Male rats were trained to escape from radiant heat of infrared lamp (250W) by pressing a bar that turned a lamp off for 8 sec. To determine effects of repetitive exercise on this heat-escape behavior rats were either subjected to a 4-week physical training program in which they were forced to swim in agitating water of 36t or 38°C for 1 hour each day or were not trained (non-exercised controls) . After the program in 36°C water, the bar-pressing rate during the test period decreased markedly compared with that before the training period. Temperatures of the tail-skin and the environment in the test box increased to significantly higher levels in the trained rats than those before the training period, while the rectal temperature in the trained rats remained at the same level to that in the pretraining period. When a 4-week physical training program was completed in the same manner but using 38t water, no differences in the heat-escape activity and the extents of temperatures concurrently measured were obtained between those before and after the training period in the trained rats or controls.
The significant reduction of heat-escape activity in rats with the repetitive exercise for 4-week in the 36t water is a result of adaptive changes in the autonomic thermoregulation due to the repetitive exercise itself.

  In Japan, there are many hospitals which do not have departments specializing in infectious diseases. Treatment of critical nosocomial infections such as candidemia is not sufficient and varies greatly from one institution to another. We reviewed the cases of candidemia in Saku Central Hospital from 2004 to 2008, and examined fungal species, clinical background, therapy, prognosis and the rate of treatment in accordance with the Infectious Diseases Society of America (IDSA) guidelines for candida infection. Blood culture revealed 43 cases diagnosed as candidemia. Candida albicans was the most common fungus. Antibiotics were administered to 84% of the patients and 79% had central venous catheters (CVC). The empirical antifungal administration included fosfluconazole and micafungin, but 23% of the patients did not receive any appropriate antifungal therapy. CVCs were removed from 23 of 34 patients, and 42% of the patients underwent ophthalmologic examination. Some of the patients (42%) were treated according to the IDSA guidelines, but most were not. The 28-day mortality rate was 33%. This study demonstrated that the strategy for treating candidemia in our hospital was insufficient, and also suggested that critical nosocomial infections cases were treated in adequately in many other regional hospitals in Japan. In conclusion, a well-organized and guideline-based therapeutic system is necessary in hospitals without the infectious diseases department.

A 44-year-old man who received left ventricular assist device (LVAD) implantation for end-stage heart failure due to dilated cardiomyopathy suffered from mediastinitis. Computed tomography confirmed mediastinitis. His mediastinum was reopened and irrigated. Negative pressure wound therapy (NPWT) was applied to the wound without closing the chest. This system enabled the patient to receive early physical rehabilitation. One year after LVAD implantation, under NPWT, the patient could walk in the general ward, and was waiting for cardiac transplantation. We used some useful materials for NPWT including a coatable non-alcoholic film, flexible sealing sheet, soft exudate absorber, in order to control wound clean, keep air-tight, prevent damage to the skin and to reduce mediastinal instability. LVAD implantation is usually performed as a bridge to transplantation or recovery. One of the most critical complications is intractable mediastinitis. We described a successful infection control of LVAD related mediastinitis with the NPWT.

Seventy patients with liver cirrhosis hospitalized into our clinic were divided into a compensatory group and a decompensatory group according to three clinical findings, ascites, hepatic encephalopathy and bleeding from gastrointestinal tract. It was suggested that five items of biochemical data for liver function were very important on discriminating these two grops. The five items were cholinesterase, indocyanine green test, albumin, prothrombin time and hematocrit.
We have tried to devise a new staging system for liver cirrhosis by scoring method using the five items. According to the total score calculated from scoring method, clinical stages were divided into four such as stage I, stage II, stage III, and stage IV. It was suggested that cases of stage III had to be treated very carefully.
Liver and spleen volume of patients with liver cirrhosis were calculated by computed tomography. It was suggested that liver volume/spleen volume ratio was very important on discriminating these two groups.

A woman in her 80s developed a feeling of abnormal sensation in her face and excessive salivation. She was diagnosed with right facial nerve paralysis and was admitted to a local hospital. On admission, serum creatinine level was 0.54mg/dL and estimated glomerular filtration rate was 79mL/min/1.73m2. She was started on oral valacyclovir at a dose of 3,000mg/day to treat the right facial nerve paralysis. However, 5 days after starting oral administration, she developed generalized fatigue, vertigo, and vomiting. Serum creatinine level rose to 4.99mg/dL with mild disturbance of consciousness, so she was transported to our hospital on suspicion of acyclovir-induced encephalopathy. We performed hemodialysis for 3 consecutive days to remove the acyclovir from the circulation, which subsequently improved all her symptoms. She was later diagnosed with allergic tubulointerstitial nephritis based on renal biopsy.After discharge from our hospital, laboratory data showed a serum creatinine level of 0.67mg/dL. We later confirmed that the serum acyclovir level before the first hemodialysis session had been very high (11.9μg/mL).

Some simulation-based education tools have been introduced in Kampo medicine. However, there are only a few brief simulation tools to learn qi-blood-fluid (QBF) patterns of traditional Chinese medicine (TCM). In this study, we developed a self-diagnostic questionnaire that allows students learn TCM interviews and QBF patterns by answering the questionnaire and evaluated its reliability and validity. We extracted questionnaire items to classify six QBF patterns (qi deficiency, blood deficiency, yin deficiency, qi stagnation, blood stasis, and phlegm-fluid retention) based on some textbooks of TCM and Kampo medicine. Then we developed an initial questionnaire comprising 35 items. Fifth year medical students at Tohoku University School of Medicine answered the questionnaire of small group teaching during 2017-2020. We evaluated the accuracy of the questionnaire if compared with the diagnosis of academic supervisors. To improve the accuracy, we adjusted the questionnaire’s thresholds and created a predictive model of the patterns using logistic regression analysis. The questionnaire’s sensitivity improved by adjusting the thresholds. Logistic regression analysis resulted in a predictive model that could determine QBF patterns with the same level of accuracy as the original for 20 items overall. The results suggest that the use of a simple questionnaire with ensured accuracy may contribute to better pre-graduate education by making it easier for students to understand their own Kampo medicine patterns.