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.

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.

Intestinal spirochetosis is a rare gastrointestinal infection caused by Brachyspira. Clinical manifestations vary, ranging from asymptomatic infection to gastrointestinal bleeding, diarrhea, or abdominal pain. Antimicrobial medications such as metronidazole are routinely given, but their clinical efficacy has not determined with any precision. We report a case of intestinal spirochetosis treated with daikenchuto extract with literature reviews. Treatment of intestinal spirochetosis can be difficult, and use of daikenchuto extract may be an option especially for patients with symptoms such as chronic diarrhea, abdominal distention, or change in flatus.

Introduction : Recommendations from healthcare providers are considered by vaccinees and their parents when they decide whether to receive an immunization. However, in Japan, the attitudes of primary care physicians toward vaccination are unknown. We assessed some practices and recommendations of, and barriers to, primary care physicians regarding vaccinations in Japan.
Methods : A self-administered questionnaire was mailed (in 2012) to 3000 randomly selected physician-members of the Japan Primary Care Association. Excluded were physicians within two years after graduation, living abroad or retired. We described respondent practices, recommendations, and barriers to the provision of routine and voluntary vaccinations.
Results : The overall response rate was 25.8%. The rates at which physicians gave routine and voluntary vaccines in their own practices were 29.0-91.4% and 15.2-89.5%, respectively. The vaccine recommendation rates for routine and voluntary vaccines were 58.2-70.2% and 14.1-50.9%, respectively. The physicians reported that their barriers to recommendation of routine vaccines were vaccination schedule complexity (32.9%), opinions of vaccinees and parents (28.9%), and vaccine safety (27.7%). They also reported that perceived vaccine safety (62.1%), lack of understanding of vaccine-preventable diseases (55.7%), and complexity of vaccine schedules (44.4%) were reasons given by vaccinees and parents for noncompliance. Physicians' barriers to recommendation of voluntary vaccines were cost (45.3%), safety (35.1%), and lack of information (30.1%). They reported that vaccinees and parents expressed concern about cost (61.8%), safety (51.8%), and lack of vaccine information (50.7%).
Conclusion : We clarified practices, recommendations, and barriers to primary care physicians regarding routine and voluntary vaccination in Japan.

The purpose of this study was to investigate the effect of constant endurance cycling exercise below Ventilatory Threshold (VT), under different pedal rate/torque regulations (PTR), on muscle oxygenation, as well as cardio-respiratory function and energy metabolism. Eight healthy male adults participated in the study for three tests. The first test was to examine the maximum oxygen uptake (VO₂max) using a ramp loading measurement of 60 rpm, 20 watt/min ; and an individual 80%VT load was obtained. The second and third tests (random) were to measure heart rate (HR), blood pressure (MAP), expired gas and NIRS data before, during and after 30 min 80%VT constant cycling exercise with low pedal rate/high torque (LPHT : 32 rpm, 23.3±6.0Nm) or high pedal rate/low torque (HPLT : 79rpm, 9.4±2.4Nm). As a result, HPLT showed higher values in HR (p<0.001), MAP (p<0.001), VO₂ (p<0.001), VCO₂ (p<0.001) and RER (p<0.05), than LPHT ; but LPHT showed a higher fat consumption rate than HPLT (p<0.05). Significant PTR effect were recognized for the parameters of the tissue hemoglobin index (THI) (p<0.001) and oxygenation hemoglobin (ΔO₂Hb) (p<0.01) ; and both indicated higher values for HPLT than LPHT ; but LPHT showed insignificantly (p=0.066) higher de-oxygenation hemoglobin (ΔHHb) than HPLT. Moreover, the significant time effects of THI and ΔO₂Hb were also recognized. In conclusion, this study indicated that during constant cycling exercise below VT, HPLT might result in greater muscle blood volume, higher muscle oxygenation concentration and higher HR and VO₂ compared with LPHT. These results suggest that, HPLT might be effective in alleviating the working load on lower limbs, as well as promoting muscle oxygenation, cardiorespiratory function (systemic oxygen supply) and energy metabolism. Therefore, HPLT constant cycling exercise below VT could be used in a rehabilitation program as a beneficial exercise for elderly people with decreasing muscle strength in their lower limbs.

The decrease of balance capacity is considered as a high risk factor of fall accident, so it is important for the middle-aged and elderly people to keep balance capacity on a high level. In this study, we investigated the effects of aqua exercise on dynamic and static balance function. Thirty-two middle-aged women (56.6±8.1 years) participated a 60-min aqua exercise program three times per week for eight weeks. After exercise intervention, body weight, body mass index, grip strength, side step, shuttle stamina walking test were significantly improved (p<0.05-0.001). Functional reach (p<0.001) and total length of centroid shake with eye close condition (p<0.05) was significantly improved, but with eye open condition was not changed. However, when we evaluate the total length of centroid shake by T-score, static balance performance with eye open and close condition was significantly (p<0.05) improved in the below average groups. In addition, measurement value of functional reach was also improved in these groups. These results indicate that aqua exercise benefits not only physical muscle strength and endurance capacity, but also balance function in middle-aged women. Particularly aqua exercise is more effective for the subjects with lower static balance function before intervention.

We investigated the relationship between body weight reduction and intensity of daily physical activities assessed with 3-dimensional accelerometer during a 3-month exercise program. Twenty-six middle-aged women (58.1±7.4 yrs.) participated in this study. Participants underwent a 90-min endurance exercise intervention once a week, and a 3-dimensionsal accelerometer was attached through the program. Body weight (BW), body mass index, fat mass and percent body fat were reduced significantly (p<0.001), while diastolic blood pressure (p<0.01) and shuttle stamina walking test (p<0.05) improved significantly after the exercise intervention. Moreover, a significant negative correlation was observed between the changes in BW and total activity time (TAT) per day of more than 3METs (TAT≥3METs)(r=−0.580, p<0.01) and TAT≥4METs (r=−0.627, p<0.001). To the contrary, the daily steps and the TAT≥2METs were not related to the changes in BW. After adjusting daily steps, TAT≥3METs (β=−0.630, p<0.01) and TAT≥4METs (β=−0.659, p<0.01) were still significantly related to the changes in BW. These results indicate that weight reduction has a much closer relationship with exercise intensity than daily steps. It is important to keep both quantity and intensity of exercise in the unsupervised exercise program aimed at weight reduction.

PURPOSE : The purpose of this study was to clarify the effects of prolonged expiration (PE) on respiratory and cardiovascular responses and autonomic nervous activity during the exercise.METHODS : Twenty-five healthy men (22±1years) were classified according to the breathing mode during the exercise : 2-second inspiration and 4-second expiration in 1 : 2 group, 3-second inspiration and 3-second expiration in 1 : 1 group and normal breathing in control group. The 6-minute exercise was performed at anaerobic threshold (AT) and 60%AT using a cycle ergometer as an exercise protocol. Respiratory rate (RR) and tidal volume (TV) were measured by the expired gas analysis. The power of low- (LF) and high-frequency components (HF) was analyzed from a Holter electrocardiogram to assess the heart rate variability. RESULTS : RR and LF/HF were significantly lower, TV and HF were significantly higher during the exercise of 60%AT and AT in the 1 : 1 and 1 : 2 groups than in the control group (P<0.05 or P<0.01). The increase of HR was significantly lower and that of HF was significantly higher during the exercise at 60%AT in the 1 : 2 group than in the 1 : 1 group (P<0.05). CONCLUSION : PE activated the parasympathetic nervous activity and consequently restrained an excessive increase of HR during the exercise at 60%AT.

Introduction: We perform our trials in Tsurumi ward, Yokohama city aiming at reducing the number of “cancer refugees” to zero. State: There are many patients who receive cancer therapy outside their hometown. Once their treatment is finished due to progressive disease or deteriorating condition, they are told to leave the hospital and to get palliative care in their district. And they become so-called “cancer refugees”. The beds of palliative care units are limited so the ability to accept patients in case of emergencies is poor. In Tsurumi ward, here are a lot of home care clinics providing palliative care but the place patients want to be or receive palliative care when their condition deteriorates isn't fixed. We organized the “Tsurumi Homecare Network” as the core of medical cooperation, and have worked on improving palliative care and increasing patients who die at home. Specifically, our hospital has played a central role as a special place for palliative care, we send out our original questionnaire to home care clinics to find out how they perform palliative care and introduce patients to the appropriate clinic. Patients who are in need of hospitalization are assured acceptance. On the other hand, we propose the cancer treatment hospitals to follow their patients together with us from their early stage of cancer treatment. Problem: To maintain a good relationship for regional palliative care, improving the management for outpatients, strict and timely backup system, advanced quality of homecare-supporting staff for palliative care and cooperation between home care clinic doctors are necessary.

Introduction : We initiated an ambulatory care training program at five community hospitals in Nagasaki, including hospitals on remote islands, for the residents of Nagasaki University Hospital. We examined the educational effect of the ambulatory care training program in meeting the achievement targets for clinical training.
Methods : The study included all residents (n=49) working in Nagasaki University Hospital in 2012. Following completion of the ambulatory care training program, the residents answered a questionnaire on the number of patients and their symptoms, inaddition to a self-assessment, and assessment by their supervisor.
Results : The mean number of patients seen was 3.29 persons / training session. The number of symptoms to be encountered, which are established by Ministry of Health, Labour and Welfare, was positively correlated with the total number of patients seen. Although residents initially had a low rating of self-assessment on diagnosis or treatment, this rating tended to increase with time. The gap in levels on assessment of history taking, diagnosis, or treatment by residents versus those by the supervisors reduced with time in the program.
Conclusion : Our ambulatory care training program is an effective program for meeting the achievement targets in clinical training for residents.