Rhubarb has been reported effective in patients with chronic renal failure, especially those patients with a high blood urea nitrogen (BUN) value. Rhubarb, however, is difficult to administer in large quantities because of its purging effect. Thus we prepared heated rhubarb, measured its sennoside A content using high performance liquid chromatography, and administered it to 2 patients.
Renal function of the first patient did not improve, following administration of extract derived from decocted rhubarb heated for 4 hours at 100°C.The extract's protective effect on renal function was considered lost by the boiling procedure. Dry-heated rhubarb was also prepared at 130°C for 4 minutes, and administered to the second patient. In this case, the extract's quantity could be increased up to 4.0g per day, and the patient's BUN value gradually decreased.
Onpito was later administered, because of increased BUN and creatinine values. Onpito was administered as a Ninjinto extract, Kakobushimatsu and rhubarb. And Onpito had a better protective effect on renal function in the second patient, than rhubarb alone.
In conclusion, we believe that dry-heated rhubarb can be effective for the improvement of nitric metabolism in patients with chronic renal failure, because of its low purging effect.

Sixty-two embalmed cadavers of elderly Japanese individuals, ranged in age from 44-98 years (48 males, 14 females), were completely dissected, and the weights of skin plus subcutaneous adipose tissue (SSATW) and Triceps Surae Muscle (TSMW) determined. Then subcutaneous adipose tissue free weight (SSATFW) was determined by subtracting SSATW from body weight (BW) .
SSATW and percentage of SSATW relative to BW in females (8.9 kg, 19.8%) were larger than those in males (6.1 kg, 12.7%) . On the other hand, TSMW and percentage of TSMW relative to BW in males (313.6 g, 0.65%) were larger than those in females (210.6g, 0.49%) . BW, SSATFW, TSMW were highly correlated (p<0.01) with each other in males. However, in females, TSMW was not significantly correlated (p>0.05) with those variables. The slopes of regression lines for SSATW against BW and SSATFW for females were about twice as steep as those for males.
From these results, it was suggested that females carried a higher proportion of their adipose tissue externally than males and relationship between muscle weight and inner adipose tissue weight in females was more variable than in males.

Case: We report the case of a female in her sixties with inoperable gastric cancer in which continuous bleeding from the cancer resulted in severe anemia and the need for frequent repetitive blood transfusions. In order to control the hemorrhage, radiation therapy of 30 Gy/10 fractions to the cancer was conducted. Her tarry stool soon stopped, her hemoglobin level increased and transfusion became unnecessary. One month later, gastric rebleeding derived from the marginal area of the radiation field occurred. Additional radiation therapy of 24 Gy/8 fractions was given and successful hemostasis was obtained. The patient has been well without transfusion for four months. Conclusion: It is difficult to control bleeding from advanced gastric cancer if the tumor cannot be resected. Endoscopic hemostasis is not always applicable. Interventional radiotherapy (IVR) can be indicated for arterial bleeding. However, the indication of this treatment is controversial in cases of continuous venous bleeding, as seen in our case. Successful hemostasis by radiation therapy was obtained without severe complications in our case. Therefore, it is conceivable that radiation therapy to resistant venous bleeding from unresectable advanced gastric cancer upon careful consideration of complications is a useful treatment modality.

　　The platelet counts documented in most of the studies using the fully automated hematology analyzer XE-5000 are values measured by impedance technology (PLT-I). If blood specimens showing an anomalous particle-size distribution curve in the area where platelet counts are low are used (exceptionally low platelet count samples), the counting method is automatically switched over to an optical method (PLT-O). In the present study, we examined the usefulness of the XE-5000 by comparing PLT-I with PLT-O, using blood samples with low platelet counts collected from patients who visited our hospital between January 1 and March 31, 2012. Dilution linearity left nothing to be desired in either of the two, but simultaneous reproducibility was higher in PLT-O than in PLT-I. The correlations of PLT-I and PLT-O with visual counts were high, working out at r＝0.889～0.984. In the exceptionally low platelet count samples, the correlation coefficient was high in PLT-O than in PLT-I. The cases showing low platelet counts frequently presented giant platelets and/or red cell fragments. Therefore, measuring the samples with low platelet counts requires a high degree of precision. In the samples with exceptionally low platelet counts, PLT-O exceeded PLT-I in simultaneous reproducibility and correlation with visual counts. Thus, our study demonstrated the usefulness of the XE-5000 that could enumerate PLT-O automatically and speedily.

Objective: The effect of antipsychotic drugs on quantitative electroencephalography (EEG) has been mainly examined by the administration of a single test dose or among patients using combinations of other psychotropic drugs. We therefore investigated the effects of strict monotherapy with antipsychotic drugs on quantitative EEG among schizophrenia patients. Methods: Data from 2,364 medical reports with EEG results from psychiatric patients admitted to the Hokkaido University Hospital were used. We extracted EEG records of patients who were diagnosed with schizophrenia spectrum disorders and who were either undergoing strict antipsychotic monotherapy or were completely free of psychotropic drugs. The spectral power was compared between drug-free patients and patients using antipsychotic drugs. We also performed multiple regression analysis to evaluate the relationship between spectral power and the chlorpromazine equivalent daily dose of antipsychotics in all the patients. Results: We included 31 monotherapy and 20 drug-free patients. Compared with drug-free patients, patients receiving antipsychotic drugs demonstrated significant increases in theta, alpha and beta power. When patients taking different types of antipsychotics were compared with drug-free patients, we found no significant change in any spectrum power for the aripiprazole or blonanserin groups. Patients taking risperidone demonstrated significant increases in alpha and beta power. Patients taking clozapine and olanzapine demonstrated significant slow wave increases. Multiple regression analysis revealed that the chlorpromazine equivalent dose was positively associated with theta power. Conclusion Use of any antipsychotic drug by patients was associated with a dose-dependent increase in theta power. However, each type of antipsychotic demonstrated different spectral power changes.

Objective: The effect of antipsychotic drugs on quantitative electroencephalography (EEG) has been mainly examined by the administration of a single test dose or among patients using combinations of other psychotropic drugs. We therefore investigated the effects of strict monotherapy with antipsychotic drugs on quantitative EEG among schizophrenia patients. Methods: Data from 2,364 medical reports with EEG results from psychiatric patients admitted to the Hokkaido University Hospital were used. We extracted EEG records of patients who were diagnosed with schizophrenia spectrum disorders and who were either undergoing strict antipsychotic monotherapy or were completely free of psychotropic drugs. The spectral power was compared between drug-free patients and patients using antipsychotic drugs. We also performed multiple regression analysis to evaluate the relationship between spectral power and the chlorpromazine equivalent daily dose of antipsychotics in all the patients. Results: We included 31 monotherapy and 20 drug-free patients. Compared with drug-free patients, patients receiving antipsychotic drugs demonstrated significant increases in theta, alpha and beta power. When patients taking different types of antipsychotics were compared with drug-free patients, we found no significant change in any spectrum power for the aripiprazole or blonanserin groups. Patients taking risperidone demonstrated significant increases in alpha and beta power. Patients taking clozapine and olanzapine demonstrated significant slow wave increases. Multiple regression analysis revealed that the chlorpromazine equivalent dose was positively associated with theta power. Conclusion Use of any antipsychotic drug by patients was associated with a dose-dependent increase in theta power. However, each type of antipsychotic demonstrated different spectral power changes.

Calcitonin (CT), a polypeptide hormone, plays important roles in a variety of physiological processes. CT has been used clinically to treat osteoporosis and humoral hypercalcemia of malignancy. In order to clarify the pharmacological effects of CT in the kidney, we identified potential downstream genes induced by CT in the renal cells. Using a cDNA subtraction hybridization method, we identified connective tissue growth factor (CTGF) as a CT-induced gene in the porcine renal cell line, LLC-PK1. Furthermore, we found that CT-mediated induction of the gene was not inhibited by cycloheximide, which suggests that CTGF gene was not induced by an increased synthesis of regulating proteins. Therefore, CTGF is an immediate early gene. We further demonstrated that the regulation of CTGF gene expression by CT involved the ERK1/2 pathway, because PD98059, a MEK1 inhibitor, partially inhibited the mRNA expression of CTGF induced by CT. CT-induced CTGF protein expression was also observed in vivo. Our present findings suggest that CT induces the transcription of CTGF through ERK1/2 phosphorylation. We also identified twelve other genes induced by CT that, like CTGF, were related to wound healing. These results suggest that CT may have an effect on renal differentiation and wound healing in the kidney.
Animals ; Calcitonin/*pharmacology ; Cell Line ; Connective Tissue Growth Factor/*genetics/metabolism ; Female ; Kidney Tubules, Proximal/*enzymology/metabolism ; *MAP Kinase Signaling System ; Mice ; Mice, Inbred BALB C ; Mitogen-Activated Protein Kinase 1/*metabolism ; Mitogen-Activated Protein Kinase 3/*metabolism ; Phosphorylation ; Swine

Calcitonin (CT), a polypeptide hormone, plays important roles in a variety of physiological processes. CT has been used clinically to treat osteoporosis and humoral hypercalcemia of malignancy. In order to clarify the pharmacological effects of CT in the kidney, we identified potential downstream genes induced by CT in the renal cells. Using a cDNA subtraction hybridization method, we identified connective tissue growth factor (CTGF) as a CT-induced gene in the porcine renal cell line, LLC-PK1. Furthermore, we found that CT-mediated induction of the gene was not inhibited by cycloheximide, which suggests that CTGF gene was not induced by an increased synthesis of regulating proteins. Therefore, CTGF is an immediate early gene. We further demonstrated that the regulation of CTGF gene expression by CT involved the ERK1/2 pathway, because PD98059, a MEK1 inhibitor, partially inhibited the mRNA expression of CTGF induced by CT. CT-induced CTGF protein expression was also observed in vivo. Our present findings suggest that CT induces the transcription of CTGF through ERK1/2 phosphorylation. We also identified twelve other genes induced by CT that, like CTGF, were related to wound healing. These results suggest that CT may have an effect on renal differentiation and wound healing in the kidney.
Animals ; Calcitonin/*pharmacology ; Cell Line ; Connective Tissue Growth Factor/*genetics/metabolism ; Female ; Kidney Tubules, Proximal/*enzymology/metabolism ; *MAP Kinase Signaling System ; Mice ; Mice, Inbred BALB C ; Mitogen-Activated Protein Kinase 1/*metabolism ; Mitogen-Activated Protein Kinase 3/*metabolism ; Phosphorylation ; Swine

Background/Aims: Natural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients. Methods: From October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course. Results: Forty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m2 , 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care. Conclusion CIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired.