Preservation of subvalvular mitral apparatus and maintenance of continuity between structures and annulus is recognized, and widely accepted as a significant factor for avoiding impairment to ventricular function and preventing left ventricular rupture during mitral valve replacement. However, we encountered a patient who developed posteromedial papillary muscle rupture following chordal sparing mitral valve replacement. The patient was a 67-year-old man who underwent mitral valve replacement with a porcine bioprosthesis 29M for acute mitral valve insufficiency due to several spontaneous chordal ruptures. The subvalvular apparatus of both leaflets was retained, the center of the anterior leaflet was excised elliptically, and the entire posterior leaflet was preserved. Although his postoperative course was uneventful, the transthoracic echocardiogram showed a floating structure prolapsing through the aortic valve in the left ventricle synchronizing with the cardiac cycle. The severed papillary muscle was removed successfully via an aortotomy through the native aortic valve on the 57th day after the first surgery. The patient recovered with no events. Surgeons should consider avoiding an excessive tension on the preserved chordae and delivering a cardioplegia sufficiently and uniformly during mitral valve replacement.

In this study the effects of endurance exercise on cardiorespiratory functions and performance in developing age were exemined in 12 year old boys. Sujects were consisted of 11 boys who had been participating in training for soccer more than 2 hours a day for 6 days per week (S) and 10 non-participating boys for control (C) . Maximal oxygen uptake (Vo₂max), maximal heart rate (HRmax) and maximal cardiac output (Qmax) by acetylnerebreathing method were measured on the exercise on a treadmill. Five minute run was also administered.
Significant differences were found in Vo₂max (p<0.05), values of which were 2.13±0.07 1⋅min^-1 for S. and 1.86±0.08 1⋅min^-1 for C., respectively, and in Qmax (p<0.001), values of which were 17.9±1.41⋅min^-1 for S. and 12.4+0.71⋅min^-1 for C. G., respectively. There were no significant differences in HRmax and V_E between both groups. Values of stroke volume and V_E/Vo₂max were significantly higher for S.. Performances on 5 minute-run were 1164 m for S. and 1083 m for C, which showed significant difference (p<0.01) . Significant correlationship (r=0.746, p<0.001) was obtained between Vo₂max and Qmax. It was also found that the higher Vo₂max was, the higher Qmax was attaind.

The influence of daily physical exercise on oxygen utilizing capacity of working muscle investigated by means of measureing lactate threshold (LT) during progressive treadmill running from the comparison between soccer group (S group: N=12, 11.9±0.1 years of age) and control group (C group ; N=14, 11.8±0.1 years of age) . LT₁ was determined as the point where blood lactate concentration (La) increased from rest level, and LT₂ was determined by the gradient, La/VO₂. body weight^-1 (2 mM/10 ml. kg^-1, min^-1) .
LT₁ and LT₂ in S group were significantly higher than those in C group expressed with absolute and relative values of VO₂ (1. min^-1, ml. kg^-1. min^-1, % VO₂max) . No significant differences in La, ventilation responses, and heart rate at the point of LT₁ and LT₂ were observed between S and C group, La showed slight decrease and was kept at lower level in S group with increase of VO₂, compared with C group. On the contrary, La in C group began to increase at lower level of VO₂. From our previous longitudinal study of LT in non-athletic children, we observed that LT shifted to lower level with growth. It was sugesed that La curve of S group, such shift had not occurred. Differences of these patterns in VO₂ and La between athletic children and non-athletic children were similar to those observed in adults athletes and non-athletes.
In conclusion it was supposed that sufficient daily physical training in 10-12 year of age might increase oxygen utilizing capacity of leg working muscle during running exercise.

Little is known about the effects of aerobic exercise on cardiac structure in children. Echocardiographic study was performed at rest in 38 boys aged 11-12 (18 soccer players and 20 untrained) . Soccer players had significantly increased left ventricular end-diastolic dimension (43.6±2.8 vs 40.1±2.8 mm) and left atrial dimension (27.7±3.7 vs 23.0±2.8 mm) . There was no difference in interventricular septum and left ventricular posterior wall thickness between the two groups, these data show that intensive aerobic exercise may influence on cardiac structure in children.

The relationships between running performances (200 m running time and 5-min run) and VO₂max, Lactate Threshold (LT), or percent fat were investigated on 11-12-year old boys. Subjects were 21 control boys (group C) and 21 soccer boys (group S) . Mean 200 m running time in group S was significantly better than that in group C. Mean distance of 5-min run in group S was significantly longer than that in group C. No significant difference was found between mean running speed of 5-min run and mean speed at exhaustion in LT experiment. In group C, 200 m running time correlated significantly with VO₂max. In group S, faster runners showed higher peak post 200 m run lactate concentration. 5-min run correlated significantly with VO₂max for group C, group S and all subjects combined. LT correlated significantly with 200 m running time and 5-min run. No significant relation was found between running petformances and percent fat. It is suggested that VO₂max and LT determine, in part, boy's running performances, but percent fat do not.

Background/Aims: Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS.The aim of this study is to determine this issue in young people. Methods: A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria.Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire. Results: The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15-1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018). Conclusion Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population.

Since the Infection Control Team (ICT) was organized in 1999, our hospital has been engaged in evidence-based operations against nosocomial infections. The ICT's major activities included guidance in preventive measures against infections, surveillance involving continuous environmental monitoring, proposition as regards prescription of antibacterial medicines, and consultation with clinicians about prophylaxis. The team comprising physicians, nurses, pharmacists and clinical laboratory technicians has made expert propositions to clinicians. To be concrete, the team members, with the liaison clerk playing a central role, met with physicians in charge or with other staff members of the hospital, studied the infection cases in question, and presented the study findings to the clinicians. Fundamentally, therefore, it is not that the ICT intervenes in the affairs of the clinical department by way of directions but that it presents clinicians with the ideas gained through discussion between ICT members and physicians and other hospital staffers. While cementing a relationship of mutual trust between hospital employees, the ICT is expected to engage in nosocomial infection prevention activities by joining forces transdeoartmentally.
Clinical ; Hospitals ; Infection Control ; seconds ; Prophylactic

Background/Aims: Functional dyspepsia (FD) may be a common digestive disease worldwide and reduces the quality of life of patients. However, only a few studies have investigated the association between eating behavior and FD. The purpose of this cross-sectional study is to examine the association between eating behavior and prevalence of FD in a young Japanese cohort. Methods: In this study, we enrolled 8923 Japanese university students. FD is diagnosed based on the Rome III criteria. Eating habits and frequency of meals were investigated using a self-administered questionnaire. Results: The FD subjects had a younger mean age, a lower body mass index, and a lower proportion of men compared to the non-FD subjects.An independent positive association between skipping breakfast and/or lunch and FD was found (adjusted ORs were 1.60 [95% CI, 1.10-2.32] for breakfast and 2.52 [95% CI, 1.04-5.18] for lunch). Skipping dinner, extra meals (snacks) or midnight snacks was not associated with FD. The prevalence of FD in subjects eating 1, 2, and 3 meals per day was 4.8%, 2.2%, and 1.7%, respectively. The frequency of meals was independently inversely associated with prevalence of FD (adjusted ORs were 1 per day: 2.72 [95% CI, 1.19-5.42], and 2 per day: 1.69 [95% CI, 1.16-2.43], P for trend = 0.001). Conclusions In the young Japanese people, the frequency of meals may be independently inversely associated with prevalence of FD. In particular, skipping breakfast and/or lunch was associated with the prevalence of FD.

Background/Aims: Evidence regarding the association between body mass index (BMI) and functional dyspepsia (FD) in the Asian population is limited.Further, no study has evaluated this issue in young people in Asian and Western populations. Thus, we aim to investigate this issueamong young Japanese people. Methods: The study subjects comprised of 8923 Japanese university students. BMI was divided into 4 categories (quartiles) on the basis of thestudy subjects’ distribution (lowest, low, moderate, and high [reference]). The definition of lean, normal, overweight, and obesewas BMI < 18.5 kg/m2 , 18.5 ≤ BMI < 25 kg/m2 (reference), 25 kg/m2 ≤ BMI < 30 kg/m2 , and 30 kg/m2 ≤ BMI, respectively. The definition of FD was based on the Rome III criteria. Results: The prevalence of FD was 1.9% in this cohort. The lowest BMI was independently associated with FD after adjustment (adjusted odds ratio [OR], 2.88; 95% confidence interval [CI], 1.46-3.67); P for trend = 0.001). The lowest BMI was independently associated with FD in women but not in men (OR, 2.94; 95% CI, 1.59-5.77; P for trend = 0.001). Leanness was independently associated with FD in total and in women but not in men (total: adjusted OR, 2.01; 95% CI, 1.40-2.86) and women (OR, 2.19; 95% CI, 1.35-3.45). However,interaction analysis showed no significant difference for sex. Conclusions Among young Japanese people, BMI may be independently inversely associated with FD. Leanness may be an independent associated factor for FD in the young Japanese women.

Methods: LSS patients who underwent decompression surgery with or without fusion were included. Clinical outcomes were measured before surgery and 6 months postoperatively using the Zurich Claudication Questionnaire (ZCQ); Visual Analog Scale (VAS) of low back pain, leg pain, and leg numbness; Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; and the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36). The Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale, and Pain Anxiety Symptoms Scale were used to evaluate psychological status before surgery. Patients were classified as satisfied or dissatisfied with surgery based on a ZCQ satisfaction subscale cutoff score of 2.5. Results: The satisfied and dissatisfied groups contained 128 and 29 patients, respectively. Six months postoperatively, outcome scores for the dissatisfied group were unchanged or worse than preoperative scores (p>0.05). Multivariate logistic regression analysis showed significant associations between dissatisfaction and preoperative low back pain VAS score ≥ median (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.10–0.74; p=0.01), preoperative mental health SF-36 score ≥ median (OR, 0.26; 95% CI, 0.08–0.89; p=0.03), and preoperative anxiety HADS score ≥ median (OR, 3.95; 95% CI, 1.16–13.46; p=0.03). Conclusions Preoperative less severe low back pain, lower mental health, and higher anxiety are associated with patient dissatisfaction with lumbar surgery, not depression, pain catastrophizing, or fear-avoidance beliefs. Pre- and postoperative psychological status should be assessed carefully and managed appropriately.