In an effort to contribute to the understanding of acupuncture therapy, using the serum cortisol level as an index we examined the responses of the dog's body to acupoint stimulation through intermittent measurement of changes in serum cortisol levels.
The experimental animals used were 5 adult beagles bred in similar environements. The areas of needle stimulation-ST-36, BL-23, throat point and various non-acupoint areas on the thigh were selected and experiments conducted 5 times at each point. The dogs were secured in place and after needle insertion, 30 minutes of electrical stimulation at 30Hz, double electrode pulse wave at 5Vp-p was administered. Blood was withdrawn before electrical stimulation, directly after stimulation, 1 hour after, 2 hours after and at 2 hour intervals for 8 hours. Also in a similar manner blood was withdrawn from those simply secured in place. The serum cortisol levels were measured through radioimmunoassay methods revealing the following results.
1) The serum cortisol levels increased most directly following electrical current and then dropped quickly and returned to original levels 2 hours after stimulation. After this there were slight variations however no remarkable changes from pre-treatment levels were observed.
2) The serum cortisol levels increased most with stimulation at the throat point followed by ST-36, the non-acupoint area, secured in place, and BL-23 in that order.
3) From the period directly after stimulation to 1 hour after, the levels after throat point stimulation showed tendencies to increase in comparison with secured in place, the non-acupoint area and BL-23 stimulation.
4) Stimulation at BL-23, opposite to that at all other points, resulted immediately following electrical current in levels lower than secured in place.
As explained above in this experiment the changes in the serum cortisol levels differed depending on the point of stimulation, however in every case the changes were temporary and recovery quick.

It is known that lactic anions and hydrogen ions (H⁺) produced during intense exercise are partly transported or diffused from muscle to blood resulting in the production of non-metabolic CO₂ through the bicarbonate buffering system. The purpose of the present study was to examine the reliability of the estimation of non-metabolic CO₂ output using respiratory gas analysis during incremental exercise. Six healthy subjects underwent an incremental pedaling exercise test accompanied by respiratory gas and arterial blood sampling. The rate of non-metabolic CO₂ output (VCO₂-NM) was calculated by subtracting projected metabolic VCO₂ from actual VCO₂ after CO₂ threshold (CT) . CT was determined using a modified V-Slope method. Bicarbonate (HCO₃^-), pH, CO₂ partial pressure and lactate concentration were measured from arterial blood samples using automatic analyzers. The kinetics of VCO₂-NM and HCO₂^- were compared throughout the exercise test. VCO₂-NM was significantly correlated with HCO₃^-decrease after CT (r=0.976, p<0.001) and the kinetics of VCO₂-NM and HCO₃^- decrease were similar during exercise. Furthermore, the amount of non-metabolic CO₂ output (NM-CO₂) calculated integrating VCO₂-NM above CT was significantly correlated with the difference in HCO₃^-between CT and exhaustion (r=0.929, p<0.01) and with the difference in arterial blood pH between rest and exhaustion (r=0.863, p<0.05) . However, NM-CO₂ was not significantly related to maximum ventilation (r=0.111, ns) . These results suggest that the estimation of non-metabolic CO₂ output during incremental exercise proposed in the present study is reliable. It was also suggested that the primary factor which influenced nonmetabolic CO₂ output during incremental exercise was the addition of H⁺ into blood and not hyperventilation.

Objectives
The study aims to clarify the difficulties of pregnancy, delivery, and child raising for immigrant women in Japan and their strategies for overcoming them.
Methods
The semi-structured interviews were conducted with 18 immigrant women who have experience of delivery or child raising in Japan. The participants were asked about their experiences and difficulties faced during pregnancy, delivery, and child raising, and how they overcame them. The data were analyzed in a qualitative and descriptive manner.
Results
Seven core categories of difficulties were extracted:«anxiety about child raising»,«problems with relationships with others»,«socio-economic problems»,«anxiety about pregnancy, delivery, and diseases»,«problems caused by illiteracy»,«lack of understanding about Japanese health system»,«choice of the delivery country». Women's«making efforts to manage»is supported by family members and it leads to«use of the Japanese health system». Getting support from friends and neighbors, and the use of an interpreter also leads to this. Some women try to overcome the difficulties by«using a non- Japanese health system»or«doing nothing».
Conclusions
When foreigners access health services, not only literacy but also health literacy, such as understanding medical terms or health systems are necessary. Many immigrant women got support from family and friends to overcome the difficulties. However, some women could not get such support and it is necessary for them to make a support network. Foreign women who take negative strategies and use non-Japanese health systems may be in the process of adjusting to Japanese society. Health providers should not deny such strategies, but understand them as a way of decreasing anxiety.

BACKGROUND : Because of its high incidence, sensitivity to specific antibiotics, and rare but severe complications, campylobacter enteritis needs to be confirmed or excluded accurately and rapidly. We investigated the validity of Gram staining of a stool sample as a quick and useful method of diagnosing campylobacter enteritis in patients with acute diarrhea presenting at primary healthcare centers.
MATERIALS AND METHODS : Stool samples obtained from 64 patients with acute diarrhea were sent to a laboratory for Gram staining and culture. To estimate the usefulness of Gram staining, we calculated the sensitivity, specificity and likelihood ratio (LR) of Gram staining. Subject profiles, symptoms and peripheral white cell counts were also examined to see if they could raise the pre-test probability prior to the Gram staining test.
RESULTS : Of 64 subjects with acute diarrhea, 38 had C. jejuni (n=37) or C. coli (n=1) (campylobacter group), and 26 had other causes (control group). Gram staining revealed campylobacter-like bacteria (Cb-like bacteria) in 22 samples from the campylobacter group and 3 from the control group, yielding a sensitivity and specificity of 0.58 and 0.88, respectively. The positive LR was 5.02 (95%CI : 1.67-15.05), and the negative LR was 0.48 (0.32-0.71). Other factors such as patient age, disease duration, fever, abdominal pain and leucocytosis failed to raise the pre-test probability prior to Gram staining test. Taking a thorough history of food intake can raise the pre-test probability, although this may be difficult and was not evaluated in this study.
CONCLUSION : Gram staining can assist in making the diagnosis of campylobacter enteritis in patients with acute diarrhea, but it cannot be used alone to make or exclude the diagnosis.

BACKGROUND: Hyperkalemia is one of the more serious complications of chronic kidney disease (CKD), and the cause of potassium retention is a reduction in urinary potassium excretion. However, few studies have examined the extent of the decrease of urinary potassium excretion in detail with respect to decreased renal function. METHODS: Nine hundred eighty-nine patients with CKD (CKD stages G1 and G2 combined: 135; G3a: 107; G3b: 170; G4: 289; and G5: 288) were evaluated retrospectively. Values for urinary potassium excretion were compared between CKD stages, and the associations between urinary potassium excretion and clinical parameters, including diabetes mellitus status and use of renin-angiotensin-aldosterone system inhibitors, were analyzed using a multivariable linear regression analysis. RESULTS: Urinary potassium excretion gradually decreased with worsening of CKD (G5: 24.8 ± 0.8 mEq/d, P < 0.001 vs. earlier CKD stages). In contrast, the value of fractional excretion of potassium at CKD G5 was significantly higher than that at the other stages (30.63 ± 0.93%, P < 0.001). Multivariable linear regression analysis revealed that urinary potassium excretion was independently associated with urinary sodium excretion (standardized coefficient, 0.499), the estimated glomerular filtration rate (0.281), and serum chloride concentration (-0.086). CONCLUSION: This study demonstrated that urinary potassium excretion decreased with reductions in renal function. Furthermore, urinary potassium excretion was mainly affected by urinary sodium excretion and estimated glomerular filtration rate in patients with CKD, whereas the presence of diabetes mellitus and use of renin-angiotensin-aldosterone system inhibitors were not associated with urinary potassium excretion in this study.
Diabetes Mellitus ; Glomerular Filtration Rate ; Humans ; Hyperkalemia ; Linear Models ; Potassium* ; Renal Insufficiency, Chronic* ; Renin-Angiotensin System ; Retrospective Studies ; Sodium

BACKGROUND: Mizoribine (MZR) is an immunosuppressive drug used in Japan for treating patients with lupus nephritis and nephrotic syndrome and has been also reportedly effective in patients with immunoglobulin A (IgA) nephropathy. However, to date, few randomized control studies of MZR are performed in patients with IgA nephropathy. Therefore, this prospective, open-label, randomized, controlled trial aimed to investigate the efficacy and safety of adding MZR to standard treatment in these patients, and was conducted between April 1, 2009, and March 31, 2016, as a multicenter study. METHODS: Patients were randomly assigned (1:1) to receiving standard treatment plus MZR (MZR group) or standard treatment (control group). MZR was administered orally at a dose of 150 mg once daily for 12 months. RESULTS: Primary outcomes were the percentage reduction in urinary protein excretion from baseline and the rate of patients with hematuria disappearance 36 months after study initiation. Secondary outcomes were the rate of patients with proteinuria disappearance, clinical remission rate, absolute changes in estimated glomerular filtration rate from baseline, and the change in daily dose of prednisolone. Forty-two patients were randomly assigned to MZR (n = 21) and control groups (n = 21). Nine patients in MZR group and 15 patients in the control group completed the study. No significant differences were observed between the two groups with respect to primary and secondary outcomes. CONCLUSION: The addition of MZR to standard treatment has no beneficial effect on reducing urinary protein excretion and hematuria when treating patients with IgA nephropathy.
Glomerular Filtration Rate ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Immunoglobulins* ; Japan ; Lupus Nephritis ; Nephrotic Syndrome ; Prednisolone ; Prospective Studies ; Proteinuria

A 57-year-old man, who had suffered chest, back and right leg pain about 10 years before, underwent CT and was found a chronic type B aortic dissection with an enlarged false lumen and a narrowed true lumen that was occluded at the infrarenal abdominal aorta. A conventional surgical repair seemed to be too high risk considering his comorbidities, thus we chose a staged hybrid repair. First, surgical repair of the abdominal aorta with an abdominal aortic fenestration was performed. Then, one month after the first operation, zone 2 thoracic endovascular aortic repair with left carotid-axillary artery bypass was performed. At the second operation, the stent graft was purposely deployed from zone 2 into Th12 level of a false lumen through the fenestration followed by coil embolization of a true lumen just distal to the entry tear. The postoperative course was uneventful and he had no complications at 6 months follow-up. Deploying stent graft into a false lumen could be a feasible option in case deploying into a true lumen is not suitable if the anatomical condition permits.

Kawasaki disease (KD) is an acute febrile vasculitis predominately affecting infants and children. The dominant incidence age of KD is from 6 months to 5 years of age, and the incidence is unusual in those younger than 6 months and older than 5 years of age. We tried to identify genetic variants specifically associated with KD in patients younger than 6 months or older than 5 years of age. We performed an age-stratified genome-wide association study using the Illumina HumanOmni1-Quad BeadChip data (296 cases vs. 1,000 controls) and a replication study (1,360 cases vs. 3,553 controls) in the Korean population. Among 26 candidate single nucleotide polymorphisms (SNPs) tested in replication study, only a rare nonsynonymous SNP (rs4365796: c.1106C>T, p.Thr369Met) in the lymphoid enhancer binding factor 1 (LEF1) gene was very significantly associated with KD in patients younger than 6 months of age (odds ratio [OR], 3.07; p(combined) = 1.10 × 10⁻⁵), whereas no association of the same SNP was observed in any other age group of KD patients. The same SNP (rs4365796) in the LEF1 gene showed the same direction of risk effect in Japanese KD patients younger than 6 months of age, although the effect was not statistically significant (OR, 1.42; p = 0.397). This result indicates that the LEF1 gene may play an important role as a susceptibility gene specifically affecting KD patients younger than 6 months of age.
Asian Continental Ancestry Group ; Child ; Genome-Wide Association Study ; Humans ; Incidence ; Infant ; Lymphoid Enhancer-Binding Factor 1 ; Mucocutaneous Lymph Node Syndrome* ; Polymorphism, Single Nucleotide ; Vasculitis