We present here an interesting case of anorexia nervosa that was well controlled by Ancyu-san, a traditional Japanese herbal medicine. A 17-year-old student was re-admitted to our department in December of 1990, because of anorexia and eating disorders. She had lost approximately 12kg body weight during 3 months. She was 154cm tall and weighed 26kg. Her blood pressure was 75/40mmHg, her pulse rate was 30beats/min, and her body temparature was 34.4°C. She was extremely emaciated and hyperactive. On oriental examination, a shallow complexion, a cold feeling in the limbs, postprandial headaches, and a feeling of obstruction of the external ear. Her pulse was slow and feeble. Abdominal examination revealed that the abdominal strength was reduced to 2/5 with Inai-teisui (abdominal water and gas retention). Based on these findings, this case was diagnosed as Deficient Spleen and Stomach due to Deficient Ki and Blood combined with Stagnated Ki, and therefore a candidate for the Kampo formula Ancyu-san. The patient began medication in January 1991. Her appetite improved gradually and her body weight increased from 26kg to 47kg in two months.

Objective : By extracting and modeling the component factors that community pharmacists have for “YARIGAI”—a Japanese colloquial expression commonly defined as “something worthwhile doing”—and by re-defining “YARIGAI,” we sought to help improve the quality of work lives of community pharmacists. Methods : All of 139 employee pharmacists participated in a workshop of the COMPASS Project (May 2011) were surveyed using a self-administered questionnaire. Responses were collected on the scene. The seventeen, 6-point-scale questions focused on the “patient-pharmacist relationship,” which may be related to “YARIGAI.” Then “YARIGAI” factors were extracted using factor analysis, and modeled using covariance structure analysis. IBM SPSS (ver. 20) and Amos 5.0J were used for the analyses. Results : To the item “I feel ‘YARIGAI’ with pharmacy work,” 12.2% of the 139 respondents said, “Strongly agree”, followed by “Agree” (41.0%) and “Somewhat agree” (33.8%). A factor analysis extracted three factors related to “YARIGAI” (knowledge, patient counseling management, and sense of personal growth). After modeling (AGFI : 0.903, RMSEA : 0.048) with these factors as latent variables and items in them as observable variables, a positive correlation was indicated for all the following factor pairs : “knowledge” and “patient counseling management”, “knowledge” and “sense of personal growth”, and “sense of personal growth” and “patient counseling management” (standardized points of estimate : 0.71, 0.55, and 0.42, respectively). Standardized coefficients for all latent and observable variables were 0.7 or higher, showing a good fit. Conclusion : “YARIGAI” of pharmacists employed by community pharmacies can consist of “knowledge,” “patient counseling management,” and “sense of personal growth”. Our results suggest that the improvement of communication skills and knowledge can lead to improvement of “YARIGAI” of pharmacists working for community pharmacies.

Medicine, Kampo ; Metabolic ; Therapeutic procedure ; Syndrome

INTRODUCTIONGamma-glutamyltransferase (GGT), bilirubin (Bil) and small dense low-density lipoprotein (sdLDL) particles are each known to be risk markers for cardiometabolic diseases which are characterised by oxidative stress conditions. These markers are connected with the oxidative milieu; however, the association between GGT, Bil, and sdLDL has been hardly examined. This hospital-based study investigated the association between GGT and sdLDL, as well as the association between Bil and sdLDL, in asymptomatic subjects.

MATERIALS AND METHODSCardiometabolic variables, GGT, Bil and the mean LDL particle size were measured in 100 asymptomatic subjects attending a clinic for screening dyslipidaemias (36 men and 64 women, mean age 64 years). Correlation analyses of the association between the mean LDL particle size and other variables, such as GGT and Bil, were performed.

RESULTSThe mean (standard deviation) levels of GGT, Bil, and the mean LDL particle size were found to be 21.7 (8.3) IU/L, 14.0 (4.3) μmol/L, and 26.7 (0.6) nm, respectively. An univariate correlation test showed both a significant inverse correlation between the mean LDL particle size and GGT (r = - 0.33, P <0.01) and a significant positive correlation between the mean LDL particle size and Bil (r = 0.32, P <0.01). A multiple regression analysis revealed similarly significant results of their correlations, independent of the other cardiometabolic variables.

CONCLUSIONThese results suggest that the correlation of GGT and sdLDL, as well as that of Bil and sdLDL, may be cooperatively associated with cardiometabolic processes. Further research is warranted in order to confirm the observed association.

Asymptomatic Diseases ; Bilirubin ; blood ; Biomarkers ; blood ; Cross-Sectional Studies ; Dyslipidemias ; blood ; diagnosis ; Female ; Humans ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; gamma-Glutamyltransferase ; blood

BACKGROUND: Circulating leptin:adiponectin ratio (L:A) is a potential surrogate marker for cardiometabolic diseases; however, the relationship of the L:A with the occurrence of metabolic syndrome (MetS) has not yet been fully explored in the general Japanese population. METHODS: We enrolled 678 Japanese subjects (208 men and 470 women, mean age: 58.8+/-14.4 [SD] yr; mean body mass index: 23.6+/-3.3 kg/m2) in this study, and determined their MetS status by using the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) recommendations with minor modifications for the Japanese population. Biochemical markers such as leptin and adiponectin present in blood were measured. The statistical analyses performed were gender-based. RESULTS: A in subjects with MetS was significantly higher than that in subjects without MetS, regardless of gender. The L:A also showed a significant and gradual increase corresponding to the increase in the number of components of MetS present in both the genders (trend P<0.01). The cut-off level of the L:A to detect MetS was 0.59 (sensitivity: 0.72, specificity: 0.70) in men and 1.04 (sensitivity: 0.72, specificity: 0.69) in women. CONCLUSIONS: These results suggest that the L:A can serve as a clinically useful marker for detecting MetS characteristics in the general Japanese population. The clinical application of this laboratory index for detecting MetS should be assessed in future studies.
Adiponectin/*blood ; Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Body Mass Index ; Female ; Humans ; Japan ; Leptin/*blood ; Male ; Metabolic Syndrome X/*blood ; Middle Aged ; ROC Curve

BACKGROUND: Circulating leptin:adiponectin ratio (L:A) is a potential surrogate marker for cardiometabolic diseases; however, the relationship of the L:A with the occurrence of metabolic syndrome (MetS) has not yet been fully explored in the general Japanese population. METHODS: We enrolled 678 Japanese subjects (208 men and 470 women, mean age: 58.8+/-14.4 [SD] yr; mean body mass index: 23.6+/-3.3 kg/m2) in this study, and determined their MetS status by using the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) recommendations with minor modifications for the Japanese population. Biochemical markers such as leptin and adiponectin present in blood were measured. The statistical analyses performed were gender-based. RESULTS: A in subjects with MetS was significantly higher than that in subjects without MetS, regardless of gender. The L:A also showed a significant and gradual increase corresponding to the increase in the number of components of MetS present in both the genders (trend P<0.01). The cut-off level of the L:A to detect MetS was 0.59 (sensitivity: 0.72, specificity: 0.70) in men and 1.04 (sensitivity: 0.72, specificity: 0.69) in women. CONCLUSIONS: These results suggest that the L:A can serve as a clinically useful marker for detecting MetS characteristics in the general Japanese population. The clinical application of this laboratory index for detecting MetS should be assessed in future studies.
Adiponectin/*blood ; Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Body Mass Index ; Female ; Humans ; Japan ; Leptin/*blood ; Male ; Metabolic Syndrome X/*blood ; Middle Aged ; ROC Curve

BACKGROUND/OBJECTIVES: Recent studies have reported an association of the angiotensin II type 2 receptor (AT2R) 3123Cytosine/Adenine (3123C/A) polymorphism with essential hypertension and cardiovascular diseases. The purpose of the study was to investigate whether the AT2R 3123C/A polymorphism affects blood pressure for free-living hypertensive men during a 5-month intervention period. SUBJECTS/METHODS: The subjects were free-living hypertensive Japanese men aged 40 to 75 years who agreed to intervention in the period from 2004 to 2011. Detection of the AT2R 3123C/A polymorphism was determined by polymerase chain reaction. The dietary intervention was designed to decrease salt level and to increase potassium level through cooking instructions and self-monitoring of the diet. The exercise session consisted of activities such as stretching, resistance training, and walking. Blood pressure, urinary sodium and potassium excretion, dietary and lifestyle data, and non-fasting venous blood sample were collected at baseline and after the intervention period. RESULTS: Thirty nine subjects were eligible for participation and the follow-up rate was 97.4%. The C allele proportion was 57.9%. AT2R 3123C/A polymorphism was X-chromosome-linked, therefore we analyzed the C and A genotypes. At baseline, no significant differences were observed between the genotype groups. After the intervention, there were no significant differences in lifestyle habit between the groups. Nevertheless, the estimated salt excretion (g/day) was significantly decreased only in the C genotype (13.0-10.3, P = 0.031). No significant change was observed in systolic blood pressure (SBP) (mmHg) in the A genotype, but a significant decrease was observed in the C genotype (150.0-141.5, P = 0.024). CONCLUSTIONS: In the C genotype, it might be easy to improve SBP through lifestyle intervention in free-living hypertensive Japanese men, however generalization could not be achieved by the small sample size.
Alleles ; Asian Continental Ancestry Group ; Blood Pressure* ; Cardiovascular Diseases ; Cooking ; Diet ; Follow-Up Studies ; Generalization (Psychology) ; Genotype* ; Humans ; Hypertension ; Life Style* ; Male ; Polymerase Chain Reaction ; Potassium ; Receptor, Angiotensin, Type 2* ; Resistance Training ; Sample Size ; Sodium ; Walking

Introduction: This study aimed to develop and validate a diet consultation tool that assesses the perceived benefits and barriers of vegetable consumption attached to the stage of change in Japanese adults. Methods: A web-based survey was conducted among university and vocational school students, medical staffs, and local residents in the Aichi, Osaka, and Kyoto prefectures of Japan between September 2017 and January 2018. Participants comprised of 379 adults aged 20–70 years (mean age: 30.5±12.6 years; men: 21.4%). The scale for decisional balance of vegetable consumption contained 15 benefit items and 15 barrier items. The internal consistency of the scale was examined using Cronbach’s alpha and construct validity was examined using an exploratory factor analysis with Promax rotation. Results: The developed questionnaire had 12 items across two domains for benefits and 12 items across three domains for barriers that were structured with high internal consistencies (Cronbach’s alpha: 0.82, 0.79, 0.82, 0.76 and 0.76, respectively). The intraclass correlation coefficient in the test-retest reliability study was substantial (0.77). We found a very clear association between decreasing barrier score with increasing vegetable consumption and progress in the stage of change. The decisional balance score (benefits score minus barriers score) was positively correlated with the number of vegetable servings as an external parameter (Spearman’s correlation: 0.461; p<0.001). Conclusion: The developed questionnaire was a valid, reliable, and useful tool for diet consultants to assess the perceived benefits and barriers of vegetable consumption in Japanese adults.