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This study focused on the effects of different intervals between sessions of a hypercholesterolemia education class on post-intervention outcomes. The same comprehensive group-programme contents on hypercholesterolemia were delivered either monthly (for 6 months) or twice-monthly (for 3 months) by the same teaching professionals in a community setting. The twice-monthly programme included 46 participants (male/female = 7/39, average age: 65.8 years)and the monthly programme consisted of 48(male/female = 9/39, age: 66.4). At the beginning of the study, all subjects belonged to the 'contemplation' stage of diet and exercise habits within the Transtheoretical Model of Change. The stage-matched intervention helped many participants move to the 'action ' stage by 6 months after the last session, especially in the twice-monthly group. The change rate of exercise from the 'contemplation' stage to the 'action' stage was significantly higher in the twice-monthly group (76.1 percent) than in the monthly (54.2 percent ). In both monthly and twice-monthly formats, participants' satisfaction and understanding levels at the end of the programme were high, but were significantly higher in the twice-monthly group. Through favorable lifestyles and higher levels of satisfaction and learning, the twice-monthly format may produce more positive results in cholesterol management than the monthly format, as the shorter period of time makes the programme more intensive.

An adriamycin (ADM)-resistant subline was established by continuous exposure of the SBC-3 cells, a cell line of human small cell lung cancer, to increasing concentrations of ADM, followed by the cloning procedure. The resistant sublines (SBC-3/ADM) thus established were 30-fold more resistant to ADM than the parent SBC-3 cells, in terms of the 70% lethal dose determined by soft agar clonogenic assay. The doubling times of the SBC-3 and SBC-3/ADM cells were 36 h and 22 h, respectively. When transplanted into athymic nude mice, the parent as well as resistant cells formed tumors, and serial passage was successful. Although the transplanted tumors from the two cell lines were very similar in histology, the resistance of the SBC-3/ADM cells to ADM developed in vitro was maintained in serially transplanted tumors. The uptake studies with [3H]daunomycin revealed decreased influx and enhanced active efflux of the drug in the resistant cells, whereas cytogenetic analysis showed that the cell lines had an identical karyotype. These results indicate that ADM resistance may be attributed to alternations in membrane transport, resulting in reduced intracellular accumulation of the drug.

The elimination of fibroblast-like cells from primary cultures of fetal human livers was studied. A fibroblast-like cell line (HuF), which was obtained by subculturing fetal human liver cells 4 or more times, was briefly treated with hydrocortisone (HC) or putrescine (PUT). The growth of HuF cells was inhibited by HC at a concentration of 10(-2) M and by PUT at a concentration higher than 10(-3) M. Long-term treatment of HuF cells with 10(-3) M HC inhibited the growth of the cells. Primary cultures of fetal human livers were made in medium containing HC or PUT, and morphological and functional examinations were made. The cultures were predominantly composed of epithelial-like cells, with few fibroblast-like cells, when the HC concentration was 10(-5)M to 10(-3) M. A high amount of albumin was secreted at these concentrations of HC. On the other hand, at 10(-3) M PUT, many epithelial-like cells were seen, but albumin was undetectable. The present results indicate that albumin-producing epithelial-like cells can be selectively maintained in medium containing HC, in primary cultures of fetal human livers.

Maximal expiratory volume-time and flow-volume (MEVT and MEFV) curves were drawn for young male nonsmoking healthy adults and for young male nonsmoking asthmatic patients. Eleven parameters, two MEVT (%FVC and FEV1.0%), six MEFV (PFR, V75, V50, V25, V10 and V50/V25), and three MTC parameters (MTC75-50, MTC50-25 and MTC25-RV) were used for the multivariate analysis. The multivariate analysis in this study consisted of correlation coefficient matrix computation, the test for mean values in the multivariates, and the linear discriminant analysis using the all possible selection procedure (APSP). Correlation coefficients among flow rate parameters and flow rate related parameters in high lung volumes were different between the two groups. In the eleven-parameter discriminant analysis by APSP using single parameters, PFR, V75 (flow rate at 75% of forced vital capacity), and FEV1.0% were considered to be the effective parameters. In the seven-parameter discriminant analysis using the parameter groups, the group of all parameters and the %FVC and flow rate-related parameter group were considered to be the effective numerical alternatives to MEFV curves discriminating between healthy adults and asthmatic patients.

1. The results of 245 pleural biopsies perfomed in 108 patients including 219 pleural needle biopsies and 26 pleural open biopsies were reported. The method of pleural biopsy seems to be superior to any other currently available diagnostic procedures for the etiological diagnosis of pleurisy. 2. When the pleural needle biopsy is compared with the pleural open biopsy, the former method has definite advantages over the open biopsy. The pleural needle biopsy is simple, repeatable and has almost no complication. The method of pleural needle biopsy is the initial method of choice as Donohoe correctly stated and should be employed in every cases of the pleurisy to confirm the etiological diagnosis. The open biopsy should be reserved only for those cases in whom the needle biopsy had not proved satisfactory. 3. Utilizing the method of needle biopsy, the pathological diagnosis was made in 86 per cent of our cases at the initial biopsy. By repeated needle biopsies, the results have improved to 91-92 per cent. 4. Most of the failures of the pleural needle biopsy were noted at the early stage of the study due to the unfamiliarity of the biopsy technique and later due to the incooperation of the patients. 5. The presence of the free pleural fluid serves as a convenient guide for the performance of the needle biopsy but successful needle biopsy was easily done without presence of pleural fluid when there is adequate pleural thickening. 6. 63-75 per cent of our diagnosed cases were proved to have granulomatous pleuritis, 13-31 per cent non-specific pleuritis and 5.4-5.8 per cent eosinophilic pleuritis due to paragonomiasis. The distribution of this pathological diagnosis seems to reflect quite well the actual picture of incidences of pleurisy of various different etiology in young adults in Korea. 7. The relationship of the success in obtaining adequate tissue by needle biopsy and interval between onset of symptom and biopsy was discussed. It was found that the interval has no significant effect on the production of adequate tissue by needle biopsy if the time elapsed is 4 weeks or more from the onset of symptom. 8. The significance of the pathological findings of ranulomatous pleuritis at one biopsy and non-specific pleuritis at another biopsy in the same patient was discussed. It is concluded that the single finding of nonspecific pleuritis at one needle biopsy cannot rule out the presence of granulomatous pleuritis and it is recommended that pleural biopsy be repeated whenever necessary. 9. The diagnostic significance of the chemical analysis of the pleural fluid was discussed in correlation with the results of the pleural needle biopsies. It is concluded that the number of examinations are not quite sufficient to draw any definite conclusion at the present stage of our study. 10. The finding of sanguinous pleural fluid in the patient of granulomatous pleuritis is quite high (72.7 %) and it was found that the sanguinous pleural fluid was most frequently found in the patients with granulomatous pleuritis in non-cancerous age. 11. Two groups of pleurisy patients with or without parenchymal lung lesion on chest X-ray were discussed in correlation with the results of the needle biopsy. It was found that the incidence of the pathological evidence of granulomatous inflammation on the biopsy specimens in these two groups is almost the same regardless of the presence of the demonstrable parenchymal lung lesion. 12. Histopathological finding of granulomatous pleuritis was discussed in conjunction with the significance of two types of tubercles, the soft tubercles and hard tubercles. In all specimens diagnosed as granulomatous pleuritis granulomas were demonstrated ranging from large, conglomerate tubercles with central caseation or giant cells to small granulomas without central caseation or Langhans' giant cells. 13. Histopathological significance of the finding of non-specific pleuritis on the biopsy specimens was discussed and the existence of a specific entity of "non-specific pleuritis" which is equivalent to the non-specific inflammation of the pericardium. 14. Cases of pleurisy due to paragonomiasis were discussed and the need of specific attention for search of new cases was emphasized.

It has long been a clinically and experimentally well recognized fact that the hearing organs of man and animal would be impaired by the excessive sound stimuli. It has also been pointed out that the hearing organ of each man is not always impaired in the same degree by the same noise, and their impairments show the individual variation in a considerable range. It is indeed not too difficult to imagine, that, under the same acoustic condition, such individual variation of the acoustic impairment owes to the inherent disposition of each man. But at the same time, this individual variation may more or less owe to the patency of the ear tube; the normal tube having a physiological function to control the unnecessary acoustic stimuli, and on the contrary, the stenosed tube being devoid of this function, induces more impairment of the hearing organ. This latter suggestion, which occured to the author, led him to attempt the following experiment.

Angiotensin I-converting enzyme (ACE) inhibitory and hypotensive effects of 7 peptide fractions (Frs) of royal jelly protein hydrolysate (RJPH) were studied in comparison with those of RJPH alone. Fr 4 and Fr 5 were the highest in ACE inhibitory activity and yield, respectively. Molecular weights (MWs) of RJPH and Fr 1-Fr 7 were distributed from 100 to 5,000 and those of Fr 1-Fr 7 increased in order from Fr 1 to Fr 7. RJPH, Fr 3 and Fr 4 at doses of 10, 30 and 100mg/kg i.v. and Fr 5 and Fr 6 at doses of 30 and 100mg/kg i.v. caused transiently significant hypotensive effects in spontaneously hypertensive rats (SHR). Fr 3, Fr 4, Fr 5 and Fr 6 at a dose of 1,000mg/kg also caused significant hypotensive effects 3h, 4-5h, 7-8h and 8h after oral administration in SHR, respectively. RJPH caused a long-lasting hypotensive effect in proportion to the magnitude of the MWs of RJPH fractions. The hypotensive pattern of RJPH was similar to the combined pattern of Fr 3-Fr 6. From these results, it can be concluded that the long-lasting hypotensive effect of oral administration of RJPH is dependent on the MWs of its ACE inhibitory peptides and the time required to digest them.

There is little information available concerning the influence of right bundle branch block (RBBB) on the prognosis of patients with inferior myocardial infarction (MI). In this study we evaluated the influence of RBBB on the short-term prognosis of patients with inferior MI. Our study subjects were 1,265 hospitalized patients with Q wave MI. Patients were divided into 4 groups based on the presence or absence of RBBB and on the location of the infarction. RBBB was classified into 4 categories according to the timing of its appearance and its duration as new permanent, transient, old and age indeterminate. In-hospital death and pulmonary congestion were observed more frequently in patients with RBBB than in those without RBBB. Moreover, in inferior MI as in anterior MI, in-hospital death and pulmonary congestion occurred more frequently in new permanent RBBB patients than in patients with other types of RBBB. Multivariate regression analysis reveals that new permanent RBBB was a strong independent predictor for an adverse short-term prognosis in patients with inferior MI, as well as in patients with anterior MI. New permanent RBBB during inferior MI is a strong independent predictor for increased in-hospital mortality, regardless of the infarction location.

Chest X-ray (CXR) examination is considered essential for health checkups of students;thus, it is important to objectively assess the CXR for a better understanding of the appropriate X-ray exposure dose, and the risks such an examination entails. Accordingly, we performed a multi-institutional study regarding students' CXR exposure, during a 6year-period from 2002 (partially including 2001) to 2007, with the collaboration of national, municipal, and private universities and colleges in Japan. A glass badge was worn by the students at the time of CXR screening examination. These glass badges were collected, and their X-ray exposure doses were measured. The results indicated a tendency of decreasing exposure dose over the 6 years, though the difference was not significant. In a comparison of the chest X-ray systems within institutions (own X-ray equipmentinside systems) with those outside the institution (mobile X-ray equipmentoutside systems), the average exposure dose with the outside systems exceeded that of the inside systems. Both inside and outside systems included a few X-ray machines with which the exposure was more than 1mSv. Based on these facts, individuals in charge of student health checkups should be aware of the exposure dose of each chest fluorographic system at their institution.

Surgical treatment of metastatic spinal cord compression is controversial. The purpose of this study was to investigate the effectiveness of our current surgical treatments and the use of spinal instrumentation. In this retrospective study covering the years between 1990 and 2006, 100 patients with spinal metastases which were secondary to various cancers underwent posterior and/or anterior decompression with spinal stabilization for the purposes of reduction of pain, and/or to help correct or improve neurological deficits. The group was made up of 60 men and 40 women whose ages ranged from 16 to 83 years (average of 60 years), and the average follow-up period was 14 months. The effect of treatment upon pain relief and neural deficits was assessed, and the cumulative survival rate was calculated by the Kaplan-Meier method. The average surgical time was 185min. This was calculated based on the following times, listed here with the surgery type:178min for posterior surgery;245min for anterior surgery;465 min for combined surgery;and 475min for total en bloc spondylectomy. Average blood loss during surgery was 1,630 ml for posterior surgery, 1,760 ml for anterior surgery, 1,930 ml for combined surgery, and 3,640 ml for total en bloc spondylectomy. Preoperative pain and paralysis were improved by 88% and 53%, respectively. In regards to surgical complications, postoperative epidural hematoma was observed in 2 patients, and instrumentation-related infection was observed in 1. Only 2 patients died within 2 months of surgery. In conclusion, posterior and/or anterior decompression with spinal stabilization is a safe and effective treatment for patients with spinal metastases, and can improve their quality of life.

The present study was performed to clarify the effect of hypertonic saline infusion into the lung parenchyma on radiofrequency ablation (RFA) of the lungs. A total of 20 ablation zones were created in 3 pigs. The ablation zones were divided into 3 groups. Group 1 (n6) consisted of ablation zones created by applying smaller radiofrequency (RF) power without saline infusion;group 2 (n5) zones were created by applying greater RF power without saline infusion;and group 3 (n9) zones were created by applying greater RF power with saline infusion. The techniques of saline infusion included administration of hypertonic saline 1ml before RFA, followed by continuous administration at a rate of 1ml/min during the first 2min after the initiation of RFA. The ablation parameters and coagulation necrosis volumes were compared among the groups. Group 3 had a tendency toward smaller mean impedance than group 1 (p0.059) and group 2 (p0.053). Group 3 showed significantly longer RF application time than group 2 (p0.004) and significantly greater maximum RF power than group 1 (p0.001) and group 2 (p0.004). Group 3 showed significantly larger coagulation necrosis volume (mean, 1,421mm3) than group 2 (mean, 858mm3, p0.039) and had a tendency toward larger necrosis volume than group 1 (mean, 878mm3, p0.077). Although this small study had limited statistical power, hypertonic saline infusion during RFA appeared to enlarge coagulation necrosis of the lung parenchyma.

The number of suicide deaths in Japan has continued to be high, and is a pressing social problem. Although the weekly distribution of suicide deaths has been documented, no nationwide analysis has yet been conducted. In the present study, the ratios of the number of suicide deaths per day, by day of the week, and on weekdays relative to holidays were calculated using the data for all suicide deaths recorded in 2003. The suicide deaths recorded on holidays were treated as the reference, and a confidence interval of 95% (95% CI) was used. We calculated the suicide death ratios among men and women of all ages (men:23,396, women:8,713, total:32,109) and also among those of productive age (age:15-64 years, men:18,552, women:5,481, total:24,033). Among men of all ages, the suicide death ratio on Mondays was found to be significantly high at 1.49 (95% CI:1.04-2.14), and the ratios were found to decrease over the course of the week from Monday to Friday. On each weekday, the suicide death ratios among men of productive age were found to be higher than those among men of all ages. Among women, the suicide death ratios on any weekday were found to be higher than 1, but there was no significant difference between the days. Among both men and women, the number of suicide deaths on holidays was lower than that on weekdays. This study revealed that the number of suicide deaths recorded per day on Mondays is 1.5 times higher than that on holidays among men. This suggests that the structure of the work week may possibly influence suicide deaths among men. Future discussions regarding the arrangement and distribution of weekly holidays should be conducted in order to reduce the number of suicide deaths.

Little information is available on the mechanism of diastolic left ventricular (LV) dysfunction in patients with chronic respiratory disease complicated by hypoxia. The purpose of this study was to investigate how chronic hypoxia impairs LV diastolic function in an hypoxic animal model. Thirty-six male Wistar rats 8 weeks old were assigned to normoxia (N), chronic hypoxia (CH), and re-normoxia (RN) groups, 12 rats per group. The N group rats were kept in ambient air for 8 weeks, while the CH group was kept hypoxic for 8 weeks. After 8 weeks of hypoxia the RN group rats were kept for a further 8 weeks in ambient air. LV systolic and diastolic functions, as well as right ventricular (RV) function, were analyzed using Doppler echocardiography;we also measured the hematocrit, and weighed the LV and RV. Hematocrit, RV weight/body weight, and RV weight/LV weight were higher in the CH group than in the other 2 groups. However, most of these parameters returned to normoxia levels after re-normoxia. In the CH group, LV dimension and area were smaller than in the other 2 groups. LV systolic function was preserved in all groups;however, in the CH group, mitral flow showed a restrictive pattern, while pulmonary flow demonstrated a pulmonary hypertensive pattern with prolonged RV ejection time. In conclusion, chronic hypoxia induced pulmonary hypertension and RV hypertrophy. Although LV systolic function was preserved, diastolic function was impaired in hypoxia. Ventricular interaction may impair LV diastolic function.

The authors previously developed a mobile ecological momentary assessment (EMA) system as a real-time data collection device using a mobile phone. In this study, a real-time advice function and real-time reporting function were added to the previous system as a supportive intervention. The improved system was found to work effectively and was applied to several clinical cases, including patients with depressive disorder, dizziness, smoking habit, and bronchial asthma. The average patient compliance rate was high (89%) without the real-time advice and higher (93%) with the advice. The trends in clinical data for patients using a mobile EMA with/without the new function were analyzed for up to several months. In the case of dizziness, an improving trend in its clinical data was observed after applying the real-time advice, and in the case of depressive disorder, a stabilizing trend was observed. The mobile EMA system with the real-time advice function could be useful as a supportive intervention in behavior modification and for motivating patients in self-management of their disease.

Angiogenesis is an essential event in the development of synovial inflammation in rheumatoid arthritis (RA). The aim of the current study was to investigate the expression of vasohibin-1, a novel endothelium-derived vascular endothelial growth factor (VEGF)-inducible angiogenesis inhibitor, in the RA synovium, and to test the effect of inflammatory cytokines on the expression of vasohibin-1 by RA synovial fibroblasts (RASFs). Synovial tissue samples were obtained at surgery from patients with osteoarthritis (OA) and RA, and subjected to immunohistochemistry to investigate the expression and distribution of vasohibin-1 relevant to the degree of synovial inflammation. In an in vitro analysis, RASFs were used to examine the expression of vasohibin-1 and VEGF mRNA by real-time PCR after stimulation with VEGF or inflammatory cytokines under normoxic or hypoxic conditions. The immunohistochemical results showed that vasohibin-1 was expressed in synovial lining cells, endothelial cells, and synovial fibroblasts. In synovial tissue, there was a significant correlation between the expression of vasohibin-1 and histological inflammation score (p0.002, r0.842). In vitro, stimulation with VEGF induced the expression of vasohibin-1 mRNA in RASFs under normoxic conditions, and stimulation with cytokines induced vasohibin-1 mRNA expression under a hypoxic condition. These results suggest that vasohibin-1 was expressed in RA synovial tissue and might be regulated by inflammatory cytokines.

We present a middle-aged, heterosexual Japanese man with mixed infections including human intestinal spirochetosis, which led us to the detection of human immunodeficiency virus (HIV) infection. The patient had syphilis without related physical or neurological findings. An examination for the serum antibody for HIV performed 9 years previously was negative. In a complete medical checkup at the present time, human intestinal spirochetosis and unspecified entamebic cysts were suggested by histological examination of colonic biopsy material and parasitic examination of the intestinal fluid, respectively. Moreover, a serological test for the antibody for HIV was positive. In specimens obtained by colonoscopy, Brachyspira aalborgi was diagnosed by ultrastructural study and the polymerase chain reaction method for bacterial 16S ribosomal deoxyribonucleic acid. Although HIV infection remains at low prevalence in Japan, we recommend examination for HIV infection in patients with human intestinal spirochetosis, especially when other co-infections are apparent.

The annual number of suicides in Japan increased sharply in 1998, and since that time it has consistently exceeded 30,000 per year. In this study, we analyze a database of personal and background characteristics of 824 cases (605 men, 219 women) who completed suicide in Okayama Prefecture in 2002 and 2003. The data were obtained with cooperation from the police. Using the methodologies in a previous European study as a model, we classified the suicide methods into 8 categories. To examine the generational and regional differences in the choice of methods, we stratified the sample into 4 age groups (<-24, 2544, 4564, and >-65) and 2 regional groups (Okayama/Kurashiki vs. other areas). Our results on gender differences in 7 of the suicide methods were mostly similar to the European data. However, our data showed a remarkably higher proportionate male-to-female mortality ratio for poisoning by other substances (ICD-10, X65-X69 codes) (1.83, 1.15-2.92). In terms of generational differences in the choice of suicide methods, the Mantel-Haenszel test of homogeneity was significant for most of the categories in our study, suggesting an impact of age on how people commit suicide. There were no remarkable regional differences in our sample. An epidemic curve for suicides via carbon monoxide poisoning using charcoal briquets revealed a trend of time clustering not observed in the other 6 means. The database constructed and used in this study contains richer information than conventional death statistics and is expected to provide helpful knowledge and insights for future epidemiological studies.

(1) We studied the permeability of erythrocytes (human, an, chicken and frog), collodion membrane_ and frog's urinary bladder, to urea and its associated substances, alcohols and glucose. (2) Hemolysis of human erythrocytes to urea, its derivates and alcohol, is due to the penetration of these substances through the erythrocytes membrane. (3) Among urea and its associated substances, it was observed that the hemolysis time of human erythrocytes was inversely proportinal to the molecular weight of these substances. (4) Chicken erythrocytes were far less permeable to urea than human erythrocytes. (5) Hemolysis time to guanidine showed no difference between human and chicken erythrocytes. (6) Frog's urinary bladder in a living condition has a high degree of semipermeability to urea. When it is injured or dead, it behaves like collodion membrane.

Protective effects of clinically used drugs against adriamycin (ADM)-induced toxicity were studied in ICR mice. The control mice, which were administered 15 mg/kg of ADM twice, survived 7.48 +/- 1.99 days (mean +/- S.D.). The survival times of mice treated with the following drugs, expressed as a percent of that of the control group, were 293.6% for coenzyme Q10 (Co Q10, 2 mg/kg), 402.2% for dextran sulfate (MDS, 300 mg/kg), 121.6% for flavin adenine dinucleotide (20 mg/kg), 236.3% for adenosine triphosphate disodium (50 mg/kg), 213.7% for reduced glutathione (100 mg/kg), 121.6% for phytonadione (50 mg/kg), 155.2% for inositol nicotinate (Ino-N, 500 mg/kg), 335.5% for nicomol (1000 mg/kg), 157.5% for nicardipine (10 mg/kg) and 123.3% for dipyridamol (50 mg/kg). Anti-hyperlipemic agents such as MDS, nicomol, Ino-N and Co Q10 strongly protected against the ADM-induced toxicity, and the mice administered these drugs lived significantly longer than the control mice. The mechanism of the protective effect was discussed.

The effects of immobilization stress on the pharmacokinetics of omeprazole were studied in rats. The immobilization stress for 30 or 60 min immediately after oral administration of the drug caused an increase in the time to reach the maximum concentration. However, such stress did not alter the area under the plasma concentration-time curve (AUC). When administered intravenously, the half-life during the elimination phase was significantly prolonged by 30 min of immobilization stress, but the AUC value remained unchanged. The intestinal propulsive activity was significantly decreased by immobilization stress. These findings suggest that immobilization stress reduces gastrointestinal motility. A resulting delay during the absorption phase of omeprazole occurs, although the degree of influence on overall pharmacokinetics is relatively insignificant.