Fifteen female caddies, aged 40 to 57 yrs, were studied to estimate the effect of mild walk habit on body composition, blood pressure and serum lipids. The subjects had 12 wk of walk habit which consists of 20 to 45% of maximal aerobic power in intensity, 7 to 8 km⋅d^-1in duration and 5 to 6 d⋅wk^-1 in frequency. Significant (P<0.01) reductions in body weight (-2.9 kg), fat-tissue weight (-4.2 kg), and percent body fat (-6.1%) were found after 12 wk of walk habit. This walk habit also significantly decreased systolic (-15 mmHg), diastolic (-6 mmHg) and mean (-11 mmHg) blood pressure at rest (P <0.01, P <0.05 and P <0.01, respectively) . In serum lipids, there were significant (P < 0.05 or P < 0.01) reductions in total cholesterol (TC), high-density (HDL-C) and low-density (LDL-C) lipoprotein cholesterol with no significant change in triglycerides. As a result, the ratio of TC to HDL-C and HDL-C to LDL-C showed no significant change by this walk habit. We conclude that 12 wk of mild walk habit results in the beneficial effect on the improvement of body composition and blood pressure.

An isolated huge unruptured aneurysm of the right coronary sinus of Valsalva was detected incidentally in a 47-year-old man. Echocardiography and aortograms revealed severe aortic insufficiency with moderate stenosis, and mild dilatation of the lower ascending aorta without annulo-aortic ectasia. At operation, a sclerotic bicuspid aortic valve was confirmed. These abnormal findings necessitated a reconstruction of the aortic root with a valved conduit and reimplantation of the coronary arteries (Bentall operation with the Carrel patch technique). Pathologic examination of the resected aortic wall showed diffuse sclerotic change and partial medial degeneration.

Preoperative blood donation is well known as one approach to reducing complications caused by homologous blood transfusion. The purpose of this study is to evaluate whether preoperative blood donation prior to coronary artery bypass grafting (CABG) reduces homologous blood transfusion. The subjects were selected from 151 consecutive patients who underwent CABG between October 1996 and October 1998. Of the 151 patients, 76 made preoperative blood donations (group A). Results in this group were compared with those obtained in the control group consisting of the subjects who received CABG without preoperative blood donation (group B, n=75). Both groups were matched for age, sex, preoperative hematocrit, cardiopulmonary bypass time, blood transfusion index (BTI; body weight×preoperative hematocrit). There were no significant differences between the two groups in terms of age and mean bypass duration. Homologous blood requirements were significantly lower in group A (78.9%) compared to group B (61.0%). BTI in group A (2, 224±447) however, was higher than that in group B (2, 129±515). In our study, preoperative blood donation was very effective to reduce homologous blood transfusion in coronary artery bypass grafting.

The purpose of this study was to clarify various components of walking activities among the high aged people, in relation with physique and heart rates at rest and post exercise recovery period. Subjects are 53 female residents of a care house in Hyogo Prefecture, whose average age being 78.9±0.9 years were tested in various parameters that are relevant to the study, such as height, weight, BMI, resting heart rate, total amount of weekly walking steps (recorded twice, i, e., in September and in October), walking velocity, walking stride, time length for climbing 15 step stairs and self-rate health. the major findings are summarized as follows
(1) Various physical functions that are related to daily activities and therefore related to muscular strength and neuromuscular coordination, were found to decrease significantly upon aging, such as walking velocity and time length for climbing stairs.
(2) The result of multiple correlation regression analysis, taking total amount of weekly walking steps with self-rated health, time length spent for 15 steps of climbing stairs and age were existent.
(3) Walking velocity, walking steps size and stair climbing velocity of good walkers (upper 25% in total amount of weekly walking steps) and it was found that the good walkers walked faster with greater steps size and climbed the stairs faster than the less walking subjects.
(4) The total amount of daily walking steps of various days of the week were compared each other and it was found that the good walkers recorded significantly less amount of walking steps on Thursday than others days. the fact that a large scale shopping center which is located near by the care-house closes on Thursday every week suggests that the amount of walking steps are influenced by social factors, such as shopping behavior.
(5) In terms of the going out behavior outside of care-house, visiting the large scale shopping center (40% of subjects), and hospitals and alike (25%) were recognized. The results suggest that there are certain common elements in the motivation and behavior of out-of- care-house activities.
The above results suggest that the study of walking behavior of the high aged people would be extremely variable not only in assessing the fitness level and physical function of the residents, but also in possible evaluation of efficiencies of the care-house location.

Background and aims:Lenvatinib(LEN)is a newly developed tyrosine kinase inhibitor,and is approved as a first-line treatment for advanced hepatocellular carcinoma(HCC)in Japan.This retrospective multi-center study investigated the effect of the relative dose intensity(RDI)of LEN on response rate,progression-free survival(PFS),and overall survival(OS). Methods:This retrospective study enrolled 123 patients with advanced HCC who were treated with LEN at six hospitals in Japan between March 2018 and December 2019.These patients were divided into two groups:RDI ≥70％(RDI 70 group,N=70)or RDI＜70％(control group,N=53)in the first 30 days.The following data were compared between groups:patient backgrounds,adverse events,treatment out-comes,PFS,and OS.PFS and OS were analyzed using the Kaplan-Meier method,followed by the log-rank test.To identify significant factors that contributed to response,PFS,and OS,multivariate analysis was performed using factors for which P-values were ＜0.10 in univariate analysis. Results:The proportion of patients with Child-Pugh class 5A was significantly greater in the RDI 70 group than that in the control group(64.3％ vs. 28.3％,P＜0.01).Dose interruption due to adverse events was significantly more common in the control group.The response rate was significantly higher in the RDI 70 group than that in the control group(35.7％ vs. 11.3％,P＜0.01).Median PFS was significantly longer in the RDI 70 group(9.4 vs.4.7 months,P＜0.01).Multivariate analysis showed that RDI ≥70％(hazard ratio(HR)=0.55,P=0.025),hypertension grade ≥2(HR=0.47,P=0.019),and response(HR=0.52,P=0.033)were independently associated with improved PFS.Median OS was also significantly longer in the RDI 70 group(20.0 vs.13.3 months,P=0.045).Multivariate analysis showed that female sex(HR=0.33,P=0.034)and disease control(HR=0.31,P＜0.01)were independently associated with improved OS.RDI ≥70％ was not statistically significant in multivariate analysis. Conclusions:Our study revealed the importance of achieving RDI ≥70％ in the first 30 days of treatment to maximize the effects of LEN.

The purpose of this study was to examine the prevalence of disordered eating patterns (DEP) and menstrual irregularities in Chinese female athletes (n=881) and nonathletic controls (n=147), by using Eating Attitudes Test-26 (EAT-26) and written questionnaires. The athletes were divided into the following 6 categories : technical, endurance I (leanness is considered important for athletic performance) and II (leanness is less important), aesthetic, ball-game and power sports. The prevalence of DEP in the athletes estimated by EAT-26 was low (technical 1.5%, endurance I 3.3%, endurance 11 1.6%, aesthetic 3.0%, ball-game 3.0% and power sports 0.9%), and didn't significantly differ from that in nonathletic controls (0.7%) . Amenorrheic athletes were not observed in endurance I and II, aesthetic, or ball-game sports and very low prevalence rates for amenorrhea were found in the athletes in technical (0.5%) and power sports (0.4%) . These figures represent no significant differences between athletes and nonathletes in the prevalence rates of amenorrhea. It was suggested that a low prevalence of DEP in Chinese athletes stems from low socioculturally- and socioeconomically-imposed desires to be thin and low requirements for weight loss to improve athletic performance. Also, the present data suggest that the low incidence of amenorrhea in Chinese athletes is partly associated with the low prevalence of DEP.

　　This study is designed to clarify the effects of increases in a rehabilitation session on the functional outcome of hip fractures in the subacute phase.　　Of 95 patients with hip fractures admitted to our subacute care ward between November 2010 and March 2012, five patients transferred to another ward due to complications were excluded, and 90 patients were taken up. The 90 patients were divided into two groups: 22 patients who underwent rehabilitation before an increase in the frequency of rehabilitation sessions (early-phase group) and 68 who underwent rehabilitation after an increase in the frequency (later-phase group). Outcomes, such as the number of rehabilitation sessions, length of hospital stay, FIM at the time of discharge, FIM efficiency and destination after hospital discharge, were compared between the two groups.　　In a comparison of all patients, the number of rehabilitation sessions significantly increased (p<0.001), but there was no significant difference in FIM at the time of discharge from hospital, FIM efficiency and post-discharge destination. Group “Rank A” stood out in a comparison of the degree of independence enjoyed by the disabled elderly in their daily life before they suffered injuries (p<0.05). Group “Rank I” stood out in a comparison of the degree of independence in the daily life by the elderly with dementia, while they were in hospital (p⁢0.05). The FIM efficiency of the later-phase group was significantly higher than that of the early-phase group.　　It is presumably effective to begin intensive rehabilitation for patients whose ADL ability is somewhat reduced and those who have cognitive impairments. It has been thought that cognitive impairment was one of the factors that inhibit rehabilitation for hip fractures. However, it has been suggested that improvements in ADL are possible with increases in rehabilitation sessions for cases with mild cognitive impairment.

Primary cardiac tumors are comparatively rare. Primary cardiac angiosarcoma is the most common cardiac malignant tumor and the most common site of this tumor is in the right atrium. It is usually difficult to diagnose and treat this condition before death. The present case of primary cardiac angiosarcoma was located in the left atrium, which is very rare. A cardiac malignant tumor was suspected in this 56-year-old man based on chest MRI examination. The operation was performed successfully but its outcome was very poor.

A 69-year-old man was admitted for treatment of thoracic aneurysm. DSA revealed multiple aortic aneurysms: three true aneurysms which were located at the distal arch, the thoraco-abdominal aorta at the diaphragm level and the infrarenal abdominal aorta, 60mm, 55mm and 55mm in diameter, respectively and two pseudo-aneurysms which were located in the abdominal aorta just below the right renal artery and the right common iliac artery. We decided to perform a two-staged operation. Before the first operation, 1, 200ml of autologous blood was stored for perioperative blood transfusion. Initially, total arch replacement was performed using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. One month after the first operation, total thoraco-abdominal aorta replacement was performed by a retroperitoneal approach with mild hypothermia. The Th 9, 10 and 11 intercostal arteries were reconstructed. Distal anastomosis was performed at both common iliac arteries. Blood transfusion was not required for blood pooling and reduction of priming volume in the cardiopulmonary bypass system.

Lung hemorrhage associated with pulmonary reperfusion injury is a rare but lethal condition. We presented a case salvaged by non-heparinized extracorporeal life support for massive lung hemorrhage after pulmonary thromboembolectomy. Sub-acute pulmonary thromboembolism with a floating right atrial thrombus was diagnosed in 63-year-old woman by computed tomography and echocardiography. An emergency pulmonary thromboembolectomy was performed using cardiopulmonary bypass and moderate hypothermia. Immediately after reperfusion, extraordinary lung hemorrhage occurred and continued. We decided to take over the standard cardiopulmonary bypass with a non-heparinized extracorporeal life support system. Fortunately, hemostasis of the lung hemorrhage was completely secured within 12h, and the extracorporeal life support was terminated at 20h after the surgery. The patient was extubated at 48h after the surgery, and was discharged after the insertion of an inferior vena cava filter for a floating deep venous thrombus. Although the necessity, efficacy and risk of the non-heparinized extracorporeal life support should be clarified, we conclude that it could be the treatment of choice for life threatening lung hemorrhage associated with pulmonary reperfusion injury.