Search

A critical factor for preventing osteoporosis after menopause is attenuation of the accelerated turnover rate of bone metabolism. The present randomized controlled study was conducted to clarify the effects of a lemon beverage with calcium (Ca) supplementation that makes use of the chelating action of citric acid. Comprehensive evaluations of bone were performed by assessments of bone mineral density (BMD) and biomarkers related to bone turnover. Seventy-nine postmenopausal women were enrolled and asked to participate in an 11-month continuous intake of the test beverages. The subjects were divided into three groups: those who consumed a lemon beverage containing citric acid with Ca supplementation (LECA group), those who consumed a lemon beverage containing citric acid without Ca supplementation (LE group), and those who consumed no test beverage (control group). Using a double-blind protocol, subjects in the LECA and LE groups consumed one bottle containing 290 mL of the test beverage each day. The ratio of change in BMD after 11 months was significantly higher in the LECA group as compared to the control and LE groups. The LECA group also showed significant decreases in concentrations of tartrate-resistant acid phosphatase 5b (TRACP-5b), a bone resorption marker, and bone alkaline phosphatase (BAP) as compared to the other groups, as well as a significant decrease in concentration of osteocalcin (OC), a bone formation marker, as compared to the LE group. Based on our findings, we speculated that bone resorption and bone formation in postmenopausal women might be suppressed along with an increase in Ca resorption caused by chelation of citric acid in association with continuous ingestion of a Ca-supplemented lemon beverage containing citric acid, resulting in suppression of high bone metabolic turnover. In addition, the results provide information regarding BMD maintenance in the bones of the trunk, including the lumbar spine and proximal femur.

Background Key approaches to preventing the onset of osteoporosis are to maximize peak bone mass (PBM) in early adulthood and to minimize the inevitable loss of bone mineral density (BMD) after menopause. Consequently, osteoporosis attracts a great deal of social as well as medical attention in Japan, a country experiencing population aging. Methods The present randomized, controlled study aimed to elucidate how bone metabolism and bone mineral density (BMD) are affected by the consumption of a lemon juice-containing, calcium-enriched beverage. The effectiveness of this investigational product was evaluated in 79 postmenopausal women. The subjects were assigned to three groups. The first two groups received calcium-supplemented (LECA group) and unsupplemented lemon (LE group) beverages, respectively. The third group (control) received no intervention. The LECA and LE groups consumed one bottle (290 ml) of the appropriate investigational product every day for 11 consecutive months. Results The results showed that the regular consumption of this lemon beverage promoted Ca absorption through the chelating function of citric acid, attenuating bone resorption. The results also suggest that the suppression of bone resorption inhibits bone formation mediated by the differentiation and activity of osteoblasts and leads to the prevention of high-turnover bone metabolism. Conclusion This hypothesis is further supported by the novel finding that the regular consumption of the lemon beverage increases the BMD of both the lumbar spine and femur. We believe that the Ca-supplemented lemon beverage used in the present study will be instrumental in developing effective strategies for the prevention of osteoporosis.

The aim of the present study was to elucidate how bone metabolism and bone mineral density are affected by the consumption of a lemon juice-containing calcium (Ca)-enriched beverage. The efficacy of this investigational product was evaluated in postmenopausal women during five months of continuous intake (intervention). This was a randomized, controlled trial. Eighty-three subjects were assigned to three groups. Using a double-blind format, the first two groups received a Ca-supplemented lemon-juice (lemon) beverage (LECA) or a Ca-unsupplemented lemon-juice (lemon) beverage (LE). The third group (control) received no intervention. Each subject in the LECA and LE groups consumed one bottle (290 mL) of their assigned investigational product every day for five consecutive months. After five months of intervention, the gain in bone mineral density at the lumbar spine was significantly larger in the LECA and LE groups than in the control group. In the femur, subjects in the LECA group gained significantly more bone mineral density than the control subjects. The largest gain in bone mineral density at the lumbar spine was observed in the LECA group. As for the concentrations of the bone resorption marker tartrate-resistant acid phosphatase 5b (TRACP-5b), subjects in the LECA group had significantly lower values than those in the control group. Similarly, when compared with the LE and control groups, a significant decrease was detected in the LECA group in the concentrations of the bone formation markers, bone alkaline phosphatase (BAP) and osteocalcin (OC). In postmenopausal women, continuous consumption of Ca-supplemented lemon beverages improved the absorption of Ca and inhibited bone resorption. This likely blocked the function of osteoblasts and led to the suppression of bone formation, resulting in the attenuation of high-turnover bone metabolism.

Aim: Although neck circumference (NC) is thought to predict obesity-related metabolic abnormality, its causal role in cardiometabolic risk is unclear. The aim of this study was to clarify the impact of changes in NC on cardiometabolic risk in healthy postmenopausal women through a community-based longitudinal study. Methods: From a local community in Japan, 63 generally healthy postmenopausal women were recruited. All participants received an assessment of obesity-related anthropometric markers, biochemical parameters, and hemodynamic measures and were followed on average for 3 years. Results: At baseline analysis, larger NC was positively associated with atherosclerosis-related markers, brachial-ankle pulse wave velocity (baPWV) and blood pressure, as well as some lipid parameters. After the follow-up period, change in NC was associated with changes in body mass index (BMI), body fat percentage, and waist circumference (WC). Interestingly, significant correlations of change in NC with changes in baPWV and blood pressure were observed, whereas changes in WC and BMI were only associated with changes in low-density lipoprotein cholesterol and/or total cholesterol. In multivariate linear regression analysis, change in NC was significantly associated with changes in baPWV and systolic blood pressure, independent of changes in BMI, WC, and biochemical parameters. In addition, an increase in NC was associated with a 2.69-fold increased odds ratio of accelerated baPWV. Conclusions: Change in NC was independently associated with changes in atherosclerosis-related markers. These observations suggest that NC is an important predictor of the risk of developing obesity-related atherosclerosis in healthy postmenopausal women.

The genotype-phenotype relationship was examined experimentally for the Pax6(Sey-4H) mutant, which carries deletion of its chromosome 2 middle region hemizygously. The genotyping has indicated that this deleted segment is between 102.6 and 109.2 Mb from the centromere. The glucose-6-phosphatase gene followed by the glucagon and carboxyl ester lipase genes were mapped adjacent to the deleted region. Phenotyping indicates that the Pax6(Sey-4H) mutant is more susceptible to diabetes. The glucose tolerance test showed that the mutants were less capable of reducing their level of blood glucose to the standard level than the normal sibs. The insulin-loading test revealed their inability to elevate their blood glucose levels up to normal levels. The time it took for the onset of diabetes induced by streptozotocin was shorter in the mutants than in normal sibs. Both the haploinsufficiency of the genes in the hemizygous segment of chromosome 2 and the quantitative imbalance of the whole genome could contribute the development of this phenotype in the mutant.

Infrared thermography provides a non-invasive and dynamic measure of heat. The thermal preservability effects of a salt footbath were evaluated by the infrared thermography technique. The subjects were 23 healthy college students. Feet were soaked for 10 min in a 40-42 degrees C normal footbath. Room temperature was set at 26.5-28 degrees C. At the same time on another day within 3 days of the normal footbath experiment, the same feet were soaked for 10 min in a 40-42 degrees C salt footbath. We measured blood pressure, heart rate and temperatures of the feet, second toes, hands and middle fingers, just before and after immersion and at 10-min intervals thereafter. Mean blood pressure changes showed no difference between the normal and the salt footbath. Mean heart rate changes were higher during the normal footbath than at 0, 15 and 20 min during the salt footbath, respectively (p0.05). Mean thermal preservability of the feet tended to be lower after the normal footbath than at 20 and 30 min, respectively, after the salt footbath, but these differences did not reach a statistical significance. Mean thermal preservability of the hands and middle fingers was significantly lower after the normal footbath than at 20 and 30 min, respectively, after the salt footbath (p0.05). The results suggest that stimulation by a salt footbath affects surface skin temperature, and that stimulation aimed at increasing skin thermal preservability shows a significant difference between normal and salt footbaths.

To investigate the toxic effect of neutrons at energies of approximately 1MeV on the ear, we exposed 7-day-old mice to 1.0 Gy of monoenergetic neutrons (1.026 MeV) or (137)Cs gamma rays, and assessed subsequent morphological changes in the inner ear by light and scanning electron microscopy. Monoenergetic neutrons, but not gamma rays, caused acute changes in the ear. The epithelium of the greater epithelial ridge in the organ of Corti had disappeared by 72 hr post-irradiation, as a result of epithelial apoptosis observed 6 hr post-irradiation. Radiation could induce apoptotic cell death of the epithelium of the greater epithelial ridge at 3 or 4 days of age. Protruding structures were detected on the surface of the hair cells by 72 hr post-irradiation. The neutron-irradiation also caused the apoptotic cell death of epithelial cells at the nasal conchae, and subsequent acute otitis media continued until 10 weeks of age.

To investigate the biological effectiveness of neutrons at energies below 1MeV with regard to ear toxicity, we exposed mice to 1.0 Gy of monoenergetic neutrons (1.026 MeV) or 137Cs gamma rays at 7 days of age, and observed subsequent morphological changes in the inner ear with light and scanning electron microscopes. Monoenergetic neutrons, but not gamma rays, caused acute changes in the ear. The epithelium of the greater epithelial ridge in the organ of Corti showed degeneration around 6 hours and disappeared by 72 hours post-irradiation. The apoptotic cell death of the epithelium of the greater epithelial ridge was inducible by the radiation at 3 or 4 days of age. The hair cells formed the protrusion structures of the surface by 72 hours post-irradiation. Neutron-irradiation also caused acute otitis media until 10 weeks of age.

Allelic loss of chromosome 2 is associated with radiation-induced murine acute myeloid leukemia. However, the gene, which contributes mainly to the leukemogenesis in a tumor suppression manner, has not been identified, yet. Expecting predisposition to acute myeloid leukemia, a radiation leukemogenensis experiment was performed with Pax6Sey3H, one of the small eye mutants. Deletion mapping of Pax6Sey3H indicated that the deleted segment extended from 106.00 to 111.47 Mb from the centromere with a length of 5.47 Mb on chromosome 2. Six known and seventeen novel genes were located in the segment. Pax6Sey3H mutants crossed back into C3H/He did not develop hematopoietic tumors spontaneously, but they did after exposure to γ-rays. The final incidence of hematopoietic tumor in mutants (45.2%) was higher than that in normal sibs (26.2%), and the survival curve of mutants shifted toward the left (p

構音位置, 構音方法などの音声学的対立に基づき構音障害患者の構音の誤りを分析する機能を備えた単語明瞭度検査を作成し, 検査の信頼性, 妥当性などを検討した.本検査をdysarthria患者10例に適用し, 録音した音声を大学生50名に聴取させた結果, 聴取者間の成績のばらつきは小さく, 再検査法による聴取者内の一致度も高かった.また既存の単語明瞭度検査との相関も有意に高いことから, 本検査の明瞭度測定の信頼性, 妥当性は高いと考えられた.本検査で設定した音声学的対立を用いて, 聴取結果を分析することで, 個々の症例の明瞭度を低下させている要因を推定する手掛かりが得られる可能性が示唆され, 本検査は構音障害のリハビリテーションを進めるうえで有用な情報を提供しうると考えられた.

We identified a missense mutation of the Cu/Zn superoxide dismutase (SOD) gene (Leu126Ser) in a Japanese family with ALS that included a patient with the homozygous mutation. The content of the Cu/Zn SOD polypeptide in erythrocytes was markedly reduced in the case with the homozygous mutation compared to those with the heterozygous mutation. We speculated that this reduction of the mutant Cu/Zn SOD molecule might be related to the severe clinical phenotype of the case.

The relationship of bone mineral density (BMD) and bone metabolic markers in women is an interesting field of research. In this study, we aimed to clarify the relationship of body weight, bone metabolic markers and BMD. The subjects were 72 women. The levels of serum bone-specific alkaline phosphatase (BAP), serum type I collagen-cross-linked peptide (s-NTx) and urinary deoxypyridinoline (u-DPD) were measured. The associations between dependent variables (BMD changes/1 or 4 years in the lumbar spine and femoral neck) and explanatory variables (body weight changes/1 or 4 years, the levels of BAP, s-NTx, u-DPD) were evaluated using multiple regression analysis. Changes in the lumbar spine BMD were significantly correlated with changes in height over a year, and those of the femoral neck were significantly correlated with changes in weight over a year. Changes in the lumbar spine BMD over 4 years were significantly correlated with age, BAP and the changes of weight over 4 years. Changes in the femoral neck BMD over 4 years were significantly correlated with the changes in weight for 4 years. These results suggest that BMD changes of different bones correlate with different explanatory variables and that, to predict BMD changes from bone metabolic markers in women, it is necessary to measure BAP levels.

We report a 75-year-old man who had shown bilateral ballistic movements. He had suffered from pulmonary emphysema for about 35 years and was treated with oxygen therapy 3 years before. When he was 70 years old, involuntary movements appeared in bilateral limbs. His involuntary movements were ballistic, and become gradually worse. T2-weighted MRI after admission demonstrated high signal intensities in the bilateral pallidum, indicating multiple brain infarcts in the subcortical white matter. Ultrasonography showed 2 plaques in the left common carotid artery. Laboratory studies revealed blood coagulation abnormalities and hypoxia. Medication with clonazepam and tiapride together with oxygen therapy normalized blood gas levels and improved his involuntary movements. But after discharge, he stopped oxygen therapy and involuntary movement became worse again, associated with hypoxia demonstrated by his blood gas analysis. These findings suggest that not only cerebrovascular disease but hypoxia might play an important role in the appearance and exacerbation of involuntary movements.

A 54-year-old man presented with tremor and unusual behavior. He was admitted two months later because of dementia and myoclonus. Periodic synchronous discharges were observed on the electroencephalogram. Based on these findings, we diagnosed the case as Creutzfeldt-Jakob disease. About two weeks after admission, decubitus, bowel dysfunction and hypohidrosis occurred. We observed various autonomic nervous system dysfunctions such as abnormal pupillary response to autonomic drugs, reduced coefficient of variation of R-R interval, and abnormal diurnal blood pressure variation.

The prolongation of the average life span of women has been associated with the rapidly aging society. However, serious problem have arisen as a result, such as an increase in the number of bed-ridden elderly patients with osteoporosis-associated femoral neck fracture. As preventive measures against osteoporosis for middle-aged to elderly women, 10,000 steps per day and intense exercise have been reported to inhibit bone mineral density (BMD) reduction. However, only a few studies have concretely reported on the type of physical fitness that is effective for BMD in particular parts of the body. In this study, a one-year longitudinal survey was performed involving generally healthy postmenopausal women to investigate physical fitness parameters influencing BMD in the lumbar spine, femoral neck, and femur. The subjects were 38 female residents of M City, aged 49-73 years. As physical fitness parameters, sit-ups, anteflexion in a sitting position, grip strength, mean amount of exercise (kcal), and area of outer body sway on standing straight with the eyes closed (m2) were measured. The BMD was measured in the lumbar spine (L2-L4), femoral neck, and femur. Logistic regression analysis was performed regarding the physical fitness parameters as explanatory variables and groups with and without BMD reduction over one year as those with and without risk as dependent variables. The number of sit-ups (odds ratio: 0.76, 95% CI: 0.61-0.96, p=0.022) was a preventive factor against BMD reduction of the lumbar spine, and ante flexion in a sitting position was a preventive factor against BMD reduction of the femoral neck (odds ratio: 0.88, 95% CI: 0.78-0.99, p=0.029). Regarding BMD reduction of the femur, the area of outer body sway on standing straight with the eyes closed tended to be not significant to the risk. It is suggested that physical fitness and local muscle strength are associated with BMD reduction in the lumbar spine, femoral neck, and femur.

We conducted a survey of 111 healthy middle-aged and older women, aged 40 to 80 years, to elucidate the relationships between blood leptin and adiponectin levels and bone mineral density (BMD) in September 2008. We examined the associations between the blood levels of these adipocytokines and the lumbar spine (L2-L4), left femoral, and distal forearm BMD after adjustment for the age and body fat percentage. No correlation was observed between leptin and the BMD. This is presumably due to the fact that the influence of menopause, age, duration of postmenopausal period, and body fat percentage on the BMD is greater than that of leptin levels in healthy women. The adiponectin levels were significantly correlated negatively with the lumbar spine and femoral BMD in premenopausal women, and with forearm BMD in postmenopausal women, regardless of adjustment for age and body fat percentage. It seems likely that adiponectin influences the BMD at different skeletal sites in pre- and postmenopausal women.

Previous studies have shown that pramipexole might have the potential to improve depressive symptoms in patients with Parkinson's disease. To provide more evidence, in five Japanese patients at HoehnYahr stage 1-3 we evaluated the Unified Parkinson's Disease Rating Scale (UPDRS), Hamilton Depression Rating Scale (HAMD) and Montgomery Asberg Depression Rating Scale (MADRS) at our hospital. After the pramipexole treatment, each total score of UPDRS, HAMD and MADRS significantly decreased compared with that before the treatment. Our data indicate that pramipexole improves depressive symptoms in patients with Parkinson's disease.

An 81-year-old man diagnosed with alcohol-induced persistent mild cognitive impairment consulted our clinic presenting with gait disturbance. Between the ages of 20 and 53 years, his alcohol consumption was 1.8 liters of alcoholic sake per day. However, from the age of 53 years onward, his consumption decreased to 360 ml per day. The patient had alcoholic neuropathy, mild cognitive impairment, and alcoholic cerebellar disorder. His score on the revised version of Hasegawa's Dementia Scale (HDS-R) was 22 and his clinical dementia rating (CDR) was 0.5. His score on the Japanese version of the Mini-Mental State Examination (MMSE) was 22. These scores indicated mild cognitive impairment (MCI). He had delusions and confabulations, without impairment of date and place orientation. Magnetic resonance imaging (MRI) demonstrated enlarged ventricles, sulcal widening, and brain atrophy. He was provided with medication and counseling to treat his alcohol abuse. He accepted our treatment and is presently doing well after 1 year 2 months of treatment.

We introduced the relationship between bone change and neurological disturbance in the patients with cerebrovascular disease (CVD) , Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS) . High incidence of osteoporosis and right/left difference in osteopenia are found in the diseases. CVD and PD patients with asymmetrical osteopenia show an association between clinical symptoms, peripheral circulatory symptoms, and predominant osteopenia. Although the muscle strength of PD patients was normal, the more severely affected side for PD symptoms and autonomic symptoms coincided with predominant osteopenia in the body. Increased bone resorption was detected in ALS patients. We speculated that neurological disturbances affect the remodeling of local sites of the bone. We have to start treatment from an early stage of the neurological disease to prevent a fracture.

The influence of age and physique on dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS) was investigated in young, middle-aged, and older women. The validity of the bilateral calcaneal QUS values was investigated regarding the bone mineral density (BMD) values on DXA of the lumbar spine, left femoral neck, and left femur as the optimal standards. The subjects were 55 young women (19.6 +/- 1.0 years), and 152 middle-aged and older women (62.9 +/- 7.2 years). The BMD on DXA was significantly correlated with the bone strength on QUS in both young and middle-aged or older women, but the positive likelihood ratios of the standard QUS values recommended by the manufacturer to the optimum standards on DXA were low, suggesting that osteoporosis cannot be diagnosed or predicted by use of the QUS method. Combination with DXA is necessary, such as primary screening by QUS followed by secondary screening by DXA.

We evaluated the association between the stress levels and biological responses of nursing students in a clinical practicum. The subjects consisted of 28 third-year nursing students at the nursing department of College A. The degree of stress was evaluated using the Japanese version of the State Trait Anxiety Inventory (STAI). As parameters of biological responses, serum estrogen, salivary cortisol, and salivary IgA were measured. These measurements were performed twice (before and during the clinical practicum). Before and during the practicum, the STAI state anxiety score increased from 46.3 +/- 8.1 to 52.3 +/- 8.9 indicating the nursing students' practicum-associated stress. No changes were observed in the salivary cortisol or IgA level, but the serum estrogen level decreased during the practicum from 36.7 +/- 14.7 to 27.0 +/- 9.2 suggesting the inhibition of estrogen secretion.

We used multi-channel near infra-red spectroscopic topography to evaluate the dynamics of cerebral circulation of patients with cerebrovascular disease (CVD). The subjects included 17 patients with chronic CVD, while 11 physically unimpaired persons served as controls. We used a spectroscopic topography device (Hitachi, ETG -100) to determine the topographic values of oxy-Hb, deoxy-Hb, and total-Hb in the right and left cerebral hemispheres. Hand grasp for 30 or 60 second duration was used as the exercise task, and each task was tried twice. In the control group, the oxy-Hb values of the left cerebral hemisphere were elevated by bilateral hand grasp, while those of the right cerebral hemisphere were elevated by left hand grasp. In patients with a lesion in the left cerebral hemisphere, oxy-Hb values of the left hemisphere were elevated by the bilateral hand grasp, while those of the right hemisphere were elevated only by the healthy left hand grasp. When the 30- and 60-second-duration grasp exercises were compared, it was found that the oxy-Hb values in the control group corresponded to the loading time. In patients with either right or left cerebral lesion, the oxy-Hb peak values were lower than those of the control group, while the peak values did not show any difference between the 30-and 60-seconds hand grip durations themselves. The latency from the start of the grasp to the maximum peak of the oxy-Hb value was significantly prolonged in CVD patients as compared with that in the control group. As for the relation between the degree of hemiparesis and the oxy-Hb values, the value of the oxy-Hb in the left cerebral hemisphere during right hand grasp decreases depending on the severity of paralysis induced by the left cerebral lesion. The determination of cerebral oxy-Hb values by near infra-red spectroscopic topography using exercise test appeared to be useful for the evaluation of the dynamic of cerebral circulation in stroke patients. Furthermore, the possibility of inducing recovery by the rehabilitation of stroke patients, who were in the chronic stage, should be studied.

We evaluated the contents and characteristics of informed consent obtained by the primary care physician from a male patient with advanced cancer and his family, and clarified the influences of the informed consent on family function. This patient was diagnosed as having advanced cancer at the age of 46 years, underwent surgery/chemotherapy, but died after 4 months at the hospital. Semi-structured interviews were held with the elder daughter of the patient, and notes on the patient's disease, the course of treatment, his family's responses, and the informed consent obtained by the primary care physician were taken during the interview. The informed consent obtained by the primary care physician had the following characteristics: (1) The physician transmitted accurate and detailed information on the treatment methods, side effects, and prognosis by appropriate communication techniques with consideration for the feelings of the patient and his family, and proposed choices so that they could participate in the decision of treatment principles. (2) During the entire course, the primary care physician frequently visited the bedside and encouraged the patient and his family to express their feelings of anxiety and to ask questions, giving continuous emotional support. With the progression of the disease and explanation by the primary care physician, the patient and his family expressed and shared feelings such as grief and powerlessness and supported each another. Gradually, they began to show practical/adaptive coping behavior and could accept the patient's death. Appropriate informed consent obtained by the primary-care physician promoted the family function of this family.

The genotype-phenotype relationship in mice was examined experimentally using one of the small eye mutants, Pax6(Sey-4H), which deletes the chromosome 2 middle region, hemizygously. The genotyping indicated that the deleted region starts at a site 102.60 Mb from the centromere and has a length of 6.51 Mb, in which 12 known and 27 novel genes are located. Expecting the development of myeloid leukemia, gamma-irradiation was performed to female mutants at the age of 10 weeks. The mutants did not develop myeloid leukemia during the observation period of 18 months. Instead, they developed tumors in the alimentary tract spontaneously (56.0%). The tumor latency was shortened by the radiation exposure, but the tumor incidence of the gamma-irradiated group (62.5%) was as high as that of spontaneously developing tumors. Intraductal proliferation of the epithelium of the Wirsung duct was observed in the gamma-irradiated mutants (18.8%). Considering the results of the Pax6(Sey-4H) mutant together with those of another small eye mutant, Pax6(Sey-3H), the anomaly and the tumorigenicity of the intestinal tract were closely related to the hemizygosity of the 3.2 Mb segment of chromosome 2, where both mutants show a common deletion.

Parkinson's disease (PD) is characterized by motor disturbances such as tremor, slow movement and rigidity. Also, pain is a common symptom in patients with PD. The prevalence of pain is 40–75% in patients with PD. Physicians should pay attention to pain in patient with PD. We report a PD patient who suffered from fibromyalgia (FM). If the amount of pain is not maximal in the side more affected by parkinsonism and pain is not markedly relieved when the patient is in the “on” state, the pain may be due to FM.

Introduction. We elucidated the cause and clinical characteristics of malignant syndrome (MS) in patients with Parkinson's disease (PD), early-onset parkinsonism (EOP), and other neurological disorders. Materials and methods. Subjects were 260 patients with PD or EOP, and three patients with other neurological disorders associated with MS. We studied clinical symptoms before and after the onset of MS, and evaluated autonomic function particularly before the onset of MS. Results. The overall incidence of MS accompanying PD and EOP in our department was eight of 260 patients (3.1%). The incidence of MS in EOP was significantly higher than that in PD. All patients with MS showed comparatively longer duration of illness and advanced stage of PD and EOP. Factors triggering MS included reduced dosage or discontinuation of anti-parkinsonian drugs, reduction of oral intake, dehydration, infectious disease, postoperative state, and treatment with major tranquilizers. Although patients demonstrated marked autonomic symptoms at the onset of MS, in many cases autonomic dysfunction developed before the onset of MS. Even EOP patients, who usually demonstrated milder autonomic dysfunction, showed abnormalities in the correlation between circadian rhythm of blood pressure and pulse rate, and/or abnormal gastric emptying test, suggesting that autonomic dysfunction plays an important role in the cause of MS. Cooling the body, fluid replacement, resumption or increasing the dosage of anti-parkinsonian drugs and administration of dantrolene sodium overcame MS in all cases. Conclusion. Autonomic dysfunction is related to the cause and clinical features of MS in PD, EOP and some other neurological disorders.

Because the complications of decreased bone mineral density, such as femoral neck fractures and severe spinal deformities, have a strong impact on daily life, prevention has become more important than therapy. The present study included as subjects 771 women residing in Innoshima City, Sera-gun, and Mihara City, all in Hiroshima Prefecture. We determined bone mineral density in the lumbar spine and femoral neck of these women, measured their height and weight, and examined the effect of age and body mass index (BMI) on bone density rate (YAM%). The subjects of the study were all volunteers. As no significant difference could be demonstrated in comparison with the results of the 1998 National Nutrition Survey of height, body weight, and BMI, we considered there would be no problem in extrapolating the results of the present determinations to middle-aged and elderly women. In the relationship between age and YAM%, a negative trend was observed prior to menopause, but was not significant. After menopause, however, a significant negative correlation was demonstrated. In addition, a significant positive correlation was observed between BMI and age-corrected YAM% for the lumbar spine and femoral neck. In future studies, the YAM% of the lumbar spine and femoral neck corrected for age and BMI should be investigated to determine the influence of lifestyle.

We reported a 62-year-old man of late-onset familial amyloid polyneuropathy type I(transthyretin Met 30-associated familial amyloid polyneuropathy) from Ehime Prefecture. There was no family history related to endemic Japanese foci (Nagano and Kumamoto foci). He demonstrated paraesthesia in the legs and mild autonomic symptoms at the age of 52. These symptoms gradually developed. Analysis of the transthyretin gene from his leucocytes demonstrated he had Met 30 transthyretin mutation. Therefore, he was diagnosed with late-onset familial amyloid polyneuropathy type I(FAP 1). In some families, asymptomatic carriers with the mutant transthyretin gene were diagnosed. In early stage, this patient's polyneuropathy and autonomic nervous system dysfunction were less serious than those of FAP 1 patients from endemic Japanese foci. These symptoms of this patient was slowly progressive. He hoped liver transplantation (brain death or living-related) treatment if possible. Now he became 68-year-old and bed-ridden.

There are no studies in the literature on the effect of exercise in reversing osteoporosis of the upper extremities for people with neurological disorders. The purpose of this study was to explore what conditions respond to a home exercise program for the upper extremities. Sixteen patients, divided randomly into experimental and control groups, were recruited for this trial for at least one year. Both upper extremities of the patients, affected and unaffected, were tested pre and post trial with the Hologic QDR for bone area, bone mineral content (BMC), bone mineral density (BMD), fat, muscle mass, muscle mass plus BMD, total weight, and relative fat content (percent). The home exercise program involved the subject squeezing a ball, one hand at a time, 20 times each, three times a day, at least three times a week, while sitting with the elbow flexed and the arm resting comfortably at the side of the trunk or on an armrest. A significant difference (p0.02) was found in bone area, BMC, BMD or relative fat content between the affected and sound sides both before and after the study, although all parameters were much different for each patient. We found a statistically significant difference in a change in the bone area for the affected upper extremities of the control group, but not of the experimental group. Subjective reactions of the subjects were positive. They stated that they felt they were improving and contributing to their recovery. Patients with Parkinson's disease, but not those with cerebral infarction, seemed to react to the exercise with an increase in bone mineral content, although the difference was not significant due to the scarce number of subjects. This is a preliminary pilot study to help develop further research on what condition is likely to respond to exercise for protection against osteoporosis.