In the treatment of type II diabetes mellitus, patient “non-compliance” has been discussed since the 1970s. It is quite important that physicians not only prescribe medicine but also instruct the patients to support their therapy through lifestyle modification etc. For that purpose it is essential to establish a good physician-patient relationship. We carried out a literature search for articles that focused on the physician-patient relationship, and discussed with German medical students of the Westphalian Wilhelms University in Münster the differences between these relationships in both Japan and Germany.“ Adequate communication” and “continuous treatment by the same physician” can be major factors contributing to a better physician-patient relationship in patients with chronic diseases such as type II diabetes mellitus. In Germany, a primary care physician system has been established to facilitate continuous medical treatment and to improve the physician-patient relationship, while systems for disease prevention such as health screening programs are well developed in Japan. From now on, comprehensive health care systems, including disease prevention and disease management programs that foster a good physician-patient relationship are highly desirable for the management of various life style-related diseases.

It is not clear what contribution makes the internal anal sphincter (IAS) to the impaired motility observed in patients with Hirschsprung's disease (HD). Neuropeptides have recently been shown to be neurotransmitters in the non-adrenergic non-cholinergic inhibitory and excitatory nerves in the human gut. To clarify the physiological significance of vasoactive intestinal polypeptide (VIP) and substance P in the IAS of HD (aganglionosis), many researchers have investigated the enteric nerve responses on lesional and normal IAS above the dentate line in vitro. Especially, a mechanographic technique has been used to evaluate in vitro muscle responses to these peptides of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers. Following results have been reported. Non-adrenergic non-cholinergic inhibitory nerves are found to act on the normal IAS, but had no effect on the enteric nerves in aganglionosis. Peptidergic (VIP and substance P) nerves are found to act on normal IAS, but no effect is observed in the aganglionic IAS. According to these results, peptidergic nerves such as VIP and substance P play an important role in the impaired motility observed in the IAS of patients with HD.

In this study, exhaled gas was analyzed to evaluate dynamic pulmonary function in patients with respiratory diseases. The ⩒O₂ was measured and the anaerobic threshold (AT) determined during treadmill exercise. Exercise tolerance in pneumonia patients was compared with that in those with other respiratory diseases before discharge from hospital to evaluate the effects of rehabilitation. Treadmill exercise tests were administered using a continuous incremental multiple-load protocol to determine oxygen demand and the AT. The ⩒O₂ levels in pneumonia patients (5.19 ± 0.77) were not significantly lower than those in the other patients (5.56 ± 0.63), and neither was the AT (5.26 ± 1.23 versus 5.84 ± 0.62, respectively). At peak exercise, the Borg scale level was 2.8 ± 0.2 (pneumonia, 3.0 ± 0.4; others, 2.8 ± 0.2, P＝0.623); SpO₂ was 90.6 ± 0.7 (pneumonia, 90.6 ± 1.2; others, 90.5 ± 0.9, P＝0.962); and heart rate (HR) was 120.3 ± 2.9 (pneumonia, 123.9 ± 6.8; others, 119.0 ± 3.2, P＝0.469). Exhaled gas analysis in patients with respiratory diseases revealed that exercise tolerance was generally decreased, and that there was a weak negative correlation between age and ⩒O₂ peak (r＝－0.248; P＝0.186). The Borg scale levels, SpO₂, and HR at peak exercise showed no significant differences between pneumonia patients and others. This analysis allowed prediction of whether patients with pneumonia could leave the hospital or not based on early-stage exercise tolerance. Such AT data could be useful in helping patients to understand their own limitations with respect to exercise tolerance.

Background: Management of syncope in accordance with a guidelines-based algorithm has recently been shown to improve the rate of diagnosis. This algorithm is not yet widely used in Japan, however. This report describes comprehensive risk stratification by means of a guidelines-based algorithm in current clinical practice in Japan, and an attempt to clarify the frequency of cardiac syncope.

Methods: Data on consecutive patients presenting with syncope between April 2012 and March 2014 were retrospectively reviewed and clinical characteristics analyzed. Our syncope management strategy is based on guidelines published by the Japanese Circulation Society and European Society of Cardiology.

Results: A total of 210 patients were included in the analysis. Risk factors for cardiac syncope were defined by the guidelines. Cardiac syncope was diagnosed in 25％ of the patients following guidelines-based evaluation. Cardiac syncope was more frequent in patients with at least one risk factor in this Japanese population. The rate of recurrence of syncope in patients in whom management was completed in accordance with the guidelines was lower than that in those it was not.

Conclusion: A syncope unit and management in accordance with current guidelines are useful in improving the rate of diagnosis and preventing recurrence.

Background: The short-term clinical effects of Tolvaptan (TLV) in patients hospitalized for heart failure (HF) are well known. Only a few of studies have investigated its long-term efficacy and safety in HF outpatients after discharge, however. The purpose of this study was to investigate the long-term effects, prognosis, and safety of TLV in HF outpatients after discharge.

Methods: A total of 167 HF patients admitted to 8 hospitals in Kanagawa, Japan, between January 2013 and August 2015 were enrolled in the study. All were treated with TLV, even after discharge. The rates of continued administration of TLV, prognosis, and safety at 6 months were retrospectively evaluated.

Results: A total of 121 patients continued to take TLV for 6 months after discharge (Treatment Continued group); 24 did not require TLV therapy due to HF stabilization (Treatment Unnecessary group); and 22 discontinued TLV therapy (Treatment Discontinued group). A comparison of patient backgrounds at discharge among these groups revealed significant differences in history of hospitalization due to HF exacerbation, B-type natriuretic peptide level, and dose of furosemide. A significant number of events were observed in the Treatment Discontinued group (p＜0.001), most of which occurred within 30 days after discharge. In this group, 55％ of the patients were readmitted within 30 days after discharge.

Conclusions: The present results showing that it is possible to identify the effects of TLV in HF outpatients within 30 days after discharge suggest that long-term administration of this drug is relatively safe.

Objective: Enabling patients to measure their blood pressure (BP) at home is recognized as being of great clinical utility. Moreover, the monitoring devices that make this possible can be equipped with accessary functions useful to the promotion of health management. These include elimination of noise due to arm movement; guidance in arm wrapping; detection of irregular pulses; and various types of information-communication technology. The most important function of the device, however, is to accurately measure BP. Therefore, protocols for validation of BP monitoring devices have been proposed. Such a device can only be considered suitable for home use if it meets the criteria of these protocols. The aim of the present study was to evaluate the performance of 3 such devices according to the ESH-IP revision 2010.

Methods: Three trained medical technologists evaluated the performance of the Omron HEM-7600T-E, HEM-9210T, and HEM-7134-E in comparison with data obtained with a standard mercury sphygmomanometer. A total of 33 participants were enrolled in the experiments.

Results: The mean differences between each device and the mercury readings for systolic and diastolic BP were as follows: HEM-7600T-E, -0.1±5.0 mmHg and 0.2±4.1 mmHg, respectively; HEM-9210T, -2.1±4.7 mmHg and -1.2±4.1 mmHg, respectively; and HEM-7134-E, -0.9±5.4 mmHg and 0.6±4.7 mmHg, respectively. These findings indicate that the readings obtained with each device were similar to those of the mercury sphygmomanometer. The number of absolute differences between the devices and observers was found to meet the requirements of ESH-IP revision 2010.

Conclusion: The Omron HEM-7600T-E, HEM-9210T, and HEM-7134-E passed all the requirements of the ESH-IP 2010 revision.