The Project for Improving Maternal and Newborn Care through Midwifery Capacity Development by Japan International Cooperation Agency (JICA) was initiated for capacity building through pre-and post-service midwifery training.
  Firstly, we have shared the concept of ideal midwifery care based on the definition of evidence-based medicine (EBM) with our counterparts, which involves the integration of the best research evidence with clinical expertise and patient values. In addition to evidence-based midwifery care, we tried to provide individualized woman-centered care.
  After sharing these concepts in our project sites, we tried to modify the lectures on the basic concepts of midwifery care in the Health Center Midwifery Training program, and care providers’ attitudes based on EBM in the Basic Emergency Obstetric and Neonatal Care Training program.
  Our trial is an essential first step towards the further reduction of maternal mortality in Cambodia.

An 8-year-old girl was admitted with vision loss. She had no history of amblyopia or other eye diseases. On examination, both eyes showed vision loss and uncorrected myopia, regardless of visual acuity correction by glasses. Her symptoms were considered exacerbated by fatigue. We diagnosed tonic accommodation because a regulatory paralysis agent provided relief. The patient had been treated with tropicamide methyl sulfate and neostigmine, but her visual acuity did not change. Based on a Kampo diagnosis, she was prescribed Shokenchuto. After 4 months' administration, her uncorrected vision improved by 1.2 in both eyes, and her visual acuity was maintained even when fatigued. Kampo medicine can be a treatment option for tonic accommodation in cases where standard treatments are ineffective.

A 54-year-old female had cesarean sections at ages 26 and 29, a left salpingophrectomy for left ovarian cyst at age 31, and a total abdominal hysterectomy for fibroids at age 41. After total abdominal hysterectomy, she had repeated bouts of ileus and started taking daikenchuto (DKT), which is commonly used to prevent ileus. At age 54, she visited our hospital when DKT failed to relieve her constipation and lower abdominal pain and had occasional heat flash above her neck. Tongue examination revealed pale red tongue and fissured tongue signs with yellow fur and dilation of the sublingual collateral vessels. Kampo diagnosis was blood stasis and excess heat, for which keishibukuryogan was prescribed to be taken daily and with which her symptoms dissipated after 7 days. Despite the popular use of DKT, its potential to cause excess heat after long-term use is not as well known. It is extremely important to warn clinicians who prescribe Kampo not to focus solely on a disease-to-prescription model but also to be learned of the discipline and to take measures to prevent adverse long-term effects and complications.

To examine the effects of pesticides on farmers working in vinyl-covered greenhouses, subacute toxicity tests were conducted on rabbits exposed in the greenhouse a period of three months to zinc ethylenebis-dithiocarbamate (ZED) and N-trichloromethylthio-tetrahydrophthalimide (NTT), which had been sprayed once or twice a week. As a result, the authors have arrived at the following conclusions:
1) Either ZED or NTT did not inhibit the growth of the rabbits during the period.
2) Any significant changes attributable to the spraying of both pesticides were not detected in blood, urine and biochemical examinations.
3) Pathohistological examination showed the infiltration of polymorphonuclear leukocytes and histocytes in the interalveolar tissue of the lungs of the NTT-exposed rabbits. However, in the case of the ZED-exposed group of rabbits, the infiltration was so slight that there was veritably no difference from the control group.
In the brain, heart, liver, kidney, spleen, suprarenal gland, stomach and intestines, there were no abnormalities worth mentioning.
4) In several cases of the NTT-exposed group, inflammation was observed in their eyes and skins, whereas nothing abnormal were observed in the ZED-exposed group.
5) The concentration of ZED in air within the vinyl greenhouse at a time of spraying was 0.35mg/m3 and NTT measured 0.20mg/m3. After a lapse of one hour, either pesticide was undetectable.

Each of the 1, 000-times dilute solution of both drugs, Salithion and Sumithion, were experimentally sprayed over rabbits in vinyl greenhouses at a rate of five hours a day for three consecutive days. Changes in the residual quantity of the drugs in the blood and also in the quantity of PNMC, a metabolite of Sumithion in urine, were measured with the passage of time after the spraying. At the same time, the liver functions of the rabbits were checked and they were also subjected to a urinalysis and a pathohistological examination. The conclusions drawn from these studies are as follows:
1) No abnormal findings were observed on the appearance of the rabbits exposed to Salithion and Sumithion. Nor were there any abnormalities in the ophthalmologic findings, especially, in the funduscopic findings, at 10 and 30 days after the spraying of these drugs.
2) The residual quantity of both drugs in all the experimented rabbit's blood was measured immediately after the spraying. However, these drugs later disappeared rapidly from the blood, and they could not be detected 10 days after the spraying.
3) There was a significant rise in the quantity of PNMC 24 hours after the spraying. Later, it decreased rapidly. Ten days after the spraying, its values returned to normal level before the spraying.
4) With respect to the serum ChE level, the changes in the groups exposed to Salithion and Sumithion were the same as those in the control groups. So, any influences were not observed on serum ChE by the spraying of these drugs.
5) In the liver function test, urinalysis and pathohistological examination, no abnomal findings attributable to the inhalation of both drugs were observed.
6) The drug concentration in the air in the vinyl greenhouses at the time of their spraying was 61.5μg/m³ for Salithion and 30.1μg/m³ for Sumithion.

In the previous report, we concluded that chances are very slim for Salithion and Sumithion to concentrate in rabbits as these organophosphorous compounds are excreted quickly. This conclusion was inferentially drawn from the results of measurements of concentration of Salithion and Sumithion residues in the blood after experimental exposures of rabbits to the pesticides.
In the present report, we will discuss the same toxicological problem based on our findings in a series of experiments using rabbits with hepatic disturbances induced by carbon tetrachloride (CCl₄).
Rabbits were divided into three groups. One consists of rabbits having light hepatic disorder. They were subcutaneously injected with 0.1ml/kg of 20% CCl4 olive oil for three days consecutively. Under the second group come rabbits with moderate liver disturbance caused by the injection of 0.3 ml/kg of 20% CCl₄ olive oil. The injection was also made for three days. The remaining group is the control group.
These rabbits were administered orally with 5mg/kg and 20mg/kg of Smithion for three days running.
The examination covered (1) Sumithion residue level in the blood, (2) PNMC level in urine, (3) hepatic function (ChE, GOT, GPT, BSP, Al-P, BUN), (4) urinalysis and (5) histopathological examination of the liver and the kidney. The results of these tests were studied in comparison with those of the control group.
The following is a summary of our conclusion:
1) In the control group, Sumithion residues in the blood disappeared quickly, and could not be detected 72 hours after administration.
2) As far as the disappearance of Sumithion and the excretion of PNMC are concerned, there was no significant difference between the control and the light and moderate liver disturbance groups of rabbits.
3) In the rabbits with CCl₄-induced liver disturbances, it was noted that the administration of Sumithion impeded serum and red-cell ChE activities to a remarkable extent, and delayed the recovery of the liver function.
4) However, the liver disturbance did not deteriorate. The histological observation of the liver and the kidney did not reveal any abnormality due to the administration of Sumithion, either.

Objective: This study aimed to elucidate the electro-clinical characteristics of epilepsy and immunological markers in patients with epilepsy after infl uenza-associated encephalopathy/encephalitis (IAE). Methods: Eighteen patients with epilepsy after IAE (8 males, 10 females; mean age of onset 6.4±6.4 years) were studied. Antibodies to glutamate receptor (GluR) ε2 (NR2B) were examined by immunoblot and ELISA. Cytokines were measured by BioPlex. Results: Mean interval between IAE and epilepsy onset was 63.2 ± 95.0 days (mean ± SD). In 16 of 18 patients, complex partial seizures were observed. Most complex partial seizures were of short durations and showed few lateralizing signs. Interictal discharges were seen in the frontal area in 7 of 14 patients. Ictal EEG showed rapid propagation to bilateral hemispheres. Patients with higher cerebrospinal fl uid levels of anti-GluRε2 antibodies, higher cerebrospinal fl uid levels of IL-1β, soluble tumor necrosis factor receptor 1 and IFN-γ during chronic stage, had higher frequency of epileptic seizures. Conclusion: This study indicates that the frontal lobes are susceptible to rapid epileptogenesis after IAE, and that epileptic partial seizures after IAE had characteristics resembling generalized seizures. Presence of anti-GluRε2 antibodies and elevated IL-1β, TNFα, and IFN-γ in cerebrospinal fl uid may be associated with intractability of epileptic seizures.

We experienced a case of palmoplantar pustulosis in which the patient's dermatological symptoms im­proved after treatment with a combination of bofutsushosan and keishibukuryogan. The patient was a 42-year-old woman. She had been prescribed biotin and a steroid ointment, but her condition did not improve. At her first visit to our Kampo clinic, we observed impetigo, cracks, and scaling on both palms and plantar surfaces. We determined that the patient was of the poisoned organ (zodoku) and stagnant blood (oketsu) constitutions,as outlined in the Ikkando school of medical thought. We prescribed bofutsushosan and keishibukuryogan as fundamental treatment and then in a few days, the patient's dermatological symptoms resolved. The patient later developed hyperthyroidism, which caused her symptoms to worsen again, we therefore switched to shofusan and eppikajutsuto as local and symptomatic treatment, and then she once again improved. Soon after, we returned to keishibukuryogan and bofutsusho for her to maintain remission. Since poisoned organ and stagnant blood constitutions contribute greatly to the Kampo pathology of palmoplantar pustulosis, we believe bofutsushosan and keishibukuryogan are effective formulations for the treatment of this condition. As far as we searched, there were no papers that selected bofutsushosan or blood stasis agents as the main cure from the viewpoint of the poisoned organ constitution and the stagnant blood constitution. Therefore, this case was considered to be a valuable case.

This report describes 20 women who underwent in vitro fertilization or microinsemination while receiving a regimen of herbal medicine, of which contents varied according to the treatment stage. Until the ova were harvested, in order to promote maturation, patients were treated with hachimijiogan for reinforcing kidney yang, and keishibukuryogan for removing blood stasis. Following this, during the period between harvesting and implantation, they were treated either exclusively with unkeito for warming meridians, dissipates cold, and replenishes blood, or with unkeito in combination with keishibukuryogan. Following implantation, they were treated with tokishakuyakusan to induce uterine relaxation. The treatment regimen was determined based on traditional herbal evidence of infertile patient's blood stasis and kidney deficiency. We adjusted applied dose depending on the conditions of patients. Fourteen of the 20 women tested positive for pregnancy; 10 of them carried to term, whereas in 4 of them, the pregnancy ended in abortion or miscarriage. Anti-Müllerian hormone concentration, endometrial thickness, estimated follicle count, recovered ova count, fertilized ova count, and numbers of ova to reach the early-embryo stage and blastocyst stage were compared between the continuing pregnancy and the non-pregnancy groups. Improvements were observed in all values after combined use of traditional herbal medicines, except in the case of endometrial thickness, and significant differences appeared in recovered ova count and fertilized ova count. These observations suggest that a regimen of herbal medicine adapted to the various stages of in vitro fertilization may be a useful complementary therapy during pregnancy.

Adult ; Female ; Hemorrhage ; etiology ; Humans ; Magnetic Resonance Imaging ; Ovarian Cysts ; diagnosis ; etiology ; Ovarian Hyperstimulation Syndrome ; complications