The aim of this study was to investigate the relationship between changes in swimming velocity (SV), stroke rate (SR), stroke length (SL) and muscle activities during a 4×50m swimming test to simulate a 200m freestyle race. A total of 20 male collegiate swimmers participated in this study. The electromyography (EMG) signals of 11 muscles, 7 muscles in the upper half of the body and 4 muscles in the lower half, were recorded with surface electrodes. SV, SR and SL were analyzed for each 50m (S1, S2, S3 and S4) from side view recordings of swimmers taken with an underwater camera.SV and SR for S1 were significantly higher than for S2 and S3. SL for S1 was significantly longer than for S3. The averaged EMGs (aEMGs) for S1 were significantly higher than for S2 or for S3 in 5 muscles (flexor carpi ulnaris, biceps brachii, triceps brachii, deltoideus posterior and rectus femoris). There were no significant changes between S3 and S4 in SV, SR, SL and aEMG of all muscles except pectoralis major which showed the highest aEMG in S4. Significant correlations were observed between changes of (Δ) aEMG and ΔSV, especially in upper half muscles (r=0.485-0.939, p<0.05).These results suggested that decline in muscle activities of the five muscles mentioned earlier caused a decrease in SV from S1 to S3; and an increase in muscle activity of the pectoralis major led preventing a decline in SV by maintaining the SR in S4.

The purposes of this study were as follows: 1) to classify competitive swimmers on the basis of their stroke rate (SR) and stroke length (SL) by applying a factor analysis and a cluster analysis, 2) to derive discriminant functions by applying a multiple discriminant analysis of the stroke characteristics, and 3) to compare the race patterns of groups classified according to the results of the cluster analysis. 94 male swimmers who had participated in 100-m freestyle events held at the All Japan Swimming Championship from 2000 to 2004 were selected as subjects. The average value of their swimming velocity, SR, and SL in four swimming phases (15-25 m, 25-45 m, 57.5-75 m, and 75-95 m) were measured from videos captured. The subjects were classified according to their SR and SL by applying a factor analysis and a cluster analysis. Results showed that the competitive swimmers could be classified into Type1-4. Type1 showed high values of SR throughout the race, Type2 showed high values of SR in the first half and high values of SL in the second half, Type3 showed high values of SL in the first half and high values of SR in the second half, and Type4 showed high values of SL throughout the race. Although there was no difference in swimming records among the four groups, each group had different race patterns. These results suggest that the knowledge of race patterns might be useful to swimmers or coaches for planning race strategies.

A 69-year-old man was admitted for treatment of thoracic aneurysm. DSA revealed multiple aortic aneurysms: three true aneurysms which were located at the distal arch, the thoraco-abdominal aorta at the diaphragm level and the infrarenal abdominal aorta, 60mm, 55mm and 55mm in diameter, respectively and two pseudo-aneurysms which were located in the abdominal aorta just below the right renal artery and the right common iliac artery. We decided to perform a two-staged operation. Before the first operation, 1, 200ml of autologous blood was stored for perioperative blood transfusion. Initially, total arch replacement was performed using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. One month after the first operation, total thoraco-abdominal aorta replacement was performed by a retroperitoneal approach with mild hypothermia. The Th 9, 10 and 11 intercostal arteries were reconstructed. Distal anastomosis was performed at both common iliac arteries. Blood transfusion was not required for blood pooling and reduction of priming volume in the cardiopulmonary bypass system.

Background: The technique of pancreatoduodenectomy (PD) has evolved, andartery first’ approach was considered for the intraoperative early determinationof resectability for borderline resectable cases before the ‘point of no return’and avoidance of blood congestion resulted in the reduction of blood loss. Also,active application of energy device was useful for the reduced operative time andblood loss. Recently, 3D simulation for hepatobiliary pancreatic surgery has beenuseful and mandatory. In this presentation, we introduced our recent refinementsand advances for PD.‘Artery first’ approach and vessel sealing system for PD: ‘Artery first’ approachwere considered as six different methods as follows; 1) Superior approach, 2)Anterior approach, 3) Posterior approach, 4) Left posterior approach, 5) Right/medial uncinate approach and 6) Mesenteric approach. A while ago, wepreferably applied the mesenteric approach to PD, and also the combination ofthis approach with vessel sealing system (VSS) significantly reduced intraoperativeblood loss (Mesenteric approach with VSS, n=21 vs. non-‘Artery first’ approachwithout VSS, n=78; 320±174ml vs. 486±263ml, p<0.01).Modified de-rotation method as complete ‘Artery first’ approach: Most recently,for further refinement of operative procedure, we refined a right/medial uncinateand posterior approach as modified de-rotation method. Point of view in thismethod was the complete clockwise rotation of small intestinal mesenteryincluding ascending colon, in order to linearize from duodenum to jejunumand look at the direct front of superior mesenteric artery (SMA), vein (SMV) andsome branched jejunal vessels originated from SMA and SMV (Fig.). Thereby, inthe posterior view, the easy dissection of all pancreatic branch originated fromSMA can be done. This modified de-rotation method was possible to achieve thecomplete ‘Artery first’ approach.Preoperative 3D simulation of arterial and venous anatomy:Until now, we applied 3D volumetery software (SYNAPSE VINCENT®) aspreoperative simulation for hepatic resection. And recently, for evaluation of theposition relationship between arteries and veins surround pancreas head, weadopted this software before PD. As first step, arteries and veins are automaticallyidentified, and small vessels are manually traced on the axial CT view. Afterthat, 3D arterial and venous simulations are combined. Grasp of detailed vesselanatomy and its relationship using preoperative 3D simulation enable to safelyperform PD, even in young surgeons (operative time; young 512±49 vs. senior445±41 min, p<0.01), (blood loss; young 353±203 vs. senior 246±109 ml,p=0.16).Conclusion: Those refinements and advances are possible to safely and easilyperform pancreatoduodenectomy.

Purpose and Method: It is known that people have insufficient recognition about hospital-based palliative care units (PCUs). Patients with cancer and their families are probably not well informed about PCUs on its admission. To understand the situation of patients and their families before and after PCU admission, a questionnaire survey was performed and evaluated by PCU nurses. Result: As a result, two points regarding PCU admission have become clear. First, about 55％ of the nurses reported that prior to PCU admission, patients and family members lacked proper information about PCUs; about 62% of the nurses felt that PCUs had not been appropriately explained to the patients; and about 37% of the nurses felt that family members had not received an appropriate explanation of PCUs at the time of PCU admission. Second, before PCU admission, the main concern of patients and their families was proper utilization of PCUs. After admission, their main concerns were the extent of treatment provided in the PCU and the progress of the disease. Conclution: These results suggest that appropriate information on PCUs, including the scope of treatment provided to patients and the requirements for PCU admission, is necessary for general ward staff as well as for the patients and their families prior to PCU admission.

Objectives: The purpose of this study was to examine common experiences among patients and primary family caregivers as they transition to hospice and palliative care units (PCU), with focus on the perspectives of cancer patients and their primary family caregivers. Methods: We conducted semi-structured interviews using a questionnaire with a purposive sample of 5 terminal cancer patients and 9 primary family members of patients who were admitted to the PCU from November 2005 to December 2006. The questionnaires consisted of questions about the PCU, and semi-structured interviews inquired about perceptions of the PCU. We analyzed interview contents from 14 participants (mean age ±SD; patients, 77.2±4.0 years; family members, 53.7±14.6) by summarizing content analysis. The Aiwa Hospital Institutional Review Board approved the present study. Results: Content analysis identified common perceptions about the PCU. Perceptions prior to the transition were summarized into 2 categories for patients and 5 categories for families, including general impressions of the PCU, PCU environment and equipment, treatment, cost, and other patients. After being admitted to the PCU, perceptions were summarized into 3 categories for patients and 7 categories for families, including general impressions of the PCU, PCU environment and equipment, treatment, staff, cost, other patients, and religion. Conclusion: Identification of these themes from patient and family perspectives suggested that patients transitioned to hospice with no particular impressions about the PCU, while families perceived the PCU as both “a place to relax” and “a place where one only waits to die” before entering the PCU. These results may aid in designing interventions that consider patient and family needs and desires during the transition to the PCU.

Topical cardiac hypothermia has unequivocal preservation effects during ischemia, but it has some disadvantages. Topical cooling, especially with ice slush, can injure the phrenic nerve, disturb the equal distribution of the cardioplegic solution due to coronary artery spasm and damage the epicardium. It is easy to prevent cooling injury without topical hypothermia, but the myocardial oxygen demands are increased. In order to supply the myocardium with oxygen for the increased oxygen demands during ischemia, isolated rat hearts were immersed in perfluorochemicals (PFC) which have excellent transportation of oxygen. The effects of immersion in PFC during mild hypothermic ischemia (at 20°C without cardioplegia and at 30°C cardioplegic arrest) on the cardiac function on reperfusion were evaluated. Under 20°C hypothermic ischemia without cardioplegia, cardiac beating was maintained for 20±4 minutes in the hearts were immersed in PFC, and for 10±2 minutes in the hearts that were not immersed in any solution. In the recovery of cardiac function (LVDP and LV_max dp/dt) after mild hypothermic (30°C) cardioplegic arrest, the hearts immersed in PFC showed better results than hearts that were not immersed.

Objectives: We developed versions 2 and 3 of the Biological Prognostic Score (BPS) for advanced cancer patients and confirmed the prediction accuracy. Methods: We conducted a parametric survival analysis using blood test data, performance status (PS), clinical symptoms, age, sex, and cancer type as variables for advanced cancer patients who completed or suspended cancer treatment, in the development of BPS2 and BPS3. We then prospectively compared the accuracy between BPS2/BPS3 and the Palliative Prognostic Index (PPI). Results: We developed the BPS2 and BPS3 based on the data from 589 patients in a development cohort. While the former version was calculated based on the cholinesterase, blood urea nitrogen, and white blood cell counts, the latter was calculated based on the BPS2, ECOG PS and edema. For 206 patients in a validation cohort, the overall accuracy in prediction of survival for 3 and 6 weeks using the BPS2 and BPS3 were significantly higher than those for the PPI. Conclusion: The usefulness of BPS2 and BPS3 was suggested.

Background: The technique of pancreatoduodenectomy (PD) has evolved, and artery first’ approach was considered for the intraoperative early determination of resectability for borderline resectable cases before the ‘point of no return’ and avoidance of blood congestion resulted in the reduction of blood loss. Also, active application of energy device was useful for the reduced operative time and blood loss. Recently, 3D simulation for hepatobiliary pancreatic surgery has been useful and mandatory. In this presentation, we introduced our recent refinements and advances for PD. ‘Artery first’ approach and vessel sealing system for PD: ‘Artery first’ approach were considered as six different methods as follows; 1) Superior approach, 2) Anterior approach, 3) Posterior approach, 4) Left posterior approach, 5) Right/ medial uncinate approach and 6) Mesenteric approach. A while ago, we preferably applied the mesenteric approach to PD, and also the combination of this approach with vessel sealing system (VSS) significantly reduced intraoperative blood loss (Mesenteric approach with VSS, n=21 vs. non-‘Artery first’ approach without VSS, n=78; 320±174ml vs. 486±263ml, p<0.01). Modified de-rotation method as complete ‘Artery first’ approach: Most recently, for further refinement of operative procedure, we refined a right/medial uncinate and posterior approach as modified de-rotation method. Point of view in this method was the complete clockwise rotation of small intestinal mesentery including ascending colon, in order to linearize from duodenum to jejunum and look at the direct front of superior mesenteric artery (SMA), vein (SMV) and some branched jejunal vessels originated from SMA and SMV (Fig.). Thereby, in the posterior view, the easy dissection of all pancreatic branch originated from SMA can be done. This modified de-rotation method was possible to achieve the complete ‘Artery first’ approach. Preoperative 3D simulation of arterial and venous anatomy: Until now, we applied 3D volumetery software (SYNAPSE VINCENT®) as preoperative simulation for hepatic resection. And recently, for evaluation of the position relationship between arteries and veins surround pancreas head, we adopted this software before PD. As first step, arteries and veins are automatically identified, and small vessels are manually traced on the axial CT view. After that, 3D arterial and venous simulations are combined. Grasp of detailed vessel anatomy and its relationship using preoperative 3D simulation enable to safely perform PD, even in young surgeons (operative time; young 512±49 vs. senior 445±41 min, p<0.01), (blood loss; young 353±203 vs. senior 246±109 ml, p=0.16). Conclusion: Those refinements and advances are possible to safely and easily perform pancreatoduodenectomy.

Abstract
Objective : In this study, we conducted a survey on both the use of supplements by customers and information provided by pharmacists, to clarify customer understanding. We also sought to ascertain the actual current state of information provided by pharmacists to customers, as well as investigating both how, and to what extent, pharmacists should be involved in customers 'use of supplements.
Methodology : During regular pharmacy visits, pharmacists used a questionnaire to interview 1,253 customers, in 14 community pharmacies, in Tokyo and Hokkaido, respectively. A different questionnaire, designed for pharmacists, was also given to 289 pharmacists who were either working in those same pharmacies, or who attended the Conference on Pharmaceutical Sciences in Hokkaido (2011, Sapporo).
Results : The results of the survey showed that approximately 50％ of consumers greatly desired the provision of safety and efficacy information about supplements by pharmacists. However, few pharmacists answered customers' questions satisfactorily (only 7.3％ of total responses).
 The results also indicated that only 30％ of pharmacists actively gathered information about supplements, despite the fact that 67.5％ of pharmacists were aware that they were expected to do so by customers, in their roles as primary information providers regarding such treatments. Furthermore, even those pharmacists who checked information regarding supplements depended mostly on information acquired from the Internet.
Conclusion : There is a large gap between customers' expectations for explanation of supplements and the reality of such explanations, and the information actually provided by pharmacists. In order to live up to their customers' expectations, pharmacists should foster both wider dissemination and better understanding of evidence-based information about supplements. Pharmacists should also provide integrated management of drugs and supplements for patients.