Hamstring muscles form a multi-articular muscle group that crosses the hip and knee joints. It has been said that the imbalance in the hamstrings:quadriceps strength ratio (H:Q ratio) due to weaker hamstring muscles results in an increased susceptibility to hamstring strains and anterior cruciate ligament injuries. Four different hamstrings trainings, Hip Lift (HL), Single-leg Deadlift (DL), Leg Curl (LC), and Nordic Hamstrings (NH), were conducted and compared in the effect on conventional H:Q ratio. After the training of two months, significant increase of hip extension torque and H:Q ratios in the hip joint were found in the DL group, and significant increase of knee flexion torque and H:Q ratios in the knee joint were found in the LC group (P < 0.05). As a conclusion, DL and LC training could be practical for hamstrings injury prevention.

Purpose: We report a case in which oral sodium valproate through a percutaneous endoscopic gastrostomy (PEG) tube for palliative decompression drainage in inoperable ileus achieved an effective drug concentration and ameliorated delirium and extrapyramidal side effects. Case Report: The patient was a male in his seventies who suffered from bladder cancer. He underwent PEG because of paralytic ileus with cancerous peritonitis. He had been receiving continuous intravenous infusion of haloperidol for the management of delirium, but needed to discontinue treatment with this agent due to tremor, an extrapyramidal side effect of haloperidol. Oral sodium valproate was therefore administered through the PEG tube for palliative decompression drainage. Plasma valproate concentrations showed effective levels, and his irritability was relieved. A good combination of sodium valproate and quetiapine fumarate allowed successful reduction of and eventual withdrawal from haloperidol, and tremor then improved. Conclusion: We often encounter difficulty with symptom control for patients who cannot use oral medications. When medication by other routes is difficult, this case suggests that sodium valproate through a PEG tube for palliative decompression drainage may be useful as a last resort for improving delirium.

“Depolarized arrest”, induced by hyperkalemic (moderately increased extracellular potassium) cardioplegia is the gold standard to achieve elective temporary cardiac arrest in cardiac surgery. Hyperkalemic cardioplegic solutions provide good myocardial protection, which is relatively safe, and easily and rapidly reversible. However, this technique has detrimental effects associated with ionic imbalance involving sodium and calcium overload of the cardiac cell induced by depolarization of the cell membrane. Hence, the development of an improved cardioplegic solution that enhances myocardial protection is anticipated as an alternative to hyperkalemic cardioplegia. In this review, we assess the suitability and clinical potential of cardioplegic agents to induce “non-depolarized arrest” from the viewpoint of rapid cardiac arrest, myocardial protection, reversibility, and toxicity. “Magnesium cardioplegia” and “esmolol cardioplegia” have been shown to exert superior protection with comparable safety profiles to that of hyperkalemic cardioplegia. These alternative techniques require further examination and investigation to challenge the traditional view that hyperkalemic arrest is best. Endogenous cardioprotective strategies, termed “ischemic preconditioning” and “ischemic postconditioning”, may have a role in cardiac surgery to provide additional protection. The elective nature of cardiac surgery, with the known onset of ischemia and reperfusion, lends it to the potential of these strategies. However, the benefit of preconditioning and postconditioning during cardiac surgery is controversial, particularly in the context of cardioplegia. The clinical application of these strategies is unlikely to become routine during cardiac surgery because of the necessity for repeated aortic crossclamping with consequent potential for embolic events, but offers considerable potential especially if “pharmacological” preconditioning and postconditioning could be established.

Introduction: The purpose of this study was to investigate the effects that a group exercise activity managed by elderly volunteers would have on the physical function of older women after they participated in a formal exercise program taught by fitness experts.

Methods: Subjects were 47 community-dwelling older women who had completed a 3-month exercise program led by expert instructors in Kasama City, Ibaraki. After completing this exercise program, 28 subjects continued to participate in a group exercise activity led by elderly volunteers for approximately 11 months. The remaining 19 subjects did not join the group activities after the formal program. In both the initial, expert-led exercise program and the subsequent, volunteer-led group activity, subjects mainly engaged in the square-stepping exercise, which is a novel exercise for improving lower extremity physical function. In order to assess participants' physical function, we conducted five physical performance tests at both the baseline and follow-up; the former is the last day of the exercise program and the latter is approximately a year after the baseline.

Results: Two-way ANOVA demonstrated a significant interaction in the timed up and go test (P=0.003). The performance of subjects who had participated in the volunteer-managed group activity improved between the baseline and follow-up tests (P=0.007).

Conclusion: Participating in a group exercise activity managed by elderly volunteers can improve mobility skills of older women who had previously completed a formal exercise program led by expert instructors.

Post-malaria neurological syndrome (PMNS) is a rare complication after the treatment of falciparum malaria. We describe a case of a 56-year-old man who developed ataxia, tremor, and confusion 16 days after a successful treatment of falciparum malaria with artesunate followed by mefloquine. Magnetic resonance imaging of the brain revealed no abnormality, and he recovered spontaneously without any specific treatment including corticosteroids. Inflammatory changes were found in the cerebrospinal fluid, suggesting a localized inflammatory reaction as the cause of the syndrome.

For the control of Crohn's disease (CD) a thorough assessment of the small intestine is essential; several modalities may be utilized, with cross-sectional imaging being important. Magnetic resonance (MR) enterography, i.e., MRE is recommended as a modality with the highest accuracy for CD lesions. MRE and MR enteroclysis are the two methods performed following distension of the small intestine. MRE has sensitivity and specificity comparable to computed tomography enterography (CTE); although images obtained using MRE are less clear compared with CTE, MRE does not expose the patient to radiation and is superior for soft-tissue contrast. Furthermore, it can assess not only static but also dynamic and functional imaging and reveals signs of CD, such as abscess, comb sign, fat edema, fistula, lymph node enhancement, less motility, mucosal lesions, stricture, and wall enhancement. Several indices of inflammatory changes and intestinal damage have been proposed for objective evaluation. Recently, diffusion-weighted imaging has been proposed, which does not need bowel preparation and contrast enhancement. Comprehension of the characteristics of MRE and other modalities is important for better management of CD.
Abscess ; Animals ; Capsule Endoscopy ; Comb and Wattles ; Comprehension ; Constriction, Pathologic ; Crohn Disease* ; Diffusion Magnetic Resonance Imaging ; Edema ; Fistula ; Humans ; Intestine, Small* ; Lymph Nodes ; Sensitivity and Specificity

STUDY DESIGN: Case-control study. PURPOSE: To evaluate the surgical magnitude and learning curve of "second-generation" total en bloc spondylectomy (TES). OVERVIEW OF LITERATURE: In June 2010, we developed second-generation TES combined with tumor-induced cryoimmunology, which does not require autograft harvesting. METHODS: TES was performed in 63 patients between June 2010 and September 2013. Three groups of patients were evaluated: 20 undergoing surgery in the first year of development of second-generation TES (group I), 20 in the second year (group II), and 23 in the third year (group III). Patient backgrounds showed no remarkable differences. Operating time, intraoperative blood loss, blood transfusion, and postoperative C-reactive protein and creatine phosphokinase were compared among the groups. RESULTS: Mean±standard deviation operating time was 486±130 minutes in group I, 441±85 minutes in group II, and 396±75 minutes in group III. The time was significantly shorter in group III than in group I (p<0.05). Intraoperative blood loss was 901±646 mL in group I, 433±177 mL in group II, and 411±167 mL in group III. Blood loss was significantly lower in groups II and III than in group I (p<0.01). Transfusion was not required in 20 of 23 patients in group III, and mean C-reactive protein levels on postoperative day 3 were significantly lower in this group than in group I (6.12 mg/L vs. 10.07 mg/L; p<0.05). Postoperative creatine phosphokinase levels did not differ among the groups. CONCLUSIONS: TES is associated with a significant learning curve. Thus, second-generation TES can no longer be considered highly invasive.
Autografts ; Blood Transfusion ; C-Reactive Protein ; Case-Control Studies ; Creatine Kinase ; Humans ; Learning Curve* ; Learning*

STUDY DESIGN: Case-control study. PURPOSE: To evaluate the surgical magnitude and learning curve of "second-generation" total en bloc spondylectomy (TES). OVERVIEW OF LITERATURE: In June 2010, we developed second-generation TES combined with tumor-induced cryoimmunology, which does not require autograft harvesting. METHODS: TES was performed in 63 patients between June 2010 and September 2013. Three groups of patients were evaluated: 20 undergoing surgery in the first year of development of second-generation TES (group I), 20 in the second year (group II), and 23 in the third year (group III). Patient backgrounds showed no remarkable differences. Operating time, intraoperative blood loss, blood transfusion, and postoperative C-reactive protein and creatine phosphokinase were compared among the groups. RESULTS: Mean±standard deviation operating time was 486±130 minutes in group I, 441±85 minutes in group II, and 396±75 minutes in group III. The time was significantly shorter in group III than in group I (p<0.05). Intraoperative blood loss was 901±646 mL in group I, 433±177 mL in group II, and 411±167 mL in group III. Blood loss was significantly lower in groups II and III than in group I (p<0.01). Transfusion was not required in 20 of 23 patients in group III, and mean C-reactive protein levels on postoperative day 3 were significantly lower in this group than in group I (6.12 mg/L vs. 10.07 mg/L; p<0.05). Postoperative creatine phosphokinase levels did not differ among the groups. CONCLUSIONS: TES is associated with a significant learning curve. Thus, second-generation TES can no longer be considered highly invasive.
Autografts ; Blood Transfusion ; C-Reactive Protein ; Case-Control Studies ; Creatine Kinase ; Humans ; Learning Curve* ; Learning*

OBJECTIVE: The aim of this study was to investigate the risk and recurrence of early invasive adenocarcinoma of the cervix, and to determine whether non-radical methods of management could be performed. METHODS: The medical and histopathological records of 50 patients with early invasive adenocarcinoma of the cervix treated at Keio University Hospital between 1993 and 2005 were reviewed, and compared with the literature. RESULTS: The median follow-up period was 64.3 months. The depth of stromal invasion was < or =3 mm in 33 cases and >3 mm, but < or =5 mm in 17 cases. The horizontal spread was < or =7 mm in 25 cases and >7 mm in 25 cases. One of the 33 cases that had tumor volumes of < or =500 mm3, and three of the 17 cases with tumor volumes of >500 mm3 were positive for lymph node metastasis. When our data were combined with previously reported results, statistically significant differences were observed between the tumor volume and the frequency of pelvic lymph node metastasis/the rate of recurrence (p<0.0001). The frequency of pelvic lymph node metastases was significantly higher in the lymphovascular space invasion (LVSI)-positive group than in the LVSI-negative group (p=0.02). No adnexal metastasis or parametrial involvement was noted. CONCLUSION: Assessment of the depth of stromal invasion, tumor volume, and LVSI is critical for selecting an appropriate therapeutic modality. Non-radical methods of management are considered suitable for patients with LVSI-negative adenocarcinoma of the cervix exhibiting a stromal invasion depth of < or =5 mm and a tumor volume of < or =500 mm3.
Adenocarcinoma ; Cervix Uteri ; Conization ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Tumor Burden ; Uterine Cervical Neoplasms

　　Capnocytophaga canimorsus is a spindle-shaped facultatively anaerobic Gram-negative rod in the oral cavity of dogs and cats. C. canimorsus rarely infects humans through an animal bite or scratch. However, it leads to severe sepsis once infection occurs, and the fatality rate is estimated to be up to 30%. The patient was a 56-year-old man with fatigue and fever. Sepsis with thrombocytopenia was suspected from the blood examination results. We decided to conduct microscopic examination of a non-stained peripheral blood smear and identified bacteria; therefore, Gram stain was immediately performed and spindle-shaped Gram-negative bacilli were detected. Additionally, the patient had a history of a bite and scratch by his cat. We suspected C. canimorsus infection from the microscopic examination findings and history. Moreover, we determined early that the pathogenic bacterium was C. canimorsus by blood culture. With immediate and proper treatment based on these results, we could rescue this septic patient with disseminated intravascular coagulation. Microscopic examination of non-stained peripheral blood smear is helpful for the early diagnosis of C. canimorsus infection.