Background/Aims: Probe-based confocal laser endomicroscopy (pCLE) requires the administration of intravenous (IV) fluorescein. This study aimed to determine the optimal dose of IV fluorescein for both upper and lower gastrointestinal (GI) tract pCLE. Methods: Patients 20 to 79 years old with gastric high-grade dysplasia (HGD) or colorectal neoplasms (CRNs) were enrolled in the study. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination of the optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by three endoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were not deemed to be visible. If all three endoscopists determined that the tissue structure was visible, the doses were de-escalated. Results: A total of 12 patients with gastric HGD and 12 patients with CRNs were enrolled in the study. Doses were de-escalated to 0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLE with IV fluorescein at 0.5 mg/kg. Conclusions In the present study, pCLE with IV fluorescein 0.5 mg/kg was adequate to visualize the magnified structure of both the upper and lower GI tract.

Objectives: It is important for patients to make correct use of drug information (DI) to promote the proper use of medicines. Many patients use the Internet to find DI, but awareness about the websites of public institutions that provide DI is low. This study aimed to identify the actual use of the Internet for DI and associated problems to inform development of a comprehensive DI website for patients.Method: Patients with diabetes were set as a model case for patients who take medicines and need DI. A questionnaire survey was conducted among patients with diabetes who visited community pharmacies in Kagoshima City from March 2019 to October 2019. The survey covered Internet use, DI needs, methods of sourcing DI, and problems obtaining DI via the Internet.Results: There were 349 valid respondents (median age 64 years), of which 52.1% used the Internet at least once a week. Around half of the Internet users searched for DI on the Internet. More than half of these respondents chose a DI acquisition site because it “appeared at the top of search results” and was “easy to understand.” However, around half of these respondents felt that “there is too much information on the internet and I don’t know what is correct.”Conclusion: This study suggests that older patients with a long history of diabetes use the Internet to obtain DI. However, patients face various problems accessing DI via the Internet. It may be necessary to construct a comprehensive website that is easy to use and enhance public health literacy to support the proper use of medicines by patients.

Background/Aims: Probe-based confocal laser endomicroscopy (pCLE) requires the administration of intravenous (IV) fluorescein. This study aimed to determine the optimal dose of IV fluorescein for both upper and lower gastrointestinal (GI) tract pCLE. Methods: Patients 20 to 79 years old with gastric high-grade dysplasia (HGD) or colorectal neoplasms (CRNs) were enrolled in the study. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination of the optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by three endoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were not deemed to be visible. If all three endoscopists determined that the tissue structure was visible, the doses were de-escalated. Results: A total of 12 patients with gastric HGD and 12 patients with CRNs were enrolled in the study. Doses were de-escalated to 0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLE with IV fluorescein at 0.5 mg/kg. Conclusions In the present study, pCLE with IV fluorescein 0.5 mg/kg was adequate to visualize the magnified structure of both the upper and lower GI tract.

An 84-year-old woman treated for tuberculosis in childhood presented to our emergency department with chronic cough and massive hemoptysis. Contrast-enhanced computed tomography (CT) on admission revealed a bronchial-pulmonary artery fistula (BPAF) for which she underwent bronchial artery embolization (BAE) and developed hemoptysis postoperatively. Contrast-enhanced CT on admission revealed a connection between the right coronary and a bronchial artery, suggesting coronary-to-bronchial artery communication. Hemoptysis persisted despite coiling of a branch of the right coronary artery. Therefore, we were consulted to perform thoracic endovascular aortic repair (TEVAR), which we performed as a semi-emergency. She did not show hemoptysis or paraplegia postoperatively and was discharged on postoperative day 40. TEVAR is effective for a BPAF in patients in whom BAE cannot control hemoptysis.

The purpose of this study was to research the physical fitness of elderly weekly hill walkers by comparison with general average values for Japanese. The participants total 77 members (28 males and 49 females) of a mountaineering party who did a hill walking once a week for at least 1 year. The test of physical fitness consisted of muscle strength (knee extension strength, back strength, grip strength and sit ups), agility (reaction time), body flexion (long sitting forward reach), balance (one-leg balancing with eyes open) and ability of daily physical actions (10-times-reapeated sit-to-stand test and 5m maximal walking test). The general average values were taken from several previous studies considered to be highly appropriate as the general average. For statistical analysis, unpaired t-test using the number of subjects, means and standard deviations of previous studies was performed. As a result, the 4 muscle strength tests were significantly higher than the general average value (P<0.001). In addition, the agility test and 2 abilities of daily physical action’s tests were significantly faster than the general average value (P<0.001). Moreover, there was no relationship between the value of knee extension and ages, but it existed in between annual climbing number of days (male: r=0.40, P<0.05, female: r=0.35, P<0.05). In conclusion, it appears that elderly people who climb the low mountain weekly have the higher physical fitness than general average values, and it can be inferred that weekly hill walking in low mountains can potentially keep higher knee extension regardless of age.

This study aimed to clarify the differences in cardiorespiratory and metabolic responses to body mass-based front lunge and squat exercises with relation to muscular activity. Seven healthy adult males performed 200 times body mass-based squat and front lunge exercises. During the exercises, oxygen uptake, heart rate (HR), blood lactate concentration (La), ground reaction force were measured. Oxygen uptake was divided by body mass (VO₂). VO₂ and HR was normalized to maximal VO₂ (%VO₂max) and maximal HR (%HRmax) obtained from an incremental load test. Electromyograms (EMGs) during the two exercises were recorded from the vastus lateralis (VL), rectus femoris, vastus medialis (VM), biceps femoris, gluteus maximus (GM). EMG amplitudes during both exercises were normalized to those during maximal voluntary contraction, and expressed as relative value (%EMG_MVC). Time that cardiorespiratory parameters became stable was 4-6 min in both exercises. VO₂, %VO₂max, metabolic equivalent, were higher in the front lunge than the squat. No significant differences in HR, %HRmax and La were found between both tasks. %EMG_MVC in VL, VM and GM were higher in the front lunge than the squat. These current findings indicate that 1) body mass-based squat and front lunge exercises are physiologically of more than moderate intensity, and 2) the cardiorespiratory responses to body mass-based front lunge are greater than those to body mass-based squat. This may be due to the difference in muscular activities of VL, VM and GM during the tasks.

The 30-seconds all-out sprint test on the cycle ergometer was performed by 10 high school and 13 college men’s cyclists. In addition, this study investigated their best time for 200 m (200mTT) and 1000 m (1000mTT) time trials in the velodrome. This study clarifies the relationship between muscle thickness of thigh, shank, and trunk and 1) the average speed for the 200mTT and 2) the 1000mTT in the field, and 3) the mean power of the 30-seconds all-out sprint cycling test. 1) The average speed for the 200mTT significantly correlated with the muscle thickness of posterior shank and front and lateral abdomen. 2) The average speed for the 1000mTT significantly correlated with the muscle thickness of posterior thigh and shank and front and lateral abdomen. 3) The mean power of the 30-seconds all-out sprint cycling test significantly correlated with the muscle thickness of anterior and posterior thigh, posterior shank, and front and lateral abdomen. Except for the average speed for the 200mTT and 1000mTT, the mean power of the 30-seconds all-out sprint cycling test was significantly related to the muscle thickness of anterior thigh. These results suggest that increasing muscle thickness of posterior thigh and shank and front and lateral abdomen is important for enhancing performance in sprint cycling.

This study aimed to elucidate how body composition, force-generating capacity and jump performances are associated with 50-m sprint velocity in circumpubertal boys, in relation to sprint phases and maturation. One hundred thirty four circumpubertal boys were allocated to preadolescent or adolescent group on basis of the height at the peak height velocity of Japanese boys (154 cm) reported in literature: those with body heights over 154 cm as adolescent group and others as preadolescent group. Body composition was determined by bioelectrical impedance analysis. In addition to maximal voluntary isometric knee extension torque, the performances of counter movement jump (CMJ), rebound jump (RJ), standing long jump (SLJ) and standing 5-step jump (SFJ) were also measured. RJ-index was calculated by dividing height by contact time. The time of 50-m sprint was determined at 10-m intervals. Multiple regression analysis showed that in preadolescent boys, SFJ become a predictor for the sprint speed during acceleration phases, and SFJ, RJ-index and CMJ as predictors for the sprint speeds during maximal speed and deceleration phases. In the adolescent boys, age, CMJ, SLJ, and SFJ become a predictor for the sprint speed during acceleration phases, and torque relative to body mass, CMJ and SFJ were selected as predictors for the sprint speeds during maximal speed and deceleration phases. Thus, the current results indicate that force-generating capacity and jumping ability are determinants for sprint performance in circumpubertal boys, but the relative contribution of each of the two factors differs between preadolescent and adolescent stages and among the sprint phases.

　　The aim of this study was to examine topophilia in the elderly living in mountainous areas. Topophilia, which is the geographical concept invented by Yi-Fu Tuan in 1999, is defined as the affective bond between people and place or environmental setting. A total of 120 elderly subjects living in a mountainous area responded to a standardized, validated 9-item Life Satisfaction Index K (subjective well-being) developed by Wataru Koyano and a new structured 6-item questionnaire on topophilia. Factor analyses revealed two domains of topophilia (public emotion and private emotion toward the living place). Public emotion was the emotion of being hard to leave the living place. Private emotion was the emotion of not loving the living place. There were areas where the elderly had a lesser degree of attachment toward the present state of the elderly could hardly have a sense of well-being and attachments to the current domicile. It is considered that not only physical but also mental approach is necessary to support the daily life of the elderly living in the mountainous area. Also, we examined the influences of aging and the living place on a subjective well-being and topophilia. There was no significant correlation between age and subjective well-being, but there was significant positive correlation between age and the degree of topophilia (r＝0.234, p‹0.01). On the other hand, the degree of subjective well-being by the place of residence was significantly different (p‹0.001; ANOVA), and the degree of topophilia by the place of residence was not significantly different. These findings suggest that subjective well-being is not influenced by age but influenced by the place of residence, and topophillia is not influenced by the place of residence but influenced by age.

We examined the effect of pre-acclimatization training under hypoxia for competition or training at high altitude on work capacity and physiological responses in hypoxia. Eight healthy male university students performed pre-acclimatization training under normobaric hypoxia (equivalent to about 2500 m; 15.4% inspired oxygen) for a week. Each student was exposed for a total of 90 minutes. During the exposure, each student rested for 60 minutes and pedaled at a workload of lactate threshold (LT) under normobaric hypoxia (equivalent to about 2500 m) for 30 minutes. In the result, workload of LT under normobaric hypoxia significantly increased after pre-acclimatization training (+15%). In physiological responses, arterial oxygen saturation at rest and exercise and peak ventilatory volume significantly increased after pre-acclimatization training. Arterial oxygen saturation at rest during pre-acclimatization training significantly increased. In addition, the ratio of low- and high-frequency power in heart rate variability significantly decreased after pre-acclimatization training. These results suggest that pre-acclimatization training is able to bring in acclimatization to high altitude on cardiopulmonary function and prevent decline of work capacity in high altitude. The ratio of low- and high-frequency power in heart rate variability as well as arterial oxygen saturation may reflect degree of acclimatization to high altitude.