小谷 和彦

To examine whether benidipine hydrochloride, one of the calcium channel blockers, up-regulate uncoupling protein 3 (UCP3) expression in two skeletal muscles (gastrocnemius and soleus) in rats. Wistar rats were treated orally with benidipine hydrochloride at 4 mg/kg for 7 days. Blood pressure was measured after 4 days. At the end of experiments, the rats were weighed, and brown adipose tissue (BAT) and skeletal muscles (gastrocnemius and soleus muscles) were removed. The mRNA levels of uncoupling protein 1 (UCP1) and UCP3 were measured using the real-time quantitative reverse transcription-polymerase chain reaction method. Benidipine reduced body weight and also had a hypotensive effect. In rats treated with benidipine, UCP1 mRNA levels were significantly increased 1.4-fold in BAT, and UCP3 mRNA levels in BAT and gastrocnemius muscle were significantly increased 1.7 and 3.0-fold, respectively, compared with the control rats. There was no difference in UCP3 mRNA levels in soleus muscle between the two groups. We concluded that benidipine up-regulates not only UCP1 gene expression in BAT but also UCP3 gene expression in BAT and gastrocnemius muscle, which may contribute to thermogenesis in rats.

The presence of small dense low-density lipoprotein (sdLDL) is closely associated with an increased risk of developing coronary artery disease. The Trp64Arg polymorphism of the beta(3)-adrenergic receptor (beta(3)-AR) gene is a genetic marker for obesity-related traits. However, any possible association between this polymorphism and sdLDL profiles is unclear. The objective of this study is to investigate the effects of the polymorphism of the beta(3)-AR gene on LDL particle size and sdLDL in a rural Japanese population. Among 277 subjects, body mass index, blood pressure, fasting serum insulin levels, and insulin resistance index (fasting glucose x fasting insulin/405) were determined. The polymorphism of the beta(3)-AR gene was assessed by polymerase chain reaction-restriction fragment length polymorphism using buccal samples. Low-density lipoprotein particle size and sdLDL were measured with the electrophoretic separation of lipoproteins on the LipoPrint System (Quantimetrix, Redondo Beach, CA). The frequency of the beta(3)-AR allele was 0.19. In Arg carriers (Trp/Arg or Arg/Arg), the mean value of LDL particle size was smaller than that of non-Arg carriers (Trp/Trp) (P < .05). The area percentage of sdLDL was higher in Arg carriers (P < .05) than in non-Arg carriers. A multiple regression analysis showed that the area percentage of sdLDL was correlated with the polymorphism of the beta(3)-AR gene (P < .05), independently of age, sex, body mass index, smoking, and insulin resistance index. The present findings suggest that the beta(3)-AR gene polymorphism plays a role in the genetic predisposition to increased sdLDL, independently of insulin resistance.

Internal stress can modify values in blood examinations such as glucose. Mood change releases us from the stress state, and the mood change tendency (MCT) may show individual differences. However, little is known about whether individual mood change tendencies in daily life affect fasting plasma glucose (FPG) levels. We investigated the effects of clinical characteristics including age, body mass index (BMI), smoking, alcohol habits and self-reported MCT (an answer to the inquiry on their daily MCT: good, average, or poor) on FPG values among 272 Japanese females (mean age 48.4 +/- 9.3 years). Subjects with normal to impaired fasting glucose levels (less than 7.0 mmol/L) were included in this study. The mean FPG levels in subjects with good, average and poor MCT were 5.32 +/- 0.48, 5.36 +/- 0.50 and 5.58 +/- 0.69 mmol/L, respectively. A significant difference was noted between subjects with good and poor MCT (p = 0.02). There was no significant difference in BMI levels among MCT-based groups. Pearson's rank correlation and multiple regression analysis, using FPG levels and other variables, demonstrated a significant relationship between FPG levels and MCT (p < or =0.01), along with age and BMI. These results suggest slight but significant effects of individual MCT on FPG, and that a consideration of MCT may occasionally be needed in the interpretation and management of FPG levels in the Japanese female population.

BACKGROUND: Serum adiponectin concentration plays a role in the development of metabolic and atherosclerotic diseases. Although elucidating the determinants that affect circulating adiponectin concentrations including lifestyle factors are important, little is known about the relationships between lifestyle and adiponectin in the general Japanese female population. METHODS: A total of 311 Japanese females (mean age 54 years) with normal lifestyles and taking no medications were enrolled in a community-based cross-sectional study to investigate which lifestyle factors were associated with serum adiponectin concentrations. Adiponectin was measured with an enzyme-linked immunosorbent assay. The modified Breslow's index (a well-known comprehensive index) was used in assessing lifestyle factors. RESULTS: The group of moderate drinkers (consuming 1-3 go/day on average) had significantly higher serum adiponectin concentrations than that of nondrinkers (consuming <1 go/day) (15.0 +/- 7.2 vs. 12.0 +/- 6.5 microg/mL). Using a partial correlation analysis on serum adiponectin concentrations adjusted for age and all lifestyle factors, there were significant positive correlations with age (r = 0.197) and alcohol intake (r = 0.130) and a significant inverse correlation with body mass index (BMI) (r = -0.178). CONCLUSIONS: Among many lifestyle factors, in addition to maintaining decreased BMI levels, moderate alcohol intake habits may have a significant, independent, and positive effect on adiponectin concentrations in the general population of Japanese females, similar to that of Caucasian populations.

BACKGROUND: Protein 1 (P1)/Clara cell 16 kDa protein (CC16, previously named CC10), a potentially immunosuppressive protein secreted by non-ciliated cells of the tracheobronchial epithelium, has been found to be a new useful lung-specific biomarker in several pathological lung conditions. Particularly, urinary P1 (uP1) may reflect the altered lung functions in pneumoconiosis. METHODS: We investigated the relationship between uP1 values and lung functions in 31 non-smoking pneumoconiotic males (mean age 73 years) with a history of dust exposure work in shipbuilding. The protein was measured using an originally prepared enzyme-linked immunosorbent assay system. The forced expiratory volume in 1 s % (FEV(1.0)%) and % vital capacity (%VC) were tested with a spirometer. RESULTS: The mean values of uP1 were 4.62 +/- 4.82 (mean +/- standard deviation) ng/mol creatinine. A univariable correlation test showed a significant positive correlation between uP1 and %VC (r = 0.356, P = 0.049). Also, a multiple regression analysis, when adjusted for age, disease duration, FEV(1.0)% and %VC, showed a significant correlation of uP1 with %VC (beta = 0.467, P = 0.030). CONCLUSION: The results suggest that a decreased uP1, corroborated by a decreased %VC, may be the result of damage to secretory cells. Measurement of uP1 may become a possible index of fibrotic changes in pneumoconiosis.

The Pro12Ala polymorphism of the peroxisome proliferator-activated receptor gamma2 (PPARgamma2) gene has been reported to predict a lower risk for developing type 2 diabetes mellitus. However, its effect on the lipid profile has been disputable. Among low-density lipoproteins, small dense low-density lipoprotein (sdLDL) particles have been linked to a greater risk for coronary artery disease. The purpose of this study was to investigate the genetic effect of the Pro12Ala polymorphism in the PPARgamma2 gene on the presence of sdLDL in the general Japanese population. In 379 subjects (aged 54 +/- 13 years), body mass index, percentage of body fat, blood pressure, and biochemical profiles were measured. Pro12Ala polymorphism was genotyped by polymerase chain reaction-restriction fragment length polymorphism. The area of sdLDL subfractions (sdLDL4-7) was analyzed by high-resolution polyacrylamide gel electrophoresis. The frequency of the Ala12 allele in PPARgamma2 was 0.04. There was no difference in total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels between genotypes. However, subjects with the X/Ala genotype (Pro/Ala + Ala/Ala) had significantly higher serum triglyceride levels (P = .001) and a larger area of sdLDL4-7 (P = .002) than those with the Pro/Pro genotype. Multiple regression analysis revealed that the Ala12 allele was a significant variable contributing to the variance in the increased area of sdLDL4-7 (P = .040). In conclusion, the Pro12Ala polymorphism in the PPARgamma2 gene was positively associated with an enlarged area of sdLDL4-7. This polymorphism may play a role in the genetic predisposition to increases in sdLDL4-7.

Adiponectin plays an important role in the development of various lifestyle-related diseases such as obesity, hypertension, type II diabetes mellitus, hyperlipidemia, and metabolic syndrome, leading to the development of heart and vascular diseases. However, the determinants that affect circulating adiponectin levels, including lifestyle factors, have still not been thoroughly investigated, in a general male population in particular. A total of 109 healthy Japanese male subjects (mean age, 55 +/- 14 years) with constant lifestyles were enrolled. All were on no medication. Fasting serum adiponectin levels were measured with an enzyme-linked immunosorbent assay. Each subject's lifestyle was assessed by the self-administered Breslow Questionnaire (a well-established method to estimate various lifestyles) with minor modifications. Partial correlation analysis for serum adiponectin levels, after controlling age and all lifestyle factors, revealed a significant and independent negative correlation between serum adiponectin levels and body mass index (BMI) (r = -0.222, P = 0.025), and a significant and independent positive correlation between serum adiponectin levels and sleep duration (r = 0.252, P = 0.011). No significant correlations were observed between adiponectin and other lifestyle factors. These data suggest that increased BMI and shorter sleep duration may be significant independent risks for low serum adiponectin levels in healthy males. Therefore, these factors may be intervention targets to modulate adiponectin to its proper levels for the prevention of cardiovascular disorders.

We investigated the serial changes in blood protein S (PS) and related proteins in 11 normal pregnant women. The PS activity decreased significantly in the third trimester and reached minimum levels (23.3%) one hour after delivery. Although the PS activity was reduced markedly below the normal limits, all the women delivered safely. The mechanisms that cause the reduction in PS activity and the clinically dangerous conditions involving PS activity during pregnancy warrant further investigation.

SUMMARY: Uncoupling protein-1 (UCP1) activity in brown adipose tissue increases energy expenditure, and contributes to diet-induced or cold-induced thermogenesis. We previously reported that children with -3826 A → G nucleotide variant of the UCP1 gene had lowered postprandial thermogenesis in response to a high-fat meal. In this study, we investigated whether the UCP1 polymorphism was associated with cold-induced thermogenesis in healthy children. Resting energy expenditure was measured in 19 children (6-10 years) by indirect calorimetry for 30 min under thermoneutral (25 °C) or cold conditions (10 °C) in an environmental chamber. The activity of autonomic nervous system (ANS) was assessed by power spectral analysis of heart rate variability (HRV). Samples of saliva were collected for cortisol determination at the end of the experimental session. Each experiment was performed on 2 consecutive days. Children were genotyped for the UCP1 polymorphism with a PCR-restriction fragment length analysis using buccal samples. During cold exposure, total power of the HRV, an index of the overall ANS activity, as well as the salivary cortisol concentration significantly increased in the children with homozygous (GG) for the UCP1 polymorphism while only cortisol response was found in the carriers of the wild-type (AA) and heterozygous (AG) alleles; however, the GG allele group showed a lower cold-induced thermogenesis compared to the AA + AG group. In conclusion, despite cold-induced autonomic stimulation, the GG allele carriers have a reduced capacity for thermogenesis in response to acute cold exposure, suggesting that such reduced UCP1-linked thermogenesis may have adverse effects on the regulation of body weight.:

We report on an 83-year-old Japanese woman with adult-onset Still's disease (AOSD), with marked hypercytokinemia (serum levels of ferritin (Fer) and interleukin (IL)-18 were markedly high). On seeing older patients with fever of unknown origin (FUO), particularly Asians, AOSD should be considered. Reduced doses of oral prednisolone following intravenous methylprednisolone (mPSL) therapy caused a flare-up of AOSD and led to Pneumocystis carinii (jeroveci) pneumonia. Low-dose methotrexate (MTX) therapy was administered as a steroid-sparing agent with good response. Our case suggests that in very elderly people, as in younger patients, MTX is useful for controlling AOSD with marked hypercytokinemia, and avoiding corticosteroid-induced adverse effects.

BACKGROUND: Angiotensin II (AngII), through the AngII type 2 receptor (AT2-R), might exert some effect on adipocyte- and lipogenesis-related biology. The Adenine/Cytosine 3123 (A/C(3123)) polymorphism in the AT2-R gene is reportedly involved in some diseases, such as hypertension. METHODS: A total of 201 healthy Japanese women (mean age 43.2 years) were enrolled in the study to investigate the association among the AT2-R A/C(3123) polymorphism detected by polymerase chain reaction methods, body mass index (BMI) and other obesity-linked metabolic parameters (blood pressure, serum lipid/lipoprotein, plasma glucose). RESULTS: Homozygotes of the C-allele in the AT2-R A/C(3123) polymorphism were associated with small but significant increases in BMI levels. There were no differences between genotype-based groups in the obesity-linked metabolic parameters. CONCLUSION: These findings suggest that the AT2-R A/C(3123) polymorphism could be a polymorphic marker related to BMI in Japanese women.

BACKGROUND: Blood platelet counts (PCs) play a role in the development of cardiovascular disease (CVD). The metabolic syndrome (MS) is also associated with high CVD risk. However, the connection between PCs and MS has not yet been thoroughly investigated in relation to various biosocial factors that can affect both PCs and the pathophysiology of MS. METHODS: A total of 152 asymptomatic female subjects (mean age 50 years) with almost normal levels of hemoglobin and white blood cell counts were recruited. MS was diagnosed according to the NCEP-ATP III criteria with a minor modification. The relationships between PCs and MS were analyzed according to the number of MS components (0, 1-2, > or =3). Biosocial factors including age and some lifestyle factors (smoking, alcohol intake and physical activity) were included in the analyses. RESULTS: PCs in subjects with > or =3 MS components (233+/-43 [SD]x10(9) /L) were strikingly and significantly higher than in subjects with 0 (194+/-34 x 10(9)/L) or 1-2 MS components (207+/-38 x 10(9)/L). General linear model analysis for PCs, adjusted for all biosocial factors and number of MS components, revealed a significant and positive correlation between PCs and number of MS components (p<0.0001). CONCLUSIONS: The results suggest that PCs may be a potential marker associated with clustered MS components, independent of some biosocial factors, in Japanese females.

BACKGROUND: The possible effects of the uncoupling protein-1 (UCP-1) gene -3826A/G polymorphism on hypertension (HT) have yet to be elucidated. METHODS: A total of 578 Japanese subjects (231 males and 347 females, mean age 58.4 years) were enrolled in the study to investigate the association between HT and the -3826A/G polymorphism by genomic PCR and Bcl1-restriction fragment length polymorphism methods. RESULTS: Multivariate logistic regression analysis for HT, adjusted for genotype (recessive model, AA+AG vs. GG) and other covariates such as cardiovascular risk factors [e.g., smoking, body mass index (BMI), dyslipidemia and diabetes] showed age [odds ratio (OR) 1.11 (95% confidence interval 1.08-1.13)] and BMI [OR 1.13 (1.06-1.21)] as independent significant factors. In the subgroup analysis, as well as age and BMI, GG genotype [OR 2.32 (1.08-4.99)] was also an independent significant factor for HT in males. Similarly, as well as age and BMI, GG genotype [OR 1.89 (1.00-3.57)] was also an independent significant factor for HT in the relatively older subgroup (> or =60 years). CONCLUSIONS: The results suggest that the GG genotype may be associated with the presence of HT in Japanese males and older subjects. Further investigation is needed to confirm our hypothesis.

Controls for second hand smoke (SHS) and adolescent smoking have been still sociomedical concerns in Japan. Restaurant smoking restrictions are associated with community social norms affecting adolescent smoking behavior, and the status in areas around Junior high schools (JHSs) in the community could be a sign of community practices on regulating SHS for adolescents. To examine whether restaurant smoking restrictions are seen especially in areas around JHSs in Japan, a survey using the direct inspection of a total of 163 restaurants (64 restaurants within and 99 outside a 1-km radius from the nearest JHSs) was conducted in May 2003 in Yonago city, Japan. We assessed smoking restriction status in each restaurant and classified them into 2 groups according to the distance from the nearest JHSs. There were only 2 (3.1%) restaurants with 100% non-smoking and 11 (17.2%) with some partial restrictions among the restaurants within a 1-km radius of JHSs. There were 1 (1.0%) restaurant with 100% non-smoking, 3 (3.0%) with complete non-smoking sections and 17 (17.2%) with some partial restrictions among the restaurants outside a 1-km radius of JHSs. Among restaurants with some partial restrictions, restriction methods were considered insufficient. The smoking restriction status was not significantly different between the restaurant groups within and outside a 1-km radius of JHSs. These results suggest that the public awareness of and attitude toward adolescent smoking problems remains low in Japan. Further SHS control actions for adolescents are needed in Japan.

Ghrelin may play a role in the development of atherosclerosis. However, the effect of serum ghrelin on carotid intima-media thickness (cIMT) (well-established as a surrogate marker to atherosclerosis) in metabolic syndrome (MS), particularly among relatively older subjects, has still not been thoroughly investigated. A total of 101 subjects >60 years of age (mean age, 72.3 years) with MS were enrolled in the study to investigate the relationship between serum total ghrelin and B-mode ultrasonographic cIMT levels. There were significantly positive correlations between cIMT and both age and systolic BP, but cIMT was significantly inversely correlated to ghrelin levels. In the multiple regression analysis for cIMT adjusted by other measured parameters, ghrelin was a significant and independent factor along with age and systolic BP. These findings suggest that decreased ghrelin levels may be related to carotid atherosclerosis among older subjects with MS.

The Internet has provided open access to health- and disease-related information for people with chronic diseases. Atopic dermatitis (AD) is mostly chronic, and the treatment of AD often requests some self-management such as skin care. For this situation, adult AD patients may have a motive of obtaining information on AD from various sources such as the Internet. Although the status of Internet access among AD patients has not been thoroughly investigated, knowledge about this status may be useful to understand AD patients in primary care. We studied the actual status among 62 adult Japanese outpatients with AD (male:female = 29:33; mean age [+/- S.D.]: 27.8 +/- 7.9 years). All 62 patients owned cellular phones, while 51 subjects (82.3%) owned personal computers (PCs). Internet web-site information on both general health and AD was more commonly accessed via PCs rather than cellular phones, but the access rates via PCs were only 35.3% among all users of PCs. When AD patients assessed the extent of credibility of web site information on AD on a scale of 0 to 100 points, it was at best 52.4 +/- 19.8 points. Moreover, both the duration and severity of AD had a positive influence on the credibility of information on AD. These results suggest that Internet access is not common and the information is not necessarily credible among adult AD patients in Japan, and that more consideration is needed for the Internet to become a powerful and vital source to support health care for AD.

The "Japan Atherosclerosis Society (JAS) Guidelines for Diagnosis and Treatment of Atherosclerotic Cardiovascular Diseases" proposed the recommended lipoprotein levels in each patient according to some categories classified by the risk factor numbers. Because the categorization is somewhat complex for some patients, we redeveloped the JAS guidelines-based survey into a simple form to easily assess each lipoprotein target level. Forty participants in the hypercholesterolemia education classes were divided into the ordinary approach group (n = 20; mean age 59 years) and the intervention group using the survey (age 58 years). When participants assessed the class by 100-point scales, the intervention group had significantly more understanding levels than the ordinary approach group (86.7 vs. 75.1 points). Our results suggested that the simplified JAS guidelines-based survey system was effectively applicable to transmitting information about lipoprotein target levels among hypercholesterolemic subjects as an educational tool.

Hyperuricemia has been associated with an increased risk for cardiovascular disease and increased mortality. However, the biologic mechanisms that link elevated serum uric acid to cardiovascular disease are uncertain. This study tested the hypothesis that elevated serum uric acid is associated with impaired endothelial function in hyperuricemic patients without any overt cardiovascular disease. Seventeen male patients with hyperuricemia (mean age 42+/-4 years) and 9 control subjects (mean age 45+/-5 years) were studied. All subjects were nonsmokers. All patients had never been treated for hyperuricemia, were on no medications, and were free of any other known diseases. Endothelial function was evaluated by flow-mediated dilation measured by ultrasound. Flow-mediated dilation was significantly impaired in patients with hyperuricemia (4.0+/-0.7%) compared with control subjects (6.4+/-0.8%) (p=0.044). Flow-mediated dilation correlated inversely with uric acid levels (r=-0.4, p=0.05). Nitrate-induced dilation was 12.3+/-1.0% in patients with hyperuricemia and 11.8+/-2.3% in control subjects (p=0.82). Impaired endothelial-dependent vasodilation is present in hyperuricemic patients even in the absence of any overt cardiovascular disease. The elevated serum uric acid, per se, may constitute a novel risk factor for endothelial dysfunction.

This study focused on the effects of different intervals between sessions of a hypercholesterolemia education class on post-intervention outcomes. The same comprehensive group-programme contents on hypercholesterolemia were delivered either monthly (for 6 months) or twice-monthly (for 3 months) by the same teaching professionals in a community setting. The twice-monthly programme included 46 participants (male/female = 7/39, average age: 65.8 years)and the monthly programme consisted of 48(male/female = 9/39, age: 66.4). At the beginning of the study, all subjects belonged to the 'contemplation' stage of diet and exercise habits within the Transtheoretical Model of Change. The stage-matched intervention helped many participants move to the 'action ' stage by 6 months after the last session, especially in the twice-monthly group. The change rate of exercise from the 'contemplation' stage to the 'action' stage was significantly higher in the twice-monthly group (76.1 percent) than in the monthly (54.2 percent ). In both monthly and twice-monthly formats, participants' satisfaction and understanding levels at the end of the programme were high, but were significantly higher in the twice-monthly group. Through favorable lifestyles and higher levels of satisfaction and learning, the twice-monthly format may produce more positive results in cholesterol management than the monthly format, as the shorter period of time makes the programme more intensive.

Japan has been behind the times in terms of promoting smoking control. The health-promotion law, which included the aim of preventing environmental tobacco smoke (ETS) in public places, was newly introduced in Japan in 2003. The community-based survey on the present state of restaurant smoking restrictions and restaurant owners' concern of smoking is important as it is a reflection of the community's desire to prevent ETS. Data on the smoking restrictions in 163 restaurants in Yonago, one Japanese community, and the owners' smoking-related awareness were collected just one month after the law was enacted. This study revealed that only 6 (3.6%) restaurants were under sufficient conditions: 3 with totally smoke-free and 3 with complete non-smoking sections. The styles (e.g., Western-, Japanese- and Chinese-styles) and kinds of restaurants (e.g., family restaurants and tearooms) were not related to the state of smoking restrictions. Rates of smokers were relatively high among owners, and smoking owners significantly provided insufficient smoking restrictions. 26.4% of owners knew about the new law. However, there were no restaurants that started their smoking restrictions due to the law. Owners' knowledge of the law did not correlate with smoking restrictions. The owners especially feared the negative effects on business due to smoking restrictions. These survey findings suggested little protection from ETS in a sample of restaurants and a large gap in restaurant smoking restrictions compared to other countries. More widespread adoption of the health-promotion law in restaurants is an issue.

A 72-year-old Japanese man displayed asymptomatic eosinophilia for 4 months. Computed tomography showed multiple space-occupying lesions in the liver. Zoonotic liver flukes were suspected based on occupational exposure to cattle, serological and radiological findings. Immunological examination was helpful in diagnosing the disease and laparoscopy was crucial in confirming Fasciola hepatica and excluding the possibility of malignant hepatic tumors. Human fascioliasis was finally diagnosed and praziquantel administered. Blood eosinophilia resolved within 4 months and liver tumors almost disappeared within 12 months. From our experience, laparoscopy with liver biopsy is very important for diagnosing human fascioliasis, particularly for asymptomatic fascioliasis.

Streptolysin O (SLO) is a toxic immunogenic protein produced by Streptococcus pyogenes (S. pyogenes). The latex agglutination photometric immunoassay with latex coated by SLO (latex agglutination method) has been most widely used for determination of antibody to SLO (ASO). We measured ASO levels by latex agglutination method in serum specimens collected from 159 healthy individuals and eight patients with S. pyogenes, who had a positive S. pyogenes culture from throat swabs. A significant frequency(about 15%) had positive ASO levels (> 200 unit/ml) in healthy individuals aged < 20 (47 individuals) and 20-29 (80 individuals), respectively, however, none of 30 or over (32 individuals) were positive. The SLO specimen purchased from Sigma Chemical Co. showed at least three protein bands on SDS-PAGE; one was considered SLO protein because it had a molecular weight of 64 kD and of the remaining proteins, one had a molecular weight higher and the other had a molecular weight lower than 64 kD. Serum antibodies among the healthy adults to Sigma-SLO specimen consisted of IgG class in the majority, with little IgM class. Immunoblotting analysis revealed that serum antibodies of the patients recognized the 64-kD protein (SLO), and serum antibodies of the healthy adults recognized different proteins from SLO. It appeared that many of the healthy adults with a positive ASO level had antibodies different from ASO, resulting in pseudo-positive ASO values when ASO was measured by latex agglutination method using SLO specimen containing non-specific proteins. Improvement of commercial kits using this method is required.

Background. A silent cerebral infarction (SCI) is often found in the elderly. However, studies on SCIs focusing on an elderly population are sparse. Our objective was to evaluate risk factors of SCIs in healthy elderly individuals. Methods. One hundred seventy-five neurologically normal community-dwelling Japanese people aged greater than or equal to65 years (128 men and 47 women 77.5 +/- 8.7 years) were studied. Among them we assessed the demographic data and detected SCIs on brain magnetic resonance imaging scans. Results. Eighty four subjects had at least one SCI. Hypertension and low body mass index (BMI) were the significant risks for SCIs in multivariate analysis adjusted for age, sex and other risk factors. Mean BMI in subjects with SCIs was significantly lower than those without SCIs (20.8 +/- 3.2 kg/m(2) vs. 22.1 +/- 3.2 kg/m(2)). In the subgroup analysis by age stratum regarding hypertension and BMI, hypertension was a significant risk factor in subjects aged 65-75 years. Lower BMI had a significant risk in subjects aged greater than or equal to81 years. Conclusions. Hypertension and increasing age have been recognized as risk factors for SCIs, and low BMI might be a significant risk especially in superelderly subjects. Further data with a larger sample size is needed to confirm the relationship between BMI and SCIs among the elderly. (C) 2004 IMSS. Published by Elsevier Inc.

Recently, many cancer patients have been cared for at home in Japan. Cancer pain control is one of the most important factors for terminal cancer patients to maintain functional lives at home. Morphine has long been the gold standard in the control of cancer pain. This paper examined the present status of the frequency of morphine use and its prescribing route for pain control in cancer patients at home monitored by doctors offering home care medicine in Japan. We reviewed the data based on the replies to questionnaires about morphine use in a textbook edited in 2001 by the doctors supportive of home care medicine nationwide in Japan. 301 (92.9%) among 324 doctors administered morphine for at-home cancer patients. 257 doctors' replies were analyzed as to the prescribed pattern of morphine after excluding data without information on the administration route. The oral administration was most frequently used in 247 (96.1%) doctors and rectal administration was used in 217 (84.4%) doctors, while intravenous injection and epidural infusions were less common. The pattern of morphine administration was similar between doctors who worked at hospitals and clinics, except that doctors who worked at hospitals administered subcutaneously more frequently than doctors who worked at clinics (69.2% in the hospital vs. 39.4% in the clinic setting). This study has revealed that morphine is commonly prescribed to control pain in at-home cancer patients by doctors who support home care medicine in Japan. The restricted administration routes of morphine among the doctors and less prevalent use of the subcutaneous routes in doctors who work at clinics are also shown in the home cancer care setting. These findings might result from mutual relationship between the thought and experience of doctors and clinical characteristics of patients under home care medicine.

The discriminating abilities of fasting plasma glucose (FPG) and HbA1c were compared on screening tests for impaired glucose tolerance (IGT) and IGT plus diabetes mellitus by the receiver operating characteristic (ROC) curve analysis. Furthermore, effects of sex, age and BMI were examined on sensitivity and specificity of the optimal cutoff points. This study included 997 subjects who were recruited for 75 g OGTT after the first screening of the Japan Diabetes Prevention Program. According to the 1997 criteria of the American Diabetes Association (ADA), 140 subjects were classified as diabetic and 256 as IGT. The areas under the ROC curves of FPG were significantly larger than those of HbA1c. The optimal cutoff points of FPG were 102 mg/dl for IGT and 105 mg/dl for IGT plus diabetes mellitus. Those of HbA1c were both 5.3%. In screening with FPG, females had significantly lower sensitivity and higher specificity than males, and the specificity for IGT plus diabetes mellitus was the lowest in the obese group. In screening with HbA1c, the specificity was low in the older and the obese groups. We concluded that FPG was superior to HbA1c for screening of IGT and IGT plus diabetes mellitus and the optimal cutoff point of FPG would be 102 mg/dl or greater.