The purpose of the present study was to investigate a useful exercise protocol and method of evaluation for determining the gas exchange threshold (VO₂GET) and correlation coefficient between VO₂GET and maximal oxygen uptake (VO₂max), which is an index of aerobic capacity. Five healthy male volunteers (age: 25.6 ± 2.0 yrs; height: 172.9±4.0 cm; weight: 69.5±6.6 kg) performed exercise tests 82 times. Each volunteer randomly conducted a RAMP exercise (1 W⋅3 sec^-1), STEP-1 exercise (20W⋅min^-1) and STEP-2 exercise (40W⋅2 min^-1), respectively, at least 4 to 8 rotations. The gas exchange parameters (VE, VO₂and VCO₂) for incremental exhaustive cycle ergometer exercise were measured using a“breath-by-breath”method. Three different methods of evaluation- (VE/VO₂and VE/VCO₂) exchange (M-1), V-slope method (M-2), and M-1 & M-2 (M-3) -were attempted to determine VO₂GET. The VO₂GET values, determined by three different methods (M-1, -2 and -3) of evaluation, were classified as‘easy’ (J-A) and‘difficult’ (J-B) in all tests. Reproducibility of VO₂max and VO₂GET were assessed using the coefficient of variation (CV) and correlation coefficients (r) between VO₂max and VO₂GET.
The results are summarized as follows:
1) The means of the reproducibility of VO₂max were determined among the 5 subjects by us ing RAMP, 4.8% (n=25), STEP-1, 3.1% (n=28) and STEP-2, 2.9% (n=29) exercise tests; STEP-2 exercise test values (CV) were lower than the others. There was no significant difference in the means of VO₂max among the 5 subjects according to the RAMP and two STEP exercise tests (Two-way ANOVA) .
2) The best reproducibility value of VO₂GET among the 5 subjects was determined using RAMP exercise tests with the V-slope method (M-2) and evaluations were classified as easy (J-A) . The value (CV) was 2.8%. There was no significant difference in the VO₂GET values (M-1 (J-A, -B), M-2 (J-A, -B) and M-3) (Two-way ANOVA) and their means among the 5 subjects concerning RAMP and two STEP exercise tests (Two-way ANOVA) .
3) The best correlation coefficient (r) value between VO₂max and VO₂GET was obtained using RAMP exercise tests with M-2 (J-A) (r=0.976, n=20) .
The present results indicate that the most useful exercise protocol and method of evaluation for determining VO₂GET is the RAMP exercise test with the V-slope method.

1) Simulation-based training is critical for medical students to acquire clinical skills. We sent questionnaires to all 80 medical schools in Japan asking about the status of clinical skills laboratories and received responses from 73 medical schools.2) Fifty-nine schools have skills laboratories. Forty-nine schools have curricula integrating simulation-based skills training. The 3 most common apparatuses are venopuncture trainers, basic life support mannequins, and skin-suturing trainers. Lung and heart sound auscultation trainers, advanced cardiac life support mannequins, and ophthalmoscopy trainers are used at more than 50 schools.3) Thirty-two of the 59 schools have simulation-based skills-training courses that are not included in the undergraduate medical curriculum. Medical staff and people in the community are participating. The four most common courses are, in descending order, basic life support, intermediate cardiac life support, advanced cardiac life support, and automated external defibrillation, which are held at more than 16 schools.

The medical school system of Korea was patterned after the system used in the United States. Objective structured clinical examination/complete physical examination will be introduced to the national medical board examination in 2009.Medical educators insist on the importance of clinical clerkships and have introduced simulation-based learning in new curricula.We report on whether this new system is working well or not for possible use in the reform of medical education in Japan.

The use of simulators for skills training has become widespread. However, no quantitative analysis has been performed to determine whether simulation-based medical education is useful for improving the acquisition of clinical skills. The educational effect must be evaluated to further develop stimulation-based education. A seminar for cardiac auscultation was held, with the skills laboratory taking the initiative; the effectiveness was verified, and various problems were identified.1)The skills laboratory held a series of training seminars to examine the effectiveness of simulation-based education.2) Sixteen medical students participated in the seminars. One seminar lasted 120 minutes, including 60 minutes of lectures and 60 minutes of skills training. All students attended the three seminars. A questionnaire survey, a written examination, and a skills test were administered to all students three times (before, immediately after, and 5 months after the seminars).3) The students were extremely satisfied with the seminars. The students believed their cardiac auscultation skills had improved and that this improvement was still present 5 months later. After the seminars, the heart sound simulators were used more frequently than before the seminar.4) The results of skills testing after the seminars were better than those before the seminars and remained better 5 months later. However, results of a written examination 5 months after the seminars were similar to those before the seminars.5) The seminars in the skills laboratory were effective for improving students' auscultation skills and increased the effective use of mannequins in the skills laboratory.

Introduction: Compared with faculties in clinical and medical research departments, those in medical departments are not appropriately evaluated in terms of their contributions to or achievements in medical education. Therefore, the aims of this study were to investigate the contributions of medical department faculties to medical education, and to examine differences in contributions according to duty positions and specialties.

Methods: Five-grade self-assessments in relation to 20 items on a rating form for performance in medical education, which was developed by the Japan Society for Medical Education's Committee for Performance Evaluation, were carried out by medical department faculties in Japanese universities. The data were then totalized and analyzed.

Results and Discussion: Although faculties belonging to departments other than medical education units did not actively participate in examinations or the education system, they still made contributions to lectures and practice. In addition, faculties with positions with more duties tended to show greater participation in the education system.

Conclusion: Based on these findings, we recommend the use of a rating form as a standard scale to evaluate performance in medical education.

　　As part of the special study project of the Japanese Association of Rural Medicine (JARM), a questionnaire survey was conducted to probe into the attitude of rural people toward their eating habits and health. Most of the people surveyed had received health checkups carried out by medical facilities affiliated with the JARM.　　Questionnaires were distributed to a total of 5,397 people (2,588 men; 2,809 women) living in and around provincial cities. Mean age was 53.4 for men and 53.8 for women. More than half of those questioned were farmers or had experienced in farming. The people aged 80 and older accounted for 3.2% of the total.　　Eighty percent of the total said they felt happy, and those who felt short of exercise also represented 80%, but with advancing age, the ratio decreased. Those over the age of 70 who said they had a habit of taking exercise made up as high as 60%.　　Many said they were satisfied with food in terms of quantity, but not a few people expressed uneasiness about food safety, dietary life and supply of food. Regarding favorite foodstuffs, many gave rice, vegetables and dairy products. There was a tendency for older people to eat meat less. It was found that, with increasing age, people took to eat dairy products, soybeans, vegetables, fruits and fish were ranked among the most popular foodstuffs.　　A study of factors related to local production for local consumption and commitment to agriculture found that a significantly large number of people were interested in social participation, eating breakfast, securing food supply and purchasing foodstuffs at outlet stores run by local agricultural cooperatives.　　From these findings, it was suggested that many residents in and around provincial cities oriented themselves to healthy eating habits and lifestyle, and were very interested in social participation, local economy, agricultural production and consumption of local farm produce.

We analyzed the relation between subjective fatigue by hard exercise and stress hormone and cytokine data. The subjects are eight healthy men who had exercise experience. In this experiment, hard exercise was carried out in the first place. After two-hour rest, a performance test was carried out. The blood test was conducted 4 times (before exercise, after exercise, rest, and a performance test). Subjective fatigue was indicated using visual analogue scale (VAS). After the hard exercise and performance test, VAS increased and showed the significant difference. Lactic acid, adrenaline, noradrenaline, growth hormone, IL-6, and IL-8 increased after each exercise and showed the significant difference. Subjective fatigue and the value of lactic acid, and IL-6 showed significant positive correlations. These results suggest that lactic acid, and IL-6 may become an index of fatigue in this exertion model.

Farmers are constantly exposed to the hazards of agrochemicals. Especially those who regularly spray their fields with pesticides are at high risk of being contracted with pesticideinduced maladies.
During the three-year period from 1980 to 1982, health examinations were conducted, covering a total of 1, 164 pesticide sprayers in eight rural communities, Miye Prefecture. Of the number, 869 were women. Mercury residues in hair were also measured.
The findings are as follows:
1. Abnormal lipid metabolism topped the list of disorders, followed by hypertension, ECG abnormalities, anemia, albuminuria and liver dysfunction in that order.
2. The rates of detection of these abnormalities were not particularly high as compared with those in ordinary health checkups.
3. When compared with previous findings, the cases of abnormal lipid metabolism and anemia decreased in number both in men and women, whereas the cases of abnormal cholinesterase activities and albuminuria increased in both sexes.
4. The majority of pesticides used by the farmers were organophosphorous.
5. The average level of mercury residues in hair was 5.35 ppm for men and 2.97 for women. 6. More than 6.0 ppm of mercury were detected in 23.1 % of the men and 1.9% of the women. None were found to carry more than 20 ppm of mercury in their hair.

The electrogenic sodium/bicarbonate cotransporter 1 (NBCe1) on the basolateral side of the renal proximal tubule plays a pivotal role in systemic acid-base homeostasis. Mutations in the gene encoding NBCe1 cause severe proximal renal tubular acidosis accompanied by other extrarenal symptoms. The proximal tubule reabsorbs most of the sodium filtered in the glomerulus, contributing to the regulation of plasma volume and blood pressure. NBCe1 and other sodium transporters in the proximal tubule are regulated by hormones, such as angiotensin II and insulin. Angiotensin II is probably the most important stimulator of sodium reabsorption. Proximal tubule AT(1A) receptor is crucial for the systemic pressor effect of angiotensin II. In rodents and rabbits, the effect on proximal tubule NBCe1 is biphasic; at low concentration, angiotensin II stimulates NBCe1 via PKC/cAMP/ERK, whereas at high concentration, it inhibits NBCe1 via NO/cGMP/cGKII. In contrast, in human proximal tubule, angiotensin II has a dose-dependent monophasic stimulatory effect via NO/cGMP/ERK. Insulin stimulates the proximal tubule sodium transport, which is IRS2-dependent. We found that in insulin resistance and overt diabetic nephropathy, stimulatory effect of insulin on proximal tubule transport was preserved. Our results suggest that the preserved stimulation of the proximal tubule enhances sodium reabsorption, contributing to the pathogenesis of hypertension with metabolic syndrome. We describe recent findings regarding the role of proximal tubule transport in the regulation of blood pressure, focusing on the effects of angiotensin II and insulin.
Acidosis, Renal Tubular ; Angiotensin II ; Blood Pressure* ; Diabetic Nephropathies ; Homeostasis ; Humans ; Hypertension ; Insulin ; Insulin Resistance ; Kidney Tubules, Proximal ; Plasma Volume ; Rabbits ; Rodentia ; Sodium ; Sodium-Bicarbonate Symporters