The purpose of this study was to examine the effects of walking 10,000 steps/day on the body composition, blood pressure, blood biochemical parameters and physical fitness. Sixty-one women, aged 56.0±5.3 yrs (mean±SD), participated in a hyperlipemia prevention program. The length of the program was 90-min and it was performed one time per week for 3 months. The program consisted of stretching and aerobic exercise (cycle exercise, walking or aerobic rhythmic gymnastics). The participants were asked to walk 10,000 steps/day or more during the program. The number of steps and physical activity (PA) were monitored using a single-axis accelerometer during the program. PA was categorized into three activity levels, namely light (L), moderate (M) and vigorous (V) PA. After 3 months in the program, the participants were divided into two groups according to the average number of steps taken daily during the program : one group (GA) walked more than 10,000 steps/day, while the other (GB) walked below 10,000 steps/day. The time spent in LPA, MPA and VPA in GA were significantly longer than in GB (LPA : 79.4±19.2 min VS 58.2±10.0 min, MPA : 38.5±9.6 min VS 21.6±6.1 min, VPA : 6.3±4.9 min VS 2.6±2.0 min, p<0.001). Decreases in the percent body fat (p<0.001), body fat mass (p<0.001), fasting glucose (p<0.001), hemoglobin A1c (p=0.026), and triglyceride (p=0.036) and an improved performance when balancing on one leg while standing with eyes closed (p=0.027) were found respectively after the program for GA. These findings indicated that GA affected the percent body fat (p=0.036), body fat mass (p=0.040) and fasting glucose (p=0.009). According to a stepwise multiple regression analysis, the time spent in MPA showed a significantly negative correlation with the change in the body fat mass (p=0.025), and the change in the body fat mass showed a significantly positive correlation with the change in the fasting glucose (p<0.001), hemoglobin A1c (p=0.002) and triglyceride (p<0.001). We thus concluded that walking 10,000 steps/day resulted in an increased amount of time spent in MPA, and thus leading to decrease in the amount of body fat. This decrease in body fat is also considered to contribute to improvement in the coronary risk factor profiles.

Purpose: The purpose of this study was to determine the relationship between 20m shuttle run (20mSRT) performance and a substantial increase in waist circumference (WC) with aging in Japanese middle-aged adults.Methods: One hundred and fifty-six Japanese middle-aged adults (40-64 yrs; 40 males, 116 females) participated in this study. Baseline data on 20mSRT, height, weight, WC, alcohol habit, smoking habit and the use of medication were collected from 2003 to 2004. Follow-up data on height, weight and WC were collected in 2008. The 20mSRT results were divided into gender-specific quartiles. A logistic regression analysis was used to predict a substantial increase in the WC (5 cm or more) during the follow-up.Results: During the follow-up, 44 people had a substantial increase in the WC. Independently from sex, age, height (baseline), weight (baseline), WC (baseline), alcohol habit, smoking habit and the use of medication, the highest quartile of 20mSRT was significantly associated with significantly lower odds ratio of a substantial increase in WC (OR: 0.07, 95%CI: 0.01-0.36) in comparison to the lowest quartile of 20mSRT. Furthermore, after additional adjustment for change in weight during follow-up, the highest quartile remained significantly predictive of a substantial increase in the WC, with odds ratio of 0.07 (95%CI: 0.01-0.39).Conclusions: These results indicate that the 20mSRT performance is a significant predictor of a substantial increase in the WC with aging in Japanese middle-aged adults.

Our hospital has a nutrition support team (NST) serving inpatients of all department. Two years ago, the team started activities with the motto “Apt nutritional management for inpatients”. It is an interdepartmental unit consisting of physicians, nurses, dietitians, pharmacists and speech therapists. Initially we found it difficult to make time to join forces, but now it has become possible to screen patients for undernourishment on a weekly basis while making nutritional assessment and planning, and holding consultations. The main purpose of the consultations is to improve the nutritional status of patients according to plans formulated after nutritional assessment made at the request of physicians and nurses in charge of the patients. To achieve the objective, we are expected to concentrate all our efforts and brains. This paper presents some consultation cases we have handled. In addition, the nutritional assessment and nutritional intervention activities of our hospital are described.
Nutrition Assessment ; Nutritional status ; Nutritional Support ; Hospitals ; Consultation

Departments of general medicine in medical schools have a mission to innovate in clinical education. However, the kind of work departments should do to promote a newly developed method of clinical education is unclear. In our medical school, the department of general medicine was organized in 1997. In that year, the first task of this department was to strengthen a program of physical-diagnosis skills. Since 1999, this program has developed further and been reorganized. The basic clinical skills course has been organized to include communication, physical diagnosis, basic laboratory examination, and basic surgical skills. In this course students do not rotate through clinics in groups but learn together via a systematic program with simulators. The department of general medicine played a central role in establishing this course. This course led to the introduction of clinical clerkships at our medical school.

We performed combination therapy with modified oxaliplatin/l-LV/5-FU (mFOLFOX) in a patient with recurrent colorectal cancer who had peritonitis carcinomatosis. In this patient, mFOLFOX therapy resulted in disappearance of ascites and a decrease in carbohydrate antigen 19-9 (CA19-9), and improved quality of life (QOL) of the patient. This 62-year-old man was diagnosed with ascending colon cancer and metastatic cancer of the liver. Right hemicolectomy and right hepatic lobectomy were performed. We had started to treat with TS-1 in ambulatory care, however, he had peritonitis carcinomatosis with massive ascite reservoir on CT and peritoneal dissemination after a half year postoperatively. Furthermore, his ECOG Performance Status (PS) was rated as level 3. Therefore, we performed puncture of ascites and palliative mFOLFOX6 therapy. After ten courses, ascites and abdominal induration had disappeared and PS recovered to level 1. At present, CPT-11/l-LV/5-FU (FOLFIRI) are being administered for peripheral neuropathy and metastatic tumor associated with mFOLFOX6. The patient is spending his daily life satisfactory after FOLFIRI without abdominal swelling or ascites, and thus mFOLFOX6 may be an option for palliative therapy against massive ascites in patients with advanced colorectal cancer. The usefulness of palliative mFOLFOX6 therapy for patients with massive ascites should be evaluated in a well-designed clinical trial.Palliat Care Res 2008; 3(2): 316-320

“Cardiac Cycle: The First Step, ” which discretely, non-ambiguously, and accurately presents basic essential information on the cardiac cycle, was compared with conventional material in terms of educational efficiency. Twenty-six first-year medical students were randomly assigned to either material. The conventional group was presented with a standard textbook with a typical figure and text. The students were blinded as to the origin of the materials. After self-study, the same quiz (30 two-item choice questions asking basic essential information) was given to both groups and was scored by a blinded rater. The number of correct answers was 25.7±3.7 (mean±SD) in the conventional group and 29.4±1.1 in the ‘first-step group’(p<0.01).

BACKGROUND AND OBJECTIVES: Reactive oxygen species (ROS) mediate various signaling pathways that underlie vascular inflammation in atherogenesis and cardiovascular diseases. Cardiac rehabilitation (CR) has a variety of multiple beneficial effects, including anti-inflammatory effects. The purpose of the present study was to investigate the effects of CR on ROS in patients with cardiovascular diseases. SUBJECTS AND METHODS: The serum level of derivatives of reactive oxidative metabolites, an index of oxidative stress, was measured in 100 patients with cardiovascular diseases before, and, subsequently, 3 and 6 months after, CR. A biological antioxidant potential (BAP) test was applied to assess the antioxidant power of the serum. RESULTS: The resting reactive oxidative metabolite levels decreased 3-6 months after CR {pre: 351+/-97 Carratelli unit (CARR U), 3 months: 329+/-77 CARR U, 6 months: 325+/-63 CARR U, all p<0.01} with the increase of the percentage of the predicted values of VO2 peak and the percentage of the predicted values of VO2 at the anaerobic threshold (VO2 AT) and the decrease of the B-type natriuretic peptide (BNP). The BAP test and antioxidative/oxidative stress ratio increased 6 months after CR. The % changes of the antioxidative/oxidative stress ratio was positively correlated with the % changes of VO2 AT, and negatively correlated with the % changes of the BNP. CONCLUSION: These results suggest that intensive supervised CR significantly improved exercise capacity, which may be attributable to an adaptive response involving more efficient oxidative metabolites or the increased capacity of endogenous anti-oxidative systems in patients with cardiovascular diseases.
Anaerobic Threshold ; Antioxidants ; Atherosclerosis ; Cardiovascular Diseases ; Exercise Therapy ; Humans ; Inflammation ; Natriuretic Peptide, Brain ; Oxidative Stress ; Oxygen Consumption ; Reactive Oxygen Species

In the Guideline for treatment of chronic headache published by Japanese Headache Society, Ibuprofen and Acetaminophen are proposed for the acute treatment of migraine in children. But prophylactic treatment of pediatric migraine is not established. We report the efficacy of Kampo medicine for preventing migraine in children and childhood periodic syndromes. We use a variety of Kampo medicine for 9 pediatric migraine and periodic syndromes patients from 8 to 15 years old. All 9 patients improve their headache and associated symptoms including abdominal pain, vertigo, nausea and vomiting. After treatment the mean average of Headache Impact Test-6 (HIT-6) improve from 63.66 points to 45.77 points. Kampo medicines is effective for migraine in children and childhood periodic syndromes.

The purpose of the present study was to examine the relationship between exercise group characteristics and participation intention in elderly individuals via conjoint analysis. A total of 977 individuals (591 males and 386 females) aged ≥60 years were enrolled in the study. The included exercise groups comprised five factors: 1) instructor (professionals, university students, or volunteers); 2) place (1, 5, or 10 km); 3) expected effect (maintaining or increasing physical fitness, preventing dementia, or relieving stress); 4) characteristics (interaction, gaming, or self-pace); and 5) fee (free, 500 yen, or 1,000 yen). A total of 18 exercise groups were created by the orthogonal table. The choice-based conjoint comprised nine choice tasks. Among these, participants were required to choose between two exercise groups or no-choice option. The utility was higher for each factor as follows: 1) professional instructor, 2) closer place, 3) expected maintenance or increased physical fitness, 4) self-pace, and 5) free. The degree of each factor’s utility differed according to sex or exercise habits. Specifically, females had higher utility for university students than males, and those who had regular exercise habits had higher utility for professional instructors than those who did not. The results of the present study may help develop strategies to stimulate elder individuals in exercise-group participation.