X type questions have been used for the national medical licensing examination since 1997. At Tsukuba University, X type questions have been used since 1996. We compared X typeand K type questions on the basis of the percentage of correct answers and discrimination power. The average percentage of correct answers was 68.2% for K type questions and 53.1% for X type questions. However, the average discrimination power was +0.227 for K type questions and +0.257 for X type questions. These results indicate that X type questions are more difficult and are suitable for achievement tests. The estimated knowledge quantity was 2.04 for K type questions and 2.32 for X type questions. This suggests that the person writing the questions decreased the essential difficulty of X type questions.

Aerobic exercise is known to reduce pulse wave velocity (PWV), which reflects arterial stiffness. However, aerobic exercise has a depressor effect, and PWV strongly depends on blood pressure (BP). Therefore, improvement of PWV with aerobic exercise may have an indirect effect on reducing BP. In this study, the relationship between changes in BP and regional PWV measured by oscillometric and tonometry sensors before and after exercise therapy emphasizing aerobic exercise was evaluated in 46 elderly people receiving outpatient treatment for lifestyle-related diseases (7 males and 39 females, mean age : 68 years). In all subjects, BP and PWV measurements were performed before and after exercise therapy. PWV was measured between the brachium and ankle (baPWV), between the heart and femoral artery (hfPWV), and between the femoral artery and ankle (faPWV). During 6 months of exercise therapy, BP, baPWV, hfPWV and faPWV decreased significantly. By multiple regression analysis, the changes in systolic BP were extracted as factors correlated with changes in baPWV and faPWV. The changes in baPWV (r=0.639, p<0.01) and faPWV (r=0.649, p<0.01) correlated significantly with changes in systolic BP. However, changes in hfPWV were not extracted as a factor correlated with changes in systolic BP (r=0.228, p=n. s). In conclusion, exercise therapy emphasizing aerobic exercise was suggested to reduce the stiffness of both the lower limb artery (peripheral artery) and the aorta (central artery). Peripheral arterial stiffness improved concurrently with a reduction in BP as a result of exercise therapy ; but there is a possibility that the improvement of central arterial stiffness is not dependent on reducing BP.

Impalement injury of the urinary bladder, especially secondary to rectal impalement, is extremely rare. In this case, a 31-year-old man sustained a steel pipe impalement injury through his perirectal region. He presented with gross hematuria, abdominal defense, and a penetrating wound. On the basis of the computed tomography findings and abdominal defense, we suspected a through-and-through bladder perforation from the rectal space to the intraperitoneum. Laparotomy revealed a through-and-through bladder perforation as well as damage to the right ureter, 3 distinct ileal injuries, and rectal anterior, anal, and right seminal vesicle injuries. Surgical repair of each damaged site was undertaken. The prompt diagnosis and surgical repair ensured good postoperative recovery.
Adult ; Hematuria ; Humans ; Laparotomy ; Rupture ; Seminal Vesicles ; Steel ; Ureter ; Urinary Bladder ; Wounds, Penetrating

A 61-year-old man underwent percutaneous coronary intervention (PCI) for the right coronary artery. However, he had an acute onset of right neck pain and swelling after PCI. Contrast enhanced computed tomography (CT) revealed extravasation into the mediastinum and aberrant right subclavian artery. After transfer to our hospital, we performed emergency endovascular repair for iatrogenic arterial injury. His postoperative course was uneventful.

This is a case report of a 40-year-old man with leiomyosarcoma of the inferior vena cava. He had suffered from shortness of breath and edema on lower limbs over several months. Clinical examinations including UCG, CT and MRI revealed the mass in the right atrium. The stalk of mass was located near junction of the right atrium and inferior vena cava by cavography. He was operated upon using extracorporeal circulation. The tumor originated from inferior vena cava, measuring 8.5×5.5×4.8cm in size, 130g in weight, was successfully removed. Partial defect of anterior wall on the inferior vena cava was reconstructed using Gore-Tex patch. Histologically, the tumor was composed of the spindled cells with arranged bundles. Immunohistochemically, they were positive for Dessmin and Vimentin. Seven months after the surgery, he has been followed at OPD. In review of the Japanese literature to our knowledge, only 14 cases were reported including this case.

This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make endof-life decisions. The clinician’s prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician’s prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.

Objective: To investigate the effect on early mobilization in patients undergoing extra-corporeal membrane oxygenation (ECMO) and acute blood purification therapy in the intensive care unit (ICU). Methods: We conducted this multicenter retrospective cohort study by collecting data from six ICUs in Japan. Consecutive patients who were admitted to the ICU, aged ≥18 years, and received mechanical ventilation for >48 hours were eligible. The analyzed were divided into two groups: ECMO/blood purification or control group. Clinical outcomes; time to first mobilization, number of total ICU rehabilitations, mean and highest ICU mobility scale (IMS); and daily barrier changes were also investigated. Results: A total of 204 patients were included in the analysis, 43 in the ECMO/blood purification group and 161 in the control group. In comparison of clinical outcome, the ECMO/blood purification group had a significantly longer time to first mobilization: ECMO/blood purification group 6 vs. control group 4 (p=0.003), higher number of total ICU rehabilitations: 6 vs. 5 (p=0.042), lower mean: 0 vs. 1 (p=0.043) and highest IMS: 2 vs. 3 (p=0.039) during ICU stay. Circulatory factor were most frequently described as barriers to early mobilization on days 1 (51%), 2 (47%), and 3 (26%). On days 4 to 7, the most frequently described barrier was consciousness factors (21%, 16%, 19%, and 21%, respectively) Conclusion The results of this study comparing the ECMO/blood purification group and the untreated group in the ICU showed that the ECMO/blood purification group had significantly longer days to mobilization and significantly lower mean and highest IMS.

Purpose: The purpose of this study was to clarify the current status of Do-Not-Resuscitate discussions (DNRd) with terminally ill cancer patients in Japan and the psychological burden on bereaved families depending on whether or not a DNRd is performed. Method: A multicenter prospective observational study of advanced cancer patients admitted to 23 palliative care units (PCUs) in Japan was conducted, and a questionnaire survey of bereaved families was also conducted after patients died. Result: 1,605 patients were included in the analysis, and 71.4% of patients had a DNRd with doctors before PCU admission, 10.8% at admission, and 11.4% during admission. In contrast, 93.3% of family members had a DNRd with doctors before PCU admission, 48.4% at admission, and 52.1% during admission. Conclusion: Although DNRd was performed between patients and physicians in 72.3% of cases at any point throughout the course of time from before PCU admission to death, there was no evidence of psychological burden such as depression or complicated grief in the bereaved families due to patient participation in DNRd.