We administered an objective structured clinical examination (OSCE) for basic life support (BLS) using an automated external defibrillator (AED) to fourth-year students of the Akita University School of Medicine. Although medical school graduates should be proficient in advanced cardiovascular life support techniques, this program is still on a trial basis. Furthermore, the general public should also be able to perform BLS. We believe that an OSCE for BLS using an AED is imperative, as Guidelines 2000 include defibrillation under the category of BLS. We formulated the questions, examination method, and standards for evaluation and arranged the schedule for the OSCE. The OSCE was administered without major problems, although some weaknesses were identified. High objectivity on the OSCE can be obtained only by constant evaluation under consistent conditions; however, the variability of evaluation between examiners on the OSCE reduced objectivity. After correcting this problem, the OSCE for BLS with an AED should be used throughout Japan.

This study was to examine the effects of quantity of taking salt diet on the body during exercise. The subjects were made to do endurance exercise on each after intake of the moderate-salt diet, the much-salt diet and a little-salt diet in a fixed duration.
The results were obtained as follows:
1) Under the much-salt diet intake, responce of systolic blood pressure and heart rate showed small increment during the exercise.
2) Under a little-salt diet intake, the CK-MB/CK ratio showed large increment during exercise.
3) Under the much-salt diet intake, serum BUN values were decreased compared with under the other diets. Under a little-salt diet intake, serum BUN, Uric Acid and Triglycerides values were increased, on the contrary serum Glucose values were decreased in resting condition. Especially, under a little-salt diet intake, serum BUN values were increased during the exercise.
4) The value of urinary sodium excretion was varied in response to the intake of salt. The value of urinary potassium excretion showed no change under the much-salt diet intake. But it showed decrease under a little-salt diet intake.
5) Under a little-salt diet intake, the creatinine clearance values were decreaced during and after the exercise.
The above mentioned findings suggested that the change of salt intake itself may become a stressor to the body and it is necessary to pay much attention when we exercise under these condition.

Introduction: We retrospectively examined the grounds for judging the consciousness level as 1 on the Japan Coma Scale (JCS) made by emergency life-saving technicians (ELSTs).

Methods: The survey involved the sick and injured who were transferred to the hospital by ambulance during the 25-month period from July 1st, 2011, and who were able to respond to questions asked by hospital staff to make records after ELSTs had judged their consciousness level as 1 on the JCS.

Result: A survey involving 105 cases was conducted to examine grounds for judgment of consciousness level of the sick and injured as 1 on the JCS. "Vacant or blank expression", "delay in reactions" or "delay in responses" were cited as the grounds by 61.0 and 47.6%, respectively.

Conclusion: When ELSTs judged the consciousness level of the sick and injured as 1 on the JCS, they made the above observations of the patients. Although these factors are useful for evaluating the status of consciousness, they are not certain. In some cases, ELSTs may have judged the consciousness level as 1 when it should have been judged as 2 or 3 on the JCS. Therefore, it is suspected that some ELSTs may not recognize disorientation appropriately.

The purpose of this study was to develop a simple and easy predictive model of leg, spine and whole body bone mineral density (BMD) from anthropometric, physical fitness, body composition and quantitative ultrasound (QUS) variables. Participants were 138 Japanese overweight and obese men (50.9 ± 9.6 yr, body mass index [BMI] 29.1 ± 2.6 kg/m²). We measured anthropometric variables (height, weight, BMI, chest, waist, hip, upper arm, thigh circumferences), physical fitness (grip strength, side steps, vertical jump, forced vital capacity), body composition (fat-free mass) and QUS. BMD was measured by dual energy X-ray absorptiometry. Multiple linear regression analyses showed that all predictive models for BMD were significant. As a result, the predictive model for leg BMD showed the highest model fitting. The Bland & Altman approaches demonstrated the (positive or negative) systematic error even though most plots were placed within ideal range. Predictive model from physical fitness, body composition and QUS would be useful for estimating whole body and regional BMD. Because these predictive models are likely to have some systemic errors, further research is needed to improve the predictive accuracy.

The inter of this study was to observe the effects of training on histochemical and biochemical properties in the skeletal muscle fibers.
Wistar strain albino rats were assigned to endurance (E), sprint (S) and control (C) group at 4 weeks old. Animals of trained groups were trained by treadmill for 12 weeks. After training, all animals were sacrificed and M. Soleus (SOL) and M. Extensor Digitorum Longus (EDL) were taken out.
Using histochemical staining methods for Hematoxylin and Eosin, Actomyosin ATPase and Succinate Dehydrogenase (SDH), area and composition of the three muscle fiber types were examined. Furthermore, the chemical properties of glycolytic and oxidative enzyme activities were examined.
The results obtained were as follows:
1. The E and S trained groups, respectivelly, showed lower increase of body weight than the control group.
2. Hypertrophy of all fiber types in EDL were observed in the both trained groups. Area of SO fibers in SOL were also increased in the E group as compared to the C group.
3. The differences observed for fiber composition among the three groups. The rate of FOG fiber in SOL decreased significantly in the both trained groups as compared to the C group. The rate of SO fiber in both muscles were slightly higer for the E group relative to the C Group, but these differences were no significant. However, in the E group significant increase was observed for oxidative enzyme activity. The Phosphofructo-kinase activity in EDL of the S group was significantly higher in comparison to the other groups.
These results suggested that there is the discrepancy between histochemical proper-ties and biochemical properties in the effects of training on skeletal muscle fibers and that the necessity of histochemical and biochemical analysis.

Daily energy expenditure has been measured by the physical activity recording and/or the questionnaire method. Recently, the accelerometer or pedometer is used to measure daily energy expenditure. The purpose of this study was to examine validity of the pedometer with accelerometer and to compare the daily physical activity between young and older Japanese. To examine validity of the pedometer, 10 young subjects worn the pedometer (Lifecorder) on the waist and then performed the walking test. Energy expenditure was measured by the expired gas analysis during the test. Fourtythree young and 54 older subjects worn the Lifecorder on the waist during free-living condition for 14 days. The intensity of Lifecorder had a high correlation with the physical activity intensity (METs) (r=0.958, P<0.001) . In the free-living condition, daily energy expenditure was 2171±305 kcal in young and 1617±196kcal in older (P<0.001) . Total step in young was significantly higher than older (young: 9490±2359 steps ; older: 6071±2804 steps, P<0.001) . There was no significant difference in the duration of physical activities at the Lifecorder intensity 1 such as desk working, watching TV sitting on a sofa and driving a car. However, the duration more than the intensity 2 corresponding to 2.2 METs in young subjects was longer than that in older (P<0.001) . We concluded that in older subjects, not only amounts of daily energy expenditure but also intensities of daily living were lower compared to the young subjects.

Para-anastomotic aneurysms may have dangerous complications such as rupture and thrombosis, with consequent loss of life. As these complications are associated with high mortality rates, early detection and prompt surgical treatment are important. Repair of para-anastomotic aneurysms may be challenging and the surgical approach should be carefully planned. A 66-year-old man had undergone thoracoabdominal aortic aneurysm repair 18 years previously. The diameter of the distal aortic anastomosis was gradually increasing. We comprehensively discussed the surgical approach preoperatively, including consideration of spinal cord protection. Abdominal aortic graft replacement was performed through a midline abdominal incision, with cross-clamping on the proximal side of the aneurysm, continuous intravenous infusion of naloxone, and segmental aortic clamping with distal aortic perfusion and selective visceral perfusion. The left renal artery was reconstructed, and the inferior mesenteric artery and lumbar arteries were preserved.

The patient was a 65-year-old man who had undergone AVR (SJM Regent : 19 mm) for AR in June 2007. Since March 2008 there had been an increase in the pressure gradient between the aorta and the left ventricle on transthoracic echocardiography (peak PG : 46 mmHg, mean PG : 27 mm Hg). Plain x-ray films of the valve showed limited opening of the metallic valve. However, no symptoms of heart failure were observed on a physical examination. Blood tests performed in December 2007 showed a PT-INR value of 1.22. Since the effects of warfarin anticoagulant therapy were insufficient, its dose was adjusted on follow-up. An examination in June revealed further stenosis of the valve (peak PG : 93 mmHg, mean PG : 58 mmHg). Valve thrombosis was suspected because the condition was poorly controlled by warfarin. Thus, thrombolytic therapy using t-PA was performed (800,000 units). However, the patient complained of chest pain 1 h 30 min after initiation of thrombolytic therapy. Twelve-lead electrocardiography was performed, and ST-segment elevations were observed in the limb and chest leads. Acute myocardial infarction due to a free-floating thrombus was suspected, and emergency cardiac catheterization was performed. Segment 7 was totally occluded, and reperfusion was achieved by thrombus aspiration. Embolization of the coronary artery was speculated to have occurred because of the improved mobility of the metallic valve and dissolution of a thrombus adhering to the valve. A case of acute myocardial infarction as a complication of thrombolytic therapy for valve thrombosis is rare. This case reaffirms the necessity of careful monitoring during thrombolytic therapy.

It has been reported that visceral fat (VF) is an independent predictor of the incidence for coronary heart disease, and is associated with its risk factors. The independent effects of exercise or dietary modification on VF remain to be fully elucidated, especially in obese middle-aged men. The purpose of this study was to investigate effects of exercise on VF compared to dietary modification. Thirty-five obese middle-aged men participated in this study. They consisted of exercise group (n=22, 51.4±11.6 yr, Group E) and diet group (n=13, 48.8±12.2 yr, Group D). Participants in Group E followed 90-min exercise sessions on a regular basis 3 days per week for 12 weeks. Participants in Group D attended weekly classes aimed at maintaining well-balanced 1,680 kcal/d diet for 12 weeks. Body weight decreased significantly in both groups (Group E : −2.9 kg, Group D : −5.4 kg). Visceral fat area (VFA) determined by computed tomography also decreased significantly (Group E : −32.0 cm², Group D : −39.4 cm²). An analysis of covariance adjusted by weight change revealed no significant group difference in VFA change. These results suggest that exercise-induced negative energy balance does not result in greater decrease in VFA as compared with dietary modification alone.

Pulmonary vein isolation procedure was performed for atrial fibrillation associated with mitral valve disease in twelve patients. This simple procedure consisted of only isolation of the four pulmonary veins. Combined mitral valve surgery consisted of mitral valve plasty, mitral valve replacement with or without aortic valve replacement and tricuspid annuloplasty. Ten patients returned to a sinus rhythm. Two patients required DDD pacemaker implant for sick sinus syndrome. Left atrial contraction was detected in eight cases by trans-esophageal echography. Compared with the maze procedure, this operation was less invasive and preserved atrial appendage, helping to maintain normal secretion of atrial natriuretic peptide. This study suggests that the pulmonary vein isolation procedure may be an effective and simple maneuver for atrial fibrillation associated with mitral valvular disease.