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Background: The Japanese medical educational model core curriculum requires an understanding of the characteristics of Kampo medicine. However, there are few reports on the methods of evaluating the skill levels of Kampo medicine practitioners. Objective: This study investigated the utility of objective structured clinical examination (OSCE) for evaluating the skills of Kampo medicine practitioners, exploring its relationship with other medical skills. Methods: The 2022 post‐clinical clerkship OSCE assessed the accuracy of Kampo‐related tasks, specifically abdominal examinations. In addition, correlation coefficients and factor analysis were used to analyze the relationship of Kampo tasks with other tasks (three clinical‐reasoning tasks, electrocardiogram attachment task, joint examination task). Results: Medical students showed significant variation in their ability to accurately assess different abdominal regions. The epigastric region had the highest accuracy (92.0%), while the para‐umbilical region had the lowest (45.1%). Correlation analysis between Kampo tasks and other clinical tasks (clinical reasoning, electrocardiogram attachment, joint examination) yielded coefficients ranging from 0.10 to 0.19, suggesting a low relationship. Factor analysis confirmed the independence of Kampo skills from other assessed medical skills across four distinct factors. Conclusions: Since Kampo diagnostic skills are highly unique, it is possible that Western medicine OSCE tasks alone may not sufficiently assess competency in Kampo medicine. Therefore, it is necessary to consider incorporating Kampo tasks into the OSCE. [ABSTRACT FROM AUTHOR]

Background Helicobacter pylori ( HP) infection induces methylation silencing of specific genes in gastric epithelium. Various stimuli activate the nonselective cation channel TRPV4, which is expressed in gastric epithelium where it detects mechanical stimuli and promotes ATP release. As CpG islands in TRPV4 are methylated in HP-infected gastric epithelium, we evaluated HP infection-dependent changes in TRPV4 expression in gastric epithelium. Materials and Methods Human gastric biopsy samples, a human gastric cancer cell line ( AGS), and a normal gastric epithelial cell line ( GES-1) were used to detect TRPV4 mRNA and protein expression by RT- PCR and Western blotting, respectively. Ca2+ imaging was used to evaluate TRPV4 ion channel activity. TRPV4 methylation status was assessed by methylation-specific PCR ( MSP). ATP release was measured by a luciferin-luciferase assay. Results TRPV4 mRNA and protein were detected in human gastric biopsy samples and in GES-1 cells. MSP and demethylation assays showed TRPV4 methylation silencing in AGS cells. HP coculture directly induced methylation silencing of TRPV4 in GES-1 cells. In human samples, HP infection was associated with TRPV4 methylation silencing that recovered after HP eradication in a time-dependent manner. Conclusion HP infection-dependent DNA methylation suppressed TRPV4 expression in human gastric epithelia, suggesting that TRPV4 methylation may be involved in HP-associated dyspepsia. [ABSTRACT FROM AUTHOR]

Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine, in collaboration with four other medical societies, launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines (all clinical questions and recommendations were shown in supplementary information). A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on nine subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two‐step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence‐based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen. Highlight Mayumi and colleagues present the first English‐language evidence‐based guidelines for primary care of acute abdomen, developed by the Japanese Society for Abdominal Emergency Medicine in collaboration with four other medical societies. The guidelines provide recommendations for specific primary management of acute abdomen with 108 clinical questions and a two‐step flowchart. [ABSTRACT FROM AUTHOR]

Objective. Patients with gastroenteropancreatic neuroendocrine carcinoma (NEC) have a poor prognosis. Platinum-based combination chemotherapy is commonly used as first-line treatment; however, the role of salvage chemotherapy remains unknown. This study aimed to analyze the efficacy and safety of amrubicin monotherapy in patients with platinum-refractory gastroenteropancreatic NEC. Methods. Among 22 patients with advanced gastroenteropancreatic NEC, 10 received amrubicin monotherapy between September 2007 and May 2014 after failure of platinum-based chemotherapy. The efficacy and toxicity of the treatment were analyzed retrospectively. Results. Eight males and two females (median age, 67 years (range, 52–78)) received platinum-based chemotherapy, including cisplatin plus irinotecan (n=7, 70%), cisplatin plus etoposide (n=2, 20%), and carboplatin plus etoposide (n=1, 10%) before amrubicin therapy. Median progression-free survival and overall survival after amrubicin therapy were 2.6 and 5.0 months, respectively. Two patients had partial response (20% response rate), and their PFS were 6.2 months and 6.3 months, respectively. Furthermore, NEC with response for amrubicin had characteristics with a high Ki-67 index and receipt of prior chemotherapy with cisplatin and irinotecan. Grade 3-4 neutropenia and anemia were observed in four and five patients, respectively. Conclusion. Amrubicin monotherapy appears to be potentially active and well-tolerated for platinum-refractory gastroenteropancreatic NEC. [ABSTRACT FROM AUTHOR]

Background: High-molecular-weight cell-associated proteins (HM-CAP) assay is the most popular serological immunoassay worldwide and has been developed from US isolates as the antigens. The accuracy is reduced when the sera are from adults and children in East Asia including Japan. To overcome the reduced accuracy, an enzyme immunoassay using Japanese strain-derived HM-CAP (JHM-CAP) was developed, in which the antigens were prepared by exactly the same procedure as HM-CAP. The performance of JHM-CAP was better than that of HM-CAP in Japanese adults as well as in children. The higher sensitivity was because of the presence of 100-kDa protein that was absent in the preparation of HM-CAP antigen. Materials and Methods: Immunoblot analysis and peptide mass fingerprinting methods were used to identify the distinctive 100-kDa protein present in JHM-CAP antigens. The peptide sequence and identification were analyzed by Mascot Search on the database of Helicobacter pylori. The identified protein was confirmed by immunoblot with a specific antibody and inhibition assay by the sera. Results: The distinctive 100-kDa protein was a fragment of CagA derived from Japanese clinical isolates, and the sera of Japanese patients had strongly reacted to the protein, probably to the exposed epitope on the fragmented CagA. The fragmentation of CagA had occurred in the process of antigen preparation in Japanese isolates, not in US isolates even under the same preparation. Conclusion: The distinctive 100-kDa protein was a fragment of CagA protein of H. pylori derived from Japanese clinical isolates, and Japanese patients including children are likely to react strongly to the exposed epitopes on fragmented CagA. [ABSTRACT FROM AUTHOR]

The article discusses the findings of a study which demonstrated the function of transient receptor potential vanilloid 4 (TRPV4) in causing the release of adenosine triphosphate (ATP) from oesophageal cells. The experiment confirmed that TRPV4 has the ability to detect warm temperature, stretch, and chemical presence in mouse oesophagus. The article also suggests the possible action of TRPV4 in the hypersensitivity of the oesophagus to heat and mechanical stimuli.