Kitaakita Municipal Hospital is located in Kitaakita City in the northern inland area of Akita Prefecture. When I started my new post at the former JA Akita Koseiren Hokusyu Central Hospital in 2002, there were two other hospitals in the area. Both were small to medium-sized hospitals with management problems and a shortage of doctors. Kitaakita City, which was already experiencing a wave of declining birthrates and an aging population, recognized the need for functional integration of its three hospitals, and in 2010, under the designated administrator system, established Kitaakita Municipal Hospital as an institution founded by the city and administered by JA Akita Koseiren. The Kitaakita district, located in a rural part of Akita Prefecture far from the Tokyo Metropolitan Area, can be seen as a forerunner of where Japan is headed in the future. The theme of this conference is “Healthcare in an Aging Society with a Declining Birthrate: Make Akita Bloom” and is intended to help people think about how to develop sustainable health care in an era of declining birthrates and aging populations. 　Japan's population has entered a phase of decline, with an aging society and a declining birthrate. It is expected that elderly patients will continue to account for larger proportions of hospitalized patients into the future. As more and more patients become frail and show signs of senility, it is necessary to train general practitioners who are able to treat patients systemically. Also, as the number of patients requiring high levels of nursing care increases, the hospitalization system must be improved so that it can accommodate them. Although the differentiation and concentration of healthcare functions is necessary to maintain the quality of healthcare amid a declining population, especially in rural areas, we continue to need hospitals that treat the elderly as well as a healthcare system that fully accounts for comprehensive community-based care.

In order to obtain the physiological information during such outdoor exercises as cross-country running or skiing, mountain climbing or diving in the sea water etc, we developed a new device employing MEMORY IC. for monitoring and recording various biological information from the subjects during exercise with no restraint. The device is composed of detecting, data processing and recording units. The application of a semiconductor, CMOS MEMORY I.C. to the recording unit enabled us to construct the instrument, which is very compact (150g) and tolerant to the mechanical vibrations as well as the enviromental disturbances. The recorded data are read out by a microcomputor system. This device was applied to ten subjects during running, where the heart rate, respiration rate and body temperature were recorded. They covered a distance of 9 km within 60 minutes. The heart rate of five trained men was stabilized at nearly fixed level during running which was consistent results with those by the treadmill, but in the untrained men different results were shown from the trained. The heart rate of the untrained men showed that they encoutered the limits of the capacity on the way of running. These results showed wide applicability of this device for the physiological analysis of outdoor exercises.

Androgens play a central role in prostate cancer pathogenesis, and hence most of the patients respond to androgen deprivation therapies. However, patients tend to relapse with aggressive prostate cancer, which has been termed as hormone refractory. To identify the proteins that mediate progression to the hormone-refractory state, we used protein-chip technology for mass profiling of patients' sera. This study included 16 patients with metastatic hormone-refractory prostate cancer who were initially treated with androgen deprivation therapy. Serum samples were collected from each patient at five time points: point A, pre-treatment; point B, at the nadir of the prostate-specific antigen (PSA) level; point C, PSA failure; point D, the early hormone-refractory phase; and point E, the late hormone-refractory phase. Using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry, we performed protein mass profiling of the patients' sera and identified a 6 640-Da peak that increased with disease progression. Target proteins were partially purified, and by amino acid sequencing the peak was identified as a fragment of apolipoprotein C-I (ApoC-I). Serum ApoC-I protein levels increased with disease progression. On immunohistochemical analysis, the ApoC-I protein was found localized to the cytoplasm of the hormone-refractory cancer cells. In this study, we showed an increase in serum ApoC-I protein levels in prostate cancer patients during their progression to the hormone-refractory state, which suggests that ApoC-I protein is related to progression of prostate cancer. However, as the exact role of ApoC-I in prostate cancer pathogenesis is unclear, further research is required.
Aged ; Amino Acid Sequence ; Antineoplastic Agents, Hormonal ; therapeutic use ; Apolipoprotein C-I ; analysis ; blood ; isolation & purification ; Blotting, Western ; Cell Line ; Disease Progression ; Drug Resistance, Neoplasm ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Molecular Sequence Data ; Prognosis ; Prostatic Neoplasms ; drug therapy ; metabolism ; Protein Array Analysis ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

Objective：To evaluate the reliability and concurrent validity of the Walking LEVEL Scale (WaLS) in patients hospitalized in a Convalescent Rehabilitation Ward (CRW).Design：The WaLS was used as an assessment scale to categorize the walking ability of patients in a CRW.Subjects/Patients：A total of 103 patients in a CRW were included in the study.Methods：Retest and inter-rater reliability were evaluated by using the WaLS to assess patients by the same rater and by two independent raters using the weighted kappa coefficient. Spearman correlation was used to assess the correlation between the WaLS and FIM-walk item scores and the WaLS and FAC scores (i.e., concurrent validity).Results：The retest and inter-rater reliability of the WaLS (weighted kappa coefficient) was 0.989 (p＜0.01) and 0.951 (p＜0.01), respectively. The WaLS scores were also significantly correlated with the FIM-walk item (p＝0.916, p＜0.01) and FAC scores (p＝0.919, p＜0.01)．Conclusion：The WaLS was found to demonstrate good reliability and concurrent validity in patients hospitalized in CRW.

Objective：To evaluate the reliability and concurrent validity of the Walking LEVEL Scale (WaLS) in patients hospitalized in a Convalescent Rehabilitation Ward (CRW).Design：The WaLS was used as an assessment scale to categorize the walking ability of patients in a CRW.Subjects/Patients：A total of 103 patients in a CRW were included in the study.Methods：Retest and inter-rater reliability were evaluated by using the WaLS to assess patients by the same rater and by two independent raters using the weighted kappa coefficient. Spearman correlation was used to assess the correlation between the WaLS and FIM-walk item scores and the WaLS and FAC scores (i.e., concurrent validity).Results：The retest and inter-rater reliability of the WaLS (weighted kappa coefficient) was 0.989 (p＜0.01) and 0.951 (p＜0.01), respectively. The WaLS scores were also significantly correlated with the FIM-walk item (p＝0.916, p＜0.01) and FAC scores (p＝0.919, p＜0.01)．Conclusion：The WaLS was found to demonstrate good reliability and concurrent validity in patients hospitalized in CRW.

Objective: The effectiveness of palliative care for patients with amyotrophic lateral sclerosis (ALS) has not been fully validated. This study aimed to evaluate the impact of palliative care interventions on ALS patients using the Integrated Palliative care Outcome Scale (IPOS). Methods: A retrospective study was conducted on ALS patients at National Hospital Organization Yamagata National Hospital who received interventions from the palliative care team between November 2020 and December 2022 and were proxy-evaluated using IPOS. Results: Eleven patients were included in the analysis. Before and after the palliative care team intervention, the total IPOS score improved significantly from 24 to 18.9 (p=0.032), and the score for “Have you felt at peace” improved from 2 to 1 (p=0.031). Conclusion: Palliative care interventions may help alleviate suffering in ALS patients. However, further studies with larger sample sizes and long-term observational research are required to confirm these findings.