This paper discussed the introductory medical training system and medical team care problems at University Hospital of Tsukuba.
The characteristics of this training system are that the duration of training is the fourth year medical students at the University of Tsukuba and to exercise the roles of nursing service at University Hospital.
In this practice, medical students are expected to comprehend about the significance of team work in medical care, to practice in the work of nurses and c-medical workers for learning their roles. We introduce our purpose and practice of this medical team care. Problems of this trial are discussed in this paper. But we have confirmed that this experimental. Trial is useful experience to all medical students and the items of this practical exercise are one of the most effective training method for them.

For the purpose of learning the comprehensive medical team care. we tried for the fourth year medical students at University of Tsukuba to exercise the nursing service and the team care system in the Hospital of University of Tsukuba.
These practice were already undergone during past twelve years.
In this practice, students are expected to comprehend about the significance of team work in medical care, to understand the meaning of medical care, to learn especially the roles of nursing and rehabilitation medicine (in total medical care system), to practice in the work of nurses and co-medical workers for understanding their roles, to study the basic science and contribution in medical team care of rehabilitation medicine, to comprehend about the outline of the health, medical care system, and medical economics.
As the items of this practical exercise, all students must work as follows:
1. collection of venous blood and check of vital signs.
2. practical work of nursing service.
day time service: 8:00 a.m.-11:30 a.m.(fourtimes)
1:00 p.m.-4:30 p.m.(once)
early night service: 5:00 p.m.-0:00 a.m.(once)
midnight service: 0:00 a.m.-8:30 a.m.(once)
Moreover 15 corelative lectures are prepared.
For these twelve years, we researched motivating effects and impression of this exercise about both medical students and nurses by method of using questionnaire. We hope to grow kindly doctors having the mind of humanity.

We performed dietary guidances for 15 male elite athletes (23±3 years of age) participating a training program for vigorous endurance run. Nutrient allowances for the athletes were determined by the guidelines of Japanese Dietary Allowances (5 th ed.), considering their physical activities at the highest level IV; total energy 3, 500 kcal, protein 140g, lipid 100g, carbohydrate 510g, calcium 1, 500 mg, iron 25 mg, vitamin A 8, 000 IU, thiamine 4.0 mg, riboflabin 5.0 mg and vitamin C 200 mg per day. We also developed food group allowances for the athletes based on their nutrient allowances and current young-aged Japanese dietary styles ; cereals 400 g, potatoes and starches 60 g, sugars 20 g fats and oils 30g, pulses 120g, meats 150g, fishes and shellfishes 150g, eggs 80g, milks 600g, green and yellow vegetables 300 g, the other vegetables 350 g, fruits 400 g and algae 20 g per day. For the experimental period of 45 days, daily diets adjusted to approximate 120% of the dietary allowances were served to the athletes who were free taking snacks and drinks. Dietary guidances for the athletes were assessed by monitors of their dietary intakes, physical constitution and clinical examinations in blood. Means of the dietary intakes of the athletes were 96-99% of the dietary allowances, determined by a nutritional survey with the 24 hrs recall method. There were less changes in the physical constitution of the athletes before, during and after the experimental period; body weight 57±2 kg and body fat 8.8 ± 2.4%. Values of the clinical marks in the blood of the athletes were maintained normally for a half year including the experimental period; red blood cells 507±9×104 cells/mm3, hemoglobin 15±0.4g/dl and hematocrit 46.6±0.7%.
It is concluded that suitable nutritional guidances and managements for young-aged male vigorous endurance runners lead good in their health and physical maintenances, which may have important consequences for their physical development as elite athletes.

Introduction: We perform our trials in Tsurumi ward, Yokohama city aiming at reducing the number of “cancer refugees” to zero. State: There are many patients who receive cancer therapy outside their hometown. Once their treatment is finished due to progressive disease or deteriorating condition, they are told to leave the hospital and to get palliative care in their district. And they become so-called “cancer refugees”. The beds of palliative care units are limited so the ability to accept patients in case of emergencies is poor. In Tsurumi ward, here are a lot of home care clinics providing palliative care but the place patients want to be or receive palliative care when their condition deteriorates isn't fixed. We organized the “Tsurumi Homecare Network” as the core of medical cooperation, and have worked on improving palliative care and increasing patients who die at home. Specifically, our hospital has played a central role as a special place for palliative care, we send out our original questionnaire to home care clinics to find out how they perform palliative care and introduce patients to the appropriate clinic. Patients who are in need of hospitalization are assured acceptance. On the other hand, we propose the cancer treatment hospitals to follow their patients together with us from their early stage of cancer treatment. Problem: To maintain a good relationship for regional palliative care, improving the management for outpatients, strict and timely backup system, advanced quality of homecare-supporting staff for palliative care and cooperation between home care clinic doctors are necessary.

Caseous calcification of mitral annulus (CCMA) is rare variant of mitral annular calcification (MAC). There is no clear consensus on the optimal management for CCMA. However, patients with CCMA have high risk of embolic strokes. We performed drainage and debridement in 3-cases of CCMA. All patients had a history of chronic kidney disease (CKD), and two of the three patients were undergoing hemodialysis. If a calcified mass at the mitral valve annulus is observed, especially in hemodialysis patients, CCMA should be recognized.

Students in all years, including those in lower years, were prohibited from coming to campus because of COVID-19, which began to spread in January 2020. However, we believed that a hospital tour and observership would be important practical training for first and second year medical students as part of the early exposure program, which aims to increase student motivation. Thus, we decided to conduct a virtual hospital tour and a virtual observation of medical doctors’ work. We used Zoom to conduct a virtual hospital tour for first-year students in June, and a virtual observation of physicians’ work for second-year students in December. Although this offered less of an opportunity to experience the reality of the clinic, there have been benefits in terms of increased learning content, fairness of learning opportunities delivered, and the promotion of independent learning. With regard to a “Hospital Tour” and the “Observation of Medical Doctors’ Work” , we believe that hybrid forms, which are able to skillfully combine the strengths of the two methods, would be effective.