Great interest has been paid to moxibustion from many thousand years ago as one of effective folk medicine, hewever while through the years only practical use has been emphasized, its scientific basis has remained unclear. About 60 years ago Dr. Shimetaro Hara studied on moxibustion histologically and pharmacologically and suspected the widespread meridian theory (theory of Keiraku) in explaination of the moxibustion effect and presented “non-specific heat aggregated autologous tissue protein therapy” theory. It can be said that his theory coincides with today's nonspecific immune regulatory therapy applied to cancer and immune deficient diseases.
Using 9 Week-old femal SLC-Wistar rats, we administered regular moxa moxibustion or electrical moxibustion under the same circumstances as regular moxa moxibustion daily fom definite duration. Following moxibustion, using 0.5mg of HG as an antigen together with Freund's incomplete adjuvant, we sensitized two sites on the foot pads of rats once or twice (2 weeks later).
On the 7th day after the primary or secondary sensitization 1.0mg of HγG in 0.1ml of saline was injected subcutaneously at an intact sites of foot pad and foot pad edema formed was measured periodically. Taking sheep red blood cells and using refined human IgG myeloma protein as an antigen and glutar-aldehyde an a fixing reagent, we admindstered PHA (passive hamagglutination) for the assay of serum antibody level of moxibusted animals.
In comparison with moxibustion, on the same schedule 5mg/kg of levamisole (LEV) was adminstered orally daily and results were examined.
The inflammatory edematous reaction which was induced with the HγG reached a peak 3 hour salter the antigen challenged on the intact foot pad, then gradually weakened until it returned to normal was an immediate type skin reaction.
This edema rection in the moxibustion group and the LEV group also when compared with the control group was significantly stregthened. The antibody titer according to the PHA reaction showed after the primary sensitization, no remarkable increase in the moxibustion group, in fact, the level was about the same as the control. After the secondary sensitization the antibody titer of the moxibustion group was much higher than that of the LEV group compared with the control.
And the strongest effects were obtained in the moxibustion and LEV group. As an immune activator, the functional mechanism of moxibustion compared with levamisole which is said to have some function on the T cells will become clear in the future.
Moreover, it will be clinically possible to use moxibustion as a supplementary therapy to build up the immune response.

In the previous papers, we reported the effects of electronic moxibustion on immune response of experimental rats to the exogeneous antigens, human γ-globulin.
The results supported the theory, “non-specific heat aggregeted autologous tissue protein stimulation therapy” presented by Dr. Shimetaro Hara in 1933.
Therefore, in this paper we chose two kinds of antigens, one is the T-cell dependent antigen, dinitrophenylated keyhole limpet hemocyanin (DNP-KLH), the other is the T-cell independent antigen dinitrophenylated Ficoll (DNP-Ficoll) to analyse the mechanism of electronic moxibustion whether it enhances the immune response or not.
Using 9 weeks old femal SLC-Wistar rats, we administered the electronic moxibustion according to the method reported in the previous papers. Following daily moxibustion for 8 weeks, antigens were giver twice at intervals of one week together with Freund's complete adjuvant. And 4 days later from the last antigen stimulation direct, DNP plaque forming cells in the spleen were counted.
The results obviously showed daily electronic moxibustion for 8 weeks enhanced immune response against the T-cell dependent antigen (DNP-KLH) stimulated rats but no effect on the immune response to the T-cell independent antigen (DNP-Ficoll) stimulated rats.
The daily electronic moxibustion for 4 weeks to rats failed to show any effective results against both antigens stimulation.
The responses of spleen cells against mitogenic lectins, PHA, Con A and PWM were analysed 3 days after the incubation with lectins by tritiated thymidine up takes into cells. The results also showed the animal group received the electronic moxibustion for 8 weeks manifested higher response against the one of T-cell mitogens, Con A compared with either the group received the electronic moxibustion for 4 weeks or the control group, not received any treatment.
These results suggested that the immune activation mechanism exhibited by the electronic moxibustion is via the activation of T-cell function and the electronic moxibustion does not act on B cell nor antibody forming cells.
The direct effects on the animal skin by the electronic moxibustion were shown exactly the same physical characteristics as the conventional moxibustion method as reported in the previous papers. Therefore, we could expect the similar T-cell activation effect on the immune response by the conventional moxibustion.
But from our results to get such a T-cell activation by the electronic moxibustion, it has been necessary to administrate the electronic moxibustion daily at least for more than 4 weeks.
Next we would like to make clear what kinds of subpopulation in the T-cell populations are activated by the electronic moxibustion.
Before the clinical administration of the electronic moxibustion as one of immune activators, it is necessary to investigate further about the optimal amounts of the moxibustion, effects of the moxibustion on the cellular immunity or tumor immunity.

Pancreatic ductal adenocarcinoma (PDAC) is the most lethal type of gastrointestinal cancer, with a 5-year survival rate of 5%; it remains a significant, unresolved therapeutic challenge. Its aggressive features include insidious presentation, unresectability due to early involvement of major vessels, debilitating symptoms at the late stage and de novo chemoresistance. However, according to the Japan Pancreatic Cancer Registry, the 5-year survival of UICC Stages 0 and 1a are 85.8% and 68.7%, respectively. Early diagnosis plays an important role in improving the overall survival of patients with PDAC; therefore, efforts should focus on early diagnosis and the reliable identification of patients who will most likely benefit from major surgical intervention. Patients with risk factors, including family history, accompanying disease, diabetes mellitus, chronic pancreatitis and intraductal papillary mucinous neoplasms (IPMN), should be followed up for early detection of PDAC. In Japan, a national team has undertaken such surveillance of patients with IPMN. The protocol comprises a semi-annual follow up using various modalities to detect not only IPMN carcinoma, but also PDAC concomitant with IPMN. I will address this protocol in detail. The most accurate imaging technique for PDAC diagnosis and staging is considered to be contrast-enhanced computed tomography (CECT). Whereas CT should be the first choice in patients with suspected PDAC, endoscopic ultrasound (EUS) is the most accurate, particularly for detecting small lesions (< 10 mm). EUS combines the potential of endoscopy, which enables visualization of the mucosal surface of the gastrointestinal (GI) tract, with ultrasonography. Thus, EUS is able to provide detailed, high-resolution images of the pancreas. However, whether a lesion is malignant or benign is unable to be discriminated solely from EUS imaging features. Obtaining samples from suspicious lesions or lymph nodes using EUS-guided fine-needle aspiration (FNA), offers the potential for cytological or histological diagnoses of pancreatic lesions with high sensitivity and specificity. Since accurate preoperative evaluation is essential to select the appropriate management strategy, the roles of EUS and EUS-FNA are crucial. Stage 0 PDAC (carcinoma in situ) has recently been discovered. This stage of PDAC is unable to be diagnosed using EUS-FNA, because EUS-FNA is only applicable after PDAC forms a cancerous mass (worse than stage1). Thus, diagnostic methods other than imaging require development. Presently, endoscopic retrograde pancreatography (ERP) combined with cytology is able to detect Stage 0 PDAC, and in Japan, nasopancreatic drainage tubes have recently been used to collect pancreatic juice for cytodiagnosis. I would also like to introduce this method.

  The purpose of this research was to clarify factors that make early hospital discharge difficult. We found that this hospital was different from other general hospitals. We repeatedly revised early discharge guidelines and were able to find factors reliable about 24% higher.
  Our findings would contribute to the shortening of hospital stay, the promotion of the efficiency of our work, the strengthening of regional alliances. What we should consider most important is the realization of the discharge that is not forced.

Pancreatic ductal adenocarcinoma (PDAC) is the most lethal type of gastrointestinalcancer, with a 5-year survival rate of 5%; it remains a significant, unresolvedtherapeutic challenge. Its aggressive features include insidious presentation,unresectability due to early involvement of major vessels, debilitating symptomsat the late stage and de novo chemoresistance.However, according to the Japan Pancreatic Cancer Registry, the 5-year survivalof UICC Stages 0 and 1a are 85.8% and 68.7%, respectively.Early diagnosis plays an important role in improving the overall survival ofpatients with PDAC; therefore, efforts should focus on early diagnosis and thereliable identification of patients who will most likely benefit from major surgicalintervention.Patients with risk factors, including family history, accompanying disease,diabetes mellitus, chronic pancreatitis and intraductal papillary mucinousneoplasms (IPMN), should be followed up for early detection of PDAC. In Japan,a national team has undertaken such surveillance of patients with IPMN. Theprotocol comprises a semi-annual follow up using various modalities to detectnot only IPMN carcinoma, but also PDAC concomitant with IPMN. I will addressthis protocol in detail.The most accurate imaging technique for PDAC diagnosis and staging isconsidered to be contrast-enhanced computed tomography (CECT). WhereasCT should be the first choice in patients with suspected PDAC, endoscopicultrasound (EUS) is the most accurate, particularly for detecting small lesions (<10 mm). EUS combines the potential of endoscopy, which enables visualizationof the mucosal surface of the gastrointestinal (GI) tract, with ultrasonography.Thus, EUS is able to provide detailed, high-resolution images of the pancreas.However, whether a lesion is malignant or benign is unable to be discriminatedsolely from EUS imaging features. Obtaining samples from suspicious lesions orlymph nodes using EUS-guided fine-needle aspiration (FNA), offers the potentialfor cytological or histological diagnoses of pancreatic lesions with high sensitivityand specificity. Since accurate preoperative evaluation is essential to select theappropriate management strategy, the roles of EUS and EUS-FNA are crucial.Stage 0 PDAC (carcinoma in situ) has recently been discovered. This stage of PDACis unable to be diagnosed using EUS-FNA, because EUS-FNA is only applicableafter PDAC forms a cancerous mass (worse than stage1). Thus, diagnostic methodsother than imaging require development. Presently, endoscopic retrogradepancreatography (ERP) combined with cytology is able to detect Stage 0 PDAC,and in Japan, nasopancreatic drainage tubes have recently been used to collectpancreatic juice for cytodiagnosis. I would also like to introduce this method.

Between January, 1975 and June, 1990, 67 patients underwent surgical treatment for infective endocarditis at our hospital. Of 67 patients, 27 patients showed active endocarditis at the time of operation. In these 27 patients, 20 had active endocarditis of the native valve (NVE), and the seven had active prosthetic valve endocarditis (PVE). The interval between onset of infective endocarditis and operation ranged from 7 to 252 days (mean, 36 days). In the operative results, 3 of 20 patients (15%) with NVE and 2 of 5 patients (40.0%) with PVE died before discharge from the hospital. According to analysis of preoperative hemodynamic state and bacteriological data, the determinant factors of operative mortality and morbidity were preoperative NYHA functional classification, the interval between onset of infection and operation, and annular destruction (annular abscess). Patient's age, preoperative renal function, positive blood culture, the site of infection, and positive culture or stain of the surgically excised valve did not play an important role to determine operative mortality and morbidity. It is our conclusion that all patients with infective endocarditis who develop progressive congestive heart failure and echocardigraphical extravalvular infection despite medical treatment, should have prompt valve replacement.

Cor triatriatum is one of the rare congenital cardiac malformations and once the diagnosis is correctly established, this is amenable to surgical correction. We reported a case of 25-year-old male of cor triatriatum, who had symptomes of easy fatiguability. The diagnosis of cor triatriatum was suspected preoperatively by two-dimensional echocardiogram at first, detecting abnormal diaphragm in the left atrium, and it was confirmed by color Doppler echocardiogram and transesophageal two-dimensional echocardiogram. Cardiac catheterization revealed high pulmonary capillary wedge pressure and the abnormal diaphragm in the left atrium was showed by the pulmonary arteriography. On the operation, the abnormal diaphragm was excised by the trans-septal approach, which had a small fenestration of 8mm in diameter at posterolateral site. Some considerations for clinical diagnosis and surgical treatment are discussed.

This study was conducted to clarify the relationship between power estimated by blood lactate movement during intermittent running test (Maximal Anaerobic Running Test : MART), and velocity of middle distance running (V 800 m, V 1500 m) . The subjects were well-trained male middledistance runners (n=8) .
MART consisted of a variable number of 20 seconds runs on a treadmill with a 100 seconds recovery period between runs. The runs were performed ona a 4° incline. After 40 second recovery, earlobe blood samples were taken and blood lactate concentrations were analyzed. The first run was performed at 250 m/min. Velocity of the treadmill was increased by 25 m/min for each consecutive run until volitional exhaustion.
The power requirement associated with the absolute value of blood lactate (La) and relative value of peak blood lactate (PBLa) was determined from the La or %PBLa vs power curve by linear interpolation from the two consecutive La values which were above and below the desired value.
Results were summarized as follows:
(1) Maximal power (Pmax) for MART was correlated positively with V800m (r=0.880, P<0.01) and V1500m (r=0.948, p<0.001) .
(2) Power estimated at 40% value of PBLa (P40%La) correlated positively with V 1500 m (r=0.903, P<0.01), and at 60% value of PBLa (P60%La) was correlated positively with V800m (r=0.835, P<0.01) and 1500m (r=0.936, p<0.001) .
These results indicate that MART is a valid test for estimating middle distance running performance and P40%La, and P60%La are important indexes with 800-m and 1500-m running.

Intestinal spirochetosis is a rare gastrointestinal infection caused by Brachyspira. Clinical manifestations vary, ranging from asymptomatic infection to gastrointestinal bleeding, diarrhea, or abdominal pain. Antimicrobial medications such as metronidazole are routinely given, but their clinical efficacy has not determined with any precision. We report a case of intestinal spirochetosis treated with daikenchuto extract with literature reviews. Treatment of intestinal spirochetosis can be difficult, and use of daikenchuto extract may be an option especially for patients with symptoms such as chronic diarrhea, abdominal distention, or change in flatus.