A clinical clerkship in medical informatics was introduced in the 5th year of medical school. One goal is computer literacy, which means comprehension of the hospital information system including security policy and privacy preservation. The other is information literacy; The students make presentations concerning the medical information system and information technology within approximately ten minutes. All participants were enthusiastic about preparing the presentation. Seventy percent of them acknowledged the significance of explaining persuasively to others what they studied and the usefulness of these skills developed in this clerkship in their future. This result implies the importance of the shift to information literacy.

The estimated prevalence of sleep-disordered breathing (SDB) with an apnea-hypopnea index (AHI) of 5 or higher was 24 percent for men, and 4 percent of men in the middle-aged work force meet the minimal diagnostic criteria for the sleep apnea syndrome (SAS) (SDB with daytime hypersomnolence). However, there are few published data about this problem in our country.A random sample of 208 men 30 to 76 years old who were staying overnight for a complete physical examination were the subjects of this study. A portable sleep data acquisition device was used to determine the frequency of episodes of apnea and hypa-pnea in them. The prevalence of SDB was worked out and the clinical significance was discussed.The estimated prevalence of SDB was 76.4 percent and that of SAS was 12.5 percent. Compared with subjects with lower AHI values, those with higher levels of SDB and AHI included a significantly large number of individuals of advanced age and with hypertension, although their body mass index, Epworth sleepiness scale, and values of total cholesterol and triglycerides were not significantly high.These data revealed a remarkable high incidence of SDB in our country and suggested an association of SDB with risk factors of cardio-vascular events. We need a regular screening for sleep disorders by polysomnography or the portable device at least.
percent ; Prevalence aspects ; Sleep Apnea Syndromes ; Male population group ; SAS

The present study was designed to examine the effects of aerobic exercise on the change of alpha wave component in electroencephalogram (EEG) and plasma β-endorphin. Exercise consisted of 30-min cycling on an ergometer with the load adjusted to elicit a heart rate rise of 50% between resting and predicted maximal value. The EEG signals and blood samples were obtained before and after 30-min exercise. The EEG signal was digitized at a sampling frequency of 64 Hz and analyzed by means of computer-aided decomposition algorithm and frequency power spectral analyses, respectively. The blood samples were immediately centrifuged for 15-min for quantitative analysis of β-endorphin by means of radioimmunoassay method. Results indicated that β-endorphin was significatly (p<.05) greater after exercise as compared to that of the resting contorol. It was also found that the larger the changes in β-endorphin following exercise, the higher the appearance rate of alpha wave in EEG. There was a positive and significant correlation (r=563, p<0.05) between the increase in alpha wave component and that of the plasma β-endorphin. These results suggest that traquilizer effects of aerobic exercise could be explained, at least in part, by the increase of alpha wave component and plasma β-endorphin which in turn bring about the relaxation effects upon the central nervous system.

The present study was designed to examine the effects of aerobic exercise on the change of alpha wave component in electroencephalogram (EEG) and plasma β-endorphin. Exercise consisted of 30-min cycling on an ergometer with the load adjusted to elicit a heart rate rise of 50% between resting and predicted maximal value. The EEG signals and blood samples were obtained before and after 30-min exercise. The EEG signal was digitized at a sampling frequency of 64 Hz and analyzed by means of computer-aided decomposition algorithm and frequency power spectral analyses, respectively. The blood samples were immediately centrifuged for 15-min for quantitative analysis of β-endorphin by means of radioimmunoassay method. Results indicated that β-endorphin was significatly (p<.05) greater after exercise as compared to that of the resting contorol. It was also found that the larger the changes in β-endorphin following exercise, the higher the appearance rate of alpha wave in EEG. There was a positive and significant correlation (r=563, p<0.05) between the increase in alpha wave component and that of the plasma β-endorphin. These results suggest that traquilizer effects of aerobic exercise could be explained, at least in part, by the increase of alpha wave component and plasma β-endorphin which in turn bring about the relaxation effects upon the central nervous system.

The purpose of the present study was to develop a new method that enables individualized determination of the optimal exercise intensity for health promotion. Our study was based on the following observations : (1) physical activity at ventilatory threshold (VT) has been useful for enhancing physical fitness and even improving medical conditions such as heart failure, hypertension and diabetes, (2) exercise intensity at VT is characterized by suppressed vagal activity, and (3) vagal activity can be evaluated by analyzing heart rate variability (HRV) . In the first study we defined a criteria for determining the exercise intensity corresponding to VT using HRV analysis (heart rate variability threshold, THRV) . In 16 normal subjects, a time series of ECG RR interval were recorded and the means of the sum of the squared differences in successive RR intervals (MSSDs) were calcu-lated during a ramp exercise test with a cycle ergometer. Based on the values of MSSD and the dif-ferences in successive MSSDs (ΔMSSD) at the intensity of VT, we defined the criteria of THRV as follows : MSSD<25 msec²and ΔMSSD<6 msec². Another exercise test with a cycle ergo-meter was performed to evaluate the relationship between THRV and VT in 63 normal subjects. Heart rate (HR) and oxygen uptake (VO₂/wt) at THRV were 111.8±13.2 beats/min and 15.2±4.4 ml/kg/min, and HR and VO₂/wt at VT were 116.2±11.6beats/min and 16.5±3.7ml/kg/min, respectively. There was a significant correlation between THRV and VT (HR : r=0.82, p<0.001, VO₂/wt : r=0.88, p< 0.001) . Thus, THRV and VT provided almost identical exercise intensities. As a result, we propose that, similar to VT, THRV can be used as an indicator of the optimal exercise intensity suitable for health promotion in normal subjects.

Reconstruction of the right ventriclar outflow tract (RVOT) in congenital heart disease often requires implantation of a valved conduit. A hand-made expanded polytetrafluoroethylene (ePTFE) trileaflet Dacron graft conduit has been used at our center since 1997, and has been implanted in 31 patients. Midterm results of this conduit were investigated in 30 of the patients who have been followed at our outpatient clinic. There were 16 males and 14 females. The mean age and body weight were 16.4±7.2 (range, 3.4-33.4) years and 41.7±13.3 (range, 13.0-64.0)kg, respectively. Diagnoses were tetralogy of Fallot with pulmonary atresia in 14 patients, RVOT reconstruction associated with Ross procedure in 8, transposition with pulmonary stenosis in 3, pulmonary atresia with intact ventricular septum in 2, tetralogy with absent pulmonary valve syndrome in 1, pulmonary regurgitation developed after tetralogy repair in 1, and hemitruncus in 1. The median size of the graft was 22 (range, 20-26)mm. All patients were in NYHA functional class I at the time of the latest follow-up. The pressure gradient across the conduit was 11.0±5.8mmHg during the same hospitalization and 13.8±6.5mmHg on the latest echocardiogram (Interval, 2.4±1.5 years, p=0.85). The valve function was well maintained in all patients, with the regurgitation graded as non-trivial in 22 patients, mild in 7, and moderate in only 1. Midterm results of hand-made ePTFE trileaflet valved cunduit was satisfactory. A longer follow-up is mandatory to assess its actual durability.

The School of Medicine, University of Tsukuba, was founded in 1974 and had graduated 1, 561 students by 1994. From 1980 through 1987, 44% to 73% of graduates became hospital staff, 16% to 40% became university staff, and 0% to 8% became general practitioners. More than 80% of graduates did a 2-year residency (sotsugo-kenshu) at our university hospital and 40% completed a 6-year residency. Almost 10 years of postgraduate training was required to become an established medical practitioner. This length of time indicates that postgraduate training is the most important part of the medical career. About 80% of graduates earned doctor of philosophy (Ph. D.) degrees, whereas 93% became registered specialists, indicating that graduates tended to become specialists rather than to pursue Ph. D. degrees. This difference is more evident among female graduates: 85% became specialists whereas only 53% received a Ph. D. Most graduates considered the School of Medicine to have a good curriculum, but some younger graduates had complaints. The graduates chose their career specialties on the basis of their own interests and aptitudes. We should take these data into account to prepare a system of life-long education and learning.

Hypercholesterolemia and hypertension are among the most important risk factors for cardiovascular (CV) disease. They are also important contributors to metabolic diseases including diabetes that further increase CV risk. Updated guidelines emphasize targeted reduction of overall CV risks but do not explicitly incorporate potential adverse metabolic outcomes that also influence CV health. Hypercholesterolemia and hypertension have synergistic deleterious effects on interrelated insulin resistance and endothelial dysfunction. Dysregulation of the renin-angiotensin system is an important pathophysiological mechanism linking insulin resistance and endothelial dysfunction to atherogenesis. Statins are the reference standard treatment to prevent CV disease in patients with hypercholesterolemia. Statins work best for secondary CV prevention. Unfortunately, most statin therapies dose-dependently cause insulin resistance, increase new onset diabetes risk and exacerbate existing type 2 diabetes mellitus. Pravastatin is often too weak to achieve target low-density lipoprotein cholesterol levels despite having beneficial metabolic actions. Renin-angiotensin system inhibitors improve both endothelial dysfunction and insulin resistance in addition to controlling blood pressure. In this regard, combined statin-based and renin-angiotensin system (RAS) inhibitor therapies demonstrate additive/synergistic beneficial effects on endothelial dysfunction, insulin resistance, and other metabolic parameters in addition to lowering both cholesterol levels and blood pressure. This combined therapy simultaneously reduces CV events when compared to either drug type used as monotherapy. This is mediated by both separate and interrelated mechanisms. Therefore, statin-based therapy combined with RAS inhibitors is important for developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity. This combined therapy can help prevent or treat CV disease while minimizing adverse metabolic consequences.
Atherosclerosis ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Diabetes Mellitus, Type 2 ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Hypercholesterolemia ; Hypertension ; Insulin Resistance ; Lipoproteins ; Metabolic Diseases ; Obesity ; Pravastatin ; Renin-Angiotensin System ; Risk Factors

No abstract available.
*Angiotensin-Converting Enzyme Inhibitors ; Humans