Increased left ventricular function as an adaptive response in vibration disease.

Vibration disease results from the long-term use of vibrating tools. Vibration, noise, and cold are stressors that impair the human body, inducing vibration disease. From echocardiographic methods, the left ventricular ejection fraction in vibration disease was 79 +/- 4%, a significantly higher value than that in control subjects (75 +/- 6%) (p less than 0.01). The increase in ejection fraction appeared to be due mainly to an increase in left ventricular end-diastolic dimension. The value of the ejection fraction was proportional to the activity of the autonomic nerves. The stroke volume index in patients with vibration disease was also significantly larger than that in the control subjects (p less than 0.001). Electrocardiograms revealed a significantly lower heart rate at rest and an increase in the ratio of T waves to R waves in precordial lead V6. These data suggest that the cardiovascular system in patients with vibration disease provides an adaptive response to the stressors.

Saliva level of free 3-methoxy-4-hydroxyphenylglycol (MHPG) as a biological index of anxiety disorders.

To access the saliva level of free 3-methoxy-4-hydroxyphenylglycol (MHPG) as a biological index of anxiety disorders, gender- or age-dependent changes in saliva MHPG level in patients with anxiety disorders were investigated. Saliva MHPG levels in 196 normal volunteers (59 male, 137 female) and 42 outpatients with anxiety disorders (20 male, 22 female) at the initial consultation to the hospital were measured by gas chromatography-mass spectrometry. Saliva MHPG levels in patients were higher than those in normal subjects. The increase in saliva MHPG levels in male patients was greater than that in female patients. Age-associated increase in the saliva MHPG level was greater in patients than in normal subjects. Especially, a significant interaction of age vs. patient effect was found in female subjects (P=0.0005), but not in male subjects (P=0. 174). These data indicate that the measurement of saliva MHPG would be valuable for detecting pathological anxiety in male patients regardless of age and in older female patients, but not in younger female patients.

[An analysis of the organizational climate found in the nursing workplace through interviews with recently-hired new graduate nurses].

PURPOSE: Nurses often talk about the need for autonomy and independence in their work. However, little is written about the organizational climate of their workplace. What is the workplace like? Does it support nursing autonomy and independence? The purpose of this study is to analyze the organizational climate of the nurses' workplace through interviews with recently-hired, new graduate nurses who have been with the organization for three to six months. METHODS: Interviewed were conducted with 34 recently-hired, new graduate nurses, three to six months from the date they joined the organization. At the beginning of the interview with each of them, I requested that they speak openly in describing their workplace. Each interview was tape-recorded and the content was analyzed. RESULT: I interviewed 34 recently-hired, new graduate nurses. Each interview lasted one hour. During this time, pre-determined questions were presented to each nurse. They responded to the questions by describing their impressions of their workplace. Their responses were divided into three groups and analyzed according to communication patterns, interpersonal relationships, organizational support and responsiveness, and organizational culture.

No association of borna disease virus with psychiatric disorders among patients in northern Kyushu, Japan.

There is controversy over the prevalence of Borna disease virus (BDV) antibodies and its RNA in the peripheral blood mononuclear cells (PBMCs) of psychiatric patients, and the contribution of BDV to human psychiatric disorders. We examined 299 plasma and 229 PBMC samples. No plasma samples were positive for BDV-p40, p24 or gp18 antibodies by western blot analysis. The prevalence of BDV RNA in the psychiatric (schizophrenic) patients (1.8%) was not significantly different from that in the healthy volunteers (0.6%). The nucleotide sequences of BDV p40 and p24 were highly conserved with those of BDV He/80. Our results suggested that there is a lack of association between BDV infection and psychiatric disorders among the patients in Northern Kyushu, Japan.

Comparable effects of oral diltiazem and verapamil in the treatment of hypertrophic cardiomyopathy. Double-blind crossover study.

The effects of oral diltiazem, 180 mg/day, were compared with those of oral verapamil, 240 mg/day, in 32 patients with hypertrophic cardiomyopathy (HCM), using a double-blind crossover study design. In the first treatment period, diltiazem and verapamil improved subjective complaints in 83% and 71% of those who were symptomatic in the baseline period. Maximal oxygen consumption on exercise stress test increased with verapamil by 2.9 +/- 4.2 ml/Kg/min (p less than 0.05), and tended to increase with diltiazem. Verapamil also reduced the amplitude of negative T wave. In the statistical analysis based on the crossover design, diltiazem and verapamil did not differ in global improvement, overall safety and global utility ratings. In addition, both drugs showed comparable effects on electrocardiographic and echocardiographic variables and exercise tolerance except for minor differences in diastolic blood pressure, T wave amplitude and peak exercise heart rate. On the other hand, verapamil tended to induce more serious side effects, forcing the discontinuation of medication in 3 patients. Therefore, the present study indicates that diltiazem is essentially equally as effective as verapamil and is preferable in the treatment of patients with HCM since it may exhibit fewer serious side effects.

Effective extracellular trehalose production by Cellulosimicrobium cellulans.

A bacterium isolated from a petal of Casa Blanca Lily (ST26 strain) produced a marked amount of extracellular trehalose (alpha- d-glucopyranosyl-[1,1]-alpha- d-glucopyranose) in culture medium containing glucose. 16S rDNA-based phylogeny showed that ST26 belongs to, or is related to, Cellulosimicrobium cellulans, a close relative of Cellulomonas spp. Various Cellulomonas strains obtained from culture collections also showed extracellular trehalose productivity, suggesting that trehalose production is a common property of this bacterial genus. ST26 accumulated trehalose in medium supplied with glucose but not with sucrose, glycerol or maltose. Effective extracellular trehalose production by ST26 was achieved by supplying 0.5-1% ammonium sulfate and 0.5-1% CaCO(3). The addition of CaCO(3) adjusted the pH of the culture to around 5.0. The optimized culture conditions yielded trehalose from glucose at a conversion rate of 61%. The addition of ammonium sulfate greatly reduced the dry cell weight of ST26 and intracellular content of trehalose, which suggests that the addition of ammonium sulfate makes ST26 cells leak trehalose into the medium. ST26 effectively propagated in minimal medium containing trehalose as a sole carbon source, which suggests that trehalose serves as a carbohydrate reserve of this organism.

Physical training in patients with valvular heart disease after surgery.

The necessity, the methodology and clinical benefit of physical training were evaluated in 85 patients with valvular heart surgery. In 21 patients who had undergone the exercise stress test before surgery, corrective valvular surgery increased maximal oxygen uptake (max.VO2) from 15.4 before to 18.9 ml/min/kg, while 11 (52%) of them failed to increase exercise capacity over 5 METs. Of the total 85 patients, 41 (58%) again showed reduced exercise capacity in the initial postoperative stress test, suggesting that a return to work might be difficult without rehabilitation in these patients. We then compared two training programs: program A of short duration and frequent exercise and program B of longer duration and less frequent exercise, both using a bicycle exercise set at an intensity of 70% of the max.VO2. Both programs similarly increased max.VO2, while patients preferred program A, suggesting that exercise of longer duration could not be tolerated because of deconditioning. Program A was then prescribed to 62 patients, and it increased max.VO2 from 18.2 to 20.7 ml/min/kg after 4 weeks training without any complication. In 9 patients who served as controls undergoing no physical training, no spontaneous improvement in exercise capacity was observed. Of the 76 patients who received either program A or B, 28 patients failed to increase the max.VO2 by 10% or more. These patients presented atrial fibrillation, a cardiothoracic ratio greater than or equal to 60% or exercise-induced ST depression more frequently, suggesting that residual cardiac dysfunction might inhibit the training effects.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mechanism of exercise-induced ST segment deviation in myocardial infarction: a 201T1-myocardial scintigraphic study].

Exercise-induced ST segment deviation was investigated using thallium-201 myocardial scintigraphy and correlated with coronary artery lesions in 25 patients with old myocardial infarction. Seven of eight patients without ST deviation showed no reversible perfusion defect by near maximal exercise, and six had no significant stenosis in the coronary arteries perfusing the non-infarcted area. During exercise, ST segment depression was induced in 12 patients and six of them developed a reversible perfusion defect in the non-infarcted area, associated with significant stenosis of the corresponding coronary arteries. Remaining six patients, however, did not show a reversible perfusion defect and four of them had no significant stenosis of the coronary arteries perfusing the non-infarcted area. In nine patients with exercise-induced ST segment elevation in leads with Q waves, a reversible perfusion defect was not detected in seven (78%) and five (71%) of them had no significant coronary artery stenosis as well. Four patients developed both ST segment elevation in leads with Q waves and ST segment depression in other leads. One patient who had significant coronary artery stenosis in the non-infarcted area and showed a reversible perfusion defect developed 1.5 mm ST elevation in II, III, a VF leads and 4 mm ST depression in precordial leads. In the remaining three patients who did not show a reversible perfusion defect and significant coronary artery stenosis in the non-infarcted area, ST depressions were less than 2 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

[A study of nursing systems in transition in developed countries].

The present study was designed to investigate nursing systems in other countries in comparison with the current system in Japan, and thereby assess how nursing personnel should be in order to improve the quality of nursing. The study focused on the actual situation of the nursing system and licensed practical nurses (LPNs) or second-level nurses similar to LPNs in other countries. The survey was conducted in regard to six countries considered to be advanced in the development of nursing activities and likely to provide useful suggestions for the future direction of nursing in Japan: Australia, Canada, France, Sweden, the United Kingdom and the United States. Questionnaires were sent to the heads or staff of a total of 29 organizations, including WHO Collaborating Centers and professional organizations for nursing, in these countries. Nineteen organizations responded (response rate: 65.5%), and an effective response with completed questionnaire forms was obtained from 15 organizations. In addition, an interview survey was conducted on three nursing administration and education experts in the United States in order to acquire clear understanding of the actual state of nursing in health care practice. The results were as follows: 1. Six countries (Japan included) excluding France had LPNs. Educational preparation for LPNs has been discontinued in the United Kingdom. 2. The number of nurses per 1,000 population was lowest in Japan: the total number of registered nurses (RNs) and LPNs in Japan was less than the number of RNs in the United Kingdom. Only in Japan the proportions of LPNs and RNs were similar, while in other countries of number of LPNs was one-third to one-fourth of the number of RNs. 3. In the five other countries having LPNs, the nurse's competency or scope of practice was clearly defined for both LPNs and RNs. In contrast, no clear line was drawn between the two in Japan. 4. The length of education required for LPNs ranged from 11 to 14 years (including the period of compulsory education) and was shortest in Japan (11 years). The educational requirement for admission to LPN school in Japan was 9 years of compulsory education (graduation from junior high school), whereas in other countries it was at the level of senior high school graduation. 5. Four countries had conversion programs for LPNs to become RNs, and the conversion courses were positioned within the framework of higher education comparable to the university level. 6. In the United Kingdom, where the educational preparation for LPNs has been discontinued, nurses are included in a single higher level profession. At the same time there was found to be a need to train and educate auxiliary personnel in order to maintain multi-level care services. Because of the increasing tendency toward advanced medical technology and highly specialized medical care associated with the rapidly increasing care needs in the community, the current educational preparation for LPNs in Japan in unsatisfactory as a training and educational system for nursing manpower to cope with the current situation. The above findings suggest that the education system for LPNs be reviewed with a view to discontinuing it and consolidating nursing education in Japan.