The purpose of this research paper is to clarify the effect of moxibustion on the protective antibody induced by the Smith strain of Staphylococcus aureus. The moxibustion test group of four rabbits and the control group of four rabbits were all immunized subcutaneously with the Smith strain of S. aureus. Sera samples were collected weekly and antibody production was detected by enzyme-linked immunosorbent assay (ELISA). Compared to the control group, the titer of IgM antibody of the moxibustion group increased significantly (p<0.05). Furthermore, ELISA inhibition tests with Smith surface antigen (SSA, a protective antigen) showed significantly (p<0.05) higher activities of IgM and IgG antibody in the moxibustion group at the 9th week after the first immunization. These results suggest that moxibustion promotes not only production of antibodies against the Smith strain of S. aureus, but also passive protective activity against SSA of S. aureus.

With the purpose of clarifying the influence of direct moxibustion on the cell count and proportion of leukocytes in peripheral blood, rabbits and humans were treated with direct moxibustion. The moxa cones were the size of a “rice grain”. In the rabbits 10 moxa cones were distributed among four points which were selected on the low back. Humans were treated with the same method except eight points were chosen on the back and legs. Peripheral blood was collected periodically following each treatment. Leukocyte counts and leukocyte differentials were then measured. Lymphocyte subpopulations were also analyzed with flow cytometry in humans.
In rabbits, the mean leukocyte count increased transiently after the treatment in both the moxibustion group and the control group. However, the greatest increase was observed in the moxibustion group. In humans, no change was found in leukocyte counts and leukocyte differentials in the moxibustion group. However, the mean T cell percentage in the moxibustion group decreased 24 hours after the moxibustion treatment. Moreover, the mean CD4/CD8 ratio of the moxibustion group increased 2 hours after the treatment, and decreased 24 hours after the treatment. These changes were statistically significant while no significant change was observed in the control group. No change was found in either rabbits or humans after the 4 weeks of treatment.
These results suggest that the immune system will be influenced by moxibustion at least transiently.

Objective: To inquire about how evaluation of physician supervisors is performed, and whether or not incentives to guide comprehensive community-based clinical clerkship for them are provided, in hospitals outside Sapporo Medical University.

Methods: We conducted field surveys using questionnaires distributed to physician supervisors and hospital directors, focusing on the evaluation of physician supervisors and whether they are provided with incentives. From the survey, we examined the attitude toward educational awareness of the physician supervisors.

Results: The number of hospitals where evaluations for physician supervisors were performed and incentives were provided was limited. In addition, 54.2% of the physician supervisors responded that incentives were unnecessary. Many of them considered that incentives for a hospital are more preferable than for individual supervisors.

Conclusion: These results suggest that with respect to community-based clinical clerkship outside the university, an appropriate method for providing incentives, including whether or not they are necessary, should be considered.

Purpose: This study aimed to evaluate the effect of continuous patient education on pain control in outpatients based on changes in pain intensity scores and occurrence of opioid-related adverse effects. Methods: The education intervention was conducted in the following phases; 1) interview at the first visit for opioid introduction, 2) telephone follow-up at home 3 to 7 days after introducing opioid analgesics, and 3) interview at the next visit. Pain intensity scores; frequency of rescue dose; and occurrence of adverse opioid-related effects such as constipation, nausea, and drowsiness were compared among the three intervention phases. Results: When comparing data at phase 2 and 3 with those at phase 1, daily maximum pain score decreased significantly, frequency of rescue dose and opioid dosage increased significantly, and occurrence rates of constipation decreased. Conclusion: Continuous patient education by pharmacist intervention based on not only patient visit interviews but also telephone communication on non-visiting days can improve the pain intensity scores and reduce the rate of opioid-related adverse effects for cancer outpatients.

Methods: A total of 14 patients with unilateral radicular symptoms and five healthy subjects were subjected to simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement signaling (SHINKEI-Quant) using a 3-Tesla magnetic resonance imaging. The Visual Analog Scale (VAS) score for neck pain and upper arm pain was used to evaluate clinical symptoms. T2 relaxation times of the cervical dorsal root ganglia of the brachial plexus were measured bilaterally from C4 to C8 in patients with radicular symptoms and from C5 to C8 in healthy controls. The T2 ratio was calculated as the affected side to unaffected side. Results: When comparing nerve roots bilaterally at each spinal level, no significant differences in T2 relaxation times were found between patients and healthy subjects. However, T2 relaxation times of nerve roots in the patients with unilateral radicular symptoms were significantly prolonged on the involved side compared with the uninvolved side (p<0.05). The VAS score for upper arm pain was not significantly correlated with the T2 relaxation times, but was positively correlated with the T2 ratio. Conclusions In patients with cervical radiculopathy, the SHINKEI-Quant technique can be used to quantitatively evaluate the compressed cervical nerve roots. The VAS score for upper arm pain was positively correlated with the T2 ratio. This suggests that the SHINKEI-Quant is a potential tool for the diagnosis of cervical nerve entrapment.

A population-based cohort study on pediatric infectious diseases was established at Khanh Hoa Province, central Vietnam in 2006, to determine the etiology and risk factors for severe pediatric infectious diseases (SPID) such as acute respiratory infection (ARI), diarrhea and dengue which are the major causes of under 5 mortality. A population census survey was conducted in Nha-Trang and Ninh-Hoa to collect demographic, social-behavioral data and disease burden on SPID. The study site covered a population of 353,525 residing in 75,826 households with 24,781 children less than 5 years. Hospital databases from two hospitals covering the region were obtained. Linking the census and hospital databases, we were able to investigate on a variety of SPID such as environmental tobacco smoking exposure and increased risked of pediatric pneumonia hospitalization, population density, water supply and risk of dengue fever and animal livestock and risk of hospitalized diarrhea. To determine incidence, viral etiology and risk factors for pediatric ARI/pneumonia, we setup a population based prospective hospitalized Pediatric ARI surveillance at Khanh Hoa General Hospital, Nha-Trang in February 2007. The study has revealed RSV, rhinovirus and influenza A as major viral pathogens, role of multiple viral infection and its interaction with bacteria in the development of pneumonia. In addition, we are also conducting a birth cohort study to investigate the incidence of congenital infection and its impact on physical-neurological development, and role of host genetic polymorphism on SPID hospitalization in Vietnam. Population mobility, high cost of regular census update and low mortality are the challenges.

A population-based cohort study on pediatric infectious diseases was established at Khanh Hoa Province, central Vietnam in 2006, to determine the etiology and risk factors for severe pediatric infectious diseases (SPID) such as acute respiratory infection (ARI), diarrhea and dengue which are the major causes of under 5 mortality. A population census survey was conducted in Nha-Trang and Ninh-Hoa to collect demographic, social-behavioral data and disease burden on SPID. The study site covered a population of 353,525 residing in 75,826 households with 24,781 children less than 5 years. Hospital databases from two hospitals covering the region were obtained. Linking the census and hospital databases, we were able to investigate on a variety of SPID such as environmental tobacco smoking exposure and increased risked of pediatric pneumonia hospitalization, population density, water supply and risk of dengue fever and animal livestock and risk of hospitalized diarrhea. To determine incidence, viral etiology and risk factors for pediatric ARI/pneumonia, we setup a population based prospective hospitalized Pediatric ARI surveillance at Khanh Hoa General Hospital, Nha-Trang in February 2007. The study has revealed RSV, rhinovirus and influenza A as major viral pathogens, role of multiple viral infection and its interaction with bacteria in the development of pneumonia. In addition, we are also conducting a birth cohort study to investigate the incidence of congenital infection and its impact on physical-neurological development, and role of host genetic polymorphism on SPID hospitalization in Vietnam. Population mobility, high cost of regular census update and low mortality are the challenges.

BACKGROUND/AIMS: Venous thromboembolism (VTE) is a major extraintestinal manifestation in inflammatory bowel disease (IBD), regarded as an independent risk factor for VTE according to reports from Western countries. However, the incidence and risk factors of VTE in Asian IBD patients are not fully understood. We aimed to reveal the incidence and risk factors of VTE in Japanese IBD inpatients. METHODS: The incidence of VTE in inpatients with IBD (n=340), gastrointestinal cancers (n=557), and other gastrointestinal diseases (n=569) treated at our hospital from 2009 to 2013 was retrospectively investigated. The characteristics and laboratory data of IBD inpatients with and without VTE were compared in univariate and multivariate analyses. Clinical courses of VTE in IBD were surveyed. RESULTS: VTE was detected in 7.1% of IBD inpatients, significantly higher than in gastrointestinal cancer inpatients (2.5%) and inpatients with other gastrointestinal diseases (0.88%). The incidence of VTE in ulcerative colitis (UC) patients (16.7%) was much higher than that in those with Crohn's disease (3.6%). In the univariate analysis, the risk factors were an older age, central venous catheter, prednisolone, surgery, low serum albumin, high serum C-reactive protein and D-dimer. According to a multivariate analysis, >50 years of age and surgery were the only risk factors. The in-hospital mortality rate of IBD inpatients with VTE was 4.2%. CONCLUSIONS: The incidence of VTE with IBD, especially UC, was found to be high compared with other digestive disease, which was almost equivalent to that of Western countries. The efficacy of prophylaxis needs to be investigated in Asian IBD patients.
Asian Continental Ancestry Group* ; C-Reactive Protein ; Central Venous Catheters ; Cohort Studies* ; Colitis, Ulcerative ; Crohn Disease ; Gastrointestinal Diseases ; Gastrointestinal Neoplasms ; Hospital Mortality ; Humans ; Incidence* ; Inflammatory Bowel Diseases* ; Inpatients* ; Multivariate Analysis ; Prednisolone ; Retrospective Studies* ; Risk Factors* ; Serum Albumin ; Venous Thromboembolism*

Objectives: Duodenal perforation as a complication of endoscopic ultrasound-guided fine needle aspiration may progress to acute peritonitis and septic shock. Open surgery, the standard treatment, can be avoided by performing closure during endoscopy using endoscopic clips.Patient: A 77-year-old woman was referred to our hospital with salivary gland swelling. She had elevated hepatobiliary enzymes and jaundice. Computed tomography (CT) revealed pancreatic head swelling and bile duct dilation. Endoscopic ultrasonography revealed a hypoechoic mass in the pancreatic head. The pancreatic head mass was punctured twice using a 22-gauge Franchine-type puncture needle at the duodenal bulb. The endoscope was advanced to the descending part of the duodenum, and part of the superior duodenal angle was perforated (diameter approximately 15 mm) with the endoscope. The duodenal mucosa around the perforation was immediately closed using endoscopic clips.Results: Abdominal CT showed gas in the peritoneal and retroperitoneal spaces. The patient experienced abdominal pain and fever and was treated with fasting and antibiotics. The gas gradually decreased, symptoms improved, and she was discharged 18 days after the perforation. Histopathologically, the pancreatic tissue was consistent as autoimmune pancreatitis.Conclusion: Endoscopic closure using endoscopic clips may be a better therapeutic option for duodenal perforation caused by endoscopy.