We asked 50 ambulatory patients with cerebrovascular disease whether their sleep had been disturbed due to cramp in the calf while they were sleeping soundly at night. Their age ranged from 32 to 81 years. Eleven patients (22%) gave an affirmative answer, and eight of these answered that they had cramp from one to three times a week or more. These eight patients received Syakuyaku-kanzo-to extract granules (2.5g) daily for two weeks. Those who responded sufficiently remained on the same dose, and those who did not received double the dose for further two weeks before the efficacy was evaluated.
All five patients who were able to comply with the treatment for four weeks improved either markedly or slightly. The onset of its action was rapid. These results are comparable to those of muscle relaxants and minor tranquilizers and suggest that Syakuyaku-kanzo-to extract granules are beneficial for spasm of the calf in patients with cerebrovascular disease.
With regard to its side-effects, one patients who received the treatment for more than two weeks developed pseudoaldosteronism. This was the only negative point of the treatment, but this disappeared rapidly after treatment was discontinued.

Modulation of the excitability of the corticospinal tract and spinal reflex in static upper and lower limbs was investigated during arm or leg cycling. The excitability of the corticospinal tract was examined with motor-evoked potentials (MEPs) following transcranial magnetic stimulation (TMS). H-reflexes were evoked by electrical stimulation of peripheral nerves in the upper and lower limbs. MEPs and H-reflexes were recorded from the soleus while the subject performed arm cycling and the soleus was at rest. In addition, MEPs and H-reflexes were recorded from the flexor carpi radialis (FCR) during leg cycling while the FCR was at rest. MEPs and H-reflexes were also evoked without arm or leg cycling as a control. TMS or electrical stimulation was delivered at 4 different pedal positions. The subjects performed arm or leg cycling at 30 and 60 rpm. The amplitudes of MEP in the soleus significantly increased during arm cycling compared to the control. In contrast, H-reflexes in the soleus significantly decreased during arm cycling compared to control values. The same results were obtained in FCR during leg cycling. MEPs and H-reflexes were not modulated in a phase-dependent manner during either arm or leg cycling. The degree of modulations in MEP and H-reflex amplitudes depended on the cadence of arm and leg cycling. These findings suggest that a differential regulation of spinal and supraspinal excitability in the static limb was induced by arm and leg cycling. The corticospinal tract and the reflex arc independently would be responsible for coordination between the upper and lower limbs.

The present study investigated an effective method of eliciting medium and long latency cutaneous reflexes in normal human subjects. The effect of changes in stimulus conditions (number of pulse train, duration of electrical pulse and inter-stimulus interval) on cutaneous reflexes in the first dorsal interosseous muscle (FDI) following non-noxious electrical stimulation to the hand digits (digit 1 ; D1, digit 2 ; D2 and digit 5 ; D5) were investigated in seven healthy volunteers. Cutaneous reflexes were elicited while the subjects performed isolated isometric contraction of FDI (D2 abduction). Under all experimental conditions, the level of muscle contraction was set at 10% of the maximal EMG amplitude, which was determined during maximal voluntary contraction. Intensity of the electrical stimulation was set at 2.0 times the perceptual threshold under all experimental conditions.Although the amplitude of E2 (excitatory response, peak latency ∼60∼90 ms) was independent of the number of pulses (1, 2, 3, and 5 pulses, pulse frequency at 333 Hz), that of I1 (inhibitory response, ∼45∼60 ms), I2 (inhibitory response, ∼90∼120 ms) and E3 (excitatory response, ∼120∼180 ms) was significantly increased depending on the number of pulses (p<0.001). Amplitudes of E2 and I2 were significantly affected by the digit stimulated (p<0.01). For all four components of the cutaneous reflexes, there were no significant differences in magnitude even by alternating both the inter-stimulus interval (fixed at 1, 2 and 3 Hz and random between at 0.7 and 2 Hz) and the duration (0.1, 0.5 and 1 ms) of the electrical stimulation.These findings suggest that the susceptibility of responsible interneurons impinging on each reflex pathway to temporal summation of the test impulse differs depending on the digit stimulated. It is also likely that almost the same population of the cutaneous afferent fibers were activated by test stimulation with different durations as far as the same stimulus intensity was utilized. As a practical application, double or more pulses up to 3 Hz without causing pain is recommended to effectively evoke medium and long latency cutaneous reflexes in FDI, which would reduce possible effects arising from fatigue.

It has recently demonstrated that central fatigue during sustained maximal voluntary contraction (MVC) progresses faster in the presence of delayed onset muscle soreness due to eccentric contractions than in normal states (Endoh et al., 2005). However, it remains to be clarified whether these findings are related to muscle damage or muscle pain induced by eccentric contractions. The present study investigated which factor plays a more critical role in the earlier onset of central fatigue during sustained MVC with muscle pain induced by injecting hypertonic saline. Ten healthy male right-handed subjects (age, 21~32 yrs.) were asked to perform brief MVCs (~3 sec) before and after injection of isotonic saline (0.9%, 1.0 ml, ISO) or hypertonic saline (5.25%, 1.0 ml, HYP) into the left biceps brachii. The subjects then performed 1 min MVC (fatigue test) with isometric elbow flexion was done in ISO or HYP condition or intact control condition (CON). During these contractions, transcranial magnetic stimulation was delivered to the contralateral motor cortex to evaluate voluntary activation (VA), the motor evoked potential (MEP) and electromyographic (EMG) silent period (SP). Ratio of root mean square of the EMG and elbow flexion force (EMGrms/F) was also measured.The peak pain induced by the injection of HYP was significantly higher than that of ISO (p<0.01). There was no significant difference in either the maximum size of the M response or the twitch force between ISO and HYP (p>0.05). However, during the brief MVCs, both maximal force (p<0.01) and VA (p<0.05) for HYP were significantly decreased compared to those for ISO. During the fatigue test, although MVC, VA, MEP and SP were significantly altered (p<0.05~0.01), there was no significant difference among CON, ISO and HYP (p>0.05). There was no significant difference in EMGrms during the fatigue test (p>0.05).These results suggest that peripheral force-producing capacity remained intact after the injection of ISO and HYP during sustained MVC, and that progression of central fatigue during sustained MVC was less affected by the increased group III and IV afferent activity induced by HYP.

[Objective]More accurate anatomical data is discussed to reveal the surrounding structures of the new and former BL54 (Zhibian, Chippen) according to the positional modification of acupuncture points by WHO (2006), and also to demonstrate the acupuncture stimulation points to the sciatic nerve as effective methods for acupuncture treatment of the pain in the lower back.
[Methods]Detailed dissections were performed on the surrounding structures of the acupuncture points of the bladder meridian at the gluteal region and the posterior aspect of the thigh in three cadavers at the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.
[Results] 1. The new BL54 (WHO, 2006) was situated at or near the infrapiriform foramen, with the posterior femoral cutaneous nerve, inferior gulteal nerve and vessels and sciatic nerve passing through.
2. The former BL54 was situated at or near the suprapiriform foramen with the inferior gulteal nerve and vessels passing through.
3. The acupuncture stimulation points to the sciatic nerve at the gluteal region and the posterior aspect of the thigh were as follows;(1) the initial portion of the sciatic nerve, (2) the infrapiriform foramen (new BL54, WHO), (3) the lateral one third point of the line connecting the sacrococcygeal junction and the greater trochanter, (4) the midpont of the line connecting the ischial tuberosity and the greater trochanter, (5) the point about 1 cm lateral to BL36 (Chengfu, Shofu), (6) the medial half portion of the biceps femoris muscle lateral to BL37 (Yinmen, Inmon).
[Conclusion] 1. The new and former BL54 are situated near the main nerves and vessels of the gluteal region and the posterior aspect of the thigh, so are considered as effective points for the acupunctural treatment.
2. The six positions are showed as the acupuncture stimulation points to the sciatic nerve in the gluteal region and the posterior aspect of the thigh.

We studied whether exercise fatigue affects somatosensorv input using somatosensory evoked potential (SEP) . Sixteen subjects performed intermittent grip strength exercises with muscle fatigue while ignoring electrical stimulation given to an elbow. We induced SEP in the exercise task (during contraction) in every stage (first stage, middle stage and final stage) . In addition, we induced SEP in the exercise task during relaxation in the first stage and final stage. As a result, the early component amplitude of SEP decreased with the progress of exercise (manifestation of muscle fatigue) during contraction and relaxation. Our findings suggested that somatosensory input decreased with the manifestation of muscle fatigue. Somatosensory input is necessary for control of voluntary movement. Therefore, we speculate that these factors play a role in decreased performance of athletes competing in long-duration events.

There were 16 patients who developed acute renal failure (ARF) follwing cardiovascular operation using extracorporeal circulation. They were treated by either CPD or CAVH because their ARF were resistant to medical treatment. These patients were divided into three groups according to their treatment; 7 patients treated by CPD (Group A), 5 patients treated both CPD and CAVH (Group B), 4 patients treated by CAVH (Group C). The survival rate was 33% in Group A, 20% in Group B, and 0% in Group C. The prognosis of the each group was poor. CPD and CAVH were effective to control the concentration of serum potasium and water removing. But CPD and CAVH were not very effective to control the concentrations of serum creatinine and blood urea nitrogen. There were three patients who developed low proteinemia which was one of the side effects of CPD. Seven of nine patients treated by CAVH, developed bleeding. The side effects of CAVH were seemed to be more severe than those of CPD.

Lower-extremity antigravity muscle contraction (the static muscle pump and muscle mechanoreflex) and the baroreflex are involved in regulating blood pressure (BP) during upright standing. We hypothesized that in females with orthostatic hypotension (showing a decrease > 20/10 mmHg within 3 min upon standing from supine), the muscle pump and mechanoreflex of the antigravity muscles is small during upright standing in those who have not undergone exercise training. To test this hypothesis, we compared the cardiovascular responses to head-up tilt, head-up suspension, head-up tilt + venous occlusion (which stops venous return from the lower extremities by static muscle pump), and head-up suspension + venous occlusion of 14 young females with orthostatic hypotension, of which seven had undergone exercise training (tOH) and seven had not (uOH), with those of eight females with orthostatic normotension (control) who had not undergone exercise training. Changes in BP, heart rate (HR), and stroke volume (SV) during both head-up tilt and suspension were measured. Although the increase in HR was larger and the decrease in SV tended to be smaller during head-up tilt than during suspension in the tOH, the response patterns of both were the same in the uOH. In occlusion trials, the increase in HR was larger during head-up tilt than during suspension in the tOH, whereas the increases in HR in both scenarios were the same in the uOH. These findings suggest a small muscle mechanoreflex of the antigravity muscles during upright standing in females with orthostatic hypotension who have not undergone exercise training.