This study examined the effects of the use of contact lenses on static and kinetic visual acuity, ocular pain, and blurred vision during a water polo match. Eleven male water polo players participated in this study, and were assigned to one of two groups: contact lens users (CL, n=5) and non-users (NCL, n=5). Both groups participated in a typical water polo match with four 7-min periods and 2-min resting intervals between the four periods. Static and kinetic visual acuity, subjective ocular pain, and blurred vision were measured before the match (pre-test), during the match (after each of four 7-min periods), and during the recovery phase at 5, 15, and 30 min after the completion of the match.Results showed that kinetic visual acuity was significantly lower for the NCL group than for CL in the 4^th period of the match. In addition, for the NCL group, kinetic visual acuity was significantly lower in the 3^rd and the 4^th periods than at the pre-test time. On the other hand, static visual acuity did not significantly differ between the two groups; but, for NCL, static visual acuity was significantly lower in the 4^th period than at the pre-test time. According to self-evaluation scores, ocular pain significantly increased in NCL compared to CL in the 3^rd and 4^th periods. Ocular pain in NCL was significantly higher between the 2^nd period and recovery phase at 5 min than at the pre-test time. Blurred vision was significantly higher in NCL than CL between the 2^nd period and recovery phase at 5 min. Blurred vision in NCL was significantly higher at the same duration than at the pre-test time.These findings indicate that the use of contact lenses may prevent ocular pain and blurred vision, maintaining both the static and kinetic visual acuity at a normal level during a water polo match. Further, the results of this study suggest that the use of contact lenses is effective for water polo players.

A 22-year-old woman with pseudocoarctation of the aorta as a complication of disal arch aortic aneurysm and aberrant right subclavian artery was successfully treated. She was the elder of identical twins, with a past history of spontaneous closure of the ventricular septal defect. Preoperative angiograms suggested pseudocoarctation of the aorta complicated by distal arch aortic aneurysm with aberrant right subclavian artery. At operation, the distal arch was replaced with a 14mm woven dacron graft and the left subclavian artery was reconstructed by interposition of 6mm IMPRA graft between the vessel and ascending aorta. The postoperative angiograms indicated successful reconstructions. Contrast-enhanced CT scans of the younger identical twin showed no anomaly of the thoracic aorta.

Isolated tricuspid regurgitation is extremely rare, and in most of the previously reported cases, both tricuspid leaflets and subvalvar tissue have been absent, hypoplastic or fused. For this reason, tricuspid valvoplasty was difficult and valve replacement was adopted in many cases. In the present case, a 52-year-old man, however, the tricuspid valve showed no abnormalities other than a severely dilated tricuspid annulus. Ring annuloplasty was performed, and this resulted in a subsequent satisfactory course.

For treatment of Stanford type A aortic dissection, we have operated only on the ascending aorta out of consideration of operative invasions and complications. However, if only the ascending aorta is replaced, the residual distal false lumen and its dilatation become problematic. We examined the risks of postoperative dilatation of the distal false lumen in terms of the following three factors (1) patency of the distal false lumen, (2) Marfan's syndrome, (3) aortic medial degeneration. Between 1984 and 1993, 55 cases of acute and chronic type A aortic dissection were treated surgically at our hospital, and a total of 33 survivors were subsequently followed up. The mean follow-up period was 92 months. None of the survivors died of late aortic complications. Five patients (15%) had Marfan's syndrome. As a result, all 18 patients (55%) with a closed distal false lumen did not show late distal dilatation or late deaths. Marfan patients had a high incidence of distal dilatation of the aorta and required additional aortic operations. Aortic medial degeneration was a high risk factor for younger onset (>40 years old) of aortic dissection, patent false lumen, and late dilatation, not only for Marfan patients but for non-Marfan patients. Non-Marfan patients with onset of aortic dissection under 40 years of age, showed significantly high incidence of medial degeneration. In conclusion, patent false lumen and medial degeneration of non-Marfan patients is a high risk factor of late dilatation as well as those of Marfan patients. On the other hand, patent false lumen is not a risk factor of late dilatation for non-Marfan patients without medial degeneration. Therefore, in both Marfan and non-Marfan patients with onset under 40 years of age, concomitant aortic arch repair should be performed because the rate of reoperation is significantly high.

Aortobronchopulmonary fistula (ABPF) caused by thoracic aortic aneurysm is uniformly fatal if not treated surgically. Here we report 12 cases, and discuss the cause, surgical treatment, and results. Between 1993 and 1998, we encountered 12 cases of ABPF. ABPFs were complicated by (A) true aneurysms without infection (n=4), (B) aortic dissection (n=1), and (C) infective pseudoaneurysms occurring after thoracic aortic surgery (n=4). Three patients refused surgery. The ABPFs were located in the ascending aorta to the trachea (n=1), the distal arch to the upper lobe of the left lung (n=6), and the descending aorta to the lower lobe (n=5). They were repaired by graft replacement or patch closure. All four patients in group A have shown an uneventful course 10 patient-years after surgery. One patient in group B died of mediastinitis. The other three patients in group B were discharged from hospital, but died of sudden recurrent hemoptysis at their homes. A patient with aortic dissection underwent patch closure of an ABPF located at the distal arch, however he died of recurrent hemoptysis due to bleeding from another ABPF at the descending aorta. All of the three patients who refused surgery died of hemoptysis at various times after diagnosis. The surgical results in the non-infection group (A) were satisfactory. The group with infection (C) showed poor results after surgery and died due to recurrence of hemoptysis caused by new ABPFs arising from infected pseudoaneurysms. ABPF caused by aortic dissection (B) is difficult to repair because of severe adhesions to the lung and the unclear location of the fistula. ABPF infection is difficult to control after thoracic surgery and it is the reason for the fatal outcomes, due mainly to sudden hemoptysis. Early diagnosis and prompt surgical intervention are important for patients with ABPF.

Generally, conservative treatment is performed at the initial stage of Osgood-Schlatter disease (OSD) to decrease pain. When this conservative treatment is no longer effective, surgery will be performed to decrease OSD pain by removing a tibial tuberosity avulsed bone and a synovial capsule. We reported a time-series change of pain before and after the OSD surgery on a wrestling athlete. The present subject was a 20-year-old male wrestler (height 183 cm ; weight 90 kg), who received OSD surgery on the left knee. Numerical rating scale (NRS) was used to determine pain before and after the OSD surgery. NRS was measured by three positions : resting position (RP), sitting with knee extending position (SKEP), squat with knee flexing 90° position (SK 90 P) and pressure pain (PP). Immediately after the OSD surgery, NRS at the RP, SKEP, SK 90 P, and PP decreased from NRS 3 to NRS 0, NRS 5 to NRS 1, NRS 8 to NRS 6, and NRS 8 to NRS 1, respectively. Three weeks after the OSD surgery, pain at the SKEP and PP decreased to NRS 0. Eight and eleven weeks after the OSD surgery, pain at the SK 90 P decreased to NRS 2 and NRS 1, respectively. The present case study suggests that OSD surgery may progressively decrease pain. Further studies are needed to clarify the effect of OSD surgery on pain.

Objective: Early life events connected with the risk of later disease can occur not only in utero, but also in infancy. In study of the developmental origins of health and disease, the relationship between infantile growth patterns and adolescent body mass index and blood pressure is one of the most important issues to verify.
Materials and Methods: We analyzed the correlation of current body mass index and systolic blood pressure of 168 female college students with their growth patterns in utero and in infancy.
Results: Body mass index and systolic blood pressure in adolescence showed positive correlations with changes in weight-for-age z scores between 1 and 18 months but not with those between 18 and 36 months. Stepwise multiple regression analysis showed that both change in weight-for-age z scores from 1 to 18 months and body mass index at 1 month were significantly and independently associated with systolic blood pressure in adolescence. Body mass index at 36 months was positively correlated with body mass index in adolescence, while body mass index at birth was negatively correlated with body mass index in adolescence.
Conclusion: Our findings shows that restricted growth in utero and accelerated weight gain in early infancy are associated with the cardiovascular risk factors of high systolic blood pressure and high body mass index in adolescence. In Japan, an increasing proportion of low birth weight infants and accelerated catch-up growth after birth have been observed in recent decades. This might be an alarming harbinger of an increase in diseases related to the developmental origins of health and disease in Japan.

A Task Force team consisting of members from pharmaceutical companies --a central player to develop and implement RMP (Risk Management Plan)-- as well as health care professionals and members from academia was established in JSPE. The Task Force developed guidance for scientific approach to practical and ICH-E2E-compliant Pharmacovigilance Plan (PVP) stated in Japanese Risk Management Plan issued in April 2012 by the Ministry of Health, Labour and Welfare. The guidance contains the following topics.
1．Introduction: JSPE's activities and this task force's objectives for pharmacovigilance activities
2．How to select Safety Specification (SS) and describe its characteristics
・Selection of SS
・Characterization of SS
・Association with Research Questions (RQ)
3．How to define and describe RQ
・What is RQ ?
・RQ interpretation in other relevant guidelines
・Methodology to develop RQ for PVP with examples
・Best approach to integrating PVP for whole aspects of safety concern
4．How to optimize PVP for specific RQ
・Routine PVP or additional PVP ?
・Additional PVP design (RQ and study design, RQ structured with PICO or GPP's research objectives, specific aims, and rationale)
・Checklist to help develop PVP
5．Epilogue:
・What can/should be “Drug use investigation” in the context of ICH-E2E-compliant PVP.
・Significance of background incidence rate and needs for comparator group
・Infrastructure for the future PVP activities
6．Appendix: Checklist to help develop PVP activities in RMP
The task force team is hoping that this guidance help develop and conduct SS and PVP in accordance with ICH E2E, as stated in Japanese Risk Management Plan Guideline.

Objective：To evaluate the reliability and concurrent validity of the Walking LEVEL Scale (WaLS) in patients hospitalized in a Convalescent Rehabilitation Ward (CRW).Design：The WaLS was used as an assessment scale to categorize the walking ability of patients in a CRW.Subjects/Patients：A total of 103 patients in a CRW were included in the study.Methods：Retest and inter-rater reliability were evaluated by using the WaLS to assess patients by the same rater and by two independent raters using the weighted kappa coefficient. Spearman correlation was used to assess the correlation between the WaLS and FIM-walk item scores and the WaLS and FAC scores (i.e., concurrent validity).Results：The retest and inter-rater reliability of the WaLS (weighted kappa coefficient) was 0.989 (p＜0.01) and 0.951 (p＜0.01), respectively. The WaLS scores were also significantly correlated with the FIM-walk item (p＝0.916, p＜0.01) and FAC scores (p＝0.919, p＜0.01)．Conclusion：The WaLS was found to demonstrate good reliability and concurrent validity in patients hospitalized in CRW.