Because of the rapid progress in genetic research, only a small part of what is known about clinical genetics is taught in medical schools. At Nippon Medical School a clinical genetics course for fourth-year students started in October 2002. In the present study, we used a questionnaire to investigate how well second-year medical school students understand clinical genetics. The results of the questionnaire suggested that many students are confused about basic concepts in clinical genetics, such as the differences between inherited disease and diseased caused by genetic disorders and between hereditary and chromosomal disorders and also suggested that education in clinical genetics is needed in medical schools. In the United States, guidelines for teaching genetics in medical schools have been established. However, in Japan, considering the lack of consensus about medical genetics terminology, to disseminate correct knowledge about clinical genetics, the present situation of medical genetics education in medical schools must be clarified, and various other measures, such as establishing what information should be taught, should be carried out.

Our present study investigated DNA sequence analysis of Human Papillomavirus (HPV) typc-33 in sexually active women. In present study 22 HPV-33 positive Endocervical specimens were obtained by use of Polymerase Chain Reaction (PCR), from total 500 participants, and further analyzed by DNA sequencing of the Long Control Region (LCR), E6 and E7 genes. For the genes LCR and E6 13 samples, for the gene E7 all 22 HPV-33 positive samples were sequenced by Applied Biosystcms. All 22 HPV-33 positive participants were Mongolian nationality. Most common Non-prototype-Likc variant in LCR is HPV-33 LCR-17 (11/13). one HPV-33 LCR-5 (1/13), and only one Prototype was found (1/13). In the E6, 12 samples were variant 33-E6-6 (12/13), and one prototype was found. lntheE7, 13 Prototype (13/22), 11 Non-prototype-Like variants were found. From the sequence result of gene sites in LCR, E6 and E7 most common HPV-33 variant in Mongolia is MN-17-6-0 (10/13), HPV-33 MN-0-6-0 (1/13), HPV-33 MN-5-6-0 (1/13) and one Montreal variant were found HPV-33 MT-17-0-0 (1/13). We identified 3 new variants of 11PV-33 which we called MN (Mongolia). From sequence result in 3 sites of genes, LCR is more variable compare with E6 and E7. F.6 were variable compare with E7. ' ' Health Sciences University of Mongolia, Ulaanhaatar, Mongolia 4,6 Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo. Japan

It has been demonstrated that excellent athletes usually have, not only a higher exercise capacity but also higher ability to maintain equilibrium which is important for assuming the various body postures required in different sports. It is thought that a method of training which enhances the sense of equilibrium will also increase the ability to perform certain of sports.
Many sensory organs and the central nervous system, which integrates these organs, are integrated to the maintenance of equilibrium. To maintain equilibrium, vestibular, visual and bathyesthetic inputs are integrated centrally (in the brainstem, cerebellum, etc.) and necessary commands are other tissues.
A series of studies which we performed demonstrated that the ability to maintain equilibrium was lower in individuals with imbalanced occlusion than in individuals with normal occlusion.
Imbalanced occlusion can be corrected by the appropriate use of rejin sprints. We recently examined the effects of such sprints on the equilibrium of athletes with imbalanced occlusion, using a gravity fluctuation analyzer. In this study, we raised the bite only within the amount of existing free way spce.
From these results, gravity fluctuation in athletes with imbalanced occlusion was greater than that in individuals with normal occlusion.However, when imbalanced occlusion was corrected by the use of rejin sprints, gravity fluctuation tended to decrease.
It these findings from the present study are combined with the knowledge that the exercise capacity of athletes has a positive correlation with their equilibrium maintenance ability. It appears that correction of imbalanced occlusion and the appropriate use of mouth protectors would contri-bute to improving the performance of athletes.

We report on three RA patients successfully treated with Yokuinin-to-ka-kyokatsu-dokkatsu-bofu (Yokuinin-to-kami). The first patient was a 47-year-old woman. In 1983, she visited a nearby hospital due to bilateral wrist joint pain. Her condition was diagnosed as RA. She was treated with gold sodium thiomalate (GST) and non-steroidal anti-inflammatory drugs (NSAIDs), but her symptoms did not improve. She visited our department in 1989. She was treated with Keishi-ka-ryojutsubu-to, Bushi-to which resulted in decreased arthralgia. However, in September 1995, her condition worsened. Administration of Yokuinin-to-kami improved her symptoms as well as her laboratory data after three months of treatment. The second patient was a 50-year-old woman. In 1986, she visited a nearby hospital with bilateral wrist joint pain. Several Kampo formulas were subsequently administered at a pharmacy. In 1991, she visited our hospital and her condition improved after treatment with Keishi-ka-ryojutsu-to-ka-boi-ogi-yokuinin. However, in May 1996, she complained of severe pain and swelling at the right shoulder joint. Treatment with Yokuinin-to-kami improved her symptoms, as well as decreased serum C-reactive protein (CRP). The third case involved a 42-year-old woman who exhibited polyarthralgia in June 1991. She visited a neighborhood hospital and was diagnosed as having RA. She was treated with NSAIDs and bucillamine. She first visited our hospital in1993. We treated her with Keishi-ni-eppi-itto-ka-ryojutsubu and Keishi-shakuyaku-timo-to, but the polyarthralgia worsened in May 1996. Subsequently, we treated her with Yokuinin-to-kami which resulted in improvement symptoms, as well as decreased serum CRP.
To identify the target group for Yokuinin-to-kami, we further analyzed the characteristics of the patients successfully treated with this formula. Yokuinin-to-kami was administered to nine patients with RA, and the symptoms in five patients improved, but the remaining patients did not respond. The score of stasis of body fluids and deficiency of blood was not considerably different between the two groups. Interestingly, there was a difference in the variation of joint symptoms throughout the day. Namely, the successfully treated patients complained of joint symptom in the evening more than in the morning. These observations suggest that Yokuinin-to-kami is a useful agent for the treatment of a subset of patients with RA, and that joint pain in the evening might be an indicator for this treatment.

We treated two patients with rheumatoid arthritis (RA) who demonstrated different signs from the perspective of traditional medicine. The first case was a 73-year-old woman. In 1977, she consulted a nearby hospital due to bilateral knee joint pain. Her condition was diagnosed as RA. In 1984, she consulted our department for Stage IV and Class III disease. She was treated with Keishi-ni-eppi-itto-ka-ryojutsubu-kagen, and her condition stabilized. In 1994, she received total replacement of the bilateral knee joints. Her ADL increased, but pain at her bilateral wrist, elbow, shoulder and ankle joints persisted. Although she was treated with Yokuininto, as well as bucillamine and salazosulfapyridine, arthralgia persisted. In 1996, her condition was as follows: general malaise, pain at the bilateral shoulder and elbow joints, severe deformity at the wrist joints, dry skin and slender limbs. She walked with a cane. Therefore, we changed the formula from Keishi-shakuyaku-chimoto to Daibofu-to. Thereafter, her symptoms significantly decreased. The second case was a 50-year-old woman. In 1994, she suffered from pain in the right hand, bilateral feet and knee joints. Her condition was diagnosed as RA at a local hospital. In 1996, polyarthralgia increased and she consulted the department of orthopaedic surgery in our hospital. She was administrated bucillamine, but it was discontinued due to eruptions. Then she consulted our department. She was first treated with Keishi-ni-eppi-itto-ka-ryojutsubu, and then with Yokuininto, which did not change her symptoms. Therefore, we tried several DMARDs; however, her condition worsened. In June 2000, her laboratory data were as follows: RF 860U/ml, ESR 72mm/hr, CRP 4.0mg/dl. Although she complained of pain at the bilateral wrist, elbow and ankle joints, there was no deformity in the bilateral wrist or finger joints of either hand. She was a medium-sized person, and without dry skin or edema at the limbs. The administration of Daibofu-to improved her symptoms as well as laboratory data after 3 months of treatment.
The clinical signs of case 1 were in accordance with the traditional indications for Daibofu-to. In contrast, those of case 2 differed from these indications with regard to blood-deficiency, since there was no dry skin, change in the nail, dizziness or deformity of the joints. These observations suggest that a subset of patients with RA, who have poor deficiency of blood or Ki, may be another population that can be successfully treated with Daibofu-to.

Kumibinroto is a Kampo formulation which was first produced by Sohaku Asada (1815-1894) and which has since been used for patients with stasis of body fluids presenting beriberi like symptoms. Previously, we reported that tympanic sounds on right side of the abdomen might be an indication for the use of kumibinroto. In this study, having both symptoms with stasis of body fluids, and tympanic sounds on right side of the abdomen were used as a target when prescribing kumibinroto. To the best our knowledge, the present study was the first to demonstrate that the effects of kumibinroto give significant improvement in dermatological disorders such as chronic prurigo, cutaneous pruritis and chronic urticaria, and susceptibility to chills. These findings suggest that tympanic sounds on right side of the abdomen may an extremely useful indicator for kumibinroto, and position it for practical use for various disorders, for which it has not been formerly used.

Advances in genetic medicine has rapidly been applied to clinical practice. However, many medical students have not studied biology or genetics in high school. There is little chance to think in Japan medical education about how to treat genetic information appropriately in the setting of clinical medicine. The timing and contents of a clinical genetics education program in medical school has hardly been discussed in Japan. This paper discusses the clinical genetics educationduring the medical-science and clinical-medicine stages at Nippon Medical School.
1) An exercise on information gathering and role-play (for 180 minutes) about color vision deficiency were performed during the second-year molecular genetics course.
2) A clinical genetics course (45 minutes 18 classes) in the fourth year was started in 2002 as a part of an integrated medical curriculum with courses classified by organ system.
3) This clinical genetics course included systematic lectures for knowledge acquisition, lectures by patient support groups, exercises in drawing pedigrees, role-play, and discussions of ethical issues. Students evaluated this course favorably.
4) Some topics in clinical genetics can be effectively presented at an early stage of medical education as part of an introduction to medicine. To maximize the educational effects and increase the possibility that students understand the importance of medical genetics, clinical genetics education in medical school will be performed after the student have grasped a basic understanding of diseases through lectures about clinical subjects.

The left atrium and left atrial appendage have unique genetic anatomical and physiological features. Recently, advances in diagnostic imaging technology have provided much new knowledge. Clinically, the risk of developing atrial fibrillation increases with age. In order to reduce the public health burden such as cerebral infarction caused by atrial fibrillation, we need to find some predictive risk factors and preventive strategies for cerebral infarction and more effective treatments. The new concept of atrial myopathy has emerged, and animal models and human studies have revealed close interactions between atrial myopathy, atrial fibrillation, and stroke through various mechanisms. Structural and electrical remodeling such as fibrosis and deterioration of the balance of autonomic nerves and complicated interactions between these mechanisms lead to deterioration of atrial fibrillation and a continuous vicious cycle, and finally thrombosis in the left atrial appendage. Although anticoagulant therapy for patients with atrial fibrillation is strongly recommended, it is difficult for many patients to continue optimal treatment. In the nearly future, it will be important to understand the anatomy and physiology of the left atrial appendage and to understand the shape changes, size and the changes of autonomic function, and thrombus formation conditions associated with LAA remodeling during atrial fibrillation, and then we should provide early therapeutic intervention.

No abstract available.
Hemodynamics* ; Humans ; Infant*

No abstract available.