The present study was designed to examine the thermoregulatory response to the alternate stress of heat and cold in relation to physical training. A heat stress was given as a 60-minute foot bath in water at 43°C in the air condition of 30°C DB and 60% RH, and a cold stress as a 60-minute exposure to an atmosphere of 20°C DB and 60% RH in summer and 17°C DB and 60% RH in winter. Two experimental conditions of four-hour exposure were set up by combining the hourly heat and cold stress alternately : Condition I was initiated with the heat stress and ended with the cold one, and condition II vice versa. In these conditions, both heat and cold stresses were given twice. In summer, as well as in winter, physical untrained and trained adult males in swimming pants were exposed to alternate heat and cold stress extending for four hours. Rectal and mean skin temperatures were taken every 5 minutes. A ten-minute metabolic rate was measured every 20 minutes during the exposure period. The effect of physical training was generally more remarkable in condition I than in condition II, and in summer than in winter. In condition I, the trained group had a smaller variation in rectal temperature and a smaller rate of variation from a resting value in energy consumption throughout the four-hour exposure than the untrained. The differences between the mean skin temperature in the last stage of the first exposure and that of the second tended to be smaller in the trained group than in the untrained. Reduced differences between these values were noticed in the untrained men after physical training. These results indicate that the effect of physical training was discernible on the thermal adaptability to the alternate stress of heat and cold. It was concluded that physical training generally promoted the acclimatization and enhanced tolerance capacity to heat and cold.

In cases of hemostasis of the femoral artery where the sheath is removed after percutaneous catheterization, there is greater improvement in patient condition and shorter duration of hospital stay when arterial puncture closing devices are used rather than standard manual compression because the use of these devices results in shorter hemostasis and rest times. However, some complications due to these devices have also been reported. Here, we report a case of femoral artery stenosis due to Angio-Seal^® use in a 67-year-old woman. Embolization of the basilar artery aneurysm by endovascular treatment was performed at another institution ; the percutaneous puncture site was the right femoral artery. When this treatment was provided, hemostasis of the artery was performed with the Angio-Seal^®. About one month after the embolization, right intermittent claudication occurred after a 300-m walk. Echography and computed tomography (CT) angiogram showed 75% stenosis of the right common femoral artery, and therefore endoarterectomy of the artery was performed. The postoperative course was favorable and the ankle brachial index score improved from 0.82 to 1.15. In addition, CT angiogram showed resolution of the stenosis of the right common femoral artery and right intermittent claudication ameliorated. Based on the intraoperative views, it was suggested that the arteriosclerotic lesion had existed at the common femoral artery before the endovascular treatment and it might be the cause of the complication mentioned above. In order to prevent complications due to Angio-Seal^® use, it is important to examine the indications of the use of this device by evaluating the puncture site of the artery with echography and other diagnostic techniques before the insertion of a sheath.

Teaching evaluations have been performed since 2002 in the Faculty of Medicine, Tottori University. The effects of evaluations over a 3-year period were assessed, and free comments obtained from students were analyzed with the textmining method to identify factors affecting students' satisfaction. A total of 566 lectures given in undergraduate courses were evaluated, and 33, 751 questionnaires were collected for a recovery rate of 74%. The collected questionnaires included 2495 free comments. Each free comment was parsed word by word, and the nouns, adjectives, adverbs, and verbs were selected as key words. The scores for almost all questions on the questionnaire for the 2003 school year were significantly higher than those for the 2002 school year. However, no difference was found between the scores of the 2003 and 2004 school years. Analysis of the free comments suggested that a well-understood lecture improves student satisfaction and that teaching materials, such as handouts and slides, play an important role in the positive evaluation of lectures. The percentage of lectures receiving poor evaluations (scores less than 3) decreased yearly. This finding suggests that teaching evaluations are effective in helping faculty members with low scores to improve their lectures.

A study was performed to elucidate the effect of physical training on the cold tolerance in human beings. Physically well trained men (T group) and untrained ones (U group) were exposed to cold stress in summer and winter. Each subject was dressed in experimental clothes and exposed to 10°C DB for 60 minutes in both seasons. Moreover, he was exposed in the semi-nude to 20°C DB in summer and to 17°C DB in winter for 60 minutes. During the period of exposure to cold, rectal and mean skin temperatures and respiratory metabolic rate were measured. To confirm the training effect further, the untrained men were asked to follow an experimental training program of daily routine which consisted of about 7 km outdoor running for 40 consecutive days in July and August. Before and after the training, they were exposed to the same cold stress as in the aforementioned summer experiments and subjected to the same measurement. Resting metabolic rate was higher in the T group than in the U group. Although no significant group differences were shown in the metabolic rate during the period of exposure to cold, the rate of increase from the resting value was lower in the T group than in the U group. There were no group differences in rectal or mean skin temperature during this period. When the untrained men were subjected continually to physical training, the resting metabolic rate was higher and the rate of increase from the resting value during the period of exposure to cold lower after the training than before. It was concluded that physical training could be a means to increase the cold tolerance.

The present study was attempted to examine whether the cold-induced vasodilation is affected by maturation and aging. Twelve prepubertal boys (10-11 yrs), 15 young men (18-26 yrs), and 8 older men (66-78 yrs) immersed their middle finger in ice-water for 15 min under air condition of 27°C and 40% RH. Before the immersion, no age-related differences were observed in skin temperature of middle finger (T_fin) . The time required for the first rise of T_fin after the immersion (TTR) was significantly longer in the older men than in the boys and young men. T_fin at the first rise after the immersion (TFR), highest value of Tfin after the first rise (HST) and the mean value of T_fin during the immersion (MST) were significantly lower in the boys than in the young men. The integral value of T_fin from the onset of cold-induced vasodilation to the end of the immersion (CIVD_index) was significantly lower in the boys and older men than in the young men. TTR, TFR, HST, MST, and CIVD_ifldex did not correlate significantly with maximal oxygen uptake, mean skinfold thicknesses at seven body sites, and length and girth of the middle finger. Oral temperature (Tor) did not change between before and after the immersion regardless of age, although the Tar in the boys was significantly higher than in the young and older men. There were no age differences in the relationship of thermal sensation or pain sensation and T_fin. These results suggest that boys and older men have inferior cold-induced vasodilation compared to young men, and that the mechanisms of inferior cold-induced vasodilation are different in these two groups.

In this study, we investigated total sweat rate per unit area of body surface per hour (TSR), the percentage of total sweat loss to initial body weight (%TSL) and the percentage of fluid intake volume to total sweat loss (%FIV) in children (during baseball or basketball practice), young adults (during softball or baseball practice), and the elderly (during gateball practice) in summer. During the practice all participants were given access to drink sports drink or Japanese tea ad libitum. In the basketball group of children no sex difference was observed in TSR, %TSL and %FIV. Although TSR and %TSL in the baseball group of children were significantly higher than in the basketball group due to a higher WBGT, there was no group difference for %FIV. Children drank sports drinks (with carbohydrate-electrolyte) of the similar volume with total sweat loss. The baseball group of children showed a significantly greater %FIV compared to the young adult group regardless of simi lar %TSL, when they drank sports drinks. Children showed a significantly higher %FIV in sports drinks than in Japanese tea, whereas the %FIV of young adults was not affected by the type of beverage. The TSR, %TSL and %FIV of the elderly group were significantly lower than in young adults and children. These results suggest that children can prevent voluntary dehydration by con-suming sports drinks with carbohydrate-electrolyte ad libitum regardless of sex and WBGT, and that periodic drinking should be actively encouraged for the elderly because of their blunted rehydration ability, to prevent heat disorders during sports activity in summer.

The guidelines for the prevention of heat disorders during sports activities were established 13 years ago in Japan. Since then, various studies on preventive measures against heat disorders have been done, yielding new knowledge about its prevention. It has been reported that the incidence of heat disorders is high in children and the elderly, and heat acclimatization and clothing are the factors involved in this disorder. We proposed to lower the WBGT (wet-bulb globe temperature) limit for warning (discontinuation of hard exercise) from “28°C or more” to “25°C or more” (corresponding to an ambient temperature of 28°C) for non-acclimatized persons, children, the elderly, and persons wearing clothes covering the entire body. We also indicated that heat disorders can occur due to unpredictable causes, because the mechanism is very complicated.

STUDY DESIGN: Prospective comparative study. PURPOSE: To compare the incidence and severity of adverse reactions associated with myelography performed in outpatients vs. in inpatients and report the safety and usefulness of outpatient myelography in Japanese patients. OVERVIEW OF LITERATURE: Myelography is normally performed as an inpatient procedure in most hospitals in Japan. No studies have reported the usefulness and adverse effects of outpatient myelography in Japanese patients. METHODS: We performed 221 myelography procedures. Eighty-five of the 221 patients underwent outpatient myelography using our new protocol. The incidence and severity of adverse reactions were compared with the other 136 patients, who underwent conventional inpatient myelography. We further compared the cost of outpatient and inpatient myelography. RESULTS: The overall rate of adverse effects was 9.4% in outpatients, as compared with 7.4% in inpatients. Overall, 1.2% of outpatients and 0.74% inpatients experienced "severe" adverse effects (requiring hospitalization). There were no significant differences between the 2 groups in either the overall rate of adverse effects or the rate of "severe" adverse effects. Moreover, the average outpatient procedure cost was only one-third to one-half that of the inpatient procedure. CONCLUSIONS: This was the first study to address the safety and usefulness of outpatient myelography in Japanese patients. If selected according to proper inclusion criteria for outpatient procedure, no significant differences were observed in the adverse effects between inpatients and outpatients. The outpatient procedure is more economical and has the added benefit of being more convenient and time-efficient for the patient.
Asian Continental Ancestry Group ; Health Care Costs ; Humans ; Incidence ; Inpatients* ; Japan* ; Myelography* ; Outpatients* ; Prospective Studies*

A 67-year-old man was admitted to our hospital with a complaint of heart failure. He had a 12-year history of chronic renal failure and hemodialysis. Coronary angiography confirmed the presence of a saccular aneurysm originating from the calcificated left main trunk with coronary artery stenosis. The aneurysm was successfully treated by saphenous vein patch repair of the orifice and coronary revascularization of the left anterior descending and circumflex arteries. A histological examination of the aneurysm wall demonstrated coronary artery dissection. Postoperative coronary angiography 2 weeks after surgery revealed no evidence of residual aneurysm and showed patent bypass grafts.