This study aimed to elucidate how body composition, force-generating capacity and jump performances are associated with 50-m sprint velocity in circumpubertal boys, in relation to sprint phases and maturation. One hundred thirty four circumpubertal boys were allocated to preadolescent or adolescent group on basis of the height at the peak height velocity of Japanese boys (154 cm) reported in literature: those with body heights over 154 cm as adolescent group and others as preadolescent group. Body composition was determined by bioelectrical impedance analysis. In addition to maximal voluntary isometric knee extension torque, the performances of counter movement jump (CMJ), rebound jump (RJ), standing long jump (SLJ) and standing 5-step jump (SFJ) were also measured. RJ-index was calculated by dividing height by contact time. The time of 50-m sprint was determined at 10-m intervals. Multiple regression analysis showed that in preadolescent boys, SFJ become a predictor for the sprint speed during acceleration phases, and SFJ, RJ-index and CMJ as predictors for the sprint speeds during maximal speed and deceleration phases. In the adolescent boys, age, CMJ, SLJ, and SFJ become a predictor for the sprint speed during acceleration phases, and torque relative to body mass, CMJ and SFJ were selected as predictors for the sprint speeds during maximal speed and deceleration phases. Thus, the current results indicate that force-generating capacity and jumping ability are determinants for sprint performance in circumpubertal boys, but the relative contribution of each of the two factors differs between preadolescent and adolescent stages and among the sprint phases.

This study aimed to determine the relationships between the torque generating capacity of the lower extremity muscles and either running or jump performance in primary and junior high school boys. A total of 102 primary and junior high school boys participated in this study. Muscle thicknesses (MTs) of the knee extensors and plantar flexors were determined using ultrasonography. Muscle volumes (MVs) of the knee extensors and plantar flexors were estimated using MTs and limb lengths. The isometric joint torques (TQs) for knee extensors and ankle plantar flexors were measured using myometer. MV and TQ were divided by body mass (MV/BM and TQ/BM, respectively). Running velocity was measured using a non-motorized treadmill. The counter movement jump (CMJ) and squat jump (SJ) were performed on a matswitch system. The flight time was measured and used to calculate the heights of CMJ and SJ using the following equation; height (cm) = g × (flight time)² /8/10. As the result of multiple regression analysis, age, MV/BM and TQ/BM were selected as predictors of running velocity in the primary school boys, whereas TQ and lean body mass in junior high school boys. In the primary school boys, TQ/BM and body fat mass was selected as significant contributors for SJ and CMJ performances, whereas, in the junior high school boys, TQ and the percent of body fat for SJ performance and MV/BM and TQ for CMJ performance. Thus, the present results indicate that the relationships between torque generating capacity of the lower extremity muscles and either running or jump performance differ between primary and junior high school boys. It may be assumed that, for running and jump performances, muscle mass and strength become determinant factors in junior high school boys, whereas their values relative to body mass in primary school boys.

We encountered a case where opioids were effective for excessive sweating caused by secondary generalized hyperhidrosis associated with cancer. ​​A 64-year-old woman diagnosed with metastatic renal cell carcinoma was admitted to the palliative care unit with right hip pain caused by bone metastasis and sudden excessive sweating. An increased dose of fentanyl transdermal patch provided pain relief. Excessive sweating seemed to have occurred due to neoplastic fever initially, but antipyretic analgesics and steroids were ineffective. Prophylactic use of immediate-release oxycodone provided excessive sweating relief. Finally, we consider that hypothalamus and fentanyl transdermal patch were involved in excessive sweating. Opioids may suppress sweating by acting on the hypothalamus.

OBJECTIVES: To clarify the prevalence and characteristics of pain associated with sarcopenia and to verify the usefulness of evaluation of pain for sarcopenia. METHODS: In total, 759 community-dwelling people (aged 65–79 years) with or without sarcopenia and lower limb pain were classified into 4 groups (NSp, nonsarcopenia; NSpP, nonsarcopenia with pain; Sp, sarcopenia; and SpP, sarcopenia with pain). Body composition, motor function, history of fractures since age 50 years, and number of falls in the past 1 year were compared between the groups. RESULTS: Participant proportions by group were: NSp, 53.9%; NSpP, 42.8%; Sp, 1.3%; and SpP, 2.0%. Participants with lower limb pain showed low single leg standing, walking speed, and 2-step value scores and high 25-question Geriatric Locomotive Functional Scale (GLFS-25) score after adjusting for age, sex, body mass index, and presence of sarcopenia. The SpP group showed lower functional reach test and higher GLFS-25 scores than the Sp group. Regarding the history of fractures since 50 years of age and falls in past 1 year, a high retention rate of fracture was noted in the NSpP group. They also experienced significantly more falls in the past 1 year than those in the NSp group. The SpP group noted more falls and fractures although it was insignificant. CONCLUSIONS: The results indicate that participants with lower limb pain showed declining motor function and a high risk for falls and fractures. Sarcopenia could escalate this risk. Therefore, evaluating patients for both pain and sarcopenia may be useful for risk assessment and treatment.
Accidental Falls ; Aged ; Body Composition ; Body Mass Index ; Humans ; Leg ; Lower Extremity ; Prevalence ; Risk Assessment ; Sarcopenia ; Walking

Objective: The addition of maintenance olaparib to bevacizumab demonstrated a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the PAOLA-1/ENGOT-ov25 trial (NCT02477644). We evaluated maintenance olaparib plus bevacizumab in the Japan subset of PAOLA-1. Methods: PAOLA-1 was a randomized, double-blind, phase III trial. Patients received maintenance olaparib tablets 300 mg twice daily or placebo twice daily for up to 24 months, plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total. This prespecified subgroup analysis evaluated investigator-assessed PFS (primary endpoint). Results: Of 24 randomized Japanese patients, 15 were assigned to olaparib and 9 to placebo. After a median follow-up for PFS of 27.7 months for olaparib plus bevacizumab and 24.0 months for placebo plus bevacizumab, median PFS was 27.4 versus 19.4 months, respectively (hazard ratio [HR]=0.34; 95% confidence interval [CI]=0.11–1.00). In patients with tumors positive for homologous recombination deficiency, the HR for PFS was 0.57 (95% CI=0.16–2.09). Adverse events in the Japan subset were generally consistent with those of the PAOLA-1 overall population and with the established safety and tolerability profiles of olaparib and bevacizumab. Conclusion: Results in the Japan subset of PAOLA-1 support the overall conclusion of the PAOLA-1 trial demonstrating that the addition of maintenance olaparib to bevacizumab provides a PFS benefit in patients with newly diagnosed, advanced ovarian cancer.

Under the current postgraduate clinical training system for physicians, three principles have been emphasized in its basic tenets; cultivation of character appropriate for physicians, generation of awareness to the societal role of medical science and healthcare, and mastery of basic clinical skills needed to respond appropriately to injuries and illnesses frequently encountered in general practice. In accordance with its quinquennial review rule, the Clinical Training Committee under the Medical Caucus of the Healthcare Professions Council released draft revisions of a notification published by the Director general of the Health Policy Bureau of the Ministry of Health, Labor and Welfare in March, 2018. The document is entitled "On the operation of the ordinance concerning the postgraduate clinical training prescribed in the paragraph (1) of Article 16-2, Medical Practitioners Act" .　A Key distinction of the revised draft is new learning outcomes featuring core values shared by physicians: commitment to physicians' societal mission of public health, altruistic behavior, respect for humanity, and maintaining one's own integrity. Another key distinction is securement of longitudinal consistency in the set of required faculties, from medical school curriculum to continuing professional development programs. Further improvements in systems and environments to enhance devotion to life-long learning are needed.

Medical education towards a specialty is a core stage of training for medical doctors. The specialty training system in Japan was initially organized by various academic societies and was recently integrated under Japan Medical Specialty Board, which was established in 2014. From April 2018, a revised specialty training system will begin and be based on new program guidelines. Its main concepts are professional autonomy, quality assurance of the medical specialty board and trustworthy medical consultation. As with undergraduate education, global standards are recently required in postgraduate education. Consistent outcome policy throughout undergraduate and postgraduate education and workplace-based assessment can hopefully be established.

Medical education towards a specialty is a core stage of training for medical doctors. The specialty training system in Japan was initially organized by various academic societies and was recently integrated under Japan Medical Specialty Board, which was established in 2014. From April 2018, a revised specialty training system will begin and be based on new program guidelines. Its main concepts are professional autonomy, quality assurance of the medical specialty board and trustworthy medical consultation. As with undergraduate education, global standards are recently required in postgraduate education. Consistent outcome policy throughout undergraduate and postgraduate education and workplace-based assessment can hopefully be established.

A community-based medicine program in the postgraduate clinical training system has been offered as a mandatory program since 2004. Training sites range from clinical attachments in rural/remote areas to public health centers in the city. The role of the program director is important for enhancing the community-based medical program and raising resident doctors. Unique training programs have been carried out, such as medical training in the afflicted area of the earthquake/Tsunami disaster area as well as an exchange program between Hokkaido and Kagoshima residents. The Japanese healthcare system is drawing global attention and local demand. Enrichment of the community-based medicine program is vital for the human resource development that makes the Japanese healthcare system innovative and sustainable.

"Quality of education" has various definitions, and the definitions are classified mainly into five categories. Introducing the definition categories of "quality of education" , we analyze what aspects of the postgraduate clinical training system for physicians as an educational program have been reconsidered and redesigned. According to the analysis, we propose to introduce a programmatic assessment, which compose of several assessment methods, for evaluation at each stage of medical education from undergraduate to continuous professional development. Realizing such evaluation, we also propose to introduce a student/trainee assessment from a patient's perspective.