1) For the future selection after 2-year primary clinical training program, most of the doctor do not desire to be a researcher in basic medicine as well as in public medicine.
2) In order to educate medical students to experience the research with joy, curriculum for integrated laboratory practice and/or assignment to basic medical department may be a good candidate in poor situation.
3) If a benefit to give favorable conditions to basic medical researcher may be legally provided, many residents assume attractive life in basic medicine.

Eight years ago the problem-based learning tutorial system was introduced for premedical education at Kinki University School of Medicine. We evaluated this unique education system with questionnaires for students in 1997 and 2000. The suitability of the problem-based learning tutorial system for medical education was 72% in 1997 and 92% in 2000. Approximately 90% students were satisfied with the tutorial system in both years, indicating that this system was widely accepted by even first-year students. However, group differences and differences due to tutors were still observed in the activities of students or the achievement of general instructional objectives or both. The content of the tutorial system and tutor training should be continuously evaluated.

Remedial education in the basic sciences (biology, physics, and chemistry) for medical students was introduced at Kinki University in 1993. The effects and problems of premedical education were examined on the basis of a questionnaire to students and of scores on biology examinations at the time of university entrance and at the end of the first academic year. From 1999 through 2002, the average percentage of incoming freshmen who had not taken a biology course in senior high school ranged from 45.8% to 61.6%. The average score of these students on biology examinations was 23.2 to 29 points higher at the end of the first academic year than at university entrance. Thus, we found that remedial education helped improve these results. However, according to the questionnaire 26.4% of students who received remedial education felt that it had had no effect. Even at the end of the first academic year, the difference in the average score between students who had studied biology in high school and those who had not was 17 points.

The collapse of community medicine has becomes a serious social problem in Japan, and a variety of measures have been implemented to counter it. In medical education, the model core curriculum has been revised, and many universities have started programs for community medical. We have had a community-based medical course at the Kinki University School of Medicine since 2005. This study examined the changes in students' consciousness about and affinity for community medicine during our program.
1)Questionnaires were completed by 494 students taking part in community-based medical training from April 2006 through July 2010. Results from before and after training were compared.
2)The questionnaire had 3 parts. The first part concerned medical activities with community residents. The second part concerned medical activities with housebound elderly persons. The third part concerned the students' future plans.
3)Many students gave themselves high scores for activities with community residents and housebound elderly persons. More students preferred hospitals in regional towns. A few students chose rural areas.
4)In an introduction to community medicine, it is important to first foster cordial relations with community residents. Cultivating problem-solving skills is the next challenge.
5)Community-based medical programs enhance medical students' understanding of and affinity for community medicine. Furthermore, some students will choose community-based medicine as a specialty.

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.

PURPOSE: Although the technical developments of radiotherapy have been remarkable, there are currently few reports on the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as initial treatment in this three-dimensional conformal radiotherapy era. Thus, we retrospectively evaluated the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as the initial treatment. MATERIALS AND METHODS: Thirty-two patients who underwent radiotherapy were enrolled in this study. The dose per fraction was 2.0–3.5 Gy. Because the treatment schedule was variable, the biological effective dose (BED) was calculated. RESULTS: Local control (LC) and overall survival (OS) rates from the completion of radiotherapy were calculated. The 1-, 2-, 3-, 4-, and 5-year LC rates were 51.5%, 24.5%, 19.6%, 19.6%, and 13.1%, respectively. LC rates were significantly higher for the high BED group (≥75 Gy10) than for the lower BED group (<75 Gy10). All patients who reported pain achieved pain relief. The duration of pain relief was significantly higher for the high BED group than for the lower BED group. The 1-, 2-, 3-, 4-, and 5-year OS rates were 82.6%, 56.5%, 45.2%, 38.7%, and 23.2%, respectively. There was a trend toward higher OS rates in with higher BED group compared to lower BED group. CONCLUSION: For patients with unresectable locally recurrent rectal cancer treated with surgery alone, radiotherapy is effective treatment. The prescribed BED should be more than 75 Gy10, if the dose to the organ at risk is within acceptable levels.
Appointments and Schedules ; Humans ; Radiotherapy* ; Radiotherapy, Conformal ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies

Purpose: To clarify the family-perceived usefulness of a pamphlet for families of imminently dying patients. Methods: Physicians and/or nurses provided medical and practical information about the dying process using a pamphlet for families of imminently dying patients. We surveyed family members 6 months after the death of the patient about the perceived usefulness. Results: We sent out a questionnaire to 325 bereaved, and obtained an answer from 260 (response rate: 85%). Overall, 81% reported the pamphlet to be “very useful” or “useful”. The experience reported by the bereaved included: “Helped me to understand the dying process” (84%); “Helped me to understand how symptoms and changes occur” (76%), “Useful in preparation for patient's death“ (75%), “Helped me to understand the physical conditions of the patient” (75%), “Helped me to know what I can do for the patient” (74%). Conclusion: “A pamphlet for families of imminently dying patients” may be useful for members of an imminently dying patient's family.

Purpose: Primary tumor location of colon cancer has been reported to affect the prognosis after curative resection. However, some reports suggested the impact was varied by tumor stage. This study analyzed the prognostic impact of the sidedness of colon cancer in stages II, III, and liver metastasis after curative resection using propensity-matched analysis. Methods: Right-sided colon cancer was defined as a tumor located from cecum to splenic flexure, while any more distal colon cancer was defined as left-sided colon cancer. Patients who underwent curative resection at Nara Medical University hospital between 2000 and 2016 were analyzed. Results: There were 110 patients with stage II, 100 patients with stage III, and 106 patients with liver metastasis. After propensity matching, 28 pairs with stage II and 32 pairs with stage III were identified. In the patients with stage II, overall survival (OS) and recurrence-free survival (RFS) were not significantly different for right- and left-sided colon cancers. In the patients with stage III, OS and RFS were significantly worse in right-sided colon cancer. In those with liver metastasis, OS of right-sided colon cancer was significantly worse than left-sided disease, while RFS was similar. Regarding metachronous liver metastasis, the difference was observed only in the patients whose primary colon cancer was stage III. In each stage, significantly higher rate of peritoneal recurrence was found in those with right-sided colon cancer. Conclusion Sidedness of colon cancer had a significant and varied prognostic impact in patients with stage II, III, and liver metastasis after curative resection.

OBJECTIVE: This study aimed to evaluate the efficacy of magnetic resonance (MR) imaging in differentiating between cutaneous basal cell carcinoma (cBCC) and cutaneous squamous cell carcinoma (cSCC) in the head and neck region.MATERIALS AND METHODS: Among patients with cutaneous head and neck cancers, 14 with primary cBCCs and 15 with primary cSCCs with a histologic tumor height of ≥ 4 mm underwent MR examinations; the findings were then examined for correlations.RESULTS: cBCCs (71%) occurred more frequently on the nose than cSCCs (13%) (p < 0.01). The maximum diameter (23.5 ± 7.2 mm vs. 12.7 ± 4.5 mm; p < 0.01) and diameter-to-height ratio (2.8 ± 0.9 vs. 1.7 ± 0.4; p < 0.01) were significantly greater in cSCCs than in cBCCs. Superficial ulcer formation (67% vs. 21%; p < 0.05), protrusion into the subcutaneous tissue (60% vs. 21%; p < 0.05), ill-demarcated deep tumor margins (60% vs. 7%; p < 0.01), and peritumoral fat stranding (93% vs. 7%; p < 0.01) were more frequently observed in cSCCs than in cBCCs. Intratumoral T2-hyperintense foci (57% vs. 13%; p < 0.05) were more frequently observed in cBCCs than in cSCCs.CONCLUSION: cBCCs predominantly occurred on the nose with intratumoral T2-hyperintense foci, whereas cSCCs predominantly exhibited a flattened configuration, superficial ulcer formation, protrusion into the subcutaneous tissue, ill-demarcated deep tumor margin, and peritumoral fat stranding.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Epithelial Cells ; Head ; Humans ; Magnetic Resonance Imaging ; Neck ; Nose ; Skin Neoplasms ; Subcutaneous Tissue ; Ulcer

Objective: To assess the noncontrast two-dimensional single-shot balanced turbo-field-echo magnetic resonance angiography (b-TFE MRA) features of the abdominal aortic aneurysm (AAA) status following endovascular aneurysm repair (EVAR) and evaluate to detect endoleaks (ELs). Materials and Methods: We examined four aortic stent-grafts in a phantom study to assess the degree of metallic artifacts. We enrolled 46 EVAR-treated patients with AAA and/or common iliac artery aneurysm who underwent both computed tomography angiography (CTA) and b-TFE MRA after EVAR. Vascular measurements on CTA and b-TFE MRA were compared, and signal intensity ratios (SIRs) of the aneurysmal sac were correlated with the size changes in the AAA after EVAR (AAA prognoses). Furthermore, we examined six feasible b-TFE MRA features for the assessment of ELs. Results: There were robust intermodality (r = 0.92–0.99) correlations and interobserver (intraclass correlation coefficient = 0.97–0.99) agreement. No significant differences were noted between SIRs and aneurysm prognoses. Moreover, “mottled high-intensity” and “creeping high-intensity with the low-band rim” were recognized as significant imaging findings suspicious for the presence of ELs (p < 0.001), whereas “no signal black spot” and “layered high-intensity area” were determined as significant for the absence of ELs (p < 0.03). Based on the two positive features, sensitivity, specificity, and accuracy for the detection of ELs were 77.3%, 91.7%, and 84.8%, respectively. Furthermore, the k values (0.40–0.88) displayed moderate-toalmost perfect agreement. Conclusion Noncontrast MRA could be a promising imaging modality for ascertaining patient follow-up after EVAR.