The management of influenza has dramatically changed since the introduction of the rapid influenza diagnostic test, or RIDT, and neuraminidase inhibitors (NI). However, it is still far from optimal due to low RIDT sensitivity and problems involving NI such as side effects and the potential emergence of resistant virus.Therefore, we developed a decision-making model for the management of influenza, which includes Kampo medicines in its strategies. First, the severity of patients is evaluated. If a patient is judged at severe or high-risk, intravenous NI would be the main component of treatment. If a patient has neither a severe condition nor is at high-risk, the patient would be asked to choose either NI or Kampo medicine. In the former, RIDT would be used if pretest probability was less than 50%, but it would not be used if it was more than 50%, based on the lack of influence on the post-test probability. For the latter, RIDT would be not used in general as Kampo targets “phenomena”, not the virus per se. This model enables us to optimize the use of RIDT by appropriately selecting patients based on the characteristics of RIDT, and by avoiding unnecessary tests and their misinterpretation.

OBJECTIVE: (1) To estimate the prevalence of atrial fibrillation (Af) in the general population of Saitama Prefecture, (2) to identify useful information obtained from subjects' history and laboratory findings for predicting imminent occurrence of Af.
DESIGN: Cross sectional study and retrospective cohort study.
SETTING: Annual health examination of the general population.
PARTICIPANTS: Subjects were 5, 375 men and 8, 419 women with a mean age±standard deviation of 47.2±9.6 and an age range of 18 to 88 years old.
MEASUREMENTS AND MAIN RESULTS: Among the 13, 794 participants who underwent conventional 12-lead electrocardiography (ECG) every year from 1994 to 1997, the prevalence of Af was 0.3%. The cross sectional data showed significant differences between male subjects with and without Af regarding age (P<0.0001), current treatment for hypertension (P<0.0001), arrhythmia (P<0.0001), angina pectoris (P<0.05), history of myocardial infarction (P<0.05), perception of palpitation (P<0.0001), perception of irregular pulse (P<0.0001), shortness of breath (P<0.0001), diastolic blood pressure (P<0.05), total cholesterol (P<0.0001), and casual glucose level (P<0.05) . Significant differences were also found between female subjects with and without Af with respect to creatinine (P<0.0001), current treatment of arrhythmia (P<0.0001), perception of palpitation (P<0.0001), perception of irregular pulse (P<0.0001), and HbAlc level (P<0.05) .
The retrospective cohort data identified 22 subjects who had persistent Af during the study period, and 20 (0.15%) who had newly developed Af during this period on the basis of consecutive ECG recordings of the 13, 772 participants in 1994-1996. Logistic regression analysis revealed that there were significant differences in perception of irregular pulse (P=0.0004), history of myocardial infarction (P=0.0134), fatigability (P=0.0243), aging (P=0.0039) and total cholesterol level (P=0.025) for men, and in history of arrhythmia (P=0.0007) for women between the group with and without Af.
The likelihood ratios and the respective 95% confidence intervals (C.I.) for ECG findings to identify the subjects who would develop Af were as follows: ST depression, 14.6 (C.I., 5.1-42) ; ventricular arrhythmia, 14.9 (3.9-56) ; incomplete RBBB, 9.2 (2.4-34) ; supraventricular arrhythmia, 8.9 (1.3-61) ; second-degree atrioventricular block, 342 (32-3624) ; abnormal Q wave, 16.3 (2.4-112) ; left atrial enlargement, 52.7 (7.2-383) .
CONCLUSIONS: Combining data from subjects' histories for the prediction of imminent Af among subjects in the general population is likely to be useful, especially for the elderly male population. Aging in men, in particular, is an important factor when combined with abnormal findings on conventional 12-lead ECG.

Background: Japanese medical student education lacks emphasis on teaching clinical reasoning skills. To partially remedy this situation, we developed a prototypic web-based module for tutors to teach clinical reasoning. We report the medical students’ opinions of this module.
Methods: Twenty-four students from two Japanese medical universities were randomly assigned to the two tutored virtual classrooms, each classroom with six students, or to the self-study group, 12 students, after taking the Internet-based Sequential Question and Answer pretest. After four weeks, each of the 24 students took the Sequential Question and Answer posttest. The entire 24 students answered a questionnaire about the Sequential Question and Answer tests; all 12 tutored students answered a questionnaire about the web-based tutored module.
Results: Although both tutored and self-study Sequential Question and Answer posttest scores increased, the increases of the tutored group’s posttest compared to the self-study posttest group were not statistically significant (p = 0.066). Ninety-two percent of the students rated the Sequential Question and Answer tests as an improved way to learn case presentation and clinical reasoning. Moreover, 79% of students felt that the Sequential Question and Answer tests were an effective way to learn clinical information. The tutored students rated the web-based tutored seminars as an ‘excellent to fair’ method to learn clinical reasoning using a five-point ‘excellent to poor’ scale.
Conclusions: We developed a prototypic web-based module for tutors to teach clinical reasoning to medical students. The students’ opinion supported the modular components of the web-based seminar format, Sequential Question and Answer test, and the tutoring syllabus as an effective way to improve learning clinical reasoning, case presentation, and medical information. Students also suggested refinements of the prototypic module.

PURPOSE: Furcation involvement in the molars is difficult to treat, and has been recognized as a risk factor for tooth loss. Although periodontal regenerative therapies, including guided tissue regeneration and various types of bone grafts, have been applied to furcation defects, the effects of these treatments are limited, especially in large class III furcation defects. The purpose of this pilot study was to investigate the effect of reciprocal autologous root transplantation on periodontal wound healing and regeneration in class III furcation defects in dogs. METHODS: Furcation defects (7 mm wide and 6 mm high) were surgically created after root separation of the unilateral third and fourth premolars in 4 dogs. Eight furcation defects were randomized to receive either reciprocal autologous root transplantation (test) or no further treatment (control). In the test group, the mesial and distal roots were transplanted into the distal and mesial extraction sockets, respectively. The animals were sacrificed 10 weeks after surgery for histologic evaluation. RESULTS: The healing pattern in the control group was characterized by extensive collapse of the flap and limited periodontal regeneration. New bone formation in the test group (3.56±0.57 mm) was significantly greater than in the control group (0.62±0.21 mm). Dense collagen fibers inserting into the residual cementum on the transplanted root surfaces were observed in the test group. Slight ankylosis was observed in 2 of the 4 specimens in the test group on the mesiodistal sides where the root-planed surfaces faced the existing bone. Root resorption (RR) was detected in both the control and test groups. CONCLUSIONS: Within the limits of this study, it can be concluded that reciprocal autologous root transplantation was effective for bone regeneration in class III furcation defects in dogs. However, further studies are required to standardize the approach in order to prevent unwanted RR prior to clinical application.
Animals ; Ankylosis ; Bicuspid ; Bone Regeneration ; Collagen ; Dental Cementum ; Dogs ; Furcation Defects* ; Guided Tissue Regeneration ; Models, Animal ; Molar ; Osteogenesis ; Periodontal Diseases ; Periodontal Ligament ; Pilot Projects ; Regeneration ; Risk Factors ; Root Resorption ; Tooth Loss ; Transplants ; Wound Healing* ; Wounds and Injuries*

STUDY DESIGN: Prospective study. PURPOSE: To assess the prevalence of periodontoid calcification and its associations with acute cervical pain. OVERVIEW OF LITERATURE: Calcium pyrophosphate dihydrate (CPPD) deposition disease is a common rheumatological disorder that occurs especially in elderly patients. Although CPPD crystals induce acute arthritis, these crystals are not usually symptomatic. Calcification surrounding the odontoid process (periodontoid calcification) has been reported to induce inflammation, resulting in acute neck pain. This disease is called crowned dens syndrome. Whether calcification induces inflammation or whether the crystals are symptomatic remains unclear. METHODS: The prevalence of periodontoid calcification at the atlas transverse ligament was examined by computed tomography of the upper cervical spine in patients suspected of brain disease but no cervical pain (control group, n=296), patients with pseudogout of the peripheral joints but no cervical pain (arthritis group, n=41), and patients with acute neck pain (neck pain group, n=22). Next, the correlation between the prevalence of periodontoid calcification and symptoms was analyzed. RESULTS: In the control group, 40 patients (13.5%) showed periodontoid calcification with no significant difference in the prevalence with gender. The prevalence of calcification increased significantly with age (p=0.002). In the arthritis group, 26 patients (63.4%) reported periodontoid calcification. In the neck pain group, 14 patients (63.6%) reported periodontoid calcification. Multiple logistic regression analysis by age and group revealed that higher age, inclusion in the arthritis group, and inclusion in the neck pain group significantly affected the prevalence of calcification. CONCLUSIONS: Our results cumulatively suggest that periodontoid calcification is an aging-related reaction and that calcification per se does not always cause neck pain. Periodontoid calcification was observed more frequently in patients with pseudogout of the peripheral joints and in those with acute neck pain than in asymptomatic control patients.
Aged ; Arthritis ; Brain Diseases ; Calcium Pyrophosphate ; Chondrocalcinosis ; Crowns ; Humans ; Inflammation ; Joints ; Ligaments ; Logistic Models ; Neck Pain ; Odontoid Process ; Prevalence ; Prospective Studies ; Spine