The Potential of a Stroke Registry Using Diagnosis Procedure Combination Data from All Hospitals in a Japanese Prefecture.

OBJECTIVES: In Japan, many hospitals have joined the diagnosis procedure combination/per-diem payment system (DPC/PDPS), which provides unified information about inpatients. DPC data are digitized, and the number of participating hospitals has increased recently. Herein, we evaluated the potential of a stroke registry constructed using these unified DPC data from all hospitals in the Iwate Prefecture, Japan. METHODS: The proportion of cerebrovascular disease (CVD) cases registered by DPC-participating hospitals was calculated and compared with all registered cases in the Iwate Stroke Registry in 2008-2017. The cases were categorized based on sex, age-groups, stroke subtypes, and first-ever onset or recurrence onset. Based on the registered cases in the stroke registry, the accuracy of the CVD cases extracted by the disease name from DPC data of a typical core hospital and a typical noncore hospital was evaluated. RESULTS: Of the 71 hospitals with 9,992 beds in the Iwate Prefecture in 2018, 50 hospitals with 8,316 beds participated in the DPC system. The proportion of registered cases from participating hospitals was 95.2% (44,779/47,018) for all stroke types (95.6% men and 94.9% women), 94.3% for cerebral infarction, 97.0% for intracerebral hemorrhage, and 98.7% for subarachnoid hemorrhage, whereas it was 95.7% for first-ever onset and 94.1% for recurrent onset. The proportion of registered cases decreased with increasing patient age. Attending doctors and researchers registered 486 and 41 CVD cases from the core and noncore hospitals, respectively, whereas 455 and 46 CVD cases were extracted from the DPC data of these hospitals, respectively. This yielded 86.6% sensitivity, 99.3% specificity, 92.5% positive predictive value, and 98.7% negative predictive value for the core hospital; these values were 92.7%, 98.6%, 82.6%, and 99.5%, respectively, for the noncore hospital. DISCUSSION/CONCLUSIONS: The stroke registry constructed using DPC data from all hospitals of Iwate Prefecture appears to be adequately complete and accurate.

Poor self-rated health predicts the incidence of functional disability in elderly community dwellers in Japan: a prospective cohort study.

BACKGROUND: Although previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers. The association between SRH and functional disability, defined as certification of the long-term care insurance (LTCI) system, in Japanese elderly community dwellers was examined in this study. METHODS: A total of 10,690 individuals (39.5% men, mean age of 71.4 years) who were 65 years of age or more who did not have a history of cardiovascular disease or LTCI certification were followed in this prospective study for 10.5 years. SRH was classified into four categories: good, rather good, neither good nor poor, and poor. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) for the incidence of functional disability among the SRH groups for each sex. RESULTS: The number of individuals with functional disability was 3377. Men who rated poor for SRH scored significantly higher for functional disability (HR [95% confidence interval]: poor = 1.74 [1.42, 2.14]) while women who rated rather good, neither good nor poor, and poor scored significantly higher for functional disability (rather good =1.12 [1.00, 1.25], neither good nor poor = 1.29 [1.13, 1.48], poor = 1.92 [1.65, 2.24]: p for trend < 0.001 in both sexes). CONCLUSION: Self-rated health, therefore, might be a useful predictor of functional disability in elderly people.

Ten-Year Cerebrovascular Disease Trend Occurrence by Population-based Stroke Registry in an Aging Japan Local Prefecture.

BACKGROUND: Cerebrovascular diseases are a major cause of death for Japanese people, but up-to-date national or prefectural incidences are unknown. We calculated the last 10-year cerebrovascular diseases incidence in an aging local prefecture in Japan with 1.2 million inhabitants and used the data to predict the future incidence. METHODS: We retrospectively analyzed inventory surveys from the Iwate Stroke Registry (data from the whole Iwate Prefecture) from 2008 to 2017. We compared age-adjusted and age-specific incidence rates between the first half period from 2008 to 2012 and the last half period from 2013 to 2017. We used the incidence change rate and the forecasted population number to predict the future incidence. RESULTS: In a decade, the age-adjusted cerebrovascular diseases incidence rate per 100,000 person-years in the Japan standard population decreased from 212.1 to 176.8 in men and from 123.1 to 97.0 in women. The age-specific incidence rates and the number of incidences of those younger than 55 years decreased only slightly, but those of people 55 years or older decreased. The total number of incidence in 2040 will decrease to two-thirds of the value in 2015, but the number of incidence of those 85 years and older will increase by 2040. CONCLUSIONS: The cerebrovascular diseases rate and number of incidence decreased during the last decade and will decrease in the future, but the incidence in the oldest-old will increase. Specific nursing care and social measures to treat cerebrovascular diseases in the oldest-old will be needed.

[Severe Traumatic Brain Injury due to Repeated Minor Head Injury while Snowboarding:A Report of Two Cases].

Second impact syndrome occurrs when a patient who has sustained an initial head injury, most often a concussion, sustains a second head injury before the symptoms associated with the first have fully resolved, leading to rapid brain swelling and herniation. However, the underlying pathophysiology remains unclear. We report two cases in which acute subdural hematoma with rapid malignant brain swelling developed after repeated head traumas while snowboarding. One patient did not undergo craniotomy and died 21h after symptom onset. The other underwent urgent decompressive craniotomy and experienced prolonged disturbance of consciousness. Axial susceptibility-weighted magnetic resonance imaging performed 1 month after surgery in the second patient revealed multiple microbleeds in the subcortical white matter and parasagittal white matter in the bilateral hemispheres. These findings indicate that axonal injuries from angular acceleration may contribute to the rapid malignant brain swelling and poor outcomes.

Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population　- Comparisons With C-Reactive Protein and Urinary Albumin.

BACKGROUND: The ability of cardiovascular biomarkers to predict the incidence of stroke subtypes remains ill-defined in the general population.Methods and Results:The blood levels of B-type natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) and urinary albumin corrected by urinary creatinine (UACR) were determined in a general population (n=13,575). The ability to predict the incidence of ischemic stroke subtypes (lacunar, atherothrombotic, cardioembolic) for each biomarker was assessed based on the area under the receiver-operating characteristic curve (AUC-ROC) and using Cox proportional hazard modeling. The predictive abilities of UACR and hs-CRP for any subtype of ischemic event were found to be suboptimal. However, the ability of BNP to predict the incidence of cardioembolic stroke was excellent (AUC-ROC=0.81). When BNP was added to established stroke risk factors, the ability to predict cardioembolic stroke in terms of the AUC-ROC significantly improved (4-year follow-up, P=0.018; 8-year follow-up, P=0.009). Furthermore, when BNP was added to the JPHC score, the ability to predict cardioembolic stroke was significantly improved (net reclassification improvement=0.968, P<0.0001: integrated discrimination improvement=0.039, P<0.05). CONCLUSIONS: In the general population, plasma BNP was an excellent biomarker for predicting the incidence of cardioembolic stroke when used alone or in combination with established stroke risk factors.

Risk of stroke and heart failure attributable to atrial fibrillation in middle-aged and elderly people: Results from a five-year prospective cohort study of Japanese community dwellers.

BACKGROUND: The relative and absolute risks of stroke and heart failure attributable to atrial fibrillation (AF) have not been sufficiently examined. METHODS: A prospective study of 23,731 community-dwelling Japanese individuals was conducted. Participants were divided into two groups based on the presence or absence of prevalent AF (n = 338 and n = 23,393, respectively). Excess events (EE) due to AF and relative risks (RRs) determined using the non-AF group as the reference for incident stroke and heart failure were estimated using Poisson regression stratified by age groups (middle-aged: 40-69 years old; elderly: 70 years of age or older) after adjustment for sex and age. RESULTS: There were 611 cases of stroke and 98 cases of heart failure during the observation period (131,088 person-years). AF contributed to a higher risk of stroke both in middle-aged individuals (EE 10.4 per 1000 person-years; RR 4.88; 95% confidence interval [CI], 2.88-8.29) and elderly individuals (EE 18.3 per 1000 person-years; RR 3.05; 95% CI, 2.05-4.54). AF also contributed to a higher risk of heart failure in middle-aged individuals (EE 3.7 per 1000 person-years; RR 8.18; 95% CI, 2.41-27.8) and elderly individuals (EE 15.4 per 1000 person-years; RR 7.82; 95% CI, 4.11-14.9). Results obtained from multivariate-adjusted analysis were similar (stroke: EE 8.9 per 1000 person-years; RR 4.40; 95% CI, 2.57-7.55 in middle-aged and EE 17.4 per 1000 person-years; RR 2.97; 95% CI, 1.99-4.43 in elderly individuals; heart failure: EE 3.1 per 1000 person-years; RR 7.22; 95% CI, 2.06-25.3 in middle-aged and EE 14.1 per 1000 person-years; RR 7.41; 95% CI, 3.86-14.2 in elderly individuals). CONCLUSIONS: AF increased the risk of stroke by the same magnitude as that reported previously in Western countries. AF increased the RR of heart failure more than that in Western populations.

The Impact and Effectivity of an Inventory Survey for a Stroke Registry in Iwate Prefecture.

BACKGROUND: The accuracy of a stroke registration program in Iwate prefecture was greatly affected by cooperation from medical facilities and doctors in the field. The number of registered cases from noncore hospitals was less, but the accuracy of registration was unknown. This report presents the impact and effectivity of an inventory survey of the stroke registry. SUBJECTS AND METHODS: Details of subjects living in coastal and northern regions of Iwate Prefecture who developed a cerebrovascular attack between 2012 and 2014 were obtained from the Iwate Stroke Registry through an inventory survey. Annual incidence rate from core hospitals and noncore hospitals were compared. To evaluate factors registered from noncore hospitals, multivariate analyses were performed for sex, age, living area, type of stroke, and past history of cerebrovascular diseases. RESULTS: Annual crude incidence rate for 100,000 residual populations were 428.8 in men and 351.2 in women from core hospitals and 38.5 in men and 43.7 in women from noncore hospitals. Ratios of noncore hospitals against all the hospitals were 8.3% for men and 11.1% for women. Multivariate analyses for age, ischemic type of stroke, past history of cerebrovascular diseases, and living in areas without a core hospital were significant; however, sex was not a significant factor. CONCLUSION: The inventory survey of the stroke registry program in the Iwate prefecture was useful to prevent missing data of stroke cases from noncore hospitals, including patients who are elderly, with ischemic stroke onset, with a past history of stroke, or living in areas without core hospitals.

Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan.

BACKGROUND: While it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known. METHODS: Standardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area. RESULTS: The prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, respectively. In male subjects, these respective values were 4.9% and 3.3%, and in female subjects they were 1.6% and 0.6%. The SPRs for AF were 2.53 (95% confidence interval [CI], 1.88-3.19) in all dialysis patients, 1.80 (95% CI, 1.30-2.29) in male dialysis patients, and 2.13 (95% CI, 0.66-3.61) in female dialysis patients. CONCLUSIONS: The prevalence of AF in dialysis patients was twice that in the population-based controls. Since AF strongly contributes to a higher risk of cardiovascular mortality and morbidity in the general population, further longitudinal studies should be conducted regarding the risk of several outcomes attributable to AF among Japanese dialysis patients.

Comparison between urine albumin-to-creatinine ratio and urine protein dipstick testing for prevalence and ability to predict the risk for chronic kidney disease in the general population (Iwate-KENCO study): a prospective community-based cohort study.

BACKGROUND: This study compared the combination of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) vs. eGFR and urine protein reagent strip testing to determine chronic kidney disease (CKD) prevalence, and each method's ability to predict the risk for cardiovascular events in the general Japanese population. METHODS: Baseline data including eGFR, UACR, and urine dipstick tests were obtained from the general population (n = 22 975). Dipstick test results (negative, trace, positive) were allocated to three levels of UACR (<30, 30-300, >300), respectively. In accordance with Kidney Disease Improving Global Outcomes CKD prognosis heat mapping, the cohort was classified into four risk grades (green: grade 1; yellow: grade 2; orange: grade 3, red: grade 4) based on baseline eGFR and UACR levels or dipstick tests. RESULTS: During the mean follow-up period of 5.6 years, 708 new onset cardiovascular events were recorded. For CKD identified by eGFR and dipstick testing (dipstick test ≥ trace and eGFR <60 mL/min/1.73 m(2)), the incidence of CKD was found to be 9 % in the general population. In comparison to non-CKD (grade 1), although cardiovascular risk was significantly higher in risk grades ≥3 (relative risk (RR) = 1.70; 95 % CI: 1.28-2.26), risk predictive ability was not significant in risk grade 2 (RR = 1.20; 95 % CI: 0.95-1.52). When CKD was defined by eGFR and UACR (UACR ≥30 mg/g Cr and eGFR <60 mL/min/1.73 m(2)), prevalence was found to be 29 %. Predictive ability in risk grade 2 (RR = 1.41; 95 % CI: 1.19-1.66) and risk grade ≥3 (RR = 1.76; 95 % CI: 1.37-2.28) were both significantly greater than for non-CKD. Reclassification analysis showed a significant improvement in risk predictive abilities when CKD risk grading was based on UACR rather than on dipstick testing in this population (p < 0.001). CONCLUSIONS: Although prevalence of CKD was higher when detected by UACR rather than urine dipstick testing, the predictive ability for cardiovascular events from UACR-based risk grading was superior to that of dipstick-based risk grading in the general population.

Elevated blood pressure at the first measurement predicts cardiovascular disease independently from the subsequent second reading in men, but not in women.

BACKGROUND AND METHODS: There have been no investigations concerning the association of each blood pressure (BP) reading with future cardiovascular disease (CVD) when multiple measurements are taken on one occasion. This community-based, prospective cohort study (n = 23 344, mean age = 62.4 years) investigated the associations between the BP obtained from the first and second of two consecutive measurements on one occasion and future cardiovascular events in men and women. RESULTS: During the mean follow-up of 5.5 years, 624 CVD events were identified. On the Cox regression analysis of age- and BP-adjusted models, the increased CVD risk of a hypertensive first measurement (systolic BP ≥ 140 mmHg) was independent from the second measurement in men. Even in subjects without a hypertensive second measurement, the CVD risk of the hypertensive first measurement was increased in men. In women, despite a hypertensive first measurement, subjects with a systolic BP < 130 mmHg on the second measurement showed a significantly reduced risk for CVD compared with subjects who retained a hypertensive level during the two measurements. CONCLUSIONS: An elevated BP on the first measurement should not be disregarded for CVD risk estimation in men, even if the second BP moves to the normal range. In women, elevated BP on the first measurement may have relatively less meaning for CVD prediction if the second BP shifts to a normal range.

Extent of flood damage increased cerebrovascular disease incidences in Iwate prefecture after the great East Japan earthquake and tsunami of 2011.

BACKGROUND: Several studies have reported on increases in the incidence of cardiovascular and cerebrovascular diseases after huge earthquakes. An increase in the incidence of cerebrovascular diseases was observed after the Great East Japan Earthquake and Tsunami of 2011. To assess whether tsunami damage or the earthquake was responsible for this trend, we assessed the relative impact of earthquake magnitude and flood damage on cerebrovascular disease. METHODS: A total of 12 coastal municipalities facing the epicenter were divided into 4 flood severity groups according to the percentage of people living in the flooded areas (<20, 20-40, 40-60, and ≥60%) and 3 groups according to the Japanese Meteorological Agency seismic intensity of the main shock (<4.5, 4.5-5.0 and ≥5.0). The standard incidence ratios (SIRs) of cerebrovascular diseases in the first 4 weeks after the disaster compared with the same periods in 2008-2010 were calculated for each flood severity group and each earthquake severity group. Odds ratios (ORs) of disease incidence and the adjusted ORs for seismic intensity (using the Mantel-Haenszel method) between the higher (≥40%) and the lower flooded area (<40%) were compared with the same periods in 2008-2010. Likewise, ORs and adjusted ORs for flood severity in the high seismic intensity area (≥4.9) were compared with those in the low seismic intensity area (<4.9). RESULTS: SIRs increased with the increased flood severity: 0.94 (0.59-1.30) at <20%, 1.02 (0.70-1.34) at 20-40%, 1.26 (0.66-1.86) at 40-60% and 1.98 (1.25-2.72) at ≥60%. However, SIRs did not increase with increased seismic intensity: 0.95 (0.60-1.29) at <4.5, 1.52 (1.07-1.98) at 4.5-5.0 and 1.17 (0.80-1.54) at ≥5.0. ORs and adjusted ORs for seismic intensity in the high flood area compared with the low flood area were significant: 1.68 (1.07-2.65) and 1.78 (1.08-2.96), respectively. However, ORs and adjusted ORs for flood severity in the high seismic intensity area compared with the low intensity area were not significant: 1.33 (0.82-2.17) and 1.19 (0.62-2.31), respectively. CONCLUSIONS: Cerebrovascular disease incidences after the Great East Japan Earthquake and Tsunami of 2011 increased because of tsunami damage and not because of the earthquake magnitude.

Influence of the great East Japan earthquake and tsunami 2011 on occurrence of cerebrovascular diseases in Iwate, Japan.

BACKGROUND AND PURPOSE: Little information is available regarding the occurrence of cerebrovascular diseases after tsunamis. This study was performed to determine the influence of the tsunami damage caused by the Great East Japan earthquake on occurrence of cerebrovascular diseases. METHODS: Subjects from the coastline and inland areas of Iwate Prefecture who developed cerebrovascular diseases before and after the disaster were included in the analysis. Standardized incidence ratios of 2011 against the previous 3 years were calculated in two 4-week periods before and four 4-week periods after the disaster, according to stroke subtype, sex, age group, and flood damage. RESULTS: The standard incidence ratio for cerebrovascular diseases was 1.20 (1.00-1.40) in the first 4-week period after the disaster and was not significant in other periods. The standard incidence ratios in the first 4-week period for cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage were 1.22 (0.98-1.46), 1.15 (0.76-1.55), and 1.20 (0.52-1.88), respectively. These values were 1.51 (1.19-1.88) for men, 1.35 (1.06-1.64) for subjects aged ≥ 75 years, and 1.35 (1.06-1.64) for the high flooding areas. The standard incidence ratio of cerebral infarction in the first 4-week period for men aged ≥ 75 years in the high flooding areas was 2.34 (1.34-3.34). CONCLUSIONS: In the areas highly flooded by the tsunami caused by the Great East Japan earthquake, the occurrence of cerebral infarction among elderly men more than doubled in the first 4 weeks after the disaster.

Comparison of predictability of future cardiovascular events between chronic kidney disease (CKD) stage based on CKD epidemiology collaboration equation and that based on modification of diet in renal disease equation in the Japanese general population--Iwate KENCO Study.

BACKGROUND: Whether estimated glomerular filtration rate (eGFR) calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Study equation (eGFRCKDEPI) improves risk prediction compared to that calculated using the Modification of Diet in Renal Disease (MDRD) study equation (eGFRMDRD) has not been examined in a prospective study in Japanese people. METHODS AND RESULTS: Participants (n=24,560) were divided into 4 stages (1, ≥90; 2, 60-89 (reference); 3a, 45-59; 3b+ <45 ml·min(-1)·1.73 m(-2)) according to eGFRCKDEPI or eGFRMDRD. Endpoints were all-cause death, myocardial infarction (MI) and stroke. Area under the receiver operating characteristic curves (95% confidence intervals) for predicting all-cause death, MI and stroke by eGFRCKDEPI vs. eGFRMDRD were 0.680 (0.662-0.697) vs. 0.582 (0.562-0.602); 0.718 (0.665-0.771) vs. 0.642 (0.581-0.703); and 0.656 (0.636-0.676) vs. 0.576 (0.553-0.599), respectively. Multivariate-adjusted Cox regression and Poisson regression analysis results were similar for adjusted incidence rates and adjusted hazard ratios in each corresponding stage between the 2 models and no differences were found in model assessment parameters. Net reclassification improvement (NRI) for predicting all-cause death, MI and stroke were estimated to be 6.7% (P<0.001), -1.89% (P=0.029) and -0.20% (P=0.421), respectively. CONCLUSIONS: Better discrimination was achieved using eGFRCKDEPI than eGFRMDRD on univariate analysis. NRI analysis indicated that the use of eGFRCKDEPI instead of eGFRMDRD offered a significant improvement in reclassification of death risk.

Factors related to tooth loss among community-dwelling middle-aged and elderly Japanese men.

BACKGROUND: Using data from a large-scale community-based Japanese population, we attempted to identify factors associated with tooth loss in middle-aged and elderly men. METHODS: A total of 8352 men aged 40 to 79 years who lived in the north of the main island of Japan and underwent health checkups were enrolled between 2002 and 2005. Number of teeth was assessed by the question, "How many teeth do you have (0, 1-9, 10-19, or ≥20)?". On the basis of the answer to this question, participants were classified into 2 groups (≤19 teeth or ≥20 teeth). Using multivariate logistic regression, factors related to having 19 or fewer teeth were estimated. RESULTS: The numbers (percentages) of participants who had 0, 1 to 9, 10 to 19, and 20 or more teeth were 1764 (21.1%), 1779 (21.3%), 1836 (22.0%), and 2973 (35.6%), respectively. Among the participants overall and those aged 65 to 79 years, having 19 or fewer teeth was significantly associated with older age, smoking status (current smoking and ex-smoking), and low education level. In addition, men with 19 or fewer teeth were more likely to have a low body mass index and low serum albumin level and less likely to be current alcohol drinkers. Among men aged 40 to 64 years, but not men aged 65 to 79 years, those with 19 or fewer teeth were more likely to have a low serum high-density lipoprotein cholesterol level and high glycosylated hemoglobin (HbA1c) level. CONCLUSIONS: Smoking, low education level, and poor nutritional status were associated with tooth loss among middle-aged and elderly Japanese men.

Incidence rate of cerebrovascular diseases in northern Japan determined from the Iwate Stroke Registry with an inventory survey system.

BACKGROUND: Long-term stroke registries in large populations often fail to maintain accuracy. This study presents an inventory survey system for stroke registries and the incidence rate of cerebrovascular diseases in a region with the highest stroke mortality rate in Japan. METHODS: Using the data of the stroke registry determined with the inventory survey from 2004 to 2008 in northern Iwate Prefecture, with a population of 235,280 (111,584 men and 123,696 women), the age-specific annual incidence rates, the age-adjusted annual incidence rates, and the ratio of incidence rate relative to mortality rate of the cerebrovascular diseases were investigated. RESULTS: A total of 3415 cases (1714 men and 1701 women) were registered and analyzed in this study. The age-adjusted incidence rates by the 1985 model population of Japan and by the world standard population (range 35-64 years) were 100.4 and 89.4 per 100,000 population in men and 49.8 and 29.7 in women for cerebral infarction; 53.6 and 77.2 in men and 34.2 and 39.5 in women for intracerebral hemorrhage; 12.9 and 23.3 in men and 21.1 and 34.6 in women for subarachnoid hemorrhage; and 166.9 and 189.8 in men and 105.0 and 103.7 in women for all subtypes. The ratios of incidence rate relative to mortality rate were 1.66 for all stroke subtypes, 1.69 for cerebral infarction, 1.76 for intracerebral hemorrhage, and 1.31 for subarachnoid hemorrhage. CONCLUSIONS: High incidence rates of cerebrovascular diseases were revealed in the stroke registry with a good inventory survey in northern Iwate Prefecture, Japan.

Association between vascular endothelial dysfunction and stroke incidence in the general Japanese population: Results from the tohoku medical megabank community-based cohort study.

Background: Flow-mediated dilation (FMD) measures vascular endothelial function by evaluating the vasodilatory response of blood vessels to increased blood flow. Nevertheless, the association between FMD and stroke incidence in a general population remains unclear. This study investigated the association between vascular endothelial function and stroke incidence in the general Japanese population. Methods: Based on cohort data from the Tohoku Medical Megabank Community-based Cohort Study, participants aged ≥18 years were recruited from Iwate Prefecture, with the final sample comprising 2952 subjects. Results: The FMD level was 0.5%-27.1%, with a median of 5.0% (interquartile, 4.2%-11.3%). The mean follow-up period was 5.5 ± 1.8 years (range, 0.6-6.9 years). After dividing the participants into two subgroups according to the median FMD value, a multivariate Cox regression analysis adjusting for gender, age, smoking, alcohol consumption, systolic blood pressure, low-density lipoprotein cholesterol, estimated glomerular filtration rate, N-terminal pro-brain natriuretic peptide, high-sensitivity cardiac troponin T and hemoglobin A1c revealed that a lower FMD value was strongly associated with incidences of total stroke (hazard ratio[HR] = 2.13, 95% confidence interval[CI] = 1.48-3.07, p < 0.001), ischemic stroke (HR = 3.33, 95%CI = 2.00-5.52, p < 0.001), nonlacunar stroke (HR = 2.77, 95%CI = 1.49-5.16, p = 0.001), and lacunar stroke (HR = 5.12, 95%CI = 1.74-16.05, p = 0.003). Conclusions: This study showed that a low FMD value might reflect vascular endothelial dysfunction and then was associated with ischemic stroke incidence in the general Japanese population, suggesting that FMD can be used as a tool to identify future stroke risk.

Association between the extent of house collapse and urine sodium-to-potassium ratio of victims affected by the 2011 Great East Japan Earthquake and Tsunami: a cross-sectional study.

People who experience natural disasters have a high risk of developing cardiovascular diseases. We investigated the association between the extent of house collapse and urine sodium-to-potassium (UNa/K) ratio of 2011 Great East Japan Earthquake victims. We used the baseline survey data of the Tohoku Medical Megabank Project Community-Based Cohort Study of 29 542 individuals (aged 20-74 years) residing in the affected areas. The UNa/K ratio was calculated using spot urinary electrolyte values. Analysis of covariance was used to calculate the multivariate-adjusted geometric means of the UNa/K ratio in the following groups stratified according to the self-reported extent of house collapse: total collapse (TC), half collapse (HC), partial collapse (PC), and no damage (ND). Multivariable-adjusted odds ratios (ORs) for a high UNa/K ratio were calculated using logistic regression. The TC, HC, PC, and ND groups comprised 5 359 (18.1%), 3 576 (12.1%), 7 331 (24.8%), and 13 276 (44.9%) participants, respectively. The TC (3.33; 95% confidence interval [CI], 3.28-3.38), HC (3.37; 3.30-3.43), and PC (3.32; 3.28-3.37) groups had significantly higher multivariate-adjusted geometric means of the UNa/K ratio than the ND (3.24; 3.21-3.27) group. The multivariable-adjusted ORs (95% CIs) for a high UNa/K ratio in the TC, HC, and PC groups vs. the ND group were 1.07 (0.99-1.15), 1.20 (1.11-1.31), and 1.20 (1.12-1.28), respectively. Similar associations between house collapse and UNa/K ratio were observed for both sexes. We report that victims of a natural disaster tend to have a diet with high sodium-to-potassium ratio.

Rapid weight change as a predictor of disability among community-dwelling Japanese older adults.

AIM: To fill the knowledge gap regarding weight change and the onset of disability in community-dwelling Japanese older adults, we investigated the potential effects of rapid weight change on disability risk as defined by Japan's long-term care insurance (LTCI) system. METHODS: We analyzed data from a longitudinal study of 10 375 community-dwelling older Japanese adults (≥65 years) who were not LTCI needs certified at baseline and joined the study from 2002 to 2005. Weight change (percentage) was calculated by subtracting participants' weight in the previous year from that measured during a physical examination at study commencement. The five weight-change categories ranged from sizable weight loss (≤ -8.0%) to sizable weight gain (≥ +8.0%). Disability was defined according to LTCI certifications at follow-up. Hazard ratios (HRs) and 95% confidence intervals were calculated for new-onset disability using a Cox proportional hazards model that fitted the proportional subdistribution hazards regression model with weights for competing risks of death. RESULTS: During the mean 10.5-year follow-up, 2994 participants developed a disability. Sizable weight loss (HR [95% confidence intervals], 1.41 [1.17-1.71]) and weight loss (1.20 [1.05-1.36]) were significant predictors of disability onset. Sizable weight gain (1.45 [1.07-1.97]) corresponded to severe disability. Stratified analyses by lifestyle and initial body mass index categories revealed more pronounced associations between weight change and disability risk in the unhealthy lifestyle and below initial normal body mass index groups. CONCLUSIONS: Rapid and sizable weight gain could be additional criteria for disability risk in older adults. Geriatr Gerontol Int 2023; 23: 809-816.

Use of magnetic resonance imaging to identify the edge of a dural tear in an infant with growing skull fracture: a case study.

PURPOSE: Growing skull fractures can be a challenging surgical problem facing pediatric neurosurgeons. The goal of this manuscript was to describe an effective surgical method used to treat a growing skull fracture. METHODS: We present a case study of a 2-month-old boy who fell from his mother's arms and hit his head on the floor; he underwent X-ray, magnetic resonance (MR), and computed tomography (CT) imaging before cranioplasty with dural plasty. RESULTS: X-ray performed on admission revealed a diastatic fracture with a gap of 8 mm in the right frontal bone and a linear fracture in the right occipital bone. X-ray performed 37 days after injury demonstrated that the gap had increased to 25 mm, and the patient was diagnosed with a growing skull fracture of the right parietal bone. Cranioplasty with dural plasty was performed on day 39. A combination of MR and CT images enabled the edge of the dural tear to be plotted on a three-dimensional image of the skull, and this was used to estimate the location of the edge of the dural tear on the scalp. CONCLUSIONS: We achieved excellent outcomes in terms of bony coverage and dural plasty. The combination of MR and CT images may be recommended for surgical repair of growing skull fracture in children.

Plasma B-type natriuretic peptide is useful for cardiovascular risk assessment in community-based diabetes subjects: comparison with albuminuria.

Diabetes mellitus (DM) is a strong risk factor for cardiovascular (CV) disease. Plasma B-type natriuretic peptide (BNP) levels are elevated in various types of cardiac diseases. Increased plasma BNP levels have been reported to be associated with CV risk in apparently healthy individuals. However, no studies have yet examined the specific value of plasma BNP for predicting CV incidence in unselected DM subjects in a community-based population.In a community-based DM cohort (n = 1,059, mean = 66 years), baseline BNP levels were determined, and CV events were followed and captured prospectively. The cohort was divided by plasma BNP quintiles. The Cox proportional hazard model was used to determine the relative hazard ratios (HR) among the quintiles. In addition, the effects of adding the plasma BNP or urine albumin-to-creatinine ratio (UACR) to an established CV risk scoring model was examined by calculating the area under the receiver operating characteristic (ROC) curve (AUC).During the 5.7 year follow-up period, CV events were identified in 65 of the DM cohort. There was a significant association between plasma BNP levels and CV event rate (P < 0.001). HR was significantly increased in the highest quintile compared to the lowest (HR = 4.38; 95%CI 1.69 -11.84). The AUC generated from ROC analysis of the Framingham risk score for predicting general CV events was improved by adding BNP testing (from 0.66 to 0.74; P = 0.05), but not by adding UACR (from 0.66 to 0.67; P = 0.49).In a community sample of people with DM, plasma BNP levels above the 80 percentile are directly associated with CV risk, and measurement of plasma BNP alone or in conjunction with an established CV risk score is of value in predicting CV events in these subjects.