The sleep-inducing effect and safety of an herbal tea containing valerian and lemon balm were subject to a preliminary open pilot study. Subjects were 14 female volunteers (age 35 ± 11, BMI 21 ± 3 kg/m²) who complained of poor sleep. After obtaining informed consent, subjects took daily 2 cups of herbal teas containing valerian and lemon balm for 1 week, followed by a control week, during which they had two cups of hot water. OSA sleep questionnaires and VAS scales were recorded every day. Sleep quality increased at the 2^nd day after starting the tea, and sleep induction and sleep maintenance were improved in particular. Those whose complaints were severe experienced greater relief than those who complaint a little. Some cases reported transient sleepiness and gastrointestinal complaints. However, these symptoms disappeared spontaneously. The safety and effectiveness of this sleep-inducing herbal tea was ascertained.

We conducted a preliminary study of the facial skin-improving effects of collagen-containing beverages as evaluated by objective indices. After obtaining written informed consent, 61 healthy females (age: 25–68, 34±8 y.o.) were randomly divided into two groups, receiving beverages containing 5 g (N=30) and 10 g (N=31), respectively, of collagen daily for one month. Facial skin moisture content and lower eyelid wrinkles were assessed before, 1 week and 1 month after consuming the test beverages. Results were analyzed of the 5 g and 10 g groups, as well as responder and non-responder groups. 10 g collagen beverages showed 50% effectiveness, and were more effective than the 5 g beverage; the effect was observable within 1 week. Furthermore, subjects with more wrinkles and drier skin showed greater benefit than those with higher facial skin moisture content and/or fewer wrinkles. It is suggested that a beverage containing 10 g collagen should be used for aged subjects with more wrinkles and/or drier skin for a period of 1–2 months in future randomized placebo-controlled trials of collagen-containing beverages.

Fresh kiwi fruit freeze-dried juice has been traditionally used for constipation of elderly patients. Its effectiveness and safety was studied in 42 elderly patients (age 60–84: median age 67±6) suffering from mild to moderate constipation, taken as a food supplement of 6 capsules/3 times per day for 4 weeks following a one week control period, after receiving written informed consent. Bowel habits and generic quality of life questionnaires were monitored. Bowel habits such as evacuation time and stool quality improved from the 14^th day and continued for 28 days compared to the control period.
Quality of life in terms of external appearance (such as skin and edema), lumbago, and headache improved. In conclusion, freeze-dried fresh kiwi fruit juice had a laxative and QOL-improving effect on the elderly. No apparent adverse effects were observed.

The aim of this study was to evaluate the association between a number of variables and the smokingbehavior of students at 2 medical and 4 nursing schools. Multivariate analysis was applied to clarify theassociation between the Brinkman index and 12 other independent variables.
The study population consisted of 1, 207 medical and 682 nursing students in Japan.
1) 35.4% of medical students (1-6th grades), 12.5% of nursing students and 28.7% of medical students (1-3rd grades) smoked. Medical students in the 5th or 6th grade smoked more frequently than the otherstudents.
2) Smokers in medical school and those giving up smoking in nursing school had more knowledge aboutsmoking and its physical effects than the others.
3) Multiple regression analysis showed that the coefficients of determination for the Brinkman indiceswere 0.197 in medical school (1-6th grades), 0.055 in nursing school and 0.106 in medical schools (1-3rd grades). The main independent variables were age, sex and maternal smoking history.

Cardiac patient simulators are commonly used in Japanese educational institutions; however, most institutions have not established concrete learning objectives or strategies for mastering physical examination of the circulatory system, including cardiac auscultation. In this study, we propose clear learning objectives and strategies for simulator practice for fifth-year medical students who have passed the objective structured clinical examination, and explored their educational effectiveness.
1)The subjects were fifth-year medical students (n=94) at the University of Miyazaki. Learning objectives were the mastery of the sequential physical examination and the ability to distinguish 6 cardiac findings, including normal status. The subjects were evaluated with a checklist before and after lectures and simulator practice.
2)The mean score (maximum score=14) significantly increased from before simulator practice (2.2±0.9) to after simulator practice (11.4±1.5; p<0.001). There was no difference in scores after practice among the cardiac diseases.
3)Before practice more than 50% of subjects could use a stethoscope on only right positions and could indicate only the maximum point of a cardiac murmur; in contrast, after practice more than 90% of the subjects could sequentially describe physical findings and accurately predict cardiac diseases.
4)In a questionnaire administered after practice, 83% of the subjects answered that all physicians should acquire proficiency in cardiac auscultation regardless of their specialty.
Simulator practice with clear learning objectives may help improve clinical examination skills when both time and human resources are limited. The reevaluation of the program's continuing educational effectiveness and the establishment of an iterative learning program will be needed.

We applied a new circulatory support system to three patients with descending aortic operation between 1989 and 1990. The new system consisted of a polyvinylchloride tube coated with hydrophilic heparinized polymer and a roller pump. Low doses of heparin (0.5mg/kg) were administered in two patients and none in one patient before aortic bypass. The aortic crossclamping time ranged between 52 and 64 minutes. In two patients, whose inflow cannulae were 18Fr. or 20Fr., successful bypass flow exceeded 2l/min and optimal distal aortic pressure were maintained during aortic cross-clamping. The postoperative courses of these patients were uneventful, free from thromboembolic episodes and subsequently discharged from hospital. Furthermore, postoperative careful examination revealed no thrombus formation occurred in the three devices. In conclusion, our new simple, antithrombogenic circulatory system is extremely useful for descending aortic operations.

A case of 65-year-old man of aorto-caval fistula induced by ruptured abdominal aortic aneurysm is reported. The symptoms were hematuria and chest pain, and an emergent operation was performed. In the operation, Fogarty's balloon occlusion catheter was used to reduce bleeding from inferior vena cava, and to prevent pulmonary embolism. The fistula was 3cm in size, and abdominal aorta was replaced with a low porosity polyester Y-graft. The symptoms of pulmonary congestion and hematuria were improved after operation. The balloon occlusion catheter was effective for reducing bleeding from IVC, and prevention from pulmonary embolism after operation.

OBJECTIVESThe appearance of 'twin language' has been highlighted as a reason for delayed language development in twins. 'Twin language' is a unique language understandable only within the pair, and not by their mother or others. The purpose of this study was to examine and clarify the factors affecting the appearance of 'twin language'.

METHODSA mailed questionnaires survey was conducted in 2733 mothers of twins. Of them, 1395 mothers returned the questionnaires. The core questionnaire asked for data on birth weight, age at first spoken word, whether the twins were as alike as two peas in a pod, household members and non-verbal play. Logistic regression analysis was used in this study.

RESULTSOut of the 1395 pairs included in this analysis, 598 pairs (42.9%) showed the appearance of a 'twin language'. When the 598 pairs were divided by whether the twin pair was exactly alike or not, there were 112 opposite sex pairs, 105 not-alike male pairs, 106 not-alike female pairs, 129 exactly alike male pairs and 140 exactly alike female pairs. Namely, 38.4% of the opposite sex pairs, 40.4% of the not-alike male pairs, 39.3% of the not-alike female pairs, 47.6% of the exactly alike male pairs and 48.4% in the exactly alike female pairs had a twin language. By multivariate logistic regression analysis controlling for twins' age, it was found that 'twin language' was significantly more frequent in exactly alike twin pairs, pairs with non-verbal play, and pairs with fewer older siblings.

CONCLUSIONSThese findings suggest that three factors (whether the twin pair is exactly alike or not, older siblings, non-verbal play) affect the appearance of 'twin language'.

Coix lacryma-jobi L. var.ma-yuen Stapf (Coix seed) is a grass crop that has long been used in traditional medicine as a nourishing food. However, high-intake safety of the extract of the husks, pellicles and astringent skin of Coix seed has rarely been evaluated. We performed a safety test of hot water extract of all parts of Coix seed (CRD extract) in rats. CRD extract showed no significant toxicity on body weight, blood analyses, urinalysis and histopathological examination in acute toxicity tests.