Phagocytic cells, polymorphonuclear leucocytes and macrophage, play an important role in a non-specific cellular immunity which is first defense line for infectious disease. The purpose of this paper is to clarify combined effects of stressful exercise and sleep disturbance on rat non-specific cellular immunity represented by yields of cells from bronchoalveolar lavage and superoxide generating capacity of alveolar macrophage.
Male Wistar rats ( 5 weeks old) were divided into following 4 groups. 1) Training group; exercised on a treadmill at a belt speed of 35 m/min for 45 min/day, 2) Jet Lag group; noninvasive sleep disturbance by the shifted day/night time every 2 week interval, 3) Training + Jet Lag (T+ J) group ; exercised on a treadmill with sleep disturbance, that we assumed one of chronic fatigue model in this paper, and 4) Control group ; set sedentary condition.
After 6 weeks of the experiment, 2 groups were newly selected from T + J group for the examination of rest effects on the chronic fatigue model rats. And to examine the combined effects of stressful exercise and sleep disturbance on matured rats (11 weeks old), Acute Training + Jet Lag (AT+J) group was selected from the Control group.
Rats were sacrificed at 11 and 17 weeks old. T + J group seemed to be able to adapt first 6 weeks but negative effects were found out at 17 weeks old. Same phenomena were also recognized in AT + J group. These results suggest that the chronic fatigue model rats may easily catch the infectious disease and there are possibility that both stress, stressful exercise and sleep disturbance, negatively affects the non-specific cellular immunity, especially after maturation.

The principal objective of this paper is basic research on the development of an easy and rapid method to estimate physical fatigue levels. The focus of the research is to determine chronically fatigued conditions at an early stage for the prevention of chronic fatigue. Special attention was given to overtraining as one form of chronic fatigue in this paper. Long-distance runners representatives of a university in Tokyo nominated for Hakone-Ekiden were recruited as subjects. Examinations with informed consent were carried out on a once a month basis during 8 months and included the following; 1) physical characteristics ; body weight and body fat weight, 2) serum-biochemical test ; 6 parameters by the dry-chemistry method and the traditional method, 3) subjective fatigue levels ; the questionnaire of subjective symptom authorized by the Japan association of industrial health and the profile of mood state (POMS) . In this paper, data obtained from 19 male runners attending all 8 examinations were statistically analyzed.
Serum parameters obtained by the dry-chemistry method, an easy and rapid method which provides clinical values on site, showed significant correlations with the traditional method.
No correlation was observed between subjective fatigue scores and serum enzyme activity levels which were used as markers for estimation of physical fatigue levels in this study, however, monthly changes of enzyme levels and fatigue scores from July to August seemed to correlate in almost subjects. In contrast, using data obtained in the entire exprimental period, there was no relationship between the monthly changes of enzyme levels and fatigue scores. The results may indicate that some subjects exhibit gaps between physical fatigue and feelings of fatigue.
The above mentioned results suggest that measurements of serum enzyme activity levels using the dry-chemistry method are a useful indicator for the prevention of overtraining.

Phagocytic cells, polymorphonuclear leucocytes and macrophages, play an important role in non-specific cellular immunity, which is the first line of defense against infectious diseases. The purposes of this study were to clarify the combined effects of forced exercise and sleep disturbance on non-specific cellular immunity in mature rats, and to compare the effects between forced and voluntary exercise. Non-specific cellular immunity represented by the yield of cells from bronchoalveolar lavage and the superoxide-generating capacity of alveolar macrophages was investigated using mature rats.
Male Wistar rats (11 weeks old) were divided into 5 groups:
1) Training group ; exercised on a treadmill at a belt speed of 35 m/min for 15 min/day,
2) Jet Lag group ; disturbance of the sleep cycle by day/night time shifts at 2-week intervals,
3) Training+ Jet Lag (T + J) group ; exercised on a treadmill with sleep disturbance, a model identified by our research group to simulate chronic fatigue, 4) Voluntary group ; housed with running wheels, and 5) Control group ; housed under sedentary conditions.
Body weight and food consumption measured during the experimental period showed coincidental changes. After 6 weeks of the experiment, the rats were sacrificed at the age of 17 weeks. Negative effects on non-specific cellular immunity were observed in the training group, and the rats were also slightly affected by sleep disturbance (Jet Lag group) . These negative effects seemed to be cumulative in the T+J group. In contrast, significant positive effects were observed in the voluntary group.
These results suggest that stress, forced exercise and sleep disturbance negatively affect non-specific cellular immunity, and that voluntary exercise is able to enhance immunity even if it is started after maturation.

Two patients, a 32-year-old man and a 23-year-old woman, underwent successful reoperations 22 and 18 years after radical repair of the tetralogy of Fallot (TOF). The former patient had a diagnosis of pulmonary stenosis and aortic regurgitation due to infective endocarditis. Patch reconstruction of the right ventricular outflow tract (RVOT) and aortic valve replacement were performed. The latter patient was diagnosed as having pulmonary stenosis and a recanalized ventricular septal defect (VSD), followed by patch reconstruction of the RVOT and direct closure of a residual VSD. Reoperation 15 years or more after radical repair of TOF is rare. Only 15 such cases including the present two have been reported in Japan.

PURPOSE: It is still unclear whether the longitudinal anal muscles or conjoint longitudinal coats (CLCs) are attached to the vagina, although such an attachment, if present, would appear to make an important contribution to the integrated supportive system of the female pelvic floor. MATERIALS AND METHODS: Using immunohistochemistry for smooth muscle actin, we examined semiserial frontal sections of 1) eleven female late-stage fetuses at 28-37 weeks of gestation, 2) two female middle-stage fetus (2 specimens at 13 weeks), and, 3) six male fetuses at 12 and 37 weeks as a comparison of the morphology. RESULTS: In late-stage female fetuses, the CLCs consistently (11/11) extended into the subcutaneous tissue along the vaginal vestibule on the anterior side of the external anal sphincter. Lateral to the CLCs, the external anal sphincter also extended anteriorly toward the vaginal side walls. The anterior part of the CLCs originated from the perimysium of the levator ani muscle without any contribution of the rectal longitudinal muscle layer. However, in 2 female middle-stage fetuses, smooth muscles along the vestibulum extended superiorly toward the levetor ani sling. In male fetuses, the CLCs were separated from another subcutaneous smooth muscle along the scrotal raphe (posterior parts of the dartos layer) by fatty tissue. CONCLUSION: In terms of topographical anatomy, the female anterior CLCs are likely to correspond to the lateral extension of the perineal body (a bulky subcutaneous smooth muscle mass present in adult women), supporting the vaginal vestibule by transmission of force from the levator ani.
Anal Canal/*anatomy & histology/embryology ; Female ; Fetus/anatomy & histology ; Humans ; Male ; Muscle, Smooth/*anatomy & histology/embryology ; Pelvic Floor/anatomy & histology ; Sex Characteristics ; Vagina/*anatomy & histology/embryology

PURPOSE: We recently demonstrated the morphology of the anococcygeal ligament. As the anococcygeal ligament and raphe are often confused, the concept of the anococcygeal raphe needs to be re-examined from the perspective of fetal development, as well as in terms of adult morphology. MATERIALS AND METHODS: We examined the horizontal sections of 15 fetuses as well as adult histology. From cadavers, we obtained an almost cubic tissue mass containing the dorsal wall of the anorectum, the coccyx and the covering skin. Most sections were stained with hematoxylin and eosin or Masson-trichrome solution. RESULTS: The adult ligament contained both smooth and striated muscle fibers. A similar band-like structure was seen in fetuses, containing: 1) smooth muscle fibers originating from the longitudinal muscle coat of the anal canal and 2) striated muscle fibers from the external anal sphincter (EAS). However, in fetuses, the levator ani muscle did not attach to either the band or the coccyx. Along and around the anococcygeal ligament, we did not find any aponeurotic tissue with transversely oriented fibers connecting bilateral levator ani slings. Instead, in adults, a fibrous tissue mass was located at a gap between bilateral levator ani slings; this site corresponded to the dorsal side of the ligament and the EAS in the immediately deep side of the natal skin cleft. CONCLUSION: We hypothesize that a classically described raphe corresponds to the specific subcutaneous tissue on the superficial or dorsal side of the anococcygeal ligament.
Aged, 80 and over ; Anal Canal/*anatomy & histology/embryology ; *Cadaver ; Female ; *Fetus ; Humans ; Male ; Muscle, Smooth/*anatomy & histology/embryology ; Rectum/*anatomy & histology/embryology

BACKGROUND: In Japan, there have been few reports about drug compliance, which is an important determinant of effectiveness, in the management of bronchial asthma patients. To clarify drug compliance and its relationship with various aspects of asthma management, a questionnaire survey was performed on asthmatic patients and their pharmacists.
METHODS: This survey was carried out, from October to November in 2001. The subjects were limited to the regular inhaled corticosteroid (ICS) users, and were restricted to patients whose medication had not been changed for at least 6 months before the survey. The questionnaires inquired about asthma status, various factors that have been reported to be associated with drug compliance and asthma management. Patients' pharmacists were asked about prescribed medications and drug compliance based on the pharmaceutical records.
RESULTS: Completed questionnaires were received from 610 patients. ICS compliance was not lower than that of anti-allergic drug but lower than that of oral sustained-released theophylline (OSRT) . Multiple regression analysis revealed a significant correlation between ICS and OSRT compliance.
CONCLUSION: These results might suggest that OSRT could improve patient's compliance to drug therapy through its bronchodilatory effect, thus resulting in better compliance to ICS. If this were the case, OSRT would play an important role in asthma management.

Whipple disease is a systemic chronic infection caused by Tropheryma whipplei. Although chronic diarrhea is a common gastrointestinal symptom, diagnosis is often difficult because there are no specific endoscopic findings, and the pathogen is not detectable by stool culture. We present a female patient with Whipple disease who developed chronic bloody diarrhea and growth retardation at the age of 4 years. Colonoscopy showed a mildly edematous terminal ileum and marked erythema without vascular patterns throughout the sigmoid colon and rectum. Subsequently, a primary diagnosis of ulcerative colitis was made. Histopathological analysis of the terminal ileum showed the presence of foamy macrophages filled with periodic acidSchiff-positive particles. Polymerase chain reaction using DNA from a terminal ileum biopsy sample amplified a fragment of 16S rRNA from T. whipplei. Antibiotic treatment relieved the patient’s symptoms. There was no evidence of immunodeficiency in the present case. Since Whipple disease worsens after anti-tumor necrosis factor inhibitor therapy, considering this infection in the differential diagnosis may be important in patients with inflammatory bowel disease, especially before initiation of immunotherapy.

BACKGROUND/AIMS: The objective of this study was to compare the clinical characteristics of patients with autoimmune pancreatitis (AIP) with or without Mikulicz's disease (MD) and with MD alone. METHODS: We investigated the clinical findings in 15 AIP patients with MD (group A+M), 49 AIP only patients (group A), and 14 MD only patients (group M). RESULTS: The male-female ratio was significantly higher in group A+M (73%, p<0.05) and group A (78%, p<0.01) than group M (21%). Serum immunoglobulin G (IgG) levels were significantly higher in group A+M than in group A (p<0.01) and group M (p<0.05). Serum IgG4 levels were significantly higher in group A+M than in group A (p<0.01). Other organ involvement was observed in 73% (11/15) of patients in group A+M. The number of patients with diabetes mellitus was significantly higher in group A+M (66%, p<0.01) and group A (51%, p<0.05) than in group M (7%). All of the patients responded well to steroid therapy, but the relapse rate in group A+M (33%) was significantly higher than that in group A (3%, p<0.01). Salivary gland function was impaired in all groups compared with the control group, but the degree of dysfunction was less in group A compared with group A+M and group M. CONCLUSIONS: The relapse rate of AIP in MD patients was significantly higher than that of AIP in patients without MD.
Diabetes Mellitus ; Humans ; Immunoglobulin G ; Mikulicz' Disease ; Pancreatitis ; Recurrence ; Salivary Glands

BACKGROUND/AIMS: Ulcerative colitis (UC) is sometimes associated with autoimmune pancreatitis (AIP). Infiltration of immunoglobulin G4 (IgG4)-positive plasma cells is sometimes detected in the colonic mucosa of AIP or UC patients. This study aimed to clarify the relation between UC and IgG4. METHODS: Associations with UC were reviewed in 85 AIP patients. IgG4 immunostaining was performed on biopsy specimens from the colonic mucosa of 14 AIP and 32 UC patients. RESULTS: UC was confirmed in two cases (type 1 AIP, n=1; suspected type 2 AIP, n=1). Abundant infiltration of IgG4-positive plasma cells in the colonic mucosa was detected in the case of suspected type 2 AIP with UC and two cases of type 1 AIP without colitis. Abundant infiltration of IgG4-positive plasma cells was detected in 10 UC cases (IgG4-present, 31%). Although 72% of IgG4-absent UC patients showed mild disease activity, 70% of IgG4-present patients showed moderate to severe disease activity (p<0.05). CONCLUSIONS: UC is sometimes associated with AIP, but it seems that UC is not a manifestation of IgG4-related disease. Infiltration of IgG4-positive plasma cells is sometimes detectable in the colonic mucosa of UC patients and is associated with disease activity.
Adult ; Aged ; Colitis, Ulcerative/*blood/complications ; Colon/*chemistry ; Female ; Humans ; Immunoglobulin G/*analysis ; Intestinal Mucosa/*chemistry ; Male ; Middle Aged ; Pancreatitis/*blood/complications ; Retrospective Studies