To clarify the function of the vastus medialis obliquus (VMO) and longus (VML), we investigated the electromyographic properties of superficial quadriceps femoris during fatiguing knee extension task.Ten healthy male and 10 female volunteers participated in this study. The subjects performed fatiguing knee extension task at maximal effort (10 times×10 set at 60 deg/sec). Surface electromyography (EMG) was recorded from the VMO, VML, vastus lateralis(VL) and rectus femoris(RF) during isometric knee extension (knee bent at 60 deg and 30% of the maximal voluntary contraction level) with a 90-sec interval between each set. Knee extension peak torque, integrated EMG (IEMG) and median power frequency (MDF) of four muscles during each set were compared using Dunnett's test.Knee extension peak torque decreased gradually and peak torque decreased significantly starting from set 9 in male subjects, while there was no significant decrease in female subjects. IEMG from VMO and VL increased linearly. IEMG increased significantly from set 7 in VMO and set 6 in VL for both male and female subjects. Then, IEMG from both VML and RF increased significantly starting from set 9 in VML and set 8 in RF in male subjects, while there was no significant change in female subjects.MDF of VMO, VL and RF also increased significantly at timepoints similar to those showing increases in IEMG in male subjects. However, MDF of VML increased significantly from set 4 in male subjects. On the other hand, MDF did not change significantly in female subjects.As a result of this study, it was suggested that VMO and VL were facilitated to maintain target knee extension torque during fatigue. Therefore, it was considered that VML and RF facilitated the maintenance of target torque under fatiguing conditions.

[Background] Although we have demonstrated the clinical effect of acupuncture therapy with epidermal stimulation by needle penetration, its neurophysiological mechanisms are unclear. To investigate the clinical effects of epidermal stimulation by needle penetration on muscle tone, we tested the Hoffmann's reflex (Hreflex) of the soleus muscle during epidermal needle stimulation.
[Methods] Eighteen healthy participants were recruited. We tested the soleus H-reflex elicited by tibial nerve stimulation before and after epidermal stimulation by needle penetration. Epidermal stimulation was performed at several points on the Achilles tendon by needle penetration. We analyzed the amplitude ratio of H/M obtained from the waveforms of the soleus muscle before and after epidermal stimulation.
[Results] The amplitude ratio of H/M was significantly decreased during stimulation when compared with ratio during rest (p < 0.05). Each participant demonstrated a decrease in soleus muscle amplitude ratio of H/M during epidermal stimulation by needle penetration as compared with the ratio during rest.
[Discussion] Epidermal stimulation of the muscle by needle penetration activated the inhibitory interneurons of the dermatome at the stimulation site. Therefore, epidermal stimulation by needle penetration was considered as a possible method to induce muscle relaxation.
[Conclusion] It is suggested that epidermal stimulation by needle penetration for 2 minutes for the insertion of the Achilles tendon results in an inhibitory effect by stimulating the spinal cord neural mechanisms that correspond to the soleus muscle.

The aim of this study was to investigate the effects of acupuncture to SP 3 on the quadriceps femoris during knee extension in patients with musculoskeletal diseases by applying the meridian concept.
The subjects included 10 healthy individuals with a mean age of 23.1 years, and all of whom provided informed consent for participation. During knee extension, each subject underwent three different types of acupuncture stimuli : 1) stimulation to SP 3, 2) stimulation to SP 4, and 3) no stimulation. For each stimulation,the subjects performed isometric contraction with 40% of maximum voluntary contraction with knee flexion to 60°. Surface electromyography (EMG) of the vastus medialis obliquus, vastus medialis longus, rectus femoris,and the four sites within the vastus lateralis was performed during knee extension before acupuncture stimulation ; immediately after starting stimulation ; and 5, 10, and 15 min after starting stimulation. Relative-integrated EMG data was recorded during and after acupuncture stimulation and compared to data that were recorded before acupuncture as reference values.
The results showed that after 15 min of acupuncture stimulation to SP 3, the relative-integrated EMG data on the vastus medialis obliquus was significantly increased compared to the data obtained without stimulation (p < 0.05).
Therefore, in conclusion, after 15 min of acupuncture stimulation to SP 3, the relative-integrated EMG data on the vastus medialis obliquus exhibited suppressed muscle function.

We report a successfully treated case of infectious endocarditis with ventricular septal defect (VSD) and double-chambered right ventricle. A 41-year-old man complained of dyspnea. Echocardiography showed his tricuspid valve, aortic valve, and pulmonary valve had vegetation and severe regurgitation. He received treatment with antibiotics but it was not effective. He underwent TVR, AVR, pulmonary valve resection, VSD patch closure and RV abnormal muscle resection. Pathological findings of resected valves showed infectious endocarditis. He recovered uneventfully and resumed his original social activities.

A 61-year-old woman developed shock during transportation to our hospital in an ambulance under a diagnosis of acute myocardial infarction, Emergency coronary angiography showed left anterior interventricular descending branch #6 to be completely occluded. At the same time, ultrasonic cardiography showed pericardial effusion. Therefore we diagnosed left ventricular free wall rupture, and performed emergency surgery to repair the rupture site. After pericardiotomy massive hemorrhage occurred and we diagnosed blow-out type left ventricular free wall rupture. We immediately established extracorporeal circulation via the femoral artery and vein, and cross clamped the ascending aorta, then achieved cardiac arrest. Because the area of myocardial infarction was extensive, we applied the David-Komeda method to avoid bleeding due to left ventricular systolic pressure, left ventricular aneurysm or ventricular septal rupture. The postoperative course was good; the patient was weaned from PCPS on the 3rd day postoperatively, IABP on the 5th day postoperatively and from the respirator on the 8th day postoperatively. She was discharged on postoperative day 40. Currently she has no cardiac complains, no left ventricular aneurysm and no neurological problems. Left ventricular free wall rupture can remain a fatal complication after acute myocardial infarction. We consider the David-Komeda method useful for repairing left ventricular free wall rupture (blow-out type) after acute myocardial infarction as well as ventricular septal rupture without a risk of left ventricular aneurysm, bleeding or ventricular septal wall rupture.

To investigate the effects of Kampo and a rehabilitation approach on patients with spinocerebellar degeneration (SCD), a 65-year-old female patient with SCD was treated with Ogi-kenchu-to and therapeutic exercise based on the Bobath concept.
She had a gait disturbance (unable to walk) with slightly increased muscle tonus and deep sensory disturbance in the left leg before therapy. In Kampo confirmations, there was a generalized cold feeling and fatigue due to decreased physical fitness. In the electrophysiological study, the amplitude of Auditory Brainstem Responses (ABR) and Somatosensory Evoked Potentials (SEP) in the left side showed a greater decrease than those in the right side. The amplitude of the F-wave in the left side showed a greater increase than that of the right side.
After two months of this therapy, the patient was able to walk unassisted. Improvement in the neurological and general findings, along with normalization of the ABR, SEP and F-wave were also observed.
It was suggested that Kampo therapy using Ogi-kenchu-to and therapeutic exercise based on the Bobath concept were effective in the treatment of this patient with SCD.