Thigh muscle cross-sectional area (CSA) and maximum voluntary isometric strength of knee extensor and flexor muscles were measured in 97 men (2065 years) and 162 women (2069 years) in sedentary Japanese adults. Each subject was assigned to one of five age groups (3^rd 4^th 5^th 6^th and 7^th decade) . Thigh muscle CSA was estimated by our developmental measuring system using an ultrasonographic device, which was connected to a PC for graphical processing. Muscle CSA for the 7^th decade in men was significantly smaller than that for the 3^rd decade. For women, muscle CSA were no significant from the 3^rd to the 7^th decade. The isometric knee extensor strength showed a significant decline with age from the 7^th decade in men, whereas there was no significant change with age in women. Isometric strength of knee flexors in men showed a gradual decline from the 5_th decade. The aging-associated reduction of muscle strength per muscle CSA in the extensors and flexors started from the 6_th decade in men. It was concluded that the size and strength of the thigh muscles begin to decrease simultaneously by approximately the 6_th decade in men, whereas there are no change until the 7^th decade in women.

In step with the widespread use of antimicrobial agents in medical treatment, microbial substitution and emergence of new drug-resistant bacteria have become life-threatening problem today. Both have resulted from the postopreative practice of administering prophylactic medication and long-term, desultory drug administration. Drug-resistant microbes can occur easily with the inadequate use of drug. Therefore, our hospital has held in check the incidence of drug-resistant microbial infection by letting ICT members make the rounds of the wards and go over the notifications of the prescription of specific antimicrobial agents and the reports on drug-resistant bacteria. At the begiing, the notification and the report were filed separately. Recently, the information obtained from thses two channels has become easier of access because all the necessary data appear on the same screen at once by using patients' IDs. We believe that the streamlining of work and putting two kinds of data together have proved very usefull for infection control, as it has become possible to keep careful watch over the use of specific antimicrobial agents and the detection of drug-resistant microorganism simulataneously. By sharing the information obtained by us with all the rest on the hospital staff, we will continue to make efforts along this line and contribute toward the prevention of the outbreak of nosocomial infections as well as community-acquired ones.
Microorganism ; Pharmaceutical Preparations ; Medical Surveillance ; microbial ; Bacterial

Recently, a long-term health concern has been identified in young Japanese women. These women have a high percentage of body fat despite a normal shape index indicator such as BMI. This condition is called marked obesity, and shows relative low lean body mass. Using an analogous determination, we investigated low percentage of muscle quantity (LM) in the extremities of young Japanese women (n=156) . The cross-sectional areas of muscle, subcutaneous fat, and bone were measured in the upper arm and thigh using ultrasonography. Extremity shape index (CSA_t/L) was defined as the total extremity cross-sectional area (CSA_t) divided by the length of the limb (L), Percent muscle in each extremity (% MA) was calculated from the ratio of muscle CSA to whole limb CSA. LM was defined as the percentage of muscle in the upper arm or thigh less than 1 SD below average and the limb shape index less than 1 SD above average. Nine of 91 subjects displayed LM for the upper arm. A similar proportion of subjects showed LM for the thigh (15/156) . The muscle mass and strength in the upper arm or thigh were compared between the subjects with LM and non-LM subjects with a similar shape index of extremity. There was a tendency towards lower muscle mass and muscle strength in the subjects with LM. From the same comparison, the subjects with LM showed a greater load on extremity muscles to sustain the body weight (i.e., body weight per unit of upper arm or thigh muscle CSA) . To mitigate the deleterious health consequences of low percent muscle quantity it is recommended that young Japanese women who display such a condition should participate in a resistance-training program.

Kyukichoketsuin is commonly used for ki-deficiency and ketsu-deficiency, especially postpartum physical and mental complaints. However it does not contain ninjin and ogi, which are actually known to be major crude drugs for ki-deficiency. The 16th century Manbyokaishun gives many ways of treatment, some including the use of ninjin and ogi with kyukichoketsuin.
We report 2 cases treated with kyukichoketsuin and hokizai. The first case was a 33-year-old woman who had dyspnea with exertion and general malaise undergoing treatment for amenorrhea. The second case was a 39-year-old woman who had fatigue, irregular menstruation and headache after childbirth. We treated the first with kyukichoketsuin and hochuekkito extract, and the second with kyukichoketsuin and rikkunshito extract. In both cases, the symptoms improved remarkably over a few weeks with kyuchichoketsuin and hokizai. Thus, this combination therapy may have efficacy for gynecological symptoms with remarkable signs of ki-deficiency.

Objective: In drug treatment for pregnant and lactating women, pharmacists need to contribute to adequate drug treatment by collecting much information from various sources.  However, it takes much time to collect information using plural sources.  In this study, we tried to develop a database system which enables expeditiously collecting the domestic and foreign drug use criteria information in order to streamline collecting information for pregnant and lactating women.  In addition, we assessed the utility of the database by comparing the time to collect information using the database to that using each information source and the usability by questionnaires.
Methods: We developed a database system that integrates drug information from the FDA Pregnancy Category, Australian categories for prescribing medicines in pregnancy, “Drugs in Pregnancy & Lactation,” and Japanese package inserts.  For assessment of the usability of the database, we assessed the time required to collect information and subjective evaluation using the five-method questionnaires.
Results: The database significantly reduced the time needed for collecting criteria information and made it possible to compile the information simultaneously from various sources.  The questionnaire survey showed that over 80% of pharmacists and students were satisfied with the database.
Conclusion: It is suggested that our database system is useful to efficiently collect drug use criteria information for pregnant and lactating women.

Extracorporeal shock wave lithotripsy (ESWL) represents the preferred treatment for most upper ureteric and renal calculi. Complication rates associated with ESWL are low, justifying the enthusiasm and acceptance of this treatment modality. We report a case of abdominal aortic pseudoaneurysm due to ESWL. A 47-year-old man had undergone ESWL treatment for ureteric calculi since 1990. He was admitted to our hospital because of lumbar pain. Physical examination revealed a pulsatile mass in his abdomen. Abdominal CT scan showed an abdominal aortic aneurysm (5.3cm in diameter). Angiography showed a fusiform aneurysm of the infrarenal abdominal aorta. Y-graft replacement was performed after aneurysm resection. Histological examination revealed that it was a pseudoaneurysm. The patient had no history of trauma, inflammation or operation except ESWL. This is the first report of abdominal aortic pseudoaneurysm due to ESWL.

A 53-year-old woman underwent mitral valve replacement for congestive heart failure due to mitral stenosis and regurgitation. She had been receiving hemodialysis because of diabetic nephropathy since 1993, and had had congestive heart failure since 1999. Echocardiography demonstrated mitral stenosis (MVA; 1.10cm²) and regurgitation with a severely calcified mitral annulus. Annular calcification extended to the posterior wall of the left ventricle and the base of bilateral papillary muscles. After removing all calcium from the mitral annulus to the base of the papillary muscle, the left ventricular posterior wall and mitral annulus were reconstructed by glutaraldehyde-preserved autologous pericardium. Then, a Carbo-Medics mechanical valve was placed at the mitral annulus using everting mattress sutures. Although her hemodynamics were stable, bacteremia and multi-organ failure developed 3 months after surgery and she died. Autopsy showed that the reconstructed left ventricular posterior wall and mitral annulus using glutaraldehyde preserved autologous pericardium were in excellent condition without any thrombus. No dehiscence was found at the suture line of the mechanical valve. Mitral annulus reconstruction with glutaraldehyde preserved autologous pericardium is thought to be effective for patients with calcified mitral annulus who require mitral valve surgery.

We report two cases effectively treated with Kampo medicines for comorbid sleep disorder in developmental disorder. Case 1 was a 15-year-old woman diagnosed Asperger's syndrome, and her main complaints were difficulty in rising, difficulty in falling asleep and fatigability. We thought that the symptoms might be caused by in and ketsu deficiency, which lost control of kanki hyperactivity and evoked tension/excitement state easily. The difficulty in rising was improved with yokukansan and kambakutaisoto and she was able to go to school every day. Case 2 was a 17-year-old man diagnosed the attention-deficit/hyperactivity disorder. His symptoms were difficulty in rising, feeling of weariness, fatigability, and frequent tension/excitement state. The previous use of shokenchuto had improved the symptoms slightly. After shigyakusan was added to cure kanki dysregulation, he succeeded in going to school every day. In the oriental medicine, ketsu has important roles in mental stability and sleep, whereas qi and ketsu tend to be insufficient in childhood. Our results suggest that replacement of in and ketsu would be useful in treating comorbidities in developmental disorder.

Objective: Combination therapy with glecaprevir and pibrentasvir (G/P) has been shown to provide a sustained virologic response (SVR) rate of >97% in patients with chronic hepatitis C virus (HCV) infection in the first published real-world Japanese data. However, a recently published study showed that the treatment was often discontinued in patients ≥75 years old, resulting in low SVR in intention-to-treat (ITT) analysis. Thus, our aim was to evaluate real-world data for G/P therapy in patients ≥75 years of age, the population density of which is high in “rural” regions.Patients and Methods: We conducted a multicenter study to assess the efficacy and safety of G/P therapy for chronic HCV infection, in the North Kanto area in Japan.Results: Of the 308 patients enrolled, 294 (95.5%) completed the treatment according to the protocol. In ITT and per-protocol analyses, the overall SVR12 rate was 97.1% and 99.7%, respectively. The old-aged patients group consisted of 59 participants, 56 of whom (94.9%) completed the scheduled protocol. Although old-aged patients tended to have non-SVR factors such as liver cirrhosis, history of HCC, and prior DAA therapies, the SVR12 rates in old-aged patients were 98.3% and 100% in the ITT and PP analyses, respectively. Of 308 patients enrolled, adverse events were observed in 74 patients (24.0%), with grade ≥3 events in 8 patients (2.6%). There was no significant difference in any grade and grade ≥3 adverse events between the old-aged group and the rest of the study participants. Only one patient discontinued the treatment because of adverse events.Conclusion: G/P therapy is effective and safe for old-aged patients.