Outpatient superficial partial-thickness burn care of an elderly patient successfully treated with Eppikajutsuto.

Eppikajutsuto (EPTJ) is used to reduce redundant body fluids and suppress inflammation. We observed that EPTJ shortened the duration of treatment in an elderly patient with burn injuries. A 96-year-old man suffered superficial partial-thickness burns on the dorsum of his right hand and left knee. The injuries showed early improvement with the use of EPTJ. This suggests that EPTJ could contribute to shortening the duration of healing for superficial partial-thickness burns in elderly patients who may experience slow wound healing and have a high mortality rate. Eppikajutsuto needs to be considered as a treatment for burns in primary care.

The Integration of Traditional Medicine with Conventional Biomedicine: A Narrative Review of the Japanese Perspective.

Objectives: This is a narrative review of the integration of traditional medicine with conventional biomedicine in present day Japan, whose aging population is considered one of the largest globally. Design: It is focused on the aging population because this age group most avails of healthcare. We also tried to describe the unique Japanese medical situations, clinical outcome of Japanese traditional medicine (Kampo medicine) which may include acupuncture, and education of Kampo medicine workforce. Results: Conventional schools of medicine in Japan are required to teach Kampo medicine, and most Japanese physicians (>80%) prescribe traditional medicine, especially in primary care settings. The universal national healthcare system covers Kampo medicine prescribed by physicians and treatment by acupuncturists (they sometimes refer patients who may need evaluation by physicians), enhancing access to primary healthcare. Additionally, pharmacists who graduated from conventional schools of pharmacy also select and sell Kampo medicine as over-the-counter (OTC) medication. Kampo medicine available as prescription drugs and OTC is effective, and has been proven to be economically beneficial in several clinical settings. Conclusions: An aging population is a global concern for both developed and developing countries. Japan, having a significantly-large aging population, integrates conventional biomedicine and traditional medicine in its universal national healthcare coverage, through its biomedically-trained physicians and pharmacists who also learned traditional medicine, as well as the acupuncturists. By reviewing the current situation in Japan, the authors hope to introduce the future of the global contribution of traditional, complementary, and integrative medicine in primary care.

An ankle sprain with long-term swelling and pain successfully treated with the traditional Japanese herbal medicine Jidabokuippo: A case report.

In this report, we present a case in which long-term swelling and pain because of an ankle sprain were successfully treated with the traditional Japanese herbal (Kampo) medicine Jidabokuippo. Jidabokuippo was created in Japan and has been used to treat swelling and pain associated with trauma. A 44-year-old woman sprained her right ankle and received the standard treatments including icing and immobilization for three weeks. However, the swelling, redness, and pain of her ankle continued for two months after the treatments. After initiating Jidabokuippo, her pain and swelling were promptly improved. This suggests that Jidabokuippo is a potentially promising pharmacotherapy for patients with ankle sprain which has not recovered smoothly. It is said that Jidabokuippo can be prescribed simply referring to pain and swelling of the affected areas; therefore, it should be considered as a treatment for trauma patients with long-term swelling and pain.

Discontinuation or reduction in benzodiazepine use by treatment with the traditional herbal medicine Hangekobokuto, case reports.

In this report, we present two cases in which benzodiazepines (BZDs) were able to be successfully reduced or discontinued by treatment with traditional Japanese herbal medicine (Kampo medicine), including Hangekobokuto (HKT). These two patients with long-term use of BZDs due to mental disorders suffered epigastric symptoms. After starting Kampo therapy including HKT, their epigastric symptoms were improved and they were able to reduce or discontinue the use of BZDs. This suggests that HKT is a potentially promising substitutive pharmacotherapy for patients with long-term use of BZDs. HKT should be considered as a treatment for patients with mental disorders who have taken BZDs for a long time and suffer from medically unexplained epigastric symptoms.

High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study.

OBJECTIVE: We investigated whether serum high-sensitivity C reactive protein (hs-CRP) levels measured in an emergency department (ED) are associated with inhospital mortality in patients with cardiovascular disease (CVD). DESIGN: A retrospective cohort study. SETTING: ED of a teaching hospital in Japan. PARTICIPANTS: 12 211 patients with CVD aged ≥18 years who presented to the ED by an ambulance between 1 February 2006 and 30 September 2014 were evaluated. MAIN OUTCOME MEASURES: Inhospital mortality. RESULTS: 1156 patients had died. The inhospital mortality increased significantly with the hs-CRP levels (<3.0 mg/L: 7.0%, 95% CI 6.4 to 7.6; 3.1-5.4 mg/L: 9.6%, 95% CI 7.9 to 11.3: 5.5-11.5 mg/L: 11.2%, 95% CI 9.4 to 13.0; 11.6-33.2 mg/L: 12.3%, 95% CI 10.5 to 14.1 and ≥33.3 mg/L: 19.9%, 95% CI 17.6 to 22.2). The age-adjusted and sex-adjusted HR for total mortality was increased significantly in the three ≥5.5 mg/L groups compared with the <3.0 mg/L group (5.5-11.5 mg/L: HR=1.32, 95% CI 1.09 to 1.60, p=0.005; 11.6-33.2 mg/L: HR=1.38, 95% CI 1.14 to 1.65, p=0.001 and ≥33.3 mg/L: HR=2.15, 95% CI 1.84 to 2.51, p<0.001). Similar findings were observed for the CVD subtypes of acute myocardial infarction, heart failure, cerebral infarction and intracerebral haemorrhage. This association remained unchanged even after adjustment for age, sex and white cell count and withstood Bonferroni adjustment for multiple testing. When the causes of death were divided into primary CVD and non-CVD deaths, the association between initial hs-CRP levels and mortality remained significant, but the influence of hs-CRP levels was greater in non-CVD deaths than CVD deaths. The percentage of non-CVD deaths increased with hs-CRP levels; among the patients with hs-CRP levels ≥33.3 mg/L, non-CVD deaths accounted for 37.5% of total deaths. CONCLUSION: Our findings suggest that increased hs-CRP is a significant risk factor for inhospital mortality among patients with CVD in an ED. Particular attention should be given to our finding that non-CVD death is a major cause of death among patients with CVD with higher hs-CRP levels.

Characterization of iron-responsive promoters in the marine diatom Phaeodactylum tricornutum.

It is well established that iron is one of the major constraints of primary productivity of marine diatoms in world oceans. In the present study, changes in the transcript levels of the 20 iron related genes were profiled in the marine diatom Phaeodactylum tricornutum during an early stage of acclimation from iron replete to iron-limited conditions. The results clearly showed that the profiles differ depending on genes, suggesting the occurrence of several modes of iron-responsive regulation at the transcriptional level. Upstream DNA sequences of iron starvation induced protein1 (Isi1), ferrichrome binding protein1 (FBP1), and flavodoxin (Fld) genes were isolated, fused with the GUS reporter gene, uidA, and transformed into P. tricornutum. Obtained transformants were subjected to the GUS reporter assay and the result clearly revealed that the GUS activity of all transformants was significantly increased upon iron limitation. Iron responsive Cis-elements in each promoter region were determined by the promoter truncation technique, demonstrating the occurrence of the critical iron-responsive regulatory regions of about 30bp in the promoter regions of three genes, Isi1, FBP1, and Fld. Interestingly, these sequences were similar with each other revealing two conserved motifs, A; A(A/C)G(G/C)C(G/-)C(A/G)TG; and B; CACGTG(T/C)C, which are homologous to the iron responsive Cis-element in the green alga, Chlamydomonas reinhardtii. The impairment of the motif B in the Isi1 promoter resulted in the loss of iron response and the core regulatory region of the FBP1 promoter conferred an iron response on the constitutive cytomegalovirus promoter, PCMV, indicating that these conserved promoter sequences are iron-responsive elements. Finally, the inductive regulation of these promoters under iron-limited conditions was dissipated specifically by 5% CO2, strongly suggesting the participation of CO2 in the transcriptional regulation of the iron-related gene promoters.