The time constants of beat-by-beat heart rate decay for the first 30 seconds (T30) after exercise is a specific index for the vagally mediated component of heart rate recovery. The aim of our study was to determine whether cardiac rehabilitation (CR) can accelerate T30 in patients after coronary artery bypass grafting (CABG) . Thirteen male patients who underwent CABG (aged 60.5±7.7years) were assigned to 7-21 day Phase I CR. Exercise training consisted of 30 minutes of aerobic exercise (bicycle ergometer) at the anaerobic threshold 2 times per day. T30 was measured as the heart rate decay regulated in patients who rested immediately after 5 minutes of pedaling exercise. After CR, T30 significantly improved from 413.3±129.7 to 300.1±124.5 sec (p<0.01) . Peak oxygen uptake (peak V02: 14.0±4.0 16.7±3.2mlin/kg: p<0.01) and heart rate at anaerobic threshold (HR @ AT: 111.9±13.4 103.6±11.7 beatsin: p<0.01) also improved significantly. There was no correlation between ΔT30 (Δ: difference before and after CR) and Δpeak VO₂or ΔHR @ AT. These results suggest that CR for patients following CABG accelerates vagally mediated heart rate recovery after dynamic exercise.

The influence of exercise on the endogenous levels of both β-endorphin (BE) and corticosteroid (CS) in the hypothalamus and plasma was examined in rats. F344 male rats, five weeks of age, were divided into three groups: involuntary exercised (IE), non-exercised (NE) and control (C) groups. Rats in the IE group were exercised every day for one hour at the speed of 20 m mm n for 7 to 28 days. After training, the hypothalamus and plasma were obtained from rats. BE levels in water soluble extracts of hypothalamus were examined by rat BE ELISA test kits; and CS contents in plasma was examined by RIA. The amount of BE in the hypothalamus obtained from rats in the IE group was much higher than that in the NE and C groups. Although there was no significant difference between rats exercised for 7, 14, and 21 days, BE levels in the hypothalamus from rats exercised for 28 days was significantly higher than for 7 days. The amount of BE in the hypothalamus of NE rats was nearly identical to that of C rats. On the other hand, there were no significant changes in plasma CS levels. These results may suggest that exercise, especially running, causes on increase in BE levels in the hypothalamus.

The influence of exercise on the endogenous levels of both β-endorphin (BE) and corticosteroid (CS) in the hypothalamus and plasma was examined in rats. F344 male rats, five weeks of age, were divided into three groups: involuntary exercised (IE), non-exercised (NE) and control (C) groups. Rats in the IE group were exercised every day for one hour at the speed of 20 m mm n for 7 to 28 days. After training, the hypothalamus and plasma were obtained from rats. BE levels in water soluble extracts of hypothalamus were examined by rat BE ELISA test kits; and CS contents in plasma was examined by RIA. The amount of BE in the hypothalamus obtained from rats in the IE group was much higher than that in the NE and C groups. Although there was no significant difference between rats exercised for 7, 14, and 21 days, BE levels in the hypothalamus from rats exercised for 28 days was significantly higher than for 7 days. The amount of BE in the hypothalamus of NE rats was nearly identical to that of C rats. On the other hand, there were no significant changes in plasma CS levels. These results may suggest that exercise, especially running, causes on increase in BE levels in the hypothalamus.

A whole body indirect calorimeter provides accurate measurement of energy expenditure and the respiration quotient over long periods of time, but has limitations to assess dynamic changes in energy metabolism due to the small amplitude of the signal in relation to the size of the room. The present study aimed to improve algorithm for the whole body indirect calorimetry by adopting a deconvolution with a regularization parameter. Performance of the new algorithm was compared with trends identification (Med. & Biol. Eng. & Comput 34 : 212, 1996) against four validation tests. In a simulated problem, in which metabolic rate cycled with a period of 20 min, mean square errors (MSEs) computed at every 1 min by the deconvolution (0.0036 for O₂ consumption and 0.0017 for CO₂ production) were smaller than those for trends identification algorithms (0.0198 and 0.0142). Deconvolution algorithm clearly separated individual CO₂ infusion of 8 min intervals, while trends identification could no longer separate them. During the validation by ethanol combustion, which produced a near-steady state condition, the deconvolution (MSEs were 0.0022 for O₂ consumption and 0.0010 for CO₂ production) performed better than trends identification algorithms (MSEs were 0.0086 and 0.0041). When validated against direct measurement of gas production rate during non-steady state condition, produced by a human subject intermittently exercising in the calorimeter, deconvolution (MSEs were 0.0032 for O₂ consumption and 0.0038 for CO₂ production) performed better than trends identification algorithms (0.0182 and 0.0167). The new algorithm significantly improved transient response of the whole body indirect calorimeter.

Background: Necrotizing fasciitis is a rare but severe condition associated with high mortality. We encountered a patient with severe and rapidly progressing necrotizing fasciitis. Patient: A 40-year-old male was hit by a tractor and received a wide laceration wound spanning the length of his posterior thigh. Soon after the accident, the wound was washed and debridement was performed. Two days postoperatively, we observed septic changes in the wound and diagnosed this condition as necrotizing fasciitis. Consequently, the patient's leg was amputated at the thigh. The patient, however, developed toxic shock syndrome after the amputation. Endotoxin adsorption using a polymyxin B-immobilized fiber column was performed for 2 days. Finally, a hip joint amputation was performed after 11 days, following which the patient's general condition gradually improved. Discussion: Treatment for necrotizing fasciitis should be initiated promptly. Early debridement is associated with a significant decrease in mortality. In severe conditions, endotoxin and cytokine removal by blood purification is one of the most effective treatments. Although group A streptococci are widely known as "flesh-eating bacteria," we should also consider a wide variety of pathogenic organisms to be the probable cause of severe necrotizing fasciitis. Conclusion: Management of necrotizing fasciitis requires careful investigation as well as an aggressive therapeutic approach, which may include urgent surgical intervention. In addition to surgery, endotoxin adsorption therapy should be considered.
Patients ; Fasciitis ; Endotoxins ; Therapeutic procedure ; Amputation

A Task Force team consisting of members from pharmaceutical companies --a central player to develop and implement RMP (Risk Management Plan)-- as well as health care professionals and members from academia was established in JSPE. The Task Force developed guidance for scientific approach to practical and ICH-E2E-compliant Pharmacovigilance Plan (PVP) stated in Japanese Risk Management Plan issued in April 2012 by the Ministry of Health, Labour and Welfare. The guidance contains the following topics.
1．Introduction: JSPE's activities and this task force's objectives for pharmacovigilance activities
2．How to select Safety Specification (SS) and describe its characteristics
・Selection of SS
・Characterization of SS
・Association with Research Questions (RQ)
3．How to define and describe RQ
・What is RQ ?
・RQ interpretation in other relevant guidelines
・Methodology to develop RQ for PVP with examples
・Best approach to integrating PVP for whole aspects of safety concern
4．How to optimize PVP for specific RQ
・Routine PVP or additional PVP ?
・Additional PVP design (RQ and study design, RQ structured with PICO or GPP's research objectives, specific aims, and rationale)
・Checklist to help develop PVP
5．Epilogue:
・What can/should be “Drug use investigation” in the context of ICH-E2E-compliant PVP.
・Significance of background incidence rate and needs for comparator group
・Infrastructure for the future PVP activities
6．Appendix: Checklist to help develop PVP activities in RMP
The task force team is hoping that this guidance help develop and conduct SS and PVP in accordance with ICH E2E, as stated in Japanese Risk Management Plan Guideline.

High-quality terminal care cannot be given without good communication and understanding among patients, their family members and health as well as medical professionals.Recently, we have taken a questionnaire survey on new inpatients in our hospital to sound them out on their thinkings about hospital care, and examined the findings along with the validity of survey.Many respondents including those contracting either benign or malignant diseases wished to be keptposted on what they are really up against and to partake in the decision-making process before treatment plans are put into practice. The recent questionnaire survey has proved to be worthwhile as a tool to know the wishes of hospitalized patients and suggested an effective way to promote the practice of obtaining informed consent before specific test and therapautic procedure.

OBJECTIVE: Equivalent cross-relaxation rate (ECR) imaging is an MRI technique used to evaluate quantitatively a change in the protein-water interaction. We aimed to evaluate retrospectively the usefulness of ECR imaging for the histologic classification of malignant lymphoma (ML). MATERIALS AND METHODS: Institutional Review Board approval was obtained and all patients provided informed consent. The study subjects included 15 patients with untreated ML who were histologically diagnosed with follicular lymphoma (FL; n = 8) or diffuse large B-cell lymphoma (DLBCL; n = 7). All patients underwent ECR imaging and the offset frequency was set at 7 ppm. RESULTS: The median ECR values were 71% (range; 60.7 to 75.5) in FL and 54% (50.8 to 59.4) in DLBCL (p = 0.001). The median cellular density was 1.5 +/- 0.17 x 10(6) / mm2 in FL and 1.0 +/- 0.70 x 10(6) / mm2 in DLBCL (p = 0.001). The correlation coefficient between the ECR values and cellular density in ML was 0.88 (p = 0.001). In FL and DLBCL, assuming ECR value cut-off points of 60%, both sensitivity and specificity were 100%. CONCLUSION: A strong correlation between ECR and cellular density in ML is demonstrated and the ECR may be a useful technique to differentiate between FL and DLBCL.
Adult ; Aged ; Cell Count ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Imaging, Three-Dimensional/methods ; Lymphoma, Follicular/*pathology ; Lymphoma, Large B-Cell, Diffuse/*pathology ; Male ; Middle Aged ; Observer Variation ; Retrospective Studies

Anti-lipopolysaccharide (LPS) antibody administration has the potential benefits of neutralizing and consequently controlling rumen-derived LPS during subacute ruminal acidosis. Four Holstein bulls were used in this crossover study with a 2-week wash-out period. Anti-LPS antibody (0 or 4 g) was administered once daily for 14 days. Significantly lower ruminal LPS and higher 1-h mean ruminal pH were identified in the 4 g group. However, blood metabolites, acute-phase proteins, cytokines, and hepatic transcriptomes were not different between the two groups. Therefore, anti-LPS antibody administration mitigated ruminal LPS release and pH depression without accompanying responses in acute-phase inflammation or hepatic transcriptomic expression.