We conducted a nationwide survey in 2000 regarding undergraduate medical education in Evidence-based Medicine (EBM) in Japan. We asked faculty members responsible for medical education at each medical school 1) whether there are any barriers to teaching EBM, 2) what these barriers are, and 3) what educational resources are needed to overcome them. Responses were received from 64 schools (80%). More than half of the respondents reported barriers to teaching EBM. We identified two kinds of barriers: before EBM is introduced, skepticism toward the concept of EBM and the value of teaching EBM is encountered; later, problems of organizing a curriculum and shortages of staff and materials are encountered. To overcome these barriers, we need: 1) to establish organizations for coordinating educational programs among medical schools, 2) to hold seminars for faculty development, 3) to develop EBM curricula and teaching materials, and 4) to provide computer facilities and appropriate networks.

It is believed that one of the principal effects of negative air ion is refreshing human psychological condition. Negative air ion can be observed in natural environments such as forest, fountain, and hot spring. In order to elucidate scientific reason of psychological effects by negative air ions, quantifying psychological effects will be important.
Healthy sixteen examinees (8 young candidates around 20 years, 8 old candidates around 60 years) are tested by SRS-18, blood pressure, questionnaire, and electroencephalogram. SRS-18, blood pressure, questionnaire was performed before and after experiment. Electroencephalogram was continuously measured during whole experiment and used for emotional spectrum analysis method (ESAM) calculation. Experiment was divided into three conditions (initial normal condition, negative air ion boosted condition at middle concentration, after ventilated condition) and three phases (accommodation, rest, calculation) at each condition.
At young group, excessive negative air ions increased human psychological concentration which is calculated by ESAM. At calculation phase, psychological concentration has a positive correlation with psychological stress (correlation factor 0.505). Otherwise at old aged group, no significant change was observed. It shows that sensitivity of negative air ions at old persons will be reduced. It also suggests that human sensitivity for negative air ion decreases with aging.
At rest phase of young group in negative air ion boosted condition, elementary emotions are balanced at ESAM. This shows that balancing among four elementary emotions is related with psychological effects of negative air ions.

We performed endovascular stent-graft placement on 39 patients with abdominal aortic aneurysms between 1996 and March 2002-a period of approximately 5 years (first half: until the end of June 1998, second half: July 1998 onward). Three patients in the first half of the period and 8 patients in the second half were 80 years or older. Two cases of mycotic aneurysm were observed. During the second half, we encountered high-risk cases in which the patients had complications such as coronary artery disease (5 patients), COPD (1 patient) and thoracic aortic aneurysm (4 patients). Although we had to switch to surgery in 3 patients during the first half of the period, we successfully placed stent-grafts in the other 36 cases (92%). Endoleaks were observed in 6 patients, and dissection of the iliac artery was observed in 5 patients (stents had been placed in all patients). In 50% of all cases in the first half of the period and 89% of all cases in the second half, stent-graft placement was successful and no endoleak was observed. During the follow-up period, 3 cases required additional treatment, and another 4 cases required surgery. Four patients died in hospital during the first half of the period, and 3 patients died during the following 3 years. The 3-year survival rate was 82%. It was considered that stent-graft placement for abdominal aortic aneurysms is particularly effective for high-risk patients, and that the results of this type of therapy will improve in the future.

BACKGROUND: Use of complementary and alternative medicine (CAM) has become popular in Japan.
OBJECTIVE: To investigate associations of symptom-related CAM use with sociodemographic factors in Japan.
DESIGN AND SETTING: A prospective cohort study of a nationally representative sample of households in Japan.
PARTICIPANTS: Community-dwelling adults who developed at least one symptom during a 31-day period.
MAIN OUTCOME MEASURES: Self-reported, symptom-related use of CAM, either physical CAM or oral CAM.
RESULTS: Of 2, 453 adults, 2, 103 participants (86%) developed at least one symptom. Of these symptomatic adults, 156 (7.4% ; 95% CI: 6.3-8.5%) used physical CAM therapy. The likelihood of using physical CAM was not significantly influenced by annual household income, employment, or education. Participants living in large cities had an increased likelihood of using physical CAM with an odds ratio (OR) of 2.6 (95% CI: 1.2-5.8), compared to those living in rural areas. Oral CAM therapy was used by 480 participants (22.8%; 95% CI: 21.0-24.6%) among the symptomatic adults. An age of 60 years old and older (OR 2.0; 95% CI: 1.2-3.3) and female gender (OR 1.8; 95% CI: 1.3-2.6) were significantly associated with an increased use of oral CAM. The unemployed participants had a lower likelihood of using oral CAM, with an OR of 0.6 (95% CI: 0.4-0.9), compared to the employed.
CONCLUSIONS: Oral CAM use is common among Japanese patients and is associated with older age, female gender, and employed status, while physical CAM use is less common and is associated with living in a large city.

The activated clotting time (ACT) is used to assess adequacy of anticoagulation during cardiopulmonary bypass (CPB). However, ACT values during CPB do not correlate with heparin concentration and are affected by variations of such factors as hypothermia and hemodilution. ACT is also used to estimate protamine doses, because excess protamine may result in hypotension and an increase in bleeding after CPB. This study was designed to evaluate the effect of heparin and protamine administration that were administered based on whole blood heparin concentration using Hepcon/HMS (HC group) on the incidence of bleeding and blood transfusion after CPB. We treated 32 of adult cases and 36 pediatric cases. For the control group (NC group), an initial fixed dose of 300U/kg heparin was administered and if the ACT was less than 400s an additional fixed dose of 100U/kg heparin was administered. Heparin was neutralized with an initial fixed dose of protamine. For the HC group, the initial dose of heparin and the additional dose of heparin were based on an automated heparin dose response assay. The initial dose of protamine was based on the residual heparin concentration. The patients in the HC group received greater doses of heparin and lower doses of protamine than the patients in the NC group. In the pediatric HC group, the amount of TAT, FTC and D-dimer post CPB were smaller than those in the NC group. Operative time and closure time were similar the two groups. Operative bleeding, mediastinal chest tube drainage in the postoperative period were similar in the two groups. The volume of total blood transfusion was also comparable in the two groups. In conclusion, the monitoring of heparin concentration during CPB in children was effective for the maintenance of coagulation factors.