This study was a nonrandomized controlled trial, aimed to identify the effects of a walking program designed to improve the physical functions of elderly people requiring support or low-level care and receiving rehabilitation services at day care centers. Participants were 28 elderly people (mean age: 77.9±7.5 years). Twelve participants agreed to wear a physical activity monitoring device. Their daily walking goals were updated every week. Sixteen subjects designated as a control group only underwent personalized rehabilitation programs. The gait functions of all subjects were evaluated by several gait parameters before and after the 4-week intervention. ADL and QOL were assessed using the Tokyo Metropolitan Institute Gerontology Index of Competence and 8-Item Short-Form Health Survey (SF-8), respectively. The step length, walking angle, the stance phase ratio and the double-support phase ratio significantly improved in the intervention group after the walking program. Interaction effects of the stance phase ratio, the double-support phase ratio and QOL (mental component summery) were observed between the two groups. The walking program, combined with rehabilitation services, showed favorable effects on the gait functions, and QOL of elderly people, suggesting that it may be useful for preventing functional deterioration of the elderly requiring support or low-level care.

  Since 2003, Clinical training center of Fujita Health University hospital has been cooperated with the Office for medical education of Fujita Health University, school of medicine, in reorganizing the previous training system based mainly on individual departments. After 9 years since then, we established Yanegawara style training system and the trainee–centered curriculums. Outcomes from new system are as follows:
1. Self–establishment by problem based learning became common understandings between trainers and trainees.
2. Teaching by trainers to trainees and between trainees （R2 to R1） became common in the hospital.
3. Trainees can learn the standardized approach in diagnosis and treatment of the patients in ER.
4. Unified understanding of the training system was established in the hospital.Although new system brought several good aspects, we found a large heterogeneity in fulfillment of our curriculums not only by the capability of individual residents but also by the effort induced by each department.

The patch test is the most reliable method for diagnosing a metal allergy. However, interpretation of patch test results depends on the experience of the investigator and on the conditions of the individual patient. In the case of patch tests for metal salts, irritant reactions such as pustular or follicular reactions are quite common. Therefore, one must be careful not to interpret irritant reactions as allergic responses, and objective standards to evaluate erythema in patch tests need to be established.In the present study, we attempted to objectively evaluate patch test results for metal salts using an erythema index meter. We used the Erythema Index Difference (EID) (patch test site erythema index (EI) minus the mean EI of healthy skin outside the patch test area and at the unit tape site) rather than the EI itself in order to eliminate the effects of the patch test unit and individual differences. We measured the EID over time in patients with suspected metal allergies to various metals. Significant differences in EID were observed among ++ assessments, + assessments and irritant reactions based on International Contact Dermatitis Research Group (ICDRG) standards. In considering changes in EID over time, allergic and irritant reactions can be discriminated with high sensitivity (73.3%) and specificity (91.2%).These results suggest that the measurement of erythema over time with an erythema index meter is useful for the objective assessment of metal patch test reactions.

Brainstem gliomas are not common in adults, and the treatment strategies and their outcomes are limited. Immunotherapy is emerging as a promising new modality for the treatment of these gliomas. Here, we report the first case of brainstem glioma treated with a combination of radiotherapy and autologous formalin-fixed tumor vaccine (AFTV). A 32-year-old man presented with left facial numbness and right hemiparesis, and was referred to our department. MRI and open biopsy indicated brainstem glioma, and he was specifically diagnosed with isocitrate dehydrogenase 1-mutant diffuse astrocytoma of WHO grade II. He was treated with stereotactic radiotherapy followed by AFTV three months later. MRI conducted at 42 months after the combination therapy showed a 91% decrease in tumor volume, and the regression was maintained for 5 years. Thus, combination treatment with radiotherapy and immunotherapy may prove to be a promising alternative for the treatment of brainstem glioma.

1）To learn the techniques required immediately after the start of clinical practice, new residents were introduced to the skills laboratory during their orientation period.
2）We attempted to establish the Yanegawara style, which is an overlapping teaching style in which the second–year residents plan the entire training schedule and simultaneously teach the first–year residents while being supported in their teaching by more senior physicians.
3）Training with the new system resulted in greater rapport among all residents as well as a greater feeling of security among first–year residents.

OBJECTIVESTo determine the difference in molecular weights of albumin in factory workers caused by non-enzymatic glycation of plasma albumin using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF/MS), and examine the epidemiological validity of this method.

METHODSForty-eight male workers were tested by random sampling. The difference in molecular weights (ΔM) between the subjects' albumin and human serum albumin was determined by MALDI TOF/MS. Correlations between ΔM vs. fructosamine, fasting plasma glucose (FPG) and HbAlc were investigated.

RESULTSΔM showed a significant correlation with all of the tested glycation indices (ΔM vs. fructosamine: r=0.487, p<0.001) (ΔM vs. FPG: r=0.482, p<0.01) (ΔM vs. HbAlc: r=0.397, p<0.01).

CONCLUSIONSSince a significant correlation between ΔM and the glycation indices was found in this investigation, further study with a larger number of subjects is needed for use in clinical applications.

OBJECTIVESBlood and saliva samples were obtained to examine if there is a correlation between saliva glycated protein and blood glycated protein.

METHODSBlood and saliva samples of 51 male workers were collected. The fructosamine and hydrazine methods were used to measure saliva glycated protein. HbA1c, fructosamine and blood glucose were measured as indices of blood glycated protein, and the correlation between blood glycated protein and saliva glycated protein was examined.

RESULTSSaliva fructosamine glycated protein showed a significant correlation with HbA1c and blood glucose (r=0.449; p=0.001 and r=0.445; p=0.001, respectively). No correlation was identified between saliva hydrazine glycated protein and the index of blood glycated protein.

CONCLUSIONSBlood glycated protein and blood glucose could be estimated by measuring saliva glycated protein.

At present, there is no photographic evidence of splitting of the trapezius and sternocleidomastoid muscles (SCMs), which share a common anlage that extends caudally toward the limb bud in the embryo at a length of 9 mm. Therefore, the aim of the present study was to identify which structures divide the caudal end of the common anlage at the first sign of splitting into two muscles. In 11 mm-long specimens, the SCM and trapezius muscles were identified as a single mesenchymal condensation. In 15 and 18 mm-long specimens, the SCM and trapezius muscles were separated and extended posteriorly and lymphatic tissues appeared in a primitive lateral cervical space surrounded by the SCM (anterior). In 21 mm-long specimens, the lymphatic vessels were dilated and the accompanying afferents were forming connections with the subcutaneous tissue through a space between the SCM and trapezius muscles. In 27 mm-long specimens, cutaneous lymphatic vessels were evident and had entered the deep tissue between the SCM and trapezius muscles. Vascular dilation may be viewed as a result of less mechanical stress or pressure after muscle splitting.