We are conducting research funded by a grant from the Ministry of Health, Labor and Welfare of Japan to create standardized, high-quality medical education content that incorporates video, images, and sound files, to develop a system that can be widely used by everyone from medical students to clinicians, and to create CBT-enabled examination questions for the future CBT National Medical Licensing Examination. The research aims to conduct trial examinations, study issues and measures to deal with them, and make proposals for their implementation.　With regard to the CBT system for the National Medical Licensing Examination, questions incorporating video, images and sound files were prepared based on the scope of the current national examination, and a trial examination was conducted with the cooperation of 10 universities nationwide using the CBT examination system via the internet. The trial was generally conducted smoothly, with smooth playback of videos, etc., and no system problems.　In conducting this research, we believe that it should not be considered as an extension of the previous national examination initiatives for doctors, nor should it be regarded merely as a technological initiative. In addition, as advances in AI-based diagnostic technology and patients’ medical literacy are foreseen to change significantly in 2040, the competence of doctors to cope with these changes will be questioned.　For this reason, it is fundamental to consider medical education content and examination questions for the CBT National Medical Licensing Examination with a view to the ideal image of doctors of the future.

OBJECTIVE: This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy. METHODS: The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database. RESULTS: A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06-2.81) and during the night shift (OR 2.29, 95% CI 1.30-4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97-2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70-2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47-3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76-4.84). CONCLUSION Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.
Case-Control Studies ; Cerebral Palsy ; epidemiology ; etiology ; Delivery, Obstetric ; statistics & numerical data ; Health Facilities ; statistics & numerical data ; Humans ; Incidence ; Infant, Newborn ; Japan ; epidemiology ; Parturition ; Perinatal Care ; statistics & numerical data ; Retrospective Studies ; Time Factors

Appropriate observational studies with sufficient external validity are apparently warranted to assess comparative effectiveness and safety of treatment with approved drugs in real world clinical practice. This kind of study must register patients consecutively without any arbitrariness, assess outcome carefully, (e.g. cardiovascular events) and automatically extract clinical data including results from laboratory tests and prescribed drugs. Clinical trials for the assessment of efficacy of newly developing drugs may also need such patients' registry. Data storage system by SS-MIX may be appropriate for this purpose. (Jpn J Pharmacoepidemiol 2013；18(1)：31-34)

The Standardized Structured Medical record Information eXchange (SS-MIX) was started in 2006 as the project supported by the Ministry of Health, Labour and Welfare (MHLW) for promoting the exchange of the standardized medical information. Free soft wares developed in the project allow the storage of medical information to receive HL7 messages for prescription, laboratory test results, diagnoses and patient demographics in the hospital information system (HIS). We encourage the use of the SS-MIX standardized storage for postmarketing surveys and clinical studies. The recommendations consist of the following 7 parts. [1] In surveys and clinical studies, the information of drugs and laboratory test results in the SS-MIX standardized storage can be directly transferred to the electronic questionnaire and the investigators may obtain the information with high accuracy and granularity. [2] The SS-MIX standardized storage works as the backup system for the HIS because it can provide the minimum information essential in patient care even under the disastrous condition like earthquake or unexpected network failure. [3] The SS-MIX standardized storage may be useful to conduct a good pharmacoepidemiology study not only because it provides the information in the storage efficiently but also it can be used to identify “new users” who started the drug after some period of non-use.The “new user” design is often essential to have the unbiased results. [4] When the drug company conducts postmarketing surveys according to the current regulation, the use of the SS-MIX standardized storage will facilitate the fast and efficient collection of data to develop the timely measure to minimize the drug-related risk. With the SS-MIX standardized storage, it is also expected that many types of study design can be employed and the quality of data is improved in the survey. [5] The SS-MIX standardized storage maybe also useful to evaluate the risk minimization action plan by comparing the prescription pattern or incidence of the targeted adverse event between two periods before and after the implementation of the action plan. [6] In planning clinical trials, the SS-MIX standardized storage may be used to estimate the size of eligible patients. The storage may also allow conducting cross-sectional studies to know characteristics of diseases or drug treatment. In addition, cohorts of those who had coronary artery angiography, new users of a drug and those with a rare disease may be readily identified. Using such cohorts, investigators can initiate a case-control study nested within the cohort, pharmacogenomic studies and comparative effectiveness researches. [7] The SS-MIX standardized storage may be used as the formal data source in clinical trials in the future when some conditions are satisfied. For instance, the formal agreement should be reached between industry, government and academia on the use of standards of data structure in Clinical Data Interchange Standards Consortium (CDISC) and on the operation of computerized system validation (CSV) in the clinical trials.

Although there are a number of reported cases of increased cerebral blood flow during exercise, there are no reports on the relation between changes of blood flow during exercise and attentional function. The purpose of this study is to clarify the relation between changes of blood flow during exercise with AT intensity and attentional function, using near-infrared spectral analysis. The subjects were 10 healthy males. The research protocol was to conduct steady load exercise. We randomly conducted two invention trials: 1) an exercise/task trial in which a trail making test (TMT) was performed as an attentional assignment during steady load exercise, and 2) a rest/task trial in which TMT was performed during rest as a control. As a result, we observed the following: increase of oxy-Hb in the prefrontal cortex during AT exercise, the significant shortening of TMT during exercise from 69.1±10.2 seconds to63.2±7.2seconds, and, with further control, that the more oxy-Hb rises, the more TMT time is shortened. From these results, it is suggested that 10 minutes of exercise would improve attentional function, and furthermore, there is a possibility that increased cerebral blood flow may be involved with the improvement of attentional function.

We investigated the system of emergency medical service in the Chuno area in Gifu prefecture.It was found that about 20,000 emergency cases were carried into the Emergency Medical Center (EMC) in Chuno Kosei Hospital annually. About 90% were patitents with mild disease or injury. During the past four years an increasing number of severely ill patients such as those acute myocardial infarction and cerebral apoplexy were transfered to our EMC from other hospitals in the Chuno area.We found that many emergency patients came to our EMC, which was not staffed with so many emergency care specialists nor equiped with so many beds for emergency patients. Therefore, we requested residents, family doctors, primary care clinics, common hospitals and administrators in the Chuno area, to contribute their share to emergency medical care together with EMC.In conclusion, we thought it necessary to build a better system of emergency medical care in this area promptly.
Area ; Medical ; Central ; Bale out ; medical care

AIMChromosome 13 is one of the most frequently altered chromosomes in prostate cancer. The present study was undertaken to examine the role of human chromosome 13 in the progression of prostate cancer.

METHODSHuman chromosome 13 was introduced into highly metastatic rat prostate cancer cells via microcell-mediated chromosome transfer.

RESULTSMicrocell hybrid clones containing human chromosome 13 showed suppression of metastasis to the lung without any suppression of tumorigenicity, except for one clone, which contained the smallest sized human chromosome 13 and did not show any suppression on lung metastasis. Expression of two known tumor suppressor genes, BRCA2 and RB1, which map to chromosome 13, was examined by reverse transcription- polymerase chain reaction analysis. BRCA2 was expressed only in the metastasis-suppressed microcell-hybrid clones, whereas RB1 was expressed in all clones.

CONCLUSIONHuman chromosome 13 contains metastasis suppressor gene(s) for prostate cancer derived from rat. Furthermore, the RB1 gene is unlikely to be involved in the suppression of metastasis evident in this system.

Animals ; Animals, Genetically Modified ; Cell Division ; genetics ; Chromosome Aberrations ; Chromosome Mapping ; Chromosomes, Human, Pair 13 ; Disease Progression ; Genetic Markers ; Humans ; In Situ Hybridization, Fluorescence ; Kinetics ; Male ; Neoplasm Metastasis ; Prostatic Neoplasms ; genetics ; pathology ; prevention & control ; Rats ; genetics