Background: Bone marrow aspiration is an essential but hazardous procedure. We have developed a mannequin simulator with posterior iliac crests to teach needle puncture.
Method: After watching a video demonstration of bone marrow aspiration, undergraduate medical students were asked to complete a questionnaire concerning their calmness （C） and self-confidence （S） in performing the procedure using 5-point rating scales （1–5: worst–best） and its estimated ease （E） （1-5: difficult–easy）. The students were given hands-on, small-group instruction using the simulator and allowed to practice, after which they were asked to answer the questionnaire again. The outcome was a change in scores between before and after practice. The paired Student’s t-test （two-tailed） was used for statistical analysis. We also evaluated correlations between pairs among 3 factors.
Results: The participants were 200 fifth-year student volunteers from Kawasaki Medical School. The scores after instruction and practice were higher than those before （C: 1.57±0.85 vs. 2.61±1.27; S: 1.61±0.85 vs. 2.86±1.01; and E: 2.36±1.13 vs. 3.65±1.11）. Estimated ease was moderately correlated with self-confidence in performing the procedure after instruction and practice, and the rank-correlation coefficients of before and after were 0.481 and 0.557, respectively. The coefficients of C and E before and after the instruction and practice were 0.346 and 0.526, respectively, whereas the coefficients S and C were 0.487 and 0.414, respectively.
Discussion: Simulator-based training may reduce medical students’ anxiety about bone marrow aspiration and its estimated difficulty.

The form and electromyographic pattern of archery shooting were compared between experts and amatures. Using methods are electromyography, photography and X-ray photography.
In the expert group, the shoulder joint of the pushing arm is in neutral position of rotation and the forearm is in supinated position. In the amature group the shoulder joint is in externally rotated and forearm is pronated. The delta muscle provides more powerful abduction of the shoulder in neutral position of rotation.
The different discharge pattern of shoulder girdle muscles between two groups suggests that fixation of the bow is essentially important from release to follow-through.

Several prospective studies on laparoscopy-assisted distal gastrectomy for early gastric cancer have been initiated, but no prospective study evaluating laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy has been completed to date. A non-randomized confirmatory trial was commenced in April 2015 to evaluate the safety of laparoscopy-assisted total gastrectomy and laparoscopy-assisted proximal gastrectomy for clinical stage I gastric cancer. A total of 245 patients will be accrued from 42 Japanese institutions over 3 years. The primary endpoint is the proportion of patients with anastomotic leakage. The secondary endpoints are overall survival, relapse-free survival, proportion of patients with completed laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy, proportion of patients with conversion to open surgery, adverse events, and short-term clinical outcomes. The UMIN Clinical Trials Registry number is UMIN000017155.
Anastomotic Leak ; Asian Continental Ancestry Group ; Conversion to Open Surgery ; Gastrectomy* ; Humans ; Japan* ; Laparoscopy ; Medical Oncology* ; Non-Randomized Controlled Trials as Topic ; Prospective Studies ; Stomach Neoplasms*

A 73-year-old man, who underwent total esophagectomy and gastric tube reconstruction via the retrosternal route for esophageal cancer 10 years eariler, was referred to our hospital with chest pain. He was suspected of acute coronary syndrome, and coronary artery angiography was performed, showing in-stent restenosis of the proximal site of the right coronary artery, diagnosed as the culprit lesion, and drug-coated ballooning was performed. His symptoms improved, however, the poor expansion of the stent and in-stent stenosis remained, and he was referred to our department for coronary artery bypass surgery. Because the gastric tube was reconstructed just below the sternum and performing sternotomy seemed to be difficult, a left mini-thoracotomy approach using great saphenous vein was planned. Under general anesthesia, an approximately 10-cm skin incision was made on the left fifth rib from the anterior axillary to the midclavicular line, and the chest wall was opened at the fifth and third intercostal spaces from the same skin incision, to secure views of the AV node branch and ascending aorta. First, the great saphenous vein was anastomosed to the ascending aorta from the third intercostal space, using 3.8 mm puncher and Heartstring III (Getinge, Lindholmspiren, Sweden). After that, the graft was guided extrapericardially via the left intrathoracic cavity, and was anastomosed to the AV nodal branch from the fifth intercostal space. The graft blood flow was 48 ml/min. The postoperative course was uneventful and contrast-enhanced CT confirmed the patency of the graft.