The injury mechanism of traumatic cervical spine injury varies, and Allen et al. divide cervical spine injuries into 6 types based on the direction of external force at the time of injury. In this report, we present 2 cases as Lateral Flexion Stage 2. A 51-year-old male (Case 1) was injured in a traffic accident. His conscious level was JCS III-200, and he was found to have a Frankel Grade of B. X-ray revealed a C5/6 fracture dislocation injury of Lateral Flexion Stage 2. We were unable to obtain good reduction. We planned to perform posterior fusion using a cervical spine pedicle screw but could not perform the procedure due to the patient’s poor general condition. A 32-year-old male (Case 2) was injured as a result of being hit by a steel sheet. He had Frankel Grade D paralysis. X-ray revealed a C5/6 fracture dislocation injury of Lateral Flexion Stage 2. We did not perform manual reduction. We performed posterior fixation, anterior decompression and anterior fixation. Bone union was confirmed, and the patient was able to return to work. In cases of this type of fracture dislocation of the cervical spine, the supporting structures of the spinal column circumferentially rupture and induce high instability. Since closed reduction is sometimes difficult and involves risk, strong internal fixation might be recommended.

A cDNA encoding novel type III polyketide synthase (PKS) was cloned and sequenced from young leaves of Chinese club moss Huperzia serrata (Thunb.) Trev. by RT-PCR using degenerated primers based on the conserved sequences of known CHSs, and named as H. serrata PKS2. The terminal sequences of cDNA were obtained by the 3'- and 5'-RACE method. The full-length cDNA of H. serrata PKS2 contained a 1212 bp open reading frame encoding a 46.4 kDa protein with 404 amino acids. The deduced amino acid sequence of H. serrata PKS2 showed 50%-66% identities to those of other chalcone synthase super family enzymes of plant origin. The recombinant H. serrata PKS2 was functionally expressed in Escherichia coli with an additional hexahistidine tag at the N-terminus and showed unusually versatile catalytic potency to produce various aromatic tetraketides, including chalcones, benzophenones, phloroglucinols, and acridones. In particular, the enzyme accepted bulky starter substrates N-methylanthraniloyl-CoA, and carried out three condensations with malonyl-CoA to produce 1, 3-dihydroxy-N-methylacridone. Interestingly, H. serrata PKS2 lacks most of the consensus active site sequences with acridone synthase from Ruta graveolens (Rutaceae).

Electromyographic muscle activities of the shoulder muscles during shoulder external rotation with reference to load magnitude were studied in 8 healthy male subjects without history of shoulder injuries. In addition, we discussed the relationship between rotator cuff muscles and superficial muscles. The subjects performed shoulder external rotation from 60°internal rotation to 45° external rotation at 20° of shoulder abduction and 20° of flexion. A Cybex dynamometer used to prescribe angle and velocity of the shoulder movement. At the same time, intramuscular wire electrodes were inserted into the supraspinous, infraspinous and teres minor muscles, and then surface electrodes were placed over the posterior deltoid and middle trapezius muscles. The load magnitude ranged 2-18 Nm and the angle velocity was set at 15 deg/sec. The rotator cuff muscles became significantly to be activated from 2 Nm (the supraspinous and infraspinous m.) and from 4-5 Nm (the teres minor m.) compared with the muscle activity during non-load. The superficial muscles became significantly to be activated from 4-7 Nm (the posterior deltoid m.) and from 3-6 Nm (the middle trapezius m.) compared with the muscle activity during non-load. Within the load range (18 Nm 46.8% MVC), %iEMG of the rotator cuff muscles was always larger than that of the superficial muscles. Therefore, we concluded that the contribution of the rotator cuff muscles was larger than that of the superficial muscles up to 3-4 Nm, and activities of the superficial muscles increased gradually from 3-4 Nm during shoulder external rotation.

Electromyographic activity of the shoulder muscle at 20 and 90°abduction (20 Abd, 90 Abd) during external rotation was investigated in seven healthy men with no history of injury or instability of the shoulder joint.
Electromyography (EMG) was recorded using intramuscular fine-wire electrodes inserted into the M. Supraspinatus, M. Infraspinatus and M. Teres minor, and with bipolar surface electrodes on the middle and posterior parts of M. Deltoid anti the upper and middle parts of M. Trapezius. To compare activity in different muscles, the integrated EMG (iEMG ) activity of each muscle was normalized.
M. Infraspinatus and M. Teres minor showed significantly higher activity at both the 20 Abd and 90Abd compared with the middle and posterior parts of M. Deltoid and upper parts of M. Trapezius. M. Supraspinatus, the middle and posterior parts of M. Deltoid, and upper and middle parts of M. Trapezius all showed a difference in activity level between the two positions.
These findings suggest that when M. Infraspinatus and M. Teres minor contribute to external rotation as a stabilizer and prime mover, consecutively, M. Supraspinatus, the middle and posterior parts of M. Deltoid, and upper and middle parts of M. Trapezius function according to the positions. Moreover, the activity of the upper and middle parts of M. Trapezius in 90Abd should influence stabilization, adduction and upward rotation of the scapula. Therefore, we conclude that the external rotation position is closely related to shoulder muscle activity and coordination.

The purpose of this study is to identify the effect of position (full can, empty can) and change of angle on the activity of shoulder muscles during scapular plane abduction ; and also to examine its application to exercises used for rehabilitation of shoulder muscles. Seven healthy subjects (23.4±1.4 yr) with normal shoulder function performed scapular plane abduction with external rotation (full can) and scapular plane abduction with internal rotation (empty can) . An electromyogram was recorded with a fine wire intramuscular electrode at the supraspinatus, deltoid anterior, middle, posterior and trapezius upper with bipolar surface. The EMG activity (RMS) of each muscle was normalized by the highest EMG activity (100%RMS) during a maximum manual muscle test for each muscle (%RMS) . The %RMS of each muscle remarkably increased with a change of the angle for empty can, whereas it showed a slight increase with a change of the angle for full can. This finding suggests that the position of full can and empty can in scapular plane abduction affects the function of shoulder muscles. In addition, full can exercise is recommended in order to improve function of the supraspinatus and the muscular activity balance between the supraspinatus and the deltoid. Empty can exercise is applied to sport-specific exercise for rehabilitation of shoulder muscles.

1)We applied a spiral curriculum devised by Harden to plan a sequential curriculum in outcome–based medical education at the Chiba University School of Medicine.
2)To plan a sequential curriculum, Miller's pyramid was applied to create a model for developing the competencies of physicians.
3)Competence levels based on the developmental model were used to plan learning objectives for each unit, and students and teachers were encouraged to understand the relevance of each lesson to competencies.

A patient developed perioperative coronary artery spasms (CAS) twice, in initial and redo open heart operations for mitral stenosis. CAS was shown by sudden ST segment elevation, hypotension, bradycardia, and decreased cardiac output. The patient, a female, had the first CAS attack in the ICU following open mitral commissurotomy at the age of 48. The Second CAS attack occurred during redo surgery for mitral valve replacement at age of 56. Preoperative coronary angiography before both operations did not indicate significant organic lesions. Intraaortic balloon pumping in conjunction with intravenous nitroglycerin and norepinephrine were effective to treat CAS in this case.

This is a case report of a 40-year-old man with leiomyosarcoma of the inferior vena cava. He had suffered from shortness of breath and edema on lower limbs over several months. Clinical examinations including UCG, CT and MRI revealed the mass in the right atrium. The stalk of mass was located near junction of the right atrium and inferior vena cava by cavography. He was operated upon using extracorporeal circulation. The tumor originated from inferior vena cava, measuring 8.5×5.5×4.8cm in size, 130g in weight, was successfully removed. Partial defect of anterior wall on the inferior vena cava was reconstructed using Gore-Tex patch. Histologically, the tumor was composed of the spindled cells with arranged bundles. Immunohistochemically, they were positive for Dessmin and Vimentin. Seven months after the surgery, he has been followed at OPD. In review of the Japanese literature to our knowledge, only 14 cases were reported including this case.