We developed a periodic hypobaric hypoxic environment (PHHE) system. Characteristics of this system varied between decreased pressure at an altitude of 1,500 m for 180 seconds and increased pressure at an altitude of 0 m for 180 seconds. The present study aimed to determine the effects of PHHE on physiological responses during endurance exercise and recovery after exercise. This study included 12 healthy men, and they provided written informed consent. All subjects performed a cycling exercise for 30 minutes and recovered after exercise for 10 minutes. The exercise protocol was performed with 20% maximum oxygen uptake for 6 minutes (warm-up), 40 % for 18 minutes (main exercise), and 20 % for 6 minutes (cool down). We established two experimental conditions: exercise with the PHHE and the control (C). The C condition involved exercise using the PHHE at an altitude of 0 m, and the atmospheric pressure was not changed. In the PHHE condition, the atmospheric pressure was changed periodically from 967 to 817 hPa (the external pressure was 1,008 hPa). Subjects’ heart rate (HR), blood pressure (BP), arterial oxygen saturation (SpO₂), rating of perceived exertion, and respiratory responses were measured in both conditions. The SpO₂, HR and systolic BP during exercise were significantly lower in the PHHE condition than in the C condition. The HR post-exercise was significantly lower. After exercise, the ln HF, an index of cardiac parasympathetic nervous system modulation, was significantly higher. In conclusion, during endurance exercise, cardiocirculatory responses in the PHHE condition were decreased.

In the year 2000, the Japan Cardiovascular Surgery Database (JCVSD) was created with the support of the Society of Thoracic Surgeons (STS). STS database software was translated to Japanese with the same definitions and in 2001, the data entry of adult cardiac surgeries was initiated online using University Hospital Medical Information Network, UMIN. In 2008, entry of the data of congenital heart surgeries was initiated in the congenital section of JCVSD and preoperative expected mortality (JapanSCORE) in adult cardiovascular surgeries was first calculated using the risk model of JCVSD. In 2011, the Japan Surgical Board system merged with JCVSD and all cardiovascular surgical data could be registered in JCVSD from 2012. The reports resulting from the analyses of data from JCVSD (Current Status of Cardiovascular Surgery in Japan, 2013 and 2014 : A report based on the JCVSD) will encourage further improvements in the quality of cardiovascular surgeries, patient safety, and medical care for patients in Japan.

Objective and Methods : Data on isolated coronary artery bypass grafting (CABG) performed in 2013 and 2014, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Results : Isolated CABG was performed off-pump in 54.7% of cases, and graft material for the LAD was left internal thoracic artery in 74.3% and right internal thoracic artery in 15.6%. Operative mortality was 2.0% in elective cases, 8.2% in emergency cases, and 3.0% overall. In elective cases, operative mortality was 1.1% for off-pump CABG compared with 3.0% for on-pump CABG. Conclusions : Clinical results of our isolated CABG was reasonable and acceptable.

Objective : To demonstrate the mortality rate and the choice of surgical procedures, especially the selection of the valve prosthesis, in each position of the valve in each age of the patients and the effects of the preoperative complications to the mortality and prosthetic valve selection, the data from JCVSD in 2013 and 2014 are analyzed. Methods : The proportion of each surgical procedure is compared in each age of the patients in the aortic, the mitral and the tricuspid position. Results : The proportion of the mechanical valve prostheses was 23.1, 40.5 and 11.4% in the aortic, mitral and tricuspid position respectively and it was higher in hemodialysis patients than in non-hemodialysis patients. The operative mortality rate was 4.3, 11.7, 15.8 and 5.6% in all cases, the hemodialysis patients, the patients with liver dysfunction and the patients with atrial fibrillation and flutter, respectively in AVR, and 4.0, 14.4, 11.2 and 4.1%, respectively in each group listed above after mitral surgery. Conclusion : These results clarify the status of cardiac valvular surgery in Japan.

Background : Although open aortic repair (OAR) is still considered to be a standard treatment for thoracic aortic diseases, recently the indication of thoracic endovascular treatment (TEVAR) /hybrid aortic repair (HAR) is expanding. The purpose of this study is to review the current status of treatment of thoracic aortic diseases. Methods : The data concerning surgery for diseases in thoracic/thoracoabdominal aorta in 2013 and 2014 are extracted from the Japan Cardiovascular Surgery Database (JCVSD). The number of cases and operative mortality are evaluated for pathology (acute dissection, chronic dissection, ruptured aneurysm, un-ruptured aneurysm), treatment modality (OAR, HAR, TEVAR), JapanSCORE (＜5%, 5 to 10%, 10 to 15%, 15%≦) and their combination. Results : The total number of cases included in this study was 30,271 and the overall operative mortality was 5.9%. Among 3 types of treatment, 73.2% of patients underwent OAR (root, 98.3% ; ascending, 97.4% ; root to arch, 95.5% ; arch, 81.7% ; descending, 34.2% ; thoracoabdominal, 64.4%). Although the rate of OAR was in negative correlation with JapanSCORE (JS) in treatment for thoracoabdominal region (JS＜5%, 80.4% ; 5%≦JS＜10%, 67.6% ; 10%≦JS＜15%, 58.8% ; 15%≦JS, 55.7%), such relation was not observed in other regions. The operative mortality of OAR was well reflected by JS (JS＜5%, 2.1% ; 5%≦JS＜10%, 5.5% ; 10%≦JS＜15%, 10.2% ; 15%≦JS, 20.3%), however, those of TEVAR/HAR was less than the range of JS. Conclusions : The distribution of treatment differs depending on site of diseases and is not much influenced by JS. It has become clear that JapanSCORE is a reliable tool for estimating operative mortality in OAR. However, the observed operative mortality was lower than JS in TEVAR/HAR and a new risk score for TEVAR/HAR should be established.

The purpose of the present study was to indicate the relationship between health-related quality of life (HRQOL) measures, the daily rhythm of oral temperature (OT), and lifestyle. Five-hundred young men volunteered to participate in this study. Their OT, measured using a digital thermometer, was recorded every 2h from the time they woke up to the time they went to sleep for 1 week. The daily rhythm of OT was calculated as a quadratic function using the 1-week data. The HRQOL was measured using the Short-Form 36-Item Health Survey version 2 (SF-36v2). The participants were divided into 3 groups: a high-value group (HG) with ≥ 55 points of each summary score and each subscale score, a middle-value group (MG) with score > 45 and < 55 points, and a low-value group (LG) with score ≤ 45 points. Lifestyle was assessed in terms of eating habits, sleeping and exercise, and the presence of unidentified complaints. At the mental component summary, the OT at the time of waking up and the peak OT in the HG were significantly higher than those in the LG. At the physical and mental component summary, lifestyle in the HG was more favorable. These data suggest that the daily rhythms of OT may reflect the mental health status of an individual. The entraining factors in circadian variation might play a role in improving mental health and reducing unidentified complaints. In conclusion, there appears to be an association between mental health status, lifestyle, and daily rhythms of OT.

Objectives : We analyzed the mortality and morbidity of congenital heart surgery in Japan by using the Japan Cardiovascular Surgery Database (JCVSD). Methods : Data regarding congenital heart surgery performed between January 2013 and December 2014 were obtained from JCVSD. The 20 most frequent procedures were selected and the mortality rates and major morbidities were analyzed. Results : The mortality rates of atrial septal defect (ASD) repair and ventricular septal defect (VSD) repair were less than 1%, and the mortality rates of tetralogy of Fallot (TOF) repair, complete atrioventricular septal defect (AVSD) repair, bidirectional Glenn, and total cavopulmonary connection (TCPC) were less than 2%. The mortality rates of the Norwood procedure and total anomalous pulmonary venous connection (TAPVC) repair were more than 10%. The rates of unplanned reoperation, pacemaker implantation, chylothorax, deep sternal infection, phrenic nerve injury, and neurological deficit were shown for each procedure. Conclusion : Using JCVSD, the national data for congenital heart surgery, including postoperative complications, were analyzed. Further improvements of the database and feedback for clinical practice are required.

In Japan, few surveys have evaluated the structure and clinical process of cardiovascular surgery programs. We mailed a questionnaire to all 149 facilities participating in the Japan Adult Cardiovascular Database as of April 1st 2007. We received responses from 129 facilities (response rate 86.6%). For CABG surgery, many facilities regard “IMA use (95.3%) ” and “off-pump surgery” is the first choice as a facility and recommend “discharge antiplatelets (89.9%) ” and “discharge antilipid (47.3%) ”. On the other hand most facilities did not made any recommendation regarding “preoperative beta blockers (72.9%) ” and “discharge beta blockers (60.5%) ”. The usage rates of preoperative beta blockers and discharge beta blockers were very low in Japan though their usage rates were relatively high in the United States.

Recently, a long-term health concern has been identified in young Japanese women. These women have a high percentage of body fat despite a normal shape index indicator such as BMI. This condition is called marked obesity, and shows relative low lean body mass. Using an analogous determination, we investigated low percentage of muscle quantity (LM) in the extremities of young Japanese women (n=156) . The cross-sectional areas of muscle, subcutaneous fat, and bone were measured in the upper arm and thigh using ultrasonography. Extremity shape index (CSA_t/L) was defined as the total extremity cross-sectional area (CSA_t) divided by the length of the limb (L), Percent muscle in each extremity (% MA) was calculated from the ratio of muscle CSA to whole limb CSA. LM was defined as the percentage of muscle in the upper arm or thigh less than 1 SD below average and the limb shape index less than 1 SD above average. Nine of 91 subjects displayed LM for the upper arm. A similar proportion of subjects showed LM for the thigh (15/156) . The muscle mass and strength in the upper arm or thigh were compared between the subjects with LM and non-LM subjects with a similar shape index of extremity. There was a tendency towards lower muscle mass and muscle strength in the subjects with LM. From the same comparison, the subjects with LM showed a greater load on extremity muscles to sustain the body weight (i.e., body weight per unit of upper arm or thigh muscle CSA) . To mitigate the deleterious health consequences of low percent muscle quantity it is recommended that young Japanese women who display such a condition should participate in a resistance-training program.

The JCVSD (Japan Cardiovascular Surgery Database) was organized in 2000 to improve the quality of cardiovascular surgery in Japan. Web-based data harvesting on adult cardiac surgery was started (Japan Adult Cardiovascular Surgery Database, JACVSD) in 2001, and on congenital heart surgery (Japan Congenital Cardiovascular Surgery Database, JCCVSD) in 2008. Both databases grew to become national databases by the end of 2013. This was influenced by the success of the Society for Thoracic Surgeons' National Database, which contains comparable input items. In 2011, the Japanese Board of Cardiovascular Surgery announced that the JACVSD and JCCVSD data are to be used for board certification, which improved the quality of the first paperless and web-based board certification review undertaken in 2013. These changes led to a further step. In 2011, the National Clinical Database (NCD) was organized to investigate the feasibility of clinical databases in other medical fields, especially surgery. In the NCD, the board certification system of the Japan Surgical Society, the basic association of surgery was set as the first level in the hierarchy of specialties, and nine associations and six board certification systems were set at the second level as subspecialties. The NCD grew rapidly, and now covers 95% of total surgical procedures. The participating associations will release or have released risk models, and studies that use 'big data' from these databases have been published. The national databases have contributed to evidence-based medicine, to the accountability of medical professionals, and to quality assessment and quality improvement of surgery in Japan.
Adult ; Asian Continental Ancestry Group ; Certification ; Evidence-Based Medicine ; Humans ; Japan* ; Patient Safety ; Quality Improvement* ; Social Responsibility ; Thoracic Surgery