Invited Review Articles
Anatomical Ligament Reconstruction for Trapeziometacarpal Osteroarthritis
HITOSHI HIRATA and ETSUHIRO NAKAO
pg(s) 1- 7
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Ostoearthritis of the trapeziometacarpal (TMC) joint, the key joint in thumb opposition, is one of the most common diseases involving the hand, especially among middle-aged and elderly women, and can seriously impair overall hand function. Previous studies have indicated that joint instability from ligament insuffi ciency is the pathological mechanism underlying the disease. Therefore, various ligament reconstruction techniques have been developed to improve both the stability and kinematics of the joint. However, none of them involve anatomical ligament reconstruction and are almost always used in combination with trapeziectomy. In order to restore joint stability as well as to save the trapezium, we developed a new technique for reconstructing the anterior oblique ligament of the TMC joint anatomically using the distal part of the transverse carpal ligament. In this article, we describe the technique in detail and report the clinical outcome of 9 patients. 6 of whom were treated by ligament reconstruction alone while the other 3 underwnet ligament reconstruction combined with surface joint replacement. All 9 patients maintained good stability and ROM of the joint at their fi nal follow-up (3 years or longer). Although that follow-up period is admittedly short, we think anatomical ligament reconstruction with or without surface joint replacement is a rational alternative to ligament reconstruction tendon interposition (LITI) prodecures.
From Translational Research to a Large Randomized Clinical Trial: a Long and Streanuous Way from Bench to Bedside
JUNICHI SAKAMOTO and SATOSHI MORITA
pg(s) 9- 16
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Several complicated steps are should be necessary to bring bioscientifi c products successfully to market. Products generated on the bench fi rst have to be called screened for safety in a Phase I clinical trial. This step is called translational research, indicating that the material must be proven safe not only for experimental animals, but also for human subjects. Once the Phase I study is completed, Phase II determines the safety of the bioscientifi c products on humans, establishing both its maximum tolerated dose and recommended dose. In a Phase II study, the material should be tested for its effi cacy against certain diseases. Once it is found to be effective, a comparison between the current actual standard therapy and the new therapy using the newly developed material will be implemented in a large or against scale randomized trial, after which a fi nal decision must be made for its approval as a new drug. The authors have illustrated the steps of: a Phase I translational research by showing the data of a monoclonal antibody A33; a Phase II trial with several combination chemotherapies of chemotherapeutic agents; a Phase III clinical trial through a comparison of antihypertension agents to show the evolutionary process from translational research to a large randomized trial based on their own experience.
Original Papers
No Association between Helicobacter Pylori Seropositivity and Ornithine Decarboxylase(ODC) A317G Polymorphism, and No Modification by NAD(P)H:Qinone Oxidoreductase 1(NQO1) C609T
YASUYUKI GOTO, KAZUKO NISHIO, YOSHIKO ISHIDA, SAYO KAWAI, TOMO OSAFUNE1, MARIKO NAITO, NOBUYUKI KATSUDA and NOBUYUKI HAMAJIMA
pg(s) 17- 22
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Our previous epidemiologic study reported that NAD(P)H:quinone oxidoreductase 1 (NQO1) 609C/C with full enzyme activity was a high risk genotype for Helicobacter pylori (H. pylori) seropositivity. Since NQO1 stabilizes ornithine decarboxylase (ODC), which attenuates the innate immune response through elevated polyamines, ODC functional polymorphisms may also infl uence H. pylori seropositivity. This study aimed to examine the association with ODC A317G polymorphism, as well as the modifi cation by NQO1 C609T. The two polymorphisms were determined by polymerase chain reaction with confronting two-pair primers (PCR-CTPP) among 465 health checkup examinees in Nagoya. The ODC A317G genotype frequency was 35.9% for A/A, 49.3% for A/G, and 14.8% for G/G. The sex-age-adjusted odds ratio (OR) of the ODC gene for H. pylori seropositivity was not signifi cant (OR=1.09 for G/A and OR=1.02 for G/G, relative to A/A). Among subjects with any NQO1 genotype, no association was observed between the ODC ploymorphism and H. pylori seropositivity. Results of the present study did not support the hypothesis that the different genetic traits in the ODC-polyamine pathway are associated with susceptibility to persistent H. pylori infection. The higher frequency of the ODC 317A allele in the Japanese population than that in the Caucasian population is fi rstly reported. The genetic traits through the ODC-polyamine pathway will be further investigated.
Measurement and Evaluation of the Acoustic Noise of a 3 Tesla MR Scanner
YOKO HATTORI, HIROSHI FUKATSU and TAKEO ISHIGAKI
pg(s) 23- 28
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We measured the sound level and frequencies of the acoustic noise generated by a 3 Tesla (T) MR scanner, and investigated the subjective sound level for 30 healthy volunteers with either earplugs, headphones or both. The sound level of 3T was found to be higher than that of 1.5T in all sequences. The peak sound pressure level of 3T ranged from 125.7 dB for MR angiography to 130.7 dB for single shot EPI on the linear scale. The equivalent noise level was from 110.0 dB for FLAIR to 115.8 dB for T1-IR on the A-weighted scale, which exceeded 99 dB, the level regulated by the International Electrotechnical Commission (IEC). The study of the subjective sound level showed that the effect of noise reduction was not signifi cantly different between earplugs and headphones. However, the use of both devices could reduce the subjective sound level signifi cantly better than either one alone (P<0.01). Thus we propose wearing both devices for ear-protection during 3T examinations.
Impact of Intensive-Care-Unit(ICU)-Acquired Ventilator-Associated Pneumonia(VAP) on Hospital Mortality: a Matched-Paired Case-Control Study
HIDEO UNO, JUN TAKEZAWA, HIROSHI YATSUYA, MACHI SUKA and KATSUMI YOSHIDA
pg(s) 29- 36
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The effect of ICU-acquired ventilator-associated pneumonia (VAP) on hospital mortality is still a controversial issue in many countries. The aim of this study was to evaluate the effect of ICU-acquired VAP on hospital mortality in a Japanese university hospital. Our study population was comprised of patients aged 16 years or older who were admitted to our ICU and received mechanical ventilation for more than 48 hours during a period of 42 months as of December 2003. To evaluate whether VAP was an independent risk factor for hospital mortality after controlling for other clinical factors, patients with fatal outcomes (cases) were compared to those who survived (controls). From 587 eligible patients, we analyzed 75 cases and 150 controls who were successfully matched on sex, age, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score using conditional logistic regression models. Univariate analysis demonstrated that hemodialysis (odds ratio [OR], 2.24; 95% confi dence interval [CI], 1.21–4.15; p=0.01), surgical site infection (OR, 2.45; 95% CI, 1.22–4.91; p=0.01), and VAP (OR, 2.69; 95% CI, 1.55–4.69; p<0.001) were signifi cantly associated with hospital mortality. After adjusting for confounding factors, multivariate conditional logistic regression analysis showed that hemodialysis (OR, 2.05; 95% CI, 1.06–3.94; p=0.03) and VAP (OR, 2.20; 95% CI, 1.10–4.39; p=0.03) were independently associated with hospital mortality. In conclusion, these data suggest that ICU-acquired VAP signifi cantly affects hospital mortality.
Follow-Up for Patients with Obstructive Sleep Apnea Syndrome Using a Portable Recording Device
SEIKO MIYATA, AKIKO NODA, KUMIKO HONDA, SEIICHI NAKATA, KEISUKE SUZUKI, TSUTOMU NAKASHIMA and YASUO KOIKE
pg(s) 37- 43
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A home screening device, LT-200, can record data on both breathing conditions and body positions during sleep for up to 3 consecutive days in patients with obstructive sleep apnea (OSAS). We investigated the usefulness of the LT-200 device for follow-up of OSAS. Eighteen patients (age 51.0±10.8 years, mean±SD) were enrolled in this study. Standard polysomnography (PSG) was performed on all patients. The number of apnea/hypopnea episodes per hour (apnea/hypopnea index: AHI), the total time that nocturnal oxygen saturation was <90% (oxygen desaturation time: ODT), and the minimum oxygen saturation during sleep (lowest Spo2) were calculated. We used the LT-200 and PSG to evaluate any improvement in the data obtained after auto-continuous positive airway pressure (auto-CPAP) therapy. AHI was also measured using the LT-200 in three sleep positions to evaluate the effi cacy of the lateral position. AHI, ODT, and lowest Spo2 values did not differ signifi cantly between the PSG and LT-200 recordings on the control and therapy nights. The LT-200 recordings showed that AHI, ODT, and lowest Spo2 tended to be better on the second night of auto-CPAP therapy than on the fi rst. AHI was signifi cantly lower in the right and left lateral sleep positions than that in the supine position. Our fi ndings suggest that since the LT-200 device provides important information about the severity of OSAS, the effi cacy of auto-CPAP therapy, and body position under unattended conditions in the home. It may prove to be a useful tool for following up patients.
Characteristics of Assessment of Motor and Process Skills and Rivermead Behavioral Memory Test in Elderly Women with Dementia and Community-Dwelling Women
AKIKO MORI and KIMIYA SUGIMURA
pg(s) 45- 53
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The purpose of this study was to demonstrate the characteristics of the Instrumental Activities of Daily Living (IADL) ability, evaluated by the Assessment of Motor and Process Skills (AMPS), and everyday memory functions (the memory necessary for daily life), assessed by the Rivermead Behavioral Memory Test (RBMT) in elderly people with dementia compared with a community-dwelling group. We divided the RBMT into three categories: prospective memory (PM), retrospective memory (RM), and PM+RM. The study was performed with 102 women, those with dementia who lived in a healthcare facility or three group homes (n=52) and those who were cognitively well and lived in their own homes (n=50). Subjects were over 68 and under 92 years old. We assessed them by Mini-Mental State Examination (MMSE), AMPS and RBMT. The results of the MMSE, AMPS, and RBMT revealed that the community-dwelling group’s averages were higher than those of the Dementia group. No associations were found between AMPS motor skills and MMSE or PM, RM, and PM+RM in both groups. There were slight associations between the AMPS process and RM in both groups, but none between AMPS process skills and PM in either group. From that result, we found that IADL performance ability and everyday memory were not simultaneously damaged. Moreover, analyzing a scatter chart revealed some subjects had a PM defi cit even though they were at the IADL independent level. In conclusion, occupational therapists need to assess both IADL performance and everyday memory, including PM, in elderly people.
Notes
Effectiveness of Implementation of Gastric and Duodenal Ulcer Clinical Protocol in the Kyrgyz Republic
MEMERIAN SHIMAROVA, AKIO NISHIMURA, KATSUKI ITO and NOBUYUKI HAMAJIMA
pg(s) 55- 59
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The introduction of a clinical protocol for the treatment of gastric and duodenal ulcer (GDU) may be one of the solutions for the high morbidity and complications of these diseases. This descriptive study was carried out to evaluate the effectiveness of the implementation of the GDU clinical protocol in the Kyrgyz Republic introduced in 2002. The effectiveness of the introduction of the clinical protocol into primary health care practice was assessed by the numbers of hospitalizations and operations due to GDU. As the result of the clinical protocol implementation for the treatment of GDU, the numbers of hospitalizations and operations have decreased in Kyrgyz Republic. The total number of hospitalized GDU patients was reduced in 2003 by 12% from the 2001 level. The number of operations due to GDU complications decreased in 2003 by 30% compared with 2001. The protocol-driven approach showed the potential to become a feasible method to improve the quality of health care in Kyrgyzstan. However, the prospective long-term effects, including their cost-effectiveness, should be evaluated in Kyrgyzstan.
Avoidable Mortality Measured by Years of Potential Life Lost(YPLL) Aged 5 before 65 Years in Kyrgyzstan, 1989-2003
MARATBEK BOZGUNCHIEV and KATSUKI ITO
pg(s) 61- 70
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There is considerable willingness in the entire medical society of Kyrgyzstan, which was directly involved in the reform process, to obtain reliable information about changes in population health that have occurred in the last decade, as well as about changes in mortality, which is the basic component of population health. The objective of this paper is to introduce the Year of Potential Life Lost (YPLL) in Kyrgyzstan caused by avoidable mortality in the population between 5 and 65 years of age during 1989-2003, and to provide a basis for setting the priorities for the reducing YPLL in the coming years. YPLL was calculated using data from the annual mortality tables according to causes of deaths and age for 1989, 1996, 1999 and 2003. YPLL is defi ned as the summation of the difference between 65 years of age and the age at death from the age of 5 and before 65. In 2003, the total number of YPLL due to avoidable mortality among those who died was 216,860, which represents a decline of 5.0% in comparison with 228,266 in 1989. During the study years, the largest proportion of YPLL in the population between 5 and 65 years of age resulted from injury and poisoning. In 2003, this proportion represented 41.5% of the total amount of YPLL due to all the causes studied here, followed by infections and parasitic diseases (12.0%), circulatory disturbance of the brain (11.5%), chronic liver diseases and cirrhosis (11.4%), diseases of the respiratory system (9.2%), and malignant neoplasm of the upper airways and digestive tract (4.6%). The decline in avoidable mortality caused by injury and poisoning, infections disease, malignant neoplasm of the female breast and uterus has to be priority-driven direction for developing Health Policy in the coming years in Kyrgyzstan. Attention also has to be given to reducing of avoidable mortality caused by malignant neoplasm of the female breast by implementing screening programs.
Current Problems in National Hospitals of Phnom Penh: Finance and Health Care
SOPHOAT UY, HIDECHIKA AKASHI, KAZUMI TAKI and KATSUKI ITO
pg(s) 71- 79
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The current problems in Cambodia’s national hospitals subsist in a geographic imbalance in the location of staff and health facilities, and low staff motivation largely due to inadequate payment. This paper aims to investigate the associations among hospital performance, hospital fi nances, and other related issues in fi ve national hospitals in Phnom Penh, using annual reports of the fi ve hospitals and annual statistics of the Ministry of Health, from 2000 to 2004. The bed occupancy rates (BOR), average lengths of stay (ALS), hospital mortality rates (HMR), maternal and neonatal mortality rates, numbers of patients, main health problems of inpatients, numbers of health personnel, staff incentives, and annual hospital income were used in this study as indicators of fi ve hospitals in Phnom Penh city. The ALS varied from 3.8 to 9 days. The numbers of health personnel (physician, medical assistant, secondary nurses, primary nurses, secondary midwives, and primary midwives) per 100 beds were from 114 to 282. Supplemental salary per staff also differed greatly among these hospitals; the salaries were the highest at Calmette hospital (US$ 212.8) and the lowest at Preah Kossamak (US$ 12.4). In the fi ve hospitals, the average BOR was 58.8%, and the mean of total annual income was US$ 1,427,852 per year. Although not signifi cant, there was a tendency for higher supplemental salaries to be associated with higher BOR (Spearman rank correlation coeffi cient 0.70, p = 0.188). This study showed the differences in the hospital indicators among fi ve national hospitals in Phnom Penh city, and the tendency of higher BOR in the hospitals paying higher supplemental salaries to the staff. Higher supplemental salary to the staff seemed to contribute the better hospital performance.
