Patients with Parkinson disease present with a variety of symptoms as well as the so-called 4 classic symptoms : tremor, muscle rigidity, akinesia, and postural instability. To treat this disease, the best combination of various antiparkinsonism drugs, deep brain stimulation, and rehabilitation should be determined and administered. Muscular training in rehabilitation for patients should place great importance on some especially vulnerable muscles including the truncal muscles, extensor muscles for hip and knee joints, and dorsiflexor muscles for ankle joints. Shifting the center of gravity and using rhythmic movements are important factors in getting the patient standing and walking. Training using visual and auditory cues and music is effective in Parkinson disease. Speech therapy using weighted noise is also available. In rehabilitation we have to pay attention to cognitive function and psychiatric symptoms in patients including depression, anhedonia, hallucination, delusion, dopamine dysregulation syndrome, and impulse control disorder. What priority should be set for rehabilitation differs according to the stages of disease. Utmost efforts must be made for patients in the advanced stage of Parkinson disease to prevent them from being bedridden, tube-fed, and demented. Medical staff must be creative in coming up with new ideas to assist such patients in sitting comfortably on chairs for long periods and in eating by mouth safely.

The purpose of this study was to determine the physiological responses, stroke rate and stroke length of front crawl leg kick and arm stroke of age-group and college swimmers and to elucidate the characteristics of male age-group swimmers, which have not been highlighted adequately. The subjects were ten 11.8-to 12.4-year-old well-trained male elementary school swimmers (group E) and nine 20.1-to 21.1-year-old well-trained male college swimmers (group C) . All the subjects were categorized into similar swimming levels for their ages. All the experiments were performed in a swimming flume (AQUAGYM made by IHI) . The water velocities during leg kicking and arm stroking were 60 and 70%, respectively, of the maximal velocity at maximal oxygen uptake (Vmax) . The oxygen uptake (VO₂), heart rate (HR), pulmonary ventilation (V_E), tidal volume (TV), respiratory rate (RR) and blood lactate (BL) level of each group were significantly higher during leg kicking than arm stroking at both velocities. VO2, V_E; and TV were significantly higher in group C than group E during leg kicking and arm stroking at both velocities, but HR, RR and BL did not differ significantly. The leg kick to arm stroke VO₂ ratio at 70% Vmax was significantly higher in group E than group C. The stroke rate at the same velocity was significantly lower and the stroke length was significantly higher in group C than group E, but the kick rate and length did not differ significantly. VO₂·SR^-1 and VO₂ KR^-1 at both velocities were significantly higher in group C than group E. VO₂ Wt^-1 SR^-1 at 70% Vmax was significantly higher in group C than group E, but VO₂ Wt^-1 KR^-1 at both velocities was significantly lower in group C than group E. These results clarified the differences between group E and group C, which must be considered carefully when designing a training program for age-group swimmers.

The purpose of this study was to determine the effects of well-rounded exercise program (WREP) on cardiorespiratory fitness, muscular strength, flexibility, body composition, and serum lipid concentration in a group of older outpatients. WREP was composed of programmed aerobic/ anaerobic accommodating circuit exercise (PACE) and flexibility exercises. Twenty-two volunteers (69.6±3.2 yr) were used as subjects. All participants engaged in a supervised exercise program (50 min/day and 3 days/week) for 12 weeks. After 12 weeks of training, there was a significant increase in VO₂ corresponding to lactate threshold (13.4%) but peak V0₂ did not change. There were significant increases for knee extension (17.1%) and flexion (12.3%), chest pull (10.9%), low back flexion (26.6%), and shoulder press (14.6%) after training. Side stepping agility (13%), trunk flexion (129%) and trunk extension (19%) were also significantly improved. There were significant decreases in percent of body fat (-8.3%), total cholesterol (-7.1%) and low-density lipoprotein cholesterol (-9.7%) . Blood pressure also decreased in SBP (-lOmmHg) and DBP (- 5 mmHg) . The decline in SBP was significant in thirteen hypertensive patients (-14 mmHg) compared to non-hypertensive patients (- 5 mmHg) . These results indicate that WREP elicits significant improvement of overall fitness in older outpatients.

Introduction
Recently, an increasing number of registered foreigners get married and bear children in Japan. At the same time, a variety of needs for maternal and child health (MCH) impose burden for medical practitioners. A questionnaire survey was conducted to clarify the situation of MCH service for foreign residents.
Method
Self-report questionnaires developed by “The study group for MCH in a multiethnic and multicultural society” were sent by mail to the pediatricians registered in the Gunma medical association or Gunma pediatric association. In total, target number was 299. The survey period was between 2003/10/6-11/3.
Result
The number of valid response was 167. Out of 167, 155 doctors replied to have experience of caring foreigners. 75% of them had the experience of trouble in communication. For the question of the need of translator, 76.8% of doctors answered “absolutely necessary” or “necessary if the quality of translation is high enough”. Desired competencies for translators were “Accurate translation of diagnosis, hands on of treatment strategy” or “To help taking detailed patient's history”.
For the experience of using MCH handbook in foreign languages, 52.9% of doctors answered “Never used it”.
Discussion
We found that the majority of doctors had difficulty in communicating with foreigners.
To meet the doctors' requirement for the competency of translator, two strategies should be considered. One is to develop professional medical translator through education of basic medical knowledge or Japan's health care system. The other is to train foreigners already engaging in translation.
For communication tools development, user friendly concept should be reflected including 1) adscript of foreign and Japanese languages, 2) illustration usage and 3) eye-friendly materials for elderly. Contents should have explanations including 1) diagnosis and treatment policy for common disease, 2) ways of coping with common symptoms, and 3) the information of a variety of Japan's welfare services.

Pulmonary blastoma is rare and its prognosis very poor. A 6-year-old boy was referred to our hospital with chest pain. Computed tomography demonstrated that the left pleural cavity was filled with a tumor. Cardiac echocardiography demonstrated that the tumor had invaded through the pulmonary vein into the left atrium and that the tumor extended into the left ventricle. Part of the tumor was adhered to the anterior leaflet of the mitral valve. To increase operative radicality, an autotransplantation technique was performed concomitantly with resection of the original lesion. Through a median sternotomy, a moderate hypothermic cardiopulmonary bypass was established to obtain cardiac arrest. First, longitudinal incision of right-sided of the left atrium was made. The tumor invaded into the left atrium through the left superior pulmonary orifice. The ascending aorta, the main pulmonary artery, and both caval veins were transected. The left atrium was incised along the pulmonary venous orifices. The heart was completely removed from the mediastinum and transferred to another table. Resection of the intracardiac metastatic lesion and mitral valve replacement was accomplished. During this time, thoracic surgeons performed a left pneunectomy. The left atrial wall around the left pulmonary venous orifices was resected in combination with the left lung. After the deficit of the left atrial wall was repaired with a Gore-Tex patch, the heart was replaced and we reconstructed the great arteries and caval veins. The autotransplantation technique is a useful procedure for combined lesions of the heart and lung.

Cellular senescence is an irreversible cell cycle arrest triggered by the activation of oncogenes or mitogenic signaling as well as the enforced expression of tumor suppressors such as p53, p16(INK4A) and promyelocytic leukemia protein (PML) in normal cells. E2F-binding protein 1 (E2FBP1), a transcription regulator for E2F, induces PML reduction and suppresses the formation of PML-nuclear bodies, whereas the down-regulation of E2FBP1 provokes the PML-dependent premature senescence in human normal fibroblasts. Here we report that the depletion of E2FBP1 induces the accumulation of PML through the Ras-dependent activation of MAP kinase signaling. The cellular levels of p16(INK4A) and p53 are elevated during premature senescence induced by depletion of E2FBP1, and the depletion of p16(INK4A), but not p53 rescued senescent cells from growth arrest. Therefore, the premature senescence induced by E2FBP1 depletion is achieved through the p16(INK4A)-Rb pathway. Similar to human normal fibroblasts, the growth inhibition induced by E2FBP1 depletion is also observed in human tumor cells with intact p16(INK4A) and Rb. These results suggest that E2FBP1 functions as a critical antagonist to the p16(INK4A)-Rb tumor suppressor machinery by regulating PML stability.
Cell Line, Tumor ; Cells, Cultured ; Cellular Senescence ; genetics ; physiology ; Cyclin-Dependent Kinase Inhibitor p16 ; antagonists & inhibitors ; genetics ; physiology ; DNA-Binding Proteins ; deficiency ; genetics ; physiology ; Down-Regulation ; Fibroblasts ; Gene Expression Regulation ; Humans ; Intranuclear Inclusion Bodies ; metabolism ; MAP Kinase Signaling System ; Nuclear Proteins ; genetics ; metabolism ; physiology ; Promyelocytic Leukemia Protein ; Protein Isoforms ; Protein Stability ; RNA Interference ; Retinoblastoma Protein ; antagonists & inhibitors ; genetics ; physiology ; Transcription Factors ; deficiency ; genetics ; metabolism ; physiology ; Transfection ; Tumor Suppressor Protein p53 ; physiology ; Tumor Suppressor Proteins ; genetics ; metabolism ; physiology ; Ubiquitination ; ras Proteins ; metabolism

OBJECTIVE: The Japan Society of Gynecologic Oncology (JSGO) published the first practice guideline for endometrial cancer in 2006. The JSGO guideline evaluation committee assessed the effect of this guideline introduction on clinical practice and patient outcome using data provided by the Japan Society of Obstetrics and Gynecology (JSOG) cancer registration system. METHODS: Data of patients with endometrial cancer registered between 2000 and 2012 were analyzed, and epidemiological and clinical trends were assessed. The influence of guideline introduction on survival was determined by analyzing data of patients registered between 2004 and 2009 using competing risk model. RESULTS: In total, 65,241 cases of endometrial cancer were registered. Total number of patients registered each year increased about 3 times in the analyzed period, and the proportion of older patients with type II endometrial cancer rapidly increased. The frequency of lymphadenectomy had decreased not only among the low-recurrence risk group but also among the intermediate- or high-recurrence risk group. Adjuvant therapy was integrated into chemotherapy (p<0.001). Overall survival did not significantly differ before and after the guideline introduction (hazard ratio [HR]=0.891; p=0.160). Additional analyses revealed patients receiving adjuvant chemotherapy showed better prognosis than those receiving adjuvant radiation therapy when limited to stage I or II (HR= 0.598; p=0.003). CONCLUSION: It was suggested that guideline introduction influenced the management of endometrial cancer at several aspects. Better organized information and continuous evaluation are necessary to understand the causal relationship between the guideline and patient outcome.
Chemotherapy, Adjuvant ; Drug Therapy ; Endometrial Neoplasms* ; Female ; Gynecology ; Humans ; Japan* ; Lymph Node Excision ; Obstetrics ; Prognosis

Objective: The Japan Society of Gynecologic Oncology published the first guidelines for the treatment of cervical cancer in 2007. The aim of this research was to evaluate the influence of the introduction of the first guideline on clinical trends and outcomes of patients with earlystage cervical cancer who underwent surgery. Methods: This analysis included 9,756 patients who were diagnosed based on the pathological Tumor-Node-Metastasis (pTNM) classification (i.e., pT1b1, pT1b2, pT2b and pN0, pN1, pNX) and received surgery as a primary treatment between 2004 and 2009. Data of these patients were retrospectively reviewed, and clinicopathological trends were assessed.The influence of the introduction of the guideline on survival was determined by using a competing risk model. Results: For surgery cases, the estimated subdistribution hazard ratio (HR) by the competing risk model for the influence of the guideline adjusted for age, year of registration, pT classification, pN classification, histological type, and treatment methods was 1.024 (p=0.864). Following the introduction of the first guideline in 2007, for patients with lymph node metastasis, the use of chemotherapy (CT) as a postsurgical therapy increased, whereas that of concurrent chemoradiotherapy (CCRT)/radiotherapy (RT) decreased (p<0.010). For pN1 cases, the estimated subdistribution HR by the competing risk model for the influence of the guideline was 1.094 (p=0.634). There was no significance in the postsurgical therapy between CT and CCRT/RT (p=0.078). Conclusions Survival of surgical cases was not improved by the introduction of the guidelines. It is necessary to consider more effective postsurgical therapy for high-risk earlystage cervical cancer.