We studied the relationship between bone mineral density (BMD) and history of habitual exercise in a group of university students comprising 41 athletes (27 males and 14 females) and 39 non-athletes (24 males and 15 females), ranging in age from 18 to 28 years. Their athletic history during elementray, junior and senior high schools was surveyed. Subjects who had engaged in athletic activities more than 3 days/week for more than two years at each school level were classified as a former physically active group, whereas the others were classified as controls. The BMD of the femur (femoral neck, Ward's triangle, trochanteric region) and vertebrae (L2-4) was ieasured using dual-photon absorptiometry with a ¹⁵³Gd source. The following results were obtained: 1) University athletes showed significantly higher BMD of the femur and L2-4 than non-athletes. 2) No significant difference was found for either sex between the physically active group on elementary school days and the control group with regard to BMD of the femur and L2-4. 3) The BMD of the femoral neck and trochanteric region in the male physically active group on junior high school days was significantly higher than that in the control group. The BMD of the femoral neck in the female physically active group on junior high school days was significantly higher than that in the control group. 4) The BMD of the femur and L2-4 in the female physically active group on senior high school days was significantly higher than that in the control group, whereas no difference was found between these two groups for males. These results suggest that regular exercise during puberty is effective for increasing BMD, especially in females. The finding that increased BMD in association with physical activity on senior high school days was observed only in females may be due to the synergistic effect of estrogen and exercise.

Bone mineral content (BMC), fat weight (FAT) and lean tissue weight (LTW) were determined by dual-energy X-ray absorptiometry (DEXA) in 20 young adults of both sexes who were performing habitual exercise. From these data, body weight, lean body weight (LBW) and the percentage of BMC relative to LBW (BMC%LBW) were obtained. First, body density based on a two-component model (D₂) was calculated using the values of FAT and LBW of the subjects and the fat and lean densities of the Reference Body, Then percentage body fat (%Fat₂) was calculated using the formula of Brozek et al. The body density for a three-component model (D₃) was then determined from the values of FAT, BMC and LTW of the subjects, and the fat, bone mineral and lean tissue densities of the Reference Body. Percentage body fat (%Fat₃) was also calculated in the same manner as %Fat₂. Analysis of the data indicated that (1) females had higher values of BMC%LBW than males, and that (2) subjects whose %Fat₂ exceeded %Fat₃ by more than 1% were exclusively females whose BMC%LBW values were more than 6.1%. In contrast, those whose %Fat₂ was lower than %Fat₃ by less than -1% were exclusively males who had BMC%LBW values less than 5.2%. It is concluded that male subjects develop their muscles more than their bones with habitual exercise, which results in a lower BMC%LBW value than in females, and that for those with BMC%LBW values exceeding 6.1% (females) or less than 5.2% (males), %Fat calculation from body density using the formula of Brozek et a1. will produce an error of more than 1% if BMC%LBW is not considered.

Purpose and Methods: Based on the medical records of 56 cases of death from hematologic malignancy, we investigated who decided end-of-life care in the terminal phase and at the end of life, what factor discourages patients from making self-decisions and whether an advance directive about end-of-life care is present. We then extracted the story of the family in decision-making for end-of-life care. Results: In 45 cases, the patient decided end-of-life care at the terminal phase. In 11 cases, the family made the decision on behalf of the patient. In the terminal phase, the factor that most discouraged patients from making a self-decision was dementia, but at the end of life the factor was symptomatic worsening in all cases. In 49 cases, the family decided end-of-life care at the end of life on behalf of the patient. Regarding end-of-life care policy, 49 cases hoped for "do not attempt resuscitation (DNAR)" and 7 cases hoped for life-support treatment. Advance directives were confirmed in 7 cases. Mental conflict about end-of-life care policy was perceived from the family's story. Despite small number of cases, it was suggested that an advance directive reduced psychological burden on the family. Conclusion: It is difficult for the patient to make self-decisions about end-of-care life at the end of life as compared to end-of-care life in the terminal phase. Further studies are required to assess the efficacy of an advance directive.

　　It is said that diabetes is one of the factors contributing to the onset of dementia and accelerating its progression. The number of dementia cases is expected to increase steadily year by year. Such being the circumstances, we encountered an elderly woman with diabetes and dementia, who managed to lower her blood glucose values to a proper level somehow or other, thus lightening the burden of caregivers. We shall hereby report the case because we thought it would make a good example for care in the region where the population is rapidly graying. The woman, then at age 80, visited our hospital complaining of languidness. Her blood sugar level was so high (random blood glucose level: 1,096 mg/dl) that she was hospitalized at once. By a stepwise insulin reinforcement therapy, the blood glucose levels were under control. During the stay in hospital, she was also diagnosed as having senile dementia. She was provided with effective health care and education for the control of blood sugar levels. Having snacks between meals was strictly prohibited. Considering that she was an elderly person living alone, only internal medicines were given. As a result, her blood glucose levels were elevated to about 300 mg/dl, but the combined use of GLP-1 injection and internal medicine once a week had good control over blood glucose levels. So, the patient was discharged from the hospital.