We report a case of spindle cell type medullary carcinoma of the thyroid in a 77-year-old man. Fine needle aspiration cytology showed numerous spindle cells without inflammation and hemorrhage. The spindle cells were uniform and exhibited no malignant features. Immunocytochemistry was positive for carcinoembryonic antigen and calcitonin, and the tumor was diagnosed as spindle cell type medullary carcinoma. There are various histological subtypes of medullary carcinoma, and diagnosis by cytomorphology alone is difficult. Preservation with LBC fixative was helpful for diagnosis by immunocytochemistry in this case.

Objective: There is enormous information flow via the Internet and papers.  Physicians require appropriate drug information from medical representatives (MRs), so fair promotion activities of MRs are necessary.  To clarify the activity and visiting aims of MRs, we investigated the visiting records for MRs.
Methods: We improved the visiting record form because there were some gaps in the records.  Subsequently, we investigated the validity of the records.  The correlations between visiting numbers of MRs and both purchase prices of our hospital and scale of drug companies were also investigated.  Two months after revision of the visiting records, a questionnaire survey was administered among MRs to determine their thoughts about promotion activities.
Results: The visiting numbers of MRs and companies did not change with revision of the visiting record.  Insufficient visiting records were significantly reduced from 5.1% to 0.8%.  There were no correlations between visiting numbers and purchase prices or scale of drug companies.  Meanwhile, sub-analysis of the visiting data indicated that MRs significantly promoted new drugs and drugs coming off patent.  The revision of visiting record format re-emphasized the importance of the visiting record on MRs.
Discussion: Almost all MRs promoted their products fairly, as there was no correlation between the purchase price and company scale.  However, they may actively promote new drugs and those with patents that have elapsed.  The visiting records are useful to determine the promotion activities of MRs.

A study was conducted to investigate changes in muscle soreness, serum creatine kinase (CK) activity and white blood cell (WBC) count following exercise bouts spaced three weeks apart.
The subjects were six male students (aged 23-25 yr), who had not participated in any training program for over 18 months. They performed muscular exercise of the nondominant arm using elbow flexors. Twenty percent of maximum voluntary contraction was used as the exercise intensity. After three weeks, the subjects repeated the same exercise bout. Perceived muscle soreness, CK activity and WBC count were assessed before, immediately after, 6h after and over 9 days after each exercise bout.
After the first exercise bout (1 st Ex), the subjects experienced muscle sorenss for 3-7 days. Also, a large increase of CK was found in five subjects (266-763%) . When the peak CK efflux was observed (day 3-4 after exercise), soreness had almost disappeared. WBC count was increased immediately and 6 h after exercise, then returned to the resting level. However, a significant increase (p<0.05) in WBC count was observed again on day 7 after exercise when CK had returned to the resting level. After the second exercise (2 nd Ex), a significant decrease of muscle soreness and the CK response was found in comparison with the 1 st Ex (p<0.41) . One interesting feature was that the CK efflux of subjects who had shown a large increase of CK after the 1 st Ex was not increased after the 2 nd Ex.
The initial exercise bout may have induced some damage to the muscle fibers or mem. bran. This damage would induce a process of repair in the damaged tissue, which in turn would adapt the muscle to the next stimulus. However, the subjects who showed a slight increase of CK after the 1 st Ex did not show this adaptation. Therefore an adaptive threshold for fiber or membrane damage may exist.

To prevent accidental falls in medical facilities, various types of bed-sensors have been produced by the clinical engineering department of our hospital. In this study a newly developed bed-sensor using a pyroelectric type infrared sensor was evaluated. The features of this bed-sensor are that it costs only 4,000 yen and can be installed anywhere on beds. It was found that the pyroelectric type infrared sensor (AMN13112) made by Matsushita Electric Works served our purpose. We test used the new bed-sensor in the for three months in the patient's ward and in the health care facility for the elderly attached to our hospital, as the systems to monitor patients who are attempting to get up, to prevent patients from leaving the bed unattended, and to replace the conventional floor sensor. As a result, it was formed that the new sensor is very usable in these applications and is also excellent in safety. But when the bed-sensor was installed in a wrong position, it was activated as a typicel nurse call system. For practical use, some improvements are necessary in stabilizing detection distance and precise control of sensitivity.
Sensors ; seconds ; Type 1 ; New ; Hospitals

A survey was conducted to better understand the current status of training of simulated and standardized patients (SP) in medical education and training protocol of SP training at each site, and to determine the future planning of the committee
1) Methods: A series of questions regarding the SP and SP training was sent to all 80 medical schools in Japan.
2) Results: Responses were received from 68 medical school (85%). According to the survey result, 43 medical schools (63%) trained their own SP. The total numbers of SP reported in this survey were 1,036 with ratio of male to female 1:3. The average numbers of SP at each medical school were 24 (range 5 to 87). SP training protocols were included basic training (88%) and to prepare common achievement test OSCE (84%), classes (74%) and advanced OSCE(60%). Only 6 medical school (14%) had the systematic curriculum for SP training.
3) Conclusion: To produce standardized, accurate SP training for medical education, the committee recommends to establish the standard curriculum and portrayal requirements for SP training.

1．The basic training curriculum for simulated and standardized patients （SPs） was provided by the 16th Medical Simulation Committee based upon a nationwide field survey that was conducted by the committee in 2009 and other data.
2．The curriculum consists of 3 essential programs: interpersonal communication, medical education involving SPs, and the medical interview.
3．The medical interview program was composed of basic issues, comprehension of scenarios, acting role and performance, and feedback and assessment.
4．The training facilities or institutions were recommended to properly assess the performance quality of SPs in the educational setting by means of a specific and clearly defined evaluation method.

The therapeutic effect of a cordless mini TENS on shoulder stiffness and painful diseases and patients' favorite intensity of stimulation were studied. Effect of this apparatus on peripheral circulation was also examind using a laser Doppler measuring instrument. The 114 cases with shoulder stiffness used the TENS only once (SS group), and the 53 cases continuasly (SC group). The 65 cases with painful diseases used the TENS only once (PS group) and the 53 cases continuasly (PC group). A great majority of the patients prefered stimulation with moderate frequency and high intensity. Effectiveness was seen in 76% of SS group and 87% of SC group, and in 75% of PS group and 91% of PC group. Peripheral circulation was significantly increased after the stimulation of the apparatus.