The erythrocyte antioxidative defense system was investigated before and after a 12km run. The effect of exercise with a bicycle ergometer on this system was also examined one and seven days after the. 12km run. Five untrained healthy men, aged 18-21 years, participated in the present study. Plasma creatine kinase (CK) activity increased after running and reached a maximum on the next day (p<0.005) . Levels of the reduced form of glutathione (GSH) decreased by 24.6% after running (p<0.005), but by 7 days later the values recovered. Levels of lipid peroxides (LPO, expressed as thiobarbituric acid-reactive substances) fell slightly after running (13.4%, not significant), then showed a significant decrease on the next day (34.7%, p<0.005) and recovered by the seventh day. Neither glutathione peroxidase (GPX) nor glutathione reductase (GR) activities (with or without FAD) showed significant changes after the 12km run. Activities of catalase (CAT) were lowest after the exercise with a bicycle ergometer on the following day (p<0.05 vs. initial levels) . Levels of GSH, GPX, GR and LPO did not change after this exercise. The decreased level of GSH after the 12km run indicates the presence of oxidative stress, while moderate exercise with a bicycle ergometer does not affect the erythrocyte glutathione metabolism in untrained men. It is also suggested that catalase activity decreases after the repeated exercise.

The purpose of this study was to determine the effects of water temperatures on respiratory regulation during head-out water immersion (HWI). A total of eight healthy young male and female subjects were immersed in water at temperatures of 25, 30, 36, 38, 40, and 42°C for 10 minutes, and breathing frequency, tidal volume, ventilation, oxygen consumption, heart rate, and sublingual temperatures were measured over a period of 40 minutes before, during, and after HWI at each water temperature. Both oxygen consumption and ventilation increased during HWI at any temperature. It was hypothesized that the increase in oxygen consumption at 25°C was due to the increase in tidal volume and that at 40 and 42°C was due to the increase in ventilation caused by the increase in breathing frequency. These results suggest that the respiratory regulation during HWI is closely related to the body temperature regulation in response to water temperatures.

Although the trunk segment shows well-coordinated movements in concert with the arms and legs during bipedal walking, little is understood about the neural mechanisms controlling the trunk muscles in response to sudden tactile sensations in the foot during walking. This study examined the cutaneous reflexes (CR) to shed light on the neural mechanisms underlying the regulation of the trunk muscles during walking and standing. Eleven healthy men participated in the study. Electromyographic (EMG) activities were recorded in the trapezius (TRAP), erector spinae (ES), and rectus abdominis (RA) muscles. To elicit CR, non-noxious electrical stimulation of the sural nerve at the ipsilateral lateral malleolus was applied during treadmill walking and tonic contraction of the test muscles during standing. During walking, cutaneous nerve stimulation in the foot gave rise to facilitatory CR in all the muscles, and the amplitude of the CR was strongly modulated in a phase-dependent manner. The amplitude of the background EMG and the amplitude of the CR showed a highly significant correlation in all the muscle tested during standing. However, this was true only in the ES during walking. In the RA, the inhibitory CR during standing changed to a facilitatory one during walking. In addition, reflex ratios were significantly larger during walking than standing. These findings suggest that common neural mechanisms in limb muscles could function in the TRAP and RA, however, in the ES disparate neural mechanisms play a crucial role in modulating cutaneous reflexes during walking and standing.

A 29-year-old man, who had undergone valvotomy for pure pulmonary stenosis at 6 months of age, was admitted to our institution for surgical treatment of a giant ascending aortic aneurysm and annuloaortic ectasia. Chest MRI revealed a 14-cm ascending aneurysm in contact with the sternum. After establishing femoro-femoral bypass for hypothermia, a left lateral thoracotomy was perfomed at the 4th intercostal space. Pulmonary artery cannulation was performed for left heart venting, and the proximal aortic arch was dissected for aortic cross-clamping. Median sternotomy was performed under circulatory arrest at 18°C and the aortic arch was opened. Under retrograde cerebral perfusion, the proximal arch was replaced by an artificial graft, and then aortic root replacement was completed using a composite graft under CPB. The postoperative course was uneventful, and the patient was discharged on the 37th postoperative day. He has been well without any complications. This case suggests that our method of approach to the giant aortic aneurysm with sternal adhesion and aortic regurgitation, and the use of extracorporeal circulation in view of the annuloaortic ectasia is effective and safe in case of reoperation.

This study was conducted to examine the effect of exercise training on heat-shock response, the protective response to heat, oxidative stress and other stresses characterized by elevated synthesis of heat-shock proteins (HSP), in strenuous exercise. Five untrained men (aged 20-21 ) participated in the study. The protocol included strenuous exercise to exhaustion by bicycle ergometer (1 st Ex), 4 weeks of training (a 2 km run three days per week) and a repetition of the strenuous exercise (2 nd Ex) . We measured VO₂ and VCO₂ with a respiratorygas analyzer, 70 kDa heat-shock protein (HSP 70) of mononuclear cells by western blotting, and rectal and mean skin temperatures by thermistors during the strenuous exercise. After 4 weeks of training, VO₂max was increased significantly (p<0.05) . HSP 70 increased immediately after the exercise in 3 of 5 subjects in the 1 st Ex, but not in the 2 nd Ex. Rectal temperatures rose significantly after both the 1 st and 2 nd Ex (p<0.05) . Mean skin temperatures fell significantly after both the 1 st and 2 nd Ex (p<0.05) . There was no correlation between rectal and mean skin temperatures and HSP 70. We observed the heat-shock response during strenuous exercise and the attenuation of this response after 4 weeks of exercise training. These results suggest that exercise training may have suppressive effects on the heat-shock response during strenuous exercise.

Aortic dissection with rupture into the right atrium is an extremely rare and rapidly fatal condition. We report the case of a 59-year-old man with a history of double valve replacement 2 years earlier at another hospital. Although the previous postoperative course had been uneventful, the patient had experienced facial edema and general fatigue for 10 days before admission to our hospital because of heart failure. The diagnosis of chronic aortic dissection with rupture into the right atrium was confirmed by intraoperative transesophageal echocardiography. At operation, we observed an aortic dissection that originated from a tear in the original aortic incision line. The fistula extended from the false lumen to the right atrium. The aortic adventitia were partially defective. The aortic dissection had ruptured and a pseudo-aneurysm had formed. We performed ascending aortic replacement and closure of the aorta-right atrium fistula under hypothermic arrest on cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day.

An 84-year-old man electively underwent abdominal aortic open repair for an abdominal aortic aneurysm. During the operation, the ureter was not confirmed when manipulating the iliac arteries. Subsequently, intestinal paralysis occurred on the fifth day after surgery and a drainage tube of the intestinal tract was inserted. Liquid retention around the left iliopsoas muscle, and left renal nephropathy were recognized on performing enhanced computed tomography (CT) on postoperative day 11. An initial diagnosis of an iliopsoas abscess was considered. Simple CT imaging was performed on the 13th day after surgery without symptomatic improvement. This scan revealed that the contrast agent had remained in the cavity since the previous CT scan, which had been misdiagnosed as an abscess. Ureteral injury was now suspected. Retrograde ureterography revealed an urinoma caused by left ureter injury. We diagnosed paralytic ileus due to urinoma. For drainage of the urine, a percutaneous renal fistula was constructed. He was discharged from the hospital on the 56th postoperative day, and by six months after the operation, the urinary tract problem had disappeared. In conclusion, we report a case of delayed ureteral injury that occurred after abdominal aortic open repair surgery.

BACKGROUND/AIMS: Tacrolimus is effective for refractory ulcerative colitis in adults, while data for children is sparse. We aimed to evaluate the effectiveness and safety of tacrolimus for induction and maintenance therapy in Japanese children with ulcerative colitis.METHODS: We retrospectively reviewed the multicenter survey data of 67 patients with ulcerative colitis aged < 17 years treated with tacrolimus between 2000 and 2012. Patients’ characteristics, disease activity, Pediatric Ulcerative Colitis Activity Index (PUCAI) score, initial oral tacrolimus dose, short-term (2-week) and long-term (1-year) outcomes, steroid-sparing effects, and adverse events were evaluated. Clinical remission was defined as a PUCAI score < 10; treatment response was defined as a PUCAI score reduction of ≥ 20 points compared with baseline.RESULTS: Patients included 35 boys and 32 girls (median [interquartile range] at admission: 13 [11–15] years). Thirty-nine patients were steroid-dependent and 26 were steroidrefractory; 20 had severe colitis and 43 had moderate colitis. The initial tacrolimus dose was 0.09 mg/kg/day (range, 0.05–0.12 mg/kg/day). The short-term clinical remission rate was 47.8%, and the clinical response rate was 37.3%. The mean prednisolone dose was reduced from 19.2 mg/day at tacrolimus initiation to 5.7 mg/day at week 8 (P< 0.001). The adverse event rate was 53.7%; 6 patients required discontinuation of tacrolimus therapy.CONCLUSIONS: Tacrolimus was a safe and effective second-line induction therapy for steroid-dependent and steroid-refractory ulcerative colitis in Japanese children.
Adult ; Asian Continental Ancestry Group ; Biological Factors ; Child ; Colectomy ; Colitis ; Colitis, Ulcerative ; Female ; Humans ; Immunologic Factors ; Japan ; Prednisolone ; Remission Induction ; Retrospective Studies ; Tacrolimus ; Ulcer