Three cases of dermatosis successfully treated with modified Mao-rensho-shakushozu-to are reported. Case 1 was a 45-year-old male who had been suffering from atopic dermatitis since childhood. He came to our clinic for treatment with Kampo formulas for unchanging symptoms. At first we prescribed Mao-rensho-shakushozu-to-go-byakko-ka-keishi-to, but this formula was not effective. After prescribing Mao-rensho-shakushozu-to-go-eppi-ka-jutsu-to, the dermatitis improved. Case 2 was a 25-year-old male student who had been suffering from atopic dermatitis since he was 19 years old. He responded to steroid ointment, but relapsed frequently after the repeated reduction of steroids. Some Kampo formulas were not effective, but the dermatitis improved after the patient used Mao-rensho-shakushozu-to-go-eppi-ka jutsu-to. Case 3 was a 65-year-old male who had been suffering from psoriasis vulgaris since he was 57. Shakushozu-to-go-byakko-ka-ninjin-to was effective for his psoriasis.
We used modified Mao-rensho-shakushozu-to in the three cases described above be cause the patients had strong itching. It is possible to apply this Kampo formula for dermatitis with strong itching.

In accordance with the advisory statement by the International Liaison Committee on Resuscitation and the Guidelines for Cardiopulmonary Resuscitation of the American Heart Association, we developed an advanced cardiac life support (ACLS) course for undergraduate medical students and assessed the effectiveness of and issues related to this program. A 2-day ACLS course with a special emphasis on MEGA code training was provided to 93 fifth-year medical students, after which evaluation testing was performed. Knowledge about airway management using airway adjuncts (correct response rate, 78.1% to 98.4%) and the treatment algorithms for ventricular fibrillation (81.3% to 95.3%) were well retained. However, knowledge about pharmacologic intervention was poorly learned. Most of the problems in the MEGA code algorithms for asystole and pulseless electrical activity were associated with drug administration. We conclude that this ACLS course for undergraduate medical students is effective but may not be sufficient for teaching certain aspects of ACLS.

Background: Blood culture is an essential examination for diagnosis of causative microorganisms and determination of optimal antimicrobials in serious cases of infectious diseases. We examined temporal trends in the number and multiplicities of blood culture submission, two pre-analytic parameters indicating quality of the examination, in the Minami Ibaraki Area.
Methods: We reviewed all computerized and available paper-based laboratory records of microbiological examination in five hospitals in the area between 2002 and 2011.
Results: Blood culture submissions, estimated to be 2.4–7.3 (median: 5.1) sets per hospital bed, 8.6–23 (17) per 1,000 inpatient-days, and 0.13–0.41 (0.25) per newly admission in 2011, almost constantly increased during the study period in all hospitals. Proportions of blood specimens to all materials for microbiological cultures also increased up to 15–30% (20%) in 2011. In contrast, it was not until the latter half of the study period that solitary submission, accounting for 26–56% (35%) in 2011, decreased. Positive blood cultures were between 11 and 28% through the study period. Coagulase-negative staphylococci accounted for approximately one fourth of recovered organisms in 2006 and 2011.
Conclusion: Frequency and multiplicity of blood culture submission markedly increased in hospitals in the Minami-Ibaraki Area of Japan.

We performed a preliminary study of the reliability of the lymphocyte stimulating test (LST) for Kampo medicine. LST for three kinds of Kampo medicines was performed in both a Kampo-administrated group and a non-administrated group. LST for each of the medicines was negative for seven of eight subjects in the non-administrated group, but was negative for four of 11 subjects in the Kampo-administrated group. The LST-positive participants had no allergic state, and some among them were negative in challenge test. This preliminary study suggests that LST for Kampo medicine is likely to be false-positive.

Objective: Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were based on clinical or basic studies with specific conditional settings and were not sufficiently based on real-world clinical practice. In particular, there was little information on the doses of mood stabilizers. Methods: The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. The questionnaire included patient characteristics such as comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment. Results: Most patients received mood stabilizers such as lithium (n = 1,317), valproic acid (n = 808), carbamazepine (n = 136), and lamotrigine (n = 665). The dose of lithium was correlated with age, body weight, number of episodes, depression and GAF. The dose of valproic acid was correlated with body weight, number of episodes, presence of a rapid cycle and GAF. The dose of carbamazepine was correlated with age, mania, and the presence of a rapid cycle. The dose of lamotrigine was correlated with the number of episodes, depression, mania, psychotic features, and the presence of a rapid cycle. Doses of coadministered mood stabilizers were significantly correlated, except for the combination of valproic acid and lamotrigine. Conclusion The dose of mood stabilizers was selectively administered based on several factors, such as age, body composition, current mood status and functioning. Further prospective studies are required to confirm these findings.

We report a case of lower back with extremities pain, whose cause could not be established in the medical sense nor relieved by analgesic drugs, was successfully treated with kanzobushito. The patient was a 69-­year-old male. Because of extremity pain of his lower left back, he could not move by himself and was transported to our hospital by an ambulance. Having persistent pain, he could not turn over or stretch his left leg and anal­gesic drugs and sacral nerve blocks were ineffective. We administered kanzobushito referring to the phrase “pain that gets worse as someone approaches” in the Shokanron. After administering kanzobushito, his pain was reduced remarkably and he could sit down on the bed. And his activities of daily living improved immedi­ately. Thus, kanzobushito may be useful for severe pain and should be administered to neuropathic pain compli­cated with psychogenic factors referring to coldness, severe pain and abnormality of qi (irritable).

Orento is generally used for upper gastrointestinal symptoms. We have used orento for various diseases based on “upper heat and middle cold”. As a result of the evaluation of 30 responders to orento, the most frequent sign of “upper heat” was “yellow tongue coating” (29/30 responders), while the most frequent sign of “middle cold” was “preference for warm foods and beverages” (27/30 responders). Compared with the non-­responder group, the responder group showed significantly higher frequencies of “gastrointestinal cold”, which is the sum of “preference for warm foods and beverages” and “aggravation of gastrointestinal symptoms by cold foods and beverages” (29/30 responders, p = 0.047), and “upper/lower gastrointestinal symptoms” (29/30 responders, p = 0.014). These results suggest that “yellow tongue coating” is the most important sign for “upper heat” while “gastrointestinal cold” is the most important sign for “middle cold”. As Kampo patterns for orento, gastrointestinal symptoms often occur, but there is a possibility of upper or lower gastrointestinal symptoms, skin disorders, and sleep disorders.

In this report, we present three cases of lower limb cellulitis. The first case was an 88-year-old woman and the second case was a 36-year-old man. In addition to standard therapy, both of them received Kampo therapies with keishinieppiitto and jidabokuippo during the acute phase of cellulitis and were promptly cured. The third case was a 52-year-old woman with severe obesity suffering from repeated and intractable cellulitis. She received Kampo therapy including keishibukuryogan. The redness and swelling in her leg gradually disappeared. Administration of adequate antibiotics and elevation of affected areas are important for the treatment of cellulitis. Even with appropriate therapy, some patients are slow to respond and difficult to treat. The skin findings in cellulitis are swelling, redness, heat, and pain, which can be recognized and treated as water imbalance, heat, and blood stasis in Kampo medicine. This case report suggests that cellulitis during the acute phase can be treated with keishinieppiitto and the treatment of water imbalance and heat is important. After the acute phase, the treatment of blood stasis is important. Considering the time of onset and skin findings in cellulitis, Kampo therapy can contribute to the rapid recovery of cellulitis.

Mokuboito is usually used for the treatment of patients with dyspnea and edema due to chronic heart failure. We herein report two cases successfully treated with mokuboito on the basis of shinkahiken (epigastric stuffiness and strong resistance). Case 1 was a 28-year-old woman. She had been experiencing occasional bouts of epigastralgia for 12 years, but they had worsened two months before the first visit to our department. When she was examined, however, the cause of epigastralgia could not be determined and she was diagnosed with functional gastroenteropathy. After being introduced to our department, she was treated with various Kampo formulas, but the symptom was poorly improved. Case 2 was a 74-year-old man who was prescribed hachimijiogan and shoseiryuto for an overactive bladder and perennial allergic rhinitis. His symptoms were stable, but suddenly deteriorated after two months. In both cases, when changing treatment to mokuboito on the basis of shinkahiken, the symptoms were improved. These results suggest that mokuboito can be used in a wide range of cases with shinkahiken.

Five cases of various diseases associated with breast cancer treatment including arthralgia, menopausal symptoms, chemotherapy-­associated symptoms (nausea, vomiting, numbness, pain, general fatigue), and anxi­ety neuroses during follow-­up were treated with Kampo medicine and a favorable course was obtained. Com­bined use of Kampo treatment can reduce the suffering caused by the side effects of breast cancer treatment, alleviate mental symptoms, prevent recurrence, and improve the patients' health. Kampo medicine plays a role in cancer supportive care for breast cancer.