We, a group of four delegates from Japan, participated in the fifth Japan-UK Primary Care Exchange Programme and visited the UK in October of 2018. This report highlights some differences between the UK and Japanese healthcare systems, such as working conditions for GPs and requirements for GP trainers, and what the Japan Primary Care Association can learn from them. We propose that the Japan Primary Care Association create opportunities to discuss and exchange views with other healthcare professionals, strengthen training programs for future GP trainers and define competencies for GP trainers in Japan.

Background: Although previous reports have shown a lower proportion of the ACTN3 XX genotype (R577X nonsense polymorphism) in sprint/power athletes compared with controls, possibly attributed to the importance of skeletal muscle function associated with alpha-actinin-3 deficiency, the findings on association between endurance athlete status and R577X genotype are equivocal. Purpose: The present study was undertaken to examine association of ACTN3 R577X genotype with elite Japanese endurance athlete status. Subjects and Methods: Subjects comprised 79 elite Japanese endurance runners (E) who participated in competition at national level and 96 Japanese controls (C). We divided endurance runners into two groups, i.e., 42 national level runners (E-N) and 37 international level runners (E-I) who had represented Japan in international competition. R577X genotype (rs1815739) was analyzed by direct sequencing. Frequency differences of polymorphisms between athletes and controls were examined by Chi-square tests. Result: The R allele frequency tended to be higher in E group than in C group (P=0.066). When we divided E into two groups, the R allele frequency in E-I group was significantly higher than that in C group (P=0.046); whereas there were no significant differences between E-N and C groups (p=0.316). Then, the three genetic models were tested. In the additive genetic model (RR>RX>XX), there were significantly differences between E-I and C (P=0.038), but not the dominant (RR vs. RX+XX) and the recessive (RR+RX vs. XX) genetic models. Conclusion: R allele of the R577X genotype in the ACTN3 gene was associated with elite Japanese endurance athlete status.

The IPCD (Immersing Powdered Crude Drugs) method, inspired by the “zhu san fa” which was widely used in the Song period of China, has been developed to prepare Kampo decoctions quickly and easily, with highyield extract from crude drugs. One trouble with the IPCD method occurs when separating the decoction from the muddy residue of the crude drug powder. When powdered ephedra herb is packed in a nonwoven fabric bag and immersed in hot water, yield of the marker compounds is much lower than that obtained when ephedra herb powder is dispersed freely in hot water without a nonwoven fabric bag. Thus the use of a nonwoven fabric bag was shown to be unsuitable with the IPCD method. In investigating an easy and more efficient separation method, we tried decanting with a commercially available wine carafe to separate the decoction and residue. With IPCD followed by decantation using the wine carafe, yields of about 80% decoction volume were obtained as compared with those when cut crude drugs are decocted and filtered using a tea strainer, in 6 of the 7 formulas tried. We find that decantation using a wine carafe is a more practical way of separation in the IPCD method.

Understanding factors associated with physical activity (PA) is important to promote PA. The purpose of the present study was to investigate factors associated with achieving PA guideline in 293 Japanese adolescents (140 boys and 153 girls). Time spent in moderate to vigorous PA (MVPA) was accessed by using accelerometers. Based on MVPA, the participants were classified as “Active” (≥60 min/day of MVPA) or “Inactive” (<60 min/day of MVPA). Anthropometry, age, screen time, mental health, participation in after-school sport activities, sleep status, and breakfast status were measured as factors potentially associated with achieving PA guideline. Adjusted logistic regression analyses revealed that after-school sports activities were positively associated with the probability of being Active for both sexes (odds ratios [ORs] [95% confidence intervals (CI)] = 3.90 [1.13-13.49] for boys, 4.80 [1.80-12.81] for girls). In addition, body fat was negatively associated with a reduced likelihood of being Active for girls (ORs [95%CI] = 0.93 [0.87-0.97]). Two factor ANOVA revealed that those in Inactive group had significantly lower PA levels than those in Active group on both regular curriculum and extra-curriculum (F _{(1, 138)} = 152.50 for boys, F _{(1, 151)} = 181.95 for girls, p < 0.001). In addition, for girls, there was a significant interaction effect between domain (regular curriculum vs. extra-curriculum) and after-school sport activities (F _{(1, 151)} = 4.91, p = 0.028), suggesting that obtaining higher PA levels on extra-curriculum might be difficult for those who do not belong to any after-school sport activities. Therefore, promoting PA on regular curriculum (i.e., physical education lessons and recess) might be alternative ways to increase PA levels for those individuals. Furthermore, special attention may be needed for girls who have higher body fat to promote PA.

Objective: The incidence of pulmonary embolism (PE) and leg deep vein thrombosis (DVT) has increased in recent years in association with aging and an increase in the number of bedridden individuals. We developed an active in-bed leg exercise apparatus labeled the Leg Exercise Apparatus (LEX) for DVT prevention. We compared the effect of leg exercises performed using the LEX to conventional active ankle exercises on increased blood flow.
Materials & Methods: The subjects were eight healthy adult volunteers [five men and three women, aged 20–34 (mean 27.0) years]. Subjects performed two types of exercise; exercise 1 consisted of leg exercises using the LEX, while exercise 2 consisted of in-bed active plantar flexion/dorsiflexion exercises without the device. Measurements were taken 1, 5, 10, 20, and 30 minutes after exercise including common femoral vein blood flow, mean blood flow velocity, maximum blood flow velocity, and vessel diameter using Doppler ultrasound. Statistical procedures included timed measurement data analysis using a linear mixed model. A Bonferroni correction was used for multiple comparisons.
Results: Compared to resting levels, blood flow reached a maximum value 1 minute after exercise for both exercise types, with a significantly greater increase after exercise 1 (1.76-fold increase) compared to exercise 2 (1.44-fold increase) (p = 0.005). There was a significant difference (p = 0.03) between the two exercises for all values from 1 minute to 30 minutes following exercise. There was no significant difference between exercises for peak or mean blood flow velocity. Compared to resting levels, blood vessel diameter reached a maximum value of 1.47-fold greater at 5 minutes post-exercise for exercise 1 and a maximum value of 1.21-fold greater at 1 minute post-exercise for exercise 2.
Conclusions: Exercise using the LEX increased lower leg venous blood flow and vessel diameter. We propose that the LEX may serve as a new DVT prevention tool.

The purpose of the present study was to examine the associations between physical fitness and body fatness with blood lipid profile in 231 Japanese children and adolescents (12.1 ± 1.5 years). The primary outcomes of the present study were a lipid risk score which was calculated by summing up z scores of three lipid items (triglycerides, low density lipoprotein-cholesterol, and high density lipoprotein-cholesterol). Physical fitness was assessed by using the Japanese standardised fitness test. For body fatness, a percentage of overweight was calculated with using age-, sex-, height-specific standardised body mass. For combined analysis (fitness × fatness), the participants were cross-tabulated into four groups (Non-Obese/Higher-Fit, Non-Obese/Lower-Fit, Obese/Higher-Fit, and Obese/Lower-Fit). The results demonstrated that the participants in fitness categories A/B [most fit] and C [middle] demonstrated the lower (better) lipid risk score than the participants in fitness categories D/E [least fit] (F _{(2, 222)} = 6.03, p = .003). For body fatness, the lipid risk score in obese group was significantly higher (worse) than that in thin and normal groups (F _{(2, 222)} = 6.08, p = .004). The combined analysis showed that there was a significant interaction (fitness × fatness) on the lipid risk score (F _{(1, 221)} = 4.05, p = .047), suggesting that Obese/Lower-Fit group had the worst risk score compared to the other groups. The present study suggests that improving both fitness and body fatness might be important for better lipid profile in Japanese children and adolescents.

A 64-year-old man under dialysis was referred for surgical treatment of Crawford type I thoracoabdominal aortic aneurysm. He had a history of idiopathic portal hypertension and chronic total occulusion of supra-renal abdominal aorta and appeared to have massive development of collateral arteries and veins in the abdomen. We chose endovascular repair with debranching of visceral arteries and bypass grafting to bilateral superficial femoral artery considering bleeding from collateral arteries and veins by conventional open surgery. Postoperative CT scan revealed no endoleak and all debranched and bypass grafts were patent. He was discharged with no postoperative complications including paraplegia.

Recently, patient safety has become a social concern in Japan. Even though cases of “incidents” and “accidents” by interns have been collected and analyzed in each hospital, few published reports have concerned teaching hospitals. The purpose of this study was to identify the incidence of “incidents” and “accidents” by first-year and second-year interns in Japan.
1) In August 2005, a questionnaire was mailed to 231 interns at 14 teaching hospitals. A total of 192 interns participated in this study, with a response rate of 83.1%.
2) The number of cases of “incidents” and “accidents” involving interns since the start of their training was collected.An “incident” was defined as an error that was prevented before occurrence, whereas an “accident” was defined as an unplanned, unexpected, and undesired event with adverse consequences.
3) Among first-year interns, “incidents” occurred at a rate of 0.79 per resident-month (95% confidence interval [CI]: 0.30-1.28), while “accidents” were observed at a rate of 0.13 per resident-month (95% CI: 0.06-0.20).
4) Among second-year interns, “incidents” occurred at a rate of 0.24 per resident-month (95% CI: 0.14-1.34), and “accidents” were observed at a rate of 0.06 per resident-month (95% CI: 0.01-0.11).
5) There was no significant difference in the number of cases of “incidents” and “accidents” in regards to sex, age, or the number of beds of teaching hospitals.