Association of marine-origin n-3 polyunsaturated fatty acids consumption and functional mobility in the community-dwelling oldest old.

OBJECTIVE: To examine whether habitual dietary intake of marine-origin n-3 polyunsaturated fatty acids (MOPUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are associated with functional mobility in the community-dwelling oldest old, 85 years or older, who are at high risk for physical disability. DESIGN: A cross-sectional study. SETTING: A community-based survey conducted at university research center or home-based. PARTICIPANTS: Four hundred seventeen (189 men, 228 women) out of 542 participants in the baseline examination of the Tokyo Oldest Old Survey on Total Health, a community-based ongoing longitudinal study among the oldest old living in the center of Japan. MEASUREMENTS: Habitual dietary intake of MOPUFA was assessed by the brief-type self-administered diet history questionnaire (BDHQ), and functional mobility was assessed by the timed up and go test. Plasma inflammatory biomarkers (C-reactive protein, interleukin-6 and tumor necrosis factor-α) were measured. We evaluated the cross-sectional association between habitual intake of MOPUFA and functional mobility using multivariate logistic regression analysis. Prior to the analysis, validation of BDHQ in this study was confirmed among 190 participants (96 men, 94 women) based on the EPA and DHA concentrations in the erythrocyte membrane phospholipids as reference. RESULTS: Moderate correlation between estimated dietary intake of EPA/DHA and concentration of EPA/DHA in the erythrocyte membrane phospholipids was obtained (Spearman's r=0.29-0.58, p<0.01). Multivariate logistic regression analysis revealed that a lower habitual intake of EPA+DHA was significantly associated with poor functional mobility in men but not in women (OR (95% CI) per 1 SD increase of EPA+DHA intake; 0.55 (0.33-0.91), 0.88 (0.59-1.32), men and women respectively). CONCLUSIONS: Habitual intake of MOPUFA was associated with functional mobility in community-dwelling oldest old men.

Intrapartum care at a tertiary hospital in Cambodia: a survey using the Bologna Score.

BACKGROUND: developing countries strive to reduce maternal- and child mortality, partly through establishing health centres/hospitals with skilled birth attendants. The aim of this study was to describe childbirth care, by the use of the Bologna Score at a tertiary hospital in Cambodia with approximately 8,500 births per year. METHODS: a prospective cross-sectional study. The Bologna Score instrument, which reflects the adaption of evidence-based care and attitudes of caregivers, was used for data collection and three study specific questions. The midwives collected data from 177 consecutive childbirths. RESULTS: all women were assisted by a skilled birth attendant, the majority by a midwife (63%) and the remaining women by a physician (35%) or midwife student under supervision. A spontaneous vaginal birth was planned for 82% of the women. All women seeking care at the hospital survived the childbirth. A full 5-point Bologna Score, suggesting evidence-based management for women with spontaneous vaginal birth, was not achieved for any of the women. The use of supine position and lack of an accompanying person in the birth room, were items responsible for loss of points. Partogram and skin-to-skin contact between baby and mother were items noted for three quarters of the planned vaginal births, and the item 'Absence of labour augmentation', was affirmed to a great extent. Little more than half of the women had an episiotomy and almost 16% of the children had an Apgar score <7 at 5 mins. CONCLUSION: the Bologna Score was easy to use and pointed at items that could be improved. It was satisfying that all women survived, but alarming that 16% of the children had a low Apgar score. The findings suggest that childbirth care can be improved at the hospital.

Assessment of dural arteriovenous fistulas of the cavernous sinuses on 3D dynamic MR angiography.

BACKGROUND AND PURPOSE: Flow voids within the cavernous sinuses and/or certain venous drainage on spin-echo MR imaging and time-of-flight (TOF) flow enhancement on MR angiography (MRA) have indicated high-velocity shunt flow and have been used for screening patients with dural arteriovenous fistulas (DAVFs) of the cavernous sinuses. In this investigation, the capabilities of 3D dynamic MRA as a flow-independent approach and those of conventional MR imaging techniques were compared with selective angiography for the diagnosis of DAVFs of the cavernous sinuses. MATERIALS AND METHODS: This retrospective study involved 18 patients with angiographically proved DAVFs of the cavernous sinuses and 12 control subjects. Sixteen partially overlapping sequential MR images were acquired on contrast-enhanced 3D dynamic MRA between the petrosal bone and the orbital roof. Two experienced observers blinded to the clinical data and results of angiography independently graded 3D dynamic MRA, fast spin-echo T2-weighted imaging (FSE T2WI), and TOF MRA. RESULTS: The average area under the receiver operating characteristic curve values and interobserver kappa scores for the diagnosis of DAVFs on 3D dynamic MRA, FSE T2WI, and TOF MRA were 0.99, 0.89, and 0.95; and 0.92, 0.71, and 0.73, respectively. Those for the diagnosis of anterior, posterior, and retrograde cortical venous drainage on 3D dynamic MRA were 0.72, 0.95, and 0.81; and 0.56, 0.50, and 0.49, respectively. CONCLUSION: In this small series, screening 3D dynamic MRA directly demonstrates DAVFs of the cavernous sinuses and has improved diagnostic capability.

Lifting of lesions during endoscopic mucosal resection (EMR) of early colorectal cancer: implications for the assessment of resectability.

BACKGROUND AND STUDY AIMS: This study assessed the indications for and limitations of endoscopic mucosal resection (EMR) for early colorectal cancer, focusing on the way in which the lesion lifts after submucosal injection. PATIENTS AND METHODS: The study included 94 patients with early colorectal cancer who received EMR treatment. The lifting of the lesion after submucosal injection was analyzed (classified as completely lifted/soft; completely lifted/hard; incompletely lifted; and non-lifted) along with the endoscopic findings, pathological findings, and clinical course. RESULTS: Almost all completely lifted/soft lesions were mucosal cancers. Some of the completely lifted/hard lesions were staged as sm2. The incompletely lifted lesions included stages sm1 to sm3. Non-lifting lesions were almost always deeper than sm3. The lifting condition was significantly associated with the depth of invasion, and the lesion type was related to the extent of lifting but not to tumor size or recurrent disease. Recurrent disease was noted in three patients who underwent piecemeal EMR. CONCLUSIONS: The indication for EMR is easily assessed on the basis of the lifting characteristics of the tumor after submucosal injection, which was found to be significantly related to the depth of invasion. The factor limiting the indication for EMR is not the size of a tumor, but its lifting condition.

[To promote hospital activities for the patient safety].

Recently, increasing news reports of adverse events in health care suggest the need for reconsideration of the role and responsibility of health care in society. In this paper, after reviewing the history and the characteristics of the health care delivery system in Japan, central issues of patient safety management are sorted out. A good example of a team approach that has prevented progress of a serious disease is also presented. It is suggested that the total quality improvement activities are useful for the patient safety management.

[A study on resource based relative values for visiting nursing services].

PURPOSE: The purpose of this study was to investigate the resource based relative values of visiting nursing services, and to analyze the relationships between the relative values and the dimensions of nursing service(time, mental effort and physical effort). METHODS: We interviewed nurses at 20 Home-visit nursing care stations (HVNCS) in the Metropolitan area using the resource based relative value questionnaires. We asked nurses about relative values of "Total Work", and also measured relative weight of 3 dimensions of nursing services. Total Work was defined as comprehensive evaluation of nursing services, with careful consideration of intensity as well as duration. With the dependent variable as Total Work and independent variables as the 3 dimensions, multiple regression analyses were carried out. Furthermore we examined the degree of influence on Total Work by service type and individual respondent. To examine the validity of the results, we timed nursing services and compared the measured time with the answered time. RESULTS: The 107 respondents were all female and their average age was 36.6 years old. They had HVNCS experience of 2.2 years and 95.3% nurses had experience of hospital nursing. "Total Work" and 3 dimension scores were standardized using common logarithms. "Total Work" of every service significantly differed among service types. The 3 dimensions explained 54.6% of Total Work in the multiple regression analysis. Service type explained 3.3% of Total Work. Individual respondent explained 16.0% of Total Work. Answered time and measured time were not significantly different with nursing services. CONCLUSIONS: Although Total Work was somewhat influenced by individual respondent, most of variation was explained by 3 dimensions. Thus, it could be concluded that Total Work is an index of nursing resource input. A further investigation about influence of patients' condition on Total Work is necessary in the future.

[Assessment of a new non-invasive cerebral blood flow determination method using the brain uptake ratio of 99mTc-ECD].

We modified the method of calculating brain uptake ratio (BUR) reported previously, and devised a new non-invasive cerebral blood flow measurements for 99mTc-ECD that does not require blood sampling. This method yields BUR that is not influenced by the gamma camera type and the choice of acquisition-reconstruction conditions, when corrected by the SPECT/Planar cross calibration coefficient. A good correlation was observed between the BUR obtained by this method and the cerebral blood flow (CBF) obtained by the 123I-IMP continuous arterial blood sampling method. And based on these results, it is now possible to convert BUR to CBF. This method is applicable to small field type of gamma cameras, and it is expected to be useful as a routine test.

[Assessment for intelligence on patients with Pick's disease].

In contrast to Alzheimer's disease, it is unclear whether the MMS (Mini-Mental State) or the RCPM (Raven's Coloured Progressive Matrices) is clinically useful as a mental test battery in patients with Pick's disease, and it has not been fully evaluated whether intelligence of these patients really deteriorate along with the staging of dementia. The present study aimed to make these problems clear. We administered the MMS and the RCPM to 17 cases of Pick's disease, including 7 cases with predominantly frontal lobe atrophy and 10 cases with predominantly temporal lobe atrophy, which were all classified into 3 groups according to the staging of dementia by using the NM scale (New Clinical Scale for Rating of Mental States). We also investigated whether these patients had "Denkfaulheit" (laziness of thinking) and/or "gogi" aphasia (word meaning aphasia), which may affect performances on the mental test batteries. Two cases with predominantly frontal lobe atrophy and 5 cases with predominantly temporal lobe atrophy were assessed by the same examinations several years later. In cases with predominantly frontal lobe atrophy, all the patients presented with "Denkfaulheit". However, the mean RCPM score was normal in the mildly damaged patients, suggesting that their intelligence were relatively preserved. In the moderately and severely damaged groups, their intelligence could not be assessed owing to their severe "Denkfaulheit". In cases with predominantly temporal lobe atrophy, all the patients had "gogi" aphasia and 3 cases of the severely damaged groups presented with "Denkfaulheit".(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlates associated with desire by caregivers to transfer elderly from home care to institutions].

A questionnaire survey was performed on 183 caregivers of elderly listed on a roster for utilization of day service or short stay service in nursing homes in order to elucidate the following; actual conditions of care at home; percentage desiring to transfer to institutionalized care in hospital, nursing homes and geriatric intermediate care facilities, reasons for continuing care at home; and factors relating to desire for transferring to institutionalized care. Results are as follows; Major items of troubles expressed by caregivers were; "high stress and mental fatigue" (55.7%), "unable to freely go out from home" (54.1%), and "loss of personal time" (46.4%), "heavy burden from food preparation, body discharge disposal and bathing of the elderly" (40.0%). 41.5% of caregivers expressed desire for transfer of elderly to institutional care. Of those who desire transfer to hospital care, 21.1% were continuing home care due to non-availability of appropriate hospital, 44.7% because of inability to meet the demand for assisting in the nursing of the elderly during hospitalization, 26.3% because they were turned away by the hospital. Where transfer to nursing homes was desired but not realized, 20.0% reported lack of nursing homes nearby. Where desire was for transfer to geriatric intermediate care facilities, lack of such facilities was reported by 37.5%. Analysis was performed to elucidate the factors that determine whether a caregiver would demand a transfer to an institutions. Main factors were age of caregiver, family relationships, family finance, the frequency of occurrence of problems with home care, and whether or not they themselves would accept institutional care when that time came. Main factors associated with the cared elderly desiring institutional care were eating ability, speaking ability and mental status score. Analysis of the problems related to desire to transfer to institutional care showed their factors such as whether or not there was room available for home care, financial family burden, perceived interference with personal time by the home care, and perception of appropriateness of coping with symptom change of elderly, all have significant relationships.

[Assessment of left ventricular contraction with LV Emax during cardiopulmonary bypass in patients with open heart surgery].

There are few reports on the assessment of left ventricular contraction during cardiopulmonary bypass (CPB) in open heart surgery. LV Emax is thought to be a load-independent index of left ventricular function. We used a left ventricular conductance catheter to measure LV Emax from "non-working beating heart" during CPB in 16 patients who underwent open heart surgery. During CPB, at 45 minutes after aortic declamping, changes of heart rate with atrial pacing (120/min) did not change LV Emax, but after intravenous dobutamine administration (DOB, 10 micrograms/kg/min) LV Emax increased by 26% (p < 0.01). DOB increased LV Emax in 14 of 16 patients during CPB. These 14 patients were weaned from CPB without difficulty. But in 2 other patients DOB didn't increase LV Emax during CPB. In order to be weaned from CPB, the two patients needed epinephrine and intraaortic balloon pumping. We concluded that change of LV Emax made by intravenous administration of dobutamine is one of useful indexes to assess left ventricular contractility during cardiopulmonary bypass.

[Intraoperative assessment of left ventricular function with left ventricular pressure-volume relationships in patients with open heart surgery].

There are few reports on the assessment of the left ventricular function from left pressure-volume relationships intraoperatively in open heart surgery. LV Emax, Ea/Ees and EW/PVA efficiency were assessed intraoperatively by using a left ventricular conductance catheter in patients with aortocoronary bypass. After dobutamine administration (DOB, 10 micrograms/kg/min), LV Emax was increased by 33 +/- 23% during cardiopulmonary bypass (CPB) and 60 +/- 38% after weaning from CPB. Ea/Ees changed from 2.14 +/- 1.36 to 1.08 +/- 0.47 after weaning from CPB with dobutamine administration. EW/PVA efficiency changed from 52 +/- 12% to 66 +/- 10%. The change of LV Emax after dobutamine administration was correlated with the change of LV Emax after weaning from CPB and was correlated with Ea/Ees and EW/PVA efficiency after weaning from CPB. We concluded that measuring LV Emax before and after dobutamine administration during CPB is useful to assess left ventricular contraction clinically.

Assessment of endothelium-derived relaxing factor from human coronary arteries using the anti-platelet aggregatory effect.

Responses of human and canine washed platelets to thrombin in the presence and absence of human and canine coronary arteries were examined to establish a simple indirect measurement system for endothelium-derived relaxing factor (EDRF). Isolated rings of coronary arteries were obtained from either adult dogs or recipient hearts of cardiac transplant patients. The addition of small segments of canine and human coronary arteries with intact endothelia inhibited thrombin-induced platelet aggregation, but those with disrupted endothelia did not. Pretreatment of human and canine coronary arteries with the cyclo-oxygenase inhibitor indomethacin markedly attenuated the observed effect. The anti-platelet aggregatory effect of indomethacin-pretreated coronary artery was enhanced by acetylcholine or histamine, stimulators of EDRF production, or superoxide dismutase, which prolongs the half-life of EDRF, and inhibited by the EDRF inhibitor hemoglobin. These results suggest that endothelial cells of the human coronary artery, like the canine coronary artery, can produce EDRF which inhibits platelet aggregation, and that this simple experimental model is useful to examine the effect of environmental chemicals on EDRF in the human coronary artery.

A simple method for screening assessment of acute toxicity of chemicals.

We proposed a simple method for screening assessment of acute oral and dermal toxicity using only three rats and mice of each sex at each dose level. Animals were first treated with chemicals at a dose of 2000 mg/kg and were carefully observed for compound-related morbidity and mortality. If none of the animals died, the following toxicity tests were suspended. If some of the animals died, toxicity tests at doses of 200 and 20 mg/kg were performed. The approximate LD50 values calculated by this method showed little difference between two separate laboratories and were in good agreement with LD50 values reported in the literature. Our toxicological data also showed that LD50 values were about 2-2.5 times the MNLD (maximum non lethal dose) in acute oral and dermal toxicity. This meant that a chemical could be regarded as having an LD50 of about 4000 mg/kg or higher when there was no mortality at the dose of 2000 mg/kg. A chemical with such low toxicity would not require further testing for lethal effects. Therefore, this simple method combining the fixed-dose procedure with the limit test is suitable for determination of approximate LD50 values of chemicals and for screening for necessity for classical full LD50 test using many animals.