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Objectives　Japan has a high prevalence of low back pain among older adults requiring long-term care, which results in increasing expenses; therefore, prevention measures are necessary. This study aimed to examine the relationship between low back pain and physical activity and sitting time according to sex and age (65-74 years [young-old adults]; ≥75 years [old-old adults]) who had not received long-term care certification.Methods　A self-administered survey was mailed to 7,080 adults >65 years of age residing in Tsuru City (Yamanashi Prefecture, Japan) from January to February 2018, and had not received long-term care certification. Demographic information, health status (body mass index and medical history), lifestyle (dietary habits, alcohol consumption, and smoking), presence of low back pain, physical activity, sitting time, and social participation were measured. Low back pain was evaluated by asking, "Did you experience pain in parts of the body other than the knees for the past month?" Those who answered, "experienced low back pain" were categorized as "with low back pain". The short form of the International Physical Activity Questionnaire was used to assess physical activity, which was categorized into three groups: <150, 150-299, and ≥300 min/week. Sitting time was divided into two groups: <480 and ≥480 min/day. Multiple logistic regression analysis was used to determine the association between low back pain and physical activity and sitting time, according to sex and age.Results　Of the 7,080 individuals surveyed, 4,877 responded (2,217 male, 2,660 female), corresponding to a response rate of 68.9%. The number of older adults with low back pain was 1,542 (31.6%) including 673 (30.4%) males and 869 (32.7%) females. The rate of low back pain in young-old adults was 29.8% and 33.6% in old-old adults. There was no significant relationship between lower back pain and physical activity among the young-old adults. In the old-old adults, there was a significant relationship in the male ≥300 min group (odds ratio [OR] 0.66 [95%CI 0.48-0.89]), and in both female 150-299 (OR 0.69 [95%CI 0.48-0.99]) and ≥300 (OR 0.59 [95%CI 0.44-0.80]) min/week groups.Conclusion　The complaint rate for low back pain was approximately 30%, regardless of sex or age. These results suggest that interventions to prevent low back pain are necessary. Moreover, physical activity, but not sitting time, was associated with low back pain in both males and females among the old-old adults.

Sarcopenia is associated with poor clinical outcomes in elderly patients with diffuse large B-cell lymphoma (DLBCL). However, the clinical significance and optimal assessment of sarcopenia remain unclear. We retrospectively evaluated the prognostic value of low skeletal muscle mass based on the psoas muscle index (PMI) in patients with DLBCL aged 70 years and older treated with R-CHOP therapy. We included 71 patients, including 27 classified under low PMI. There were no differences in baseline characteristics (body mass index, lactate dehydrogenase, performance status [PS], stage, revised-IPI, relative dose intensity) and overall response rate between the low and high PMI groups. The low PMI group had a significantly worse overall survival (OS, p=0.015), but not progression-free survival (PFS, p=0.252), compared with the high PMI group. On multivariate analysis, low PMI and PS were independent negative prognostic factors for OS. Subgroup analysis revealed that the low PS groups had significantly worse PFS regardless of the PMI status. The low PMI and low PS group had markedly poorer OS than all the other groups. However, the poor prognosis associated with low PS was overcome by a high PMI.

Aim: To clarify changes in location before hospital admission and discharge destination over the 10-year period of 2010 to 2020 and to identify prognostic factors associated with the survival in hospitals with chronic-phase inpatients., Methods: The subjects were patients newly admitted to 12 hospitals in 2010 and 2020. The age, sex, location before hospital admission, outcomes at 90 days after admission, discharge destination, and results of 6 biochemical tests at admission were evaluated. A survival analysis was performed for the age, sex, and biochemical tests at admission., Results: We analyzed 8007 newly hospitalized patients. Compared with 2010, there were more hospital admissions from acute-care hospitals and fewer admissions from long-term-care facilities in 2020. In addition, relative to 2010, regarding the outcomes at 90 days after admission, there were more discharges to home and residential facilities in 2020, fewer discharges to long-term-care facilities, and lower mortality rates. In the survival analysis, a multivariate analysis revealed that an elderly age, male sex, low albumin, high total cholesterol, high urea nitrogen, and low serum sodium were poor prognostic factors. These five variables were consistently poor prognostic factors in both 2010 and 2020, and Kaplan-Meier curves showed that the scores were dose-dependent prognostic factors for a poor survival., Conclusions: The present analysis of pre-admission location and discharge destination in hospitals with chronic-phase patients revealed an elderly age, male sex, high urea nitrogen, low serum sodium, and low albumin at the time of admission to be strong predictors of poor outcomes in these patients.

Objectives　The aim of this study was to examine the effect of an exercise program targeting knee pain on longitudinal medical costs (MC) of elderly community-dwelling adults.Methods　A community-based health program using specific exercises for improving knee pain was held from January to February, 2015. Twenty-eight individuals participated in the program (intervention group) and seventy individuals were selected from the respondents of a health and lifestyle survey by matching age, sex, and baseline value of severity of knee pain as a control group. Twenty individuals from the intervention group and twenty-nine from the control group were included in the final analysis. The changes in MC from 2014 to 2018 were compared between the two groups using a linear mixed-effects model.Results　The effect of the program on MC, estimated as a change from the baseline in 2014, showed a reduction of -5.6×10 3 yen/person (95% CI: -39.2-28.0) for the entire four-year period after the intervention. However, this difference was not significant. The changes in MC each year after the intervention were 9.3×10 3 yen/person (95% CI: -39.6-58.3) in 2015, -2.0×10 3 yen/person (95% CI: -44.4-40.5) in 2016, -10.3×10 3 yen/person (95% CI: -42.5-21.9) in 2017, and 8.2×10 3 yen/person (95% CI: -39.1-55.4) in 2018.Conclusion　The exercise program did not show a clear benefit in reducing the MC of elderly community-dwellers during the four years after the intervention. Further research with longer study durations and larger sample populations would be necessary to determine the effect of such intervention programs on MC.

Objectives　Promoting physical activity is a key public health issue. Incentive programs have attracted attention as a technique for promoting physical activity. For the use of effective incentives, there is a need to clarify the most effective incentive program conditions for the promotion of physical activity. Therefore, the present study used the conjoint analysis to examine the effective incentive program conditions for strengthening the motivation to increase physical activity.Methods　Data on 1,998 subjects (aged 40-74) were analyzed. The main variables in this study were physical activity (IPAQ-Short Form) and the strengthening of motivation to increase physical activity. The incentive programs that were implemented, comprised four factors: 1) cash equivalents (1,000 yen, 2,000 yen, and 3,000 yen); 2) duration between increase in physical activity and receipt of the incentive (1, 2, or 3 months); 3) method to record the physical activity (recording sheet, recording website, and automatic pedometer recording); and 4) lottery (yes or no). Eleven incentive programs were created, which was the minimum number required for comparison of these factors and levels. The average importance of each of the four factors was calculated to compare their contributions to the strengthening of the motivation to increase physical activity. The utility of each level was also calculated to compare their contributions to the strengthening of motivation. All statistics were stratified by age (≤65 years and 65+ years) and physical activity (<150 min/week, 150+ min/week) for additional analysis.Results　Cash incentives and the lottery ranked equally on average importance, followed by duration and recording methods. Utility was higher for each factor, as follows: 1) more valuable cash incentives, 2) shorter duration, 3) automatic pedometer recording, and 4) no lottery. There was no notable difference in the average importance and utility of age and physical activity.Conclusions　The results of this study suggest that no lottery and more valuable incentives were important for improving the effectiveness of incentive programs in increasing physical activity. Moreover, these two factors would be important regardless of age and physical activity levels. Further intervention studies on incentive programs for increasing physical activity considering the present results are needed.

Aim: The aim of this study was to examine the relationship between cognitive decline and physical activity, sitting time, and social participation among elderly people living independently in a local community., Methods: In January 2015, 1,133 independently-living elderly individuals from a local Japanese community completed self-administrated questionnaires. A total of 929 participants completed the questionnaire (valid response rate: 82.0%). A multiple logistic regression analysis was conducted to examine the relationship between cognitive decline, physical activity, sitting time, and social participation. The factors related to cognitive decline were examined using three statistical models: (1) Model 1 was not adjusted for any factors; (2) Model 2 was adjusted for age, education level, smoking status, and drinking status; and (3) Model 3 was adjusted for the covariates in Model 2, plus depression., Results: Cognitive decline was observed in 33% of men and 26% of women. The results indicated that decreased social participation was significantly related to cognitive decline in Models 1 and 2. For men, local community activity and political/economic activity were significantly associated with cognitive decline in Models 1 and 2. Among women, physical activity was significantly related to cognitive decline in Model 1. There was also a significant association between social participation and cognitive decline in Models 1 and 2; decreased volunteer activity was significantly related to cognitive decline in all three models., Conclusion: The results of the present study indicated that attending volunteer activities was significantly related to cognitive decline in women.

Objectives　The objectives of this study were to determine the prevalence of knee pain in independent community-dwelling elderly people and to examine the basic characteristics (sex and age) of those experiencing knee pain.Methods　Survey on the health status and lifestyle habits was conducted for all (6,790) independent elderly who were 65 years or older, living in Tsuru City, Yamanashi Prefecture, Japan. The survey was carried out using a mailing questionnaire for 1 month from January 12 to February 11, 2016. Knee pain was defined as subjective pain in and around the knee joint in either one or both knees, on most days during the past month. Participants answered "Yes" if they were experienced knee pain, and "No" if they did not experience knee pain. Sex and age were investigated as basic characteristics of the participants by the questionnaire. The prevalence rate of knee pain was calculated as follows: the total number of people with knee pain divided by the total number of the respondents in the study. To examine the relationships between knee pain and age or sex, these basic characteristics were analyzed using a Chi-square test for the prevalence of knee pain within sex and age groups.Results　The number of survey respondents was 5,328 (response rate: 78.5%). The number of valid respondents with complete data was 5,186 (valid response rate: 76.4%). The number of subjects who responded "with knee pain" was 1,733. The prevalence rate of knee pain was 33.4%. In addition, sex and age demonstrated strong associations with the prevalence of knee pain (both, P<0.001). In other words, the prevalence rate was higher in the elderly women than in elderly men and increased with age.Conclusion　The present study suggested that one in three independently living elderly who live in medium-sized local municipalities in Japan experience chronic knee pain. The basic characteristics of a community-dwelling independent elderly with knee pain are to be a woman and older age.

Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH), Vol. 63 (2016) No. 9 p. 560-568: p563(Tables 1, 2).

A 54-year-old woman was admitted to our hospital for detailed examination of acromegaly because she noticed bilateral hand and finger swelling at the age of 43 and plantar thickening, facial changes and unclear articulation at the age of 49. She had prominent brow ridges, mandibular protrusion, and enlargement of the hands, feet, nasal wings, lips and tongue. Her growth hormone (GH) level was 39.8 ng/ml, insulin-like growth factor-1 (IGF-1) level was 717 ng/ml, GH level was not suppressed (22.9 ng/ml) during a 75-g oral glucose tolerance test (OGTT). Radiography showed cauliflower-like enlargement of the distal phalanx of the fingers, thickening/enlargement of the plantar soft tissues, and increased antero-posterior diameter of the sella turcica. Magnetic resonance imaging showed a mass (21×17 mm) growing towards the right suprasellar region and invading the cavernous sinus. She was diagnosed with acromegaly based on the characteristic physical findings, GH excess, high IGF-1, lack of GH suppression during the 75-g OGTT, and the presence of a pituitary tumor. She was started on octreotide long acting release (Oct-LAR) 20 mg/4w for tumor shrinkage. After three doses, her GH and IGF-1 levels decreased to 2.19 ng/ml (1.69 during the 75-g OGTT) and 205 ng/ml, respectively, meeting cure criteria for acromegaly. In this case, a decrease in GH and IGF-1 levels, tumor shrinkage, and resolution of cavernous sinus invasion allowed the patient to undergo surgery with curative intent (the first-line treatment for acromegaly) without postoperative complications. Thus, preoperative Oct-LAR administration has the potential to improve treatment outcomes of acromegaly.

Objective To clarify the comprehensive relevant factors for knee pain in elderly men and women independently living in the community.Methods A health and lifestyle survey was conducted using 1,133 independent living elderly participants from a district in local community. Demographics, health status, lifestyle, knee pain, and physical activity were measured. Knee pain was evaluated based on whether the individual had reported experiencing pain when he or she was walking at the ground level during the last two weeks. The International Physical Activity Questionnaire Short Version assessed physical activity and sitting time. With regards to physical activity, subjects were classified into two groups -"non-sufficiency" or "sufficiency"- based on the recommendation by the World Health Organization of 150 minutes per week. With regards to sitting time, subjects were classified into two groups -"long time" or "short time"- based on a median value of 5 hours of sitting time per week. The demographic variables evaluated were age, sex, education, and marital status. Health status was evaluated by measuring the individual's Body mass index (BMI) and by their current disease history. Lifestyle was evaluated based on the individual's dietary habits, alcohol consumption, and smoking status. Each variable was classified into two groups. Multiple logistic regression analysis was used to examine the association of knee pain with physical activity, sitting time, dietary habits, drinking, smoking, and BMI in men and women. All variables were entered simultaneously as independent variables. The models were adjusted for sex, age, education, marital status, and health status.Results The number of valid respondents for the analysis was 801 (response rate: 70.7%), including 365 men (74.9±6.9 years) and 436 women (74.9±6.9 years). Survey responses for men and women who had reported experiencing knee pain suggested that, only physical activity was significantly associated with knee pain in men (P=0.035). The odds ratio (OR) and 95% confidential interval (95% CI) for knee pain were 0.605 and 0.308-0.964, respectively. In women, BMI and dietary habits were significant relevant factors for knee pain (P=0.023 and P=0.004, respectively). The OR for BMI and dietary habits were 0.595 and 0.547, respectively while the 95% CI were (0.380-0.931) and (0.364-0.823), respectively.Conclusion The results of this study suggest that physical activity was a related factor for knee pain in men. In contrast, BMI and dietary habits were relevant factors for knee pain in women.

A 42-year-old woman visited our hospital with palpitations, excessive sweating, and finger tremors in March 2011. She was diagnosed with Graves' disease based on the following test results: thyroid stimulating hormone < 0.01 μU/ml, free thyroxine 6.15 ng/ml, and thyrotropin receptor antibody 7.8 U/ml. Treatment with methimazole 30 mg and propranolol 30 mg was started, and her thyroid function showed improvement. However, significant manic symptoms, irritability, hallucinations, and delusions were noted, and she was hospitalized for her own protection in May 2011. Although treatment with aripiprazole 24 mg and lithium 400 mg was started, the hallucinatory and delusional symptoms persisted, necessitating adjustment of the antipsychotics. Her psychiatric symptoms showed amelioration in July 2011 after improvement in her thyroid function, and she was discharged from our hospital. After discharge, her thyroid function remained normal with methimazole 10 mg, and administration of the antipsychotics was discontinued. Affective psychotic symptoms such as altered mood and activity are frequently observed in cases with Graves' disease, but there have been few reports describing cases with full-blown psychiatric disorders manifesting with features such as hallucinations and delusions as the chief symptoms requiring hospitalized treatment, as in the present case. In symptomatic psychosis associated with Graves' disease, prolonged psychiatric symptoms might develop, and close cooperation with psychiatrists is thus important.

We report a case of apathetic hyperthyroidism associated with unrecognized slowly growing functional thyroid adenoma (Plummer's disease), atrial fibrillation and heart failure. An 81-year-old woman with worsening thyroid dysfunction was admitted to our hospital for the treatment of heart failure. The patient had developed heart failure associated with chronic atrial fibrillation at 76 years of age, and one year later was found to have asymptomatic hyperthyroidism. Anti-thyroid autoantibodies were negative, but thyroid echography showed a 32-mm tumor devoid of internal blood flow in the left lower lobe. Free thyroxine 4 (FT4) decreased from 3.30 to 2.60 ng/dl without treatment. The patient was diagnosed with transient thyroiditis and was followed-up without treatment. However, a repeat thyroid echography showed growth of the tumor to 41 mm in 4 years. Thyroid scintigraphy showed uptake that matched the thyroid mass. Based on these findings, the established diagnosis was Plummer's disease complicated with heart failure. The patient was treated with anti-thyroid drugs, which resulted in improvement of FT4 and reduced the severity of heart failure. In this rare case of an elderly patient, Plummer's disease was associated with a slowly-growing functional thyroid adenoma, apathetic hyperthyroidism, repeated episodes of atrial fibrillation and heart failure. Since symptoms of thyrotoxicosis are likely to be missed in the elderly, it is necessary to include hyperthyroidism in the pathoetiology of heart failure and atrial fibrillation in this population.

It has become possible in Japan to use high-dose metformin for patients with type 2 diabetes. The aim of this retrospective study was to determine the effects and safety of metformin in elderly patients with type 2 diabetes. The study subjects (98 patients who were treated with metformin) were assigned into two groups: (Ⅰ) 59 patients who were younger, aged less than 65 years, and (Ⅱ) 39 patients who were elderly, aged more than 65 years. The primary endpoint was the change in glycosylated hemoglobin A1c (HbA1c) at 12 weeks. The secondary endpoints were the safety variables, including hypoglycemic events and adverse events. Although HbA1c decreased significantly in both group Ⅰ (-0.5%) and group Ⅱ (-0.9%), the difference between the two groups in the change in HbA1c was not significant. There were no incidences of hypoglycemia or adverse events in either group. Metformin improved glycemic control in the elderly patients as well as in the non-elderly patients. It is necessary to examine what dose of metformin and serum creatinin level (Cre), eGFR is appropriate for elderly patients.

A 49-year-old man was referred to our clinic for suspected hypoglycemic symptoms of palpitation, cold sweat, faintness and sinking feeling at movement since 43 years old. The 75 g oral glucose tolerance test showed a decrease in plasma glucose to 56 mg/dl at five hours, but this was not associated with clear hypoglycemic symptoms, and normal plasma glucose level recovered naturally after the test. At 48-hour fasting test, plasma glucose dropped to under 50 mg/dl, but the patient didn't feel hypoglycemia symptom and plasma glucose recovered naturally, but the patient developed cold sweat and hyperventilation after returning to his own room after the test. At that stage, the heart rate increased to 140 beats/min of sinus tachycardia, as confirmed by Holter monitoring. Postural orthostatic tachycardia syndrome (POTS) was suspected because tachycardia occurred only in daytime after an event such as consumption of diet and urination. A head-up tilt test was ordered since sinus tachycardia developed especially on standing. The results showed an increase in heart rate without reduction in blood pressure, confirming the diagnosis of POTS. A repeat head-up tilt test under the use of a beta-blocker showed no increase in heart rate. Though it is generally difficult to distinguish POTS from other forms of tachyarrhythmia, such as inappropriate sinus tachycardia and sinus node reentry tachycardia, and from neutrally mediated reflex syncope (NMS), POTS should be differentiated from hypoglycemia since each condition should be treated differently.

The effects of water management in rice paddies on the levels of cadmium (Cd) and arsenic (As) in Japanese rice grains were tested. In order to reduce the Cd concentration in rice grains, flooding for 3 weeks before and after heading was most effective, but this treatment increased As concentration considerably. Aerobic treatment was effective in reducing As concentration in rice grains, but increased Cd concentration markedly. In the pot experiment, flooding treatment after heading was more effective than flooding treatment before heading in reducing both Cd and As concentrations in rice grains. The concentration of dimethylarsinic acid (DMA) in rice grains was very low under aerobic conditions, but increased in the continuous-flooding treatment. In the field experiment, the grain As concentration in the case of flooding for 3 weeks before and after heading was higher than that in the case of intermittent irrigation. The ratios of DMA to the total As concentration were 3-52% in the pot experiment and 7-13% in the field experiment.

Objective: The study was a non-randomized, parallel-group comparison to evaluate the efficacy of a community-based weight reduction program with exercise and diet modification for overweight adults using existing community health services., Methods: The study population consisted of 1,115 community-dwelling people who underwent annual health checkups in 2002 and were screened by exclusion criteria (age> 65, body mass index (BMI) < 24.2). They received a mail request to select one of two courses; a usual single-session health instruction course (control group) or a 9-month weight management course (intervention group). Forty six patients registered in the intervention group, and fifty patients in the control group. The analyzed sample consisted of 76 participants (9 males and 67 females) excluding dropouts from November 2002 to July 2003. Intervention included monthly classes (2 hours per class, 9 classes) consisting of an individual support program for behavioral change and a community support program for continuation after the class. The control group participants received conventional instructions based on their health status., Results: No significant inter-group differences were observed at baseline, except in age and height of females. The mean BMI decreased from 27.2 (SD = 2.8) kg m(-2) to 25.3(3.1) kg m(-2) in the intervention group, and 26.4 (1.7) kg m(-2) to 26.1(1.7) kg m(-2) in the control group. Repeated measures analysis of variance showed significant time and group interaction adjusted for gender and age. The proportion showing maintenance and action in stage of exercise behavior increased in the intervention group (31% to 60%), but remained stable in the control group (45% to 48%) . The proportion showing maintenance and action in stage of diet behavior increased in the intervention group (24% to 80%), but remained stable in the control group (29% to 26%)., Conclusion: Community-based weight reduction programs may be effective to facilitate change in exercise and diet behavior for body weight reduction in overweight adults.

We report a case of 72-year-old male of adenocarcinoma with micropapillary component of the lung. Though the hilar lymph node metastasis was eminent, primary site was difficult to identify by using computed tomography (CT). SUV max with positron emission (PET)-CT in the case suggested the lung cancer in the emphysematous lung and it became an operation. The pathology diagnosis of the excision lungs was T4 (pml) N1 (#10, 12u) M0 stage IIIB. It was generated in emphysema, and it seemed that an adenocarcinoma with micropapillary component that did typical progress.

We report a 61-year-old woman who was admitted to our hospital in August 2004 with severe hypercalcemia and osteoporosis. Although she was found to have hypercalcemia five years earlier, she has never been treated. The patient was transferred to our hospital for further management of a recently-identified left neck mass. Serum calcium level was 15.0 mg/dL and intact parathyroid hormone (PTH) 3,321 pg/mL. (99m)Tc-methoxyisobutylisonitrile (MIBI) scintigraphy showed marked accumulation in the left neck. We diagnosed the tumor as parathyroid gland tumor and it was enucleated surgically. Although serum Ca level returned to normal after surgery, the patient suffered multiple rib fractures, complicated with marked paradoxical breathing. Internal fixation of the thorax was necessary due to deterioration of the heart failure. Progression of severe osteoporosis was associated with multiple fractures of the ribs and other serious complications including congestive heart failure occurred after surgery, reflecting the extreme difficulty in treating this patient.

Prader-Willi Syndrome (PWS) is a complex neurogenetic disorder with considerable clinical variability, and is considered to be mainly the result of a hypothalamic defect. PWS is characterized by hyperphagia, obesity, mental retardation and hypogonadism from a young age. Hyperphagia is one of the most serious problems, which is organic in origin, inducing morbid obesity and leading to respiratory failure. Most studies attempting to control obesity in children with PWS by dietary management reported limited success due to difficulty in controlling foraging and food stealing. Here we report 16- and 20-year-old female patients with PWS who showed marked weight loss and improvement of respiratory failure by behavior modification and improvement of the environment.

A 88-year-old woman was admitted with appetite loss and dehydration in April 1999. She first noticed finger swelling in May 1996 and systemic sclerosis (SSc) was diagnosed in February 1997 on the basis of a clinical picture of low-grade fever, diffuse skin thickening, Raynaud's phenomenon, and pulmonary fibrosis. Retrospectively pulmonary fibrosis could have been identified on chest X ray film in September 1995. Although her appetite loss and dehydration were improved by hydration, pleural effusion continued. After detailed examinations, anti-topoisomerase 1 (Scl-70) antibody, anti-Sm antibody, and an anti-double-stranded DNA antibody (dsDNA) were found in her serum. However, the other antibodies to anti-SS-A, SS-B, Jo-1, and RNP were not detected. These results suggest that this elderly case was a very late onset overlap syndrome of systemic lupus erythematosus (SLE) and SSc. Thus, the pleural effusion in this case may have been caused by SLE-associated pleuritis. Although the late onset elderly cases with overlap syndrome are very rare, SLE, SSc, and their combination can be found in aged patients over 80 years old. SLE and SSc should be carefully considered for the differential diagnosis of pleural effusion and skin thickening even in elderly patients.

To examine the association of level of functional fitness to demographic, health, and life behavioral or social factors, cross sectional data were obtained for 737 persons aged 60 years or older, and who were independently living in the community. Functional fitness was measured with a functional fitness test containing 4 task items: standing, walking, hand performance, and self-care performance. Among the demographic factors, statistically significant associations with functional fitness were found for age in both male and female and for the presence of spouse in male. Health status, previous or present history of circulatory diseases and musculo-skeletal diseases were significantly associated with lower levels of functional fitness in male, and previous or present history of musculo-skeletal diseases and presence of higher obesity associated with lower fitness level in female. With life behaviors, men who had habitual exercise activities and women who had no habitual nap but habitual exercise activities and frequent out-of-home activities showed significantly higher fitness level than their counterparts. These results suggest that level of functional fitness in independently living aged people in the community was significantly associated with the presence of spouse, history of circulatory and musculo-skeletal diseases, and habitual exercise activities in males; and with the history of musculo-skeletal diseases, obesity, and habitual exercise activities, napping, and frequent out-of-home activities in females.

A test of functional fitness defined as physical capacity to independently perform daily functional activities was developed for aged persons. The functional fitness test was composed of four physical capacity evaluation tasks representing physical abilities necessary to perform main activities of daily living; viz. sitting and standing up test, zig-zag walking test, hand working test with pegboard for dexterity evaluation, and rope working test for self-care evaluation. The reliability and feasibility of the test were examined with 765 aged persons living in the community. The distribution of measurement values in each item showed neither extreme skewness nor kurtosis. Retest reliabilities for each task were 0.857 to 0.942, but the second trial showed significantly reduced (p < 0.001) values than the first trial in test-retest. Significant relationships (r = 0.503 to 0.627) between measurement values in each items and chronological age were found in both male and female. Functional fitness test and physical fitness test scores were correlated 0.740. These results showed that the functional fitness test developed in the present study has a high reliability and feasibility to evaluate functional capacity of daily living in aged persons.

It is known that some athletes use androgenic anabolic steroids to promote skeletal muscular strength and muscle hypertrophy in response to muscle strength training. However, it is not defined whether anabolic steroids are effective for muscle hypertrophy. In order to make this question clear, we examined the conditions of a binding assay of cytosolic androgen receptor on rat skeletal muscle as the first step. We used 3H-mibolerone as the ligand for specific binding to the androgen receptor. The following conditions of the assay were examined in this study: the incubation temperature and time, concentration of 3H-mibolerone, the effects of monothioglycerol and triamcinolone acetonide, and the effect of repeated freezing and thawing of the samples on binding. It was a suitable condition for an androgen receptor assay that samples prepared from unfrozen fresh muscle were incubated with 16nM 3H-mibolerone at 4 degrees C for 20 hrs, with monothioglycerol (20mM) and triamcinolone acetonide (25 microM) added. Using these assay conditions, we measured the binding capacity of androgen receptor in rat skeletal muscles. The values of Kd and Bmax in M. gastrocnemius were 3.61 +/- 0.60 x 10(-9)M and 3.18 +/- 2.23fmol/mg protein respectively.

Blood Group related antigens Lewis A, Lewis B, CA 19-9, and sialyl SSEA-1 were examined in normal human skin and oral mucosa, using monoclonal antibodies to the respective antigen immunohistochemically. These antigens were not expressed on normal keratinocytes but Lewis A and Lewis B were expressed on oral mucous epithelium. Lewis A, Lewis B, and CA 19-9 were expressed clearly on intraepidermal and dermal eccrine duct, but sialyl SSEA-1 was poorly expressed in some cases. In secreting portion of eccrine gland, Lewis A was expressed in 20%, Lewis B was expressed in 70%, and CA 19-9 was expressed in 10%, and sialyl SSEA-1 was expressed weakly in 20% of cases. It's noteworthy that sialyl SSEA-1 was expressed on dendritic cell in epidermis and some infiltrated small round cell in dermis. There is no correlation between patient's peripheral blood type (Lewis) and expression of Lewis antigen in normal skin.

Sixteen cases of Basal Cell Carcinoma have been tested with monoclonal antibodies to HLA-class I, beta 2-microglobulin, HLA-DR, DP and DQ antigens immunohistochemically using frozen tissues. HLA-class I antigens were expressed weakly on BCC in thirteen and fifteen out of sixteen cases using two different monoclonal antibodies respectively. beta 2-microglobulin was expressed differently with the same intensity as normal epidermis in 6 cases, weaker than normal epidermis in 8 cases and absent in 2 cases. There is no correlation with the expression of HLA-class I between histological type and lymphocyte infiltration. On the other hand, HLA-DR, DP and DQ antigens were positive in 4, 3 and 3 cases respectively. But the percentage of positive cells for HLA-class II were only 1-2%. The expression of HLA-DR antigen was most strongest among HLA-class II antigens.

Malignant skin carcinomas occur in a large variety of forms, among them malignant melanoma with a poor prognosis, such as squamous cell carcinoma, basal cell carcinoma, appendix tumors of skin (e.g., sweat gland carcinoma, sebaceous gland carcinoma), metastatic carcinomas of skin, intraepidermal carcinomas (e.g., Bowen's disease, Paget's disease) and mesenchymal carcinomas including mycosis fungoides (cutaneous T cell lymphoma). Furthermore, not only do they present with varied clinical symptoms, some forming tumors or erythemas, some being infiltrative in nature and some being flat in shape, but the clinical symptoms also vary with time during treatment. All these conditions conspire to make the evaluation of chemotherapeutics complicated and difficult. In the field of dermatology topical drugs provide a no less powerful weapon than drugs for systemic administration with which to combat skin carcinomas and are simple and easy to administer. In consideration of those clinical and therapeutic aspects of malignant skin carcinomas new evaluation criteria for chemotherapeutics for topical and systemic administration have been established by adding three-way measurement to the conventional methods of one- and two-way measurement for measurable lesions along with the evaluation of the response of clinical symptoms to chemotherapeutics in unmeasurable carcinomas. The new version of criteria is based in its general framework on the Japan Society for Cancer Therapy's Evaluation Criteria for Chemotherapeutics for Solid Carcinomas by Koyama and Saito and the new version has been approved at the 26th general meeting of the Japan Society for Cancer Therapy (1988, Niigata).

The immunogenicity in patients with melanoma of three high molecular weight melanoma associated antigens (HMW.MAA) defined by murine monoclonal antibodies (MoAb) was investigated. For this end sera from patients with melanoma (stage I, IV) and normal individuals were tested by inhibition assay and sandwich assay using antiidiotypic MoAb to anti HMW.MAA MoAb. In inhibition assay, sera were tested for their ability to inhibit the binding of murine antiidiotypic MoAbs to biotin conjugated anti HMW.MAA MoAbs. Some of the sera from patients with melanoma significantly inhibited the binding of antiidiotypic MoAb to anti HMW.MAA MoAb in comparison with that from normal individuals. In sandwich assay, sera were tested for their ability to bind to precoated murine antiidiotypic MoAb and to biotin conjugated anti HMW.MAA MoAbs. Positive findings suggest the existence of anti HMW.MAA antibodies in sera were showed in several sera from the patients, which were less in frequency than that in inhibition assay. These results suggest that HMW.MAA could elicit the immune response in some melanoma patients and also suggest that the assay anti HMW.MAA MoAb in sera will help us to understand the prognosis of the patients and to evaluate the usefulness of treatment with antiidiotypic MoAb as vaccine therapy.

Seventeen primary and sixteen metastatic surgically removed melanoma lesions were stained indirect immunoperoxidase with anti-GD3, GD2, GD2 + GD3, and acetyl-GD3 monoclonal antibodies. In primary melanoma 94%, 59%, 53%, and 76% of the lesions tested were evidently stained by anti-GD3, GD2, GD2 + GD3, and acetyl-GD3 monoclonal antibodies, respectively. In metastatic lesions 94%, 63%, 31%, and 31% of the lesions were stained by monoclonal antibodies, respectively. Expression of GD2 + GD3 and acetyl-GD3 were evidently decreased from primary lesion to metastatic lesions. And the heterogeneity of positive cells in lesions were noteworthy. It is also interesting that expression of ganglioside in ALM were much decreased than that of ganglioside in NM.

Immunohistochemical localization of nerve growth factor (NGF) receptor in normal skin and melanocytic tumor was analysed using monoclonal antibody. In normal skin and fetal skin NGF receptor was good marker for cutaneous nerve sheath and schwann cells. In melanocytic lineage, the NGF receptor was not expressed in fetal, normal and dermal melanocyte and weakly positive in only small part of nevus cell nest. Positive staining was seen in primary and metastatic melanoma lesion and restricted to melanoma cell membrane. The distribution of the receptor suggests that the NGF-receptor may be involved in the control of proliferation and malignant transformation in melanocytic lineage.

A total of 23 cases of human papillomavirus-associated epidermoid cysts, including one presented here, have been reported in Japan. A review of the literature revealed that the appearance of eosinophilic intracellular substances and that of vacuolar substances in the horny layer of cysts characterize these cases. High detection of human papillomavirus, the pathological features in these cases, and the observation of our case from the onset in which verrucous lesions had preceded a cyst may favor the possibility that HPV would directly produce cysts in these cases.

Sixteen primary and ten metastatic melanoma lesions were stained in indirect immunoperoxidase with HLA-DR, DP and DQ monoclonal antibodies. In primary lesions, HLA-DR, DQ and DP antigens were much more expressed in nodular melanoma lesions than in acral lentiginous melanoma lesions. In metastatic lesions HLA-DR, DQ and DP antigens were expressed more than in primary lesions, but there were no significant differences between ALM and NM. In primary melanoma, 82%, 75%, and 75% of lesions tested were stained by anti HLA-DR, DP and DQ monoclonal antibodies, respectively. In metastatic melanoma, 90% of the lesions tested were stained by anti HLA-DR, DP and DQ monoclonal antibodies. HLA-class II antigens on melanoma cells were much more expressed in cases of high levels of invasion, high degrees of lymphocyte infiltration, and lower melanin content.

Reported was a 16-year old Japanese girl suffering from peculiar viral warts on the soles. All lesions showed whitish punctate keratotic appearance. Three biopsy specimens taken from one patient were found to have particular intracytoplasmic basophilic eosinophilic filamentous substances in each cell. These intracytoplasmic substances were quite different from those of myrmecia, which was described as inclusion wart by Lyell and Myles. Myrmecia is caused by human papillomavirus type 1 (HPV-1) and its intracytoplasmic substances are characterized by numerous intracytoplasmic eosinophilic granules. In spite of that immunohistologically papillomavirus common antigens were detected, HPV-1,2,4 was never detected by in situ hybridization method in our case. We assume that our case is a new type of viral wart.

An 11-year-old Japanese girl developed a horny tumor branching into three parts in the fourth interdigital fold of the left hand; histologically it had numerous eosinophilic granular inclusion bodies. A histological diagnosis of myrmecia was made, which was further confirmed by the demonstration of human papillomavirus type 1 (HPV-1) by the in situ hybridization method. However, the clinical picture did not resemble the so-called myrmecia. A review of other atypical cases of myrmecia on areas other than the palms and soles may indicate the role of topical factors in determining the shape of viral warts. The concept of myrmecia should be revised in view of the additional information that there is histological heterogeneity in the cytoplasmic inclusion bodies, which are the basis of the definition of myrmecia.

Skin changes associated with internal malignancies can be classified into five groups: 1) cutaneous metastasis from internal malignancies, 2) non-specific reactional skin changes caused by toxic or allergic processes due to these malignancies, including pruritus cutaneous, urticaria and so on, 3) specific skin changes or diseases closely related to the malignancies, including acanthosis nigricans, dermatomyositis, Leser- Trélat syndrome, 4) the syndrome caused by simultaneous effects of oncogenesis both on the skin and on the internal organs, including multiple Bowen's disease, and 5) congenital hereditary syndrome, including Gardner syndrome, Torre syndrome. It is appropriate for the cutaneous internal malignancy syndrome to include above groups 3) 4) 5), because of the close and specific interrelation between the skin changes and internal malignancies. Two cases of glucagonoma syndrome, 2 cases of dermatomyositis with malignancy and one case of Leser- Trélat syndrome were described as typical cutaneous-internal malignancy syndrome. Characteristics findings of these skin changes suggest the presence of particular internal malignancies in cases, and the study of the etiologic process of these skin changes will be useful in the basic oncological investigation.

Carcinoma of cutaneous appendages, which are derived from hair follicles, sebaceous glands and sweat glands, are generally rare. Although no papers on malignant tumors derived from hair follicles have been reported either at home or abroad, several cases of distinct hair follicle carcinoma have recently been reported in this country. In this paper, malignant change of epidermoid cyst (follicular), malignant proliferating trichilemmal tumor, malignant change of trichilemmoma, and BCC-like tumor associated with immature hair follicle formation, were discussed as several types of malignant changes occurring in the hair follicle. Both sebaceous and sweat gland carcinomas, frequently show a relatively poor prognosis due to a marked tendency for widespread metastasis. In apocrine gland carcinoma appearing in axillar and chest areas, there is a difficulty in making differential diagnosis from carcinoma of latent accessory mammary gland. An outline of metastatic carcinoma to the skin was given.