The ratio of men to women was studied in 331 patients hospitalized into our department for the past three years for various liver diseases. Two factors seemed to affect the sex difference in the morbidity of liver disease. One was a history of drinking, the other a positive ratio of HBs antigen. So, heavy drinkers and HBs antigen positive cases were excluded from the patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma, and the male/female ratio was studied again. The ratio of men to women in the patients with liver cirrhosis was 1.3: 1, 4. 1: 1 in the patients with hepatocellular carcinoma and 2.0: 1 in the patients with chronic hepatitis. The male ratio was strikingly high in the case of hepatocellular carcinoma. It is thought that liver cirrhosis is a cause of hepatocellular carcinoma. And then differences in the results of liver function tests between men and women were studied in the patients with liver cirrhosis. However, no remarkable difference was found between men and women.

The subjects are 223 women who participated in a mass medical examination. Their ages are between 40 and 79 years. We divided them into four age groups, and studied how aging and obesity influenced their physical health. The results showed the obesity index and serum total protein level were significantly low in the 70-to-79 age group. The serum total cholesterol level was significantly high in the age group between 40 and 50, and it was thought that the elevated cholesterol levels were due to menopause. Thus in females this suggests that a great physical change occurs first in the age group between 40 and 50, and second in the age group between 60 and 70.
Using 165 female cases whose ages were between 40 and 69 years were subdivided into four obesity index groups, we studied how the obesity influenced their physical health. The results showed that the problems include the elevation of diastolic blood pressure levels and serum uric acid levels.

1) We found that students of the Graduate Entry Program (GEP) had the will to realize the aim of the recruitment but did not think highly of the GEP and were not highly motivated to contribute to medicine, the school, or the region. These findings reflect their low self-evaluation and their lack of real activities.
2) The GEP students had various proposals about the recruitment and examination methods of the GEP. Most proposals request clarification of how the program fits into the university's future goals.
3) Many GEP students foresaw that 5 to 10 years would be needed to distinguish themselves to from non-GEP students. At that time, more extensive research on GEP should be conducted.

Objectives : We analyzed the mortality and morbidity of congenital heart surgery in Japan by using the Japan Cardiovascular Surgery Database (JCVSD). Methods : Data regarding congenital heart surgery performed between January 2013 and December 2014 were obtained from JCVSD. The 20 most frequent procedures were selected and the mortality rates and major morbidities were analyzed. Results : The mortality rates of atrial septal defect (ASD) repair and ventricular septal defect (VSD) repair were less than 1%, and the mortality rates of tetralogy of Fallot (TOF) repair, complete atrioventricular septal defect (AVSD) repair, bidirectional Glenn, and total cavopulmonary connection (TCPC) were less than 2%. The mortality rates of the Norwood procedure and total anomalous pulmonary venous connection (TAPVC) repair were more than 10%. The rates of unplanned reoperation, pacemaker implantation, chylothorax, deep sternal infection, phrenic nerve injury, and neurological deficit were shown for each procedure. Conclusion : Using JCVSD, the national data for congenital heart surgery, including postoperative complications, were analyzed. Further improvements of the database and feedback for clinical practice are required.

We report a 25-year-old man with ventricular septal perforation due to blunt chest trauma. He was transferred by ambulance to our hospital following a traffic accident. On admission, he had no cardiac murmur. Two days later, a pansystolic murmur appeared over the left lower sternal border. Doppler echocardiogram revealed a large left-to-right shunt through a ventricular septal perforation. We postponed surgical treatment as long as possible because he also exhibited bronchial bleeding due to a lung contusion. Surgical repair of the ruptured ventricular septum was performed 8 days after the chest trauma, because the pulmonary to systemic flow ratio was elevated to 4.6 and cardiac function had deteriorated. During the operation, the site of the septal perforation was easily detected by epicardial echocardiography. A 4-cm tear in the muscular septum was closed through a right ventriculotomy using a pericardial patch reinforced with a Dacron patch. Postoperative recovery was uneventful with the exception of transient right ventricular failure. There was no residual shunt.

The JCVSD (Japan Cardiovascular Surgery Database) was organized in 2000 to improve the quality of cardiovascular surgery in Japan. Web-based data harvesting on adult cardiac surgery was started (Japan Adult Cardiovascular Surgery Database, JACVSD) in 2001, and on congenital heart surgery (Japan Congenital Cardiovascular Surgery Database, JCCVSD) in 2008. Both databases grew to become national databases by the end of 2013. This was influenced by the success of the Society for Thoracic Surgeons' National Database, which contains comparable input items. In 2011, the Japanese Board of Cardiovascular Surgery announced that the JACVSD and JCCVSD data are to be used for board certification, which improved the quality of the first paperless and web-based board certification review undertaken in 2013. These changes led to a further step. In 2011, the National Clinical Database (NCD) was organized to investigate the feasibility of clinical databases in other medical fields, especially surgery. In the NCD, the board certification system of the Japan Surgical Society, the basic association of surgery was set as the first level in the hierarchy of specialties, and nine associations and six board certification systems were set at the second level as subspecialties. The NCD grew rapidly, and now covers 95% of total surgical procedures. The participating associations will release or have released risk models, and studies that use 'big data' from these databases have been published. The national databases have contributed to evidence-based medicine, to the accountability of medical professionals, and to quality assessment and quality improvement of surgery in Japan.
Adult ; Asian Continental Ancestry Group ; Certification ; Evidence-Based Medicine ; Humans ; Japan* ; Patient Safety ; Quality Improvement* ; Social Responsibility ; Thoracic Surgery

It is common knowledge that exposure to asbestos causes asbestos-related diseases, such as asbestosis, lung cancer and malignant mesothelioma, not only in people who have had long-term contact with asbestos in their work environment but also in residents living near factories that handle asbestos. Since the summer of 2005, these revelations turned into a large medical problem and caused and social unrest. We have focused on the immunological effects of both asbestos and silica on the human immune system. In this brief review, we introduce immunological alterations found in patients with malignant mesothelioma and describe the experimental background in which these were found. Analyzing the immunological effects of asbestos may improve our understanding of the biological effects of asbestos.

Silica and silicates may disturb immune functions such as autoimmunity and tumor immunity, because people who are exposed to the materials sometimes develop autoimmune and malignant diseases, respectively. Although silica-induced disorders of autoimmunity have been explained as adjuvant-type effects of silica, more precise analyses are needed and should reflect the recent progress in immunomolecular findings. A brief summary of our investigations related to the immunological effects of silica/asbestos is presented. Recent advances in immunomolecular studies led to detailed analyses of the immunological effects of asbestos and silica. Both affect immuno-competent cells and these effects may be associated with the pathophysiological development of complications in silicosis and asbestos-exposed patients such as the occurrence of autoimmune disorders and malignant tumors, respectively. In addition, immunological analyses may lead to the development of new clinical tools for the modification of the pathophysiological aspects of diseases such as the regulation of autoimmunity or tumor immunity using cell-mediated therapies, various cytokines, and molecule-targeting therapies. In particular, as the incidence of asbestos-related malignancies is increasing and such malignancies have been a medical and social problem since the summer in 2005 in Japan, efforts should be focused on developing a cure for these diseases to eliminate the nation wide anxiety about these malignancies.

This review is partly composed of the presentation "Cytokine alteration and speculated immunological pathophysiology in silicosis and asbestos-related diseases" delivered during the symposium "Biological effects of fibrous and particulate substances and related areas" organized by the Study Group of Fibrous and Particulate Studies of the Japanese Society of Hygiene and held at the 78th Annual Meeting in Kumamoto, Japan. In this review, we briefly introduce the results of recent immunological analysis using the plasma of silica and asbestos-exposed patients diagnosed with silicosis, pleural plaque, or malignant mesothelioma. Thereafter, experimental background and speculation concerning the immunological pathophysiology of silica and asbestos-exposed patients are discussed.

Objective: Caffeine may cause dependence and sleep disturbance, and interact with psychotropic drugs.　Therefore, the caffeine intake of patients with mental disorders should be monitored.　However, in Japan, there is no report on the effects of caffeine in mental disease patients or on their caffeine intake.　Therefore, we conducted a questionnaire survey to clarify the perception of caffeine for psychiatric outpatients.Methods: We conducted an anonymous survey on caffeine recognition for outpatients at 8 medical institutions that advocate psychiatry.Results: We collected questionnaires from 180 people.　The knowledge of foods containing caffeine tended to be high in those who had a positive attitude toward caffeine.　More than 90% of those surveyed knew that coffee contains caffeine, but cocoa and jasmine tea were recognized by less than 25%.　Of those surveyed, 39.4% consumed caffeine‐containing beverages at night.　In addition, the rate of consumption of caffeine‐containing beverages tended to be higher at night because they had a positive attitude toward caffeine.Conclusion: The knowledge and intake situation of caffeine by patients with mental disorders differed depending on their interests and way of thinking about caffeine.　As caffeine intake may influence psychiatric treatment, correct knowledge regarding caffeine is important.