Pursuing Quality Education in Physical and Rehabilitation Medicine in Japan

In Japan, medical education and training are the combined responsibility of two ministries namely Ministry of Education, Culture, Sports, Science and Technology, and the Ministry of Health, Labor and Welfare. The medical education system underwent a major transformation in August 2021 making it a seamless clinical education blending pre-graduation and post-graduation training. Not all universities offer rehabilitation medicine curriculum. Furthermore, where rehabilitation medicine is taught, the curriculum content is not standardized. All medical students sit for a common national medical practitioner qualifying examination. However, only a few questions on Rehabilitation Medicine are included. The personal experience of the author's teachings in rehabilitation medicine at Saga University medical school is described. Emphasis is placed on experiential learning on subjects that are current and state-of-the-art in Japan including robotics. It is aimed at promoting inspired motivation for the students to pursue specialized training in rehabilitation medicine. Japan can take lessons from the European Union's white book on Physical Medicine and Rehabilitation as well as the International Society of Physical and Rehabilitation Medicine core curriculum. In addition, the Rehabilitation Medicine education system can be further improved through a well-coordinated preclinical and clinical medical education. There is also a need to expand the rehabilitation medicine field and address the gaps with other specialties

Cigarette smoking, N-acetyltransferase 2 polymorphisms and systemic lupus erythematosus in a Japanese population.

Cigarette smoking may be associated with an increased risk of systemic lupus erythematosus (SLE), but the underlying mechanism of this association remains unclear. N-acetyltransferase 2 (NAT2) is highly variable and detoxifies aromatic amines, an important class of carcinogens in tobacco smoke. Individuals who possess homozygous polymorphic alleles have a slower rate of metabolic detoxification of aromatic amines. We investigated the relationship of the NAT2 polymorphism to the risk of SLE with special reference to the interaction with cigarette smoking among 152 SLE cases and 427 controls in a female Japanese population. NAT2 4, NAT2 5B, NAT2 6A and NAT2 7B alleles were detected with polymerase chain reaction-restriction fragment length polymorphism. Individuals carrying the 4/4 genotype are rapid acetylators, whereas those with homozygous non- 4 genotypes have a slow acetylator phenotype. Cigarette smoking was associated with an increased risk of SLE (odds ratio [OR] = 2.26; 95% confidence interval [CI] = 1.46-3.50). The slow acetylator genotype of NAT2 was significantly associated with an increased risk of SLE (OR = 2.34, 95% CI = 1.21-4.52) compared with the rapid acetylator genotype. A gene-environment interaction was suggested, with a combination of the NAT2 slow acetylator genotype and smoking conferring significantly higher risk (OR = 6.44, 95% CI = 3.07-13.52; attributable proportion due to interaction = 0.50, 95% CI = 0.12-0.88), compared with the NAT2 rapid acetylator genotype and no history of smoking. This study suggests that, in this Japanese population, the NAT2 slow acetylator status may be a determinant in susceptibility to SLE

Combination of TNF-RII, CYP1A1 and GSTM1 polymorphisms and the risk of Japanese SLE: findings from the KYSS study.

OBJECTIVES: Association of the polymorphisms of the genes, TNF receptor type II gene (TNF-RII), cytochrome P4501A1 gene (CYP1A1) and glutathione S-transferase M1 gene (GSTM1), with SLE was investigated. TNF-RII mediates inflammatory and immune response, whereas CYP1A1 and GSTM1 are involved in the metabolism of xenobiotics. These three genes are involved in the generation of reactive oxygen species (ROS), which play a critical role for autoimmune diseases.\nMETHODS: A total of 152 SLE patients and 427 healthy individuals in a female Japanese population were enrolled in the study. Case-control studies were performed for the polymorphisms of these three genes.\nRESULTS: The carriers of TNF-RII 196R were at a significantly increased risk for SLE with odds ratio (OR) of 1.59 (95% CI = 1.01, 2.52). CYP1A1 3801C homozygotes had a significantly increased risk of SLE (OR = 2.47, 95% CI = 1.28, 4.78). On the other hand, GSTM1 null genotype was not associated with SLE risk. As for combination action of two loci, CYP1A1 3801C/GSTM1 null combination was more strongly associated with an increased risk of SLE (OR = 4.35; 95% CI = 1.76, 10.73). Moreover, TNF-RII 196M/CYP1A1 3801C/GSTM1 null genotype combination was most significantly associated with SLE (OR = 5.83; 95% CI = 2, 17.04).\nCONCLUSIONS: The individuals carrying two or more \u27at-risk\u27 genotypes of TNF-RII, CYP1A1 and GSTM1 had a significantly more increased risk for SLE compared with those having each \u27at-risk\u27 genotype. Combination of the risk genotypes will be important to more clearly identify the population at risk for SLE

Relationships between the Occlusal Force and Physical/Cognitive Functions of Elderly Females Living in the Community

Purpose: The present study, was conducted to examine the occlusal force and physical, cognitive, and attentional functions of elderly females living in the community to evaluate the significance of measuring the occlusal force. Subjects and Methods: The number of subjects was 104. The Occlusal Force Meter GM10 was used to measure their occlusal force. Their physical functions were assessed using eight examinations, including the 30-second Chair Stand Test, and the cognitive functions of the Mini-Mental State Examination and attention functions of the Trail Making Test. Results: Significant correlations were noted between the occlusal force and all measurements, except for the results of forward bending in a sitting position. Multiple regression analysis was conducted with the occlusal force as an objective variable, and significant partial correlations were noted with the 30-second Chair Stand Test. Conclusion: These results suggest that it is necessary to provide the elderly with comprehensive support focusing on maintaining their occlusal force, as a nursing care-prevention measure, to help them continue to live a healthy, independent life