Mamushi is a species of pit viper distributed throughout Japan excluling the Ryukyu Islands and sighted from spring to autumn. It is estimated that about ten people dies in a year. It is important in the rural medicine because a lot of people are bitten in mountains and fields. A total of 35 cases of mamushi viper bite were treated from 1999 to 2006 in our hospital. The patients were 17 men and 18 women ranging in age from 7 to 80 years old (average: 60). Local swelling and pain were manifest in all the cases. Sixteen patients had systemic symptoms, and toxic effects commonly appeared in the eyes. The blood tests revealed elevated CPK levels in 24 patients (69%). The elevation correlated to the seriousness of the clinical symptoms. In accordance with our manual for mamushi viper bites, all patients were hospitalized after incision for exclusion of the toxin. The median length of time before the worst symptoms began to subside was 3 days. The median length of hospitalization stays was 7 days. It took long before the patients fully recovered. The severity of envenomation was different from patient to patient and one case needed intensive care. The median of treatment period was 31 days. The quick and appropriate primary care for the mamushi viper bits is important to prevent serious complications.
Median Statistical Measurement ; symptoms <1> ; Agkistrodon halys blomhoffi ; Clinical ; Cases

Exercise therapy as well as diet therapy, is fundamental in the treatment of diabetes mellitus, however, its methods and effects of long term physical exercise therapy has not yet been clarified.
The present study has been designed to evaluate the effects of physical exercise therapy in diabetic patients with fasting hyperglycemia. Ten non-insulin dependent diabetic patients participated in a 6-month physical exercise program consisting of 30 min, of jogging performed 3 times per week (Exercise group) . The exercise intensity represented 40% of estimated Vo₂max.
The following results were obtained:
1. More significant improvement of glucose tolerance and plasma insulin response to glucose load was observed in exercise group as compared with the patients treated with mild caloric restriction alone (Diet group, N=15) .
2. The significant increase in plasma HDL-cholesterol and HDL-cholesterol/total cholesterol ratio was observed only in exercise group.
3. The reduction of body weight in exercise group was significantly greater than that in diet group.
4. The physical exercise also resulted in an improvement of cardiovascular adaptaion to exercise.
5. Improvement of symptoms in daily life activity was also found after physical exercise therapy. However, some medical troubles such as hypoglycemia, muscle pain and arthralgia were found during observation period.
In conclusion, physical exercise therapy is useful as an adjunct to diet to improve metabolic control in patients with diabetes mellitus. And for effective exercise therapy, exercise program must be individualized, and motivation is stimulated by team including physician, trainer, nurse and dietitian.

Exercise has been well known to a fundamental treatment of diabetes mellitus, as well as diet therapy. Nevertheless, its therapeutic use and clinical effects are still unknown in details. The aim of this study is the establishment of practical exercise therapy for the patients with diabetes mellitus. The present study shows the acute exercise effects on blood metabolites and the effects of long term physical training in diabetics.
The following results were obtained.
1) Although no significant change of blood glucose level was observed in normals, the decrease of blood glucose and triglyceride levels were observed in diabetics in acute exercise. Moreover marked elevation of FFA level was also observed after acute exercise in diabetics.
2) Significant decrease of blood glucose and increase of HDL-cholesterol levels were found in diabetics by long term regular physical training.
3) Body weight reduction without loss of lean body mass and the improvement of physiological response to exercise test were achieved after long term physical training.
These results suggest that the regular physical training leads to the better control of diabetes mellitus and keeps good condition in patients with diabetes mellitus, and that it may have a important role of the prevention for the diabetic vascular complication.

Reactive oxygen species (ROS) are produced under oxidative stress, such as high oxygen concentration and during the metabolic consumption of oxygen molecules. Male reproductive tissues appear to be continuously exposed to ROS produced by active metabolism. In addition, spermatozoa must pass through a high oxygen environment during the mating process. Thus, to maintain viable reproductive ability, a protective mechanism against oxidative stress is of importance. Here, we overview our current understanding of the cooperative function of antioxidative and redox systems that are involved in male fertility. Superoxide dismutase and glutathione peroxidase are major enzymes that scavenge harmful ROS in male reproductive organs. In turn, glutathione and thioredoxin systems constitute the main redox systems that repair oxidized and damaged molecules and also play a role in regulating a variety of cellular functions. While glutathione functions as an antioxidant by donating electrons to glutathione peroxidase and thioredoxin donates electrons to peroxiredoxin as a counterpart of glutathione peroxidase. In addition, aldo-keto reductases, which detoxify carbonyl compounds produced by oxidative stress, are present at high levels in the epithelia of the genital tract and Sertoli cells of the testis. Since these systems are involved in cross-talk, a comprehensive understanding will be required to maintain the physiological functions of male reproductive system.
Animals ; Antioxidants ; metabolism ; Catalase ; metabolism ; Genitalia, Male ; enzymology ; metabolism ; Glutathione ; biosynthesis ; Glutathione Peroxidase ; metabolism ; Humans ; Male ; Oxidation-Reduction ; Oxidative Stress ; physiology ; Oxidoreductases ; metabolism ; Superoxide Dismutase ; metabolism ; Thioredoxins ; metabolism

In career education, devising ways to elicit proactive participation is vital, thus we conducted face-to-face workshops to drive learners’ participation. However, the COVID-19 pandemic forced us to teach classes online. Therefore, to motivate more than 100 students to participate actively in the online format, we conducted career education using Active Book Dialogue® where several students read a book together in a short period of time. Each student read a specific part of the book they were assigned and summarized it in collaboration with their group members. This enabled them to learn career theory. Additionally, the online format allowed several lectures to be held within a remote and interactive environment. We will reflect on this experience and report on how this can be applied in other schools.

We developed a virtual career thinking game and provided third-year medical students with workshop-type career instruction to identify "transition" in a career and their own values. The game is a group work activity based on the assumption that the virtual character will respond to a turning point during undergraduate school and after graduation, and experience the story of a doctor's life. After playing the game and sharing the story of each group, participants were asked to think about what they would do at a possible turning point. Although favorable response were observed in the first year, problems were found, and improvements were made in the second year, and further effects were observed. The results show that career education using games increases students' ability to respond to turning points and is an effective technique in career education.

PURPOSE: Opioids improve pain from knee and hip osteoarthritis (OA) and decrease the functional impairment of patients. However, there is a possibility that opioids induce analgesia and suppress the physiological pain of OA in patients, thereby inducing the progression of OA changes in these patients. The purpose of the current study was to investigate the possibility of progressive changes in OA among patients using opioids. MATERIALS AND METHODS: Two hundred knee or hip OA patients were evaluated in the current prospective, randomized, active-controlled study. Patients were randomized 1:1:1 into three parallel treatment groups: loxoprofen, tramadol/acetaminophen, and transdermal fentanyl groups. Medication was administered for 12 weeks. Pain scores and progressive OA changes on X-ray films were evaluated. RESULTS: Overall, pain relief was obtained by all three groups. Most patients did not show progressive OA changes; however, 3 patients in the transdermal fentanyl group showed progressive OA changes during the 12 weeks of treatment. These 3 patients used significantly higher doses than others in the transdermal fentanyl group. Additionally, the average pain score for these 3 patients was significantly lower than the average pain score for the other patients in the transdermal fentanyl group. CONCLUSION: Fentanyl may induce progressive changes in knee or hip OA during a relatively short period, compared with oral Non-Steroidal Anti-Inflammatory Drugs or tramadol.
Aged ; Aged, 80 and over ; Analgesics, Opioid/*adverse effects/therapeutic use ; Disease Progression ; Female ; Fentanyl/*adverse effects/therapeutic use ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip/*drug therapy/radiography ; Osteoarthritis, Knee/*drug therapy/radiography ; Pain/drug therapy