Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis.

Despite the potential of cardiac rehabilitation (CR) to reduce atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA), its prescription is not routine. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of CR in this setting. Inclusion criteria comprised randomized controlled trials (RCTs) comparing CR with usual care in patients with AF following RFCA. We performed a comprehensive search of six databases up to August 17, 2023, and conducted a thorough risk of bias assessment. We synthesized safety outcomes using AF recurrence rates to calculate relative risks (RR). Furthermore, we conducted a meta-analysis on peak oxygen uptake (VO2 peak) and the six-minute walk test (6MWT) to gauge efficacy, utilizing mean differences (MD) for comparison. The GRADE framework was employed to determine the certainty of evidence, with two independent reviewers completing all processes. Our analysis encompassed eight studies with 772 participants aged 55-70 years engaged in moderate-intensity CR for a median of six months. Results showed no significant difference in AF recurrence after CR (RR = 0.69 (0.41-1.14)), with low evidence certainty due to heterogeneity. Subgroup analyses suggested a poor risk reduction effect in patients with obesity and persistent AF. Significant improvements were observed in VO2 peak and 6MWT outcomes (VO2 peak; MD = 2.53 (0.78-4.28), 6MWT; MD = 38.81 (0.65-76.97)), with moderate-certainty evidence. While CR may decrease AF recurrence after RFCA, its effectiveness varies, potentially diminishing in patients with obesity or persistent AF. Moderate gains in physical performance were achieved with minimal adverse events. Further RCTs are warranted to confirm these findings.

Convergent validity of a simplified device and relationship between blood lactate and salivary lactate after a vertical squat jump in healthy non-athletes.

[Purpose] The aims of this study were 1) to examine the convergent validity between Lactate pro 2 and a standard JCA-BM 8000 automatic analyzer using salivary lactate and 2) to investigate the relationship between blood and salivary lactate levels after a vertical squat jump. [Participants and Methods] Healthy non-athletes participated in this observational study. The participants performed a vertical squat jump for 1 min 30 s. Blood and salivary lactate levels were measured before and after exercise using Lactate Pro 2. [Results] The intraclass correlation coefficient between Lactate Pro 2 and the JCA-BM 8000 automatic analyzer was 0.773, which can be considered as substantial convergent validity. However, in some samples, the salivary lactate level was out of the measurable range, and numerical values could not be obtained. The cross-correlation function between the blood and salivary lactate levels was 0.535 at lag 0 and 0.750 at lag 1, which indicated a 5-min lag between the salivary and blood lactate values. [Conclusion] Salivary lactate levels can be easily measured using Lactate Pro 2, although its sensitivity needs to be resolved. Further research is required for salivary lactate level, which can be collected non-invasively, to be used as an alternative parameter to blood lactate level.

Cough Strength Is an Indicator of Aspiration Risk When Restarting Food Intake in Elderly Subjects With Community-Acquired Pneumonia.

BACKGROUND: The incidence of community-acquired pneumonia (CAP) is relatively high in elderly subjects. Cough peak flow (CPF) is an objective indicator of cough strength, and CPF evaluation might be useful to assess whether food intake can be restarted. We aimed to examine whether cough strength assessed with CPF can be used as an indicator of the aspiration risk when restarting food intake in elderly subjects with CAP. METHODS: This cross-sectional study included 82 elderly subjects with CAP between August 2016 and March 2018. CPF was measured using a peak flow meter, and we performed the repetitive saliva-swallowing test (RSST), which is a videoendoscopic evaluation of swallowing and is used to assess dysphagia and aspiration. Receiver operating characteristic (ROC) curve analysis was performed. The cutoff value was determined, and the area under the ROC was calculated. RESULTS: The areas under the RSST and CPF curves were 0.87 and 0.83, respectively. The RSST value for identifying the aspiration risk was 2.5 swallows. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 70.0%, 71.7%, 2.5, and 0.42, respectively. The CPF for identifying the aspiration risk was 190 L/min. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 82.6%, 69.4%, 2.7, and 0.25, respectively. CONCLUSIONS: Our findings suggest that cough strength assessed with CPF can be used as an indicator of the aspiration risk when restarting food intake in elderly subjects with CAP and that CPF evaluation is not inferior to the RSST. However, CPF evaluation should be performed together with swallowing screening tests to determine the aspiration risk.

An Incremental Sit-to-Stand Exercise for Evaluating Physical Capacity in Older Patients with Type 2 Diabetes.

Exercise is recommended for older patients with type 2 diabetes mellitus (T2DM), and increased physical activity contributes to better management of their condition. The conventional exercise test with treadmill or cycle ergometer (CE) for assessing physical capacity, such as peak oxygen uptake (VO2) and anaerobic threshold (AT), is not always usable for older patients with T2DM. The incremental sit-to-stand (ISTS) exercise is an incremental exercise test using external signals to control the sit-to-stand rate in a given time frame and can be performed in a small space using only a chair. This study aimed to examine the validity of the physical capacity assessment during the ISTS exercise, based on the relationships between the ISTS performance, peak VO2, AT on ISTS exercise and CE test, in older patients with T2DM. Twenty-two patients with T2DM (10 men, 12 women; mean age, 68.0 years; range, 61-77 years) performed ISTS exercise (according to an existing protocol) and CE test in a randomized manner. Peak VO2, AT, and completion time were determined for the ISTS exercise and CE test. Peak VO2 during ISTS exercise was significantly associated with that during the CE test (r = 0.89, p < 0.01). The completion time on the ISTS exercise was significantly associated with peak VO2 (r = 0.80, p < 0.01) and AT on the ISTS exercise (r = 0.78, p < 0.01). The ISTS exercise is a useful tool to determine the physical capacity and estimate peak VO2 and AT in older people with T2DM.

Validity and reproducibility of an incremental sit-to-stand exercise test in healthy middle-aged individuals.

[Purpose] We aimed to evaluate the validity and reproducibility of the incremental sit-to-stand exercise test for aerobic fitness evaluation in healthy middle-aged individuals. [Participants and Methods] Thirteen healthy middle-aged individuals randomly underwent the incremental sit-to-stand exercise and cycle ergometer tests, and the peak oxygen uptake was measured during both tests. Pearson's correlation coefficients were used to assess the strength of the association between the peak oxygen uptake measured during the aforementioned tests. Intraclass correlation coefficients with 95% confidence intervals for peak oxygen uptake obtained during the first, second, and third incremental sit-to-stand exercise tests were used to determine the reproducibility of this test. [Results] The peak oxygen uptake measured during the incremental sit-to-stand exercise test was strongly associated with that measured during the cycle ergometer test (r=0.86). The intraclass correlation coefficients (95% confidence intervals) used to verify the association of the peak oxygen uptake between the first and the second incremental sit-to-stand exercise tests and between the second and third incremental sit-to-stand exercise tests were 0.92 (0.66-0.99) and 0.96 (0.82-0.99), respectively. [Conclusion] The incremental sit-to-stand exercise test is a valid and reproducible tool to evaluate aerobic fitness in healthy middle-aged individuals.

Clinical and Histopathologic Characteristics of Melanocytic Lesions on the Volar Skin Without Typical Dermoscopic Patterns.

Importance: It is challenging to differentiate melanoma from melanocytic nevus on the volar skin in the absence of typical dermoscopic patterns. Objective: To identify the frequency and clinical and dermoscopic characteristics of melanocytic lesions on the volar skin not displaying a parallel furrow pattern, lattice-like pattern, fibrillar pattern, or parallel ridge pattern on results of dermoscopy. Design, Setting, and Participants: In this retrospective cohort study, a total of 504 melanocytic lesions on the volar skin were evaluated in the Shinshu University Hospital department of dermatology between January 1, 2000, and December 31, 2012. Dermoscopic images were independently assessed by 3 dermoscopists for the presence of established dermoscopic criteria. Statistical analysis was performed from October 1, 2017, to April 30, 2018. Main Outcomes and Measures: Frequency of dermoscopic criteria and corresponding clinical (patient age and size and location of lesion) and histopathologic features. Results: Of 504 lesions, 110 (21.8%) (melanocytic nevus, 97; melanoma, 8; and equivocal melanocytic lesion, 5) from 108 patients (68 female and 40 male patients; mean age, 40.1 years [range, 1-86 years]) did not show a parallel furrow pattern, lattice-like pattern, fibrillar pattern, or parallel ridge pattern. Among them, the mean patient age was significantly higher for melanoma than for melanocytic nevus (65.3 vs 38.0 years; P < .001), as was mean maximum lesion diameter (11.8 vs 5.7 mm; P < .001). Melanomas and equivocal melanocytic lesions tended to be distributed on weight-bearing areas of the foot sole, such as the heel, while nevi were spread over non-weight-bearing regions. Dermoscopically, 95 melanocytic nevi (97.9%) were symmetrical in 1 or 2 axes while melanomas were not. A total of 91 melanocytic nevi (93.8%) had 1 or 2 colors per lesion, and 4 melanomas (50.0%) had more than 2 colors. Vascular structures were seen in 3 melanocytic nevi (3.1%) and 3 melanomas (37.5%). Blue-white structures were seen in 18 melanocytic nevi (18.6%) and 3 melanomas (37.5%). Dots and globules were seen in 22 melanocytic nevi (22.7%) and 4 melanomas (50.0%). Vascular structures, blue-white structures, and dots and globules were irregularly distributed in the melanomas. Ulcer, hyperkeratosis, and irregular streaks were observed only in melanomas. Conclusions and Relevance: More than one-fifth of melanocytic lesions on the volar skin did not display typical dermoscopic patterns. Asymmetry, numerous colors (≥3), and other melanoma-specific dermoscopic findings were more frequently observed for melanomas. Clinical information, including patient age and lesion size and location, was helpful in differentiating melanoma from melanocytic nevus. Further prospective clinical studies are warranted to clarify the diagnostic accuracy of dermoscopy combined with clinical information.

Image quantification technology of the heterochromatin and euchromatin region for differential diagnosis in the lobular endocervical glandular hyperplasia.

BACKGROUND: Lobular endocervical glandular hyperplasia (LEGH) was first described by Nucci et al. in 1999 and is believed to be a precancerous lesion of minimal deviation adenocarcinoma and gastric-type adenocarcinoma in the uterine cervix. LEGH lesions do not always exhibit apparent cellular and structural atypia, so are difficult to distinguish from normal endocervical cells (EC cells) with cytological examination. Therefore, we often struggle to make a definite diagnosis of LEGH. METHODS: We used microscopy images of cytological specimens that were diagnosed as EC cells and LEGH cells. Signal intensity in whole nuclear area and in heterochromatin and euchromatin regions, euchromatin area ratio, and nuclear morphological features were quantified in each cell nucleus of the cases. Statistical analyses were conducted to determine statistical significance. Finally, we performed linear support vector machine (LSVM) modeling as a discriminant analysis using the quantified features. RESULTS: Signal intensity in whole nuclear area, and heterochromatin and euchromatin regions of EC cell nuclei were higher than that of the LEGH cell nuclei. Morphologically, EC cell nuclei were larger than LEGH cell nuclei, and nuclei of LEGH cells had irregular nuclear respectively membrane structure and an elongated shape. The LSVM accuracy of 10-fold cross validation and leave-one-case-out cross-validation (LOCOCV) using all measured features were 84.7% to 89.3% and 78.6% to 86.0%, respectively. CONCLUSIONS: The LVSM analysis using features extracted from signal intensity and morphological analysis was useful for discrimination of EC cells vs LEGH cells. We therefore believe that this image analysis method could be used for early detection of LEGH.

Infant Suffocation Incidents Related to Co-Sleeping or Breastfeeding in the Side-Lying Position in Japan.

Co-sleeping and breastfeeding in the side-lying position have recently been pointed out as risk factors for suffocation in sleeping infants; however, there is no actual report on an "incident." "Incident" is defined as a tense or sobering experience without a consequential fatal suffocation accident. It is important to understand infant suffocation incidents to prevent accidents during co-sleeping and breastfeeding in the side-lying position. We investigated factors and frequency of infant suffocation incidents associated with co-sleeping and breastfeeding in the side-lying position using a self-administered questionnaire survey of 895 mothers during their infant's 1-, 4-, or 10-month health checkups. Co-sleeping and breastfeeding in the side-lying position were practiced by 28.3% and 56.0% of mothers, respectively; thus, 84.3% of the mothers surveyed were practicing either co-sleeping or breastfeeding in the side-lying position. Of those who received guidance from a medical professional, 36.1% practiced only co-sleeping while 60.1% practiced only side-lying breastfeeding. In the co-sleeping group, 10.6% had faced infant suffocation incidents, while 13.2% in the breastfeeding in the side-lying position group had faced similar incidents. Regarding factors associated with suffocation incidents while co-sleeping, the frequency of occurrence was significantly more in mothers of 1-month and 4-month-old infants compared with those of 10-month-old infants. Of mothers who faced suffocation incidents while breastfeeding in the side-lying position, 45% also had faced similar incidents while co-sleeping. These results demonstrate the importance of thoroughly educating mothers about the risks associated with co-sleeping and breastfeeding in the side-lying position for preventing infant suffocation.

Serum 5-S-cysteinyldopa behavior in the early phase of nivolumab treatment of 12 melanoma patients.

Along with the expansion of therapeutic options for metastatic melanoma, the development of useful biomarkers is urgently required to predict and monitor treatment response. Serum 5-S-cysteinyldopa (5-S-CD) has been identified as a diagnostic marker of malignant melanoma, but its utility as a biomarker for emerging therapeutic agents remains unknown. We assessed serum 5-S-CD in 12 metastatic melanoma patients (median age, 76 years; six men and six women) who had been treated with nivolumab (Nivo) at Shinshu University Hospital between 2014 and 2016. Serum 5-S-CD and lactate dehydrogenase levels before and at 3-6 weeks of Nivo treatment were obtained and their changes were compared with clinical responses as defined by the Response Evaluation Criteria in Solid Tumors criteria (version 1.1). A decrease of 10 nmol/L or more of serum 5-S-CD was observed only in partial response patients (2/3 cases, 67%), while an increase of 10 nmol/L or more of serum 5-S-CD was witnessed only in progressive disease patients (4/8 cases, 50%). Serum 5-S-CD changes were within ±10 nmol/L in the remaining six patients (partial response, one; stable disease, one; progressive disease, four). The results of the four moderately affected progressive disease patients were suspected to have been influenced by small-sized metastatic lesions, a mixed response that included diminished and enlarged metastatic lesions, prior therapy to Nivo with BRAF inhibitors or radiation, or the development of brain metastasis. Serum 5-S-CD in the early phase of Nivo treatment may be helpful to predict therapeutic response in metastatic melanoma.

Development of an Incremental Sit-to-Stand Exercise for Aerobic Fitness Evaluation.

Incremental sit-to-stand exercise (ISTS) is an incremental exercise test using external signals to control the sit-to-stand rate in a given time frame. This study aimed to investigate the concurrent validity and reproducibility of the ISTS in aerobic fitness evaluation among healthy elderly women. Sixteen elderly women performed the ISTS and cycle ergometer test at 3-day to 2-week intervals, and six of the participants performed the ISTS twice. Peak oxygen uptake (VO2), peak heart rate and completion time on the ISTS and cycle ergometer test were determined. Measured peak VO2 on the cycle ergometer test was significantly related to the peak VO2 (r=0.80, P<0.05) and the completion time (r=0.65, P<0.05) on the ISTS. The intraclass correlation coefficients were 0.96 for peak VO2 values and 0.91 for the completion time values during the two ISTSs. In conclusion, the ISTS is a valid, reproducible and safe test for aerobic fitness evaluation in healthy elderly women.

Activities of daily living (ADL) of single elderly individuals using social assistive programs in a rural community.

Objectives　The proportion of elderly individuals living alone is increasing in Japan. Matsumoto city office provides social assistive programs such as home help, lunch delivery, life advice, and safety check telephone calls. The purpose of this study was to compare the level of ADL between the elderly using social assistive programs (the use group) and those who did not (the non-use group).Methods　We conducted a cross-sectional study at Shiga district of Matsumoto city in September 2014. A total of 128 elderly individuals participated in this study. Health volunteers asked these subjects to complete a questionnaire without assistance. Measurement items included lifestyle variables and social support networks. With respect to the frequency of use, we used questions that inquired about the use of the social assistive program. We included a set of instruments commonly used in the health assessment of elderly populations: functional capacity (Instrumental ADL, Intellectual Activity, Social Role), social support, nutrition (Mini Nutrition Assessment [MNA]) and depressive symptoms (Geriatric Depression Scale [GDS]).Results　The use group consisted of 24 elderly individuals participating in the social support program. The non-use group consisted of 89 elderly individuals living alone without programs. The mean age of those who completed the survey was 83.9±4.2 years for the use group and 82.3±4.3 years for the non-use group. Comparisons between the two groups did not show significant difference in terms of their intellectual activity, social role, emotional social support, and MNA or GDS scores. The use group was more likely to use the public transfer service and receive instrumental social support from children and relatives.Conclusions　By means of utilizing the public transfer service, and receiving family support, the elderly living alone who used social assistive programs could live independently. These findings suggest a need for improvement in the public transfer service and social network.

Effect of Different Seat Heights during an Incremental Sit-To-Stand Exercise Test on Peak Oxygen Uptake in Young, Healthy Women.

'Sit-to-stand' exercise uses the repetitive motion of standing up and sitting down in a chair, a common activity of daily living. A new assessment using an incremental sit-to-stand exercise test employs an external sound to control the speed of standing-up and allows increases in work rate. The aims of the study were to examine the effect of different seat heights on peak oxygen uptake (peak VO2) during an incremental sit-to-stand exercise and to assess any difference between peak VO2 values during incremental sit-to-stand exercise compared with a cycle ergometer test. Thirteen healthy young women (age: 23.1 ± 2.6 years, height: 1.61 ± 0.06 m, body mass: 51.9 ± 7.4 kg·m-2) participated in four incremental sit-to-stand tests with different seat heights and cycle tests in random order. The seat heights were adjusted to 100%, 80%, 120%, and 140% of knee height distance (100%, 80%, 120%, and 140% incremental sit-to-stand exercise, respectively). The peak VO2 and completion time were measured during incremental sit-to-stand and cycle ergometer tests, and repeated-measures analysis of variance and Student's paired t-test with Holm's method were used to evaluate differences between these variables. The peak VO2 values increased by about 10-12 mL·min-1·kg-1 as the seat height on the ISTS decreased over a 60% range of lower leg lengths. The peak VO2 values on the 80%, 100%, 120%, and 140% incremental sit-to-stand tests were about 11%, 25%, 40%, and 50% lower than that on the cycle ergometer test, respectively. The peak VO2 on the incremental sit-to-stand test increased as seat height decreased. These findings are useful to determine which seat height on the incremental sit-to-stand tests test is suitable for different populations.

Validity and Reproducibility of an Incremental Sit-To-Stand Exercise Test for Evaluating Anaerobic Threshold in Young, Healthy Individuals.

Sit-to-stand exercise (STS) is a common activity of daily living. The objectives of the present study were: 1) to assess the validity of aerobic fitness measurements based on anaerobic thresholds (ATs), during incremental sit-to-stand exercise (ISTS) with and without arm support compared with an incremental cycle-ergometer (CE) test; and 2) to examine the reproducibility of the AT measured during the ISTSs. Twenty-six healthy individuals randomly performed the ISTS and CE test. Oxygen uptakes at the AT (AT-VO2) and heart rate at the AT (AT-HR) were determined during the ISTSs and CE test, and repeated-measures analyses of variance and Tukey's post-hoc test were used to evaluate the differences between these variables. Pearson correlation coefficients were used to assess the strength of the relationship between AT-VO2 and AT-HR during the ISTSs and CE test. Data analysis yielded the following correlations: AT-VO2 during the ISTS with arm support and the CE test, r = 0.77 (p < 0.05); AT-VO2 during the ISTS without arm support and the CE test, r = 0.70 (p < 0.05); AT-HR during the ISTS with arm support and the CE test, r = 0.80 (p < 0.05); and AT-HR during the ISTS without arm support and the CE test, r = 0.66 (p < 0.05). The AT-VO2 values during the ISTS with arm support (18.5 ± 1.9 mL·min(-1)·kg(-1)) and the CE test (18.4 ± 1.8 mL·min(-1)·kg(-1)) were significantly higher than those during the ISTS without arm support (16.6 ± 1.8 mL·min(-1)·kg(-1); p < 0.05). The AT-HR values during the ISTS with arm support (126 ± 10 bpm) and the CE test (126 ± 13 bpm) were significantly higher than those during the ISTS without arm support (119 ± 9 bpm; p < 0.05). The ISTS with arm support may provide a cardiopulmonary function load equivalent to the CE test; therefore, it is a potentially valid test for evaluating AT-VO2 and AT-HR in healthy, young adults. Key pointsThe ISTS is a simple test that varies only according to the frequency of standing up, and requires only a small space and a chair.The ISTS with arm support is valid and reproducible, and is a safe test for evaluating AT in healthy young adults.For evaluating the AT, the ISTS may serve as a valid alternative to conventional CPX, using either a cycle ergometer or treadmill, in cases where the latter methods are difficult to implement.

The Effect of Different Standing up Frequencies in Sit-to-stand Exercise on Oxygen Uptake.

[Purpose] The aim of this study was to investigate the steady state of oxygen uptake (VO2) at several standing up frequencies to clarify whether workload in the sit-to-stand exercise (STSE) is greater than the anaerobic threshold (AT). [Subjects] Ten healthy young subjects performed the STSE. [Methods] In the STSE, subjects stood up and sat down without using their arms to push-off from the chair at standing up frequencies of 6, 12, 18, 24, 30, and 36 times per minutes. Subjects exercised for 5 minutes at each frequency with 5 minutes of rest between each consecutive frequency trial. The steady state of VO2 was evaluated by the difference in the VO2 between the 3rd and 5th min at each frequency. The correlation between the VO2 of the STSE and the standing up frequency was analyzed. [Results] At standing up frequencies greater than 24 times/min, the steady state of VO2 could not be confirmed. The relationship between the standing up frequency (at less than 24 times/min) and VO2 was strong (r=0.94). [Conclusion] The STSE may be a potentially useful test for determining AT and predicting the physical capacity of patients.

Analysis of pelvic movement in the elderly during walking using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope.

The incidence of falls in the elderly is increasing with the aging of society and is becoming a major public health issue. From the viewpoint of prevention of falls, it is important to evaluate the stability of the gait in the elderly people. The pelvic movement, which is a critical factor for walking stability, was analyzed using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope. The subjects were 95 elderly people over 60 years of age. The criteria for instability were open-eye standing on one leg for 15s or less, and 11s or more on 3m timed up and go test. Forty subjects who did not meet both of these criteria comprised the stable group, and the remaining 55 subjects comprised the unstable group. Pelvic movement during walking was compared between the two groups. The angle, angular velocity, and acceleration were analyzed based on the wave shape derived from the device worn around the second sacral. The results indicated that pelvic movement was lower in all three directions in the unstable group compared to the stable group, and the changes in the pelvic movement during walking in unstable elderly people were also reduced. This report is the first to evaluate pelvic movement by both a triaxial accelerometer and a triaxial gyroscope simultaneously. The characteristics of pelvic movement during walking can be applied in screening to identify elderly people with instability, which is the main risk factor associated with falls.

Effects of low-intensity resistance exercise with vascular occlusion on physical function in healthy elderly people.

Some successful fall prevention programs include resistance or balance training, but less is known about the effects of low-intensity resistance exercise with moderate vascular occlusion (LIO) on physical function in healthy elderly people. In LIO, appropriate pressure is applied to the proximal parts of the upper and lower extremities with a specially designed belt. The reduction of muscle blood flow is considered likely to induce the secretion of growth hormone. The aim of this study was to compare the effects of two training programs, LIO versus dynamic balance exercise (DBE) in elderly people in a community. Fifty-one healthy subjects aged 65 and older were randomly assigned to the LIO program (n = 24) or the DBE program (n = 27). Performance, balance, muscle strength were measured in both groups before and after the 8-week programs. In addition, blood was sampled from LIO participants (n = 11) and analyzed for growth hormone and lactate. Overall improvements, but no group differences, were found in performance and balance after the programs. Muscle strength in the lower extremities was significantly increased in the LIO group, but not in the DBE group. Growth hormone was significantly increased immediately after LIO. The 8-week LIO program improved physical function, especially muscle strength, which may be associated with the exercise-induced secretion of growth hormone. Further studies are needed to determine the contents and duration of an LIO program for elderly people.

Environmental exposure and p53 mutations in esophageal cancer patients in areas of low and high incidence of esophageal cancer in China.

Esophageal cancer is the 6th most common cancer in the world, and genetic factors (p53 mutations) in addition to the environmental factors (food, nutrition, smoking, drinking, etc.) are involved in its development. In this study, the association between the both factors, environmental risk factors for esophageal cancer and p53 mutations, in tumor tissues was investigated in 77 patients living in a high-incidence area and 50 patients living in a low-incidence area in Hebei Province, China. Among these patients, p53 mutations were observed in about 50%, without regional differences in the respective frequencies. G:C>A:T (G to A or C to T) transition mutations were the major type of mutations observed in patients in the high-incidence area (19 patients, 50%), whereas G:C>A:T transitions and insertions were observed with equal frequency (8 patients, 33.3%) in the low-incidence area. As for the association with environmental factors, p53 mutations occurred with higher frequency in patients with a daily intake of spicy foods and in those who used unboiled well water in the low-incidence area. Logistic regression analysis showed no association between food intakes and p53 mutations in high- and low-incidence areas. Thus, higher frequency of spicy food intake and use of unboiled well water may be risk factors of esophageal cancer via p53 mutations in China.

Influence of self efficacy for health promotion on functional decline of elderly living in a rural community in Japan.

OBJECTIVE: To clarify whether self efficacy for health promotion is associated with functional ability among elderly inhabitants of a rural community in Japan. METHODS: The research was a longitudinal study of inhabitants aged 65 and over in a community in Nagano, Japan, who completed a questionnaire at the baseline in 1998 and at follow-up in 1999. The questionnaire included 1) Self Efficacy Scale for Health Promotion measuring the belief in task performance on health, 2) health behavior, 3) a functional ability scale consisting of instrumental activities of daily living, effectance, and social role (Tokyo Metropolitan Institute of Gerontology Index of Competence: TMIG Scale), and 4) demographic factors such as age and sex. RESULTS: At the baseline, 477 subjects completed the questionnaire by themselves and achieved full marks on the TMIG Scale. Of these, 457 responded again 12 months later. Low self efficacy for health promotion at baseline was a significant correlate for functional decline during the 12-month period. CONCLUSION: Self efficacy for health promotion is a predictive factor for functional ability and can be important as an intervention target for elderly people.