The response of systolic blood pressure (SBP) to pedalling exercise was studied in 32 healthy young men. The subjects performed the exercise at different intensities for 3 min using an incremental loading method. The first work load was 30W and increased by 30W until the heart rate (HR) reached about 170 bpm. SBP at HR 100. 160 bpm (SBP@HR 100-160) was calculated from the cubic regression equation in each subject. Mean SBP and SEM at HR 100, 110, 120, 130, 140, 150, 160 were 143.9 (2.49), 152.9 (2.79), 161.6 (3.02), 170.0 (3.16), 177.8 (3.25), 184.5 (3.34), and 189.7 (3.45) mmHg, respectively. However, the rate of elevation of SBP was zero at HR 175 bpm, which was calculated from the cubic regression equation. This may indicate that SBP is inhibited by baroreceptors and other factors at HR above 170 bpm. There were no significant relationships between SBPs@HR 100-160 and indices of aerobic capacity such as maximal oxygen consumption or PWC 170. Double product (DP) as an index of oxygen consumption by cardiac muscle increased with HR without any reduction in its rate of elevation during exercise.

More than 2 years have passed since the new postgraduate clinical training program was instituted in 2004 to improve the clinical ability of Japanese physicians. However, there have already been discussions about whether the undergraduate curriculum and the postgraduate program should be improved.
After the first physicians finished their training under the new program in the spring of 2006, questions were raised about whether the identical final goals of training could be achieved by transferring some items of postgraduate clinical training to the undergraduate period. Such a change might invigorate the undergraduate curriculum and enhance the effectiveness of the postgraduate program.
1) Are-evaluation of the final goals of postgraduate clinical training might allow some items to be taught during the undergraduate period.
2) Several questionnaires were sent to 211 supervising physicians and 184 first-year residents who had just completed the new internship program at 25 teaching hospitals (university hospitals and postgraduate training hospitals).
3) Both trainees and supervising physicians reacted positively about and expressed a willingness to participate in training items, including noninvasive diagnostic procedures and laboratory studies not harmful to patients, during advanced courses in the undergraduate period.
4) Both trainees and supervising physicians reacted negatively to participating in any invasive procedures that might affect a patient's welfare or sense of shame during the undergraduate period.
5) In the future, training with simulated procedures before actual patients are encountered and enlisting enough supervising physicians are essential for unifying the undergraduate medical school curriculum and postgraduate clinical training programs.

The School of Medicine, University of Tsukuba, was founded in 1974 and had graduated 1, 561 students by 1994. From 1980 through 1987, 44% to 73% of graduates became hospital staff, 16% to 40% became university staff, and 0% to 8% became general practitioners. More than 80% of graduates did a 2-year residency (sotsugo-kenshu) at our university hospital and 40% completed a 6-year residency. Almost 10 years of postgraduate training was required to become an established medical practitioner. This length of time indicates that postgraduate training is the most important part of the medical career. About 80% of graduates earned doctor of philosophy (Ph. D.) degrees, whereas 93% became registered specialists, indicating that graduates tended to become specialists rather than to pursue Ph. D. degrees. This difference is more evident among female graduates: 85% became specialists whereas only 53% received a Ph. D. Most graduates considered the School of Medicine to have a good curriculum, but some younger graduates had complaints. The graduates chose their career specialties on the basis of their own interests and aptitudes. We should take these data into account to prepare a system of life-long education and learning.

Pancreatic cancer is the fifth leading cause of cancer-related death in Japan. Surgical treatment is the effective way to achieve a long survival. Because of the development of surgical procedure and perioperative management, pancreatic surgery becomes safer. However, it still includes a certain number of morbidities and mortalities. It is important to perform safe operation for long survival. We herein introduce our operative procedure for pancreatic surgery including pancreaticoduodenectomy (PD) and distal pancreatectomy. In patients undergoing PD, leakage from the pancreatic anastomosis remains an important cause of morbidity and contributes to prolonged hospitalization and mortality. Recently, a new end-to-end pancreatojejunostomy technique without the use of any stitches through the pancreatic texture or pancreatic duct has been developed. In this novel anastomosis technique, the pancreatic stump is first sunk into deeply and tightened with a purse string in the bowel serosa. We modified this method in an end-to-side manner to complete the insertion of the pancreatic stump into the jejunum, independent of the size of the pancreas or the jejunum. Since April 2013, we have performed this new anastomosis technique in 36 patients. The breakdown of preoperative diagnosis of 36 patients were 13 pancreatic cancers, 8 extrahepatic bile duct cancers, 7 intraductal papillary mucinous neoplasms and so on. Of 36 PD, 32 were subtotal stomach preserving PD (SSPPD), and the rest were SSPPD combined with left hemihepatectomy or distal pancreatectomy, and middle pancreatectomy. The concentration of amylase in discharged fluid through an abdominal drain decreased day by day. According to the ISGPF definition, pancreatic fistula (PF) was observed in 4 patients (11%). Of 4, only 1 case had grade C PF. This case had a hemorrhage from pancreatic cut end. This occurred probably because the pancreatic cut end was not compressed by the intestinal wall with this technique. This case had reoperation and the hemostasis of pancreatic cut end was secured. The other severe complications were not observed. This new method can be performed safely and is expected to reduce the occurrence of leakage from PD. The development of PF following distal pancreatectomy is an unsolved problem. We introduce a simple technique, the parallel suturing technique, which prevents severe PF by hand-sewn closure of the pancreatic stump. After standard distal pancreatectomy in the described cases, the main pancreatic duct was secured. The stump of the pancreatic remnant was closed with three nonabsorbable monofilament sutures. The three sutures were positioned about 3 mm proximal to the cut end of the pancreas and tied parallel to the pancreatic stump. Ascites fluid was collected through a drain tube, and its concentration of amylase was measured on days 1, 2, 3, and 4 postoperatively. PF was diagnosed according to the ISGPF classification. On postoperative day 4, three patients were categorized as having grade A PF, six were diagnosed with no PF, and the drain tubes of the remaining three were removed on day 3. This simple technique may effectively lighten the severity of PF following distal pancreatectomy. It may have a particular advantage in patients with a wide pancreatic stump.