BACKGROUND: Hyperglycemia is believed to be a risk factor for cognitive decline, but the longitudinal relationship between hyperglycemia and cognitive decline in the Japanese population is unclear. The present study aimed to clarify the association between blood glucose levels and information processing ability in middle-aged and older adults. METHODS: The subjects were 866 men and 815 women aged 40-79 years not taking medication for diabetes who participated in the first study wave (1997-2000) and then participated at least once in the subsequent six study waves (2000-2012) of the National Institute for Longevity Sciences-Longitudinal Study of Aging, Japan. Hemoglobin A1c (HbA1c) levels were categorized into four groups (< 5.6, 5.6 to < 6.0, 6.0 to < 6.5, ≥ 6.5%), and a mixed-effects model was used to evaluate the effects of the HbA1c level (four groups) on repeated measures of information processing speed. The models also included baseline age, body mass index, ethanol intake, smoking status, educational level, family income, and history of stroke, hypertension, heart disease, and dyslipidemia as covariates. RESULTS: Mean (standard deviation) HbA1c and follow-up time in participants were 5.2 (0.5) % and 10.0 (3.6) years, respectively. A linear mixed model showed that the main effect of the four HbA1c groups on information processing ability was not significant in either men or women, but the interaction of HbA1c and time with information processing speed in the higher HbA1c level groups (≥ 6.5% group in men, 6.0 to < 6.5% and ≥ 6.5% groups in women) was significant compared to the lower HbA1c level (< 5.6%) group (P < 0.05). When the slope of information processing speed by HbA1c level at baseline was examined, the slope of information processing speed in the higher HbA1c level (≥ 6.5%) group was higher than in the lower HbA1c level (< 5.6%) group, both in men (- 0.31/year) and in women (- 0.30/year), as well as in women with an HbA1c level of 6.0 to < 6.5% (- 0.40/year). CONCLUSIONS Higher baseline HbA1c was associated with greater subsequent decline in information processing ability in Japanese community dwellers, even with the pre-clinical HbA1c level (6.0 to < 6.5%) in women. The results suggest that good glycemic control or prevention of hyperglycemia may contribute to maintaining information processing ability.
Adult ; Aged ; Cognition ; physiology ; Cognitive Dysfunction ; blood ; epidemiology ; psychology ; Female ; Glycated Hemoglobin A ; analysis ; Humans ; Hyperglycemia ; blood ; epidemiology ; psychology ; Independent Living ; statistics & numerical data ; Japan ; epidemiology ; Longitudinal Studies ; Male ; Middle Aged ; Risk Factors

In Mongolian gerbils, bilateral common carotid artery occlusion (BCCAO) for several minutes induces ischemia, due to an incomplete circle of Willis, resulting in delayed neuronal cell death in the Cornet d'Ammon 1 (CA1) region of the hippocampus. Neuronal cell death in the hippocampus and changes in behavior were examined after BCCAO was performed for 5 min in the gerbils. One day after BCCAO, the pyramidal neurons of the CA1 region of the hippocampus showed degenerative changes (clumped chromatin in nuclei). At 5 and 10 days after BCCAO, extensive neuronal cell death was observed in the hippocampal CA1 region. Cognitive performance was evaluated by using the radial maze and passive avoidance tests. In the radial maze test, which examines win-stay performance, the number of errors was significantly higher in ischemic gerbils than in sham-operated gerbils on days 1 and 2 post-operation. In the passive avoidance test, the latency and freezing times were significantly shorter in ischemic gerbils than in sham-operated gerbils on the days 1, 2, and 4–6 post-operation. These results indicate that transient forebrain ischemia impairs cognitive performance, even immediately after the ischemic insult when there are only subtle signs of neuronal cell death.
CA1 Region, Hippocampal ; Carotid Artery, Common ; Cell Death ; Chromatin ; Circle of Willis ; Freezing ; Gerbillinae ; Hippocampus ; Ischemia ; Neurons ; Prosencephalon ; Pyramidal Cells

OBJECTIVE: Galvanic vestibular stimulation (GVS) activates the vestibular afferents, and these changes in vestibular input exert a strong influence on the subject's posture or standing balance. In patients with Parkinson's disease (PD), vestibular dysfunction might contribute to postural instability and gait disorders. METHODS: Current intensity was increased to 0.7 mA, and the current was applied to the patients for 20 minutes. To perform a sham stimulation, the current intensity was increased as described and then decreased to 0 mA over the course of 10 seconds. The patient's status was recorded continuously for 20 minutes with the patient in the supine position. RESULTS: Three out of 5 patients diagnosed with PD with postural instability and/or abnormal axial posture showed a reduction in postural instability after GVS. The score for item 12 of the revised Unified Parkinson's Disease Rating Scale part 3 was decreased in these patients. CONCLUSIONS: The mechanism of postural instability is complex and not completely understood. In 2 out of the 5 patients, postural instability was not changed in response to GVS. Nonetheless, the GVS-induced change in postural instability for 3 patients in our study suggests that GVS might be a therapeutic option for postural instability.
Gait ; Humans ; Parkinson Disease* ; Posture ; Supine Position

We report a case of pneumothorax successfully treated with hochuekkito.
The patient was a 56-year-old female, who was diagnosed with right-sided pneumothorax, and who improved after resting cure. However, her condition did not completely resolve. About three years later, we prescribed hochuekkito because her pneumothorax became worse with general fatigue. Five days after taking hochuekkito, the pneumothorax improved in her chest X-ray. But it became worse again, and finally she underwent an endoscopic operation. This case suggests the possibility that hochuekkito can improve pneumothorax temporally. There is no literature on Kampo therapy as it applies to pneumothorax, and we believe this case to be the first report of value on the subject.

Rikkunshito is known as a drug used for recovery from epigastric distress and loss of appetite. However, here we report four patients with symptoms involving non-gastrointestinal disorders successfully treated with rikkunshito. In Case 1 there was a complaint of erythema around the right eye, in Case 2 of hot flushes, in Case 3 of gonarthrosis, and in Case 4 of urticaria. After taking rikkunshito, these symptoms improved. The four cases were instances of hikyo, because in Cases 1, 3, 4 their disorders of the stomach were so severe that they couldn't take shishihakuhito, boiogito, jumihaidokuto and inchingoreisan, and in Case 2 there was poor appetite in summer. Thus we believe it is important to improve gastrointestinal symptoms with rikkunshito when various hikyo disorders arise.

Objective: The feasibility of peri-orbital electrodes, which are not invasive and do not induce pain, as a supplemental electrode for detection of ictal discharges in medial temporal lobe epilepsy (MTLE) was examined. Methods: Patients with MTLE, who underwent video-EEG monitoring with simultaneous peri-orbital and sphenoidal electrodes and obtained good outcome following standard anterior temporal lobectomy, were subjects in this study. Initial ictal discharge amplitudes were compared between sphenoidal (Sp1/ 2), standard anterior temporal in 10-20 system (F7/ 8), peri-orbital (superior orbital lateral: SOL, inferior orbital medial: IOM), frontopolar (Fp1/ 2), frontal (F3/4) and ear (A1/ 2) electrodes. Results: A total of 34 consecutive seizures from 20 patients were analyzed, with a maximum amplitude observed at Sp1/2 (57.57±5.59), followed by F7/8 (54.89±5.59), SOL (50.97±5.59), IOM (46.95±5.59), A1/2 (45.07±5.69), Fp1/2 (44.78±5.62), and F3/4 (37.75±5.66) (mean±standard error, μV). There was no statistical difference between Sp1/2, F7/8, SOL, and IOM values. When the sphenoidal electrode was omitted, 13 seizures (13/34, 38.2%) resulted in the highest amplitude at peri-orbital electrodes and 10 seizures (10/ 34, 29.4%) at F7/8. Conclusions: Peri-orbital electrodes could detect ictal discharges in MTLE as well as sphenoidal and standard anterior temporal electrodes in 10-20 system and are useful for supplemental recording for detecting ictal epileptiform discharges in MTLE.

We examined the complaints of adult patients with ‘weak’ sho symptoms using their first-visit medical questionnaires. Our subjects were 39 patients (3 males and 36 females) who fatigued easily, and who had a weak constitution with stress and the changing of seasons.
Over 60% of these ‘weak’ patients complained of excessive sensitivity to cold. The majority had stiff shoulders, a stiff neck, low back pain, sleeplessness, headache, fatigue of the eyes and vertigo. Their gastrointestinal constitutions were poor because of over eating.
Although we understood many of the complains these ‘weak’ patients had through their medical questionnaires, their chief complaints were various. We hope these results are useful in understanding treatments for patients with ‘weak’ sho.

We examined the complaints of adult patients with ‘weak’ sho symptoms using their first-visit medical questionnaires. Our subjects were 39 patients (3 males and 36 females) who fatigued easily, and who had a weak constitution with stress and the changing of seasons.Over 60% of these ‘weak’ patients complained of excessive sensitivity to cold. The majority had stiff shoulders, a stiff neck, low back pain, sleeplessness, headache, fatigue of the eyes and vertigo. Their gastrointestinal constitutions were poor because of over eating.Although we understood many of the complains these ‘weak’ patients had through their medical questionnaires, their chief complaints were various. We hope these results are useful in understanding treatments for patients with ‘weak’ sho.
seconds ; Weak ; Complaint, NOS ; Sleeplessness ; Financially poor

This study was conducted to clarify the relationship between power estimated by blood lactate movement during intermittent running test (Maximal Anaerobic Running Test : MART), and velocity of middle distance running (V 800 m, V 1500 m) . The subjects were well-trained male middledistance runners (n=8) .
MART consisted of a variable number of 20 seconds runs on a treadmill with a 100 seconds recovery period between runs. The runs were performed ona a 4° incline. After 40 second recovery, earlobe blood samples were taken and blood lactate concentrations were analyzed. The first run was performed at 250 m/min. Velocity of the treadmill was increased by 25 m/min for each consecutive run until volitional exhaustion.
The power requirement associated with the absolute value of blood lactate (La) and relative value of peak blood lactate (PBLa) was determined from the La or %PBLa vs power curve by linear interpolation from the two consecutive La values which were above and below the desired value.
Results were summarized as follows:
(1) Maximal power (Pmax) for MART was correlated positively with V800m (r=0.880, P<0.01) and V1500m (r=0.948, p<0.001) .
(2) Power estimated at 40% value of PBLa (P40%La) correlated positively with V 1500 m (r=0.903, P<0.01), and at 60% value of PBLa (P60%La) was correlated positively with V800m (r=0.835, P<0.01) and 1500m (r=0.936, p<0.001) .
These results indicate that MART is a valid test for estimating middle distance running performance and P40%La, and P60%La are important indexes with 800-m and 1500-m running.

Medical education in Japan has centered upon Western medicine since the Meiji Era. Nevertheless, because patients have a great interest in Oriental medicine, many physicians have treated patients with traditional Chinese medicine. The Oriental Medicine Research Institute of Tokyo Women's Medical University opened in 1992, when education in Oriental medicine became a part of the curriculum. To understand the status of education in Oriental medicine in Japan, we conducted a questionnaire survey of all medical schools in the nation. With a response rate of 97.5%, the survey found that one university in four teaches Oriental medicine.
Since 1990, recognition of “alternative medicine, ” in contrast to “modern medicine, ” has gradually increased in both research and education around the world. In Germany, which was the model for the introduction of western medicine to Japan, the use of traditional herbs and spa treatment is already taught in medical school. In the United States, where the National Institutes of Health have established an alternative treatment clinic, research and education are already ongoing at many medical schools.
In such a global situation, the need for education in traditional Oriental medicine will increase, and systematizing such education may become a great challenge. We expect that Oriental medicine will one day be taught at all medical schools in Japan and will become part of the state medical examination.