The purpose of this study was to investigate differences between underwater and land-based exercise in leg muscle activity. Nine healthy males (mean age : 21.7±0.5 years, mean height : 173.4±2.2 cm) had electrodes placed on their left leg muscles (Tibialis Anterior ; TA, Medial Gastrocnemius ; MG, Soleus ; SOL, Rectus Femoris ; RF, and Biceps Femoris ; BF), and their muscle activity was measured during various exercises. The subjects performed six types of exercise such as the forward walk, backward walk, squat, calf raise, leg range, and one leg wave, both in the water (waist level) and on land. These exercises were categorized as 3 types of leg movement according to direction ; horizontal, vertical, and mixed movement.
In the forward walk and backward walk, categorized as horizontal movements, the integrated electromyogram (IEMG) significantly increased during underwater exercise compared with on land. In the squat, as a vertical movement, the IEMG showed a similar change under both conditions. In the calf raise, as a vertical movement, and leg range and one leg wave, as mixed movements, the IEMG significantly decreased during underwater exercise compared with on land. These results suggest that leg muscle activity during underwater exercise is different based on the movement direction of the legs. In a word, it was apparent that movement in a horizontal direction underwater provides greater activity for leg muscles than on land; but movement in a vertical and/or mixed direction underwater provides less activity for leg muscles than on land. In prescribing an exercise program, it may be helpful to understand the differences between underwater and land-based exercise in leg muscle activity.

To investigate the effect of intense exercise on immunological factors in saliva, we measured secretory immunoglobulin A (sIgA), lactoferrin and fibronectin. We used a reliable saliva collection method that has already been reported. Timed saliva samples were obtained from 16 healthy young males. Samples were collected before, immediately after, 1 day after and 5 days after endurance running (42.195 km) . The concentrations (μg/ml) of sIgA, lactoferrin and fibronectin were measured by ELISA, and the secretion rates (μg/min) of each were calculated. Immediately after the exercise, the concentration of total protein in saliva increased significantly, but the sIgA secretion rate decreased to 53%. The secretion rates of both lactoferrin and fibronectin did not change significantly. The local immune system plays an important role in mucosal surface defense against upper respiratory tract infection. The sIgA level in the oral cavity was temporarily decreased after intense exercise. A decreased sIgA secretion rate might partly explain the increased susceptibility to upper respiratory tract infection after endurance exercise.

The purpose of this study was to investigate the relation between alterations of salivary secretory immunoglobulin A (SIgA) and the occurrence of upper respiratory tract infections (URTI) in rugby football players.We examined the relationship between the onset of URTI and the daily alterations of SIgA levels in 32 male collegiate rugby football players (20.5±1.3 years) during summer training camp for 36 days.Total of 6 in 32 subjects had the appearance of URTI symptoms (18 %). SIgA secretion rate decreased significantly in the middle of training camp compared to the baseline (P＜0.05). Furthermore, SIgA secretion rate during the appearance of URTI (13.7±1.1μg/min) were significantly lower than that without symptoms (19.2±1.4 μg/min, P＜0.01). These results suggest that serial monitoring of SIgA may be useful to assess the risk status of URTI affection in athletes.

The patient was a 74-year-old woman who had undergone mitral valve replacement with a mechanical valve for rheumatic mitral valve stenosis at age 60. She was scheduled for aortic valve replacement for severe aortic stenosis. However, she had significantly worsening anemia before the operation. Capsule endoscopy showed angiodysplasia with bleeding in her small intestine, which was considered the cause of the anemia. Because of progressive anemia, we tried embolization under angiography. However, there was no evidence of extravasation. Neither melena nor exacerbation of anemia was observed, and she underwent aortic valve replacement. She was discharged on postoperative day 22 without gastrointestinal bleeding. Heyde syndrome is aortic valve stenosis associated with gastrointestinal bleeding induced by von Willebrand disease and angiodysplasia in small intestine. Molecular multimeric analysis of von Willebrand factor and the existence of angiodysplasia with hemorrhage of the digestive tract are important for definitive diagnosis. Capsule endoscopy, which is a general examination, is more useful for diagnosis than molecular multimeric analysis of von Willebrand factor. Aortic valve replacement is the only therapeutic option for Heyde syndrome. It is important to decide the appropriate timing of AVR with cardiopulmonary bypass.

It is generally accepted that visually impaired individuals generally have a low aerobic capacity, which may be partly attributed to a lack of physical activity, and have hypothesized that their response to exercise may differ from that of normal-sighted people. In this study, we investigated the effect of exercise on local immunity in the oral cavity in 24 visually impaired males (n=8 ; totally blind group, n=16 ; partially sighted group) and 8 normal-sighted males. The subjects performed submaximal graded bicycle ergometer exercise to an intensity of 75% heart rate max for 12 min. Before and immediately after exercise, we collected timed saliva samples and measured secretory immunoglobulin A (sIgA) .
The totally blind group had lower levels of aerobic capacity and a lower sIgA secretion rate compared to the partially sighted and sighted groups. Immediately after exercise, the sIgA secretion rate tended to increase in the totally blind group.
It is suggested that the exercise-induced response of local immunity in the totally blind group differed from that in the other groups.

An investigation was performed about clinical histories before hospitalization in 1142 cases of gastric cancer during 16 years from 1969 to 1984.
The average term from onset of the disease to hospitalization was 4.53 months which tends to decrease becoming 3.49 months in the latest 5 years. The patients had visited 0.72 other doctor in average before coming to our hospital, 0.35 in early cancer cases and 0.83 in advanced cases. The sources of patients of our surgery were as follows ; 60.5% were introduced from medical department of our hospital, 20.2% were introduced from other clinics or hospitals, 10.6% visited our surgical department directly, and 8.7% came to us after visiting one or some other doctors. The rate of early cancer cases were high and unresectable cases were low relatively in cases from our medical department and direct visitors to our surgical department.
The causative factors of delay of hospitalization more than one month were considered from both sides of patient and doctor. The results were ; no delay 55.3%, delay due to patient's fault 28.2%, delay due to doctor's fault 19.9%. The delay of hospitalization due to either side's fault was one factor of decreasing early cancers and increasing advanced cases. Among those with no delay, however, 22.6% were unresectable cases. Gastric cancers are too malignant to be cured by visiting hospitals with complaints. Gastric mass survey among symptomeless people is the only reasonable way to come out of this difficult situation.

An 8 year-old boy had a cardiac murmur pointed out on day three after birth and was given a diagnosis of ventricular septal defect (VSD). He underwent VSD patch closure at two months after birth. He was also found the having Loeys-Dietz syndrome on the basis of mutation of TGFBR2 and physical examination at the age of 2 years. He had been followed up at pediatrics clinic of our hospital since then, and was hospitalized for a 46.5-mm extension of valsalva sinus diameter and moderate aortic insufficiency. The aortic valve was three-cusped and had no abnormality. We performed valve-sparing aortic root replacement. He was discharged on day 18 after the operation without any problems in the postoperative course. Use of an artificial heart valve for the surgery of the aortic root lesion in childhood will probably cause reoperation in the future and difficulty in Warfarin anticoagulation control. A careful decision is needed in the choice of an operation method. Valve-sparing aortic root replacement is a useful operation for patients without aortic valve abnormality.

Background : The Japanese Society for Dialysis Therapy in 2011 reports that the number of hemodialysis patients has been increasing and that there is an increase in long-term hemodialysis patients and the aging of hemodialysis induction. Therefore, it can be expected that the number of valve surgeries in chronic hemodialysis patients will increase. However, there are many problems between chronic hemodialysis and valve surgery. Objectives : To describe the results of valve surgery in chronic hemodialysis patients at our institution and evaluate the selection of prosthetic valve and associated problems. Methods : Between January 2001 and June 2011, a total of 29 patients on chronic hemodialysis including 3 patients for re-operation, underwent valve replacements. The average age was 67.3±9.3 years and 17 (65%) were men. The average dialysis duration was 7.9±6.4 years. The etiologies of renal failure were 8 for chronic glomerulonephritis (31%), 8 for nephrosclerosis (31%) and 3 for diabetic nephropathy (12%). Results : There were 2 (7.7%) in-hospital deaths, which resulted from ischemia of intestine and multiple organ failure due to heart failure. Twelve (46%) patients died during the follow-up period and the 5-year survival rate after surgery was as poor as another authors have reported previously (30.6%). However, the 5-year survival rate after hemodialysis introduction was 87.1%, which was better than the report of the Japanese Society for Dialysis Therapy in 2011 (60%). Average age was significantly higher in bioprosthetic valves than in mechanical valves (p=0.02). There was no significant difference in survival rate among mechanical and bioprosthetic valves (p=0.75). There was no significant difference in valve-related complication free rate among mechanical (27.5%) and bioprosthetic valves (23.4%) (p=0.9). Three patients with mechanical valves had cerebral hemorrhage, and 1 patient with bioprosthetic valve had structural valve deterioration. Conclusions : Surgical result of valvular disease in hemodialysis patients was as poor as another authors reported previously (5-year survival rate : 30.6%), but survival rate after hemodialysis introduction was not very poor (87.1%). There was no significant difference in survival rate among mechanical and bioprosthetic valves. Bioprosthetic valve has the risk of reoperation due to early structural valve deterioration, but there was no significant difference in valve-related complication free rates. Therefore, we should select prosthetic valve in consideration of individual cases.

The biological, medical and environmental roles of trace elements have attracted considerable attention over the years. In spite of their relevance in nutritional, occupational and toxicological aspects, there is still a lack of consistent and reliable measurement techniques and reliable information on reference values. In this review our understandings of the urinary profilings of boron, lithium and strontium are summarized and fundamental results obtained in our laboratory are discussed.Over the past decade we have successfully used inductively coupled plasma emission spectrometry for the determination of reference values for urinary concentrations of boron, lithium and strontium. Taking into account the short biological half-life of these elements and the fact that their major excretion route is via the kidney, urine was considered to be a suitable material for monitoring of exposure to these elements. We confirmed that urinary concentrations of boron, lithium and strontium follow a lognormal distribution. The geometric mean reference values and 95% confidence intervals were 798 μg/l (398-1599 μg/l) for boron, 23.5 μg/l (11.0-50.5 μg/l) for lithium and 143.9 μg/l (40.9-505.8 μg/l) for strontium. There were no discrepancies between our values and those previously reported. Our reference values and confidential intervals can be used as guidelines for the health screening of Japanese individuals to evaluate environmental or occupational exposure to these elements.

OBJECTIVEMonochloroacetic acid (MCA) is corrosive to skin, and causes not only chemical injury but also fatal systemic poisoning. Little is known about the cause of death. We studied the acute toxicity of MCA before clinical symptoms appeared in fasting rats.

METHODSBlood samples were analyzed 2 h after subcutaneous MCA injection (Ld(90): 162 mg/ml kg body weight). Control rats were injected with saline.

RESULTSAspartate aminotransferase (AST) and alanine aminotransferase (ALT) were about 1.5-fold higher than in the controls, and mitochondrial AST (mAST) was 2-fold higher. Blood urea nitrogen and creatinine were significantly increased, while serum glucose was significantly decreased in the treated group. Lactate was 6-fold higher and pyruvate was 13-fold higher than in the controls.

CONCLUSIONSMCA caused injury to the liver and kidneys but these injuries were slight. However, the larger increase in mAST indicated that hepatocellular mitochondria were selectively targeted. Hepatocellular mitochondrial injury decreased gluconeogenesis and caused hypoglycemia and extremely high levels of lactate and pyruvate. Hypoglycemia and lactic acidosis were insidious before the critical symptoms appeared and this combination accelerated to death, affecting other organs such as the heart and brain. Nosotropic therapy of these abnormalities up to the appearance of symptoms may help to establish an early therapy for skin exposure to MCA.