It is generally known that oriental medicine is based on the concept of deficiency and excess to explain disease in a complex living system. However, a disease model based upon the expression of the relationship between the rhythm of the five basic elements and the living body's control system has not been proposed. Therefore, we investigated this relationship by modeling “Kyo-Ja” and “Jitsu-Ja” on abnormal rhythms of the five basic elements.
We constructed models that always reflect changes in the rhythm of the five basic elements to show that disease occurs by breaking these control systems. The present model suggests that treatments of disease should not only incorporate the characteristics of the five basic elements but should also consider the course of a disease and the patient's overall condition.

Masked obesity is the presence of obesity based on percent body fat (%BF) when the body mass index (BMI) shows an absence of obesity. To examine the relationship between masked obesity and arteriosclerosis risk factors, we compared both serum lipid levels and the prevalence of hyperlipidemia in male and female high school freshmen with and without masked obesity. Subjects consisted of 403 male and 326 female high school students aged 15∼16 years. Of these, 34(8.4%) males and 36(11.0%) females had masked obesity, defined as 17≤BMI<23.60 and %BF≥25% in males, and 17≤BMI<24.17 and %BF≥30% in females, while the remaining 300 males and 246 females were not obese, having 17≤BMI<23.60 and %BF<25% and 17≤BMI<24.17 and %BF<30%, respectively. For both sexes, serum total-cholesterol (TC), low-density lipoprotein cholesterol (LDLC), triglycerides and the arteriosclerotic index (AI) were significantly higher (p<0.05∼0.01) in those with masked obesity. And many of the subjects with masked obesity had abnormal levels of TC, LDLC and AI, compared with those who were not obese (p<0.05∼0.01). Additionally, we compared both serum lipid levels and the prevalence of hyperlipidemia between subjects with masked obesity and control groups with the same BMI values. As a result, subjects with masked obesity had high serum lipid levels and a prevalence of hyperlipidemia. These results support the existence of masked obesity and suggest that masked obesity is associated with increased serum lipid levels, and thus could be a risk factor for arteriosclerosis in male and female high school freshmen.

We present here a rare case of coronary artery bypass grafting through a left thoracotomy after substernal gastric interposition for esophageal cancer. A 58-year-old man, who had undergone esophagectomy and substernal gastric interposition 11 years previously, was admitted for cerebral infarction from which he made a good recovery without any complication. At this time, the patient was diagnosed as having coronary artery disease on electrocardiogram. Cardiac catheterization revealed triple vessel disease. Coronary artery bypass grafting to the left anterior descending artery and obtuse marginal branch through a left thoracotomy was performed using a radial artery Y-graft under femorofemoral bypass. The aorta was cross-clamped and the heart was arrested with antegrade cold cardioplegic solution for the distal anastomosis of the left anterior descending artery and the obtuse marginal branch which was embedded within the myocardium. The postoperative angiography showed good coronary flow. Left thoracotomy approach provides a good exposure of the left coronary artery. This approach, therefore, is advocated as an alternative method for cases requiring coronary artery bypass but in which median sternotomy is difficult, such as the present case. The appropriate procedure for the site of thoracotomy, supporting methods, choice of graft, and the site of graft anastomosis should be selected in each patient.

Objective: Antiplatelet therapy is useful for infraction prevention.  But, in elderly patients, adverse events are easily observed, owing to the decrease in metabolism and excretion of drugs.  Furthermore, applying guidelines for medical care of each disease does not necessarily result in good conclusions.  Therefore, we used Japanese Adverse Drug Event Report database and assessed safety signals with signal detection about adverse events developed by the antiplatelet therapy in the elderly patients.
Methods: We analyzed all adverse events reported on ticlopidine hydrochloride that should be carefully administered, and clopidogrel, bisulfate and aspirin that are recommended as the alternative drugs.  We used the proportional reporting ratio for a safety index of drugs.
Results: While some adverse events were expressed in only ticlopidine hydrochloride, bleeding signal was detected in all the subject agents.  In addition, onset risk of ticlopidine hydrochloride was found to be the lowest value.  Moreover, adverse events expressed in clopidogrel bisulfate and aspirin were of a wide-variety compared with ticlopidine hydrochloride.
Conclusion: It is necessary to carefully administer not only ticlopidine hydrochloride but also the alternative drugs to the elderly patients as indicated, and there is a need to pay careful attention to administration of the alternative drugs.

Objective: Medical education was initiated in 2012 as part of health and physical education (HPE) in junior high schools.  This new measure was a result of a revision of school curriculum guidelines.  In this study, we aimed to clarify the implementation status of medical education in schools.
Methods: A questionnaire survey targeting junior high school teachers in Gifu (from 184 junior high schools) was conducted by mail.
Results: 60.9% of schools responded (112/184).  HPE teachers and school pharmacists were found to be in charge of providing medical education in 94.6% and 10.7% of schools, respectively.  The average duration of classes was 50 min and the average frequency was 1.2 times a week.  On average, 0.9% of schools stated that implementing medical education was “under contemplation,” 2.7% held “occasional” classes, and 2.7% only held “drug abuse-related” classes.  It was also found that the most commonly used educational material was the school textbook (91.1% of schools).  Additionally, 87.5% of schools responded “yes” to “lectures are delivered by outside lecturers,” and 69.6% responded “yes” to “we hope to introduce workshop participation.”
Conclusion: The results of the survey indicated that many junior high schools have provided medical education classes and that HPE teachers were in charge of teaching these classes.  However, some schools have not provided these classes.  It is considered necessary to enhance medical education activities in the pharmaceutical field by involving specialists from different areas.

Introduction: In Japanese emergency departments, many physicians have to decide immediately whether they should limit life-sustaining treatments for critically ill elderly patients who may be at their end-of-life (EOL) or in cardiopulmonary arrest. To propose effective medical training, we investigated the ability of junior residents to recognize this challenging problem.

Method: We conducted a semi-structured interview of 38 junior residents who had completed the junior residency program of University Hospital, Kyoto Prefectural University of Medicine. We then qualitatively analyzed the transcripts of the interviews.

Results: Through observation of the attending physician's interview, which is a discussion about decision-making with the patients and their families, junior residents recognized the problem of EOL and made their decision. Finally, they preferred "doctor-led discussion" or "neutral discussion."

Discussion: We recommend that attending physicians should give junior residents many opportunities to observe their interview about decision-making.

The purpose of this study was to ascertain whether exercise training cardiac adaptation exists in student rugby athletes, to define an adaptive pattern and to observe the student rugby athletics cardiac adaptive process. Subjects consisted of 42 male senior high school student rugby athletes, who participated in sports in junior high school, and a control group of sedentary students from the same senior high school who were matched for age. Student athletes were measured once a year over a three-year period. Left ventricular internal dimension at the end-diastole (LVIDd) and left ventricular posterior wall thickness at the end-diastole (PWT) were both measured by echocardiography. Because all subjects were growing adolescents, allometric scaling data (which is LVIDd/BSA^0.5 and PWT/BSA^0.5) was used for comparison, to preclude the effect of differences in body size on LVIDd and PWT. Cross-sectional comparisons of athletic students with controls were conducted for each of the three senior high school grades, respectively. The data of student athletes during the three-year study was used for longitudinal comparisons. The results of cross-sectional comparisons showed that LVIDd/BSA^{0, 5} in a student athlete group consisting of the three grades combined was greater than the corresponding control group (P<0.05, P<0.01, respectively) . PWT/BSA^0.5 in the athletic group was greater than the control group for the third grade level (P<0.05) . The results of the longitudinal comparison revealed that no significant differences were present in LVIDd/BSA^0.5 during the three-year investigation (P>0.05, respectively) . PWT/BSA^0.5 at the second and third grade level were obviously greater than at the first grade level (P<0.05, respectively) ; however, no dif. ference between the second and third grade levels existed. The results of this present study suggest that regular rugby exercise training during senior high school obviously induced left ventricular posterior wall thickening in the athletic students. An enlarged left ventricular cavity was observed at the first grade level of senior high school and did not significantly change during three years of senior high school.

Objective: Many of the elderly patients are suffering from constipation, are using the oral laxative.  However the risk assessment of the oral laxative is not performed.  Therefore, we used Japanese Adverse Drug Event Report database (JADER) and examined for the safety of the oral laxative in the elderly patients.
Methods: Since the analysis target medicines; 12 oral laxatives and target ADEs; “digestive disorders” and “electrolyte abnormality,” the JADER database for April 2004 to January 2015 were analyzed in adults of age exceeds 60.  We used the reporting odds ratio for a safety index of drugs, using reporting odds ratio, when the Lower bound of the 95% two-sided confidence interval exceeds 1, it is the signal detection of ADE.
Results: The oral laxatives detected the signal of “digestive disorders” were three medicines, and “electrolyte abnormality” were five medicines.  Especially, for electrolyte abnormalities not only increases the blood magnesium values as magnesium oxide, that there is also affect other electrolyte revealed.
Conclusion: Some oral laxatives were also intended to signal detections of the adverse events that are not listed in the attached document, it is necessary to pay attention to the use of them for the elderly patients.