We studied the effects of bathing in warm water on cerebral blood flow (CBF). Seven healthy male volunteers were subjected to experiments. The subjects were bathed in warm water at 39°C for 20 minutes in a sitting position immersed up to the neck. Each subject received two CBF examinations: one under normal conditions and the other after taking a bath mentioned above. There was an interval of at least seven days between the two examinations. To measure CBF, we used the Patlak plot method with technetium-99m ethyl cysteinate dimer (99m-Tc ECD). To examine CBF after bathing, 99m-Tc ECD was injected within 10 minutes after bathing. Brain perfusion index (BPI) and regional CBF (rCBF) were used as indexes for evaluating CBF. The body temperature, pulse, blood pressure, arterial oxygen and carbon dioxide pressure, and hematocrit were also measured. Wilcoxon's signed rank test was used for statistical analyses. The following were observed:
1) BPI increased significantly after bathing (p<0.05).
2) rCBF in the cerebral cortex, particularly in the frontal lobe, tended to increase after bathing (p<0.05). No definite changes were observed in the cerebellar cortex, caudate nucleus, or thalamus.
3) The body temperature and pulse increased significantly after bathing. No definite changes were observed in blood pressure, arterial oxygen and carbon dioxide pressure, or hematocrit. From the above, we conclude that bathing in warm water causes the cerebral blood flow to increase in healthy subjects.

The present study was carried out to elucidete whether the accumulation of triglyceride (TG) in rat liver during fasting was stimulated by swimming. Male Wistar rats were divided into three groups; C: control, 24 F: 24 hour-fasted and 48 F: 48 hour-fasted. These animals were required to swim for 120 min.
In rats with both 24F and 48F, the liver glycogen contents did not change during swimming. The level of TG in rat liver was higher in 24 F and 48 F rats than the control group, and the exercise significantly affected the liver TG in each group. There was significant correlation betweem the level of TG in rat liver and the plasma free fatty acid (FFA) concentration (r=0.681, p<0.01) . However, although plasma TG did not change during exercise in each group, the TG secretion rate (TGSR) of the 48 F group was significantly lower than that of the C and 24F groups (p<0.01) .
These results provide evidence that exercise may result in the accumulation of TG in liver during fasting and suggest that the process not only depends on the surplus supply of FFA, but also inhibits very low density lipoprotein-TG secretion from liver.

Previous studies of the effect of exercise on glucose metabolism in diabetes mellitus have focused on the stimulation of glucose disposal capacity by insulin and muscle contraction. We have investigated the effects of hyperglycemia on the increase in muscle glycogen after exercise and the role of physiological saline (saline) injection under hyperglycemic conditions. Male Wistar rats weighing 100-150g (n=52) were made diabetic (DM) by injection of 90 mg/kg streptozotocin (STZ) . Glycogen content was reduced by in situ electrical stimulation of the sciatic nerve. Immediately after stimulation, the rats were injected with glucose or saline. After a 20 min recovery period, the glycogen content of the white and red gastrocnemius (WG, RG), soleus (SOL), plantaris (PL), extensor digitorum longus (EDL) and tibialis anterior (TA) was significantly increased by glucose injection in the control rats. In DM rats, the glycogen content of the TA and EDL was increased, whereas there was no change in the WG, RG, SOL and PL. These results suggest that, in hyperglycemic rats, muscle glycogen resynthesis in only fast-twitch fibers is increased by muscle contraction. However, after injection of saline, the plasma osmolality decreases significantly and glycogen resynthesis by all muscles except the SOL in diabetic rats is improved, although there is no significant increase in control rats. It is concluded that glycogenolysis and resynthesis after muscle contraction are reduced by hyperglycemia. The data suggest a possible role of saline injection in the development of glycogen resynthesis in hyperglycemia.

Integration of instruction and more well-rounded curriculum are needed owing to the increasing specialization of nursing education.
In this study we evaluated the teaching of clinical neurology in nursing education from various viewpoints.
1) The clinical neurology curriculum at the Tokyo Women's Medical College School of Nursing for the past 20 years and the results of examinations given at the school.
2) The frequency of test questions on basic and clinical neurology in the past 15 years on the national nursing license examination.
3) Questionnaires on the teaching of clinical neurology filled out by student nurses. Conclusions:
Most nursing students consider the neuroanatomy and pathophysiology of neurologic disorders to be extremely important subjects, while others feel that clinical neurology is difficult to understand.
In the future, the number of elderly persons will increase more rapidly, and highly specialized neurologic teaching will be required in nursing schools.

I took a summer course at the School of Nursing of the University of Delaware in the United States. The 4-week neurology and neurosurgery course had been organized by a clinical nurse specialist. The curriculum was extremely effective because one clinical topic was taught for a certain period of time. This system has been judged to be useful for teaching clinical nursing. A similar program might also be useful for nursing schools in Japan.

A 31-year-old healthy mother of twins developed Guillain-Barré syndrome in her fourth gestational week of pregnancy. Impaired motor coordination, sensation, and joint position sense were observed. Immunoglobulin therapy was not performed given the early stage of pregnancy. She received rehabilitation to accommodate changes in her body shape and movements necessary for pregnancy, childbirth, and childcare. The patient delivered a healthy baby by cesarean section. By 42 weeks postpartum, she was capable of almost all housework activities and childcare. Family support was important in this case. Patient-oriented intervention, which included periodic confirmation and establishment of goals in each phase and continuity of intervention, was also essential.

　　We have been working to improve nursing care for patients who are receiving chemotherapy by understanding the feelings of nurses who work in the chemotherapy outpatient unit. Previous efforts to understand the feeling of nurses involved with cancer chemotherapy revealed that they felt anxious about whether their care of chemotherapy patients was sufficient. To clarify their level of anxiety and difficulties faced, structured group interview analysis was conducted in the present study. Based on our findings, a number of nurses reported anxiety and psychological burden, which were classified into four categories: “Unclear how to interact with patients and their families”, “Mental burden of nurses”, “Anxiety handling anti-cancer agents”, and “Problems with human relations”. In particular, nurses were psychologically burdened by feeling unable to provide individual nursing care to patients and their families. The findings suggest that nurses should acquire professional expertise related not only to chemotherapy nursing itself but also to palliative care. A multipronged approach based on interprofessional collaboration is also needed to satisfy the individual requirements of patients who are receiving chemotherapy and their families.

Aim:Shakuyakukanzoto is a Japanese herbal medicine that is known to be useful for the treatment of urinary stone pain. In this study, we investigated the effects of shakuyakukanzoto for acute renal colic.Methods:Twenty-five patients were enrolled in this study. Eleven patients took 5.0 g of shakuyakukanzoto powder, and 14 control patients took non-steroidal anti-inflammatory drugs (NSAIDs) for their acute renal colic. The effects were evaluated before and 15, 30, and 60 minutes after treatment with a numerical rating scale (NRS). We defined scale point zero as not having pain, and scale point ten as having the strongest pain.Results:Mean NRS scores improved from 6.7 ± 2.3 to 3.4 ± 3.5 after 15 minutes (shakuyakukanzoto group), and from 8.3 ± 1.8 to 7.0 ± 1.9 after 15 minutes (control group). NRS scores were improved immediately and significantly in both groups. The NRS score of shakuyakukanzoto group was significantly lower than that of control group at the any time after treatment. No side effects were observed in this study.Conclusion : Shakuyakukanzoto has an immediate effect, and it is more effective than NSAIDs. Shakuyakukanzoto was a useful treatment for acute renal colic.

A 40-year-old man was admitted because of prolonged fever after extraction of teeth. Infective endocarditis, congestive heart failure and hepatorenal failure were diagnosed in a series of examinations. Electrocardiograms showed complete atrio-ventricular block and QT prolongation. After continuous hemodiafiltration (CHDF) and high doses of antimicrobials promptly initiated for the treatment of multiple organ failure, the aortic valve with regurgitation and vegetation was replaced with an artificial valve. Serious arrhythmias occurred after the operation, which disappeared by the administration of antiarrhythmic agents. In cases of infective endocarditis with multiple organ failure, preoperative intensive treatment such as CHDF in combination with high doses of antimicrobials and surgical intervention represent a good strategy for successful outcome.