Objective: To clarify the reason why the target levels of low-density lipoprotein (LDL)-cholesterol are hardly attained.
Methods: The questionnaire was performed for 237 general practitioners on prescription of HMG-CoA reductase inhibitors (statins), just after the publication of “Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2007”.
Results: The responses could be summarized as 1) almost all doctors recognized the significance of target levels of LDL-cholesterol; 2) however, general physicians have such a recognition to a lesser extent, compared with cardiologists; 3) when prescribing statins, 66.2% of them had concerns about drug-drug interactions; 4) as the adverse events with statins, they listed creatine kinase (CK) elevations (86.5%), hepatic dysfunction (74.3%) and myalgias/rhabdomyolysis (70.9%); 5) in contrast, less than 20% of them listed the fulminant hepatic failure, gastrointestinal symptoms and fluctuation of blood glucose levels; 6) the threshold value of CK to discontinue statins was 500 IU/L in 44.4% and 200-300 IU/L in 39.6%; and 7) 78.5% of them believed that statins have the pleiotropic ability such a anti-inflammatory effect clinically, in addition to lipid-lowering.
Conclusions: It is important to serve the drug information about the safety of statins to the general practitioners for the management of hyperlipidemia, based on original articles.

OBJECTIVETo observe the effects of Porphyromonas gingivalis (Pg), Actinobacillus actinomycetemcomitans (Aa), Escherichia coli (Ec) lipopolysaccharides (LPS) on the production of IL-11 and IL-6 from healthy human gingival fibroblasts (HGF), and the effects of endogenous prostaglandin on HGF IL-11 and IL-6 production stimulated with the above LPS.

METHODSHGF were stimulated with Pg-, Aa-, Ec-LPS of different concentrations (0.1, 1, 10 mg/L) for 24 h. And HGF were also stimulated with the combinations of 10 mg/L Pg-, Aa-, Ec-LPS and 10(-6) mol/L indomethacin respectively for 24 h. Levels of IL-11 and IL-6 in the supernatants were quantitated by ELISA.

RESULTSLPS from Aa, Ec, at the concentration of 10 mg/L and from Pg at the concentrations 1, 10 mg/L significantly augmented IL-11 production by HGF. IL-6 production was also significantly increased by stimulation with Aa-LPS at concentrations 1, 10 mg/L and with Ec-, Pg-LPS at concentrations 0.1, 1, 10 mg/L. In addition, IL-11 production was lower than IL-6 production by HGF stimulated with LPS. Indomethacin significantly inhibited IL-6 and IL-11 production in LPS-stimulated HGF.

CONCLUSIONSAa-, Pg-, Ec-LPS may significantly increase IL-11 and IL-6 level in the supernatants of HGF, and endogenous prostaglandin may upregulate IL-11 and IL-6 production in LPS-stimulated HGF.

Aggregatibacter actinomycetemcomitans ; chemistry ; Cells, Cultured ; Dose-Response Relationship, Drug ; Escherichia coli ; chemistry ; Fibroblasts ; drug effects ; metabolism ; Gingiva ; cytology ; metabolism ; Humans ; Indomethacin ; pharmacology ; Interleukin-11 ; biosynthesis ; Interleukin-6 ; biosynthesis ; Lipopolysaccharides ; pharmacology ; Porphyromonas gingivalis ; chemistry

PURPOSE: To introduce a new simple technique using suture anchors and ceramic spacers to stabilize the elevated laminae in open-door cervical laminoplasty. Although ceramic spacers were placed in the opened laminae and fixed with nylon threads in this series, it was occasionally difficult to fix the nylon threads to the lateral mass. MATERIALS AND METHODS: Study 1: A preliminary study was conducted using a suture anchor system. Sixteen consecutive patients who underwent surgery for cervical myelopathy were prospectively examined. Study 2: The second study was performed prospectively to evaluate the feasibility of this new technique based on the result of the preliminary study. Clinical outcomes were examined in 45 consecutive patients [cervical spondylotic myelopathy (CSM)] and 43 consecutive patients (OPLL). The Japanese Orthopedic Association scoring system (JOA score), axial neck pain, and radiological findings were analyzed. RESULTS: 1) In one case, re-operation was necessary due to dislodgement of the ceramic spacer following rupture of the thread. 2) In all patients, postoperative CT scans showed that the anchors were securely inserted into the bone. In the CSM group, the average JOA score improved from 9.5 points preoperatively to 13.3 at follow-up (recovery 51%). In the OPLL group, the average JOA score improved from 10.1 (5-14) points preoperatively to 14.4 (11-16) at follow-up (recovery 62%). There were no serious complications. CONCLUSION: The use of the suture anchor system made it unnecessary to create a hole in the lateral mass and enabled reliable and faster fixation of the HA spacers in open-door laminoplasty.
Adult ; Aged ; *Ceramics ; Cervical Vertebrae/radiography ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Laminoplasty/*methods ; Male ; Middle Aged ; Postoperative Period ; Prospective Studies ; Spinal Cord Diseases/*surgery ; Suture Anchors ; *Sutures ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND/AIMS: Colonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH. METHODS: Among patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort. RESULTS: Among the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors. CONCLUSIONS: Severe DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.
Anti-Inflammatory Agents, Non-Steroidal ; Cohort Studies ; Colon* ; Colonoscopy ; Dizziness ; Hemorrhage* ; Humans ; Incidence ; Japan ; Rare Diseases ; Recurrence ; Retrospective Studies ; Risk Factors*

Purpose: To determine how nurses perceive the need for advance care planning (ACP) for chronic heart failure with patients and their families. Methods: A questionnaire survey was administered with 427 nurses who were affiliated with implantable cardioverter-defibrillators and resynchronization therapy. The survey included 13 items related to the need for ACP for simulated advanced heart failure cases with patients and their families. Results: Valid Responses were obtained from 207 nurses. On out of all items, the least proprtion of participants (51%) responded “giving predictions about functional prognosis and life expectancy” should be performed with patients. The participants’ perceptions regarding 8 items, which included the items on communication about prognosis, reflected their belief that ACP should be performed with family members rather than the patient. It was found that participants with certification in chronic heart failure nursing were more likely to respond in favor of ACP being performed with the patients in relation to 7 items, which included “ask about what has been important in one’s life”, and being performed with the family in relation to 10 items that included “ask the family what kind of life you want the patient to have hereafter”, as compared to other nurses. Conclusion: Regarding ACP, it is suggested that nurses are careful in discussing prognosis with patients, and certified nurses tend to attach importance to the individualities and values of patients and their families.