Surgical outcomes of very-early-onset ulcerative colitis: retrospective comparative study with older pediatric patients.

PURPOSE: The study compares the surgical outcomes of very-early-onset ulcerative colitis (VEO-UC), which is a rare disease diagnosed in pediatric patients < 6 years, with those of older pediatric patients with ulcerative colitis (UC). METHODS: A retrospective observational study of 57 pediatric patients with UC was conducted at a single center. The study compared surgical complications and postoperative growth between the two groups. RESULTS: Out of the 57 patients, 6 had VEO-UC, and 5 of them underwent total colectomy. Compared with the surgical cases of older patients with UC (n = 6), the rate of postoperative complications in patients with VEO-UC (n = 5) was not significantly different, except for high-output ileostomy (80% vs. 0% at 3 weeks postoperatively, p = 0.02). The rate of postoperative central venous catheter (CVC) placement at > 90 days was higher in patients with VEO-UC (100% vs. 17%, p = 0.02). The median change in the Z-score of height before and 2 years after colectomy was not significantly different between VEO-UC and older patients (1.1 vs. 0.3, p = 0.13). CONCLUSION: With regard to complications and outcomes, total colectomy for VEO-UC patients and that for older pediatric UC patients is comparable. However, high-output ileostomy and the long duration of CVC placement may pose management challenges.

Left ventricular apical aneurysm resection and mitral valve replacement for apical hypertrophic cardiomyopathy.

Key clinical message: Left ventricular apical hypertrophic cardiomyopathy with an apical aneurysm carries a risk of thrombosis and can also lead to atrial fibrillation and functional mitral regurgitation. Abstract: A 78-year-old woman underwent left ventricular apical aneurysm (LVAA) resection and mitral valve replacement for severe atrial functional mitral regurgitation. ApHCM can cause atrial fibrillation and atrial functional mitral valve regurgitation. LVAA resection in addition to mitral valve replacement was reasonable to prevent fatal complications associated with LVAA.

Large left atrial thrombus resection in a patient in sinus rhythm without mitral valve disease: A case report.

INTRODUCTION: Left atrial (LA) ball thrombi are often associated with atrial fibrillation (AF) and mitral valve disease (MVD). Differentiating between thrombi and LA tumors can be challenging. PRESENTATION OF A CASE: A 63-year-old man with a prior mesh insertion for abdominal incisional hernia was admitted with fever. He was diagnosed with an abdominal mesh-related infection requiring surgical debridement. Preoperative transthoracic echocardiography revealed a 39-mm smooth mass in the LA adherent to the atrial septum. The mass was suspected to be a cardiac tumor based on the morphology. The patient underwent mass resection. Pathophysiology revealed that the mass was a thrombus, necessitating anticoagulation therapy. No recurrence of thrombus formation was reported. DISCUSSION: In this case, a plausible factor causing the thrombus formation is the chronic mesh. Since LA thrombi can become free-floating or grow rapidly, early surgical intervention is essential to prevent thrombotic events or sudden death. CONCLUSION: An LA thrombus should be included in the differential diagnosis when an LA mass is detected. Prompt surgical resection prevents thrombotic events and improves patient outcomes.

Frank's sign with acute aortic dissection.

A 59-year-old man with a long smoking history presented with sudden back pain. Frank's sign was noticed in his bilateral ears, and computed tomography revealed Stanford type A acute aortic dissection. If young patients have Frank's sign, attention should be paid to aortic disease in addition to coronary artery disease.

[A case report of Legionella pneumonia in a patient with ulcerative colitis undergoing remission maintenance using azathioprine].

A 67-year-old man was diagnosed with ulcerative colitis one year ago. Remission was induced via the oral administration of prednisolone and azathioprine;prednisolone was gradually reduced and discontinued. He maintained remission with azathioprine but developed fever and general malaise and visited the Kagawa Prefectural Central Hospital. Chest radiography and a urinary antigen test revealed Legionella pneumonia. His symptoms reduced immediately after the initiation of levofloxacin. Azathioprine suppresses cellular immunity and may increase the risk of Legionella pneumonia.

How to Maintain Maximal Straight Path Running Speed on a Curved Path in Sprint Events.

This study aims to clarify the ideal technique for running on a curved path during sprinting events. Participants were twelve male track and field athletes including long jumpers and sprinters. The participants performed a 60-m sprint with maximal effort on straight and curved paths. Participants were divided into "good curve runners" and "poor curve runners" according to the curved path running speed relative to that of the straight path. Kinematic variables and ground reaction forces (GRFs) were registered and compared between the groups and paths. The running speed, step length, and flight distance of the outside leg on the curved path were lower than on the straight path only in poor curve runners. The medial-lateral GRF and impulse showed an increase during curved path running for both groups. However, the maximum posterior GRF and impulse decreased only in poor curve runners. The ideal technique for running on a curved path is to maintain the same kinematics and kinetics in the sagittal plane as on a straight path.

A Subjective Assessment of the Prevalence and Factors Associated with Poor Sleep Quality Amongst Elite Japanese Athletes.

BACKGROUND: The amount, quality, and timing of sleep are considered important for athletes' ability to train, maximize training responses, and recover. However, some research has shown that elite athletes do not obtain sufficient sleep. Based on this background, researchers recently started to assess and manage sleep in elite athletes. The purpose of this study was to clarify the prevalence of poor sleep quality and its associated factors amongst elite Japanese athletes. METHODS: Eight hundred and ninety-one candidates for the 17th Asian Games Incheon 2014, who were over 20 years old, participated in this study. They completed a questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, two-question case-finding instruments, and a checklist for sleep hygiene. Data from 817 of the 891 athletes (91.7%) with no missing values were analyzed. RESULTS: The mean time in bed was 7 h and 29 min. Two hundred and twenty-nine (28.0%) athletes showed a PSQI global score above the clinical criteria. A multiple logistic analysis revealed that sleep quality was significantly associated with five factors: "time in bed," "eating breakfast every morning," "avoiding the use of electronic devices (PC, smartphone, etc.) just before bedtime," "depressive mood", and "not thinking about troubles while in bed." Forty percent of athletes reported they had been informed by someone about "snoring loudly" and/or "leg twitching or jerking during sleep." CONCLUSIONS: The results of this study demonstrate that 28% of the athletes showed the PSQI score above the cutoff for poor sleep quality (> 5.5), which suggests that there may be a high prevalence of poor sleep quality in this population of athletes. To improve athletes' sleep, the five factors associated with sleep quality should be emphasized in athletes' sleep education. Furthermore, in medical evaluations of athletes, it may be desirable to include screening for sleep disorders.

Effects of systemic hypoxia on human muscular adaptations to resistance exercise training.

Hypoxia is an important modulator of endurance exercise-induced oxidative adaptations in skeletal muscle. However, whether hypoxia affects resistance exercise-induced muscle adaptations remains unknown. Here, we determined the effect of resistance exercise training under systemic hypoxia on muscular adaptations known to occur following both resistance and endurance exercise training, including muscle cross-sectional area (CSA), one-repetition maximum (1RM), muscular endurance, and makers of mitochondrial biogenesis and angiogenesis, such as peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), citrate synthase (CS) activity, nitric oxide synthase (NOS), vascular endothelial growth factor (VEGF), hypoxia-inducible factor-1 (HIF-1), and capillary-to-fiber ratio. Sixteen healthy male subjects were randomly assigned to either a normoxic resistance training group (NRT, n = 7) or a hypoxic (14.4% oxygen) resistance training group (HRT, n = 9) and performed 8 weeks of resistance training. Blood and muscle biopsy samples were obtained before and after training. After training muscle CSA of the femoral region, 1RM for bench-press and leg-press, muscular endurance, and skeletal muscle VEGF protein levels significantly increased in both groups. The increase in muscular endurance was significantly higher in the HRT group. Plasma VEGF concentration and skeletal muscle capillary-to-fiber ratio were significantly higher in the HRT group than the NRT group following training. Our results suggest that, in addition to increases in muscle size and strength, HRT may also lead to increased muscular endurance and the promotion of angiogenesis in skeletal muscle.

Disulphide linkage in mouse ST6Gal-I: determination of linkage positions and mutant analysis.

All cloned sialyltransferases from vertebrates are classified into four subfamilies and are characterized as having type II transmembrane topology. The catalytic domain has highly conserved motifs known as sialylmotifs. Besides sialylmotifs, each family has several unique conserved cysteine (Cys) residues mainly in the catalytic domain. The number and loci of conserved amino acids, however, differ with each subfamily, suggesting that the conserved Cys-residues and/or disulphide linkages they make may contribute to linkage specificity. Using Matrix Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-TOF)-mass spectrometry, the present study performed disulphide linkage analysis on soluble mouse ST6Gal-I, which has six Cys-residues. Results confirmed that there were no free Cys-residues, and all six residues contributed to disulphide linkage formation, C(139)-C(403), C(181)-C(332) and C(350)-C(361). Study of single amino acid-substituted mutants revealed that the disulphide linkage C(181)-C(332) was necessary for molecular expression of the enzyme, and that the disulphide linkage C(350)-C(361) was necessary for enzyme activity. The remaining disulphide linkage C(139)-C(403) was not necessary for enzyme expression or for activity, including substrate specificity. Crystallographic study of pig ST3Gal I has recently been reported. Interestingly, the loci of disulphide linkages in ST6Gal-I differ from those in ST3Gal I, suggesting that the linkage specificity of sialyltransferase may results from significant structural differences, including the loci of disulphide linkages.

A hypervalent pentacoordinate boron compound with an N-B-N three-center four-electron bond.

For the purpose of synthesizing and characterizing hypervalent boron compounds with strong hypervalent interaction, we have prepared a boron compound with a tridentate ligand bearing two pyrimidine rings as nitrogen donors. X-ray analysis and molecular orbital calculations suggested that the boron compound was of hypervalent pentacoordinate structure with an N-B-N hypervalent bond. Thus, we have prepared the first hypervalent second row element compound with apical N coordination. A breakdown of energy contributions by DFT calculations revealed that the N-B-N bond energy of the pentacoordinate state ground state (13) was 2.8 kcal mol(-1). Implications were that the conjugation energy difference of 6.6 kcal mol(-1) (14.2-7.6 kcal mol(-1)) with the tetracoordinate state was a crucial factor for shifting stability toward the pentacoordinate structure.

Factors determining the spin axis of a pitched fastball in baseball.

In this study, we wished to investigate the factors that determine the direction of the spin axis of a pitched baseball. Nineteen male baseball pitchers were recruited to pitch fastballs. The pitching motion was recorded with a three-dimensional motion analysis system (1000 Hz), and the orientations of the hand segment in a global coordinate system were calculated using Euler rotation angles. Reflective markers were attached to the ball, and the direction of the spin axis was calculated on the basis of their positional changes. The spin axis directions were significantly correlated with the orientations of the hand just before ball release. The ball is released from the fingertip and rotates on a plane that is formed by the palm and fingers; the spin axis of the ball is parallel to this plane. The lift force of the pitched baseball is largest when the angular and translational velocity vectors are mutually perpendicular. Furthermore, to increase the lift forces for the fastballs, the palm must face home plate.

[A case of small cell carcinoma of esophagus treated by chemotherapy with CDDP plus CPT-11 and radiotherapy].

We present a case of small cell carcinoma of esophagus treated by chemotherapy with CDDP plus CPT-11 and radiotherapy. A 73-year-old woman visited our hospital with complaints of neck mass and discomfort during swallowing. Upper gastrointestinal endoscopy revealed a type 3 tumor in the middle portion of the esophagus, which was pathologically diagnosed as small cell carcinoma. A computed tomography showed lymph node swelling from neck to mediastinum. Then she was administered chemotherapy with CDDP plus CPT-11 and radiotherapy. The main tumor and lymph node swelling was remarkably reduced by chemoradiotherapy. The prognosis of small cell carcinoma of the esophagus is extremely poor because it may cause a general metastasis in early stage. This case was for long-term survival with chemoradiotherapy, and we report our case with the literature cited.

[The assessment of chemoradiation therapy with CDDP/S-1 for advanced gastric cancer that was actively bleeding].

In the management of inoperable patients with advanced gastric cancer, it is important to control a tumor bleeding actively and to make sure that the patient can take meals through the stenotic cardia for the purpose of keeping the patients' quality of life well. We treated five gastric cancer patients with chemoradiation therapy consisting of CDDP (6 mg/m2) and S-1 (100 mg/body). In the treatment results, we have never seen an active tumor bleeding and anemic state, which required a blood transfusion after the treatment. In all of the 5 cases, a total quantity of taking meals increased due to a cardia stenosis improvement by tumor. We thought this treatment was useful for patients with cardia stenosis and actively bleeding in advanced gastric cancer.

[Assessment of chemoradiation therapy for advanced rectal cancer invaded the pelvic organ].

We assess the effect of chemoradiation therapy for four cases of advanced rectal cancer. The radiation therapy consisted of 40-50 Gy delivered in fraction of 2 Gy/day. A treatment of 5-fluorouracil (500 mg/body) with l-leucovorin (100 mg/body) intravenously once a week, or oral S-1 (100 mg/day/body) for four weeks, was given during radiation therapy. Efficacy for primary carcinoma was evaluated as partial response in all four cases. We performed a curative operation in two cases. Histological efficacy for primary tumors was diagnosed as Grade 2 and Grade 3. Grade 3 adverse effect for neutropenia occurred in one patient, and Grade 3 adverse effect for appetite loss occurred in 2 patients. All cases survived without a recurrence for a period of 4 months-5 years and 3 months. Chemoradiation therapy was safe and an effective treatment prior to curative operation for advanced rectal cancer which invaded the pelvic organ.

Shoulder and elbow kinematics in throwing of young baseball players.

In this study we compared the kinematic features of the throwing motion between young baseball players of different age groups. Forty-four Japanese baseball players aged 6.1 to 12.3 years who regularly played baseball, including pitchers and position players, had their throwing actions analyzed three-dimensionally using high speed videography. Of this sample, 26 players aged above 9 years of age were categorized as the senior group, while the remaining 18 were categorized as the junior group. Senior group throwers had greater height and body mass, and produced a greater ball speed than junior group throwers. The throwing arm movement of senior group throwers was similar to that of adult skilled players. However, in the junior group throwers, the shoulder horizontal adduction angle was larger during the arm acceleration phase, and the maximum angular velocities of elbow extension and shoulder internal rotation occurred later than in senior group throwers. These results indicate that players aged above 9 years can acquire a mature throwing arm movement, while players younger than that will use an immature motion. A possible reason why these differences were shown is that the official baseball is relatively heavy for junior group throwers; they would be better advised to use a lighter ball in throwing practice.

Improved septal contraction and coronary flow velocity after cardiac resynchronization therapy elucidated by strain imaging and pulsed wave Doppler echocardiography.

OBJECTIVES: The effects of cardiac resynchronization therapy (CRT) with various atrioventricular conduction delay settings were investigated on cardiac hemodynamic changes involved in coronary flow velocity using color and pulsed wave Doppler modalities and myocardial regional contractility using a novel echocardiographic technique (strain imaging). METHODS: Seven patients with advanced heart failure (left ventricular ejection fraction < 35%) and left bundle branch block(QRS > or = 140 msec) were treated with CRT. Color and pulsed wave Doppler imaging were performed from the apical four-chamber view to examine the cardiac functions such as stroke volume, cardiac output, mitral regurgitant volume and coronary flow velocity. Strain imaging was performed to quantify the asynchrony of both intraventricular and interventricular time delay between the septum and left ventricular free wall (posterior wall) and to assess the regional contractile function. Wall motion was also evaluated. RESULTS: Intraventricular and interventricular asynchrony were improved from 173 +/- 18 to 60 +/- 6 msec, and 69 +/- 25 to 12 +/- 3 msec, respectively. Stroke volume (55.2 +/- 6.2 to 76.8 +/- 10.8 ml; 39% up), cardiac output (3.9 +/- 0.3 to 5.4 +/- 0.5 I/min; 38% up) and coronary flow velocity (24 +/- 3 to 36 +/- 5 cm/sec; 50% up) were greatly increased and mitral regurgitant volume (59.7 +/- 18.0 to 38.9 +/- 11.3 ml; 35% down)was clearly decreased. Septal wall shortening was greatly increased from 10.2 +/- 2.3% to 17.0 +/- 1.8% and septal wall motion (radial thickening)was also improved simultaneously. Atrioventricular interval settings influenced all above parameters. CONCLUSIONS: CRT improved the cardiac hemodynamics involved in coronary flow significantly due to both resynchronization of inter and intra asynchrony, and improvement of the regional myocardial contraction in patients with severe congestive heart failure and complete left bundle branch block.

Predicting prognosis based on the shape of the left ventricular cavity in dilated cardiomyopathy: analysis using rate of improvement in the circle index.

PURPOSE: To elucidate the relation between a quantitative measure of the shape of the left ventricular cavity, cardiac function, and prognosis in patients with dilated cardiomyopathy (DCM). METHODS: The hearts of 20 healthy individuals and 18 patients with DCM were evaluated. Participants were aged 48.5 ± 5.0 years. On the basis of end-systolic four-chamber view echocardiograms, the endocardium of the left ventricle was traced and the resulting curve was segmented using 100 points. A line tangential to the curve was then drawn at each point, and the angle between two adjacent tangential lines was calculated. The deviation of these angles was designated as the circle index. The circle index and hemodynamic findings in patients with DCM were compared, and the rate of improvement in the circle index in these cases of DCM was determined. These patients were then placed into one of two groups: group R (11 patients), those with improvement rates of 10% or higher at time of discharge; and group NR (seven patients), those with rates less than 10%. Diuretic (furosemide) use, New York Heart Association (NYHA) classification, and readmission rate for the two groups were compared 2 years after discharge. RESULTS: The circle index was 2.7 ± 0.9 in the DCM group and 17.5 ± 4.2 in the healthy group (P < 0.01). The circle index in the DCM group was correlated with pulmonary capillary wedge pressure (r(2) = 0.42). Use of furosemide was unchanged in group R 2 years after discharge, but had increased for all patients in group NR. All cases in group R were classified as NYHA I 2 years after discharge. In group NR, in contrast, although all cases were classified as NYHA I at discharge, five of seven cases had deteriorated to NYHA III-IV 2 years later and were readmitted to hospital. CONCLUSION: There appears to be a quantifiable correlation between the circularity of the left ventricular cavity and the circle index. This suggests that rate of improvement after treatment for heart failure could predict prognosis in patients with DCM.