Background: There is an increasing demand for general practitioners capable of examining patients from a broad perspective. Although the training of such doctors is urgently needed, the accreditation system was only recently put into place.Purpose: Our aim was to identify factors that influence career decision-making among doctors who were interested in general practice but chose to be specialists, in addition to finding methods to improve general practitioner training in the future.Method: From April 2017 to April 2018, we conducted semi-structured interviews with five subjects to understand the process leading up to the selection of their current careers. The verbatim records were analyzed using the modified grounded theory approach.Results: The reasons given for choosing specialist careers included "attraction as a field of study", "being relied upon by other doctors", and "the sense of security from having a specialty". Cited barriers to entering general practice included "uncertainty about the future" and "criticism from specialists".Conclusion: Improving the training curriculum for general practitioners will require improvement of the quality of community-based medical education and the general practice board certification system, in addition to the implementation of general practice retraining for specialists.

We report the case of a 63-year-old male with diabetes who was diagnosed with staphylococcal bacteremia. Paralysis of the extremities (right upper, left lower) and bladder and bowel dysfunction developed 5 days after treatment initiation. Spinal magnetic resonance imaging revealed a spinal epidural abscess at the L4/5 level. Despite right upper extremity palsy, there was no visible cervical spine abscess. Emergency surgery was undertaken, which resulted in complete neurological recovery. General physicians must be aware that damage to the spinal cord can be caused not only by direct compression of an epidural abscess but also by impaired blood circulation or inflammation.

A 64-year old man was admitted to our hospital with a diagnosis of aortic stenosis. Pre-operative chest CT revealed pseudocoarctation of the aorta with a hypoplastic aortic arch, elongation and kinking of the aortic arch and proximal descending aorta. There was also a large aneurysm from the distal arch to descending aorta. We performed a single-stage repair of the aortic lesion from the ascending to the descending aorta with aortic valve replacement. For the surgical approach, transverse clamshell incision was applied safely. Concomitant aortic valve replacement in surgical repair of pseudocoarctation and thoracic aneurysm was rare, and clamshell incision seemed beneficial in such single-stage repair from the aortic root to the descending aorta.

It is reported that myasthenia gravis (MG) with thymoma occupy 20% of all MG and extended thymectomy is recommended. After having operation, it is rare, but cases of recurrence of thymoma and, what is worse, thymic cancer from residual thymus tissue are reported. A 69-year-old man came to our hospital to have his dyspnea level examined. He had a past history of MG with thymoma and he had undergone extended thymectomy 17 years previously. Enhanced CT showed pericardial thickening and many tumors in the epicardium. Catheterization study showed dip and plateau pattern of left ventricular pressure. We therefore diagnosed constrictive pericarditis (CP). We performed pericardiectomy under cardiopulmonary bypass. He was discharged ambulatorily on postoperative day 24. Histological findings of the tumor and the pericardium showed that they were dissemination of thymic cancer. It was considered that thymic cancer caused CP and it was an extremely rare case. We think this is the first report to the best of our knowledge.

We developed a percutaneous left ventricular assist system (PLVAS) using a centrifugal pump. PLVAS is the transseptal left atrial-femoral artery bypass to unload the left ventricle using a centrifugal pump. This PLVAS can be implanted through the inguinal vessels under fluoroscopy and also in 2 cases additional transesophageal echocardiogram guiding was performed. This PLVAS was applied to 6 patients with profound heart failure and refractory cardiogenic shock. The implantation of PLVAS required 30-60 minutes. The PLVAS assist flow was maintained at 3.0-4.0l/min. One patient with acute myocardial infarction survived and has been doing well for more than 1 year. The complications directly related to this procedure were minimal. PLVAS appears to be useful for patients with severe heart failure and may be useful as a short-time support or bridge to other more aggressive forms of life support.

Aim To investigate more efficient synthetic method of the nitrogen analogue 4 of salacinol (1) for searching new antidiabetic agents. Methods The synthesis of the key intermediate 2,4-O-isopropylidene-L-erythritol 1,3-cyclic sulfate (2a) was accomplished by modification of reports from Dglucose via seven steps in much more less expensive. Using this method, an efficient synthesis of 4 was carried out. The glycosidase inhibitory activity of 4 was tested for the intestinal α-glucosidase in vitro and compared with that of salacinol. Results A nitrogen analogue 4 of salacinol (1) was synthesized by the coupling reaction between the cyclic sulfate 2a and an azasugar 3b. Conclusion Substitution of the sulfur atom in 1 with a nitrogen reduced the activity considerably.

AIMTo study the chemical composition of Opuntia dillenii Haw.

METHODSMany kinds of chromatography methods were used to separate the chemical constituents. Their structures were determined by NMR and MS spectral analysis.

RESULTSA new compound, together with five known compounds, were isolated from the 80% ethanolic extract of the stems.

CONCLUSIONThe new compound was identified as 4-ethoxyl-6-hydroxymethyl-alpha-pyrone. Compounds 1, 3, 4 and 5 were obtained for the first time from the genus of Opuntia, and they were: 3-O-methyl isorhamnein, 1-heptanecanol, vanillic acid, isorhamnetin-3-O-beta-D-rutinoside. Ruin was isolated from this plant for the first time.

Molecular Structure ; Opuntia ; chemistry ; Plant Stems ; chemistry ; Plants, Medicinal ; chemistry ; Pyrones ; chemistry ; isolation & purification ; Rutin ; chemistry ; isolation & purification ; Vanillic Acid ; chemistry ; isolation & purification

OBJECTIVETo study the chemical composition of Opuntia dillenii.

METHODMany kinds of chromatography methods were used in the isolation procedure, while the structures of isolated compounds were determined on the aids of NMR and MS spectral analysis.

RESULTA new compound, together with five known compounds, was isolated form the 80% ethanolic extract of its stems.

CONCLUSIONThe new compound was characterized as opuntioside. Four compounds were obtained for the first from the genus Opuntia, and they were daucosterol, p-hydroxybenzoicacid, L-(-)-malic acid, (E)-ferulic acid. Opuntiol was also separated for the first from the plant.

Coumaric Acids ; chemistry ; isolation & purification ; Molecular Structure ; Monosaccharides ; chemistry ; isolation & purification ; Opuntia ; chemistry ; Plant Stems ; chemistry ; Plants, Medicinal ; chemistry ; Sitosterols ; chemistry ; isolation & purification

A new educational program for the medical doctor was introduced at Tokyo Women's Medical College in 1990 with a 4-year tutorial education model as its core. To develop the program for educational training more efficiently, current facilities were reviewed on a large scale, and various types of equipment and supplementary materials were made available. We are now investigating utilization and problems of the current program. Supplies and materials of tutorial rooms and mirror rooms have been used effectively. The library has become increasingly useful as a place for independent study and research. However, audiovisual materials have not yet been made fully available. We suggest that further improvements to the system and fostering an environment of open access to information are necessary to increase the accessibility of the support system for tutorial education.