Clinical ethics consultation is desired for medical staff, but it is limited nationwide. Ethical dilemmas arise in clinical situations; however, there is no consensus on the implementation of clinical ethics and clinical ethics consultation. This paper intends to clearly show the implementation of clinical ethics consultation. First, previous literature on clinical ethics was reviewed, and the concrete processes of clinical ethics were discussed, in an easy-to-understand manner, regardless of the historical context of clinical ethics that were derived from bioethics. Then, the processes of clinical ethics were confirmed in the parties concerned, between attending medical staffs and patients and families. After the processes of clinical ethics consultation were confirmed, a method of responding to clients was proposed to be differentiated between advices of fact confirmation and those accompanied by value judgement. Several examples were provided based on our clinical experiences. The discussion and the proposals in this paper are expected to promote the establishment of clinical ethics support and encourage clinical ethics consultants to maintain their standard of daily activities, similar to medical safety and infection control protocols in a hospital.

Endometrial decidualization is essential for embryo implantation and maintenance of pregnancy. A defect in decidualization leads to infertility, miscarriage, and perinatal diseases such as hypertensive disorders of pregnancy. Progesterone (P), secreted from the corpus luteum after ovulation, causes morphological and functional differentiation of endometrial stromal cells (ESCs). The Heart and neural crest derivatives-expressed transcript 2 (HAND2) in ESCs is one of transcriptional regulators that are directly regulated by the P receptor. The increase in HAND2 activity regulates the production and secretion of angiogenic factors and cytokines in ESCs. Through these factors, ESCs interact with vascular endothelial cells and immune cells, contributing to the establishment of vasculature and immune tolerance. We have reported that HAND2 in ESCs may contribute to vasculature in the secretory endometrium by suppressing fibroblast growth factor (FGF9)-FGF receptor signaling, thereby reducing angiopoietin 2 (ANGPT2) production. Furthermore, we found that HAND2 also plays an important role in the establishment of immune tolerance by directly regulating IL15 gene expression.

Eosinophilic chronic rhinosinusitis (ECRS) is an upper and lower airways eosinophilic airway inflammation that is frequently associated with asthma. Infiltrating the inflammatory region, tissue eosinophils are activated and play an important role in pathogenesis. Although CD69 is known as a marker of eosinophil activation, the functional role of CD69 has not been well understood. Therefore, we isolated eosinophils from the tissues of patients with ECRS to investigate the correlation between eosinophil activation and CD69 expression and its functional role. The results showed that CD69 was highly expressed in tissue eosinophils compared to eosinophils from peripheral blood, and that the expression level of CD69 correlated with the severity of symptoms. Furthermore, we found that CD69 stimulated the release of EPX (Eosinophilic Peroxidase). Thus, CD69 is expected to be a new target for therapeutic strategies against ECRS.

Proper glycemic control is an essential goal of critical care medicine, including perioperative patient care that can influence patients’ prognosis. Insulin secretion from pancreatic β-cells is generally assumed to play a critical role in glycemic control in response to an elevated blood glucose concentration. A line of animal and human studies have demonstrated that perioperative drugs, including volatile anesthetics, have an impact on glucose-stimulated insulin secretion (GSIS). However, the effects of intravenous anesthetics on glucose metabolism and insulin sensitivity are largely unknown at present. We have shown that propofol, at clinically relevant doses, facilitates GSIS in MIN6 and INS-1 cells and inhibits stromatoxin-1-sensitive voltage-gated potassium (Kv) channels. In other words, propofol specifically blocks Kv currents in β-cells, and the inhibitions result in the facilitation of insulin secretion in the presence of glucose. Elucidating the effects of anesthetics on insulin secretion and their mechanism is important to understand their impact on patients in clinical use.

Congenital hydronephrosis (CH) have the highest incidence among congenital malformations that are found in the fetal or neonatal period. As the prognosis of the CH is not always benign, neonates with CH need to be followed up. Although repeated renal ultrasonographic examination is recommended for the follow-up of CH, no standardized strategy is currently available for mild CH due to lack of large cohort surveys on their natural course. Therefore, this study was conducted to determine a follow-up plan for mild CH in Japanese individuals. Among 1009 neonates, CH was detected in 118 affected renal units of 100 (9.9%) patients. According to the definition of the Society for Fetal Urology, 118 affected renal units were graded as grade 1 in 87 (74%), grade 2 in 30 (25%), grade 3 in one (1%) and grade 4 in 0 units. The grade 1 CH was improved 90% and 99%, by 13 and 25 months of age. The grade 2 CH was improved 32% and 60%, by 13 and 25 months of age. In conclusion, Grade 1 CH does not need to be followed up, because it mostly shows spontaneous resolution by 2 years of follow up without any complications. However, ultrasonographic examinations at 1-year intervals for grade 2 CHs are recommended to determine the subsequent follow-up plan of patients.

The COVID-19 pandemic has generally prompted the education to move to an online, non-face-to-face format. However, it is very hard to make anatomical practice online because anatomy treats the sophisticated and elaborate three dimensional human structure, which is normally studies with cadavers. In this study, medical students currently studying anatomy undergo the educational program of reconstructing three-dimensional images from open resource medical images to ask the effectiveness of this program on familiarization with the usage of medical images and improving their understanding of the three-dimensional structure of the human body. We created on-demand movies for obtaining online resources and usage of several free DICOM viewers and provided them to students. Ninety six percentages of students who participated in this program submitted reconstructed three-dimensional images. We divided students into 4 groups by the points they obtained in this program and whether they participated in this program and assessed the correlation between points in this program and deviation scores in anatomical examination. Although there was no statistical differences, we found a tendency of correlation between points in this program and mean deviation scores of the hands-on exam. These findings indicate the effectiveness of this program in familiarization with the usage of medical images and suggest the possibility of this non-face-to-face teaching program to improve the understanding of the three-dimensional structure of the human body by medical students.