Many frail older patients with multiple comorbidities are hospitalized in long-term care hospitals and nursing facilities. Due to pre-existing conditions and immunosuppressive states, there are significant individual differences, such as weakness, sluggishness, and asymptomatic status. These differences make it challenging to find a patient’s exacerbation using a conventional threshold of vital signs. We developed a circadian rhythm anomaly-detection system designed for each patient, which compares each patient’s past 2 weeks average respiratory rate circadian rhythm with that of the last 24 hours. Respiratory rate was measured using a piezoelectric sensor located under the mattress. Prior to the doctor’s diagnosis of acute exacerbation of lobar pneumonia and heart failure, a bedridden 88-year-old female patient with multiple chronic diseases showed abnormal circadian rhythm status. However, there were no significant changes in vital signs. A circadian rhythm anomaly-detection system appears promising as a future tool to promote medical checkups for the older person.

High-intensity interval exercise leads to greater improvements in the vascular endothelial function than continuous exercise at moderate intensity. However, few studies have been performed on the effects of repetition exercise consisting of high-intensity exercise followed by complete rest on the arterial function. Therefore, the purpose of this study was to investigate the effects of repetition exercise on the vascular endothelial function determined by flow-mediated vasodilation (FMD). Eleven healthy male subjects completed two exercise sessions on a cycle ergometer in a counterbalanced order. The exercise sessions were 20 min cycling at 50% maximal work rate (Wmax) (continuous exercise, CE) and 20 × 20-sec intervals at 100%Wmax interspersed with 40-sec intervals at complete rest (repetition exercise, RE). Before and after each protocol, the brachial systolic and diastolic blood pressure were measured in the supine position. Relative FMD was assessed at rest and 30 and 60 min after each exercise regimen, and then the normalized FMD (nFMD) was calculated from the peak shear rate. The FMD significantly increased 30 min after RE (8.2 ± 1.5% to 11.5 ± 3.1%, p<0.01) and non-significantly increased 30 min after CE (7.5 ± 1.6% to 8.1 ± 2.1%, n.s.) before returning to baseline at 60 min after both exercise regimens. The FMD value at 30 min after RE was significantly greater than that at 30 min after CE (p<0.01). The nFMD (a.u.) significantly increased 30 min after RE (1.38 ± 0.64 to 2.00 ± 0.94, p<0.05) and non-significantly increased 30 min after CE (1.20 ± 0.54 to 1.49 ± 0.57, n.s.) before returning to baseline at 60 min after both exercise regimens. These results suggest that repetition exercise may lead to an acute improvement in the vascular endothelial function.

No abstract available.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Amino Acid Sequence ; Calreticulin/*genetics ; Child ; DNA/chemistry/genetics/metabolism ; Exons ; Female ; Humans ; Janus Kinase 2/*genetics ; Male ; Middle Aged ; Molecular Sequence Data ; Polymorphism, Single Nucleotide ; Receptors, Thrombopoietin/genetics ; Sequence Analysis, DNA ; Sex Factors ; Thrombocythemia, Essential/*diagnosis/genetics ; Young Adult

High-intensity interval exercise (IE) leads to greater improvements in the arterial function than continuous exercise at moderate intensity (CE). However, few studies have been performed on the effects of the repetition exercise (RE) on the vascular endothelial function. The purpose of this study was to compare the effects of CE vs. IE vs. RE during aerobic exercise on the vascular endothelial function determined by flow-mediated vasodilation (FMD). Ten healthy male subjects randomly performed 3 trials as follows: CE (20-min cycling at 50%W_max), IE (10 × 1-min intervals cycling at 75%W_max interspersed with 1-min intervals cycling at 25%W_max), and RE (30 × 20-sec intervals cycling at 100%W_max interspersed with 20-sec intervals at rest). FMD was assessed at rest and 30 and 60 min after each exercise, and then the normalized FMD (nFMD) was calculated from the peak shear rate. The nFMD (a.u.) significant increased 30 min after IE (1.2 ± 0.2 to 3.0 ± 1.0, p<0.05) and increased 30 min after CE (1.0 ± 0.2 to 1.4 ± 0.2, n.s.) and returned to baseline at 60 min after both exercises, while the nFMD decreased 30 min after RE (1.3 ± 0.2 to 1.2 ± 0.1, n.s.) and was sustained at 60 min. The nFMD value at 30 min after IE was significantly greater than that at 30 min after RE (3.0 ± 1.0 versus 1.2 ± 0.1, p<0.05). These results suggest that RE may lead to a less improvement in the vascular endothelial function than CE and IE.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.

In order to investigate the safety and efficacy of low energy laser irradiation to the arthritis of the patients with rheumatoid arthrtis, a multi-center double blind comparative study was conducted.
Sixty eight patients with rheumatoid arthritis were randomly allocated into two groups of laser and sham irradiation. The each inflamed knee joint received 3 minut's irradiation of Ga-AI-As laser at 20mw with wave length of 830nm or 3 minut's sham irradiation, twice a week during 5 weeks. Evaluation items included pain and swelling of the knee joint, 15m walking time, ESR and morning stiffness. Routine laboratory tests including CBC, blood chemistry such as GOT, GPT, and LDH were also examined at the entry of the study and the completion of 10 times irradiation. Among various evaluation items, 15m walking time showed significant decrease in the laser group comparing with that in the sham group (P<0.01). The remaining items showed no significant differences between two groups. Laboratory data showed no remarkable changes during the study and no apparent adverse effect with irradiation was observed.
These results show some beneficial effect of low energy laser therapy to the patient with rheumatoid arthritis and also safety of irradiation.