Objective：Although prediction of functional recovery after lacunar infarction is challenging, quantitative evaluation of brain imaging may be promising. In this article, we investigate association of the amount of corticospinal tract (CST) injury on Computed Tomography (CT) and functional recovery of lacunar infarction in the corona radiata.Methods：In 24 patients with lacunar infarction of the corona radiata, we investigated association of the amount of virtual CST injury with upper and lower limb motor function at 90 days after the stroke onset. The optimal area of the virtual CST to predict motor function was also determined. Finally, we evaluated whether the quantitative CST injury predicted practical motor function regarding activities of daily living.Results：The amount of virtual CST injury, evaluated with Hounsfield unit value of CT, was significantly associated with upper and lower limb function at 90 days after stroke onset. Among them, 6 mm radius CST circle for upper limb had the highest regression coefficient to predict Brunnstrom stage for the upper extremity (R2＝0.69), grip strength (R2＝0.52) and Simple Test for Evaluating Hand function (R2＝0.75). Also, 7 mm radius CST circle for lower limb had the highest regression coefficient to predict Brunnstrom stage for the lower extremity (R2＝0.51), weight bearing index (R2＝0.53) and Berg Balance Scale (R2＝0.52). These virtual CSTs predicted practical function including practical upper limb and ambulation.Conclusion：Quantitative evaluation of CST on CT predicted functional recovery after lacunar infarction of the corona radiata.

Objective：Although prediction of functional recovery after lacunar infarction is challenging, quantitative evaluation of brain imaging may be promising. In this article, we investigate association of the amount of corticospinal tract (CST) injury on Computed Tomography (CT) and functional recovery of lacunar infarction in the corona radiata.Methods：In 24 patients with lacunar infarction of the corona radiata, we investigated association of the amount of virtual CST injury with upper and lower limb motor function at 90 days after the stroke onset. The optimal area of the virtual CST to predict motor function was also determined. Finally, we evaluated whether the quantitative CST injury predicted practical motor function regarding activities of daily living.Results：The amount of virtual CST injury, evaluated with Hounsfield unit value of CT, was significantly associated with upper and lower limb function at 90 days after stroke onset. Among them, 6 mm radius CST circle for upper limb had the highest regression coefficient to predict Brunnstrom stage for the upper extremity (R2＝0.69), grip strength (R2＝0.52) and Simple Test for Evaluating Hand function (R2＝0.75). Also, 7 mm radius CST circle for lower limb had the highest regression coefficient to predict Brunnstrom stage for the lower extremity (R2＝0.51), weight bearing index (R2＝0.53) and Berg Balance Scale (R2＝0.52). These virtual CSTs predicted practical function including practical upper limb and ambulation.Conclusion：Quantitative evaluation of CST on CT predicted functional recovery after lacunar infarction of the corona radiata.

[Introduction]This symposium was organized for the adoption of the Tokyo Declaration for Japanese Acupuncture and Moxibustion at the final meeting of the congress and was composed of three subjects that were supposed to become a framework for the declaration draft.
[Subjects] 1. History of acupuncture in Japan 2. Analysis of the present circumstances 3. Tasks for the future
The first subject was an explanation of important matters in acupuncture development in Japan, based on the key note lecture given prior to this symposium. The second subject was analysis from both aspects of research studies and clinical situations. The third subject was to be suggestions for further development of acupuncture after revealing present problems.
There are more or less many issues in the acupuncture field;clinical practice, education, research and clinical training, but these issues may not have been approached either systematically or generally before. Whereas, in the light of opinions gathered from many others, many future issues came apparent through the three subjects of this symposium. In conclusion, the goal was to find a strategy that would make Japanese acupuncture become a prevailing therapy in the future more than what it is today.

The purpose of this study was to investigate the pathologic changes of jumper's knee before and after jumping and effects of icing after jumping. Sixteen healthy college students and sixteen collegiate volleyball players with jumper's knee were divided into two groups by eight, without icing group and with icing group after jumping exercise. Without icing groups rested for 20 minutes, while with icing groups were treated with ice for 20 minutes after eighty times of jumping. Signal to noise ratio (SNR) and sectional area of patellar tendon with Magnetic Resonance Imaging and the tenderness of patellar tendon with visual analog scale were measured before and after exercise, following with or without icing and 24 and 48 hours later from the treatment. In jumper's knee group, significant increase was found in the SNR, sectional area of patellar tendon, and tenderness of patellar tendon after exercise compared to before exercise. In addition, in jumper's knee with icing group, significant decrease was found in the SNR, sectional area of patellar tendon after icing and 24 and 48 hours after icing, and the tenderness of patellar tendon after icing compared to after exercise. These results suggested that icing was an effective treatment for jumper's knee after exercise.

Bone (tibia, femur, and lumbar spine) and blood samples were obtained from 100 (50 males and 50 females) Wistar-Imamichi rats in groups aged 3, 5, 7, 9, 12, 15 and 20 weeks old to investigate the changes in bone mass during puberty in relation to insulin-like growth factor 1 (IGF-1), IGF binding protein (IGFBP) -3, osteocalcin (OC) and sex steroids in normal rats.
Sharp increases in BMD (bone mineral density) in the tibia, femur and lumbar appeared earlier in female than in male rats, and the BMD in females tended to be higher than in males between 5 and 9 weeks old. After 9 weeks old, BMD in males was higher than that in females, as BMD in males continued to increase whereas that in females tended to remain in a steady state after this stage. This sex-related difference in changes in BMD pattern is probably related to the serum concentrations of IGF-1, IGFBP-3, testosterone, and 17β-estradiol with maturation. In males, marked increases in serum IGF-1 and IGFBP-3 concentrations appeared earlier than that in serum testosterone level. IGF-1 and testosterone peaked at 9 weeks of age, and thereafter remarked in a steady state, whereas IGFBP-3 reached a peak at 7 weeks of age, and then declined gradually. In females, the changes in patterns of serum 17β-estradiol, IGF-1, and IGFBP-3 levels were very similar. The levels increased gradually from 3-5 weeks old, peaked at 9 weeks, and then decreased slowly thereafter. In contrast, serum OC concentrations remain relatively high from 3 to 9 and from 3 to 7 weeks old in males and females, respectively, although OC in both sexes declined gradually with aging.
These observations suggest that BMD development occurs earlier in female than in male rats. This sex-related difference in changes in the BMD pattern may result from the earlier onset of puberty in females, and from the sex-specific differences in concentrations of IGF-1, IGFBP-3 and sex steroids with maturation.

Physical activity in the growing period has been shown to be effective for increasing bone mass because immature bones are more sensitive than mature adult bones to the stimulation with mechanical stress. However, bone growth is not uniform and changes markedly at puberty. Therefore, the response of bone to exercise may differ according to the growth process. The purpose of the present study was to investigate the process of the bone response to running training, and the relationship between the bone response and serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels in female rats. Thirty-three female Wistar-Imamichi rats 4 weeks of age were divided randomly into control (CON) and running training (RUN) groups for 6 and 12 weeks. Training consisted of running on a flatbed treadmill at 30 m/min for 60 min/day, 5 days/week. The bone mineral content (BMC) and bone mineral density (BMD) in the whole and five parts of the tibia were measured by a dual-energy X-ray absorptiometer (DXA) . Simultaneously, we measured serum concentrations of IGF-I, IGFBP-3, osteocalcin and 17β-estradiol. The whole tibial BMD was significantly higher in the RUN groups than in the age-matched CON groups. When BMD was analyzed at five different studied parts within the same tibia, the increase of BMD. was noted in the proximal and distal cancellous bone in the 6-week RUN group, and in the diaphysial, cortical bone, in the 12-week RUN group. Serum concentrations of osteocalcin, a marker of bone formation, were not altered by training, whereas they decreased with aging. Serum IGF-I levels in the training groups were not changed, but IGFBP-3 levels were increased significantly only in 6-week RUN rats. As a complex between IGFBP-3 and IGF-I may be more improve than free IGF-I in the bone formation, the high levels of IGFBP-3 in the 6-week RUN group may induce an increase in the activity of IGF-I. There was a significant positive relationship between serum IGF-I concentration and BMD of the whole tibia in the 6-week study, and between the IGFBP-3 level and BMD in both the 6 and 12-week studies.
In conclusion, 1) the process of the skeletal response to running training is site-specific within the same bone, and 2) the increment of the IGFBP-3 level with training in the growth period may reflect the increment of tibial BMD through training.

The purpose of this study was to investigate the effects of running training on bone formation in rats in relation to the age training started. The first experimental period was set from 6 to 12 weeks (wks) old and the second from 12 to 19 wks old. Sixty-four Wistar strain 6-wk-old male rats were initially divided into a non-exercise (N) and an exercise (E) group. At 12 wks old, each group was subdivided into two groups, providing four groups: non-exercise·non-exercise (NN), non-exercise·exercise (NE), exercise·non-exercise (EN) and exercise·exercise (EE) . Exercise consisted of treadmill running at a speed of 30 m/min, 60 mm day, 5 days wk. The animals were sacrificed before the experiment (6 wks old), post-first experiment (12wks old) and postexperiment (19 wks old), the bilateral tibiae were removed and their lengths, bone mineral content (BMC), bone mineral density (BMD) and bone histomorphometric parameters were measured. The tibial length was significantly shorter in 12-wk-old E than N rats and in 19-wk-old EE than NN. At 19 wks old, the total tibial BMD values were significantly higher in EE than NN, and the BMD values of the proximal and distal tibiae, where the cancellous bone was the main component, had increased markedly, whereas no differences between the diaphyseal BMD of each group were noted. Bone histomorphometry at 12 wks old, considered the immature period, showed that the osteoid surfaces and labeled surfaces tended to be increased by running training, but the bone volume was unchanged. In contrast, at 19 wks old, considered the early mature period, the osteoid surfaces showed a tendency to decrease and labeled surfaces to increase and consequently the bone volume increased albeit not significantly. These results suggest that: 1) running training started in immature rats represses longitudinal tibial growth, 2) the cancellous bone is more sensitive then the cortical bone to this type of training and 3) training of early mature rats increases bone volume by increasing the efficiency of osteoid calcification.

Surface induced hypothermia was introduced in six cases with low cardiac output syndrome after open heart surgery to reduce oxgen consumption. The patients were consisted of two ACBG, two LV rupture after MVR, MVR with ACBG and AVR with poor LV function. Hemodynamic changes such as heart rate, mean arterial pressure, cardiac index, systemic vascular resistance, pulmonary artery wedge pressure, were measured every 3-4 hours throughout the course of hypothermia. Acid-base balance, mixed venous oxgen saturation and oxygen consumption were also monitored. Hypothermia was induced using a blanket and ice-beutels. Temperature in hypothermia was maintained at about 33°C. We are intended to increase SVO₂ up to the level of 50% and to improve anerobic condition. Hypothermia was continued for 45 hours in the shortest and 148 hours in the longest case with a mean of 78 hours. Arrythmia was not seen. Hemodynamic and acid-base balance were in significantly changed in comparison of the control values. However, SVO₂ and VO₂ changed significantly after introduction of hypothermia. They increased from 47.8±7.5% to 58.7±7.9% and reduced from 231±29.7 to 188±31.3ml O₂/min respectively. Hemodynamic condition was improved and IABP was successfully weaned in all cases. We suggest that the use of hypothermia is one of the effective modality in the management of low cardiac output syndrome after open heart surgery.

A 59-year-old man, who had received graft replacement for the “inflammatory” abdominal aortic aneurysm two years previously was admitted to our hospital because of preshock caused by intermittent intestinal hemorrhage. Gastrointestinal endoscopy revealed an ulcer at the 3rd portion of the duodenum. As aortoenteric fistula was diagnosed and he underwent an emergency operation. After initial axillo-bifemoral bypass grafting, the aortic graft was removed and the aortic stump was closed directly. The duodenal rent was closed by Albert-Lembert suture, He survived the operation and was discharged. We suggest that extra-anatomic bypass is safer than in situ graft replacement in patients with secondary aortoenteric fistula after operation for “inflammatory” abdominal aortic aneurysm, because adjacent organs adhere firmly to the proximal suture line in such cases.

A total of 183 patients who underwent surgical repair of secundum type atrial septal defect (ASD), were divided into 5 age groups. Hemodynamic parameters, arrhythmia, and abnormality of the atrio-ventricular valve function were compared among the 5 groups. Although the pulmonary to systemic blood flow ratio was not different, the pulmonary to systemic pressure ratio was higher in the sixth decade than in the third (p<0.05) and fourth (p<0.01). Pulmonary to systemic vascular resistance ratio increased with age, although the difference was not statistically significant. The cardiothoracic ratio, atrial fibrillation and tricuspid regurgitation (TR) also increased with age. These data suggest that ASD progresses with age. There were 41 patients who showed more than grade II TR, 10 patients underwent tricuspid annuloplasty (TAP), 1 underwent tricuspid valve replacement, and the other 30 patients had no treatment of the tricuspid valve. TAP with DeVega's (6 cases) or Carpentier-ring (1) method was effective. In 30 untreated TR patients, 9 patients remained with grade II TR after closure of the defect. Because TAP is an easy and very effective procedure, TAP should have been applied to all patient with TR more severe than grade II. There were 10 patients with mitral regurgitation (MR) of more than grade II. Two patients in whom mitral valve prolapse had been detected on ultrasound cardiography (UCG) before operation underwent mitral valve plasty successfully. Although MR decreased in 6 patients after only ASD closure, two patients remained with grade II MR. We now recommend that the mitral valve should be assessed under direct vision, and intraoperative trans-esophageal echo cardiography, and also that the mitral regurgitation test as well as preoperative UCG should be performed. Because ASD is progressive with age, surgical repair should be performed before age 40.