In this revision, we have attempted to align the Model Core Curriculum for Medical Education competency, "problem-solving ability based on specialized knowledge," with the "Standards of National Examination for Medical Practitioners." The major diseases and syndromes in "Essential Fundamentals" correspond to the basic diseases in Table 1 of the Core Curriculum, symptoms, physical and laboratory examinations, and treatment in "General Medicine" correspond to the items in Table 2 of the Core Curriculum, and the diseases in "Medical Theory" correspond to the diseases in PS-02 of the Core Curriculum. The validity of the diseases in the Core Curriculum was verified using the evaluation results of the examination level classification of the "Research for Revision of National Examination Criteria." Approximately 690 diseases were conclusively selected. This revision mentions the number of diseases in the Core Curriculum for the first time. Hopefully, this will lead to a deeper examination of diseases that should be studied in medical schools in the future.

In the new Model Core Curriculum, the objective stated is to "understand the importance of medical research for the advancement of medicine and medical care, and support innovation in medicine through involvement in academic and research activities, developing one's scientific thinking skills." Importantly, scientific background and researcher training education, such as laboratory assignments, are clearly positioned in the Model Core Curriculum and are available to all students. The curriculum consists of five components : Developing a research mindset, Understanding established theories, Conducting Research, Publishing Research, and Research Ethics. In addition, laboratory experience and practical training in basic medicine were also added to the description. Further policy and financial support for researchers will be necessary to increase the number of basic medical researchers in the future.

Background/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions. Methods: We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events. Results: En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm2/min). Perforation and postoperative bleeding were observed in one patient in each group. Conclusions PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.

INTRODUCTIONPulse oximetry (SpO2) measures oxygen saturation but not alveolar ventilation. Its failure to detect alveolar hypoventilation during sedated endoscopy under oxygen supplementation has been reported. The aim of this study was to measure the masking effect of oxygen supplementation in SpO2 when alveolar hypoventilation develops during sedated endoscopy.

METHODSA total of 70 patients undergoing sedated diagnostic colonoscopy were randomly divided into two groups - oxygen supplementation group (n = 35) and room air breathing group (n = 35). SpO2 and end-tidal carbon dioxide (etCO2) were measured by non-intubated capnography during the procedure for all the patients.

RESULTSThe rise of etCO2 caused by alveolar hypoventilation was comparable in the two groups after sedation. SpO2 was significantly higher in the oxygen supplementation group than in the room air breathing group (98.6% ± 1.4% vs. 93.1% ± 2.9%; p < 0.001) at peak etCO2, and oxygen supplementation caused SpO2 to be overestimated by greater than 5% when compared with room air. SpO2 at peak etCO2 was reduced from the baseline before sedation for the oxygen supplementation and room air breathing groups by 0.5% ± 1.1% and 4.1% ± 3.1%, respectively (p < 0.001).

CONCLUSIONSpO2 alone is not adequate for monitoring alveolar ventilation during sedated endoscopy under oxygen supplementation due to possible delays in detecting alveolar hypoventilation in patients. Even if SpO2 decreases by only 1% during the procedure and its level remains near 100%, physicians should consider the onset of severe alveolar hypoventilation, which requires immediate intervention.

Adult ; Aged ; Carbon Dioxide ; analysis ; Colonoscopy ; Conscious Sedation ; Endoscopy ; Female ; Humans ; Hypoventilation ; diagnosis ; Male ; Middle Aged ; Monitoring, Intraoperative ; methods ; Oximetry ; methods ; Oxygen ; administration & dosage ; Respiration, Artificial

The committee of continuing medical education in Japan Society for Medical Education discussed on PRA of American Medical Association [AMA]. We have first analyzed the brochure of PRA for the members of AMA, and then prepared the questionnaire for AMA. We were able to obtained the answers to the questionnaire which were sent to AMA through courtesy of Japanese Medical Association (JMA). It was realized that AMA emphasizes an importance of PRA for medical practice to the patients; nevertheless acquisition rate of PRA is actually low, and so AMA proceeds with efforts towards completion of PRA.

In March 1986, an academic program on family care medicine was started at Jikei University School of Medicine upon consultation with Prof. Masakazu Abe, then President of the Jikei University School of Medicine, and Dr. Tomojiro Nagai, founder of the Medical Practitioners' Association of Japan. The program offers two elective seminars on family care medicine in the spring and summer for 4th and 5th year medical students. The objective was to give students opportunities to visit and observe medical care provided by practitioners, to teach them the importance of the function of family physicians, and to offer them options in their future careers.
The total number of participating students from the first through 20th seminars was 121, with a maximum number of participants per seminar of 11 and a minimum of 3 (average of 6). A total of 37 instructors took part in the program by giving from 1 to 18 seminars per instructor (average of 3.3). We found these seminars to be highly educational not only for the students but also for the instructing physicians.

Surveys on the snail intermediate hosts were undertaken in the paddy fields in Yatomi-cho, Aichi Prefecture, once a year over a 5-year period (1983-1987).
And the cercariae of two different avian schistosomes were detected from snails in paddy fields.
The cercariae from Polyplis haemisphaerula were identified as species beloning to the genus Gigantobilharzia and the cercariae from austropeplea ollula as species belonging to the genus Trichobilharzia.
It was concluded that the paddy field dermatitis occurring in Yatomi-cho was proved to be caused by the invasion of these cercariae.

Two hundred and thirty adipose tissues were collected from inpatients, who had undergone an operation and an autopsy in the Saku Central Hospital from 1980 to 1982. Organochlorine pesticides were extracted from the adipose tissues and determined by gas-liquid chromatography with an electron-capture detector.
The mean value was 1, 429 ppm for total BHC among males, and 1.665 ppm among females, 4.893 ppm and 3.791 ppm for total DDT, 1.082 ppm and 0.782 ppm for PCB, respectively. Regression analysis between the total BHC residue and the ages of patients indicated a positive correlation for both sexs. As for the relation between the rate of obesity and the residues, low rates of obesity (-10%--19%) were most significantly correlated with high values of total BHC, total DDT and PCB.
We also discussed relations between cancerous diseases and the residues.