The impact of water immersion recovery to the neck after short distance swimming on pulmonary functions in individuals with the past history of bronchial asthma / 体力科学

<p>The purpose of this study was to assess an impact of water immersion recovery after short distance swimming on the recovery process in pulmonary functions in individuals with the past history of bronchial asthma (PHA). Eleven Japanese healthy males with PHA (23 years) volunteered to perform two bouts of a 25-m maximal front crawl session in an indoor pool. The two bouts were separated by either 10-min of recovery on the land (L-session) or the same condition with water immersion to the neck (W-session), using a counterbalanced crossover design. Water temperature was 30 °C. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV_1.0) (%predicted) were measured according to the following time course; at baseline (REST), water immersion to the neck (WIN) before the swimming session, after 5-min (REC-5) and 10-min (REC-10) recovery with the assessment of dyspnea sensation (ADS) at the same time point. %FVC and %FEV_1.0 at WIN, REC-5 and REC-10 in the W-session were significantly lower than those REST. A similar reduction was observed at WIN in the L-session, and %FEV_1.0 at REC-5 was significantly different from those REST. The subjects had higher ADS at REC-5 in both sessions compared with those REST. %FVC and %FEV_1.0 at REC-5 and REC-10 in W-session were significantly lower than those at REC-5 and REC-10 in L-session. These results indicates a negative impact of not only water immersion recovery but also recovery on the land after short distance swimming on pulmonary function in individuals with PHA.</p>

Vitrectomy combined with heavy silicone oil tamponaded for severe proliferative vitreous retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To assess clinical efficacy of vitrectomy combined with heavy silicone oil tamponaded for severe proliferative vitreous retinopathy. <p>METHODS: Totally 13 severe proliferative vitreous retinopathy(PVR)patients(13 eyes)admitted to our hospital between June 2012 and December 2015 were included. We analyzed the clinical efficacy of vitrectomy combined with heavy silicone oil tamponaded and heavy silicone oil removal combined with C₃F₈ tamponaded at late phase for 13 patients. Heavy silicone oil removal of 13 patients were performed at 10 to 17wk after heavy silicone oil tamponaded. The patients were reviewed at 1-7d after vitrectomy combined with heavy silicone oil tamponaded, 1, 2, 4 and 17wk after hospital discharge, 1-7d after the heavy silicone oil removal, 1, 2, 4, 8, 12 and 24wk after the second hospital discharge. Patients were followed up for at least 24wk after the heavy silicone oil removal. The observed indicators included the rate of retinal reattachment, the best corrected visual acuity, intraocular pressure(IOP), intraocular lens and postoperative complications.<p>RESULTS: During follow-up,13 eyes showed a stably reattached after heavy silicone oil tamponaded. Heavy Silicone oil of 13 patients were removed combined with C₃F₈ tamponaded for 10 to 17 wk after heavy silicone oil tamponaded. But the fifth case had retinal detachment recurrence for 4wk after heavy silicone oil removed because of macular hole and the eighth case had retinal detachment recurrence for 8wk after heavy silicone oil removed because of new superior temporal retinal hole. Follow up for 24wk, the other 11 eyes showed a stably reattached after heavy oil silicone removed. The best corrected visual acuity range of 13 eyes were in light perception to hand move before heavy oil silicone tamponaded and the best corrected visual acuity range of 13 eyes were in hand move to 20/250 for 24wk after heavy oil silicone removed. The best corrected visual acuity of the fifth case and the eighth case were count finger and hand move for 24wk after heavy oil silicone removed. Four eyes had high intraocular pressure 1wk after heavy oil silicone tamponaded which were reduced to 10-21mmHg after drug treatment. At late phase 5 eyes had drug uncontrollable high intraocular pressure which we took silicone oil removal timely. Three eyes had temporarily high intraocular pressure after heavy oil silicone removed which were reduced to 10-21mmHg after drug treatment. At late phase 3 eyes did not appear high intraocular pressure after stopping anti-glaucoma medication. Thirteen eyes had no serious complications such as anterior chamber inflammation and endophthalmitis during the treatment. <p>CONCLUSION: Vitrectomy combined with heavy silicone oil tamponaded and heavy oil silicone removed combined with C₃F₈ tamponaded at late phase for 13 severe proliferative vitreous retinopathy patients could achieve a satisfactory rate of retinal reattachment and improve the patients' prognostic visual acuity.

Effects of hydrogen bathing on exercise-induced oxidative stress and delayed-onset muscle soreness / 体力科学

Several studies have reported that molecular hydrogen (H₂) acts as a therapeutic medical gas owing to scavenging reactive oxygen species (ROS). However, little is known about effects of H₂ on exercise-induced oxidative stress. The purpose of this study was to investigate the effects of weekly hydrogen bathing on exercise-induced oxidative stress and delayed-onset muscle soreness (DOMS). Nine healthy and active young men participated in this study, and each subject performed hydrogen bathing trial and placebo bathing trial in a crossover design. The subjects performed downhill running (8 % decline) at 75 % peak oxygen uptake (VO₂peak) for 30 min, and each subjects conducted hydrogen or placebo bathing for 20 min, respectively, 1-6 days after downhill running. Before and after exercise, we measured visual analogue scale (VAS) and collected blood samples (Pre- and 5 min, 60 min after the end of bathing, 1day, 2days, 3days, 7days after downhill running). Blood sample analyses include creatine kinase (CK), myoglobin (Mb), malondialdehyde (MDA), reactive oxygen metabolites (d-ROMs), biological antioxidant potential (BAP), myeloperoxidase (MPO), interleukin-6 (IL-6), interleukin-17a (IL-17a) and lactate concentrations. Weekly hydrogen bathing had no effects of exercise-induced oxidative stress and muscle damage. On the other hand, hydrogen bathing significantly reduced DOMS (VAS) 1 and 2days after downhill running (p=0.033). These findings suggest that hydrogen bath after downhill exercise can be effective for reduction of DOMS.

Effects of Immersion in Artificial Carbon Dioxide on Endothelial Function Assessed with Flow-Mediated Dilation in Patients with Type 2 Diabetes / 日本温泉気候物理医学会雑誌

<b>Purpose:</b> The aim of present study was to investigate the endothelial function of immersion of patients with diabetes in carbon dioxide (CO₂)-enriched water<BR><b>Methods:</b> Sixteen diabetic patients with minor complications were immersed in CO₂-enriched water for 4 weeks, and 8 patients were immersed in normal spa water for the same duration. To assess endothelial function, forearm flow-mediated dilation (FMD) was measured in those patients, and %FMD at pre-immersion was compared to that at post-immersion in CO₂-enriched water. The pulse wave velocity (PWV) was also measured to determine whether vascular stiffness was affected in those patients. The percent coefficient of variation of R-R intervals was examined as CVR-R (%). All patients were medicated with antidiabetic drugs, which were not changed during the study.<BR><b>Results:</b> %FMD showed no significant difference in any patients between pre- and post-CO₂-enriched water bathing. However, %FMD was significantly increased inpatients under 8.0% of HbA1c after CO₂-enriched water bathing (p<0.05), but it was not significantly increased in patients over 8.0 of HbA1c. PWV and CVR-R (%) were significantly reduced in all patients after CO₂-enriched water bathing. <BR><b>Conclusion:</b> CO₂-enriched water immersion had a positive effect on endothelial function, and reduced arterial wall stiffness in patients with diabetes. These findings suggest that CO₂-enriched water bathing may improve microcirculation, as well as subjective symptoms, in patients with controlled diabetes.

History of Physical Fitness and Sports Medicine in Japan / 体力科学

Kanehiro Takaki, the founder of The Jikei University School of Medicine suggested that a nutritional factor was important for preventing beri-beri, which was a common disease in the Meiji era in Japan and Southeast Asia. He improved the rations fed to crews of the Imperial Japanese Navy to include wheat and meat. The rations he devised effectively prevented beri-beri. Some 30 years later, vitamin B₁ was discovered, and a deficiency of vitamin B₁ was found to be the cause of beri-beri. Takaki believed that nutrition and exercise were important for keeping our bodies fit. He often gave lectures on how people could keep fit to prevent diseases. Thus, his activities are considered to be the beginning of preventive medicine in Japan. The contributions of Takaki to the physical fitness of the Japanese people have been continued by the graduates of The Jikei University School of Medicine. Some of the graduates became professors of The Jikei University School of Medicine and Tokyo University of Education (now, Tsukuba University). Thus, both universities have the common basis and tradition for research and education in the fields of physical fitness and sports medicine, and have collaborated with each other in these fields. In this article, we provide a brief overview of the history of the development of research regarding physical fitness and sports medicine in Japan. We discuss the contribution of various persons including our graduates, to the health and physical fitness of the Japanese people.

S2-2Carbon dioxide (CO₂) balneotherapy in Germany / 日本温泉気候物理医学会雑誌

  Balneotherapy for humans has a long tradition in Germany. Carbonated water or CO₂ containing spring water has been known for ancient times, not only in spas for bathing but also for drinking. In 1845 the German spa physician Dr. F. Bodo from Bad Nauheim noted a “congested, velvety reddened skin” after taking a bath in warm CO₂ enriched water. Conducting absorption experiments Hediger in 1928 demonstrated for the first time that CO₂ is absorbed into the body by passing through the intact skin. In Germany 80% of the natural mineral spas contain the minimum concentration of 400mg/kg CO₂ required for treatment and 50% of all spas have a CO₂ content higher than 1000 mg/kg which is required for the designation as carbon dioxide enriched water. The spa resorts Bad Nauheim and Bad Krozingen harbor natural mineral springs with the world wide highest CO₂ concentrations containing 2600 mg/kg and 2200 mg/kg, respectively. These springs belong to artesian wells which means the spring water is under a hydrostatic pressure that is high enough to well up to the surface without any pumps. <BR>  The beneficial effects of CO₂ balneotherapy are not known in detail yet. However, animal studies have shown that bathing in carbon dioxide rich water enhances collateral blood flow in ischemic hindlimb through mobilization of endothelial progenitor cells and activation of NO system. Daily CO₂ bathing for 28 days induced a 4 fold increase in collateral vessel density which was prevented by the administration of L-NAME a NO inhibitor. In humans CO₂ bathing improves arteriolar blood flow in patients with arterial occlusive diseases. Patients with necrosis of skin and soft tissue due to disturbed blood flow showed profound improvement of the skin defects with decrease of the necrosis area. To the skin CO₂ enriched water has topical effects. Ten days of rinsing detergent-damaged skin with CO₂ enriched water enhanced clinical skin regeneration, enhanced epidermal lipid synthesis and enhanced barrier repair. Taking together CO₂ balneotherapy has different beneficial effects on human diseases. This review presents the effects of CO₂ enriched water on humans diseases and discusses its clinical indications.

S2-1Effects of CO₂-enriched water bath treatment on blood flow and angiogenesis in ischemic hind limb / 日本温泉気候物理医学会雑誌

<b>Objectives:</b> Peripheral artery disease (PAD) is a major health problem; however, no satisfactory intervention is available for its treatment. This study was undertaken to investigate the effects as well as mechanisms of the CO₂-enriched water bath (CEWB) treatment on blood flow in the ischemic hind limb.<BR><b>Experimental Model: </b>For inducing PAD, the femoral artery was occluded for 5 weeks in rats. The animals were treated with or without CEWB at 37°C for 4 weeks (20 min daily; 5 days per week) starting one week after the artery occlusion. CEWB was prepared by using Carbothera (Mitsubishi Rayon Engineering Tokyo). The blood flow was measured by Pulse Wave Doppler Ultrasound technique before and after the ligation as well as at the end of 4 weeks treatment. The angiogenesis (formation of new blood vessels) in the skeletal muscle was studied by histological examination.<BR><b>Results:</b> The peak, mean or minimal blood flow was not detected in the untreated ischemic hind limb animals due to arterial ligation. However, the values for blood flow were about 50% of the control values upon treatment with CEWB; 67% of the ligated animals showed positive blood flow by CO₂ treatment. Morphological examination of the treated ischemic skeletal muscle revealed a 3-fold increase in small artery count. Although plasma triglycerides were decreased and plasma NO concentration was increased in the ischemic animals, CEWB treatment produced no effects on these parameters. No mortality or changes in body wt, heart rate and plasma glucose, cholesterol or high density lipoproteins were seen in the control and experimental animals.<BR><b>Conclusion:</b> This study demonstrates the beneficial effect of CEWB treatment on blood flow in hind limb PAD. Furthermore, it is suggested that this beneficial action of CO₂ therapy may be due to the formation of new blood vessels in the ischemic skeletal muscle.

S2-4Topical application of artificial CO₂-enriched water - Clinical efficacy / 日本温泉気候物理医学会雑誌

  The impairment of vasodilatory function is common symptom in elderly especially among those who have arteriosclerosis and diabetic merits. In the 19th-century Europe, CO₂-enriched water had been used as naturopathy for hypertensions, exclusively. In 1997 Japan, the CO₂-enriched water could be adopted as a clinical application, since the device was developed to produce artificial CO₂-water easier. <BR>  Thereafter, artificial CO₂-water had been comparable effect of natural CO₂-hot spring water in experimental animal models (Hashimoto, 1999), and the efficacy has been studied in various disease states of human. In the therapy of peripheral arterial disease (PAD), several reports demonstrated the effects for intermittent claudication including the improved hemodynamic status of immersion part (Hartmann et al, 1997).<BR>  Based on these findings, we focused on microcirculatory effects of topical application of artificial CO₂-enriched water, and studied clinical efficacy in patients with PAD especially critical limb ischemia (CLI). Initially, we showed that immersion of feet in artificial CO₂-water (CO₂ immersion) increased the blood flow of feet much higher than the plain water even in the patients with CLI, and it improved the limb preservation rate in patients without indication of revascularization (Toriyama et al, 2002). Furthermore, we clarified that CO₂ immersion accelerated wound healing after lower extremities bypass surgery in CLI patients with ulcer/gangrene as an adjuvant therapy (Hayashi et al, 2008). <BR>  We summarize the clinical studies for artificial CO₂-water foot bathing in PAD, and clarify the therapeutic usefulness of CO₂ immersion in CLI patients.

18-4Beneficial effects of artificial carbon-dioxide water bathing on the quality of sleep in healthy volunteers: A pilot study / 日本温泉気候物理医学会雑誌

<b>Objectives:</b> To preliminarily assess the effects of a single warm-water bath (WWB) on the quality of sleep, we measured sleep pattern after WWB in healthy volunteers. The primary objective of the present before-after study was to evaluate whether a single 10-minute WWB at 41°C could modulate sleep pattern in a single group of healthy subjects. In this pilot study, we also assessed the difference in general fatigue and subjects’ satisfaction responses to WWB under two conditions: WWB using tap water (WWB with tap water) and WWB using a bath additive that included inorganic salts and artificial carbon-dioxide (CO₂) (WWB with ISCO₂). <BR><b>Methods:</b> Eleven healthy volunteers aged 20 to 48 years (29.8±8.9 years, mean ± SD) participated in this study. Inclusion criteria were as follows: age 20-50 years; free of cardiovascular disease; not taking medications or supplements. In this within-subject, two-way crossover study, all subjects underwent WWB with tap water or WWB with ISCO₂ in random order for two consecutive nights. Objective sleep measures from sleep sensor mat (sleep-scan) and subjective subjects’ reports were collected. This study was approved by the Ethics Committee of Kagoshima University Hospital and written informed consent was obtained from all of the subjects. <BR><b>Results:</b> None of the subjects experienced discomfort before, during or after the study period. The objective sleep measures and subjects’ reports were completed safely in all subjects. WWB with ISCO₂ bathing produced significant improvement in objective and subjective sleep latency compared with WWB with tap water bathing (P<0.05). Sleep-scan-determined wake time after sleep onset (WASO), sleep efficiency, and number of awakenings (NA), and patient-reported measures of WASO, NA, sleep quality, sleep depth, and daytime functioning significantly improved following WWB with ISCO₂ bathing versus WWB with tap water bathing (P<0.05). WWB with ISCO₂ bathing also increased deep sleep time and sleep score (P<0.01 for both comparisons), but did not alter REM or slow-wave sleep. <BR><b>Conclusion: </b>In conclusion, in our group of healthy volunteers, a single warm-water bath was shown to have the potential to modulate the quality of sleep. These findings demonstrate that WWB with ISCO₂ bathing might be effective in improving some domains of sleep quality of healthy volunteers, and the subjects showed acceptance towards the intervention. Strengths and limitations of the present study as well as suggestions for further studies were considered. Further evaluations with larger and longer-term randomized double-blind placebo-controlled trials based on the present study are needed.

The Effect of Transcutaneous Carbon Dioxide (CO₂) Application after Endurance Exercise in Rats / The Japanese Journal of Rehabilitation Medicine

Objective : In Europe, carbon dioxide therapy has been used for treating cardiac disease and skin problems for a long time. Previously, we demonstrated that transcutaneous carbon dioxide (CO₂) application facilitated dioxygen (O₂) dissociation from hemoglobin (Hb) in the human body. Additionally, we proved that transcutaneous CO₂ application to the lower limbs of rats increased the expression of peroxisome proliferator-activated receptor (PPAR) gamma coactivator-1α (PGC-1α), vascular endothelial growth factor (VEGF) and silent mating type information regulation 2 homologs 1 (SIRT1). It also increased the number of mitochondria, and changed IIB fiber to IIA fiber in similar manner to the change that occurs after exercise. The transcutaneous CO₂ application caused a similar effect to that of exercise training in skeletal muscle and indicated the possibility of improved endurance strength. However, the effect of transcutaneous CO₂ application on endurance exercise and the recovery of muscle fatigue has not been studied. Methods : In this study, we investigated the performance of endurance exercise in rats with/without transcutaneous CO₂ application and analyzed the muscle fiber changes, capillary density and mitochondrial DNA number of the skeletal muscles after training, using activity wheels. Results： Training with CO₂ application resulted in a higher percentage of TA muscle transformed to IIA and/or IID than training alone, suggesting that transcutaneous CO₂ application may increase the production of ATP, mitochondria number, and capillary density. Therefore, transcutaneous CO₂ application might lead to muscle damage recovery. Conclusion : We suggest that transcutaneous CO₂ application has a therapeutic potential for recovery of damaged muscle after excessive exercise and rehabilitation.

MAXIMAL OXYGEN UPTAKE OF PERSONS WHO HAVE NO HABITUAL EXERCISE / 体力科学

Generally, a person who has higher cardiorespiratory fitness has lower lifestyle-related disease(LRD)morbidity rates and lower mortality rates. In Japan, Ministry of health, labor and welfare has defined the reference values of the maximal oxygen uptake(VO₂max)for health promotion by gender and age in 2006. The reference values were defined based on the systematic review of the japanese and foreign articles for the relationship between VO₂max and LRD. However, the articles based on japanese subjects were few. The purpose of this study is to examine the morbidity rates of LRD and VO₂max of japanese persons who have no habitual exercise. The subjects of this study comprise 141 males and 287 females aged from 20 to 69. The LRD morbidity rates of males and females suffered from dyslipidemia, hypertention, diabetes / impaired glucose tolerance were 78.7% and 58.5%, respectively. The mean VO₂max obtained by an incremental bicycle exercise at all group divided by gender and age did not achieve the reference values. The rate of the LRD subjects of males and females who achieved the reference values were 9.9%(n=11)and 4.8%(n=8), respectively. And the rate of the non-LRD subjects of males and females who achieved the reference values were 36.7%(n=11) and 14.3%(n=17), respectively. To obtain the habitual exercise and to keep higher physical activity is important to control a decline of VO₂max with aging and to prevent the LRD.

EFFECT OF EXERCISE TRAINING ON THE HEART RATE PERFORMANCE CURVE IN PATIENTS WITH CARDIOVASCULAR DISEASE / 体力科学

Left-ventricular dysfunction is diagnosed when the heart rate performance curve (HRPC) of patients deflects upwards during incremental exercise. The aim of this study was to investigate the effect of exercise training on the upward deflection of the HRPC in patients with cardiovascular disease.This study comprised 11 patients who had cardiovascular disease and showed an upward deflection of the HRPC. The patients underwent exercise training (aerobic training, AT intensity: 30-40 minutes, 2-3 sessions/week, and 3-month follow-up). The HRPC of the patients was measured before and after exercise training. We used a method described by Pokan for evaluating the HRPC; the performance curve (PC) index ([PC1 - PC2] × [1 + PC1 × PC2]^-1) was calculated from PC1 and PC2. PC1 and PC2 refer to the heart rate response before and after the O₂ pulse deflection point, respectively. The PC index indicates the following: PC > 0.1, downward deflection; -0.1 ≤ PC ≤ 0.1, linear time course; PC < -0.1, upward deflection.The PC index significantly increased after exercise training (from -0.22 ± 0.09 to -0.14 ± 0.07; p < 0.05). In addition, the HRPC of 4 patients (37%) changed in linear time course.These results suggest that an upward deflection of the HRPC in patients with cardiovascular disease may shift to a linear time course after exercise training.

Effects of Bathing With Artificial Bath Additive Including Inorganic Salts and Carbon Dioxide on Body Flexibility, Muscle Stiffness and Subjective Feeling of Bathing / 日本温泉気候物理医学会雑誌

 The effects of bathing in a solution of artificial bath additive including inorganic salts and carbon dioxide (CO<SUB>2</SUB>-bathing: 41°C, 10 minutes; the concentration of carbon dioxide was 160-180 ppm, and that of inorganic salts was about 64 ppm) on the cardiovascular system, body flexibility, muscle stiffness and the subjective feeling of bathing were compared with those of no bathing and plain water bathing in the healthy subjects.<br> The deep body temperature and skin blood flow increased after bathing, and the increases after CO<SUB>2</SUB>-bathing were significantly greater than those after plain water bathing.<br>Body flexibility after CO<SUB>2</SUB>-bathing was similar to that of no bathing and plain water bathing.<br> Stiffness of the trapezius muscle was decreased at both 15 min and 30 min after CO<SUB>2</SUB>-bathing and plain water bathing, with no change in no bathing. The changes at 15 min after CO<SUB>2</SUB>-bathing and plain water bathing were statistically significant. Stiffness in the latissimus dorsi muscle decreased at both 15 min and 30 min after CO<SUB>2</SUB>-bathing and plain water bathing, with no change in no bathing. However, only these changes at 15 min and 30 min after CO<SUB>2</SUB>-bathing were statistically significant.<br> A large decrease in the stiffness of the trapezius muscle by its isometric contraction was observed during both CO<SUB>2</SUB>-bathing and plain water bathing, and the decrease after CO<SUB>2</SUB>-bathing was greater than that after plain water bathing. These changes did not reach statistical significance.<br> Improvements in subjective feeling of bathing were observed after both plain water bathing and CO<SUB>2</SUB>-bathing. Improvements after CO<SUB>2</SUB>-bathing in stiffness of muscle, ease of movements and mental relaxation were statistically greater than those after plain water bathing.<br> Compared with plain water bathing, CO<SUB>2</SUB>-bathing showed additional effects on muscle stiffness and subjective feeling of bathing. Further research is needed to confirm the effectiveness of the CO<SUB>2</SUB>-bathing alone and combined with isometric movements on muscle stiffness.

REFERENCE INTERVAL OF MAXIMAL OXYGEN UPTAKE (VO₂max) AS ONE OF THE DETERMINANTS OF HEALTH-RELATED PHYSICAL FITNESS IN JAPAN / 体力科学

Maximal oxygen uptake (VO₂max) is an important determinant of health-related physical fitness. In 2006, the Japan Ministry of Health, Labour and Welfare (JMHLW) officially declared a standard reference value and reference interval of VO₂max. However, these values were established on the basis of a systematic review of reports published in Western countries and were not based on actual VO₂max data of the Japanese population. Therefore, we conducted a study entitled “The study on a minimum zone of VO₂max as one of the determinants of health-related physical fitness in Japan” from 2004 to 2006 as a project of the Japanese Society of Physical Fitness and Sports Medicine (JSPFSM). In addition, we collected published VO₂max data of the Japanese population from the JSPEFM website. In the present study, we attempted to determine the reference interval of VO₂max with regard to age, gender, and different methods of exercise. Further, we established a cut-off value of VO₂max for determining metabolic syndrome (MS).1. Reference interval of VO₂maxFor both men and women, 325 and 364 values for the treadmill exercise, and 1175 and 2178 values for the cycle ergometer exercise, respectively, were collected. This data revealed a balanced distribution of VO₂max with regard to age. Data that satisfied the VO₂max criterion were used for the analysis. These data were regressed to age on gender and methods of exercise. The percentage of VO₂max was calculated using the following equation: %VO₂max = measured VO₂max × 100/age-estimated VO₂max. The iterative truncation method was used to calculate the reference interval of VO₂max (70%∼130% VO₂max) from the crude data of %VO₂max, and then converted to actual VO₂max. Thus, the reference interval of VO₂max for healthy Japanese was determined with regard to age, gender, and different methods of exercise.2. Cut-off value of VO₂max for determining MSUsing the VO₂max data of subjects with body mass index (BMI) of ≧25kg/m² and ≧2 MS risk factors, and the data of subjects with normal BMI without any risk factors, we calculated sensitivity and specificity. The cut-off value was determined using the receiver operating characteristic curve. This cut-off value was defined as the critical value of VO₂max that should be maintained to avoid MS and remain healthy.

A Case Report of a Patient with Small Bowel Adenocarcinoma Undergoing Combination Therapies with Chemotherapy and Phototherapy / 日本温泉気候物理医学会雑誌

A case report<br>A 70-year-old male with small bowel adenocarcinoma involving retroperitoneal invasion had undergone chemotherapy after non-curative operation. However, this patient had to discontinue the first and second lines of chemotherapies within one month due to serious side effects of anti-cancer agents. Subsequently, the patient complained of severe low-back pain and there was evidence of local recurrence around the resected small intestine. Therefore, phototherapy was applied three times a week to relieve the low-back pain while the patient underwent the third line of chemotherapy. It was interesting to note that these combination therapies coincidentally ameliorated the various side effects caused by anti-cancer drugs. For one year during the third line of chemotherapy, the patient had to temporarily discontinue chemotherapy only two times when phototherapy was not available for one week due to consecutive national holidays in May and November. The quality of life of this patient was well maintained, and he only needed to be hospitalized for the last two months before he died.<br>Epidemiological studies have shown a high incidence of cancer in people less exposed to solar rays. The sunshine “vitamin” 1 alpha, 25-dihydroxy vitamin D₃ (1, 25(OH)₂D₃) is involved in these epidemiological studies based on the evidence that 1, 25(OH)₂D₃ is an antiproliferative agent that may inhibit proliferation of cancer cells in vitro and development in animals. To elucidate the synergetic effect of phototherapy in combination with chemotherapy, we assayed serum levels of 1, 25(OH)₂D₃ in this patient compared with those of end-stage cancer patients undergoing chemotherapy alone. Serum levels of 1, 25(OH)₂D₃ in this patient after receiving the combination therapies were higher than those in other cancer patients treated with chemotherapy alone.<br>Our results indicate that phototherapy may be a good complementary therapy with chemotherapy for cancer patients.

Comparison of the Physio-phycho-biochemical Effects of Carbon Dioxide-enriched and Plain Water Footbath / 日本温泉気候物理医学会雑誌

Carbon dioxide (CO₂)-enriched water, one of the Japanese pharmacopeias, has been used as an alternative thermotherapy to treat the intractable diabetic skin diseases. However, few scientific researches on the physiological effects of CO₂-enriched footbath have been reported. Fifteen males (aged 22-52, 31±10) took part in this study after providing their written informed consents. They took three kinds of footbath (plain water, CO₂-enriched water and control without water) at 38°C for 30min in random sequence. Their core temperature from oral and tympanic membrane, cutaneous blood flow, tissue hemoglobin concentration at the cerebral frontal cortex and trapezoid muscle, systemic blood pressure, heart rate variability, salivary IgA, comfortable feeling with face scale were measured before, during and after footbath. CO₂-enriched footbath showed significant physiological effects on the systemic and peripheral circulation. Local (under water) cutaneous blood flow, and tissue blood flow of the frontal cortex were significantly higher than in the plain water footbath. The systolic and diastolic blood pressure and heart rate in CO₂-enriched footbath were also lower than those in the plain water footbath. Heart rate variability of CO₂-enriched footbath showed an decrease of LF/HF ratio and more HF/(LF+HF) ratio than that of plain water footbath. These parameters indicated lesser stress for the heart in CO₂-enriced footbath than in the plain water footbath. The relaxing effect of CO₂-enriched footbath was also indicated from the results of face scale and salivary IgA concentration. All of these results supported that the CO₂-enriched footbath was less stressful and more relaxing, and had more physiological effects on the local systemic and cerebral circulatory system and autonomic nervous system than plain water footbath.

Changes in HSP (Heat Shock Protein) 70 due to C02 Warm Water Bathing / 日本温泉気候物理医学会雑誌

HSP70 is a kind of stress protein that takes care of protein through its life, and it has attracted attention as a factor to promote health. This protein is known for its induction route through hyperthermia stimulation. We compared differences between the effects of carbonic warm water bathing and tap warm water bathing, and the report obtained interesting results. The subjects are six healthy adults (average age: 23.8±5.5 years, each three from males and females), applied full immersion bathing at 41°C for 10min in both ca. 1, 000ppm of high concentration CO₂ warm water and tap warm water, and compared HSP70 before the bathing and one day after the bathing. During the observation of 24h, external thermal stimulation such as warm bathing was banned. 3 persons took warm bathing in CO₂ water first and the other 3 persons took tap water first. There was 10 days interval between the bathing in both types of bathing.<br>The results showed that an increase in precordial temperature measured with a deep-body thermometer was 1.0°C in tap warm water bathing and 2.3°C in CO₂ warm water bathing. The change in HSP70 was 3.31→4.35 (AU/mg protein: p=0.08) in tap warm water bathing and 3.42→5.04 (p<0.05) in CO₂ warm water bathing. Although a slight increase was recognized in tap warm water bathing, a significant increase in HSP70 was recognized in CO₂ warm water bathing.

INCLINATION OF EXPONENTIAL CURVE-FITTING MODEL FOR HEART RATE AND OXYGEN UPTAKE DURING INCREMENTAL EXERCISE AS INDEX OF CARDIO-PULMONARY FUNCTIONAL IN PATIENTS WITH ISCHEMIC HEART DISEASE / 体力科学

This study was conducted to clarify the validity and availability of inclination of exponential curve-fitting model for oxygen uptake (VO₂) and heart rate (HR) during incremental exercise (I-ECOH) as an index of cardio-pulmonary functional reserve in patients with ischemic heart disease (IHD). A treadmill exercise test was used to measure the VO₂(L/kg/min) and HR (beat/min) during incremental exercise of all subjects. I-ECOH was derived from the following equation : HR=A·exp^B·VO2. The constant "B" represents I-ECOH. The following two identifications were made : 1) the relation between peak oxygen uptake (VO₂peak) and I-ECOH in IHD patients with normal left ventricular function and with chronic heart failure (CHF); 2) the relation between I-ECOH and the New York Heart Association (NYHA) functional classification of IHD patients with CHF.There were significant differences among IHD patients with normal left ventricular function, CHF patients, normal controls and long distance runners in I-ECOH and VO2peak, respectively (p<0.001). There were inverse correlations between I-ECOH and VO2peak in IHD patients with normal left ventricular function (r=-0.64, p<0.001) and CHF (r=-0.63, p<0.001). I-ECOH could be used to discriminate effectively between NYHA functional classes (p<0.001).In conclusion, these results suggest that I-ECOH is adequate and useful as an index of cardio-pulmonary functional reserve in patients with ischemic heart disease.

EVALUATION OF SCUBA DIVING WORK LOAD / 体力科学

Divers' heart rates were measured under real ocean diving conditions with the purpose of evaluating the workload during SCUBA diving. For the subjects, all-out tests were conducted and evaluated in each of the following conditions: 1. ergometer cycling, 2. ergometer cycling using diving regulator, 3. fin-swimming in a swimming pool with diving equipment. No significant heart rate difference was found between the pre-dive and post dive of each subject; although, in novice divers, high heart rates such as 140/min or more were observed especially during the dive gear wearing phase on the topside and/or floating on the surface phase, suggesting there should be some high heart rate inducing factors, other than the exercise, like stress. Whereas, in the results of the all-out tests, the heart rate for fin-swimming was 16~18 beats/min lower, as well as 5.7~14.2 ml/kg/min lower for VO₂max, as compared to the ergometer cycling. This may suggest that fin-swimming like scuba diving could give a diver some degree of physical load without on increased heart rate.

EFFECTS OF BICYCLE ERGOMETER EXERCISE AND PGE₁ INJECTION FOR PATIENTS WITH INTERMITTENT CLAUDICATION / 体力科学

The purpose of this study was to clarify the effects of bicycle ergometer training and prostaglandin E₁ (PGE₁) for patients with intermittent claudication. Subjects were divided into four groups : the medication group (M), the PGE₁ group (P), the exercise group (E) and the PGE₁ and exercise group (PE). The P group was injected with 10<i>μ</i>g of PGE₁, the E group performed bicycle ergometer exercise 3 times a week for 6 weeks, and the PE group was injected with PGE₁ and performed exercises. The maximal walking distance (MWD) was evaluated by a treadmill test. Muscle oxygenation level was measured by near-infrared spectroscopy and recovery half time (T_1/2) was calculated. MWD was significantly improved for P (142%), E (216%) and PE (240%) groups. T_1/2 was significantly improved in the E and PE groups. This study indicates that improvement of MWD was a result of development of muscle perfusion in lower limbs and PGE₁ injection may support exercise therapy.