Reliability, validity, and sensitivity of the Japanese version of the University of California Los Angeles scleroderma clinical trial consortium gastrointestinal tract instrument: Application to efficacy assessment of intravenous immunoglobulin administration.

This study aimed to develop and assess the reliability, validity, and sensitivity of the Japanese version of the University of California Los Angeles Scleroderma Clinical Trial Consortium gastrointestinal tract (GIT) Instrument 2.0 (the GIT score), as an evaluation tool for GIT symptoms in systemic sclerosis (SSc). The Japanese version of the GIT score was constructed using the forward-backward method. The reliability and validity of this instrument were evaluated in a cohort of 38 SSc patients. Correlation analysis was conducted to assess the relationship between the GIT score and existing patient-reported outcome measures. Additionally, the sensitivity of the GIT score was examined by comparing GIT scores before and after intravenous immunoglobulin (IVIG) administration in 10 SSc-myositis overlap patients, as IVIG has recently demonstrated effectiveness in alleviating GIT symptoms of SSc. As a result, the Japanese version of the GIT score exhibited internal consistency and a significant association with the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease. Furthermore, the total GIT score, as well as the reflux and distention/bloating subscales, displayed moderate correlations with the EuroQol 5 dimensions (EQ-5D) pain/discomfort subscale and the Short Form-36 body pain subscale. Notably, following IVIG treatment, there was a statistically significant reduction in the total GIT score and multiple subscales. We first validated the Japanese version of the GIT score in Japanese SSc patients in real-world clinical settings. This instrument holds promise for application in future clinical trials involving this patient population.

Utility of nailfold capillary assessment for predicting pustulotic arthro-osteitis in palmoplantar pustulosis based on a prospective cohort study.

BACKGROUND: Pustulotic arthro-osteitis (PAO) is 1 of the most serious comorbidities associated with palmoplantar pustulosis (PPP). Risk factors of PAO development are not well-known. OBJECTIVE: To evaluate the clinical significance of nailfold capillary (NFC) changes in patients with PPP. METHODS: We conducted a prospective cohort study in a population of 102 PPP patients. Correlations of NFC abnormalities, including nailfold bleeding and enlarged capillaries, with the prevalence of PAO, the incidence of new PAO, and serum levels of cytokines were analyzed. RESULTS: Detailed examination revealed that of 102 PPP patients, 52 without PAO and 50 with PAO. Both nailfold bleeding and enlarged capillaries were significantly more frequent in patients with PAO (50.0% vs 92.0%, P < .0001; 50.0% vs 94.0%, P < .0001). In addition, PPP patients without PAO were prospectively observed before they developed PAO (mean 28 months [1-52 months]). Multivariate analysis suggested that these NFC abnormalities were predictors of PAO development (hazard ratio 3.37, 95% confidence interval 1.13-10.07; 3.37, 1.13-10.07) and guselkumab prevent PAO development (0.093, 0.012-0.76). The degree of NFC abnormalities correlated with the severity of PAO and serum cytokine levels. LIMITATIONS: All participants were Japanese. CONCLUSION: NFC abnormalities could be predictors of PAO in PPP patients, and their degree indicators of disease severity.

Inter-rater reliability of the Conversational Assessment of Neurocognitive Dysfunction.

BACKGROUND: Cognitive assessment through communication has been the focus of recent studies because the conventional cognitive tests are often considered invasive for older people. Although the Conversational Assessment of Neurocognitive Dysfunction is designed to assess cognitive function non-invasively, inter-rater reliability remains unclear. The current study investigated the Conversational Assessment of Neurocognitive Dysfunction's reliability. METHODS: The Conversational Assessment of Neurocognitive Dysfunction was used by four clinical psychologists, who evaluated 38 older people with and without cognitive dysfunction. One clinical psychologist evaluated the assessment based on face-to-face communication with participants, while the other clinical psychologists evaluated it according to the audio data in the digital voice recorder. All clinical psychologists were blind to the results of other conventional cognitive tests and details surrounding participants' daily living activities. RESULTS: The univariate correlation scores of the Conversational Assessment of Neurocognitive Dysfunction among evaluators ranged from 0.61 to 0.79, all of which were significant (P < 0.001). The intraclass correlation coefficient was 0.64 (P < 0.001, 95% CI: 0.53-0.79 for agreement) and 0.67 (P < 0.001, 95% CI: 0.45-0.77 for consistency). The Conversational Assessment of Neurocognitive Dysfunction score of all evaluators was significantly associated with conventional cognitive tests like the Mini-Mental State Examination (P < 0.001). CONCLUSIONS: The findings suggested that the Conversational Assessment of Neurocognitive Dysfunction has moderate to good inter-rater reliability and high concurrent validity as a cognitive assessment tool, and it would be useful in clinical practice.

Trends in stroke, cardiovascular disease, and medical expenditure under a community-based long-term stroke prevention program.

BACKGROUND: Evidence on the effects of preventive measures for noncommunicable disease is urgently needed for low-income and middle-income countries suffering from stroke epidemics along with population aging. OBJECTIVES: We sought to examine the impact of a community-based stroke prevention program on incidences of stroke and ischemic heart disease, mortality from cardiovascular disease, and medical expenditure. METHODS: Trends in the incidences of stroke and ischemic heart disease were documented in a Japanese rural community, Kyowa, from 1981 through 2015. Trends in mortality from cardiovascular disease and in medical expenditures were compared between Kyowa and its surrounding municipalities from 1981 through 2004. RESULTS: In Kyowa, the age-and-sex-adjusted incidences of stroke and of ischemic heart disease decreased by half (from 4.1 to 1.9 and from 1.5 to 0.7 per year/1000 persons, respectively) over the past 35 years. A similar decreasing trend was observed for the age-and-sex-adjusted mortality from cardiovascular disease, and this decreasing trend occurred earlier than that in the surrounding municipalities. The medical expenditures for cardiovascular disease became lower in Kyowa than in the surrounding municipalities over time. CONCLUSION: Our study's findings suggest that a community-based stroke prevention program augmented the decline in the incidences of stroke and ischemic heart disease, mortality from cardiovascular disease, and attenuated the increase in medical expenditures for cardiovascular disease.

Utility of nailfold capillary assessment for predicting psoriatic arthritis based on a prospective observational cohort study.

OBJECTIVES: PsA is one of the most serious comorbidities associated with psoriasis. While the early intervention in PsA is demanded, risk factors of PsA development are not well-known. This is the first prospective study to evaluate the clinical significance of nailfold capillary (NFC) changes in patients with psoriasis. METHODS: We conducted a prospective cohort study in a population of 449 psoriasis patients who had not been treated with systemic therapy or topical finger therapy. NFCs were observed by dermoscopy and capillaroscopy, and the correlation of NFC abnormalities, including nailfold bleeding (NFB) and enlarged capillaries, with the prevalence of PsA, incidence of new PsA, and serum levels of TNF-a, IL-17A and IL-23 were analysed. RESULTS: Detailed examination at the time of inclusion revealed that of 449 patients, 236 had Psoriasis vulgaris (PsV) and 213 had PsA. Both NFB and enlarged capillaries were significantly more frequent in patients with PsA (34.7% vs 84.5%, P < 0.0001; 25.4% vs 100%, P < 0.0001). In addition, PsV patients were prospectively observed before they developed PsA (mean 21 months, 95% CI 2, 77 months). Multivariate analysis suggested that the appearance of NFB and enlarged capillaries was a predictor of PsA development (HR 2.75, 95% CI 1.38, 5.47 and HR 4.49, 95% CI 2.25, 8.96, respectively). The degree of NFC abnormalities also correlated with the severity of PsA and serum cytokine levels. CONCLUSIONS: NFC abnormalities were suggested to be a predictor of PsA in psoriasis patients, and at the same time, its degree could be an indicator of disease severity.

Assessment of synthetic red cell therapy for extremely preterm ovine fetuses maintained on an artificial placenta life-support platform.

BACKGROUND: Artificial placenta therapy (APT) is an experimental care strategy for extremely preterm infants born at 21-24 weeks' gestation. In our previous studies, blood taken from the maternal ewe was used as the basis of priming solutions for the artificial placenta circuit. However, the use of maternal blood as a priming solution is accompanied by several challenges. We explored the use of synthetic red cells (hemoglobin vesicles; HbV) as the basis of a priming solution for APT used to manage extremely early preterm ovine fetuses. METHODS: Six ewes with singleton pregnancies at 95 d gestation (term = 150 d) were adapted to APT and maintained with constant monitoring of key vital parameters. The target maintenance period was 72 h in duration. A synthetic red cell solution consisting of HbV, sheep albumin and electrolytes was used as priming solutions for the APT circuit. Fetuses were evaluated on gross appearance, physiological parameters and bleeding after euthanasia. RESULTS: Two out of six APT fetuses were successfully maintained for the targeted 72 h experimental period with controllable anemia (>10 g/dl) and methemoglobinemia (<10%) using an infusion of blood transfusion and nitroglycerin delivered >1 h after APT commencement, a sufficient period of time to cross-match blood products and screen for viral agents of concern. CONCLUSIONS: Extremely preterm sheep fetuses were maintained for a period of up to 72 h using APT in combination with circuit priming using a synthetic red cell (HbV) preparation. Although significant further refinements are required, these findings demonstrated the potential clinical utility of synthetic blood products in the eventual clinical translation of artificial placenta technology to support extremely preterm infants.

Diagnostic Specificity of Cerebral Magnetic Resonance Imaging for Punctate White Matter Lesion Assessment in a Preterm Sheep Fetus Model.

Recent studies, using magnetic resonance imaging (MRI) to assess white matter injury in preterm brains, increasingly recognize punctate white matter lesions (PWML) as the primary lesion type. There are some papers showing the relationship between the size and number of PWML and the prognosis of infants. However, the histopathological features are still unknown. In this study, we experimentally induced periventricular leukomalacia (PVL) in a sheep fetus model, aiming to find whether MRI can visualize necrotic foci (small incipient lesions of PVL) as PWML. Three antenatal insults were employed to induce PVL in preterm fetuses at gestational day 101-117: (i) hypoxia under intrauterine inflammation, (ii) restriction of artificial placental blood flow, and (iii) restriction of artificial placental blood flow after exposure to intrauterine inflammation. MRI was performed 3-5 days after the insults, and standard histological studies of the PVL validated its findings. Of the 89 necrotic foci detected in histological samples from nine fetuses with PVL, 78 were visualized as PWML. Four of the lesions detected as abnormal findings on MRI could not be histologically detected as corresponding abnormal findings. The diagnostic sensitivity and positive predictive values of histologic focal necrosis visualized as PWML were 0.92 and 0.95, respectively. The four lesions were excluded from these analyses. These data suggest that MRI can visualize PVL necrotic foci as PWML 3-5 days after the injury induction. PWML can spontaneously become obscure with time after birth, so their accurate diagnosis in the acute phase can prevent overlooking mild PVL.

Assessment of the risk of malnutrition due to aspiration pneumonia and oral feeding difficulty.

INTRODUCTION: Introduction: many patients with acute-phase swallowing disorders experience malnutrition, which can be caused by oral intake difficulties. Many diseases can cause swallowing difficulties such as aspiration pneumonia, and it is, therefore, necessary to consider the risk of malnutrition during oral feeding therapy in patients with aspiration pneumonia. Objectives: we aimed to evaluate the risk of malnutrition in patients with aspiration pneumonia and other diseases. Methods: the participants comprised 62 patients (45 males, 17 females) with acute-phase swallowing disorders who underwent speech therapy (ST) for swallowing rehabilitation. The patients were divided into four groups: 1) oral feeding with pneumonia, 2) parenteral feeding with pneumonia, 3) oral feeding without pneumonia, and 4) parenteral feeding without pneumonia. The serum albumin and total protein levels were measured to evaluate malnutrition, and swallowing ability was assessed using the Fujishima grade. Results: at the time of ST initiation, serum albumin levels were significantly higher in the oral feeding with pneumonia and oral feeding without pneumonia groups than in the parenteral feeding with pneumonia and parenteral feeding without pneumonia groups. The Fujishima grades differed significantly between the pneumonia/parenteral feeding group and the non-pneumonia/parenteral feeding group. Conclusions: patients with difficulty in swallowing due to aspiration pneumonia were at higher risk of malnutrition than were those without these difficulties. These findings suggest that the nutritional status of parenterally fed patients who developed pneumonia may be inherently poorer than that of orally fed patients.

INTRODUCCIÓN: Introducción: muchos pacientes que padecen trastornos de la deglución en fase aguda experimentan desnutrición, que pueden estar causados por dificultades en la ingesta oral. Muchas enfermedades pueden causar dificultades de la deglución, incluida la neumonía por aspiración, y, por lo tanto, es necesario considerar el riesgo de desnutrición durante la terapia de alimentación oral en los pacientes que padecen neumonía por aspiración. Objetivos: nuestro objetivo fue evaluar el riesgo de desnutrición en pacientes que padecen neumonía por aspiración y otras enfermedades. Métodos: los participantes comprendían 62 pacientes (45 hombres, 17 mujeres) con trastornos de la deglución en fase aguda que se sometieron a tratamiento logopédico (speech therapy, ST) por rehabilitación de la deglución. Los pacientes se dividieron en cuatro grupos: 1) alimentación oral con neumonía, 2) alimentación parenteral con neumonía, 3) alimentación oral sin neumonía y 4) alimentación parenteral sin neumonía. La albúmina sérica y los niveles totales de proteínas se calcularon para evaluar la desnutrición, y la capacidad de deglución se evaluó usando el grado de Fujishima. Resultados: en el momento de iniciar el tratamiento logopédico (speech therapy, ST), los niveles de albúmina en suero fueron significativamente más altos en los grupos de alimentación oral con neumonía y alimentación oral sin neumonía que en los grupos de alimentación parenteral con neumonía y alimentación parenteral sin neumonía. Los grados de Fujishima difieren de forma significativa entre los grupos de alimentación oral/alimentación parenteral con neumonía y los grupos de alimentación oral/alimentación parenteral sin neumonía. Conclusiones: los pacientes que poseen dificultades de la deglución debido a neumonía por aspiración presentan un riesgo mayor de desnutrición que aquellos que no poseen estas dificultades. Estas conclusiones sugieren que el estado nutricional de los pacientes alimentados parenteralmente que desarrollaron una neumonía puede ser inherentemente más pobre que el de los pacientes alimentados oralmente.

Multi-dry-electrode plate sensor for non-invasive electrocardiogram and heart rate monitoring for the assessment of drug responses in freely behaving mice.

Monitoring of electrocardiogram (ECG) and heart rate (HR) is essential in a wide range of experiments. For conscious animal studies, telemetry is the preferred approach; however, it requires 1-3 weeks of recovery after surgical device-implantation. The present paper describes a novel multi-dry-electrode plate (MDEP) sensor system to monitor ECG/HR in freely behaving mice without the need for surgery for device/electrode implantation. The MDEP sensor is a rectangular plate with 15 gold-plated stripe pattern electrodes, on which a mouse can walk around freely, and detects ECG whenever ≥2 paws (footpads) come in contact with the electrodes. Here we show that the MDEP sensor detected distinct QRS complexes which, were fragmented due to locomotion and insufficient perspiration on the footpads. Nonetheless, the HR calculated from the QRS complexes were similar to the HR calculated from R-R intervals simultaneously recorded from lead-II ECG (difference = 0.0 ±â€¯0.16 ms) as part of the validation exercise. Also, the archetypal responses to isoproterenol and metoprolol injections were successfully detected as a significantly elevation (+151 ±â€¯15 bpm) and reduction (-77 ±â€¯6 bpm) in HR, respectively, compared to vehicle at 20-60 min postdose. Conversely, the P wave was rarely identifiable unless signal averaging was undertaken. These results indicate a potential utility for the MDEP-sensor system for cardiac pharmacological studies. In addition, signal averaging appeared to be effective for detection of ECG intervals such as PR and QT, although the QT cannot be measured in the mouse heart as there is no T wave.

Assessment of endothelial function during the loading phase of infliximab in psoriasis: a potential predictor of its drug survival.

BACKGROUND: Tumor necrosis factor inhibitors decrease the risk of cardiovascular events in moderate to severe psoriasis, but the association between their effects on endothelial function and those on skin lesions has not been well studied. We investigated the association between infliximab effects on endothelial function during the loading phase and those on skin lesions in patients with psoriasis. METHODS: We evaluated endothelial function with reactive hyperemia-peripheral arterial tonometry index (RHI) in 15 patients with psoriasis before the first and third infusions of infliximab. Patients were stratified into two groups; those who maintained Psoriasis Area and Severity Index (PASI) 75 response for more than 6 months (defined as responders) and the others (defined as nonresponders). RESULTS: Six weeks after the initiation of infliximab (before the third infusion), PASI scores were significantly improved compared with baseline, while RHI values were not altered in the whole patient group. However, when the responders and the nonresponders were analyzed separately, RHI values tended to be decreased before the third infusion compared with baseline in the nonresponders, while being unchanged in the responders. Importantly, the difference in ∆RHI reached a statistical significance between the two groups, and the cutoff value (mean - 2 standard deviation of RHI values in the responders) identified the nonresponders with 67% of sensitivity and 100% of specificity. CONCLUSIONS: The decrease in RHI values before the third infusion may serve as a predictor for the long-term unfavorable effect of infliximab on psoriatic skin lesions.

Conversational assessment of cognitive dysfunction among residents living in long-term care facilities.

BACKGROUND: There are some existing barriers posed by neuropsychological tests that interfere with the assessment of cognitive functioning by staff who work in long-term care facilities. The purpose of this study was to investigate the feasibility of assessing cognitive function through conversation. METHODS: A total of 100 care staff was randomly selected as participants. Each staff member evaluated cognitive function in one to three residents using the Conversational Assessment of Neurocognitive Dysfunction (CANDy), which is a screening test for dementia using conversation. Other scales used were the Mini-Mental State Examination (MMSE), Behavioral Pathology in Alzheimer' s Disease (BEHAVE-AD), and quality-of-life questionnaire for the elderly with dementia (QOL-D). RESULTS: A total of 80 care staff members and 158 residents were analyzed. When the CANDy involved an evaluation based on face-to-face communication, it demonstrated significant correlations with the MMSE, BEHAVE-AD, and several indices of the QOL-D (e.g. negative affect and actions, communication ability, restless, and spontaneity and activity). In contrast, when the CANDy involved an evaluation based on an impression of a typical conversation, it only demonstrated significant relationships with the MMSE and the spontaneity and activity index of the QOL-D. CONCLUSIONS: Conversational assessment is a useful means to assess cognitive functioning and to promote interactions between residents and care staff in long-term care facilities.

Cost-effectiveness and budget impact analyses of a long-term hypertension detection and control program for stroke prevention.

OBJECTIVES: The nation-wide, community-based intensive hypertension detection and control program, as well as universal health insurance coverage, may well be contributing factors for helping Japan rank near the top among countries with the longest life expectancy. We sought to examine the cost-effectiveness of such a community-based intervention program, as no evidence has been available for this issue. METHODS: The hypertension detection and control program was initiated in 1963 in full intervention and minimal intervention communities in Akita, Japan. We performed comparative cost-effectiveness and budget-impact analyses for the period 1964-1987 of the costs of public health services and treatment of patients with hypertension and stroke on the one hand, and incidence of stroke on the other in the full intervention and minimal intervention communities. RESULTS: The program provided in the full intervention community was found to be cost saving 13 years after the beginning of program in addition to the fact of effectiveness that; the prevalence and incidence of stroke were consistently lower in the full intervention community than in the minimal intervention community throughout the same period. The incremental cost was minus 28,358 yen per capita over 24 years. CONCLUSION: The community-based intensive hypertension detection and control program was found to be both effective and cost saving. The national government's policy to support this program may have contributed in part to the substantial decline in stroke incidence and mortality, which was largely responsible for the increase in Japanese life expectancy.

Assessment of a new piezoelectric transducer sensor for noninvasive cardiorespiratory monitoring of newborn infants in the NICU.

BACKGROUND: Electrocardiogram (ECG) and impedance pneumography (IPG), the most widely used techniques for cardiorespiratory monitoring in the neonatal intensive care unit (NICU), have the disadvantage of causing skin damage when used for very premature newborn infants. To prevent skin damage, we designed a new piezoelectric transducer (PZT) sensor. OBJECTIVE: To assess the potential of the PZT sensor for cardiorespiratory monitoring in the NICU. METHODS: The PZT sensor was placed under a folded towel under a neonate to detect an acoustic cardiorespiratory signal, from which heart rate (HR) and breathing rate (BR) were calculated, together with simultaneous ECG/IPG recording for 1-9 days for long and brief (1-min) assessment. RESULTS: The brief assessment showed average correlation coefficients of 0.92 +/- 0.12 and 0.95 +/- 0.02 between instantaneous HRs/BRs detected by the PZT sensor and ECG/IPG in 27 and 11 neonates examined. During the long assessment, the HR detection rate by the PZT sensor was approximately 10% lower than that by ECG (82.6 +/- 12.9 vs. 91.8 +/- 4.1%; p = 0.001, n = 27), although comparable (90.3 +/- 4.1 vs. 92.5 +/- 3.4%, p = 0.081) in approximately 70% (18/27) of neonates examined; BR detection rate was comparable between the PZT sensor and IPG during relatively stable signal conditions (95.9 +/- 4.0 vs. 95.3 +/- 3.5%; p = 0.38, n = 11). The PZT sensor caused neither skin damage nor body movement increase in all neonates examined. CONCLUSION: The PZT sensor is noninvasive and does not cause skin irritation, and we believe it does provide a reliable, accurate cardiorespiratory monitoring tool for use in the NICU, although the issue of mechanical-ventilation noise remains to be solved.

Establishment of long-term monitoring system for blood chemistry data by the national health and nutrition survey in Japan.

AIM: We established a monitoring system for the annual follow-up of blood chemistry data obtained by the National Health and Nutrition Survey in Japan. METHODS: Blood chemistry testing has been entrusted to SRL Inc. We used two external quality control assurance programs established by the Japan Medical Association (JMA) and by CDC/CRMLN during the previous 8-year period. Ten analytes were measured: total cholesterol, HDL cholesterol, triglycerides, urea nitrogen, uric acid, creatinine, AST (GOT), ALT (GPT), gamma-GT (gamma-GTP), and glucose. Total error (TE) was calculated from accuracy by the JMA program and precision by internal quality control of SRL. The permissible range of TE values was determined to be 50% of the evaluation limit on one side in the evaluation criteria of the College of American Pathologists (CAP). When TE fell within the permissible range, the follow-up of annual changes was considered possible. RESULTS: Annual follow-up of blood chemistry data was considered possible for all the analytes except urea nitrogen. Based on this study, new permissible TE ranges are proposed. CONCLUSION: We confirmed the functioning of the monitoring system for the annual follow-up of blood chemistry data obtained by the National Health and Nutrition Survey in Japan.

Caregiver burden for impaired elderly Japanese with prevalent stroke and dementia under long-term care insurance system.

BACKGROUND: Limited data are available on caregiver burden for stroke and dementia patients. We examined the associations of prevalent stroke and dementia with family caregiver burden in Japanese general populations. METHODS: A total of 916 Japanese home caregivers, whose family members were covered by long-term care insurance, responded to the caregiver burden questionnaire. The questionnaire included the caregiver's age, sex and employment status, the patient-caregiver relationship, the patient's history of stroke, symptoms of dementia, care levels under long-term care insurance and the Zarit Caregiver Burden Interview. RESULTS: The mean total score from the Zarit Caregiver Burden Interview was 12% higher in patients with stroke than in those without (p = 0.02) and 40% higher in those with dementia than in those without (p < 0.001). Compared with nonstroke patients without dementia, the mean total score was 21% higher in stroke patients without dementia (p = 0.01), 49% higher in nonstroke patients with dementia (p < 0.001) and 55% higher in stroke patients with dementia (p < 0.001). After adjustment for the caregiver's age, sex and employment status, the patient-caregiver relationship, and the patient's care level and community, the higher scores remained statistically significant for nonstroke patients with dementia and for stroke patients with dementia but not for stroke patients without dementia. CONCLUSIONS: Prevalent stroke and, more strongly, dementia were associated with increased family caregiver burden. Among patients with dementia, the presence of stroke did not enhance caregiver burden further.

[Pharmacoeconomic analysis of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor therapy for the secondary prevention of coronary heart disease].

OBJECTIVE: The pharmacoeconomics of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (pravastatin) therapy were evaluated using data from an open-labeled, randomized, controlled trial (PCS: Prevention of Coronary Sclerosis study) with a two-year follow-up period. METHODS: Patients with a serum total cholesterol concentration of between 180 and 219 mg/dL at baseline were randomly assigned to two groups: the pravastatin group (n=54) and the group that did not receive cholesterol-lowering drugs (no-pravastatin group, n=66). A cost-minimization analysis and a cost-effectiveness analysis were then performed from the perspective of a health insurance company, using insurance information obtained from the subjects. In the cost-minimization analysis, the expected costs associated with percutaneous transluminal coronary angioplasty (PTCA) and the pravastatin prescription were compared; the total medication costs between the two groups were also compared. In the cost-effectiveness analysis, the estimated savings per event-free year were calculated. RESULTS: The median cost of a PTCA procedure was 1,323,492 yen. The expected insurance cost for two years was 182,532 yen per patient in the pravastatin group and 224,444 yen per patient in the no-pravastatin group. The cost-minimization analysis showed that the cost of healthcare for the no-pravastatin group was higher than that for the pravastatin group. The mean total cost of medication was 729,849 yen per patient in the pravastatin group and 989,606 yen per patient in the no-pravastatin group. The cost-effectiveness ratio for coronary heart disease was 2,766,994 yen. CONCLUSION: Pravastatin therapy in normocholesterolemic patients with coronary sclerosis seems to have an excellent pharmacoeconomic profile.

Quantitative trait loci analysis for growth and carcass traits in a Meishan x Duroc F2 resource population.

We constructed a pig F2 resource population by crossing a Meishan sow and a Duroc boar to locate economically important trait loci. The F2 generation was composed of 865 animals (450 males and 415 females) from four F1 males and 24 F1 females and was genotyped for 180 informative microsatellite markers spanning 2,263.6 cM of the whole pig genome. Results of the genome scan showed evidence for significant quantitative trait loci (<1% genomewise error rate) affecting weight at 30 d and average daily gain on Sus scrofa chromosome (SSC) 6, carcass yield on SSC 7, backfat thickness on SSC 7 and SSC X, vertebra number on SSC 1 and SSC 7, loin muscle area on SSC 1 and SSC 7, moisture on SSC 13, intramuscular fat content on SSC 7, and testicular weight on SSC 3 and SSC X. Moreover, 5% genomewise significant QTL were found for birth weight on SSC 7, average daily gain on SSC 4, carcass length on SSC 6, SSC 7, and SSC X and lightness (L value) on SSC 3. We identified 38 QTL for 28 traits at the 5% genomewise level. Of the 38 QTL, 24 QTL for 17 traits were significant at the 1% genomewise level. Analysis of marker genotypes supported the breed of origin results and provided further evidence that a suggestive QTL for circumference of cannon bone also was segregating within the Meishan parent. We identified genomic regions related with growth and meat quality traits. Fine mapping will be required for their application in introgression programs and gene cloning.

Evaluation of functional disability using the health assessment questionnaire in Japanese patients with systemic sclerosis.

OBJECTIVE: To assess whether the functional disability in Japanese patients with systemic sclerosis (SSc) can be adequately evaluated by the Health Assessment Questionnaire (HAQ) developed in the United States. METHODS: The HAQ was completed by 121 Japanese patients with SSc, in whom SSc-specific physical examinations and laboratory tests were performed at the same time. Clinical findings associated with the disability index (DI) and individual components of the HAQ were examined using Student's t tests and Pearson's correlation tests. Logistic regression analysis was used to identify clinical findings that independently contributed to the increase in the HAQ-DI score. RESULTS: Japanese patients with SSc had significant functional disability, especially in the categories of eating and gripping, but the degree of disability was much less than was reported in previous studies carried out in the US. The increase in the HAQ-DI score was strongly correlated with increased total skin score, reduced oral aperture, reduced hand extension, increased finger flexion, subcutaneous calcinosis, flexion contractures, increased erythrocyte sedimentation rates, decreased percent vital capacity, and vascular involvement (p < 0.001 for all correlations). Multivariate logistic regression analysis showed that hand extension was the most important and an independent correlate of the HAQ-DI. CONCLUSION: Our multicenter, cross-sectional study has demonstrated that the self-administered HAQ is a valuable assessment tool of functional disability in Japanese SSc patients, who have social customs different from Americans, but functional disability measured by the HAQ is potentially influenced by ethnic variability.