Coronary artery spasm—Clinical features, diagnosis, pathogenesis, and treatment

SummaryCoronary (artery) spasm plays an important role in the pathogenesis of ischemic heart disease, including stable angina, unstable angina, myocardial infarction, and sudden death. The prevalence of coronary spasm differs among populations, is higher in Japan and Korea than in the Western countries probably due to genetic as well as environmental factors. Coronary spasm occurs most often from midnight to early morning and is usually not induced by exercise in the daytime. The attacks of coronary spasm are associated with either ST segment elevation or depression, or negative U wave on ECG. Patients with multi-vessel coronary spasm may suffer from lethal arrhythmia, including advanced AV block, ventricular tachycardia or fibrillation, or even sudden death, and they are often resistant to conventional medical therapy including Ca-channel blockers (CCBs). Endothelial nitric oxide (NO) activity is reduced and markers of oxidative stress are elevated in patients with coronary spasm. Thrombogenesis is enhanced and plasma levels of hsCRP and P-selection are elevated in patients with coronary spasm. Thus, patients with coronary spasm have endothelial dysfunction and are suffering from a low-grade chronic inflammation. Polymorphisms of endothelial NO synthase, smoking, and low-grade inflammation are the most important risk factors for coronary spasm. Coronary spasm is a hyper-contraction of coronary smooth muscle triggered by an increase of intracellular Ca2+ in the presence of an increased Ca2+ sensitivity. It has been shown that RhoA/ROCK pathway is involved in Ca2+ sensitivity and that the reduced endothelial NO activity results in increased Ca2+ sensitivity through enhanced RhoA/ROCK pathway. Accordingly, it is possible that in addition to CCBs, RhoA/ROCK pathway blockers may prove to be useful for the treatment of coronary spasm

Repair of olecranon fractures using fiberWire without metallic implants: report of two cases

Olecranon fractures are a common injury in fractures. The tension band technique for olecranon fractures yields good clinical outcomes; however, it is associated with significant complications. In many patients, implants irritate overlying soft tissues and cause pain. This is mostly due to protrusion of the proximal ends of the K-wires or by the twisted knots of the metal wire tension band. Below we described 2 cases of olecranon fractures treated with a unique technique using FiberWire without any metallic implants. Technically, the fragment was reduced, and two K-wires were inserted from the dorsal cortex of the distal segment to the tip of the olecranon. K-wire was exchanged for a suture retriever, and 2 strands of FiberWire were retrieved twice. Each of the two FiberWires was manually tensioned and knotted on the posterior surface of the olecranon. Bony unions could be achieved, and patients had no complaint of pain and skin irritation. There was only a small loss of flexion and extension in comparison with that of the contralateral side, and the patient did not feel inconvenienced in his daily life. Using the method described, difficulty due to K-wire or other metallic implants was avoided

Worldwide Trends of Dioxin Levels in Human Breast Milk With Comparison between Toyama Prefecture in Japan and Other Areas

金沢大学大学院自然科学研究科金沢医科大学金沢大学大学院医学系研究科Scedule:17-18 March 2003, Vemue: Kanazawa, Japan, Kanazawa Citymonde Hotel, Project Leader : Hayakawa, Kazuichi, Symposium Secretariat: XO kamata, Naoto, Edited by:Kamata, Naoto

Seventeen-Year Observation on Urinary Cadmium and β2-Microglobulin in Inhabitants After Cessation of Cadmium-Exposure in Japan

金沢大学大学院医学系研究科保健看護科学専攻金沢大学医薬保健研究域保健学系The purpose of this study was to clarify the change and relationship of urinary cadmium (Cd) and β2-microglobulin (β2-MG) concentrations of inhabitants in Cd-polluted areas after soil restoration. The urinary Cd and β2-MG concentrations of 25 males and 28 females did not show a significant change, 22 years after the Cd-polluted soil was restored. Once exposed to Cd, it was found to remain in the body, 22 years after the Cd -polluted soil was restored. However, this did not influence renal tubular dysfunction in most of the younger generation compared with elders heavily exposed to Cd. © 2010 Springer Science+Business Media, LLC

血清ペプシノゲン検査に基づく胃がん発生率と有効性に関する15年間のコホート研究

Objectives : The incidence of and mortality from gastric cancer in Japan have remained high and prophylaxis is important. However, the number of the individuals undergoing gastric mass radiography has decreased in recent years because the examination has a big burden at the time of the consultation. Many studies have reported the ease and effectiveness of the pepsinogen test and a higher incidence of gastric cancer in positive groups. However, the longest survey period was 10 years. Therefore, we conducted a 15-year cohort study to examine the validity of the testing period and the incidence of gastric cancer in serum pepsinogen positive and negative groups at a private company utilizing pepsinogen test. Methods : Subjects were 4383 employees who received a pepsinogen test. Subjects were followed for 15 years. For the purpose of examining the three periods over five-, 10-, and 15-year periods, we analyzed the validity of testing during each period, carried out a log-rank test, and analyzed hazard ratio in the Cox proportional hazard model. Results : The number of individuals who developed gastric cancer during the survey was nine in the five-year negative group, 18 in the five-year positive group, 16 in the 10-year negative group, 27 in the 10-year positive group, 31 in the 15-year negative group, and 29 in the 15-year positive group. The sensitivity of testing was 0.667 over the first five years, 0.628 over 10 years, and 0.483 over 15 years, and the specificity was 0.744 over the first five years, 0.745 over 10 years, and 0.745 over 15 years. The five-year incidence of gastric cancer was 57 per 100,000 person years in the negative group and 350 per 100,000 person years in the positive group. The ten-year incidences were 53 per 100,000 person years in the negative group and 279 per 100,000 person years in the positive group. The 15-year incidence was 75 per 100,000 person years in the negative group and 231 per 100,000 person years in the positive group. The hazard ratio of the positive group toward the negative group was 4.98 over the first five years, 4.71 over 10 years, and 2.76 over 15 years (p＜0.001). Conclusions : This study clarified that the first five years after the testing showed the highest hazard ratio and validity, therefore, the validity of testing was approximately 10 years. 【目的】我が国の胃がんの死亡率及び罹患率は現在も上位であり、その予防対策は重要で ある。けれども、近年X線の胃集団検診の受診者は、受診時の負担が大きいことから減少 している。一方職域の胃がん予防対策は、法的義務が無いため、企業により様々であるが 地域同様減少している。多くの先行研究では、血清ペプシノゲン検査法が簡便で有益とし ており、陽性群に発症率が高いとしているが、調査期間は最長10年であり、15年間の調査 はなかった。そこで、一企業において15年間の“陽性群”と“陰性群”での発症率の違い と検査の有効性の期間を検討することを目的にコホート調査を行った。 【方法】ペプシノゲン検査を受診した4,383名を15年間追跡した。５年間、10年間、15年間の ３期間に区切って各期間の検査の有効性を算出し、発症率をLog-rankで検定し、発症危険 度をCox比例ハザードで分析した。 【結果】追跡期間中に陰性群と陽性群のそれぞれの胃がん発症数は、５年間で９人と18人、 10年間で16人と27人、15年間で31人と29人であった。検査の感度は５年間で0.667、10年間 で0.628、15年間で0.483であり、特異度は、５年間で0.744、10年間で0.745，15年間で0.745 であった。発症率では、５年間の陰性群と陽性群で57、350per 100,000 person yearsであり、 10年では53、279 per 100,000 person years であり、15年では 75、231 per 100,000 person yearsであった。陰性群に対する陽性群の発生危険度は、５年間4.98、10年間4.71、15年間 2.76であった (p＜0.001)。 【結論】胃がんの発症率及び発症危険度や検査の有効性が最も高かったのは、2000年まで の５年間であり、検査の有効性は、約10年であることが明らかになった。Thesis of Takami Okuno / 奥野 敬生 博士論文 金沢大学医薬保健学総合研究科（保健学専攻

日本人男性海外勤務者の精神的健康度と職業関連要因との関係

目的：海外勤務者の精神的健康度と職業関連要因の関係と日本国内勤務者の精神的健康度の違いを明らかにすることである。方法：同一の金属製品製造業に勤務する男性海外勤務者450名と男性日本国内勤務者683名を対象に自記式質問紙調査を行った。精神的健康度は日本版気分プロフィール検査を用いて評価した。 結果：日本国内と海外勤務者の精神的健康度の比較では、34－39歳において海外勤務者が日本国内より低く、40代と50代では海外勤務者が日本国内より高かった。 　ロジスティック重回帰分析の結果、精神的健康度の不良に関連していたものは、ヨーロッパに対して東アジア（e.g. オッズ比 : 7.548, 95%信頼区間［以下CI］: 2.912－22.293［抑うつ－落込み〔以下D〕］）、東南・南アジア（e.g. オッズ比 : 4.675, 95% CI : 1.679－14.433［D］）、北米（e.g. オッズ比 : 3.997, 95% CI : 1.495－11.895［D］）。管理職に対してエンジニア（e.g. OR : 2.328, 95% CI : 1.168－4.679［緊張－不安〔以下T－A〕］）と生産管理（OR: 5.268, 95% CI : 1.520－18.013［T－A］）。労働時間10－11時間未満に対して12－13時間未満（e.g. OR : 2.063, 95% CI : 1.007－4.283［D］）、13時間以上（e.g. OR : 2.651, 95% CI :1.227－5.814［D］）。休日日数 8 日以上に対して 5 日未満（e.g. OR : 2.285, 95% CI : 1.276－4.129［疲労〔以下F〕］）、5－7日以下（e.g. OR : 2.219, 95% CI: 1.246－4.000［F］）であった。結論：海外勤務者の精神保健対策は、地域別ではアジア圏特に東アジア、職種ではエンジニアや生産管理を中心に取り組んでいく必要がある。また実労働時間が12時間を超える者や休日日数が7日以下の者には、就労時間の制限や休日日数を 8 日以上確保することも対策として考えられた。Objectives : The aim of this study was to clarify the relationship between the mental-health status of overseas employees and work-related factors, and also to determine the difference between the mental-health status of these employees and their counterparts in Japan. Method : Four hundred and fifty male overseas employees and 683 male employees in Japan were surveyed using a self-assessment questionnaire, namely the Japanese version of the Profile of Mood States, which is used to assess mental-health status. Result: The mental-health status of overseas employees in the age range 34－39 years was worse, and that for those in their forties and fifties better, than those o employees in Japan. A multiple logistic regression analysis showed that employees in East Asia Southeast & South Asia and North America were positively associated with poor ental-health status compared with employees in Europe (e.g. odd ratio [OR] : 7.548, 95% confidence interval [CI] : 2.912－22.293, OR : 4.675, 95% CI : 1.679－14.433 and OR: 3.997, 95% CI : 1.495－11.895 in depression/dejection, respectively). Engineers and production controllers were positively associated with poor mental-health status compared with those in managerial posts (e.g. OR : 2.328, 95% CI : 1.168－4.679 and OR : 5.268, 95% CI : 1.520－18.013 in tension/anxiety, respectively). As regards average daily working hours, those employees working for between 12 and less than 13 hours and 13 hours or more were positively associated with poor mentalhealth status compared with those working for between 10 and less than 11 hours (e.g. OR : 2.063, 95% CI : 1.007－4.283 and OR : 2.651, 95% CI : 1.227－5.814 in depression/dejection, respectively). In terms of number of days’ holiday in the last month, those employees who had taken less than five days and between five days and seven days were positively associated with poor mental-health status comparison with those who had taken eight days or more (e.g. OR : 2.285, 95% CI : 1.276－4.129 and OR : 2.219, 95% CI : 1.246－4.000 in fatigue, respectively). Conclusion : Mental-health protection measures in overseas bases need to focus on Asia, especially East Asia and employees who work as engineers or production controllers. Furthermore, average daily working hours should be shortened as much as possible and employees should take at least eight days’ holiday per month

J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes: An 8-year follow-up of relatively lean Japanese individuals

金沢大学医薬保健研究域医学系金沢医科大学健康増進予防医学（公衆衛生学）Aims This study investigated the relationship between waist circumference and the subsequent incidence of Type 2 diabetes and the association with insulin resistance and pancreatic B-cell function in relatively lean Japanese individuals. Methods The study participants were 3992 employees (2533 men and 1459 women, aged 35-55 years) of a metal-products factory in Japan. The incidence of diabetes was determined in annual medical examinations during an 8-year follow-up. We calculated age- and sex-adjusted hazard ratios (HRs) according to the sex-specific quintile of waist circumference at baseline. Differences in baseline insulin resistance [homeostatis model assessment (HOMA)-IR] and pancreatic B-cell function (HOMA-B) were compared between participants who developed diabetes and those who did not. Results During the follow-up, 218 participants developed diabetes. Age- and sex-adjusted HRs across the quintiles of waist circumference were 1.78, 1.00 (reference), 1.59, 3.11 and 3.30, respectively (P for trend, < 0.0001). The HR for the lowest quintile was significantly higher than that for the second quintile. Among participants with waist circumference of the lowest quintile, HOMA-B was lower in those who developed diabetes than in those who did not [33.1 (24.1-45.0) vs. 54.3 (37.9-74.6) median (interquartile range), P < 0.0001], but HOMA-IR did not differ between these groups. Conclusions There was a J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes in relatively lean Japanese individuals; lower pancreatic B-cell function may also increase the risk of diabetes in very lean Japanese people. © 2009 Diabetes UK