A study was conducted to investigate changes in muscle soreness, serum creatine kinase (CK) activity and white blood cell (WBC) count following exercise bouts spaced three weeks apart.
The subjects were six male students (aged 23-25 yr), who had not participated in any training program for over 18 months. They performed muscular exercise of the nondominant arm using elbow flexors. Twenty percent of maximum voluntary contraction was used as the exercise intensity. After three weeks, the subjects repeated the same exercise bout. Perceived muscle soreness, CK activity and WBC count were assessed before, immediately after, 6h after and over 9 days after each exercise bout.
After the first exercise bout (1 st Ex), the subjects experienced muscle sorenss for 3-7 days. Also, a large increase of CK was found in five subjects (266-763%) . When the peak CK efflux was observed (day 3-4 after exercise), soreness had almost disappeared. WBC count was increased immediately and 6 h after exercise, then returned to the resting level. However, a significant increase (p<0.05) in WBC count was observed again on day 7 after exercise when CK had returned to the resting level. After the second exercise (2 nd Ex), a significant decrease of muscle soreness and the CK response was found in comparison with the 1 st Ex (p<0.41) . One interesting feature was that the CK efflux of subjects who had shown a large increase of CK after the 1 st Ex was not increased after the 2 nd Ex.
The initial exercise bout may have induced some damage to the muscle fibers or mem. bran. This damage would induce a process of repair in the damaged tissue, which in turn would adapt the muscle to the next stimulus. However, the subjects who showed a slight increase of CK after the 1 st Ex did not show this adaptation. Therefore an adaptive threshold for fiber or membrane damage may exist.

Introduction: We described a patient with lung cancer who suffered from severe pain due to pelvic bone metastasis and opioid-induced delirium. Induction of subarachnoid analgesia using implanted intrathecal catheter almost abolished his pain and enable home palliative care. Case description: Seventy-year old man was admitted for intractable leg and hip pain due to pelvic bone metastasis and delirium induced by opioid. Although he was initially administered continuous subcutaneous morphine injection for opioid titration, delirium was deteriorated. Opioid rotation to oxycodone and increase in antipsychotic drugs could not improve his delirium. Epidural analgesia with local anesthetic and small dose of morphine improve his delirium with adequate analgesic effect. Finally, he was received intrathecal catheter implantation and discharged to home palliative care. Conclusion: Neuraxial analgesia may provide not only sufficient analgesia but also lower risk of delirium in patient who was administered high dose of opioids because of intractable cancer pain.

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.