A total of 20 chronic headache cases in which other Kampo medicines were ineffective or hardly effective were treated with Kumi-binro-to extract, and the effect of this medicine was investigated.
At the start of administration, we investigated the following items: any deficiency or excess, presence or absence of stagnation of vital energy (facial erythema, ophthalmologic injection, bitter taste in the mouth, etc.) and disease caused by contaminated water (tendency of edema, sound of fluctuating liquid in the region of the stomach, decreased urine volume) as well as the presence or absence of grasping pain (pressure pain) in the gastrocnemius muscle which is a characteristic symptom as a target of this drug. The efficacy of Kumi-binro-to was assessed by a pain score after weeks from the start of administration.
Kumi-binro-to was markedly effective in 5 cases, effective in 11 cases and ineffective in 4 cases, indicating that the ratio of markedly effective and effective cases accounted for 80% of the patients treated. There was no adverse reaction. When the characteristics of 16 cases assessed as markedly effective or effective were investigated, disease caused by contaminated water and stagnation of vital energy was observed in 13 and 14 of the 16 cases respectively. The grasping pain in the gastrocnemius muscle that is a characteristic target of this drug was noted in only one case.
The above result suggests that Kumi-binro-to promotes diuresis to eliminate wetness-evil and regulates vital energy, and is effective against chronic headache, especially when the disease caused by contaminated water is accompanied with stagnation of vital energy.

Long-term results of surgery for abdominal aortic aneurysms in the over-80 age group were studied. Among nine survivors we found four of them to have had a late death. Their survivals ranged from 17 to 96 months. The ratio of life expectancy was poor (29-51%) in men but good (159%) in women. Long-term survival was not significantly influenced by any preoperative complication but by unexpected disease, such as pancreatic cancer and pneumonia. In postoperative general care, it is important to pay attention not only to preoperative complication but also to the unexpected disease in other organs for octogenarians to achieve a goal of normal Japanese postoperatial survival.

We have recently seen an increasing number of patients with osteoporosis of the type that occurs as a chronic illness in the elderly, and particularly in elderly female patients. It is important not only to treat pain but to follow-up with treatments to prevent further bone mass loss. To measure bone mass in patients with osteoporosis, we employed Digital Imaging Processing (DIP). In this study, the authors examined changes in the bone mass of patients in long-term therapy with Keishi-ka-Jutsubu-to and Gosha-Jinki-Gan. As a comparative-control group, or non-treatment group, we selected 11 patients who had been diagnosed as having osteporosis in an outpatient clinic, and whose bone mass had been measured with DIP. These patients discontinued treatment, but returned to the outpatient clinic six months to one year later. The average duration of non-treatment in the control group was 9.8 months. Metacarpal index (MCI) and metacarpal bone mineral density (m-BMD) at the first visit were 0.40±0.07 and 2.22±0.38, but 10 months later they were 0.36±0.05 and 1.97±0.38, which represents a significant decrease.
In 20 cases given Keishi-ka-Jutsubu-to, the initial bone mass data were: MCI, 0.39±0.08; m-BMD, 2.07±0.32. Measurements performed after three, six, and nine months of treatment showed no difference or increase from the initial values.
In 12 cases given Gosha-Jinki-Gan, the initial data were: MCI, 0.40±0.07; m-BMD, 2.06±0.27. Measurements performed after three, six and nine months of treatment showed no difference from the initial values.
The severity of pain was equally reduced by treatment with Kampo formulation or NSAIDs (non-steroidal anti-inflammatory drugs) by four weeks, but after eight weeks low back pain in patients treated with the Kampo formulation was significantly reduced compared with low back pain in the group treated with NSAIDs.

Afatinib is an oral tyrosine kinase inhibitor (TKI) approved for treating advanced non-small cell lung cancer. It is necessary to develop a simple quantification method for TKIs in order to facilitate therapeutic drug monitoring (TDM) in clinical settings. This study sought to develop a simple and sensitive com-petitive enzyme-linked immunosorbent assay (ELISA) to quantify afatinib in plasma for routine phar-macokinetic applications. An anti-afatinib antibody was obtained using (S)-N-4-(3-chloro-4-fluor-ophenyl)-7-(tetrahydrofuran-3-yloxy)-quinazoline-4,6-diamine (CTQD), which has the same sub-structure as afatinib, as a hapten. Enzyme labeling of afatinib with horseradish peroxidase was similarly performed using CTQD. A simple competitive ELISA for afatinib was developed based on the principle of direct competition between afatinib and the enzyme marker for the anti-afatinib antibody, which had been immobilized on the plastic surface of a microtiter plate. Plasma afatinib concentrations below the limit of quantification of 30 pg/mL were reproducibly measurable. Also, the values of plasma afatinib levels measured from 20 patients were comparable with those measured by high-performance liquid chromatography, and there was a strong correlation between the values determined by both methods (Y = 0.976X – 0.207, r = 0.975). As indicated by its specificity and sensitivity, this newly developed ELISA for afatinib is an important tool for TDM and studies of the pharmacokinetics of afatinib.

In the previous paper, we reported a clinical study on laser irradiation stimulation for pain diseases. In the present study, we examined the effect of laser irradiation stimulation on peripheral blood circulation and its clinical effectiveness in the treatment of shoulder stiffness.
[METHOP] Five healthy adults were irradiated with low energy semiconductor laser (Ga-Al-As, 70mw, 830nm) at the Jianjing (VF21) for ten minutes. Skin blood flow near the stimulated point was measured using Laser-Doppler method before and after (for 20min.) irradiation.
Clinical effectiveness was examined for 50 patients with clonic shoulder stiffness who visited Anesthesiological Department of Osaka Medical College Hospital. The patients were randomly devided into two groups: laser irradiation group (L group) and Non-irradiation group (C group). To the C group, the apparatus was set but no laser was irradiated. Stimulation points were Tianzhu (VU10), Jianjing (VF21), Jianwaishu (IT14) and other points commonly used for shoulder stiffness. According to the numerical scale of subjective symptom reported by the patients immediately after the stimulation, therapeutic effictiveness was rated into four grades: “marked improvement” “improvement” “slightJimprovement” and “no change”. “Marked improvement” and “improvement” were regarded as effective cases.
[RESULTS] After laser stimulation, blood flow increased several times heigher than the original level but it tended to decrease back to the original level within the measuring period. The incedence of effective cases was 58% for L group and 40% for C group.
[CONCLUSION] Laser irradiation stimulation has been reported to have same effect as acupuncture, and gathering attention as stimulation method with less adverse effects. Our study demonstrated that laser stimulation induced transient improvement of local blood circulation.

Objective:We successfully treated a patient suffering from pain and numbness in the waist and lower limbs with phobia. Sedative acupuncture treatment was performed in addition to somatic treatment.
Case:A 64-year-old woman complained mainly of pain and numbness in the right waist and the lower limbs and had a sense of fear. Following the postoperative pain of lumbar disk herniation (L4-L5) in X-14 year, dorsal positioning without grasping anything frequently triggered a sense of fear with a scary feeling that her body was suspended in midair, which could not be alleviated by medication. As the symptoms in the waist and lower limbs recurred due to a fall in January of X year, she consulted an orthopedist in April. She was given a diagnosis of lumbar disk hernia (L5-S1) and hospitalized. Since the symptoms sustained, she consulted the department of acupuncture attached to the Kansai University of Health Sciences Clinic in November. The sense of fear triggered by dorsal position in the acupuncture treatment interfered with the treatment. When she was referred to the department of psychosomatic medicine, the diagnosis of "Other types"of the DSM-IV "300.29 specific phobia"was given. While low-frequency acupuncture electrotherapy on the same side and the same level as the hernia was provided, we applied sedative acupuncture treatment once a week 30 times using the following acupuncture points:GV23;PC6;CV17;and CV6. Before and after every acupuncture treatment after the 10th, the symptoms were evaluated with Finger Floor Distance (FFD), Visual Analogue Scale (VAS) of pain and mood (feelings) and State-Trait Anxiety Inventory (STAI).
Results:The sense of fear during the acupuncture treatment slowly decreased after the 14th treatment. Decreases in FFD, VAS for pain and mood (feelings), and state anxiety score of STAI were observed. The pain and the numbness in the waist and the lower limbs decreased in parallel with the sense of fear. Furthermore, the dosage of hypnotic agent decreased gradually as sleep improved.
Conclusion:Pain and numbness in the waist and the lower limbs with phobia were relieved by sedative acupuncture treatment.

Purpose : This study aims to measure the peak cough flow (PCF) in patients with subacute myelo-optic neuropathy (SMON) and study its relation with muscle strength, functional ability and vocal cord function. Methods : We performed a cross-sectional study in 7 patients with SMON (2 men and 5 women, mean age (SD) 81.6 (7.2) years) and in 7 age- and gender-matched patients with orthopedic problems as a control group. Their PCF, ability to walk, the Barthel Index, grip strength and maximum phonation time were assessed. Results : Mean PCF was 218.6± 66.2 L/min (110-300) for the SMON group and 267.1±76.3 L/min (170-360) for the control group (ns). The PCF was correlated with the maximum phonation time (r = 0.91 ; p<0.01), but not with grip strength, the Barthel Index or the ability to walk scale. Conclusion : The PCF in patients with SMON tended to be lower compared to the control group. Therefore, evaluating PCF is suggested to be necessary to assess the risk of pneumonia.

A 63-year-old man suffered from type A acute aortic dissection associated with descending thoracic aortic aneurysm and coronary stenosis. He was treated surgically 49 days after onset of acute aortic dissection. Deep hypothermic selective cerebral perfusion was carried out for brain protection. It revealed the aneurysm, 51mm in diameter, located just distal to the aortic arch, and an intimal tear of the dissection located posterior wall of aneurysm. The total arch was replaced with 24mm vascular graft and CABG (LITA-to-seg. 8) was carried out. The postoperative course was uneventful and he was discharged on the 18th postoperative day.

Two manganese peroxidases (MnPs), MnP1 and MnP2, and a laccase, Lac1, were purified from Trametes polyzona KU-RNW027. Both MnPs showed high stability in organic solvents which triggered their activities. Metal ions activated both MnPs at certain concentrations. The two MnPs and Lac1, played important roles in dye degradation and pharmaceutical products deactivation in a redox mediator-free system. They completely degraded Remazol brilliant blue (25 mg/L) in 10–30 min and showed high degradation activities to Remazol navy blue and Remazol brilliant yellow, while Lac1 could remove 75% of Remazol red. These three purified enzymes effectively deactivated tetracycline, doxycycline, amoxicillin, and ciprofloxacin. Optimal reaction conditions were 50 °C and pH 4.5. The two MnPs were activated by organic solvents and metal ions, indicating the efficacy of using T. polyzona KU-RNW027 for bioremediation of aromatic compounds in environments polluted with organic solvents and metal ions with no need for redox mediator supplements.
Amoxicillin ; Biodegradation, Environmental ; Ciprofloxacin ; Doxycycline ; Hydrogen-Ion Concentration ; Ions ; Laccase ; Manganese ; Oxidation-Reduction ; Peroxidases ; Pharmaceutical Preparations ; Solvents ; Tetracycline ; Trametes