The change in R-R interval (RRI) induced by rapid postural change from a squat posture to standing was analyzed in 8 healthy male students (20.3±1.2 years of age) before and immediately after maximal running exercise. We instructed subjects to stand up as quickly as possible, and to repeat the standing-up movement three times at intervals of 2 min. Heart rate responses and heart rate variability were analyzed by the change in RRI induced by standing up. Heart rate (HR) increased quickly at the onset of standing up. The time (T) until the maximal HR (Hmax) was reached 9.79±1.44 s after standing up, and then the HR after Hmax decreased rapidly with time. The maximal HR was 1.20 times higher while standing up than in the squat position. Maximal running exercise significantly delayed the time taken to reach Hmax after standing up, and significantly diminished the increased HR to 1.15 times. The Hmax/Hmin ratio, which expressed the magnitude of autonomic activity during standing up, was significantly lower following maximal exercise, indicating that the cardiac sympathetic nervous system seems to be in a state of hyperfunction immediately after maximal running exercise. These findings suggest that disturbance in the postural adjustment of the cardiovascular system immediately after intense exercise may be induced by the delayed response and decreased amplitude of the HR.

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.