[Objective]It is important for students to learn in school education how to prevent medical accidents caused by deep insertion of a needle. Also, it is essential in safe acupuncture treatment that students are always reminded there are individual variations in subcutaneous structure and to confirm the position of the needle tip in the subcutaneous tissue. To recognize the acupuncture needle tip, muscle twitch induced by electrical stimulation through the acupuncture needle tip was felt with fingers of training students.
[Methods]To prevent accidental pneumothorax, acupuncture training was performed in the upper and lower extremities. After the class, we conducted a questionnaire investigation with the students.
[Result]As the result, students realized that the position of the needle tip which they assumed is different from the real position in subcutaneous tissue.
[Discussion]Without knowing the precise position of the acupuncture needle tip, a desirable effect is not provided, and furthermore, a medical accident may be caused. It is important to confirm the position of the acupuncture needle tip with consideration to individual variation for safe and effective acupuncture treatment.
[Conclusion]We concluded that the skill to prick and insert the acupuncture needle to the correct position is so important in preventing medical accidents that training to learn correct needle tip position should be given in acupuncture education.

We studied the appearance of pleural effusion and inflammatory reactions after endovascular grafting in cases of aortic dissection. From December 1995 to January 2000, 16 patients with chronic double-barrel type aortic dissection (DeBakey type III b) were treated by endovascular grafting. In all cases, enhanced computed tomography (CT) of the chest was examined before operation and at about the 7th postoperative day (POD). Patients were divided into 3 groups. Group P: patients who had pleural effusion before the operation. Group E: patients who had new pleural effusion after the operation. Group N: patients who did not have any pleural effusion. In each group, onset of dissection, patient's age, maximum diameter of dissecting aorta, period of postoperative fever (above 37.0°C), and WBC counts and CRP value at POD 1, 3, 7 and 14 were compared. Four patients were in group P, 4 patients were in group F, and 8 patients were in group N. Period between onset and operation was 41.6±34.6 months in group P, 18.2±27.3 months in group E and 7.3±11.6 months in group N. There was no relation between the effusion and the period after onset. Postoperative fever continued for 5.0±2.0 days in group P, 13.5±2.6 days in group E and 2.5±0.3 days in group N. The period of fever of group E was significantly longer than in group N and P (p<0.01). WBC showed a peak on the first POD in each group. CRP showed a peak value on POD 3 in group P and N. There was no significance among the 3 groups about WBC and CRP, but group E showed slightly high CRP values on POD 7 and 14. No patient had complications regarding respiratory function. After endovascular grafting for aortic dissection, postoperative pleural effusion appeared in 25% of patients. They had prolonged postoperative fever, but there was no respiratory function complication. Endovascular grafting is a minimally invasive procedure with regard to respiratory function.

A 40-year-old man was admitted because of prolonged fever after extraction of teeth. Infective endocarditis, congestive heart failure and hepatorenal failure were diagnosed in a series of examinations. Electrocardiograms showed complete atrio-ventricular block and QT prolongation. After continuous hemodiafiltration (CHDF) and high doses of antimicrobials promptly initiated for the treatment of multiple organ failure, the aortic valve with regurgitation and vegetation was replaced with an artificial valve. Serious arrhythmias occurred after the operation, which disappeared by the administration of antiarrhythmic agents. In cases of infective endocarditis with multiple organ failure, preoperative intensive treatment such as CHDF in combination with high doses of antimicrobials and surgical intervention represent a good strategy for successful outcome.

The method of cardioplegic myocardial protection is often controversial for re-cardiotomy after a coronary artery bypass grafting (CABG). A 69-year-old woman with a history of three previous surgeries consisting of closed mitral commissurotomy (CMC), dual valve replacement (DVR), and CABG underwent mitral valve replacement (MVR) and CABG for perivalvular leakage (PVL). As a result, the bilateral coronary ostium and the bypass graft to the right coronary artery (RCA) were totally occluded. The left internal thoracic artery (LITA) graft to the left anterior descending (LAD) coronary artery was the only inflow to the left coronary artery system and the right coronary artery system developed collateral inflow. Cardioplegia was carried out by performing a temporary anastomosis graft on the saphenous vein graft (SVG) in the left anterior descending coronary artery and a new bypass graft in the RCA was used for the administration of cardioplegic solution with no complications. There are various strategies for cardioplegic myocardial protection. The best method should be selected depending on the patient characteristics and condition.

A patient, an adultJapanese traveler who had just returned from Thailand, had developed denguehemorrhagic fever (DHF). A primary infection of dengue virus (DENV) wasconfirmed, in particular, DENV serotype 2 (DENV-2) via the detection of the virusgenome, a significant increase in its specific neutralizing antibody and the isolationof DENV-2. DHF is often observed following a secondary infection from another serotypeof dengue virus, particularly in children, but this case was a primaryinfection of DENV. Japan is a non-endemic country of dengue disease. Instead,only Japanese encephalitis (JE) is known to be an endemic flavivirus family. Inthis study, IgG antibody against Japanese encephalitis virus (JEV) was detected.JEV belongs to the family of dengue virus and prevails in Japan, particularly inKyushu. Among many risk factors for the occurrence of DHF, a plausiblecandidate could be a cross-reactive antibody-dependent enhancement (ADE)mechanism by JEV antibody. This indicates that most Japanese travelers, wholive in non-endemic areas of dengue, particularly in Kyushu, should payattention to the occurrence of DHF.

Introduction: The regional palliative care support center (PCSC) has set the following palliative care goals for correction of misunderstanding and prejudice of the general community against palliative care, home care and home death of cancer patients: practice palliative care early after diagnosis, educate the community to understand palliative care and build a regional palliative care cooperation system. Method: This study reviewed four years (2009-2012) of data from the PCSC. Outcome data of the patients were collected during outpatient care, inpatient care, and in-home care that were supported by the PCSC. The PCSC managed palliative care based on patient conditions and symptoms in the early stage after diagnosis. The PCSC worked to spread the idea and importance of palliative care to the general community and health care professionals of the region, and also worked to promote the regional palliative care cooperation. Result: These efforts led to an increase in the number of first center visit of patients, especially introduction patients, and an extension of the period of treatments of both tumor department and palliative care department. These outcomes resulted in an increase in the rate of in-home care transitions, the length of in-home care and the number of deaths at home. These results suggest that the place of appropriate medical and caregiving treatments and the place of death are converting into home gradually from hospital.

Medical students at Kurume University begin practical training in clinical skills in their fourth year. At that time, students use the skills laboratory to improve their clinical skills. Medical education resources in the skills laboratory include simulators for emergency resuscitation and heart diseases, wireless stethoscopes, and videotapes. All students use the skills laboratory for 2 months, and its usefulness was evaluated with questionnaires after practical training. More than 50 % of students approved of their practice in the skills laboratory. However, some students were unsatisfied because they were unable to make effective use of the simulators. In the future, an improved skills laboratory will be necessary to improve practical training in the clinical skills for medical students.

OBJECTIVETo examine the effectiveness of a drug abuse prevention program focusing on social influences for drug education classes in high school.

METHODSThe social influence program in the experimental group used role-playing led by a pharmacist, a police officer and a teacher. The intervention evaluation used a quasi-experimental design. The subjects were first-year students from 10 high schools assigned to the experimental group (6 schools, 828 students) and the control group (4 schools, 408 students). In the control group, a pharmacist used a conventional information program in a lecture format.

RESULTSRegarding knowledge about drug abuse, in both the experimental and control groups, and for both males and females, a long-term effect was observed immediately after the program and lasted up to 15 months. For three other measures, attitudes toward drug abuse problem, self-efficacy regarding drug abuse prevention, and perception of social support for preventing drug abuse, a short-term effect was generally observed in the experimental group beginning immediately after the program and lasting for 3 months. A long-term effect was evident in high-risk students with positive opinions regarding drugs. In the control group and for both males and females, although an effect was generally evident immediately after the program, neither a short-nor a long-term effect was observed in males, suggesting the difficulty in achieving lasting effects.

CONCLUSIONSThe social influence program in the experimental group showed remarkable effectiveness. Thus, the program may be useful for preventing drug abuse among high school students in Japan.

Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.