Objective: In Sweden, primary healthcare centers play an important role in the performance of general practice, education, and clinical research. In Japan, general physicians or general practitioners are expected to be more active in the small-scale hospitals and clinics in rural areas. This study aimed to explore the differences in attitudes toward general practice and clinical research among medical students in Japan and Sweden to present solutions to help doctors stay in rural areas of Japan.Materials and Methods: This cross-sectional study was conducted at two medical schools in Japan and Sweden in 2018, using an anonymous and self-administered questionnaire survey that comprised 16 items including 9 items on clinical research.Results: Participants were 154 medical students (response rate: 69.4% for 222 students) in Japan and 56 (27.1% for 201 students) in Sweden. The proportion of medical students who wanted to become general physicians was greater in Japan than in Sweden (Japan:Sweden=36.4%:17.9%; P=0.012). Although fewer Japanese students wanted to conduct research in rural areas than Swedish students (43.5%:57.1%; P<0.001), the positive proportion of Japanese students working in clinical research and/or taking an academic degree in rural areas was greater than that of Swedish students (52.0%:23.2%; P=0.032).Conclusion: As Swedish medical students and young doctors learn considerably from primary healthcare centers, their attitudes toward clinical research are more developed than those of their Japanese counterparts. However, more Japanese medical students than Swedish students wish to become general practitioners, and they are likely to strive to conduct clinical research at small-scale hospitals/clinics in rural areas. Therefore, the improvement of the clinical research environment in small-scale hospitals and clinics in rural areas is needed at the earliest in Japan.

Objective: In the instructions for package inserts (PI) of prescription drugs revised in June 2017, the section “persons with reproductive potential” was established under “precautions concerning patients with specific backgrounds.” The description rules associated with contraceptive duration were modified in these. In this study, we investigated descriptions of contraceptive duration in PI that were prepared based on the revised instructions, interview forms (IF), and other proper use materials (PM).Methods: We collected PI, IF, and PM of prescription drugs containing a new active ingredient approved from April 2017 to March 2022 for which the PI were prepared based on the revised instructions and investigated descriptions of PI, contraceptive duration, and its evidence in each information material.Results: Of the 181 drugs studied, 43.1 and 12.7% required females and males to use contraception during the period of drug consumption, respectively. Among these, the ratio of drugs that had descriptions of contraceptive duration were 15.4 and 0% for females and males at PI, respectively; 51.3 and 39.1% for female sand males at IF, respectively. Anticancer drugstended to describe contraceptive duration in the PM rather than PI or IF. For some drugs, there was no description of contraceptive duration in any of the materials. Contraceptive durations ranged from the period of administration of that drug to over a year for females and approximately one week to six months for males. The reasons for these contraceptive durations were diverse.Conclusion: Contraceptive information in the PI based on revised instructions were not sufficient for use by healthcare workers, even when the IF and PM were confirmed. These results suggest that there is a need for standardizing the descriptions, types of materials to be described, and choice of evidence for contraceptive duration.

Because of societal aging, Japanese pharmacists have an increasingly important role in home medical care. This is particularly true because more pharmacists are required to perform physical assessments to optimize patient treatment. However, few investigations have examined whether patients understand the role of pharmacists and the importance of home medical care. In this study, a questionnaire was provided to 260 patients aged 20-90 years to determine patients’ attitudes toward home medical care and pharmaceutical interventions. After conducting factor analysis, items related to home medical care were excluded at the stage of exploratory factor analysis, indicating that patients are not interested in home medical care. However, regarding pharmaceutical interventions, the questionnaire revealed that 42% of the patients required the pharmacists to provide information regarding the prescribed drugs during home medical care visits. Furthermore, it was demonstrated that 85% of the patients were unaware that physical assessments are also perform by pharmacists. In contrast, >50% of the patients believed that pharmacists had an important role in physical assessment interventions.

Cancer stem cells (CSCs) play an important role in cancer development, its main functions are self-renewing capacity, chemoresistance and tumorigenic capacity. The aim of this study is to clarify the possible role of Shh signaling in regulation of CSCs. METHODS: Normal cancer cells (HCT-116) were cultured with serum medium and cancer stem-like cells (CSCs) were obtained from serum-free medium after incubation for 14 days. After cell culturing was done RNA extraction and cDNA transcription of NCs and CSCs (HCT-116). The expressions mRNA of surface markers (CD44, EpCAM), stemness genes (Oct-4, Nanog), Shh signaling (Ptch1, SMO), and shh pathway downstream gene (Gli1), EMT markers (E-Cadherin, Vimentin) and TJ genes (Claudin-4, Occludin) were determined by real time RT-PCR before and after administration of cyclopamine (2, 5 μM). RESULTS: The expressions of surface markers (CD44, EpCAM) and stemness genes (Oct-4, Nanog) were significantly highly expressed in CSCs. Shh signaling pathway Ptch1, SMO and downstream gene Gli1 were significantly higher in CSCs than in NCs. Epithelial marker E-Cadherin was reduced in CSCs, mesenchymal marker Vimentin was up-regulated in CSCs. The expressions of Claudin-4 and Occludin were significantly higher in CSCs compared with NCs. SMO, Gli1 and Vimnetin were significantly inhibited after administration of cyclopamine (2, 5μM), but E-Cadherin was up-regulated in CSCs. Tight junction proteins were significantly inhibited by cyclopamine (2, 5μM). Although CD-44, Oct-4 and Nanog were inhibited in CSCs after administration of cyclopamine, these alterations were statistically significant in different genes respectively, but EpCAM was not inhibited. CONCLUSION: EMT, TJ and CSCs markers were affected by Shh signaling pathway in CSCs. Shh signaling pathway may play in an important role of regulation of CSCs.

Cancer stem cells (CSCs) play an important role in cancer development, its main functions are self-renewing capacity, chemoresistance and tumorigeniccapacity. The aim of this study is to clarify the possible role of Shh signaling in regulation of CSCs.METHODS:Normal cancer cells (HCT-116) were cultured with serum medium and cancer stem-like cells (CSCs) were obtained from serum-free medium after incubation for14 days. After cell culturing was done RNA extraction and cDNA transcription of NCs and CSCs (HCT-116). The expressions mRNA of surface markers (CD44,EpCAM), stemness genes (Oct-4, Nanog), Shh signaling (Ptch1, SMO), and shh pathway downstream gene (Gli1), EMT markers (E-Cadherin, Vimentin) and TJgenes (Claudin-4, Occludin) were determined by real time RT-PCR before and after administration of cyclopamine (2, 5 μM).RESULTS:The expressions of surface markers (CD44, EpCAM) and stemness genes (Oct-4, Nanog) were significantly highly expressed in CSCs. Shh signaling pathwayPtch1, SMO and downstream gene Gli1 were significantly higher in CSCs than in NCs. Epithelial marker E-Cadherin was reduced in CSCs, mesenchymal markerVimentin was up-regulated in CSCs. The expressions of Claudin-4 and Occludin were significantly higher in CSCs compared with NCs. SMO, Gli1 and Vimnetin were significantly inhibited after administration of cyclopamine (2, 5μM), but E-Cadherin was up-regulated in CSCs. Tight junction proteins were significantly inhibited by cyclopamine (2, 5μM). Although CD-44, Oct-4 and Nanog were inhibited in CSCs after administration of cyclopamine, these alterations were statistically significant in different genes respectively, but EpCAM was not inhibited.CONCLUSION:EMT, TJ and CSCs markers were affected by Shh signaling pathway in CSCs. Shh signaling pathway may play in an important role of regulation of CSCs.

During the perioperative period after total hip arthroplasty (THA), much attention has been recently paid to deep venous thrombosis, yet there are few reports concerning stroke after THA and there is no such data at all in Japan at present. The purpose of this retrospective study was to elucidate the occurrence rate and the characteristics of stroke cases during the THA perioperative period. A total of 1,551 primary THAs performed between January 1999 and December 2008 were investigated. Cerebral infarction occurred in three patients (0.19%) during three weeks after THA. Concerning the related factors, one male had foramen ovale, one female had untreated diabetes and atrial fibrillation, and one female had severe stenosis of the internal carotid artery. Cerebral infarction occurred at Day 1 in one male, at Day 2 in one female, and at Day 5 in the other female, and they underwent anticoagulant therapy just after their diagnosis. In all three patients, motor paralysis fully improved and they came back to the THA rehabilitation program within Day 9. One male was discharged at 4 weeks, and another two females were discharged at 8 weeks. Because many people eating a more European diet are now getting older in Japan, prophylaxis for not only DVT but also stroke after THA should be emphasized.

The decrease of balance capacity is considered as a high risk factor of fall accident, so it is important for the middle-aged and elderly people to keep balance capacity on a high level. In this study, we investigated the effects of aqua exercise on dynamic and static balance function. Thirty-two middle-aged women (56.6±8.1 years) participated a 60-min aqua exercise program three times per week for eight weeks. After exercise intervention, body weight, body mass index, grip strength, side step, shuttle stamina walking test were significantly improved (p<0.05-0.001). Functional reach (p<0.001) and total length of centroid shake with eye close condition (p<0.05) was significantly improved, but with eye open condition was not changed. However, when we evaluate the total length of centroid shake by T-score, static balance performance with eye open and close condition was significantly (p<0.05) improved in the below average groups. In addition, measurement value of functional reach was also improved in these groups. These results indicate that aqua exercise benefits not only physical muscle strength and endurance capacity, but also balance function in middle-aged women. Particularly aqua exercise is more effective for the subjects with lower static balance function before intervention.

We investigated the effects of long-term administration of bisoprolol (β-blocker), exercise and their combination on blood pressure, heart rate, and baroreflex function in spontaneously hypertensive rats (SHR).SHR aged 5 week were randomly assigned to control group (C), bisoprolol-treated group (Biso), exercise group (Exer), and combination group (Biso+Exer)(n=8/each group). In Biso and Biso+Exer, bisoprolol (20 mg/kg/day) was administered. In Exer and Biso+Exer, exercise training was performed on treadmill 5 days/week for 12 weeks. Systolic blood pressure (SBP) and heart rate (HR) were measured using the tail-cuff method under restraint from 5 to 16 weeks of age. After 12-week intervention period, sigmoidal mean artery pressure (MAP) and HR reflex curve were obtained by intravenous injections of various doses of phenylephrine and nitroprusside under non-restraint condition. To determine vagal component of baroreflex function, baroreflex MAP-HR relation were also examined after intravenous injections of atenolol (β-blocker). After measurements of all baroreflex function, atropine was additionally injected to determine intrinsic HR.At 15 and 16 weeks of age, SBP and HR in Biso and Exer were significantly lower than those in C. SBP and HR in Biso+Exer were further reduced compared with Biso. Before atenolol, resting MAP, HR and upper and lower HR plateaus in the sigmoid curve were lower in Biso, Exer, and Biso+Exer compared with C. There were no significant differences in these parameters between Biso and Biso+Exer. There were no significant differences in baroreflex gain before atenolol among the four groups except for between Biso and Biso+Exer. After atenolol, baroreflex gain and HR range in Biso, Exer, and Biso+Exer were significantly higher than those in C. HR range of sympathetic component (upper HR plateau before atenolol-itrinsic HR) was significantly reduced in Biso, Exer, and Biso+Exer compared with C. There were no significant differences in baroreflex gain of vagal component or HR range of vagal and sympathetic component between Biso and Biso+Exer.These findings suggest that both chronic treatment with β-blocker and exercise decrease resting blood pressure and HR in SHR, associated with reduced sympathetic component and increased vagal component of baroreflex function. The additive effects of β-blocker and exercise are not evident under non-stressful conditions, but could be obtained in the presence of stress such as restraint.

We investigated the relationship between body weight reduction and intensity of daily physical activities assessed with 3-dimensional accelerometer during a 3-month exercise program. Twenty-six middle-aged women (58.1±7.4 yrs.) participated in this study. Participants underwent a 90-min endurance exercise intervention once a week, and a 3-dimensionsal accelerometer was attached through the program. Body weight (BW), body mass index, fat mass and percent body fat were reduced significantly (p<0.001), while diastolic blood pressure (p<0.01) and shuttle stamina walking test (p<0.05) improved significantly after the exercise intervention. Moreover, a significant negative correlation was observed between the changes in BW and total activity time (TAT) per day of more than 3METs (TAT≥3METs)(r=−0.580, p<0.01) and TAT≥4METs (r=−0.627, p<0.001). To the contrary, the daily steps and the TAT≥2METs were not related to the changes in BW. After adjusting daily steps, TAT≥3METs (β=−0.630, p<0.01) and TAT≥4METs (β=−0.659, p<0.01) were still significantly related to the changes in BW. These results indicate that weight reduction has a much closer relationship with exercise intensity than daily steps. It is important to keep both quantity and intensity of exercise in the unsupervised exercise program aimed at weight reduction.

Aim:The usefulness of high-density barium, which was made to 150w/v% (MIX150), was examined to obtain better radiographs of the intestines. Methods: “MIX150” was compared with existing pharmaceutical “BAM100” to evaluate x-ray images (barium adhesion, dryness evaluation). MIX150 was used in 232 patients (mean age 56 years), while BAM 100 in 210 patients (mean age 55 years). Results: In terms of adhesion, MIX150 was excellent in the the cecum significantly and in dryness evaluation, in the entire region of the colon. Conclusion: High-density barium (150w/v%) was useful for enhancing the quality of radiographic images.
physical density ; Euphoric mood ; Roentgen Rays ; Barium ; Lower case vee