Effects of neck muscle training and their changes after discontinuation of training (detraining) were studied in 22 athletes (college American football players) and 19 non-athletes. The subjects underwent narrow grip shoulder shrug training using free weights (NGSS group), isometric training of the neck in pairs (PAIR group), or both types of training (COMB group) for 14 weeks, and were then detrained during the following 14 weeks. Extension and flexion muscle strength (maximum isometric muscle strength) of the neck were measured using a method in which subjects pulled a wire attached over the head in a sitting position at 2-week intervals after the start of training.The following results were obtained.
1. In the athletes, the flexion muscle strength increased by 16.9±5.6% (mean±standard deviation) in the COMB group and by 14.8±5.2% in the NGSS group, and the increases in these groups were significantly greater than the increase in the PAIR group (p<0.01) . The extension muscle strength also increased, most notably in the COMB group (12.2±4.7%) .
2. In the non-athletes, the flexion muscle strength increased by 29.4±7.2% in the COMB group, and this increase was significantly greater than that in the PA1R group (p<0.01) . This increase was also significantly greater than that in the COMB group of the athletes (p<0.01) . The extension muscle strength increased by 19.1±5.2% in the COMB group.
3. In the athletes, the flexion muscle strength of the COMB group was increased by 8.3% after 14 weeks of training and 14 weeks of detraining as compared with that at the start of training. In the non-athletes, the flexion and extension muscle strength of the COMB group increased by 17.4% and 9.8%, respectively, after the start of training.
These results suggest that narrow grip shoulder shrug training used for the development of muscle strength in the lower neck is effective for improving flexion as well as extension muscle strength, and that the decrease in muscle strength due to detraining can be reduced by combining this training with isometric training performed by the PAIR group.

The relationship between environmental conditions and water balance during training for baseball and American football was analyzed. The environmental conditions were assessed in terms of WBGT (wet-bulb globe temperature) based on NDB (natural dry-bulb temperature), NWB (natural wet-bulb temperature) and GT (globe temperature), as WBGT=0.7NWB+0.2GT+0.1NDB,
During baseball training, a commercially available sports drink was provided ad libitum, whereas during American football training, the effect of free water intake was compared between tap-water and sports drink. The sweat rate and the amount of water consumption were significantly correlated with WBGT under each experimental condition. Body weight loss was 0.2% body wt./h during baseball training, whereas during American football training, body weight loss was 0.5%/h with tap-water and 0.4%/h with sports drink on average, revealing a significantly higher value for tap-water.
These results indicate that both sweat loss and water intake during exercise increase with WBGT, and that body weight loss is maintained at a fairly constant level during exercise with free water intake, although the loss is significantly higher when tap-water is provided.

The relationship between environmental conditions and water balance during training for baseball and American football was analyzed. The environmental conditions were assessed in terms of WBGT (wet-bulb globe temperature) based on NDB (natural dry-bulb temperature), NWB (natural wet-bulb temperature) and GT (globe temperature), as WBGT=0.7NWB+0.2GT+0.1NDB,
During baseball training, a commercially available sports drink was provided ad libitum, whereas during American football training, the effect of free water intake was compared between tap-water and sports drink. The sweat rate and the amount of water consumption were significantly correlated with WBGT under each experimental condition. Body weight loss was 0.2% body wt./h during baseball training, whereas during American football training, body weight loss was 0.5%/h with tap-water and 0.4%/h with sports drink on average, revealing a significantly higher value for tap-water.
These results indicate that both sweat loss and water intake during exercise increase with WBGT, and that body weight loss is maintained at a fairly constant level during exercise with free water intake, although the loss is significantly higher when tap-water is provided.

We evaluated the association between respiratory symptoms and hydration volume during last 1 week of life in terminal cancer patients using retrospective study. The subjects were 138 terminally patients with malignancies. Patients were classified into two groups: the low hydration group (group L, n=85) who received 1,000 ml or less of artificial hydration per day in 1 week before death and high hydration group (group H, n=53) who received over 1,000 ml per day. We compared appearance of dyspnea and bronchial secretion on group L with group H. 64.1% of group H had dyspnea, and 52.8% had bronchial secretion. These fractions are significantly higher than group L (32.9%, 15.3%). In the results of multiple regression analysis, lung involvement (odds ratio: 3.55), hydration over 1,000 ml per day (3.54), and administration of opioid (0.40) were significantly related dyspnea. Lung involvement (7.29), hydration over 1,000 ml per day (4.43), and oral intake (0.31) were significantly related bronchial secretion. Our results provide preliminary evidence that excessive artificial hydration therapies influence the respiratory symptoms in terminal cancer patients. 1,000 ml of hydration may be used as a rough indication in terminal stage.

Introduction: This study used a meta-analysis to investigate factors related to dizziness/vertigo and their effect size in community-dwelling elderly people.Methods: The search terms "elderly," "dizzy," "community dwelling," and others were used, and a database search was conducted using Ichushi Web and PubMed.Result: In total, 10 studies were extracted. Meta-analysis calculated 28 items as significantly related factors: anxiety, fatigue, taking nitric acid drugs, taking anxiolytics, low self-rated health, memory impairment, depression, sleep disorder, dementia, cancer, balance failure, gait disturbance, physical dysfunction, taking diuretics, living alone, heart disease, fall history, rheumatoid arthritis, stroke, taking sleeping pills, taking multiple drugs, visual impairment, female, ADL impairment, osteoporosis, taking antihypertensive drugs, hypertension, and low education level.Conclusion: The above items may be key variables for investigating dizziness/vertigo in the future.

The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.
Adult ; Carcinoid Tumor* ; Colonoscopy ; Germinal Center ; Humans ; Lymphoid Tissue ; Lymphoma, B-Cell, Marginal Zone* ; Palatine Tonsil* ; Rectum ; Twins*

A 2-month-old female Holstein calf and a 5-month-old female Japanese black calf presented with gingival vascular hamartoma located in the interdental space between the second and third mandibular incisors in the right and left mandibles, respectively. On radiographic or computed tomographic images, osteolytic changes appeared within the mandibular bones adjacent to the masses. The masses were removed along with affected mandibular bone by using unilateral rostral mandibulectomy. After surgery, both cases exhibited a normal appetite and grew normally, with no cosmetic changes or recurrences. Unilateral rostral mandibulectomy can be applied for invasive gingival vascular hamartomas associated with osteolytic changes.
Animals ; Appetite ; Asian Continental Ancestry Group ; Cattle ; Female ; Hamartoma ; Humans ; Incisor ; Infant ; Mandible ; Mandibular Osteotomy ; Radiography ; Recurrence

Background/Aims: Digital single-operator cholangioscopy (DSOC)-guided mapping biopsy (DMB) and tube-assisted mapping biopsy (TMB) are two techniques used for preoperative evaluation of biliary tract cancer (BTC). However, data regarding the diagnostic performance of these techniques are limited. Methods: We retrospectively examined consecutive patients with BTC who underwent either technique at our institution between 2018 and 2020. We evaluated the technical success rate, adequate tissue acquisition rate, and diagnostic performance of these techniques for the evaluation of lateral spread of BTC. Results: A total of 54 patients were included in the study. The technical success rate of reaching the target sites was 95% for DMB and 100% for TMB. The adequate tissue acquisition rate was 61% for DMB and 69% for TMB. The adequate tissue acquisition rate was low, especially for target sites beyond the secondary biliary radicles. The sensitivity of DMB alone was 39%, which improved to 65% when combined with visual impression. Experts demonstrated a higher negative predictive value and diagnostic accuracy with respect to both DSOC visual impression and DMB for the evaluation of lateral spread of BTC compared to trainees. Conclusions Adequate tissue acquisition rates were similar between the two techniques. Since DMB requires expertise, TMB may be an acceptable option when DSOC is unavailable or when DSOC expertise is limited.

Background/Aims: Selective bile duct or pancreatic duct cannulation remains a significant initial hurdle in endoscopic retrograde cholangiopancreatography (ERCP) despite advances in endoscopy and accessories. This study evaluated our experience with a rotatable sphincterotome in cases of difficult cannulation. Methods: We retrospectively reviewed ERCP cases using TRUEtome, a rotatable sphincterotome, as a rescue device for cannulation at a cancer institute in Japan from October 2014 to December 2021. Results: TRUEtome was used in 88 patients. Duodenoscopes were used for 51 patients, while single-balloon enteroscopes (SBE) were used for 37 patients. TRUEtome was used for biliary and pancreatic duct cannulation (84.1%), intrahepatic bile duct selection (12.5%), and strictures of the afferent limb (3.4%). Cannulation success rates were similar in the duodenoscope and SBE groups (86.3% vs. 75.7%, p=0.213). TRUEtome was more commonly used in cases with steep cannulation angles in the duodenoscope group and in cases requiring cannulation in different directions in the SBE group. There were no significant differences in adverse events between the two groups. Conclusions The cannulation sphincterotome was useful for difficult cannulations in both unaltered and surgically altered anatomies. It may be an option to consider before high-risk procedures such as precut and endoscopic ultrasound-guided rendezvous techniques.

Background/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO). Methods: Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared. Results: Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS. Conclusions No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.