This study was intended to examine the specific nature and an aerobic value of jumping jacks (Fig. 1) which has a greater movement in shoulders and is easy to perform in standing position without specific skill and equipment and in also a narrow place.
Individual's self-selected (free) tempo in jumping jacks was determined for 92 subjects by administering it for 5 minutes.
The optimal tempo was obtained from measuring energy expenditures on two subjects when they performed five minutes of jumping jacks at each tempo of 50, 60 and 70 times/min and also at one's free tempo. Exercise intensity of jumping jacks as a general endurance activity was determined from energy expenditures and % Vo₂2max of 9 subjects who performed 5 minutes of jumping jacks at 60 times/min. Training effect of jumping jacks was examined on the basis of the changes in Vo₂max and heart rate (jumping jacks at 60 times/min for 3 min) before and after one month of training on 7 subjects who participated 180 jumping jacks at free tempo a day, averagely 6.3 times a week. Subjects were all college male students aged between 18 and 22. Followings are the results obtained in this study.
1) Individual's self-selected (free) tempo in jumping jacks was about 60 times/min.
2) The optimal tempo in jumping jacks determined on the basis of energy expenditure was also about 60 times/min.
3) Oxygen requirement and RMR at the optimal tempo (60 times/min) in jumping jacks were 40.9 ml/kg/min and 12.3, respectively. Percent Vo₂max, Oxygen requirement and RMR in jumping jacks was smaller for persons who have greater Vo₂max/body weight.
4) One month of training by jumping jacks demonstrated significant increases in Vo₂max and Vo₂max/body weight, which were 2.59 to 2.751/min (p<0.01) and 43.5 to 46.1 ml/kg/min (p<0.05), respectively. Significant decreases in heart rate were also observed during and recovery after the exercise.
5) From above results, jumping jacks could be used as an effective general endurance exercise, provided that some necessary modifications should be made according to each individual's fitness level.

Since April 1992 we have introduced a beclomethasone dipropionate (BDP) inhalation therapy with a large spacer for patients with bronchial asthma who were admitted to the internal medicine department of our hospital because of the exacerbation of asthma.
To find out the effect of this BDP inhalation therapy, we investigated the number of emergency room visits by the patients with bronchial asthma who had been admitted to our hospital with asthmatic attacks before and after the introduction of the new therapy.
From April 1991 to March 1994, the proportion of asthma patients decreased significantly (p<0.05): from April 1991 to March 1992 (before the introduction of the BDP inhalation therapy) 10.4±3.0%; from April 1992 to March 1993 5.3±1.4%, from April 1993 to March 1994 3.7±1.4%.
We checked the inhalation technique of 21 patients who visited our hospital regularly during the same period. The BDP therapy could decrease the number of emergency-room visits by 10 patients whose inhalation technique was imperfect, as well as by the other 11 patients whose inhalation technique was perfect.

Based on the assessment of the home health care services provided by our hospital over the past five years and the results of a survey of the people concerned, we studied the problems of home care and dwelt on what it should be in the future. An alarming fact was brought to light: Many of those who look after patients in their homes are stress-ridden. Even among those who said they are satisfied with the present care system, not a few expressed uncertainty about the future. Many were of the opinion that without option of putting the patients in hospitals or nursing homes if need be, the home health care system would not hold water.
Our hospital admits only those patients who are badly in need of hospital treatment, and technically many cases cannot be referred to general practitioners. To add to the development of home health care, it is necessary to establish a coll aborative system between hospitals and neighborhood clinics. Under the system, patients will be screened according to the degree of their need for medical care, and visiting nurses will be able to show their skill fully and provide care confidently while keeping close contact with physicians.

Between February 1999 and November 1999, 33 patients (age 67.0±7.6 years old) underwent off-pump CABG using coronary shunt tubes. The number of graft anastomoses per patient was 2.8±0.8. The operative mortality was 0%. There was no incidence of on-pump conversion, low cardiac output syndrome, IABP insertion, mediastinitis or stroke. The maximum CPK-MB during the perioperative period was 25.9±18.8IU/l. One patient had perioperative myocardial infarction probably due to native coronary artery spasm. In patients with off-pump CABG, the intubation time, the ICU stay and the hospital stay were shorter. The number of patients who were extubated in the operating room was higher and the cost was lower than those with on-pump CABG. An early phase study revealed patency ratios of 85% (the previous term) and 97% (the latter term). Off-pump CABG is a safe and effective means of revascularization with no mortality, minimal morbidity and good short-term patency.

Nephroblastomatosis (NBM) is a precursor of Wilms tumor. We herein report a case in which Wilms tumor was initially suspected and the affected kidney was removed.The tumor was subsequently diagnosed as intralobar NBM and a favorable outcome was achieved with postoperative chemotherapy. A 2-year-old boy who presented with gross hematuria was found to have an enlarged left kidney with hydronephrosis.Needle biopsy of the left kidney suggested Wilms tumor and left nephrectomy was performed. The tumor was histopathologically diagnosed as intralobar NBM.Although NBM is regarded as a precancerous lesion, a definite treatment plan has not yet been established. In the present case, we used a similar chemotherapy regimen to that for Wilms tumor. Eight years after the completion of chemotherapy, Wilms tumor has not developed or recurred. Appropriate management plans need to be developed by accumulating similar cases.

We developed an educational program on cultural competence for psychiatric professionals. Regarding social justice education that critically questions dominant ideologies, we held weekly 30-minute discussion groups with multidisciplinary professionals. Rather than focusing on a particular culture group, we aimed to realize through critical self-reflection, as advocated by Kumagai and Lypson, that “there is a part of the other that I cannot know,” and named this group the “Discussion Group on Otherness.” Using essays on medical culture written by researchers in the medical humanities as our main teaching material, we discussed what is (or should be) the relevant problem. This article discusses the issues that have emerged so far, the responses to these issues, and future developments.

The first author set up a study group with other members in 2014, aiming to improve multidisciplinary collaboration through reflection and discussions on discomfort ( “Moyatto” in Japanese) while focusing on group members’ experiences at work. One-hour online sessions were conducted monthly with multidisciplinary professionals from several institutions. We reflected on interprofessional collaboration based on Moyatto. This paper describes the history of the study group’s inception and development, the learning process of each session, and the theory as a framework. It also reports on the practice and changes in our study group, concluding that interprofessional collaboration requires first-order reflection within a same-profession group and second-order reflection among diverse professionals.

We had previously reported a close association between pathological response and the maximum tumor standardized uptake value (SUVmax) measured by 18F-fluorodeoxyglucose positron emission tomography prior to chemotherapy in estrogen receptor (ER)-positive breast cancer. We hypothesized that glucose hypermetabolism by luminal B tumors may result in chemotherapy responsiveness. Using a single-gene expression assay, TargetPrint(R) (Agendia) and a 70-gene expression classifier, MammaPrint(R) (Agendia), we divided 20 patients with ER-positive primary breast cancer into luminal A and luminal B subtypes and compared the tumor SUVmax value between the two groups. A significantly higher SUVmax was measured for luminal B tumors (n=10; mean+/-SD, 7.6+/-5.6) than for luminal A tumors (n=10; mean+/-SD, 2.6+/-1.2; p=0.01). Glucose hypermetabolism could help predict intrinsic subtyping and chemotherapy responsiveness as a supplement to ER, progesterone receptor, HER2, and Ki-67 histochemical scores.
Breast ; Breast Neoplasms ; Estrogens ; Glucose ; Humans ; Phenobarbital ; Positron-Emission Tomography ; Receptors, Progesterone

A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.
Adenocarcinoma* ; Biopsy ; Endoscopy ; Endosonography ; Gastrectomy ; Gastric Mucosa ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Middle Aged ; Mucous Membrane ; Neoplasm Metastasis*

The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as grade 1 (strong) or grade 2 (weak) according to the concepts of the grading of recommendations assessment, development, and evaluation system. The 31 CQs covered the six topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, and (6) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.