A study was conducted to investigate muscle fatigue during isometric contraction of the indicis proprius using EMG analysis (BIMUTAS Ver. 2. 1) .
The subjects were 8 healthy men (ranging in age from 19 to 42 years) .
Plummets (ranging from 300g to 600g) were placed on the distal knuckle of the index finger to create loads on the indicis proprius muscle. EMG was recorded until the plummet dropped, and the total time required was divided into 10 equal parts. In each part, the EMG record for the first 1000 ms was picked out. Then the mean power frequency (MePF) and median power frequency (MdPF) of the power spectrum were calculated.
The results were as follows:
1) Both MePF and MdPF showed shits to lower frequency bands.
2) Integrated values of the EMG power spectrum increased with time.
3) The time courses of the MePF and MdPF in each EMG sample for the 8 subjects were determined by the 3-point moving average method.
A break-point was observed in each MePF and MdPF diagram.
It was considered that two-break points observed in the time courses of the EMG record were valid as an objective index of local muscle fatigue.

Acute aortic dissection complicated with acute myocardial infarction in a case of 61-year-old woman with an aberrant right coronary artery was successfully treated by emergency operation fore type A acute aortic dissection. However, cardiogenic shock and bradycardia occurred after induction of anesthesia due to right ventricle myocardial ischemia. Cardiopulmonary bypass was established quickly and deep hypothermia was induced. We also perfused the right coronary artery with an external shunt tube to prevent the progression of the right ventricular infarction. The right coronary artery, which originated above the left coronary sinus, was dissected totally. We performed ascending and aortic arch replacement and coronary artery bypass grafting with a saphenous vein graft to the right coronary artery under hypothermic circulatory arrest. She had no major reduction of cardiac function. Although it was a rare combination, aberrant right coronary artery was vulnerable to myocardial ischemia associated with acute type A dissection. The external coronary shunt tube was useful for this type of myocardial ischemia.

In 2005, a 64 year-old man underwent implantation of a sirolimus-eluting stent at another hospital for the treatment of severe stenosis of the right coronary artery (RCA) that caused unstable angina pectoris affecting the inferior cardiac wall. He was subsequently admitted to our hospital because of recurrent angina. Diagnostic coronary angiography, performed in November 2006, revealed 75% stenosis of the left main trunk and 99% stenosis of the left circumflex artery. We planned to perform off-pump coronary artery bypass grafting on May 6, 2007. Ticlopidine and aspirin were discontinued 14 days and 1 day before the operation, respectively. We then started continuous intravenous heparin administration. During the operation, the right internal mammary artery was grafted to the left anterior descending artery, and after rotation of the heart in order to graft to the circumflex artery, hypotension and ST elevation in electrode II occurred. The left internal mammary artery was grafted to the left circumflex artery under the support of intra-aortic balloon pumping, but the ST elevation did not normalize. Therefore, an extracorporeal cardiopulmonary bypass was started. Despite the coronary recanalization, the ST elevation in electrode II did not recover. Because of thrombosis of the drug-eluting stent, an aorto-coronary bypass graft to the RCA was performed with a saphenous vein graft. There was no proximal blood flow at the RCA incision. Therefore, we perfused the RCA via a shunt tube from the cardiopulmonary bypass, and subsequently the ST change normalized. However, ST elevation recurred after the operation. An emergency angiography performed immediately postoperatively revealed a patent saphenous vein graft and drug-eluting stent, and spastic change in the RCA distal from drug-eluting stent. After the initiation of a continuous intravenous drip of nicorandil, hypotension and the ST change recovered. Attention to coronary artery spasm after drug-eluting stent implantation is important.

An epidemiological survey on allergic conditions of 58 male (aged 38.6±11.8yrs) and 47 female (aged 42.2 ± 9.6yrs) farmers engaged in growing chrysanthemums.
Among the subjects, 47% of males and 62% of females had complaints of at least one of inquired allergic symptoms associated with the work. The immediate type of allergic reaction on nasal and/ or upper respiratory system raised in the process of sorting flowers in the working room and delayed ype of contact dermatitis in pinching the lateral bud of chrysanthemums or spraying agricultural chemicals in the field were the main complaints of those farmers.
Incidence of positive reaction for patch testing to six kinds of chrysanthemums was 5% for males and 17% for females and that of eight kinds at agricultural chemicals was 34% and 45% for each sex. And relatively high incidence was also observed in those subjects from other immunological tests such as determination of serum immunoglobulin, prick testing and calculation of eosinophil in blood and rhinorrhoea.
There were 39 (67%) males and 36 (77%) females who had at least one of the abnormal finding of those test items above mentioned. However, not the particular kind of Chrysanthemum cultivated in that area was found to be strong causative allergen for the observed allergic conditions.
From these results, it is indicated that relatively high incidence of allergic disorders may be found in the chrysanthemum growers due to inhalation and/or contact of some kinds of allergens introduced from the process of growing to forwarding, such allergen as Chrysanthemum itself, agricultural chemicals and other elements.

The physical work load of farmers and dust conditions in the harvesting process of chrysanthemums were investigated for two households (seven workers for A and three for B household, respectively) at mid March in 1984.
The total working hours a day of each household were 3225 min (460 min as average per a worker) for A and 1954 min (652 min) for B, being allotted more times to males than females. However, all of the house keeping hours were carried out only by females.
The intensity of each working load of farmers was not so heavy, as “light” and “moderately heavy” by Christesen's criteria and energy expenditure a day was calculated 2895-3604 kcal for males and 2155-2295 kcal for females.
In this working process farmers were enforced to keep careful handling with chrysanthemums and fixed body posture for 4 to 6 hours a day. Particulary, the working posture of sorting and bundling chrysanthemums may cause over strained load to the muscle and joint of the lower back and legs.
The dust concentrations of the sorting room were not so high. However, the farmers were exposed a large quantity of cilia of chrysanthemum leaves, calculated 37-259 pieces/cm² on the slide grass a day. The numbers of cilia varied with amounts of handling chrysathemums.
It was suggested that the cilia of chrysanthemums may be the most important allergen to the immediate type of allergy of the chrysanthemum growers.

　　With the introduction of the diagnosis procedure combination (DPC) system, the reduction of the health expenditure is expected. The use of generic drugs is promoted. It is imperative for introduction of generic drugs to assure the appropriate use of drugs to decrease medical costs without reducing medical services. Additionally, we should make a concerted effort to prevent the injudicious use of antimicrobial agents resulting in the emergence of drug resistance. In this study, we assessed the effects of switching to generic antimicrobial drugs on drug purchases cost, AUD (antimicrobial use density), hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. This study was carried out at Yashima General Hospital for the period from April 2008 to September 2011. The Health, Labor and Welfare Ministry designated Yashima General Hospital as a DPC hospital from July 2009. Since the DPC introduction, the drug purchase cost has been decreased about 40% without reduction of AUD, hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. Hospitals are making efforts to assess and improve management efficiency while maintaining the quality of medical care. Our results suggested that the introduction of generic drugs with assessment of efficacy may be one of the useful methods for pharmacy management.

To seek longitudinal changes in metacognitive processes through problem-based learning (PBL), we analysed the contents of all comments written reflectively by the third-year students after they finished discussions in each PBL session. After dividing their comments into meaningful units, we focused on two major thematic categories and five sub-categories to be analysed.
1) The number of units decreased significantly (chi-square: p=0.02).
2) Only the proportion of units categorised as “comprehension” in “individual learning” showed significant increase (Bonferroni: p<0.001).
3) Comments in this category stated that “I don't understand so-and-so.”
4) The increase of “comprehension” as they experienced more PBL suggested that students' knowledge of ignorance as metacognition was fostered through sessions in medical PBL.

Aggressive anticoagulation therapy is necessary when Toyobo-LVAS is used for long-term treatment of severe heart failure. However, it is necessary to regulate it carefully if there is a hemorrhagic complication due to thromboembolism, but repeated blood testing is painful. We compared simple measurement with the CoaguChek XS^® with the conventional blood testing method. The correlation coefficient was 0.916, and the regression line was Y=0.8027X+0.3399. In addition, drawing blood using the CoaguChek XS^® was very effective in the reported pain reduction in patients.

Problem-based learning (PBL) tutorials were introduced at our university in April 2001. Because a complete PBLbased curriculum could not be adopted, a transitional curriculum incorporating 3-hour PBL tutorial sessions into the traditional curriculum was introduced. More than 80% of students agreed that PBL is an effective way of learning problem solving at the bedside. Twenty percent to 40% of teachers felt that students who took PBL were more motivated for bedside learning and self-directed learning and had better at presentation than were students who did not take PBL. Because of 80% of the curriculum comprised didactic lectures, most students considered PBL tutorials a type of lecture. For this reason, motivating students to learn additional material originating from PBL tutorials was difficult. Although the combination of a traditional curriculum and PBL tutorials may appear to be a new curriculum, this type of PBL has limited value as a method for studying problem solving.

It is to be noted that in rural districts where they live and work in fresh and clean air the incidence of chronic obstructive pulmonary diseases is as high as in the districts of air-pollution. Besides, there are a variety of respiratory diseases particularly incidental to life-environment and farm work. To be more informed of their actual conditions, the Japanese Association of Rural Medicine organized a special study group and has carried out various studies for four consecutive years with grants from the Ministry of Health and Welfare. The major results obtained are as follows
(1) There were a variety of farm operations which produced or increased respiratory symptoms, including thrashing and scattering of agricultural chemicals;
(2) It became clear that there existed in an advanced age group certain cases of “agricultural pneumoconiosis” which could be regarded as the terminal of the so-called “thrash-bronchitis”
(3) Among the cultivators of rush, raw material for Tatami, There existed cases of pneumoconiosis;
(4) There were a variety of agents to produce bronchial asthma, such as rice straw, chaff, tea-leaves and chrysanthemum-leaves;
(5) In Japan only two cases of farmer's lung were reported prior to this study. One more case was added to the list by this study group. Besides, cases positive to fungous agents were found among farmers in considerably high percentage.