Objectives  There are only a few quantitative studies focusing on religious and cultural barriers among non-Japanese-speaking patients and discussing the association in Japanese healthcare institutions. This study aims to clarify the association between the religious and cultural backgrounds of non-Japanese-speaking patients and their difficult experiences in the healthcare institutions.Methods  The Google Forms questionnaire survey was conducted in four languages (Plain Japanese, English, Chinese, Vietnamese) among non-Japanese-speaking patients who had visited a Japanese healthcare institution. Of the 376 respondents (response rate: 19.7%), 350 were included in the analysis while excluding invalid responses. The association between their religions and difficulties were examined by logistic regression analysis with putting their gender, age, Japanese language proficiency, the purpose of visit and the way to communicate in examination rooms as adjustment variables. Results  237 (67.7%) had no religion, 29 (8.3%) were Christian, 12 (3.4%) were Muslim, 22 (6.3%) were Hindu and 50 (14.3%) were Buddhist of those analyzed. Odds ratios for experiencing difficulties were significantly higher for Hindu (odds ratio ［95% confidence interval］＝6.35［1.51-26.77］) and Christian (3.67［1.27-10.61］) compared with those who do not have religion. Regarding difficulties, it was found that the half of Hindu respondents identified “food” (50%) indicating a religious and cultural background, while various difficulties were identified for Christian respondents including “religion” (22%), “culture” (22%), and “medical costs” (22%).Conclusions  This study demonstrated an association between religion and difficulties in Japanese healthcare institutions among non-Japanese patients with a large proportion of outpatients. It was observed that Christian and Hindu respondents were more likely to have difficult experiences in the healthcare institutions. The results of this study suggest a need for religious and cultural consideration in outpatient settings such as the use of healthcare interpreters and the practice of transcultural nursing by medical professionals.

Objective：We aimed to examine the criterion-related validity of observable items of gait abnormality in patients with knee osteoarthritis (OA) using three-dimensional gait analysis and to assess the test-retest reliability.Methods：The items of gait abnormality were pooled from a prior study and rated using a 3-point scale. Content validity was examined by four experts in knee OA research and accepted when there was an agreement among at least three experts. Correlation between abnormality rating and three-dimensional gait analysis data was examined. The test-retest reliability of the agreement rate was then assessed in the same subject twice.Results：Eleven items were pooled, and all met the criterion of content validity. Eight items showed adequate correlation with the three-dimensional gait analysis data and had test-retest reliability exceeding 0.61.Conclusion：In patients with knee OA, observable items of gait abnormality had good test-retest reliability and criterion-related validity according to the three-dimensional gait analysis data.

Objective：We aimed to examine the criterion-related validity of observable items of gait abnormality in patients with knee osteoarthritis (OA) using three-dimensional gait analysis and to assess the test-retest reliability.Methods：The items of gait abnormality were pooled from a prior study and rated using a 3-point scale. Content validity was examined by four experts in knee OA research and accepted when there was an agreement among at least three experts. Correlation between abnormality rating and three-dimensional gait analysis data was examined. The test-retest reliability of the agreement rate was then assessed in the same subject twice.Results：Eleven items were pooled, and all met the criterion of content validity. Eight items showed adequate correlation with the three-dimensional gait analysis data and had test-retest reliability exceeding 0.61.Conclusion：In patients with knee OA, observable items of gait abnormality had good test-retest reliability and criterion-related validity according to the three-dimensional gait analysis data.

Background: A workshop for training clinical clerkship staff has been held since 2009. We examined how the participants felt about the workshop.
Method: The questionnaire was sent to the participants of the workshop.
Result: Of the participants, 82％ thought that the workshop was helpful and that the benefits had continued for more than 2 years. Their motivation for undergraduate medical education was improved. They started to consider how medical students become members of a medical team and to think about the goals of medical practice. To promote further increases in the numbers of clinical clerkships, the participants cited the necessity of increasing the number of faculty advisors, encouraging medical students’ positive attitudes, changing attitudes about patients, extending the training period, and holding such workshops.
Conclusion: The workshop was beneficial for the staff, and the beneficial effects continued long after the workshop was held.

The activated clotting time (ACT) is used to assess adequacy of anticoagulation during cardiopulmonary bypass (CPB). However, ACT values during CPB do not correlate with heparin concentration and are affected by variations of such factors as hypothermia and hemodilution. ACT is also used to estimate protamine doses, because excess protamine may result in hypotension and an increase in bleeding after CPB. This study was designed to evaluate the effect of heparin and protamine administration that were administered based on whole blood heparin concentration using Hepcon/HMS (HC group) on the incidence of bleeding and blood transfusion after CPB. We treated 32 of adult cases and 36 pediatric cases. For the control group (NC group), an initial fixed dose of 300U/kg heparin was administered and if the ACT was less than 400s an additional fixed dose of 100U/kg heparin was administered. Heparin was neutralized with an initial fixed dose of protamine. For the HC group, the initial dose of heparin and the additional dose of heparin were based on an automated heparin dose response assay. The initial dose of protamine was based on the residual heparin concentration. The patients in the HC group received greater doses of heparin and lower doses of protamine than the patients in the NC group. In the pediatric HC group, the amount of TAT, FTC and D-dimer post CPB were smaller than those in the NC group. Operative time and closure time were similar the two groups. Operative bleeding, mediastinal chest tube drainage in the postoperative period were similar in the two groups. The volume of total blood transfusion was also comparable in the two groups. In conclusion, the monitoring of heparin concentration during CPB in children was effective for the maintenance of coagulation factors.

We report a 5-year-old girl with a diagnosis of an anomalous origin of the left coronary artery from the pulmonary artery with an intramural aortic route. The left coronary artery entered the aortic wall running parallel to the aorta. With the aid of cardiopulmonary bypass, she underwent establishment of two coronary artery systems by intraaortic reconstruction (unroofing and anastomosis). Her postoperative course was uneventful. Postoperative cineangiogram demonstrated patency and prograde flow in the new coronary systems.