Characteristics and Gender Differences in the Medical Interview Skills of Japanese Medical Students.

Objective To examine the characteristics of the communication skills of medical students, we observed their performance during introductory medical interview training with simulated patients (SPs). Methods The subjects of the present study included fifth-year medical students (male, n=180, female, n=99) who were undergoing clinical training in Japan from 2012 to 2014. Each student was assigned to one of four 10-minute clinical scenarios, which was conducted with an SP. Three or four teachers observed and assessed the performance of each of the students. The overall performance was rated on a 10-point scale, and nine basic communication skills that were common to each of the scenarios were rated using a four-point scale. The students also assessed their own performance on these items. The SPs assessed the students' performance from a patient's perspective on four items. Results There were significant correlations between the teacher and student scores. However, the students tended to score themselves significantly lower than the teachers. The female students were rated significantly higher by the teachers on the following four items; 'eye contact and appropriate attitude,' 'nodding and back-channeling,' 'giving empathic verbal responses,' and 'acquisition of patient's psychosocial information.' However, the self-assessments of the female students were only significantly higher than the male students in one item, 'acquisition of patient's psychosocial information.' In contrast, self-assessments of the male students were significantly higher in two items; none of their items was scored higher by the teachers. There was no significant gender difference in the assessments made by the SPs. Conclusion There were significant gender differences in the communication skills of the medical students during introductory training, suggesting the possibility that there were gender-specific traits and gender-based differences in the students' degrees of readiness.

Rapid and reliable species identification of wild mushrooms by matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS).

Mushrooms are a favourite natural food in many countries. However, some wild species cause food poisoning, sometimes lethal, due to misidentification caused by confusing fruiting bodies similar to those of edible species. The morphological inspection of mycelia, spores and fruiting bodies have been traditionally used for the identification of mushrooms. More recently, DNA sequencing analysis has been successfully applied to mushrooms and to many other species. This study focuses on a simpler and more rapid methodology for the identification of wild mushrooms via protein profiling based on matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF MS). A preliminary study using 6 commercially available cultivated mushrooms suggested that a more reproducible spectrum was obtained from a portion of the cap than from the stem of a fruiting body by the extraction of proteins with a formic acid-acetonitrile mixture (1 + 1). We used 157 wild mushroom-fruiting bodies collected in the centre of Hokkaido from June to November 2014. Sequencing analysis of a portion of the ribosomal RNA gene provided 134 identifications of mushrooms by genus or species, however 23 samples containing 10 unknown species that had lower concordance rate of the nucleotide sequences in a BLAST search (less than 97%) and 13 samples that had unidentifiable poor or mixed sequencing signals remained unknown. MALDI-TOF MS analysis yielded a reproducible spectrum (frequency of matching score ≥ 2.0 was ≥6 spectra from 12 spectra measurements) for 114 of 157 samples. Profiling scores that matched each other within the database gave correct species identification (with scores of ≥2.0) for 110 samples (96%). An in-house prepared database was constructed from 106 independent species, except for overlapping identifications. We used 48 wild mushrooms that were collected in autumn 2015 to validate the in-house database. As a result, 21 mushrooms were identified at the species level with scores ≥2.0 and 5 mushrooms at the genus level with scores ≥1.7, although the signals of 2 mushrooms were insufficient for analysis. The remaining 20 samples were recognized as "unreliable identification" with scores <1.7. Subsequent DNA analysis confirmed that the correct species or genus identifications were achieved by MALDI-TOF MS for the 26 former samples, whereas the 18 mushrooms with poorly matched scores were species that were not included in the database. Thus, the proposed MALDI-TOF MS coupled with our database could be a powerful tool for the rapid and reliable identification of mushrooms; however, continuous updating of the database is necessary to enrich it with more abundant species.

Identification of Mushroom Species by Automated rRNA Intergenic Spacer Analysis (ARISA) and Its Application to a Suspected Case of Food Poisoning with Tricholoma ustale.

Automated rRNA intergenic spacer analysis (ARISA), a method of microbiome analysis, was evaluated for species identification of mushrooms based on the specific fragment sizes. We used 51 wild mushroom-fruiting bodies collected in the centre of Hokkaido and two cultivated mushrooms. Samples were hot-air-dried and DNA were extracted by a beads beating procedure. Sequencing analysis of portions of the rRNA gene (rDNA) provided 33 identifications of mushrooms by genus or species. The results of ARISA identification based on the combination of the fragment sizes corresponding to two inter spacer regions (ITS2 and ITS1) of rDNA within±0.1% accuracy showed that 27 out of the 33 species had specific fragment sizes differentiated from other species. The remaining 6 species formed 3 pairs that showed overlapping fragment sizes. In addition, within-species polymorphisms were observed as 1 bp differences among 32 samples of 13 species. ARISA was applied to investigate a case of suspected food poisoning in which the mushroom was thought to be a toxic Kakishimeji. The morphological identification of the mushroom was ambiguous since the remaining sample lacked a part of the fruiting body. Further, yeast colonies had grown on the surface of the fruiting body during storage. The ARISA fragment size of the mushroom showed 7 bp difference from that of the candidate toxic mushroom. Although ARISA could be a useful tools for estimation of mushroom species, especially in case where the fruiting bodies have deteriorated or been processed, further studies are necessary for reliable identification. For example, it may be necessary to adopt more informative genes which could provide clearer species-specific polymorphisms than the ITS regions.

Toxic effects of nicotinamide methylation on mouse brain striatum neuronal cells and its relation to manganese.

OBJECTIVE: It is well known that manganese (Mn) exposure is involved in parkinsonism. The aim of our study was to test the hypotheses that Mn affects nicotinamide N-methyltransferase (NNMT) activity, increases the metabolism of nicotinamide (NA) to 1-methylnicotinamide (MNA), and leads to neurocytotoxicity. METHODS: Following demonstration of the effects of Mn concentrations on the survival rate of Mouse CD1 brain striatum neuronal cells (MS cells), the effect of Mn on NNMT activity was investigated by comparing the difference in the amount of MNA produced after various Mn concentrations were added to mouse brain cytosol fractions as an enzyme solution. Toxicity induced by MNA and its precursor NA on MS cells was measured. RESULTS: The survival rate of MS cells decreased significantly with increasing concentrations of Mn in the culture medium. With respect to the influence of Mn on NNMT activity, NNMT activity increased significantly at Mn concentrations of 1 µmol/mg protein. MNA and NA neurotoxicity were compared by comparing cell survival rate. Cell survival rate dropped significantly when the cells were cultivated with 10 mM of MNA. There was also a tendency for the survival rate to fall following the addition of 10 mM NA; however, the difference with the control was not significant. CONCLUSIONS: Our study suggests the possibility that Mn causes increased NNMT activity, thereby increasing MNA levels in the brain and bringing about neuron death. Daily absorption of Mn and NA may thus contribute to idiopathic Parkinson's disease.

Increased detection of clinically significant antibodies and decreased incidence of delayed haemolytic transfusion reaction with the indirect antiglobulin test potentiated by polyethylene glycol compared to albumin: a Japanese study.

BACKGROUND: The indirect antiglobulin test (IAT) can be potentiated by agents such as polyethylene glycol (PEG-IAT) and albumin (Alb-IAT). PEG-IAT is generally regarded as superior to Alb-IAT for the detection of clinically significant red blood cell (RBC) antibodies. However, supporting data come from Caucasian-dominant populations. Non-Caucasian populations should be investigated as well. MATERIAL AND METHODS: In this single-centre, retrospective, sequential study, Alb-IAT was used from 1989 to 1996 (8 years) and PEG-IAT from 1997 to 2008 (12 years). Pre-transfusion RBC alloantibody detection rates and specificity, post-transfusion alloantibody production, and the incidence of delayed haemolytic transfusion reaction were assessed and compared for the two periods. RESULTS: Although overall RBC alloantibody detection rates were comparable, PEG-IAT more frequently detected clinically significant antibodies such as anti-E, anti-Fy(b), and anti-Jk(a), and less frequently detected insignificant antibodies such as anti-Le(b) and anti-P(1). New alloantibodies emerged comparably during the two periods. Delayed haemolytic transfusion reaction was less frequent during the PEG-IAT period (0.30% versus 0.12%, p<0.05). CONCLUSION: PEG-IAT was superior in the detection of clinically significant antibodies, reduced the detection of insignificant antibodies, and prevented delayed haemolytic transfusion reaction better than Alb-IAT among Japanese transfusion recipients in this retrospective survey of limited power.

Preventing platelet-derived microparticle formation--and possible side effects-with prestorage leukofiltration of whole blood.

CONTEXT: Platelet-derived microparticles (PDMPs) probably function in hemostasis, thrombosis, inflammation, and transfusion-related immunomodulation. OBJECTIVE: To compare PDMP levels of leukocyte-filtered and unfiltered whole blood during storage. DESIGN: Ten whole blood donations were collected and processed. Half of each collection was filtered, half remained unfiltered, and both halves were measured for red cell, white cell, and platelet (PLT) content before storage. Samples were drawn on days 0, 1, 2, 3, 5, 7, 14, 21, 28, and 35 and analyzed by flow cytometry. RESULTS: Leukocyte filtration lowered prestorage PDMP and PLT counts by an average of 72% and 99%, respectively. Prestorage PDMP counts were 123 +/- 51/microL in unfiltered whole blood supernatant versus 34 +/- 18/microL after filtration. Prestorage PLT counts were 190 +/- 49/microL in unfiltered whole blood supernatant versus 2 +/- 4/microL after filtration. Moreover, PDMP and PLT counts in filtered whole blood remained low throughout storage, typically below 100/microL. In contrast, unfiltered whole blood PDMP- and PLT-gated events increased approximately 2 log during storage, with the peak number of PLT-gated events tending to coincide with the peak number of PDMP-gated events (4 donors) or to come after the peak number of PDMP-gated events (6 donors). CONCLUSIONS: Leukocyte filtration of whole blood lowers prestorage PDMP and PLT counts. Platelet-derived microparticle and PLT counts remain low throughout 35 days of storage. In contrast, PDMP- and PLT-gated events increase significantly in unfiltered whole blood. The nature of PLT-gated events in stored blood warrants further investigation.

[Case of fulminant hepatic failure in an elderly asymptomatic HBV carrier without proximate cause].

A 82-year-old asymptomatic HBV carrier man was admitted with liver dysfunction in May 2007. With anti-HBe antibody and high viral load, he had fulminant hepatic failure without proximate cause. He was treated with entecavir and corticosteroids, but died about one month later. Autopsy specimen of liver revealed submassive hepatic necrosis with faint regeneration. HBV obtained was segregated into genotype Bj, and mutation was detected at nt1896 in a precore region.

[Pancreatic groove carcinoma in a young adult].

A 26-year-old woman was admitted to our hospital with jaundice. Under a diagnosis of biliary and duodenal stenosis due to so called "groove pancreatitis", prednisolone (30 mg/day, 2 weeks) was administered. But these stenosis did not improve after the treatment, and pancreaticoduodenectomy was performed. Histologically, poorly differentiated adenocarcinoma was found in the "groove" between the duodenum and the pancreatic head. We should be kept of "pancreatic groove carcinoma" in mind when making a diagnosis of "groove pancreatitis".

Correction of protein kinase C activity and macrophage migration in peripheral nerve by pioglitazone, peroxisome proliferator activated-gamma-ligand, in insulin-deficient diabetic rats.

Pioglitazone, one of thiazolidinediones, a peroxisome proliferator-activated receptor (PPAR)-gamma ligand, is known to have beneficial effects on macrovascular complications in diabetes, but the effect on diabetic neuropathy is not well addressed. We demonstrated the expression of PPAR-gamma in Schwann cells and vascular walls in peripheral nerve and then evaluated the effect of pioglitazone treatment for 12 weeks (10 mg/kg/day, orally) on neuropathy in streptozotocin-diabetic rats. At end, pioglitazone treatment improved nerve conduction delay in diabetic rats without affecting the expression of PPAR-gamma. Diabetic rats showed suppressed protein kinase C (PKC) activity of endoneurial membrane fraction with decreased expression of PKC-alpha. These alterations were normalized in the treated group. Enhanced expression of phosphorylated extracellular signal-regulated kinase detected in diabetic rats was inhibited by the treatment. Increased numbers of macrophages positive for ED-1 and 8-hydroxydeoxyguanosine-positive Schwann cells in diabetic rats were also corrected by the treatment. Pioglitazone lowered blood lipid levels of diabetic rats, but blood glucose and nerve sorbitol levels were not affected by the treatment. In conclusion, our study showed that pioglitazone was beneficial for experimental diabetic neuropathy via correction of impaired PKC pathway and proinflammatory process, independent of polyol pathway.

[Mutual relationship between prevalence statistics and mortality statistics in Parkinson's disease].

OBJECTIVE: The purpose of this study is to determine whether the statistics from three published reports on Parkinson's disease (PD) are mutually interrelated and to clarify the relationship between the prevalence statistics and mortality statistics of PD. These statistics included data on "number of patients with PD (PD Patients)", "number of patients with PD receiving financial aid for treatment (PD Recipients)" as an indicator showing the prevalence of PD, and "number of deaths from PD (PD Deaths, i.e., mortality)". METHODS: The data on PD Patients, PD Recipients and PD Deaths were cited from "Patient Survey" by Ministry of Health, Labour and Welfare, a report by the Research Committee on Epidemiology of Intractable Diseases and "Vital Statistics of Japan" by Ministry of Health, Labour and Welfare, respectively. The expected PD Patients, PD Recipients and PD Deaths were calculated as products of their respective rates for the entire country and prefecture population, adjusting for a difference in population composition. Observed/expected number ratios (O/E ratio) of PD Patients, PD Recipients and PD Patients were calculated by prefecture. The correlation between the O/E ratios was examined. In addition, the relationships of the O/E ratios with the number of hospitals or physicians per person were examined. RESULTS: There were no significant correlations between the O/E ratios of PD Patients, PD Recipients or PD Deaths. The O/E ratio of PD Recipients significantly correlated with the numbers of hospitals and physicians per person. CONCLUSION: PD Patients and PD Recipients were included in number of people with PD and PD Deaths was derived from people with PD. However, these statistics do not necessarily reflect the prevalence of PD in each prefecture. When using these published statistics as an indicator of the prevalence of PD, it is necessary to clarify the purpose of their use and to comprehend their characteristics.

Effects of lifestyle, body composition, and physical fitness on cold tolerance in humans.

In the present study, we attempted to clarify the effects of lifestyle and body compositions on basal metabolism and to clarify the effects of physical training on thermoregulatory responses to cold. Basal metabolism, body compositions, and questionnaires regarding lifestyle were evaluated in 37 students. From multiple linear regression analysis, sex, muscle weight, fat intake, and diurnal temperature were selected as significant explanatory variables. In a second experiment, rectal and the skin temperature at 7 different points as well as the oxygen uptake of eight males were measured at 10 degrees C for 90 min before and after training. The decline in rectal temperature that was observed before training was not observed after training. In addition, rectal temperature was significantly higher at post-training than at pre-training. These results suggest that some lifestyle factors affect cold tolerance; in particular, daily activity might improve our ability to control heat radiation and basal heat production.

The effect of heavy metals on nicotinamideN-methyltransferase activityin vitro relating to Parkinson's disease.

OBJECTIVE: The aims of this study were to determine the effects of heavy metals such as manganese on nicotinamideN-methyltransferase (EC 2.1.1.1) (NNMT) activity and to consider the possibility of involvement of NNMT activation in the pathogenesis of heavy metal induced Parkinson's disease. METHODS: NNMT activity in supernatants separated from brain, liver and kidney homogenates of 5 elderly male Wistar rats by centrifugation were measured by high performance liquid chromatography system with fluorescence. NNMT activity under the conditon of 0.5 or 5.0 mM Mn(2+), Fe(2+), Cu(2+) or Cd(2+) was compared with control (no metal ion existence). RESULTS: NNMT activities in rat brain, liver and kidneys were significantly decreased by Cu(2+), and those in the liver and kidneys were significantly decreased by Cd(2+). Mn(2+) reduced NNMT activity only in the liver. Fe(2+) had no effect on NNMT activity. CONCLUSIONS: No metal increased NNMT activity in this study, contrary to our hypothesis. Further study is needed to clarify the reason why the effects of Mn(2+) and Fe(2+) which have a high relevance to Parkinson's disease on NNMT activity differ from those of Cu(2+) and Cd(2+).