We conducted a study to evaluate the efficacy of mashiningan for constipation in Parkinson's disease. Twenty-three patients with constipation in Parkinson's disease were enrolled and were evaluated after 1 month in this study. The mashiningan efficacy endpoint in the study was bowel movement frequency. We categorized treatment effect as “effective”, “ineffective”, and “worsened” to calculate increased, unchanged, and decreased bowel movement frequencies, respectively. Previously administered laxative was also switched to mashiningan and subsequent effect was evaluated as well. Mashiningan was effective in 78.3% of patients, and there were no patients determined to have “worsened”. The only adverse effect was diarrhea which was noted in 13.0% of patients. Mashiningan was effective in 86.7% of the 15 patients without laxative administration history, and was effective in 62.5% of 8 patients who had taken laxative previously. Therefore, mashiningan showed a higher degree of efficacy in the patients off medication for constipation. Additionally, mashiningan could be safely switched to from other laxatives without worsening constipation. In conclusion, mashiningan is a useful medication for the treatment of constipation in Parkinson's disease.

The purpose of this study was to investigate the causes of failure to return to the pre-fracture place of residence at hospital discharge following an operation for a hip fracture and to continue medical treatment for osteoporosis. Herein, we discuss methods for improving discharge protocols for these patients. We examined patients who sustained osteoporotic fractures and were operated on for a hip fracture between 2001 and 2003 (83 males and 386 females; 81.2 ± 9.0 years old) and between 2011 and 2013 (121 males and 462 females; 83.1 ± 9.3 years old). In a follow-up study, we examined patients who moved into our related rehabilitation institution over a 3-year period, from 2011 to 2013. The incidence of hip fractures had increased from 2001-2003 to 2011-2013 in both genders, and it tended to increase in patients greater than 80 years of age in male and 90 years of age in female. The most common destination residence after discharge from the rehabilitation institution was the pre-fracture place of residence. The Barthel Index at discharge from the rehabilitation institution was significantly lager in patients who returned to the pre-fracture place of residence compared to those who returned to nursing home and our hospital. These results suggest improved mobility and ADL level of patients enable them to return to the pre-fracture place of residence. We propose the construction of a feedback system that aids in a medical pass to increase the ambulant consultation rate for orthopedics and prevent fragile fractures.
Activities of Daily Living ; Female ; Follow-Up Studies ; Hip Fractures ; Hip* ; Humans ; Incidence ; Male ; Nursing Homes ; Orthopedics ; Osteoporosis* ; Osteoporotic Fractures ; Rehabilitation

Objective: The physiological changes of the respiro-circulatory functions between skilled subject and unskilled subjects during the practice of Up-right Standing Posture of Shaolin Internal Qigong were compared. Method: The heart rate (HR), maximum oxygen uptake (VO2), respiratory efficiency (RE), and respiratory rate (RR), blood pressure, and lactic acid in the blood were measured.Results: The high correlations between the HR and the VO2 values obtained from the exhaustion test were observed in all subjects. The higher values than at the rest were observed in the average HR and the average VO2 during practicing the Up-right Standing Posture both in the skilled subject and unskilled subjects. However, both HR and VO2 levels were almost constant during the practice in both the skilled subjectand unskilled subjects. The RE values changed in the time course of the practice, whereas the RR values were almost constant during the practice. The average RE showed different patterns between the skilled subject and unskilled subjects, the former increased and the latter decreased their RE levels.In addition, the average values of systolic and diastolic blood pressure of the skilled subject increased each 10 mmHg approximately at pre- and post- Up-right Standing Posture, and the increasing tendency was also recognized in the unskilled subjects. The values of the lactic acid in the blood of the skilled subject increased slightly, whereas the average values of the unskilled subjects increased by 3.4 mmol/1. Conclusion: Shaolin Internal Qigong could improve respiratory efficiency by the maximum isometric muscle contraction while the skilled subject maintained natural breathing. In addition, Shaolin Internal Qigong was considered to influence the reflex system because it inhibited both blood pressure increase and respiratory rate change. Shaolin Internal Qigong fit very well with Tuina doctor training course for promoting the physical ability and manipulation abilities of them.

Recently, patient safety has become a social concern in Japan. Even though cases of “incidents” and “accidents” by interns have been collected and analyzed in each hospital, few published reports have concerned teaching hospitals. The purpose of this study was to identify the incidence of “incidents” and “accidents” by first-year and second-year interns in Japan.
1) In August 2005, a questionnaire was mailed to 231 interns at 14 teaching hospitals. A total of 192 interns participated in this study, with a response rate of 83.1%.
2) The number of cases of “incidents” and “accidents” involving interns since the start of their training was collected.An “incident” was defined as an error that was prevented before occurrence, whereas an “accident” was defined as an unplanned, unexpected, and undesired event with adverse consequences.
3) Among first-year interns, “incidents” occurred at a rate of 0.79 per resident-month (95% confidence interval [CI]: 0.30-1.28), while “accidents” were observed at a rate of 0.13 per resident-month (95% CI: 0.06-0.20).
4) Among second-year interns, “incidents” occurred at a rate of 0.24 per resident-month (95% CI: 0.14-1.34), and “accidents” were observed at a rate of 0.06 per resident-month (95% CI: 0.01-0.11).
5) There was no significant difference in the number of cases of “incidents” and “accidents” in regards to sex, age, or the number of beds of teaching hospitals.

We report the succesful treatment for improvement of orthostatic hypotension of a case of Shy-Drager syndrome (SDS).
CASE REPORT
A 56 year-old man diagnosed with SDS was admitted to our hospital on July 8, 1988 because of orthostatic hypotension. He had been suffering from dizziness, dysuria and muscular rigidity for 2 years. He had been treated with drug-therapy, but these sympton had progressed. Physical examination on admission revealed severe orthostatic hypotension due to disorders of autonomic nervous system, so he could not stand still.
For the treatment, we performed Yushi and punctured its points (Geshu. Hachiyu, Danshu, Pishu, Weishu) or 3 points (Sanyinjiao, Taixi, Taichong) that is located on legs. Acupuncuture therapy was applied from July 13, 1988 to December 10, 1988, every day except on holiday. We estimated the effect of acupuncture therapy with transition of blood pressure and orthostatic hypotension. Transition of acupuncture therapy were as follows.
(1) Yushi were performed alone.
(2) 3 points of legs (Sanyinjiao, Taixi, Taichong) were punctured alone.
(3) Yushi were performed, and 3 points of legs were punctured.
(4) Geshu, Genshu, Pishu and 3 points of legs were punctured.
(5) Subcutaneous needle at Yushi points.
(6) Punctured depth of 1cm to Yushi points.
Symptomatical respons was observed at about 70th treatment, and blood pressure was stabilized constantly and activity of daily life was improved.
Kinoshita et al. reported that Yushi act to sympathetic nervous system inhibitory, so serve to treat for hypertension. But in this case, its act was accelerate. It is speculated that Yushi act to autonomic nervous system homeostatically.

We examined relation between mucosal findings of tongue and gastric mucosal lesion by comparison photographic findings of tongue with gastroendoscopic findings of stomach. Subjects of this study were 115 cases undergoing gastroendoscopic examination in our hospital. The state of tongue surface was evaluated by thickness and color of tongue coating and tongue fissure. Especially, the tongue area was divided into 9 sections in order to investigate distribution of coating and fissure. The cases showing thick coating at the lateral sections of tongue were significantly numerous in patients who had gastric ulcer, compared with the cases in those who had no gastric ulcer. From these results, it was suggested that inspection of tongue mucosa could become one of the useful examination of oriental medicine for gastrointestinal disease.

OBJECTIVES: This is an open labeled and retrospective cohort study which compared the effectiveness and safety of ibandronate (IBN) and minodronate (MIN) combined with eldecalcitol (ELD) in primary osteoporosis of women. METHODS: One hundred and forty-eight primary osteoporotic women were classified into 3 groups; 1) intravenous IBN combined with oral ELD (IBN + ELD group, N = 50; 81.8 ± 6.2 years), 2) oral MIN combined with oral ELD (MIN + ELD group, N = 50; 77.2 ± 6.9 years) and 3) oral ELD alone (ELD group, N = 48; 75.0 ± 8.3 years). For statistical analysis, L-BMD, H-BMD, serum corrected Ca, serum iP, intact-PTH, TRACP-5b, BAP, serum Hcy, eGFR and urine Ca/Cr ratio were measured until 12 months after the start of therapy. RESULTS: L-BMD values increased significantly in both IBN + ELD and MIN + ELD group, however, H-BMD increased significantly in the IBN + ELD group only. TRACP-5b values decreased rapidly during the first 6 months in both IBN + ELD and MIN + ELD group. However, BAP value in the IBN + ELD group decreased more gradually compared with that in the MIN + ELD group. Both serum Ca value and urine Ca/Cr ratio tended to increase, and the eGFR value decreased significantly in each group. CONCLUSIONS: IBN combined with ELD administration can act more effectively to increase BMD compared with MIN combined with ELD administration. Differences of decreasing rate in TRACP-5b and BAP value may lead to differences of increased rate of BMD in the IBN + ELD and MIN + ELD group. Because many cases of osteoporosis are elderly persons associated with chronic kidney disease, monitoring of kidney function and concentration of Ca in blood and urine is essential.
Aged ; Cohort Studies ; Female ; Follow-Up Studies* ; Humans ; Kidney ; Osteoporosis* ; Renal Insufficiency, Chronic ; Retrospective Studies

We examined the effects of acupuncture stimulation (ACP-S) to the bilateral Quchi points (Q-P) on insulin secretion with or without electric stimulation (E-S) after an oral glucose load of 75g. This study was performed for 9 healthy volunteers classified into 5 group, a group of ACP-S to Q-P without E-S, a group of ACP-S to Q-P with E-S, a group of ACP-S to the bilateral points 1.5cm laterally apart from Q-P (P apart from Q) without E-S, a group of ACP-S to P apart from Q-P with E-S and a group of no ACP-S. Values of blood suger and serum insulin were determined before and 30min, 60min and 120min after an oral glucose administration. The value of serum insulin at 30min after oral glucose load and the total insulin values during the oral glucose tolerance test were significantly higher in a group of ACP-S to Q-P without E-S compared with those in the other group. These results suggested that acupuncture stimulation to Quchi points might increase insulin secretion.

BACKGROUND AND PURPOSE: Plasma D-dimer levels are elevated during the acute phase of cerebral infarction (CI). We investigated whether the D-dimer level on admission and other clinical characteristics could be used to predict the poor outcome of patients with acute CI. METHODS: The clinical characteristics and plasma D-dimer levels measured within 3 days of onset were compared according to outcome among patients with acute CI. RESULTS: In total, 359 consecutive patients (mean age, 71.8 years) were examined, of which 174 had a poor outcome [score on the modified Rankin scale (mRS) > or =3] at 30 days after hospitalization. The mean mRS score was higher and a poor outcome was observed more frequently among women than among men (p<0.001 for each). The proportions of women, cardioembolism, atrial fibrillation, advanced age (> or =75 years), prior history of CI or transient ischemic attack, and elevated D-dimer level (> or =1.0 microg/mL) were significantly higher among patients with a poor outcome than among those with a good outcome. A multivariate analysis showed that elevated D-dimer level [> or =1.0 microg/mL; odds ratio (OR), 2.45; 95% confidence interval (95% CI), 1.52-3.89; p<0.01], advanced age (OR, 1.93; 95% CI, 1.21-3.07; p<0.01), and female gender (OR, 1.75; 95% CI, 1.08-2.83; p=0.02) were independent predictors of a poor outcome. CONCLUSIONS: Certain clinical characteristics (gender and advanced age) and an elevated D-dimer level upon admission can be used to predict the outcome of patients with acute CI at 30 days after hospitalization.
Atrial Fibrillation ; Cerebral Infarction ; Female ; Fibrin Fibrinogen Degradation Products ; Hospitalization ; Humans ; Ischemic Attack, Transient ; Male ; Multivariate Analysis ; Odds Ratio ; Plasma ; Stroke