As is often the case with rural communities in Japan, a dearth of health resources poses a serious problem in a mountainous region of Shimane Prefecture. Although a medical care plan focusing on needs of people should be devised with a view to building up a sustainable health care system, studies have not always adequately been pursued. The aim of this study was to assess the data on the patients with lifestyle-related health problems to and from health care facilities. A Geographic Information System was used for measuring the travel time and road distance. The data for 255 patients with hypertension, 114 patients with hyperlipidemia, and 42 patients with diabetes were amassed. The results showed that the average travel time and distance were much longer in patients with diabetes than those with hypertension. Statistically no significant difference was observed in severity of diabetes (HbA1c, BMI and LDL-c) and blood pressure levels between patients who received regular treatment at clinics in the two towns and those who went all the way to clinics outside of the towns. In addition, compared with the patients with diabetes aged 75 years or over, the average travel time and road distance for aged of 74 years or younger were much longer. Similarly, compared with the patients with hypertension aged 75 years or over, the average travel time and road distance for aged of 74 yeras or younger were also much longer. These results indicated that the diabetics and the elderly age 74 or younger tended to go to health facilities beyond the secondary-medical care zone. These findings also suggested that a closer cooperation between facilities in the neighboring secondary-medical care zones to improve the quality of medical services and support general practitioners to review the existing disease management program would make it possible to cope with the present situation.

　　Health care plan has been established in each secondary medical area. Although health care plan should be focused on needs of people live in such units, studies with a view from residents’ perspective have not always been considered adequately. The aim of this study was to examine the factors that effect on utilization of health care facilities located outside of the secondary medical area in a rural region. The data included 515 patients with hypertension, 253 patients with hyperlipidemia, and 104 patients with diabetes. Factors relating utilization of health care facilities were assessed by age, sex, employment, number of diseases, body mass index (BMI), carotid plaque score, HbA1c, distance to the nearest clinic, and distance to the nearest bus stop. We conducted a logistic regression analyses of that data divided into two groups; car use and non car use. The result showed that sex, BMI, carotid plaque score and distance to the nearest bus stop were statistically significantly associated with the utilization of health care facilities located outside of the secondary medical area in patients with car use. Whereas, there were no statistically significantly associations in patients with non car use. Our findings suggested that it is important to consider health utilization of patients with lifestyle related diseases for making sustainable health care plan.

Since 1976, allergic contact dermatitis caused by Chrysanthemum morifolium Ramalk (commercial name: Kinriki) occured on the grower in Tokushima Prefecture. Consequently, a systematic study aimed at the isolation of the allergen of the chrysanthemum was udertaken.
The allergens were contained in the fresh juice of the leaves of chrysanthemum and they were of two types: one was water-soluble and the other was fat-soluble, judging from the results of application test of the skin reaction for sensitized guinea pigs.
The fresh juice of the chrysanthemums was fractionated with ammonioum sulfate saturation method and the active precipitates were chromatographed on Sephacryl S-300 and DEAE-cellulose column, successively. The most active fractions contained sugar and protein, suggesting that the water-soluble principles are high molecular glyco-protein. The other hand fat-soluble fraction was obtained from ethyl acetate extract of the supernatant of 65% ammonium sulfate saturation. The extract was chromatographed on silica gel column and on the thin layer to yield 5, 7-dihydroxychromone (I) and sesquiterpens (II-VI). Unfortunately, at that time the sensitization of ginea pigs was unsuccessfuly. Therefore their compounds could not be tested for the allergenic reaction.
When the precipitates of ammonium sulfate were extrcted with ethyl acetate, the allergenic activeity of the precipitates decreased. However, re-addition of the ethyl acetate extracts to the extracted precipitates recovered the activity. Cross reaction between the juice of leaves and sesquiterpene lactone, alantolactone, failed on skin reaction of sensitized ginea pigs.

A 52-years-old female farmer has suffered from bronchial asthma during the last 10 years during the lettuce growing season (NOV.-May). Laboratory test findings showed that her sumptoms were due to type I allergy. Namely, she showed eosinophilia, an increased level of Ig E and an immediate positive reaction to intracutaneous lettuce allergen. But, she gave negative reactions in RAST and immediate skin reaction test to 23 common allergens. By provocation tests she showed positive reactions to both the environment (FEV_1.0-26.8%) and allergen inhalation (FEV_1.0-30.0%), and had amoderate attack 15 minutes after inhalation of undiluted lettuce juice. The allergen was extracted from fresh lettuce juice by Coca's method. The protein concentration of the allergen was 8.74 mg/ml and its concentration in crude juice was 0.874 mg/ml.
Inhalation of lettuce juice during the harvest time was concluded to be the cause of this allergy.
A survey of farmers cultivating lettuce by a questionnaire and by mass physical examination revealed dermatitis as the most frequent complaint, with a similar incidence (7.1%) of respiratory symptoms including rhlnitis. However, further detailed questioning showed that the cause of most respiratory symptoms was not allergic, and the intracutaneous reaction of the farmers to the allergen was similar to that of control subjects who were not farm workers. The positive rate of the skin patch test was significantly higher in farmers growing lettuce than in control who were not farm workers.
Allergic disease caused by lettuce might be generated as allergic dermatitis of type IV. Type I allergy caused by lettuce is rare, but here we reported one case of this rare type.

　　The establishment of a sustainable healthcare system based on residents’ needs is an urgent issue in a rural region. For this purpose, considering the structure of a healthcare system, such as the numbers of beds, doctors, and nurses is important. In addition, the study of healthcare utilization using the date gathered through geographic information systems (GIS) would be very helpful in building such a healthcare system. In Japan, however, there are few published studies available on how health services are utilized. The aim of this paper was to review articles of GIS research on healthcare utilization. We conducted a systematic search of published peer-reviewed literature on PubMed. We found 38 articles that satisfied our inclusions criteria for review. Of them, 12 articles had a map for understanding health needs or demands, 23 articles carried analyses of distance and time for health utilizations, and seven articles had a buffer or database for analyses of healthcare utilization. Most of these articles have dealt with pediatric care and emergency care. Given the aging population in a rural region, we concluded that a more evidence-based approach should be taken to rural health focussing on lifestyle-related diseases.

[Objective]Although warm-tube moxibustion is easy-to-use in acupuncture therapy, the timing of moxa removal varies among practitioners. In the present study, we used near infrared spectroscopy (NIRS) to compare effects of different durations of moxibustion stimulation on improvement in local circulation as measured by changes in blood oxygenation dynamics in muscle tissue.
[Methods]Twelve healthy adults underwent warm-tube moxibustion with a single cone applied to the upper right shoulder region;measurements of tissue blood oxygenation dynamics (ΔOxy-Hb, ΔTotal-Hb) were obtained at intervals of 0.5 s. Control measurements were first taken for 15 min without intervention (Control);then, subjects received moxibustion 2 min after the start of measurement and had the moxa removed at the following time points: 30 s after patients experienced heat pain (Removal 30, moxibustion group); 45 s after heat pain (Removal 45, moxibustion group);or did not have the moxa removed (Continuous moxibustion group). These 4 different conditions were compared. Additionally, we determined the burning temperature of moxa and the skin temperature and intensity of heat pain sensation at the site of moxibustion.
[Results]Compared with the Control, the Removal 30, Removal 45, and Continuous moxibustion groups had significant increases in ΔOxy-Hb, ΔTotal-Hb, and skin temperature, with no significant differences among the moxibustion groups. No significant difference in the intensity of heat pain sensation was observed among the moxibustion groups. All moxibustion groups began to show rapid increases in both ΔTotal-Hb and ΔOxy-Hb around the time when subjects began to feel heat pain, suggesting that the axon reflex evoked by noxious stimuli of heat pain increased blood volume and arterial blood flow.
[Conclusion]Hemodynamic improvement in muscle tissue through the use of continuous warm-tube moxibustion for 30 s or longer after the occurrence of heat pain was confirmed.

Vitamin K2 is widely used for the treatment of osteoporosis in Japan. To understand the effects of vitamin K2 on bone mass and bone metabolism, we reviewed its effects on the development of osteopenia in rats, which characterizes models of osteoporosis. Vitamin K2 was found to attenuate the increase in bone resorption and/or maintain bone formation, reduce bone loss, protect against the loss of trabecular bone mass and its connectivity, and prevent the decrease in strength of the long bone in ovariectomized rats. However, combined treatment of bisphosphonates and vitamin K2 had an additive effect in preventing the deterioration of the trabecular bone architecture in ovariectomized rats, while the combined treatment of raloxifene and vitamin K2 improved the bone strength of the femoral neck. The use of vitamin K2 alone suppressed the increase in trabecular bone turnover and endocortical bone resorption, which attenuated the development of cancellous and cortical osteopenia in orchidectomized rats. In addition, vitamin K2 inhibited the decrease in bone formation in prednisolone-treated rats, thereby preventing cancellous and cortical osteopenia. In sciatic neurectomized rats, vitamin K2 suppressed endocortical bone resorption and stimulated bone formation, delaying the reduction of the trabecular thickness and retarding the development of cortical osteopenia. Vitamin K2 also prevented the acceleration of bone resorption and the reduction in bone formation in tail-suspended rats, which counteracted cancellous bone loss. Concomitant use of vitamin K2 with a bisphosphonate ameliorated the suppression of bone formation and more effectively prevented cancellous bone loss in tail-suspended rats. Vitamin K2 stimulated renal calcium reabsorption, retarded the increase in serum parathyroid hormone levels, and attenuated cortical bone loss primarily by suppressing bone resorption in calcium-deficient rats while maintaining the strength of the long bone in rats with magnesium deficiency. These findings suggest that vitamin K2 may not only stimulate bone formation, but may also suppress bone resorption. Thus, vitamin K2 could regulate bone metabolism in rats, which represented the various models of osteoporosis. However, the effects of vitamin K2 on bone mass and bone metabolism seem to be modest.
Vitamin K 2/chemistry/metabolism/*pharmacology ; Tomography, X-Ray Computed ; Tibia/pathology ; Rats ; Osteoporosis/*drug therapy/*prevention & control ; Male ; Magnesium Deficiency/diagnosis ; Magnesium/metabolism ; Homeostasis ; Female ; *Disease Models, Animal ; Diphosphonates ; Calcium/metabolism ; Bone and Bones/*drug effects/metabolism ; Bone Resorption ; Bone Diseases, Metabolic/*metabolism ; Animals

The purpose of the present study was to discuss the effects of risedronate on osteoarthritis (OA) of the knee by reviewing the existing literature. The literature was searched with PubMed, with respect to prospective, double-blind, randomized placebo-controlled trials (RCTs), using the following search terms: risedronate, knee, and osteoarthritis. Two RCTs met the criteria. A RCT (n = 231) showed that risedronate treatment (15 mg/day) for 1 year improved symptoms. A larger RCT (n = 1,896) showed that risedronate treatment (5 mg/day, 15 mg/day, 35 mg/week, and 50 mg/week) for 2 years did not improve signs or symptoms, nor did it alter radiological progression. However, a subanalysis study (n = 477) revealed that patients with marked cartilage loss preserved the structural integrity of subchondral bone by risedronate treatment (15 mg/day and 50 mg/week). Another subanalysis study (n = 1,885) revealed that C-terminal crosslinking telopeptide of type II collagen (CTX-II) decreased with risedronate treatment in a dose-dependent manner, and levels reached after 6 months were associated with radiological progression at 2 years. The results of these RCTs show that risedronate reduces the marker of cartilage degradation (CTX-II), which could contribute to attenuation of radiological progression of OA by preserving the structural integrity of subchondral bone. The review of the literature suggests that higher doses of risedronate (15 mg/day) strongly reduces the marker of cartilage degradation (CTX-II), which could contribute to attenuation of radiological progression of OA by preserving the structural integrity of subchondral bone.
Animals ; Calcium Channel Blockers/pharmacology/*therapeutic use ; Cartilage/drug effects ; Diphosphonates/therapeutic use ; Etidronic Acid/*analogs & derivatives/pharmacology/therapeutic use ; Humans ; Osteoarthritis, Knee/*drug therapy

The purpose of this study was to determine factors that could predict the one-year response of the lumbar bone mineral density (BMD) to alendronate treatment in elderly Japanese women with osteoporosis. Eighty-five postmenopausal women with osteoporosis, all of whom were between 55-88 years of age, were treated with alendronate (5 mg daily) for 12 months. Serum calcium, phosphorus, and alkaline phosphatase (ALP) and urinary NTX levels were measured at the baseline and 6 months, and lumbar (L1-L4) BMD was measured by dual energy X-ray absorptiometry at the baseline and 12 months. Multiple regression analysis was used to determine factors that were correlated with the percent change in lumbar BMD at 12 months. Lumbar BMD increased by 8.1 % at 12 months with a reduction in the urinary NTX level by 51.0 % at 6 months. Baseline lumbar BMD (R2=0.226, p< 0.0001) and percent changes in serum ALP and urinary NTX levels (R2=0.044, p< 0.05 and R2=0.103, p< 0.001, respectively) had a negative correlation with the percent change in lumbar BMD at month 12, while the baseline number of prevalent vertebral fractures (R2=0.163, p< 0.001), serum ALP level, and urinary NTX level (R2=0.074, p< 0.05 and R2=0.160, p< 0.001, respectively) had a positive correlation with it. However, baseline age, height, body weight, body mass index, years since menopause, serum calcium and phosphorus levels, and percent changes in serum calcium and phosphorus levels at 6 months did not have any significant correlation with the percent change in lumbar BMD at 12 months. These results suggest that lumbar BMD was more responsive to one-year of alendronate treatment in elderly osteoporotic Japanese women with lower lumbar BMD, more prevalent vertebral fractures, and higher bone turnover, who showed a greater decrease in bone turnover at 6 months, regardless of age, years since menopause, and physique. Alendronate may be efficacious in elderly Japanese women with evident osteoporosis that is associated with high bone turnover, and the percent changes in serum ALP and urinary NTX levels at 6 months could predict the one-year response of lumbar BMD to alendronate treatment.
Aged ; Aged, 80 and over ; Alendronate/*administration & dosage ; Alkaline Phosphatase/blood ; Bone Density/*drug effects ; Calcium/blood ; Collagen/urine ; Densitometry, X-Ray ; Female ; Humans ; Incidence ; Japan ; *Lumbar Vertebrae/radiography ; Middle Aged ; Osteoporosis, Postmenopausal/*drug therapy/epidemiology/radiography ; Peptides/urine ; Phosphorus/blood ; Spinal Fractures/epidemiology/prevention & control

Etidronate is an oral bisphosphonate compound that is known to reduce bone resorption through the inhibition of osteoclastic activity. The efficacy of etidronate for involutional (postmenopausal and senile) and glucocorticoid-induced osteoporosis, as well as that for other skeletal diseases, was reviewed in Japanese patients. Cyclical etidronate treatment (200 mg or 400mg/day for 2 weeks about every 3 months) increases the lumbar bone mineral density (BMD) in patients with involutional osteoporosis and prevents incident vertebral fractures in patients with glucocorticoid-induced osteoporosis. The losses of the lumbar BMD in patients with liver cirrhosis and the metacarpal BMD in hemiplegic patients after stroke are prevented, and the lumbar BMD is possibly increased, preventing fragile fractures in adult patients with osteogenesis imperfecta type I. Furthermore, proximal bone resorption around the femoral stem is reduced and some complications may be prevented in patients who undergo cementless total hip arthroplasty. Oral etidronate treatment may also help to transiently relieve metastatic cancer bone pain followed by a decrease in abnormally raised bone resorption in patients with painful bone metastases from primary cancer sites, such as the lung, breast and prostate. Thus, oral etidronate treatment is suggested to be efficacious for osteoporosis, as well as other skeletal diseases associated with increased bone resorption, in Japanese patients. Randomized controlled trials needed to be conducted on a large number of patients to confirm these effects.
Administration, Oral ; Bone Diseases/*drug therapy ; Etidronic Acid/*administration & dosage ; Humans ; Japan