Objectives: To determine the relationship between obesity and cardiac autonomic nerve activity in healthy children. Methods: 16 healthy male children comprising of 9 nonobese and 7 obese subjects (body mass index > 19.1 kg/m2) aged 8−9 years were selected. Electrocardiograms were measured for 10 min. under controlled ventilation (0.25 Hz) in the supine position. Consecutive 256-second RR interval data were transformed by the Fast Fourier Transform method into power spectral data. Very low frequency (VLF; 0.003−0.04 Hz), low frequency (LF; 0.04−0.15 Hz), high frequency (HF; 0.15−0.40 Hz), and total power (TP; 0.003−0.40 Hz) were calculated and transformed into a natural logarithm (ln). Normalized units (nu) were also calculated as follows: LFnu = LF / (TP - VLF) x 100. HFnu = HF / (TP - VLF) x 100. Low/high-frequency ratio (LHR) was calculated as LF divided by HF. Unpaired t test was performed to compare the 2 groups. Results: TP ln and HFnu, reflecting cardiac parasympathetic nerve activity, in obese children were significantly lower than those in nonobese children. In contrast, LFnu and LHF, reflecting cardiac sympathetic nerve activity, in obese children were significantly higher than those in nonobese children. Conclusions: These findings suggest that obese children have higher sympathetic nerve activity and lower parasympathetic nerve activity than nonobese children.
Child ; Hz ; Cardio- ; Nerve ; With frequency

Introduction: Lifelong learning is important for physicians because of patient safety and the need to constantly improve the quality of medical practice. However, few studies have investigated the specific topics that are required.
Methods: We examined the lifelong learning needs of physicians by means of a self-administered questionnaire that was completed by 595 subjects, who were clinical practitioners working in Gunma Prefecture.
Results: Subjects of all ages needed lectures about the use of evidence-based medicine in medical examinations, clinical studies and the interpretation of epidemiological data, and diagnostic imaging. The younger subjects had a greater need for learning about clinical skills and techniques, such as advanced cardiac life support／intensive care life support, abdominal ultrasonic diagnosis, and cardiac ultrasonic diagnosis. Regarding the ideal times for these lectures, some physicians working at Gunma University Hospital expressed a preference for weekdays after normal business hours, while others preferred the weekends.
Discussion: The lifelong learning needs of physicians were clarified. Because physicians work on different shifts and at different institutions, scheduling training sessions that everyone can attend is difficult, especially for those who are off-campus. The timing of the training sessions, as well as the content of lectures, must be considered. Ideally, sessions should be held more than once to accommodate the busy schedules of physicians. We believe that providing an opportunity for lifelong learning will help attract more people to a career in medicine and thereby help address the physician shortage.

Introduction and Methods: An immediate effect of the physician shortage is the return to clinical work by physicians who had earlier left. Therefore, the needs of returning physicians were examined by means of a self-administered questionnaire. The subjects were clinicians working in Gunma Prefecture.
Results: About 50% of female physicians and 25% of male physicians had left clinical practice. The reasons given for leaving were “studying abroad” for most male physicians and “pregnancy and child-rearing” for most female physicians. More than 70% of physicians who had left clinical work felt uneasy about returning. The degree of anxiety after returning did not differ significantly between male and female physicians. Problems encountered by returning physicians involved “changes in medicines,” “changes and progress in technology and medical theories,” and deterioration of their “skills and techniques.” Moreover, returning physicians felt a need for increased “practical skills training.”
Discussion: Our study has clarified the needs of physicians returning to clinical work. The development and adoption of a simple system that will help physicians return to clinical practice is required.

We report the case of a 33-year old man with ulcerative colitis and attacks of melena who responded positively to a change in prescription, in accordance with change in his disease state. His melena developed in May of the year XXXX. He was diagnosed with ulcerative colitis (proctitis) after a thorough evaluation at another medical institution, administration of 5-ASA, steroid suppositories and an antidiarrheal agent had brought no relief, and he consequently sought Kampo treatment at our institution. Saireito (9.0g/day) and kyukikyogaito(9.0g/day) extract granules were initially administered for two weeks in addition to the aforementioned drug therapy, which resulted in improvement of his melena. However, the same Kampo formulations prescribed later, when his attacks recurred, failed to effectively halt rectal bleeding. These recurrent attacks differed from his first, in that blood was seen after the elimination of feces (feces first, blood later), and as “feces-first, blood-later” conditions are described in the Synopsis of the Golden Chamber as “enketsu” indications for odoto decoction, his prescription was changed to odoto. After odoto administration for 2 months, his melena gradually resolved, and active rectal inflammatory change was improved as seen with colonoscopy. His melena then lessened after 1 month's administration, and symptoms of melena had almost completely disappeared after 2 month's administration. Amelioration of active rectal inflammatory change was also confirmed with colonoscopy findings. This was an interesting case where the progression of a clinical condition required a corresponding change in prescription for effective management of symptoms.

We experienced a difficult case which had multiple impairments caused by antiphospholipid syndrome. This disease is a thrombophilic disorder in which venous or arterial thrombosis, or both, may occur in patients with antiphospholipid antibodies (e.g. anticardiolipin antibody, lupus anticoagulant). This disease is well demonstrated as a cause of ischemic stroke in young adults. But the optimal treatment of these patients is unclear, and their prognosis is not good. Antiphospholipid syndrome causes recurrent multiple ischemic strokes, induces severe impairments and the disturbance of various higher brain functions, and shows resistance against rehabilitation. To address these difficulties we should, as rehabilitation experts, conduct chronic disease-management with the cooperation of the neurologists, and devise a rehabilitation approach that takes into consideration the nature and severity of this disease. In other words, a diversified approach, which is characteristic to rehabilitation, is no less important than medical remedies in treating antiphospholipid syndrome patients.

　　Introduction: Reimbursement for breathing care services was started with the revision of the nation's medical service fee system in 2010. Our hospital was not properly equipped in the light of certain standards governing facilities. Nonetheless, we started giving instructions to nurses on how to check the respirator at work. In addition to the on-the-job training, we are engaged in educational activity and information gathering. Out team comprises clinical engineers, physical therapists and registered nurses. They are all certified respiratory therapists. We hereby report our activities and refer to future problems.　　Activities: 1. Safety checks of respirators while in use. 2. Respiratory rehabilitation during hemodialysis. 3. Respirator-related workshops. 4. Review of accidents.　　Results: 1. It has become easier to discover potential problems and meet them at once. This is because our team is made up of different specialists, each used to looking at things differently. 2. Being constantly on the alert for any indication of a trouble ensures safety during breathing rehabilitation. 3. The number of accidents during 2012 decreased from 2011.　　Future: We think that since “safety management” is the center piece of our activity, our team ought to be recognized as an official organization of the hospital.

A 63-year-old man had been receiving medical treatment for hypertrophic cardiomyopathy (HCM) for 20 years. Sustained ventricular tachycardia (VT) had often occurred over the previous 2 years in spite of the administration of antiarrhythmic drugs. He therefore received an implantable cardioverter defibrillator (ICD). However, his symptoms did not improve thus dilated-phase HCM was diagnosed. Because sustained VT often occurred subsequently, the ICD had to be frequently used. An electrophysiological study (EPS) using the CARTO electroanatomical mapping system revealed the earliest activation site to be in the posterolateral wall of the left ventricle (LV). VT did not stop despite 2 endocardial catheter ablation procedures. Therefore, the VT foci was thought to be a reentry circuit on the epicardial side of the posterolateral LV wall. A part of the posterolateral LV wall that involved the reentry circuit was therefore resected. Since undergoing this surgical procedure, the patient has experienced no recurrence of VT during a follow-up period of 14 months.

Background: Regional anesthesia techniques that provide analgesia to the entire lateral abdomen are limited. We present a modified external oblique intercostal block for complete lateral abdominal analgesia with a single injection. Case: We performed a modified version of the external oblique intercostal block unilaterally at the tenth rib along the mid-axillary line in three patients undergoing robot-assisted partial nephrectomy (two single injections, one catheter placement) and tested the technique on a cadaver with 20 ml of dye bilaterally. All patients reported good postoperative pain relief without complications and had consistent sensory coverage of the T8–T12 dermatomes from the anterior-to-posterior axillary line. Anatomical assessment confirmed consistent bilateral staining of the lateral cutaneous branches T8–T12. Conclusions The initial clinical success and anatomical findings of the modified approach to the external oblique intercostal block suggest that this technique may be an effective option for lateral abdominal analgesia.

Background: Regional anesthesia techniques that provide analgesia to the entire lateral abdomen are limited. We present a modified external oblique intercostal block for complete lateral abdominal analgesia with a single injection. Case: We performed a modified version of the external oblique intercostal block unilaterally at the tenth rib along the mid-axillary line in three patients undergoing robot-assisted partial nephrectomy (two single injections, one catheter placement) and tested the technique on a cadaver with 20 ml of dye bilaterally. All patients reported good postoperative pain relief without complications and had consistent sensory coverage of the T8–T12 dermatomes from the anterior-to-posterior axillary line. Anatomical assessment confirmed consistent bilateral staining of the lateral cutaneous branches T8–T12. Conclusions The initial clinical success and anatomical findings of the modified approach to the external oblique intercostal block suggest that this technique may be an effective option for lateral abdominal analgesia.

Background: Regional anesthesia techniques that provide analgesia to the entire lateral abdomen are limited. We present a modified external oblique intercostal block for complete lateral abdominal analgesia with a single injection. Case: We performed a modified version of the external oblique intercostal block unilaterally at the tenth rib along the mid-axillary line in three patients undergoing robot-assisted partial nephrectomy (two single injections, one catheter placement) and tested the technique on a cadaver with 20 ml of dye bilaterally. All patients reported good postoperative pain relief without complications and had consistent sensory coverage of the T8–T12 dermatomes from the anterior-to-posterior axillary line. Anatomical assessment confirmed consistent bilateral staining of the lateral cutaneous branches T8–T12. Conclusions The initial clinical success and anatomical findings of the modified approach to the external oblique intercostal block suggest that this technique may be an effective option for lateral abdominal analgesia.