De-Training Effects Following Leucine-Enriched Whey Protein Supplementation and Resistance Training in Older Adults with Sarcopenia: A Randomized Controlled Trial with 24 Weeks of Follow-Up.

OBJECTIVES: This study aimed to evaluate the effectiveness of de-training after a combined intervention of leucine-enriched whey protein supplementation and resistance training on skeletal muscle mass and strength in older adults with sarcopenia. DESIGN: A randomized controlled trial. SETTING: A community in Hyogo, Japan. PARTICIPANTS: The study included older adults aged ≥ 65 years who were screened for sarcopenia at the Care Center from, a community in Hyogo, Japan. The participants were randomly allocated to one of three groups: whey protein supplementation after resistance training (RT + PRO; n = 27), resistance training only (RT; n = 27), and whey protein supplementation only (PRO; n = 27). INTERVENTIONS: An intervention program was conducted over a period of 24 weeks. The program included RT and/or PRO supplementation twice a week for 24 weeks, followed by a de-training period for another 24 weeks. PRO supplementation included 11.0 g of protein and 2,300 mg of leucine. The total energy and protein intake amounts for the participants in all groups were controlled to achieve at least 30 kcal/kg ideal body weight (IBW)/day and 1.2 g/kg IBW/day, respectively, during the intervention and de-training periods. MEASUREMENTS: The primary outcomes, such as mean change of appendicular skeletal muscle mass index (ΔASMI), and secondary outcomes, such as handgrip strength (ΔHGS), were measured at baseline, the end of intervention, and at 12 and 24 weeks of de-training. RESULTS: Compared to baseline, ASMI and HGS increased significantly at the end of the intervention period in the RT+PRO group (ASMI and HGS, p < 0.01); however, there were no significant differences in ΔASMI and ΔHGS between each group. At 24 weeks of the de-training period, ΔASMI and ΔHGS were higher in the RT + PRO group than in the RT group (p < 0.05 and p < 0.01, respectively). CONCLUSION: We demonstrated that combined intervention of RT and PRO showed long-term maintenance in treating sarcopenia than RT only at 24 weeks after de-training. Therefore, PRO intake after RT may be useful in the treatment of sarcopenia in older adults.

Dysmenorrhea among Japanese women.

OBJECTIVE: To investigate the epidemiology of dysmenorrhea in Japanese women of menstrual age. METHODS: A prospective cohort study was conducted using a health diary in a sample representative of Japanese women. Information on health care use was also collected. RESULTS: Among 823 enrolled participants (age range, 18-51 years), dysmenorrhea (mean duration 1.75 days; range 1-5 days) was reported in 15.8% (95% CI, 13.3-18.3) during the 1-month study period. Common associated symptoms included headache (10.77%), back pain (6.92%), and fatigue (5.38%). No participant with dysmenorrhea visited a physician, while 51.5% of the women used self-medication, and 7.7% used complementary/alternative medicine. CONCLUSION: Dysmenorrhea is common in Japanese women. In our study, about half used self-medication, while some preferred complementary/alternative medicine. Dysmenorrhea is significantly associated with younger age and employment status.

[Emergent surgical treatment of type A acute aortic dissection in an elderly patient].

An 86-year-old man with severe chest pain and shock was transferred to our hospital. Computed tomography revealed type A aortic dissection with cardiac tamponade. He needed intubation and closed chest massage preoperatively. At operation, intrapericardial space was filled with clotted blood and rupture of the ascending aorta was confirmed. He underwent a successful emergency graft replacement of the ascending aorta. Postoperative course was uneventful except for mild hemianopsia due to cerebral infarction. He had recovered to be able to walk and is doing well.

Persistent effects of a structured psychiatric intervention on breast cancer patients' emotions.

The aim of the present study was to investigate persistence of the clinical effectiveness of a 5-weekly structured group intervention program for Japanese breast cancer patients. Each program is a series of five 90-min sessions, which include psycho-education, problem-solving, psychological support, relaxation training, and guided imagery. Fifty-seven patients with breast cancer participated in the program and the 47 who completed were analyzed. The results of the Profile of Mood States (POMS) scores were compared before, just after, and 6 months after the intervention. According to the change in POMS scores, the clinical effectiveness of a structured group intervention program persisted for 6 months for the patients who had no psychiatric diagnoses at entry. By contrast, this 5-weekly intervention program did not show persistent effects for patients who had a psychiatric diagnosis at entry. Therefore, additional intervention would be needed for patients with psychiatric diagnosis at entry.

Analgesic effects of sub-Tenon's versus retrobulbar anesthesia in planned extracapsular cataract extraction.

BACKGROUND: A prospective study was conducted to compare the analgesic effects of sub-Tenon's and retrobulbar anesthesia by assessing patients' response to the visceral stimulus. METHODS: Seven hundred and twenty eyes of 720 patients underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation. They received retrobulbar anesthesia with 3 ml lidocaine (225 eyes), retrobulbar anesthesia with 5 ml lidocaine (216 eyes), or sub-Tenon's anesthesia with 3 ml lidocaine (279 eyes). Pain scores were recorded when an acetylcholine chloride solution was injected into the anterior chamber to attain miosis after lens implantation. RESULTS: Pain scores were significantly different among the three anesthesia groups (P<0.0001, Kruskal-Wallis test). The multiple comparison revealed that analgesic effects were highest with sub-Tenon's anesthesia, followed by 5-ml retrobulbar and 3-ml retrobulbar anesthesia. CONCLUSION: Sub-Tenon's anesthesia is an effective and reliable anesthetic method in cataract surgery.

Effects of a structured psychiatric intervention on immune function of cancer patients.

The aim of the present study was to examine the influence of mood state and coping styles on the immune function in Japanese breast cancer patients who participated in a structured group intervention program. The program consisted of five-weekly 90-minute sessions, including psycho-education, psychological support, problem-solving technique and relaxation/imagery. Out of 77 breast cancer patients who participated in this program, 34 were eligible for measurement of immune functions because they received adjuvant chemotherapy. Comparison of the pre- and post-intervention scores of the Profile of Mood States (POMS) revealed significant decreases in Depression (p < 0.05), Lack-of-Vigor (p < 0.01), Tension-Anxiety (p < 0.01), Confusion (p < 0.05) and Total Mood Disturbances (p < 0.01), as expected. Concerning coping styles, there were tendencies to decrease the score of active-cognitive coping (p = 0.09), although the differences were not statistically significant. In contrast, the pre- and post-intervention values of immune parameters such as CD3, CD4, CD8, CD4/8 and natural-killer cell activity showed no significant differences. In this report, we discuss several possibilities underlying these findings. Further studies with a larger number of subjects and controls are needed to reach conculusions.

Anesthetic dose and analgesic effects of sub-Tenon's anesthesia in cataract surgery.

PURPOSE: To compare the analgesic effects of different doses of sub-Tenon's anesthesia in cataract surgery by assessing patient response to visceral stimulus. SETTING: Inouye Eye Hospital, Tokyo, Japan. METHODS: A prospective study was done of 1019 eyes of 1019 patients having phacoemulsification and posterior chamber intraocular lens implantation. They received a 1.0 mL (391 eyes), 2.0 mL (366 eyes), or 3.0 mL (262 eyes) anesthetic infiltration into the sub-Tenon's space. Pain scores were recorded when the anterior chamber was irrigated with an acetylcholine chloride solution to attain miosis after lens implantation. RESULTS: The distribution of pain scores was significantly different among the 3 groups (P < .0001, Kruskal-Wallis test). Multiple comparison revealed that the 3.0 mL anesthetic infiltration offered significantly higher analgesic effects than the 2 lower doses. The 3.0 mL sub-Tenon's anesthesia effectively blocked the visceral stimulus. CONCLUSION: For cataract surgery, 3 mL is the optimal dose of anesthetic solution in sub-Tenon's anesthesia.

A dose-finding study of lenograstim (glycosylated rHuG-CSF) for peripheral blood stem cell mobilization during postoperative adjuvant chemotherapy in patients with breast cancer. Lenograstim/Breast Cancer Study Group.

BACKGROUND: The optimum dose of granulocyte colony-stimulating factor (G-CSF) for peripheral blood stem cell (PBSC) mobilization after disease-oriented, conventional-dose chemotherapy remains unknown. METHODS: A multicenter dose-finding study of glycosylated G-CSF (lenograstim) for the mobilization of PBSCs following adjuvant CAF chemotherapy (cyclophosphamide, doxorubicin and 5-fluorouracil) was performed in 38 patients with postoperative breast cancer. Each 10, ten and eight patients were sequentially allocated to one of the three dose groups (2, 5 and 10 micrograms/kg, respectively) of lenograstim. Lenograstim was administered subcutaneously (s.c.) daily from day 8 to the day of the last apheresis and CD34+ cells and colony-forming units-granulocyte macrophage (CFU-GMs) in peripheral blood were measured serially. Additionally, 10 patients who received adjuvant CAF chemotherapy alone also participated in the study, as a control. RESULTS: Lenograstim was well tolerated up to 10 micrograms/kg, except for one patient given 10 micrograms/kg who developed transient grade 3 hepatic enzyme elevation. The peak levels of CD34+ cells and CFU-GMs in peripheral blood showed dose-response relationships. The median peak CD34+ cells for the 0, 2, 5 and 10 micrograms/kg dose groups were 5.4, 34.3, 55.0 and 127.6 cells/microliter, respectively, and those of CFU-GMs for the 0, 2, 5 and 10 micrograms/kg dose groups were 0.01, 0.33, 1.32 and 3.30 CFU-GMs/microliter, respectively. CONCLUSIONS: Considering the previous reports suggesting that a pre-apheresis number of 40-50 CD34+ cells/microliter in peripheral blood is highly predictive for achievement of more than 2.5 x 10(6) CD34+ cells/kg in a standard apheresis procedure of 10 litres, the optimum dose of lenograstim for PBSC mobilization following CAF chemotherapy in patients with postoperative breast cancer is 5 micrograms/kg/day s.c.

Comparison of sub-Tenon's anaesthesia by different delivery techniques in cataract surgery.

PURPOSE: To compare the analgesic effects of three different delivery techniques of sub-Tenon's anaesthesia in cataract surgery by assessing patients' response to the visceral stimulus. METHODS: A prospective, randomised study was conducted on 345 eyes of 345 patients undergoing phacoemulsification and posterior chamber intraocular lens implantation. They received anaesthetic infiltration into the sub-Tenon's space through a conjunctival incision (115 eyes), infiltration into the posterior sub-Tenon's space (retrobulbar space) through a conjunctival incision (114 eyes), or injection into the intra-Tenon's space (subconjunctival space) without making a conjunctival incision (116 eyes). Pain scores were recorded when the anterior chamber was irrigated with an acetylcholine chloride solution to achieve miosis after lens implantation. RESULTS: There were no significant differences in pain scores among the three groups (chi-squared test of homogeneity, p = 0.814). Approximately 10-20% of patients reported slight to severe pain at the time of acetylcholine administration. CONCLUSIONS: The three anaesthetic delivery methods of sub-Tenon's anaesthesia possess similar and reasonable analgesic effects in cataract surgery, but may not block visceral stimuli completely.

cDNA cloning and functional expression of a human monocyte chemoattractant protein 1 receptor.

A novel human G-protein-coupled seven-transmembrane-type receptor gene, 24-1, has been cloned from THP-1 cells. The 24-1 was 56% and 34% identical to the macrophage inflammatory protein-1 alpha (MIP-1 alpha) receptor and the interleukin-8 (IL-8) receptors at the amino acid level, respectively. To examine the ligand specificity of the receptor, we have established a stable transfectant of this gene with human kidney 293 cells. Monocyte chemoattractant protein-1 (MCP-1) induced a rapid increase of Ca++ influx in the 24-1-transfectant, while other C-C chemokines tested did not. This indicates that the 24-1 encodes the human MCP-1 receptor.

Copper deficiency in an infant on prolonged total parenteral nutrition.

An infant with the megacystis microcolon intestinal hypoperistalsis syndrome, required total parenteral nutrition due to ineffective gastrointestinal function, and developed copper deficiency after a prolonged course in total parenteral nutrition in conjunction with a chronic draining jejunostomy. She responded promptly to copper supplementation.

[High-dose combination chemotherapy with autologous bone marrow transplantation in breast carcinoma].

Twelve patients with breast carcinoma were treated with high-dose combination chemotherapy supported by autologous bone marrow transplantation (ABMT). Seven of them had advanced metastatic disease and received 12 cours of A treatment, response rate (CR +PR) was 71.5% (CR: 1, PR: 4, NC: 2 and PD: 0) and it should be noted that all 4 patients who had received adriamycin 150 mg+5-fluorouracil 1,500 mg divided in two consecutive days or equivalent high-dose of other chemotherapeutic regimen responded (CR: 1 and PR: 3). To the therapy Five other patients received ABMT-supported adjuvant chemotherapy because of high risk of recurrence. One of them died of unrelated cause and other 4 are free of disease at 11, 14, 17 and 17 months following this treatment. A major toxicity was of myelosuppression and nadirs of neutrophils were 100-1,800 on days 9-19 (median: 400 on day 12), neutrophils recovered rather rapidly to levels of greater than or equal to 1,000, greater than or equal to 1,500 and greater than or equal to 2,000 by day 15, 16 and 17, respectively. High-dose combination chemotherapy with ABMT seemed quite effective in advanced breast carcinoma and a similar approach in adjuvant setting has also been suggested.

Theory and practice of image art psychotherapy.

Image Art Psychotherapy (IAPT) and its practical applications were presented through one case study. The synthetic house-tree-person (Syn. HTP), a part of the whole therapeutic process, is a unique and excellent method for obtaining information on psychoneurotic patients with problems in family dynamics. Free expression, spontaneous expression and thematic drawings are utilized simultaneously in IAPT. It is important to note again that there are image expressions applicable not only to one graphic representation but to a whole series involving the 'drawing-observing-examining-continuing to draw again' process, and somatic self-expression; that these too reflect the preconceptual emotion and total psychosomatic rhythm, and that there exists a process of approaching the true self over the ordinary defences. The importance of the experience process of images or psychosomatic rhythm lies in the fact that not only an understanding and perception of, and insight into the self can be obtained through creative and somatic rhythm expression, but also the flow of the unconceptualized raw emotion and psychosomatic rhythm is manifest as it is and is reorganized in the total psychosomatic sense.