Large-scale international volleyball competition in "bubble" under the COVID-19 pandemic.

OBJECTIVE: To verify whether a large-scale international volleyball competition could be conducted safely using the bubble method, both for our participating team and as a whole. METHODS: All 32 men's and women's teams were gathered in one place and a large-scale international volleyball competition was held for over a month without spectators using the bubble method. More than 1,000 people participated in the event, and 572 volleyball players played a total of 248 matches during the competition. There were 54 participants from Japan, including 27 male and female staff and players each. There was one team doctor for both men and women. A total of 2,250 PCR tests and 7,920 antigen tests were performed over 38 days. We investigated the incidence of infection in our team and in all participating teams. RESULTS: There were 9 fever cases from our men's team, but all of them tested negative for COVID-19. Overall, a total of 10,170 tests were performed and only one was positive. CONCLUSION: In order to ensure the health and well-being of all participants, the indoor competition was concluded safely without the occurrence of COIVD-19 clusters in the bubble system with strict adherence to various strict protocols of COVID-19.

Circadian challenge of astronauts' unconscious mind adapting to microgravity in space, estimated by heart rate variability.

It is critical that the regulatory system functions well in space's microgravity. However, the "intrinsic" cardiovascular regulatory system (ß), estimated by the fractal scaling of heart rate variability (HRV) (0.0001-0.01 Hz), does not adapt to the space environment during long-duration (6-month) space flights. Neuroimaging studies suggest that the default mode network (DMN) serves a broad adaptive purpose, its topology changing over time in association with different brain states of adaptive behavior. Hypothesizing that HRV varies in concert with changes in brain's functional connectivity, we analyzed 24-hour HRV records from 8 healthy astronauts (51.8 ± 3.7 years; 6 men) on long (174.5 ± 13.8 days) space missions, obtained before launch, after about 21 (ISS01), 73 (ISS02), and 156 (ISS03) days in space, and after return to Earth. Spectral power in 8 frequency regions reflecting activity in different brain regions was computed by maximal entropy. Improved ß (p < 0.05) found in 4 astronauts with a positive activation in the "HRV slow-frequency oscillation" (0.10-0.20 Hz) occurred even in the absence of consciousness. The adaptive response was stronger in the evening and early sleep compared to morning (p = 0.039). Brain functional networks, the DMN in particular, can help adapt to microgravity in space with help from the circadian clock.

Long-term exposure to space's microgravity alters the time structure of heart rate variability of astronauts.

BACKGROUND: Spaceflight alters human cardiovascular dynamics. The less negative slope of the fractal scaling of heart rate variability (HRV) of astronauts exposed long-term to microgravity reflects cardiovascular deconditioning. We here focus on specific frequency regions of HRV. METHODS: Ten healthy astronauts (8 men, 49.1 ± 4.2 years) provided five 24-hour electrocardiographic (ECG) records: before launch, 20.8 ± 2.9 (ISS01), 72.5 ± 3.9 (ISS02) and 152.8 ± 16.1 (ISS03) days after launch, and after return to Earth. HRV endpoints, determined from normal-to-normal (NN) intervals in 180-min intervals progressively displaced by 5 min, were compared in space versus Earth. They were fitted with a model including 4 major anticipated components with periods of 24 (circadian), 12 (circasemidian), 8 (circaoctohoran), and 1.5 (Basic Rest-Activity Cycle; BRAC) hours. FINDINGS: The 24-, 12-, and 8-hour components of HRV persisted during long-term spaceflight. The 90-min amplitude became about three times larger in space (ISS03) than on Earth, notably in a subgroup of 7 astronauts who presented with a different HRV profile before flight. The total spectral power (TF; p < 0.05) and that in the ultra-low frequency range (ULF, 0.0001-0.003 Hz; p < 0.01) increased from 154.9 ± 105.0 and 117.9 ± 57.5 msec2 (before flight) to 532.7 ± 301.3 and 442.4 ± 202.9 msec2 (ISS03), respectively. The power-law fractal scaling ß was altered in space, changing from -1.087 ± 0.130 (before flight) to -0.977 ± 0.098 (ISS01), -0.910 ± 0.130 (ISS02), and -0.924 ± 0.095 (ISS03) (invariably p < 0.05). INTERPRETATION: Most HRV changes observed in space relate to a frequency window centered around one cycle in about 90 min. Since the BRAC component is amplified in space for only specific HRV endpoints, it is likely to represent a physiologic response rather than an artifact from the International Space Station (ISS) orbit. If so, it may offer a way to help adaptation to microgravity during long-duration spaceflight.

Erratum: Intrinsic cardiovascular autonomic regulatory system of astronauts exposed long-term to microgravity in space: observational study.

[This corrects the article DOI: 10.1038/npjmgrav.2015.18.].

Effects of long-term microgravity exposure in space on circadian rhythms of heart rate variability.

We evaluated their circadian rhythms using data from electrocardiographic records and examined the change in circadian period related to normal RR intervals for astronauts who completed a long-term (≥6-month) mission in space. The examinees were seven astronauts, five men and two women, from 2009 to 2010. Their mean ± SD age was 52.0 ± 4.2 years (47-59 yr). Each stayed in space for more than 160 days; their average length of stay was 172.6 ± 14.6 days (163-199 days). We conducted a 24-h Holter electrocardiography before launch (Pre), at one month after launch (DF1), at two months after launch (DF2), at two weeks before return (DF3), and at three months after landing (Post), comparing each index of frequency-domain analysis and 24-h biological rhythms of the NN intervals (normal RR intervals). Results show that the mean period of Normal Sinus (NN) intervals was within 24 ± 4 h at each examination. Inter-individual variability differed among the stages, being significantly smaller at DF3 (Pre versus DF1 versus DF3 versus Post = 22.36 ± 2.50 versus 25.46 ± 4.37 versus 22.46 ± 1.75 versus 26.16 ± 7.18 h, p < 0.0001). The HF component increased in 2 of 7 astronauts, whereas it decreased in 3 of 7 astronauts and 1 was remained almost unchanged at DF1. During DF3, about 6 months after their stay in space, the HF component of 5 of 7 astronauts recovered from the decrease after launch, with prominent improvement to over 20% in 3 astronauts. Although autonomic nervous functions and circadian rhythms were disturbed until one month had passed in space, well-scheduled sleep and wake rhythms and meal times served as synchronizers.

Intrinsic cardiovascular autonomic regulatory system of astronauts exposed long-term to microgravity in space: observational study.

The fractal scaling of the long-term heart rate variability (HRV) reflects the 'intrinsic' autonomic regulatory system. Herein, we examine how microgravity on the ISS affected the power-law scaling ß (beta) of astronauts during a long-duration (about 6 months) spaceflight. Ambulatory electrocardiographic (ECG) monitoring was performed on seven healthy astronauts (5 men, 52.0±4.2 years of age) five times: before launch, 24±5 (F01) and 73±5 (F02) days after launch, 15±5 days before return (F03), and after return to Earth. The power-law scaling ß was calculated as the slope of the regression line of the power density of the MEM spectrum versus frequency plotted on a log10-log10 scale in the range of 0.0001-0.01 Hz (corresponding to periods of 2.8 h to 1.6 min). ß was less negative in space (-0.949±0.061) than on Earth (-1.163±0.075; P<0.025). The difference was more pronounced during the awake than during the rest/sleep span. The circadian amplitude and acrophase (phase of maximum) of ß did not differ in space as compared with Earth. An effect of microgravity was detected within 1 month (F01) in space and continued throughout the spaceflight. The intrinsic autonomic regulatory system that protects life under serious environmental conditions on Earth is altered in the microgravity environment, with no change over the 6-month spaceflight. It is thus important to find a way to improve conditions in space and/or in terms of human physiology, not to compromise the intrinsic autonomic regulatory system now that plans are being made to inhabit another planet in the near future.

Percutaneous transhepatic drainage of lung abscess through a diaphragmatic fistula caused by a penetrating liver abscess.

Liver abscesses occurring just below the diaphragm can penetrate or perforate the thoracic cavity, resulting in lung abscess or pyothorax. Although surgical or percutaneous transpleural drainage is often required in such cases, the latter approach has some risks, including hemothorax and bronchopleural fistula formation when the cavity is surrounded by normal lung parenchyma. The present report describes a treatment technique of percutaneous transhepatic drainage through the diaphragmatic fistula to avoid the risks of a transpulmonary approach in a case of lung abscess caused by a penetrating liver abscess.

High-dose methylprednisolone with chemotherapy for invasive thymoma: a case report.

A case of invasive thymoma that responded well to the administration of a high-dose methylpredonisolone with cisplatin and adriamycin is reported. A 63-year-old woman was admitted to our hospital because of dyspnea, chest oppression and edema of the face. Chest CT revealed a large mass in the anterior mediastinum with the opacification of superior vena cava. Biopsy specimens from the mass revealed a spindle cell thymoma, consisting of epithelial cells and lymphoid cells. A diagnosis of invasive thymoma was made and the patient was intravenously treated with a high-dose of methylprednisolone (1000 mg on days 1-5 and 500 mg on days 6 and 7), cisplatin (80 mg/m2 on day 1) and adriamycin (40 mg/m2 on day 1). The treatment with three courses of this combined chemotherapy resulted in the improvement and regression of all clinical signs and symptoms. This case demonstrated that a high-dose methylprednisolone with cisplatin and adriamycin might be potentially effective for invasive thymoma.

Successful treatment of hypertrophic osteoarthropathy by gefitinib in a case with lung adenocarcinoma.

Hypertrophic osteoarthropathy is an important manifestation of lung carcinoma, particularly in a non-small cell tumor, and hampers quality of life. Although removal of the primary tumor usually resolves this syndrome, effective treatment in patients with advanced lung carcinoma has not been established. Recently, an orally active, selective epidermal growth factor receptor tyrosine kinase (EGFR) inhibitor ("Gefitinib") provided clinical anti-tumor activity. We describe a 71-year-old male smoker with cough, who presented with clubbed fingers. A transbronchial lung biopsy (stage T2N3M1-IV) on a cavity lesion in the left lower lobe showed the features of adenocarcinoma, while bone scintigram revealed bilaterally symmetrical abnormal uptakes in the lower extremities, suggesting secondary hypertrophic osteoarthropathy. The serum level of growth hormone was increased to 1.42 ng/ml. Chemotherapy (cisplatin, vinorelbine) was not effective. Gefitinib, as a second-line therapy, induced disappearance of the abnormal accumulation on bone scintigraphy and decrease of the cavity in the lung and of serum growth hormone. The presented case suggests that the EGFR inhibitor might be a promising option for the treatment of hypertrophic osteoarthropathy with advanced lung adenocarcinoma.

Tuberculous liver abscess not associated with lung involvement.

Hepatic tuberculosis is one of the uncommon forms of extrapulmonary tuberculosis. We report a 78-year-old woman who developed tuberculous liver abscesses with splenic abscess not associated with pulmonary foci. Ultrasonography and computed tomography of the abdomen showed the low-density lesions in the liver and spleen. Histopathology of specimens obtained by percutaneous needle biopsy revealed coagulation necrosis and epithelioid cells but not tumor cells, suggesting tuberculosis infection in the liver and spleen. Systemic chemotherapy with anti-tuberculous agents led to the improvement of the lesions in the liver as well as spleen. Although tuberculous liver abscess is a very rare case, it should be included in the differential diagnosis of unknown hepatic mass lesions.

[A case of Lemierre syndrome].

We present a case of Lemierre syndrome characterized by thrombophlebitis of the internal jugular vein with multiple metastatic foci after acute otopharyngeal infection in a 30-year-old woman. Despite treatment with tonsillectomy leading to a diagnosis of peritonsillar abscess, her condition worsened and she was admitted with high fever. Chest radiograph and CT scan of the thorax revealed multiple pulmonary cavities and pleural effusion on the right side. On neck CT, a thrombus was detected in the left internal jugular vein. She received with intravenous clindamycin (CLDM) and cefepime (CFPM) and progressively improved. Although Lemierre syndrome is a relatively uncommon disease with the potentially life-threatening complication of acute pharyngotonsillitis, this syndrome should be considered in cases of severe tonsillitis or pharyngitis.