Patient 1, a 75-year-old woman with a past history of osteoarthritis of the right knee and Parkinson disease, had a subarachnoid hemorrhage. She complained of right knee pain during her rehabilitation. It turned out that she had sustained a right trochanteric fracture after falling out of bed in another hospital. Patient 2, an 86-year-old woman with a past history of rheumatoid arthritis, was treated with the Gamma nail technique for a left trochanteric fracture. She described experiencing pain in the region from the left knee to the lateral side of the left thigh during her rehabilitation, about two months after the hip operation. X-ray and computed tomography images showed varus displacement of the femoral head due to screw cut-out. In each of these cases, it took some time for us to detect the underlying hip diseases. The dermatome shows regions of the skin innervated by each single spinal segment. Similarly, the sclerotome shows regions of bone and periosteum innervated by each single spinal segment. According to Inman and Saunders's sclerotome, the proximal portion of the femur is mainly innervated by L3, L4 and L5. On the other hand, in dermatome perspective, L3, L4 and L5 innervate the knee and region around the knee. It means that hip diseases can cause referred pain to the knee.Untypical pain in distant regions from the hip joint makes it difficult to examine the hip joint and causes delay in an accurate diagnosis, as in the cases just described. Therefore, we should keep in mind that hip diseases can cause referred pain to the knee.

The objective of this study was to investigate whether isometric resistance exercise (IRE) can attenuate musculoskeletal atrophy during unloading and accelerate its recovery during reloading. Twenty-six female Fischer 344 rats, aged 16 weeks, had their hindlimbs suspended for 3 weeks (unloading) ; 12 of these rats were allowed subsequent cage activity (reloading) for 3 weeks with or without IRE. IRE (stationary support on a cylindrical grid inclined 60 or 80 degrees) was done for 30 min/day, 6 days/week, with an additional load of 30% or 50% body mass attached to the tail during the unloading and reloading periods. The tibial bone and hindlimb skeletal muscles from four experimental and two age-matched control groups were evaluated with dual-energy X-ray absorptiometry, mechanical testing, and muscle mass measurement. Bone mineral density (BMD) was measured in the whole tibia and in 7 regions divided equally along the long axis of the epiphysis from proximal (R1) to distal (R7) . After unloading, fat-free dry mass (FFDM), bone mineral content (BMC), and BMD of the whole tibia decreased by 8%, 10%, and 6%, respectively. FFDM and BMC, but not BMD, returned to the levels of age-matched controls during reloading. Unloading-induced decreases in BMD were observed in the regions from the proximal epiphysis to the diaphysis (R1 to R4) and the distal epiphysis (R7) . The rate of decrease in BMD was regionally specific and was particularly pronounced (12%) in the most proximal region (R1) . These findings indicate regional variations in responses of BMD to skeletal unloading. The BMD in R2 to R4 remained less than that in age-matched control after reloading. No significant changes were observed in maximum breaking load, energy, and deformation after unloading and reloading. Hindlimb-unloading induced loss of mass in the soleus (38%), plantaris (14%), gastrocnemius (25%), tibialis anterior (8%), extensor digitorum longus ( 8%), and rectos lemons (17%) muscles, but the mass of muscles, except for the soleus muscle, recovered during reloading. IRE ameliorated the loss of mass in the soleus and gastrocnemius muscles during unloading but did not promote the recovery of mass in any muscles during reloading. Moreover, IRE showed no effect on bone responses after unloading and reloading. This lack of beneficial effects of IRE on osteopenia may be due, in part, to insufficient exerciseinduced load. We concluded that 1) regional analysis of BMD can be used to assess local bone metabolism, 2) the response of BMD to altered loading conditions does not necessarily depend on the response of muscle mass, 3) recovery from osteopenia progresses more slowly than that from sarcopenia, and a longer time than the unloading period is required to restore BMD. Further studies are needed to develop more effective countermeasures against osteopenia and sarcopenia.

Purpose : We examined the effect of therapeutic exercise on osteoarthritis (OA) of the knee. Objects and Method : We evaluated seven women with bilateral OA of the knees of over Grade I on the Kellgren and Lawrence scale. The patients were instructed in therapeutic exercise for both knees. The exercise was to tie a Thera-Band ^® around the leg just above both ankles in the 8 figure, and then, in a sitting position, extend one leg while simultaneously retracting the other, repeating alternatively every 5 seconds. One set consisted of repeating this motion 10 times, and 2 sets were performed per day. Before exercise, 1 month, and 3 months after exercise, we evaluated the effect of this therapy by the JOA score, isokinetic muscle strength of knee extensors and flexors, and surface EMG signals recorded from rectos femoris (RF), vastus medialis (VM), vastus lateralis (VL), and biceps lemons (BF) . The integrated signal, the root mean square (RMS), and the mean power frequency (MPF) parameters were extracted.
Result : The parameters of the JOA score, muscle strength of knee flexors, integrated EMG from RF, VM, VL, and RMS from VM, VL were significantly increased at 3 months after exercise. MPF from VM at 3 months after exercise decreased significantly.
Conclusion : We thought a proper balance of knee extensors and flexors are related to the improvement of symptoms of OA of the knee. The decrease of MPF might suggest the possibility of muscle fiber type change. It is also possible that pain reduction results from the improvement of balance between knee extensors and flexors as well as from the increase of knee joint stability. Therapeutic exercise with the Thera-Band R is extremely easy and is effective in promoting con-tinuous exercise.

Objective: The water-soluble extract of Ganoderma lucidum mycelia (WER), which is used as a health food, reduced hyperglycemia and enhanced glucose transporter 4 (GLUT4) translocation to the plasma membrane in skeletal muscle and adipose tissue in KK-A^y mice, a type 2 diabetic animal model with obesity.In order to elucidate the reduction of hyperglycemia by WER, we investigated the translocation of glucose transporter 4, glucose uptake and associating signal transduction in rat skeletal muscle (L6) cells. Method: The glucose uptake was analyzed with radioactive 2-deoxy-D-glucose.The localization of GLUT4 in L6 cells treated with various concentrations of WER was analyzed with immunohistochemical staining and Western blot technique.As a positive control, insulin or troglitazone was used in these experiments.Furthermore, the activation of intracellular signaling pathways by Western blot analysis and the influence of glucose uptake using four kinds of inhibitors (LY294002 as potent PI3K inhibitor, rapamycin as mTOR inhibitor, Gö6983 as broad PKC inhibitor, compound C as AMPK inhibitor) was evaluated. Results: GLUT4 protein content in the plasma membrane was induced in a dose-dependent manner of WER without increasing the gene expression and amount of total protein in the L6 cells and the glucose uptake was augmented with increasing the amount of GLUT4 translocated on the plasma membrane.The phosphorylation of phosphatidylinositol-3 kinase (PI3K), Akt and acetyl CoA carboxylase (ACC) were induced in a concentration dependent manner and inhibited by the above inhibitors except rapamycin. Conclusion: These results indicate that the hypoglycemic effect of some material(s) in WER may be due to the enhancement of glucose uptake through GLUT4 translocation on the plasma membrane by activating the PI3K/Akt pathway through improving insulin resistance.

Purpose: The purpose of this study is to evaluate hangeshashinto rinse for oral discomfort in terminally-ill cancer patients and to compare the effectiveness of hangeshashinto rinse with or without honey rinse. Methods: Patients with oral discomfort were randomized to receive either hangeshashinto rinse or hangeshashinto with honey rinse as first-line treatment. Patients performed oral rinse three to five times a day for 2 weeks. Further, oral wetness, halitosis, oral mucositis, mouth discomfort, compliance of rinse were then evaluated before and after the intervention. Results: 144 patients were enrolled during this period and 22 patients completed the study (hangeshashinto 13 / hangeshashinto with honey 9). After the intervention, oral wetness was improved, and end-tidal concentration of hydrogen sulfide was decreased in both cases. Although there was no statistically significant difference, oral discomfort by subjective and objective evaluations, also and symptom of oral mucositis were improved. Other volatile sulfur compounds decreased. Frequency of rinsing between groups receiving hangeshashinto or hangeshashinto with honey did not differ, however, the acceptability was slightly better in the honey combination group. Conclusion: Both hangeshashinto rinse and hangeshashinto with honey rinse reduced end-tidal concentration of hydrogen sulfide and improved oral wetness. Oral rinse by hangeshashinto or hangeshashinto with honey may be effective for oral discomfort in terminally-ill cancer patients.