Botulinum toxin A (BTX-A) was used in adult cerebral palsy patients for chronic pain treatment. Five patients (quadriplegia 3, diplegia 1, and athetosis 1 with an average age of 47) were all classified as GMFCS level IV. As a treatment for neck and trunk muscle pain, BTX-A injections were administered with a total dose below 6 units per kilogram of body weight. To investigate the efficacy of BTX-A, the Visual Analogue Scale and Modified Tsui Scale were used to evaluate the patients before and at regular monthly follow-ups after their injections. We found significant improvement in the Visual Analogue Scale scores at 1 month after initial injection and also found the same difference at the second injection. Also, although we found improvement in the Modified Tsui Scale scores at 1 month after injection, these improvements did not last as long as the Visual Analogue Scale improvements. BTX-A has been used in a growing number of indications for the treatment of muscle spasticity including blepharospasm, facial spasm and spasmodic torticollis. We found that BTX-A may also be useful in treating patients with cerebral palsy suffering from chronic pain.

By means of indirect sphygmomanometer called “volume compensation technique” systolic and diastolic blood pressure in finger arteries were noninvasively and continuously measured during and after the “doshi” which is the acupuncture of the carotid sinus. After 15-min resting, 2-min puncture of the right and left carotid sinus was carried out in 23 healthy subjects (8 males and 15 females, aged 18-55). Finger arterial blood pressure was measured during the rest and the in-situ puncture, and then at 30 minutes after the withdrawing. For the control the dodged puncture of the carotid sinus was also made in other 6 healthy subjects (2 males and 4 females, aged 23-55).
Decreasing in blood pressure were observed during and after the doshi in 87% of the subjects. The mean magnitude of the decrease in the systolic and diastolic pressure at 15-21 minutes after the withdrawal of the needle were 12 and 10mmHg, respectively. Pulse pressure and heart rate showed little changes during the experiment. To the control dodged puncture, the maximum change in the systolic and diastolic pressure were 3.4 and 5.0mmHg, respectively, which were within the range of the physiological blood pressure variation. These data suggests that the blood pressure response to the “doshi” may not be induced by the vagal cardiac inhibition but by the change in peripheral vascular resistance.

During and after the “Toshi” which is the acupuncture of the carotid sinus, systolic and diastolic blood pressure were measured in the basal pharanx of finger arteries by means of indirect sphygmomanometer called the “volume compensation method”. After 15 minutes resting, 2 minutes acupuncture on both sides of the carotid sinus was carried out in 16 hypertensive subjects. Finger arterial pressure showed a significant decrease by about 14mmHg (mean) in systolic pressure and by 9mmHg (mean) in diastolic pressure during and after the acupuncture (p<0.05). The decrease in blood pressure showed a maximum at 15-20 minutes after the withdrawal of needles. Pulse pressure and heart rate did not show a significant change. These results were almost similar to those obtained in normotensive subjects. These data suggests that hypertensive subjects are also responsible to “Toshi” and that this effect may not be caused by the cardiac inhibition refrex but the change in vascular tonus.

Purpose: There are many cancer patients who hope to be able to walk to the toilet for as long as they can before death. However, there are no reports of investigation of the ability of advanced cancer patients to go to the toilet, and how the symptoms affect this ability at the end of life in these patients. Methods: We retrospectively investigated the ability of advanced cancer patients to walk to the toilet during their final month of life in our palliative care unit. Data of a total of 154 patients who had died of cancer between January 2010 and December 2011 （median age 75.0±11.6 years） were analyzed in the study. In addition, we compared the frequencies of the symptoms （pain, shortness of breath, drowsiness, delirium, opiate use, oxygen use） between the walking group and the non-walking group. Results: Of the 154 patients, 79 （51.3%） were able to walk to the toilet in the month before their death, 54 （35.1%） in the two weeks before their death, and 33 （21.4%） in the final week before their death. The walking group showed more shortness of breath as compared to the non-walking group. The non-walking group showed more delirium and drowsiness. Conclusion: This study showed that the ADL are relatively preserved in terminal cancer patients. There is the possibility of providing support to their physical ability by rehabilitation. The consciousness level and shortness of breath should take into consideration to provide rehabilitation.

This study was conducted to assess the appropriateness of preparation fees for dispensing herbal medicines, which were revised in 2006. We investigated the amount of time needed to dispense herbal, and general medicines. For prescriptions of1to 15 days length, the average time needed for herbal prescriptions was 13.4 minutes, which was about 3 times longer than for other prescriptions, which took only 4.4 minutes. For prescriptions of over 30 days length, this was about 7 times longer. Next we comparatively investigated fees charged per minute to prepare herbal medicines, with those for other medicines. Fees for all prescriptions of 1 to 15 days length were nearly equal, while fees for herbal prescriptions of over 15 days length were approximately 1/3 to 1/5l ess. Finally, we investigated the number of prescriptions filled out at one university hospital. In 2003 the number of herbal prescriptions exceeding 30 days length was 2.7% overall, while in 2008 this had increased approximately 14 times, to 42%. We would like to recommend an increase in herbal medicine preparation fees, based on the number of days a prescription is for, as the number of long-term prescriptions is increasing.

During and after the LI4 and LI10 Acupuncture, the volume elastic modulus Ev in the basal phalanx of finger arteries were measured. Ev values were noninvasively obtained using a new type of plethysmograph called the “electric impedance-cuff” which can detect indirect arterial pressure and volume change in the artery. After 15 minutes of rest, 2 minutes acupuncture on LI4 and LI10 were carried out in 16 healthy subjects, respectively. Volume elastic modulus showed a significant decrease (p<0.01) during and after the LI10 Acupuncture. Its decrease were maintained at least 20 minutes after the withdrawal of the needle. While the Ev values did not show the typical change during and after the LI4 acupuncture. These date suggest that the elasticity of the peripheral wall was lagely affected by the LI10 acupuncture, and the effect was caused not only by peripheral reflex but by other factors.

Cordyceps militaris has been known to produce an anticancer agent, cordycepin. Investigation on optimum culture condition for C. militaris had been performed. In the research program for discovering a novel function in the culture of C. militaris, the culture media was applied to a proliferation assays using various cell lines. The media showed significant anti-proliferative activities against al cell lines, especially to human leukemia cell line HL-60. The activity-guided purification of active ingredient was performed to obtain uracil. To the best of our knowledge, uracil has not been reported to possess anti-proliferative activity. However, the uracil obtained from the culture media was subjected to ICP-MS analysis to reveal that sodium, potassium and magnesium were found to co-exist with uracil, which might show anti-proliferative activity. Further study on the mechanism of the expression of the activity is now underway.

The Ministry of Health and Welfare of Japan is planning a pooling system for multiple-choice questions (MCQs) for the national examination for medical practitioners. To clarify possible problems of such a system, a field study was performed by 10 medical schools in Japan using 90 MCQs from previous examinations. Nine hundred twenty-four 6th-year students participated in the field test. For each MCQ, the correct-response rates at the originating school and those obtained in the field test were significantly correlated. Thus, the correct-response rates to questions on the field test could be predicted from the rates at the originating schools. However, for each question the correct-response rate was significantly higher for students of the originating school than for students of other schools. In the national examination, care should be taken to prevent differences in scores on the basis of question sources.

PURPOSE: To evaluate whether hydrodistention with fulguration of Hunner lesions (HD/FUL) plus maintenance dimethyl sulfoxide (DMSO) therapy prolongs the recurrence-free time in patients with Hunner type interstitial cystitis (IC).METHODS: The study enrolled patients with Hunner type IC who required repeat HD/FUL due to recurrence of IC symptoms after the first HD/FUL at our institution. All patients received a second HD/FUL plus maintenance DMSO therapy. The maintenance DMSO therapy was performed every 2 weeks for a total of 8 instillations, and then once every 4 weeks thereafter. The recurrencefree time from HD/FUL to therapeutic failure was estimated using the Kaplan-Meier method. The recurrence-free time between the first HD/FUL and second HD/FUL plus maintenance DMSO therapy was statistically compared using the log-rank test.RESULTS: A total of 21 patients (mean age, 66.3±10.8 years) with Hunner type IC were evaluated. The recurrence-free time for the second HD/FUL plus maintenance DMSO therapy was significantly longer than that for the first HD/FUL (P<0.0001). The median recurrence-free time for the first HD/FUL was 10.1 months, while that for the second HD/FUL plus maintenance DMSO therapy has yet to be reached. The recurrence-free rate for the first HD/FUL was 81.0% at 6 months, 38.1% at 1 year, 9.5% at 2 years, and 4.8% at 3 years. In contrast, the rate for the second HD/FUL plus maintenance DMSO therapy was 100% at 6 months, 94.7% at 1 year, 82.6% at 2 years, and 82.6% at 3 years. There were no significant differences in efficacy between the first and second HD/FUL.CONCLUSIONS: HD/FUL plus maintenance DMSO therapy clearly prolongs the recurrence-free time compared with HD/FUL alone in Hunner type IC.
Cystitis, Interstitial ; Dimethyl Sulfoxide ; Humans ; Methods ; Pilot Projects ; Recurrence