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Get PDFIn order to address regional inequality in healthcare delivery in Japan, healthcare districts were established in 1985. However, regional healthcare delivery has now become a national issue because of population migration and the aging population. In this study, the state of healthcare delivery at the district level is examined by analyzing population, the number of physicians, and the number of hospital beds. The results indicate a continuing disparity in healthcare delivery among districts. We find that the rate of change in population has a strong positive correlation with that in the number of physicians and a weak positive correlation with that in the number of hospital beds. In addition, principal component analysis is performed on three variables: the rate of change in population, the number of physicians per capita, and the number of hospital beds per capita. This analysis suggests that the two principal components contribute 90.1% of the information. The first principal component is thought to show the effect of the regulations on hospital beds. The second principal component is thought to show the capacity to recruit physicians. This study indicates that an adjustment to the regulations on hospital beds as well as physician allocation by public funds may be key to resolving the impending issue of regionally disproportionate healthcare delivery.departmental bulletin pape
Get PDFEven though English is most frequently the common language when the patient’s native language differs from that of a dentist, the opportunities for Japanese undergraduate dental students to learn dental English are now quite limited. The purposes of our study were to investigate: the effectiveness and feasibility of the computer-assisted simulation materials as one solution strategy for dental English education in Japan, and the needs and demands for dental English from the learners’ side. Interactive simulation materials for medical interviews in English and clinical cases which were translated to English, were delivered via Learning Management System (LMS) to nineteen trainee residents of dentistry (residents). Evaluation for the materials, learners’ knowledge and interests in the contents, and ease of operation were obtained by post-questionnaire (response rates were 100% and 95%, respectively). Both questionnaire-surveys received positive feedback toward the materials, yet 47% answered that they lacked the level of knowledge about contents of the medical interview in English. Results were sufficient to suggest that the residents would like to have the opportunity to study or practice medical interview in English, or English related to dentistry, and that the simulation materials could be one of the solution strategies for opportunity provision.departmental bulletin pape
Get PDFThe aim of this study was to investigate which parameters among the ankle brachial index (ABI), toe brachial pressure index (TBI) and transfer function index (TFI) are useful to accurately diagnose PAD in patients with / without arterial calcification, who have undergone some type of diagnostic imaging. Patients and Methods: A total of 102 patients with 192 limbs (mean age: 72.0 ± 8.4 years) underwent plain radiography, ABI, TBI and TFI. A receiver operating characteristics (ROC) analysis was performed to assess possible threshold values that predict PAD in these patients. Results: T he a rea u nder t he c urve ( AUC) o f t he ABI, TBI and TFI were 83.0%, 87.9%, 93.1% in the all limbs group, respectively. In the non-calcified lesion group, the AUC of the ABI, TBI and TFI were 94.4%, 87.9%, 93.1%, respectively. In the calcified lesion group, the AUC of the ABI, TBI and TFI were 71.4%, 87.9% and 92.9%, respectively. Conclusions: A cut-off value of TFI ≦ 1.025 exhibits a higher AUC for detecting the presence of PAD than the ABI and TBI. Therefore, the TFI is considered to be useful to estimate the presence of PAD in all types of patients, especially those with arterial calcification.departmental bulletin pape
Get PDFSynovial mesenchymal stem cells (MSCs) are an attractive cell source for cartilage and meniscus regeneration. Use of primary MSCs is the preferable because these cells are safer than cells passaged several times in terms of probability of chromosome abnormalities. The effect of hypoxia on the proliferation of MSCs is controversial and remains unknown in primary synovial MSCs. Primary synovial MSCs were cultured at normoxia or hypoxia, and colony number, cell number, surface epitopes, mitochondria activity, TEM finding, and chondrogenic potential were analyzed. To investigate the effect of hypoxia on attachment of synovial MSCs, cells were cultured at hypoxia for the first 3 days, then cultured at normoxia. To investigate the effect of hypoxia on proliferation, cells were also cultured at hypoxia for the last 11 days. Hypoxia increased colony number and cell number per dish in primary synovial MSCs. Hypoxia did not affect cell number per colony, surface epitopes, mitochondria activity, TEM finding or chondrogenic potential. Hypoxia for the first 3 days did not alter colony number per dish or cell number per dish, while hypoxia for the last 11 days increased. Hypoxia enhanced proliferation through increase of colony formation rate with chondrogenic potential in primary synovial MSCs.departmental bulletin pape
Get PDFEndoscopic retrograde cholangiopancreatography (ERCP) brushing cytology often cannot distinguish adenocarcinoma from reactive epithelial changes. We attempted to improve the diagnostic sensitivity of ERCP using the following methods: systematic cytological evaluation, immunocytochemical examination of minichromosome maintenance proteins (MCM) 2 and p53, and a combination of these methods. ERCP specimens from 53 patients (13 benign and 40 malignant cases) were studied. First, we reclassified the cases into three categories according to the systematic cytological evaluation: negative, suspicious, and positive. Secondly, immunocytochemistry was performed for MCM 2 and p53. The cut-off values were set at 25% labeling index (LI) for MCM 2 and 10% LI for p53, respectively. We evaluated the sensitivity, specificity, and diagnostic accuracy. The sensitivity of the systematic cytological evaluation alone did not improve significantly, compared with the original screening examination (77% vs. 68%). The sensitivity of immunocytochemistry for MCM 2 and p53 was 90% (P < 0.05) and 68%, respectively. Applying only the suspicious or positive categories, the sensitivity improved significantly to 93% for the combination of systematic cytological evaluation and immunocytochemistry for MCM 2 and p53 (P < 0.01). In conclusion, the combination of morphology and immunocytochemistry for MCM 2 and p53 may help to overcome the diagnostic cytological difficulties of pancreaticobiliary adenocarcinoma.departmental bulletin pape
Get PDFWe have cloned a gene from a rat liver cDNA library, representing alternatively spliced cDNAs encoding 83-kDa and 68-kDa proteins, which we have designated as UKp83 and UKp68, respectively. Both proteins have a predicted nuclear localization signal and five CCCH motifs (zinc-binding motifs), and share a degree of sequence similarity with Nab2, a yeast protein that contains nucleic acidbinding motifs and tandem CCCH zinc fingers. Nab2 binds homopolymeric RNA and single-stranded DNA and regulates poly(A) tail length and the export of mRNA to the cytosol. The CCCH motifs of UKp83/68 bound poly(A) and ssDNA strongly and other RNA homopolymers and dsDNA less efficiently. The UKp83/68 protein localized within the nucleus with a fibrous or punctate structure that reflected the distribution of SC35, a known marker of nuclear speckles which are nuclear domains enriched in pre-mRNA splicing factors and located in the interchromatin regions of the nucleoplasm of mammalian cells. The distribution of UKp83/68 changed during the different stages of mitosis. During prometaphase, when the nuclear envelope disintegrates, the protein becomes partially localized on the chromosomes; at other times, transiently dispersed over the cytoplasm with the formation of fibrous structure. The transient expression of UKp83 in HEK293T cells had no apparent effect on cellular function, whereas the expression of an antisense sequence or C-terminal domain of UKp83 induced apoptosis. These results suggest that UKp83/68 is probably essential for cell viability and may play important role in mRNA processing.departmental bulletin pape
Get PDFThis study aimed to clarify the characteristics of the Japanese version of the Infant-Toddler Social and Emotional Assessment (J-ITSEA), a parentreport questionnaire concerning social-emotional/behavioral problems and delays in competence in 1- to 3-year-old children. The differences in score between genders, ages, and between the J-ITSEA and the original Infant-Toddler Social and Emotional Assessment were examined. The data of 617 participants recruited from Saitama prefecture through stratified two-stage sampling were analyzed. The Cronbach's alpha ranged from 0.76 to 0.93. Gender differences emerged for some problems and all competence scales, with boys rated higher in the Externalizing problem domain and Activity/Impulsivity subscale and girls ratedhigher in the Internalizing problem domain, Inhibition to Novelty subscale, and all Competence scales. The Competence domain score increased across age groups. Compared with a normative sample in the US, participants in this study rated higher in Aggression/Defiance and Separation Distress, and rated lower in Peer Aggression and most of the Competence scales. The results indicate that the J-ITSEA scores should be interpreted in comparisonwith standard scores assigned for gender and 6-month age groups, and that specific criteria for the cut-off points for the J-ITSEA are required instead of those in the original questionnaire.departmental bulletin pape
Get PDFThis study investigated the effects of the Japanese Early Promotion Program (JEPP), which is based on the Infant Mental Health (IMH) program. The JEPP aims to promote mother-infant interactions by enhancing the mother’s ability to respond appropriately her child. Mothers in the JEPP group (n = 15) received support from IMH nurses in a pediatric clinic until their infants reached 12 months of age. The nurses provided positive feedback that emphasized strength of parenting, and assisted the mothers in understanding the construct of their infants. Mother-infant interactions and mother’s mental health status were assessed at intake (1–3 months), and at 6, 9, and 12 months of infants’ age. The JEPP group data were compared with cross-sectional data of the control group (n = 120). Although JEPP dyads were not found to be significantly different from the control group in general dyadic synchrony, both before and after intervention, JEPP mothers significantly improved their ability to understand their infant’s cues and to respond promptly. In the JEPP group, unresponsiveness to infants was reduced in mothers, while infants showed reduced passiveness and enhanced responsiveness to the mother. Furthermore, the intervention reduced the mothers’ parenting stress and negative emotions, thereby enhancing their self-esteem.departmental bulletin pape
Get PDFSince the understanding of emotional changes induced by dental treatments is important for dentists to provide a safe and comfortable dental treatment, we analyzed physiological responses during watching video images of dental treatments to search for the appropriate objective indices reflecting emotional changes. Fifteen healthy young adult subjects voluntarily participated in the present study. Electrocardiogram (ECG), electroencephalogram (EEG) and corrugator muscle electromyogram (EMG) were recorded and changes of them by viewing videos of dental treatments were analyzed. The subjective discomfort level was acquired by Visual Analog Scale method. Analyses of autonomic nervous activities from ECG and four emotional factors (anger/stress, joy/satisfaction, sadness/ depression and relaxation) from EEG demonstrated that increases in sympathetic nervous activity reflecting stress increase and decreases in relaxation level were induced by the videos of infiltration anesthesia and cavity excavation, but not intraoral examination. The corrugator muscle activity was increased by all three images regardless of video contents. The subjective discomfort during watching infiltration anesthesia and cavity excavation was higher than intraoral examination, showing that sympathetic activities and relaxation factor of emotion changed in a manner consistent with subjective emotional changes. These results suggest that measurement of autonomic nervous activities estimated from ECG and emotional factors analyzed from EEG is useful for objective evaluation of subjective emotion.departmental bulletin pape
Get PDFDisease staging, first developed in 1970, has been used to assess the levels of biological severity, defined as the risk of organ failure or death, of specific medical diseases. Because few studies to date have evaluated disease staging in Japan, a small pilot study was designed to determine whether disease staging is available and useful in actual medical practice in Japan. The relationships between disease staging and length of stay, medical costs and age were retrospectively evaluated in patients admitted to Japan Association for Development of Community Medicine - Tokyo Bay Urayasu Ichikawa Medical Center for appendicitis, type 2 diabetes mellitus, and cerebrovascular diseases from April 2012 to March 2013. Patients were easily staged based on information at the time of hospital discharge. Disease stages were found to be affected significantly by length of hospital stay and medical costs. Age also affected disease stages in patients with appendicitis. These findings indicate that disease staging was available in Japan and was affected by hospital resources, including length of hospital stay and medical costs.departmental bulletin pape