We are the first to introduce the name “clinical brain sports medicine.”, Previously a “brain and sports” category had been discussed only for sports head injuries. We have therefore attempted to systematize the field for research and to develop this field.
We introduced table tennis into brain rehabilitation ten years ago, and achieved good results. Table tennis is a safe and pleasant sport in which everyone makes quick progress without difficulties. It is the optimal sport for people of middle and advanced ages as well as for brain disease patients.
The following three points were examined through the table tennis exercise: brain blood-flow, brain high function, and brain rehabilitation.
The effect of table tennis exercise on brain blood flow was examined as follows: Six male volunteers played table tennis for 10 minutes and their brain blood flows were measured by SPECT (single photon emission computed tomography). An increase in brain blood flow was shown for four persons, no change for one, and a reduction for one. The increase areas were observed mainly on the cerebellum, brain stem, and frontal lobe.
The effect of table tennis exercise on brain function was examined as follows: A “KANA Pickup test” reflecting the grade of “dotage” was performed by 2,900 players who participated in the game of table tennis, and the degree of “dotage” was analyzed. The results demonstrated that, in all age groups, the table tennis players gave many correct answers and had few degrees of “dotage” statistically compared with 256 persons who did not play table tennis.
The effect of table tennis exercise on brain rehabilitation was examined as follows: Table tennis rehabilitation was introduced into the rehabilitation of 113 brain disease patients. The average period was two months. They started with easy rolling-over play, then showed gradual improvement. The treatment effect was evaluated by motor function, the degree of progress of skill, Benton visual test, Hasegawa dementia scale (HDS-R), and self-depressed scale (SDS). The results demonstrated that improvement was found by every appraisal method in many cases. It was thought that table tennis treatment had an effect not only on improvement of motor function but on improvement in a patient’s attentiveness, concentration, and endurance.
For the purpose of performing brain sports medical treatment, we established the nation’s first “brain sports visitor” in June 2002, at the National Nishi Beppu Hospital. There are as many as 24 medical staffs there. I hope our “Oita project” will develop not only over Japan but also over the world.

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The aim of this study is to clarify the effects of large ball table tennis for elderly people with omalgia. 10 consecutive cases (one male, nine female), who had omalgia at the beginning of a large ball table tennis course for elderly people, were investigated. The omalgia score (VAS) and ROM of the shoulder were evaluated at the beginning of the course and two months later. We also investigated whether or not it was possible to continue the course after two months. The average age of patients was 66.9 years old (58-74 years old). The average omalgia score (VAS) was 3.7 points at the beginning and 2.6 points two months later. Omalgia score (VAS) decreased in 5 cases. In ROM evaluation, the average flexion changed from 137° to 139°, the average external rotation from 46° to 49.5°, the average distance of C7-thumb from 16.5cm to 15.9cm. In all cases, patients hoped to continue the course. An elderly person with omalgia could continue large ball table tennis course without increasing pain or decreasing ROM of the shoulder. Large ball table tennis is a useful sport for an elderly person.

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The effect of combined treatment with X-irradiation and 5-fluorouracil (5-Fu) on the spheroids of rat glioma clone-6 cells was compared with that on exponentially grown monolayer cells. Isobolographic analysis showed the effect of the combined treatment to be supra-additive in both multicellular spheroids and monolayer cells when irradiation followed 24 hours of treatment with 5-Fu.
X-irradiation prior to 5-Fu treatment showed an additive effect. The effect of X-irradiation on spheroids was enhanced after 3 hours of 5-Fu treatment, whereas its effect on monolayer cells was augmented only when prior 5-Fu treatment exceeded 12 hours. Potentiation of the effect of X-irradiation on spheroids by prior treatment with 5-Fu is thought to be due to reoxygenation of previously hypoxic cells and partial synchronization of proliferating cells. These results suggest that when X-irradiation is applied shortly after 5-Fu treatment the effect on solid tumors is selectively enhanced, while the effect on actively proliferating normal tissues is reduced.

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The combined effect of 1-(4-amino 2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (AC NU) and 5-fluorouracil (5-Fu) on cells grown exponentially as a monolayer and multicell spheroids of rat glioma clone-6 (RG cells) was analyzed by the colony forming assay in order to obtain a more effective way of the combination.
Mature spheroids (500-600 μm in diameter) with central necrosis resembled the solid tumors in vivo in histological appearance and in the distribution of cells labeled by ³H-thymidine. Both mature spheroids and cells in monolayer were exposed to ACNU for 2 hours and to 5-Fu for 24 hours. After the drug exposure, spheroids and cells in the monolayer were trypsinized and single cells were plated for the colony forming assay. The dose survival curves for 5-Fu, for ACNU and for the combination of ACNU and 5-Fu were obtained for both spheroids and cells in the monolayer. The dose survival curve for ACNU showed an exponential cell killing following a shoulder for both cells in the monolayer and spheroids. However, the terminal slope of the curve expressed as the reciprocal of Co (concentration of drug to reduce the surviving fraction to e^-1) was steeper for spheroids than for cells in the monolayer. The dose survival curve for cells in monolayer treated by 5-Fu again showed an exponential cell killing following a shoulder. On the other hand, the dose survival curve for spheroids treated by 5-Fu showed a biphasic curve. This suggested that a proportion of cells in these spheroids was resistant to treatment by 5-Fu.
The cytotoxic effect of ACNU was enhanced by the combined treatment with 5-Fu for cells both in monolayer and spheroids. The enhancement was more marked when 5-Fu was administered before ACNU. The combined treatment also reduced the fraction of cells in spheroids resistant to 5Fu, suggesting that ACNU may be more effective for quiescent cells. The enhancement by the combined treatment on spheroids was compared with that on cells in the monolayer, based on the ratio of the surviving fraction to the concentration of the drug. The results indicated that there was a concentration range, which was more effective for spheroids than for cells in the monolayer. That was 10-35 μg/ml of ACNU and 2-15 μg/ml of 5-Fu.

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Multicellular spheroids of rat glioma clone-6 cells were developed in a spinner flask. The histological appearance of these mature spheroids was similar to that of tumor cord structure of solid tumors in vivo. Namely, spheroids showed a central necrosis surrounded by a viable rim. The viable rim was composed of actively proliferating cells (P cells) in the outer cell-layers and of non-proliferating cells (Q cells) in the inner layers.
The X-ray dose-survival curve of cells in the mature spheroids was biphasic, indicating the presence of hypoxic cells, whereas the dose-survival curve of single cells from the same batch of the spheroids was monophasic.
Mature spheroids were killed more effectively with 1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) treatment than cells grown as a monolayer. Response of small spheroids without necrosis to ACNU was intermediate. Comparison of ACNU treatment under various conditions indicated that single cells from mature spheroids were most sensitive to ACNU. These results suggest that cells highly sensitive to ACNU may be located close to the central necrosis.

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A case of a successfully removed glioma at the base of the IVth ventricle was reported. The patient was a 43-year-old woman who had complained of gait and visual disturbances four years before admission. Plain and enhanced CT showed remarkable hydrocephalus, dilatation of Sylvian aqueduct, and deformity of the IVth ventricle. An exploratory craniotomy was performed and the tumor, 25×15×7 mm in size, was found at the base of the IVth ventricle and was macroscopically totally removed. Histological diagnosis was fibrillary astrocytoma. Post-operative course was favorable. Symptoms, diagnosis, and operation of the tumor were discussed.

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The authors describe two criteria in current use for evaluating the direct effect of a treatment on brain tumors.
One of them has been made by authors following the criteria for evaluating patients with a solid tumor which was reported by Koyama and Saito. In these criteria, the effect of therapy was evaluated mainly from the results of computed tomography (CT) scan. Complete response was defined as complete resolution of all radiographic signs of intracranial tumor; partial response as a 50% or greater decrease in tumor size; no change as a decrease less than 50% and increase less than 25%; progressive disease as a 25% or greater increase in tumor size. The other criteria were described by Levin, et al. in which the effect of therapy was evaluated from results of a neurological examination, radionuclide scintiscan and CT scan. Response was defined as an improvement in at least two of the three tests while the patient was receiving a stable or decreasing dose of steroids. Progressive disease was defined as a deterioration in at least two of the three tests while the patient was receiving a stable or increasing dose of steroids. No change was defined as disease which neither progressed nor regressed as defined above.
The details of the criteria are described and their role is discussed.

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Aerodynamic characteristics have great influences on fuel economy and environmental problems nowadays. The aim of this research is to analyze the influence of configurations and diffusers of road vehicles on aerodynamic characteristics. As configuration parameters, the rear window angle and the side window angle are adopted, and together with the diffuser angle, totally 126 patterns of configurations changing from box type through fastback to notchback types are investigated by wind-tunnel experiments using the moving belt. As results, by the rear diffuser, the lift is decreased with the minimum at diffuser angle 15°, but overall the drag is increased except for diffuser angle 5°~10° with the minimum at diffuser angle 5°. The drag is greatly reduced when combined with side angles 30° and diffuser angle 5°. The well-known tendency that the drag increases steeply at rear angle from 20° to 35° appears with side angles 0° and 15° for most diffusers, while this tendency does not with side angle 30°. Visualization by the five-hole Pitot tube suggests that the drag reduction can be obtained by restraining longitudinal vortices.

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Spheroids of rat glioma clone-6 cells having a central necrosis were used to determine the effect of combined treatment of x-rays and 1-(4-amino 2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU), where the optimum time intervals and doses in the combination were analyzed.
The treatment with ACNU 2 to 6 hours prior to x-ray irradiation was most effective for cells in both monolayers and in spheroids. The dose survival curves with x-ray irradiation indicated that the hypoxic cell fraction in spheroids disappeared with a prior treatment by ACNU. The enhancement ratio in spheroids was thus larger for larger x-ray doses, and was always larger than that in monolayer cells. The survival curves versus concentration of ACNU indicated that the enhancement ratio in spheroids was more than 1.2 in all concentrations with the combined x-ray irradiation, and exceeded that in monolayer cells with a surviving fraction of less than 0.4.

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Upper limb rehabilitation training and functional assessment for hemiplegic patients are conducted by the occupational therapist (OT). Quantitative assessment is difficult, because assessment depending on the experience of the OT. Robot rehabilitation enables quantitative assessment, because the robot rehabilitation does not depend on the experience of the OT. In this study, we conducted clinical evaluations with an occupational therapy training program, WIPE with an upper limb rehabilitation system SEMUL. Experimental results show game level of WIPE and relations of Fugl Meyer Assessment (FMA) or Simple Test for Evaluating Hand Function (STEF). In addition, we discussed the usage of SEMUL with a wearable robot, and an electrical stimulation device.

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　 クモ膜下出血の原因は殆んど脳動脈瘤の破裂である。再破裂率は高く，予後はしだいに不良となる為，その防止を図ることは重要となる。入院中再破裂をおこした症例について血圧変動との関係を分析しその結果をもとに88例について調査を行った。その結果，再破裂防止に有用な知見が得られた。それは以下の通りである。
（1）　入院時の血圧上昇は２～３日以降安定する症例が多い。入院当初の血圧上昇は，入院時の精神緊張や検査の影響が考慮される。
（2）　頭痛時は血圧の有意の上昇がみられる。頭痛は破裂予知の警告症状であり，その程度と共に血圧の変動を経時的に観察する必要がある。
（3）　通常の検査では血圧の変動はみられない。脳血管撮影では一部の症例で明らかな血圧上昇をきたし慎重な観察が必要である。
（4）　全身清拭，体位変換では血圧の変動はみられない。

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Human glioblastoma A-7 (GB A-7) cells can apparently recover from potentially lethal X-irradiation. The authors, using a colony-forming assay, studied the influence of pretreatment with 1-(4amino-2-methyl-5-pyrimidinyl) methyl-3 (2-chloroethyl) -3-nitrosourea hydrochloride (ACNU) on the effectiveness of X-irradiation against GB A-7 cells grown in monolayers and as multicellular spheroids. Pre-exposure to ACNU inhibited the recovery of irradiated GB A-7 cells. In monolayer cells, the combination treatment was most effective when ACNU was applied 2 to 8 hours prior to irradiation, and the larger the X-ray dose, the more potent the effect. ACNU pretreatment was more effective against large spheroids (enhancement ratio 1.86) than against small ones (1.34). Large spheroids showed necrosis, whereas small ones did not. Isobolographic analysis disclosed that the effect of combining X-irradiation and ACNU is within an additive envelope at the surviving fraction of 10^-2, while supra-additive at the surviving fraction of 10^-3. These results suggest that the potency of X-irradiation is augmented by ACNU pretreatment through an interactive mechanism. Further, suppression of recovery from X-ray induced potentially lethal damage was influenced by the presence of necrosis.

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