The purpose of this study was to determine whether body composition alterations induced by aerobic exercise training show seasonal varition. Ninety-five middle-aged Japanese obese women volunteered as subjects. All subjects participated in our “exercise+diet” program for 3 months. The subjects were categorized into two groups (Summer group : S, and Winter group : W) based on the season when they participated in the program. Body composition, cardiorespiratory variables and dietary habituation were evaluated before and after the programs. More desirable changes in body composition were observed in Group W than in Group S. Group W showed a significant decrease in body mass from 62.2±8.7 kg to 60.3±8.6 kg, and in percentage body fat from 34.0±7.0% to 30.5±6.0%, while fat-free mass increased significantly from 41.0±3.9 kg 41.9±3.6 kg. However, alterations in cardiorespiratory variables were not associated with body composition alterations. It is concluded that season may have an effect on body composition alterations, but has no effect on cardiorespiratory variables, and that body composition may be improved by an exercise+diet program more effectively in winter than in summer.

Exercise-induced changes in body composition are dependent on various external factors. The psychological factor seems to be an important determinant for reducing body mass. However, the effect of changes in mood on weight loss have not been thoroughly investigated. The purpose of this study was to investigate the relationships among mood status, body composition and anthropometric characteristics observed during an exercise training program. Thirty-four obese women, aged 46.5±7.7 years, participated in our 3-month weight loss program. Body mass and % fat significantly decreased from 66.3±7.1 kg to 59.8±6.5kg, and from 31.8±3.1% to 27.9±4.0% (P<0.05), respectively. Aerobic power, as represented by maximal oxygen uptake, significantly increased (from 29.1±5.0 mlin/kg to 34.6±5.2 mlin/kg), and oxygen uptake corresponding to lactate threshold increased as well (from 17.2±2.8mlin/kg to 20.0±3.0mlin/kg) after training (P<0.05) . Accord. ing to the degree of body mass change, the subjects were divided into the following two groups : good-responder group (Group G : -9.2±2.7 kg) and poor-responder group (Group P : -3.8±1.4 kg) . Analyses of variance revealed significant differences (P<0.05) in total mood disturbance between Group G (103.54±16.30) and Group P (115.20±21.17) . These results show the possibility of the effects of mood on the success of weight loss in obese middle-aged women.

Objective : We performed a systematic review to investigate improvements in body function and structure, activity, and health-related quality of life from exercise programs of >150 days' duration in patients with knee osteoarthritis (OA). Methods : We collected data on randomized controlled trials (RCTs) comparing the effects of exercise intervention with those of either nonintervention or psychoeducational intervention in patients with knee OA. Data were collected on pain, stiffness, muscle strength, range of motion, flexibility, maximal oxygen uptake, proprioception, time to climb a flight of stairs, disability as assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC), walking distance (e.g., 6-min walking-distance test), walking time (e.g., time to walk arbitrary distances), walking velocity, and health-related quality of life assessed using the SF-36^® Health Survey (SF-36). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to determine the quality of the evidence. Results: Forty-one RCTs were identified. Outcomes that were significantly affected by exercise programs of >150 days were knee flexion muscle strength at a functional level, time to climb a flight of stairs and walking distance at activity level, and SF-36 General Health, Physical Functioning, Role-Physical, and Bodily Pain scales. The quality of evidence for these outcomes was moderate to high. Conclusion : In patients with knee OA, improvements in body function, activity, and health-related quality of life can be maintained with exercise programs of >150 days' duration, and these findings are supported by a moderate to high level of evidence.

The effect of moxibustion on duodenal motility was examined. Duodenal motility was measured by the balloon method in anesthetized, artificially ventilated rats. The stimulation temperature and duration of moxibustion varied. Treatments were applied to the hind paw and abdomen.
The duodenal motility exhibited an excited response by pinch stimulation of hind paw, and inhibitory response by abdominal pinch stimulation. Duodenal motility did not show any response to indirect moxibustion stimulation of the hind paw and abdomen. Duodenal motility exhibited an excited response by direct application of moxibustion to the hind paw and an inhibitory response by direct application of moxibustion to the abdomen.

A 64-year-old man who underwent aortic valve replacement with a 25mm Bjork-Shiley valve in 1993 began to have severe anemia and required repeated transfusions by November 2003. Doppler echocardiography showed only mild aortic regurgitation, but revealed turbulent flow around the mechanical valve. Autoimmune hemolytic anemia (AIHA) was diagnosed and he was treated with prednisolone (PSL) starting May 2004. Because of unremitting hemolysis requiring multiple transfusions and the occurrence of renal dysfunction, he underwent rereplacement of the aortic valve with a 25-mm Freestyle valve. His hemolysis and general condition immediately improved. This case suggests the possibility that mild regurgitant jet and turbulent jet stress can cause severe hemolysis when AIHA develops.

It is commonly believed that prosthetic valve implantation in actively infected patients is to be avoided. After normalization of C-reactive protein and white blood cell counts, and sterilization of blood cultures by treatment with antibiotics, we performed valvular surgery. We performed mitral valve repair in cases where the mitral valve lesion did not involve the annulus. From July 1992 to November 1996, 13 patients (mean age, 50 years) were treated surgically for infective endocarditis (IE) at Kansai Medical University. Twelve of the patients had native valve endocarditis (NVE), and 1 had prosthetic valve endocarditis (PVE). In 6 patients, the causative organisms were determined. These included: α-Streptococcus in 4 patients, Enterococcus in 1, and methicillin-resistant Staphylococcus aureus (MRSA) in 1. The affected valves were as follows: aortic valve alone in 4 patients, mitral valve alone in 6, aortic and mitral valves in 2, and a prosthetic aortic valve in 1. The PVE was due to a MRSA infection which occurred 9 months after aortic valve replacement. All patients were treated preoperatively for heart failure and the infection. The surgical procedures performed were: aortic valve replacement in 4 patients, mitral valve replacement in 3, mitral repair in 3, double valve replacement in 2, and re-aortic valve replacement in 1. There were no deaths or recurrences of IE in hospital or during follow-up to date. In all of the mitral valve repair cases, the mitral regurgitation on follow-up echocardiograms was grade I. Our results show that surgical treatment of IE after management of preoperative conditions can be successful. Furthermore, despite the absence of laboratory findings indicative of ongoing inflammation or infection, pathologic examination revealed active inflammatory reactions and organisms in 4 cases. In 1 patient, MRSA was culthued from an annular abscess that was resected intraoperatively. We suggest that cessation of antibiotic therapy be regarded with caution and suggest that the infected site must be resected surgically.

A 64-year-old man who had chronic aortic dissecting aneurysm with true lumen obstruction of the abdominal aorta was referred to our hospital for surgery. He underwent total aortic arch replacement with the elephant trunk technique using an aortofemoral artery bypass as a first-stage operation. Reconstruction of the thoracic aortic descending aneurysm using the previous elephant trunk graft in a second-stage operation was feasible. His perioperative course was uneventful and he had no neurologic complications.

　　Introduction: Reimbursement for breathing care services was started with the revision of the nation's medical service fee system in 2010. Our hospital was not properly equipped in the light of certain standards governing facilities. Nonetheless, we started giving instructions to nurses on how to check the respirator at work. In addition to the on-the-job training, we are engaged in educational activity and information gathering. Out team comprises clinical engineers, physical therapists and registered nurses. They are all certified respiratory therapists. We hereby report our activities and refer to future problems.　　Activities: 1. Safety checks of respirators while in use. 2. Respiratory rehabilitation during hemodialysis. 3. Respirator-related workshops. 4. Review of accidents.　　Results: 1. It has become easier to discover potential problems and meet them at once. This is because our team is made up of different specialists, each used to looking at things differently. 2. Being constantly on the alert for any indication of a trouble ensures safety during breathing rehabilitation. 3. The number of accidents during 2012 decreased from 2011.　　Future: We think that since “safety management” is the center piece of our activity, our team ought to be recognized as an official organization of the hospital.

[Objective]To analyze the situation of clinics that want to employ acupuncturists and masseurs and to obtain basic data to find employment in the clinic in the future.
[Methods]The subjects were 52 clinics that responded to the questionnaire survey saying they wanted to employ acupuncture and massage therapists. They were divided into three groups according to the license (acupuncture group (n = 5), acupuncture &massage group (n = 25), massage group (n = 22)). The situation and the business realities of the clinic were analyzed.
[Results]Clinics with obstetrics and gynecology want to employ only acupuncturists. There were as many employment needs for both acupuncturists and masseurs in clinics with orthopedics and rehabilitation. The employment satisfaction rating is higher for the patient's need standpoint than cost-effectiveness.
[Conclusion]We analyzed the status of clinics that want to employ acupuncturists and masseurs. This study is expected to help promote the employment of medical acupuncturists and masseurs.

We evaluated 13 patients (4 men & 9 women, mean age: 61 years-old) who required steroid treatment for more than 1 month before open heart surgery. The subjects included 3 patients with collagen diseases, 3 with dermatopathy, 2 with bronchial asthma, one each with Takayasu's disease, autoimmune hemolytic anemia, paroxysmal nocturnal hemoglobinuria, brain tumor and post-renal transplantation. Surgical procedures were performed with an AC bypass in 9 cases, one each with AVR, MVR, reMVR and ASD patch closure. The steroid treatment before open heart surgery had been continued for a mean of 4 years and 11 months at a mean dose of 9.4mg/day equivalent of prednisolone. We evaluated the adrenocortical function on the rapid ACTH test and found hypoadrenalism in 5 of 8 cases (63%). In these cases we gave either 100mg of hydrocortisone or 1, 000mg of methylprednisolone before open heart surgery. The total perioperative dosage of steroid was a mean of 2, 488mg equivalent of prednisolone, including 4mg/kg of betamethasone during the extra corporeal circulation. Postoperatively we lost one case due to ventricular rupture after MVR. Other major complications were seen in one case each, cardiac tamponade, temporary clamp, wound infection and lumbar vertebral fracture. For steroid treated patients, it is important to select the patient who really need steroid by the rapid ACTH test, and to use the minimum dosage of steroids in open heart surgery.