The effect of changes in vascular transmural pressure upon differential digital plethysmogram (delta DPG) was studied in seven normal subjects. Changes in vascular transmural pressure were produced by the gravitational potential energy change (GPEC method) of an extremity from the heart level. Delta DPG which was characteristic of stability, discrimination and low speed record by modified devices was applied for the experiments including postural, static and dynamic exercises. Room temperature during experiments was kept constant. The Delta DPG-P wave amplitude in maximal elevation of upper and lower extremities (mean±S. D., n) increased to 162.3±33.5% (38) and 176.7±33.4% (12), respectively, and that in maximal lowering of upper and lower extremities decreased to 36.9±10.5% (35) and 37.5±12.6% (15), respectively. These data reveal that the GPEC method may be useful for the determination of arteriolar sensitivity in humans.

We experienced a surgically treated case of chronic contained rupture of a common iliac artery aneurysm. A large number of cases of chronic contained ruptures of the abdominal aorta have been reported; however, that of the common iliac artery is very rare. A 66-year-old man was injured in a bicycle accident. Three months later, the patient felt a dull abdominal pain and noticed a tumor in the left lower abdomen. On presenting computed tomography (CT) scan revealed an aneurysm of the left common iliac artery. After further examinations, a contained rupture of the left common iliac artery aneurysm was diagnosed. At operation, the main aneurysm, 7.5×6.5cm in size, was seen in the left common iliac artery, extending to the right common iliac artery and the infrarenal abdominal aorta. A 5.0×3.0cm tear, was found oil the posterior wall of the left common iliac aneurysm, surrounded by a huge hematoma. The aneurysm was resected and the abdominal aorta and the common iliac arteries were replaced with a Bard Albumin-coated DeBakey vascular bifurcated graft (16×8mm). The postoperative course was uneventful.

We evaluated regional differences of muscle O₂ dynamics between distal and proximal sites in the vastus lateralis (VL) muscle using near infrared spatial resolved spectroscopy (NIR_SRS). forty-one male subjects performed a 30 W ramp incremental bicycle exercise test until exhaustion. The NIR_SRS probes were attached on each distal and proximal site in the VL. The pulmonary O₂ uptake and heart rate were monitored continuously during the experiment. The TOI at rest was significantly higher in proximal than distal sites (65.0±5.2 vs. 69.7±4.6%, p<0.001). The TOI at exhaustion was also significantly higher in proximal than distal sites (39.5±6.7 vs. 47.5±7.6%, p<0.001). Moreover, a significant correlation was found between VO₂max and the TOI at exhaustion in each proximal and distal site in the VL. Half time reoxygenation, the time to reach a value of half-maximal recovery, was significantly slower in distal sites than proximal sites (27.1±5.6 vs. 25.0±6.1 sec, p<0.01). In conclusion, lower muscle oxygenation at exhaustion in higher VO₂max may be due to enhanced O₂ extraction in high oxidative capacity muscle. In addition, slower reoxygenation and lower muscle deoxygenation at the distal site in the VL may be explained by differences in O₂ supply and/or muscle fiber composition between distal and proximal sites.

This study aimed to examine the effects of an 8-week physical activity program, which mainly comprised home-based bench-stepping exercise training at the intensity of lactate threshold (LT), on mental health (MH), health-related quality of life (HRQOL), and physical fitness in Japanese returnees from China. Thirty Japanese returnees (63 ± 9 y) participated in the exercise program. Another six subjects were enrolled as the control group. The subjects performed 212 ± 57 min of training, and their daily step counts were increased. Aerobic capacity (LT: 4.5 ± 0.8 vs. 5.5 ± 1.1 METs), lower limb strength (30-s chair stand test [CS-30]: 19.1 ± 5.5 vs. 21.3 ± 5.1 times), and sit-and-reach flexibility (sitting-posture body anteflexion: 36.1 ± 9.4 vs. 39.0 ± 8.4 cm) were significantly increased after the intervention compared with before the intervention. Furthermore, MH, as assessed by the total score of the GHQ-28 (3.4 ± 4.4 vs. 0.3 ± 0.8 points), and the mental component score (MCS) of HRQOL, as evaluated by the SF-36v2 (55.1 ± 11.4 vs. 58.5 ± 10.0), were significantly changed in a positive manner. However, a two-way repeated measures ANOVA (group × period) showed significant interactions for LT and MCS (p<0.05), and a tendency for interactions of CS-30 (p=0.063) and the total score of the GHQ-28 (p=0.098). These results indicate that this bench-stepping exercise program could become a useful health support program for improving physical fitness, as well as MH and HRQOL, in Japanese returnees.

Following the revision of the structure and content of the Model Core Curriculum for Medical Education to be more outcome-based and the legal status of the medical practice performed by medical students in the clinical clerkship, we have revised the Guideline for Participatory Clinical Clerkship. The following items were revised or newly described : significance of enhancing the participatory clinical clerkship, scope of medical practice, confidentiality, patient consent, patient consultation and support service, objectives of the clinical clerkship, simulation education, departments where the clinical clerkship is conducted, assessment in the clinical practice setting, CC-EPOC, and entrustable professional activities. A foundation has been established to promote seamless undergraduate and postgraduate medical education. However, future work is needed to examine the specific level of performance expected at the end of the clinical clerkship and department-specific clinical practice goals and educational strategies.

OBJECTIVE: This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy. METHODS: The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database. RESULTS: A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06-2.81) and during the night shift (OR 2.29, 95% CI 1.30-4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97-2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70-2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47-3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76-4.84). CONCLUSION Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.
Case-Control Studies ; Cerebral Palsy ; epidemiology ; etiology ; Delivery, Obstetric ; statistics & numerical data ; Health Facilities ; statistics & numerical data ; Humans ; Incidence ; Infant, Newborn ; Japan ; epidemiology ; Parturition ; Perinatal Care ; statistics & numerical data ; Retrospective Studies ; Time Factors