Dietary collagen peptides alleviate exercise-induced muscle soreness in healthy middle-aged males: a randomized double-blinded crossover clinical trial.

BACKGROUND: Post-exercise muscle soreness and fatigue can negatively affect exercise performance. Thus, it is desirable to attenuate muscle soreness and fatigue and promote recovery even for daily exercise habits aimed at maintaining or improving health. METHODS: This study investigated the effects of dietary collagen peptides (CPs) on post-exercise physical condition and fitness in healthy middle-aged adults unfamiliar with exercise. Middle-aged males (n = 20, 52.6 ± 5.8 years) received the active food (10 g of CPs per day) or the placebo food for 33 days in each period of the randomized crossover trial (registered at the University Hospital Medical Information Network Clinical Trials Registry with UMIN-CTR ID of UMIN000041441). On the 29th day, participants performed a maximum of five sets of 40 bodyweight squats. Muscle soreness as the primary outcome, fatigue, the maximum knee extension force during isometric muscle contraction of both legs, the range of motion (ROM), and the blood level of creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) were assessed before and after the exercise load. RESULTS: The analysis set was the per-protocol set (n = 18, 52.6 ± 6.0 years) for efficacy and the full analysis set (n = 19, 52.8 ± 5.9 years) for safety. The visual analog scale (VAS) of muscle soreness immediately after the exercise load was significantly lower in the active group than in the placebo group (32.0 ± 25.0 mm versus 45.8 ± 27.6 mm, p < 0.001). The VAS of fatigue immediately after the exercise load was also significantly lower in the active group than in the placebo group (47.3 ± 25.0 mm versus 59.0 ± 22.3 mm, p < 0.001). Two days (48 hours) afterthe exercise load, muscle strength was significantly higher in the active group than in the placebo group (85.2 ± 27.8 kg versus 80.5 ± 25.3 kg, p = 0.035). The level of CPK did not change over time. The level of LDH increased slightly but was not different between the groups. No safety-related issues were observed. CONCLUSIONS: These results showed that dietary CPs alleviated muscle soreness and fatigue and affected muscle strength after exercise load in healthy middle-aged males.

Quantitative Assessment of Age-dependent Changes in Porphyrins from Fluorescence Images of Ultraviolet Photography by Image Processing.

BACKGROUND: Skin is the first line of defense against harmful external environmental factors. Skin flora living on the skin surface impact skin health and skin disease. Bacteria, form part of the unique and complex skin micro-ecological system. For example, Propionibacterium acnes (P. acnes) is a member of the anaerobic organisms and is involved in the induction of skin acne. It produces porphyrins that absorb ultraviolet light and emit red fluorescence in response. As a result, fluorescence surveillance of the skin can be important in both the diagnosis of skin acne and the evaluation of therapeutic effects. Many different measurement methods for single skin biophysical properties have been reported.. This study focused on the age-dependent changes in porphyrins for normal skin, and developed a novel algorithm to evaluate porphyrins using the fluorescence images by image processing quantitatively. MATERIALS AND METHODS: An extraction algorithm was proposed for the segmentation of porphyrin fluorescence images in OpenCV. The algorithm consisted primarily of preprocessing, conversion from RGB color space to HSV color space, and classification of fluorescence. There are 3595 healthy Japanese aged 16-85 years enrolled in the study and fluorescence images were acquired from their cheek sites under 375 nm UV-LED excitation. Age-related fluorescence variation was conducted applying the algorithm implemented. RESULTS: A new extraction algorithm has been proposed with fluorescence image input and three indexes output, including the number of fluorescence, area of fluorescence, and mean intensity of fluorescence. Proposed algorithm was verified by three parameters, the accuracy, sensitivity, and precision, which refer to the ability of algorithm to detect the number of fluorescence correctly and repeatedly. The verification results were 71%, 72%, and 88% respectively, taking a validly fundamental step for skin health record and analysis. Furthermore, large-scale fluorescence image segmentation results revealed that similar trends were coming out for all three indexes in cheek as people get older. All the fluorescence number, area and mean intensity arrived at the highest at 30 years old and fell off since then. CONCLUSION: The number, area, and fluorescence intensity of porphyrins can be extracted well from fluorescence images with the proposed algorithm in the study, which has the potential to aid in thediagnosis of skin acne and predict skin conditions as an assisted tool. It is implicated that fluorescence status is influenced by age, which rises to the peak around 30 years old for normal cheek's skin.

Oxygen use and survival in patients with advanced cancer and low oxygen saturation in home care: a preliminary retrospective cohort study.

BACKGROUND: The role of oxygen therapy in end-of-life care for patients with advanced cancer is incompletely understood. We aimed to evaluate the association between oxygen use and survival in patients with advanced cancer and low oxygen saturation in home care. METHODS: We conducted a retrospective cohort study at a primary care practice in suburban Tokyo. Adult patients in home care with advanced cancer demonstrating first low oxygen saturation (less than 90%) detected in home visits were consecutively included in the study. Cox proportional hazards regression was used to investigate the effect of oxygen use on overall survival and survival at home, adjusted for systolic blood pressure, decreased level of consciousness, dyspnea, oral intake, performance status, and cardiopulmonary comorbidity. RESULTS: Of 433 identified patients with advanced cancer, we enrolled 137 patients (oxygen use, n = 35; no oxygen use, n = 102) who developed low oxygen saturation. In multivariable analysis, the adjusted hazard ratio (HR) of oxygen use was 0.68 (95% confidence interval 0.39-1.17) for death and 0.70 (0.38-1.27) for death at home. In patients with dyspnea, the HR was 0.35 (0.13-0.89) for death and 0.33 (0.11-0.96) for death at home; without dyspnea, it was 1.03 (0.49-2.17) for death and 0.84 (0.36-1.96) for death at home. CONCLUSIONS: Oxygen use was not significantly associated with survival in patients with advanced cancer and low oxygen saturation, after adjusting for potential confounders. It may not be necessary to use oxygen for prolongation of survival in such patients, particularly in those without dyspnea.

Abdominal pain and nausea in the diagnosis of streptococcal pharyngitis in boys.

OBJECTIVES: This study was designed to assess the accuracy of gastrointestinal symptoms, including abdominal pain, nausea, and vomiting, in the diagnosis of Group A streptococcal (GAS) pharyngitis in children and to determine differences in diagnostic accuracy in boys versus girls. METHODS: This retrospective cross-sectional study included 5,755 consecutive patients aged <15 years with fever in the electronic database at a primary care practice. Gastrointestinal symptoms were recorded in the database according to the International Classification of Primary Care codes, and the data were extracted electronically. The reference standard was GAS pharyngitis diagnosed with a rapid test. Patients with a clinical diagnosis of probable GAS pharyngitis were excluded from the primary analysis. RESULTS: Among the 5,755 children with fever, 331 (5.8%) were coded as having GAS pharyngitis, including 218 (65.9%) diagnosed with rapid tests and 113 (34.1%) clinically diagnosed with probable GAS pharyngitis. Among patients with fever and abdominal pain, rapid-test-confirmed GAS pharyngitis was significantly more common in boys (11/120, 9.2%) than in girls (3/128, 2.3%; p=0.026). The positive likelihood ratio of abdominal pain was 1.49 (95% CI =0.88-2.51): 2.41 (95% CI =1.33-4.36) in boys and 0.63 (95% CI =0.20-1.94) in girls. The positive likelihood ratio of nausea was 2.05 (95% CI =1.06-4.00): 2.74 (95% CI =1.28-5.86) in boys and 1.09 (95% CI =0.27-4.42) in girls. The association between abdominal pain and GAS pharyngitis was stronger in boys aged <6 years than in boys aged 6-15 years. CONCLUSION: Abdominal pain and nausea were associated with GAS pharyngitis in boys, but not in girls. Abdominal pain and nausea may help determine the suitability of rapid tests in younger boys with fever and other clinical findings consistent with GAS pharyngitis, even in the absence of sore throat.

Efficacy of a leukotriene receptor antagonist for pediatric cedar pollen allergy complicated by asthma.

Leukotriene receptor antagonists (LTRAs) are identified as a monotherapy for asthma and allergic rhinitis; however, their use in children for treatment of these diseases has not been examined. Accordingly, the present study investigated the efficacy of pranlukast dry syrup for children with both pollinosis and asthma. The subjects were children receiving treatment for asthma who were also diagnosed with cedar pollen allergy. Patients were divided into a group that received continuous treatment with pranlukast (group A; n=20) and a group that commenced add-on treatment for pollinosis following the onset of symptoms (group B; n=20). Patients in group B were randomly allocated to subgroup B1 (add-on treatment with pranlukast dry syrup) or subgroup B2 (add-on treatment with a second-generation antihistamine). In both groups, nasal and ocular symptoms were evaluated every day and recorded in a diary. Exacerbation of nasal obstruction was demonstrated in group B; however, not in group A. There was a significant difference in symptoms observed between the two groups during the late peak pollen period (P<0.05). The incidence of nasal obstruction (defined as a nasal obstruction score ≥3 or use of a nasal steroid spray) was significantly lower in group A compared with group B (P<0.05). The maximum scores for sneezing and nasal obstruction during the late peak of the pollen season were lowest in group A, followed by subgroup B1 and subgroup B2. The present study demonstrated that long-term administration of LTRA for the management of asthma may improve nasal symptoms of pollinosis during the pollen season in children with pollinosis and asthma.

Development of Wearable Sheet-Type Shear Force Sensor and Measurement System that is Insusceptible to Temperature and Pressure.

A sheet-type shear force sensor and a measurement system for the sensor were developed. The sensor has an original structure where a liquid electrolyte is filled in a space composed of two electrode-patterned polymer films and an elastic rubber ring. When a shear force is applied on the surface of the sensor, the two electrode-patterned films mutually move so that the distance between the internal electrodes of the sensor changes, resulting in current increase or decrease between the electrodes. Therefore, the shear force can be calculated by monitoring the current between the electrodes. Moreover, it is possible to measure two-dimensional shear force given that the sensor has multiple electrodes. The diameter and thickness of the sensor head were 10 mm and 0.7 mm, respectively. Additionally, we also developed a measurement system that drives the sensor, corrects the baseline of the raw sensor output, displays data, and stores data as a computer file. Though the raw sensor output was considerably affected by the surrounding temperature, the influence of temperature was drastically decreased by introducing a simple arithmetical calculation. Moreover, the influence of pressure simultaneously decreased after the same calculation process. A demonstrative measurement using the sensor revealed the practical usefulness for on-site monitoring.

Ultrasound-guided subclavian venipuncture is more rapidly learned than the anatomic landmark technique in simulation training.

PURPOSE: Both ultrasound-guided subclavian venipuncture (US-SV) and landmark-guided subclavian venipuncture (LM-SV) are important in critical care, because the clinical utility of ultrasound guidance is still debated. Education of residents and medical students should include both techniques. The aim of this study is to compare learning these two techniques in a simulation environment. METHODS: This study was approved by the research ethics review committee. Trainees included residents and medical students who were instructed using the "Videos in Clinical Medicine" for LM-SV, or a dedicated slide series for US-SV, using the long-axis in-plane with needle-guide technique. After the lecture, trainees attempted to perform venipuncture in a simulator. All participants performed both techniques. The procedure time from initial skin puncture to detecting back-flow of fluid from the simulated vein was measured. A procedure time over 3 min, arterial puncture, or pneumothorax was counted as a failure. The end-point for each trainee was three successive successful venipunctures without a failure. A trainee who reached the end-point was considered as having acquired adequate skill. Statistical analysis of the procedure time comparing the techniques was done using the Mann-Whitney U test. RESULTS: Twenty trainees participated in this training. Adequate skill to perform US-SV was achieved within three tries, but up to nine attempts were needed for LM-SV. One arterial puncture occurred during LM-SV. No pneumothoraxes occurred during the simulation training. CONCLUSIONS: US-SV was learned more quickly than LM-SV in a simulation model.

[Research studies on independent verification of monitor units in radiation therapy].

To prevent the recurrence of irradiation accidents, monitor-unit (MU) verification that is independent of the MU values calculated using the radiation treatment planning system (RTPS) is required. In this study, we investigated whether independent verification of MU values is being conducted in medical settings and examined the types and methods used. Our results indicate that 93.8% of facilities conduct independent MU verification. The methods used vary according to the facility: 30.4% conduct actual measurements, 18.6% use MS-Excel calculation sheets, 16.7% use specialized commercially-available software, 14.7% use spreadsheets 13.7% use calculators, and 5.9% use other methods. In this study, we were able to formulate basic data that can be used for information-sharing between facilities.

Investigation of errors by radiological technologists and evaluation of preventive measures: general and mobile X-ray examinations.

The first objective in this study was to identify the errors of incidents and accidents that occurred in general and mobile X-ray examinations. Based on the analysis of results, the second purpose in this study was to propose useful measures to prevent such errors. As much as 553 radiological technologists in the Gunma Prefecture were surveyed on their experience with errors related to general and mobile X-ray examinations. The questionnaire asked for descriptions of errors experienced during examinations and the responses given (multiple answers possible), and evaluations of the degree of busyness on a five-point scale. A total of 115 questionnaires were returned. Analysis revealed that there was no significant relationship between errors and degree of busyness for either general or mobile examinations. The most frequent error both in general and in mobile examinations was to X-ray a patient mistakenly, the cause of which was cited as failure to confirm the patient's name. After the use of solution priority number to evaluate proposed preventive measures, such as finger-pointing and call, independent double-checks, and verbal self-confirmation would be the simplest and most easily implemented countermeasure.

Generating induced pluripotent stem cells from common marmoset (Callithrix jacchus) fetal liver cells using defined factors, including Lin28.

Although embryonic stem (ES) cell-like induced pluripotent stem (iPS) cells have potential therapeutic applications in humans, they are also useful for creating genetically modified human disease models in nonhuman primates. In this study, we generated common marmoset iPS cells from fetal liver cells via the retrovirus-mediated introduction of six human transcription factors: Oct-3/4, Sox2, Klf4, c-Myc, Nanog, and Lin28. Four to five weeks after introduction, several colonies resembling marmoset ES cells were observed and picked for further expansion in ES cell medium. Eight cell lines were established, and validation analyses of the marmoset iPS cells followed. We detected the expression of ES cell-specific surface markers. Reverse transcription-PCR showed that these iPS cells expressed endogenous Oct-3/4, Sox2, Klf4, c-Myc, Nanog and Lin28 genes, whereas all of the transgenes were silenced. Karyotype analysis showed that two of three iPS cell lines retained a normal karyotype after a 2-month culture. Both embryoid body and teratoma formation showed that marmoset iPS cells had the developmental potential to give rise to differentiated derivatives of all three primary germ layers. In summary, we generated marmoset iPS cells via the transduction of six transcription factors; this provides a powerful preclinical model for studies in regenerative medicine.

Metastasectomy for renal cell carcinoma as a strategy to obtain complete remission.

We report a case of 67-year-old Japanese woman with two types of metastasectomy for metachronous metastases of renal cell carcinoma (RCC). The initial nephrectomy for left RCC was performed in April 1977. The pathological diagnosis was clear cell carcinoma grade1-2, pT1b. In May 1996, computed tomography (CT) revealed a tumor in the upper pole of the remaining right kidney. The renal tumor was enucleated in June 1996. The histopathological diagnosis of the tumors was clear cell carcinoma. In December 1998, conventional B-mode ultrasound US detected solid tumors in the uncus, body, and tail of pancreas, and the patient underwent partial pancreatectomy, preserving the pancreatic head. Histologically, the tumor consisted of clear cell carcinoma. Eleven years following the second metastasectomy, patient was disease free without adjuvant therapy.

Kawasaki disease patients with redness or crust formation at the Bacille Calmette-Guérin inoculation site.

BACKGROUND: A specific diagnostic test for Kawasaki disease (KD) is currently unavailable. Redness or crust formation at the Bacille Calmette-Guérin (BCG) inoculation site is listed as a positive sign in the diagnostic guidelines of KD. The purpose of this study was to investigate the epidemiologic features of KD patients with such changes at the BCG inoculation site and to evaluate the specificity of this sign in KD diagnosis. METHODS: Data on KD patients who received BCG vaccination were analyzed from a Japanese nationwide epidemiologic survey on KD conducted in 2007. Patients who had 5 or 6 principal signs (complete cases) with redness or crust formation at the BCG inoculation site were compared by sex, year of hospital visit, day of first hospital visit, recurrent status, and presence of KD in siblings. To evaluate the specificity of the sign for KD diagnosis, patients aged 2 years or younger who were diagnosed as having respiratory syncytial virus or rotavirus infection using a commercial rapid test and who required hospitalization were observed. RESULTS: Of the 15,524 KD patients with a history of BCG vaccination, 7745 (49.9%) had redness or crust formation at the BCG inoculation site. This was observed in more than 70% of complete KD patients aged 3 to 20 months. Of these patients, the proportion with this sign in the group whose first day of hospital visit was within 1 to 4 days from the onset was significantly larger than that of the other patients groups (5-9 or 10+ days) (52.1%, P < 0.001). Among the patients with respiratory syncytial virus or rotavirus infection, none showed these changes at BCG inoculation site. CONCLUSIONS: Redness or crust formation at the BCG inoculation site is a useful diagnostic sign for KD among children aged 3 to 20 months in countries with a BCG vaccination program. Even if patients have 4 or fewer signs of the clinical criteria for KD, physicians should consider that patients with redness or crust formation at the BCG inoculation site could suffer from KD.

[Difficult airway management due to obesity and lingual tonsillar hyperplasia].

We experienced anesthesia for a female patient of BMI 39.2 with unanticipated lingual tonsillar hyperplasia. At the induction of anesthesia, both mask ventilation and tracheal intubation were difficult due to the lingual tonsillar hyperplasia. However, tracheal intubation was performed by Intubating LMA with the fiberoptic bronchoscopy. After the placing of TE (the catheter for tracheal tube exchanger), the tracheal tube was extubated without any airway trouble. Following the extubation, the opening of the respiratory tract was evaluated by TE and the fiberoptic bronchoscopy. In this case we confirmed that the ASA difficult airway algorithm was also useful in the presence of lingual tonsillar hyperplasia.

[Case of facial edema and tongue swelling after aortic surgery in the lateral position].

The facial edema and tongue swelling after oral surgery are not rare complications and many case reports were published, but they were limited after anesthesia for surgery of other parts. A 70-year-old woman who had underwent thoraco-abdominal aortic graft surgery showed severe facial edema and tongue swelling after the surgery in the right lateral position. The tongue was largely protruded outside of the mouse when entering ICU and was gradually improved. Twelve hours later, the tongue was shrunken into the mouse. The patient was moved to a general ward without any complications on the 5th postoperative day. The patient had taken anti-hypertensive drugs including candesartan for a long period. She might have become susceptible to angioedema by angiotensin receptor blocker such as angiotensin-converting enzyme inhibitor and stress of surgery, and anesthesia might have induced a complication of the acute tongue swelling. Although, prevention and treatment of angioedema have not been established, careful observation would be required.

[Investigation of the present management status of calibration source based on the law concerning prevention of radiation hazards due to radioisotopes].

An amendment concerning the enforcement of the law on the prevention of radiation hazards due to radioisotopes, etc., and the medical service law enforcement regulations were promulgated on June 1, 2005. This amendment concerned international basic safety standards and the sealing of radiation sources. Sealed radiation sources < or =3.7 MBq, which had been excluded from regulation, were newly included as an object of regulation. Investigation of the SPECT system instituted in hospitals indicated that almost all institutions adhere to the new amendment, and the calibration source, the checking source, etc., corresponding to this amendment were maintained appropriately. Any institutions planning to return sealed radioisotopes should refer to this report.

[Investigation of academic degrees sought by radiological technologists].

This study attempted to clarify whether medical radiological technologists of the Japanese Society of Radiological Technology in Gunma sought to obtain Bachelor degrees and Master of Science degrees. In September 2005, a postal questionnaire survey was conducted on a sample of 153 technologists, and 68.0% (104/153) of the questionnaires were returned. The percentage of respondents who wished to obtain a degree was 25.0% (26/104) . The first reason for wishing to obtain a degree was to improve the quality of their work 47.8% (11/23) . Moreover, 28.8% (30/104) of respondents indicated a desire to obtain a master's degree. A total of 103 respondents indicated the subject they wished to study: 45.6% (47/103) indicated their own specific area, and 34.0% (35/103) indicated clinical psychology. The results of the survey showed that a high ratio of radiological technologists in Gunma would like to obtain an advanced degree. Even the radiological technologists who did not wish to obtain an advanced degree indicated their desire to continue in more specialized areas of radiology. The above investigation suggested some ways to implement lifelong education at the Gunma Prefectural College of Health Sciences.

[Hepatic infarction following prolonged prone position].

A 61-year-old woman with chronic renal failure was scheduled for posterior spinal fusion. The duration of surgery was over ten hours and the patient was placed on prone position almost whole period of surgery. Although the surgery was finished without any obvious complications, laboratory examinations revealed marked liver dysfunction the day after the surgery. On the third postoperative day, computed tomography examination strongly suggested the liver infarction. Liver infarction has been considered as a rare complication because of two kinds of blood streams, the hepatic artery and the portal vein, but we should suspect the liver dysfunction from ischemia after the surgery of prolonged prone position.

Syringe pump displacement alters line internal pressure and flow.

PURPOSE: It has been reported that the actual flow from a syringe pump changes due to vertical movement of the pump in vitro, but a direct study of the in vivo effects of fluid delivery irregularities caused by vertical pump displacement has not been performed. The aim of this study was to assess the influence of positional changes of the syringe pump on the internal pressure (IP) and flow from the circuit, and to examine blood pressure changes caused by pump movement in animals with or without hemorrhagic shock. METHODS: To simulate clinical conditions, we used a rabbit model. We first measured the changes in line IP and flow from the syringe pump after moving the pump 50 cm vertically upwards or downwards. With the same animal, we then recorded the blood pressure changes under these conditions during norepinephrine (NE) infusion, using a rabbit hemorrhagic shock (HS) model. RESULTS: Following downward movement of the syringe pump, the IP increased by 37.5 +/- 4.0 mmHg and IP decreased by 37.3 +/- 3.1 mmHg following upward movement of the syringe pump. In the rabbit HS model, movement downwards decreased systolic blood pressure (SBP) by -17 +/- 6.9% (P < 0.001), while upward movement raised SBP by 45.7 +/- 21.5% (P < 0.001) from baseline values. CONCLUSIONS: Vertical displacement of the syringe pump alters the flow due to a change of line IP, and blood pressure can be affected by pump movement during NE infusion.

[The first practical seminar of difficult airway management in the 51st annual meeting of Japan Society of Anesthesiologists].

Difficult Airway Management (DAM) is one of the most important skills for medical practice, especially for anesthesiologists. A seminar of DAM was held in the 51 st annual meeting of Japan Society of Anesthesiologists. It consisted of a 60-minute lecture about ASA difficult airway management algorithm, and a 120-minute hands-on training session using a mid-fidelity human simulator. The lecture was held twice, and was opened to every JSA member without pre-registration. More than 100 participants attended each lecture. The hands-on training session, which required preregistration, was held three times. Each training session was limited to 8 participants, and a total of 23 participants attended the session. The training session was restricted to only participants and staffs so that their privacy was secured. The questionnaire about DAM was collected after the lectures or the training sessions. Most of the participants of lectures were certified anesthesiologists, and they agreed that the DAM seminar was useful. The questionnaire revealed that the most popular technique for DAM was insertion of laryngeal mask airway (ILMA). Otherwise the invasive techniques were difficult to be experienced in the clinical practice. We suspected that the DAM seminar was useful, especially for the invasive technique without substitute training methods under clinical situation.