体外循環開始後早期にアルカレミア環境で出現する回路内の血液凝集塊形成

Purpose : This study investigated the relationship between blood clotting in the circuit soon after initiating cardiopulmonary bypass (CPB) and echinocytes that appear with alkalemia, using a recirculation circuit filled with heparinized bovine blood. Methods : Alkalemic conditions in the recirculation circuit were prepared by adding various concentrations of NaHCO3 to the priming fluid. Albumin was also added to confirm its inhibitory effect on blood clotting. Blood pH, hold-up, the pressure gradient, and red blood cell (RBC) reduction rate were monitored. Blood clots were examined microscopically. Results : Although blood pH was elevated under all experimental conditions, clotting in the circuit increased with increased concentrations of HCO3-. Albumin inhibited the clotting under the same alkalemic conditions. Microscopic findings revealed echinocytes in the blood clots. Conclusions : The shape of echinocytes was transformed by a reduction in the Donnan equilibrium ratio because of changes in pH inside and outside the RBC membrane. Blood clotting in the circuit soon after initiating CPB may be caused by echinocytes that appear under alkalemic conditions. This was inhibited by albumin, suggesting that the addition of albumin to the priming fluid may prevent such clotting in the circuit after initiating CPB.博士（医学）・甲第664号・平成29年3月15日Copyright © 2016 Japanese Journal of Extra-Corporeal Technology（日本体外循環技術医学会）This is a non-final version of an article published in final form in "http://doi.org/10.7130/jject.43.339

Spillover effect of Japanese long-term care insurance as an employment promotion policy for family caregivers

We evaluate a spillover effect of the Japanese public long-term care insurance (LTCI) as a policy to stimulate family caregivers’ labor force participation. Using nationally representative data from 1995 to 2013, we apply difference-in-difference propensity score matching to investigate the spillover effect in two periods: before and after the introduction of the LTCI in 2000 and before and after its major amendment in 2006. Our results show that the LTCI introduction has significant and positive spillover effects on family caregivers’ labor force participation and the effects vary by gender and age. In contrast, the LTCI amendment is found to have generally negative spillover effects on their labor force participation. We draw attention to these spillover effects, as expanding labor market supply to sustain the economy would be a priority for Japan and other rapidly aging countries in the coming decades

Comprehensive Assessment of Risk Factors of Cause-Specific Infant Deaths in Japan

Background: Public attention is given to infants with socially high risks of child abuse and neglect, while clinical attention is provided to infants with a biologically high risk of diseases. However, few studies have systematically evaluated how biological or social factors cross over and affect cause-specific infant mortality.Methods: We linked birth data with death data from the Japanese national vital statistics database for all infants born from 2003–2010. Using multivariate logistic regression, we examined the association between biological and social factors and infant mortality due to medical causes (internal causes), abuse (intentional external causes), and accidents (unintentional external causes).Results: Of 8,941,501 births, 23,400 (0.26%) infants died by 1 year of age, with 21,884 (93.5%) due to internal causes, 175 (0.75%) due to intentional external causes, and 1,194 (5.1%) due to unintentional external causes. Infants with high social risk (teenage mothers, non-Japanese mothers, single mothers, unemployed household, four or more children in the household, or birth outside of health care facility) had higher risk of death by intentional, unintentional, and internal causes. Infant born with small for gestational age and preterm had higher risks of deaths by internal and unintentional causes, but not by intentional causes.Conclusions: Both biological as well as social factors were associated with infant deaths due to internal and external causes. Interdisciplinary support from both public health and clinical-care professionals is needed for infants with high social or biological risk to prevent disease and injury

Changes in mortality inequalities across occupations in Japan: a national register based study of absolute and relative measures, 1980-2010

Objective Changes in mortality inequalities across socioeconomic groups have been a substantial public health concern worldwide. We investigated changes in absolute/relative mortality inequalities across occupations, and the contribution of different diseases to inequalities in tandem with the restructuring of the Japanese economy.Methods Using complete Japanese national death registries from 5 year intervals (1980–2010), all cause and cause specific age standardised mortality rates (ASMR per 100 000 people standardised using the Japanese standard population in 1985, aged 30–59 years) across 12 occupations were computed. Absolute and relative inequalities were measured in ASMR differences (RDs) and ASMR ratios (RRs) among occupations in comparison with manufacturing workers (reference). We also estimated the changing contribution of different diseases by calculating the differences in ASMR change between 1995 and 2010 for occupations and reference.Results All cause ASMRs tended to decrease in both sexes over the three decades except for male managers (increased by 71% points, 1995–2010). RDs across occupations were reduced for both sexes (civil servants 233.5 to −1.9 for men; sales workers 63.3 to 4.5 for women) but RRs increased for some occupations (professional workers 1.38 to 1.70; service workers 2.35 to 3.73) for men and decreased for women from 1980 to 2010. Male relative inequalities widened among farmer, fishery and service workers, because the percentage declines were smaller in these occupations. Cerebrovascular disease and cancer were the main causes of the decrease in mortality inequalities among sexes but the incidence of suicide increased among men, thereby increasing sex related inequalities.Conclusions Absolute inequality trends in mortality across occupations decreased in both sexes, while relative inequality trends were heterogeneous in Japan. The main drivers of narrowing and widening mortality inequalities were cerebrovascular disease and suicide, respectively. Future public health efforts will benefit from eliminating residual inequalities in mortality by considering the contribution of the causes of death and socioeconomic status stratification

Feasibility study of high-resolution coherent diffraction microscopy using synchrotron x rays focused by Kirkpatrick-Baez mirrors

High-flux coherent x rays are necessary for the improvement of the spatial resolution in coherent x-ray diffraction microscopy (CXDM). In this study, high-resolution CXDM using Kirkpatrick-Baez (KB) mirrors is proposed, and the mirrors are designed for experiments of the transmission scheme at SPring-8. Both the photon density and spatial coherence of synchrotron x rays focused by the KB mirrors are investigated by wave optical simulation. The KB mirrors can produce nearly diffraction-limited two-dimensional focusing x rays of ∼1 μm in size at 8 keV. When the sample size is less than ∼1 μm, the sample can be illuminated with full coherent x rays by adjusting the cross-slit size set between the source and the mirrors. From the estimated photon density at the sample position, the feasibility of CXDM with a sub- 1-nm spatial resolution is suggested. The present ultraprecise figuring process enables us to fabricate mirrors for carrying out high-resolution CXDM experiments.Yukio Takahashi, Yoshinori Nishino, Hidekazu Mimura, Ryosuke Tsutsumi, Hideto Kubo, Tetsuya Ishikawa, and Kazuto Yamauchi, "Feasibility study of high-resolution coherent diffraction microscopy using synchrotron x rays focused by Kirkpatrick–Baez mirrors", Journal of Applied Physics 105, 083106 (2009) https://doi.org/10.1063/1.3108997

Development of incident X-ray flux monitor for coherent X-ray diffraction microscopy

An incident X-ray flux monitor for coherent X-ray diffraction microscopy was developed. The intensities of x-rays passing through the sample were measured using an X-ray photodiode, with the simultaneous measurement of the X-ray diffraction intensities of the sample. As a result of the normalization of the X-ray diffraction intensities by the incident X-ray flux determined from the monitor, the fluctuation of the speckle intensities was successfully suppressed. © 2009 IOP Publishing Ltd.Takahashi Y., Kubo H., Furukawa H., et al. Development of incident X-ray flux monitor for coherent X-ray diffraction microscopy. Journal of Physics: Conference Series, 186, , 012060. https://doi.org/10.1088/1742-6596/186/1/012060.9TH INTERNATIONAL CONFERENCE ON X-RAY MICROSCOPY 21–25 July 2008, Zürich, Switzerlan

Impact of long-hours family caregiving on non-fatal coronary heart disease risk in middle-aged people: Results from a longitudinal nationwide survey in Japan

AimThe effects of family caregiving, especially long-hours caregiving, on coronary heart disease (CHD) are debatable. We examined the impact of family caregiving on incident non-fatal CHD.MethodsWe used data from the Longitudinal Survey of Middle-Aged and Elderly Persons from 2005 to 2010, a nationwide panel survey for Japanese people aged 50–59 years in 2005 (baseline). After we excluded non-respondents and people with missing key variables at baseline, 25 121 individuals without CHD, stroke or cancer were followed up for a mean of 4.6 years. The exposure was assessed at baseline by three indicators: (i) family caregiving; (ii) hours spent caregiving; and (iii) kinship type of care recipient. The non-fatal CHD incidence was identified according to questionnaire responses from 2006 to 2010.ResultsCox\u27s proportional hazards analysis did not show a statistically significant association between family caregiving and incident non-fatal CHD (hazard ratio [HR] 1.13, 95% confidence interval [CI] 0.92–1.40). Caregivers who spent 20–69 h per week on care showed a statistically significant increased risk for non-fatal CHD (HR 1.78, 95% CI 1.23–2.58) compared with non-caregivers; whereas this increased risk was statistically significant only among women (HR 1.98, 95% CI 1.27–3.08), but not among men (HR 1.35, 95% CI 0.67–2.71). Kinship type of care recipient did not make a significant difference to the effects of family caregiving on incident non-fatal CHD.ConclusionsLong-hours family caregiving could be an independent risk factor for incident non-fatal CHD among middle-aged women in Japan. Geriatr Gerontol Int 2017; 17: 2109–2115

Resident and facility characteristics associated with care-need level deterioration in long-term care welfare facilities in Japan

AimTo determine the resident and facility characteristics associated with residents’ care‐need level deterioration in long‐term care welfare facilities in Japan.MethodsA nationally representative sample of 358 886 residents who lived in 3774 long‐term care welfare facilities for at least 1 year from October 2012 was obtained from long‐term care insurance claims data. Facility characteristics were linked with a survey of institutions and establishments for long‐term care in 2012. We used a multilevel logistic regression according to the inclusion and exclusion of lost to follow‐up to define the resident and facility characteristics associated with resident care‐need level deteriorations (lost to follow‐up: the majority were hospitalized residents or had died; were treated as deterioration in the including loss to follow‐up model).ResultsAdjusting for the covariates, at the resident level, older age and lower care‐need level at baseline were more likely to show deterioration in the care‐need level. At the facility level, metropolitan facilities, unit model (all private room settings) and mixed‐model facilities (partly private room settings) were less likely to experience care‐need level deterioration. A higher proportion of registered nurses among all nurses was negatively related to care‐need level deterioration only in the model including lost to follow‐up. A higher proportion of registered dietitians among all dietitians and the facilities in business for fewer years were negatively associated with care‐need level deterioration only in the model excluding lost to follow‐up.ConclusionsThe present study could help identify residents who are at risk of care‐need level deterioration, and could contribute to improvements in provider quality performance and enhance competence in the market. Geriatr Gerontol Int 2018; 18: 758–766