Objective: Due to the spread of new cultivation methods for strawberries, working conditions have changed in recent years. In addition, the average age of strawberry growers has been increasing. As a result, the need to take new measures to prevent physical fatigue in middle-aged strawberry growers has been increasing. Due to a general paucity of epidemiological studies, we investigated the relationship between physical fatigue and farmwork among middle-aged strawberry growers during the harvest season.
Materials and Methods: A mail survey was carried out among 621 healthy Japanese strawberry growers (368 men and 253 women) in January 2003.
Results: Lower back pain was the most frequent complaint (71% of males and 67% of females), followed by shoulder pain (45% of males and 59% of females), and eye pain (46% of males and 57% of females). After adjusting for such factors as age, working hours, and sleeping hours using a multiple logistic regression analysis, lower back pain demonstrated the strongest association with the application of gibberellins at bloom among males (odds ratio 2.0) and with the harvesting of strawberries among females (odds ratio 1.8). Shoulder pain had the strongest association with the removal of older leaves among males (odds ratio 1.9) and with the harvesting of strawberries among females (odds ratio 2.2). Eye pain had the strongest association with the clipping of needless runners among males (odds ratio 1.6) and with the application of gibberellins at bloom among females (odds ratio 2.4).
Conclusion: Although the three main types of physical fatigue -- lower back pain, shoulder pain, and eye pain -- tended to have a similar prevalence, the related farmwork differed between males and females. Our results therefore suggest that it is necessary to take appropriate measures based on gender differences in order to prevent physical fatigue in middle-aged strawberry growers. Consequently, there is now an urgent need to evaluate ergonomic intervention in a controlled trial.

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Objective: The objective of this study is to investigate the outcome-determining factors of stroke patients treated in our hospital which is the largest hospital in Ibaraki Prefecture with more than 1,000 beds.
Methods: Ninety two patients (62 with cerebral infarction and 30 with hemorrhage) who were hospitalized for stroke for the first time between January and June in 2004, and underwent rehabilitation. The patients were classified into two groups according to their outcomes: Group 1 patients who were directly discharged to home and Group 2 patients who were transferred to other hospitals or nursing homes. We investigated the severity of paresis, high cortical functional disorder as complication, functional outcome, and family background of these patients, and analyzed the outcome-determining factors.
Result: Among the patients, 65.2% were directly discharged to home. Their paresis was not severe in most cases, and 70% of them could walk independently (with or without canes and devices). There were no significant differences in age or family size between the two groups. Fifteen patients did not choose to go home, even though they were physically able to do so. They all had higher brain dysfunction or difficulty in accepting their disability. For such patients, the shortage of caregivers was not necessarily considered as a factor in their decision not to go home.
Conclusion: The severity of paresis and walking ability (locomotion) are the key factors in determining of whether the patients can be discharged to home or not.

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 Small, dense low density lipoprotein (LDL) has been suggested to be highly atherogenic as a result of their low-binding affinity to LDL receptors, their prolonged plasma half-life and low resistance to oxidative stress. Although marine n-3 polyunsaturated fatty acids (PUFAs) have beneficial effects for the prevention of cardiovascular diseases, there is little information on detailed fatty acid composition in LDL particles. In the present study, LDL subfractions were isolated from the plasma of 45 clinically healthy Japanese women by density gradient ultracentrifugation using a light fraction of 1.025-1.034 g/ml (LDL-I), an intermediate fraction of 1.034-1.044 g/ml (LDL-II), and a dense fraction of 1.044-1.060 g/ml (LDL-III). A clear relationship between the frequency of fish intake and increases in plasma n-3 PUFAs was apparent. Although plasma n-3 PUFAs in women with small-sized LDL using non-denaturing gradient gel electrophoresis (GGE) did not show a significant difference, n-3 PUFAs and n-3 PUFAs/n-6 PUFAs in dense LDL-III subfraction increased in the small-sized LDL group using GGE, compared to those with buoyant LDL particles. The result of enriched n-3 PUFAs in dense LDL subfraction suggests that n-3 PUFAs may help prevent atherosclerosis in the arteries of Japanese women with small-sized LDL.

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Objective: The aim of the present study was to clarify whether patients with Graves' disease who have lost bone mass can restore bone mass to age-matched control levels by antithyroid drug therapy.
Patient/Materials and Methods: One male and 16 female patients (aged 21-71 years, mean±SE 39.9±16.5) with untreated Graves' disease were included in the study. Methimazole or propylthiouracil was given to all of the patients. Biochemical markers (serum N-mid osteocalcin (OC_N-mid), alkaline phosphatase (ALP), type I collagen C-terminal telopeptide (sCTx), urinary pyridinoline (Pyr), deoxypyridinoline (Dpyr) and type I collagen C-terminal telopeptide (uCTx) and bone mineral density at the distal one third of the radius were assessed prior to treatment, and in the first, third, sixth and twelfth months of treatment.
Results: All biochemical markers had increased significantly 12 months after treatment compared with the baseline values (OC_N-mid, p<0.05; ALP, p<0.01; sCTx, p<0.05; Pyr, Dpyr, uCTx, p<0.01). Among the biochemical markers, urinary Pyr and Dpyr had decreased the most prominently 12 months after treatment. However, BMD at the distal one third of the radius did not improve after 12 months of treatment.
Conclusion: Based on assessments of BMD at the distal one third of the radius, one year is not enough to restore bone mass using antithyroid drug therapy in patients with Graves' disease.

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 We report on three elderly patients with stroke-like onset of atypical Miller Fisher syndrome (MFS). The serum titer of anti-GQ1b IgG was markedly elevated in these patients. Their prognoses were sufficiently good with immunoadsorption therapy with or without intravenous immune globulin (IVIg) therapy. However, some neurological findings were not characteristic of typical MFS. Patient 1 suffered from prolonged dysesthesia in her left extremities, and Patients 2 and 3 showed no ataxia. Moreover, complete bilateral gaze limitation is rare in MFS. The sudden stroke-like onset along with the gaze limitation of these patients suggests that the unexpected elevation in the serum titer of anti-GQ1b IgG due to unknown immune dysregulation might have severely affected the third, fourth, and sixth nerves and this potent antibody rapidly attacked these nerves and induced stroke-like clinical features and complete ophthalmoplegia.

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Objective: Clinical studies suggest that maintaining a lower postprandial glycemic response is important for improvement and prevention of metabolic syndrome and type 2 diabetes mellitus. Amylose, an ingredient in many food grains, is a major factor for the lowering of postprandial glycemic and insulinemic response. The aim of the present study was to determine the influence of rice with different level of amylose on postprandial glycemic and insulinemic response in mice and humans.
Materials and Methods: The two types of rice used in the study contained 29 wt% (high amylose rice) or 17 wt% (low amylose rice) amylose. In mice and humans, postprandial glycemic and insulinemic responses were measured and then the area under the response curves of both rice groups were compared.
Results: In mice, comparisons of postprandial glycemic response showed high amylose rice was lower than that for low amylose rice in all time points. Notably postprandial glycemic responses for high amylose rice at 15, 30, 45 and 60 min were significantly lower (19%, 31%, 16% and 17% respectively). The area under the glycemic response curve for high amylose rice was a remarkably 16% less than for the low amylose rice. In humans, postprandial glycemic response at 30 min and insulinemic response at 60 min for high amylose rice were significantly lower than for low amylose rice (15% and 40% lower, respectively). Furthermore, general linear measurement multivariate analysis after adjustment for eating time and hemoglobin A1c at baseline showed that postprandial glycemic response at 30 and 60 min and insulinemic response at 60 min, and the area under the glycemic response curve for high amylose rice were significantly lower than for low amylose rice in human.
Conclusion: The higher amylose content of the rice lowered the postprandial glycemic and insulinemic response, demonstrating the potential to prevent or improve metabolic syndrome and type 2 diabetes mellitus.

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 We operated on an 87-year-old female suffering from a giant bladder stone. Her chief complaint was fever and lower abdominal pain, which was caused by lodgement in the urethra. The stone was easily removed in one piece without breakage or injury to the urethral orifice and urethra using forceps normally used for grasping bones in orthopedics. The stone measured 75×50×45 mm and was composed of magnesium ammonium phosphate. To our knowledge, this is the largest bladder and/or urethral stone that was transurethrally removed without being broken. Thus, forceps that are normally used for grasping bones in orthopedics can be used to remove giant bladder stones without leaving stone fragments.

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 We report on a right-handed 43-year-old policeman with atypical Marchiafava-Bignami disease (MBD). The typical clinical manifestations of MBD are reduced consciousness, confusion, seizures, psychotic and emotional symptoms, hemiparesis, dysarthria, ataxia, and coma and death. However, our patient had not developed any of the above symptoms except for slowly progressive cognitive impairment mimicking that of Alzheimer disease. The incidence of MBD may be higher and its prognosis less severe than generally believed. MBD has been underdiagnosed and underreported, and nonspecific general symptoms and encephalopathy in an alcoholic might indicate undiagnosed MBD.

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 A 46-year-old female patient with non-alcoholic steatohepatitis (NASH) was administered nateglinide, an insulin secretagogue, for 7 months, and then polyenephosphatidylcholine, an anti-oxidant medication, in accordance with the two-step hypothesis of NASH, with insulin resistance as the initial pathogenesis and oxidative stress as the second. HOMA-R, an index of insulin resistance, improved, and hepatic marker levels improved markedly by four weeks after initiation of polyenephosphatidylcholine. The beneficial effects of treatment continued over the 24 months of the study. A liver biopsy evaluated using Brunt's criteria showed improvement from stage 2 to stage 0 after 9 months. These findings suggest the therapeutic efficacy of step by step treatment of NASH in accordance with the two-stage hypothesis.

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