To determine the minimum duration of exercise for improving the aerobic capacity of patients with coronary heart disease (CHD), 23 female patients with CHD and/or hypertension, aged 52.8±8.7 years, were studied. After pre-testing, all the patients were conditioned for 4 months in order to elicit improvements in their aerobic capacity and other healthrelated factors. Duration and contents of daily activities were recorded by each patient. After 4 months, oxygen uptake at lactate threshold (VO_2LT) and VO_2peak were increased significantly from 12.9±2.6 to 16.0±3.4ml/kg/min and from 18.5±4.2 to 22.3±5.6ml/kg/min, respectively. Duration of exercise conditioning for the 4 months averaged 23.8±12.2min per day, ranging from 4.6 to 49.7min. Correlational analyses were applied in order to determine the extent to which the improvement in aerobic capacity was associated with the individual mean duration of exercise conditioning. As a result, changes in VO_2LT and VO_2peak correlated significantly with the exercise duration (Pearson's r=0.51, Spearman's rho=0.47 for VO_2LT; Spearman's rho=0.58 for VO_2peak) . Both VO_2LT and VO_2peak tended to improve markedly when daliy exercise duration was 20 min or longer. Furthermore, it was shown that the improvement in aerobic capacity remained almost the same within a range of exercise duration of 20 to 60min. We suggest that the minimum exercise duration for improving the aerobic capacity of cardiac patients is 20 to 30min per day or 140min or more per week.

To estimate how much physical activity is needed to improve overall health status in female patients with ischemic heart disease (IHD), the dose-response relationship between the duration of daily aerobic exercise and change in vital age (VA) was assessed for 4 months of exercise training. VA was considered as an index of physical health status and was computed from various coronary risk facotrs and physical fitness elements. Eighteen female patients with IHD, aged 54.3±9.1 yrs, continued the supervised exercise training 1-2 d/wk and the self-controlled exercise training 1-5 d/wk for 4 months. The intensity of exercise was set at individually determined lactate threshold. Daily duration of aerobic type exercise calculated for each patient averaged 21.1±11.0min/d, rang ing from 4.6 to 46.7 min/d. After the 4-month exercise training, VA decreased from 59.6±12.1 yrs to 54.2±11.8 yrs (P<0.05) . Significant correlation was found between daily duration of exercise and the change in VA (Spearman's rho=-0.60 ; Pearson's r=-0.62) . In this relationship, 10 min/d of exercise induced the decrease in VA and no further decrease in VA was found over the 30 min/d of exercise. In the 11 variables which constitute the equation of VA, oxygen uptake at lactate threshold (Spearman's rho=0.65; Pearson's r=0.64) and balancing on one leg with eyes closed (Spearman's rho=0.48; Pearson's r=0.51) significantly correlated with daily duration of aerobic exercise. From these results, it is suggested that the amount of moderate intensity exercise required to improve physical health status in female patients with IHD may be 10-30 minutes per day.

Ten athletic women (5 normal ovulatory cycles, 5 short luteal phases) and 6 non-athletic women with normal ovulatory cycles were subjected to an investigation of episodic gonadotropin secretion. In the middle follicular phase, blood samples were obtained via an indwelling venous catheter every 15 minutes for 4 hours.
Mean levels of gonadotropins in both athletic groups were lower (p<0.001) than in the control group. LH pulse frequencies in the short luteal group were significantly lower than in the control group (p<0.001) . LH pulse amplitudes were similar in all groups. FSH dynamics were the same as those for LH.
In athletic women, low mean levels and infrequent episodic secretion of gonadotropins were obvious. These data suggest that strenuous athletic activity may cause hypothalamic-pituitary insufficiency, especially that of hypothalamic origin.

Athletic women often exhibit menstrual disorders such as luteal insufficiency, oligomenorrhea and amenorrhea are often seen. It has been suggested that such disorders are related to prolactin release caused by physical activity. To investigate the mechanism by which the disorders are promoted, prolactin secretion was studied in 10 athletic women (5 with normal ovulatory periods, and 5 with short luteal periods) and 6 non-athletic controls. Blood samples were obtained during the early follicular phase of the menstrual cycle through an indwelling venous catheter at 15-minute intervals for 4 hours. The concentration of prolactin was measured by radioimmunoassay.
The mean prolactin concentration in the athletic group was lower than that in the control group (p<0.001), and pulse frequency in the athletic group was higher than that of the control group (p<0.01) . Pulse amplitude in the athletic women with short luteal periods was higher than that of those with normal ovulation. Pulse duration in the athletic women with short luteal periods was significantly longer than that of those with normal ovulation (p<0.01) .
These findings suggest that prolactin is one of the most important factors in menstrual disorders in athletic women.

Biological age based on the assessment of various physiological factors measured in a resting state has been proposed as an appropriate index of aging. We have recently developed an equation for estimation of physical fitness age (PFA), which is composed of eight age-related physical fitness variables. These include oxygen uptake corresponding to lactate threshold (Vo₂@LT), maximal oxygen uptake (Vo₂max), side step, grip strength, vertical jump, foot balance with eyes closed, trunk extension, and trunk flexion. In this study, the validity of PFA as a critical index of physical health and/or aging status was investigated from a longitudinal standpoint on the assumption that exercise habituation does contribute to health promotion. The subjects were 14 Japanese middle-aged and elderly men, aged 50 to 70 years, all of whom were patients with coronary heart disease (CHD) . The subjects participated in a supervised exercise conditioning program for 90 to 120 min each session, 2 times weekly for 4 months. Analyses of the data indicated that the mean PFA of the subjects (66.0±9.0 yr) after conditioning was significantly (P<0.05) lower than the mean PFA (72.8±8.6 yr) obtained before conditioning. After the exercise program, significant increases were documented in Vo₂@LT (17%), Vo₂max (12%), side step (26%), trunk flexion (109%), trunk extension (7%), vertical jump (12%), and foot balance with eyes closed (31%) . Therefore, we conclude that our exercise conditioning program may alter the overall physical fitness of patients with CHD, and that PFA could be a valid physical health and/or aging index.

A typical feature of mid-ventricular obstructive hypertrophic cardiomyopathy (MVO-HCM), is obvious hypertrophy of the mid-ventricular muscle and ventricle with transformation into the shape of an hourglass. We report a 60-year-old woman who had been given a diagnosis of apical type hypertrophic cardiomyopathy 12 years previously, but it changed to MVO-HCM with apical left ventricular aneurysm. We considered the impending rupture of the aneurysm because its wall was thin and pericardial effusion was detected by UCG (ultrasonic cardiograph). Urgent surgery was performed consisting of ventricular aneurysmectomy and patch reconstruction. After the surgery, a pseudoaneurysm was found in cardiac apex, so we performed surgery again. A residual shunt in the trabeculation caused the pseudoaneurysm, but its origin was not clear. She has been fine for 18 months without complications such as recurrence of aneurysm, ventricular arrhythmia or left ventricular dysfunction since the last surgery.

Between January 1994 and October 2004, 87 patients underwent emergency thoracic aortic surgery. Of these, 11 patients were more than 80 years old (O-group) and 76 were less than 80 years old (Y-group). A total of 58 patients (6 in O-group and 52 in Y-group) were treated for acute type-A aortic dissection, 5 (0 in O-group and 5 in Y-group) for acute type-B aortic dissection and 21 (4 in O-group and 17 in Y-group) for the involved rupture of a thoracic aortic aneurysm. The operative procedures consisted of the replacement of either the ascending, or the ascending and transverse aorta in 71 patients (8 in O-group and 63 in Y-group), and the replacement of the distal descending aorta in 15 patients (3 in O-group and 12 in Y-group). The operative mortality rates were 27.2% (3 patients) and 19.7% (15 patients) in the O- and Y-groups, respectively, with no significant difference between the groups. The rate of early complications, including circulatory failure, respiratory failure and cerebral infarction, did not statistically differ between the 2 groups. The overall 2-year survival rates of the patients who survived the operation were 83.3% in the O-group and 95.1% in the Y-group. Moreorer, 75% of the patients (6 of 8) who survived the surgery regained normal activities of daily life after the surgery, at a level similar to before the surgery. The present data indicates that emergency thoracic aortic surgery can be justified in selected in octogenarian patients.

OBJECTIVE: To determine the interleukin (IL)-6 levels in gingival crevicular fluid (GCF) of patients with severe root resorption after orthodontic treatment and investigate the effects of different static compressive forces (CFs) on IL-6 production by human periodontal ligament (hPDL) cells and the influence of IL-6 on osteoclastic activation from human osteoclastic precursor (hOCP) cells in vitro. METHODS: IL-6 levels in GCF samples collected from 20 patients (15 and 5 subjects without and with radiographic evidence of severe root resorption, respectively) who had undergone orthodontic treatment were measured by ELISA. The levels of IL-6 mRNA in hPDL cells and IL-6 protein in conditioned medium after the application of different uniform CFs (0, 1.0, 2.0, or 4.0 g/cm2 for up to 72 h) were measured by real-time PCR and ELISA, respectively. Finally, the influence of IL-6 on mature osteoclasts was investigated by using hOCP cells on dentin slices in a pit-formation assay. RESULTS: Clinically, the IL-6 levels were significantly higher in the resorption group than in the control group. In vitro, IL-6 mRNA expression significantly increased with increasing CF. IL-6 protein secretion also increased in a time- and magnitude-dependent manner. Resorbed areas on dentin slices were significantly greater in the recombinant human IL-6-treated group and group cultured in hPDL cell-conditioned medium with CF application (4.0 g/cm2) than in the group cultured in hPDL cell-conditioned medium without CF application. CONCLUSIONS: IL-6 may play an important role in inducing or facilitating orthodontically induced inflammatory root resorption.
Culture Media, Conditioned ; Dentin ; Enzyme-Linked Immunosorbent Assay ; Gingival Crevicular Fluid ; Humans* ; Interleukin-6* ; Interleukins ; Osteoclasts ; Periodontal Ligament ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Root Resorption*

Background : The effects of rehabilitation on hemodialysis patients are unknown. We assessed the effects and investigated the association between rehabilitation treatment effects and all-cause mortality. Methods : This prospective cohort study included 120 patients on maintenance hemodialysis. ADL was assessed using the Functional Independence Measure (FIM) score (total points, 126), which comprises 13 motor items (total points, 91) and five cognitive items (total points, 35). A survival curve was constructed using the Kaplan-Meier analysis and stratified into an increase or no-increase of the FIM score. Multivariable logistic regression analysis was used to determine factors associated with the effects of rehabilitation. Discriminative sensitivity of FIM cognitive items for an increase in total FIM was estimated using the area under the receiver operating characteristic (AuROC) curve. Results : The average total FIM score increased from 64.2±3.6 to 75.8±3.0, and the increase in FIM motor and cognitive items was 11.0±1.3 and 0.5±0.6, respectively. The cumulative survival rate within 2.5 years was significantly higher in the FIM increase group than that in the FIM no-increase group. FIM cognitive items and anemia were significantly associated with rehabilitation effects, and AuROC showed that a cutoff of 34 points in cognitive FIM had moderate discriminative sensitivity for a total FIM increase (AuC, 0.719 ; p<0.0008). Conclusions : Rehabilitating hemodialysis patients improved their FIM score (particularly the motor items), and a higher FIM score resulted in a better prognosis. The effectiveness of rehabilitation depends on maintaining a perfect FIM cognitive score.