Protection against age-related immune suppression is important in elderly individuals. This study determined the effect of yoga on mucosal immune function and mental stress. Saliva samples were collected from 23 adult women (age: 60.4 ± 10.4 years) before and after 90 minutes of yoga stretching or rest to measure secretory immunoglobulin A (SIgA), cortisol, and testosterone. The SIgA concentration and secretion rate were significantly higher after yoga than before (p &lt
.05). The cortisol concentration and secretion rate were lower and testosterone secretion rate higher after yoga (p &lt
.05). Yoga stretching can reduce stress and enhance mucosal immune function in elderly women.

An intensive consecutive high-volume training camp may induce appetite loss in athletes. Therefore, this study aimed to investigate the changes in stress and appetite responses in male power-trained athletes during an intensive training camp. The measurements at Day 2 and at the end of a 9-day intensive training camp (Camp1 and Camp2, respectively) were compared with those of the resting period (Rest) and the regular training period (Regular; n = 13). The stress state was assessed based on plasma cortisol level, salivary immunoglobulin A level, and a profile of mood states score. The sensation of appetite was assessed using visual analog scale scores, and fasting plasma acylated ghrelin, insulin, and glucose were measured. The cortisol concentrations were significantly higher at Camp2 (466.7 +/- 60.7 nmol . L-1) than at Rest (356.3 +/- 100.9 nmol .L-1; p = 0.002) or Regular (361.7 +/- 111.4 nmol . L-1; p = 0.003). Both prospective and actual food consumption significantly decreased at Camp2, and acylated ghrelin concentration was significantly lower at Camp1 (34.2 +/- 8.0 pg . m L-1) and Camp2 (32.0 +/- 8.7 pg . m L-1) than at Rest (47.2 +/- 11.2 pg . m L-1) or Regular (53.4 +/- 12.6 pg . m L-1). Furthermore, the change in acylated ghrelin level was negatively correlated with the change in cortisol concentration. This study's findings suggest that an early-phase physiological stress response may decrease the acylated ghrelin level in male power-trained athletes during an intensive training camp.

This study examined ageing and free-living daily physical activity effects on salivary human beta-defensin 2 (hBD2). A total of 168 healthy elderly and 26 healthy young volunteers underwent saliva sampling. Free-living step count, energy expenditure and activity durations at specific intensity levels (inactive, light, moderate and vigorous) were evaluated. The results show significantly lower salivary hBD2 secretion rates for elderly than for young participants (P<0.05). Data from elderly participants were stratified by steps per day using quartiles (Q1-Q4) for distribution. Elderly in quartiles respectively showed step counts of 3145 +/- 129 in Q1, 5294 +/- 83 in Q2, 7001 +/- 86 in Q3 and 10,236 +/- 416 steps day(-1) in Q4. In elderly participants, significant differences were found in the mean step count, energy expenditure and activity duration with increasing pedometer-determined activity quartiles. hBD2 secretion rates were significantly higher for Q2, Q3 and Q4 than for Q1 (P<0.05). Elderly participants in Q3 had the highest hBD2 secretion. In conclusion, these results suggest that moderate physical activity in daily living improves age-related impairment of oral immune function mediated by hBD2. For oral immune function enhancement and for prevention of upper respiratory tract infections in elderly people, we recommend accumulation of more than 7000 steps day(-1).

This study examined changes in toll-like receptor 4 (TLR-4)-expressing monocytes and lymphocyte subpopulations in response to continuous intensive exercise training in athletes, as well as the effect of coenzyme Q10 (CoQ10) supplementation on these changes. Eighteen male elite kendo athletes in Japan were randomly assigned to a CoQ10-supplementation group (n = 9) or a placebo-supplementation group (n = 9) using a double-blind method. Subjects in the CoQ10 group took 300 mg CoQ10 per day for 20 days. Subjects in the placebo group took the same dosage of placebo. All subjects practiced kendo 5.5 h per day for 6 consecutive days during the study period. Blood samples were collected 2 weeks before training, on the first day (day 1), third day (day 3), and fifth day of training (day 5), and 1 week after the training period (post-training) to ascertain TLR-4(+)/CD14(+) monocyte and lymphocyte subpopulations (CD3(+), CD4(+), CD8(+), CD28(+)/CD4(+), CD28(+)/CD8(+), and CD56(+)/CD3(-) cells) using flow cytometry analysis. The group x time interaction for TLR-4(+)/CD14(+) cells did not reach significance (p = 0.08). Within the CoQ10 group, the absolute number of TLR-4(+)/CD14(+) cells was significantly higher only at day 5. The placebo group showed a significant increase in the absolute number of TLR-4(+)/CD14(+) cells at day 3, day 5, and post-training (p < 0.05). There was no significant group x time interaction for any lymphocyte subpopulation. CD3(+), CD8(+), and CD56(+)/CD3(-) cells were significantly reduced at day 3 in both groups (p < 0.05). In conclusion, CoQ10 supplementation might downregulate the increase of TLR-4-expressing monocytes in response to continuous strenuous exercise training in kendo athletes.

Objective: To investigate supplement use among Japanese elite athletes.
Design: We conducted a cross-sectional survey study using individual interviews during athletes' medical evaluations.
Setting: One to 5 months before the Olympic Games in 2012, London, United Kingdom.
Participants: Five hundred fifty-two Japanese athletes for the London Games, including candidates.
Independent Variables: Sex, sports, supplement category, and participation.
Main Outcome Measures: Whether athletes used supplements, what products were used, the frequency and purposes of use, and from what sources athletes received information on supplements.
Results: All 552 athletes were interviewed by pharmacists regarding supplement use and agreed to the survey. Of them, 452 (81.9%) used 1 or more supplement products in the year before the study; a total of 952 different products (mean = 1.7, SD = 1.4) were used. The most commonly used supplement was amino acids (310 athletes; 56.2%), and 358 (38.7%) of the total products were amino acids. Of the athletes, 241 (43.7%) took at least 1 supplement daily, and of the supplements, 457 (49.4%) were taken daily. The most common purpose for supplement use was recovery from fatigue-327 (59.2%) athletes chose this answer, and 486 (52.5%) products were used for this purpose. Finally, regarding athletes' information sources on supplements, coaches, managers, and trainers were the most frequent advisors (275 athletes, 49.8%; 466 products, 50.4%).
Conclusions: The results revealed widespread supplement use among Japanese elite athletes for the London Olympic Games. Education system was required not only for athletes but also for athletes' entourage, such as coaches, managers, trainers, and supplement companies.

The purpose of the study was to evaluate the effects of Lactobacillus pentosus strain b240 (b240) intake and appropriate physical training on salivary secretory immunoglobulin A secretion in elderly adults with low physical fitness. Elderly adults with low physical fitness (daily step count below 3,500 steps) were divided into 2 groups: a b240 intake + exercise group (b240 group) and a placebo intake + exercise group (placebo group). Each subject continued intake of b240 or placebo and moderate-intensity resistance exercise for 12 weeks. Before and 4, 8, and 12 weeks after the start of intervention, each subject underwent saliva sampling. Before and after intervention, physical fitness tests and step count were measured. Our results showed that secretory immunoglobulin A secretion in 57 subjects during the b240/placebo intake period was significantly greater in the b240 group than in the placebo group (p<0.05). There were no significant changes in physical fitness tests before and after intervention in the 2 groups. The daily amount of walking increased significantly after intervention in both groups (p<0.05). These results suggest that in elderly adults with low physical activity and fitness, intake of b240 with appropriate physical exercise elevate salivary secretory immunoglobulin A secretion.

The purpose of the study was to evaluate the effects of Lactobacillus pentosus strain b240 (b240) intake and appropriate physical training on salivary secretory immunoglobulin A secretion in elderly adults with low physical fitness. Elderly adults with low physical fitness (daily step count below 3,500 steps) were divided into 2 groups: a b240 intake + exercise group (b240 group) and a placebo intake + exercise group (placebo group). Each subject continued intake of b240 or placebo and moderate-intensity resistance exercise for 12 weeks. Before and 4, 8, and 12 weeks after the start of intervention, each subject underwent saliva sampling. Before and after intervention, physical fitness tests and step count were measured. Our results showed that secretory immunoglobulin A secretion in 57 subjects during the b240/placebo intake period was significantly greater in the b240 group than in the placebo group (p<0.05). There were no significant changes in physical fitness tests before and after intervention in the 2 groups. The daily amount of walking increased significantly after intervention in both groups (p<0.05). These results suggest that in elderly adults with low physical activity and fitness, intake of b240 with appropriate physical exercise elevate salivary secretory immunoglobulin A secretion.

The purpose of the study was to evaluate the effects of Lactobacillus pentosus strain b240 (b240) intake and appropriate physical training on salivary secretory immunoglobulin A secretion in elderly adults with low physical fitness. Elderly adults with low physical fitness (daily step count below 3,500 steps) were divided into 2 groups: a b240 intake + exercise group (b240 group) and a placebo intake + exercise group (placebo group). Each subject continued intake of b240 or placebo and moderate-intensity resistance exercise for 12 weeks. Before and 4, 8, and 12 weeks after the start of intervention, each subject underwent saliva sampling. Before and after intervention, physical fitness tests and step count were measured. Our results showed that secretory immunoglobulin A secretion in 57 subjects during the b240/placebo intake period was significantly greater in the b240 group than in the placebo group (p<0.05). There were no significant changes in physical fitness tests before and after intervention in the 2 groups. The daily amount of walking increased significantly after intervention in both groups (p<0.05). These results suggest that in elderly adults with low physical activity and fitness, intake of b240 with appropriate physical exercise elevate salivary secretory immunoglobulin A secretion.

Yoga stretching can be done comfortably and easily by beginners and older adults to compensate for lack of exercise or poor health maintenance. The aim of this study was to determine the effect of yoga stretching on mucosal immune functions, primarily human beta-defensin 2 (HBD-2) in saliva.
Fifteen healthy adults (age, 60.4 +/- A 8.0 years) participated in the study. Participants rested for 90 min on the first day and performed yoga for 90 min on the second day. Measurements were carried out before and after rest or yoga. Saliva samples were collected by chewing a sterile cotton at a frequency of 60 cycles per min. Salivary HBD-2 concentration was measured using an enzyme-linked immunosorbent assay.
HBD-2 concentration after yoga stretching (165.4 +/- A 127.1 pg/mL) was significantly higher than that before yoga stretching (84.1 +/- A 63.4 pg/mL; p < 0.01). HBD-2 expression rate after yoga stretching (232.8 +/- A 192.9 pg/min) was significantly higher than that before yoga stretching (110.7 +/- A 96.8 pg/min; p < 0.01). HBD-2 concentration (p < 0.05) and HBD-2 expression rate (p < 0.01) at post on the second day (yoga) was significantly higher than that on the first day (rest). POMS score of anger-hostility was lower after yoga than before.
Yoga stretching for 90 min can increase salivary HBD-2 expression in older adults. Therefore, yoga stretching might be useful for older adults and athletes to maintain their health.

Yoga stretching can be done comfortably and easily by beginners and older adults to compensate for lack of exercise or poor health maintenance. The aim of this study was to determine the effect of yoga stretching on mucosal immune functions, primarily human beta-defensin 2 (HBD-2) in saliva.
Fifteen healthy adults (age, 60.4 +/- A 8.0 years) participated in the study. Participants rested for 90 min on the first day and performed yoga for 90 min on the second day. Measurements were carried out before and after rest or yoga. Saliva samples were collected by chewing a sterile cotton at a frequency of 60 cycles per min. Salivary HBD-2 concentration was measured using an enzyme-linked immunosorbent assay.
HBD-2 concentration after yoga stretching (165.4 +/- A 127.1 pg/mL) was significantly higher than that before yoga stretching (84.1 +/- A 63.4 pg/mL; p < 0.01). HBD-2 expression rate after yoga stretching (232.8 +/- A 192.9 pg/min) was significantly higher than that before yoga stretching (110.7 +/- A 96.8 pg/min; p < 0.01). HBD-2 concentration (p < 0.05) and HBD-2 expression rate (p < 0.01) at post on the second day (yoga) was significantly higher than that on the first day (rest). POMS score of anger-hostility was lower after yoga than before.
Yoga stretching for 90 min can increase salivary HBD-2 expression in older adults. Therefore, yoga stretching might be useful for older adults and athletes to maintain their health.

Eda, N, Shimizu, K, Suzuki, S, Tanabe, Y, Lee, E, and Akama, T. Altered secretory immunoglobulin A on skin surface after intensive exercise. J Strength Cond Res 27(9): 2581-2587, 2013The aim of this study was to determine the effects of high-intensity endurance exercise on skin immunity by estimating secretory immunoglobulin A (SIgA) and staphylococci on skin surface. Seven healthy adult men (age, 22.3 +/- 2.0 years) performed bicycle exercise at 75% HRmax for 60 minutes from 2030 to 2130 hours. Secretory immunoglobulin A was obtained from 1 ml extraction liquids stirred with the microtube homogenizer in the open end of a polypropylene tube for 60 seconds. Secretory immunoglobulin A concentrations were measured using enzyme-linked immunosorbent assay. Staphylococci were harvested by pressed agar-based media against skin surface. Skin surface samples were collected from the chest and the forearm on the first day at 2030 hours (before rest, A1), 2130 hours (after rest, A2), and 2230 hours (after showering, A3); the next morning at 0700 hours (A4); on the second day at 2030 hours (before exercise, B1), 2130 hours (after exercise, B2), and 2230 hours (after showering, B3); and the next morning at 0700 hours (B4). Secretory immunoglobulin A concentration on the forearm was significantly lower at B2 (p < 0.05) and B3 (p < 0.05) than that at B1 and that on the chest at B1 tended to be higher compared with B2 (p = 0.084) and B3 (p = 0.075). The number of staphylococci was significantly higher at B2 than that at B1 (p < 0.01) and B4 (p < 0.01) on the forearm. We conclude that high-intensity endurance exercise might depress immune function and enhance infectious risk on skin surface. Coaches should encourage their athletes to take a shower and change into clean clothes immediately after sports activities and athletes should maintain a clean skin surface to decrease the infectious risk on skin surface.

Eda, N, Shimizu, K, Suzuki, S, Tanabe, Y, Lee, E, and Akama, T. Altered secretory immunoglobulin A on skin surface after intensive exercise. J Strength Cond Res 27(9): 2581-2587, 2013The aim of this study was to determine the effects of high-intensity endurance exercise on skin immunity by estimating secretory immunoglobulin A (SIgA) and staphylococci on skin surface. Seven healthy adult men (age, 22.3 +/- 2.0 years) performed bicycle exercise at 75% HRmax for 60 minutes from 2030 to 2130 hours. Secretory immunoglobulin A was obtained from 1 ml extraction liquids stirred with the microtube homogenizer in the open end of a polypropylene tube for 60 seconds. Secretory immunoglobulin A concentrations were measured using enzyme-linked immunosorbent assay. Staphylococci were harvested by pressed agar-based media against skin surface. Skin surface samples were collected from the chest and the forearm on the first day at 2030 hours (before rest, A1), 2130 hours (after rest, A2), and 2230 hours (after showering, A3); the next morning at 0700 hours (A4); on the second day at 2030 hours (before exercise, B1), 2130 hours (after exercise, B2), and 2230 hours (after showering, B3); and the next morning at 0700 hours (B4). Secretory immunoglobulin A concentration on the forearm was significantly lower at B2 (p < 0.05) and B3 (p < 0.05) than that at B1 and that on the chest at B1 tended to be higher compared with B2 (p = 0.084) and B3 (p = 0.075). The number of staphylococci was significantly higher at B2 than that at B1 (p < 0.01) and B4 (p < 0.01) on the forearm. We conclude that high-intensity endurance exercise might depress immune function and enhance infectious risk on skin surface. Coaches should encourage their athletes to take a shower and change into clean clothes immediately after sports activities and athletes should maintain a clean skin surface to decrease the infectious risk on skin surface.

For athletes, preventing infectious disease on skin is important. Examination measurement of epidermal barriers could provide valuable information on the risk of skin infections. The aim of this study was to determine the effects of high-intensity endurance exercise on epidermal barriers. Six healthy adult males (age; 22.3 +/- 1.6 years) performed bicycle exercise at 75%HRmax for 60 min from 18:30 to 19:30. Skin surface samples were measured 18:30 (pre), 19:30 (post), 20:30 (60 min), and 21:30 (120 min). Secretory immunoglobulin A (SIgA) and human beta-defensin 2 (HBD-2) concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). SIgA concentration at pre was significantly higher than at post, 60 min and 120 min (p < 0.05). HBD-2 concentration at post and 120 min was significantly higher than at pre (p < 0.05). Moisture content of the stratum corneum was significantly higher at post than at pre, 60 min, and 120 min (p < 0.05). On the chest, moisture content of the stratum corneum was significantly lower at 120 min than at pre (p < 0.05). The number of staphylococci was significantly higher at post than at pre (p < 0.05), and tended to be higher at 60 min than at pre on the chest (p = 0.08). High-intensity endurance exercise might depress the immune barrier and physical barrier and enhance the risk of skin infection. On the other hand, the biochemical barrier increases after exercise, and our findings suggest that this barrier might supplement the compromised function of other skin barriers.

For athletes, preventing infectious disease on skin is important. Examination measurement of epidermal barriers could provide valuable information on the risk of skin infections. The aim of this study was to determine the effects of high-intensity endurance exercise on epidermal barriers. Six healthy adult males (age; 22.3 +/- 1.6 years) performed bicycle exercise at 75%HRmax for 60 min from 18:30 to 19:30. Skin surface samples were measured 18:30 (pre), 19:30 (post), 20:30 (60 min), and 21:30 (120 min). Secretory immunoglobulin A (SIgA) and human beta-defensin 2 (HBD-2) concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). SIgA concentration at pre was significantly higher than at post, 60 min and 120 min (p < 0.05). HBD-2 concentration at post and 120 min was significantly higher than at pre (p < 0.05). Moisture content of the stratum corneum was significantly higher at post than at pre, 60 min, and 120 min (p < 0.05). On the chest, moisture content of the stratum corneum was significantly lower at 120 min than at pre (p < 0.05). The number of staphylococci was significantly higher at post than at pre (p < 0.05), and tended to be higher at 60 min than at pre on the chest (p = 0.08). High-intensity endurance exercise might depress the immune barrier and physical barrier and enhance the risk of skin infection. On the other hand, the biochemical barrier increases after exercise, and our findings suggest that this barrier might supplement the compromised function of other skin barriers.

国立スポーツ科学センターを受診した1209名のトップアスリート(男性669名:平均年齢23.4歳、女性540名:22.9歳)の血液生化学検査値を検討した。各検査値を一般人の基準範囲と比較したところ、クレアチンキナーゼ(CK)値は、平均値が一般人の基準範囲の上限値より明らかに高値を呈した(平均値[95%信頼区間]男性:268U/L[130-554]U/L、女性:166U/L[90-306]U/L)。また尿酸(UA)値は過去の報告と異なり、一般人の基準範囲と同等の分布であった。トップアスリートではCK値は高値を呈すことが多いが、トレーニング強度や時期・競技日程などの項目を加味した詳細な検討も望まれる。またUA値に関しても、競技レベルや運動強度などとの関連性について更なる検討が望まれる。(著者抄録)

Objective: To investigate the prevalence of supplement use among young elite Japanese athletes.
Design: Survey study.
Setting: 2010 Youth Olympic Games, Singapore.
Participants: Data were collected from individual interviews during medical evaluations of 75 athletes selected for the Japanese national team.
Main Outcome Measures: Main outcome measures included the use of supplements, products used, frequency of use, purpose of use, and relationships between supplement use and athlete attitudes toward a balanced diet.
Results: All 75 athletes agreed to participate in this study, and individual interviews by pharmacists made it possible to collect complete answers from all athletes. Of these athletes, 47 (62.7%) used 1 or more supplement products (average number of products used, 1.1 +/- 1.3). The most popular supplement was amino acids, which were used by 33 athletes (44.0%). Of the supplements used, 28 (32.6%) were taken every day, whereas 28 (32.6%) were used only on special occasions. Moreover, 34 of the supplement products (39.5%) were taken to enhance recovery from fatigue, whereas 19 (22.1%) were used to improve athletic performance. Statistical analysis suggested that there was no significant relationship between supplement use and attitudes toward a balanced diet.
Conclusions: The results revealed widespread supplement use among young elite athletes in the Japanese national team for the Singapore Youth Olympic Games in 2010. Moreover, these athletes apparently used supplements without considering the effects of their normal diets.

Objective: To investigate the prevalence of supplement use among young elite Japanese athletes.
Design: Survey study.
Setting: 2010 Youth Olympic Games, Singapore.
Participants: Data were collected from individual interviews during medical evaluations of 75 athletes selected for the Japanese national team.
Main Outcome Measures: Main outcome measures included the use of supplements, products used, frequency of use, purpose of use, and relationships between supplement use and athlete attitudes toward a balanced diet.
Results: All 75 athletes agreed to participate in this study, and individual interviews by pharmacists made it possible to collect complete answers from all athletes. Of these athletes, 47 (62.7%) used 1 or more supplement products (average number of products used, 1.1 +/- 1.3). The most popular supplement was amino acids, which were used by 33 athletes (44.0%). Of the supplements used, 28 (32.6%) were taken every day, whereas 28 (32.6%) were used only on special occasions. Moreover, 34 of the supplement products (39.5%) were taken to enhance recovery from fatigue, whereas 19 (22.1%) were used to improve athletic performance. Statistical analysis suggested that there was no significant relationship between supplement use and attitudes toward a balanced diet.
Conclusions: The results revealed widespread supplement use among young elite athletes in the Japanese national team for the Singapore Youth Olympic Games in 2010. Moreover, these athletes apparently used supplements without considering the effects of their normal diets.

Shimizu, K, Suzuki, N, Nakamura, M, Aizawa, K, Imai, T, Suzuki, S, Eda, N, Hanaoka, Y, Nakao, K, Suzuki, N, Mesaki, N, Kono, I, and Akama, T. Mucosal immune function comparison between amenorrheic and eumenorrheic distance runners. J Strength Cond Res 26(5): 1402-1406, 2012-This study examined the effects of amenorrhea on mucosal immune function and susceptibility to upper respiratory tract infection (URTI) in elite female distance runners. Based on their menstrual cycles during the prior year, 21 elite, collegiate, female distance runners were designated as eumenorrheic runners (ERs; n = 8; 19.9 +/- 0.8 years) or amenorrheic runners (ARs; n = 13; 20.0 +/- 0.3 years). Resting saliva and blood samples were collected in the morning. The secretory immunoglobulin A (SIgA) concentration was measured using enzyme-linked immunosorbent assay. The SIgA secretion rate was calculated. Serum 17 beta-estradiol concentrations and serum progesterone concentrations were measured using radioimmunoassay. Subjects reported the appearance of URTI symptoms (sore throat, headache, runny nose, coughing, or fever), if any, during the prior month. The serum estradiol concentration and salivary SIgA secretion rate were significantly lower for ARs than for ERs (p < 0.05). Serum progesterone concentration was not significantly different between groups. Higher frequencies of headache, runny nose, coughing, and fever were observed in ARs than in ERs. Results show that athletic amenorrhea with low estrogen might accelerate downregulation of mucosal immune function in athletes and enhance susceptibility to infection.

Shimizu, K, Suzuki, N, Nakamura, M, Aizawa, K, Imai, T, Suzuki, S, Eda, N, Hanaoka, Y, Nakao, K, Suzuki, N, Mesaki, N, Kono, I, and Akama, T. Mucosal immune function comparison between amenorrheic and eumenorrheic distance runners. J Strength Cond Res 26(5): 1402-1406, 2012-This study examined the effects of amenorrhea on mucosal immune function and susceptibility to upper respiratory tract infection (URTI) in elite female distance runners. Based on their menstrual cycles during the prior year, 21 elite, collegiate, female distance runners were designated as eumenorrheic runners (ERs; n = 8; 19.9 +/- 0.8 years) or amenorrheic runners (ARs; n = 13; 20.0 +/- 0.3 years). Resting saliva and blood samples were collected in the morning. The secretory immunoglobulin A (SIgA) concentration was measured using enzyme-linked immunosorbent assay. The SIgA secretion rate was calculated. Serum 17 beta-estradiol concentrations and serum progesterone concentrations were measured using radioimmunoassay. Subjects reported the appearance of URTI symptoms (sore throat, headache, runny nose, coughing, or fever), if any, during the prior month. The serum estradiol concentration and salivary SIgA secretion rate were significantly lower for ARs than for ERs (p < 0.05). Serum progesterone concentration was not significantly different between groups. Higher frequencies of headache, runny nose, coughing, and fever were observed in ARs than in ERs. Results show that athletic amenorrhea with low estrogen might accelerate downregulation of mucosal immune function in athletes and enhance susceptibility to infection.

わが国のトップレベルの競技者の聞き取り調査と視力測定をした。対象は国立スポーツ科学センターでメディカルチェックを行った夏季と冬季のオリンピック・アジア大会53競技の競技者1,574人。聞き取り調査は競技時の矯正方法と眼の既往症歴について行った。視力は競技時と同様の矯正状態で片眼と両眼の遠方視力を測定した。1)視力1.0以上の競技者は全体の82.5%で、球技群が最も多く86.2%、格闘技群が最も少なく74.0%であった。2)視力の矯正は90.3%が使い捨てコンタクトレンズを使用していたが、5.4%はLASIK(laser in situ keratomileusis)、0.5%はオルソケラトロジーを選択していた。3)眼既往症者は3.0%、スポーツ眼外傷は1.0%であった。眼既往症発症率はスピード群が最も高く4.5%、スポーツ眼外傷発症率は球技群が最も高く1.5%であった。眼既往疾患では角膜疾患とその他の疾患が最も多く25.5%、ついで網膜疾患14.9%であった。(著者抄録)

高強度持久性運動が皮膚の物理的バリアに及ぼす影響を検討した。健常成人男性7例を対象とした。1日目は安静状態とし、2日目は自転車ペダリング運動を実施した。緊張-不安は、安静日の安静前と比較してシャワー入浴後、翌朝に有意に低値を示し、運動日の運動前と比較して運動後、シャワー入浴後、翌朝に有意に低値を示した。胸部角質水分量は、安静日の安静前と比較してシャワー入浴後に有意に低値を示し、運動後に有意に増加した。運動日の胸部角質水分量は、運動前と比較してシャワー入浴後に低値を示す傾向がみられた。前腕角質水分量は、安静日の安静前と比較してシャワー入浴後、翌朝に有意に低値を示し、運動後に有意に増加した。運動日の前腕角質水分量は、運動前と比較して翌朝に低値を示す傾向がみられた。運動日における体水分喪失率は、運動後-シャワー入浴後、シャワー入浴後-翌朝と比較して運動中に有意に高値を示した。

Shimizu, K, Suzuki, N, Imai, T, Aizawa, K, Nanba, H, Hanaoka, Y, Kuno, S, Mesaki, N, Kono, I, and Akama, T. Monocyte and T-cell responses to exercise training in elderly subjects. J Strength Cond Res 25(9): 2565-2572, 2011-The purpose of this study was to examine the effects of exercise training on age-related impairment of immune parameters related to T-cell activation in elderly individuals. Twenty-four elderly subjects were assigned to an exercise training group (EXC: 3 men, 9 women; age 61-76 years) or a nonexercise control group (CON: 4 men, 8 women; age 62-79 years). Subjects in EXC participated in exercise sessions 2 d.wk(-1) for 12 weeks. The training session included stretching and endurance exercise (10 minutes), resistance training comprised leg extension, leg press, hip abduction, and hip adduction using exercise machine and each subject's body weight. Subjects in CON maintained their normal physical activity levels during the study period. Blood samples were collected before and after the training period. Samples were measured for the numbers of leukocytes, lymphocytes, and monocytes, and for CD3(+), CD4(+), CD8(+), CD28(+) CD4(+), CD28(+) CD8(+), TRL-4(+) CD14(+), and CD80(+)CD14(+) cells. The number of leukocytes, lymphocytes, monocytes, CD3(+), CD4(+), and CD8(+) cells did not change after 12 weeks in either EXC or CON. The number of CD28(+)CD8(+) cells increased significantly after training in EXC (p <= 0.05), although CON showed no significant change. In the EXC group, CD80(+)CD14(+) cell counts were significantly higher after training (p <= 0.05), but the TLR-4(+)CD14(+) cell counts were unchanged. In the CON group, no significant alteration existed in TLR-4(+)CD14(+) and CD80(+)CD14(+) cell numbers. In conclusion, exercise training in elderly people is associated with increased CD28-expressing Tc cells and CD80-expressing monocytes. Therefore, exercise training might upregulate monocyte and T-cell-mediated immunity in elderly people.

Shimizu, K, Suzuki, N, Imai, T, Aizawa, K, Nanba, H, Hanaoka, Y, Kuno, S, Mesaki, N, Kono, I, and Akama, T. Monocyte and T-cell responses to exercise training in elderly subjects. J Strength Cond Res 25(9): 2565-2572, 2011-The purpose of this study was to examine the effects of exercise training on age-related impairment of immune parameters related to T-cell activation in elderly individuals. Twenty-four elderly subjects were assigned to an exercise training group (EXC: 3 men, 9 women; age 61-76 years) or a nonexercise control group (CON: 4 men, 8 women; age 62-79 years). Subjects in EXC participated in exercise sessions 2 d.wk(-1) for 12 weeks. The training session included stretching and endurance exercise (10 minutes), resistance training comprised leg extension, leg press, hip abduction, and hip adduction using exercise machine and each subject's body weight. Subjects in CON maintained their normal physical activity levels during the study period. Blood samples were collected before and after the training period. Samples were measured for the numbers of leukocytes, lymphocytes, and monocytes, and for CD3(+), CD4(+), CD8(+), CD28(+) CD4(+), CD28(+) CD8(+), TRL-4(+) CD14(+), and CD80(+)CD14(+) cells. The number of leukocytes, lymphocytes, monocytes, CD3(+), CD4(+), and CD8(+) cells did not change after 12 weeks in either EXC or CON. The number of CD28(+)CD8(+) cells increased significantly after training in EXC (p <= 0.05), although CON showed no significant change. In the EXC group, CD80(+)CD14(+) cell counts were significantly higher after training (p <= 0.05), but the TLR-4(+)CD14(+) cell counts were unchanged. In the CON group, no significant alteration existed in TLR-4(+)CD14(+) and CD80(+)CD14(+) cell numbers. In conclusion, exercise training in elderly people is associated with increased CD28-expressing Tc cells and CD80-expressing monocytes. Therefore, exercise training might upregulate monocyte and T-cell-mediated immunity in elderly people.

Shimizu, K, Aizawa, K, Suzuki, N, Masuchi, K, Okada, H, Akimoto, T, Mesaki, N, and Akama, T. Influences of weight loss on monocytes and T-cell subpopulations in male judo athletes. J Strength Cond Res 25(7): 1943-1950, 2011-The purpose of this study was to examine weight loss effects on immune function in judo athletes. Six elite male Japanese judo athletes (20.3 +/- 0.4 years) were enrolled in this study. They completed usual weight loss programs during 2 weeks preceding an actual competition. Subjects noted the appearance of upper-respiratory tract infection (URTI) symptoms during the study period. Blood samples were obtained at 40 (baseline period: BL) and 3 (weight loss period: WL) days before and 1 day after the competition (AC). The CD3(+), CD4(+), CD8(+), CD56(+)CD3(-), CD28(+)CD4(+), CD28(+)CD8(+), and Toll-like-receptor-4(+) (TLR-4) CD14(+) cells were counted by using flow cytometer analysis. The 6 subjects reported 1 headache, 3 runny nose conditions, and 1 coughing instance during the WL. The CD3(+), CD4(+), CD8(+), and CD28(+)CD4(+) cell counts were significantly lower at WL than at BL (p <= 0.05); they reverted to the baseline value at AC. The TLR-4(+)CD14(+) cells were significantly fewer at WL (p <= 0.05); they remained fewer than they had been at BL, even at AC. These results suggest that 2 weeks of weight loss before a competition can impair cell-mediated immune function and induce high susceptibility to URTI in judo athletes. Coaches, support staff, and athletes should monitor athletes' weight loss, hydration status, appearance of URTI symptoms, and immunocompetence such as lymphocytes and monocytes to prevent the physical condition from becoming worse.

Shimizu, K, Aizawa, K, Suzuki, N, Masuchi, K, Okada, H, Akimoto, T, Mesaki, N, and Akama, T. Influences of weight loss on monocytes and T-cell subpopulations in male judo athletes. J Strength Cond Res 25(7): 1943-1950, 2011-The purpose of this study was to examine weight loss effects on immune function in judo athletes. Six elite male Japanese judo athletes (20.3 +/- 0.4 years) were enrolled in this study. They completed usual weight loss programs during 2 weeks preceding an actual competition. Subjects noted the appearance of upper-respiratory tract infection (URTI) symptoms during the study period. Blood samples were obtained at 40 (baseline period: BL) and 3 (weight loss period: WL) days before and 1 day after the competition (AC). The CD3(+), CD4(+), CD8(+), CD56(+)CD3(-), CD28(+)CD4(+), CD28(+)CD8(+), and Toll-like-receptor-4(+) (TLR-4) CD14(+) cells were counted by using flow cytometer analysis. The 6 subjects reported 1 headache, 3 runny nose conditions, and 1 coughing instance during the WL. The CD3(+), CD4(+), CD8(+), and CD28(+)CD4(+) cell counts were significantly lower at WL than at BL (p <= 0.05); they reverted to the baseline value at AC. The TLR-4(+)CD14(+) cells were significantly fewer at WL (p <= 0.05); they remained fewer than they had been at BL, even at AC. These results suggest that 2 weeks of weight loss before a competition can impair cell-mediated immune function and induce high susceptibility to URTI in judo athletes. Coaches, support staff, and athletes should monitor athletes' weight loss, hydration status, appearance of URTI symptoms, and immunocompetence such as lymphocytes and monocytes to prevent the physical condition from becoming worse.

Epidemiological studies suggest that highly trained athletes are more susceptible to upper respiratory tract infections (URTI) compared with the general population. Upper respiratory symptoms (URS) often appear as either primary invasion of pathogenic organisms and/or reactivation of latent viruses such as Epstein-Barr virus (EBV). The purpose of this study was to examine the relationship between EBV reactivation and the appearance of URS during intensive training in collegiate rugby football players. We evaluated EBV-DNA expression in saliva and examined the relationship between onset of URS and daily changes in EBV-DNA as well as secretory immunoglobulin A (SIgA) levels among 32 male collegiate rugby football players during a 1-month training camp. The EBV-DNA expression tended to be higher in subjects who exhibited sore throat (p = 0.07) and cough (p = 0.18) than that of those who had no symptoms, although their differences were not significant. The SIgA level was significantly lower 1 day before the EBV-DNA expression (p < 0.05). The number of URS increased along with the EBV-DNA expression and decrease of SIgA levels. These results suggest that the appearance of URS is associated with reactivation of EBV and reduction of SIgA during training.

中高齢女性を対象として、日常の身体活動量の違いが口腔内粘膜免疫能および全身免疫能に及ぼす影響を検討した。健康な中高齢女性101例を対象とした。計測した歩数を階層化し、3分位数値によって3等分することで3群(T1、T2、T3)に分けた。SIgA分泌量およびT細胞の各サブセットにおいて身体活動レベルによる影響の違いは認めなかった。T1群はT2群に比べて明らかに低い身体活動量を維持していた。T2群の歩数は60歳代の平均歩数にやや近似した。また、T1群の歩数は一般に比べても低い値であった。年齢と唾液SIgA分泌速度の間に弱いながらも有意な負の相関関係を認めた。CD28発現Th細胞数と年齢との間には、有意ではないが弱い負の相関関係を認めた。CD28発現と日常の身体活動量の間に関係がない可能性が考えられた。身体活動量と各免疫学的指標との間に関係を認めなかった。

We aimed to develop a valid model of immunosuppression induced by intense exercise in rats. Rats were divided into three groups. In the rest (Rest) group, saliva was collected from resting rats on 4 consecutive days. In the exercise (Ex) group, rats ran on a treadmill untill exhaustion (exercise time: 60.0 +/- 3.7 min), and their saliva was collected before and after exercise; the salivary glands were removed after exercise. In the control (Con) group, saliva collection and gland removal were also performed, but the rats did not exercise. Secretory immunoglobulin A (SIgA) concentrations in saliva and polymeric immunoglobulin receptor (pIgR) mRNA expression in the glands were measured. There was no significant change in SIgA concentration in the Rest group over 4 days. In the Ex group, SIgA concentration decreased significantly after exercise compared with before, whereas there was no significant change in the Con group. The expression of pIgR mRNA was significantly lower in the Ex group post-exercise than in the Con group. Our procedure for saliva collection appeared suitable, and the exercise-induced SIgA suppression was probably caused by a decline in pIgR mRNA expression. We propose to use this reproducible and reliable rat model of exercise-induced SIgA suppression in future studies.

Purpose: The aim of this work was to assess the relationship in elderly subjects between free-living daily physical activity and mucosal immunity, especially salivary secretory immunoglobulin A (SIgA). Methods: Elderly volunteers (114 men and 170 women) aged 71.3 +/- 0.3 yr (range: 65-86 yr) participated in this study. Resting saliva samples were collected in the morning. Saliva samples stimulated by chewing a sterile cotton ball at a frequency of 60/60 s were collected. The SIgA concentration was measured using enzyme-linked immunosorbent assay (ELISA), and the SIgA secretion rate was calculated. Free-living step count (steps per day), energy expenditure (kJ(.)kg(-1)-d(-1)), and activity durations (min(.)d(-1)) at specific intensity levels (inactive, light, moderate, and vigorous) were evaluated using an electric pedometer. The data obtained were stratified by pedometer-determined steps per day using quartiles (Q1-Q4) for distribution. Results: Elderly in quartiles showed step counts of 2962 94, 5118 62, 6832 59, and 9951 264 steps per day. Significant differences were found in the mean step count (P < 0.0001), energy expenditure (P < 0.0001), and activity duration (P < 0.0001) with increasing pedometer-determined activity quartiles. Both SIgA concentration and SIgA-secretion rate were significantly higher for Q3 than for Q1 (P < 0.05). Meanwhile, saliva flow rates showed no significant differences across quartiles. Conclusion: These results suggest that a free-living daily physical activity level of approximately 7000 steps per day might be regarded as a moderate daily physical activity target for elderly people to improve mucosal immune function.

Background: The immune system declines in efficiency with advancing age, making the elderly less resistant to pathogenic microorganisms. Upper respiratory tract infection (URTI) is a common illness. Recent studies have shown that suppression of secretory immunoglobulin A (SIgA) is associated with increased incidence of URTL
Objective: To assess the effect of exercise on salivary SIgA in elderly subjects.
Methods: Forty five elderly subjects (18 men, 27 women; mean (SD) age 64.9 (8.4) years) performed both 60 minute resistance and 60 minute moderate endurance training a week for 12 months. Saliva samples were obtained before training, and at four and 12 months during the training period. Salivary SIgA concentrations were measured by enzyme linked immunosorbent assay, and the SIgA secretion rate was calculated.
Results: SlgA concentrations before training, and at four and 12 months during training were 24.7 (14.4), 27.2 (14.2), and 33.8 (18.5) mug/ml respectively. SIgA secretion rates were 29.5 (26.0), 33.8 (27.2) and 46.5 (35.1) mug/min respectively. The results indicate that both the concentration and secretion rate of SlgA significantly (p<0.01) increased during 12 months of exercise in these elderly subjects.
Conclusion: Regular moderate exercise seems to enhance mucosal immune function in elderly subjects.

Intercellular adhesion molecule-1 (ICAM-1) plays an important role in leukocyte migration from the circulation and intervention at sites of inflammation. We investigated the effects of various types of exercise on circulating levels of soluble ICAM-1 (sICAM-1) in normal healthy male adults. Plasma concentrations of sICAM-1 were measured before and after bicycle ergometer exercise at intensity of 80% maximal oxygen consumption (VO2max) (16 min), 42 km endurance running and 30-min downhill running at intensity of ventilation threshold (VT). The plasma sICAM-1 level increased 1 day after the endurance running (12%) and downhill running (14%), but not after ergometer exercise. Plasma C-reactive protein (CRP) and creatine kinase (CK) concentrations also increased 1 day after running. Our data suggest that exercise associated with muscle damage and/or inflammation results in increased levels of plasma sICAM-1. The physiological significance of post-exercise high plasma sICAM-1 levels is not clear at this stage, but changes in plasma sICAM-1 may reflect the status of the immune system.

PURPOSE: We examined the levels of autoantibodies against prethrombin-1 and fragment-1 in pregnant women to determine the type of autoantibodies that were associated with severe, preeclampsia or spontaneous abortion.
SUBJECTS AND METHODS: We measured autoantibodies bound to prethrombin-1, prethromhin-1, and fragment-1 by using an enzyme-linked immunosorbent assay (ELISA) in 12 healthy nonpregnant women, 36 women with normal pregnancies, 28 pregnant women with severe preeclampsia, and 19 pregnant women who subsequently had spontaneous abortion.
RESULTS: Plasma samples in 10 (36%) of the 28 women with severe preeclampsia and 11 (58%) of the 19 women with spontaneous abortion were positive for antiprothrombin antibodies as compared with 3 (9%) of the 36 women with normal pregnancies. AU II of the positive samples from women who had spontaneous abortions were positive for antiprethrombin-1 antibody, but only 1 was positive for antifragment-1 antibody. The mean ( +/- SD) titer of antiprethrombin-1 1 antibodies in patients with spontaneous abortion (36 +/- 9 U) was higher than that in women with normal pregnancies (10 +/- 4 U; P < 0.01). Antiprethrombin-1 antibody was detected in only 28 women with severe preeclampsia, whereas all 10 women with antiprethrombin antibodies were positive for antifragment-1 antibody. The antifragment-1 antibody titer in patients with severe pre eclampsia (49 +/- 15 U) was higher than in women with normal pregnancies(l3 +/- 6 U, P <0.01).
CONCLUSIONS: There is a strong and specific association between various types of antiprothrombin antibodies with severe preeclampsia and spontaneous abortion. (C)2001 by Excerpta Medica, Inc.

Palmar fasciitis and polyarthritis (PFA) is a rare paraneoplastic rheumatic syndrome characterized by flexion contractures of both hands and thickening of palmar fascia. Several reports have suggested that this syndrome is a tumor-associated autoimmune disorder. We report a 44-year-old Japanese man who presented with flexion contractures of both hands associated with thickening of palmar fascia and polyarthritis. These clinical pictures were suggestive of PFA associated with occult neoplasm. Upper gastrointestinal endoscopic examination revealed advanced gastric cancer. Resection of the cancer resulted in a gradual resolution of palmar fasciitis and polyarthritis. This clinical course suggests an underlying tumor-related immunologic process in this syndrome.

Objective. To examine the relationship between serum immunoglobulin (Ig) levels and pulmonary function in patients with systemic sclerosis (SSc).
Methods. Twenty-four patients with SSc who had at least 2 sets of pulmonary function tests (PFT) at intervals of more than one year were eligible. Multiple linear regression models were constructed for prediction of the annualized rates of change of forced vital capacity (FVC), carbon monoxide diffusing capacity (DLco), and DLco per unit alveolar volume (K-co).
Results. The rates of change of FVC and K-co correlated with the annualized rate of change of IgG (p < 0.001 and p = 0.005, respectively), and the rate of change of DLco correlated with the serum IgM level at the first PFT (p = 0.020) and with the annualized rate of change of IgG (p = 0.007).
Conclusion. The rates of change of serum Ig levels are associated with those of pulmonary function in SSc. Use of this model may assist investigation of pulmonary involvement.

Interleukin-12 (IL-12) is a cytokine that was originally identified as natural killer cell stimulatory factor. It induces the activity of T-helper 1 (Th1) cells and exhibits strong anti-tumor activity. In this study, we studied the effects of brief anaerobic maximal exercise on circulating levels of IL-12. Six healthy males [mean (SD) 25.2 (2.6) years] performed a modified Wingate test exercise (resistance 0.075 kg/kg of body mass). The exercise consisted of five bouts of maximal cycling for 10 s, with rest intervals of 50 s between them. Blood samples were taken before, immediately after, 30 min after, 60 min after and 120 min after the exercise. Plasma concentrations of IL-12 were measured using an enzyme-linked immunosorbent assay. Data were corrected for hemoglobin and hematocrit measurements. Plasma concentrations of IL-12 averaged [mean (SD)] 234.2 (40.9) pg/ml before, 305.2 (62.1) pg/ml immediately after, 202.8 (24.2) pg/ml 30 min after, 239.7 (35.1) pg/ml 60 min after, and 199.6 (49.2) pg/ml 120 min after the exercise. We showed that plasma concentrations of IL-12 increased significantly immediately after brief anaerobic maximal cycle ergometer exercise (P < 0.01).

Objective. Some investigators have reported that anti-prothrombin autoantibodies (aPT) in lupus anticoagulant positive sera were detectable by ELISA. Discrepancies in aPT ELISA were observed by some investigators. To clarify this situation, we tested the binding of aPT positive sera to purified prothrombin under various conditions. Methods. We performed aPT ELISA under different conditions. The variables we tested were: ELISA plate (untreated or gamma irradiated polystyrene plates), buffer (phosphate buffered saline or Tris buffered saline), detergent (presence or absence of Tween-20), and antigen condition (intact or fragmented prothrombin). Results. Anti-PT from patients with lupus or antiphospholipid syndrome were similarly bound to prothrombin with both buffers. Addition of Tween-20 to the buffer increased reactivity in the irradiated plate assay, but decreased reactivity in the untreated plate assay. Reactivities in 90% of lupus sera were decreased by the use of fragmented prothrombin. In contrast, the reactivity of serum from a healthy subject was remarkably increased by antigen fragmentation. Conclusion. The discrepant ELISA results in measurement of aPT in the various reports may have been due to the use of detergent in the buffer and condition of the prothrombin used as antigen. In our experiments the best ELISA condition for measurement of aPT was achieved using buffer with Tween-20 detergent, with prothrombin directly coated onto irradiated polystyrene plates.

Autoantibodies against prothrombin, including lupus anticoagulant antibodies (LAC), have been identified in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). To identify the epitopes of LAC in patients with SLE and APS, we analyzed B cell epitopes of anti-prothrombin Abs. Prothrombin was purified from fresh plasma samples from healthy subjects, and fragmented by thrombin. Two fragments (prethrombin-1, 50 kDa, and fragment-1, 22 kDa) were separated and used for further experiments. The two fragments were coated on irradiated plate and the binding activities of sera from 13 patients with anti-prothrombin Abs (SLE, 7; APS, 4; SLE + APS, 2) were determined by using ELISA. The assay was conducted under the following conditions: use of irradiated plates, and TBS containing Tween-20. We detected two types of anti-prothrombin Abs. The first was anti-prethrombin-1 (n = 5) while the other was Ab against fragment-1 (n = 8). There were no patients with Abs that showed binding activities to both fragments. A higher proportion of patients with thrombosis were positive for anti-prethrombin-1 Abs (80%) than for anti-fragment-1 Abs (25%). Two patients with anti-prethrombin-1 Ab were positive for LAC and negative for anti-cardiolipin-beta(2) glycoprotein I antibody (aCL-beta(2)GPI). Our results strongly support the notion that both prethrombin-1 and fragment-1 on prothrombin molecule are B cell epitopes.

Most kendo players have gone through a traditional form of training, called Kangeiko. Kangeiko is a high intersity training camp carried out during the cold early mornings of winter. The aim of Kangeiko is to cultivate the mind and improve the physical fitness of the kendo players. In this study, we examined the changes in nocturnal urinary catecholamines excretion, aerobic fitness, and subjective condition during kangeiko in kendo. Training in Kangeiko was performed for about two hours from 5: 00 to 7: 00 am., and Kangeiko was continued for ten days in January in 1995. Training program during Kangeiko consisted of Kirikaeshi and Kakarigeiko for 30-40minutes, and Gokakugeiko for about 30minutes by interval training form. We measured nocturnal urinary catecholamines (dopamine, adrenaline, and noradrenaline) excretion in five female college kendo players throughout Kangeiko, and evaluated their aerobic fitness before and the 3rd day after Kangeiko using multistage fitness test. Resting blood creatine kinase (CK) activity was measured before training on the first,6th, and 10th days of Kangeiko, and the 3rd day after Kangeiko. Each players kept recording their subjective condition, such as fatigue, muscle soreness etc., using 7-point rating scale from 1 (very bad) to 7 (very well) throughout Kangeiko. Nocturnal urinary catecholamines excretion were increased on the 3rd and/or 8th days of Kangeiko, but with no significance. Aerobic fitness fell the 3rd day after Kangeiko. There were significant correlations between changes in nocturnal urinary catecholamines excretion and aerobic fitness. Subjective condition was significantly decreased throughout Kangeiko. In most of the players, some of subjective condition became worse with the changes in nocturnal urinary catecholamines excretion. Compared with the first day of Kangeiko, resting blood CK activities were significantly increased on the 6th and 10th days of Kangeiko, indicated that repetition of high intensity training during Kangeiko produced remarkable disruption of muscle tissue. Change in basal sympathetic activity induced by extreme physical and mindful stress during Kangeiko might cause changes in aerobic fitness and subjective condition of the kendo players. Training program should be designed in consideration of individual differences in those stress during Kangeiko, as well as adequate health care.