We present here an interesting case of anorexia nervosa that was well controlled by Ancyu-san, a traditional Japanese herbal medicine. A 17-year-old student was re-admitted to our department in December of 1990, because of anorexia and eating disorders. She had lost approximately 12kg body weight during 3 months. She was 154cm tall and weighed 26kg. Her blood pressure was 75/40mmHg, her pulse rate was 30beats/min, and her body temparature was 34.4°C. She was extremely emaciated and hyperactive. On oriental examination, a shallow complexion, a cold feeling in the limbs, postprandial headaches, and a feeling of obstruction of the external ear. Her pulse was slow and feeble. Abdominal examination revealed that the abdominal strength was reduced to 2/5 with Inai-teisui (abdominal water and gas retention). Based on these findings, this case was diagnosed as Deficient Spleen and Stomach due to Deficient Ki and Blood combined with Stagnated Ki, and therefore a candidate for the Kampo formula Ancyu-san. The patient began medication in January 1991. Her appetite improved gradually and her body weight increased from 26kg to 47kg in two months.

Background: The current study aimed to investigate factors associated with the prognosis of activities of daily living (ADL) in elderly patients with pneumonia who had undergone rehabilitation during their hospitalization.
Methods: The study included patients of age ≥65 years who were hospitalized due to pneumonia and had undergone rehabilitation for disuse syndrome at Tsukuba Memorial Hospital. The main outcome was measured using the functional independence measure (FIM) scores to assess ADL. The participants were divided into a high-recovery group (≥80%) and a low-recovery group (<80%) based on the FIM recovery rate score. Further, factors associated with the prognosis of ADL were evaluated using multivariate logistic regression analysis. Basic characteristics, consciousness, usual mode of transportation, FIM score, grip strength, range of motion, orthostatic hypotension, exercise tolerance (6-minutes walking distance), respiratory disorder (Hugh–Jones classification), constipation, malnutrition (mini-nutritional assessment), cognitive (mini-mental state examination), depression (geriatric depression scale), balance (functional balance scale), urinary incontinence, and pressure ulcers were included as the evaluation items.
Results: Among the 51 elderly patients with pneumonia (average age ± SD; 82.0 ± 11.3), 34 patients were classified in the high-recovery group and 17 in the low-recovery group. In multivariate logistic regression analysis, it was revealed that the number of days from the onset until the initiation of rehabilitation (days of inactivity) and nutritional status were factors associated with a high-recovery FIM score.
Conclusions: The study results suggest that days of inactivity and early management of nutritional status after hospitalization are important for elderly patients with pneumonia to return to their ADL.

The results of a trial treatment of primary biliary cirrhosis using combined Kampo and conventional drug therapy are reported.
A 79-year-old female with a chief complaint of pruritis was diagnosed as having primary biliary cirrhosis because of elevations in serum alkaline phosphatase, serum bilirubin, serum IgM, and positive tests for antimitochondrial antibodies and anti-M2.
In accordance with the Kampo diagnosis, she was first treated with Shinbu-to, which, however, did not cause any clinical alleviaton of the itching. Shishihakuhi-to was then given concomitantly, which resulted in the disappearance of the pruritis on the second day. Ursodeoxycholic acid was also added to her treatment from the 2nd month on. The serum level of bilirubin was observed to decrease gradually thereafter.
This case suggests that Kampo therapy, combined with the Western medical drug ursodeoxycholic acid, may be effective in the treatment of primary biliary cirrhosis.

Electromyographic muscle activities of the shoulder muscles during shoulder external rotation with reference to load magnitude were studied in 8 healthy male subjects without history of shoulder injuries. In addition, we discussed the relationship between rotator cuff muscles and superficial muscles. The subjects performed shoulder external rotation from 60°internal rotation to 45° external rotation at 20° of shoulder abduction and 20° of flexion. A Cybex dynamometer used to prescribe angle and velocity of the shoulder movement. At the same time, intramuscular wire electrodes were inserted into the supraspinous, infraspinous and teres minor muscles, and then surface electrodes were placed over the posterior deltoid and middle trapezius muscles. The load magnitude ranged 2-18 Nm and the angle velocity was set at 15 deg/sec. The rotator cuff muscles became significantly to be activated from 2 Nm (the supraspinous and infraspinous m.) and from 4-5 Nm (the teres minor m.) compared with the muscle activity during non-load. The superficial muscles became significantly to be activated from 4-7 Nm (the posterior deltoid m.) and from 3-6 Nm (the middle trapezius m.) compared with the muscle activity during non-load. Within the load range (18 Nm 46.8% MVC), %iEMG of the rotator cuff muscles was always larger than that of the superficial muscles. Therefore, we concluded that the contribution of the rotator cuff muscles was larger than that of the superficial muscles up to 3-4 Nm, and activities of the superficial muscles increased gradually from 3-4 Nm during shoulder external rotation.

A 46-year-old man who developed fever and general fatigue was referred to our hospital with suspicion of infective endocarditis. A ventricular septal defect had been previously diagnosed. Transthoracic echocardiography revealed vegetation on the aortic, mitral, and pulmonary valves, and each valve had significant regurgitation. An emergency operation was performed because of congestive heart failure. The aortic and mitral valves were replaced with mechanical valves. The pulmonary valve was repaired ; the anterior leaflet was resected and replaced by glutaraldehyde-treated autologous pericardium. The patient's postoperative course was uneventful. Recurrence of infection was not observed for 3 years after the operation. Triple-valve endocarditis, especially that involving a combination of the aortic, mitral, and pulmonary valves, is rare. Involvement of multiple valves on both sides of the heart may be attributed to a congenital intracardiac shunt. Early surgical intervention may be useful to control infection and heart failure, as in the present case.

A 22-year-old woman had been treated with a Ross operation for aortic root aneurysm and aortic regurgitation 10 years previously. In the initial Ross operation, a handmade tri-leaflet conduit was used for the right ventricle outflow tract (RVOT) reconstruction. The conduit was prepared preoperatively, by sewing a folded 0.1 mm expanded polytetrafluoroethylene (ePTFE) membrane onto the luminal cavity of the 24 mm woven double velour vascular graft, thereby creating a tri-leaflet valve. During ambulatory follow up after discharge, dilation of the pulmonary autograft had been observed, and its maximal diameter reached 60 mm. Furthermore, preoperative a pressure study revealed a 25 mmHg pressure gradient between the right ventricle and the pulmonary artery. At the time of reoperation, we performed an aortic root replacement combined with RVOT conduit replacement. A 24-mm woven double velour vascular graft integrating a 21-mm On-X mechanical prosthesis was used for aortic root replacement. A handmade ePTFE tri-leaflet conduit, 26 mm in size, was used to replace the previous RVOT conduit. The operation was successful, and the postoperative course was uneventful. The explanted conduit was sent for microscopic examination, which revealed that the graft was covered by a fibrocollagenous membrane. On the contrary, no surface membrane was found on the ePTFE valve. Moreover the microscopic examination showed cystic medionecrosis of the pulmonary autograft. Both dilatation of the pulmonary autograft and RVOT conduit failure were successfully treated at the second operation. However this young patient will require follow-up of the mechanical prosthesis and RVOT conduit for the rest of her life.

Guidelines recommend that clinical laboratories perform phenotypic tests (nitrocefin-based test and penicillin 10-U [P10] or 1-U [P1] zone edge tests) to detect penicillinase in Staphylococcus aureus isolates. This study aimed to assess the prevalence of blaZ encoding penicillinase and perform various phenotypic tests in S. aureus isolates from Japan. We prospectively collected 200 methicillin-susceptible S. aureus isolates from June 2015 to January 2016 and performed six phenotypic tests (nitrocefin-based test, P10 zone edge test/P10 diffusion test, penicillin 2-U [P2] zone edge test/P2 diffusion test, and cloverleaf test) on each sample. We confirmed the presence of blaZ (two blaZ-positive isolates) using PCR. Using blaZ PCR as a standard, we observed a low sensitivity (50%) and positive predictive value (PPV, 50%) of the nitrocefin-based test, low PPV (18.2%) of the P10 zone edge test, low sensitivity (50%) of the P10 diffusion test, low PPV (50% and 22.2%) of the P2 zone edge test and P2 diffusion test, respectively, and low sensitivity (50%) of the cloverleaf test. These data suggest a low performance (sensitivity and PPV) of these six phenotypic tests because of the low prevalence (1%) of blaZ in S. aureus isolates from Japan.
Diffusion ; Japan* ; Penicillinase* ; Penicillins ; Polymerase Chain Reaction ; Prevalence* ; Prospective Studies ; Staphylococcus aureus* ; Staphylococcus*

Objective: To measure muscle activity before and after robot-assisted gait training (RAGT) in patients with stroke and examine the differences in muscle activity changes compared with conventional gait training (CGT). Methods: Thirty patients with stroke (RAGT group, n=17; CGT group, n=13) participated in the study. All patients underwent RAGT using a footpad locomotion interface or CGT for 20 minutes for a total of 20 sessions. Outcome measures were lower-limb muscle activity and gait speed. Measurements were performed before the start of the intervention and after the end of the 4-week intervention. Results: The RAGT group showed increased muscle activity in the gastrocnemius, whereas the CGT group showed high muscle activity in the rectus femoris. In the terminal stance of the gait cycle, the gastrocnemius, the increase in muscle activity was significantly higher in the RAGT group than in the CGT group. Conclusion The results suggest that RAGT with end-effector type is more effective than CGT to increase the gastrocnemius muscle activity.

Purpose: This is the first report to compare 3-dimensional computed tomography (3D-CT) images between pediatric patients with enuresis and children without lower urinary tract symptoms who underwent pelvic CT for other reasons. Methods: Forty-seven children (33 boys and 14 girls) with primary enuresis underwent 3D-CT of sacrococcygeal bones. The control group consisted of 138 children (78 boys and 60 girls) who underwent pelvic CT for other reasons. First, we determined the presence or absence of unfused sacral arches at the L4-S3 levels in both cohorts. Subsequently, we compared the fusion of sacral arches in age- and sex-matched children from these 2 groups. Results: Dysplastic sacral arches, characterized by lack of fusion at 1 or more levels of the S1–3 arches, were observed in nearly all patients in the enuresis group. In the control group (n=138), 54 of 79 children over 10 years old (68%) exhibited fused sacral arches at 3 S1–3 levels. All 11 control children under 4 years old displayed at least 2 unfused sacral arches at the S1–3 levels. In a comparative study of age- and sex-matched patients with enuresis and control children aged 5 to 13 years (n=32 for each group, with 21 boys and 11 girls; mean age, 8.0±2.2 years [range, 5–13 years]), only 1 patient (3%) in the enuresis group exhibited fusion of all S1–3 arches. In contrast, 20 of 32 control group participants (63%) had 3 fused sacral arches (P<0.0001). Conclusions Sacral vertebral arches typically fuse by the age of 10 years. However, in this study, children with enuresis exhibited a significantly elevated prevalence of unfused sacral arches, suggesting that dysplastic development of sacral vertebral arches may play a pathological role in enuresis.

Objective: For effective use of over-the-counter (OTC) drugs that are provided as relief supplies during a disaster, we aimed to develop a list of OTC drugs that can be used during a disaster.
Methods: We obtained information about OTC drugs useful during a disaster by examining results of previous studies and lists of drugs used during a disaster.  We analyzed this information with the expert pharmacist of disaster support and established a rationale for our list and developed “the List of Useful OTC Drugs During a Disaster” and “the Information Card on Useful OTC Drugs During a Disaster.”
Results: We developed our list of OTC drugs based on the following parameters: (1) while people with severe disorders (e.g. renal failure) are treated by medical teams, those with minor physical conditions are treated using OTC drugs and (2) those OTC drugs that can be used as substitutes for prescription drugs were preferably selected.  The List of Useful OTC Drugs ()—During a Disaster (containing 56 items) was developed for use mainly by medical professionals.  Further, pharmacists from disaster-relief medical teams may not always be available in disaster-stricken areas; therefore, the Information Card on Useful OTC Drugs During a Disaster was developed to enable disaster victims to independently make a certain level of decision.  The information card contained pictograms to call the attention of the disaster victims.
Conclusion: Our results can provide a common tool for drug suppliers, medical professionals engaging in relief works in disaster-stricken areas, and disaster victims.