The purpose of this study was to compare the thigh muscle oxygenation state of competitive road cyclists and non-cyclists during varied pedaling frequency cycling. Six male college road cyclists (CY group) and five male students (NC group) performed four sets of cycling bouts, consisting of 2 minutes of warm up (60 rpm, 50 watts) followed by 5 minutes of pedaling (150 watts) using an electro-magnetic braked cycle ergometer at 40, 60, 90, and 120 rpm. Oxygenated hemoglobin and/or myoglobin (Oxy-Hb/Mb) and deoxygenated Hb/Mb (Deoxy-Hb/Mb) concentrations in the vastus lateralis were measured by near infrared spatially resolved spectroscopy. The Oxy-Hb/Mb level was significantly higher in the CY group than the NC group. But there was no significant intraction effect of the group and pedaling rate on the Oxy-Hb/Mb level. These results suggest that the changes in muscle oxygenation state according to pedaling cadence do not differ between cyclists and non-cyclists. And though the whole body work efficiency decreased according to increasing pedaling cadence, Oxy-Hb/Mb and Deoxy-Hb/Mb levels in the vastus lateralis remained unchanged up to 90 rpm. However, at 120 rpm, the Oxy-Hb/Mb level decreased remarkably and the Deoxy-Hb/Mb level increased. These results suggest that deoxygenation in the vastus lateralis at 120 rpm was higher than that for lower frequencies. And, conversely, oxygen uptake in the vastus lateralis might have increased steeply at 120 rpm. It may be that the maximum pedaling cadence that would not reduce work efficiency in the vastus lateralis is around 90 rpm.

OBJECTIVE: Our goal was to develop a system using virtual reality (VR) technology to test the haptic skills of medical students. Currently, surgical skills are learned on live patients in a clinical environment in which the student practices under the close supervision of an experienced surgeon. We are interested in using haptic feedback devices to enhance surgical skills, because simulated touch in a virtual world improves the performance of trainee surgeons. In this study, we evaluated the efficacy of a test that evaluates the surgical skill of medical students by using a VR simulator.
METHODS: We used a microsurgical simulator with a force-feedback system. Its effectiveness in helping 36 medical students to acquire the tactile skills used in microscopic surgery was evaluated experimentally. Operating time and the number of sites of hemorrhage were measured to evaluate surgical aptitude. We also evaluated system performance with respect to reality, immersiveness, and operability as secondary measures. Data were analyzed using descriptive methods.
RESULTS: The operating time and number of hemorrhagic sites were positively correlated. Subject students were clustered into three groups: dexterous, awkward, or clumsy. The relation between the number of hemorrhages in the retina and immersion and operability differed between the group of would-be surgeons and those of would-be internists and pediatricians. All the students commented that the simulator was a useful tool for medical education.
CONCLUSIONS: The VR simulator can be used not only to teach and evaluate subtle tactile and surgical skills relevant to the surgical profession, but also to test the aptitude of medical students. The training transfer from a haptic simulator to actual practice methodology should be quantifiable in the near future. This work has steered medical informatics research into a new type of medical education.

Background: Physician shortage affects mortality at the city level in Japan. The medical administrative district (MAD) covering the area (town, city, etc.) in which the patients live and is the unit responsible for recruiting doctors. The number of physicians or changes in this number in each MAD varies. The relationship between the number, or the change in number, of physicians and the mortality in each MAD has been unclear.
Methods: We designed a descriptive study using publicly-available national statistics. In all 358 MADs in Japan, we analyzed the relationship between the changes in the number of physicians (total, clinic, and hospital) from 2000 to 2005 and the standardized mortality ratio (all causes of death, cancer, heart disease, and stroke).
Results: In MADs, the number of physicians and mortality are not related, nor are changes in number of physicians and mortality. Further investigation including factors associated with mortality is needed.
Conclusion: In MAD, there is no relationship between the number of physician and the mortality, between the change in number of physician and the mortality. Further investigation is needed including factors associated with mortality.

A 67-year-old man receiving treatment for choledocholithiasis was found to have an abdominal aortic aneurysm on CT. The maximum diameter of the aneurysm was 60mm, and the isthmus of a horseshoe kidney was also observed. A total of four renal arteries, two each on the right and left sides, was detected by angiography and helical CT. Two of four arteries bifurcated from the aneurysm. Laparotomy confirmed the presence of a fifth renal artery, which extended from the left common iliac artery to the isthmus. It was not difficult to free the isthmus from the aneurysm. A Y-shaped prosthesis was placed between the normal portion of the aorta and the common iliac arteries without severing the isthmus. The left renal artery arose from the aneurysm and was reconstructed with 6mm knitted Dacron. The right renal artery, which was located below the isthmus, was ligated. The absence of postoperative renal dysfunction confirmed the patency of the reconstructed renal artery. Eleven such cases have been reported in Japan, including the present case. In 5 cases, renal artery reconstruction was performed, and the isthmus was preserved in 8 cases. However, the sites of renal artery bifurcation were correctly detected preoperatively in only 3 of these patients. It appears that accurate preoperative imaging is very important, along with renal artery reconstruction.

To assess the effects of Byakko-ka-ninjin-to on thirst and body weight gain in chronic hemodialysis patients with excessive interdialytic body weight gain, 8 patients (4 men and 4 women, ranging in age from 47 to 75) were prescribed Byakko-ka-ninjin-to extract tablets, 6-12 tablets per day, for 10 weeks. In 4 of the patients, thirst symptoms improved, resulting in significant reduction of interdialytic weight gain. This effect continued to be significant even after cessation of the agent. In the cases of 4 patients whose thirst symptoms did not improve, interdialytic weight gain was not reduced either during or after treatment. For all 8 patients, there were no significant changes in cardiothoracic index, and no adverse effects or events were observed either during or after treatment. Significant reduction in interdialytic weight gain was observed only in the patients with reduced thirst, which suggests that Byakko-ka-ninjin-to allows patients to limit their weight gain by drinking less. These results suggest that Byakko-ka-ninjin-to could be a useful and safe agent to reduce excessive interdialytic body weight gain, at least in a significant cohort of chronic hemodialysis patients.

Introduction : The appropriate size of the regional coverage area for primary care in Japan has been unclear. The aim of this study was to determine the geographical distribution of primary care clinics for elderly ambulatory diabetic patients.
Methods : Using an insurance claims database, we extracted data of patients aged 75 years and older requiring ambulatory diabetic care in May 2010 in Ibaraki prefecture. The geographical distance from each municipal office to the clinics was analyzed.
Results : A total of 17,717 data points were extracted from the database. Data points that could not be mapped due to coding errors were eliminated, resulting in 17,144 (96.8%) data points that were ultimately analyzed. The median [25th-75th percentile] geographical distance was 5.5 [2.3-9.9] km. The distance was not related to municipal population, aging rate, or area size.
Conclusion : The coverage area for diabetic care in this primary care setting was estimated. For most elderly ambulatory diabetic patients, clinics are distributed within a 10-km radius area. Further investigation is needed to clarify primary care coverage areas that result in the most efficient use of medical resources.

We herein review the early results of minimally invasive coronary artery bypass (MIDCAB). From April 1994 to November 1998, 23 patients underwent MIDCAB, and 12 patients underwent coronary artery bypass grafting with cardiopulmonary bypass (CABG). We compared and analyzed the findings of these two groups. Regarding preoperative factors, the MIDCAB group included elderly patients, while the CABG group consisted of younger patients. However, the frequency of hemodialysis, respiratory disorders and cerebral vascular accidents did not differ significantly between the 2 groups. Regarding perioperative factors, the MIDCAB group needed a shorter operation time, and also had a lower bleeding volume, and a low incidence of blood transfusion. Regarding the postoperative course, the MIDCAB group needed a shorter artificial respiration time, and a shorter postoperative hospital stay, and no mortality was observed. The graft patency of the MIDCAB group was lower (88%) than the CABG group (100%). However, the graft patency of the MIDCAB group reached 94% after we used a stabilizer in the operation. In conclusion, the operation results of the MIDCAB group were comparatively better than those of the CABG group. Thanks to recent technological advances, the results of MIDCAB continue to improve. Though MIDCAB remains an invaluable operative modality for the treatment of one-vessel disease, surgeons must be careful to select appropriate candidates for this operative method.

We purified a novel angiotensin-I converting enzyme (ACE) inhibitor from fish sauce Ishiru prepared from squid, and identified it as the tripeptide Leu-Ala-Arg (LAR). IC₅₀ of this ACE inhibitor was 2.5 μM, demonstrating high potency among peptides previously purified from fish sauces. Moreover, LAR acted as an antihypertensive peptide, reducing systolic blood pressure in spontaneously hypertensive rats.

A 2-year-old girl who had been followed because of pulmonary valve stenosis since birth, underwent unsuccessful balloon valvuloplasty twice. The angiographic study showed thin cusps and remarkably thick and immobile filling defects in the main pulmonary artery, which indicated supravalvular PS or pulmonary valve dysplasia. Operation was done under conditions of a beating heart and total cardiopulmonary bypass. Pulmonary valve dysplasia was localized on the edge of all three cusps. After resection of the dysplastic lesion, the stenosis was released and slight regurgitation was observed by ultrasonography study.

Ulcer developed on the left leg of a 47-year-old man, in 1989, and phlebography showed deep vein thrombosis extending from the politeal to the common femoral vein. Subfascial ligation of the perforators achieved healing of the ulcers. In November 1991, at the age of 52 years the patient noticed a pulsatile mass on the right side of his neck. CT scanning showed a carotid artery aneurysm 4cm in diameter. Angiography indicated that the aneurysm was located at the bifurcation of the carotid artery. In February 1992, reconstructive surgery was performed with a Dacron graft, but an anterile abscess developed around the graft. In September 1992, the graft was removed and the carotid artery was ligated. Only seven cases of carotid aneurysm associated with Behçet's disease have previously been reported in Japan. Five of them underwent reconstructive surgery and two of them underwent carotid ligation due to complications. Because of the clinical course of Behçet's disease, carotid aneurysmectomy without reconstructive surgery may be the procedure of choice.