Since many patients are still dying from asthma and COPD, developing more effective drugs with little side-effect which can be taken for a long time, is very important. Clinical usage of herbal medicines for chronic airway diseases has been increasing. Bakumondo-to is a useful herbal medicine with little side-effect for the treatment of chronic airway diseases. There are some similarities of pharmacological profile of herbal medicines to those of glucocorticoids. Although the regulation of gene expression by glucocorticoids has been clarified, that of Bakumondo-to is not well known. Elucidation of the mechanism of Bakumondo-to will be helpful in establishing a more effective treatment of chronic airway diseases. This article focuses on the regulation of gene expression by Bakumondo-to in airway epithelial cells, and describes the increase in mRNA expression for β-adrenergic receptors by Bakumondo-to and in glucocorticoid-sensitive promoter activity. We also discuss the mechanisms of the regulatory action of Bakumondo-to.

Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer.
Biliary Tract ; Biopsy, Fine-Needle ; Diagnosis ; Diagnosis, Differential ; Elasticity ; Elasticity Imaging Techniques ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography* ; Needles ; Pancreas ; Pancreatic Neoplasms ; Pancreatitis, Chronic

Background/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS). Methods: This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room. Results: The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001). Conclusions During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.

To ensure public trust in health professions, it is imperative for health professionals to understand the concept of conflict of interest (COI) in health professions education and manage it appropriately. However, there are not enough formal curricula on COI in health professions education in Japan. We propose an educational curriculum on COI in health professions education which focuses on relationship between physicians and for-profit corporations. We hope that this proposed curriculum stimulates educational activities on the ground while taking context into account. We also hope the proposed curriculum leads to the formal incorporation of COI in health professions education and educational policies nationwide.

Background/Aims: 5-Aminosalicylic acid (ASA) causes intolerance reactions in some patients. This study was performed to examine the prognosis of patients with ulcerative colitis (UC) and 5-ASA intolerance, and to evaluate the potential interaction between 5-ASA intolerance and the intestinal microbiota. Methods: We performed a retrospective cohort study of patients with UC who visited participating hospitals. The primary endpoint was to compare the incidence of hospitalization within 12 months between the 5-ASA intolerance group and the 5-ASA tolerance group. The secondary endpoint was to compare the risk of adverse clinical outcomes after the start of biologics between the 2 groups. We also assessed the correlation between 5-ASA intolerance and microbial change in an independently recruited cohort of patients with UC. Results: Of 793 patients, 59 (7.4%) were assigned to the 5-ASA intolerance group and 734 (92.5%) were assigned to the 5-ASA tolerance group. The admission rate and incidence of corticosteroid use were significantly higher in the intolerance than tolerance group (P< 0.001). In 108 patients undergoing treatment with anti-tumor necrosis factor biologics, 5-ASA intolerance increased the incidence of additional induction therapy after starting biologics (P< 0.001). The 5-ASA intolerance group had a greater abundance of bacteria in the genera Faecalibacterium, Streptococcus, and Clostridium than the 5-ASA tolerance group (P< 0.05). Conclusions In patients with UC, 5-ASA intolerance is associated with a risk of adverse clinical outcomes and dysbiosis. Bacterial therapeutic optimization of 5-ASA administration may be important for improving the prognosis of patients with UC.