One day the doctor-hepatologist in Japan
Greetings to all! My name Kaharman Esmembetov, I'm a doctor, hepatologist. I invite all to plunge in one day in my life in Japan, in Japan, the centuries-old culture and technology of the future. You will visit the laboratory where are forged high-profile medical discoveries, in the department at the Japanese circuit of doctors and a Japanese restaurant where they cook exotic dishes. But all this in order. It will be interesting, I promise!
Sunrise in the Land of the Rising Sun - truly one of the earliest in the world. Upland, constituting more than 75% of the country, established during dawn and dusk exciting whimsical painting
Breakfast bachelor. For lack of yogurt and cottage cheese, must be content with a sandwich, cereal and favorite black tea with milk. "Aperitif" is a proven tool - the morning newsletter
Almost all of the sidewalks along the city roads throughout Japan paved tactile paths for the blind. Clinic 3-minute walk, and this way you can go down the path, napping, "on autopilot"
The National Nagasaki Medical Center (NMC) - one of the largest medical institutions of Kyushu. The Center among the other 144 similar institutions included in the National Organization of hospitals in Japan. In clinic center compartment 31 (10-storey building pictured) simultaneously may be more than 600 patients clinic (3-storeyed building is in communication with the clinic) takes an average of 800 patients per day. Of the total number of permanent staff of 900 people at each of the 182 doctors an average of 3 nurses
"Green" in the literal and figurative sense of the car park. On my bike I still only here. Bike way, provide clinic. As I have said, the clinic in a 3-minute walk from the house, but I go by bike, but if I have to in the evening to go somewhere
The entrance and exit from the NMC thought possible: a few parking spaces for two-wheeled transport avtomobileyi surround the clinic with 3 sides, taxis on duty in front of parade output clock, and works like a clock Japanese public transport links to the center of the important points of the city
Reception clinic in the early morning. It is assumed here to greet each counter of the staff, no matter how familiar you are with him / her or not. "Good morning" in Japanese - "Ohio gozaimasu" greeting is usually accompanied by a bow depending on the status of the acclaimed, by a slight nod his head to a deep bow. Bow in Japan - a kind way of communication, it is not just a greeting, using it as grateful and apologetic. It is difficult to get used to the fact that a handshake is not accepted
A cup of coffee and a croissant will brighten your expectation in the lobby clinics NMC
The second floor - offices specialists, diagnostic department and a mini-operating
from Specialists on the 3rd floor of the clinic life is in full swing
In this office for the doctors of the Clinical Research Center, located on the 2nd floor of the NMC is my workplace. The research center lab, I spend my scientific experiments, which is the main purpose of my being here. I study the liver and biliary tract, particularly the problem of viral hepatitis. This question is very serious in many countries, but Kazakhstan is a kind of acute problems - according to official WHO estimates, our country is a country with a high prevalence of hepatitis B and moderate - Hepatitis C
My workplace my eyes. Computer left - official, provides access to a local clinic network to a shared printer, and institutovsky online access to articles from the world's leading medical journals. My computer for security reasons to the center of the network to connect declined, so we have to use both. In fairness it should be noted that all the other tables, too, at least for 2 computers for the same reason
Nursing position in the hepatology department on the 8th floor of the clinic. To the daily morning briefing at 8:45 with the head of the experiment time to see the schedule of offices today - a planned surgery, radiofrequency ablation of tumor foci in the liver and bypass patients. Separate nursing room to room, common in clinics in the post-Soviet space is not here, they simply have no time to sit. Every 8 hours sisters follow each other, the day of their course over
A weekly briefing in the office of the General Director of the Clinical Research Center of the NMC, Professor Ishibashi (center), which monitors the implementation of all scientific publications in the walls of the clinic. The theme of the briefing - the course of my scientific experiment, discuss progress and next steps. Dr. Migita (left), head of the experiment, with whom I discussed all the working points, gives valuable practical advice. After the first week of work at the center, I learned to take these meetings very seriously, while all painted to the minute, so weekly briefings - almost the only opportunity to discuss the important issues at the same time with both my leaders
It is known that each person reacts differently to the same hepatitis B virus - some are cured independently because of their immune system and do not even notice it, while others develop chronic hepatitis B with prolonged favorable course, which practically does not prevent live, the third disease in the short term actively progresses to liver cirrhosis and liver cancer. The aim of our research experiment - an attempt to identify DNA in the genetic factors that contribute to human susceptibility to viral hepatitis B. My mission - to highlight the desired portion of the DNA from the blood of patients with hepatitis B, encoding susceptibility to the virus and testing it for the presence of possible changes that can determine the extent susceptibility to the same virus different people
experiment key to success - perseverance and accuracy. The reactions are carried out with the amount of material izmeryamym in microliters, t. E. 1/1000 grams
Setting the thermocycler program of the polymerase chain reaction (PCR). PCR allows you to copy almost indefinitely increase the amount needed for the study of the DNA fragment. During the reaction, DNA in the test tubes in a thermocycler periodically heated and cooled, which allows to split the double-stranded structure, allocate the desired portion and replay it to achieve the desired material volume
The PCR program is given, the tubes loaded into the preheated to the desired temperature cycler, the apparatus can be run. After about 2 hours of reaction the product will be ready and can start the second stage
Implementation of the second phase of the experiment - restriction analysis, new to me. One of the assistants of Dr. Migitas extensive experience of laboratory work helps to avoid the phenomenon of "the first pancake"
The final product was obtained by PCR and restriction analysis, electrophoresis is subjected, being immersed in a special gel. During electrophoresis, which was first described by the way the walls of the Moscow State University, the DNA fragments move in the gel, depending on the molecular weight due to the created electric field
The last and most exciting stage - the digital processing of the agarose gel with the final product in a fluorescent image analyzer and checking the results. Minutes necessary for the issuance of the result rereadings from an emotions load comparable to several hours painstaking preliminary lab
The 3 samples (indicated by arrow) identified changes in the DNA molecule. After processing all DNA samples of patients with hepatitis B, and several hundreds of them, the final analysis of the results, and based on the comparison to be carried out with similar data from healthy people ultimately summed. This study has the potential to shed light on the patterns of people's susceptibility to hepatitis B virus and the severity of the disease at the genetic level
Lunch time at the clinic - from 12 to one in the afternoon, but this time frame is not rigidly fixed. I usually manage to escape home for lunch after an hour, but today every minute counts, and here I am in the dining room for the staff on the 10th floor. My usual menu - salad, Japanese national miso soup, fried chicken, rice and a glass of water. Price question - 450 yen (about 180 rubles).
The dining room offers spectacular views of the city and the bay of Omura. afternoon rush hour and was quite nelyudno in the dining room. A few words about the table layout: the choice of available rods ( "hashi") or spoons and forks. There are certain rules for using chopsticks, which I, frankly, found only here in Japan, although eastern restaurants frequented quite often: Hashi not be left stuck in the rice, not taken to indicate them to anyone, as well as gestures and cross. Soup to drink, and its contents are to eat with chopsticks. At first, it was strange to me that the Japanese are very often quite loud smack one's lips when eating soup, we do this with the public is unacceptable
In the dining room self-service. Japanese service should pay tribute, on the universal recognition of the sincere hospitality, kindness and positive mood staff is hard to find anywhere else
On the 10th floor there is a restaurant for the patients (see photo), a hall for the tea ceremony, the vendor version machines for drinks and coin-operated laundry. Last - is another proof of the traditional Japanese attention to detail, because often close for a long time are together with patients, especially with seriously ill patients and the possibility of a much-needed laundry service
the vendor version machine with drinks in this case, as an indicator of food culture in Japan. Firstly, these devices are found absolutely everywhere, can be firmly convinced in any part of the sleepy provincial town in Japan, you will not feel thirsty (provided that you have in your pockets 100-150 yen - 40-60 rubles). Secondly, a good half of the range occupied by green tea, which is a great variety here. The remaining half is represented mineral water, juice, black tea with milk and coffee with milk (Yes, in plastic bottles). Of carbonated drinks - only "Coca-Cola", "Pepsi" and sometimes "Fanta"
Pride NMC- helicopter service. In terms of Japan, with its many small islands scattered - it is not a luxury but a vital necessity. Now there is the center of 2 helicopters, one designed for the transport of emergency patients is the second helicopter-taxi for doctors
Every year, NMC provides emergency assistance to more than 10 000 patients, including about 180 - with the help of helicopters
Mini-library of research center - the dream of a hepatologist. Here in one room contains the most authoritative global publication of Hepatology. Half an hour after dinner before the crawl in Gastroenterological department will be spent here with benefit
Weekly bypass Ishibashi Director General of the Research Center Professor, Head of Department of Hepatology Abiru doctors and senior nursing department.
M-san observed department about cirrhosis in the outcome of hepatitis C for more than 15 years. Regular monitoring and inspection to successfully control the disease. Chamber in the photo - the usual 4-seater, which is provided by default to patients free at the expense of insurance
C-san prepares to elective surgery for radiofrequency ablation (RFA) of tumor foci in the liver (see. The operation description below). Over the past 8 years this procedure it passed 5 times in connection with the appearance of new lesions, and each time successfully. Although the patient, this operation is not new, Ishibashi professor still found it necessary to pay attention to and encourage the patient. Chamber in the photo - Single, for her patients to pay extra around 5,000 yen per day (about 2000 rubles)
Life Frank-san 2 weeks ago literally hanging in the balance due to liver failure. Currently, his condition has stabilized. The last bar in the treatment of - removing the liquid from the right pleural cavity which has accumulated as a result of ascites (accumulation of excess it into the abdominal cavity), and the extract can discuss home. The reason was the ascites of liver cirrhosis in which normal liver tissue is replaced by fibrous connective tissue (scars) and compacted liver prevents outflow of blood vessels in the surrounding
VIP-chamber, single. For staying in such conditions the patient needs to pay about 10,000 yen per day (about 4000 rubles).
Dr. Nagaoka introduced me to the exponential of electronic health records in the hepatology department. The use of electronic medical records, is very comfortable, with a single click you can see the dynamics of changes in the liver by computed tomography in recent years, or the result of an important analysis in the previous hospitalization. All data is stored on central servers, where they can be downloaded and edited in any of the dedicated and established everywhere in the center of the computers. Access to the data requires authentication and is only available for full-time staff
Discussion patient of Dr. Nagaoka and work under the supervision of a senior resident Dr Bekki. Postgraduate medical education in Japan lasts much longer than in Kazakhstan and Russia. After graduation, graduate, depending on the chosen specialization must work up to 6 years in the profile clinic / office as an intern and resident, before proceeding to independent practice
The center of the tumor in the liver is clearly visualized with ultrasound. In this case, one of the foci of metastatic gallbladder cancer. Given the elderly, primary tumor size and number of foci of metastasis prognosis unfavorable. In Japan, there is no legislative provision for failure to inform patients about the prognosis of the disease in each case is decided individually. Each patient being hospitalized at the clinic, fills in the questionnaire, noting the desire to be informed about the prognosis of the disease. AN-san originally wanted to stay in the dark about his prediction
Dr. Bae performs radiofrequency ablation (RFA) of tumor foci in the liver in a mini-operating in the department. Under ultrasound guidance in the center of the hearth electrode is introduced percutaneously into the liver, the tip of which is heated and destroys the tumor cells. The number of performed RFA is growing every year, performing technique possess all the doctors of the department, in 2010 about 90 such procedures were performed. Japanese hepatologists skillfully operate ultrasound RFA liver tumor biopsy liver tissue and liver tumor, endoscopic ligating varices of the esophagus and stomach, biliary tract stenting (percutaneous and endoscopic) and laparoscopic manipulation. All of the above post-Soviet space is a prerogative of the surgeons. Aware of a range of procedures performed and the need for related knowledge and skills, unwittingly imbued with the Japanese Hepatology profound respect
2-3 times a week, Professor Itoh, an expert center for pathology, giving me time, and I do with him studying Pathomorphology (pathological changes in the organs at the cellular level) in liver diseases. Correct diagnosis is critical for treatment and prognosis of any disease and liver disease, are no exception. In practice, the physician hepatologist often arise situations where accurate diagnosis can not be established by laboratory or instrumental methods (x-ray, computed tomography, ultrasound and the like. D.). In many such cases, the ultimate truth, especially in clarifying the contentious issues is to get a piece of liver tissue by biopsy, and study it under a microscope. Thus patomorfologija can help identify disease stage and extent of progression of time and prescribe the effective treatment
The working day is over. At the exit from the hospital noticed the young clinic administrators in suits and ties, carefully polishing the wall in the lobby. Later I learned that the next day it was expected the arrival of the official delegation from one of China's leading clinics. During the day at the clinic are trained on viral hepatitis, which came participants from developing countries. In the evening, a farewell dinner was planned with the participants of the training in the traditional Japanese restaurant
Professor Ishibashi, with whom we have left from the center, on his electric bike did not leave me a chance at the second steep incline on the way to the restaurant. At that moment, when I still caught up, to my surprise, he sent a letter in the mail. Yes, the written correspondence as it turns out, is still relevant
Aquarium with squid in the main hall of the restaurant. A few minutes later one of them was at our disposal
And here is our squid. Anticipating his unhappy fate, he occasionally twitched nervously. Squids and lobsters, sushi and sashimi is certainly entertaining, but I personally do not compare me with kazi, beshbarmak and mare's milk!
to satisfy hunger, all the company quickly breaks up into smaller groups. Doctors from different countries enthusiastically discuss topical issues of hepatology
Dr. Ulziitumur from Ulaanbaatar adjusts the tone of voice for the performance of Mongolian songs. Each of those present in turn had to present their national culture by virtue of ability, someone chose to sing, and someone to dance. Some people successfully escaped this fate, regularly changing the dispositions under the guise of a better view for the photo. If the Japanese doctor from Mongolia, and I had no problems sitting legs folded "Kazakh", the rest of the guests spend the entire evening in search of a comfortable posture
Dr. Bocar from Senegal under the chatter of cameras enthusiastic audience sings a song in the native language
group photo as a souvenir. Hospitable Japan united under one roof representatives of Indonesia, Kazakhstan, China, Mongolia, Myanmar, Senegal and Fiji
The working day was intense and interesting, and the evening - delicious and fun. Overview of current developments in Kazakhstan and the world and chat with friends and family on Skype put an end to the daily routine
From day to day, expecting the arrival of his bride to visit me, she goes into a vacation, and I have a well-earned break for a few days. Pleasant thoughts on this topic are for me the best sleeping pills. Goodnight, Japan!