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OBJECTIVE: In sample isolation processing by stereomicroscopy (SIPS), a technique used to assess the quality of specimens collected during endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA), the cutoff value of stereomicroscopically visible white core (SVWC) (≥11 mm) indicates high diagnostic sensitivity. However, the procedure of SIPS is complicated and time-consuming. Therefore, we devised the stereomicroscopic on-site evaluation (SOSE), a new rapid assessment method that is simpler than SIPS and only determines if the SVWC cutoff value is attained. We aimed to examine the usefulness of SOSE in a multicenter, prospective setting. METHODS: Seventy patients from multiple institutions with solid pancreatic masses suspected to be pancreatic cancer were included. EUS-TA was performed using a 22-gauge Franseen needle. SVWCs were measured on-site using stereomicroscopy. The primary outcome was the sensitivity of SVWC cutoff value in EUS-TA with SOSE. RESULTS: The total number of punctures was 214 and SOSE was performed on 150 punctures. The SVWC cutoff value collection rate was 100% per lesion, with 80% in the first pass, 79% in the second pass, and 78% per puncture in all passes. The median time taken to determine the SVWC cutoff value for SOSE was 47 s. The sensitivity of the SVWC cutoff value was 93.2% for histology and 96.6% for cytology + histology. The per-lesion accuracy of pathological diagnosis reached the highest level (98.6%) at the second puncture. CONCLUSIONS: SOSE showed high diagnostic sensitivity and may be a new rapid assessment method for the diagnosis of malignant pancreatic cancer using EUS-TA.
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Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Neoplasias Pancreáticas , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Endosonografía/métodos , Humanos , Agujas , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Estudios ProspectivosRESUMEN
BACKGROUND: Stone removal using endoscopic papillary large balloon dilation (EPLBD) is extremely effective. However, limited research exists regarding the risk factors for perforation of the duodenal papilla and bile duct, which may be fatal. AIMS: We aimed to investigate the risk factors for perforation during EPLBD + stone removal. METHODS: We included patients who underwent EPLBD + stone removal at four medical facilities between January 2008 and December 2018. We retrospectively analyzed the risk factors for perforation and their relationship between overdilation and adverse events. Overdilation was defined as a ratio of the balloon diameter to the diameter of the bile duct that exceeded 100%. The diameter of the distal bile duct was measured using the diameter of the intrapancreatic bile duct at a point 10 mm toward the liver from the narrow distal segment on a cholangiogram. RESULTS: We included 310 patients (177 males; median age: 79 years [range: 46-102 years]). Perforation occurred in five patients (1.6%). Multivariate analysis indicated that no surrounding-pancreas (half or less of the circumference of the intrapancreatic bile duct was surrounded by the pancreatic parenchyma) was a significant risk factor (perforation rate: 8.3%, p = 0.011, odds ratio: 12.7 [95% confidence interval: 1.8-90.5]). No significant difference was found between the overdilation and non-overdilation groups regarding the occurrence of pancreatitis, bleeding, and cholangitis. Perforation rate in patients with no surrounding pancreas + overdilation was 16.7% (2/12). Patients with perforation underwent conservative therapy, which improved their conditions. CONCLUSIONS: EPLBD + stone removal should be avoided in patients with no surrounding pancreas. Overdilation is not a risk factor for adverse procedural events; however, it should be limited in patients with surrounding pancreas.
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Cálculos Biliares , Esfinterotomía Endoscópica , Anciano , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Dilatación/efectos adversos , Cálculos Biliares/etiología , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Esfinterotomía Endoscópica/efectos adversos , Resultado del TratamientoRESUMEN
A 73-year-old man underwent distal gastrectomy, D2 lymphadenectomy, and Billroth â reconstruction for Type 3 advanced cancer in the lower corpus lesser curvature in 20XX. After postoperative adjuvant chemotherapy, he self-detected a mass in the left breast. It was diagnosed as breast cancer. He underwent mastectomy and axillary lymphadenectomy 16 months after gastric cancer surgery. After postoperative adjuvant chemotherapy, gastric or breast cancer did not recur. However, periodic upper gastrointestinal endoscopy revealed an 8-mm 0-â ¡a lesion in the anterior wall of the remnant middle stomach(Group 5)80 months after gastric cancer surgery. Endoscopic submucosal dissection(ESD)was performed, and radical resection was achieved. Periodic upper gastrointestinal endoscopy was performed thereafter; an ectopic 0-â ¡a lesion was detected in the greater curvature of the remnant middle stomach(Group 5)21 months after ESD. Since this lesion suggested massive submucosal invasion, total resection of the remnant stomach and Roux-en-Y reconstruction were performed. The postoperative course has been favorable, and the patient has been alive without recurrence for 6 months postoperatively. A long period passes before intestinal juice reflux induces progression of a chronic inflammatory gastric mucosal lesion to cancer in the remnant stomach. Thus, long-term endoscopic follow-up may be necessary.
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Neoplasias de la Mama , Muñón Gástrico , Neoplasias Gástricas , Masculino , Humanos , Anciano , Muñón Gástrico/cirugía , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Neoplasias de la Mama/cirugía , Resultado del Tratamiento , Estudios Retrospectivos , Mastectomía , GastrectomíaRESUMEN
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with complications such as post-ERCP pancreatitis (PEP). Protease inhibitors, including nafamostat mesylate (NM), have been evaluated for prophylaxis against PEP. AIM: We describe the first multicenter randomized controlled trial assessing the prophylactic efficacy of NM against PEP. METHODS: In this multicenter prospective study, we aimed to enroll 800 patients aged ≥ 20 years with a planned ERCP between December 2012 and March 2019. The primary outcome was the incidence and severity of PEP in patients who did not receive NM (non-NM) versus those who did (NM; 20 mg). Secondary outcomes included the incidence of PEP by NM initiation (pre- and post-ERCP), risk factors for PEP, and NM-related adverse events. RESULTS: Only 441 of the planned 800 patients were enrolled (non-NM: n = 149; NM: n = 292 [pre-ERCP NM: n = 144; post-ERCP NM: n = 148]). Patient characteristics were balanced at baseline with no significant differences between groups. PEP occurred in 40/441 (9%) patients (non-NM: n = 15 [10%]; NM: n = 25 [9%]), including 17 (12%) and eight (8%) in the pre-ERCP and post-ERCP NM groups, respectively. In the NM group, the incidence of PEP was lower in the low-risk group than in the high-risk group. Pancreatic injection and double-guidewire technique were independent risk factors for PEP. NM-related adverse events of hyperkalemia occurred in two (0.7%) patients. CONCLUSIONS: We found no evidence for the prophylactic effect of NM against PEP, regardless of the timing of administration; however, further studies are needed.
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Benzamidinas/uso terapéutico , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Guanidinas/uso terapéutico , Pancreatitis/prevención & control , Inhibidores de Tripsina/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/etiología , Estudios ProspectivosRESUMEN
BACKGROUND: The efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-PTX) plus gemcitabine (GEM) in elderly Japanese patients with pancreatic cancer remain unclear. Therefore, we prospectively investigated the tolerability and efficacy of nab-PTX + GEM in Japanese patients aged ≥ 75 years with non-curatively resectable pancreatic cancer. METHODS: We treated eligible patients (n = 27) with nab-PTX + GEM until disease progression, appearance of adverse events, or withdrawal of consent. The primary endpoints included adverse events as well as dosing- and survival-related parameters. RESULTS: The rates of 2-cycle completion were 48.1% for nab-PTX and 55.6% for GEM; the relative dose intensities for the 7th (median) treatment cycle were 65.1% and 74.1%, respectively, whereas the dose-reduction rates were 81.5% and 48.1%, respectively. Grade 3 or higher hemotoxicity was observed in 14 of 27 subjects (51.9%); moreover, 22% experienced grade ≥ 3 peripheral nerve disorder and 1 patient (3.7%) died owing to chemotherapy-related interstitial pneumonia. The disease control rate was 92.6% (25/27), while the median progression-free and overall survival times were 7 and 10.3 months, respectively. CONCLUSION: The nab-PTX + GEM regimen is as efficacious in elderly patients who meet certain criteria as it is in previously reported non-elderly patients. The regimen is feasible with appropriate dose adjustments and attention to adverse events. TRIAL REGISTRATION: Clinical trial registration number: UMIN000018907.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/mortalidad , Anciano , Anciano de 80 o más Años , Albúminas/administración & dosificación , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Estudios de Factibilidad , Femenino , Enfermedades Hematológicas/inducido químicamente , Humanos , Masculino , Paclitaxel/administración & dosificación , Neoplasias Pancreáticas/cirugía , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Estudios Prospectivos , Resultado del Tratamiento , GemcitabinaRESUMEN
BACKGROUND: Long-term studies evaluating self-expandable metal stents in patients who have unresectable malignant hilar biliary obstruction (UMHBO) after surgical reconstruction of the intestine remain inadequate. We developed a side-by-side (SBS) technique using a two-channel endoscope to place self-expandable metal stents in patients with UMHBO occurring after Billroth II reconstruction. AIMS: We validated the long-term outcomes obtained with this technique. METHODS: The study group comprised seven patients with UMHBO in whom we attempted to place metal stents by the SBS technique using a two-channel scope. The procedure was validated retrospectively. RESULTS: The technical success rate was 86% and functional success rate was 100%. The median time to recurrent biliary obstruction (RBO) was 222 days (95% CI 4.9-439.1). Besides RBO, there were no other complications. CONCLUSIONS: The SBS procedure performed using a two-channel scope is a safe and useful new technique for the treatment of UMHBO occurring after Billroth II reconstruction.
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Colestasis/terapia , Neoplasias del Sistema Digestivo/cirugía , Endoscopios , Endoscopía del Sistema Digestivo/instrumentación , Gastroenterostomía/efectos adversos , Stents Metálicos Autoexpandibles , Anciano , Anciano de 80 o más Años , Colestasis/diagnóstico por imagen , Colestasis/etiología , Neoplasias del Sistema Digestivo/complicaciones , Neoplasias del Sistema Digestivo/patología , Endoscopía del Sistema Digestivo/efectos adversos , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Diseño de Prótesis , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Peroral cholangioscopic lithotripsy is a useful procedure in patients with a normal gastrointestinal anatomy who have difficult-to-treat stones. We evaluated the usefulness of peroral direct cholangioscopy (PDCS) using single-balloon enteroscope (SBE) in patients with difficult-to-treat stones who had undergone Roux-en-Y reconstruction. METHODS: Among 118 patients (169 sessions) who underwent SBE-assisted endoscopic retrograde cholangiopancreatography to treat biliary stones after Roux-en-Y reconstruction, patients in whom it was difficult to remove biliary stones via a transpapillary or transanastomotic approach and difficult to switch to ultra-slim endoscope, were retrospectively enrolled. The biliary insertion success rate, procedure success rate, procedure time, and procedural complications were assessed. The SBE was inserted into the bile-duct, first using a free-hand technique, second using a guide wire, and third using the large balloon anchoring and deflation (LBAD) technique. RESULTS: A total of 11 patients (14 sessions) were enrolled in this study. The biliary insertion success rate was 100%. Bile-duct insertion was performed using a free-hand technique in 4 sessions, a guide wire in 3 sessions (rendezvous technique, 2 sessions), and the LBAD technique in 7 sessions. The procedure success rate was 86% in first session, and 100% in second session. The median procedure time was 81 min (range 49-137). The median procedure time in the bile-duct was 21.5 min (range 6-60). Mild pancreatitis occurred as a complication in one patient. The median follow-up was 528 days (range 282-764). No patient had stone recurrence. CONCLUSIONS: PDCS using SBE is a useful procedure in patients with Roux-en-Y reconstruction. The LBAD technique is an useful technique of inserting SBE into the bile-duct.
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Colangiopancreatografia Retrógrada Endoscópica/instrumentación , Colelitiasis/cirugía , Endoscopios Gastrointestinales , Anciano , Anciano de 80 o más Años , Anastomosis en-Y de Roux , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios RetrospectivosRESUMEN
Recent studies have shown the contribution of genetic determinants to athletes' physical ability. However, despite the fact that cognitive abilities like self-control and stress-tolerance influence athletes' competitive performance, few studies to date have investigated the association between genetic polymorphism, which is linked to cognitive ability and athletic performance. The present study investigated the link between single-nucleotide polymorphisms (SNPs), which are known to exert influences on dopaminergic neural function and competitive performance of swimmers. The results have revealed superior competitive performance in competitive swimmers with Met allele of catechol-O-methyltransferase Val158Met polymorphism than those with Val/Val genotype. The investigated SNPs of DRD2 and DRD3 were not associated with swimmer's competitive performance. This finding indicates that genetic polymorphism linked to cognitive ability influences the athletes' performance.
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Catecol O-Metiltransferasa/genética , Conducta Competitiva/fisiología , Polimorfismo de Nucleótido Simple , Natación/fisiología , Genotipo , Humanos , Masculino , Adulto JovenRESUMEN
[Purpose] The purpose of this study was to evaluate the relationship between malalignment and lower-extremity injury and to determine the optimal dynamic alignment of the lower extremity with wall squats. [Subjects and Methods] Healthy individuals from one therapy school were enrolled and assigned to a wall squat normal or abnormal group based on their forms during wall squats. The abnormal group was found to be more prone to lower-extremity injury on three-dimensional motion analysis. Eight students from each group were randomly chosen for the study. The effects of single-leg landing movements were assessed using three-dimensional motion analysis. [Results] In the sagittal plane, significant flexion of the hip and knee joints occurred 0.02 and 0.04 seconds after initial foot contact with the ground in the normal and abnormal groups, respectively. In the frontal plane, significant adduction of the hip joint occurred at 0.07 seconds in the abnormal group. [Conclusion] The abnormal group tended to display later flexion of the hip and knee joints and narrower hip, knee, and ankle range of motion than the normal group, suggesting that dynamic alignment of the lower extremity in the abnormal group likely made them susceptible to injury.
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Outdoor exercise often proceeds in rainy conditions. However, the cooling effects of rain on human physiological responses have not been systematically studied in hot conditions. The present study determined physiological and metabolic responses using a climatic chamber that can precisely simulate hot, rainy conditions. Eleven healthy men ran on a treadmill at an intensity of 70% VO2max for 30 min in the climatic chamber at an ambient temperature of 33°C in the presence (RAIN) or absence (CON) of 30 mm · h(-1) of precipitation and a headwind equal to the running velocity of 3.15 ± 0.19 m · s(-1). Oesophageal temperature, mean skin temperature, heart rate, rating of perceived exertion, blood parameters, volume of expired air and sweat loss were measured. Oesophageal and mean skin temperatures were significantly lower from 5 to 30 min, and heart rate was significantly lower from 20 to 30 min in RAIN than in CON (P < 0.05 for all). Plasma lactate and epinephrine concentrations (30 min) and sweat loss were significantly lower (P < 0.05) in RAIN compared with CON. Rain appears to influence physiological and metabolic responses to exercise in heat such that heat-induced strain might be reduced.
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Regulación de la Temperatura Corporal , Calor , Lluvia , Carrera/fisiología , Temperatura Cutánea , Glucemia/metabolismo , Epinefrina/sangre , Esófago/fisiología , Ácidos Grasos no Esterificados/sangre , Frecuencia Cardíaca , Humanos , Ácido Láctico/sangre , Masculino , Norepinefrina/sangre , Percepción , Esfuerzo Físico , Sudoración , Triglicéridos/sangre , Adulto JovenRESUMEN
The level of hypohydration at which power output during intermittent exercise performance starts to decrease is not fully understood. The purpose of this study was to investigate the effects of 2% hypohydration without hyperthermia on intermittent exercise performance. Eight collegiate amateur boxers completed 2 exercise tests. On day 1, subjects hypohydrated by 2% of body mass by exercising in a hot environment, and on day 2, subjects performed intermittent exercise (4 × 2 minute per round [R] separated by 1-minute recovery) under a randomly assigned condition of with (HYP) or without (EUH) hypohydration. Each bout consisted of 8 × 5 seconds of maximal cycling exercise (0.05 kp × body mass) separated by 10 seconds of passive recovery. Mean power output per kilogram (MPO), total power output per kilogram (TPO), energy system relative contribution, and core rectal temperature (Tre) were measured. Changes in body mass before the exercise tests were -2.25 ± 0.18% (HYP) and -0.17 ± 0.19% (EUH) (p < 0.001). Mean power output, TPO, and each energy contribution ratio were not significantly different between the trials, and pre- and postexercise test Tre did not differ significantly between trials. Results demonstrated that approximately 2% hypohydration lies below the point at which power output during intermittent exercise starts to decline.
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Boxeo/fisiología , Deshidratación/fisiopatología , Ejercicio Físico/fisiología , Calor/efectos adversos , Umbral Anaerobio , Temperatura Corporal , Prueba de Esfuerzo , Fiebre , Humanos , Masculino , Distribución Aleatoria , Adulto JovenRESUMEN
BACKGROUND: Cooling devices reduce thermal strain during pre-, between-, and postexercise. However, their efficacy during moderate/intensity runs in hot conditions with airflow equivalent to the running speed remains unclear. This study assessed physiological and perceptual responses to neck and upper back fan-cooling through an air-perfused rucksack under such conditions. METHODS: Ten young men ran at 60% VÌO
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Long-term facilitation (LTF) of respiration has been mainly initiated by intermittent hypoxia and resultant chemoreceptor stimulation in humans. Comparable levels of chemoreceptor stimulation can occur in combined exercise and carbon dioxide (CO2) inhalation and lead to LTF. This possibility was supported by data collected during combined interval exercise and 3% inhaled CO2 in seven normal subjects. These data were further analyzed based on the dynamics involved using mathematical models in this study. Previously estimated peripheral chemoreceptor sensitivity during light exercise (40 W) with air or 3% inhaled CO2 approximately doubled resting sensitivity. Ventilation after a delay increased by 17.0 ± 2.48 L/min (p < 0.001) during recovery following 45% maximal oxygen uptake ([Formula: see text] ) exercise consistent with LTF which exceeded what can be achieved with intermittent hypoxia. Model fitting of the dynamic responses was used to separate neural from chemoreceptor-mediated CO2 responses. Exercise of 45% [Formula: see text] was followed by ventilation augmentation following initial recovery. Augmentation of LTF developed slowly according to second-order dynamics in accordance with plasticity involving a balance between self-excitatory and self-inhibitory neuronal pools.
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Dióxido de Carbono , Respiración , Humanos , Hipoxia , Pulmón , Ejercicio Físico/fisiologíaRESUMEN
BACKGROUND/AIMS: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs). METHODS: In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA's diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs. RESULTS: The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture. CONCLUSION: Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.
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Background/Aims: To validate endoscopic ultrasound-guided tissue acquisition (EUS-TA) used in conjunction with stereomicroscopic on-site evaluation (SOSE) as a preoperative diagnostic tool for resectable pancreatic cancer (R-PC) and borderline resectable PC (BR-PC). Methods: Seventy-eight consecutive patients who underwent EUS-TA for suspected R-PC or BR-PC were enrolled. The primary endpoint was the sensitivity of EUS-TA together with SOSE based on the stereomicroscopically visible white core (SVWC) cutoff value. One or two sites were punctured by using a 22-gauge biopsy needle for EUS-TA, based on the SOSE findings. Results: We collected 99 specimens from 56 and 22 patients with R-PC and BR-PC, respectively. Based on the SOSE results, we performed 57 procedures with one puncture. The SVWC cutoff values were met in 73.7% and 73.1% of all specimens and in those obtained during the first puncture, respectively. The final diagnoses were malignant and benign tumors in 76 and two patients, respectively. The overall sensitivity, specificity, and accuracy of EUS-TA for the 78 lesions were 90.8%, 100%, and 91.0%, respectively. The sensitivity for malignant diagnosis based on the SVWC cutoff value were 89.5% and 90.4% for the first puncture and all specimens, respectively. Conclusions: The sensitivity of EUS-TA in conjunction with SOSE for malignancy diagnosis in patients with suspected R-PC or BR-PC was 90.4%.
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BACKGROUND: Assessment of sentinel lymph node status is commonly performed in the treatment of cutaneous melanoma. However, there are no definite guidelines for thin melanomas with Breslow tumor thickness <1.0 mm, in part because thin melanomas are relatively infrequently positive for lymph node metastasis. METHODS: We analyzed the clinicopathologic relationship among tumor thickness, mitotic index, tumor infiltrating lymphocytes (TIL), tumor size, regional lymph node metastasis and prognosis in 66 Japanese patients with thin melanomas. Immunohistochemical evaluations for TIL were also performed. RESULTS: Thirty-one of the 66 melanomas were Clark level I without lymph node metastasis (0/31, 0%). In tumors of Clark level II or higher (35/66), there were five (14%) regional lymph node metastasis. Melanomas with two or more mitoses in 1 mm(2) per high-power fields showed higher frequencies of lymph node metastasis (2/3, 67%), compared to those with fewer than two mitoses (3/32, 9%). Tumors with intensive TIL that partially or completely surrounded the tumor revealed higher frequencies of lymph node metastasis (5/28, 18%), compared to those with none or slight TIL (0/7, 0%). The main components of TIL were CD8-positive T lymphocytes. No metastasized tumors were under 2.0 cm(2) . CONCLUSIONS: The presence of mitotic activity, large tumor size and an intense lymphocytic infiltrate should prompt sentinel lymph node biopsy in thin melanomas.
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Melanoma/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Linfocitos T CD8-positivos/patología , Femenino , Humanos , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Biopsia del Ganglio Linfático CentinelaAsunto(s)
Angiofibroma/diagnóstico , Angiofibroma/genética , Coactivador 2 del Receptor Nuclear/genética , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/genética , Angiofibroma/cirugía , Biopsia , Mejilla , Diagnóstico Diferencial , Femenino , Reordenamiento Génico , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias de los Tejidos Blandos/cirugíaRESUMEN
To reduce the risk of heat-related illness, appropriate body cooling strategies are needed during men's lacrosse competitions in hot-humid environments. The current study investigated whether additional in-play cooling breaks would attenuate the core (rectal) body temperature rise during exercise designed to mimic the activity patterns of a men's lacrosse match while wearing uniform in hot-humid environments. In randomized and counterbalanced order, ten physically active men completed two experimental trials comprising four quarters of 15-min intermittent cycling exercises separated by a 10-min simulated half-time break and two 2-min quarter breaks in a climate chamber (35°C, 50% relative humidity). The two trials included a regular simulated match condition (REG) and a water break time out condition (WBTO) that included additional 2-min breaks 7.5-min into each quarter. Rectal temperature was significantly lower (p=0.017) in the WBTO condition (38.23±0.23°C) compared with the REG condition (38.50±0.46°C) at the end of the 4th quarter. In addition, ratings of perceived exertion, thermal sensation, heart rate and the physiological strain index were significantly lower (all p<0.05) in the WBTO condition compared with the REG condition. The current results indicated that, even when wearing lacrosse uniforms, the implementation of WBTO attenuated the core body temperature elevation only in the latter stages of an intermittent cycling exercise protocol designed to mimic the exercise pattern of a men's lacrosse match. Therefore, WBTO may provide a feasible and effective cooling strategy for lacrosse players to reduce the risk of heat-illness.
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In summer and winter, young, sedentary male (N = 5) and female (N = 7) subjects were exposed to heat in a climate chamber in which ambient temperature (Ta) was raised continuously from 30 to 42°C at a rate of 0.1°C min(-1) at a relative humidity of 40%. Sweat rates (SR) were measured continuously on forearm, chest and forehead together with tympanic temperature (Tty), mean skin temperature (â»Ts) and mean body temperature â»Tb. The rate of sweat expulsions (Fsw) was obtained as an indicator of central sudomotor activity. Tty and â»Tb were significantly lower during summer compared with winter in males; SR was not significantly different between summer and winter in males, but was significantly higher during summer in females; SR during winter was higher in males compared with females. The regression line relating Fsw to â»Tb shifted significantly from winter to summer in males and females, but the magnitude of the shift was not significantly different between the two subject groups. The regression line relating SR to Fsw was steepened significantly from winter to summer in males and females, and the change in the slope was significantly greater in females than in males. Females showed a lower slope in winter and a similar slope in summer compared to males. It was concluded that sweating function was improved during summer mediated by central sudomotor and sweat gland mechanisms in males and females, and, although the change of sweat gland function from winter to summer was greater in females as compared with males, the level of increased sweat gland function during summer was similar between the two subject groups.
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Temperatura Corporal/fisiología , Estaciones del Año , Conducta Sedentaria , Glándulas Sudoríparas/fisiología , Sudoración/fisiología , Adulto , Femenino , Humanos , Japón , Masculino , Factores Sexuales , Adulto JovenRESUMEN
The epidural block therapy is offered to reduce one of the side effects of systemic administration of opioids such as drowsiness. Hence, it is necessary to set a subcutaneous reservoir to prevent a catheter-related infection for a long period of time. One hundred twenty five patients with this manipulation during the year 2004 to 2010 showed a significant improvement in their pain level calculated by Numerical Rating Scale(NRS). However only 30 cases could be proceed to the homecare. There was one case of catheter-related infection in 30 homecare cases. It is useful to establish the common strict guidelines between hospital doctors and general practitioners for the management of the epidural catheter with subcutaneous reservoir.