The curriculum evaluation by students was introduced into the two-weeks clinical curriculum of fifth years students at Saga Medical School, Department of Anesthesiology. The evaluation form is consisted of forty questions with the eleven figures from -5 to +5. These questionaries were divided into seven parts and covered instructors' evaluation and the minute course evaluation. This evaluation was done anonymously at the end of the two-weeks clinical course in Anesthesiology.
The analysis was done as follows: 1) divided up into the positive group, the neutral group and the negative group; 2) difined the positive rate, the negative rate and the effective rate; 3) presented these rates visually.
The result runs as follows: 1) the effective rate is proportional to the interaction between instructors and students; 2) a quick feedback can be done on instructors.
Finally, the important thing for medical education is not only curriculum but the interaction between instructors and students. In this sense, this trial in Saga Medical School is significant for medical education.

Introduction: We report a case of severe headache caused by lung cancer metastasis to the base of the skull that was difficult to diagnose due to a lack of imaging evidence. Case: A 70-year-old man diagnosed with advanced lung cancer experienced sudden, severe headache. He was diagnosed as having a tension-type headache because magnetic resonance imaging of his head failed to detect any pathology. He was prescribed various drugs, which except for strong opioids failed to treat his headache. He referred to our palliative care unit to treat the pain. Re-evaluation of his head CT revealed metastasis to the clivas. His pain was treated with rapid titration of subcutaneous oxycodone injection. Conclusion: Even if radiographic investigations fail to identify the metastasis, the patient should be re-evaluated if the headache worsens and/or is accompanied with cranial nerve dysfunction.

Purpose: The simple conversion ratio of 1：1：1/50 between oxycodone injection (OXJ), morphine injection and fentanyl injection is used at Saga－Ken Medical Centre Koseikan. However, there are no studies on the validity of the simple conversion ratio. Methods: A total of 18 patients with opioid switching to OXJ using the simple conversion ratio were reviewed in this investigation. We surveyed the change in the numeric rating scale (NRS) and adverse effects before and after opioid switching. Result: The average period needed to reach a stable dose of OXJ was 0.6 days. The reasons of opioid switching to OXJ were the uncontrolled cancer pain in 11 patients, the impossibility of oral administration in 6 patients, the drowsiness in 1 patient. The average NRS decreased from 3.3 to 1.1 in 11 patients with uncontrolled cancer pain (p＝0.007). No obvious change in the NRS was observed in 6 patients with the impossibility of oral administration. In 18 patients, there was no significant difference in adverse effects before and after opioid switching. Conclusion: These results indicate that the simple conversion ratio could be safety for opioid switching between OXJ and other opioid in cancer pain treatment.

We previously reported that a case of yokukansan efficaciousness for weight gain due to overeating behavior following bariatric surgery. The reason is considered that yokukansan stabilized the patient's mental state. So, we proposed that administration of oriental medicines for mental state might be a new way of treating obesity. We investigated the efficacy of mazindol, bofutsushosan or yokukansan for obese patients. We retrospectively reviewed clinical data to identify patients administered mazindol, bofutsushosan or yokukansan for treatment of obesity. The inclusion criteria were patients tolerant to medicine for 3 months, and who could be administered yokukansan for anger. A total of 107 patients met these selection criteria. After 3 months of drug administration, significantly body weight reduction was observed in either the mazindol group or yokukansan group. We also selected and analyzed patients with diabetes mellitus to clarify the efficacy of these drugs for glucose metabolism. Reduction in HbA1c was not significant in the groups. These results suggest that mental health problems are very important for the treatment of obesity. And we suggest that oriental medicine is an effective treatment for mental health in obesity patients.

We investigated the actual condition of patients treated by acupuncture and moxibution in Ibaragi Prefecture.
Subjects were 1823 patients (846 men, 977 women) under the treatment of 14 acupuncture clinics in September to November, 1985.
We prepared the evaluated list that consisted of 11 levels of activities of daily life and 8 degrees of pain.
In every treatment, we wrote down the patient's clinical progress in relation with the list.
The following results were obtained
1. There were many patients in thier forties and fifties.
2. There were many patients who received only one treatment.
3. The chief complaints were low back pains (509 patients), shoulder discomfort (273) knee joint pain (132), etc.
4. Most of the patients could still go on with thier daily lives in spite of the pains.
5. The effects of treatment were rated as follows; better 69.5%, no change 23.9%, worse 5.9%.

To determine the physical symptoms and ki, ketsu and sui (qi, blood and fluid) factors associated with the presence of hie-sho (chill syndrome). Total 118 healthy university students (66 males and 52 females, median age 22 years, range 21­-29) were enrolled. A cross-­sectional study about the presence of chill syndrome in par­ticipants was performed. Terasawa's ki, ketsu and sui diagnostic score was used to identify the presence of physical symptoms. Number rating scale (NRS) was used to classify the chill and NRS more than 5 was de­fined as chill syndrome based on Furuya's report. Eighteen students (4 males and 14 females) were docu­mented as chill syndrome. The multivariate analysis of physical symptoms identified female (OR 4.65, p = 0.0427), heavy sensation of head (OR 2.98, p = 0.0190) and chill of extremities (OR 1.94, p = 0.0480) as sig­nificantly associated factors with chill syndrome. The score of ki-kyo (qi deficiency), ketsu-kyo (blood defi­ciency) and suitai (fluid retention) showed higher score in students with chill syndrome compared to students without chill syndrome in univariate analysis. Being female and two indicators of qi abnormalities including heavy sensation of head and chill of extremities were associated with the presence of chill syndrome in univer­sity students.

BACKGROUND: Adjuvants used in inactivated vaccines often upregulate type 2 immunity, which is dominant in allergic diseases. We hypothesised that cumulative adjuvant exposure in infancy may influence the development of allergies later in life by changing the balance of type 1/type 2 immunity. We examined the relationship between immunisation with different vaccine types and later allergic disease development. METHODS: We obtained information regarding vaccinations and allergic diseases through questionnaires that were used in The Japan Environment and Children's Study (JECS), which is a nationwide, multicentre, prospective birth cohort study that included 103,099 pregnant women and their children. We examined potential associations between the initial vaccination before 6 months of age and symptoms related to allergies at 12 months of age. RESULTS: Our statistical analyses included 56,277 children. Physician-diagnosed asthma was associated with receiving three (aOR 1.395, 95% CI 1.028-1.893) or four to five different inactivated vaccines (aOR 1.544, 95% CI 1.149-2.075), compared with children who received only one inactivated vaccine. Similar results were found for two questionnaire-based symptoms, i.e. wheeze (aOR 1.238, 95% CI 1.094-1.401; three vaccines vs. a single vaccine) and eczema (aOR 1.144, 95% CI 1.007-1.299; four or five vaccines vs. a single vaccine). CONCLUSIONS: Our results, which should be cautiously interpreted, suggest that the prevalence of asthma, wheeze and eczema among children at 12 months of age might be related to the amount of inactivated vaccine exposure before 6 months of age. Future work should assess if this association is due to cumulative adjuvant exposure. Despite this possible association, we strongly support the global vaccination strategy and recommend that immunisations continue. TRIAL REGISTRATION UMIN000030786 .
Asthma ; epidemiology ; etiology ; Cohort Studies ; Dermatitis, Atopic ; epidemiology ; etiology ; Female ; Food Hypersensitivity ; epidemiology ; etiology ; Humans ; Hypersensitivity ; epidemiology ; etiology ; Infant ; Infant, Newborn ; Japan ; Male ; Vaccines, Inactivated ; adverse effects ; Viral Vaccines ; adverse effects