Renal plasma flow (RPF) and glomerular filtration rate (GFR) are decreased in patients with heat stroke. Heat stroke after prolonged exercise under high temperatures is usually associated with hypotension and dehydration, leading to decreased RPF. However, whether renal blood flow (RBF), RPF, and GFR are increased or decreased during immersion in mild warm water remains unknown.
Para-aminohippurate clearance (C_PAH), sodium thiosulfate clearance (C_thio), and creatinine clearance (C_cr) were determined in 14 healthy men aged 19 to 27 years old (mean±SD, 22±2), 161 to 181cm (171.5±6.3) tall, and weighing 52 to 78kg (64.2±7.4) without immersion at about 25°C (room temperature) and during immersion in water at 41±0.5°C.
C_PAH, C_thio, and RBF significantly increased during immersion compared with those without immersion (P<0.0001, P<0.03, P<0.0001, respectively). C_cr did not change (P=0.108). The filtration fraction (FF) was significantly decreased (P<0.001). Levels of plasma atrial natriuretic peptide, aldosterone, anti-diuretic hormone and renin did not significantly differ between these two conditions.
This investigation suggests that daily immersion at 41°C is beneficial for renal function.

Objective: Distigmine can cause cholinergic crisis as the side effect.  In 2010, the safety information of distigmine was announced and its dosage was changed up to 5 mg per day.  However, the malpractice that a pharmacist dispensed over dose of distigmine caused severe health damages in a community pharmacy.  Therefore, we made the protocol with the urologists for the appropriate use of distigmine, including contents of monitoring the side effects.  The purpose of this study was to measure using the protocol was useful for the propulsion of proper use of distigmine.
Methods: The protocol was introduced in 10 community pharmacies and 1 hospital pharmacy from December 2013 to April 2014, and the patients and pharmacists were filled out the answer to the questions that we have made.  The protocol consisted of five main checks; the dosage, lower urinary tract symptom, presence of renal disease, combined drugs, and signs of the side effects.  Each patient was filled out the checklist given by the pharmacist to monitor the signs of the side effects for 2 weeks.
Results: The 3 prescriptions of distigmine (18.8%) were more than 10 mg per day.  Although 2 patients were confirmed diarrhea and sweating etc., they were mild.  The pharmacists significantly more (p<0.05) answered that the protocol made their motivation to do the pharmaceutical interventions.  All of the patients answered that the pharmaceutical interventions made them relieved.
Conclusion: The use of protocol that we made supported pharmacists to do the pharmaceutical interventions and patients welcome them.

Objective: Adequate periconceptional intake of folic acid decreases the risk of neural tube defects.  The present study aimed to investigate pharmacists’ awareness of the importance of folic acid intake for the prevention of neural tube defects and to identify factors associated with pharmacists’ awareness.
Design: Questionnaire survey.
Methods: A self-administered questionnaire regarding the importance of folic acid intake for the prevention of neural tube defects was distributed to pharmacists who attended educational seminars offered by the Sendai City Pharmaceutical Association in December 2010.
Results: Among the 166 respondents, 104 (62.7%) pharmacists were aware that folic acid intake decreases neural tube defects.  After stratification for age and sex including history of delivery, female gender and history of delivery were significantly associated with the awareness of the importance of folic acid intake only among pharmacists younger than 40 years old. Of 104 pharmacists who recognized the importance of folic acid intake for the prevention of neural tube defects, 51.0% and 27.9% recognized that women should begin intake of folic acid before conception and should take about 400 μg of folic acid per day during pregnancy, respectively.
Conclusion: Although about 60% of pharmacists recognized that folic acid intake decreases the risk of neural tube defects, many did not know the intake level required to effectively prevent neural tube defects.  Therefore, more aggressive promotion of the awareness of the importance of folic acid intake among pharmacists is warranted.

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients’ busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as costeffectiveness and insurance coverage still persist.

Previous studies have reported that poor posture can induce various musculoskeletal disorders. Recently, poor posture in children has become a problem. This study aimed to determine the characteristics of sagittal spinal alignment in standing and sitting positions in elementary school students and how spinal alignment changes from standing to sitting position. Moreover, it clarifies how poor posture (hyperkyphosis) in the standing position affects sitting posture. This study was conducted among 83 elementary school students. The Spinal-Mouse® System was used to measure the thoracic kyphosis angle (TKA), upper thoracic angle (UTA), lower thoracic angle (LTA), lumbar lordosis angle (LLA), and sacral anteversion angle (SAA) in the standing and sitting positions. Hyperkyphosis was defined as a thoracic kyphosis angle of >40°. Participants were assigned to two groups: hyperkyphosis and non-hyperkyphosis. Significant differences were noted in all spinal alignment characteristics in both the positions. When spinal alignment was changed from standing to sitting, ΔUTA and ΔLTA correlated with ΔLLA and ΔSAA, respectively. A strong negative correlation was noted between ΔLLA and ΔSAA. In the sitting position, TKA, UTA, and LLA were significantly higher in the hyperkyphosis group than in the non-hyperkyphosis group. ΔUTA was significantly higher in the hyperkyphosis group than in the non-hyperkyphosis group when spinal alignment was changed from standing to sitting. The characteristics of sagittal spinal alignment in the sitting position were significantly different from those in the standing position. The study findings suggest that poor posture (hyperkyphosis) in the standing position affects the sitting posture.

Poor posture (thoracic hyperkyphosis) in children is reportedly caused by changes in their living environment. A previous study (conducted 30 years ago) reported that the position of the center of pressure (COP) in a child with an upright posture was approximately 40% from the heel. The present study aimed to determine the position and characteristics of the COP while standing in children aged 6–12 years. This study enrolled 83 elementary school students. A Win-Pod (Medicapteurs) platform was used to measure the COP. The COP position was expressed as a percentage from the heel as a relative ratio with a foot length of 100%. Spinal Mouse® was used to measure thoracic kyphosis, lumbar lordosis, sacral anteversion, and trunk inclination angles in the standing position. The COP position was 30.3±8.9% from the heel. We found positive correlations between the COP position, height, and weight. Further, the COP position was significantly more anterior in 28 upper elementary grade children (35.1 ± 9.2%) than in 25 middle (29.5 ± 8.6%) and 30 lower grade children (26.5 ± 6.7%). Regarding sex differences, the COP position was significantly more anterior in 46 boys (32.3 ± 9.8%) than in 37 girls (27.9 ± 6.9%). There was a weak positive correlation between the COP position and trunk inclination angle (r=0.251, p<0.05). Thus, we found that the COP position in modern children aged 6–12 years while standing was 30.3 ± 8.9% from the heel, indicating a shift toward the heel (backward) compared to that reported in previous studies.

Recently, poor posture (hyperkyphosis) has become a problem among children. This study investigated the effectiveness of an intervention (a spine mat) by measuring spinal alignment before and after the intervention in elementary school students. The study included 83 elementary school students. For the intervention, each participant was placed in a supine position on a bed and a spine mat was inserted ensuring that it adhered to the thoracic spine. The primary outcome variables included the thoracic kyphosis angle (TKA), upper thoracic angle, lower thoracic angle, lumbar lordosis angle (LLA), and sacral anteversion angle (SAA) measured in the standing and sitting positions using Spinal Mouse® before and after the intervention. Based on this evaluation, we assigned the participants to two groups: hyperkyphosis (n=25) and non-hyperkyphosis (n=58). Significant differences were observed between the pre-test and post-test TKA in the hyperkyphosis group in the standing position (pre-test: 45.3±4.5° and post-test: 40.8±9.0°, P<0.05). In the non-hyperkyphosis group, significant differences were observed between the pre-test and post-test LLA and SAA in the standing position. However, no significant difference was observed between the pre-test and post-test spinal alignment in the sitting position in both groups. The results of this study indicated that using a spine mat in elementary school children resulted in decreased TKA in the standing position only in the hyperkyphosis group, which exhibited a TKA of 40° or more after the intervention.