Effects of lunges inserted in walking (eccentric walking) on lower limb muscle strength, physical and cognitive function of regular walkers.

INTRODUCTION: Walking is a popular exercise but does not increase lower limb muscle strength and balance. We hypothesized that muscle strength, physical and cognitive function would be improved by inserting lunges in conventional walking. METHODS: Eleven regular walkers (54-88 years) who had more than 5000 steps in exercise walking a day at least 5 days a week participated in this study. They walked as usual for the first 4 weeks and included lunges and descending stairs or slope walking (i.e., eccentric walking) for the next 8 weeks. The steps of eccentric walking were gradually increased from 100 to 1000 steps per week over 8 weeks. RESULTS: The average steps per day were 10,535 ± 3516 in the first 4 weeks, and 10,118 ± 3199 in the eccentric walking period without a significant difference. No significant changes in maximal voluntary isometric contraction torque of the knee extensors (MVC), 30-s chair stand (CS), 2-min step, balance assessed by center of pressure movement area with eyes close, sit and reach, a digit symbol substitution test (DSST) for cognitive function were observed in the first 4 weeks. However, significant (P < 0.05) improvements were evident in MVC (18.6 ± 15.7%), CS (24.2 ± 17.3%), balance ( - 45.3 ± 34.5%), and DSST (20.8 ± 16.7%) from weeks 4 to 12. Serum complement component 1q concentration decreased (P < 0.05) from weeks 4 to 12, although no changes in serum glucose, triglyceride, and cholesterol concentrations were observed. CONCLUSION: These results supported the hypothesis, and suggest that eccentric walking provides effects that are not achieved by conventional walking.

[Questionnaire survey of municipalities on policies to promote physical activity among residents: An examination by administrative sector and population size].

Objectives　National policies to promote physical activity and exercise have been formulated by several ministries and agencies in Japan. This study aimed to examine the formulation and implementation of such policies in municipalities by administrative sector and population size.Methods　After stratifying all municipalities in Japan at the population level, we randomly selected 272 municipalities. We collected 1,632 cases in six sectors (health, sports, education, urban planning, transportation, and environment) within these municipalities.　A questionnaire survey on the status of policy formulation, implementation, and coordination among departments was conducted as a cross-sectional study. Differences between groups of municipalities were statistically analyzed using Fisher's exact test. The survey period was from September 2018 to March 2019.Results　A total of 616 responses were collected (response rate 37.7%). The response rates for health and education were lower than those for the other sectors. The rate of policy formulation to promote physical activity was extremely high in the health and sports sectors, and there was slight variation by population size. In contrast, formulation rates were generally low in the urban planning, transportation, and environment sectors, especially in smaller municipalities. In the sectors mentioned above, physical activity promotion projects mainly involved the development of exercise and sports infrastructures. Health, sports, and education were the primary sectors that used those environments. Regarding interdepartmental coordination in policy implementation, a cooperative relationship existed among the health, sports, and education sectors and between the urban planning and transportation sectors. However, smaller municipalities were found to have fewer opportunities for such collaboration and tended to implement policies independently.Conclusion　This study clarifies the policy formulation and implementation for promoting physical activity in municipalities at the national level in Japan. In addition, their characteristics were identified based on different administrative sectors and population size. These results are expected to be used in future local government policies.

Do the Impacts of Mentally Active and Passive Sedentary Behavior on Dementia Incidence Differ by Physical Activity Level? A 5-year Longitudinal Study.

BACKGROUND: It has not been determined whether mentally active sedentary behavior (MASB) and passive sedentary behavior (PSB) differentially affect cognitive function and whether these associations differ according to physical activity (PA) level. We examined the comparative impacts of MASB and PSB on dementia onset and aimed to understand whether the associations differed by PA level. METHODS: We conducted a 5-year longitudinal study involving all community-dwelling older adults in a rural area in Japan (n = 5,323). Dementia onset was examined using long-term care insurance data. PA was evaluated using the International Physical Activity Questionnaire and categorized as low (<2.5 metabolic equivalent of task [MET]-h/week), moderate (2.5-16.0 MET-h/week), or high (≥16.0 MET-h/week). We also assessed PSB (TV-watching time; <1 h/day, 1-3 h/day, ≥3 h/day) and MASB (Book-reading time; <10 min/day, 10-30 min/day, ≥30 min/day). To examine the associations of MASB and PSB with dementia onset, we performed the Fine-Gray models accounting for competing risk of death. RESULTS: During the follow-up period, 606 (11.4%) participants developed dementia. MASB was independently associated with a lower risk of dementia; the magnitude of the impact was significant at higher PA levels. There was no association between PSB and developing dementia across all PA levels. Furthermore, dementia risk for individuals with high PA levels and moderate or high MASB levels was approximately 60% lower than those with low PA levels and low MASB. CONCLUSION: Providing interventions to promote MASB, which reduces dementia risk, and PA, which increases MASB's effect on dementia incidence, can be beneficial in delaying or preventing dementia onset.

[Relationship between low back pain and physical activity and sitting time among community-dwelling older adults: A cross-sectional study].

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.

[Effect of an exercise program targeting knee pain on medical costs of elderly community-dwelling adults].

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 -5.6×103 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 9.3×103 yen/person (95% CI: -39.6-58.3) in 2015, -2.0×103 yen/person (95% CI: -44.4-40.5) in 2016, -10.3×103 yen/person (95% CI: -42.5-21.9) in 2017, and 8.2×103 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.

Metabolomics with 15N Labeling for Characterizing Missing Monoterpene Indole Alkaloids in Plants.

Monoterpene indole alkaloids (MIAs) in medicinal plants remain uncharacterized owing to their complicated structure by metabolomics using liquid chromatography-tandem mass spectrometry (LC-MS/MS) despite their pharmaceutical importance. We demonstrate an untargeted metabolome analysis with 15nitrogen (N) labeling to characterize MIAs having an indolic skeleton in the flowers, leaves, petioles, stems, and roots of Catharanthus roseus. Principal component analysis using 15N- and nonlabeled metabolome data showed that N-containing metabolites (N-metabolites) are labeled with 15N. Paring of the 15N- and nonlabeled precursor ions were performed using the criteria of retention time, difference of m/z value, and a nonlabeled product ion at m/z 144.08 that indicates an indolic skeleton. The mass shift of the m/z value of the product and precursor ions to their 15N-labeled ions identified the number of N of their ions. Finally, molecular formula of 45 MIAs was unambiguously identified using the identified N number. The alkaloid network analysis using the MS/MS similarity showed the structural commonness and uniqueness among the MIAs. Of them, antirhine was identified using an authentic standard compound. Multimetabolomics using LC-MS/MS and imaging mass spectrometry showed that antirhine accumulates considerably in the epidermis and vascular cylinder of the roots. The developed approach showed the existence of the missing MIAs. The modification of this approach will identify other MIAs that contain a hydroxylated or methoxylated indolic skeleton.

[Physical parameters and physical function in older drivers with driving-related anxiety: the Nakagawa Study].

AIM: This study investigated whether driving-related anxiety was independently associated with physical parameters and physical function in community-dwelling older people. METHODS: Participants were 523 community-dwelling older drivers (353 men and 170 women). Participants self-reported driving-related anxiety when driving in familiar environments, and completed physical assessments: visual impairment, auditory impairment, cerebrovascular disease (CVD), hand grip strength, knee extension strength, timed up and go (TUG), chair stand, one leg standing with open eyes, functional reach, vertical jump, preferred gait speed and maximal gait speed. Participants were divided into a driving-related anxiety group (72.8±5.1 years; 21 men, seven women) and a no-anxiety (non-anxiety) group (70.7±4.7 years; 325 men, 163 women). We examined physical performance differences between the anxiety and non-anxiety groups using analysis of covariance, and investigated the relationship between anxiety, physical function and performance using logistic regression analysis (forward stepwise selection). RESULTS: The driving-related anxiety group was significantly older, with higher rates of visual impairment, auditory impairment, and CVD than the non-anxiety group. The anxiety group exhibited independently poorer TUG and maximal gait speed (P<0.05 for both). Logistic regression analysis revealed significant relationships between anxiety and visual impairment (odds ratio [OR]: 5.6, 95% confidence interval [CI]: 2.5-12.6), auditory impairment (OR: 3.0, 95% CI: 1.3-7.0), TUG (OR: 1.46, 95% CI: 1.1-1.9) and CVD (OR: 3.1, 95% CI: 1.0-9.4) (P<0.05 for all). CONCLUSIONS: Driving-related anxiety was significantly associated with worse physical performance, visual impairment, auditory impairment, and CVD in community-dwelling older drivers.

Comparison between eccentric and concentric resistance exercise training without equipment for changes in muscle strength and functional fitness of older adults.

PURPOSE: The present study tested the hypothesis that resistance exercise training focusing on eccentric muscle contractions would improve muscle strength and functional physical fitness more than concentric contraction-focused resistance training in older adults. METHODS: Healthy older adults (65-84 years) were placed into eccentric (ECC; n = 9) or concentric training group (CON; n = 8). They performed 4-6 basic manual resistance exercises focusing on either eccentric or concentric muscle contractions once at a community centre and at least twice at home a week for 8 weeks. Muscle thickness of the quadriceps femoris (MT), knee extensor maximal voluntary isometric contraction strength (MVC), 30-second chair stand (CS), 3-metre timed up and go (TUG), 2-minute step (2MS), sit and reach (SR), and static balance with eyes open and closed (Bal-EC) were assessed before and 7 days after the last community centre session. RESULTS: Changes in MT (ECC: 21.6 ± 9.2% vs CON: 6.7 ± 7.1%), MVC (38.3 ± 22.6% vs 8.2 ± 8.4%), CS (51.0 ± 21.7% vs 34.6 ± 28.3%), TUG (16.7 ± 9.9% vs 6.3 ± 7.7%), 2MS (9.9 ± 6.0% vs 6.0 ± 7.3%) and Bal-EC (35.1 ± 6.7% vs 8.8 ± 16.2%) from baseline were greater (P < 0.05) for the ECC than the CON group. CONCLUSION: These results show that the eccentric manual resistance exercise training was more effective for improving lower limb strength, mobility, and postural stability of older adults when compared with the concentric training. This suggests the significance of emphasising eccentric muscle contractions in movements to maintain and improve physical function.

Efficacy of the traditional Japanese medicine goreisan for the resolution of spermatic cord hydrocele in children.

PURPOSE: Goreisan, a traditional Japanese medicine, has previously been used for hydrostatic modulation. This retrospective study investigated the efficacy of goreisan for spermatic cord hydrocele resolution in children. METHODS: Seventy-two boys treated for spermatic cord hydrocele between 2012 and 2015 were included; Goreisan was administered to 16 [group G, median age 3 (1-8) years], and 56 were followed without medication [group C, median age 1 (0-8) years]. An age-matched comparison was conducted between 14/16 group G patients (group g) and 14/56 group C patients (group c). RESULTS: Incidences of resolution were higher in groups G and g than in groups C and c, respectively, both during the study period and within the first 6-month observation period; groups G and g also had a significantly lower incidence of surgery for hydrocele than in groups C and c, respectively. The interval from the commencement of observation until hydrocele resolution was significantly shorter in group G than in group C, but not in group g than in group c. CONCLUSION: Goreisan can effectively promote the resolution of spermatic cord hydrocele in children and may be a valid treatment choice for this condition.

RAMP1 suppresses mucosal injury from dextran sodium sulfate-induced colitis in mice.

BACKGROUND AND AIMS: Calcitonin gene-related peptide (CGRP) is thought to be involved in the modulation of intestinal motility. CGRP receptor is composed of receptor activity-modifying protein (RAMP) 1 combined with calcitonin receptor-like receptor (CRLR) for CGRP. The study investigated the role of CGRP in mice with experimentally induced colitis. METHODS: The study used dextran sodium sulfate (DSS) to induce colitis in mice. The study compared the severity of colitis in wild-type (WT) mice, mice treated with a CGRP receptor antagonist (CGRP8-37 ), and RAMP1 knockout (-/- ) mice. Pathological changes in the mucosa were assessed, and inflammatory cells and cytokine levels were measured. RESULTS: The severity of inflammation in DSS-induced colitis increased markedly in CGRP8-37 -treated mice and RAMP1-/- mice compared with WT mice. RAMP1-/- mice showed more severe damage compared with CGRP8-37 -treated mice. The number of periodic acid-Schiff-positive cells decreased in CGRP8-37 -treated mice compared with WT mice and was even further decreased in RAMP1-/- mice. RAMP1 was expressed by macrophages, mast cells, and T-cells. RAMP1-/- mice exhibited excessive accumulation of macrophages and mast cells into the colonic tissue with increased levels of tumor necrosis factor-α and interleukin-1ß as compared with WT mice. Infiltration of T-cells into the colonic mucosa, which was associated with the expression of T helper (Th) cytokines including Th1 (interferon gamma) and Th17 (IL-17), was augmented in RAMP1-/- mice. CONCLUSIONS: The findings of this study suggest that RAMP1 exerted mucosal protection in DSS-induced colitis via attenuation of recruitment of inflammatory cells and of pro-inflammatory cytokines.

Errata: The relevant factors for knee pain in community-dwelling elderly: A cross-sectional study.

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

The prevalence and basic characteristics of knee pain in community-dwelling independent elderly: A complete survey.

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.

A cross-sectional study on the factors related to cognitive decline in community-dwelling elderly.

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.

The relevant factors for knee pain in community-dwelling elderly: A cross-sectional study.

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.

Pentraxin-3 as a Biomarker for Febrile Neutropenia in Patients with Lung Cancer.

BACKGROUND: Pentraxin-3 (PTX3) is a newly discovered biomarker for various inflammatory conditions. We measured plasma PTX3 levels in patients with febrile neutropenic lung cancer and examined the utility of PTX3 levels as a biomarker for febrile neutropenia. METHODS: Fourteen patients with febrile neutropenic lung cancer were enrolled in the study. In addition, 10 untreated lung cancer patients and 12 healthy adults were enrolled as a disease control group and a healthy control group, respectively. On the day of onset of febrile neutropenia (day 1) and days 3 and 7, PTX3 and C-reactive protein (CRP) levels were measured. In the control groups, PTX3 and CRP levels were measured once. RESULTS: On day 1, plasma CRP levels in febrile neutropenia during chemotherapy or chemoradiotherapy for lung cancer (FN/LC) patients (8.11 ± 6.42 mg/dL) were significantly higher than those in healthy controls (HC) and chemotherapy/chemoradiotherapy-naïve lung cancer (CN/LC) patients (p < 0.05). However, CRP levels of the CN/LC group (0.33 ± 0.02 mg/dL) were also significantly higher than those of the HC group (0.07 ± 0.09 mg/dL) (p < 0.05). In contrast, plasma PTX3 levels of the FN/LC group (6.14 ± 5.28 ng/mL) were significantly higher than those of the HC and CN/LC groups on day 1 (p < 0.05), but PTX3 levels of the CN/LC group (1.60 ± 0.64 ng/mL) were not significantly higher than those of the HC group (1.05 ± 0.25 ng/mL). In the FN/LC group, PTX3 levels peaked immediately on day 1. CONCLUSIONS: PTX3 may be a useful biomarker for diagnosis of FN in patients with LC.

Somatic CTNNB1 mutation in hepatoblastoma from a patient with Simpson-Golabi-Behmel syndrome and germline GPC3 mutation.

Simpson-Golabi-Behmel syndrome is a rare overgrowth syndrome caused by the GPC3 mutation at Xq26 and is clinically characterized by multiple congenital abnormalities, intellectual disability, pre/postnatal overgrowth, distinctive craniofacial features, macrocephaly, and organomegaly. Although this syndrome is known to be associated with a risk for embryonal tumors, similar to other overgrowth syndromes, the pathogenetic basis of this mode of tumorigenesis remains largely unknown. Here, we report a boy with Simpson-Golabi-Behmel syndrome who had a germline loss-of function mutation in GPC3. At 9 months of age, he developed hepatoblastoma. A comparison of exome analysis results for the germline genome and for the tumor genome revealed a somatic mutation, p.Ile35Ser, within the degradation targeting box of ß-catenin. The same somatic mutation in CTNNB1 has been repeatedly reported in hepatoblastoma and other cancers. This finding suggested that the CTNNB1 mutation in the tumor tissue represents a driver mutation and that both the GPC3 and the CTNNB1 mutations contributed to tumorigenesis in a clearly defined sequential manner in the propositus. The current observation of a somatic CTNNB1 mutation in a hepatoblastoma from a patient with a germline GPC3 mutation supports the notion that the mutation in GPC3 may influence one of the initial steps in tumorigenesis and the progression to hepatoblastoma.

Randomized controlled trial to examine the tolerability of bronchoscopy with and without pharyngeal laryngeal anesthesia (TACOYAKI study).

BACKGROUND: The SARS-CoV-2 pandemic, pharyngeal anesthesia such as nebulizer or lidocaine pump spray is the risk of droplet transmission to health care workers from coughing due to spraying anesthesia. Absence of pharyngeal anesthesia may induce coughing and reduce patient and operator satisfaction, but the efficacy of pharyngeal anesthesia under sedation is still limited. Therefore we evaluated a prospective, randomized, single-blind trial to evaluate efficacy of pharyngeal anesthesia in patients receiving sedation. MATERIALS AND METHODS: We conducted a randomized comparison of pharyngeal anesthesia with or without bronchoalveolar lavage in patients undergoing bronchoscopy at our hospital between March and October 2022. Pharyngeal anesthesia was performed using 8％ lidocaine spray and the operators were blinded to eliminate bias. Two hundred patients were entered into the study and divided into two groups: those who received pharyngeal anesthesia(control group) and did not receive pharyngeal anesthesia(test group). The primary endpoint was the operator's satisfaction with the procedure. The secondary endpoints were the patient's cough during the examination as perceived by the operator, cough and discomfort experienced by the patient and the dose of analgesic/sedative/lidocaine administered. These scales were scored from 0 to 100. RESULT: In primary endpoint, there was no significant difference in the operator-rated procedure satisfaction between the 2 groups. The median for the discomfort score for patients in the control group was tendency higher than in the test group. There were no significant differences in other secondary endpoints. CONCLUSION: Pharyngeal anesthesia may not be recommended for flexible bronchoscopy performed under combined sedation and analgesia. TRIAL REGISTRATION: Registration number: UMIN000046975Date of registration: 2022/03/07.

Congenital prepubic sinus associated with a urachal remnant: report of a case.

Congenital prepubic sinus is a rare congenital anomaly situated in the midline of the lower abdomen. We report a case of congenital prepubic sinus, closely associated with a urachal remnant. Preoperative magnetic resonance imaging showed clearly that the sinus tracked the urachus caudally. This finding supports the theory that the anomaly is caused by abnormal remnant tissue originating from the cloacal membrane, which tracks the allantois duct caudally along with fetal longitudinal growth.

Surgical technique to prevent spillage of cyst fluid during operation for cystic ovarian tumors.

We describe a new technique to prevent spillage of cyst fluid in patients undergoing surgery for cystic ovarian tumors. The cyst is first covered with a sterilized surgical sheet applied with quick-drying glue and is then punctured. This technique completely prevents spillage of cyst fluid into abdominal cavity.

Association of social participation (including inconsistent participation) with the progression of frailty among older adults: Community-based cohort study in Japan.

AIM: This study examined the relationship between continuity of social participation and progression of frailty among community-dwelling older adults, by baseline frailty level. METHODS: This study was part of a 3-year community-based cohort study among adults aged ≥65 years, living independently in a rural municipality in Japan. Mail surveys were carried out in 2016, 2018 and 2019. This study involved 2799 participants who responded to the question about social participation in every survey. Frailty was evaluated by Kihon Checklist total scores. Social participation was categorized into consistent non-participation, interrupted recent non-participation, interrupted recent participation and consistent participation. We assessed the relationship between social participation and change in frailty scores using general linear regression analysis, stratifying the participants into groups by their frailty level at baseline. RESULTS: There was a smaller frailty score increase in the robust (ß -0.61, 95% CI -0.99 to -0.22) and prefrail groups (ß -0.73, 95% CI -1.18 to -0.27) for consistent participation than consistent non-participation. Interrupted recent participation showed significant suppression in the prefrail group (ß -0.96, 95% CI -1.60 to -0.32). Social participation had no clear effect on progression in the frail group. CONCLUSIONS: Consistent social participation might reduce the progression of frailty in robust and prefrail people. Inconsistent participation might also help to reduce progression in prefrail older adults. It is important for prefrail older adults to return to their social activities and continue to engage as long as possible, even if their participation was intermittent in the past. Geriatr Gerontol Int 2023; 23: 25-31.