A study was conducted to analyze the height growth velocity curve based upon the maturity rate. Ninety-eight longitudinal data points for height (for subjects aged 6 to 17 years) were obtained retrospectively from health examination records in 1983. Growth distance and growth velocity curves of each individual were described by the wavelet interpolation method, and PHV age was determined with the described graph using computer simulation. We classified the growth velocity curve by the maturity rate approximated according to the PHV age. As a result, it was shown that the after-growth spurt in early maturity and somewhat early maturity type appeared more than in the average and somewhat late maturity types, and that conversely, the mid-growth spurt in the late maturity and somewhat late maturity types appeared more than in the early maturity and somewhat early maturity types. Specifically, it was demonstrated that two mid-growth spurts appeared in the late maturity and somewhat late maturity types.

The purpose of this study was to examine the effects of walking 10,000 steps/day on the body composition, blood pressure, blood biochemical parameters and physical fitness. Sixty-one women, aged 56.0±5.3 yrs (mean±SD), participated in a hyperlipemia prevention program. The length of the program was 90-min and it was performed one time per week for 3 months. The program consisted of stretching and aerobic exercise (cycle exercise, walking or aerobic rhythmic gymnastics). The participants were asked to walk 10,000 steps/day or more during the program. The number of steps and physical activity (PA) were monitored using a single-axis accelerometer during the program. PA was categorized into three activity levels, namely light (L), moderate (M) and vigorous (V) PA. After 3 months in the program, the participants were divided into two groups according to the average number of steps taken daily during the program : one group (GA) walked more than 10,000 steps/day, while the other (GB) walked below 10,000 steps/day. The time spent in LPA, MPA and VPA in GA were significantly longer than in GB (LPA : 79.4±19.2 min VS 58.2±10.0 min, MPA : 38.5±9.6 min VS 21.6±6.1 min, VPA : 6.3±4.9 min VS 2.6±2.0 min, p<0.001). Decreases in the percent body fat (p<0.001), body fat mass (p<0.001), fasting glucose (p<0.001), hemoglobin A1c (p=0.026), and triglyceride (p=0.036) and an improved performance when balancing on one leg while standing with eyes closed (p=0.027) were found respectively after the program for GA. These findings indicated that GA affected the percent body fat (p=0.036), body fat mass (p=0.040) and fasting glucose (p=0.009). According to a stepwise multiple regression analysis, the time spent in MPA showed a significantly negative correlation with the change in the body fat mass (p=0.025), and the change in the body fat mass showed a significantly positive correlation with the change in the fasting glucose (p<0.001), hemoglobin A1c (p=0.002) and triglyceride (p<0.001). We thus concluded that walking 10,000 steps/day resulted in an increased amount of time spent in MPA, and thus leading to decrease in the amount of body fat. This decrease in body fat is also considered to contribute to improvement in the coronary risk factor profiles.

Purpose: To investigate the indications for use of the Japanese version of the Liverpool Care Pathway (LCP), we evaluated the conditions of patients using and those not using the LCP. Methods: We retrospectively investigated the medical records of 71 LCP patients and 60 non－LCP patients who died in our palliative care unit between March and December 2013. Results: There was no significant difference in patients’ background between the LCP and non－LCP groups. For patients in the non－LCP group, sudden changes in condition were significantly more frequent and deep continuous sedation was used significantly less than in the LCP group. In the LCP group, the average duration on the LCP was 4.0 days, and the beginning criterion was met by three－point or more of all the patients. The initial assessment was achieved except for one case. In the non－LCP group, reasons for not using the LCP were a sudden change in condition (35 patients), a rapid change in medical condition (14), and a risk of falling (4). Conclusions: The LCP met the beginning criterion and was started at suitable time in the LCP group. The LCP is not useful for all patients; it cannot be used for a patient with sudden or rapid changes in condition, or at a risk of falling.

The patient was a 58-year-old woman with untreated diabetes. She consulted a local doctor in May 2006 complaining of constipation that had persisted for 2 weeks, under gradually worsening abdominal pain. She was transferred to our hospital with a diagnosis of aortic aneurysm. Blood tests indicated high inflammatory response, and CT showed hematoma around the aorta from directly under the diaphragm to the level of superior mesenteric artery and influx of contrast medium into the hematoma. Control of the infection was first attempted with antibiotics, but eventually surgery was performed because the hematoma increased. The hematoma and aortic wall were completely excised from the local of the diaphragm to the level beneath the renal artery, with partial cardiopulmonary bypass and selective perfusion to abdominal branches, and anatomic reconstruction was performed with a synthetic graft and omental implantation. The hematoma was fetid and Citrobacter koseri was detected in culture. The patient was discharged after 4 weeks of antibiotic treatment, without complications and with satisfactory progress. At present, there has been no recurrence of infection in the 22 months since her discharge.

A 68-year-old woman with a diagnosis of atrial septal defect (ASD) presented with dyspnea. Chest radiography demonstrated cardiomegaly and infiltration in both lungs, suggestive of cardiac decompensation due to ASD. Detailed evaluation with transthoracic echocardiography revealed a mobile tumor on the aortic valve. Intraoperatively, tumors were identified on all aortic cusps. Preservation of the aortic valve was difficult. We therefore performed aortic valve replacement and patch closure of the ASD. The existing literature suggests that mobile papillary fibroelastoma should be excised irrespective of size, to prevent the risk of embolism. Excision of the tumor alone is usually sufficient. However, the present case showed clustered tumors on the aortic valve, so preservation of the cusps could not be achieved in this case.

At the Niigata University School of Medicine, objective structured clinical examinations (OSCEs) were performed for the first time in 2001 for 92 fourth-year medical students. The average evaluation scores students received from instructors were summarized, and the differences between scores given by different instructors were examined. We found that practice methods for the medical interview and physical examination before OSCE and the question topics and evaluation methods of OSCE were appropriate, but scores on some items were extremely low. The standardization and objectivity of the evaluation were satisfactory, perhaps because one explanatory conference and two training conferences were held for instructors before OSCE. However, some questions tended to produce differences between instructors, as did some topics, especially in the medical interview. The scores with standardized patients and those by teachers were strongly correlated, but those with the former were lower than those by the latter.

Type II endoleak after stent graft for abdominal aortic aneurysm generally permits a wait-and-see approach, however, additional second therapy is necessary if the aneurysm increases. A 78-year-old woman had undergone endovascular treatment with a stent-graft for abdominal aortic aneurysm. Computed tomography (CT) 3 months after the operation showed type II endoleak, and enlargement of the aneurysm was noted at 1 year. She underwent transarterial embolization for third and fourth lumbar arteries, but endoleak from the fourth lumbar artery remained, and the aneurysm was further enlarged. Surgical conversion was performed 2 years after the first operation. We applied a ligature to the forth lumbar artery by a laparotomy. Postoperative CT revealed disappearance of the endoleak. As endovascular treatment for abdominal aortic aneurysm is increasing and the number of cases necessitating additional therapy appears to be rising, we need to develop processes and strategies for coping with endoleaks.

Purpose：We evaluated that the current state from which a palliative care unit receives emergency admission of cancer patients at home. Methods：We retrospectively investigated the medical records of 393 cancer patients who hospitalized in our unit between January 2013 and December 2014. The patients were shared with a group of two, schedule admission (schedule group) and emergency admission (emergency group), and it was compared with a result on discharge and with a hospitalization period. We investigated admission process, the date and time of admission, and reason for admission in emergency group. Results：The number of patients was 224 of schedule group and 169 of emergency group. The mortality rates were 81% in schedule group and 78% in emergency group (not significant). An emergency group for an average of 24.3 days was shorter for 9 days than schedule groups in a hospitalization period of dead leaving patients (p<0.05). In emergency group, admission process included 128 completed-interviews with the hospitalization, 11 incompleted-interviews before admission and 30 first visits, and 129 patients (76％) admitted within the weekday daytime. Many patients had a complaint of severe pain, appetite loss and oral absorption difficulty, and so much. Conclusions：An emergency group admitted the various processes and the much symptom. There were a lot of cases of early hospital death, but also admitted return at home, and our unit played the role of emergency admission.

Pure autonomic failure (PAF) is a degenerative disorder with diverse autonomic nervous symptoms, but without somatic nervous symptoms. We encountered a patient with PAF who was successfully treated with keishikashakuyakuto. A 61-year-old man complained of diarrhea, abdominal pain, dysuria and orthostatic hypotension. PAF was strongly suspected, based on a low level of plasma noradrenalin at rest and a finding of severe diffuse sympathetic nerve injury on ¹²³I MIBG myocardial scintigraphy. Various Kampo formulas were not effective, or could not be administered continually. Urinary retention was treated with self-catheterization. After the extract of keishikashakuyakuto was administered, his complaints of diarrhea and abdominal pain gradually decreased, and he was able to eat various kinds of food. His daily living activities improved.Moreover, he could urinate by himself, so the self-catheterization was stopped. Five years later, the diagnosis of PAF was clinically confirmed, but his daily living activities did not deteriorate. This suggests that keishikashakuyakuto can be effective for diseases with diverse autonomic nervous symptoms, such as the present case.

Afatinib is an oral tyrosine kinase inhibitor (TKI) approved for treating advanced non-small cell lung cancer. It is necessary to develop a simple quantification method for TKIs in order to facilitate therapeutic drug monitoring (TDM) in clinical settings. This study sought to develop a simple and sensitive com-petitive enzyme-linked immunosorbent assay (ELISA) to quantify afatinib in plasma for routine phar-macokinetic applications. An anti-afatinib antibody was obtained using (S)-N-4-(3-chloro-4-fluor-ophenyl)-7-(tetrahydrofuran-3-yloxy)-quinazoline-4,6-diamine (CTQD), which has the same sub-structure as afatinib, as a hapten. Enzyme labeling of afatinib with horseradish peroxidase was similarly performed using CTQD. A simple competitive ELISA for afatinib was developed based on the principle of direct competition between afatinib and the enzyme marker for the anti-afatinib antibody, which had been immobilized on the plastic surface of a microtiter plate. Plasma afatinib concentrations below the limit of quantification of 30 pg/mL were reproducibly measurable. Also, the values of plasma afatinib levels measured from 20 patients were comparable with those measured by high-performance liquid chromatography, and there was a strong correlation between the values determined by both methods (Y = 0.976X – 0.207, r = 0.975). As indicated by its specificity and sensitivity, this newly developed ELISA for afatinib is an important tool for TDM and studies of the pharmacokinetics of afatinib.