Objective: To assess the effectiveness of preferred colored light on psychosomatic state.
Methods: Preferred color light and other colored light were projected on a screen and shown to experimental and control subjects. To determine the effect of such light, mood adjective scores as determined by the Multiple Mood Scale (MMS) were measured as an emotional parameter, and levels of salivary chromogranin A (CgA) and salivary immune globulin A were measured as biochemical parameters. This study was performed in a randomized, crossover design. These data were analyzed statistically and a p value less than 0.05 was considered significant.
Results: After being exposed to preferred colored lights, mean MMS scores indicating positive moods, such as well-being increased significantly (p = 0.025), and scores indicating negative moods, such as depression and boredom decreased significantly (p = 0.005, p = 0.041). Mean value of salivary CgA also decreased and was significantly different between experimental and control group (p < 0.001).
Conclusion: Preferred colored light may be effective in promoting a calm positive state.

We have surveyed what physicians in our department think about postgraduate education in bioethics. Although 90% of physicians recognized the importance of bioethics education, 90% of physicians had not taught bioethics to residents and had not read any bioethics books in the last 2 years. Approximately 80% of physicians believed that discussions were needed to confirm residents' awareness of bioethics and life-and-death issues but that residents and physicians do not need to read relevant books and mandatory reports to deepen their awareness of bioethics. Because many physicians in our department have little motivation to improve their view of bioethics, postgraduate education in bioethics is needed for both residents and physicians.

Risk analysis models are becoming more important in various aspects of the clinical setting. We have used the logistic EuroSCORE as a risk analysis model, but there is divergence between the model and actual clinical reality in our country. The Japan Score is a risk model based on the Japan Adult Cardiovascular Surgery Database and it is considered to be better reflect from Japanese clinical results. We compared the logistic EuroScore (ES) and Japan Score (JS) and their predictive accuracy, using our clinical results. Between October 2006 and June 2011, 733 operations suitable for evaluation by the Japan Score were performed at our institute. Isolated coronary artery bypass grafting (CABG) was performed in 151 cases, valve surgery (Valve) in 346 cases and aortic surgery (Aorta) in 236 cases. In these cases we calculated 30-day mortality using the EuroSCORE and JapanSCORE and compared the results and prediction accuracy, by calculating the receiver operating characteristic curve (ROC curve) and the area under the ROC curve (AUC). We also calculated 30-day mortality and morbidity by the JapanSCORE and analyzed it by the same method. In the entire group, logistic 30-day mortality by ES and JS was 7.28 and 4.05% respectively. The AUC was 0.740 and 0.806, while 30-day mortality and morbidity calculated by JS was 17.72% and the AUC was 0.646. In the CABG group the 30-day mortality by ES and JS was 5.7 and 3.18% respectively, the AUC was 0.636 and 0.770, the 30-day mortality and morbidity was 13.37% and the AUC was 0.631. In the Valve group 30-day mortality by ES and JS was 6.00 and 3.79% respectively. The AUC was 0.715 and 0.794, 30-day mortality and morbidity was 17.54% and the AUC was 0.606. In the Aorta group 30-day mortality was 10.17 and 4.99% respectively. The AUC was 0.720 and 0.827. The 30-day mortality and morbidity was 20.83% and the AUC was 0.640. The 30-day mortality calculated by JS was significantly lower than that of ES (p<0.001). The prediction accuracy of both of the ES and the JS was satisfactory but the prediction accuracy of JS was better than that of the ES. The prediction accuracy of the logistic 30-day mortality and morbidity were not as accurate as 30-day mortality. JS was a good risk analysis model not only for prediction of surgical results but also for improving surgical outcome.

Objective: To assess the effectiveness of color images as mood stimulants by using an image selection system.
Methods: Color images of flowers and seascapes, each mainly comprising of 5 colors, were arranged into a set of 50 images (10 images for each of 5 colors) on a personal computer and shown to 40 university students on stressful days during (i) an examination period and (ii) a non-examination period. The students selected color images according to their individual preferences by using an image selection system. To determine the effect of viewing the color images, mood adjective scores as determined by the Multiple Mood Scale (MMS) were measured as an emotional parameter, and the levels of salivary chromogranin A (CgA) and salivary cortisol were measured as biochemical parameters. These data were analyzed statistically and a p value less than 0.05 was considered significant.
Results: After viewing the color images, mean MMS scores indicating positive moods, such as well-being and friendliness increased significantly (p<0.05), and scores indicating negative moods, such as depression, boredom and hostility decreased significantly(p<0.05). The mean value of salivary CgA also decreased significantly after viewing the images (p<0.05).
Conclusion: Color images could possibly be used to induce a parasympathetically dominant state.

Stentless bioprosthetic valves have been implanted for treatment of aortic valve disease, especially in elderly patients ; these valves have the advantage of durability and excellent hemodynamics compared with stented bioprosthetic valves. Although good long-term results in patients with stentless bioprosthetic valves have been reported recently, reoperation has been gradually increasing. We performed reoperation for the SJM Toronto SPV and Medtronic Freestyle valves in one patient each. The SJM Toronto SPV was used in a 30-year-old woman ; however, 8 years later, the valve showed severe calcification and adhesions, and could not be completely removed (Case 1). The other reoperation case, wherein a 69-year-old man underwent aortic valve replacement with the Medtronic Freestyle 4 years previously, showed no adhesion around the implanted valve, which could be easily removed from the autologous aortic annulus. Consequently, the first patient required reimplantation of a small mechanical valve (SJM #19). In contrast, we were able to use a stentless bioprosthetic valve (Prima Plus #23) for the second patient. Further observations on stentless bioprosthetic valves are required.

Objective: Pharmacotherapy for patients with breast cancer is now administered in an ambulatory setting, and we assume that patients would benefit if clinical pharmacists perform all stages of pharmacological intervention up to prescription in an ambulatory setting as well, especially for medicines requiring chronic administration and those that affect the patient’s life, such as hormonal therapy.  A thorough understanding of guidelines and the clinical reports is paramount for effective pharmacological intervention.  Since ambulatory care clinical pharmacists are involved in the treatment of a large number of patients, effective utilization of evidence outlined in guidelines and clinical reports is difficult.  Therefore, we developed a system for utilizing evidence as outlined in guidelines and clinical reports with a focus on hormonal therapy for patients with breast cancer.
Methods: A database based on the 2013 version of the clinical practice guidelines for breast cancer and clinical reports was constructed using Microsoft® Access 2010.
Result: Clicking on a guideline algorithm according to the disease stage of the patient results in a clinical question being displayed, and the ambulatory care clinical pharmacist is immediately able to determine suitable medications based on clinical reports that are run through the database.
Conclusion: With the use of this database, which includes information required for pharmacological intervention, ambulatory care clinical pharmacists could care for a large number of patients.

We performed endovascular stent grafting of a perforated descending aorta, caused by empyema after surgery for lung cancer, in a 75-year-old man. After diagnosing hemorrhage from a perforation of the proximal descending aorta, caused by left empyema, the perforation was repaired with a saphenous vein patch and a pectoralis major muscle flap. However, re-hemorrhage from the same lesion occurred 2 months postoperatively. Temporary hemostasis was achieved with gauze packing and he was transferred to our hospital for endovascular stent grafting. The infection did not resolve after fenestration, so the descending aorta was cropped out to the fenestration lesion. Therefore, endovascular stent grafting was performed on the same day. Postoperatively the bleeding stopped completely without any signs of graft infection, and he was transferred to another hospital on postoperative day 9. No re-hemorrhage or graft infection of the aortic perforative lesion occurred in the early postoperative period. However, the patient died of massive bleeding from the aorta wall of the proximal stump of the stent graft, caused by recurrence of the infection 2 months after the 2nd operation. In this situation, endovascular scent grafting provides the only chance of saving the patient's life. If endovascular stent grafting is performed as a lifesaving procedure, meticulous operative technique is imperative.

The use of the internal mammary artery (IMA) is now routine in most coronary artery bypass grafting (CABG) because of its improved long-term patency and survival. A small but important percentage of these patients will require valve surgery and thoracic aortic aneurysm repair following CABG. These operations present a challenging problem for the cardiac surgeon because of difficulties regarding approach, dissection around the IMA and optimal myocardial protection. We investigated surgical results and the effectiveness of various methods of myocardial protection in 8 patients who underwent reoperations between December 1983 and June 2005. The mortality was 13%. There were 2 perioperative myocardial infarctions (25%), 6 cases of prolonged ventilation (75%), 3 cases of low output syndrome (38%), 1 case of acute renal failure (13%) and 1 case of sepsis (13%). We carried out resternotomy for 6 patients without any hospital death or perioperative myocardial infarction. Our reoperation approach had acceptable risk control with resternotomy, avoidance of dissecting the IMA and hypothermic perfusion.