1. The effect of thyroidectomy on histochemical properties of the extensor digitorum longus and soleus muscles was studied in rats. Two or 13 months after thyroidectomy animals were killed and muscle sections of 10μm thickness were stained for succinate dehydrogenase and myosin adenosine triphosphatase activities.
2. No significant difference of the body weight was found between the thyroidectomized and sham-operated control groups. There was also no significant difference in the muscle weight between the two groups except that 13 months after thyroidectomy the soleus muscle weight was significantly lower in the thyroidectomized group than in the sham-operated control group.
3. The measurement of muscle fiber diameter revealed that fast-twitch oxidative glycolytic fibers of the soleus muscle were smaller in the thyroidectomized group than in the sham-operated control group two or 13 months after thyroidectomy.
4. The percentage of fast-twitch fibers decreased significantly after thyroidectomy with a concomitant increase in the percentage of slow-twitch fibers in both the extensor digitorum longus and soleus muscles. This finding suggests the involvement of thyroid hormone in determining a phenotypic expression of muscle fiber type.
5. The results show that thyroidectomy-induced changes differ not only between the extensor digitorum longus and soleus muscles but also between same types of fibers from the two muscles. The results also indicate that thyroidectomy-induced changes depend on the period after thyroidectomy.

Postnatal changes of myosin light chain patterns and enzyme activities were examined in the fast extensor digitorum longus and slow soleus muscles of Wistar strain rats aged 5, 10 and 20 weeks. Sex differences in each parameter were also studied.
The results were summarized as follows:
1) The extensor digitorum longus muscle contained mostly the fast light chains (fLC 1, fLC 2, fLC 3) . However, small amounts of the slow light chains (sLC 1, sLC 2) were also found. There were no postnatal changes in myosin light chain patterns in the extensor digitorum longus muscle.
2) The soleus muscle contained slow and fast light chains (sLC 1, sLC 2, fLC 1, fLC 2, fLC 3) in 5 weeks of age, slow light chains being more predominant than fast light chains. There were an increase in the percentage of slow light chains and a concomitant decrease in the percentage of fast light chains with age. FLC 3 which was found at 5 weeks of age did not be detected in the soleus muscle from the 20-week-old rat.
3) PFK activity decreased significantly with age in the soleus muscle, whereas there was no postnatal changes in PFK activity in the extensor digitorum longus muscle.
4) There was a significant increase in SDH activity during growth in both the extensor digitorum longus and soleus muscles with the exception of the extensor digitorum longus muscle from the male rat.
5) The enzyme activity ratio (PFK/SDH) significantly decreased with age in all muscles with an exception of the extensor digitolum longus muscle from the male rat.
6) In the soleus muscle an increase in the relative amount of slow type myosin light chains and a decrease in the enzyme activity ratio (PFK/SDH) occurred coincidentally during postnatal growth.
7) In most cases no significant sex differences existed in myosin light chain pattern and enzyme activity examined.

Sex difference in enzyme activities of the skeletal muscle were examined in rats aged 10 and 35 weeks. At 10 and 35 weeks of age, animals were anesthetized with ether and weighed. M, gastrocnemius, m.extensor digitorum longus and m.soleus were removed from both legs under pentobarbital anethesia and weighed. These muscles were used for the determination of myosin ATPase activity, phosphofruktokinase (PFK) activity, succinate dehydrogenase (SDH) activity and non-collagenous protein (NCP) content.
The results were summarized as follows:
1) Thirty-five week-old rats had heavier body and muscle weights than 10-weekold rats in both sexes and males had significantly heavier body and muscle weights than females at both 10 and 35 weeks of age.
2) Similar tendency was observed with regard to total NCP content. Furthermore, it was found that total NCP content was positively correrated to muscle weight (r=0.871, r=0.909 and r=0.871 in m. gastrocnemius, m.extensor digitorum longus and m.soleus, respectively) . However, no significant difference in NCP content per wet weight was found between both sexes and between different age groups.
3) Myosin ATPase activity tended to be lower at 35 weeks of age than at 10 weeks of age, the tendency being the most prominent in the gastrocnemius muscle of male rat (p<0.05) . However, no significant sex difference in myosin ATPase activity was observed in three muscle examined in both age groups.
4) Although not statistically significant, mean PFK activity was slightly lower in 35-week-old rats than in 10-week-old rats, and there was no sex difference in PFK activity at both weeks of age.
5) SDH activity was significantly lower in 35-week-old rats than in 10-week-old rats except that there was no significant age difference in the gastrocnemius muscle of males. There was no significant sex difference in SDH activity in both age groups with an exception of the extensor digitorum longus muscle from 35-week-old rats, where males had significantly higher SDH activity than females.

Myosin light chain patterns were examined in single fibers from the extensor digitorum longus (EDL) and soleus muscles of Wistar strain rats. The fiber type composition of both muscles was also determined to estimate the relationship between myosin light chain patterns and histochemical fiber types.
The results were summarized as follows ;
1. All of single fibers from the EDL muscle was typical fast type which contained fast light chains only (fLC 1·fLC 2·fLC 3), except that there was one mixed type fiber cotaining both fast and slow light chains (fLC 1·fLC 2·sLC 1·sLC 2) .
2. There were two myosin light chain patterns in single fibers from the soleus muscle. One was typical slow type which contained slow light chains only (sLC1·sLC 2) and the other, mixed type in which fast and slow light chains coexisted. Mixed type fibers were divided into eight groups based on the light chain composition. The percentage occurence of typical slow type and mixed type fibers was 35.4% and 64.6%, respectively.
3. The average percentage of type II fibers was 94.6% in the EDL muscle 5.4% in the soleus muscle.
4. These results suggest that both fast and slow skeletal muscles contain mixed type fibers. The results further imply that in slow skeletal muscle, myosin light chain pattern of mixed type occurs not only in type II but also in type I fibers.

Introduction
 On 8 March 2009, the Workshop on Infectious Diseases Control Programmes and Health System Strengthening (HSS) was conducted in the 24th East Japan Regional Conference of the Japan Association for International Health. This article reports the discussion in the Workshop and the internet-based open forum that followed.
Method
  After four presentations reflecting on the field-based experiences regarding the relation between disease-specific programmes and HSS, following three aspects were discussed: 1) health system-wide barriers perceived through the implementation of disease-specific programmes; 2) shortcomings of the disease-specific initiatives in light of the HSS; and 3) how the disease-specific initiatives can contribute to the HSS.
Results
 As the system-wide barriers, insufficient quantity and quality of health human resources, lack of health infrastructure and material resources and limitation of the technology applicable to community level of developing countries were commonly perceived. Shortfall of disease-specific programmes in light of the HSS included the lacked coordination between different programmes and donors, duplicated heavy workload put on community health workers especially in recording and reporting, dissociation between local health needs and programme priorities, lack of contributions to strengthening mid-level health administration, deviation of resources to the priority programmes and lack of sharing of potentially sharable material resources. It was proposed that the disease-specific initiatives should contribute to resource mobilization, programme management models, capacity building of mid-level health administration, supplementing personnel cost and presenting hardware and software outcome resources to the HSS.
Conclusions
 The disease-specific initiatives need to pursue the above mentioned practical contributions to the HSS. At the same time, a wider scope addressing political and policy-wise justifications of the form of the overall health system needs to be further discussed with developing countries stakeholders.

The combined superior transsseptal approach (CSTA) has been used for 12 mitral or left atrial myxoma operations. This approach provided excellent exposure of the mitral valve or myxoma. This approach was compared with the transseptal and left atrial approaches in 1 and 3 cases, respectively. There were no differences in operative time, cardiopulmonary bypass time, anoxic time, bleeding volume, blood transfusion volume and postoperative arrhythmic complications. We use CSTA for cases with tricuspid valve disease, small left atrium, reoperation and left atrial myxomas.

PURPOSE: Comatose elderly patients with acute neurological illness have a great risk of deep vein thrombosis (DVT). In this study, the incidence of DVT and the effectiveness of early initiation of treatment were evaluated in those patients. MATERIALS AND METHODS: Total 323 patients were admitted to our ward due to neurological diseases in one year, and 43 patients, whose Glasgow Coma Scale was < or =11 and who was older than > or =60 years, were included in this study. D-dimer was measured on admission and day 7, and lower-extremity ultrasonography was performed on day 7. When DVT was positive, heparin treatment was initiated, and further evaluation of pulmonary embolism (PE) was conducted. Vena cava filter protection was inserted in PE-positive patients. Incidence of DVT and PE, alteration of D-dimer value, and effect of heparin treatment were analyzed. RESULTS: DVT was positive in 19 (44.2%) patients, and PE was in 4 (9.3%). D-dimer was significantly higher in DVT-positive group on day 7 (p<0.01). No DVT were identified in patients with ischemic disease, while 66.7% of intracerebral hemorrhage and 53.3% of brain contusion patients were DVT positive. Surgery was a definite risk factor for DVT, with an odds ratio of 5.25. DVT and PE disappeared by treatment in all cases, and no patients were succumbed to the thrombosis. CONCLUSION: Patients with hemorrhagic diseases or who undergo operation possess high risk of DVT, and initiation of heparin treatment in 7 days after admission is an effective prophylaxis for DVT in comatose elderly patients without causing bleeding.
Acute Disease ; Aged ; Anticoagulants/adverse effects/therapeutic use ; Antifibrinolytic Agents/therapeutic use ; *Coma ; Female ; Fibrin Fibrinogen Degradation Products/therapeutic use ; Hemorrhage/*epidemiology ; Heparin/adverse effects/therapeutic use ; Humans ; Incidence ; Japan/epidemiology ; Lower Extremity ; Male ; Middle Aged ; Nervous System Diseases/epidemiology ; Neurosurgical Procedures/*adverse effects ; Pulmonary Embolism/*complications/epidemiology/prevention & control ; Risk Factors ; Venous Thrombosis/epidemiology/*etiology/prevention & control

We present a rare case of a patient who underwent complete microendoscopic excision of an osteoid osteoma, which induced radiculopathy without nerve root compression. A 20-year-old man presented severe right groin pain that was temporarily relieved by nonsteroidal anti-inflammatory drugs. A computed tomography (CT) scan showed typical features of a nidus located in the inferior cortex of the right L3 pedicle. We performed surgery using a posterior microendoscopic approach. We drilled vertically along the line of the cortex of the caudal pedicle using a high-speed drill. After identifying the tumor, en bloc resection of the nidus was achieved. Immediately after surgery, pain in the right groin disappeared. A CT scan showed that most of the right L3 pedicle remained. This minimally invasive technique preserves spinal structures, including the facet and pedicle, and is a viable option for the treatment of spinal osteoid osteomas located close to vital structures.
Groin ; Humans ; Osteoma, Osteoid* ; Radiculopathy ; Spine* ; Tomography, X-Ray Computed ; Young Adult

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*