Objective: The water-soluble extract of Ganoderma lucidum mycelia (WER), which is used as a health food, reduced hyperglycemia and enhanced glucose transporter 4 (GLUT4) translocation to the plasma membrane in skeletal muscle and adipose tissue in KK-A^y mice, a type 2 diabetic animal model with obesity.In order to elucidate the reduction of hyperglycemia by WER, we investigated the translocation of glucose transporter 4, glucose uptake and associating signal transduction in rat skeletal muscle (L6) cells. Method: The glucose uptake was analyzed with radioactive 2-deoxy-D-glucose.The localization of GLUT4 in L6 cells treated with various concentrations of WER was analyzed with immunohistochemical staining and Western blot technique.As a positive control, insulin or troglitazone was used in these experiments.Furthermore, the activation of intracellular signaling pathways by Western blot analysis and the influence of glucose uptake using four kinds of inhibitors (LY294002 as potent PI3K inhibitor, rapamycin as mTOR inhibitor, Gö6983 as broad PKC inhibitor, compound C as AMPK inhibitor) was evaluated. Results: GLUT4 protein content in the plasma membrane was induced in a dose-dependent manner of WER without increasing the gene expression and amount of total protein in the L6 cells and the glucose uptake was augmented with increasing the amount of GLUT4 translocated on the plasma membrane.The phosphorylation of phosphatidylinositol-3 kinase (PI3K), Akt and acetyl CoA carboxylase (ACC) were induced in a concentration dependent manner and inhibited by the above inhibitors except rapamycin. Conclusion: These results indicate that the hypoglycemic effect of some material(s) in WER may be due to the enhancement of glucose uptake through GLUT4 translocation on the plasma membrane by activating the PI3K/Akt pathway through improving insulin resistance.

Background: Antithrombin III (AT III) deficiency is a rare disorder and thrombosis can be induced by a minor cause that does not normally lead to thrombosis, such as an external injury and surgery. Therefore, patients with AT III deficiency undergoing cardiac surgery that involves heparinization require careful perioperative management. Objective and Methods: From September 2013 through December 2023, we experienced 8 patients (1.92%) with AT III deficiency who underwent cardiac surgery and were managed with AT III replacement. By administration of AT III concentrate, preoperative AT III activity was maintained at ≥ 120% and postoperative AT III activity at ≥ 80%. Results: All five patients were treated successfully without postoperative complications such as hemorrhage or thrombosis. In a case of aortic valve stenosis in a hemodialysis patient, reoperation was performed 9 months after aortic valve replacement with a bioprosthetic valve. Pathological examination suggested that the deterioration was caused by a large amount of thrombus on the outflow side of the valve leaflet and not by iatrogenic calcification due to dialysis. Conclusions: In patients with AT III deficiency undergoing cardiac surgery, it is important to perform AT III replacement to achieve preoperative AT III activity ≥ 120% and postoperative AT III activity ≥ 80%, while the activated clotting time is maintained at > 400 s during cardiopulmonary bypass. In addition, long-term postoperative anticoagulant therapy is necessary in hereditary AT III deficiency patients with a history of thrombosis.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.