The purpose of this study was to investigate the effects of running training on bone formation in rats in relation to the age training started. The first experimental period was set from 6 to 12 weeks (wks) old and the second from 12 to 19 wks old. Sixty-four Wistar strain 6-wk-old male rats were initially divided into a non-exercise (N) and an exercise (E) group. At 12 wks old, each group was subdivided into two groups, providing four groups: non-exercise·non-exercise (NN), non-exercise·exercise (NE), exercise·non-exercise (EN) and exercise·exercise (EE) . Exercise consisted of treadmill running at a speed of 30 m/min, 60 mm day, 5 days wk. The animals were sacrificed before the experiment (6 wks old), post-first experiment (12wks old) and postexperiment (19 wks old), the bilateral tibiae were removed and their lengths, bone mineral content (BMC), bone mineral density (BMD) and bone histomorphometric parameters were measured. The tibial length was significantly shorter in 12-wk-old E than N rats and in 19-wk-old EE than NN. At 19 wks old, the total tibial BMD values were significantly higher in EE than NN, and the BMD values of the proximal and distal tibiae, where the cancellous bone was the main component, had increased markedly, whereas no differences between the diaphyseal BMD of each group were noted. Bone histomorphometry at 12 wks old, considered the immature period, showed that the osteoid surfaces and labeled surfaces tended to be increased by running training, but the bone volume was unchanged. In contrast, at 19 wks old, considered the early mature period, the osteoid surfaces showed a tendency to decrease and labeled surfaces to increase and consequently the bone volume increased albeit not significantly. These results suggest that: 1) running training started in immature rats represses longitudinal tibial growth, 2) the cancellous bone is more sensitive then the cortical bone to this type of training and 3) training of early mature rats increases bone volume by increasing the efficiency of osteoid calcification.

A 46-year-old man who developed fever and general fatigue was referred to our hospital with suspicion of infective endocarditis. A ventricular septal defect had been previously diagnosed. Transthoracic echocardiography revealed vegetation on the aortic, mitral, and pulmonary valves, and each valve had significant regurgitation. An emergency operation was performed because of congestive heart failure. The aortic and mitral valves were replaced with mechanical valves. The pulmonary valve was repaired ; the anterior leaflet was resected and replaced by glutaraldehyde-treated autologous pericardium. The patient's postoperative course was uneventful. Recurrence of infection was not observed for 3 years after the operation. Triple-valve endocarditis, especially that involving a combination of the aortic, mitral, and pulmonary valves, is rare. Involvement of multiple valves on both sides of the heart may be attributed to a congenital intracardiac shunt. Early surgical intervention may be useful to control infection and heart failure, as in the present case.

The purpose of this study was to investigate the pathologic changes of jumper's knee before and after jumping and effects of icing after jumping. Sixteen healthy college students and sixteen collegiate volleyball players with jumper's knee were divided into two groups by eight, without icing group and with icing group after jumping exercise. Without icing groups rested for 20 minutes, while with icing groups were treated with ice for 20 minutes after eighty times of jumping. Signal to noise ratio (SNR) and sectional area of patellar tendon with Magnetic Resonance Imaging and the tenderness of patellar tendon with visual analog scale were measured before and after exercise, following with or without icing and 24 and 48 hours later from the treatment. In jumper's knee group, significant increase was found in the SNR, sectional area of patellar tendon, and tenderness of patellar tendon after exercise compared to before exercise. In addition, in jumper's knee with icing group, significant decrease was found in the SNR, sectional area of patellar tendon after icing and 24 and 48 hours after icing, and the tenderness of patellar tendon after icing compared to after exercise. These results suggested that icing was an effective treatment for jumper's knee after exercise.

Physical activity in the growing period has been shown to be effective for increasing bone mass because immature bones are more sensitive than mature adult bones to the stimulation with mechanical stress. However, bone growth is not uniform and changes markedly at puberty. Therefore, the response of bone to exercise may differ according to the growth process. The purpose of the present study was to investigate the process of the bone response to running training, and the relationship between the bone response and serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels in female rats. Thirty-three female Wistar-Imamichi rats 4 weeks of age were divided randomly into control (CON) and running training (RUN) groups for 6 and 12 weeks. Training consisted of running on a flatbed treadmill at 30 m/min for 60 min/day, 5 days/week. The bone mineral content (BMC) and bone mineral density (BMD) in the whole and five parts of the tibia were measured by a dual-energy X-ray absorptiometer (DXA) . Simultaneously, we measured serum concentrations of IGF-I, IGFBP-3, osteocalcin and 17β-estradiol. The whole tibial BMD was significantly higher in the RUN groups than in the age-matched CON groups. When BMD was analyzed at five different studied parts within the same tibia, the increase of BMD. was noted in the proximal and distal cancellous bone in the 6-week RUN group, and in the diaphysial, cortical bone, in the 12-week RUN group. Serum concentrations of osteocalcin, a marker of bone formation, were not altered by training, whereas they decreased with aging. Serum IGF-I levels in the training groups were not changed, but IGFBP-3 levels were increased significantly only in 6-week RUN rats. As a complex between IGFBP-3 and IGF-I may be more improve than free IGF-I in the bone formation, the high levels of IGFBP-3 in the 6-week RUN group may induce an increase in the activity of IGF-I. There was a significant positive relationship between serum IGF-I concentration and BMD of the whole tibia in the 6-week study, and between the IGFBP-3 level and BMD in both the 6 and 12-week studies.
In conclusion, 1) the process of the skeletal response to running training is site-specific within the same bone, and 2) the increment of the IGFBP-3 level with training in the growth period may reflect the increment of tibial BMD through training.

Bone (tibia, femur, and lumbar spine) and blood samples were obtained from 100 (50 males and 50 females) Wistar-Imamichi rats in groups aged 3, 5, 7, 9, 12, 15 and 20 weeks old to investigate the changes in bone mass during puberty in relation to insulin-like growth factor 1 (IGF-1), IGF binding protein (IGFBP) -3, osteocalcin (OC) and sex steroids in normal rats.
Sharp increases in BMD (bone mineral density) in the tibia, femur and lumbar appeared earlier in female than in male rats, and the BMD in females tended to be higher than in males between 5 and 9 weeks old. After 9 weeks old, BMD in males was higher than that in females, as BMD in males continued to increase whereas that in females tended to remain in a steady state after this stage. This sex-related difference in changes in BMD pattern is probably related to the serum concentrations of IGF-1, IGFBP-3, testosterone, and 17β-estradiol with maturation. In males, marked increases in serum IGF-1 and IGFBP-3 concentrations appeared earlier than that in serum testosterone level. IGF-1 and testosterone peaked at 9 weeks of age, and thereafter remarked in a steady state, whereas IGFBP-3 reached a peak at 7 weeks of age, and then declined gradually. In females, the changes in patterns of serum 17β-estradiol, IGF-1, and IGFBP-3 levels were very similar. The levels increased gradually from 3-5 weeks old, peaked at 9 weeks, and then decreased slowly thereafter. In contrast, serum OC concentrations remain relatively high from 3 to 9 and from 3 to 7 weeks old in males and females, respectively, although OC in both sexes declined gradually with aging.
These observations suggest that BMD development occurs earlier in female than in male rats. This sex-related difference in changes in the BMD pattern may result from the earlier onset of puberty in females, and from the sex-specific differences in concentrations of IGF-1, IGFBP-3 and sex steroids with maturation.

Kinki University School of Medicine introduced clerkships for undergraduate clinical training in 1999. Clinical clerkships are performed for the first 8 weeks of the sixth academic year. In 1999 and 2000 we conducted questionnaire surveys asking students about this system. The teaching staff encourages students to participate extensively in clinical situations, which reflects the consensus about this system. We also performed similar surveys of nurses and teaching staff. Clinical clerkships did not increase the incidence of problems between patients and medical staff. Many students felt their motivation to be a physician was increased. Although the findings of these questionnaire surveys indicate that our clerkship system works successfully, they also revealed some problems for sixth-year students. Although we recognize the significance of this system for undergraduate clinical training, further improvement is required.