Osteoarthritis (OA) is a frequent musculoskeletal disorder in the elderly population. OA is characterized by a gradual loss of extracellular matrix in the articular cartilage of joints. No medical agents have shown evidence that they are disease-modifying OA drugs, which attenuates progression of OA, nor has practical application of biological agents that are intended to alleviate symptoms been realized. Therefore, it is preferable to administer conservative therapy that is easy, simple, and effective in inhibiting OA progression at an early stage. Heat shock protein 70 (HSP70) has a protective effect on the cartilage and inhibits the apoptosis of chondrocytes. Hyperthermia to the joints can increase HSP70 expression in chondrocytes, and, at the same time, HSP70 expression partially enhances matrix metabolism of the cartilage. These findings suggest that hyperthermia can be applied to the treatment of OA. Hyperthermia is, therefore, expected to be an inexpensive and less-invasive conservative therapy for OA.

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Developing an effective home-based palliative care system in Japan has become more urgent following the addition of Home-Care Support Medical Clinics to the National Health Insurance scheme in 2006 and implementation of the Cancer Control Act in 2007. Additionally, shortening the number of days spent in acute-care hospitals and switching the provision of most anticancer therapies from a hospital setting to the home have increased this urgency. However, the number of cancer patients who choose to die at home remains low (5% to 6%) and indicates that a home-based palliative care system has not been adequately promoted. We discuss these issues from the pharmacist's viewpoint in this article.

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Gathering information in the forms of complaints from patients, reports from staff, and surveys conducted by the hospital is an essential element in providing safe, high-quality medical care. We have analyzed the contents of letters placed to the opinion box in 1 year from January 1, 2010, and examined them from the viewpoint of the quality of medical care. In total, 121 letters with 127 opinions were posted. Overall, 74.4% of the letters were anonymous. The largest percentage of opinions (44.9%; 57 of 127 opinions) were about the behaviors and attitudes of the hospital staff towards patients, followed by requests to the hospital (15%; 19 opinions) , opinions about hospital facilities (12.6%; 16 opinions) , and complaints about waiting time and other issues (9.4%; 12 opinions) . Overall, 83.5% of all comments were complaints. From the viewpoint of the quality of medical care, 27.6% of the comments were about "structure," 66.9% were about "process," and 3.1% were about "results." A large part of the structural problems can be improved with the launch of the new hospital. The remaining structural problems and process problems might be addressed by conducting cross-sectional restructuring and by upgrading the organization of the existing hospital, thus improving both the patients' satisfaction rate and the quality of medical care. Letters in the opinion box should be regularly reviewed (Plan-Do-Check-Action Cycle) in the future to maintain and improve the quality of medical care.

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The protein expression system in bacteria is widely used to overproduce recombinant proteins. Many established expression vectors are on the market. The Escherichia coli expression system is extremely useful for biochemical and biophysical analysis. Here, we describe the results of the expression of mammalian protein in E. coli and an experiment on the structural analysis of recombinant protein.

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Vertigo and nausea suddenly developed in a 33-year-old man without a relevant medical history. He reported that he had had throbbing headaches for 1 month. On admission, neurological examination revealed dysarthria, right Horner syndrome, and hypoesthesia of the left side of the face and of the left side of the body below the neck. Initial magnetic resonance imaging of the brain showed no areas of abnormal intensity on diffusion-weighted imaging, but magnetic resonance angiography showed a stringlike structure of the right vertebral artery. Acute infarction due to right vertebral artery dissection was diagnosed. Heparin sodium was immediately administered intravenously. Three days after symptom onset, magnetic resonance imaging-diffusion-weighted imaging of the brain clearly showed a high-intensity area in the right lateral medulla oblongata, a finding that confirmed the clinical diagnosis. This case emphasizes that vertebral artery dissection should be considered in patients with vertigo, especially young patients without risk factors for cerebrovascular disorders. The clinical history and neurological examination remain fundamental aspects of patient assessment in the era of advanced neuroimaging.

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A 19-year-old man was admitted to our hospital for elective surgery to replace the ascending aorta. The patient's father had died suddenly of aortic dissection associated with Marfan syndrome. Because of the patient's family history and physical findings, we suspected Marfan syndrome and began regular observations of aortic size when he was an infant. When he was 18 years old, magnetic resonance cardiography showed a marked increase in the size of the ascending aorta, replacement of which was indicated. Computed tomography performed before the planned elective surgery incidentally revealed dissection of the ascending aorta, although the patient was asymptomatic. Thus, we failed to prevent the aortic dissection in this patient, although we had regularly observed the aorta since he was an infant. Surgery should have been performed earlier than it was. Our experience suggests more frequent observation and stricter indications for aortic surgery should be considered in Marfan syndrome.

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