1) Anjo Kosei Hospital has nearly 40 years of history of the post-primary clinical training course.
2) More than 90% of the young doctors, passed through 2 years of the primary clinical training course, have chosen further training at Anjo Kosei Hospital. During this course they began to start the experience for their own career for specialist.
3) This education program is closely coordinated with Medical Colleges such as Nagoya University and Nagoya City College of medicine. After 4 or 5 years of training at Anjo Kosei Hospital, they continued their training at Nagoya University Hospital or Nagoya City College Hospital for the further career.

BACKGROUND: In recent years, various studies have analyzed the concepts of “good death” and “quality of dying and death” in the world. The objective of this study was to compare community residents and physicians regarding their perceptions of “good death” in a terminal cancer setting in Fukushima, Japan.
METHODS: One thousand residents of Fukushima City (40 years or older) were randomly selected for comparison to the 483 physicians working in the same city. A self-administered questionnaire was used to query residents and physicians on 52 items about “good death.”
RESULTS: The response rate was 73.6% for the residents and 53.0% for the physicians. The concept of “good death” was composed of 14 factors for both groups. We elucidated the structure of the concept of “good death” in the general population and physicians in Japan, and only the third factor, “religion and spiritual beliefs, ” was the same between the general population and physician.
CONCLUSION: The data offers useful information pertaining to palliative care education for medical providers. Specifically, physicians should understand the differences between concepts held by the general population and physicians. For example, some same items were included in factor X (continuance of one's lifestyle) for citizen and factor II for physician. But contribution ratios of factor X for citizen and factor II for physician were different. This should lead to the better palliative care provision.

 This cross-sectional study examined cigarette smoking knowledge, attitudes, and practices among medical students in a southwestern region of China. The subjects included 557 and 223 first and fourth year Chinese medical students, respectively. Comparison data were collected from 74 Japanese and 90 Vietnamese fourth year medical students. The smoking rate among the fourth year medical students in China (7.0%) was significantly higher than among the first year medical students (2.8%), and higher than among the medical students from Vietnam, but lower than the medical students from Japan. The fourth year Chinese students had a more permissive attitude toward cigarette smoking by physicians compared with the first year students, and the lowest knowledge base on cigarette smoking-related diseases among the students from all three countries. Based on a multivariate analysis, the factors associated with cigarette smoking were male gender, having friends who smoked, and exhibiting a permissive attitude toward smoking. Implementations aimed at improving tobacco education and addressing the gender differences and peer influences related to cigarette smoking are needed to improve Chinese medical students’ knowledge and attitudes about cigarette smoking, and to prevent students from starting to smoke cigarettes.

No abstract available.
Aortic Valve ; Bicuspid ; Coronary Stenosis ; Coronary Vessels ; Heart Valve Diseases

In the present study, the effects of bulb type palatal lift prosthesis (bulb-PLP) therapy on nasality and velopharyngeal function (VPF) of patients with velopharyngeal incompetence (VPI) following palatoplasty were longitudinally assessed.The subjects included 18 patients (3 to 52 years of age) who had shown persistent VPI following palatoplasty and who had received bulb-PLP therapy. Nasality and VPF were assessed by perceptual voice analysis, nasometer test, blowing test, and cephalometric radiographic examination. Based on the outcomes of bulb-PLP therapy, the subjects were classified into two groups: the effective group and the ineffective group. Furthermore, the obturating and VPF-activating effects by bulb-PLP therapy were analyzed, and factors relating to different VPF activities were determined.All subjects achieved adequate VPF by wearing a bulb-PLP. After treatment, 10 patients (55.6%) achieved successful activation of VPF without bulb-PLP (the effective group), while persistent VPI remained in 8 patients (the ineffective group). The beginning-blowing ratio of the effective group was significantly greater than that of the ineffective group (P < 0.05) and the velopharyngeal distance (V-P distance) of the effective group tended to be smaller (P = 0.07). Regarding the shape of the bulb head, the angular type was dominant in the ineffective group, while the round type was dominant in the effective group.Bulb-PLP therapy was useful for providing adequate VPF activation. Possible signs of the subsequent effective activation of VPF are considered to be: 1) preexisting adequate VPF on blowing, 2) smaller V-P distance, and 3) synchronized palatopharyngeal movement.

While the session-RPE (rating of perceived exertion) method can quantify training volume in athletes, this method is not able to evaluate energy expenditure (EE) during a training session. We developed an RPE-based activity record for assessing EE during athletic training, and we compared its results to those obtained using the flex-heart rate (flex-HR) method. The EE of nine female collegiate endurance runners was assessed by the RPE-based activity record and flex-HR methods during eight days in the normal training season. Subjects were asked to record their RPE in the record at 5-minute intervals, and to wear a HR monitor during training. All subjects also participated in an incremental treadmill exercise test, which was used to determine their RPE-EE and HR-EE regression equations. Although the RPE-based activity record significantly overestimated EE (RPE-activity record, 572 kcal/session; flex-HR method, 499 kcal/session; p = 0.031), it had high validity relative to the flex-HR method (intra-class correlation coefficient, 0.891; 95% confidence interval, 0.845–0.923) and there were no systematic errors in EE estimation between the two methods. Therefore, the RPE-based activity record can be used to assess EE during training in female runners. However, RPE-based activity record might overestimate EE for athletes who have more intermittent activities during training than endurance runners, because RPE takes more time for returning to the resting level than HR when the intensity of activity declines. Further research is needed to verify the validity of the RPE-based activity record for assessing EE during other sporting activities or measurement conditions, and to identify the factors affecting the degree of estimation error associated with this method.

OBJECTIVE: To test the concept of taxane sequencing, this feasibility trial evaluated maintenance of docetaxel after paclitaxel and carboplatin combination chemotherapy in patients with stage IC-IV ovarian cancer. METHODS: All patients received debulking surgery followed by paclitaxel and carboplatin chemotherapy. Attainment of clinically defined complete or partial response was confirmed by image scanning. Maintenance of docetaxel started at an initial dose of 70 mg/m2 every 4 weeks for 6 cycles and was extended to 10 cycles unless disease progression and/or recurrence during the protocol therapy or unacceptable toxicities were seen. RESULTS: Stage subsets in 20 eligible patients were as follows: IIIB, 2 patients (10%); IIIC, 13 patients (65%); IV, 5 patients (25%). Neutropenia was common (40% with grade 3 or 4) and was most frequent during first or second cycle although the disabling peripheral neuropathy was not observed. Twelve patients completed protocol therapy (6< or =cycles), while 8 patients failed to complete 6-cycle chemotherapy, because of progressive disease (5 patients) or grade 4 toxicities (3 patients). Median PFS was 20 months and 3-year PFS rate was 12%. Median overall survival was 39 months and 3-year OS rate was 69%. CONCLUSION: Six cycles of single-agent docetaxel maintenance chemotherapy is feasible and generally tolerable to women with advanced ovarian cancer who attained a clinically defined response to initial paclitaxel and carboplatin based chemotherapy.
Bridged Compounds ; Carboplatin ; Disease Progression ; Drug Therapy, Combination ; Feasibility Studies ; Female ; Humans ; Maintenance Chemotherapy ; Neutropenia ; Ovarian Neoplasms ; Paclitaxel ; Peripheral Nervous System Diseases ; Recurrence ; Taxoids

Seven wrestlers, whose body weights should be reduced about ten per cent in relatively short period of time to be acknowledged for intercollegeate competition, were selected, and their daily food intakes in reduction through recovery period of body weight were estimated. Simultaneously, some blood and urine components were analysed, performance capacities (grip and back strength power) were measured, and gross balances of nitrogen and potassium were calculated as the difference between their intakes and urinary outputs, to discuss the influence of rapid weight reduction.
For several days of the last stage of reduction period, the average intakes per kg body weight per day were about 20 kcal for energy, about 1.7 g for protein, about 20 g for food moisture and drinking water, total intakes per day were about 2 g for sodium and about 1 g for potassium respectively.
During about seven days of recovery period, these intakes were increased to higher level, which were as average about 60 kcal for energy, about 2 g for protein, 46-73 g for food moisture and drinking water per kg body weight, about 5 g for sodium and about 3 g for potassium per day, respectively.
During reduction period, the negative balances of nitrogen and potassium, slight reduction of performance capacities and dehydration symptoms in blood components (Ht value, and contents of Hb, plasma protein plasma urea nitrogen) were observed.
During recovery period, the body weights were recovered rapidly to normal level, nitrogen and potassium were turned to positive balance, but some components (Ht value, plasma protein) were not completely recovered to their normal level.
As far as the average food composition in recovery period was concerned, not so remarkable deficiency was observed, but the personal deviations in their intakes were distinct. From these results, it is suggested that by better balanced combination of food intake, personal body conditions of these young sportsmen with high physical strength would recover to their normal level more quickly and more completely.

Objectives: First steps to promote the proper use of medicines in remote islands and rural areas are as follows: (1) recognition of the profession of “pharmacist” from secondary-remote-island residents who do not have a pharmacy or drugstore or the opportunity for pharmacist contact and (2) an understanding by remote-island residents of the advantages of having a “family pharmacist.”
Methods: Repeated “medicine information and consultation sessions” for secondary-remote-island residents of Japan’s Nagasaki Prefecture were held.  Residents were then surveyed for changes in awareness of or demand for pharmacists and the nature of such changes.
Results: Before the information sessions, 29.7% of residents did not recognize the profession of pharmacy, but the extent of their recognition increased after information sessions were concluded.  They were asked “Who explains medicines in a way that is easy to understand ?”; more than half responded “doctors” before the information session, but after information sessions were concluded, those who said “pharmacists” increased.
Conclusion: Conducting “medicine information and consultation sessions” for residents of secondary-remote islands and rural areas enabled them to understand the profession of pharmacy.  The initiatives in the present study are first steps toward promoting proper use of medicines by residents of remote islands and rural areas who use “family pharmacies/pharmacists.”

　　A 56-year-old woman was referred to our hospital because of an abnormal finding in the right pulmonary hilum on chest X-ray. Enhanced chest computed tomography showed hyperplastic bronchial arteries dilating and winding around the trachea and bronchi. A racemose hemangioma of the bronchial artery with multiple bronchial artery aneurysms (diameter <20mm) was seen displacing the trachea and both main bronchi. Bronchoscopy showed submucosal tumor-like lesions at the distal trachea and in both main bronchi, and a dusky-red elevated pulsatile lesion at the orifice of the left B3b＋c. We performed coil embolization of the bronchial artery aneurysm to prevent abrupt rupture of the bronchial aneurysm.