We three students of Saga Medical School visited medical centers in the United States and the United Kingdom as an elective course in the sixth year of medical education. One of us went to Sutter Medical Center, Santa Rosa, California, in the United States for 4 weeks, and two of us went to the University of Leicester in the United Kingdom for 4 weeks. These experiences led us to reconsider Japanese medical education, medical system, and hospital volunteers from different points of view.

 This cross-sectional study examined cigarette smoking knowledge, attitudes, and practices among medical students in a southwestern region of China. The subjects included 557 and 223 first and fourth year Chinese medical students, respectively. Comparison data were collected from 74 Japanese and 90 Vietnamese fourth year medical students. The smoking rate among the fourth year medical students in China (7.0%) was significantly higher than among the first year medical students (2.8%), and higher than among the medical students from Vietnam, but lower than the medical students from Japan. The fourth year Chinese students had a more permissive attitude toward cigarette smoking by physicians compared with the first year students, and the lowest knowledge base on cigarette smoking-related diseases among the students from all three countries. Based on a multivariate analysis, the factors associated with cigarette smoking were male gender, having friends who smoked, and exhibiting a permissive attitude toward smoking. Implementations aimed at improving tobacco education and addressing the gender differences and peer influences related to cigarette smoking are needed to improve Chinese medical students’ knowledge and attitudes about cigarette smoking, and to prevent students from starting to smoke cigarettes.

OBJECTIVESWe have attempted to upgrade and validate an in-house cDNA microarray system developed by our group for the evaluation of chemical toxicity.

METHODSTo establish an in-house microarray, we selected genes that play pivotal roles in detoxifying exogenous substances and maintaining homeostasis in the liver. To validate the system, we examined gene expression profiles in mouse liver following treatment with different doses of carbon tetrachloride (CCl(4)). The data were also analyzed by pathway analysis tools.

RESULTSWe upgraded our array system by collecting genes that are responsive to xenobiotic receptors, apoptosis-related genes, and stress-responsive genes. The acute toxicity of CCl(4) was confirmed by elevated levels of serum transaminase and histopathological findings. The microarray data showed the CCl(4) treatment induced significant changes in gene expression in the mouse liver, and the ingenuity pathways analysis revealed alterations in gene expression in inflammation-related networks.

CONCLUSIONSWe have established a focused microarray system that may be useful for use in toxicogenomics studies. Using this array system, we gained insight into the mechanisms by which CCl(4) exerts its toxic effects. The results of our study also indicate that the combination of focused arrays and bioinformatics tools is helpful in the mechanistic analysis of chemical toxicity.

BACKGROUND: Continuous glucose monitoring (CGM) is reported to be a useful technique, but difficult or inconvenient for some patients and institutions. We are developing a glucose area under the curve (AUC) monitoring system without blood sampling using a minimally invasive interstitial fluid extraction technology (MIET). Here we evaluated the accuracy of interstitial fluid glucose (IG) AUC measured by MIET in patients with diabetes for an extended time interval and the potency of detecting hyperglycemia using CGM data as a reference. METHODS: Thirty-eight inpatients with diabetes undergoing CGM were enrolled. MIET comprised a pretreatment step using a plastic microneedle array and glucose accumulation step with a hydrogel patch, which was placed on two sites from 9:00 AM to 5:00 PM or from 10:00 PM to 6:00 AM. IG AUC was calculated by accumulated glucose extracted by hydrogel patches using sodium ion as standard. RESULTS: A significant correlation was observed between the predicted AUC by MIET and CGM in daytime (r=0.76) and nighttime (r=0.82). The optimal cutoff for the IG AUC value of MIET to predict hyperglycemia over 200 mg/dL measured by CGM for 8 hours was 1,067.3 mg·hr/dL with 88.2% sensitivity and 81.5% specificity. CONCLUSION: We showed that 8-hour IG AUC levels using MIET were valuable in estimating the blood glucose AUC without blood sampling. The results also supported the concept of using this technique for evaluating glucose excursion and for screening hyperglycemia during 8 hours in patients with diabetes at any time of day.
Area Under Curve ; Blood Glucose ; Diabetes Mellitus ; Extracellular Fluid* ; Glucose* ; Humans ; Hydrogel ; Hyperglycemia ; Inpatients ; Mass Screening ; Plastics ; Sensitivity and Specificity ; Sodium

This study was undertaken to elucidate the usefulness and problems of autologous blooddonation for the patients with low-lying placenta. Seventy-eight women with low-lying placentawho gave birth in our institution were retrospectively analyzed. Autologous blood donation wasperformed in 58 patients (74%). The median volume of donated blood was 300 mL. Patients withor without autologous blood donation showed no significant difference in the distance betweenthe edge of the placenta and the internal os of the uterus. Median blood loss due to intrapartumhemorrhage was 1183 mL. All 7 patients with blood loss of more than 2000 mL had donatedautologous blood. The donated blood was transfused in 9 of the 58 patients (16%) who underwentautologous blood donation. No patients underwent allogenic blood transfusion. Althoughautologous blood donation was expected to be useful for avoiding allogenic blood transfusion inthese patients with low-lying placenta, the high discard rate suggests the need for a strategy toselect those patients at high risk for blood loss requiring transfusion.

Objective: This study sought to estimate the prevalence of erectile dysfunction (ED) and to ascertain risk factors among Vietnamese men with diabetes. Methodology: One hundred and fifty one diabetic patients were recruited from the People’s Hospital 115 between August 2011 and March 2012. They were asked to complete a self-administered questionnaire that included the International Index for Erectile Function Questionnaire (IIEF-5) and the World Health Organization (WHO) - Five Well-being Index. Medical history, anthropometric measures, and laboratory test results were recorded. ED was classified based on the IIEF-5 total score. Results: Of the 151 diabetic men, 135 (89%) completed the IIEF-5. The overall prevalence of ED was 84%; majority (65%) were classified as mild to moderate, while 10% were considered severe. The prevalence of ED was higher among those with peripheral neuropathy [adjusted odds ratio (OR) 5.22, 95% confidence interval (CI) 1.14-21.89] and longer duration of diabetes (OR 1.11, 95% CI 1.00-1.24). Conclusion ED represents a prevalent major complication among men with type 2 diabetes. The presence of peripheral neuropathy and long duration of diabetes may be useful indicators of ED.
Diabetes Mellitus ; Erectile Dysfunction ; Vietnam ; Peripheral Nervous System Diseases ; Surveys and Questionnaires

BACKGROUND: Slow-motion training, an exercise marked by extremely slow movements, yields a training effect like that of a highly intense training, even when the applied load is small. This study evaluated the effects of low-intensity bodyweight training with slow movement on motor function in frail, elderly patients. METHODS: Ninety-seven elderly men and women aged 65 years or older, whose level of nursing care was classified as either support required (1 and 2) or long-term care required (care level 1 and 2), volunteered to participate. Two facilities were used. Participants in the first facility used low-intensity bodyweight training with slow movement (the LST group, n = 65), and participants in another facility used machine training (the control group, n = 31). Exercises were conducted for 3 months, once or twice a week, depending on the required level of nursing care. Changes in motor function were examined. RESULTS: Post-exercise measurements showed significant improvements from the pre-exercise levels after 3 months, based on the results of the Timed Up and Go test (p = 0.0263) and chair-stand test (p = 0.0016) in the low-intensity exercise with slow movement and tonic force generation (LST) group. Although the ability to stand on one leg with eyes open tended to improve, no significant change was found (p = 0.0964). CONCLUSIONS: We confirmed that carrying out LST bodyweight training for 3 months led to improvements in ambulatory function and lower-limb muscle strength. In this way, it is possible that LST training performed by holding a bar or by staying seated on a chair contributes to improved motor function in elderly patients within a short time. TRIAL REGISTRATION UMIN000030853 . Registered 17 January 2018. (retrospectively registered).
Aged ; Aged, 80 and over ; Female ; Frail Elderly ; Humans ; Long-Term Care ; Male ; Motor Activity ; Movement ; Prospective Studies ; Resistance Training ; methods

The Tokyo 2020 Olympic and Paralympic Games (the Games) were held from 23 July to 5 September 2021 in Tokyo, Japan, after a 1-year delay due to the coronavirus disease (COVID-19) pandemic. The Tokyo Metropolitan Government was responsible for monitoring and responding to infectious disease outbreaks other than COVID-19 during the Games. A multi-source surveillance system was used from 1 July to 12 September 2021 for the early detection and rapid response to infectious diseases. This included routine notifiable disease surveillance, sentinel surveillance, syndromic surveillance, cluster surveillance, ambulance transfer surveillance and the Tokyo Infectious Alert system. Daily reports were disseminated summarizing the data collected from the multi-source surveillance system. No case of infectious disease under the Tokyo Metropolitan Government system required a response during the Games. The multi-source surveillance was useful for providing intelligence during the Games and, if required, could contribute to the early detection and rapid response to outbreaks during other mass gatherings. The system could be improved to overcome the challenges implied by the findings of this multi-source surveillance.

BACKGROUND: The gender-specific characteristics of individuals at an increased risk of developing depression currently remain unclear despite a higher prevalence of depression in women than in men. This study clarified socioeconomic and lifestyle factors associated with an increased risk of subclinical depression in general Japanese men and women. METHODS: Study participants were residents not receiving psychiatric treatments in 300 sites throughout Japan in 2010 (1152 men, 1529 women). Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95%CIs) for socioeconomic factors and lifestyle factors were calculated using a logistic regression analysis. RESULTS: Risk of depressive tendencies was significantly higher in men who were single and living alone (OR, 3.27; 95% CI, 1.56-6.88) than those married. The risk was significantly lower in women who were not working and aged ≥ 60 years (OR, 0.39; 95% CI, 0.22-0.68) and higher in men who were not working and aged < 60 years (OR, 3.57; 95%CI, 1.31-9.72) compared with those who were working. Current smoking was also associated with a significantly increased risk of depressive tendencies in women (OR, 2.96; 95% CI, 1.68-5.22) but not in men. CONCLUSIONS Socioeconomic and lifestyle factors were associated with an increased risk of depressive tendencies in general Japanese. Related factors were different by sex.
Adult ; Aged ; Community Psychiatry ; statistics & numerical data ; trends ; Depression ; epidemiology ; Female ; Health Surveys ; Humans ; Japan ; epidemiology ; Life Style ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Risk Factors ; Socioeconomic Factors