亀井 哲也

ICEBPが実施している成人体外循環症例登録の入力項目を日本の実情に合致させた体外循環症例データベースを構築することを目的に各施設における体外循環の実施に関する基本情報を調査した。調査対象施設は、JaSECT正会員が所属する557施設。基本調査項目および体外循環の実施に関する項目の108問を調査した。<BR> 回収率は48％であった。インターネット接続可能な施設は87％。データを取り扱うアプリケーションソフトウェアの所持率は、MS-Excelが81％、次いでFileMaker 51％であった。回路調査において、体外循環記録方法は手書きが最多で53％であった。分離体外循環使用回路は35％であった。無輸血組成の回路充填液は87％であった。<BR> 体外循環症例数はJACVSDの2010年の年間登録数の74％に達し、JaSECT会員の施設がすべて体外循環症例登録事業に参加し、順調に登録数が増加すれば、統計解析機能を早期に提供できると考えられる。<BR> ICEBP等のデータベース項目が日本で共通して使用できると判断できた。また、本邦の開心術症例分類の結果から冠動脈疾患、弁疾患、大動脈疾患に対する体外循環症例がほぼ均等に登録可能であり、世界的に見ても特徴ある疫学的評価が行える環境にある。

To construct a perfusion database in Japan by modifying the input parameters of the adult perfusion registry of the International Consortium for Evidence-based Perfusion (ICEBP) to suit the present status of Japan, we surveyed basic information on perfusion using a questionnaire consisting of 108 questions (basic survey items and items regarding the practice of perfusion) in 557 institutions to which regular members of the Japanese Society of Extra-Corporeal Technology in Medicine (JaSECT) were affiliated.<br>The questionnaire recovery rate was 48%. Access to the Internet was possible in 87% of the responder institutions. As applications for data processing, 81% possessed MS-Excel, and 51% possessed FileMaker. Concerning circuits, handwriting was used for perfusion recording for 53% of circuits, and selective cerebral perfusion was used for 35%. A crystalloid priming solution was used for 87%.<br>The number of perfusion cases in these institutions accounted for 74% of that of registered cases during this year in the Japan Adult Cardiovascular Surgery Database (JACVSD). If all institutions where JaSECT members work participate in the perfusion case registration project, the number of registered cases will steadily increase, and a sufficient statistical power will be achieved early.<br>This survey suggested that the database parameters used by the ICEBP can be used commonly in Japan. In addition, based on the results of the open heart surgery cases in Japan, almost equal numbers of perfusion cases of coronary heart diseases, those of valve disease, and those of aortic diseases can be registered, which allows globally valuable characteristic epidemiological evaluation.

Background: There have been few reports on longitudinal change in activities of daily living (ADL), functional capacity, and life satisfaction in patients with subacute myelo-optico-neuropathy (SMON). Methods: A total of 1309 SMON patients 40 to 79 years of age underwent a medical examination conducted by the SMON Research Committee during the period from 1993 through 1995 (baseline) in Japan; 666 (51%) were followed-up after 12 years and were thus eligible for analysis. We calculated scores for ADL, functional capacity, and life satisfaction at baseline, and at 3, 6, 9, and 12 years after baseline, using data from medical examinations conducted in 1993 through 2007. The Barthel Index, the Tokyo Metropolitan Institute of Gerontology Index of Competence, and the patient&apos;s response to the question "Are you satisfied with life?" were used to assess ADL, functional capacity, and life satisfaction, respectively. Results: As compared with baseline, the mean scores for ADL, functional capacity, and life satisfaction were all significantly lower after 12 years in men and women, with the exception of life satisfaction in women. The change in scores for functional capacity from baseline to year 12 was significantly associated with change in life satisfaction; however, the changes in ADL and age at baseline were not. Conclusions: We observed decreases in ADL, functional capacity, and life satisfaction among SMON patients. Our results suggest that a decrease in life satisfaction can be prevented by maintaining or improving functional capacity.

Background: Patients with subacute myelo-optico-neuropathy (SMON) suffer from a number of serious neurological symptoms that adversely affect their activities of daily living (ADL). However, the effects of these neurological symptoms on functional capacity and life satisfaction have not been reported. Methods: We analyzed data from 1,300 SMON patients aged 55-94 years that was obtained at medical check-ups carried out by the SMON Research Committee in 2004-2006 in Japan. The neurological symptoms investigated were visual impairment, dysbasia, symptoms of the lower extremities, and sensory symptoms. Neurological symptoms were classified by severity. The Barthel Index, the Tokyo Metropolitan Institute of Gerontology Index of Competence, and the participant&apos;s response to the question "Are you satisfied with life?" were used to evaluate ADL, functional capacity, and life satisfaction, respectively. Data were analyzed using a proportional odds model with the scores for these items as ordinal dependent variables. Results: For most neurological symptoms, scores for ADL, functional capacity, and life satisfaction were significantly lower in participants with severe or moderate neurological symptoms than in those with nearly normal results upon examination. The odds ratio for life satisfaction due to superior functional capacity was significant after adjustment for sex, age, and ADL score. Conclusion: The presence of neurological symptoms in SMON patients was associated with low functional capacity, life satisfaction, and ADL. Our results suggest that the life satisfaction of SMON patients can be increased by improving their functional capacity.

目的 胃がんと肺がんにおいて,人口構成の変化を調整した上で,死亡率と罹患率とともに,死亡年齢と罹患年齢の年次推移を検討した。方法 1975〜1999年の性・年齢階級別の死亡数と罹患数から,年齢調整死亡率,年齢調整罹患率,調整平均死亡年齢と調整平均罹患年齢を算出した。結果 胃がんにおいて,1999年の平均死亡年齢は男で70.9歳と女で73.0歳,平均罹患年齢は男で67.7歳と女で69.7歳であった。年齢調整死亡率と年齢調整罹患率は年次とともに低下傾向,調整平均死亡年齢と調整平均罹患年齢は上昇傾向であった。肺がんにおいて,1999年の平均死亡年齢は男で72.4歳と女で73.8歳,平均罹患年齢は男で71.1歳と女で71.6歳であった。年齢調整死亡率と年齢調整罹患率は上昇傾向であったが,1990年ごろから上昇の鈍化傾向あるいは横ばい傾向がみられた。調整平均死亡年齢と調整平均罹患年齢は上昇傾向であったが,1990年ごろから男で上昇の鈍化傾向,女で横ばい傾向がみられた。結論 胃がんと肺がんにおいて,死亡年齢と罹患年齢が年次とともに大きく変化していることを示した。(著者抄録)

保健統計に基づいて,糖尿病と高血圧の受療者数について,1995〜2002年の年次推移を観察した.また,複数の保健統計を組み合わせて,受療の有無別の有病者数の推移を検討し,これらの推移について,人口の年齢構成を調整した場合も検討した.糖尿病の年次推移は,通院者数と主傷病通院者数が増加傾向,総患者数と1日患者数がほぼ横ばい傾向であった.高血圧の年次推移は,通院者数が増加傾向,主傷病通院者数,総患者数と1日患者数が減少傾向であった.入口の年齢構成を調整すると,通院者数は糖尿病で増加傾向,高血圧でほぼ横ばい傾向となった.有病者数は両疾患ともに増加傾向で,人口の年齢構成を調整すると糖尿病で増加傾向,高血圧で減少傾向となった.有病者の受療割合は両疾患ともに20%程度で,やや上昇傾向であった

The mean mammary gland dose, which is used as an index of the dose of exposure to radiation in mammography, is obtained by multiplying the in-air exposure on the entrance surface by the absorbed dose conversion factor. Sobol et al. reported a method of calculating the absorbed dose conversion factor that is determined by x-ray quality(tube voltage and half-value layer), compressed dreast thickness, and breast composition. A method of calculating mean mammary gland dose, however, has not been established, and no software for estimation of the dose of exposure to radiation in mammography has been developed. Recently, the authors developed software for the estimation of exposure dose that can be easily used in a facility without a dosimeter. They confirmed that the use of this new software enabled the calculation of meanmammary gland dose based on the mammary gland ratio. In a facility without measurement equipment such as a dosimeter, a user can estimate the exposure dose without difficulty simply by entering the exposure conditions. Furthermore, half-value layer, in-air exposure, and conversion factor can be calculated by using the newly developed software. This technique seemed to be sufficienlty useful if a user simply estimates'exposure dose.

Computational human phantoms have been widely used to estimate organ doses and other dosimetric quantities related to the human body where direct measurements are difficult to perform. In recent years, voxel phantoms (voxel = volume element) based on computed tomographic (CT) data of real persons have been constructed which provide a realistic description of the human anatomy. A CT phantom of a Japanese male adult with an average body size was developed as the first Asian voxel phantom. The segmented phantom consists of more than 100 regions enabling the calculation of doses for various parts of the body. The bone marrow distribution was precisely modelled according to the CT values. The EGS4 Monte Carlo transport code was combined with the phantom to calculate organ doses for external exposure due to photons and electrons up to 1 TeV. The calculated organ doses were compared with respective data using MIRD-type mathematical phantoms. In some cases, significant discrepancies in doses were observed, demonstrating the necessity of sophisticated models for accurate dose calculations.