The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 55, Issue 3
Displaying 1-4 of 4 articles from this issue
REVIEW
  • 2. A blueprint for reform of medical education in Japan
    R Harsha Rao
    2006 Volume 55 Issue 3 Pages 81-95
    Published: 2006
    Released on J-STAGE: October 13, 2006
    JOURNAL FREE ACCESS
    A blueprint for reform of medical education in Japan is presented, with the goal of training well rounded physicians who possess the ability to think critically and the clinical skill to function as generalists before they enter specialty training. Practical solutions are offered in three problem areas that lie at the heart of the shortcomings in Japanese medical education. They have to do with (i) the way Japanese students learn, (ii) the way Japanese teachers teach, and (iii) the material that students are taught. The inherently passive nature of Japanese students can be changed by emphasizing "active learning" and "critical thinking at the bedside" through a problem-oriented approach, both in the classroom and in the wards. Changing student learning, however, requires a commitment to teaching. At the present time, there is no incentive to teach at all, let alone teach in a constructive or interactive way. Teaching is widely perceived as a burden that takes time away from research, rather than as a credible and rewarding academic pursuit. Thus, promotion policies must be altered to reward teachers and accord teaching its rightful place as a primary function of the faculty. Finally, the introduction of active learning and interactive teaching depends on reducing the current emphasis on didactic instruction, which is passive and unidirectional. Thus, medical school curricula must be restructured to emphasize a problem-oriented, organ system-based approach throughout medical school, starting from the preclinical years.Reforms in all three areas must be implemented in concert for them to succeed.
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  • Jonathan D. Kaunitz, Yasutada Akiba
    2006 Volume 55 Issue 3 Pages 96-106
    Published: 2006
    Released on J-STAGE: October 13, 2006
    JOURNAL FREE ACCESS
    The duodenum serves as a buffer zone between the stomach and jejunum. Over a length of only 25 cm, large volumes of strong acid secreted by the stomach must be converted to the neutral-alkaline chyme of the hindgut lumen, generating large volumes of CO2, which the duodenum then absorbs. The duodenal mucosa consists of epithelial cells connected by low-resistance tight junctions, forming a leaky epithelial barrier. Despite this high permeability, the epithelial cells, under intense stress from luminal mineral acid and highly elevated Pco2, maintain normal functioning. Furthermore, the duodenum plays an active role in foregut acid-base homeostasis, absorbing large amounts of H+ and CO2 that are recycled by the gastric parietal cells. Prompted by the high expression of cytosolic and membrane carbonic anhydrase (CAs) in duodenal epithelial cells, and the intriguing observation that CA activity appears to augment cellular acid stress, we formulated a novel hypothesis regarding the role of CA in duodenal acid absorption, epithelial protection, and chemosensing. In this review, we will describe how luminal CO2/H+ traverses the duodenal epithelial cell brush border membrane, acidifies the cytoplasm, and is sensed in the subepithelium.
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ORIGINAL ARTICLE
  • Itsuki Ajioka, Takuya Maeda, Kazunori Nakajima
    2006 Volume 55 Issue 3 Pages 107-110
    Published: 2006
    Released on J-STAGE: October 13, 2006
    JOURNAL FREE ACCESS
    Oligonucleotide-based microarrays, such as GeneChip, are widely used to determine the large-scale gene expression profiles. However, GeneChip only provides information on the identity of the molecules, and the investigator must obtain each cDNA clone for further analyses. In this study, we devised a program which enables us to correlate a large number of DNA accession numbers to the FANTOM (functional annotation of the mouse) full-length mouse cDNA clone set, and made a correlative table between mouse GeneChip clones and FANTOM clones. This allows easy identification of the corresponding FANTOM clone for each GeneChip clone, even if the sequence of the GeneChip clone does not directly match the FANTOM clone. Using this table, for example, a large number of in situ hybridization probes can be synthesized easily, because the FANTOM clones are flanked by T3/T7 promoters on both ends. In addition, we further developed a program which retrieves the amino acid sequence (AA Seq) for each clone, even for the FANTOM clones that lack the AA Seq description, and classifies the proteins automatically. As an example, we devised a correlation table with predictions of the secretory or transmembrane molecules. The correlation table is useful for a large-scale screening of molecules involved in cell-cell communication in various biological processes. The full correlation table for the GeneChip clones is available at http://www.kjm.keio.ac.jp/past/55/3/correlation_table1.html
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  • Hidetsugu Saito, Shinichiro Tada, Hirotoshi Ebinuma, Hiromasa Ishii, K ...
    2006 Volume 55 Issue 3 Pages 111-117
    Published: 2006
    Released on J-STAGE: October 13, 2006
    JOURNAL FREE ACCESS
    We examined therapeutic superiority of induction therapy with twice-daily IFN-β (3X2=6 million units/day) onto 6-months consensus interferon monotherapy for chronic hepatitis C. Patients were randomly assigned to monotherapy without (group I, n=16) and with induction therapy (group II, n=12). The mean age of group II was older than that of group I, and other baseline condition was not statistically significant. Sustained virological response (SVR) rates of group I and II were 81.3% (13/16) and 58.3% (7/12), respectively (p=0.365). SVR rates in patients with genotype 1b were 66.7% (4/6) and 0% (0/2, because of drop-out), and those with high viral load were 70% (7/10) and 75% (6/8) in group I and II, respectively (p=1.000). Drop-out rates during therapy were 6.3% (1/16) and 33.3% (4/12) in group I and II, respectively (p=0.176). Age less than 50 years was the only independent factor that was shown by multivariate logistic model analysis to be associated with a sustained virological response. Although randomization failed to produce and equal age distribution in the two groups in this study, our results suggest that induction therapy with twice-daily IFN-β has no beneficial effect on the efficacy of monotherapy with consensus interferon, probably because of the higher drop-out rates and incidence of adverse reactions with induction therapy.
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