The purpose of this study is to determine the progress of whole body sweating rate (SR) in the initial stage of moderate work in two hot environments, and to relate the SR to the body temperature attained.
Four healthy males, 28 to 31 years of age, performed leg exercise of 40% VO₂max with a Monark bicycle ergometer set up on a platform scale (Potter bed balance) . All the experiments were carried out in a climatic chamber at ambient temperature (Ta) of 30°C or 40°C (relative humidity, 45%) in winter season following body heating for 30 min at a room temperature of 30°C. Skin sweating was monitored by the bed balance with automatic weight change indicator throughout the experimental period. Rectal (Tre) and 7 skin temperatures were measured every minute by a thermistor and thermocouples, respectively. Oxygen consumption was determined before and during the work by the Douglas bag method. Heart rate was recorded by electrocardiography throughout the experiment.
At Ta 40°C, the SR increased as soon as the work started, whereas at Ta 30°C it took a few minutes. The mean SR during the work at Ta 40°C was significantly higher than that at Ta 30°C. The level of mean skin temperature (Tsk) was higher at Ta 40°C (35°C) than Ta 30°C (33°C), and Tre was approximately 37.3°C at Ta 30°C and 40°C. The changes in the Tre and Tsk were similar in two different conditions. The negative correlations were found between the SR and the Tsk during the work. The regression line was significantly different at Ta 30°C and 40°C. The Tsk decreased in proportion to increase of the SR. Moreover, there was a good correlation between the SR and heart rate during the work in both environments. Heat production stood at the same level in two different thermal conditions.
The present study suggests that the body core temperature in working men is maintained at least constant level, since the evaporation in the initial stage of the work is largely stimulated, and the reduction of skin temperature may be caused by other factors than the evaporation.

During exercise at high temperatures, body temperature increases impairing exercise performance and resulting in heat illnesses. Water ingestion during exercise is a simple and practical strategy to prevent hyperthermia. In the present study, we examined the effects of water ingestion interval on thermoregulatory responses during exercise in a hot, humid environment (32t, 80% relative humidity) . Eight male university students performed a 60-min cycling exercise (60% of the maximal O₂ uptake) under four separate conditions; no drinking (ND), water ingestion (mineral water) at 5 (D5), 15 (D15), and 30 (D30) min intervals. The total volume of water ingestion (TWI) was identical during D5, D15, and D30, and equal to the amount of fluid lost in sweat during ND. TWI was divided equally by the number of drinking times in each experiment. During exercise, both rectal and mean skin temperature were lower in D5 than those in the other conditions (p<0.05) . There was no significant difference in total sweat loss between the four conditions, however, evaporative sweat loss and sweat efficiency (evaporative sweat loss total sweat loss) were significantly (p<0.05) higher in D5 than those in the other conditions. These results suggest that the shorter water ingestion interval increases evaporative sweating and attenuates higher body temperature during exercise in a hot, humid environment.

The purpose of this study was to investigate the benefits of sports participation in the prevention of pressure sores. A questionnaire was mailed to 668 men and woman with spinal cord injury. The questionnaire was designed to clarify the effects of physical activity and lifestyle on the development of pressure sores. Usable questionnaires were received from 466 persons, representing a response rate of 70%. Thirty-eight percent were quadriplegic and 62% paraplegic, with incomplete injuries accounting for 26% of the combined group. About half of the 466 subjects reported the development of pressure sores in their wheelchair life. Only 34% of the active subjects, participated in sports regularly, reported the development of pressure sores in their wheelchair life. On the other hand, 49% of the inactive subjects who did not participate in wheelchair sports reported the development of pressure sores. When the development of pressure sores before sports participation was compared with that after commencement of sports participation, there was no significant difference in the development of pressure sores between these periods. It was concluded that although quadriplegics and paraplegics without pressure sores had a greater tendency to participate in sports activity, there were no clear positive benefits of sports involvement on the prevention of pressure sores.

Objective: It is important to ensure the quality of preparation in hospital pharmacies.  Therefore, we evaluated the quantitative method of preparation and the stability of allopurinol for external use in a new dosage form.
Methods: The new dosage form utilized two kinds of ointment, white petrolatum and hirudoid soft ointment, and liquid.  Allopurinol was extracted from these preparations by the liquid-liquid partition method, and assayed by high performance liquid chromatography.  A stability test was conducted for six months in the case of the ointments and one month in the case of the liquid.
Results: Good linearity was obtained, in the range of 30˜670 μg/mL (r²≥0.999).  The recovery of allopurinol added to the two kinds of ointment was 97.7-102.0%, and the relative standard deviation was less than 3.0%.  It was observed that the quantity remained relatively constant for one month, and increased after three months.
Conclusion: A quantitative method for the preparation of allopurinol in ointment, using white petrolatum and hirudoid soft ointment, was evaluated.  The results confirmed that allopurinol was stable for one month in ointment and liquid.

To clarify changes in body temperature during endurance exercise in patients with spinal cord injury (SCI), we measured tympanic temperature (Tty) and skin temperature in the head, arm, chest, thigh, shin and calf in 5 patients with SCI (T6-T 12) and 7 normal controls during 30 minutes arm cranking exercise (20 watts) from 10 minutes before the initiation of exercise until 10 minutes after the termination of exercise in an artificial climate room at a temperature of about 25°C with a relative humidity of about 50%. The Tty in the SCI group was lower than that in the control group from 10 minutes before the initiation of exercise to 10 minutes after the termination of exercise with a significant difference only at the initiation of exercise. The difference in Tty slightly decreased with continuation of exercise. The Tty in the SCI group at rest was 36.05-37.15°C. Four patients in this group showed a decrease of 0.04-0.12°C in the early stage and an increase of 0.66°C±0.19 (mean±SD) at the end of exercise over the value at the initiation of exercise.
The skin temperature was lower in the SCI group than in the control group in all sites excluding the arm. Significant differences were observed in the head in the early stage of exercise and after exercise, in the chest from 10 minutes before the initiation of exercise to 5 minutes after the termination of exercise, in the thigh from 10 minutes before the initiation of exercise to 10 minutes after the termination of exercise, in the shin 10 minutes and 5 minutes before the initiation of exercise, and in the calf from before to 15 minutes after the initiation of exercise. In the SCI group, marked individual differences were observed in the skin temperatures in the thigh, shin, and calf, suggesting specificity of the skin temperature response in and near the paralysis area.
Results in Tty in this study suggested no heat retention in the SCI patients. Therefore, the risk for heat disorders seems to be low during moderate or mild exercise under moderate temperature environment at a temperature of about 25°C with a relative humidity of about 50% even when the skin temperature is low, and thermolysis is not marked.

Here we report 3 cases of advanced cancer using multidisciplinary treatment including reibaisan (WTMCGEP, a dry extract of Wisteria floribunda, Trapa natans, Myristica fragrans, Coix semen, Ganoderma lucidum, Elfvingia applanata, Punica granatum). Case 1 : 87-year-old man, suffering from stage IV esophageal squamous cell carcinoma (ESCC) with aortic and bronchial invasion, was referred to our clinic for palliative care. He had radiotherapy and chemotherapy. Only one course of chemotherapy was performed due to its intolerable side effects. The treatment with reibaisan started 11 months after the diagnosis. ESCC disappeared after 17 months of reibaisan treatment, and no relapse was observed for 66 months after the diagnosis. Case 2 : 79-year-old man, suffering from stage III ESCC, was initially scheduled for surgery after preoperative chemotherapy. Only one course of preoperative chemotherapy was performed because of its intolerable side effects. Therefore, radiotherapy combined with reibaisan followed. ESCC disappeared 6 months later, and no relapse was observed for 33 months after the diagnosis. Case 3 : 73-year-old woman, suffering from stage IV pancreatic cancer with systemic metastasis (brain, lung, and peritoneum). She initially showed Trousseau syndrome and was treated with low-molecular-weight heparin for multiple cerebral infarctions. One-month palliative chemotherapy and reibaisan resulted in a rapid reduction of ascites and improvement of neurological symptoms. Her progression-free survival period was 7 months. She lived 13 months thereafter. This suggests that reibaisan, which contains crude drugs that have been shown to have antitumor effects, may be another promising treatment for advanced cancers.

We report a case of refractory transient ischemic attack (TIA) successfully treated with chotosan. A 64-year-old woman with recurrent right hemiparesis and dysarthria was seen in our clinic. Twenty-three months before coming to our clinic, she had a history of right hemiparesis and dysarthria, which resolved soon after treatment. Magnetic resonance imaging (MRI) revealed an ischemic legion in the left corona radiata. Then 4 months before coming, she had repeated transient right hemiparesis and dysarthria, which lasted for 40 to 50 minutes and recurred 3 to 4 times a week. She was hospitalized and treated with an intensive TIA therapy including direct thrombin inhibitor, dual antiplatelet therapy, statin, calcium channel blocker and benzodiazepine. Though she continued the therapy for 4 months, it proved ineffective. She was referred to our clinic, and we started to administer chotosan 7.5 g per day for anxiety and dizziness during an attack. Chotosan attenuated TIA within a week, but aggravated after discontinuation on her own. The medication was resumed and TIA diminished within three months. Chotosan treatment has now been continued for 17 months without a single TIA for 14 months. Multiple studies have shown the protective effect of chotosan against cerebrovascular diseases including cerebral infarction and TIA. Therefore, chotosan may be an effective prescription for refractory TIA.

Background/Aims: A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowband imaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimed to determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectal adenoma and carcinoma. Methods: A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resection or surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before the histopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a marker of colorectal carcinoma. Results: The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 were adenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was 86%. Conclusions This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differential diagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms.

Background/Aims: A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowband imaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimed to determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectal adenoma and carcinoma. Methods: A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resection or surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before the histopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a marker of colorectal carcinoma. Results: The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 were adenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was 86%. Conclusions This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differential diagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms.

BACKGROUND/AIMS: When a person is experiencing stress, corticotropin-releasing hormone (CRH) can modulate gut physiologies, such as visceral sensation or gastrointestinal motility, and its intravenous administration mimics stress-induced physiological changes. However, the influence of CRH on the esophagus is yet unknown. Accordingly, we investigated whether intravenous CRH administration increases esophageal sensitivity to electrical stimulation in healthy Japanese subjects. METHODS: Twenty healthy subjects were recruited. We quantified the initial perception threshold (IPT) every 15 minutes after CRH injection. Venous blood was collected with a cannula, and both plasma adrenocorticotropic hormone (ACTH) and cortisol were measured at pre-stimulation, 0, 30, 60, 90, and 120 minutes. The results from each time point were compared against a baseline IPT obtained before electrical stimulation was initiated. RESULTS: When compared to the baseline IPT value (16.9 ± 4.5), CRH significantly decreased electrical threshold of the esophagus at 30, 45, 60, 75 minutes (14.1 ± 4.2, 13.1 ± 5.0, 12.1 ± 5.7, 14.0 ± 5.8 minutes, P < 0.01, respectively) after CRH injection, suggesting that CRH increased esophageal sensitivity to the electrical stimulus. CRH also significantly increased plasma ACTH levels at 30 minutes (50.3 ± 17.7, P < 0.01), and cortisol levels at 30 minutes (22.0 ± 6.7 minutes, P < 0.01) and 60 minutes (20.3 ± 6.7 minutes, P < 0.01) after CRH injection, when compared to the pre-stimulation ACTH and cortisol values. CONCLUSION: Intravenous CRH administration increased esophageal electrical sensitivity in normal subjects, emphasizing the important role of stress in esophageal sensitivity.
Administration, Intravenous ; Adrenocorticotropic Hormone ; Asian Continental Ancestry Group ; Catheters ; Corticotropin-Releasing Hormone* ; Electric Stimulation ; Esophagus ; Gastrointestinal Motility ; Healthy Volunteers ; Humans ; Hydrocortisone ; Plasma ; Sensation