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Anxiety and depression often occur with gastrointestinal symptoms. Although the Japanese traditional medicine (Kampo medicine) bukuryoingohangekobokuto (BGH) is approved for treating anxiety, neurotic gastritis, and heartburn, its effect on gastrointestinal motility remains poorly known. This study aimed to examine the effect of BGH on delayed gastric emptying in stress model mice and clarified its action mechanism. Seven-week-old C57BL/6 male mice were acclimated for a week and fasted overnight. Stress hormone, corticotropin-releasing factor (CRF), was intracerebroventricularly injected to mice, and solid nutrient meal (ground chow and distilled water) was orally administered 1 hour after. Gastric contents were collected to evaluate gastric emptying rates by measuring its dry weight. Injection of CRF (0.3 or 1.0 μg/mouse) significantly delayed the 2-hour gastric emptying in mice. BGH (1.0 g/kg), which was administered 30 minutes before the CRF injection, significantly ameliorated the delayed gastric emptying induced by CRF (0.3 μg/mouse). BGH (0.5, 1.0 g/kg) significantly enhanced the 1-hour gastric emptying and slightly increased the 2-hour gastric emptying in mice without CRF injection. In vitro functional assays showed that components of BGH antagonized or inhibited CRF type-2, dopamine D2/D3, neuropeptide Y Y2 receptors, or acetylcholinesterase. In conclusion, the components of BGH may exert synergistic effects on improving gastric emptying via various targets. BGH is considered to be potentially useful for treating gastrointestinal dysmotility with psychological symptoms.

Clinical application of accumulated medical big data is a hot topic in medical informatics. Not only for suggesting possible diagnoses in each individual, large medical database can be possibly used for detecting undiagnosed patients in the general population. In this study, we tried to develop a computerized system of detecting overlooked undiagnosed patients with rare chronic diseases in the community population by utilizing the uniformed national medical insurance record database. A cumulative total of 489,823 hospital visits at one tertiary medical center were collected for this project. As the target disease, we selected esophagogastric junction outflow obstruction (EGJOO), including achalasia, which is known to be easily overlooked without performing a barium swallow test. Patient selection software automatically picked out 17,814 individuals with the given suspected diagnoses that could be misdiagnosed in patients with the target disease, from which the software further picked out 526 individuals who underwent upper endoscopy but did not undergo barium swallow test. Of them, the hospital medical records suggested that 39 people still suffered from prolonged symptoms lasting for more than 6 months after the first hospital visit. Among them, 16 individuals agreed to undergo the barium swallow test. One of them was confirmed to suffer from EGJOO, possibly based on some undiagnosed connective tissue diseases. An automated computerized detection system with uniform big medical data would realize more efficient and less expensive screening system for undiagnosed chronic diseases in the general population based on symptoms and previously performed examinations in each individual.

In the era of precision medicine, targeted therapies have been implemented for various diseases. Genomic information guides decision-making in cancer treatment. The improvements in next-generation sequencing and polymerase chain reaction have made it possible to access the genetic information using circulating-tumor DNAs (ctDNAs). Molecular characteristics of individual tumors can be obtained by analysis of ctDNAs, thus making them excellent tools to guide decision-making during treatment. In oncology, the use of ctDNAs in clinical practice is now gaining importance. Molecular analysis of ctDNAs has potential for multiple clinical applications, including early diagnosis, prognosis of disease, prognostic and/or predictive biomarkers, and monitoring response to therapy and clonal evolution. In this paper, we highlight the applications of ctDNAs in cancer management, especially in metastatic setting, and summarize recent studies about the use of ctDNAs as predictive biomarkers for the therapeutic adaptation/response in lung cancer, breast cancer, and colorectal cancer. These studies offer the evidence to use ctDNAs as a promising approach to solve unmet clinical needs.

Background ALN dissection (ALND) is the only way to obtain information on ALN metastasis status accurately when sentinel lymph node (SLN) metastasis is present. In this study, we established a model for intraoperatively predicting non-SLN metastasis and the presence of four or more ALNs (pN2), based on the combined use of one-step nucleic acid amplification (OSNA) and histological examination following SLN biopsy. Materials and methods Subjects comprised 318 consecutive breast cancer patients (cTis-3, N0) who underwent SLN biopsy with a combination of OSNA and histological examination, and who were found to have SLN metastasis and were treated by ALND. We allotted points to each patient according to their SLN metastasis status as defined by both OSNA and histology, then defined the “National Cancer Center sentinel lymph node metastatic score” (NCS score) based on the total points. Correlations between the NCS score and both non-SLN metastasis and pN2 status were analyzed by logistic regression analysis. The accuracy of this score was evaluated using receiver operating characteristic (ROC) analysis. Results The NCS score was significantly correlated with both non-SLN metastasis and pN2 status (adjusted odds ratio: 1.26 for non-SLN metastasis, 1.56 for pN2 status). The area under the ROC curve (AUC) of the NCS score demonstrated 0.74 for non-SLN metastasis, 0.91 for pN2 status. Conclusions The NCS score was a strong independent predictor of non-SLN metastasis and pN2 status. Use of this score will facilitate the selection of optimal adjuvant therapies without requiring unnecessary ALND.

After a massive disaster, many residents in affected areas are forced to temporarily stay in evacuation shelters. The exact impact of the state of resource supply and infrastructure in evacuation shelters on the health status of evacuees has not been sufficiently studied. Two weeks after the 2011 Great East Japan Earthquake (GEJE), comprehensive surveillance related to the health status and hygiene level was performed for all evacuation shelters (328 shelters with 46,480 evacuees at the peak) in one of the most devastating medical zones after the tsunami hit the area (Ishinomaki City). The joint relief team regularly visited all evacuation shelters across the area to assess the situation of resource supply levels, infrastructural damage, rapid need of resources, and the health status of the evacuees. In this cross-sectional observational study, we evaluated the relationship between the resource supply levels and health status among evacuees in two time periods (days 14–19 and 20–25). Among the evaluated vital resources, clean tap water supply was among the most disrupted by the disaster, and was not fully restored in most shelters during the assessment period. The cross-sectional relationship between resource supplies and morbidity was inconsistent between the two assessment periods, reflecting the multifactorial nature of health status in evacuation shelters. The clean tap water supply level at the first assessment showed a strong negative correlation with the subsequent prevalence of respiratory or gastrointestinal infectious conditions at the second assessment. Restorations in the clean tap water supply and toilet hygiene correlated each other, and both correlated with a decrease in the prevalence of gastrointestinal infectious conditions. In conclusion, disrupted clean tap water supply and inadequate toilet hygiene after a massive disaster would jointly harm the health status of those in shelters. Prompt assessments using quick visual assessment and restorations of these key resources have validity with suppressed environmental health risks among evacuees., Disaster; Evacuation shelter; Infectious diseases; Toilet hygiene; Water supply.

The electronic structure of newly synthesized marcasite-type cobalt pernitride (CoN2) is investigated using X-ray absorption and photoelectron spectroscopy (XAS and XPS), in combination with the el...

A 17-year-old girl with hypoxic encephalopathy was hospitalized over four times in a year because of recurrent aspiration pneumonia (AP). She had dysphagia and reduced cough reflex as sequelae of brain damage. To prevent aspiration, a gastric tube was placed for feeding, but it did not reduce the frequency of AP because the gastroesophageal reflux caused backflow. However, after the Kampo medicine bukuryoingohangekobokuto (BRIHK) was added to the prescriptions, her sputum and gastroesophageal reflux was remarkably reduced. BRIHK is a Kampo medicine that confers multiple benefits such as improving swallowing and cough reflexes, reducing sputum, and improving gastric emptying. Subsequently, the frequency of sputum suction reduced from every 15 min to 30 min, thus reducing the burden on her mother. As a result, she has never been hospitalized for AP in the 7 years after treatment. Overall, BRIHK may be a treatment of choice for similar patients.

Recent retrospective studies have reported discordance rate of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses between primary and recurrent tumors and prognostic values of discordance. However, the results of these reports may possibly include analytical error.We analyzed 153 patients from whom pathological specimens of tumor tissues were available from both primary and recurrent sites. For all specimens, immunohistochemistry was performed for these statuses with a standardized method. Two experienced pathologists evaluated these specimens in a blinded fashion.The discordance rates for estrogen receptor, progesterone receptor, and HER2 were 18%, 26%, and 7%, respectively. Subtype changes based on HR and HER2 status occurred in 21% of patients. Clinical outcome was significantly worse in the patients with the tumors that were primarily HR-positive (HR(+)) converted to HR-negative (HR(-)) at recurrent sites than in the patients with the tumors in which HR status did not change or converted from HR(-) to HR(+) (P = .001). Clinical outcome was also significantly worse in the patients with the primarily HR(+) tumor that converted to triple negative in the recurrence sites than in the patients with a constantly HR(+) tumor (P .001). By the Cox multivariate analyses, loss of HR expression and conversion to triple negative at the recurrence sites were independent indicators of worse clinical outcome.Discordance in HR and HER2 status often occurred between primary and recurrent breast cancer and had independent prognostic impact in the patients with recurrent breast cancer.

The Japan Geriatrics Society revised its criteria for the medical treatment and safety of the elderly in 2015. The Japan Geriatrics Society guidelines contain a chapter for traditional Chinese medicine (TCM; traditional medicines in East Asian countries, such as China, Japan, Korea, Taiwan, Vietnam and Singapore), because it is widely used for elderly patients and is sometimes covered by national medical insurance in Japan. The updated guidelines should be improved based on a comprehensive, systematic review and evidence grading. TCM is rapidly expanding in the literature, and is under intensive investigation in clinical trials. The objective of the present trial was to review TCM systematically and reflect the results to update the TCM chapter of the Japan Geriatrics Society guidelines. Here, we introduce the results of the systemic review of TCM for geriatrics. Geriatr Gerontol Int 2017; 17: 679-688.

We present a case of a 71-year-old woman who accidently swallowed a large fish bone that penetrated into the pulmonary vein. She visited the hospital the next day with a complaint of mild chest discomfort with slight pain and fever of 37.4 °C. Contrast-enhanced chest computed tomography (CT) scan revealed a large fish bone with a length of 35 mm impacted in the middle esophagus. The bone had penetrated into the pulmonary vein, causing mediastinitis. Blood tests revealed elevation in the white blood cell count and C-reactive protein level. Because intractable bleeding from pulmonary vein after endoscopic removal can be lethal, endoscopic removal of the fish bone in an operating room under general anesthesia with cardiovascular surgical standby for possible emergency surgery was selected. After endoscopic removal, mediastinal hematoma was absent with a follow-up chest CT scan, and the mediastinitis was treated with intravenous antibiotics. The patient shortly became afebrile with normalized blood test findings. After confirming the normal findings on the follow-up chest CT scan and endoscopic inspection in the next week, she was discharged from the hospital 10 days after hospitalization without any complications. When the swallowed bone penetrates into the major pericardial vessels, unprepared endoscopic removal may result in fatal sequelae such as intractable mediastinal hemorrhage. Urgent consultation with cardiovascular or thoracic surgeons for a possible emergent surgery is needed before endoscopic removal is attempted., Medical imaging; Gastrointestinal system; Emergency medicine; Internal medicine; Radiology; Chest computed tomography, Endoscopic removal, Mediastinitis, Penetration, Pulmonary vein, Swallowed fish bone.

Metaplastic carcinoma (MC) is a highly malignant tumor that is mainly classified as a triple-negative subtype exhibiting basal markers on immunohistochemical testing. Immunohistochemical findings of S-100 and SOX10 are useful and valuable in the differential diagnosis of Schwannian, melanocytic, and myoepithelial/basal cell epithelial neoplasms, particularly of unknown differentiation or origin. We report an extremely rare case of MC with a basal-HER2 phenotype (HER2 phenotype breast carcinoma with basal marker expression) that exhibited unusual S-100 and SOX10 immunoreactivity. A 54-year-old Japanese woman presented with a 2-month history of a painful, growing mass in her left breast. Core needle biopsy was performed and immunohistochemical results suggested poorly differentiated carcinoma or melanocytic neoplasm. Because the tumor was located in the breast, the immunohistochemical panel included the St. Gallen consensus markers, which showed focal expression of HER2 (score: 2+, equivocal) and a Ki-67 labeling index of 87.0%, but no expression of estrogen receptors or progesterone receptors. Fluorescence in situ hybridization identified HER2 gene amplification based on the 2013 ASCO–CAP HER2 Test Guidelines (HER2/CEP17 ratio: 3:3; HER2 copy number: 14.7 per cell). The histopathological results suggested that this was a primary breast carcinoma of a “basal-HER2” phenotype. After histological examination of the resected specimen, the tumor was ultimately diagnosed as metaplastic carcinoma. Tumors like this could potentially be mis-diagnosed as other S-100-positive and SOX10-positive malignant neoplasms based on limited sampling, such as that occurring with core needle biopsies. This case highlighted the importance of performing careful histological examinations of HER2 status to correctly diagnose a primary breast neoplasm.

Benign inclusions, such as endosalpingiosis, in an axillary sentinel lymph node (SLN) can be misdiagnosed as metastatic breast carcinoma. However, endosalpingiosis is rare in lymph nodes above the diaphragm. Among 792 patients with breast carcinoma who underwent sentinel lymph node biopsy at our center, 2 patients have experienced benign glandular inclusions in 3 SLNs, and all of these glandular inclusions were lined with columnar and ciliated epithelial cells. Immunohistochemistry revealed that the epithelial cells were positive for Mullerian markers (e.g., PAX8 and WT-1) and negative for mammary markers (e.g., mammaglobin, GCDFP-15, and GATA3), which confirm the diagnosis of endosalpingiosis. The epithelial cells were positive for CK19 but the one-step nucleic acid amplification assay revealed negative results for the axillary SLNs. Although endosalpingiosis is rare in axillary SLNs, care is needed to identify these rare cases and avoid unnecessary axillary lymph node dissection, overstaging, and overtreatment.

Antihypertensive treatment has beneficial effects in the elderly. Surveying the situation of blood pressure in the elderly is quite important for planning strategies to manage elderly hypertensives. The aim of the present study was to investigate changes in blood pressure in the elderly over the past 15 years. As part of a physical check-up program between 2001 and 2015, 29,363 elderly participants (≥65 years of age) attended and were enrolled in the present study. The characteristics of the participants in each year were analyzed cross-sectionally and the results were compared over the 15 years. Changes in blood pressure, hypertension prevalence, and treatment rates, and the rate of reaching target blood pressure in the elderly were investigated. The prevalence of hypertension during the study period increased with increasing participant age. However, both the treatment rate and the rate of reaching target blood pressure in treated subjects improved. The blood pressure of treated hypertensive elderly subjects decreased from 146.1/83.0 to 130.6/75.4 mm Hg, and the reduction was most evident after revision of Japanese Society of Hypertension guidelines regarding target blood pressure in elderly hypertensives. Blood pressure in the entire cohort of elderly subjects decreased from 133.8/78.4 mm Hg in 2001 to 127.9/74.6 mm Hg in 2015. Blood pressure in elderly subjects had decreased over the 15-year study period primarily due to reductions in blood pressure in elderly hypertensive patients on medication. Guidelines for the treatment of hypertension have had a beneficial effect on the management of hypertension in the elderly.

Background Positive margin of breast-conserving surgery (BCS) is well known to be a risk factor for ipsilateral breast tumor recurrence (IBTR). SSO/ASTRO guidelines defined ink on invasive cancer or DCIS as positive margin and recommend considering doing re-excision of the site of positive margin. However, whether re-excision can reduce IBTR has not been fully investigated yet. The aim of this study was to retrospectively assess the oncological impact of re-excision for positive margin status after BCS in invasive breast cancer. Methods The subjects were 196 invasive breast cancer patients who underwent BCS, and who were found to have positive margin. Of the 196 patients, 55 underwent re-excision after initial BCS (group A), and 139 did not (group B). We analyzed IBTR free survival in each group and evaluated the predictors for IBTR and overall survival (OS) using Cox proportional hazards modeling. Results Of the 196 patients, 188 (96%) underwent adjuvant radiotherapy and 24 of 55 re-excision (43%) identified residual disease. There was no significant difference in 10-year IBTR free survival between group A and group B (94.4% versus 93.8%; P = 0.58). In a multivariate analysis, re-excision was not associated with IBTR and OS, while younger age, lack of adjuvant radiotherapy, and invasive component of margin status were independent predictors of IBTR. Conclusions In our retrospective study, re-excision for positive margin after initial BCS in invasive breast cancer does not contribute to prevent IBTR and may not translate into improved OS. Further treatment should be considered when patient was younger and margin status was invasive component. Legal entity responsible for the study Kenjiro Jimbo. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Banxia Houpu Tang, a traditional Chinese medicine, helped in initiating oral feeding in a stroke patient, after three years of nasogastric tube feeding. This Chinese medicine has potential in eliminating the need for nasogastric feeding and for physical restraints in geriatric individuals after a stroke.

Aim Orengedokuto (coptis detoxification decoction) is a medicinal extract widely used in Japan for the alleviation of symptoms of alcohol hangover and flush reaction. There have been no studies, however, on the effects of this medication on the concentration of alcohol in humans. The aim of this preliminary experiment was therefore to determine the effects of orengedokuto given before alcohol consumption, on breath alcohol concentration. Methods Three healthy adults participated in the experiment. Breath alcohol concentration was measured with a breathalyzer at multiple intervals under two conditions: one with only the alcoholic beverage and one with orengedokuto extract (Matsuura orengedokuto fine powdered extract, 1.45 g) followed by an alcoholic beverage. Results There was a lower peak and a faster decrease in breath alcohol concentration when the extract was given prior to alcohol consumption, suggesting that the extract accelerated the metabolism and/or inhibited the absorption of alcohol. Conclusions This preliminary study was limited by small sample size and lack of blood sampling. Additional trials using a cross-over design with a larger sample size to further investigate the effects of orengedokuto on blood ethanol and acetaldehyde levels after consumption of alcohol, are currently in progress.

On March 11, 2011, a magnitude 9.0 earthquake and huge tsunami occurred near the Pacific coast of northeast Japan, in which more than 18,000 people died or went missing and more than 120,000 buildings were destroyed. In Taro district, one of the areas struck hardest by the tsunami, a middle-aged woman was found deceased in the rubble. Generally, a family physician can recognize victims based on their appearance; the place where they were found; their home or work address; their belongings; the identifying marks on their clothes; their dental charts; and their living biological parents, children, or multiple siblings through DNA analysis. However, in this case, the middle-aged woman remained the area's sole unidentified person for months, because her appearance was different, her body was slightly swollen, and she was missing some teeth. The district's medical and dental facilities were destroyed and almost all medical records and dental charts lost. Fortunately, a family physician who had worked in the district for many years survived the disaster, and was available to provide background information about the victim, her family, and their relationship. He recalled the existence of tissue samples of her mother who had died several years earlier. Subsequently, the individual was identified through the DNA analysis of her blood and mother's tissue samples. As demonstrated in the case, appropriately managed medical information and samples from previously deceased relatives can aid disaster victim identification. The destruction caused by the Great East Japan Earthquake forms our investigation's background.

We report an elderly male patient with hyperammonemia induced by intrahepatic portal-systemic shunt without cirrhosis (IPSSwoC). The occasional emergence of his erratic behaviors was misdiagnosed as a psychiatric disorder. Regardless of his uneven symptoms, IPSSwoC was suspected due to his hyperammonemia. The contrast computed tomography of the abdomen revealed a congenital type of IPSSwoC. As blood ammonia levels are inconstant, repeated blood tests are recommended when this disease is suspected in elderly patients with psychiatric symptoms.

Traditional Japanese Kampo Medicine Yokukansan for Behavioral and Psychiatric Symptoms of Dementia in Alzheimer rsquo s Disease

To evaluate laser speckle flowgraphy (LSFG) measurements of the optic nerve head (ONH) blood flow (BF) response to hyperoxia.This prospective study included 30 eyes of 30 healthy volunteers (mean age: 28.5 ± 4.0, male:female = 13:17). The testing protocol had three phases: in the baseline phase, subjects breathed room air; in the hyperoxic phase, they breathed pure oxygen (6 L/min) for 15 min; and in the recovery phase, they were room air for 15 min. LSFG measurements of mean blur rate (MBR), which represents ONH BF, were taken every minute. The MBR ratio in the hyperoxic and recovery phases was calculated with reference to this baseline. Clinical parameters, including systemic blood pressure, pulse rate, and saturation of pulse-oximetry oxygen (SpO2), were measured every 5 min.SpO2 increased significantly during hyperoxia (97.3 ± 1.1% to 99.3 ± 0.7%, p 0.001). While clinical parameters were similar in hyperoxia and baseline, MBR decreased significantly after 2 min of hyperoxia (90.8 ± 12.6%, p = 0.02), stayed steady throughout hyperoxia (mean: 89.5 ± 10.8%, p range:0.001-0.04) compared with baseline, and returned to baseline 1 min after recovery (93.7 ± 10.3%, p = 0.25). A linear regression using a third-order polynomial fitting curve analysis revealed that the time to reach minimum MBR was 7.78 min (adjusted R(2 )= 0.87).LSFG could effectively assess ONH BF changes during hyperoxia.

Background. Japan is a superaging society, with the percentage of persons aged >65 years increasing year after year. Traditional medicine (TM) for elderly has been practiced worldwide for thousands of years. Treatment methods for aspiration pneumonia, gait disorder, glaucoma, and bowel symptoms have been developed. The ideas of acupuncture, moxibustion, and herbal medicine have been implemented in modern medical settings, and medical devices using heat transfer engineering and nanotechnology have been developed. An ultrasound scanner can be used for the evaluation of effects and indications for these therapeutic measures. Objectives. To review published literature and our studies that evaluated medical treatments for the elderly on the basis of ideas of TM. Search Methods. We searched Pubmed, Scopus, and reference lists of relevant clinical trials. Authors’ Conclusions. Many studies were found. But there are insufficient data on the effects of traditional medical therapies and further research is needed. TM therapies vary widely and studies of these therapies that ascertain practical application are essential for the utilization of ideas of TM in modern medicine. Moreover, to verify practical application, a quantitative evaluation index is necessary. Nonetheless, modalities using ideas of TM may be promising treatments for some diseases in the elderly.

The aim of this study was to examine the effects of oral administration of kampo medical formulas on ocular blood flow (OBF). A crossover protocol was used to randomly administer five grams of yokukansan, tokishakuyakusan (TSS), keishibukuryogan, or hachimijiogan to 13 healthy blinded subjects (mean age: 37.3 ± 12.3 years). The mean blur rate, a quantitative OBF index obtained with laser speckle flowgraphy, was measured at the optic nerve head before and 30 minutes after administration. Blood pressure (BP) and intraocular pressure (IOP) were also recorded. No significant changes were observed in mean BP or IOP after the administration of any of the kampo medical formulas. There was a significant increase in OBF 30 minutes after administration of TSS (100% to 103.6 ± 6.9%,P<0.01). Next, TSS was administered to 19 healthy subjects (mean age: 32.0 ± 11.0 years) and OBF was measured before and 15, 30, 45, and 60 minutes after administration. Plain water was used as a control. OBF increased significantly after TSS administration compared to control (P<0.01) and also increased from 30 to 60 minutes after administration compared to baseline (P<0.05). These results suggest that TSS can increase OBF without affecting BP or IOP in healthy subjects.

Intrarenal Doppler ultrasonography is a non-invasive method to evaluate the renal blood flow in patients with renal arterial stenosis as well as chronic kidney diseases (CKD). Until recently, the relationship between ultrasonography findings and CKD stage has not been fully understood. Overall, 162 patients with CKD without apparent renal arterial stenosis were included in this study, and the pulsed-wave Doppler ultrasonography findings were evaluated in terms of the following parameters: peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) at the renal arterial trunk, hilum, segmental, and interlobar regions. Age showed a significant negative correlation with the estimated glomerular filtration rate (eGFR), kidney size, and aortic PSV. Additionally, age showed a significant positive correlation with RI in all 4 regions. The eGFR showed a positive correlation with the aortic PSV and kidney size, but a negative correlation with RI. Both age and eGFR were found to be independently associated with aortic blood flow. On the intrarenal ultrasound, EDV and RI showed stronger correlations with eGFR than PSV, suggesting that the former indices would be better markers of renal function. In particular, the interlobar EDV was found to be the best index that reflects renal function. Although the RI is also a good marker of renal function, it is confounded by age; thus, its utility would be weaker than that of the EDV. In conclusion, intrarenal pulsed-wave Doppler ultrasonography is a useful tool to estimate and evaluate the renal function; the interlobar EDV may be the best index to estimate the effective perfusion and filtration of the kidneys.

Traditional Chinese medicine Hemp seed pill (麻子仁丸) could improve chronic constipation of elderly in the difficult case.

The present study examined the association between food intake and endometrial cancer restricted to endometrial endometrioid adenocarcinoma (EEA) using a case-control study in Japanese women. One hundred sixty-one cases and 380 controls who completed a questionnaire regarding demographic, lifestyle, and food frequency questionnaire were analyzed. Odds ratio (OR) between selected food intakes and EEA were calculated by logistic regression analysis. After adjustment putative confounding factors, the higher intakes of vegetables [odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.26-0.83], peanuts (OR = 0.48, CI = 0.27-0.86), fish (OR = 0.52, CI = 0.29-0.93), boiled egg (OR = 0.24, CI = 0.33-0.92), instant noodles (OR = 1.94, CI = 1.12-3.34), instant food items (OR = 2.21, CI = 1.31-3.74), and deep-fried foods (OR = 2.87, CI = 1.58-5.21) were associated with a risk for EEA. The inverse association with a risk of EEA was also seen in higher intakes (g/1000 kcal) for vegetables (0.45, CI = 0.25-0.81) and fish (0.53, CI = 0.30-0.94) as compare to lower intake. Higher intake of vegetables, peanuts, fish, and boiled egg was associated with a reduced risk for EEA, whereas instant noodles, instant food items, and deep-fried foods was associated with an increased risk for EAA as compared to lower levels of intake.

Background: This multicentre open-label trial examined the efficacy and safety of the traditional Japanese medicine, or Kampo medicine, yokukansan (YKS), for behavioural and psychological symptoms of dementia (BPSD) in patients with dementia with Lewy bodies. Methods: Sixty-three dementia with Lewy bodies patients with probable BPSD (M : W, 30 : 33; mean age, 78.2 ± 5.8 years) were enrolled and treated with YKS for 4 weeks. Results: Significant improvements in Neuropsychiatric Inventory scores (mean decrease, 12.5 points; P < 0.001) and Zarit Burden Interview-Japanese edition tests (mean decrease, 3.6 points; P= 0.024) were observed. In patients who consented to an assessment after 2 weeks of treatment, a time-dependent significant improvement was observed in the Neuropsychiatric Inventory score (n= 23; mean decrease, 14.4; P < 0.001), each subscale, including delusions and hallucinations, the Zarit Burden Interview-Japanese edition (n= 22; mean decrease, 8.2; P < 0.01) and the behavioural pathology in Alzheimer's disease insomnia subscale. The Mini-Mental State Examination and the Disability Assessment for Dementia (DAD) showed no significant change. Adverse events were observed in 11 (18%) patients. Three patients (5%) discontinued YKS due to adverse reactions, namely, spasticity and exacerbation of BPSD, edema, and nausea. Hypokalaemia (

Dementia has been considered as a disease since the seventeenth century in traditional Asian medicine. In the nineteenth century, Wan Qingren described about dementia in a scientific manner at first time in the world. Recently, a traditional herbal medicine yokukansan (YKS) is paid attention to ameliorate behavioral and psychological symptoms of dementia (BPSD) without deterioration of extrapyramidal symptoms. YKS improves BPSD and ADL of demented people. Also, it ameliorates hallucination of dementia with Lewy bodies (DLB). Pharmacological mechanism of YKS is mainly owing to Uncaria and contained alkaloids related to serotonergic and glutamatergic functions.

Traditional Japanese Kampo medicine has been widely used in clinical practice in Japan. Though it is a compulsory subject in Japanese medical schools, a standard educational program in Kampo medicine does not exist. Tohoku University has incorporated Kampo medicine into clinical education via didactic lectures since 2003; however, student evaluations have been lower for Kampo than for all other clinical specialties. We administered a questionnaire about a Kampo medicine course for fifth-year students from 2009 to 2012 and developed an educational program based on feedback obtained. The questionnaire consisted of nine questions (a clear training plan; opportunities for learning, practice, and patient contact; acquisition of medical knowledge and physical examination; learning professionalism; understanding the specialty; overall assessment) that were rated on a 5-point Likert scale along with open-ended questions about the course's strengths and weaknesses. The students responded to the questionnaire after clinical practice in Kampo medicine and other clinical specialty courses. Scores for Kampo medicine and the average of other clinical specialties were compared. All 389 students who participated in Kampo clinical practice answered the questionnaire. In 2009, scores for Kampo medicine for nine questions were lower than for the average of the other clinical specialties. After curriculum reformation involving hands-on training in 2012, all scores except "opportunities to learn about clinical cases" and "opportunities to practice involvement" were higher than the average of all other clinical specialties. In conclusion, we have successfully developed a Kampo medicine educational program for our university through this survey study.

IntroductionThere were 5,385 deceased and 710 missing in the Ishinomaki medical zone following the Great East Japan Earthquake that occurred in Japan on March 11, 2011. The Ishinomaki Zone Joint Relief Team (IZJRT) was formed to unify the relief teams of all organizations joining in support of the Ishinomaki area. The IZJRT expanded relief activity as they continued to manually collect and analyze assessments of essential information for maintaining health in all 328 shelters using a paper-type survey. However, the IZJRT spent an enormous amount of time and effort entering and analyzing these data because the work was vastly complex. Therefore, an assessment system must be developed that can tabulate shelter assessment data correctly and efficiently. The objective of this report was to describe the development and verification of a system to rapidly assess evacuation centers in preparation for the next major disaster.ReportBased on experiences with the complex work during the disaster, software called the “Rapid Assessment System of Evacuation Center Condition featuring Gonryo and Miyagi” (RASECC-GM) was developed to enter, tabulate, and manage the shelter assessment data. Further, a verification test was conducted during a large-scale Self-Defense Force (SDF) training exercise to confirm its feasibility, usability, and accuracy. The RASECC-GM comprises three screens: (1) the “Data Entry screen,” allowing for quick entry on tablet devices of 19 assessment items, including shelter administrator, living and sanitary conditions, and a tally of the injured and sick; (2) the “Relief Team/Shelter Management screen,” for registering information on relief teams and shelters; and (3) the “Data Tabulation screen,” which allows tabulation of the data entered for each shelter, as well as viewing and sorting from a disaster headquarters’ computer. During the verification test, data of mock shelters entered online were tabulated quickly and accurately on a mock disaster headquarters’ computer. Likewise, data entered offline also were tabulated quickly on the mock disaster headquarters’ computer when the tablet device was moved into an online environment.ConclusionsThe RASECC-GM, a system for rapidly assessing the condition of evacuation centers, was developed. Tests verify that users of the system would be able to easily, quickly, and accurately assess vast quantities of data from multiple shelters in a major disaster and immediately manage the inputted data at the disaster headquarters.IshiiT, NakayamaM, AbeM, TakayamaS, KameiT, AbeY, YamaderaJ, AmitoK, MorinoK. Development and verification of a mobile shelter assessment system “Rapid Assessment System of Evacuation Center Condition featuring Gonryo and Miyagi (RASECC-GM)” for major disasters. Prehosp Disaster Med. 2016;31(5):539–546.

Background: Radial artery (RA) pulse diagnosis has been used in traditional Asian medicine. Blood pressure (BP) and pulse rate related to heart rate variability (HRV) can be monitored via the RA. The fluctuation in these parameters has been assessed using fast Fourier transform (FFT) analytical methods that calculate power spectra. Methods: We measured blood flow volume (Volume) in the RA and evaluated its fluctuations. Normal participants (n = 34) were enrolled. We measured the hemodynamics of the right RA for approximately 50 s using ultrasonography. Results: The parameters showed the center frequency (CF) of the power spectrum at low frequency (LF) and high frequency (HF). More than one spectral component indicated that there were fluctuations. The CF at LF for Volume was significantly different from that for vessel diameter (VD); however, it was significantly correlated with blood flow velocity (Velocity). On the other hand, the CF at HF for Volume was significantly different from that for Velocity; however, it was significantly correlated with VD. Conclusion: It is suggested that fluctuation in the Volume at LF of RA is influenced by the fluctuation in Velocity; on the other hand, fluctuation in the Volume at HF is influenced by the fluctuation in VD.

Aim In 2005, the Japan Geriatrics Society published a list of potentially inappropriate medication that was an extract from the “Guidelines for medical treatment and its safety in the elderly 2005.” The 2005 guidelines are due for a revision, and a new comprehensive list of potentially inappropriate medications is required. Methods A total of 15 diseases, conditions and special areas related to their clinical care were selected. We originated clinical questions and keywords for these 15 areas, carried out a systematic review using these search criteria, and formulated guidelines applying the Grading of Recommendations Assessment, Development and Evaluation system advocated by Minds2014. If we did not find good evidence despite the drug being clinically important, we looked for evidence of efficacy and for disease-specific guidelines, and incorporated them into our guidelines. Results We selected 2098 articles (140 articles per area), and extracted another 186 articles through a manual search. We further added guidelines based on disease entity and made two lists, one of “drugs to be prescribed with special caution” and the other of “drugs to consider starting,” primarily considering individuals aged 75 years or older or those who are frail or in need of special care. Conclusions New lists of potentially inappropriate medications and potential prescribing omissions called “Screening Tool for Older Person's Appropriate Prescriptions for Japanese” were constructed. We anticipate that future studies will highlight more evidence regarding the safety of high-quality drugs, further improving the provision of appropriate medical care for the elderly. Geriatr Gerontol Int 2016: 16: 983–1001.

The Japan Geriatrics Society revised its criteria for the medical treatment and safety of the elderly in 2015. The Japan Geriatrics Society guidelines contain a chapter for traditional Chinese medicine (TCM; traditional medicines in East Asian countries, such as China, Japan, Korea, Taiwan, Vietnam and Singapore), because it is widely used for elderly patients and is sometimes covered by national medical insurance in Japan. The updated guidelines should be improved based on a comprehensive, systematic review and evidence grading. TCM is rapidly expanding in the literature, and is under intensive investigation in clinical trials. The objective of the present trial was to review TCM systematically and reflect the results to update the TCM chapter of the Japan Geriatrics Society guidelines. Here, we introduce the results of the systemic review of TCM for geriatrics. Geriatr Gerontol Int 2017; 17: 679-688.

The Great East Japan Earthquake inflicted immense damage over a wide area of eastern Japan with the consequent tsunami. Department of Traditional Asian Medicine, Tohoku University, started providing medical assistance to the disaster-stricken regions mainly employing traditional Asian therapies. We visited seven evacuation centers in Miyagi and Fukushima Prefecture and provided acupuncture/massage therapy. While massage therapy was performed manually, filiform needles and press tack needles were used to administer acupuncture. In total, 553 people were treated (mean age, 54.0 years; 206 men, 347 women). Assessment by interview showed that the most common complaint was shoulder/back stiffness. The rate of therapy satisfaction was 92.3%. Many people answered that they experienced not only physical but also psychological relief. At the time of the disaster, acupuncture/massage therapy, which has both mental and physical soothing effects, may be a therapeutic approach that can be effectively used in combination with Western medical practices.

Acupuncture is commonly performed at acupoints. No comparisons of quantitative physiological alterations in the brachial artery (BA) induced by the stimulation of different acupoints in the lower limbs have been performed in humans. Therefore, we investigated changes in blood flow volume (BFV) in the BA as an indicator of the physiological effects induced by stimulation at 3 points. Seventy-five healthy participants aged 33 ± 9 years (mean ± SD) were enrolled and randomly assigned to 3 groups; they received stimulation at 3 different points located on the lower limbs: ST36, LR3, and a non-acupoint. Stimulation was performed bilaterally with manual rotation of the needles. Using ultrasonography, BFV was measured continuously from rest to 180 seconds after stimulation. LR3 stimulation significantly increased BFV compared to that before needle insertion. Meanwhile, stimulation at ST36 and the non-acupoint significantly decreased BFV compared to that before needle insertion. Stimulation at LR3 elicited a significant increase in BFV compared to that at ST36 and the non-acupoint. The results suggest that the stimulation of different points on the lower limbs causes distinct physiological effects on BFV in the BA.

Zusammenfassung Nachdem am 11. Marz 2011 ein schweres Erdbeben den Osten Japans erschutterte, verursachte der darauffolgende Tsunami noch verheerendere Schaden. Praktisch wurden in der betroffenen Region alle sozialen Versorgungseinrichtungen lahmgelegt oder zerstort, so auch die medizinische Basisversorgung [ 1 , 2 ]. Wir leisteten arztliche Unterstutzung in den betroffenen Gebieten, indem wir hauptsachlich die traditionelle Medizin, wie sie in Japan praktiziert wird, anwandten. Dort, wo Infrastrukturen mit modernen medizinischen Einrichtungen zerstort waren, wurden traditionelle Methoden auf der Basis von einfacher korperlicher Untersuchung und Behandlung mit Kampo-Phytotherapie, Akupunktur & Moxibustion bzw. Massagen wirksam eingesetzt. Diese erwiesen sich sowohl fur die Diagnostik als auch fur die Therapie als sehr nutzlich in einer derartig kritischen Situation.

Acupuncture is commonly performed on acupoints. A comparison of quantitative physiological alterations induced by stimulation on different acupoints has never been performed in the superior mesenteric artery (SMA) in humans. Therefore, we investigated changes in blood flow volume (BFV) in the SMA as an indicator of physiological effects induced by stimulation on 3 points. Thirty healthy participants aged29±10years (mean±SD) were enrolled. All participants underwent stimulations on 3 points located in the lower legs: ST36, LR3, and a non-acupoint. Control pertains to a condition with no-stimulation. Stimulation was performed bilaterally with manual rotation of the needles. BFV was measured by ultrasonography before insertion and 10, 20, 30, and 60 minutes after stimulation. Following acupuncture on ST36, BFV increased significantly 20 and 30 minutes after stimulation, compared to BFV before insertion (P<0.05). Following stimulation on LR3 and the non-acupoint, no significant differences in BFV could be found. Relative to the no-stimulation group, stimulation on LR3, and the non-acupoint, stimulation on ST36 elicited a significant increase in BFV (P<0.05). The results suggest that stimulation on the different points causes distinct physiological effects in BFV in the SMA.