A rural medicine experience camp is held every year for medical students of Sapporo Medical University who are obligated to work in rural area after graduation. We organized two method in our camp : 1. the lecture about rural medicine by senior medical students, 2. setting up the learning content in camp by participant before camp. We investigated how these methods make an impact on the participant's motivation about rural medicine. The results suggested that a method 1 enhanced the understanding of rural medicine and method 2 raised an a warenss about rural medicine. We thought that it was important to try various education about rural medicine for increasing the motivation to rural medicine for medical student.

Surveys of mosquito larvae were carried out in six areas of Kosrae Island, Kosrae State, the Federated States of Micronesia in December 2009 and June 2012. A total of 962 larvae of six species were collected from 106 natural and artificial habitats. They were identified as Aedes aegypti, Ae. albopictus, Ae. marshallensis, Culex quinquefasciatus, Cx. annulirostris, and Cx. kusaiensis. This is the first report from Kosrae Island for three of these species—Ae. marshallensis, Cx. quinquefasciatus, and Cx. annulirostris. The most abundant species was Ae. albopictus, followed by Ae. marshallensis, and these two species were found in all areas. Relatively large numbers of Cx. quinquefasciatus and Cx. kusaiensis were found in five areas. Fewer Cx. annulirostris were found, and only in three areas. Aedes aegypti larvae were collected from a single habitat at Tafunsak in 2009. To prevent the outbreak of dengue fever, environmental management should focus on the destruction, alteration, disposal and recycling of containers that produce larger numbers of adult Aedes mosquitoes.

Many reports say that DWI (diffusion-weighted-image) is very useful for the diagnosis of cerebral infarction, especially in the acute phase, but it is difficult to have a fine image because DWI is very sensitive to artifacts caused by the “body-move” of the patient.
About the degree of MPG (motion probing gradient), criteria are yet to be established. Many persons try in their own way. With MPG5, the intensity of CSF and that of the focal lesion are almost equal, so that it is difficult to distinguish infarcts from adjacent ventricles.
The stronger the degree of MPG is, the more artifacts or noises we get, We recommend MPG6 or 7 in the right-left direction.

We have previously reported that the thoracolumbar posterior nerve root shows a tortuous epidural course, based on studies of human fetuses near term. For comparison with the cervical nerve, examinations were conducted using frontal, sagittal and horizontal sections of cervical vertebrae from 22 fetuses at 30–38 weeks of gestation. The cervical nerve root showed a short, straight and lateral course near the zygapophysial joint. Multiple rather than single bundles of the cervical posterior root seemed to account for the majority of sensory nerve fibers innervating the upper extremity. Fasciculation of rootlets was evident near the thoracolumbar spinal cord, whereas it was seen in the dural pocket at the nerve exit from the dural sac although both sites were subdural. As in the thoracolumbar region, the nerve sheath was continuous with the dura mater and independently surrounded each of the anterior and posterior roots. Radicular arteries were few in the cervical region. In 2 of the 22 fetuses (31 weeks and 33 weeks), there was a segmental, unilateral abnormality of nerve rootlet fasciculation where the dorsal root ganglion was located lateral or peripheral to the intervertebral region. Long nerve roots running inferiorly are a necessary adaptation to the delayed and marked growth of the thoracolumbar vertebral column.In children, the cervical nerve roots are likely to be affected by movement or dislocation of the vertebrae. The segmental abnormality of the cervical nerve root may be linked to rare variations in the brachial plexus.

BACKGROUND: In general practice, though patients often stop visiting ambulatory clinics of their own vo-lition despite the need for ongoing medical treatment, there is little reported research on the reasons for nonattendance in Japan. In this study, we investigated whether the patient/doctor relationship influences nonattendance rates in general practice. In addition, we investigated the reasons why patients stopped visiting the hospital.
METHODS: We collected data from 115 patients (58 males, 57 females; age range: 16 to 94 years old, median age: 52 years old) whose initial diagnoses were made in our department from June to July 2000. We classified the patients into five groups based on the level of their complaints concerning the initial consultation (‘A’ representing the highest degree of complaint, ‘E’ representing the lowest) and determined the relationship between the strength of complaints and the non-attendance rate. Furthermore, we investigated the reasons for non-attendance concerning 28 patients who stopped visiting the hospital from April 2000 to November 2001.
RESULTS: The non-attendance rates were 0% (014) for group A, 14.3% (2114) for group B, 5.6% (5189) for group C, 33.3% (216) for group D, and 50% (1/2) for group E. The rate tended to be higher in groups with fewer complaints. The reasons for non-attendance were the following: remission of symptoms (9 patients), request for another hospital or department (6 patients), relief due to consultation at the university hospital (6 patients), and lack of time to come to the particular hospital (5 patients) . In contrast, the most common reason for satisfaction at the time of consultation was ‘enough explanation and listening to complaints well’ in 7 of 11 patients who were satisfied with the consultation.
CONCLUSIONS: The level of patient's complaints at the time of consultation is related to the non-attendance rate. However, sufficient explanation about symptoms and careful listening to complaints are important for establishing a good patient/doctor relationship.

Perivalvular leakage (PVL) is one of the serious complications of mitral valve replacement. Between 1991 and 2006, 9 patients with mitral PVL underwent reoperation. All of them had severe hemolytic anemia before surgery. The serum lactate dehydrogenase (LDH) level decreased from 2,366±780 IU/l to 599±426 IU/l after surgery. The site of PVL was accurately defined in 7 patients by echocardiography. PVL occurred around the posterior annulus in 3 patients, anterior annulus in 2, anterolateral commissure in 1, and posteromedial commissure in 1. The most frequent cause of PVL was annular calcification in 5 patients. Infection was only noted in 1 patient. In 4 patients, the prosthesis was replaced, while the leak was repaired in 5 patients. There was one operative death, due to multiple organ failure, and 4 late deaths. The cause of late death was cerebral infarction in 1 patient, subarachnoid hemorrhage in 1, sudden death in 1, and congestive heart failure (due to persistent PVL) in 1. Reoperation for PVL due to extensive annular calcification is associated with a high mortality rate and high recurrence rate, making this procedure both challenging and frustrating for surgeons.

The aim of this study was to examine the effects of fibroblast growth factor-2 (FGF-2) on cancer cell invasion and on fibroblast proliferation in an in vitro model of invasion. Three kinds of human oral squamous cell carcinoma cell lines with different invasive activity were used: OSC-20, OSC-19 (lower invasive type), and HOC313 (higher invasive type). FGF-2 and its high-affinity receptors FGFR-1 and FGFR-2 were detected by western blotting. The expression of FGF-2 and FGFRs mRNA was examined in cultured human oral squamous cell carcinoma cells by reverse transcriptase polymerase chain reaction (RT-PCR). Furthermore, recombinant human FGF-2 (rhFGF-2) was reacted with each cell line, and the invasion rate was determined by invasion assay. We also observed the behavior of cancer cell invasion in the collagen gel invasion model in the presence or absence of FGF-2-neutralizing antibody (anti-FGF-2). HOC313 cells showed higher expression of FGF-2 than OSC-20 and OSC-19 cells. The addition of rhFGF-2 promoted not only the proliferation of fibroblasts, but also the invasion of all cancer cell lines. In contrast, the addition of anti-FGF-2 completely inhibited the invasion of OSC-20 and OSC-19 cells. These results suggest that a higher invasiveness of squamous carcinoma cells is associated with higher production of FGF-2, which acts in an autocrine fashion to promote cancer cell invasion, and in a paracrine fashion to promote fibroblast proliferation.

1) We investigated the patients'evaluations of the students, our management of the medical training, and the patients' recognition of our outpatient clinic education. We then requested the patients to give their opinions regarding such interviews.
2) The patients'evaluations of the outpatient clinic and the patients'recognition of our outpatient clinic education were relatively good, but some patients complained about the short duration of medical care and also expressed anxiety over the students'medical interview.
3) Many patients expressed the desire to positively participate in medical education because the patients had high expectations of the medical students.In addition, this interview training fulfilled the patients'desire to be listened to and have their concerns acknowledged.