The DCCT syudy report (in 1993) showed that long-term maintenance of near normoglycemia markedly delays the onset and/or progression of microangiopathic complications of type 1 diabetes. Now, intensive insulin therapy has been considered to be a standard treatment of type 1 diabetes. However, it brings about serious hypoglycemia three times as frequently as conventional therapy with split-dose insulin mixtures. If IDDM patients could predict their blood glucose levels, it would be beneficial to prevention of hypoglycemia and to strict glycemic control. We intended to research whether insulin-treated diabetic children in a diabetic summer camp could predict their blood glucose levels. The number of subjects was 28. They were elementary and junior high school children 9 to 16 years of age. They predicted their blood glucose levels before every meal and bedtime, and then monitored their blood glucose levels. Their HbA₁c was 7.6±0.3%, total daily insulin dosage 36.0±3.2U/day, and infection times 3.3±0.2/ day.
Measured blood glucose levels and predicted blood glucose levels were not distributed normally, but their natural logarithms (Ln (mBG), Ln (pBG)) were. Ln (pBG) (5.01±0.02) was significantly higher than Ln (mBG) (4.92±0.03) (p<0.01)
A positive correlation was found between Ln (mBG) (x) and Ln (pBG) (y) (y=0.359 x+3.239, r=0.495). Events of which Ln (pBG) was within±20% and±30% of Ln (mBG) were 124 (31.5%) and 175 (44.5%), respectively, of the total 393 events. As for the relationship between Ln (mBG) and Ln (pBG) at each time, a change of Ln (mBG) was significantly larger than that of Ln (pBG).
These results showed that prediction of blood glucose levels was difficult for type 1 iabetic children, especially when blood glucose levels were extremely high or low and when they fluctuated sharply.

Integrated lecture programs for high school students involving university teaching staff have recently become popular. Here, we report on such a program involving lectures on tumor pathology attended by 110 high school students at the Yokohama City University School of Medicine. Two weeks before the lectures at our university, the students were given a 45-minute introductory lecture by a teacher at their school. The 1-day course at our university comprised an overview lecture by the author (40 minutes), light-microscopic observation of histologic specimens of normal and tumor tissues (50 minutes), and a summary with an introduction to diagnostic pathology (20 minutes). During light-microscopic observation, medical students served as teaching assistants. The high school students were given handouts of microscopic

Objectives: This study examined whether cancer patients who received home care lived in the places they and their families preferred, and whether their preferences changed while receiving home care.Methods: We conducted a medical record survey of 111 cancer patients who received home care provided by a clinic in Japan, and examined the patients' and their families' preferred places to live in the case of their condition deteriorate (the patients and their families were asked when they began to receive home care, and whenever their and their families' conditions changed), and the actual places where the patients lived out their lives.Results: Among those who preferred home at the beginning of receiving home care, 95.6% of patients and 96.8% of families preferred home in the last survey period. Of those who did not prefer home at the beginning, 87.9% of patients and 84.8% of families preferred home by the last survey period. For 97.4% of patients and 97.2% of families, the actual places where the patients lived out their lives were consistent with their preferred places.Conclusion: We found that cancer patients receiving home care provided by the clinic and their families who preferred home from the beginning often still preferred home until the end of their lives, and that those who did not prefer home at the beginning often preferred home by the last survey period. Thus, most of the patients lived out their lives in the places they and their families preferred.

OBJECTIVES: The purpose of this study is to clarify the psychological factors related to sarcopenia in patients with lumbar spinal stenosis (LSS). METHODS: This cross-sectional study included 72 patients with LSS (38 males and 34 females; mean age, 70.4 ± 6.9 years). Demographic data, lower extremity pain, back pain, Japanese Orthopaedic Association score, Pain Catastrophizing Scale (PCS) score, Hospital Anxiety and Depression Scale (HADS) score, Fear-Avoidance Beliefs Questionnaire score, walking velocity, grip strength, walking distance, and appendicular muscle mass were assessed. Muscle mass was measured using bioelectrical impedance analysis. Patients were grouped based on sarcopenia status according to skeletal muscle mass index. RESULTS: The prevalence of sarcopenia was 13.9% (10 of 72 patients). Sarcopenia was significantly more common in females. The incidence of dyslipidemia and cardiovascular disease were significantly higher in the sarcopenia group. The sarcopenia group had lower body weight, body mass index, grip strength, and walking distance than the control group. The sarcopenia group had higher PCS scores and HADS-anxiety scores. Multivariate analysis identified body weight, dyslipidemia, walking distance, and PCS score as significantly related to sarcopenia. CONCLUSIONS Pain catastrophizing might be the most relevant psychological factor in sarcopenia. Evaluation of both physical function and pain catastrophizing is needed when investigating sarcopenia in LSS.

STUDY DESIGN: Prospective study. PURPOSE: To examine the changes in body sway using stabilometry in patients who underwent cervical laminoplasty for cervical myelopathy. OVERVIEW OF LITERATURE: Although the patients of cervical myelopathy complain body sway there are few report to examine body sway objectively. METHODS: Patients who received treatment for cervical myelopathy between October 2010 and February 2013 were included. Twenty-one patients underwent cervical laminoplasty (myelopathy group). Body sway was assessed using stabilometry, wherein patients stood on a stabilometer with their eyes closed for 30 seconds. The Romberg ratio, outer peripheral area (OPA) with eyes closed (cm²), and total locus length per unit area (L/A) with eyes closed (/cm) were examined. Examinations were performed preoperatively (at baseline) and at 8 weeks postoperatively. Examination results of patients in the myelopathy group were compared with those of 17 healthy individuals (control group). Clinical symptoms were evaluated using the Japanese Orthopaedic Association scale score (JOA score) and the timed up and go (TUG) test. RESULTS: In the myelopathy and control groups, the mean baseline Romberg ratio, OPA, and L/A were 2.3±1.2, 8.9±5.5 cm², and 14.2±5.3/cm and 1.4±1.0, 4.3±2.8 cm², and 23.7±10.1/cm, respectively. Eight weeks after laminoplasty, only L/A showed significant improvement from baseline in the myelopathy group (23.2±10.1 to 16.8±7.9; p=0.03). The Romberg ratio and OPA showed improvement in the myelopathy group, but the changes were not statistically significant. JOA scores and TUG test results in this group significantly improved from baseline to 8 weeks after laminoplasty (12.7 to 13.4 and 10.8 to 8.0 seconds, respectively; both p<0.05). CONCLUSIONS: L/A is a useful parameter for measuring body sway to assess the recovery of body sway after laminoplasty.
Asian Continental Ancestry Group ; Humans ; Laminoplasty ; Postural Balance ; Prospective Studies ; Spinal Cord Diseases* ; Spine

Methods: In this study, we prospectively examined 70 LSS patients with intermittent claudication symptoms at a multicenter outpatient clinic. A walking test was administered at baseline and week 4 to assess patients’ walking distance and lower limb pain and numbness. Immediately after the walking test, patients were asked to use the Visual Analog Scale (VAS) to rate their pain and numbness in the front, back, outside, inside, and hip of the lower legs. The reproducibility of the walking test was evaluated using Cohen’s κ analysis and intraclass correlation coefficients (ICCs). Meanwhile, the Swiss Spinal Stenosis (SSS) Questionnaire was used to evaluate the severity of the stenosis. Results: The walking distance ICC at baseline and at week 4 remained unchanged at 0.7, with acceptable interobserver reliabilities for lower limb pain and numbness in both legs. The average VAS score for lower leg pain was 23.2±25.2 mm at baseline and 27.4±28.8 mm at week 4, while the corresponding average VAS score for numbness was 23.4±26.7 mm at baseline and 24.8±25.2 mm at week 4. The ICC score was 0.7 for leg pain and 0.7 for numbness. The mean SSS was 30.2±5.5 at baseline and 29.2±5.2 at week 4, and there was no significant difference in the severity. Conclusions The walking test for LSS has acceptable reproducibility.

Methods: This cross-sectional study included 361 individuals aged ≥65 years (mean age, 75.0 years) living in a local mountain area and underwent medical check-ups from 2014 to 2018. The survey items included kyphosis index, body mass index, back pain prevalence, back pain Visual Analog Scale score, Oswestry Disability Index, walking speed, grip strength, skeletal mass index, osteoporosis (% young adult mean [YAM]), LOCOMO 5 score, and presence of sarcopenia (Asian Working Group for Sarcopenia). The participants were divided into the N (kyphosis index: <12; n=229, 63.4%), M (kyphosis index: 12–15; n=99, 27.4%), and K (kyphosis index: ≥15; n=33, 9.2%) groups. p -values of <0.05 were considered statistically significant. An association factor of kyphosis (kyphosis index: ≥15) was investigated with logistic regression analysis. Results: Age and LOCOMO 5 scores were significantly higher (p <0.05) and %YAM and walking speed were significantly lower (p <0.05) in the K group than in the M and N groups. Other survey items showed significant differences. Only %YAM (odds ratio, 0.20; 95% confidence interval, 0.04–0.96) was an independent factor associated with a kyphosis index of ≥15. Conclusions Decreased muscle mass and muscle strength would be related to kyphosis; however, no such relations were noted. Bone loss was significantly related to kyphosis. Osteoporosis-induced decrease in vertebral body height is present in the background. Sarcopenia and locomotive syndrome were not related to kyphosis, whereas decreased bone density was independently associated with kyphosis in older individuals living in a mountain area.

Methods: Nineteen volunteers (16 men, three women) lifted a 60-kg doll from a seated position to a standing position. The first transfer was performed without the HAL for Care Support, and the second was performed with the HAL for Care Support assistive robot. We evaluated transfer performance, the visual analog scale (VAS) score for lumbar fatigue, and electromyogram analyses of the trunk and hip. Results: Four participants (two men, two women) succeeded with the HAL for Care Support even though they were unable to perform the task without it. The mean lumbar fatigue VAS score for all participants without the HAL for Care Support was 62 mm, while that with it was 43 mm. With lumbar assistance from the HAL for Care Support, subjective lumbar fatigue during the transfer decreased significantly. A power analysis indicated adequate statistical power to detect a difference in the VAS score for lumbar fatigue (0.99). The activity of the left gluteus maximus alone increased significantly during transfers with the HAL for Care Support. No adverse events occurred during use of the HAL for Care Support for transfers. Conclusions The HAL for Care Support was able to reduce lumbar load in a simulated patient transfer.

A 77-year-old woman was admitted to our hospital with a decreased level of consciousness and left hemiplegia. Contrast-enhanced CT showed acute type A aortic dissection and right common carotid artery occlusion. Electrocardiogram findings showed ST segment elevation in the anterolateral wall. The results suggested that the aortic dissection had extended to the left main trunk and caused acute myocardial infarction. Percutaneous coronary intervention (PCI) was performed preoperatively to improve myocardial ischemia reperfusion. After a successful PCI, the patient underwent ascending aorta replacement immediately. In cases of acute aortic dissection involving the left main artery, preoperative PCI prevents extensive myocardial damage and serves as a bridge to surgery.