There is a need for suitable non-clinical teaching models in undergraduate medical education.This study was undertaken to demonstrate the feasibility of using an animal model to teach surgical skills to medical students.Two gastrotomies were created in each pig, and then closed using stapled and hand-sewn techniques.Animals were sacrificed seven days later and the closures examined grossly and histologically.
1) Medical students, as surgeons with minimal experience, are able to significantly reduce the time needed to perform closure of a gastrotomy in a porcine model using surgical staplers compared to a hand-sewn closure.
2) Medical students can perform advanced abdominal surgery techniques with adequate instruction resulting in excellent surgical outcomes in a porcine model.
3) The porcine model is a valuable tool to teach animal ethics as well as basic surgical techniques in the non-clinical environment and may help to increase interest among students in a surgical career.

Background: To date there had been no investigations using the International Classification of Primary Care, Second Edition (ICPC-2) at a clinic on an isolated island. In order to analyze health problems on the island, we investigated the reasons for visits, chronic illnesses, and the number of cases referred to other medical facilities using the ICPC-2.
Methods: The study was conducted over a 12-month period, from April 1, 2006 to March 31, 2007. Patient complaints/symptoms were classified according to ICPC-2, and diseases of patients who regularly visited the clinic as of November 2006 were investigated.
Results: Half of the patients that regularly visited the clinic had lifestyle-related or musculoskeletal diseases. On the first visit, several patients presented with cold, musculoskeletal, or skin symptoms. The specialist care to which the patients were most frequently referred was orthopedic surgery.
Conclusion: Physicians working at a clinic on an isolated island need to be able to control lifestyle-related diseases and provide initial treatment for musculoskeletal or skin diseases.

Medical students in Japan often want to do clinical rotations abroad. Preparation for these important clinical experiences is essential to maximize the learning opportunities. Language ability is only one small part of assuring success.1) It is important to consider the hospital where the rotation will take place, the specific rotation, the living arrangements and commuting to the hospital. Preparation before the rotation should include practice in performing and writing a complete patient history and physical examination.2) It is very helpful to have a cell phone while abroad, as well as a credit card. Students must bring a white coat, and it is recommended that they also bring a Japanese textbook in the field they will study.3) While on a clinical rotation, students must be active participants in patient care and in discussions. They must be aggressive about answering questions during ward rounds. Students must be aware of many cultural differences to have good relationships with patients and colleagues.

BACKGROUND/AIMS: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice. METHODS: To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch. RESULTS: In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean +/- standard deviation, 22.7+/-1.1 seconds vs. 34.7+/-2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3+/-42.0 seconds vs. 300.6+/-46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2+/-7.6 seconds vs. 38.0+/-15.9 seconds, p<0.001). CONCLUSIONS: An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel.
Diagnosis ; Early Detection of Cancer ; Endoscopes* ; Endoscopy, Digestive System* ; Humans ; Retrospective Studies ; Suction* ; Water

The publisher wishes to apologize for the incorrectly inputted arrow in the figure.

The small bowel had long been considered a dark unapproachable tunnel until the invention of capsule endoscopy and doubleballoon enteroscopy in the 21st century, which revolutionized the diagnosis and management of small bowel diseases, including bleeding. Various imaging modalities such as computed tomographic enterography, angiography, capsule endoscopy, and balloonassisted enteroscopy play vital roles in the diagnosis and management of small bowel bleeding. The choice of modality to use and timing of application differ according to the availability of the modalities, patient’s history, and physician’s experience. Small bowel bleeding is managed using different strategies as exemplified by medical treatment, interventional radiology, endoscopic therapy, or surgical intervention. Balloon-assisted enteroscopy enables endoscopic interventions to control small bowel bleeding, including electrocautery, argon plasma coagulation, clip application, and tattooing as a prelude to surgery. In this article, we clarify the recent approaches to the optimal diagnosis and management of patients with small bowel bleeding.

1) We conducted a workshop to discuss the definition of the term "physician scientist", what thought processes and competencies are expected, and how to better help physician scientists develop through medical schools.2) The definition of a physician-scientist is a physician who both provides patient care and approaches unsolved questions in understanding the mechanisms of diseases and developing new treatments.3) Essential conditions for a medical school to cultivate physician scientists include providing good role models for physician scientists, making efforts to stimulate students' motivation, and supporting collaboration among physicians and scientists on the faculty.

BACKGROUND: Long-term management of bronchial asthma based on the fractional exhaled nitric oxide (FeNO) value alone is not conclusive yet. Therefore, we combined FeNO testing and spirometry, a commonly used test in routine practice, to evaluate acute exacerbation and respiratory function in children with bronchial asthma. OBJECTIVE: We combined FeNO testing and spirometry, commonly used in routine practice, to evaluate acute exacerbations and respiratory function in children with bronchial asthma. METHODS: Subjects were school aged children 7 years and older with bronchial asthma who underwent FeNO testing in January 2015 to May 2016. We evaluated the changes in the frequency of acute exacerbations and respiratory function in the 30 subsequent months. Subjects were divided into 2 groups: those with initial FeNO levels ≥ 21 parts per billion (ppb) (high FeNO) and < 20 ppb (normal FeNO) groups. RESULTS: There were 48 children (33 boys) in the high FeNO group and 68 children (46 boys) in the normal FeNO group. Spirometry was conducted on 83 children (72%) prior to the initial FeNO test, revealing no difference in the ratio of detecting lung dysfunction between the 2 groups. The observation period was 25.8 ± 0.7 and 24.7 ± 0.6 months for the high and normal FeNO groups, respectively. The children in the high FeNO group with lung dysfunction in the initial FeNO test continued to exhibit lung dysfunction at the test at 30 months. In the normal FeNO group, even if lung dysfunction was observed at the initial FeNO, it improved within the 20-month point, and the improvement was maintained thereafter. CONCLUSION: Children with bronchial asthma with high FeNO levels and lung dysfunction are at a higher risk of prolonged lung dysfunction.
Asthma ; Child ; Humans ; Lung ; Nitric Oxide ; Spirometry

No abstract available.
Rectum*

Superficial colonic neoplasms sometimes extend into a diverticulum. Conventional endoscopic mucosal resection of these lesions is considered challenging because colonic diverticula do not have a muscularis propria and are deeply inverted. Even if the solution is carefully injected below the mucosa at the bottom of the diverticulum, the mucosa is rarely elevated from the diverticular orifice, and it is usually just narrowed. Although endoscopic submucosal dissection or full-thickness resection with an over-the-scope clip device enables the complete resection of these lesions, it is still challenging, time consuming and expensive. Underwater endoscopic mucosal resection without submucosal injection (UEMR) is an innovative technique enabling en bloc resection of superficial colon lesions. We report three patients with colon adenomas extending into a diverticulum treated with successful UEMR. UEMR enabled rapid and safe en bloc resection of colon lesions extending into a diverticulum.