Objective: This study assessed the distribution of "lethal dose/pharmaceutical product strength" in high-risk drugs.Methods: In 707 pharmaceutical products (312 ingredients) that had been defined as high-risk drugs in Japan, we collected acute toxicity information from these products on single dose toxicity studies conducted in mice, including median lethal dose (LD50) and approximate lethal dose (aLD). The LD50 and aLD were then divided by the strength (quantity of active ingredients) of the pharmaceutical product, after which the LD50or aLD values having an inequality sign was excluded.Results: We collected data on the acute lethal dose of 707 products (312 ingredients) from high-risk drugs. Data with an inequality sign, which was 143 of 495 products (28.9%) in tablets and capsules, then 43 of 212 items (20.3%) in injections, were excluded from the analysis. As observed, median (Q1, Q3) of "LD50/pharmaceutical product strength" and "aLD/pharmaceutical product strength" for tablets or capsules was 36.8 tablet/kg (11.5 tablet/kg, 144 tablet/kg) and 16.7 tablet/kg (6.9 tablet/kg, 65 tablet/kg), respectively. However, median (Q1, Q3) of "LD50/pharmaceutical product strength" and "aLD/pharmaceutical product strength" for injections were 1.3 bottle/kg (0.6 bottle/kg, 4.7 bottle/kg) and 0.8 bottle/kg (0.4 bottle/kg, 15 bottle/kg), respectively. In both cases, injections were distributed at a lower value than oral products.Conclusion: From this study, the distribution of "lethal dose/pharmaceutical product strength" in high-risk drugs was clarified. This information will therefore help pharmacists assess risks associated with individual pharmaceutical products.

Ibi Welfare Hospital covers a local town that has an aging population, and the development of a community-based integrated care system is an important issue. We have established and are operating a regional integrated NST system to maintain oral nutrition intake essential for daily life and prevention of pneumonia in this area, and here we report on outcomes and future issues. In this study, we investigated the regional integrated NST system (NST outpatient · NST hospitalization · NST visit) and examined dissemination of its service. Data was collected from February 2016 to March 2017. The investigation involved the following: (1) extraction of survey results of latent NST subjects and retrospective investigation of medical records; (2) expansion of NST outpatient services (examinations by surgeons, endoscopic evaluation of swallowing function, blood tests, dental examination, and evaluation by a dietician speech-language-hearing therapist, and return of a joint report created by the individual professionals to the introducing professional); and (3) introduction of NST hospitalization (2-week hospital stay for local inclusion sickbed care, introduction of swallowing passport, initiation of rehabilitation, oral care roundtrip, NST roundtrip, personnel care meetings with home staff, and introduction of visiting speechlanguage-hearing therapist rehabilitation to support home care after discharge). To increase awareness of this system, we visited the local nursing care insurance agency and welfare hospitals and tried to obtain cooperation through transparency. Introducing and initiating this regional integrated NST system “Ibi Model” revealed that the system is greatly needed in our region. We think that it has the potential to become a key supporting tool for the home-based medical care system within the regional comprehensive care system. Further verification is needed to assess real outcome changes such as a decrease in the incidence of pneumonia and improvement in quality of life.

There is a limitation to estimate vitamin B12 intake due to lack of data on vitamin B12 content in many Korean foods. In this study, vitamin B12 content was determined in some soybean or vegetable-fermented foods, edible seaweeds and other frequently consumed foods in Korea by microbioassay using Lactobacillus delbruecki ATCC 7830. The traditional type of Doenjang and Chungkookjang contained 1.85 microgram/100 g and 0.69 microgram/100 g of vitamin B12, respectively, while the factory-type of Doenjang and Chungkookjang contained 0.04-0.86 microgram/100 g and 0.06-0.15 microgram/100 g. Vitamin B12 was not detected in steamed soybeans and Tofu which is a not-fermented soybean product, indicating that vitamin B12 in Doenjang and Chungkookjang might be produced during the fermentation process. The Korean-style soy sauce contained 0.04 microgram vitamin B12/100 mL, but vitamin B12 was not detected in Japanese-style soy sauce and white miso. Commercial Kimchi, a representative Korean vegetable- fermented food, made of Korean cabbage, Yeolmu, or Mustard leaves contained 0.013-0.03 microgram vitamin B12/100 g, while Kimchi without red pepper and fermented fish sauce (White Kimchi) did not. Vitamin B12 content was very high in some edible seaweeds such as laver (66.76 microgram/ 100 g dry weight) and sea lettuce (84.74 microgram/100 g dry weight), and it was 17.12 microgram/100 g of dried small anchovy, 1.07 microgram/100 g of whole egg, and 0.02 microgram/100 g of coffee mix. From these results, it is assumed that Koreans take substantial amount of vitamin B12 from plant-origin foods. And, with these data, we will be able to calculate dietary vitamin B12 content more correctly than before. In conclusion, soybean-fermented foods, Kimchi, laver and sea lettuce are recommendable as good sources of vitamin B12 for vegetarians or Korean elderly on grain and vegetable based diet.
Aged ; Brassica ; Capsicum ; Edible Grain ; Coffee ; Diet ; Fermentation ; Humans ; Isoflavones ; Korea ; Lactobacillus ; Mustard Plant ; Ovum ; Soy Foods ; Soybean Proteins ; Soybeans ; Steam ; Ulva ; Vegetables ; Vitamin B 12 ; Vitamins

We report a 5-year-old girl with a diagnosis of an anomalous origin of the left coronary artery from the pulmonary artery with an intramural aortic route. The left coronary artery entered the aortic wall running parallel to the aorta. With the aid of cardiopulmonary bypass, she underwent establishment of two coronary artery systems by intraaortic reconstruction (unroofing and anastomosis). Her postoperative course was uneventful. Postoperative cineangiogram demonstrated patency and prograde flow in the new coronary systems.

A study was conducted to determine the accuracy of body composition prediction equations using the bioelectrical impedance (BI) method and skinfold thickness (ST) method for predicting longitudinal alterations in the body composition of schoolchildren. Seventeen healthy junior high school boys, aged 12 to 13 yr, participated in the study. Body density (Db) was determined by underwater weighing (UW) . Impedance was measured using a portable four-terminal impedance plethysmograph (800 μA, 50 kHz ; Selco, SIF-891) . Db values by the BI method were estimated from the equations developed for schoolchildren by Watanabe et al. (1993) and Kim et al. (1993) . Db by the ST method was estimated from the equations developed for schoolchildren by Nagamine et al. (1974) and Watanabe et al. (1993), using the sum of skinfold thickness at the triceps and subscapular area. Skinfold thickness was measured on the right side of the body with an Eiken-type skinfold caliper. The changes in Db and body fat measured by UW were small every year. The fat free mass (FFM) measured by UW increased significantly every year. The body composition (average Db, body fat and FFM) values estimated by the BI and ST methods showed no significant differences against average UW values. However, these average values estimated using the equation of Nagamine et al. (1974) were significantly different from the average UW values. The absolute amount of change in FFM (Δ FFM) estimated from BI and ST methods were correlated significantly with absolute amount of change in FFM (Δ FFM) determined by UW. In particular, the accuracy of body composition prediction equations for the BI method (r²= 0.81 for Watanabe et al., r² = 0.77 for Kim et al.) was higher than that of body composition prediction equations for the ST method (r²=0.41 for Nagamine et al., r²= 0.55 for Watanabe et al) . The findings of this study suggest that the body composition prediction equations based on the BI method are useful for valid assessment of longitudinal alterations in the body composition of schoolchildren.

We studied 90 consecutive cases undergoing open heart surgery with preoperative collection of autologous blood and ultrafiltration during extracorporeal circulation. Among the 58 out of 90 patients (64.4%), open heart surgeries were achieved without homologous blood. We evaluated 13 factors (age, height, weight, body surface area, cardiopulmonary bypass time, aortic cross clamping time, dilutional rate, Hct before predonation, lowest Hct during cardiopulmonary bypass, amount of predonated autologous blood, term of autologous blood predonation, amount of bleeding during surgery, amount of bleeding after surgery) in connection with open heart surgery without homologous blood. Among these factors, age, body surface area, cardiopulmonary bypass time, aortic cross clamping time, lowest Hct during cardiopulmonary bypass, amount of predonated autologous blood, amount of bleeding during surgery and amount of bleeding after surgery demonstrated differed significantly between the only autologous blood transfusion group and the homologous blood transfusion group. According to the evaluation by multivariate regression analysis of these factors, the amount of bleeding after surgery was the most contributor to open heart surgery without homologous blood, followed by amount of bleeding during surgery and body surface area. We concluded that open heart surgery without homologous blood may be achieved in more patients by understanding these factors. Autologous blood predonation by the “leapfrog” method, control of the dilution rate by ultrafiltration during extracorporeal circulation and fresh autologous blood transfusion after extracorporeal circulation were effective to achieve open heart surgery without homologous blood.

The purpose of this investigation was to determine the effects of daily walking on aerobic work capacity, vital age and other fitness components in middle-aged and elderly walkers. The subjects were thirty-six walkers (average 65.0±8.0 yr, 51-80 yr), whose training period averaged 13.5±9.0 yr. The walkers were significantly greater in maximal oxygen uptake (VO₂max), and oxygen uptake at the lactate threshold (VO₂LT), and were 6.5 yr younger in vital age (VA) than sedentary middle-aged and elderly. These findings suggest that middle-aged and elderly walkers have more favorable profile of aerobic work capacity and of health status when compared to sedentary persons.

This is a case report of a rare combination of a single coronary artery and a coronary artery fistula. An 8-year-old girl was asymptomatic with a grade II continuous murmur in the third left intercostal space. Selective coronary angio-graphy revealed that a single coronary artery arising from the left aortic sinus was dilated and ended as a fistula to the outflow tract of the right ventricle. At operation, the fistula could not be exposed on the surface of the heart. On cardiopulmonary bypass, the aorta was clamped, and the fistula was closed by direct suture in the right ventricle. The postoperative course was uneventful with no complications.

To investigate the effect of nafamostat mesilate (FUT) for disseminated intravascular coagulation (DIC) after surgery using cardiopulmonary bypass, we studied DIC scores and parameters of coagulation and fibrinolysis in the DIC cases. Although 12 patients developed DIC, the platelet counts improved by administration of FUT apart from one complicated by sepsis. The DIC scores decreased as a result of the increase of platelets and fibrinogen and improvement of FDP. Thrombin-antithrombin III complex, D-dimer and plasmin-α₂ plasmin inhibitor complex showed an even higher value at the endpoint of FUT administration. These results indicate that patients with DIC after cardiopulmonary bypass may have severe fibrinolytic acceleration and that administration of FUT can be useful in those cases.

A study was conducted to investigate the validity of skinfold-based prediction equations for body density (Db, g/ml) developed by Nagamine et al. (1974), and to formulate convenient, useful equations for predicting Db by the skinfold thickness (ST) method in junior high school boys and girls. The subjects of the study were 269 healthy boys and girls, aged 12-15 years. The dependent variable, Db, was determined by underwater weighing (UW) . Independent variables included single skinfold thickness at three sites (triceps, subscapular and abdomen) and the sum of two skinfolds. Db by the ST method was estimated from the equations developed by Nagamine et al. (1974) for boys and girls, using the sum of skinfold thickness at the triceps and subscapular area. Skinfold thickness was measured on the right side of the body with an Eiken-type skinfold caliper. Db estimated by the ST method was correlated significantly with Db determined by UW (r=0.873 for boys and r=0.723 for girls) . However, average Db values estimated by the ST method were significantly lower than those deter-mined by UW (differences in Db values when predicted by the Nagamine equations: 0.0099 for boys and 0, 0114 for girls) . Therefore, we developed linear regression equations for predicting Db. The best-fitting prediction equation for Db was Db=1.0881-0.0010·X for boys, and Db=1.0715-0.0007·X for girls, where X is the sum of the triceps and subscapular skinfold thickness (mm) for boys and girls. Db estimated from the respective equation was correlated significantly with hydrodensitometrically determined Db (r=0.872, SEE=0.0089 for boys; r=0.722, SEE=0.0104 for girls) .
Furthermore, in a cross-validation analysis of prediction equations for Db developed in the present study, Db estimated from the respective equation was correlated highly with hydrodensitometrically determined Db (r=0.887 for boys and r=0.740 for girls) . There were no significant differences between the Db values predicted by the ST method against hydrodensitometrically determined Db values (difference values: 0.0012 for boys and 0.0013 for girls) . The final phase of this study was to develop more stable equations, combining validation and cross-validation samples. On the basis of the final analyses, we recommend the equations Y=1.0875-0.0010X and Y=1.0716-0.0007X, with SEE of 0.0088g/ml for boys and 0.0105g/ml for girls, respectively. It is suggested that the prediction equations finally developed in the present study will be applicable to junior high school boys and girls.