In order to re-evaluate the mechanical efficiency during bicycle pedalling the total mechanical work (internal work + external work) and the energy expenditure were determined on four adult males (20-21 years) . The subject worked on a Monark bicycle ergometer with 6 different loads (0-5kp) at a constant pedal frequency of 50rpm. The internal work (W-int) to accelerate the leg itself was determined by a cinematographic procedure used by Fenn (1930) . With the data of external work (W-ext) and energy expended above resting (E_t-E_r), the‘true’efficiency has been calculated as
‘True’efficiency=W-int+W-ext/E_t-E_r×100
The result obtained was as follows : 1) The time course of kinetic energy due to leg movement was similar to those in walking and running reported previously. 2) The W-int at 0kp ranged in about 70-90kgm/min. In the mean values of four subjects the W-int tend to be constant at the loads from 0 to 3kp (about 80kgm/min), but increased appreciably at higher loads of 4-5k p (about 100-110kgm/min) . 3) The ratios of W-int to W-ext were about 20-30% at lkp, 10-20% at 2kp and 5-10% at 3-5kp. 4) The efficiency of leg movement only at Okp resulted in high values of about 40-85%, suggesting energy transfer between leg and inertia wheel. 5) The efficiency values at 1 to 5kp, ranging in 23.5-36.2%, appeared to show a maximum at intermediate work loads. 6) The‘true’efficiency so calculated did not largely differ from the efficiency calculated by conventional way ; 1.5-4% higher than the work efficiency, 2-5% higher than the net efficiency, and 3-5% higher than the apparent efficiency at intermediate loads.

The effects of different training programs on the force-velocity relation and the maximum power output from the elbow flexor muscles were examined in eighteen male adults. The subjects were divided into three equal groups (G 30, G 30+0, G 30+ 100) . Training for G 30 was performed with ten repetitions at 30% P_o (P_o: maximum strength), for G30+0 with five repetitions at 30% P_o and five contractions with no load (0 % P_o), and for G 30+100 with five repetitions at 30% P_o and five isometric contractions (100% P_o) .
Maximum power was increased significantly in all groups after training. The amounts of power increase tended to be greatest for G 30+ 100, followed by G 30+0 and G 30. A significant difference was observed between G 30 + 100 and G 30 + 0. Maximum strength increased most in G 30 + 100, followed by G30 and G 30+0. The strength gain in G 30+100 was significantly greater than that in G 30. Maximum velocity increased significantly in all groups. No significant difference in velocity gain was observed between any pair of groups.
These results suggest that isometric training at maximum strength (100% P_o) appears to be a more effective form of supplementary training to increase power production than would no load training at maximum velocity.

Ifenprodil, NMDA receptor antagonist, was very effective in the treatment of 3 patients with severe trigeminal neuralgia. Patient 1：A 70-year-old female had been treated for macroglobulinemia in our hospital. She had been suffered from severe trigeminal neuralgia for more than ten years. Carbamazepine given in another hospital was ineffective. We gave ifenprodil to her and it reduced her pain within 4 weeks. However, her pain relapsed after 1.5 years, so we gave pregabalin instead of ifenprodil to her. Patient 2：A 89-year-old male had been treated for myelodysplastic syndrome in our hospital. He also had been treated for trigeminal neuralgia in another hospital. Carbamazepine was ineffective and nerve block relieved his pain temporarily. We gave ifenprodil to him and it reduced his pain within 2 months. Patient 3：A 62-year-old female was referred to our hospital for the treatment of trigeminal neuralgia. She had been suffered from severe pain for about 10 years. She had taken carbamazepine with no effect. We gave ifenprodil to her and it reduced her pain within 4 weeks. Ketamin, non-selective NMDA receptor antagonist, is known to be effective in neuropathic pain, but it has various side effects. Ifenprodil, specific NMDA receptor subunit NR2B antagonist, may show better separation between efficacy and side effects.

To develop a simple test of endurance capacity in the elderly, we evaluated the reliability and validity of the shuttle stamina walk test (SSTw), in which the running in the shuttle stamina test (SST : 3-minute shuttle running along a 10-meter course) was changed to walking.
We found that: 1) The walking distance in the SSTw was correlated with Vo₂max (r=0.827), 2) the walking distance showed a correlation between the first test and a re-test (r=0.853), 3) the mean peak heart rate during the test was 86.3% of the estimated maximum heart rate with no difference according to age or sex, 4) subjective evaluation of the intensity of exercise was expressed as“fairly light”or“somewhat hard”by 73.7% of the subjects, 5) the results of the SSTw reflected the subjects' self-evaluation of endurance capacity, and 6) the age-related percentage reduction of the walking distance in the SSTw was similar to that in V₂max in subjects aged 40 years and above.
These results suggest that the SSTw, a simple test of endurance capacity that can be performed safely over a wide range of middle-aged to elderly people including those in late old age and those with a low fitness level, has sufficient reliability and validity.

In the context of energetics related to a pendular model, the mechanical power (W) and ‘pendular motion efficiency’ (PME) were determined during walking of the subjects who consist of 37 healthy elderly women (65-85 years) and 21 young women (18-25 years) . Using a force plate, the potential and kinetic energies of the body's centre of mass were measured at various constant speeds. Walking speeds were selected and controlled by a newly devised pace-maker. PME, which is equivalent to ‘% recovery’ by Cavagna (1976), indicates a sort of efficiency in transforming potential energy into kinetic energy and vice versa. The external power to accelerate the body (Wext ), which is thought to be supplied by muscles, increased with walking speed, and the rate of increase in Wext tended to be greater in the elderly than in the young subjects. It was noted that the maximal PME values at the optimum speed in both age groups were comparable, but PME values in the elderly decreased more markedly than in the young subjects as walking speed deviated from the optimum. This fact suggests that an adaptability to different walking speeds reduced in the elderly population.

Two patients with spondylosis deformans and three patients with psychosomatic disease were treated by partial bathing with artificial spring of sodium sulfate. Fifteen minutes a day of bathing in artificial spring water prepared by dissolving 1000mg of sodium sulfate into 1 liter of 38°C-tap water was continued for one month.
Based on the findings on thermography, temperature changes were classified into four types. Correlation was found in three types as follows: p<0.01 in the crossing type, p<0.01 in the converging type, p<0.001 and p<0.05 in the ascending type. No correlation was found in the diffusing type. Plethysmography revealed a significant difference in the converging type and also a difference of p<0.01 in the diffusing type. MCV disclosed a slower change in temperature on the affected side than on the normal side. Blood gas analysis revealed a slight increase in PO₂, SATO₂ after one month of bathing. Subjective symptoms were improved from point 9 to point 3 to 4 on the VAS scale. Numbness changed from the trembling stage to the slightly smarting sensation stage. Psychroesthesia disappeared from all patients.
A combination of nerve block therapy and warm bath cure with sodium sulfate brought good therapeutic results in patients with chronic pain including psychosomatic disease.

The effects of different intensities of muscle training on the force, velocity and power relationship have been examined on human elbow flexor muscles. Twenty male subjects, 18-22 years of age, were divided into 4 different groups ; G₀, G₃₀, G₆₀, and G₁₀₀. Their training loads were prescribed by a fraction of isometric strength (P₀) measured at right angle of elbow joint : 0% P₀ (G₀ ; isotonic contraction without load), 30% P₀ (G₃₀), 60% P₀ (G₆₀), and 100% P₀ (G₁₀₀ ; isometric contraction) . The subject contracted his elbow flexors with maximum effort 10 times a day, 3 days a week for 12 weeks. The force-velocity relations and the resultant power output were determined, before and after training period, by a modified Wilkie's apparatus.
The training by maximum isotonic contraction without load (G₀) was found to be most effective for improving maximum velocity (V₀), while the isometric training improved isometric strength (P₀) most. For this, the P-V relations of these groups were specifically modified by greater velocity component (G₀) or greater force component (G₁₀₀) . The G₃₀ and G₆₀ groups showed such all-round improvements that the P-V relations shifted in parallel with those of pre-training period. The maximum power (PVmax), which calculated from P-V relationship, increased most in G₃₀, followed by G₁₀₀, G₆₀, and G₀ groups.
From these results it was concluded that the different training loads brought about specific effects on P-V relation, and that the most effective load for improving maximum power was 30% of isometric strength.

A 51-year-old man with osteogenesis imperfecta and who had aortic regurgitation was admitted to our hospital for aortic valve replacement. His height was 146cm and his weight was 49kg. The patient had suffered from bone fractures several times since childhood. Bone deformity, blue sclera and his status were clinically indicative of osteogenesis imperfecta. Aortic valve replacement with a 25mm SJM^® prosthetic valve was successfully performed for aortic valve insufficiency and slight annulo-aortic ectasia. Soft tissues and the sternum were fragile. Pathological examination (Elastica-Masson stain) of the aortic valve and left ventricular wall revealed a loss of fibrous tissues and remarkable thickening due to elastic fibers. The patient was discharged 31 days after surgery. Osteogenesis imperfecta is one of the collagen diseases caused by gene abnormality, in which fragile bones are easily fractured. Cardiovascular disease is rarely associated with it and the surgery-related mortality rate is reported to be approximately 30%, due to bleeding.

An educational video describing the acupunctural stimulation of the pudendal nerve for treatment of urinary disturbances was produced. Treatment points on the meridian were selected within the limits of the top 1/2 to 3/5 of the line that connects the superior posterior iliac spine and the inner lower edge of the ischiatic tuberosity. Since the pudendal nerve is situated between the sacrospinous ligament in this region, it could be readily stimulated from the body surface. A 90mm (#24) acupuncture needle was used for the treatments. When the needle was inserted to a depth of 50-80mm from the body surface, the pudendal nerve was reached. Echo sensation in the penis indicated that the acupuncture needle had contacted the pudendal nerve.
Either the sparrow-pecking, needle-twisting, or the low frequency acupunctural techniques were used to delver stimulation to the pudendal nerve. In conclusion, acupunctural stimulation of the pudendal nerve was clinically useful for treatment of urinary disturbances, such as uncoordination of the detrusor muscles in neurogenic bladder and urinary incontinence.

The questionnaire was distributed to caregivers regarding their management for home medication therapy. The purpose of this questionnaire was to clarify the role of community pharmacists in city “Z”, Hiroshima in supporting this activity. The results were compared among seven administrative zones. The percentage of caregivers who had routinely administered medications to dependent patients was 81%. Of these, the percentage of caregivers who had encountered difficulty in medication administration to dependent patients was 66%. Only 13% of these caregivers had sought assistance from pharmacists in dealing with issues they faced in the administration of medications. The percentage of caregivers who had easy access to pharmacists was 44%. The percentage of caregivers who received pharmacist-initiated information about patients was 23%. Among the 7 administrative zones in city “Z”, the 2 zones (H-zones) with the highest percentage of elderly citizens, 38.7%, were compared with the other 2 zones (L-zones) with the lowest percentage of elderly citizens, 25.7%, regarding medication management by caregivers. It was observed that the frequency of missing side effects or crushing medicines by caregivers was higher in H-zones as compared to L-zones. The results of this research suggest that close cooperation between pharmacists and caregivers improves the quality of medication therapy management. In an aging society, pharmacist intervention could be very beneficial to providing support and information that would improve the quality of patients’ medication therapy.