Objectives: To clarify differences in medical students’ emotional intelligence and empathy among 4 school years and sex.
Methods: A cross-sectional study of 370 medical students in years 1, 2, 4, and 6 was performed with Japanese versions of 2 self-reported questionnaires: the Trait Emotional Intelligence Questionnaire–Short Form （TEIQue-SF） and the Jefferson Scale of Physician Empathy–Student Version （JSPE-S）.
Results: Total scores of the TEIQue–SF tended to decrease in higher school years. However, the total score of the JSPE-S was significantly increased in year 6 but was decreased in year 4. Male students had higher TEIQue–SF scores, and female students had higher JSPE-S scores. Of the 4 factors of the TEIQue–SF compared （well-being, self-control, emotionality, and sociability）, only sociability was higher in males. No differences were found among school years. The scores of the TEIQue–SF and the JSPE-S showed a weak correlation. Of the factors of the TEIQue–SF, only self-control showed no correlation with the JSPE-S.
Discussion and Conclusion: These results suggest that the emotional intelligence of both male and female medical students tends to decline. The increase in JSPE-S scores in year 6 suggests that medical interview training is effective. Furthermore, training is important both to enhance emotional intelligence and to teach self-control skills.

1) We visited 5 Scottish universities (the Universities of Aberdeen, St Andrews, Dundee, Glasgow, and Edinburgh) to observe and learn about simulated-patient programs and communication-skills training.
2) Each medical school has developed its own approach for using simulated patients in training and for giving feedback to medical students.
3) In Scotland, where all medical schools adhere to“Tomorrow's Doctors”and“the Scottish Doctor Curriculum Outcomes, ”curriculum styles vary greatly, but the differences are celebrated.The simulated-patient programs are integrated into each program in a way unique to each school.

Purpose: Olanzapine has antiemetic activity for chemotherapy-induced nausea and vomiting (CINV). The purpose of this retrospective study is to evaluate the efficacy of olanzapine for prevention of CINV in patients with severe nausea resistant to standard antiemetic regimen for highly emetogenic chemotherapy (HEC). Methods: Olanzapine was administered in twenty gynecological cancer patients receiving HEC. They had grade 3 nausea (CTCAE ver.4.0) for the acute (24 hours postchemotherapy) and/or delayed (24-120 hours postchemotherapy) period despite the combined use of 5-HT3 receptor antagonist, NK-1 receptor antagonist, and dexamethasone. Oral olanzapine (5 mg/day) was administered on day -1 prior to chemotherapy and continued for 7 days in combination with standard antiemetic regimen. The nausea control rate (grade 0-1) with olanzapine were evaluated. Results: The nausea control rate improved from 30% to 95% for the acute period, 0% to 95% for the delayed period, and 0% to 90% for the overall period. In each period, the nausea control rate improved significantly (p≤0.001). Grade 0-1 sleepiness was observed but there were no grade 3 or 4 toxicities. Conclusion: In this study, olanzapine combined with the standard antiemetic regimen had good antiemetic activity at both acute and delayed period in most of chemotherapy-naive patients receiving HEC. The efficacy of olanzapine suggested additional improvement in the control of severe CINV resistant to standard antiemetic regimen for HEC.

The Medical Education Development Center has organized seminars and workshops for medical education 30 times from 2000 through 2008 throughout Japan. The participants have numbered more than 3200 and have included educators, physicians, students, and simulated patients. The topics of seminars and workshops have included problem-based learning tutorial systems, medical interview skills, objective structured clinical examinations, evidence-based medicine, coaching technology, simulations, and community medicine in response to educational needs. A questionnaire survey of 1793 participants of the 11th to 30th seminars and workshops (response rate, 85.6%) showed a high degree of satisfaction (4.33±0.13 of 5 points). Invited lecturers and directors from throughout the country often organized these workshops. The results of workshops are reported in our annual monograph, "Trends in Medical Education."

  Emotional intelligence and empathy are crucial in patient–physician relationships and clinical outcomes. It has been reported that both emotional intelligence and empathy decrease as students advance through medical school. This study aimed to validate Japanese versions of the Trait Emotional Intelligence Questionnaire–Short Form （TEIQue–SF）, developed by Petrides and Furnham （2001）, and the Jefferson Scale of Physician Empathy （JSPE）, developed by Hojat et al. （2001）.
1）The TEIQue–SF and JSPE were translated and administered to 370 medical students. Valid responses were obtained from 321 students（88%）.
2）Cronbach’s alpha for internal reliability was high for both the TEIQue–SF （0.87） and the JSPE （0.89）. All item total score correlations were positive for both the TEIQue–SF （range, 0.29 to 0.64） and the JSPE （range, 0.27 to 0.72）.
3）Cronbach’s alpha was smaller if an item was deleted than if all items were included for both the TEIQue–SF （0.84–0.85） and the JSPE （0.81–0.86）.
4）Factor analysis of both the TEIQue–SF and the JSPE revealed that the Japanese versions had some structural differences from the original versions. However, criterion–related analysis showed that the TEIQue–SF and the JSPE were highly correlated with the NEO–Five Factor Inventory, a measure of the Big Five personality traits.
5）These findings provide support for the construct validity and reliability of the Japanese versions of the TEIQue–SF and the JSPE when used for medical students. Further investigation is needed.

Objective: The aim of this study was to establish the proper definitions of venous thromboembolism (VTE) and bleeding events for a healthcare database in Japan.
Study Design: Validation study.
Methods: The study comprised patients with VTE or who had undergone orthopedic surgery of the lower extremities and whose outpatient or inpatient medical information from April 1, 2008 to September 30, 2013 was available.  The source population of the database was derived from 100 acute-care hospitals.  The endpoints were VTE events (deep venous thrombosis [DVT], pulmonary thromboembolism [PE]) and bleeding events (bleeding requiring blood transfusion, intracranial hemorrhage, intraocular hemorrhage, upper gastrointestinal [GI] bleeding, and lower GI bleeding).  The frequent events with laboratory data were randomly extracted and evaluated, while all the infrequent events with laboratory data were extracted and evaluated.  Positive predictive value (PPV) was defined as the proportion of events judged to be clinical by medical experts of all the extracted events.  First, we conducted a test with a small number of cases and then revised the definitions of events.  Second, we extracted and evaluated data in 50 patients for VTE and bleeding events patients, based on which we defined the target PPV level between 60 and 70%.
Results: Of the 5,044,743 patients in the database, 36,947 patients underwent orthopedic surgeries of the lower extremities and 3,578 patients experienced a VTE event.  The PPV at the first evaluation was 80.0% (8/10) for DVT, 57.1% (4/7) for PE, and 27.3% (6/22) for bleeding events.  At the second evaluation using the revised definitions, the PPV were 75.0% (42/56) for VTE and 73.3% (33/45) for bleeding events.  Overall, the PPVs for VTE and bleeding events were over 70%.  The PPV of the VTE events were 76.9% (30/39) for DVT and 70.6% (12/17) for PE.  The PPVs of each type of bleeding event were over 70% except for intracranial hemorrhage (44.4%, 4/9).
Conclusion: The PPV was high for VTE events (75.0%) and bleeding events (73.3%).  The definitions used in this study are rational for the identification of VTE, DVT, PE, and bleeding events in the healthcare database in Japan.  The definition for each type of bleeding event should be investigated in further studies.

OBJECTIVE: The purpose of this study was to assess whether peritoneal cytology has prognostic significance in uterine cervical cancer. METHODS: Peritoneal cytology was obtained in 228 patients with carcinoma of the uterine cervix (International Federation of Gynecology and Obstetrics [FIGO] stages IB1-IIB) between October 2002 and August 2010. All patients were negative for intraperitoneal disease at the time of their radical hysterectomy. The pathological features and clinical prognosis of cases of positive peritoneal cytology were examined retrospectively. RESULTS: Peritoneal cytology was positive in 9 patients (3.9%). Of these patients, 3/139 (2.2%) had squamous cell carcinoma and 6/89 (6.7%) had adenocarcinoma or adenosquamous carcinoma. One of the 3 patients with squamous cell carcinoma who had positive cytology had a recurrence at the vaginal stump 21 months after radical hysterectomy. All of the 6 patients with adenocarcinoma or adenosquamous carcinoma had disease recurrence during the follow-up period: 3 with peritoneal dissemination and 2 with lymph node metastases. There were significant differences in recurrence-free survival and overall survival between the peritoneal cytology-negative and cytology-positive groups (log-rank p<0.001). Multivariate analysis of prognosis in cervical cancer revealed that peritoneal cytology (p=0.029) and histological type (p=0.004) were independent prognostic factors. CONCLUSION: Positive peritoneal cytology may be associated with a poor prognosis in adenocarcinoma or adenosquamous carcinoma of the uterine cervix. Therefore, the results of peritoneal cytology must be considered in postoperative treatment planning.
Adenocarcinoma ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; Prognosis* ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms*

OBJECTIVE: The concept of platinum sensitivity and cross-resistance among platinum agents are widely known in the management of recurrent ovarian cancer. The aim of this study was to evaluate two hypotheses regarding the validity of the concept of platinum sensitivity and non-cross-resistance of cisplatin analogue with cisplatin in recurrent cervical cancer. METHODS: In this retrospective study, the clinical data of patients with recurrent cervical cancer, who had a history of receiving cisplatin based chemotherapy (including concurrent chemoradiotherapy [CCRT] with cisplatin) and who received second-line chemotherapy at the time of recurrence between April 2004 and July 2012 were reviewed. RESULTS: In total, 49 patients-34 squamous cell carcinomas (69.4%) and 15 non-squamous cell carcinomas (30.6%)-were enrolled. The median age was 53 years (range, 26 to 79 years). Univariate and multivariate analysis showed that a platinum free interval (PFI) of 12 months has a strong relationship with the response rate to second-line chemotherapy. Upon multivariate analysis of survival after second-line platinum-based chemotherapy, a PFI of 12 months significantly influenced both progression-free survival (hazard ratio [HR], 0.349; 95% confidence interval [CI], 0.140 to 0.871; p=0.024) and overall survival (HR, 0.322; 95% CI, 0.123 to 0.842; p=0.021). In patients with a PFI of less than 6 months, the difference of progression-free survival between patients with re-administration of cisplatin (3.0 months) and administration of cisplatin analogue (7.2 months) as second-line chemotherapy was statistically significant (p=0.049, log-rank test). CONCLUSION: The concept of platinum sensitivity could be applied to recurrent cervical cancer and there is a possibility of noncross-resistance of cisplatin analogue with cisplatin.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Carboplatin/administration & dosage ; Carcinoma, Squamous Cell/*drug therapy/mortality ; Cisplatin/administration & dosage/*analogs & derivatives ; Drug Resistance, Neoplasm ; Female ; Humans ; Kaplan-Meier Estimate ; Middle Aged ; Neoplasm Recurrence, Local/*drug therapy ; Organoplatinum Compounds/administration & dosage ; Retreatment ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/*drug therapy/mortality

Palmoplantar pustulosis is a chronic inflammatory skin disease involving the palms and soles where mild accumulation of helper T cells and neutrophils in the dermis histologically are observed. Leukoencephalopathy is a brain disease affecting white matter but is rarely accompanied by skin lesion. Here we report a unique case of leukoencephalopathy accompanied by palmoplantar pustulosis with identical pathological feature of helper T cell accumulation in both the brain and skin, suggesting a possible link in the pathogenesis.

A fungal carotid aneurysm is an infrequently occurring infectious aneurysm that is usually treated by antifungal therapy plus surgical debridement of the infected vessel. We herein report an extremely rare case involving a patient with a medical history of bladder cancer treated by Bacillus Calmette– Guérin (BCG) who developed a fungal aneurysm of the internal carotid artery and thrombosis of the superior ophthalmic vein caused by maxillary Aspergillus sinusitis. The patient was successfully treated by antifungal, anticoagulant, and antiplatelet drugs combined with internal carotid artery ligation therapy. Internal carotid artery fungal aneurysm is associated with a high mortality rate, but the present case suggests that it can be successfully treated by antifungal therapy combined with a less invasive endovascular therapy.