1) Anjo Kosei Hospital has nearly 40 years of history of the post-primary clinical training course.
2) More than 90% of the young doctors, passed through 2 years of the primary clinical training course, have chosen further training at Anjo Kosei Hospital. During this course they began to start the experience for their own career for specialist.
3) This education program is closely coordinated with Medical Colleges such as Nagoya University and Nagoya City College of medicine. After 4 or 5 years of training at Anjo Kosei Hospital, they continued their training at Nagoya University Hospital or Nagoya City College Hospital for the further career.

Pulmonary vein isolation procedure was performed for atrial fibrillation associated with mitral valve disease in twelve patients. This simple procedure consisted of only isolation of the four pulmonary veins. Combined mitral valve surgery consisted of mitral valve plasty, mitral valve replacement with or without aortic valve replacement and tricuspid annuloplasty. Ten patients returned to a sinus rhythm. Two patients required DDD pacemaker implant for sick sinus syndrome. Left atrial contraction was detected in eight cases by trans-esophageal echography. Compared with the maze procedure, this operation was less invasive and preserved atrial appendage, helping to maintain normal secretion of atrial natriuretic peptide. This study suggests that the pulmonary vein isolation procedure may be an effective and simple maneuver for atrial fibrillation associated with mitral valvular disease.

A 75-year-old man who presented with fever and cough was given a diagnosis with active pulmonary valve endocarditis and transferred to our institution. Blood cultures were positive for Enterococcus faecalis, and transthoracic echocardiography showed a mobile vegetation attached to the pulmonary valve. Despite an 8-week treatment with antibiotics, a relapse of the infection required surgery. During the surgical procedure, we found that the vegetation had destroyed all of the pulmonary valve leaflets. After excising the pulmonary valve leaflets, we implanted a bioprosthetic valve and closed the pulmonary artery with autologous pericardium. The patient completed a 6-week course of intravenous antibiotics and was discharged on postoperative day 68. Postoperative transthoracic echocardiography demonstrated an adequate effective orifice area index. Our case report of isolated pulmonary valve endocarditis without predisposing factors is rare. The implantation of a bioprosthetic valve and enlargement with an autologous pericardial patch is an effective option for achieving a satisfactory hemodynamic profile.

The present study was to evaluate endothelial nitric oxide synthase (eNOS) protein expression and hemodynamics of pulmonary circulation in rats of "Living high and Training low" (LH+TL). The Sprague Dawley strain of male rats were used at the age of 9 weeks. They were divided according to four conditions of a living low (LL) group, living low and training low (LL+TL) group, living high (LH) group and LH+TL group, for 10 days. We assessed the effects of LH+TL on exercise-induced pulmonary arterial pressure and blood lactic acids under sea-level altitude in catheter-implanted conscious rats. Also, we measured the pulmonary artery under anesthesia and analyzed eNOS protein expression by western blot analysis. The blood lactate levels in the LH+TL rats decreased after maximal treadmill running compared to LL, LL+TL and LH rats (p<0.05). The increase in pulmonary arterial blood pressure with exercise was significantly lower in the LH+TL group than in the LL group (p<0.05). The eNOS protein expressions of pulmonary artery were higher in the LH+TL group than in the LL group (p<0.05). This study indicates that LH+TL reduced the increase of pulmonary arterial blood pressure with exercise at below sea-level altitude. In addition, eNOS protein expressions were enhanced in the pulmonary arteries of LH+TL rats. Thus, we conclude that the high altitude training of LH+TL was a useful method for improvement of endurance exercise ability and this improvement may be associated with pulmonary arterial response.

A 29-year-old female with aortic regurgitation associated with aortitis syndrome and severe stenosis of bilateral carotid arteries was reported. She had no symptom of brain ischemia, although an aortogram revealed complete occlusion of the left common carotid artery and the left subclavian artery, and severe stenosis of the right common carotid artery. The intracranial major arteries were perfused totally by the right vertebral artery via collaterals. The transcranial Doppler method and perfusion cintigraphy revealed normal cerebral perfusion. Therefore, we performed conventional aortic valve replacement without reconstruction of carotid arteries. During cardiopulmonary bypass, the mean systemic blood pressure was kept higher than 60mmHg under moderate-hypothermic (tympanic temperature: 25°C) pulsatile perfusion with monitoring of the left middle cerebral artery flow velocity. The patient did not develop any cerebral complications during or after the operation.

Objective: The purpose of this study was to examine the effects of Coenzyme Q10 (CoQ10) supplementation on salivary secretory immunoglobulin A (SIgA) and health-related Quality of Life (QOL) in middle-aged and elderly individuals. Methods: Sixty healthy middle-aged and elderly individuals were assigned randomly to a CoQ10 supplementation group (n = 30) or a placebo supplementation group (n = 30) using a double blind method. Subjects took 150 mg CoQ10 or placebo per day for 8 weeks. Salivary SIgA secretion rate and SF-36 test (physical and mental health-related QOL) were determined before and after the intervention. Results: CoQ10 group showed that a tendency to increase of salivary SIgA secretion rate (p = 0.08), although placebo group did not show significant change. Physical health-related QOL did not significantly change in both groups. Vitality and mental health scores, which were subscale of mental health-related QOL, were significantly increased after the intervention in CoQ10 group (p < 0.05), although placebo group did not show significant change. Conclusion: 8 weeks of CoQ10 supplementation may bolster SIgA-mediated oral immunity and mental health-related QOL in middle-aged and elderly individuals.

To demonstrate delayed neuro-toxicity of organophosphate, we administered 13 types of organophosphorous pesticide to hens. Initially, a screening test was performed with nine varieties of the chemical product. Later, four types were given to the fowls. Those hens dosed with S-Seven and Surecide developed ataxia and other neurophatic symptoms in the lower limbs.
After 50 days of observation, all the hens were killed and anatomized. Phathohistological examination revealed various changes in the hens that developed neuropathic symptoms: atrophy, diminution and disappearance of nerve cells in the anterior horn of the spinal cord ; edematous changes in the myelin; swelling of the neuroglia ; atrophy and vaculolar degeneration of liver cells; and necrobiosis of nepaticlobures.
It was found that these changes are closely related with the development of ataxia and doses of the chemical.
It was also found that the pathotistological changes occurred to a less extent in those hens which did not develop toxicoses.

The relationships between physical activity and childhood body size, low physical fitness epidemic are still unclear. The purpose of this study was to examine the relationship between energy expenditure estimated by doubly labeled water (DLW) method and body fatness, physical fitness in children, and the relationship between physical activity levels and percent time spent in activities. 30 healthy Japanese children (20 boys and 10 girls) participated in this study. The total energy expenditure (TEE) and % body fat were measured by the DLW method over a 6-day period. The physical activity-related energy expenditure (PAEE) was calculated as (TEE × 0.90) – basal metabolic rate (BMR). The physical activity level (PAL) was also calculated as TEE/BMR. The physical fitness tests (8 items) were applied to evaluate fitness, and scores of each test were calculated as overall physical fitness score. The TEE was 2009.8 ± 272.6 kcal/day, the PAEE was 558.4 ± 206.1 kcal/day and the PAL was 1.61 ± 0.18. TEE per weight and PAEE per weight (PAEE/wt) was significantly negatively correlated with % body fat (r = - 0.626; r = - 0.400, respectively). These results suggest that increasing energy expenditure is important for achieving adequate body size. The PAEE/wt was most strongly correlated with physical fitness score (r = 0.680). The PAL was associated with percent time spent of inactivity ( r = -0.506), light-moderate activity ( r = 0.450) and vigorous activity ( r = 0.545). It was suggested that physically active lifestyle would be necessary for childhood health.

The purpose of this study was to examine the relationships between patterns of daily physical activities measured by accelerometer and physical activity level (PAL) in children. Firstly, activity intensities during incremental exercise were measured using a tri-axial accelerometer (HJA-350IT) in twenty one children aged 10.6 ± 0.9 years. As a result of receiver-operating characteristic curve analysis, the cut-off value for discrimination between walking and running activity was set at 7.2 METs of HJA-350IT. Secondly, total energy expenditure (TEE) in daily life was measured by doubly labeled water method, and durations of lifestyle, walking, and running activities were measured by the accelerometer in 6^th grade elementary school children (11 boys and 10 girls). TEE and physical activity level (PAL) were 2,021 ± 343 kcal/day and 1.56 ± 0.17, respectively. The average durations of lifestyle, walking and running activities were 188 ± 30 min/day (50.6 ± 6.0 %), 171±28 min/day (45.9 ± 5.0 %) and 13.3 ± 7.6 min/day (3.5 ± 1.8 %), respectively. The proportion of the duration of running activity was positively correlated with PAL (r = 0.615, p < 0.01), and the proportion of the duration of lifestyle activity was negatively correlated with PAL (r = -0.439, p < 0.05). There was no relationship between the proportion of the duration of walking activity and PAL (r = 0.300, n.s.). These results suggest that running activity is important to increase PAL more than ever in primary school children.

A 62-year-old woman was admitted to a regional hospital for acute myocardial infarction. Emergency coronary angiography revealed occlusion of the first diagonal branch, and transesophageal echocardiography showed severe mitral regurgitation due to anterior papillary muscle rupture. She was transferred to our hospital in a state of cardiogenic shock despite the use of high-dose catecholamine and intra-aortic balloon pumping. We immediately performed mitral valve replacement. The patient's postoperative course was uneventful and she was ambulatory when transferred to another hospital on foot on postoperative day 19. Physicians should be aware that fatal anterior papillary muscle rupture may be caused by isolated occlusion of the diagonal branch.