Optimal strategies for learning professionalism have not been established to date. For the purpose of resolving this problem, the author developed a novel workshop activity in which scenarios describing unprofessional behavior were represented. In the scenarios, participants performed role play followed by small group discussions. Key words chosen during discussion were pooled and reconstructed into an association chart using KJ method.　From 2014 through 2017, a total of forty-four junior residents participated in the activity. To estimate the effectiveness of the workshop, participants completed a post-activity questionnaires composed of a ten-point rating scale (higher value denotes a positive evaluation) and free commentary.　Most residents indicated interest in this workshop (mean rating, 8.5±1.25, median, 9). Similarly, a considerable number of residents reported that the activity allowed them an opportunity to reflect on their behavior (mean, 8.05±1.43;, median 8). Qualitative analyses of free commentary was performed using Steps for Coding and Theorization (SCAT). Consequently, 6 themes were extracted: interest in learning professionalism, exchange of diverse values, importance of reflection, recognition of objectives, difficulty in understanding professionalism, and proposals for the workshop. On association charts, key words were sorted into four to six categories; these were further arranged in such a way as to converge toward the concepts of patient-centered care.　We consider that our scenario-based workshop may be an effective strategy to facilitate learning professionalism for residents.

Optimal strategies for learning professionalism have not been established to date. For the purpose of resolving this problem, the author developed a novel workshop activity in which scenarios describing unprofessional behavior were represented. In the scenarios, participants performed role play followed by small group discussions. Key words chosen during discussion were pooled and reconstructed into an association chart using KJ method.　From 2014 through 2017, a total of forty-four junior residents participated in the activity. To estimate the effectiveness of the workshop, participants completed a post-activity questionnaires composed of a ten-point rating scale (higher value denotes a positive evaluation) and free commentary.　Most residents indicated interest in this workshop (mean rating, 8.5±1.25, median, 9). Similarly, a considerable number of residents reported that the activity allowed them an opportunity to reflect on their behavior (mean, 8.05±1.43;, median 8). Qualitative analyses of free commentary was performed using Steps for Coding and Theorization (SCAT). Consequently, 6 themes were extracted: interest in learning professionalism, exchange of diverse values, importance of reflection, recognition of objectives, difficulty in understanding professionalism, and proposals for the workshop. On association charts, key words were sorted into four to six categories; these were further arranged in such a way as to converge toward the concepts of patient-centered care.　We consider that our scenario-based workshop may be an effective strategy to facilitate learning professionalism for residents.

Hybrid revascularization by MIDCAB and stent was performed in a 70-year-old man for reperfusion in the treatment of graft stenosis after CABG. The right SVG, which supplied coronary blood flow, was immediately under the median incision site, and was approached safely by the present method. After intervention, bleeding in the left thoracic cavity occurred, but this was treated conservatively. During intervention after cardiac surgery, transient heparinization of blood was performed for prevention of coagulation. Since strong anticoagulative treatment was continued thereafter, the patient was easily bled. Therefore, it appeared preferable to take time after cardiac operation or insert an indwelling drainage tube into the pleural cavity to monitor hemorrhage. The present method appears useful for patients undergoing re-operation or of high risk.

Introduction: Long-term cardiac hypertrophy causes heart failure. One of the mechanisms of this transition from hypertrophy to heart failure is collapse of hypoxic response and angiogenesis. Heat shock protein 27 (HSP27) was found to act as an anti-apoptotic protein and its phosphorylation is responsible for the protection of cells against heat stress. HSP27 has been reported to regulate p53 expression, which contributes to down-regulate angiogenic factors through hypoxia inducible factor-1α(HIF-1α). We have reported that thermal therapy, namely Waon therapy, improves cardiac and vascular function in patients with chronic heart failure. However, the effect of this therapy on cardiac hypertrophy due to pressure overload is unknown. The purpose of this study is to investigate the effects and mechanisms of thermal therapy (Waon therapy) on the transition from cardiac hypertrophy to heart failure after pressure overload. Methods: Cardiac hypertrophy was induced by transverse aortic constriction (TAC) in C57BL/6 mice. At 2 weeks after TAC, all mice were examined by echocardiography and showed left ventricular hypertrophy. Then, mice were randomly divided into thermal therapy or untreated group. Thermal therapy group received thermal therapy using an experimental far infrared ray dry sauna, which elevates the core temperature by 1 degree Celsius for 30 minutes, daily for 4 weeks. Sham operated mice were used as control. At 6 weeks after TAC, we measured body weight, heart rate and blood pressure before sacrifice, and eviscerated heart and leg muscle. Western blot analysis of p53, phosphorylated HSP27, HIF-1α and vascular endothelial growth factor (VEGF) was performed using extracted protein form heart. Results: At 6 weeks after TAC, body weight, heart rate and blood pressure did not differ in three groups. Echocardiography showed that left ventricular fractional shortening of thermal therapy group was significantly larger than that of untreated group (Sham vs. Untreated vs. Thermal; 50.0±1.7 vs. 36.7±1.3 vs. 46.2±0.5, P<0.01, n=6 each). Heart weight/tibia length ratio of thermal therapy group was significantly smaller than that of untreated group (6.7±0.1 vs. 9.7±0.5 vs. 7.9±0.2, P<0.01, n=9 each). Western blot showed that thermal therapy increased phosphorylation of HSP27 and reduced p53. Thermal therapy also increased HIF-1α and VEGF at 6 weeks after TAC. Capillary/myofiber ratio was larger in thermal therapy group than that in untreated group (1.71±0.05 vs. 2.04±0.04 vs. 2.41±0.10, P<0.01, n=4 each). Conclusion: Thermal therapy, namely Waon therapy, prevented the transition from cardiac hypertrophy to heart failure induced by pressure overload in mice. As the mechanism, thermal therapy amplified the phosphorylation of HSP27 and inhibited p53, increased HIF-1α and VEGF, and then increased angiogenesis.

INTRODUCTION: The pathophysiology and mechanism of in-stent restenosis (ISR) after implantation of second-generation drug-eluting stents (DESs) are not fully clear. We compared the morphological characteristics of ISR between first- and second-generation DESs using frequency domain optical coherence tomography (OCT). METHODS: Patients who underwent follow-up coronary angiography (CAG) after first-generation (CYPHER™ and TAXUS™) and second-generation (Nobori®, PROMUS Element™, Resolute Integrity and XIENCE) DES implantations were examined. ISR was defined as lesions of over 50% diameter stenosis at follow-up CAG. Frequency domain OCT was performed at the time of revascularisation of ISR. Tissue morphology was assessed at minimum lumen area. OCT images of DESs at both early (≤ 1 year) and late (> 1 year) phase follow-up were compared. RESULTS: On qualitative OCT assessment, the ratios of homogeneous, layered, heterogeneous without-attenuation and heterogeneous with-attenuation morphologies were 57.1%, 17.1%, 20.0% and 5.7%, respectively, for second-generation DES ISR (n = 35), and 16.7%, 25.0%, 25.0% and 33.3%, respectively, for first-generation DES ISR (n = 36). At late phase follow-up, homogeneous morphology was significantly more common for second-generation DES ISR compared to first-generation DES ISR (first-generation: 8.0% vs. second-generation: 50.0%; p < 0.01) while heterogeneous with-attenuation morphology was significantly more common for first-generation DES ISR (first-generation: 44.0% vs. second-generation: 5.6%; p < 0.01). CONCLUSION Homogeneous tissue morphology was more frequently found for second-generation than first-generation DES ISR, especially in the late phase. This suggested that neointimal hyperplasia was the main mechanism in second-generation DES ISR, and that the neointima was stabilised, much like in bare metal stent implantation.
Aged ; Constriction, Pathologic ; pathology ; Coronary Angiography ; Coronary Restenosis ; diagnostic imaging ; pathology ; Coronary Vessels ; diagnostic imaging ; pathology ; surgery ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Incidence ; Male ; Metals ; Middle Aged ; Neointima ; Retrospective Studies ; Tomography, Optical Coherence

The objective of this study was to investigate the knowledge physicians expect pharmacists to have when discussing the safety of medicines. Survey questionnaires were distributed to 81 physicians working at 2 general hospitals in the Jōetsu region of Niigata Prefecture, Japan. The survey instrument included 22 knowledge items, and for each item physicians were asked to select either “Necessary knowledge” or “Knowledge that should be understood” for pharmacists. We obtained 71 valid responses (response rate: 87.7%). Results showed that “Package inserts” were selected by most physicians: 95.8% for specialist-related inserts and 85.9% for non-specialist inserts, followed in order by “Guidelines in Japan”, “Interview forms”, “Blue letter and yellow letter”, and “Recent topics in academic meetings in Japan”. Knowledge of specialty-related fields was significantly more likely to be expected of pharmacists than non-specialty fields: 48.0% and 36.5%, respectively (p < 0.001). Overall, physicians in this study suggested that when pharmacists share information with physicians, their communications may be enhanced by referring to Japanese guidelines and relevant topics that have previously been discussed at academic meetings.

Objective: Few cases of Takotsubo cardiomyopathy with apical hypertrophic cardiomyopathy (APH)-like morphological changes during the recovery process have been reported.Patient: A 56-year-old woman diagnosed with Takotsubo cardiomyopathy showed a morphology similar to that of APH during recovery. We examined this patient using 2D speckle-tracking echocardiography based on the method used for hypertrophic cardiomyopathy, which suggested that the circumferential strain (CS) of the middle wall indicated myocardial function of the left ventricle, and the CS of the inner wall was associated with left ventricular chamber function.Results: We measured the CS of the endocardial, middle, and epicardial layers and found that the apical inner layer CS (CSinner), middle layer CS, and outer layer CS were all decreased at the onset. CSinner showed a strong tendency to recover on echocardiography performed when APH-like morphology was observed.Conclusion: The morphology of the apex in our case likely contributed to the maintenance of chamber function.