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.

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.

A 27-year-old man who presented with worsening dyspnea was transferred to our hospital due to congestive heart failure with multiple organ dysfunction. Echocardiogram showed severe left ventricular systolic dysfunction and a huge thrombus in the left ventricle. An urgent operation was performed to remove the thrombus simultaneously with the placement of bilateral extracorporeal ventricular assist devices. After the operation, despite a rapid improvement in the liver function, renal dysfunction persisted and he remained anuric for nearly a month. We continued maximal circulatory support with biventricular assist device to optimize his end-organ function. His renal function gradually improved, allowing him to be registered as a heart transplant candidate on the 140th postoperative day. On the 146th postoperative day, the patient underwent successful removal of the right ventricular assist device, and the left extracorporeal device was replaced by an implantable device (HeartMate II). He was discharged 78 days after the implantation. We present here a case where adequate support with biventricular assist device enabled a successful bridge to transplantation even in a patient with end-stage heart failure having end-organ dysfunction.

Background : Acute massive pulmonary embolism is a life-threatening disease. It is often treated with thrombolytic therapy, however, the mortality rates are unsatisfactorily high in patients who developed shock and subsequent cardiac arrest. Surgical pulmonary embolectomy is a last resort for patients with hemodynamic instability. We studied the outcomes of our patients who underwent pulmonary embolectomy for acute pulmonary embolism. Methods : Eight patients who underwent pulmonary embolectomy between January 2011 and December 2014 were studied. Our surgical indications were as follows. Patients who experienced cardiac arrest and treated with PCPS, and those in persistent vital shock, with contraindications of thrombolytic therapy, or with right heart floating thrombus. However, patients with ischemic encephalopathy or acute exacerbation of chronic thromboembolic pulmonary hypertension, and those who had already been treated with thrombolytic therapy were excluded. Preoperative ECMO was indicated for those in sustained shock. Pulmonary embolectomy was performed through median sternotomy and with cardiopulmonary bypass. After antegrade cardiac arrest, all clots were removed with forceps under direct vision through incisions in the bilateral main pulmonary arteries. IVC filter (Günther Tulip) was placed through the right atrial appendage. In our early cases, IVC filter (Neuhaus Protect) was placed after chest closure. Anticoagulation was not administered until hemostasis was achieved. Results : Seven patients underwent pulmonary embolectomy for massive pulmonary embolism, and in one patient pulmonary embolectomy was indicated for right heart floating thrombi although the pulmonary embolism was submassive. Three patients underwent cardiopulmonary resuscitation and were treated with ECMO. Other 3 patients in sustained shock vital were electively treated with ECMO. The other patient developed cardiopulmonary arrest shortly after anesthetic induction and intubation, and suffered disturbance of consciousness postoperatively. All patients were successfully weaned from cardiopulmonary bypass and underwent IVC filter placement (5 Neuhaus Protect, and 3 GProtec Tulip). One patient died due to a vascular complication associated with catheter insertion (retroperitoneal hematoma). No patients developed residual pulmonary hypertension. There were postoperative complications including pneumonia in 5 patients, tracheostomy in 2 patients, atrial fibrillation in 3 patients, and pericardial effusion in 1 patient. One patient who suffered disturbance of consciousness died 2.4 months after the surgery. Other patients had not developed any thrombotic and hemorrhagic complications during a median follow-up of 13.1 months. Conclusions : Pulmonary embolectomy is an effective treatment of acute massive pulmonary embolism. We believe that our strategy is useful, consisting of preoperative hemodynamic stability by an institution of ECMO, complete removal of clots by bilateral main pulmonary incisions, and prevention of recurrence by IVC filter placement.

A new educational program for the medical doctor was introduced at Tokyo Women's Medical College in 1990 with a 4-year tutorial education model as its core. To develop the program for educational training more efficiently, current facilities were reviewed on a large scale, and various types of equipment and supplementary materials were made available. We are now investigating utilization and problems of the current program. Supplies and materials of tutorial rooms and mirror rooms have been used effectively. The library has become increasingly useful as a place for independent study and research. However, audiovisual materials have not yet been made fully available. We suggest that further improvements to the system and fostering an environment of open access to information are necessary to increase the accessibility of the support system for tutorial education.

Tutors must understand their role in advance so that tutorial education can be conducted smoothly and effectively. These abilities and attitudes require training. At our school, tutors serve as faculty for basic courses and clinical courses. We assessed their training conditions and future tasks. Of the 1, 077 faculty members who received tutor training between 1988 and 1997, 935 are current faculty members who have completed in-service training (basic course, 115; clinical course, 820). Before 1989, training was on campus, but since 1990 it has been conducted at Shirakawa Seminar House with a 2-day program. The number of working tutors per year is 192, with a basic course to clinical course ratio of 3: 7. About half of the faculty members in the basic course have had four or more experiences as tutors, whereas most clinical course faculty members have had only one experience. Thus, many tutors have had no experience. In a questionnaire survey after undergoing the training program, most participants felt that they were able to understand the theory of tutorial education and the actual role of the tutor and that they were able to concentrate on off-campus training that was removed from their everyday work. To provide added impetus to tutorial education, we suggest that in the future, in addition to the understanding and mutual cooperation of those involved, it will be necessary to provide an advanced program to train tutors who have appropriate abilities and attitudes.

Tokyo Women's Medical University introduced tutorial education in 1990 for 1st-through 4th-year students. To examine the effectiveness of this system in a basic-medicine course, questionnaires were given to all 2nd-year students. Many students felt that they had become accustomed to performing self-learning tasks through collecting information themselves and discussing their findings in a group; in particular, they found that tutorial education markedly improved their communication skills. A few students thought that this method helped them develop the ability of logical/critical thinking and analytic skills from multiple viewpoints. These findings suggest that an assessment system should be established by which students themselves could recognize the extent to which they have developed their abilities, which was the aim of tutorial education.

Personal interviews and group discussions were conducted with all 2nd-year students to examine how they feel about tutorial education used as the core of the basic-medicine course and how they recognize the importance of developing their abilities, which was the aim of this course. Many students showed slight anxiety about the results of their learning with tutorials, felt inadequate in their self-learning ability, and hoped the guidance by instructors would be improved. These findings suggest that students' anxiety will decreased and their willingness to learn will increase if their developed abilities are evaluated appropriately and if they receive adequate feedback. These findings also suggest that a retraining program for experienced instructors is needed to improve their guidance skills and to reinforce the importance of their role.

Triplet surveys were conducted in the city of Xi' an and two villages (one in the vicinity and the other at a distance) in Shaanxi Province in China in October-November (when agricultural activitis were low), 1997, to elucidate nutrient intakes with a focus on possible urban-rural differences. Total food duplicate samples were collected from non-smoking and non-habitually drinking adult healthy women (about 50 subjects per site and 149 in total). The nutrient intakes were estimated from the weight of food items in reference to national food composition tables. On average, the women took 1873 kcal energy, 54 g protein and 37 g lipid per day, with a lipid energy ratio of18.4%. Both excess and insufficient energy intake was observed as a result of food intake analysis and body mass index determination. With regard to minor nutrient intakes, insufficiency was serious in the case of calcium, vitamin A and vitamin B2, but not with iron. Whereas dependency on plant foods for sources of energy and protein was common to the three regions, Xi' an people consumed more animal foods than those in the villages. Intake of fish and shellfish was quite low throughout the three regions. Among the four types of cereals, wheat was consumed most substantially in the three regions and in three meals (except for the village where people essentially did not take lunch in reflection of low agricultural activities), whereas rice was consumed more in Xi' an than in the two villages. Maize consumption was higher in the two villages (especially for breakfast) than in the city.In contrast, foxtail millet (although in small amounts) was taken primarily in Xi'an and only at the time of breakfast.

The present study was initiated to make an urban-rural comparison of the prevalence of cases positive to hepatitis B and C virus (HBV and HCV, respectively) infection markers in densely populated eastern half of China. For this purpose, 10 survey sites were selected, i.e., six sites in urban areas (the city group; Beijing, Shanghai and four provincial capitals) and four sites in rural areas (the village group ; one village each in Jilin and Shandong Provinces, and two villages in Shaanxi Province). About 50 adult women per site volunteered to participate, from whom 494 valid blood samples were collected. Positivities to HBsAg (HBsAg+), anti-HBs (anti-HBs+) and anti-HBc (anti-HBc+) were examined by RIA methods, and that to anti-HCV (anti-HCV+) by either EIA or RIA. Those positive to any one of the three HBV infection markers were taken as HBV infection-positive (HBV+). The prevalence of HBsAg+, HBV+ and anti-HBc+ was 8%, 70% and 2.7% in the city group, and 8%, 65% and 2.0% in the village group, and no significant difference was found between the two groups. The overall prevalence was 8% for HBsAg+, 68% for HBV+, and 2.4% for anti-HCV+. The results were discussed in reference to some 20 papers each on HBV+ and anti-HCV+ prevalence in China published since 1991. The reviewing of these papers confirmed that the prevalence of HBV was high (i.e., in excess of 50%), whereas the prevalence of anti-HCV was low (well below 5%), and that no substantial difference was found between the rural and urban populations.