Purpose : The purpose of this study was to determine how frequently cancer patients would be missed if primary care clinics do not participate in the Japanese National Cancer Survey, and to describe the characteristics of those cancer patients who would be missed.
Methods : This research is a case series study. We collected cancer patients who were identified in Ryuocho-Kokuminkenkouhoken Clinic and Yuge medical clinic for 26 years and were registered in the Shiga Cancer survey. We then extracted the records of those cancer patients who would be potentially missed from the national cancer registry and investigated the background.
Results : The total number of cancer patients registered was 441. Of these, 28 (6.3%) patients who did not admit to the hospitals may be missed from the national cancer registry ; ten patients had their cancer diagnosed at an advanced stage and died at home without hospital admission. Two further cases had treatment for cancer (endoscopic resection) completed in the primary care clinic without hospital admission. Twelve patients only attend the hospital outpatient clinic for investigation and died at home without admission. And four patients received only CT scan examination and didn't attend the hospital outpatient clinic and died at home without admission.
Conclusion : Primary care clinics that deal with the cancer patients treated completely in the clinics or home terminal care should participate in the Japanese National Cancer survey.

We investigated the effects of underwater exercise plus hot-spring bathing on middle aged people.
Twenty-five subjects (mean age: 59.6±8.9 years) were divided into three groups (A, B, and C) and examined. Group A (three males, seven females) was subjected to underwater exercise and hot-spring bathing. Group B (eight females) was subjected to underwater exercise and fresh water bathing. Group C (seven females) was a control group (no exercise and no bathing).
Group A and B performed underwater exercise consisting of underwater walking, basic exercise, and swimming for 70 minutes. Group A was then subjected to hot-spring bathing (sodium bicarbonate spring, PH 8.0, 39°C) for 20min, and while Group B was subjected to fresh-water bathing (30°C).
Blood pressure was measured and blood tests were conducted early in the morning on the day of exercise plus bathing and on the following day. Further, Profile of Mood Status (POMS) tests were also conducted on the day following the exercise with bathing and data were compared.
The findings were as follows.
1) On the day following the exercise plus bathing, group A (underwater exercise plus hot-spring bathing) had significantly lower diastolic blood pressure, total cholesterol, CD4, red blood cells, hematocrit and total protein when compared with values before treatment (p<0.05).
2) After the exercise plus bathing, group A (underwater exercise plus hot-spring bathing) had significantly lower levels of depression-dejection, anger-hostility and confusion in POMS tests when compared with those of Group C (control group, no exercise and no bathing) (p<0.05).
We concluded that underwater exercise plus hot-spring bathing has good effects on the health of middle aged people.

STUDY DESIGN: Retrospective study. PURPOSE: To determine the presence and frequency of factors for degenerative spondylolisthesis (DS) in patients with hip osteoarthritis (OA). OVERVIEW OF LITERATURE: OA of the hip joint (hip OA) in Japanese patients is associated with a high incidence of degenerative lumbar spondylolisthesis (DS). However the associated factors for DS in patients with hip OA are unclear. METHODS: The study included 518 patients (59 men and 459 women) with a mean age of 63.8 years who underwent total hip arthroplasty for hip OA at our hospital between January 2004 and May 2014. The presence of DS was assessed using preoperative standing lateral radiographs of the hip joint including the lower lumbar spine. To identify the associated factors for DS in patients with hip OA, multiple logistic regression analysis was conducted in which the presence or absence of DS was used as a dependent variable, and age, female sex, body mass index (BMI), sacral slope (SS), Crowe classification, and primary OA (P-OA) not associated with acetabular dysplasia were independent variables. RESULTS: Patients with DS accounted for 114 (22.0%) of 518 cases. In multiple logistic regression analysis to identify associated factors for DS in patients with hip OA, the odds ratio for age was 1.05 (95% confidence interval [CI], 1.02–1.08), female sex was 2.48 (95% CI, 1.11–5.54), BMI was 1.08 (95% CI, 1.02–1.14), SS was 1.07 (95% CI, 1.04–1.09), Crowe classification was 0.60 (95% CI, 0.40–0.91), and P-OA was 1.90 (95% CI, 1.20–3.75). CONCLUSIONS: Age, female sex, BMI, SS, low Crowe classification, and P-OA are independently associated factors for DS in patients with hip OA.
Acetabulum ; Arthroplasty, Replacement, Hip ; Asian Continental Ancestry Group* ; Body Mass Index ; Classification ; Crows ; Female ; Hip Joint ; Hip* ; Humans ; Incidence ; Logistic Models ; Male ; Odds Ratio ; Osteoarthritis* ; Osteoarthritis, Hip ; Retrospective Studies ; Spine ; Spondylolisthesis*

STUDY DESIGN: Experimental human study. PURPOSE: To determine whether angiopoietin-like protein 2 (ANGPTL2) is highly expressed in the hyperplastic facet joint (FJ) synovium and whether it activates interleukin-6 (IL-6) secretion in FJ synoviocytes. OVERVIEW OF LITERATURE: Mechanical stress-induced synovitis is partially, but significantly, responsible for degenerative and subsequently osteoarthritic changes in the FJ tissues in patients with lumbar spinal stenosis (LSS). However, the underlying molecular mechanism remains unclear. IL-6 is highly expressed in degenerative FJ synovial tissue and is responsible for local chronic inflammation. ANGPTL2, an inflammatory and mechanically induced mediator, promotes the expression of IL-6 in many cells. METHODS: FJ tissues were harvested from five patients who had undergone lumbar surgery. Immunohistochemistry for ANGPTL2, IL-6, and cell markers was performed in the FJ tissue samples. After cultured synoviocytes from the FJ tissues were subjected to mechanical stress, ANGPTL2 expression and secretion were measured quantitatively using real-time quantitative reverse-transcription–polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA), respectively. Following ANGPTL2 administration in the FJ synoviocytes, anti-nuclear factor-κB (NF-κB) activation was investigated using immunocytochemistry, and IL-6 expression and secretion were assayed quantitatively with or without NF-κB inhibitor. Moreover, we assessed whether ANGPTL2-induced IL-6 modulates leucocyte recruitment in the degenerative process by focusing on the monocyte chemoattractant protein-1 (MCP-1) expression. RESULTS: ANGPTL2 and IL-6 were highly expressed in the hyperplastic FJ synovium samples. ANGPTL2 was co-expressed in both, fibroblast-like and macrophage-like synoviocytes. Further, the expression and secretion of ANGPTL2 in the FJ synoviocytes increased in response to stimulation by mechanical stretching. ANGPTL2 protein promoted the nuclear translocation of NF-κB and induced IL-6 expression and secretion in the FJ synoviocytes. This effect was reversed following treatment with NF-κB inhibitor. Furthermore, ANGPTL2-induced IL-6 upregulated the MCP-1 expression in the FJ synoviocytes. CONCLUSIONS: Mechanical stress-induced ANGPTL2 promotes chronic inflammation in the FJ synovium by activating IL-6 secretion, leading to FJ degeneration and subsequent LSS.
Chemokine CCL2 ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunohistochemistry ; Inflammation ; Interleukin-6 ; Spinal Stenosis ; Stress, Mechanical ; Synovial Membrane ; Synovitis ; Zygapophyseal Joint

　　Pancreatic neuroendocrine tumors, relatively rare cancers, mostly arise in the pancreatic parenchyma with infrequent involvement of the main pancreatic duct. Now and then, however, case reports have been published on pancreatic neuroendocrine carcinoma in which the main pancreatic duct is obstructed by tumor cells with severely fibrous stromal cells. Here, in this paper, we report a case of pancreatic neuroendocrine carcinoma with obstruction of the main pancreatic duct. A 59-year-old man complained of right upper abdominal pain. Magnetic resonance cholangiopancreatography and fat-suppressed T1-weighted magnetic resonance imaging showed gallbladder stones, a low-intensity-area measuring 8 mm in diameter in the pancreatic body, and club-shaped dilatation at the distal end of the pancreatic duct. The patient was thus diagnosed with a tumor in the pancreatic body and cholecystolithiasis, and underwent distal pancreatectomy and cholecystectomy. HE-staining showed tumor cells with eosinophilic cytoplasm and nuclear atypia. The infiltrative growth of the cells with severe fibrosis caused stenosis of the pancreatic duct. Based on the positive results of immunohistochemical staining for chromogranin A and synaptophysin and the Ki-67 index, the tumor was finally identified as pancreatic neuroendocrine carcinoma. The patient has been under follow-up with no additional treatment for >3 years since the surgery, without evidence of tumor recurrence.

Introduction: The aim of this study is to explore career perceptions of male and female medical students.
Methods: Semi-structured interviews to 16 medical students (9males, 7 females) were undertaken.
Results: Qualitative data analysis showed that development of their career perceptions were affected by “gender view”, “interests in medicine” as well as their “perceptions of family”. Specifically, female students in the lower grades felt difficulty in making decisions on career choices due to the conflict between carrying out family responsibilities (e.g., housework and childcare) and interests in medicine. After clinical clerkships, their perceptions of a career were formed in one of two ways: giving priority to family responsibilities or interest in medicine. On the other hand, male students in lower and higher grades consistently gave priority to their interests in medicine for their career choices.
Conclusion: Differing career perceptions between male and female medical students emerged from this study, and supports the need for undergraduate education on gender-equality in society.

 The increase of female physicians and its undeveloped supporting system can be one of the causes of physicians' shortage. Although physicians' marriage/family perceptions and their influences on career choices have been extensively studied, those of medical students are not fully understood. An anonymous questionnaire survey was conducted involving male/female medical students in years 2 and 5 at Gifu University School of Medicine. The results showed that many male/female students hoped to get married, have children, and continue to work in the future, but different perceptions were demonstrated between the sexes with regards to the partners' occupation, working style, and influences of family/marriage perceptions on students' specialty choice. The results suggest the presence of sex-related differences in perceptions among medical students. The survey indicates the necessity of early undergraduate education for a better mutual understanding of gender issues.

Objective: The aim of this study is to explore the factors associated with the burden of home care for doctors. Methods: In July 2013 a survey was mailed to a cross-section of clinics and hospitals in Kobe City. Results: Questionnaires were sent to 1,589 clinics and hospitals and 899 (57%) responded. Of these, data from 807 respondents were available for analysis. The burden of home care was felt to be considerable for 30% and slight for 31% of respondents. Determinants associated with the burden of home care were; 80 years and older doctors (P=0.05), particular medical measures (P=0.036), building links with other medical facility or care staff (P=0.002), and ensuring the sufficient time and staff (P<0.001). Conclusion: The majority of doctors reported a burden associated with home care.