Proposing a Questionnaire for Assessing English Proficiency Among Japanese Medical Students: Current Perspectives and a Pilot Survey.

Background Japanese medical schools have made advances in terms of English and Medical English teaching in the past decade, in keeping with their importance in medical communication and research. English skills and proficiency levels differ across different institutions due to the variable adoption of general teaching requirements. A limitation in assessing English proficiency among Japanese medical students continues to exist due to the lack of standardized testing requirements. Methods A new questionnaire was developed by faculty members and medical students. Areas of importance were: demographics, proficiency and confidence ratings, history of learning and usage, duration of usage, perceived importance, and improvement goals. The final draft of the constructed questionnaire contained 21 questions in total. The questionnaire was administered over a three-month period in incremental order of enrollment through a digital online platform. Results A total of 133 students, 64 (48.1%) males and 69 (51.9%) females, participated. The average age was 23.7 ± 4.8 years. Based on an incremental Likert scale, respondents rated themselves as 1.0 ± 0.8 for English proficiency and 0.5 ± 0.7 for Medical English proficiency. The confidence level for English medical discussions was 0.2 ± 0.6 on a similar scale. Students on average attended 18.0 ± 30.0 classes per year and presented medical materials in English around 1.7 ± 1.7 times in total. The English language was used for 2.1 ± 6.3 hours per week in personal settings and 0.5 ± 1.7 hours per week in professional settings. Conclusions The proposed questionnaire was able to give valuable information about language skills and proficiency levels, but would require an incentive for improved participation. The pilot analysis showed that English and Medical English proficiency levels remain low with limited opportunities for using English in some areas within Japan. It may be beneficial to provide Japanese medical students with more occasions where they can use or practice their English skills.

Non-vascularized bone grafting in scaphoid nonunion: principles and type of fixation.

In scaphoid fractures, delayed diagnosis and nonunion are fairly common as a result of several factors, including the difficulty of radiographic diagnosis of non-displaced fractures and underestimation of the injury by the patient. Main factors to consider when deciding treatment are the type of fracture and fracture stability. In the stable nonunion (Type D1 according to the Filan and Herbert classification, or linear type of Ikeda's classification), percutaneous screw fixation without bone graft is recommended. The indications of non-vascularized bone grafting are as follows: (1) arthroscopic cancellous bone graft in type D1 and cystic type of Ikeda's classification. (2) tricortical bone graft from the iliac crest in type D2 or D3 if the possibility of avascular necrosis of the proximal fragment is excluded. In this paper, our non-vascularized bone grafting for scaphoid nonunion would like to be described mainly about principles and type of fixation.

Ethnic and gender diversity in hand surgery trainees.

PURPOSE: To evaluate whether the lack of diversity in plastic and orthopedic surgery persists into hand surgery through assessment of trainee demographics. METHODS: Demographic data were obtained from compilations on graduate medical education by the Journal of the American Medical Association. Ethnic diversity was assessed using the proportions of minority trainees. We analyzed the trends in ethnic diversity in hand, orthopedic, and plastic surgery from 1995 to 2012 by evaluating changes in proportions of African American, Hispanic, and Asian trainees. In addition, we compared the proportions of minority trainees in various surgical specialties during 2009 to 2012. Trends in gender diversity were similarly analyzed using the proportions of female trainees. RESULTS: During 1995 to 2012, the proportions of minority and female trainees increased significantly in the fields of orthopedic, plastic, and hand surgery. To assess the current state of diversity in various specialties, we compared minority and female population proportions using pooled 2009 to 2012 data. The percentage of non-Caucasian trainees in hand surgery was significantly higher than that in orthopedic sports medicine and orthopedic surgery and significantly lower than in general surgery. The percentage of female trainees in hand surgery was significantly higher than that in orthopedic sports medicine and orthopedic surgery and significantly lower than in plastic and general surgery. CONCLUSIONS: Ethnic and gender diversity in hand surgery increased significantly between 1995 and 2012. Women constitute a fifth of hand surgery trainees. Efforts to increase diversity should be further pursued using proven strategies and innovating new ones. CLINICAL RELEVANCE: Diversity in the medical field has shown to be a beneficial factor in many aspects including research productivity and patient care. Understanding how the field of hand surgery has changed with regard to the diversity of its trainees may aid in providing more equitable and effective health care.

Accuracy of image-free computer navigated total knee arthroplasty is not compromised in severely deformed varus knees.

In severe varus knee deformity, image-free computer navigated total knee arthroplasty (TKA) may result in a malaligned knee. The aim of this study was to compare the results of 17 severe varus knees (≥ 20°) and 81 varus knees (< 20°) that underwent image-free computer navigated TKA and analyze postoperative malalignment. Computer navigated TKA was performed according to standard protocol, and component angles and mechanical axes were evaluated postoperatively with weight bearing full-length standing radiographs. All severe varus knees were corrected to within 3° of neutral lower limb alignment despite having a mean preoperative varus deformities of 22.4°. Neutral alignment was obtained in 88.9% of the varus group (mean preoperative varus deformity of 11.7°), without significant difference between the two groups. No significant difference was found in either the femoral or tibial component angles, or in the frequency of complications. Severity of varus deformity did not affect the accuracy of image-free computer navigated TKA.

A case of adult-onset Still's disease complicated by thrombotic thrombocytopenic purpura with retinal microangiopathy and rapidly fatal cerebral edema.

We present a patient who had adult-onset Still's disease (AOSD) complicated by thrombotic thrombocytopenic purpura (TTP) that resulted in retinal microangiopathy and rapidly fatal cerebral edema. The patient was a 37-year-old male who developed fever, eruption, arthritis and hepatic dysfunction, that, based on close examination, was diagnosed as AOSD. Despite treatment with corticosteroids, the patient developed acute visual field defect, neurological deterioration including convulsions and impaired consciousness, as well as acute renal failure that ultimately resulted in death. Pathological examination of autopsy specimens revealed multiple fibrin thrombi disseminated in small vessels of the brain and kidney, which was consistent with TTP, along with marked cerebral edema. Although TTP has rarely been reported in association with AOSD, awareness of the possible coexistence of these two diseases is important for diagnosis and treatment.

Post injury changes in the properties of mesenchymal stem cells derived from human anterior cruciate ligaments.

PURPOSE: The anterior cruciate ligament (ACL) rarely heals spontaneously after rupture. Mesenchymal stem cells (MSCs) contribute to healing in various tissues, therefore, they may also have a key role in healing after ACL rupture. The purpose of this study was to investigate the properties of MSCs in ruptured ACLs. METHODS: Human ACL samples were harvested from patients undergoing primary ACL reconstruction, and samples were classified by the number of days post rupture (phase I<21 days; phase II 21­56 days; phase III 57­139 days phase IV≥140 days). We evaluated the characteristics of MSCs, such as colony-forming capacity, differentiation potential and cell-surface markers. RESULTS: There was a tendency for high colony-forming capacity during phases I and II, which tended to decrease in phase III. Chondrogenic, adipogenic and osteogenic differentiation potential was maintained until phase II but decreased in phase III. Most surface-epitope expression was consistent from phase I to III: positive for CD44, CD73, CD90 and CD105; negative for CD11b, CD19, CD34, CD45 and human leukocyte antigen-D-related (HLA-DR). The presence of these surface markers proved the existence of MSCs in ruptured ACL tissue. CONCLUSIONS: Our results suggest that colony-forming and differentiation potential decrease over time. It is important to consider changes in properties of MSCs and use ACL tissue in the acute phase of rupture when biological manipulation is required.

Behçet's disease initially presenting with meningitis and sudden hearing loss.

We report a patient with neuro Behçet's disease (BD) initially presenting with meningitis and severe hearing loss. A 51-year-old man with no noteworthy past history was hospitalized for evaluation of non-pulsating headache and high fever. Lumbar puncture on admission only showed slight pleocytosis (6 /microL, monomorphonuclear cells predominantly) but no evidence of meningitis. However, after admission, he continued to have a fever of over 38 degrees, and he developed painful oral aphthous ulcer and pseudofolliculitis on the upper limbs and trunk. Prior to admission he had often experienced oral ulceration and had bought commercially available mouthwash for prophylaxis. Subsequently, genital ulceration appeared. A small ulcer was observed at the blood collection site, leading to the diagnosis of BD. On the seventh hospital day, the patient developed sudden hearing loss, which was diagnosed as severe sensorineural hearing loss. Lumbar puncture was performed again. Cerebrospinal fluid (CSF) analysis showed mild pleocytosis (60 /microL, predominantly monomorphonuclear cells), with high CSF IL-6 levels. Neither edematous change nor atrophy of the brainstem was noted and there were no other abnormal findings on the brain MRI/MRA. Auditory brainstem response was normal, suggesting that the patient had developed hearing loss due to peripheral neuropathy. We speculate that the hearing loss was likely due to vasculitis associated with BD. This case is considered to be a rare case of Behçet's disease caused by severe hearing loss and meningitis.