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.

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.

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.

BACKGROUND/OBJECTIVES: Poor oral health has been predicted the development of frailty and sarcopenia as well as the subsequent need for long-term care. This cross-sectional study examined the relationships among tooth loss, prefrailty, and dietary patterns in communitydwelling older Japanese females. SUBJECTS/METHODS: Information on the number of teeth, food consumption, and lifestyle factors was collected from 271 participants aged ≥ 65 yrs using a questionnaire. The number of teeth was self-reported and classified into 2 groups: natural teeth ≥ 20 and natural teeth < 20. Prefrailty was assessed using the Japanese version of the Cardiovascular Health Study. Three dietary patterns (“vegetables and dairy products” [VD], “rice and fish and shellfish” [RF], and “bread and beverages”) were adopted from a cluster analysis of the intakes of 20 foods evaluated using the Food Frequency Questionnaire. The odds ratios (ORs) for prefrailty and dietary patterns were calculated using a binary logistic regression analysis. RESULTS: A total of 267 participants were analyzed, excluding those with frailty (n = 4). The rates of natural teeth < 20 and prefrailty were 57.3 and 37.4%, respectively. Natural teeth < 20 was positively correlated with prefrailty (OR, 4.66; 95% confidence interval [CI], 2.54–8.52) and inversely correlated with VD pattern (OR, 0.43; 95% CI, 0.27–0.69). Furthermore, both VD (OR, 0.38; 95% CI, 0.16–0.91) and RF (OR, 0.26; 95% CI, 0.11–0.62) patterns were inversely correlated with prefrailty. CONCLUSIONS Maintaining the number of natural teeth ≥ 20 into old age plays an important role in preventing a prefrailty. The promotion of VD and RF dietary patterns has potential as an effective nutritional strategy for preventing tooth loss and prefrailty.

BACKGROUND/OBJECTIVES: Poor oral health has been predicted the development of frailty and sarcopenia as well as the subsequent need for long-term care. This cross-sectional study examined the relationships among tooth loss, prefrailty, and dietary patterns in communitydwelling older Japanese females. SUBJECTS/METHODS: Information on the number of teeth, food consumption, and lifestyle factors was collected from 271 participants aged ≥ 65 yrs using a questionnaire. The number of teeth was self-reported and classified into 2 groups: natural teeth ≥ 20 and natural teeth < 20. Prefrailty was assessed using the Japanese version of the Cardiovascular Health Study. Three dietary patterns (“vegetables and dairy products” [VD], “rice and fish and shellfish” [RF], and “bread and beverages”) were adopted from a cluster analysis of the intakes of 20 foods evaluated using the Food Frequency Questionnaire. The odds ratios (ORs) for prefrailty and dietary patterns were calculated using a binary logistic regression analysis. RESULTS: A total of 267 participants were analyzed, excluding those with frailty (n = 4). The rates of natural teeth < 20 and prefrailty were 57.3 and 37.4%, respectively. Natural teeth < 20 was positively correlated with prefrailty (OR, 4.66; 95% confidence interval [CI], 2.54–8.52) and inversely correlated with VD pattern (OR, 0.43; 95% CI, 0.27–0.69). Furthermore, both VD (OR, 0.38; 95% CI, 0.16–0.91) and RF (OR, 0.26; 95% CI, 0.11–0.62) patterns were inversely correlated with prefrailty. CONCLUSIONS Maintaining the number of natural teeth ≥ 20 into old age plays an important role in preventing a prefrailty. The promotion of VD and RF dietary patterns has potential as an effective nutritional strategy for preventing tooth loss and prefrailty.

BACKGROUND/OBJECTIVES: Poor oral health has been predicted the development of frailty and sarcopenia as well as the subsequent need for long-term care. This cross-sectional study examined the relationships among tooth loss, prefrailty, and dietary patterns in communitydwelling older Japanese females. SUBJECTS/METHODS: Information on the number of teeth, food consumption, and lifestyle factors was collected from 271 participants aged ≥ 65 yrs using a questionnaire. The number of teeth was self-reported and classified into 2 groups: natural teeth ≥ 20 and natural teeth < 20. Prefrailty was assessed using the Japanese version of the Cardiovascular Health Study. Three dietary patterns (“vegetables and dairy products” [VD], “rice and fish and shellfish” [RF], and “bread and beverages”) were adopted from a cluster analysis of the intakes of 20 foods evaluated using the Food Frequency Questionnaire. The odds ratios (ORs) for prefrailty and dietary patterns were calculated using a binary logistic regression analysis. RESULTS: A total of 267 participants were analyzed, excluding those with frailty (n = 4). The rates of natural teeth < 20 and prefrailty were 57.3 and 37.4%, respectively. Natural teeth < 20 was positively correlated with prefrailty (OR, 4.66; 95% confidence interval [CI], 2.54–8.52) and inversely correlated with VD pattern (OR, 0.43; 95% CI, 0.27–0.69). Furthermore, both VD (OR, 0.38; 95% CI, 0.16–0.91) and RF (OR, 0.26; 95% CI, 0.11–0.62) patterns were inversely correlated with prefrailty. CONCLUSIONS Maintaining the number of natural teeth ≥ 20 into old age plays an important role in preventing a prefrailty. The promotion of VD and RF dietary patterns has potential as an effective nutritional strategy for preventing tooth loss and prefrailty.