The purpose of the present study was to determine the change in total excess volume of CO₂output (CO₂excess) due to bicarbonate buffering of lactic acid produced during exercise and change in swimming performance following resistance training for 8 weeks in competitive swimmers. Ten healthy university competitive swimmers were assigned to either a resistance training and swimming training group (COMBINE: N=5) or a swimming training only group (SWIM: N=5) . Muscle mass was measured using magnetic resonance imaging (MRI) . CO₂excess and blood lactate concentration were measured during incremental exercise on a cycle ergometer and swimming performance was measured during competition. COMBINE showed a significantly higher percentage change in muscle mass (11.1±4.5%) than SWIM (3.5±2.5%) . The percentage change in CO₂excess, CO₂excess per body weight (CO₂excess/BW) and CO₂excess/BW per blood lactate accumulation (CO₂excess/BW/ΔLa) during exercise was significantly higher in COMBINE (107.3±60.1, 102.6±56.8, 59.1±37.7%, respectively) than in SWIM (42.5±10.0, 42.9±10.4, 13.4±22.4%, respectively) . The percentage change in swimming performance was significantly higher in COMBINE (2.2±1.8%) than in SWIM (-2.0±3.6%) . A negative correlation between percentage change of muscle mass and percentage change of CO₂excess/BW/ ΔLa (SWIM: r=-0.993, P<0.01, COMBINE: r=-0.744, P>0.05) was found. It was suggested that combined swim and resistance training resulted in greater increases in the bicarbonate buffering system (CO₂excess/BW/ΔLa) . However, increases in muscle mass may have subsequently caused a relative decrease in the contribution of the bicarbonate buffering system.

　　The purpose of this study was to elucidate the effects of “shoulder girdle training” that is used to correct scapular muscle imbalance. We investigated 100 shoulders in 50 healthy volunteers free of any complaints related to the shoulder joint. In the posture for performing the infraspinatus test, male volunteers held a 5-kg load and female volunteers held a 3-kg load for 3 s thrice, and the muscular activity of the trapezius muscle was simultaneously measured. Next, shoulder girdle training was performed for 5 s twice, followed by muscle activity measurement in the same manner described above. Muscle activity levels before and after this training and also between the dominant and non-dominant sides were compared. The shoulder girdle training significantly reduced the level of muscle activity of the upper fibers of the trapezius muscle and significantly increased the level of muscle activity of the middle and lower fibers of the trapezius muscle (both p<0.05). Moreover, the levels of muscle activity of the upper, middle, and lower fibers of the trapezius muscle were significantly higher on the dominant side than on the non-dominant side (p<0.05).

　　Rotator cuff repair provides favorable outcomes for range of motion of the shoulder joint and repair of the cuff. However, we often have patients for whom shoulder elevation is difficult due to failure to improve shoulder shrugging motion. This study investigated how the shoulder shrugging motion affects activity patterns of the muscles surrounding the shoulder joint. Subjects were 50 shoulders in 50 young healthy volunteers free from shoulder joint complaints (27 men, 23 women; mean age, 26.3±4.3 years). The subjects were placed in the lateral position with the dominant arm facing upwards and suspended with a sling. They performed two types of movements: forward elevation of the arm with no particular instructions (group N) and forward elevation combined with shoulder shrugging (group S). Simultaneously, the activity of the anterior, middle, and posterior fibers of the deltoid muscle and of the upper, middle, and lower fibers of the trapezius muscle of the dominant upper limb were measured by surface electromyography and compared between the two groups. In the trapezius muscle, upper fiber activity was more enhanced in group S than in group N, whereas lower fiber activity was more strongly suppressed in group S. However, the anterior and middle fiber activity of the deltoid muscle was more strongly suppressed in group S than in group N. Thus, it was observed that an elevation pattern with shoulder shrugging reduces the strength of forward flexion.

Objective: To develop and confirm the validity of a Biological Prognostic Score using only blood test results for prediction of prognosis in patients with advanced cancer. Methods: We conducted parametric survival time analysis using blood test results, age, sex, and primary diagnosis as independent variables, and event of death as a dependent variable, among patients in a palliative care unit (a development cohort). We then developed the Biological Prognostic Score (BPS). Thereafter, we confirmed the accuracy of the BPS and the Palliative Prognostic Index (PPI) prospectively among patients, who withdrew or withheld further curative or life-prolonging therapies, in other facilities (a validation cohort). Results: We developed the BPS, which consists of cholinesterase, blood urea nitrogen, and total iron-binding capacity, from 122 patients in a development cohort. We then examined 195 patients in a validation cohort and found that the area under the receiver operating characteristic curve for 1-9 week survival prediction was BPS=0.76-0.86 and PPI=0.69-0.73. Discussion: Our results suggest that the BPS was valid. It will be necessary to perform further examinations in multiple facilities and to explore more generalized parameters that could replace total iron-binding capacity in our BPS.

Objectives: We developed versions 2 and 3 of the Biological Prognostic Score (BPS) for advanced cancer patients and confirmed the prediction accuracy. Methods: We conducted a parametric survival analysis using blood test data, performance status (PS), clinical symptoms, age, sex, and cancer type as variables for advanced cancer patients who completed or suspended cancer treatment, in the development of BPS2 and BPS3. We then prospectively compared the accuracy between BPS2/BPS3 and the Palliative Prognostic Index (PPI). Results: We developed the BPS2 and BPS3 based on the data from 589 patients in a development cohort. While the former version was calculated based on the cholinesterase, blood urea nitrogen, and white blood cell counts, the latter was calculated based on the BPS2, ECOG PS and edema. For 206 patients in a validation cohort, the overall accuracy in prediction of survival for 3 and 6 weeks using the BPS2 and BPS3 were significantly higher than those for the PPI. Conclusion: The usefulness of BPS2 and BPS3 was suggested.

[Introduction] In 2006 the WHO and WPRO agreed on standard acupuncture point locations. To promotepagate these standards, in 2009 the Second Japan Acupuncture Standardization Committee published a Japanese edition of 'WHO STANDARD ACUPUNCTURE POINT LOCATIONS FOR THE WESTERN PACIFIC REGION.' Based on this Japanese edition, a new textbook was published by the Japan Association of Massage & Acupuncture Teachers and the Japan College Association of Oriental Medicine. Since one year has passed since the start of education based on standard acupuncture point locations at Japanese universities, colleges, vocational schools and training centers for anma (Japanese traditional massage), massage, and shiatsu (acupressure); acupuncture; and moxibustion therapies, we administered a questionnaire survey as an evaluation of international standardization and the problems of introducing standard acupuncture point locations .
[Subjects and methods] Subjects were mainly teachers and included a small number of researchers, clinicians, and other groups concerned with acupuncture and moxibustion. We used a questionnaire that we originally created at the Second Meeting of the Japan Standardization of Acupuncture Point Locations Committee.
[Results] Among the 180 institutions surveyed, we obtained answers from 149 people from 93 institutions in total. Agreement on the question of standard acupuncture points, "functional existence" (44.3%) was most common, and "anatomical existence" came next at 26.6%. For the question on acupuncture treatment, 82.4% replied with "use ofboth acupuncture points and reaction points." For the answers to agreeing with international standardization, "no opinion" was 41.7% and 51.7% for "appreciate." However, both of those groups appreciated globalization of acupuncture and moxibustion by a common　language. There were many opinions on proportional bone measurement. Specifically, opinions indicated a change "from the cubital crease to the wrist crease" (from 10B-cun to 12B-cun) and a need for proportional bone measurement of the upper arm. Whereas, for individual acupuncture points, opinions expressed the difficulty of locating application points and not understanding reasons for change and notations including body surface segments.
[Discussion] We were able to classify the opinions collected into the following groups: (1) problems that can be corrected immediately, including typographic errors, (2) problems that need to be reviewed at the next international gathering, and (3)problems that need to be understood by making full use of related documents.
[Conclusion] We were able to determine primarily for a wide range of teachers, problems understanding individual acupuncture point locations, including consideration of acupuncture points, evaluation of standardization of acupuncture point locations, and other guidelines

STUDY DESIGN: Retrospective study. PURPOSE: We conducted a study to investigate the time course changes in bone metabolic markers after the administration of the anti-receptor activator of nuclear factor-kappa B ligand (RANKL) antibody and to assess drug compliance among osteoporotic patients. OVERVIEW OF LITERATURE: The anti-RANKL antibody is expected to provide an improvement in those with a bone metabolism disorder. However there are only a few clinical reports available on the effect of treatment. METHODS: We included 40 post-menopausal osteoporotic patients who received the anti-RANKL antibody. To determine the time course changes in the bone metabolic markers, we measured the serum tartrate-resistant acid phosphatase 5b (TRACP 5b; a bone resorption marker) and the serum N-terminal propeptide of type 1 collagen (P1NP; a bone formation marker) levels prior to and 1 month after administrating the anti-RANKL antibody. To evaluable drug compliance, we assessed the dropout rate during treatment and at 6 months after treatment. RESULTS: The average TRACP 5b level significantly decreased from 574.8 mU/dL before treatment to 153.2 mU/dL 1 month after treatment (p<0.05). There was no significant difference in the average P1NP level, which was 56.9 microG/L and 35.1 microG/L before and 1 month after treatment, respectively (p>0.05). As for drug compliance, we did not have any dropouts during the treatment or after 6 months (dropout rate: 0%). CONCLUSIONS: Our study suggests that anti-RANKL antibody treatment suppresses bone resorption and maintains bone formation.
Acid Phosphatase ; Bone Resorption ; Collagen Type I ; Compliance* ; Humans ; Metabolism ; Osteogenesis ; Osteoporosis* ; Patient Dropouts ; RANK Ligand ; Retrospective Studies

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Background/Aims: We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE. Methods: Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points. Results: The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon’s signed-rank test). Conclusions In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102)