Case：A 57 year-old man, who had received home oxygen therapy and noninvasive ventilation（NIV）as outpatient, was admitted to our hospital because he felt shortness of breath. He could not eat meals because he was required to receive NIV in all days. He therefore was admitted to our palliative care unit（PCU）on a permanent basis in order to improve the quality of his life. In the PCU, he could take a bath, eat meals and appreciate local folk songs while receiving NIV. Complications were only desaturation and feeling shortness of breath while bathing or eating. Conclusions：NIV may be a useful device for the patients with terminal respiratory failure.

The aim of this study is to evaluate the effects of agricultural activity on cognitive function, physical function, motivation, activity of daily living (ADL), self-efficacy and quality of life (QOL) of hospitalized elderly with dementia using multivariate statistical analysis. Elderly with dementia performed them for 2 months that replaced with agricultural activities once a week after they performed ordinary activities for 2 months. Ordinary and agricultural activities showed higher score than control condition. Two therapies are compared by principal component analysis (PCA), correlation analysis and multiple regression analysis (MRA). From the PCA analysis, motivation, muscular strength, walking ability, and mobility ability tended to improve during agricultural activities, but there was no significant difference in cognitive function, daily life, and behavioral disorders. In the correlation analysis, walking speed, walking time, timed up and go test (TUG), and grip strength showed a high score. MRA showed that improved physical function is improved during agricultural activities, but no significant improvement in cognitive function and ADL. Therefore, it was found that agricultural activities may be useful for improving physical functions. Long-term evaluation is needed for discussing the effects on cognitive functions and ADL.

Objective: The influence of depression, anxiety, and family function in breast cancer patients on the quality of life of their children was investigated from the perspective of the participants’ demographic characteristics after controlling for their attributes. Methods: The demographic characteristics and confounding factors were divided into two subgroups, and two-factor analysis of variance was conducted with depression, anxiety, and family function as the independent variables, and the children’s quality of life scores as the dependent variable. Results: The quality of life of children in each characteristic demographic-subgroup was significantly lower when their mother had high depressed. Moreover, the quality of life in children of the subgroup with mothers receiving chemotherapy varied according to the quality of family function regardless of having siblings. Conclusion: It is necessary to focus on the conditions of children in addition to the psychological status of breast cancer patients. This investigation suggested that understanding mothers’ psychological status helps to identify children’s psychosocial problems. Moreover, it is suggested that the demographic characteristics of families with breast cancer patients should be considered when approaching mothers’ psychological status and family function.

Methods: HFCs were obtained from patients with LSS who underwent surgery. HFCs were stimulated by tumor necrosis factor-α (TNF-α) and a p38 MAP kinase inhibitor, SB203580. Phosphorylation of the p38 MAP kinase was analyzed by western blotting. The concentration of interleukin-6 (IL-6) in the conditioned medium was measured by enzyme-linked immunoassay and IL-6 messenger RNA expression levels were determined by real-time polymerase chain reaction. Results: TNF-α induced the phosphorylation of p38 MAP kinase in a time-dependent manner, which was suppressed by the p38 MAP kinase inhibitor, SB203580. TNF-α also stimulated IL-6 release in both a time- and dose-dependent manner. On its own, SB203580 did not stimulate IL-6 secretion from HFCs; however, it dramatically suppressed the degree of IL-6 release stimulated by TNF-α from HFCs. Conclusions This is the first report suggesting that TNF-α stimulates the gene expression and protein secretion of IL-6 via p38 MAP kinase in HFCs. A noted association between tissue hypertrophy and inflammation suggests that the p38 MAP kinase inflammatory pathway may be a therapeutic molecular target for LSS.

Approximately 40%–65% of new fitness club (FC) members cancel their membership within 6 months. To prevent such cancellations, it is essential to identify members at high risk of doing so. This study developed a model to predict the probability of discontinuing FC membership among new members. We conducted a cohort study and enrolled participants from 17 FCs in Japan. We asked 5,421 individuals who became members from March 29, 2015 to April 5, 2016 to participate in the study; 2,934 completed the baseline survey, which was conducted when the participants became FC members. We followed up the participants until September 30, 2016. We excluded 883 participants with missing values and 69 participants under aged 18 years; thus, our analysis covered 1,982 individuals. We conducted the random survival forest to develop the prediction model. The mean follow-up period was 296.3 (standard deviation, 127.3) days; 488 participants (24.6%) cancelled their membership during the follow-up. The prediction model comprised 8 predictors: age; month of joining FC; years of education; being under medical follow-up; reasons for joining FC (health improvement, relaxation); and perceived benefits from exercise (maintaining good body weight, recognition of one’s ability by other). The discrimination and calibration were acceptable (C statistic: 0.692, continuous ranked probability score: 0.134). Our findings suggest that the prediction model could assess the valid probability for early FC cancellation among new members; however, a validation study will be needed.

The purpose of this study was to develop prediction models of sarcopenia in 1,894 Japanese men and women aged 18-85 years. Reference values for sarcopenia (skeletal muscle index, SMI; appendicular muscle mass/height2, kg/m2) in each sex were defined as values two standard deviations (2SD) below the gender-specific means of this study reference data for young adults aged 18-40 years. Reference values for predisposition to sarcopenia (PSa) in each gender were also defined as values one standard deviations (1SD) below. The subjects aged 41 years or older were randomly separated into 2 groups, a model development group and a validation group. Appendicular muscle mass was measured by DXA. The reference values of sarcopenia were 6.87 kg/m2 and 5.46 kg/m2, and those of PSa were 7.77 kg/m2 and 6.12 kg/m2. The subjects with sarcopenia and PSa aged 41 years or older were 1.7% and 28.8% in men and 2.7% and 20.7% in women. The whole body bone mineral density of PSa was significantly lower than in normal subjects. The handgrip strength of PSa was significantly lower than in normal subjects. Stepwise regression analysis indicated that the body mass index (BMI), waist circumference and age were independently associated with SMI in men; and BMI, handgrip strength and waist circumference were independently associated with SMI in women. The SMI prediction equations were applied to the validation group, and strong correlations were also observed between the DXA-measured and predicted SMI in men and women. This study proposed the reference values of sarcopenia in Japanese men and women. The prediction models of SMI using anthropometric measurement are valid for alternative DXA-measured SMI in Japanese adults.