Because Japanese high school graduates have poor basic English skills they have difficulty acquiringduring the 6 years of medical school English skills sufficient to write medical papers in easily understood English and to converse with foreign medical researchers at international medical conferences in fluent English. In an attempt to improve English teaching in medical schools we analyzed the structures of sentences in high school English textbooks and compared them with those of sentences in more advanced English, as in the journals Science and Nature. We found that the English in high school textbooks has significantly lower subordination ratios. Thus, we propose that English with higher subordination ratios be taught in the 1st year of medical school.

A 62-year-old man with chronic renal failure had impending rupture of a right internal iliac aneurysm. He had a rate blood type (Type:AB and Rh+. Antibody: anti-Fya, anti-E, and anti-P1), so homologous blood transfusion seemed impossible. While blood pressure was reduced by bed rest and drug administration, 800ml of autologous blood was obtained within four weeks before operation. Furthermore the intraoperative autotransfusion method was used. Aneurysmectomy was successfully performed without homologous blood transfusion.

To confirm the safety and efficacy of a low-calorie mayonnaise supplemented with phytosterol esters (PEM) at a daily consumption dose of 884 mg given for 12 weeks with the goal of lowering serum low-density lipoprotein (LDL) cholesterol levels, we conducted a double-blind comparative study in healthy adults with marginally high serum levels of LDL cholesterol and total cholesterol using a mayonnaise without phytosterol esters supplementation (CM) as the control food. Serum LDL cholesterol levels decreased significantly in the PEM group as compared with the CM group during the 12-week intervention period (136.3 ± 16.4 vs. 145.0 ± 19.3 mg/dL at Week 8 (P < 0.05) and 135.0 ± 17.4 mg/dL vs. 144.9 ± 17.5 mg/dL at Week 12; P < 0.05). No observable adverse effects were observed due to the ingestion of PEM in this study. The safety of PEM was again confirmed by an additional clinical study in which healthy adult subjects ingested a 3-fold greater amount of PEM (2,652 mg of phytosterol esters as a daily dose) for 4 weeks. Thus, we concluded that PEM is effective in lowing serum levels of LDL cholesterol and is safe and well tolerated without any clinical problems.

This study was conducted to assess the proper fee for dispensing herbs prescribed under the national health insurance. We investigated the cost of dispensing a) general medicine and b) Kampo formulae in relation to the time needed in three pharmacies. One prescription of general medicine including packed extract of Kampo formulae, and one Kampo formula consisting of different kinds of herbs, were counted as one sample each. The former counted 125 samples, and 176 samples of the latter. The mean time for dispensing one sample of Kampo formulae was 9 minutes and 33 seconds, and it was 5.4 times longer than for the general medicine (1 minute and 46 seconds). The time for dispensing herbs grew longer as the days of the prescription increased; with a mean number of 9-12 herbs in the formulae about twice the time was needed for a prescription for 22-28 days than for one of 8-14 days. As the number of herbs in the formulae increased, the time for dispensing them also increased. The cost of pharmacist's work was calculated based upon the time expended and the pharmacist's hourly wage. It amounted to one fifth of the fee for dispensing general medicine, but it was nearly equal or higher when involving herbs. According to the Regulation of Dispensary Awards revised in 2004, the fee for dispensing herbal medicine is \1200 whatever the formulae. We would like to recommend that a re-evaluation of the fee should be made based on the number of days of the prescription, the number of herbs in the formulae, and the cost of preserving herbs in pharmaceutical facilities.

The first trial of common achievement test-computer-based testing was held from January through August 2002. The number of examinees was 5, 693, of whom 5, 676 were analyzed. Single-best-answer, five-choice questions were used. The highest score was 92 points, the lowest score was 19 points, and the average score was 55.9±10.2 points (standard deviation). Scores were distributed normally. The test sets did not differ significantly in difficulty, although test-set items differed for each student. The percentage of correct answers, the ∅-coefficient, and the point-biserial correlation coefficient were calculated for each category of the model core curriculum. The percentage of correct answers was highest in category A of the model core curriculum, and percentages of correct answers were similar in categories B, C, D, E, and F. The ∅-coefficient and the correlation coefficient were low in categories A and F and were highest in category C. Although the percentage of correct answers in this trial was lower than expected, many test items had discriminatory power. The Test Items Evaluation Subcommittee is now evaluating test items, determining pool items, and revising new test items for the second trial and expect to compile a useful item bank.

A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Diabetes Mellitus, Insulin-Dependent ; Diabetes Mellitus ; symptoms <1> ; Type 1 ; Urinary tract infection

Background:Although radiofrequency ablation(RFA)is a minimally invasive treatment for early-stage hepatocellular carcinoma(HCC),it remains unclear whether RFA achieves favorable outcomes in pa-tients aged ≥80 years.This study aimed to determine the efficacy and safety of RFA for HCC in patients aged ≥80 years. Methods:A total of 512 naive patients with HCC who had undergone RFA from January 2001 to December 2016 were enrolled.They were categorized into the ≥80-year-old group and the control group(aged ＜80 years).The primary endpoint was overall survival(OS),and the secondary endpoints were recurrence-free survival,complications associated with RFA,and cause of death.Propensity score matching was performed to adjust for patients'sex,liver function,tumor number,tumor diameter,and hepatitis C virus infection.Finally,the data of 68 patients in the ≥80-year-old group and 68 in the control group were analyzed;their baseline characteristics,primary endpoint,and secondary endpoints were compared. Results:There were significant differences in the alanine aminotransferase level and prothrombin time between the groups.The cumulative OS rate was not significantly different between the groups(P=0.83):98.5％,87.9％,and 50.5％ in the ≥80-year-old group and 94.1％,72.8％,and 49.3％ in the control group at 1,3,and 5 years,respectively.Age ≥80 years was not significantly associated with OS in multivariate analyses.Liver-related death occurred in 17 patients in the ≥80 year-old group and in 16 patients in the control group(P=1.00). Conclusions:RFA is safe and effective for the treatment of patients with HCC aged ≥80 years.

In 2002, Japanese medical students began computer-based testing (CBT) to assess their basic and clinical medical knowledge, based on the model core-curriculum, before starting clinical clerkships. Of 9, 919 multiple choice questions submitted by 80 medical schools, 2, 791 were used for CBT and 7, 128 were rejected. To improve the quality of future CBT, we analyzed why questions were rejected. The most commons reasons were difficulty, length, and inappropriate choice of answers. A training course may be needed to improve the ability of medical school staff to devise questions.