A study was conducted to examine the relationship between percent body fat (%fat) and medical examination parameters. The subjects were 250 women aged 17 to 68 years, who neither drank nor smoked. The results obtained were as follows:
After controlling for the effects of age and maximal oxygen intake per kilogram body weight (VO₂max/wt), %fat showed a significant correlation with high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio (TC/HDL-C), β-lipoprotein (β-L), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic tansaminase (GPT), uric acid (UA), white blood cell count (WBC), red blood cell count (RBC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) . Values of %fat calculated from each regression equation when HDL-C=38mg/dl, TC/HDL-C=4.9, β-L=500 mg/dl, GOT=41mu/ml, GPT=46 mu/ml, UA=5.7mg/dl, WBC=8500/mm3, RBC=520×104/mm3, SBP=159 mmHg, and DBP=94 mmHg were 32.2%, 31.9%, 30.8%, 35.4%, 36.4%, 31.8%, 30.7%, 35.0%, 33.8% and 32.6%, respectively.
The subjects were then divided into 2 groups, above (above group) or below (below group) 30%, 31%, 32%, 33%, 34% or 35% body fat. Wherever the subjects were divided into 2 groups at these values of %fat, the above group showed a significantly higer occurrence of abnormal values for medical parameters than the below group.
The subjects were further divided into 3 groups: 154 subjects with %fat below 29.9% (N group), 47 subjects with %fat between 30% and 34.9% (MO group), and 49 subjects with %fat above 35% (O group) . The O group showed significantly higher occurrence of abnormal values for medical parameters than the MO and N groups. The O group also showed a significantly higher mean value of DBP than the MO and N groups. Furthermore, the O group showed a significantly lower mean value of HDL-C and significantly higher mean values of TC/HDL-C, UA, GOT, GPT, SBP, FBS than the N group. There was no significant difference between the N and MO groups in the occurrence of abnormal values for medical parameters. However, the MO group showed a significantly lower mean value of HDL-C and significantly higher mean values of TC/HDL-C, UA and β-L.
These results suggest that the values of medical parameters become poorer when %fat exceeds 30%, a level widely used in Japan as a criterion for evaluation of obesity.
The subjects were further divided into 3 groups: 50 subjects who were non-obese and fit (NF group) ; 104 subjects who were non-obese and unfit (NU group) ; 88 subjects who were obese and unfit (OU group) . There were significant differences in the occurrence of abnormal values for medical parameters among these groups. The NF group showed the lowest values, followed by the NU and OU groups. Thus, it seems preferable to evaluate individuals using a combination of %fat and VO₂max/wt.

A study was conducted to derive a criterion for evaluation of obesity based on relationships between percent body fat (%fat) and clinical parameters. The subjects were 457 men aged 18 to 73 years. The results obtained were as follows:
After controlling for the effects of age, maximal oxygen intake per kilogram body weight (VO₂max/wt), alcohol intake and cigarette smoking, %fat showed significant correlations with high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio (TC/HDL-C), fasting blood sugar (FBS), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), γ-glutamyl transpeptidase (γ-GTP), white blood cell count (WBC), red blood cell count (RBC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) . Values of %fat estimated from borderline values of these clinical parameters ranged from 17.9% to 20.4%.
When the subjects were divided into 11 groups from a below 12% fat group to an above 22% fat group, the 18%, 20%, 21% and above 22% fat groups showed significantly higher occurrence of abnormal values for clinical parameters than the below 12% fat group.
When the subjects were divided into 2 groups, i, e, above (above group) or below (below group) 18%, 19%, 20%, or 21% body fat, the above group always showed a significantly higher occurrence of abnormal values for clinical parameters than the below group.
The subjects were further divided into 3 groups: 250 subjects with %fat below 17.9% (N group), 63 subjects with %fat between 18% and 19.9% (MO group), and 144 subjects with %fat above 20% (O group) . The O group showed the highest occurrence of abnormal values for clinical parameters, followed in order by the MO and N groups. These differences were significant. The O group showed a significantly lower mean value of HDL-C and significantly higher mean values of TC, TC/HDL-C, TG, GPT, SBP, DBP and FBS than the N group. The O group also showed significantly higher mean values for WBC and RBC than the MO and N groups. The O and MO groups showed significantly higer mean values of β-L, γ-GTP and UA than the N group.
From these results and the fact that a value above 20% fat is widely used as a criterion for evaluation of obesity, men with a %fat range of 18.0% to 19.9% are defined as mildly obese, whereas those with above 20% fat are defined as obese.
The subjects were further divided into 3 gooups: %fat below (non-obese) or above (obese) 20%, and VO₂max/wt above (fit) or below (unfit) values recommended by the Ministry of Public Welfare for each age group. One hundred fifty-one subjects were non-obese and fit (NF group), 142 subjects were non-obese and unfit (NU group) and 107 subjects were obese and unfit (OU group) . The NF group showed the lowest occurrence of abnormal values for clinical parameters, followed in order by the NU and OU groups. These differences were significant. Thus, it seems appropriate to evaluate obesity by using a combination of %fat and VO₂max/wt.

Cardiac patient simulators are commonly used in Japanese educational institutions; however, most institutions have not established concrete learning objectives or strategies for mastering physical examination of the circulatory system, including cardiac auscultation. In this study, we propose clear learning objectives and strategies for simulator practice for fifth-year medical students who have passed the objective structured clinical examination, and explored their educational effectiveness.
1)The subjects were fifth-year medical students (n=94) at the University of Miyazaki. Learning objectives were the mastery of the sequential physical examination and the ability to distinguish 6 cardiac findings, including normal status. The subjects were evaluated with a checklist before and after lectures and simulator practice.
2)The mean score (maximum score=14) significantly increased from before simulator practice (2.2±0.9) to after simulator practice (11.4±1.5; p<0.001). There was no difference in scores after practice among the cardiac diseases.
3)Before practice more than 50% of subjects could use a stethoscope on only right positions and could indicate only the maximum point of a cardiac murmur; in contrast, after practice more than 90% of the subjects could sequentially describe physical findings and accurately predict cardiac diseases.
4)In a questionnaire administered after practice, 83% of the subjects answered that all physicians should acquire proficiency in cardiac auscultation regardless of their specialty.
Simulator practice with clear learning objectives may help improve clinical examination skills when both time and human resources are limited. The reevaluation of the program's continuing educational effectiveness and the establishment of an iterative learning program will be needed.

STUDY DESIGN: Prospective study based on magnetic resonance (MR) imaging of the lumbar spinal root of the intervertebral foramen. PURPOSE: This study was to compare MR three-dimensional (3D) sequences for the evaluation of the lumbar spinal root of the intervertebral foramen. OVERVIEW OF LITERATURE: The diagnosis of spinal disorders by MR imaging is commonly performed using two-dimensional T1- and T2-weighted images, whereas 3D MR images can be used for acquiring further detailed data using thin slices with multi-planar reconstruction. METHODS: On twenty healthy volunteers, we investigated the contrast-to-noise ratio (CNR) of the lumbar spinal root of the intervertebral foramen with a 3D balanced sequence. The sequences used were the fast imaging employing steady state acquisition and the coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC). COSMIC can be used with or without fat suppression (FS). We compared these sequence to determine the optimized visualization sequence for the lumbar spinal root of the intervertebral foramen. RESULTS: For the CNR between the nerve root and the peripheral tissue, these were no significant differences between the sequences at the entry of foramen. There was a significant difference and the highest CNR was seen with COSMIC-FS for the intra- and extra-foramen. CONCLUSIONS: In this study, the findings suggest that the COSMIC-FS sequences should be used for the internal or external foramen for spinal root disorders.
Diagnosis ; Healthy Volunteers ; Magnetic Resonance Imaging ; Prospective Studies ; Spinal Nerve Roots

Background/Aims: Immune checkpoint blockade has recently been reported to be effective in treating microsatellite instability (MSI)-high tumors. Therefore, sufficient sampling of histological specimens is necessary in cases of unresectable pancreatic cancer (UR-PC). This multicenter study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for MSI evaluation in patients with UR-PC. Methods: A total of 89 patients with UR-PC who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB using 22-G needles at three hospitals in Japan (2018–2021) were enrolled. Fifty-six of these patients (FNB 23 and FNA 33) were followed up or evaluated for MSI. Patient characteristics, UR-PC data, and procedural outcomes were compared between patients who underwent EUS-FNB and those who underwent EUS-FNA. Results: No significant difference in terms of sufficient tissue acquisition for histology was observed between patients who underwent EUS-FNB and those who underwent EUS-FNA. MSI evaluation was possible significantly more with tissue samples obtained using EUS-FNB than with tissue samples obtained using EUS-FNA (82.6% [19/23] vs. 45.5% [15/33], respectively; p<0.01). In the multivariate analysis, EUS-FNB was the only significant factor influencing the possibility of MSI evaluation. Conclusions EUS-FNB using a Franseen needle is desirable for ensuring sufficient tissue acquisition for MSI evaluation.