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.

The eight subjective symptoms (shoulder stiffness, lumbago, urinary frequency at night, numbness of extremities, shortness of breath, sleep disturbance, dizziness and abdominal distension) were checked at the screening of circulatory diseases performed in a rural district in Ehime prefecture.
1. The complaint rates of the eight subjective symptoms were higher in female than those in male. The influence of aging was observed in urinary frequency at night and sleep disturbance. The higher complaint rates in the agricultural workers were not evident in the subjective symptoms except lumbago.
2. Factor analysis indicated that the eight subjective symptoms were constituted by (1) fatigue of circulatory system, (2) fatigue of musculoskeletal system and (3) aging effect.
3. The higher complaint rates were observed in these diagnosed as circulatory diseases, musculoskeletal diseases or gynecological diseases. The correlations between the eight subjective symptoms and the laboratory findings were not apparent. The result of path analysis indicated that the eight subjective symptoms were independently referable to the presence of illness.
4. The eight subjective symtoms were considered considered to be to evaluate health status of inhabitants in rural district.

Recent remarkable advances in medical computer technology have allowed earlier and more accurate diagnosis. These improvements in diagnosis have led to the wider recognition of the importance of computer literacy and teaching medical students to use computers. However, establishing a well-defined course for teaching computer science is difficult because of the rapid advances in computer technology. In this paper we present an outline of an educational program and practical exercises for the development of computer literacy which were introduced at Iwate Medical University in 1998.

Thromboexclusion method for thoracic aortic aneurysm was studied in 10 patients who had dissecting aneurysm in 7 and atherosclerotic aneurysm in 3. The aortic aneurysms extended from the left subclavian artery to the diaphragma or more widely. The operations were extraanatomic bypass and permanent aortic clamp proximal to the aneurysm in 9, and proximal and distal to the aneuysm in one. The follow up periods were 14 days to 80 months. Eight patients survived more than 3 months and 5 of them had thromboexclusion of aneurysm to the diaphragma. One with the aneurysms of incomplete thromboexclusion resulted in aneurysmal rupture 28 months after operation, and recovered by additional clamp distal to the aneurysm. Another had aneurysmal rupture, and died 63 months after operation. A patient had the penetration of the clamp to the pulmonary artery, and died 12 months after operation. Temporary paraplegia occurred in a patient 15 months after operation. Two patients developed constipation without ileus. Any difference of blood pressure between upper and lower extremities was not recognized, and no patient had deterioration of renal function. Indication of this method should be strictly selected, and careful follow up study is mandatory.

Periodontal tissue has a unique structure in that the human periodontal ligament (hPDL) lies between the hard tissues of cementum and alveolar bone. Although the role of cytokines in hPDL function is not clearly understood, we investigated the effect of mechanical stress as hydrostatic pressure (HP) on cytokine expression in hPDL cells.The hPDL cells were obtained from a healthy maxillary third molar. After the 3rd to 4th passage, the cells were exposed to HP ranging from 1 MPa to 6 MPa as previously described. The expression of cytokine mRNA was determined by RT-PCR and cytokines in the culture supernatants were assessed by enzyme-linked immunosorbent assay (ELISA).The exposure to 6 MPa of HP caused no morphological changes of hPDL cells, and did not affect cellular viability. No expression of IL-1β, IL-6, IL-8, TNF-α, RANK, RANKL or OPG mRNA was observed in the control cells under atmospheric pressure, whereas in hPDL cells treated with HP, enhancement of IL-6, IL-8, RANKL and OPG mRNA expression was observed between 10 and 60 minutes after the exposure to HP. After the exposure to HP, the production of IL-6 and TNF-α were induced significantly in hPDL cells, but IL-1β and IL-8 were not produced.These results suggest that hPDL cells may play a role in the production of cytokines in response to mechanical stress in vivo.

BACKGROUND/AIMS: Several studies have shown the usefulness of endoscopic nasogallbladder drainage (ENGBD) in patients with acute cholecystitis. However, the procedure is difficult, and factors that affect technical success have not yet been clarified. We conducted a prospective study to evaluate the technical feasibility, efficacy, and predictive factors for the technical success of ENGBD in patients with acute cholecystitis. METHODS: All patients with moderate or severe acute cholecystitis who were enrolled underwent ENGBD between April 2009 and April 2011. Patients with surgically altered anatomy or pancreatobiliary malignancies were excluded. The primary outcomes included technical success, clinical success, and complications. Factors that could affect the technical success were also examined. RESULTS: Of the 27 patients who underwent ENGBD during the study period, technical success was achieved in 21 (78%) and clinical improvement was achieved in 20 (95%). Early complications were encountered in four patients (15%). Gallbladder wall thickness (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.08 to 2.47) and age (OR, 1.16; 95% CI, 1.00 to 1.35) were effective predictors of technical failure. CONCLUSIONS: ENGBD was effective in resolving acute cholecystitis; however, this modality was technically challenging and had a limited success rate. Because of technical difficulties, ENGBD should be reserved for limited indications.
Age Factors ; Aged ; Aged, 80 and over ; Cholecystitis, Acute/*surgery ; Drainage/*methods ; Endoscopy, Gastrointestinal/*methods ; Feasibility Studies ; Female ; Gallbladder/pathology/*surgery ; Humans ; Male ; Middle Aged ; Odds Ratio ; Postoperative Complications/epidemiology ; Prospective Studies ; Sphincterotomy, Endoscopic ; Treatment Outcome

BACKGROUND/AIMS: Several studies have shown the usefulness of endoscopic nasogallbladder drainage (ENGBD) in patients with acute cholecystitis. However, the procedure is difficult, and factors that affect technical success have not yet been clarified. We conducted a prospective study to evaluate the technical feasibility, efficacy, and predictive factors for the technical success of ENGBD in patients with acute cholecystitis. METHODS: All patients with moderate or severe acute cholecystitis who were enrolled underwent ENGBD between April 2009 and April 2011. Patients with surgically altered anatomy or pancreatobiliary malignancies were excluded. The primary outcomes included technical success, clinical success, and complications. Factors that could affect the technical success were also examined. RESULTS: Of the 27 patients who underwent ENGBD during the study period, technical success was achieved in 21 (78%) and clinical improvement was achieved in 20 (95%). Early complications were encountered in four patients (15%). Gallbladder wall thickness (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.08 to 2.47) and age (OR, 1.16; 95% CI, 1.00 to 1.35) were effective predictors of technical failure. CONCLUSIONS: ENGBD was effective in resolving acute cholecystitis; however, this modality was technically challenging and had a limited success rate. Because of technical difficulties, ENGBD should be reserved for limited indications.
Age Factors ; Aged ; Aged, 80 and over ; Cholecystitis, Acute/*surgery ; Drainage/*methods ; Endoscopy, Gastrointestinal/*methods ; Feasibility Studies ; Female ; Gallbladder/pathology/*surgery ; Humans ; Male ; Middle Aged ; Odds Ratio ; Postoperative Complications/epidemiology ; Prospective Studies ; Sphincterotomy, Endoscopic ; Treatment Outcome

BACKGROUND/AIMS: Noninvasive liver fibrosis evaluation was performed in patients with nonalcoholic fatty liver disease (NAFLD). We used a quantitative method based on the hepatic volume acquired from gadoxetate disodium-enhanced (Gd-EOB-DTPA-enhanced) magnetic resonance imaging (MRI) for diagnosing advanced fibrosis in patients with NAFLD. METHODS: A total of 130 patients who were diagnosed with NAFLD and underwent Gd-EOB-DTPA-enhanced MRI were retrospectively included. Histological data were available for 118 patients. Hepatic volumetric parameters, including the left hepatic lobe to right hepatic lobe volume ratio (L/R ratio), were measured. The usefulness of the L/R ratio for diagnosing fibrosis ≥F3–4 and F4 was assessed using the area under the receiver operating characteristic (AUROC) curve. Multiple regression analysis was performed to identify variables (age, body mass index, serum fibrosis markers, and histological features) that were associated with the L/R ratio. RESULTS: The L/R ratio demonstrated good performance in differentiating advanced fibrosis (AUROC, 0.80; 95% confidence interval, 0.72 to 0.88) from cirrhosis (AUROC, 0.87; 95% confidence interval, 0.75 to 0.99). Multiple regression analysis showed that only fibrosis was significantly associated with the L/R ratio (coefficient, 0.121; p<0.0001). CONCLUSIONS: The L/R ratio, which is not influenced by pathological parameters other than fibrosis, is useful for diagnosing cirrhosis in patients with NAFLD.
Body Mass Index ; Fibrosis* ; Humans ; Liver Cirrhosis ; Magnetic Resonance Imaging ; Methods ; Non-alcoholic Fatty Liver Disease* ; Retrospective Studies ; ROC Curve