Although glycyrrhizin (SNMC), and ursodeoxycholic acid (UDCA), alone or in combination have been administered in patients with active HCV-associated chronic hepatitis (HCV-CH) or liver cirrhosis (HCV-LC), there are many patients who do not respond well to these anti-inflammatory treatments. In this study, we examined retrospectively the possibility for juzentaihoto to alleviate inflammation in such patients. We calculated average ALT levels every 6 months for all 67 patients. If we assume an improvement in average serum ALT levels of more than 25% after juzentaihoto administration to be significantly effective, as compared with average ALT levels before juzentaihoto administration, 23 out of 40 patients (57.5%) showed significant improvement within one year. In the 32 patients with HCV-associated liver disease who were treated with combination SNMC and UDCA therapy, and whose average ALT levels did not decline to less than 80 IU/L, 18 (56.3%) showed significant improvement when juzentaihoto was added. Juzentaihoto was effective in 62.5% of patients with CH, and 54.2% of those with LC. Moreover, juzentaihoto was effective in 41.2% of male, and 69.6% of female patients. And in about 40% of patients, average ALT levels lowered increasingly over time, out to 2 years. Juzentaihoto may be an effective anti-inflammatory agent for intractable cases of active HCV-CH, or HCV-LC.

In the farm household of “vegetable planting by plastic green house”, “mandarin orange”, “rush (igusa)”, “dairy-farming” and “silk worm”, measurement of energy expenditure in agricultural work and analysis of daily working hours were conducted at the busy season of each crops. The results are as follows:
The energy consumption per day are estimated respectively to be 3300 Cal for male and 2900 Cal for female in the household of the “plastic green house”; 3500 and 2500 Cal in the “mandarin orange”, 3800 and 3600 Cal in the “rush”, 3300 and 2700 Cal in the “dairy-farming”, 3400 and 2700 Cal in the “silk worm”.
The agricultural machines and tools are mainly operated by male and so attached muscular works not yet machanized are carried by female. And management of animals or crops specially required prudent care have a tendency to be also carried by female. Then the average relative metabolic rate (RMR) a working day is relatively higher in female than male, except “mandarin orange”.
In the “rush harvesting” and “dairy-farming”, having the most development of the agricultural mechanization it seems obviousely to be rising the labor efficiency, but because of expansion of management scale and decreasing number of employee the reduction of work load for a worker is not necessory obvious.

Mass health survey was conducted to discuss the relationship between obesity and some factors of agricultural managements and living and working conditions among 349 pairs of housewives and their husbands selected from the rural communities in Kumamoto prefecture.
The prevalence rates of obesity (20% over of the Minowa's standard weights) were 13.1% for housewives of farmers, 13.7% for their husbands and 15.6 % for housewives of non-farmers, 9.2% for their husbands. The significant correlationship was found in the degree of obesity by Minowa's standard between housewives and their husbands (r= 0.1566, P<0.05).
Being compared the prevalence of obesity according with the kinds of each household's producting crops, peoples of the household of “shiitake: cortinellus shiitake”, “vegetables by plastic greenhouse”, “tabacco” and “animal husbandary ” were more likely to be obese and, inversely, those of “barley”, “vegetables in upland” and “sericulture” were less, than those of “rice”, “mandarin orange” and “forestry”. In the household of “vegetables by plastic greenhouse”, “rice”, “barley”, “mandarin orange” and “vegetables in upland” husbands were more obese than housewives and, inversely, in the household of “shiitake” and “forestry” housewives were more obese than husbands.
Peoples of fishing households were less likely to be obese than those of the farm households and/or other profession. Among the households of non-farmers it was noteworthy that higher prevalence rates of obesity were found in housewives than husbands, being inverse finding in the farmers case.
The results suggested that the agricultural management and it's labor conditions, as well as the level of agricultural economics, might strongly affect the occurrence of obesity in the Japanese rural community.

A 19-year-old girl was admitted to our hospital with nausea, vomiting, hiccups, constipation and syncope. After hiccups or vomiting sinus arrest developed and lasted more than 5-8 seconds. She lost consciousness every one hour. Based on an electrocardiographic diagnosis of sick sinus syndrome (SSS), a temporary pacemaker was implanted. The next day, although her syncope and bradycardia disappeared, she had orthostatic tachycardia of over 120 beats/minute and swelling of the legs, which led to a diagnosis of postural orthostatic tachycardia syndrome (POTS). Neurologically, she showed the right-sided tongue deviation and parasympathetic system disorders revealed by coefficient of variation of R-R interval (CV_R-R), the Achner eye-ball pressure test, the valsalva ratio, and the head-up-tilt test. Brain MRI disclosed a small hyperintense lesion on a T2-weighted image with gadolinium enhancement in the right dorsal medulla including the hypoglottis nucleus and the posterior nucleus of vagus. After steroid pulse therapy (methyl prednisolone 1 g/day×3 days, 5 times) was administered, this lesion became smaller and finally disappeared. Before the lesion disappeared, she was able to begin rehabilitation by wearing elastic stockings and treatment with midodrine hydrochloride. The following year, she developed other MRI-proven brain lesions, suggestive of demyelination. Such a spinal and temporal distribution of lesions led to a diagnosis of multiple sclerosis (MS). A case of POTS caused by MS has not been reported previously, however, MS often affects the medullary paraventricular regions associated with autonomic failures. Autonomic failures often prevent patients from experiencing early rehabilitations. We should promptly give symptomatic treatment against autonomic failures, which leads to good patient recovery not only in patient vitality but also functionality.

Objective: A hospital Formulary (HF) is useful not only for providing a list of formulary drugs, but also for drug safety management and clinical practice in hospitals.  Our Pharmacy Division serves as a clinical training facility for the Faculty of Medicine and offers a bedside learning (BSL) program that allows students to participate in medical services.  Providing medical students with a requisite understanding of pharmacotherapy in order to effectively provide medical services is the goal of the core curriculum of medical education and HF use in BSL may be effective in achieving this goal.  We conducted a survey in order to examine the usefulness of an HF for medical students during clinical training and to determine what drug information is required by students.
Methods: Between April 2012 and March 2013, a questionnaire survey was conducted on 88 fifth-year medical students    who participated in a 1-day BSL program using an HF.
Results: The response rate was 100%.  All students responded that they understood how to use the HF and believed it was useful in BSL.  However, the level of satisfaction with the explanatory notes was significantly lower than that of other sections providing clinically useful additional information such as monographs or supplementary tables (p<0.05).  More than 80% of the students considered monographs to be useful for obtaining information on side effects, warnings and contraindications, dosage and administration, indications, dosing in renal impairment, and drug name.  Students generally considered supplementary tables useful for obtaining information on serious side effects and their early identification, points of drug use in renal dysfunction, appropriate drug use in cancer chemotherapy, insulin and diabetes treatment, calculations of pediatric dosing, and a list of clinically used abbreviations.
Conclusion: These results suggest that medical students believe an HF is useful in BSL.  When medical students participate in pharmacotherapy during BSL programs outside the Pharmacy Division, an HF that not only lists drugs but also contains supplementary tables of clinically useful information may be required.

Very-late-onset schizophrenia-like psychosis (VLOSLP) is a condition in which psychotic symptoms emerge after the age of 60 years. Given its heterogeneous nature, VLOSLP remains a diagnostic and therapeutic dilemma. Here, we report a case of a 68-year-old patient with psychosis refractory to antipsychotics who was successfully treated with mirtazapine monotherapy. This case suggests that mirtazapine monotherapy may be effective for the treatment of patients with antipsychotic-refractory VLOSLP.

The usefulness of individual care of patients in the attitude education of undergraduates was evaluated with questionnaires completed by 4th-year medical students and patients. Ninety-eight percent of students finished performing patient care during a 2-week period. Seventy percent of patients completed questionnaires. The appearance, manner of greeting, and language of the students were considered good by 87% or more of the patients, and the students' consideration for the patients' safety, privacy, and communication was considered good by 86% or more of the patients. The practice was approved by 77% of the patients and was objected to by none. Ninety-nine percent of students completed questionnaires, and 79% of the respondents approved of the practice. Fourteen percent of the student respondents, many of whom had been treated as outpatients, objected to the practice. These results suggest that individual care of patients by medical students is useful for both patients and students.

Ulcerative colitis (UC) is one of the major clinical phenotypes of inflammatory bowel diseases. Although 5-aminosalicylic acid (5-ASA) is widely used for UC and its efficacy and safety have been demonstrated, a few patients paradoxically develop a severe exacerbation of colitis by 5-ASA administration. It is crucial to know clinical features including endoscopic findings in this condition for making a correct diagnosis and a prompt decision to withdraw the medication. Here, we report case series with UC exacerbated by 5-ASA. Medical records of 8 UC patients experiencing an exacerbation of colitis after induction of 5-ASA that was improved by the withdrawal of 5-ASA but also re-aggravated by dose increase or re-administration of 5-ASA were reviewed. The patients were newly diagnosed with UC, started 5-ASA and developed an exacerbation in approximately 2 to 3 weeks. They did not appear to have systemic allergic reactions. Seven of the 8 patients had a high fever. Three of 5 patients who undertook total colonoscopy showed right-side-dominant colitis. These findings suggest clinical characteristics in this condition. Further assessment of clinical and endoscopic features in more cases is necessary for establishing diagnostic criteria and understanding underlying mechanisms in those cases where 5-ASA aggravates the colitis.
Colitis* ; Colitis, Ulcerative* ; Colonoscopy ; Diagnosis ; Fever ; Humans ; Hypersensitivity ; Inflammatory Bowel Diseases ; Medical Records ; Mesalamine* ; Phenotype ; Ulcer*