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Get PDFBACKGROUND: The effect of multidisciplinary education on clinical decision making by medical students is not well known. METHODS: Twenty of fourth, fifth or sixth year medical students were randomly assigned to multidisciplinary groups (MultiG, n = 7) with two medical, pharmacy and nursing students or medical student groups (MedG, n = 10) with six medical students only and given a two-day PBL program using evidence-based medicine (EBM) methodology. The main outcome measure is clinical decision making by medical students for the case, measured by a 100 mm visual analog scale (VAS). Additional patient information requested and self-evaluation of the PBL program were also measured. RESULTS: Correct answers to assess clinical epidemiology knowledge increased significantly in both groups (4.1 to 9.9 points in MultiG, p < 0.001: 3.6 to 9.7 points in MedG, p = 0.002), while scores at baseline and post-program were not significantly different. The number of additional patient information cards requested was not significantly different (p = 0.10). After the program, the VAS for clinical decision making was significantly different (54 mm and 89 mm, p = 0.013), although preprogram values for both groups were similar. CONCLUSION: Pharmacy and nursing students may have potential to change the clinical decision making by medical students.departmental bulletin pape
Get PDFObjectives. The purpose of the present study is to find out the clinical characteristics which determine candidates for tinnitus retraining therapy (TRT) with a sound generator (SG) as well as the prognosis of this treatment. Method. This study enrolled 270 serious tinnitus patients who visited this institute between January 2004 and December 2008 in the TRT program. The relationships among compliance, efficacy, clinical characteristics, and affinity for SG were evaluated retrospectively. Results. The persistence rate at one month was 61.5%. The shorter duration and higher pitch of tinnitus were significant independent predictors of compliance. Six months after the initiation of TRT, 65.2% subjects demonstrated significant relief from tinnitus. The Kaplan-Meier method demonstrated that the overall efficacy rate at 18 months was 86.5%. The lower loudness of tinnitus, recognition of tinnitus attenuation by a sound generator, and patient’s positive attitude toward TRT were significant variables for predicting favorable results. Conclusion. The patients with lower loudness of tinnitus were suitable for TRT with a SG.departmental bulletin pape
Get PDFTo investigate the adhesion factor of Bacteroides vulgatus derived from ulcerative colitis (UC), we isolated B. vulgatus strains from the large intestinal mucosa of UC patients and non-UC individuals, and examined their adherence to tissue-cultured cells. The adherence to tissuecultured cells in UC-derived strains (36.5 ± 7.9 %) was higher than that in non-UC-derived strains (13.2 ± 7.7 %). PCR and sequencing analysis of outer membrane proteins revealed that the strains derived from five of seven (71.4 %) UC patients had ompA genes belonging to either ompA variant type A or B. The adherence rates in Escherichia coli DH5α transformants with ompA type A variants (33.3 ± 4.6 %) and type B variants (34.6 ± 7.1 %) were higher than the rate in those with non-UC ompA (16.4 ± 4.0 %). Our results suggest that B. vulgatus isolates in the mucosal flora of the large intestine of UC patients have a high frequency of ompA variants and that the variation of ompA variants is one of the factor causing an increase in the adherence of the bacterium.departmental bulletin pape
Get PDFGiven that previous studies have shown that recreational music-making has benefi ts for younger individuals, we explored two questions. 1. Could a recreational music-making protocol improve mood and modulate immunological responses in a direction opposite to that associated with chronic stress in older adults? 2. Would the protocol affect older and younger participants differently? Two groups of volunteers demarcated at age 65 years underwent identical one-hour recreational musicmaking interventions. Pre-and post-intervention data were collected using blood samples and mood state questionnaires. Data from 27 older and 27 younger volunteers were analyzed for cytokine production levels, natural killer cell activity, plasma catecholamines, and numbers of T cells, T cell subsets, B cells, and natural killer cells. Exercise expenditure was also recorded. In the older group, we found signifi cant increases in the number of lymphocytes, T cells, CD4+ T cells, memory T cells, and production of interferon- γ and interleukin-6. In the younger group, modulation was non-significant. Worthy of note was the specific immunological changes in the direction opposite to that expected with chronic stress in the older group. The increase in Th1 cytokine IFN-γ and unchanged Th2 cytokine IL-4 and IL-10 levels in the older group suggests a shift to a Th1- dominant status, a shift opposite to that expected with stress. However, the immunological changes were not statistically different between the two groups. Mood states improved in both groups, but were also not statistically different between groups. Although no statistically significant difference was found between the two age groups, the improvement in immunological profile and mood states in the older group and the low level of energy required for participation suggest this music-making protocol has potential as a health improvement strategy for older individuals.departmental bulletin pape
Get PDFBackground: Diffuse noxious inhibitory control (DNIC) is thought to be mediated by neural networks in supraspinal brain structures. The descending antinociceptive system (DAS) is an important component of the DNIC neural network, but the precise structure of the neural network and the related neurotransmitters have not been examined. Methods: The study was designed to examine whether systemic administration of the adrenergic agonists dexmedetomidine (DEX) and phenylephrine (PE) influences DNIC in the rat. Changes in the C-fiber reflex evoked by electromyographic activity were recorded following noxious tail immersion in hot water. Results: Inhibition of the C-fiber reflex by the conditioning stimuli was reduced from 77.1 ± 22.6% to 26.6 ± 38.2% with continuous administration of DEX, and restored to 58.3 ± 29.2% by intramuscular injection of atipamezole hydrochloride(APZ), a selective α 2- adrenoceptor antagonist. Inhibition of the C-fiber reflex was reduced from 75.6 ± 25.8% to 22.7 ± 38.9% with continuous administration of PE, and restored to 84.9 ± 9.7% by intramuscular injection of phentolamine mesylate (PT), an α - adrenoceptor antagonist. Conclusion: The results show that clinical doses of DEX and PE inhibit DNIC, thereby aff ecting and modulating the intrinsic pain inhibition system. These findings suggest that adrenergic neurons are involved in DNIC.departmental bulletin pape
Get PDFAlthough evidence suggests that peripheral B cell death plays a role in maintenance of B cell homeostasis including elimination of self-reactive B cells, the site of B cell death in unimmunized peripheral lymphoid organs has not yet been studied. Here we demonstrate that cells exhibiting reduced mitochondrial membrane potential and those expressing active caspase 3, both of which are characteristic for apoptosis, are specifically accumulated in the marginal zone (MZ) B cell compartment compared to the other B cell subsets in normal unimmunized mouse spleen. These apoptotic MZ B cells exhibit increased expression of MHC class II and CD22, whose expression is shown to be increased upon B cell activation, but not other activation markers such as CD69 and CD86, suggesting that apoptotic MZ B cells are activated with partial expression of B-cellactivation- associated antigens. These results indicate that MZ is the major site of peripheral B cell apoptosis in unimmunized mice. Apoptosis of MHC class IIhi CD22hi MZ B cells may contribute to B cell homeostasis.departmental bulletin pape
Get PDFBackground: Neoadjuvant chemotherapy (NAC) has been administered since the 1990s and is now one of the major treatments for breast cancer. It can achieve extremely positive results in some patients. Whether NAC affects immediate breast reconstruction (IBR) using an expander, however, remains unclear. Methods: A retrospective study was performed at Tokyo Medical and Dental University (TMDU) hospital. Seventy-five cases of immediate breast reconstruction using an expander were performed in 69 patients between January 2001 and January 2007. The patients were evaluated for tumor size, histological type, sites of invasion, staging, lymph node metastasis, NAC regimen, response to NAC, type of immediate breast reconstruction (IBR), complications, and prognosis. Results: In patients treated with an expander, there was no significant difference in the complication rate between those who underwent NAC and those who did not. Conclusions: NAC did not increase the complication rate after IBR using an expander. However, for reconstruction using autologous tissue, more data are needed.departmental bulletin pape
Get PDFConfocal laser microscopy is a well-recognized research tool in the fields of biological and material science which enables high-resolution images of samples with minimum requirements for specimen preparation. Here we introduce an innovative technique for the 3-D description and measurement of resorption pits using Super Depth Surface Profile Measurement Microscope based on the principle of confocal microscope. We show one example of culturing for 48 h with an established NF-κB inhibitor named NBD-peptide after plating mature osteoclasts on dentine slices with osteoblasts. The activity of osteoclasts is measured by determining the volume of resorbed portion of dentine by osteoclasts in vitro. The 3-D surface profile could be obtained by detecting the position at which the reflected laser intensity from the target becomes the maximum on z-axis. The volume and depth of resorption lacunae by stimulated osteoclasts is significantly increased compared to the un-stimulated group without changing of resorption area. The increase in volume and depth are dose-dependently inhibited by the NBD-peptide. Comparing to the classical method by measuring 2-D area of pits, analysis based on this technique could provide reliable quantitative assessment reflecting the osteoclast activity.departmental bulletin pape
Get PDFTo determine whether staining with iodine solution provides an efficient criterion for determining the area of resection for the lesions surrounding squamous cell carcinoma (SCC) and leukoplakia of the tongue, we determined the optimum density of iodine solution and staining procedure and analyzed the color of lightly stained lesions (LSLs) in relation to the histopathologic findings. Sixtyfive patients with SCC or leukoplakia of the tongue were divided into two groups: lesions stained with 3% Lugol solution and restained with either 5% Lugol solution (n=38) or 10% iodine glycerin (n=27). Among the lesions stained with 5% Lugol solution, significant differences were found in all color values. Color difference values (ΔE*ab) using 3% and 5% Lugol solutions were significantly different between epithelial hyperplasia/mild epithelial dysplasia and moderate to severe dysplasia (P < 0.05). According to the evaluations of five clinicians in 46 LSLs, a distinctive boundary was most often obtained using 5% Lugol solution. These results suggest that the most effective method for obtaining a clear boundary and distinguishing moderate to severe dysplasia from mild or no epithelial dysplasia according to the measured color value was to stain with 3% followed by 5% Lugol solution.departmental bulletin pape
Get PDFWe compared occlusal discomfort in patients with temporomandibular disorders (TMD) between myofascial pain (MFP) and disc displacement (DD) using a database created from Sep, 2003 to Aug, 2005. We selected 71 patients with MFP and 170 patients with DD to construct a null model of structural equation modeling (SEM) in which anxiety influenced depressive mood, depressive mood aggravated occlusal discomfort and sleep complaints, and sleep complaints or an onset event caused by another person aggravated occlusal discomfort. We performed a simultaneous analysis of patients with MFP and DD. The estimated parameter of the path from depressive mood to occlusal discomfort was significant for patients with MFP, but not for patients with DD. The path from an onset event caused by another person, such as dental treatment to occlusal discomfort was significant in patients with MFP and those with DD. The Goodness of Fit Index (=0.909), The Adjusted Goodness of Fit Index (=0.867), and The Root Mean Square Error of Approximation (=0.039) indicated good acceptability. These results suggested that an increase in depressive mood may aggravate occlusal discomfort in patients with MFP, and an onset event caused by another person, such as dental treatment, also may aggravate occlusal discomfort in patients with MFP and those with DD.departmental bulletin pape