We report a case of quadricuspid aortic valve concomitant with infective endocarditis. A 73-year-old woman was admitted to our hospital because of general fatigue, loss of body weight and high fever. Transthoracic echocardiography showed moderate aortic regurgitation and left ventricle-right atrium fistulae with vegetation. Infectious endocarditis was diagnosed. Since her fever and hemolytic anemia were not controlled by antibiotics, we operated and the aortic valve had four cusps and there were vegetations on the aortic valve and left ventricle outflow tract. Perforation of the membranous septum was observed. Complete debridement and aortic valve replacement with patch repair of a left ventricle-right atrium (LV-RA) fistula was performed. Although she needed a permanent pacemaker due to complete AV block, her postoperative course was uneventful.

A 48-year-old man was admitted with shortness of breath. He had been given a diagnosis of ankylosing spondylitis by an orthopedic surgeon 20 years previously. A grade III/VI to-and-fro murmur was audible at the left sternal border. Echocardiography revealed moderate to severe aortic regurgitation with annular dilatation. He had also suffered complained rigidity of the neck muscles and back pain for 20 years. He underwent aortic root replacement and his postoperative course was uneventful. Aortic valve regurgitation with ankylosing spondylitis in Japan has been seldom reported, compared with European or American. We discuss surgical problems and the management of these lesions are discussed.

A 62-year-old man presented with a chief complaint of swelling of the left lower extremity. Idiopathic retroperitoneal fibrosis had been diagnosed 6 years previously. Enhanced computed tomography demonstrated occlusion of the left common iliac vein, but without deep vein thrombosis, and a thick dense fibrous layer around the abdominal aorta and in front of the sacrum. After we administered steroid and anticoagulant therapy, remission of the swelling of the left lower extremity was obtained. Presently steroids are being gradually tapered, and he has remained free of recurrence of the swelling of his left lower extremity.

We report a rare case of cystic adventitial disease of the popliteal artery causing intermittent claudication. About 2 months previously, a 21-year-old man had sudden intermittent claudication in the left leg. The left-sided ankle brachial pressure index (ABI) at rest was 0.66. Computed tomography revealed that the arterial occlusion was segmentally caused by cystic lesions. A cystic adventitial lesion of the popliteal artery, measuring 9 cm in diameter, was surgically removed and reconstruction was performed with a saphenous vein graft. Postoperatively the left ABI improved to 1.01, and his symptoms disappeared. The histopathological diagnosis was cystic adventitial disease and the cysts were in the adventitia. The postoperative course was uneventful and he has been without recurrence for 14 months.

Objective: Acanthopanax senticosus Harms extract (ASE) is an ingredient of functional foods, such as health supplements, in Japan. We investigated the effects of ASE on CYP2C9 activity.
Methods and Results: CYP2C9-catalyzed diclofenac 4′-hydroxylase activities in human intestinal and liver microsomes (abbreviated as HIM and HLM, respectively) were significantly decreased by the addition of ASE in a concentration-dependent manner. Kinetic studies of diclofenac 4′-hydroxylase in HLM revealed that ASE addition significantly decreased V_max but had no effect on K_m. These results suggest that diclofenac 4′-hydroxylase activity is suppressed by ASE addition in a non-competitive manner. Then, we investigated the time courses of diclofenac 4′-hydroxylase activity in rat liver microsomes after ASE oral administration (50 to 400 mg/kg). Diclofenac 4′-hydroxylase activities were significantly lowered by the administration of 200 and 400 mg/kg ASE at 0.5 to 4 hr compared with control (0 hr). Furthermore, we investigated the effects of ASE oral administration on the pharmacokinetics of tolbutamide (substrate for CYP2C9) in rats. The area under the concentration-time curve of tolbutamide after ASE oral administration (400 mg/kg) was enhanced by approximately 1.6 times compared with that without ASE oral administration.
Conclusion: These findings indicated that ASE inhibits human intestinal and hepatic CYP2C9 activities.

Eleven healthy subjects repetitively performed maximal cycling movement for 10 s with 20 s rest intervals. The load of the cycling was respectively set to 30% (high frequency task, lIF' task) and 80% (high power task, TIP task) of the optimal load for exerting maximum anaerobic power. Each task was finished when the exerted maximal power was decreased to 80% of the initial value. While performing each task, transcranial magnetic stimulation (TMS) was delivered to the motor cortex which was effectively able to evoke motor evoked potential (MEP) from the thigh muscles. Elec-tromyographic (EMG) activity of the left rectos femoris (RF), vastus lateralis (VL) and the MEP was analyzed.
The maximal power exerted was decreased to 80.6±1.58 % in the HF task, and 77.3±0.77 % in the HP task. The number of repeated sets in each task was 10.1 ± 1.45 (HF task) and 4.1±0.25 sets (HP task) . The MEP area of the RF and VL was not changed significantly in the HF task, though it was significantly increased in the latter half of the HP task. A two-way ANOVA showed that the time course of the changes in the MEP area was significant in the VL (p<0.01), but not in the RF. In both tasks, the duration of the MEP was progressively prolonged in each 10 sec pedaling, and the prolongation was evident in the latter half of the tasks. However, the magnitude of the prolongation was significantly larger during the HP task. The ratio of the integrated amplitude of the EMG and the exerted power at the initial 5 bouts of cycling (EMG/Power ratio) was significantly increased in both the RF and VL, suggesting that peripheral muscular fatigue was induced during at the latter half of each task. Furthermore, the EMG/Power ratio in the VL was significantly higher during the HP task than the HF task.
These results suggest that central fatigue plays a significant role in decreasing the maximum power output, and that it takes place in a muscle-dependent fashion. It was also suggested that during low load, but relatively higher cadence frequency, central fatigue other than that involving the motor cortex accounts for the decreased power output.

Changes in the motor evoked potential (MEP) evoked by transcranial magnetic motor cortex stimulation (TMS) of rectos femoris (RF) and vastus lateralis (VL) was examined during constant cadence cycling tasks for 60 sec. Subjects were 11 normal male volunteers aged between 19 and 25 years. Pedaling load was set at 100% and 80% of the estimated optimal value for maximum anaerobic power output. For the low load task (LL task), the pedaling rate was set at half the value of the maximum pedaling rate with the load set at 80% of the optimal for maximum anaerobic power output. For the high load task (HL task), the pedaling rate was set such that the power was equivalent to the LL task.
The route mean square of the electromyographic (EMG) activity amplitude tended to steeply increase during the latter half of the task. The magnitude of the increase in the RMS was significantly larger in the HL task than the LL task. The area of the MEP also tended to increase in both tasks, though the degree of the increase was significantly larger in the LL task than the HL task. The EMG silent period (SP) after the MEP tended to steeply increase just after the task initiation and to decrease in the latter half of the task in the HL task. However, in the LL task the facilitation of MEP was not found, but it showed a gradual decrease while performing the task. The duration of the MEP tended to increase in both tasks, though the degree of the increase in the VL was significantly larger in the LL task than the HL task. The linear regression analysis between the size of the MEP and the background EMG shows a significant positive correlation coefficient during isometric contraction, but not during the two types of cycling tasks.
These results suggest that the neural circuit responsible for the MEP was controlled differentially during isometric contraction and constant cadence pedaling. Also it is likely that the mechanism of central fatigue differed depending on the cadence and or load in a task-dependent fashion irrespective of the same power output.

The present study investigated how resistance training affects behaviors related to central and peripheral fatigue during a sustained maximal voluntary contraction (MVC) . The subjects were well-trained (TR, n=8) and sedentary untrained (UT, n=6) males. The subjects were asked to repetitively perform 3 sets of MVC (elbow flexion) for 1 min with a rest interval of 1 min. Transcranial magnetic stimulation (TMS) was delivered to the contralateral motor cortex to evoke the motor evoked potential (MEP) and electromyographic (EMG) silent period (SP) after the MEP. Ratio of root mean square (RMS) of the EMG and elbow flexion force (RMS/F) was also calculated.
The time course of the decrease in elbow flexion force that was standardized with respect to the maximal value obtained at the beginning of the first MVC was almost identical in both TR and UT. At the end of the task, the elbow flexion force decreased to around 30 % of the initial value in both groups. Decrease in voluntary activation (VA) estimated by the increment of the force after TMS was significantly larger in UT (77.3%) than in TR (88.2%) at the end of the task. Although the increase in MEP during the first set was significantly greater in UT than in TR, elongation of SP was significantly larger in UT than in TR. Increase in RMS/F, which is a manifestation of peripheral fatigue, was significantly larger in TR than in UT.
These results suggest that decrease in MVC in UT and in TR is respectively more attributable to central and peripheral fatigue, and that inhibitory inputs to motor cortex were larger in UT than in TR. It is concluded that expression of central and peripheral fatigue is affected by resistance training.