Summarized in the following are lessons and recommendations gained through the three-year project on -Strengthening of Malaria Control in Solomon Islands”. The poor quality of malaria services and people's lack of access to proper services remain as a tremendous obstacle in developing countries. In areas remote from the central town, both morbidity and mortality from malaria tend to be higher than those in the central area. The concern shared by many living in such remote areas is how to prevent severe cases of malaria. Recommendations for malaria-related strategies in the isolated area include (1) fostering the capacity of the community to respond to severe cases of malaria through strengthening the key health facility in the malaria management (2) having the community residents themselves to have the ownership of the activities, and constructing malaria control for the community by the community. Nevertheless, it has been recognized that creating a malaria control guideline as well as its complete implementation is not enough to achieve the objectives. The guideline simply provides a standard or a benchmark, and it is, above all, not only flexible but also sensible and timely decisions suited to each circumstance, as well as actions backed by a strong sense of mission that, in the end, save the lives of malaria patients. In addition, if self-help efforts in the country are to be expected, it is of foremost importance to train healthcare workers and reserve officers.

We report a 77-year-old woman who underwent mitral valve repair using leaflet folding plasty for mitral regurgitation due to bilatelal commissural prolapse. A Carpentier prosthetic ring was applied to remodel the annulus and to reinforce repair. Postoperative echocardiography revealed no regurgitation and good mitral valve opening. Leaflet folding plasty is considered to be a simple and effective technique to accomplish mitral valve repair for mitral regurgitation due to commissural prolapse.

1) Children's data (10-18 years old) of back strength, height, grip strength and running long jump from data book of Japan Education Ministry (1964-1981) were analyzed. Back strength was mainly studied and was compared with other data (grip strength etc.) . The groups with high average values for back strength at 10-14 years old did not necessarily show high values for back strength at 17 years old, or vice versa. Values for back strength at 10-14 years old were not significantly correlated with those at 17 years old.
2) Using the data from data book mentioned above, tension of deep back muscle (FMUS) was calculated based on kinetic models (FMUS. I, II, III) . Calculated FMUS values were 3-5 times larger than measured back strength values at each age.
3) Relative change of back strength and FMUS in 1964-1981 were compared. All values for back strength were lower than those for FMUS except in 1967. During the late 1960th and the 1970th, average back strength values gradully decreased, but the decrease of FMUS was less obvious than that of back strength.
4) Based on the data of 422 children (7-12 years old, male and femele), values of diaphragm area were approximated with some assumptions, and then FMUS values were calculated. FMUS values calculated by approximate diaphragm area were significantly larger than those calculated by constant diaphragm area (465 cm2) .
The figure for getting FMUS values easily was offered to avoid troublesome calculation. This consists of two graphs, and one can read FMUS values with reasonable precision. Parameters needed for getting FMUS values are sexuality, height, body weight and back strength.

A 9-year-old boy was first noted to have a heart murmur on the 7th postnatal day. Cardiac catheterization at the age of 4 months showed combined valvular and supravalvular aortic stenosis, bicuspid aortic valve and hypoplastic aortic annulus. Emergency open aortic valvotomy was performed. At the age of 6 years, he had infectious endocarditis which was treated medically. Echo-cardiography at this time showed a 90mmHg pressure gradient across the aortic valve. In August 1992 and in March 1993, ballon valvuloplasties were done but without a significant reduction in the pressure gradient. In July 1993, when the patient was 7 years old, repeated surgical valvotomy and Doty's aortoplasty were performed. Two years later the boy had exertional dyspnea, and a cardiac catheterization showed pulmonary artery pressure of 60/27mmHg, and a 110mmHg pressure gradient across the aortic value. In July 1995, he underwent aortic valve replacement with Konno's aortoventriculoplasty, and a SJM 19mm AHP valve was implanted. One year after surgery, he is without any symptoms. Although the end result was acceptable, earlier AVR with Konno procedure may have spared the child from one extra surgical procedure. Strategic options in the surgical therapy of this condition are discussed.

Purpose：We evaluated that the current state from which a palliative care unit receives emergency admission of cancer patients at home. Methods：We retrospectively investigated the medical records of 393 cancer patients who hospitalized in our unit between January 2013 and December 2014. The patients were shared with a group of two, schedule admission (schedule group) and emergency admission (emergency group), and it was compared with a result on discharge and with a hospitalization period. We investigated admission process, the date and time of admission, and reason for admission in emergency group. Results：The number of patients was 224 of schedule group and 169 of emergency group. The mortality rates were 81% in schedule group and 78% in emergency group (not significant). An emergency group for an average of 24.3 days was shorter for 9 days than schedule groups in a hospitalization period of dead leaving patients (p<0.05). In emergency group, admission process included 128 completed-interviews with the hospitalization, 11 incompleted-interviews before admission and 30 first visits, and 129 patients (76％) admitted within the weekday daytime. Many patients had a complaint of severe pain, appetite loss and oral absorption difficulty, and so much. Conclusions：An emergency group admitted the various processes and the much symptom. There were a lot of cases of early hospital death, but also admitted return at home, and our unit played the role of emergency admission.

　For female physicians, it is important to nurture an environment that enables them to take advantages of support for child rearing as well as for their return to their original jobs. It is also critical for physicians, whether female or male, to receive education to recognize the professional/occupational missions of being a physician. Once they have received environmental support and mission clarification, they will be able to realize an uninterrupted career in order to attain their social contributions.

　The Committee on Studies of Career Education for Female Physicians has set five learning objectives by examining the required abilities and capabilities of a physician.

The proposed five learning objectives are to acquire:

(1) Professional awareness of the missions of being a physician,

(2) Ability to make career plans,

(3) Flexibility to embrace diverse values of the profession,

(4) Appropriate attitudes for both those receiving and those offering the support, because it should be the responsibility of the medical community,

(5) Recognition of social gender differences and acquires the capability to deal with such differences.

All organizations related to medical education should promote these five learning objectives.

　The Committee on Studies of Career Education for Female Physicians set five learning objectives for all physicians to nurture abilities for continuous public participation by women physicians. Next, we discussed the learning objectives corresponding to the learning period and made a road map. Further more, we proposed our new target-based education program and methods for its assessment.

Background: Febrile neutropenia (FN) remains an important complication in pediatric cancer patients. The present study compared the efficacy of meropenem (MEPM) and piperacillin/tazobactam (PIPC/TAZ) with or without intravenous immunoglobulin (IVIG) as second-line therapy for FN in pediatric patients. Methods: As first-line treatment for FN, 394 episodes in 99 patients were randomly assigned to receive PIPC/TAZ (360 mg/kg/day, maximum 18 g/day) or MEPM (120 mg/ kg/day, maximum 3 g/day). Eighty-four episodes in 42 patients were judged as failures, and, thus, were enrolled for second-line treatment. In second-line treatment, antibiotics were switched to MEPM or PIPC/TAZ, and episodes were further randomized for treatment with or without concomitant IVIG at 100 mg/kg/day (maximum 5 g/day) for 3 consecutive days. Results: The total success rate of second-line treatment was 50.0% (52.0% in PIPC/ TAZ and 47.2% in MEPM with or without IVIG, P=0.826). The success rates of patients treated with (IVIG+ group) and without IVIG (IVIG− group) were 53.8 and 46.7%, respectively (P=0.662). In the IVIG+ group, the success rate of patients younger than 8 years old was 78.6%, which was significantly higher than that of those aged 8 years and older (40.0%, P=0.043). Conclusion PIPC/TAZ and MEPM were equally effective as second-line treatment. Concomitant IVIG was also effective, particularly in patients younger than 8 years.

Nephroblastomatosis (NBM) is a precursor of Wilms tumor. We herein report a case in which Wilms tumor was initially suspected and the affected kidney was removed.The tumor was subsequently diagnosed as intralobar NBM and a favorable outcome was achieved with postoperative chemotherapy. A 2-year-old boy who presented with gross hematuria was found to have an enlarged left kidney with hydronephrosis.Needle biopsy of the left kidney suggested Wilms tumor and left nephrectomy was performed. The tumor was histopathologically diagnosed as intralobar NBM.Although NBM is regarded as a precancerous lesion, a definite treatment plan has not yet been established. In the present case, we used a similar chemotherapy regimen to that for Wilms tumor. Eight years after the completion of chemotherapy, Wilms tumor has not developed or recurred. Appropriate management plans need to be developed by accumulating similar cases.