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Introduction: Early clinical exposure (ECE) is an educational methodology where medical students are exposed to the clinical settings in the undergraduate curriculum. This study aimed to examine the implementation status of ECE at medical schools in Japan. Methods: Based on published syllabi, we investigated the existence, location, and subjects (medical/non-medical staffs) of the training programs in medical schools. Results: Of 78 universities, 74 (95%) offered a total of 173 ECE practical training courses, and 51 (69%) combined on-campus and off-campus ECE training. Regarding the location and subjects, 81% of the on-campus ECE training was for medical personnel, 47% of the off-campus was for non-medical personnel, and 61% of the on- and off-campus was for both medical and non-medical personnel. Conclusions: More medical universities combined ECEs on-campus and off-campus and did not offer exposure only to medical staffs. The national trend can serve as a reference to discuss the circumstance of ECE and to plan ECE courses in the near future.
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Objective: Rural surgical training for residents is expected to increase the number of general surgeons working in rural areas; however, the impact of rural training programs to ensure such surgeons remains to be determined. Therefore, we reviewed the relevance of rural surgical rotation to the increase of general surgeons in rural areas.Materials and Methods: Studies on the outcomes of rural surgical rotations during the residency period in comparison to non-rural surgical rotations were retrieved using electronic databases through April 2022.Results: Among the 514 articles, five were eligible for review. All studies were published in the United States. Four studies reported an increased number of general surgeons in rural areas owing to rural surgical rotations. A meta-analysis of all studies showed a positive impact on the number of general surgeons in rural areas (odds ratio=2.19, 95% confidence interval=1.23–3.91). The programs generally ranged from 2 to 12 months with extensive experience with minor surgery and subspecialties necessary for surgery.Conclusions: Rural surgical rotations during the residency period can increase the number of general surgeons working in rural areas. Further studies are needed to evaluate the placement of general surgeons in rural areas.
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Community-based clinical clerkship, which involves travel outside the university or prefecture, was restricted or reduced due to the outbreak of the new coronavirus infection. What kind of shortage of learning this caused and how the shortage was compensated for were discussed in a special symposium at the 53rd Annual Meeting of the Japanese Society for Medical Education. As a result, two “essences” of community-based medical education emerged: 1) to recognize one’s role and responsibility in the future in the context of interprofessional practice, and 2) to look beyond the framework of medical institutions and view the whole scope of medicine with the patient at the center. It was concluded that online supplementary education should be utilized to enhance the value of practical training experience even in the post-Corona era. It was also supposed that this would lead to the “evolution” of community-based medical education itself.
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<p><b>INTRODUCTION</b>Gamma-glutamyltransferase (GGT), bilirubin (Bil) and small dense low-density lipoprotein (sdLDL) particles are each known to be risk markers for cardiometabolic diseases which are characterised by oxidative stress conditions. These markers are connected with the oxidative milieu; however, the association between GGT, Bil, and sdLDL has been hardly examined. This hospital-based study investigated the association between GGT and sdLDL, as well as the association between Bil and sdLDL, in asymptomatic subjects.</p><p><b>MATERIALS AND METHODS</b>Cardiometabolic variables, GGT, Bil and the mean LDL particle size were measured in 100 asymptomatic subjects attending a clinic for screening dyslipidaemias (36 men and 64 women, mean age 64 years). Correlation analyses of the association between the mean LDL particle size and other variables, such as GGT and Bil, were performed.</p><p><b>RESULTS</b>The mean (standard deviation) levels of GGT, Bil, and the mean LDL particle size were found to be 21.7 (8.3) IU/L, 14.0 (4.3) μmol/L, and 26.7 (0.6) nm, respectively. An univariate correlation test showed both a significant inverse correlation between the mean LDL particle size and GGT (r = - 0.33, P <0.01) and a significant positive correlation between the mean LDL particle size and Bil (r = 0.32, P <0.01). A multiple regression analysis revealed similarly significant results of their correlations, independent of the other cardiometabolic variables.</p><p><b>CONCLUSION</b>These results suggest that the correlation of GGT and sdLDL, as well as that of Bil and sdLDL, may be cooperatively associated with cardiometabolic processes. Further research is warranted in order to confirm the observed association.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Asymptomatic Diseases , Bilirubin , Blood , Biomarkers , Blood , Cross-Sectional Studies , Dyslipidemias , Blood , Diagnosis , Lipoproteins, LDL , Blood , gamma-Glutamyltransferase , BloodABSTRACT
<p><b>INTRODUCTION</b>Oxidative stress, assessed using 8-hydroxy-2'-deoxyguanosine (8-OHdG), can be associated with arterial stiffness in patients with type 2 diabetes mellitus (T2DM) and/or hypertension (HT). We investigated the correlation between urinary 8-OHdG and pulse wave velocity (PWV) in hypertensive and non-hypertensive T2DM patients with fair glycaemic control to determine the clinical significance of HT as a comorbidity in the diabetic state.</p><p><b>METHODS</b>Clinical data, including traditional cardiovascular risk factors, diabetic complications, prescribed agents, urinary 8-OHdG level and brachial-ankle PWV, was collected from T2DM patients with and without HT.</p><p><b>RESULTS</b>There were 76 patients (45 men, 31 women; mean age 61 years; mean haemoglobin A1c level 6.5%) in the study cohort. T2DM patients with HT had significantly higher mean PWV than patients without HT (1,597 cm/s vs 1,442 cm/s; p < 0.05). Patients with HT showed no significant difference in 8-OHdG levels relative to those without HT (median 7.9 ng/mg creatinine vs 8.8 ng/mg creatinine; p > 0.05). Simple linear correlation and stepwise multiple linear regression analyses revealed that 8-OHdG levels correlated independently, significantly and positively with PWV among T2DM patients with HT (r = 0.33, p < 0.05; β= 0.23, p < 0.05). No significant correlation was observed between 8-OHdG levels and PWV among T2DM patients without HT.</p><p><b>CONCLUSION</b>In the hypertensive state, oxidative stress can be responsible for the development of arterial stiffness, even in patients with fairly well controlled T2DM. Oxidative stress management may be necessary for the prevention of cardiovascular disease in this population.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Ankle Brachial Index , Cohort Studies , Deoxyguanosine , Urine , Diabetes Complications , Urine , Diabetes Mellitus, Type 2 , Urine , Glycated Hemoglobin , Metabolism , Hypertension , Urine , Oxidative Stress , Pulse Wave Analysis , Vascular StiffnessABSTRACT
Atherosclerotic risk factors contribute to carotid atherosclerosis. Carotid intima-media thickness (IMT), as assessed using a non-invasive high-resolution ultrasound, can predict cardiovascular disease (CVD). Whereas the control of CVD is crucial for the Mongolian people, the studies on carotid atherosclerosis are lacking. The present population-based survey was a cross-sectional investigation of the determinants of carotid IMT in the general Mongolian population.A total of 344 Mongolian volunteers, aged 18-69 years, without CVD and on no medication, were recruited from a health screening setting. The current smoking habits, body mass index, mean blood pressure (MBP), blood total cholesterol (TC), glucose, insulin and carotid IMT (maximum level) were measured.Mongolian males had a significantly higher prevalence of current smoking and a higher level of IMT than females (average=0.58 mm in males vs 0.46 in females). Both a single and multiple regression analysis adjusted for all the regression analysis adjusted for all the measures revealed that IMT was significantly and positively correlated with age, male sex, MBP, TC and glucose among all of the participants. IMT was significantly and positively correlated with age, followed by MBP, TC and glucose among males, while among females, IMT was significantly and positively correlated with age, followed by MBP and TC.Age was the strongest determinant of carotid atherosclerosis, and the increases in blood pressure and cholesterol levels were also important measures in both sexes as well as glucose levels in males in particularly, thus suggesting a preventive strategy necessary for CVD in the general Mongolian population.
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Atherosclerotic risk factors contribute to carotid atherosclerosis. Carotid intima-media thickness (IMT), as assessed using a non-invasive high-resolution ultrasound, can predict cardiovascular disease (CVD). Whereas the control of CVD is crucial for the Mongolian people, the studies on carotid atherosclerosis are lacking. The present population-based survey was a cross-sectional investigation of the determinants of carotid IMT in the general Mongolian population. A total of 344 Mongolian volunteers, aged 18-69 years, without CVD and on no medication, were recruited from a health screening setting. The current smoking habits, body mass index, mean blood pressure (MBP), blood total cholesterol (TC), glucose, insulin and carotid IMT (maximum level) were measured. Mongolian males had a significantly higher prevalence of current smoking and a higher level of IMT than females (average=0.58 mm in males vs 0.46 in females). Both a single and multiple regression analysis adjusted for all the regression analysis adjusted for all the measures revealed that IMT was significantly and positively correlated with age, male sex, MBP, TC and glucose among all of the participants. IMT was significantly and positively correlated with age, followed by MBP, TC and glucose among males, while among females, IMT was significantly and positively correlated with age, followed by MBP and TC. Age was the strongest determinant of carotid atherosclerosis, and the increases in blood pressure and cholesterol levels were also important measures in both sexes as well as glucose levels in males in particularly, thus suggesting a preventive strategy necessary for CVD in the general Mongolian population.
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BACKGROUND: Circulating leptin:adiponectin ratio (L:A) is a potential surrogate marker for cardiometabolic diseases; however, the relationship of the L:A with the occurrence of metabolic syndrome (MetS) has not yet been fully explored in the general Japanese population. METHODS: We enrolled 678 Japanese subjects (208 men and 470 women, mean age: 58.8+/-14.4 [SD] yr; mean body mass index: 23.6+/-3.3 kg/m2) in this study, and determined their MetS status by using the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) recommendations with minor modifications for the Japanese population. Biochemical markers such as leptin and adiponectin present in blood were measured. The statistical analyses performed were gender-based. RESULTS: A in subjects with MetS was significantly higher than that in subjects without MetS, regardless of gender. The L:A also showed a significant and gradual increase corresponding to the increase in the number of components of MetS present in both the genders (trend P<0.01). The cut-off level of the L:A to detect MetS was 0.59 (sensitivity: 0.72, specificity: 0.70) in men and 1.04 (sensitivity: 0.72, specificity: 0.69) in women. CONCLUSIONS: These results suggest that the L:A can serve as a clinically useful marker for detecting MetS characteristics in the general Japanese population. The clinical application of this laboratory index for detecting MetS should be assessed in future studies.
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adiponectin/blood , Biomarkers/blood , Body Mass Index , Japan , Leptin/blood , Metabolic Syndrome/blood , ROC CurveABSTRACT
BACKGROUND: Circulating leptin:adiponectin ratio (L:A) is a potential surrogate marker for cardiometabolic diseases; however, the relationship of the L:A with the occurrence of metabolic syndrome (MetS) has not yet been fully explored in the general Japanese population. METHODS: We enrolled 678 Japanese subjects (208 men and 470 women, mean age: 58.8+/-14.4 [SD] yr; mean body mass index: 23.6+/-3.3 kg/m2) in this study, and determined their MetS status by using the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) recommendations with minor modifications for the Japanese population. Biochemical markers such as leptin and adiponectin present in blood were measured. The statistical analyses performed were gender-based. RESULTS: A in subjects with MetS was significantly higher than that in subjects without MetS, regardless of gender. The L:A also showed a significant and gradual increase corresponding to the increase in the number of components of MetS present in both the genders (trend P<0.01). The cut-off level of the L:A to detect MetS was 0.59 (sensitivity: 0.72, specificity: 0.70) in men and 1.04 (sensitivity: 0.72, specificity: 0.69) in women. CONCLUSIONS: These results suggest that the L:A can serve as a clinically useful marker for detecting MetS characteristics in the general Japanese population. The clinical application of this laboratory index for detecting MetS should be assessed in future studies.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adiponectin/blood , Biomarkers/blood , Body Mass Index , Japan , Leptin/blood , Metabolic Syndrome/blood , ROC CurveABSTRACT
BACKGROUND: An effective approach to lifestyle-related factors could be a main treatment for hypertensives. The components of blood pressure (BP) have been reported to have different clinical implications; however, the relationship between various lifestyle-related factors and BP components has not been thoroughly studied in hospital-based general medicine.<BR>METHODS: This relationship was cross-sectionally investigated in a population of outpatients with hypertension but free of other diseases (136 subjects, aged 30 to 75, mean 54.2 years) . A self-administered questionnaire, which included items related to demographics, smoking, alcohol use, affinity for salt, habitual exercise, and sleep status, was used.<BR>RESULTS: After controlling for lifestyle-related factors, multiple regression analysis revealed that body mass index (BMI) and smoking were significantly and positively correlated with systolic BP (SBP) and pulse pressure (PP) . For diastolic BP (DBP), age had a significantly negative, and lack of sleep had a significantly positive, correlation. BMI was also significantly and positively correlated with mean BP (MBP) .<BR>CONCLUSIONS: Our results suggest that lifestyle-related factors are associated with differing BP components. Weight control should receive more attention in SBP, MBP and PP control, anti-smoking in SBP and PP control, and sleep management in DBP control.
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The aim of this investigation was to outline the present situation concerning home medical care and its contents in Japan, excluding general medication.<BR>We examined answers to questionnaires about care contents published in a book that nationally involved doctors who were providing medical care in the patient's home. More than 80 percent of the doctors who responded to the survey gave treatment with intravenous drip-infusions, bladder/urine catheters, injections or tube feeding. Treatment of intravenous hyperalimentation or rehabilitation was also applied by many doctors. General practitioners tended to treat their patients with continuous infusions, injections or home oxygen masks more frequently than hospital doctors. There was no marked difference between generations of doctors in the performance of various care services. We described in part the situation of home medical care and its contents and the performance of some care services might be influenced by providers-hospital or clinic-based doctors.
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The patient was a 68-year-old female being treated for hypertention and diabetes mellitus. She initially complained of a headache. Then, she developed symptoms including pyrexia, tenderness of right nodular and swollen temporal artery, urinary incontinence and strength ebbs of limbs. Laboratory findings reflencted active inflammation. Brain computerized tomography and right temporal artery biopsy revealed chronic right subdural hematoma and giant cell arteritis, respectively. Drainage from the head was performed with a suction apparatus attached to the perforated tube. Steroid therapy with predonisolone was started. Clinical symptoms and signs were ameliorated. A case of subdural hematoma associated with temporal arteritis was previously described. This is the second report. The mechanism of the complication is yet to be defined clearly. Further observations will be needed.
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The natural course of hepatocellular carcinoma (HCC) was investigated retrospectively in the cases especially related to hepatitis B virus (HBV) and hepatitis C virus (HCV). The average diagnostic age of the patients was significantly higher in HCV-related HCC cases than those associated with HBV, and females were older than men as a general trend regardless of viral type. In the progressive duration of such chronic liver diseases as chronic hepatitis, liver cirrhosis and HCC, there was no significant difference between HCC caused by HBV and HCV-related HCC, but the progress tended to be slower in female cases than in male ones. In the same drinking habit, each progressive duration indicated no remarkable difference between cases related to HBV and HCV, and insignificant difference was also found between those who ingest more than 86 g per day in terms of ethanol comsumption and none or under 86 g per day, regardless of viral type.
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Two adult cases of acute tobacco poisoning are reported. Some adult cases occur from intentional ingestion of tobacco, so they give severer indications of poisoning than infant cases which are usually accidental. One person (case 1), who seemed to have taken a nearly fatal dose of tobacco (nicotine) under unfavorable conditions, was carried into hospital some hours after ingestion, but recovered nicely without inducing vomiting and gastric lavege. It was suspected that the tolerance for nicotine and the degree of nicotinic elution might affect his course. Another person (case 2), who had swallowed a large amount of tobacco, also did well. It was supposed that immediate initial treatment was one of the causes for good progress.
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Cardiovascular accidental cases which occurred after the injection of an enema or evacuation are reviewed. 1) The accidents occurred not only in the aged but the youth, so care should be taken at all ages. 2) They occurred especially in the patients with underlying diseases, mainly in cardiovascular or autonomous nervous systems. 3) Therefore age and basal diseases are considered separate factors. 4) Many of the cases occurred soon or in 10 minutes after evacuation. These observations are discussed in light of literatures on changes of blood pressure, mechanism related to the autonomous nervous system, treatments, and so on.
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A case of type C chronic hepatitis with depressive states probably induced by interferon treatment is reported. Some other Japanese cases of type B or C chronic hepatitis with psychotic symptoms induced by interferon treatment were also reviewed. The state of symptoms, the time of onset, the course of development, dosage, many factors (endogenous, exogenous, psychogenic), predictability, and so on were examined.
