Clinical research is necessary for progress in medicine. However, for securing the human rights and safety of the trial subjects, the contents of ethical procedure required to clinical researchers has drastically changed in this decade. And, clearness of the research fund flow is progressing for preventing the influence by the research fund offer to the research. Especially, as conflict exists between the researcher's interest and the patient's interest in clinical research (including investigative pharmacotherapy), the management of the conflict of interests is required in clinical research field further than the other field. As described above, the duty which required to the clinical investigators participated in clinical research is changing affected by the social perception at that time. It is important that all investigators participated in clinical research recognize that "the requirement is changing".

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Febrile response is a complex physiological reaction to disease including a cytokine-mediated rise in body temperature and activation of inflammatory systems. Fever has beneficial roles in terms of disease prognosis, partly by suppressing expression of inflammatory cytokines. However, the molecular mechanisms underlining fever- mediated suppression of inflammatory gene expression have not been clarified. We showed that heat shock suppresses lipopolysaccaride (LPS)-induced induction of interleukin-6 (IL-6), a major pyrogenic cytokine, in mouse embryo fibroblasts and macrophages. Heat shock transcription factor 1 (HSF1) activated by heat shock induced activating transcription factor 3 (ATF3), a negative regulator of IL-6, and ATF3 was necessary for heat-mediated suppression of IL-6, indicating a fever-mediated feedback loop consisting of HSF1 and ATF3. When HSF1-null and ATF3-null mice were injected with LPS, they expressed much higher levels of IL-6 than wild-type mice, resulting in an exaggerated febrile response. These results demonstrate a feedback mechanism of the inhibition of inflammatory and febrile response.

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Transcatheter arterial chemoembolization (TACE) has become one of the most popular for hepatocellular carcinoma (HCC) patients. TACE has been reported to be a useful treatment. On the other hand, transcatheter arterial infusion chemotherapy using an emulsion of iodized oil (lipiodol) and an anticancer agent (Lip-TAI) (without gelatin sponge particle) has usually been performed for HCC patients in whom the catheter could not be inserted in the targeted segment or a feeding artery was not detected in the tumor. However, it has been reported that the effect of Lip-TAI was lower than that of TACE in the local tumor control. We designed a novel transcatheter arterial infusion chemotherapy using lipiodol and degradable starch microspheres [Lip+DSM-TAI] for HCC patients. We induct the efficacy of this novel therapy.

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This study was conducted to examine specialty preferences of students attending Yamaguchi University School of Medicine. In total, 447 of 600 medical students of 2010 fiscal year responded to a self-administrated questionnaire about the probability of selecting each specialty in the future. Internal medicine was the most commonly preferred specialty, with 48. 4% of students answering "very high" or "high" probability. General surgery (23. 5%), pediatrics (23. 3%), general medicine (20. 7%) and emergency medicine (17. 2%) followed. There was a remarkable gender difference; general surgery, neurosurgery, orthopedics and emergency medicine tended to be preferred by males, while pediatrics, anesthesiology, gynecology and obstetrics, and dermatology were generally preferred by females. There was no significant difference in the specialty preferences between 2008 and 2010 surveys. The preference for internal medicine increased with advancing student years. The students of quotas related to rural and community medicine preferred pediatrics and gynecology and obstetrics more compared to other students. The results of this study should be considered for effective strategies to address specialty maldistribution of physicians.

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Computed tomography enteroclysis (CTE) is used for diagnosing lesions in the small intestine. In this technique, dynamic computed tomography is performed after a neutral enteric contrast material is infused through an enteroclysis catheter. Numerous overseas studies have been performed on Crohn's disease (CD), which is characterized by a high incidence of intestinal tract inflammation, strictures, and fistulae. We report the case of a man who was affected with Crohn disease. He was in his 30's and frequently experienced bleeding during defecation. We initially performed gastroscopy and colonoscopy. The results of these procedures led to a suspicion of small intestinal bleeding because the source of bleeding could not be identified. Subsequently, CTE was safely performed and showed intestinal wall thickening , ileal strictures, and an ileorectal fistula. On the basis of these findings, we decided that it was essential for the patient to undergo surgery. The ileorectal fistula diagnosed by CTE was in accordance with the intraoperative findings. The conventional small-bowel follow-through technique is usually used for diagnosing internal fistulae in CD; however, clear visualization is difficult with this technique. Therefore, as reported in previous studies, we think that CTE is a better technique than conventional small-bowel follow-through technique for detecting internal fistulae.

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