Notes

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4% reported in 2013). As the social stigma associated with drug use is extremely high in Japan, avoiding illegal drugs prohibited by law by using easily available Kiken drugs may be more socially acceptable among youth in the nightlife areas.In recent years, frequent cases of people suffering disturbed consciousness, dyspnea, etc. due to abuse of synthetic cannabis and being transported by ambulance or causing traffic accidents are occurring and are becoming a serious social problem in Japan. Most law-evading herbal products have colorful illustrations and logos and are sold as incense or herbs. Law-evading herbal products consist of finely chopped dry vegetative matter mixed with chemical substances (drugs), and the drugs are injurious to health. Analysis of chemical substances in herbal products clarified that they contain synthetic cannabinoid, a chemical component that exhibits action similar to that of hemp. There are many affinity compounds of cannabinoid, so presently, even if a particular drug is regulated, similar compounds that partially differ in structure will propagate. There is thus a cat-and-mouse game between regulations on chemical substances and their propagation. This paper summarizes the pharmacological actions and danger of chemical substances contained in law-evading herbal products by focusing on synthetic cannabinoid or synthetic cathinone, a chemical substance it contains.The persons with marijuana abuse tend to be increasing in Japan, although illegal drugs use in lifetime is remarkably lower than other advanced countries, Europe and USA. In addition, there have been many methamphetamine users in Japan. As use of methamphetamine induces psychotic states, we recognize them as one of the key illegal drugs for clinical psychiatrists. Regarding to diagnosis of methamphetamine psychosis, there is a large difference between Japanese psychiatrists and other advanced countries' ones. The former considers that they have persistent symptoms. In contrast, the latter embraces it as the model of acute toxicosis. The Japanese government has been based on a full commitment to the crackdown on drug problems. However, they will execute the new law in 2016, in which some persons charged with violating the methamphetamine control law will be adapted to partially probation on drug charges. Then, we have to improve our therapeutic and recovery supports to charged illegal drug users as rapidly as possible.Positron emission tomography studies investigating dopamine release by drug or reward demonstrated blunted dopamine release in relation to addiction to psychostimulants such as cocaine and amphetamine. However, recent studies reported that nicotine and gambling addiction showed opposite results. Several factors such as illness stage or neurotoxicity of substances could be considered for this discrepancy. Behavioral addiction such as gambling disorder is a good target of neuroimaging because it is free from overt neurotoxicity. However, even in gambling disorder, the results of fMRI studies investigating neural response to reward are mixed. Neuroimaging together with taking the various backgrounds of patients into account should contribute not only to a better understanding of the neurobiology of addiction but also to the development of more effective and individually tailored treatment strategies for addiction.It has been widely known that vulnerability to substance dependence varies widely among individual subjects. Individual differences can be attributed to both genetic and environmental factors, although the relative influence of each of these factors can be diverse. Numerous molecules have been identified to be involved in the etiology of substance dependence, as well as response to or metabolism of related substances. Further, many technologies of genotyping polymorphisms, most often single nucleotide polymorphisms (SNPs), have been developed and advanced, which has accelerated the understandings of many associations between various genetic polymorphisms and vulnerability to substance dependence. In this article, we review the evidence of these associations accumulated thus far.Nationwide surveys to clarify the characteristics and trends of the addictive disorders and behaviors including alcohol dependence, nicotine dependence, internet addiction and pathological gambling among Japanese adults were carried out in 2003, 2008, and 2013. At the part of the surveys on addictive behaviors in disaster stricken area by the Great East Japan Earthquake, the nationwide survey on benzodiazepine dependence was conducted in 2013. Epidemiological features of prevalent addictive disorders and behaviors were described. We observed large number of estimated patients with addictive disorders or behaviors in Japan, and the considerable proportion of them was not connect to appropriate medical services.As for substance-related disorders, there were several differences between ICD-10 and DSM-IV, however, the concept of "dependence" had been essential for both criteria. DSM-5 published in 2013 had erased dependence. This confuses us. It is important to recognize dependence again. "Abuse" is the self-intake behavior of drug against the social norms. selleckchem Repeated abuse results in dependence. Dependence is a state of loss of control against drug use due to craving. Abuse can produce "acute intoxication", and repeated abuse under dependence can produce "chronic intoxication". It is important to understand abuse, dependence and "intoxication" based on their relationship from the point of time course.Clostridium difficile-associated diarrhea is a problem most hospital-based physicians will face in their career. This review aims to refresh current knowledge with regard to Clostridium difficile infection and bring physicians up to date with the latest developments in the growing field of fecal microbiota transplantation, the benefits it offers, and the promise this and other developments hold for the future.
Cardiac resynchronization therapy (CRT) is a non-pharmacological option for patients with heart failure and interventricular dyssynchrony. Elevated red cell distribution width (RDW) reflects higher size and heterogeneity of erythrocytes and is associated with poor outcome in patients with chronic heart failure.

To examine the association between RDW levels and outcomes after CRT implantation.

We conducted a cohort analysis of 156 patients (126 men, median age 69.0 years) who underwent CRT implantation in our institution during 2004-2008. RDW was measured at three time points before and after implantation. Primary outcome was defined as all-cause mortality, and secondary outcome as hospital re-admissions. We investigated the association between RDW levels and primary outcome during a median follow-up of 61 months.

Ninety-five patients (60.9%) died during follow-up. Higher baseline RDW levels were associated with all-cause mortality (unadjusted HR 1.35, 95% CI 1.20-1.52, P < 0.001). On multivariate analysis adjusted for clinical, electrocardiographic and laboratory variables, baseline RDW levels were associated with mortality (HR 1.33, 95%CI 1.16-1.53). RDW levels 6 months and 12 months post-implantation were also associated with mortality (HR 1.22, 95%CI 1.08-1.38, P = 0.001; and HR 1.15, 95% CI 1.01-1.32, P = 0.02, respectively). Patients who were re-admitted to hospital during follow-up (n = 78) had higher baseline RDW levels as compared to those who were not (14.9%, IQR 14.0, 16.0% vs. 14.3%, IQR 13.7, 15.0%, respectively, P = 0.03).

An elevated RDW level before and after CRT implantation is independently associated with all-cause mortality.
An elevated RDW level before and after CRT implantation is independently associated with all-cause mortality.
Anemia confers an adverse prognosis in patients with ST-elevation myocardial infarction (STEMI). Several mechanisms have been implicated in the etiology of anemia in this setting, including inflammation, blood loss, and the presence of comorbidities such as renal failure.

To evaluate the adequacy of bone marrow response as potentially reflected by elevation in blood and reticulocyte counts.

Consecutive men with STEMI who underwent primary percutaneous intervention within 6 hours of symptom onset and who presented to our catheterization laboratory during a 36 month period were included in the study. The cohort was divided into quartiles according to hemoglobin concentration, and differences in clinical and laboratory characteristics between the groups were evaluated.

A total of 258 men with STEMI were recruited, 22% of whom suffered from anemia according to the World Health Organization classification (hemoglobin < 13 g/dl). Men in the lowest quartile of hemoglobin concentration presented with significantly lower white blood cell and platelet counts (9.6 ± 2.9 vs. 12.6 ± 3.6 x 103/μl, P < 0.001) and (231 ± 79 vs. 263 ± 8 x 103/μl, P < 0.01), respectively, despite higher inflammatory biomarkers (C-reactive protein and fibrinogen) compared with patients in the upper hemoglobin concentration quartile. Reticulocyte production index was not significantly higher in anemic patients, with a value of 1.8, 1.4, 1.5 and 1.6 in the ascending hemoglobin quartiles, respectively (P = 0.292).

Anemic men with STEMI have relatively lower leukocyte and platelet counts as well as a reduced reticulocyte count despite higher inflammatory biomarkers. These findings might suggest inadequate bone marrow response.
Anemic men with STEMI have relatively lower leukocyte and platelet counts as well as a reduced reticulocyte count despite higher inflammatory biomarkers. These findings might suggest inadequate bone marrow response.
In Israel, where the "Do not resuscitate code" and "advanced directives" are not yet universally practiced, physicians are frequently 'forced' to mechanically ventilate patients despite an upfront unfavorable prognosis. Due to the shortage of intensive care unit (ICU) beds, patients are mostly hospitalized in general medicine wards.

To differentiate between patients with particularly grim prognoses and those with good prognoses, in order to inform the potential decision-making process regarding whether or not to offer aggressive medical care.

This retrospective study included all mechanically ventilated patients hospitalized exclusively in one of the six general internal medicine wards at the Assaf Harofeh Medical Center during 2009-2010. Demographic and ventilation-related data, laboratory values and main medical diagnoses were correlated to in-hospital mortality.

The study group comprised 437 patients with a median age of 83 years. Mortality was 72%. Initiation of mechanical ventilation out of the hospital or in the emergency room improved outcome. Age, anemia, leukocytosis and renal failure correlated negatively to outcome. In-hospital mortality was 80% in patients after in-hospital resuscitation, 90% in patients ventilated due to infections, but 50% in patients ventilated for cardiac or respiratory failure.

The prognosis of mechanically ventilated patients can be foreseen, which could help in deciding whether aggressive life support would be in the interest of the patient.
The prognosis of mechanically ventilated patients can be foreseen, which could help in deciding whether aggressive life support would be in the interest of the patient.
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