Because recent changes in medical care security policy have made clinical skills training difficult, even in teaching hospitals, training with suitable models and simulators is becoming essential for medical students to acquire clinical skills. On the basis of these changes, we performed a nationwide survey on the prevalence and application of clinical skills laboratories for clerkships in Japan. Registered questionnaires were sent to all medical schools in Japan （n＝80） in December 2012. The response forms were filled out by clinical instructors and by the staff responsible for the skills laboratory. The response rate was 94% （75 of 80 schools）. Seventy-one schools （95%） have already installed clinical skills laboratory; however, floor area and availability varied greatly among schools. Floor space ranged from 24 to 2,250 m2 （median, 214 m2）. The number of uses of the facility by medical students in the 2011 school year ranged from less than 100 to more than 10,000 （median, 1,402）. Forty-two schools （59%） had a resident director for the skills laboratory. Simulators of most universities （> 90%） were venopuncture simulators, lung-sound simulators, basic life support mannequins, heart-sound simulators, surgical suture trainers, and automated external defibrillator trainers, and all were frequently used. These results suggest considerable differences among schools in simulation-based learning environments during clinical clerkships. Although most medical schools in Japan have their own clinical skills laboratories, their size, service, and frequency of use vary greatly.

To accurately assess the clinical competencies of medical students at Fukushima Medical University, we have developed a novel online self–assessment system, which covers all goals in the "Model Core Curriculum for Medical Education in Japan." We added "Emergency," "Communication skills with staff," and "Simulation–based learning." Following their clinical clerkships, 79 sixth–year medical students assessed themselves and their clinical clerkships.
1)This novel online self–assessment system, consisting of 68 checklists in 15 fields, easily informs us of the actual conditions of clinical clerkships and students' confidence in their clinical competencies.
2)This internet–based self–assessment system revealed the current status and problems of clinical clerkships, prompting feedback to clinical instructors and members of the instruction committee.
3)Students felt "confident" or "confident to a certain degree" in most learning areas; however, simulation–based learning seems to be necessary in several areas, such as clinical skills, where feelings of shame or discomfort may be associated with patient care.
4)Students who had high total self–assessment scores evaluated clinical clerkships favorably. In contrast, students whose self–assessments frequently included "no learning experience" evaluated their clerkships negatively in the educational aspects of "skill" and "attitude."

To investigate the effects of generational factors on the lives of medical students in the first and second years, we surveyed students about the frequency of problems and the seeking of advice.1) A questionnaire was distributed to first- and second-year students in January 2009 asking about problems regarding academic work, mental health, financial concerns, career options, physical wellness, and interpersonal relationships.2) About 70% of the students had sought advice regarding academic work and interpersonal relationships. Also, about 50% had sought advice regarding mental health.3) Students chose potential advisors depending on the type of problem; however, they preferred to consult with their classmates and upperclassmen. In addition, their parents played a role. In contrast, students rarely consulted with teachers.4) High percentages of first- and second-year medical students had various problems. Creating a support system to address these problems is important.

OBJECTIVEThe aims of this study were to determine the effects of heavy metals such as manganese on nicotinamideN-methyltransferase (EC 2.1.1.1) (NNMT) activity and to consider the possibility of involvement of NNMT activation in the pathogenesis of heavy metal induced Parkinson's disease.

METHODSNNMT activity in supernatants separated from brain, liver and kidney homogenates of 5 elderly male Wistar rats by centrifugation were measured by high performance liquid chromatography system with fluorescence. NNMT activity under the conditon of 0.5 or 5.0 mM Mn(2+), Fe(2+), Cu(2+) or Cd(2+) was compared with control (no metal ion existence).

RESULTSNNMT activities in rat brain, liver and kidneys were significantly decreased by Cu(2+), and those in the liver and kidneys were significantly decreased by Cd(2+). Mn(2+) reduced NNMT activity only in the liver. Fe(2+) had no effect on NNMT activity.

CONCLUSIONSNo metal increased NNMT activity in this study, contrary to our hypothesis. Further study is needed to clarify the reason why the effects of Mn(2+) and Fe(2+) which have a high relevance to Parkinson's disease on NNMT activity differ from those of Cu(2+) and Cd(2+).

Fatigue is a common symptom of long COVID. Fatigue can majorly disrupt daily life and be challenging to treat. Herein, we describe the effect of saikokeishito, a Kampo medicine, on fatigue in patients with long COVID.Between October 2020 and March 2023, we prescribed saikokeishito to 22 patients with long COVID in the general medicine outpatient department of our hospital. Among them, seven patients (age: 15-58 years, two females) had fatigue, a previously confirmed diagnosis of COVID-19, and no concomitant use of other Kampo formulas. We compared their condition at the start of saikokeishito administration to that 3 months later. Five patients had a slight fever, and four had inflammatory findings on blood tests. Within 3 months, all patients had a 20% or greater reduction in fatigue on a visual analogue scale. Six patients had a 20% or greater increase in health-related QOL and were able to return to society. On the other hand, one patient required a transition to an alternative medication, and one patient's follow-up was prematurely discontinued. Fatigue after COVID-19 may be improved by saikokeishito, especially for the treatment of patients with slight fever or inflammatory findings.

Background: With the expanding use of social media, medical students have been posting an increasing amount of content that against ethics and professionalism.　Objective: To develop a checklist for social media use within medical education based on our national survey.　Methods: We analyzed and classified unprofessional behaviors that occurred over the past ten years in Japan. Then, we developed an event-based checklist for the use of social media use.　Result: The behaviors violating ethics and professionalism were classified into 3 categories. We have developed a social media checklist consisting of 10 items.　Discussion: Since social networking services are becoming vital information technology, every medical student or professional may risk unprofessional behaviors when they post or exchange any professional information. We propose appropriate education using an event-based checklist for social media usage.

The patient was a 52-year-old woman who had undergone laparoscopic colectomy with lymph node dissection and inferior mesenteric artery preservation for cancer of the descending colon. Functional end-to-end anastomosis was performed using a linear stapler. Colonoscopy at the 1-year follow-up revealed a type 2 tumor at the anastomotic site. She was diagnosed with anastomotic recurrence. We performed laparoscopic high anterior resection with inferior mesenteric artery dissection. Rectal resection preceded mobilization of the mesocolon because of severe adhesion around the anastomotic site. Laparoscopic surgery for anastomotic site recurrence is an option under the condition that the initial surgery was laparoscopic.

Introduction: To implement effective medical education, it is important to clarify the process of recognizing and comprehending medical terms.　Methods: We conducted a questionnaire survey of 492 first- to fifth-year medical students to evaluate the recognition and comprehension rates of 57 medical terms in each grade. The terms were classified using the hierarchical cluster analysis based on the recognition and comprehension rates.　Results: The response rate was 91.1% (n=448). The 57 terms were classified into the following five clusters: #1, 30 terms that the students recognized and comprehended from Y1; #2, 18 terms that the students recognized from Y1 and comprehended as the grade increased; #3, six terms that the students recognized and comprehended as the grade increased; #4, two terms that the students recognized from Y1 but had not comprehended even in upper grades; #5, one term that the students recognized as the grade increased but had not comprehended even in Y5.　Discussion: Teachers may need to devise educational strategies while considering different patterns of students’ recognition and comprehension of medical terms.

The purpose of this study was to compare the results of open surgery and laparoscopic surgery for acute appendicitis in adults. In 2013, we primarily selected open surgery for acute appendicitis, but in 2017 we opted to select mainly laparoscopic surgery. We compared between 92 patients who had undergone open surgery in 2013 and 88 patients who underwent laparoscopic surgery group in 2017. There was no difference in age, sex, body mass index, white blood cell count, C-reactive protein, or perforation rate on computed tomography between the two groups. The laparoscopic surgery group had significantly longer operation time but significantly lower blood loss and postoperative complication rate. In particular, laparoscopic surgery was advantageous in terms of hemostasis for moderate bleeding. The results suggest that laparoscopic surgery may be more useful in adult appendicitis than open surgery.