Objective: The delivery of medicines by the postal service from pharmacies to patients' homes has increased to address medicine supply shortages. However, owing to recent abnormal weather conditions, medicines may be delivered in harsh environments exceeding 40℃. Therefore, this study aimed to measure the temperature at which medicines were mailed in the summer and investigate whether the interview form contained evidence that could guarantee the quality of the medicines mailed under those temperature conditions.Methods: Between August 5 and September 11, 2024, medicines were mailed from 15 postbox locations using a service provided by the Japan Post. The mailing environment was assessed via mean kinetic temperature (MKT) with reference to the United States Pharmacopeia (USP). The medicines in shortage were identified based on information published by the Japan Pharmaceutical Manufacturers Association.Results: Approximately 87.5% of the medicines mailed had an MKT above 25℃ (maximum 28.0℃), which deviates from the USP standard. Some medicines temporarily reached a maximum temperature of 47.5℃. Moreover, the results of the stress tests at temperatures above 40℃ were not listed in the interview form for 78.3% of the medicines that were likely to be mailed due to inventory shortages.Conclusion: To guarantee the medicines quality when mailed in the summer, it is important to consider appropriate measures to protect medicines from excessive heat, even medicines stored at room temperature. Furthermore, it is important to assess the medicine stability by referring to the stress tests (50℃) results listed on the interview forms for the product in question and the original and longlisted drugs. To resolve dissatisfaction between pharmacies and patients due to supply instability, it is necessary to actively publish the results of stress tests on interview forms and make appropriate efforts.

The reform of the way physicians work was started from April 2024. Restrictions on doctors' working hours is expected to be difficult to achieve the level required by the government. U40 Kyushu-Okinawa Branch conducted a questionnaire survey of young cardiovascular surgeons nationwide on their working conditions. While some institutions have taken measures such as streamlining doctors' work and shifting tasks, others seem to have made a few change to their previous work content. The reform of work styles of cardiovascular surgeons requires not only individual improvement of work styles, but also efforts by cardiovascular surgeons as a one team, including department heads and facility directors, and requires the involvement of academic societies and governments.

Intestinal ultrasound (IUS) is a promising modality for the management of inflammatory bowel disease (IBD) and has the potential to particularly contribute in monitoring disease activity, an advantage crucial for optimizing the therapeutic strategy. While many IBD physicians appreciate and are interested in the use of IUS for IBD, currently only a limited number of facilities can employ this examination in daily clinical practice. A lack of guidance is one of the major barriers to introducing this procedure. Standardized protocols and assessment criteria are needed such that IUS for IBD can be considered a feasible, reliable examination in clinical practice, and multicenter clinical studies can be conducted for further clinical evidence of the application of IUS in IBD for best patient care. In this article, we provide an overview of how to start IUS for IBD and introduce basic procedures. Furthermore, IUS images from our practice are provided as a color atlas for understanding sonographic findings and scoring systems. We anticipate this “first aid” article will be helpful to promote IUS for IBD in daily practice.

This study aimed to explore the association of breakfast (BF) dietary patterns with physical activity (PA) and fitness in elementary school children. This study enrolled 242 school children of 5th and 6th grade. BF dietary patterns were evaluated by questionnaires on whether the child consumes the following food categories: staple, main dish, side dish, soup, milk or dairy products, and fruit. Individual PA levels were categorized into high and low PA groups using a PA scale for children. The measured 8 assessments of physical fitness scores were converted to Z-scores normalized for sex, age and height as previously reported. High PA group had significantly higher scores in running and muscle strength as well as in the total score of physical fitness. The frequency of eating BF (with or without BF omission) and the level of PA were not significantly related in both sexes. However, in girl children, BF, including staple, main dish, side dish, and soup, was significantly more prevalent in high PA group than low PA group (55.9% vs. 32.1%; χ2 = 5.638, p = 0.018). A similar tendency was observed in girls who had BF, including staple, main dish, and side dish (49.0% vs. 31.1%; χ2 = 3.720, p = 0.054). No associations between dietary patterns and PA were observed in boys. The results suggested that the frequency of eating BF was not associated with PA levels, which was significantly related to physical fitness in Japanese 5th and 6th grade elementary school children. In contrast, the results indicated that a high-quality BF dietary pattern, such as a meal including staple, main dish, side dish, and soup, might be associated with a physically active girl child.

OBJECTIVEHie (cold sensation) is one of the most well-known health complaints in Japan and elsewhere in East Asia. Those who suffer from severe hie are considered to have hiesho (cold disorder). This study was conducted to determine symptoms associated with hie in young females using a survey consisting of the hie scale and hie diary.

METHODSTwo hundred and seventy-one participants were included for the analysis. Survey forms were distributed to the participants. Diagnosis of hiesho was determined by using the hie scale. A discriminant score of over -0.38 was considered hiesho. The Short Form-8 Health Survey Standard Version (SF-8) was used to measure health-related quality of life (QOL). The participants were also asked to respond to the questionnaire evaluating 14 physical and emotional symptoms, utilizing a six-level Likert scale item.

RESULTSThe 1st factor (hie factor) was correlated with hie (r = 0.546), dry mouth (r = 0.332), lower-extremity edema (r = 0.450), headrushes (r = 0.470), shoulder stiffness (r = 0.311), headrushes with chills (r = 0.726), and fatigue (r = 0.359). Cronbach's α of the 1st factor was 0.748, which indicated reliability between the items. When hie factor was the dependent variable, standardized partial regression coefficient was β = -0.387 for physical component score (P < 0.001) and β = -0.243 for mental component score (P < 0.001).

CONCLUSIONThis study indicated that hiesho symptoms among young female adults were associated with bodily pain and general health perceptions of the SF-8 QOL survey.

The patient was a 57-year-old man who, in 1973, at 19 years of age, had undergone mitral valve replacement for mitral valve stenosis using a Björk-Shiley Delrin (BSD) valve. When the patient visited our hospital, he was living in an assisted-living facility due to paresis of the right side of the body, dysarthria, and other sequelae of cerebral infarction. The patient was referred to and visited our hospital with a chief complaint of chest pain in 2011, 38 years after the BSD valve was implanted. In 2012, mitral valve re-replacement, aortic valve replacement, and tricuspid annuloplasty were performed for congestive heart failure associated with prosthetic valve failure, combined aortic stenosis and insufficiency, and tricuspid insufficiency, which were identified by transesophageal echocardiography. The patient's postoperative course was generally favorable. The disc of the resected prosthetic valve showed a groove and bidirectional cracks caused by wear, and its condition suggested a risk of potential rupture. Transthoracic echocardiography on admission showed mild to moderate prosthetic transvalvular regurgitation, and the symptoms were therefore unlikely to have resulted from the prosthetic valve failure alone at this time. Consequently, it was considered that the heart failure was attributed to the prosthetic transvalvular regurgitation caused by the disc abnormalities in addition to the combined valvular disease by transesophageal echocardiography. In this case, detailed investigation of the heart failure by transesophageal echocardiography led to the discovery of prosthetic valve abnormalities, thus enabling the prevention of a serious cardiac accident due to disc rupture. Detailed examination by transesophageal echocardiography is essential, and early surgical intervention should also be considered if transthoracic echocardiography suggests even a minor prosthetic valve abnormality in a patient who has had this prosthetic valve implanted for such a long time.

OBJECTIVE: Donepezil is used to improve cognitive impairment of dementia with Lewy bodies (DLB). Visuo-spatial dysfunction is a well-known symptom of DLB. Non-verbal Raven’s Colored Progressive Matrices (RCPM) were used to assess both visual perception and reasoning ability in DLB subjects treated with donepezil. METHODS: Twenty-one DLB patients (mean age, 78.7±4.5 years) were enrolled. RCPM assessment was performed at the time of starting donepezil and within one year after starting donepezil. RESULTS: There were significant improvements of RCPM in the total scores between one year donepezil treatment (p=0.013), in both Set A score (p=0.002) and Set AB score (p=0.015), but trend in the Set B score (p=0.083). CONCLUSION: Donepezil is useful for improving visuo-spatial impairment in DLB, but not for problem-solving impairment.
Cholinesterase Inhibitors ; Cognition Disorders ; Dementia* ; Humans ; Lewy Bodies* ; Lewy Body Disease ; Spatial Processing ; Visual Perception

OBJECTIVEHie (cold sensation) is one of the most common health complaints in Japan. Those who suffer from severe hie are considered as having hiesho (cold disorder). However, exact hiesho symptoms have not been defined clearly and the decision as to whether a person suffers from hiesho is subjective and based on self-awareness. The study was conducted in attempt to develop a standardized hiesho diagnostic scale.

METHODSSubjects comprised 1 146 students. From the self-awareness of hiesho symptoms, males and females were divided into hiesho and non-hiesho groups. Physical, behavioral and adaptive characteristics were compared using the 24-item questionnaire (four-grade survey) and indicators for hiesho symptoms were extracted. Based on the scores, a receiver operating characteristic curve was drawn for the total ordinal scale score of the extracted items in relation to the presence and absence of hiesho symptoms, and an optimal cutoff value was determined.

RESULTSThe self-awareness of having hiesho was found in 23.2% males and in 55.6% females. The sensitivity was 84.5% for males and 83.3% for females in the hiesho groups, and the specificity was 86.0% for males and 85.2% for females in the non-hiesho groups.

CONCLUSIONA questionnaire consisting of the extracted items may be useful to identify hiesho in young males and females with a high level of accuracy.

Adult ; Cold Temperature ; Female ; Humans ; Male ; Surveys and Questionnaires ; Thermosensing

OBJECTIVETo determine whether any difference exists in the skin-temperature responses of the lower limbs to hot-stone application relative to one-site and three-site abdominal application.

METHODSTwenty-five female students participated in experimental sessions after a random allocation: 14 participants received a hot-stone application on the umbilicus, superior-umbilicus, and inferior-umbilicus regions (hereafter referred to as the three-site stimulation group); and 11 participants received the hot-stone application on the umbilicus region only (hereafter referred to as the one-site stimulation group). Heated stones were applied for 9 min to participants in both groups. Four arbitrary frames (the lower leg, ankle, proximal foot, and distal foot regions) were created in order to observe and analyze the skin temperature of a lower limb using a thermograph. Observation periods were as follows: before hot-stone stimulation, immediately after stimulation, and 5, 10, 15, and 20 min after stimulation.

RESULTSThere was a significant offset interaction of distal foot skin temperature between the groups. The left-side distal foot skin temperature increased at 15 and 20 min following the three-site abdominal hot-stone stimulation. The right-side distal foot skin temperature increased immediately and at 5, 10, 15, and 20 min following the three-site abdominal hot-stone stimulation. No significant change in distal foot skin temperature was observed following the one-site stimulation.

CONCLUSIONLower-limb skin temperature was altered following hot-stone stimulation applied to the abdomen, and the one-site stimulation and three-site stimulation yielded different distal foot skin-temperature reactions.

Adult ; Hot Temperature ; therapeutic use ; Humans ; Lower Extremity ; Male ; Massage ; methods ; Skin Temperature

OBJECTIVEThe aim of this study was to examine the changes in natural killer (NK) cell activity, pulse rate, and pain intensity among older adults before and after acupuncture treatment.

METHODSFifty-six individuals (16 males and 40 females), age 60 to 82 years (mean age 72.4 ± 5.0), who were experiencing pain in the shoulder, low back, or knee, participated in the study. NK cell activity, leukocyte differentiation (granulocytes and lymphocytes), pulse rate, and blood pressure values obtained. Pain intensity was used to analyze NK cell activity, leukocytes (granulocyte counts and granulocyte-to-lymphocyte ratio), and the VAS score in accordance with the location of pain complaints before and after acupuncture treatment.

RESULTSNK cell activity decreased after acupuncture treatment for pain in the shoulder-pain and knee-pain groups. Further, the lymphocyte and granulocyte counts increased after acupuncture treatment for the shoulder-pain group. Pulse rate decreased for the shoulder-pain, low-back-pain, and knee-pain groups after acupuncture treatment. The VAS score decreased after acupuncture treatment for the shoulder-pain, low-back-pain, and knee-pain groups.

CONCLUSIONThis study showed that in older adults, acupuncture treatment decreases pulse rate, relieves pain in the shoulder, low back, and knee, and reduces NK-cell activity.

Acupuncture Therapy ; Aged ; Aged, 80 and over ; Blood Pressure ; Female ; Heart Rate ; Humans ; Killer Cells, Natural ; immunology ; Low Back Pain ; immunology ; physiopathology ; therapy ; Male ; Middle Aged ; Pain Measurement ; Shoulder Pain ; immunology ; physiopathology ; therapy ; Treatment Outcome