The purpose of this study was to measure the effectiveness of RPE on exercise intensity for senior citizens. A maximum workload test was administered with the use of a bicycle ergometer on older male and female subjects. The results of our study can be summarized as follows:
1. Two trials were performed on separate days. A high correlation coefficient for the first trial and the second trial was found. The reliability for the male group was r=0.76 (p<0.01) and that for the female group r=0.90 (p<0.01) .
2. A correlation range of r=0.55-0.79 (p (0.01) was found for RPE and physiological exercise intensity (which includes oxygen intake and heart rate) . A higher result was found when the relative value was used in the analysis of the oxygen intake and the heart rate instead of the absolute value.
3. Significant correlation coefficients of r=0.63-0.64 (p<0.01) were found for RPE and the work load in terms of watt units.
4. The majority of the physiological variables were statistically determined ; however, there were no correlations between RPE and systolic blood pressure.
In conclusion, based on our study, we have found that RPE and HR ; RPE and %Vo₂max: RPE and watts grouped individually had a high correlation for effectiveness. The only exception in our study was the RPE and the blood pressure group because no correlation was found overall. Therefore, the overall effectiveness of RPE was proven to be quite sensitive even for senior citizens, and as a result RPE can be utilized when exercise is prescribed for evaluatory measurement in senior citizens.

Eight young girls as an experimental group (E group) and another eight as a control group (C group), (all aged 4-5 years), participated in the present study to observe the effects of training from May 1992 through November 1993. E group performed a 915m endurance run on an agricultural road every day except Sundays for an 18 month training period. No special training was given to C group. In May 1992 (T 1), November 1992 (T 2), May 1993 (T 3), and November 1993 (T 4), both groups underwent treadmill tests in order to check aerobic variables such as heart rate (HR) and oxygen uptake (VO₂) during the course of the training period.
Times required for the run became shorter from summer to fall and from winter to spring (shortening phase), whereas they became prolonged from spring to summer and from fall to winter (prolongation phase) . Therefore, there was a definite seasonality of performance endurance. The rates of shortening in the required times observed from summer to fall were considerably higher than from winter to spring, and this was reflected in the significant improvement of maximal running speed on the treadmill (Vmax) and maximal oxygen uptake in terms of body weight (VO₂max⋅ TBW^-1) from T 1 to T 2 as well as from T 3 to T 4. Thus, significant differences were found between the groups at T 2 and T 4. HR levels during the endurance run were close to 95% HRmax regardless of the phase. Accordingly, the prolongation phases, during which circulatory parameters and ventilatory capacity were least improved, could be regarded as a preparatory period for the following shortening period, during which work load intensities furthermore increased the arteriovenous oxygen differences. Thus, when planning research on the effects of training on aerobic work capacity in the field, special attention should be paid to the season and the training period, and the timing of the examination for training effects, or otherwise, misleading conclusions could be drawn.

The purpose of this investigation was to determine the effects of daily walking on aerobic work capacity, vital age and other fitness components in middle-aged and elderly walkers. The subjects were thirty-six walkers (average 65.0±8.0 yr, 51-80 yr), whose training period averaged 13.5±9.0 yr. The walkers were significantly greater in maximal oxygen uptake (VO₂max), and oxygen uptake at the lactate threshold (VO₂LT), and were 6.5 yr younger in vital age (VA) than sedentary middle-aged and elderly. These findings suggest that middle-aged and elderly walkers have more favorable profile of aerobic work capacity and of health status when compared to sedentary persons.

Although maximal oxygen uptake (VO₂max) or oxygen uptake corresponding to lactate threshold (VO₂@LT) is considered the single best determinant of one's cardio-respiratory endurance or aerobic capacity, the direct measurement of these attributes requires elaborate equipment, trained personnel, special knowledge, and/or a maximal effort on the part of the subject who is tested. In addition, the measurement is time consuming. The current investigation was designed to examine the validity of aerobic capacity estimated from submaximal cycling exercise and field performance tests in the elderly. The subjects tested were 18 sedentary men and women aged 63 to 75 years (69.7±3.4) . Indirect VO₂max tests were selected from those proposed by Astrand and Ryhming, Siconolfi et al., and Margaria et al. (step test), and YMCA. The VO₂max values estimated by these methods, with the exception of the Siconolfi method, were found to have large errors when compared to the errors obtained in previous studies for younger subjects. There were no significant correlations between step test scores and VO₂max and VO₂@LT in the elderly. Correlations of 12-min distance walk with VO₂max (r=.711) and VO₂@LT (r=.714) were significant. Our findings suggest that 12min distance walk be a better aerobic capacity test than other indirect VO₂max tests including Astrand and Ryhming test.

A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Diabetes Mellitus, Insulin-Dependent ; Diabetes Mellitus ; symptoms <1> ; Type 1 ; Urinary tract infection

Physicians expect nurses to be able to understand electrocardiographic (ECG) findings.However, many nurses have difficulty learning how to interpret ECGs.We suspect that the reason for such difficulty might be the nurses'mental responses to ECGs, rather than improper teaching methods.
1) We performed a questionnaire survey to investigate the mental responses to ECGs based on the responses of 197 experienced nurses and 43 new nurses and on an additional survey of 37 nurses who took ECG evaluation tests.
2) Almost all nurses recognized the necessity and importance of understanding ECG findings, and most wished to master ECGs.On the other hand, many nurses said that they disliked ECGs and did not feel competent interpreting ECGs.In particular, their perceived lack of competence in interpreting ECGs was greater than their dislike of ECGs.
3) The nurses'perceived lack of competence interpreting ECGs tended to result from feelings that developed during nursing school.Many nurses continued to have such feelings even after they began working.
4) Nurses with a poor understanding of ECGs reported many factors as being associated with their perceived lack of competence.In addition, such negative feelings toward ECGs (such as fear of making a mistake) made these nurses avoid ECGs.We believe that these feelings were likely a factor in why many nurses had difficulty mastering ECGs.
5) Nurses should be provided with appropriate ECG training that carefully considers the perceived incompetence and fear of many nurses regarding ECGs.

A 73-year-old woman was admitted to undergo three simultaneous operations: aortic valve replacement (AVR), coronary artery bypass grafting (CABG) and abdominal aortic aneurysm repair. She had previously undergone percutaneous catheter intervention in the left coronary anterior descending artery. Computed tomography revealed an abdominal aortic aneurysm 5cm in diameter. Aortic valve stenosis (AS) was shown with a pressure gradient of 60mmHg, and 90% stenosis of the distal right coronary artery was also shown. CT scan and aortography revealed porcelain ascending aorta. The patient underwent simultaneous operations because of severe AS, coronary artery disease and abdominal aortic aneurysm. An aortic cannula was placed in a position higher in the ascending aorta with no calcification. Cardiopulmonary bypass was started using a two-staged venous cannula through the right atrium. At first, AVR was performed with cardioplegic solution and ice slush. Because it was difficult to inject the cardioplegic solution into the coronary artery selectively due to the calcified orifice of coronary artery, we closed it immediately by removing the calcified intima of the porcelain aorta after completion of AVR. The second cardioplegic solution was injected through the ascending aorta. Next, CABG to RCA was performed using the right gastroepiploic artery without anastomosis to the ascending aorta. Cardiac surgery was first performed, followed by abdominal aortic aneurysm repair after discontinuation of cardiopulmonary bypass. The patient was extubated the next day and stayed for two days in the intensive care unit. She is very well now one year after the operation.

Maximal oxygen uptake (Vo₂max) and lactate threshold were measured during an incremental bicycle ergometer test in 40 healthy middle-aged and older runners between 43 and 79 years of age. Although the 10-km run time slowed with increasing age, there were no significant differences in recent training habits or relative amount of body fat between four age groups. However, our cross-sectional data revealed an annual decrement of -0.74 ml/kg/ min/yr, which was significantly greater than that reported in previous studies. Vo₂max values for the runners were greater than those for sedentary men of similar ages by about 50% in each age group. Significant correlations were found between the age at the onset of running training and Vo₂max (r=-0.600, p<0.05) . Vo₂@LT declined significantly but less rapidly with age (r=0.686, p<0.05) than Vo₂max. Both the mean maximal heart rate (HRmax) and HR@LT also declined with age. No significant differences in HRmax were observed between the runners and sedentary men of the respective age groups. Significant correlations were also found between the estimated HRmax and directly measured HRmax (r=0.600) . Neither systolic blood pressure nor diastolic blood pressure during submaximal-maximal exercise were found to increase with age. We suggest that maintenance of a higher lactate threshold in older runners when expressed as a percentage of Vo₂max is attributable to a greater age-dependent decline in Vo₂max with a smaller change in Vo₂@LT.

Europe has a long history with its own traditional medicines. In Germany, the practice of traditional European and Asian medicine along with modern medicine is called Integrative Medicine. The pain clinics at Munich University, TCM Klinik Bad Kotzting, Immanuel Klankenhaus and Zen Haus Klinik are well-known centers of Integrative Medicine in Germany. We visited these hospitals and clinics and report on the state of their treatment.
Four-week programs in chronic pain, traditional Chinese medicine, natural therapy, and traditional Japanese medicine with aromatherapy are given at these facilities. Moreover, Complementary and Alternative medicines are widely covered by public or private insurance. And one reason for the spread of Integrative Medicine may be these social conditions, in addition to historical background.

Objective: The practices pertaining to hereditary breast and ovarian cancer (HBOC) in Japan have been rapidly changing owing to the clinical development of poly(ADP-ribose) polymerase inhibitors, the increasing availability of companion diagnostics, and the broadened insurance coverage of HBOC management from April 2020. A questionnaire of gynecologic oncologists was conducted to understand the current status and to promote the widespread standardization of future HBOC management. Methods: A Google Form questionnaire was administered to the members of the Japan Society of Gynecologic Oncology. The survey consisted of 25 questions in 4 categories: respondent demographics, HBOC management experience, insurance coverage of HBOC management, and educational opportunities related to HBOC. Results: A total of 666 valid responses were received. Regarding the prevalence of HBOC practice, the majority of physicians responded in the negative and required human resources, information sharing and educational opportunities, and expanded insurance coverage to adopt and improve HBOC practice. Most physicians were not satisfied with the educational opportunities provided so far, and further expansion was desired. They remarked on the psychological burdens of many HBOC managements. Physicians reported these burdens could be alleviated by securing sufficient time to engage in HBOC management, creating easy-to-understand explanatory material for patients, collaboration with specialists in genetic medicine, and educational opportunities. Conclusion Gynecologic oncologists in Japan are struggling to deal with psychological burdens in HBOC practice. To promote the clinical practice of HBOC management, there is an urgent need to strengthen human resources and improve educational opportunities, and expand insurance coverage for HBOC management.