Tomohiro Hirao

Seasonal Blood Pressure Variation and Its Relationship to Environmental Temperature in Healthy Elderly Japanese Studied by Home Measurements

The purpose of the present study was to examine seasonal blood pressure variation and its relationship to environmental temperature in healthy elderly Japanese, as studied by home measurements. Fifteen healthy elderly Japanese (79.3 ± 5.9 yrs) measured their blood pressure at home each morning for more than 25 times per month for 3 years. Monthly mean outdoor temperatures were obtained from the Takamatsu meteorological Observatory. The highest levels of systolic and diastolic blood pressure measured at home were observed in February (129 ± 14 and 81 ± 13 mmHg). The lowest levels of systolic and diastolic blood pressure measured at home were observed in August (117 ± 11 and 73 ± 10 mmHg). Likewise, the lowest and highest means of outdoor temperature were observed in February (5.0°C) and August (29.2°C), respectively. Hence, both systolic and diastolic blood pressure demonstrated a close inverse correlation with the means of outdoor temperature (r = −0.973, p < 0.001 and r = −0.985, p < 0.001, respectively). A 1°C decrease in the mean outdoor temperature was associated with rises of 0.43 mmHg in systolic blood pressure (SBP) and 0.29 mmHg in diastolic blood pressure (DBP). Seasonal variations in home blood pressure and outdoor temperature showed complete correspondence in healthy elderly Japanese, with the blood pressures being inversely related to the ambient temperature. These seasonal home blood pressure variations should be kept in mind when controlling blood pressure in elderly patients.

Pre-Existing Arteriosclerotic Intimal Thickening in Living-Donor Kidneys Reflects Allograft Function

Background: Donor shortage is a serious problem worldwide and it is now debated whether kidneys from marginal donors are suitable for renal transplantation. Recent studies have shown that the findings of preimplantation kidney biopsy are useful to evaluate vasculopathy in the donated kidney, and may predict transplant outcomes in deceased- donor kidney transplantation. However, few studies have focused on the pathological findings of preimplantation biopsy in living-donor kidney transplantation. Therefore, we investigated whether arteriosclerotic vasculopathy in living-donor kidneys at the time of transplantation predicts the recipient’s kidney function (allograft function) later in life. Methods: We retrospectively analyzed 75 consecutive adult living-donor kidney transplants performed at Kagawa University Hospital. Renal arteriosclerotic vasculopathy was defined according to the presence of fibrous intimal thickening in the interlobular artery. Results: Forty-one kidneys exhibited mild arteriosclerotic vasculopathy on preimplantation kidney biopsies. The decreases in estimated glomerular filtration rate after donation were similar in donors with or without renal arteriosclerotic vasculopathy. Pre-existing arteriosclerotic vasculopathy did not affect graft survival rate, patient survival rate or the incidence of complications. Recipients of kidneys with arteriosclerotic vasculopathy had lower allograft function at 1 and 3 years after transplantation than the recipients of arteriosclerosis-free kidneys with or without donor hypertension. In multivariate analysis, fibrous intimal thickening on preimplantation biopsy was predictive of reduced allograft function at 1 year after transplantation. Conclusions: The present study demonstrated that mild arteriosclerotic vasculopathy in the donated kidney is an important pathological factor that reflects future impaired function of renal allografts from marginal donors.

The new school absentees reporting system for pandemic influenza A/H1N1 2009 infection in Japan

Objective To evaluate the new Japanese School Absentees Reporting System for Infectious Disease (SARSID) for pandemic influenza A/H1N1 2009 infection in comparison with the National epidemiological Surveillance of Infectious Disease (NESID). Methods We used data of 53,223 students (97.7%) in Takamatsu city Japan. Data regarding school absentees in SARSID was compared with that in NESID from Oct 13, 2009 to Jan 12, 2010. Results Similar trends were observed both in SARSID and NESID. However, the epidemic trend for influenza in SARSID was thought to be more sensitive than that in NESID. Conclusion The epidemic trend for influenza among school-aged children could be easily and rapidly assessed by SARSID compared to NESID. SARSID might be useful for detecting the epidemic trend of influenza.

Investigation of Indoor Air Pollution by Chlorpyrifos : Determination of Chlorpyrifos in Indoor Air and 3,5,6-Trichloro-2-pyridinol in Residents' Urine as an Exposure Index

ObjectsWe carried out an investigation to clarify the real state of indoor air pollution by chlorpyrifos (termiticide) and exposure to chlorpyrifos of residents by measuring its urinary metabolite 3,5,6-trichloro-2-pyridinol (TCP) as an exposure index, such as biological monitoring.MethodsThe investigation was conducted in 43 individual houses with termiticide application (whether the termiticide was chlorpyrifos is uncertain) and 3 control houses without any termiticide application in Kagawa, Japan. Urine samples were collected from 46 healthy adult residents of the aforementioned houses.ResultsChlorpyrifos in indoor air in the control houses was not detected (ND<1 ng/m3, n=3), while 41 of 43 houses with termiticide application showed 1–350 ng/m3. Although the chlorpyrifos concentrations in these 41 houses did not exceeded the indoor air quality guideline of 1000 ng/m3, but 3 houses were higher than the guideline 100 ng/m3 for children in Japan. Urinary TCP concentrations of 0.1–7.8 ng/mg·creatinine were detected in 41 residents from the 41 houses where chlorpyrifos had been detected. The chlorpyrifos concentration and the urinary TCP revealed a positive correlation (r=0.5468, p<0.01, n=41).ConclusionsThe immediate health hazard from air born chlorpyrifos in the examined houses was negligible, but the findings suggest that it is necessary to monitor chemicals which may contaminate indoor air and to assess the risk of prolonged exposure to such chemicals. The measuring of urinary metabolite TCP of chlorpyrifos via biological monitoring would be useful, allowing comprehensive evaluation of the exposure to chlorpyrifos in indoor air.

Effort-reward Imbalance and Low Back Pain among Eldercare Workers in Nursing Homes: A Cross-sectional Study in Kagawa Prefecture, Japan

Effort‐reward Imbalance and Low Back Pain among Eldercare Workers in Nursing Homes: A Cross‐sectional Study in Kagawa Prefecture, Japan; Katsunori YOKOYAMA, et al. Department of Anesthesiology, Graduate School of Medicine, Kagawa University—

A Method for On-Site Analysis of Urinary Benzene by Means of a Portable Gas-Chromatograph

Benzene is one of the toxic air pollutants released from automobile fuel, exhaust, tobacco smoke etc., and is commonly found in both indoor and outdoor air. Since benzene is a carcinogenic substance classified into group 1 (carcinogenic to humans) by the International Agency for Research on Cancer (IARC), it is important to assess the human health risk posed by exposure to environmental or occupational benzene. The analytical trials were performed to determine blood and urinary unchanged benzene as a specific index for low benzene exposure. But these methods require sophisticated and expensive instruments such as a gas chromatograph-mass spectrometer which can be used only in a laboratory. Moreover, benzene in biological fluids is volatilized so easily that it may cause the loss of samples during collection, transportation and preservation which is the most common cause of uncertainties. Therefore, the development of simple and specific methods to perceive benzene exposure are expected. In this study, we developed a method for on-site analysis of benzene in urine by head space-gas chromatography (HS-GC) employing a field portable GC, since on-site analysis can provide rapid data without time-consuming and loss-inducing processes such as transportation and preservation.

A New Index of Cardiac Age Derived from Echocardiography : Influence of Hypertension and Comparison with Pulse Wave Velocity

Although pulse wave velocity is the primary indicator of arteriosclerosis and is widely used as an index of vascular age in anti-aging medicine, no index is available to quantify cardiac age. We proposed a “cardiac age” index and sought to clarify its clinical significance. The study subjects were 234 patients with atherosclerosis-related diseases. These patients were divided into 127 normotensive (mean age: 64±12 years) and 107 hypertensive (mean age: 65±11 years) patients. Echocardiography was performed, and brachial-ankle pulse wave velocity (baPWV) was measured using an automatic waveform analyzer. The index of cardiac age was determined as 1,000×VSot/BSA/(VS-AO), where VSot (mm) was the ventricular septal thickness at the left ventricular outflow tract, BSA (m2) was the body surface area, and VS-AO (degree) was the angle between the basal ventricular septum and the ascending aorta. The index of cardiac aging correlated significantly with age in both the normotensive (r=0.63, p<0.001) and hypertensive (r=0.58, p<0.001) patients, and these correlations were closer than those between transmitral E/A (early to atrial velocity) ratio and age in normotensive (r=0.54, p<0.001) and hypertensive (r=0.44, p<0.001) patients. The slope between age (xaxis) and the index of cardiac age (y-axis) was greater in hypertensive (1.50) than normotensive (1.32) patients. Stepwise regression analysis showed that age (β coefficient = 0.35, p < 0.001), the presence of hypertension (β coefficient = 0.26, p < 0.001), the left ventricular mass index (β coefficient = 0.34, p < 0.001), the left ventricular end-diastolic dimension (β coefficient = −0.35, p < 0.001), the dimension of the left atrium (β coefficient = 0.14, p = 0.014), and the ratio of E to A (E / A) (β coefficient = −0.12, p = 0.046) were independ- ently associated with the index of cardiac age. The index was also significantly correlated with baPWV (r = 0.53, p<0.001). The proposed index of cardiac age can quantitatively assess cardiac morphological changes due to aging and/or hypertension and may be a useful marker of peripheral arterial stiffening.

Impact of Health Professionals on Health Promotion Activities in Japanese Worksites

Impact of Health Professionals on Health Promotion Activities in Japanese Worksites: Tomohiro Hirao, et al. Department of Hygiene & Public Health, Faculty of Medicine, Kagawa Medical University—We tried to assess the impact of health staff on health promotion activities in Japanese worksites. We surveyed all worksites with 50 or more employees in Kagawa Prefecture, western Japan through self‐administered questionnaires. We constructed a general linear model that contained three health professions, occupational physicians, health supervisors and occupational health nurses, which are common in the Japanese workplace as co‐regressors, and fourteen health promotion activities as dependent variables. The impact of occupational physicians was small. The impact of health supervisors was considered high in workplace defined activities. The impact of occupational health nurses was considered high in person‐to‐person services and life‐style related activities. Through assessing the impact, the strengths and weaknesses of each health professional were clarified.

Cost of illness of the non-alcoholic liver cirrhosis in Japan - a time trend analysis and future projections

Liver cirrhosis is a preneoplastic condition to hepatocellular carcinoma that is an important worldwide public health concern, and its economic burden has been estimated in some countries. The objective of this study was to estimate and predict the cost of illness (COI) associated with non‐alcoholic liver cirrhosis in Japan.

Possible sources of urinary benzene among nonoccupationally exposed Japanese subjects.

Unmetabolized benzene in urine (U-benzene) is known to be the best marker among the indices for the biological monitoring of occupational and environmental exposure to benzene. In this study, we determined the levels of U-benzene among Japanese university students exposed to benzene nonoccupationally and analyzed the relation between U-benzene levels and the possible factors responsible for environmental benzene exposure. In urinalysis, U-benzene concentration among 124 students was detected in the range from 18 (minimum detection limit) to 249 ng/l. The frequency distribution of U-benzene concentration peaked at 0–19 ng/l. Mean and median values of 40 and 20 ng/l for U-benzene concentration in nonoccupationally exposed subjects were lower than those in a previous study. Stepwise multiple linear regression analysis was performed to assess the potential sources of exposure to environmental benzene by analyzing the relation between U-benzene and personal, behavioral, and environmental factors. The results showed that only smoking habit (P < 0.01) and residential house age (P < 0.05) were independent determinants of U-benzene levels. In addition, U-benzene levels in relation to smoking and house age suggested that these factors could be associated with the synergistic elevation of U-benzene. The present study showed U-benzene levels among non-occupationally exposed Japanese subjects and revealed that the major exposure sources to benzene in the general environment were tobacco smoking and indoor air contamination.