3.EFFECTS OF “LIVING HIGH AND TRAINING LOW” ON PULMONARY CIRCULATION HEMODYNAMICS AND ENDOTHELIAL NITRIC OXIDE SYNTHASE PROTEIN EXPRESSION IN PULMONARY ARTERY OF RATS
TOMOYA KASHIWAGI ; TOMONOBU SAKURAI ; KAZUHIRO MINAMI ; KENTA SUZUKI ; OSAMU KASHIMURA
Japanese Journal of Physical Fitness and Sports Medicine 2009;58(2):285-294
The present study was to evaluate endothelial nitric oxide synthase (eNOS) protein expression and hemodynamics of pulmonary circulation in rats of "Living high and Training low" (LH+TL). The Sprague Dawley strain of male rats were used at the age of 9 weeks. They were divided according to four conditions of a living low (LL) group, living low and training low (LL+TL) group, living high (LH) group and LH+TL group, for 10 days. We assessed the effects of LH+TL on exercise-induced pulmonary arterial pressure and blood lactic acids under sea-level altitude in catheter-implanted conscious rats. Also, we measured the pulmonary artery under anesthesia and analyzed eNOS protein expression by western blot analysis. The blood lactate levels in the LH+TL rats decreased after maximal treadmill running compared to LL, LL+TL and LH rats (p<0.05). The increase in pulmonary arterial blood pressure with exercise was significantly lower in the LH+TL group than in the LL group (p<0.05). The eNOS protein expressions of pulmonary artery were higher in the LH+TL group than in the LL group (p<0.05). This study indicates that LH+TL reduced the increase of pulmonary arterial blood pressure with exercise at below sea-level altitude. In addition, eNOS protein expressions were enhanced in the pulmonary arteries of LH+TL rats. Thus, we conclude that the high altitude training of LH+TL was a useful method for improvement of endurance exercise ability and this improvement may be associated with pulmonary arterial response.
4.Effects of Low-Intensity Brief Exercise and Training on Cell-Mediated Immunity
Osamu TERADA ; Katsuhiko SUZUKI ; Yoshiko KURIHARA ; Satoru MORIGUCHI
Japanese Journal of Complementary and Alternative Medicine 2007;4(2):71-77
We investigated the effects of low-intensity brief exercise on lymphocyte functions and plasma cytokine concentrations. Six young sedentary women performed 30-min walking exercise (6 km/h, 50–65% HR max) per day for 3 weeks. Each subject’s peripheral blood was sampled before training, 1 week and 3 weeks after training, and analyzed for natural killer (NK) cell activity, T cell proliferation activity, granzyme B, interleukin-2 (IL-2), IL-6, IL-10, IL-12p40 and interferon.γ (IFN-γ). Lymphocyte functions did not change significantly following training, but plasma concentrations of IL-12p40 decreased significantly. These results suggest that cytokine balance towards significant Th1>Th2 is induced by low-intensity training.
5.Reliability of the Estimation of Non-Metabolic CO2 Output During Incremental Exercise.
OSAMU ITO ; YASUHIRO SUZUKI ; KAZUYUKI KAMAHARA ; KAORU TAKAMATSU
Japanese Journal of Physical Fitness and Sports Medicine 2001;50(1):129-138
It is known that lactic anions and hydrogen ions (H+) produced during intense exercise are partly transported or diffused from muscle to blood resulting in the production of non-metabolic CO2 through the bicarbonate buffering system. The purpose of the present study was to examine the reliability of the estimation of non-metabolic CO2 output using respiratory gas analysis during incremental exercise. Six healthy subjects underwent an incremental pedaling exercise test accompanied by respiratory gas and arterial blood sampling. The rate of non-metabolic CO2 output (VCO2-NM) was calculated by subtracting projected metabolic VCO2 from actual VCO2 after CO2 threshold (CT) . CT was determined using a modified V-Slope method. Bicarbonate (HCO3-), pH, CO2 partial pressure and lactate concentration were measured from arterial blood samples using automatic analyzers. The kinetics of VCO2-NM and HCO2- were compared throughout the exercise test. VCO2-NM was significantly correlated with HCO3-decrease after CT (r=0.976, p<0.001) and the kinetics of VCO2-NM and HCO3- decrease were similar during exercise. Furthermore, the amount of non-metabolic CO2 output (NM-CO2) calculated integrating VCO2-NM above CT was significantly correlated with the difference in HCO3-between CT and exhaustion (r=0.929, p<0.01) and with the difference in arterial blood pH between rest and exhaustion (r=0.863, p<0.05) . However, NM-CO2 was not significantly related to maximum ventilation (r=0.111, ns) . These results suggest that the estimation of non-metabolic CO2 output during incremental exercise proposed in the present study is reliable. It was also suggested that the primary factor which influenced nonmetabolic CO2 output during incremental exercise was the addition of H+ into blood and not hyperventilation.
6.A Novel Approach to Surgical Treatment of Scimitar Syndrome: Relocation of the Anomalous Pulmonary Vein and Intra-Atrial Baffle Rerouting
Yoshimasa Uno ; Takaaki Suzuki ; Kentaro Hotoda ; Osamu Ishida ; Toyoki Fukuda
Japanese Journal of Cardiovascular Surgery 2007;36(5):305-308
Scimitar syndrome is a rare congenital cardiac anomaly with anomalous right pulmonary veins draining to the inferior caval vein. Currently, it is widely accepted that there are 2 forms of presentation with either an infantile manifestation or an adult form. Patients in the latter category are usually less severely affected and frequently asymptomatic on diagnosis. A 16-year-old boy who had been given a diagnosis of scimitar syndrome was observed for years because of his unwillingness to undergo surgery. However, since the latest catheter examination demonstrated an elevated pulmonary-to-systemic flow ratio of 2.39, he consented to undergo surgical treatment. Preoperative studies demonstrated an intact atrial septum and abnormal bronchial arborization of the right lung. Pulmonary angiography demonstrated abnormal right pulmonary veins that converged to a single venous trunk, the so-called scimitar vein, and drained into the inferior caval vein at the level of diaphragma. Because of the morphological abnormalities including a wide distance between the pulmonary veno-caval junction and interatrial septum, counterclockwise rotation of the heart, and a small left atrium, surgical management was performed with a novel approach, consisting of relocation of the scimitar vein to the anterolateral wall of the right atrium, total excision of the oval fossa, and intra-atrial baffle rerouting with the pulmonary venous blood being conveyed to the left atrium through the atrial septal defect. During the cardiopulmonary bypass vacuum assisted venous drainage through a femoral venous cannula was highly effective to secure a clear operative field without occlusion of the inferior caval vein. Postoperative recovery was uneventful and the repeat Doppler echocardiography demonstrated an unobstructed flow through the baffle. This experience indicates that the above novel approach is a promising surgical option for the management of scimitar syndrome.
7.Fate of the Communicated False Lumen Following Surgical Treatment for Aortic Dissection.
Shigeru Hosaka ; Kihachiro Kamiya ; Shoji Suzuki ; Osamu Suzuki ; Shinpei Yoshii ; Ryoichi Hashimoto ; Yusuke Tada
Japanese Journal of Cardiovascular Surgery 1996;25(2):99-104
The purpose of this study was to estimate the postoperative growth of untreated segments of the dissected aorta with non-thrombotic communicating false lumen, and also to evaluate the clinical outcome in relation to the aortic enlargement after surgery. Nineteen patients who underwent surgical treatment of aortic dissection were studied with enhanced CT scans and angiograms during the postoperative follow-up period. In Stanford type A patients, mean aortic dilatation rate calculated at the segment showing maximal dilatation was 5.1mm/year during 13-82 months (average, 41 months) after surgery, as a sequela of enlargement of the false lumen. Differences in the aortic dilatation rates between the different segments of the aorta were observed and these were per annum 4.8mm in the ascending aorta, 5.4mm in the transverse aortic arch, 4.3mm in the proximal descending aorta, 2.7mm in the distal descending aorta and 2.4mm in the abdominal aorta. In all patients, major communications were detected at the perianastomotic sites on angiography. In Stanford type B patients, false lumens with small communications were observed to show gradual thrombotic occlusion, but no significant aortic dilatation was detected during the follow-up period (13-70 months, average: 44 months), except three cases of sudden death who had major communications. Nine late events related to dissection, consisting of 4 sudden deaths suspected to be due to aortic rupture, 2 intestinal necroses and 3 cerebral infarctions, occured in 6 patients (32%), among which three patients had undergone arterial fenestration, one of whom had double barrel anastomosis. In the remaining two, major leakages were recognized at distal aortic anastomotic sites on postoperative angiography. The results of this study, we stress the importance of periodic check-ups using enhanced CT scan and if necessary, angiography after surgery of the patients having communicating false lumen. Early detection of progressive aneurysm formation and timely surgical reintervention can yield a good prognosis.
8.Cytokine Response to Exercise during Exposure to Cold
Takamasa KONDOU ; Kishiko OGAWA ; Osamu TERADA ; Kijin KIM ; Mitsuharu OKUTSU ; Katsuhiko SUZUKI
Japanese Journal of Complementary and Alternative Medicine 2009;6(2):89-95
This study examined cytokine responses to cold exposure together with the effects of exercise and thermal adaptation. Ten male short-track skaters who had adapted to a cold environment, and ten male inline skaters who had not, were each assigned to two experimental conditions. For the cold condition, subjects sat for 60 min at 5–8°C, then exercised on a cycle ergometer for 60 min at 65% maximal oxygen uptake (at 5–8°C), and finally sat again for 120 min at room temperature (20–25°C). In the control condition, subjects participated in the same protocol as the above but at room temperature (20–25°C). Blood samples were collected at pre-cold exposure, post-cold exposure (pre-exercise), post-exercise, post-30 min, post-60 min, and post-120 min, and analyzed for plasma concentrations of interleukin (IL)-1 receptor antagonist (IL-1ra), IL-8, IL-10, IL-12p40, soluble tumor necrosis factor receptor I (sTNFR-I), cortisol, and myoglobin by using enzyme-linked immunosorbent assay (ELISA). 60-min cycle ergometer exercise induced significant increases in plasma IL-1ra, IL-10 and IL-12p40 at room temperature in short-track skaters adapted to the cold, but significant decreases in these cytokines were observed with exposure to cold. These results indicate that acute cold exposure has a suppressive effect on cytokine response during exercise, suggesting the possibility of preventive effects on immunosuppression, heat stroke and allergy induced by exercise.
9.GROWTH OF THE VETRICULAR VOLUMES AND THE CHANGES OF INDICES OF CARDIAC PERFORMANCE
SHIGEYUKI ECHIGO ; KENJI KISHIDA ; TORU NAKAJIMA ; HIDESHI TOMITA ; ATSUKO SUZUKI ; TETSURO KAMIYA ; OSAMU YAMADA
Japanese Journal of Physical Fitness and Sports Medicine 1985;34(Supplement):121-130
The purpose of this clinical investigation is to analyse the growth of the ventricular volumes and the changes of indices of cardiac performance during infancy and childhood. The materials were composed of 129 healthy infants and children (4 months to 13 years of age), who had a history of Kawasaki disease and without any evidence of coronary artery lesion. All the cases underwent cardiac catheterization and cineangiography under sedation. Volumes of the left and right ventricles were calculated by integration methods in tow frames for end-diastole and end-systole from biplane cineangiograms. Left ventricular mass was calculated in 120 infants and children by Rackley's method.
All the volumes and masses were deviled by body surface area in order to normalize the crude values for infants and children of different size. The mean values of left ventricular end-diastolic volume index (LVEDVI), right ventricular end-diastolic volume index (RVEDVI) and stroke index (SI) for each age were less in the younger children than those in the older children, and abrupt stepwise increase was observed at 1 year, 6 years and 10-11 years of age in the values of LVEDVI, RVEDVI and SI.
The infants and chidren were divided into four groups according to age (under 1 year, 1 to 5 years, 6 to 10 years and more than 11 years) . The values of LVEDVI, RVEDVI, SI and LVmass index were less in the younger age groups than those in the older age groups, and the difference of each age groups was statistically significant. The value of left ventricular ejection fraction (LVEF) was less in the youngest group (under 1 year) than those in the another groups (p<0.01) . The value for right ventricular ejection fraction (RVEF) was not significantly different in the age groups. End-systolic pressure-volume ratio was normalized with left ventricular mass (LVESP/ (LVESV/LVmass) ) . This normalized ratio was the lowest in the youngest group (under 1 year) and the highest in the oldest group (more than 11 years) .
As mentioned before, abrupt stepwise increase was observed in the“normal”values of LVEDVI, RVEDVI and SI in infancts and children. The explanation of this fact may be difficult at present. By the evidence of the normalized end-systolic pressure-volume ratio, it can be said that the contractility of the left ventricle in“healthy”infants and children was increased according to age. The reason why the value of LVEF was less in the youngest group than those in the another groups can be attributed to the lower contrac-tility in the youngest group. A possible factor that the value of RVEF was not significantly different between the youngest group and the another groups is; because the right ventricle works under higher pressure during fetal and neonatal period, then the right ventricular performance developed already in infancy.
10.Recent Trends of Medical Education Reforms in United Kingdom:
Machiko Shibahara ; Hiroshi Nishigori ; Mariko Nakamura ; Toshiya Suzuki ; Yuko Takeda ; Yasuhiko Konishi ; Osamu Fukushima ; Nobuo Nara
Medical Education 2013;44(2):63-70
Background: Globalization urges us to discuss rationale and policy towards establishing a medical education accrediting body in Japan. Experience of General Medical Council (GMC) suggests us some useful lessons.
Method: Based on our visits and investigation into in GMC, we inquire how Quality Assurance (QA) was introduced in UK with what incentives and how QA has brought reforms in the medical schools in UK.
Result: Since 2003, GMC has changed its policy for QA from ‘inspection’ to ‘dialogue’. Dialogical QA asks a medical school to think critically of their education and consider vigorous actions for further improvements.
Discussion: Implications from the experience of GMC are: 1.QA process in GMC makes medical schools take robust steps towards changes, 2. Sharing the rational and policy for QA created the solid base for its effective implementation, 3. There are possible difficulties in establishing structure to do an enormous amount of coordinating work, which is necessary for constructing ‘dialogue with medical schools’.