We developed a problem-oriented simulation system for medical diagnosis which works on personal computers without special equipment. In this simulation system the history of illness can be presented by voice, and physical findings are presented audiovisually through the student's actions, in a manner that closely resembles an actual medical examination. The laboratory findings are also presented through the student's actions. Students compile a database with information that they collect, create a problem list, and devise an initial diagnostic plan for the patient's most important problem. This computer-assisted system will help medical students learn diagnostic strategies in a simulated clinical setting. We believe that this system is a promising method that will facilitate problem-oriented learning in the virtual multimedia environment with special convenience for medical students to share time and facilities and to lower costs.

The running behavior and muscle characteristics associated with voluntary running activity were studied in female Fischer 344 rats after 9 weeks of training in voluntary exercise wheel cages. The exercise wheel employed allowed a load to be added to the wheel axis. The running activity was recorded as the number of rotations every 10 s for 24 h, and the number of running bouts, running duration, running speed and distance run per day were varied. Addition of a load to the wheel axis allowed the running style to be changed, and reduced the running duration and speed in each bout. The voluntary running training was done with no load, 30% per body weight load, and 60% per body weight load, and as treadmill running (40 m/min, 60 min/day) .
In the voluntary training, a difference in the total running distance was observed with increased load. The total distance run under 0%, 30% and 60% load in the voluntary group was about 552, 475, and 438 km, respectively, after training for 9 weeks. As a result of training, the weights of dorsiflexor muscles tended to increase with treadmill running, whereas weights of plantar-flexor muscles increased significantly in the voluntary training groups. In the plantaris muscle, the cross-sectional area of all fiber types was not changed by treadmill training, but in voluntary training, almost every type of fiber was enlarged. Voluntary running with a 30% load increased the cross-sectional area of type I and type ha fibers in the plantaris muscle compared with no load exercise. However, no significant differences in the cross-sectional area of these fibers were observed between 30% and 60% load exercise. The fatigue tolerance of the plantaris muscle improved significantly in all training groups, and the 60% load group showed the highest value.
These results suggest that voluntary loaded running is more effective for muscle enlargement than treadmill training and/or voluntary training with no load.

  In this study, we aimed to clarify the socio-cultural factors affecting the mental and physical health of pregnant and puerperal Brazilian women living in Japan. The study participants were 18 pregnant and puerperal Brazilian women living in two prefectures with large Brazilian populations. A Japanese investigator and a Portuguese interpreter comprised the team, and conducted semi-structured interviews at the participants’ homes. The study period was between 2013 and 2014. The interviews were carried out using the Cultural Determinants of Help Seeking theory. Analytical ethnography was used for data coding and theme extraction.

  The results revealed that “worry” and “shoulder and back pain” were the most common mental and physical symptoms, followed by “headache,” “irritability and anger,” “insomnia and sleeplessness,” and “anxiety.” The reasons given for these included: “pregnancy and child rearing;” “anxiety about work and income;” “complications of being a foreigner;” and “the absence of someone to depend upon.” Moreover, the following five core categories of socio-cultural factors influencing these causes were extracted: “equal and deeply connected family;” “strength to continue working;” “choosing the right conditions to settle down in;” “low satisfaction with the healthcare system;” and “the blessings of God.”

  Pregnant and puerperal Brazilian women living in Japan have various mental and physical distress symptoms, and our findings revealed that differences between Brazilian and Japanese patterns of family life and religion were the major influencers on these. These findings must be understood to provide intervention in order to lead pregnant and puerperal Brazilian women to appropriate health behaviors.

　　With the aim of revamping hospital service as a pillar of our hospital reform movement, the Service Training Committee came into being in 2012.　　A questionnaire survey was conducted on the entire personnel and tenant suppliers (the entire personnel, tenants and contractors’ employees?). About 80% (705 people) of those queried replied. More than 90% of the respondents were of the view that an improvement in the manner of reception should enhance not only the prestige of the hospital, the evaluation its medical treatment and patients&rsauo; degree of satisfaction, but also hospital employees’ degree of satisfaction and their quality of life.　　On the other hand, some respondents said that there was much to be desired in the way hospital employees exchange greetings with their colleagues and in the manners or the language they use when they speak to patients.　　Most of the hospital staff seemed to understand the importance and meaning of service and hospitality very well. It was clear that the hospital employees were willing to join in our drive to improve the quality of service. They also understood the problems they should address to in earnest.　　We thought it was our task to make use of their positive attitude toward the quality improvement of service. What we have in view is to create a hospital culture that makes it seem natural to provide a high-quality service to visitors and patients. To this end, we will develop various activities and hold workshops.

Objective: This study aimed to assess gynecologic oncologists (GOs)’ perceptions and attitudes toward cancer survivorship to help improve survivor care. Methods: We conducted a web-based questionnaire survey about survivorship issues for the GOs belonging to the Japan Gynecologic Oncology Group. We analyzed the proactiveness of the participants toward addressing 25 survivor issues. In addition, the practice patterns and barriers to care for survivors’ long-term health issues, such as second primary cancer (SPC) and lifestyle-related diseases (LSRD), and return-to-work (RTW) support were assessed. Results: We received 313 responses. The respondents had a mean of 22 years of physician experience. The ratio of men to women was approximately 7:3, and 84.7% worked at facilities for multidisciplinary cancer treatment. The respondents’ proactiveness for addressing psychosocial problems was significantly lower than physical and gynecological issues (p<0.01 by χ2 test). However, most GOs tried to contribute to such issues according to patients’ demands. Women GOs were more proactively involved in some survivorship issues than the men (p<0.05 by logistic regression analysis). The rates of the respondents who proactively discussed SPC, LSRD, and RTW were unexpectedly high (60.7%, 36.1%, and 52.4%, respectively). However, the GOs only provided verbal support for these issues in many cases. Conclusion The Japanese GOs were enthusiastic about survivorship care. However, their tendency to deal with survivors’ problems through their own knowledge and judgments raises concerns about the quality of care. Therefore, creating survivorship care guidelines and enhancing multidisciplinary collaboration should be prioritized.

BACKGROUND/AIMS: It is important to determine the noninvasive parameters of histological features in nonalcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the value of genetic variations as surrogate markers of histological features. METHODS: The parameters that affected the histological features of NAFLD were investigated in 211 Japanese patients with biopsy-proven NAFLD. The relationships between genetic variations in PNPLA3 rs738409 or TM6SF2 rs58542926 and histological features were analyzed. Furthermore, the impact of genetic variations that affected the pathological criteria for the diagnosis of nonalcoholic steatohepatitis (NASH) (Matteoni classification and NAFLD activity score) was evaluated. RESULTS: The fibrosis stage of PNPLA3 GG was significantly more progressive than that of CG by multiple comparisons. Multivariate analysis identified PNPLA3 genotypes as predictors of fibrosis of stage 2 or more, but the impact tended to decrease at stage 3 or greater. There were no significant differences among the histological features of the three genotypes of TM6SF2. PNPLA3 genotypes partly affected the definition of NASH by the NAFLD activity score, but TM6SF2 genotypes did not affect the definition of NASH. CONCLUSIONS: In Japanese patients with biopsy-proven NAFLD, PNPLA3 genotypes may partly affect histological features, including stage of fibrosis, but the TM6SF2 genotype does not affect histological features.
Asian Continental Ancestry Group ; Biological Markers ; Classification ; Diagnosis ; Fatty Liver* ; Fibrosis ; Genetic Variation* ; Genotype ; Humans ; Japan* ; Multivariate Analysis

Miriplatin is a novel lipophilic platinum complex that was developed to treat hepatocellular carcinoma (HCC). Although HCC patients frequently have coexisting chronic renal failure, little prospective data are available regarding the clinical toxicity of chemotherapeutic agents used to treat HCC patients with chronic renal failure. In a phase II study, the plasma concentration of total platinum in patients who received miriplatin was very low, and no severe renal toxicity caused by miriplatin injection was reported. Here, we present three cases of HCC with stage 4 chronic renal failure who received transcatheter arterial chemotherapy with miriplatin. All cases were male, ages 72, 84, and 83 years, and had serum creatinine levels of 2.3, 1.6, and 1.9 mg/dL, respectively. Their estimated glomerular filtration rates were 21.9, 20.3, and 22.2 mL/min, respectively. All cases were treated for unresectable HCC with transcatheter arterial chemotherapy with miriplatin. No serious adverse events were observed, and serum creatinine levels did not elevate, even in the patient who experienced renal failure caused by cisplatin administration. These results might suggest that transcatheter arterial chemotherapy with miriplatin can be safely used in HCC patients with chronic renal failure.
Carcinoma, Hepatocellular ; Cisplatin ; Creatinine ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic ; Male ; Organoplatinum Compounds ; Plasma ; Platinum ; Renal Insufficiency

BACKGROUND/AIMS: The aim of this study was to determine the pharmacodynamics of cisplatin following three different treatment procedures for intrahepatic arterial infusion therapy for hepatocellular carcinoma (HCC). METHODS: We divided 13 HCC patients into the following three groups: group A, lone injection of cisplatin (n=3); group B, combined injection of cisplatin and lipiodol, with embolization using small gelatin cubes (GCs) (n=5); and group C, injection of suspended lipiodol with cisplatin powder, with embolization using small GCs (n=5). In each group, the free cisplatin concentration in the hepatic vein was measured at 0, 5, 10, and 30 minutes. RESULTS: The mean free cisplatin concentrations were as follows. For group A, the mean was 48.58 microg/mL at 0 minute, 7.31 microg/mL at 5 minutes, 5.70 microg/mL at 10 minutes, and 7.15 microg/mL at 30 minutes. For the same time points, for group B, the concentrations were 8.66, 4.23, 3.22, and 1.65 microg/mL, respectively, and for group C, the concentrations were 4.81, 2.61, 2.52, and 1.75 microg/mL, respectively. The mean area under the curve (AUC)0-infinity for the free cisplatin concentration was 7.80 in group A, 2.48 in group B, and 2.27 in group C. The AUC0-infinity for the free cisplatin concentration gradually decreased, from group A to group C. CONCLUSIONS: These results indicate that the combination of lipiodol and small GCs may be useful for delaying cisplatin drainage from the liver.
Carcinoma, Hepatocellular ; Cisplatin ; Drainage ; Drug Delivery Systems ; Ethiodized Oil ; Gelatin ; Hepatic Veins ; Humans ; Liver ; Pilot Projects

  Introduction  This study aimed to clarify social networking and help seeking behaviors in relation to the health of pregnant and puerperal Brazilian women in Japan, using unanalyzed data collected in the article titled “Socio-cultural factors affecting the health of pregnant and puerperal Brazilian women in Japan” published in this journal.Methods  We conducted semi-structured interviews of pregnant and puerperal Brazilian women aged ≥20 years in their homes in Prefectures A and B during 2013-2014. We used the Japanese version of the interview guide based on the cultural determinants of help seeking developed by Arnault. The analysis was guided by analytic ethnography, and core themes were derived.Results  The interviews were conducted with 18 women. Their mean age was 32.4 years (5 women in their 20s and 13 women in their 30s). The average length of stay was 12.6 years (6 women: <10 years and 12 women: ≥10 years). Regarding residential status, 12 women were permanent residents. Two categories for social networking were derived: (1) limited social interaction and (2) reliance on family and trusted others. Two categories for help-seeking behaviors were derived: (1) reliance on informal resources close to them and (2) self-reliant problem solving.Conclusions  The social networking and help-seeking behaviors of pregnant and puerperal Brazilian women in Japan were related to their way of cultivating relationships in their transnational life as migrant workers. Their behaviors were also related to their perception on the family, their religion, and their self-reliant problem-solving behaviors.