We performed dietary guidances for 15 male elite athletes (23±3 years of age) participating a training program for vigorous endurance run. Nutrient allowances for the athletes were determined by the guidelines of Japanese Dietary Allowances (5 th ed.), considering their physical activities at the highest level IV; total energy 3, 500 kcal, protein 140g, lipid 100g, carbohydrate 510g, calcium 1, 500 mg, iron 25 mg, vitamin A 8, 000 IU, thiamine 4.0 mg, riboflabin 5.0 mg and vitamin C 200 mg per day. We also developed food group allowances for the athletes based on their nutrient allowances and current young-aged Japanese dietary styles ; cereals 400 g, potatoes and starches 60 g, sugars 20 g fats and oils 30g, pulses 120g, meats 150g, fishes and shellfishes 150g, eggs 80g, milks 600g, green and yellow vegetables 300 g, the other vegetables 350 g, fruits 400 g and algae 20 g per day. For the experimental period of 45 days, daily diets adjusted to approximate 120% of the dietary allowances were served to the athletes who were free taking snacks and drinks. Dietary guidances for the athletes were assessed by monitors of their dietary intakes, physical constitution and clinical examinations in blood. Means of the dietary intakes of the athletes were 96-99% of the dietary allowances, determined by a nutritional survey with the 24 hrs recall method. There were less changes in the physical constitution of the athletes before, during and after the experimental period; body weight 57±2 kg and body fat 8.8 ± 2.4%. Values of the clinical marks in the blood of the athletes were maintained normally for a half year including the experimental period; red blood cells 507±9×104 cells/mm3, hemoglobin 15±0.4g/dl and hematocrit 46.6±0.7%.
It is concluded that suitable nutritional guidances and managements for young-aged male vigorous endurance runners lead good in their health and physical maintenances, which may have important consequences for their physical development as elite athletes.

We investigated biochemical and morphological changes in electrically stimulated gastrocnemius muscle of rats fed normal (20% casein) and low-protein (5% casein) diets. Tissue weight and protein content per tissue weight of gastrocnemius muscle were significantly decreased in rats fed 5% casein diet than in rats fed 20% casein diet. Immunohistochemically, cathepsin B antigen was detected in inflammatory cells, and injured sites determined immunological intensity of anti-cathepsin B were lower in 5% casein diet group than 20% casein diet group. Electron microscopically, there was delayed repairment of muscle components (sarcometric units) in 5% casein diet as compared with that in 20% casein diet group.

We report the case of a 34-year-old man who was initially diagnosed with a tension-type headache after complaining of a headache and nausea. His headache worsened in severity and it was exacerbated on standing in the upright position. The patient was admitted to the hospital on suspicion of spontaneous low cerebrospinal fluid (CSF) pressure headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement, brain sagging, cerebellar tonsillar herniation, brainstem descent and a subdural hematoma. Successful emergency surgery was undertaken.
Spontaneous low CSF pressure headache syndrome is characterized by orthostatic headache, and if such a headache worsens, clinicians should consider a subdural hematoma, a life-threatening complication of this unusual disorder.

In C1–C2 posterior fixation, the C1 lateral mass and C2 pedicle/translaminar screw insertion under spine navigation have been used frequently. To avoid the risk of neurovascular damage in atlantoaxial stabilization, we assessed the safety and effectiveness of a preoperative computed tomography (CT) image-based navigation system with intraoperative independent C1 and C2 vertebral registration. It is ideal when a reference frame can be linked directly to the C1 posterior arch for C1-direct-captured navigation, but there is a mechanical challenge. A new spine clamp-tracker system was implemented recently, which allows reliable C1- and C2- direct-captured navigation in nine patients with traumatic C2 fractures. In this way, there was no misalignment of C1–C2 screws. C1 lateral mass screws were used except for one case, and translaminar screws were primarily used as an anchor for C2. The C1 lateral mass screw locations, which are 19 mm laterally from the C1 posterior arch’s center, are taken to be constant. However, there is one unusual circumstance in which using a C1 laminar hook instead of a C1 lateral mass screw appears to be a beneficial substitute. The increase of surgical accuracy for posterior C1–C2 screw fixation without cost constraints is significantly facilitated by intraoperative C1- and C2-direct-captured navigation with preoperative computed CT images.

To improve the quality of palliative care in the Kyoto region, we thought that closely connecting hospice and palliative care units (PCU) is necessary. Subsequently, we established the Kyoto PCU Liaison Committee in September 2017. This committee was created as a place to casually discuss the problems that individual PCU facilities have, deliberate on their worries together, grow and develop, and support newly launched facilities. Furthermore, discussions were held on current topics (emergency hospitalization, blood transfusion, smoking, bereaved family meetings, etc.) at the liaison meetings. While meetings were adjourned in 2020 due to the COVID-19 pandemic, we continued to exchange opinions on infection control, PCU management, etc., using the email network at first. Later, these meetings resumed via web conference systems. Thus, by having face-to-face relationships on a daily basis, we were able to maintain cooperation between PCUs even during the pandemic, and collaborate with cancer treatment hospitals. Overall, by forming a team of PCUs in Kyoto Prefecture, we aim to enable patients and their families to live with peace of mind wherever they are.