Eight young girls as an experimental group (E group) and another eight as a control group (C group), (all aged 4-5 years), participated in the present study to observe the effects of training from May 1992 through November 1993. E group performed a 915m endurance run on an agricultural road every day except Sundays for an 18 month training period. No special training was given to C group. In May 1992 (T 1), November 1992 (T 2), May 1993 (T 3), and November 1993 (T 4), both groups underwent treadmill tests in order to check aerobic variables such as heart rate (HR) and oxygen uptake (VO₂) during the course of the training period.
Times required for the run became shorter from summer to fall and from winter to spring (shortening phase), whereas they became prolonged from spring to summer and from fall to winter (prolongation phase) . Therefore, there was a definite seasonality of performance endurance. The rates of shortening in the required times observed from summer to fall were considerably higher than from winter to spring, and this was reflected in the significant improvement of maximal running speed on the treadmill (Vmax) and maximal oxygen uptake in terms of body weight (VO₂max⋅ TBW^-1) from T 1 to T 2 as well as from T 3 to T 4. Thus, significant differences were found between the groups at T 2 and T 4. HR levels during the endurance run were close to 95% HRmax regardless of the phase. Accordingly, the prolongation phases, during which circulatory parameters and ventilatory capacity were least improved, could be regarded as a preparatory period for the following shortening period, during which work load intensities furthermore increased the arteriovenous oxygen differences. Thus, when planning research on the effects of training on aerobic work capacity in the field, special attention should be paid to the season and the training period, and the timing of the examination for training effects, or otherwise, misleading conclusions could be drawn.

Background: Globalization urges us to discuss rationale and policy towards establishing a medical education accrediting body in Japan. Experience of General Medical Council （GMC） suggests us some useful lessons.
Method: Based on our visits and investigation into in GMC, we inquire how Quality Assurance （QA） was introduced in UK with what incentives and how QA has brought reforms in the medical schools in UK.
Result: Since 2003, GMC has changed its policy for QA from ‘inspection’ to ‘dialogue’. Dialogical QA asks a medical school to think critically of their education and consider vigorous actions for further improvements.
Discussion: Implications from the experience of GMC are: 1.QA process in GMC makes medical schools take robust steps towards changes, 2. Sharing the rational and policy for QA created the solid base for its effective implementation, 3. There are possible difficulties in establishing structure to do an enormous amount of coordinating work, which is necessary for constructing ‘dialogue with medical schools’.

During the perioperative period after total hip arthroplasty (THA), much attention has been recently paid to deep venous thrombosis, yet there are few reports concerning stroke after THA and there is no such data at all in Japan at present. The purpose of this retrospective study was to elucidate the occurrence rate and the characteristics of stroke cases during the THA perioperative period. A total of 1,551 primary THAs performed between January 1999 and December 2008 were investigated. Cerebral infarction occurred in three patients (0.19%) during three weeks after THA. Concerning the related factors, one male had foramen ovale, one female had untreated diabetes and atrial fibrillation, and one female had severe stenosis of the internal carotid artery. Cerebral infarction occurred at Day 1 in one male, at Day 2 in one female, and at Day 5 in the other female, and they underwent anticoagulant therapy just after their diagnosis. In all three patients, motor paralysis fully improved and they came back to the THA rehabilitation program within Day 9. One male was discharged at 4 weeks, and another two females were discharged at 8 weeks. Because many people eating a more European diet are now getting older in Japan, prophylaxis for not only DVT but also stroke after THA should be emphasized.

A 84-year-old man was admitted with an abdominal tumor. Prosthetic graft replacement between the aorta and the left external iliac artery was performed 17 years previously. CT scan and angiography showed a large anastomotic pseudoaneurysms at the sites of proximal and distal anastomosis. A Y graft prosthesis replacement was performed. The size of the proximal anastomotic pseudoaneurysm was 7×6×5cm, and that of the distal anastomotic pseudoaneurysm was 15×10×10cm. They resulted from cutting at anastomosis. Large anastomotic pseudoaneurysms at both sites is rare.

A descending thoracoaortic aneurysm excluded by stent-grafting had expanded during a period of one and a half years. There was no endoleakage but there was shortening of the stent-landing on both proximal and distal sides. Aneurysm seemed to be pressed by blood pressure through the graft in TEE. The aneurysm was replaced by an artificial graft through a left heart bypass. Because ESP diminished during the operation, VIth intercostal arteries were reconstructed immediately, and CSF drainage was performed. Following this procedure there was no paraplegia.

The Ibaraki Prefectural University of Health Sciences has introduced an integrated education management system to improve the quality of education. The management system was implemented by the Academic Affairs Committee and is run by the newly-created Kyouiku Suishin Shitsu (Educational Development Services). The management system evaluated past curricula and coordinated the introduction of new courses and integrated curricula designed to stimulate selflearning by students. The management system also integrated the student evaluation system and simultaneously coordinated faculty development workshops for all university staff to improve teaching skills. Several questionnaires showed that the new curricula met students' learning needs and provided a more objective evaluation system. The integrated education management system functions as a positive component in the improvement of the education system for students of allied health professions.

Introduction
Recently, an increasing number of registered foreigners get married and bear children in Japan. At the same time, a variety of needs for maternal and child health (MCH) impose burden for medical practitioners. A questionnaire survey was conducted to clarify the situation of MCH service for foreign residents.
Method
Self-report questionnaires developed by “The study group for MCH in a multiethnic and multicultural society” were sent by mail to the pediatricians registered in the Gunma medical association or Gunma pediatric association. In total, target number was 299. The survey period was between 2003/10/6-11/3.
Result
The number of valid response was 167. Out of 167, 155 doctors replied to have experience of caring foreigners. 75% of them had the experience of trouble in communication. For the question of the need of translator, 76.8% of doctors answered “absolutely necessary” or “necessary if the quality of translation is high enough”. Desired competencies for translators were “Accurate translation of diagnosis, hands on of treatment strategy” or “To help taking detailed patient's history”.
For the experience of using MCH handbook in foreign languages, 52.9% of doctors answered “Never used it”.
Discussion
We found that the majority of doctors had difficulty in communicating with foreigners.
To meet the doctors' requirement for the competency of translator, two strategies should be considered. One is to develop professional medical translator through education of basic medical knowledge or Japan's health care system. The other is to train foreigners already engaging in translation.
For communication tools development, user friendly concept should be reflected including 1) adscript of foreign and Japanese languages, 2) illustration usage and 3) eye-friendly materials for elderly. Contents should have explanations including 1) diagnosis and treatment policy for common disease, 2) ways of coping with common symptoms, and 3) the information of a variety of Japan's welfare services.

A 73-year-old woman was admitted to undergo three simultaneous operations: aortic valve replacement (AVR), coronary artery bypass grafting (CABG) and abdominal aortic aneurysm repair. She had previously undergone percutaneous catheter intervention in the left coronary anterior descending artery. Computed tomography revealed an abdominal aortic aneurysm 5cm in diameter. Aortic valve stenosis (AS) was shown with a pressure gradient of 60mmHg, and 90% stenosis of the distal right coronary artery was also shown. CT scan and aortography revealed porcelain ascending aorta. The patient underwent simultaneous operations because of severe AS, coronary artery disease and abdominal aortic aneurysm. An aortic cannula was placed in a position higher in the ascending aorta with no calcification. Cardiopulmonary bypass was started using a two-staged venous cannula through the right atrium. At first, AVR was performed with cardioplegic solution and ice slush. Because it was difficult to inject the cardioplegic solution into the coronary artery selectively due to the calcified orifice of coronary artery, we closed it immediately by removing the calcified intima of the porcelain aorta after completion of AVR. The second cardioplegic solution was injected through the ascending aorta. Next, CABG to RCA was performed using the right gastroepiploic artery without anastomosis to the ascending aorta. Cardiac surgery was first performed, followed by abdominal aortic aneurysm repair after discontinuation of cardiopulmonary bypass. The patient was extubated the next day and stayed for two days in the intensive care unit. She is very well now one year after the operation.

Background/Aims: The objective of this research is to examine factors related to irritable bowel syndrome (IBS) prevalence in a large population-based study. Methods: A cross-sectional study was conducted with participants in the Miyagi part of the Tohoku Medical Megabank Project CommunityBased cohort study who completed the Rome II Modular Questionnaire. Multivariate odds ratios (ORs) for the presence of IBS and 95% confidence intervals (95% CIs) for the reference group were calculated for each factor. Additionally, a stratified analysis was performed by sex and age group (20-49 years, 50-64 years, and ≥ 65 years). Results: Among 16 252 participants, 3025 (18.6%) had IBS, comprising 750 men (15.5%) and 2275 women (19.9%). Multivariate ORs for the presence of IBS decreased significantly with each year of age (OR, 0.98; 95% CI, 0.98-0.99). Moreover, compared with the reference group, ORs for the presence of IBS were significantly higher in individuals whose home was partially damaged by the Great East Japan Earthquake, those with < 16 years of education, those who spent less time walking, those with high perceived stress (1.77, 1.57-2.01), those with high psychological distress (1.58, 1.36-1.82), and those with high symptoms of depression (1.76, 1.60-1.94). In stratified analyses, a significant relationship was found between psychological factors and IBS prevalence in all sex and age groups. Conclusions This large cross-sectional population-based cohort study identified several factors associated with IBS prevalence. Psychological factors were significantly associated with IBS prevalence across all age groups and sexes.

BACKGROUND: It has been pointed out that prolonged television (TV) viewing is one of the sedentary behaviors that is harmful to health; however, the association between socioeconomic status (SES) and prolonged TV viewing time has not been sufficiently investigated in Japan. METHODS: The study population are the participants of NIPPON DATA2010, which is a prospective cohort study of the National Health and Nutrition Survey 2010 in Japan. They were residents in 300 randomly selected areas across Japan. This study included 2752 adults. SES was classified according to the employment status, educational attainment, living status, and equivalent household expenditure (EHE). Prolonged TV viewing time was defined as more than or equal to 4 h of TV viewing per day. Multivariable logistic regression analyses were conducted to examine the association of SES with prolonged TV viewing time. RESULTS: The mean TV viewing time was 2.92 h in all participants. Of 2752 participants, 809 (29.4%) prolonged TV viewing, and the mean TV viewing time of them was 5.61 h. The mean TV viewing time in participants without prolonged TV viewing time was 1.81 h. The mean TV viewing time was prolonged as age classes increased and significantly longer in aged ≥60 years. Prolonged TV viewing time was associated with not working for all age classes and sexes. Only among women, education attainment and living status were also associated with prolonged TV viewing time. For education attainment, the lower the received years of education, the higher odds ratios (OR) of prolonged TV viewing time. For living status, in women aged <60 years, living with others had a significantly higher OR compared to living with spouse. On the other hand, in women aged ≥60 years, living alone had a significantly higher OR. EHE did not have any significant associations with prolonged TV viewing time. CONCLUSIONS In a general Japanese population, it should be noted that the association between SES and prolonged TV viewing time differed by age and sex. Particularly, it must draw attention to the prolonged TV viewing in elderly. The intervention in order to shorten TV viewing time needs to consider these attributes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Educational Status ; Female ; Humans ; Infant ; Japan ; Male ; Middle Aged ; Prospective Studies ; Sedentary Behavior ; Sex Factors ; Social Class ; Socioeconomic Factors ; Television/statistics & numerical data* ; Young Adult