No Abstract Available.
Helicobacter pylori* ; Helicobacter*

Introduction: Lifelong learning is important for physicians because of patient safety and the need to constantly improve the quality of medical practice. However, few studies have investigated the specific topics that are required.
Methods: We examined the lifelong learning needs of physicians by means of a self-administered questionnaire that was completed by 595 subjects, who were clinical practitioners working in Gunma Prefecture.
Results: Subjects of all ages needed lectures about the use of evidence-based medicine in medical examinations, clinical studies and the interpretation of epidemiological data, and diagnostic imaging. The younger subjects had a greater need for learning about clinical skills and techniques, such as advanced cardiac life support／intensive care life support, abdominal ultrasonic diagnosis, and cardiac ultrasonic diagnosis. Regarding the ideal times for these lectures, some physicians working at Gunma University Hospital expressed a preference for weekdays after normal business hours, while others preferred the weekends.
Discussion: The lifelong learning needs of physicians were clarified. Because physicians work on different shifts and at different institutions, scheduling training sessions that everyone can attend is difficult, especially for those who are off-campus. The timing of the training sessions, as well as the content of lectures, must be considered. Ideally, sessions should be held more than once to accommodate the busy schedules of physicians. We believe that providing an opportunity for lifelong learning will help attract more people to a career in medicine and thereby help address the physician shortage.

Introduction and Methods: An immediate effect of the physician shortage is the return to clinical work by physicians who had earlier left. Therefore, the needs of returning physicians were examined by means of a self-administered questionnaire. The subjects were clinicians working in Gunma Prefecture.
Results: About 50% of female physicians and 25% of male physicians had left clinical practice. The reasons given for leaving were “studying abroad” for most male physicians and “pregnancy and child-rearing” for most female physicians. More than 70% of physicians who had left clinical work felt uneasy about returning. The degree of anxiety after returning did not differ significantly between male and female physicians. Problems encountered by returning physicians involved “changes in medicines,” “changes and progress in technology and medical theories,” and deterioration of their “skills and techniques.” Moreover, returning physicians felt a need for increased “practical skills training.”
Discussion: Our study has clarified the needs of physicians returning to clinical work. The development and adoption of a simple system that will help physicians return to clinical practice is required.

For endurance exercise in swimming mice, 1.8% VAAM (Vespaamino acid mixtiure) which has the same amino acid components as hornet (Vespamandarinia) larval saliva, 1.8% casein amino acid mixture (CAAM), 10% glucose, or amino acid mixtures in which the amino acids were varied while maintaining the same molar ratio as VAAM were administered orally to mice. Mice recieving 1.8% VAAM showed significantly longer maximum swimming times than mice receiving other nutrients. Among these nutrients, mixtures of proline, glycine, and essential amino acid mixture (EAAM) from the VAAM component, showed maximum times near those with VAAM. In swimming exercise in mice earring of 0.3g tail weight, mice administered 1.8% VAAM showed lower blood lactate concentrations and higher blood glucose concentrations than mice recieving other nutrients. Mice recieving 1.8% VAAM also had lower lactate concentrations in muscle as well as blood. This suggests that VAAM suppresses lactate production and glucose catabolism during exercise. The effects of hornet larval saliva were stronger than those of VAAM. VAAM therefore showed the major effect of the saliva. The results suggest that VAAM improves physiological condition during endurance exercise. A positive correlation was observed between the blood concentrations of lactate and glucose in exercising mice administered various nutrients (r=0.779) . This suggests metabolic equilibration between glucose and lactate during exercise. A positive correlation (r=0.507) was also found between the maximum swimming time and blood glucose concentration. Maximum swimming times were highest at low (Ca. 2.5 mMol) and high (Ca. 4.0 mMol) blood lactate concentrations in high blood glucose concentrations. These facts support that glucose homeostasis is important in prolonged exercise.

Using a highly concentrated CO₂-bathing, authors studied an effect of the bathing (CO₂: 1, 000ppm, for 10min at 40°C) on circadian blood pressure in six cases of antihypertensive drug-refractory hypertension. The patients were females, ranging from 62 to 70 years old (mean age: 65.8±2.6). All of the patients were diagnosed as the III stage of essential hypertension (according to WHO criteria) and have been treated with captopril, nifedipine or α-methyl DOPA since three to ten years ago. Out of six cases five showed non-dipper pattern in circadian blood pressure. All bathings were done at 16:30 and comparative study of circadian blood pressure between plain water and CO₂-bathing was carried out.
The results obtained were as follows.
1) In five cases of non-dippers CO₂-bathing exerted the therapeutic effect upon the high blood pressure at night and resulted in the significant decrease in hyperbaric indici of systolic, mean and diastolic blood pressure, comparing with plain water-bathing. However, no significant difference of heart rate was observed between plain water and CO₂-bathing.
2) In a case of good responder to antihypertensive drug, a relatively low blood pressure continued all day after CO₂-bathing.
From these results it is expected that a highly concentrated CO₂-bathing is useful as supportive therapy to essential hypertension, specially to non-dipper.

For endurance exercise in swimming mice, 1.8% VAAM (Vespaamino acid mixtiure) which has the same amino acid components as hornet (Vespamandarinia) larval saliva, 1.8% casein amino acid mixture (CAAM), 10% glucose, or amino acid mixtures in which the amino acids were varied while maintaining the same molar ratio as VAAM were administered orally to mice. Mice recieving 1.8% VAAM showed significantly longer maximum swimming times than mice receiving other nutrients. Among these nutrients, mixtures of proline, glycine, and essential amino acid mixture (EAAM) from the VAAM component, showed maximum times near those with VAAM. In swimming exercise in mice earring of 0.3g tail weight, mice administered 1.8% VAAM showed lower blood lactate concentrations and higher blood glucose concentrations than mice recieving other nutrients. Mice recieving 1.8% VAAM also had lower lactate concentrations in muscle as well as blood. This suggests that VAAM suppresses lactate production and glucose catabolism during exercise. The effects of hornet larval saliva were stronger than those of VAAM. VAAM therefore showed the major effect of the saliva. The results suggest that VAAM improves physiological condition during endurance exercise. A positive correlation was observed between the blood concentrations of lactate and glucose in exercising mice administered various nutrients (r=0.779) . This suggests metabolic equilibration between glucose and lactate during exercise. A positive correlation (r=0.507) was also found between the maximum swimming time and blood glucose concentration. Maximum swimming times were highest at low (Ca. 2.5 mMol) and high (Ca. 4.0 mMol) blood lactate concentrations in high blood glucose concentrations. These facts support that glucose homeostasis is important in prolonged exercise.

Westernization of lifestyles among Japanese, in particular among young generations, is a matter of concern for future increase in coronary heart disease. We surveyed a total of 349 male university students to examine changes in lifestyles and coronary risk factors in campus life. We compared dietary habits and serum fatty acid compositions as well as other coronary risk characteristics between freshmen (n=171) and fourth-year (senior) students (n=178). Serum fatty acid compositions and dietary intakes of selected foods as well as serum lipids, blood pressures and physical characteristics were examined at the 1996 and 1997 annual health examinations. Compared to freshmen, senior students had a lower frequency of fish, vegetable, milk and egg intake, and a higher frequency of oil and fat intake. The proportions of serum saturated and monounsaturated fatty acids were significantly higher among senior students than among freshmen, whereas the proportion of serum polyunsaturated fatty acids was significantly lower among senior students than among freshmen. Senior students also had higher systolic and diastolic blood pressures, percent body fat, smoking rate and alcohol usage than freshmen. Mean body weight and mean body mass index were not different between the two groups. Senior students generally showed Westernized dietary habits and higher coronary risk profiles than freshmen as indicated by the change of serum fatty acid compositions. Modification of these dietary habits and lifestyles may be important for the prevention of future CHD among Japanese young adults.
Serum ; Fatty Acids ; seconds ; Cardio- ; Risk

A 69-year-old woman was admitted with fever and dyspnea. We diagnosed the congestive heart failure due to infective endocarditis (IE) with mitral valve regurgitation and stenosis. We immediately started medical therapy in order to control both the heart failure and the infection. However, we had to semi-emergency mitral valve replacement additionally perform a days after the initial hospitalized due to a progression of the heart failure. The operative findings showed an area of vegetation to be incarcerated in the mitral orifice. In cases of IE which are associated with mitral stenosis, we therefore should consider the possibility that vegetation may be present in the mitral orifice and closely follow such patients by echocardiography.

A 20-year-old male was referred to our hospital to undergo operative treatment due to aortic valve insufficiency which had gradually worsened. The patient's chief complaint was a loss of breath upon effort which had progressively worsened after undergoing aortic valve plasty (AVP) for aortic valve insufficiency with infective endocarditis at another institution. AVP by the cusp extension method had been performed because of the patient's youth and there had been no change in the morbid state, except for the presence of a non-coronary cusp. In addition, the aortic valve insufficiency was controlable and postoperative course was also excellent. The cusp extension method was therefore considered to be an appropriate procedure for this case since it would allow the patient to return it to a state with a more normal heart, since the valve organization after this procedure would be able to reach a maximum level.

Subepithelial tumors are divided into benign subepithelial and potentially malignant gastrointestinal stromal tumors. It is difficult to distinguish between these tumor types. Contrast-enhanced harmonic endoscopic ultrasound is reportedly useful for diagnosing subepithelial tumors, can be safely and easily performed by understanding the principle and method, and can be used to distinguish between tumor types with high sensitivity on the basis of differences in contrast effect. The generated image shows a hyper-enhancement pattern in gastrointestinal stromal tumors (sensitivity, 78%–100%; specificity, 60%–100%; accuracy, 60%–100%) and hypo-enhancement pattern in benign subepithelial tumors. Contrast-enhanced harmonic endoscopic ultrasound can be used to estimate the malignancy potential of gastrointestinal stromal tumors by evaluating the uniformity of the contrast and the blood vessels inside the tumor, with abnormal intra-tumor blood vessels, heterogeneous enhancement, and non-enhancing spots suggesting malignancy. Contrast-enhanced harmonic endoscopic ultrasound has a higher sensitivity than other imaging modalities for the detection of vascularity within gastrointestinal stromal tumors. Additionally, it has been reported that treatment effects can be estimated by evaluating the blood flow in the gastrointestinal stromal tumor before and after treatment with tyrosine kinase inhibitors using contrast-enhanced ultrasound. However, there will be subjective-bias and the results depends on the performer’s skill.
Blood Vessels ; Clothing ; Gastrointestinal Stromal Tumors ; Methods ; Protein-Tyrosine Kinases ; Sensitivity and Specificity ; Ultrasonography