From the standpoint of pediatricians, we have cautiously watched the increased prevalence of obesity among children as a phenomenon concomitant with the urbanization of agricultural communities.
In this paper the findings of the latest survey of obesity in primary school children are axamined in comparison with the results of 1970 survey.
The number of the children covered by the latest survey was 10, 606, of which 839 children (79.1%) were found in the condition of obesity, or 20% or more over a desired weigth, showing the incidence of obesity is 9 times higher than that in the previous survey.

This report deals with the response of heart rate, blood pressure and respiratory rate when the subjects of different ages and sexes worked on a bicycle ergometer. The subjects were 126 healthy persons of both sexes. They consisted of 8 groups : prepuberty male (N=15) and female (N=16), puberty male (N=20) and female (N=18), young adult male (N=15) and female (N=16), middle aged male (N=17) and female (N=9) . All subjects tried pedalling exercise with 3 kinds of loads, i.e., 5kgm/kg/min, 10kgm/kg/min and 12.5 kgm/kg/min for 6 minutes.
Heart rate was calculated from chest lead ECG and respiratory rate was measured by the thermistor method continuously recorded before, during and after exercise. Blood pressure was measured by Riva Rocci sphygmomanometer before exercise, at the early stage of recovery and in 10 minutes after exercise.
The results of this study are summarized as follows
1) In both sexes the heart rate decreased with age in resting status and exponentially increased during moderate and heavier exercise. A linear relationship was found between the work load and the exercise heart rate.
In males the heart rate during light exercise was high in the prepuberty and the puberty, low in the young adult and the middle aged. But the heart rate during heavy exercise in the middle aged was extremely high. The heart rate in females was higher than that in males when the same work load was given in both sexes. The rising phase of heart rate in prepuberty was the earliest of 4 age groups.
2) The systolic blood pressure and the pulse pressure in resting status increased with age. As for the blood pressure during exercise, it was low in the youth and high in the middle aged. The blood pressure after exercise in the middle aged males was the highest of 4 groups. Generally in all females the systolic blood pressure and the pulse pressure increased with work load, but the former levelled off during heavy exercise.
3) The respiratory rate during exercise increased rapidly, but when the exercise was stopped, the increased respiratory rate returned rapidly to the resting level. As for the respiratory rate, in both sexes it decreased with age from the prepuberty to the middle aged in resting status and during exercise. The sex difference of the respiratory rate during heavy exercise was large.
4) In the youth the correlation coefficient between the heart rate and the blood pressure was high. Therefore, it was suggested that the heart rate was important in adaptation to exercise.

Many researchers report that cigarette smoking by parents adversely affects their children. We carried out a survey about cigarette puffing by distributing questionnaires to mothers of sucklings and little children. The survey found that mothers and family members were not well aware of the health consequences of passive smoking. It was also found that children frequently exposed to smoking are at high risk of contracting infections of the respiratory tract. The average weight at birth was less in babies borned by smoking mothers than by those who do not smoke. Furthermore, it was revealed that a larger number of smoking mothers had given birth to low birth weight infants than nonsmoking mothers had.
These findings suggested that passive cigarette smoking is linked to low birth weight and respiratory tract infection. We think it is incumbent on us, health-care professionals, to bring home to mothers and the rest of the family members how serious the consequences of passive smoking are.

College athletes often tend to suffer from defective nutrition status due to excessive physical training with inadequate dietary intakes, which resulted in various physical disorders such as anemia. This study was conducted to investigate the effects of nutrition interventions to the anemic state of long distance runners. A nutritional education program was applied and daily single pack of nutritional supplement drink rich in iron, zinc, copper, selenium as well as eleven vitamins were provided for two months. Blood hemoglobin, red blood cells as well as serum ferritin and iron levels after the intervention were significantly higher compared with the basal, pre-intervention level of respective items. Among the subjects, two were found to be anemic (hemoglobin<13g/dl) before the intervention. Both of them, however, were successfully recovered to normal status (hemoglobin≧13g/dl) thereafter. The pre-intervention levels of hemoglobin were negatively correlated to the amount of difference between those of pre- and post-intervention, which appeared to indicate an improvement of nutrient deficiency that caused the hypochromia. On the other hands, the intake of energy and nutrients from meals did not change before and after the intervention. From the results obtained, it seems to be appropriate to emphasize the importance of nutrition education, especially, a possible effectiveness of including multiple nutrient supplementation in nutrition program for college athletes is suggested.

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

During the 18-month period from January 1, 1981 to June 30, 1082, we encountered a total of 11 cases of child peptic ulcer-three gastric ulcer and eight duodenal ulcer casen.
There is every indication that the incidence of child peptic ulcer will increase in a rural area like Yuri, which is situated in Japan's northeastern prefecture of Akita.
To be noted is the fact that 10 cases out of 11 of peptic ulcer were found in three-year lower secondary schoolchildren and the remaining one was found in a sixth grader of six-year elementary school. The incidence as well as the number of visits to our clinics went up as the age advances and reached a peak in third graders of lower secondary school.
The reason why third graders of lower secondary school were attacked most by peptic ulcer is probably that they, at puberty, are under psychic or psychogenic stress with anxiety over high school entrance examinations, mental strain from forced attendance at a cramming school, trouble in getting along with friends, and dissatisfaction with parents.
Therefore, child peptic ulcer should not be treated as a disease of the digestive organ alone but as a disorder in the autonomic nervous system with an aid of psychosomatic medicine and psychiatry. For the prevention of the disease, it would also be necessary to take account of socio-cultural factors.

Our survey was conducted at 522 elementary schools and junior high schools in Akita prefecture in July 1981. Thus the survey was intended for 105, 137 elementary school pupils bnd 51, 029 junior high school pupils. Questionnaires were sent to teachers in charge at each school. The return rate of questionnaires wan 98.4 % for elementary school and 100.0 % for junior high school. The rate of bronchial asthma was 1.2 %(boy 1.5 %, girl 0.9 %) in elementary school pupils and 0.6 %(boy 0.8 %, girl 0.5 %) in junior high school pupils. The number of schools where pupils with bronchial asthma were found was 205 elementary schools (56.0 %) and 71 junior high schools (47.0 %). The rate of bronchial asthma in boys was greater than girls, by 1.7 times in case of elementary school and 1.6 times in junior high school. The rate of bronchial asthma in urban children was 1.2 %, while that in rural children was 0.8 %. Out of the children interpreted as bronchial asthma at the time of our survey 82.4 % of the elementary school children and 77.6 % of the junior high school children with bronchial asthma were or had been undergoing apropriate treatment. The rate of children who are absent from school due to asthma more than 10 days a year was 24.4 % in elementary school and 26.7 % in junior high school.

Methods: Participants included 376 patients who received denosumab (60 mg every 6 months) from January 2013 to June 2021. The time from therapy initiation to discontinuation was used to measure persistence, and that between initial and subsequent injections was used to determine adherence. The pandemic period was from March 2020 to December 2021. Results: Patients were divided into those treated after March 2020 (pandemic group, n=244) and those who discontinued treatment before March 2020 (non-pandemic group, n=132). Non-persistent cases accounted for 154, including 24 (20%), 64 (19%), and 66 (53%) aged ≤59 years, 60–79 years, and ≥80 years, respectively. The overall persistence rate at 78 months was 59.2%. Postponed cases were significantly lower in the non-pandemic group than in the pandemic group (8% vs. 15%, p =0.042). Postponement with a delay of 1–2 months did not significantly differ between the two groups, but with a significant difference for a delay of ≥3 months (0% vs. 36%, p =0.024). Conclusions Denosumab adherence remained constant but postponed cases significantly increased during the COVID-19 pandemic. Better communication by health providers on denosumab adherence and alternative administration may reduce dosing interruptions in similar pandemic situations.

BACKGROUND: Management of postprandial hyperglycemia is a key aspect in diabetes treatment. We developed a novel system to measure glucose area under the curve (AUC) using minimally invasive interstitial fluid extraction technology (MIET) for simple monitoring of postprandial glucose excursions. In this study, we evaluated the relationship between our system and continuous glucose monitoring (CGM) by comparing glucose AUC obtained using MIET with that obtained using CGM for a long duration. METHODS: Twenty diabetic inpatients wearing a CGM system were enrolled. For MIET measurement, a plastic microneedle array was applied to the skin as pretreatment, and hydrogels were placed on the pretreated area to collect interstitial fluid. Hydrogels were replaced every 2 or 4 hours and AUC was predicted on the basis of glucose and sodium ion levels. RESULTS: AUC predicted by MIET correlated well with that measured by CGM (r=0.93). Good performances of both consecutive 2- and 4-hour measurements were observed (measurement error: 11.7%±10.2% for 2 hours and 11.1%±7.9% for 4 hours), indicating the possibility of repetitive measurements up to 8 hours. The influence of neither glucose fluctuation nor average glucose level over the measurement accuracy was observed through 8 hours. CONCLUSION: Our system showed good relationship with AUC values from CGM up to 8 hours, indicating that single pretreatment can cover a large portion of glucose excursion in a day. These results indicated possibility of our system to contribute to convenient monitoring of glucose excursions for a long duration.
Area Under Curve* ; Extracellular Fluid ; Glucose* ; Humans ; Hydrogel ; Hydrogels ; Hyperglycemia ; Inpatients ; Plastics ; Skin ; Sodium

Introduction: Voriconazole (VRCZ) is a triazole antifungal agent for which therapeutic drug monitoring (TDM) is recommended. At Juntendo University Hospital, the VRCZ TDM implementation rate was 42% between January 2011 and October 2017. Here, we report that modifications to the hospital’s drug ordering system improved the implementation rate of VRCZ TDM.Method: In August 2018, the drug ordering system was modified so that a message appeared on the screen to notify clinicians of the need to monitor VRCZ blood concentrations and to recommend a date for sample collection. In addition, the laboratory orders for VRCZ levels were digitized. We compared two one-year periods before and after implementation of the modifications (August 2017 to July 2018 and August 2018 to July 2019) to verify the effect of the changes.Result: Results showed an increase in the TDM implementation rate: 12 patients (42.8%) received TDM before modification of the system, and 26 patients (92.9%) received TDM after modification of the system. Further, the rate of blood sampling at the recommended time point for estimating blood concentration (day 5-7 after the start of administration) improved after system modification, i.e., blood samples were collected from 18 patients (64.3%) at the steady state point. In contrast, blood samples were collected from only 6 patients (21.4%) before system modification. When blood concentrations deviated from the target range in patients who received TDM, clinicians took appropriate actions, such as reducing drug doses, prescribing drug holidays, or discontinuing medications.Conclusion: A system that provides information related to VRCZ blood concentration measurements can help clinicians provide patients with optimal pharmacotherapy.