臨床所見および検査成績からのスコアーによる喘息分類の特徴

Twenty six patients with bronchial asthma was classified by clinical symptoms and singns (clinical diagnosis), and the classification by clinical diagnosis was compared with the classification by a score calculated from clinical findings and examinations (score diagnosis). 1. Of 12 subjects with type Ia classified by clinical diagnosis, 8 cases with 0 to 49 ml/day of expectoration were evaluated as type Ia by score diagnosis. While four type Ia cases with 50 to 99ml/day of expectoration were calssified as type Ib by score diagnosis. The increased incidence of eosinophils in bronchoalveolar lavage fluid (BALF) of these four cases was similar to the incidence in type Ib cases with hypersecretion. 2. All of 6 subjects with type Ib by clinical diagnosis were estimated as type Ib by score diagnosis. 3. Of 8 cases with type II by clinical diagnosis, 7 cases were assessed as type II by score diagnosis. One case with type II by clinical diagnosis and with the score of 10 points was evaluated as questionable type II by score diagnosis.気管支喘息36例を対象に,臨床病態による喘息の分類（臨床診断）を試み,この分類と臨床所見および臨床検査より求めたスコアーによる分類（スコアー分類）との比較検討を行った｡1.臨床分類でIa.単純性気管支攣縮型と診断された12症例のうち,1日喀痰量0-49mlの8症例は,スコアー分類では同様にIa.型と分類された｡一方,1日喀痰量50-99mlの4症例はスコアー分類ではIb.型（気管支攣縮+過分泌型）と分類された｡これら4症例のBALF中好酸球増多はIb.型に類似した病態であった｡2.臨床診断によりIb.型に分類された6症例はいずれもスコアー診断でもIb.型と分類された｡3.臨床診断によりII.型（細気管支閉塞型）と分類された8症例のうち,7症例はスコアー診断でもII.型と分類されたが,1症例はスコアー10でII.型の診断基準に合わず,questionable II.型と診断された

Total synthesis of TMG-chitotriomycin based on an automated electrochemical assembly of a disaccharide building block

The total synthesis of TMG-chitotriomycin using an automated electrochemical synthesizer for the assembly of carbohydrate building blocks is demonstrated. We have successfully prepared a precursor of TMG-chitotriomycin, which is a structurally-pure tetrasaccharide with typical protecting groups, through the methodology of automated electrochemical solution-phase synthesis developed by us. The synthesis of structurally well-defined TMG-chitotriomycin has been accomplished in 10-steps from a disaccharide building block

老令者の気管支喘息,各臨床病型における換気機能の特徴

Ventilatory function was examined in 20 elderly patients with bronchial asthma in relation to clinical asthma types, and the results were compared with those of younger asthmatics. 1. Ventilatory parameters such as FEV(1.0%), % PEFR, % MMF, % V(50) and % V(25), which repressent obstructive ventilatory dysfunction, were in general lower in older asthmatics than in the youger cases. 2. The values of % V(50) and % V(25), representing ventilatory dysfunction in small airways, were significantly lower in the older subjects with type Ib and II compared to the younger cases with same types. 3. Markedly decreased values in ventilatory parameters, particularly in % MMF, % V(50) and　% V(25) were observed in both older and younger subjects with type II. The results suggest that ventilatory function decreases with aging and the decrease is related to the pathophysiological changes in the airways.60才以上の老年気管支喘息20例(平均年令;66.7才)を対象に,その換気機能について,臨床病態別に59才以下の症例(平均年令;44.9才)との比較検討を行った｡1.FFV(1.0%), % PEFR, % MMF, % V50, % V25などの閉塞性換気障害を表すパラメーターは,59才以下の症例に比べ老年症例で全般的に低い傾向が見られた｡2.小ないし細気管支領域の換気榛能を反映すると考えられる% V(50)および% V(25)は,Ib型およびII型喘息を示す老年症例において,59才以下の症例に比べ,有意に低い値を示した｡3.II型喘息症例では,59才以下および老年症例のいずれにおいても, %　MMF, % V(50)および% V(25)は他の臨床病型にくらべ著明に低い値を示した｡これらの結果は,気管支喘息における換気機能は,加令とともに低下傾向を示すこと,そしてその低下は臨床病態と関連していることを示しているものと考えられた

日本の百寿者及び非百寿者における死亡前1年間に発生する医療費の比較

Importance: Although research has shown that centenarians tend to experience shorter periods of serious illness compared with other age groups, few studies have focused on the medical expenditures of centenarians as a potential indicator of the scale of medical resources used in their last year of life. Objective: To compare Japanese centenarians' and noncentenarians' monthly medical expenditures during the year before death according to age and sex. Design, setting, and participants: This retrospective cohort study used linked national health and long-term care insurance data collected from April 2013 to March 2018 in Nara Prefecture, Japan, for residents aged 75 years or older who were insured under the Medical Care System for older adults and died between April 2014 and March 2018. Data were analyzed from April 2013 to March 2018. Exposures: Age of 100 years or older (centenarians) vs 75 to 99 years (noncentenarians). Main outcomes and measures: The numbers of unique inpatients and outpatients and medical expenditures related to decedents' hospitalization and outpatient care were extracted and analyzed based on sex and age group. The Jonckheere-Terpstra test was used to identify trends in unadjusted medical expenditures by age group, and generalized estimating equations were used to estimate monthly median expenditures by age group with adjustment for comorbidity burden and functional status. Results: Of 34 317 patients aged 75 to 109 years (16 202 men [47.2%] and 18 115 women [52.8%]) who died between April 2014 and March 2018, 872 (2.5%) were aged 100 to 104 years (131 men [15.0%] and 741 women [85.0%]) and 78 (0.2%) were aged 105 to 109 years (fewer than 10 were men). The analysis of unadjusted medical expenditures in the last year of life showed a significant trend of lower expenditures for the older age groups; the median adjusted total expenditures during the 30 days before death by age group were $6784 (IQR,$4884-$9703) for ages 75 to 79 years,$5894 (IQR, $4292-$8536) for 80 to 84 years, $5069 (IQR,$3676-$7150) for 85 to 89 years,$4205 (IQR, $3085-$5914) for 90 to 94 years, $3522 (IQR,$2626-$4861) for 95 to 99 years,$2898 (IQR, $2241-$3835) for 100 to 104 years, and $2626 (IQR,$1938-$3527) for 105 to 109 years. The proportion of inpatients among all patients in the year before death also decreased with increasing age: 4311 of all 4551 patients aged 75 to 79 years (94.7%); 43 of all 78 patients aged 105 to 109 years (55.1%); 2831 of 2956 men aged 75 to 79 years (95.8%); 50.0% of men aged 105 to 109 years (the number is not reported owing to the small sample size); 1480 of 1595 women aged 75 to 79 years (92.8%); and 55.7% of women aged 105 to 109 years (the number of women is not reported to prevent back-calculation of the number of men). Specifically, 274 of 872 patients aged 100 to 104 years (31.4%) and 35 of 78 patients aged 105 to 109 years (44.9%) had not been admitted to a hospital in the year before death. Conclusions and relevance: This cohort study found that medical expenditures in the last year of life tended to be lower for centenarians than for noncentenarians aged 75 years or older in Japan. The proportion of inpatients also decreased with increasing age. These findings may inform future health care services coverage and policies for centenarians.博士（医学）・甲第801号・令和3年12月21日© 2021 Nakanishi Y. et al.JAMA Network Open. Open Access: This is an open access article distributed under the terms of the CC-BY License(https://creativecommons.org/licenses/by/4.0/)

Correlations between bone mineral density measured by QCT and risk factors of Osteoporosis

27～85才の女性143例における骨塩量を,定量的QCT法 (quantitative computed tomography)を用いて測定し,年令,身長,体重及び原疾患(慢性関節リウマチ),使用薬剤(ステロイド･骨強化剤)の因子の骨塩量に及ぼす影響について検討した｡その結果,1)加令とともに骨塩量は低下するが,特に40才代後半から60才代にかけての低下が顕著であり,また, 他因子の影響を受けやすい｡2)体型的因子としては.痩せ型で低身長の人に低値の傾向がある｡3)ステロイド使用の有無における検討において,特に50才代で使用群が著明に低値であることが明らかとなった｡また,薬剤の因子の考察に関しては,さらに経時的検討か必要であると思われた｡Bone mineral density (BMD) was measured in 143 females aged 27 to 85 years old to investigate the correlations between BMD and several factors such as age, height, presence of rheumatoid arthritis and corticosteroid or bone intensifying drug therapy. 1) BMD values decreased with aglng and the most remarkable decrease was observed at the age of latter half of 40's to 60's. 2) Women with slim and low stature tended to have low BMD values. 3) BMD values of women with steroid therapy were significantry lower than those without corticosteroid at the age of 50's (p<0.01). However, further study is necessary to confirm the effect of drugs on BMD

Relationship of household salt intake level with long-term all-cause and cardiovascular disease mortality in Japan: NIPPON DATA80.

In Asian countries, a major source of salt intake is from seasoning or table salt added at home. However, little is known about the adverse effects of salt intake evaluated according to household unit. We investigated the relationship between household salt intake level and mortality from all-cause and cardiovascular diseases (CVDs). Participants included 8702 individuals (56% women) who were living with someone else and who were aged 30-79 years and enrolled in the National Nutritional Survey of Japan in 1980 with a 24-year follow-up. Household nutrient intake was evaluated using a 3-day weighing record method in which all foods and beverages consumed by any of the household members were recorded. The household salt intake level was defined as the amount of salt consumed (g) per 1000 kcal of total energy intake in each household, and its average was 6.25 (2.02) g/1000 kcal. During the follow-up, there were 2360 deaths (787 CVD, 168 coronary heart disease [CHD], and 361 stroke). Cox proportional hazard ratios (HRs) for an increment of 2 g/1000 kcal in household salt intake were calculated and adjusting for sex, age, body mass index, smoking status, alcohol consumption status, self-reported work exertion level, household potassium intake, household saturated fatty acid intake, and household long-chain n-3 polyunsaturated fatty acid intake. The HRs (95% confidence intervals) were 1.07 (1.02, 1.12) for all-cause mortality, 1.11 (1.03, 1.19) for CVD, 1.25 (1.08, 1.44) for CHD, and 1.12 (1.00, 1.25) for stroke. The household salt intake level was significantly associated with long-term risk of all-cause, CVD, CHD, and stroke mortality in a representative Japanese population

Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese: a 24-year follow-up of NIPPON DATA80

Background:Dietary intake of long-chain n-3 PUFA (LCn3FA) among Japanese is generally higher than that in Western populations. However, little is known whether an inverse association of LCn3FA with cardiovascular disease (CVD) risk exists in a population with higher LCn3FA intake.Objective:To investigate the association between LCn3FA intake and the long-term risk of CVDs in a Japanese general population.Methods:We followed-up a total of 9190 individuals (56.2% women, mean age 50.0 years) randomly selected from 300 areas across Japan and free from CVDs at baseline. Dietary LCn3FA intake was estimated using household weighed food records. Cox models were used to calculate multivariate-adjusted hazard ratios (HR) and confidence intervals (CI) according to sex specific quartiles of LCn3FA intake.Results:During 24-year follow-up (192,897 person-years), 879 cardiovascular deaths were observed. The median daily intake of LCn3FA was 0.37% kcal (0.86 g/day). Adjusted HR for CVD mortality was lower in the highest quartile of LCn3FA intake (HR 0.80; 95% CI 0.66-0.96) compared with the lowest quartile, and the trend was statistically significant (P = 0.038). The similar but statistically non-significant trends were observed for coronary heart disease death and stroke death. In analyses by age groups, the inverse associations of LCn3FA intake with the risk of total CVD death and stroke death were significant in younger individuals (30-59 years at baseline).Conclusion:LCn3FA intake was inversely and independently associated the long-term risk of total CVD mortality in a representative sample of Japanese with high LCn3FA intake

Association between socioeconomic status and physical inactivity in a general Japanese population: NIPPON DATA2010.

Background:Lower socioeconomic status (SES) may be related to inactivity lifestyle; however, the association between SES and physical inactivity has not been sufficiently investigated in Japan.Methods:The study population is the participants of NIPPON DATA2010, which is a prospective cohort study of the National Health and Nutrition Survey 2010 in Japan. They were residents in 300 randomly selected areas across Japan. This study included 2,609 adults. Physical activity was assessed by physical activity index (PAI) calculated from activity intensity and time. The lowest tertile of PAI for each 10-year age class and sex was defined as physical inactivity. Multivariable logistic regression analyses were conducted to examine the association of SES (employment status, educational attainment, living status, and equivalent household expenditure (EHE)) with physical inactivity.Results:In the distribution of PAI by age classes and sex, the highest median PAI was aged 30-39 years among men (median 38.6), aged 40-49 years among women (38.0), and median PAI was decreased with increasing age. Multivariable-adjusted model shows that not working was significantly associated with physical inactivity after adjustment for age in all age groups and sexes. Not living with spouse for adult women and elderly men was significantly associated with physical inactivity compared to those who living with spouse. However, neither educational attainment nor EHE had any significant associations with physical inactivity.Conclusions:The result indicated that physical inactivity was associated with SES in a general Japanese population. SES of individuals need to be considered in order to prevent inactivity lifestyle