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The present study investigated the relationship between the type of residential area and each factor of the International Classification of Functioning, Disability and Health (ICF) framework among elderly subjects receiving home-visit rehabilitation.This was a cross-sectional study conducted at two institutions. A total 84 participants (46 men and 38 women, age: 79.1±7.8 years old) who were receiving home-visit rehabilitation in urban and rural areas were examined. The parameters measured included the modified Gait Efficacy Scale (mGES), grip strength, 30-seconds chair stand test (CS-30), Functional Independence Measure (FIM), Life-Space Assessment (LSA), Frenchay Activities Index (FAI), Ikigai-9, and Home and Community Environment (HACE), which is based on the ICF concepts of health status, physical structure, physical and mental functions, activities, participation, personal factors, and environmental factors respectively; these points were evaluated by physical or occupational therapists. The health status was based on the diagnosis obtained from the clinical record.Receiving home-visit rehabilitation in a rural area was significantly associated with the LSA (odds ratio [OR]=1.075, p=0.028), optimistic and positive feelings for life (OR=0.698, p=0.040), and community mobility scores (OR=5.755, p=0.001).Environmental factors, activities, and personal factors differed depending on the region where the elderly subject received home-visit rehabilitation. Thus, intervention methods concerning home-visit rehabilitation may need to be adjusted according to the region where the patient lives.

Home-visit rehabilitation is critical for cancer patients because it facilitates recovery. However, few studies have reported relevant information and practices concerning this patient support. This study investigated the factors influencing the self-efficacy of cancer survivors receiving home-visit rehabilitation compared with non-cancer home-visit rehabilitation users by matching propensity scores.The present study was a cross-sectional study involving participants from two cancer care institutions. Fifteen cancer survivors who received home-visit rehabilitation (9 men, 6 women; age=77.6±11.1 years) were matched for their propensity scores (adjusted for age, sex, and comorbidity) with 15 home-visit rehabilitation users without cancer (8 men, 7 women; age=74.7±11.7 years). Self-efficacy was measured based on the self-efficacy for activities of daily living (SEADL) scale and self-efficacy for going out among community-dwelling elderly people (SEGE) scale. Grip strength (GS), 30-second chair stand test (CS-30), Functional Independence Measure (FIM), and Life-Space Assessment (LSA) were measured based on objective evaluation items.In cancer survivors, the SEADL was significantly correlated with GS, CS-30, FIM, motor-FIM (mFIM), and LSA. The CS-30 of cancer survivors was significantly correlated with SEGE. Among home-visit rehabilitation users without cancer, although the correlation between SEADL and FIM or mFIM was significant, SEGE was not significantly correlated with the other measurements.When compared with home-visit rehabilitation users without cancer, self-efficacy among cancer survivors was influenced not only by activities of daily living but also by physical function and life-space mobility.

[Purpose] The purpose of this study was to investigate the differences in respiratory function, physical function, and Activities of Daily Living (ADL) between respiratory and non-respiratory patients using community-based home rehabilitation. [Participations and Methods] Maximum Phonation Time (MPT), upper and lower limb muscle strength, and ADL were compared in two groups: a respiratory disease group including respiratory patients and those with respiratory comorbidities, and a non-respiratory disease group. Cutoff values were determined for items that showed significant differences between groups. [Results] There were no significant differences between the two groups in assessments other than MPT. MPT was significantly lower in the respiratory disease group, with an MPT cutoff value of 10.1 sec and an area under the curve of 0.74. [Conclusion] Use of the MPT cutoff value may help to determine whether respiratory function is impaired in patients with respiratory disease.

PURPOSE This study aimed to develop a questionnaire to evaluate indoor life-space mobility and assess its validity in community-dwelling older adults certified as needing support or care. METHODS The participants included 37 community-dwelling older adults undergoing home-visit rehabilitation (mean age: 78.5±7.0 years). We developed a questionnaire to assess the degree of indoor life-space mobility (home-based life-space assessment (Hb-LSA)), evaluating the functional status (life-space assessment (LSA), time spent away from bed, functional independence measure (FIM), bedside mobility scale (BMS)), physical function (hand grip power (HGP), 30-second chair stand (CS-30), one-leg standing (OLS)) and cognitive status (mental status questionnaire (MSQ)). RESULTS The average Hb-LSA score was 56.3±24.3 (minimum 4 to maximum 102.5). The test-retest reliability was high (intraclass correlation coefficients: (1, 1)=0.986, (1, 2)=0.993). The Hb-LSA scores were significantly associated with the LSA (r=0.897), time spent away from bed (r=0.497), FIM (r=0.786), BMS (r=0.720), HGP (r=0.388), CS-30 (r=0.541) and OLS (r=0.455). There were no significant associations between the Hb-LSA scores and the FIM cognitive subscores (r=0.180) or MSQ scores (r=-0.240). The Hb-LSA scores were significantly higher among the participants able to move independently indoors (75.8±18.8 points) than in those who required help to move (45.7±20.2 points). CONCLUSIONS The Hb-LSA is a useful, reliable and valid tool for assessing the degree of indoor physical mobility in the life-space. The Hb-LSA score is related to the degree of independence of indoor mobility.

Aim To identify elderly patients who are at high risk for falls, we used the timed up-and-go test (TUG) as an assessment tool for gait and balance function in a comprehensive geriatric assessment (CGA) initiative named 'Dr. SUPERMAN'. However, this test is difficult to perform in a small area because it requires at least 3 meters of movement space. Therefore, we investigated whether another, newly-developed test, based on the Berg balance test, could be an alternative to the TUG test. Methods We enrolled a total of 99 eligible subjects out of 105 elderly patients with disorders such as Alzheimer disease, Parkinson disease, cerebral infarction, osteoporosis and vascular risk factors, and administered the TUG test and the newly-developed standing and balance test (SBT). Of these 99, 6 patients could not stand independently. While the time to accomplish TUG was determined, any unsteadiness during TUG was also recorded. The SBT consists of 3 components: standing up independently, standing on a narrow base for 15 seconds without any swaying of the trunk, and a timed one-leg standing test (TOLS) for 15 seconds on both sides. Taking more than 14 seconds to accomplish the TUG or abnormal unsteadiness during the test was defined as positive, and each cut-off point was measured on the TOLS, with or without swaying of the trunk. Results The time to accomplish TUG significantly increased with age, and positive TUG findings were observed in 43 subjects. The mean TOLS time significantly and suddenly worsened at over 75 years of age, including among those subjects who showed swaying of the trunk and who could only perform the TOLS for less than 1 second. The receiver operating curve indicated that a TOLS cut-off point of less than 3 seconds, together with standing with help or swaying of the trunk during the SBT, most efficiently determined a positive TUG score, with high sensitivity (86%), high specificity (87.5%), and a high positive predictive value (84.1%). Conclusion In a narrow space, the SBT can adequately determine gait and balance abnormalities among elderly patients, indicating it to be an alternative to the TUG test. Subjects who could stand dependently, who showed swaying of the trunk in SBT, or who had a TOLS cut-off point of less than 3 seconds, were at high risk for falls. Further assessment of similar patients is necessary.

AIM The assessment of cognitive function is important in comprehensive geriatric assessment (CGA), and several standardized screening tests for dementia such as the Mini-Mental State Examination (MMSE) are available. However, it takes 5 to 20 minutes to perform the MMSE. We have developed a CGA initiative named 'Dr. Superman' which is designed to accomplish CGA within 10 minutes. In this study, we evaluated a short-form screening test for cognitive decline preceding the MMSE. METHODS The MMSE and a question on episodic memory, ("What kind of food did you have last night?") were administered to 90 elderly outpatients with various diseases. They were divided into 2 groups according to their MMSE scores: a normal group (MMSE score≥24) and an abnormal group (MMSE score≤23). Within these groups, each domain (D) (D1: time orientation, D2: place orientation, D3: immediate memory, D4: calculation, D5: recall, D6: language, and D7: spatial cognition) and episodic memory was separately scored and the sensitivity, specificity, and positive predicative value of each were calculated. Based on these data, the best combination of the domains was evaluated for practical use as an assessment tool. RESULTS The MMSE scores ranged from 10 to 30, and 42 cases were classified into the normal group. High sensitivity, specificity, or positive predicative value was observed in D1, D2, D4, D5 and episodic memory categories. On the basis of the characteristics of each item in these domains in order to make a short-form assessment, a combination of "What is this year" in D1, "Serial 7's twice" in D4, and a question on episodic memory was found to be superior to other combinations (sensitivity: 93.8%; specificity: 71.4%; positive predicative value: 78.9%). Using this combination for 50 outpatients with 2 raters, it took 32 to 55 seconds to accomplish the assessment with good inter-rater reliability (κ=0.861). CONCLUSIONS The combination of "What is this year?", "Serial 7's twice", and "What kind of food did you have last night?" was the best and most valuable short-form screening test for cognitive decline.

〔目的〕高齢者における転倒の多くは滑りやつまずきといった外乱刺激が加わった時に生じており，既存の評価指標では明らかにすることのできない転倒リスク保因者を，外乱刺激を与えることで発見できる可能性がある。そこで本研究では，新たに開発した歩行時側方傾斜外乱刺激装置を用いて，高齢者と若年者の外乱負荷応答の違いを明らかにすることを目的とした。〔対象〕対象は，高齢者群13名（年齢77.9±3.9歳），若年者群15名（年齢20.1±3.1歳）であった。〔方法〕測定は重心動揺計を用い，至適歩行速度での歩行中，不意に与えられた側方傾斜外乱刺激に対する反応を計測し，反応動態を高齢者と若年者とで比較した。〔結果〕重心の座標推移から加速度を算出した結果，高齢者群は若年者群に比べ，外乱刺激に対して姿勢バランスを保持する二次的な負荷応答が有意に小さかった。〔結語〕この指標が外乱刺激に対する高齢者と若年者の反応動態の違いを反映している可能性が示唆された。

〔目的〕本研究では，地域在住高齢者を対象にLife-Space Assessment（LSA）を用いて活動量と身体機能およびIADLとの関連性を検証することを目的とした。〔対象〕対象は都市部に在住する地域在住高齢者411人（平均年齢76.7±5.3歳）であった。〔方法〕活動量の指標としてLSA，ならびにその下位項目であるIndependent Life-Space（LS-I），Life-Space using equipment（LS-E），Maximal Life-Space（LS-M）を調査した。また，質問紙調査として，要介護認定の有無とともに，健康状態，身体機能，IADLに関する項目について面接にて聴取した。〔結果〕LS-I，LS-E，LS-Mの値はいずれも約95％以上の者が5点満点を示し，LSAにおいても平均92.7点と高い値であった。LSAを5歳の年齢階級別に比較した結果，85歳以上の群におけるLSAは，65-69歳，70-74歳，75-79歳の各群に比べ，有意に低かった。また，健康状態，身体機能，IADLの状況によってLSAを比較した結果，「要介護認定あり」，「転倒恐怖感あり」，「健康感なし」，「3種以上の服薬あり」，「1 km歩行不可」，「5 m歩行時間が基準値以上」，「爪先立ち不可」，「握力が基準値以下」，「1人での外出が不可」，「趣味・稽古事なし」，「辞めた趣味あり」の各群においてLSAは有意に低い値を示した。〔結語〕以上の結果から，都市部に在住する高齢者は活動範囲が広く，活動量が高いものの，加齢によって低下することが示唆された。また，LSAは移動機能に必要な身体機能や健康状態，移動機能の必要性の高いIADLといった諸因子とより密接に関連し，高齢者における活動量の評価指標として有用であることが明らかになった。

AIM Assessment of the nutritional state is important in comprehensive geriatric assessment (CGA). Several standardized screening tests for malnutrition are available such as the Mini-Nutritional Assessment (MNA) and MNA-Short Form (MNA-SF). However, it takes more than 10 minutes to perform the MNA-SF alone. We have developed a CGA initiative named 'Dr. SUPERMAN', which is designed to accomplish CGA within 10 minutes. In this study, we evaluated a short-form screening test for malnutrition preceding the MNA. METHODS The MNA-SF, which consists of 6 items (A-F), was administered to 163 elderly outpatients (mean age: 83.4 years, 80 men) with various diseases. Using the results of the MNA-SF score (normal ≥ 12 and abnormal ≤ 11) as a gold standard, the sensitivity, specificity, and positive predictive values (PPVs) of each item were calculated and the best combination of 2 items for identifying malnutrition among the elderly outpatients was selected. According to the combination of 2 items (item B: weight loss during the last 3 months; item F: body mass index (BMI)/calf circumference (CC) in cm), they were divided into 2 groups: the normal control (NC) group (neither items B nor F) and the malnutrition/at risk (MN) group (either items B or D, or both). Findings of the clinical feature, anthropometric measurement, and nutritional biomarker between the 2 groups were examined to clarify the characteristics of each. RESULTS The MNA-SF score was distributed as follows: 3-7 in 12 cases, 8-11 in 68 cases, and 12-14 in 83 cases. Based on the MNA-SF score, the combination of items B and F revealed the highest sensitivity (91.3%), specificity (63.9%), and PPV (70.9%), resulting in 103 cases in the MN group and 60 cases in the NC group. A high frequency of anorexia, living alone, hypoprealbuminemia, lymphocytopenia, and dehydration was observed in the MN group, whereas a high frequency of leg edema was observed in the NC group. Cases showing a positive wall-occiput test, which compelled the alternation of CC with BMI, accounted for 24% of all cases. CONCLUSIONS The combination of 'weight loss during the last 3 months' and initial BMI ≥ 23/CC

Two arylsulfatase-producing streptomycetes that desulfated etoposide 4'-sulfate were isolated from soil samples. Taxonomical study identified one soil isolate as Streptomyces griseorubiginosus S980-14 (Es-1 arylsulfatase producer), while the other was considered new and tentatively designated Streptomyces sp. T109-3 (Es-2 arylsulfatase producer). Both strains produced extracellular arylsulfatase activities, provided that cultivation media were prepared with distilled water. Unlike the two known types of arylsulfatases, which had significant activity on p-nitrophenyl sulfate but none on etoposide 4'-sulfate, the crude streptomycete arylsulfatases efficiently desulfated etoposide 4'-sulfate and p-nitrophenyl sulfate, which supports the establishment of a new type of arylsulfatases.

AIM The purpose of this study was to determine the predictors of interruption to living at home as a result of death, hospitalization, or admission to a long-term care facility in frail elderly people enrolled in a home visit rehabilitation service. METHODS A total of 311 patients entered a home visit rehabilitation service within a study period of 1 September, 2005 to 31 March, 2010, 146 of whom met the criteria to be enrolled in this study and gave consent. Of these, 73 received a continuous home visit rehabilitation service (continuous group) of over 2 years and 73 experienced interruption to this service due to death, hospitalization, or admission to a long-term care facility (interruption group). The following physical, social, and medical factors were recorded and analyzed: age, sex, care level, disease diagnoses, gait disability, cognitive impairment, living with another person and cause of the interruption to the home-visit rehabilitation service. We compared each item between the interruption and continuous groups. Logistic regression analysis was used to identify the significant predictors of interruptions to living at home. RESULTS Patients in the interruption group demonstrated significantly lower functioning in activities of daily living (ADL), gait ability and lower cognitive status, and higher rates of respiratory diseases and cancer compared with the continuous group. On logistic regression analysis, ADL score (odds ratio [OR]=0.97, p

The 2''-O-, 3''-O- and 2'',3''-di-O-substituted derivatives (4a--p) of etoposide were prepared by nucleophilic substitution of 4'-O-benzyloxycarbonyletoposide (2) followed by deprotection. Controlled reaction (a limited amount of reagents and low temperature) was required for preparing the mono-O-substituted derivatives. In terms of ED125 values, doses which show 125% of T/C against P388 leukemia in mice, both the 2''-O-acetate (4a, ED125 = 0.18 mg/kg) and 3''-O-acetate (4b, 0.23 mg/kg) were nearly as active as etoposide (1, 0.19 mg/kg), while the 2'',3''-di-O-acetate (4c, 1.9 mg/kg) was somewhat less potent. In the replacement with other substituents, antitumor activity of the 2''-O-substituted derivatives was affected much more by the difference of the substituents as compared with that of the corresponding 3''-O-substituted derivatives. In the 2'',3''-di-O-substituted derivatives, the activity was decreased additively on the substituents.

As part of a search for new potent derivatives, electrochemical oxidation of etoposide (1) was carried out under controlled potential (500 mV) to yield 1,2-dehydroetoposide (4), 4'-O-demethyl-1,2,3,4-tetradehydro-4-dehydroxy-podophyllotox in (5) and 1,2,3,4-tetradehydroetoposide (6). They showed no cytotoxicity against B16-melanoma.

Etude de la reduction electrochimique sur electrode de mercure dans le DMF-tetrafluoroborate de tetraethylammonium, de la (bis-[benzyl tosyl amino]-2',5' p-tolyl-2 methyl-2 cyclopentanedione-1,3. Preparation de (benzyl-1 benzylamino-8 dimethyl-6,9 hexahydro-1,2,3,4,5,6) benzoazocine-1

The arenesulfonyl group of sulfonamide (12) was efficiently removed by utilization of electrochemical reduction in a new cooperative system of anthracene and ascorbic acid, and subsequent electrogenerated bases were very effective to produce the 1-benzazocinone derivatives, in one pot, through the controlled crisscross annulation.

Synthese de l'acetal-5 de la dimethyl-6,9 methoxy-8 octahydro-1,2,3,4,5,6,7,10 tosyl-1 benzoazocine-1 trione-5,7,10 a partir de benzyl-1 benzylamino-8 dimethyl-6,9 hexahydro-1,2,3,4,5,6 benzoazocine-1-dione-2,5

For the last decade the high level yields, 5t-6t/ha, max. 6.5t/ha, of soybean (cv. Okushirome) have been recorded continuosly under the upland conditions converted from rice paddy fields at Saihoku Branch of the Yamagata Prefectural Agricultural Experiment Station, located in Shinjo (38°45'N, 140°18'E). In 1982 and 1983, dry matter accumulation pattern, canopy structure and light penetration for Okushirome under the converted fields at Saihoku Branch were compared with those of some cultivars (Table 2) grown under the fields of Experimental Farm of Hokkaido University (Sapporo, 43°35'N, 141°20'E). Okushirome produced the highest yields in both years, 5.3t/ha in 1982 and 4.6t/ha in 1983. It had also large LAIs (about 6), small light extinction coefficients (K:0.38 and 0.42), long leaf area duration (LAD) and high harvest indices (62% and 56%) compared with those of the cultivars grown in Sapporo (Table 3 and Fig. 5). Grain yield was closely correlated with number of pods (r = 0.886), LAD (r = 0.800) and grain filling period (r = 0.813), regardless of years, locations and cultivars. The K value was related to number of pods per maximum LAI (r = - 0.796), though not related directly to grain yield. As shown in Fig. 6, in 1982 Okushirome showed a peculiar unique plant form that the upper 3 to 4 large leaves on main stem had vertical and long (25 cm to 30 cm) petioles though stem height was very short (Table 2). In addition, leaflets of Okushirome did active solar tracking movements in both years during early morning to late afternoon, suggesting the relation to effective light penetration within the canopies (Fig. 4).