Convergent validity of a simplified device and relationship between blood lactate and salivary lactate after a vertical squat jump in healthy non-athletes

[Purpose] The aims of this study were 1) to examine the convergent validity between Lactate pro 2 and a standard JCA-BM 8000 automatic analyzer using salivary lactate and 2) to investigate the relationship between blood and salivary lactate levels after a vertical squat jump. [Participants and Methods] Healthy non-athletes participated in this observational study. The participants performed a vertical squat jump for 1 min 30 s. Blood and salivary lactate levels were measured before and after exercise using Lactate Pro 2. [Results] The intraclass correlation coefficient between Lactate Pro 2 and the JCA-BM 8000 automatic analyzer was 0.773, which can be considered as substantial convergent validity. However, in some samples, the salivary lactate level was out of the measurable range, and numerical values could not be obtained. The cross-correlation function between the blood and salivary lactate levels was 0.535 at lag 0 and 0.750 at lag 1, which indicated a 5-min lag between the salivary and blood lactate values. [Conclusion] Salivary lactate levels can be easily measured using Lactate Pro 2, although its sensitivity needs to be resolved. Further research is required for salivary lactate level, which can be collected non-invasively, to be used as an alternative parameter to blood lactate level.

Clinical and Histopathologic Characteristics of Melanocytic Lesions on the Volar Skin Without Typical Dermoscopic Patterns

Importance

It is challenging to differentiate melanoma from melanocytic nevus on the volar skin in the absence of typical dermoscopic patterns.

Objective

To identify the frequency and clinical and dermoscopic characteristics of melanocytic lesions on the volar skin not displaying a parallel furrow pattern, lattice-like pattern, fibrillar pattern, or parallel ridge pattern on results of dermoscopy.

Design, Setting, and Participants

In this retrospective cohort study, a total of 504 melanocytic lesions on the volar skin were evaluated in the Shinshu University Hospital department of dermatology between January 1, 2000, and December 31, 2012. Dermoscopic images were independently assessed by 3 dermoscopists for the presence of established dermoscopic criteria. Statistical analysis was performed from October 1, 2017, to April 30, 2018.

Main Outcomes and Measures

Frequency of dermoscopic criteria and corresponding clinical (patient age and size and location of lesion) and histopathologic features.

Results

Of 504 lesions, 110 (21.8%) (melanocytic nevus, 97; melanoma, 8; and equivocal melanocytic lesion, 5) from 108 patients (68 female and 40 male patients; mean age, 40.1 years [range, 1-86 years]) did not show a parallel furrow pattern, lattice-like pattern, fibrillar pattern, or parallel ridge pattern. Among them, the mean patient age was significantly higher for melanoma than for melanocytic nevus (65.3 vs 38.0 years; P < .001), as was mean maximum lesion diameter (11.8 vs 5.7 mm; P < .001). Melanomas and equivocal melanocytic lesions tended to be distributed on weight-bearing areas of the foot sole, such as the heel, while nevi were spread over non-weight-bearing regions. Dermoscopically, 95 melanocytic nevi (97.9%) were symmetrical in 1 or 2 axes while melanomas were not. A total of 91 melanocytic nevi (93.8%) had 1 or 2 colors per lesion, and 4 melanomas (50.0%) had more than 2 colors. Vascular structures were seen in 3 melanocytic nevi (3.1%) and 3 melanomas (37.5%). Blue-white structures were seen in 18 melanocytic nevi (18.6%) and 3 melanomas (37.5%). Dots and globules were seen in 22 melanocytic nevi (22.7%) and 4 melanomas (50.0%). Vascular structures, blue-white structures, and dots and globules were irregularly distributed in the melanomas. Ulcer, hyperkeratosis, and irregular streaks were observed only in melanomas.

Conclusions and Relevance

More than one-fifth of melanocytic lesions on the volar skin did not display typical dermoscopic patterns. Asymmetry, numerous colors (≥3), and other melanoma-specific dermoscopic findings were more frequently observed for melanomas. Clinical information, including patient age and lesion size and location, was helpful in differentiating melanoma from melanocytic nevus. Further prospective clinical studies are warranted to clarify the diagnostic accuracy of dermoscopy combined with clinical information.

An Incremental Sit-to-Stand Exercise for Evaluating Physical Capacity in Older Patients with Type 2 Diabetes

Exercise is recommended for older patients with type 2 diabetes mellitus (T2DM), and increased physical activity contributes to better management of their condition. The conventional exercise test with treadmill or cycle ergometer (CE) for assessing physical capacity, such as peak oxygen uptake (VO₂) and anaerobic threshold (AT), is not always usable for older patients with T2DM. The incremental sit-to-stand (ISTS) exercise is an incremental exercise test using external signals to control the sit-to-stand rate in a given time frame and can be performed in a small space using only a chair. This study aimed to examine the validity of the physical capacity assessment during the ISTS exercise, based on the relationships between the ISTS performance, peak VO₂, AT on ISTS exercise and CE test, in older patients with T2DM. Twenty-two patients with T2DM (10 men, 12 women; mean age, 68.0 years; range, 61-77 years) performed ISTS exercise (according to an existing protocol) and CE test in a randomized manner. Peak VO₂, AT, and completion time were determined for the ISTS exercise and CE test. Peak VO₂ during ISTS exercise was significantly associated with that during the CE test (r = 0.89, p < 0.01). The completion time on the ISTS exercise was significantly associated with peak VO₂ (r = 0.80, p < 0.01) and AT on the ISTS exercise (r = 0.78, p < 0.01). The ISTS exercise is a useful tool to determine the physical capacity and estimate peak VO₂ and AT in older people with T2DM.

Cough Strength Is an Indicator of Aspiration Risk When Restarting Food Intake in Elderly Subjects With Community-Acquired Pneumonia

BACKGROUND

The incidence of community-acquired pneumonia (CAP) is relatively high in elderly subjects. Cough peak flow (CPF) is an objective indicator of cough strength, and CPF evaluation might be useful to assess whether food intake can be restarted. We aimed to examine whether cough strength assessed with CPF can be used as an indicator of the aspiration risk when restarting food intake in elderly subjects with CAP.

METHODS

This cross-sectional study included 82 elderly subjects with CAP between August 2016 and March 2018. CPF was measured using a peak flow meter, and we performed the repetitive saliva-swallowing test (RSST), which is a videoendoscopic evaluation of swallowing and is used to assess dysphagia and aspiration. Receiver operating characteristic (ROC) curve analysis was performed. The cutoff value was determined, and the area under the ROC was calculated.

RESULTS

The areas under the RSST and CPF curves were 0.87 and 0.83, respectively. The RSST value for identifying the aspiration risk was 2.5 swallows. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 70.0%, 71.7%, 2.5, and 0.42, respectively. The CPF for identifying the aspiration risk was 190 L/min. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 82.6%, 69.4%, 2.7, and 0.25, respectively.

CONCLUSIONS

Our findings suggest that cough strength assessed with CPF can be used as an indicator of the aspiration risk when restarting food intake in elderly subjects with CAP and that CPF evaluation is not inferior to the RSST. However, CPF evaluation should be performed together with swallowing screening tests to determine the aspiration risk.

Validity and reproducibility of an incremental sit-to-stand exercise test in healthy middle-aged individuals

[Purpose] We aimed to evaluate the validity and reproducibility of the incremental sit-to-stand exercise test for aerobic fitness evaluation in healthy middle-aged individuals. [Participants and Methods] Thirteen healthy middle-aged individuals randomly underwent the incremental sit-to-stand exercise and cycle ergometer tests, and the peak oxygen uptake was measured during both tests. Pearson’s correlation coefficients were used to assess the strength of the association between the peak oxygen uptake measured during the aforementioned tests. Intraclass correlation coefficients with 95% confidence intervals for peak oxygen uptake obtained during the first, second, and third incremental sit-to-stand exercise tests were used to determine the reproducibility of this test. [Results] The peak oxygen uptake measured during the incremental sit-to-stand exercise test was strongly associated with that measured during the cycle ergometer test (r=0.86). The intraclass correlation coefficients (95% confidence intervals) used to verify the association of the peak oxygen uptake between the first and the second incremental sit-to-stand exercise tests and between the second and third incremental sit-to-stand exercise tests were 0.92 (0.66–0.99) and 0.96 (0.82–0.99), respectively. [Conclusion] The incremental sit-to-stand exercise test is a valid and reproducible tool to evaluate aerobic fitness in healthy middle-aged individuals.

Infant Suffocation Incidents Related to Co-Sleeping or Breastfeeding in the Side-Lying Position in Japan

Co-sleeping and breastfeeding in the side-lying position have recently been pointed out as risk factors for suffocation in sleeping infants; however, there is no actual report on an "incident." "Incident" is defined as a tense or sobering experience without a consequential fatal suffocation accident. It is important to understand infant suffocation incidents to prevent accidents during co-sleeping and breastfeeding in the side-lying position. We investigated factors and frequency of infant suffocation incidents associated with co-sleeping and breastfeeding in the side-lying position using a self-administered questionnaire survey of 895 mothers during their infant's 1-, 4-, or 10-month health checkups. Co-sleeping and breastfeeding in the side-lying position were practiced by 28.3% and 56.0% of mothers, respectively; thus, 84.3% of the mothers surveyed were practicing either co-sleeping or breastfeeding in the side-lying position. Of those who received guidance from a medical professional, 36.1% practiced only co-sleeping while 60.1% practiced only side-lying breastfeeding. In the co-sleeping group, 10.6% had faced infant suffocation incidents, while 13.2% in the breastfeeding in the side-lying position group had faced similar incidents. Regarding factors associated with suffocation incidents while co-sleeping, the frequency of occurrence was significantly more in mothers of 1-month and 4-month-old infants compared with those of 10-month-old infants. Of mothers who faced suffocation incidents while breastfeeding in the side-lying position, 45% also had faced similar incidents while co-sleeping. These results demonstrate the importance of thoroughly educating mothers about the risks associated with co-sleeping and breastfeeding in the side-lying position for preventing infant suffocation.

Serum 5-S-cysteinyldopa behavior in the early phase of nivolumab treatment of 12 melanoma patients

Along with the expansion of therapeutic options for metastatic melanoma, the development of useful biomarkers is urgently required to predict and monitor treatment response. Serum 5-S-cysteinyldopa (5-S-CD) has been identified as a diagnostic marker of malignant melanoma, but its utility as a biomarker for emerging therapeutic agents remains unknown. We assessed serum 5-S-CD in 12 metastatic melanoma patients (median age, 76 years; six men and six women) who had been treated with nivolumab (Nivo) at Shinshu University Hospital between 2014 and 2016. Serum 5-S-CD and lactate dehydrogenase levels before and at 3-6 weeks of Nivo treatment were obtained and their changes were compared with clinical responses as defined by the Response Evaluation Criteria in Solid Tumors criteria (version 1.1). A decrease of 10 nmol/L or more of serum 5-S-CD was observed only in partial response patients (2/3 cases, 67%), while an increase of 10 nmol/L or more of serum 5-S-CD was witnessed only in progressive disease patients (4/8 cases, 50%). Serum 5-S-CD changes were within ±10 nmol/L in the remaining six patients (partial response, one; stable disease, one; progressive disease, four). The results of the four moderately affected progressive disease patients were suspected to have been influenced by small-sized metastatic lesions, a mixed response that included diminished and enlarged metastatic lesions, prior therapy to Nivo with BRAF inhibitors or radiation, or the development of brain metastasis. Serum 5-S-CD in the early phase of Nivo treatment may be helpful to predict therapeutic response in metastatic melanoma.

Development of an Incremental Sit-to-Stand Exercise for Aerobic Fitness Evaluation

Incremental sit-to-stand exercise (ISTS) is an incremental exercise test using external signals to control the sit-to-stand rate in a given time frame. This study aimed to investigate the concurrent validity and reproducibility of the ISTS in aerobic fitness evaluation among healthy elderly women. Sixteen elderly women performed the ISTS and cycle ergometer test at 3-day to 2-week intervals, and six of the participants performed the ISTS twice. Peak oxygen uptake (VO₂), peak heart rate and completion time on the ISTS and cycle ergometer test were determined. Measured peak VO₂ on the cycle ergometer test was significantly related to the peak VO₂ (r=0.80, P<0.05) and the completion time (r=0.65, P<0.05) on the ISTS. The intraclass correlation coefficients were 0.96 for peak VO₂ values and 0.91 for the completion time values during the two ISTSs. In conclusion, the ISTS is a valid, reproducible and safe test for aerobic fitness evaluation in healthy elderly women.

[Activities of daily living (ADL) of single elderly individuals using social assistive programs in a rural community]

Objectives　The proportion of elderly individuals living alone is increasing in Japan. Matsumoto city office provides social assistive programs such as home help, lunch delivery, life advice, and safety check telephone calls. The purpose of this study was to compare the level of ADL between the elderly using social assistive programs (the use group) and those who did not (the non-use group).Methods　We conducted a cross-sectional study at Shiga district of Matsumoto city in September 2014. A total of 128 elderly individuals participated in this study. Health volunteers asked these subjects to complete a questionnaire without assistance. Measurement items included lifestyle variables and social support networks. With respect to the frequency of use, we used questions that inquired about the use of the social assistive program. We included a set of instruments commonly used in the health assessment of elderly populations: functional capacity (Instrumental ADL, Intellectual Activity, Social Role), social support, nutrition (Mini Nutrition Assessment [MNA]) and depressive symptoms (Geriatric Depression Scale [GDS]).Results　The use group consisted of 24 elderly individuals participating in the social support program. The non-use group consisted of 89 elderly individuals living alone without programs. The mean age of those who completed the survey was 83.9±4.2 years for the use group and 82.3±4.3 years for the non-use group. Comparisons between the two groups did not show significant difference in terms of their intellectual activity, social role, emotional social support, and MNA or GDS scores. The use group was more likely to use the public transfer service and receive instrumental social support from children and relatives.Conclusions　By means of utilizing the public transfer service, and receiving family support, the elderly living alone who used social assistive programs could live independently. These findings suggest a need for improvement in the public transfer service and social network.

Effect of Different Seat Heights during an Incremental Sit-To-Stand Exercise Test on Peak Oxygen Uptake in Young, Healthy Women

'Sit-to-stand' exercise uses the repetitive motion of standing up and sitting down in a chair, a common activity of daily living. A new assessment using an incremental sit-to-stand exercise test employs an external sound to control the speed of standing-up and allows increases in work rate. The aims of the study were to examine the effect of different seat heights on peak oxygen uptake (peak VO2) during an incremental sit-to-stand exercise and to assess any difference between peak VO2 values during incremental sit-to-stand exercise compared with a cycle ergometer test. Thirteen healthy young women (age: 23.1 ± 2.6 years, height: 1.61 ± 0.06 m, body mass: 51.9 ± 7.4 kg·m-2) participated in four incremental sit-to-stand tests with different seat heights and cycle tests in random order. The seat heights were adjusted to 100%, 80%, 120%, and 140% of knee height distance (100%, 80%, 120%, and 140% incremental sit-to-stand exercise, respectively). The peak VO2 and completion time were measured during incremental sit-to-stand and cycle ergometer tests, and repeated-measures analysis of variance and Student's paired t-test with Holm's method were used to evaluate differences between these variables. The peak VO2 values increased by about 10-12 mL·min-1·kg-1 as the seat height on the ISTS decreased over a 60% range of lower leg lengths. The peak VO2 values on the 80%, 100%, 120%, and 140% incremental sit-to-stand tests were about 11%, 25%, 40%, and 50% lower than that on the cycle ergometer test, respectively. The peak VO2 on the incremental sit-to-stand test increased as seat height decreased. These findings are useful to determine which seat height on the incremental sit-to-stand tests test is suitable for different populations.

Validity and Reproducibility of an Incremental Sit-To-Stand Exercise Test for Evaluating Anaerobic Threshold in Young, Healthy Individuals

Sit-to-stand exercise (STS) is a common activity of daily living. The objectives of the present study were: 1) to assess the validity of aerobic fitness measurements based on anaerobic thresholds (ATs), during incremental sit-to-stand exercise (ISTS) with and without arm support compared with an incremental cycle-ergometer (CE) test; and 2) to examine the reproducibility of the AT measured during the ISTSs. Twenty-six healthy individuals randomly performed the ISTS and CE test. Oxygen uptakes at the AT (AT-VO2) and heart rate at the AT (AT-HR) were determined during the ISTSs and CE test, and repeated-measures analyses of variance and Tukey's post-hoc test were used to evaluate the differences between these variables. Pearson correlation coefficients were used to assess the strength of the relationship between AT-VO2 and AT-HR during the ISTSs and CE test. Data analysis yielded the following correlations: AT-VO2 during the ISTS with arm support and the CE test, r = 0.77 (p < 0.05); AT-VO2 during the ISTS without arm support and the CE test, r = 0.70 (p < 0.05); AT-HR during the ISTS with arm support and the CE test, r = 0.80 (p < 0.05); and AT-HR during the ISTS without arm support and the CE test, r = 0.66 (p < 0.05). The AT-VO2 values during the ISTS with arm support (18.5 ± 1.9 mL·min(-1)·kg(-1)) and the CE test (18.4 ± 1.8 mL·min(-1)·kg(-1)) were significantly higher than those during the ISTS without arm support (16.6 ± 1.8 mL·min(-1)·kg(-1); p < 0.05). The AT-HR values during the ISTS with arm support (126 ± 10 bpm) and the CE test (126 ± 13 bpm) were significantly higher than those during the ISTS without arm support (119 ± 9 bpm; p < 0.05). The ISTS with arm support may provide a cardiopulmonary function load equivalent to the CE test; therefore, it is a potentially valid test for evaluating AT-VO2 and AT-HR in healthy, young adults. Key pointsThe ISTS is a simple test that varies only according to the frequency of standing up, and requires only a small space and a chair.The ISTS with arm support is valid and reproducible, and is a safe test for evaluating AT in healthy young adults.For evaluating the AT, the ISTS may serve as a valid alternative to conventional CPX, using either a cycle ergometer or treadmill, in cases where the latter methods are difficult to implement.

The Effect of Different Standing up Frequencies in Sit-to-stand Exercise on Oxygen Uptake

[Purpose] The aim of this study was to investigate the steady state of oxygen uptake (VO₂) at several standing up frequencies to clarify whether workload in the sit-to-stand exercise (STSE) is greater than the anaerobic threshold (AT). [Subjects] Ten healthy young subjects performed the STSE. [Methods] In the STSE, subjects stood up and sat down without using their arms to push-off from the chair at standing up frequencies of 6, 12, 18, 24, 30, and 36 times per minutes. Subjects exercised for 5 minutes at each frequency with 5 minutes of rest between each consecutive frequency trial. The steady state of VO₂ was evaluated by the difference in the VO₂ between the 3rd and 5th min at each frequency. The correlation between the VO₂ of the STSE and the standing up frequency was analyzed. [Results] At standing up frequencies greater than 24 times/min, the steady state of VO₂ could not be confirmed. The relationship between the standing up frequency (at less than 24 times/min) and VO₂ was strong (r=0.94). [Conclusion] The STSE may be a potentially useful test for determining AT and predicting the physical capacity of patients.

Chronic hepatitis E: a review of the literature

In 1978, the first case of hepatitis E was identified as non-A, non-B hepatitis. Hepatitis E virus (HEV) infection is believed to be one of the common causes of enterically transmitted acute hepatitis in developing countries and is rare in developed countries, except in patients with a history of travel. However, an increasing number of chronic HEV infection cases have recently been reported in developed countries. In these countries, immunosuppressed patients with HEV infection, such as organ transplant recipients, human immunodeficiency virus (HIV)-infected patients or patients with haematological malignancies, could develop chronic hepatitis E (CHE) infection. Approximately 60% of HEV infections in immunocompromised patients after solid organ transplantation evolve to CHE without antiviral treatment. Clinical manifestations of CHE are often nonspecific symptoms. Many patients with CHE infection are asymptomatic, but some have jaundice, fatigue, abdominal pain, fever and asthenia. Several extrahepatic manifestations have also been reported. Although chronic HEV infection can result in progressive severe liver failure and cirrhosis, diagnosis is often controversial because of the lack of specific diagnostic criteria. Many CHE cases are diagnosed by HEV RNA-positive serum or stool for >6 months. Immunosuppressive drugs, interferon-alpha and ribavirin have been used for treatment. Diagnostic reverse-transcription polymerase chain reaction is useful for estimating treatment efficacy. Preventive measures for HEV infection have been discussed, while systematic guidelines have not yet been reported.

Analysis of pelvic movement in the elderly during walking using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope

The incidence of falls in the elderly is increasing with the aging of society and is becoming a major public health issue. From the viewpoint of prevention of falls, it is important to evaluate the stability of the gait in the elderly people. The pelvic movement, which is a critical factor for walking stability, was analyzed using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope. The subjects were 95 elderly people over 60 years of age. The criteria for instability were open-eye standing on one leg for 15s or less, and 11s or more on 3m timed up and go test. Forty subjects who did not meet both of these criteria comprised the stable group, and the remaining 55 subjects comprised the unstable group. Pelvic movement during walking was compared between the two groups. The angle, angular velocity, and acceleration were analyzed based on the wave shape derived from the device worn around the second sacral. The results indicated that pelvic movement was lower in all three directions in the unstable group compared to the stable group, and the changes in the pelvic movement during walking in unstable elderly people were also reduced. This report is the first to evaluate pelvic movement by both a triaxial accelerometer and a triaxial gyroscope simultaneously. The characteristics of pelvic movement during walking can be applied in screening to identify elderly people with instability, which is the main risk factor associated with falls.

Effects of low-intensity resistance exercise with vascular occlusion on physical function in healthy elderly people

Some successful fall prevention programs include resistance or balance training, but less is known about the effects of low-intensity resistance exercise with moderate vascular occlusion (LIO) on physical function in healthy elderly people. In LIO, appropriate pressure is applied to the proximal parts of the upper and lower extremities with a specially designed belt. The reduction of muscle blood flow is considered likely to induce the secretion of growth hormone. The aim of this study was to compare the effects of two training programs, LIO versus dynamic balance exercise (DBE) in elderly people in a community. Fifty-one healthy subjects aged 65 and older were randomly assigned to the LIO program (n = 24) or the DBE program (n = 27). Performance, balance, muscle strength were measured in both groups before and after the 8-week programs. In addition, blood was sampled from LIO participants (n = 11) and analyzed for growth hormone and lactate. Overall improvements, but no group differences, were found in performance and balance after the programs. Muscle strength in the lower extremities was significantly increased in the LIO group, but not in the DBE group. Growth hormone was significantly increased immediately after LIO. The 8-week LIO program improved physical function, especially muscle strength, which may be associated with the exercise-induced secretion of growth hormone. Further studies are needed to determine the contents and duration of an LIO program for elderly people.

Environmental exposure and p53 mutations in esophageal cancer patients in areas of low and high incidence of esophageal cancer in China

Esophageal cancer is the 6th most common cancer in the world, and genetic factors (p53 mutations) in addition to the environmental factors (food, nutrition, smoking, drinking, etc.) are involved in its development. In this study, the association between the both factors, environmental risk factors for esophageal cancer and p53 mutations, in tumor tissues was investigated in 77 patients living in a high-incidence area and 50 patients living in a low-incidence area in Hebei Province, China. Among these patients, p53 mutations were observed in about 50%, without regional differences in the respective frequencies. G:C>A:T (G to A or C to T) transition mutations were the major type of mutations observed in patients in the high-incidence area (19 patients, 50%), whereas G:C>A:T transitions and insertions were observed with equal frequency (8 patients, 33.3%) in the low-incidence area. As for the association with environmental factors, p53 mutations occurred with higher frequency in patients with a daily intake of spicy foods and in those who used unboiled well water in the low-incidence area. Logistic regression analysis showed no association between food intakes and p53 mutations in high- and low-incidence areas. Thus, higher frequency of spicy food intake and use of unboiled well water may be risk factors of esophageal cancer via p53 mutations in China.

Influence of self efficacy for health promotion on functional decline of elderly living in a rural community in Japan

OBJECTIVE

To clarify whether self efficacy for health promotion is associated with functional ability among elderly inhabitants of a rural community in Japan.

METHODS

The research was a longitudinal study of inhabitants aged 65 and over in a community in Nagano, Japan, who completed a questionnaire at the baseline in 1998 and at follow-up in 1999. The questionnaire included 1) Self Efficacy Scale for Health Promotion measuring the belief in task performance on health, 2) health behavior, 3) a functional ability scale consisting of instrumental activities of daily living, effectance, and social role (Tokyo Metropolitan Institute of Gerontology Index of Competence: TMIG Scale), and 4) demographic factors such as age and sex.

RESULTS

At the baseline, 477 subjects completed the questionnaire by themselves and achieved full marks on the TMIG Scale. Of these, 457 responded again 12 months later. Low self efficacy for health promotion at baseline was a significant correlate for functional decline during the 12-month period.

CONCLUSION

Self efficacy for health promotion is a predictive factor for functional ability and can be important as an intervention target for elderly people.

[Intervention study using a fall prevention program to prevent functional decline of old-old elderly in a rural community]

The purpose of this study was to determine the effects of a fall prevention program for old-old elderly in a rural community in Japan. The subjects were 71 inhabitants aged 75 and over who used community health and welfare services such as day services and social activity classes. They were divided into two groups: 34 in the experimental group, and 37 controls. Physical therapists and care staff instructed the experimental group in fall prevention exercises once per two weeks from December 2000 to March 2001. The control group utilized the usual services without any special instructions. All subjects were evaluated by physical performance tests and a self-administered questionnaire before and after 4 months following the intervention. Collected data were analyzed by two-way ANOVA using intervention and time as independent variables, and physical performance tests as dependent variables. Twenty-three of the experimental group and 26 of the control group completed both baseline and follow-up surveys. There were no significant differences in physical ability between the two groups at the time of the baseline survey. The experimental group showed excellent compliance and participated in all sessions during the intervention period. Interaction effects on body mass index and Timed Up and Go Test were shown to be significant (F = 5.623, P < 0.01: F = 6.541, P < 0.05). There were no changes in terms of other physical and psychological factors. Our results showed specific exercises could improve some aspects of physical performance. Since the group exercise program can be effective for old-old elderly, it might contribute to decreasing falls and prolong independent living.

Transduction of thymidine phosphorylase cDNA facilitates efficacy of cytosine deaminase/5-FC gene therapy for malignant brain tumor

The in vivo gene delivery of E. coli cytosine deaminase (cd) cDNA and systemic 5-fluorocytosine (5-FC) administration have been studied extensively because of their clinical relevance to cancer gene therapy. This approach has the potent advantage of a stronger bystander effect compared to the previous thymidine kinase suicide gene system of the herpes simplex virus. However, 5-fluorouracil (5-FU), an active metabolite in cd with 5-FC therapy, is not always effective for every type of tumor since the enzymes responsible for further drug metabolism vary significantly in each tissue. In this study, we aimed to increase the sensitivity of 5-FU by transduction of thymidine phosphorylase (dThdPase) cDNA into brain tumor cells. After retroviral transfer of the cDNA, we obtained 9L murine gliosarcoma cells showing stable expression of the target enzyme (9L-dThdPase). The growth of the cells was identical to wild type (9L-WT) or control-vector transfected (9L-Neo) cells in vitro. Sensitivity to 5-FU was increased in 9L-dThdPase cells. After the adenoviral delivery of cytosine deaminase gene into these cells, 9L-dThdPase cells also demonstrated an increased sensitivity to 5-FC. Moreover, we showed that transduction of dThdPase cDNA prolongs the survival of animals bearing intracerebral tumors after experimental in vivo cytosine deaminase gene therapy. These results suggest that transduction of thymidine phosphorylase may be a beneficial approach to increasing the efficacy of cd/5-FC suicide gene therapy in certain types of tumor.

[A comparison of the effectiveness of transtracheal heating and humidification system in maintaining body temperature during general anesthesia with low flow gases]

We evaluated the effectiveness of transtracheal heating and humidification system in maintaining body temperature during general anesthesia with low flow gases in 12 gastric cancer patients. Patients were divided into two group; Control group A in which a hot-water circulating system was used and group B in which a transtracheal heating and humidification system by ANAMED HUMITUBE was used, during gastric cancer operation. Compared to the hot-water circulating system, the transtracheal heating and humidification system is more effective for maintaining body temperature and humidification after abdominal lavage by warm saline water. But there was no difference between the two groups about awakening from general anesthesia. We concluded that transtracheal heating and humidification system by ANAMED HUMITUBE is effective in maintaining body temperature under general anesthesia with low flow gases.

Cerebral atrophy in multiple system atrophy by MRI

Cranial magnetic resonance images (MRI) of the cerebral areas of 40 patients with multiple system atrophy (MSA) and of 61 age-matched controls were analyzed. The cerebral area of MSA patients was 131. 95+/-15.89 cm(2) (mean+/-S.D.), which was significantly smaller than that of normal controls at 149.01+/-10.93 cm(2) (P<0.0001). All 23 MSA cases subjected to the MRI study over a 1-year period showed progressive cerebral atrophy, and the atrophy rate was 2.46+/-1. 66%/year. There were no significant differences within the MSA subtypes or between gender. The progression of cerebral atrophy in MSA correlated more with duration (r=-0.634) than age (r=-0.421). We conclude that MRI findings throughout the course of MSA suggest progressive cerebral atrophy, which is common in all subtypes and reflects duration of the disease rather than age.

Stress-induced factor involved in flower formation of Lemna is an alpha-ketol derivative of linolenic acid

A stress-induced substance(s) (factor C) incubated with norepinephrine (NE) has strong flower-inducing activity in Lemna paucicostata. We isolated an essential component (FIF) of factor C, and clarified its chemical structure as 9-hydroxy-10-oxo-12(Z),15(Z)-octadecadienoic acid, an alpha-ketol derivative of linolenic acid, which is formed via 9-hydroperoxy linolenic acid. Synthesized FIF showed flower-inducing activity after incubation with NE (factor C activity) equivalent to that formed in the stressed Lemna. Jasmonic acid and 13-hydroxy-12-oxo-9(Z),15(Z)-octadecadienoic acid (12,13-alpha-ketol linolenic acid), both of which are formed via 13-hydroperoxide of linolenic acid and all other derivatives of FIF synthesized by chemical and enzymatic processes failed to show the factor C activity. These results suggest that the molecular structure of FIF is very specific for the factor C activity.

Ecological study on the risks of esophageal cancer in Ci-Xian, China: the importance of nutritional status and the use of well water

Our purpose was to determine the environmental risks in the development of esophageal cancer in Ci-Xian, which has one of the highest incidences of esophageal cancer in China. The subjects included 404, 352 and 400 inhabitants living in high-, medium-, and low-incidence areas of esophageal cancer, as well as 301 esophageal cancer patients. A food intake-frequency survey using a 7-day weighted inventory questionnaire was conducted on these individuals. Questions on occupation, working conditions, income per year, family disease history, medical complaints, and demographic features were also included in the questionnaire. The levels of nitrogen compounds in selected samples of well water were also measured in each of the 3 areas. Clear-cut differences in food intake were seen among inhabitants living in the 3 different areas, suggesting that regional differences in nutritional styles do exist. In both males and females, the intake of potatoes, fruit, vegetables, and meat were significantly lower in inhabitants living in the high-incidence area than in the other inhabitants, much the same as that of cancer patients. A low intake of carotene, and vitamins A and C was also seen in populations living in the high-incidence area of esophageal cancer. The well water polluted with nitrogen compounds was significantly related to the high incidence of esophageal cancer. In contrast, tobacco, alcohol consumption, and the intake of pickled vegetables and moldy foods did not relate to the different incidence rates. Our results suggest that low intake of fruit, vegetables, potatoes and meat, and the quality of well water may be important factors in the development of esophageal cancer in Ci-Xian.

Ecological study on the risks of esophageal cancer in Ci-Xian, China: the importance of nutritional status and the use of well water

Our purpose was to determine the environmental risks in the development of esophageal cancer in Ci-Xian, which has one of the highest incidences of esophageal cancer in China. The subjects included 404, 352 and 400 inhabitants living in high-, medium-, and low-incidence areas of esophageal cancer, as well as 301 esophageal cancer patients. A food intake-frequency survey using a 7-day weighted inventory questionnaire was conducted on these individuals. Questions on occupation, working conditions, income per year, family disease history, medical complaints, and demographic features were also included in the questionnaire. The levels of nitrogen compounds in selected samples of well water were also measured in each of the 3 areas. Clear-cut differences in food intake were seen among inhabitants living in the 3 different areas, suggesting that regional differences in nutritional styles do exist. In both males and females, the intake of potatoes, fruit, vegetables, and meat were significantly lower in inhabitants living in the high-incidence area than in the other inhabitants, much the same as that of cancer patients. A low intake of carotene, and vitamins A and C was also seen in populations living in the high-incidence area of esophageal cancer. The well water polluted with nitrogen compounds was significantly related to the high incidence of esophageal cancer. In contrast, tobacco, alcohol consumption, and the intake of pickled vegetables and moldy foods did not relate to the different incidence rates. Our results suggest that low intake of fruit, vegetables, potatoes and meat, and the quality of well water may be important factors in the development of esophageal cancer in Ci-Xian.

Ecological study on the risks of esophageal cancer in Ci-Xian, China: the importance of nutritional status and the use of well water

Our purpose was to determine the environmental risks in the development of esophageal cancer in Ci-Xian, which has one of the highest incidences of esophageal cancer in China. The subjects included 404, 352 and 400 inhabitants living in high-, medium-, and low-incidence areas of esophageal cancer, as well as 301 esophageal cancer patients. A food intake-frequency survey using a 7-day weighted inventory questionnaire was conducted on these individuals. Questions on occupation, working conditions, income per year, family disease history, medical complaints, and demographic features were also included in the questionnaire. The levels of nitrogen compounds in selected samples of well water were also measured in each of the 3 areas. Clear-cut differences in food intake were seen among inhabitants living in the 3 different areas, suggesting that regional differences in nutritional styles do exist. In both males and females, the intake of potatoes, fruit, vegetables, and meat were significantly lower in inhabitants living in the high-incidence area than in the other inhabitants, much the same as that of cancer patients. A low intake of carotene, and vitamins A and C was also seen in populations living in the high-incidence area of esophageal cancer. The well water polluted with nitrogen compounds was significantly related to the high incidence of esophageal cancer. In contrast, tobacco, alcohol consumption, and the intake of pickled vegetables and moldy foods did not relate to the different incidence rates. Our results suggest that low intake of fruit, vegetables, potatoes and meat, and the quality of well water may be important factors in the development of esophageal cancer in Ci-Xian.

Assembly of binding loops on aromatic templates as VCAM-1 mimetics

The design and synthesis of cyclic mimetics of VCAM-1 protein that reproduce the integrin-binding domain are presented. The unprotected peptide precursor 37-43, Thr-Gln-Ile-Asp-Ser-Pro-Leu, was grafted onto functional templates of type naphthalene, biphenyl and benzyl through the chemoselective formation of C- and N-terminal oximes resulting in a mixture of four isomeric forms due to syn-anti isomerism of the oxime bonds. Some isomers could be monitored by HPLC and identified by NMR. The molecule containing a naphthalene-derived template was found to inhibit the VCAM-1/VLA-4 interaction more efficiently than previously reported for sulfur-bridged cyclic peptides containing similar sequences. The finding confirms the importance of incorporating conformational constraints between the terminal ends of the peptide loop 37-43 in the design of synthetic inhibitors of the VCAM-1/integrin interaction.

[Development of a "self efficacy for health promotion scale" in community-dwelling elderly]

The purpose of this study is to develop a Japanese version of a self efficacy scale for health promotion activities by the elderly. In September to October 1997, we asked all of 1758 persons aged 65 and over who were living in a village in Nagano Prefecture to answer a questionnaire. The questionnaire included 15 self efficacy items for health promotion, Activities of Daily Living (ADL), general self efficacy, health behavior, and community activities. The present study examined reliability and validity of the scale by investigating the correlation to other factors. 1173 of the subjects completed the answer sheet by themselves. The mean age of the subjects was 72.9 +/- 6.1, and 54.7% were female, the education level of 52.2% was middle school, 54.0% worked as a laborers, and 41 persons (3.5%) needed help in instrumental ADL. Almost half of the subjects participated in various community activities. When applied to the 1173 subjects, the first principal component accounted for 53.9% of variance. We considered a self efficacy scale for health promotion by using the sum of 15 items. Alpha coefficient of the scale was 0.93 and test-retest reliability was 0.68, showing the reliability of the scale. Criterion-related validity was demonstrated by the significant relationship between the self efficacy scale and general self efficacy (r = 0.42). The score of the 15-item version did not correlate with age and sex but ADL and health behavior (r = 0.29, 0.21, p < 0.001). High self efficacy was found among those who had high self rated health, and participated in health counseling, health screening, golden-age community center activity, and volunteer activities. This scale can be used to measure personal belief for health promotion as well as the effects of interventions to alter health behaviors. To standardize the scale, further study of urban dwelling elderly and the disabled elderly is necessary.

Inhibition of the proliferation of Ehrlich ascites tumor cells by hydrostatic pressure

The effect of high pressure on the viability of Ehrlich ascites tumor cells was examined. The tumor cells were subjected to various pressures (0.1-150 MPa) for 30 min at 37 degrees C. The viability of pressure-treated cells was examined by the dye exclusion method. The number of stained cells increased significantly at pressures above 130 MPa. In addition, the pressure-treated cells were intraperitoneally inoculated into the mice. The tumor cells which were subjected to pressures below 110 MPa proliferated in the peritoneal cavity of the mice, so that the mice died. In contrast, the mice, which were inoculated with the tumor cells treated at pressures above 130 MPa, remained alive. These results suggest that the destruction of the tumor cells begins to occur at about 130 MPa.

Comparison of the melanogenesis in human black and light brown melanocytes

We examined how and to what extent the constitution of melanin and the expression, as well as the activity, of melanosomal proteins influence the production of melanin pigment by human black and light brown melanocytes, Mel (b) cells and Mel (l) cells, respectively. Melanin pigment in Mel (b) and Mel (l) cells consisted of a mixture of eumelanin and pheomelanin, and Mel (b) cells contained a larger amount. The signal intensity ratio of eumelanin to pheomelanin was similar in both cell types, though the two cell types differed in appearance. Tyrosinase activity and the amount of tyrosinase-related protein (TRP-1) of Mel (b) cells were higher than those of Mel (l) cells. Dopachrome tautomerase (DCT) activity and the amount of 6H5MICA were reduced in Mel (b) cells in comparison with Mel (l) cells. No significant difference in DHICA-converting activity or catechol-O-methyltransferase activity was found between Mel (b) and Mel (l) cells. There was no correlation between DHICA-converting activity and amount of TRP-1. These results suggest that the difference in the pigmentation of the two human melanocyte cell lines, Mel (b) and Mel (l), is derived from differences in the activity and expression of tyrosinase, TRP-1 and DCT, which affect the content and constitution of melanin polymers.

The primary structure and characterization of carbohydrate chains of the extracellular glycoprotein proteinase inhibitor from latex of Carica papaya

A secretory proteinase inhibitor was isolated from the latex of green fruits of papaya (Carica papaya). The protein exhibited stoichiometric inhibition of bovine trypsin and alpha-chymotrypsin by the same site or overlapping binding sites. The complete covalent structure consisting of 184 amino acids and two disulfide bonds was determined by protein analysis. During the structural analysis, a procedure was established to separate very hydrophilic peptides by reverse-phase HPLC. The result revealed that the latex protein belongs to an extensively diverse plant protein family that includes inhibitors of serine, cysteine and aspartic proteases, a taste-modifying protein, wound responsive proteins, storage proteins, amylase inhibitors and even an oxidoreductase. In this superfamily, the latex proteinase inhibitor is most similar to the curious protein, miraculin, which makes sour food taste sweet. Two carbohydrate chains, each probably composed of (mannose)5, (xylose)1, (fucose)0-2, and (N-acetylglucosamine)2 residues, were attached to asparagine 84 and 90. Mass-spectrometric and compositional analysis suggested that they may represent a new class of plant xylose-containing carbohydrate chains with five mannose residues.

Indonesian medicinal plants. XV. Chemical structures of five new resin-glycosides, merremosides a, b, c, d, and e, from the tuber of Merremia mammosa (Convolvulaceae)

Five new resin-glycosides, named merremosides a (1), b (2), c (3), d (4), and e (5), were isolated from the tuber of Merremia mammosa (LOUR.) HALLIER f. (Convolvulaceae), an Indonesian medicinal plant. The structures of 1, 2, 3, 4, and 5 have been elucidated on the basis of chemical and physiochemical evidence, including syntheses of (11S)-(+)- and (11R)-(--)-jalapinolic acid (16b and 18b) and the glycosidic acid designated as merremoside i (6).

Indonesian medicinal plants. XVI. Chemical structures of four new resin-glycosides, merremosides f, g, h1, and h2, from the tuber of Merremia mammosa (Convolvulaceae)

Four new resin-glycosides named merremosides f (6), g (7), h1 (8), and h2 (9) were isolated from the tuber of Merremia mammosa (Lour.) Hallier f. (Convolvulaceae), an Indonesian medicinal plant. Their chemical structures have been elucidated on the bases of their chemical and physicochemical properties.

Syntheses, immunosuppressive activity, and structure-activity relationships of myriocin analogs, 2-epi-myriocin, 14-deoxomyriocin, Z-14-deoxyomyriocin, and nor-deoxomyriocins

Nine myriocin analogs, 2-epi-myriocin, 14-deoxomyriocin, Z-14-deoxomyriocin, and nor-deoxomyriocins, were synthesized from 2-deoxy-D-glucose via common intermediates used in previous myriocin and Z-myriocin syntheses. Immunosuppressive activities of those myriocin analogs on mouse allogeneic mixed lymphocyte reaction were examined, and Z-14-deoxomyriocin was found to show the most potent activity among them. The structure-activity relationships are discussed.

Tyrosinase inhibitors from Bolivian medicinal plants

Bioassay-guided fractionation monitored by mushroom tyrosinase (EC 1.14.18.1) activity, afforded six inhibitors from three Bolivian medicinal plants, Buddleia coriacea, Gnaphalium cheiranthifolium, and Scheelea princeps. These inhibitors, which are all known phenolic compounds, inhibited the oxidation of L-3,4-dihydroxyphenylalanine (L-DOPA) mediated by a mushroom tyrosinase.

Synthesis of new immunosuppressive myriocin analogs, 2-epi-myriocin, 14-deoxomyriocin, Z-14-deoxomyriocin, and nor-deoxomyriocins: their structure-activity relationships

Eight new myriocin analogs, 2-epi-myriocin, Z-14-deoxomyriocin, and nor-deoxomyriocins, and a known myriocin derivative, 14-deoxomyriocin, were synthesized from 2-deoxy-D-glucose via common intermediates in previous myriocin and Z-myriocin syntheses. The immunosuppressive activities of new myriocin analogs and Z-myriocin on mouse allogeneic mixed lymphocyte reaction were examined, and, by comparing with those of myriocin and 14-deoxomyriocin, some structure-activity relationships have been found.

Total synthesis of a novel immunosuppressant, myriocin (thermozymocidin, ISP-I), and Z-myriocin

Myriocin (thermozymocidin, ISP-I), which was known to exhibit several interesting biological properties such as potent immunosuppressive and antifungal activities, and a new analog Z-myriocin were synthesized from 2-deoxy-D-glucose. This synthetic pathway comprises a stereoselective formation of the chiral alpha, alpha-disubstituted amino acid structure in myriocin and Z-myriocin from the isopropylidene six-membered ketone by using a modified Darzen reaction as its key step.

Tyrosinase inhibitors from Anacardium occidentale fruits

Anacardic acids, 2-methylcardols, and cardols isolated from various parts of the cashew [Anacardium occidentale] (Anacardiaceae) fruit have been found to exhibit tyrosinase inhibitory activity. Kinetic studies with the two principal active compounds, 6-[8(Z),11(Z),14-pentadecatrienyl]salicylic acid and 5-[8(Z),11(Z),14-pentadecatrienyl]resorcinol, have indicated that both of these phenolic compounds exhibit characteristic competitive inhibition of the oxidation of L-3,4-dihydroxyphenylalanine (L-DOPA) by mushroom tyrosinase.

Novel macrocyclic antibiotics: megovalicins A, B, C, D, G and H. II. Isolation and chemical structures of megovalicins

Myxococcus flavescens AJ12298 was found to produce the complex of macrocyclic antibiotics named megovalicins. The physico-chemical studies revealed that megovalicins C and B were identical to myxovirescin A1 and antibiotic M-230B, respectively, and that megovalicins A, D, G and H were closely related new antibiotics.