Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
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Education, resident training, guidelines, and evaluation are necessary to improve health care quality. Changing the resident system, re-organizing medical associations and Evidenced-Based Medicine (EBM) are becoming popular, and clinical practice using guidelines has been stressed in recent years in Japan. However, clinical evaluation is generally not so popular, except within internal conferences, and during short discussions at medical societies, although evaluation of the hospital services is on going by the Japanese Council for Quality Health Care (JCQHC). ⋯ Outcome reviews will offer the opportunity to assess comparability with national standards and norms. Trauma registry and evaluation are recommended for all emergency centers in Japan. These evaluation processes may be useful for systematic improvement of the emergency medical field.
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Partial peripheral nerve injury produces a persistent neuropathic pain which is difficult to relieve. In order to determine whether different degrees of peripheral nerve injury are related with the severity of neuropathic pain, we examined pain-related behaviors, histological changes and NGF in the skin in rats treated with different types of spinal nerve injury: tight ligation of the left L5 spinal nerve, incomplete ligation of the left L4 and L5 spinal nerves and incomplete crush of the left L4 and L5 spinal nerves. In all model rats, the thresholds of paw withdrawal in response to mechanical and heat stimuli began to decrease on the injured side 1 day after the operation, and the decreases in the thresholds persisted for more than 1 month. ⋯ Nerve growth factor (NGF) in the skin of the hindpaw on the injured side was accumulated after incomplete ligation and incomplete crush of the left L4 and L5 spinal nerves, but not tight ligation of the left L5 spinal nerve, on day 15 after the operation, possibly due to impairment of transport via unmyelinated primary afferents. Regeneration of the sciatic nerve alleviated the accumulation of NGF in the injured side hindpaw skin on day 32. The present results suggested that the severity of neuropathic pain was related with the degrees of both degeneration and/or regeneration of myelinated fibers and of functional damage of unmyelinated fibers.