Since 1998 the Synthetic Personality Inventory (SPI), a well-established aptitude test, has been used to select residents at St. Luke's International Hospital. The aims of our study were to analyze the association of the SPI with several characteristics of residents, e. g., intellectual capability, results of examinations in medicine, and evaluation during 2 years of residency, and to clarify the significance of the SPI for selecting residents. General mental ability measured with the SPI was strongly correlated with the intellectual capability of residents but was not correlated with results of examinations in medicine. High scores for general mental ability, for activity, and for tendency of extroversion were correlated with high evaluations of residents for 2 years, whereas a cooperative personality, reasoning ability, and practicality were related to an improvement in grades from the first to second years. These results demonstrate that the results of the SPI are correlated with several characteristics of residents.

From March 1981 to March 1990, 61 patients with Stanford type B acute aortic dissection were initially treated by conservative therapy. Among these 61 patients, the dissected lumen became occluded due to thrombosis early after diagnosis in 25 patients (Group T) and remained patent in 36 patients (Group P). Twentythree patients in Group T (92%) and 22 patients in Group P (61%) were discharged without major complications related to acute aortic dissection. However, 2 patients in Group T (8%) and 14 patients in Group P (39%) required additional surgical therapy or died during hospitalization. The mean aortic diameter at the time of admission in Group T was smaller than that of Group P (38±3mm vs 43±7mm, p<0.05). During the observation period, there was a tendency for the diameter of the dissected aorta in Group T to decrease, but to increase in Group P. Long-term survival appeared to be better in Group T than in Group P, but there was no significant difference in the overall survival curve. Large aortic diameter at the time of admission and the presence of a true thoracic aortic aneurysm were major contributing factors influencing the prognosis. A long-term follow-up study showed that the dissected lumen reduced or disappeared in 14 of 23 patients in Group T (61%) but only 2 of 16 patients in Group P (12.5%). We concluded that the patients with small dissected aortas and thrombosed dissected lumens (Group T) can recuperate only with conservative therapy. However, patients with large dissected aortas and patent dissected lumen (Group P) may require surgical therapy even in Stanford type B aortic dissection.

We have carried out a health developing project for three years at two flat rural areas in Ibaraki prefecture, O in Ushiku town and N in Iwai city, taking female farmers as the subjects.
As a result, people in these areas obtained by developing reciprocal assistance a belief in selfsupport and knowledge of diseases, which lead to remarkable progress of their health such as improvement of nutrition and cosolidation of agricultural and life environment. Some observations in the study are discussed below.
1) In the two areas, the number of people with no abnormality increased while those requiring care decreased, The number of people to be treated or under treatment was nearly unchanged, probably because of chronic deseases. No death and complication occured during the three years.
2) Owing to the difference between O and N areas in the age structure of examinees, areal characteristics and types of agricultural products, the results of health examinations in these two areas were somewhat different.
3) The health developing project will become more effective if male farmers participate together with the female farmers.
4) Continuation of the health care activity in these areas will establish voluntary organizations of residents.

This study examined relationships between physical activity and sleep relative to leisure-time, household, and occupational physical activity in community-dwelling, older adults. From 3,000 randomly chosen community-dwelling, adults, aged 65-85 years, we recruited 509 eligible subjects (mean age 73.2 ± 5.1 years). We assessed nocturnal sleep duration, sleep onset latency and subjective sleep quality over the previous month through a questionnaire. Physical Activity Scale for the Elderly was used to assess leisure-time, household, and occupational physical activity. Items pertaining to sleep were expressed as dichotomous variables (good/poor), and each physical activity score was divided into two categories based on activity level. To investigate the relationship between sleep (dependent variable) and physical activity (independent variable), we used a logistic regression analysis, controlling for age, gender, living arrangement, depressive symptoms, and cognitive function. Prolonged sleep latency was significantly related to no participation in low intensity exercise (OR 2.14; 95% CI 1.42-3.21) and muscle strength exercise (OR 1.99; 95% CI 1.06-3.74). Our data suggest that not participating in low intensity exercise or muscle strength exercise may be associated with difficulty initiating sleep in older adults.

Among 62 patients who underwent hybrid arch TEVAR, which is a combination of supra-aortic bypass and TEVAR to treat arch aneurysm, 5 patients encountered postoperative cerebral infarction. In 2 patients, whose thoracic aorta were extremely shaggy, cerebral infarction were multiple and fatal. Other 3 patients, whose aorta were not shaggy, developed visual disturbance after TEVAR and minor cerebral infarction were detected in the area of vertebral artery. To prevent cerebral infarction after hybrid arch TEVAR, the blood flow from the left subclavian to vertebral artery is considered to be significant.

We report the rare case of a 68-year-old man, who was admitted to our hospital with a diagnosis of aortic arch anastomotic pseudoaneurysm, with concomintant aortic root enlargement and coronary artery stenosis. Eleven years previously, at age 56, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed redo total arch replacement, aortic root replacement and coronary artery bypass, making use of a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery and femoral vein before resternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation ; however, he was discharged in good condition on the 50th post-operative day. The case suggests that island reconstruction has the potential to cause an aortic arch pseudoaneurysm, particularly after a long postoperative period of time. Therefore, thorough postoperative care strategy is required. We also need to consider surgical reconstructive techniques which eliminate vascular lesions as much as possible at the time of the primary surgery, particularly in cases of chronic aortic dissection.

Objective：The aim of this study was to examine the relationships between the timing of gait acquisition and the length of hospitalization, and to clarify the differences in background factors and functional recovery during the early postoperative period and their effect on the variability in gait acquisition.
Methods：We recruited 148 patients who underwent total knee arthroplasty (TKA) at three hospitals. The participants were divided into two groups on the basis of the number of days needed to achieve independent gait at ≤14 days after surgery (group A) and ＞14 days after surgery (group B). We compared the background factors between the two groups. Additionally, we compared the preoperative and postoperative function in each group.
Results：We observed a significant positive correlation between the number of days needed to achieve independent gait and the length of hospitalization. In group A, the significant background factors were younger age and higher preoperative activity level. In group A, compared with the level of preoperative function, the postoperative maximum knee extension angle on the operated side and pain had significantly improved. In both groups, the postoperative knee extensor strength on the operated side, knee extensor strength on the nonoperated side, knee flexion strength on the operated side, maximum knee flexion angle on the operated side, and walking speed were significantly reduced.
Conclusion：During early rehabilitation, it is necessary to consider the age and previous activities of patients. In addition, we suggest that early rehabilitation with a focus on reducing pain by alleviating inflammation and improving maximum knee extension angle on the operated side may be effective for fast acquisition of gait.

Objective：To elucidate factors associated with physical function and clarify the actual condition of functional deterioration in patients with knee osteoarthritis (OA) prior to total knee arthroplasty (TKA)．

Methods：We enrolled 467 patients with severe knee OA and preoperatively assessed the following parameters：background factors (sex, age, BMI, K-L grade, and pain) and physical function (muscle strength of knee extensors and flexors, and knee joint angles). A multiple regression analysis was performed to determine the relationship between the independent background factors and dependent physical functions. The median of preoperative function based on selected factors of physical function was calculated.

Results：Based on the multiple regression analysis, sex, BMI, K-L grade, and pain statistically significantly correlated with muscle strength of knee extensors and flexors. Sex and BMI statistically significantly correlated with knee joint flexion angle. K-L grade statistically significantly correlated with knee joint extension angle. The median of muscle strength for knee extension was 0.98/0.92 Nm/kg (Grade 3/Grade 4) for males and 0.70/0.59 Nm/kg for females. The median of muscle strength for knee flexion was 0.53/0.45 Nm/kg for males, 0.36/0.30 Nm/kg for females. The median for knee joint flexion angle was 130° for males and 120° for females. The median for knee joint extension angle was -5°/-10° (Grade 3/Grade 4)．

Conclusion：We clarified the degree of muscle strength and range of motion before TKA in patients with knee OA. We believe that the findings obtained in this study will contribute to explaining the functional deterioration of patients with knee OA.

Congenital heart disease of partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly was very rare. 21-year-old man, who was pointed out heart disease 6 months ago, was diagnosed as partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly by cardiac catheterization and angiography. The patient underwent surgery through the left forth intercostal incision without cardiopulmonary bypass. The end-to-side anastomosis was made between the vertical vein and the left atrial appendage following ligation of the vertical vein near the innominate vein. Surgical treatment was satisfactory in the postoperative angiography which was shown widely patent anastomosis. He was discharged with uneventful postoperative course and returned to full activity.