Purpose: There are many cancer patients who hope to be able to walk to the toilet for as long as they can before death. However, there are no reports of investigation of the ability of advanced cancer patients to go to the toilet, and how the symptoms affect this ability at the end of life in these patients. Methods: We retrospectively investigated the ability of advanced cancer patients to walk to the toilet during their final month of life in our palliative care unit. Data of a total of 154 patients who had died of cancer between January 2010 and December 2011 （median age 75.0±11.6 years） were analyzed in the study. In addition, we compared the frequencies of the symptoms （pain, shortness of breath, drowsiness, delirium, opiate use, oxygen use） between the walking group and the non-walking group. Results: Of the 154 patients, 79 （51.3%） were able to walk to the toilet in the month before their death, 54 （35.1%） in the two weeks before their death, and 33 （21.4%） in the final week before their death. The walking group showed more shortness of breath as compared to the non-walking group. The non-walking group showed more delirium and drowsiness. Conclusion: This study showed that the ADL are relatively preserved in terminal cancer patients. There is the possibility of providing support to their physical ability by rehabilitation. The consciousness level and shortness of breath should take into consideration to provide rehabilitation.

AIM　To study the effects of superoxide anion (O.2) on Ca2+ homeostasi and contractility in cultured bovine aortic smooth muscle cell. METHODS　Using Fura-2 fluorescence technique to determine Ca2+ level and collagen gel contraction system to analyze muscle contractility. RESULTS　ATP (10 μmol*L-1 )-induced Ca2+ transient was smaller in xanthine oxidase treated cells(X/XO) than control. The mean peak increment of ［Ca2+］i(△［Ca2+］i peak) and the time integral of the elevated ［Ca2+］i(∫△［Ca2+］i dt) for 5 min were decreased from (206.1±10.2) to (147.4±14.7) nmol·L-1,and from (12.2±0.5) to (9.8±0.8) μmol·L-1·s-1. Δ［Ca2+］i peak induced by thapsigargin（1 μmol·L-1 ）in Ca2+-free solution was not affected by X/XO, but was decreased from (27.3±1.0) nmol·L-1 to (13.5±1.0) nmol·L-1 in Ca2+-containing solution because of the activation of CRAC(△［Ca2+］i CRAC). X/XO accelerated the velocity of thapsigargin-induced Ca2+ leak from (78.7±3.4) s to (64.8±4.40) s. Gel contraction area in X/XO-treated cells induced by ATP or thapsigargin (in Ca2+ free solution and in Krebs solution)was decreased from 23.6%±4.6% to 7.4%±0.2%, from 3.5%±0.6% to -1.0%±0.5%, and from 7.9%±1.4% to -0.5%±0.7%, respectively. CONCLUTION　O.2 attenuats smooth muscle contraction by impairing some of Ca2+ mobilization pathways.

AIM To study the effects of superox- ide anion (O ) on Ca2+ homeostasi and contractility in cultured bovine aortic smooth muscle cell. METHODS Using Fura-2 fluorescence technique to determine Ca2+ level and collagen gel contraction system to analyze muscle contractility. RESULTS ATP (10 ?mol? L-1 )-induced Ca2+ transient was smaller in xanthine oxidase treated cells(X/XO) than control. The mean peak increment of [Ca2+ ]i (△[Ca2+ ], peak) and the time integral of the elevated [Ca2+ ], (∫ △[Ca2+ ]i dt) for 5 min were decreased from (206. 1 ? 10.2) to (147.4 ? 14.7) nmol? L-1, and from (12.2 ?0.5) to (9.8 ? 0.8) ?mol?L-1 .s-1. △ [Ca2+ ], peak induced by thapsigargin(1 ?mol. L- 1 ) in Ca2+ -free solution was not affected by X/XO, but was decreased from (27. 3 ? 1 .0) nmol? L－l to (13 .5 ? 1 .0 ) nmol? L- １ in Ca2+ -containing solution be cause of the activation of CRAC(△［Ｃa2+ ], CRAC). X/XO accelerated the velocity of thapsigargin-induced Ca2+ leak from (78.7 ? 3.4) s to (64.8 ? 4.40) s. Gel contraction area in X/XO-treated cells induced by ATP or thapsigargin (in Ca2+ free solution and in Krebs solution) was decreased from 23.6% ? 4.6% to 7.4% ?0.2%, from 3.5% ?0.6% to － l.0% ? 0.5%, and from 7.9% ? l.4% to － 0.5% ? 0.7%, respectively. CONCLUTION O2- attenuats smooth muscle contraction by impairing some of Ca2+ mobilization pathways.

Ninety patients with abdominal aortic aneurysm underwent endovascular stent grafting in our hospital between 2001 and 2006 and two patients required graft replacement of abdominal aortic aneurysms during the late postoperative phase. Case 1 was a 77-year-old man for whom endovascular stent grafting for an abdominal aortic aneurysm and thoracic aortic aneurysm had been performed concomitantly. Six months later, because the abdominal aortic aneurysm had expanded from 68mm to 75mm in diameter, due to a type I endoleak which was detected postoperatively, he underwent open surgery. An occlusion balloon was inflated at the proximal site of the celiac artery until the stent graft was extracted. After positioning the aortic clamp below the origin of the renal arteries, a bifurcated graft was implanted. The postoperative course was uneventful. Case 2 was an 86-year-old woman who had undergone endovascular stent grafting for an abdominal aortic aneurysm. The endovascular procedure was successful and no endoleak was detected postoperatively. However, 13 months later, a community hospital admitted her in a state of shock due to ruptured abdominal aortic aneurysm. She was transferred to our hospital and underwent an emergency operation. Because insertion of an occlusion balloon into the brachial artery failed, we primarily performed supravisceral aortic cross clamping. After opening the aneurysm sac, the stent graft was removed and a bifurcated graft was implanted. After declamping, we found that the right common iliac artery was occluded, and therefore aorto-right external iliac bypass grafting was then also performed. The postoperative course was uneventful.

To clarify the effect of sports wear on exercise-heat stress, we analyzed quantitative differences in thermoregulatory responses among baseball uniforms (BB), soccer uniforms (SC), and swimming trunks (NU) during exercise in a hot environment. Eight male subjects performed three sessions of 20-min cycling at light intensity (250W/m²) wearing BB, SC and NU in a room maintained at 28°C (wet-bulb globe temperatures, WBGT) . Esophageal (Tes), mean skin (Tsk), and mean body temperatures (Tb), heart rate (HR), thermal sensation (TS), and total sweat loss (m_SW) were measured during the exercise. Increases in Tes, Tsk, Tb, HR, and TS during exercise were significantly (p<0, 05) higher, and m_SW, was significantly (p<0.001) greater for BB than SC and NU. The increase in Tes at the end of the exercise was 3.0 times higher for BB than NU ; and also 2.0 times higher for SU than NU. Under all conditions, the increase in Tes significantly correlated with Tsk (r=0.634, p<0, 001) and HR (r=0.854, p<0.001) ; m_SW also significantly correlated with Tb (r=0.683, p<0.001) at the end of the exercise. These findings suggest that quantitative differences regarding the increase in Tes among BB, SC and NU relate to Tsk elevation due to attenuation of heat dissipation depending on sports wear ; body temperature elevation also relates to the increase in HR and m_SW during light exercise in a hot environment.

　　It usually takes several days to detect slow-growing bacteria by a blood culture system. Moreover, even if the microbial growths are detected in blood samples, they will escape our notice at a microscopic examination using Gram’s stain. Consequently, the results are often regarded as false positive.　　This paper reports case of malignant lymphoma in which bloodstream infection caused by slow-growing spirillum was observed. The patient in chemotherapy for malignant lymphoma, complained of repeated fever. Repeated blood cultures were taken and occasionally positive signals, which mean increased CO2 concentrations in the culture bottle, were detected by BACTEC 9240 (Becton Dickinson). However, routine microscopic examination with Gram’s stain did not detect any bacteria. Thus, the results of BACTEC were thought to be false positive. Thereafter, the bacterial culture period was extended. Finally, a spirillum, suspected of one of Helicobacter species, was observed microscopically. The detected spirillum was regarded as Helicobacter canadensis with 98.08% homology, using polymerase chain reaction with the 16S rRNA method and basic local alignment search tool (BLAST).　　H. canadensis is one of new species isolated from humans with diarrhea. This bacterium is considered to cause a zoonotic infection. There have been some case reports that this bacterium infected immunosuppressive patients, so we should exercise caution against such conditions. Moreover, we should keep vigilant against the spread of slow-growing bacteria when there are discrepancies in findings between blood culture system and microscopic examination. It is useful to extend the culture period to detect such slow-growing bacteria.

A 61-year-old man underwent thoracic aortic graft replacement and abdominal aortic graft replacement because of a dissecting aneurysm. He presented with a ruptured residual dissecting thoraco-abdominal aortic aneurysm and underwent emergency thoraco-abdominal aortic graft replacement in February 2007. An inverted bifurcated graft was fashioned by cutting one of the two graft legs and creating an elliptical patch, like a cobra-head. In order to prevent paraplegia after the operation, it was necessary to shorten the duration of spinal cord ischemia. Once the elliptical patch was sutured to the orifices of the internal costal arteries with running sutures, selective intercostal arterial perfusion was initiated by using a cardiopulmonary bypass. After the operation, he did not suffer paraplegia.

To clarify the effects of varying skin temperature due to several types of clothing on temperature responses and heat-stress during exercise, we analyzed thermoregulatory responses while wearing various types of sportswear including soccer (SC), baseball (BB), and fencing uniforms (FU), and while wearing water-perfused suits (WS) and vests (WV) during exercise in a hot environment. We also compared these results with those obtained under a semi-nude condition (NU). Eight male subjects performed three 20-min cycling sessions at light intensity (250W/m²) in a room maintained at 28°C (wet-bulb globe temperature, WBGT). The experiment was performed under ten conditions, with six sets of clothing, WS and WV at 14°C (WS14, WV14), 20°C (WS20, WV20) and 26°C (WS26, WV26), and FU, SC, BB or NU. While wearing sport-swear, increases in esophageal (ΔTes), mean skin (Tsk), mean body (Tb) temperature, heart rate (HR), thermal sensation (TS) at the end of exercise, and total sweat loss (m_{sw, tot}) during exercise were significantly (p<0.01) higher in BB and FU than in NU. In comparison to WS or WV conditions, ΔTes was significantly (p<0.01) higher under WV conditions than under NU, while there was no significant difference in ΔTes between WS and NU. Tsk, Tb, HR, TS and m_{sw, tot} tended to be lower in WS14 and 20, and higher in WV26 than in NU. Under all conditions at the end of exercise, the ΔTes markedly increased when Tsk exceeded 34°C ; and ΔTes was significantly correlated with Tsk (r=0.861, p<0.01) for all conditions except WS14 and 20. For Tsk less than 34°C, however, ΔTes remained constant. ΔTes, Tsk, and Tb significantly correlated with HR (r=0.932, p<0.001), TS (r=0.888, p<0.001), and m_{sw, tot} (r=0.961, p<0.001), respectively. These results show that during light exercise under hot conditions, 1) in several types of clothing, a critical level of skin temperature causing core temperature elevation may exist, 2) cooling the skin temperature can alleviate heat-stress due to body temperature elevation, and 3) the semi-nude condition is the simplest method of alleviating core temperature elevation without using body cooling materials such as WS or WV.

Objective：The aim of this study was to examine the relationships between the timing of gait acquisition and the length of hospitalization, and to clarify the differences in background factors and functional recovery during the early postoperative period and their effect on the variability in gait acquisition.
Methods：We recruited 148 patients who underwent total knee arthroplasty (TKA) at three hospitals. The participants were divided into two groups on the basis of the number of days needed to achieve independent gait at ≤14 days after surgery (group A) and ＞14 days after surgery (group B). We compared the background factors between the two groups. Additionally, we compared the preoperative and postoperative function in each group.
Results：We observed a significant positive correlation between the number of days needed to achieve independent gait and the length of hospitalization. In group A, the significant background factors were younger age and higher preoperative activity level. In group A, compared with the level of preoperative function, the postoperative maximum knee extension angle on the operated side and pain had significantly improved. In both groups, the postoperative knee extensor strength on the operated side, knee extensor strength on the nonoperated side, knee flexion strength on the operated side, maximum knee flexion angle on the operated side, and walking speed were significantly reduced.
Conclusion：During early rehabilitation, it is necessary to consider the age and previous activities of patients. In addition, we suggest that early rehabilitation with a focus on reducing pain by alleviating inflammation and improving maximum knee extension angle on the operated side may be effective for fast acquisition of gait.

Objective：To elucidate factors associated with physical function and clarify the actual condition of functional deterioration in patients with knee osteoarthritis (OA) prior to total knee arthroplasty (TKA)．

Methods：We enrolled 467 patients with severe knee OA and preoperatively assessed the following parameters：background factors (sex, age, BMI, K-L grade, and pain) and physical function (muscle strength of knee extensors and flexors, and knee joint angles). A multiple regression analysis was performed to determine the relationship between the independent background factors and dependent physical functions. The median of preoperative function based on selected factors of physical function was calculated.

Results：Based on the multiple regression analysis, sex, BMI, K-L grade, and pain statistically significantly correlated with muscle strength of knee extensors and flexors. Sex and BMI statistically significantly correlated with knee joint flexion angle. K-L grade statistically significantly correlated with knee joint extension angle. The median of muscle strength for knee extension was 0.98/0.92 Nm/kg (Grade 3/Grade 4) for males and 0.70/0.59 Nm/kg for females. The median of muscle strength for knee flexion was 0.53/0.45 Nm/kg for males, 0.36/0.30 Nm/kg for females. The median for knee joint flexion angle was 130° for males and 120° for females. The median for knee joint extension angle was -5°/-10° (Grade 3/Grade 4)．

Conclusion：We clarified the degree of muscle strength and range of motion before TKA in patients with knee OA. We believe that the findings obtained in this study will contribute to explaining the functional deterioration of patients with knee OA.