Нойр булчирхайн хорт хавдрын мэс засал эмчилгээ / Шинэ санаа Шинэ нээлт

Pancreatic cancer is the fifth leading cause of cancer-related death in Japan. Surgical treatment is the effective way to achieve a long survival. Because of the development of surgical procedure and perioperative management, pancreatic surgery becomes safer. However, it still includes a certain number of morbidities and mortalities. It is important to perform safe operation for long survival. We herein introduce our operative procedure for pancreatic surgery including pancreaticoduodenectomy (PD) and distal pancreatectomy. In patients undergoing PD, leakage from the pancreatic anastomosis remains an important cause of morbidity and contributes to prolonged hospitalization and mortality. Recently, a new end-to-end pancreatojejunostomy technique without the use of any stitches through the pancreatic texture or pancreatic duct has been developed. In this novel anastomosis technique, the pancreatic stump is first sunk into deeply and tightened with a purse string in the bowel serosa. We modified this method in an end-to-side manner to complete the insertion of the pancreatic stump into the jejunum, independent of the size of the pancreas or the jejunum. Since April 2013, we have performed this new anastomosis technique in 36 patients. The breakdown of preoperative diagnosis of 36 patients were 13 pancreatic cancers, 8 extrahepatic bile duct cancers, 7 intraductal papillary mucinous neoplasms and so on. Of 36 PD, 32 were subtotal stomach preserving PD (SSPPD), and the rest were SSPPD combined with left hemihepatectomy or distal pancreatectomy, and middle pancreatectomy. The concentration of amylase in discharged fluid through an abdominal drain decreased day by day. According to the ISGPF definition, pancreatic fistula (PF) was observed in 4 patients (11%). Of 4, only 1 case had grade C PF. This case had a hemorrhage from pancreatic cut end. This occurred probably because the pancreatic cut end was not compressed by the intestinal wall with this technique. This case had reoperation and the hemostasis of pancreatic cut end was secured. The other severe complications were not observed. This new method can be performed safely and is expected to reduce the occurrence of leakage from PD. The development of PF following distal pancreatectomy is an unsolved problem. We introduce a simple technique, the parallel suturing technique, which prevents severe PF by hand-sewn closure of the pancreatic stump. After standard distal pancreatectomy in the described cases, the main pancreatic duct was secured. The stump of the pancreatic remnant was closed with three nonabsorbable monofilament sutures. The three sutures were positioned about 3 mm proximal to the cut end of the pancreas and tied parallel to the pancreatic stump. Ascites fluid was collected through a drain tube, and its concentration of amylase was measured on days 1, 2, 3, and 4 postoperatively. PF was diagnosed according to the ISGPF classification. On postoperative day 4, three patients were categorized as having grade A PF, six were diagnosed with no PF, and the drain tubes of the remaining three were removed on day 3. This simple technique may effectively lighten the severity of PF following distal pancreatectomy. It may have a particular advantage in patients with a wide pancreatic stump.

Улаан хоолойн хорт хавдрын эмчилгээний стратегийн орчин үеийн ололт / Шинэ санаа Шинэ нээлт

Recent advances in both diagnostic and therapeutic technologies have caused dramatic changes in treatment strategy for esophageal cancer patients. In this lecture, we will introduce the advances in multimodal treatment for esophageal cancer, based on our own experiences. 1. Neoadjuvant chemotherapy (NAC) with Docetaxel/Cisplatin/5-fluorouracil (DCF) for node-positive esophageal cancer. Recently, in Japan, an efficacy of NAC for resectable advanced squamous cell carcinoma of the esophagus has been reported. DCF is expected to be a powerful alternative to cisplatin/5-fluorouracil. Our experience on neoadjuvant or induction DCF will be demonstrated. 2. Efficacy and safety of salvage esophagectomy after dCRT. Salvage esophagectomy is an almost only method to cure the patients with local failure after dCRT, although high mortality and morbidity rates have been reported. We performed 40 cases of salvage esophagectomy during the last 7 years and no hospital mortality has been experienced. Benefit of salvage surgery and procedures to decrease surgical risk will be discussed. 3. Basic research for individualized treatment. If an individualized treatment strategy can be established based on some predictive markers, both improved survival and preserved quality of life will be realized. We will demonstrate the possibility of epigenetic analysis (e.g., LINE-1 methylation level) as biomarkers to predict patient prognosis.

Analyses of Scores of Examinations for Practical Training in Clinical Skills and for Clinical Training and Scores of Graduation Examinations in Undergraduate Medical Students / 医学教育

We analyzed the scores of objective structured clinical examinations (OSCEs) and written examinations administered to fourth-year medical students after practical training in clinical skills and to fifth-year medical students after clinical training and scores of graduation examinations taken by sixth-year medical students. Correlations were analyzed among the scores of 96 students who had taken all 3 examinations during a 3-year period. Mean scores on examinations in the fourth, fifth, and sixth years were compared between sixth-year students who did or did not graduate and between graduating students who did or did not pass the national examination for medical practitioners in Japan. Significant correlations in the scores were found between 1) OSCEs and written examinations for fourth-year students versus those for the fifth-year students; 2) OSCE and written examinations for fourth-year students versus graduation examination scores for the sixth-year students; and 3) OSCE and written examinations for fifth-year students versus graduation examination scores for sixth-year students. In addition, the mean scores in the fourth and fifth years were significantly higher for sixth-year students who graduated and passed the national examination than for students who did not graduate or who graduated but failed the national examination. These results suggest that the practical training in clinical skills given to fourth-year students and the clinical training given to fifth-year students strongly affect the overall evaluation of the ability of sixth-year students and success on the national examination.

Utility and Usefulness of the Skills Laboratory to Improve Practical Training in Clinical Skills / 医学教育

Medical students at Kurume University begin practical training in clinical skills in their fourth year. At that time, students use the skills laboratory to improve their clinical skills. Medical education resources in the skills laboratory include simulators for emergency resuscitation and heart diseases, wireless stethoscopes, and videotapes. All students use the skills laboratory for 2 months, and its usefulness was evaluated with questionnaires after practical training. More than 50 % of students approved of their practice in the skills laboratory. However, some students were unsatisfied because they were unable to make effective use of the simulators. In the future, an improved skills laboratory will be necessary to improve practical training in the clinical skills for medical students.

Effect of hyperglycemia on glycogen repletion after skeletal muscle contraction / 体力科学

Previous studies of the effect of exercise on glucose metabolism in diabetes mellitus have focused on the stimulation of glucose disposal capacity by insulin and muscle contraction. We have investigated the effects of hyperglycemia on the increase in muscle glycogen after exercise and the role of physiological saline (saline) injection under hyperglycemic conditions. Male Wistar rats weighing 100-150g (n=52) were made diabetic (DM) by injection of 90 mg/kg streptozotocin (STZ) . Glycogen content was reduced by in situ electrical stimulation of the sciatic nerve. Immediately after stimulation, the rats were injected with glucose or saline. After a 20 min recovery period, the glycogen content of the white and red gastrocnemius (WG, RG), soleus (SOL), plantaris (PL), extensor digitorum longus (EDL) and tibialis anterior (TA) was significantly increased by glucose injection in the control rats. In DM rats, the glycogen content of the TA and EDL was increased, whereas there was no change in the WG, RG, SOL and PL. These results suggest that, in hyperglycemic rats, muscle glycogen resynthesis in only fast-twitch fibers is increased by muscle contraction. However, after injection of saline, the plasma osmolality decreases significantly and glycogen resynthesis by all muscles except the SOL in diabetic rats is improved, although there is no significant increase in control rats. It is concluded that glycogenolysis and resynthesis after muscle contraction are reduced by hyperglycemia. The data suggest a possible role of saline injection in the development of glycogen resynthesis in hyperglycemia.

Effect of swimming exercise on the accumulation of triglyceride in rat liver during fasting / 体力科学

The present study was carried out to elucidete whether the accumulation of triglyceride (TG) in rat liver during fasting was stimulated by swimming. Male Wistar rats were divided into three groups; C: control, 24 F: 24 hour-fasted and 48 F: 48 hour-fasted. These animals were required to swim for 120 min.<BR>In rats with both 24F and 48F, the liver glycogen contents did not change during swimming. The level of TG in rat liver was higher in 24 F and 48 F rats than the control group, and the exercise significantly affected the liver TG in each group. There was significant correlation betweem the level of TG in rat liver and the plasma free fatty acid (FFA) concentration (r=0.681, p<0.01) . However, although plasma TG did not change during exercise in each group, the TG secretion rate (TGSR) of the 48 F group was significantly lower than that of the C and 24F groups (p<0.01) .<BR>These results provide evidence that exercise may result in the accumulation of TG in liver during fasting and suggest that the process not only depends on the surplus supply of FFA, but also inhibits very low density lipoprotein-TG secretion from liver.

Changes in creatine kinase isoenzyme compositions of skeletal and heart muscles during exercise training in rats / 体力科学

The effect of swimming training on creatine ki nase (CK) isoenzyme compositions (cytoplasmic CK : CK-MM, -MB, -BB ; mitochondrial CK : m-CK) of coleus (SOL), extensor digitorum longus (EDL) and heart muscles were studied. Wistar strain male rats were trained by swimming at a water temperature of 38±2°C, loaded with a weight equal to 5% of their body weight attached to their tails, and made to swim 4-days per week from the age of 4 weeks old for 4, 6 and 8 weeks. CK isoenzyme compositions of SOL, EDL and heart were different from those of other muscles. The activities of CK-MB and m-CK of SOL, EDL and heart increased following exercise training. CK isoenzyme composition of skeletal muscle (SOL and EDL) tended to qualitatively resemble the heart with training. These results suggest that the training-induced metabolic change in skeletal muscle causes similar CK isoenzyme composition to the heart muscle, and ensure energy production for the continuous muscle contraction during endurance exercise. The possibility that the source of the increased serum CK-MB activity after exercise is from the skeletal muscle should be examined thoroughly when the high serum CK-MB activity is interpreted.

STUDIES ON EXERCISE-INDUCED STRESS IN GROWING STATE / 体力科学

This study was performed to investigate the exercise-induced stress in growing state in order to prevent the death during or after exercise. Thirty eight male and female subjects in junior high school were administered 5 minutes running test for 3 succesive years. Heart rate, blood pressure, electrocardiogram, and blood biochemical components were measured before and after 5 minutes running test. Prior to 5 minutes running test the investigation of the number of food intake and total steps a day were performed. The results obtained were as follows;<BR>1) After 5 minutes running test, the subjects who had larger increment in CK-MB/ CK ratio walked fewer steps a day and had fewer number of food intake. And they had more drinks, especially juices.<BR>2) In female subjects an excess of body fat was not a risk factor, but not in male subjects.<BR>3) The subjects, who had larger increment in body fat than in body weight, tended to become higher levels in blood pressure and heart rate in resting than others.<BR>4) The subjects, who walked more longer in 2 nd grade than 1 st grade in junior high school, tended to decrease the increment of heart rate before to immediately after 5 minutes running test.<BR>5) Blood biochemical components were normal even if electrocardiogram was abnormal.<BR>6) At 24 hours after 5 minutes running test, CK-MB/CK ratio and serum lipoperoxide levels increased and serum protein and albumin levels defreased in 3 rd grade in junior high school.<BR>Consequently in order to prevent the death during or after exercise the investigation of food intake, total steps a day, and body fat must be administered before exercise sufficiently. And then electrocardiogram and blood biochemical components, especially CK-MB activity must be checked before, during, and after exercise testing.

A basic study for establishing a suitable exercise prescription with long distance walking. II / 体力科学

The present study was performed to investigate the effects of 120 km walking, 40 km a day for 3 successive days on the condition that taking rest and foods freely, upon physical functions for healthy male and female subjects. All measurements were enforced at postabsorptive state early in the morning for the 10 successive days including the days of walking. Blood pressure, heart rate, and body weight were measured every morning. Blood samplings enforced, too. Urine collections were enforced from first day to 7 th day. The results obtained were as follows;<BR>1) There were no changes in heart rate, blood pressure, and body weight, which were measured early in the morning, before and after 120 km walking.<BR>2) Serum GOT and GPT activities had little changes, while serum LDH, α-HBDH, and CK activities increased gradually after walking.<BR>3) Serum CK-MB activities, which indicate myocardial injury, increased after walking, on the contrary CK-MB/CK ratio decreased. It was suggested that effects of 120km walking to myocardium were rather than slight ones.<BR>4) In spite of the same sorce in which serum CK-MB and LDH-1 were resulted, both did'nt exhibit same patterns in serum.<BR>5) Serum lipids decreased gradually after walking.<BR>6) Urinary excretion of creatinine and uric acid increased after 120km walking especially.<BR>7) If it is allowed to take sufficient foods and rest, 120km walking, 40km a day for 3 successive days, would not result in such a physical stress over the following days.

EFFECTS OF TAURINE ON THE METABOLISM WITH EXERCISE (III) THREE KILOMETER RUNNING IN MIDDLE AGED MALES AND FEMALES / 体力科学

Effects of taurine on the functions of the body and metabolism with 3km running upon taking a diet, which is constituted of lowest possible amount of carbohydrate and highest possible amount of fat and protein, were investigated in 25 male and female subjects of age thirties by double blind test method. The results were as follows<BR>1) Taurine administration (T. A.) proved to inhibit the degree of increase in heart rate and increase the maximal degree of pulse pressure in response to 3 km running.<BR>2) T. A. proved to inhibit the degree of increase in serum creatine kinase isozyme MB (CK-MB) activities and CK-MB/CK ratio.<BR>3) T. A. proved to inhibit the decrease of serum total protein values immediately before running and in the following morning. Similar trends in terms of the particuler times were observed, too, in the case of the degree of decrease of serum triglycerides values.<BR>4) T. A. seemed to accelerate the utilization of saturated fatty acids especially.<BR>5) Three kilometer running seemed to increase in serum taurine concentrations from several hours after running to the morning immediately after running.

EFFECT OF TAURINE ON THE METABOLISM WITH EXERCISE (II) / 体力科学

Effects of 5 km running upon taking a low-carbohydrate, high-fat and protein diet on the body, in fourteen healthy young males and three healthy young females, all being affected by taurine inducement, were investigated by double blind test method. The results obtained were as follows ;<BR>1) As to the degree of in heart rate upon 5 km running, in males, there were no differences between taurine administration group (M-group) and placebo administration group (P-group) . But in females, recordings in P-group were much larger than those of M-group.<BR>2) As to the degree of increase in systolic blood pressure upon 5 km running, in males, no differences between both groups were observed, but in females, recordings in P-group were larger than those of M-group.<BR>3) Both serum creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) activities did not recover to pre-exercise levels during 3 days after 5 km running in both groups of both sexes.<BR>4) In the rate of CK-MB against CK, not only P-group of females had extraordinary high levels immediately after 5 km running, but also P-group of both sexes had higher levels on 3rd and 5th day after 5 km runnning than M-group.<BR>5) In both sexes P-group was larger than M-group in the degree of increase in blood lactate and serum triglyceride levels.<BR>6) As to the changes in serum total protein levels, in males, no differences between both groups were observed, but in females, P-group had extraordinary low levels on 1st day after 5 km running and maintained low levels during 5 days recovery.<BR>7) As to the changes in both serum total fatty acids levels and the rate of unsaturated fatty acids against total fatty acids, no differences were observed between both groups of both sexes.<BR>8) As to the degree of increase in plasma noradrenalin and adrenalin levels, in males, no differences between both groups were observed, but in females, recordings in M-group were larger than those of P-group.

A BASIC STUDY FOR ESTABLISHING A SUITABLE PRESCRIPTION OF EXERCISE ON THE LONG DISTANCE WALKING / 体力科学

The present study was performed to investigate the effect of long distance walking upon physical functions for healthy male subjects. The first experiment was carried out in 1977, the second, in 1978, and the third, in 1979 in each autum season. At the first experiment, subjects began walking upon having breakfast, then ate and drank noting during first 30km, and took some foods during another 26km. Twelve hours and fifty minutes of time was spent for 56km walking including 15, 60, and 30 minutes rest periods in between. In the second experiment, subjects ate nothing after dinner of the previous evening and 35km walking took 6 hours during which some rest periods were taken for blood sampling. The third was 80km walking for two days. Subjects walked 40km in 8 hours in the first day and on the following day they walked 40km in ten hours and twenty minutes. They took foods and rest freely.<BR>From the view points of the changes in blood and urinary recordings obtained from those three experiments, the influences of long distance walking on the body indicate as follows ;<BR>1) In case of long distance walking while nothing to eat and drink, the rate of serum saturated fatty acids composition decreased and unsaturated fatty acids increased.<BR>2) In a fasting state, blood glucose gradually decreased, LDH activity increased and blood lactate, GOT and GPT activity presented no significant changes on long distance walking.<BR>3) It was shown that the longer distance to walk, the lesser tendency in blood triglyceride even though subjects take a carbohydrate rich diet while walking.<BR>4) In fasting state, less than 35km walking without foods, the stress to the body seemed not to be critical.<BR>5) More than 40km walking in a day, even though taking meals, would result a significantly severe stress for body.<BR>6) As long as usual meals are taken, 80km walking for two days continuously, 40km in each day, would not result in such a physical stress over the following days.

SIGNIFICANCE OF UNINTERRUPTED MEASUREMENTS OF GRIP STRENGTH FROM THE VIEW POINTS OF EXERCISE PHYSIOLOGY / 体力科学

Uninterrupted recordings of grip strength were measured in the male and female physical education students, university sports club members, middle-aged physical laborers and clerks, and young weight-lifters. The results were as follows ;<BR>1) In the rate of supporting of uninterrupted measurements of grip strength, recordings among the males were greater than females. But, there were no differences between the recordings in the rate of supporting at morning and at evening.<BR>2) In the university sports club members, the rate of supporting of Basketball club members were the most, Judo, the medium, Volleyball, Tennis, and others, the least.<BR>3) Among the middle-aged subjects, the rate of supporting of uninterrupted measurements of grip strength indicate high in physical laborers and low in the clerks.<BR>4) The rate of supporting of uninterrupted measurements of grip strength in youngweight-lifters was smaller than in well trained weight-lifters.<BR>5) By the comparison between right and left recordings in the rate of supporting of uninterrupted measurements of grip strength, certain tendencies were observed in some sports, but, not greater than differences among some sports. Certain individual, however, indicate great differences between right and left recordings.<BR>6) No significant correlations between maximum grip strength and rate of supporting of uninterrupted measurements were observed.

EFFECTS OF SIT-UPS TO EXHAUSTION ON RESPIRATORY-CIRCULATORY FUNCTIONS AND ITS SEX DIFFERENCES / 体力科学

Effects of sit-up exercise in the healthy adults to the point of exhaustion on the respiratory-circulatory functions and oxygen consumption were studied in thirtyone males and thirtysix females whose age varied between twenty and thirtyf our years old. The subjects were classified into two groups, the superior and the inferior, according to the number of sit-ups to reach the exhaustion point. Collected vallues were compared between the pre-exercise and the post-exercise records. The results were as follows ;<BR>1) No sex differences in the inferior group were found in the degree of increase in systolic pressure, heart rate and respiratory rate.<BR>2) In the superior group, no sex difference was found in the degree of increase in respiration rate, but male subjects were greater than female subjects in the degree of increase in both systolic pressure and heart rate.<BR>3) In males, when the superior subjects were compared with the inferior subjects, the former were greater than the latter in the degree of increase in both systolic pressure and heart rate, but in females no differences were found.<BR>4) In males the more the degree of increase in blood pressure, the more the degree of increase in heart rate. In contrast with males, in females there were no relation between them were observed.<BR>5) It was recognized that relative metabolic rate varied in values from 4.7-13.5 and there was a tendency among the inferior subjects to have a large relative metabolic rate.

EFFECT OF TAURIN ON THE METABOLISM WITH EXERCISE (I) / 体力科学

Effects of 20km running uppn taking a low-carbohydrate, high-fat and protein diet on the changes in blood pressure, heart rate, body weight, skinf old thickness, blood components and urinary recordings in five healthy young men were investigated and the changes in these items which occured by taurine inducement were studied by double blind test method. The results were as follows:<BR>1) As to the degree of decrease in body weight in 20km running, the case in taurine administration (T. A.) was more than in placebo administration (P. A.) .<BR>2) As to the degree of increase in systolic pressure upon 20km running, T. A. was less than P. A. 3) The rate of creatine kinase isozyme (CK-MB) against creatine kinase (CK), which increased after 20km running in P. A., was possible to reduce by T. A.<BR>4) T. A. was less than P.A. in the rate of increase in lactate dehydrogenase (LDH) on 20km running.<BR>5) In P. A., triglyceride increased after 20km running, but in T. A., it decreased.<BR>6) T. A, much influenced the rate of individual fatty acid composition on 20km running<BR>7) T. A, was more than P. A. in the secretion of adrenaline on 20km running.<BR>8) No changes were observed in other blood components and urinary kallikrein.

ARRHYTHMIA AND PALMITOLEIC ACID / 体力科学

The variation of venous concentration of FFA as the effect of exercise under several nutritive conditions were tested on two subjects, <I>i, e</I>., 56 years old male and 20 years old female.<BR>Arrhythmia were recorded when sudden increase in palmitoleic acid in venous concentration was observed, while no arrhythmia were recorded otherwise. Arrtythmia seemed to have been prevented by intaking glucose prior to exercise.<BR>It was also observed that arrhythmia would easily be produced by sudden uprise of palmitoleic acid under hunger after low carbohydrate nutrition.

VARIATION OF THE VENOUS CONCENTRATION OF THE FATTY ACID BY THE PHYSICAL FITNESS TEST OBSERVED ON AGED MALE AND FEMALE / 体力科学

Before and after the physical fitness tests included 1000 meter endurable walking, aged males and females more than 61 to 80 years old were tested on the blood pressure, heart rate and blood components. The results were as follows.<BR>1) The systolic and diastolic blood pressure were not varied so distinctly.<BR>2) Heart rates were increased in all groups.<BR>3) Serum cholesterol, GOT and GPT were not influenced.<BR>4) Fatty acid, especially unsaturated one, was increased remarkably.<BR>5) Fatty acid increasing observed on excellent performer of the endurable walking was higher than that of poor performer.<BR>6) Increasing ratio of the fatty acid which was found on the subjects with abnormal ECG was higher than that of the subjects with normal ECG.<BR>As above mentioned facts, the test of serum fatty acid seemed very important item to the aged people from the view point of security of the exercise.

STUDY ON THE VARIATION OF CONCENTRATION OF LYSINE AND OTHER AMINO ACIDS BY THE ALL OUT EXERCISE WITH A BICYCLE ERGOMETER / 体力科学

Venous concentration of lysine and other 16 amino acids were determined in healthy 5 male 20-22 years of age subjects in the resting state, after 2 min from bigining of exercise, immediatetly after all-out exercise and 30 min after of the exercise with a bicycle ergometer at work intensities which will be fell into all-out in about 6 or 7 min.<BR>During 2 min exercise lysine only was increased, no change of glycine and puoline were observed and other amino acids were decreased. At the point of all out increase of threonine, lysine and histidine were observed, compared with resting state<BR>Alanine concentration at 30 min after of all out exercise was very high than that of resting state and same tendency but a little was observed on lysine. Other amino acids were decreased.<BR>A risk connected with exercise was discussed from the data of lysine obserbed high concentration during two min exercise concerning with the variation of other amino acids by the all-out exercise.

INFLUENCE OF THE BRIEF FAST AND VARIOUS EXERCISE ON THE VENOUS CONCENTRATION OF THE BRANCHED AMINO ACID AND LYSINE / 体力科学

The remarkable increase of branched amino acid and pretty decrease of lysine venous concentration were observed in healthy nine male and female adults by the brief fast.<BR>The increase of branched amino acid wasn't able to find by the various exercise generally. The increase of lysine venous concentration was found after the running more than 10km frequently.<BR>Only on the subjects of 44 and 55 years of age, the increase of branched chain amino acid and lysine were observed by the running. It looks like have to take precautions that aged people run under the conditions of empty stomach.