Laser-assisted vascular anastomosis (LAVA) of arteries and veins in mongrel dogs was performed using a low-powered carbon dioxide laser. The anastomotic site was irradiated at a point 10mm distal from focus and the beam at this point was 0.8mmφ in diameter. Adequate laser power for anastomosis was 160-200mW for arteries and 120-160mW for veins, and the required duration of radiation was 5-10sec per 1mm anastomotic length for both vessels. In arteries successful anastomosis was achieved by LAVA in 44% of transverse incisions and 65% of longitudinal incisions, compared to 65% and 95% for veins, respectively. LAVA ruptured at a pressure of 102±28mmHg on average in arteries and 77±24mmHg in veins. However, LAVA reinforced with etyl 2-cyanoacrylate were safe at high pressures more than 300mmHg in arteries. Follow up has been achieved in 99 anastomotic sites for 9 months. No stenosis, occlusion, thrombus or infection were found apart from one (1%) pseudoaneurysm formation 4 months after LAVA. Angioscopic views and histological findings of anastomotic tissue welded by mean of LAVA revealed good layer-to-layer continuity of the three-layer structure of arterial wall. LAVA seems to be a useful method for vascular anastomosis.

Objectives : Persistent coldness is a common complaint for which Kampo, traditional Japanese herbal medicine, is often tried, because there is no definition or objective measure of subjective coldness in Western medicine. The aim of this study was to evaluate the efficacy of a common Kampo agent, tokishigyakukagoshuyushokyoto, and to identify key symptoms that would predict positive treatment outcomes for coldness.
Design : A retrospective cohort study.
Setting : 181 patients who complained of coldness without any organic abnormalities self-surveyed their health using a Kampo questionnaire database system on their first visit. Another 28 patients were assigned to verify the discriminatory predictability of treatment efficacy.
Interventions : Patients were treated with extract product, 7.5 grams a day for a month.
Outcome measures : Treatment efficacy as a binary response.
Results : Frequency and severity scales (0 to 4) for coldness decreased from 3.2 ± 0.7 to 2.1 ± 0.1 (p < 0.01)and from 3.1 ± 0.7 to 2.2 ± 0.9 (p < 0.01), respectively. Improvements in both frequency and severity of coldness were observed in 74.0% of patients. The status of tenderness in the iliac region, without upset stom ach or depression, was obtained as an appropriate model for the prediction of treatment effect, and its discrimi natory predictability was calculated as 84.4%. The predictive accuracy of the model was validated with 82.1% for the 28 new patients.
Conclusions : Coldness susceptible to tokishigyakukagoshuyushokyoto was very frequently accompanied by tenderness in iliac region, without upset stomach or depression.

Exercise-induced changes in body composition are dependent on various external factors. The psychological factor seems to be an important determinant for reducing body mass. However, the effect of changes in mood on weight loss have not been thoroughly investigated. The purpose of this study was to investigate the relationships among mood status, body composition and anthropometric characteristics observed during an exercise training program. Thirty-four obese women, aged 46.5±7.7 years, participated in our 3-month weight loss program. Body mass and % fat significantly decreased from 66.3±7.1 kg to 59.8±6.5kg, and from 31.8±3.1% to 27.9±4.0% (P<0.05), respectively. Aerobic power, as represented by maximal oxygen uptake, significantly increased (from 29.1±5.0 mlin/kg to 34.6±5.2 mlin/kg), and oxygen uptake corresponding to lactate threshold increased as well (from 17.2±2.8mlin/kg to 20.0±3.0mlin/kg) after training (P<0.05) . Accord. ing to the degree of body mass change, the subjects were divided into the following two groups : good-responder group (Group G : -9.2±2.7 kg) and poor-responder group (Group P : -3.8±1.4 kg) . Analyses of variance revealed significant differences (P<0.05) in total mood disturbance between Group G (103.54±16.30) and Group P (115.20±21.17) . These results show the possibility of the effects of mood on the success of weight loss in obese middle-aged women.

Objectives : We evaluated the efficacy of tokishakuyakusan and kamishoyosan for patients who complained of feeling cold, and identified key symptoms that would predict positive treatment outcomes for coldness with these medicines.
Design : A retrospective cohort study
Subjects and Methods : The subjects were 188 patients who reported feeling cold. They were treated with tokishakuyakusan or kamishoyosan according to their Sho for more than one month. The relationships between improvement of cold sensation and 62 factors, including other symptoms noted at the first medical examination, were evaluated by means of cross-sectional analysis, followed by logistic regression.
Results : The factors of coldness of the abdomen (odds ratio, 5.0), vertigo (7.7), dimness of sight (16) and blushing (5.6), without anger (0.11) or tinnitus (0.025), were found to be predictors of a positive effect with tokishakuyakusan treatment (p < 0.001). The factors of hot flushes (14), without coldness of the whole body (0.099), and faint feeling (0.21) were significant for kamishoyosan (p < 0.001). This suggests that kamishoyosan can improve subjective coldness of the extremities (AIC -8.64), especially of the legs (-2.23).
Conclusions : Coldness in the abdomen was an important indicator for treatment with tokishakuyakusan, while coldness in the legs, but not in the whole body, was important in the case of kamishoyosan.

Placebo is commonly used in clinical trials but it is also used in clinical practice. However, it is difficult to get informed consent for the placebo use from patients in clinical practice. Thus, placebo use in such occasion can lead to an ethical problem. We have previously reported the current use of placebo and the psychological conflict of doctors and nurses about the use of placebo treatments in the actual medical settings. However, to date, no study has reported the perception of pharmacists, some of whom prepare and explain the use of placebo medicines to patients, as their medication. We conducted a survey of the current use of placebo in clinical practice and the perception of pharmacists regarding its use in 3 hospitals based on anonymous self-report questionnaire as a pilot study prior to a nationwide survey. We administered the questionnaire to 92 pharmacists belonging to 3 hospital pharmacies between July 2 and 24, 2012. Of the 92 pharmacists, 84 (91.3%) returned the questionnaire, then we analyzed the data by descriptive statistics and a contingency table. Our results showed that 54.8% of the pharmacists had experience of placebo use in medical settings, and 9.9% of them had instructed on the use of placebo ; while 43.2% of them (answered that they feel uncomfortable with the use of placebos in clinical settings) tended to feel antipathy toward the use of placebos in clinical practice. While the use of placebos in medical setting may have a potential ethical issue, 66.7% of the pharmacists considered that placebo use in clinical settings is not necessarily unethical. Pharmacists who had previously discussed this issue with other staff thought that placebo use in clinical practice is unethical (p＝0.009).

Background : Menstrual migraine is more resistant to treatment than that of nonmenstrual episodes. Hormonal progesterone changes may cause sui (water/fluid) disturbance, in Kampo medicine terms. We therefore treated patients with menstrual migraine in which goshuyuto was ineffective, with the combination of goreisan and goshuyuto.
Subjects & Methods : Subjects were 37 female patients with coldness (mean age 37 years, age range 23-48 years), whose migraine during their intra-menstrual periods was successfully treated with goshuyuto for 3 months. In order to treat migraine in the menstrual period, goreisan was added to goshuyuto from 1 week before onset, until the end of their menstrual period. Results : Among 37 patients, the treatment was effective in 26 patients (70%). Significant variables were found to be dull headache (p = 0.003), edema (p = 0.006), vertigo (p = 0.014) and oliguria (p = 0.014) during attacks, as well as worsening before rain (p = 0.004). Conclusion : The periodical combination of goreisan and goshuyuto seems to be effective in patients with menstrual migraine who report symptoms of sui disturbance, such as dull headache and oliguria during their attacks.

Angiotensin I converting enzyme (ACE) gene Insertion/Deletion (I/D) polymorphism was first shown as a genetic factor which influences human physical performance in 1998. Since then, various gene polymorphisms which influence physical performance and trainability have been reported. ACE is a key enzyme which produces angiotensin II in the renin-angiotensin system, and its activity was determined by I/D polymorphism. Many studies indicate that the I/I genotype is frequently found in elite endurance athletes, while the D/D genotype is frequently found in power-oriented elite athletes. Longitudinal studies show that the D/D genotype may contribute to enhanced strength trainability. However, it is still unclear whether the I/I genotype enhances endurance trainability. Therefore, the ACE gene I/D polymorphism can be a genetic factor which influences human physical performance.

The decrease of muscle glycogen may be useful for the improvement of endurance performance. Intense anaerobic exercise requires a high rate of glycogen utilization, but consecutive intense anaerobic exercises induce a pronounced decline of external power and muscle glycogen consumption. We hypothesized that a long rest period between consecutive intense anaerobic exercises may aid in sustaining external power and glycogen consumption. Secondly, we hypothesized that active rest (AR) during the long resting period may be more effective than passive rest (PR).Six subjects performed four 30-second Wingate tests (WAnT) with a 4-minute recovery between each bout (Consecutive method). The subjects also performed a similar exercise procedure, but with a 30-minute seated resting period after the second bout (PR method).The other six male subjects performed four 30-second WAnTs with a 4-minute recovery between each bout, with 30-minutes of cycling at 40% VO₂max after the second bout (AR method). The subjects also performed PR method.The total work during the third and fourth bouts was greatest under the AR condition, followed by the PR condition, and finally the Consecutive method (p<0.05 for all comparisons). Blood lactate concentration during resting period was significantly lower, while muscle glycogen consumption was greater AR method than PR method (p<0.05 for both).A long resting period between consecutive intense anaerobic exercises may prevent the decline in external power and work. Additionally, AR has more favorable effects on muscle glycogen consumption, resulting in very low muscle glycogen levels, even with a small total amount of exercise.

In a 3 year-old girl with acyanotic tetralogy of Fallot, preoperative echocardiography revealed a thick fibrous tissue hanging on the right side of large ventricular septal defect. According to the definition of Kirklin, we diagnosed it as “flap valve ventricular septal defect.” And this diagnosis was supported by the findings of electrocardiogram and cardiac catheterization. At the operation, it was confirmed that the flap was only attached to the posterior margin of ventricular septal defect, and that it hardly played any part in tricuspid valve function. To our knowledge, this is the first case of “tetralogy of Fallot with flap valve ventricular septal defect” reported in Japan.