We reported 2 cases of plantar keratosis (59 years of age, female/39 years of age, male) successfully improved by intake of hot water extract of Coix lacryma-jobi L. var. ma-yuen Stapf with Husks. Both subjects were administered coix seed extract containing food for 20 weeks. The lesions improved gradually after 12 weeks, and almost cured by 20 weeks of administration. Although the food seemed to be effective in these cases, further studies are needed to define the optimal dose and duration.

A 73-year-old man visited our hospital with complaints of fever, epigastric painand jaundice. Laboratory examinations showed elevation of GOT, GPT, ALP, LAP and amylase. Abdominal ultrasonography revealed gall bladder stones. Endoscopic findings showed parapapillary diverticulum, but the common bile duct stone was not revealed by endoscopic retrograde cholangiography. He was conservatively treated and then discharged. Two months after, the patient was readmitted for cholecystitis and underwent cholecystectomy. After further 2 months, he was again admitted for the same symptoms as those on first admission. We diagnosed this case as Lemmel's syndrome and performed emergency endoscopy. Endoscopic findings revealed the meal rest inside the parapapillary diverticulum. After we removed the meal rest obstructing the orifice of the papilla of Vater using grasping forceps, we performed EST. Purulent bile gushed out from the orifice. Two years have elapsed since them. Cholangitis has not recurred during this period. Therefore, we concluded that EST is effective in treating Lemmel's syndrome.

A survey was carried out on how the To-no District is coping with the need of first aid for patients requiring life-supporting treatment before hospitalization. Although there were cities in this district where statistics on first aid were not available, the survey found that, during the 4-year period from 1994 through 1997, bystander CPR (cardiopulmonary resuscitation) saved 11.2% of the lives of patients with CPA (cardiopulmonary arrest). Incidentally, 11.3% of the population attended CPR courses offered by public institutions. Gifu Prefecture has helicopters for use in rescue work, but the survey found that some cities had not ever sponsored drills using helicopters in life-saving operations. Our findings revealed the indifference of the general public as well as administrators in this district toward emergency care. Public recognition of the importance of the care of suddenly ill or injured patients must be gained. Furthermore, acquisition of skills required for first aid by lay people and technical improvement of these skills in professional rescuers are necessary. The authors think that these are the community educational responsibility of hospitals and other medical institutions.

While the session-RPE (rating of perceived exertion) method can quantify training volume in athletes, this method is not able to evaluate energy expenditure (EE) during a training session. We developed an RPE-based activity record for assessing EE during athletic training, and we compared its results to those obtained using the flex-heart rate (flex-HR) method. The EE of nine female collegiate endurance runners was assessed by the RPE-based activity record and flex-HR methods during eight days in the normal training season. Subjects were asked to record their RPE in the record at 5-minute intervals, and to wear a HR monitor during training. All subjects also participated in an incremental treadmill exercise test, which was used to determine their RPE-EE and HR-EE regression equations. Although the RPE-based activity record significantly overestimated EE (RPE-activity record, 572 kcal/session; flex-HR method, 499 kcal/session; p = 0.031), it had high validity relative to the flex-HR method (intra-class correlation coefficient, 0.891; 95% confidence interval, 0.845–0.923) and there were no systematic errors in EE estimation between the two methods. Therefore, the RPE-based activity record can be used to assess EE during training in female runners. However, RPE-based activity record might overestimate EE for athletes who have more intermittent activities during training than endurance runners, because RPE takes more time for returning to the resting level than HR when the intensity of activity declines. Further research is needed to verify the validity of the RPE-based activity record for assessing EE during other sporting activities or measurement conditions, and to identify the factors affecting the degree of estimation error associated with this method.

OBJECTIVESThe objective of this metallomics study is to investigate comprehensively some relationships between cancer risk and minerals, including essential and toxic metals.

METHODSTwenty-four minerals including essential and toxic metals in scalp hair samples from 124 solid-cancer patients and 86 control subjects were measured with inductively coupled plasma mass spectrometry (ICP-MS), and the association of cancer with minerals was statistically analyzed with multiple logistic regression analysis.

RESULTSMultiple logistic regression analysis demonstrated that several minerals are significantly correlated to cancer, positively or inversely. The most cancer-correlated mineral was iodine (I) with the highest correlation coefficient of r = 0.301, followed by arsenic (As; r = 0.267), zinc (Zn; r = 0.261), and sodium (Na; r = 0.190), with p < 0.01 for each case. In contrast, selenium (Se) was inversely correlated to cancer (r = -0.161, p < 0.05), followed by vanadium (V) (r = -0.128). Multiple linear regression value was highly significantly correlated with probability of cancer (R (2) = 0.437, p < 0.0001), and the area under the receiver-operating characteristic (ROC) curve was calculated to be 0.918. In addition, using contingency table analysis and the chi-square test, the precision of discrimination for cancer was estimated to be 0.871 (chi-square = 99.1, p < 0.0001).

CONCLUSIONSThese findings suggest that some minerals such as arsenic, selenium, and probably iodine, zinc, sodium, and vanadium contribute to regulation of cancer and also that metallomics study using multiple logistic regression analysis is a useful tool for estimating cancer risk.

Methods: Volunteers over 50 years of age underwent radiographic analysis. Radiographic parameters including pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), thoracic kyphosis, and sagittal vertical axis (SVA) were measured. The the three Scoliosis Research Society-Schwab sagittal modifiers (PT, SVA, PI–LL) were categorized and the KL grade was assessed. Differences in spinopelvic parameters and Oswestry Disability Index (ODI) scores among KL grades were evaluated. Results: A total of 396 volunteers (160 men, 236 women; mean age, 74.4 years) were analyzed. PI–LL and PT in KL4 were significantly higher compared to that in the other KL grades. However, there were no significant group differences in SVA. In women, but not in men, higher frequencies of the worst modifier grade (++) were observed for PI–LL and PT in the KL3 and KL4 groups compared to those for the other KL grades. In women, the ODI score in KL4 was worse compared to that in the other KL grades. Conclusions Individuals over 50 years of age with severe knee osteoarthritis had poor lumbo-pelvic sagittal alignment. Moreover, the progression severity of knee osteoarthritis had more impact onstronger relationship with lumbo-pelvic malalignment and disability-related low back pain in women than in men.

Objectives: Locomotive syndrome stage 3 (LS3), which has been established recently, may imply a greater need for care than LS stage 0 (LS0), LS stage 1 (LS1), and LS stage 2 (LS2). The relationship between LS3 and long-term care in Japan is unclear. Therefore, this study aimed to examine this relationship. Methods: A total of 531 patients (314 women and 217 men; mean age, 75 years) who were not classified as requiring long-term care and underwent musculoskeletal examinations in 2012 were grouped according to their LS stage. Group L comprised patients with LS3 and Group N comprised those with LS0, LS1, and LS2. We compared these groups according to their epidemiology results and long-term care requirements from 2013 to 2018. Results: Fifty-nine patients (11.1%) were diagnosed with LS3. Group L comprised more patients (50.8%) who required long-term care than Group N (17.8%) (P < 0.001). Group L also comprised more patients with vertebral fractures and knee osteoarthritis than Group N (33.9% vs 19.5% [P = 0.011] and 78% vs 56.4% [P < 0.001], respectively). A Cox proportional hazards model and Kaplan–Meier analysis revealed a significant difference in the need for nursing care between Groups L and N (log-rank test, P < 0.001; hazard ratio, 2.236; 95% confidence interval, 1.451–3.447). Conclusions Between 2012 and 2018, 50% of patients with LS3 required nursing care. Therefore, LS3 is a highrisk condition that necessitates interventions. Approaches to vertebral fractures and osteoarthritis of the knee could be key.

We examined the influence of hot water extract of coix seed (Coix lacryma-jobi L. var. ma-yuen Stapf) with husks on facial skin. Ten females (28-58 years old) took hot water extract of coix seed with husks 1 g/day for 8 weeks, and various skin parameters were measured. The results showed that the total amount of subsurface reflection of blue light, which is an index of skin translucency, increased significantly after 8 weeks of intake (p = 0.011). In addition, skin texture improved significantly after 4 and 8 weeks of intake (p = 0.007, p = 0.042). Additionally, the condition of tape-stripped stratum corneum also indicated significant improvement after 4 and 8 weeks intake (p = 0.0002, p = 0.020). These results suggested that the hot water extract of coix seed with husks exhibited effects even at 1 g/day, which is less than in previous reports.