A critical review of health services in Japan

Japan was the first Asian country to introduce social insurance measures and it has expanded them during the last few decades. The first social insurance law was passed in 1922, dealing with worker's health insurance, and it was followed by the National Health Insurance in 1938, Seamen's Insurance in 1939, and Employees' Pension Insurance in 1921. However, these were seldom widely available in actual practice because of the characteristics of public assistance which limited them to the poor.</p

An approach to teaching a computer programming language

The 9th World Conference on Continuing Engineering Education, WCCEE 2004, slides ; Place : Tokyo, Japan ; Date : May 16-19, 200

Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure

BACKGROUND: Polypharmacy is a common problem among patients with acute decompensated heart failure (ADHF) who often have multiple comorbidities. OBJECTIVE: The aim of this study was to define the number of medications at hospital discharge and whether it is associated with clinical outcomes at 1 year. METHODS: We evaluated the number of medications in 2578 patients with ADHF who were ambulatory at hospital discharge in the Kyoto Congestive Heart Failure Registry and compared 1-year outcomes in 4 groups categorized by quartiles of the number of medications (quartile 1, ≤ 5; quartile 2, 6-8; quartile 3, 9-11; and quartile 4, ≥ 12). RESULTS: At hospital discharge, the median number of medications was 8 (interquartile range, 6-11) with 81.5% and 27.8% taking more than 5 and more than 10 medications, respectively. The cumulative 1-year incidence of a composite of death or rehospitalization (primary outcome measure) increased incrementally with an increasing number of medications (quartile 1, 30.8%; quartile 2, 31.6%; quartile 3, 39.7%; quartile 4, 50.3%; P < .0001). After adjusting for confounders, the excess risks of quartile 4 relative to those of quartile 1 remained significant (P = .01). CONCLUSIONS: In the contemporary cohort of patients with ADHF in Japan, polypharmacy at hospital discharge was common, and excessive polypharmacy was associated with a higher risk of mortality and rehospitalizations within a 1-year period. Collaborative disease management programs that include a careful review of medication lists and an appropriate deprescribing protocol should be implemented for these patients

Impact of left ventricular ejection fraction on the effect of renin-angiotensin system blockers after an episode of acute heart failure: From the KCHF Registry

Objective: This observational study aimed to examine the prognostic association of angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARB) in different left ventricular ejection fraction (LVEF) categories. Methods: In 3717 patients enrolled in the KCHF Registry, a multicentre registry including consecutive patients hospitalized for acute heart failure (HF), we assessed patient characteristics and association between ACE-I/ARB and clinical outcomes according to LVEF. In the three LVEF categories (reduced LVEF [HFrEF], mid-range LVEF [HFmrEF] and preserved LVEF [HFpEF]), we compared the patients with ACE-I/ARB as discharge medication and those without, and assessed their 1-year clinical outcomes. We defined the primary outcome measure as a composite of all-cause death and HF hospitalization. Results: The 1-year cumulative incidences of the primary outcome measure were 36.3% in HFrEF, 30.1% in HFmrEF and 33.8% in HFpEF (log-rank P = 0.07). The adjusted risks of the ACE-I/ARB group relative to the no ACE-I/ARB group for the primary outcome measure were significantly lower in HFrEF and HFmrEF (HR 0.66 [95%CI 0.54–0.79], P<0.001, and HR 0.61 [0.45–0.82], P = 0.001, respectively), but not in HFpEF (HR 0.95 [0.80–1.14], P = 0.61). There was a significant interaction between the LVEF category and the ACE-I/ARB use on the primary outcome measure (Pinteraction = 0.01). Conclusions: ACE-I/ARB for patients who were hospitalized for acute HF was associated with significantly lower risk for a composite of all-cause death and HF hospitalization in HFrEF and HFmrEF, but not in HFpEF. ACE-I/ARB might be a potential treatment option in HFmrEF as in HFrEF

Record of Cryptopsara couesii GILL (Lophiiformes: Ceratiidae) from off-Kume Island, Ryukyu Islands, Western Japan

深層水取水施設にはしばしば深海生物が迷入するので,深海生物研究の定点観測施設としての意義もある。このたび,深海魚の一種であるミツクリエナガテョウチンアンコウが沖縄県深層水研究所(久米島)で採取された。この深層水取水施設の取水口は久木島沖の東シナ海,水深612mにある。ミツクリエナガチョウチンアンコウの分布域にはまだ不明な点が多いが,本種が東シナ海にまで分布することが初めて分かったので報告する。Facilities for the utilization of deep-sea water often catch deep-sea organisms that stray actively or passively into the influx tubes, and thus provide the chances for long-term in situ collection. Recently, a female specimen of the ceratioid, Cryptopsara couesii, was collected at the Okinawa dee-sea water facility. The inlet has been placed off Kume Island at the water depth of 612 m in the Eastern China Sea. Information about the distribution of C. couesii is only limited, and this finding adds a new geographical record to be archived.原著論

青色光は滑膜肉腫に対して活性酸素種によるミトコンドリア機能障害を起こし、アポトーシスとオートファジーを誘導する

Background: Synovial sarcoma (SS) has limited treatment options and there is an urgent need to develop a novel therapeutic strategy to treat SS. Blue light (BL) has been shown to inhibit the growth of several cancer cells. However, the efficacy of BL in soft tissue sarcomas such as SS has not been demonstrated, and the detailed mechanism underlying the antitumor activity of BL is not fully understood. In this study, we investigated the antitumor effect of BL on SS. Methods: Human SS cell lines were continuously irradiated with BL using light-emitting diodes (LEDs) in an incubator for in vitro analysis. The chicken chorioallantoic membrane (CAM) tumors and xenograft tumors in mice were subjected to daily BL irradiation with LEDs. Results: BL caused growth inhibition of SS cells and histological changes in CAM tumors. BL also suppressed the migration and invasion abilities of SS cells. The type of cell death in SS cells was revealed to be apoptosis. Furthermore, BL induced excessive production of reactive oxygen species (ROS) in mitochondria, resulting in oxidative stress and malfunctioned mitochondria. Reducing the production of ROS using N-acetylcysteine (NAC), a ROS scavenger, attenuated the inhibitory effect of BL on SS cells and mitochondrial dysfunction. In addition, BL induced autophagy, which was suppressed by the administration of NAC. The autophagy inhibitor of 3-methyladenine and small interfering RNA against the autophagy marker light chain 3B facilitated apoptotic cell death. Moreover, BL suppressed tumor growth in a mouse xenograft model. Conclusion: Taken together, our results revealed that BL induced apoptosis via the ROS-mitochondrial signaling pathway, and autophagy was activated in response to the production of ROS, which protected SS cells from apoptosis. Therefore, BL is a promising candidate for the development of an antitumor therapeutic strategy targeting SS

甘藷を原料とした機能性食品の整腸効果について

甘藷を原料とした機能性食品の整腸効果について調べたところ, 次の知見が得られた。　(1)排便回数はprobiotics IMOを摂食した場合, 増加する傾向がみられ, 特に便秘傾向者ではその傾向が強かった。排便量に関してはprobiotics IMOを摂食することにより, 増加する傾向がみられ, 特に便秘傾向者ではその傾向が強かった。　(2)便の色調ではprobiotics IMOを摂食することにより, 黄色化する傾向がみられ, 便秘傾向者ではその傾向が強かった。それは便が酸性に傾き, 便が黄色味を帯びたものと考えられる。便臭ではprobiotics IMOを摂食することにより, 弱くなる傾向がみられ, 排便後の爽快感は改善される傾向がみられた。　(3)便の形状は項目を「コロコロ状+カチカチ状」「バナナ状+半練り状」「泥状+水状」に分けて解析した。「コロコロ状+カチカチ状」はいずれの被験者でも, probiotics IMOを摂食することにより減少する傾向がみられ, 一方「バナナ状+半練り状」は増加する傾向がみられた。また「泥状+水状」は出現率が低く, 便秘傾向者で1回みられたものの非便秘傾向者ではみられなかった。　(4)蒸し芋とprobiotics IMOについて, 10人の評価者により5段階評価法でおいしさを比較したところ, 前者の評点平均値が3.4に対し, 後者は3.8であった。二つの平均値間の有意性をt検定したところ, p<0.05で有意で, 高次加工により美味しさが向上した。Experimental results of the effects of the intake of a functional food, derived from sweet potato, on defecation are described. After ingestion, functional food significantly increased the weekly defecation frequency and the defecation output, and the effect was more prominent in constipated subjects. The quality of defecation (color, odor, shape) was also measured and all of the qualities were improved after ingestion, especially in constipated subjects. Although the effect was not significant in the non-constipated adults, there was some tendency of the improvement. In conclusion, ingestion of the functional food derived from sweet potato promoted the defecation frequency as well as the stool quality and increased the stool amount in constipated subjects