The usefulness of the implantable cardioverter defibrillator (lCD) for the prevention of sudden cardiac death caused by ventricular tachyarrhythmias has been proven by several international randomized multi-center clinical trials. Recent advances in medical technologies, such as size reduction and the functional improvements of the device, have resulted in relatively easy implantation. As a result, the number of lCD recipients has been rapidly increasing and the indications for lCD implantation have been expanding. Dual chamber ICDs offer improved tachyarrhythmia detection algorithms such as discrimination of supraventricular arrhythmias. In Europe and the United States, biventricular ICDs are now available for the treatment of congestive heart failure associated with ventricular tachyarrhythmias. Although the incidence of inappropriate shock by ICDs is decreasing, inappropriate discharges of ICDs and a declining quality of life are still problems.

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We developed a lung sound auscultation simulator "Mr. Lung" in 2001. To improve the auscultation skills of lung sounds, we utilized this new device in our educational training facility. From June 2001 to March 2002, we used "Mr. Lung" for our small group training in which one hundred of the fifth year medical students were divided into small groups from which one group was taught every other week. The class consisted of ninety-minute training periods for auscultation of lung sounds. At first, we explained the classification of lung sounds, and then auscultation tests were performed. Namely, students listened to three cases of abnormal or adventitious lung sounds on "Mr. Lung" through their stethoscopes. Next they answered questions corresponding to the portion and quality of the sounds. Then, we explained the correct answers and how to differentiate lung sounds on "Mr. Lung". Additionally, at the beginning and the end of the lecture, five degrees of self-assessment for the auscultation of the lung sounds were performed. The ratio of correct answers for lung sounds were 36.9% for differences between bilateral lung sounds, 52.5% for coarse crackles, 34.1% for fine crackles, 69.2% for wheezes, 62.1% for rhonchi and 22.2% for stridor. Self-assessment scores were significantly higher after the class than before. The ratio of correct lung sound answers was surprisingly low among medical students. We believe repetitive auscultation of the simulator to be extremely helpful for medical education.

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Sex education by peers is becoming popular in Japan. To improve youth's reproductive health by continuous peer education and to encourage medical students to obtain the methodology necessary for health promotion, we started peer sex education by medical students in the annual public health course. One junior high school and one senior high school in Kitakyushu City in Japan asked medical students to conduct peer sex education classes at their schools. Medical students planned and carried out these classes based on the results of a questionnaire that they gave to the junior high school and senior high school students before the peer education. After the class, the students' responses to the class were investigated by another questionnire. In this questionnaire, over 90% of the students answered that they were interested in talking about sexual issues with medical students. As for the medical students, they said that they could understand better the methodology of health promotion and also gained confidence by this experience. We will continue to carry out peer education in the medical school's public health course, and we intend to research further how junior high school and senior high school students' sexual behavior may change in the future.

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A rare outbreak of acute hepatic damage in workers exposed to dichloropropanols was reported in 1992. As there are no detailed reports of dichloropropanols (DCPs) toxicity and its mechanism, we reviewed the toxicity of dichloropropanols using our results. 1) A marked elevation of serum AST and ALT with massive necrosis of the liver was noted in the 1/2×, the 1× and 2×LD₅₀ (0.149mg/kg) of 1, 3-dichloro-2-propanol (DC 2 P). Hepatic malondialdehyde level was significantly increased, and associated with a decrease in liver glutathione S-transferase activity and reduced glutathione content. It is suggested that the free radical is associated with DCPs. 2) A reduction of leukocytes, platelets and fibrinogen, and prolonged prothrombin time were observed in the 1× LD₅₀ of DC 2 P. 3) In the CA1 area of the hippocampus, inhibition of population spikes was reduced by the 1× LD₅₀ of DC 2 P. This research was completed with the assistance of several other papers concerning dichloropropanols toxicity.

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Skeletal loading plays an important role in the maintenance of bone mass, bone shape and bone strength. Skeletal unloading, such as during space flight and long-term bed rest, induces bone loss in loaded bones in humans. The mechanotransduction system in bone tissue is not fully elucidated. Our observations demonstrate that generation of nitric oxide through inducible nitric oxide synthase is essential for the stimulation of bone formation upon mechanical reloading, and that disruption of p53 gene in response to 1-week unloading does not result in reductions in bone volume and bone formation. It should be significantly helpful for our understanding of various skeletal disorders to clarify the mechanism underlying regulation of bone mass after skeletal loading and unloading.

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Prostaglandin (PG), an arachidonic acid metabolite produced by various cell types, regulates a broad range of physiological activities, and maintains the local homeostasis. PGE₂, one of the PGs, is produced by the action of the enzyme PGE synthase and cyclooxigenase (COX) on arachidonic acid liberated from the membrane phospholipid by phospholipase A₂ (PLA₂). In the immune system, PGE₂ is mainly produced by antigen presenting cells such as macrophages and dendritic cells. PGE₂ regulates immune responses, for example, the production of cytokines and chemokines and the expression of cytokine receptors and cell surface molecules, and the main action is mediated by intracellular accumulation of cyclic AMP via the activation of adenylate cyclase. The main function of PGE₂ in the immune system is the suppression of Th1 activation and the enhancement of Th2 activation. Therefore, in this paper, PGE₂, a pivotal factor in the pathogenesis of Th1/Th2-related diseases, is highlighted.

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There has been little change in the average survival of patients with malignant glioma these past two decades, despite extensive treatment including surgical resection, radiotherapy and chemotherapy. Immunotherapy has attracted the attention of many investigators as a new adjuvant therapy, but early approaches were largely unsuccessful. This seems to have been related to the immunological microenvironment within the central nervous system in which the blood brain barrier exists, and where no dendritic cells, potent antigen-presenting cells, are distributed. Furthermore, the immunobiological characters of glioma, which have many mechanisms to escape host's immnological surveillance, are the reason for the difficulty of immunotherapy. However, the modern advanced understanding of immunology and molecular biology has yielded novel immunostimulatory strategies such as immunogene therapy and dendritic cell manipulations, which have caused dramatic preclinical results in glioma models. Although definitive clinical results and solutions to side effects remain to be seen, immunotherapy shows great promise for the future.

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The areas of conduct and professional roles in occupational health nursing in Japan has not been defined as yet, even though occupational health nurses have contributed to implementing jobs related to the health examination in workplaces every year. We surveyed public health nurses regarding their awareness of the abilities, skills and knowledge necessary to fulfill an occupational health nurses' role. When answering, they became aware of deficiencies in their abilities, skills and knowledge. This was particularly true in counseling, health assessment skills and management abilities, specialized knowledge of occupational safety and health, ergonomics and environmental health. We propose a curriculum at the master level for occupational health nurse specialists with reference to the core curriculum for occupational and environmental health nursing in the USA.

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Occupational physicians are expected to play important roles in helping workers with an acquired disability return to work. However, the key elements to develop a successful program to help these workers return to work are still unclear. In this study, we searched the literature referring to occupational physicians' role in the return-to-work process of the workers with acquired disability. Many of these studies mentioned the following; occupational physicians should start co-operating with the treating physician right after the appearance of the disability and exchange medical and occupational health information with each other. When a disabled worker wishes to return to work, the occupational physician in charge should carefully evaluate his/her work ability, and fitness for the work. We also performed a hearing survey at 15 diverse institutions and organizations that are generally aimed at promoting employment, social welfare and medical service for disabled persons located in at least a 5 million population prefecture in Japan. Among them, the Local Occupational Center for the Disabled functions as the practical gateway for employment, and the Health and Welfare Center is the principal window for the social welfare of the disabled. However, their services are sometimes limited to only those who have become jobless and not for those returning to their original work. We considered that occupational physicians should also communicate positively with the organizations to promote successful returning of the workers with acquired disability to their former work.

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A 68-year-old man was admitted to our hospital for the treatment of angina and ventricular tachyarrhythmia. A coronary and left ventricular angiography showed coronary artery disease and ischemic cardiomyopathy with severe left ventricular dysfunction. A percutaneous transluminal coronary angioplasty was performed successfully in the right coronary artery and his angina symptoms disappeared. However, ventricular tachycardia (VT) /ventricular fibrillation (VF) occurred spontaneously and converted to sinus rhythm with direct current shock (300J). Oral amiodarone (200 mg/day) and continuous intravenous infusion of nifekalant and lidocaine were started. In addition, a dual chamber implantable cardioverter defibrillator (ICD) for his VT/VF was implanted. However, VT/VF occurred repeatedly after discontinuation of nifekalant. After the administration of bepridil (200 mg/day), VT/VF was completely prevented without nifekalant administration. The hybrid therapy with lCD and oral bepridil is very useful for the treatment of amiodarone resistant ventricular tachyarrhythmia.

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