In 1994, a basic diagnosis training course was introduced for 2nd-year medical students at Jichi Medical School (JMS) to teach basic interview and physical examination skills with an emphasis on diagnostic processes and principles. In planning and preparing the course, instructors at JMS frequently held discussions to determine learning objectives and activities. We used a comprehensive manual for small-group teaching to standardize lectures as much as possible. In all sessions of the basic physical examination, students were taught in small groups. We also constructed original models to teach palpation and percussion. These models allowed students to participate actively and helped them understand the principles, skills, and findings of palpation and percussion. Instructors at JMS concluded that the models were useful training tools.

Objective: To investigate whether postgraduate education through evidence-based medicine can affect the knowledge and behavior of residents.
Design: Self-controlled and externally controlled trial.
Setting: University hospital.
Participants: Fifteen residents specializing in family medicine.
Intervention: Four 2-hour seminars and weekly evidence-based medicine-style journal club meetings.
Main outcome measures: Scores from a test of knowledge of evidence-based medicine and the number of MEDLINE searches conducted each month.
Results: All residents improved their knowledge of evidence-based medicine and conducted more MEDLINE searches each month than did other medical residents or residents of our department last year.
Conclusion: Postgraduate education through evidence-based medicine is effective in improving residents' knowledge and behavior.

In order to determine the effectiveness of Orengedoku-to in the treatment of schizophrenia, Orengedoku-to was added to the drug regimens of 10 patients who had been hospitalized with onset episodes or acute exacerbation of this condition. Before Orengedoku-to was added, the schizophrenic symptoms associated with the active phase had already been ameliorated with administration of antipsychotic drugs such as haloperidol for 4-12 weeks, with administration continuing at least two weeks after these symptoms had stabilized. Symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS) three times: before Orengedoku-to was added, immediately following cessation of administration, and four weeks after administration had ended. The BPRS scores indicated significant decreases both immediately following cessation of administration and four weeks later (from 36.3±9.8 to 30.5±6.7). In particular, significant improvement was noted for the symptoms of guilt feelings, depressive mood, suspiciousness and excitement. These improvements were not thought to be due to haloperidol, because the plasma haloperridol levels did not change. No adverse effects were noted.

We investigated the change of “Kyo-kyo-kuman, ” after the administration of Saiko-zai (including Bupleuri Radix) or Non-saiko-zai (not including Bupleuri Radix). Subjects were 44 patients (7 males, 37 females, with a mean age of 42.8±16.4). We evaluated their levels of the Kyo-kyo-kuman, with blood biochemical tests, their depressive levels using Zung's Self Depression Scale (SDS), and their subjective well-being levels using the Subjective Well-being Inventory (SUBI) scale, at baseline and 3 and 6 months after the administration of Kampo formula. In the S-group (20 patients), administered Saiko-zai for 6 months, the K-scale (Keio's Kyo-kyo-kuman scale) scores showed significant decreases at 3 and 6 months. In the C-group (16 patients), administered Non-saiko-zai for 6 months, the K-scale scores did not change significantly. There was a statistically significant decrease in the K-scale scores of the patients of S-group as compared to the patients of C-group. The decreases in the left K-scale scores correlated significantly with the rises in plasma protein concentrations.

Subdural hematoma in infants can be caused by abuse, and is thought to be more likely if subdural hematoma is associated with retinal hemorrhage and cerebral edema. In Japan, few doctors disagree that cases of subdural hematoma with retinal hemorrhage and cerebral edema with multiple findings on the body are more likely to have been caused by abuse rather than by household accident. On the other hand, in cases where there are no other significant physical findings, only subdural hematoma and retinal hemorrhage, there is a difference of opinion as to whether the injury was caused by an accident or abuse. The reason for this is that neurosurgeons in Japan promoted the concept that infants can develop subdural hematomas and retinal hemorrages due to minor trauma at home before the concept of abusive head trauma became known. In addition, the age distribution of subdural hematomas in Japan differs from that in other countries, with peaks at around 8 months, and the reason for this remains unclear. Therefore, the etiology of infant subdural hematoma in Japan needs to be investigated in greater detail.

Eighteen untreated patients with schizophrenia and other psychotic disorders, all of whom had insomnia among their chief complaints, were randomly divided into two groups. For four weeks, nine patients (group A) were treated with neuroleptics (haloperidol) and Orengedokuto, and the remainder (group B) were treated with neuroleptics alone. Changes in schizophrenic symptoms and the number of doses of hypnotics (nitrazepam) were examined. In group A, the thought disturbance (conceptual disorganization, grandiosity, hallucinatory behavior, unusual thought content) aspect of schizophrenic symptoms improved (p=0.06), and the number of doses of hypnotics (mean=1.9) was smaller (p=0.06), as compared with group B (mean=7.7). These observations suggest that augmentation therapy with Orengedoku-to is potentially effective for the treatment of insomnia associated with schizophrenia and other psychotic disorders.

We attempted to analyze “Kyo-kyo-kuman, ” using biochemical and psychiatric approaches. One hundred and twenty patients (23 males, 97 females) with a mean age of 42.4±16.2 years were evaluated for their levels of Kyo-kyo-kuman, using blood biochemical tests, depression levels as measured by Zung's Self Depression Scale (SDS), and subjective well-being levels as measured by the Subjective Well-being Inventory (SUBI) scale. Ninety-three patients (77.5%) had the Kyo-kyo-kuman. Plasma creatinine level and a score of factor 11 (general well-being-negative affect) of SUBI were significantly lower in patients who had the right Kyo-kyo-kuman than in patients who did not have the right Kyo-kyo-kuman. Scores of factor 9 (perceived illhealth) and factor 11 of SUBI were significantly lower in patients who had the left Kyo-kyo-kuman than in patients who did not have the left Kyo-kyo-kuman. In conclusion, patients under the strong stressors tended to have Kyo-kyo-kuman.

It has been experienced that Kampo, with its philosophy that every disease is psychosomatic in origin and that herbs affect both the psyche and the soma, sometimes has a dramatic effect on somatoform disorders, though there has been no study examining the effects of Kampo on somatoform disorders. In this preliminary study, the morbidity of somatoform disorders among patients who visited the Keio Kampo Clinic and the patients' psychological well-being were examined.
One hundred patients (17 males and 83 females; mean age [±SD], 39±16) who sought Kampo treatment for the first time at Keio University Hospital participated in this study. A Japanese checklist derived from the somatoform disorders schedule (version 1.1) was used to check the somatoform symptoms. To assess psychological well-being, the subjective well-being inventory (SUBI) was performed. The subjects' clinical records were examined afterwards to rule out symptoms which could be medically explained.
Somatoform patients and medically ill (non-somatoform) patients were 65% and 26% of the total respectively. The somatoform patients showed significantly lower SUBI positive scores than the non-somatoform patients (p=0.042), while SUBI negative scores were significantly higher (p=0.001). Among the somatoform patients, there was a negative correlation between numbers of somatoform symptoms and SUBI positive scores (r=0.267; p=0.032), and a positive correlation between numbers of somatoform symptoms and SUBI negative scores (r=0.337; p=0.006).
Following the SUBI scores through treatment courses may lead to a better understanding of the pathology of somatoform disorders and to more effective use of Kampo.

Guanylyl cyclase C (GC-C) is a member of a family of enzymes that metabolize GTP to cGMP and was first identified as a receptor for heat-stable enterotoxin. Guanylin (GNY) has since been identified as an endogenous ligand for GC-C in the intestine of several mammalian species. The GNY/GC-C system regulates ion transportation and pH in the mucosa. Recently, it was reported that GC-C and GNY are involved in lipid metabolism in rat mesenteric adipose tissue macrophages. To examine the role of GC-C and GNY in lipid metabolism in cattle, we used a bovine mesenteric adipocyte primary culture system and a coculture system for bovine adipocytes and GNY-/GC-C-expressing macrophages. Fat droplets were observed to accumulate in bovine mesenteric adipocytes cultured alone, whereas few fat droplets accumulated in adipocytes indirectly cocultured with macrophages. We also observed that GC-C was present in bovine mesenteric adipose tissue, and that fat droplet accumulation decreased after in vitro GNY administration. Expressions of mRNAs encoding lipogenic factors decreased significantly in adipocytes after either coculture or GNY administration. These results suggest that the GNY/GC-C system is part of the control system for lipid accumulation in bovine mesenteric adipose tissue.
Adipocytes ; Adipose Tissue* ; Animals ; Cattle* ; Coculture Techniques ; Enterotoxins ; Guanosine Triphosphate ; Guanylate Cyclase* ; Humans ; Hydrogen-Ion Concentration ; In Vitro Techniques ; Intestines ; Ion Transport ; Lipid Metabolism ; Macrophages ; Mucous Membrane ; Rats ; RNA, Messenger