We evaluated the efficacy of chotosan for headache patients via multiple regression analysis. The subjects were 46 patients with headache (31 migraine, 14 tension-type, and1combination headache), consisting of 1 3males and 33 females, mean age 48 years (range 19-77 years), who were treated with chotosan according to their Sho (symptoms) for more than1month. The relationships between the improvement of headache and 38 factors, including age, sex, height, body weight, hypertension and other symptoms noted upon first medical examination, were examined through multi-dimensional cross-sectional analysis. Morning headache, dizziness, insomnia, body weight, tinnitus and vasodilatation of sublingual veins were significant factors. Morning headache is traditionally an indication for the use of chotosan, and our results support its efficacy for this purpose. Three factors, i.e. morning headache, vasodilatation of sublingual veins and stiff shoulder, were the best subset of explanatory variables. Stiff shoulder is a key symptom for the application of chotosan, while stiffness in the back is a key symptom for the application of yokukansan.
Headache ; symptoms <1> ; multiple regression ; Analysis ; Pulmonary evaluation

Exercise therapy as well as diet therapy, is fundamental in the treatment of diabetes mellitus, however, its methods and effects of long term physical exercise therapy has not yet been clarified.
The present study has been designed to evaluate the effects of physical exercise therapy in diabetic patients with fasting hyperglycemia. Ten non-insulin dependent diabetic patients participated in a 6-month physical exercise program consisting of 30 min, of jogging performed 3 times per week (Exercise group) . The exercise intensity represented 40% of estimated Vo₂max.
The following results were obtained:
1. More significant improvement of glucose tolerance and plasma insulin response to glucose load was observed in exercise group as compared with the patients treated with mild caloric restriction alone (Diet group, N=15) .
2. The significant increase in plasma HDL-cholesterol and HDL-cholesterol/total cholesterol ratio was observed only in exercise group.
3. The reduction of body weight in exercise group was significantly greater than that in diet group.
4. The physical exercise also resulted in an improvement of cardiovascular adaptaion to exercise.
5. Improvement of symptoms in daily life activity was also found after physical exercise therapy. However, some medical troubles such as hypoglycemia, muscle pain and arthralgia were found during observation period.
In conclusion, physical exercise therapy is useful as an adjunct to diet to improve metabolic control in patients with diabetes mellitus. And for effective exercise therapy, exercise program must be individualized, and motivation is stimulated by team including physician, trainer, nurse and dietitian.

Exercise has been well known to a fundamental treatment of diabetes mellitus, as well as diet therapy. Nevertheless, its therapeutic use and clinical effects are still unknown in details. The aim of this study is the establishment of practical exercise therapy for the patients with diabetes mellitus. The present study shows the acute exercise effects on blood metabolites and the effects of long term physical training in diabetics.
The following results were obtained.
1) Although no significant change of blood glucose level was observed in normals, the decrease of blood glucose and triglyceride levels were observed in diabetics in acute exercise. Moreover marked elevation of FFA level was also observed after acute exercise in diabetics.
2) Significant decrease of blood glucose and increase of HDL-cholesterol levels were found in diabetics by long term regular physical training.
3) Body weight reduction without loss of lean body mass and the improvement of physiological response to exercise test were achieved after long term physical training.
These results suggest that the regular physical training leads to the better control of diabetes mellitus and keeps good condition in patients with diabetes mellitus, and that it may have a important role of the prevention for the diabetic vascular complication.

STUDY DESIGN: Case-control study. PURPOSE: To evaluate the surgical magnitude and learning curve of "second-generation" total en bloc spondylectomy (TES). OVERVIEW OF LITERATURE: In June 2010, we developed second-generation TES combined with tumor-induced cryoimmunology, which does not require autograft harvesting. METHODS: TES was performed in 63 patients between June 2010 and September 2013. Three groups of patients were evaluated: 20 undergoing surgery in the first year of development of second-generation TES (group I), 20 in the second year (group II), and 23 in the third year (group III). Patient backgrounds showed no remarkable differences. Operating time, intraoperative blood loss, blood transfusion, and postoperative C-reactive protein and creatine phosphokinase were compared among the groups. RESULTS: Mean±standard deviation operating time was 486±130 minutes in group I, 441±85 minutes in group II, and 396±75 minutes in group III. The time was significantly shorter in group III than in group I (p<0.05). Intraoperative blood loss was 901±646 mL in group I, 433±177 mL in group II, and 411±167 mL in group III. Blood loss was significantly lower in groups II and III than in group I (p<0.01). Transfusion was not required in 20 of 23 patients in group III, and mean C-reactive protein levels on postoperative day 3 were significantly lower in this group than in group I (6.12 mg/L vs. 10.07 mg/L; p<0.05). Postoperative creatine phosphokinase levels did not differ among the groups. CONCLUSIONS: TES is associated with a significant learning curve. Thus, second-generation TES can no longer be considered highly invasive.
Autografts ; Blood Transfusion ; C-Reactive Protein ; Case-Control Studies ; Creatine Kinase ; Humans ; Learning Curve* ; Learning*

STUDY DESIGN: Case-control study. PURPOSE: To evaluate the surgical magnitude and learning curve of "second-generation" total en bloc spondylectomy (TES). OVERVIEW OF LITERATURE: In June 2010, we developed second-generation TES combined with tumor-induced cryoimmunology, which does not require autograft harvesting. METHODS: TES was performed in 63 patients between June 2010 and September 2013. Three groups of patients were evaluated: 20 undergoing surgery in the first year of development of second-generation TES (group I), 20 in the second year (group II), and 23 in the third year (group III). Patient backgrounds showed no remarkable differences. Operating time, intraoperative blood loss, blood transfusion, and postoperative C-reactive protein and creatine phosphokinase were compared among the groups. RESULTS: Mean±standard deviation operating time was 486±130 minutes in group I, 441±85 minutes in group II, and 396±75 minutes in group III. The time was significantly shorter in group III than in group I (p<0.05). Intraoperative blood loss was 901±646 mL in group I, 433±177 mL in group II, and 411±167 mL in group III. Blood loss was significantly lower in groups II and III than in group I (p<0.01). Transfusion was not required in 20 of 23 patients in group III, and mean C-reactive protein levels on postoperative day 3 were significantly lower in this group than in group I (6.12 mg/L vs. 10.07 mg/L; p<0.05). Postoperative creatine phosphokinase levels did not differ among the groups. CONCLUSIONS: TES is associated with a significant learning curve. Thus, second-generation TES can no longer be considered highly invasive.
Autografts ; Blood Transfusion ; C-Reactive Protein ; Case-Control Studies ; Creatine Kinase ; Humans ; Learning Curve* ; Learning*

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the immunity-enhancing effect of implantation of a liquid nitrogen-treated tumor. OVERVIEW OF LITERATURE: We have developed a new technique of implanting a tumor frozen in liquid nitrogen after posterior decompression and stabilization, with the aim of enhancing antitumor immunity in order to prolong the survival period of the patient. In the current study, the immunity-enhancing effect of this new technique has been evaluated. METHODS: The subjects were 19 patients in whom we had earlier performed decompression and stabilization between April 2011 and September 2013. The 19 subjects were divided into two groups, namely a frozen autologous tumor tissue implantation group (n=15; "implantation group"), which consisted of patients, who underwent implantation with autologous tumor tissue frozen in liquid nitrogen, and a control group (n=4), which consisted of patients, who did not undergo autologous cancer transplantation. To evaluate the immunity-enhancing effect of the protocol, plasma cytokines (interferon [IFN]-gamma and interleukin [IL]-12) were analyzed before surgery and a month after surgery. RESULTS: The mean rate of increase in IFN-gamma was significantly higher in the implantation group (p=0.03). Regarding IL-12, no significant difference was observed between the groups, although the implantation group exhibited increased levels of IL-12 (p=0.22). CONCLUSIONS: Decompression and stabilization combined with autologous frozen tumor cell implantation can enhance cancer immunity in metastatic spinal tumor patients. It is hypothesized that this procedure might prevent local recurrence and prolong survival period.
Cytokines ; Decompression* ; Humans ; Interleukin-12 ; Interleukins ; Nitrogen* ; Plasma ; Recurrence ; Retrospective Studies

PURPOSE: Recently, the clinical application of the forced oscillation technique (FOT) has progressed with the spread of commercially available FOT devices, including the impulse oscillation system and MostGraph. We investigated the usefulness of color 3D imaging of respiratory impedance in asthma using MostGraph. METHODS: Whole-breath and within-breath respiratory system resistance (Rrs) and reactance (Xrs) were measured in 78 patients with asthma. Color 3D images were classified into three patterns: the chronic obstructive pulmonary disease (COPD)-like pattern (high values of Rrs and Xrs with a marked respiratory cycle and frequency dependence), the asthma pattern (moderately high Rrs over the entire frequency and a respiratory cycle with slight Xrs changes), and a normal-like pattern (low Rrs and Xrs with few within-breath changes). The classification was performed by three researchers, who were unaware of the clinical information, and the clinical characteristics were compared among the three groups. RESULTS: Color 3D imaging provided a COPD-like pattern in 25 patients, an asthma pattern in 39 patients, and a normal-like pattern in 14 patients. Patients with the COPD-like pattern were predominantly female with a higher body mass index, lower forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and higher Rrs and Xrs values (whole-breath and within-breath variation). Those with the normal pattern had higher FEV1 and FVC, and a lower single-breath nitrogen washout slope. There were no differences in asthma control or exhaled nitric oxide levels among the three groups. CONCLUSIONS: These results suggest that color 3D imaging of respiratory impedance may show asthma phenotypes.
Asthma ; Body Mass Index ; Electric Impedance ; Female ; Forced Expiratory Volume ; Humans ; Nitric Oxide ; Nitrogen ; Phenotype ; Pulmonary Disease, Chronic Obstructive ; Respiratory System ; Vital Capacity

Objective: Owing to the potential benefits of minimally invasive hysterectomy for endometrial cancer, the practice pattern has recently shifted in Japan. This study examined the trends in minimally invasive surgery (MIS) in patients with endometrial cancer in Japan. Methods: This retrospective observational study examined the Japan Society of Obstetrics and Gynecology Tumor Registry database between 2015–2019. This study examined the time-specific proportion change and predictors of MIS use in initial endometrial cancer treatment in Japan, and compared it with the use of abdominal surgery. Additionally, the association between hospital surgical treatment volume and MIS use was examined. Results: A total of 14,059 patients (26.5%) underwent minimally invasive hysterectomy, and 39,070 patients (73.5%) underwent abdominal hysterectomy in the study period. Patients who underwent MIS were more likely to be treated at high-volume centers, younger, central, or western Japan residents, registered in recent years, and had a tumor with stage I disease, type 1 histology, and less myometrial invasion (all adjusted p<0.05). The proportion of MIS treatments increased from 19.1% in 2015 to 34.3% in 2019 (p<0.001). On multivariable analysis, treatment at high-volume centers was a contributing factor for MIS (adjusted odds ratio=3.85; 95% confidence interval=3.44–4.30). MIS at high-volume centers increased significantly from 24.8% to 41.0% (p<0.001) during the study period, whereas MIS at low-volume centers remained at median 8.8%. Conclusion MIS has increased significantly in recent years, accounting for nearly 34% of surgical management of endometrial cancer in Japan. High-volume treatment centers take the lead in performing MIS.