We developed a system to evaluate internal medicine residents in terms of general internal medicine and subspecialties and assessed whether the evaluation system was effective and satisfactory for them. Evaluations were performed by the residents and their instructors at 6 months, 12 months, and every year thereafter. A questionnaire was completed by the residents to assess the effectiveness of the evaluation system. In every field, the scores given by the residents themselves after 6 months of residency were an average of 1 grade lower (on a 5-grade scale) than those given by their instructors. The students thought that the evaluation system was effective but contained too many items and had obscure standards. Although evaluation systems for medical residents are uncommon in Japan, we found that the results of the residents' and instructors evaluations were closely correlated. Self-evaluation systems are important in postgraduate education; a standardized system is required for a uniform level of education throughout the country.

  To examine the status of pharmaceutical industry support for junior residency education in Japan, we performed a questionnaire survey of 445 residency program directors （response rate, 76%）.
1） Fifty-one percent of respondents thought that industry support was necessary for education, and 28% did not believe that industry support negatively affects residents’ prescribing behaviors.
2） Twelve percent said their institutions had a curriculum for physician-industry relationships. Ten percent prohibit residents from meeting with pharmaceutical representatives, and 30% ban gifts from industry.
3） Fifty-one percent reported that they had pharmaceutical industry-sponsored in-hospital educational events for residents, and 73% reported that they had industry-sponsored in-hospital educational events which residents were allowed to attend.
4） Program directors’ belief that industry support was necessary for education predicted that programs would receive such support.

Three cases of LMCAP for the isolated LMCA stenosis were presentd. In two cases of the proximal LMCA stenosis, the connective tissue between the ascending aorta and the main pulmonary artery was prepared to detect the LMCA. From the left lateral wall of the ascending aorta to the anterior wall of the LMCA over the stenotic lesion was excised and the saphenous vein patch was sutured (anterior approach). In the third case, because the stenosis was locarized at the distal LMCA, the patch angioplasty using the saphenous vein was performed by direct opening of the distal LMCA accessed from the left lateral side of the main pulmonary artery without aortotomy (lateral approach). Ultrasonic cuser was quite useful to isolate the LMCA. LA-LV vent was indispensable to obtain the non-blood clean operation field. All three cases showed the successful enlargement of LMCA at the postopeorative coronary angiography.

Our experience with 13 patients (mean age 52, range 35-71 years) undergoing pericardiectomy at Mitsui Memorial Hospital in the 13 years (from 1977 to 1990) has examined with clinical features and M-mode echocardiographic study. Preoperatively, the patients were either in N. Y. H. A. Functional Class III (11 cases), or Class IV (2 cases). Median sternotomy without using cardiopulmonary bypass was employed in all cases. The area of the right ventricle, atria, cavae, pulmonary veins and left ventricle where can be reached without cardiopulmonary bypass or other hemodynamic support were decorticated completely, and the posterior portion of the left ventricle were not decorticated partially. Intraoperative hemodynamic responses were observed between before and after pericardiectomy monitored by Swan-Ganz catheter; central venous pressure (CVP) were changed from 21.3±5.6 to 13.6±4.0cmH₂O, pulmonary artery diastolic pressure (PADP) were changed from 19.8±5.5 to 11.3±6.6mmHg, cardiac index (CI) were changed 2.14±1.34 to 3.16±1.73l/min/m². There were no early deaths and no late heart complicated deaths. There were 2 cases died, one for advanced gastric carcinoma and another for wide cerebral infarction whthin 3 years from pericardiectomy. M-mode echocardiographic study that were examined between preoperative and late postoperative periods (mean follow-up time 51 months) showed effective recovery in cardiac function; left ventricular end-diastolic volume index (LVEDVI) were from 34.3±12.1 to 39.5±14.5ml/m², left ventricular end-systolic volume index (LVESVI) were from 17.2±7.8 to 13.1±6.7ml/m², stroke index (SI) were from 17.1±7.3 to 26.6±12.5ml/m², ejection fraction (EF) were from 45.1±19.2 to 61.2±22.5%, mean velocity of circumferential fiber shortening (mean Vcf) were from 0.80±0.35 to 1.13±0.53circ/sec. All the patients showed functional improvement; 9 are in N. Y. H. A. Functional Class I, and 4 are in Class II. These findings would be permitted this procedure with median sternotomy for chronic constrictive pericarditis as one of a safety and effective method conventionally.

No abstract available.
Acanthosis Nigricans* ; Hyperandrogenism* ; Insulin Resistance* ; Insulin* ; Proliferating Cell Nuclear Antigen*

No abstract available.
Acanthosis Nigricans* ; Hyperandrogenism* ; Insulin Resistance* ; Insulin* ; Proliferating Cell Nuclear Antigen*

With advances in cancer treatment, such as cytotoxic chemotherapy and radiotherapy, grave new sequelae of treatment have emerged for young cancer survivors. One sequela that cannot be overlooked is male infertility, with reportedly 15% to 30% of cancer survivors losing their fertility potential. Cytotoxic therapy influences spermatogenesis at least temporarily, and in some cases, permanently. The degree of spermatogenesis impairment depends on the combination of drugs used, their cumulative dose, and the level of radiation. The American Society of Clinical Oncology has created an index to classify the risks to fertility based on treatment. Medical professionals currently use this risk classification in fertility preservation (FP) programs. FP programs are currently being promoted to prevent spermatogenesis failure resulting from cancer treatment. For patients who are able to ejaculate and whose semen contains sperm, the semen (sperm) is cryopreserved. Moreover, for patients who lack the ability to ejaculate, those with azoospermia or severe oligozoospermia, and those who have not attained puberty (i.e., spermatogenesis has not begun), testicular biopsy is performed to collect the sperm or germ cells and cryopreserve them. This method of culturing germ cells to differentiate the sperm has been successful in some animal models, but not in humans. FP has recently gained popularity; however, some oncologists and medical professionals involved in cancer treatment still lack adequate knowledge of these procedures. This hinders the dissemination of information to patients and the execution of FP. Information sharing and collaboration between reproductive medicine specialists and oncologists is extremely important for the development of FP. In Japan, the network of clinics and hospitals that support FP is expanding across prefectures.

Auto-transplantation of adipose tissue is commonly used for the treatment of tissue defects in plastic surgery. The survival of the transplanted adipose tissue is not always constant, and one of reasons is the accelerated apoptosis of the implanted preadipocytes. We have recently established highly homogeneous preadipocytes, named ccdPAs. The aim of the current study was to evaluate the regulation of the potency of platelet-rich plasma (PRP) on the apoptosis of ccdPAs in vitro. PRP stimulated the proliferation of the preadipocytes in a dose-dependent manner, and the stimulatory activity of 2% PRP was significantly higher than that of 2% FBS or 2% platelet-poor plasma (PPP). The presence of 2% PRP significantly inhibited serum starvation- or TNF-alpha/cycloheximide-induced apoptosis in comparison to 2% FBS or 2% PPP. DAPK1 and Bcl-2-interacting mediator of cell death (BIM) mRNAs were reduced in the preadipocytes cultured with 2% PRP in comparison to those cultured in 2% FBS. The gene expression levels were significantly higher in cells cultured without serum in comparison to cells cultured with 2% FBS, and the levels in the cells with 2% PRP were reduced to 5-10% of those in the cells without serum. These results indicated that ccdPAs exhibit anti-apoptotic activities, in addition to increased proliferation, when cultured in 2% PRP in comparison to the same concentration of FBS, and that this was accompanied with reduced levels of DAPK1 and BIM mRNA expression in in vitro culture. PRP may improve the outcome of transplantation of adipose tissue by enhancing the anti-apoptotic activities of the implanted preadipocytes.
Adipocytes/*cytology ; Adipose Tissue/cytology/metabolism ; Apoptosis/*physiology ; Apoptosis Regulatory Proteins/antagonists & inhibitors/metabolism ; Calcium-Calmodulin-Dependent Protein Kinases/antagonists & inhibitors/metabolism ; Cell Culture Techniques/*methods ; *Cell Differentiation ; Cell Proliferation ; Cells, Cultured ; Gene Expression Regulation ; Humans ; Membrane Proteins/antagonists & inhibitors/metabolism ; *Platelet-Rich Plasma/metabolism/physiology ; Proto-Oncogene Proteins/antagonists & inhibitors/metabolism ; Tissue Transplantation

The development of clinically applicable scaffolds is important for the application of cell transplantation in various human diseases. The aims of this study are to evaluate fibrin glue in a novel protein replacement therapy using proliferative adipocytes and to develop a mouse model system to monitor the delivery of the transgene product into the blood and the fate of the transduced cells after transplantation. Proliferative adipocytes from mouse adipose tissue were transduced by a retroviral vector harboring the human lecithin-cholesterol acyltransferase (lcat) gene, and were subcutaneously transplanted into mice combined with fibrin glue. The lcat gene transduction efficiency and the subsequent secretion of the product in mouse adipocytes were enhanced using a protamine concentration of 500 microg/ml. Adipogenesis induction did not significantly affect the lcat gene-transduced cell survival after transplantation. Immunohistochemistry showed the ectopic enzyme production to persist for 28 days in the subcutaneously transplanted gene-transduced adipocytes. The increased viability of transplanted cells with fibrin glue was accompanied with the decrease in apoptotic cell death. The immunodetectable serum LCAT levels in mice implanted with the fibrin glue were comparable with those observed in mice implanted with Matrigel, indicating that the transplanted lcat gene-transduced adipocytes survived and functioned in the transplanted spaces with fibrin glue as well as with Matrigel for 28 days. Thus, this in vivo system using fibrin is expected to serve as a good model to further improve the transplanted cell/scaffold conditions for the stable and durable cell-based replacement of defective proteins in patients with LCAT deficiency.
Adipocytes/*cytology/transplantation ; Animals ; Blotting, Western ; Cell Differentiation ; Cell Survival/drug effects ; Cells, Cultured ; Collagen/metabolism ; Drug Combinations ; Drug Delivery Systems ; Fibrin Tissue Adhesive/*administration & dosage ; Genetic Vectors/administration & dosage ; Humans ; Laminin/metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Nude ; Phosphatidylcholine-Sterol O-Acyltransferase/*genetics/*metabolism ; Proteoglycans/metabolism ; RNA, Messenger/genetics ; Reverse Transcriptase Polymerase Chain Reaction ; *Tissue Engineering

Non-alcoholic fatty liver disease is currently the most common chronic liver disease, affecting up to 25% of the global population. Simple fatty liver, in which fat is deposited in the liver without fibrosis, has been regarded as a benign disease in the past, but it is now known to be prognostic. In the future, more emphasis should be placed on the quantification of liver fat. Traditionally, fatty liver has been assessed by histological evaluation, which requires an invasive examination; however, technological innovations have made it possible to evaluate fatty liver by non-invasive imaging methods, such as ultrasonography, computed tomography, and magnetic resonance imaging. In addition, quantitative as well as qualitative measurements for the detection of fatty liver have become available. In this review, we summarize the currently used qualitative evaluations of fatty liver and discuss quantitative evaluations that are expected to further develop in the future.