In this study, we investigated the effects of L-Arginine, which increases the production of nitricoxide (NO) with vasodilative actions, on forearm bathing. The subjects were 12 healthy adult males with 24±1 years old. We compared the changes of blood pressure, heart rate, deep/superficial temperatures, and dermal blood flow by forearm batlmg with or without the oral ingestion of 2000mg L-Arginine. After a 30-minute rest following ingestion, the subjects took a forearm bathing ; immersion of the right forearm below the elbow in 41°C hot water for 15 minutes. There were no significant differences neither in blood pressure, heart rate, nor sublingual temperature between the changes by L-Arginine and water ingestion. Although the superficial temperature of the left toe was significarttly increased 15 minutes after the start of bathing regardless of the presence or absence of L-Arginine (p<0.01), the increase with L-Argilline ingestion was significantly greater (p<0.01) than that without L-Arginine. Furthemore, an increase in left dorsal skin blood flow after 10 to 15 minutes bathing with L-Arginine was more marked than that without L-Arginine. The increasing ratio of blood flow after 15 minutes of right forearm bathing against pre-bathing value was significantly higher (p<0.05) in case with L-Argitme than that in its absence. These results suggest that the oral administration of L-Arginine accelerates thermal vasodilative effects during forearm bathing.

We experienced a case of chronic pain responding to electrical acupuncture therapy while on spinal cord stimulation. A 35 year-old male presented with chronic neck pain. At 16 years of age, he had neck pain due to traffic accident with stellate ganglion block and epidural block. At 29 years of age, he sensed radiating pain in the 3rd to 5th digits of the left hand during epidural block. At 33 years of age, nerve root injury occurred after insertion of an epidural catheter, resulting in epidural abscess. Although the abscess resolved after antibiotic treatment, he had stiff fingers in the left hand together with neck pain and restricted range of motion of the neck. At 34 years of age, a spinal cord stimulation device was inserted which improved the stiff fingers in the left hand, but not the neck pain and restricted neck motion. He therefore visited our institute. At presentation, neck pain together with dysphagia and mastication pain were observed, and the patient was on a liquid diet. He was given electrical acupuncture treatment in additional to trigger point block and stellate ganglion laser. After two treatments, he was able to resume a normal diet. With reduced neck pain, he also undergo rehabilitation mainly through voluntary neck movements. This case demonstrates that electrical acupuncture treatment may be safe and effective for patients fitted with spinal cord stimulation device.

In stroke patients, excessive oxidative stress impairs brain nerve cells and leads to arteriosclerosis. On the other hand, rehabilitative exercise is necessary for the functional improvement and maintenance after stroke, and exercises themselves increase reactive oxygen species production simultaneously. Therefore, it is essential to elucidate how exercises influence oxidative stress in stroke patients. We assessed the effects of exercises on 29 Japanese subacute-phase stroke patients (exercise group, 20; control group, 9), in terms of oxidative stress by examining changes in reactive oxygen metabolite (ROM) level (i.e., oxidative stress) and biological antioxidant potential (BAP) level (i.e., antioxidant capacity) in blood plasma. The exercise group performed two sets of 1-hour exercises 6 days/week for 56 days. The control group performed the same 1-hour exercises, but only on days 1 and 56. ROM and BAP levels in blood plasma in both groups were measured immediately before and after the exercises and at rest on days 1 and 56. ROM level significantly decreased and BAP level significantly increased at rest from days 1 to 56 in the exercise group. However, no significant change was observed in these levels in the control group. Conclusion: Regular rehabilitative exercise can improve antioxidant capacity and attenuate oxidative stress even in stroke patients.
Oxidative Stress ; Stroke ; Arteriosclerosis

In order to examine the attitudes of medical students toward oriental medicine before and after lecture course, self-administered questionnaires were given the medical students of Kyoto Prefectural University of Medicine. Eighteen percent of the students had some experience with the prescription of Kampo medicine by doctors; 53% had used Kampo medicine purchased in pharmacies, and 13% had been treated with acupuncture and moxibustion. Eighty-four percent of the students were interested in oriental medicine; 82% thought that oriental medicine was worth learning; 76% thought that oriental medicine was essential in contemporary medicine and 54% wanted to introduce oriental medicine into their clinical practice in the future. These percentages increased after the lecture course to 92%, 85%, 87% and 62%, respectively.

We investigated causes of interrater disagreements in the observational assessment of clinical training for first-year postgraduate trainees. In 1998 25 first-year postgraduates rotated through the Second Department of Surgery for 3 months, including 1 month in cardiovascular surgery, thoracic surgery, and upper-gastrointestinal surgery. Each trainee cared for several patients at most with a senior resident under the supervision of senior staff members. Nine attending physicians (staff members), 3 doctor-course graduates, and 2 chief residents assessed the trainees at the end of the rotation with special reference to clinical, social, and supervisory abilities. Trainees were given scores of “Good, ” “Fair, ” “Pass, ” or “Fail” for each ability. Interrater disagreements often involved responsibility and activeness, which reflected social abilities, and rapid patient consultations, orderly arrangement of laboratory examinations and procedures, and avoiding ordering of unnecessary laboratory examinations and medications, which reflected supervisory abilities. Assessments of poorly performing trainees often disagreed. Some interrater disagreements were seen among 4 of 14 attending physicians, but disagreements were fewer among the 3 doctor-course graduates and 2 chief residents who were graduates of the college. Both the proper training of assessors and a good relationship between assessors and rotators are necessary to make appropriate evaluations that might affect the career of postgraduates trainees.

At Tokyo Women's Medical University, our curriculum for first-year students is designed to teach the dynamics and etiquette of human relations. During the third year, medical students are expected to anticipate and plan effective therapeutic communication and interaction with patients. A discussion group of 6 students and a member of the human-relations committee first clarify the purpose and develop the training; students then independently participate in human-relations training during the summer vacation. After training, experiences are discussed during class. Although this curriculum has been used for some 10 years, its benefits have been assumed but not validated. We used student reports and questionnaires to examine the effects of this curriculum. The results clearly show that planning and training give the students an opportunity to learn how to establish an effective physician-patient relationship.

In order to study the physical fitness of rural children in Gifu prefecture, a total of 128 rural boys and girls aged 8-14 years old in the Tokuyama-Elementary School and-Middle School, which are in a far rural district from busy civilized urban distriet, were measured for the developmental status, i. e, physique, examination of physical fitness, maximum working capacity, cardiorespiratory function and urinary excretion in summer, 1962, and the comparison was made on the results obtained there with those of the average Japanese children of the same age.
The results obtained were as follows:
1) Little or no difference was found between physical development of rural children and that of average Japanese boys and girls ; i. e, the physique of rural children was not superior nor inferior to the value of the average Japanese children.
2) The record of sprint games, such as 50m-sprint-run, broad jumping, ball throwing, Sargent-jump, grip strength and back strength of rural children was lower than that of the Japanese average. Whereas, the endurance ability measured with a long-distance running (1500m for boys and 1000m for girls) was tended to be higher in the rural children, especially in the girls, than the average Japanese value. However, no significant difference was presented in the flexibility test (forward bending of the upper-body in standing posture) between rural and average Japanese values.
3) The examination of cardiopulmonary function : i.e. E.C.G., blood pressure, heart rate, vital capacity and maximum expiratony flow rate exhibited no abnormal sign. The systolic and diastolic blood pressure tended to increase with age, but the heart rate tended to decrease. The examination of the urinary glucose, protein and occult-blood remained normal, and most of the urine pH of the girls were within the range between 6 and 7, whereas, those of boys were between 5 and 6.
4) The maximum working capacity (maximum oxygen intake, vital capacity) showeda linear increase proportional to age and physique (body height, body weigmt, body surface, etc, ) over the range of the age tested. Sexual difference appeared after 12 years of age.
5) The possibility was suggested that the maximum O₂ intake could be predicted from the vital capacity of the same individual regardless of age, sex and physique, and a theoretical background for that was discussed.

Physiological responses to heat and heat tolerance were examined in summer and winter on 13 male athletic university students and male nonathletec university students. After staying for 30 min. in a climatic chamber maintained at 30°C with 70% relative humidity, sweating reaction was examined far 90 min, by immersing both legs up to the knees in a stirring water bath of 42°C.
Both groups showed significantly greater sweat volume, significantly lower Na concentration in sweat and considerably lower rise in rectal temperature and less increase in heart rate in summer than in winter. In both seasons, athletes showed smaller volume of sweat, lower Na concentration in sweat, lower rise in rectal temperature and less increase in heart rate than nonathletes.
It is concluded that heat tolerance of athletes was superior to that of nonathletes when assessed by our heat tolerance indices and this superior heat tolerance of athletes could be explained due to a result of physical training. Heat tolerance index, representing the magnitude of physiological strain in the body induced by heat load, was modified by using relative increase in heart rate in place of salt loss. It can be said that the modified heat tolerance index is useful as a substitute of the original heat tolerance index in field studies.

In the present study, we instiuted a long-term mild aerobic training program for older patients with hypertension and investigated its effects on serum lipids and lipoprotein concentrations. The intensity of exercise in mild aerobic training was adjusted to the lactate threshold level (LT), i, e., the level at which the blood lactate concentration began to increase nonlinearly with increasing work intensity. The training group (15 patients, 7 men and 8 women) and control group (15 patients, 7 men and 8 women) were 65-83 year-old patients with mean ages of 75.5±5.6 and 73.7±4.4 (mean±S.D), respectively, who had never exercised regularly up to that time. Treadmill training at the LT was carried out for 30min/day 3-6 times/week and continued for 9 months under the supervision of exercise physiology specialists.
In the training group, LT speed significantly increased from 3.43±0.65 km/h to 3.73±0.67 km/h (9.0%) in men, and from 2.75±0.57 km/h to 3.05±0.61 km/h (11.8%) in women (both P<0.05) . HDL-c was significantly increased 9 months after training both in men (19.2%) and women (20.9%) (both P<0.05) . The TC/HDL-c ratio, an atherogenetic index, was significantly (P<0.05) decreased by training in women but not in men. The other serum lipid and lipoprotein profiles were unchanged in both men and women. In the control group, all serum lipid and lipoprotein profiles were unchanged in both men and women.
The HDL-c level in the training group was higher than in the control group after 9 months in both men and women (both P<0.02) . The TC/HDL-c ratio in the training group was lower only in women (P<0.02) . There were no significant differences in other values between the training group and the control group in either men or women.
These results suggest that mild aerobic training at the LT is an effective method of improving the level of serum HDL-c, the TC/HDL-c ratio and aerobic capacity in the older patients with hypertension.