A 31-year-old woman infected with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) at 33-weeks pregnant was subject to cesarean delivery due to a worsening respiratory condition. On the fourth day of illness, the patient was placed on a ventilator, with extracorporeal membrane oxygenation (ECMO) treatment initiated on the ninth day. Passive range of motion (ROM) training started on the day 33 of illness. She was weaned off ECMO on day 55 of illness and taken off of the ventilator on day 8. The tracheostomy tube was replaced with a speech cannula on day 87 of illness, at which time the patient began to complain of pain during passive ROM training. Plain X-ray photography and computed tomography (CT) showed ossification around the bilateral shoulder and hip joints, as well as on medial thighs, accompanied by an alkaline phosphatase (ALP) value of 942 U/L. She was subsequently diagnosed with heterotopic ossification, after which passive ROM training was changed to protective ROM training, in addition to treatment with indomethacin farnesyl and etidronate disodium. The patient was transferred to our hospital on day 122 of illness for the purpose of continuing rehabilitation. On day 155 of illness, ossification decreased on the medial thighs, according to CT. She was able to walk independently indoors and was discharged home on day 181 of illness. This case demonstrates the importance of checking the ALP levels and palpating the periarticular area in patients infected with SARS‑CoV‑2 before initiating passive ROM training, as well as being aware of any pain experienced during training. In the case of any abnormalities, assessing the ossification around the joints of extremities by imaging examination is a priority.

A 31-year-old woman infected with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) at 33-weeks pregnant was subject to cesarean delivery due to a worsening respiratory condition. On the fourth day of illness, the patient was placed on a ventilator, with extracorporeal membrane oxygenation (ECMO) treatment initiated on the ninth day. Passive range of motion (ROM) training started on the day 33 of illness. She was weaned off ECMO on day 55 of illness and taken off of the ventilator on day 8. The tracheostomy tube was replaced with a speech cannula on day 87 of illness, at which time the patient began to complain of pain during passive ROM training. Plain X-ray photography and computed tomography (CT) showed ossification around the bilateral shoulder and hip joints, as well as on medial thighs, accompanied by an alkaline phosphatase (ALP) value of 942 U/L. She was subsequently diagnosed with heterotopic ossification, after which passive ROM training was changed to protective ROM training, in addition to treatment with indomethacin farnesyl and etidronate disodium. The patient was transferred to our hospital on day 122 of illness for the purpose of continuing rehabilitation. On day 155 of illness, ossification decreased on the medial thighs, according to CT. She was able to walk independently indoors and was discharged home on day 181 of illness. This case demonstrates the importance of checking the ALP levels and palpating the periarticular area in patients infected with SARS‑CoV‑2 before initiating passive ROM training, as well as being aware of any pain experienced during training. In the case of any abnormalities, assessing the ossification around the joints of extremities by imaging examination is a priority.

Objective: The provision of drug information from medical representatives (MRs) of pharmaceutical departments was changed to non-face-to-face on the principle of preventing further spread of the Coronavirus disease 2019 (COVID-19). However, there have been no reports investigating the impact of operational changes under such circumstances on the drug information response service and drug information provision activities of MRs. In this study, we investigated the influence of such changes.Methods: We investigated the number of requests for drug information from MRs, the number of visits by MRs, and the response rate for information issued by companies. In addition, a questionnaire survey was conducted with MRs who provided information to drug departments to investigate their workload, work efficiency, and sense of anxiety about the provision of information.Results: The MRs’ average number of requests per operating day was 16.0±6.4 (cases/day). The median number of visits to the pharmacy department per operating day was 11 before the operational change, compared to 1 after the change, revealing a significant decrease (p < 0.001). The response rate for information provided by companies was 64.9% (161/248) after the operational change,compared to 64.6% (93/170) after the change, showing no significant difference (p=1.00). As for the influence on information provision activities, less than half of the MRs perceived a negative influence in terms of workload and efficiency; however, more than half of the MRs perceived a negative influence in terms of anxiety about information provision.Conclusion: We clarified the impact of operational changes during the COVID-19 pandemic on our work. We believe that the results of this study can be one of the most useful sources of information for continuing information provision activities based on the principle of non-face-to-face communication.

PURPOSE: This study was performed to compare nursing students' attitudes toward death among South Korea, Japan and Indonesia, and to confirm the need for death education in nursing. METHODS: A total of 294 nursing students completed a questionnaire titled as the Death Attitude Profile-Revised (Wong, Recker, Gesser. 1994). Participating students were from two nursing schools in South Korea, two in Japan and one in Indonesia. Data were analyzed by using descriptive statistics and inferential statistics including, chi2-test, ANOVA and multiple comparison analysis. RESULTS: The total mean score of the DAP-R for the three countries combined was 3.84+/-0.73. By country, the mean was the highest for Indonesian students (4.32+/-0.71), followed by Korean (3.75+/-0.57) and Japanese (3.56+/-0.70) respectively. In relation to subcategories, Indonesian students showed the highest mean score for death avoidance (3.67+/-1.38) and approach acceptance (5.37+/-1.00). Korean students marked the highest (5.51+/-0.91) in neutral acceptance and Japanese students scored the best (3.63+/-1.46) in escape acceptance. Nursing students who had an experience of caring terminally ill patients tended to be affirmative in approach acceptance (P=0.047). There were significant differences in each of the four subcategories except fear of death among the three countries (P<0.001). CONCLUSION: The above results indicate it is necessary to develop education programs based on each country's social and cultural background to help nursing students form desirable attitudes toward death.
Asian Continental Ancestry Group ; Humans ; Indonesia ; Japan ; Republic of Korea ; Schools, Nursing ; Students, Nursing ; Terminally Ill ; United Nations

Since ancient times, acupuncture and moxibustion have been widely administrated for any emergency case. In this country, they have been endeavored at establishing the harmony between Kampo and Modern medicine. Based on such background, we report two cases of colic pain attack of lithiasis successfully treated with contact needle therapy established by Bunkei Ono.In case one, ureterolithiasis brought colic back pain. Symptoms were improved with satisfaction for one session and the stone discharged via following Kampo-medication.In case two, the patient suffered from colic epigastralgia of choledocholithiasis complicated by severe appetite loss. Although one session successfully extinguished the symptoms, blood chemistry revealed implying signs of cholangitis. A laparotomy with T-tube drainage was performed eventually.These cases pronounced the efficacy of contact needle therapy in the treatment of colic pain and invited deliberate estimation with Modern medicine. The harmony between Kampo and Modern medicine was considered as a prerequisite for clinical practice.

We analyzed the scores of objective structured clinical examinations (OSCEs) and written examinations administered to fourth-year medical students after practical training in clinical skills and to fifth-year medical students after clinical training and scores of graduation examinations taken by sixth-year medical students. Correlations were analyzed among the scores of 96 students who had taken all 3 examinations during a 3-year period. Mean scores on examinations in the fourth, fifth, and sixth years were compared between sixth-year students who did or did not graduate and between graduating students who did or did not pass the national examination for medical practitioners in Japan. Significant correlations in the scores were found between 1) OSCEs and written examinations for fourth-year students versus those for the fifth-year students; 2) OSCE and written examinations for fourth-year students versus graduation examination scores for the sixth-year students; and 3) OSCE and written examinations for fifth-year students versus graduation examination scores for sixth-year students. In addition, the mean scores in the fourth and fifth years were significantly higher for sixth-year students who graduated and passed the national examination than for students who did not graduate or who graduated but failed the national examination. These results suggest that the practical training in clinical skills given to fourth-year students and the clinical training given to fifth-year students strongly affect the overall evaluation of the ability of sixth-year students and success on the national examination.

AIM To examine the effect of cilostazol, a no vel selective phosphodiesterase type 3 inhibitor, on adherence between neutrophils and human umbilical e ndothelial cells ( HUVECs ) and investigate its possible mechanisms. MET HODS Confluent HUVECs between 4～6 passages were used and stimulated by l ipopolysaccharide (LPS, 5 mg?L -1 ) with or without coincubation of cilosta zol (1～10 ?mol?L -1 ) for 24 h. Soluble cell adhesion molecules (sCAMs), including vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1) and endothelial leukocyte adhesion molecule-1 (sELAM-1, sE-selectin) in cell culture medium were measured by ELISA. RESULTS Cilostazol (1～10 ?mol?L -1 ) inhibited adherence between neutrophils and HUVECs in a dose- dependent manor. At the same time, cilostazol didn't affect sICAM-1 and sE-sel ectin release from LPS-stimulated HUVECs, but in contrast, it significantly inh ibited sVCAM-1 production under the same experiment condition, and this effect was canceled by H-89, an inhibitor of protein kinase A ( PKA ). CONCLUS ION Cilostazol significantly inhibits adherence between neutrophils and H UVECs, and downregulates sVCAM-1 release from LPS-activated HUVECs, and these effects on cytokine-challenged endothelial cells might be via a PKA-dependent pathway. The present result suggests that cilostazol partially eliminates some o f the adherent reactions of HUVECs to LPS, a deleterious cytokine, and it is rea sonable to consider that cilostazol might be a strategy for preventing atheroscl erosis and other cardiovascular diseases.

The purpose of this study was to evaluate the function of cardiac autonomic nervous activity and post-exercise vagal reaction during the menstrual cycle. The subjects were healthy young women (n=13, age 19.9±0.6 years) with normal menstrual cycles. Power spectral analysis of heart rate variability was used to examine cardiac autonomic nervous activity. In addition, the time con stant of heart rate decline for the first 30 sec (T₃₀) after exercise was used to examine post-exercise vagal reactivation.
Results show that the cardiac autonomic nervous activity changes during the menstrual cycle. Also, T₃₀ shows significant change during the menstrual cycle, especially T₃₀ retardation in the early luteal phase. These results suggest that an imbalance of estradiol and progesterone hormones may be responsible for these changes in cardiac autonomic nervous activity during the menstrual cycle.

‹Objective› In previous animal studies, it has been observed that ovarian hormones centrally alter baroreflex modulation of cardiovagal nervous control. If this central action of ovarian hormones is observed in human females, non-baroreflex modulation of cardiovagal nervous control should change with the menstrual cycle. The hypothesis in this study was that cardiovagal nervous response to facial cold stimuli (non-baroreflex modulation) changes throughout menstrual cycle.‹Subjects and methods› Eight young healthy women with a normal menstrual cycle participated in this study. The menstrual cycle was divided into 5 phases (menstrual, follicular, ovulatory, early luteal and late luteal) . Resing ECG RR intervals, cardiovagal nervous activity (by heart rate variability), RR intervals and cardiovagal nervous response to facial cold stimuli were measured during each menstrual phase. RR intervals and cardiovagal nervous response to facial cold stimuli were evaluated paying attention to the “quantity” and “quickness” of the changes.‹Results› There were no phase differences in resting RR intervals and cardiovagal nervous activity. Quantity of RR intervals and cardiovagal nervous response and quickness of. RR intervals to facial cold stimuli did not change throughout the menstrual cycle. The speed of cardiovagal nervous response to facial cold accelerated in the follicular phase, and to the contrary, slowed down in the early luteal phase, ‹Conclusion› These data suggest the speed of cardiovagal nervous response mediated non-baroreflex mechanism changes throughout the menstrual cycle.

Purposes: We performed a white coat ceremony for medical students, because there had not been a definite passage ceremony to create the desire to serve and the awareness of being physician. Opinions about the ceremony were with a questionnaire survey. Methods: The ceremony of white coat conferment was performed for the first time for 112 fourth-year medical students on January 11, 2001, just before the start of clinical training. A white coat and an identification badge with photograph were presented to the medical students, who were taking the first step to becoming a physician. A questionnaire survey was performed the next day to evaluate students' feelings. The questionnaire asked about student's 1) sense of responsibility to be engaged in medical practice, 2) feelings of kindness to patient, 3) love for of their school, 4) attachment to the white robe, 5) consciousness of being a professional, 6) sense of mission as a physician, 7) motivation to learn, 8) feelings of seriousness, and 9) desire to live ethically. A listening survey for the school staff and students was also included. Results: Clear improvements in consciousness were recognized in all items of the questionnaire (P>.0001). Approximately 80% of students approved of the ceremony being performed annually from the following year. The ceremony had had no established form, but many people acknowledged its significance. However, some students who did not realize the significance of the ceremony because it was performed in the middle of the semester. Conclusions: Although this was the first experience for us, many students and teaching staff were understanding and responded favorably to this passage ceremony. The ceremony to instill medical professionalism in student doctors will be improved with further efforts and experiences.