Objectives: Locomotive syndrome (LS) leads to reduced physical function and a high risk of becoming bedridden.Grip strength serves as an indicator of upper limb and overall physical function. Rheumatoid arthritis (RA) patients with reduced grip strength frequently show finger and wrist joint inflammation. The purpose of this study was to verify grip strength as an evaluation tool for physical function and LS in RA patients. Methods: As part of an ongoing multicenter observational study, 591 consecutive RA patients whose background information was available, including data for the 25-question Geriatric Locomotive Function Scale (GLFS-25) and grip strength, were examined. LS was defined as a GLFS-25 score ≥ 16 points. Finger and wrist joint inflammation were defined as tender or swollen joints. Results: Among the 591 patients, 244 (41.3%) patients had LS, and 167 (28.3%) were male. Receiver operating characteristic curve analysis yielded cut-off values of grip strength for LS of 24 kg (specificity 72.2%; sensitivity 62.7%) for males and 17 kg (specificity 65.7%; sensitivity 67.6%) for females. Multivariable logistic regression analysis revealed a significant association of grip strength with LS, even after adjusting for finger and wrist joint inflammation. Conclusions LS was significantly associated with grip strength, even after adjusting for the presence of finger and wrist joint inflammation. We recommend adopting grip strength measurement as a screening tool for evaluating LS and guiding interventions.

Objective: Pharmacists need to know at what positioning a drug is recommended in clinical practice guidelines when they make prescription proposals.  However, the format of guidelines and the definition of recommendation grades differ between academic societies, making it difficult to comprehensively extract only the information one needs.  Therefore, we developed a guideline utilization system to support prescription proposals by pharmacists.
Methods: We built a database comprised of clinical practice guidelines on pharmacological therapy for breast cancer and breast cancer-related conditions.  FileMaker®was used in the development of the system.
Result: This system allows the comprehensive extraction of clinical questions and recommendations from multiple guidelines by means of standardized keywords.
Conclusion: This system supports prescription proposals by pharmacists when generating pharmacological therapy protocols or when in discussions with healthcare professionals as information on the positioning of therapeutic agents in different guidelines and recommended drugs is readily available.

　　A 63-year-old woman was admitted with complaints of thirst and polyuria about 1 year after ceasing therapy in November, X and in October, X+1. Her blood glucose levels at the beginning of her admissions were 347 at the first admission and 486 at the second admission. We administered glargine, a long-acting type insulin, 8U/day, and　a short-acting insulin, glulisine, 4U/day, during the first admission. We administered glargine, a long-acting type insulin, 4U/day, and a short-acting insulin, glulisine, 3U/day, during the second admission. We also administered a GLP-1 receptor agonist, liraglutide, 0.3mg/day. Blood glucose levels (mg/dl) during the 5 days of the first admission were as follows: first, -, -, 347, and 180; second, 273, 266, 109, and 188; third, 75, 192, 186, and 182; fourth, 93, 194, 91, and 144; fifth, 78, 95, 124, and 127. In the second admission, blood glucose levels were as follows: first, -, -, 486, and 299; second: 140, 137, 195, and 128; third: 101, 122, 114, and 108; fourth: 101, 123, 123, and 137; and fifth, 89, 136, 111, and 129. CGM data showed an average of 128mg/dl and standard deviation of 34 during the first admission. CGM data showed an average of 125mg/dl and standard deviation of 20 during the second admission. The reduction of insulin and rapid flattening of blood sugar were achieved by GLP-1 receptor agonist with promotion of insulin secretion and suppression of glucagon secretion.

　　It is said that diabetes is one of the factors contributing to the onset of dementia and accelerating its progression. The number of dementia cases is expected to increase steadily year by year. Such being the circumstances, we encountered an elderly woman with diabetes and dementia, who managed to lower her blood glucose values to a proper level somehow or other, thus lightening the burden of caregivers. We shall hereby report the case because we thought it would make a good example for care in the region where the population is rapidly graying. The woman, then at age 80, visited our hospital complaining of languidness. Her blood sugar level was so high (random blood glucose level: 1,096 mg/dl) that she was hospitalized at once. By a stepwise insulin reinforcement therapy, the blood glucose levels were under control. During the stay in hospital, she was also diagnosed as having senile dementia. She was provided with effective health care and education for the control of blood sugar levels. Having snacks between meals was strictly prohibited. Considering that she was an elderly person living alone, only internal medicines were given. As a result, her blood glucose levels were elevated to about 300 mg/dl, but the combined use of GLP-1 injection and internal medicine once a week had good control over blood glucose levels. So, the patient was discharged from the hospital.

Background: Total pancreatectomy (TP) for pancreatic neoplasms has not been shown to confer any benefit over less aggressive resections, and is associated with high morbidity and mortality rates. Recently, clinical indications for TP are increasingly reported, with advances in surgical techniques, improvements in glycemic monitoring, and the development of synthetic insulin and pancreatic enzymes. TP is indicated for patients with large invasive tumors, multifocal intraductal papillary mucinous neoplasms, multifocal islet cell neoplasms, and longstanding chronic pancreatitis. Clinicophysiological findings after TP have only been reported in a small number of cases, however. The aim of this study was to evaluate clinicophysiological outcomes after TP. Methods: A total of 41 patients who underwent TP between 2007 and 2013 at Tokyo Women’s Medical University were examined retrospectively. Clinicophysiological parameters (BMI, HbA1c, albumin, creatinine, total cholesterol, triglycerides, WBC, lymphocytes, hemoglobin, HU level of the liver in CT) were collected and analyzed from preoperative state to 12 month after TP (preoperative condition,1 month, 3 months, 6 months, and 12 months after TP). Basal, bolus, and total insulin as well as pancreatic enzymes, were also measured 12 months after TP. Average values were compared with Student’s t-test, and numeric data are expressed as mean ± SD. Results: There were 23 male and 18 female patients. The mean age was 65.2 years (range, 47–77 years). There were 25 patients with intraductal papillary mucinous neoplasms (5 low grade, 8 high grade, and 12 invasive); 13 with invasive pancreatic ductal carcinoma; 1 with intraductal tubulopapillary neoplasm; and 2 with multiple pancreatic metastases from renal cell carcinoma. Twenty-eight patients underwent pylorus-preserving TP (PPTP); 8 underwent subtotal stomach-preserving TP (SSPTP); and 5 underwent duodenum-preserving TP (DPTP). Preoperative measurements were as follows: BMI, 21.02 ± 0.46 kg/m2; HbA1c, 6.42 ± 0.21% (29.3% of patients used insulin) and liver attenuation on CT, 63.05 ± 0.90 HU. No statistically significant differences in clinicophysiological parameters were observed, except in HbA1c, which was significantly different between the preoperative state and 12 months after TP. Albumin, creatinine, lymphocytes and hemoglobin were decreased at 1, 3, and 6 months after TP, but had normalized by 12 months. Basal insulin was 5.84 ± 0.55 U; bolus insulin, 24.79 ± 1.15 U; total insulin, 30.44 ± 1.48 U; and volume of pancreatic enzymes (lipase) was 18000 U, 12 month after TP. Conclusions: Several clinicophysiological parameters, with the exception of HbA1c, were temporarily decreased after TP, but had normalized by 12 months. Therefore, treatment of pancreatic neoplasms with the potential to spread across the entire pancreas by TP is feasible, and should be supplemented with adequate administration of synthetic insulin and pancreatic enzyme supplements.

Background: Total pancreatectomy (TP) for pancreatic neoplasms has not beenshown to confer any benefit over less aggressive resections, and is associatedwith high morbidity and mortality rates. Recently, clinical indications for TP areincreasingly reported, with advances in surgical techniques, improvements inglycemic monitoring, and the development of synthetic insulin and pancreaticenzymes. TP is indicated for patients with large invasive tumors, multifocalintraductal papillary mucinous neoplasms, multifocal islet cell neoplasms, andlongstanding chronic pancreatitis. Clinicophysiological findings after TP haveonly been reported in a small number of cases, however. The aim of this studywas to evaluate clinicophysiological outcomes after TP.Methods: A total of 41 patients who underwent TP between 2007 and 2013at Tokyo Women’s Medical University were examined retrospectively.Clinicophysiological parameters (BMI, HbA1c, albumin, creatinine, totalcholesterol, triglycerides, WBC, lymphocytes, hemoglobin, HU level of the liverin CT) were collected and analyzed from preoperative state to 12 month after TP(preoperative condition,1 month, 3 months, 6 months, and 12 months after TP).Basal, bolus, and total insulin as well as pancreatic enzymes, were also measured12 months after TP. Average values were compared with Student’s t-test, andnumeric data are expressed as mean ± SD.Results: There were 23 male and 18 female patients. The mean age was 65.2years (range, 47–77 years). There were 25 patients with intraductal papillarymucinous neoplasms (5 low grade, 8 high grade, and 12 invasive); 13 withinvasive pancreatic ductal carcinoma; 1 with intraductal tubulopapillaryneoplasm; and 2 with multiple pancreatic metastases from renal cell carcinoma.Twenty-eight patients underwent pylorus-preserving TP (PPTP); 8 underwentsubtotal stomach-preserving TP (SSPTP); and 5 underwent duodenum-preservingTP (DPTP). Preoperative measurements were as follows: BMI, 21.02 ± 0.46 kg/m2;HbA1c, 6.42 ± 0.21% (29.3% of patients used insulin) and liver attenuation on CT,63.05 ± 0.90 HU. No statistically significant differences in clinicophysiologicalparameters were observed, except in HbA1c, which was significantly differentbetween the preoperative state and 12 months after TP. Albumin, creatinine,lymphocytes and hemoglobin were decreased at 1, 3, and 6 months after TP, buthad normalized by 12 months. Basal insulin was 5.84 ± 0.55 U; bolus insulin,24.79 ± 1.15 U; total insulin, 30.44 ± 1.48 U; and volume of pancreatic enzymes(lipase) was 18000 U, 12 month after TP.Conclusions: Several clinicophysiological parameters, with the exception ofHbA1c, were temporarily decreased after TP, but had normalized by 12 months.Therefore, treatment of pancreatic neoplasms with the potential to spread acrossthe entire pancreas by TP is feasible, and should be supplemented with adequateadministration of synthetic insulin and pancreatic enzyme supplements.

This study was conducted to assess the ability of two-dimensional tissue tracking (2DTT) to evaluate changes in left ventricular (LV) myocardial function associated with sustained high electrical pacing. Pacemakers were implanted at the right ventricular (RV) apex of five female Beagles, and sustained high electrical pacing of 250 beats per minute (bpm) was performed for three consecutive weeks. Conventional echocardiography and 2DTT were performed at baseline, and at every week for three weeks with pacing. The baseline parameters were then compared to those of weeks 1, 2, and 3. Three weeks of pacing resulted in significant reduction of radial and circumferential global strains (p < 0.001). Regional analysis revealed reduction of segmental strains in both radial and circumferential directions, as well as increased dyssynchrony after three weeks of pacing in the radial direction (p = 0.0007). The results of this study revealed the ability of 2DTT to measure radial and circumferential strains in dogs with sustained high-electrical pacing, and allowed assessment of global and regional myocardial function and the degree of dyssynchrony.
Animals ; Cardiac Pacing, Artificial ; Dogs ; Echocardiography/*methods ; Female ; Heart Rate ; Heart Ventricles/*ultrasonography ; *Ventricular Function, Left

[Introduction]Recently, in the development of information technology, VDT workers are increasing rapidly. Physical and mental health symptoms associated with working at visual display terminals (VDTs) are controversial. However, there are few studies about the effect of acupuncture treatment on eye fatigue, neck and shoulder stiffness that many VDT workers have.
Therefore, in this prospective study, we examined the effect of acupuncture treatment for complaints of VDT workers.
[Methods]Sixty-one VDT workers participated as subjects (41 males, 20 females). Acupuncture sessions were performed once a week for four weeks. Acupuncture points were decided by the patient's muscleskeletal distress.
Disposable press tack needles were used. Visual Analogue Scale (VAS) was used to determine eye fatigue, neck and shoulder stiffness. Improvements of each VAS were evaluated. Then we analyzed improvement on shoulder and neck stiffness associated with eye fatigue.
[Results]The neck and shoulder distress of patients was reduced in four weeks by acupuncture treatment. A regular correlation between the improvement rate of eye fatigue and neck/shoulder stiffness was observed.
[Conclusion]The neck and shoulder stiffness was improved by acupuncture treatment. According to improved symptoms, eye fatigue was mitigated as well. Thus it was suggested that utility of acupuncture is high in the field of industrial medicine.

1) We visited 4 universities in Germany, from where medical systems were once introduced to Japan as a model of modern medicine, and investigated the present conditions of medical education.2) The reform of curricula and methods of medical education has been actively performed in Germany, as it has been in Japan.