The present study was conducted to investigate the effect of acid-base disturbance on blood lactate concentration (bLA) and OBLA (Onset of Blood Lactate Accumulation) during an incremental bicycle test.
Nine healthy male subjects underwent the incremental test at 60 min after the oral administration of NH₄Cl (acidotic-treatment ; Acid), NaHCO₃ (alkalotic-treatment ; Alk) and NaCI (control ; Cont) at 1.87 mM⋅kg^-1body weight. Exercise was started at a load of 80W, which was subsequently increased by 10W every minute until exhaustion. During exercise, O²intake (VO²), ventilatory volume (VE) and heart rate (HR) were monitored continuously. Venous blood samples were obtained before administration and every 2 min during exercise.
No change could be detected in resting VO₂, VE and HR following oral administration of NH₄Cl, NaHCO₃and/or NaCl. At 60 min after oral administration venous blood pH (_vpH) and bicarbonate ion concentration (_v [HCO₃^-] ) were significantly lower in Acid (7.265±0.033; p <0.001, 23.6±1.8 mM⋅1^-1; p<0.01) ; and significantly higher in Alk (7.370±0.045 ; p<0.01, 29.7±1.6 mM⋅1^-1; p<0.01) compared to Cont (7.318±0.041, 26.6±2.1 mM⋅1^-1) . Changes in VO₂, VE and HR during exercise were essentially the same in all cases. No differences were observed in exercise time. During exercise, vpH and_v [HCO₃^-] gradually decreased, but remained significantly lower in Acid and higher in Alk compared to Cont. Blood lactate concentration (bLA) increased during exercise. Peak values were observed at exhaustion, but it was lower in Acid (8.03±1.18mM⋅1^-1) and higher in Alk (10.73±1.48) compared to Cont (9.49±1.79) in all subjects. The Onset of Blood Lactate Accumulation (OBLA) was determined for each subject. OBLA was significantly higher in Acid (71.9±9.1%VO₂max) than Cont (62.5±9.9%VO₂max) and Alk (62.2±8.0%VO₂max) .
Changes in acid-base balance were found to cause differences in bLA responses to the same exercise load and possibly change OBLA. Care must be taken when using OBLA or LT as an index of aerobic capacity in some patients with acid-bace disorders; hemodialitic, obese or diabetic patient.

The tongue possesses a complex muscular structure, and its motor functions are also intricate. Therefore, it would be beneficial to use a computational physiological model of the tongue to examine its vital functions in normal and pathological conditions. Thus far, the studies of tongue models have focused on symmetric movements for normal speech. For clinical purposes, it is necessary to develop a physiological model to deal with daily vital activities such as mastication and swallowing. To do so, we constructed a full 3D physiological model of the tongue based on MRI data from a normal subject, and verified the basic functions of the model based on anatomic and physiological knowledge. In this study, the model was applied to clinical issues: prediction and verification of the changes in movements of the tongue with a tumor before and after partial glossectomy, respectively. Tongue protrusion and lateral bending motion were examined for the prediction and verification. The simulation results were consistent with the observations for a patient with a tumor in the tongue. Comparisons of the simulation and observation in the clinical case showed that the model could predict potential effects of the glossectomy on the tongue movements. It is suggested that the model is a useful tool for pre-operative planning of glossectomy.

We examined the relationship between serum magnesium (sMg) change and urinary Mg (uMg) excretion, lipid metabolism and hormonal responses induced by prolonged physical exercise. Six recreational runners voluntary participated in the study, and their sMg, uMg, serum lipid and circulatory levels of plasma hormones (ACTH, cortisol, ADH, aldosterone) were determined during a 1-week recovery period after a full-marathon race. Immediately after the race, fall of sMg was significant, but recovered to the pre-race level in the next day. Urinary Mg excretion decreased significantly after the race and the tubular reabsorption rate (%TRMg) was elevated for one week. The negative correlation between sMg and %TRMg suggested that a decreased level of sMg enhanced tubular reabsorption of Mg. On the other hand, no correlation was observed between the plasma hormone levels and %TRMg, thus hormonal responses induced by prolonged exercise had less effect on the tubular reabsorption of Mg. Therefore, fall of sMg after the full marathon race may not be a reflection of Mg depletion, but seems to be the result of a Mg shift to other regions (muscle, erythrocytes and adipose cells) from the serum. Increased level of serum FFA after the race suggested enhanced lipolysis, which might be a cause of sMg reduction.

In Japan, there are insufficient measures to ensure that women can maintain good health while working. In addition, many women have limited health literacy, making it difficult for them to access information on physical and mental health problems that are specific to them. In this context, it is essential for pharmacists to become the first point of contact for women seeking information about their physical health, as they are familiar with healthcare providers in the community. To address this issue, we organized a Women's Health Care Cafe for pharmacy students to provide them with an opportunity to learn about women's health.

This study aimed to explore participant experiences and perspectives of a multidisciplinary conference held after a cancer patient's death in the home setting under planning by the regional palliative care team. The multidisciplinary conferences studied were held in the community following the deaths of three cancer patients who were cared for at home or in nursing homes and supported by a regional palliative care team. We surveyed a total of 56 participants across the three conferences using a questionnaire comprising demographical questions and free description. We asked for impressions of the conference and perspectives regarding palliative care. The survey drew 48 effective responses (response rate, 87.5%). Content analysis of the participants' descriptions extracted the following issues with the multidisciplinary conferences, categorized under either as availability or problems: “mutual understanding through dialogue between multidisciplinary members”, “awareness leading to future practice”, “learning about palliative care”, and “barrier to dialogue between multidisciplinary members”. Highlighted problems surrounding the practice of palliative care with multi-institutional and multidisciplinary members were “conditions for practice in palliative care and care for dying patients” and “multi-institutional and multidisciplinary coordination”. The results indicated that multidisciplinary conferences held with the regional palliative care specialists following a cancer patient's death might be useful to facilitate multidisciplinary coordination and lead to better practice in palliative care in the community.

  Generic drugs have received much attention especially from an economic point of view.  In Japan, the form of medical prescriptions has been revised twice in recent two years to disseminate generic drugs in recent two years.  The pharmacists are irresistibly required the detail knowledge of various generic drugs.  However, sufficient information on generic drugs has not always been provided in comparison with the original drugs.  This study intends to reveal such problems with the generic drugs.  Glibenclamide and gliclazide were selected as the model drugs for this study because these two drugs are often taken together with supplements.  Two approaches were used to compare the original drug and the corresponding generic drugs.  The first approach concerns the amount of information as well as the quality of the information that is provided from manufacturers.  The second approach concerns the physicochemical properties, dissolution test and hardness test.  Regarding the pharmacokinetic information in the package insert of glibenclamide, six generic drugs among eleven samples provided sufficient information while four samples seemed insufficient.  As for gliclazide, three samples among eight did not provide AUC and the time dependence of the blood concentration curve.  The results of the dissolution test revealed that all generic drugs satisfied most of the equivalence to the original drug except for one generic glibenclamide.  On the other hand, different behaviors in the swelling property and the time required to completely disperse were observed.  Two samples for glibenclamide and four samples for gliclazide required a fairly long time to completely disperse.  Irregular and significant variations were observed in the hardness test.  The difference in the dissolution process and hardness test suggested the different drug formulations among manufacturers.

Fulminant myocarditis is known as a disastrous disease that requires intensive care with mechanical cardiopulmonary support. Percutaneous cardiopulmonary bypass (PCPS), which is referred to as extracorporeal membrane oxygenation, is usually used for fulminant myocarditis. However, in some cases, PCPS may be ineffective because of circulatory insufficiency and could be associated with various severe complications such as multiple organ failure or leg ischemia. In such cases, placement of a ventricular assist device (VAD) is required. A 46-year-old man with fever and severe fatigue was admitted to a local hospital and diagnosed as having fulminant myocarditis. Although an intra-aortic balloon pump and PCPS were introduced, cardiac function was not recovered, causing multiple organ failure and leg ischemia. Hence, he was transferred to our hospital for further mechanical support. Transesophageal echocardiography (TEE) revealed severe biventricular cardiac dysfunction, and radiography showed pulmonary edema. His total bilirubin level was 6.9 mg/dl and platelet level was 3,300/μl. Thus, we implanted a biventricular assist device (BiVAD). At 12 days after the implantation, TEE revealed improvement of cardiac function, and blood biochemical examination revealed recovery of multiple organ function. Thereafter, the patient was weaned from the BiVAD successfully. After the operation, the patient underwent a long rehabilitation. He was discharged 51 days after the operation, without any neurological or cardiac complication.

  This research was carried out to review the current state of thinga involving trainees (students and business workers) accepted by Anjo-Kosei Hospital and to clarify the role the Education Center in our hospital is expected to play in supporting trainees. The subjects were medical and non-medical students and business workers who signedup for our internship program and junior and senior high school students who paticipated in the hands-on training program at Anjo-Kosei Hospital between April 2006 and March 2009. A total of about 1,300 students and business workers had experienced the actual hands-on work each year. The number of medical students accepted was 289, 289, and 339 in 2006, 2007, and 2008, respectively. Besides, the number of non-medical students also increased from 847 to 1,045 in the period of three years. The business workers accepted came from 15 different types of occupation. It was found that junior and senior high school students were interested in the nursing-care field and this seemed to help them consider seriously their life as students and members of society, leading to the increased number of students who joined our program. In addition, unfortunately, two-fifths of the program were unfavorable for trainees because of poor management. The present research suggested that the Education Center take on a signification role in managing the internship and the hands-on training programs to accelerate the potential of students and business workers.

To clarify the relationship between the perceptual diagnoses of hypernasality and its physical correlates, we conducted three experiments using the Japanese vowel /i/. We performed a spectral analysis of hypernasality on five cleft palate patients and six velum resection patients to investigate the spectral features related to hypernasality (experiment 1). Psychoacoustic experiments were conducted using various spectrally modified vowels to investigate the relationships between the spectral features and auditory perceptions of hypernasality (experiment 2). We analyzed the estimated spectral envelopes using an articulatory speech synthesis model to clarify the relationship between the spectral features and the velopharyngeal opening (experiment 3). Experiments 1 and 2 suggested four spectral features as the characteristics of hypernasality: (1) broadening of the F1 bandwidth, (2) an additional peak at around 1 kHz [P1], (3)^* a decrease in the magnitude of F2, and (4)^* a dip between F2 and F3 [D2]. In particular, the simultaneous modification of the decrease in the magnitudes of F2 and D2 is a very important cue for the auditory perception of hypernasality. Experiment 3 showed that the dips caused by nasal coupling resulted in the spectral modifications. In addition, the dip regions appeared to spread from the low-frequency region (around F1) to the high-frequency region (above F2), as the velopharyngeal opening enlarged. This suggests that the decrease in the magnitude of F2 and the dip between F2 and F3 [D2] are related to excessive acoustic coupling of the nasal cavity.^* New findings.

To seek longitudinal changes in metacognitive processes through problem-based learning (PBL), we analysed the contents of all comments written reflectively by the third-year students after they finished discussions in each PBL session. After dividing their comments into meaningful units, we focused on two major thematic categories and five sub-categories to be analysed.
1) The number of units decreased significantly (chi-square: p=0.02).
2) Only the proportion of units categorised as “comprehension” in “individual learning” showed significant increase (Bonferroni: p<0.001).
3) Comments in this category stated that “I don't understand so-and-so.”
4) The increase of “comprehension” as they experienced more PBL suggested that students' knowledge of ignorance as metacognition was fostered through sessions in medical PBL.