While the session-RPE (rating of perceived exertion) method can quantify training volume in athletes, this method is not able to evaluate energy expenditure (EE) during a training session. We developed an RPE-based activity record for assessing EE during athletic training, and we compared its results to those obtained using the flex-heart rate (flex-HR) method. The EE of nine female collegiate endurance runners was assessed by the RPE-based activity record and flex-HR methods during eight days in the normal training season. Subjects were asked to record their RPE in the record at 5-minute intervals, and to wear a HR monitor during training. All subjects also participated in an incremental treadmill exercise test, which was used to determine their RPE-EE and HR-EE regression equations. Although the RPE-based activity record significantly overestimated EE (RPE-activity record, 572 kcal/session; flex-HR method, 499 kcal/session; p = 0.031), it had high validity relative to the flex-HR method (intra-class correlation coefficient, 0.891; 95% confidence interval, 0.845–0.923) and there were no systematic errors in EE estimation between the two methods. Therefore, the RPE-based activity record can be used to assess EE during training in female runners. However, RPE-based activity record might overestimate EE for athletes who have more intermittent activities during training than endurance runners, because RPE takes more time for returning to the resting level than HR when the intensity of activity declines. Further research is needed to verify the validity of the RPE-based activity record for assessing EE during other sporting activities or measurement conditions, and to identify the factors affecting the degree of estimation error associated with this method.

PURPOSE: To identify the parameters on noncontrast computed tomography (NCCT) that best predict the success of shock wave lithotripsy (SWL). MATERIALS AND METHODS: We reviewed the records of 75 patients who underwent SWL for urinary calculi measuring 5 to 20 mm. Using NCCT images, we estimated the largest stone cross-sectional area and contoured the inner edge of the stone. Clinical outcome was classified as successful (stone-free or <4 mm in diameter) or failed (stone fragments, > or =4 mm). The impact of preoperative parameters was evaluated by univariate and multivariate analysis. RESULTS: The overall success rate was 73.3%. Average stone attenuation value, stone length, and stone cross-sectional area in the success and failure groups were 627.4+/-166.5 HU (Hounsfield unit) vs. 788.1+/-233.9 HU (p=0.002), 11.7+/-3.8 mm vs. 14.2+/-3.6 mm (p=0.015), and 0.31+/-0.17 cm2 vs. 0.57+/-0.41 cm2 (p<0.001), respectively. In the multivariate analysis, stone attenuation value was the only independent predictor of SWL success (p=0.023), although stone cross-sectional area had a tendency to be associated with SWL success (p=0.053). Patients were then classified into four groups by using cutoff values of 780 HU for stone attenuation value and 0.4 cm2 for cross-sectional area. By use of these cutoff values, the group with a low stone attenuation value and a low cross-sectional area was more than 11.6 times as likely to have a successful result on SWL as were all other groups (odds ratio, 11.6; 95% confidence interval, 3.9 to 54.7; p<0.001). CONCLUSIONS: Stone attenuation value and stone cross-sectional area are good predictors of extracorporeal SWL outcome.
Humans ; Lithotripsy ; Multivariate Analysis ; Shock ; Treatment Outcome ; Urinary Calculi

BACKGROUND AND PURPOSE: Plasma D-dimer levels are elevated during the acute phase of cerebral infarction (CI). We investigated whether the D-dimer level on admission and other clinical characteristics could be used to predict the poor outcome of patients with acute CI. METHODS: The clinical characteristics and plasma D-dimer levels measured within 3 days of onset were compared according to outcome among patients with acute CI. RESULTS: In total, 359 consecutive patients (mean age, 71.8 years) were examined, of which 174 had a poor outcome [score on the modified Rankin scale (mRS) > or =3] at 30 days after hospitalization. The mean mRS score was higher and a poor outcome was observed more frequently among women than among men (p<0.001 for each). The proportions of women, cardioembolism, atrial fibrillation, advanced age (> or =75 years), prior history of CI or transient ischemic attack, and elevated D-dimer level (> or =1.0 microg/mL) were significantly higher among patients with a poor outcome than among those with a good outcome. A multivariate analysis showed that elevated D-dimer level [> or =1.0 microg/mL; odds ratio (OR), 2.45; 95% confidence interval (95% CI), 1.52-3.89; p<0.01], advanced age (OR, 1.93; 95% CI, 1.21-3.07; p<0.01), and female gender (OR, 1.75; 95% CI, 1.08-2.83; p=0.02) were independent predictors of a poor outcome. CONCLUSIONS: Certain clinical characteristics (gender and advanced age) and an elevated D-dimer level upon admission can be used to predict the outcome of patients with acute CI at 30 days after hospitalization.
Atrial Fibrillation ; Cerebral Infarction ; Female ; Fibrin Fibrinogen Degradation Products ; Hospitalization ; Humans ; Ischemic Attack, Transient ; Male ; Multivariate Analysis ; Odds Ratio ; Plasma ; Stroke

With aging of inpatients, the prevention of falls in old people is an important task nurses have to take upon themselves. In our hospital, we have been tackling the task in earnest by utilizing a fall prevention assessment score sheet. Our efforts have resulted in changes in the attitude of nurses as shown by a survey. (1) By working on the nursing plan with use of the fall prevention assessment score sheet, nurses have become alert to risk factors for falling. (2) They have realized that assistance suited to the needs of each patient is vital and that collaboration between patients, their families and hospital staff contributes to the prevention of falls greatly. (3) The use of an intervention manual has made it easy for nurses to cope with falls and consequent injury. (4) To share information of every factor for falling among the nursing staff has added greatly to the prevention of the recurrence of the fall.
Prevention ; Fall, NOS ; Surveys ; Attitude ; Knowledge acquisition using a method of assessment

We evaluated the relation of changes in skin temperature, measured by thermography, to clinical symptoms and findings in patients who underwent coronary artery bypass surgery using the radial artery. All had a negative Allen test before operation. Ten consecutive patients who underwent surgery at least 3 months prior to the study were selected. Left radial artery grafts were harvested in all patients. Skin temperature was measured twice, before and after exercise. Two patients had a cold sensation at the arterial harvest site at rest. Three, including these two, complained of pain along the harvest site after exercise. No differences in temperature were observed before and after exercise in the ulnar aspects of the palm or forearm on either the left or right side. On the other hand, the increase in radial aspect temperature on the left side was smaller than that on the right. Skin temperature was clearly decreased after loaded exercise in 3 patients. We believe that the indications of grafting should be carefully considered because patients can show findings associated with circulatory disturbance at arterial harvest sites.

A 26-year-old man with Marfan's syndrome suffered aortic dissection repeatedly during hospitalization. He was admitted with a diagnosis of annuloaortic ectasia with severe aortic regurgitation. A type A aortic dissection occurred after diagnostic angiography. Three weeks after the onset of the dissection, an aortic root replacement in combination with a total arch replacement was performed. Eight months later, residual dissection in the descending thoracic aorta was replaced with distal perfusion by a temporary bypass from the left subclavian artery to the descending thoracic aorta. At the termination of the operation, abdominal aortic dissection occurred with acute bilateral limb ischemia, which was treated with abdominal aortic intimal fenestration. He recovered uneventfully and was discharged 3 weeks after operation. In light of our experience, because of vascular fragility, great care should be taken in treating patients with Marfan's syndrome to avoid iatrogenic aortic dissection.

The purpose of this study was to confirm both the reproducibility of indices (NIRS slope, NT2, %NIRS fall) and the specificity obtained by analyzing the muscle oxygenation curve measured by near-infrared spectroscopy (NIRS) during ramp exercise. Ten healthy men participated in this study. The NIRS probe was placed on the vastus lateralis muscle. An increase in oxygenation was observed from rest to warm-up at 0 watts (Δ NIRS) . Oxygenation began to decrease lineally as the workload increased (NIRS slope) . In the latter phase of exercise, the oxygenation curve flattened out despite an increasing workload, and as a result, an inflection point was formed (NT2) . The minimum value of oxygenation during ramp exercise was indicated as“%NIRS fall.”
Protocol 1. After a warm-up period of 3 min at 0 watts, a ramp exercise (20 watt/min) test was performed until volitional fatigue. The test was performed for each subject twice (test-1, test-2) with a 1-week interval. Protocol 2. A test was performed with three consecutive ramp exercises (lOwatt/min·20watt/min·30watt/min) up to120watt each with sufficient rest between the exercises.
NT2 was observed in 7 of 10 subjects. Test-1 and test-2 mean values of ANIRS, NIRS slope, watts at NT2 (NT2) and %NIRS fall were not significantly different, and the correlations between test-1 and test-2 were highly significant (r=0.94, P<0.0001: ANIRS, r=0.99, P<0.0001: NIRS slope, r=0.91, P<0.002: NT2 and r=0.78, P<0.005 : %NIRS fall) . The regression lines obtained for correlations of results of test-1 and test-2 were y=-5.89+1.38X (Δ NIRS), y=0.02+ 1.03X (NIRS slope), y=31.52+0.83X (NT2), and y=19.91+0.61X (%NIRS fall) . No significant differences in both intercept and coefficient between the regression line and identity line were found in the NIRS slope and NT2. The rate of decrease in the oxygenation curve became steeper with an increase in work-load from 10 watts/min to 20 watts/min and to 30 watts/min. However, the mean values of the NIRS slope, modified by watts, were 0.29±0.06%/watt, 0.29±0.07%/watt and 0.29±0.07%/watt, respectively. There were no significant differences of the NIRS slopes among these exercises. The results indicate constancy of the rate of decrease in oxygenation per workload.
In conclusion, these findings demonstrate the reproducibility of the NIRS slope and the appearance of NT2 during ramp exercise, and the specific way in which the decrease in muscle oxygenation reflects workload. They suggest that analysis of the muscle oxygenation curve can be used to estimate muscular metabolism and indices of training effects.

A study was conducted to establish a method for quantitative evaluation of both the rate and degree of muscle oxygenation during ramp exercise using Near Infrared Spectroscopy (NIRS), and to determine the relationship of the indices to body composition and physical fitness. The subjects were 13 healthy men. After a warm-up period of 3 min at 20-W, the ramp exercise test was conducted. The exercise consisted of an increasing work rate at a slope of 20 W/min on a cycle ergometer performed until volitional fatigue. The NIRS probe used in the cycling exercise was placed on the vastus lateralis muscle. After 30 min of exercise, calibration was performed by cuff occlusion for 10 min with a pressure of 260 mmHg for quantitative determination of the NIRS curve. The oxygenation curve measured by NIRS during the exercise initially exhibited a linear decrease as the work rate increased. This rate of decrease in oxygenation was indicated by the NIRS slope (%/W) obtained from the calibration curve. In later stages of the exercise, the NIRS curve became flattened with increased work rate. The breaking point between the sloping phase and the flat phase was named the “NIRS Threshold 2, NT 2”. In addition, the rate of decrease in oxygenation at the end of exercise per maximal NIRS decrease obtained from the calibration curve was indicated as the %NIRS fall. The mean NIRS slope and %NIRS fall were 0.3±0.1%/W (range, 0.13 to 0.50%/W) and 29.9±11.8% (range, 12.0 to 50.0%), respectively. NT 2 was observed in 8 of the 13 subjects. The subjects were divided into two groups (NT 2 (+) and NT 2 (-) ) based on the appearance of NT 2. Both the NIRS slope and %NIRS fall in the NT 2 (+) group were significantly higher than those in the NT 2 (-) group. The NIRS slope was significantly correlated with VO₂/wt at VT (r=0.73, p<0.05) and wattage at VT (r=0.86, p<0.0001) . The %NIRS fall was significantly correlated with VO₂/wt at peak (r=0.80, P<0.001) . The NIRS slope and %NIRS fall were not significantly correlated with body mass index, %fat or thigh circumference.
These findings suggest that the NIRS slope indicates the efficiency of oxygen exchange in muscles activated during incremental exercise, and that the %NIRS fall indicates the ability to utilize Oxy-Hb+Mb against maximal oxygenation capacity in muscles. The NIRS slope and %NIRS fall can therefore be used as indices of muscular limitation during exercise, and as indices of muscular adaptation during exercise.

Re-do open cardiac surgery may sometimes require complete ablation around the pericardium for the 2 major reasons of attaining better myocardial protection and obtaining effective DC cardioversion. However, this ablation may increase postoperative hemorrhage which may require blood transfusion. Hypothermia is based on the concept of myocardial protection during open heart surgery by suppressing myocardial metabolism, but recently the approach has been changed to maintaining myocardial metabolism with aerobic or anaerobic energy production. We have already reported that histidine-buffered cardioplegia which promote anaerobic glycolysis, provided an excellent functional recovery of myocardium post-ischemia with lower inotropic requirements in a range from 10°C to 37°C of myocardial temperature. Based on our theoretical background and clinical data, we tested the efficacy of this type of cardioplegia in patients receiving multiple surgical procedures with minimum ablation after sternotomy. First case, who had undergone a Bentall procedure for annulo-aortic ectasia 14 years previously had a thrombotic valve and mitral regurgitation. Aortic valve plasty and mitral valve replacement (MVR) was performed. The second case who had undergone MVR 15 years previously had malfunction of the prosthetic valve and underwent re-MVR. The third and fourth cases had ventricular septal defect (VSD) which were closed using Teflon patches. The third case had patch closure during second operation for residual shunt. The fourth case received tricuspid valve replacement (TVR) for tricuspid regurgitation due to a pacemaker lead implanted into the right ventricle through the left subclavian vein. The fifth case received coronary artery bypass surgery in a second operation for restenosis of the graft and progressing atherosclerosis. All hearts started beating spontaneously without DC cardioversion after the aortic unclamp. Ventricular fibrillation occurred in the first case while the patient was weaned from cardiopulmonary bypass and treatment was performed by aortic cross clamp, infusion of the cardioplegia followed by aortic unclamp to start own beat again. Two of 3 patients who were able to donate their own blood preoperatively did not require homologous blood transfusion. Due to advantages such as excellent myocardial protection under hypothermic or normothermic condition, ease of use and relatively lower potassium concentration, histidine-buffered cardioplegia can be an excellent candidate for myocardial protection in re-do cases with less ablation technique.

A study was performed to clarify the effects of endurance training above the anaerobic threshold (AT) on the isocapnic buffering phase during incremental exercise in athletes. Eight middle-distance runners aged 19.6±1.2 years performed incremental exercise testing with a modified version of Bruce's protocol. After a 6-month high-intensity interval and paced running training at levels above AT, maximal oxygen uptake (VO₂max) (ml⋅ kg^-1⋅min^-1) was significantly increased from 60.1±5.7 to 64.7±5.5 (p<0.05) . AT (m⋅lkg^-1⋅min^-1) was slightly but significantly increased from 28.2±3.5 to 29.6±4.3 (p<0.05) . The respiratory compensation point (RC) (ml⋅ kg^-1⋅min^-1) was markedly increased from 53.0±8.3 to 57.7±8.2 (p<0.05) . Although neither the slope of the first regression line below AT (S1) nor that of the second line above AT (S2) calculated by V-slope analysis was altered, the range of isocapnic buffering (ml⋅kg^-1⋅min^-1) from AT to RC was significantly extended from 24.8±5.9 to 28.1±6.0 after the 6-months of training (p<0.05) . In addition, the amount of change in VO₂max after the 6-month of training period (ΔVO₂max) was correlated with Δisocapnic buffering (R=0.72, p<0.05) . We conclude that the degree of increased respiratory compensation point is larger than that of AT after high-intensity endurance training at levels above AT, and that the range of isocapnic buffering may be an important factor in relation to the increase in the maximal aerobic capacity of athletes.