Sports medicine is generally recognized as a specialty in the field of musculoskeletal medicine and encompasses the prevention and treatment of injuries related to sports and exercise. Additionally, sports medicine plays a role
in our daily life, as it is important for maintaining our physical and mental health and preventing the onset of lifestyle-related diseases. Approximately 2400 years ago, the Greek doctor and philosopher Hippocrates stated that
“walking is the best medicine”. I aim review the trends in insufficient physical activity among Japanese people
and the intensity and amount of exercise required to maintain a healthy lifestyle.
Exercise affects human immune functions through the hypothalamus-pituitary-adrenal (HPA) axis and reward
systems in the brain. Most immune cells, including T cells, B cells and phagocytes, express functional hormone
and neurotransmitter receptors and are regulated through the neuroendocrine immune network. Light-to-moderate
exercise improves the defense activity against pathogens and prevents metabolic disorders. Many epidemiological
and experimental studies have suggested there is an inverse relationship between moderate exercise training and
illness risk. Furthermore, habitual exercise might improve immune regulation, reduce the activity of autoimmune
disorders and delay age-related dysfunctions, such as sarcopenia. On the other hand, high-intensity exercise suppresses immune defense activity, especially against upper respiratory infections. Thus, high-intensity training and
competitions possibly increase the risk of infection in athletes. Appropriate nutritional intake and hygiene control
are also essential to protect both athletes and non-athletes.
Obesity-induced metabolic syndrome is becoming a severe health problem in Japan due to the increasing
popularity of the Western-style diet and fast food. Endurance exercise is one of the most effective ways to reduce
fat content and thus prevent metabolic syndrome, as endurance exercise leads to larger amounts of fatty acids
being used to create energy with higher efficiency in skeletal muscle. There are two major types of skeletal muscle
fibers: type I muscle fibers, which contain a large number of mitochondria and burn fatty acids for energy, and
type II fibers, which contain fewer mitochondria and depend on glycolysis to acquire energy. Endurance exercise
results in the development of type I muscle fibers and enhanced mitochondrial function, with increased expression
and activity of mitochondrial enzymes such as carnitine palmitoyltransferase 1, β-hydroxy-acyl-CoA dehydrogenase and citrate synthase. On the other hand, in adipose tissues, higher amounts of fatty acids are released to
support their increased usage in muscle fibers by increasing the activity levels of adipocyte triglyceride lipase and
hormone-sensitive lipase following endurance exercise. The increased usage of fatty acids is considered an outcome of activated peroxidase proliferator-activated receptors (PPARs), nuclear receptors for fatty acids, and the
induced transcription of proteins that play essential roles in fatty acid metabolism upon stimulation of those fatty
acids. In three PPAR isoforms, muscle fibers predominantly express PPARγ, a regulator of mitochondrial enzyme
transcription and type I muscle fiber development. In adipocytes, PPARγ is abundantly expressed to regulate fatty
acid catabolism. Furthermore, skeletal muscles, adipose tissues and other tissues communicate through hormones
such as myokines and adipokines, which optimize fatty acid metabolism in the entire body during endurance exercise. Collectively, endurance exercise shifts our energy metabolism to be more lipolytic for a healthier lifestyle.
It is expected that knowledge on the relationship between respiration and sports is beneficial for promoting both
physical and mental health. With that knowledge, we can learn to exercise effectively every day. We supply oxygen to tissues by breathing. During exercise, respiration and circulation work closely together to carry oxygen to
the mitochondria in muscles to generate energy. Exercise increases oxygen demand and carbon dioxide emissions.
We increase the minute ventilation volume (MVV), thereby increasing V̇ O2 (oxygen consumption) as the exercise
intensity increases. Endurance athletes exhibit higher levels of these parameters. MVV (maximum voluntary ventilation), which is a parameter used for evaluating the strength and endurance of inspiratory and expiratory muscles, improves after strength training. Strength training is thought to be effective in increasing the strength of the
respiratory muscles. The combination of endurance training and strength training can improve lung function. Not
only strengthening the respiratory muscles but also increasing the elastic contraction force of the lungs by training
can improve respiratory ability. There are diseases in which sports affect lung function. Attention should be paid
to exercise-induced asthma, vocal cord dysfunction, and COPD (chronic obstructive disease).
Since 2013, we have been performing laparoscopic inguinal hernia repair (transabdominal preperitoneal repair:
TAPP) for inguinal hernias in adults, and it is currently the first-choice treatment at our institution. Herein, we
report the treatment outcomes and strategies of TAPP for inguinal hernia at our hospital.
【Materials and Methods】 We investigated the surgical time, amount of blood loss, length of postoperative
hospital stay, and postoperative complication rate of 700 patients (792 lesions) who underwent TAPP from February 2013 to July 2020 at our hospital. 【Results】 The median operation time was 61 minutes (one side), bleeding
was negligible, and the median postoperative hospital stay was 1 day. Two patients (0.3%) experienced postoperative recurrence, but there were no reports of chronic pain. 【Conclusion】 The short-term treatment results of TAPP
for inguinal hernia at our hospital were generally satisfactory. For surgeons skilled in laparoscopic surgery, TAPP
could be a reasonable first-choice treatment for inguinal hernias.
This study investigated the outcomes of multiple myeloma (MM) patients after the introduction of bortezomib.
We analyzed the backgrounds, treatment statuses, and prognoses of patients who were initially treated between
December 2006 and May 2020. Because initial therapy with bortezomib was approved in May 2011 in Japan, the
154 eligible patients were divided into two groups according to whether initial therapy was started before May
2011 (before group, “B” group; n = 52) or after May 2011 (after group, “A” group; n = 110). There were no significant differences in the patient backgrounds between the two groups. The 3-year overall survival rates were 46%
and 75% in the “B” and “A” groups, respectively, and the survival rate was significantly higher in the latter group.
Thalidomide was more frequently used in the “B” group, while bortezomib, pomalidomide, elotuzumab, and daratumumab were more frequently used in the “A” group. These results suggested that the initial treatment intervention using a novel agent and an appropriate regimen contributed to the improved survival rate of MM patients.
A 24-day-old boy was admitted to our hospital with fever. Three days after admission, his condition worsened,
and he presented with reticular cyanosis. He was diagnosed with sepsis-like syndrome. Human parechovirus type
4 was detected in serum and stool samples by reverse transcription polymerase chain reaction and sequencing. His
condition improved after intravenous gamma-globulin treatment. There are few reports of sepsis-like syndrome
caused by human parechovirus type 4, and its clinical features and treatment have not been established, but immunoglobulin therapy may be effective in severe cases