Objective : The aim of this study was to examine the influence of a liaison-clinical pathway for stroke rehabilitation. Methods : We initiated the pathway in January 2008. The patients enrolled in this study included 82 patients with acute stroke sustained during the 4 months after the initiation of the pathway and 151 patients with acute stroke sustained during the same period in the following year. Results : The mean length of stay in acute stroke centers was significantly reduced in the second year of employing the pathway. However, an evident reduction of the functional independence measure gain was observed in the convalescent rehabilitation wards, especially in severely physically handicapped patients. Conclusion : The liaison-clinical pathway is an effective approach for advancing a regional cooperation network among hospitals and for shortening the stay in acute stroke centers. On the other hand, the clinical outcome of stroke patients can deteriorate if enough efforts are not made to improve the medical management of severely physically handicapped patients in convalescent rehabilitation wards.

The purpose of this study was to examine the effects of eccentric contractions (Ecc) on cation (i.e., K⁺, Na⁺ and Ca²⁺) regulation in skeletal muscle. The left anterior crural muscles of male Wistar rats were subjected in vivo to either Ecc or isometric contrations (Iso) for 200 cycles. The extensor digitorum longus and tibialis anterior muscles were removed immediately after and 2, 4 and 6 days following contractions and used for measures of force output and biochemical analyses, respectively. Ecc led to a 75% decrease in maximal tetanic force. Decreased force output did not revert to pre-exercise levels during 6 days of recovery. Sarcoplasmic reticulum (SR) Ca²⁺-ATPase activity was reduced by 52 and 60% 4 and 6 days after Ecc, respectively. The reduction in catalytic activity after 6 days was accompanied by a 63% decrease in SR Ca²⁺-ATPase protein and an approximately 3.5-fold increase in calpain activity. Na⁺-K⁺-ATPase acticity was decreased by 23% immediately after Ecc and restored during 2 days of recovery. These alterations were specific for Ecc and not observed for Iso. These results suggest that disturbances in cation regulation may account, at least partly, for Ecc-induced decreases in force and power which can take a number of days to recover and that the decrease in SR Ca²⁺-ATPase activity would result from the degradation of the enzyme.

Plasma concentrations of tumor necrosis factor α (TNFα), interleukin-1β (IL-1β) and interleukin-6 (IL-6) were measured successively during and after open heart surgery (13 cases). Plasma concentrations of TNFα did not increase during surgery but increased gradually after the 1st operative day reached the maximum level at the 7th operative day (128±15pg/ml, which was a 3-fold increase compared with the previous value). Plasma concentrations of IL-1β remained at the previous level during surgery and increased only once at 6 hours after operation. Conversely, plasma concentrations of IL-6 increased dramatically during cardiopulmonary bypass (CPB) reaching a peak at the end of CPB (260±200pg/ml, which was a 15-fold increase over the previous value) and recovered to previous values rapidly thereafter. Plasma IL-6 concentrations changed rapidly during surgery, while plasma concentrations of TNFα and IL-1β did not increase sharply. This may indicate that IL-6 may play a role as a mediator of acute inflammatory reaction.