Objective: A direct renin-inhibitor (DRI), aliskiren, was administered to anuric patients to investigate whether it can be a new optional therapy against hypertension in hemodialysis (HD) patients. Patients: The patients that received aliskiren comprised 8 males and 2 females with a mean ± SD age of 63 ± 8 years (43-72 years). They were exposed to dialysis therapy for 118 ± 73 months (8-251 months), with diabetes mellitus in 4 cases, chronic glomerulonephritis in 4 cases, and other diagnoses in 2 cases. Methods: After the plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were measured before an HD session, aliskiren, 150 mg as an initial dose, was administered to the patients. PRA and PAC were also examined a week after initiating aliskiren. The blood pressure (BP) levels at the start of each HD session for a period of 2 weeks (6 HD sessions) were compared between before and after administration of aliskiren. The change of doses in other antihypertensive agents was also counted. Results: The averaged reduction of mean blood pressure was 4 ± 5 mmHg, and doses of antihypertensives other than aliskiren were reduced in 4 patients. Of the examined parameters, only the reduction rate of PRA x PAC seemed correlated with the BP lowering effect of aliskiren, which was calculated as the sum of the mean BP reduction in mmHg and drug reduction with 1 tablet (capsule)/day considered to be 10 mmHg. Conclusion: A DRI, aliskiren, was effective even in anuric dialysis patients, and monitoring of PRA and PAC was valuable for selecting cases responsive to aliskiren.

Objective: Since the conventional drip-infusion method for measuring inulin clearance (Cin) has problems related to its accuracy and performance, we explored a more accurate and concise method by rapid intravenous injection of a newly developed inulin fraction (Inulead^®), in which spot urine sampling was omitted and the administration period of inulin was shortened from 120 to 5 minutes. Patients and Methods: Twenty seven patients (M/F: 15/12, 67.8 ± 12.9 years old) admitted to the Nephrology ward were enrolled in this study. Inulead^®, 1500 mg dissolved in 150 mL of saline, was intravenously administered in 5 minutes. Then, sequential blood samplings and urine collection were performed for 24 hours. Cins were calculated by the following three formulae: (1) a pharmacokinetic analysis using a two compartments model based on the plasma inulin concentration to determine Cin, which was the administered dose divided by the area under the curve (AUC) from 0 to ∞, (2) urinary inulin excretion divided by the AUC for 24 hours and (3) the Bayesian method using a three-point set of plasma inulin concentrations to predict the change of inulin concentration to determine Cin as in 1. These Cins were compared with levels of estimated GFR (eGFR), creatinine clearance (Ccr), serum β2 microglobulin (β2MG) and serum cystatin C (Cys C). Results: Cins obtained by the above three methods were well correlated with each other (r. = 0.9088 – 0.9998) and with eGFR (r. = 0.8286 – 0.8650), Ccr (r. = 0.821 – 0.864), 1/β2MG (r. = 0.631 –0.752) and 1/CysC (r. = 0.830 – 0.857). The averaged differences of each Cin from eGFR were distributed between –4.4 and –4.5 mL/min. Conclusion: Since the Cins by rapid inulin injection showed satisfactory correlation and differences with other GFR parameters, this method will be a good alternative to the drip infusion method, and may reduce the burden of patients and medical staff.

  Komono Town is a well-known spa and health resort in Mie Prefecture. Komono Town has been seeking ways to promote the activities of hot spring area and health resources in surrounding areas. As part of these efforts, Komono Town has developed town-walk programs to promote the health of local residents. In this study, focusing on effect of walking on relaxation, we compared levels of stress hormones and emotional scores obtained before and after walking.

  After giving their informed consent, adult participated in two walking programs, each for a distance of approximately 7 km. Salivary cortisol levels were measured before and after intervention. In addition, the Mood Check List-Short form. 2 (MCL-S.2) and a Visual Analog Scale (VAS) were used to rate emotions before and after intervention.

  In both programs, walking tended to lower levels of salivary cortisol than resting. Low levels of cortisol, an adrenocortical hormone released during a state of predominantly sympathetic nervous activity, are thought to reflect mental relaxation; our result implies that the walking program enhanced relaxation in subjects. In addition, both MCL-S.2 and VAS rating showed that the subjects tended to feel better, more relaxed and less anxious after intervention.

  These findings suggest that the walking programs are beneficial human body thorough, for example, enhanced relaxation.

Background/Aims: Thiopurines are key drugs for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Recently, NUDT15 polymorphism (R139C, c.415C > T) has been shown to be associated with thiopurineinduced adverse events in Asian populations. In patients with the C/T genotype, low-dose thiopurine treatment is recommended, but its long-term efficacy and tolerability remain unclear. This study aimed to uncover the long-term efficacy and appropriate dosage of thiopurine for IBD patients with the C/T genotype. Methods: A total of 210 patients with IBD (103 UC and 107 CD) determined to have NUDT15 R139C variants were enrolled. Clinical data were retrospectively reviewed from medical records. Results: Of 46 patients (21.9%) with the C/T genotype, 30 patients (65.2%) were treated with thiopurines. Three of whom (10.0%) discontinued thiopurine treatment due to adverse events and 27 of whom continued. The median maintenance dosage of 6-mercaptopurine was 0.25 mg/kg/day (range, 0.19–0.36 mg/kg/day), and 6-thioguanine nucleotides level was 230 (104–298) pmol/8 × 108 red blood cells. Cumulative thiopurine continuation rates for 120 months for patients with the C/C and C/T genotypes were not significantly different (P= 0.895). Cumulative non-relapse rates in the patients with UC treated with thiopurine monotherapy and surgery-free rates in CD patients treated with combination therapy (thiopurines and anti-tumor necrosis factor-α agents) for maintenance remission were not significantly different at 60 months (C/C vs. C/T, P= 0.339 and P= 0.422, respectively). Conclusions Low-dose thiopurine treatment is an effective and acceptable treatment for patients with C/T genotype.

OBJECTIVE: To analyze whether sufficient energy intake (EI) improves performance of activities of daily living (ADL) in patients with hip fracture admitted to rehabilitation hospitals. The adequate amount of EI for improving performance of ADL in patients with hip fracture remains unknown. METHODS: This retrospective cohort study included all patients with hip fracture (n=234) admitted to rehabilitation hospitals in Japan. The inclusion criteria for this study were age >65 years and body mass index <30.0 kg/m². Patients who were transferred to an acute hospital and those with missing case data were excluded. According to the amount of EI, the patients were classified into energy sufficiency and shortage groups (EI/total energy expenditure ≥1.0 and <1.0, respectively). The Functional Independence Measure (FIM) and FIM gain were used to evaluate the patient disability level and change in patient status in response to rehabilitation. Finally, FIM gain was calculated as the discharge FIM score minus the admission FIM score. RESULTS: The final analysis targeted 202 patients—53 (26.2%) were in the energy shortage group and 149 (73.8%) were in the energy sufficiency group. The energy sufficiency group had a greater FIM gain than the energy shortage group (mean, 25.1±14.2 vs. 19.7±16.4; p=0.024). Furthermore, sufficient EI in the first week since admission (β=0.165; 95% confidence interval, 0.392–5.230; p=0.023) was an independent factor of FIM gain. CONCLUSION: Among elderly patients with hip fracture admitted to rehabilitation hospitals in Japan, the amount of EI during the first week after admission was an independent factor of FIM gain.
Activities of Daily Living ; Aged ; Body Mass Index ; Cohort Studies ; Energy Intake ; Energy Metabolism ; Femoral Fractures ; Hip ; Humans ; Japan ; Nutritional Support ; Recovery of Function ; Rehabilitation ; Retrospective Studies

  【Introduction】One of the effects of the hot spring provides worm temperature. This effect raises temperature, and temperature control function operates and causes increase of the bloodstream. This time, these changes examined the thing by the size of the bathtub and the spring quality of the hot spring.   【Subjects and Methods】The subjects were 10 healthy adult men (mean age: 25.2 years). They bathed for 10 min in bathtubs at 42°C. The enforcement used plunge bath (approximately 1,700 L: simple alkaline hot spring) and home bathtub (approximately 300 L: hot water, 0.1% artificially chlorinated spring). Measurement item of the maximum arterial blood flow rate using the Ultrasonic Rheometer Smart Doppler 45, deep body temperature using the deep body temperature monitor core temperature CM-210, I compared each value 10 min during the bathing, and during a 10-min, 20-min, 30-min resting period after bathing, furthermore, I found the conjugation on each condition resting period after bathing.   【Result】The rise in deep body temperature and maximum arterial blood flow rate showed the result that a hot spring of the plunge bath was more meaningful than the value of the home bathtub after 10 min of bathing. The deep body temperature of the hot spring of the plunge bath significantly rose from bathing 3 min after. In deep body temperature with the resting period after bathing, in the hot spring of the plunge bath, a meaningful rise was maintained in hot water 13 min for population chloride spring 16 min of the home bathtub for 15 min.  【Discussion】In thinks that a population spring let you maintain a temperature rise that it disturbs a drop of the water temperature by abundant quantity of water in the plunge bath that hot spring plunge bath had a bigger deep body temperature rise, maximum arterial blood flow rate than home bathtub, and the deep body temperature rise in the home bathtub was continued.

Objectives: Diagnosis and treatment of osteoporosis are instrumental in obtaining good outcomes of hip surgery.Measuring bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. However, due to limited access to DXA, there is a need for a screening tool to identify patients at a higher risk of osteoporosis. We analyzed the potential utility of the Osteoporosis Self-assessment Tool for Asians (OSTA) as a screening tool for osteoporosis. Methods: A total of 1378 female patients who underwent hip surgery at 8 institutions were analyzed. For each patient, the BMD of the proximal femoral region was measured by DXA (DXA-BMD), and the correlation with OSTA score (as a continuous variable) was assessed. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of OSTA score to predict osteoporosis. Lastly, the OSTA score was truncated to yield an integer (OSTA index) to clarify the percentage of patients with osteoporosis for each index. Results: DXA-BMD showed a strong correlation with OSTA (r = 0.683; P < 0.001). On ROC curve analysis, the optimal OSTA score cut-off value of − 5.4 was associated with 73.8% sensitivity and 80.9% specificity for diagnosis of osteoporosis (area under the curve: 0.842). A decrease in the OSTA index by 1 unit was associated with a 7.3% increase in the probability of osteoporosis. Conclusions OSTA is a potentially useful tool for screening osteoporosis in patients undergoing hip surgery. Our findings may help identify high-risk patients who require further investigation using DXA.

INTRODUCTIONAn observational study was carried out to estimate the strength of the relationships among balance, mobility and falls in hemiplegic stroke inpatients. The objective was to examine factors that may aid in the prediction of the likelihood of falls in stroke patients.

METHODSA total of 53 stroke patients (30 male, 23 female) aged 67.0 ± 11.1 years were interviewed regarding their fall history. Physical performance was assessed using the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM) scale. Variables that differed between fallers and non-fallers were identified, and a discriminant function analysis was carried out to determine the combination of variables that effectively predicted fall status.

RESULTSOf the 53 stroke patients, 19 were fallers. Compared with the non-fallers, the fallers scored low on the FIM, and differed with respect to age, time from stroke onset, length of hospital stay, Brunnstrom recovery stage and admission BBS score. Discriminant analysis for predicting falls in stroke patients showed that admission BBS score was significantly related to the likelihood of falls. Moreover, discriminant analysis showed that the use of a significant BBS score to classify fallers and non-fallers had an accuracy of 81.1%. The discriminating criterion between the two groups was a score of 31 points on the BBS.

CONCLUSIONThe results of this study suggest that BBS score is a strong predictor of falls in stroke patients. As balance is closely related to the risk of falls in hospitalised stroke patients, BBS might be useful in the prediction of falls.

Accidental Falls ; prevention & control ; Aged ; Discriminant Analysis ; Female ; Hemiplegia ; complications ; Humans ; Male ; Middle Aged ; Postural Balance ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Stroke ; complications ; Stroke Rehabilitation

  Komono Town is a well-known spa and health resort in Mie Prefecture. Komono Town has been seeking ways to promote the activities of hot spring area and health resources in surrounding areas. As part of these efforts, Komono Town has developed town-walk programs to promote the health of local residents. In this study, focusing on effect of walking on relaxation, we compared levels of stress hormones and emotional scores obtained before and after walking.  After giving their informed consent, adult participated in two walking programs, each for a distance of approximately 7 km. Salivary cortisol levels were measured before and after intervention. In addition, the Mood Check List-Short form. 2 (MCL-S.2) and a Visual Analog Scale (VAS) were used to rate emotions before and after intervention.  In both programs, walking tended to lower levels of salivary cortisol than resting. Low levels of cortisol, an adrenocortical hormone released during a state of predominantly sympathetic nervous activity, are thought to reflect mental relaxation; our result implies that the walking program enhanced relaxation in subjects. In addition, both MCL-S.2 and VAS rating showed that the subjects tended to feel better, more relaxed and less anxious after intervention.   These findings suggest that the walking programs are beneficial human body thorough, for example, enhanced relaxation.

Introduction: Recently, community-based medical education has become widespread in Japanese medical schools, but the current status is not clear on a national level. A second survey of community-based medical education at all Japanese medical schools was conducted. The first survey was done in 2011. Methods: Members of the Council made and distributed a questionnaire to medical schools in order to assess the situation of community-based medical education as of April 2014. Results: A total of eighty schools responded. The number of schools which had community medicine programs was seventy-eight. In the first survey, the number was seventy-three. Seventy-seven schools gave community-based clinical clerkships. Discussion: The number of medical schools that had curriculum about community medicine was more than indicated in the first survey. Further research about the contents or implementation system of community-based clerkships is needed.