[Hokkaido igaku zasshi] The Hokkaido journal of medical science最新文献

Background: The lack of primary care physicians working in rural areas is a major problem both in Japan and worldwide. Particularly in Japan, healthcare provision in the community is seriously deteriorating, due to the absence of a regulated instructional system for primary care physicians in rural areas. Understanding what influences the career choice of rural primary care physicians is vital, and this study aims to examine those factors.

Methods: Qualitative research methodology with semi-structured interviews and content analysis was used. All interviews were conducted in interviewees' rural clinics over three days in September 2007 and 2008; each interview lasted for 60 minutes. All interviews were recorded, transcribed verbatim, and analyzed thematically by two independent researchers, then the preliminary results were presented to the third and fourth authors. All authors were in agreement with the final results.

Results: Fourteen physicians (13 males and 1 female; mean age 43-years-old) agreed to participate in the interviews, and four themes emerged: "existence of role models for younger primary care physicians," "affinity with rural backgrounds and culture," "understanding the importance of a holistic approach," and "internal motivation for challenging and rewarding work as a doctor." DISCUSSION & CONCLUSIONS: Our research results were similar to those of previous overseas studies, regardless of differences in cultural background. We could explain our themes with the concept of the "rural pipeline into medical practice" by JP Geyman et al. according to the time frame described therein. Taking some potential limitations like generalizability and translation into account, we could utilize our research results to indicate how the number of rural primary care physicians may be increased.

To elongate healthy life expectancy, anti-aging action is important. Main causes of disease in aged patients who need to be cared are cerebral artery disease, bone and joint disease, and dementia. It is important to enlighten the method to prevent these diseases. In the present symposium, we explained etiology and prevention of these diseases. We hope that the symposium would help the attendee to understand how to elongate the healthy life expectancy.

Dose-related curves of the airway responses to Methacholine by Astograph are frequently biphasic. That is, respiratory resistance (Rrs) increases slowly at first and rapidly after that. We proposed (-dGrs/dt)/Grs obtained by using Astograph as an index of dynamic property of the airway, which we suggested was related to a coefficient of the contraction or dilatation of the airway. Grs represents respiratory conductance. By calculating (-dGrs/dt)/Grs, we found that biphasic dose-related curves were composed of the slow and subsequently rapid contraction of the airways. And by mathematical analysis, we found that all segments of the airway contracted simultaneously at a uniform velocity. The combination of slow and rapid contraction explains three types of the airway responses, that is, the monophasic reactivity of the airway with slow contraction, the monophasic reactivity of the airway with rapid contraction and the biphasic reactivity of the airway with slow and subsequently rapid contraction. We found that the frequency of the monophasic reactivity of the airway with slow contraction was significantly higher in patients with COPD than in healthy subjects or in patients with mild asthma. But there was no significant difference in (-dGrs/dt)/Grs values among healthy subjects, patients with mild asthma and patients with COPD.

We studied the energy metabolism of cataracts induced by ultraviolet (UV) irradiation by observing metabolic changes in lenses using 31P-, 1H-, and 13C-nuclear magnetic resonance (NMR) spectroscopy. % of hexose monophosphate shunt flux activity increased over time. The lactate/glucose ratio in the UV irradiation group decreased to about half of that of the corresponding control group (11.6 +/- 2.0% vs. 20.7 +/- 1.7%, respectively, p < 0.05) after 10 h of irradiation and to about 30% of that of the control group (25 +/- 2% vs. 92 +/- 6%, respectively) after 24 h. The adenosine triphosphate (ATP) level significantly decreased after 3 h of irradiation (86 +/- 29%, p < 0.05) and continuously decreased to 68 +/- 33% (p < 0.01) after 10 h of irradiation and 26 +/- 2% (p < 0.01) after 24 h of irradiation. Conversely, a significant increase in inorganic phosphate (Pi) was observed after 1 h of irradiation (111 +/- 26%, p < 0.05), and the Pi level gradually increased to 140 +/- 28% after 10 h of irradiation (p < 0.01) and 207 +/- 26% after 24 h (p < 0.01). A significant decrease in alpha-glycerophosphate was noted after 24 h (38 +/- 13%, p < 0.01). The ribose-5-phosphate (R-5-P) level gradually increased after irradiation to 128 +/- 13% (p < 0.05) after 10 h and 141 +/- 21% after 24 h (p < 0.01). The results suggest that of these metabolic changes a marked decline in glycolytic production of ATP, which inhibits membrane metabolism, may be an important cataract-inducing factor following UV irradiation.

A 17-year-old Japanese male with a three-year history of recurrent episodic chest pain and fever, each lasting for one to three days, was diagnosed with familial Mediterranean fever (FMF) because of the following: 1) short attacks of chest pain and fever recurring at varying intervals; 2) no symptoms with a sense of well-being between attacks; and 3) identification of the Mediterranean fever gene (MEFV) mutation demonstrating M6941. Although FMF has been described primarily in several limited ethnic groups, a limited number of cases have been reported in Japan. No specific diagnostic tests are commercially available for FMF so identifying the characteristic clinical picture of FMF is important.