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Our hospital has an established outpatient chemotherapy room, and medical doctors have accessed veins for infusion so far. We trialed venous access by nurses for the purpose of managing safe and proper cancer chemotherapy, reducing the work of doctors, and reducing patient waiting time. A questionnaire was conducted in June 2013, and nurses secured routes at 19 facilities(58%)of the 33 national university hospitals. In November of the same year, the working group was established, and from September 2016 to March 2017, lectures, practical skills, a paper test, and a practical test were conducted; successful applicants were approved as in-hospital certified nurses. From April 2017, we started intravenous injection of anti-cancer drugs by nurses in outpatient chemotherapy rooms and always waiting for doctor in chemotherapy room. There have been many favorable reports of reduced pain and less route failure from patients, and issues, such as extravasation and dyspnea, have not occurred yet. The doctors who were interrupting their work by 29 minutes(20 minutes to and from the patient for a 9-minute procedure)could concentrate on their own tasks. However, patient waiting time increased from 14 minutes to 21 minutes because the amount of work for nurses increased. In the future, reducing the burden on nurses, for example, by increasing the number of nurses, is warranted.

Objective The symptoms with optic ataxia suggest that simple and visually guided hand movements are controlled by 2 different neural substrates. To assess the differential frequency-coded posterior parietal cortex (PPC) role in planning visuo-motor goal-directed tasks, we studied the action specificity of event-related desynchronization (ERD) in this area. Methods We investigated cortical activity by electroencephalography, while 16 healthy subjects performed self-paced reaching or wrist extension (control) movements. Time–frequency representations were calculated for each movement during the preparatory period. Results ERD dynamics in upper alpha-band indicated that preparing a goal-directed action activates contralateral PPC to the moving hand around 1.2 s before starting the movement, while this activation is later (around 0.7 s) in preparing a not-goal-directed action. The posterior dominant rhythm had peak frequency of lower alpha-band at bilateral parietal. Conclusions Posterior parietal cortex encodes goal-directed movement preparation through upper alpha-band activity, whereas general attention is processed via lower alpha-band oscillations. Significance Preparing to reach an object engages posterior parietal cortex earlier than a not-goal directed movement.

Resonance Raman spectra are measured for copper(II) complexes ([Cu(RL)2]) using a series of β-diketiminate ligands (L) carrying different α-substituents (R = Me, H, CN, and NO2), and quantum chemic...

Although tissue confirmation is essential for a diagnosis of primary central nervous system large B-cell lymphoma (PCNSBL), accurate assessment may still be difficult, even when tissue is obtained. We report a 59-year-old man, first diagnosed as multiple sclerosis by open biopsy at another institution, who was then correctly diagnosed as PCNSBL after stereotactic biopsy at our hospital. The initial biopsy showed heavy lymphoid and macrophage influx with visible demyelination. On rebiopsy, a diffuse infiltrate of small to medium-sized lymphocytes was prominent and largely stained as T cells (CD3) by immunohistochemistry. There was also an admixture of macrophages, but this time, relatively low numbers of large malignant cells were also identified. The latter stained as B cells (CD20), enabling a diagnosis of B-cell lymphoma, and the condition responded fully to high-dose methotrexate. It is thus possible for PCNSBL to be histologically misinterpreted as a result of ancillary inflammation, characterized here as a profusion of T cells and macrophages.

The transvenous approach via the superior ophthalmic vein (SOV) is an available approach for carotid cavernous fistula (CCF), especially in the event that there is no other suitable approach route to the fistula. Surgical exposure of the peripheral roots of the SOV is commonly used; however, often, the SOV is often not accessible because of anatomical problems and/or complications. In this paper, we present and discuss our original direct-puncture approach to the extraconal portion of the SOV.An attempt on three patients with traumatic CCF failed with the transarterial approach and the conventional venous approach via the inferior petrosal sinus; therefore, the patients were treated with the direct-puncture approach to the extraconal portion of the SOV using two-dimensional digital subtraction angiography with local anesthesia.All cases that had tortuous and partially stenotic division of the SOV were treated successfully with this approach and without complications.This approach will become an alternate approach, especially when the peripheral roots of the SOV are focally narrowed and tortuous, making it impossible to insert a catheter.

Angiosarcoma is a rare, highly malignant tumor with a poor clinical outcome. From January 2004 to September 2005, we advocated transarterial chemotherapy using a port system for four patients with angiosarcomas of the face and scalp. A heparin coated ANTHRON P-U catheter was introduced into the feeding artery. The proximal part of the P-U catheter was connected to the port system and buried in subcutaneous tissue. The amount of chemotherapeutic drug applied using the port system was almost the same as the conventional intravenous dose. Paclitaxel was the standard agent, at 50–100mg/diluted in 15–30 ml of physiological saline fluid slowly injected over 0.5–1 hour. For immunotherapy where appropriate, r-IL2 was mainly used at a dose of 70.000U/diluted in 5ml of physiological saline fluid injected into the port system over 30 seconds. This was continued for two to three weeks (five days/week) until recognition of a disappearance of the tumor. Macroscopic size reduction of the tumor was achieved in three out of the four cases. One case could not be evaluated because of eruptions induced by immunotherapy. Unfortunately two patients died after placement of port system, but the other two are still alive and are enjoying useful lives. Transarterial infusion chemotherapy using such a port system may be particularly effective for angiosarcoma in the early stages because small lesions with limited invasion mean a small territory of blood supply to be covered, and useful life was possible because the port system embedded in subcutaneous tissue allows treatment in an out-patient clinic.

An alternative technique for cutting the bone flap in supratentorial craniotomy uses a threadwire saw (T-saw), originally developed for spinal surgery. After placing a burr hole at each corner of the intended craniotomy, osteotomy is performed between adjacent burr holes using a craniotome, leaving a bony bridge of approximately 1/3 of the length of the osteotomy. The T-saw is introduced between adjacent burr holes through the epidural space and the bridge is cut with reciprocating strokes. The narrow beveled cut reduces the bone gap for fitted bone flap fixation. On closure, the bridge firmly supports the flap and only sutures are needed for fixation. A minimal amount of filler is required to fill the bone gap. Successful bone flap fixation was obtained in more than 100 cases. No technique-related complications such as dural laceration or flap displacement occurred. Osteotomy using a T-saw was somewhat time-consuming, but cutting efficiency was improved with a Diamond T-saw, featuring a section of cable covered with diamond particles. This method is ideal for bone cuts in cosmetic cranioplasty; is easy and safe to perform, is inexpensive, and avoids the need for flap fixation with metal devices.

Thirteen patients under an intensified regimen in which regular insulin was being administered 3-4-times a day were selected for our study. In order to improve both postprandial glucose control and QOL for these patients, the regular insulin was changed to rapid-acting human insulin analogues.Self-monitoring of blood glucose (SMBG) was conducted and glycosylated hemoglobin A (1C) (HbA1c), rate of hypoglycemic episodes, and body mass index were also monitored. In our role of pharmacist/Certified Diabetes Educator, wead-justed the doses in accordance with patient symptoms under the guidance of their doctors.Patients' comments were obtained and from them, their sense of unease before and after the change was investigated. Pharmaceutical care, nutrition control, and counseling were carried out on the basis of the results in order to keep the patients in an appropriate state in accordance with their symptoms. Regardless of variation in insulin doses, their QoL improved and incidence of hypoglycemia decreased. Patient autonomy and compliance were also enhanced.

For surgeons operating in the standing position, the manipulation of foot switches involves shifting of the weight to the pivoting leg and the possible loss of contact between the switch and the foot. We solved this problem by changing the position of the switch that operates bipolar forceps. Our novel device is made of aluminum plates. The base plate features a foot strap and a height-adjustable overhang over the switch-operating foot. A commercially-available disc type foot switch is attached to the underside of the overhang in upside-down position, so the switch is operable with the toe. To turn on the switch, the toe is flexed dorsally to push the switch pedal, so the action is limited to the part distal to the metatarsophalangeal joints. Our switch was used in more than 100 consecutive microsurgeries performed by surgeons operating in the standing position. The switch manipulation required no shifting of the weight and was easier and quicker than manipulation of conventionally-placed switches. The surgeons were able to change the foot position freely with the modified switch, thereby avoiding loss of contact with the switch. The modified switch placement reduced physical fatigue in the lower extremities, annoyance related to the manipulation of conventionally-placed switches, and increased the comfort of surgeons operating in the standing position.

To study whether the body fat-reducing potential of conjugated linoleic acid (CLA) could be increased through dietary manipulations, the effects of the combination of CLA with different proteins, fats, and sesamin were examined in rats. Male rats were fed diets containing 1% CLA or linoleic acid (LA) in combination with different proteins (20% of casein or soybean protein), fats (7% perilla oil or soybean oil) and 0.2% sesamin (SES) for 3 or 4 weeks. When the dietary fat source was soybean oil, CLA, as compared with LA, significantly reduced weights of epididymal and perirenal adipose tissues, irrespective of the dietary protein sources. However, the highest reducing effect was shown when soybean protein was given as a protein source. SES stimulated the reduction of epididymal and perirenal adipose tissue weights in both protein diets. In contrast, CLA increased the weight of brown adipose tissue, and SES further increased it in combination with soybean oil but not with perilla oil. No effect of dietary manipulation was observed on serum leptin and TNF-alpha levels. Thus, the body fat-reducing potential of CLA can be increased by an appropriate combination with food factors that may stimulate fatty acid beta-oxidation.

A plasticization method for cellulose acetates (CAs) has been developed that is based on the reaction with dibasic acid anhydrides and monoepoxides during the melting processing. As a continuation of the discussion in the previous report, additional evidence is presented for the role of grafting oligoesters onto cellulose acetates to prevent the bleeding of homo-oligoesters from the inside of molded articles to their surface. Based on these results, a method for enhancing the amount of grafting has been pursued by varying the combination of dibasic acid anhydrides and monoepoxides. The resulting reactive meltprocessing method allows preparation of biodegradable cellulosic plastics using practical process conditions. Higher biodegradability has been found for the oligoester-grafted CAs than for the unmodified parent CAs.

We present a case with spinal myolipoma that was unique in its anatomical composition and symptomatology.An 18-year-old male presented with urinary retention and buttock pain exacerbated by standing on tiptoe underwent untethering of the low-set conus associated with a sacral fatty tract. Electrical stimulation of the spinal roots beside the upper conus induced anomalous caudal movement of the conus and contraction of the gastrocnemius muscle. In the lower conus, an ectopic muscle bridging the conus and dura was found, and the tissue contracted upon electrical stimulation. The histopathological diagnosis was myolipoma involving mature striated muscle and fat cells. Postoperatively his buttock pain was relieved immediately, but urinary retention persisted.We posit that his buttock pain, exacerbated by standing on tiptoe, was due to traction of the conus by contraction of the ectopic muscle that was aberrantly innervated from the sacral spinal roots.

Analogs 2–24 of the N-terminal tripeptide region of the tethered peptide ligand for human thrombin receptor have been synthesized for elucidation of the receptor bound conformation of the ligand peptide and the conformational analysis of model structures 25–30 of those peptide analogs suggested a plausible conformation for the receptor bound structure of the tripeptide region. Analogs of the N-terminal tripeptide region of the tethered peptide ligand for human thrombin receptor have been synthesized and the conformational analysis of model structures of those peptide analogs suggested a plausible conformation for the receptor bound structure of the tripeptide region.

Two new alkaloids possessing a cyclobutane ring, named pipercyclobutanamides A ( 1 ) and B ( 2 ), have been isolated from the fruits of Piper nigrum. Their stereostructures were determined by extensive spectroscopic methods.

A series of 1-aminoalkyl-pyrrolo[2,3-c]azepin-8-one derivatives was synthesized and evaluated as alpha 1 adrenergic and serotonin 2 (5-HT2) receptor antagonists, with the aim of finding a novel antihypertensive agent potently exhibiting both activities. Some compounds with a 4-[4-(4-fluorobenzoyl)piperidino]butyl group at the 1-position exhibited both activities, and varied significantly in terms of the substituents at the 4-position of the pyrroloazepine ring. Among the compounds obtained in this study, (E)-1-[4-[4-(4-fluorobenzoyl)piperidino]-butyl]-4-hydroxyimino-7- methyl-1,4,5,6,7,8-hexahydropyrrolo[2,3-c]azepin-8-one (15a, SUN9221) displayed potent alpha 1-adrenergic antagonistic activity (pA2 = 8.89 +/- 0.21) and 5-HT2 antagonistic activity (pA2 = 8.74 +/- 0.22) in isolated guinea pig arteries. This compound exhibited antihypertensive activity and a duration of action equivalent to orally administered prazosin or doxazosin, 3 mg/kg, in conscious spontaneously hypertensive rats, as well as potent antiplatelet aggregation activity.

Two new alkaloids possessing a cyclobutane ring, named pipercyclobutanamides A ( 1 ) and B ( 2 ), have been isolated from the fruits of Piper nigrum. Their stereostructures were determined by extensive spectroscopic methods.

In the preceding paper (Kawai, H. et al. (1992) Biochim. Biophys. Acta 1133, 172-178), we reported that in mastocytoma P-815 cells dexamethasone and 12-O-tetradecanoylphorbol-13-acetate (TPA) synergistically enhanced the de novo synthesis of L-histidine decarboxylase (HDC). Here we found that Ca2+ acted synergistically with cAMP in the induction of HDC mRNA and HDC activity in mastocytoma P-815 cells, and that the mechanism underlying the enzyme induction by Ca2+ plus cAMP was distinguishable from that by dexamethasone plus TPA. Ca2+ ionophore A23187, itself having no significant activity, markedly enhanced the induction of HDC activity by N6,O2'-dibutyryl cAMP (db cAMP) or cAMP-inducible prostaglandins such as PGE1, PGE2 and PGI2 in the presence of the phosphodiesterase inhibitor, Ro201724. However, A23187 had little effect on increases in HDC activity induced by other known stimulants, such as TPA, dexamethasone and sodium butyrate. These results suggest that A23187 has a specific effect on the induction of HDC activity due to an increased level of cAMP. The finding that both A23187 and cAMP enhanced HDC activity suggests that both Ca2+/calmodulin and cyclic nucleotide dependent protein kinase play essential roles in the process of enhancement of HDC activity. To examine this possibility, we studied the effects of W-7, an inhibitor of calmodulin, removal of extracellular Ca2+, and H-8, an inhibitor of cAMP-dependent protein kinase, on the enhancing activity of A23187 plus db cAMP. The enhancement of HDC activity by A23187 plus db cAMP was inhibited by W-7, removal of extracellular Ca2+, and H-8. The increase in HDC activity was due to the de novo synthesis of the enzyme, since it was suppressed by the addition of cycloheximide or actinomycin D, and was well correlated with the marked accumulation of a 2.7 kilobase HDC mRNA. Furthermore, the mechanism underlying the induction of HDC by db cAMP plus A23187 is distinguishable from that in the case of dexamethasone plus TPA, since preexposure to dexamethasone plus TPA for 12 h, for a plateau level to be reached, did not affect the subsequent increase in HDC activity due to db cAMP plus A23187.

Sodium nitroprusside, nitroglycerin and carperitide (alpha-human ANP) all reduced mean blood pressure, but only carperitide increased the hematocrit in rats with bilateral renal artery- and ureter-ligation. NG-Monomethyl-L-arginine, a selective inhibitor of nitric oxide synthesis, elevated the mean blood pressure but did not change the hematocrit significantly. These findings suggest that ANP has a physiological role in regulating circulatory blood volume distinct from that of NO, although both increase intracellular cyclic GMP in the vasculature.

Some treatments were examined to prolong freshness in green-mature Yuzu (Citrus junos Tanaka) fruits stored in polyethylene (a type of linear low density plastic) bags.1. Degreening of fruits had already begun on the 35th day of storage at 5°C, but no chilling injury occurred over a period of 110 days. All injuries occurred on the 35th day of storage at 0°C. There was not a great difference between a 20μm and a 30μm thick film in the degreening index and the percent of injury.2. The thickness of polyethylene film was 30μm in the case of storage at 2°C. The storage with a freshening agent prolonged the period for reaching 100% chilling injury for 1 to 3 months longer than that without it. The period without injury lasted at least 6 months when the fruits were stored with a freshening agent after they had been preliminarily dipped in hot water at 50°C for 2 to 5min. These storage conditions did not affect the degreening of fruits, since there was no significant difference between initial values and those of 6-months later for the color indexes (a and b) based on the L-a-b system. The fruits pretreated with water at 30°, 40°and 20°C (as a control), however, suffered chilling injury in 3 to 4 months, even though accompanied with a freshening agent.

The treatment of dissecting aneurysms of the vertebral artery (VA) involving the posterior inferior cerebellar artery (PICA) or presenting with hypoplasia of the contralateral VA is controversial. We describe our experience with 4 ruptured and 2 unruptured VA dissecting aneurysms and discuss the efficacy of endovascular surgery using stents. All patients were male; their mean age was 50.7 years. According to World Federation of Neurological Surgeons (WFNS) grading, 3 of the ruptured aneurysms were grade V, the other was grade I. All patients were successfully treated using stents; in 5 we also coil-embolized the aneurysmal lumen. One aneurysm was treated by the placement of 2 stents covering the dissection site; there was a danger of aneurysmal rupture during coil embolization. No technical complications were encountered although one patient suffered minor rebleeding 5 days post-treatment. Delayed vasospasm occurred in 4 cases. According to the Glasgow Outcome Scale (GOS), at 3 months after treatment 2 patients had made a good recovery, one was moderately disabled, one suffered severe disability, and 2 had died. One death each was due to acute myocardial and brain stem infarction. Endovascular surgery using stents may be a useful treatment in patients in poor condition who manifest dissecting VA aneurysms involving the PICA or hypoplasia of the contralateral VA, especially in the acute period after rupture.

An alternative technique for cutting the bone flap in supratentorial craniotomy uses a threadwire saw (T-saw), originally developed for spinal surgery. After placing a burr hole at each corner of the intended craniotomy, osteotomy is performed between adjacent burr holes using a craniotome, leaving a bony bridge of approximately 1/3 of the length of the osteotomy. The T-saw is introduced between adjacent burr holes through the epidural space and the bridge is cut with reciprocating strokes. The narrow beveled cut reduces the bone gap for fitted bone flap fixation. On closure, the bridge firmly supports the flap and only sutures are needed for fixation. A minimal amount of filler is required to fill the bone gap. Successful bone flap fixation was obtained in more than 100 cases. No technique-related complications such as dural laceration or flap displacement occurred. Osteotomy using a T-saw was somewhat time-consuming, but cutting efficiency was improved with a Diamond T-saw, featuring a section of cable covered with diamond particles. This method is ideal for bone cuts in cosmetic cranioplasty; is easy and safe to perform, is inexpensive, and avoids the need for flap fixation with metal devices.

As endovascular surgery (EVS) of symptomatic unruptured aneurysms can result in symptom exacerbation due to intra-aneurysmal thrombosis or lump formation by coils, this treatment remains controversial. We present five women ranging in age from 58 to 76 years (mean 65.6 years) who suffered post-EVS symptom exacerbation attributable to local inflammation. The aneurysms measured from 8 to 25 mm (mean 19 mm) and were located at the cavernous portion in four patients and at the origin of the ophthalmic artery in one. All underwent endosaccular embolization under local anesthesia. Immediately after embolization, 24 h anticoagulation therapy was started via the continuous injection of heparin; they also received anti-platelet therapy. At one to three days post-EVS, all five patients manifested worsening of their cranial nerve symptoms. In three other patients the symptoms were improved after EVS. We posit that inflammation induced by coil embolization may worsen cranial nerve symptoms transiently. Our findings suggest that post-EVS follow-up is necessary and that patients exhibiting an inflammatory reaction be treated with anti-inflammatory drugs.

In order to discover the effect of CLA on the body fat size and serum cytokine levels, four groups of male mice were fed diets containing either 1% linoleic acid (LA) or conjugated linoleic acid (CLA) with or without 0.2% sesamin for 8 weeks. The weight gain and feed efficiency were significantly lower in the CLA groups. CLA significantly reduced relative weights (g/100 g body weight) of epididymal and perirenal adipose tissues, in particular the former. Concentrations of serum TNF-alpha and leptin were significantly reduced by dietary CLA. Sesamin did not show additional effects in all of these parameters. There was a positive correlation between cytokine production and body-fat reducing potential of CLA. These results indicated that mice appeared to be a hyperresponder to dietary CLA insofar as the reduction of body fat size is concerned.

A series of 1-aminoalkyl-pyrrolo[2,3-c]azepin-8-one derivatives was synthesized and evaluated as alpha 1 adrenergic and serotonin 2 (5-HT2) receptor antagonists, with the aim of finding a novel antihypertensive agent potently exhibiting both activities. Some compounds with a 4-[4-(4-fluorobenzoyl)piperidino]butyl group at the 1-position exhibited both activities, and varied significantly in terms of the substituents at the 4-position of the pyrroloazepine ring. Among the compounds obtained in this study, (E)-1-[4-[4-(4-fluorobenzoyl)piperidino]-butyl]-4-hydroxyimino-7- methyl-1,4,5,6,7,8-hexahydropyrrolo[2,3-c]azepin-8-one (15a, SUN9221) displayed potent alpha 1-adrenergic antagonistic activity (pA2 = 8.89 +/- 0.21) and 5-HT2 antagonistic activity (pA2 = 8.74 +/- 0.22) in isolated guinea pig arteries. This compound exhibited antihypertensive activity and a duration of action equivalent to orally administered prazosin or doxazosin, 3 mg/kg, in conscious spontaneously hypertensive rats, as well as potent antiplatelet aggregation activity.

Recently we have found that C-type natriuretic peptide (CNP) inhibits proliferation of cultured rat vascular smooth muscle cells through an elevation of cGMP. We have now tested whether administration of CNP inhibits the development of intimal lesions induced by air-drying injury in rat common carotid arteries in vivo. CNP treatment (1 microgram/kg per min, iv infusion) for either 14 or 5 days resulted in 70% or 60% reduction, respectively, of intimal cross-section area 14 days after injury as compared with control rats. We also found that CNP potently stimulated cGMP production in injured carotid arteries with intimal thickening, but not in intact ones. These results indicate that GC-B, CNP specific receptor/guanylyl cyclase, is expressed at the sites of vascular injury, and that CNP might be efficacious in the prevention of restenosis caused by intimal thickening following coronary angioplasty.

Two new series of 2-arylmethyl-1,4-benzoquinones (2 and 3) were synthesized for evaluation of their pharmacological activities. These compounds showed significant inhibition of platelet aggregation and some of them possessed a protective against endothelial cell injury. Structure-activity relationship studies indicated that 2b, 2d and 3b are potent inhibitors of platelet aggregation induced by arachidonic acid (AA) with an IC50 in the range of 1-10 micrograms/ml. Among them, 3b showed a significant inhibitory activity against endothelial cell injury caused by hydrogen peroxide (H2O2) at 1 microM.

The fruits of Yamamomo, ‘Kamezo’ and ‘Kanton’ (cultivars of Myrica rubra Sieb. et Zucc.) packaged in polyethylene bags (30μm thick) were stored at 20 or 2°C, using an ethylene removing agent (E.A.), nitrogen or a water-absorbing mat.1. Fruits produced about 3μl/kg/h of ethylene at the peak. The fruits at the breaker stage became full-ripe within two days after harvest, but neither endogenous nor exogenous ethylene stimulated pigmetation in immature yellow-green fruits.2. The firmness of ‘Kamezo’ decreased to less than 60% of initial firmness (220g/cm2) after 3 days at 20°C, but the use of E. A. resulted in retention of 80% of the initial firmness for 7 days. Nitrogen had no effect on keeping quality. The carbon dioxide level reached 10 to 13% at 20°C, but only 2 to 3% at 2°C. There were no physiological disorders such as chilling or carbon dioxide injury during cold storage.3. The initial firmness of ‘Kanton’ was 265g/cm2, but was reduced to 60% of this after 4 days. It seems that the shelf life of ‘Kanton’ would be one or two days longer than that of ‘Kamezo’. The rating of firmness remained at more than 80% of the initial value after 10 days at 2°C, and more than 90% after 6 days when E. A. was applied, or after 8 days when the water-absorbing mat was used together with E. A.4. The level of water-soluble pectins increased remarkably in the two cultivars at 20°C. Although it increased 2-fold in 7 days in ‘Kamezo’ at 2°C, there was no increase in ‘Kanton’ throughout 8 days.5. There were great differences between the ratios of reducing sugar (glucose+fructose) to sucrose in the two cultivars: 6.7 in ‘Kamezo’ and 0.21 in ‘Kanton’, measured in fresh materials. It was presumed that these differences related to the storage quality of the fruits.

The English teachers at Showa Women's University Junior and Senior High Schools, Tokyo, have been searching for a more efficient English-teaching method for a long time. We are using a ‘team teaching’ programme to motivate the students to learn to use English in their school environment. This particular scheme involves two teachers, teaching simultaneously in these same classroom. Each team is made up of one Japanese teacher of English and one native speaker. Our students are 13 and 14 years old and are junior high school first graders.