Although skeletal muscle mass decreases with aging, its decrease rate may differ among parts of the body. There have been few studies examining the differences in the muscle mass decrease rate between proximal and distal parts of the limbs or between the left and right legs in a large population. Bioelectrical impedance (BI) index, calculated as the ratio of the square of segment length to impedance, is linearly correlated with the muscle mass calculated by MRI (r=0.902-0.976, p<0.05, Miyatani et al., 2001) in the limb segments. The purpose of this study was to examine differences in the decrease rate of muscle mass between the proximal and distal parts of the limbs and between the upper and lower limbs in healthy Japanese. The BI index was measured in the bilateral thighs, lower legs, upper arms, and forearms of 1006 healthy Japanese men and women (aged 15-97 years). While the BI index decreased with aging in all examined parts of the body, the decrease rate was larger in the lower limb than in the upper limb, and in the thigh than in the lower leg. The percentage of people who showed a difference of more than 10 % in the BI index between the left and right lower limbs was significantly higher in the elderly than in young subjects. These differences in the decrease rate of muscle mass between limbs may be associated with decreases in physical functions in the elderly.

Gait analysis was conducted on 7 healthy pregnant women (pregnant group) and 6 non-pregnant women (pseudo-pregnant group) using a 3-D motion analysis system (VICON 460) and two forceplates (Kistlar 9286A). The data was collected at 8-9 months of gestation (pregnant condition) and 4-8 months postpartum (non-pregnant condition) in the pregnant group. In the pseudo-pregnant group, the participants walked with a 5kg-load on their belly (pregnant condition) and without any load (non-pregnant condition). Comparisons using two-way ANOVAs with repeated measures were conducted. Interaction of group × condition was not observed in the measured gait parameters except the angle of the maximum hip adduction. Main effect in the condition and the group was found in some parameters. In the pregnant condition, gait velocity was slower (pregnant group 68.7±8.6 m/min pseudo-pregnant group 63.8±4.8 m/min) than in the non-pregnant condition (pregnant group 75.5±3.2 m/min pseudo-pregnant group 69.8±8.7 m/min). The second vertical peak ground reaction force was smaller in the pregnant condition (pregnant group 105.4±4.8 % pseudo-pregnant group 108.4±6.3 % of body-weight) than in the non-pregnant condition (pregnant group 114.3±7.4 % pseudo-pregnant group 113.5±4.2 % of body-weight). These results demonstrated that pregnant condition changed kinetic and kinematic characteristics of the gait.

The aim of this study was to investigate the relationship between changes in swimming velocity (SV), stroke rate (SR), stroke length (SL) and muscle activities during a 4×50m swimming test to simulate a 200m freestyle race. A total of 20 male collegiate swimmers participated in this study. The electromyography (EMG) signals of 11 muscles, 7 muscles in the upper half of the body and 4 muscles in the lower half, were recorded with surface electrodes. SV, SR and SL were analyzed for each 50m (S1, S2, S3 and S4) from side view recordings of swimmers taken with an underwater camera.SV and SR for S1 were significantly higher than for S2 and S3. SL for S1 was significantly longer than for S3. The averaged EMGs (aEMGs) for S1 were significantly higher than for S2 or for S3 in 5 muscles (flexor carpi ulnaris, biceps brachii, triceps brachii, deltoideus posterior and rectus femoris). There were no significant changes between S3 and S4 in SV, SR, SL and aEMG of all muscles except pectoralis major which showed the highest aEMG in S4. Significant correlations were observed between changes of (Δ) aEMG and ΔSV, especially in upper half muscles (r=0.485-0.939, p<0.05).These results suggested that decline in muscle activities of the five muscles mentioned earlier caused a decrease in SV from S1 to S3; and an increase in muscle activity of the pectoralis major led preventing a decline in SV by maintaining the SR in S4.

A 22-year-old man shot himself with a nail gun. He was admitted to a local hospital with chest pain. Chest x-ray film and chest computed tomography showed 5 nails penetrating the left thorax and some of these nails were considered to reach the pericardium. He was transferred to our hospital for intervention. Left thoracotomy was performed. Three nails reached the left ventricle and one nail was embedded the left lung. The last nail was found by transesophageal echocardiography to be completely buried in the left ventricle wall. All nails were removed and the left ventricular wounds were repaired with felt 4-0 surgipro mattress sutures. He made an uneventful postoperative recovery with a normal postoperative echocardiography and he was discharged on postoperative day 12 in good condition.

In 2010, we at Konan Kosei Hospital introduced a menu with 8 days set as a cycle for inpatients undergoing chemotherapy. We have thus far used it for 258 patients. Over the 6-month period extending from October 2011 and March 2012, we performed a questionnaire survey on 23 patients (8 with lung cancer, 5 with acute myeloid leukemia and 3 with lymphoma) about their meals. On the basis of the findings, we have made a number of improvements in the menu.　　To the question of ease with which to eat, 96% of patients responded the meals were “easy to eat.” When it came to the volume of meals, 29% replied that breakfast was “small,” whereas 83% said lunch and dinner were “just right.” Cold chawan-mushi (custard-like egg and vegetable dish steamed in a cup) was difficult to eat for 7 patients, whereas there were indications that fish meals were also hard to eat.　　Based on this survey, we have increased the volume of breakfast, and replaced cold chawan- mushi with hot chawan-mushi. Furthermore, in order to reduce the smell peculiar to fish, we substituted kaba-yaki (spitchcocks) and ankake (food dressed with a thick, starchy sauce) fish- cooking styles for nitsuke (fish boiled and seasoned with sugar and soy sauce) and mushizakana (steamed fish) styles. Further surveys are necessary to produce a menu suitable for as many patients undergoing chemotherapy as possible.

The purposes of this study were as follows: 1) to classify competitive swimmers on the basis of their stroke rate (SR) and stroke length (SL) by applying a factor analysis and a cluster analysis, 2) to derive discriminant functions by applying a multiple discriminant analysis of the stroke characteristics, and 3) to compare the race patterns of groups classified according to the results of the cluster analysis. 94 male swimmers who had participated in 100-m freestyle events held at the All Japan Swimming Championship from 2000 to 2004 were selected as subjects. The average value of their swimming velocity, SR, and SL in four swimming phases (15-25 m, 25-45 m, 57.5-75 m, and 75-95 m) were measured from videos captured. The subjects were classified according to their SR and SL by applying a factor analysis and a cluster analysis. Results showed that the competitive swimmers could be classified into Type1-4. Type1 showed high values of SR throughout the race, Type2 showed high values of SR in the first half and high values of SL in the second half, Type3 showed high values of SL in the first half and high values of SR in the second half, and Type4 showed high values of SL throughout the race. Although there was no difference in swimming records among the four groups, each group had different race patterns. These results suggest that the knowledge of race patterns might be useful to swimmers or coaches for planning race strategies.

The patient was a 37 year-old man. We diagnosed Loeys-Dietz syndrome based on his physical characteristics that were widely spaced eyes and brachycephaly etc. Since he developed De Bakey III b aortic dissection 3 months later, he needed surgical repair for saccular-shaped distal arch aortic aneurysm. We performed total aortic arch replacement for the aneurysm and valve-sparing aortic root reconstruction for dilatation of the Valsalva sinus. Furthermore we performed the frozen elephant trunk technique for residual aortic dissection at the same time. After 18 months from the operation, we were able to recognize by computed tomography that the false lumen of the aorta next to the stent graft was thrombosed and absorbed and finally disappeared. The stent graft treatment for patients with connective tissue disease might be an effective method and deserves more attention.

  In recent years, changes in Japanese dietary habits have been associated with the increased incidence of obesity and lifestyle diseases even among children. Dietary education is considered essential for stemming this trend. In this study, we introduced the following initiative in dietary education for children admitted to hospital and their parents from the standpoint of health care workers providing meals to inpatients. We added a ‘Children's Lunch’ to the menu. Designed for the fussy children, it was a nutritionally balanced meal. On traditional seasonal festival days, we wrote an introduction to Japanese seasonal cuisine and showed it to the children. To the parents, we distributed a regular weekly pamphlet outlining the importance of dietary education, with an explanation of the ingredients used in the meals, and recipes.  To assess the results of this initiative, we conducted a questionnaire survey of parents on a weekly basis. The results of the surveys (n=215, recovery rate 87%) taken during the first three months showed that the majority of parents rated all four aspects of the ‘Children's Lunch’ high menu content, presentation, child's response, and the pamphlet contents. The parents displayed a deep interest in our activity, because 93% of those parents said that they were impressed with dietary education. On the other hand, some dietary problems were identified, with tendencies to use only ingredients preferred by the children, and eat out often.  This was a short term initiative, limited to hospitalization, but we were cwetain that we had been able to provide an opportunity for parents to think about their children's diets. We plan to continue this initiative, thereby making a contribution to dietary education for children.

  The incidence of fever in children admitted to general hospitals is very high. Provision of adequate nutrition and fluid supplements to febrile children is very important, but with some children it is difficult to maintain an adequate intake. To address this problem, we devised a new ‘febrile children's menu’, utilizing preparation methods and foods to produce a palatable menu for patients with fever.
  We introduced this ‘febrile children's menu‘ on January 6, 2011, providing it to 109 patients (age range: 1 to 8 years, average age: 3.3±1.9 years) over the ensuing 3-month period. We provided a mean 4.0±2.9 meals per day to each patient during their febrile stage (≥37.5°C). To evaluate the usefulness of the ‘febrile children's menu’, we investigated eating rates during the febrile period in all patients who had been provided with the menu, and performed a questiomaire survey on their parents/guardians. The mean eating rates during the febrile period were 39±30% for main meals, and 28±22% for side dishes. No significant difference was seen in the eating rates during the febrile period recorded over the 2-month period prior to introduction of the new menu to 112 febrile children (age range: 1 to 8 years, average age: 3.3±2.1 years), 39±30% for main meals, and 29±22% for side dishes. The questionnaire survey was responded by 43 parents/guardians (a recovery rate of 39%). The ‘febrile children's menu’ was assessed as ‘good’ by 67% of respondents, representing an overall favourable impression from the parents/guardians. With reference to the survey results, we will attempt to further improve the ‘febrile children's menu’ with the aim of increasing eating rates during the febrile period.