A 70-years-old woman who had been on hemodialysis for 8 years was referred to our institution to undergo mitral surgery for mitral valve stenosis. Intraoperative investigations confirmed severe calcification of the posterior mitral leaflet and all-around mitral annulus. We excised the mitral leaflet using the Ultrasonic Surgical System and preserved the calcified annulus to prevent a fatal complication such as left ventricular rupture. We passed 2-0 polyester mattress sutures through the calcified annulus from the left ventricle to the left atrium, and mitral valve replacement was performed using a reversed 19 mm On-X mechanical heart valve for the aortic valve. The postoperative course was uneventful. Mitral annular calcification is a factor of fatal complications such as left ventricle rupture and coronary artery injury. We succeeded in preserving the calcified annulus and using a small diameter mechanical heart valve.

A workshop entitled "Health Literacy Primer: Enhancing Patients' Skills to Promote Their Good Health" was held during the 30th Family Medicine Summer Seminar for medical students and residents by the Japanese Primary Care Association. Participants carried out four group activities to learn about health literacy. First, participants watched a skit of a conversation between two women with low health literacy to recognize the importance of promoting health literacy among citizens. Second, they practiced evaluating the reliability of health information based on the Health on the Net (HON) Code and "How to read health news" published by the British National Health Service. Third, they conducted medical interviews with patients who had brought documents containing questionable health information. Fourth, they practiced interviewing citizens with a low literacy in healthcare matters using the "teach back" technique and "Ask Me 3" questions. Many participants stated that our workshop was satisfying and understandable. We think it is necessary to hold such workshops to establish the concept of health literacy in our country, especially in the field of healthcare. In this report, we summarize the content of our workshop, and discuss future objectives for spreading and developing health literacy in Japan.

Aged ; Androgen Antagonists/adverse effects* ; Anticholesteremic Agents/therapeutic use* ; Cholesterol, HDL/blood* ; Cholesterol, LDL/blood* ; Humans ; Hypercholesterolemia/chemically induced* ; Lipids/blood* ; Male ; Middle Aged ; Prostatic Neoplasms/therapy* ; Retrospective Studies ; Testosterone/blood*

We report a case of endovascular surgery in a patient of common iliac artery aneurysm with arteriovenous (A-V) fistula. A 60-year-old woman was admitted because of dyspnea. She had a clinical history of lumbar disk surgery at age of 40. On physical examination, we detected a pulsatile mass and pansystolic murmurs in her left lower abdomen. A chest X-ray film demonstrated severe cardiomegaly with 70% of cardiothoracic ratio. Contrast-enhanced CT revealed left common artery aneurysm with A-V fistula between the left common iliac artery and the left common iliac vein. Three-dimensional CT showed hyper-vascularity in the region from the pelvic vein to IVC. We considered that she had high risk of intraoperative massive bleeding for open abdominal surgery. We conducted endovascular repair for this iliac artery aneurysm with A-V fistula by the GORE EXCLUDER C3^® stent graft system. Postoperative contrast-enhanced CT showed complete exclusion of both left common iliac artery aneurysm and A-V fistula. After surgery, her symptoms improved significantly.

Introduction: Compared with faculties in clinical and medical research departments, those in medical departments are not appropriately evaluated in terms of their contributions to or achievements in medical education. Therefore, the aims of this study were to investigate the contributions of medical department faculties to medical education, and to examine differences in contributions according to duty positions and specialties.

Methods: Five-grade self-assessments in relation to 20 items on a rating form for performance in medical education, which was developed by the Japan Society for Medical Education's Committee for Performance Evaluation, were carried out by medical department faculties in Japanese universities. The data were then totalized and analyzed.

Results and Discussion: Although faculties belonging to departments other than medical education units did not actively participate in examinations or the education system, they still made contributions to lectures and practice. In addition, faculties with positions with more duties tended to show greater participation in the education system.

Conclusion: Based on these findings, we recommend the use of a rating form as a standard scale to evaluate performance in medical education.

While the session-RPE (rating of perceived exertion) method can quantify training volume in athletes, this method is not able to evaluate energy expenditure (EE) during a training session. We developed an RPE-based activity record for assessing EE during athletic training, and we compared its results to those obtained using the flex-heart rate (flex-HR) method. The EE of nine female collegiate endurance runners was assessed by the RPE-based activity record and flex-HR methods during eight days in the normal training season. Subjects were asked to record their RPE in the record at 5-minute intervals, and to wear a HR monitor during training. All subjects also participated in an incremental treadmill exercise test, which was used to determine their RPE-EE and HR-EE regression equations. Although the RPE-based activity record significantly overestimated EE (RPE-activity record, 572 kcal/session; flex-HR method, 499 kcal/session; p = 0.031), it had high validity relative to the flex-HR method (intra-class correlation coefficient, 0.891; 95% confidence interval, 0.845–0.923) and there were no systematic errors in EE estimation between the two methods. Therefore, the RPE-based activity record can be used to assess EE during training in female runners. However, RPE-based activity record might overestimate EE for athletes who have more intermittent activities during training than endurance runners, because RPE takes more time for returning to the resting level than HR when the intensity of activity declines. Further research is needed to verify the validity of the RPE-based activity record for assessing EE during other sporting activities or measurement conditions, and to identify the factors affecting the degree of estimation error associated with this method.

[Introduction]Insomnia and anxiety are major symptoms of depression and severely limit the daily activities of depressed patients. We report the case of a depressed patient who had developed liver dysfunction caused by medication and whose depression was successfully managed by acupuncture after discontinuation of antidepressants.
[Case]A 37 years-old male had been taking noradrenergic and specific serotonergic antidepressant (NaSSA) and Chai Fu Jia Long Gu Mu Li Tang Jia Wei Gui pi Tang for insomnia and anxiety due to depression. Although his symptoms had improved by the medication, abnormalities in his liver functions were found after 3months of medication. After he was diagnosed as having drug-induced liver damage, he was admitted to Meiji University's Integrative Medicine Hospital and all medication was replaced by Glycyrrhizin and Glutathione. Consequently his depression and symptoms returned. We then tried to relieve his symptoms by applying acupuncture, which was prescribed according to traditional Chinese medical diagnosis (TCM diagnosis, Heart Yin Deficiency , Liver Qi Stagnation , and Kidney Yin Deficiency ).
[Results]After 4 acupuncture treatments, the patient's duration and depth of sleep considerably improved compared with that before the acupuncture sessions, and comparable results were maintained until discharge. Beck Depression Inventory (BDI) scores were also markedly improved from 'moderate depression'(24 points) at the beginning of treatment to 'minimal depression'(8 points) at the end (9th treatment, 16 days from the first session).
[Conclusion]The results of this case suggest that acupuncture treatment may be an effective alternative for anti-depressants when there is a limitation to administer those drugs.

Background: Sleep apnea syndrome (SAS) is a common medical condition with significant adverse effects; however, it remains undiagnosed in many individuals. This study was conducted to assess the prevalence of SAS in fatigued subjects and to elucidate the factors associated with SAS.
Methods: From March 2008 to March 2011, a cross-sectional, observational study was conducted in patients with persistent (≥1 month) fatigue. Patients with known causes of persistent fatigue were excluded. Data on patient characteristics (e. g., blood pressure, neck circumference, etc.) and overnight pulse oximetry were collected. SAS was defined as a 3% oxygen desaturation index (ODI) of 15 or more.
Results: Among 46 subjects, the prevalence of SAS was 6.5% (95% CI, 1.4-17.9%). SAS was significantly more prevalent in patients with high systolic blood pressure (≥140 mmHg) than in patients with normal systolic blood pressure (<140 mmHg) (33.3% vs. 2.8%, P=0.049). Even after adjustment for age and sex, high systolic blood pressure showed a statistically significant association with SAS.
Conclusions: Promoting awareness about SAS could be necessary in patients with persistent fatigue, especially in patients with high systolic blood pressure.