Five-Year Technological Changes of Distant Medical Education in Asia

All physicians would benefit from more comprehensive distance learning. However, the technology is often difficult to use because technological infrastructure is limited in many hospitals in Asia. Since 2003, we have worked to advance international distant medical education implemented through the Internet in Asia. This paper presents an analysis of our activities over the past five years to evaluate the technical transition and its effects on modes of distant medical education. Methods: We analysed distant medical education programmes that we conducted from 2011 to 2015. We used a Digital Video Transport System (DVTS), H.323 and Vidyo, along with commercial and research and education networks (REN) installed in the subject hospitals. Questionnaires were randomly distributed to the audience to evaluate image resolution, image movement, sound quality, and programme content. Results: The number of programmes increased to over 90 per year in 2014–2015. The main system gradually changed from DVTS (58%, 30/52 in 2011) to Vidyo (64%, 67/104 in 2015). The number of new institutions increased to 149 in 2014–2015. Over 92% of the ratings for image resolution and movement were positive. Sound quality was somewhat lower at 83%. Ultimately, 98% of respondents rated the programmes “very good” or “good.” Conclusions: Continuous technical development was observed with increasing numbers of sites for each programme. This resulted in expansion of activity involving non-university hospitals. Practical distant medical education, satisfies physicians’ need for quality and inclusiveness could be expanded to normal hospitals in Asia and beyond

AtPHT4;4 is a chloroplast-localized ascorbate transporter in Arabidopsis

Ascorbate is an antioxidant and coenzyme for various metabolic reactions in vivo. In plant chloroplasts, high ascorbate levels are required to overcome photoinhibition caused by strong light. However, ascorbate is synthesized in the mitochondria and the molecular mechanisms underlying ascorbate transport into chloroplasts are unknown. Here we show that AtPHT4;4, a member of the phosphate transporter 4 family of Arabidopsis thaliana, functions as an ascorbate transporter. In vitro analysis shows that proteoliposomes containing the purified AtPHT4;4 protein exhibit membrane potential- and Cl-dependent ascorbate uptake. The AtPHT4;4 protein is abundantly expressed in the chloroplast envelope membrane. Knockout of AtPHT4;4 results in decreased levels of the reduced form of ascorbate in the leaves and the heat dissipation process of excessive energy during photosynthesis is compromised. Taken together, these observations indicate that the AtPHT4;4 protein is an ascorbate transporter at the chloroplast envelope membrane, which may be required for tolerance to strong light stress

Assessing Burden, Anxiety, Depression, and Quality of Life among Caregivers of Hemodialysis Patients in Indonesia: A Cross-Sectional Study

Family caregivers endure the burden of caring for patients receiving hemodialysis, which can affect their psychological status and may disrupt the care process. This study aims to assess the level of burden, anxiety, depression, and quality of life (QOL) among family caregivers, to investigate the influence of caregivers’ sociodemographic factors and patients’ clinical conditions on the level of burden, and investigate how burden affects anxiety/depression and QOL. A descriptive, cross-sectional study was conducted from September to October 2020. A total of 104 caregivers with a mean age of 44.4 ± 12.7 years (63.5% women) in the hemodialysis department of a hospital in Indonesia were examined. Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale, and WHOQOL-BREF were used. Descriptive analysis was conducted to assess the level of psychological status, and multiple regression analysis and path analysis were performed to evaluate the association among all factors. As result, regarding burden, 10.2% had a moderate-to-severe burden, and in terms of anxiety and depression, 25% and 9.6% showed abnormal cases; the mean scores of 4 domains of QOL were about 60 points. Burden and anxiety/depression were significantly negatively associated with all domains of QOL (p < 0.001); however, sociodemographic and clinical factors were not associated with any of the QOL domains. The path analysis results showed that burden positively correlated with anxiety/depression and negatively correlated with QOL via anxiety/depression. In conclusion, family caregivers’ QOL was found to be indirectly influenced by burden through anxiety/depression. Further evaluation of clinical significance and implications for caregiver’s lifestyle regarding anxiety and depression, which result in caregiver burden, is warranted

Exploration of the Pressurization Condition for Killing Human Skin Cells and Skin Tumor Cells by High Hydrostatic Pressure

High hydrostatic pressure (HHP) is a physical method for inactivating cells or tissues without using chemicals such as detergents. We previously reported that HHP at 200 MPa for 10 min was able to inactivate all cells in skin and giant congenital melanocytic nevus (GCMN) without damaging the extracellular matrix. We also reported that HHP at 150 MPa for 10 min was not sufficient to inactivate them completely, while HHP at 200 MPa for 10 min was able to inactivate them completely. We intend to apply HHP to treat malignant skin tumor as the next step; however, the conditions necessary to kill each kind of cell have not been explored. In this work, we have performed a detailed experimental study on the critical pressure and pressurization time using five kinds of human skin cells and skin tumor cells, including keratinocytes (HEKas), dermal fibroblasts (HDFas), adipose tissue-derived stem cells (ASCs), epidermal melanocytes (HEMa-LPs), and malignant melanoma cells (MMs), using pressures between 150 and 200 MPa. We pressurized cells at 150, 160, 170, 180, or 190 MPa for 1 s, 2 min, and 10 min and evaluated the cellular activity using live/dead staining and proliferation assays. The proliferation assay revealed that HEKas were inactivated at a pressure higher than 150 MPa and a time period longer than 2 min, HDFas and MMs were inactivated at a pressure higher than 160 MPa and for 10 min, and ASCs and HEMa-LPs were inactivated at a pressure higher than 150 MPa and for 10 min. However, some HEMa-LPs were observed alive after HHP at 170 MPa for 10 min, so we concluded that HHP at a pressure higher than 180 MPa for 10 min was able to inactivate five kinds of cells completely

International Telemedicine Activities in Thailand

The development of information and communication technology has had a dramatic impact on people’s lives, including medical matters. The Internet has made it possible for telemedicine to be implemented with excellent image quality at low cost; such telemedicine was first applied between Japan and South Korea in 2002. The technology is not restricted to advanced countries: it can also be applied in developing nations, and it has expanded rapidly to other parts of Asia and beyond. In 2005 Thailand became the seventh country to be associated with the Telemedicine Development Center of Asia (TEMDEC). As of 2017, TEMDEC operates 144 programs in Thailand, mainly in endoscopy (55, 38%) and surgery (40, 28%): 17 hospitals or medical institutions are active members, and there are 165 telemedicine connections. Siriraj Hospital, Mahidol University was the first participant; it has 71 telemedicine connections; King Chulalongkorn Memorial Hospital became the second participant; it has 52 such connections. These two hospitals account for 74.5% (123/165) of all telemedicine activities in Thailand. Compared with outside Bangkok, the number of telemedicine connections is 14 times (154/11) greater and the number of such connections per hospital is 10 times (15.4/1.6) greater in the capital-even though the number of hospitals is only 1.4 times (10/7) greater in Bangkok. To efficiently meet local needs, we strongly hope that telemedicine will expand into rural parts of Thailand and into more medical specialties through ongoing technological development

マイクロ波CTマンモグラフィの開発

24個の固定ダイポールアンテナを用いて三次元マイクロ波CT実験を行い，スーパーコンピュータを用いてForward-Backward Time Stepping（FBTS）法によるCT計算を行った．その結果得られた知見は，FBTS法が雑音に強いこと，及び計算の初期設定やキャリブレーション設定が精度向上に重要なことである．また計算モデル化が容易な広帯域平面アンテナの開発も行った．これらの知見を生かし，FBTS法マイクロ波CTマンモグラフィ装置の概念設計を行った