Background: New onset fever is a common symptom among hospitalized patients and it may be a manifestation of fatal illnesses such as infection. However, its epidemiology and predictors for mortality have not been fully determined in a Japanese teaching hospital.
Methods: We investigated adult patients with new onset elevated temperature of 37.5 degrees Celsius or greater the 3^rd day after admission during a 4-month study period. Only the first, single episode per patient was analyzed. We determined the causes of fever among these patients with new onset fever. We also analyzed predictors for in-hospital mortality among these patients. These predictors were based on multivariable adjusted logistic regression using demographics, vital signs at the time of fever onset, baseline diseases, and basic laboratory data.
Results: From a total of 2,271 admitted patients, 126 patients (5.6%) developed fever. Among these febrile patients, 98 (78%) had infectious diseases with a prevalence of 4.3% in all admitted patients. The most common cause of infection among those patients was respiratory tract infection, followed by urinary tract infection. Causes for non-infectious fever included neoplastic diseases, inflammatory diseases, and drug fever. In-hospital mortality was associated with lower mean blood pressure <60 mmHg with odds ratio (OR) of 12.7 (95% CI, 1.3–121), tachycardia >90/min with OR 4.1 (95% CI, 1.2–13.5), tachypnea >20/min with OR 10.0 (95% CI, 2.8–35.2), and neoplastic disease with OR 4.1 (95% CI, 1.3–13.1). Infection as a cause of fever was not associated with mortality.
Conclusion: The majority of inpatients with new onset fever had infectious diseases, however fever was also caused by neoplastic diseases, inflammatory diseases and drug fever. Abnormality of vital signs and neoplastic disease were related to in-hospital mortality.

The patient was a 45-year-old woman who began suffering from pain in her extremities 1 year and 6 months previously, and who received Oketsu-reducing Kampo. Her pain disappeared in a year. Six months after her treatment ended, she visited our hospital again complaining of the same symptom. Due to strong signs of Oketsu, we prescribed her a Kampo that reduces Oketsu, but her pain largely persisted. On re-examination, we noticed that her condition had occurred during the rainy season on both instances and speculated that high humidity and strong ‘wind' may be the reason. Therefore, Byakujutsubushito was prescribed for her, and her pain disappeared in 2 weeks. However, in the following rainy season, she visited us again complaining of the same pain, and Byakujutsubushito was again administered, and that relieved her from pain in 11 days. Although it is stated that Byakujutsubushito is useful for the treatment of pain resulting from dampness and ‘wind', there are very a few reports on this in the Kinkiyoryaku text. Nowadays, we live in air-conditioned spaces, and high humidity results in ‘cool wind’ and exterior dampness. Frequent movement in and out of such spaces worsens extremity pain, and we believe that the incidence of this condition is increasing. And we believe that Byakujutsubushito is one of the most useful formulations for the treatment of this condition that occurs during rainy season.

The efficacy of acupuncture-moxibustion for hypertension is often experienced by many clinicians. Nevertheless the mechanism whereby the therapy improves the symptoms has been scarcely elucidated. Our present study was designed to examine some effects of acupuncture upon the organism, especially upon the renal function which is implicated in hypertension.
Experiment I
Acupuncture therapy was undertaken four times on a patient with essential hypertension who was given no hypotensive drugs. In each therapy, needles (No. 2, Seirin) were perpendicularly inserted to the depth of 1.5cm at V₂₀ Fengchi, VU₂₁ Weishu, and G₃₆ Zusanli and left there for 15 minutes. The blood samples and urine were collected three times: before the insertion, 15min. and 60min. after withdrawing the needles. At the same time, blood pressure, pulse, and the amount of urine were measured. The amount of Na, K, Cl, kallikrein, catecholamines, etc. was measured in urine. The renin activity and the concentration of aldosterone, catecholamines, and BUN were determined in the blood. Result: a marked increase was seen in the excretion of urine, Na, and Cl. An upward tendency of kallikrein excretion which is correlated with urine volume, and a downward tendency of renin in the blood were found. Blood pressure and pulse showed a slight tendency to decline. However, neither catecholamines in the blood, nor K in urine changed significantly.
Experiment II
Subjects were two healthy adult men. Urine was collected once an hour for twenty-five times by means of a balloon inserted in the bladder. Immediately after the twenty-first collection, acupuncture stimulation was given to VU₂₁ Weishu in the same manner as Exp. I. With the same measurements and determinations undertaken, a marked increase of urine, Na, and Cl excretion was observed 15min. after withdrawing the needle.
Experiment III
Subjects were three healthy adult men. Urine was collected for two days. The amount of urine and the electrolyte content were calculated on a per hour basis. Without having breakfast after rising, the subjects were given a transfusion of glucose-electrolyte solution, equivalent to the calculated urinary output, every hour for four hours. The VU₂₁ Weishu was stimulated in the same manner two hours after the onset of the first transfusion. Result: a marked increase was seen in the excretion of urine, Na, and Cl.
Conclusion
It can be seen from the above that acupuncture stimulation to the VU₂₁ Weishu facilitates the selective excretion of Na and Cl in the urinary tubule.

Objective : We examined the effects of acupuncture stimulation on hyper lipidemia induced by a cholesterol-free, high-fructose diet (HFD) in rats.
Methods : Acupoints on the rats' bodies were selected at the positions relative to the human acupoints, such as BL 18, LR 14, CV 12, ST 36 and T13-L1, which starts of the origin of splanchnic nerve and runs at intervals of 1 cm on both sides of the nerve between the spinous process of the thirteenth thoracic vertebra and the first lumber vertebra (T13-L1). Nonacupoints were selected on bi lateral buttocks for rats fed with a normal diet and HFD control. Acupuncture stimulations were administered by the subcutaneous insertion of acus. The stimulation was started with HFD feeding and continued for two weeks.
Results : Feeding with HFD for 2 weeks incresed the levels of total cholesterol (TC), especially in very low density lipoprotein (VLDL) and low density lipoprotein (LDL), free cholesterol (FC), triglyceride (TG) and phospholipiid (PL) in serum. Acupuncture stimulations of BL18, LR14, CV12 and S36 inhibited the increase of TC, while the increase of VLDL·LDL-C was inhibited by the acupuncture stimulation of all acupoints. The stimulation of BL18, LR14 and ST36 inhibited the increase of FC. The stumulation of T13-L1 inhibited the increases of TG, TG in high density lipoprotein and PL. The increase of TG in liver by HFD feeding was inhibited by the stimulations on LR14, T13-L1 and CV 12. The reductions of glucose-6-phosphate dehydrogenase and malic enzyme activities in the liver of rats fed by HFD feeding were enhanced by the stimulation of T13-L1 and S36. The activity of β-oxdation in the liver was slightly increased by the stimulations on LR14 and ST36.
Conclusions : These results suggest that the acupuncture stimulation on BL18, LR14, CV12 and ST36 inhibited the increase of intrinsic cholesterol and enhanced the metabolism of VLDL·LDL-C. In addition, it appears that the mechanism of TG decrease by the stimulation on LR14, T13-L1 and ST36 was related to the inhibition of fatty acid synthesis and the enhancement of fatty acid metabolism in the liver.

Objective: To clarify administrators' awareness of outpatient cancer nursing clinics.Methods: We conducted semi-structured interviews of six administrators overseeing outpatient cancer nursing clinics and performed a qualitative, inductive analysis.Results and discussion: In this study, interviews with the administrators led to the identification of ten categories for outpatient cancer nursing clinics such as [the nurses' role in easing the concerns and worries of patients with cancer and their families], [challenges in training and securing outpatient cancer nursing clinic personnel], and [the influence of the passion and confidence of nurses on practice in outpatient cancer nursing clinics]. These interviews revealed that, in practice, outpatient cancer nursing is a useful skill for elucidating the real needs of patients and supporting their decision-making. Coordinated efforts and collaboration among human resources/disciplines may affect day-to-day outpatient cancer nursing clinics.Conclusion: This study revealed that the development of assessment indices to substantiate the accomplishment of outpatient cancer nursing clinics and the training of personnel with a high level of practical skills are two challenges for the expansion of outpatient cancer nursing clinics.

The removal of aspiration objects is often required for aspiration, which takes place at the time of a video fluoroscopic examination of swallowing (VF) for the assessment of dysphagia rehabilitation. We report our approach against correspondence for aspiration at VF.　　As subjects for this report, we sampled 6 patients (average age: 78.3±3.0, four males and two females) from 19 patients, who had aspiration of barium sulfate or meal with barium contrast medium at the time of VF form October 1, 2009, to March 31, 2011. For the first step of correspondence for aspiration at VF, we dealt with coughing, huffing, suction and postural drainage under the guidance of a Speech-Language-Hearing Therapist and, depending on the case, a Physical Therapist who dealt with chest physical therapy. When expectoration was found impossible, we checked to see if it was necessary to perform biphasic cuirass ventilation with a clinical engineer. We assessed the chest X-ray films and existence or non-existence of expectoration immediately after aspiration, and fever, inflammatory response, respiratory symptoms and gastrointestinal symptoms one week after the examination, and retrospectively checked the influence of aspiration.　　As a result, three patients had residue as revealed on chest X-ray films, and the three remaining patients had none. For the former three patients, we intervened in a team approach and succeeded in removing the residue from two patients (one with initial correspondence, and the other with execution by the Physical Therapist). Though two patients had fever and inflammatory response one week later, It was hardly possible that aspiration at the time of VF became a direct cause. No patient had either the respiratory or gastrointestinal symptom.　　Correspondence for aspiration was attained by establishing a team approach system. Even if a patient had heavy aspiration, it was not reflected on chest X-ray films, depending on the case, and therefore deliberation was required for correspondence.

Objective: Ganoderma lucidum (Rei-shi) is widely used as an alternative medicine agent to promote health and longevity. The water-soluble extract from culture medium of Ganoderma lucidum mycelia (WER) is prepared from a solid medium composed of bagasse and rice bran overgrown for 3–4 months with Ganoderma lucidum mycelia.
Design: In this study, we evaluate antioxidant activity of WER in vitro, and examined the effects of oral treatment of WER on oxidative stress in streptozotocin (STZ)-induced diabetic mice.
Method: Male ICR mice were treated with STZ (150 mg/kg, i.p.) and were housed for a week for induction of experimental diabetic state. WER (1 g/kg daily) was orally administered for an additional 9 weeks, and the levels of blood glucose, oxidative stress in plasma, liver and kidney of the mice were assessed.
Result: WER inhibited generation of superoxide anion and lipid peroxidation in concentration dependent manner in vitro. Oral administration of WER to diabetic mice significantly reduced the levels of blood glucose, hydroperoxides, triglyceride, ALT, and AST. Moreover, WER prevented the increase in lipid peroxide levels and the decrease in activity of antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase) in liver and kidney of diabetic mice. In addition, histochemical studies revealed that treatment of WER precluded the sinusoidal dilation in liver and expansion of mesangial matrix in kidney of diabetic mice. Normal mice treated with WER showed no change in any parameters studied.
Conclusion: These data suggested that WER can act as an antioxidant in vivo, and show the antidiabetic effects by relieving diabetic hyperglycemia-induced oxidative stress.

Objective: The water-soluble extract of Ganoderma lucidum mycelia (WER) is prepared from a solid medium composed of bagasse and rice bran overgrown with Ganoderma lucidum mycelia. Recently, we reported that WER shows a blood glucose-lowering effect in maltose-loaded non-diabetic mice. Here, we investigated the efficacy of WER in type 2 diabetic state using KK-A^y mice. Moreover, the food-drug interactions of WER with α-glucosidase inhibitors, voglibose or acarbose were examined using both in vitro and in vivo experiments.
Methods: The glucose-lowering effects of oral administration in vivo of WER alone, or concomitant administration of WER with voglibose/acarbose on the elevation of blood glucose levels by sugar-tolerance tests were examined in KK-A^y mice. The inhibitory effects on α-glucosidase in vitro were also evaluated.
Results: Oral administration of WER (1 g/kg), which did not affect fasting blood glucose, significantly suppressed the hyperglycemia after loading of maltose (18% of decrease in AUC) compared to the water-administrated control mice. In vitro study showed that WER inhibited maltase in concentration-dependent manner. The inhibitory effects of lower concentrations of voglibose or acarbose on α-glucosidase activity were additively enhanced by the presence of WER, but those of higher concentrations were not affected. The glucose-lowering effect of voglibose (0.1 mg/kg) disappeared in maltose-loaded KK-A^y mice when the drug was concomitantly administrated with WER (1 g/kg), whereas acarbose (16 mg/kg) with WER showed no significant change in its effect.
Conclusion: These results demonstrated that WER shows the glucose-lowering effect in maltose-loaded KK-A^y, which may be based on inhibition of the α-glucosidase activity. The present study suggests that concomitant intake of WER with voglibose may override the therapeutic effect of voglibose on postprandial hyperglycemia by food-drug interaction in diabetic state.

A prospective case–control study was conducted in urban districts in Hanoi, northern Vietnam to evaluate the effect of migration on the risk of hospitalisation for dengue in a Vietnamese urban population. We enrolled laboratory-confirmed dengue patients aged >18 years who were hospitalised in local hospitals in November and December 2010. Four neighbourhood-matched controls for each case were recruited within a week of hospitalisation. Sociodemographic data were collected by interviews, and the number of immature and adult mosquitoes within household premises was counted by entomological survey. Matched-pair analyses were conducted using conditional logistic regression models. Among 43 cases and 168 controls, 84% and 83% were migrants from rural areas, respectively. Although statistical significance was marginal, recent migration (residing in study area for <5 years) independently increased the risk of hospitalisation for dengue compared with inhabitants after controlling for potential confounders (adjusted odds ratio [aOR] = 3.78; 95% confidence interval [CI] = 0.99–14.27), whereas longer-term migration (residing in study area for >6 years) did not change the risk (aOR = 1.1; 95% CI = 0.30–4.05). Younger age (18–34 years) (aOR = 7.26; 95% CI = 2.39–22.06) and higher adult Aedes aegypti infestation level within household premises (aOR = 9.25; 95% CI = 1.68–51.09) were also independently associated with hospitalisation for dengue. Recent migration from rural areas seems to increase the risk of hospitalisation for dengue in urban populations in endemic areas. Further research including cohort study should be done to confirm the impact of migration on the risk of dengue in urban areas.