[Case 1] At 37 weeks and 5 days, a 27-year old woman was admitted to our clinic due to spontaneous rupture of the membranes. Her first pregnancy had come to term in a cesarean section delivery, because of toxemia and the breech presentation. This time, she wanted to deliver spontaneously. She didn't go into spontaneous labor, however, 44 hours after rupture of her membranes. Past history included the cesarean section, so labor induction with oxytocin or prostaglandin was not attempted. Active labor was established after administered keishibukuryogan as a saiseito, and she delivered spontaneously at 38 weeks and 1 day.
[Case 2] At 39 weeks and 5 days, a 33-year old woman was admitted to our clinic, due to elective induction of labor. Her first pregnancy had come to term in a labor induction with oxytocin for the uterine inertia. In this pregnancy she wanted to deliver without the use of oxytocin. Active labor was established after administered Keishi-bukuryogan as a Saisei-to, and she delivered spontaneously at the same 39 weeks and 5 days.
The present cases suggest that keishibukuryogan may be effective for establishment of labor, not to say a labor inducer or stimulator such as oxytocin and prostaglandin.

A 26-year-old woman visited our hospital complaining of infertility. Initially treatment was given based on clomiphene for induction of ovulation. However, she suffered from ovarian hyperstimulation syndrome (OHSS) due to the clomiphene, accompanied by abdominal pain. Unkei-to was decided on as the best mode of treatment since clomiphene could not be continued. The patient's basal body temperature (BBT) returned to its biphasic cycle. Three months later, natural pregnancy occurred that resulted in the birth of a healthy boy by normal delivery.
Unkei-to is frequently given for a variety of gynecological disorders, such as irregular menstruation, dysmenorrhea, discharge, climacteric disturbance, etc.
Although induction of ovulation is often a necessary and effective infertility therapy, multiple pregnancies and OHSS can be problematic. The present case suggests that Unkei-to may be effective for infertility involving clomiphene-induced OHSS

Introduction:
The mechanism of moxa-needle therapy is unknown to us in spite of its significant effect. We observed variations in the temperature of the moxa-needle and that of the microwave-applied needle.
Method:
Chinese needles of the said two types were inserted into meat specimens (3×3×2cm) nd a house rabbit to the depth of 1.0cm and 1.5cm, respectively, and temperature was taken by a thermister around the needles at the depth of 15, 10, 5, and 1.0mm, respectively.
Effect:
1. In the moxa-needle, the temperature went up mainly at the top surface of the specimen or the surface of rabbit skin.
2. In the microwave-applied needle, from the beginning the temperature increased and as it plateaued, the heat was transmitted to the needle tip.
3. Typical temperature curve of the rabbit was found rather flat as compared with the same of meat specimen.
Conclusion:
1. In the moxa-needle, a rise in the temperature was limited under the subcutaneous area, it was not transmitted to the acupoint.
2. In the microwave-applied needle, it elevated the temperature around the needel; therefore, we believe that it stimulated the acupoint greatly.
3. In the light of the foregoing observations, it may be concluded that the microwave-assisted acupuncture would be significantly useful.

Pulmonary vein isolation procedure was performed for atrial fibrillation associated with mitral valve disease in twelve patients. This simple procedure consisted of only isolation of the four pulmonary veins. Combined mitral valve surgery consisted of mitral valve plasty, mitral valve replacement with or without aortic valve replacement and tricuspid annuloplasty. Ten patients returned to a sinus rhythm. Two patients required DDD pacemaker implant for sick sinus syndrome. Left atrial contraction was detected in eight cases by trans-esophageal echography. Compared with the maze procedure, this operation was less invasive and preserved atrial appendage, helping to maintain normal secretion of atrial natriuretic peptide. This study suggests that the pulmonary vein isolation procedure may be an effective and simple maneuver for atrial fibrillation associated with mitral valvular disease.

Dengue virus is an arthropod-borne virus transmitted by Aedes mosquitoes. Dengue virus causes fever and hemorrhagic disorders in humans and non-human primates. Direct interaction of the virus introduced by a mosquito bite with host receptor molecule(s) is crucial for virus propagation and the pathological progression of dengue diseases. Therefore, elucidation of the molecular mechanisms underlying the interaction between dengue virus and its receptor(s) in both humans and mosquitoes is essential for an understanding of dengue pathology. In addition, understanding the molecular mechanism(s) of virus entry is crucial for the development of effective new therapies to treat dengue patients. Binding of dengue virus to its receptor molecules is mediated through a viral envelope glycoprotein, termed E protein. We present a summary and describe the structures, binding properties, and pathological relevance of dengue virus receptor molecules proposed to date. In mammalian cells, there are many candidate molecules that may act as receptors, such as sulfated glycosaminoglycans (GAGs), lectins that recognize carbohydrates, glycosphingolipid (GSL), proteins with chaperone activity, laminin-binding proteins, and other uncharacterized proteins. There are also several lines of evidence for receptor molecules such as GSLs, proteins with chaperone activity, laminin-binding proteins, and other uncharacterized proteins in mosquito cells and organs. This review focuses on several molecules involved in carbohydrate-dependent binding of the virus.

Background：Although octreotide is effective in the relief of symptoms of gastrointestinal obstruction, it is also effective for gastrointestinal bleeding. It has been reported that octreotide reduced the splanchnic blood flow, and reduced the bleeding from esophageal varices, peptic ulcer and the tumor of gastrointestinal tract. We experienced four cases of end―stage cancer patients admitted to a palliative care unit whose symptoms of gastrointestinal bleeding were alleviated by octreotide（300μg／day）. Case：Case 1；A 75―year―old woman with gastric cancer developed melena and received octreotide. After octreotide was discontinued, melena and hematemesis recurred. Octreotide was restarted subsequently, and hematemesis resolved. Case 2；An 87―year―old woman with gastric cancer received octreotide for increase of bloody drainage from a stomach tube. She had epigastric pain and emotional distress from the blood. These symptoms were alleviated following the administration of octreotide. Cases 3 and 4；A 76―year―old man with gastric cancer and a 62―year―old man with bile duct cancer received octreotide for massive vomiting of blood. After the administration of octreotide, there was no reoccurrence of hematemesis in both patients. Conclusion：Octreotide may alleviate symptoms of gastrointestinal bleeding in end―stage cancer patients.

Objective: Celecoxib has been reported to enhance the action of warfarin by inhibiting CYP2C9, its major hepatic drug-metabolizing enzyme, but sufficient information about the mechanism has not been obtained, especially in Japan.
Methods: A study was conducted to investigate the prothrombin time international normalized ratio (PT-INR) and the warfarin sensitivity index (WSI) before and after concurrent administration of celecoxib, as well as the Drug Interaction Probability Scale (DIPS) scores to determine causality with drug interactions, in patients commencing concurrent therapy with celecoxib and warfarin at Kanagawa Prefectural Keiyukai Keiyu Hospital during the 4-year period from October 2011 to September 2015.
Results: Analysis of 18 patients showed that the PT-INR increased significantly from 1.53±0.43 before concurrent therapy to 2.18±1.01 after concurrent therapy (p=0.0101).  The WSI also increased significantly from 0.76±0.50 before concurrent therapy to 1.01±0.65 after concurrent therapy (p=0.0044).  According to the DIPS scores, the causal relation was not rated as “Highly Probable” in any of the patients, while it was considered to be “Probable” in 3 patients, “Possible” in 10 patients, and “Doubtful” in 5 patients.
Conclusion: The findings of this study suggested that when celecoxib treatment is initiated in patients who are already taking warfarin, attention must be paid to changes of coagulation profile, especially in elderly patients.

Objective : We examined the utility of distal perfusion (DP) in open stent grafting (OSG) for the treatment of thoracic aortic aneurysm. Methods : Fifty patients who underwent OSG were categorized into two groups (the Non-DP group and the DP group) based on the presence or absence of distal perfusion in OSG. There was no statistically significant difference between the two groups with regard to patient characteristics. Results : There was no statistically significant difference between the two groups with regard to operation time, but, cardiopulmonary bypass time (178±22 min vs. 193±18 min ; p <0.01) and aortic cross clamp time (84±23 min vs. 106±19 min ; p<0.01) were significantly longer in the DP group. Lower-body circulatory arrest time (46±11 min vs. 20±5 min ; p<0.001) was significantly longer in the Non-DP group. Postoperative paraplegia and paraparesis occurred in one case each in the Non-DP group, whereas permanent spinal cord ischemia did not occur in the DP group. Postoperative intubation time (72.6±40.1 h vs. 40.1±34.7 h ; p<0.05) was significantly longer in the Non-DP group. There were two in-hospital deaths due to stroke and respiratory failure in the Non-DP group, and one in-hospital death due to respiratory failure in the DP group. The postoperative maximum value of BUN (38.5±15.6 mg/dl vs. 30.8±9.8 mg/dl ; p<0.05) and s-Cr (1.9±1.0 mg/dl vs. 1.3±0.4 mg/dl ; p<0.01) were significantly higher in the Non-DP group. Conclusion : DP in OSG was an effective method for prevention of spinal cord ischemia, and for protection of respiratory and renal function.

In dialysis cases complicated with ischemic heart disease, there are many problems, such as poor preoperative general condition, calcified aorta, water-electrolyte control, and the necessity for other simultaneous operations. Off-pump coronary artery bypass grafting (OPCAB) was considered very useful in coping with these problems. OPCAB, employed in five cases, was compared with conventional coronary artery bypass grafting with extracorporeal circulation (ECC group, 9 cases). Regarding preoperative coexisting diseases, collagen diseases, porcelain aorta, cerebral infarction, and others were recognized in the OPCAB group in 3 of 5 cases. Emergency operations were performed in 5 of 9 cases in the ECC group, and in 2 of 5 cases in the OPCAB group. The bypass number (3.2 vs. 2.0) and complete revascularization rate (7 of 9 vs. 2 of 5), tended to be higher in the ECC group. The OPCAP group was significantly superior in blood transfusion (6.7 vs. 3.0u), postoperative CK-MB (63 vs. 33u), and the postoperative usual hemodialysis commencing time (4.2 vs. 1.0 day). Concerning use of postoperative IABP (3 of 9 vs. 0 of 5), and postoperative ventilator weaning time (2.7 vs. 1.0 day), a good tendency was shown in the OPCAB group. Although a high mortality rate (2 of 5) was recognized in OPCAB group compared with ECC group (1 of 9), those were urgent cases who had a very poor preoperative condition, and both cases suffered non-cardiac deaths. Excluding special cases, such as an unstable hemodynamic state requiring assisted circulation, and poor coronary run off, OPCAB seems useful for the treatment of coronary artery disease in dialysis patients.