In this report, we describe three hemodialysis patients with carpal tunnel syndrome (CTS) that were successfully treated with Goshakusan, one of the well-known traditional Japanese herbal (Kampo) medicines.
Case 1 was a 77-year-old woman suffering from sleep disorder due to night pain in the bilateral forearms. Case 2 was a 66-year-old woman complaining of sleep disorder due to lancinating pain in right upper and lower limb. They had undergone surgical decompression procedures for CTS several times in the bilateral forearms. However, they still needed a periodical injection of glucocorticoid into the region of carpal tunnel for the relief from pain. Case 3 was a 54-year-old man, who has been suffering from the recurrence of numbness of the left fingers since surgical treatment for CTS.
We diagnosed that the symptom of CTS in those three patients may be due to kan-shitsu (damp-cold or interior cold with dampness), because all of them were anuric hemodialysis patients, who tend to easily acquire phlegm and dampness, and their symptom was partially relieved by warming the forearm and fingers. Therefore, they were prescribed an oral goshakusan extract formula to remove kan-shitsu. Soon after they started taking the formula, the intensity of their pain or numbness markedly decreased. Taken together, our report suggests that it is worth trying to remove kan-shitsu by Kampo medicines for the conservative treatment of CTS.

In this report, we describe four hemodialysed patients with upper abdominal discomfort successfully treated with Heiisan, one of the known traditional oriental herbal medicine.Case 1 was a 61-year-old man suffering from upper abdominal discomfort after each meal even though daily taking some medicine for gastritis. Case 2 was a 45-year-old man, who has also been suffering from upper abdominal discomfort after breakfast and supper despite daily taking H₂-blocker. Case 3 was a 61-year-old man complaining of upper abdominal discomfort. He has had loss of appetite despite being treated with H₂-blocker and gastroprokinetic medication. Case 4 was a 69-year-old woman complaining of upper abdominal discomfort with dull pain before eating. She was diagnosed as chronic gastritis and healing stage of duodenal ulcer and prescribed H₂-blocker. However, this medicine did not work.We diagnosed that upper abdominal discomfort in all the patients came from shitsu-jya (pathogenic dampness) in hii (Spleen-Stomach functional unit), and treated them with Heiisan, which was popular to remove shitsu-jya in Hii. Their symptom disappeared soon after taking this medicine.It is also difficult for hemodialysed patients to control their weight due to anuria and they tend to easily gain the weight due to inappropriate eating and drinking, leading to shitsu-jya in such patients. Therefore, our reports suggested that Heiisan was good for hemodialysed patients to control various upper abdominal symptoms that might be caused by shitsu-jya in Hii.

The objective of this study was to test our preliminary in vivo evaluations of central cholinergic abnormalities in schizophrenia patients. Short latency afferent inhibition (SAI) is based on coupling peripheral nerve stimulation with motor cortex Transcranial Magnetic Stimulation (TMS), which has been shown to be a putative marker of central cholinergic activity. Methods: We evaluated SAI in 5 patients with schizophrenia and 5 healthy subjects. Results: The level of SAI was significantly lower in the patients with schizophrenia than in the controls (p=0.008). Conclusion: Our findings suggest involvement of central cholinergic neurotransmission in schizophrenia, which indicates a possible approach for treatment of cognitive dysfunction related to the disease.

Renal plasma flow (RPF) and glomerular filtration rate (GFR) are decreased in patients with heat stroke. Heat stroke after prolonged exercise under high temperatures is usually associated with hypotension and dehydration, leading to decreased RPF. However, whether renal blood flow (RBF), RPF, and GFR are increased or decreased during immersion in mild warm water remains unknown.
Para-aminohippurate clearance (C_PAH), sodium thiosulfate clearance (C_thio), and creatinine clearance (C_cr) were determined in 14 healthy men aged 19 to 27 years old (mean±SD, 22±2), 161 to 181cm (171.5±6.3) tall, and weighing 52 to 78kg (64.2±7.4) without immersion at about 25°C (room temperature) and during immersion in water at 41±0.5°C.
C_PAH, C_thio, and RBF significantly increased during immersion compared with those without immersion (P<0.0001, P<0.03, P<0.0001, respectively). C_cr did not change (P=0.108). The filtration fraction (FF) was significantly decreased (P<0.001). Levels of plasma atrial natriuretic peptide, aldosterone, anti-diuretic hormone and renin did not significantly differ between these two conditions.
This investigation suggests that daily immersion at 41°C is beneficial for renal function.

Along with clinical practice and education, research is among the most important activities for medical doctors. The same is true in cardiovascular surgery: Young cardiovascular surgeons are expected to improve their surgical techniques and prioritize their clinical practice. However, their perspective on the role of research in their field of expertise is unknown. Therefore, we conducted a survey of and discussion with young cardiovascular surgeons to clarify their thoughts and concerns about performing research. Here we review and report the survey and discussion results.

BACKGROUND/AIMS: Sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) has a potent effect on internal hemorrhoids. In this retrospective study, we compared the effects of endoscopic ALTA therapy and standard ALTA therapy.METHODS: We investigated patients who underwent treatment for internal hemorrhoids at our institution between 2014 and 2016. They were divided into a standard ALTA group (n=33, treated using proctoscopy) and an endoscopic ALTA group (n=48). We compared the clinical findings between the 2 groups.RESULTS: There were no intergroup differences in background factors. The mean ALTA dose was 21.9±7.2 mL and 17.8±3.4 mL in the standard and endoscopic ALTA groups, respectively (p<0.01). Adverse events occurred in 4 patients (12.1%) from the standard ALTA group and 6 patients (12.5%) from the endoscopic ALTA group. In both groups, the patients reported good satisfaction with the therapeutic effect at 1 month after the procedure. Hemorrhoids recurred in 2 patients (6.3%) from the standard ALTA group and 4 patients (8.3%) from the endoscopic ALTA group.CONCLUSIONS: Endoscopic ALTA sclerotherapy is equivalent to standard ALTA therapy in terms of efficacy, adverse events, and recurrence. Therefore, it is a useful non-surgical option for patients with internal hemorrhoids who prefer a less invasive treatment.
Aluminum ; Endoscopy ; Hemorrhoids ; Humans ; Potassium ; Recurrence ; Retrospective Studies ; Sclerotherapy ; Tannins

Objective: The clinical course of human metapneumovirus (hMPV) infection is similar to that of coronavirus 2019 disease (COVID-19). However, community-acquired hMPV infections in adults have not yet been sufficiently investigated. We examined the detection status of hMPV antigens and the clinical features of positive patients during the first wave of COVID-19, which coincided with the epidemic season of hMPV infection in Japan.Methods: In this cross-sectional, observational, and single-center study, we recruited consecutive individuals who visited the Japan Agricultural Cooperatives Kochi Hospital due to fever, respiratory symptoms, or close contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected persons during the period from January to May 2020.Results: The positive rate of immunochromatography for hMPV antigens from nasopharyngeal swabs was 9.5% (4/42), and four positive cases were community-acquired pneumonia (CAP) (5.3% of all CAP). The positive rate of hMPV antigens in the CAP group (30.8%, 4/13) was higher than that in the non-pneumonia group (0.0%, 0/19) (p < 0.05). The average age of the four adult patients with CAP was 69.8 years (range 35–93). Mean white blood cell counts and C-reactive protein blood levels were 6,250 cells/μL (3,500–12,180) and 4.30 mg/dL (4.05–7.04), respectively. Chest computed tomography images were diverse and two patients showed dense consolidation. No multi-organ disorder was noted during the clinical course in any of the four cases, and their prognoses were good.Conclusion: hMPV infection may be considered in the differential diagnosis of COVID-19 and CAP in Japan under the preventive measures for SARS-CoV-2 infection, at least during the epidemic season of hMPV infection.

In 2021, the National Institute of Infectious Diseases, Japan, undertook enhanced event-based surveillance (EBS) for infectious diseases occurring overseas that have potential for importation (excluding coronavirus disease 2019 [COVID-19]) for the Tokyo 2020 Olympic and Paralympic Summer Games (the Games). The pre-existing EBS system was enhanced using the World Health Organization Epidemic Intelligence from Open Sources system and the BlueDot Epidemic Intelligence platform. The enhanced EBS before and during the Games did not detect any major public health event that would warrant action for the Games. However, information from multiple sources helped us identify events, characterize risk and improve confidence in risk assessment. The collaboration also reduced the surveillance workload of the host country, while ensuring the quality of surveillance, even during the COVID-19 pandemic.

The establishment of enhanced surveillance systems for mass gatherings to detect infectious diseases that may be imported during an event is recommended. The World Health Organization Regional Office for the Western Pacific contributed to enhanced event-based surveillance for the Tokyo 2020 Olympic and Paralympic Games (the Games) by using Epidemic Intelligence from Open Sources (EIOS) to detect potential imported diseases and report them to the National Institute of Infectious Diseases (NIID), Japan. Daily screening of media articles on global infectious diseases was conducted using EIOS, which were systematically assessed to determine the likelihood of disease importation, spread and significant impact to Japan during the Games. Over 81 days of surveillance, 103 830 articles were screened by EIOS, of which 5441 (5.2%) met the selection criteria for initial assessment, with 587 (0.6%) assessed as signals and reported to NIID. None of the signals were considered to pose a significant risk to the Games based on three risk assessment criteria. While EIOS successfully captured media articles on infectious diseases with a likelihood of importation to and spread in Japan, a significant manual effort was required to assess the articles for duplicates and against the risk assessment criteria. Continued improvement of artificial intelligence is recommended to reduce this effort.