Possible relationship between rural surgical rotations during a residency period and an increased number of general surgeons in rural areas: a systematic review / Journal of Rural Medicine

Objective: Rural surgical training for residents is expected to increase the number of general surgeons working in rural areas; however, the impact of rural training programs to ensure such surgeons remains to be determined. Therefore, we reviewed the relevance of rural surgical rotation to the increase of general surgeons in rural areas.Materials and Methods: Studies on the outcomes of rural surgical rotations during the residency period in comparison to non-rural surgical rotations were retrieved using electronic databases through April 2022.Results: Among the 514 articles, five were eligible for review. All studies were published in the United States. Four studies reported an increased number of general surgeons in rural areas owing to rural surgical rotations. A meta-analysis of all studies showed a positive impact on the number of general surgeons in rural areas (odds ratio=2.19, 95% confidence interval=1.23–3.91). The programs generally ranged from 2 to 12 months with extensive experience with minor surgery and subspecialties necessary for surgery.Conclusions: Rural surgical rotations during the residency period can increase the number of general surgeons working in rural areas. Further studies are needed to evaluate the placement of general surgeons in rural areas.

An Overview of Early Clinical Exposure for Undergraduate Medical Education in Japan / 医学教育

Introduction: Early clinical exposure (ECE) is an educational methodology where medical students are exposed to the clinical settings in the undergraduate curriculum. This study aimed to examine the implementation status of ECE at medical schools in Japan. Methods: Based on published syllabi, we investigated the existence, location, and subjects (medical/non-medical staffs) of the training programs in medical schools. Results: Of 78 universities, 74 (95%) offered a total of 173 ECE practical training courses, and 51 (69%) combined on-campus and off-campus ECE training. Regarding the location and subjects, 81% of the on-campus ECE training was for medical personnel, 47% of the off-campus was for non-medical personnel, and 61% of the on- and off-campus was for both medical and non-medical personnel. Conclusions: More medical universities combined ECEs on-campus and off-campus and did not offer exposure only to medical staffs. The national trend can serve as a reference to discuss the circumstance of ECE and to plan ECE courses in the near future.

Current Status and Prospects of Community-based Medical Education: A Discussion Based on the Special Symposium "Evolution and Essence of the Community-based Medical Education through COVID-19 Pandemic" / 医学教育

Community-based clinical clerkship, which involves travel outside the university or prefecture, was restricted or reduced due to the outbreak of the new coronavirus infection. What kind of shortage of learning this caused and how the shortage was compensated for were discussed in a special symposium at the 53rd Annual Meeting of the Japanese Society for Medical Education. As a result, two “essences” of community-based medical education emerged: 1) to recognize one’s role and responsibility in the future in the context of interprofessional practice, and 2) to look beyond the framework of medical institutions and view the whole scope of medicine with the patient at the center. It was concluded that online supplementary education should be utilized to enhance the value of practical training experience even in the post-Corona era. It was also supposed that this would lead to the “evolution” of community-based medical education itself.

cohort study of chronic diseases for Mongolian people: Outline with baseline data of the Moncohort study

Many Mongolian people suffer from non-communicable chronic diseases. In order to plan preventive strategies against such diseases, we designed a community-based prospective cohort study of chronic diseases, called the Moncohort study, in Mongolia. This is the first nationwide large-scale cohort study of chronic diseases. This paper describes the study's rationale, design and methods with baseline data. Mongolian residents aged P40 years were selected nationwide from many geographic regions in 2009. Data were collected on demographics, socioeconomic status, lifestyle, and anthropometric and biochemical measurements. In total, 2280 Mongolian residents were registered in the survey. Socioeconomic, lifestyle, anthropometric and biochemical characteristics were differentiated by gender and geographical area in descriptive data. Aging, low social class, physical inactivity and infrequent fruits intake were positively associated with histories of chronic disease in men, while aging was positively associated with histories of chronic disease in women. Factors associated with chronic diseases reveal gender-oriented strategies might be needed for their prevention. Detailed prospective analyses will illustrate the impact of risk factors on chronic diseases and lead to evidence for designing programs aimed at preventing chronic diseases and related disorders in Mongolia

The relationship between gamma-glutamyltransferase (GGT), bilirubin (Bil) and small dense low-density lipoprotein (sdLDL) in asymptomatic subjects attending a clinic for screening dyslipidaemias

<p><b>INTRODUCTION</b>Gamma-glutamyltransferase (GGT), bilirubin (Bil) and small dense low-density lipoprotein (sdLDL) particles are each known to be risk markers for cardiometabolic diseases which are characterised by oxidative stress conditions. These markers are connected with the oxidative milieu; however, the association between GGT, Bil, and sdLDL has been hardly examined. This hospital-based study investigated the association between GGT and sdLDL, as well as the association between Bil and sdLDL, in asymptomatic subjects.</p><p><b>MATERIALS AND METHODS</b>Cardiometabolic variables, GGT, Bil and the mean LDL particle size were measured in 100 asymptomatic subjects attending a clinic for screening dyslipidaemias (36 men and 64 women, mean age 64 years). Correlation analyses of the association between the mean LDL particle size and other variables, such as GGT and Bil, were performed.</p><p><b>RESULTS</b>The mean (standard deviation) levels of GGT, Bil, and the mean LDL particle size were found to be 21.7 (8.3) IU/L, 14.0 (4.3) μmol/L, and 26.7 (0.6) nm, respectively. An univariate correlation test showed both a significant inverse correlation between the mean LDL particle size and GGT (r = - 0.33, P <0.01) and a significant positive correlation between the mean LDL particle size and Bil (r = 0.32, P <0.01). A multiple regression analysis revealed similarly significant results of their correlations, independent of the other cardiometabolic variables.</p><p><b>CONCLUSION</b>These results suggest that the correlation of GGT and sdLDL, as well as that of Bil and sdLDL, may be cooperatively associated with cardiometabolic processes. Further research is warranted in order to confirm the observed association.</p>

Association between urinary 8-OHdG and pulse wave velocity in hypertensive patients with type 2 diabetes mellitus

<p><b>INTRODUCTION</b>Oxidative stress, assessed using 8-hydroxy-2'-deoxyguanosine (8-OHdG), can be associated with arterial stiffness in patients with type 2 diabetes mellitus (T2DM) and/or hypertension (HT). We investigated the correlation between urinary 8-OHdG and pulse wave velocity (PWV) in hypertensive and non-hypertensive T2DM patients with fair glycaemic control to determine the clinical significance of HT as a comorbidity in the diabetic state.</p><p><b>METHODS</b>Clinical data, including traditional cardiovascular risk factors, diabetic complications, prescribed agents, urinary 8-OHdG level and brachial-ankle PWV, was collected from T2DM patients with and without HT.</p><p><b>RESULTS</b>There were 76 patients (45 men, 31 women; mean age 61 years; mean haemoglobin A1c level 6.5%) in the study cohort. T2DM patients with HT had significantly higher mean PWV than patients without HT (1,597 cm/s vs 1,442 cm/s; p < 0.05). Patients with HT showed no significant difference in 8-OHdG levels relative to those without HT (median 7.9 ng/mg creatinine vs 8.8 ng/mg creatinine; p > 0.05). Simple linear correlation and stepwise multiple linear regression analyses revealed that 8-OHdG levels correlated independently, significantly and positively with PWV among T2DM patients with HT (r = 0.33, p < 0.05; β= 0.23, p < 0.05). No significant correlation was observed between 8-OHdG levels and PWV among T2DM patients without HT.</p><p><b>CONCLUSION</b>In the hypertensive state, oxidative stress can be responsible for the development of arterial stiffness, even in patients with fairly well controlled T2DM. Oxidative stress management may be necessary for the prevention of cardiovascular disease in this population.</p>

Determinants of carotid atherosclerosis in the general Mongolinan population using ultrasonography / Шинэ санаа Шинэ нээлт

Atherosclerotic risk factors contribute to carotid atherosclerosis. Carotid intima-media thickness (IMT), as assessed using a non-invasive high-resolution ultrasound, can predict cardiovascular disease (CVD). Whereas the control of CVD is crucial for the Mongolian people, the studies on carotid atherosclerosis are lacking. The present population-based survey was a cross-sectional investigation of the determinants of carotid IMT in the general Mongolian population.A total of 344 Mongolian volunteers, aged 18-69 years, without CVD and on no medication, were recruited from a health screening setting. The current smoking habits, body mass index, mean blood pressure (MBP), blood total cholesterol (TC), glucose, insulin and carotid IMT (maximum level) were measured.Mongolian males had a significantly higher prevalence of current smoking and a higher level of IMT than females (average=0.58 mm in males vs 0.46 in females). Both a single and multiple regression analysis adjusted for all the regression analysis adjusted for all the measures revealed that IMT was significantly and positively correlated with age, male sex, MBP, TC and glucose among all of the participants. IMT was significantly and positively correlated with age, followed by MBP, TC and glucose among males, while among females, IMT was significantly and positively correlated with age, followed by MBP and TC.Age was the strongest determinant of carotid atherosclerosis, and the increases in blood pressure and cholesterol levels were also important measures in both sexes as well as glucose levels in males in particularly, thus suggesting a preventive strategy necessary for CVD in the general Mongolian population.

Determinants of carotid atherosclerosis in the general Mongolinan population using ultrasonography / Шинэ санаа Шинэ нээлт

Atherosclerotic risk factors contribute to carotid atherosclerosis. Carotid intima-media thickness (IMT), as assessed using a non-invasive high-resolution ultrasound, can predict cardiovascular disease (CVD). Whereas the control of CVD is crucial for the Mongolian people, the studies on carotid atherosclerosis are lacking. The present population-based survey was a cross-sectional investigation of the determinants of carotid IMT in the general Mongolian population. A total of 344 Mongolian volunteers, aged 18-69 years, without CVD and on no medication, were recruited from a health screening setting. The current smoking habits, body mass index, mean blood pressure (MBP), blood total cholesterol (TC), glucose, insulin and carotid IMT (maximum level) were measured. Mongolian males had a significantly higher prevalence of current smoking and a higher level of IMT than females (average=0.58 mm in males vs 0.46 in females). Both a single and multiple regression analysis adjusted for all the regression analysis adjusted for all the measures revealed that IMT was significantly and positively correlated with age, male sex, MBP, TC and glucose among all of the participants. IMT was significantly and positively correlated with age, followed by MBP, TC and glucose among males, while among females, IMT was significantly and positively correlated with age, followed by MBP and TC. Age was the strongest determinant of carotid atherosclerosis, and the increases in blood pressure and cholesterol levels were also important measures in both sexes as well as glucose levels in males in particularly, thus suggesting a preventive strategy necessary for CVD in the general Mongolian population.

Association between angiotensin II type 2 receptor gene A/C3123 polymorphism and high-density lipoprotein cholesterol with hypertension in asymptomatic women

The present study investigated the association between the angiotensin II type 2 receptor [AT2R] gene adenine/cytosine [A/C]-3123 polymorphism and cardiometabolic variables in subjects with and without hypertension. Cardiometabolic variables, in addition to genotyping by an allele-specific DNA assay, were measured in 161 asymptomatic community-dwelling Japanese women [age range 30-83 years]. They were divided into hypertensive [n = 82, age 50-81 years] and nonhypertensive [n = 79, age 30-83 years] subjects. The A-allele carriers [n = 53] showed significantly lower high-density lipoprotein cholesterol [HDL-C] levels than the non-A-allele carriers [n = 26] among nonhypertensive subjects [1.45 +/- 0.38 vs. 1.66 +/- 0.33 mmol/l, p = 0.02]. Even when multiple-adjusted analyses were performed, the HDL-C levels continued to differ significantly and independently of other variables, including the body mass index and insulin resistance index, between A-allele and non-A-allele carriers. However, this association was not observed among hypertensive subjects. The present study demonstrated that A-allele carriers had significantly lower HDL-C levels than did non-A-allele carries among nonhypertensive women, while this association was not observed among hypertensive women. This indicates that the A/C3124 polymorphism may be a marker associated with HDL metabolism by hypertension. This was a small study, so further research is warranted to confirm the observed association

Effect of ezetimibe on remnant-like particle cholesterol in subjects with metabolic syndrome

To investigate the influence of ezetimibe monotherapy on remnant-like particle cholesterol [RLP-C] in subjects with metabolic syndrome [MetS]. Ezetimibe [10 mg/daily] was prescribed over a 12-week period for hypercholesterolemic subjects divided into groups with MetS [n = 28; male/female = 13/15; mean age 67 years] and without MetS [n = 22; male/female = 9/13; mean age 66 years]. In the pre- and post-treatment phases, BMI, blood pressure and fasting blood levels of glucose, lipid panels and RLP-C were measured. The group with MetS showed significantly higher RLP-C levels than the group without MetS [median level: 0.18 vs. 0.12 mmol/l [7.1 vs. 4.4 mg/dl], p < 0.01] in the pre-treatment phase. In the post-treatment phase, the low-density lipoprotein cholesterol levels were significantly reduced in both groups to a similar level [p < 0.001 in both], while there was a significantly greater reduction in RLP-C in the group with MetS than the group without MetS [median level: 0.12 vs. 0.11 mmol/l [4.8 vs. 4.1 mg/dl], p < 0.05]. This difference in RLP-C remained significant after adjusting for confounding factors. Ezetimibe monotherapy may be associated with a greater reduction in RLP-C levels in subjects with MetS than in those without MetS

White blood cells, neutrophils, and reactive oxygen metabolites among asymptomatic subjects

Chronic inflammation and oxidative stress are associated with health and the disease status. The objective of the present study was to investigate the association among white blood cell [WBC] counts, neutrophil counts as a WBC subpopulation, and diacron reactive oxygen metabolites [d-ROMs] levels in an asymptomatic population. The clinical data, including general cardiovascular risk variables and high-sensitivity C-reactive protein [hs-CRP], were collected from 100 female subjects [mean age, 62 years] in outpatient clinics. The correlation of the d-ROMs with hs-CRP, WBC, and neutrophil counts was examined. The mean/median levels were WBC counts 5.9 x 10[9]/L, neutrophil counts 3.6 x 10[9]/L, hs-CRP 0.06 mg/dL, and d-ROMs 359 CURR U. A simple correlation analysis showed a significant positive correlation of the d-ROMs with the WBC counts, neutrophil counts, or hs-CRP levels. The correlation between d-ROMs and neutrophil counts [beta = 0.22, P < 0.05], as well as that between d-ROMs and hs-CRP [beta = 0.28, P < 0.01], remained significant and independent in a multiple linear regression analysis adjusted for other variables. A multiple linear regression analysis showed that WBC counts had only a positive correlation tendency to the d-ROMs. Neutrophils may be slightly but more involved in the oxidative stress status, as assessed by d-ROMs, in comparison to the overall WBC. Further studies are needed to clarify the biologic mechanism[s] of the observed relationship

Oral contraceptive therapy increases oxidative stress in pre-menopausal women

Oral contraceptive therapy [OCT] is associated with an increased risk of deep vein thrombosis, venous thromboembolism and stroke. However, the underlying mechanisms have not yet been elucidated. The objective of this study was to investigate the influence of OCT on blood levels of an oxidative stress maker in pre-menopausal women. Oxidative stress was determined in 87 pre-menopausal healthy women [24 with and 63 without OCT] using a blood assay for reactive oxygen metabolites [by the d-ROMs test]. The subjects with OCT received a triphasic preparation consisting of ethinyl estradiol and norethisterone. Subjects with OCT showed significantly higher d-ROMs levels [median: 380; interquartile range: 328-502 Carr U] than those without OCT [325 [271-369]; P 0.05]. The results remained the same after adjusting for potential confounders. The use of OCT may increase oxidative stress levels, independent of traditional cardiovascular risk factors, in pre-menopausal women, providing new insights to the primary prevention of vascular complications in these subjects

LDL particle size and reactive oxygen metabolites in dyslipidemic patients

Small dense low density lipoprotein [sdLDL] which has a small LDL particle size with greater susceptibility to oxidation is regarded as a risk marker for cardiovascular disease. The diacron reactive oxygen metabolites [d ROMs] test has recently been introduced as an oxidative stress related marker in the clinic. The aim of the present study was to investigate the correlation between the mean LDL particle size and the oxidative stress status as evaluated by the d ROMs in dyslipidemic patients. The study included 278 dyslipidemic patients [121 male and 157 female, mean age, 60 years]. Clinical data including the conventional atherosclerotic risk factors in addition to the mean LDL particle size measured with the gel electrophoresis and the d ROMs were collected. Male patients had a significantly smaller mean LDL particle size than females [262.2 +/- 7.5 [SD] vs. 264.3 +/- 6.7 A, P<0.05], while female patients had a significantly higher d ROMs level than males [318 +/- 68 vs. 350 +/- 72 U. Carr., P<0.01]. A multiple regression analysis revealed that there was an independent, significant, and inverse correlation between the mean LDL particle size and the d ROMs [beta=?0.19, P<0.05]. These findings of the co existence of both markers suggest that sdLDL and oxidative stress can be cooperative in atherogenesis, possibly leading to the incidence of CVD, in dyslipidemic patients

Leptin:Adiponectin Ratio and Metabolic Syndrome in the General Japanese Population / 대한진단검사의학회지

BACKGROUND: Circulating leptin:adiponectin ratio (L:A) is a potential surrogate marker for cardiometabolic diseases; however, the relationship of the L:A with the occurrence of metabolic syndrome (MetS) has not yet been fully explored in the general Japanese population. METHODS: We enrolled 678 Japanese subjects (208 men and 470 women, mean age: 58.8+/-14.4 [SD] yr; mean body mass index: 23.6+/-3.3 kg/m2) in this study, and determined their MetS status by using the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) recommendations with minor modifications for the Japanese population. Biochemical markers such as leptin and adiponectin present in blood were measured. The statistical analyses performed were gender-based. RESULTS: A in subjects with MetS was significantly higher than that in subjects without MetS, regardless of gender. The L:A also showed a significant and gradual increase corresponding to the increase in the number of components of MetS present in both the genders (trend P<0.01). The cut-off level of the L:A to detect MetS was 0.59 (sensitivity: 0.72, specificity: 0.70) in men and 1.04 (sensitivity: 0.72, specificity: 0.69) in women. CONCLUSIONS: These results suggest that the L:A can serve as a clinically useful marker for detecting MetS characteristics in the general Japanese population. The clinical application of this laboratory index for detecting MetS should be assessed in future studies.

Leptin:Adiponectin Ratio and Metabolic Syndrome in the General Japanese Population / 대한진단검사의학회지

BACKGROUND: Circulating leptin:adiponectin ratio (L:A) is a potential surrogate marker for cardiometabolic diseases; however, the relationship of the L:A with the occurrence of metabolic syndrome (MetS) has not yet been fully explored in the general Japanese population. METHODS: We enrolled 678 Japanese subjects (208 men and 470 women, mean age: 58.8+/-14.4 [SD] yr; mean body mass index: 23.6+/-3.3 kg/m2) in this study, and determined their MetS status by using the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) recommendations with minor modifications for the Japanese population. Biochemical markers such as leptin and adiponectin present in blood were measured. The statistical analyses performed were gender-based. RESULTS: A in subjects with MetS was significantly higher than that in subjects without MetS, regardless of gender. The L:A also showed a significant and gradual increase corresponding to the increase in the number of components of MetS present in both the genders (trend P<0.01). The cut-off level of the L:A to detect MetS was 0.59 (sensitivity: 0.72, specificity: 0.70) in men and 1.04 (sensitivity: 0.72, specificity: 0.69) in women. CONCLUSIONS: These results suggest that the L:A can serve as a clinically useful marker for detecting MetS characteristics in the general Japanese population. The clinical application of this laboratory index for detecting MetS should be assessed in future studies.

relationship between urinary 8-hydroxydeoxyguanosine and metabolic risk factors in asymptomatic subjects

The aim of this study was to Investigate the relationship between metabolic risk factors and oxidative stress using urinary 8-hydroxydeoxyguanosine [8-OHdG], a recently utilized biological marker, in asymptomatic subjects. Ninety subjects [males/females = 30/60; mean age = 52 years], who were nonsmoking, nondiabetic and not on any medicine, were enrolled in the study. The body mass index, blood pressure, total cholesterol, triglyceride [TG], high-density lipoprotein cholesterol [HDL-C] and glucose as well as urinary 8-OHdG and creatinine were measured. The median level of 8-OHdG was 9.3 ng/mg creatinine [nterquartile range: 5.8-23.2]. TG [Pearson's correlation: r = 0.262, p - 0.013] and HDL-C [r - -0.259, p - 0.014] showed a significant correlation with 8-OHdG. A multiple linear regression analysis adjusted for all the variables revealed that only TG had an independently significant and positive correlation with 8-OHdG [p = 0.231, p = 0.046]. The data in this population suggest that, among metabolic risk factors, hypertriglyceridemia may be weakly but significantly associated with hyperoxidative stress as assessed by 8-OHdG

Relationship between reactive oxygen metabolites and carotid intima-media thickness in subjects with hypercholesterolemia

It was the aim of this study to investigate whether there is any relationship between oxidative stress, as assessed by the diacron reactive oxygen metabolite [d-ROM] test, and carotid atherosclerosis among hypercholesterolemic patients. A well-defined group of patients with type II hypercholesterolemia [n = 81, mean age 59 years] was studied to observe the correlation between the levels of serum d-ROMs and carotid artery intima-media thickness [IMT] using B-mode ultrasound, in relation to the traditional atherosclerotic risk factors [age, sex, smoking, body mass index, blood pressure, glucose and lipid panels]. The mean level in low-density lipoprotein cholesterol [LDL-C] in this population was 4.45 mmol/l, d-ROMs were 323.2 Carr U, and IMT was 0.91 mm. A multiple regression analysis revealed a positive and significant correlation between IMT and d-ROMs [beta = 0.27, p < 0.05], along with age and LDL-C. These results indicate that the increased oxidative stress levels using the d-ROM test, independent of aging and increased LDL-C levels, may be associated with carotid atherosclerosis even in hypercholesterolemic patients

Influence of smoking habits on the GA/HbA1c ratio in patients with type 1 diabetes mellitus

To assess the influence of smoking on glycated albumin [GA] to hemoglobin A1c [HbA1c] ratio among type 1 diabetes mellitus [T1DM] patients. Eighty-one T1DM patients [49 females, 32 males, mean age 48 +/- 18 years] were recruited, and data concerning GA/HbA1c ratio and smoking were collected. The median levels of GA and HbA1c were 23.3 and 7.4%, respectively. Independent of age, sex and/or body mass index, the GA/HbA1c ratio in smokers was significantly lower than that in nonsmokers [3.0 vs. 3.3, p < 0.05]. The data suggest that smoking might affect the GA/HbA1c ratio among T1DM patients

Lifestyle-related Factors Which Affect Blood Pressure Components in Outpatients with Hypertensive Status : A Hospital-based Study / General Medicine

BACKGROUND: An effective approach to lifestyle-related factors could be a main treatment for hypertensives. The components of blood pressure (BP) have been reported to have different clinical implications; however, the relationship between various lifestyle-related factors and BP components has not been thoroughly studied in hospital-based general medicine.<BR>METHODS: This relationship was cross-sectionally investigated in a population of outpatients with hypertension but free of other diseases (136 subjects, aged 30 to 75, mean 54.2 years) . A self-administered questionnaire, which included items related to demographics, smoking, alcohol use, affinity for salt, habitual exercise, and sleep status, was used.<BR>RESULTS: After controlling for lifestyle-related factors, multiple regression analysis revealed that body mass index (BMI) and smoking were significantly and positively correlated with systolic BP (SBP) and pulse pressure (PP) . For diastolic BP (DBP), age had a significantly negative, and lack of sleep had a significantly positive, correlation. BMI was also significantly and positively correlated with mean BP (MBP) .<BR>CONCLUSIONS: Our results suggest that lifestyle-related factors are associated with differing BP components. Weight control should receive more attention in SBP, MBP and PP control, anti-smoking in SBP and PP control, and sleep management in DBP control.

The Present Situation of Home Medical Care and its Contents / 日本農村医学会雑誌

The aim of this investigation was to outline the present situation concerning home medical care and its contents in Japan, excluding general medication.<BR>We examined answers to questionnaires about care contents published in a book that nationally involved doctors who were providing medical care in the patient's home. More than 80 percent of the doctors who responded to the survey gave treatment with intravenous drip-infusions, bladder/urine catheters, injections or tube feeding. Treatment of intravenous hyperalimentation or rehabilitation was also applied by many doctors. General practitioners tended to treat their patients with continuous infusions, injections or home oxygen masks more frequently than hospital doctors. There was no marked difference between generations of doctors in the performance of various care services. We described in part the situation of home medical care and its contents and the performance of some care services might be influenced by providers-hospital or clinic-based doctors.