We are conducting research funded by a grant from the Ministry of Health, Labor and Welfare of Japan to create standardized, high-quality medical education content that incorporates video, images, and sound files, to develop a system that can be widely used by everyone from medical students to clinicians, and to create CBT-enabled examination questions for the future CBT National Medical Licensing Examination. The research aims to conduct trial examinations, study issues and measures to deal with them, and make proposals for their implementation.　With regard to the CBT system for the National Medical Licensing Examination, questions incorporating video, images and sound files were prepared based on the scope of the current national examination, and a trial examination was conducted with the cooperation of 10 universities nationwide using the CBT examination system via the internet. The trial was generally conducted smoothly, with smooth playback of videos, etc., and no system problems.　In conducting this research, we believe that it should not be considered as an extension of the previous national examination initiatives for doctors, nor should it be regarded merely as a technological initiative. In addition, as advances in AI-based diagnostic technology and patients’ medical literacy are foreseen to change significantly in 2040, the competence of doctors to cope with these changes will be questioned.　For this reason, it is fundamental to consider medical education content and examination questions for the CBT National Medical Licensing Examination with a view to the ideal image of doctors of the future.

A 29-year-old man, who had undergone valvotomy for pure pulmonary stenosis at 6 months of age, was admitted to our institution for surgical treatment of a giant ascending aortic aneurysm and annuloaortic ectasia. Chest MRI revealed a 14-cm ascending aneurysm in contact with the sternum. After establishing femoro-femoral bypass for hypothermia, a left lateral thoracotomy was perfomed at the 4th intercostal space. Pulmonary artery cannulation was performed for left heart venting, and the proximal aortic arch was dissected for aortic cross-clamping. Median sternotomy was performed under circulatory arrest at 18°C and the aortic arch was opened. Under retrograde cerebral perfusion, the proximal arch was replaced by an artificial graft, and then aortic root replacement was completed using a composite graft under CPB. The postoperative course was uneventful, and the patient was discharged on the 37th postoperative day. He has been well without any complications. This case suggests that our method of approach to the giant aortic aneurysm with sternal adhesion and aortic regurgitation, and the use of extracorporeal circulation in view of the annuloaortic ectasia is effective and safe in case of reoperation.

Background. In recent years, aortic valve stenosis in the elderly is increasing. To determine the treatment of aortic stenosis in the elderly, we retrospectively evaluated the patients who underwent aortic valve replacement. Method. Between 1992 and 1997, 22 patients older than 70 years underwent aortic valve replacement for aortic stenosis. There were 15 women and 7 men, with a mean age of 73.0±4.0 years. Seven patients underwent concomitant procedures: 5 patients required coronary artery bypass grafts, 1 mitral valve plasty and 1 aortic root plasty. SJM prosthetic valves of sizes 19mm, 21mm and 23mm were used in 11, 8 and 3 patients respectively. Nobody underwent aortic annuloenlargement. Three patients underwent supraannular aortic valve replacement. All patients had New York Heart Association (NYHA) class III or IV symptoms. Results. There was no operative or hospital death. Five patients had atrial fibrillation after operation. There was only one late death, due to a traffic accident, and there was no significant complication during the follow up period. Of the 22, 21 patients improved to NYHA class I or II after operation. There were significant differences between patients who were 70 years or more and those under 70. BSA in these two groups were 1.495 and 1.615m²; p<0.01, and the amounts of blood transfusion were 918±702 and 408±428ml, p<0.01. However, there was no significant difference between these two groups in terms of ACC time (56.8 and 59.9min), CPB time (88.7 and 92.1min), ICU stay (4.0 and 3.3 days) and hospital stay (29.5 and 25.5 days). Conclusion. The results of aortic valve replacement in patients aged 70 years or more, were satisfactory. If the aortic annulus being small, a small mechanical valve prosthesis is suitable, and supraannular positioning yielded good results.

Objective: The efficacy of intra-abdominal cytoreductive surgery in patients with endometrial cancer and distant metastasis is equivocal. We investigated the effectiveness of such surgical treatment and whether it should be performed before or after chemotherapy (CT). Methods: This study included patients with an International Federation of Gynecology and Obstetrics stage IVB endometrial cancer who received initial treatment at our hospital between January 2006 and December 2017. Results: We retrospectively reviewed 67 patients with stage IVB endometrial cancer with distant metastases and classified them into preceding surgery (PS, n=23), chemotherapy followed by a surgery (CS, n=27), and CT (n=17) groups. We examined the achievement of resection with [R (1)] or without [R (0)] intra-abdominal macroscopic residue and survival. The median survival time for R (0) was 44 (95% confidence interval [CI]=9–not available [NA]) months in the PS group and 27 (95% CI=11–NA) months in the CS group. The median survival time for R (1) was 9 (95% CI=0–24) months in the PS group and 12 (95% CI=7–19) months in the CS group. The similar prognosis in both groups was worse with R (1) than with R (0). The survival curve for R (1) in the resection groups was similar to that of the CT group. Conclusion Achieving resection without intra-abdominal macroscopic residue for endometrial cancer with distant metastases, whether before or after CT, could extend patients’ survival.

Purpose: This study aimed at identifying difficulties among post thoracic esophagectomy cancer patients during outpatient follow-up. Methods: Patients who had radical esophagectomy at a cancer center hospital in Japan were prospectively observed and were interviewed by a certified nurse assigned at esophageal surgical outpatient division. Their responses were documented in medical records and were analyzed by content analysis method. This study was approved by the study hospital's research ethics committee. Results: The data from 66 patients were obtained. Content analysis yielded 221 extracts, 25 categories, and 65 codes of difficulties, including: concerns or signs/symptoms associated with dietary intake, physical activity, and anxiety. Implications: The majority of post-thoracoabdominal esophagectomy patients experienced multiple dysfunctions and symptoms after discharge. The results underscore the significance of nurses' role in assessing and instructing patients to address these issues.

Background: Patients having thoracic esophagectomy, a standardized treatment for esophageal cancer patients in Japan, are known to have various postsurgical signs and symptoms for a period of time. The current status of nursing interventions at outpatients need to be clarified. Purpose: This study aimed at identifying the nurses' interventions for cancer patients at the outpatient setting who previously had thoracic radical esophagectomy. Methods: Patients who had esophagectomy at a cancer center hospital in Japan were prospectively observed and interviewed by outpatient nurses between January 2009 and December 2010. Their documented responses in medical record were prospectively investigated and were qualitatively analyzed via content analysis method. This study was approved by the study hospital's research ethics committee. Results and discussion: The data analysis of nursing interventions for 66 patients yielded 372 extracts, 12 categories, and 74 codes. Nurses were assessing patients' signs and symptoms affected by postsurgical changes, and were utilizing patients' active self-monitoring skills. The results also showed the significance of facilitating postsurgical recovery in relation to nutritional intake and physical activity in patients' daily life. Implications: Based upon the study results, the development of a systematic program is underway, which facilitates esophageal cancer patients' postsurgical recovery.

BACKGROUND/AIMS: Although studies using conventional animal models have shown that specific stressors cause irritable bowel syndrome (IBS), it is unclear whether depression itself causes IBS. Our aim was to establish a rat model to determine if depression itself promotes the onset of IBS and to elucidate the role of gut microbiota in brain-gut axis pathogenesis during coincident depression and IBS. METHODS: Rat models of depression were induced using our shuttle box method of learned helplessness. Visceral hypersensitivity was evaluated by colorectal distension (CRD) to diagnose IBS. Gut microbiota compositions were analyzed using high-throughput sequencing. In the subanalysis of rats without depression-like symptoms, rats with posttraumatic stress disorder (PTSD) were also examined. RESULTS: The threshold value of CRD in depressed rats was significantly lower than that in control rats. Microbial community analysis of cecal microbiota showed that the relative abundance of Clostridiales incertae sedis, the most prevalent microbe, was significantly lower in depressed rats than in control rats. The distribution pattern of the microbiota clearly differed between depressed rats and control rats. Neither visceral hypersensitivity nor the composition of gut microbiota was altered in rats with PTSD-like phenotypes. CONCLUSIONS: Our rat model of depression is useful for clarifying the effect of depression on IBS and suggests that depression itself, rather than specific stressors, promotes the onset of IBS. Further, we provided evidence that various psychiatric diseases, viz., depression and PTSD, are associated with unique gut microbiota profiles, which could differentially affect the onset and progression of coincident IBS.
Animals ; Clostridiales ; Depression ; Dysbiosis ; Gastrointestinal Microbiome ; Helplessness, Learned ; Hypersensitivity ; Irritable Bowel Syndrome ; Methods ; Microbiota ; Models, Animal ; Phenotype ; Rats ; Stress Disorders, Post-Traumatic