A 58-year old man without Marfan syndrome was referred to our hospital for congestive heart failure due to severe mitral regurgitation. He had undergone sternal turnover with a rectus muscular pedicle for pectus excavatum 36 years previously. We were able to perform mitral valve repair via median sternotomy using a usual sternal retractor. There was no adhesion in the pericardium and the exposure of the mitral valve was excellent. We closed the chest in ordinary fashion without any problems in the fixation of the sternum or costal cartilage. There were no complications such as flail chest or respiratory failure.

Purpose: To clarify the factors that affect the family caregiver’s quality of life (QOL) of cancer patients. Methods: We conducted an internet survey including 21 items of the Japanese version CQOLC for 400 families of cancer patients in March 2012. Results: Factors that increased psychological burden were that caregivers were women, other family needed long-term care, and the patient had higher need for care. Factors that increased the family caregiver’s difficulty in their daily activities due to long-term care were caregivers are women, other family needed long-term care, caregivers did not think they had a good relationship with the patient, and the patient had higher need for care. Factors that increased financial burden were that the age of caregivers was less than 60 years, decreased of income after the patient’s diagnosis, and patients were men. Factors that increase the positive feeling for caregiving were that caregivers thought they had good relationship with the patient, and the patient’s need for care was higher. Conclusions: To reduce the burden in family caregiver of cancer patients without losing the positive feeling for caregiving would be important for both improving the family caregiver’s QOL, and to continue the care for patient in long term.

Introduction and Purpose
Overweight and obesity have recently emerged as major problems of malnutrition among children in developing countries. However, risk factors for childhood obesity in Asian countries remain largely unknown. Identification of target populations for its prevention and intervention is urgently needed. This survey was conducted to assess the prevalence of overweight and obesity and identify possible risk factors among kindergarten children in Ho Chi Minh City, Vietnam.
Methods
In this cross-sectional study conducted in March, 2005, 780 children in their third and fourth years in kindergarten and their mothers were randomly selected from eight local kindergartens. Height and weight of mother-child pairs were measured, and an interview was conducted by trained staff using a questionnaire in Vietnamese. Overweight/obesity was defined as a weight-for-height > 2 SD above the National Center for Health Statistics median reference value. Risk factors for overweight/obesity were analyzed using logistic regression.
Results
There were 741 respondents (377 boys and 364 girls); the response rate was 95.0%. Average age of children was 61.8 ± 6.8 months; the average age of mothers was 35.0 ± 5.2 years. The average height and weight were 110 ± 5.7cm and 21.2 ± 4.0kg respectively. Of the 741 children, 27.8% were identified as being overweight/obesity. Four possible variables selected were: 1) child's sex, 2) mother's awareness of her child's current body type, 3) mother's expectation for her child's body type in the future, 4) mother's awareness of her own current body type .
Conclusion
Our findings point to the importance of addressing appropriate body images in the management of children's nutritional health. Providing sufficient amounts of information on appropriate body type in addition to feeding practice to mothers should be a priority at the Ho Chi Minh City Nutrition Center to prevent child overweight and obesity.

Objective: Distigmine can cause cholinergic crisis as the side effect.  In 2010, the safety information of distigmine was announced and its dosage was changed up to 5 mg per day.  However, the malpractice that a pharmacist dispensed over dose of distigmine caused severe health damages in a community pharmacy.  Therefore, we made the protocol with the urologists for the appropriate use of distigmine, including contents of monitoring the side effects.  The purpose of this study was to measure using the protocol was useful for the propulsion of proper use of distigmine.
Methods: The protocol was introduced in 10 community pharmacies and 1 hospital pharmacy from December 2013 to April 2014, and the patients and pharmacists were filled out the answer to the questions that we have made.  The protocol consisted of five main checks; the dosage, lower urinary tract symptom, presence of renal disease, combined drugs, and signs of the side effects.  Each patient was filled out the checklist given by the pharmacist to monitor the signs of the side effects for 2 weeks.
Results: The 3 prescriptions of distigmine (18.8%) were more than 10 mg per day.  Although 2 patients were confirmed diarrhea and sweating etc., they were mild.  The pharmacists significantly more (p<0.05) answered that the protocol made their motivation to do the pharmaceutical interventions.  All of the patients answered that the pharmaceutical interventions made them relieved.
Conclusion: The use of protocol that we made supported pharmacists to do the pharmaceutical interventions and patients welcome them.

OBJECTIVECadmium is known to affect the vascular tone of isolated blood vesselsin vitro and the arterial pressure of ratsin vivo. However, the mechanisms of cadmium actions on the vascular system have not been clarified. To elucidate the actions of cadmium on vascular tonus, effects of cadmium on vasocontractile and vasorelaxant responsesin vitro were investigated using aortic strips isolated from rats.

METHODSAortic strips isolated from male Wistar rats were incubated with CdCl(2) (10μM) for 24 hr, washed with fresh CdCl(2)-free medium, and then used for measurement of isometric tension and Western blot analysis of eNOS (endothelial nitric oxide synthase) and iNOS (inducible nitric oxide synthase).

RESULTSIn the aortas pretreated with cadmiumin vitro, the contractile response to phenylephrine was significantly higher than that in the control aortic strips pretreated with a vehicle. The sodium nitroprusside-induced relaxing response was significantly higher in the aortic strips pretreated with cadmium for 24 hr, compared with that in the control pretreated with a vehicle. The isoproterenol-induced relaxing response was also significantly higher in the cadmium-accumulated aortic strips.In vitro cadmium treatment slightly but not significantly increased the acetylcholine-induced relaxation of the aortic strips. Cadmium treatment induced expression of iNOS and significantly increased expression of eNOS in the aortic strips, while it did not affect expression of β-actin.

CONCLUSIONSCadmium treatmentin vitro augmented the α1 adrenoceptor-mediated contractile response, even though eNOS and iNOS were upregulated by cadmium treatment. NO-induced and β-adrenoceptor-mediated relaxing responses were also augmented by cadmium treatment. These results suggest that both vasocontractile and vasorelaxing responses are augmented in cadmium-accumulated aortas.

OBJECTIVETo examine the effectiveness of a drug abuse prevention program focusing on social influences for drug education classes in high school.

METHODSThe social influence program in the experimental group used role-playing led by a pharmacist, a police officer and a teacher. The intervention evaluation used a quasi-experimental design. The subjects were first-year students from 10 high schools assigned to the experimental group (6 schools, 828 students) and the control group (4 schools, 408 students). In the control group, a pharmacist used a conventional information program in a lecture format.

RESULTSRegarding knowledge about drug abuse, in both the experimental and control groups, and for both males and females, a long-term effect was observed immediately after the program and lasted up to 15 months. For three other measures, attitudes toward drug abuse problem, self-efficacy regarding drug abuse prevention, and perception of social support for preventing drug abuse, a short-term effect was generally observed in the experimental group beginning immediately after the program and lasting for 3 months. A long-term effect was evident in high-risk students with positive opinions regarding drugs. In the control group and for both males and females, although an effect was generally evident immediately after the program, neither a short-nor a long-term effect was observed in males, suggesting the difficulty in achieving lasting effects.

CONCLUSIONSThe social influence program in the experimental group showed remarkable effectiveness. Thus, the program may be useful for preventing drug abuse among high school students in Japan.

　　Chronic kidney disease (CKD) has recently been reported to be an independent risk factor for stroke. However, a detailed analysis was yet to be conducted according to stroke subtype. We attempted to determine the risk factors for stroke using data from the “specific health checkup” for metabolic syndrome conducted by the 9 hospitals affiliated with the Akita Prefectural Federation of Agricultural Cooperatives, and evaluate and determine the risk factors for stroke. There were 401 patients who had undergone metabolic syndrome checkups from 2007 and 2010 and suffered from stroke afterwards within 3 years after the screening. The controls were all 69,407 subjects who were screened during the same period. The predictors examined were sex, age, blood pressure, BMI, cholesterol values (HDL・LDL), history of diabetes mellitus, presence of atrial fibrillation, CKD, and drinking and smoking habits. Analysis was conducted using logistic regression. The risk factors for stroke as a whole were male sex, age, blood pressure, diabetes, atrial fibrillation, CKD, and smoking history. For cerebral infarction, the risk factors were male sex, age, blood pressure, diabetes, atrial fibrillation, CKD, and smoking habit. The risk factors for cerebral hemorrhage were age, blood pressure, and CKD. For subarachnoid hemorrhage, the risk factors were female sex, age, blood pressure, low HDLemia, and CKD. In conclusion, CKD is an independent risk factor for the 3 subtypes of stroke, and in particular plays an important role as a higher risk factor for cerebral hemorrhage. Smoking cessation and controls of blood pressure, diabetes and atrial fibrillation are the important measures for stroke prevention. In addition, the further intervention should also be targeted to those with the result of CKD revealed by specific health checkups.

The aims of this study were (1) to develop and validate the scale to measure evidence-based nursing practice in cancer pain management and (2) to identify associated factors. We developed potential items based on the 2014 version of Japanese Clinical Guidelines for Cancer Pain Management and administered anonymous questionnaire for 189 oncology nurses in a designated cancer center. We conducted a re-test to test reliability.167 nurses participated in the study. As a result of item analysis and exploratory factor analysis, we developed a nursing practice scale of cancer pain management and its shortened version. This scale consists of 1 domain 50 items The Cronbach’s α coefficient showing internal consistency was 0.98 (shortened version 0.88). The intra-class correlation coefficient of reliability was 0.52 (shortened version 0.77). Concurrent validity was confirmed by the correlation between the total score of the whole scale and the total score of the practice of palliative care, knowledge, difficulty, self-confidence scale. We concluded that this scale was valid and reliable. Factors related to the nursing practice of cancer pain management were years of experience in cancer nursing, opportunities of postgraduate education, and satisfaction with postgraduate education. This scale can be used for evaluation of daily clinical practice and practice evaluation after educational efforts such as cancer pain nursing training.

Following the revision of the structure and content of the Model Core Curriculum for Medical Education to be more outcome-based and the legal status of the medical practice performed by medical students in the clinical clerkship, we have revised the Guideline for Participatory Clinical Clerkship. The following items were revised or newly described : significance of enhancing the participatory clinical clerkship, scope of medical practice, confidentiality, patient consent, patient consultation and support service, objectives of the clinical clerkship, simulation education, departments where the clinical clerkship is conducted, assessment in the clinical practice setting, CC-EPOC, and entrustable professional activities. A foundation has been established to promote seamless undergraduate and postgraduate medical education. However, future work is needed to examine the specific level of performance expected at the end of the clinical clerkship and department-specific clinical practice goals and educational strategies.