Introduction: This study examines the relationship between learning styles and outcomes of interprofessional education (IPE) through co-curricular learning for medical and welfare students.Method: To analyze changes over time, we utilized IPE evaluations of students from Nagasaki University School of Medicine and the Department of Comprehensive Community Care Services, Nagasaki Junshin Catholic University, who participated in either face-to-face or online classes.Results: The learning outcomes from medical and welfare perspectives in IPE significantly increased regardless of the learning style. As for the same perspective on students from each department, the value of many outcomes in face-to-face learning showed significant increases compared to online classes.Discussion: The learning outcomes of IPE in medical and welfare through online classes were considered to have achieved certain results. Additionally, differences in learning outcomes depending on the learning style were thought to be due to variations in understanding between the groups. It was suggested that long-term studies are necessary for effective co-curricular learning in the future.

Objective: Environmental deprivation, a type of childhood maltreatment, has been reported to constrain the cognitive developmental processes such as associative learning and implicit learning, which may lead to functional and morphological changes in the ventral pallidum (VP) and pessimism, a well-known cognitive feature of major depression. We examined whether neonatal isolation (NI) could influence the incidence of learned helplessness (LH) in a rat model mimicking the pessimism, and the number of vesicular glutamate transporter 2 (VGLUT2)-expressing VP cells and Penk-expressing VP cells. Methods: The number of escape failures from foot-shocks in the LH test was measured to examine stress-induced depression-like behavior in rats. The number of VGLUT2-expressing VP cells and Penk-expressing VP cells was measured by immunohistochemistry. Results: In NI rats compared with Sham rats, the incidence of LH in adulthood was increased and VGLUT2-expressing VP cells but not Penk-expressing VP cells in adulthood were decreased. VGLUT2-expressing VP cells were decreased only in the LH group of NI rats and significantly correlated with the escape latency in the LH test. Conclusion These findings suggest that the aberrant VP neuronal activity due to environmental deprivation early in life leads to pessimistic associative and implicit learning. Modulating VP neuronal activity could be a novel therapeutic and preventive strategy for the patients with this specific pathophysiology.

Purpose: The anatomical distribution of perianal warts is associated with patient characteristics such as sexual orientation. The purpose of this study is to confirm this experiential knowledge using a quantitative classification system and analysis and to obtain findings useful for future treatment. Methods: From January 2014 to December 2020, 93 patients with perianal warts presented to our hospital. Patients were analyzed for age, sex, lesion site, and recurrence type, among other factors. The lesion site was divided into skin (S) and anal epithelium (anoderm, A), and the number and degree of each were classified into grades 0 to 3. The higher grade between S and A determines its dominant type, such as type S (e.g., S3A1) and type A (e.g., S0A2). Results: The average age of the patients was 39.6 years, and the percentage of patients who were not married was 54.8%. In all, 95.8% of patients were positive for low-risk human papillomavirus (HPV). Type S accounted for 80.6%, whereas type A accounted for 9.7%. Type A cases were all male and were all presumed to be men who have sex with men (MSM). This indicates that the determination of type A may be highly specific for MSM. The type at the time of recurrence was the same type at the time of the first surgery in almost all cases. Conclusion In cases of perianal warts, it is useful to analyze the lesion by considering the range and grade separately for daily clinical practice on proctologist.

Background/Aims: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA; EUS-FNA) allows for diagnostic tissue specimens from various regions to be analyzed. How-ever, diagnosing recurrent pancreaticobiliary cancer after surgery is sometimes difficult. We evaluated the efficacy of EUS-FNA in the diagnosis of local recurrence of pancreatico-biliary cancer and analyzed the factors associated with falsenegative results. Methods: Fifty-one consecutive patients who underwent EUS-FNA due to suspected recurrence of pancreaticobiliary cancer after surgery in an academic cen-ter were retrospectively analyzed. The criteria for EUS-FNA were a resected margin or remnant pancreas mass, round swollen lymph node (≥10 mm in diameter), and soft-tissue enhancement around a major artery. Patients with suspected liver metastasis or malignant ascites were excluded. Results: Thirty-nine of the 51 patients had pancreatic cancer; the remaining 12 had biliary cancer. The target sites for EUS-FNA were the soft tissue around a major artery (n=22, 43%), the resected margin or remnant pancreas (n=12, 24%), and the lymph nodes (n=17, 33%). The median size of the suspected recurrent lesions was 15 mm (range, 8 to 40 mm). The over-all sensitivity, specificity and accuracy of EUS-FNA for the diagnosis of recurrence was 84% (32/38), 100% (13/13), and 88% (45/51), respectively. FNA of the soft tissue around major arteries (odds ratio, 8.23; 95% confidence interval, 1.2 to 166.7; p=0.033) was significantly associated with a falsenegative diagnosis in the multivariate analysis. Conclusions EUS-FNA is useful for diagnosing recurrent cancer, even after pancreaticobiliary surgery. The diagnoses of recurrence at soft-tissue sites should be interpreted with caution.

BACKGROUND/AIMS: We applied a back light system (BLS) with a magnifying glass to improve the ability to assess the adequacy of specimen sampling using endosonography. We conducted this study to evaluate the efficacy of the BLS in sampling of specimens by endoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses. METHODS: This was a prospective, randomized, crossover, single-center clinical trial. An endosonographer evaluated adequacy on gross visual inspection and identified whitish specimen sampling sites with and without the BLS according to a randomization sequence in the first and second passes with a 25-G needle. On cytological evaluation, the presence of well-defined pancreatic ductal epithelium was evaluated by a cytopathologist who was blinded to any clinical information. RESULTS: A total of 80 consecutive patients were eligible during the study period. Adequacy was observed for 52 specimens (65%) with the BLS and 54 (68%) without the BLS (p=0.88). In assessment of specimen adequacy on gross examination, only fair agreement was observed both with and without BLS (kappa score 0.40 and 0.29, respectively). CONCLUSIONS: The BLS did not influence the ability to identify specimen sampling sites or reliable assessment of specimen site adequacy using gross visual inspection.
Biopsy, Fine-Needle ; Cross-Over Studies ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Epithelium ; Glass ; Humans ; Needles ; Pancreatic Ducts ; Pancreatic Neoplasms ; Prospective Studies ; Random Allocation

BACKGROUND/AIMS: This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascular invasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance. METHODS: In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUS image findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion, types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors and evaluated vessels. RESULTS: The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in the veins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings were significantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0–742] µm vs. 2,833 [1,076–5,694] µm, p=0.012) and arteries (623 [0–854] µm vs. 3,097 [1,396–6,000] µm, p=0.0061). All cases with a distance of ≥1,000 µm between the tumors and main vessels were correctly diagnosed. CONCLUSIONS: Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.
Arteries ; Diagnosis ; Endosonography ; Humans ; Pancreatic Neoplasms ; Retrospective Studies ; Sensitivity and Specificity ; Veins

A 47-year-old man was found to have a thoracic aortic aneurysm. When the patient was 20 years old, he underwent aortic correction with Dacron graft for coarctation of the descending aorta. CT showed an enhanced true aneurysm and a pseudolumen in the proximal anastomotic site of the graft of the distal arch and an aneurysm in the left subclavian artery bifurcation. The operation was performed. Because we anticipated severe adhesion due to the preceding left thoracotomy, we approached by median sternotomy and the transmediastinal replacement method (pull-through method). Before cardio pulmonary bypass was started, an 8-mm Dacron graft was anastomosed to the left subclavian artery via a subclavian incision. The patient was given heparin and we cannulated the ascending aorta via the right femoral artery. A venous cannula was placed in the superior and inferior vena cava and patent left superior vena cava confirmed during operation. Antegrade cardioplegia was initially administered. During deep hypotheremic circulatory arrest antegrade cerebral perfusion was employed. The heart was retracted and the descending aorta was exposed through the posterior pericardium. The old graft was excised and a new Dacron graft was pulled down into the descending aorta from the distal arch. The graft was anastomosed to the descending aorta. After we repaired the other aortic arch branch and ascending aorta, the left subclavian graft and graft branch were anastomosed. There was no bleeding or other complication and the patient was discharged. The pull-through method should be considered for such descending aortic aneurysm cases.

A 66-year-old woman who had percutaneous mitral valve commissurotomy 12 years before was admitted complaining of dyspnea on effort. Echocardiography showed severe mitral stenosis and regurgitation, and moderate tricuspid regurgitation associated with atrial fibrillation. Based on her past history we suspected allergy to metal, and skin patch tests showed a positive reaction to zinc, manganese, nickel, cobalt, dichromate, stainless steel, titanium alloys, and nickel-chromium-cobalt alloys. We selected an artificial organ which would not cause an allergic reaction. The St. Jude Medical standard cuff mechanical valve was the only compatible prosthetic valve. Anterolateral right thoracotomy, instead of median sternotomy, was selected. Mitral valve replacement with a 27-mm St. Jude Medical standard cuff mechanical valve and tricuspid valve annuloplasty with a 27-mm Duran flexible band were performed. Her postoperative course was uneventful. She is doing well without any allergic symptom 18 months after the surgery.

In order to clarify the effect of exercise on the walking performance and the muscle volume in lower limbs, elderly athletes long continuing to be trained and untrained elderly were compared with regard to their muscle cross-sectional area (CSA) of m. psoas major, thigh muscle and crus muscle and their walking ability. The subjects used consisted of thirty-six 80's-aged male and 70's-aged female elderly athletes and twenty-four elders having no regular exercise (control male group : CM, control female group : CF) . The elderly athletes were further divided into two groups in accordance with their results of Japan Fitness Test (high performance male group : HPM, low performance male group : LPM, high performance female group : HPF, low performance female group : LPF) . The walking performance was evaluated by analyzing their walking speed, stride-length and step rate during walking along a 15 m-strip of passage at normal and fast paces using videotaping. The muscle CSA was determined at m. psoas major, thigh muscle (extensors and flexors) and crus muscle (m. tibialis anterior and m. triceps surae) using MRI. As for the walking speed and stride-length at the normal pace, only HPM and HPF showed significantly higher values than CM and CF (male : p<0.05, female : p<0.01) . Meanwhile at the faster pace, HPF and LPF showed significantly higher values than CF in female (HPF : p<0.01, LPF : p<0.05) and in the case of males, only HPM have a higher value only of the walking speed than CM (p<0.05) . The CSA of m. psoas major in HPM and HPF significantly higher than that in CM and CF (all p<0.05), while in CSAs of knee extensor muscles and m. triceps surae, the statistical differences were not consistent among male and female groups. The results suggested that greater muscle mass of m. psoas major could influence higher walking speed in elderly people, and might be affected by regular exercise training.

The purpose of this study was to prove the hypothesis that the effect of strength training is memorized and reinforced by retraining. Untrained university-age men participated in this training program. The retraining leg was subjected to 5 weeks of isometric training, 17 weeks of detraining and 5 weeks of retraining in knee extension. The contralateral training leg was subjected to 5 weeks of isometric training during the same period as the retraining phase of the retraining leg. Maximal isometric torque of knee extension increased after the 5-week training and remained at the trained level during the 17week detraining period. Torque gain by retraining of the retraining leg was 2.6 times greater than that of the contralateral training leg. These changes in isometric torque corres-ponded with changes in iEMG of the vastus lateralis. The cross-sectional area of the quadriceps femoris muscle did not change with training. Results support the hypothesis that the effect of strength training is memorized and reinforced by retraining. In addition, results show that these adaptations would be explained by recruitment and rate coding of motor units.