http://www.med.u-ryukyu.ac.jp/

U N I V E R S I T YO F

T H E R Y U K Y U SGRADUATE SCHOOL OF MEDICINE,

GRADUATE SCHOOL OF HEALTH SCIENCES,FACULTY OF MEDICINE

SCHOOL OF MEDICINE, SCHOOL OF HEALTH SCIENCES,AND UNIVERSITY HOSPITAL

207 Uehara, Nishihara-cho,

Nakagami-gun, Okinawa, Japan

TEL:+81-98-895-3331

GUIDE BOOK

UNIVERSITYOF

THE RYUKYUSGRADUATE SCHOOL OF MEDICINE,

GRADUATE SCHOOL OF HEALTH SCIENCES,FACULTY OF MEDICINE

SCHOOL OF MEDICINE, SCHOOL OF HEALTH SCIENCES,AND UNIVERSITY HOSPITAL

2 3

Dean, Hajime Ishida, M.D., Ph.D.

Dean, Graduate School of Health Sciences,School of Health Sciences

Takuya Fukushima, M.D., Ph.D.

Head, School of Medicine Chitoshi Takayama, M.D., Ph.D.

Vice-Dean,Hidehiro Kishimoto, M.D., Ph.D.

Vice-Dean,Tetsu Yamashiro, M.D., Ph.D.

Vice-Dean,Kenzo Takahashi, M.D., Ph.D.

Vice-Dean,Takao Yokota, R.N., Ph.D.

FOUNDING CONCEPT CONCEPT & BASIC POLICY

The essential purpose of the Faculty of Medicine is to nurture physicians and medical science specialists who are willing to develop their specialized knowledge and ski l ls with high ethical standards in professional research areas, and to carry out the research in all fields of medicine and medical sc ience by responding adequately to the latest progress and social problems. In addition, the Faculty is obligated to i m p r o v e m e d i c a l c a r e i n t h e l o c a l community , to resolve medical and healthcare problems, and to extend its promotional activities to countries in the Asian and Paci f ic reg ions based on recognition of the natural environmental condit ions, geographic location and historical situation in the Ryukyu Islands.

As the University Hospital, we aim to develop international-minded medical staff who will provide high quality healthcare in a c c o r d a n c e w i t h o u r p a t i e n t s ’ requirements. We also aim to provide optimal medical care with profound compassion for patients, and also to improve the community healthcare and welfare. As the only designated “Advanced Treatment Hospital” in the Okinawa Prefecture, we have demonstrated a firm commitment to provide innovative and advanced medical care.

Our basic policies are:1 ) t o p r o v i d e h i g h q u a l i t y m e d i c a l treatment to ensure the dignity of life;2) to improve the quality of community h e a l t h c a r e a n d w e l f a r e t h r o u g h cooperation with the other medical and allied health organizations;3) to develop and apply advanced medical knowledge and technologies; and4) to nurture physicians and medical staff who possess international viewpoint and outlook.

Since being appointed the community AIDS Clinical Center (March 2007), and the Landmark Hospital for cancer therapy (February 2008), and l iver diseases (November 2009), and for medical care in remote areas (March 2011), the University Hospital functions as the pivotal center for a d v a n c e d m e d i c a l c a r e i n O k i n a w a Prefecture. As the leading hospital in Southeast Asia, it is also expected to contr ibute to improving community healthcare and to provide updated medical treatments, especially in the fields of i n f e c t i o u s d i s e a s e s , c a n c e r a n d lifestyle-related diseases.

UNIVERSITY HOSPITAL

Director, Jiro Fujita, M.D., Ph.D.

Vice-Director,Tadashi Nishimaki, M.D., Ph.D.

Vice-Director,Yusuke Ohya, M.D., Ph.D.

Vice-Director,Mikio Suzuki, M.D., Ph.D.

Vice-Director,Manabu Kakinohana, M.D., Ph.D.

Vice-Director,Chiyomi Omine,

Certified Nurse Administrator

GRADUATE SCHOOL OF MEDICINE,GRADUATE SCHOOL OF HEALTH SCIENCES,FACULTY OF MEDICINESCHOOL OF MEDICINE, SCHOOL OF HEALTH SCIENCES,

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Improvement of dysfunction of pancreatic islets　 ! cells (enhancement of GSIS) " cells (suppression of glucagon)

Correction of imbalance of gut microbiota and subsequent production of SCFAs via fermentation

Modification of feeding behavior Marked amelioration of addiction to animal fat via suppression of ER stress and epigenetic modification 　　　

Leading publications of our research on brown rice

! Japanese Patent; No. 6098973（ March 3, 2017） ! Japanese Patent ; No. 6143215（ May 19, 2017） ! Japanese Patent ; No. 2014-553210 (June 29, 2017)

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Brown rice-derived bioactive substance, #-oryzanol exerts multi-factorial, metabolically-beneficial impact on brain, pancreatic islets and gut microbiota

An overweight man considers which kinds of food to eat. Excess dietary fats strengthen the preference for fatty foods via dysregulation of the brain reward system.The cover shows oil droplets containing a variety of foods, including vegetables, fruits, French fries, brown rice, pizza and desserts.In the present issue of Diabetologia, we report that the brown rice-specific bioactive substance #-oryzanol acts as a potent inhibitor of DNA methyltransferases in brain striatum in mice, thereby attenuating the preference for dietary fat via the epigenetic modulation of the dopamine D2 receptor. The study highlights # oryzanol as a promising anti-obesity treatment with a distinct property as an epigenetic modulator in humans.

Diabetologia 60:1502-1511, 2017

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People in Okinawa used to have healthy life-style, and highest longevity in Japan. However, introduction of western life-style 20 years prior to Japan main-islands results in higher prevalence of obesity and lifestyle-related diseases, such as diabetes mellitus, and mortality rates for middle aged people in Okinawa are now highest in Japan. During last decade, advances in technologies and accumulation of human genomic information have provided a large number of information regarding susceptibility to common diseases or responsiveness and/or adverse effects to several drugs, those are considered useful to establish a future precision medicine. It has been also well known that genetic backgrounds vary among different ethnic populations, and people living in Okinawa have been shown to possess a unique genetic background, which is clearly different from that in people from Japan main-islands. Therefore, genetic studies using an Okinawa population are required to provide useful information for the establishment of precision medicine in Okinawa.

Okinawa Bio-information Bank Project has been started under the support of Okinawa Prefecture and Japanese government. We will collect about 20,000 genomic DNA samples and clinical information from participants living in O k i n a w a . W e t h i n k t h a t t h e r e s o u r c e o f O k i n a w a Bio-information Bank contributes to the identification of new therapeutic targets, elucidation of disease mechanism. In addition, promotion of collaboration using this resource with research institutes or pharmaceutical companies is useful to

Okinawa Bio-information Bank Project toward future precision medicine

Okinawa Prefecture, located at the center point between Southeast Asia and mainland Japan, was previously recognized as a healthy society with a high life expectancy. However, the average lifespan has dropped in Okinawa, down from first place in Japan to third for women and thirtieth for men. This situation, known as the “330 Shock”, has caused confusion and worry among medical personnel in Okinawa. Lifestyle-related diseases due to dietary change are thought to be one of the main causes. Alongside increasing aging of the population on remote islands, improvement of medical services for the elderly have become a more important issue. The School of Health Sciences aims to improve health and longevity, and offers hospital-based medical care for residents

of Okinawa Prefecture through its education of healthcare professionals. Its nursing and medical laboratory-based courses train staff to help provide community medicine and health services. Undergraduate students gain comprehensive knowledge in lectures given by instructors in various fields and master practical care skills by training in community medical facilities. Through exchange agreements with institutions in Southeast Asian countries, they also learn to consider local issues from a global viewpoint. The School of Health Sciences endeavors to develop leaders of community medicine in Okinawa Prefecture, teaching staff that can work in research and education, and talented global human resources.

The development of human resources in islands of Okinawa with a high life expectancy

Okinawa Clinical Simulation Center is established in March 2012, for the purpose of improving medical education, patient safety and clinical skill training by the support from Okinawa Prefecture. This center has been used by all medical staff in medical institutes and educational institutes inside and outside of Okinawa. Simulation-based medical education has been accepted as an innovated teaching method using a simulated clinical situation and circumstances. Our institute is three stories, and the total floor area is 2,150m2. We have 21 training rooms, and six debriefing/meeting rooms with variety of simulators and medical devices which can be used for the purpose from basic skill trainings to advanced simulation trainings. The total number of users of our institute in one year has exceeded 18,000. Users are medical students, nursing students, doctors, nurses, pharmacists, dentists, nursing teachers, cl inical laboratory technicians, and cl inical engineering technicians. Not only providing those facilities, but we have held our original courses to develop the teaching skills of the simulation educators for years. Instructors and teachers, who had taken

our courses are now coaching in their institutions for improving the levels of medical systems in Okinawa. S imulat ion-based educat ion is most suitable for understanding team works and patient safety, those are the most important missions for healthcare providers to improve. We hope that more medical and educational institutions will utilize our facilities for that purpose, and contributing to patients benefit. For more detailed information, visit our website http://okinawa-clinical-sim.org/

Okinawa Clinical Simulation Center

Okinawa, which was once an island of the longest-lived people in the world, has recently ranked near the top of all Japanese prefectures in terms of the proportion of obese people and patients with type 2 diabetes mellitus, and the average lifespan of people has been rapidly decreasing (the Okinawa crisis). High-fat meals, which are rare in the wild, disrupt the appetite control mechanism of the brain. The similarity between the dependence on high-fat meals and addiction to narcotics, alcohol, tobacco, gamble and internet is attracting social and academic attention. Endoplasmic reticulum (ER) stress in the hypothalamus, the center of appetite, is aggravated by excessive intake of animal fat, further increasing the preference for animal fat. Of note, among various kinds of natural foods, γ-oryzanol, which is contained specifically and abundantly in brown rice, functions as a molecular chaperone and decreases ER stress in hypothalamus. γ-Oryzanol also alleviates ER stress in pancreatic β cells, thereby improving glucose-stimulated insulin secretion. Furthermore, γ-oryzanol ameliorates dysbiosis of gut microbiota, resulting in augmented production of short chain fatty acids (Fig.1). Supported by a couple of national strategic research grants, we are now investigating the potential benefits of

γ-oryzanol in addiction to alcohol and nicotine, cognitive impairment and decreased physical activity, all of which are often associated with obesity and diabetes (Fig.2). A series of our research has recently been highlighted in Nature journal (30th of March, 2017, spotlight on food science in Japan) (Fig.3). Furthermore, our latest work demonstrating that γ-oryzanol ameliorates HFD-induced DNA hypermethylation of the promoter region of type 2 dopamine receptor (D2R) in the striatum of mice was selected for a cover story of Diabetologia, August issue of 2017. Our experimental paradigm highlights γ-oryzanol as a promising anti-obesity substance with the distinct property of being a novel epigenetic modulator, which does transform insatiable brain into satisfied brain (Fig.4).

A novel approach toward the reconstruction of healthy longevity in Okinawa via the cutting edge science of brain and molecular nutrition

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The Graduate School of Health Sciences, comprising the areas of Human Health Promotion, and International and Island Health, is conducting research into human health and longevity in Okinawa Prefecture, the physical, psychosocial, and cultural factors that influence health, the development of health resources and advanced healthcare technology, and island health in the Asia-Pacific region. The results obtained from research relating to the subtropical physical environment are helping the promotion of health services in Asia-Pacific and Africa and the development of medical staff in remote areas. We are currently focusing on promoting the exchange of human resources with institutions in the Asia-Pacific region. A memorandum of understanding was signed with the University of the Philippines, Chiang Mai University in Thailand, and the University of Health Sciences in Lao PDR to start collaboration efforts and develop closer partnerships. We are also inviting graduate students from these universities to participate in a

special program for government-sponsored foreign students and to join collaborative global health studies. The mission of the Graduate School of Health Sciences is to develop talented human resources for global health, acting as researchers and leaders in universities, core hospitals, and international organizations such as the Japan International Cooperation Agency (JICA) and World Health Organization (WHO).

The international academic exchange with the Asia - Pacific region

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Figures University of the Ryukyus Hospital is pushing ahead with research on regenerative medicine as the only university hospital in Okinawa Prefecture. Towards achieving the practical application of regenerative medicine using Adipose Derived Stem Cells (ADSCs), we launched our Cell Processing Center (CPC) in March 2015. This paved the way for implementing regenerative medicine in which adipose tissue is harvested from a patient, ADSCs are extracted and cultured on a large scale at CPC, and then transplanted back into the patient. In March 2016, we performed the first successful case of ADSCs transplantation to a patient, who was suffering from malar deformity after an operation for maxillary sinus carcinoma. In performing regenerative therapy in which cultured ADSCs were used to correct facial deformity for the first time in Japan, our team made a substantial contribution to the development of regenerative medicine. By conducting groundbreaking research and developing leading-edge technology for regenerative medicine, we are establishing University of the Ryukyus Hospital as a leader in advanced medical technology, both at home and abroad. The

mission of our regenerative medicine initiative is to bring a bright future to many patients suffering from intractable diseases.

Aiming to be at the forefront of regenerative medicine

FIMACC (Functional Imaging and Communication Center) has been in operation as PET (Positron Emission Tomography) scan section since March 2013, and is adjacent to University of the Ryukyus Hospital, where we conduct FDG-PET scan. PET with FDG (fluorodeoxyglucose) provides valuable functional information based on the increase glucose uptake and glycolysis of cancer cells. It is a valuable tool for staging and restaging of various cancers without little side effect. As a characteristic of our section, we are actively conducting FDG-PET for urological tumor that is often difficult to evaluate. Many patients are referred for FDG-PET scan, the radiologists can read images and prepare reports promptly. In addition, we can conduct FDG-PET scan for evaluation of cardiac sarcoidosis. And also we would like to provide PET examination as a medical checkup.

About FIMACC

Academic staff in the Faculty

University Hospital

School / Graduate School Department

Medicine 42 courses

Health Sciences 6 courses (18 fields)

Professors Associate Professors Lecturers Assistant

Professors Total

The School

Students School Number Total

Medicine 722

57 42 40 166

972Health Sciences 250

Graduate SchoolNumber Total

Course

MedicineMaster’s 15

249

305

Doctoral 180

Health Sciences

Master’s 27

Doctoral 27

Advanced Treatment Hospital (Cancer, AIDS, Liver diseases, Specific infectious diseases, and Tuberculosis)

Number of beds (including beds for patients with tuberculosis) 600

87.7%

203

1,172.9

13,096

7,648

Average bed occupancy rate (2016)

Number of doctors (as of May 1, 2017)

Number of outpatients per day (2016)

Number of operations per year (2016)

Number of anesthesia per year (2016)

(as of May 1, 2017)

(as of May 1, 2017)(as of May 1, 2017)

Faculty of medicine and university hospital are scheduled to move to a new campus in West Futenma, Ginowan City in 2024. To establish a leading position in Asia-Pacific region, we are focusing on following actions; (1) Amelioration in

state-of-the-art medical care and research activity, (2) Support for promoting the standard of medical care in communities, (3) Activate international research cooperation, and (4) Enhance the educational level of medical care staff and students.

Okinawa Health Sentinel Sites

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Campus Map

Bicycle and MotorcycleParking PlaceBicycle and MotorcycleParking Place

Charnel House

Disabled Parking PlaceDisabled Parking Place

Regenerative Medicine Research CenterRegenerative Medicine Research Center

Basic MedicineBasic Medicine

Institute for Animal Research/Radioisotope CenterInstitute for Animal Research/Radioisotope Center

Emergency UnitEmergency Unit

Central Facilities/Electricity UnitCentral Facilities/Electricity Unit

Comprehensive HealthProfessions Education CenterComprehensive HealthProfessions Education Center

58 330

34

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NahaAirport

NahaBus

Terminal PrefecturalGovernment

Haebaru

Torihori Shuri Sta.

NishiharaGateway

IshimineGateway

Naha IC

Asato

Tomari PortFurujima

Gibo

Aja

Uehara

Senbaru CampusUehara Campus

Okinawa Expressway

Ojana

NorthGate

Yonabaru

Naha-City

Urasoe-City

Ginowan-City Nakagusuku-Village

Nishihara-Town

Universityof the Ryukyus

Faculty ofMedicine・University

Hospital

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Wide area guide map

Miyako Island

Kume Island

Ishigaki Island

Iriomote Island Tropical Biosphere Research Center

University of the Ryukyus(Iriomote Station)

OKINAWAJAPAN

Okinawa Island

Senbaru CampusUehara Campus

Yona Field

Oku Mountain cottage

Tropical Biosphere Research CenterUniversity of the Ryukyus

(Sesoko Station)

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Faculty of Medicine and University Hospital

Faculty of Medicine and University Hospital