In 1995, an experimental examination consisting of an Objective Structured Clinical Examination (OSCE) and multiple choice questions (MCQs) regarding physical examinations was held by a research group conducted by Prof. Saichi HOSODA, Tokyo Women's Medical College, and subsidized by the Ministry of Health and Welfare.
Sixty-two fifth-year students (volunteers) were assessed their skills in interviewing, physical examination, and cardio-pulmonary resuscitation at five stations, by faculty members from several universities using detailed checklists. The group found: 1) No correlation was observed between OSCE and MCQ tests, 2) Two-ranked checklists improved the reliability of the evaluation, 3) Examinees showed great interest in the method and expressed a hope that OSCE might be introduced into undergraduate education. OSCE will encourage the learning activities of students.

A pilot study of the Doppler renal arterial flow pattern was done on 34 patients (68 kidneys) with benign prostatic hypertrophy, 14 patients (28 kidneys) with hydronephrosis and 22 patients (37 kidneys) with reflux nephropathy. Renal scintigraphy was also performed besides the color Doppler scanning.
Results:
Mean minimum blood flow values were significantly smaller in all the subjects than those in normal control groups with one of the three diseases respectively
In patients with reflux nephropathy, minimum blood flow values were extremely low, suggesting the severe scars and scarce blood flow. A high correlation was found between uptake rates measured by renal scintigram and minimum blood flow. This fact suggests that the blood flow scan can reveal the profile of the renal function.
We conclude that the color Doppler sonography is useful in a routine initial examination and a simple follow-up test for detecting renal dysfunction in some urological diseases.

We report a case of Nothnagel syndrome with inattention. A 69-year-old laborer was admitted to our hospital for rehabilitation therapy complaining of gait disturbance a month after the onset of brainstem infarction. He had right oculomotor palsy, ataxia on the left side and upward movement limitation of the left eye. Magnetic resonance imaging demonstrated high signal intensity in the right tegmentum of the midbrain and the medial aspect of the right thalamus on T2-weighted and diffusion weighted images. This lesion involving nuclei in the medial aspect of the right thalamus, which is considered to be closely related with the reticular activating system, might explain his inattention. And it is suggested that the low blood flow in the right basal ganglia and parietal lobe revealed by his SPECT scan, could be related with that as well. We administered rehabilitation programs for his ataxia and inattention. Because diplopia is thought to be difficult to improve, we did not attempt to treat the patient's eye movement limitation. Three months after our intervention, he was able to walk without support. However, his inattention remained. Patients with brainstem infarction are apt to have plural impairments concurrently. In such cases, it is necessary to assess the treatment priority for each impairment adequately. Evidence based guidelines for the assessment of treatment priority would aid in this endeavor and the development of such guidelines is therefore expected.

In stroke patients, excessive oxidative stress impairs brain nerve cells and leads to arteriosclerosis. On the other hand, rehabilitative exercise is necessary for the functional improvement and maintenance after stroke, and exercises themselves increase reactive oxygen species production simultaneously. Therefore, it is essential to elucidate how exercises influence oxidative stress in stroke patients. We assessed the effects of exercises on 29 Japanese subacute-phase stroke patients (exercise group, 20; control group, 9), in terms of oxidative stress by examining changes in reactive oxygen metabolite (ROM) level (i.e., oxidative stress) and biological antioxidant potential (BAP) level (i.e., antioxidant capacity) in blood plasma. The exercise group performed two sets of 1-hour exercises 6 days/week for 56 days. The control group performed the same 1-hour exercises, but only on days 1 and 56. ROM and BAP levels in blood plasma in both groups were measured immediately before and after the exercises and at rest on days 1 and 56. ROM level significantly decreased and BAP level significantly increased at rest from days 1 to 56 in the exercise group. However, no significant change was observed in these levels in the control group. Conclusion: Regular rehabilitative exercise can improve antioxidant capacity and attenuate oxidative stress even in stroke patients.
Oxidative Stress ; Stroke ; Arteriosclerosis

The purpose of this study was to confirm both the reproducibility of indices (NIRS slope, NT2, %NIRS fall) and the specificity obtained by analyzing the muscle oxygenation curve measured by near-infrared spectroscopy (NIRS) during ramp exercise. Ten healthy men participated in this study. The NIRS probe was placed on the vastus lateralis muscle. An increase in oxygenation was observed from rest to warm-up at 0 watts (Δ NIRS) . Oxygenation began to decrease lineally as the workload increased (NIRS slope) . In the latter phase of exercise, the oxygenation curve flattened out despite an increasing workload, and as a result, an inflection point was formed (NT2) . The minimum value of oxygenation during ramp exercise was indicated as“%NIRS fall.”
Protocol 1. After a warm-up period of 3 min at 0 watts, a ramp exercise (20 watt/min) test was performed until volitional fatigue. The test was performed for each subject twice (test-1, test-2) with a 1-week interval. Protocol 2. A test was performed with three consecutive ramp exercises (lOwatt/min·20watt/min·30watt/min) up to120watt each with sufficient rest between the exercises.
NT2 was observed in 7 of 10 subjects. Test-1 and test-2 mean values of ANIRS, NIRS slope, watts at NT2 (NT2) and %NIRS fall were not significantly different, and the correlations between test-1 and test-2 were highly significant (r=0.94, P<0.0001: ANIRS, r=0.99, P<0.0001: NIRS slope, r=0.91, P<0.002: NT2 and r=0.78, P<0.005 : %NIRS fall) . The regression lines obtained for correlations of results of test-1 and test-2 were y=-5.89+1.38X (Δ NIRS), y=0.02+ 1.03X (NIRS slope), y=31.52+0.83X (NT2), and y=19.91+0.61X (%NIRS fall) . No significant differences in both intercept and coefficient between the regression line and identity line were found in the NIRS slope and NT2. The rate of decrease in the oxygenation curve became steeper with an increase in work-load from 10 watts/min to 20 watts/min and to 30 watts/min. However, the mean values of the NIRS slope, modified by watts, were 0.29±0.06%/watt, 0.29±0.07%/watt and 0.29±0.07%/watt, respectively. There were no significant differences of the NIRS slopes among these exercises. The results indicate constancy of the rate of decrease in oxygenation per workload.
In conclusion, these findings demonstrate the reproducibility of the NIRS slope and the appearance of NT2 during ramp exercise, and the specific way in which the decrease in muscle oxygenation reflects workload. They suggest that analysis of the muscle oxygenation curve can be used to estimate muscular metabolism and indices of training effects.