In order to evaluate iron balance in the human body, we studied the effects of exercise on iron excretion in urine, sweat and feces. The subjects were five healthy male, college athletes. The daily intake of nutrients by the subjects was regulated by a prescribed diet (Calorie Mate, Ohtsuka), and the control measurements and the exercise measurements were performed within seven days. Excretion of iron in the urine during the exercise period was significantly higher than in the control period. The excretion of iron in the sweat was 1.076±0.118 mg, i. e, , about 70% of total iron physiologically excreted from the human body. The excretion of iron in the feces during the exercise period was significantly lower than during control period. Feces volume was positively correlated with energy expenditure and negatively correlated with the excretion of iron in the feces. Iron absorption during the exercise period was significantly higher than during the control period. These findings suggest that exercise stimulates not only iron excretion via urine and sweat, but iron absorption, and that iron balance remains positive in healthy male subjects who have normal iron status.

The purpose of the present study was to investigate a useful exercise protocol and method of evaluation for determining the gas exchange threshold (VO₂GET) and correlation coefficient between VO₂GET and maximal oxygen uptake (VO₂max), which is an index of aerobic capacity. Five healthy male volunteers (age: 25.6 ± 2.0 yrs; height: 172.9±4.0 cm; weight: 69.5±6.6 kg) performed exercise tests 82 times. Each volunteer randomly conducted a RAMP exercise (1 W⋅3 sec^-1), STEP-1 exercise (20W⋅min^-1) and STEP-2 exercise (40W⋅2 min^-1), respectively, at least 4 to 8 rotations. The gas exchange parameters (VE, VO₂and VCO₂) for incremental exhaustive cycle ergometer exercise were measured using a“breath-by-breath”method. Three different methods of evaluation- (VE/VO₂and VE/VCO₂) exchange (M-1), V-slope method (M-2), and M-1 & M-2 (M-3) -were attempted to determine VO₂GET. The VO₂GET values, determined by three different methods (M-1, -2 and -3) of evaluation, were classified as‘easy’ (J-A) and‘difficult’ (J-B) in all tests. Reproducibility of VO₂max and VO₂GET were assessed using the coefficient of variation (CV) and correlation coefficients (r) between VO₂max and VO₂GET.
The results are summarized as follows:
1) The means of the reproducibility of VO₂max were determined among the 5 subjects by us ing RAMP, 4.8% (n=25), STEP-1, 3.1% (n=28) and STEP-2, 2.9% (n=29) exercise tests; STEP-2 exercise test values (CV) were lower than the others. There was no significant difference in the means of VO₂max among the 5 subjects according to the RAMP and two STEP exercise tests (Two-way ANOVA) .
2) The best reproducibility value of VO₂GET among the 5 subjects was determined using RAMP exercise tests with the V-slope method (M-2) and evaluations were classified as easy (J-A) . The value (CV) was 2.8%. There was no significant difference in the VO₂GET values (M-1 (J-A, -B), M-2 (J-A, -B) and M-3) (Two-way ANOVA) and their means among the 5 subjects concerning RAMP and two STEP exercise tests (Two-way ANOVA) .
3) The best correlation coefficient (r) value between VO₂max and VO₂GET was obtained using RAMP exercise tests with M-2 (J-A) (r=0.976, n=20) .
The present results indicate that the most useful exercise protocol and method of evaluation for determining VO₂GET is the RAMP exercise test with the V-slope method.

The present study aimed to examine the change cold-induced vasodilation (CIVD) of finger between seven female alpine (AP group) and six female cross-country skiers (CC group) at different points in their training programs. The CIVD test was performed twice, once in spring period after ski-training, once in the summer period during physical-training.From the onset of ice-water immersion in each CIVD test, finger skin temperature in each group fell followed by an incline. Thereafter, finger skin temperature began to rise and fall in an attenuated fashion during ice-water immersion. The resistance index (RI) in summer (7.1±1.7) for AP group was significantly (P<0.01) higher than that in spring (4.6±1.1). However, that of CC group showed no difference between spring and summer.These results suggested that the physical training during summer period for AP group may influence on the improvement of CIVD.

This study analyzed the effects of various body surface areas being cooled by water-perfused suits (WPS) on thermoregulatory response during exercise in a hot environment. Seven male subjects, dressed in clothing with low moisture permeability (rain coats) over WPS covering the whole body surface except for the face, hands, and feet, performed three sessions of 20-min cycling at low intensity (250w/m²) in a room maintained at 30℃ under six conditions of body surface cooling : whole body (WB), upper body (UB), lower body (LB), lower body except lower legs (LBEL), head and neck (HN), and no body cooling (NBC). The coolant temperature at the inlet was 20℃ for all conditions, and heat extraction (HE) was estimated by the difference between inlet and outlet water temperatures and water flow rate. Esophageal (Tes) and deep thigh temperatures (T-d.thigh) and heart rate (HR) during exercise were significantly (p＜0.01) higher for NBC and HN, and forearm skin blood flow (SkBF) and dehydration (DEH) were significantly (p＜0.01) lower for WB than for other conditions. There was a similar tendency concerning Tes and T-d.thigh among WB, LBEL, and LB ; however, T-d.thigh for UB was significantly (p＜0.01) higher than for WB, LBEL, and LB. In comparison with resting levels, the mean skin temperature (Tsk) and thermal sensation (TS) significantly (p＜0.01) increased for NBC and HN, and decreased for UB and WB, but remained constant for LBEL and LB during exercise. Under all conditions, increases in Tes (ΔTes) and T-d.thigh (ΔT-d.thigh) at the end of exercise were significantly (p＜0.01) increased when less than 40% of the body surface was cooled (Tsk : above 35.8℃, HE : less than 110W). Furthermore, ΔTes at the end of the exercise was related to ΔTsk×SkBF, while the slope of the regression line between those parameters was steeper when ΔTsk×SkBF values were negative, as opposed to positive values. These results suggest that during light exercise under different body surface cooling conditions : 1) UB leads to a high T-d.thigh while Tes, Tsk, and TS are as low as those for WB, 2) critical levels of body surface cooling area causing a decrease in core temperature elevation might exist, and 3) changes in blood circulation due to body cooling might be affecting temperature responses at the end of exercise.

We investigated the effect of the difference of exercise intensity on the changes in ammonia and oxypurines (hypoxanthine·xanthine) . The subjects were 7 male university students who belonged to the Judo club. By using a bicycle ergometer with the same total work load (kpm), they performed following exercise : light exercise (27.1±0.8% HRmax), moderate exercise (72.6±2.5% HRmax) and exhaustive exercise. After light exercise, blood ammonia, serum oxypurines and urinary oxypurines excretion did not increase. Urinary uric acid excertion increased significantly, but serum uric acid decreased slightly. After moderate exercise, the significant increase was observed with blood ammonia (+ 35.3±5.9μmol/l) . Urinary oxypurines excretion also increased significantly, while serum oxypurines did not change. Also, serum uric acid rose slightly. After exhaustive exercise, the significant increase was observed with blood ammonia, serum oxypurines and serum uric acid. Each peak level and appearance time were +67.2±15.1μmol/l after 3 min, +31.4±7.6μmol/l after 30 min, 155.7±39.9μmol/l after 1 hr of exercise, respectively. These results suggest that AMP deamination occur during moderate intensity, while remarkable production of oxypurines which lead the increase of serum uric acid occur in higher exercise intensity.

In order to elucidate effects of the exercise intensity on purine catabolism, we performed exhausitve exercise (Exh-ex), 80% VO₂max exercise (80%-ex) and 70% VO₂max exercise (70%-ex) test by a bicycle ergometer, and estimated the purine catabolism by the changes in blood ammonia, plasma oxypurines and urinary oxypurines in five healthy male subjects who were given allopurinol. The results were summarized as follows;
1) Plasma oxypurines concentrations (POP) increased gradually after exercise with each intensity. The order of their maximal levels and of cumulative areas under the curves of POP were exh-ex>80%-ex>70%-ex>control, respectively, and that of urinary excretions of oxypurines was exh-ex>80%-ex>70%-ex≥control.
2) Blood ammonia concentrations (BNH₃) increased sharply after exercise with each intensity. The order of their maximal levels was 80%-ex = exh-ex>70%-ex>control, and that of cumulative areas under the curves of BNH₃ was 80%-ex>exh-ex>70%-ex>control.
3) Blood lactate concentrations (BLA) increased sharply after exercise with each intensity. The order of their maximal levels and of cumulative areas under the curves of BLA were exh-ex =80%-ex>70%-ex>control, respectively.
These results suggest that the purine catabolism leading to uric acid production is activated by the physical exercise in the order of increasing intensities. The discrepancy between the increase in ammonia and those in oxypurines suggests that the increased purine catabolic pathway was mediated not only by AMP deamination but also by other factors.

In order to prevent sports anemia, caused especially by iron deficiency or shortage, a special type of food supplementation was designed. This was called“iron-food”and contained 510% of the therapeutic iron dose. According to hemoglobin (Hb) values, female subjects who had been performing hard daily training were divided into two groups ; an anemia group (A group, Hb≤11.9 g/dl, n=4) and a potential anemia group (PA group, 12.0≤Hb≤12.9g/dl, n=4) . Then the iron-food was administered for six weeks following placebo treatment. Iron status, hematological profiles and aerobic work capacity of the two groups were examined before and after the two periods to investigate the effect of the iron-food. Serum iron, iron saturation and ferritin were significantly increased in the PA group. Serum iron tended to be increased in the A group, but not significantly. Red blood cell count, Hb and hematocrit were significantly increased in the PA group, and the reticulocyte count was also increased in the A group. These results suggest that iron-food helped to increase daily iron intake in the anemic subjects, but not to a sufficient extent to aid recovery from anemia. However the ironfood was effective for improving iron status in subjects with potential anemia (latent iron deficiency) .

A survey was made of the state of home care for healthy old folks and those elderly patients who have been disabled by illness or injury, and the care provided by institutions in six areas throughout the nation.
The number of healthy old people was larger in women than in men. However, men had the edgeon women in Activity Daily Living (ADL). Compared to the healthy aged people, many ill or disabled elderly patients receiving home care were found to be suffering from anemia, low cholesterol level, hypoproteinemia, and poor glucose-tolerance. The major cause of disability was cerebral apoplexy. Recently, the cases of cerebral hemorrhage have decreased in number, and the rate of death in acute stage has notability declined ; however, the incidence of cerebral infarction is on the increase among the aged.
There are limits to care for disabled elderly patients at home by the family because of the aging of their spouses and the increasing trend toward the nuclear family. Many of those who look after the sick persons are crying for expert help and services capable of coping with a sudden change in the patient's condition. Hence the need to establish a 24-hour home care providing system. It is desirable to establish old people's homes, as residential care institusion, in alignment with hospitals. This system would facilitate hospitalization in case of emergency. To execute care programs more effectively, close collaboration will be necessary among hospital, home care services, clinics, local governments, agricultural cooperatives, and neighborhood associations.

A 64-year-old man under dialysis was referred for surgical treatment of Crawford type I thoracoabdominal aortic aneurysm. He had a history of idiopathic portal hypertension and chronic total occulusion of supra-renal abdominal aorta and appeared to have massive development of collateral arteries and veins in the abdomen. We chose endovascular repair with debranching of visceral arteries and bypass grafting to bilateral superficial femoral artery considering bleeding from collateral arteries and veins by conventional open surgery. Postoperative CT scan revealed no endoleak and all debranched and bypass grafts were patent. He was discharged with no postoperative complications including paraplegia.

We reviewed our experience with 19mm size aortic valve prostheses for cases with small aortic annulus. Forty-six patients operated on between 1990 and Septembr 2002 were enrolled in this study. Clinical late assessment was performed to evaluate the incidence of valverelated complications, residual transprosthetic gradient, left ventricular mass index (LVMI), and NYHA functional class. Postoperative echocardiography was performed to evaluate hemodynamic performance of the prostheses. Follow up was 1 to 12.7 years (mean 5.3±3.6). There was no hospital mortality (0%). Actuarial survival rates at 10 years were 81.4±1.5%. The late postoperative peak gradient was 25±11mmHg. LVMI was significantly reduced in late phase. NYHA functional class significantly improved in the late period. Although 19mm size aortic valve prosthesis remains small transprosthetic pressure gradient, LVMI significantly reduced and patient activity was satisfactory maintained in the late period.