To examine the relationships between anger expression and blood pressure (BP) levels and their effect modification by stress coping behaviors, the authors analyzed data from a cross−sectional study of 790 Japanese male workers aged 20−60 years. We used the Spielberger anger expression scales to measure anger−out, anger−in, and anger−control. Relationships between anger expression scales and mean systolic and diastolic BP levels were examined in the total sample and in two subgroups of high and low stress coping behaviors (low coping behavior group: having none, one, or two coping behaviors; and high coping behavior group: having three or more coping behaviors). Anger expression scales were not associated with BP levels in the total sample. Among men who reported only two or fewer coping behaviors, however, the anger−out score was significantly associated with systolic blood pressure (SBP) levels while no association was found among men who reported the larger number of coping behaviors. Anger−in and anger−control were not associated with BP levels in either low or high coping behavior groups. This study suggests that male workers who do not express their anger have a higher probability of developing high BP when they have no or few stress coping behaviors.
Anger ; Coping Behavior ; seconds ; Blood pressure determination ; workforce

The patient was a 25-year-old man, who had been stabbed with a weapon siarilar to long ice pick. Thirty minutes later, he was admitted to our emergency center by ambulance. Anchocardiogram on admission revealed moderate pericardial effusion with normal heart function. Contrast medium enhanced computed tomography revealed that the weapon had entered from the left anterolateral chest wall and reached the posterior wall of the aortic root, approximately 1 cm above the left coronary artery orifice, through the left lung. During examinations, he suddenly went into shock and emergency open pericardial drainage was performed immediately. Approximately 400 ml of blood with a clot was removed from the pericardial cavity. After this procedure, there was no continuous bleeding. Subsequently, pseudoaneurysm developed at the aortic root injury site. Twenty seven days later, aortic surgery was performed. The injury site was resected and sutured directly, employing 4-0 polypropylene sutures with felt pledgets. He was discharged 14 days after the operation without any complications.

A number of studies have shown that sleep disordered breathing (SDB) has a strong relation with obesity. The purpose of this study was to examine the effect of a short-term weight-loss program in obese men with SDB. In our 14-week weight-loss program, forty-one obese men (mean±SD, age ; 49.6±10.8 yr, body mass index ; 27.9±2.5 kg/m²) were assigned to 2 subgroups : diet only (DO ; n=19) and diet plus aerobic exercise (DE ; n=22). 2%, 3%, and 4% oxygen desaturation index (ODI) were measured by pulse oximetry before and after the weight-loss program. Weight and %fat significantly (p<0.05) decreased in the total subject pool consisting of DO plus DE (weight ; -8.4±3.5 kg, %fat ; -7.5±3.5%). 2%, 3%, and 4% ODI significantly decreased by -3.46±5.01 event/hour, -2.37±3.57 event/hour, and -1.99±2.84 event/hour, respectively. Significant correlations were found between 2%, 3%, and 4% ODI at baseline and changes of 2%, 3%, and 4% ODI during the weight-loss program (2% ODI ; r=0.48, 3% ODI ; r=0.51, 4% ODI ; r=0.67). Weight loss and %fat loss did not differ significantly between DO and DE (DO : -7.6±3.2 kg, -6.8±3.2%, DE : -9.2±3.7 kg, -8.1±3.7%). The increase in maximal oxygen uptake was slightly larger for DE (4.7±4.6 ml/kg/min) compared to DO (2.5±3.3 ml/kg/min), but there was no significant interaction. Changes of 2%, 3%, and 4% ODI did not differ significantly between groups. These results suggest that for obese men with SDB, the weight-loss program is an effective method, leading to improvement in SDB, although the combination of aerobic exercise to diet may not produce additional effects to SDB, compared with the diet only.

This study examined the effectiveness of a communication program in undergraduate medical education in improving communication in physicians' clinical practice. The effectiveness of the program was assessed with a mail survey using self-rated questionnaires 9 years later. Ninety participants were follwed up in late 1994; 57.8% of them replied to the questionnaire. Of the respondents, 60% replied that programs concerned with active listening and role-playing had benefits on communicating with patients and families. In addition, 40% of respondents answered that case studies aimed at teaching comprehensive medicine with the team approach was effective in improving communication with co-medical staff. These results suggest that the communication program in undergraduate medical education is effective in improving clinical communication in clinical practice when students are highly motivated.

Objective: Despite the fact that the total energy intake of Japanese peoplehas decreased, the percentage of obese people has increased. This suggests that the timingof meals is related to obesity. The purpose of the study was to investigate therelationship between the timing of meals and obesity, based on analyses of physicalmeasurements, serum biochemical markers, nutrient intake, and lifestyle factors in thecontext of Chrononutrition.
Participants and Methods: We analyzed data derived from 766 residents ofToon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medicalexaminations between 2011 and 2013. These medical examinations included. (1) physicalmeasurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers(total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors suchas family structure and daily habits (22 issues), exercise and eating habits (28 issues),alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups(FFQg); and (5) a questionnaire concerning the times at which meals and snacks areconsumed.
Results: The values for body mass index (BMI) and waist circumference werehigher for participants who ate dinner less than three hours before bedtime (<3-hgroup) than those who ate more than three hours before bedtime (>3-h group). TheChi-square test showed that there was a significant difference in eating habits, e.g.,eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after9 p.m., between the <3-h group and the >3-h group. Multiple linear regressionanalysis showed that skipping breakfast significantly influenced both waist circumference(β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed onlyinfluenced BMI (β = 0.581).
Conclusion: Skipping breakfast had a greater influence on both waistcircumference and BMI than eating dinner <3-h before going to bed.

Objectives: Despite the fact that the total energy intake of Japanese people has decreased, the percentage of obese people has increased.This suggests that the timing of meals is related to obesity.
The purpose of the study was to investigate the relationship between the timing of meals and obesity, based on analyses of physical measurements, serum biochemical markers, nutrient intake, and lifestyle factors in the context of Chrononutrition.
Participants and Methods: We analyzed data derived from 766 residents of Toon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medical examinations between 2011 and 2013. These medical examinations included. (1) physical measurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers (total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors such as family structure and daily habits (22 issues), exercise and eating habits (28 issues), alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups (FFQg);and (5) a questionnaire concerning the times at which meals and snacks are consumed.
Results: The values for body mass index (BMI) and waist circumference were higher for participants who ate dinner less than three hours before bedtime (<3-h group) than those who ate more than three hours before bedtime (>3-h group). The Chi-square test showed that there was a significant difference in eating habits, e.g., eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after 9 p.m., between the <3-h group and the >3-h group.
Multiple linear regression analysis showed that skipping breakfast significantly influenced both waist circumference (β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed only influenced BMI (β = 0.581).
Conclusion: Skipping breakfast had a greater influence on both waist circumference and BMI than eating dinner <3-h before going to bed.

Objectives: Few studies examined the association between deterioration of masticatory ability assessed by objective marker and physical function. Therefore, we examined the association between salivary flow rate which is one of the objective and surrogate marker of masticatory ability and lower Timed Up & Go (TUG) performance which is one of major measurement of physical function among aging Japanese. Methods: This cross-sectional study enrolled 464 Japanese aged 60e84 years old. Participants chewed tasteless and odorless gum for 5 min, calculated stimulated salivary flow rate (g/min) during all chews.The 3 m TUG was conducted, and 75th percentile value (6.8 s for men and 7.0 s for women) or higher was defined as lower TUG performance. Logistic regression analysis was used to examine the association between stimulated salivary flow rate and lower TUG performance. Results: We found that the stimulated salivary flow rate tended to be negatively associated with the TUG time. We also observed significant negative association between stimulated salivary flow rate and lower TUG performance; the multivariable-adjusted OR (95% confidence interval, CIs) of lower TUG performance for the highest quartile of stimulated salivary flow rate compared with the lowest quartile was0.34 (0.16e0.69, P for trend ¼ 0.02). Further adjusting for BMI, the association was attenuated but remaind significant; the OR (95% CIs) in highest quartile was 0.37 (0.18e0.76, P for trend ¼ 0.04). Conclusions Higher stimulated salivary flow, which means well masticatory ability, was inversely associated with lower TUG performance in the aging Japanese population.

A 24-year-old man was admitted to another hospital due to fever and chest and back pain. Enhanced chest computed tomography showed an aneurysm between the distal aortic arch and left pulmonary artery. The patient was transferred to our hospital for surgery. Because of suspicion of an infectious ductus arteriosus aneurysm, antibiotic therapy was started. Urgent graft replacement of the descending aorta was performed on the third day due to the enlargement of the aneurysm. All blood cultures including the preoperative examination, and the aneurysmal culture were negative. The histopathological study showed non-specific inflammatory response with plasma cell, T lymphocyte, and B lymphocyte infiltrations. There was no evidence of infection. Eventually we diagnosed this patient as having a ductus arteriosus aneurysm with non-specific inflammation. The antibiotic therapy was terminated on postoperative day 10, and the postoperative course was uneventful.