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We investigated the link between prolonged sedentary bouts and all-cause mortality in patients on chronic hemodialysis, using a prospective cohort. A total of 104 outpatients on chronic hemodialysis from 2013 to 2019, aged 71.4±11.4 years, were enrolled. Prolonged sedentary bouts (≥ 30 min and ≥60 min) (min and bouts) and relative prolonged sedentary bouts (≥ 30 min and ≥ 60 min) (%) on the patients’ non-hemodialysis days were measured by a tri-accelerometer, and we also analyzed the patients’ clinical parameters. The relationship between prolonged sedentary bouts and all-cause mortality was evaluated by a survival analysis and the Cox proportional hazard model. Thirty-five patients died during the follow-up period. A Kaplan-Meier analysis detected significant differences in the survival rate between two groups stratified by the median for all prolonged sedentary-bout parameters. After the adjustment for confounding factors, all of the prolonged sedentary-bout parameters were determinant factors for all-cause mortality. These results indicate that prolonged sedentary bouts on non-hemodialysis days were closely related to all-cause mortality in the patients on hemodialysis.

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This study aimed to investigate the link between prolonged sedentary bouts and health-related quality of life (QOL) in patients on chronic hemodialysis (CHD). A total of 84 outpatients on CHD, aged 71.6±11.8 years, were enrolled in this cross-sectional study. Parameters for prolonged sedentary bouts [i.e., ≧ 30 min (% and bout) and ≧ 60 min (% and bout)] were measured using a triaxial accelerometer. Health-related QOL (HRQOL) was evaluated by the Euro-QOL (EQ-5D). Clinical parameters were obtained from medical records. Relatively prolonged sedentary bouts (%) were 44.0±18.2 (≧ 30 min) and 29.8±16.5 (≧ 60 min) for total days. Prolonged sedentary bouts (bouts) were 6.2±2.7 (≧ 30 min) and 2.7±1.6 (≧ 60 min) for total days. EQ-5D scores were 0.728±0.220. All prolonged sedentary bout parameters were negatively correlated with EQ-5D scores, except for prolonged sedentary bouts (≧ 60 min) (min) and relatively prolonged sedentary bouts (%) on hemodialysis days. Multiple regression analysis showed that prolonged sedentary bout parameters were an important factor in EQ-5D scores even after adjusting for confounding factors for total and non-hemodialysis days. Our results suggested that prolonged sedentary bouts were closely associated with HRQOL in patients on CHD, especially on non-hemodialysis days.

Background Pancreatic trauma is reportedly associated with high morbidity and mortality. Main pancreatic duct (MPD) injury is critical for treatment. Methods As a study project of the Japanese Society for Abdominal Emergency Medicine (JSAEM), we collected the data of 163 patients with pancreatic trauma who were diagnosed and treated at JSAEM board‐certified hospitals from 2006 to 2016. Clinical backgrounds, diagnostic approaches, management strategies, and outcomes were evaluated. Results Sixty‐four patients (39%) were diagnosed as having pancreatic trauma with MPD injury that resulted in 3% mortality. Blunt trauma and isolated pancreatic injury were independent factors predicting MPD injury. Nine of 11 patients with MPD injury who were initially treated nonoperatively had serious clinical sequelae and five (45%) required surgery as a secondary treatment. Among all cases, the detectability of MPD injury of endoscopic retrograde pancreatography (ERP) was superior to that of other imaging modalities (CT or MRI), with higher sensitivity and specificity (sensitivity = 0.96; specificity = 1.0). Conclusions Acceptable outcomes were observed in pancreatic trauma patients with MPD injury. Nonoperative management should be carefully selected for MPD injury. ERP is recommended to be performed in patients with suspected MPD injury and stable hemodynamics., Highlight Ando and colleagues analyzed data from 163 patients with pancreatic trauma in a nationwide multicenter study. They found that serum amylase and C‐reactive protein levels were significantly higher in patients with main pancreatic duct injuries, indicating that endoscopic retrograde pancreatography was the most accurate imaging modality for assessing pancreatic duct injury.

Additional file 1. Associations of glucocorticoid use with PROM and preeclampsia.

Additional file 1: Table S1. Nutrition, health, and fitness parameters in the active, control, and PA intervention groups over the 3 years of the study. baPWV, brachial-ankle pulse wave velocity; choles., cholesterol; circum., circumference; gr., group; ITT, p-value for the intent-to-treat statistical treatment; LPA, light physical activity; MPA, moderate physical activity; MVPA, moderate-to-vigorous physical activity; N/A, non-applicable (for instance, when pairwise comparisons are not conducted due to the absence of interaction); ns, non-significant; PA, physical activity; PP, p-value for the per-protocol statistical treatment; RCT, randomized controlled trial; TG, triglycerides; +1-year: end of the intervention; +2-year: 1 year after the end of intervention. 1Not reported in the table, a significant time effect has been observed for HR, blood glucose, TG (decrease), mean arterial pressure, baPWV, HbA1c, total cholesterol (increase). In addition, a significant group effect was noted for waist circumference, HR, VO2PEAK. 2Refer to the difference between the low-dose PA intervention and the control group, i.e. not including the active group. 3Trend (p

Additional file 4: Table S4. Incidence of lifestyle-related diseases (hypertension, dyslipidemia, diabetes) at baseline, +1-year follow-up and +2-year follow-up. Page 1: data for all participants. Page 2: data for the 453 participants who participated in the 3 visits.

Additional file 2: Table S2. [Table 4 counterpart for the control group] Relationship between the changes in physical activity and the change in health parameters at +1 and +2-year in the control group. HbA1c, Glycosylated hemoglobin; HR, heart-rate; MVPA, moderate-to-vigorous physical activity; ns: non-significant; R, correlation coefficient; TG, Triglycerides; VO2PEAK, maximal oxygen consumption; “+1-year”: end of the intervention; “+2-year”: 1 year after the end of intervention. 1Trend (p = 0.069).

Few studies have considered the causal relationship between psychological distress and social participation in elderly people. Here we investigated this relationship based on an initial survey and a follow-up survey. In 2016, a survey was distributed to 86 participants. A follow-up survey of 80 of those participants was performed in 2017. We adopted the following variables: psychological distress and social participation as represented by the Kessler psychological distress scale and social participation scores, respectively. By using cross-lagged and synchronous effects models, we found that the 2016 Kessler psychological distress scale had a significant influence on the 2017 social participation scores (standardization factor=−0.221, p=0.020) and the 2017 Kessler psychological distress scale significantly influenced the 2017 social participation scores (standardization factor=−0.345, p=0.039). The results suggest that psychological distress may affect social participation one year later.

We investigated the relationship between sedentary behavior and all-cause mortality in patients undergoing hemodialysis. A total of 71 patients (39 men, 32 women, aged 72.1±11.7 years) were enrolled in this longitudinal study. Their sedentary behavior was measured using a tri-accelerometer that provides relative values per daily wearing time. We classified the sedentary behavior time into 2 groups (under the median: short-sedentary behavior (SB) group; over the median: long-SB group) and compared the groups’ clinical parameters. We compared the groups’ survival rates by using Kaplan-Meier curves and the log-rank test, and we performed multivariate analyses by a Cox-proportional hazard model to evaluate the relationship between the sedentary behavior and the survival rate. Twenty patients (28.2%) died during the observation period. The survival rate of the short-SB group was significantly higher than that of the long-SB group. Sedentary behavior was thus an important factor for all-cause mortality even after adjusting for confounding factors by a Cox-proportional hazard model. Sedentary behavior is closely linked to all-cause mortality, especially total days and non-hemodialysis days, and reducing sedentary behavior may be beneficial to reduce the all-cause mortality of patients on chronic hemodialysis.

We aimed to clarify the state of thyroid function in female high school long-distance runners. We evaluated the associations between thyroid function and menstrual condition, bone mineral density (BMD), nutritious status, and body composition. The subjects’ height and weight were measured, along with fat percentage, fat mass, muscle mass, and BMD with dual-energy X-ray absorptiometry. A nutrition and dietary survey measured the subjects’ intake of energy and nutrients based on meals provided at the subjects’ dorm for 3 days in July of 2016 and 2017. Blood parameters including thyroid hormone and estradiol were measured. Most of the subjects (81.3%) were underweight (body mass index

Several studies indicated that chronic low back pain (CLBP) worsened psychological distress (PD) and social participation (SP) improved PD. The relationships among CLBP, SP and PD have not been established. Here we investigate whether SP mediates the relationship between CLBP and PD in 96 elderly people. We evaluated CLBP and SP by a self-administered questionnaire and PD by K6 questionnaires. We used simple correlation analyses, the unpaired t-test, and a mediation analysis following the approach outlined by Structural Equation Modeling (SEM) to clarify the relationships among CLBP, SP and PD. Using SEM, was observed a significant relationship between CLBP and SP (β=−0.321, p=0.003), a significant negative correlation between SP and K6 scores (β=−0.357, p=0.001), and a significant positive correlation between CLBP and K6 scores (β=0.333, p=0.002). By including SP as a parameter, the coefficient of correlation between CLBP and K6 scores varied from 0.333 (p=0.002) to 0.218 (p=0.035). After bootstrapping, 0 was not included in the 95% confidence interval (0.119, 1.913). SP as a mediator may reduce PD in elderly people with CLBP.

We explored the relationship between sedentary behavior and the health-related quality of life (HRQOL) in patients on chronic hemodialysis. A total of 60 outpatients, aged 71.1±12.0 years, were enrolled in this cross-sectional study. Sedentary behavior was measured using a tri-accelerometer and HRQOL was evaluated by the Euro-QOL questionnaire (EQ-5D). The relationship between the patients’ sedentary behavior and HRQOL was evaluated by simple and multiple correlation analyses. The relative sedentary behavior (%) for total days was 73.7±12.9% and the EQ-5D scores were 0.688±0.233. Relative sedentary behavior (%) was negatively correlated with EQ-5D scores for total days, hemodialysis days and non-hemodialysis days. The relative light-intensity physical activity (LPA) (%) and relative moderately vigorous-intensity physical activity (MVPA) (%) were correlated with EQ-5D scores. Multiple regression showed that the relative sedentary behavior (%) had a clinical impact on EQ-5D scores after adjusting for confounding factors for total, hemodialysis and non-hemodialysis days. Sedentary behavior is closely linked to HRQOL, and reducing sedentary behavior may be beneficial to improve the HRQOL of patients on chronic hemodialysis.

Resistance training is effective against type 2 diabetes (T2DM), but the effect of resistance training on toe pinch force (TPF) is unknown. Here we investigated the effect of short-term toe resistance training on TPF in patients with T2DM, in a prospective, parallel-group, single-blind, randomized controlled trial. Twelve patients with T2DM who were hospitalized to improve glycemic control were enrolled. The patients were randomly allocated to the intervention (n=6) and control (n=6) groups. The intervention group performed traditional aerobic exercise and 4 newly developed toe-resistance training exercises. The control group performed aerobic exercise only. After 2 weeks of the exercise intervention program, we evaluated anthropometric parameters, clinical parameters, motor function, and muscle parameters in each patient. After the exercise intervention program, the TPF and toe muscle quality, isometric knee extension force, and knee muscle quality were significantly higher in the intervention group compared to the control group. Two weeks of toe-resistance training significantly increased the TPF in the T2DM patients. Toe resistance training is thus recommended in clinical practice for patients with T2DM.

We investigated the link between proteinuria and psychological distress among patients with type 2 diabetes mellitus (T2DM). A total of 130 patients with T2DM aged 69.1±10.3 years were enrolled in this cross-sectional study. Urine and blood parameters, age, height, body weight, and medications were analyzed, and each patient’s psychological distress was measured using the six-item Kessler Psychological Distress Scale (K6). We compared the K6 scores between the patients with and without proteinuria. Forty-two patients (32.3%) had proteinuria (≥±) and the level of HbA1c was 7.5±1.3%. The K6 scores of the patients with proteinuria were significantly higher than those of the patients without proteinuria even after adjusting for age and sex. The clinical impact of proteinuria rather than age, sex and HbA1c was demonstrated by a multiple regression analysis. Proteinuria was closely associated with higher psychological distress. Preventing and improving proteinuria may reduce psychological distress in patients with T2DM.

In a longitudinal study, we examined the link between changes in physical activity and changes in health-related quality of life (HRQOL) in patients on chronic hemodialysis. Seventy-one patients (43 males, 28 females; aged 70.9±10.6 years) on chronic hemodialysis in September 2013 were enrolled. The data of the 43 patients whose complete measurements were taken again in September 2014 were used for the longitudinal analysis. Clinical parameters including age, height, dry weight, duration of hemodialysis, blood pressure (BP), blood triglyceride and HDL cholesterol levels, physical activity, and HRQOL were evaluated. Physical activity was measured by a tri-accelerometer, and HRQOL was evaluated by the EuroQol questionnaire (EQ-5D). In the first cross-sectional analysis, EQ-5D scores were significantly correlated with daily step counts (steps per day) on all days and non-hemodialysis days. In the second longitudinal analysis, in the women, changes in EQ-5D scores were positively correlated with changes in daily step counts on all days. In all patients, changes in EQ-5D were weakly and negatively correlated with changes in physical activity (1-3 METs: min per day) on hemodialysis days. Promoting daily physical activity may improve the HRQOL in patients on chronic hemodialysis, especially in women.

application/pdf, 香川大学医学部では，今後のよりよいカリキュラム・授業のために，医学科，看護学科学生に対し，「医学部におけるカリキュラム・授業等についての全般的な評価」に関するアンケート調査を行った．対象は医学科593 名，看護学科255名で，アンケート回収率はそれぞれ75.7％， 92.9％であった．香川大学医学部学生のカリキュラム・授業に対する満足度は比較的高かった．しかし，教養科目に対する満足度は低く，特に英語を含めた内容の充実，科目の意義を伝える必要があると思われた．, We evaluated the class curriculum at faculty of medicine, Kagawa University in 2009. A total of 593 students in division of medicine and 255 students in division of nursing were enrolled in this study. The response rate of questionnaire was 75.7% in division of medicine and 92.9% in division of nursing. Most students were satisfied with the class curriculum. However, they were not satisfied with the basic education curriculum including English program compare to other professional curriculum. We need to improve basic education curriculum and communicate the necessity of those curriculum.

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The link between lifestyle modification and changes in both proteinuria and estimated glomerular filtration rates (eGFRs) was evaluated in Japanese subjects with proteinuria who were not taking medications. We used data from 51 men (35.8±10.0 years) and 74 women (38.0±11.0 years) with proteinuria at baseline and a 1-year follow up. eGFR was defined by a new equation developed specifically for Japanese subjects. Subjects were given advice for dietary and lifestyle improvement at the initial appointment. At the 1-year follow up, eGFR was increased in both sexes, but not at significant levels. (men:p＝0.7709, women:p＝0.2180). Proteinuria was also improved in many subjects. A decrease in proteinuria may be associated with improving eGFR in Japanese.

We investigated the link between renal function as evaluated by estimated glomerular filtration rate (eGFR) and metabolic syndrome in Japanese. A total of 11,711 Japanese subjects, aged 20-79 years, were recruited in a cross-sectional clinical investigation. From this group, we further investigated the data on 1,576 subjects. eGFR was calculated using serum creatinine (Cr), age and sex. The diagnosis of metabolic syndrome was based on the Japanese criteria. In the first analysis, 288 men (7.8%) and 498 women (6.2%) were diagnosed with reduced eGFR (

We evaluated the visceral adipose tissue accumulation in university students in Okayama prefecture, Japan. Fifty-eight Japanese university students (10 men and 48 women, age 18.4 +/- 0.6 years)were enrolled in this study. Fat distribution was evaluated by visceral fat (V) and subcutaneous fat (S) areas measured with computed tomography (CT) scanning at umbilical levels. Anthropometric parameters,i.e., height, weight, waist circumference, hip circumference, and body fat percentage; blood examination; and blood pressure (BP) were also measured. In 58 subjects, the V area was 23.4 +/- 21.0 cm(2) and the S area was 122.5 +/- 57.9 cm(2). V areas were significantly correlated with hepatic enzymes, uric acid, triglyceride, and BP in men, while they were weakly correlated with hepatic enzymes, triglyceride, and high density lipoprotein (HDL) cholesterol in women. Correlation coefficients between V areas and clinical parameters were comparatively higher than those between other body composition parameters,i.e., S areas, weight, body mass index (BMI), body fat percentage, and clinical parameters. The present study suggests that visceral adipose tissue accumulation is important for hepatic enzymes, uric acid, triglyceride, and BP in university students.