It is considered that hepatitis C virus (HCV) infection may be a pathogenic factor in cryoglobulinemia and glomerulonephritis. The purpose of this study was to determine whether there is any relation between the presence of hepatic disorder due to HCV infection and the association with cryoglobulinemia and urinary abnormalities, i. e. proteinuria and/or hematuria, in HCV-infected patients. Cryoglobulinemia was found in 11.4% of our HCV patients. However, seropositivity of cryoglobulin detected in all the patients was low. The prevalence of the association with cryoglobulinemia in patients with hepatic disorder was significantly higher than that in patients without hepatic disorder. Urinary abnormalities were found in 10.0% of the HCV patients. No significant difference was observed in the prevalence of urinary abnormalities between patients with and without hepatic disorder. In addition, there was no significant difference in the prevalence of urinary abnormalities between the association with and without cryoglobulinemia. These results suggest the close relation between the presence of hepatic disorder due to HCV infection and the association with cryoglobulinemia. However, renal involvement may have no relation with the presence of hepatic disorder and cryoglobulinemia.

It has been known that access recirculation is positively related to dialyzer blood flow and is negatively related to access blood flow in the vascular access in hemodialysis patients. The present study was designed to examine whether an increase in access recirculation generated by an increase in dialyzer blood flow is related to access blood flow. All patients had native end-to-side arteriovenous anastomoses at the radial site. We measured access recirculation at two different dialyzer blood flow rates (85 and 170 ml/min) using a three-needle technique. Access blood flow rates (mean 668 ml/min ranging from 493 to 1038 ml/min) were measured using Doppler ultrasound sonography. We confirmed that an increase in dialyzer blood flow rate led to an increase in access recirculation (5.4±1.1 vs. 9.9±1.9%, p<0.05), and that access recirculation was negatively related to the access blood flow rate (y=-30.78x+972.20, r=-0.79, p<0.05). We further found a negative correlation between the increase in access recirculation generated by the increase in dialyzer blood flow rate and access blood flow rate (y=-33.88x+821.57, r=-0.75, p<0.05). These results suggested that dialyzer blood flow less affects access recirculation when access blood flow is higher.

This report presents our experience in using a dual-lumen catheter with a Dacron cuff as longterm vascular access for homodialysis in an elderly patient. The female patient who at first treated with continuous ambulatory peritoneal dialysis for chronic renal failure, but the treatment could not be continued because she developed inveterate peritonitis. Thereafter, hemodialysis was performed. However, a lot of blood access troubles occurred and consequently peripheral access was exhausted. Therefore, we placed the catheter into a right internal jugular vein. This procedure made it possible to secure enough and stable blood flow during the hemodialysis session. Thus, the clearence ratios of blood urea nitrogen and serum creatinine and the value of KT/V increased. No complications have been observed since then. We further examined whether the placement of the catheter would affect hemodynamics in brain and upper extremities, using transcranial Doppler ultrasound and plethysmography. No remarkable difference in blood flow between right and left ophthalmic arteries and decrease in arterial blood flow of right finger tips were observed. Furthermore, venous dilatation, swelling in neck and right upper extremities, and facial edema were not found. The catheter, therefore, represents a significant advance, providing immediate, durable and relatively safe access for hemodialysis after repeated blood access troubles and exhausted peripheral access.

Because recent changes in medical care security policy have made clinical skills training difficult, even in teaching hospitals, training with suitable models and simulators is becoming essential for medical students to acquire clinical skills. On the basis of these changes, we performed a nationwide survey on the prevalence and application of clinical skills laboratories for clerkships in Japan. Registered questionnaires were sent to all medical schools in Japan （n＝80） in December 2012. The response forms were filled out by clinical instructors and by the staff responsible for the skills laboratory. The response rate was 94% （75 of 80 schools）. Seventy-one schools （95%） have already installed clinical skills laboratory; however, floor area and availability varied greatly among schools. Floor space ranged from 24 to 2,250 m2 （median, 214 m2）. The number of uses of the facility by medical students in the 2011 school year ranged from less than 100 to more than 10,000 （median, 1,402）. Forty-two schools （59%） had a resident director for the skills laboratory. Simulators of most universities （> 90%） were venopuncture simulators, lung-sound simulators, basic life support mannequins, heart-sound simulators, surgical suture trainers, and automated external defibrillator trainers, and all were frequently used. These results suggest considerable differences among schools in simulation-based learning environments during clinical clerkships. Although most medical schools in Japan have their own clinical skills laboratories, their size, service, and frequency of use vary greatly.

To accurately assess the clinical competencies of medical students at Fukushima Medical University, we have developed a novel online self–assessment system, which covers all goals in the "Model Core Curriculum for Medical Education in Japan." We added "Emergency," "Communication skills with staff," and "Simulation–based learning." Following their clinical clerkships, 79 sixth–year medical students assessed themselves and their clinical clerkships.
1)This novel online self–assessment system, consisting of 68 checklists in 15 fields, easily informs us of the actual conditions of clinical clerkships and students' confidence in their clinical competencies.
2)This internet–based self–assessment system revealed the current status and problems of clinical clerkships, prompting feedback to clinical instructors and members of the instruction committee.
3)Students felt "confident" or "confident to a certain degree" in most learning areas; however, simulation–based learning seems to be necessary in several areas, such as clinical skills, where feelings of shame or discomfort may be associated with patient care.
4)Students who had high total self–assessment scores evaluated clinical clerkships favorably. In contrast, students whose self–assessments frequently included "no learning experience" evaluated their clerkships negatively in the educational aspects of "skill" and "attitude."

To investigate the effects of generational factors on the lives of medical students in the first and second years, we surveyed students about the frequency of problems and the seeking of advice.1) A questionnaire was distributed to first- and second-year students in January 2009 asking about problems regarding academic work, mental health, financial concerns, career options, physical wellness, and interpersonal relationships.2) About 70% of the students had sought advice regarding academic work and interpersonal relationships. Also, about 50% had sought advice regarding mental health.3) Students chose potential advisors depending on the type of problem; however, they preferred to consult with their classmates and upperclassmen. In addition, their parents played a role. In contrast, students rarely consulted with teachers.4) High percentages of first- and second-year medical students had various problems. Creating a support system to address these problems is important.

Fetal development of the cartilage of the pharyngotympanic tube (PTT) is characterized by its late start. We examined semiserial histological sections of 20 human fetuses at 14-18 weeks of gestation. As controls, we also observed sections of 5 large fetuses at around 30 weeks. At and around 14 weeks, the tubal cartilage first appeared in the posterior side of the pharyngeal opening of the PTT. The levator veli palatini muscle used a mucosal fold containing the initial cartilage for its downward path to the palate. Moreover, the cartilage is a limited hard attachment for the muscle. Therefore, the PTT and its cartilage seemed to play a critical role in early development of levator veli muscle. In contrast, the cartilage developed so that it extended laterally, along a fascia-like structure that connected with the tensor tympani muscle. This muscle appeared to exert mechanical stress on the initial cartilage. The internal carotid artery was exposed to a loose tissue facing the tubal cartilage. In large fetuses, this loose tissue was occupied by an inferior extension of the temporal bone to cover the artery. This later-developing anterior wall of the carotid canal provided the final bony origin of the levator veli palatini muscle. The tubal cartilage seemed to determine the anterior and inferior margins of the canal. Consequently, the tubal cartilage development seemed to be accelerated by a surrounding muscle, and conversely, the cartilage was likely to determine the other muscular and bony structures.
Arteries ; Carotid Artery, Internal ; Cartilage ; Eustachian Tube ; Fetal Development ; Fetus ; Humans ; Muscles ; Palate ; Pregnancy ; Stress, Mechanical ; Temporal Bone ; Tensor Tympani

Background: Type 1 diabetes mellitus induced by immune-checkpoint inhibitors (ICI-T1DM) is a rare critical entity. However, the etiology of ICI-T1DM remains unclear. Methods: In order to elucidate risk factors for ICI-T1DM, we evaluated the clinical course and immunological status of patients with ICI-T1DM who had been diagnosed during 2016 to 2021. Results: Seven of 871 (0.8%, six men and one woman) patients developed ICI-T1DM. We revealed that the allele frequencies of human leukocyte antigen (HLA)-DPA1*02:02 and DPB1*05:01 were significantly higher in the patients with ICI-T1DM In comparison to the controls who received ICI (11/14 vs. 10/26, P=0.022; 11/14 vs. 7/26, P=0.0027, respectively). HLA-DRB1*04:05, which has been found to be a T1DM susceptibility allele in Asians, was also observed as a high-risk allele for ICI-T1DM. The significance of the HLA-DPB1*05:01 and DRB1*04:05 alleles was confirmed by an analysis of four additional patients. The absolute/relative neutrophil count, neutrophils-lymphocyte ratio, and neutrophil-eosinophil ratio increased, and the absolute lymphocyte count and absolute/relative eosinophil count decreased at the onset as compared with 6 weeks before. In two patients, alterations in cytokines and chemokines were found at the onset. Conclusion Novel high-risk HLA alleles and haplotypes were identified in ICI-T1DM, and peripheral blood factors may be utilized as biomarkers.

Objective: Human papillomavirus subtypes are predictive indicators of cervical intraepithelial neoplasia (CIN) progression. While colposcopy is also an essential part of cervical cancer prevention, its accuracy and reproducibility are limited because of subjective evaluation. This study aimed to develop an artificial intelligence (AI) algorithm that can accurately detect the optimal lesion associated with prognosis using colposcopic images of CIN2 patients by utilizing objective AI diagnosis. Methods: We identified colposcopic findings associated with the prognosis of patients with CIN2. We developed a convolutional neural network that can automatically detect the rate of high-grade lesions in the uterovaginal area in 12 segments. We finally evaluated the detection accuracy of our AI algorithm compared with the scores by multiple gynecologic oncologists. Results: High-grade lesion occupancy in the uterovaginal area detected by senior colposcopists was significantly correlated with the prognosis of patients with CIN2. The detection rate for high-grade lesions in 12 segments of the uterovaginal area by the AI system was 62.1% for recall, and the overall correct response rate was 89.7%. Moreover, the percentage of high-grade lesions detected by the AI system was significantly correlated with the rate detected by multiple gynecologic senior oncologists (r=0.61). Conclusion Our novel AI algorithm can accurately determine high-grade lesions associated with prognosis on colposcopic images, and these results provide an insight into the additional utility of colposcopy for the management of patients with CIN2.