Fifty years has passed since Sarasin described a case of osteomalacia.
We studied the efficacy of Hochu-ekki-to compared with a regimen of activated vitamin D and lactate calcium. The efficacy was confirmed by administration of the drug to 6 patients with bone disorder after gastrectomy.
MD/MS (microdensitometry/multiple scanning) examinations demonstrated the efficacy of the drug with improvement of three indices of bone mineral content.

Metastasis is the chief cause of mortality in cancer patients. Recently, chemokines and chemokine receptors were shown to play an important role in the metastasis of various cancers. We examined the role of chemokine receptor-mediated signaling in the invasion potential of human oral squamous cell carcinoma (OSCC) cell lines that were derived from 5 primary tumors and 6 cervical lymph node metastases. Comprehensive analysis of the mRNAs for human chemokine receptors showed that the OSCC cell lines had uniform expression patterns of chemokine receptors. Overall, there were no consistent differences in the expression of chemokine receptors between primary site- and lymph node metastasis-derived cell lines. However, a highly invasive OSCC cell line (SAS-H1) expressed up-regulation of CCR5, CCR6, CCR7, CXCR1, CXCR6 and CX3CR1 compared to a poorly invasive OSCC cell line (SAS-L1). Then we examined whether factors in the tumor microenvironment regulated chemokine receptor expression in SAS-H1 cells. Specifically, transforming growth factor (TGF) -β1 enhanced the expression of CCR5, CCR6, CCR7 and CX3CR1. Pretreatment of SAS-H1 cells with transforming growth factor (TGF) -β1 increased the expression of CCR7 and CX3CR1, and then enhanced CCL21- and CX3CL1-induced directional migration (1.5-fold enhancement as compared with untreated control). In addition, CX3CL1 increased the adhesion of SAS-H1 cells on uncoated tissue culture plates. Neither chemokine stimulated cell proliferation. Treatment of SAS-H1 cells with CX3CL1 activated the phosphotidylinositol-3-kinase (PI3K) and MEK signal transduction pathways. Our results suggest that chemokine receptor-mediated signaling is involved in the local invasion and metastasis of human OSCC.

To assess the effectiveness of a problem-based learning tutorial system introduced at Gifu University School of Medicine in 1995, we conducted a questionnaire survey of medical knowledge, attitudes about learning, communication ability, and social behavior in sixth-year medical students. The questionnaire was given to instructors and attending physicians at community hospitals who were involved in clinical education. Many of the evaluators felt that students who trained with the tutorial system showed improved understanding, a more active attitude toward learning, and a better attitude toward patients than did students who received traditional, lecture-based education.

The Common Achievement Tests Organization performed the first nationwide trial of computer-based testing (CBT) used to assess students entering the clinical phase of medical education. Seventy-seven medical schools participated in the trial. We compared performance on the national CBT with performance on preclinical tests administered at Gifu University School of Medicine. Despite some methodologic differences between the national CBT and our system, the overall results correlated well. Students who did poorly on the national CBT also did poorly on Gifu University's preclinical test. Correlation of these two performance scales suggests that nationwide CBT could be used to accurately assess preclinical skills.

The Medical Education Development Center has organized seminars and workshops for medical education 30 times from 2000 through 2008 throughout Japan. The participants have numbered more than 3200 and have included educators, physicians, students, and simulated patients. The topics of seminars and workshops have included problem-based learning tutorial systems, medical interview skills, objective structured clinical examinations, evidence-based medicine, coaching technology, simulations, and community medicine in response to educational needs. A questionnaire survey of 1793 participants of the 11th to 30th seminars and workshops (response rate, 85.6%) showed a high degree of satisfaction (4.33±0.13 of 5 points). Invited lecturers and directors from throughout the country often organized these workshops. The results of workshops are reported in our annual monograph, "Trends in Medical Education."

We have organized the Seminar and Workshop for Medical Education (SWME) 10 times from 2000 through 2003. More than 1, 200 persons have participated, including teachers, physicians, students, and simulated patients. The themes of the SWME have included a problem-based learning tutorial system, medical interview skills, objective structured clinical examinations, medical ethics, advanced cardiac life support/basic life support, evidence-based medicine, coaching technology, medical English education, and crisis management education. Invited lecturers from throughout the country organized most of these workshops. Advantages of the SWME are two-fold:(1) improving the medical teaching skills of each participant and (2) scouting for good young lecturers. Workshop reports are published in our annual monographs and other materials. The present paper is a historical review of the SWME and also describes the nationwide scope of faculty development.

The purpose of this study was to investigate the effects of short-term living and training at an altitude of 1, 300 to 1, 800 m on physiological responses of high school elite endurance athletes. Fifteen male and seven female senior high school elite athletes, aged from 15 to 18, from three different sports (cross-country skiing, long-distance running and endurance cycling), participated in our study. The short-term (6 days) altitude exposure did not elicit abnormal responses of body tempera-ture, body weight, blood pressure or urine samples. There were also no significant changes in blood parameters examined before and after altitude exposure. Resting heart rate (HR) increased at altitude and presented an initial peak value followed by a steady decline on the following days of altitude exposure. Blood lactate concentration and exercise peak llR examined by submaximal 20-m shuttle run test decreased after the ascent to altitude and still showed lower values at postaltitude than at prealtitude. We conclude that 6-day living and training at an altitude of 1, 300 to 1, 800 m elicits positive decrements of exercise blood lactate and exercise peak HR as well as adaptive changes of resting IlR for these high school elite endurance athletes, which are probably related to an attenuation of muscle glycogen utilization and alterations in the autonomic neural system taken at altitude.

This present study was conducted among the nine centers of Akita prefectural Welfare Federation of Agricultural Cooperatives. This applied to women over 30 years of age, and carried out following to the standard method of the Japan Cancer Society.
The total of women examined by the first screening from April 1983 to January 1985 amounted to 15903, of which the number of women over 60 years of age was only 7 per cent of the total. According to the type of screening, the number of women slightly more in the center screening than in the local screening. However, in both types of screening, the number of women examined by the combination method, for example, anemia or uteric cancer, was much higher than that of the mass screening for breast cancer alone.
The second screening rates indicaded a marked difference of 0.4 to 21.7 per cent depending on the location of the center. The over-all average for the second screening was 3.8 per cent. As a result of the second screening, breast cancers were detected in 12 cases (0.07%). The breast cancer detection rate increased with age. It is notable that the breast cancer detection rate for women over 60 years of age was 5 times higher than for women over 40 years of age. Among other diseases detected in the second screening were mastpathy (233 cases), fibroadenoma (15 cases), mastitis (40 cases) and others.
As far the stage distribution and screening history for detected breast cancers, 60 per cent of all cancer cases were diagnosed as stage I, and 70 per cent were the initial screening. Seven out of 12 cases were aware the breast lump themselves before the first screening. From this point of view, it was suggested that every women should be educated in order to perform selfexamination.

Multiple endocrine neoplasia type 1 (MEN1) is an inherited autosomal dominant disease presenting with pancreatic neuroendocrine tumors (pNETs), parathyroid tumors, or pituitary tumors. Using the PubMed database, we reviewed the literature on information regarding the proper diagnosis and treatment of MEN1-associated pNET. Many cases of MEN1-associated pNET are functioning pNETs. Gastrinomas and insulinomas tend to occur frequently in the duodenum and pancreas, respectively. In addition to diagnostic imaging, the selective arterial secretagogue injection test (SASI test) is useful for localizing functioning pNET. The standard treatment is surgical resection. However, in the case of a functioning pNET, the tumor should first be accurately located using the SASI test before an appropriate surgical method is selected. In cases of a MEN1-associated non-functioning pNET that exceeds 2 cm in diameter, the incidence of distant metastasis is significantly increased, and surgery is recommended. In cases of unresectable pNET, a somatostatin analog has been shown to demonstrate antitumor effects and is considered to be a promising treatment. In addition, molecular-targeted drugs have recently been found to be effective in phase III clinical trials.
Diagnostic Imaging ; Duodenum ; Gastrinoma ; Incidence ; Insulinoma ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors ; Pancreas ; Pituitary Neoplasms ; Somatostatin