In recent years, physical exercise has been proposed for improvement of health. However, dehydration by physical exercise is known to be harmful to health and may injure blood fluidity which affects the cardiovascular system. Therefore, we studied the effects of two different exercises (aerobic or anaerobic) and water (intake or no intake) on blood fluidity by MC-FAN (Micro Channel array Flow Analyzer) which mimics the capillary system. The subjects were 24 healthy male volunteers divided into four groups: anaerobic and no water intake (6 subjects), aerobic and no water intake (6 subjects), aerobic and 100 mL water intake (6 subjects), aerobic and 500 mL water intake (6 subjects) . Blood flow time immediately after exercise was longer than that before exercise in all four groups. Blood flow time of 30 minutes after exercise (BF30) returned to pre-exercise levels in the aerobic and no water intake group. However. BF30 did not return to the pre-exercise level in the aerobic and no water intake group. BF30 returned to the pre-exercise level in the aerobic and 500 mL water intake group but did not return to the pre-exercise level in the aerobic and 100 mL water intake group. Statistically significant data were obtained only in the case of heparin used as an anticoagulant. Heparin blocks blood coagulation but does not block platelet agglutination. However, constant data were not obtained when EDTA, which blocks both blood coagulation and platelet agglutination was used as an anticoagulant. The blood fluidity deteriorated after both anaerobic and aerobic exercises. When using EDTA, the most important factor affecting blood fluidity is the deformation of red blood cells because platelet agglutination is blocked. On the other hand, in the case of heparin, the most important factor affecting blood fluidity is platele agglutination since platelet agglutination is not blocked by heparin. These data suggest that aerobic and anaerobic exercises may affect blood fluidity mainly through the platelet agglutination mechanism, and water intake to a certain extent is indispensable for restoration of blood fluidity after aerobic exercise through the platelets agglutination mechanism.

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In comparison with other regions, the incidence of malignant skin tumors in Southern Kyushu is particularly high. Our hospital, a base hospital in Kagoshima Prefecture, is also experiencing an increase in the number of skin tumor cases. This trend may have been caused by increased exposure to sunlight among farmers and fishermen in addition to the difficulty in receiving treatment on the many remote islands that exist in this region, which in the long-term has led to increases in malignancy and tumor size. Diseases included basal cell carcinoma (n = 251), squamous cell carcinoma (n = 194), actinic keratosis (n = 116), Bowen's disease (n = 60), malignant melanoma (n = 17), and other tumors (n = 125) . Each disease was investigated with regard to age, gender, site of onset, and regional characteristics. Although the number of cases is increasing each year, early detection and treatment have been possible by treatment of potential cases through the establishment of pathological diagnosis as well as enhanced regional awareness. Awareness of dermatology and plastic surgery must be further promoted in this region in the future.

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CX3CL1 is involved in the recruitment of cells into tissues undergoing inflammatory responses. To determine the regulation of CX3CL1 during inflammatory bone diseases, such as rheumatoid arthritis (RA), human osteoblasts (OB), derived from patients with RA or osteoarthritis (OA), were incubated in the presence or absence of various inflammatory stimuli, then assessed for soluble CX3CL1 (sCX3CL1) levels and the expression of CX3CL1 mRNA transcripts using ELISA and quantitative real-time PCR, respectively. Although either tumor necrosis factor (TNF) -α or interferon (IFN) -γ induced no or little sCX3CL1 secretion by either RA or OA OB for 24 hours incubation, OB stimulated in the presence of both TNF-α and IFN-γ resulted in a synergistic expression pattern for both sCX3CL1 protein and mRNA transcripts in a dose- and time-dependent manner: this effect was more marked in RA OB. The synergistic secretion and expression of OB-derived CX3CL1 were markedly inhibited by specific inhibitors for nuclear factor kappa B. These findings suggest that osteoblasts are an important cellular source of CX3CL1 and may have an important role in inflammatory bone-joint diseases, as well as in osteoclastogenesis.

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The critical pathway has been an indispensable tool for modern medical care. The critical pathway criteria used for the discharge of patients after colon cancer (CP) surgery has been determined to be six days. However, because of the possible development of complications, the six-day pathway cannot always be enforced. Therefore, symptoms involving complications must be detected early. The purpose of this examination was to find markers for these exceptions. Following colon cancer surgery, 62 subjects showed no post-operative complications, 3 cases suffered leakage (2 major cases, 1 minor) . 6 cases involved infected wounds, and 10 cases had various other complications. These data were compared with 62 cases without complications (control group) and 2 cases of major leaks (major leak group) and their white blood cell count (WBC), CRP, Total Protein, Cr and body temperature (BT) . The mean WBC and BT in the control group showed a maximum of 10036/ul and 37.3 degrees at 1 postoperative day (pod) ; these scores decreased afterward. As for the major leak group, the WBC did not return to a normal range at 3-pod, and a slight fever of about 37 degrees continued after 3-pod. These results suggest that serious complications can be avoided by monitoring WBC and BT.

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The term metabolic syndrome refers to an apparent clustering of several findings in patients: central obesity, insulin resistance, hypertension, and dyslipidemia. Recently, albuminuria is associated with metabolic syndrome and may be an indicator of general vascular endothelial damage in adults. In this study we measured albuminuria and high molecular weight to determine whether or not in childhood adiponectin-to-total adiponectin ratios (HA/TA) and investigated that in childhood there are significant differences between obese and the non-obese subjects. A total of 69 subjects were entered into the final analysis. HA/TAs of non-obese children were 0.53 ± 0.10 (male) and 0.55 ± 0.12 (female) : those of obese children were 0.38 ± 0.13 (male) and 0.39 ± 0.08 (female) . The values of urinary albumin of non-obese children were 2.1 ± 1.5 (male) and 2.4 ± 1.4 (female) : those of obese children were 3.3 ± 3.4 (male) and 2.4 ± 3.6 (female) . The HA/TAs in the obese subjects were significantly lower than those in the non-obese subjects. However, there was no significant difference of albuminuria between the obese subjects and the non-obese subjects. Clinical data in this study showed that only uric acid in the obese subjects was higher than that in the non-obese subjects. Our study could not reveal a strong relationship between albuminuria and obesity in childhood. We suggest that renal failure in childhood, such as albuminuria, does not appear significant, but the effect of long duration obesity in children cannot be ignored. A more comprehensive and intensive management of obesity in childhood from an early stage is important to prevent the progression of renal injury. Studying the transition of albuminuria and adiponectin may provide insight concerning the health status of obese children.

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Cementless total hip arthroplasty is one surgical procedure now being established as a treatment method of coxarthrosis: however, this method has various problems. This study assessed whether inflammatory cytokines are useful as a screening parameter of osteolysis since inflammatory cytokines are assumed to be related to the onset of osteolysis. Plain orbital radiography and peripheral blood inflammatory cytokine levels were compared among outpatients in our hospital who had THA at least 5 years prior. Regarding inflammatory cytokines, four factors were evaluated: IL-1, IL-6, TNF-α, and GM-CSF. Moreover, the presence of osteolysis was determined based on the en face view of plain orbital radiography. Of 50 subjects treated with cementless THA, one infected subject was excluded from the assessment and used as a reference; the remaining 49 subjects were assessed. The site of osteolysis was determined from the en face radiographic view; cases were classified according to Gruen's zone classification. Osteolysis in the area of acetabular side was most often observed in Zone II, and the osteolysis in the area of stem was most in Zone 2. No subjects showed elevated IL-I and GM-CSF. Increased TNF-α was observed in 3 subjects, all of them had osteolysis. IL-6 was significantly increased in the subjects with osteolysis. No definitive correlation of increased cytokine was observed regarding the amount of wire abrasion and the annual mean amount of wire abrasion. The results show that a significant increase of serum cytokines was observed in the subjects with osteolysis. However, the increase of wire abrasion amount and annual mean wire abrasion amount did not correlate with an increase of serum cytokine. The results suggest that the response to cytokine is not enhanced by increase of abrasion powder but depends on the amount of abrasion powder penetrated into the space between the bone and the implant. The site of osteolysis was concentrated in Zone II at the screw and the surrounding area of the screw hole on the acetabular side. On the stem side osteolysis was concentrated in the proximal area relatively near to the articular surface. An increase of cytokine does not necessarily develop into os-teolysis. Osteolysis is the result of the balance between osteoclast stimulated and activated by an increase of cy-tokines and the original level of osteoblast. Therefore, osteolysis might be greatly controlled by biological back-ground. In conclusion, IL-6 and TNF-α are useful indicators when diagnosing osteolysis although complete clinical information and plain orbital radiographic assessment are most important.

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A 54 year-old woman came to our hospital complaining of pain of the bilateral lower limbs and intractable bilateral lower extremity ulcers. Bilateral arteriosclerosis obliterans of Fontaine classification N degree was diagnosed. The right leg had a type C lesion; the left leg had a type D lesion in TASC (TransAtlantic Inter-Society Consensus for the Management of PAD) II. We chose percutaneous transluminal angioplasty for revascularization rather than surgical operation because of the risk of infection. The guide wire passed the complete occlusion lesion with high calcification of the left superficial femoral artery, but passage of a catheter for penetration was difficul. Therefore, we used a rotablator, a device for coronary arteries and succeeded in passage of the later balloon. When we treat peripheral arterial disease by percutaneous transluminal angioplasty, we sometimes encounter peripheral arterial disease in complicated lesions. Procedural success can be obtained by the application of a device for coronary artery.

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Obturator externus muscle pyomyositis in adults is rare. We report the successful treatment of a case of obturator externus muscle pyomyositis that developed without any evident cause. A 59-year old male com-plained of pain of the left hip and a fever. An MRI fat suppression image showed a high signal intensity area located mainly on the obturator externus muscle and mild pooling of joint fluid. After admission to our hospital, administration of antibiotics and NSAIDs quickly improved the hip pain. In addition, laboratory examinations showed reduced inflammation within two weeks. Two months after the initial diagnosis an MRI indicated that the high signal intensity area of the obturator externus muscle had returned to normal. It is necessary to consider not only coxitis but also obturator externus muscle pyomyositis for patients with coxalgia.

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