The Ministry of the Environment is promoting an Onsen Stay policy, is suggesting long stays at spa health resorts and is working on activation in a spa from 2017. What kind of program can be carried out to accept long stay guests at the spa which fills the capacity of the health resort? Programs targeted for Gero Spa, the Osaka hot spring village (Yuya Spa, Shimojima Spa and Nigorigo Spa), Yuwaku Spa, the Hakusan hot spring village (Tedori Spa, new Iwama Spa, Ichirino Spa and Chugu Spa) and Yunokuchi Spa were investigated in this survey.  The necessity of creating a space of relaxation suitable for a stay was shown to add new space value and experience value when the area resources including the ambient surroundings in a spa were utilized for long stays in a thesis of Shimomura, who studied the spatial form of the spa and the spatial structure, and in an Onsen Stay promotion plan of the Ministry of the Environment.  In the above-named 10 spas the extent to which space value and experience value was added was investigated by listening to the guests concerned and by a local inspection of whether such a program was carried out. Since the program’s implementation in Gero Spa, the Osaka hot spring village and Ichirino Spa, as a result, I found that the long-stay program was feasible. But I also found that there are almost no long-stay guests who utilized the program because needs weren’t taken into consideration in the utilization. In high plains areas in the mountains, I also found that eco-tourism is considered as a stay plan and that town walks utilizing cultural facilities in downtown, walks and day trips to the surrounding scenic and recreation spots are considered as a stay plan in the newly-formed spa towns.  I suggest that an investigation in spas where long-stay programs have been put into effect is the next necessary step in this research.

  In the present day when the space structure of the spa has been transformed, creation of a relaxation space appropriate for a long stay is in demand. The Onsen Stay promotion plan of the Ministry of the Environment calls for the creation of an expanded relaxation space and experience which utilizes local resources including the ambient surroundings. Furthermore, in the present age, which is said to be a stress society, there is room for the viewpoint that “existence of high-quality communication with the external environment of a spa relieves stress”. This justifies our investigation into whether there is a situation that the external environment of the spa is applied as a relaxation space for long stays.  Therefore, in national hot spring health resorts designated as the spas that promoted the Onsen Stay policy, I investigated what kind of program was carried to raise demand for a long-term stays. In this report, I investigate and report on Ruri Highland spa, Hamasaka spa, Umegashima spa, Hatake spa, Hirayu spa, Tazawa spa, Kakeyu spa, and Ichirino spa. I clarified that there were five methods for the making of programs to raise stay demand. Combinations of these five are possible. And I clarified that if these methods analyzed the external environment of the spa appropriate for a long stay, stay demand might be raised for a long term, as shown by an example.  I concluded that the possibility of long stays is raised when the external environment including cultural history resources and surroundings nature were utilized, including the creation of various walks and walking courses.

Coronary artery obstruction, pulmonary stenosis, aortic valve regurgitation, and enlargement of the neo-aortic root are major complications of arterial switch operation (ASO) for transposition of the great arteries (TGA). Supravalvular aortic stenosis following ASO is rarely reported, and technical factors should be considered as causes in such cases. We report a case of supravalvular aortic stenosis following ASO, in which we speculated that the cause of the stenosis was tissue overgrowth caused by the surgical suture. The patient was a 4-month-old girl with TGA (II) who had undergone ASO on the 12th day after birth. Neo-aortic anastomosis was performed with 7-0 polydioxanone absorbable suture (PDS^®, Ethicon, Somerville, NJ, USA). Transthoracic echocardiography performed 1 month after the surgery showed severe stenosis at the aortic anastomosis which worsened progressively. Therefore, the patient was reoperated 4 months after the previous surgery. The concentrically stenosed aortic wall at the anastomotic site was resected and aortic reanastomosis was performed using an interrupted suture pattern with 7-0 polypropylene (Prolene^®, Ethicon). The histological findings showed proliferation of collagenous fibers around the PDS^® suture. Because of the worsening stenosis over time and the histological findings, we speculated that the tissue overgrowth in reaction to the PDS^® suture was the main cause of the stenosis. Absorbable sutures are useful because they do not leave a foreign substance in the body ; however, the possibility of tissue overgrowth leading to anastomotic stenosis cannot be denied. When using absorbable suture, careful observation is mandatory until the material is completely absorbed.

  The Ministry of the Environment’s the Onsen Stay policy calls for the creation of a plan to increase the demand for long-term stays in spa health resorts. A report on the development of such plans, focusing on spa health resorts, has been published. According to the report, it was suggested that five external environments around the spa resort should be utilized in combination with each other, namely: making the most of the natural environment, making the most of the historical and cultural environment, making the most of the artificial environment and facilities, making the most of different environments by moving around, and making the most of the nighttime hours. In this report, I will try to verify whether these five types of programs are appropriate or not by using the program for a stay in the national park resort village. In addition, I will evaluate whether the proposed program will enhance the demand for a stay in the national park resort village, and suggest improvements.  The 11 national park resort villages in this report are Retreat Azumino Hotel, Norikura Kogen, Minami-Izu, Fuji, Noto-Senrihama, Echizen-Mikuni, Omihachiman, Minami-Awaji, Takeno Kaigan, Nanki-Katsuura, and Hiruzen Kogen.  I confirmed the validity of the five types, and the necessity to create a program for a stay in these villages by making the best use of the five external environments of the spa. In addition, it was shown that the importance of the program was not so much the diversity of the external environment of the spa along the walking course, but rather the nearness to the place of origin and destination and the sustainability of the program as well as the time to complete it.

  The author has researched and reported on “Efforts to increase the demand for long-term stays in spa resorts” over three reports up until now. The target areas were spa health resorts and national park resort villages with spas. There, I pointed out the necessity to create programs for stays that combine the natural environments, historical and cultural environments, artificial environments and facilities, different environments by moving around and night-time hours that exist around each stay facility.  In this repot, I investigated the creation of programs for public Kokumin Shukusha, which are dormitories for the people who can stay with peace of mind, even with their families, at a low cost. I investigated whether or not efforts are being made to create programs for staying, such as setting walking trails that make use of external environments around the public Kokumin Shukusha.   As a result, although efforts were made, the number and diversity of course settings were insufficient. In order to increase the demand for long-term stays, it will be necessary to utilize the external environment that make the most of the nearness to existing villages. In addition, it became clear that the Onsen Stay policy promoted by the Ministry of the Environment has not been publicized, and it is necessary to promote the publicity of this policy in order to revitalize spa resorts nationwide.

  The author has researched and reported on “Efforts to increase the demand for long-term stays in spa resorts” over three reports up until now. The target areas were spa health resorts and national park resort villages with spas. There, I pointed out the necessity to create programs for stays that combine the natural environments, historical and cultural environments, artificial environments and facilities, different environments by moving around and night-time hours that exist around each stay facility.  In this repot, I investigated the creation of programs for public Kokumin Shukusha, which are dormitories for the people who can stay with peace of mind, even with their families, at a low cost. I investigated whether or not efforts are being made to create programs for staying, such as setting walking trails that make use of external environments around the public Kokumin Shukusha.   As a result, although efforts were made, the number and diversity of course settings were insufficient. In order to increase the demand for long-term stays, it will be necessary to utilize the external environment that make the most of the nearness to existing villages. In addition, it became clear that the Onsen Stay policy promoted by the Ministry of the Environment has not been publicized, and it is necessary to promote the publicity of this policy in order to revitalize spa resorts nationwide.

Methods: Male and female patients with computed tomography data were selected. Dimensions of the first thoracic (T1), fourth lumbar (L4), and fifth lumbar (L5) vertebrae were measured, and bone models consisting of the cancellous and cortical bones made from polyurethane foam were created. PS with diameters of 4.5 mm, 5.5 mm, and 6.5 mm were used. T1 PS were 25 mm long, and L4 and L5 PS were 40 mm long. The bone models were secured with cement, and the MIT was measured using a calibrated torque wrench. After MIT testing, the PS head was attached to the machine’s crosshead. POS was then calculated at a crosshead speed of 5 mm/min until failure. Results: The L4 and L5 were notably larger in female bone models, whereas the T1 vertebra was larger in male bone models. Consequently, the MIT and POS for L4 and L5 were higher in female bone models across all PS diameters than in male bone models. Conversely, the MIT for T1 was higher in male bone models across all PS; however, no significant differences were observed in the POS values for T1 between sexes. Conclusions The mechanical properties of the proposed bone models can vary based on the vertebral structure and size. For accurate 3D surgical and mechanical simulations in the creation of custom-made medical devices, bone models must be constructed from patientspecific medical images.

Methods: Male and female patients with computed tomography data were selected. Dimensions of the first thoracic (T1), fourth lumbar (L4), and fifth lumbar (L5) vertebrae were measured, and bone models consisting of the cancellous and cortical bones made from polyurethane foam were created. PS with diameters of 4.5 mm, 5.5 mm, and 6.5 mm were used. T1 PS were 25 mm long, and L4 and L5 PS were 40 mm long. The bone models were secured with cement, and the MIT was measured using a calibrated torque wrench. After MIT testing, the PS head was attached to the machine’s crosshead. POS was then calculated at a crosshead speed of 5 mm/min until failure. Results: The L4 and L5 were notably larger in female bone models, whereas the T1 vertebra was larger in male bone models. Consequently, the MIT and POS for L4 and L5 were higher in female bone models across all PS diameters than in male bone models. Conversely, the MIT for T1 was higher in male bone models across all PS; however, no significant differences were observed in the POS values for T1 between sexes. Conclusions The mechanical properties of the proposed bone models can vary based on the vertebral structure and size. For accurate 3D surgical and mechanical simulations in the creation of custom-made medical devices, bone models must be constructed from patientspecific medical images.

Methods: Male and female patients with computed tomography data were selected. Dimensions of the first thoracic (T1), fourth lumbar (L4), and fifth lumbar (L5) vertebrae were measured, and bone models consisting of the cancellous and cortical bones made from polyurethane foam were created. PS with diameters of 4.5 mm, 5.5 mm, and 6.5 mm were used. T1 PS were 25 mm long, and L4 and L5 PS were 40 mm long. The bone models were secured with cement, and the MIT was measured using a calibrated torque wrench. After MIT testing, the PS head was attached to the machine’s crosshead. POS was then calculated at a crosshead speed of 5 mm/min until failure. Results: The L4 and L5 were notably larger in female bone models, whereas the T1 vertebra was larger in male bone models. Consequently, the MIT and POS for L4 and L5 were higher in female bone models across all PS diameters than in male bone models. Conversely, the MIT for T1 was higher in male bone models across all PS; however, no significant differences were observed in the POS values for T1 between sexes. Conclusions The mechanical properties of the proposed bone models can vary based on the vertebral structure and size. For accurate 3D surgical and mechanical simulations in the creation of custom-made medical devices, bone models must be constructed from patientspecific medical images.

Methods: Male and female patients with computed tomography data were selected. Dimensions of the first thoracic (T1), fourth lumbar (L4), and fifth lumbar (L5) vertebrae were measured, and bone models consisting of the cancellous and cortical bones made from polyurethane foam were created. PS with diameters of 4.5 mm, 5.5 mm, and 6.5 mm were used. T1 PS were 25 mm long, and L4 and L5 PS were 40 mm long. The bone models were secured with cement, and the MIT was measured using a calibrated torque wrench. After MIT testing, the PS head was attached to the machine’s crosshead. POS was then calculated at a crosshead speed of 5 mm/min until failure. Results: The L4 and L5 were notably larger in female bone models, whereas the T1 vertebra was larger in male bone models. Consequently, the MIT and POS for L4 and L5 were higher in female bone models across all PS diameters than in male bone models. Conversely, the MIT for T1 was higher in male bone models across all PS; however, no significant differences were observed in the POS values for T1 between sexes. Conclusions The mechanical properties of the proposed bone models can vary based on the vertebral structure and size. For accurate 3D surgical and mechanical simulations in the creation of custom-made medical devices, bone models must be constructed from patientspecific medical images.