Objective : We analyzed changes in the affected side motor function according to the region and severity of motor paralysis in patients during convalescent rehabilitation. Methods : The subjects recruited were 1,903 hemiplegic patients with primary stroke from a supratentorial unilateral lesion, for which a full-time integrated treatment (FIT) program was implemented. We excluded patients with severe complications, those in whom the stroke recurred or its condition rapidly changed during hospitalization, and those in whom the duration from the onset to admission to our hospital was 61 days or longer. The remaining 1,634 patients served as the study subjects, from among whom we chose 917 patients who had been hospitalized for 8 weeks or longer. The affected side motor function was assessed using 5 motor items of the Stroke Impairment Assessment Set (SIAS) every 2 weeks starting from admission. Results and Conclusion : The affected side motor function significantly improved from admission to a convalescent rehabilitation ward through to week 8 in stroke patients, who were actively engaged in daily routines and had mainly walking and ADL exercise. In addition, improvement was more likely to occur for the lower-limb compared to upper-limb, as well as for the proximal compared to distal motor function. This tendency was more marked for more severe cases of paralyses.

The remarkable increase of branched amino acid and pretty decrease of lysine venous concentration were observed in healthy nine male and female adults by the brief fast.
The increase of branched amino acid wasn't able to find by the various exercise generally. The increase of lysine venous concentration was found after the running more than 10km frequently.
Only on the subjects of 44 and 55 years of age, the increase of branched chain amino acid and lysine were observed by the running. It looks like have to take precautions that aged people run under the conditions of empty stomach.

Venous concentration of lysine and other 16 amino acids were determined in healthy 5 male 20-22 years of age subjects in the resting state, after 2 min from bigining of exercise, immediatetly after all-out exercise and 30 min after of the exercise with a bicycle ergometer at work intensities which will be fell into all-out in about 6 or 7 min.
During 2 min exercise lysine only was increased, no change of glycine and puoline were observed and other amino acids were decreased. At the point of all out increase of threonine, lysine and histidine were observed, compared with resting state
Alanine concentration at 30 min after of all out exercise was very high than that of resting state and same tendency but a little was observed on lysine. Other amino acids were decreased.
A risk connected with exercise was discussed from the data of lysine obserbed high concentration during two min exercise concerning with the variation of other amino acids by the all-out exercise.

In this study, the effect of moderate endurance training on muscle morphological properties of human thigh muscles and isokinetic strength was examined. Five sedentary females carried out a training program of 30 min./day, 3 times a week for a ten-week period. The load requirement was set to 60% of maximal aerobic capacity (Vo₂max) of the subjects. In the determination of muscle cross-sectional areas (CSAs) by MRI, longitudinal sections were first imaged, and ten axial images along the length of femur were taken before and after the endurance training. Muscle CSA and mus-cle volume of knee extensors (KE), flexors (KF), and adductors (AD) were calculated, using the ten axial images. Vo₂max was significantly increased after endurance training (14.6%, p<0.01) . Muscle CSA in KE was significantly increased at the ten levels of femur length. There were also significant increases at seven levels of femur length after endurance training in KF (p<0.05, and 0.01) . Percentage increase of msucle CSA in KE and KF were 10.9 to 16.5% and 7.7 to 15.8%, respectively. Although the muscle volume of KE, KF, and AD was significantly increased, no change in fat volume was observed after endurance training. Isokinetic knee extension and flexion peak torque and peak torque per unit of muscle CSA at three angular velocities (30, 180, and 300 deg/sec) didn't show significant changes. These results suggest that muscle hypertrophy induced by moderate endurance training has no effect on muscle strength.

We used near-infrared spectroscopy (NIRS) to study noninvasively the effects of aging on changes in muscle oxygenation during steady bicycle exercise. For the study, 6 healthy young males and 13 healthy elderly male volunteers were recruited. To evaluate the physical fitness level and to determine exercise intensity, the ventilatory threshold (VT) was first measured. As a result, elderly subjects were divided into two groups according to O₂ uptake at VT (Elderly-H ; 936.0±26.4, Elderly-L ; 695.3±29.9, Young ; 790.0±51.19 ml) . Secondly we measured muscle oxygenation by NIRS at rest and during exercise at relative work intensities of VT ; 20%, 40%, 60%, 80% and 100%. In all cases muscle oxygenation at rest and during exercise was expressed as a relative value from 100% oxygenation (oxygen capacity) established by thigh occlusion (ischemia) . All subjects showed progressive deoxygenation with increasing intensity. There were no differences between the three groups in muscle oxygenation during exercise at relative work intensity of VT. These data suggest that aging and physical fitness level have no effect on muscle oxygenation below relative work intensity of VT.

In this study, the effect of moderate endurance training on muscle morphological properties of human thigh muscles and isokinetic strength was examined. Five sedentary females carried out a training program of 30 min./day, 3 times a week for a ten-week period. The load requirement was set to 60% of maximal aerobic capacity (Vo₂max) of the subjects. In the determination of muscle cross-sectional areas (CSAs) by MRI, longitudinal sections were first imaged, and ten axial images along the length of femur were taken before and after the endurance training. Muscle CSA and mus-cle volume of knee extensors (KE), flexors (KF), and adductors (AD) were calculated, using the ten axial images. Vo₂max was significantly increased after endurance training (14.6%, p<0.01) . Muscle CSA in KE was significantly increased at the ten levels of femur length. There were also significant increases at seven levels of femur length after endurance training in KF (p<0.05, and 0.01) . Percentage increase of msucle CSA in KE and KF were 10.9 to 16.5% and 7.7 to 15.8%, respectively. Although the muscle volume of KE, KF, and AD was significantly increased, no change in fat volume was observed after endurance training. Isokinetic knee extension and flexion peak torque and peak torque per unit of muscle CSA at three angular velocities (30, 180, and 300 deg/sec) didn't show significant changes. These results suggest that muscle hypertrophy induced by moderate endurance training has no effect on muscle strength.

Surface induced hypothermia was introduced in six cases with low cardiac output syndrome after open heart surgery to reduce oxgen consumption. The patients were consisted of two ACBG, two LV rupture after MVR, MVR with ACBG and AVR with poor LV function. Hemodynamic changes such as heart rate, mean arterial pressure, cardiac index, systemic vascular resistance, pulmonary artery wedge pressure, were measured every 3-4 hours throughout the course of hypothermia. Acid-base balance, mixed venous oxgen saturation and oxygen consumption were also monitored. Hypothermia was induced using a blanket and ice-beutels. Temperature in hypothermia was maintained at about 33°C. We are intended to increase SVO₂ up to the level of 50% and to improve anerobic condition. Hypothermia was continued for 45 hours in the shortest and 148 hours in the longest case with a mean of 78 hours. Arrythmia was not seen. Hemodynamic and acid-base balance were in significantly changed in comparison of the control values. However, SVO₂ and VO₂ changed significantly after introduction of hypothermia. They increased from 47.8±7.5% to 58.7±7.9% and reduced from 231±29.7 to 188±31.3ml O₂/min respectively. Hemodynamic condition was improved and IABP was successfully weaned in all cases. We suggest that the use of hypothermia is one of the effective modality in the management of low cardiac output syndrome after open heart surgery.

A 52-year-old man suffering from Behçet's disease had undergone 6 operations for recurrent aneurysms of the bilateral iliac and femoral arteries. Thereafter, the patient underwent graft replacement for abdominal aortic aneurysm. Six years later he complained of lower abdominal pain and back pain. Abdominal CT-scan revealed abnormality of the proximal anastomotic site. The proximal suture line was completely dehiscent. The distal edge of infra-renal abdominal aorta was closed with interrupted mattress sutures. A right axillo-iliac bypass using a Dacron graft was performed for arterial reconstruction of the lower extremity. The patient has been free of recurrence for 4 years after the operation.

Purpose: In terminally ill patients with advanced cancer,it is recognized that delirium is reversible in 20-50% of the patients with it. Identification of its cause is vital to ensure the quality of life of the patients with delirium at the end of life. We would like to report a case of the advanced cervical cancer patient with delirium, successfully treated by intravenous administration of vitamin B1. Case: An 83-year-old woman, who was diagnosed the advanced cervical cancer with carcinomatous peritonitis, was admitted to Shizuoka Cancer Center Palliative Care Unit. Four days after the admission, she presented sleep-wake cycle disturbance, poor attention, poor concentration,and short-term memory loss, and these conditions were diagnosed with delirium. Vitamin B1 deficiency was suspected by normal examinations including laboratory results and head computed tomography except for the low level (19ng/ml) of vitamin B1. One week after starting intravenous administration of vitamin B1, the symptoms of delirium were improved. Conclusion: In this case, delirium by vitamin B1 deficiency developed even though having adequate oral intake (about 1,000kcal/day), indicating malabsorption of vitamin B1 due to hypoperistalsis and edema of the bowel. Advanced cancer patients can easily develop vitamin B1 deficiency due to inadequate oral intake, increased consumption of vitamin B1 and malabsorption of vitamin B1. Therefore,the examination of vitamin B1 deficiency is necessary for patients with delirium that cannot be specified. Palliat Care Res 2009; 4(2): 330-333