The purpose of this study was to elucidate the relation between double product break point (DPBP) and pulse wave velocity (PWV).Two hundred three healthy Japanese females were studied (mean age; 53.5 +/- 11.7 years old). The DPBP was measured by continuous incremental exercise test with a bicycle ergometer (ML-3600, Fukuda Electronic Co. Ltd). The work rate at DPBP was converted into metabolic equivalents (METs@DPBP). The brachial-ankle PWV (baPWV) was also measured. In addition, height, weight and mean blood pressure (mBP) were measured and physical activity condition in daily life (PA) was evaluated by questionnaire.The mean METs@DPBP was 5.0 +/- 0.7 METs. The mean baPWV was 1,373 +/- 254 cm/ sec. The relation between METs@DPBP and baPWV was investigated with the use of multiple linear regression models with adjustment for affecting factors of baPWV.In this study, it was identified that there was a significantly inverse relation between METs@DPBP and baPWV (p <0.01). This finding was independent from age, height, weight, mBP and PA. Thus, there was an inverse relation between sub-maximal aerobic capacity and arterial stiffness.

An 89-year-old man was referred to our hospital for treatment of hepatolithiasis causing recurrent cholangitis. He had undergone a prior Whipple procedure. Computed tomography demonstrated left-sided hepatolithiasis. First, we conducted peroral direct cholangioscopy (PDCS) using an ultraslim endoscope. Although PDCS was successfully conducted, it was unsuccessful in removing all the stones. The stones located in the B2 segment were difficult to remove because the endoscope could not be inserted deeply into this segment due to the small size of the intrahepatic bile duct. Next, we substituted the endoscope with an upper gastrointestinal endoscope. After positioning the endoscope, the SpyGlass digital system (SPY-DS) was successfully inserted deep into the B2 segment. Upon visualizing the residual stones, we conducted SPY-DS-guided electrohydraulic lithotripsy. The stones were disintegrated and completely removed. In cases of PDCS failure, a treatment strategy using the SPY-DS can be considered for patients with hepatolithiasis after a Whipple procedure.
Aged, 80 and over ; Bile Ducts, Intrahepatic ; Cholangitis ; Endoscopes ; Endoscopes, Gastrointestinal ; Humans ; Lithotripsy

Objective: The Hyogo Hospital Pharmaceutical Society has been conducting an original pharmacy postgraduate education program, “lifelong learning program (to nurture pharmacy specialists)”, since 2002 using the Internet.  To understand the status of using this program, this study employed a questionnaire survey involving all registered members.
Methods: Subjects were all members (1,870) of the society.  Questionnaires were distributed and collected by mail.
Results: Only 20.1% of the members had experience of using the program, and the frequency of using it was less than once per 6-12 months in 60% of the members.  Their level of awareness concerning the acquisition of credits for lifelong learning was 36.9%.  The program category they wished to take was an infection-related program in 26.1% of the members, which was the highest.
Conclusion: As reasons for only a small number of members using the program, the following are considered: loss of user’s ID and password required to login, and lack of awareness concerning the acquisition of credits for lifelong learning offered by the Japanese Society of Hospital Pharmacists.  As future issues, we must encourage members to obtain a new password and be proactively involved in preparing new program categories that the members wish to take, in order to promote the continuous use of the program.

In this study, we examined a reliability of age-predicted heart rate (HR) for the 50%VO₂max which is widely used during a training program for health promotion as compared to HR at the double product break point (DPBP). Two hundred fifty six non-hypertensive subjects (NHT), and 49 hypertensive ones under medication (HT) were studied. HT subjects were divided into two subgroups based on antihypertensive medications, ones with HR non-suppression agents (HT+HRNS) and the other with HR suppression agents (HT+HRS). DPBP was measured with the use of an incremental exercise test, and HR at DPBP (HR@DPBP) was determined. Age-predicted HR for the 50%VO₂max intensity of exercise was calculated with the following formula; HR=138–age/2. Measurable rate of DPBP and HR@DPBP in NHT, HT+HRNS and HT+HRS were 93.8% and 120±14bpm, 92.7% and 104±12bpm, 78.5% and 94±16bpm, respectively. There were significant differences in HR@DPBP and age-predicted HR in NHT and HT+HRS (p<0.01 in both groups). But %ΔHR ((age-predicted HR–HR@DPBP)/HR@DPBP x 100) within -10%∼+10% in NHT, HT+HRNS and HT+HRS were 68%, 58% and 14%, respectively. This might be due to HR at rest with sitting position that was significantly correlated to %ΔHR in all groups (r=-0.604, p<0.001 in NHT, r=-0.689, p<0.001 in HT+HRNS and r=-0.761, p<0.05 in HT+HRS, respectively). And the range of HR at rest with sitting position corresponding to -10%∼+10% of %ΔHR were 70∼95bpm in NHT, 71∼93bpm in HT+HRNS and 83∼102bpm in HT+HRS. In addition, this study indicated that DPBP could be measured even under antihypertensive medication that might affect DPBP measurement.In conclusion, we demonstrated that HR at DPBP and age-predicted HR were similar among 58-68% of NHT and HT+HRNS. And the range of HR at rest with sitting position to ensure reliability of age-predicted HR was elucidated.

The aim of this study is to elucidate the relationship between the predicted 50%VO₂max/wt (ml/kg/min) and coronary risk factors (CRFs).Seven hundred eighty six men (37.3 +/- 13.5 years old) and 1,268 women (41.5 +/- 13.6 years old) were studied. The predicted 50%VO₂max/wt was calculated by utilizing data from the continuous incremental exercise test with a stationary bicycle ergometer and the age-predicted heart rate at 50%VO₂max (=138-age/2). As CRFs, percent body fat, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting blood sugar and HbA1c were measured.The age-adjusted odds ratio of having abnormal values in CRFs across quartiles of the predicted 50%VO₂max/wt (highest to lowest) were 1.00 (reference), 1.39, 2.64, and 6.78 in men, and 1.00, 1.73, 2.33 and 3.44 in women (for trend, p<0.001), respectively.This study indicated that the lower 50%VO₂max/wt resulted in the higher odds ratio of having abnormal values in CRFs among Japanese. It was also confirmed that the sub-maximal aerobic capacity was associated with CRFs.

ZIP (ZRT/IRT-like Protein) and CDF (Cation Diffusion Facilitator) are two large metal transporter families mainly transporting zinc into and out of the cytosol.Several ZIP and CDF transporters have been characterized in mammals and various model organisms, such as yeast, nematode, fruit fly, and zebrafish, and many candidate genes have been identified by genome projects. Unexpected functions of ZIP and CDF transporters have been recently reported in some model organisms,leading to major advances in our understanding of the functions of mammalian counterparts. Here, we review the recent information on the sequence similarity and functional relationship among eukaryotic ZIP and CDF transporters obtained from the representative model organisms.

Previously, we have reported that age-predicted heart rate at 50%VO₂max (HR@50%VO₂max) is an effective index of adjusting appropriate exercise intensity for health promotion exercise. Thus, the aim of this study is to elucidate the change in HR at double product break point (HR@DPBP) and the validity of HR@50%VO₂max due to improvement of cardiovascular fitness. Ninety two healthy adults (57 +/- 9 years old), who participated in the health exercise training course, were studied. Participants were instructed how to control the intensity of physical activity for DPBP during their daily life. DPBP was determined with the use of incremental exercise test, and METs at DPBP (METs@DPBP), HR@DPBP, ratings of perceived exertion at DPBP (RPE@DPBP) were measured before and after the course. HR@50%VO₂max was calculated with the following formula; 138 - age/2 (bpm). METs@DPBP significantly increased (p<0.001) after 10 weeks of the course, whereas HR@DPBP did not change. Interestingly, however, there was a significantly positive correlation (p<0.001) between amount of change in METs@DPBP and that in HR@DPBP (ΔHR@DPBP). Multiple linear regression analysis indicated this correlation was independent from sex, age and amount of change in HR at rest (p<0.001). Before and after the course, proportion of study subjects’ %ΔHRs ((HR@50%VO₂max - HR@DPBP) / HR@DPBP x 100) within -10% ~ +10% were both 48.9%, and proportion of study subjects’ RPEs@DPBP within 11~13 were 92% and 85%, respectively. In this study, it was identified that significantly positive relation between amount of change in cardiovascular fitness and that of ΔHR@DPBP. This finding was independent from potentially affecting factors. In conclusion, this longitudinal study could suggest that HR@50%VO₂max and RPE were valuable indexes of determining exercise intensity for health promotion exercise.

Introduction  Given the increasing number of foreign nationals residing in Japan, more opportunities are expected to provide nursing care for these residents in the home-based care setting. This study aimed to clarify qualitatively the difficulties and coping experiences faced by home-visiting nurses providing care to foreign nationals residing in Japan.Methods  In this qualitative descriptive study, semi-structured interviews were conducted with home-visiting nurses providing care to foreign nationals residing in Japan.Results  The study participants were 14 female home-visiting nurses aged in their 40s to 70s with 3-25 years of experience as a visiting nurse. Nine categories regarding difficulties and seven regarding coping with difficulties were identified from the interviews.Conclusions  Home-visiting nurses reported facing difficulties in terms of language barriers, differences in religions and customs, the complexity of the Japanese medical and long-term care insurance system, and various aspects of life and mental support. However, home-visiting nurses could still provide care while respecting the feelings and demands of patients and their families. These findings may contribute to the development of more effective approaches to support home-visiting nurses providing care to foreign nationals residing in Japan.

Since the effect of the submaximal aerobic exercise on bone had been controversial, the aim of this study was to elucidate the effect of the bench step (BS), that seemed to deliver higher mechanical load on bone than any other aerobic exercises, on the total bone mineral content (BMC) and the bone metabolism of menopausal women. Sixteen menopausal women (65 ± 9 years old) as the exercise group (ExG) and 28 pre-menopausal women (43 ± 3 years old) as the control group (CG) were studied. ExG carried out BS training with the exercise intensity at lactate threshold (LT) for 21 weeks. In ExG, BMC was measured by dual energy X-ray absorptiometry (DXA) at one year before the intervention (A year before), pre-intervention (Pre) and post-intervention (Post). Serum osteocalcin (OC) as the marker of bone formation and serum type I collagen cross-linked N-telopeptide (NTx) as the marker of bone absorption at Pre, 11th week of the intervention and Post. In CG, BMC was measured annually without the intervention. In ExG, OC was not changed, but NTx was significantly decreased by intervention (p<0.05). The decreased amount of annual change in BMC between a year before and Pre (T1) was significantly higher compared to that between Pre and Post (T2) (p<0.01) and CG (p<0.001). There was no significant difference between T2 and CG. In conclusion, BS with LT could prevent decreasing BMC in menopausal women, and maintain the same level of BMC in pre-menopausal women by suppressing the bone absorption.

A decline in the immunopotential of the host plays an essential role in the occurrence of infections with methicillin-resistant Staphylococcus aureus (MRSA) or other multi-drug resistant microorganisms. In the present study, mytomycin C (MMC)-treated mice with or without the infection of MRSA were used to examine the bacteriostatic action as well as the immunopotentiating action of the promising herbal medicine, Hochu-ekki-to (HET). Basic experimental data showed the drug to be effective in the treatment of MRSA infection. Eight to ten week old male C57BL mice were injected with MMC at a dosage of 5mg/kg/day to inhibit the bone marrow, thus creating a mouse model with reduced immunopotential. A powder extract of HET was administered orally at a dosage of 500mg/kg/day for seven consecutive days. For the infection of MRSA 1×10⁹ cell were injected intraperitoneally. Peritoneal macrophages were prepared by the adherence technique. Macrophage migration, phagocytic activity, and the bactericidal activity were examined by the Boyden chamber method, by the phagocytosis for fluorescent-activated latex beads, and by the nitroblue tetra zolium (NBT) reduction test, respectively.
After the administration of HET, the number of white blood cells in the MMC-treated mice recovered to 80% of the normal value. In addition, the phagocytic activity of macrophages increased to 50%, although that of the non-treated group was only 20%. The bactericidal activity also recovered to a level close to the normal value. The ratio of neutrophils in the HET administered MMC-treated group increased to 2.2% (normal mice, 2.6%) whereas that of the MMC-treated control group was 0.5%. Concerning the function of the immunological cells, IL-1beta and IFNgamma levels were recovered by treatment with HET, as observed by IL-1beta, IL-2 and IFNgamma monitoring. The bacterial count in the liver of the MRSA challenged mice, with or without HET administration peaked 6 hours after the challenge. The number of the group with HET administration was, however, much greater than that of the group without HET administration. The bacteria count in the blood showed an increase 12 and 24 hours after the challenge. Even 24 hours after the challenge, a significant number of bacterial cells existed in the blood of the group without HET administration, whereas only a small number of cells were detected 6 hours after the challenge. All of the control mice died 8 days after the MRSA challenge, whereas the survival rates were 60% for HET treatment, 40% for the vancomycin treatment, and 80% for the HET plus vancomycin treatment, respectively.
As we move towards a society with a high percentage of elderly people, the authors believe Chinese herbal medicine, which activates the immunopotential, will be very helpful in the treatment of opportunistic infections that are common among elderly patients.