We performed this study to evaluate the chronic effect of training on neutrophil functions in humans. Twenty-six university students (14 males and 12 females) with a mean age of 19.1±0.8 years were divided into the athlete group and the control group based on answers given to a written questionnaire. The capacity of circulating neutrophils to ingest bacteria (phagocytosis) and to produce superoxide (nitroblue tetrazolium reduction) was measured under resting conditions in the absence of training activities. In addition, we measured hematological and serum biochemical parameters. The present analyses revealed that the frequency of subjective symptoms concerning susceptibility to infections (sum of males and females) was higher in the athlete group than in the control group (p<0.05). In the investigation of males, hemoglobin and serum protein levels of the athlete group were lower than that of the control group (p<0.01, p<0.05, respectively). Although total and differential leukocyte counts, and phagocytic activity of neutrophils were not significantly different between the groups, superoxide productivity of neutrophils in the male athlete group was higher than that in the control group (p<0.05). Since significant differences were observed in hemoglobin and serum protein levels in the male athletes, the training is considered to have been intense. An increase was noted in the neutrophil superoxide production along with these changes, but no significant difference was observed in the phagocytic activity. Therefore, there is the possibility of superoxide overproduction, which may lead to tissue damage.
Neutrophils ; Training ; lower case pea ; athlete ; Superoxides

Ionescu-Shiley pericardial xenografts implanted in the mitral position between April 1980 and October 1984 were studied. In some cases the cusp was torn in a relatively early postoperative phase, thus requiring an emergency operation. Functional disorders, such as caused by the calcification of the cusp, advance at a relatively moderate pace, and the prognosis of a second operation in cases with valve dysfunction and a chronic course was favorable. The actuarial probability of freedom from reoperation was 88.5±8.7% at 5 years and 55.7±14.5% at 10 years. The structural deterioration of the pericardial valve increased about 5 years after replacement. This tendency was the same as in other bioprostheses. At 10 years the overall actuarial survival rate was 67.2±12.1%. Freedom at 10 years from thromboembolism was 84.6±9.8%. For cases whose the course is under observation at present, the strategy is to recommend an additional operation as far as possible, while continuously observing the function of the valve.

SPs have made a dramatic development in medical education over 10 years, due to the influence of medical education curriculum reform and the introduction of the Objective Structured Clinical Examination. However the quality of SPs' activities varies. In order to increase the quality it is necessary to analyze the psychological needs of SPs. The purpose of this survey is to explore SPs' personal characteristics and how they feel during their activities.
1) In a nationwide survey of Japanese SPs, 332 SPs (62%) out of 532 responded.
2) Sixty percent of SPs were between the ages of 50 and 69 years and the ratio of male to female SPs was 1: 4. The ratio of workers and non-workers was 1: 2.
3) A qualitative analysis found that SP motivations were derived mainly from making a contribution to society and self-improvement. Ninety six percent of SPs were satisfied with being an SP, especially when they saw improvements in the students.
4) However, 67% of SPs expressed difficulty with the three core skills of feedback, evaluation and performance.

1) We visited 5 Scottish universities (the Universities of Aberdeen, St Andrews, Dundee, Glasgow, and Edinburgh) to observe and learn about simulated-patient programs and communication-skills training.
2) Each medical school has developed its own approach for using simulated patients in training and for giving feedback to medical students.
3) In Scotland, where all medical schools adhere to“Tomorrow's Doctors”and“the Scottish Doctor Curriculum Outcomes, ”curriculum styles vary greatly, but the differences are celebrated.The simulated-patient programs are integrated into each program in a way unique to each school.

The role of standardized patients (SPs) has developed rapidly over the last10years because of medical education curriculum reform and the introduction of the objective structured clinical examination (OSCE). As the participation of SPs in medical education has increased, the anxieties and frustrations of SPs have also increased. We believe that an understanding of the attitudes of SPs would improve the quality of their activities. The purpose of this survey was to study the activities and psychological needs of Japanese SPs in the OSCE.
1) The response rate to the nationwide survey was62% (332of532SPs).
2) Role-playing and group discussion were the most common training methods, and the length of training varied from 0 to 40 hours.
3) The factors that SPs felt difficult were judging how much to respond in their performances (73%) and maintaining consistent standards in evaluating examinees (66%).
4) Our results suggest that SPs require more training and that the number of SP educators should be increased.

Objectives: To clarify differences in medical students’ emotional intelligence and empathy among 4 school years and sex.
Methods: A cross-sectional study of 370 medical students in years 1, 2, 4, and 6 was performed with Japanese versions of 2 self-reported questionnaires: the Trait Emotional Intelligence Questionnaire–Short Form （TEIQue-SF） and the Jefferson Scale of Physician Empathy–Student Version （JSPE-S）.
Results: Total scores of the TEIQue–SF tended to decrease in higher school years. However, the total score of the JSPE-S was significantly increased in year 6 but was decreased in year 4. Male students had higher TEIQue–SF scores, and female students had higher JSPE-S scores. Of the 4 factors of the TEIQue–SF compared （well-being, self-control, emotionality, and sociability）, only sociability was higher in males. No differences were found among school years. The scores of the TEIQue–SF and the JSPE-S showed a weak correlation. Of the factors of the TEIQue–SF, only self-control showed no correlation with the JSPE-S.
Discussion and Conclusion: These results suggest that the emotional intelligence of both male and female medical students tends to decline. The increase in JSPE-S scores in year 6 suggests that medical interview training is effective. Furthermore, training is important both to enhance emotional intelligence and to teach self-control skills.

Introduction: The problems of problem learners hare not been systematically demonstrated. The purpose of this study was to summarize the English expression and definition of problem learners and classify factors associated with problems.

Method: A systematic literature review was conducted.

Results: The expressions extracted were disability, learning disorders, at-risk, difficult, problem, struggle, underperform, unprofessional, unsafe, gifted, and outstanding. Factors associated with the problems were classified into learners' characteristics, cognition, attitude, and skill.

Discussion: These findings will help teachers understand and detect the problems of problem learners appropriately.

　This study examined the cases of the difficult encounters with problematic students that academic administrative staffs in the health professions education institutons faces. 185 cases were obtained from the 143 administrative staffs who participated in the training program for academic administrative staffs training from 2013 to 2015. Although there are 136 cases (73.5%) related to the problem students, some cases existed which problems were from the system or faculty members. In order to dealing with difficult encounters appropriately in the health care professional training institutions, the cooperation between teachers and academic administrative staffs is indispensable.

A study was conducted to evaluate the chronic effects of regular physical activity on nonspecific and specific immune responses. Male Fischer rats (SPF) exercised voluntarily on running wheels for 4 months, and were then injected intraperitoneally with sheep red blood cells (SRBC), followed by measurement of the host defense functions at -2 d, 3h, 24h and 4 d of antigen stimulation. The following results were obtained:
1) The ability of circulating neutrophils to produce superoxide measured by the spontaneous NBT test showed an earlier and higher (p<0.05) rise after SRBC injection in the exercise group, suggesting that neutrophils were activated in vivo more promptly against foreign-body invasion. This might reflect a priming response of neutrophils at the early phase of SRBC-induced host defense reactions modulated by the previous regular exercise.
2) The ability of neutrophils to produce superoxide in response to in vitro stimulation with Staphylococcus aureus 209 P was markedly reduced during inflammatory response in the sedentary group, whereas that in the exercise group was maintained at a constant level. The value at 4 d after SRBC injection in the sedentary group was decreased to more than 20% below the baseline (p<0.02) . In addition, a significantly (p<0.02) lower value than that in the exercise group was shown, although phagocytic activity was similar in the two groups. This suggested that neutrophil bactericidal activity was decreased in the sedentary group.
3) Plasma IgG levels in the exercise group were consistently and significantly (p<0.0001) higher by about 30% than those in the sedentary group, regardless of SRBC injection. This suggested an enhanced host defense status by regular exercise.
4) The specific humoral immune response to SRBC injection was assessed in terms of hemagglutination and plasma IgM levels, but no significant differences were shown between the groups.

Renal damage caused by hemolysis during cardiopulmonary bypass (CPB) was investigated, and the preventive effects of haptoglobin in regard to this condition was also evaluated. Nineteen patients who underwent open heart surgery were divided into two groups: a control group (n=11) and a haptoglobin group (n=8). In the control group, the level of plasma-free hemoglobin increased significantly after CPB (p<0.01), and this level was strongly correlated with renal tubular leaking enzymes: NAG (r=0.76) and γ-GTP (r=0.81), in the Intensive Care Unit or on the first day after surgery. On the contrary, in the haptoglobin group, in which 4, 000 units of haptoglobin was added in the priming solution of CPB, no increased level of plasma free hemoglobin was observed. Furthermore, leak age of renal tubular enzymes were statistically less (p<0.05). It was concluded that free hemoglobin was a cause of renal damage during CPB and the damage was preventable by the administration of haptoglobin.