The time constants of beat-by-beat heart rate decay for the first 30 seconds (T30) after exercise is a specific index for the vagally mediated component of heart rate recovery. The aim of our study was to determine whether cardiac rehabilitation (CR) can accelerate T30 in patients after coronary artery bypass grafting (CABG) . Thirteen male patients who underwent CABG (aged 60.5±7.7years) were assigned to 7-21 day Phase I CR. Exercise training consisted of 30 minutes of aerobic exercise (bicycle ergometer) at the anaerobic threshold 2 times per day. T30 was measured as the heart rate decay regulated in patients who rested immediately after 5 minutes of pedaling exercise. After CR, T30 significantly improved from 413.3±129.7 to 300.1±124.5 sec (p<0.01) . Peak oxygen uptake (peak V02: 14.0±4.0 16.7±3.2mlin/kg: p<0.01) and heart rate at anaerobic threshold (HR @ AT: 111.9±13.4 103.6±11.7 beatsin: p<0.01) also improved significantly. There was no correlation between ΔT30 (Δ: difference before and after CR) and Δpeak VO₂or ΔHR @ AT. These results suggest that CR for patients following CABG accelerates vagally mediated heart rate recovery after dynamic exercise.

Objective: It is unclear whether the importance of the healthcare professional’s role and the relationship between healthcare users and providers are well understood in self-medication (SM) practices.  We conducted a self-report survey to examine how the role of healthcare professionals in SM is interpreted and how the reciprocal relationship between consumers and pharmacists in SM is recognized.
Design: Questionnaire survey.
Methods: The sample comprised 493 medical professionals (283 pharmacists at hospitals, community pharmacies, and drug stores; 74 instructors at colleges of pharmacy; and 136 personnel of SM-related academic societies).  We mailed questionnaires with informed consent forms from September to November, 2014; those who agreed to participate mailed completed questionnaires back.  We examined how individuals define and interpret SM, clarified each role of pharmacists and consumers regarding several aspects of SM, and collected respondents’ demographic information.
Results: Of the 493 questionnaires mailed, 125 (25%) were returned.  Over 65% of respondents reported familiarity with the preexisting definitions of SM that include the healthcare professional’s role.  However, when asked to define SM in their own words, only 30% included the role of healthcare professionals.  Among respondents who were not engaged in SM-related research, education or promotion, only 24% included the healthcare professionals’ role.  Also, when asked to describe the concrete roles of both pharmacists and consumers, respondents wrote fewer comments on improving living habits, consulting about health concerns, and implementing self-checks than on serving consumers with over-the-counter drugs and health foods.
Conclusion: The importance of reciprocal relationships in SM was not well recognized in our sample.  Our results suggest that it is imperative to disseminate information to raise healthcare professional’s recognition on the importance and clarification of some or all roles of theirs in SM.

Thirty-four patients with congenital cardiac disease were studied to evaluated the role of ultrafiltration after cardiopulmonary bypass without homologous blood transfusion. We used either polypropylene microporous hollow fiber hemoconcentrator (HC-30M or 100M) or polyacrylonitrile microporous hollow fiber hemoconcentrator (PHC-500). Ultrafiltration was useful in the reduction of fluid overloading after cardiopulmonary bypass with extreme hemodilution. Thirty-two patients tolerated the procedure uneventfully without donor blood transfusion and were discharged from the hospital. The values of hematocrit, serum protein and free hemoglobin increased significantly after ultrafiltration with either type of hemoconcentrator. However the degree of concentration of blood components was significantly higher with polyacrylonitrile hemoconcentrator than those with polypropylene hemoconcentrator. These results indicated that ultrafiltration was useful for maintaining water balance after cardiopulmonary bypass without homologous blood transfusion in pediatric cardiac surgery and that polyacrylonitrile microporous hollow fiber hemoconcentrator should be employed in patients with shorter bypass time and less hemolysis.

Transcatheter embolization of 25 aortopulmonary collateral arteries (7 bronchial arteries and 18 intercostal arteries) was attempted prior to intracardiac repair in 7 patients. The underlying disease was tetralogy of Fallot in 3 patients, pulmonary atresia with ventricular septal defect in 2, double-outlet right ventricle with ventricular septal defect and pulmonary stenosis in 1 and tricuspid stenosis with pulmonary atresia in 1. The intervals between embolization and intracardiac repair ranged from 0 to 17 days (mean 4.5 days). Embolization resulted in total occlusion in 7 bronchial arteries and 17 intercostal arteries, with an overall success rate of 96%. Complications included a coil dislodgement from a collateral artery into the aorta in one patient, necessitating surgical removal of the dislodged coil from the femoral artery, an exacerbation of cyanosis and dyspnea on exercise in 5, and slight fever in 2. In one patient with tetralogy of Fallot, who had 5 collateral vessels, transcatheter embolization caused hypoxemia, bradycardia and hypotension and therefore intracardiac repair was performed immediately after embolization. Aortopulmonary collateral arteries in patients with congenital heart disease can be effectively treated by transcatheter embolization. Embolization should be performed just before intracardiac repair because an excessive decrease in arterial oxygen saturation after embolization may require an emergency operation.

We have organized the Seminar and Workshop for Medical Education (SWME) 10 times from 2000 through 2003. More than 1, 200 persons have participated, including teachers, physicians, students, and simulated patients. The themes of the SWME have included a problem-based learning tutorial system, medical interview skills, objective structured clinical examinations, medical ethics, advanced cardiac life support/basic life support, evidence-based medicine, coaching technology, medical English education, and crisis management education. Invited lecturers from throughout the country organized most of these workshops. Advantages of the SWME are two-fold:(1) improving the medical teaching skills of each participant and (2) scouting for good young lecturers. Workshop reports are published in our annual monographs and other materials. The present paper is a historical review of the SWME and also describes the nationwide scope of faculty development.

Previous studies have reported that poor posture can induce various musculoskeletal disorders. Recently, poor posture in children has become a problem. This study aimed to determine the characteristics of sagittal spinal alignment in standing and sitting positions in elementary school students and how spinal alignment changes from standing to sitting position. Moreover, it clarifies how poor posture (hyperkyphosis) in the standing position affects sitting posture. This study was conducted among 83 elementary school students. The Spinal-Mouse® System was used to measure the thoracic kyphosis angle (TKA), upper thoracic angle (UTA), lower thoracic angle (LTA), lumbar lordosis angle (LLA), and sacral anteversion angle (SAA) in the standing and sitting positions. Hyperkyphosis was defined as a thoracic kyphosis angle of >40°. Participants were assigned to two groups: hyperkyphosis and non-hyperkyphosis. Significant differences were noted in all spinal alignment characteristics in both the positions. When spinal alignment was changed from standing to sitting, ΔUTA and ΔLTA correlated with ΔLLA and ΔSAA, respectively. A strong negative correlation was noted between ΔLLA and ΔSAA. In the sitting position, TKA, UTA, and LLA were significantly higher in the hyperkyphosis group than in the non-hyperkyphosis group. ΔUTA was significantly higher in the hyperkyphosis group than in the non-hyperkyphosis group when spinal alignment was changed from standing to sitting. The characteristics of sagittal spinal alignment in the sitting position were significantly different from those in the standing position. The study findings suggest that poor posture (hyperkyphosis) in the standing position affects the sitting posture.

Poor posture (thoracic hyperkyphosis) in children is reportedly caused by changes in their living environment. A previous study (conducted 30 years ago) reported that the position of the center of pressure (COP) in a child with an upright posture was approximately 40% from the heel. The present study aimed to determine the position and characteristics of the COP while standing in children aged 6–12 years. This study enrolled 83 elementary school students. A Win-Pod (Medicapteurs) platform was used to measure the COP. The COP position was expressed as a percentage from the heel as a relative ratio with a foot length of 100%. Spinal Mouse® was used to measure thoracic kyphosis, lumbar lordosis, sacral anteversion, and trunk inclination angles in the standing position. The COP position was 30.3±8.9% from the heel. We found positive correlations between the COP position, height, and weight. Further, the COP position was significantly more anterior in 28 upper elementary grade children (35.1 ± 9.2%) than in 25 middle (29.5 ± 8.6%) and 30 lower grade children (26.5 ± 6.7%). Regarding sex differences, the COP position was significantly more anterior in 46 boys (32.3 ± 9.8%) than in 37 girls (27.9 ± 6.9%). There was a weak positive correlation between the COP position and trunk inclination angle (r=0.251, p<0.05). Thus, we found that the COP position in modern children aged 6–12 years while standing was 30.3 ± 8.9% from the heel, indicating a shift toward the heel (backward) compared to that reported in previous studies.

Recently, poor posture (hyperkyphosis) has become a problem among children. This study investigated the effectiveness of an intervention (a spine mat) by measuring spinal alignment before and after the intervention in elementary school students. The study included 83 elementary school students. For the intervention, each participant was placed in a supine position on a bed and a spine mat was inserted ensuring that it adhered to the thoracic spine. The primary outcome variables included the thoracic kyphosis angle (TKA), upper thoracic angle, lower thoracic angle, lumbar lordosis angle (LLA), and sacral anteversion angle (SAA) measured in the standing and sitting positions using Spinal Mouse® before and after the intervention. Based on this evaluation, we assigned the participants to two groups: hyperkyphosis (n=25) and non-hyperkyphosis (n=58). Significant differences were observed between the pre-test and post-test TKA in the hyperkyphosis group in the standing position (pre-test: 45.3±4.5° and post-test: 40.8±9.0°, P<0.05). In the non-hyperkyphosis group, significant differences were observed between the pre-test and post-test LLA and SAA in the standing position. However, no significant difference was observed between the pre-test and post-test spinal alignment in the sitting position in both groups. The results of this study indicated that using a spine mat in elementary school children resulted in decreased TKA in the standing position only in the hyperkyphosis group, which exhibited a TKA of 40° or more after the intervention.