The following analgesic effects have resulted from irradiating each finger joint (DIP, PIP, and MCP) of patients with rheumatoid arthritis for 20 seconds using the semiconductor laser, “uni-Laser” (10mw, 790nm) from ITO company.
1) Comparison of the post-exposure state with the pre-exposure state in the open test
i) Of 13 cases of joint pain, 7 cases showed improvement and 6 cases showed no change with no case showing aggravation.
ii) Duration of analgesic effect was less than 48 hours in 2 cases, less than 72 hours in 1 case, and more than 96 hours in 3 cases.
2) Comparison of the post-exposure state with the pre-exposure state in the single blind test on a total of 25 patients with rheumatoid arthritis. Twelve patients were exposed to the irradiation twice per week, 10 times a session (irradiated group) and 13 were exposed to the dummy of the above (control group).
i) The irradiated group improved considerably in the number of painful joints, frequency of joint pain, and grasping power. The rate of improvement was superior to that of the control group (P<0.05).
ii) No significant improvement in duration of morning stiffness was shown in either group.

Objective: The aim of this study was to identify the content and methods of ethics education for medical representatives as part of the continuing education program and to suggest a preferable supportive method of ethics education accordingly.
Method: A questionnaire was mailed to the medical representative education managers of all 214 companies, all members of the MR Education & Accreditation Center, Japan.  The questionnaire was carried out from 31st July 2009 to 25th August 2009, and data from this questionnaire survey was analyzed by simple and cross tables.
Results: Out of the 182 (response rate: 85.0%) who responded, we analyzed the 173 institutions for analysis as they responded as having the continuing education program.  In terms of education, “the fair competition code” was the most widely educated (82.6%).  Although “the fair competition code” required most time, “the ethics as a medical representative” was considered as the most important.  The simple kappa coefficient between actual educating item and important item was 0.29.  Answers were affected by whether he/she had experience as a medical representative.  As the method of ethics education, “lecture” style was most common (87.4% of respondents), “group work discussion” was considered the most effective (70.6%) for training a medical representative to think and learn by himself/herself.  The respondents of 82.2% referred to the continuing educations’ guidelines made by MR Education & Accreditation Center, and 81.0% respondents felt “training materials for lectures and/or discussions” necessary in the future.
Conclusion: The ethics education for medical representatives placed a disproportionate emphasis on the importance of “the fair competition code.” Dissociation was seen between the actual education and the education considered as important by the respondents.  Accordingly, there is a need for appropriate materials for training and for a more adequate curriculum, taking time and content of education into consideration, especially for contents which training ways aren’t built up.

A 52-year old man was referred to our hospital for atrial fibrillation ablation therapy. A multislice computed tomography study demonstrated a giant coronary artery aneurysm situated just proximal to the left anterior descending (LAD), LAD stenosis and coronary-pulmonary artery fistula. The fistula was ligated and the aneurysm was resected under cardiopulmonary bypass. The left internal thoracic artery was used as a bypass graft to the LAD as well as a patch for closure of the LAD orifice to avoid left circumflex artery stenosis. We report a rare case of giant LAD aneurysm with coronary-pulmonary artery fistula.

It is known that the prognosis of preductal type coarctation of the aorta is poor because cardiac malformation is frequent in these cases. There have been very few reports on adult cases of the coarctation. We have recently carried out aneurysmectomy and reconstructed the descending aorta by a 30mm Veri-Soft tube graft for one adult case of descending aortic aneurysm associated with coarctation of the aorta. The patient was 49-year-old female. Segmental stenosis 5cm in length was demonstrated in the thoracic descending aorta immediately below the bifurcation of the left subclavian artery. The poststenotic dilatation was shown at the distal portion of the segmental stenosis. The postoperative clinical course was uneventful.

The preparation for influenza pandemic has become very important. However, no standardized educational package against pandemics has been established to date. We developed a simulation–based education drill for Japanese medical students based on the package developed by U.S. medical school. The drill was adapted to 201 medical students, and was evaluated by self–administered questionnaires.
1)More than 90% of the students indicated that the use of this drill is appropriate to experience a simulated pandemic situation, and to learn skills and attitudes such as teamwork and communication.
2)Up to 65% of the students answered they learned a "very clear image" for the "Importance of working as a team with other professionals".
3)The results suggest that this simulation–based education drill make the students aware not only of the need for the preparation for pandemic but also the importance of team–based approach.

No abstract available.
Gallbladder ; Meals

The purpose of this study was to determine whether improved physical fitness through a new exercise program intervention including elements of Tai Chi Chuan and Kung Fu gymnastics among elderly people who have lower physical. Eighty older adults with less physical strength aged 71-89 (mean age±SD=77.3±3.9), recruited from Tsurugaya area of Sendai, participated in a 3-month randomized controlled trial, with allocation to a new exercise program or well-accepted exercise program control. Physical performance measures included the timed up and go test (TUGT), the functional reach test, a 6 min continuous walking test, and the sit-and-reach test were conducted before and after the intervention. Data were analyzed through on-treatment-analysis of variance. After training, although no significant between-groups differences were observed for all the measures, TUGT, which is recommended as a simple screening tool to identify those at risk of falling was improved in both groups following the intervention (P<0.05). The findings revealed that the new exercise program including Tai Chi Chuan and Kung Fu gymnastics element could improve physical fitness to a similar level as the well-accepted exercise program.