Rapid Change in the Direction of Hand Movement to Increase Hand Propulsion During Front Crawl Swimming.

This study aims to investigate the difference in hand acceleration induced by rapid changes in hand movement directions and propulsion between fast and slow groups of swimmers during front crawl swimming. Twenty-two participants, consisting of 11 fast and 11 slow swimmers, performed front crawl swimming at their maximal effort. Hand acceleration and velocity and the angle of attack were measured using a motion capture system. The dynamic pressure approach was used to estimate hand propulsion. In the insweep phase, the fast group attained significantly higher hand acceleration than the slow group in the lateral and vertical directions (15.31 [3.44] m·s-2 vs 12.23 [2.60] m·s-2 and 14.37 [1.70] m·s-2 vs 12.15 [1.21] m·s-2), and the fast group exerted significantly larger hand propulsion than the slow group (53 [5] N vs 44 [7] N). Although the fast group attained large hand acceleration and propulsion during the insweep phase, the hand velocity and the angle of attack were not significantly different in the 2 groups. The rapid change in hand movement direction could be considered in the technique of underwater arm stroke, particularly in the vertical direction, to increase hand propulsion during front crawl swimming.

[Efficacy and safety of administration of low-dose unfractionated heparin (LDUH) for the prevention of pulmonary thromboembolism after surgery for lung cancer; the long term outcome].

We evaluated the efficacy and safety of the administration of low-dose unfractionated heparin(LDUH)for the prevention of pulmonary thromboembolism after lung cancer surgery. We operated on 206 patients with primary lung cancer for 8 years;128 males and 78 females, mean age:69.9±8.8 years. All patients were administrated LDUH 5,000 units every 12 hours from the operation day until the day when the patient could walk around the floor. No patients suffered from clinical pulmonary thromboembolism in this period. The duration of treatment was 4.6±2.6 days and the chest tube duration was 5.4±3.0 days. We experienced post-operative intra-thoracic bleeding in 2 patients during the previous 4 years. Based on this experience, we introduced new eligibility criteria;we discontinued LDUH administration on the operation day if diffuse adhesion in the thoracic cavity was observed at operation or intraoperative blood loss was over 500 ml. The dose of LDUH was decreased to 2,500 unit every 12 hours if the postoperative bleeding was over 400 ml on the operation day or the patient's body weight was less than 40 kg. After introduction of the new criteria, no severe bleeding complications occurred during the latter 4 years.

Estimation of factors contributing to level differences in Japanese university decathlon athletes.

This study aimed to estimate the factors that cause differences in competition level based on the competition performance structure among university student decathletes in Japan. The results of factor analysis using the maximum likelihood method (Oblimin rotation), assuming a five-factor structure estimated from parallel analysis and the information criterion, revealed the following competitive performance structures: "running speed and body projection," "running endurance," "rotational throwing power," "translational throwing power," and "vertical leaping power." Some of these were similar to the competitive performance structures of the world's top athletes, but they were found to have a unique structure: two throwing powers. The analysis results using latent rank theory allowed us to evaluate them on a seven-point scale. The calculated item reference profile, difficulty index, and discrimination index for each rank indicated that shot put and 100 and 400 m performance formed the basis of decathlon performance. In addition, high jump and pole vault, which fall under the category of "vertical leaping power," retained high difficulty and discrimination and were revealed to affect the stage of achievement of overall performance in the decathlon.

Relationship between decreased swimming velocity and muscle activity during 200-m front crawl.

The aims of this study were (1) to evaluate changes in muscle activity associated with physiological fatigue and decreased swimming velocity (SV) during 200 m of front crawl swimming, and (2) to examine the relationship between the decreased SV and changes in kinematic or electromyogram parameters. Twenty swimmers participated in a 4 × 50-m swim test. The surface EMG of 11 muscles (7 in the upper limbs and 4 in the lower limbs) was measured and the mean amplitude value (MAV) for one stroke cycle was obtained. The SV and arm angular velocity (AAV) of shoulder flexion during the first (early stroke) and second (late stroke) half of the underwater arm stroke were analyzed using an underwater camera. The AAV, the MAV of flexor carpi ulnaris (FCU), biceps brachii (BB), and triceps brachii during the early stroke, and the MAV of rectus femoris decreased along with a decrease in SV. In contrast, the MAV of the pectoralis major (PM) increased significantly in the final 50 m. The rate of change in MAVs (ΔMAVs) of FCU, BB and latissimus dorsi during the early stroke, and ΔMAV of biceps femoris were significantly correlated with ΔSV and/or ΔAAV. Positive correlations were identified between ΔMAVs of several muscles. However, no negative correlations were observed between ΔMAVs. These results suggest that the decrease in SV was related to decreases in the activities of several muscles that coordinated with each other, and that a compensating strategy occurred between PM and other muscles in the final 50 m.

[A review of cases of surgery for acute empyema].

We retrospectively reviewed cases of acute empyema treated surgically in our hospital from April 2005 to April 2010. Patients comprised 10 men and 4 women, with a mean age of 62.5 years( range, 23~ 80 years). One case required open thoracotomy and decortication, and was in the organized phase at the time of operation( duration of symptoms before surgery, 44 days). The remaining 13 cases were in the fibropurulent phase at the time of operation and underwent video-assisted thoracoscopic surgery (VATS). In 6 of these 13 remaining cases, we performed mini-thoracotomy combined with the thoracoscopic operation due to the presence of severe intrathoracic adhesions. Median durations of postoperative drainage and postoperative stay were 5 days( range, 2~7 days) and 13.5 days( range, 6~17 days), respectively. Postoperative complications of subcutaneous abscess, drug-induced hepatitis, pseudomembranous enterocolitis and reexpansion pulmonary edema were observed in 1 case each, but all patients survived to discharge without perioperative deaths. VATS is a safe and effective method for the management of acute empyema, and is favorable to perform in the fibropurulent phase. Appropriate combination with mini-thoracotomy was useful in accomplishing surgery in cases with dense adhesion.

Contribution of upper trunk rotation to hand forward-backward movement and propulsion in front crawl strokes.

The study aims to test three hypotheses: (a) the rotation of the upper trunk consists of roll, pitch and yaw of frequencies harmonic to the stroke frequency of the front crawl stroke, (b) the rotation of the upper trunk generates back-and-forth movements of the shoulders, which enhances the movements of the stroking arms, and (c) the angular velocities of roll, pitch and yaw are associated with hand propulsion (HP). Front crawl strokes performed by twenty male swimmers were measured with a motion capture system. The roll, pitch and yaw angles about the three orthogonal axes embedded in the upper trunk were determined as three sequential Cardan angles and their angular velocities were determined as the three respective components of the angular velocity. HP and the drag and lift components of HP (HPD and HPL) were estimated by the hand positions and the data from twelve pressure sensors attached on hands. The roll, pitch, and yaw angles were altered in frequencies harmonic to the stroke frequency during the front crawl stroke. Shoulders alternately moved back and forth due to the upper trunk rotation. In the pull phase the angular velocity of roll was correlated with HPL (r = -0.62, p = 0.004). Based on the back-and-forth movements of the shoulders and roll motion relative to a hand movement, the arm-stroke technique of the front crawl swimming was discussed in terms of increasing the hand velocity and HP.

Tubular adenocarcinoma of the thymus: case report and review of the literature.

Primary carcinomas of the thymus are rare. A variety of histologic patterns have been reported, and the most common are squamous cell carcinoma, lymphoepithelioma like carcinoma, and basaloid carcinoma. Adenocarcinomas of the thymus are extremely rare. As determined from a literature search, a pure tubular adenocarcinoma has never been previously described, and thus, this is first case report of tubular adenocarcinoma of the thymus. A combined resection of the superior vena cava and pericardium was performed. Immunohistochemically, the tumor cells were positive for CD5.

Lower muscle co-contraction in flutter kicking for competitive swimmers.

The purpose of this study was to examine the difference in muscle activation pattern and co-contraction of the rectus and biceps femoris in flutter-kick swimming between competitive and recreational swimmers, to better understand the mechanism of repetitive kicking movements during swimming. Ten competitive and 10 recreational swimmers swam using flutter kicks at three different velocities (100%, 90%, and 80% of their maximal velocity) in a swimming flume. Surface electromyographic signals (EMG) were obtained from the rectus (RF) and biceps femoris (BF), and lower limb kinematic data were obtained at the same time. The beginning and ending of one kick cycle was defined as when the right lateral malleolus reached its highest position in the vertical axis. The offset timing of muscle activation of RF in the recreational swimmers was significantly later at all velocities than in the competitive swimmers (47-48% and 26-33% of kick time of one cycle for recreational and competitive swimmers, respectively), although the kinematic data and other activation timing of RF and BF did not differ between groups. A higher integrated EMG of RF during hip extension and knee extension induced a higher level of muscle co-contraction between RF and BF in the recreational swimmers. These results suggest that long-term competitive swimming training can induce an effective muscle activation pattern in the upper legs.

[A case of brain metastasis discovered after surgery for lung cancer based on changes in CEA, in which long-term survival was obtained by repeated gammaknife irradiation].

A 58-year-old man underwent right lower lobectomy for lung adenocarcinoma in June 1998. Since a high level of tumor marker CEA persisted after surgery, chemotherapy was additionally performed, and the CEA level subsequently normalized. However, the CEA level increased in April 1999, and brain metastasis was found in the left occipital lobe, and the first gammaknife irradiation was performed. Multiple brain metastases were found when CEA increased again in August 1999, and the second gammaknife irradiation was performed. Moreover, brain metastases were found in the left frontal and occipital lobes in February 2000, and the third gammaknife irradiation was performed. CEA normalized thereafter, but increased in February 2001. Brain metastasis was found in the right occipital lobe, and the fourth gammaknife irradiation was performed. CEA has remained within the normal range for about 4 years thereafter. Long-term survival was possible by repeated gammaknife irradiation for brain metastases. Monitoring of CEA played an important role in finding recurrent brain metastasis in this patient.

Chromosome 8 numerical aberrations in stage II invasive ductal carcinoma: correlation with patient outcome and poor prognosis.

Aberrations in chromosome 8 are common in breast cancer. However, the relationship between numerical aberrations of chromosome 8 and clinical behavior (especially prognosis) in breast cancer is not well understood. In this study, a total of 40 specimens of stage II invasive ductal carcinomas (IDCs) was analyzed by fluorescence in situ hybridization (FISH) with a chromosome 8 centromere-specific probe and DNA flow cytometry (stage IIA: 20 cases; stage IIB: 20 cases). All cases were followed for at least 5.7 yr (mean: 7.5 yr; median: 7.7 yr) after surgery or until death. Single (loss), double, and triple or more signals (gain) of chromosome 8 were found in 7.6 +/- 3.5% (range: 2-16%; median: 7%), 53.7 +/- 13.2% (range: 25-81%, median: 53%), and 38.7 +/- 13.2% (range: 17-65%, median: 38%), respectively, of tumors. The frequencies of chromosome 8 gain and disomy correlated with patient outcome (respectively p < 0.05 and p < 0.01). When median ratios of chromosome 8 loss, disomy, and gain were used as the cutoff values, the survival curves revealed that patients in the low-frequency group survived significantly longer than those in the high-frequency group for chromosome 8 gain (p < 0.05), and patients in the high-frequency group survived significantly longer than those in the low-frequency group for chromosome 8 disomy (p < 0.05). Poor prognosis was not associated with age, tumor size, lymph node metastasis, histologic type, TNM stage, estrogen-receptor status, progesterone- receptor status, or DNA ploidy. Our results suggest that the frequencies of chromosome 8 gain and disomy is a potentially useful parameter for predicting prognosis of stage II IDCs.

[Clinical evaluation of transbronchial needle aspiration for histological specimens].

Specimens were obtained from 10 patients with radiological abnormalities involving mediastinal or hilar areas, for histological examination using 19 G transbronchial needle aspiration (TBNA). The tissues examined proved diagnostic in 6 patients (60%) including one with a benign condition (sarcoidosis). Clinical characteristics (sex, age, puncture site, number of specimens, size of radiological abnormalities) in the 6 positive patients were compared with those for the 4 negative patients. No significant differences in the number of specimens or the size of radiological abnormalities were observed between groups. However, a punctured trachea was seen in significantly more cases in the negative group (3/4, 75%) than in the positive group (1/6, 17%; p<0.05). Few minor complications were encountered. The use of a 19 G TBNA appears effective for obtaining tissue for histological examination and diagnosis of benign conditions. Training in this technique should increase the diagnostic utility of the histology needle.

Intracyclic velocity variation and arm coordination for different skilled swimmers in the front crawl.

The aim of this study was to examine whether the intracyclic velocity variation (IVV) was lower in elite swimmers than in beginner swimmers at various velocities, and whether differences may be related to arm coordination. Seven elite and nine beginner male swimmers swam front crawl at four different swimming velocities (maximal velocity, 75%, 85%, and 95% of maximal swimming velocity). The index of arm coordination (IDC) was calculated as the lag time between the propulsive phases of each arm. IVV was determined from the coefficient of variation of horizontal velocity within one stroke cycle. IVV for elite swimmers was significantly lower (26%) than that for beginner swimmers at all swimming velocities (p<0.01, 7.28 1.25% vs. 9.80 1.70%, respectively). In contrast, the IDC was similar between elite and beginner swimmers. These data suggest that IVV is a strong predictor of the skill level for front crawl, and that elite swimmers have techniques to decrease IVV. However, the IDC does not contribute to IVV differences between elite and beginner swimmers.

Surgical treatment for lung cancer in octogenarians.

PURPOSE: We conducted this study in order to determine how we should perform the surgical treatment for clinical stage I non-small cell lung cancer (NSCLC) in octogenarians. METHODS: Thirty-three octogenarians with clinical stage I NSCLC participated in this study. They were retrospectively divided into two groups: one group of 11 patients who underwent a lymph node dissection (ND group), and one group of 22 patients who did not undergo this procedure (ND0 group). We analyzed the surgical invasiveness, morbidity, mortality, and survival in both groups. RESULTS: The morbidity rate in the ND group (45%) was higher than that in the ND0 group (23%); however, the difference was no statistically significant (P = 0.1805). There was no significant difference in the overall survival rates of the two groups (P = 0.1647), and the median survival time of the ND0 group (76 months) was slightly longer than that of the ND group (26 months). There was no significant difference in local recurrence rate between the two groups (9.1% vs 4.5%, P = 0.6059). CONCLUSION: We thus conclude that a limited operation without lymph node dissection might be the best surgical treatment for carefully selected octogenarians with clinical stage I NSCLC.

Pulmonary tractotomy for a patient with traumatic penetrating lung injury: report of a case.

We report a case of traumatic hemopneumothorax caused by penetrating lung injury in a 26-year-old man. The patient underwent emergency thoractomy, which revealed hemorrhage in the lingular segment of the left lung. We found the bleeding point and controlled the hemorrhage using pulmonary tractotomy by inserting a linear stapler into the stab wound in the pulmonary parenchyma. The original technique of pulmonary tractotomy was performed for complete through-and-through injury by dividing the bridge of lung tissue between the aortic clamps. We were able to apply this procedure safely to stop bleeding from a stab wound that did not go through the lung. Thus, pulmonary tractotomy is an effective damage-control operation for the lung with obvious advantages over major lung resection.

Presentation of a major histocompatibility complex class 1-binding peptide by monocyte-derived dendritic cells incorporating hydrophobized polysaccharide-truncated HER2 protein complex: implications for a polyvalent immuno-cell therapy.

Recognition of the essential role of dendritic cells (DCs) as professional antigen-presenting cells has prompted investigators to search for methods to use DCs as natural adjuvants in immunotherapy. A number of antigenic oligopeptides, recognized by CD8(+) cytotoxic T lymphocytes (CTLs) specific for cancer cells, have been applied in clinical trials using DCs. Such a monovalent vaccine with a single epitope for a particular type of HLA class 1 molecule would be effective. However, a polyvalent vaccine might be more potent. We designed a novel protein delivery system consisting of hydrophobized polysaccharides complexed with target proteins. The truncated HER2 protein encompassing 147 N-terminal amino acids, including the 9-mer HER2p63-71 peptide (HER2p63), TYLPTNASL, the human homologue of an antigenic murine tumor rejection peptide, was prepared. We report here that HLA-A2402(+) DCs could incorporate hydrophobized polysaccharide-truncated HER2 protein complexes and process the protein to present major histocompatibility complex class 1-binding HER2p63 peptide. The complexes enter DCs by phagocytosis, and then the truncated protein is processed through a pathway similar to that for endogenous proteins. DCs sensitized by these complexes primed and boosted HER2p63-specific CD8(+) T cells in the context of HLA-A2402. Vaccination with DCs incorporating these complexes completely suppressed lung metastases in a HER2-expressing murine tumor model. We also generated 3 CD4(+) clones reactive with different HER2- derived 25-mer peptides from lymph node cells in mice treated with CHP/HER2-147. Thus, hydrophobized polysaccharide-protein complexes are promising candidates for the construction of polyvalent vaccines.

Activities of granulocyte-macrophage colony-stimulating factor and interleukin-3 on monocytes.

We examined the actions of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-3 (IL-3) on human monocytes, using a serum-free culture system. GM-CSF and IL-3 did not promote the differentiation of monocytes into macrophages but rather into cells with a phenotype compatible with that of immature dendritic cells (DCs). The addition of fetal bovine serum to serum-free cultures with GM-CSF or IL-3 restored the differentiation of monocytes into macrophages. Cells generated with GM-CSF or IL-3 elicited phagocytic activity. Cells generated in the presence of GM-CSF or IL-3, followed by the addition of tumor necrosis factor-alpha, displayed a phenotype of mature DCs, and primed and stimulated immunogenic peptide-specific T lymphocytes. Surprisingly, GM-CSF and IL-3 inhibited macrophage colony-stimulating factor (M-CSF)-dependent differentiation of monocytes into macrophages and induced differentiation into immature DCs. We asked if the inhibition of M-CSF-dependent differentiation into macrophages by GM-CSF or IL-3 was associated with the expression of M-CSF receptors (M-CSFR). GM-CSF or IL-3 down-regulated the expression of M-CSFR. These data demonstrate that GM-CSF and IL-3 primarily support the differentiation of monocytes into DCs and inhibit M-CSF-dependent differentiation into macrophages by suppressing the expression of M-CSFR, thereby promoting differentiation into DCs.