The peptidase entity of angiotensin-converting enzyme 2 (ACE2) accommodates the receptor-binding domain of SARS-COV2 spike (S) protein initiating cell infection.Compounds binding to ACE2 or the S-protein have the potential to impair cell entry by the virus.The ACE2 substrate angiotensin II (ANGII) shares common amino acid sequences with the S-protein.This study focuses on one sequence, the N-terminal valine/arginine/aspartate peptide of ANGII.Computer modeling identifies relative molecular similarity within the tripeptide sequence and ligands for ACE2, ANGII and sigma receptor proteins with in vitro toxicity for SARS-CoV2.Molecular similarity is also evident within drug structures of several neurotransmitter classes and agents from natural sources.Application of these observations may prove useful for the further development of SARS-CoV2 antiviral drugs.
Objective: The aim was to identify factors influencing patient motivation for cancer treatment to obtain information for the realization of satisfactory survivorship. Methods: A 44-item questionnaire survey was conducted with cancer patients attending three university hospitals in Japan between September 2015 and January 2016. The relationships of patient motivation for treatment with patient background factors (cancer type, sex, age, performance status, treatment content, and family environment), treating physician’s judgment, physical/emotional symptoms, impact on job (work or housework, job performance), and economic status were investigated. Results: Completed questionnaires were collected from 969 patients (response rate, 88.4%).A multivariate logistic regression analysis showed that treating physician’s judgment to recommend the patient to receive treatment (odds ratio [OR] = 1.88, p = 0.049) and patient concern about disease progression (OR = 1.39, p = 0.007) were significantly correlated with greater patient motivation for treatment. Impact on job (being unable to work or do housework as before) (OR = 0.38, p = 0.011) and economic status (reduced patient income) (OR = 0.39, p = 0.023) were significantly correlated with lower patient motivation for treatment. Conclusion: This is the first study of patients with a wide range of cancer types to explore factors influencing patient motivation for treatment. Four influencing factors were identified. Further research is needed to determine whether supportive measures for these factors are useful in enhancing cancer survivors’ motivation for treatment. keywords: medical Education, undergraduate, quality improvement, patient safety, service-learning 2020; 2(1): 412– 422.doi: 10.31488/jjm.152
Water is a tasteless, odorless, and nearly colorless chemical substance that is the main constituent of most living organisms. On the other hand, water posesses a number of unique properties which can be explained by natural science only insufficiently. This present study used current cell biological methods to investigate whether tap water, after passing through an unique AO water activator, has received and stored informations that induce beneficial health effects. The effects of AO water on cultured cells (connective tissue fibroblasts and functional neutrophils) were directly compared with the initial tap water without activation. The results show an increased dose-dependent basal metabolic activity for both cell types and an increased regeneration/wound healing process for connective tissue fibroblasts when treated with AO water in comparison to initial tap water. Thus, AO water has clearly demonstrated its beneficial efficacy in relationship to cell metabolism, cell regeneration and front-line defense against invading (microbial) pathogens. From the experiments, a continuous daily intake of AO water can be highly recommended for the improvement and maintenance of well-being. 330 Japan Journal of Medicine 2018; 2(1): 330 334 . doi: 10.31488/jjm.1000135
Mobile phone modulation technologies like LTE, UMTS and GSM are now fully established. Among these, mobile phones have been considered to emit only a radiation with low intensities when they are actively working and are placed near to the head. However, the safety aspects are not cleared evaluated. To address this topic, we have already investigated the cellular effects of DECT base radiation and its compensation by multiple compartment cavity resonance devices (RD). Prompted by this background, this study compares the efficacy of a second-generation RD with an optimized design in comparison to the first-generation RD used in previous studies. Connective tissue fibroblasts (cell line L-929) were exposed to the radiation of an actively transmitting commercially available mobile phone with 1.25 W/m2 at the level of the cells with and without the two different RD directed crosswise towards the cell layer during mobile phone irradiation. Unexposed cells in a similar incubator served as corresponding controls. The resulting cell vitality was checked by measurement of the enzymatic activity of mitochondrial dehydrogenases by the color change of the sodium salt 2,3-bis[2-methoxy-4-nitro-5-sulfo-pheny]-2H-tetrazolium-5-carboxyanilide (XTT). The results clearly demonstrate that exposure to mobile phone radiation caused a significantly reduced cell vitality by more than 50 % for non-thermal radiation with an intensity of 1.25 W/m2 at the level of the cells. The decreased cell vitality after mobile phone radiation exposure could be largely compensated by use of two crossed RD directed towards the cells. However, the newly designed RD construction was even more effective (reduction of cell vitality by 13.01 ± 1.86 %; mean value ± standard deviation) than the standard RD (reduction of cell vitality by 20.17 ± 2.16 %; mean value ± standard deviation) which has been already used successfully to compensate digitally enhanced cordless telecommunication (DECT) phone base station radiation.
Introduction Medication-related osteonecrosis of the jaw (MRONJ) results from infection and side effect by antiresorptive agents and angiogenesis inhibitors that it causes healing failure of the upper and lower jaw and soft tissue [1,2]. The approaches to dental issues and treatment of MRONJ showed reduced incidence and severity, but MRONJ may still adversely affects quality of life (QOL) and produces substantial morbidity [3]. The current national survey revealed a rapid rise in the number of cases of MRONJ in recent years in Japan [4]. This report presents; 1) pathophysiology of the disease, 2) therapy of MRONJ, and 3) management of MRONJ, mainly.
The purpose of this study is the evaluation of the difference in elicited EuroQol-5-Dimension Questionnaire (EQ-5D) health utility values across the range of different health states derived from the UK, Japanese tariffs.Hence, we conducted a comparative study on UK and Japanese Value Sets of EQ-5D-3L and 5L.Distributions of EQ-5D-3L tariffs were compared between the Japanese and UK versions.For the Japanese tariff, the mean value of Utility was 0.423 (mean)±0.217(standard deviation: SD), and that for the UK tariff was 0.147±0.312;the median value for the Japanese tariff was 0.466, the minimum value -0.106, and for the UK tariff, the median was 0.122, the minimum value -0.594.Furthermore, distributions of EQ-5D-5L tariffs were compared between the Japanese and UK versions.The mean values of Utility for the Japanese and UK tariffs were 0.449±0.154and 0.391±0.228,respectively; the median value for the Japanese tariff was 0.450, minimum value -0.0.25, and for the UK tariff, the median was 0.396, the minimum value -0.281.The correlation between the Japanese and UK tariffs for EQ-5D-3L was R2＝0.739,RSME＝0.160.For EQ-5D-5L, the correlation between the Japanese and UK tariffs was R2＝0.907,RSME＝0.069.We clarify Japanese and UK value sets was closer in EQ-5D-5L than in EQ-5D-3L.Moreover, the correlation was observed more prominently in EQ-5D-5L than in EQ-5D-3L as well.Therefore, it is recommended that in the future we should use EQ-5D-5L in Japan when conducting a clinical study to collect health state data using EQ-5D.
Background: Diabetic nutritional treatment involves the discussion of Low Carbohydrate Diet (LCD) and Calorie Restriction (CR). Authors have initiated and developed LCD in Japan and continued clinical research. In this study, we investigated glucose variability in patients with type 2 diabetes mellitus (T2DM). Subjects and Methods: Subjects were 60 T2DM patients of 62.7 years in average with its fasting immunoreactive insulin (IRI) less than 5μU/mL. Methods include basal blood test, daily profile of blood glucose and insulinogenic index (IGI) for 70g of carbohydrate (0-30min) in CR breakfast. Correlation among these and comparison in 4 groups categorized by Morbus value were analyzed. Results: Basal data revealed HbA1c 7.9%, daily glucose 222 mg/dL in average, and Triglyceride 83 mg/dL, Morbus value 150, HOMA-R 1.1, HOMA-β 11.0 in median. Delta Ratio of IGI and AUC ratio of IGI showed significant correlations with M value and HbA1c (p<0.01). Discussion and Conclusion: Meal Tolerance Test (MTT) has been recently used for convenient methods and meaningful results. AUC ratio suggests a little superior than Delta ratio for its higher correlation coefficient. These results would become the basal data in this field, and further development of related research is expected in the future.
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that affects many tissues and organs, but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints. Various conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) have been used to reduce disease activity. Methotrexate (MTX) is currently the most frequently used in the treatment of RA, and its hematological toxicity is well documented. Meanwhile, as for the other csDMARDs, hematological toxicity remains to be fully investigated. In the clinical practice we sometimes encounter large mean corpuscular volume (MCV) and low disease activity in RA patients treated with MTX. Additionally, we also encounter large MCV in RA patients without using MTX. The purpose of our study was to investigate the association between MCV and disease activity, and the association between MCV and vitamins associated with hematopoiesis. In this study a total of 70 patients with RA were evaluated. All patients were treated without MTX. These 70 patients were analyzed for the correlation between disease activity and other variables. Significant inverse correlations were present between CRP and age, and MCV and hemoglo-bin. However, serum levels of folic acid and vitamin B12 were not significantly correlated, respective-ly. The correlation between CRP quintile and other variants was tested by Spearman rank-order correlation coefficient. Significant inverse correlations were present between CRP and MCV. As for MCV, the fluctuation was within the normal range, but the more the CRP increased, the more MCV decreased. In contrast, the other variants including sex, age, hemoglobin, folic acid and vitamin B12 were found not to be significant. Our data suggested that change of MCV was depend on the inflammation and was not related to the level of folic acid and vitamin B12 .
Patients' right to self-determination is sure to receive increasing support in the future.As a result, physicians will need to be much more respectful of patients' decisions, and their own discretion during treatment will be restricted.Nevertheless, physicians must also uphold their professional obligations to care for patients' life and health.When this obligation is emphasized, physicians' discretion tends to be more readily accepted.Physicians must also explain the risks involved in possible treatments, not only to respect patients' right to self-determination, but also to meet their own professional obligations related to preserving patients' dignity.In other words, physicians must honor both patients' right to self-determination and their own duty to provide medically appropriate care to the patient.The overlap of these two obligations does not appear to be fully resolved.The recent advent of the concept of libertarian paternalism-that is, interfering in individual decision-making to improve choosers' situation while trying to preserve their freedom of choice-offers hope for an ideal synthesis between these obligations.However, as libertarian paternalism has not yet been fully realized in medical practice in Japan, further investigation and dissemination of research findings is necessary.
Management of cobalamin deficiency with vitamin B12 injections is currently well codified, but new routes of vitamin B12 administration (oral and nasal) are being studied. In the setting of Biermer’s disease, two prospective controlled randomized studies, a recent systematic review by the Cochrane group and four prospective studies were found and provide evidence that oral vitamin B12 treatment may adequately treat cobalamin deficiency. The efficacy was particularly highlighted when looking at the marked improvement in serum vitamin B12 levels and hematological parameters, for example hemoglobin level, mean erythrocyte cell volume, reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. Oral cobalamin treatment avoids the discomfort, inconvenience and cost of monthly injections. 276 Japan Journal of Medicine 2018; 1(6): 276 284 . doi: 10.31488/jjm.1000128
Background Immuno-cell therapy using activated lymphocytes (ALs) and/or dendritic cells (DCs) is considered one of the less toxic supportive therapies compared with conventional chemotherapy and radiotherapy, especially for the treatment for advanced cancers. To improve the efficacy of immuno-cell therapy for such cancer, clinical data were analyzed in this preliminary study.Patients and methods The clinical data of 38 consecutive patients with advanced cancer who underwent at least one course of treatment with ALs and/or matured DCs, with or without antecedent surgery or additional conventional chemotherapy and/or radiotherapy, were evaluated.Results Of the 23 patients who received surgery before immuno-cell therapy, 2 (8.7%) showed a complete response (CR) and 15 (65%) showed a partial response (PR) or prolonged stable disease (SD). Of the 15 remaining patients who did not undergo antecedent surgery, there was no CR but 7 (46%) showed PR or prolonged SD. Actuarial survival is one of the important indices for the evaluation of anticancer therapies that present longer durable efficacy of immunotherapy compared with conventional anticancer chemotherapy and radiotherapy, and actuarial survival analysis revealed that immuno-cell therapy with antecedent surgery afforded significantly longer survival than immunocell therapy without antecedent surgery (P < 0.001).Conclusion Antecedent surgical resection of tumors is advisable for obtaining better efficacy of immuno-cell therapy, even in advanced cancer patients.
Royal Navy believed in physiognomy, i.e., the "art" of identifying the character of a person based on the shape of his (or her) face.Darwin's third daughter, Henrietta Litchfield (1843Litchfield ( -1927)), later pointed out that captain FitzRoy had "made up his mind that no man with such a nose could have energy".Fortunately, however, "his brow saved him", so that he was offered the job [3].As detailed in biographies on the biologist and geologist Charles Darwin, the young traveler suffered from sea-sickness so that, during the five years of his trip to South America, he repeatedly thought of ending his life by jumping into the cold ocean waters.Nevertheless
Psychiatric inpatients are likely to develop constipation and it is generally considered due to the adverse effect of psychotropic drugs.However, the analytical results of drug surveys in inpatients of Tottori Medical Center suggested that not only drugs but also treatment environment strongly influence constipation.If psychiatric treatment is administered at a lower dose in a free environment, it may be possible to improve abnormal autonomic nerve functions such as constipation.
Once subtotal or total meniscectomy of the knee joint decreases tibiofemoral contact area leading to higher contact stresses, it deteriorates the cartilage resulting in faster progression of the osteoarthritis (OA).Because neither artificial implants nor autologous grafts have been established for the painful meniscus-deficient knees of young patients, meniscal allograft transplantation (MAT) has been thought to be a better alternative procedure to reduce higher stresses and prevent OA.In this paper, literatures concerning MAT are reviewed about the indications, contra-indications, meniscal allografts, complications, outcomes and rehabilitation.By presenting our experience, the medico-social problem of MAT in Japan is also discussed.
Background: Knowledge on under-five childhood immunization has been identified as a key factor in determining understanding and compliance to the schedule.Understanding the current levels of knowledge and introducing a health intervention to improve the level will benefit the population to be healthier and reduce morbidity.Methods: A quasi-experimental study was conducted in nurseries in Putrajaya and Cyberjaya from January 2016 to January 2018.98 respondents from Putrajaya were the intervention group and 98 from Cyberjaya were the wait-listed control group.The intervention was a technology based health education module.Intervention groups received the intervention through the messaging service of Whatsapp at pre-determined intervals.Respondents answered a validated, self-administered questionnaire at baseline, immediately post-intervention and 3 months post-intervention that were specifically targeted to examine their levels of knowledge.Results: Data was analyzed using Statistical Package for Social Science (SPSS) Version 23.The level of knowledge at baseline was 58.9% for the intervention group and 61.7% for the control group with no significant difference between both groups.At 3 months post-intervention the intervention group was 95.5% and the control was at 85.1%.Immediate post intervention showed a big gap between both groups.Conclusion: The level of knowledge improved after receiving the health intervention module and was effective in the increasing of knowledge among the respondents.However, there are still gaps in research that must be addressed in future studies to help further improve knowledge on under-five childhood immunization schedule.
Constrictive pericarditis (CP) is a form of heart failure related to constrictive physiology.Every patient presenting with right heart failure should be examined for CP using multimodality diagnostic tools.One of the most important diagnostic clues would be clinically suspected presence of CP in patients with signs and symptoms of right sided heart failure that are disproportionate to pulmonary or left sided heart disease.Hence, investigations have a crucial importance, because a surgical operation can be curative when an appropriate diagnosis is made without missing the right timing.
Diabetic osteopenia is recognized as one of the major complications of diabetes mellitus. Because of the increasing population of aged people and diabetic patients in present Japan, it has been predicted that a greater number of diabetic patients will suffer from this complication than in the past. Prevention of the occurrence of this complication will become increasingly important not only for the quality of life in aged patients with diabetes, but also for the sociomedical aspects of all humanbeings. Accordingly, the results of our studies on the pathophysiology and etiology of diabetic osteopenia are summarized here.
To study the present status of TB in a general hospital, we reviewed the records of 186 patients with TB at the Saga Medical School Hospital. Ninety-two patients (49.5%) had extrapulmonary tuberculosis and 59 patients (31.7%) had complicated severe diseases. The variety of TB lesions and underlying diseases often caused diagnostic delay and misdiagnosis. In fact, 16 cases were not identified to be TB until after death. The TB prevalence was significantly high in malignant disease, diabetes mellitus, collagen disease and chronic renal failure among the total number of patients discharged. Twenty-one patients developed TB while on an intensive therapy for underlying diseases. Unfortunately, 22 patients with TB died in our hospital. These findings suggest that special care must be taken to prevent TB in a general hospital. We emphasize that early diagnosis of TB depends on the suspicion of this infection on the part of the physician.
Interactions of lipoproteins containing apolipoprotein (apo) A-I with or without apoA-II with human hepatoma cell line HepG2 were studied to investigate the ligand specificity for high density lipoprotein receptor on human hepatic cells and their metabolism. The two types of lipoproteins were isolated by immunoaffinity chromatography, in which apoE-containing lipoproteins were removed. Specific binding kinetics at 0 degrees C were observed for the apoA-I-containing lipoproteins with or without apoA-II (Kd = 18 or 20 micrograms protein/ml, Bmax = 110 or 120 ng/mg cell protein, respectively). The binding of these lipoproteins to HepG2 cells was competitively inhibited by excess unlabeled apoA-I-containing lipoproteins or apoA-I-phospholipid complexes, but not by apoA-II.phospholipid complexes. Interactions of these lipoproteins with HepG2 cells at 37 degrees C were further examined. These results suggested that HepG2 cells have a specific binding site for apoA-I-containing lipoproteins, and that apoA-I might be a crucial component in the binding of these lipoproteins to human hepatic cells.
Mixed connective tissue disease (MCTD) is characterized as a benign rheumatic disease with a favorable response to therapy. When pulmonary hypertension is a complication, however, it is often reported to be fatal. A 32-year-old female patient with MCTD who had developed rapidly progressive pulmonary hypertension and disseminated intravascular coagulopathy was admitted to our hospital and was successfully treated with corticosteroids and anticoagulants. The failure of microcirculation due to coagulopathy is considered to be one of the possible entities of pulmonary hypertension.
