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.

A 53-year-old woman with atrial septal defect (ASD) and atrial fibrillation (AF) with idiopathic thrombocytopenic purpura (ITP), was scheduled to undergo ASD closure and the maze procedure. Because steroid therapy was not effective, high-dose γ-globulin administration (400mg/kg/day) was performed for 5 days before surgery. The platelet count increased from 5.4×10⁴/mm³ to 14.0×1⁴/mm³. ASD patch closure and modified bilateral appendage preserving (BAP) maze procedure were performed. No hemorrhagic tendency was recognized. The postoperative course was uneventful, and the sinus rhythm was recovered. The maze procedure become possible in this ITP patient with preoperative administration of high-dose γ-globulin.

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

The pain eliminating effects of electroacupuncture have long been known however the analgesic mechanism involved has yet to be clarified. Recently with the discovery of endogenous analgesic peptids called endorphins much attention has been called to the relationship of these endorphins and the acupuncture analgesic effect. We examined to determine how electroacupuncture influences lumbar CSF endorphins and the so-called pain transmitting substance, Substance P.
In order to establish continuous lumbar anesthesia using tetracaine for 8 patients with gynecological lower abdominal diseases, a Tuohy needle was inserted from the lumbar area and a catheter inserted into the subarachnoidal space. In each case at the time of the insertion of the catheter 5ml. CSF was tapped. As pre-medication 0.01mg/kg. atropine sulfate, 2mg/kg secobarbiturate were administered. To maintain the analgesic effect hyperbaric or hypobaric tetracaine was administered according to individaul needs. For hypotension during the operations a plasma expander and when necessary ephedrine were administered by intramuscular or intravenous injection.
Immediately following the start of surgery acupuncture needles were inserted at right and left LI-4 and electrical stimulation at 3c/s, 1.0mA was administered for 50-120 minutes using the acupuncture therapy apparatus “TOKKI”. when the operation was finished, after 5ml. of CSF was again tapped through the catheter, the catheter was withdrawn as far as the subdural space and 20-40ml. physiological saline injected to combat the headache due to spinal fluid leakage. The test substance was immediately transferred to a siliconized test tube and cooled to a temperature of-80°C.
The RIA methods were used for the measurement of both endorphins and substance P. The crossover reaction between the β-endorphin and the βLPH was 50%. (Using the β-endorphin measuring kit manufactured by NEN).
The results in 7 of 8 examples showed a significant increase in CSF endorphins after electroacupuncture. It also became clear that there was a tendency for substance P levels to decrease due to electroacupuncture.

    Clinical research is essential for the practice of evidence-based medicine. This study reports on our current practice of clinical research support in Mito Kyodo General Hospital and discusses future challenges. In April 2013, the University of Tsukuba hired a clinical research assistant to provide clinical research support in Mito Kyodo General Hospital. The clinical research assistant worked full-time in the hospital in collaboration with 3 university faculty members. The target population for this study comprised 450 medical personnel including doctors, nurses, and other medical staff. From April 2014, 1 of the 3 faculty members visited the hospital once a month to offer clinical research consultations and deliver a lecture on nursing research. We analyzed past records of clinical research support and conducted a questionnaire survey to explore the level of satisfaction of the medical personnel. Four-hundred and ninety records of 91 research topics proposed by 68 medical personnel were identified. Of these, 93.4% were proposed by doctors or nurses. Most studies employed an observational study design (64.8%) and were conducted in order to make a presentation at an academic conference (51.1%). The consultation sessions were held 1–5 times, for 40–405 min, and lasted from 1–84 days per research topic. Consultations mostly pertained to research design and protocol planning (57.1%). Forty-seven clients were invited to participate in the questionnaire survey, 30 of whom provided valid responses. The results showed that 96.6% of the clients were satisfied with the consultations. The number of clients who participated in the consultations comprised only 15.1% of the target population. These practice biases need to be addressed in future. However, nearly all respondents were satisfied with the consultations. These findings suggest that our clinical research support was beneficial to medical personnel.

From a point of stress, the competitive sports are totally different from exercises for the health promotion. It would be even harmful especially for middle-distance or long-distance women runner. It brings them paramenia, defatigation and other orthopedic troubles which makes them unable to exercise further more.We have investigated the possibility of the preventive use of Kampo Medicine for those athletes and found that it is useful. The nine women who belong to the Tohoku-Region women team of long-distance relay road race had received Kampo medical treatment for 7 months. Serum CPK and AST were elevated with training exercise. In the cases whose CPK level was above 500 IU/l, most of them suffered from fatigue, leg pain, low back pain, and lower abdominal pain, which is very important for Kampo diagnosis. Because these symptoms unable athletes to exercise as planned, we understand that for the improvement of physical capacity, it is important to prevent those symptoms. For the treatment and prevention of the symptoms, we prescribed Keishibukuryogan, Rikkunshito, and Shimotsuto. We defined preventive medication period as “Mibyou” and continued to use Kampo medicine for 7 months. During the period, they were free from any troubles that would make them unable to exercise. These medicines enabled them to improve their records drastically. This study shows that preventive use of Kampo Medicine is extremely effective for any athletes to maintain their good conditions.
Medicine, Kampo ; athlete ; Exercise ; symptoms <1> ; Human Females

A 25-year-old man was admitted with high fever and heart murmur. Echocardiogram showed left ventricular chamber dilatation and vegetations attached to the aortic valve. Blood cultures obtained on admission revealed Streptococcus viridans. Despite adequate antibiotic therapy, congestive heart failure progressively worsened and large splenic abscesses were detected by computed tomography. Urgent aortic valve replacement and splenectomy were performed. The aortic valve was bicuspid and markedly destroyed. Pathology of the spleen showed findings consistent with large infarct and abscesses due to septic emboli. The postoperative course was uneventful.

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.

We controlled the hemodilution and electrolyte levels during coronary artery revascularization in chronic hemodialysis patients by hemofiltration during the period of extracorporeal circulation. Subjects comprised 7 chronic hemodialysis patients (males, average age 53) undergoing coronary artery revascularization in our department from January 1988 to December 1989. All patients had been undergoing hemodialysis for chronic renal failure and in one patient, after admission, continuous ambulatory peritoneal dialysis (CAPD) was additionally performed. During surgery, the dialyzer was equipped with an extracorporeal circulation circuit and the electrolyte level and hemodilution were adjusted using transfusion (1, 270±372ml). A large infusion volume (12, 657± 3, 966ml) was maintained and removal of water was carried out by ultrafiltration. After surgery, all patients underwent hemodialysis twice or more by the 3rd day of recovery. Concentrations of electrolytes were maintained at appropriate levels throughout the day of surgery except for one case of postoperative hypokalemia, but no marked changes in hemodynamics were observed during and after surgery. Hemofiltration during extracorporeal circulation is safe and useful in coronary surgery because it is simpler and requires less time than hemodialysis.

A 12-year-old girl had relative graft stenosis following the reconstruction of type A interrupted aortic arch. At 25 days after birth she underwent ascending aorta-descending aorta bypass with a 7mm knitted Dacron graft, ligation of the patent ductus arteriosus and pulmonary artery banding. She had patch closure of a ventricular septal defect (VSD) as well at 20 months of age. At age 12 catheterization was carried out, because she had headache and dizziness on exertion. The pressure of the ascending aorta was 163/79mmHg and the pressure gradient between the ascending and the descending aorta was 65mmHg. Aortography revealed severe stenosis of the graft, which might have occurred according to her growth. An extra-anatomic bypass was placed between the right axillary and the right common iliac artery through the intrapleural and preperitoneal route with a 10mm Dacron graft. Six months later, the blood pressure was 108/63mmHg in the upper extremities, the pressure gradient between the upper and lower extremities was reduced to 18mmHg, and headache and dizziness had disappeared.