A 74-year-old man presenting with general fatigue and dyspnea was admitted to another hospital. He was transferred to our hospital because his symptoms deteriorated and pericardial fluid increased. The symptoms did not improve even after percutaneous pericardial drainage. On a diagnosis of heart failure due to pericardial constriction, he underwent pericardiectomy. No hemodynamics improvement was found despite subtotal pericardiectomy. Multiple longitudinal and transverse incisions like a waffle were made in the thickened epicardium and improved the hemodynamics. The symptoms improved after sugery. Steroid therapy was effective after pathological examination of the excised epicardium that confirmed an emerging manifestation of hyper-IgG4 disease. We report a waffle procedure with good results for a constrictive pericarditis with hyper-IgG4 disease.

Objective: Securing a sufficient number of medical residents to work in rural areas is an urgent issue. This study sought to clarify the factors that cause medical students at a rural university in Japan to select a particular place for their initial clinical training.Materials and Methods: A questionnaire was administered to all medical students at Saga University between February and March 2021. Participants were divided into two groups based on their training location choice: those who chose Saga Prefecture (Saga group) and those who selected other prefectures (non-Saga group). Then, logistic regression analysis was performed.Results: The questionnaire was answered by 300 students (46.3% response rate), of whom 291 agreed to participate in the study; 122 (41.9%) and 169 (58.1%) students were allocated to the Saga and non-Saga groups. Within the Saga group, the following factors were statistically significant: being admitted to Saga University’s medical school through the system of special allotment of admission to applicants pledging to work in Saga Prefecture following graduation (or regional quota programs for admission) (odds ratio [OR], 19.18; 95% confidence interval [CI], 6.99–52.60); and being from Saga Prefecture (OR, 6.05; 95% CI, 2.24–16.35). With the non-Saga group, the desire to work in an urban area (OR, 0.03; 95% CI, 0.00–0.37) was statistically significant.Conclusion: To encourage medical residents to choose this prefecture for their initial clinical training, the focus should be on medical students who are from Saga Prefecture or admitted through the regional quota program.

Sweat contains electrolytes (minerals), therefore, it is necessary to consider its loss through sweat in the fluid replacement strategy in sports. The purpose of this study was to compare the concentration of components in sweat, such as electrolytes (minerals), when endurance exercise is performed in hot and neutral thermal environments. Eight men cycled for 60 min at 55% VO2peak under two envitonment conditions: a hot environment (WetBulb Globe Temperature (WBGT): 29.0±0.2℃; Heat) and a neutral thermal environment (WBGT: 20.5±0.2℃; Con). During exercise, sweat loss, core temperature, and heart rate (HR) were measured, and sweat from the chest, back, and thigh was collected. The core temperature, sweat loss, and HR increased significantly in Heat. The sweat electrolyte concentration was significantly higher in Heat than in Con only for Na. Regarding the amount of electrolyte loss from sweat, Na and K showed a significantly higher value than Con in Heat in comparison of each region, and the total loss amount of three regions in Cu also had a significantly higher value than Con in Heat. In addition, there was no difference in the concentration of Ca and Cu between the regions, but there was a significant difference in the amount of loss. It was concluded that even if there was no difference in the electrolyte concentration in sweat, the amount of electrolyte loss increased in K and Cu in a hot environment, and that there was a site difference in the amount of loss in Ca and Cu.