Although the combined administration of glycyrrhizin (SNMC) and ursodeoxycholic acid (UDCA) is usually used for intractable patients with active HCV-associated chronic hepatitis (HCV-CH) or cirrhosis (LC), there are many cases that do not respond to this combination therapy. In this study, we examined the effects of adding Juzen-taiho-to (TJ-48) to lower the serum alanine aminotransferase (s-ALT=s-GPT) levels in such cases. Methods: The average s-ALT levels for 6 months were compared before and after 7.5g of Juzen-taiho-to was added to the combined therapy of SNMC and UDCA for 9 HCV-CH and 12 HCV-LC patients. In some cases, the effectiveness of the therapy over 12 months was also evaluated. Results: In the HCV-CH cases s-ALT levels were significantly decreased in 3 of 9 (33%) cases in 6 months (about 30 INU in average). In the HCV-LC cases, s-ALT levels were significantly decreased in 5 of 12 (42%) cases in 6 months (more than 40 INU in average). There were some patients whose s-ALT levels decreased significantly after 6 months. As to the improvement of clinical symptoms, general fatigability improved in 12 out of 20 cases (60%) and anorexia improved in 10 out of 19 cases (53%). Conclusions: Juzen-taiho-to (TJ-48, 7.5g daily) added to the combined therapy of SNMC and UDCA may be an effective therapy for intractable cases of active HCV-CH or LC.

1) For third-year students at Keio University Medical School, 10 lectures are given about why kampo medicine is effective, Fourth-year students receive 8 lectures on kampo medicine and participate in independent study sessions 3 times a week for 4 months.
2) In lectures entitled “Why Is kampo Medicine Effective?”we introduce the functional mechanism of action of kampo medicine and address the skepticism of medical students. In the lecture series entitled “Kampo Medicine, ”we introduce the clinical foundations of kampo practice and provide students with a checklist of the key points of each lecture.
3) In the independent study sessions, several students perform mentored basic-science research into kampo's mechanism of action.

Extensive calcification of the mitral annulus presents a formidable technical challenge to surgeons and increases the risk of serious complications such as intractable hemorrhage, atrioventricular disruption, and ventricular rupture during mitral valve surgery. We present a case of aortic and mitral valve replacements for a patient with extensive calcification of an intervalvular fibrous body. A 76-year-old woman was admitted with dyspnea on effort, leg edema and syncope. Transthoracic echocardiography showed severe aortic stenosis, and mitral stenosis with regurgitation, and extensive mitral annular calcification. Decalcification was performed with CUSA and we selected a trans-aortic-valve approach for decalcification of the intervalvular fibrous body. The calcification was left to a certain extent in order to preserve annular strength. Postoperative echocardiography showed no perivalvular leakage from either prostheses. The patient was transferred to a local hospital for further rehabilitation.

In May 2012, a teacher of a nursing school with about 300 staff members and students in Japan was diagnosed with sputum smear-positive pulmonary tuberculosis (TB), leading to an investigation involving nearly 300 contacts. We describe the contacts’ closeness to the index TB patient and the likelihood of TB infection and disease. A case of TB was defined as an individual with positive bacteriological tests or by a physician diagnosis of TB. A latent TB infection (LTBI) case was defined as an individual who had a positive interferon-gamma release assay (IGRA). A total of 283 persons screened with IGRA were analysed. Eight persons (2.8%, 95% confidence interval [CI]: 1.2–5.4) tested positive by IGRA; one student who had intermediate (less than 10 hours) contact with the index patient was found to have pulmonary TB by chest X-ray. The positivity in IGRA among staff members with very close contact with the index patient (4 of 21, 19%, 95% CI: 5.4–42%) with a statistically significant relative risk of 17 (95% CI: 2.0–140) was high compared with that of the intermediate contacts (1 of 88, 1.1% [95% CI: 0.028–6.2]). There was a statistically significant trend in the risk of TB infection and closeness with the index patient among the staff members and students (P < 0.00022). In congregate settings such as schools, the scope of contact investigation may have to be expanded to detect a TB case among those who had brief contact with the index patient.

Methods: The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75–84, and 65–74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications. Results: The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048). Conclusions Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.

Methods: The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75–84, and 65–74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications. Results: The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048). Conclusions Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.

Methods: The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75–84, and 65–74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications. Results: The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048). Conclusions Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.