We report on a case of left ventricular outflow tract myectomy with Y-incision annular enlargement and aortic valve replacement for aortic valve regurgitation associated with subvalvular aortic stenosis. Subvalvular aortic stenosis is recognized as congenital heart disease, with a few reports in adult cases. Left ventricular outflow obstruction in cases of subvalvular aortic stenosis can be relieved by either the Konno procedure or a modified Konno procedure. Additionally, there has been an increasing number of reports of valve annular enlargement using the Y-incision technique recently. Unlike the Manouguian and Konno procedure, the Y-incision technique allows for valve annular enlargement without cutting the left atrium, mitral valve, or right ventricular outflow tract. While the Konno procedure would typically be considered for this case, the Y-incision technique was selected for valve annular enlargement. This approach provided a clear view from the aortic valve annulus, enabling the excision of fibrous thickening and abnormal myocardium excision. This case resulted in a favorable postoperative course.

  In Japan, few health care professionals have a basic understanding（core competency）of the design of clinical research and statistical analysis. We developed a blended distance–learning program comprising face–to–face lectures with e–learning for busy health care professionals who work in the clinical settings to achieve core competency in clinical research. The purpose of this study was to examine the educational effects of this program.
1）Four months after the end of the program, 64％ of the participants had started to conduct clinical research.
2）This program may increase the number of research colleagues that can discuss clinical research.
3）This program could enhance the confidence（self–efficacy）of health care professionals in clinical research.

Objective: The present study examined the status of the provision of drug information to hypertensive patients at community-based pharmacies by evaluating patients' satisfaction, understanding, and wishes.
Design: A cross-sectional study was conducted by surveying patients using a self-administered questionnaire.
Methods: Three items were evaluated: 1) the level of patient satisfaction with provision of drug information; 2) the level of patient understanding of information provided on antihypertensive drugs; and, 3) patient wishes regarding provision of drug information.
Results: The level of satisfaction with provision of drug information was high (86.6%). Although patients were found to understand the precautions for use of antihypertensive drugs, their understanding of drug efficacy was insufficient. Also, patients wished to receive more explanation from pharmacists regarding the efficacy of drugs in addition to explanations of associated adverse reactions or precautions for use of the drugs.
Conclusions: Hypertensive patients were highly satisfied with the provision of drug information at community-based pharmacies, but did not show sufficient understanding of the efficacy of antihypertensive drugs, an issue to be addressed in the future by pharmacists in their instructions to patients on the use of drugs.