The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid

The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.

Advances in ultrasound diagnosis in chronic liver diseases

Chronic liver disease is a major disorder worldwide. A better understanding of anatomy, blood flow, and pathophysiology may be a key issue for their proper management. Ultrasound (US) is a simple and non-invasive diagnostic tool in the abdominal field. Doppler mode offers real-time hemodynamic evaluation, and the contrast-enhanced US is one of the most frequently used modalities for the detailed assessment. Further development in digital technology enables three-dimensional (3D) visualization of target images with high resolution. This article reviews the wide ranges of application in the abdominal US and describes the recent progress in the diagnosis of chronic liver diseases.

Ultrasonography for Noninvasive Assessment of Portal Hypertension

Portal hypertension is a major pathophysiology in patients with cirrhosis. Portal pressure is the gold standard to evaluate the severity of portal hypertension, and radiological intervention is the only procedure for pressure measurement. Ultrasound (US) is a simple and noninvasive imaging modality available worldwide. B-mode imaging allows broad applications for patients to detect and characterize chronic liver diseases and focal hepatic lesions. The Doppler technique offers real-time observation of blood flow with qualitative and quantitative assessments, and the application of microbubble-based contrast agents has improved the detectability of peripheral blood flow. In addition, elastography for the liver and spleen covers a wider field beyond the original purpose of fibrosis assessment. These developments enhance the practical use of US in the evaluation of portal hemodynamic abnormalities. This article reviews the recent progress of US in the assessment of portal hypertension.

Workplace postgraduate education and changes in rehabilitation therapists’autonomy during the medical examination of stroke patients / 医学教育

Introduction: In the rehabilitation period following a stroke, rehabilitation therapists must thoroughly evaluate the condition of patients for the purposes of goal-setting and effective training. Postgraduate education in the medical examination of patients after stroke was provided for rehabilitation therapists, and changes in their autonomy during medical examinations were subsequently assessed.<br>Method: The education consisted mainly of reading case reports about patients who had strokes and learning neurological examination techniques. A total of 35 once-weekly education sessions were provided to rehabilitation therapists working in a convalescent rehabilitation ward. The rehabilitation therapists evaluated their independence with respect to obtaining patient backgrounds, vital signs, physical findings, neurological findings, laboratory results, and basic knowledge of illness at the beginning and end of the education sessions and 6 months after the sessions ended. Each evaluation item was compared according to the time of evaluation.<br>Results: Rehabilitation therapists’ autonomy over obtaining patient backgrounds, neurological findings, laboratory results, and basic knowledge of illness was greater at the end of the education sessions than at the start of the sessions. Their autonomy over obtaining information in these 4 areas and obtaining physical findings was greater 6 months after the end of the education sessions than at the start of the sessions.<br>Discussion: We conclude that workplace postgraduate training in the medical examination of patients who have had strokes improves rehabilitation therapists’ autonomy during medical assessments.

Motor abilities of older adults in Japanese urban and rural communities / 体力科学

A motor performance test was administered to elderly adults in Koganei City and Nangai Village of Japan as the baseline study of Tokyo Metropolitan Institute of Gerontology, Longitudinal Interdisciplinary Study on Aging (TMIG-LISA) . The participants in this study totaled 405 (183 males and 222 females) aged 65 to 84 from Koganei City, and 734 (295 males and 439 females) aged 65 and over from Nangai Village. The test consisted of measurement of grip strength, one-leg stand-ing, walking at preferred and maximum speeds, and finger-tapping. All motor performances examined were higher among males than females, and they all deteriorated with aging. A regional difference was found in terms of motion speed abilities: finger-tapping rate and walking speed were higher among urban residents than rural residents. Individual differences (coefficient of variation) in the motor ability increased with aging, and reached 106% (maximum tapping rate in female) to 290% (maximum walking speed in female) of those in the twenties. Significant correlations between motor abilities were detected indicating that the specificity of the motor ability found in the young may not account for older adults.

Effect of aging on motor ability in men aged 18 to 83 years / 体力科学

A study was conducted to determine the effect of aging on motor ability and to establish a test battery for physical fitness in the elderly. The subjects were 150 men aged 18 to 83 years. The test items examined were selected, according to Fleishman's list of motor abilities; (1) trunk flexion, (2) grip and isometric knee extension strength, (3) postural sway with eyes open and closed, (4) step test, (5) walking test at preferred and maximum speeds, (6) simple visual reaction time, (7) peg-board test, (8) finger tapping test at maximum rate and in time to metronome sounds. Performances for the test items, except for preferred walking speed and coefficient of variation in finger tapping at 5 Hz, showed significant decreases with aging. The decrease in motor performance at age 80 years relative to the level at age 20 years was less than 30% for finger dexterity and reaction time, 40-60% for muscle strength, maximum walking speed and the step test, and over 70% for trunk flexion and postural sway with eyes closed. A test battery composed of trunk flexion, grip strength, knee extension, step test, walking as fast as possible, postural sway with eyes closed, and finger tapping, is therefore recommended for assessing the effect of aging on physical fitness.