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Multicultural (MC) and social justice (SJ) training have been areas of exploration within the field of counseling psychology and have gained continual traction within the supporting Canadian literature. This article provides a critique of the current ways in which MC and SJ training are understood within the field of counseling psychology, how they are taught, and how this training is taken up and perceived by graduate students. We discuss the importance of counseling psychology continuing to move beyond dichotomizing MC and SJ competencies from foundational counseling competencies, to expand past traditional strategies of pedagogy, and to further commit to engaging in practices of decolonization, community involvement, and ongoing faculty training. Recommendations for instructors and graduate training programs are made to support more critical systemic dialogs for the advancement of an MC and SJ agenda in Canadian counseling psychology programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Public Significance Statement—This article is a critical review of the literature that pertains to multicultural and social justice training in Canadian counseling psychology. It contextually examines MC and SJ principles in light of its history, and in its training, application, and reception in the field. This article offers suggestions and recommendations to enhance MC and SJ training in counseling psychology and to recommit to social justice initiatives in the field. Refereed/Peer-reviewed

Takafumi Yamano,1 Kensuke Nishi,1 Fumitaka Omori,2 Kaori Wada,2 Toru Naito3 1Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, 814-0193, Japan; 2Department of Otorhinolaryngology, Fukuoka Dental College Hospital, Fukuoka, 814-0193, Japan; 3Section of Gerodontology, Department of General Dentistry Fukuoka Dental College, Fukuoka, 814-0193, JapanCorrespondence: Takafumi Yamano, Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, 2-15-1 Tamura,Sawara-ku, Fukuoka, 814-0193, Japan, Fax +81 928013678, Email yamano@fdcnet.ac.jpObjective: Although the oral environment significantly affects the risk of pneumonia, there have been few studies regarding its relation with swallowing. There is no doubt that there is a significant link between the oral environment and the development of pneumonia; however, there have been few comparative studies of swallowing using video endoscopy (VE) and video fluorography (VF) as indicators to determine the actual availability of oral intake and the choice of food form. This study was performed to examine whether the oral environment or swallowing function contributes more to the development of pneumonia in the elderly.Methods: The study population consisted of 24 patients (7 men and 17 women; age range: 64– 97 years; average age: 86 years) assessed using the Oral Health Assessment Tool (OHAT), VE and VF at Fukuoka Dental College Hospital. The most common disease was pneumonia (17 patients), followed by cerebral infarction (5 patients), pyelonephritis (4 patients), bronchitis (2 patients), Parkinson’s disease (2 patients), scleroderma (1 patient), diabetes (1 patient), eosophageal cancer (1 patient) and Parkinson’s syndrome> (1 patient). Some patients had multiple diseases. Oral intake was possible in 20 patients (80%), whereas tube feeding and gastric banding were required in 4 patients.Results: The OHAT score was not correlated with either the VE or VF score. Furthermore, the OHAT score was not significantly different between the multiple- and no/single-pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than those with no or only a single episode of pneumonia.Conclusion: Oral assessment, VE and VF are necessary to evaluate swallowing in patients with suspected dysphagia. Swallowing function, especially as assessed by VE and VF, is more important than examination of the oral environment for evaluating risk of recurrent aspiration pneumonia in the elderly. In addition, multiple factors contribute to recurrent pneumonia in patients with a good oral environment, including subclinical aspiration, pharyngeal clearance and delayed activation of the gag reflex.Keywords: dysphagia, Oral Health Assessment Tool, video endoscopy, video fluorography

ObjectiveOral care is effective for preventing pneumonia, but objective evaluation of its effect on swallowing is lacking. Oral assessment scores, such as the Oral Health Assessment Tool (OHAT), are used to evaluate the oral environment to monitor oral care. Methods: We investigated the relationship between OHAT score and swallowing function in 24 patients aged 64–97 years.ResultsThe OHAT score did not correlate with the video endoscopy (VE) or video fluorography (VF) scores. Furthermore, the OHAT score was not significantly different between the multiple and no or single pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than that with no or a single episode of pneumonia (p < 0.01).ConclusionsOral assessment, VE, and VF scores are necessary to evaluate swallowing in patients with suspected dysphagia. In addition, recurrent pneumonia among patients with a good oral environment has multiple contributing factors, including subclinical aspiration, pharyngeal clearance, and delayed activation of the gag reflex.

Given the call for increased emphasis on multicultural and social justice orientations in the field of counselling psychology, this manuscript explores how the union of different knowledge traditio...

The number of Transgender and Gender Non-Conforming (TGNC) individuals who are presenting for counseling is increasing; yet counselors receive little to no exposure to gender-diversity throughout t...

The voices of nearly 40 scholars, activists, and practitioners are brought together in Critical Inquiries for Social Justice in Mental Health. Their diverse contributions are united around a fundamental goal of deconstructing mental health systems to reveal how they produce and sustain social injustices. This review is structured around the three central organizing principles that Morrow and Malcoe weave throughout the book: (a) challenging dominant epistemologies, (b) emphasizing individuals’ resistance to social injustices, and (c) reimagining mental health systems. We offer our reflections about the book’s utility from the perspectives of a professor and a graduate student.

This article summarizes and elaborates upon the themes discussed by members of the “Future of Counselling Psychology Education and Training in Canada” working group at the 2018 Canadian Counselling Psychology Conference (2018 CCPC) by 19 participants in attendance. Complexities in program requirements, external and internal program regulations, research competency and advancement, and cultural/social justice responsiveness and internationalization are explicated and analyzed. The current state of counselling psychology education and training is highly intricate and nuanced, while many strengths and opportunities for growth exist despite some long-standing tensions. It is hoped that this article not only will help outline and contextualize the current status and challenges facing the future of counselling psychology education and training in Canada but also will recruit others in helping to improve Canadian counselling psychology education and training. Advocating for what is needed to achieve this is consistent with the theme of the 2018 CCPC. Continued dialogue, program evaluation, theorizing, and research are needed on the nature and dynamics of Canadian counselling psychology education and training.

This special issue of Canadian Journal of Counselling and Psychotherapy is an outgrowth of the landmark 2018 Canadian Counselling Psychology Conference called “Advocating for Ourselves, Advocating for Our Communities: Canadian Counselling Psychology Into the Next Decade and Beyond.” This conference centred on seven working groups: the future of counselling psychology education and training in Canada, foregrounding clinical practice and clinical supervision within the field of Canadian counselling psychology, student advocacy in Canadian counselling psychology, responding to the TRC in Canadian counselling psychology, internationalization of counselling psychology, the role of Canadian counselling psychology in advocating for the needs of members of under-represented groups, and the responsibility of Canadian counselling psychology to reach systems, organizations, and policy-makers. This introduction highlights the seven articles included in this special issue, each of which summarizes the discussion included within one working group and elaborates upon topics that emerged within each working group discussion. We expect that, after reading the articles contained within this special issue, readers will be able to experience some of the intellectual stimulation and inspiration felt by many who attended the working groups in person. We also hope that this collection of articles will inspire those who did not attend the conference to advocate for and to help increase the presence and the influence of Canadian counselling psychology locally, provincially, nationally, and globally as it seeks to promote the best interests of the various communities it serves.

Responding to DSM's call for research on Persistent Complex Bereavement Disorder (PCBD), this study examined to what extent people perceive the criteria as pathological. In total, 385 undergraduate students answered the Continuing Bonds Scale and Persistent Complex Bereavement Inventory as they believe an ideally healthy person of their demographic would respond 12 months post loss. People identifying as women, religious, without past bereavement, and who endorsed continuing bonds as normal tended to perceive PCBD criteria as more normative. Results shed light on whose norms may be reflected in criteria and highlight the importance of assessing client's norms when diagnosing.

The results of a feminist research endeavour that explored multicultural (MC) counselling and social justice (SJ) training experiences from the standpoint of eight culturally non-dominant doctoral students are presented. Participants represented students within the five counselling psychology programs accredited by the Canadian Psychological Association. Specifically, the research aimed to address the following research question: How do counselling psychology doctoral students who self-identify with non-dominant cultural identities perceive their experiences of MC and SJ training? This research adopted a feminist standpoint theory epistemology to guide an interpretative phenomenological analysis to reflect the culturally rich, complex, and situated experiences of participants, while concurrently emphasizing the role that systems of privilege and oppression play in influencing these experiences. Results point to seven superordinate themes, including: (a) MC and SJ are personal and rooted in identity; (b) Instructors—their role and impact; (c) Classmates—a mixed bag; (d) Perceptions of MC and SJ courses; (e) Perceptions of clinical supervision; (f) Systemic engagement with MC and SJ principles; and (g) The emotional and psychological burden of MC and SJ training. Findings are discussed considering sociocultural practices in North America, and MC and SJ training implications are explored.

In our prior published study, we extracted evaluation items suitable for remote administration, and made a relatively simple Remote Examination of Deglutition (RED). This study aimed at verifying the reliability and validity of RED. The participants were 21 healthy elderly individuals and 72 postoperative oral cancer (OC) patients. OC patients underwent videofluoroscopic dysphagia examination, and severity was judged on the dysphagia severity scale (DSS). Reliability and validity of RED were examined in all participants under face-to-face conditions, in comparison with the Mann Assessment of Swallowing Ability (MASA). Reliability and validity of remote administration of RED were examined in 40 participants. ROC curves were used to find cut-off RED scores to predict aspiration and deglutition disorders. The Cronbach's alpha coefficient for the items was 0.882. There was a high correlation between the total score of RED and MASA in the face-to-face condition. When RED score was compared among different severity groups (DSS1-4, DSS5-6, and DSS7), the total and oral preparatory stage scores revealed significant group differences. The area under the curve (AUC) for aspiration based on the ROC curve was 0.913, with a sensitivity/specificity of 0.80/0.98. The AUC for deglutition disorders was 0.819, with a sensitivity/specificity of 0.74/0.67. In both face-to-face and remote conditions, the reliability of RED was good.The reliability and validity of RED were confirmed. RED has shown the potential to assess the likelihood of aspiration and deglutition disorders in OC patients remotely as an initial assessment tool.

Local conformation and overall conformation of poly(γ-DL-glutamic acid) (PγDLGA) and poly(γ-L-glutamic acid) (PγLGA) in aqueous solution was studied as a function of degree of ionization e by (1) H-NMR, circular dichroism, and potentiometric titration. It was clarified that their local conformation is represented by random coil over an entire e range and their overall conformation is represented by expanded random-coil in a range of e > e(*) , where e(*) is about 0.3, 0.35, 0.45, and 0.5 for added-salt concentration of 0.02M, 0.05M, 0.1M, and 0.2M, respectively. In a range of e

We prepared novel cerium meso-tetrathienylporphyrin double-decker complexes with 2-thienyl and 3-thienyl substituents. The X-ray structures show that the porphyrin rings are distorted in a half-pipe fashion, which seems to be a common type of distortion for double-decker complexes of tetraarylporphyrins. The side-arm thienyl groups rotate more than two orders of magnitude faster than the phenyl groups of the corresponding double-decker complex of meso-tetraphenylporphyrin in solution at room temperature because of the lower rotational barriers.

With growing attention to the internationalization of counseling psychology in the past decade, discussion on effective training of international students is much-needed. In order to provide effective mentorship to international students, the mentor needs to be aware of specific challenges faced by international students and cultural differences that may affect their mentoring relationship. With this in mind, this article discusses ways to provide culturally sensitive mentoring particularly to Asian international students in counseling psychology programs. A brief overview of Asian values is provided as a contextual backdrop to the article, followed by a discussion of culturally sensitive mentoring to Asian international mentees. In particular, the article addresses the mentor’s awareness and knowledge of unique issues faced by Asian international students, the structure and format of mentoring, communication between the mentor and the mentee, and professional development and career-related issues.

Hydroxyl groups of amylose are barely dissociated into ions at pH lower than about 12, and so amylose is almost insoluble in neutral and acidic aqueous solutions and its conformation in solution has been a question under debate. Carboxymethylamylose (CMA) has much better solubility in aqueous solution than amylose and the conformation of CMA is expected to reflect that of the parent amylose. In the present study, CMA was prepared by substituting H of 24.5 mol.% hydroxyl groups of amylose with carboxymethyl groups, and the conformation of CMA in KI aqueous solution was studied as a function of the concentration of iodine I₂ and the degree of ionization α by potentiometric titration. Different conformational behaviors were observed in different α domains: In a low‐α domain, CMA in KI/I₂ aqueous solution and in KI aqueous solution behaves as a tightly‐wound helical chain and a loosely‐wound helical chain, respectively. The helical‐ and psedo‐helical‐chain are gradually collapsed to extended‐coils as α increases and CMA equally behaves as an extended‐coil in a medium‐α domain and as a more extended‐coil in a higher‐α domain. Such a conformational change was reflected in a change of persistence length of a chain with α, which was clarified by small‐angle X‐ray scattering study.

The field of grief counseling has yet to see an integration of Buddhist psychology. Drawing on Buddhist psychology literature and Western models of grief, this article explores possible integrations of two approaches. To lay the foundation for this discussion, the authors introduced a brief overview of the history of Buddhism as well as a Buddhist conception of death and other relevant Buddhist concepts. Integrations of Buddhist psychology and Western models of grief are explored within the context of death and grief as part of life, grief as a process, balancing doing and being, and an interpersonal approach to grief counseling. Application of the Buddhist approach for individual and group practice was illustrated, followed by a cautionary note on the caveats of integrating two approaches. The article ends with a discussion on the implications of the Buddhist approach for counselor self-care.

Local conformation and overall conformation of poly(γ-DL-glutamic acid) (PγDLGA) and poly(γ-L-glutamic acid) (PγLGA) in aqueous solution was studied as a function of degree of ionization ε by (1) H-NMR, circular dichroism, and potentiometric titration. It was clarified that their local conformation is represented by random coil over an entire ε range and their overall conformation is represented by expanded random-coil in a range of ε ε(*) , where ε(*) is about 0.3, 0.35, 0.45, and 0.5 for added-salt concentration of 0.02M, 0.05M, 0.1M, and 0.2M, respectively. In a range of ε ε(*) , however, ε dependence of their overall conformation is significantly differentiated from each other. PγDLGA tends to aggregate intramolecularly and/or intermolecularly with decreasing ε, but PγLGA still behaves as expanded random-coil. It is speculated that spatial arrangement of adjacent carboxyl groups along the backbone chain essentially affects the overall conformation of PγGA in acidic media.

We report a case of localized primary sclerosing cholangitis (PSC) which was difficult to distinguish from gallbladder carcinoma. A 75-year-old woman with elevated serum bilirubin was hospitalized and underwent endoscopic nasobiliary drainage (ENBD). There was no history of diseases such as gallbladder stone, pancreatitis, or ulcerative colitis. Cholangiography through the ENBD tube showed localized stenosis of the common bile duct; the gallbladder could not be seen. Angiography showed no encasement of the hepatic artery. Ultrasonography showed a tumor in the cystic duct, and the tumor had invaded the gallbladder and common bile duct. We diagnosed gallbladder carcinoma on radioimaging, and performed an S4aS5 subsegmentectomy of the liver and resection of the extrahepatic biliary tree. Pathologically, no malignant cells were detected, and fibrosis around bile ducts and infiltration of inflammatory cells into hepatic tissue were found. It is well known that PSC is sometimes difficult to differentially diagnose from cholangiocarcinoma. Our case is of high interest because ultrasonography showed findings suggestive of gallbladder carcinoma. It is therefore necessary to keep the possibility of PSC in mind for the diagnosis and treatment of such localized biliary stenosis.

To detect cell specific apoptosis factors, Fas and Fas ligand, and the common intracellular apoptosis modulators, interleukin-1 beta converting enzyme (ICE)-like protease (caspase 1), Bcl-2, Bcl-xL and Bax in lens epithelial cells (LEC) of human cataracts. To study the effects of Fas-stimulating monoclonal antibody on inhibition of LEC proliferation.Reverse-transcriptase-polymerase chain reaction (RT-PCR) was used to detect Fas, Fas ligand, caspase 1, Bcl-2, Bcl-xL and Bax, after cDNA was synthesized from the total RNA isolated from human cataractous LEC obtained by capsulotomy during cataract surgery. Fas-stimulating monoclonal antibody was added at the concentrations of 10, 30, 100, 300 and 1000 ng/ml to the incubation medium of human cataractous LEC; and the specimens were incubated for 24 h at 37 degrees C with 5% CO(2) circulation and 100% humidity. The specimens were then stained with Hoechst 33342, and the number of apoptotic cells was counted.Fas, caspase 1, Bcl-2, Bcl-xL and Bax mRNA were detected by RT-PCR. Fas ligand mRNA was not detected by RT-PCR. At each concentration, Fas-stimulating monoclonal antibody significantly inhibited LEC proliferation.Human cataractous LEC expressed mRNA of Fas and various modulators of apoptosis pathways. Fas-stimulating monoclonal antibody may have the potential to prevent posterior capsule opacification after cataract surgery by inhibiting LEC proliferation.

Although it has been shown that bile acids possess antibacterial activity against Helicobacter pylori, few reports on their activity have been published. We determined the minimum inhibitory concentration at 72 h of various unconjugated and conjugated bile acids against laboratory standard strains and clinical isolates of H. pylori, and studied morphologic changes of H. pylori under the scanning electron microscope during treatment with deoxycholic acid and ursodeoxycholic acid at the minimum inhibitory concentrations for 24 h. We found that only the unconjugated form of dihydroxy bile acid has antibacterial activity. The minimum inhibitory concentration of deoxycholic acid is 200-400 microg/ml, that of chenodeoxycholic acid is similar to that of deoxycholic acid, and that of ursodeoxycholic acid is 400-800 microg/ml. The morphology of H. pylori changed from its primary rodlike shape to a spherical shape with blebs on the cell surface, and was further degraded to an irregularly condensed mass, following an increase in bile acid. This morphologic change in H. pylori was different from the change to a spherical shape caused by amoxicillin. On the basis of these results, it seems that unconjugated dihydroxy bile acid might be a candidate drug for eradication of H. pylori, but further investigations of the clinical usefulness of bile acid for this purpose should be done.

· Background: Testing our hypothesis that residual lens epithelial cells (LEC) participate in the pseudophakic inflammation by producing cytokines, prostaglandins (PG) or both, we detected interleukin-1 (IL-1), IL-6, b-FGF and PGE2 in the incubation medium of cultured LEC. This paper describes our subsequent work on the expression of TGF-α, TGF-β2, IL-4 and IL-8 mRNA in postsurgical and cultured LEC. · Methods: The anterior lens capsule with attached LEC was obtained by anterior capsulotomy during cataract surgery and cultured. Specimens in serum-free medium immediately after surgery or those in serum-added medium after 2 weeks of culture were used. Reverse transcriptase–polymerase chain reaction (PCR) and electrophoresis were used to detect mRNA coding for TGF-α, TGF-β2, IL-4 and IL-8 in human cataract LEC. · Results: Electrophoresis of the PCR products showed that appropriately sized amplification products were specific for TGF-α and TGF-β2 in the specimens immediately after surgery and after culturing, and IL-8 in the cultured LEC. IL-4 was not detected in either group of specimens. · Conclusions: Human cataract LEC synthesize TGF-α and TGF-β2 mRNA in situ and after culturing, and the cultured LEC also synthesize IL-8 mRNA. These cytokines may be synthesized by LEC in vitro and play an important role in an autocrine or paracrine manner in the proliferative process of LEC after cataract surgery, which can cause inflammation and aftercataract.

Lithostathine S2-5 inhibits in vitro crystal growth of CaCO3. We developed an antibody against the peptide region responsible for inhibitory effect to determine whether lithostathine S2-5 levels are different in the pancreatic juice of patients with and without chronic pancreatitis. The antibody against the synthetic peptide of the N-terminal end of lithostathine S2-5 detected lithostathine S2-5 but not lithostathine S1 or lithostathine extracted from pancreatic calculi. Lithostathine S2-5 was detected in samples of pancreatic juice protein by immunoblotting using the specific antibody. The concentration of lithostathine S2-5 was compared between control and chronic pancreatitis groups. The mean concentrations of lithostathine S2-5 were significantly (p=0.002) lower in chronic pancreatitis, 16.3 microg/mg of total protein, than in the control, 47.1 microg/mg of total protein. A decreased concentration of lithostathine S2-5 seems to increase the risk of stone formation in the ducts during the course of chronic pancreatitis because of insufficient inhibition of CaCO3 crystal growth.

Based on his observations in Japanese clinical settings, Fujinawa (1972) conceptualized egorrhea syndrome, which includes symptoms such as olfactory reference syndrome, fear of eye-to-eye confrontation, delusions of sleep talking, delusions of soliloquy, and thought broadcasting. The key feature of this syndrome is self-leakage, a perceived sense that one’s personal internal information, such as feelings and thoughts, are leaking out. To reach a more comprehensive understanding of egorrhea, this paper aims to present general overview and reconsider the phenomenon of self-leakage using cultural-clinical psychology as a framework. First, the symptoms of egorrhea are reviewed in relation to other related psychopathologies such as social anxiety disorder (SAD) and taijin kyofusho (TKS), as well as schizophrenia. Second, a series of empirical studies conducted using Japanese non-clinical samples are summarized. The results of these studies form the basis for subsequent discussions, which incorporates the cultural-clinical psychology perspective proposed by Ryder, Ban, Chentsova-Dutton (2011). This paper ends with a general discussion regarding implications for research and clinical practice.

This study was conducted to examine the expression of Fas/Fas ligand (FasL), to elucidate its relationship with tumor-infiltrating lymphocytes (TILs), and to detect possible gene mutation of Fas/FasL in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC). Methods. Indirect immunohistochemical staining was performed on formalin-fixed, paraffin-embedded sections of liver biopsy and surgery specimens from five normal livers, and from the livers of 30 patients with HCC. Fas/FasL mRNA-expressing cells and apoptotic cells were detected by in situ hybridization and DNA nick end labeling (TUNEL), respectively. We also performed polymerase chain reaction (PCR)-amplifying and direct sequencing for the Fas/FasL gene. Results. Fas/FasL and its mRNA were localized on the membrane or in the cytoplasm in some HCC cells, as well as hepatocytes. Their expression was enhanced in areas with infiltrating inflammatory cells in the noncancerous regions of liver tissue and on the margins of the cancerous tissue. The positivity rate for TUNEL was elevated along these margins. The labeling index of Fas/FasL was lower in the cancerous liver tissue than in the surrounding noncancerous region (P < 0.01), and tended to decrease in proportion to the malignancy of tumor cells; Fas/FasL expression was not found on poorly differentiated type cancer cells. Fas(−)/FasL(+), FasL-mRNA(+) HCC cells were seen in one specimen of moderately differentiated type. Some CD8+T lymphocytes were TUNEL-positive around the cancerous region. In this study, cancerous and noncancerous tissues in HCC revealed no genetic mutations in any exons of Fas/FasL. Conclusions. These findings suggest that Fas/FasL expression was decreased in proportion to the malignancy of tumor cells, and that infiltrating CD8+T lymphocytes play a role in apoptosis in HCC. The apoptosis in HCC could be regulated by the suppression of Fas/FasL expression, or, sometimes, by the enhancement of FasL expression.

A standardized compression injury of rat spinal cord brought about a time-dependent biphasic production of thromboxane A2 (detected as thromboxane B2) and prostaglandin I2 (detected as 6-ketoprostaglandin F1alpha). Thromboxane B2 was predominant during the first 1 h, whereas the 6-ketoprostaglandin F1alpha level exceeded that of thromboxane B2 at 8 h postinjury. As examined by inhibitor experiments and northern blotting, cyclooxygenase-1 was responsible for the first phase, and cyclooxygenase-2 was involved in the second phase. On compression injury the levels of interleukin-1alpha and -1beta detected as mRNA and protein increased and peaked at 2-4 h. Injection of exogenous interleukin-1alpha into the spinal cord resulted in an increase of cyclooxygenase-2 mRNA content and a predominant production of 6-ketoprostaglandin F1alpha resembling the second phase of eicosanoid production. Concomitantly, extravascular migration of polymorphonuclear leukocytes was enhanced after the interleukin-1alpha injection. These cells together with vascular endothelial cells and glial cells were stained positively with an anti-cyclooxygenase-2 antibody. The results suggest that the immediate eicosanoid synthesis after spinal cord injury was due to the constitutive cyclooxygenase-1 and the delayed synthesis of eicosanoids was attributable to the induction of cyclooxygenase-2 mediated by interleukin-1alpha.

We determined the usefulness of pure pancreatic juice collected by endoscopic procedures for assaying impaired pancreatic function in patients with chronic pancreatitis. The functional findings were compared with the degree of morphological change in endoscopic retrograde pancreatograms. Samples of pancreatic juice were collected from 23 patients with suspected chronic pancreatitis by endoscopic cannulation after a bolus intravenous injection of secretin, 100 IU, for 20 min in four 5-min samples. Volume and amylase and bicarbonate concentrations were measured. The maximum bicarbonate concentration (MBC) was found in fractions collected after 10 min. The MBC in patients with chronic pancreatitis (n = 7) was lower than in normal subjects (n = 10) (p < 0.05). When we regarded 125 mEq/L (mean - 1.5 SD) as the normal limit of MBC, the sensitivity, specificity, and overall efficiency of the pancreatic functional test using pancreatic juice to detect chronic pancreatitis were 86, 100, and 94%, respectively. In comparison with the group with normal pancreatogram findings (n = 10), the MBC, volume, amylase output, and bicarbonate output were lower in the combined group (n = 9) of Cambridge II and III (p < 0.05). MBC was the most reliable parameter in the evaluation of the exocrine pancreatic functional test using pancreatic juice samples.