Nutritional support for patients who develop cancer is necessary to increase their food intake, which is often insufficient due to the adverse effects of anticancer drugs and radiation treatment. In December 2011, our center introduced Bocchiri meals for cancer patients to improve their quality of life and support ongoing treatment. In this study, we examined the efficacy of Bocchiri meals, which were developed to help increase the amount of food intake during cancer treatment. Target patients were those who could eat half or less than half of their daily required food intake, averaged over 3 days.Patients could order the meal 2 h before serving time and it was served at the temperature and amount that individual patients requested.We evaluated age, sex, main disease, use of anticancer drugs, radiation treatment, time taken to eat the Bocchiri meals, number of orders made, average energy intake before and after eating the Bocchiri meals, and rate of eating a Bocchiri Meal with a side menu order. Average energy intake was increased from 226.6±14.8 kcal with regular meals to 294.1±15.3 kcal with Bocchiri meals. Furthermore, a strong correlation was seen after the Bocchiri meals were introduced between the rate of eating Bocchiri meals with a side menu order and average energy intake. These results suggest that Bocchiri meals may be an effective supportive nutritional measure to enhance food intake among cancer patients.

The effect of moxibustion on duodenal motility was examined. Duodenal motility was measured by the balloon method in anesthetized, artificially ventilated rats. The stimulation temperature and duration of moxibustion varied. Treatments were applied to the hind paw and abdomen.
The duodenal motility exhibited an excited response by pinch stimulation of hind paw, and inhibitory response by abdominal pinch stimulation. Duodenal motility did not show any response to indirect moxibustion stimulation of the hind paw and abdomen. Duodenal motility exhibited an excited response by direct application of moxibustion to the hind paw and an inhibitory response by direct application of moxibustion to the abdomen.

A 64-year-old man under dialysis was referred for surgical treatment of Crawford type I thoracoabdominal aortic aneurysm. He had a history of idiopathic portal hypertension and chronic total occulusion of supra-renal abdominal aorta and appeared to have massive development of collateral arteries and veins in the abdomen. We chose endovascular repair with debranching of visceral arteries and bypass grafting to bilateral superficial femoral artery considering bleeding from collateral arteries and veins by conventional open surgery. Postoperative CT scan revealed no endoleak and all debranched and bypass grafts were patent. He was discharged with no postoperative complications including paraplegia.

This study aimed to examine the association between body mass index (BMI) and muscle strength, and mobility limitation (ML). A cross-sectional analysis was conducted on data from 570 community-dwelling older Japanese women aged 65-91 years [mean age, 73.9 ± 5.8 (SD) years]. Muscle strength was assessed by hand-grip strength (HGS). ML was assessed using self-reported difficulty level in walking 400 m and ascending 10 steps without resting. BMI and muscle strength were divided into tertiles (high: BMI ≧ 25.1 kg/m², HGS ≧ 22.5 kg; middle: BMI 22.4-25.0 kg/m², HGS 18.8-22.4 kg; low: BMI ≦ 22.3 kg/m², HGS ≦ 18.7 kg) respectively, and logistic regression analysis was used to determine the association between BMI and muscle strength with ML. 256 participants (44.9%) were identified as having ML. Adjusted odds ratios of BMI for ML were 1.64 (95% confidence interval (CI): 1.00-2.68) in the middle group and 1.89 (95% CI: 1.15-3.12) in the high group when compared to the low group. Adjusted odds ratios of muscle strength for ML were 1.25 (95% CI: 0.77-2.04) in the middle group and 1.85 (95% CI: 1.11-3.09) in the low group when compared to the high group. Compared to the low BMI plus high muscle strength group, adjusted odds ratio for ML was significantly higher in the high BMI plus low muscle strength group (2.65, 95% CI: 1.02-6.87) and the high BMI plus middle muscle strength group (3.09, 95% CI: 1.25-7.61). Our findings indicate that the combination of overweight plus muscle weakness is more predictive for having ML than overweight or muscle weakness alone.

Although the physical activity reference value for older adults (10 METs*hour/week) has been promoted by Japan Ministry of Health, Welfare, and Labour since 2013, little is known about how many steps/day cut-off values that optimally identify meeting the reference value according to the differences of age, sex, medical history, and joint pain. The purpose of this study were 1) to determine the steps/day that optimally identify meeting the reference value, and 2) to identify the differences by the effects of age, sex, medical history, and joint pain on cut-off values. This study included 583 community-dwelling older Japanese adults (aged 73.2 ± 5.4 years; 153 men, 430 women). A uniaxial accelerometer survey was conducted to estimate the total physical activity volume and steps/day. Receiver operating characteristic (ROC) analyses were used to detect steps/day cut-off values for meeting the reference value among all participants and stratified by age, sex, medical history, and joint pain. The optimal cut-off value (AUC (area under the ROC curve), sensitivity, and specificity) for the reference value was 4376 steps/day (0.99, 95.2%, and 97.2%) in all participants. Differences among the cut-off values according to age, sex, medical history, and joint pain ranged from 39 to 169 steps/day. These results suggest that step counts has satisfactory validity to represent the reference value in older adults, and the effects of age, sex, medical history, and joint pain on cut-off values were considerably small. Therefore, this step-count level may be a useful indicator for modifying the daily-life activities of older adults.

Introduction :
 This article aims to explain the new Membership of Royal College of General Practitioners (nMRCGP), new postgraduate general practice training in the UK. It will also compare this with that of the Japan Primary Care Association to identify areas requiring further development in postgraduate family medicine training in Japan.
Methods :
 The introduction of the nMRCGP based on the available literature, followed by discussion amongst family physicians and trainees in Japan.
Results :
 Following a comparison between the postgraduate general practice training in the UK and Japan, the following three points were raised : 1) The need for a clear definition of the role that family physicians play in Japan. 2) The importance of formative assessment as part of the membership examination in the form of portfolios. 3) The need for clear competency areas to form the framework for formative assessment, and for the clear standard that trainees are judged against in each of those competency areas.
Conclusion :
 The above results were highlighted and discussed as possible areas for further development in postgraduate family medicine training in Japan.

We report the rare case of a 68-year-old man, who was admitted to our hospital with a diagnosis of aortic arch anastomotic pseudoaneurysm, with concomintant aortic root enlargement and coronary artery stenosis. Eleven years previously, at age 56, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed redo total arch replacement, aortic root replacement and coronary artery bypass, making use of a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery and femoral vein before resternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation ; however, he was discharged in good condition on the 50th post-operative day. The case suggests that island reconstruction has the potential to cause an aortic arch pseudoaneurysm, particularly after a long postoperative period of time. Therefore, thorough postoperative care strategy is required. We also need to consider surgical reconstructive techniques which eliminate vascular lesions as much as possible at the time of the primary surgery, particularly in cases of chronic aortic dissection.

A 69-year-old woman was given a diagnosis of moderate aortic stenosis (AS) associated with congenital bicuspid valve in 2011. In 2014, surgery was indicated because of progression of AS and dilatation of the sinus of Valsalva and ascending aorta. Preoperative contrast-enhanced CT and echocardiography showed the saccular space (2×2 cm) located at the left ventricular outflow tract just below the aortic annulus. At surgery, the saccular aneurysm was located just below the aortic annulus of the noncoronary cusp. We resected the aneurysm and closed the orifice with interrupted sutures from the inside of the LV and the outside. Aortic subannular left ventricular aneurysm is a very rare malformation with only 25 reported cases and its natural course is largely unknown. Rupture of aneurysms, infection, thrombus formation, arrhythmia, and heart failure etc. has been reported as complications. We reported a case of aortic subannular left ventricular aneurysm with bicuspid aortic valve stenosis with a literature review.