Yamaguchi Medical Journal Vol. 63(2014) No. 4

By echocardiography, short axis image of the left ventricle（LV）is nearly circle at end-diastole. LV wall increases in its thickness and LV endocardial surface moves inward uniformly during systole. When LV wall is assessed by dividing into two layers, subendocardial half（inner half：IH）and subepicardial half（outer half：OH），the systolic wall thickening of IH is superior to that of OH under the normal physiological hemodynamic conditions. This fact was confirmed by previous animal experiments, and was also supported by simulation studies. A previous animal experiment with sonomicrometer revealed the attenuation of nonuniformity of systolic wall thickening between IH and OH in severe hemodynamic conditions（such as afterloading with negative inotropism）．Later, IH and OH wall dynamics was also studied with magnetic resonance imaging or advanced echocardiographic technology. In recent years, LV strain analysis using speckle tracking echocardiography revealed the functional damage of the IH by ischemia in clinical studies, even though insignificant wall motion abnormality by visual estimation. These findings are interesting as an aspect of importance of IH. Further investigation with such an analytic technique is required to confirm its usefulness and limitation.

[in Japanese]

The high fatality rate currently associated with severe fever with thrombocytopenia syndrome（SFTS）in Japan suggests that some mild cases of SFTS have been underdiagnosed. To find mild cases of SFTS in Japan, we retrospectively investigated the status of anti-SFTS virus antibody in hospitalized patients from January 2008 to January 2013, who presented with high fever and one or more characteristics of thrombocytopenia, leukocytopenia, and elevation of liver transaminase. Anti-SFTS virus antibodies in their convalescent period were analyzed using an indirect fluorescent assay, an enzyme-linked immunosorbent assay, and a plaque reduction neutralization test. Nine patients, in the age group of 20?80 year-old were investigated（20’s = 2, 30’s = 3, 40’s = 1, 50’s = 1, 60’s = 1, and 80’s = 1）．Blood samples of the patients were taken 5 to 66 months after the onset of illness（the median was 12 months）．All the patients tested negative for anti-SFTS virus antibody. Although we could not confirm SFTS in any of the patients in this study, attempts to investigate patients with mild SFTS-like symptoms is necessary to detect the presence of mild cases of SFTS and to promote further understanding of the epidemiology of SFTS in Japan.

It has long been considered important for medical students to undergo practical training early after admission to medical school（early exposure）．At Yamaguchi University, as a part of early exposure, we have been providing first-year students with an opportunity for practical training in welfare facilities for the elderly shortly after admission to the school of medicine. Here, we report the current situation and problems encountered in early exposure, along with the literature on this topic and the results of a questionnaire completed by the students after training. According to the survey results, the training experience has been well accepted by both the facilities and the students. As many as 89% of the students were satisfied with the practical training experience, as expected. However, some problems were encountered from the point of view of the facility, the students, and the university. We need to address these problems to establish a better training system.

First year medical school students are offered a course on introductory medicine to prepare themselves for professional education. The present study is aimed to explore the current situation and challenges in offering such a course. This paper shows the results of a student questionnaire administered on this course, which are then discussed in the light of literatures. We found that, after students had received communication skill training via small group learning, this course on introductory medicine helped students learn ethics, professionalism, and medical knowledge；provides early exposure；and aids lifelong education. The questionnaire results revealed that students were highly satisfied with the introductory contents. In addition, owing to this course, as expected, majority of the students have developed an active learning attitude. These findings suggest that there is a need to continue offering a course on introductory medicine that flexibly incorporates the current demands as medical professionals, and prepares students for professional education.

Objectives：Role models, that is, persons whose behavior, example, or success are or can be emulated by others, are increasingly important in medical education. A class asking medical students about their role models was conducted, and career education related to role models in medical schools is discussed. Methods：I had the class for second grade students of Yamaguchi University School of Medicine in 2013. The class consisted of introduction of the concept of role models, homework considering the students’role models, and group discussion. The students’role models were analyzed. Results：A total of 138 persons were given as role models, including mainly specialists, researchers, general physicians, family doctors and academics. Most of them were well known, such as through the media. The role models included 16 women and 11 faculty members（9 basic scientists and 2 clinicians）of Yamaguchi University. Conclusions：The students considered various persons as their role models. However, there were only a few immediate clinicians and female doctors. In medical education, students need more opportunities for contact with possible role models, especially women and clinicians at the university.