Objective: The soybean has long been an important protein source for approximately 5000 years in Oriental countries. Therefore, soy protein has been widely investigated for its variety of function. However, the side effects had been reported for its close structure of the female hormone, estrogen. In this report, we prepare a new soy peptide derivative and focus on the potency, with special attention to the linkage of peripheral leukocytes in number, emotional hormone and brain blood flow.
Method: Dried powder of soybean-protein or peptide were administered orally at dosage 8g (dry weight) suspension, the blood sample was collected before and after one week at the same hour and served for assessment in order to avoid circadian rhythm.
Results: The cell numbers were up-regulated in the group that had a smaller number of leukocytes before the test, but in the larger number group before the test, they were down-regulated in the soybean-protein and peptide. Therefore, when the number of all subjects were totaled and make mean, indicating no difference. As for the leukocyte subsets, lymphocyte numbers of CD_11b⁺ cells, and CD₅₆⁺ cells significantly increased after ingestion of a single gradient in the soybean-peptide group. On the contrary, only CD₁₉⁺ cell counts were down regulated. In the soybean-peptide group, the adrenalin level in serum, which is regarded as one of the emotional hormones, was down regulated, and another emotional hormone, dopamine, was up regulated. There were no change of CD positive cells and emotional hormones in the soy protein and placebo group. In NIRS, a significant increase in amplitude of all the frequency bands was observed in the peptide group just after 5 min of administration by the sample, peptide.
Conclusion: These results indicate that the soybean peptides can regulate the leukocyte subsets and emotional hormones are also closely related with the change of the brain blood flow in healthy young volunteers.

 We have previously reported that hot-spring hydrotherapy for a short duration can change hormone levels in the blood and quantitatively as well as qualitatively regulate leukocytes and their subpopulations. In this study, we examined the effect of hot-spring hydrotherapy on the lymphocytes expressing β₂-adrenergic receptors (β₂-ARs). We obtained peripheral blood from 9 healthy volunteers (age, 49.7±11.2 years) at the same sampling time before and after (the next day) hot-spring hydrotherapy, and measured the total and differential leukocyte counts and the levels of 3 catecholamines (adrenaline, noradrenaline, and dopamine). We also analyzed the β₂-AR of lymphocyte subsets by combination with fluorescent monoclonal antibodies (CD3, CD4, CD 8, CD 19, and CD56) by using flow cytometry.
 The number of granulocytes significantly decreased after hot-spring hydrotherapy (p < 0.05). The ratio of β₂-AR⁺ CD4⁺ cells and β₂-AR⁺ CD3⁺ cells was low, but that of β₂-AR⁺ CD56⁺ cells and β₂-AR⁺ CD8⁺ cells was high. The CD8⁺ cell and CD56⁺ cell counts tended to increase after hot-spring hydrotherapy, but no significant variation was found in the β₂-AR⁺ cells of each subset. Adrenaline levels also significantly decreased after hot-spring hydrotherapy (p < 0.05). The rate of change in adrenaline levels before and after hot-spring hydrotherapy was highly correlated with the rate of change in the levels of CD56⁺, CD8⁺, and β₂-AR⁺ CD56⁺ cells. Thus, we found a difference in thepercentage of β₂-AR-expressing cells in the lymphocyte subsets. Therefore, it is possible that a short duration of hot-spring hydrotherapy decreased adrenaline levels and quantitatively influenced the natural killer cells and CD8⁺ cells, which express large amounts of β₂-AR.

Locally advanced breast cancer (tumor > 5 cm, widespread infiltration of the skin and muscle, or metastases to lymph nodes) is difficult to resect by surgery, and even when it is resectable, there is a high probability of local recurrence and distant metastasis. Therefore, systemic therapy should be administered first. However, as cutaneous infiltration progresses, the patient's quality of life is impaired by pain, bleeding, presence of exudates, and a foulsmelling odor. Treatment with Mohs paste with systemic therapy can control symptoms associated with skin infiltration and can also be expected to decrease tumor volume.Herein, we report a case in which a tumor was resected following Mohs paste and systemic chemotherapy administration, and the skin defect was reconstructed with a latissimus dorsi myocutaneous flap. We also review the literature for previously reported cases of breast cancer involving Mohs paste.

We evaluated the efficacy, usefulness and safety of acupuncture and moxibustion treatment in rheumatoid arthritis, by the randomized, parallel-group, multi-center study with the drug-treated outpatient group as the control. The endpoints, important in the clinical assessment of acupuncture treatment, included the improvement criteria in ACR core set variables and the Japanese version of the Arthritis Impact Measurement Scales Version 2 (AIMS-2), a system of evaluation of the QOL of patients with RA.
Regarding intervention (therapy), a therapy chart for each stage of disease was drawn up to give local and systemic treatment in consideration of the patient's activity and disability in each stage of rheumatoid arthritis, so that generally consistent therapy adapted to the patient's condition would be provided. Result 1. Patients eligible for analysis were 80 patients of A-group (drug therapy group) (80 females, 2 males, 2dropped) and 90 patients of B-group (drug plus acupuncture and moxibustion group), total 170 patients. 2. Patients who satisfied the improvement criteria in ACR core set variables (improved patients) were 8 of 80 patients in A-group and 20 of 90 patients in B-group. The improvement rate was significantly higher for B-group treated by drug plus acupuncture and moxibustion versus A-group, with P=0.04 in 2×2 table chi square test. 3. In QOL change investigated by AIMS-2 questionnaire, the improvement occurred significantly more frequently in the drug plus acupuncture and moxibustion group, with difference between groups at 12 months after the initiation of clinical study at P=0.001. 4. Changes in the subjects included in AIMS-2 questionnaire: Improvement was significantly more frequent in the drug plus acupuncture and moxibustion group versus drug therapy group in respect to the ability to walk, finger function, housework, sociableness, pain, mood, and the degree of subjective improvement. In the present randomized, parallel-group, multicenter study, a significant improvement was detected in the drug plus acupuncture and moxibustion group versus the drug therapy group in the aforesaid respect, which suggested that the use of acupuncture and moxibustion combined with the conventional therapy would prevent deterioration of physical functions, improve blood circulation, stabilize mental status, and thereby contribute to the improvement of QOL in patients with rheumatoid arthritis.

Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]). Conclusions RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

Objectives: There are known barriers to advance care planning practices for both health care providers and patients. Since physicians were the main occupations that introduce ACP, the goal of this study was to clarify where the difficulties were felt in the practice of ACP by looking back on the practice of physicians who were working in a designated cancer hospital. Methods: Semi-structured interviews were conducted with 10 physicians who were recommended by the palliative care team as physicians who clinically practice ACP for cancer patients. Interviews were transcribed verbatim, coded, and analyzed using content analysis by Graneheim et al. Results: We finally classified into 6 major categories as follows: Insufficient readiness of patients/Insufficient readiness of medical staff/Discrepancy in communication/Lack of evaluation index of ACP/Dilemma with professional ethics. Conclusion: Patients and health care providers each lacked readiness for ACP, and physicians found it difficult due to the resulting communication discrepancies and lack of colleagues with whom they could collaborate.

In the new Model Core Curriculum, the objective stated is to "understand the importance of medical research for the advancement of medicine and medical care, and support innovation in medicine through involvement in academic and research activities, developing one's scientific thinking skills." Importantly, scientific background and researcher training education, such as laboratory assignments, are clearly positioned in the Model Core Curriculum and are available to all students. The curriculum consists of five components : Developing a research mindset, Understanding established theories, Conducting Research, Publishing Research, and Research Ethics. In addition, laboratory experience and practical training in basic medicine were also added to the description. Further policy and financial support for researchers will be necessary to increase the number of basic medical researchers in the future.

In the 2022 revision of the Model Core Curriculum, a new "Educational Strategies and Assessment" section was added as a further development in outcome-based education. By adding a chapter on strategies and evaluation, which is an important element of the curriculum, and linking it to qualities and abilities, we have devised a way for learners and instructors to make use of the Core Curriculum more easily. In addition, 11 example of strategy and assessment cases are included as Good Practice to encourage practical application. However, since these are only examples, we hope this chapter will be further developed as universities create strategies and evaluations that make the most of their unique characteristics.

BACKGROUND: The Hokkaido Study on Environment and Children's Health is an ongoing study consisting of two birth cohorts of different population sizes: the Sapporo cohort and the Hokkaido cohort. Our primary objectives are to (1) examine the effects that low-level environmental chemical exposures have on birth outcomes, including birth defects and growth retardation; (2) follow the development of allergies, infectious diseases, and neurobehavioral developmental disorders, as well as perform a longitudinal observation of child development; (3) identify high-risk groups based on genetic susceptibility to environmental chemicals; and (4) identify the additive effects of various chemicals, including tobacco. METHODS: The purpose of this report is to provide an update on the progress of the Hokkaido Study, summarize recent results, and suggest future directions. In particular, this report provides the latest details from questionnaire surveys, face-to-face examinations, and a collection of biological specimens from children and measurements of their chemical exposures. RESULTS: The latest findings indicate different risk factors of parental characteristics on birth outcomes and the mediating effect between socioeconomic status and children that are small for the gestational age. Maternal serum folate was not associated with birth defects. Prenatal chemical exposure and smoking were associated with birth size and growth, as well as cord blood biomarkers, such as adiponectin, leptin, thyroid, and reproductive hormones. We also found significant associations between the chemical levels and neuro development, asthma, and allergies. CONCLUSIONS Chemical exposure to children can occur both before and after birth. Longer follow-up for children is crucial in birth cohort studies to reinforce the Developmental Origins of Health and Disease hypothesis. In contrast, considering shifts in the exposure levels due to regulation is also essential, which may also change the association to health outcomes. This study found that individual susceptibility to adverse health effects depends on the genotype. Epigenome modification of DNA methylation was also discovered, indicating the necessity of examining molecular biology perspectives. International collaborations can add a new dimension to the current knowledge and provide novel discoveries in the future.
Biomarkers/blood* ; Child ; Child Health ; Child, Preschool ; Cohort Studies ; Environmental Exposure/adverse effects* ; Environmental Health ; Environmental Pollutants/adverse effects* ; Female ; Fetal Blood/chemistry* ; Follow-Up Studies ; Growth/drug effects* ; Humans ; Hypersensitivity/etiology* ; Infant ; Japan/epidemiology* ; Male ; Neurodevelopmental Disorders/etiology* ; Pregnancy ; Prenatal Exposure Delayed Effects/etiology* ; Prevalence ; Smoking/adverse effects*