The subjects comprised 230 men aged 77 ± 10 (range: 50–100) years and 279 women aged 81 ± 10 (50–101) years that visited the medical department. We examined the relationship between increased serum bilirubin and renal function evaluated by estimated glomerular filtration rate (eGFR) using CKD-EPI equations modified by a Japanese coefficient. Compared with the fourth quartile in serum bilirubin (1.01–1.97 mg/dL), the nonadjusted, age and gender-adjusted, and multivariate-adjusted odds ratios {95% confidence interval (CI)} of eGFR <60 mL/min/1.73 m2 for the first quartile in serum bilirubin (0.13–0.50 mg/dL) were 2.08 (1.25–3.44), 1.82 (1.07–3.09), and 1.53 (0.83–2.81), respectively. Moreover, compared with the fourth quartile, nonadjusted, age and gender-adjusted, and multivariate-adjusted odds ratios (95% CI) of eGFR <45 mL/min/1.73 m2 for the first quartile were 3.50 (1.95–6.23), 3.12 (1.72–5.65), and 3.53 (1.71–7.26), respectively. The data were further stratified by gender, age, medication (antihypertensive, antidyslipidemic, and antidiabetic agents), and prevalence of cardiovascular disease (CVD). The standardized coefficients for eGFR were significant in all the subgroups other than the prevalence of CVD, and there were significant interactions between the two groups regarding CVD. Our data demonstrated an independent positive association between serum bilirubin and eGFR among diabetic patients.

We report a case of a patient with incarcerated obturator hernia who presented with right thigh pain. An 88-year-old woman who had experienced right thigh pain for the previous 3 years was given a diagnosis of sciatica at the orthopedic department. In July 2009, she was hospitalized with the chief complaint of appetite loss. The day after admission she experienced increased right thigh pain and lower abdominal pain. Abdominal ultrasonography revealed a keyboard sign. Based on this finding, we diagnosed an ileus, which was alleviated by the insertion of an ileus tube. However, after the removal of the ileus tube, her right thigh pain recurred. Therefore, a diagnosis of hernia was considered. Contrast-enhanced computed tomography revealed an incarcerated bowel in the region between the pectineus muscle and muscle obturator. Laparotomy showed that the ileal part located about 15 cm from the terminal ileum was incarcerated in the right foramen obturatum; therefore, ileal resection and end-to-end anastomosis were performed. After the operation, her intestinal obstruction symptoms and right pain disappeared. If right pain and ileus symptoms of unknown cause occur in elderly persons, obturator hernia should be considered.

Multivariate linear regression analysis showed that baseline TG and γ-glutamyltransferase (GGT) were significantly associated with baseline HOMA-IR. After the 12-week training program, changes in TG, SUA and GGT were significantly associated with changes in HOMA-IR. In addition to their direct associations, we observed a synergistic association between changes in TG and SUA and changes in HOMA-IR. Participants were divided into three groups (tertiles) according to changes in TG and SUA. The tertiles of changes in SUA correlated significantly with changes in HOMA-IR in participants in the tertile with the greatest decrease in TG (r = 0.525, p = 0.001), but not in the other two tertiles of change in TG (r = 0.049, p = 0.699). There was a significant interaction between SUA and TG for changes in HOMA-IR (β = 0.281, p = 0.005). These results suggest that changes in TG and SUA are synergistic factors associated with changes in insulin resistance after a 12-week walking exercise program in community-dwelling older women.

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a b s t r a c tIntroduction: Nordic walking, characterized by the use of two walking poles, is becoming increasingly popular. The aim of this study was to analyze the effects produced by a 12-week Nordic walking training program on functional abilities and metabolic profiles, specifically walk distance and insulin resistance, among elderly women. Methods: The present study included 74 women (68 ± 7 years). The Nordic walking training program of 120 minutes per week was performed for 12 weeks. Before and at the end of the 12-week intervention, 6-minute walking distance (6MWD) and the homeostasis of the model assessment of insulin resistance (HOMA-IR) were measured. Results and conclusions: After the 12-week Nordic walking training program, 6MWD increased significantly (p < 0.001). HOMA-IR improved significantly from a median (interquartile range) of 2.01 (1.31 e2.59) to 1.32 (0.86e2.08) after intervention. Stepwise multiple linear regression analyses for changes in HOMA-IR showed that changes in the body mass index (BMI; b ¼ 0.255, p ¼ 0.019), triglycerides (TG; b ¼ 0.266, p ¼ 0.015), and uric acid (b ¼ 0.279, p ¼ 0.009) were independently and significantly associated with changes in HOMA-IR. The increased 6MWD correlated significantly with improved HOMA-IR in participants with baseline gamma-glutamyl transferase (GGT) ! 26 IU/L (r ¼ À0.682, p ¼ 0.005), but not in those with baseline GGT < 26 IU/L (r ¼ À0.127, p ¼ 0.338). Analysis of covariance showed that two regression lines in each graph were significantly different (F ¼ 5.64, p ¼ 0.020). These results suggest that increased 6MWD predicts improvement in insulin resistance after a 12-week Nordic walking training program in participants with elevated GGT.