To respond to the physician shortage, the capacity of medical schools has been increased through selective admission of student to practice in medically underserved areas; however, neither a system nor a curriculum for such students has been established. At Nagoya University, selected students have been admitted, and the division of Education for Community–Oriented Medicine was established in fiscal year 2009. We have introduced special curricula for these students, such as a seminar for community–oriented medicine, training for medical research, local hospital tours, and a special interprofessional education course. In fiscal year 2013, community medicine is expected to be implemented as a compulsory subject in the 4th year curriculum. For the education of students selected to practice in medically underserved areas, we believe that older students serving as role models and cooperation with other organizations and community are important.

　In the coming ″Super-aging society″ , collaboration between medical professionals and health workers in home-care will be critical. Thus, undergraduate interprofessional education is important for the improvement of a collaborative attitude. We ran a 2-day IPE program for a medical and a rehabilitation student focused on collaboration for patients who have chronic diseases and problems in Activities of Daily Life (ADL) . As a result, one showed marked improvement in ADL while the other did not. Students learned not only roles and perceptions of other professionals but also a sense of worth and an appreciation of the difficulty of patient-centered home-care.

We encountered a case of ruptured sinus of Valsalva aneurysm caused by an unusual event. A 38-year-old-man was referred to our hospital owing to cough and orthopnea after being struck in the chest while playing baseball. Echocardiography showed a ruptured right sinus of Valsalva aneurysm and ventricular septal defect (VSD). Intraoperative findings revealed rupture of the sinus of Valsalva aneurysm into the right ventricle, with a typical “windsock” appearance. The fistula and VSD were closed with Dacron patches at both the right coronary cusp and right ventricular outflow tract. The patient was discharged on the 11th postoperative day without any complications.

  Teaching hospitals play an increasingly important role in clinical training, and improvement of the education system is required. To effectively utilize limited human and material resources for clinical education and to enhance clinical education and medicine treatment throughout a region, cooperation between hospitals is essential. However, cooperation for clinical education training beyond prefectures or training hospitals cannot be said to be sufficient. The Kisogawa Medical Conference, a collaborative system of 5 training hospitals located around the Kiso River estuary, held medical lectures, hands–on seminars, and joint–hospital case conferences. Cooperation in medical education training and exchanges beyond prefectures and training hospitals is expected to lead to substantial improvements, not only in medical education training, but also in medical care throughout a region.

  In scenarios developed by a multidisciplinary faculty for interprofessional education, practical problems that emerged included: “medical incident” and “shortage of medical resources” from the perspective of patient and families,” and “information sharing,” “evaluation and feedback,” and “insufficient feeling of accomplishment” from the perspective of health-care professionals. Discussions identified “interprofessional collaboration,” “mutual understanding for professionalism,” and “embodiment of professional culture” as key words for problem solving. Finally, scenarios were developed in the hospital, home-care, nursing, or community care settings that referred to 2 themes, “end of life” and “dementia.” Pilot case studies performed with health care professionals demonstrated the utility of the scenarios and the effectiveness of interprofessional education.

Objectives: To study the effect of astaxanthin contained drink to skin conditionMethod: The study was conducted to the Japanese females between age over thirty to less than fifty , who had weakening of skin (including aging, sag and dry skin) and skin dullness. In order to conduct the objective evaluation, the comparison between the groups by the double-blind test was taken. Twenty of subjects were randomly allocated to the intake group of astaxanthin contained drink (astaxanthin 3mg contained) and the placebo group. After eight weeks intake of the drink, each group was evaluated with skin water contents, transepidermal water loss, skin elasticity, VISIA and skin texture etc.Result: In between the groups, the intake group of astaxanthin contained drink was greatly excellent in the categories of skin moisture, transepidermal water loss, skin elasticity , erythema dose and skin texture.Conclusion:Astaxanthin has protecting effect of skin barrier and is considered to increase the water retention capability to reduce skin dryness. Astaxanthin is also effective to erythema dose, skin elasticity and skin texture.　As no adverse events resulting from the test drink was seen, such food containing astaxanthin is considered as a safe and useful health functional food material to skin.

A 27-year-old man who presented with worsening dyspnea was transferred to our hospital due to congestive heart failure with multiple organ dysfunction. Echocardiogram showed severe left ventricular systolic dysfunction and a huge thrombus in the left ventricle. An urgent operation was performed to remove the thrombus simultaneously with the placement of bilateral extracorporeal ventricular assist devices. After the operation, despite a rapid improvement in the liver function, renal dysfunction persisted and he remained anuric for nearly a month. We continued maximal circulatory support with biventricular assist device to optimize his end-organ function. His renal function gradually improved, allowing him to be registered as a heart transplant candidate on the 140th postoperative day. On the 146th postoperative day, the patient underwent successful removal of the right ventricular assist device, and the left extracorporeal device was replaced by an implantable device (HeartMate II). He was discharged 78 days after the implantation. We present here a case where adequate support with biventricular assist device enabled a successful bridge to transplantation even in a patient with end-stage heart failure having end-organ dysfunction.

1)A workshop to promote interprofessional health–care collaboration in the community is reported.
2)The three topics discussed were: "the needs of an interprofessional network in the community," "barriers that can prevent the promotion of an interprofessional network in the community," and "strategies to overcome the barriers."
3)The critical issues identified were, communication, information sharing, and leadership. Working to improve the health–care system and clarifying and promoting the significance of an interprofessional network were also identified as critical issues.

In 2004 a program of community health and medicine was included in the national residency system. However, the contents and achievements of this program have not been adequately studied. We surveyed residents, program directors, and collaborating facilities for clinical training in community medicine in the Tohoku–Hokuriku region of Japan about the contents, practices, training period, curriculum development, and other aspects of the program.
1)We conducted a survey of 230 residents who had completed the program, 82 program managers, and 101 collaborating facilities.
2)The survey consisted of surveys of residents (survey 1), of program directors (survey 2), and of collaborating facilities (survey 3) and asked about the programs' consistency with the training objectives of the Ministry of Health, Labour and Welfare and satisfaction with community medicine.
3)Approximately 70% of residents, program managers, and collaborating facilities believed the training period for community medicine is appropriate.
4)Furthermore, 69.1% of residents, 65.5% of program directors, and 85.2% of facilities believed that the community medicine program in the national system was important or very important.
5)Training programs should be enhanced so that residents "understand and practice health care in outlying and rural areas" and to increase active involvement of program directors.

We reported a rare case of myxoma originating from the anterior leaflet of the mitral valve. A 65-year-old woman was admitted with sympotomes of easily fatigability and palpitation. On auscultation, a grade II/IV systolic murmur was audible at the apex. Echocardiography demonstrated a dense mass arising from the anterior mitral leaflet. The tumor (16×13×10mm in size) was resected from the anterior leaflet of the mitral valve. There was no definite evidence of a tumor stalk on the mitral valve nor valve regurgitation after the operation. Microscopically, polyhedral cells were recognized, indicating myxoma. The postoperative course was uneventful and no recurrence has been noticed during the past 6 years.