Makoto Arai

Associations of endogenous sex hormones and sex hormone-binding globulin with lipid profiles in aged Japanese men and women

BACKGROUNDnThe associations of endogenous estrogen with lipid profiles and insulin resistance were conflicting in both men and women. We determined the associations of serum estradiol level and free estradiol index (FEI) with lipid profiles and insulin resistance in aged Japanese men and women.nnnMETHODSnOne hundred seventy-four men and 208 postmenopausal women aged from 50 to 85 y were included in this study. Lipid profiles, fasting glucose and insulin as well as estradiol, testosterone, dehydroepiandrosterone-sulfate (DHEA-S) and sex hormone-binding globulin (SHBG) in serum were measured.nnnRESULTSnSerum estradiol concentration in men showed a significant and negative correlation with high density lipoprotein-cholesterol (HDL-C) concentration and a significant and positive correlation with triglyceride (TG) after adjustment for age and body mass index (BMI). In addition, estradiol level was positively correlated with insulin and HOMA index. In women, serum levels of estradiol and testosterone were not correlated with lipid profiles and insulin resistance. SHBG concentration was negatively correlated with TG after adjustment for age and BMI in women.nnnCONCLUSIONnEndogenous estradiol level is associated with unfavorable lipid profiles and insulin resistance in aged men. In aged women, SHBG level is associated with favorable lipid profiles.

Current status of Kampo medicine curricula in all Japanese medical schools

BackgroundThere have been a few but not precise surveys of the current status of traditional Japanese Kampo education at medical schools in Japan. Our aim was to identify problems and suggest solutions for a standardized Kampo educational model for all medical schools throughout Japan.MethodsWe surveyed all 80 medical schools in Japan regarding eight items related to teaching or studying Kampo medicine: (1) the number of class meetings, target school year(s), and type of classes; (2) presence or absence of full-time instructors; (3) curricula contents; (4) textbooks in use; (5) desire for standardized textbooks; (6) faculty development programmes; (7) course contents; and (8) problems to be solved to promote Kampo education. We conducted descriptive analyses without statistics.ResultsEighty questionnaires were collected (100%). (1) There were 0 to 25 Kampo class meetings during the 6 years of medical school. At least one Kampo class was conducted at 98% of the schools, ≥4 at 84%, ≥8 at 44%, and ≥16 at 5%. Distribution of classes was 19% and 57% for third- and fourth-year students, respectively. (2) Only 29% of schools employed full-time Kampo medicine instructors. (3) Medicine was taught on the basis of traditional Japanese Kampo medicine by 81% of the schools, Chinese medicine by 19%, and Western medicine by 20%. (4) Textbooks were used by 24%. (5) Seventy-four percent considered using standardized textbooks. (6) Thirty-three percent provided faculty development programmes. (7) Regarding course contents, “characteristics” was selected by 94%, “basic concepts” by 84%, and evidence-based medicine by 64%. (8) Among the problems to be solved promptly, curriculum standardization was selected by 63%, preparation of simple textbooks by 51%, and fostering instructors responsible for Kampo education by 65%.ConclusionsJapanese medical schools only offer students a short time to study Kampo medicine, and the impetus to include Kampo medicine in their curricula varies among schools. Future Kampo education at medical schools requires solving several problems, including curriculum standardization.

Differences in Sensitivity to Cold in Japanese Men and Postmenopausal Women Aged ≥50 Years

BACKGROUNDnSensitivity to cold is associated with several factors, such as aging, sex, and body composition. However, no previous studies have examined the differences in sensitivity to cold in men and women or the association of hormonal levels with sensitivity to cold.nnnOBJECTIVEnThe aim of the present study was to clarify both the change in sensitivity to cold with aging and the difference in sensitivity to cold between men and women. Associations were also examined between circulating hormonal concentrations and the changes with aging and differences in sensitivity.nnnMETHODSnThis population-based cohort study enrolled healthy Japanese men and women aged > or = 50 years. A standardized 210-item health questionnaire was used to obtain information on symptoms of sensitivity to cold. Serum concentrations of luteinizing hormone, follicle-stimulating hormone (FSH), estradiol, testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin (SHBG) were measured.nnnRESULTSnOf the 154 men and 180 women enrolled in this study, more women than men had sensitivity to cold. Whereas the percentage of men who had sensitivity to cold significantly increased with aging (P < 0.05), the percentage of women who had sensitivity to cold was already high (23.7%) at 50 to 60 years of age and did not change with aging. In men, advancing age and low body mass index (BMI) were significantly associated with sensitivity to cold (P < 0.05); however, age and BMI in women were not similarly associated. In addition, the effect of sex after adjustment for age was significant (P < 0.05), and there was also a numeric but nonsignificant effect of sex after adjustment for BMI. In men, low serum levels of the gonadal hormone FSH were significantly associated with sensitivity to cold in logistic analysis, but this association was nonsignificant after multivariate analysis. Serum concentrations of gonadal hormones and SHBG in women were not associated with sensitivity to col.nnnCONCLUSIONSnThe association of age with sensitivity to cold was different in men and women; the association of BMI with sensitivity to cold might be different in men and women. In addition, these changes in sensitivity to cold were not associated with circulating hormonal concentrations.

The education of traditional Japanese (Kampo) medicine: surveys of training hospitals and residents

BackgroundJapanese physicians prescribe Kampo medicine, but Kampo education is not standardized. We surveyed training hospitals and residents to identify problems and suggest solutions to promote Kampo education during and after residency.MethodsThis was a double questionnaire survey of 1011 training hospitals in Japan and 93 Tokai University School of Medicine graduates of 2011.ResultsThere were 816 effective responses (81%) from the training hospitals. Most instructors (84%) thought physicians should have Kampo clinical skills; 67% thought positively about introducing Kampo education into clinical training; 23% of the hospitals provided Kampo education; 70% of instructors at hospitals without Kampo education indicated the lack of Kampo instructors, 16% lack of time, and 7% no necessity for Kampo education; hospitals permitted Kampo education through voluntary study (42%), lectures sponsored by Kampo manufacturers (35%), and study sessions with other hospitals (32%); independent study sessions (10%); smaller hospitals were less active in Kampo education than larger ones. The survey of residents had 72 effective responses (77%): 91% were interested in Kampo medicine; 96% thought it worth learning; 31% could learn it during residency; 52% were not satisfied with the training, 83% wanted to learn it; 73% thought it should be introduced into the curricula; 93% prescribed Kampo medicine, and residents who learned it prescribed it more; 48% were reluctant to prescribe it after residency; 89% thought Western and Kampo medicine should be integrated.ConclusionsInstructors knew Kampo education was needed, but little of it was taught, especially in small hospitals, because of the lack of Kampo instructors. Residents recognized the need for Kampo medicine and were motivated to learn it. Kampo medicine was mostly prescribed because instructors suggested it. Because of the limited opportunities to learn Kampo medicine, it should be taught during residency. In small hospitals, cooperation with other hospitals could be a solution to teach Kampo medicine.

Hypertriglyceridemia and pancreatitis in a patient with apolipoprotein E7 (p.[E244K; E245K])/E4

BACKGROUNDnThe etiology of hypertriglyceridemia is complex and one of the common variants in affecting plasma lipid levels is apolipoprotein (apo) E isoform. Scores of apo E variants have been reported, including apo E7. However, a clinical lipid phenotype of apo E7 has not been fully elucidated.nnnMETHODSnA 48-year-old Japanese male had hypertriglyceridemia and a history of repeated episodes of acute pancreatitis. The measurement of serum apolipoproteins and apo E phenotyping, and the sequencing analyses of several genes regulating triglyceride metabolism were performed in the patient.nnnRESULTSnThe apo E phenotype of the patient was E7/E4. Apo E7 had the same point mutations p.[E244K; E245K] in APOE as reported previously. In addition, he had APOA5 haplotypes associated with hypertriglyceridemia. Laboratory examinations excluded deficiency of apolipoproteins, lipoprotein lipase, and GPI-HBP1 in this patient.nnnCONCLUSIONSnThis is, to our knowledge, the first report of severe hypertriglyceridemia and acute pancreatitis in a patient with apo E7.

Usefulness of measurement of heart rate variability by holter ECG in hemodialysis patients

BackgroundMajor adverse cardiac and cerebrovascular event (MACCE) is one of most common complications of hemodialysis patients. Heart rate variability (HRV) is the predictor of death in heart disease patients. However, there are no studies on the role of HRV in hemodialysis patients.MethodsFrom September 2009 to March 2011, 24-h electrocardiography was performed in 101 hemodialysis patients. Standard deviation of sequential 5-minute N-N interval means (SDANN) and standard deviation of the N-N interval (SDNN) was examined by a 24-h ECG analysis. Patients were observed prospectively. The primary endpoints were incidence of MACCE and MACCE-free survival.ResultsWe studied 90 hemodialysis patients (64 males, 63.4u2009±u200911.8xa0years old). During a follow-up period of 32.0u2009±u200911.7xa0months, 33 patients developed MACCE. 24-h ECG showed mean SDNN 93.4u2009±u200933.4xa0ms and mean SDANN 83.2u2009±u200931.3xa0ms. MACCE group showed significantly lower SDNN and SDANN than event-free group. In Kaplan-Meier analysis higher SDNN and SDANN group showed significantly higher event-free survival rate than lower group. Using a Cox proportional hazards model, SDNN was independent prognostic factor while SDANN or diabetic status was not significant. In diabetic cases, there were no differences in any factors for the incidence of MACCE between higher SDNN, SDANN groups and lower groups. On the other hand in non-diabetic cases, lower SDNN or SDANN group developed significantly higher MACCE than higher groups.ConclusionMeasurement of HRV by Holter ECG is useful to predict MACCE in hemodialysis patients, especially non-diabetic group.

Medical residents’ interest in and current status of Japanese postgraduate education in acupuncture and moxibustion: a follow-up survey

Background Japanese traditional medicine (Kampo medicine) is an important subject in Japanese medical schools. Acupuncture and moxibustion (AM), essential categories of Kampo medicine, are taught in a few medical schools today. However, the current state of postgraduate AM education is unknown. Objective To compare medical residents’ awareness of AM before their AM education in the 4th year of medical school with that after completion of their 2-year postgraduate medical residency. Methods We conducted a postal questionnaire survey of medical residents at the end of their 2-year residency. We required a signature on this questionnaire so that we could examine for changes in their awareness of AM with those determined by similar, signed, former questionnaire surveys conducted before and at the end of their 4th-year AM lectures in medical school (reported previously). The completed questionnaires were returned by mail or facsimile. Results Among 93 residents, there were 72 (77.4%) effective responses. Only three residents (4%) had opportunities to learn AM during residency. Among the 68 residents who were not afforded the opportunity to do so, after completing their two-year residency, 32(47%) stated that they would like to study AM. Interest in AM was significantly less than that of the proportion of medical students (81%) who were initially interested in AM when surveyed just before their fourth year lectures on AM. Conclusions Postgraduate AM education for medical residents appears to be relatively scarce in Japan. Moreover, medical residents’ levels of interest in AM were lower than those demonstrated before their 4th-year AM lectures in medical school.

Functional improvement of deglutition after hangekobokuto treatment in two cases: Endoscopy and fluoroscopy evaluation

Patients with dysphagia frequently suffer from aspiration pneumonia, are frequently hospitalized, and are often deprived of the joys of eating. Although dysphagia is life‐threatening, treatment for dysphagia is still limited. Recently, the effectiveness of hangekobokuto (Banxia‐houpo‐tang in Chinese; HKT) for dysphagia has attracted attention. We treated two dysphagic patients with HKT and evaluated deglutition before and after HKT treatment on imaging.