A case of progressive systemic sclerosis (PSS) with peripheral circulation disturbance, pulmonary fibrosis and stenosis of esophagus-cardia (E-C) junction, was treated with acupuncture and traditional Chinese medicine. The patient had digital pitting scar due to the peripheral circulation disturbance. Effect of acupuncture was examined using laser Doppler velosimetry (LDV). Acupuncture treatment was operated 3 times a week and laser therapy, once a week. And Chinese medicine was administered. The LDV measurements were done before and after acupuncture. In the total 9 times of measurements, 8 were increased in peripheral blood flow. Two times from the measurements of peripheral blood flow after acupuncture reached in the normal flow level. After the treatment of 2 months, polyarthralgia was reducted, vomiting was disappeard, and the stenosis of the E-C junction was improved. Present data suggest that the acupuncture therapy to the PSS patient is effective.

Comparing the effects of low energy laser and acupuncture was conducted in 14 patients with gonarthrosis. Effectiveness on the pain on going up or down stairs, range of motion (ROM) of knee joint and tenderness were examined. After acupuncture treatment, the pain on going up or down stairs, and ROM of knee joint were significantly improved. Laser therapy showed the same significant effects both on the pain on going up or down stairs and ROM of knee joint. In addition, laser therapy showed a significant effect on tenderness. In the statistical evaluation, no remarkable difference was shown between acupuncture therapy and laser therapy. Present data suggest that the laser therapy is as effective as acupuncture therapy in gonarthrosis.

Laser-Doppler velocimetry was used to evaluate the effects of acupuncture stimulation on peripheral circulation disturbance in patients with collagen disease, progressive systemic sclerosis (PSS) and systemic lupus erythematosus (SLE). The response to acupuncture stimulation to shou-san-li was recorded in 8 patients with PSS and 6 patients with SLE. The digital pitting scars and Raynaud's phenomenon were observed in all the patients. The mean of laser-Doppler flow values in fingertips at room temperature 23°C was 4.83 (V) in normals (n=11), 2.82 (V) in patients (n=14). Patient group showed significantly lower values than normals (p<0.01). Ten minutes after acupuncture stimulation to shou-san-li, the flow values increased in 7, and decreased in 1 out of 13 patients (p<0.05). In normals no significant change was observed after the same stimulation. Present data suggest that the acupuncture therapy to the patients with PSS or SLE who suffered from peripheral circulation disturbance is effective.

Osaka City has the highest tuberculosis (TB) notification rates in Japan. In the period 1999–2003, the TB control programme was strengthened, and the Stop TB Strategy was implemented to reduce the number of notified cases. The objective of this study was to assess the effect of these control activities in Osaka City, including the implementation of directly observed treatment (DOT), by analysing TB surveillance and routinely collected data. We reviewed the surveillance data of all sputum smear-positive pulmonary tuberculosis (PTB) cases registered in the Osaka City Public Health Office from 2001 to 2008 and data collected from the routine TB programme. The DOT implementation rate increased from 0% in 2001 to 68% in 2008 for smear-positive PTB cases of the general public and to 61% for all PTB cases of the homeless. The proportion of smear-positive PTB cases that had treatment failure and default combined, declined from 8.0% (52 of 650) in 2001 to 3.6% (20 of 548) in 2006. The proportion of cases among the homeless with previous treatment declined from 28% in 2001 to 15% in 2008. The proportion of cases with multidrug resistant-TB (MDR-TB) among those without previous treatment declined from 1.7% in 2001 to 0.9% in 2008. It is logical that reduction in the failure and default rate would lead to the reduction of cases with previous treatment and TB transmission, including resistant TB, therefore to the reduction of MDR-TB rates.

1) In 2004, Shinshu University School of Medicine started a program for third-year medical students to experience nursing services during both the day and night shifts. The program included lectures on nursing sciences before practice and debriefing sessions after practice.2) Most students viewed this program favorably and felt that the night-shift training was particular meaningful. They also had favorable opinions about the nurses who taught them.3) Some practical issues remain to be solved, such as security during the night shift and the possible excessive burden upon nurses.

Laser-Doppler velocimetry (LDV) was used to evaluate the effects of low energy laser irradiation on peripheral circulation disturbance in patients with collagen diseases, progressive systemic sclerosis (PSS) and systemic lupus erythematosus (SLE).
Using a commercially available LDV flometer (Periflux, Perimed KB, Sweden), the response to laser irradiation at the acupuncture points of Tian zhu, Feng chi, Jian jing, Shou san li, Jing qu, He gu, Stellate ganglion, was recorded in 4 patients with PSS and 6 with SLE. The digital pitting scars and Raynaud's phenomenon were observed in all the patients. The low energy of 10mW laser was irradiated for 1 minute at each acupuncture points, and LDV flow values ware recorded in fingertips at room temperature 25±0.5°C. Ten minutes after the laser irradiation, the LDV flow values increased significantly (p<0.5).
Present data suggest that the low energy laser irradiation to patients with PSS or SLE who suffered from circulation disturbance is effective.

Background/Aims: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA; EUS-FNA) allows for diagnostic tissue specimens from various regions to be analyzed. How-ever, diagnosing recurrent pancreaticobiliary cancer after surgery is sometimes difficult. We evaluated the efficacy of EUS-FNA in the diagnosis of local recurrence of pancreatico-biliary cancer and analyzed the factors associated with falsenegative results. Methods: Fifty-one consecutive patients who underwent EUS-FNA due to suspected recurrence of pancreaticobiliary cancer after surgery in an academic cen-ter were retrospectively analyzed. The criteria for EUS-FNA were a resected margin or remnant pancreas mass, round swollen lymph node (≥10 mm in diameter), and soft-tissue enhancement around a major artery. Patients with suspected liver metastasis or malignant ascites were excluded. Results: Thirty-nine of the 51 patients had pancreatic cancer; the remaining 12 had biliary cancer. The target sites for EUS-FNA were the soft tissue around a major artery (n=22, 43%), the resected margin or remnant pancreas (n=12, 24%), and the lymph nodes (n=17, 33%). The median size of the suspected recurrent lesions was 15 mm (range, 8 to 40 mm). The over-all sensitivity, specificity and accuracy of EUS-FNA for the diagnosis of recurrence was 84% (32/38), 100% (13/13), and 88% (45/51), respectively. FNA of the soft tissue around major arteries (odds ratio, 8.23; 95% confidence interval, 1.2 to 166.7; p=0.033) was significantly associated with a falsenegative diagnosis in the multivariate analysis. Conclusions EUS-FNA is useful for diagnosing recurrent cancer, even after pancreaticobiliary surgery. The diagnoses of recurrence at soft-tissue sites should be interpreted with caution.