The purpose of this study was to examine the effects of dynamic neck muscle training using a cervical extension machine (CEM) on isometric cervical extension strength (ICES) and a cross-sectional area of neck extensor muscles.Subjects were 18 male college judo athletes divided into a control group (n=10) and training group (n=8), respectively. In the training group, dynamic neck muscle training was performed for a 6 week training period, followed by a 10 week training period. There was a detraining period of 12 weeks between the first training period and the second. The ICES was measured at eight angles using a CEM, and the neck muscle cross-sectional area was determined using magnetic resonance imaging.The ICES and cross-sectional area of neck extensor muscles in the training group showed significant increases after the second training period. In particular, the increase in the cross-sectional area was greater in the deepest layer of the neck extensor muscles (rotator, multifidus and semispinaris cervicis muscles) than in the superficial layer (trapezius muscle). In the control group, no significant changes in ICES or cross-sectional area were observed.In conclusion, it was shown that dynamic neck muscle training using a CEM was effective in developing both ICES and the cross-sectional area of neck extensor muscles, especially in the deepest layer.

The purpose of this study was to examine the effect of two kinds of neck muscle training on the isometric cervical extension strength (ICES) and cross-sectional area (CSA) of the neck extensor muscles.The subjects which were examined consisted of 22 male college judo athletes. Each was assigned to one of three groups: shrug and upright rowing training (SU); shrug, upright rowing and dynamic neck muscle training (COM); and control (CONT). The SU and COM groups trained 3 days per week for 9 weeks. The ICES and CSA of the neck muscles were measured before and after muscle training.The ICES of the COM group showed a significant increase after training. For the CSA, although a significant increase was only found in a superficial area of the neck extensor muscles in the SU group, the COM group showed significant increases in all areas.This study determined that combined neck muscle training is effective for developing the neck extensor muscles.

1) 34, 9 and 57% of the 5th year medical students participating in clinical clerkship training program agreed on the need for selecting palliative therapy, death with dignity, and euthanasia, respectively, in response to a terminal stage of malignancy.
2) 60% of medical students supported the organ transplant legislations, but only 23% actually carried an organ donor card. 26% of the surveyed students supported the Japan Society of Obstetrics and Gynecology's attitude towards preimplantation diagnosis.
3) It was pointed out that they had better educated about bioethics.

The purpose of this study was to compare two methods of CO₂ rebreathing-equilibrium method (Collier, 1965) and extrapolation method (Defares, 1958) -for determining the mixed venous CO₂ pressure (PvCO₂) during exercise. Following a sitting rest for 5 min, five healthy males performed upright bicycle ergometer exercises with work rate of 100 and 150W for 5 min. During both at rest and in exercise, PvCO₂ was measured twice to evaluate the reproducibility of both methods. The equilibrium method was performed according to that by Jones & Campbell (1982) . In the extrapolation method, instead of using the graphical analysis described by Klauaen (1965), PvCO₂ was directly calculated by applying the modified exponential equation (Defares, 1958) . In the duplicate tests, coefficient of variation was lower while correlation coefficient was higher, with increasing work rate in both methods. It was noted that these tendencies were more pronounced in the extrapolation method than in the equilibrium method. It was concluded that in contrast to the results of Auchincloss et al. (1980), the extrapolation method was more reproducible than the equilibrium method.

An increasing number of children who have ADHD are visiting pediatric clinics. In this study, we focused on the behavior of ADHD children in different situations.The behavior of ADHD children was evaluated with a specially designed checklist in a person-to-person situation in which the subject was face to face with the clinical psychologist at the counseling room and in a group situation in which the subject participated in an outdoor program organized by the Department of Pediatries of Enshu General Hospital.In the person-to-person context, all of the performance scores with respect to attention-deficit, impulsivity, hyperactivity and difficulty with communication were decreased after psychotherapy. This suggested the regular person-to-person therapy with medication could improve the behaviors and development of ADHD children. On the other hand, the hyperactivity score was increased in the group context because of a lot of stimulation. These findings suggested ADHD children’s behavior changes according to the situation, and that we should take care of them with this fact in mind.
Child ; Child attention deficit disorder ; Pulmonary evaluation ; seconds ; behavioral aspects

A 66-year-old woman complained of dyspnea due to congestive heart failure, and was given a diagnosis of severe aortic insufficiency. Antiphospholipid syndrome and idiopathic thrombocytopenic purpura (ITP) had been diagnosed with 9 years previously. We planned preoperative plasma exchange and steroid pulse infusion to reduce the level of auto-antibodies for phospholipids. The aortic valve replacement was performed safely. Anticoagulant therapy with low molecular weight heparin and oral steroid therapy was administered after the operation to avoid thrombosis or bleeding. The patient's postoperative course was stable. She was discharged without any complication. In conclusion, preoperative plasma exchange and steroid pulse infusion, postoperative anticoagulant therapy and oral steroids resulted in a favorable outcome in a case of heart surgery for a patient with antiphospholipid syndrome.

1) We investigated the patients'evaluations of the students, our management of the medical training, and the patients' recognition of our outpatient clinic education. We then requested the patients to give their opinions regarding such interviews.
2) The patients'evaluations of the outpatient clinic and the patients'recognition of our outpatient clinic education were relatively good, but some patients complained about the short duration of medical care and also expressed anxiety over the students'medical interview.
3) Many patients expressed the desire to positively participate in medical education because the patients had high expectations of the medical students.In addition, this interview training fulfilled the patients'desire to be listened to and have their concerns acknowledged.

BACKGROUND: In general practice, though patients often stop visiting ambulatory clinics of their own vo-lition despite the need for ongoing medical treatment, there is little reported research on the reasons for nonattendance in Japan. In this study, we investigated whether the patient/doctor relationship influences nonattendance rates in general practice. In addition, we investigated the reasons why patients stopped visiting the hospital.
METHODS: We collected data from 115 patients (58 males, 57 females; age range: 16 to 94 years old, median age: 52 years old) whose initial diagnoses were made in our department from June to July 2000. We classified the patients into five groups based on the level of their complaints concerning the initial consultation (‘A’ representing the highest degree of complaint, ‘E’ representing the lowest) and determined the relationship between the strength of complaints and the non-attendance rate. Furthermore, we investigated the reasons for non-attendance concerning 28 patients who stopped visiting the hospital from April 2000 to November 2001.
RESULTS: The non-attendance rates were 0% (014) for group A, 14.3% (2114) for group B, 5.6% (5189) for group C, 33.3% (216) for group D, and 50% (1/2) for group E. The rate tended to be higher in groups with fewer complaints. The reasons for non-attendance were the following: remission of symptoms (9 patients), request for another hospital or department (6 patients), relief due to consultation at the university hospital (6 patients), and lack of time to come to the particular hospital (5 patients) . In contrast, the most common reason for satisfaction at the time of consultation was ‘enough explanation and listening to complaints well’ in 7 of 11 patients who were satisfied with the consultation.
CONCLUSIONS: The level of patient's complaints at the time of consultation is related to the non-attendance rate. However, sufficient explanation about symptoms and careful listening to complaints are important for establishing a good patient/doctor relationship.

　　Safe introduction of laparoscopic partial liver resection (LPLR) requires the selection of appropriate cases not exceeding the surgeon's skills as well as standardization of surgical procedures. After introduction at our institution, 60 LPLR procedures were performed between April 2010 and May 2016. To identify indices for case selection, short-term perioperative parameters were analyzed, including operative time, blood loss, postoperative complications, and postoperative hospital stay. Operative time was significantly shorter in the last 30 cases compared with the first 30 cases (182.5 min vs. 253 min; p＝0.023) and in 16 cases involving the left lobe (S2-4) compared with 44 cases involving the right lobe (S1, S5-8; 148.5 min vs. 246 min; p＝0.004). Blood loss was significantly less (0 mL vs. 50 mL; p＝0.028) and operative time was significantly shorter (185 min vs. 250 min; p＝0.048) in 27 cases with tumor diameter ＜2.5 cm compared with 33 cases with tumor diameter ≥ 2.5 cm. Operative time tended to be longer in 9 cases of multiple-site resection compared with 51 cases of single-site resection (207 min vs. 260 min; p＝0.085). BMI, pathology, and hepatitis virus status showed no significant difference in perioperative short-term results. For the introduction of LPLR, it may be preferable to select cases located in the left lobe with a tumor diameter ＜2.5 cm and to accumulate a certain amount of experience in similar cases first.

Adrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenocorticotropic hormone (ACTH) has benefits such as improving the success rate, some unilateral cases could be falsely diagnosed as bilateral. Selectivity index of 5 with ACTH stimulation to assess the selectivity of catheterization and lateralization index (LI) >4 with ACTH stimulation for unilateral diagnosis is used in many centers. Co-secretion of cortisol from the tumor potentially affects the lateralization by the LI. Patients aged <35 years with hypokalemia, marked aldosterone excess, and unilateral adrenal nodule on CT have a higher probability of unilateral disease. Patients with normokalemia, mild aldosterone excess, and no adrenal tumor on CT have a higher probability of bilateral disease. Although no methods have 100% specificity for subtype diagnosis that would allow bypassing AVS, prediction of the subtype should be considered when recommending AVS to patients. Methodological standardization and strict indication improve diagnostic quality of AVS. Development of non-invasive imaging and biochemical markers will drive a paradigm shift in the clinical practice of PA.