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Engine oil consumption must be reduced because it produces particulate matter in exhaust gases and poisons the catalyst in an aftertreatment system. Oil transport upward via piston ring gaps is one of the factors for oil consumption. It is known that piston rings rotate circumferentially during engine operation, and that oil consumption increases when the ring gaps of multiple piston rings are close to each other. Force acting on a piston ring in the circumferential direction was investigated in a past study [3], and a wave form of the force was measured against the crank angle. Furthermore, the forces were varied according to the measurement position in the circumferential direction. It means that the ring gap tends to stay where the force showed a small value. The force shows a periodic wave form against the crank angle for each cycle, and some parts of the waveform show a correlation with piston slap motion [3]. Piston motion consists of lateral motion, tilting motion and up-and-down motion. In this study, the effect of such motions on the force which rotates the piston ring was investigated respectively using newly developed rig testers. The measured results of the rig tests were compared with the force measured during engine operation, and the mechanism of the ring rotation was analyzed.

Although no large studies have shown that exercise helps maintain bone volume in the two representative types of renal osteodystrophy (ROD), some case reports have supported this effect, leading to speculation about the usefulness of exercise in these conditions. Dialysis patients can develop chronic kidney disease–mineral and bone disorder, which includes bone lesions termed ROD. Examples of ROD lesions are osteitis fibrosa (high-turnover bone) due to secondary hyperparathyroidism, which is associated with high parathyroid hormone (PTH) levels, and adynamic bone (low-turnover bone) due to hypoparathyroidism, which is associated with low PTH levels. In osteitis fibrosa, osteoblastic bone formation and osteoclastic bone resorption occur simultaneously in different locations, double tetracycline (Tc) labeling is observed, and a woven bone structure is characteristic. Moderate exercise promotes bone formation and maintains bone mass and volume and connectivity of cancellous bone. However, if patients do not exercise enough, bone resorption becomes dominant, the cancellous bone becomes osteopenic and is replaced by fatty marrow, the dense cortical bone becomes more porous, osteocyte nuclei are lost, and empty lacunae develop. In adynamic bone, tests show no evidence of active osteogenesis by osteoblasts, no bone resorption by osteoclasts, and no Tc labeling, but studies have shown that exercise may help maintain bone mass by minimodeling and improving lamellar bone structure. Osteocyte nuclei are visible. In patients with renal failure, 1,25(OH) 2 D 3 levels are inevitably decreased, so administration of activated vitamin D 3 derivative is necessary; if activated vitamin D 3 derivative is not administered, mineralization is impaired, and osteomalacia occurs. In all types of ROD, continued appropriate exercise increases bone mass, whereas cessation of exercise leads to bone loss. This article presents bone biopsy results in hemodialysis patients with and without exercise. The purpose of this review is to speculate on the importance of exercise in each condition on the basis of previously published case reports, with some new cases added.

Purpose The phase angle (PhA), calculated by bioelectrical impedance analysis, is used as a nutritional risk indicator. A low preoperative PhA has been reported as a marker of postoperative complications in patients with cancer; however, the relationship between the PhA and postoperative complications in patients with lung cancer remains unknown. We conducted this study to assess the predictive ability of the preoperative PhA for postoperative complications in patients undergoing surgery for primary lung cancer. Methods We reviewed the data on 240 patients who underwent surgery for primary lung cancer at our institution between August, 2019 and August, 2021. Results The PhA value in this study was 4.7 ± 0.7°. According to the Clavien–Dindo classification, grade ≥ II postoperative complications occurred in 53 patients (22.0%). Based on the multivariate logistic analysis, only the PhA (odds ratio, 0.51, 95% confidence interval, 0.29–0.90, p  = 0.018) was an independent predictor of Clavien–Dindo grade ≥ II postoperative complications. Conclusions The PhA may be a valuable marker for predicting the risk of postoperative complications following lung cancer surgery.

Background: Medical nutrition therapy (MNT) is crucial for diabetes management. This study evaluated a hands-on nutrition education program that incorporated cooking demonstrations for glycemic control, anthropometrics, and dietary behavior over a 2-month period. Methods: Nineteen type 2 diabetes patients (four males and 15 females; 79% female) participated. The median [IQR] age was 70.0 [65.5–73.0] years; the duration of diabetes was 12.0 [8.5–14.0] years; the body mass index (BMI) was 24.3 [21.05–27.90] kg/m2, and the baseline HbA1c level was 6.90 [6.55–7.50%]. Approximately 20–25% of patients used injectable therapies. Pre- and post-treatment comparisons were performed via Wilcoxon signed-rank tests, while effect sizes were quantified via rank–biserial correlation (RBC). Results: In females (n = 15), carbohydrate intake decreased significantly (RBC = −0.583; p = 0.050). The protein levels per 1000 kcal exhibited a strong positive effect (RBC = 0.550; p = 0.065). HbA1c levels improved significantly (overall: RBC = −0.689 and p = 0.009; females: RBC = −0.725 and p = 0.014), and while body fat increased significantly (overall: RBC = 0.979 and p < 0.001; females: RBC = 0.983 and p < 0.001), the skeletal muscle index tended to decrease in females (RBC = −0.333; p = 0.268). Conclusions: Short-term hands-on nutrition education resulted in significant HbA1c improvement and dietary behavior changes but was accompanied by body composition deterioration. The findings of this study clarify the potential risks of nutritional interventions in elderly diabetic patients and provide important insights for improving future programs.

Oxidative stress affects bone turnover. Preventative effects of antioxidants such as vitamin E on reduced bone mineral density and fractures associated with aging, osteoporosis, and smoking have been examined in animals and humans. The effects of vitamin E (α-tocopherol; αT) on bone health have yielded conflicting and inconclusive results from animal studies. In this study, to determine the bone effects of αT, we investigated the in vivo effects of αT on the bone mineral density, bone mass, bone microstructure, bone resorption, and osteogenesis through peripheral quantitative computed tomography (pQCT) measurements, micro-computed tomography (micro-CT) analyses, and bone histomorphometry of lumbar vertebrae and femurs in normal female Wistar rats fed diets containing αT in different quantities (0, 30, 120, or 600 mg/kg diet) for 8 weeks. To validate our hypotheses regarding bone changes, we examined ovariectomized rats as an osteoporosis model and control sham-operated rats in parallel. As expected, ovariectomized rats had reduced bone mineral density in lumbar vertebrae and the distal metaphyses of their femurs, reduced bone mass and deteriorated microstructure of cancellous bones in the vertebral body and distal femur metaphyses, and reduced bone mass due to resorption-dominant enhanced bone turnover in secondary cancellous bones in these sites. In comparison, αT administered to normal rats, even at the highest dose, did not induce reduced bone mineral density of lumbar vertebrae and femurs or a reduced bone mass or fragile microstructure of cancellous bones of the vertebral body and distal femur metaphyses. Instead, αT-fed rats showed a tendency for an osteogenesis-dominant bone mass increase in secondary cancellous bones in the vertebral body, in which active bone remodeling occurs. Thus, αT consumption may have beneficial effects on bone health.

Background: Sarcopenia and metabolic deterioration are major health concerns in adults aged ≥ 75 years with type 2 diabetes (T2DM), a population characterized by anabolic resistance, reduced dietary intake, and limited renal reserve. Optimizing protein nutrition may support muscle maintenance in this high-risk group, but clinical evidence for individualized high-protein guidance in the oldest-old population remains limited. Objective: We investigated whether an 18-month dietary intervention improves muscle mass and strength in adults aged ≥ 75 years with T2DM and whether serum amino acid (AA) and hormonal profiles reflect these changes. Methods: In this 18-month, single-arm, prospective intervention study, 44 community-dwelling adults aged ≥ 75 years with T2DM received individualized, dietitian-led nutritional guidance targeting a protein intake of approximately 1.4 g/kg ideal body weight (IBW)/day. Assessments at baseline and every 6 months included body composition, muscle strength, renal function, and fasting serum amino acid and hormonal profiles. Longitudinal changes were analyzed using paired t-tests and linear mixed-effects models. This trial was registered in the UMIN Clinical Trials Registry (UMIN000044687). Results: Skeletal muscle index and grip strength showed significant improvements at specific time points during follow-up (both p < 0.05), while gait speed improved at 6 months. Renal function remained clinically stable (eGFRcreat slope: +0.18 mL/min/1.73 m2/year; eGFRcys slope: −2.97 mL/min/1.73 m2/year), with no significant increase in CKD stage. Changes in glucagon correlated positively and C-peptide negatively with changes in skeletal muscle index, whereas glucagon was inversely associated with grip strength. Serum fibroblast growth factor 21 (FGF21) levels decreased over time, suggesting metabolic adaptation to the intervention. Conclusions: Individualized high-protein nutritional guidance for 18 months improved sarcopenia-related parameters, including skeletal muscle index and grip strength, without clinically significant deterioration of renal function in adults aged ≥ 75 years with T2DM. These findings support the feasibility and safety of protein-focused dietary counseling as a strategy to preserve muscle health in advanced age.

Mobile food records are currently used to determine the nutrition of healthy subjects. To determine the accuracy of such records, we evaluated the nutritional composition of a test meal (noodles and fruit juice) and a hospital meal (Japanese set meal) using two types of mobile food records. Eighteen healthy subjects (2 males and 16 females) were enrolled. Using these diets and validated nutrient-composition information, we evaluated the accuracy of the dietary assessments made by two dietary-record applications, Asken® and Calomeal®, over 5 days. For the test meal, the values provided by the two applications were close to the actual values. In contrast, for the hospital meal, the values provided by the two applications were approximately 1.5 times higher than the actual values. A linear-mixed-model analysis showed that the total energy, carbohydrate, and salt contents were significantly overestimated in the hospital meal. Protein also tended to be overestimated, while the fat content was not significantly overestimated. Furthermore, the total energy and fat contents increased significantly over time. No association with age was observed. A comparison of the coefficients of variation (CVs) for each nutrient in the hospital meal indicated that the fat levels were significantly higher than those in the test meal. In conclusion, the accuracy of mobile food records depends on the type of meal. Our data will provide lessons for the use of meal-recording applications in special cases, such as hospital food.

Bone formation using the process known as minimodeling forms only lamellar bone in the absence of prior bone resorption even in uremic patients. In patients undergoing parathyroidectomy for secondary hyperparathyroidism, we compared the contribution of minimodeling to remodeling during the change in bone volume. Iliac bone biopsies were used to measure parameters related to minimodeling and remodeling before, at 3 to 4 weeks and 10 to 12 weeks after parathyroidectomy. Osteoblast surface due to minimodeling was greater than the entire bone osteoblast surface before and at 10 to 12 weeks after parathyroidectomy, but not 3 to 4 weeks after surgery. Minimodeling significantly increased osteoid volume 3 to 4 weeks after parathyroidectomy. The rate of change of osteoid volume by minimodeling was greater than that of osteoid volume during the first 3 to 4 weeks after surgery, indicating osteoid formation was more active at the minimodeling surface than at the entire bone surface. Furthermore, higher mineral apposition rates at the minimodeling sites than at remodeling sites yielded increased minimodeling bone volume at 10 to 12 weeks after surgery. Our results show that bone formation by minimodeling is more active than by remodeling and accounts, in part, for the increase of bone volume following parathyroidectomy.

The aim of this study is to investigate the effects of a low-carbohydrate staple food (i.e., low-carbohydrate bread) on glucose and lipid metabolism and pancreatic and enteroendocrine hormone secretion in comparison with meals containing normal-carbohydrate bread, without consideration of the carbohydrate content of the side dishes. T2DM patients (n = 41) were provided meals containing low-carbohydrate bread (LB) together with side dishes or normal-carbohydrate bread (NB) together with side dishes every other day as a breakfast. Blood glucose levels were evaluated by using a continuous glucose monitoring system; blood samples were collected before and 1 and 2 h after the breakfast. Postprandial blood glucose levels, plasma insulin, plasma glucose-dependent insulinotropic polypeptide (GIP) and plasma triglyceride were significantly lower and plasma glucagon levels were significantly higher in LB compared with those in NB. Plasma glucagon-like peptide-1 (GLP-1) levels did not differ in the LB and NB groups. These results indicate that changing only the carbohydrate content of the staple food has benefits on glucose and lipid metabolism in T2DM patients concomitant with the decrease of insulin and GIP secretion, which ameliorate body weight gain and insulin resistance.

Hypomineralized matrix is a factor determining bone mineral density. Increased perilacunar hypomineralized bone area is caused by reduced mineralization by osteocytes. The importance of vitamin D in the mineralization by osteocytes was investigated in hemodialysis patients who underwent total parathyroidectomy (PTX) with immediate autotransplantation of diffuse hyperplastic parathyroid tissue. No previous reports on this subject exist. The study was conducted in 19 patients with renal hyperparathyroidism treated with PTX. In 15 patients, the serum calcium levels were maintained by subsequent administration of alfacalcidol (2.0 μg/day), i.v. calcium gluconate, and oral calcium carbonate for 4 weeks after PTX (group I). This was followed in a subset of 4 patients in group I by a reduced dose of 0.5 μg/day until 1 year following PTX; this was defined as group II. In the remaining 4 patients, who were not in group I, the serum calcium (Ca) levels were maintained without subsequent administration of alfacalcidol (group III). Transiliac bone biopsy specimens were obtained in all groups before and 3 or 4 weeks after PTX to evaluate the change of the hypomineralized bone area. In addition, patients from group II underwent a third bone biopsy 1 year following PTX. A significant decrease of perilacunar hypomineralized bone area was observed 3 or 4 weeks after PTX in all group I and II patients. The area was increased again in the group II patients 1 year following PTX. In group III patients, an increase of the hypomineralized bone area was observed 4 weeks after PTX. The maintenance of a proper dose of vitamin D is necessary for mineralization by osteocytes, which is important to increase bone mineral density after PTX for renal hyperparathyroidism. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.