[Use of a Guidebook for Stroke Patients to Promote Health and Employment Support].

When stroke patients consider a return to work, several difficulties are encountered regarding the promotion of support for both their health and employment due to the different perspectives of the patients, their families, and medical institutions. The Japanese Ministry of Health, Labour and Welfare has published a guideline for medical institutions and offices, but not for stroke patients or their families. As a result, patients and their families do not know how to process both medical treatments and their work after the occurrence of a stroke. We have therefore published the "Guidebook for Stroke Patients to Promote Health and Employment Support" based on the concept of the previously published "Guidebook for Cancer Patients for Promoting Health and Employment Support". This publication offers an overview of stroke and the flow from stroke onset to return to work. Patients can confirm how they should be handled at different phases of stroke. A stroke affects the patient, their family, and the individuals providing support, so this publication offers an information tool to facilitate the participation of stroke patients in society. The guide can thus be expected to contribute to an increased rate of return to work by stroke patients.

Efficacy and Safety of the Traditional Japanese Medicine Keigairengyoto in the Treatment of Acne Vulgaris.

Several traditional Japanese medicines including Keigairengyoto (KRT) are used to treat acne vulgaris, but there is no robust evidence of their effectiveness. In this study, we examined the effectiveness and safety of KRT in treating acne vulgaris. An open-label, randomized, parallel control group comparison was conducted with a conventional treatment group (adapalene and topical antibiotics; control group) and a KRT group (control treatment plus KRT). The test drugs were administered for 12 weeks to patients (15 to 64 years, outpatient) with inflammatory acne on their face, and the amount of acne at 2, 4, 8, and 12 weeks was measured. Sixty-four patients were enrolled; 29 patients in each group were included in the analysis. Twenty-eight patients in the control group and 24 patients in the KRT group were included in the efficacy analysis. The number of inflammatory skin rashes at 4 and 8 weeks in the KRT group was significantly decreased compared with the control group. There was no significant difference between the two groups in noninflammatory eruptions and general rashes. There were no serious adverse events in both groups. KRT may be a useful agent in patients with inflammatory acne in combination with conventional treatments. This trial is registered with UMIN 000014831.

Glycosylation of quercetin with cultured plant cells and cyclodextrin glucanotransferase.

Quercetin was glucosylated by cultured plant cells of lpomoea batatas to its 3- and 7-O-beta-D-glucosides, and 3,7-O-beta-D-diglucoside. On the other hand, further glycosylation of quercetin 3-O-beta-D-glucoside by cyclodextrin glucanotransferase gave the 3-O-beta-maltoside, 3-O-beta-maltotrioside, and 3-O-[beta-maltotetraosides of quercetin.

The preparation of trisubstituted alkenyl nucleoside phosphonates under ultrasound-assisted olefin cross-metathesis.

Intermolecular ultrasound-assisted olefin cross-metathesis is reported. This approach allows an easy access to challenging trisubstituted alkenyl nucleoside phosphonates. Regioselective chemoenzymatic deacetylation and Mitsunobu coupling are also described.

Regioselective hydroxylation and glucosylation of alpha- and beta-pinenes with cultured cells of Eucalyptus perriniana.

Cultured plant cells of Eucalyptus perriniana regioselectively hydroxylated (+)- and (-)-alpha-pinenes to the corresponding (+)- and (-)-verbenols. In addition, (+)- and (-)-verbenols were converted into mono-beta-D-glucosides. On the other hand, (+)- and (-)-beta-pinenes were transformed into (+)- and (-)-pinocarveol 3-O-beta-D-glucosides via (+)- and (-)-pinocarveols.

Glucosylation of taxifolin with cultured plant cells.

Cultured plant cells of Eucalyptus perriniana glucosylated taxifolin to its 3'- and 7-O-beta-D-glucosides and 3',7-O-beta-D-diglucoside. On the other hand, taxifolin was converted into 3'- and 7-O-beta-D-glucosides by cultured cells of Nicotiana tabacum and Catharanthus roseus.

Regioselective hydroxylation and glucosylation of flavanones with cultured plant cells of Eucalyptus perriniana.

Cultured plant cells of Eucalyptus perriniana catalyzed reduction, regioselective hydroxylation, and regioselective glycosylation of flavanones. (2S)-Flavanone was converted into (2S)-flavan-4-ol, (2S)-flavan-4,7-diol, (2S)-flavan-7-ol, (2S)-flavan-7-yl glucoside, and (2S)-flavan-7-yl gentiobioside. The cells glucosylated (2S)-flavan-6-ol to (2S)-flavan-6-yl glucoside. (2S)-Flavan-2'-ol was transformed to (2S)-flavan-2',4-diol, (2S)-flavan-2',7-diol, (2S)-flavan-2'-yl glucoside. In addition, (2S)-flavan-4'-ol was transformed to (2S)-flavan-4,4'-diol, (2S)-flavan-4',7-diol, (2S)-flavan-4'-yl glucoside.

Synthesis of resveratrol glycosides by cultured plant cells.

Incubation of cultured cells of Glycine max with trans-resveratrol gave its 3-O-beta-D- and 4'-O-beta-D-glucosides. Cultured Gossypium hirsutum cells glycosylated trans-resveratrol to its 3-O-beta-D-, 4'-O-beta-D-, and 3,4'-O-beta-D-diglucosides. On the other hand, trans-resveratrol was converted into cis-resveratrol 4'-O-beta-D-glucoside, together with trans-resveratrol 3-O-beta-D-glucoside and trans-resveratrol 4'-O-beta-D-glucoside, by Eucalyptus perriniana.

Synthesis and broad spectrum antiviral evaluation of bis(POM) prodrugs of novel acyclic nucleosides.

A series of seventeen hitherto unknown ANP analogs bearing the (E)-but-2-enyl aliphatic side chain and modified heterocyclic base such as cytosine and 5-fluorocytosine, 2-pyrazinecarboxamide, 1,2,4-triazole-3-carboxamide or 4-substituted-1,2,3-triazoles were prepared in a straight approach through an olefin acyclic cross metathesis as key synthetic step. All novel compounds were evaluated for their antiviral activities against a large number of DNA and RNA viruses including herpes simplex virus type 1 and 2, varicella zoster virus, feline herpes virus, human cytomegalovirus, hepatitis C virus (HCV), HIV-1 and HIV-2. Among these molecules, only compound 31 showed activity against human cytomegalovirus in HEL cell cultures with at EC50 of ∼10 µM. Compounds 8a, 13, 14, and 24 demonstrated pronounced anti-HCV activity without significant cytotoxicity at 100 µM.

Synthesis and antiviral evaluation of bis(POM) prodrugs of (E)-[4'-phosphono-but-2'-en-1'-yl]purine nucleosides.

Seventeen hitherto unknown bis(POM) prodrugs of novel (E)-[4'-phosphono-but-2'-en-1'-yl]purine nucleosides were prepared in a straight approach and at good yields. Those compounds were synthesized by the reaction of purine nucleobases directly with the phosphonate synthon 3 bearing POM biolabile groups under Mitsunobu conditions. All obtained compounds were evaluated for their antiviral activities against a large number of DNA and RNA viruses including herpes simplex viruses 1 and 2, varicella zoster virus, Feline herpes virus, human cytomegalovirus, HIV-1 and HIV-2. Among these molecules, some of them exhibit anti-VZV and anti-HIV activity at submicromolar concentrations. This class of compound will be of further interest for lead optimization as anti-infectious agents.

Chemo-enzymatic synthesis of glycolyl-ester-linked taxol-monosaccharide conjugate and its drug delivery system using hepatitis B virus envelope L bio-nanocapsules.

Chemo-enzymatic synthesis of glycolyl-ester-linked taxol-glucose conjugate, ie, 7-glycolyltaxol 2″-O-α-D-glucoside, was achieved by using α-glucosidase as a biocatalyst. The water-solubility of 7-glycolyltaxol 2″-O-α-D-glucoside (21 µM) was 53 fold higher than that of taxol. The hepatitis B virus envelope L particles (bio-nanocapsules) are effective for delivering 7-glycolyltaxol 2″-O-α-D-glucoside to human hepatocellular carcinoma NuE cells.

Chemo-enzymatic synthesis of ester-linked 2-phenylindole-3-carboxaldehyde-monosaccharide conjugate as potential prodrug.

Chemo-enzymatic synthesis of ester-linked 2-phenylindole-3-carboxaldehyde-glucose conjugate (2-phenylindole-3-carboxyl-10″-O-ß-D-glucosyl ester) was achieved by using plant cell cultures as biocatalysts. The anticancer agent, 2-phenylindole-3-carboxaldehyde, induced apoptosis in cells, whereas 2-phenylindole-3-carboxyl-10″-O-ß-D-glucosyl ester showed no cytotoxicity and induced no apoptosis.

Pneumatosis cystoides intestinalis with systemic sclerosis, limited type resulting in a poor prognosis.

Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of multilocular intramural clusters of gas in the alimentary tract and has been considered to have a favorable response to conservative treatment. We describe the first case of limited type of systemic sclerosis (SSc) with PCI. A 74-year-old Japanese woman presented with a 4-month history of an unhealed cutaneous ulcer on the right third finger, along with sclerodactyly of bilateral hands. Proximal skin sclerosis was absent. The patient reported acute abdominal pain, and a diagnosis of PCI was established on plain radiography. The patient died of multiple organ failure 5 months after the development of PCI. PCI is rarely complicated with SSc, and all cases previously reported were associated with diffuse SSc. Because PCI is one of the poor prognostic factors of SSc, we should recognize the presence of this condition even in patients with limited cutaneous involvement.

Pressure cutaneous ulcer over a pacemaker successfully treated with left subcostal transplantation in an extremely thin patient.

Implantation of a permanent cardiac pacemaker is becoming common with the increase in the elderly population. A cutaneous ulcer over the pacemaker is a rare complication. Most such cases previously reported demonstrate non-specific granuloma histologically, negative patch testing of materials used in the device, and no growth in the bacterial culture taken from the generator pocket. To date, the conventional treatments often result in a disappointing outcome. We describe an extremely thin 79-year-old Japanese male with a pressure cutaneous ulcer caused by the presence of a pacemaker device. This patient was referred to us with a 1-month history of repeated cutaneous ulcer and exposure of the cardiac pacemaker in the left pectoral area. Conservative treatment was not effective. Treatment with left subcostal implantation of a new pacemaker, which was not wrapped, and disposition of the electrodes in the subcutaneous tissue of the thorax was successful. Cutaneous manifestations have not recurred for 5 years. Considering the poor condition of the patient, subcostal translocation of the pacemaker was a simple and acceptable treatment for pressure cutaneous ulcer over the pacemaker.

A case of genital folliculosebaceous cystic hamartoma with an unique aggregated manifestation.

Folliculosebaceous cystic hamartoma (FCH) is a recently recognized cutaneous hamartoma composed of follicular, sebaceous and mesenchymal components, and usually occurring on the head and neck. We describe herein a case of FCH with an unique aggregated manifestation in a genital lesion. The patient was a 40-year-old woman with a genital lesion composed of a pedunculated nodule, a dome-shaped nodule and a subcutaneous nodule, measuring 5 cm in the greatest dimension. The largest, pedunculated nodule was histologically composed of an infundibulo-cystic structure with follicular, sebaceous and mesenchymal elements accompanied by cystic structures of various sizes lined by stratified squamous epithelium and follicular germinative cells suggesting follicular cysts. The dome-shaped nodule consisted of anastomosing strands of epithelial cells with follicular components. The subcutaneous nodule had two components, an infundibulo-cystic structure and a cyst lined by squamous epithelium. In our case, the unusual clinical feature of large and multiple nodules was due to the presence of several prominent hamartomatous cystic structures with FCH. This is the third case of giant FCH. The clinical presentation and location of giant FCH is unusual.

Epidemiology of cutaneous tuberculosis in Japan: a retrospective study from 1906 to 2002.

BACKGROUND: Interest in tuberculosis has recently been revived, especially in association with the onset of acquired immunodeficiency syndrome (AIDS). In Japan, the incidence of tuberculosis has declined since the 1950s, but has shown a tendency to increase in the past 10 years. METHODS: To determine the patterns of prevalence of cutaneous tuberculosis in Japan, data for cutaneous tuberculosis cases recorded between 1906 and 2002 were obtained from the dermatologic clinic of Kyushu University Hospital. The population of tuberculosis-infected patients was stratified into groups encompassing 10-year periods. Each patient group was then classified as having true tuberculosis or tuberculid, as well as being classified by gender. The total number of patients with cutaneous tuberculosis analyzed was 1324. RESULTS: The incidence of cutaneous tuberculosis, both true tuberculosis and tuberculid, decreased between 1906 and 1935, increased between 1936 and 1955, and decreased again from 1955. The incidence of true tuberculosis was higher than that of tuberculid between 1906 and 1925. The incidence rates of true tuberculosis and tuberculid were equal from 1926 to 1945, and since 1946 the incidence of tuberculid has been higher than that of true tuberculosis. The incidence of tuberculid decreased between 1986 and 1995, but showed a dramatic increase between 1996 and 2000. The frequency of cutaneous tuberculosis was highest in the 10-49 year age group before 1980, but since 1981 has been highest in groups over 40 years of age. CONCLUSIONS: The incidence of cutaneous tuberculosis in Japan is decreasing and shows a shift towards older generations. However, there is an increase in the incidence of tuberculid, especially in elderly female patients.

Ciliated cyst of the vulva.

Ciliated cyst of the vulva is a rare anomaly. The cyst is lined with columnar ciliated epithelium that resembles müllerian epithelium and is located on the superior portion of the labium minus, occasionally associated with pregnancy or exogenous progesterone. We describe a case of an 11-year-old Japanese girl with a ciliated cyst of the vulva and a history of atopic dermatitis. Epithelial cells in our case showed negative staining for estrogen receptor. The origin of the ciliated epithelium is still unknown. However, chronic inflammation of the vulvar vestibulae may contribute to the pathogenesis of ciliated cyst of the vulva.

A case of varicella-associated idiopathic thrombocytopenic purpura in adulthood.

We describe here an adult case of varicella-associated idiopathic thrombocytopenic purpura (ITP). A 23-year-old Japanese male presented with generalized hemorrhagic vesicles and fever. Laboratory examinations revealed severe thrombocytopenia associated with anti-platelet IgG auto-antibody. The patient rapidly recovered within a few days after antiviral agent (vidarabine) administration, and the platelet count returned to normal with skin lesion improvement. Idiopathic thrombocytopenic purpura associated with viral infection in adulthood is relatively rare.

A case of multifocal lupus vulgaris that preceded pulmonary tuberculosis in an immune compromised patient.

We describe the rare case of a Japanese male with multifocal lupus vulgaris that preceded asymptomatic pulmonary tuberculosis and adult T-cell leukemia/lymphoma (ATL). He visited our hospital with multiple reddish plaques and erythema of 4-12 months duration. A skin biopsy revealed non-caseating epithelioid granulomas. Mycobacterium tuberculosis was detected by polymerase chain reaction (PCR)-hybridization from a skin biopsy specimen and was also isolated from a culture of the skin biopsy sample. The result of chest roentogenography was compatible with pulmonary tuberculosis. In addition, the diagnosis of ATL was based upon the presence of atypical lymphocytes with convoluted nuclei in his peripheral blood and a positive anti-ATL antibody reaction. Cases of cutaneous tuberculosis presenting with unusual clinical features may be on the increase, accompanying the spread of tuberculosis in immunosuppressed patients, including those with ATL and acquired immunodeficiency syndrome (AIDS).