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It is difficult to easily estimate skeletal muscle (SM) volume in children. We aimed to develop regression-based prediction equations to estimate the total body and regional SM volume using calliper measurements of skinfold thickness and limb circumference and to investigate the validity of these equations. In total, 142 healthy, prepubertal, Japanese children, aged 6–12 years, were divided into two groups: the model development group (sixty boys, thirty-eight girls) and the validation group (twenty-six boys, eighteen girls). Contiguous magnetic resonance images were obtained from the first cervical vertebra to the ankle joints as reference data. SM volume was calculated from the summation of the digitised cross-sectional areas. Limb and waist circumferences were measured at mid-upper arm, mid-thigh, maximal calf and at the level of umbilicus. Each girth was corrected for subcutaneous adipose tissue thickness, as estimated by skinfold thickness measurements. Skinfold thickness was measured at the posterior upper arm, anterior thigh, medial calf and lateral to the umbilicus, using callipers. Significant correlations were observed between the site-matched SM volume, measured by MRI, and each corrected girth × standing height value in the model development group. When these SM volume prediction equations were applied to the validation group, the measured total body and regional SM volume were similar to the predicted values. These results suggest that the anthropometric prediction equations developed in this study provide reliable information about the total and regional SM volume in prepubertal Japanese children, with varying degrees of estimation accuracy for each region. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on the use of soap in skin care for atopic dermatitis in Japan. Thus, this study aimed to evaluate the efficacy of soap to maintain eczema remission in atopic dermatitis patients during the fall‐winter period in Japan. Methods: This assessor‐blinded, pragmatic randomized, non‐inferiority study enrolled atopic dermatitis patients whose eczema was controlled by regular steroid ointment application less than or equal to 2 days / week (tacrolimus ointment was permitted). For 8 ± 3 weeks, participants washed their upper and lower limbs on one side with soap (soap side) and on the other side with water alone (water side). The primary outcome was an Eczema Area and Severity Index score at week 8 ± 3. Results: Twenty‐nine participants were analyzed. The Eczema Area and Severity Index scores at week 8 ± 3 of the water and soap sides were 0.0 (0.0–0.4) and 0.0 (0.0–0.4), respectively (P = 0.18). The difference between both sides was −0.02 (−0.11–0.08), and the limits of the 95% confidence interval did not reach the prespecified non‐inferiority margin. The average Patient‐Oriented Eczema Measure score was 1.27 ± 1.7 and 1.32 ± 1.8 for the water and soap sides, respectively (P = 0.92). The total number of additional steroid ointment applications was four (0–20) times and six (0–23) times, respectively (P = 0.98). Participants were categorized according to self‐assessments of the usefulness of soap, with 2, 24, and 3 participants in the water‐effective, invariant, and soap‐effective groups, respectively. Conclusions: For children with controlled atopic dermatitis, washing with water alone was not inferior to washing with soap for maintaining remission of eczema during the fall‐winter period in Japan. [ABSTRACT FROM AUTHOR]

Surveillance of cardiovascular Events in Antiplatelet-treated arterioSclerosis Obliterans patients in JapaN (SEASON) is a 2-year, prospective, real-world, registry study conducted in Japan from 2009 to 2013. This post hoc analysis evaluated risk factors for limb ischemia in patients with peripheral arterial disease (PAD) and ankle–brachial index (ABI) <0.90. Vascular events were adjudicated by an Efficacy Endpoint Review Committee. Cox regression identified predictors of limb-specific peripheral vascular events (amputation, development of critical limb ischemia, and acute limb ischemia). Patients (n = 6565) were stratified according to ABI: normal (≥1.0; n = 1300), borderline (0.90 ≤ ABI ≤ 1.0; n = 776), and abnormal (<0.90; n = 4489). Compared to normal ABI, patients with ABI <0.90 had a significantly higher risk of any vascular event, all-cause death, and any limb-specific peripheral vascular event. Risk factors for limb-specific vascular events included history of lower extremity revascularization/amputation (adjusted hazard ratio: 2.18; 95% confidence interval [CI]: 1.49-3.20), chronic kidney disease (2.00; 1.33-3.00), diabetes (1.71; 1.16-2.52), and ABI <0.4 (4.45; 2.62-7.55) or <0.7 (1.78; 1.15-2.76). These findings from a Japanese real-world population confirm the increased vascular risk of patients with PAD and ABI <0.90 and identified risk factors for limb-specific peripheral vascular events. [ABSTRACT FROM AUTHOR]

Aim: The Kihon Checklist is a useful screening tool for assessing frailty in older individuals. However, the clinical significance of the Kihon Checklist in cardiac rehabilitation patients remains unclear. The present study aimed to evaluate the relationship between the Kihon Checklist and the clinical parameters in patients who participated in cardiac rehabilitation. Methods: We enrolled 845 consecutive patients (584 men, mean age 71 years) who participated in cardiac rehabilitation at Juntendo University Hospital, Tokyo, Japan, between November 2015 and October 2017. The patients were divided into non‐frailty (n = 287), pre‐frailty (n = 270) and frailty (n = 288) groups according to their Kihon Checklist scores. Cardiopulmonary exercise testing was carried out in 302 patients. Results: The frailty group was older and had a higher prevalence of history of heart failure than the non‐frailty group, although left ventricular ejection fraction did not differ significantly between groups. Nutritional index, trunk and limb muscle mass, lean body weight, and grip strength were significantly lower in the frailty and pre‐frailty groups than those in the non‐frailty group. In the cardiopulmonary exercise test, a stepwise significant decrease in peak oxygen uptake was observed across the three groups (non‐frailty 17.2 ± 3.6, pre‐frailty 16.0 ± 3.4, frailty 14.4 ± 3.5 mL/kg/min, P < 0.01). Multivariate regression analyses showed that the Kihon Checklist score was significantly and independently associated with peak oxygen uptake (r = −0.34, P < 0.0001). Conclusions: The Kihon Checklist, which was associated with frailty and exercise tolerance, could be used as a clinical assessment method for patients who participated in cardiac rehabilitation. Geriatr Gerontol Int 2019; 19: 287–292. [ABSTRACT FROM AUTHOR]

BACKGROUND: The robotic Hybrid Assistive Limb (HAL) provides motion according to the wearer's voluntary activity. HAL training effects on walking speed and capacity have not been clarified in subacute stroke. OBJECTIVES: To determine improvement in walking ability by HAL and the most effective improvement measure for use in future large-scale trials. METHODS: Sixteen first-ever hemiplegic stroke patients completed at least 20 sessions over 5 weeks. Per session, the experimental group received no more than 20 min of gait training with HAL (HT) and 40 min of conventional physiotherapy, whereas the control group received at least 60 min of conventional physiotherapy. Primary outcome was maximum walking speed (MWS). RESULTS: The change in MWS from baseline at week 5 was 11.6±10.6 m/min (HAL group) and 2.2±4.1 m/min (control group) (adjusted mean difference = 9.24 m/min, 95% confidence interval 0.48-18.01, P = 0.040). In HAL subjects there were significant increases in Self-selected walking speed (SWS; a secondary outcome) and in step length (a secondary outcome) at MWS and SWS compared with controls. CONCLUSIONS: HT improved walking speed in hemiplegic sub-acute stroke patients. In future, randomized controlled trials are needed to confirm the utility of HT. [ABSTRACT FROM AUTHOR]

Background: Wide resection is the generally recommended surgical treatment for dedifferentiated liposarcoma (DDLPS) in the extremities. However, it may be appropriate to distinguish the surgical margin of low-grade atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLPS) area from the high-grade dedifferentiated area, because the low- and high-grade areas can be clearly separated, both radiologically and histologically. This study re-evaluated the details of surgical margin of DDLPS in the extremities, and aimed to investigate the optimal surgical margin and the usefulness of adjuvant therapy for DDLPS in the extremities.Methods: Seven patients diagnosed with DDLPS in the extremities and treated between 1995 and 2013 were analyzed. The use of adjuvant therapy before and after surgery was assessed, and the surgical margins for the ALT/WDLPS and dedifferentiated areas were re-evaluated by using the specimens resected at surgery. Subsequently, the recurrence rates, metastatic rates, and oncological outcomes were examined.Results: Four and three patients had wide (adequate wide margin, n = 3; inadequate wide margin, n = 1) and marginal margins for the dedifferentiated area, respectively, while three and four patients had wide (adequate wide margin, n = 2; inadequate wide margin, n = 1) and marginal margins for the ALT/WDLPS area, respectively. Postoperative radiotherapy was performed in three patients with an inadequate wide margin or a marginal margin for the dedifferentiated area. No patient had local recurrence. Distant metastases occurred in two patients. These patients died of their disease. The other five patients were disease-free.Conclusion: The ALT/WDLPS and dedifferentiated areas in the tumor margin may be better to be considered separately in determining the appropriate resection extent for DDLPS in the extremities. Postoperative radiotherapy may provide good local control for cases with a narrow surgical margin. [ABSTRACT FROM AUTHOR]

Background: Systemic immune response to injury plays a key role in the pathophysiological mechanism of blunt trauma. We tested the hypothesis that increased blood interleukin-6 (IL-6) levels of blunt trauma patients on emergency department (ED) arrival are associated with poor clinical outcomes, and investigated the utility of rapid measurement of the blood IL-6 level. Methods: We enrolled 208 consecutive trauma patients who were transferred from the scene of an accident to a level I trauma centre in Japan and admitted to the intensive care unit (ICU). Blood IL-6 levels on ED arrival were measured by using a rapid measurement assay. The primary outcome variable was prolonged ICU stay (length of ICU stay > 7 days). The secondary outcomes were 28-day mortality, probability of survival and Abbreviated Injury Scale (AIS) scores. Results: Patients with prolonged ICU stay had significantly higher blood IL-6 levels on ED arrival than the patients without prolonged ICU stay (P < 0.0001). The receiver-operating characteristic curves produced an area under the curve of 0.75 (95 % confidence interval [CI], 0.66-0.84; P < 0.0001) for prolonged ICU stay. The patients who had increased blood IL-6 levels on ED arrival had increased 28-day mortality (P = 0.021) and decreased probability of survival (P < 0.0001). The AIS scores for the thorax, abdomen, extremity, and external body regions independently correlated with blood IL-6 levels (unstandardized coefficients [95 % CI] for the thorax: 23.8 [12.6-35.1]; P < 0.0001; abdomen: 42.7 [23.8-61.7]; P < 0.0001; extremity: 19.0 [5.5-32.4]; P = 0.0060; external body regions: 62.9 [13.2-112.7]; P = 0.030); the standardized coefficients for the thorax (0.27) and abdomen (0.28) were larger than those for the extremity (0.18) and external body regions (0.15). Conclusions: Increased blood IL-6 level on ED arrival was significantly associated with prolonged length of ICU stay. Blood IL-6 level on ED arrival independently correlated with the AIS scores for the abdomen and thorax, and, to a lesser extent, those for the extremity and external body regions. The rapid measurement of blood IL-6 level on ED arrival can be utilized as a fast screening tool to improve assessment of injury severity and prediction of clinical outcomes in the initial phase of trauma care. [ABSTRACT FROM AUTHOR]

Aim Little is known about longitudinal changes of body composition measured by dual-energy X-ray absorptiometry ( DXA) in middle-aged and elderly individuals. We evaluated longitudinal changes of body composition, and age and sex differences in appendicular skeletal muscle mass. Methods Participants were 1454 community-dwelling Japanese men and women aged 40-79 years. Body composition at baseline and 6-year follow up was measured by DXA. Results Fat increased significantly in men of all ages, and in women aged in their 40s and 50s. Among men, arm lean tissue mass ( LTM) changed by 0.9%, −0.5%, −1.4% and −3.7%, respectively, for the 40s to the 70s, and decreased significantly in the 60s and 70s. Leg LTM in men changed by −0.4%, −1.3%, −1.7% and −3.9%, respectively, and decreased significantly from the 50s to the 70s. Compared with the preceding age groups, significant differences were observed between the 60s and 70s in arm and leg LTM change in men. Among women, arm LTM changed by 0.7%, 0.2%, 1.6% and −1.5%, respectively, which was significant in the 60s and 70s. Leg LTM decreased significantly in all age groups of women by −2.0%, −2.8%, −2.4% and −3.9%, respectively. With respect to sex differences, leg LTM loss rates were significantly higher in women than men at the 40s and 50s. Conclusions Longitudinal data suggest that arm and leg LTM decreased markedly in men in their 70s, and leg LTM had already decreased in women in their 40s. Geriatr Gerontol Int 2014; 14: 354-361. [ABSTRACT FROM AUTHOR]

The article discusses the genus and species of the family calometridae from the middle miocene of Southwestern Japan called the Kiimetra miocenica. A sample is studied which contains over 100 specimens on a single bedding plane and are almost all articulated and preserve delicate structures of arms, pinnules, and cirri because of rapid and virtually in situ. Skeletal terminology is also provided.

We encountered a persistent median artery in the forearms and hands bilaterally in a 78-year-old Japanese male cadaver during dissection practice at Wakayama Medical University. The brachial arteries divided into the ulnar and radial arteries. The ulnar artery gave off the median and posterior interosseous arteries at the same point, although the anterior interosseous artery was not found. The median artery ran along the median nerve and bifurcated in the hand. In the superficial layer of the palm, one branch of the median artery ran to the ulnar side of the thumb, whereas the other passed to the second interdigital space. The ulnar artery reached the third and fourth interdigital spaces and the ulnar side of the little finger, and showed no anastomosis with the median artery in the superficial layer of the palm. The radial artery did not give off the superficial palmar branch. Therefore, the formation of the superficial palmar arch was incomplete. In the deep layer of the palm, the radial artery formed the deep palmar arch with the deep palmar branch of the ulnar artery and gave off the princeps pollicis artery. In the dorsum of hand, the radial artery passed over the first dorsal interosseous muscle to the index finger and communicated with the palmar pollical artery from the median artery in the first interosseous space. The present study reports an unusual variation of the persistent median artery in the hand and briefly reviews the literature about the median artery. [ABSTRACT FROM AUTHOR]

We have recently seen two cases of hyperpigmentation in children, which was reticulate and distributed in a zosteriform fashion. As another two cases of hyperpigmentation of this kind in children have been reported previously, described as reticulate hyperpigmentation distributed in a zosteriform fashion,1,2 this gives a total of four cases of hyperpigmentation of this kind reported recently from Japan. These four cases differed from progressive cribriform and zosteriform hyperpigmentation, the condition which these cases resembled most closely, with respect to the age of onset of the hyperpigmentation, which in the four Japanese cases was not confined to a dermatome. Like a variant of incontinentia pigmenti (IP), all four cases showed eosinophilia. But they differed from IP in that there was no inflammatory stage, no pigmentary incontinence detectable on histology, and no evidence that the condition was hereditary. These four cases do not conform completely to any described entities and we suggest that they represent a new clinical entity. [ABSTRACT FROM AUTHOR]

Abstract: Japanese monkeys walked spontaneously on their hind limbs, when their vision was impaired either by narrowing the visual field or by reducing the incoming light. These variables were manipulated via goggles with translucent pipes and neutral density filters. The bipedal locomotion was observed more frequently as the impairment of the incoming visual information increased. It is very likely that facultative bipeds walk on their hind limbs when they feel the need to “free” their forelimbs to grope their way. [Copyright &y& Elsevier]

The article discusses the case of Japanese boy who was suspected of being born with Osteogenesis imperfecta (OI). The case of successful pamidronate therapy for the preterm infant with severe Osteogenesis imperfecta (OI), a genetic brittle bone disorder and birth weight and course of medication offered and the results are mentioned.

Aim The association between sarcopenia diagnosed according to the criteria of the Asian Working Group for Sarcopenia and increased mortality risk is currently unknown. The present study assessed the longitudinal relationship between sarcopenia and mortality risk in an elderly Japanese population. Methods Participants were 720 community-dwelling Japanese individuals aged 65-79 years at baseline (November 1997 to April 2000). The participants were followed from baseline to 31 December 2014 (mean duration 11.0 years). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria, using extremity muscle mass assessed by dual-energy X-ray absorptiometry, grip strength and gait speed. A population dynamics survey was used to obtain information on deaths. The relationship between sarcopenia and mortality was assessed using Kaplan-Meier survival curves and Cox proportional hazards regression. The Cox proportional hazards model was used to control for potential confounders, including age at baseline, body mass index, total caloric intake, alcohol intake, current smoking habits, leisure-time physical activity and the number of current diseases. Results The fully adjusted hazard ratio for all-cause mortality among men in the sarcopenia group was 1.95 (95% confidence interval 1.04-3.67) compared with that in the normal group. No significant association between sarcopenia and all-cause mortality was observed among women. Conclusion The complications of sarcopenia, including low muscle mass, low grip strength and low gait speed, appear to be significant risks for mortality in older Japanese men. Geriatr Gerontol Int 2017; 17: 1642-1647. [ABSTRACT FROM AUTHOR]