Background/Aims: Intestinal fibrosis is a major complication of Crohn’s disease (CD). The profibrotic protein transforming growth factor-β (TGF-β) has been considered to be critical for the induction of the fibrotic program. TGF-β has the ability to induce not only the expression of extracellular matrix (ECM) including collagen, but also the production of plasminogen activator inhibitor-1 (PAI-1) that prevents enzymatic degradation of the ECM during the onset of fibrotic diseases. However, the significance of PAI-1 in the developing intestinal fibrosis has not been fully understood. In the present study, we examined the actual expression of PAI-1 in fibrotic legion of intestinal inflammation and its correlation with the abnormal ECM deposition. Methods: Chronic intestinal inflammation was induced in BALB/c mice using 8 repeated intrarectal injections of 2,4,6-trinitrobenzene sulfonic acid (TNBS). TM5275, a PAI-1 inhibitor, was orally administered as a carboxymethyl cellulose suspension each day for 2 weeks after the sixth TNBS injection. Results: Using a publicly available dataset (accession number, GSE75214) and TNBS-treated mice, we observed increases in PAI-1 transcripts at active fibrotic lesions in both patients with CD and mice with chronic intestinal inflammation. Oral administration of TM5275 immediately after the onset of intestinal fibrosis upregulated MMP-9 (matrix metalloproteinase 9) and decreased collagen accumulation, resulting in attenuation of the fibrogenesis in TNBS-treated mice. Conclusions PAI-1-mediated fibrinolytic system facilitates collagen degradation suppression. Hence, PAI-1 inhibitor could be applied as an anti-fibrotic drug in CD treatment.

　The education program in all medical schools in Japan has been studied and analyzed every 2 years since 1974 by the curriculum committee of the Association of Japan Medical Colleges. Based on the most recent analysis in 2015, the marked innovation of medical education, such as an integrated curriculum, active learning, and clinical clerkship, was recognized.

This review represents the clinical significance of home blood pressure (BP) and its possible practical application. Home BP is highly reproducible and its reproducibility is better than ambulatory BP. According to this feature home BP has a greater prognostic value at least than clinic BP and is extremely effective for the evaluation of drug effects and their duration. The introduction of home BP to the diagnosis and treatment of hypertension facilitates long-term BP control. Home BP is particularly important for the diagnosis and treatment of hypertension in diabetes mellitus, pregnancy, children and renal diseases. Home BP measurements improve the adherence to medications and medical consultations, and are indispensable for diagnosis of white coat hypertension and masked hypertension. Such efficiency of home BP improves medical economy. Home BP can detect minimal charge in BP mediated by medication, and intrinsic and extrinsic stimuli and detect long-term change in BP. Thus, home BP is now indispensable for improvement in the management of hypertension in medical practice as well as for the recognition of hypertension in the general population. Standardization of the measurement procedure may elevate the position of home BP in the practice of diagnosing and treating hypertension.
Blood Pressure ; Child ; Diabetes Mellitus ; Fees and Charges ; Humans ; Hypertension ; Masked Hypertension ; Pharmacology, Clinical ; Pregnancy ; Referral and Consultation ; White Coat Hypertension

Introduction: Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA) and the previous reports show that may reduce nausea by inhibition of the serotonin 5-HT3receptor. Case report: A 38-year-old woman with advanced renal cancer with distant metastases was administered by sunitinib and oxycodone. Refractory nausea and vomiting developed during the course and mirtazapine at a daily dose of 1.875 mg was begun. The patient's nausea improved during the next day, and furthermore, by increasing the daily dose to 3.75 mg, vomiting was also improved on the third day. The therapy could be continued without withdrawal of sunitinib and oxycodone due to digestive symptoms. Although somnolence might be induced at a daily dose of 15 mg, the present low-dose mirtazapine could improve digestive symptoms without somnolence. Conclusion: We conclude that low-dose mirtazapine is one effective option for refractory nausea and vomiting during administration of sunitinib and oxycodone.

We studied 1809 oral cancer patients who visited and were treated in 2002 at the 148 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons, which is composed of 39 dental university hospitals, 44 medical university hospitals, 64 general hospitals, and 1 unknown institution. The patients consisted of 1071 (59.2 %) males and 738 (40.8 %) females (male:female ratio, 1.45:1), who had a mean age of 65.2 years old. The tongue (40.2 %) was the most common site affected, followed by the gingiva (32.7 %), buccal mucosa (10.1 %), and oral floor (9.0 %). There were 6 cases of intraoral multiple cancer. In histopathological examinations, squamous cell carcinoma (88.7 %) was the most common type found, followed by adenoid cystic carcinoma (2.1 %), and mucoepidermoid carcinoma (1.7 %). In addition, non-epithelial tumors comprised 1.8 % , among which malignant melanoma was the most common type. Cases classified as T2N0 were the most common (32.1 %), followed by T1N0 (21.4 %), T4N0 (8.0 %), and T2N1 (7.6 %). Distant metastasis occurred in 17 patients (1.0 %). The sizes of the non-epithelial malignant tumors ranged from 1.0 to 7.0 cm, with a mean size of 3.7 cm.
Asian Continental Ancestry Group ; Carcinoma, Adenoid Cystic ; Carcinoma, Mucoepidermoid ; Carcinoma, Squamous Cell ; Epidemiologic Studies ; Female ; Floors and Floorcoverings ; Gingiva ; Hospitals, General ; Hospitals, University ; Humans ; Male ; Melanoma ; Mouth Mucosa ; Mouth Neoplasms ; Neoplasm Metastasis ; Surgery, Oral ; Tongue

We studied 1809 oral cancer patients who visited and were treated in 2002 at the 148 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons, which is composed of 39 dental university hospitals, 44 medical university hospitals, 64 general hospitals, and 1 unknown institution. The patients consisted of 1071 (59.2 %) males and 738 (40.8 %) females (male:female ratio, 1.45:1), who had a mean age of 65.2 years old. The tongue (40.2 %) was the most common site affected, followed by the gingiva (32.7 %), buccal mucosa (10.1 %), and oral floor (9.0 %). There were 6 cases of intraoral multiple cancer. In histopathological examinations, squamous cell carcinoma (88.7 %) was the most common type found, followed by adenoid cystic carcinoma (2.1 %), and mucoepidermoid carcinoma (1.7 %). In addition, non-epithelial tumors comprised 1.8 % , among which malignant melanoma was the most common type. Cases classified as T2N0 were the most common (32.1 %), followed by T1N0 (21.4 %), T4N0 (8.0 %), and T2N1 (7.6 %). Distant metastasis occurred in 17 patients (1.0 %). The sizes of the non-epithelial malignant tumors ranged from 1.0 to 7.0 cm, with a mean size of 3.7 cm.
Asian Continental Ancestry Group ; Carcinoma, Adenoid Cystic ; Carcinoma, Mucoepidermoid ; Carcinoma, Squamous Cell ; Epidemiologic Studies ; Female ; Floors and Floorcoverings ; Gingiva ; Hospitals, General ; Hospitals, University ; Humans ; Male ; Melanoma ; Mouth Mucosa ; Mouth Neoplasms ; Neoplasm Metastasis ; Surgery, Oral ; Tongue

We experienced two cases of paralysis in the facial area treated with complementary oriental medicine.
Case 1
A 68-year-oid female presented herself in the emergency department at the Iwate Medical University with a complaint of facial deformity.
She was diagnosed as left facial paralysis with ptosis and drooping of a corner of the mouth.
In our clinic, she was first treated with stellate ganglion block, steroids and antivirals.
One week later, we adopted trans-cutaneous electric stimulation therapy and 2 months later used acupuncture. All the symptoms disappeared over a 9 month period.
Case 2
A 49-year-old female was referred to Iwate Medical University Department of Oral Maxillo-facial Surgery because of her facial itching and hypesthesia.
She was diagnosed as herpes zoster and transferred to our clinic. She was treated with stellate ganglion block, trans-cutaneous electric stimulation therapy and steroids.
One month later, her symptoms were partially lessened.
Two months later, a diagnosis of peripheral trigeminal nerve paralysis of the fist, second and third divisions, was established after a complete medical examination.
After that, her paresthesia gradually changed neuralgia-like in spite of our clinical care.
Five years later, her symptoms improved to a certain extent with the use of acupuncture.
Conclusion
We conclude that oriental medicine is effective in the treatment of paralysis.

We experienced a case of polymyalgia rheumatica (PMR) which responded to Kampo medicine. A 53-year-old female patient first complained of stiffness and pain in the neck. Myalgia was severe and gradually eypanded to both shoulders and both upper extremities. Body weight decreased, and the erythrocyte sedimentation rate (ESR) was greater than 100mm/hour. Because her condition tended to improve when treated with prednisolone 10mg/day, she was diagnosed as having PMR. Her condition was well controlled until the dose of prednisolone decreased. Myalgia then recurred, and the ESR increased to 83mm/hour. The patient visited our outpatient department for treatment with Kampo therapy. Two months after treatment with Sairei-to plus Yokuinin-to, all signs and symptoms disappeared other than the stiff neck. Her body weight showed a tendency to increase. Six months after she first visited us, prednisolone was decreased and then stopped. Her condition still remains well controlled with this Kampo therapy alone. She has no clinical signs and symptoms, and the ESR has improved to 16mm/hour.

In 1984 a 42-year-old female complaining of general malaise and loss of strength in the proximal muscles of the limbs came to the 2nd Department of Internal Medicine for an examination. From her high CPK value, electromyogram, muscle biopsy, etc., she was diagnosed as having polymyositis. Initially she responded well to steroids, but a year later the condition recurred. Treatment with various methods such as the immunosuppressants methotrexate and azathioprine, steroid pulse therapy and plasma replacement were tried without success. In September 1991, the patient's CPK value remained abnormal at about 800mU/ml. According to the Oriental Medical viewpoint, the condition was diagnosed as Kidney yin Deficiency. Rokumi-gan was therefore administered daily (7.5g/day) for a period of 80 days. The CPK value was brought down to the vicinity of 200mU/ml, and the feeling of general malaise and lack of strength in the proximal muscles of the limbs was improved. However, due to the persistence of edema in the lower limbs, the Kampo formula was changed from Rokumigan to Chorei-to, also administered at a dosage of 7.5g/day. This reduced the edema and normalized the CPK value to the 100mU/ml range. During this period, steroid administration was maintained with prednisolone (30mg/day). At present, with the improvement in the CPK value, steroid administration is gradually being reduced.