Purpose: Morphine is often administrated through a nosogastric catheter in palliative medicine. As adhesion to the catheter and its stoppage is problematic, adhesion of morphine granules in a nosogastric-tube was investigated. Methods: We investigated it in three following conditions. (1)four morphine products, which were three morphine granules (Pacif®, MS-twicelon® and Kadian®) and a morphine fine granule (Morphes®). (2)four different suspensions of composition, which were water, milk, enteral nutrition liquid and jellied suspension liquid. (3)two sizes of nosogastric catheter (10.5Fr and 13.5Fr). Each morphine product at a dose of 30mg was diluted by each suspension of 20mL in a cup, and injected into each size of nosogastric catheters using a syringe. And the catheter was flushed by the same suspension of 20mL. We counted the granule that adhered to the cup, the syringe and the catheter. Results: As for Pacif® and MS-twicelon®, jellied suspension liquid significantly decreased the number of morphine granules adhered than any of the other suspensions (One-Way Factorial ANOVA and Scheffe's F test: p<0.05) in both sizes of catheters. Only jellied suspension liquid made Kadian® pass the both catheters, but they were obstructed by Kadian® diluted in the other suspensions. Morphes® diluted in water had a tendency to adhere compared to those in milk, enteral nutrition liquid or jellied suspension liquid. Additionally, using the jellied suspension liquid, the maximum dosing of Pacif®, MS-twicelon® and Kadian® were 240mg, 90mg and 60mg, respectively. Conclusion: When administering morphine granules through a nasogastric-tube, using jellied suspension liquid is recommended. Palliat Care Res 2008; 3(2): 101-107

We have been successful in preventing induced cavities in rats using acupuncture stimulation. In order to more profoundly understand one aspect of that preventative mechanism, we studied rises in natural antibody values and special antibody values using the Jerne method. In so doing, we proved that when D-phenylalanine (DPA) is administered 30 minutes proir to acupuncture stimulation the rise which occurrs in antibody counts with acupuncture is great and the duration of the period of increase is lengthened. Such reports about acupuncture effects on the living body are many. That acupuncture strengthens the stability of the living body is an unquestionable fact.
In an effort to study the preventative effects of acupuncture or acupuncture supplemented by DPA, we performed the following experiment. We planted Sarcoma-180, a homotransplantable tumor which often displays an immune resistant effect in mice and observed the immunity level rises produced by acupuncture and acupuncture supplemented by the administration DPA.
ICR mice (male, 3 weeks old) were divided into 5 groups: I-control grop, II-treatment with carboxymethyl cellulose sodium (CMC) III-treatment with CMC and DPA, IV-treatment with CMC and acupuncture, V-treatment with CMC, DPA and Acupuncture
Sarcoma-180 cells were administered to all the rats subcutanously in a ratio 10⁶ cells/0.1ml after which cells were administered every 3rd day for a total of 4 times. DPA combined with 1% CMC was administered into the abdominal cavity in a concentration of 250mg/kg.
All of the mice were sacrificed on the 13th following the cancer transplant and the weight of the cancer, the liver and the spleen measured. Upon examinig for significant differences it was found that sigificant differences were indicated between Groups I and III, and I and V with a 1% danger rate, and I and IV with a 5% rate of danger. No signicant differnce was obseved between I and II.
It can be said that in the mice which received the Sarcoma-180 transplants macrophage funcctional insufficiency occured in a relatively early stage with decreased T lymph corpuscle functions occuring in the later stages. It can be assumed that in the process of interference with the functional in sufficiency, a preventative effect comes into play. In future studies we'd like to investingate the meaning of acupuncture for resistance to infection, etc.

Background: Rapid diagnostic tests (RDTs) have widely been used in the diagnosis of malaria. Although the effectiveness of RDTs for malaria has previously been described in many reports, the low performance of RDTs particularly for Plasmodium ovale malaria in travellers have rarely been reported. Methods: This was retrospective cohort study conducted among Japanese travellers who were diagnosed with malaria at the National Center for Global Health and Medicine between January 2004 and June 2013. Diagnosis of malaria by microscopic examination, RDT, and polymerase chain reaction were performed for all the patients. The RDTs used in our study were Binax NOW Malaria (Binax Inc., Scarborough, Maine, USA) (BN) and SD Malaria Antigen Pf/Pan (Standard Diagnostics Inc., Korea) (SDMA). We compared the sensitivity of the RDTs of P. ovale malaria with that of Plasmodium vivax malaria. Results: A total of 153 cases of malaria were observed, of which 113 patients were Japanese travellers. Nine patients with P. ovale malaria and 17 patients with P. vivax malaria performing RDTs were evaluated. The overall sensitivity of RDTs for P. ovale malaria was 22.2% and that for P. vivax malaria was 94.1% (P < 0.001). The sensitivity of SDMA for P. vivax malaria was 100% and that for P. ovale malaria was 50%. The sensitivity of BN for P. vivax malaria was 90.0%; however, it was unable to detect the cases of P. ovale malaria. Conclusions: The sensitivity of RDTs was not high enough to diagnose P. ovale malaria in our study. Thus, microscopic examination is indispensable not to overlook P. ovale malaria.

A correction of a coauthor's name from Chigusa Nakamura to Chigusa Nakagawa on the author list and the abstract.

Purpose: From shortly after the fentanyl patch became commercially available, we have been using it as part of our armamentarium for cancer therapy to produce a reliable analgesic effect from the active treatment period to the terminal stage in patients who are expected to develop resistance to oral analgesics. To confirm the usefulness of fentanyl patch, a retrospective study was conducted to determine its efficacy and safety. Method: A survey was conducted of 28 cancer patients who were undergoing pharmacological pain control. The following parameters were recorded: opioids administered prior to fentanyl patch use, reasons for switching to fentanyl patch, duration of administration and dosage of fentanyl patch, pain score before switching to fentanyl patch, adverse effects (nausea, vomiting, constipation and drowsiness), and the results of clinical tests. Results: The major reasons for switching to fentanyl patch were: "pain control with oral agents was expected to become difficult in future" and "adverse effects of chemotherapy were noted or were likely to develop". The mean duration of fentanyl patch use was 133 days, during which time the pain score and the constipation symptom were significantly reduced. No significant difference was found with nausea, vomiting, drowsiness or the results of clinical tests. Conclusion: It is concluded that fentanyl patch is a highly useful opioid for analgesia when administered during chemotherapy for cancer and continued to the terminal stage.

Background: Rapid diagnostic tests (RDTs) are used widely in the diagnosis of malaria. Although the effectiveness of RDTs for malaria has been described in many previous studies, the low performance of RDT particularly for Plasmodium ovale malaria in traveller has rarely been reported. Methods: This was a retrospective cohort study conducted on Japanese travellers diagnosed with malaria at the National Center for Global Health and Medicine between January 2004 and June 2013. The diagnosis of malaria was confirmed by microscopic examination, RDT, and polymerase chain reaction in all patients. The RDTs used in our study were Binax NOW Malaria (Binax Inc., Scarborough, Maine, USA) (BN) and SD Malaria Antigen Pf/Pan (Standard Diagnostics Inc., Korea) (SDMA). We compared the sensitivity of the RDTs to P. ovale malaria and Plasmodium vivax malaria. Results: A total of 153 cases of malaria were observed, 113 of which were found among Japanese travellers. Nine patients with P. ovale malaria and 17 patients with P. vivax malaria undergoing RDTs were evaluated. The overall sensitivity of RDTs for P. ovale malaria and P. vivax malaria was 22.2% and 94.1%, respectively (P < 0.001). The sensitivity of SDMA for P. ovale malaria and P. vivax malaria was 50% and 100%, respectively. The sensitivity of BN for P. vivax malaria was 90.0%, but it was ineffective in detecting the cases of P. ovale malaria. Conclusions: The sensitivity of RDTs was not high enough to diagnose P. ovale malaria in our study. In order not to overlook P. ovale malaria, therefore, microscopic examination is indispensable.

STUDY DESIGN: Examination of hyaluronidase-4 (Hyal-4) expression in a rat spinal cord hemisection model. PURPOSE: To determine the status of Hyal-4 expression after hemisection of the spinal cord, and the relationship between its expression and that of chondroitin sulfate proteoglycans (CSPGs). OVERVIEW OF LITERATURE: CSPGs are expressed at the site of spinal cord injury and inhibit axon regeneration. Administration of exogenous chrondroitinase ABC (ChABC), derived from bacteria, digested CSPGs and promoted axonal regrowth. Using a rat hemisection model, we have demonstrated peak CSPGs levels at by 3 weeks after injury but then decreased spontaneously. Could there be an endogenous enzyme similar to ChABC in the spinal cord? It has been suggested that Hyal-4 is involved in CSPG degradation. METHODS: A rat hemisection model was prepared and spinal cord frozen sections were prepared at 4 days and 1, 2, 3, 4, 5, and 6 weeks post-cordotomy and stained for CSPGs and Hyal-4 and subjected to Western blotting. RESULTS: CSPGs appeared at the injury site at 4 days after hemisection, reached a peak after 3 weeks, and then decreased. Hyal-4 was observed around the injury site from 4 days after cordotomy and increased until after 5-6 weeks. Double staining showed Hyal-4 around CSPGs. Western blotting identified a band corresponding to Hyal-4 from 4 days after hemisection. CONCLUSIONS: Hyal-4 was expressed in a rat hemisection model in areas surrounding CSPGs, and as its peak was delayed compared with that of CSPGs. These results suggest the involvement of Hyal-4 in the digestion of CSPGs.
Animals ; Axons ; Bacteria ; Blotting, Western ; Chondroitin Sulfate Proteoglycans ; Cordotomy ; Digestion ; Frozen Sections ; Hyaluronoglucosaminidase ; Rats* ; Regeneration ; Spinal Cord Injuries ; Spinal Cord*

We encountered a probable case ofloiasis in a returned traveler from Central Africa. A 52-year-old Japanese womanpresented to our hospital complaining of discomfort in her eyes and skin. She reportedhaving frequently visited Central Africa over many years and having been extensivelyexposed to the rainforest climate and ecosystem. Although no microfilariae werefound in her blood, there was an elevated level of IgG antibodies against thecrude antigens of Brugia pahangi,which have cross-reactivity with Loa loa.She was treated with albendazole for 21 days, after which the antigen-specificIgG level decreased and no relapse occurred.

We encountered a probable case of loiasis in a returned traveler from Central Africa. A 52-year-old Japanese woman presented to our hospital complaining of discomfort in her eyes and skin. She reported having frequently visited Central Africa over many years and having been extensively exposed to the rainforest climate and ecosystem. Although no microfilariae were found in her blood, there was an elevated level of IgG antibodies against the crude antigens of Brugia pahangi, which have cross-reactivity with Loa loa. She was treated with albendazole for 21 days, after which the antigen-specific IgG level decreased and no relapse occurred.

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.