Introduction: Our school adopted team-based learning （TBL） in symptomatology classes for fourth-year students in 2010.
Method: This study examined the effects and problems of using a questionnaire survey involving students.
Results: The final scores of the students were distributed widely between approximately 65 to 90 points, indicating that TBL increased the spread of scores. The results of the survey showed that many students considered TBL to be a more effective approach than class-based learning, but most students showed an unfavorable attitude toward peer assessment. However, the results of multiple linear regression analysis showed no correlation between the survey results and final scores. The students who did not work together had better scores than students who did （p＝0.048）.
Discussion: The findings suggest that students’ scores after TBL are correlated with those after class-based teaching and that TBL helps improve students’ scores, especially those for case-study questions.

Objective: Generic drugs similar in appearance to their brand-name counterparts have both advantages and disadvantages.  This study aimed to investigate patient preferences regarding the appearance of generic drugs.
Design: A cross-sectional survey.
Methods: We conducted a web-based survey between 2013 and 2014.  Patients aged ≥40 years who reported taking prescription drugs for >6 months were asked to provide their opinions on the appearance of generic drug formulations and press-through packages (PTPs).  Medical doctors and pharmacists were asked as to what type of appearance of generic drugs would be suitable as well as whether the appearance of these drugs and PTPs should be similar to that of their brand-name counterparts.
Results: A total of 911 patients, 238 pharmacists, and 81 medical doctors responded to the survey.  Most of the patients (45.3%) surveyed reported that the similarity in the appearance of generic drug formulations and PTPs to those of their brand-name counterparts was not important, whereas only 15.6% of patients preferred generic drug formulations and PTPs similar in appearance to their brand-name counterparts.  In contrast, most of the medical doctors (53.1%) and pharmacists (88.2%) reported that the appearance of generic drug formulations and PTPs should be similar to that of their brand-name counterparts.
Conclusion: Patients’ opinions on the appearance of generic drugs differ from what medical doctors and pharmacists perceive them to be.  Therefore, health care professionals should select generic drugs with an appearance as per the individual patient’s preference.

Infective endocarditis in association with pyogenic vertebral osteomyelitis is rarely observed. We report an 80-year-old man with infective endocarditis and pyogenic vertebral osteomyelitis requiring reoperation due to aortic prosthetic valve dysfunction. He suffered from back pain as the initial symptom, and he was admitted to our hospital. On magnetic resonance imaging, vertebral osteomyelitis was revealed, and antibiotics were started. On blood sampling α-streptococcus was identified and infective endocarditis was diagnosed. He responded to the antibiotic treatment. Despite the improvement in his general condition and the inflammatory parameters of blood samples, the aortic prosthetic valve dysfunction progressed. On echocardiography, aortic regurgitation worsened to 4/4, and the ejection fraction decreased from 72 to 46%. As heart failure was apparent, we performed a redo aortic valve replacement. Tears were found in the leaflets of the removed prosthetic valve (Hancock II). The 21-mm Carpentier-Edwards PERIMOUNT valve (CEP Magna Ease TFX) was replaced. His post-operative course was uneventful, and intravenous administration of ampicillin was continued. Oral rifampicin was also continued. On the 69th post-operative day, he was discharged and was ambulatory. Although we have no evidence that the tissue valve deterioration had resulted from bacterial damage, we were able to confirm that the structural valve deterioration involved bacterial contact in this case. Patients with infective endocarditis and pyogenic vertebral osteomyelitis should be treated cautiously regardless of whether or not the inflammation is controlled.

After April 2006, the Japanese Ministry of Health and Labor raised the permitted training time from 6 to 9 units (1 unit of training time corresponds to 20 minutes of exercise with a therapist) for patients in a kaifukuki (convalescent) rehabilitation ward. We examined the effect of the increased rehabilitative training time on patients using feeding tubes in a kaifukuki rehabilitation ward after an initial cerebrovascular disorder, with a particular focus on improving swallowing disorders. Our study was comprised of post-stroke patients with feeding tubes who underwent rehabilitation from April 2001 to March 2006 (N=14, 6-unit group) and from April 2006 to March 2009 (N=16, 9-unit group). All patients went to the ward within two months after suffering a stroke. There was no significant difference in the Functional Independence Measure(FIM) efficiency or length of hospital stay between the two groups. Feeding tube removal was more common in the 9-unit group compared to the 6-unit group (81.3% vs. 35.7%, p<0.05), and the 9-unit group also had more training time per day. Logistic regression analysis showed that the increased training time per day spent with a speech therapist contributed to improving swallowing disorders (p<0.01).

Relationship between serum OCT activity and nutrient intake pattern were investigated in 90 young adults. Applying multiple regression and factor analysis, we found the following results:
1) Multiple regression analysis showed that the variables which correlated best with the serum OCT activity were dietary intakes of the energy, fat and vitamin C.
2) In the factor analysis, no significant correlation was found between serum OCT and food intake pattern.

The purpose of this research paper is to clarify the effect of moxibustion on the protective antibody induced by the Smith strain of Staphylococcus aureus. The moxibustion test group of four rabbits and the control group of four rabbits were all immunized subcutaneously with the Smith strain of S. aureus. Sera samples were collected weekly and antibody production was detected by enzyme-linked immunosorbent assay (ELISA). Compared to the control group, the titer of IgM antibody of the moxibustion group increased significantly (p<0.05). Furthermore, ELISA inhibition tests with Smith surface antigen (SSA, a protective antigen) showed significantly (p<0.05) higher activities of IgM and IgG antibody in the moxibustion group at the 9th week after the first immunization. These results suggest that moxibustion promotes not only production of antibodies against the Smith strain of S. aureus, but also passive protective activity against SSA of S. aureus.

With the purpose of clarifying the influence of direct moxibustion on the cell count and proportion of leukocytes in peripheral blood, rabbits and humans were treated with direct moxibustion. The moxa cones were the size of a “rice grain”. In the rabbits 10 moxa cones were distributed among four points which were selected on the low back. Humans were treated with the same method except eight points were chosen on the back and legs. Peripheral blood was collected periodically following each treatment. Leukocyte counts and leukocyte differentials were then measured. Lymphocyte subpopulations were also analyzed with flow cytometry in humans.
In rabbits, the mean leukocyte count increased transiently after the treatment in both the moxibustion group and the control group. However, the greatest increase was observed in the moxibustion group. In humans, no change was found in leukocyte counts and leukocyte differentials in the moxibustion group. However, the mean T cell percentage in the moxibustion group decreased 24 hours after the moxibustion treatment. Moreover, the mean CD4/CD8 ratio of the moxibustion group increased 2 hours after the treatment, and decreased 24 hours after the treatment. These changes were statistically significant while no significant change was observed in the control group. No change was found in either rabbits or humans after the 4 weeks of treatment.
These results suggest that the immune system will be influenced by moxibustion at least transiently.

We reported a rare case of aorto-left ventricular fistula with the unruptured aneurysm of the Valsalva sinus due to the infective endocarditis. Preoperatively trans-echocardiographic examination revealed the ruptured left sinus of Valsalva aneurysm protruded toward the left ventricule. Aorto-left ventricular fistula contiguous to the unruptured aneurysm of the right valsalva sinus, however, was detected at operation. Granulation tissue resembling healed infective vegetation was detected in the margin among the orifices of this fistula and Valsalva aneurysm. Pathological examination showed excessive accumulation of white blood cells, which suggested infective endocarditis.

We report a rare case of acute type A aortic dissection with paraplegia which was reversed using cerebrospinal fluid drainage (CFD). The patient was a 80-year-old man who was admitted with acute back pain and paraplegia. Computed tomographic scans showed an acute type A aortic dissection. Four hours after onset of paraplegia, CFD was initiated by inserting an intrathecal catheter at L3-L4. Cerebrospinal fluid was drained freely by gravity whenever the pressure exceeded 10cmH₂O. After 32h, the neurological deficit was completely resolved. CFD can be considered a useful treatment in patients with paraplegia after acute aortic dissection.