Kampo medicine lectures at Tokai University School of Medicine are an elective subject this year. In order to evaluate student acceptance of this elective, we performed a questionnaire investigation prior to lectures for all fourth-year medical students (n=96). Among the 76 students who provided effective answers, 47 considered attending the Kampo medicine lectures, and 35 of these did attend them. Ten could not attend though they had wanted to. Three could not attend because applicant numbers surpassed class quotas, and 6 reported that other elective subjects were of greater interest to them. Regarding a new model core curriculum for medical education, 6 students (8%) knew that questions about Kampo medicine might be included in a medical state examination, and only 3 (4%) knew that Kampo medicine was included as a specific behavioral objective (SBO). Regarding attitudes toward Kampo medicine, 64 students (84%) were interested in it, while 47 (57%) had a good image of it. However, about two-thirds of students had skeptical or negative images of Kampo medicine citing phrases such as “lack of evidence, ” “mysterious, ” “unscientific, ” “difficult to understand, ” “doubtful” and “works slowly.” These findings suggest that a minimal knowledge of Kampo medicine should be taught to all medical students as a required subject. Furthermore, establishment of advanced programs should be considered as well, since medical students have great interest in, and expectations of Kampo medicine.

This report deals with the response of heart rate, blood pressure and respiratory rate when the subjects of different ages and sexes worked on a bicycle ergometer. The subjects were 126 healthy persons of both sexes. They consisted of 8 groups : prepuberty male (N=15) and female (N=16), puberty male (N=20) and female (N=18), young adult male (N=15) and female (N=16), middle aged male (N=17) and female (N=9) . All subjects tried pedalling exercise with 3 kinds of loads, i.e., 5kgm/kg/min, 10kgm/kg/min and 12.5 kgm/kg/min for 6 minutes.
Heart rate was calculated from chest lead ECG and respiratory rate was measured by the thermistor method continuously recorded before, during and after exercise. Blood pressure was measured by Riva Rocci sphygmomanometer before exercise, at the early stage of recovery and in 10 minutes after exercise.
The results of this study are summarized as follows
1) In both sexes the heart rate decreased with age in resting status and exponentially increased during moderate and heavier exercise. A linear relationship was found between the work load and the exercise heart rate.
In males the heart rate during light exercise was high in the prepuberty and the puberty, low in the young adult and the middle aged. But the heart rate during heavy exercise in the middle aged was extremely high. The heart rate in females was higher than that in males when the same work load was given in both sexes. The rising phase of heart rate in prepuberty was the earliest of 4 age groups.
2) The systolic blood pressure and the pulse pressure in resting status increased with age. As for the blood pressure during exercise, it was low in the youth and high in the middle aged. The blood pressure after exercise in the middle aged males was the highest of 4 groups. Generally in all females the systolic blood pressure and the pulse pressure increased with work load, but the former levelled off during heavy exercise.
3) The respiratory rate during exercise increased rapidly, but when the exercise was stopped, the increased respiratory rate returned rapidly to the resting level. As for the respiratory rate, in both sexes it decreased with age from the prepuberty to the middle aged in resting status and during exercise. The sex difference of the respiratory rate during heavy exercise was large.
4) In the youth the correlation coefficient between the heart rate and the blood pressure was high. Therefore, it was suggested that the heart rate was important in adaptation to exercise.

Background: Necrotizing fasciitis is a rare but severe condition associated with high mortality. We encountered a patient with severe and rapidly progressing necrotizing fasciitis. Patient: A 40-year-old male was hit by a tractor and received a wide laceration wound spanning the length of his posterior thigh. Soon after the accident, the wound was washed and debridement was performed. Two days postoperatively, we observed septic changes in the wound and diagnosed this condition as necrotizing fasciitis. Consequently, the patient's leg was amputated at the thigh. The patient, however, developed toxic shock syndrome after the amputation. Endotoxin adsorption using a polymyxin B-immobilized fiber column was performed for 2 days. Finally, a hip joint amputation was performed after 11 days, following which the patient's general condition gradually improved. Discussion: Treatment for necrotizing fasciitis should be initiated promptly. Early debridement is associated with a significant decrease in mortality. In severe conditions, endotoxin and cytokine removal by blood purification is one of the most effective treatments. Although group A streptococci are widely known as "flesh-eating bacteria," we should also consider a wide variety of pathogenic organisms to be the probable cause of severe necrotizing fasciitis. Conclusion: Management of necrotizing fasciitis requires careful investigation as well as an aggressive therapeutic approach, which may include urgent surgical intervention. In addition to surgery, endotoxin adsorption therapy should be considered.
Patients ; Fasciitis ; Endotoxins ; Therapeutic procedure ; Amputation

The left ventricle assist device (LVAD) has become an important therapeutic option in the treatment of acute or chronic heart failure. It is usually used as bridge to transplantation or recovery. At present, destination therapy with LVAD has been a therapeutic option in patients with heart failure in whom transplantation is not indicated. We describe a patient, who received destination therapy with LVAD, and was able to go home temporarily. The patient was a 63-year-old man with low output syndrome after acute myocardial infarction. An LVAD (TOYOBO) was implanted at Oita University Hospital, however the patient suffered from MRSA mediastinitis 6 months later. He and his family wished for him to temporarily go home to Ibaraki. The patient, supported by LVAD, was transferred from Oita to Ibaraki by a regular commercial flight and ambulance. Rehabilitation training involved stretching, in-bed muscle strength training, maintaining a standing position, walking on flat ground with a walker and going up and down ramps. All training was measured at the patient's home. The patient was out of hospital for 5 hours, and this period was uneventful upon leaving hospital. The patient also took an active part in rehabilitation after discharge. This program can help to improve the quality of life (QOL) of patients with implanted LVADs for destination therapy.

　　With a view to preventing surgical site infection (SSI), administration of antimicrobial agents during surgery should be performed every 3-4 hours after the first administration before surgery begins. In our hospital, the infection control team (ICT) tried to intervene with surgeons and all operating room staff to improve compliance with the administration of antimicrobial agents. The purpose of this study was to evaluate the impact of this intervention by the ICT on correct administration of antimicrobial agents during surgery. In total, 435 surgeries which included ≥ 210 min under anesthesia or 180 min of the operation were analyzed. All antimicrobial agents were first administered within 60 min before the start of surgery. At some point, the ICT intervened, recommending that antimicrobials be administered every 3 h during surgery. The compliance rate (CR) of surgeries for the correct administration of antimicrobial agents was investigated. Differences in CR were evaluated (1) among departments (gastroenterology and general medicine [GM], orthopedic surgery [OR], otorhinolaryngology [OL], gynecology [GY], and urology [UR]), (2) whether intervention of ICT was carried out or not, and (3) in terms of specific procedures (endoscopy and laparoscopy). Total CR was 51.0% (GM: 67.0%, OR: 27.1%, OL: 40.5%, GY: 45.5%, and UR: 37.5%). CR was significantly higher in GM than in any other departments. CR with and without intervention was 69.9% and 42.7%, respectively, and this was statistically significant. CR in endoscopy was 25.8%, which was significantly lower than that in other surgeries (55.2%). CR in laparoscopy was 63.1%, which was significantly higher than that in other surgeries (47.3%). Intervention by the ICT resulted in significant improvement of CR for correct administration of antimicrobial agents. However, CR was low in some situations. This could be improved by more careful dialogue with surgeons and operating room staff.

To determine the Kampo therapy indications for global infertility treatment, and the criteria for objective and rational evaluation of its efficacy, we analyzed the sho (Zheng), type of ovarian dysfunction, types of Western drugs used concomitantly, length of treatment, age upon pregnancy, etc., in 100 women with infertility due to ovarian dysfunction as diagnosed by Western medicine who succeeded in becoming pregnant and giving live births, after Kampo therapies diagnosed by sho based on Hakko, Ki, Ketsu and Sui. The diagnosis of the sho in these women was compared with that in 2737 control women. Their types of sho by frequency were Kyo (51%), Shoyo (Hanhyo-Hanri) (69%), Jonetsu-Gekan (52%), Kigyaku (47%), Oketsu (71%) and Suidoku (67%). When compared to the control group, the percentage of women whose Sho was rated as Jitsu, Taiyo, Shoyo, Jonetsu-Gekan, Oketsu or Suidoku was significantly higher. The sho type Hyonetsu-Rikan was lower. The preparation sho, rated on the basis of a general assessment, was most frequently Kamishoyosan(55%). The predominant type of ovarian dysfunction was luteal dysfunction (73%), whose frequency was significantly higher than that in the control group. Of all women studied, 46% were treated with Kampo alone and 54% were treated with Kampo + Western medicine. In terms of the percentage of each type of ovarian dysfunction, there was no significant difference between the two groups. The Western drugs used in combination with Kampo therapy were hCG preparations (33%), terguride preparations (18%), clomiphene preparations (3%) and hMG preparations (6%). The period of treatment until pregnancy was significantly shorter in the Kampo alone group (5.0 ± 4.4months) than in the combined therapy group (9.5 ± 6.8months). These results allow us to make the following conclusions:1.The type of infertility indicated for Kampo medicine is infertility due to ovarian dysfunction as diagnosed by methods of Western medicine.2.Women who successfully became pregnant following Kampo medicine were often cases of Shoyo disease complicated by sho with Jonetsu-Gekan, accompanied by Kigyaku, Oketsu and Suidoku.3.Uncombined Kampo medicine may be effective in cases of severe infertility.4.If pregnancy does not occur within 5 or 6 months after the start of Kampo therapy, combined use of Western medicines should be considered.
Medicine, Kampo ; Therapeutic procedure ; Infertility ; Western Herbs and Botanicals ; Functional disorder

Clinical efficacy of tokishakuyakusan against immunologic recurrent abortion was evaluated using methods of diagnostic statistics. The subjects of this study were 38 women with recurrent abortion who had experienced a spontaneous abortion during their first trimester (within 12 weeks of pregnancy) twice, and who took tokishakuyakusan (extract granules) after development of their third pregnancy, but experienced spontaneous abortion again during their first trimester, with the karyotype of the aborted fetus being rated as 46, XX or 46, XY. The control group consisted of 244 women who had experienced 3 or more spontaneous abortions during their first trimester of pregnancy. The detection rates of autoimmune disorders and alloimmune disorders were compared statistically between the two groups. Neither the detection rate of autoimmune recurrent abortion nor the detection rate of alloimmune recurrent abortion differed significantly between the two groups, suggesting that tokishakuyakusan is not clinically effective against immunologic recurrent abortion. Tokishakuyakusan is estimated to prevent abortion caused by compromised luteal insufficiency of the uterus. Thus, saireito seems to provide a more rational means of Kampo therapy for immunologic recurrent abortion.
Unspecified Abortion ; immunologic ; tokishakuyakusan ; Therapeutic procedure ; Pregnancy Trimester, First

The efficacy of Saireito (a herbal preparation) against autoimmune recurrent abortion was evaluated clinically and immunologically. Saireito therapy was performed with 87 women having experienced 3 or more recurrent abortions in the early stages of pregnancy (less than 12 weeks gestation), and whose antinuclear antibody (ANA) and anti-cardiolipine antibody (ACA) test results were positive. The effects of this therapy on the percentage of women in whom abortion was successfully prevented (the abortion prevention rate), and on the antibody titer were investigated. Among the 49 women who became pregnant during the study period, the abortion prevention rate was 63.3%, the percentage of ANA positive cases was 65.6%(32/49), the percentage of ACA IgG and/or IgM positive cases (as evaluated by SRL methods) was 65.5%(29/49) and the percentage of both ANA and ACA IgG and /or IgM positive cases was 75.0%(12/49). Although the titer of ANA was not significantly reduced by this therapy, the titer of ACA IgM was reduced significantly.These results suggest that Saireito exerts its efficacy by suppressing humoral immunity through its adjustment of the Th1/Th 2 cytokine balance. This therapy is expected to be effective against ACA-positive recurrent abortion by reducing the effects of ACA. Furthermore, in 2 observed child birth cases whose ACA titer were not decreased by Saireito, different effective mechanisms were speculated; for example, suppression of platelet aggregation via saireito's component herbs (ninjin and bukuryou) similar to the effect seen with low-dose aspirin therapy, or its “risui” effect via its components (bukuryou, soujyutu, takusha and chorei).
Therapeutic procedure ; Unspecified Abortion ; Antinuclear Antibody Assay ; Antibodies ; Immunoglobulin M measurement

For two infertile couples with normal tubal function and spermatogenesis, who were diagnosed with infertility attributed to lack of competent ovum with poor grade embryo in spite of having received timing therapy and step-up therapy (artificial fertilization from husband ; AIH and in vitro fertilization and embryo transfer ; IVF-ET), Kampo-only therapies diagnosed according to their “Zheng” syndrome-type consisting of one cycle of tokishigyakukagoshuyushokyoto, and two cycles of kamishoyosan and anchusan was performed. As a result, both women became pregnant and gave live births. The causes of infertility in these two cases were analyzed, and problems with step-up therapy, commonly used in Western medicine and efficacy of Kampo-therapy diagnosed according to their Zheng were evaluated from the standpoint of Western medicine.Kampo-therapy diagnosed by Zheng was found to improve the follicular and luteal functions as well as related functions. The two cases presented were diagnosed as infertile due to ovarian dysfunction on the basis of therapeutic diagnosis. The indications of IVF-ET are tubal and male infertilities, not to be ovarian dysfunctional infertility.For infertility due to ovarian dysfunction, Kampo-therapy diagnosed by Zheng with Kuoketsu and Risui effects are drugs of first choice, rather than clomiphene, which has an anti-estrogen activity.
Therapeutic procedure ; Medicine, Kampo ; Infertility ; Ovarian ; Ovum

  This research was performed with the family assessment tool at critical and emergency care settings (CNS-FACE) as a standard tool at the ICU of Hospital A. It clarified changes in the awareness and practice of family support by staff in order to obtain clues to how to provide family support in the future.
  Initially, a briefing session was held to acquaint nurses with CNS-FACE. A total of 28 nurses assigned to the ICU were invited to the session. They were informed of the importance of using CNS-FACE to understand the family needs and coping. The staff members were requested to use CNS-FACE to obtain an objective assessment of patients' families selected at random by the nursing research members. Subsequently, questionnaires were distributed to investigate the changes in the nurses' awareness. Those who reported a change in relationship with the families after using CNS-FACE accounted for 100% of the nurses with one to three years' experience, 64% of the urses with four to six years' experience, and 50 % of the nurses with seven or more years' experience. An understanding of the 46 items in CNS-FACE was thought to lead to more positive intervention awareness. It was believed that this would result in a reduction in stress for nurses providing family nursing and to bring about a change in their awareness of family nursing, irrespective of their number of years of nursing experience. CNS-FACE gave the nurses with one to six years' experience with an objective understanding of needs and coping and changed their awareness of family nursing. A change of awareness was achieved by 50% of the nurses with seven or more years' experience. Over 60 % of the staff members recognized CNS-FACE to br effective for family nursing.