In this article, I introduce one of the lectures of Dr. Gerald Stein (courtesy clinical assistant professor, Department of Medicine, University of Florida, USA) on problem-based thinking processes.
The patient was an 85-year-old woman who presented complaining of fever, cervical pain, headache, and shoulder pain. First, a problem list was prepared based on a careful patient interview. Next, differentiation was performed for “diseases that must not be overlooked.” It is most important to avoid jumping suddenly into a plan. Identifying the relationships between all three categories of problem list, differential diagnosis, and plan is necessary. The entire problem list is related to differential diagnoses, and all differential diagnoses are linked to the plan. Conversely, all plans should traceable back to identified problems.
Particularly in cases where a variety of symptoms are present, a thought process such as shown in this lecture is very important to reduce missed diagnoses and eliminate unnecessary tests.
The Health and Sports Department established on 18 May 1996 is comprised of four divisions: a Health and Sports Clinic, a Consultation by Appointment Clinic, a Members-only Refresse Club, and a Complete Medical Examination Service. The Health and Sports Clinic, the biggest feature of this project, was conceived as a facility to address various lifestyle diseases through offering consultations on exercise, health, and nutrition. It operates on a membership system with an annual fee of 300,000 JPY per member. The Consultation by Appointment Clinic is a specialty outpatient facility which charges appointment fees that are treated as special healthcare expenditures. When it opened in 1996, there were two examination rooms. It has since moved to the south side of the third floor of Building B in May 2016, and there are now 10 examination rooms. For the first time, these have also been established to meet the needs of otolaryngological, ophthalmological, gynecological, and urological patients. The Refresse Club is a members’ club providing the best and the most exclusive medical services at Juntendo University Hospital. There are approximately 140 members registered at present, with membership growing recently at the rate of a few new applications per year. The Medical Examination Services started with doctors on temporary transfer to the Health and Sports Department who performed one to two complete checkups a day. This service started with different lecturers and senior staff from various internal medicine departments taking turns to provide physical examinations and document results. Subsequently, with the cooperation of the Department of General Medicine, doctors were deployed to this clinic long enough to perform 4-5 complete medical checkups a day. At present, around 10 people a day can receive a complete medical checkup on an outpatient basis, and an additional 10 people per month can have an inpatient medical checkup.
Atopic dermatitis (AD) is a common skin disorder with evolving and complex pathogenesis. The research on pathogenesis has shifted from focusing primarily on the generalized immune system abnormalities, to skin barrier dysfunctions contributing to the overall phenotype. It is noteworthy to highlight Professor Hideoki Ogawa’s epoch-defining editorial review in the Journal of Dermatological Science, “A speculative view of atopic dermatitis: barrier dysfunction in pathogenesis” (1993). Under his outstanding guidance and collaboration, I have increasingly become aware of how to see and think about patients with AD. Prof. Ogawa is an exceptional teacher, a mentor, and a preeminent physician-scientist in the true sense, who vividly translates skin rashes into pathophysiology. Furthermore, he and his colleagues have succeeded in the treatment of patients with severe, long-standing, and intractable AD with psolaren photochemotherapy (PUVA). Such passionate therapeutic attempts have been strongly influenced by his own philosophies of “dream and spirit” and “a true clinician cures the patient.”
I graduated from Juntendo University in 1977. Until my retirement, I have belonged to Juntendo University for approximately 41 years. My 41-year career as the surgeon at Juntendo University is divided into 28 years in Juntendo Main Hospital “Juntendo Iin” and 13 years in Juntendo University Nerima Hospital. On the occasion of my retirement, I would like to highlight our procedure of pancreaticojejunostomy that is end-to-side anastomosis using the invagination method without a pancreatic stenting tube at Juntendo University Nerima Hospital. This procedure appears to be simple and secure for the GI tract surgeons. I hope many surgeons try this procedure without hesitation.
Objective: The purpose of this study was to investigate the effect of different contraction types on muscle structures, functions and muscle hardness.
Materials: 6 healthy males (age: 22.8±1.5 years, height: 176.1±4.0 cm, weight: 72.3±11.0 kg) participated in this study.
Methods: Subjects performed concentric contraction (CC) exercise of elbow flexor with one arm, and eccentric contraction (EC) exercise of elbow flexor with the other arm with the same total work. Muscle hardness of the biceps brachii measured by strain ratio, elbow joint angle, and maximal voluntary contraction (MVC) torque of elbow flexors were measured before (PRE), 1 hour (1H), 3 hours (3H) and 24 hours (24H) after the exercise protocol. Muscle soreness was measured at 1H, 3H, and 24H time points.
Results: A significant interactions (time×type) was found in MVC torque (p<0.01), elbow joint angle (p<0.01), and muscle thickness (p=0.013). Strain ratio, MVC torque significantly decreased at 1H, 3H, and 24H compared to PRE after the EC exercise (p<0.05). Main effect in time was detected in Strain ratio (p=0.046) and upper arm circumference (p=0.044). Main effect in contraction type was detected in muscle soreness (p<0.01) with the greater level after the EC exercise. Elbow joint angle significantly increased at 1H, 3H, and 24H (p<0.05) compared to PRE after the EC exercise, and at 1H, 3H compared to PRE after the CC exercise (p<0.05). Upper arm circumference significantly increased at 1H compared to PRE after the CC exercise (p<0.05).
Conclusions: The disruption of muscle function is greater and longer lasting after the eccentric contraction exercise than the concentric contraction exercise, and the muscle hardness only increased after the eccentric exercise when the exercises are performed with the same total work. The mechanisms of functional disruption following exercises and its effect on the muscle hardness may different according to the type of muscle contraction.
Objective: Corresponding to an increasingly aging society, percutaneous coronary intervention (PCI) has been performed in elderly patients for the past few decades. However, there is a few data regarding patients’ characteristics and clinical outcomes in the subset of patients.
Materials and Methods: We used database of patients aged 70 to 85 who underwent PCI at Juntendo University between 1985 and 2010. The patients were divided into three groups depending on the timing of PCI (between December, 1985 and December, 1997; plain old balloon angioplasty (POBA)-era; between January, 1998 and July, 2004; bare metal stents (BMS)-era, between August, 2004 and December, 2010; drug-eluting stents (DES)-era). The clinical outcome was a composite of all-cause death and acute coronary syndrome (ACS) within 3-year after PCI.
Results: A total of 1,070 patients (POBA-era; 184, BMS-era; 367 and DES-era; 519) were examined. Mean age and body mass index (BMI), the prevalence rates of diabetes, hypertension and dyslipidemia were higher in the DES-era. Lipid profiles were better and prescription rates of evidenced-based medicine were higher in the DES-era. Event-free survival rates for 3-year all-cause death and ACS was not different between the three groups. Univariable Cox regression analysis showed that hazard ratio for the clinical outcome was not statistically different between the DES- and POBA-era. A similar result was found between the BMS-era and POBA-era. Multivariable Cox regression analysis showed that higher BMI, statin-use, and higher left ventricular ejection fraction and estimated glomerular filtration rate were associated with reduction in long-term clinical outcomes.
Conclusions: Clinical outcomes following PCI were similar among the POBA-, BMS- and DES-eras, despite the higher risk profiles of the elderly patients in the current DES-era.
We live in a modern era where researchers are expected to undertake high-quality research to address the growing challenges that our global society faces. Contemporary neuroscience demands experimental approaches that can relate anatomical and functional studies. To this end, it is necessary to perform a technical tour de force study to understand the relationship between the structure and the function of the brain. In this paper, I review some of the tools currently available to neuroscientists to study brain both at the circuit and synaptic level. The wealth of information that can be harnessed by incorporation of multiple research techniques will ultimately prove useful to tackle many societal issues, including the development of novel therapeutics to treat neurological diseases.