Muscle tenderness or stiffness is generally attributed to local muscle spasm or aggravated tonus however electro-myographic studies have indicated no spontaneous discharge as usual and any kind of change of N M U weve patterns, certainly. There is a great deal of uncertainty about the fundamental chracter, identified factor of these conditions.
To analize (_??_-S curves) -the mean inteerval (_??_) of the single unit NMU discharges and the standard deviation (S) of the same it was learned that these phenomena could be classified into two types of muscle activities, the one is kinetic activity (K-curve) and the other is tonic one (T-curve) so to speak. We conducted examinations concerning about the character of the notor unit activity of the trigger point in low back pain patient with _??_-S relation. In comparison with the distribution of (_??_-S) of the low back pain patient group (14 patients, 295 units) and that of the control group most (_??_) was up to about 120 msec. with (S) relatively stable, an almost horizontal distribution along the x-axis with an increase when (_??_) was any larger.
As compared to this, in most examples in the lumbago group (_??_) was horizontally up to 120 msec. after which a gradual rise xas indicated. The various distributions showed that that of the lumbago group was moved to the right of the awis of co-ordination as was the recovery line. Consequently, we observed that the NMU discharges of the trigger point in low back pain patients showed more tonic activity than that of normal subjects. And this finding strongly indicates that voluntary muscular activity in trigger points is under the predominant influence of spinal motoneuron than homonymous neuron segmentally.

A 50-year-old man was diagnosed as having aortic valve insufficiency, complete occlusion of the right coronary artery and 75% stenosis of the left main trunk due to syphilitic aortitis. Aortic valve replacement and coronary artery bypass grafting to three vessels were successfully performed. The selection of surgical procedures for the coronary lesion with syphilitic aortitis should be made carefully, since the progression of aortic root inflammation in the acute phase and the development of atherosclerotic changes are not preventable in the future. It is most important to select effective and safe surgical interventions, especially for patients with such a low cardiac function as our patient.

Surgical mortality associated with ruptured abdominal aneurysm remains high, especially in elderly patients, despite recent progress in improved patient management. We present the successful salvage of a 90-year-old woman with ruptured abdominal aortic aneurysm. She was transferred from another hospital because of severe abdominal and back pain and pulsatile abdominal tumor. One hour after admission, shock suddenly developed. We diagnosed her illness as ruptured abdominal aneurysm on enhanced CT scan. Emergency surgery was performed. The hematoma surrounding the aneurysm occupied the retroperitoneal space below the level of the diaphragm (Fitzgerald III). Aortic cross clamp was quickly performed below the level of the diaphragm approaching from the lesser omentum. After controlling bleeding, the site of the aortic cross clamping was changed to the infrarenal aorta. The aneurysm was resected and replaced by a knitted Dacron Y-graft (albumin coated). Duration of surgery was 5 hours and 5 minutes. Blood loss was 6200ml. After surgery, artificial ventilation was required for ten days to avoid hypoxemia. On the 5th postoperative day disseminated intravascular congulation (DIC) developed but she recovered. On the 30th postoperative day, she was discharged. Advanced age may not be an absolute contraindication for surgical treatment even in cases of rupture.

Background: Development in internet technology enables e-learning at the higher education level. We have developed the Internet PBL-Tutorial System/Rakuichi that allows multi-directional communication among participants with web-based bulletin boards. Although this system has been successful in medical education at the undergraduate level, we sought to encourage “readonly members” to participate more fully in the program. Methods: To this end, we compared the posting frequency among three strategies: (1) students and tutors had an off-site meeting to promote face-to-face communication during the course, (2) several classes were allowed to watch the discussion in other classes in the second half of the course, (3) three classes (5 – 6 students each) in one topic were combined into one class (16 students) in the second half. Results: No meaningful effects were observed for strategies (1) or (2). However, the posting frequency increased 50 % for strategy (3). Conclusion: Facilitation of communication among participants was achieved by increasing the number of student participants. We predicted that an optimal number of students in each class in internet-based PBL would be ~20 people.

This study investigated the effects of exercise intervention with a 12-week slightly-weighted shoe on lower-limb skeletal muscle and gait patterns in the elderly. A total of 29 healthy elderly Japanese who had irregular walking habits were randomly assigned to either slightly-weighted-shoe (WS group, n = 14; Age, 70.6 ± 5.7 years; WS, 493 g) or normal-shoe (NS group, n = 15; Age, 69.3 ± 6.9 years; NS, 293 g) intervention groups. The participants were instructed to maintain their normal daily physical activity (PA) during the intervention period. Segmental intracellular water (ICW) and muscle thickness (MT) were measured as an index of skeletal muscle mass in the lower limb, and kinematic gait data were acquired by motion analysis. Walking stability was assessed as a standard deviation of the vertical fluctuation in whole-body center of mass (COM fluctuation). The daily PA was monitored using an accelerometer and an activity record. ICW in the upper leg and MT of rectus femoris increased significantly in the WS group compared with the NS group (ICW: 13.8% vs. 2.2%, MT: 12.1% vs. 1.3%), while COM fluctuation was significantly reduced in the WS group (p<0.05) during normal walking. The present study demonstrated that interventions with a slightly-weighted-shoe may be able to increase muscle volume in the upper leg and change gait patterns in the healthy elderly.

The Research Committee for the Meridian Point held its third workshop at the 57th Annual Meeting of the Japan Society Acupuncture and Moxibustion in Kyoto. Evaluations and reports were presented on two topics.

The first topic:Study of PSC in Japan and China.
1) Literature search on PSC in China (Wang):A literature search on major studies on PSC in China since 1979 was conducted. The report introduces the definition, characteristics and the mechanism of PSC development together with meridian phenomena.

2) PSC in reference to the ryodoraku (Morikawa):Development of the reactive ryodo point in patients under hemodialysis or those who have had a total gastrectomy and the cases in which reactive ryodo points or needle sensation developed when specific regions were stimulated were reported. The relationship between reactive ryodo points and PSC was examined.

3) The mechanism by which PSC develops (Yamada):Neurotransmitter substances are released from sensory nerve endings during acupuncture stimulation. Absorbed by lymphatic vessels, these substances stimulate the smooth muscle of these vessels, thus causing the PSC. Based on factors such as transmission velocity and inhibitory factors, the mechanism by which PSC develops was investigated.

The second topic:Specific locations of meridian points and clinical effects of the meridian point.
1) Anatomical regions for GB 30 huantiao (Ozaki and Matsuoka):In establishing the international standard for the meridian points under the guidance of WHO, both Chinese and Japanese proposals were listed for GB 30. The clinical effects-presumably emanating from the subcutaneous structure when acupuncture stimuli are applied to these points in a direction perpendicular to the body surface-were comparatively evaluated.

2) Transition in the regions and main effects of GB 30 (Sakaguchi):As stated above, both Japanese and Chinese definitions were cited in establishing the international standard for GB 30 under the guidance of WHO. By quoting the classic literature from China and Japan, changes in the regions and main effects of GB 30 were comparatively evaluated.

　To encourage the broad use of simulation-based medical education and establish partnerships to promote objective structured clinical examinations after clinical clerkship among medical teachers, we hosted the first team-based clinical skills competition event for medical students in Japan, named ‘Medical Students' Simlympic Games 2014'. Thirty-six (12 teams of three) open-recruited 5th or 6th grade medical students participated in this event. Student teams performed clinical tasks at 6 stations, which actively utilized the strengths of simulators or simulated patients. Contents, composition, difficulty level, and validity were tested by trainee doctors and examined by committee members in advance. In this report, we describe our concept, executive committee formation, a variety of arrangements, the outline on the day of the event, and the results of a questionnaire targeting participants. (126 words)

In a consecutive series of abdominal aortic aneurysm repairs, a non-washing autotransfusion unit system was used in 47 patients, and was not used in 25. In the 47 patients treated with the autotransfusion unit, the average amount of autotransfused blood was 1, 109±131ml in elective cases. The amount of banked blood transfusion was significantly smaller in autotransfused patients (mean; 712ml), compared to non-autotransfused patients (mean; 1, 405ml). Postoperative levels of serum bilirubin were higher in patients with greater autotransfused blood volumes than those with smaller volumes. The combination of preoperative autologous blood donation (2-3 units) and intraoperative autotransfusion is necessary to perform abdominal aortic aneurysm repair without homologous blood transfusion.

A 74-year-old man was admitted to our hospital to undergo an operation for distal aortic arch aneurysm with chronic aortic dissection. The first operation was attempted through left lateral thoracotomy. Since the aorta had a severely calcified false lumen, conventional aortic replacement was considered to entail greater risk and graft replacement was given up. As an another option, endovascular stent grafting via the aortic arch through median sternotomy was selected as a second operation. Deep hypothermic circulatory arrest with selective cerebral perfusion was used during delivery and deployment of the stented graft through the aortotomy site. The distal stented graft was deployed into the true lumen at the ninth thoracic vertebral level. Neither endoleaks nor complications were observed. Postoperative computed tomography showed complete thrombosis of the distal aortic arch aneurysm and the false lumen. The postoperative course was uneventful. Transaortic endovascular stent grafting is an effective and less invasive treatment for aortic arch aneurysms with severely calcified aorta.

Six members of the Research Committee for the Meridian Point (former Committee for the Meridian Point) reported on three themes regarding meridian and acupuncture point at Workshop II of the 54th Science Rally of The Japan Society of Acupuncture and Moxibustion held in Fukuoka.
1st theme : Anatomical examination of the meridian and meridian point.
1) Anatomic structure showing path and meridian running. (Kenji Matsuoka) : Similarity of meridian pathway and course of nerve and blood vessels in cadaver.
2) Gross anatomical study of meridian and acupuncture point in upper limbs (Kansho Yamada) : Doctoral study of Katsuyosi Toyoda, former Nagoya City University School of Medicine researcher and Yamada's study (Relation between running of meridian & acupuncture point and subdermal nerve & blood vessels) were reported.
2nd theme : Study of acupuncture safety depth in Japan and China.
1) Research and progress situation of acupuncture safety depth in China. (WANG Cai Yuan) : Data of Yan Zhenguo, professor of anatomy at Shanghai University of Traditional Chinese Medicine, an authority on the study of acupuncture safety depth and progress situation of recent study of acupuncture safety depth in China.
2) Retrospective study of acupuncture safety depth (Tomofumi Ozaki) : Study of acupuncture safety depth published by Ozaki to date and comparative study alongside Prof. Yan Zhenguo data.
3rd theme : Examination of clinical effect of a few meridian points.
1) Acupuncture clinical effect using a few meridian points (Syunji Sakaguchi) : Paper research and analysis of acupuncture clinical effects using 1-4 meridian points of Japana Centra Revuo Medicina.
2) Inflence on skin energizing current by various acupuncture stimulation of LI4 (Gokoku) (Kazuhiro Morikawa) : Influence on the amount of skin energizing current by acupuncture stimulation, direct current electricity stimulation and stimulation of electroacupuncture to LI4.