Introduction: Tetanus is a highly fatal infection that causes tonic convulsions. Although magnesium sulfate may be effective as a treatment option for myopathic symptoms, there is little knowledge regarding its use. Therefore, this study assessed the use of magnesium sulfate for patients with tetanus requiring critical care management.Methods: Using multiple mailing lists of registered physicians in Japan, a questionnaire survey was conducted on the conditions during which magnesium sulfate was used for patients with tetanus requiring critical care management. An internet questionnaire form service was utilized.Results: The number of targets in this study was 24,266 and responses were received from 604 physicians, 252 of whom treated patients with tetanus requiring critical care management. In total, 126 of the above physicians used magnesium sulfate for tetanus.Conclusion: Magnesium sulfate was used for a substantial number of patients with tetanus requiring critical care management. To establish the utility of magnesium sulfate as a tetanus treatment option, further evidence is required.

We treated five patients with palpitation at rest due to imbalance of Ki-distribution, a concept of traditional Chinese medicine in which there is abnormal upward flowing of “Ki, ” who showed rapid improvement after Shakuyaku was excluded from their original regimen or after initiation of treatment with Shakuyaku-free regimens. All these patients shared in common two findings before the initiation of the Shakuyaku-free treatment: first, the absence of strain of the rectus abdominas muscle in the whole abdomen between the hypochondrium and the upper margin of the pubic bones, and secondly, the presence of abdominal pulsation diagnosed as pericardiac, infra-umbilical or sub-umbilical pulsation. We also treated patients who developed palpitation at rest only after Shakuyaku-free regimens were replaced with regimens including Shakuyaku. These findings suggest that there may be many patients in whom Shakuyaku-free regimens may improve palpitation when they have an imbalance of Ki-distribution as an underlying condition.

A 40-year-old woman visited our emergency room (ER) with fever and shaking chills. Blood cultures for suspicion of urinary tract infection revealed bacteremia two days later. Since Streptococcus mitis was detected, infective endocarditis was strongly suspected. In addition to her history of dental calculus removal, careful cardiac auscultation revealed a continuous murmur, leading to the existence of patent ductus arteriosus (PDA). PDA was confirmed by echocardiography and 3D-CT angiography. The patient was successfully treated by antibiotics and then received transcatheter PDA closure. Careful auscultation after detection of bacteremia led to a diagnosis of PDA.

Background: The relationships between the postpartum subacute ruminal acidosis (SARA) occurrence and predicted bacterial functions during the periparturient period are still not clear in Holstein cows. Objectives: The present study was performed to investigate the alterations of rumen fermentation, bacterial community structure, and predicted bacterial functional pathways in Holstein cows. Methods: Holstein cows were divided into the SARA (n = 6) or non-SARA (n = 4) groups, depending on whether they developed SARA during the first 2 weeks after parturition.Reticulo-ruminal pH was measured continuously during the study period. Reticulo-ruminal fluid samples were collected 3 weeks prepartum, and 2 and 6 weeks postpartum, and blood samples were collected 3 weeks before, 0, 2, 4 and 6 weeks postpartum. Results: The postpartum decline in 7-day mean reticulo-ruminal pH was more severe and longer-lasting in the SARA group compared with the non-SARA group. Changes in predicted functional pathways were identified in the SARA group. A significant upregulation of pathway “PWY-6383” associated with Mycobacteriaceae species was identified at 3 weeks after parturition in the SARA group. Significantly identified pathways involved in denitrification (DENITRIFICATION-PWY and PWY-7084), detoxification of reactive oxygen and nitrogen species (PWY1G-0), and starch degradation (PWY-622) in the SARA group were downregulated. Conclusions The postpartum SARA occurrence is likely related to the predicted functions of rumen bacterial community rather than the alterations of rumen fermentation or fluid bacterial community structure. Therefore, our result suggests the underlying mechanisms, namely functional adaptation of bacterial community, causing postpartum SARA in Holstein cows during the periparturient period.