The present study investigated an effective method of eliciting medium and long latency cutaneous reflexes in normal human subjects. The effect of changes in stimulus conditions (number of pulse train, duration of electrical pulse and inter-stimulus interval) on cutaneous reflexes in the first dorsal interosseous muscle (FDI) following non-noxious electrical stimulation to the hand digits (digit 1 ; D1, digit 2 ; D2 and digit 5 ; D5) were investigated in seven healthy volunteers. Cutaneous reflexes were elicited while the subjects performed isolated isometric contraction of FDI (D2 abduction). Under all experimental conditions, the level of muscle contraction was set at 10% of the maximal EMG amplitude, which was determined during maximal voluntary contraction. Intensity of the electrical stimulation was set at 2.0 times the perceptual threshold under all experimental conditions.Although the amplitude of E2 (excitatory response, peak latency ∼60∼90 ms) was independent of the number of pulses (1, 2, 3, and 5 pulses, pulse frequency at 333 Hz), that of I1 (inhibitory response, ∼45∼60 ms), I2 (inhibitory response, ∼90∼120 ms) and E3 (excitatory response, ∼120∼180 ms) was significantly increased depending on the number of pulses (p<0.001). Amplitudes of E2 and I2 were significantly affected by the digit stimulated (p<0.01). For all four components of the cutaneous reflexes, there were no significant differences in magnitude even by alternating both the inter-stimulus interval (fixed at 1, 2 and 3 Hz and random between at 0.7 and 2 Hz) and the duration (0.1, 0.5 and 1 ms) of the electrical stimulation.These findings suggest that the susceptibility of responsible interneurons impinging on each reflex pathway to temporal summation of the test impulse differs depending on the digit stimulated. It is also likely that almost the same population of the cutaneous afferent fibers were activated by test stimulation with different durations as far as the same stimulus intensity was utilized. As a practical application, double or more pulses up to 3 Hz without causing pain is recommended to effectively evoke medium and long latency cutaneous reflexes in FDI, which would reduce possible effects arising from fatigue.

Clinical clerkships have been gradually introduced in medical schools in Japan. Because all students do not rotate through the same departments, the satisfaction of medical students differs among the departments, although the underlying reasons for such differences are unclear. To investigate the factors associated with student satisfaction with clinical clerkships, we performed a questionnaire survey.1) Questionnaires were distributed to 99 fifth-year medical students at Kyoto University Medical School. The questionnaire consisted of Likert-type 5-level scales of satisfaction, clinical clerkship assignments, and the attitudes of clerkship supervisors and other attending staff. Eighty-nine students responded.2) The independent factors for students' satisfaction were the attitude of attending staff (beta coefficient, 0.34), the attitude of the clerkship supervisor (0.30), and the frequency of physical examinations (0.09).3) Twenty-two of the 34 students who expressed the lowest level of satisfaction (level 1) reported that "the attending staff rarely had contact with students."4) Factors not associated with satisfaction were: whether the rotation was in internal medicine or surgery; whether the rotation was in a community hospital or a university hospital, and the department.5) These results suggest that medical students are satisfied with a clerkship if they perform frequent physical examinations and if the attending staff have an enthusiastic attitude.

Rikkunshito is comprised of 8 crude drugs and is used for the treatment of gastrointestinal dysfunctions such as anorexia and heavy stomach feeling. These symptoms are often caused by delay in gastric emptying. Cisplatin is a representative cancer chemotherapeutic drug with severe adverse effects such as anorexia and nausea, that gives rise to a delay in gastric emptying. However, it is still unknown whether rikkunshito has effects on improving the delayed gastric emptying induced by cisplatin. In the present study, we examined the effects of rikkunshito (an Atractylodis rhizoma-containing formula) on cisplatin-induced delay in gastric emptying in the rat. Rikkunshito improved this. Among the crude drugs that comprise rikkunshito, Atractylodis rhizoma, Ginseng radix, Poria and Aurantii nobilis pericarpium individually improved the delay in gastric emptying, suggesting that they all contribute to the action of rikkunshito. Moreover, the effects of these 4 crude drugs in combinations were also examined, and as a result, tended to be stronger when Atractylodis rhizoma was included. On the other hand, when Atractylodis rhizoma was excluded from rikkunshito, the effects were weaker. Meanwhile, atractylenolide III, a specific chemical constituent of Atractylodis rhizoma, improved delay in gastric emptying in a manner similar to that of rikkunshito with Atractylodis rhizoma. These results, taken together, suggest that Atractylodis rhizoma likely contributes greatly to the improving effect of rikkunshito on cisplatin-induced delay in gastric emptying.