The postgraduate medical training system will officially start the initial clinical training this year, but the subsequenttraining of medical specialists is left, as a matter of fact, to the independence of medical scientific societies which certifiesmedical specialists. The Ministry of Health, Labour and Welfare has approved in spring 2002 the advertisement ofmedical specialists certified by societies under certain conditions as an alleviating measure of the medical advertisementregulations. The Japanese Board of Medical Specialties comprising from medical scientific societies that participate inthe Japanese Association of Medical Sciences and own a medical specialist certification system, is asking cooperationfrom medical societies in order to foster the respectable medical specialists and establish a medical specialist system.However, many problem awaiting solution have been pointed out in the current medical specialist certification system.For fostering high quality medical specialists, the Japanese Board of Medical Specialties needs to be functioning as athird party.

Previously, we observed that hypoxic pulmonary vasoconstriction (HPV) can be reduced by endurance exercise training. This study determined whether nitric oxide (NO) plays a role in inhibition of the HPV after endurance exercise training in isolated rat lung perfused with physiological saline solution containing meclofenamate. Sprague-Dawley rats were used, and were divided into two groups: a control (Cont) group and an endurance exercise-trained (ET) group. Endurance exercise training was carried every day on a small-animal motorized treadmill. The training protocol was 30 to 40 min/day and the rats ran at a speed of 15 to 30 m/min for 2 weeks. It appeared that HPV could be reduced by short-term endurance exercise training. The NO-forming enzyme inhibitor, N^G-nitro-L-arginine methyl ester (1.5×10^-8M, L-NAME), administered to the ET group increased the HPV compared in that of the Cont group. These findings indicate that endothelial NO synthesis may contribute to the inhibition of HPV in ET rats. Our data suggest that endurance exercise training promotes endothelium dependent-pulmonary vasodilation through the stimulation of NO released during HPV.

This study reviewed the influence of hypoxic training on hypoxic pulmonary vasoconstriction (HPV) sensitivity in the isolated perfused lungs preparation of rats. In addition, the study examined the kind of mechanism involved. Therefore, we inhibited nitric oxide (NO) release of endothelial cells, using on NO synthase inhibitor, and reviewed the impact on HPV.As a result, the following became clear. 1)Hypoxic training inhibited HPV. 2) HPV was increased by the administration of NO synthase inhibitor L-NMMA, in particular, conspicuously inhibited HPV in the hypoxic training group was increased. 3) The negative correlation between the onset of blood lactate accumulation and HPV was significant.From the above, it can be concluded that hypoxic training inhibited HPV and NO release for a pulmonary vascular endothelial cell. In addition, we understood that HPV was decreased by hypoxic training as the ability for endurance exercise was increased.

We report a case of dysphagia caused by compression of the esophagus by the nonaneurysmal tortuous descending aorta (dysphagia aortica). A 69-year-old woman was admitted suffering from dysphagia. Esophagoscopy showed esophageal stenosis caused by pulsatile and extramural compression. Esophagography and aortograms also showed that the nonaneurysmal tortuous descending aorta compressed the esophagus in an anteromedian direction. To avoid the esophageal ulcer and the aortoesophageal fistula, resection of the tortuous aorta and a Dacron graft replacement was performed. After operation compression of the esophagus was released and her complaint improved.

1) The historical development to date of the systems of medical education and medical licensure were reviewed, and the quantitative and qualitative evolution of medical schools was divided into 7 stages.2) In the early Meiji era, persons who had already practiced medicine could apply to receive a medical license. Until the Taisho era, medical licenses were granted either to graduates of medical universities and relevant special schools or to those who passed the national examination. Thus, the criteria for medical license were not uniform during this period.3) Before the end of World War II, medical schools aimed to improve the quality of medical education so that their graduates could receive medical licenses without taking the national examination and to raise their status to the level of universities. However, because the types of medical schools during this period varied and included imperial universities, colleges, and specialty schools, the quality of medical education also varied.4) After World War II, the introduction of the state examination for the license to practice medicine and a new university system standardized medical education to guarantee its quality.5) The quantitative expansion of the medical education occurred mainly in the 12 years after 1919, in the 7 years after 1939 and during the war, and in the 10 years after 1970, and, except for the years of violent change before 1887, the number of medical schools has otherwise remained stable.

BACKGROUND: Estrogens exert preferable effects on bone metabolism through two estrogen receptors (ERs), ER1 and ER2, which activate the transcription of a set of genes as ligand-dependent transcription factors. Thus, growth factors and hormones which modulate ER expression in the bone, if any, may possibly modulate the effect of estrogens on bone metabolism. However, research as to which of these molecules regulate the expression of ERs in osteoblasts has not been well documented. METHODS: A reporter assay system developed in this study was used to explore molecules that modulate ER1 expression in MC3T3-E1 osteoblastic cells. Gene expression was analyzed by reverse transcription-polymerase chain reaction. RESULTS: A pilot study using the reporter system revealed that bone morphogenetic protein (BMP)-2 negatively regulated ER1, but not ER2, expression in MC3T3-E1 cells. Consistently, estradiol-induced reporter activity via an estrogen responsive element was strongly suppressed in MC3T3-E1 cells pretreated with BMP-2. CONCLUSIONS: BMP-2 desensitizes osteoblastic cells to estrogen through downregulation of ER1 expression.
Bone Morphogenetic Proteins ; Down-Regulation* ; Estrogen Receptor alpha* ; Estrogens* ; Gene Expression ; Intercellular Signaling Peptides and Proteins ; Metabolism ; Osteoblasts* ; Pilot Projects ; Receptors, Estrogen ; Transcription Factors

An 81-year-old man who had a saccular abdominal aortic aneurysm (AAA) with a narrow terminal aorta underwent endovascular aortic aneurysm repair (EVAR) with the Medtronic Endurant^® stent graft system. After 4 days, computed tomography (CT) showed stenosis of the stent graft left limb, which was pressed flat against the right limb at the narrow terminal aorta. We performed re-intervention to dilate the narrow terminal aorta and bilateral limbs with kissing stenting using Express Vascular LD^® (Boston Scientific). After operation his ankle brachial pressure index rose from 0.88 to 0.99 and there was no evidence of stenotic limbs at CT image. We need to be careful about the stenotic limb after EVAR with Medtronic Endurant stentgraft system for AAA with a narrow terminal aorta.

A rare surgical case of chronic expanding hematoma in the pericardial cavity is reported. A 78-year-old man had undergone coronary artery bypass grafting 2 years previously. He had suffered from general malaise, increasing shortness of breath and systemic edema from 18 months after the operation. Echocardiography revealed an intrapericardial mass compressing the cardiac chambers resulting in insufficiency of the ventricular expansion. Under extracardiopulmonary bypass and cardiac beating, resection of the mass and additional coronary artery surgery were implemented. The mass was encapsulated with thick fibrous membrane containing old degenerated coagula the bacterial culture of which was negative and was histopathologically diagnosed as chronic expanding hematoma. The patient's postoperative course was uneventful and symptoms with cardiac failure were relieved. There has been no recurrence for more than 18 months.

We report a case of a 64-year-old man who had a fistula from the right coronary artery to the right ventricle, with an asymptomatic giant coronary aneurysm. Multi-detector computer tomography showed an aneurysm from the sinus of Valsalva to the mid-right coronary artery (RCA). Its diameter was over 50 mm. We performed aneurysmectomy direct closure of the fistula, and coronary artery bypass graft with saphenous vein graft cardiopulmonary bypass. The enlarged RCA orifice was closed with a vascular prosthesis, and the postoperative course was uneventful.