Background: Sarcopenia negatively affects the short-term prognosis of hospitalized older adults. However, no evidence currently supports a direct relationship between sarcopenia and readmission among individuals who have experienced an acute stroke. Therefore, we investigated whether sarcopenia is associated with readmission after discharge. Methods: This retrospective cohort study included patients who had experienced acute stroke. Sarcopenia was defined as the coexistence of low skeletal muscle mass index (SMI) and grip strength. We applied the log-rank test and Cox proportional hazards regression analysis to analyze whether sarcopenia, low SMI, and low grip strength were associated with readmission within 6 months. Results: Among 228 included patients (mean age, 72.8 years; 146 males), the prevalence of sarcopenia was 24.6% (n=56; male 17.8%; female 36.6%). Cox proportional hazards regression analysis using the propensity score as a covariate revealed that sarcopenia (hazard ratio [HR]=7.21; 95% confidence interval [CI] 1.45–35.8; p=0.016) and low skeletal muscle mass (HR=7.40; 95% CI 1.14–48.1; p=0.036), but not low grip strength (HR=1.42; 95% CI 0.281–7.21; p=0.670), were significantly associated with readmission for stroke within 6 months. Conclusions Sarcopenia was negatively associated with readmission within 6 months of stroke onset in patients in Japan who had experienced an acute stroke. These findings suggest that the identification of sarcopenia may facilitate prognostic prediction from the acute stage and intervention(s) to prevent rehospitalization.

Background: We assessed the relationship between patient age and remifentanil dosing rate in patients managed under general anesthesia with spontaneous breathing using low-dose remifentanil in sevoflurane. Methods: The participants were patients with an American Society of Anesthesiologists Physical Status of 1 or 2 maintained under general anesthesia with low-dose remifentanil in 1.5-2.0% sevoflurane. The infusion rate of remifentanil was adjusted so that the spontaneous respiratory rate was half the rate prior to the induction of anesthesia, and γH 　(µg/kg/min) was defined as the infusion rate of remifentanil under stable conditions where the respiratory rate was half the rate prior to the induction of anesthesia for ≥ 15 minutes. The relationship between γH and patient age was analyzed statistically by Spearman's correlation analysis. Results: During dental treatment under general anesthesia using low-dose remifentanil in sevoflurane, a significant correlation was detected between γH and patient age. The regression line of y = − 0.00079 x + 0.066 (y-axis; γH , x-axis; patient's age) was provided. The values of γH provide 0.064 µg/kg/min at 2 years and 0.0186 µg/kg/min at 60 years. Therefore, as age increases, the dosing rate exhibits a declining trend. Furthermore, in the dosing rate of remifentanil when the patient's respiratory rate was reduced by half from the preanesthetic respiratory rate, the dosing rate provided was around 0.88 mL/h in all ages if the remifentanil was diluted as 0.1 mg/mL. EtCO2 showed 51.0 ± 5.7 mmHg, and SpO2 was controlled within the normal range by this method. In addition, all dental treatments were performed without major problems, such as awakening and body movement during general anesthesia, and the post-anesthetic recovery process was stable. Conclusion General anesthesia with spontaneous breathing provides various advantages, and the present method is appropriate for minimally invasive procedures.

Behçet’s disease (BD) is a multisystem inflammatory disease of unknown origin. Rarely, BD occurs together with myelodysplastic syndrome (MDS). Interestingly, it is speculated that these are not simple coexistence but that the etiology of intestinal BD is at least partly derived from MDS itself. Furthermore, there is a relationship between MDS in patients with intestinal BD and trisomy 8. Immunosuppressive agents alone are insufficient to control MDS-associated BD, and many of these patients die of infection or hemorrhage. Surgery is considered for intestinal BD patients who are unresponsive to medical treatment or those with bowel complications such as perforation or persistent bleeding. We report a case of intestinal BD associated with MDS and trisomy 8. The patient was unresponsive to oral steroids and immunosuppressive treatment; the patient improved by surgical repair of a bowel perforation. Five years after the surgery, the patient is free of recurrence and not on medication. Our experience suggests that surgery may provide an effective therapeutic option for the treatment of MDS-related BD.

The purpose of this study was to assess the status of nutrients intake in male Japanese collegiate athletes. Each 20 of baseball (B), soccer (S), volley ball (V), and long distance (L) athletes participated in this study. The B, S, and V athletes lived by themselves, whereas the L athletes lived in an athletes dormitory with provided meal. The nutritional status was assessed for 2 days. Mean energy intakes in the B, S, V, and L groups were 43.6, 53.7, 47.0, and 55.0 kcal/kg body weight, respectively. Mean protein intakes were 1.2, 1.6, 1.3 and 2.4 g/kg, respectively. In B athletes, skipping of breakfast was recognized frequently. Most of micronutrients intakes in the B, S, and V groups were less than the recommended dietary allowances for athletes. We suggest that a provided meal system is a better system for collegiate athletes and more nutritional education is necessary for Japanese male collegiate athletes, in particular, those living by themselves.

We examined three cases where Kampo medicine had effects on palindromic rheumatism. All the patients are men with arthralgia accompanied by redness, fever, and swelling. All cases are RF negative. Cases 2 and 3 are brothers. Case 1: A 58-year-old patient with recurrent arthralgia on shoulders, hands, and legs for 30 years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) was noted, the administration of Sho-Saiko-to reduced the symptom.
Case 2: A 40-year-old patient with recurrent arthralgia on shoulders, hands and legs for nine years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) was noted, the administration of Eppi-ka-jutsu-to-go-Shigyaku-san-ryo was replaced, which reduced the symptoms.
Case 3: A 46-year-old patient with recurrent arthralgia on knees and fingers, and pain in hip joints. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) were noted, the administration of Shigyaku-san reduced the symptoms.
All cases were typical palindromic rheumatism, and Eppi-ka-jutsu-to was effective to a certain degree. Kampo diagnosis of Saiko (Saiko-sho) was made and additional Saiko-drugs (Saiko-zai) reduced the frequency, the degree, and the length of the period of symptoms.

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.

Idiopathic thrombocytopenic purpura is an autoimmune disease and is caused by a blood antiplatelet antibody that reacts to thrombocyte membrane. The platelet associated immunoglobulin G (PAIgG) is admitted in idiopathic thrombocytopenic purpura.
Adrenocortical steroids are our first choice as a treatment for idiopathic thrombocytopenic purpura.
However, a sufficient thrombocyte increase is not obtained even when adrenocortical steroids are administered to the idiopathic thrombocytopenic purpura patient.
On the other hand, we use Kampo medicine widely clinically. We are admitting the effectiveness of Kampo medicine in treating many refractory diseases. Even if it corresponds to idiopathic thrombocytopenic purpura that is one of a chronic refractory disease effective Kampo medicine is reorted several Kampo pharmaceutical preparations that are assumed when it is effective in idiopathic thrombocytopenic purpura are Sairei-to, Sho-saiko-to, Kami-kihi-to, etc.
This time we carried out Kampo therapy (Rikkunshi-to, Shimatsu-to) on patients with digestive and cutaneous problems but no other symptoms of hemopathy. A blood specialist at this university hospital tentatively diagnosed the patients' condition as thrombocytopenic purpura. Kampo therapy increased the thrombocyte count and alleviated the symptoms.
This result might suggest the possibility of a therapy for idiopathic thrombocytopenic purpura and even the importance of the therapy in accordance with the oriental medical syndromes.

We reported that a patient with ascites arising from liver cirrhosis was successfully treated with Dai-kentyu-to. The case was a 67-year-old woman who was diagnosed as having C-type chronic hepatitis. After the operation of gastric cancer, ascites appeared. She was treated by diureatics, but ascites increased. When she was operated on for an abdominal hernia, the liver was cirrhotic. She lost appetite and was fatigued. She visited our clinic to undergo Kampo therapy. Hochu-ekki-to, Gorei-san, Sho-kenchu-to were given for her symptoms, but had no effects. However, since she began taking Dai-kenchu-to for her cold and rumbling abdomen, her ascites decreased gradually, and diuretics were stopped.

The term “half exterior half interior” is not found in the Oriental Medical Classic, the ‘Shang Han Lun’. Rather, the phrase “half outside and half inside” appears. It was Cheng Wu Ji that first used the term “half exterior half interior” in the phrase “Those in whom the disease-causing agent is half in the exterior and half in the interior are considered to be of the fever manifestation-type” appearing in his ‘Shang Han Ming Li Lun’. In the ‘Zhu Jie Shang Han Lun’ which Cheng Wu Ji wrote shortly afterwards, he explains that the phrase “half outside and half inside” found in the ‘Shang Han Lun’ means half exterior and half interior. Since this commentary on the ‘Shang Han Lun’ was more frequently published and more widely circulated than the original text, it is thought to be this explanation that accounts for the popularization of the term “half exterior half interior”.