In order to clarify why orthopedic complaints such as lumbago are ameliorated by hot-spring bathing, serum levels of sialic acid and fucose, which form glycoconjugates and are markers of connective tissue metabolism, were measured before and after each hot-spring bathing. No changes were observed in serum sialic acid for persons who took hot-spring bathing more than three times per day for 10 days. However, many of them showed a decreasing tendency in serum fucose level after bathing. Although it is not clear why this tendency occurs, it strongly suggests that hot-spring bathing influences on connective tissue metabolism.

It is well known that gynecological complaints are ameliorated by hot spring bathing. We therefore investigated the changes in urinary mucin excretion before and after 14 days of daily hot spring bathing in order to clarify the relationship between hot spring bathing and complaint amelioration. Urine was collected from 28 female adults (64.3±7.0 years old) before and after the 14 days of hot spring bathing. Urinary mucins containing sialoglycopeptides and sulfated glycopeptides were separated from the urine using the ethanol and cetylpyridinium chloride precipitation methods, then indentified with two-dimensional electrophoresis on cellulose acetate membranes.
After the removal of glycosaminoglycan contamination by glycosaminoglycan-degrading enzymes, mucin amounts were determined by the phenol-sulfuric acid method. The results showed that the levels of both sialoglycopeptides and sulfated glycopeptides increased after 2 weeks of bathing. The level of urinary mucin, which is synthesized and excreted from the epithelial cells, increased as a result of hot-spring bathing. Therefore, it is highly likely that the amelioration of gynecological complaints of females is related to the chages in urinary mucin excretion brought about by hot spring bathing.

The School of Medicine, University of Tsukuba, was founded in 1974 and had graduated 1, 561 students by 1994. From 1980 through 1987, 44% to 73% of graduates became hospital staff, 16% to 40% became university staff, and 0% to 8% became general practitioners. More than 80% of graduates did a 2-year residency (sotsugo-kenshu) at our university hospital and 40% completed a 6-year residency. Almost 10 years of postgraduate training was required to become an established medical practitioner. This length of time indicates that postgraduate training is the most important part of the medical career. About 80% of graduates earned doctor of philosophy (Ph. D.) degrees, whereas 93% became registered specialists, indicating that graduates tended to become specialists rather than to pursue Ph. D. degrees. This difference is more evident among female graduates: 85% became specialists whereas only 53% received a Ph. D. Most graduates considered the School of Medicine to have a good curriculum, but some younger graduates had complaints. The graduates chose their career specialties on the basis of their own interests and aptitudes. We should take these data into account to prepare a system of life-long education and learning.

This study aimed to clarify the resources required to relieve distress during palliative care delivery to cancer patients. Between April 2015 and March 2017, 1479 outpatients receiving chemotherapy for cancer were screened using the Japanese version of the Support Team Assessment Schedule (STAS-J). When the STAS-J result was 2 points and higher, the patient was considered positive for distress. A certified nurse or pharmacist performed STAS-J screening and, in cases where the patient exhibited distress, took steps to alleviate the problem themselves or consulted another resource. Distress was identified in 181 (12.2%) of the 1479 patients. These 181 patients needed 288 resources. The resources used to alleviate distress were categorized as follows: direct support by certified nurse or pharmacist (153), consultation with the attending physician (98) and other (37). The required resource included the following twelve professionals: attending physician, ophthalmologist, dermatologist, dentist, orthopedic surgeon, palliative care physician, certified nurse, certified pharmacist, medical social worker, clinical psychologist, volunteers for cancer patients, and palliative care team. The frequency of the intervention by the certified nurse or pharmacist (61, 39.9%) in directly alleviating psychiatric distress was significantly higher than by consultation with the attending physician (10, 10.2%) (p<0.0001). However, the frequency of consultation with the attending physician in alleviating physical distress (88, 89.8%) was significantly higher than that of the certified nurse or pharmacist (92, 60.1%) (p<0.0001). We conclude that the certified nurse or pharmacist is important for the delivery of palliative cancer care, because they can directly provide relief from psychiatric distress.