Objective: The purpose of this study was to clarify the importance of therapeutic drug monitoring (TDM) at acute care hospitals using Diagnosis Procedure Combination (DPC) data.
Methods: We used DPC data from about 3,500,000 inpatients at about 950 acute care hospitals.  The investigation period was from July 2010 to December 2010.  Patients were divided into 2 groups: TDM intervention (n=22,012); and non-TDM intervention (n=26,400).  We compared the clinical indicators (length of hospital stay, payment based on performance and drug costs) and use of antimicrobials.
Results: TDM intervention was carried out in 45.5% patients for whom an anti-MRSA agent was prescribed.  The duration of anti-MRSA agent administration was significantly longer in the TDM intervention group than in the non-TDM intervention group.  The total daily cost of anti-MRSA agents was significantly lower in the TDM intervention group than in the non-TDM intervention group.
Conclusion: Our results suggest that TDM intervention is often performed for seriously ill patients who require continuous treatment.  TDM intervention may prevent adverse reactions as a result of adjusting the dosage of the anti-MRSA agent.

Objective: Very few studies have been reported on the specific functions of individual meridians and acupuncture points. We examined the functional relations between “the gallbladder Meredian and gallbladder” using the gallbladder's form as an index, in older to identify the specific functions of individual meridians and acupuncture points.
Subjects and Methods: This study was made on five healthy male adult volunteers who fasted during the experiment day.
The gallbladder was selected as the target organ and its form was measured with an ultrasonic diagnostic apparatus (Toshiba SSA-90A). The images of the gallbladder form were taken at the pointwhen the major axis of the cross-sectional area of the gallbladder was maxium. The cross-sectional area of the gallbladder was measured with an image analyzer. The gallbladder form was measured 15 minutes after the subject had lied on his back. Images were taken at intervals of 2 to 5 minutes 10 minutes before stimulation and for 30 minutes during and after stimulation. Acupuncture stimulation was given at the points of C34. Dannang, G36, G37, G40, and G44 on the right side of the body. After getting the degi, 1 minute of sparrow picking needle technique and 1 minute of leaving needle technique were repeated three times.
Results: 1) Stimulation of the G34, G36, G37, and G44 gave no effects on the gallbladder form. 2) Stimulation of the Dannang (EX) produced contraction of the gallbladder. 3) Stimulation of the G40 produced distension of the gallbladder. From the above results, we found that there two types of acupuncture points; one causes contraction of the gallbladder, and the other, distension of the gallbladder. This suggests that individual acupuncture points have specific functions.

To investigate the effect of acupuncture treatment combined with extreme infra-red rays radiation, we measured both skin surface and deep temperature at the stimulated area and peripheral site. The subjects were seven healthy volunteers with no problems involving the skin or autonomic nervous system. Acupuncture stimulation was performed on the Subject's back in combination with extreme infra-red rays radiation. The skin surface and deep temperature were measured at both the stimulated area and peripheral site (sole of the foot) using a thermistor temperature sensor and deep tissue thermometer during stimulation. We also measured temperature at those sites during extreme infrared rays radiation without acupuncture stimulation as a control study. Acupuncture stimulation combined with extreme infra-red rays radiation on the subject's back increases both surface and deep temperature at both the stimulated area and the peripheral site (sole of the foot), while the radiation alone had no effect on the temperature at the peripheral site. We suggested that acupuncture treatment combined with extreme infra-red rays radiation was useful to increase skin surface and deep temperature not only at the stimulated area but also at the peripheral site.

We studied the effects of electro acupuncture stimulation of Baxie on local tolerance as an index of cold induced vasodilation (CIVD). The subjects consisted of 22 healthy adult volunteers. The skin temperature and skin blood flow in the middle finger were simultaneously examined before, during, and after immersion of the finger in cold water. Electroacupuncture stimulation at 1 Hz with a 66 to 100V intensity was performed for 5 minutes. Experiments of no stimulation and electroacupuncture stimulation were conducted on the same subject on different days.
The results revealed the following:
1. CIVD was caused by rapid increase of skin blood flow during immersion of the finger in cold water.
2. The minimum skin temperature, minimum skin blood flow, maximum skin blood flow, mean skin temperature in the rising phase of skin temperature, and the index of resistance to frostbite of the electroacupuncture stimulated group were higher than those of the unstilmulated group, and rates of skin temperature increase and decrease during immersion of the finger in cold water in the electroacupuncture stimulated group were significantly higher. These results show that electroacupuncture stimulation increases local cold tolerance in the finger.

We studied the effects of transcutaneous electrical nerve stimulation (TENS) of Baxie on local cold tolerance as an index of cold induced vasodilatation (CIVD). The subjects consisted of 22 healthy adult volunteers.
The skin temperature and skin blood flow in the middle finger were measured simultaneously before, during, and after immersing the finger in cold water. TENS at 1Hz with 100-V intensity was applied for 5 minutes before immersion of the finger.
Experiments were conducted with no stimulation and with TENS on the same subjects on different days.
The results revealed the following:
1. The minimum skin temperature and minimum skin blood flow during immersion of the finger in cold water were higher in the TENS group than in the control (no stimulation) group.
2. The maximum skin temperature, mean skin temperature, and increase and decrease of skin blood flow rate during immersion of the finger in cold water and in the rising phase of skin temperature were higher in the TENS group than in the control group.
3. The index of resistance to frostbite was higher in the TENS group than in the control group.
4. The number of fluctuations in skin temperature during immersion of the finger in cold water was significantly higher in the TENS group than in the control group.
5. The incidence of abnormal perception during immersion of the finger in cold water was lower in the TENS group than in the control group.
These results suggest that TENS enhances the local cold tolerance of fingers by suppressing SSA in the initial falling phase on skin temperature and increasing the motion of skin blood vessels in the rising phase of skin temperature.

Atherosclerotic risk factors contribute to carotid atherosclerosis. Carotid intima-media thickness (IMT), as assessed using a non-invasive high-resolution ultrasound, can predict cardiovascular disease (CVD). Whereas the control of CVD is crucial for the Mongolian people, the studies on carotid atherosclerosis are lacking. The present population-based survey was a cross-sectional investigation of the determinants of carotid IMT in the general Mongolian population. A total of 344 Mongolian volunteers, aged 18-69 years, without CVD and on no medication, were recruited from a health screening setting. The current smoking habits, body mass index, mean blood pressure (MBP), blood total cholesterol (TC), glucose, insulin and carotid IMT (maximum level) were measured. Mongolian males had a significantly higher prevalence of current smoking and a higher level of IMT than females (average=0.58 mm in males vs 0.46 in females). Both a single and multiple regression analysis adjusted for all the regression analysis adjusted for all the measures revealed that IMT was significantly and positively correlated with age, male sex, MBP, TC and glucose among all of the participants. IMT was significantly and positively correlated with age, followed by MBP, TC and glucose among males, while among females, IMT was significantly and positively correlated with age, followed by MBP and TC. Age was the strongest determinant of carotid atherosclerosis, and the increases in blood pressure and cholesterol levels were also important measures in both sexes as well as glucose levels in males in particularly, thus suggesting a preventive strategy necessary for CVD in the general Mongolian population.

　　A 38-year-old woman was examined at our hospital because of cough, night sweats, and facial edema. Computed tomography of the chest revealed a large mass in the anterior mediastinum measuring 8.2×12.2 cm, with multiple nodules on both lungs. Bronchoscopy revealed multiple nodules parallel to the tracheal rings and obstruction of the anterior segmental bronchus of the right lung. The histopathological features were diagnostic of primary mediastinal large B-cell lymphoma. She underwent chemotherapy followed by radiation therapy to the mediastinal mass. After 8 months, she developed right cerebellar metastasis. Eventually, she received peripheral stem cell transplantation after 17 months.

The effect of acupuncture on the autonomic nervous system was analyzed by simultaneous measurement of sympathetic skin response (SSR), sympathetic flow response (SFR) and Palmer emotional sweating evoked with electric stimuli to the forehead at random interval and intensity. The mutual relation of measurements by those parameters was examined electrophysiologically.
The subjects were ten healthy male volunteers. SSR at the left palm and SFR at the fingertip of the left forefinger were measured using laser doppler flowmetry, and emotional sweating at teh right palm was measured with the ventilated capsule method (hydrography). The measurements were performed in two sessions, with and without acupuncture stimulation that was given at L14 with the technique of sparrow picking (1Hz) for 1 minute and retaining the needle for 10 minutes. The amplitude of SSR, the reduction rate of SFR, and the sweat rate were measured before and after acupuncture stimulation, while those were measured before and after resting in the other session as a control study. As a result, habituation in each response was not seen and the correlation coefficient in each index was low, while SSR and Palmar sweating were inhibited significantly in the stimulation group only, and SFR was inhibited in both groups.
These results suggested that acupuncture stimulation might inhibit the activity of the skin sympathetic nerve system.

Objective: In pharmacy school, most faculty members use generic names when discussing medicine; however, in clinical clerkships, most staff members use brand names. This sometimes leads to poor communication and understanding between the students and medical staff.  The purpose of this study was to clarify the need for a tool to improve communication and understanding in relation to drug information.  Based on the findings of this survey, our secondary aim was to develop and subsequently evaluate such a tool.
Methods: To clarify the need for a self-learning tool, we conducted a questionnaire survey on 58 faculty members who teach courses on drug informatics.  Based on their responses, we then developed a self-learning tool that was subsequently evaluated by a total of 78 undergraduate students.
Results: Most of the faculty agreed concerning the necessity of a self-learning tool for drug information, particularly in regard to the establishment of a more user-friendly system and reduced user fees for students.  The faculty also believed that students should be able to associate the generic drug name with various kinds of information, including its safety, efficacy, and brand name.  All students agreed that the tool was helpful, very easy to use, and could be learned during their commute to school.
Conclusion: Our results suggest that most faculty members support the idea of having a tool capable of promoting a better understanding and grasp of drug information.  Therefore, our self-learning tool should be helpful in promoting increased knowledge concerning drug information for students in clinical clerkships.

Objective: The purpose of this study was to identify existing problems related to the provision of drug information in clinical clerkships.  In addition, we aimed to develop a self-learning tool based on our findings.
Methods: We conducted a questionnaire survey on students who had completed a clinical clerkship between December 2012 and February 2013 concerning the actual status of the provision of drug information.  Based on responses received from 86 students, we then developed an online self-learning tool.  This online tool was subsequently evaluated by the same 86 students.
Results: More than 20% of students surveyed reported never having made inquiries at their clerkship site; therefore, we developed an online self-learning tool for inquiry services in which students were able to learn step-by-step how to analyze, search, evaluate and provide inquiries.  A total of 89% of the students who tried this tool reported being satisfied with its use.
Conclusion: Our results suggest that students in clinical clerkships lack sufficient experience regarding drug information-related inquiries.  Therefore, our online self-learning tool should be helpful in promoting understanding of how to manage such inquiries for students in clinical clerkships.