74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications. Results: The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048). Conclusions Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.

Methods: The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75–84, and 65–74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications. Results: The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048). Conclusions Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.

Our survey was conducted at 522 elementary schools and junior high schools in Akita prefecture in July 1981. Thus the survey was intended for 105, 137 elementary school pupils bnd 51, 029 junior high school pupils. Questionnaires were sent to teachers in charge at each school. The return rate of questionnaires wan 98.4 % for elementary school and 100.0 % for junior high school. The rate of bronchial asthma was 1.2 %(boy 1.5 %, girl 0.9 %) in elementary school pupils and 0.6 %(boy 0.8 %, girl 0.5 %) in junior high school pupils. The number of schools where pupils with bronchial asthma were found was 205 elementary schools (56.0 %) and 71 junior high schools (47.0 %). The rate of bronchial asthma in boys was greater than girls, by 1.7 times in case of elementary school and 1.6 times in junior high school. The rate of bronchial asthma in urban children was 1.2 %, while that in rural children was 0.8 %. Out of the children interpreted as bronchial asthma at the time of our survey 82.4 % of the elementary school children and 77.6 % of the junior high school children with bronchial asthma were or had been undergoing apropriate treatment. The rate of children who are absent from school due to asthma more than 10 days a year was 24.4 % in elementary school and 26.7 % in junior high school.

Herein, we describe a novel posterior lumbar interbody fusion (PLIF) technique with annulus fibrosus (AF) release and the use of expandable cages (called “anterior-release PLIF” [ARPLIF]). In this technique, posterior column osteotomy (PCO) and AF release provide excellent intervertebral mobility. AF release involves circumferentially peeling off the AF above or below the endplate between the fixed vertebrae under radiographic guidance without cutting the AF and anterior longitudinal ligament. Subsequently, high-angle variable-angle expandable cages are used to simultaneously expand both sides before inserting the percutaneous pedicle screws and correcting to achieve good local lumbar lordosis. PCO and AF release achieve excellent intervertebral mobility. Intervertebral mobility and simultaneous expansion of both cages disperse the force on the endplates, reducing cage subsidence, and the high-angle cages facilitate high intervertebral angle creation. The novel ARPLIF intervertebral manipulation technique can promote good local lumbar lordosis formation.

OBJECTIVEAcute myeloid leukemia progressed from myelodysplastic syndrome (MDS/AML) is generally incurable with poor prognosis for complex karyotype including monosomy 7 (-7). Qinghuang Powder (, QHP), which includes Qing Dai (Indigo naturalis) and Xiong Huang (realgar) in the formula, is effective in treating MDS or MDS/AML even with the unfavorable karyotype, and its therapeutic efficacy could be enhanced by increasing the Xiong huang content in the formula, while Xiong huang contains > 90% arsenic disulfide (As2S2). F-36p cell line was established from a MDS/AML patient with complex karyotype including -7, and was in cytokine-dependent. The present study was to investigate the effects of As2S2 on F-36p cells.

METHODSCell proliferation was measured by an 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Cell apoptosis was identified by Annexin V-staining. Cell viability was determined by a propidium iodide (PI) exclusion. Erythroid differentiation was evaluated by the expression of cell surface antigen CD235a (GpA).

RESULTSAfter treatment with As2S2 at concentrations of 0.5 to 16 μmol/L for 72 h, As2S2 inhibited the proliferation of F-36p cells. The 50% inhibitory concentrations (IC50) of As2S2 against the proliferation of F-36p cells was 6 μmol/L. The apoptotic cells significantly increased in a dose-dependent mannar (P<0.05). The cell viabilities were significantly inhibited by As2S2 dose-dependent in a dose-dependent manner (P<0.05). Significant increases of CD235a-positive cells were concurrently observed (P<0.05) also in a dose-dependent manner.

CONCLUSIONSAs2S2 could inhibit proliferation and viability, induce apoptosis, and concurrently promote erythroid differentiation dose-dependently in F-36p cells. As2S2 can inhibit proliferation and viability, induce apoptosis, and concurrently promote erythroid differentiation in cytokine-dependent MDS-progressed human leukemia cell line F-36p with complex karyotype including -7. The data suggest that QHP and/or As2S2 could be a potential candidate in the treatment of MDS or MDS/AML even with unfavorable cytogenetics.

Apoptosis ; drug effects ; Arsenicals ; Cell Differentiation ; drug effects ; Cell Line, Tumor ; Cytokines ; physiology ; Humans ; Karyotyping ; Myelodysplastic Syndromes ; genetics ; pathology ; physiopathology ; Sulfides ; toxicity

Background: and Purpose Although numerous measures for stroke exist, stroke remains one of the leading causes of death in Japan. In this study, we aimed to determine the long-term survival rate after first-ever stroke using data from a large-scale population-based stroke registry study in Japan. Methods: Part of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry is an ongoing population-based registry study of stroke, which covers approximately 1.4 million residents of Shiga Prefecture in Japan. A total 1,880 patients with non-fatal first-ever stroke (among 29-day survivors after stroke onset) registered in 2011 were followed up until December 2016. Five-year cumulative survival rates were estimated using the Kaplan-Meier method, according to subtype of the index stroke. Cox proportional hazards models were used to assess predictors of subsequent all-cause death. Results: During an average 4.3-year follow-up period, 677 patients died. The 5-year cumulative survival rate after non-fatal first-ever stroke was 65.9%. Heterogeneity was present in 5-year cumulative survival according to stroke subtype: lacunar infarction, 75.1%; large-artery infarction, 61.5%; cardioembolic infarction, 44.9%; intracerebral hemorrhage, 69.1%; and subarachnoid hemorrhage, 77.9%. Age, male sex, Japan Coma Scale score on admission, and modified Rankin Scale score before stroke onset were associated with increased mortality during the chronic phase of ischemic and hemorrhagic stroke. Conclusions In this study conducted in a real-world setting of Japan, the 5-year survival rate after non-fatal first-ever stroke remained low, particularly among patients with cardioembolic infarction and large-artery infarction in the present population-based stroke registry.