In repair of the tricuspid valve (TV) due to Ebstein's anomaly, mobilization of the anterior leaflet associated with longitudinal right ventricle placation (Carpentier's procedure) has provided good results in both short- and long-term follow-up. However, if the anterior leaflet is small or severely deformed, such repair may be ineffective. We report two cases of Ebstein's anomaly (63 and 53 years old) with deformed anterior leaflets of the TV in whom Carpentier's procedure was not feasible. In one patient, the anterior leaflets were broadly plastered on the right ventricle and Carpentier's procedure was tried. However, the repair was converted to valve replacement because of significant residual regurgitation. The other patient had a cleft in the anterior leaflet, therefore Carpentier's procedure was not suitable. The repair restructured the valve mechanism below the true annulus by using the most mobile leaflets for valve closure (modified Hetzer's procedure). This method of repair could be an alternative method to repair of the TV in Ebstein's anomaly, particularly when the anterior leaflet is deformed.

Strenuous exercise induces upper respiratory tract infection (URTI), whereas moderate exercise prevents URTI. This study aimed to assess the incidence of URTI and the association between URTI episodes and exercise duration in Japanese collegiate athletes. A cross-sectional survey was conducted with 1,740 participants; 1,235 responses were eligible for analysis. Participants were classified into three groups: control group (weekly total exercise duration <60 min, n=405), exercise group (weekly total exercise duration >60 min, n=193), and athlete group (joined a sports club and weekly exercise frequency >5 days, n=637). We requested the following information from participants: basic characteristics, incidence of URTI symptoms (fever, runny or plugged nose, sore throat, and cough) or influenza for each month over the past year, day of the week exercise is typically performed, and duration of exercise per week. The incidence of URTI episodes per year was significantly lower in the athlete group (2.0 ± 2.4 episodes) compared to the control group (2.6 ± 2.4 episodes, p<0.001). The incidence of URTI episodes did not significantly differ between the control group and exercise group (2.9 ± 2.9 episodes, p=0.607). Although the frequency of URTI episodes and exercise duration were not significantly associated among male athletes (p=0.209), they were positively associated in female athletes (p=0.027). These results indicate that Japanese collegiate athletes experience fewer URTI episodes than non-athletes, but athletes who exercise for long durations may frequently experience URTI, particularly female athletes.

BACKGROUND AND OBJECTIVES: Little information is available regarding adult patients with congenital heart disease (CHD) who needed unscheduled hospitalization (USH). This paper aims to elucidate the clinical features of adult patients with CHD requiring USH. SUBJECTS AND METHODS: Study subjects included patients with CHD aged 18 years or older who were hospitalized at our facility during a 5-year study period. Medical records were retrospectively reviewed and data regarding USH were collected. Patient's background, underlying heart disease, cause of hospitalization, and prognosis (second USH regardless of cause or death) were examined. RESULTS: Overall, 959 CHD patients underwent a total of 1761 hospitalizations, including 145 patients who were unexpectedly hospitalized 239 times. The median age at USH was 27 years old. Of the 959 patients, 54% were male. Underlying heart diseases included repaired tetralogy of Fallot (21%), single ventricular physiology after Fontan operation (17%), and Eisenmenger syndrome (12%). The causes of USH included arrhythmia (40%), heart failure (20%), infectious disease (13%), and hemorrhage or thrombus (13%). A total of 48 patients required readmission. In total, 13 patients died, including four hospital deaths. The USH-free survival rate was 77% for 1 year and 58% for 3 years. CONCLUSION: The rate of USH was high for adults with complicated CHD. Common causes of USH included arrhythmia, heart failure, hemorrhage-related or thrombus-related conditions and infection. These data provide the current status of medical care for adult CHD patients in Japan and their therapeutic needs.
Adult* ; Aging ; Arrhythmias, Cardiac ; Communicable Diseases ; Eisenmenger Complex ; Fontan Procedure ; Heart Defects, Congenital* ; Heart Diseases ; Heart Failure ; Hemorrhage ; Hospitalization* ; Humans ; Japan ; Male ; Medical Records ; Physiology ; Prognosis ; Retrospective Studies ; Survival Rate ; Tetralogy of Fallot ; Thrombosis

Methods: We reviewed 125 patients (79 men and 46 women) who had lumbar spinous process splitting laminectomy (LSPSL) for LSS. We assessed the following clinical information: Japanese Orthopedic Association (JOA) score; numerical rating scale (NRS) for low back pain (LBP), leg pain, and leg numbness; Zurich Claudication Questionnaire; JOA Back Pain Evaluation Questionnaire; Roland- Morris Disability Questionnaire (RMDQ); and Short Form 8 (SF-8) as HRQOL. We compared the HRQOLs of men and women pre- and postoperatively. Results: Although the preoperative NRS results for LBP were significantly higher in women (p <0.05), there were no significant differences in clinical outcomes between men and women postoperatively. For HRQOL, the RMDQ scores were significantly worse in women preoperatively (p <0.05), but no significant differences were found postoperatively between men and women. Similarly, the SF-8 mental health score was also significantly lower in women preoperatively (p <0.05), but no significant differences were noted between the two groups postoperatively. Conclusions LSPSL greatly reduced LBP, leg pain, and leg numbness in both genders. There were limited differences in pain and several HRQOL questionnaire responses between men and women after surgery. We found that women had greater sensitivity to and/or lower tolerance for pain than men, which led to lower HRQOL mental health scores preoperatively.

Purpose: To investigate the clinical significance of adaptive radiotherapy (ART) in locally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT). Materials and Methods: Eligible patients were treated with concurrent chemoradiotherapy using IMRT. Planning computed tomography in ART was performed during radiotherapy, and replanning was performed. Since ART was started in May 2011 (ART group), patients who were treated without ART up to April 2011 (non-ART group) were used as the historical control. The Kaplan-Meier method was used to calculate overall survival (OS), locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). LRFS for the primary tumor (LRFS_P) and regional lymph node (LRFS_LN) were also studied for more detailed analysis. Statistical significance was evaluated using the log-rank test for survival. Results: The ART group tended to have higher radiation doses. The median follow-up period was 127 months (range, 10 to 211 months) in the non-ART group and 61.5 months (range, 5 to 129 months) in the ART group. Compared to the non-ART group, the ART group showed significantly higher 5-year PFS (53.8% vs. 81.3%, p = 0.015) and LRFS (61.2% vs. 85.3%, p = 0.024), but not OS (80.7% vs. 80.8%, p = 0.941) and DMFS (84.6% vs. 92.7%, p = 0.255). Five-year LRFS_P was higher in the ART group (61.3% vs. 90.6%, p = 0.005), but LRFS_LN did not show a significant difference (91.9% vs. 96.2%, p = 0.541). Conclusion Although there were differences in the patient backgrounds between the two groups, this study suggests the potential effectiveness of ART in improving locoregional control, especially in the primary tumor.

  Frequent bathtub bathing (BB) improves sleep quality and mental health of middle-aged and older Japanese individuals. This study investigated the chronic effects of BB with and without a bath additive (bathtub bathing with KIKIYU [BBK]) in healthy young adults. The study involved healthy young adults who habitually showered, as opposed to bathing. Nineteen participants were randomly assigned to either the BB or BBK groups for 14 consecutive nights. After a 2-week washout period (shower bathing), the participants were asked to switch their bathing styles (a crossover design). The artificial bath additive for the BBK group contained inorganic salts and carbon dioxide. The participants were evaluated by using the Oguri-Shirakawa-Azumi Sleep Inventory-Middle-aged version (OSA-MA) and 1-ch sleep electroencephalography (EEG) for sleep quality, the Profile of Mood States (POMS), Self-rating Depression Scale (SDS), and Apathy Scale (AS) for mental conditions.  Sleepiness on waking and refreshing scores in the OSA-MA significantly differed between the shower bathing and BBK groups. EEG results did not significantly differ among the bathing styles. Vigor T-score and total mood disturbance (TMD) scores showed significant differences in the two bathing groups (shower vs. bathing), and fatigue T-score was significantly lower in the BBK group compared with both the BB and shower groups. SDS score was significantly lower in the BBK group compared with the shower group. AS score was significantly lower in the two bathing groups (shower vs. bathing).   The OSA-MA score was possibly influenced by vasodilatation and circulation by using carbon dioxide and keeping the body warm after bathing by using inorganic salts. The OSA-MA score was possible also affected by fatigue alleviation and maintenance of vitality by using a citrus lemon scent and yellow-green hue. Furthermore, frequent body heating affects the central nervous function related to mood and emotion.  Based on these results, we can conclude that BB and BBK prior to shower bathing improved the mental health of the young adults in this study.

Introduction: Some students take showers instead of baths for economic reasons or because they dislike cleaning the bathtub. The purpose of this study was to examine the effect of bathing routines on students’ working efficiency. Subjects: Seventeen (six male and 11 female) healthy young students (19.6 ± 0.7 years old, mean ± SD) who habitually took showers instead of baths participated in this study. Informed consent was obtained from all the subjects and the study was approved by the Ethics Committee of Kumamoto Health Science University. Method: Subjects were randomly assigned into two groups. The subjects in the first group (bathtub bathing [BB]) were immersed to the supraclavicular level in their home bathtub and instructed to rest for 10 minutes with the temperature regulated at 41°C. The subjects of the second group (whole-body warming after BB [BBW]) followed the same bathing protocol and then rested in a sleeping bag and sheet for 30 minutes to keep their bodies warm. Each period was carried out over 2 weeks in a cross-over design. Washout periods were 2 weeks long. The evaluation items of this study included the obstructive sleep apnea (OSA) sleep inventory MA version (OSA-MA), a questionnaire containing a visual analog scale (VAS) to judge the subjective bathing effect, profile of mood states, salivary stress marker (α-amylase), and the Purdue Pegboard test. These tests were evaluated before and after the BB sessions, BBW sessions, and washout interval for a total of four times in a 6-week period. Result: Participants tended to report a better sleep feeling on the OSA-MA after the BB or BBW sessions than after showering. There were significantly better changes in both the BB and BBW in the VAS for bathing effect in terms of “Sense of deep sleep,” “Body fatigue,” “Light feeling of the body” than after a shower. The mean α-amylase value in the saliva of the BBW group participants was significantly lower than that after showering. The mean Purdue Pegboard test scores of both the BB and BBW sessions were significantly higher than that after the shower. Discussion: Sleep quality seemed to be more improved after BB or BBW than after showering, perhaps due to reduced stress. Work efficiency also increased in the BB and BBW groups.

Objective: The purpose of this study was to examine the effects of bathtub bathing （BB） on sleep and working efficiency of healthy young adult students. Furthermore, the effects of BB and prolonged increased body temperature from the use of insulating sheets and sleeping bags after BB （warming after BB: BBW） on sleep and working efficiency were investigated. Subjects: Eighteen （six males, 12 females） healthy young students （19.6±0.7 years old, mean±SD） who habitually took showers instead of baths participated in this study. Informed consent was obtained from all of the subjects, and the study was approved by the Ethics Committee of Kumamoto Health Science University. Methods: Subjects were randomly assigned to two groups （n＝9 in each group）. The subjects in the BB group were immersed in their home bathtub to the supraclavicular level and instructed to rest for 10 min with the temperature regulated at 41°C. The subjects in the BBW group followed the same bathing protocol, and they then rested in a sleeping bag and sheet for 30 min in order to keep their bodies warm. The length of each study period was 2 weeks in a crossover design. After the 2-week-long washout periods, the subject groups were switched. The subjects were evaluated with the Oguri-Shirakawa-Azumi sleep inventory, MA version （OSA-MA）, which utilizes a visual analog scale （VAS） with which subjects rate their sleep when they wake up, and Purdue Pegboard Assembly test. These tests were employed before and after the BB and BBW sessions, resulting in four testing periods in the 6-week period. Results: Sleep rating on the OSA-MA was no significant difference in both the BB and BBW groups compared to ratings recorded after showering. The subjects in the BB and BBW groups had significantly increased VAS ratings for “Feeling of sound sleep,” “Refreshing,” and “Lightness of the body” compared to the ratings after showering. The mean Purdue Pegboard test scores of the subjects in both the BB and BBW groups were significantly higher than those recorded after showering. Discussion: Changing bathing style from shower to BB or BBW improved the working efficiency of students on the Purdue pegboard test. BB and BBW resulted in soothing effects owing to improvements in the subjects’ quality of sleep.

Objective: The purpose of this study was to clarify the chronic effects of bathtub bathing (BB), whole body warming after bathtub bathing (BBW), and bathtub bathing with herbal extracts (BBH) on the mental condition of healthy young persons. Subjects and Methods: Experiment 1: Eighteen (6 male and 12 female; age: 19.6±0.7 years, mean ± SD) healthy young persons who were taking a shower habitually but not bathtub bathing participated in this study.   From November 2012 to December 2012, subjects were randomly assigned into two groups (each 3 male, 6 female): those who had BB or 30-min BBW 14 times for 14 consecutive nights during a 2-week period. After a 2-week washout period, subjects were asked to switch their bathing conditions (a cross-over design). Experiment 2: Twenty (8 male and 12 female; age: 21.3±1.6 years, mean ± SD) healthy young persons who were taking a shower habitually but not bathtub bathing participated in this study.   From October 2013 to November 2013, subejects (4male and 6 female) were randomly assigned to undergo BB or BBH.   The herbal extract contained Dong dang gui (Japanese Angelica Root), Chimpi (Citrus Unshiu peel), Chamomilla recutita, and ginger extracts.   After a 2-week washout period, subjects were asked switch to the other bathing condition (a cross-over design).   All participants provided informed consent for participation in these studies, and these studies were approved by the Ethics Committee of the Kumamoto Health Science University.   The subjects immersed their bodies up to the supraclavian for 10 min, in tap water adjusted to a temperature of 41 °C in their bathtub at home. The subjects’ mental conditions were assessed using Profile of Mood States short version questionnaire.   The differences in the effect of BB and BBW, as well as those of BB and BBH on the subjects’ mental conditions and their mental conditions pre-BB and post-BB, pre-BBW and post-BBW, pre-BBH and post-BBH were analyzed using Wilcoxon’s signed-rank sum test. Results: The points for depression-dejection, fatigue, and confusion in those who had BBH significantly converged to the median average (50 points) compared to the points in those who had BB.   The points for anger-hostility before BBW and BBH significantly converged to the median average (50 points) after BBW and BBH, and there were no significant differences in points before and after BB. Conclusions: The subjects’ anger-hostility was influenced by body warming in BBW and the vasodilatory components of the herbal extracts.   The subjects’ depression-dejection and fatigue was influenced by the fragrance and color of herbal extracts.