A Pulmonary arterial flow-directed catheter (Oxymetry 93A-741-7.5F), combining the fiberoptic reflectometric system of continuous measurement of mixed venous blood oxygen saturation (SvO₂) was used for hemodynamic measurements including thermodilution cardiac output estimation and hemoglobin value in 21 cases of open heart surgery. Immediately after open heart surgery there was low correlation between Hb (hemoglobin value) and SvO₂ (r=0.513, p<0.05). However there was no correlation between SvO₂ and cardiac function (pulmonary capillary wedge pressure and cardiac index). With almost normal Hb (10-13g/dl) the average cardiac index (CI) in cases of SvO₂ less than 60% was 2.47l/min/m² which was significantly lower than those with SvO₂ more than 60% (p<0.01). With normal CI (2.5-4.0l/min/m²) the average Hb in cases of SvO₂ less than 60% was 7.40g/dl which was significantly lower than those of more than 60% (p<0.01). This study suggested that there is low cardiac function or severe anemia in the state of SvO₂ less than 60%.

Aortic valve replacement was carried out for aortic regurgitation in Behçet's disease. A prosthetic valve was fixed using reinforced felt-strip mattress sutures. Difficulty to ensure adequate myocardial protection due to ostial stenosis in the right coronary artery resulted in the occurrence of intraoperative myocardial infarction. Right ventricular assist with the help of a centrifugal pump was employed to obtain successful recovery from right cardiac failure. It was noted that at operation attention should have been paid to the aortic valve and also to abnormalities of the coronary artery and that control of the inflammatory reaction by steroids was essential before and after the operation.

We studied the effects of granulocytic elastase (GEL) and fibronectin (FN) on the coagulation and fibrinolytic system when using cardiopulmonary bypass (CPB). Blood sampling was performed before CPB (Pre), just after CPB (Post) the 1st postoperative day (PD1) and the second postoperative day (PD2). Laboratory parameters were GEL, FN, fibrinogen (Fib), prothrombin time (PT), fibrin degradation products (FDP), D dimer (D-D), α2 plasmin inhibitor plasmin complex (PIC) and antithrombin III (AT III). The level of GEL was highest and that of FN was lowest at Post. The levels of Fib, PT and AT III were lowest and that of PIC was highest just after CPB. The levels of FDP and D-D were highest on PD1. The levels of GEL and D-D correlated just after CPB and on PD1 and PD2. The level of GEL correlated with that of PIC on PD1. These results demonstrated that the level of FN decreased with CPB. And it was expected that CPB time affected the level of GEL. The levels of GEL affects D-D and PIC which are fibrinolysic factors particularly related to secondary fibrinolysis.

A Case of abdominal aortic occlusion caused by acute aortic dissection (DeBakey's type III b) is reported. A 59-year-old woman was admitted with sudden onset back pain and sensory disturbance of bilateral lower extremities. The pulsations of bilateral femoral arteries were absent. CT and aortogram revealed dissection of the thoracic descending aorta and infrarenal aortic occlusion. Since ischemic change had progressed, bilateral axillofemoral bypass was performed for limb salvage, and the symptoms improved rapidly. Axillofemoral bypass is an easy and safe procedure even in the acute phase of aortic dissection. It provides fast reperfusion, and so is considered to be useful to preventing myonephrotic metabolic syndrome MNMS.

BACKGROUND: Before the COVID-19 vaccine became available, many Japanese people were undecided about whether or not to receive them. Their decisions were keys to achieving herd immunity. The impact of the type of information source on the COVID-19 vaccine uptake decision-making process remains unclear. We aimed to investigate the association between information source usage on COVID-19 and subsequent vaccine uptake status among those who have yet to decide whether to receive vaccines from non-prioritized people for vaccination. METHODS: Prospective cohort online self-administered surveys were conducted in February 2021 (T1), before the start of the mass vaccination program, and September-October 2021 (T2), when the vaccines were available to all citizens. The survey's target population was registered monitors of an Internet research company. Participants who answered "I want to get vaccinated after waiting to see how it goes." at T1 were eligible for analysis. The outcome variable was the COVID-19 vaccine uptake status in T2, and the predictors were 20 types of information sources, categorized based on people (family members, etc.), institutions (governments, etc.), or media (TV news, etc.). Adjusted odds ratio and 95% confidence intervals were estimated using logistic regression adjusted for possible confounders. RESULTS: The 5,139 respondents, mean age and standard deviation was 42.8 ± 12.5, 55.7% female, were eligible for analysis. 85.7% completed vaccination (including reserved/intended people) in T2. In the multivariate logistic analysis, odds ratios (95% confidence interval) for vaccine uptake were 1.49 (1.18-1.89) for workplaces/schools, 1.81 (1.33-2.47) for LINE, 0.69 (0.55-0.86) for Internet news and 0.62 (0.48-0.82) for video sharing sites. CONCLUSIONS The type of information source usage played an important role in the decision to vaccinate against COVID-19. Although caution is needed in interpreting the results, obtaining information from workplaces/schools and LINE was influential in promoting immunization.
Humans ; Female ; Male ; Information Sources ; COVID-19 Vaccines ; Prospective Studies ; Intention ; Japan ; COVID-19/prevention & control* ; Vaccination

The Professionalism subcommittee of Japan Society for Medical Education has been examining a diverse range of issues related to medical professionalism education for approximately the past 20 years. In July 2015, the committee formulated and presented a draft on “ The Attributes and Competencies of Physicians: An Exploration of Professionalism” Based on this, we have been conducting educational activities on professionalism education, but we had not documented this draft. We are now re-presenting the draft here with minor lexical corrections and additional notes. The professionalism of physicians is delineated in seven attributes and competencies :1. Sense of mission and responsibility towards society2. Practice of patient-centered health care3. Demonstration of integrity and justice4. Acceptance of diverse values and sharing of fundamental values5. Fulfilling roles as leaders/members in organizations and teams6. Pursuit of excellence and lifelong learning7. Self-management and career developmentThis document is presented with the expectation that it will contribute to future discussions on professionalism education.