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Induction of c-FOS and c-JUN occurred in the areas surviving after transient cerebral ischemia, but the extent of induction and the latent period varied depending on the duration of the insult and the location. In the areas with ischemic or postischemic damage detected by loss of the reaction for microtubule-associated proteins, the induction of c-FOS and c-JUN was either absent or minimal, suggesting that active induction of those immediate early gene products occurred early in surviving neurons. On the other hand, the induction of HSP 70 did not occur until reperfusion for 24 hours and actively occurred only in the areas with earlier induction of c-FOS and/or c-JUN, suggesting that the induction of HSP 70 occurred in neurons that survived to that point, but it did not participate in early responses for neuronal survival after global cerebral ischemia.

Ten children with a tethered cord and also an anorectal malformation are reported in this document. The anorectal malformations comprised 5 vesicointestinal fissures, 2 cloacal exstrophies, 2 rectovesical fistulas and 1 rectobulbar fistula. All of the patients underwent colostomy in advance of surgery for untethering of the spinal cord. Although their neurologic deficits had previously been considered static, they were subjected to radiographic examination of the caudal spine and found to have a tethered cord. These 10 children were among 55 children with a tethered cord surgically treated at the Division of Neurosurgery of the Osaka Medical Center and Research Institute for Maternal and Child Health during the last 11 years. Data were obtained for these 10 children (6 boys and 4 girls, mean age 1.7 years) who underwent surgical untethering. Several hypotheses are offered to explain this association. Anorectal malformations are related to underlying spinal cord anomalies, which may be amenable to neurosurgical correction. Eight of our patients had no skin stigma of the lumbosacral region, in contrast to an ordinary tethered cord. Spinal cord imaging is necessary to closely scrutinize these children.

Aim: Millions of Japanese people suffer from influenza every year. Many of these patients are treated with neuraminidase inhibitors, particularly with oseltamivir. In traditional Japanese herbal medicine (Kampo medicine), maoto is effective against influenza; it can be administered to children and adolescents, and is much cheaper than oseltamivir or other neuraminidase inhibitors. We estimated the annual savings in medical costs (ASMC) at a national level when oseltamivir was partly replaced with maoto in influenza treatment. Methods: We estimated the following variables: (i) number of influenza patients in a normal (non-pandemic) year in Japan; (ii) number of patients who would be prescribed oseltamivir; (iii) number of patients who could be prescribed maoto instead of oseltamivir; and (iv) medical cost reduction per patient when maoto extract is prescribed instead of oseltamivir. ASMC were calculated by multiplying (iii) and (iv). Results: An approximate estimate of the ASMC was as high as 9 billion yen, given that an estimated 3 million patients were prescribed maoto rather than oseltamivir, with a medical cost reduction of 3000 yen per patient. Conclusion: The direct medical cost reduction with maoto and the magnitude of ASMC were considerably large. Influenza treatment can be more efficient if maoto is introduced into practice.

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