X type questions have been used for the national medical licensing examination since 1997. At Tsukuba University, X type questions have been used since 1996. We compared X typeand K type questions on the basis of the percentage of correct answers and discrimination power. The average percentage of correct answers was 68.2% for K type questions and 53.1% for X type questions. However, the average discrimination power was +0.227 for K type questions and +0.257 for X type questions. These results indicate that X type questions are more difficult and are suitable for achievement tests. The estimated knowledge quantity was 2.04 for K type questions and 2.32 for X type questions. This suggests that the person writing the questions decreased the essential difficulty of X type questions.

Exercise therapy as well as diet therapy, is fundamental in the treatment of diabetes mellitus, however, its methods and effects of long term physical exercise therapy has not yet been clarified.
The present study has been designed to evaluate the effects of physical exercise therapy in diabetic patients with fasting hyperglycemia. Ten non-insulin dependent diabetic patients participated in a 6-month physical exercise program consisting of 30 min, of jogging performed 3 times per week (Exercise group) . The exercise intensity represented 40% of estimated Vo₂max.
The following results were obtained:
1. More significant improvement of glucose tolerance and plasma insulin response to glucose load was observed in exercise group as compared with the patients treated with mild caloric restriction alone (Diet group, N=15) .
2. The significant increase in plasma HDL-cholesterol and HDL-cholesterol/total cholesterol ratio was observed only in exercise group.
3. The reduction of body weight in exercise group was significantly greater than that in diet group.
4. The physical exercise also resulted in an improvement of cardiovascular adaptaion to exercise.
5. Improvement of symptoms in daily life activity was also found after physical exercise therapy. However, some medical troubles such as hypoglycemia, muscle pain and arthralgia were found during observation period.
In conclusion, physical exercise therapy is useful as an adjunct to diet to improve metabolic control in patients with diabetes mellitus. And for effective exercise therapy, exercise program must be individualized, and motivation is stimulated by team including physician, trainer, nurse and dietitian.

Objective: Monitoring the incidence of atypical femoral fractures (AFFs) using medical claim databases is useful to assess the safety of long-term bisphosphonate exposure. Therefore, we aimed to validate the relationship between clinically-defined suspected AFFs and the candidate patients obtained from claims data at three hospitals in Japan.

Design: A cross-sectional study involving three hospitals that perform bone fracture surgery and from which electronic medical record databases of diagnoses and procedures are available.

Methods: Candidate patients were at the medical databases using two International Classification of Diseases, 10th Edition (ICD-10) codes (subtrochanteric fracture and fracture of shaft of femur) in the claims databases. These potential cases by claim-based definition were validated using clinically-confirmed information such as, the patient operation records, the discharge records, or radiographic imaging findings as suspected AFFs.

Results: Among fracture cases in the hospitals, and 9 cases with subtrochanteric fracture and 23 cases with femoral shaft fracture were identified based on the ICD-10 codes in the claims databases. Clinically confirmed subtrochanteric fracture had a sensitivity of 81.8% (95% CI: 48.2-97.7%), and a specificity of 100.0% (95% CI: 99.9-100.0%). For femoral shaft fracture, the sensitivity was 82.1% (95% CI: 63.1-93.9%), and the specificity was 100.0% (95% CI: 99.9-100.0%). In subgroup analyses, the sensitivities in patients over the age of 50 years with a single fracture site and with osteoporosis were relatively higher than in other subgroups.

Conclusion: The claims-based definitions of suspected AFFs are accurate, indicating the value of pharmacoepidemiological studies using the National Receipt Database.

Among early colorectal carcinoma, endoscopic treatment is generally indicative for cases with intramucosal to submucosal (SM) superficial invasion, because cases with SM deep invasion should be treated surgically due to the risk of lymph node metastasis. It is important, therefore, to distinguish between superficial and deep SM invasion in early colorectal carcinoma prior to treatment. In this review we assessed the clinical usefulness and knack of pit pattern and narrow band imaging (NBI) diagnosis using magnifying observation. VN type pit pattern, type C3 in NBI Hiroshima classification and NBI type 3 in NBI international colorectal endoscopic (NICE) classification are useful predictors of SM deep invasion. In NBI magnifying observation evaluation of both the vascular pattern and surface pattern are important. We have to use pit pattern diagnosis and NBI magnifying diagnosis as the situation demands with the knowledge of both advantage and disadvantage in each diagnostic method.
Colonoscopy ; Colorectal Neoplasms ; Imidazoles ; Lymph Nodes ; Narrow Band Imaging ; Neoplasm Metastasis ; Nitro Compounds

Exercise has been well known to a fundamental treatment of diabetes mellitus, as well as diet therapy. Nevertheless, its therapeutic use and clinical effects are still unknown in details. The aim of this study is the establishment of practical exercise therapy for the patients with diabetes mellitus. The present study shows the acute exercise effects on blood metabolites and the effects of long term physical training in diabetics.
The following results were obtained.
1) Although no significant change of blood glucose level was observed in normals, the decrease of blood glucose and triglyceride levels were observed in diabetics in acute exercise. Moreover marked elevation of FFA level was also observed after acute exercise in diabetics.
2) Significant decrease of blood glucose and increase of HDL-cholesterol levels were found in diabetics by long term regular physical training.
3) Body weight reduction without loss of lean body mass and the improvement of physiological response to exercise test were achieved after long term physical training.
These results suggest that the regular physical training leads to the better control of diabetes mellitus and keeps good condition in patients with diabetes mellitus, and that it may have a important role of the prevention for the diabetic vascular complication.

PURPOSE: The purpose of this study was to evaluate the efficacy of two different metal conditioners for non-precious metal alloys for the bonding of porcelain to a cobalt-chromium (Co-Cr) alloy. MATERIALS AND METHODS: Disk-shaped specimens (2.5x10.0 mm) were cast with Co-Cr alloy and used as adherend materials. The bonding surfaces were polished with a 600-grid silicon carbide paper and airborne-particle abraded using 110 microm alumina particles. Bonding specimens were fabricated by applying and firing either of the metal conditioners on the airborne-particle abraded surface, followed by firing porcelain into 5 mm in diameter and 3 mm in height. Specimens without metal conditioner were also fabricated. Shear bond strength for each group (n=8) were measured and compared (alpha=.05). Sectional view of bonding interface was observed by SEM. EDS analysis was performed to determine the chemical elements of metal conditioners and to determine the failure modes after shear test. RESULTS: There were significant differences among three groups, and two metal conditioner-applied groups showed significantly higher values compared to the non-metal conditioner group. The SEM observation of the sectional view at bonding interface revealed loose contact at porcelain-alloy surface for non-metal conditioner group, however, close contact at both alloy-metal conditioner and metal conditioner-porcelain interfaces for both metal conditioner-applied groups. All the specimens showed mixed failures. EDS analysis showed that one metal conditioner was Si-based material, and another was Ti-based material. Si-based metal conditioner showed higher bond strengths compared to the Ti-based metal conditioner, but exhibited more porous failure surface failure. CONCLUSION: Based on the results of this study, it can be stated that the application of metal conditioner is recommended for the bonding of porcelain to cobalt-chromium alloys.
Alloys* ; Aluminum Oxide ; Chromium Alloys ; Dental Porcelain* ; Fires ; Shear Strength ; Silicon

Magnetic resonance imaging (MRI) for diagnostic evaluation of the breast was performed in 61 patients who visted the Breast Clinic of our hospital and were suspected to have malignant tumors by physical examination and mammography between January and December 1999. In 58 patients undergoing histological diagnostic tests (8 with benignancy and 50 with breast cancer), we compared the imaging characteristics and the time-signal intensity curves acquired by dynamic imaging between benign and malignant lesions, and evaluated the usefulness of analyzing enhancement patterns on contrast MRI. Contrast MRI revealed strong tumor enhancement in all patients; the mean time required for the signal intensity to reach a peak was about 7 min in patients with benign tumors and about 2 min in those with breast cancer. Peripheral ring enhancement was observed in 40 of the 50 patients with breast cancer (80.0%), while such enhancement was not noted in any of the patients with benign tumors.
Although diagnosis of breast disease by imaging has primarily relied on mammography and ultrasonography, the pattern of contrast enhancement on dynamic MRI also appears to be useful for determining the treatment method of breast tumors.

Purpose: Dental floss clip (DFC) traction-assisted endoscopic submucosal dissection (ESD) is widely performed owing to its simplicity. This study aimed to clarify the appropriate indications for the DFC traction method in early gastric cancer when ESD is performed by less-experienced endoscopists. Methods: and Methods: We retrospectively analyzed 1,014 consecutive patients who had undergone gastric ESD performed by less-experienced endoscopists between January 2015 and December 2020. Gastric ESD was performed without DFC in all cases before December 2017 [DFC (−) group, 376 cases], and ESD was performed with DFC in all cases after January 2018 [DFC (+) group, 436 cases]. The procedure time and rates of en bloc resection, complete resection, and adverse events of the groups were compared. Results: The procedure time did not differ significantly between the 2 groups. However, when comparing lesions >20 mm, the procedure time in the DFC (+) group was significantly shorter than that in the DFC (−) group (95±46 vs. 75±31, P<0.01). The procedure time for lesions located in the greater curvature of the upper or middle stomach and lesions >20 mm located in the lesser curvature side of the stomach in the DFC (+) group was significantly shorter than that in the DFC (−) group. Conclusions The indications for DFC during gastric ESD by less-experienced endoscopists include lesions located in the greater curvature of the upper or middle stomach, and lesions >20 mm located in the lesser curvature of the stomach.

STUDY DESIGN: Animal study. PURPOSE: To review the present warning point criteria of the compound muscle action potential (CMAP) and investigate new criteria for spinal surgery safety using an animal model. OVERVIEW OF LITERATURE: Little is known about correlation palesis and amplitude of spinal cord monitoring. METHODS: After laminectomy of the tenth thoracic spinal lamina, 2-140 g force was delivered to the spinal cord with a tension gage to create a bilateral contusion injury. The study morphology change of the CMAP wave and locomotor scale were evaluated for one month. RESULTS: Four different types of wave morphology changes were observed: no change, amplitude decrease only, morphology change only, and amplitude and morphology change. Amplitude and morphology changed simultaneously and significantly as the injury force increased (p<0.05) Locomotor scale in the amplitude and morphology group worsened more than the other groups. CONCLUSIONS: Amplitude and morphology change of the CMAP wave exists and could be the key of the alarm point in CMAP.
Action Potentials* ; Animals* ; Contusions ; Gravitation ; Laminectomy ; Models, Animal* ; Spinal Cord

Background/Aims: Dual red imaging (DRI) is a new, image-enhanced endoscopy technique. There are few reports about the usefulness of DRI during gastric endoscopic submucosal dissection (ESD). We aimed to examine the usefulness of DRI in endoscopic hemostasis during gastric ESD. Methods: We enrolled a total of 20 consecutive patients who underwent gastric ESD. Five endoscopists compared DRI with white light imaging (WLI) for the visibility of blood vessels and bleeding points while performing endoscopic hemostasis. Results: The visibility of blood vessels was increased in 56% (19/34) of the cases, and the visibility of bleeding points was improved in 55% (11/20) of the cases with the use of DRI compared with the use of WLI. Conclusions DRI improved the visibility of blood vessels and bleeding points in cases with oozing bleeding, blood pooling around the bleeding points, and multiple bleeding points.