Influence of one-step professional mechanical tooth cleaning pastes on surface roughness and morphological features of tooth substrates and restoratives

PURPOSE

This study investigated the influence of professional mechanical tooth cleaning (PMTC) pastes on the surface texture of different subject materials.

METHODS

Two one-step PMTC pastes, Clinpro Cleaning Paste for PMTC (CP) and PRG Pro-Care Gel (PG), and multiple-step PMTC pastes, Merssage Regular (MR), Merssagge Fine (MF), and Merssage Plus (MP), were used. For comparison, PMTC was performed using distilled water without paste (DW). The subjected materials used were bovine enamel (ENA) and dentin (DEN), a resin composite (FSU), and lithium disilicate (IEC). The prepared specimens were polished using a #2000-grit silicon carbide paper. PMTC was performed using a brush at 1,000 rpm for 15 s.

RESULTS

The surface roughness (Ra) values of the specimens before and after PMTC were measured by laser scanning microscopy. The Knoop hardness number (KHN) of the subjected material was obtained. The types of PMTC pastes and subject materials had a significant influence on the Ra values and KHN. For the majority of subject materials, the descending order of Ra values after PMTC was MR > MF > CP > PG > MP > DW. The descending order of KHN of the materials was IEC > ENA > FSU > DEN.

CONCLUSION

Although one-step PMTC pastes appeared to be effective, it is important to consider the subject material during PMTC.

Baseline and changes in serum uric acid independently predict 11-year incidence of metabolic syndrome among community-dwelling women

INTRODUCTION

Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. In women, increased serum uric acid (SUA) levels are associated with MetS and its components. However, whether baseline and changes in SUA predict incidence of MetS and its components remains unclear.

METHODS

The subjects comprised 407 women aged 71 ± 8 years from a rural village. We have identified participants who underwent a similar examination 11 years ago, and examined the relationship between baseline and changes in SUA, and MetS based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report.

RESULTS

Of these subjects, 83 (20.4%) women at baseline and 190 (46.7%) women at follow-up had MetS. Multiple linear regression analysis was performed to evaluate the contribution of each confounding factor for MetS; both baseline and changes in SUA as well as history of cardiovascular disease, low-density lipoprotein cholesterol, and estimated glomerular filtration ratio (eGFR) were independently and significantly associated with the number of MetS components during an 11-year follow-up. The adjusted odds ratios (ORs) (95% confidence interval) for incident MetS across tertiles of baseline SUA and changes in SUA were 1.00, 1.47 (0.82-2.65), and 3.11 (1.66-5.83), and 1.00, 1.88 (1.03-3.40), and 2.49 (1.38-4.47), respectively. In addition, the combined effect between increased baseline and changes in SUA was also a significant and independent determinant for the accumulation of MetS components (F = 20.29, p < 0.001). The ORs for incident MetS were significant only in subjects with age ≥ 55 years, decline in eGFR, and no baseline MetS.

CONCLUSIONS

These results suggested that combined assessment of baseline and changes in SUA levels provides increased information for incident MetS, independent of other confounding factors in community-dwelling women.

Interaction between gender and uric acid on hemoglobin A1c in community-dwelling persons

INTRODUCTION

Higher glycated hemoglobin (Hb) (HbA1c) is significantly associated with an increased risk of cardiovascular disease (CVD). Serum uric acid (SUA) levels are associated with glucose intolerance and type 2 diabetes. Whether gender-specific differences regarding the relationship between SUA levels and HbA1c exist is unknown.

AIM

We recruited 1636 (men, 696 aged of 70 ± 10 years; women, 940 aged of 70 ± 9 years) participants and enrolled in the study during their annual health examination from a single community. We investigated the association between SUA levels and HbA1c within each gender.

RESULTS

Multiple linear regression analysis showed that in men, SUA (β = -0.091, p = 0.014) with prevalence of antidiabetic medication (β = 0.428, p < 0.001) and eGFR (β = 0.112, p = 0.016) were significantly and negatively associated with HbA1c, and in women, SUA (β = 0.101, p = 0.002) with prevalence of antidiabetic medication (β = 0.458, p < 0.001) were significantly and positively associated with HbA1c. Moreover, the interaction between gender and SUA (β = 0.445, p < 0.001) as well as gender (β = -0.465, p < 0.001), prevalence of antidiabetic medication (β = 0.444, p < 0.001), eGFR_CKDEPI (β = 0.074, p = 0.014), and SUA (β = -0.356, p < 0.001) was a significant and independent determinant of HbA1c. A significant interactive effect of gender and SUA on determinants of HbA1c was noted in patients not on antidiabetic medications, regardless of age, HbA1c, and renal function.

CONCLUSIONS

The interaction between gender and SUA was associated with HbA1c independent of other metabolic factors in community-dwelling persons.

Health-related quality of life in patients with lower rectal cancer after sphincter-saving surgery: a prospective 6-month follow-up study

This longitudinal descriptive study examined whether rectal cancer patients report changes in health-related quality of life (HRQOL) over a 6-month period after different types of sphincter-saving surgery (SSS): intersphincteric resection (ISR), ultra-low anterior resection (ULAR) and low anterior resection (LAR). It also compares HRQOL among the three groups of patients. Seventy-three patients from two hospitals in Japan completed questionnaires on HRQOL and defecation symptoms immediately before surgery and 1 and 6 months afterwards. Results showed that ISR patients had significantly worse HRQOL scores than ULAR and LAR patients and more defecation symptoms that persisted during the 6 months post-SSS. Thus, patients undergoing ISR require psychological and social support, including skills in competent self-management, during the early post-operative period. Furthermore, defecation problems substantially influence HRQOL. The first month post-SSS is particularly challenging. The assumption that HRQOL is better after SSS compared to living with a permanent stoma might not be valid.

Ultrasonic assessment of the effects of self-assembling peptide scaffolds on preventing enamel demineralization

OBJECTIVES

This study evaluates the effect of self-assembling peptide P11-4 (Curodont Repair, CDR) on bovine enamel remineralization by measuring changes in ultrasonic propagation velocity.

METHODS

Six specimens per group were prepared by sectioning bovine teeth into enamel blocks. These blocks were then immersed in lactic acid buffer solution (pH = 4.75) for 10 min twice a day and stored in artificial saliva. Other specimens were first treated with CDR, followed by a 10-min immersion in the lactic acid buffer solution twice a day, before storage in artificial saliva. The propagation time of longitudinal ultrasonic waves was measured using a pulser/receiver. Six specimens were used for each treatment protocol. The obtained data were statistically analyzed using ANOVA followed by Tukey's honestly significant difference tests (α = 0.05). Specimens were observed using laser scanning microscopy and scanning electron microscopy.

RESULTS

Sonic velocity was found to decrease with time for specimens stored in the demineralizing solution. On the other hand, increases in sonic velocity were found for specimens treated with CDR. These specimens also exhibited signs of mineral deposition.

CONCLUSIONS

By measuring the ultrasonic propagation velocity, it can be concluded that CDR application has an ability to promote bovine enamel remineralization.

Evaluation of a calcium phosphate desensitizer using an ultrasonic device

This study evaluated the effect of a calcium phosphate desensitizer on the demineralization of bovine dentin by measuring changes in transmitted ultrasonic velocity. Bovine dentin specimens with and without application of desensitizer were immersed in 0.1 M lactic-acid buffer solution (pH 4.75) 10 min twice daily throughout the test period, and stored in artificial saliva solution (pH 7.0) between treatments. The propagation time of longitudinal ultrasonic waves was measured by a pulser-receiver. Data were evaluated using one-way ANOVA followed by Tukey HSD test (α=0.05). The ultrasonic velocity decreased over time in specimens stored in demineralizing solution (3,785-3,462 m/s); however, desensitizer-applied specimens had a significantly higher sonic velocity (3,945-3,990 m/s) than those without application. The calcium phosphate desensitizer appeared to reduce the demineralization of dentin and occluded dentinal tubules.

Effect of Pre-reacted Glass-ionomer Filler Extraction Solution on Demineralization of Bovine Enamel

Objective

To determine the effect of pre-reacted glass-ionomer (PRG) filler extraction solution on the demineralization of bovine enamel by measuring changes in the ultrasound transmission velocity.

Methods

The specimens were prepared by cutting bovine teeth into enamel blocks. The specimens were immersed in buffered lactic acid solution for 10 minutes twice a day, and then stored in artificial saliva. Other specimens were stored in PRG filler extraction solution for 10 minutes, followed by 10-minute immersion in the buffered lactic acid solution twice a day. The propagation time of longitudinal ultrasonic waves was measured by a pulser receiver. Six specimens were used for each condition, and analyses of variance followed by Tukey tests (α=0.05) were done.

Results

No changes in sonic velocity were found for specimens stored in the PRG filler extraction solution, indicating that the PRG extraction solution had an effect on inhibiting the demineralization of bovine enamel.

Conclusions

The results obtained with the use of an ultrasound measurement technique suggested that PRG filler extraction solution has the ability to prevent demineralization of enamel.

Inhibition of 5-hydroxytryptamine receptor prevents occlusive thrombus formation on neointima of the rabbit femoral artery

BACKGROUND

Thrombus propagation on disrupted plaque is a major cause of acute coronary events and serious complication after coronary intervention. 5-Hydroxytryptamine (5-HT) is a potent vasoactive and platelet-aggregating substance that is predominantly mediated by 5-HT2A receptor. However, the roles of 5-HT2A receptor in occlusive thrombus formation on disrupted plaque remain obscure.

OBJECTIVE

We investigated the role of 5-HT2A receptor in thrombus formation using a rabbit model of repeated balloon-injury.

METHODS

Three weeks after a first balloon-injury of the femoral arteries, luminal diameter, neointimal growth, and vasoconstriction by 5-HT in vitro were examined. Thrombus propagation and the role of 5-HT2A receptor after a second balloon-injury were evaluated using sarpogrelate, a selective 5-HT2A receptor antagonist.

RESULTS

Three weeks after the first balloon-injury, luminal stenosis was evident in the femoral arteries, where the neointima expressed tissue factor and 5-HT2A receptor. The hypercontractile response of the stenotic arteries to 5-HT was significantly reduced by sarpogrelate. Balloon-injury of the neointima with substantially reduced blood flow promoted the formation of occlusive thrombus that was immunoreactive against glycoprotein IIb-IIIa, 5-HT2A receptor and fibrin. Intravenous injection of sarpogrelate significantly inhibited ex vivo platelet aggregation induced by adenosine 5'-diphosphate, thrombin and collagen alone as well as with 5-HT, and significantly prevented occlusive thrombus formation in vivo.

CONCLUSIONS

The 5-HT2A receptor appears to play a crucial role in occlusive thrombus formation in diseased arteries via platelet aggregation and vasoconstriction. Inhibition of 5-HT2A receptor might help reduce the onset of acute coronary events and of acute coronary occlusion after the intervention.

An association of 5,10-methylenetetrahydrofolate reductase (MTHFR) gene polymorphism and common carotid atherosclerosis

Plasma homocysteine (Hcy) concentration has been shown to be influenced by a mutation in the gene coding methylenetetrahydrofolate reductase (MTHFR). Although plasma Hcy is related to atherosclerotic disorders, conflicting results have been reported about the association between MTHFR gene polymorphism and sclerotic lesions of the common carotid arteries. The effect of age-gene interaction on carotid arterial remodeling was investigated in elderly subjects with several risk factors for atherosclerosis. We evaluated sclerotic lesions of the common carotid arteries by ultrasonography in 326 patients (mean age +/- standard deviation, 73 +/- 12 years) and studied relations among the known risk factors for atherosclerosis, including MTHFR gene polymorphism and its interactions with age and sex. Of the 326 subjects studied, 136 had MTHFR genotype CC, 136 genotype CT, and 54 genotype TT. The three groups did not differ with respect to background factors such as age, history of cigarette smoking, blood pressure, lipids or uric acid, or in the incidence of atherosclerotic diseases. Spearman's rank correlation revealed a significant relationship between gender, age, Brinkman index, systolic blood pressure, triglycerides, HDL-cholesterol (HDL-C), uric acid, and MTHFR gene polymorphism. Multiple regression analysis using intima-media complex thickness (IMT) as a criterion variable and risk factors, including MTHFR gene polymorphism as explanatory variables showed that MTHFR gene polymorphism (P = 0.039) was a significant independent explanatory variable for IMT, along with gender (male) (P < 0.001), age (P < 0.001), systolic blood pressure (SBP) (P = 0.047), total cholesterol (T-C) (P < 0.001), and HDL-C (P < 0.001). Furthermore, a general linear model analysis revealed that interaction between age and MTHFR gene polymorphism was significantly associated with IMT, independently of age, SBP, T-C, and HDL-C in male subjects. However, age-gene interaction was not observed in female subjects. The findings of the present study confirm an association between MTHFR gene polymorphism and common carotid atherosclerosis in the Japanese population and further support the role of risk factor-gene interaction in common carotid atherosclerosis.

Association of plasma homocysteine concentrations with carotid atherosclerosis in elderly Japanese

OBJECTIVE

Homocysteine (Hcy) is a sulfhydryl amino acid. Its precursor, the essential amino acid methionine, is derived from dietary protein; recently a number of studies have suggested its relation to atherosclerosis. The present study was performed to clarify the relation between the plasma Hcy concentration and sclerotic lesions of the common carotid arteries.

METHODS AND PATIENTS

We evaluated sclerotic lesions of common carotid arteries by ultrasonography in 120 elderly in-patients (77+ /- 9 years), and studied the relationship of the known risk factors for atherosclerosis including plasma Hcy. An ultrasonograph and 7.5 MHz linear type B-mode probe were used by a specialist to evaluate sclerotic lesions of the common carotid arteries. Blood was drawn from the patients while fasting for determination of plasma Hcy. Plasma Hcy concentrations were determined using a high-performance liquid chromatography assay.

RESULTS

Logistic regression analysis using IMT as an object variable, adjusted by various risk factors including the plasma Hcy concentration, revealed that the relative risk in the group combining the second and the third highest Hcy groups was 6.49 (95% confidence interval (CI): 1.95-21.9) compared with the first group and the plaque presence showed a relative risk of 4.45 (95% CI: 1.53-12.9).

CONCLUSION

The findings of this study confirmed that observations of an association between plasma Hcy concentration and common carotid atherosclerosis in Western populations is also present among the elderly Japanese.

Microvascular angina in a patient with aortic stenosis

A 39-year-old woman had exercise-induced ST segment depression associated with chest pain. Cardiac evaluation revealed moderate aortic stenosis (AS), related to the bicuspid valves, with an aortic mean pressure gradient of 22 mmHg, a calculated aortic valve area of 1.3 cm2 and normal left ventricular (LV) peak systolic and end-diastolic pressures, but no LV hypertrophy, resulting in normal LV wall stress. Although the coronary arteries were angiographically normal, rapid atrial pacing and an intracoronary papaverine injection revealed a significantly decreased coronary flow reserve (CFR), which may have played an important role in the pathogenesis of angina pectoris in this patient. Though the CFR is usually decreased in patients with AS, as well as in microvascular angina, in this particular case, it appeared to have decreased as a consequence of microvascular dysfunction rather than of AS-related mechanisms.

An association between an antibody against Chlamydia pneumoniae and common carotid atherosclerosis

OBJECTIVE

Chlamydia pneumoniae (C. pneumoniae) is an important pathogen for infections of the respiratory tract, and there are recently also a number of reports suggesting its relation with atherosclerosis. This study was performed to clarify the relation between C. pneumoniae infection and sclerotic lesions of the common carotid arteries.

METHODS AND PATIENTS

We evaluated sclerotic lesions of common carotid arteries by ultrasonography in 147 in-patients (mean age, 70 years; 95% confidence interval, 68-72) in the internal medicine ward, and studied the relation of the known risk factors for atherosclerosis including C. pneumoniae infection. An ultrasonograph and 7.5 MHz linear type B-mode probe were used by a specialist to evaluate sclerotic lesions of common carotid arteries. C. pneumoniae infection was determined by measuring anti-C. pneumoniae IgG specific antibody level (IgG index) using enzyme-linked immunosorbent assay (ELISA) method with serum of fasting blood, which had been preserved at -70 degrees C.

RESULTS

IgG index (p=0.0263), from multiple regression analysis using various risk factors as explanatory variables, was a significant independent contributing factor (R2=0.3465, p<0.0001) along with known risk factors such as male (p=0.0289), age (p=0.0007), Brinkman index (p=0.0067), hypertension (p=0.0443) and T-Chol (p=0.0220).

CONCLUSION

This study confirmed that the observations of an association between antibody against C. pneumoniae and common carotid atherosclerosis in Western nations is also present in Japan. Our results suggests that C. pneumoniae infection is also an important risk factor for common carotid atherosclerosis.

[A study of mental health in community-dwelling older persons--influence of cared elderly]

This study aimed to evaluate mental health of elderly persons living in the community and understand the various backgrounds and effects of care giving. The study used a questionnaire from similar to the one used by Matsubayashi et al in the Kahoku-cho study. The Japanese Version of General Health Questionnaire 12 (GHQ-12) was used to evaluate mental health. Responses were received from 2,799 (81.5%) of 3,432 Numura-cho residents (81.5%). After removing inadequate responses, 1,268 (36.9%) (575 men and 693 women) were analyzed. Fifty-five men (9.6%) and 69 women (10.0%) were caring for someone at home. Multiple logistic regression analysis which examined the relation between mental health and the background factors such as having someone to care for, revealed that their mental health was significantly poor compared to those having no one to care for (odds ratio (OR) = 2.01, 95% confidence interval (CI), 1.29-3.15). As for the relation between the degree of care giving and their mental health, the subjective burden was significantly poor at 72-100% (OR = 3.40, 95% CI, 1.71-6.78) and for those with three to eight years of care-giving (OR = 2.22, 95% CI, 1.00-4.90), disabled activity of daily living (almost bed ridden) of the cared for person (OR = 5.53, 95% CI, 2.23-13.7), severely demented state (OR = 5.13, 95% CI, 2.14-12.3), their mental health was significantly poor. However, being able to participate in an event (OR = 0.12, 95% CI, 0.03-0.49) and strong emotional support (OR = 0.12, 95% CI, 0.03-0.49) were negatively associated with caregivers' psychiatric distress. Having someone to care for largely affected mental health of the elderly to subjects living in the community. Services should be devised to serve the needs such as psychological care of care-givers as well as those being cared for.

[Pulse pressure and common carotid arterial wall thickness assessed by ultrasonography]

This study was conducted on a total of 358 normotensive (mean blood pressure < 107 mmHg) inpatients (182 men and 176 women, mean age: 67.8 years) who had no cardiorenal or nutrition disorders that would affect blood pressure, lipid and glucose metabolism and who had not been given depressors or antilipidemic agents during the four years from September 1995 to August 1999. In addition to the known risk factors for atherosclerosis, the effects of pulse pressure and mean blood pressure on sclerotic changes of the carotid arteries were examined. These sclerotic changes were assessed by measuring the thickness of the combined intima-media of the common carotid artery (carotid arterial wall thickness) by ultrasonography (Hitachi EUB-565) and linear probe (7.5 MHz). When the patients were divided into three groups based on pulse pressure (PP1, lower than 51 mmHg: PP2, 51-65 mmHg; PP3, higher than 65 mmHg), the age of the group with higher pulse pressure was significantly higher (p = 0.0011), women more (p = 0.0315). However there were no differences in background factors such as body mass index, Brinkman index, lipid metabolism, uric acid, and glucose metabolism. There was observed a positive correlation between the mean blood pressure and the pulse pressure for both men and women (r = 0.31, p < 0.001, respectively). As for the relation between the pulse pressures and the blood pressure parameters, the systolic blood pressure, pulse pressure and the mean blood pressure were significantly higher in the group with higher pulse pressure (p < 0.001, respectively), but the diastolic blood pressure was significantly lower (p = 0.0275). As for the relation between the pulse pressure and the carotid wall thickness, the groups of both men and women with higher pulse pressures had significantly greater carotid arterial wall thickness (p < 0.001, p = 0.0042, respectively). Logistic regression analysis of the carotid arterial wall thickness (defined as hypertrophic if greater than 1.0 mm) as the object variable and various risk factors including pulse pressure as the explanatory variables revealed that pulse pressure and LDL-C were significant independent contributing factors for men. The age, Brinkman index, T-Chol and HDL-C were significant independent contributing factors for women. For all subjects men, the age, Brinkman index, pulse pressure, TG and LDL-C were significant independent contributing factors. These facts suggest that pulse pressure is an important risk factor for thickening of the carotid arterial wall.

[Simple screening test for dementia in elderly persons the time and charge test]

Dementia, with its associated morbidity and mortality, has emerged as a leading public health problem with elderly persons and its early detection is of obrious importance for treatment in curable cases and referral of patients to optimal medical facilities with education support for family members. While the precision of detecting demented subjects by the existing screening methods has improved in recent years, they are still complex and time consuming in practice and therefore difficult to use. We have developed an screening method adapted for Japanese based on "The Time and Charge Test" of Froehlich and coworkers. The time test evaluates the understanding of clock hands indicating 11:10, and the charge test the ability selecting 100 yen from a group of coins consisting of one 50-yen coin, seven 10-yen coins and seven 5-yen coins. This test was conducted on 40 persons (two out of whom dropped out) living in Roken facility (a health facility for the elderly) and another 40 visiting a day care center for the elderly. The test results were studied using Mini-Mental State Examination and Hasegawa's Dementia Scale-revised version. The sensitivity of our test was 49.1%, the specificity 95.2%, the negative predictive value 40.8%, and the positive predictive value 96.6%. When a time limit 5 seconds for completing the task for the time test and 20 seconds for the charge test, the sensitivity was 87.7%, the specificity 57.1% the negative predictive value 63.2%, and the positive predictive value 84.7%. As for reproducibility, test-retest gave a value of 85.0%, and the inter-observer agreement was 89.5%. This simple method thus appears useful for screening for dementia.

[Blood pressure measurement by primary care physicians: comparison with the standard method]

OBJECT

To examine the usual methods of blood pressure (BP) measurement by primary care physicians and to compare them with the standard methods.

METHOD

DESIGN

Cross-sectional survey by self-administered questionnaire.

SUBJECTS

Primary care physicians who graduated from Jichi Medical School and were working at clinics. Each standard method for 20 items was defined as the one that was most frequently recommended by 6 guidelines (USA 3, UK 1, Canada 1, Japan 1) and a recent comprehensive review about BP measurement.

RESULTS

Of 333 physicians, 190 (58%) responded (median age 33, range 26 to 45 years). Standard methods and percentages of physicians who follow them are: [BP measurement, 17 items] supported arm 96%; measurement to 2 mmHg 91%; sitting position 86%; mercury sphygmomanometer 83%; waiting > or = 1 minute between readings 58%; palpation to assess systolic BP before auscultation 57%; check accuracy of home BP monitor 56%; Korotkoff Phase V for diastolic BP 51%; bilateral measurements on initial visit 44%; small cuff available 41%; > or = 2 readings in patients with atrial fibrillation 38%; > or = 2 readings on one visit 20%; cuff deflation rate of 2 mmHg/pulse 14%; large cuff available 13%; check accuracy of monitor used for home visit 8%; waiting time > or = 5 minute 3%; readings from the arm with the higher BP 1%. [Knowledge about BP monitor, 2 items] appropriate size bladder: length 11%; width 11%. [Check of sphygmomanometer for leakage, inflate to 200 mmHg then close valve for 1 minute] leakage < 2 mmHg 6%; median 10 (range 0-200) mmHg. Average percentage of all 20 items was 39%. Number of methods physicians follow as standard: median 8 (range 4 to 15) and this number did not correlate with any background characteristics of the physicians. Furthermore, we also obtained information on methods not compared with the standard. Fifty-four percentage of physicians used more standard methods in deciding the start or change of treatment than in measuring BP of patients with good control. About 80% of physicians use home BP readings in diagnosis or treatment of hypertension, but about half of physicians with ambulatory BP monitors use their measured readings.

CONCLUSION

Primary care physicians used various techniques for routine BP measurement and no physician completely followed the standard. Such measurements may affect the diagnosis and treatment of hypertension, but measuring all BPs solely by the standard is not practical. We need to have a practical and efficient method of BP measurement for routine practice in the primary care setting.

[Happiness and background factors in community-dwelling older persons]

In order to maintain and improve mental health of elderly people living in the community, a cross sectional survey was conducted to elucidate their happiness and background factors. The subjects were elderly persons living in the community who were able to fill in the questionnaire themselves. The study employed the self-recording questionnaire forms used in Kahoku Longitudinal Aging Study by Matsubayashi et al. Happiness was assessed using a visual analogue scale. Out of 2,379 elderly persons who were able to fill in the questionnaire by themselves in 2,361 (99.2%) returned the questionnaire sheets. After removing inadequate responses, analysis was possible for 1,873 (78.7%) (860 men (average age 72.7 years) and 1,013 women (average age 72.8 years). Among those with greater happiness, the ratio of those living with others (p = 0.0051) was high as well as those with spouses (p = 0.0240), without a history of hypertension (p = 0.0096) and apoplexy (p = 0.0039), not receiving medication regularly (p = 0.0039), with regular habit of walking (p < 0.001), or with work (p < 0.001). As for the relationship between happiness and various scores, the higher the happiness scale became, the scores for ADL, information-related function, functional and emotional support network, healthy condition, appetite condition, sleep condition, memory condition, family relationships, friendship, economic condition became significantly higher (p < 0.001, respectively). On multiple regression analysis using the background factors for happiness as explanatory variables, factors such as functional support network (p < 0.001), emotional support network (p = 0.0254), healthy condition (p < 0.001), good memory condition (p = 0.0027), friendship (p < 0.001), good economic condition (p < 0.001) were significant independent contributing factors. As for the relation between SDS and happiness, the more serious the SDS score (higher score) became, the scores for the feeling of happiness became significantly smaller (p < 0.001). For amelioration of the happiness of elderly persons living in the community, attempts should be made to improve the background factors clarified by the present study by efficiently utilizing health, medical and welfare services.

[A case of pituitary apoplexy approving as severe headache and nausea]

The causes of pituitary apoplexy are unclear. We report a case of pituitary apoplexy presenting with headache and nausea. On June 17th, 1997 a 74-year-old woman had complained of retro-orbital headache, fever and vomiting. A cold was diagnosed for which she recurred medication. In addition to the previous symptoms she was getting to lose appetite. She was admitted to our hospital for further examination and treatment on June 21. On admission neurological examination showed left pupil mydriasis, the left eye had no light reflex and the right eye had only a slight response to the light. She could hardly move both eyeballs up. Laboratory data showed a normal white blood cell count and the CRP was 16.2 mg/dl. Lumbar puncture showed 97 mg/dl total protein and 82 cells per microliter, most of which were lymphocytes. We diagnosed viral infection based on the evidence of clinical symptoms and lumbar puncture data. The patient was treated with gamma-globulin and improved. From the 16th day of sickness we recognized symptoms of oculomotor paralysis and the syndrome of inappropriate antidiuretic hormone. On the 23rd day of sickness we strongly suspected pituitary apoplexy based on transaxial MR images. After absorption of intra-tumor hemorrhage, the oculomotor symptoms recurred. We finally reached a diagnosis of pituitary apoplexy based on pathological material, MR images, symptoms and laboratory data. We must think of pituitary apoplexy when we see an aged out-patient with severe headache, nausea, vomiting and oculomotor paralysis. It was difficult to diagnose this disease in the early time course of the disease.

[A study of depressive state and background factors in community-dwelling older persons]

In order to maintain and improve the mental health of elderly people living in the community, a cross-sectional survey was conducted to elucidate their depressive state and its background factors. Subjects were elderly persons living in the community who were able to fill in the questionnaire themselves. The study used the self-recording questionnaire sheets used in the Kahoku Longitudinal Aging Study by Matsubayashi et al and the Zung Self-rating Depression Scale (SDS). Out of 2,379 elderly persons who were able to fill in the questionnaire by themselves in the community, 2,361 (99.2%) returned the questionnaire sheets. After removing inadequate responses, analysis was possible for 1,181 (49.6%) (542 males (average age 72.3 +/- 5.5) and 639 females (average age 73.0 +/- 6.3). Degree of depressive state as evaluated by SDS was normal for 731 persons (61.9%); mild, 240 (20.3%); moderate, 181 (15.3%); and severe, 29 (2.5%). The average age became higher as the SDS became high, of being indicating the seriousness of the depressive state (p = 0.0155), with the ratio women significantly higher (p = 0.0077). Among those with severe SDS, the ratio of single persons was high (p < 0.001) as well as those who were non-drinkers (p = 0.0015), without regular habit of walking (p < 0.001), or without work (p < 0.001). The ratio of those receiving medication regularly was also significantly high (p = 0.0022). As for the relation of SDS with various of the scores, the higher the SDS score became, the scores for ADL, information-related function, functional and emotional support network, family relationship, friendship, economic condition became significantly lower (p < 0.001, respectively). In logistic regression analysis using the background factors for SDS as explanatory variables, factors such as being women (odds ratio, 1.73; 95% confidence interval, 1.10-2.72). ADL (0.80; 0.69-0.93), emotional support network (0.88; 0.81-0.96), friendship (0.98; 0.96-0.99) were significant independent contributing factors. As for the relation between SDS and subjective senses, the more serious the SDS score became, the scores for feelings of healthiness and satisfaction became significantly smaller (both p < 0.001). For prevention and amelioration of the depressive state of elderly persons living in the community, attempts should be made to improve the background factors which were clarified by the present study by efficiently utilizing health, medical and welfare services and following the future course with a positive attitude.

[A decrease in urinary proteins in an elderly patient with refractory minimal change nephrotic syndrome administration of an angiotensin converting enzyme inhibitor in combination with steroids]

A 72-year-old woman had been treated for hypertension and hyperthyroidism by a local doctor. In May 1998, she came to this institution with a chief complaint of leg edema. Based on the clinical findings, she was diagnosed as having nephrotic syndrome with massive proteinurea, hypoproteinemia and hyperlipidemia. Renal biopsy findings showed minimal change nephrotic syndrome (MCNS). No substantial improvement was obtained by steroid therapy. We therefore additionally administered angiotensin-converting enzyme inhibitor (enalapril maleate). The urinary protein concentration significantly decreased. On decreasing the dose of steroids, the urinary protein concentration increased. Cyclophosphamide helped us to decrease the steroid dosage. This treatment resulted in type II incomplete remission. The final diagnosis was refractory MCNS. During steroid therapy, she developed hyperglycemia. She had no histology of diabetes mellitus. There is therefore a possibility that steroids can induce hyperglycemia even in patients without a history of diabetes mellitus. These results suggest that careful monitoring of plasma glucose is necessary during steroid therapy and that the administration of an angiotensin-converting enzyme inhibitor is effective in elderly patients with refractory primary nephrotic syndrome.

[A study of the degree of burden and subjective sense of well being in care-givers involved in home care]

We investigated the degree of burden on care-givers and their subjective sense of well being, and studied the factors affecting them. Twenty people who were responsible for at least a year for constant care of elderly or bed-ridden patients under visitation care and nursing supervision of this hospital were registered. Regarding the care-givers, we investigated age, sex, duration of care, the relations between the care-givers and the cared-for, assistant care-givers, profession and hobbies, if any, of the care-givers, the depression scores; the social support, the degree of burden imposed by care, and the subjective sense of well being. As for the cared-for, we investigated their age, disease and degree of ADL. The burden felt by the care-giver became greater if the care-giver was a woman (p < 0.05), if the relationship with the cared or the health status of the care-giver was poor (p < 0.05, respectively), and if the scores for functional and emotional support networks were poor (p < 0.005 and p < 0.05, respectively). As for the cared-for, the burden was greater if they were older (p < 0.05) and if it was difficult for them to leave bed (p < 0.05). The sense of subjective well being of the care-giver was greater if there was an assistant care-giver (p < 0.005); if the scores for the functional and the emotional support networks were higher (p < 0.05, respectively): and if understanding of information in terms of ADL was not adequate (p < 0.05). The present study suggested the importance of improving the emotional and functional support networks for the care-giver in helping them continue care by alleviating the burden and not suffering a loss in the subjective sense of well being.

A study of clinical features and treatment of acute bronchitis by Japanese primary care physicians

OBJECTIVE

This study aimed to examine the factors affecting prescription of antibiotics for acute bronchitis in ambulatory care settings in Japan.

METHOD

A prospective study was conducted on 92 physicians engaged in primary care regarding their prescription behaviour for a series of 20 new patients with acute respiratory diseases seen during November 1996 and the background factors affecting the behaviour.

RESULTS

A total of 1755 patients were registered during the study period, 302 (17.2%) of whom were diagnosed with acute bronchitis and 1165 (66.4%) with upper respiratory tract infection. Independent background factors related to diagnosis of acute bronchitis included self-care prior to visit (odds ratio 1.93, 95% CI 1.33-2.80), complaints such as cough (8.80, 4.77-16.2), sputum (2.24, 1.59-3.14) and purulent sputum (6.47, 3.02-13.9). The odds ratio was high in patients with more severe findings of the chest (5.00, 3.64-6.85), given chest X-ray (2.68, 1.33-5.38) while it was low in those feeling cold (0.68, 0.48-0.96), and those with a sore throat (0.63, 0.45-0.90), nasal symptoms (0.75, 0.54-1.04) and more severe findings of the pharynx (0.74, 0.58-0.92). In those with an upper respiratory tract infection, the odds ratio was high for complaints such as feeling cold (1.51, 1.11-2.05) and nasal symptoms (1.39, 1.04-1.86), while it was low for complaints such as cough (0.67, 0.48-0.95), sputum (0.43, 0.30-0.62), purulent sputum (0.19, 0.08-0.44), wheeze (0.34, 0.13-0.92), in those with more severe findings of the tonsil (0.36, 0.29-0.44) and the chest (0.30, 0.19-0.47) and given chest X-rays (0.29, 0.12-0.66). For acute bronchitis, antibiotics were administered to 67.5% and symptomatic therapy concurrently given to 64.9%. As for independent background factors related to prescription of antibiotics for acute bronchitis, the odds ratio was higher in physicians denying the efficacy of antibiotics for treating a cold (4.58, 1.94-10.8), and the patients with complaints such as purulent sputum (22.9, 2.66-197.2), more severe findings of the pharynx (2.26, 1.34-3.79) and of the chest (2.73, 1.53-4.88), and those who had a body temperature measurement taken (4.42, 1.71-11.4) and a chest X-ray (6.11, 1.07-34.9), but was lower in those complaining of chills (0.16, 0.04-0.66) and diarrhoea (0.11, 0.01-1.11).

CONCLUSIONS

A majority of patients receiving medical care for acute bronchitis are given an unnecessary antibiotic prescription. The result of this study may be useful for the finding of appropriate forms of intervention for changing physicians' prescription behaviour.

Psychological stress and educational effect during bedside practice on psychiatric nursing

The aim of this study is to analyze the educational effect and the factors of psychological stress of bedside practice on psychiatric nursing. The subjects studied were 76 nursing students in a nursing college. They answered a questionnaire and underwent the STAI-test before and after the periods of their bedside practice during psychiatric nursing. The results obtained were as follows; 1. The awareness structure of the nursing students was composed of 6 factors, that is, anxiety and detestation factor, understanding and acceptance factor, social alienation factor, denial factor, affirmation factor and closed society factor. 2. The changes in their awareness were observed before and after the periods of bedside practice. 3. The STAI-test showed that the nursing students frequently complained of anxiety before the bedside practice because they had only studied about the psychoses. 4. The nursing students who had strong anxiety also showed a deep fear and detestation. 5. Some nursing students who had had a deep anxiety before the bedside practice found their anxiety reduced because of the direct contact with psychotic patients. 6. Although the nursing students had psychological stress, they were also interested in the psychiatric nursing.

[Effect of warm bathing on blood pressure in bedridden patients]

The effects of warm bathing on short-term and circadian rhythms for blood pressure (BP), pulse rate (PR), and endocrine function were studied in 10 bed-ridden patients (5 men and 5 women; age 78.9 +/- 10.5 years old) hospitalized in Nomura Municipal Hospital. The results indicated a transient elevation of BP with bathing and its rapid fall after bathing. Compared with the days when patients did not take bath, systolic BP was significantly lower for 12 to 16 hours (p < 0.005) after bathing and diastolic BP was also significantly lower during 8 to 12 hours (p < 0.01), 12 to 16 hours (p < 0.001) and 20 to 24 hours (p < 0.001). The PR was significantly higher from 0 to 4 hours after bathing (p < 0.01), but became significantly lower during 8 to 12 hours (p < 0.001) and 12 to 16 hours (p < 0.001). Plasma renin activity increased significantly after bathing (p < 0.05). Thus, the effects of bathing in lowering BP of bedridden patients in stable condition may continue for several hours after bathing.

[Relation between atherosclerotic risk factors and abdominal wall fat thickness]

We used ultrasonography to assess the accumulation of visceral fat and its relation to known risk factors for atherosclerotic disease, and examined its relation with atherotic changes in the common carotid artery. The subjects were 315 consecutive inpatients (173 men, 142 women; mean age, 68.3 years) hospitalized during a 21-month period. Those with a history of epigastric surgery or nutrition disorders that might affect fat thickness were excluded. A 7.5-MHz transducer was used to evaluate the maximum thickness of preperitoneal fat (Pmax) at the anterior surface of the liver, and the minimum thickness of subcutaneous fat (Smin) of the abdomen. The fat/height ratio was calculated. Age, gender, smoking status, blood pressure, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, atherogenic index ((total cholesterol-HDL-cholesterol)/HDL-cholesterol), blood sugar, serum insulin, and uric acid were examined as confounders. Pmax/height was found to be related to systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol and atherogenic index, and was positively associated with the thickness of the common carotid arterial wall. Pmax/height may be a useful means to evaluate known risk factors for atherosclerotic disease.

Double cancer of the stomach, one AFP-producing tumor

In recent years, many cases of alpha-fetoprotein-producing gastric cancer (AFPGC) characterized by increased serum levels of alpha-fetoprotein (AFP) and AFP positivity of the gastric cancer have been reported. Here we present a case of AFPGC coexistent with a different histological type of gastric cancer: The AFPGC was Borrmann type 1 advanced gastric cancer with multiple liver metastasis and appeared to produce both AFP and des-gamma-carboxy prothrombin (PIVKA-II). The second cancer was IIc type early gastric cancer and did not produce AFP. Despite receiving palliative chemotherapy, the patient died, due to hepatic failure, 45 days after admission.

[Risk factors related to the wall thickness of the common carotid artery in elderly patients]

We used ultrasonography to evaluate atherosclerotic lesions in the common carotid arteries of 147 inpatients (82 men, 65 women; mean age, 72.2 years). We sought to determine the relation between these lesions and various risk factors for atherosclerosis, as well as the utility of ultrasonography in quantitative evaluation of atherosclerotic disease. A 7.5 MHz transducer was used and atherosclerotic lesions were evaluated on the basis of the thickness of their intimal-medial complex, which we term wall thickness. The relations between these measurements and age, sex, blood pressure, smoking history, lipid metabolism, diabetes mellitus, and atherosclerotic disease were studied. Wall thickness of the common carotid arteries correlated with age (men: r = 0.45; women: r = 0.38). Brinkman Index (r = 0.25), systolic blood pressure (r = 0.44), diastolic pressure (r = 0.18), and high-density lipoprotein cholesterol (HDL-C, r = -0.23). Multiple regression analysis with these risk factors as explanatory variables showed that age, Brinkman Index, systolic blood pressure, HDL-C, and diabetes mellitus contributed significantly to increased wall thickness. Wall thickness was significantly greater in patients with atherosclerotic disease such as cerebral infarction and ischemic heart diseases. These findings indicate that appropriate treatment for multiple atherosclerotic risk factors may be necessarily in the elderly.

[Health problems of elderly patients in a rural area]

The purpose of this study was to identify diseases frequently found in elderly populations in rural areas as well as to discuss the role of geriatric physicians in medical care for elderly patients. The study was conducted using ICHPPC-2-Defined (Japan version) which had been compiled by WONCA for the classification of diseases. The acute health problems treated by the clinic consisted of 183 types (2070 items) in 1916 patients seen during 19 months compared to 66 types of chronic problems consisting of 505 items in 179 patients. The most frequent acute complaints and health problems were acute infections of the upper respiratory tract, followed by diseases of the stomach and duodenum, then osteoarthritis and allied conditions. The most common chronic health problems were uncomplicated hypertension, osteoarthritis and allied conditions, osteoporosis, lipid metabolism disorders, complicated hypertension, cataract, and various other illnesses extending over all specialties of medicine. Geriatric physicians are required to have broad and multidisciplinary knowledge and skill to provide comprehensive and continual medical care for elderly patients in rural areas.

[Studies on "acid red standard" for the dye standard of the National Institute of Hygienic Sciences]

The "Acid Red Standard (C.I. 45100)" for the Dye Standard of the National Institute of Hygienic Sciences was prepared. The content of this Dye Standard determined by the titanium trichloride method was 96.4% on the average. The ultraviolet-visible absorption and infrared spectra of the Dye Standard were also measured.

[Studies on "new coccine standard" for the dye standard of the National Institute of Hygienic Sciences]

The "New Coccine Standard (C.I. 16255)" for the Dye Standard of the National Institute of Hygienic Sciences was prepared. The content of this Dye Standard determined by the titanium trichloride method was 97.5% on the average. The ultraviolet-visible absorption and infrared spectra of the Dye Standard were also measured.

[Studies on "indigo carmine standard" for the dye standard of the National Institute of Hygienic Sciences]

The "Indigo Carmine Standard (C.I. 73015)" for the Dye Standard of the National Institute of Hygienic Sciences was prepared. The content of this Dye Standard determined by the titanium trichloride method was 97.0% on the average. The ultraviolet-visible absorption and infrared spectra of the Dye Standard were also measured.

[Estimated production of coal-tar dyes (including dye aluminum lakes) based on official inspections in 1991]

The total number of official inspection of coal-tar dyes and their lakes from April in 1991 to March 1992 was 835. The quantity which passed inspection amounted to 240 tons in Japan. The official production of color dyes each month in summarised in Table 1 and that by various manufacturers in Table 2. The food coal-tar dye produced in the largest quantity was Food Yellow No. 4, occupying 44.6% of the total during this period.

[Studies on "Tartrazine Standard", Dye standards of National Institute of Hygienic Sciences]

"Tartrazine Standard (C.I. 19140)", Dye Standards of National Institute of Hygienic Sciences, was prepared. The content of this Dye Standard was determined by the titanium trichloride method. This contents averaged 99.0%. Ultra violet-visible absorption and infrared spectra of the Dye Standard were also determined.

[Estimated production by the official inspection of coal-tar dyes (including dye aluminum lakes) in 1990 based on official inspection figures]

The number of official inspections of coal-tar dyes and their lakes from april in 1990 till march in 1991 was 836 in total. The quantity passed amounted to 238 ton in Japan. The production of color for each month was summarised in Table 1, and by each producing company in Table 2. The food coal-tar dye produced in the largest quantity was Food Yellow No. 4, occupying 46.2% in this period.

[Studies on "Erythrosine Standard", Dye Standards of National Institute of Hygienic Sciences]

"Erythrosine Standard (C.I. 45430)", Dye Standards of National Institute of Hygienic Sciences, was prepared. The content of this Dye Standard was determined by the gravimetric method. This content averaged 99.1%. Ultra violet-visible absorption and infrared spectra of the Dye Standard were also determined.

[Studies on "brilliant blue FCF standard", dye standards of National Institute of Hygienic Sciences]

"Brilliant Blue FCF Standard (C.I. 42090)", Dye Standards of National Institute of Hygienic Sciences, was prepared. The content of this Dye Standards was determined by titanium trichloride method. This content averaged 96.3%. Ultra violet-visible absorption and infrared spectra of the Dye Standard were also determined.

[Studies on "allura red AC standard", dye standards of National Institute of Hygienic Sciences]

"Allura Red AC Standard (C.I. 16035)", Dye Standards of National Institute of Hygienic Sciences was prepared. The content of this Dye Standards was determined by the titanium trichloride method. This content averaged 95.5%. Ultra violet-visible absorption and infrared spectra of the Dye Standard were also determined.