A study was conducted to investigate the validity of bioelectrical impedance measurement (BIM) for determining changes in body composition during treatment of obesity with an exercise and diet regimen. Eleven obese women, aged 38-57 yr (44±6.0 yr), participated in a weight reduction study. Before and after the weight reduction period, body composition was measured by the deuterium oxide (D₂O) dilution and BIM methods. For both methods, the correlation coefficients were of the same order of magnitude under both pre- and postregimen conditions. Mean weight reduction was 3.59±1.518 kg and loss of total body fat was estimated to be 4.8±1.72 kg by the D₂O method and 2.5±1.14 kg by the BIM method. Thus the BIM method underestimated the change in body fat compared with the D₂O method. Changes in resistance (R) and height squared divided by R were not significant at the p>0, 05 level. However, the mean change in fat-free mass (FFM) found by the D₂O method was significantly greater than that found by the BIM method. Furthermore, there was no significant correlation between the changes in FFM estimated by the D₂O and BIM methods. These results show that after weight reduction the BIM method overestimates body composition. It is concluded that the BIM method is not a valid approach for measuring the small changes in body composition that occur during treatment of obesity.

In the present study, we investigated the associations of the body mass index (BMI ; kg/m²) and the waist to hip circumference ratio (WHR) with metabolic features in 134 Japanese women ranging in age from 24 to 79 years. We found that the BMI was reasonably well correlated with the WHR (r=0.693, p<0.001), which may be related to the health risk profile. The BMI and WHR both showed significant negative correlation with high-density lipoprotein cholesterol (HDL) level, and positive correlation with triglyceride (TG) and plasma glucose (GL) levels and systolic blood pressure (SBP) and diastolic blood pressure (DBP) . Following adjustment for the effect of the BMI, the partial correlation coefficients of WHR with HDL, TG, and GL were lower than those obtained before adjustment, and were not significant. However, the partial correlation coefficient of WHR with HDL/total cholesterol ratio (HDL/TC), SBP, and DBP were significant. These results suggest that the levels of HDL, TG and GL are associated with the BMI among subjects with similar WHR. We therefore propose that a combination of the BMI and WHR would be a superior indicator in obesity screening than the BMI alone.

We have been collecting various ideas on safer acupuncture practice from participants in our workshop as well as members of the committee. Subjects and presentations of the present workshop were as follows:
1. Forgotten needles
  1) Ideas of prevention based on a questionnaire survey (Egawa and Ishizaki)
  2) Effect of incident reporting system (Yamashita)
2. Cleaner method of needle insertion and Oshide (needle-supporting fingers)
  1) Merits and demerits of sterilized fingerstall and glove (Miyamoto)
  2) History of the clean needle development (Umeda)
  3) A novel clean acupuncture needle device (Imai and Ishizaki)
Although there was not enough time for discussion, we collected some useful ideas from the participants. A novel clean needle invented by Imai gave a strong impression to the audience. We should continue to discuss a diverse impact when such new devices and concepts become widespread in traditional acupuncture practices. We welcome more ideas and opinions from relevant facilities, clinics and fields in order to further improve safety of acupuncture.

We reported that Interferon (IFN) induces the analogous state of the initial stage of Yang disease with ectodermal symptoms (tai yang bing). Flu-like symptoms from IFN treatment were reduced or disappeared with Mao-to and Dai-seiryu-to. We consider that flu-like symptoms induced by IFN can be a symptomatic model of hyper-functioning condition of tai yang bing. Pulse of sinking and deficiency was seen in all five patients with the symptoms of having caught a chill. These results suggest that there is the possibility that pulse of sinking and deficiency is seen in the very early stage of tai yang bing.

Although visual examination and palpation are used to assess shoulder motion in clinical practice, there is no consensus on shoulder motion under dynamic and static conditions. This study aimed to compare shoulder joint motion under dynamic and static conditions. Methods: The dominant arm of 14 healthy adult males was investigated. Electromagnetic sensors attached to the scapular, thorax, and humerus were used to measure three-dimensional shoulder joint motion under dynamic and static elevation conditions and compare scapular upward rotation and glenohumeral joint elevation in different elevation planes and angles. Results: At 120° of elevation in the scapular and coronal planes, the scapular upward rotation angle was higher in the static condition and the glenohumeral joint elevation angle was higher in the dynamic condition (P<0.05). In scapular plane and coronal plane elevation 90°– 120°, the angular change in scapular upward rotation was higher in the static condition and the angular change in scapulohumeral joint elevation was higher in the dynamic condition (P<0.05). No differences were found in shoulder joint motion in the sagittal plane elevation between the dynamic and static conditions. No interaction effects were found between elevation condition and elevation angle in all elevation planes. Conclusions: Differences in shoulder joint motion should be noted when assessing shoulder joint motion in different dynamic and static conditions. Level of evidence: Level III, diagnostic cross-sectional study.

PURPOSE: Although various strategies have been reported, there are no defined criteria for cosmetic evaluation methods after breast-conserving surgery (BCS). Since Asians tend to have smaller breasts, indistinct inframammary folds, and conspicuous scars, differences in the cosmetic results are expected. So we examined two subjective methods and one objective method to determine the differences, and elements necessary for a cosmetic evaluation after BCS. METHODS: Frontal photographs of 190 Japanese were evaluated using the Harris scale (Harris) and the evaluation method proposed by the Japanese Breast Cancer Society Sawai group (Sawai group) as the subjective methods, and the Breast Cancer Conservation Treatment cosmetic results (BCCT.core) as the objective method, respectively. In order to examine the necessary elements for developing a new ideal method, 100 out of 190 were selected and assessed separately by six raters using both the Harris and modified Sawai group methods in the observer assessment. The correlation between the two methods was examined using the Spearman rank-correlation coefficient. RESULTS: The results of the BCCT.core and the other two methods were clearly different. In the observer assessment, the consensuses of the six raters were evaluated as follows: 27, 27, 26, and 20 cases were evaluated as "excellent," "good," "fair," and "poor," respectively. For the Spearman rank-correlation coefficient, values higher than 0.7 indicated a strong correlation, as seen by the values of 0.909 for the breast shape and 0.345 for the scar. The breast shape accounted for the most significant part of the evaluation, and the scar had very little correlation. CONCLUSION: In this study, we recognized a clear difference between the subjective and objective evaluation methods, and identified the necessary elements for cosmetic evaluation. We would like to continue developing an ideal cosmetic evaluation that is similar to subjective one and is independent from raters.
Asian Continental Ancestry Group* ; Breast ; Breast Neoplasms ; Cicatrix ; Consensus ; Esthetics ; Humans ; Mastectomy, Segmental*

Background: Several systematic reviews have reported on the conservative treatment of full-thickness rotator cuff tears; however, clinical results of this treatment still remain determined. Methods: PubMed, Cochrane Library, PEDro, and CINAHL databases were systematically searched for randomized clinical trials and observational studies. Two independent researchers reviewed a total of 2,981 articles, 28 of which met the criteria for inclusion in the study. Clinical outcome measures included Constant score, visual analog scale score for pain, range of motion, and short-form 36. The meta-analysis used a linear mixed model weighted with the variance of the estimate. Results: The meta-analysis showed a significant improvement after surgery. Pain score is 26.2 mm (1 month) to 26.4 mm (3 months) and 24.8 mm (12 months) (P<0.05); active abduction: 153.2º (2 months), 159.0º (6 months), 168.1º (12 months) (P<0.05); Constant score: 67.8 points (2 months) to 77.2 points (12 months) (P<0.05); short-form 36 “vitality” section: 57.0 points (6 months) and 70.0 points (12 months) (P<0.05). Conclusions Our data confirmed the effectiveness of conservative treatment in patients with full-thickness rotator cuff tears 12 months post-intervention. The results suggest that conservative treatment for patients with full-thickness rotator cuff tears should be the first line of treatment before considering surgery.

Background/Aims: Intestinal fibrosis is a major complication of Crohn’s disease (CD). The profibrotic protein transforming growth factor-β (TGF-β) has been considered to be critical for the induction of the fibrotic program. TGF-β has the ability to induce not only the expression of extracellular matrix (ECM) including collagen, but also the production of plasminogen activator inhibitor-1 (PAI-1) that prevents enzymatic degradation of the ECM during the onset of fibrotic diseases. However, the significance of PAI-1 in the developing intestinal fibrosis has not been fully understood. In the present study, we examined the actual expression of PAI-1 in fibrotic legion of intestinal inflammation and its correlation with the abnormal ECM deposition. Methods: Chronic intestinal inflammation was induced in BALB/c mice using 8 repeated intrarectal injections of 2,4,6-trinitrobenzene sulfonic acid (TNBS). TM5275, a PAI-1 inhibitor, was orally administered as a carboxymethyl cellulose suspension each day for 2 weeks after the sixth TNBS injection. Results: Using a publicly available dataset (accession number, GSE75214) and TNBS-treated mice, we observed increases in PAI-1 transcripts at active fibrotic lesions in both patients with CD and mice with chronic intestinal inflammation. Oral administration of TM5275 immediately after the onset of intestinal fibrosis upregulated MMP-9 (matrix metalloproteinase 9) and decreased collagen accumulation, resulting in attenuation of the fibrogenesis in TNBS-treated mice. Conclusions PAI-1-mediated fibrinolytic system facilitates collagen degradation suppression. Hence, PAI-1 inhibitor could be applied as an anti-fibrotic drug in CD treatment.

OBJECTIVESThe aim of this study was to determine whether the serum nitrite plus nitrate (NO( x )) level correlates with biomarkers that are known components of the metabolic syndrome (MetS).

METHODSSerum NO( x ) levels were measured using a commercial kit in 608 Japanese men and women between the ages of 39 and 85 years. Multivariate adjustments for age, smoking status, alcohol consumption and exercise were made in the analysis of covariance (ANCOVA). The components of the metabolic syndrome were defined based on the following criteria: body mass index (BMI) >/=25.0 kg/m(2), glycated hemoglobin (HbA1c) >/=5.6%, systolic blood pressure >/=130 mmHg or diastolic blood pressure >/=85 mmHg, high-density lipoprotein-cholesterol (HDL-C) /=1.69 mmol/l.

RESULTSThe logarithmically transformed age-adjusted serum NO( x ) (lnNO( x )) value was significantly higher in the low HDL-C group (1.76 +/- 0.05 mumol/l; p < 0.05) than MetS component groups (1.65 +/- 0.01 mumol/l) in men, but no difference was found in women. The means of serum lnNO( x ) after multivariate adjustment were 1.64, 1.65, 1.64, 1.66, and 1.81 mumol/l for 0, 1, 2, 3, and 4-5 MetS components for all subjects, respectively. The results of ANCOVA confirmed that the serum lnNO( x ) level was significantly correlated with the clustering of MetS components in both men and women (p < 0.0001 for trend).

CONCLUSIONOur results suggest that an increase in the clustering of MetS components was associated with the increase in serum NO levels in our general population.

Some serious infections due to Group A streptococci (Streptococcus pyogenes, GAS) manifest as primary peritonitis, which traditionally and commonly leads to the selection of laparotomy for initial treatment. We encountered a case in which laparoscopic surgery proved effective in treating primary peritonitis due to GAS. The patient was a 30-year-old woman transported via ambulance to our hospital with complaints of fever, abdominal pain, diarrhea, and vomiting on day 5 after a miscarriage. Diagnostic laparoscopy was performed under a presumptive diagnosis of acute generalized peritonitis. Accumulation of purulent ascites was found in the peritoneal cavity, but no primary lesion was identified. Peritoneal lavage and drainage were performed, and the surgery was concluded. Postoperatively, GAS were detected in blood, ascites, and vaginal discharge cultures, and primary peritonitis due to GAS was diagnosed. Antibiotics were switched to ampicillin sodium and clindamycin phosphate, and her condition started to improve. When primary peritonitis due to GAS is suspected, laparoscopic surgery can be considered for initial treatment.