The purpose of this study was to assess the usefulness of the time-axis variable function of the digital stethoscope in teaching cardiac auscultation. The subjects were 61 fifth-year medical students. The effectiveness of the time-axis variable function of the digital stethoscope for cardiac auscultation was assessed with five representative heart sounds or murmurs. The students reported that auscultatory findings were clearer at half speed than at normal speed for the following sounds, in decreasing order of frequency: systolic murmur following a systolic click, splitting of the second heart sound, systolic ejection murmur, and the third heart sound. In contrast, students frequently reported that auscultatory findings were clearer at normal speed for systolic regurgitation murmur. We suggest that the time-axis variable function is useful for improving auscultatory ability and would be particularly effective for helping students identify and understand the temporal relation of sequential heart sounds or of multicomponent murmurs.

OBJECTIVE: The present study assessed the validity of the benchmark, 75 years old, that divides elderly people into an early and a late stage, based on health checkup results for two consecutive years. We also investigated prevalent health problems and improvement trends.
METHODS: This retrospective study was conducted on 1,416 subjects (1,007 early and 409 late elderly subjects) who received health checkups at the Health Care Center of the St. Marianna University School of Medicine Hospital between April 2006 and March 2007. The survey consisted of blood pressure, required blood test results, diagnoses according to the criteria defined by Kawasaki city, outcomes, and the presence or absence of a primary care doctor.
RESULTS: The number of subjects with anemia and/or renal dysfunction was significantly greater in the late elderly than the early elderly (p<0.01). The results of the survey demonstrated that 79.6% of the early elderly and 87.4% of the late elderly had primary care doctors (p<0.01). In the early elderly, 57.0% of the subjects with primary care doctors and 43.2% of those without primary care doctors showed improvement; the subjects with primary care doctors showed significant improvement compared to those without primary care doctors (p<0.05). In the late elderly, 50.2% of the subjects with primary care doctors and 54.2% of those without primary care doctors showed improvement, resulting in no significant difference between the subjects with and without primary care doctors.
CONCLUSIONS: We found differences in the detected health problems and outcomes between the early and late elderly. These results support the appropriateness of the current age segmentation and future prospects for medical care in detecting and managing health problems in the elderly.

Objectives: To determine the effect of hot bathing on blood circulation, we analyzed pressure wave using Wave Intensity (WI), which is defined as changes in blood pressure (dP)×changes in blood flow velocity (dV) during hot bathing, as the index for assessment.
Methods: Using a combined Doppler and ultrasonic echo-tracking system, we recorded changes in vascular diameter (dD) and dV of the common carotid artery simultaneously in six healthy subjects before (Pre-bathing), during (Bathing), and 10 minutes after bathing (41°C) (Post-bathing). We then measured the product of their changes at fixed intervals as WI and evaluated the positive component of the early systolic phase (FE) (representing the forward-traveling pressure wave), negative components following FE (B) (representing the reflection pressure wave), and the appearance time of (RT). RT was measured as the percentage ratio.
Results: 1) The magnitudes of FE and B tended to decrease during 10min of bathing (Bathing) and recover to the level of the pre-bathing stage after 10min of bathing. 2) The value of RT measured after 10min of bathing (Post-bathing) was significantly longer than the level before bathing (Pre-bathing).
Conclusion: The effect of the reflection pressure wave (i. e., the after load on the vascular system) decresses during hot bathing. We can thus conjecture that the time phase of appearance of the reflecting pressure wave is delayed when the arrival time of the forwardtraveling pressure wave to the periphery is delayed and the propagation of the reflection pressure wave from the periphery slows down due to the expansion of vessels during hot bathing. Hot bating can therefore be expected to reduce after loads of healthy adult subjects.