Primary Sjögren's syndrome is an autoimmune disorder characterized by lymphocytic infiltrates and destruction of the salivary and lacrimal glands, and systemic production of autoantibodies to the ribonucleoprotein (RNP) particles SS-A/Ro and SS-B/La, leading to clinical symptoms of dryness of the mouth and eyes (sicca syndrome). Autoreactive T cells bearing the CD4 molecule may recognize an unknown self antigen, triggering autoimmunity in the salivary and lacrimal glands. Although several candidate autoantigens including α-fodrin have been reported in Sjögren's syndrome, the pathogenic roles of the autoantigens in initiation and progression of SS are still unclear. It is possible that individual T cells activated by an appropriate self antigen can proliferate and form a restricted clone. Recent evidence suggests that the apoptotic pathway plays a central role in making T cells tolerant to tissue-specific self antigen, and may drive the autoimmune phenomenon. We recently reported that tissue-specific apoptosis in estrogen-deficient mice may contribute to autoantigen cleavage, leading to the development of autoimmune exocrinopathy. The studies reviewed imply that tissue-specific apoptosis and caspase-mediated α-fodrin proteolysis are involved in the progression of autoimmune lesions in Sjögren's syndrome. Moreover, Fas ligand (FasL) and its receptor Fas are essential in the homeostasis of the peripheral immune system. It is considered that a defect in activation-induced cell death (AICD) of effector T cells may result in the development of autoimmune exocrinopathy in Sjögren's syndrome.

A study was conducted to investigate the effect of exercise intensity on the recovery of autonomic nervous activity after exercise. Ten subjects performed four kinds of 10-min cycle exercise with target heart rates of 100, 120, 140, and 160 beats/min (THR 100, THR 120, THR 140 and THR 160, respectively) following 5 min of exercise to increase the heart rate to the target level. The beat-by-beat variability of the R-R interval was recorded throughout the experiment including the 5-min pre-exercise control period and the 30-min recovery period. Spectral analysis (fast Fourier transform) was applied to every 5-min R-R interval data set before, during ( 5-10 min) and after exercise at the target heart rate. The low- (0.05-0, 15 Hz : P₁) and high- (0, 15-1.0 Hz : P_h) frequency areas were calculated to evaluate sympathetic (SNS) and parasympathetic (PNS) nervous activities as P₁/P_hand P_h, respectively. During exercise, SNS of THR 160 was significantly higher, and PNS of THR 140 and THR 160 was significantly lower than the respective pre-exercise values (p<0.05) . Althouglt all indicators recovered to, or overshot the pre-exercise values at 20-30 min after THR 100 and THR 120, heart rate and SNS were still higher and PNS was still lower than the pre-exercise value after THR 160. These results suggest that the recovery of cardiac autonomic nervous activity is slower after high-intensity exercise than after low-intensity exercise, and that the recovery of autonomic nervous activity after acute exercise does not always corrrespond linearly on the exercise intensity.

The purpose of this study was to examine the effect of class walking on lifestyle activity. The subjects were recruited from the community around the university, and volunteered to eight weeks intervention. The intervention groups were 2 different walking program groups that included a class-walking group (A : n=32) and a voluntary walking group (B : n=31) ; and the control was a blood-pressure monitor group (C : n=22) . Only A group participated in a walking class with group instruction. Physical activity was measured by pedometer counts before the start of the intervention, during the 8-week intervention and again as follow up four months afterwards. In A group, the number of pedometer counts, during the group walking activity of the 5 th and 6 th weeks, was measured in order to evaluate the number of voluntary steps on the class-walking day. Although there was no significant difference among the three groups in daily activity before the intervention, the activity of A group (12367±3290) and B group (9988±3461) was significantly increased during the intervention. Also, there were significant differences between A and B, A and C. As for A group, the number of steps due to group walking (9025±584 steps) enhanced the daily activity on the class-walking days (16191±3988 steps), but significantly attenuated the voluntary steps on the class-walking days (7166±3988 steps), which did not significantly differ from the baseline of the daily activity. The number of steps on the non-class walking days (i. e. steps other than those taken on the class-walking day ; 11719±3454 steps) was not significantly different than that of B. There was significant enhancement of daily activity 4 months after the intervention for A (11487±4057) and B (9564±2545 steps), but not for C (9070±3485 steps), compared to the baseline. There was not a significant difference between the daily activity of A and B after the intervention. These data suggest that the instruction given and the steps taken in class walking enhance daily activity during the intervention period, and that voluntary steps play a more important role in whether or not one remains active and adheres to regular exercise.

A 51-year-old man was emergently admitted for acute renal failure. Blood tests showed a high serum creatinine level and metabolic alkalosis. He had a history of recurrent vomiting starting one month prior to admission to our hospital, and had circumferential thickening of the cardia on upper gastrointestinal endoscopy and CT. He underwent total gastrectomy and was given a diagnosis of scirrhous gastric carcinoma at the pylorus. After total gastrectomy, acute renal failure and metabolic alkalosis showed amelioration. We report this very rare case with metabolic alkalosis and acute renal failure resulting from pyloric stenosis caused by scirrhous gastric carcinoma.

The aim of this study was to examine a weight reduction program and residual effects, through confirming the relationship between changes in the morphological and psychological indices including personality and self-efficacy (SE) of the participants. Twenty-five middle-aged women were divided into two groups based on type of weight reduction program intervention. Thirteen women participated in a 3-month diet-only weight reduction program (DO group, 53.3±7.4 yr), and 12 women took part in a 3-month diet and aerobic exercise program (DE group, 48.3±9.6 yr). After the programs, the compatibility score of personality in the DO group was negatively correlated to SE that is indicated as confidence in ability to maintain decreased body weight at 2, 3, and 4 years after the program (r=-0.69, -0.58, and -0.60). It can be seen that personality has an effect on the results of the DO group weight reduction program. Additionally, despite a significant decrease in body-weight and %fat in both groups, only the change of %fat significantly correlated with SE. On the basis of these correlations, the changes of %fat that related to the movability perception of body movements has a greater effect on SE after the program than the information only of weight loss. The results of this study suggest that personality and SE accounted for weight maintenance, and were associated with the results of the weight reduction program.

Purposes: We performed a white coat ceremony for medical students, because there had not been a definite passage ceremony to create the desire to serve and the awareness of being physician. Opinions about the ceremony were with a questionnaire survey. Methods: The ceremony of white coat conferment was performed for the first time for 112 fourth-year medical students on January 11, 2001, just before the start of clinical training. A white coat and an identification badge with photograph were presented to the medical students, who were taking the first step to becoming a physician. A questionnaire survey was performed the next day to evaluate students' feelings. The questionnaire asked about student's 1) sense of responsibility to be engaged in medical practice, 2) feelings of kindness to patient, 3) love for of their school, 4) attachment to the white robe, 5) consciousness of being a professional, 6) sense of mission as a physician, 7) motivation to learn, 8) feelings of seriousness, and 9) desire to live ethically. A listening survey for the school staff and students was also included. Results: Clear improvements in consciousness were recognized in all items of the questionnaire (P>.0001). Approximately 80% of students approved of the ceremony being performed annually from the following year. The ceremony had had no established form, but many people acknowledged its significance. However, some students who did not realize the significance of the ceremony because it was performed in the middle of the semester. Conclusions: Although this was the first experience for us, many students and teaching staff were understanding and responded favorably to this passage ceremony. The ceremony to instill medical professionalism in student doctors will be improved with further efforts and experiences.

Approximately 100 kinds of Foods for Specified Health Use (FOSHU) are used to “control postprandial elevated blood glucose level”. In this review, we describe their safety and effectiveness.

Side to side difference in tennis players' mid-radius and cross-sectional study on mid-tibia of jumpers and sedentary controls suggest that the improvement of mechanical properties of cortical bone in response to long-term exercise is related to geometric adaptation and not to volumetric bone mineral density. In the present study, geometric and mechanical properties of right tibia were estimated along 64 directions centering center of gravity of the bone on cross-sectional peripheral quantitative computed tomography (pQCT) images. The tibias of 17 jumpers (7 females, 10 males) and 15 controls (8 females, 7males), aged 18-23, were scanned at mid site using pQCT. Periosteal and endocortical radius were larger, cortical thickness was thicker, and mechanical properties (moment of inertia of area and strength strain index) were greater in jumpers compared to those of controls. The differences in cortical thickness between the two groups were dependent on direction of measurement. Defined a direction from tibia's center of gravity to fibula's as 0°, difference in the cortical thickness between jumpers and controls was the greatest at around 240°. Along this direction, differences in mechanical properties were also the most significant, suggesting that the site-specific adaptation of bone to long-term exercise is due to geographical relation of bone to muscle.

No abstract available.
Rupture ; Transcatheter Aortic Valve Replacement

The usefulness of individual care of patients in the attitude education of undergraduates was evaluated with questionnaires completed by 4th-year medical students and patients. Ninety-eight percent of students finished performing patient care during a 2-week period. Seventy percent of patients completed questionnaires. The appearance, manner of greeting, and language of the students were considered good by 87% or more of the patients, and the students' consideration for the patients' safety, privacy, and communication was considered good by 86% or more of the patients. The practice was approved by 77% of the patients and was objected to by none. Ninety-nine percent of students completed questionnaires, and 79% of the respondents approved of the practice. Fourteen percent of the student respondents, many of whom had been treated as outpatients, objected to the practice. These results suggest that individual care of patients by medical students is useful for both patients and students.