In this report, we present a case in which good results were achieved by treatment using a free jejunal patch graft with virtual endoscopy (VE) assistance in a patient whose swallowing had failed to improve for 40 years after he mistakenly swallowed sulfuric acid, despite pectoralis major myocutaneous flap grafting and frequent balloon dilatation surgery. During the last 20 years, virtual computed tomography imaging has improved remarkably and continues to be used to address new challenges. For reconstructive surgeons, the greatest advantage of VE is that it is a noninvasive modality capable of visualizing areas inaccessible to a flexible endoscope. Using VE findings, we were able to visualize the 3-dimensional shape beyond the stenosis. VE can also help predict the area of the defect after contracture release.

The interval between undergraduate medical education and graduate medical education causes residents to become disorganized when they start their first-year residency programs.This disorganized transition may be stressful for residents and preceptors and may cause resident to make medical errors.We performed a pilot study to examine the degree to which program directors agree about the abilities required for the start of the first of year residency.
1) We asked the residency directors at university hospitals and residency hospitals nationwide (343 institutions) to indicate what abilities residents were expected to have at various stages of the residency program.The data received were then analyzed.
2) A total of 134 residency directors (39%) returned the questionnaire.We calculated the percentage (expectation rate) of institutions that reported expected prerequisites at the start of the first year of residency and calculated the accumulated values (cumulative rate) of the percentages.
3) Only 43 (30%) of 141 abilities upon the completion of residency-preparatory programs had a cumulative rate of more than 50%.
4) Domains for which the expectation rate was more than 50% at the start of residency were medicine and related knowledge and practical skills for obtaining physical measurements.
5) Physical examination and practical skills for which the cumulative rate was less than 50% on completion of residency-preparatory programs were those for the reproductive and urinary systems and pediatrics and the insertion and maintenance of intravenous lines and indwelling urinary catheters.
6) Disparities are likely between the abilities of residents and the tasks expected of them upon entry into a residency program.This problem must be urgently addressed through medical education and graduate medical education.

The purpose of this study was to confirm the causal structure model of muscle, motor and living functions utilizing structural equation modeling (SEM) . As subjects, 103 community-dwelling older men and women, aged 65.7±6.9years of age, participated in the study to measure muscle cross-sectional area, maximum voluntary contractions, muscle power, 4 physical performance tests, and 16 questionnaires regarding ability of activities of daily living. The causal structure model of muscle, motor and living functions was hypothesized to be a hierarchical causal structure. The causal structure model of muscle function was hypothesized to be a hierarchical causal structure consisting of 3 sub-domains of muscle mass, muscle strength, and muscle power. Data analysis procedures were as follows : a) testing of construct validity of muscle function variables using confirmatory factor analysis (CFA) in SEM ; b) testing of causal structure using SEM ; c) testing of factor invariance using multi-group analysis for gender. The highest goodness of fit indices was obtained in the causal structure model of muscle, motor and living functions (NFI= .928, CFI= .978, RMSEA =.061) . The causal coefficient of muscle function to motor function was .98 (p<.05), followed by.34 for motor function to living function. From the results of multi-group analysis, the measurement invariance model indicated the highest goodness of fit indices (TLI=.968, CFI .977) . It was concluded that the hierarchical causal relation was among muscle, motor and living functions, and in which muscle function was consisted of 3 sub-domains.

The purpose of this study was to confirm the reliability and validity of a physical fitness questionnaire (PFQ) with self-rating for elderly people applying structural equation modeling (SEM) . As subjects, 105 community-dwelling older men and women aged 67.1±6.1 years participated in the study to measure 13 PFQ items and 13 performance tests. The data analysis procedures were as follows : a) testing reliability of PFQ ; b) testing of construct validity of PFQ using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) ; c) testing of criterion-related validity of PFQ to the performance tests using SEM ; d) testing of correlations of the PFQ to walking ability using SEM. Cronbaeh's alpha coefficient for consistency reliability of the PFQ was .83. Four common factors of muscle strength-power, endurance, coordination, and flexibility were extracted in EFA. The high and enough goodness of fit indices were obtained in the confirmatory factor structure model, and in each sub-domain of criterion-related validity to performance tests and correlation to walking ability models. The criterion-related validity coefficient of muscle strength and power was .77, followed by .66 for endurance, .59 for coordination and .82 for flexibility. The correlation coefficient of muscle strength and power to walking ability was -.51, followed by -.58 for coordination, - .43 for endurance and - . 28 for flexibility. These results indicated that the PFQ consisting of 13 items and 4 sub-domains satisfied reliability and construct validity although criterion related validity to performance tests was insufficient. It was concluded that the PFQ is of useful for physical fitness checking of elderly people.

The purpose of this study was to confirm the causal effect model of strength on walking ability development as a result of exercise participation among elderly people in a community, utilizing the latent curve model (LCM) in structural equation modeling (SEM) . Twenty-six male and 57 female subjects, 83 in total, aged 67.8±5.7, 63.9±7.1 and 65.1±6.9 in a pooled sample participated in the exercise program which lasted for two years. Grip strength and sit-ups used in the Japan Fitness Test were measured for muscular strength, 10-m hurdle walk and 6-min walk for walking ability, and the fitness test score for physical ability. The data analysis procedures were as follows : a) analysis of test-retest reliability and construct validity of measurement items, b) analysis of causal structure model of aging, muscular strength and walking ability, c) analysis of variance for repeated measurement of walking performance by sex, age and year, d) analysis of LCM for walking performance development. The highest goodness-of-fit indices of SEM were obtained in the LCM of 10-m hurdle walk performance development (GFI=0.989, AGFI=0.920, CFI=0.998, RMSEA=0.038) . The path coefficient of sit-ups at pre-test effect on the intercept of 10-m hurdle walk performance development was significant (p<0.05) . The path coefficients of age to intercept and slope of 10-m hurdle walk development were also significant (p<0.05) . It was concluded that walking ability development through participation in exercise age and strength level was more effective for maintaining walking ability in older age.

Oral mucositis is reported to occurs in 40% of cancer patients on chemotherapy, suggesting the need for early oral care intervention in such patients. However, the oral care depends on each nurse and there has been no special document on the oral care for patients in the Respiratory Medicine and the Hematology/Oncology Ward, in which are managed around 100 regimens of chemotherapy per month. Here, to develop an oral care assessment sheet (OC sheet), we conducted a questionnaire survey of 24 ward nurses on oral care for chemotherapy patients and evaluated their assessment abilities using an oral care assessment test that was compliant with the items of the Eiler’s Oral Assessment Guide. The questionnaire survey revealed that nurses performed certain observations and/or interventions without basis and confidence, and that they did not always have patients’ cooperation while assessing their oral condition. They also tended to give inconsistent instructions. Use of the OC sheet enabled nurses to provide early oral care interventions and to confirm the utility of the chosen intervention. Test scores after the introduction of the OC sheet were significantly higher than before, indicating that use of the OC sheet improved nurses’ assessment and nursing care abilities.