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Background: This study investigated the effects of mobility restrictions (MRs) during the COVID-19 epidemic on physical activity, body composition, and exercise tolerance in patients with obesity. Methods: We analyzed data of obesity patients participating in a 6-month weight loss program in February 2020, and after, when the epidemic was considered to have had some effect on outdoor activity in Osaka, Japan (MR group). MR group patients were compared to patients with obesity attending the program in 2018 and 2019 (non-MR group) who had a similar number of months as MR group. Changes in physical activity, body composition, and exercise tolerance (O2 consumption; VO2) owing to the weight loss program were analyzed between both groups using analysis of covariance and logistic regression analysis. Results: Decreases in body fat were significantly higher in MR group than in non-MR group. However, increases in physical activity, VO2 at anaerobic threshold, and peak VO2 were significantly lower in MR group; however, increases in peak VO2 owing to the weight loss program were less likely to be achieved in MR group (odds ratio, 0.21; 95% confidence interval, 0.06–0.81). Conclusion: MR during the COVID-19 epidemic may have affected the exercise tolerance of patients with obesity.

Background An effective strategy for weight loss in patients who are overweight or obese is to reduce body fat mass while maintaining skeletal muscle mass. Adiponectin and myostatin are affected through changes in body composition due to weight loss, and examining their dynamics may contribute to strategies for maintaining skeletal muscle mass through weight loss. We aimed to examine the relationships among myostatin, adiponectin, and body composition, depending on the extent of weight loss, in patients with obesity undergoing a weight loss program. Methods We examined 66 patients with obesity (age: 46.8 ± 14.0 years, body mass index: 34.3 [31.0–38.4] kg/m2) attending a hospital weight loss program. We categorized the patients into two groups, namely an L group (those with a weight reduction of 5% from baseline). All patients underwent blood tests and were assessed for body composition, insulin resistance, adipocytokine and myokine levels, exercise tolerance, and muscle strength at baseline and post-intervention. Results Serum myostatin and adiponectin levels increased post-intervention in both groups. Body weight and %fat decreased, and the rate of lean body mass (%LBM) increased in both groups. Exercise capacity and muscle strength improved in the M group only. Change in (⊿) myostatin correlated with ⊿%fat, ⊿%LBM, and ⊿adiponectin. ⊿adiponectin (β = − 0.262, p = 0.035) was an independent predictor of ⊿myostatin. Conclusions Myostatin and adiponectin might cross-talk and regulate changes in skeletal muscle and fat mass with or without successful weight loss. These findings indicate that evaluating serum myostatin and adiponectin levels in clinical practice could be used to predict the effects of weight loss and help prevent skeletal muscle mass loss.

[Purpose] We aimed to evaluate oxygen uptake adjusted by total skeletal muscle mass in patients with cardiovascular disease with or without type 2 diabetes mellitus. [Participants and Methods] The participants included 54 males ≥50 years of age without heart failure who underwent cardiopulmonary exercise testing during cardiac rehabilitation. We divided the participants into two groups: patients with type 2 diabetes mellitus (DM group) and patients without type 2 diabetes mellitus (NDM group). [Results] We found no significant differences in age, weight, fat mass, or skeletal muscle mass between the groups. There were also no differences in cardiac function, body composition, and heart rate response. The DM group showed significantly lower peak oxygen uptake values adjusted by skeletal muscle mass, despite the absence of significant differences in skeletal muscle mass. A significant positive correlation was found between peak oxygen uptake and age, weight, and skeletal muscle mass. Stepwise regression analysis revealed that age, skeletal muscle mass, and medical history of diabetes were independent predictors of absolute peak oxygen uptake. [Conclusion] Peak oxygen uptake adjusted by skeletal muscle mass in patients with cardiovascular disease and type 2 diabetes mellitus is lower than that in those without type 2 diabetes mellitus.

Objective DNA methylation is an epigenetic mechanism that regulates gene expression. The obesity-related (FTO) gene is the first gene found to be associated with fat mass and obesity. However, no studies have examined the relationship between weight-loss intervention effect and FTO methylation in obese individuals with whole blood DNA. The purpose of this study was to quantify FTO whole blood DNA methylation and investigate the relationship between body composition, exercise capacity, and blood parameters with a 6-month weight-loss program intervention. Participants and methods Eighteen female participants (mean age, 50.6 ±12.1 years, body mass index (BMI), 33.5 ± 6.2 kg/m2) who completed a 6-month weight-loss program at the obesity outpatient department at the Health Science Center of Kansai Medical University Hospital from March 2017 to October 2018 were included in the analysis. Participants were randomized into a normal treatment group (NTG) and a group with additional resistance training (RTG). Body composition, exercise tolerance and metabolic index were measured in each participant. DNA methylation status in whole blood samples was determined using pyrosequencing. All measurements were taken during the first visit and at the 6-month post-intervention visit. Results The methylation rate was significantly decreased in the NTG in CpG1 (p=0.011) and total value of CpG (p=0.011), whereas in the treatment group containing resistance training (RTG), CpG3 (p=0.038) was increased significantly. Furthermore, the independent factors that determine %CpG3 of RTG were visceral fat area change rate (%VFA) (β = -0.568, P = 0.007, R2 = 0.527) and resistance training (β = 0.517, P = 0.012, R2 = 0.527), which have been extracted. Conclusion A 6-month weight-loss program, including resistance training, may be associated with decreased visceral fat area changes and increased RTG CpG3 methylation changes. However, further replication studies with larger sample sizes are warranted to verify the findings of this study.

Angiopoietin-like protein 2 (ANGPTL2) promotes chronic inflammation and plays a key role in the pathogenesis of heart failure. Cardiac rehabilitation (CR) is an integral component of heart failure management and has been shown to have anti-inflammatory effects. However, ANGPTL2 concentration in chronic heart failure patients undergoing CR has not been evaluated. This study aimed to investigate serum ANGPTL2 levels and their associated factors and compare the results with those of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with chronic heart failure undergoing phase III CR.A total of 56 patients were enrolled. Clinical characteristics including body composition, grip strength, exercise tolerance, duration of CR, blood counts and biochemistry, and echocardiographic parameters were evaluated for their association with serum ANGPTL2 and NT-proBNP levels.The median (first and third quartiles) value of ANGPTL2 was 4.05 (2.70-5.57) ng/mL. Clinical parameters that correlated with serum ANGPTL2 levels were body weight, body mass index, body fat mass, body fat percentage, anaerobic threshold (AT), C-reactive protein, and total protein (TP), which were mostly distinct from those that correlated with serum NT-proBNP levels. A multivariate analysis revealed that AT and TP were independent factors related to ANGPTL2 levels, whereas age, left ventricular ejection fraction, and left atrial dimension were independently related to NT-proBNP levels.These observations suggest that CR increases the exercise tolerance and exhibits anti-inflammatory effects simultaneously, and this situation is reflected by decreased serum ANGPLT2 and TP levels. ANGPTL2 may be a useful marker of inflammation and impaired exercise tolerance in patients with chronic heart failure.

Background Because of the advanced age of patients with cardiovascular disease (CVD), prevention of sleep disorder and dementia is a priority for cardiac rehabilitation (CR) during their long-term care. This study aimed to investigate the association of physical activity with sleep quality and cognitive function in elderly patients with CVD in the CR maintenance phase. Methods We conducted a multicenter study through the Clinical Exercise Physiology Association Japan network, which included 102 elderly patients (mean age, 74 ± 7.4 years) with CVD undergoing phase III CR at 6 institutions. Physical activity was assessed using a triaxial accelerometer for 7 consecutive days and was classified as locomotive and household activities. Physical fitness was assessed via 6-min walking distance (6MD), hand grip power, 10-m walking speed, one leg standing time with eyes open, and 10 times sit-to-stand tests. Sleep quality and cognitive function were evaluated using the Pittsburgh sleep quality index (PSQI) and mini-mental state examination (MMSE) scores, respectively. Results The patients performed 5506.8 ± 3743.6 steps/day and scored 5.8 ± 3.5 points in the PSQI and 28.4 ± 1.7 points in the MMSE. Sleep latency and MMSE scores correlated with locomotive activity, but not with household activity. Locomotive activity and 6MD were independent predictors of sleep latency and MMSE score, respectively. When patients with heart failure were excluded, the relationship between sleep latency and locomotive activity was preserved, but the relationship between exercise tolerance and cognitive function disappeared. Conclusion Locomotive activity and exercise tolerance are associated with sleep latency and cognitive function in elderly patients with CVD continuing phase III CR. However, in this study, the relationship between exercise tolerance and cognitive function was offset by the presence of heart failure.

Background: Previously, we observed that adiponectin—an adipose tissue-derived hormone—was negatively correlated with muscle strength while myostatin—a myokine protein secreted by skeletal muscle—was positively correlated with appendicular lean mass. Albeit interesting, the relevance of these relationships is unclear. Thus, we aimed to examine the relationship between myostatin, adiponectin, and body composition in patients with obesity undergoing a weight loss program.Methods: We studied 66 patients with obesity (age: 46.8 ± 14.0 years, body mass index: 34.3 [31.0, 38.4] kg/m2) attending a hospital for a weight loss program. Participants were divided into those with weight reduction less than 5% (the L group) and greater than 5% (the M group) from the baseline. All patients underwent blood tests and were assessed for body composition, insulin resistance, adipocytokines, myokines, exercise tolerance, and muscle strength at baseline and after the program. Results: Serum myostatin and adiponectin levels increased after the program in both groups. Body weight and %fat decreased, and the rate of lean body mass (%LBM) increased in both groups. Exercise capacity and muscle strength improved in the M group only. Change in (⊿) myostatin correlated with ⊿%fat, ⊿%LBM, and ⊿adiponectin. ⊿adiponectin (β = -0.262, p = 0.035) as an independent predictor of ⊿myostatin. Conclusions: Myostatin and adiponectin might crosstalk and regulate changes in skeletal muscle and fat mass. These findings might predict the effects of weight loss and prevent skeletal muscle mass loss by evaluating serum myostatin and adiponectin in clinical practice.

BackgroundAdiponectin has been reported to be associated with lower skeletal muscle mass and skeletal strength and may be involved in skeletal muscle regulation along with myostatin. This study aims to evaluate the association between serum adiponectin and myostatin levels and identify independent factors using body composition and metabolic parameters in patients with obesity.MethodsOverall, 148 patients (age, 45.9 ± 14.3 years, body mass index, 37.2 ± 8.0 kg/m2) who initially visited the outpatient clinic of obesity between November 2013 and November 2019 were included. Body composition was measured using InBody 720 and dual energy X-ray absorptiometry. In addition, muscle strength, vascular function, and metabolic parameters were measured. Serum levels of adiponectin, leptin, myostatin, and irisin were measured from blood samples.ResultsThe serum adiponectin level was 2.9 μg/mL (1.7–4.1 μg/mL), and the serum myostatin level was 2398.4 pg/mL (1,777.1–2952.5 pg/mL). The stepwise regression analysis revealed less leg strength, homeostasis model assessment of insulin resistance, and C-reactive protein as an independent predictor of serum adiponectin levels based on the significance of the univariate analysis (R2= 0.190, P < 0.001). A high appendicular lean mass/body weight, reactive hyperemia index, and irisin were independent factors for serum myostatin levels (R2= 0.260, P < 0.001)ConclusionThe serum adiponectin level was associated with less muscle strength. Although serum myostatin was associated with a high appendicular lean mass, it is possible that myostatin was regulated by the percentage of body weight from appendicular lean mass.

非常に稀な腹壁ヘルニアである,半月状線ヘルニアの1例を経験した.患者は65歳女性,約1年前からの右下腹部の有痛性の膨隆を主訴に来院した.右下腹部に直径3cmの圧痛のある腫瘤を認め,圧迫で大きさはやや縮小した.腹部CTで,右腹直筋外縁に腱膜の欠損と腹腔内より脱出するヘルニアを認めた.半月状線ヘルニアと診断し,入院の上全身麻酔下に手術を行った.腹直筋外縁での腱膜の欠損と,ヘルニア嚢の脱出を認めた.内容物は大網であった.ヘルニア嚢の切除とヘルニア門の閉鎖を行った.術後早期に痛みは消失し,経過良好にて7日目に退院した.半月状線ヘルニアは,頻度が少なく本邦報告例は自験例を含め19例である.この疾患を念頭に置かなければ確定診断に苦慮することも多い.診断には腹部CTが非常に有用であった.

The epidemic of obesity is now a major public health concern in many parts of the world. Face-to-face tailored lifestyle modification therapy is one of the major approaches used for weight loss. However, the lack of time for multiple visits and the lack of resources for administering therapy hinder its implementation. We administered a web-based weight loss program for obese patients from July 2010 to January 2012 that required only 2 personal interviews over 6 months. The program used a system of auto-extraction of behavioural objectives and auto recording of daily weight and number of steps taken. The subjects included 3 obese men (mean age, 35.7 ± 2.3 years; mean body mass index (BMI), 30.4 ± 0.8 kg/m²) and 17 obese women (mean age, 39.3 ± 9.5 years; mean BMI, 28.1 ± 1.8 kg/m2) who volunteered to participate in this weight loss program. Weight loss achieved through this program was significant (mean, 2.7%, p=0.047). Abdominal visceral fat area (VFA) decreased significantly (mean, 12.6%, p=0.017), and the serum cholinesterase and alanine aminotransferase levels improved (mean, 33 U/L, p=0.003; mean, 7 IU/L, p=0.033 respectively). Metabolic syndrome criteria number had a tendency to decrease. Dietary and nutrient intake levels on the food frequency questionnaire improved. Weight loss ratio after 6 months and initial weight loss ratio were strongly significantly correlated. A web-based weight loss program with auto-extraction of behavioural objectives and recording of daily weight and steps can achieve weight loss, as determined by VFA reduction, on low manpower.目前，肥胖是世界上许多地方的一个重要的公共卫生问题。通过面对面地制定 个性化生活方式来治疗肥胖是一个非常重要的方法。但是时间和人员的短缺导 致此方法难以推广。我们制订了一套针对肥胖病人基于网络的减肥方案，此方 案从2010 年7 月到2012 年1 月间开展，期间，6 个月内仅需要与病人会面两 次。该方案使用一套可以智能提取减肥目标和智能记录每日体重以每日所采用 的步骤。参与此方案的有3 位肥胖男性（平均年龄：35.7±2.3 岁，平均身高体 重指数（BMI）：30.4±0.8 kg/m2）和17 位肥胖女性（平均年龄：39.3±9.5 岁，平均BMI：28.1±1.8 kg/m2），均自愿参与此项方案。在此项方案实施 中，体重明显减轻（平均下降2.7%，p=0.047），腹部内脏脂肪面积（VFA） 也有显著下降（平均下降12.6%, p=0.017），血清胆碱酯酶和丙氨酸氨基转移 酶升高明显（分别为33 U/L，p=0.003; 7 IU/L, p=0.033）。代谢综合征指标也 有所下降。有关食物频率问卷调查显示饮食和营养的摄入水平都有所提高。6 个月体重降低率和初始体重降低率显著相关。此项可以智能提取减肥目标和记 录每天体重及具体实施步骤的网络减肥方案在节约人力资源的情况下，能够有 效减轻体重、减少VFA。

症例は40歳,女性. 10年前,他院にてCrohn病のため回盲部切除を受け,以後特に治療を受けることなく経過していた.今回,右背部痛・腫脹,右下肢痛を主訴に来院し,腹部CTで右腸腰筋膿瘍と診断され,切開排膿ドレナージを施行.炎症の改善を待ち,後日右半結腸切除術を施行した.手術所見では吻合部口側の回腸狭窄を認め,吻合部付近から右腸腰筋への痩孔が確認できた.術後問題なく経過し,現在まで再発を認めていない.腸腰筋膿瘍を合併したCrohn病の本邦での報告例は自験例を含めて33例のみであった.若干の文献的考察を加えて報告する.

Adrenal metastasis of colonic carcinoma uncommonly occurs. We experienced a resected case of solitary left adrenal metastasis from a colonic carcinoma which was operated on about 6 months before. A 65-year-old woman had undergone a right hemicolectomy for cecal carcinoma 6 months before. Histologically, the primary lesion was moderately differentiated adenocarcinoma ss, n(-), in stage II. After discharge from the hospital increases in serum CEA and CA19-9 levels were confirmed when she was followed on an ambulant basis. Abdominal CT scan revealed a left suprarenal mass. It was a non functionning tumor. Under a suspicious of adrenal metastasis from the colonic carcinoma, left adrenectomy was performed. Histologically and clinically it was diagnosed as metastasis from the colonic carcinoma. Adrenal metastasis from a malignant tumor is often seen, but is relatively rare from a colorectal carcinoma. There have been only eight cases of adrenal metastasis of colorectal carcinoma following an operation for the primary lesion, resulting in a successful excision, in Japan.

A new method to evaluate endothelial function, namely, reactive hyperemia peripheral arterial tonometry (RH-PAT), has been developed. RH-PAT is an index of endothelial function, indicating initial atherosclerotic lesions. The present study aimed to investigate the effect of lifestyle modification with a focus on exercise training on RH-PAT in obese patients. We studied 43 obese patients (body mass index ≥ 30). RH-PAT was measured, and the RH-PAT index was calculated as a ratio of the digital pulse volume during reactive hyperemia divided by that at baseline. Further, we assessed body composition, arterial stiffness, insulin resistance, adipocytokine levels, and exercise tolerance. The exercise program consisted of 30 min on a cycle ergometer or treadmill, 3 times per week for 6 months. Training intensity was adjusted to the anaerobic threshold. Significant improvements were observed in the RH-PAT index following exercise training. We noted a significant reduction in weight, body fat percentage, and leptin values, and a significant increase in adiponectin levels and exercise tolerance. An abnormal baseline RH-PAT index was observed in 24 patients (55.8%); however, the improvement rate was higher in these patients than in patients with normal RH-PAT index values. Stepwise multiple regression analysis revealed that changes in insulin resistance (Δ”HOMA-IR) were independently correlated with changes in the RH-PAT index. Our results indicate that lifestyle modification with a focus on exercise training improved the RH-PAT index in obese patients. Patients with abnormal RH-PAT index values before lifestyle modification with exercise training demonstrated a high rate of improvement following exercise. Further, our results suggest that insulin resistance was the only independent factor influencing improvement in endothelial function.

Two cases of ischemic bowel disease associated with chronic hemodialysis patients are presented. Case 1: A 66-year-old man with chronic hypotension was seen at the hospital because of lower abdominal pain, melena and anemia. There was a 23-year history of receiving hemodialysis. An ascending colon tumor was suspected, and laparotomy was performed. A longitudinal ulcer of the ascending colon was confirmed, and right hemicolectomy was done. Pothological examination revealed ischemic colitis. Case 2: A 58-year-old man with chronic hypotension complained of right lower abdominal pain. There was a 6-year history of receiving hemodialysis. Appendicitis with peritonitis was suspected, and emergency laparotomy was performed. An abscess lesion in the mesenterium of the ileum near the cecum was confirmed and ileocecal resection was done. Pathological examination was compatible with ischemic change of the ileum. Some case reports of ischemic bowel disease associated with chronic hemodialysis patients have been seen recently. There were few anemic patients and most patients had chronic hypotension, and a stagnation or standstill of the blood flow in the intestinal wall is regarded as a reason of the ischemia.

An experience with popliteal arterial aneurysm associated with medial mucoid degeneration is described, A 37-year-old male visited a nearby practitioner because of paresthesia in the right foot.He was pointed out having a pulsatile mass and referred to our hospital.Ultrasonography, CT, and angiography showed a right popliteal aneurysm with intramutal thrombosis. AT operation, the aneurysm was transected and vascular reconstruction was performed by the end-to-end anastomosis of autogenous saphenous vein. Pathological examination showed medial mucoid degeneration, where smooth muscle and elastic fibers decreased. There were also no findings of arteriosclerosis and inflammatory infiltrates. This popliteal arterial aneurysm is supposed to be classified as arterial dysplasia reported by D. Melliere.

A patient with hepatocellular carcinoma having rib and lung metastases was treated with surgical resection of all lesions. The patient, a 65-year-old male complaining of a right lateral back tumor, was examined carefully and diagnosed to have a hepatocellular carcinoma which metastasized to the right 10th rib and right middle lobe of the lung. Resections of the liver, rib and lung were performed, because no more metastasis was recognized and the liver function was relatively fair. Microscopic findings of all lesions revealed hepatocellular caricnoma. Postoperative course was favourable and there is no sign of recurrence.The prognosis of hepatocellular carcinoma which has a distant metastasis is poor and there has been no establised therapy. The better prognosis can be expected by such aggressive surgical treatment. A review of resected cases of bone metastases from hepatocellular carcinoma is also provided.

We present a 63-year-old man who developed multiple brain infarction after ingesting a 35% hydrogen peroxide solution. Neurologic examination revealed left hemiparesis, primarily affecting the lower limb, and mild weakness of the right lower limb. Gadolinium-enhanced MRI revealed patchy bilateral brain lesions. Oxygen gas embolization is the likely cause of the brain infarctions.

The patient, a 27 year-old man, was admitted to the hospital with complaints of abdominal pain, diarrhea, fever and loss of body weight. Physical examination showed diffuse tenderness of the abdomen, but no peritoneal irritation. Plain abdominal X-ray revealed no free air under the diaphragma. initial laboratory data showed abnormal ESR, CRP, WBC, thrombocytes and serum cholesterol. As his condition did not improve in spite of various conservative treatments, operation was done 15 days later. We diagnosed this case as Crohn's disease from multiple skip stenoses of the small bowel and so-called creeping sign. We also encountered perforation and abscess of the terminal ileum. Until recently, 36 cases of Crohn's disease associated with perforation have been reported in Japan. We report another rare case of Crohn's disease and consider that in such cases double-contrast study of the small intestine should be done.