We present a case of juvenile type dermatomyositis and severe retinopathy. A 10-year-old girl presented with progressive weakness of proximal muscles, generalized rash, including heliotrope-type eyelid erythema, and bilateral visual disturbance. Laboratory data showed a markedly elevated serum creatine kinase and electromyography revealed a myogenic pathology. Funduscopic examination showed numerous cotton wool spots and macular edema. She developed massive rhabdomyolysis, generalized skin lesions, systemic edema, renal failure, and respiratory failure. After she received steroid pulse therapy, plasma exchange, and high-dose immunoglobulin, her general condition and visual symptoms improved. She remained well when we followed up her condition 5 years after the discharge.

Compared with normal mice, the concentration of serum zinc in zinc-deficient mice was significantly increased after oral administration of 1ml of 1000ppm ZnSO₄ solution, while that of zinc-deficient mice treated with Kampo (Pogostemi Folium et Rhizoma, Perilla Herba, Saussureae Radix, Aurantii Nobilis Pericarpium, Anemarrhena Rhizoma, etc.) was not increased. The intestinal mucosa of zinc-deficient mice was also remarkably injured with administration of ZnSO₄ but the Kampo formula inhibited its injury.

The injury of intestinal mucosa of mice with zinc-deficiency was inhibited by the Chinese herbal medicine (_??__??_, _??__??_, _??__??_, _??__??_, _??__??_, _??__??__??_), while the concentration of serum zinc in zinc deficient mice was not increased after administrations of the Chinese herbal medicine.

The Chinese herbal medicine (_??__??_, _??__??_, _??__??_, _??__??_, _??__??_, _??__??__??_) suppressed the injury of intestinal mucosa in mice with excess zinc administrations. The increase of serum zinc concentration with excess zinc administrations was also inhibited by administrations of the Chinese herbal medicine.

We investigated the relationship between lifestyle and cognitive function in elderly subjects who had their checkups at a memory clinic. The 136 elderly study subjects included 51 with Alzheimer’s disease, 22 with vascular dementia, 23 with frontotemporal dementia, 25 with mild cognitive impairment, and 15 healthy control. The patients’ lifestyles were assessed using the Frenchay activities index (FAI), and their cognitive functions were assessed by neuropsychological tests, such as the mini-mental status examination and the frontal assessment battery (FAB). The FAI score was lower in the demented patients than in the control subjects. Strong correlations were observed between the FAI scores and the scores in the neuropsychological tests. The FAI scores did not correlate with the educational level or the duration of disease. The fi ndings from the stepwise regression analysis indicated that the FAB score, the number of family members, gender, and age were factors independently affecting the FAI score. The results indicated that the lifestyles of the elderly people might be affected by not only their age and family organization but also their cognitive function. We concluded that cognitive function could play a role in the lifestyle of elderly people.

The peak (dPower/dt), the maximum value of dPower/dt calculated by differentiation of ventricular power with respect to time, is verified from the physiological studies to be quite useful index indicating the ventricular contractility independent of the pre- and afterloads. However, the index has the disadvantage in the clinical application that it can not be measured by a non-invasive method. In the present study, peak (dPower/dt) could successfully be determined in a non-invasive manner as the product of aortic flow as measured with an ultrasonic pulsed Doppler flowmeter and brachial blood pressure as measured with cuff in the new apparatus. Involved in this study were 21 children, 52 adults with normal cardiac performance and 11 adult patients with coronary artery disease. The measurement of the index was successfully carried out in 28 of 61 adults and especially 16 of 21 children. The results of the study are summarized as follows:
1. Power waveform is similar to blood flow waveform and is little influenced by blood pressure waveform.
2, Peak (dPower/dt) can be determined as product of peak rate of change of aortic flow (peak (dF/dt) ) and mean brachial blood pressure without resorting to measurement of blood pressure waveform.
3. Peak (dPower/dt) was found significantly lower in cases having an ejection fraction less than 50% (93.5 J/sec²) than in those showing an ejection fraction of above 50% (145.3 J/sec²) (p<0.001) .
4. Peak (dPower/dt) normalized with body surface area was not significantly different from 8 years old children (80.2 J/sec²/m²) and 21-34 years old adults (88.0 J/sec²/m²) . According to this index, the cardiac contractility of 8 yearus old children seemed to reach the adult level.
From these findings it is concluded that the non-invasive method of determining a cardiologic parameter, peak (dPower/dt), as an index of cardiac contractility provides a means of salient clinical value.

Whole gland perfusion technique was applied to rat parotid glands to assess whether amylase affects fluid secretion. Control perfusion without any secretagogue evoked no spontaneous secretion. Carbachol (CCh 1 microM) induced both amylase and fluid secretion with distinctive kinetics. Fluid secretion occurred constantly around 60 microL/g-min, whereas amylase secretion exhibited an initial peak, followed by a rapid decrease to reach a plateau. Isoproterenol (Isop 1 microM) alone did not induce fluid secretion although it evoked amylase secretion as measured in isolated perfused acini. Addition of Isop during CCh stimulation evoked a rapid and large rise in amylase secretion accompanied by small increase in oxygen consumption. Morphological observations carried out by HR SEM and TEM revealed exocytotic profiles following Isop stimulation. CCh stimulation alone seldom showed exocytotic profiles, suggesting a low incidence of amylase secretion during copious fluid secretion. Combined stimulation of CCh and Isop induced both vacuolation and exocytosis along intercellular canaliculi. These findings suggest that control of salivary fluid secretion is independent of the amylase secretion system induced by CCh and/or Isop.
Amylases/metabolism* ; Animal ; Carbachol/pharmacology ; Cholinergic Agonists/pharmacology ; In Vitro ; Isoproterenol/pharmacology ; Male ; Microscopy, Electron ; Microscopy, Electron, Scanning ; Oxygen Consumption/physiology ; Oxygen Consumption/drug effects ; Parotid Gland/ultrastructure ; Parotid Gland/secretion* ; Parotid Gland/enzymology* ; Perfusion ; Rats ; Rats, Wistar ; Saliva/metabolism* ; Sympathomimetics/pharmacology

At present, lifestyle-related diseases are one of the most critical health issues worldwide. It has been reported that lipopolysaccharide derived from a Gram-negative bacteria (IP-PA1) symbiotic with wheat exhibited several advantageous biological effects, such as the reduction of plasma glucose levels in NOD mice and low-density lipoprotein (LDL) levels in WHHL rabbits. In this study, the beneficial effects on plasma glucose and lipids of a tea (SI tea) consisting of IP-PA1 and Salacia (which contains an inhibitor of alpha-glucosidase) were investigated in the KK-Ay/TaJcl type 2 diabetic model mice and in human subjects with premetabolic syndrome in a double-blind, randomized study. SI tea significantly decreased plasma glucose levels in KK-Ay/TaJcl mice. A clinical trial of SI tea was performed with 41 subjects between the ages of 40 and 69, who belonged either to a high plasma glucose group (HG: FPG 100-125 mg/dl) or to a hyperlipidemia group (HL: TG > or = 150 mg/dl, or LDL > or = 120 mg/dl, or HDL < 40 mg/dl). These subjects ingested either Salacia without IP-PA1 (the control) or SI tea. Blood samples were collected at 0, 30, and 60 days after initiating SI tea treatment, and were measured for FPG, HbA1c, TG, LDL, and HDL. These results showed that SI tea reduced FPG and HbA1c more rapidly than the control in the HL group, and also significantly improved LDL and HDL levels in the HG group. Thus, SI tea may be helpful in preventing lifestyle-related diseases.
Animals ; Cholesterol ; Fasting ; Glucose ; Gram-Negative Bacteria ; Humans ; Hyperlipidemias ; Lipoproteins ; Mice ; Mice, Inbred NOD ; Plasma ; Rabbits ; Salacia ; Tea ; Triticum

Medical students at Kurume University begin practical training in clinical skills in their fourth year. At that time, students use the skills laboratory to improve their clinical skills. Medical education resources in the skills laboratory include simulators for emergency resuscitation and heart diseases, wireless stethoscopes, and videotapes. All students use the skills laboratory for 2 months, and its usefulness was evaluated with questionnaires after practical training. More than 50 % of students approved of their practice in the skills laboratory. However, some students were unsatisfied because they were unable to make effective use of the simulators. In the future, an improved skills laboratory will be necessary to improve practical training in the clinical skills for medical students.

Background: and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. Methods: The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. Results: Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.