This is a case report evaluating the improvement of activities of daily living (ADL) after TKA in stroke patient with hemiplegia and knee osteoarthritis. The case was a 73-year-old female with left hemiplegia caused by cerebral infarction. She also suffered from severe bilateral knee osteoarthritis and obesity. The hemiplegia and knee dysfunction disturbed her ADL. When she was admitted to our hospital, her FIM motor subscore was 23 and body mass index (BMI) was 36.0. She went on a diet and continued rehabilitation. Her knees were treated conservatively. Six months after the stroke, her FIM motor subscore was 35 and BMI was 29.8. For the purpose of pain relief and improvement of range of motion, right TKA was performed seven months after stroke. And left TKA and lengthening of the gastrocnemius were performed eleven months after her stroke. Rehabilitation was continued carefully in order to avoid deep venous thrombosis. In addition, a left obturator nerve block was performed as treatment for spasticity of her hip adductor muscle. Fifteen months after the stroke, her FIM motor subscore was 77 and BMI was 25.7. TKA is a common treatment for osteoarthritis but when a patient has a stroke, it is difficult to determine whether to perform surgery or not. In this case, bilateral TKA achieved improvement of ADL. We suggest that even if a patient has stroke hemiplegia, TKA should be considered for knee osteoarthritis based on the appropriate assessment and careful risk management.

The purpose of this study was to determine the differences between walking stairs one step at a time versus using alternating feet by evaluating muscle tensions and joint forces. This quantitative basic knowledge will be useful in setting safe guidelines for stair walking in rehabilitation programs. Five healthy young males participated as subjects. Ascending and descending motions were measured by utilizing a 3 D motion analysis system, a force platform and an EMG telemetry system. Measurements were made for three conditions : 1) Both limbs during alternating feet walking (normal stair walking : NW), 2) The leading limb (LL) and 3) The trailing limb (TL) when walking stairs one step at a time. Moments of force on the joints, muscle tensions and joint forces were calcu-lated using two mathematical models (the link segment and musculoskeletal models, Yamazaki (1992) ) . When ascending, maximum flexion angles of three joints in the TL were smaller than during NW. Also, quadriceps tension in the TL and soleus tension in the LL were smaller than during NW. Except for joint force, which was directed toward the anterior of the tibia, knee joint forces in the TL were smaller than during NW. When descending, maximum flexion angles of the three joints of the LL were smaller than during NW. The quadriceps tension and the soleus tension in the LL were smaller than during NW. Knee joint forces in the LL were smaller than during NW. The results suggested that : 1) When ascending, if a patient has a failure in the system of knee extension, the unaffected side should be made the LL and the affected side the TL. Also, if there is a failure in the system of plantar flexion, the unaffected side should be the TL and the affected side the LL. 2) When descending, if there is a failure in one limb, the unaffected side should be the TL and the affected side the LL.

Objective: The Hyogo Hospital Pharmaceutical Society has been conducting an original pharmacy postgraduate education program, “lifelong learning program (to nurture pharmacy specialists)”, since 2002 using the Internet.  To understand the status of using this program, this study employed a questionnaire survey involving all registered members.
Methods: Subjects were all members (1,870) of the society.  Questionnaires were distributed and collected by mail.
Results: Only 20.1% of the members had experience of using the program, and the frequency of using it was less than once per 6-12 months in 60% of the members.  Their level of awareness concerning the acquisition of credits for lifelong learning was 36.9%.  The program category they wished to take was an infection-related program in 26.1% of the members, which was the highest.
Conclusion: As reasons for only a small number of members using the program, the following are considered: loss of user’s ID and password required to login, and lack of awareness concerning the acquisition of credits for lifelong learning offered by the Japanese Society of Hospital Pharmacists.  As future issues, we must encourage members to obtain a new password and be proactively involved in preparing new program categories that the members wish to take, in order to promote the continuous use of the program.

We report the findings in a 75-year-old woman who was given diagnosis of rupture of the internal thoracic artery (ITA) and was successfully treated by coil embolization. The patient suddenly felt chest pain, and a chest CT revealed a mediastinal hematoma. She was suspected to have an acute aortic dissection, and therefore transferred to our hospital. Upon careful examination, a CT showed a hematoma in the superior mediastunum and the extravasation of the left internal thoracic artery. Emergency coil embolization was thus performed to stop the bleeding. After the embolization, no further hemorrhaging was observed. The patient was uneventfully discharged in a healthy state 2 weeks later. Rupture of the internal thoracic artery is rare. However, it is important to include this potential disease in the differential diagnosis when encountering a patient presenting with an atraumatic mediastinal hematoma.

In this study, we examined a reliability of age-predicted heart rate (HR) for the 50%VO₂max which is widely used during a training program for health promotion as compared to HR at the double product break point (DPBP). Two hundred fifty six non-hypertensive subjects (NHT), and 49 hypertensive ones under medication (HT) were studied. HT subjects were divided into two subgroups based on antihypertensive medications, ones with HR non-suppression agents (HT+HRNS) and the other with HR suppression agents (HT+HRS). DPBP was measured with the use of an incremental exercise test, and HR at DPBP (HR@DPBP) was determined. Age-predicted HR for the 50%VO₂max intensity of exercise was calculated with the following formula; HR=138–age/2. Measurable rate of DPBP and HR@DPBP in NHT, HT+HRNS and HT+HRS were 93.8% and 120±14bpm, 92.7% and 104±12bpm, 78.5% and 94±16bpm, respectively. There were significant differences in HR@DPBP and age-predicted HR in NHT and HT+HRS (p<0.01 in both groups). But %ΔHR ((age-predicted HR–HR@DPBP)/HR@DPBP x 100) within -10%∼+10% in NHT, HT+HRNS and HT+HRS were 68%, 58% and 14%, respectively. This might be due to HR at rest with sitting position that was significantly correlated to %ΔHR in all groups (r=-0.604, p<0.001 in NHT, r=-0.689, p<0.001 in HT+HRNS and r=-0.761, p<0.05 in HT+HRS, respectively). And the range of HR at rest with sitting position corresponding to -10%∼+10% of %ΔHR were 70∼95bpm in NHT, 71∼93bpm in HT+HRNS and 83∼102bpm in HT+HRS. In addition, this study indicated that DPBP could be measured even under antihypertensive medication that might affect DPBP measurement.In conclusion, we demonstrated that HR at DPBP and age-predicted HR were similar among 58-68% of NHT and HT+HRNS. And the range of HR at rest with sitting position to ensure reliability of age-predicted HR was elucidated.

The aim of this study is to elucidate the relationship between the predicted 50%VO₂max/wt (ml/kg/min) and coronary risk factors (CRFs).Seven hundred eighty six men (37.3 +/- 13.5 years old) and 1,268 women (41.5 +/- 13.6 years old) were studied. The predicted 50%VO₂max/wt was calculated by utilizing data from the continuous incremental exercise test with a stationary bicycle ergometer and the age-predicted heart rate at 50%VO₂max (=138-age/2). As CRFs, percent body fat, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting blood sugar and HbA1c were measured.The age-adjusted odds ratio of having abnormal values in CRFs across quartiles of the predicted 50%VO₂max/wt (highest to lowest) were 1.00 (reference), 1.39, 2.64, and 6.78 in men, and 1.00, 1.73, 2.33 and 3.44 in women (for trend, p<0.001), respectively.This study indicated that the lower 50%VO₂max/wt resulted in the higher odds ratio of having abnormal values in CRFs among Japanese. It was also confirmed that the sub-maximal aerobic capacity was associated with CRFs.

The purpose of this study was to clarify the effects of different frequencies of skipping rope on the elastic components of muscle and tendon in human triceps surae. Six male subjects performed ten rounds of skipping rope. Skipping tempos were with in a range of 100-170 skips per minute (SPM) . The vertical ground reaction force and the surface EMG of triceps surae muscles were recorded during each skipping round. Elastic components of muscle and tendon were estimated by Residual Time (RT : lag time difference between the vanishing point of muscle discharge and disappearance of EMG, and the end of the ground reaction force wave) and RTintegrate (integration of ground reaction force while RT still appears) . RT and RTintegrate at 100 SPM were the smallest values for all jump frequencies. On the other hand, integrated EMG (iEMG) at 100 SPM was the largest value for all jump frequencies. Although RT and RT_integrateprogressively increased as SPM was increased, iEMG correspondingly decreased. Rate in utilization of elastic components of muscle and tendon assessed by RT_integrateat 170 SPM corresponds to 150% at 100 SPM. These results suggest that the rate in utilization of the elastic components of muscle and tendon while skipping rope, depend on jump frequency.

Previously, we have reported that age-predicted heart rate at 50%VO₂max (HR@50%VO₂max) is an effective index of adjusting appropriate exercise intensity for health promotion exercise. Thus, the aim of this study is to elucidate the change in HR at double product break point (HR@DPBP) and the validity of HR@50%VO₂max due to improvement of cardiovascular fitness. Ninety two healthy adults (57 +/- 9 years old), who participated in the health exercise training course, were studied. Participants were instructed how to control the intensity of physical activity for DPBP during their daily life. DPBP was determined with the use of incremental exercise test, and METs at DPBP (METs@DPBP), HR@DPBP, ratings of perceived exertion at DPBP (RPE@DPBP) were measured before and after the course. HR@50%VO₂max was calculated with the following formula; 138 - age/2 (bpm). METs@DPBP significantly increased (p<0.001) after 10 weeks of the course, whereas HR@DPBP did not change. Interestingly, however, there was a significantly positive correlation (p<0.001) between amount of change in METs@DPBP and that in HR@DPBP (ΔHR@DPBP). Multiple linear regression analysis indicated this correlation was independent from sex, age and amount of change in HR at rest (p<0.001). Before and after the course, proportion of study subjects’ %ΔHRs ((HR@50%VO₂max - HR@DPBP) / HR@DPBP x 100) within -10% ~ +10% were both 48.9%, and proportion of study subjects’ RPEs@DPBP within 11~13 were 92% and 85%, respectively. In this study, it was identified that significantly positive relation between amount of change in cardiovascular fitness and that of ΔHR@DPBP. This finding was independent from potentially affecting factors. In conclusion, this longitudinal study could suggest that HR@50%VO₂max and RPE were valuable indexes of determining exercise intensity for health promotion exercise.