A 34-year-old male with chest pain and shock was admitted as an emergency case to our unit. Ruptured acute aortic dissection with annuloaorticectasia was suspected and emergency operation was performed. Acute aortic dissection was localized at the aortic root. The right coronary orifice was involved with the dissection, and an intimal tear was found just above it. Aortic root replacement with composite graft was performed as follows. The aortic wall around the coronary orifice was incised in a circular manner like a button and the dissection of the aorta around the coronary orifice was repaired. Dacron tubes with xenopericardial skirts were interposed between the coronary orifices and the composite graft. Wrapping of the composite graft was completed using the aortic wall and xenopericardium. The postoperative course was uneventful with only slight bleeding. Our procedure is useful for acute aortic dissection around the coronary orifice.

　A crucial step in clarifying and consolidating the learning gained from simulations in healthcare is to debrief those simulation experiences-that is, to methodically review what happened and why. Leading a debriefing is a learned skill, and can be improved with practice and feedback. The Debriefing Assessment for Simulation in Healthcare （DASHTM） Handbook and Rating Forms are designed to assist in evaluating and developing debriefing skills. Additional information, rating forms, and contact information can be found at the DASH website: http:／／www.harvardmedsim.org／dash.html.

A case of a 51-year old male with pulmonary valve endocarditis accompanied by aortic regurgitation, and ruptured aneurysm of Valsalva sinus was reported. Repeated blood cultures grew α-streptococcus on a single occasion. After medical treatment, resection of pulmonary valve vegetation, resection and patch closure of aneurysm, and aortic valve replacement were performed successfully. Twenty one cases of pulmonary valve endocarditis reported in Japan, including our case, were collected and reviewed. Causative organism was streptococcus in 93% of cases. No case of intravenous drug abuse was found in this series. A variety of preexisting heart diseses were found in 20 cases out of 21 (95%). All these diseases were congenital ones, such as ven-tricular septal defect, patent ductus arteriosus, pulmonary stenosis and ruptured aneurysm of Valsalva sinus. This fact means that jet lesion of pulmonary valve is a major predisposing factor of pulmonary valve endocarditis. Surgical procedures were reported in 12 cases: resection of vegetation in 4 cases, resection of pulmonary valve in 2, and pulmonary valve replacement in 5. Appropriate surgical procedures should be chosen, depending upon the activity of infective endocarditis, severity of destruction of the valve, and pulmonary vascular resistance.

It is well known that decreased physical performance induces the decreased activity of daily living and increment of mortality rate in elderly subjects. On the other hand, a prolonged heart rate corrected-QT (QTc) interval is associated with an increased risk of cardiac sudden death and cardiac autonomic dysfunction. We investigated the associations between physical performance and QTc interval in elderly subjects. The subjects included 605 elderly persons (274 men and 331 women, age; 71.2±4.7 years) without a history of cardiovascular disease and taking cardioactive drugs. Resting 12-leads electrocardiography was measured after more than 5 minutes of rest. The QTc interval was calculated according to Bazett’s formula. The physical fitness test was performed to determine the physical performance (muscle strength, balance and walking abilities). The subjects were divided into four categories, which were defined as equally quantile distributions of QTc interval. The physical performance levels were significantly lower in the longest QTc interval group compared to the shortest QTc interval group in both men and women (p<0.05, respectively). Moreover, after adjusting for the age, the physical performance levels were significantly lower in the longest QTc interval group compared to the shortest QTc interval group, especially, this relationship was observed in late-stage elderly group (p<0.05, respectively). These results suggest that decreased physical performance levels were also associated with prolonged QTc interval in elderly subjects.

Taking charge of in-vitro fertilization and embryo transfer in the laboratory per se amounts to a form of clinical support. To infertile patients, it would be of great benefit if laboratory technicians make direct contact with them and give a full account of the procedure.The apprehensions entertained by them regarding infertility treatment would be removed by hearing what they want to know.In hopes of dispelling the patients' fears and doubts, we have recently started to dialogue with the patients. The face-to-face interview has made us feel confident in what we are doing aside from the lab work and feel a sense of responsibility. Moreover, we have become aware of the need to further devote ourselves to reproductive medicine in order to improve the treatment outcome.One third of the questions frequently asked by patients concerns the quality of embryos and the risk of birth defects, which are issues that challenge us involved in reproductive medicine. To give answers to these and other questions most aptly, it is necessary to share all the up-to-date information, data and knowledge among members of the staff concerned.As the tasks to be grappled with fromnow on, there are problems with unsuccessful cases after repeated IVF trials and an increasing number of patients rangingin age from 45 to 49 years. Where the infertility treatment stops is yet to bedecided in the case of elder women.For providing information and psychological support sought by patients, we keenly felt that there is a necessity to establish a closer collaborative inter-departmental relationship.
Clinical ; Fertilization ; Laboratory culture ; Support ; therapeutic aspects

This study examined whether physical and cognitive function was independently associated with risk of Musculoskeletal Ambulation Disorder Symptom Complex (MADS) in community-dwelling older people. We examined 640 older people (315 men, 325 women; 65–89 years). We assessed physical performance by one-leg standing with eyes open, timed up and go (TUG), muscle strength, muscle power, and gait speed. Cognition was assessed using Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Trail-Making Tests (TMT) A and B. We divided participants by physical function into “MADS” (one-leg standing < 15s or TUG ≥ 11s) and “non-MADS”, and identified cognitive impairment if MMSE was < 27 and CDR ≥ 0.5. We also grouped by sex and age (younger-old: 65–74 years and older-old: 75–89 years), and controlled for age, Body Mass Index, education and steps. Physical and cognitive function was significantly worse in the MADS groups. The younger-old men had poorer muscle strength, muscle power and TMT-A. The younger-old women had poorer muscle power, gait speed, MMSE and TMT-B. Older-old men had poorer muscle strength, and older-old women poorer gait speed (P < 0.05). The MADS groups also had significantly higher adjusted odds ratio (OR) for cognitive impairment (younger-old men: OR: 4.62; 95% confidence interval [CI]: 1.08–19.8; younger-old women: OR: 6.09; 95% CI: 1.03–35.9; P < 0.05). This study suggested that poorer physical and cognitive function was significantly associated with the risk of MADS, and these associations may be differ with sex and age.

The patient was a 56-year-old male with an 8-year history of Behcet's syndrome, who presented with chest pain. A saccular aneurysm (4×4cm) of the descending aorta was disclosed by X-ray and CT. Impending rupture of the aneurysm was suspected and emergency surgery was performed under cardiopulmonary bypass. The aneurysm consisted of a large thrombus, and a punched-out lesion on the aorta (φ10mm) was found beneath the thrombus. Closure with a Dacron patch was carried out successfully. Pathologic examination revealed the patient to have vasculo-Behcet's syndrome. Generally this desease has a poor prognosis, especially if an aneurysm is present, since sudden rupture can occur. Thus, prompt surgical treatment of the aneurysm should be considered. The patient was free of recurrence at the time of writing this report.

This study aimed to examine characteristics of physical functions, physical activity, and cognitive functions among community-dwelling older people who stopped driving automobiles. Participants were 589 community-dwelling older people (age: 65–89, 71.4 ± 5.1 years; 403 men, 186 women). The participants underwent nine physical assessments—hand grip strength, knee extension strength, timed up-and-go test, chair stand, one leg standing with open eyes, functional reach, vertical jump, preferred gait speed, maximal gait speed—and were evaluated for physical activity; and five cognitive assessments—the Mini-Mental State Examination (MMSE), Logical Memory I and II (WMS-R LM-I, LM-II) subtests of the Wechsler Memory Scale-Revised; and Trail Making Test A and B (TMT-A, TMT-B). They were divided into current driver (379 men, 169 women) and driving cessation (24 men, 17 women) groups. Among men, the driving cessation group had poorer vertical jump, TMT-A, and TMT-B results, while women had poorer hand grip strength, one leg standing with open eyes, WMS-R LM-II, and LM-II results, and longer inactivity time, compared with the current driver group and adjusted for covariates (P < 0.05 for all). The findings suggest driving cessation among community-dwelling older people is significantly associated with poorer physical functions, physical activity, and cognitive functions compared with those in current drivers.

This study aimed to evaluate the effects of ingesting yogurt fermented with Lactobacillus delbrueckii subsp. bulgaricus (OLL1073R-1) on the immune function of healthy university men track and field athletes. Study design Randomized, double-blind, placebo-controlled, parallel-group study. A total of 37 track and field athletes aged ≥18 years were randomly assigned into two groups. For 2 weeks, two bottles of yogurt fermented with OLL1073R-1 and Streptococcus thermophilus OLS3059 or placebo sour milk were ingested daily to the participants. During the intake period, a 1-week training camp was held and participants were subjected to strenuous exercise. Natural killer (NK) cell activity, which is the primary endpoint, was significantly lower in the placebo group after ingestion than that at baseline; however, it remained unchanged during the pre-exercise level of the yogurt group. The two-way repeated measures analysis of variance showed an interaction effect in the NK cell activity change (P=0.018) and a significant difference between the groups after the 2-week ingestion (P=0.015). Among the secondary endpoints, cytokines and chemokines levels involved in activating innate immunity maintained or enhanced only in the yogurt group. ALT, LDH, and CK significantly elevated only in the placebo group. Furthermore, amino acid levels were significantly lower in the placebo group after ingestion than that at baseline; however, it remained unchanged during the pre-exercise level in the yogurt group. Consuming yogurt fermented with OLL1073R-1 prevents the decline in immune function associated with strenuous exercise. Additionally, the yogurt may contribute to stable physical condition.

In accordance with the new model-core-curriculum for medical education, the current status of education about the science of radiation health was surveyed in all medical schools in Japan. Among the four learning points related to the “Biological effects of radiation and radiation hazards” , about half of the schools covered issues on “radiation and human body” and the “effect of medical radiation exposure” in one, or less than one, 60-minutes class, but did not touch on “radiation risk communication” and “radiological disaster medicine” . A significant deviation of human resources was also observed between schools. Learning tools such as presentation files and video content were preferred as education support materials. Therefore, development and distribution of the learning tools, especially in “radiation risk communication” and “radiological disaster medicine” , may be a first step to promoting high-quality education on the science of radiation health risk in each school’s curriculum.