We report three cases of panic disorder treated with kampo formulae including shohangekabukuryoto. Case One was a 47-year-old driver. Sharp rises in blood pressure caused transient ischemic attacks in the brain. We suspected that anxiety over recurrent brain attacks stagnated his water and qi below the heart and caused phlegm heat, which lead to his panic disorder. His symptoms were cured with shohangekabukuryoto and the substance of orento. Case Two was a 49-year-old homemaker. Her domestic anxiety developed into a panic disorder. We suspected that her anxiety diminished the blood and the function of her liver, as well as her splenic sufficiency. Her attacks were cured with kamishoyosan, and with bukuryoingohangekobokuto which contains shohangekabukuryoto. Case Three was a 32-year-old homemaker. Overwork through her child-raising tasks developed into a panic disorder. We suspected that fatigue caused her splenic insufficiency and resulted in blood deficiency with the extra water below the heart. Shohangekabukuryoto and juzentaihoto were very effective, and resolved her attacks.These cases suggest that shohangekabukuryoto improved epigastric discomfort, dizziness and palpitation by justifying middle-jiao dysfunction, qi and water regurgitation. In each of the three cases, shohangekabukuryoto showed efficacy for panic disorder with other kampo formulae for respective signs and symptoms.
Panic Disorder ; Three ; Water ; Anxiety ; Cases

　　This study was conducted to clarify the benefits of using cervical cytological examinations and human papilloma virus (HPV) testing in our cervical cancer screening program, which was carried out during the period from April 2012 through March 2013 in the Yuri-Honjo district of Akita Prefecture. A total of 772 women underwent this screening. About 11.3% (87/772) of the examinees tested positive for HPV, and of these 87 women, 64 were also positive for HPV DNA in the examinations subsequently conducted in the outpatient clinic. Of the HPV DNA-positive women who showed no sign of abnormalities in cytology, 67.6% had lesions cervical intraepithelial neoplasia (CIN) 1 and above, and five women had l CIN 2/3. Compared with the conventional cytology which detected nine women with CIN 2/3, our screening method with a combination of cytology and HPV testing found 14 women with CIN 2 or 3. To upgrade the cervical cancer screening, we recommend HPV testing should be used in combination with cervical cytology.

　　This study was conducted to document a correlation between the age distribution of patients with cervical cancers and their genotype patterns of human papilloma virus (HPV). Retrospective analysis was performed on 53 patients in the clinical stage of CIN 3 and above. The patients were treated in our hospital during the period between January 2008 and May 2011. The age distribution showed that the patients in their twenties accounted for 28.0%, those in their thirties 34.0%, those in their forties 24.0%, those in their fifties 4.0%, and those in their sixties and older 10.0%, the average of the subjects was 39.5 years. This distribution pattern also indicated that the women aged 49 and younger are prone to cervical cancer. The overall detection rate of positive HPV in the high risk group was 97.1%. The detection rates varied according to the HPV genotypes, being 41.2% in HPV16, 17.6% in HPV52, 13.2% in HPV58, and 5.9% in HPV18. The average ages of patients at the stage of CIN3 and above who demonstrated the positive and negative results for HPV16/18 were 35.4 years and 44.7 years, respectively. During the follow-up period of 40 months, 27 of 179 patients with positive HPV of the high risk group showed development of grades from below CIN2 to those CIN3 and above. Of the patients positive for HPV16/18, 30.9% demonstrated a further development of the lesions, whereas there were only 8.1% in the patients negative for HPV16/18. These studies suggested a significant connection between the viral infection of HPV16/18 and the development of cervical cancer in young women.

Rehabilitative intervention led to some improvement in bodily function in a patient with amyotrophic lateral sclerosis (ALS) and aspiration pneumonia. By alleviating dyspnea and providing successful supportive care, he improved his sitting position in a wheelchair and reacquired transfer skills. Achieving this reduced burden on his primary caregiver. During rehabilitation, our multidisciplinary team considered the necessary support and care required for the patient to live at home in a sparsely populated area. As a result, we plan to improve his home life after discharge. This stimulated hope and motivation in both the patient and his caregiver to improve his home life, and their increased motivation led them to participate in ALS group meetings. Ultimately, the patient was discharged home.

Background: This study aimed to examine whether genotype categories of high-risk human papillomaviruses (HR-HPVs), when divided into HPV16/18, HPV 31/33/45/52/58, and HPV35/39/51/56/59/68, had an effect on the time required for and the proportion of cases that progressed to cervical intraepithelial neoplasia (CIN) grade 3 among women with CIN2.Patients: A total of 160 women aged 20–49 years and having CIN2 were recruited between January 2008 and June 2018. The time required for progression to CIN3 was determined by Kaplan-Meier time-to-event analysis. HPV genotypes were determined using the Linear Array HPV genotyping test.Results: During an average follow-up time of 22 months, 62 (39%) women with CIN2 progressed to CIN3, whereas 34 (21%) eliminated HR-HPVs and became cytologically normal. The majority (63%) of the women harboring HPV16/18 progressed to CIN3 with a 50% progression time of 11 months, whereas 26% of those harboring HPV31/33/45/52/58 progressed to CIN3 with a 50% progression time of 70 months.Conclusion: For every patient diagnosed with CIN2, genotyping to distinguish HPV16/18 from other HR-HPVs should be performed. Therefore, electing a surgical treatment, such as conization, should be considered as the primary option for women who are positive for HPV16/18, particularly when they are likely to be lost for follow-up or are 40 years old or older. In contrast, follow-up cytology should be repeated every 12 months for women harboring non-16/18 HR-HPVs. Those who tested negative for HR-HPV may be followed at the maximum interval of 24 months.

Objective: Human papillomavirus (HPV) vaccination was introduced in Japan in April 2013, as a national immunization program for girls aged 12–16 years, after an initial introduction in 2010 as a public-aid program for girls aged 13–16 years. The Yuri-Honjo district had the highest vaccine coverage among women aged 17–51 years in 2017, due to the original public-aid program. The aim of this study was to evaluate the differences in the vaccine types of HPV16/18 infections between 2008–2012 (pre-vaccine era) and 2013–2017 (vaccine era).Materials and Methods: We evaluated whether HPV vaccination was associated with a decrease in the prevalence of HPV16/18 and high-risk HPV and the incidence of HPV-associated cervical lesions. A total of 1,342 women aged 18–49 years, covering both the pre-vaccine and vaccine eras, who visited Yuri Kumiai General Hospital and underwent HPV genotype tests from June 2008 to December 2017 were compared.Results: Among women aged 18–24 years with higher vaccine coverage (68.2%), the prevalence of HPV16/18 and high-risk HPV decreased from 36.7% and 69.4%, respectively, in the pre-vaccine era to 5.8% and 50.0%, respectively, in the vaccine era (p=0.00013 and p=0.047, respectively). Among those with cervical intraepithelial neoplasia grade 2− and grade 2+, HPV16/18 prevalence decreased from 30.0% to 2.7% (p=0.0018) and from 81.8% to 36.4% (p=0.030), respectively. In this age group, the rate of HPV16/18 positivity decreased significantly. Among age groups with lower vaccine coverage, HPV prevalence did not significantly differ between the two eras.Conclusion: The prevalence of HPV16/18 and high-risk HPV significantly decreased in women aged 18–24 years, most of whom were vaccinated. HPV vaccination effectively reduced the prevalence of HPV16/18 infections in the Yuri-Honjo district.

This study sought to demonstrate the benefits of conducting cervical cytology and human papillomavirus (HPV) testing in our cervical cancer screening program and was conducted between April 2012 and March 2017 in the Yuri-Honjo district of Akita Prefecture. A total of 3581 women aged 20-49 years underwent this combined screening for 5 years. Of these, 10.3% (369/3581) tested positive for HPV, and 433 women were initially diagnosed as positive for atypical squamous cells of undetermined significance and/or positive for HPV. Of those, 342 women (79.0%) underwent cervical biopsy, among whom 62 (18.1%) were diagnosed as positive for cervical intraepithelial neoplasia (CIN)2+. Of 204 women who were positive for HPV but showed no abnormalities in cytology, 24 women (11.8%) were positive for CIN2+ and 6 women were positive for CIN3+. Conventional cytology (Pap test) detected only 0.58% of the examinees positive for CIN2+ in Akita Prefecture, whereas our combined screening involving a Pap test and HPV testing detected 1.73% of the examinees (P<0.0001). We recommend HPV testing be used in combination with the Pap test to improve cervical cancer screening and accurately identify CIN2/3 disease.