[99m]Tc-MIBI washout rate to evaluate the effects of steroid therapy in cardiac sarcoidosis

We sought to determine the usefulness of the [99m]Tc-MIBI [MIBI] washout rate for the evaluation of steroid therapy in cardiac sarcoidosis [CS]. Eleven CS patients underwent MIBI myocardial SPECT both before and 6 months after initiating steroid therapy. The washout rate [WOR] of MIBI was calculated using early and delayed polar map images. The washout score [WOS] of MIBI was derived from the difference between the early and delayed total defect scores [TDS]. Serum ACE and BNP exhibited significant improvement after the therapy [p = 0.004, p = 0.045]. In the LV function, EDV and E/A ratio exhibited significant improvement after the therapy [p = 0.041, p = 0.007], while there were no significant differences between before and after therapy in EF or ESV. Early and delayed TDS showed no significant differences between before and after the therapy. In contrast, WOR differed significantly [p < .0001], while WOS did not differ significantly between before and after the therapy. The washout rate of MIBI is suitable for assessment of cardiac function in CS with steroid therapy, being especially better than the washout score of MIBI for assessment of disease activity of mild myocardial damage in CS with steroid therapy

Postgraduate clinical training program at Fujita Health University Hospital / 医学教育

  Since 2003, Clinical training center of Fujita Health University hospital has been cooperated with the Office for medical education of Fujita Health University, school of medicine, in reorganizing the previous training system based mainly on individual departments. After 9 years since then, we established Yanegawara style training system and the trainee–centered curriculums. Outcomes from new system are as follows:<br>1. Self–establishment by problem based learning became common understandings between trainers and trainees.<br>2. Teaching by trainers to trainees and between trainees （R2 to R1） became common in the hospital.<br>3. Trainees can learn the standardized approach in diagnosis and treatment of the patients in ER.<br>4. Unified understanding of the training system was established in the hospital.Although new system brought several good aspects, we found a large heterogeneity in fulfillment of our curriculums not only by the capability of individual residents but also by the effort induced by each department.

Construction of Yanegawara-style skills training in our clinical skills laboratory for new residents / 医学教育

1）To learn the techniques required immediately after the start of clinical practice, new residents were introduced to the skills laboratory during their orientation period.<br>2）We attempted to establish the Yanegawara style, which is an overlapping teaching style in which the second–year residents plan the entire training schedule and simultaneously teach the first–year residents while being supported in their teaching by more senior physicians.<br>3）Training with the new system resulted in greater rapport among all residents as well as a greater feeling of security among first–year residents.