Fifth Japan-UK Primary Care Exchange / 日本プライマリ・ケア連合学会誌

We, a group of four delegates from Japan, participated in the fifth Japan-UK Primary Care Exchange Programme and visited the UK in October of 2018. This report highlights some differences between the UK and Japanese healthcare systems, such as working conditions for GPs and requirements for GP trainers, and what the Japan Primary Care Association can learn from them. We propose that the Japan Primary Care Association create opportunities to discuss and exchange views with other healthcare professionals, strengthen training programs for future GP trainers and define competencies for GP trainers in Japan.

A Successfully Treated Case of Crawford Type I Thoracoabdominal Aortic Aneurysm with Supra-renal Abdominal Aorta Occulusion by Endovascular Repair and Debranching Visceral Arteries / 日本心臓血管外科学会雑誌

A 64-year-old man under dialysis was referred for surgical treatment of Crawford type I thoracoabdominal aortic aneurysm. He had a history of idiopathic portal hypertension and chronic total occulusion of supra-renal abdominal aorta and appeared to have massive development of collateral arteries and veins in the abdomen. We chose endovascular repair with debranching of visceral arteries and bypass grafting to bilateral superficial femoral artery considering bleeding from collateral arteries and veins by conventional open surgery. Postoperative CT scan revealed no endoleak and all debranched and bypass grafts were patent. He was discharged with no postoperative complications including paraplegia.

THE <i>ACTN3</i> R577X NONSENSE ALLELE IS UNDER-REPRESENTED IN ELITE-LEVEL JAPANESE ENDURANCE RUNNERS / 体力科学

<b>Background:</b> Although previous reports have shown a lower proportion of the ACTN3 XX genotype (R577X nonsense polymorphism) in sprint/power athletes compared with controls, possibly attributed to the importance of skeletal muscle function associated with alpha-actinin-3 deficiency, the findings on association between endurance athlete status and R577X genotype are equivocal. <b>Purpose:</b> The present study was undertaken to examine association of <i>ACTN3</i> R577X genotype with elite Japanese endurance athlete status. <b>Subjects and Methods:</b> Subjects comprised 79 elite Japanese endurance runners (E) who participated in competition at national level and 96 Japanese controls (C). We divided endurance runners into two groups, i.e., 42 national level runners (E-N) and 37 international level runners (E-I) who had represented Japan in international competition. R577X genotype (rs1815739) was analyzed by direct sequencing. Frequency differences of polymorphisms between athletes and controls were examined by Chi-square tests. <b>Result:</b> The R allele frequency tended to be higher in E group than in C group (P=0.066). When we divided E into two groups, the R allele frequency in E-I group was significantly higher than that in C group (P=0.046); whereas there were no significant differences between E-N and C groups (p=0.316). Then, the three genetic models were tested. In the additive genetic model (RR>RX>XX), there were significantly differences between E-I and C (P=0.038), but not the dominant (RR vs. RX+XX) and the recessive (RR+RX vs. XX) genetic models. <b>Conclusion:</b> R allele of the R577X genotype in the <i>ACTN3</i> gene was associated with elite Japanese endurance athlete status.

Long Term Effects of 19 mm Bileaflet Aortic Valve Prosthesis / 日本心臓血管外科学会雑誌

We reviewed our experience with 19mm size aortic valve prostheses for cases with small aortic annulus. Forty-six patients operated on between 1990 and Septembr 2002 were enrolled in this study. Clinical late assessment was performed to evaluate the incidence of valverelated complications, residual transprosthetic gradient, left ventricular mass index (LVMI), and NYHA functional class. Postoperative echocardiography was performed to evaluate hemodynamic performance of the prostheses. Follow up was 1 to 12.7 years (mean 5.3±3.6). There was no hospital mortality (0%). Actuarial survival rates at 10 years were 81.4±1.5%. The late postoperative peak gradient was 25±11mmHg. LVMI was significantly reduced in late phase. NYHA functional class significantly improved in the late period. Although 19mm size aortic valve prosthesis remains small transprosthetic pressure gradient, LVMI significantly reduced and patient activity was satisfactory maintained in the late period.